Public reports pack
Argyll and Bute Council · 29 January 2025
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 29 January 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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22 January 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, 29 JANUARY 2025 at 1:00 PM, which you are requested to attend. BUSINESS 1. APOLOGIES FOR ABSENCE 2. DECLARATIONS OF INTEREST 3. MINUTES (Pages 3 - 8) Argyll and Bute Integration Joint Board held on 27 November 2024 4. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Clinical and Care Governance Committee held on 28 November 2024 (Pages 9 - 12) (b) Argyll and Bute HSCP Strategic Planning Group held on 12 December 2024 (Pages 13 - 16) (c) Argyll and Bute HSCP Audit and Risk Committee held on 17 December 2024 (Pages 17 - 20) (d) Argyll and Bute HSCP Finance and Policy Committee held on 21 January 2024 (Pages 21 - 22) 5. CHIEF OFFICER REPORT (Pages 23 - 30) Report by Chief Officer 6. MEMBERSHIP OF THE INTEGRATION JOINT BOARD (Pages 31 - 32) Report by Business Improvement Manager FINANCE 7. BUDGET MONITORING - 8 MONTHS TO 30 NOVEMBER 2024 (Pages 33 - 48) Report by Head of Finance 8. BUDGET UPDATE 2025/26 (a) Report by Head of Finance (Pages 49 - 64) E1 (b) Appendix 1 (Pages 65 - 66) Public Document Pack
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9. STRATEGIC RISK REGISTER UPDATE (Pages 67 - 82) Report by Head of Finance 10. 2025/26 SOCIAL WORK FEES AND CHARGES (Pages 83 - 126) Report by Principal Accountant 11. NHS HIGHLAND DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT 2024 - HEALTH INEQUALITIES (Pages 127 - 130) Report by Director of Public Health and Policy The full report can be accessed here - https://indd.adobe.com/view/ff013007-f1c4- 414c-84be-d2e99d8d3a29 12. ARGYLL AND BUTE HSCP PERFORMANCE REPORT FQ2 2024/25 (Pages 131 - 146) Report by Head of Strategic Planning, Performance and Technology 13. INTEGRATION JOINT BOARD - REVIEW OF THE STANDING ORDERS (Pages 147 - 180) Report by Business Improvement Manager 14. CATEGORY 1 RESPONDER ASSURANCE UPDATE (Pages 181 - 186) Report by Business Improvement Manager REPORTS FOR NOTING 15. Q1 AND Q2 WHISTLEBLOWING REPORT 2024/25 (Pages 187 - 200) Report by Director of People and Culture 16. DIRECTION LOG UPDATE (Pages 201 - 202) Verbal update by Business Improvement Manager 17. DATE OF NEXT MEETING Wednesday 27 March 2025 The Board will be asked to pass a resolution in terms of Section 50(A)(4) of the Local Government (Scotland) Act 1973 to exclude the public for items of business with an “E” on the grounds that it is likely to involve the disclosure of exempt information as defined in the appropriate paragraph of Part I of Schedule 7a to the Local Government (Scotland) Act 1973. The appropriate paragraph is:- E1 Paragraph 6 Information relating to the financial or business affairs of any particular person (other than the authority). 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 BY MICROSOFT TEAMS on WEDNESDAY, 27 NOVEMBER 2024 Present: Councillor Dougie McFadzean, Argyll and Bute Council (Chair) Councillor Kieron Green, Argyll and Bute Council Councillor Ross Moreland, Argyll and Bute Council Councillor Gary Mulvaney, Argyll and Bute Council Graham Bell, NHS Highland Non-Executive Board Member (Vice Chair) Karen Leach, NHS Highland Non-Executive Board Member Susan Ringwood, NHS Highland Non-Executive Board Member Emily Austin, 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 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 Angus MacTaggart, GP Representative, Argyll and Bute HSCP Alison McGrory, Associate Director of Public Health, Argyll and Bute HSCP Takki Sulaiman, Chief Executive, Argyll and Bute Third Sector Interface Kirstie Reid, Carers Representative, NHS Highland Fiona Thomson, Lead Pharmacist, NHS Highland Tracey White, Carers Representative, NHS Highland Attending: Caroline Cherry, Head of Adult Services, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP Nicola Gillespie, Acting Head of Adult Care, Argyll and Bute HSCP Hazel MacInnes, Senior Committee Officer, Argyll and Bute Council Karl McLeish, Unscheduled Care Programme Lead, Argyll and Bute HSCP Pippa Milne, Chief Executive, Argyll and Bute Council Angela Tillery, Principal Accountant, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE Apologies for absence were received from David Gibson, Kenny Mathieson and Duncan Scott. 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. 3. MINUTES The Minutes of the meeting of the Argyll and Bute HSCP Integration Joint Board held on 25 September 2024 were approved as a correct record. Page 3 Agenda Item 3
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4. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Finance and Policy Committee held on 27 September 2024 The Minutes of the Argyll and Bute HSCP Finance and Policy Committee held on 27 September 2024 were noted. (b) Argyll and Bute HSCP Finance and Policy Committee held on 22 November 2024 The Minutes of the Argyll and Bute HSCP Finance and Policy Committee held on 22 November 2024 were noted. 5. CHIEF OFFICER REPORT 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 September 2024. Decision The Integration Joint Board noted the report from the Chief Officer. (Reference: Report by Chief Officer dated 27 November 2024, submitted) The Chair advised of his intention to reorder the Business and to take item 10 of the agenda (Integrated Community Services Improvement Plan) at this point in proceedings to allow the Head of Adult Services – Health and Community Care to attend another important meeting at 2.00pm. 6. INTEGRATED COMMUNITY SERVICES IMPROVEMENT PLAN The Board gave consideration to a report providing an overview of the system wide health and community care improvement plan. Decision The Integration Joint Board noted – 1. the strategic national context around unscheduled care; and 2. developments around sustainable integrated community services. (Reference: Report by Head of Adults – Health and Community Care dated 27 November 2024, submitted) 7. INTEGRATION JOINT BOARD MEMBERSHIP AND ADVISORY The Board gave consideration to a report in respect of continued membership and advisory to the Integration Joint Board. Decision The Integration Joint Board – Page 4
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1. noted the death of Elizabeth Rhodick and thanked her for her service to the board; 2. noted the term end for Ms Susan Ringwood and thanked her for her service to the board; 3. noted NHS Highlands’ arrangements for a replacement non-executive member; 4. agreed the nomination of Kirstie Reid and Kenny Matheson for a further term of 3 years in line with the Standing Orders; and 5. appointed Kirstie Reid to the Strategic Planning Group and Kenny Mathieson to the Finance and Policy Committee. (Reference: Report by Business Improvement Manager dated 27 November 2024, submitted) In respect of the foregoing item, the Chair, on behalf of the Board, offered condolences to Betty Rhodick’s family and expressed his thanks for her contribution to the Board. He invited other members of the Board to pay tribute to Betty if they so wished. Councillor Green advised that since he joined the Board in 2016, taking on the role of Chair, Betty had been a valuable contributor to the Board, who drew on her personal experience and that of others. He advised that having a service user perspective was important and that she had carried out that role very well. He advised that she would be sorely missed. The Business Improvement Manager echoed Councillor Green’s words adding that Betty had been a robust community voice who had presented challenge to the Board, always striving for improvement. She advised that she would be sorely missed. The Chair, on behalf of the Board, noted that this was Susan Ringwood’s last meeting of the Board. He thanked her for her contribution to Board and its Committees. The Chair invited Kirstie Reid to say a few words on her re-appointment to the Board for a further three years. The Chair then invited Susan Ringwood to say a few words about her time on the Board. 8. FINANCE (a) Budget Monitoring - 7 months to 31 October 2024 The Board gave consideration to a report providing a summary of the financial position as at the end of month 7 and a forecast for the year. Decision The Integration Joint Board noted that – 1. the HSCP had overspent its budget by £1.6m; 2. an overspend of £2.9m was forecast; Page 5
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3. actions were required to reduce spend and additional funding was required from Argyll & Bute Council who hold pension saving resource on behalf of the IJB; and 4. savings of £4.7m had been delivered, 72% of target. (Reference: Report by Head of Finance dated 27 November 2024, submitted) (b) 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 progress made in developing savings plans. Decision The Integration Joint Board noted – 1. that budget planning for 2025/26 was on-going and national budgeting intentions were not yet published; 2. the HSCP was not currently operating on a financially sustainable basis; 3. the potential budget gap of £15.0m for 2025/26; 4. the on-going work and next steps in the budget preparation process; and 5. that the HSCP did not expect to be able to propose a balanced budget for NHS services based on current planning assumptions. (Reference: Report by Head of Finance dated 27 November 2024, submitted) (c) Climate Change Reporting 2023/24 The Board gave consideration to a report providing an opportunity to review the climate change report for 2023/24 in advance of its submission to the Sustainable Scotland Network. Decision The Integration Joint Board – 1. noted that the IJB was required to submit a Climate Change Duties Report by 30 November 2024; 2. approved the proposed submission attached as Appendix 1 to the submitted report; and 3. endorsed the partnership approach taken by the HSCP in respect of its Climate Change Duties. (Reference: Report by Head of Finance dated 27 November 2024, submitted) Page 6
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9. Q2 WORKFORCE REPORT 2024/25 The Board gave consideration to a report detailing workforce data of the HSCP as at 30 September 2024. Decision The Integration Joint Board noted the content of the submitted report. (Reference: Report by Deputy Director of People dated 27 November 2024, submitted) 10. ARGYLL AND BUTE HSCP PERFORMANCE REPORT FQ1 2024/25 The Board gave consideration to a report detailing performance for financial quarter 1 2024/25. Decision The Integration Joint Board – 1. acknowledged performance for FQ1 2024/25 (April - June); 2. acknowledged performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 1); and 3. noted Delayed Discharge Sitrep as of 01 July 2024 (Appendix 2). (Reference: Report by Head of Strategic Planning, Performance and Technology dated 27 November 2024, submitted) 11. PUBLIC HEALTH ANNUAL REPORT 2023 TO 2024 The Board gave consideration to a report outlining public health activity in Argyll and Bute to prevent ill-health and improve health and wellbeing outcomes for the population. Decision The Integration Joint Board – 1. noted the report, “Health and Wellbeing in Argyll and Bute” covering Public Health activity for the year 2023 to 2024; 2. noted the strategic approach to prevention in Argyll and Bute; 3. endorsed the role of the IJB in providing leadership to prevent health and social care problems from arising; and 4. noted the forthcoming Population Health Framework for Scotland expected in early 2025. (Reference: Report by Associate Director of Public Health dated 27 November 2024, submitted) Page 7
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12. UPDATE - RENEWAL OF JOINT STRATEGIC PLAN The Board gave consideration to a report providing the draft Strategic Priorities for the Joint Strategic Plan to cover the period 1 April 2025 to 31 March 2030. Decision The Integration Joint Board noted – 1. the draft Strategic Priorities for the Joint Strategic Plan; and 2. timelines. (Reference: Report by Head of Strategic Planning, Performance and Technology dated 27 November 2024, submitted) 13. DRAFT PROGRAMME OF MEETINGS 2025/26 The Board gave consideration to a draft Programme of Meetings for the year 2025/26. Decision The Integration Joint Board approved the draft Programme of Meetings for 2025/26. (Reference: Draft Programme of Meetings 2025/26 by Business Improvement Manager, submitted) 14. DATE OF NEXT MEETING The date of the next meeting was noted as Wednesday 29 January 2025. Page 8
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MINUTES of MEETING of ARGYLL AND BUTE HSCP CLINICAL AND CARE GOVERNANCE COMMITTEE held BY MICROSOFT TEAMS on THURSDAY, 28 NOVEMBER 2024 Present: Graham Bell (Chair) Karen Leach Evan Beswick Rebecca Helliwell Elizabeth Higgins David Gibson Alison McGrory Councillor Dougie McFadzean 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 Nicola Gillespie, Interim Head of Adult Services – Acute and Complex Care, Argyll and Bute HSCP Linda Currie, Associate Director of AHP, NHS Highland Fiona Thomson, Associate Director of Pharmacy, NHS Highland Leah Smith, Interim Clinical and Care Governance Manager, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Fiona Coffield, Service Planning Manager, NHS Highland Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council 1. WELCOME AND APOLOGIES The Chair welcomed everyone to the meeting. Apologies for absence were intimated on behalf of :- Councillor Ross Moreland Dr Duncan Scott Fiona Broderick 2. MINUTES (a) Minute of the previous meeting of the Clinical and Care Governance Committee, held on 15 August 2024 The Minute of the previous meeting of the Clinical and Care Governance Committee, held on 15 August 2024 was approved as a correct record. (b) Minute of the Clinical and Care Governance Group, held on 19 Page 9 Agenda Item 4a
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September 2024 The Minute of the Clinical and Care Governance Group, held on 19 September 2024 was noted. (c) Minute of the Clinical and Care Governance Group, held on 31 October 2024 The Minute of the Clinical and Care Governance Group, held on 31 October 2024 was noted. 3. ACTION LOG Having given consideration to the Action Log, the Committee agreed:- Action 1 - It was noted that, due to further information and engagement being required 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 - Following discussion on the information required, it was agreed that an update on progress would be provided at the next meeting of the Committee. Action 3 – It was noted that this item was on the agenda for discussion at item 7 (Sexual Health Services in Argyll and Bute). Action 4 – It was noted that this item was on the agenda for discussion at item 8 (HIS Inspection Custody Healthcare Report and Update). 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. Action 6 – Having noted that work was now progressing to ensure a consistent approach to addressing the variances between Health and Social Work Complaints, it was agreed that this item could be removed from the action log. 4. HEALTH & SOCIAL CARE PARTNERSHIP- PERFORMANCE REPORT - FQ1 2024/25 (APR - JUN) The Committee gave consideration to a report which detailed the performance for FQ1 2024/25 (April – June) 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:- Page 10
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1. Acknowledged performance for FQ1 2024/25 (April – June). 2. Acknowledged supporting commentary from Heads of Service and Service Leads. 3. Acknowledged performance update on the National Health and Wellbeing Outcomes and Ministerial Steering Group Integration Indications, as outlined in Appendix 1 of the report. 4. Noted the Delayed Discharge Sitrep as of 1 July 2024, as outlined in Appendix 2 of the report. (Reference: Report by Head of Strategic Planning, Performance and Technology, 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 Interim Clinical and Care Governance Manager, submitted) 6. WINTER PLANNING BRIEFING Consideration was given to a report which presented an overview on all aspects of planning and delivery over the winter period. Decision The Clinical and Care Governance Committee noted the briefing on Winter Planning and discussed the actions that support the safe delivery of care over winter. (Reference: Report by Head of Adult Care – Health and Community, submitted) 7. SEXUAL HEALTH SERVICES IN ARGYLL AND BUTE Having noted the previous update provided to Committee in June 2024, consideration was given to a report which provided an update on the position of sexual health provision as currently known in Argyll and Bute and the current risks. Decision The Clinical and Care Governance Committee noted the update provided. Page 11
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(Reference: Report by Chief Officer, Argyll and Bute HSCP, submitted) 8. HIS INSPECTION CUSTODY HEALTHCARE REPORT AND UPDATE Having noted that a multidisciplinary team is in place to deliver the action plan based on the recommendations of the HIS Inspection Custody Healthcare report, the Committee gave consideration to a report which outlined the progress of the team against those actions. Decision The Clinical and Care Governance Committee:- 1. Noted the publication of the report. 2. Noted action in respect of the report recommendations and governance. (Reference: Report by Associate Medical Director, submitted) 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, 6 February 2025. Page 12
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MINUTES of MEETING of ARGYLL AND BUTE HSCP STRATEGIC PLANNING GROUP held BY MICROSOFT TEAMS on THURSDAY, 12 DECEMBER 2024 Present: Councillor Ross Moreland (Chair), Argyll and Bute Council Graham Bell, NHS Highland Non-Executive Board Member and Member of IJB Samantha Campbell, Health Improvement Principal, Argyll and Bute HSCP Caroline Cherry, Head of Adult Services, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Linda Currie, Associate Director AHP, NHS Highland Nicola Gillespie, Acting Head of Adult Care, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Liz Higgins, Associate Nurse Director, NHS Highland 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 Saskia Schmitz, Public Health Intelligence Officer, Argyll and Bute HSCP Takki Sulaiman, Chief Executive, Argyll and Bute TSI 1. WELCOME, INTRODUCTIONS AND APOLOGIES FOR ABSENCE The Chair welcomed those present. Apologies for absence were received from: Evan Beswick, Chief Officer, Argyll and Bute HSCP Fiona Broderick, Staffside Lead (Health), Argyll and Bute HSCP David Gibson, Chief Social Work Officer, Argyll and Bute HSCP Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP Douglas Hunter, Senior Performance & Improvement Manager, Argyll and Bute HSCP The Chair ruled, and the Strategic Planning Group agreed, to vary the order of business and consider Agenda item 5 (Island Strategy – Update Report on Engagement) after Agenda item 3 (Minutes and Matters Arising) to facilitate Alison Ryan leaving early to attend another meeting. Page 13 Agenda Item 4b
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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 September 2024 were approved as a correct record. There were no matters arising. 3. ISLAND STRATEGY - UPDATE REPORT ON ENGAGEMENT The draft Island Strategy has been developed through a short life working group over a period of eighteen months. During October and November 2024 engagement took place with those working or living on islands to comment on the draft strategy. A review of the feedback received has taken place and the Island Strategy and Action was updated to reflect this. A report and presentation on the engagement undertaken on the draft Island Strategy and Action Plan was before the Strategic Planning Group for consideration. Decision The Strategic Planning Group: 1. Noted and commented on the engagement feedback; and 2. Noted and commented on the action plan developed further from the engagement feedback. (Reference: Report by Senior Service Planning Manager, Argyll and Bute HSCP dated 12 December 2024, submitted) 4. UPDATE JOINT STRATEGIC NEEDS ASSESSMENT 2024 Consideration was given to an update on the Joint Strategic Needs Assessment 2024. Decision The Strategic Planning Group acknowledged the pre-final version of the 2024 JSNA and discussed options for making content of the JSNA best accessible to the public. (Reference: Report by Public Health Intelligence Specialist dated 12 December 2024, submitted) 5. UPDATE - RENEWAL OF JOINT STRATEGIC PLAN Consideration was given to a report setting out the draft strategic priorities for the Joint Strategic Plan covering the period 1 April 2025 – 31 March 2030. Decision The Strategic Planning Group: Page 14
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1. Noted the draft strategic priorities for the Joint Strategic Plan; and 2. Noted timelines, including the delayed public engagement. (Reference: Report by Senior Service Planning Manager, Argyll and Bute HSCP dated 12 December 2024, submitted) 6. REVIEW OF LOCALITY PLANNING GROUPS Consideration was given to a report advising on the outcome of a review undertaken on the format and future of the Locality Planning Groups. Decision The Strategic Planning Group: 1. Considered the outputs of the review; 2. Discussed the potential for supporting meaningful engagement and planning with communities on an ongoing basis; 3. Supported the route forward with groups; and 4. Agreed to authorise planning to consider the membership, meeting the planning and engagement functions which were monitored separately. (Reference: Report by Business Improvement Manager dated 12 December 2024, submitted) 7. OLDER ADULTS STRATEGY VERBAL UPDATE Consideration was given to an update on the Older Adults Strategy. Decision The Strategic Planning Group noted the updated. (Reference: Verbal Update by Head of Adult Services, Argyll and Bute HSCP) 8. DATE OF NEXT MEETING - 13 MARCH 2025 The date of the next meeting was noted as Thursday 13 March 2025. Page 15
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MINUTES of MEETING of ARGYLL AND BUTE HSCP AUDIT AND RISK COMMITTEE held in the BY MICROSOFT TEAMS on TUESDAY, 17 DECEMBER 2024 Present: Councillor Kieron Green (Chair) Emily Austin Susan Ringwood Councillor Ross Moreland Attending: Evan Beswick, Chief Officer, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, 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 Paul MacAskill, Chief Internal Auditor, Argyll and Bute Council Mhairi Weldon, Senior Audit Assistant, Argyll and Bute Council Gregory Oduor, Director, 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 intimated. 3. MINUTES The Minute of the meeting of the Argyll and Bute HSCP Audit and Risk Committee held on 17 September 2024 was approved as a correct record. 4. ANNUAL ACCOUNTS AND EXTERNAL AUDIT The Committee gave consideration to a verbal update regarding the Annual Accounts and External Audit. It was reported that the work on this item is in the final stages and will be presented to a special meeting of the Audit and Risk Committee in January 2025 and then to the Integrated Joint Board for approval. Decision The Audit and Risk Committee noted the content of the verbal update. Page 17 Agenda Item 4c
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(Reference: Verbal update) 5. STRATEGIC RISK REGISTER REVIEW The Committee gave consideration to a report recommending changes to the Strategic Risk Register to reflect perceived increasing risk. Decision The Audit and Risk Committee – 1. noted that the Strategic Risk Register had been reviewed by the Leadership Team; 2. reviewed and approved the Strategic Risk Register and Risk Appetite; and 3. noted that the HSCP had reviewed its Strategic Risk Register against its Strategic Objectives (Reference: Report by Head of Finance dated 19 December 2024, submitted) 6. INTERNAL AUDIT UPDATE The Committee gave consideration to a report which provided an update on the work carried out by Health and Social Care Partnership’s Internal Audit Team on audits which are of operational relevance to the Committee. Decision The Audit and Risk Committee noted the progress on completion of the internal audit recommendations. (Reference: Report by Chief Internal Auditor dated 17 December 2024, submitted) 7. CULTURE The Committee gave consideration to a report detailing an Audit focussed on Culture which has been carried out. Decision The Audit and Risk Committee reviewed and endorsed the Internal Audit report on Culture. (Reference: Report by Chief Internal Auditor dated 17 December, submitted) 8. STANDARD REVIEW OF THE IJB COMMITTEE TERMS OF REFERENCE The Committee gave consideration to a report detailing both the membership and terms of reference within the current context. Decision Page 18
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The Audit and Risk Committee – 1. reviewed the Audit and Risk Committee Terms of Reference in the context of the wider standard review; and 2. agreed to recommend to the IJB that the Terms of Reference were considered them reviewed and fit for purpose until information changes or the next scheduled review period. (Reference: Report by Business Improvement Manager dated 17 December 2024, submitted) 9. 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. Decision The Audit and Risk Committee noted that Audit Scotland have recently published a number of reports that may be of relevance to the Committee. (Reference: Report by Head of Finance dated 17 December 2024, submitted) 10. DATE OF NEXT MEETING The Audit and Risk Committee noted a Special Meeting was scheduled to take please on Friday 17 January 2025, and that the next ordinary meeting would take place on Tuesday 18 February 2025. Page 19
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held BY MICROSOFT TEAMS on TUESDAY, 21 JANUARY 2025 Present: Councillor Dougie McFadzean (Chair) Graham Bell (Vice Chair) Fiona Thomson Karen Leach Tracey White 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, Business Improvement Manager, Argyll and Bute HSCP David Gibson, Chief Social Worker / Head of Children and Families and Justice, Argyll and Bute HSCP Kristin Gillies, Interim Head of Strategy and Transformation, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Nicola Gillespie, Interim Head of Adult Services (Mental Health, Disabilities, ASP & Dementia Services), Argyll and Bute HSCP Katie McKenzie, Committee Services Officer, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE Apologies for absence were received from Kenny Matheson. 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 22 November 2024 were approved as a correct record. 4. BUDGET MONITORING - 8 MONTHS TO 30 NOVEMBER 2024 The Committee gave consideration to a report providing a summary of the financial position as at the end of month 8 and a forecast for the year. Decision The Finance and Policy Committee – Page 21 Agenda Item 4d
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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 hold 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 21 January 2025, submitted) 5. 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 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 continues 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 21 January 2025, submitted) 6. TRANSFORMATION BOARD REDESIGN - UPDATE The Committee gave consideration to a report detailing the latest update against the key transformation projects for 2024/25. Decision The Finance and Policy Committee noted the latest update with regards to the Transformation Projects for 2024/25. (Reference: Report by Senior Manager Performance & Improvement dated 21 January 2025, submitted) 7. DATE OF NEXT MEETING The Finance and Policy Committee noted the date of the next meeting as Tuesday 25 February 2025. Page 22
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1 Integration Joint Board Agenda item: Date of Meeting: 29 January 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 first Chief Officer Report of 2025. I would firstly like to thank our HSCP staff for their hard work, dedication and commitment to the people of Argyll and Bute over the last year. This makes a big positive difference for our local communities and is really valued and appreciated. I also want to thank teams for the work they have done over the festive period in maintaining services over this challenging time. Over the festive period, an extraordinary meeting of the national Collaborative Response Assurance Group was called following a meeting held with the First Minister (26 December) due to reports of a rise in pressure and demand across the health and social care systems and early reports of a significant rise in Influenza A cases being detected through Public Health Scotland surveillance. Our teams across health, social care and social work responded quickly to the request from the First Minister, retaining the focus on vaccinations, early supported discharge planning, multi-professional discharge coordination and operational huddles that have been a key feature of our approach to tackling delayed discharge. I am proud of the work they have done in challenging circumstances. Routinely, the HSCP has a systems pressures oversight group which is currently meeting weekly to discuss local pressures such as bed occupancy and delayed discharges and it is working closely with local managers to ensure that services are operating as efficiently and smoothly as possible. This effort is invaluable in ensuring we meet our aspirations for the people we serve. Nonetheless, it is important to reflect on the winter pressures and underlying context across Health and Social Care in Scotland. Across Scotland the number of patients experiencing delay remains higher than twelve months ago, in spite of the focussed national mission. This is reflective of a system-wide imbalance in care capacity outside a hospital setting, and of an ongoing pressure on the resources we have to Page 23 Agenda Item 5
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2 provide that care. We know clearly from data that our demographic direction tends towards a greater need for that care over the next decade. The need for local and national action is evident. As an HSCP we are continuing to face significant financial challenges with a projected overspend of £2.6m and the financial papers presented to the IJB at this month’s meeting provides much more context around this and what steps have been put in place to try and mitigate this overspend. We are not alone in facing financial pressures as many HSCPs across the country are in a similar financial situation and much like in Argyll and Bute are having to assess where cost savings can be made. We are also awaiting the conclusion of the Scottish Government’s budget process for the next financial year and we expect this to be concluded in the Scottish Parliament in February. This will hopefully provide us with more clarity as to the financial resources that will be made available to us. You will see from papers that our discussions with our key partners (NHS Highland and Argyll and Bute Council) are ongoing. I am grateful for the collaborative nature of this dialogue. There remains a number of other areas in the delivery of health, social care and social work services where there continues to be operational pressures, but also where my team is clear-sighted about the work we can do in Argyll and Bute to make improvements. This includes the recruitment and retention of staff particularly within the care at home sector. This again is a national problem though the remote and rural nature of Argyll and Bute brings its own specific challenges. The delivery of a high standard of care at home service remains one of our top priorities and we are working with our care at home partners, who deliver many of these services, to see what else we can do to help with recruitment in this sector. As noted in the papers, care at home is an area of focus for our redesign agenda and this will mean both modernised systems and processes, as well as careful consideration of how limited resources best meet the needs of our population as a whole. A further area of challenge and opportunity is the west area of our patch, with service sustainability a key risk within Kintyre, and delayed discharge showing up a symptom of system pressure in the Oban area. Again, this is noted in the papers. We have begun a refreshed approach in both of these areas, which will necessitate us being innovative around our working between health, social care, social work and hospital and community. This will mean that the shape of our services will change and I will keep this board updated as that progresses. On that note, I am delighted to update that Donald Watt has been successful in a competitive process and will step into an interim Adult Head of Service role working across Lorn & Islands Hospital and West Community Services in order to step beyond current working practices. Donald, who commenced in this post on 3 January 2025, is well known to many people across the HSCP and brings with him a great deal of experience and knowledge and I wish him well in his new role. Public Health Scotland publish weekly information on flu levels and their most recent report has highlighted that flu is still circulating at high levels across the country. I would remind people, who are eligible, that it’s still not too late to get your flu or COVID vaccination. You can find more information through NHS Inform or by calling the national vaccination helpline on 0800 030 8013. If you have symptoms of flu or other respiratory illnesses then it is important to stop them being spread to others. The latest advice about flu, including information about symptoms, vaccination and what to do is available on the NHS Inform website. Page 24
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3 Our Emergency Departments across Argyll and Bute are open 24/7 for emergencies such as a suspected heart attack or stroke and we prioritise patients with the greatest clinical need which can mean that some patients may wait longer than we would like. If you go to our Emergency Departments and these are not the most appropriate place for your care then our staff will direct you to a more appropriate service. Please remember that if your need is urgent but not an emergency then NHS 24 is available by calling 111 and they will guide you to the best source of care for your needs. Moving on to the details of my report I am delighted to be able to highlight that we have offered the General Medical Services (GMS) contract and Out of Hours (OOH) contract for Colonsay to Dr Clive Mast who is currently working in the Cowal area. We have also awarded the GMS and OOH contracts for Coll to Denny Cross Medical Practice who will be responsible for sourcing and providing GP contractors. These new contracts are really good news for the local communities served by the GP Practices concerned and will ensure that we continue to have high quality health professionals who will provide a safe, resilient and sustainable service. In my report I have also highlighted a recent event sponsored by the Alcohol and Drug Partnership. This event led to 50 people coming together in celebration of National Recovery Month to watch a sponsored screening of The Outrun movie (which tells the story of alcohol addiction) in the Campbeltown Picture House. It was great to hear about the local community coming together to highlight the work that is taking place locally to help people with alcohol and drug problems and my thanks go to Kintyre Recovery Group and everyone else involved in putting this event together. I was also very interested in the event held recently by the Mid Argyll Visual Impairment Social Group where those attending had an opportunity to learn and understand more about the challenges faced by individuals with sensory impairments. It also provided attendees with a heightened awareness of the needs and the barriers that are encountered. As per usual I have included in the National Updates section information on some of the recent key announcements from the Scottish Government and there are also web links where you can find out more details on these announcements. Thank you 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 25
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4 HSCP Updates Isle of Coll to Welcome New GP Contractors We are absolutely delighted that after a robust procurement process, which included the involvement of community representatives from the island, we have been able to offer the General Medical Services contract and Out of Hours contract to Denny Cross Medical Practice. Denny Cross will be responsible for providing GP contractors who will deliver General Medical Services and Out of Hours services for the local communities on the island. I would also like to thank the previous GP Dr Celine O’Neill, who recently retired, for her commitment and hard work in delivering GP services for the communities served by the Practice. GP services on the island will continue to be delivered by locums until the new arrangements come into place on the 1 April 2025. Isle of Colonsay to Welcome New GP We are also really pleased that after a robust procurement process, which included the involvement of community representatives from the island, we have been able to offer the General Medical Services contract and Out of Hours contract for Colonsay to Dr Clive Mast. I would also like to thank the previous GP Dr Simon Willetts, who recently retired, for his commitment and hard work in delivering GP services for the communities served by the Practice. GP services on the island will continue to be delivered by locums until the new arrangements come into place on the 1 April 2025. Living Well Networks We have been continuing to work on the ways in which we link in with communities to ensure that local priorities are integral to the way in which we deliver our services. Over the last few years one of the ways we linked in was through the Argyll and Bute Living Well Networks (LWNs) which offered a platform for partners to connect with community members, services, local/national organisations committed to improving health and wellbeing. Information sharing over that time has however transformed through modern technology and digital solutions such as social media platforms, community forums, local newsletters, digital health apps and the Argyll and Bute Community Directory. The HSCP is also investing in the Community Assets for Living Well initiative which is focused on promoting healthy communities. This includes plans to further Page 26
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5 improve the community directory by developing a centralised and accessible platform for health and wellbeing information, resources, support, and services. The Community Links project is also expanding to more GP practices this year and connects individuals facing social, financial, and practical difficulties with community-based support. With the development of the above initiatives and the wider use of modern technology and digital solutions, coupled with our current financial pressures, we have taken the difficult decision to inform the LWNs that the networks will not continue after April 2025. We would like to express our sincere gratitude to our past and present LWN coordinators for their outstanding dedication and hard work and we will work with the LWNs over the coming months to help consider future opportunities for working with communities. There are exciting opportunities for exploring the development of ongoing relationships in Citizen or People Panels. Service Updates National Recovery Month Fifty people recently came together, in celebration of National Recovery Month, to watch a sponsored screening of The Outrun in the Campbeltown Picture House. This movie, starring Saoirse Ronan, tells the true life and hard hitting story of alcohol addiction and a journey back to Orkney based on the memoirs of Amy Liptrot. The event was sponsored by the Alcohol and Drug Partnership (ADP) and guests to the screening were treated to free mocktails and were welcomed to the event by members of the Kintyre Recovery Group. Kintyre Recovery Group, which was formed a year ago with support from the ADP, is made up of people in recovery who support each other with weekly get togethers and activities like walking groups. National Recovery Month in Scotland is where people come together to celebrate recovering from alcohol and drug problems. The recovery movement recognises the importance of raising awareness of the hope and optimism that comes from people supporting each other. New Pharmacy to Open in Campbeltown A joint consultation exercise was recently undertaken by NHS Highland and Zakpharma Ltd to gauge support for a pharmacy application in Campbeltown. Following the consultation a decision to grant the application was made by NHS Highland's Pharmacy Practice Committee on 1 November 2024. As of 4 December 2024, Zakpharma Ltd was able to progress opening their new pharmacy, which will be known as Campbeltown Pharmacy. They will be able to provide all NHS contracted services, as well as locally negotiated services, to members of the public. A date of opening has still to be confirmed. Page 27
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6 National Updates NHS 24 Resilience Over Festive Period An information campaign and increased recruitment of call handlers are among the initiatives NHS 24 has put in place to help protect vital front line health and care services over the festive period. First Minister John Swinney visited the NHS 24 call centre in Dundee to observe preparations ahead of the Christmas and New Year period and to express his gratitude to staff. Further information is available here. Public Satisfaction in Local Health Services The level of satisfaction with local health services has increased, the Scottish Household Survey 2023 showed. The proportion satisfied rose in a year from 64% to 67% and nearly nine in ten (87%) reported being treated with dignity and respect. Adults were more likely (78%) to express trust in the health system than any other public institution. Further information is available here. Additional Investment in General Practice An additional £13.6 million will be invested in General Practice this financial year to support GPs to retain and recruit key staff, Health Secretary Neil Gray has announced. Speaking at the annual conference of BMA Scotland’s Local Medical Committees, Mr Gray confirmed the immediate funding for 2024-25 will address known financial pressures, support staff costs and enable GPs to take on partners and salaried GP staff. Further information is available here. Carers Urged to Check for Financial Help Unpaid carers across the country are being encouraged to check their eligibility for financial support from Social Security Scotland. It is estimated that there are around 800,000 unpaid carers, including 30,000 under the age of 18, providing care for a family member, friend or neighbour in Scotland. Research also suggests that many do not see themselves as a carer, meaning they do not take up support they are entitled to. There are three payments delivered by Social Security Scotland dedicated to supporting unpaid carers. Further information is available here. News Argyll and Bute Carers Urged to Come Forward The HSCP was pleased to support Carers Rights Day at the end of November. This national event marks the massive commitment made by the many thousands of unpaid carers across the UK. Page 28
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7 1 in 6 adults have unpaid caring responsibilities for someone with a longstanding illness or disability. For many people, looking after a loved one who is ill, frail or disabled is something they do out of love and because it feels like the right thing to do. We also recognise the outstanding work carried out by local carer centres across Argyll and Bute. The Carers' Centres are run by charitable organisations and can support carers to complete an Adult Carer Support Plan or Young Carer Statement which helps identify a wide range of information, support and services that could benefit the carer. Further information is available here. Sight and Hearing Loss Festive Community Engagement Event The Mid Argyll Visual Impairment Social Group held a Christmas gathering on 9 December in Lochgilphead where those attending the event had an opportunity to learn and understand more about the challenges faced by individuals with sensory impairments. The HSCP’s Sensory Impairment Team was also in attendance to highlight equipment designed for individuals with sight and hearing loss. They also brought with them simulation glasses so that members of the public could experience what living with sight loss can feel like. Individuals experiencing visual impairments often encounter substantial obstacles in their daily lives, impacting activities such as reading, communication, and navigation within public environments. By engaging with and observing the challenges faced by individuals with sensory impairments, attendees at events such as this can develop a heightened awareness of the needs and the barriers that are encountered. Further information is available here. Blarbuie Woodland Walk Appeal The HSCP is seeking community support to maintain a key local asset - the Blarbuie Woodland Walk in Lochgilphead. While this site does not fall under HSCP services, we understand its significance to local walkers. Throughout the years the site has been managed and developed by local groups and organisations however, their departure has led to challenges in maintenance. To uphold public safety, the HSCP is responsible for mitigating risks and ultimately dismantling any unsafe structures on the site. We have been reaching out to the local community seeking groups or organisations that are interested in assisting us in taking over the management of the woodland walk. We kindly ask that all expressions of interest be submitted by 31 March 2025 by emailing nhs.abhscp@nhs.scot Page 29
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8 Staffing Updates Head of Service for Acute and Community Care Following an open process, Donald Watt (Senior Manager for Health & Community Care) has been appointed, in an interim position, as Head of Service covering Acute and Community Care across Oban, Mid-Argyll and Kintyre. Donald, who commenced in post on 3 January 2025, brings with him a great deal of experience and knowledge and I would like to wish him well in his new role. Page 30
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1 Integration Joint Board Date of Meeting: 29 January Title of Report: Membership of the Integration Joint Board Presented by: Charlotte Craig, Business Improvement Manager The Board is asked to: ▪ Note the proposal of Janice Preston, NHS Highland non-executive director to the Integration Joint Board ▪ Following confirmation, appoint to the Audit and Risk Committee vacancy 1. EXECUTIVE SUMMARY Susan Ringwood has completed her term as non-executive director with the NHS Highland Board. The NHS Board have nominated an appointee to the Integration Joint Board on 28 January 2025 to ensure they have representation. The IJB is asked, pending successful appointment, to welcome the new member to the Integration Joint Board and appoint to the current Audit and Risk Committee vacancy. This report notes the proposal to the NHS Board and seeks action from the IJB based on the outcome of the decision. 2. RECOMMENDATIONS The Integration Joint Board welcome the appointee to the Integration Joint Board and ensure committee representation in line with the Terms of Reference. 3. DETAIL OF REPORT The Integration Joint Board periodically reviews and recruits new members to the board and has a change of appointed members based on the completion of an appointed term with each partner orgainsation. This report highlights the proposal of Janice Preston, NHS Highland non executive director to the integration Joint Board. Pending NHS Board approval it is recommended that the IJB welcome the new member and appoint the vacant Audit and Risk Committee role. 4. RELEVANT DATA AND INDICATORS Reference proposal paper to the NHS Highland Board 28/01/2025. Page 31 Agenda Item 6
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2 5. CONTRIBUTION TO STRATEGIC PRIORITIES NHS non executive directors are essential to the voting membership of the Integration Joint board. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact - none 6.2 Staff Governance - none 6.3 Clinical and Care Governance – none 7. PROFESSIONAL ADVISORY Appointments are commensurate with required IJB membership and will ensure that the IJB has full operational capacity. 8. EQUALITY & DIVERSITY IMPLICATIONS Recruitment for NHS non executive members of the board is an open public process undertaken by NHS Highland. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE N/A 9. RISK ASSESSMENT Maintaining membership of the IJB is essential in the delivery of good governance. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Recruitment for NHS non executive members of the board is an open public process undertaken by NHS Highland. 11. CONCLUSIONS The IJB is asked to welcome the appointment to the IJB and appoint to the vacant Audit and Risk Committee role. 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 32
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1 Integration Joint Board Date of Meeting: 29 January 2024 Title of Report: Budget Monitoring – 8 months to 30 November 2025 Presented by: James Gow, Head of Finance The Integration Joint Board is recommended to: • Note that the HSCP has overspent its budget by £1.6m. • Note that an overspend of £2.6m is forecast. • Note actions are required to reduce spend and additional funding is required from Argyll & Bute Council who hold pension saving resource on behalf of the IJB; • Note savings of £4.8m have been delivered, 73% of target. 1. EXECUTIVE SUMMARY 1.1 This report provides a summary of the financial position as at the end of month 8 and a forecast for the year. The forecast remains of concern as costs within social work services in particular are well in excess of the approved budget. Steps are required to manage this through reduced spend and / or increased use of reserves and 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. 1.2 The forecast is currently an overspend against budget estimated at £2.6m. The approach to managing this will be to: • Increase scrutiny of spend and vacancy management. • Progress the savings programme. • Develop additional controls to reduce spend within Social Care. • Request Argyll & Bute Council make available additional resourcing from the pension fund savings. The Health and Social Care sector across Scotland continues to be in a very difficult and unsustainable financial position, this has been highlighted by Audit Scotland in various reports in recent months. Page 33 Agenda Item 7
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2 2. Recommendations 2.1 • Note that the HSCP has overspent its budget by £1.6m. • Note that an overspend of £2.6m is forecast. • Note actions are required to reduce spend and additional funding is required from Argyll & Bute Council who hold pension saving resource on behalf of the IJB; • Note savings of £4.8m have been delivered, 73% of target. 3. DETAIL OF REPORT 3.1 8 Months to 30 November 2024 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 an analysis of the variances: Service Actual £000 Budget £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 56,367 55,239 (1,128) (2.0%) HEALTH SERVICES TOTAL 177,343 176,904 (439) (0.2%) GRAND TOTAL 233,710 232,143 (1,567) (0.7%) 3.1.1 For social care budgets there are several areas of concern: • 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. This issue is particularly relevant to social care on the islands and west area. Absence cover is increasingly 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 also overspent, the main drivers continue to be the use of agency staffing and medical locums along with an increase in high-cost external mental health placements. Agency staff are only employed to cover for essential posts which are either vacant or there is an absence and there has been some reductions achieved, particularly for nursing and AHP groups, this has been supported by national initiatives to cut back spend. Page 34
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3 3.2 3.2.1 Forecast Outturn The forecast remains of concern, particularly for social work services. 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 relies upon the use of reserves and an allocation from the non- recurring pension fund saving. Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 91,794 93,641 (1,847) (2.0%) HEALTH SERVICES TOTAL 277,654 278,400 (746) (0.3%) GRAND TOTAL 369,448 372,041 (2,593) (0.7)% 3.2.2 Within Social Work, children’s and families, mental health and older adult budgets are all overspending and a £1.8m adverse variance forecast. The overspend in Children’s Services is driven by increased number of children in out of area placements, there are now 18 in such placements. These are considered to have been unavoidable and each one is carefully considered before being contracted. This cost pressure was not foreseen at the time the budget was prepared. The forecast overspend on this heading is £0.7m on a budget of £6.7m. A detailed report on this was provided to the Finance & Policy Committee in September 2024. Additionally, one group of staff were upgraded which has added £0.2m to staff costs with no funding to offset. Spend on older adults remains above budget with agency staffing a particular issue. The budgets summarised below were increased from £35.6m to £38.5m (8%) to allow for increasing demand and inflation. Social Care agency spend is currently at £3.1m for 8 months. This is close to the £3.2m spend for the whole of last year and has increased from £0.8m in 2021/22. The cost of accommodation for these workers on islands is adding to the problem. Alternative arrangements on Islay will be available in the coming weeks to reduce this aspect of spend. Agency within our nursing homes is likely to reduce with recruitment but care at home agency is meeting current service demand and there is little scope for short term 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 £20.5m (£0.9m) Internal Care Home Placements £7.5m £ 7.4m £0.1m Total £38.5m £40.3m (£1.8m) External residential placement spend includes provision within Argyll and Bute and in other local authority areas. These placements are generally at the nationally negotiated care home rates. While the figures fluctuate from week to week, there are typically around 210 people in out of area placements of the Page 35
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4 490 or so that are in non-HSCP care homes. This can be due to lack of local capacity or the choice of the individual / family concerned. The new Care at Home contract has been implemented in and is reducing costs 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 the staffing levels and available budget, in order to meet increasing demand. Recovery actions are required for the HSCP and care at home is an area of focus. To date no action has been taken to restrict provision of care for financial reasons. Work on a recovery plan is under development for the end of the current and for future years. A detailed report on actions to manage this will be available at the February meeting. The Social Work budget assumed that £1.3m of the pension fund saving (£3.0m is held by the Council) would be allocated to revenue costs in 2024/25. The HSCP has informed Council officers that it expects to require all of this resource to fund the overspending. This has also been highlighted as a risk to the HSCP leadership group. The table below summarises the extent of forecast reliance upon non-recurring savings: Social Work £m Budgeted Reliance on Pension Fund Savings 1.3 Forecast revenue budget variance (M4) 1.8 Underlying budget gap 3.1 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 with Hub North), and the completion of the Tigh a Rudha care home refurbishment and remodelling. 3.2.3 NHS services are forecasting an overspend of £0.7m, key concerns are: - Agency staff – agency, locum and bank staff costs continue to be the largest cost pressure. Gross spend on agency, locum and bank staffing across all services is £8.2m. LIH remains the highest spending service area, with spend of £3m, most of which relates to medical staffing, there has been no improvement in respect of the medical model at LIH this year. - 2c GP practices (directly operated) – the HSCP has taken over the running of 2 further practices. This is creating additional locum cost pressures and is driving a £0.5m overspend. There is a lack of certainty about the funding impact of the GMS uplift on 2c practice funding. - High cost out of area referrals – 8 admitted patients have created a cost pressure of £531k at the end of November. The costs of these are circa £4k per week each with no funding identified. Page 36
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5 - Prescribing – a small pressure exists within prescribing and further investigation is ongoing into the potential value of non-cash limited prescribing that may be impacting this. Some excess costs will continue to be offset by vacancies. However, the Health budget is already dependent upon the use of reserves (£4.3m) and there is limited scope to increase reliance on reserves. A tightening of spend controls is now being implemented to bring NHS spend back in line with budget, progress on agency/locum staffing is critical to achieving this. NHS Highland are aware of the overspend and the HSCP is continuing to work towards bringing the NHS budget into line. A further issue which has added to the forecast overspend has been that SG have cut Multi Disciplinary Teams funding in-year by £14% (£5.7m for the sector and £106k for the HSCP). The SG health finance team have confirmed that it does not intend to make any additional funding available for the NHS. The national context within the NSH is that Boards are collectively projecting an overspend in excess of £400m. 3.2.4 Overall the HSCP is operating in excess of its approved budget. Steps are in place to try and mitigate this including: • Continuing vacancy management processes. • 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 it is anticipated that further mitigations are required, these overlap with actions associated with the work on the budget: • A request for the remainder of the pension fund saving held by council; • A moratorium 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); • Recovery of direct payment balances where these are not being fully spent (non recurring); and • Reviewing the operation of the care at home service, a paper will be developed looking at detail such as the way the service is accessed. These measures, to the extent that they are implemented, may result in some reduction in service and increase in unmet need or further waiting times for care packages. It is not expected the HSCP will be able to recover its Social Work / Social Care financial position by year end. The position is consistent with the national situation in the Health and Social Care sector with many IJBs taking action. 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 to address the issue. There are a number of risks including: Page 37
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6 • The Council pay award has been implemented but not agreed by all unions; • In year budget cuts have been announced by the Scottish Government to fund the pay increases, including a reduction in the Health and Social Care Budget; • The impact of NI increases next year is a heightened risk for 3rd sector and commissioned service providers in the short term while funding remains uncertain; • There are further staff re-grading exercises underway which will result in increased pay costs; and • Demand for services, impact of winter pressures and the priority given to managing delayed discharges. 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 8, £4.8m (73%) of the £6.6m target has been declared: 2024/25 Savings Year to 30 November 2024 Target Achievement Balance % £' 000 £' 000 £' 000 Fully Achieved 4,091 4,091 0 Partially Complete 2,522 315 2,207 Non Recurring - 425 (425) Total 6,613 4,831 1,782 73% Appendix 3a lists the fully delivered savings and 3b summarises the remaining savings, risk rated: Savings regarded as low risk £339k Savings unlikely to be achieved in full in 2024/25 £1,130k Savings unlikely to be deliverable in 2024/25 £738k Work is on-going to deliver as much of the balance as possible. There are a number of projects where change processes are required and are taking time. The new medical staffing model in Cowal is now starting to be implemented and it is hoped that the savings relating to FME contracts can be progressed soon. The amber and red rated savings projects represent a financial risk already incorporated in forecasts. 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 £10.7m 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 reserves are reduced to £9.2m, many of these are earmarked for specific Page 38
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7 3.4.2 4 4.1 5 5.1 6 6.1 6.2 6.3 purposes. The Scottish government have suggested that there is some scope for reallocating reserves to fund cost pressures. Much of the remaining reserves balance has been allocated to projects. To some extent these are compensating for insufficient investment in infrastructure by partners: • £600k for the Prevention / Wellbeing project; • Estimated £529k for remodelling the Campbeltown Hospital to better locate new radiography equipment; • £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). Much of the 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 and a proper solution to the mis-match between recurring funding and spend requires to be identified as reserves reduce and the pension fund saving will not be available beyond 2025/26. 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 could be accessed if the HSCP continues to overspend, the HSCP is required to progress its recovery planning. 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 from this report. Page 39
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8 9. 9.1 10. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. RISK ASSESSMENT 10.1 There are a number of financial risks and these are reported to the Finance & Policy Committee: • Continuing impact of high service demand and winter pressures; • Inability to reduce supplementary staffing; • Pressure on support services relating to HR, administrative and finance processes; and • Delivery of the balance of the savings programme. The HSCP is not in a sustainable financial position as spend and service demand exceed available funding. Financial recovery and development of the savings programme for 2025/26 are 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 8. The forecast remains of concern and the management team are seeking to manage spend down. The reliance upon non-recurring resourcing is an increasing problem for 2025/26 and future years. It is not expected that spend can be reduced to the extent that would be required to operated within budget in the current year. The HSCP will require to seek additional support from the non-recurring savings relating to pension costs from Argyll and Bute Council to fund the overspend. This will restrict flexibility in future years, adds to the longer-term gap between spend patterns and available resources. This will also limit funding for development and transformation as the balance shifts further towards managing immediate pressures rather than longer term change. Page 40
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9 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 Monitoring M8 8/01/25 N/A 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 41
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# ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 1 REVENUE BUDGET MONITORING SUMMARY - YEAR TO DATE POSITION AS AT 30 NOVEMBER 2024 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 706 508 (198) (39.0%) Adverse variance due to the under recovery of vacancy savings and termination payment for a senior officer leaving their substantive post. Service Development 265 267 2 0.7% Outwith reporting criteria. Looked After Children 4,707 4,237 (470) (11.1%) Overspend due to a retainer payment being required for 4 weeks for 2 children transitioning from secure to residential along with a rates increase agreed by Scotland Excel and a change in the split of the funding for a package. Child Protection 1,926 2,062 136 6.6% The YTD variance is based on known demands for the service coupled with deferred income received from previous years. Children with a Disability 595 718 123 17.1% The underspend is due to two third sector grants ending. Criminal Justice 86 139 53 38.1% The YTD variance is due to additional grant funding. Children and Families Central Management 1,963 1,972 9 0.5% Outwith reporting criteria. Older People - Homecare 12,637 11,627 (1,010) (8.7%) Overspend reflects an increase in payments to third party providers and the use of agency staff. Older People - Internal Residential 4,434 4,223 (211) (5.0%) Variance is due the use of agency staff to cover sickness, holidays and vacancies. Older People - External Residential 6,484 6,580 96 1.5% The YTD variance is due to timing difference with third party payments. Older People - Other 5,543 5,629 86 1.5% Variance is due to timing of re-charges to NHS and timing of payments to third parties. Physical Disability 2,413 2,540 127 5.0% The YTD variance is due to re-assessed care packages. Learning Disability 11,638 11,951 313 2.6% Underspend due to reduced service demand for this service area. Mental Health 2,559 2,322 (237) (10.2%) Overspend due to movements in assessed packages. Adult Services Central Management Costs 411 464 53 11.4% The YTD variance due to underspends on centrally held funds. COUNCIL SERVICES TOTAL 56,367 55,239 (1,128) (2.0%) HEALTH SERVICES: Explanation Health & Community Care Services 31,161 31,639 477 1.5% Underspend is due to vacancies across a number of services Acute & Complex Care Services 28,885 27,448 (1,437) (5.2%) Overspending is due to continued agency and locum usage to cover medical & nursing vacancies in LIH & Mental Health, high cost out of area private sector mental health placements Children & Families Services 7,245 7,198 (47) (0.7%) Outwith reporting criteria. Commissioned Services - NHS GG&C 51,990 51,309 (681) (1.3%) Overspending on cost per case activity within GGC relating to drug treatment prescribing Commissioned Services - Other 3,032 2,926 (106) (3.6%) High cost other Scottish Board services charge for emergency care on a cost per case basis Primary Care Services inc Dental 20,551 20,472 (80) (0.4%) Misc overspending due to 2C practises Other Primary Care Services 7,060 7,060 0 0.0% Outwith reporting criteria. Prescribing 16,506 16,373 (133) (0.8%) Continuing supply shortages and pricing increases Public Health 1,524 1,575 51 3.2% The YTD variance is due to vacancies Lead Nurse 1,259 1,331 72 5.4% The YTD variance is due to vacancies/ secondments Management Service 504 702 198 28.2% The YTD variance is due a technical accounting adjustment relating to clinical negligence provisions Planning & Performance 1,667 1,659 (8) (0.5%) Outwith reporting criteria. Budget Reserves 0 1,250 1,250 100.0% Slippage on reserves due to delays in implementation, generally due to recruitment Income (1,517) (1,389) 128 (9.2%) Seasonal increase in activity and long stay Mental Health patient Estates 7,476 7,352 (123) (1.7%) Inflationary pressures and increased demand for maintenance due to limited availability of capital funding, unachieved savings HEALTH SERVICES TOTAL 177,343 176,904 (439) (0.2%) GRAND TOTAL 233,710 232,143 (1,567) (0.7%) Page 43
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# ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 2 REVENUE BUDGET MONITORING FORECAST OUTTURN - AS AT 30 NOVEMBER 2024 Reporting Criteria: +/- £50k or +/- 10% Service Annual Budget £000 Outturn £000 Variance £000 % Variance Explanation COUNCIL SERVICES: Chief Officer (600) (302) (298) 49.7% The forecast overspend reflects an under recovery in vacancy savings and a termination payment due to a senior officer leaving their substantive post. Service Development 453 456 (3) (0.7%) Outwith reporting criteria. Looked After Children 6,691 7,419 (728) (10.9%) Forecast overspend reflects current known demand for the service. Currently have 18 children in residential placements with an average cost of £132k per annum and potentially more under consideration along with an overspend on staff costs due to a re-grading process (£240k). Child Protection 3,603 3,436 167 4.6% The forecast underspend is as a result of demand for contact and welfare services. Children with a Disability 1,052 849 203 19.3% The forecast underspend reflects a reduction in third sector grants payable to external organisations, one of which may re-start before the end of the financial year. Criminal Justice 174 77 97 55.7% Underspend reflects additional grant funding received along with vacant posts. Children and Families Central Management 3,733 3,698 35 0.9% Outwith reporting criteria. Older People - Homecare 19,550 20,406 (856) (4.4%) Overspend reflects the latest assessed needs packages for the homecare service and increasing reliance on agency staff. The forecast overspend on agency staff is curently £2.3m however this is partially offset by underspend in staffing budgets and third party payments. Older People - Internal Residential 7,483 7,387 96 1.3% Forecast underspend is due to a projected increase in other income from residential care partial offset by an overspend in agency staff costs. Older People - External Residential 11,425 12,381 (956) (8.4%) Overspend reflects the latest demand for service based care packages with highest demand being in Mid Argyll, Lorn, and H&L partially offset by a drop in demand in Bute. Older People - Other 9,383 9,331 52 0.6% Overspend is predominatly due to the costs associated with delayed discharge service. Physical Disability 3,852 3,664 188 4.9% Underspend is due to a combination of re-assessed needs packages and attritions. Learning Disability 20,289 19,784 505 2.5% Underspend reflects demand for service and known commitments with MAKI and OLI showing an underspend position partial offset by a small overspend in H&L. Mental Health 3,894 4,270 (376) (9.7%) Forecast overspend is based on assessed care needs and agreed packages. We currently have 13 clients in residential placements. Adult Services Central Management Costs 812 785 27 3.3% Outwith reporting criteria. COUNCIL SERVICES TOTAL 91,794 93,641 (1,847) (2.0%) HEALTH SERVICES: Explanation Health & Community Care Services 47,317 47,047 270 0.6% Saving due to vacancies across a number of services Acute & Complex Care Services 40,925 43,025 (2,100) (5.1%) Overspend on 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 10,781 10,781 0 0.0% Outwith reporting criteria. Commissioned Services - NHS GG&C 76,963 77,458 (495) (0.6%) Cost per case activity within GGC relating to homecare drug prescribing & high cost procedures Commissioned Services - Other 4,321 4,470 (149) (3.4%) High cost other Scottish Board services charge for emergency care on a cost per case basis Primary Care Services inc Dental 29,930 30,579 (649) (2.2%) 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 24,792 24,956 (164) (0.7%) Anticipated additional costs of prescribing, PSD reporting on the detail of costs runs two months in arrears. On going supply shortages and price increases are also impacting. Public Health 2,682 2,612 70 2.6% Saving due to vacancies Lead Nurse 1,988 1,913 75 3.8% Saving due to vacancies/secondments Management Service 1,614 1,368 246 15.2% The forecast variance is due a technical accounting adjustment relating to clinical negligence provisions & vacancies Planning & Performance 2,462 2,525 (63) (2.6%) Overspend due to unachieved Savings Budget Reserves 13,855 11,755 2,100 15.2% Slippage on reserves due to delays in implementation, generally due to recruitment Income (1,944) (2,101) 157 (8.1%) Forecast activity for patients from outwith A&B, long stay Mental Health patient discharged Estates 11,227 11,271 (44) (0.4%) Inflationary pressures and increased demand for maintenance due to limited availability of capital funding and unachieved savings HEALTH SERVICES TOTAL 277,654 278,400 (746) (0.3%) GRAND TOTAL 369,448 372,041 (2,593) (0.7%) Page 44
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# Appendix 3a - 2024/25 Fully Complete Savings Target Ref. Savings Description £' 000 Social Work 2425-04 Increased income - fees and charges inflation already approved 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 AB2324-28 Prescribing 110 AB2324-30 Reduction in training SLA with UWS 5 AB2324-30 Marie Curie Contract underspend 10 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 4,091 Page 45
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# 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 only 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 150 119 31 Underway 2425-08 Sleepovers Review 80 46 34 Underway Health AB1920-35 Bed reduction savings : Dunoon 150 150 Declared on a non-recurring basis 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, good progress has been made AB2021-64 FME (Dunoon) 50 50 Stable staffing at CCH required to enable saving to be delivered, good progress has been made AB2223-9 Forensic Service Contracts 20 20 Stable staffing at CCH required to enable saving to be delivered, good progress has been made AB2021-19 Hotel Services redesign to reflect reduction in inpatient numbers 99 30 69 Project underway and some savings delivered, more is anticipated AB2021-23 Catering & Domestic Underspends 30 30 Some savings declared on a non-recurring basis only 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 Underway, savings not yet identified AB2425-01 Review of Primary Care Drugs - Drugs of limited value etc, switches etc 150 26 124 Work on-going - some oportunties identified 2,522 315 2,207 530 191 339 1,254 124 1,130 738 0 738 Page 46
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# Opening Reserves £ Spend during 2024/25 £ Additional Reserves 2024/25 £ Closing Reserves Balance £ Primary Care Projects 96,772 96,772 Technology Enabled Care (Near Me) 30,902 13,100 17,802 Technology Enabled Care 615 615 ADP Funding 494,873 200,000 294,873 Best Start - Maternity Services (Board re-provision) 110,773 8,000 102,773 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 Primary Care OOH Funding 234,363 30,000 204,363 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 26,300 253,198 Perinatal MH Funding 19,887 6,000 13,887 Mental Health Officer Training / Recovery 28,787 28,787 Type 2 Diabetes Framework 45,379 45,379 Trauma Training Programme 85,717 25,934 59,783 Wellbeing Funding 39,528 39,528 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 21,700 109,548 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 General Reserves - Service Transformation & Estates 2,597,782 2,597,782 Social Work Workforce 38,990 38,990 Nurse Director Support for Care Homes 62,386 62,386 Digital Therapies 58,773 58,773 GDS element of the Public Dental Service 278,500 36,911 241,589 Hospital at Home Project 415,067 285,500 129,567 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 66,300 533,700 General Reserves - Revenue Funding 4,266,000 4,266,000 0 General Reserves - Estates & Transformation Projects 950,537 950,537 Total 19,878,849 10,725,320 0 9,153,529 Held by NHS 16,489,832 10,699,386 0 5,790,446 Held by Argyll & Bute Council 3,389,017 25,934 0 3,363,083 Total 19,878,849 10,725,320 0 9,153,529 Appendix 4 - Reserves Page 47
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1 Integration Joint Board Date of Meeting: 29 January 2025 Title of Report: Budget Update 2025/26 Presented by: James Gow, Head of Finance The Integration Joint Board is recommended to: • Note that budget planning for 2025/26 is on-going. • Note the HSCP is not currently operating on a financially sustainable basis. • Note the budget gap before savings and use of non-recurring resources is £15m. • Endorse the savings proposals to date and approve that work continues on developing these further. • Note that the HSCP may not be able to propose a balanced budget In March and the implications are being discussed with partners. 1. EXECUTIVE SUMMARY 1.1 This report provides the IJB with an estimate of the budget gap for 2025/26 and a summary of progress made in developing savings plans. The report updates the financial planning figures for the implications of the draft budget and public pay policy published in December 2024. Public finances remain under severe pressure and the Health and Social Care sector is not operating in a sustainable way. Local modelling of the national funding allocations will continue to be refined as the budget cycle progresses. 1.2 The budget gap, before the application of non-recurring funding or savings for 2025/26, is estimated at £15m. This has improved as a consequence of the budget but not to a sufficient enough extent to enable the HSCP to provide assurance that it can balance its budget in 2025/26. The cost and demand pressures are significant and take account of Social Care cost pressures experienced in the current year. The HSCP has not been able to develop savings plans which address this gap, without impacting severely on access, availability or quality of service provision. Savings proposals will be progressed on the basis that they are proportionate and seek to minimise adverse impacts on the most vulnerable. The estimated budget gap will be refined as detailed work on the budget and saving proposals continues. Based on current assumptions, additional resourcing from both partners will be required and constructive discussions are ongoing and will continue as the budgeting cycle progresses. Page 49 Agenda Item 8a
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2 2. Recommendations • Note that budget planning for 2025/26 is on-going • Note the HSCP is not currently operating on a financially sustainable basis. • Note the budget gap before savings and use of non-recurring resources is £15m. • Endorse the savings proposals to date and approve that work continues on developing these further. • Note that the HSCP may not be able to propose a balanced budget and the implications are being discussed with partners. 3. DETAIL OF REPORT 3.1 Budget Context The HSCP is not operating on a sustainable basis at present, this situation is common across the sector with many IJBs reliant upon reserves (where available) to achieve financial balance. Budget planning commenced early as a consequence of the scale of the problem. Multiple management team meetings have now taken place to identify potential projects to deliver savings. In addition to the challenge for next year, the HSCP is overspending in the current year which is an indicator of the on-going high levels of demand for care and dependency upon supplementary staffing to deliver it, particularly within social care. The draft Scottish Budget was published in December 2024 and this report takes this into account although there are still material uncertainties, particularly regarding funding for the Employer National Insurance increase. The budget has allocated some additional funding for the NHS and in a more limited way for Local Authorities. There is no new money at present for Social Care as all additional allocations are to fund inflationary increases. This approach fails to recognise increasing numbers of older adults requiring health and social care. Local authorities have been allocated additional funding which could be used to help support increasing Social Care costs locally. Some of the key points are: • A new Public Pay Policy has been published, 9% over 3 years. • Funding has not been confirmed to cover the NI increase for directly employed local authority staff or for commissioned service providers in the health and social care sector. • The minimum pay rate for health and social care staff is to increase from £12 to £12.60 per hour (5%) and funding allocated which is expected to cover this increase. • There is a general 3% uplift for non-pay cost pressures within the NHS budget and the NI increase is expected to be funded for NHS staff. • Health Boards in deficit are expected to work towards breaking even over a number of years and no brokerage available from 2025/26. • The NHS is expected to set out how 3% savings can be made each year to move towards financial balance. Page 50
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3 3.2 • Funding for Agenda for Change banding uplifts and reduced working week is expected to be made available to cover costs. There are no new medium term planning figures available and therefore this report focusses only on the single year budget for 2025/26. Service Demand An increasing concern for financial planning relates to demographic change. It is clear that both health and social care spend are directly correlated to age and that 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 wholly 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 and the implications for future service demand and models of care in our communities. The modelling below summarises Argyll & Bute population projections: 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 The conclusion is that we can expect demand to increase incrementally each year well into the 2040’s. For example, 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 appear to be making little allowance for this, as has been highlighted by Audit Scotland and Alzheimer Scotland (Commission on the future of long-term care in Scotland) in recent months. While funding models do allocate resources to areas based on demographics, the total budget is not being uplifted in a way that makes specific allowance. Recent uplifts do not take account of cost inflation fully, never-mind increasing service demand. This approach is likely to result in continuing annual overspending as budgets are not increased in correlation with a well understood pressure for the sector. Alternatively, budget setting will require a significant element of service reduction year on year as the pressure cannot be managed through efficiencies and management controls alone. 3.3 Social Work / Social Care Budget – 2025/26 Detailed work on the Social Work budget is underway. The gap is such that the HSCP is in on-going discussions with the Council to establish the most appropriate response to the pressures in Social Care. Local Authorities have been allocated additional funding in the budget and some of this could be passed to the HSCP, there is no additional funding for social care other than for increases in costs, mainly to fund the living wage increase. Page 51
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4 A fundamental risk to the delivery of social care services next year is the increase in employer National Insurance, the threshold change in particular has an adverse impact on the sector due to the number of part time employees. An estimate from one key partner is that the cost is circa 3% on total contract values and funding for this is a threat to viability. While the HSCP is not in a position to accurately assess the cost, it is likely in the £1-1.4m range with no funding confirmed either from the UK or Scottish Government at the time of writing. The table below provides an outline of the expected position for 2025/26: Social Work Budget 2025/26 £m £m Underlying budget deficit 1.3 Direct Pay Costs 3% Pay increase 1.0 Pay increments 0.2 National Insurance Increase 1.0 Less assumed additional funding via Council: 1% of pay 3% increase funded (0.3) TBC Staff NI Increase – 50% funded by SG / 50% from Council (1.0) TBC Net additional pay costs 0.9 Cost & Demand Pressures Anticipated unfunded inflation on contracts, supplies and services 0.9 Estimated Living Wage increase (5%) 2.9 Children & Families Cost pressures 0.7 Older Adult Residential – fund current level of overspend 1.2 Care @ Home – fund current level of overspend 0.8 Allowance for 1% demand growth Older Adults – Demographic Change 0.5 Cost & Demand Pressures 7.0 Additional Resourcing: Real Living Wage Funding 2.9 Inflation on NHS Resource Transfer 0.4 Community Mental Health 0.1 Total Additional Resourcing (3.4) Budget gap before savings 2025/26 5.8m The budget gap does not include an allowance for the impact of the National Insurance increase for contractors. It is unlikely that the HSCP will be able to address this gap in full next year. Intended proposals for addressing the situation are: Page 52
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5 3.4 Quantified Savings Service Risk Review of Care at Home Services – target saving 0.9 Medium Use of non-recurring pension fund saving 2.5 - Inflation increases on Fees and Charges TBC 0.3 Medium Non-recurring reserves resourcing – potential cancellation of projects 0.5 Medium Flat cash settlements on some contracts / other adjustments 0.3 Medium Savings Target 4.5 Residual Gap £1.3m Potential NI pressure for contracted services £1.3m Priorities are for improvement and spend to save intended to move towards addressing the challenge in the medium term. The HSCP is seeking to look at these in as integrated a way as possible. Some of these could start to deliver savings during 2025/26. • 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 Packages and direct payments. • Kintyre and Mid Argyll Service Sustainability. The HSCP is working with the Council to establish how the remaining budget gap can be managed in 2025/26. The use of £3m in non-recurring resourcing is not sustainable and must be addressed during 2025/26. COSLA are also in the process of raising the issues outlined in this paper with SG. NHS Budget The expectation from Scottish Government is that all Boards should improve their financial position (where they are in deficit) each year with a view to achieving a balanced budget in the medium term. Efficiency savings of 3% are to be delivered each year. The implication for the HSCP is that the savings target is therefore 3% of circa £280m or £8.5m. If it is accepted that it is not possible for the HSCP to cut its SLA payments, mainly to GG&C, (£81m) or Primary Care related costs (£30m) a more reasonable interpretation of this target for the HSCP might be £5m. There are several other budgets which cannot be reduced easily including the PFI contract and the provision of small-scale services in remote communities. Additionally, current operating frameworks within the NHS are being maintained and these restrict the ability of Boards to change the way in which they operate in the short term. Significant service change needs to comply with the Planning with People Guidance and there are currently no mechanisms Page 53
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6 which would enable boards to reduce permanent staffing other than through natural turnover. Current budget planning for the HSCP NHS services: NHS Budget 2025/26 £m £m Opening Underlying Deficit 5.2 Baseline Uplift - NRAC improvement and Funding (13.8) Inflation & Cost Pressures Pay Inflation 3% 3.0 SLA Inflation 3% 3.1 Non-Pay elements Agenda for Change 2.8 Prescribing Inflation 8% 2.5 LIH Medical Staffing 1.8 Out of Area & Complex Care Packages - MH 1.0 Resource Transfer Uplift 0.4 National Services Increased Top Slice 0.7 Regional Heart & Lung SLA uplift 0.5 Glasgow - service increases 0.4 Safe Staffing Act 0.3 Fleet 0.2 Estates & PFI Charges 0.6 Others 0.5 Total Cost Pressures 17.8 2025/26 Recurring Deficit 9.2 To date the following costed savings proposals have been identified and governance is in place for monitoring these within the fortnightly leadership team meetings: Saving Opportunity Risk Rating/Potential for Saving £'000 £'000 £'000 Team Depreciation - end of life assets 70 Estates Energy price reduction 50 Estates Performance Analyst 0.5wte Band 5 22 Planning Public Health - Contract Cost Reduction - Addictions 47 Public Health Band 4 health intelligence support worker 0.5 wte 20 Public Health Living Well Grants 12 Public Health Living Well Network Funding 25 Public Health Effective prevention outcomes framework 12 Public Health Flow Navigation & Unscheduled Care Management - NHSH 277 Management Total 277 22 236 £535,000 There are number of other opportunities to deliver cash releasing savings in 2025/26 that are still to be costed. Specifically work on prescribing is expected to result in a saving, specific areas under consideration include: Page 54
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7 3.5 • Medicines of Low Clinical Value – SG Initiative • Prescribing Costs – Drugs switches etc • Medical staffing, locum and agency staffing • Contract reviews • Telecoms rationalisation A material risk to the NHS budget which could impact in 2025/26 is the outcome of the new SLA model being developed by Greater Glasgow and Clyde Health Board. While we have no firm information on the impact, it is clear GG&C are looking to pass on cost increases to other Boards to the extent that they have not be funded. It is acknowledged that the model has not been updated to reflect current activity patterns for some years and cost and activity patterns may not align with the contract value. Additionally, there are circa £1.1m of current savings which will be carried forward into 2025/26. The HSCP does not expect to be able to put in place a plan for deliverable savings which align with the target outlined above. It will continue to work to narrow its budget gap for 2025/26 and will progress the longer term projects summarised in the following sections. These, as with the Social Care priorities, are not necessarily expected to deliver significant savings in 2025/26. The position has been discussed with NHSH on this basis and they are aware of both the expected budget position and the plans that are being progressed to deliver longer term change. HSCP Summary Financial Planning Estimate 2025/26 NHS £m Social Care £m IJB Total £m Opening Underlying Gap 5.2 1.3 6.5 Additional Resourcing (13.8) (3.4) (17.2) Estimated Pay, Cost & Demand Pressures 17.8 7.9 25.7 2025/26 Gap 9.2 5.8 15.0 Mitigations Non-recurring Resources (3.0) (3.0) Quantified Savings Proposals (0.3) (1.5) (1.8) Remaining Gap / Additional Funding Requirement 8.9 1.3 10.2 Detailed work is on-going within both finance teams and will identify other opportunities for reducing the gap. This will include ensuring that the cost pressures are unavoidable and estimating slippage where they may not apply for the whole year. Prescribing, an analysis of reserves and modelling of the agenda for change costs are expected to improve the NHS position. It is not expected that deliverable savings can be identified to the extent required to enable the HSCP to propose a balanced budget in March. Both Page 55
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8 3.6 3.6.1 3.6.2 partners are aware and dialogue is on-going to ensure that the HSCP has a workable expenditure budget at the start of 2025/26. • The NI issue for Health and Social Care providers is a significant risk for 2025/26. • Reliance on non-recurring funding is a risk for 2026/27. The main issues to be addressed in the remainder of the planning and budgeting cycle for 2025/26 include: • Confirming approach to the expected budget shortfall with partners. • Finalising work on savings proposals and EQIAs to enable IJB approval in March. • Establishing plans to address the structural deficit. Savings 2025/26 The IJB will be asked to approve specific savings proposals in March. Failure to have the savings proposals endorsed will clearly have implications for both partners. The management team expect to present a list of non-contentious budget savings, some of which are included above. These will continue to develop as the detailed budget work between finance teams and budget holders progresses. They will be supported by equality impact assessments where appropriate (EQIAs). There will additional be proposals that will have material impacts upon the provision of health and social care services or upon local communities. These will also be supported by EQIAs where appropriate. Summaries are provided below of the ones under development: Care at Home Services - £0.9m Progress on this saving is being withheld at this stage due to commercial sensitivity. Inflation on Contracts £0.3m estimate Minimising the impact of inflation is a further mitigation. Analytical work is continuing to establish where there are opportunities to offer flat cash only and request providers and grant recipients to scale service to available resource where possible. This has to be considered alongside the high- grade strategic risk relating to the sustainability of commissioned service providers and recognise that many contracts and uplifts are negotiated nationally (national care home contract) or linked to external measures such as inflation or the living wage. Efforts to minimise this will apply to both Social Care and NHS services. Page 56
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9 6.6.3 3.7 The review of contracts may also identify opportunities to review the value for money associated with them. This will be considered in more detail by the Finance & Policy Committee in February. Fees and Charges £0.3m estimate Social Care Fees and Charges are typically increased in line with the rate of increase in cost. The proposed increased is therefore above current measures of inflation as staff (and other) cost increases exceed this level. Actual income generation depends upon numbers of self-funders in care homes and assessments of contributions towards care costs. Normal governance processes are being followed whereby Fees and Charges are formally approved by the Council. 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 in the short and longer term. Investment in change is challenging as resources that could have been targeted here are now being used to fund revenue cost pressures. There is also a continuing shortage of the capital resource required to enable estates and digital transformation as for example as resources that are available are used to address backlog maintenance. 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 A full review of maternity services is underway. It is intended that the process will pilot a model for reviewing all services within Children, Families and Justice. The process 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 scope of the directly delivered 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 review is anticipated to complete in February 2025, organisational change processes will follow, if the review recommends changes to service provision. The outcome will be reported through existing governance structures. If immediate savings derive from this work it will be reported in the March budget paper but delivery of savings is likely to fall into 2026 and beyond. Adult Services – Care @ Home Services The care at home service is a priority for transformation as it is not operating on a sustainable basis in some areas and different models are now operating. Some areas are largely or wholly covered by the new contract, Page 57
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10 3.7.3 others delivered by HSCP employed staff and others highly dependent upon agency staff as part of a mixed approach. Challenges include: • Continuing high demand and unmet need. • Increasing use 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 such as those offered by community nurses, AHP teams and demand for residential care. The budget sits at circa £20m. Specific consideration is being given to: • The linkages between telecare, care @ home services and contracts. • How the service can 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 package implementation. • A requirement for an improved scheduling system and digital systems • A value for money review of the different models currently operating and re-consideration of the best strategic approach. The draft expenditure budget has made some allowance for the impact of demographic change. Longer-term planning for the financial and staffing implications of the increasing number of older adults is not adequately resolved nationally or locally. In order to reduce cost, it will be necessary to change the way care needs are assessed and the level of care that can be provided within the available budget. A principled and values-based approach is being taken which will seek to deliver on the priorities (as 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 utilisation. A strategic development process is also underway in respect of HSCP operated care homes, this piece of work is complex and will take some 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 approximately half-way through, 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. The process will also focus on the training and development of systems and people at team leader and management levels. There are some opportunities for efficiencies, however this does not necessarily mean it will be easy to realise savings. It is intended that the project will report in February in a way that will enable savings to be attributed to it. These are not likely to be immediate cash releasing savings Page 58
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11 3.7.4 3.7.5 3.7.6 but could help identify opportunities to reduce supplementary staffing in some areas. Acute & Complex Care – Rural General Hospital A review of the services offered within LIH is in its early stages. It is intended that the HSCP will work with NHS Highland to look for opportunities to better co-ordinate activity in Oban and Fort William in particular. It is anticipated that there may be some options to reduce duplication across the sites and create more joined up and sustainable staffing structures. There are expensive out of hours arrangements in place and excess theatre capacity. An approach to making better use of theatre capacity would also feature in this transformation work with potential for income generation or reduction in activity within SLA contracts. Mid Argyll & Kintyre Service Model This project is intended to review all services delivered across the area to: • Address consistent and continuing staffing shortages. • 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 areas of unnecessary duplication. It is expected that this work will identify savings, some of these could be available during the course of 2025/26 but some should be considered as a longer-term change to sustain services although there may be specific services where shorter term change is required due to staffing challenges. No specific changes are being incorporated in the savings plans at present. Care Package Reviews A decision has been made to invest in the review of care packages. The programme is being scoped out but will include: • Care @ Home packages • LD/PD and Mental Health packages • Direct payments (Self Directed Support) The process will look to improve governance over care package decision making and the process will set specific targets for the number of packages to be revied starting with most expensive ones. Care packages at present have a total cost of around £30m with 55 packages costing over £100k or £8.5m of the total. The reviews will be designed to ensure that care provision appropriately meets the needs of the vulnerable people being supported. It is not possible to set a target financial saving at this stage. Page 59
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12 3.8 Next Steps The development of the budget will include progressing the projects described above as well as seeking to identify other opportunities for savings through, for example vacancy and expenditure control processes: • Chief Officer approval of all locum and agency contracts and extensions. • Further scrutiny of vacant posts. • Changes to PECOS approval processes to stop unnecessary spend. • Tightening of care package approval processes. The situation is challenging, particularly in the operational context facing the management team. On-going communication and consultation are critical as is engagement with partners as they will be required to provide support for the change required. In particular, support with the HR aspects of change is a gap within the management structure. It is accepted that some mechanisms that organisations normally apply to reducing costs are not available in the context of HSCPs as a result of policy commitments and approaches to HR management. Engagement with staff and the IJB and Finance and Policy Committee will continue throughout the process. The financial challenge should be viewed as continuing rather than annual one at this stage. January / February -Firm up savings plans and agree target savings -Develop engagement plans for staff and communities where appropriate. January 2025 Detailed discussions with both partners at exec level January 2025 Update F&P and IJB on progress, anticipated position and key savings proposals January – February 2025 Conduct engagement and detailed planning in respect of proposals March 2025 Approval of Expenditure budget and savings by IJB On-going Establishment and monitoring of service change plans to address structural deficit 4 4.1 5 5.1 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 Plan and the priorities therein. Page 60
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13 6 6.1 6.2 6.3 GOVERNANCE IMPLICATIONS Financial Impact – the budget gap is significant and plans to reduce spend are required. The HSCP will continue to work with both partners with a view to being able to propose a workable expenditure budget in March 2025. As things stand it is unlikely that this will be within the totality of the resources that would normally be available to the HSCP in 2025/26. 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 are fully engaged. They are playing a key role in the on-going work to deliver financial savings from a key social care contract. 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, 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 propose a balanced budget. This could result in interventions from partners or Government. • 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 due to increased risk. • Some of the planning assumptions turn out to be optimistic. • Scottish Government or partners do not pass on funding as assumed or make available resources. • Adverse impact upon workforce and lack of HR and support service 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. Page 61
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14 The HSCP is not currently in a sustainable financial position as spend and service demand exceed available funding, this is included in the Strategic Risk Register. 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 of this was reported to the IJB in March. 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 is not intending to re-run the exercise as there is both an opportunity cost and real cost of extending the license for the software (circa £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 12.3 This report provides an update on the likely financial position of the HSCP following publication of the draft Scottish Budget. The report outlines some key savings plans which will require formal approval. It also confirms that on-going work on budgets is expected to improve the position outlined this report which is that there is a remaining gap of £10m in total. The HSCP does not anticipate that it can close this gap fully and expects to be reliant on both partners for additional support in 2025/26. This is a structural and national problem facing Health and Social Care. The consequences the National Insurance increase will have upon commissioned service providers is highlighted as a key risk that has not yet been resolved. Dialogue with both partners in respect of the situation is required and the sector is seeking to ensure government are aware of the scale of the challenge facing the sector, as have Audit Scotland. It is not realistic to assume that the HSCP can deliver a balanced budget for 2025/26 based on current planning assumptions. The constraints on the pace of service change do not enable such a level of change in the timescale available. Page 62
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15 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 Recommendations 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 21/01/25 Noted Appendix 1 – Commercially Sensitive - Not in Public Domain AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk Page 63
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Document is Restricted Page 65 Agenda Item 8bNOT FOR PUBLICATION by virtue of paragraph(s) 6 of Schedule 7A of the Local Government(Scotland) Act 1973
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1 Integration Joint Board Date of Meeting: 29 January 2025 Title of Report: Strategic Risk Register Presented by: James Gow, Head of Finance The Audit & Risk Committee is asked to: • Note that the Strategic Risk Register has been reviewed by the Leadership Team and the Audit & Risk Committee. • Review and approve the Strategic Risk Register. • Note the Strategic Risk Register has been considered against the Strategic Objectives 1. EXECUTIVE SUMMARY 1.1 An important element of effective Risk Management is to regularly review the Strategic Risk Register (SRR). The Audit & Risk Committee undertake this on behalf of the IJB. This report recommends changes to the SRR to reflect perceived increasing risk. The changes reflect a perceived worsening of the operational context facing the HSCP and have been discussed and agreed by the leadership team. 1.2 The leadership team is recommending that the number of ‘very high’ graded risk is increased by one as there is a perception that risks associated with support services have increased to the extent that this should now be rated as a red risk, the rationale for this assessment is described in the report. This report also seeks to address an internal audit recommendation for improvement in the way in which the HSCP considers risk relating specifically to its strategic objectives. 1.3 Detailed discussion at the Audit & Risk Committee also highlighted the inter- relationships between many of the risks on the register. This, in part, is reflected in the general upward trend in the assessment of residual risk. 2. Recommendations 2.1 The Integration Joint Board is recommended to: • Review and Approve the Strategic Risk Register. Page 67 Agenda Item 9
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2 3. DETAIL OF REPORT 3.1 The Risk Register is used to identify risks, assess their perceived likelihood and impact and outline how they are being mitigated. It is a dynamic document and is reviewed by the IJB twice annually. The current version is attached as appendix 1. The Register describes 21 strategic risks facing the HSCP. The table below summarises the number and assessment of perceived residual risks: Residual Risks Very High High Medium Total May 2021 2 9 9 20 June 2022 4 14 6 24 June 2023 4 13 7 24 June 2024 5 15 1 21 December 2024 6 15 0 21 The total number of risks have been reduced with some consolidated post pandemic. The main change now suggested is that the risk in respect of support services is increased to ‘very high’. This relates to a series of challenges that the HSCP is facing at present: • HR Management - the management team no longer has a dedicated, integrated HR representative as part of its structure. Qualified HR support is often not available when decisions are being considered and made. Additionally, the absence of such a role places additional pressure on service managers and heads of service to manage HR issues independently. Effective HR management is key to change management and the situation impacts on transformation planning and delivery. The HSCP is continuing to work with both partners to seek a resolution. • Support Services – previous savings programmes, staffing shortages within teams and system changes are all placing additional pressure on support teams. This is now resulting in service risk across Social Work and Social Care support services, including child and adult protection and finance processes. 0 2 4 6 8 10 12 14 16 Residual Risk Trend Medium High Very High Page 68
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3 This issue has been discussed at length and it is the opinion of the management team that it should be escalated in the risk register. Addressing the risk is complex as the HSCP relies on partners for some support services it depends upon. However, there are aspects of managing this risk that sit with the management team and it is expected that some essential recruitment will be required urgently to address the risk, despite the lack of financial resource. The draft Scottish Budget was published in early December 2024, at the time of writing the implications of the budget are not well enough understood to enable any reduction in financial sustainability or other risks to be recommended at this stage. It is clear that there is additional funding being made available but much of this will be required to fund pay increases, the increase in the minimum wage and potentially National Insurance increases for employers. The Scottish Government have also signalled an end to current brokerage arrangements within the NHS, this is a concern in respect of the HSCP and NHS Highland’s financial position. 3.2 The risk register incorporates an indicator which illustrates the perceived direction of each risk, the six ‘Very High’ risks are: Financial Sustainability (SSR01) The underlying budget gap for 2025/26 is substantial and the most recent modelling outlines a series of risks relating to funding and costs as well as severe challenges facing public funding. It is recommended that this risk remains very high but will be kept under review. Sustainability of Commissioned Service Providers (SSR08) This risk remains very high as a number of service providers continue to struggle to recruit staff and deliver the services they are contracted to. Several are also requesting unaffordable uplifts in contract values. Work is on-going to provide additional support and change ways of working, particularly for care at home services. It is difficult to estimate the impacts the actions taken by the HSCP have had but it is likely that some services have been protected that would have otherwise been withdrawn, this has come at a financial cost. The increase in the employer national insurance rate is adding to this risk. There will be a 5% increase in the minimum pay rate for commissioned service staff to £12.60 per hour, this may be of some help in mitigation of this risk. Workforce Recruitment and Retention (SSR11) The HSCP continues to experience difficulty in recruiting staff to a variety of roles. Staffing is a constraint on service delivery in some areas. This risk is both a local and a national one, however the ageing and reducing population and the housing emergency provide an increasingly difficult local context. The Workforce group is meeting regularly and is in the process of implementing the Workforce Strategy. The HSCP is also seeking to improve accommodation options in the most challenging localities. However, the perception is that the problem is not improving and some agency and locum rates are increasing. Socio-Economic Situation & Increasing Poverty (SSR21) This risk continues to be considered as very high and has multiple strands. It is largely outwith the influence of the HSCP. It is expected that the cost of living Page 69
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4 crisis will continue to drive increased poverty and deprivation and service demand. The HSCP is also experiencing increased costs and reduced real terms value of resourcing. Recent public health publications and performance data support this evaluation of the risk. The growing impact of poverty, deprivation and exclusion is perceived to be being exacerbated by the impact the lockdowns have had upon some of the most vulnerable in society, particularly those with mental health issues and some children. Infrastructure and Assets (SSR07) Significant backlog maintenance requirements have been identified and it is clear there is insufficient funding available to address these although some additional capital has been announced in the Draft Scottish Budget. Additionally, there are excess requests for equipment replacement across the NHSH area and insufficient funding for digital infrastructure replacement and development. The HSCP cannot fund capital investment from its reserves, this risk to a large extent is therefore not in the control of the HSCP and is the responsibility of partners. The risk of building failure in the short term is perceived to be increasing but there is an improved understanding for the problem and a recognition that assets require investment. Communication with both partners is on-going and the HSCP is contributing to investment plans. Mitigations are in place and works are planned or progressing within some buildings. Support Services (SSR 16) It is recommended that this risk is increased to very high as described above. 3.4 Risk management within the HSCP relies heavily upon processes and procedures within the partner organisations, particularly in respect of cyber security, data protection, infrastructure replacement and financial processes and systems. Recent Cyber Security breaches within the NHS further highlight the growing and strategic nature of this risk. 3.5 Audit Recommendations The Risk Management Strategy has been reviewed and risk management training is now being implemented across the HSCP over a 4 week period. There is now additional focus on operational risk management and how this relates to the Strategic Risk Register. Relevant staff are engaging well with this process at present. These actions are addressing outstanding risk management audit recommendations. Additionally, the Internal Auditor made a risk management recommendation within the audit of the Joint Strategic Planning process: ‘Risks - The JSP outlines financial risks and challenges, with mitigation factors identified. However, the plan lacks clarification on how these risks might specifically impact the delivery of the JSP itself. Moreover, although the Health and Social Care Partnership (HSCP) maintains a Strategic Risk Register to address potential failures of the overall plan, Page 70
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5 there is no dedicated register for risks associated with individual JSP priorities and objectives.’ The HSCP agreed with the recommendation and agreed to consider how it addresses it. Upon further reflection, there is perhaps limited value in having a separate risk register in addition to the Strategic Risk Register (SRR). The SSR should capture all of the strategic risks facing the HSCP which would include risks that relate to the Strategic Objectives. Appendix 2 provides a summary of the Strategic Objectives in the current Joint Strategic Plan and outlines specific risks relating to each of these objectives. These key risks are then mapped to the SRR to provide assurance that the underlying risk factors are included where appropriate. Additionally, the SRR has a specific risk relating to the delivery of the Strategic Objectives. 3.6 Risk Appetite An IJB development workshop was held in October 2023 to develop the risk appetite for the HSCP. The main purpose is to ensure that the management understanding of risk appetite aligns with the IJB’s as summarised below: RISK APPETITE RATING Risk Grouping 0 1 1.5 2 2.5 3 3.5 4 Operational Risks Strategic Risk Legal / Regulatory Financial Development & Innovation Clinical & Care People & Workforce Reputational The risk appetite ratings quantitively indicate that there is a willingness within the IJB to accept higher levels of risk relating to strategic change, innovation and workforce. This reflects a recognition through the IJB and HSCP that there are significant drivers for change and transformation. It is also clear that the IJB has a lower appetite for clinical, legal / regulatory and financial risks. It is recognised that the Risk Appetite requires to be reviewed and refreshed in light of the changing context. 4. RELEVANT DATA AND INDICATORS 4.1 The identification and rating of risk is based on internal and external data and indicators as well as a wider environmental scan. 5 CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 Robust risk management is an important aspect of the overall strategic management of the HSCP. This report also seeks to ensure that risks relating to strategic objectives are adequately reflected in the SRR. Page 71
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6 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – This report outlines a need for the HSCP to change the way it operates in order to remain financially sustainable. 6.2 Staff Governance – the current lack of strategic and operational HR support within the needs identified has a potential impact on leadership and management time. 6.3 Clinical Governance – There would be potential impact in clinical/care delivery as a consequence of the management of the risks outlined in the SRR 7. Professional Advisory 7.1 Professional leads are embedded in operational and strategic risk management processes. 8. EQUALITY & DIVERSITY IMPLICATIONS 8.1 None arising directly from the contents of this report but it is considered that the implications of measures that may be required to achieve a sustainable financial position will have an impact upon people with protected characteristics. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 Note a systems risk with the changeover from Datix to Inphase which will be updated to committee in a separate paper 10. RISK ASSESSMENT 10.1 This report provides a detailed review of the strategic risks facing the HSCP. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 11.1 None arising directly from this report but again the implications of efforts to achieve a sustainable financial position may result in increasing risk in terms of the implementation of the HSCP’s engagement strategy. 12. CONCLUSIONS 12.1 Overall the risk environment facing the HSCP remains challenging and is perceived to be worsening. Finance and staffing issues continue to be perceived as the main challenges. The local assessment aligns well with the national picture with recent reports published by Audit Scotland providing independent evidence. The implications of the budget are yet to be fully understood, this will likely assist the financial position to some extent but is not expected to fully address the financial sustainability issues facing Health and Social Care. 12.2 This report also provides the IJB with an opportunity to review the Risk Appetite and the HSCP approach to ensuring its Risk Management processes align with the Strategic Plan and Strategic Objectives. Page 72
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7 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 Strategic Risk Register Review 04/12/24 Changes outlined in paper agreed Audit & Risk Committee Strategic Risk Register Review 17/12/24 Approved and agreed that Risk Appetite is to be reviewed during 2025. Inter-relationships between risks to be noted. REPORT AUTHOR AND CONTACT James Gow, Head of Finance : james.gow@argyll-bute.gov.uk Appendix 1: Strategic Risk Register Appendix 2: Risk Mapping – Strategic Objectives Page 73
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# Appendix 1 Argyll & Bute HSCP - Strategic Risk Register - December 2024 SSR Ref Description Of Risk Consequence Likelihood Impact Risk Rating /Score Mitigations/ Control Measures 2024/25 Likelihood Impact Risk Rating /Score Proposed New Control Measures Risk Owner(s) 1 Medium Term Financial Sustainability - risk of financial failure arising from costs and demand outstripping funding. This could be as a result of demand, cost pressures, inflation, failure to deliver savings or as a result of the level of delegated resource to the IJB from Scottish Government and / or partners being insufficient to deliver on strategic objectives. Inability to deliver on the Strategic Plan, reduction in performance, progress not being made in respect of national priorities and targets, reputational damage to IJB and partners and the requirement to implement service changes or reductions that don't line with strategy. Possibility of intervention in management of HSCP. 4- Likely 5 - Extreme VERY HIGH 20 o Financial information reported to Finance & Policy Cttee and IJB for current year and the 3 year budget outlook o Review of funding allocations and settlements from government and partners and engagement with sector networks oFinance & Policy Committee scrutiny of financial performance, risk management, savings programme and financial planning oDelivery of Savings, project management approach to monitor and record progress oFinancial governance, integrated financial reporting, financial risk register, operational and strategic reporting along with modelling of cost pressures. oIndependent external audit of accounting and financial planning and reporting process of partners and HSCP oEngagement with budget holders, SIO's and finance teams to improve financial forecasting. oUse of general reserves to protect services and enable longer term approach. 4- Likely 5- Extreme VERY HIGH 20 o Detailed plans for use of reserves and refresh of Transformation Programme, available resources now being allocated to cover overspending o Engagement with NRAC modelling team and allocations o External audit highlighting risk to IJB, NHSH and A&B Council o HSCP inclusion in NHSH enhanced expenditure control processes being implemented o Risk increasing due to potential impact of Employer NI increase and overspending in the current year. oOn going engagement with both partners as the budget process develops Chief Finance Officer / Chief Officer / SLT ↑ 2 Going Concern Status - Risk of financial failure within a 1 year time horizon due to overspending of service budgets, inflation and cost pressures or reductions in funding Inability to deliver on the Strategic Plan, reduction in performance, progress not being made in respect of national priorities and targets, reputational damage to IJB and partners and the requirement to implement service changes or reductions that don't align with the strategic objectives. Possibility of external intervention in management. 4- Likely 5 - Extreme VERY HIGH 20 Mitigations are as above. Budget for 2024/25 has a significant gap, however the HSCP has reserves in place which will able it to fund the anticipated budget gap arising during the year. 3 - Possible 5- Extreme HIGH 15 Level of reserves and non-recurring funding currently in place mitigate but these are reducing - a revised assessment is required depending upon the Scottish Government budget in December 2024, the position of both partners and progress with savings delivery. Chief Finance Officer / Chief Officer / SLT ↑ 3 Delivery of Strategic Objectives - Inability to design and deliver transformational change could lead to a failure to deliver on strategic outcomes and the Strategic Plan. The pace of change to re-design services doesn't keep up with the demographic pressures. Inability to engage with the workforce and communities on the need for change could lead to reputational damage and the increased fragility of health and social care services and poorer health outcomes for local people. 4- Likely 4- Major HIGH 16 ○Locality Planning Groups with agreed terms of reference and engagement strategy guidelines ○Delivery of the annual Savings Plan with EQIAs produced to highlight impacts ○Medium term budget planning integrated with strategic planning ○Performance reporting - management information and transparent reporting to IJB ○Communications and engagement strategies ○SLT reporting structure and links with partner organisations, including Chief Officer representation on partner senior management teams ○Engagement with staff representatives ○Clearly articulated impact on Quality and Performance in all service redesign plans 4- Likely 4 - Major HIGH 16 o New Strategic Plan and Commissioning Strategy consulted widely upon o Review of transformation programme structure and increased resourcing of key projects o Financial and staffing constraints putting ability of HSCP to deliver on strategic objectives at increasing risk o Service redcutions being considered which will impact on delivery of strategic objectives - consideration being given to increasing to 'very high' Chief Officer / SLT ↑ 4 Demographic Changes - failure to implement strategies and actions to address future demographic challenges of declining population, reduced working age population and an increase in older people. Failure to accurately forecast the impact on services including shifting the balance of care and implementing new models of care and / or ensuring there is sufficient capacity. This could lead to service failure to meet needs of service users and deliver against the Strategic Plan objectives. 5-Almost Certain 4 - Major VERY HIGH 20 ○Strategic Plan and role of Strategic Planning Group ○Incorporation of demographic forecasts into Strategic Planning and Locality Planning ○Locality Planning Groups to inform service re-designs in each locality in line with needs of the population OStrategic Workforce Planning Group established to share data and good practice and develop 3 year workforce plans ○Demand pressures for services incorporated into budget process ○National awareness of demographic changes been driver for change in the way services are delivered ○Ongoing engagement with Community Planning Partners and joint planning 4- Likely 4- Major HIGH 16 ○Resourcing and commencement of prevention agenda and co-production work ○Planning for future workforce demographic changes in Workforce Plan O Updated Adult Health Strategic Needs Assessment OReview of Transformation and change programme and re-commencement of transformation activities OUpdated population modelling and indication of increasing demand for Older Adult Services and review of care home provision Chief Officer / SLT ↑ 5 Governance and Leadership - IJB arrangements are not conducive to effective working and lead to poor decision making and lack of strategic direction and inability to have appropriate risk management, contingency and resilience processes in place to reposnd appropriately to emergencies and changing circumstances. Service and reputational damage, lack of confidence in the IJB and inability to deliver on strategic objectives in a consistent manner. 4- Likely 4 - Major HIGH 16 ○Appropriate representation on the IJB. ○Programme of development sessions for IJB members. ○Integration Scheme reviewed March 2021, Strategic Plan, Standing Orders and Code of Conduct. ○Effective sub-committee structure in place ○Internal Audit review of governance arrangements and recommendations implemented. ○External Audit review of governance and annual governance statement ORegular engagement with Standards Officer and regulatory bodies OFull engagement of Board in development of Strategic Plan and Commissioning Strategy 4- Likely 4- Major HIGH 16 O Development of continuous improvement to achieve an holistic approach to the overall Governance of the IJB and regular review of performance O Implementation of governance improvement actions and audit recommendations O Strategic Plan approved and in place O Resilience and contingency planning now incorporated within SLT rather than as a separate group and contingency plans in place O Current gaps in management structure a concern in respect of capacity to effect strategic development, change and transformation Chief Officer ↑ Gross Risk Residual Risk Page 75
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# 6 Partnership Working - service delivery failure due to inadequate relationships with partners including the Council and Health Board and commissioned service providers including NHS GG&C and the third sector. May lead to duplication of effort, poor relationships and the inability to effectively negotiate the IJB's position. The partnership may be viewed as failing or not achieving objectives, leading to reputational damage and loss of confidence in IJB. Could also result in a reduction or loss of services to the community and failure to exploit opportunities for joint working, innovation and efficiencies. 4 -Likely 4 - Major HIGH 16 ○Integration Scheme reviewed outlining roles and responsibilities ○Independent scrutiny arrangements in place and work of internal audit, including assurance mapping. ○Representation on IJB from partners, community representatives and third sector representatives. ○Clear channels of communication and information sharing protocols in place ○Directions are issued to partners in line with strategic direction and operational delivery of services. ○Strategic Planning work with Commissioned Service providers and new Commissioning Strategy ○Third Sector representation on the IJB & commitment to co- production 4- Likely 4- Major HIGH 16 OApproval of Commissioning Strategy following consultation with partners OResourcing and Commencement of Prevention and Co- Production work and activities and integration of these within Transformation programme ORe-establishment of regular meetings with GGCHB OImproved engagement mechanisms and establishment of prevention and co-production workstreams OImproved engagement with RSLs and the Housing Crisis agenda. ODiscussions with partners over funding becoming increasingly challenging and change management processes within HSCP and partners present a risk to working relationships, Employers NI increase presents an additional risk. Chief Officer ↑ 7 Infrastructure and Assets - Assets are owned by the Council and Health Board. Risk that these do not meet the current and future requirements due to underinvestment in maintenance, equipment and ICT or that assets are not being used or managed efficiently and effectively. Risk assets not being maintained / replaced or being otherwise appropriate to support the IJB's strategic outcomes and do not enable efficient, safe and effective service delivery. Properties will fail to meet standards required by regulators and fail to deliver on carbon reduction commitments. Equipment will become unreliable with additional downtime and ICT infrastructure will not support Digital Transformation ambitions or may add to cyber security risks. Increasing risk of failure which could result in facilities or equipment being unavailable. 5-Almost Certain 4 - Major VERY HIGH 20 O Progressing co-location options with Argyll & Bute Council O Represented on Council and NHS Highland Asset Management Boards O Partnership working to reflect joint planning approach with membership of both partner asset groups ○ Appointment of new senior management post to increase capacity O securing of additional external resource for investment in Tiree and in carbon reduction. o Establishment of Infrastructure Transformation Board 5-Almost Certain 4 - Major VERY HIGH 20 oHSCP Digital / IT strategy now complete to enable TEC / remote working oDevelopment of a strategic approach to the estate and the identification of priorities for investment and replacement of infrastructure assets. oNew Strategic Estates & Sustainability Post and Infrastructure Transformation Board. oBudget suggests NHS capital replacement projects will be halted, costs of projects increasing and insufficient funding to replace or maintain assets. Limited flexibility to spend reserves on asset replacement. oStrategic Assessment work underway to try and get replacement assets in capital pipeline at Scottish Government level - now halted. oFocus to shift to maintenance of existing assets and rationalisation and do minimum approach. Budget is not sufficient to address backlog maintenance or essential asset replacement. Risk increasing. Chief Officer, Head of Strategic Planning and Performance, Head of Finance ↑ Risk relates to both local operational and strategic impacts. 8 Sustainability of commissioned service providers - financial and operational sustainability of care at home and care home commissioned service providers deteriorates as a result of financial and workforce pressures. Market failure would lead to disruption of service, the implementation of contingency plans, increased costs and an adverse impact on individuals and their families. Would also impact on the ability of the IJB to deliver on the planned shift in the balance of care. 5 - Almost Certain 5 -Extreme VERY HIGH 25 ○Commissioning team supplier relationship and market management, including contract management and review processes and solvency checks as part of contract management ○Additional funding for providers to facilitate the implementation of wage increases and Fair Work Practices ○Engagement with national work supporting the National Contracting OContingency planning in localities for care at home. Care Home and Care at Home Assurance Group for Argyll and Bute to identify and manage local and short term risks. OStrategically the Care Home Programme Board will assist planning ahead with forecasting demand. ○Engagement with national workforce planning and local training providers around promotion of care professions. 5 - Almost Certain 4- Major VERY HIGH 20 ○ Continuing work with providers in partnership and quarterly provider forums for care homes and care at home O Ongoing engagement nationally with financial sustainability plans and flexible approach to local support where necessary O Implementation of Strategic Commissioning Plan based on Joint Strategic Needs Assessment O Ability to respond effectively to issues as they arise (eg KCC, Cowal Care @ Home) O Engagement with key providers and project planning to address issues as they arise. O Regular management escalation where issues arise O Effective use of additional winter planning funding to try and improve sustainability of providers O Positive internal audit review provides assurance risk is being managed appropriately. O contingency planning where there are specific issues O Work with Hub North to progress strategic assessment work. O Increased challenge in commissioning and processing of payments O Potential service reductions could increase this risk further especially if NI increase is not funded Chief Finance Officer / Chief Officer / SLT ↑ 9 Equalities - services are not delivered in a way that addresses inequality or takes into account the needs of those with protected characteristics. Service users are put at unnecessary risk of harm and people with poorer life chances may have their health and wellbeing impacted. Groups with protected characteristics may be perceived to be impacted unfairly. 4 - Likely 3- Moderate HIGH 12 ○Equalities Outcomes Framework in place ○Equalities impact considered as part of IJB decision making and service change. ○Communication with service users as part of implementation of service change using engagement and communication strategies. ○Adjustments to implementation plans are actioned where appropriate to mitigate any potential negative impact. ○Service changes not implemented where this would constitute unlawful discrimination. 4 - Likely 3 - Moderate HIGH 12 o EQIA process are improving but provider sustainability issues have a significant impact on those with protected characteristics Review of Equality outcomes in line with policy o requirement to make savings may result in increasing adverse impacts Chief Officer ↑ Page 76
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# 10 Scottish Government Policies - risk of further legislative, policy developments or change which impacts on the IJBs ability to deliver on the current Strategic Plan. Inability to deliver SG policies alongside the Strategic Plan and IJB's agreed objectives and the impact of additional unfunded cost pressures. 5 - Almost Certain 4 - Major VERY HIGH 20 ○Horizon scanning for policy developments through partners and SMT network groups ○Regular liaison with senior officers in the Scottish Government and through Cosla Groups ○Respond to Scottish Government information requests on impact of future policies ○Early impact assessment locally for national policies, including any impact in budget outlook ○Implement and adopt innovative ways of implementing policies ○Role of Elected Members and IJB members to influence Scottish Government decision making through political routes 4- Likely 4 - Major HIGH 16 o Engagement in sector developments and networks relating to the implementation of the National Care Service and Single Authority Model proposals oEngagement with government officials including visits to area and meetings to discuss local impacts of NCS oRespond to requests for evidence from parliamentary committees oPositive relationships with key partners, civil servants and politicians oWork on-going re implementation of Staffing Act oPerceived disconnect between policy landscape, available resources and sustainability, highlighted by Audit Scotland oNCS now on hold and SAM models under consideration Chief Officer, Heads of Service ↑ 11 Workforce Recruitment and Retention - inability to recruit and retain the required workforce because of local or national workforce shortages. This may result in increased costs, increased risk or reduced service. Applies to commissioned services as well as direct provision. Service users needs for particular disciplines or in particular areas may not be met if workforce is not in place. Some sites and services at risk of closure due to persistent staffing shortages. 5 - Almost Certain 5 - Extreme VERY HIGH 25 ○Joint and integrated Workforce Plan ○Strategic Workforce Planning Group to ensure overall visibility of recruitment, retention and development challenges across HSCP ○#abplace2b campaign framework for attracting people into area. OService re-designs to plan for changes to services in line with workforce capacity O Modern Apprentices to reduce average age of workforce O Support commissioned service providers with recruitment and retention, for example supporting implementation of Living Wage and pay rate increases. O Links with Open University assisting recruitment of students for social work and nursing O Programme for delivering SVQs for social care 5 - Almost Certain 4 - Major VERY HIGH 20 ○Strategic Workforce Planning group to implement Workforce Strategy ○Heads of Service and Managers engaged in workforce planning and sevice pressure group meeting regularly ○Promote ABC and NHSH as employers of choice and ensure all vacancies promoted using abplace2b.com. OWork to reduce reliance on locum and agency staff OEnsure on-going support for CPD OProgressing options to address housing shortages and progress key worker housing in partnership with Housing Associations, Shelter Scotland and Argyll & Bute Council SLT / Head of People, Planning and Reward / People Partner ↔ 12 Communications and Engagement with Communities - risk of inadequate arrangements in place to communicate with stakeholders, communities and partners. Could result in failure to gain community support for service changes and ineffective partnership working with communities. Reputational damage from failure to adequately consult and engage. Could result in failure to deliver planned change. 5 - Almost Certain 4- Major VERY HIGH 20 ○Communication and Engagement Strategies delivered but require to monitor practice through assurance frameworks. ○Openness and transparency of publicly available information ○Communications events and information widely available to engage stakeholders in conversations about service changes and the need for change. ○Engagement with politicians to ensure the Argyll and Bute position is shared and understood. ○Locality Planning Groups and other forums are used to communicate with communities and explore new ways of getting the IJB message across ○Communication plans developed as part of implementation of service changes 4- Likely 4- Major HIGH 16 ○Support local ownership of communications and engagement ○Roll out of social media use at a local level ○Review of Communications and Engagement Strategy and framework. O Deliver communication and engagement plans within guidelines. Ensure conforms to SG guidance "Planning with People" and standards for community engagement. OEffective engagement on strategic plan, commissioning strategy and co-production work. OSupport from Health Improvement Scotland and staff training and awareness raising OImproved budget consultation process launched in 2024 OLocality planning groups under review Associate Director Public Health, Communications team, Heads of Service ↑ 13 Workforce Shift - risk that there is not appropriate engagement with staff groups, particularly over the need for service changes and the requirement to work in a different way. There may be professional concerns about inter-disciplinary working and cultural barriers will prevent effective integration. Would result in poor morale and the failure to gain staff support for the workforce shift and culture change required. Resistance from the staff group would in turn limit the flexibility required to deploy the workforce in line with changed models of care, full integration will not be achieved and teams will be disjointed. Ultimately impacting on the service provided to communities. 4 - Likely 4 - Major HIGH 16 ○Joint Partnership Forum and Staff side Liaison facilitate communications and information flow between management to staff side and Trade Unions ○Communications plan for each service change project, including staff as stakeholders ○Support from staff side partnership to support staff with new ways of working with an integrated partnership approach. ○Compliance with terms and conditions of employment for both staff groups ○Individual staff development plans and training programmes ○Workforce Planning ○Staff surveys used to inform targeted improvement work with individual teams ○Strengthened communication and cascade of information from Chief Officer 4- Likely 4- Major HIGH 16 OClarity over role and function of teams working in our communities.OD support will be offered to Area Managers to support teams. OOngoing work of the culture and staff wellbeing workstreams OImplementation of the Workforce strategic plan OImprove management of redeployment Ostaff side involvement in SLT meetings and Transformation Board OPlanning for reductions in working week for NHS employed staff underway ORequirement for change likely to put upward pressure on this risk Chief Officer ↔ 14 Safety of Services - inability to maintain the safety of services due to demographic changes, increasing need and complexity and the ability to recruit staff for direct employment and for delivery partners May result in harm to service users or patients, the failure to provide appropriate care and reputational damage to the IJB and partners. 4-Likely 5 - Extreme VERY HIGH 20 ○Clinical and Care Governance Committee and professional leadership ○Risk Management Strategy recently updated and operational risk management arrangements ○Recruitment, retention and training of staff ○Triggers for service re-designs including ensuring clinical safety is not compromised ○Prioritisation of need frameworks in place to determine need for access to services ○Develop and implement contingency arrangements for localities and services, Improved clinical and care governance at service level 4-Likely 4- Major HIGH 16 O Increased focus on training and development of staff and improved flexibility O Increased engagement with commissioned service providers O New Contingency, Risk and Resilience group Oimproved Health & Safety Training and governance arrangements Onew focus on establishment setting and risk management to comply with Staffing Act requirements Professional Leads / Chief Social Work Officer ↑ Page 77
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# 15 Waiting Times -failure to meet waiting times targets and treatment times guarantees for treatment in specialities in NHS GG&C and outreach clinics in Argyll and Bute. Waiting times have increased due to Covid-19 response and disruption and pressures within the Health system continue. Poor level of service for patients, the potential to have to travel further for appointments, and is not in line with the anticipatory and preventative approach to care. 4-Likely 4 - Major HIGH 16 ○ Continued engagement with NHS GG&C to agree a strategic jointly planned approach to outreach services ○ Monitoring and reporting of waiting times ○ Development of new delivery models such as specialist nurses, tele-consultation and direct or follow up referral to primary care or AHP professionals O Plans for use of Waiting List and winter planning funding 4- Likely 4- Major HIGH 16 OInclusion in NHS Highland Remobilisation plan to request additional funding to redesign services and address backlog. Initiatives include increasing virtual clinics/services, digital and appointment modernisation, enhanced role of AHPs and waiting times initiatives additional clinics. OUse and expansion of Near Me and Outreach Clinics. OEvidence of continuing disruption to services and staffing shortages throughout local and national healthcare system continuing to make it challenging to address increased waiting times. This is a serious national issue at present. Pass through of funding required. Heads of Service ↔ 16 Support Services - risk that support services do not adequately support front line service delivery. Inability to integrate support services which are not fully delegated to the IJB. Continued reliance on two systems, processes and approaches may lead to confusion and ongoing inefficiency. Risk that partners will not support changes to current arrangements. Could adversely affect services experienced by patients and service users if support services cannot fully support front line services. Wasteful duplication and inefficient use of resource and impacts on partners if payments and assessments not processed efficiently. Also increased risk of legal challenge. 5 - Almost Certain 4- Major VERY HIGH 20 OCo-location of staff OSome IT systems integrated and further plans to review this and to facilitate access to joint systems ORollout of MS Teams - IT services and remote working are much improved as a result OCommittee support arrangements in place OContinuous improvement in support service provision 5 - Almost Certain 4- Major VERY HIGH 20 OReplacement programmes for new systems Social work (eclipse), Hospital Telecoms, and portal (link systems) funded and in place. ODevelopment of corporate services agreement with partners O Work to improve recruitment processes on-going O Implementation of staffing act presents an additional pressure on support services O Dedicated HR support at SLT removed, presents increased risk to management of change across HSCP Chief Officer, Heads of Service ↑ 17 New General Medical Services Contract - risk that the HSCP are not in a position to support the implementation of the new GP contract as a result of availability of funding and capacity for the HSCP to deliver services transferred from GPs. Higher risk of implementation across remote and rural areas. Could adversely affect services experienced by patients as gaps in service may arise. Potential for negative impact on relationships with Primary Care practitioners. 4-Likely 4 - Major HIGH 16 ○Ongoing collaboration between the HSCP and Primary Care to support practices ○Primary Care Modernisation Board with priorities established and Programme Manager in place ○Regular updates on progress to Transformation Board and the IJB, constructive progress being made pharmacotherapy, physiotherapy and mental health workstreams 3-Possible 4- Major HIGH 12 ○Head of Primary Care in place to add management capacity. OFunding for Primary Care improvement reduced substantially by Scottish Government and acknowledged that the contract cannot be delivered in full within existing resourcing. Associate Medical Director / Head of Primary Care ↔ 18 Culture - risk that perception of negative culture results in increased difficulties in recruiting and retraining staff, staff wellbeing and wider reputation of the HSCP. Adverse impact on reputation and ability to recruit. Also impacts on service delivery if teams are unhappy or short staffed as a consequence 4-Likely 5 - Extreme VERY HIGH 20 o Wellbeing groups and workforce strategy group in place o Whistleblowing process in operation o extensive roll out of courageous conversations training 4- Likely 3 - Moderate HIGH 12 oSome indications of improving culture from staff surveys oContinuing high levels of pressure on staff across many working environments Chief Officer, Heads of Service ↑ 19 Statutory/Mandatory Training - risk that patient / service user harm could result directly from, or be attributed to, a failure to comply with statutory and mandatory training requirements. This could result in harm to an individual or group of service users, members of staff and could result in financial claims and reputational damage. Adverse effect on quality and safety of care and service delivery. -Potential to result in Adverse Events with harm to service users and staff which could result in civil claims being made with a risk of high financial cost. -Potential for enforcement action being taken against the HSCP by the HSE with severe financial and reputational consequence 5-Almost certain 5- Extreme VERY HIGH 25 - Stat/Man training policy in place. -Training programmes in place via on-line training and face to face -Induction programme 3-Possible 5- Extreme HIGH 15 • Head of Service/senior managers to compile service improvement plans with local delivery based on individual service position. Plans in place for online training and for face to face training. • Heads of Service to ensure there is a regular forum for reviewing the plan, ensuring implementation and escalating barriers. • All staff to receive a communication from the Chief Officer on responsibilities for undertaking mandatory training. • Managers to ensure that they are up to date with their own training. • Managers to monitor compliance, support staff to access computers and have time to bring their mandatory training up to date. • Managers to support staff who are falling behind with their compliance with mandatory training and follow up until the training has been completed. • The Health & Safety Committee and Strategic Leadership Team to review, compliance is improving. Chief Officer ↔ 20 Climate Change - risk that the HSCP will not achieve the climate change decarbonisation and emissions targets set for it. This is likely to result in reputational damage at both a community and political level as well as a financial cost. -Perception that the HSCP is not fully committed to delivering on the Scottish Government Climate Change targets as a result of lack of capital and revenue funding or management capacity to prioritise this work. 4-Likely 3- Moderate HIGH 12 oOn-going engagement and participation with A&B council, NHS Highland and Scottish Government partners in respect of all health and care areas producing CO2 emissions including procurement decisions, estate, travel and transport. Services provided by the HSCP. - Access to funding revenue and capital to undertake CO2 reduction projects e.g. zero emission NHS fleet by 2025 4-Likely 3- Moderate HIGH 12 oSecured funding for carbon reduction consultancy but no capital available in 2024/25 and targets being pushed back nationally. oDevelopment of capital and revenue investment plans in HSCP, Argyll and Bute Council and NHS Highland . oLocal projects underway, climate change report submitted and potential for case study oNew Estates and Sustainability manager now in post and some HSCP funds available for investment but SG reducing capital resource. oShort term direct impacts limited Head of Finance & Senior Manager - Estates & Sustainability ↑ 21 Socio-Economic Situation & Increasing Poverty and Deprivation - multiple risks relating to the current socio economic situation. Risk is driven by direct and indirect implications of high inflation, expected increase in poverty, increasing interest rates and tightening public funding position. Linked to impact of lockdowns on mental and physical health. Risk that the health and wellbeing will deteriorate and the HSCP will be unable to respond appropriately to increased service demand. Consequences may include: -increased staff and non-staff costs reducing real terms values of budget and reserves. -potential for strike action within HSCP, partners and in other services and industries. -additional service demand arising from cost of living crisis, increased poverty levels, increased pressure on mental health services may be a particular pressure. -shortages of supplies and services which could include supplies of drugs and other critical supplies and care provision. 4-Likely 5 - Extreme VERY HIGH 20 o recognition that this is a national socio-economic issues and local mitigations and influence is limited o resilience and contingency planning o remobilisation of services o involvement in sector discussions in respect of strike exemptions o may need to consider prioritisation of services and resources 4-Likely 5 - Extreme VERY HIGH 20 o HSCP planning sensitive to issues facing local communities o awareness of pressures and careful financial and service planning to mitigate impact particularly on most vulnerable o initial evidence of increase in cases requiring expensive residential care packages which could result in severe cost pressures. ocontinuing to work with key partners and community planning to help mitigate the impact. o largely outwith the control of the HSCP 0removal of fuel allowance, service reductions and sustainability of 3rd sector increasing this risk to communities further. Chief Officer & SLT ↑ Page 78
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# Risk Matrix Risk Rare (1) Unlikely (2) Possible (3) Likely (4) Almost Certain (5) Extreme (5) MEDIUM 5 HIGH 10 HIGH 15 VERY HIGH 20 VERY HIGH 25 Major (4) MEDIUM 4 MEDIUM 8 HIGH 12 HIGH 16 VERY HIGH 20 Moderate (3) LOW 3 MEDIUM 6 MEDIUM 9 HIGH 12 HIGH 15 Minor (2) LOW 2 LOW 4 MEDIUM 6 MEDIUM 8 HIGH 10 Insignificant (1) LOW 1 LOW 2 LOW 3 MEDIUM 4 MEDIUM 5 Table 1 Assessment of likelihood Score Description 1 Rare 2 Unlikely 3 Possible 4 Likely 5 Almost Certain Table 2 Assessment of Impact Descriptor Insignificant Minor Moderate Major Extreme Score 1 2 3 4 5 Patient Experience Reduced quality of patient experience / clinical outcome not directly related to delivery of clinical care. Unsatisfactory patient experience / clinical outcome directly related to care provision – readily resolvable. Unsatisfactory patient experience / clinical outcome, short term effects – expect recovery <1wk. Unsatisfactory patient experience / clinical outcome: long term effects – expect recovery - >1wk. Unsatisfactory patient experience / clinical outcome: continued ongoing long term effects. Injury (physical and psychological) to patient / visitor / staff. Adverse event leading to minor injury not requiring first aid Minor injury or illness, first aid treatment required Agency reportable, e.g. Police (violent and aggressive acts) Significant injury requiring medical treatment and/or counselling. Major injuries/long term incapacity or disability (loss of limb) requiring medical treatment and/or counselling. Incident leading to death or major permanent incapacity. Complaints/ Claims Locally resolved verbal complaint Justified written complaint peripheral to clinical care. Below excess claim. Justified complaint involving lack of appropriate care. Claim above excess level. Multiple justified complaints. Multiple claims or single major claim. Complex justified complaint. Staffing and Competence Short term low staffing level temporarily reduces service quality (< than 1 day). Short term low staffing level (> 1 day), where there is no disruption to patient care. Ongoing low staffing level reduces service quality. Minor error due to ineffective training/ implementation of training. Late delivery of key objective / service due to lack of staff. Moderate error due to ineffective training/implementati on of training. Ongoing problems with staffing levels. Uncertain delivery of key objective / service due to lack of staff. Major error due to ineffective training/implementati on of training. Non-delivery of key objective / service due to lack of staff. Loss of key staff. Critical error due to ineffective training/implementati on of training. Financial (including damage/ loss/ fraud) Negligible organisational/ personal financial loss (< £1k) (NB. Please adjust for context) Minor organisational/per sonal financial loss (£1-10k). Significant organisational /personal financial loss (£10-100k). Major organisational/ personal financial loss (£100k - £1m). Severe organisational/ personal financial loss (>£1m). Adverse Publicity / Reputation Rumours, no media coverage. Little effect on staff morale Local media coverage – short term. Some public embarrassment. Minor effect on staff morale / public attitudes. Local media – long- term adverse publicity. Significant effect on staff morale and public perception of the organisation National media / adverse publicity, less than 3 days. Public confidence in the organisation undermined. Use of services affected National / International media / adverse publicity, more than 3 days. MSP / MP concern (Questions in Parliament). Court Enforcement. Public Enquiry/ FAI. Strong possibility that this could happen again This is expected to frequently happen again – more likely to re-occur than not LIKELIHOOD IMPACT Chance of Occurrence Can’t believe this event would happen again – will only happen in exceptional circumstances Not expected to happen again, but definite potential exists Has happened before on occasions – reasonable chance of re-occurring Page 79
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Appendix 2 Argyll & Bute HSCP - Strategic Objectives & Risk Management Strategic Objective Key Risks to Objective Strategic Risk Register Reference Reduce the number of avoidable hospital emergency admissions & minimise the time that people are delayed in hospital Insufficient staffing within care at home services 11 and 13 Insufficient capacity within residential care services 7 Demographic change increasing demand 4 and 21 Lack of resourcing and staff for preventative services including AHP 1, 11 and 13 Delays to progressing required adaptations work by RSLs due to financial constraints 6 and 1 Lack of staffing to conduct necessary assessments, set up and commission care packages 11 and 13 Support people to live fulfilling lives in their own homes for as long as possible The risks relating to this objective include all of the above As above Reducing capacity of the 3rd sector to provide support and social / cultural opportunities for vulnerable people 8 and 6 Increasing poverty 21 Institute a continuous quality improvement management process across the functions delegated to the partnership Lack of staffing resources 11 and 13 Lack of capacity to transform and improve services 1, 5 and 16 Focus on financial sustainability increasingly removing space for development of improvement ideas 1 and 5 Staff do not have access to appropriate training and development opportunities or do not participate 18 and 19 Keep the Promise Increasing demand from most vulnerable children due to impact of lockdowns and wider social change 21 Lack of financial resource, resulting in increasing policy costs becoming unaffordable 1 and 10 Lack of staffing 11 and 13 Support unpaid carers to reduce the impact of their caring role on their own health and well being Lack of financial support for carers services 1 Lack of sustainability within 3rd sector 6 and 8 increasing numbers of carers becoming incapable of providing support 4 lack of capacity to provide respite services due to lack of sustainable options 6,7 and 8 Promote Health and Wellbeing across our communities and age groups Staffing and resourcing of public health and engagement function 1,4,10 and 12 Support staff to continuously improve the information, support and care they deliver Vacancies and lack of staffing resulting in limited capacity for training and development of services 11,13,18,19 Lack of capital finance to support digital and systems improvement 1 and 7 Efficiently and Effectively mange all resources to deliver best value Financial sustainability challenge increasing at a faster rate than ability to improve 1,5 and 13 Policy and legal imperatives constraining ability to operate within resourcing 10 and 1 Page 81
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Integration Joint Board Agenda Item: Date of Meeting: 29 January 2025 Title: 2025/26 Social Work Fees and Charges Presented by: Angela Tillery 1. EXECUTIVE SUMMARY 1.1 This report provides details of the proposed annual Social Work Fees and Charges uplifts for 2025/26. In accordance with normal practice, a standard uplift percentage has been applied to all of the department’s fees and charges with several exceptions which are explained in the detail of the report. A standard rate of 6% has been applied for 2025/26 to reflect the mid-range assumption in the Council’s latest budget outlook for 2025/26. 1.3 Members are reminded that decisions on changes to the partnership’s Non-Residential Care Charging Scheme are reserved to Argyll and Bute Council (the Council) and that members of the IJB are asked to review and, if so minded, endorse the proposed changes to the scheme ahead of a formal submission to the Council’s 2025/26 budget meeting to seek ratification for their implementation from April 2025. 2. INTRODUCTION 2.1 This report sets out the schedule of proposed fees and charges for Social Work services for the 2025/26 financial year. The detailed list of proposed charges, including the 2024/25 rates for comparison, is attached as appendix 1 to the report. The board is asked to: ▪ Review and endorse the appended 2025/26 Social Work Fees and Charges proposals so that the proposals can be submitted to Argyll and Bute Council for ratification at its 2025/26 budget meeting. ▪ Note the increase in the means tested community based service charges from £125 per week to £145 per week. Page 83 Agenda Item 10
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3. DETAIL 3.1 Appendix 1 to this report provides the list of uprated fees and charges for 2025/26 after the application of a 6% annual inflationary uplift – there may be some minor variations due to rounding in the smaller charges. 3.2 The proposed charges for the following service areas are not calculated by applying a standard 6% uplift: 3.2.1 Local Authority Residential Care Provision (Older People) Charges for the provision of residential care are based on the budgeted cost of the service for 2025/26 which takes account of a number of inflationary assumptions across the range of costs incurred by the homes. The overall uplift for 2025/26 is 9%. The proposed rate will be charged to other health and social care partnerships and local authorities with clients placed in the HSCP’s care homes and to local people residing in the homes who own capital and assets exceeding £35,000 (threshold as at 2024/25). As at December 2024, there were 18 self-funding clients out of 85 residents in the HSCP’s care homes (equivalent to 21% of the current residents). The majority of residents, 79% of the current residents, pay substantially less based on their ability to pay as assessed under the National Assistance (Assessment of Resources) Regulations issued by the Scottish Government. 3.2.2 Local Authority Nursing Care Provision (Older People) The charge for the provision of nursing care at Kintyre Care Centre has been set at the same rate as the residential rate across the authority, an increase of 9%. The additional cost of nursing provision is offset by its significant economies of scale, it being a 40-bed unit compared to residential units ranging from 9 to 22 beds. In the unlikely event of residential care being provided at Kintyre Care Centre, a residential rate has been set at 86.3% of the Nursing rate based on the same prorate seen in the National Care Home Contract rates. 3.2.3 Sleepovers The sleepover charge is based on £12.60 per hour minimum pay rate for staff working in adult social care as confirmed by the Scottish Government in their Budget Announcement in December 2024. The overall increase in the sleepover rate is 7%. 3.2.4 Domestic Home Care, Housing Support and Employment Support Provision The hourly charges for domestic home care, housing support and employment support are all affected by the same changes to pay rates described in 3.2.3 above for sleepovers and are also impacted by inflation Page 84
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on non-pay costs in line with the Consumer Price Index. The overall increase in these charges is 6%. 3.2.5 Children and Families Local Authority Residential Care Provision 4. 4.1 As above at 3.2.1, the proposed charges for Dunclutha, Shellach View and East King Street reflect the budgeted cost for 2025/26 and are affected by the same payroll and inflationary cost pressures explained previously. The charges for the three units would only be payable by other councils placing clients in the HSCP’s children’s houses. None of the children or their families would be charged for the service provided at the three houses. Community Based Care Charging Scheme Community based care services such as homecare, housing support and sleepover services are charged on a means test basis whereby all clients will undergo a financial assessment and will be charged according to their ability to pay. Service users will not be charged more than £145 per week for their care and support which is an increase of £20 per week to reflect the increases in Scottish Living Wage in 2024/25 and 2025/26. 5. RECOMMENDATION 5.1 It is recommended that the proposed rates increases and amendment to the Non-Residential Care Charging Policy are endorsed by the IJB and the proposals submitted to the Council for ratification at its 2025/26 budget meeting ahead of implementation of the new rates and policy from April 2025. 6. CONTRIBUTION TO STRATEGIC PRIORITIES 6.1 The HSCP faces a combination of increasing demand and service costs which is outstripping the funding available to sustain service delivery in its current form. The annual adjustment to fees and charges ensures that charges remain relevant to service costs which enables the IJB to maintain income at levels proportionate to service costs in order to sustain services and avoid potential service reductions. 7. GOVERNANCE IMPLICATIONS 7.1 Financial Impact The annual adjustment to fees and charges ensures that charges remain relevant to service costs which enables the IJB to maintain proportionate income levels in order to sustain services and avoid potential service reductions. Page 85
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7.2 Staff Governance Updated fees and charges lists will be provided to staff and built into revised 2025/26 versions of the Social Work service’s charge calculation templates once the rates have been ratified by the Council. 7.3 Clinical Governance Not applicable. 8. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 The proposed changes apply equally to everyone who receives a service which the partnership will continue to charge for. Subsequently, there are no anticipated adverse equality or diversity issues arising from this report. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 Not applicable. 10. RISK ASSESSMENT 10.1 The key risk arising from the above proposal relates to service users who are unable to afford to pay increased charges. To ensure that charges are levied fairly and that service users are not placed into financial hardship, the Council’s Non-Residential Care Charging Policy is reviewed annually in line with changes to state benefits rates and other related guidance issued by the Scottish Government and COSLA – a single change to the Non-Dependent Rent Allowance is proposed for 2024/25. In addition, staff are able to signpost service users to local advice services and the Council’s Welfare Rights Team to ensure that their benefit entitlements have been maximised and for help and advice with managing their money. Finally, a waivers and abatement procedure is in place which provides service managers with discretion to adjust charges where necessary. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 Not applicable. 11. CONCLUSIONS 12.1 This report sets out the proposed annual increases to the Social Work fees and charges rates, which reflect the increased cost of delivering social care services in Argyll and Bute, and an amendment to the Non- Residential Care Charging Policy to ensure that the Policy is fair and correct. Members are asked to endorse the proposals for submission to the Council for ratification at the Council’s 2025/26 budget meeting. Page 86
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13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: Tick No directions required Argyll and Bute Council ✓ NHS Highland Health Board Argyll and Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name: Angela Tillery Email: angela.tillery@argyll-bute.gov.uk Page 87
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APPENDIX 1 – 2025/25 SCHEDULE OF PROPOSED FEES AND CHARGES FOR SOCIAL WORK SERVICES Description Other Net £ VAT Rate VAT £ Gross £ Net £ VAT Rate VAT £ Gross £ £ % Notes/Comments SOCIAL WORK Local Authority Residential Care Provision (Community Care) Weekly Charge (excluding Kintyre Care Centre) 1,705.50 Outwith the Scope 0.00 1,705.50 1,853.38 Outwith the Scope 0.00 1,853.38 147.88 9% Local Authority Residential Care Provision at Kintyre Care Centre (Community Care) Weekly Charge 1,463.87 Outwith the Scope 0.00 1,463.87 1,598.61 Outwith the Scope 0.00 1,598.61 134.74 9% Local Authority Nursing Care Provision (Community Care) Weekly Charge 1,705.50 Outwith the Scope 0.00 1,705.50 1,853.38 Outwith the Scope 0.00 1,853.38 147.88 9% Non - Residential Services - Lunch Clubs - per meal 5.40 Outwith the Scope 0.00 5.40 5.70 Outwith the Scope 0.00 5.70 0.30 6% Non - Residential Services - Telecare - Community Alarms - per week 6.45 Outwith the Scope 0.00 6.45 6.85 Outwith the Scope 0.00 6.85 0.40 6% Non - Residential Services - Telecare - Care Assist System - per week 5.50 Outwith the Scope 0.00 5.50 5.85 Outwith the Scope 0.00 5.85 0.35 6% Non - Residential Services - Telecare - Mobile Devices and Monitoring - per week 3.05 Outwith the Scope 0.00 3.05 3.24 Outwith the Scope 0.00 3.24 0.19 6% Non - Residential Services - Telecare - Canary System - per week 2.40 Outwith the Scope 0.00 2.40 2.55 Outwith the Scope 0.00 2.55 0.15 6% Non - Residential Services - Home Help - hourly rate 25.62 Outwith the Scope 0.00 25.62 27.16 Outwith the Scope 0.00 27.16 1.54 6% Adjusted to reflect estimated changes in staff pay from April 2025. Non - Residential Services - Housing Support - hourly rate 25.62 Outwith the Scope 0.00 25.62 27.16 Outwith the Scope 0.00 27.16 1.54 6% Adjusted to reflect estimated changes in staff pay from April 2025. Non - Residential Services - Employment Support - hourly rate 25.62 Outwith the Scope 0.00 25.62 27.16 Outwith the Scope 0.00 27.16 1.54 6% Adjusted to reflect estimated changes in staff pay from April 2025. Non - Residential Services -Sleepover Service - per night 133.92 Outwith the Scope 0.00 133.92 143.64 Outwith the Scope 0.00 143.64 9.72 7% Adjusted to reflect estimated changes in staff pay from April 2025. Non - Residential Services -Transport - per day 3.40 Outwith the Scope 0.00 3.40 3.60 Outwith the Scope 0.00 3.60 0.20 6% Adjusted to be divisible by 2 to enable one- way charging Non - Residential Services -Elderly Day Care - hourly rate 10.80 Outwith the Scope 0.00 10.80 11.45 Outwith the Scope 0.00 11.45 0.65 6% Adjusted to be divisible by 4 to reflect quarter hour visits Non - Residential Services -Learning Disability Resource Centre Service - hourly rate 28.60 Outwith the Scope 0.00 28.60 30.30 Outwith the Scope 0.00 30.30 1.70 6% Adjusted to be divisible by 4 to reflect quarter hour visits Provision of Occupational Therapy Consultation - Per assessment/consultation 300.30 Outwith the Scope 0.00 300.30 318.30 Outwith the Scope 0.00 318.30 18.00 6% Provision of Professional Services - Per Community Care Assessment/ Consultation 752.60 Outwith the Scope 0.00 752.60 797.75 Outwith the Scope 0.00 797.75 45.15 6% Provision of Professional Services - Full needs assessment only 571.45 Outwith the Scope 0.00 571.45 605.75 Outwith the Scope 0.00 605.75 34.30 6% Provision of Professional Services - Needs Review only 208.95 Outwith the Scope 0.00 208.95 221.50 Outwith the Scope 0.00 221.50 12.55 6% Children & Families - Local Authority Residential Care Provision: Dunclutha (weekly charge) 2,399.48 Outwith the Scope 0.00 2,399.48 3,416.76 Outwith the Scope 0.00 3,416.76 1,017.28 42% Charge levied to other HSCPs/Councils buying places from Argyll and Bute. Children & Families - Local Authority Residential Care Provision: Shellach View (weekly Charge) 2,318.91 Outwith the Scope 0.00 2,318.91 3,317.76 Outwith the Scope 0.00 3,317.76 998.85 43% Charge levied to other HSCPs/Councils buying places from Argyll and Bute. Children & Families - Local Authority Residential Care Provision: Helensburgh (weekly Charge) 2,273.57 Outwith the Scope 0.00 2,273.57 3,287.90 Outwith the Scope 0.00 3,287.90 1,014.33 45% Charge levied to other HSCPs/Councils buying places from Argyll and Bute. Children & Families - Other Charges - Inter Country Adoptions 7,889.25 Outwith the Scope 0.00 7,889.25 8,362.60 Outwith the Scope 0.00 8,362.60 473.35 6% 2024-25 2025-26 Increase Page 88
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Description Other Net £ VAT Rate VAT £ Gross £ Net £ VAT Rate VAT £ Gross £ £ % Notes/Comments SOCIAL WORK Inter-Authority Substitute Family Care Placements: Within Scotland In line with British Association of Adoption and Fostering (BAAF) recommended figures Outwith the Scope Outwith the Scope In line with British Association of Adoption and Fostering (BAAF) recommended figures. Inter-Authority Substitute Family Care Placements: Elsewhere - 1 child In line with British Association of Adoption and Fostering (BAAF) recommended figures Outwith the Scope Outwith the Scope In line with British Association of Adoption and Fostering (BAAF) recommended figures. Inter-Authority Substitute Family Care Placements: Elsewhere - 2 children (siblings placed together) In line with British Association of Adoption and Fostering (BAAF) recommended figures Outwith the Scope Outwith the Scope In line with British Association of Adoption and Fostering (BAAF) recommended figures. Inter-Authority Substitute Family Care Placements: Elsewhere - 3 children (siblings placed together) In line with British Association of Adoption and Fostering (BAAF) recommended figures Outwith the Scope Outwith the Scope In line with British Association of Adoption and Fostering (BAAF) recommended figures. 2024-25 2025-26 Increase Page 89
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Revision Date: 06/01/2025 APPENDIX 2 – PROPOSED 2025/26 NON-RESIDENTIAL CARE CHARGING POLICY Argyll and Bute Health & Social Care Partnership Social Work – Adult Care Community Based Care Charging Scheme Page 90
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1 Contents Section Page Introduction 2 Charging Structure 3 Charging Process 8 Personal Care 9 Domestic Care 10 Housing Support 11 Means Test Mechanism 13 Income 15 Capital 24 Applicable Housing Costs 33 Applicable Disregard 33 Income Thresholds 34 Residual Income and Taper 34 Final Charge 35 Lunch Clubs 35 Transport 35 Telecare 36 Page 91
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2 Introduction The following charging scheme applies to all adults who reside within Argyll and Bute, or are deemed to be ordinarily resident within Argyll and Bute in accordance with the Scottish Government’s Ordinary Residence guidelines, who are assessed as requiring and subsequently benefit from community based care services provided, commissioned or funded by Argyll and Bute Council on behalf of the Argyll and Bute Health Social Care Partnership. Community based care services are deemed to comprise one or a combination of the services listed below: • Homecare; • Housing Support; • Supported Living; • Sleepover Services; • Employment Support; • Daycare (including travel to and from day care units and meals and refreshments); • Respite, at home or in a care home; • Lunch clubs; • Community Alarm and Telecare services; • Occupational Therapy equipment and adaptations, and; • Progressive Care. The following charging scheme will apply equally to all service users regardless of the delivery mechanism(s) deployed to most appropriately and effectively meet the needs and aspirations of individuals, which include: • Direct service delivery by Council staff; • Indirect service delivery through services commissioned from the private and voluntary sectors by the Council on the service user’s behalf, and; • Direct payments to service users to enable them to arrange their own care through the employment of their own assistants or by purchasing care from the private and voluntary sectors. This scheme is founded upon the following list of principles; that: • Personal Care services will be provided free of charge to all adults who have been assessed as needing it and who meet the local eligibility criteria to receive services; • All clients in receipt of community based care services will undergo a financial assessment and will be charged according to their ability to pay; • Service users will not be charged more than it costs to provide the services(s) for which their contribution has been assessed; • Service users will not be charged more than £145 per week for their care and support services, which includes all of the above community based care services except for Lunch Clubs, Community Alarm and Telecare services and Transport to Care services. Page 92
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3 • Services will, at all times, be provided in accordance with service users’ assessed needs and not their ability to pay; • No charges will be levied where: o The primary reason for service provision is to monitor children under “supervision” or children and families in crisis; o Services are provided to adults with mental health problems who are subject to measures under the Mental Health (Care and Treatment) (Scotland) Act 2003; o Services fall within the scope of Criminal Justice Social Work Services; o Services are provided to adults subject to measures under the Adult Support and Protection (Scotland) Act 2007, or; o Services are provided to support a carer, either directly to the carer or as replacement care to enable a carer to take a break from their caring role, where the carer’s assessed needs meet the local eligibility criteria to receive services under the Carers (Scotland) Act 2016. Charging Structure Charges for community based services will be levied in accordance with the structure defined in the table below: Service Charging Method Home Care Means tested weekly charge based on an approved hourly charge – see below for domestic only homecare services Housing Support Means tested weekly charge based on an approved hourly charge Supported Living Means tested weekly charge based on an approved hourly charge Sleepover Services Means tested weekly charge based on an approved nightly charge Employment Support Means tested weekly charge based on an approved hourly charge Day Care Means tested weekly charge based on an approved hourly charge for care services and flat rate charges for meals and refreshments provided Lunch Clubs Flat rate charge for each meal provided Community Alarm and Telecare Services Flat rate weekly charge Transport to Care Flat rate weekly charge Page 93
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4 All charges will be reviewed annually as part of the Council’s budget setting process and will be subject to approval by the Council Members. The means test mechanism used by the Council to determine service users’ charges will be reviewed annually to ensure that it reflects any changes in: • Government legislation or regulation relevant to charging for the services for which charges are assessed under the means test; • The guidance issued by COSLA upon which the means test mechanism is based, and; • The allowances and premiums calculated by the Department for Work and Pensions which underpin the affordability test within the means test mechanism. Where a service user receives more than one service which is assessed for charging using the means test mechanism, a consolidated assessment will be undertaken to ensure that service users are not charged more than they can afford for the package of care services which they receive. Older People Leaving Hospital Adults leaving hospital who are assessed as requiring support should receive this service free, for up to 42 days, if they have been in NHS inpatient care for more than one day (24 hours) for treatment, assessment or rehabilitation, or had surgery as an NHS day case. Relief from charging should not apply to discharges following admission on a regular or frequent basis as part of the person’s ongoing care arrangements. This would cover, for example, admissions for respite care or ongoing but episodic treatment. Only new or additional services provided after a person comes out of hospital will be free and services that were in place pre-admission and continue after discharge will continue to be chargeable. Domestic Only Homecare Services Domestic only homecare services will be charged for at a flat rate equal to the Council’s standard charge for homecare and will not be means tested. This is to ensure that service users who receive domestic only homecare services from the Council are charged in the same way as service users whose service provision has been transferred from the Council to external providers who charge at a flat rate. Breaks in Service Where a service user’s service is suspended, the service user will not be charged for the services which have not been provided. Charging should resume when services are reinstated. Financial Re-assessment The charges payable by service users will be reviewed on an annual basis, to reflect the annual changes in charges and service users’ income and capital. Page 94
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5 The contribution payable by service users should be reviewed in the event of a change in the service provided or such other change in the service user’s circumstances as would affect their ability to contribute towards the cost of their care. Couples Where a service is provided to a service user who is married or lives with a partner as a couple, the charge assessment should include the income and capital of both the service user and their partner. To ensure that the assessed charge is fair, the upper and lower capital allowance for couples will be equal to double the single person’s capital allowances which would be used for the elder partner. Tariff increments are also doubled. The income threshold to be included in the charge assessment for couples should be based on the age of the elder partner. Income disregards will be applied to couples in the same way as individuals; the disregards are not doubled but are applied to both individuals on the basis of their respective incomes. Where a service user’s partner receives disability benefits, including disability and/or severe disability allowances within Income Support or Pension Credit, but does not receive any care services or funding for care services from the Council, the partner’s disability benefits should be disregarded in full. Where there is any doubt or dispute regarding whether or not two people are living together as a couple, the Council will defer to the decision made by the Department for Work and Pensions when assessing the two people’s entitlement to state benefits. Where two service users reside together but are not a couple, they should be assessed individually for charges. Independent Living Fund Service user’s eligible to claim financial assistance towards the cost of their care from the Independent Living Fund will be subject to charging for chargeable services under this scheme. Adults with Incapacity Where a service user is unable to deal with their own financial affairs due to incapacity, the department will liaise with another appropriate person, or persons, in order to gather information about the service user’s financial affairs and to arrange for the collection of charges. Appropriate persons would include: • Power of Attorney; • Financial guardian, appointed in accordance with the Adults with Incapacity (Scotland) Act 2000; Page 95
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6 • An individual permitted to act on the service user’s behalf under an intervention order granted by a Sheriff Court under the Adults with Incapacity (Scotland) Act 2000; • Department for Work and Pensions benefits appointee, or; • A relative, friend or advocate of the service user who assists the service user, with the service user’s knowledge and agreement, to manage their financial affairs. Incapacitated adults will be charged for the chargeable elements of their service in accordance with this scheme. Where the Council is unable to collect a service user’s charges because they have no one to manage their financial affairs and it is not financially viable to pursue a financial guardianship through the courts, a claim will be lodged against the service user’s estate following their death to recover the accrued unpaid care charges. Age Definition Due to the changes currently affecting the state retirement age for women, the age definitions applied in this scheme have been amended to classify service users as either: • Working age – for service users aged below state retirement age, or; • Pension age - for service users aged at or above state retirement age. Where a service user is aged between 60 and 65, staff should check the service user’s retirement age status. This can be done via the Gov.UK website. Charge Waivers Service users may apply for a partial or full charge waiver if they meet the following criteria: • The service user has been diagnosed as terminally ill and has been issued with a DS1500 Form by their doctor and/or BASRiS Form. In this case charges will be waived in full; • The service user feels that they can’t afford to pay their charge due to financial hardship; • The service users incurs costs for specialist therapies, supplies or services because they are disabled and which have not been taken into account in their charge assessment; • The service user has rejected a service because they don’t want to pay for it but without which they will be at substantial risk of harm; or • The Council has redesigned how it delivers the type of support the service user and other similar customers need, resulting in an increase in charge for the service user. For further details and how to apply for a charge waiver, please refer to the separate Social Work Waivers Scheme Procedures. Page 96
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7 Charge Collection Charges will be collected via 4 weekly Direct Debit unless there are extenuating circumstances which negate the client or the Council’s ability to collect payment in this manner. Extenuating circumstances would include, for example: • The client does not have access to a suitable bank account from which a Direct Debit can be paid (eg they only have a savings account and no current account); • The client does not have capacity to give instruction to their bank to set up the Direct Debit and does not have a Power of Attorney, Financial Guardian or other suitable representative to act on their behalf; or • The client struggles to manage their funds and the operation of a Direct Debit from their account could make their situation worse, potentially resulting in bank charges and placing the client in financial hardship. Page 97
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8 Charging Process The process of assessing, checking and collecting a service user’s care charges is set out below: Step Description Responsible Person 1 Following the completion of the service user’s needs assessment, a CBC Form is completed detailing the services required by the service user, the service’s costs and the service user’s and, where relevant, their partner’s financial circumstances. The CBC Form will calculate any charges payable by the service user towards their service. Please note that the financial circumstances of the service user and their partner are not required where the service user’s service consists entirely of personal care and/or services charged for at a flat rate, such as lunch clubs, Telecare or transport or the service is provided for the sole benefit of an informal carer (includes direct support to the carer and/or replacement care to provide respite to the carer). Case Manager 2 The case manager passes the completed CBC Form to their manager for checking and approval. Case Manager 3 The Team Leader / vetting manager should check to ensure that the CBC Form has been completed appropriately, based on the service user’s age and service needs, that the relevant evidence of the service user’s financial circumstances have been provided with the form and that the relevant budget codes(s) has been added to the form before approving it / passing to the relevant manager for approval. Team Leader 4 The authorising manager should forward the completed CBC Form with service approval to the local social work finance team. Approving Manager 5 The social work finance team will check to ensure that the charge assessment is correct and that all relevant evidence has been provided by the case manager. Social Work Finance 6 The social work finance team will check to ensure that the service user is set up on the Council’s Corporate Debtor’s System and will liaise with the Case Manager regarding any reason why payment by Direct Debit would not be appropriate for the client. Social Work Finance 7 The social work finance team will add the service user’s debtors, personal and charge details onto the area debtors upload spreadsheet and will process the service users billing via the standard 4 weekly billing cycle. Social Work Finance 8 Where the case manager becomes aware of a change in the service user’s service, financial or personal circumstances, they should inform the social work finance team so that the service user’s billing can be amended or stopped. Case Manager Page 98
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9 Personal and Domestic Care The following services can be broken down into personal, domestic or other support services: • Homecare, including homecare provided on a respite basis; • Supported Living, and; • Daycare. Since the Council is required to ensure that adult service users are not charged for personal care, it is essential to define which tasks would be considered to be personal care and subsequently excluded from charging. The following definitions provide a model to be used by assessment staff to classify the tasks required to meet service user needs into personal or domestic care. Personal Care Definition Classification Task Personal Hygiene ▪ Shaving ▪ Oral hygiene ▪ Nail care ▪ Toileting (assisting the person with going to the toilet or with using a bedpan or other receptacle) ▪ Catheter/stoma care (ensure cleanliness and that skin is kept in a favourable hygienic condition) ▪ Where the person is incontinent: o The consequential making of the person’s bed and consequential changing and laundering of the person’s bedding and clothing; o Caring for the person’s skin to ensure that it is not adversely affected Food and Diet ▪ Eating ▪ Meal preparation Mobility ▪ Dealing with the consequences of not being able to move ▪ Moving and handling Simple Treatments – if the person requires medical treatment, assisting with medication for example by:- ▪ Applying creams or lotions ▪ Administering eye drops ▪ Applying dressings in cases where this can be done without the physical involvement of a registered nurse or medical practitioner ▪ Assisting with the administration of oxygen as part of a course of therapy Page 99
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10 Classification Task General Well-Being ▪ Assisting with getting dressed ▪ Assisting with surgical appliances, prosthesis and mechanical and manual equipment ▪ Assisting with getting up and going to bed ▪ The provision of devices to help memory and of safety devices (see note 1) ▪ Behaviour management and psychological support Note 1 Only memory and safety devices which help individuals to manage their own personal care needs are included (eg the use of personal reminder systems to allow individuals to manage their medicines or the use of sound/movement alarms linked to light controls to guide people with dementia to the toilet and minimise the risks related to wandering at night). Community alarms and other associated devices are not included. Domestic Care Definition Classification Task Personal Laundry ▪ Carrying out personal laundry (excluding incontinence laundry) Ironing ▪ Carrying out ironing Clothing Repairs ▪ Carrying out clothing repairs Nutrition ▪ Management of food stores/fridges etc (including shopping) ▪ Menu planning ▪ Supervision at mealtimes Pet Care ▪ Coping with domestic pets including day to day care and feeding Page 100
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11 Housing Support From 1 April 2011, Housing Support services became subject to charging under this scheme. To provide a single charging framework, Housing Support services will be charged for subject to the standard means test. The cost of housing Support services will be calculated using the standard homecare hourly charge. Housing Support services are defined in the following table. Housing Support Definition Classification Task Life Skills – worker provides life skills training to the service user in maintaining the dwelling and curtilage (ie close, stairs, paths, bin area, garden pertaining to the service user’s accommodation) in appropriate condition. Worker assists and advises service user on: ▪ Kitchen/food hygiene ▪ Kitchen routines eg cleaning, washing up, bin emptying ▪ Personal laundry routines, ironing ▪ Cleaning (hovering, dusting, window cleaning, floor cleaning, kitchen and bathroom cleaning ▪ Appropriate personal routines ▪ Appropriate clothing/footwear ▪ Appropriate personal hygiene ▪ Prompting re the above ▪ Prompting re medication routines ▪ How to keep garden, close, stairs, bin areas etc in appropriate condition Service User Welfare – Worker assists the service user to engage with individuals, professionals and other bodies with an interest in the welfare of the service user to: ▪ Arrange and attend doctors/hospital etc (including escort) ▪ Attend day care (including escort) ▪ Attend groups, social activities and reviews (including escort) ▪ Maintain contact with friends and family (including escort) Adaptations – Worker arranges adaptations to enable the service user to cope with disability. ▪ Assist service user to make referral to OT department or make referral for service user ▪ Arrange appointments and attend appointments with or for the service user in relation to adaptations ▪ Arrange to be present when adaptations are being carried out in the service user’s home ▪ Remind the service user of the safe use of adaptations Page 101
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12 Classification Task Budgeting/Debt Management – Worker advises or assists the service user with personal budgeting and debt counselling. ▪ Collect benefits with or for the service user ▪ Advise and assist the service user to budget income ▪ Advise and assist service user to pay bills ▪ Enable service user to access debt counselling services ▪ Enable service user to access advocacy services ▪ Enable service user to access legal services ▪ Advise and assist service user to set up and maintain bank account appropriately, including direct debits, standing orders etc ▪ Advise and assist the service user to plan/save for future expenditure (eg furniture purchases, holidays etc) Relationships/Neighbour Disputes – Advising or assisting the service user in dealing with relationships and disputes with neighbours ▪ Advise and assist the service user to sustain appropriate relationships with neighbours, friends and family ▪ Advocate and negotiate appropriately with or on behalf of the service user in disputes Benefits/Correspondence – Advising or assisting the service user in dealing with benefit claims and other official correspondence relevant to sustaining the occupancy of the dwelling. ▪ Assist the service user to access the benefits agency ▪ Assist the service user to read and understand correspondence ▪ Assist the service user to complete forms ▪ Assist the service user to provide evidence of income and/or savings ▪ Liaise/advocate for the service user with Housing and Council Tax Benefit ▪ Liaise/advocate for the service user with the landlord ▪ Assist the service user to access welfare rights services Page 102
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13 Means Test Mechanism The means test mechanism described below is based upon the model recommended by COSLA as representing best practice in finding the balance between maximising income generation and minimising reduced opportunity and financial hardship for service users. To ensure parity between service users who contribute towards their care costs in the community and in care homes, the Scottish Government’s Charging for Residential Accommodation Guidance (CRAG) has been used extensively to ensure equal treatment of income, capital and assets. The means test will be used to assess charges for the following services: • Homecare; • Housing Support; • Supported Living; • Sleepover Services; • Employment Support; • Daycare (care elements of service), and; • Respite at home (including sleepover services). Means Test Qualification Service users who own capital and assets, excluding their home, equivalent or greater in value to the upper capital limit contained within CRAG will be excluded from relief under the means test and will be charged the standard cost of their care. This limit will be doubled where a couple is being assessed. Service users who are eligible for relief under the means test will pay either: • The standard cost of their care up to a maximum of £145 per week, or; • The maximum that they can afford to pay, as determined using the means test. Means Test Calculation To determine the maximum amount the service user can afford to contribute towards their care package, the following calculation will be completed: Total Assessed Income (A) Less Applicable Housing Costs (B) Less Applicable Disregards (C) Less Relevant Income Threshold (D) Equals residual income (E) Maximum charge (F) is equal to residual income (E) multiplied by a taper of 80%. Page 103
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14 A detailed explanation of each of the above steps is provided in the following section. The section on income has been split into income and capital and includes the rules for how different types of income and capital are to be treated in the means test mechanism. Page 104
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15 Income Income is a payment which: • Is made in respect of a period, and; • Forms part of a series of payments (whether or not payments are received regularly). A payment of income is taken into account for a period equivalent to that which it represents, e.g. a payment due to be made weekly is taken into account for a week, a payment due to be made calendar monthly is taken into account for a month, but a weekly rate is calculated before assessment. Treatment of Income Income is treated in one of three ways: • Taken into account in full; • Partly disregarded, or; • Fully disregarded. Income Taken Fully into Account The following types of income are taken into account in full: • Most Social Security Benefits, including: o State Retirement Pension; o Attendance Allowance; o Disability Living Allowance (care component); o Disability Working Allowance; o Job Seekers Allowance; o Income Support; o Pension Credit; o Industrial Death Benefit; o Incapacity Benefit; o Employment and Support Allowance; o Maternity Allowance; o Severe Disablement Allowance; • Annuity Income (see Annuity Income section below); • Occupational Pensions; • Refund of Income Tax; • Trust Income (see Income from certain disregarded capital below); • War Orphan’s Pension; • Income from an insurance policy (except mortgage protection insurance); • Income from certain sub-lets; • Income from certain disregarded capital Page 105
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16 The above list has been extracted from CRAG and is not exhaustive. Where a service user receives an income from a source the treatment of which is not mentioned explicitly in this guidance, advice should be sought before completing the financial assessment. Deductions from Benefits Where any Social Security benefit is being subjected to a reduction (other than a reduction because of voluntary unemployment) e.g. because of an earlier overpayment, the amount to be taken into account should be the gross amount of benefit before reduction Annuity Income An annuity is a fixed sum payable at specified intervals (normally annually), in return for a premium payable either in instalments or as a single payment. The annuity income is payable for a specified period, such as the recipient's lifetime. Income from an annuity is to be taken fully into account except when the annuity is: • Purchased with a loan secured on the service user’s home, or; • A gallantry award (eg Victoria Cross Annuity, George Cross Annuity) Income from certain disregarded capital Income from capital will generally not be treated as income. However, income which comes from certain forms of disregarded capital is taken fully into account as income for as long as the capital is disregarded. This will be the case where the capital is: • The normal dwelling of a temporary resident; • Business assets which the resident is taking steps to dispose of, or; • Any capital held in trust which is as a result of personal injury. Income from certain sub-lets When a resident sub-lets a part of their property which is not part of the living accommodation, for example the garage or the garden, the income from that sub-let is taken fully into account. Income Partly Disregarded The following types of income attract a £10 disregard: • Payments to victims of National Socialist persecution (paid under German or Austrian law); • Civilian war injury pension; or • War widow’s and war widower’s pension. Page 106
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17 Overall disregard Where more than one payment qualifies for a £10 disregard, the amount disregarded overall is £10. Other Disregarded Sums Income from boarders A boarder is someone for whom at least one cooked meal is provided. Where a resident has income from a boarder (whether paid by the boarder or a third party) the first £20 of the income should be ignored plus half of any balance over £20. Earnings from Employment/Self-Employment Where a service user is in receipt of earned income, the first £20 of their net earnings should be disregarded. Where a service user’s partner is in receipt of earned income, 50% of the partner’s net earnings should be disregarded. For couples, where both have earnings from employment, both of the above treatments are applied and aggregated to produce an overall earnings disregard for the couple. High Rate Attendance Allowance/DLA Care Component Where a client is receiving the higher rate of Attendance Allowance or the higher rate of the Care Component of Disability Living Allowance and is not provided with a night time service, that is a service between 10:00pm and 6:00am, they should be assessed as receiving the lower rate of Attendance Allowance or the middle rate of the Care Component of Disability Living Allowance. Page 107
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18 Income Fully Disregarded The following types of income are fully disregarded: • Disability benefits and/or allowances paid for service user’s partners who are disabled but who do not receive care services or funding for care services from the Council; • Direct payments made by a local authority under Section 12B of the Social Work (Scotland) Act 1968 to individuals in respect of a care service that they or a dependent child have been assessed as requiring; • Child Support Maintenance Payments and Child Benefit; • Child Tax Credit; • Guardian’s Allowance; • Where the service user is a student, any grant payment from a public source intended for the childcare costs of a child dependant; • Christmas bonus; • Carers Allowance; • Carers Premiums within Income Support/ Job Seekers Allowance or the guarantee element of Pension Credit; • Any payment made under the Age-Related Payments Act 2004; • Any payment from: o the Macfarlane Trust; o the Macfarlane (Special Payments) Trust; o the Macfarlane (Special Payments) (No 2) Trust; o the Fund (payments to haemophiliacs infected with HIV); o the Eileen Trust; o The value of any ex-gratia payments from the Skipton Fund to people infected with Hepatitis C as a result of NHS treatment with blood or blood products; o the Independent Living (Extension Fund); o the Independent Living (1993) Fund (8.042); o the Thalidomide Trust • Council Tax Benefit; • Housing Benefit; • Disability Living Allowance (Mobility Component); • Disabled Students Allowances; • Therapeutic Earnings; • Mobility supplement; • Dependency increases paid with certain benefits ; • Gallantry awards; • Income frozen abroad; • Income in kind; • Social Fund payments (including winter fuel payments); • Certain payments made to trainees; • War disablement pension; • Armed Forces Compensation Scheme; • War widows and widowers special payments; Page 108
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19 • Statutory Redress Scheme and Advance Payment Scheme– Survivors of Historical Child Abuse; • Future Pathways – Discretionary Fund; • Child Disability Payment (CDP) and Short-Term Assistance (STA); • Scottish Infected Blood Scheme (SIBSS) (and equivalent UK schemes e.g. England Infected Blood Support Scheme); • Victims Payment Regulations 2020; • Redress Board (Northern Ireland); • Payment Scheme for Former British Child Migrants; • Windrush Compensation Scheme; • UK Energy Bills Support Scheme; • Homes for Ukraine Payments; • Work expenses paid by employer, and expenses paid to voluntary workers, and; • Any payment made section 51A of the Adoption (Scotland) Act 1978. Christmas Bonus A Christmas Bonus is paid each year in the week starting the first Monday in December. It is paid to people who are entitled to specified benefits, for example: • Attendance Allowance; • Retirement Pension; • Widow's and War Widow's and widower’s Pensions; • War Disablement Pension; • Armed Forces Compensation Scheme; • Incapacity Benefit or Severe Disablement Pension. The Christmas bonus is fully disregarded in assessing the charge. Payments from any of the Macfarlane Trusts, The Fund or the Independent Living Funds Payments from the Macfarlane Trust, the Macfarlane (Special Payments) Trust, the Macfarlane (Special Payments) (No 2) Trust, the Eileen Trust, the Fund, the Independent Living (Extension) Fund or the Independent Living (1993) Fund do not have to be declared if they are kept in a separate bank or building society account from the service user’s other resources. All payments are fully disregarded. Gallantry awards Gallantry awards are: • Victoria Cross Annuities; • George Cross Annuities, or; • Analogous awards e.g. one from another country. These payments are fully disregarded. Page 109
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20 Income Frozen Abroad Income paid outside the UK which cannot be transferred to the UK should be fully disregarded so long as it continues to be frozen outside the UK. Income in kind Income in kind means income received in the form of food, clothing, cigarettes, etc. The value of such income is disregarded in full. Payments made to trainees Trainees on certain employment schemes may receive a training premium and reimbursement of travelling expenses. These should be fully disregarded. The actual training allowance should be taken into account. War widows and war widowers’ special payments War widows and war widowers’ special payments are made to the widows of men or widowers of women who died from injuries or illness which resulted from service ending before 31 March 1973. The special payments are intended to compensate those widows and widowers who did not benefit from the amendments to the Armed Forces Pension Scheme. These payments, which are made under the legislation, are fully disregarded. Work expenses paid by employer Where a person who is in paid employment receives a payment from the employer in respect of expenses which are incurred in the course of the employment that payment is fully disregarded. The payments must be for expenses incurred exclusively and necessarily in the course of work. Expenses paid to voluntary workers Where a person works for a charitable or voluntary body or as a volunteer, and receives no other payment as a result of the employment, any payment in respect of expenses which are actually incurred is fully disregarded. Income Available Upon Application General Subject to certain exemptions, income which the local authority is satisfied would be available to the service user if an application were made, but which has not yet been acquired, is to be treated as belonging to that service user. Page 110
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21 Amount of income Payments of the following cannot be taken into account as notional income: • Income payable under a discretionary trust; • Income payable under a trust derived from a payment made in consequence of a personal injury; • Working Families Tax Credit; • Disability Working Allowance, and; • Rehabilitation Allowance. Also income which would be fully disregarded should not be included as notional income, for example Housing Benefit and DLA (mobility). Income which is subject to the awarding authority's discretion, ie the resident has no right to payment shall also not be taken into account. Any potential entitlement to Severe Disablement Allowance should not be taken into account. This is because entitlement to this benefit is based on medical conditions which the local authority cannot assume are satisfied. All other income should be considered. Examples of income which may be treated as belonging to the claimant are: • unclaimed councillors attendance allowance; • unclaimed Social Security benefits (but not Severe Disablement Allowance), and; • occupational pension not claimed. Date taken into account The income should be taken into account from the date it could be expected to be acquired if an application was made. In considering the earliest date that account can be taken of the income the local authority should: • assume the application was made on the date the local authority first became aware of the possible income; and • take into account any time limits which might limit the period the period of arrears. Deprivation of Income A service user is to be treated as possessing income of which he has deprived himself for the purpose of paying a reduced charge. Meaning of deprive A person will have deprived himself of a resource if, as a result of his own act, he ceases to possess that resource. Page 111
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22 Questions for consideration: Where the service user appears to have deprived himself of income the local authority should consider the questions covered in the following paragraphs: Was it the service user’s income? Where a person, before he deprived himself of an income, was in receipt of that income it is reasonable to assume that the resource belonged to him. Sometimes there will be other evidence such as a letter or documentation which shows that the income was properly payable to the resident. Has deprivation occurred? Deprivation will have occurred if a person relinquishes, or transfers to another person, an income which: • he has been receiving or was due to receive and: • would have continued to receive had he not relinquished or transferred it. It is up to the service user to prove that he no longer has the income. If he cannot prove that the income has been disposed of, the local authority should treat the service user as still possessing the actual income. Purpose of the disposal of income There may have been more than one purpose of the disposal of income only one of which is to avoid a charge, or a lower charge. This may not be the service user’s main motive but it must be a significant one. Timing of the disposal of income Consideration should be given to the timing of the disposal of the asset when deciding whether the purpose of disposing of the asset was to avoid a charge for the service. The local authority should make a judgement as to the purpose of the disposal of income only after balancing all the person's motives, explicit and implicit, and the timing behind the action. The local authority should bear in mind, however, that deprivation can be considered for resources disposed of at any time. Conversion of income to a capital asset Where, for the purposes of paying a reduced charge or no charge, the right to receive an income resource has been sold, and therefore converted from income to a capital asset, the local authority should consider taking account of: • the amount of the former income resource or Page 112
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23 • if the newly acquired capital gives rise to a tariff income or an increase in tariff income, the difference between the former income resource and the tariff income, or the increase in tariff income, arising from that capital asset. Deprivation decided If it is decided that the service user has disposed of income in order to avoid a charge or to reduce the charge payable, the local authority will need to assess the charge payable using the service user’s notional income. If the service user is unable to pay the assessed charge, the relevant Service Manger has delegated authority to waive or abate all or part of the charge Non-disclosure of Income Where the service user refuses to fully disclose their or their partner’s income, they will be excluded from the means test and will be required to meet the standard charge for their care. Page 113
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24 Capital A service user’s resources are either capital or income. It may not always be obvious whether a payment should be treated as capital or income, but generally, a payment of capital is one which is: • Not in respect of a specified period, and; • Not intended to form part of a series of payments. Examples of capital are shown in the following list. The list is intended as a guide and is not exhaustive. • Buildings; • Land; • National Savings Certificates and Ulster Savings Certificates; • Premium Bonds; • Stocks and shares; • Capital held by the Court of Protection or a Receiver appointed by that Court; • Any savings held in: o building society accounts - income which is paid into an account becomes capital once the period over which it is taken into account as income expires; o bank current accounts, deposit accounts or special investment accounts. This includes savings held in the National Savings Bank, Girobank and Trustees Savings Bank - income which is paid into an account becomes capital once the period over which it is taken into account as income expires; • SAYE schemes; • Unit Trusts; • Co-operative share accounts; • Cash; • Trust funds; Page 114
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25 The Effect of Capital • A service user with capital of more than £35,000 is liable to meet the standard charge for the chargeable services provided to them; • Where the service user is of working age, the first £6,000 of the capital they own is disregarded, this is the lower capital allowance; • Where the service user is of pension age, the first £10,000 of the capital they own is disregarded, this is the lower capital allowance; • Capital owned over the lower capital allowance and up to £35,000 is taken into account in full for the purposes of calculating the service user’s weekly tariff income: o For service users of working age, a weekly tariff income is calculated as £1.00 per week for every £250.00, or part thereof, owned by the service user between £6,000 and £35,000. o For service users of pension age, a weekly tariff income is calculated as £1.00 per week for every £500.00, or part thereof, owned by the service user between £10,000.00 and £35,000. Note The upper capital threshold of £35,000 above is taken from the Scottish Government’s Charging for Residential Accommodation Guidance (CRAG). This rate will be reviewed annually to ensure that it matches the CRAG threshold. The lower capital thresholds and tariff charge increments are taken from the Department for Work and Pension’s (DWP) Council Tax Benefit and Housing Benefit assessment rules. These rates will be reviewed annually to ensure that they match any changes in the DWP’s rules. Tariff Income Tariff income is meant to represent an amount that a service user with capital over a certain limit should be able to contribute towards their service costs, not the interest earning capacity of that capital. Beneficial Ownership of capital A capital asset normally belongs to the person in whose name it is held. The following paragraphs provide guidance on how to establish beneficial ownership where there is a dispute. Ownership disputed Where ownership is disputed, ask for written evidence to prove ownership. Where a service user is said to be holding capital for another person, obtain evidence of the arrangement and the origin of the capital, and evidence to show the intentions for its future use and for its return to the rightful owner. Page 115
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26 Joint Beneficial Ownership of Capital Where a service user has joint beneficial ownership of capital, unless it is an interest in land with someone else, divide the total value equally between the joint owners, and treat the service user as owning an equal share. This method of treatment avoids administrative difficulties. Once the service user is in sole possession of their actual share, treat them as owning that actual amount. Valuation For the purposes of valuation only the value of a capital asset (for example property) other than National Savings Certificates (see specific section below) is the current market or surrender value, whichever is higher, less: • 10% of that value if there would be any expenses involved in selling the asset only where there will be actual expenses. The expenses must be connected with the actual sale, and not simply the realisation of an asset, e.g. the cost of fares to withdraw money from a bank are not expenses of sale. The deduction is always 10% even if it is known from the outset that the actual expenses will be more or less than 10%; and • any outstanding debts secured on the asset, e.g. a mortgage. A capital asset may have a current market value (e.g. stocks and shares) or a surrender value (e.g. premium bonds). The current market value will be the price a willing buyer would pay a willing seller. The way the market value is obtained will depend on the type of asset held, e.g. the values of stocks and shares or unit trusts which are quoted in newspapers. If the service user and the assessing officer both agree that, after deducting the amounts in the paragraph above (where appropriate), the total value of the service user’s capital will be: • more than £35,000; or • £6,000 or less it is not necessary to obtain a precise valuation. If there is any dispute, obtain a precise valuation. In the case of land, buildings or a house, where it is necessary to obtain a precise valuation because of a dispute, a professional valuer should be asked to provide a current market valuation. Expenses of sale Once the asset has been sold (e.g. a property), the capital to be taken into account is the actual amount realised from the sale less the actual expenses incurred during the sale. Debt secured on asset "Secured on" means a legal charge or mortgage must be made on the actual capital asset. Page 116
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27 The value of the land to be taken into account is the market value of that piece of land, less 10% of that value for expenses of sale and the whole of the mortgage secured on the home and the extra land. National Savings Certificates The original purchase price should be used when valuing National Savings Certificates. Capital Disregarded Indefinitely The capital assets listed below are disregarded indefinitely: • Property in specified circumstances; • Surrender value of any: o Life insurance policy; o Annuity; • Payments of training bonus up to £200; • Payments in kind from a charity; • Any personal possession such as painting or antiques unless they were purchased with the intention of reducing capital for the purpose of reducing the local authority charge; • Any capital which is to be treated as income or student loans • Any payment made by or derived from: o the Macfarlane Trust; o the Macfarlane (Special Payments) Trust; o the Macfarlane (Special Payment) (No 2) Trust; o the Fund (payments to haemophiliacs infected with HIV); o the Eileen Trust; o The Independent Living Fund; o the Independent Living (Extension) Fund; o the Independent Living (1993) Fund; • The value of funds held in trust or administered by a court which derive from a payment for personal injury to the service user (e.g. vaccine damage, criminal injuries compensation funds); • The value of a right to receive: o Income under an annuity; o Outstanding instalments under an agreement to repay a capital sum; o Payment under a trust where the funds derive from a personal injury; o Income under a life interest or a life rent; o Income (including earnings) payable in a country outside the UK which cannot be transferred to the UK o An occupational pension; o Any rent • Any Social Fund payment • Refund of tax on interest on a loan which was obtained to acquire an interest in a home or for repairs or improvements to the home • Any capital resource which the service user has no rights to as yet, but which will come into their possession at a later date, e.g. on reaching a certain age (reversionary interest) Page 117
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28 • The amount of any bank charges or commission paid to convert capital from foreign currency to sterling • Payments from the Department for Work and Pensions to compensate for the loss of entitlements to Housing Benefits or Housing Benefit Supplement • Any payment made under the Age-Related Payments Act 2004. • Payments to jurors or witnesses for court attendance (but not compensation for loss of earnings or benefit) • Community charge rebate/council tax rebate • Money deposited with a Housing Association as a condition of occupying a dwelling • The value of any ex-gratia payments made on or after 1 February 2001 by the Secretary of State in consequence of a person’s or person's spouse's or civil partner’s imprisonment or internment by the Japanese during the Second World War. Disregarded for 52 weeks The following payments of capital are disregarded for a maximum period of 52 weeks from the date they are received. The balance of any arrears of, or compensation for arrears due to non-payment of: • Mobility Allowance; • Mobility Supplement; • Attendance Allowance; • Constant Attendance Allowance; • Disability Living Allowance; • Disability Working Allowance; • Exceptionally Severe Disability Allowance; • Severe disablement occupational allowance; • Armed forces service pension based on need for attendance; • Pension under the Personal Injuries (Civilians) Scheme 1983, based on the need for attendance; • Income Support/ Pension Credit; • Minimum Income Guarantee; • Working Families Tax Credit; • Disabled Person’s Tax Credit; • Working Tax Credit; • Child Tax Credit; • Housing Benefit, and; • Special payments to pre-1973 war widows. As the above payments will be paid for specific periods, they should be treated as income over the period for which they are payable; any money left over 52 weeks after the end of the period for which they are treated as income has elapsed should be treated as capital. Page 118
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29 Disregarded for 2 years Payments made under a trust established out of funds provided by the Secretary of State in respect of persons suffering from variant Creutzfeldt-Jakob disease to: • The victim’s parent (or guardian) for 2 years from the date of death of the victim (or from the date of payment from the trust, if later) or • A dependent child or young person until they cease to be a member of the family (i.e. until they leave school between ages of 16 and 19) – but with a minimum of 2 years. Income treated as capital The types of income in the following paragraphs should be treated as capital. Tax Refunds Any refund of income tax charged on profits of a business or earnings of an employed earner. Holiday Pay Any holiday pay paid by an employer more than 4 weeks after the termination or interruption of employment. Income from a capital asset Income derived from capital, e.g. building society interest or dividends from shares, should be treated as capital from the date it is normally due to be credited to the resident's account. This does not apply to income from disregarded capital. Bounty Payments Any bounty paid at intervals of at least one year from employment as: • A part time fireman • An auxiliary coastguard • A part time lifeboatman • A member of the territorial or reserve forces. Page 119
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30 Advance of earnings or loan from employer Any advance of earnings or loan made to an employed earner by the employer, should be treated as capital, if the service user is not still in work, as the payment does not form part of the employee’s regular income and would have to be repaid. Example A service user received £294 in one week but the pay slip showed that £200 of this was a loan made by the employer. The local authority should treat £94 as earnings and £200 as capital. Irregular charitable and voluntary payments Apart from certain exemptions (payments from AIDS trusts), charitable and voluntary payments which are neither made regularly nor due to be made regularly should be taken into account as capital in the normal way. Deprivation of Capital General The local authority may feel that a service user has deprived themselves of a capital asset in order to reduce their service charge. If this is the case the local authority may treat the service user as still possessing the asset. The following factors will need to be considered. Pension Credit includes slightly more relaxed notional capital rules compared with Income Support. In Income Support, individuals may be treated as if they still possess capital in circumstances where they have deliberately deprived themselves of it in order to maximize their benefit entitlement. Pension Credit specifies circumstances in which this would not apply. For example, individuals who choose to use their savings to reduce or clear a debt (including debts not immediately repayable) will no longer be considered as having deliberately deprived themselves to maximise entitlement. Pension Credit will also have slightly different rules for what resources an individual may be assumed to have when they apply for benefits. Forms of capital to be considered The local authority should only consider questions of deprivation of capital when the service user ceases to possess capital which would otherwise have been taken into account. E.g. a service user gives a diamond ring worth £2,000 to her daughter the week before her service starts. The local authority should not consider deprivation as, had the ring still been possessed, it would not be taken into account as capital. However, if the service user had purchased the ring immediately prior to giving it to her daughter with £2,000 which had previously been in a Building Society account, deprivation should be considered. Page 120
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31 Ownership The local authority should decide from available evidence whether the service user owned the capital. Has deprivation occurred? It is up to the service user to prove that they no longer has a resource. Failure to do so will result in the local authority treating the service user as if they still possess the actual capital. Examples of acceptable evidence of the disposal of capital would include • a trust deed • deed of gift • receipts for expenditure • proof that debts had been repaid. Examples of where a person has deprived themselves of capital (although not necessarily for the purposes of avoiding a charge for accommodation) • A lump-sum payment has been made to someone else (e.g. as a gift or to repay a debt) • Substantial expenditure has been incurred (e.g. on an expensive holiday) • The title deeds of a property have been transferred to someone else • Money has been put into a trust which cannot be revoked • Money has been converted into another form which would fall to be disregarded (e.g. personal possessions) • Capital has been reduced by living extravagantly (e.g. gambling or following a much higher standard of living than the service user could normally afford). • Capital has been used to purchase an investment bond with life insurance. Local authorities will wish to give consideration, in respect of each case, to whether deprivation of assets has occurred i.e. did the individual place their capital in such an investment bond so that it would be disregarded for the purposes of the charge assessment. Purpose of disposing of an asset There may be more than one purpose for disposing of a capital asset only one of which is to avoid a charge for services. Avoiding the charge need not be the service user’s main motive but it must be a significant one. If, for example, a person has used capital to repay a debt, careful consideration should be given to whether there was a need for the debt to be repaid at that time. If it seems unreasonable for the service user to have repaid that debt at that time, it may be that the purpose was to avoid a charge for services. Page 121
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32 Timing of the disposal The timing of the disposal should be taken into account when considering the purpose of the disposal. It would be unreasonable to decide that a service user had disposed of an asset in order to reduce his charge when the disposal took place at a time when he was fit and healthy and could not have foreseen the need for services. The local authority should bear in mind, however, that deprivation can be considered for resources disposed of at any time. Conversion of capital to personal possessions Where, for the purpose of avoiding or reducing the charge for services, capital which would not have been disregarded has been used to acquire personal possessions, the current market value of those possessions should be taken into account as an actual resource. Their market value should not be disregarded under these circumstances. If the service user, in depriving himself of an actual resource, converted that resource into another actual resource of lesser value, he should be treated as notionally possessing the difference between the value of the new resource and the one which it replaced e.g., if the value of personal possessions acquired is less than the sum spent on them the difference should be treated as a notional resource. Deprivation decided If the local authority decides that the service user has disposed of capital in order to avoid a charge or to reduce the charge payable, the local authority will need to decide whether to treat the service user as having the capital (notional capital) and assess the charge payable accordingly and then whether it is realistic to recover the assessed charge from the service user (bearing in mind that they may not have the means to pay the debt which will be accruing) Diminishing notional capital Calculation of the rate at which notional capital should reduce Where a service user has been assessed as having notional capital that capital will have to be reduced each week by the difference between the rate which he is paying for the service and the rate he would have paid if he was not treated as possessing the notional capital. Page 122
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33 Applicable Housing Costs Deductions will be made from the service user’s assessed income for the following net housing costs: • Rent; • Mortgage; • Council tax (including water and sewerage charges), and; • Interest payable on loans that have been taken out to improve, extend or adapt the service user’s home, as long as they are related to the service user’s disability. Non-Dependent Rent Allowance (NDRA) Where a service user resides with their parents and/or other family members, a weekly deduction will be made for rent equivalent to the non-dependant deduction applied in Housing Benefit for non-dependants receiving Income Support/ESA. Where the client’s housing costs exceed the standard allowance, for example as a direct consequence of their disability, an application for an additional disregard should be made through the waivers and abatements policy. Applicable Disregard The applicable disregard is the weekly equivalent total of all of the items of income which are partially or fully disregarded, as specified in the Income section of this scheme, and allowable expenses which includes: • Any personal contribution payable by the service user and/or their partner towards an Independent Living Fund funding package, and; • Any charges payable by the service user for other privately or separately arranged care which meets the following criteria: o The care delivered is assessed as P1 or P2 under the Council’s priority of need framework; o The care delivered is included within the client’s care plan, and; o The price being paid is the lowest available to the client (for example where a client purchases private physiotherapy which would be available to them free on the NHS, the council would not disregard the cost of this service in the client’s assessment as it does not meet the lowest cost criteria). Other Care Charges and Contributions Taper Adjustment To compensate for the effect of the 80% taper used to calculate the charge payable by the service user, a taper adjustment equal to one quarter of the total deduction allowed for the service user’s ILF contribution, partner’s assessed contribution and/or charges for other private or separately arranged care is applied. This ensures that the service user receives the full benefit of the allowable deductions for these expenses. Page 123
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34 Financial and charge assessments will be calculated on a gross basis and deductions detailed to ensure the transparency of the assessment for the service user and to avoid any confusion about how charges have been calculated. Income Thresholds Income thresholds represent the minimum amount of money which the Government, via the Department for Work and Pensions, determines that a service user of a particular age and circumstance requires to meet their weekly living costs. To ensure full compliance with the COSLA Guidance on Charging for Non-Residential Services, this scheme requires that the Council’s Income Thresholds are calculated using the allowances and premiums calculated by the Department for Work and Pensions for the purpose of determining minimum weekly living costs and that an additional 25% Buffer is added thereto to minimise service users’ exposure to financial hardship. Income thresholds will be calculated annually and published for use within the Social Work Service. Staff undertaking financial and charge assessments should select the most appropriate threshold to apply to individual assessments using the following criteria: • The age of the service user; whether the service user is of working or pension age, and; • Whether the service user is one of a couple or an individual. When assessing a couple, threshold selection should always be determined on the circumstances of the elder member of the couple. Residual Income and the Taper Residual income is the income which the service user has left over after deducting housing costs, disregarded income and weekly living costs (income threshold). The maximum charge that the service user can afford to pay is thereafter calculated on the basis of 80% of their residual income. The level of taper applied is at the Council’s discretion and will be reviewed on an annual basis to ensure that a balance between cost recovery and fair charging is maintained. Standard Charge The standard charge is equal to the lesser of the actual cost of the service user’s service or the maximum charge levied by the Council for the service (this represents a capped charge in order to protect individual service users from excessive charges due to higher than average care needs). The maximum Charge levied by the Council comes from the Council’s list of Fees and Charges, agreed annually by Council Members. Page 124
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35 Final Charge The final charge to be paid by the service user will be the lesser of the standard charge for the service user’s service or the maximum charge they can afford to pay or £145 per week. Collection Service user charges for homecare, housing support, supported living, employment support and day care will be collected on a 4 weekly in arrears basis. Service user charges for respite at home will be collected as soon as practically possible following the delivery of service. Lunch Clubs Charges of the Lunch Club service will be levied at a flat rate per meal provided to the service user. The Council will review the charge for the Lunch Club service on an annual basis to ensure that the charge levied is sufficient to recover the costs to the Council of providing the service. Collection Charges for the Lunch Club service will be collected at the point of delivery with the exception of Lunch Club services provided to service users suffering from Dementia, where charges will be collected on a 4 weekly in arrears basis. Transport Transport to and from day care facilities, including to resource centres, provided by the Council, directly using Council vehicles or indirectly by private transport companies including minicab companies, will charged for from 1 April 2011. It is hoped that by implementing this new charge, service users will be encouraged to use public transport, reducing the Council’s costs and carbon footprint. Where service users cannot or will not use public transport, implementation of a transport charge will enable the Council to recover some of its transport costs. Transport provided for excursions will be charged for in accordance with the mileage allowances set by Her Majesty’s Inland Revenue and Customs, The total charge will then be divided equally between all of the participating service users. Collection Charges for transport services will be collected weekly in arrears by the day care and resource centres delivering the users service. Page 125
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36 Telecare Charges for the Telecare service will be levied at a flat rate based on the type of service provided. The Council will review the charges for the Telecare service on an annual basis to ensure that the charge levied is sufficient to recover the costs to the Council of providing the service. Collection Charges for the Telecare service will be collected on a 4 weekly in arrears basis Page 126
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NHS Highland Meeting: NHS Highland Board Meeting date: 28 January 2025 Title: Director of Public Health Annual Report: Health Inequalities Responsible Executive/Non-Executive: Tim Allison, Director of Public Health & Policy Report Author: Tim Allison, Director of Public Health & Policy 1 Purpose This is presented to the Board for: Awareness and Discussion This report relates to a: Legal requirement This report will align to the following NHS Scotland quality ambition(s): Safe, Effective and Person Centred This report relates to the following Strategic Outcome(s) Start Well Thrive Well Stay Well Anchor Well Grow Well Listen Well Nurture Well Plan Well Care Well Live Well Respond Well Treat Well Journey Well Age Well End Well Value Well Perform well Progress well All Well Themes X 2 Report summary 2.1 Situation The Annual Report of the Director of Public Health for 2024 is presented. 2.2 Background Directors of Public Health are required to produce an annual report concerning the state of health of their local population. There is no set format for the report Page 127 Agenda Item 11
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and in recent years the reports have tended to focus on individual themes rather than acting as a repository for population health intelligence. 2.3 Assessment The report for 2024 is brought to the Board of NHS Highland along with a presentation. A link is provided for the full report. The report sets out information about the health and wellbeing of people in Highland and Argyll and Bute and focuses on health inequalities. It starts with information about the overall health of the population including people’s life expectancy and how things have changed over several years. Then there is a chapter about health inequalities, what they are and how they affect local people. This is followed by a section about ways of tackling health inequalities. The remainder of the report consists of chapters looking at different groups of people or different factors that relate to health inequalities including chapters on children, on vaccination, on the effects of alcohol and on under-represented groups. The report is not a comprehensive review of health inequalities but is intended to generate action which will tackle this important priority for NHS Highland and its partners. There are recommendations for action which are designed to help all agencies work to reduce inequality. 2.4 Proposed level of Assurance This report proposes the following level of assurance: Substantial Moderate Limited None Comment on the level of assurance There is substantial assurance that the requirement for the publication of the report is met. Other elements of public health reporting will continue to need further work as will implementation of the recommendations from the report. 3 Impact Analysis 3.1 Quality/ Patient Care Tackling health inequalities is an important part of both quality improvement and patient care. It is vital that health inequalities remain a major aspect of NHS Highland strategy and service delivery. 3.2 Workforce It is important that the board’s staff members are aware of the impact of health inequalities and the need to act to reduce their effects. A focus on employability and inequalities is also important both to support the community and strengthen the workforce. Page 128
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3.3 Financial There are no direct financial implications from the paper. Tackling health inequalities will entail costs but there are also possibilities for savings. Addressing health inequalities is a fundamental part of the work of the board and its partners, for example through community planning. 3.4 Risk Assessment/Management Risks are managed in line with NHS Highland’s policy. 3.5 Data Protection No personally identifiable information is involved. 3.6 Equality and Diversity, including health inequalities The focus of the report is on health inequalities; these include inequalities relating to protected characteristics. 3.7 Other impacts No other impacts to note. 3.8 Communication, involvement, engagement and consultation The principles of public and user involvement and engagement are embedded in public health actions. This is an independent report from the Director of Public Health. 3.9 Route to the Meeting This is an independent report from the Director of Public Health. Considerable work has been undertaken within the Public Health Directorate to produce the report. 4 Recommendation The Board is asked to note and discuss the 2024 Director of Public Health Annual Report. 4.1 List of appendices The full report can be accessed using this link: https://indd.adobe.com/view/ff013007-f1c4-414c-84be-d2e99d8d3a29 Page 129
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1 Integration Joint Board Date of Meeting: 29th Jan 2025 Title of Report: Health & Social Care Partnership - Performance Report – FQ2 2024/25 (Jul – Sep) Presented by: Kristin Gillies - Head of Strategic Planning, Performance & Technology The Board is asked to: • Acknowledge performance for FQ2 2024/25 (July - September) • Acknowledge performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 1) • Note Delayed Discharge Sitrep as of 30 September 2024 (Appendix 2) EXECUTIVE SUMMARY This report details performance for Financial Quarter (FQ) 2 2024/25 (July - September), 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 FQ2 notes 51 of 84 measures reporting as on target (61%). The report details performance against each of the service areas and the 84 supporting Key Performance Indicators. Analysis of the KPI’s is supported by performance commentary from the Heads of Service and Service Leads. 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 focussed approach to the access and analysis of data, offering scope for self-service. 2. RECOMENDATIONS The Integration Joint Board are asked to acknowledge current FQ2 24/25 performance. 3. DETAIL OF REPORT The report details the HSCP (Health and Social Care Partnership) performance for FQ 2 2024/25 (July - September) highlighting key performance trends across the 84 KPIs (Key Performance Indicators). In addition, the report includes performance updates from Heads of Service and Service Leads across the twelve service areas. 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 (Appendix 2). Page 131 Agenda Item 12
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2 4. RELEVANT DATA & INDICATORS 4.1 FQ2 2024/25 (July - September) Performance Summary Overall performance for FQ2 notes that 84 KPI’s are scoring against target, with 51 (61%) reporting as on-track. This is an increase of 11% from FQ1 position, where 42 KPI were on track (50%). 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 Key Performance Indicators (KPIs) for Children & Families & Justice shows 4 KPIs (57%) on track, with 3 KPIs (43%) reported as off track against the targets set in FQ2 24/25. Performance on track reports an increase of 28 % from the reported FQ1 24/25 position (29%) Performance on or above target: • The percentage of Child Protection Register (CPR) cases that have an allocated Social Worker remains at 100% for FQ2. • The number of teams that have delivered 75% or more of the Universal Health Visiting Pathway (UHVP) reports 78% for FQ2, up from 61% FQ1. • The number of statutory individual Health Assessments commenced within four weeks of coming into care in FQ2 again reports 100%. • The numbers 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 122 against target of 6. Performance below target & areas for improvement: • The percentage of Child Protection Planning Meetings (CPPM's) held within 28 days of the initial referral reports 17% in FQ2 against 90% target, an increase from 0% reported in FQ1. • Children & Adolescent Mental Health Services (CAMHS) children and young people seen within 18 weeks of referral reports 73% FQ2 up from 60% FQ1. • Percentage of Criminal Justice social work reports submitted by 12 noon, 2 days before court reports is noted at 82% in FQ2, against 90% target and down slightly from 87% reported in FQ1. Page 132
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3 4.2.2 Telecare and Digital Performance across 13 Key Performance Indicators (KPIs) for Strategic Planning, Performance & Technology Services shows 5 KPIs (38%) on track, with 8 KPIs (62%) reported as off track against the targets set for FQ2 24/25. Performance on track reports an increase of 7% from the reported FQ1 24/25 position (31%) 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: • FQ2 reported 219 Telecare clients starting a new service, an increase of 10% from the previous quarter (198) and above target of 200. • There has been a 2% increase in the digitalisation of telecare device equipment, with FQ2 showing 54% and achieving the 54% rolling performance target set for FQ2. • Implementation of Just Checking activity monitoring equipment has been successfully carried out in nine homes during FQ2, up 33% from 6 in FQ1. • Usage of digital blood pressure monitoring in Primary Care has seen a significant rise, increasing from 40 users in FQ1 to 79 users in FQ2 against a target of 40. Performance below target & areas for improvement: • E-health reported resolving 99% of support requests in FQ2, narrowly missing 100% target • Consultations delivered via Near Me fell slightly from FQ1 (1014), with 999 noted in FQ2 against target of 1025. • The number of telecare clients overdue for their annual review has decreased significantly to 52%, missing the 50% target (and work is continuing to improve data quality around this measure). • Silvercloud referrals performance remains stable with an increase of 1 from 57 in FQ1 to 58 in FQ2 against the target noted, against a target of 60 per quarter. • Percentage of telecare clients with an enhanced package, FQ2 performance remains unchanged at 42%, below the desired target of 45% (work is ongoing to improve data quality around this measure). • FQ2 performance for Waiting Times for Cancer Appointments at 31 & 62 Days reports 12 against target of zero, an increase from 1 reported as at FQ1. • New Outpatient Waiting Times breaches over 12 weeks have reduced from 50% in FQ1 to 49% in FQ2 against a 46% target. • Outpatient Long waiting over 52 weeks also noted a reduction from 3.8% at FQ1 to 3.3% against a 2.8% target. 4.2.3 Primary Care Performance across 10 Key Performance Indicators (KPIs) for Primary Care shows 7 KPIs (70%) on track, with 3 KPIs (30%) reported as off track against the targets set for FQ2 24/25. Performance on track reports an increase/decrease of 10% from the reported FQ1 24/25 position (60%) Performance on or above target: • FQ2 noted 81% of children who received Fluoride Varnish treatment did not require be referred for further dental treatment, an increase from 80% in FQ1. • FQ2 performance notes 4% of eligible residents have so far received their Winter Covid 19 booster. This is 1% higher than the national average. Page 133
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4 • FQ2 notes zero GP practices were returned to HSCP Control during FQ2, against a zero target. • GP practices remained at level zero during FQ2 resulting in no reduction in services provided. • 4.5% of consultations by GPs and other HSCP within the primary care setting were done digitally in FQ2 down slightly from 4.7% in FQ1 however remains on the target of 4.5%. • Primary Care Out-of-Hours Services covered 46% of all recorded out of hour consultations during Q1 exceeding their 45% target. • 96% of children at 12 months of age received their 6 in 1 vaccination achieving the 95% national target (*data for this indicator is 1 quarter behind due to availability of statistics). Performance below target & areas for improvement: • HSCP-run practices did not meet their target of 14 by recording 55 instances of practices operating under contingency measures, up from 7 in FQ1. • The Oral Health Improvement Team noted delivery of 95% of their planned activity, against 100% target. • FQ2 performance notes HSCP Dental services utilised 48% of clinic appointments, missing their 90% target and falling from 52% reported at FQ1. 4.2.4 Public Health Performance across 5 Key Performance Indicators (KPIs) for Public Health shows 5 KPIs (100%) on track against the targets set for FQ2 24/25. Performance on track reports an increase of 20% from the reported FQ1 24/25 position (80%) Performance on or above target: • 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 29 quit dates achieved against a target of 10. This represents a 164% increase compared to FQ1. This success is due to a change in the methodology for counting measure. • 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 26 against a target of 20. • 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 FQ2 we successfully exceeded our target with 111 attendances, against a target of 102. • Increase the number of referrals to community link workers supported by “We Are with You”. Performance this quarter achieved approximately 110% above the target, with an actual performance of 212 against a target of 101. • 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. FQ2 noted 14 instances of working with Scottish Government or National Agencies on National Strategy and Policy development. Performance below target & areas for improvement: None noted this quarter. Page 134
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5 4.2.5 Finance Performance across 6 Key Performance Indicators (KPIs) for Finance shows 5 KPIs (83%) on track, with 1 KPIs (14%) reported as off track against the targets set for FQ2 24/25. Performance on track reports an increase/decrease of 33% from the reported FQ1 24/25 position (50%) Performance on or above target: • Costs for Hospital Delayed Discharges actual spend reports £306,500 against a target of £317,000, noted as 3.3 % under target, and 25% reduction from FQ1 position. • Agency and Locum staffing expenditure with actual spend (6%) being 4% under target of 10% and a reduction from 14% noted at FQ1. • Older People Internal Residential actual spend being under projected target by 17%, from projected overspend of 21% noted at FQ1. • Older People External Residential actual spend reports being 28% below projected target, an increase of 10% from the reported FQ1 position. • Older People Homecare actual spend reports being 8% below projected target, am improvement form the 2% noted at FQ1. Performance below target & areas for improvement: • GP prescribing expenditure with actual spend being 2% over the projected FQ2 spend target. This is a percentage terms increase of 2% from the FQ1 position. 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 FQ2 24/25. Performance on track reports a decrease of 25% from the reported FQ1 24/25 position (100%). 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 3359 (2%) noted from previous FQ1. • The ACSP reviews, which now include welfare contacts, are well above target of 700 per quarter with 1396 achieved in FQ2 compared to 913 in FQ1. • Young Carer Statements completed in FQ2 notes 35, is up from 26 recorded in FQ1 and remains above the target of 4. Performance below target & areas for improvement: • The number of Adult Carer Support Plans completed have decreased this quarter (-17%), with 114 reported against target of 133. 4.2.7 Allied Health Professionals Performance across 7 Key Performance Indicators (KPIs) for Allied Health Professionals shows 5 KPIs (71%) on track, with 2 KPIs (29%) reported as off track against the targets set for FQ2 24/25. Performance on track reports an increase of 14% from the reported FQ1 24/25 position (57%). Page 135
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6 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 again significantly down in FQ2 to 967 (-14%) and meeting target of 1120. • AHP Priority 1&2 referrals breaching > 4 weeks in FQ2 reported 46 against a target of 48 • AHP Outpatient Completed Waits continue to increase in FQ2 (+6%) with 1033 reported against the target of 945. • Community Patient Discharges continue to increase in FQ2 (+8%) to 2034, against the target of 1632. • The percentage of New versus Return Outpatient Physio AHP Referrals remains above the 30% target, with 33% noted in FQ2. Performance below target & areas for improvement: • Outpatients waiting over 12 weeks for AHP services have continued to trend downwards in FQ2 – with a reported total of 504 against the target of 500. • Priority 3 and 4 Community Patient Referrals breaching over 12 weeks have increased quarter on quarter, with FQ2 reporting 571 against a target of 400, up 2% from 558 noted in FQ1. 4.2.8 Delayed Discharges Performance across 6 Key Performance Indicators (KPIs) for Delayed Discharges shows 5 KPI (83%) on track, with 1 KPIs (17%) reported as off track against the targets set for FQ2 24/25. Performance on track reports an increase/decrease of 66% from the reported FQ1 24/25 position (17%). 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: • The number of overall people delayed in hospital at Monthly Census Point as at the end of Q2 was 31, against target of 31. This reflects a fall of 21% compared to FQ1 position (39). 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 Q2 census point, the overall length of stay in a hospital (Delayed Discharge Bed Days) at Monthly Census Point was 613 against the target of 634. This represents a decrease of 25% with 820 recorded in FQ1. The target was set based on the average bed days over the past four quarters of 23/24, which ranged from 598 to 695. • Reduce the Number of people delayed in hospital with AWI code at Monthly Census Point. Performance was above target having achieved actual of 2 against a maximum target of 6. Page 136
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7 In this quarter, the number of people delayed with AWI code recorded fell from 5 in July to 3 in August and to 2 in September. • The number of people delayed awaiting a Care Home Placement was 1, compared to a target of 4. This is a noted reduction (88%) from FQ1 where 8 were recorded. 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 Q2, the number of people delayed in hospital awaiting assessment (Codes 11A and 11B) was 7, which is 23% of census clients, against a target of 10. The target was based on the average from the previous four quarters of 23/24, which ranged 9 to 11. This is a noted reduction of 46% from FQ 1 position with 13 reported. Performance below target & areas for improvement: • At the end of Q2, the number of people delayed in hospital awaiting care at home availability was 20, representing 65% 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 increased by 25% compared to FQ1 position (16). 4.2.9 Adult Social Care Performance across 4 Key Performance Indicators (KPIs) for Adult Social Care shows 2 KPIs (50%) on track, with 2 KPI (50%) reported as off track against the targets set for FQ2 24/25. Performance on track is consistent with the reported FQ1 24/25 position. Performance on or above target: • The number of Unplanned Admissions to A&B hospitals directly from a care home in FQ2 was reported at 16, below the target of 36, and an improvement from 45 reported in FQ1. • Increasing the occupancy rates across A&B Care Homes was above target, achieving 96% occupancy against a target of 95% in FQ2, consistent with. This KPI is now measured against available places (previously all empty beds). Performance below target & areas for improvement: • Increasing the % of Older People who had their homecare monitoring review completed within 6 months was noted at 37% for FQ2, against a target of 49%. This represents a 6% improvement from FQ1 to FQ2, increasing from 31%. • The FQ2 performance looking to reduce the value of assessed unmet need for care at home was £16,679.04, which is £5,269.32 (46%) above the target. Target is set at previous quarter’s value. Page 137
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8 4.2.10 Community Hospitals Performance across 5 Key Performance Indicators (KPIs) for Community Hospitals shows 4 KPIs (80%) on track, with 1 KPIs (20%) reported as off track against the targets set for FQ2 24/25. Performance on track reports an increase/decrease of 40% from the reported FQ1 24/25 position (40%) Performance on or above target: • The average length of stay for inpatients in A&B Community Hospitals was reduced to 7.7 days across the quarter, against the target of 7.8 days. This represents an 11% improvement compared to FQ1, where the average length of stay was 8.7 days. • A&E attendances meeting the 4 hrs wait target reached 97.1%, exceeding the 95% target by 2.1%. This is a slight improvement from FQ1, where performance was noted as 97%. • Maintain A&B Community Hospitals Bed occupancy rates below 80% target. Bed occupancy rates remained well below target at 69.3% for FQ2, marking a 4% reduction from 73.6% in FQ1. • Reduce the number of falls being reported in a Community Hospital setting in A&B. In FQ2, we reported 37 falls, well below the FQ1 total of 63 and the target of 54. Performance below target & areas for improvement: • Reduce the rate of unplanned admissions to Community Hospitals for 65+ population. This KPI reported 487 admissions, 8% above the target of 452 for FQ2. This represents a 2% increase compared to FQ1. 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/ ASP/ADP shows 2 KPIs (25%) on track, with 6 KPIs (75%) reported as off track against the targets set for FQ1 24/25. Performance on track reports a decrease of 13% from the reported FQ1 24/25 position (38%) 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: • 12 Adults were reported on the dynamic support register with a category red or amber status, in line with FQ target and no change from the FQ1 position. • 135 Adults are waiting for a psychological therapy service achieving the target of 175 or fewer. Page 138
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9 Performance below target & areas for improvement: • FQ2 noted 7% of 18-64 people with a Learning Disability were reported as overdue an Adult Review against 3% target, no change from the FQ1 position. • 446 Adults are waiting for a Mental Health outpatient service, this is over the target of 390 or less, and an increase of 16% from 383 noted in FQ1. • 30% of Adult Support and Protection 'duty to inquire' procedures were completed within the 5 working day target of 70%, and down from 56% in FQ1. • 55% of Adult Support and Protection inquiries requiring investigative powers were completed within the 15 working day target of 70%, and down from 65% reported in FQ1. • 53% of Case Conferences began within 20 days of referral or within 12 weeks of the initial conference for review, a drop from 70% noted last quarter. • 89.6% of individuals referred to Alcohol and Drug treatment services were seen within the target waiting period, against 90% target, which is an increase from 79.7% noted in FQ1. 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 FQ2 24/25. Performance on track reports an increase/decrease of 23% from the reported FQ1 24/25 position (67%) Performance on or above target: • Reduce the total number of unplanned bed days in LIH. The actual number of unplanned bed days reported was 2969, 354 below the target of 3323, based on the 23/24 average • Reduce the Average Length of Stay for inpatients in LIH. FQ2 Performance noted we achieved an actual rate of 4.2, against the target of 4.8. This is up slightly from 4.0 noted in FQ1. • Maintain LIH Bed Occupancy Rates below 90% target. FQ2 performance noted an actual rate of 85.8%, a 4% increase from 81.8% noted at FQ1. • Reduce the number of medication errors in LIH. Quarterly indicative target was set at no more than 6 per reporting period, 6 based on 23/24 average. In FQ 2 we achieved an actual of 5, and a slight increase from3 noted in FQ1. Performance below target & areas for improvement: • Reduce the rate of unplanned admissions to LIH 65+ population. FQ2 performance noted the actual number of unplanned admissions was 383, up 12% from 341 in FQ1 and missing the target set of 345. • Our FQ2 target is for 95% of A&E attendances to meet the 4-hour target. Actual FQ2 performance noted 92.9%, down slightly from 93.8% noted at FQ1. • Reduce the number of falls being reported in a hospital setting in LIH. FQ2 target was to reduce reported falls to no more than 26 per quarter, however the actual recorded was 33. This reflects a 27% reduction of 12 from FQ1, where 45 Falls were reported. Page 139
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10 • Reduce 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. However, FQ2 performance on actual instances was 9, increasing from 5 reported in FQ1. • Reduce the number of LIH A&E Attendances that result in an unplanned admission. The FQ 2 performance for reducing unplanned admission from A&E attendances was 19.8% against a target of 19.2%. This is an increase of 2% from FQ1, where the rate was 17.9%. 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. 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 is able to 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 Page 140
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11 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 indictors used to inform the HSCP E&D work. 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 considerer and acknowledge FQ2 2024/25 (July - September) performance as detailed in the IPMF Dashboard Page 141
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12 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) REPORT AUTHOR AND CONTACT Author Name: Douglas Hunter- Senior Manager Performance & Improvement Email: douglas.hunter@argyll-bute.gov.uk Page 142
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13 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 143
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14 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 144
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15 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 145
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16 Appendix 2 - Delayed Discharge Sitrep – 30th September 2024 Page 146
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1 Integration Joint Board Date of Meeting: 29 January 2024 Title of Report: Integration Joint Board Review of the Standing Orders Presented by: Charlotte Craig The Board is asked to: ▪ Consider the Standing Orders ▪ Approve the Standing Orders 1. EXECUTIVE SUMMARY The Standing Orders were previously updated on 25 May 2022 to reflect the updated Model Code of Conduct for Members of Devolved Public Bodies. This is a routine review and a minor amendment is noted to reflect the updated representation of unpaid carers from one to two as previously agreed by the IJB allowed within the current Standing Orders. Further to consultation with the Standards Officer, Governance Manager and the Standards Commission we are advised that Scottish Government have been asked to consider feedback on the provision of gifts and hospitality, otherwise there are no additional items for change and that a response is not imminent. As such the IJB is asked to review the Standing Orders as competent in the current state until such time as advised otherwise. 2. RECOMMENDATIONS Routine review and Standing Orders recommended for approval. 3. DETAIL OF REPORT The Ethical Standards in Public Life etc. (Scotland) Act 2000 requires Scottish Ministers to issue a Code of Conduct for Councillors (Councillors Code) and a Model Code of Conduct for members of devolved public bodies (Members’ Code) as listed in Schedule 3 of the Act. The updated Model Code was scrutinised by the Scottish Parliament and approved in October 2021. A further clarification was provided by letter re Category Six: Interest in Shares and securities on 20 May 2022. IJB Members have previously approved reviews to Standing Orders as noted within the document control section in Appendix 1. Regular review of key governance documents is essential to ensure the framework is in place to support good governance. Page 147 Agenda Item 13
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2 Members are asked to approve the standing orders and in line with the Model Code of Conduct agree to abide by this. The Standards Commission also provides further information for members which can be accessed at the link below. 1638785304211202AdviceNoteforMembersofHealthandSocialCareIntegratio nJointBoardsv1.pdf Members are asked to read the reviewed Standing Orders and note the consensus model of decision making and the application of the Model Code of Conduct for Devolved Public Bodies to members. Members are further are to note where consensus cannot be reached, the arrangement for voting members in that within the consensus model this is a different approach to other public bodies. Members are also asked to note that the Committee Terms of Reference are currently being reviewed at committee level and will be presented to the IJB for approval on completion. 4. RELEVANT DATA AND INDICATORS Regular meetings of the Integration Joint Board. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The Integration Joint Board requires a good governance framework to ensure it operates within guidelines. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – IJB has additional financial regulations which are regularly reviewed. 6.2 Staff Governance – not specific to this report 6.3 Clinical and Care Governance – not specific to this report 7. PROFESSIONAL ADVISORY Consultation with the Standards Officer, Governance Manager and Standards Commission. 8. EQUALITY & DIVERSITY IMPLICATIONS Good governance and an alignment with the behaviours explicit in the Model Code of Conduct ensures that the IJB is proactive in its public duties. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Not applicable to this report. 9. RISK ASSESSMENT A lack of good governance impacts on the decision making of the Integration Joint Board. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Not required for this report. 11. CONCLUSIONS Page 148
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3 The board is asked to consider the Standing orders as part of the routine review with approval sought that these remain competent to support the business of the Integration Joint Board. 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 Appendix 1 Argyll & Bute IJB Standing Orders ver 3.4 Page 149
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STANDING ORDERS ARGYLL AND BUTE INTEGRATION JOINT BOARD January 2025 Page 151
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Document control Title IJB and Committee Terms of Reference Author Integration Joint Board Creation date Document Control added May 2022 Date of version January 2025 Version history Version Comments V3.3 May 2022 Draft approved at May IJB in line with updated Model Code of Conduct V 3.4 January 2025 Reviewed and in line with current Model Code of Conduct. Update to item 2.2 j I to reflect updated unpaid carer membership. Note the previous approval to use Chief Officer instead of the standard Chief Executive. Text formatting Page 152
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1. General These Standing Orders are made under the Public Bodies (Joint Working) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. These Standing Orders shall, as far as applicable be the rules and regulations for the proceedings of Committees and working groups and therefore reference to the term ‘Board’ in the said Standing Orders should be interpreted accordingly. The term ‘Chairperson’ shall also be deemed to include the Chairperson of any Committee or working groups but only in relation to such Committees or working groups. 1.2 In these Standing Orders “the Integration Joint Board” shall mean Argyll and Bute Integration Joint Board established in terms of the (SSI 2015/88) Order 2015. ‘’The Council’’ means Argyll & Bute Council and ‘’The Health Board’’ means NHS Highland Health Board. 1.3 Any statutory provision, regulation or direction issued by the Scottish Ministers shall have precedence if they are in conflict with the Standing Orders. 2. Membership 2.1 Voting membership of the Integration Board shall comprise four NHS Highland Board members, nominated by the NHS Board, and four Elected Members of Argyll & Bute Council, (hereinafter referred to as the Council) nominated by the Council. 2.2 Non-voting membership of the Integration Board shall comprise: a. the Chief Social Work Officer of the Council; b. the Chief Officer of the Integration Joint Board; c. the proper officer of the Integration Joint Board appointed under section 95 of the Local Government (Scotland) Act 1973; d. a registered medical practitioner whose name is included in the list of primary medical services performers prepared by the Health Board in accordance with Regulations made under section 17P of the National Health Service (Scotland) Act 1978; e. a registered nurse who is employed by the Health Board or by a person or body with which the Health Board has entered into a general medical services contract; f. a registered medical practitioner employed by the Health Board and not providing primary medical services. g. one member staff from the Health Board and one member of staff from the Council engaged in the provision of services provided under integration functions; h. one member in respect of third sector bodies carrying out activities related to health or social care in the area of the local authority; i. two members in respect of service users residing in the Council area Council; j. two member in respect of persons providing unpaid care in the Council area of ; and k. such additional members as the Integration Joint Board sees fit to appoint with the proviso that a member appointed under this paragraph may not be a councillor or a member of the Health Board. The members appointed under paragraphs (d) to (f) must be determined by the Health Board. 2.3 A member of the Integration Joint Board in terms of 2.2 (a) to (c) will remain a member for as long as they hold the office in respect of which they are appointed. Otherwise, the term of office of Members of the Integration Joint Board shall be for a period of up to 3 years. Page 153
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2.4 Where a member resigns or otherwise ceases to hold office, the person appointed in his/her place shall be appointed for the unexpired term of the Member they replace. 2.5 On expiry of a member’s term of appointment the member shall be eligible for re- appointment provided that he/she remains eligible and is not otherwise disqualified from appointment. 2.6 A voting member appointed under paragraph 2.1 ceases to be a member of the Integration Joint Board if they cease to be either a Councillor or a member of the NHS Board or an Appropriate Person in terms of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 from the date they cease to be a councillor or member of NHS Board or appropriate person. 2.7 A member of the Integration Joint Board, other than those members referred to in paragraph 2.2(a) to (g, may resign his/her membership at any time during their term of office by giving notice to the Integration Joint Board in writing. The resignation shall take effect from the date notified in the notice or on the date of receipt if no date is notified. If this is a voting member the Integration Joint Board must inform the constituent authority that made the nomination. 2.8 If a member has not attended three consecutive meetings of the Integration Joint Board, and their absence was not due to illness or some other reasonable cause as determined by the Integration Joint Board, the Integration Joint Board may, by giving one month’s notice in writing to that member, remove that person from office. 2.9 If a member acts in a way which brings the Integration Joint Board into disrepute or in a way which is inconsistent with the proper performance of the functions of the Integration Joint Board, the Integration Joint Board may remove the member from office with effect from such date as the Integration Joint Board may specify in writing. 2.10 If a member is disqualified under article 8 of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 during a term of office they are to be removed from office immediately. 2.11 A constituent authority may remove a member which it nominated by providing one month’s notice in writing to the member and the Integration Joint Board. (Article 14.1) 2.12 If a member is unable to attend a meeting, a suitably experienced proxy may be appointed by the constituent authority which nominated the member. The appointment of such proxy members will be subject to the same rules and procedures for members. Proxy members shall receive papers for meetings of the Integration Joint Board and shall be entitled to attend or vote at a meeting, only in the absence of the principal member they represent. If the Chairperson or Vice Chairperson is unable to attend a meeting of the Integration Joint Board, any depute member attending the meeting may not preside over that meeting. 2.13 The acts, meetings or proceedings of the Integration Joint Board shall not be invalidated by any defect in the appointment of any member. 2.14 Where there is a temporary vacancy in the voting membership of the Integration Joint Board, the vote which would have been exercisable by a member appointed to that vacancy may be exercised jointly by the other members nominated by the relevant constituent authority. Where two or more temporary vacancies occur, or a temporary Page 154
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vacancy remains unfilled for longer than 6 months Article 13 of the Order shall be applied. Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 3. Chairperson and Vice Chairperson 3.1 The Chairperson and Vice Chairperson will be drawn from the NHS Board and the Council voting members of the Integration Joint Board. If a Council member is to serve as Chairperson then the Vice Chairperson will be a member nominated by the NHS Board and vice versa. The first Chairperson of the Integration Joint Board will be appointed on the nomination of the Council. 3.2 The appointment to Chairperson and Vice Chairperson is time limited to a period not exceeding two years and carried out on a rotational basis between Council and NHS Board appointed Chairperson, as agreed in the Integration Scheme. The Council or NHS Board may change their appointee as Chairperson or Vice Chairperson during an appointing period. 3.3 The Vice-Chairperson may act in all respects as the Chairperson of the Integration Joint Board if the Chairperson is absent or otherwise unable to perform his/her duties. 3.4 At every meeting of the Integration Joint Board or committee of the Integration Joint Board the Chairperson, if present, shall preside. If the Chairperson is absent from any meeting the Vice-Chairperson, if present, shall preside. If both the Chairperson and the Vice-Chairperson are absent, a Chairperson shall be appointed from the voting members by the voting members present for that meeting. Any proxy member attending the meeting may not preside over that meeting. 3.5 Powers, authority and duties of Chairperson and Vice-Chairperson. The Chairperson shall amongst other things:- (a) Preserve order and ensure that every member has a fair hearing; (b) Decide on matters of relevancy, competency and order, and whether to have a recess during the meeting, having taken into account any advice offered by the Chief Officer or other relevant officer in attendance at the meeting; (c) Determine the order in which speakers can be heard; (d) Ensure that due and sufficient opportunity is given to members who wish to speak to express their views on any subject under discussion; (e) If requested by any member, ask the mover of a motion, or an amendment, to state its terms; (f) Maintain order and at his/her discretion, order the exclusion of any member of the public who is deemed to have caused disorder or misbehaved; (g) The decision of the Chairperson on all matters within his/her jurisdiction shall be final; (h) Deference shall at all times be paid to the authority of the Chairperson. When he/she rises to speak, the Chairperson shall be heard without interruption; and (i) Members shall address the Chairperson while speaking; 4. Meetings 4.1 The first meeting of the Integration Joint Board will be convened at a time and place to be determined by the Chairperson. Thereafter Integration Joint Board shall meet at such place and such frequency as may be agreed by the Integration Joint Board. Page 155
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4.2 The Chairperson may convene special meetings if it appears to him/her that there are items of urgent business to be considered. Such meetings will be held at a time, date and venue as determined by the Chairperson. If the Office of Chairperson is vacant, or if the Chairperson is unable to act for any reason the Vice-Chairperson may at any time call such a meeting. 4.3 If the Chairperson refuses to call a meeting of the Integration Joint Board after a requisition for that purpose specifying the business proposed to be transacted, signed by at least two thirds of the voting members, has been presented to the Chairperson or if, without so refusing, the Chairperson does not call a meeting within seven days after such requisition has been presented, those members who presented the requisition may forthwith call a meeting provided no business shall be transacted at the meeting other than specified in the requisition. 4.4 Adequate provision will be made to allow for members to attend a meeting of the Integration Joint Board or a committee of the Integration Joint Board either by being present together with other members in a specified place, or in any other way which enables members to participate despite not being present with other members in a specified place. 5. Notice of Meeting 5.1 Before each meeting of the Integration Joint Board, or a committee of the Integration Joint Board, a notice of the meeting, specifying the time, place and business to be transacted at it and agreed by the Chairperson, or by a member authorised by the Chairperson to agree on his/her behalf, shall be delivered to every member by electronic means so as to be available to them at least five full working days before the meeting. Failure of service of the notice on any member shall not affect the validity of anything done at a meeting. 5.2 In the case of a meeting of the Integration Joint Board called by members in default of the Chairperson, the notice is to be signed by those members who requisitioned the meeting. 5.3 At all ordinary or special meetings of the Integration Joint Board, no business other than that on the agenda shall be discussed or adopted except where by reason of special circumstances, which shall be specified in the minutes, the Chairperson is of the opinion that the item should be considered at the meeting as a matter of urgency. 6. Quorum 6.1 No business shall be transacted at a meeting of the Integration Joint Board unless there are present, and entitled to vote both Council and NHS Board members and at least one half of the voting members of the Integration Joint Board are present. 6.2 If within ten minutes after the time appointed for the commencement of a meeting of the Integration Joint Board, a quorum is not present, the meeting will stand adjourned to such date and time as may be fixed and the minute of the meeting will disclose the fact. 7. Codes of Conduct and Conflicts of Interest 7.1 Members of the Integration Joint Board shall subscribe to and comply with both the Standards in Public Life - Code of Conduct for Members of Devolved Public Bodies and Councillors Code of Conduct and Guidance made in respect thereto which are deemed to be incorporated into these Standing Orders. All members who are not already bound Page 156
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by the terms of either Code shall be obliged before taking up membership, to agree in writing to be bound by the terms of the Code of Conduct for Members of Devolved Public Bodies. 7.2 If any member has a financial or non-financial interest as defined in the Councillors’ Code of Conduct or the Code of Conduct of Members of Devolved Public Bodies and is present at any meeting at which the matter is to be considered, he/she must as soon as practical, after the meeting starts, disclose that he/she has an interest and the nature of that interest and if he/she is precluded from taking part in consideration of that matter. 7.3 If a member or any associate of theirs has any pecuniary or any other interest direct or indirect, in any contract or proposed contract or other matter and that member is present at a meeting of the Integration Joint Board, that member shall disclose the fact and the nature of the relevant interest and shall not be entitled to vote on any question with respect to it. A member shall not be treated as having any interest in any contract or matter if it cannot reasonably be regarded as likely to significantly affect or influence the voting by that member on any question with respect to that contract or matter. 7.4 Where an interest is disclosed, the other members present at the meeting in question must decide whether the member declaring the interest is to be prohibited from taking part in discussion of or voting on the item of business. 8. Adjournment of Meetings 8.1 A meeting of the Integration Joint Board may be adjourned to another date, time or place by a motion, which shall be moved and seconded and put to the meeting without discussion. If such a motion is carried by a simple majority of those present and entitled to vote, the meeting shall be adjourned to the day, time and place specified in the motion. In addition the Chairperson may adjourn the meeting at their sole discretion. 9. Disclosure of Information 9.1 No member or officer shall disclose to any person any information which falls into the following categories:- • Confidential information within the meaning of Section 50(a) (2) of the Local Government (Scotland) Act 1973. • The full document, or any part of any document marked “not for publication by virtue of the appropriate paragraph of Part 1 of Schedule 7A of the Local Government (Scotland) Act 1973, unless and until the document has been made available to the public or press under section 50B of the said 1973 Act. • Any information regarding proceedings of the Integration Joint Board from which the public have been excluded unless or until disclosure has been authorised by the Integration Joint Board or the information has been made available to the press or to the public under the terms of the relevant legislation. 9.2 Without prejudice to the foregoing no member shall use or disclose to any person any confidential and/or exempt information coming to his/her knowledge by virtue of his/her office as a member where such disclosure would be to the advantage of the member or of anyone known to him/her or which would be to the disadvantage of the Integration Joint Board. Page 157
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10. Recording of Proceedings No sound, film, video tape, digital or photographic recording of the proceedings of any meeting shall be made without prior written approval of the Integration Joint Board. 11. Admission of Press and Public 11.1 Subject to the extent of the accommodation available and except in relation to items certified as exempt, meetings of the Integration Joint Board shall be open to the public. The Chief Officer shall be responsible for giving public notice of the time and place of each meeting of the Integration Joint Board by posting within the main offices of the Integration Joint Board not less than five days before the date of each meeting. 11.2 The Integration Joint Board may by resolution at any meeting exclude the press and public during consideration of any item of business where it is likely, in view of the nature of the business to be transacted or of the nature of the proceedings, that if members of the press and public were present there would be a disclosure to them of exempt information as defined in Schedule 7(A) of the Local Government (Scotland) Act 1973 Act or it is likely that confidential information would be disclosed in breach of an obligation of confidence. 11.3 Every meeting of the Integration Joint Board shall be open to the public but these provisions shall be without prejudice to the Integration Joint Board’s powers of exclusion in order to suppress or prevent disorderly conduct or other misbehaviour at a meeting. The Integration Joint Board may exclude or eject from a meeting a member or members of the press and public whose presence or conduct is impeding the work or proceedings of the Integration Joint Board. 12. Alteration, Deletion and Rescission of Decisions of the Integration Joint Board Except insofar as required by reason of illegality, no motion to alter, delete or rescind a decision of the Integration Joint Board will be competent within six months from the decision, unless a decision is made prior to consideration of the matter to suspend this Standing Order in terms of Standing Order 13. 13. Suspension, Deletion or Amendment of Standing Orders Any one or more of the Standing Orders in the case of emergency as determined by the Chairperson upon motion may be suspended, amended or deleted at any meeting so far as regards any business at such meeting provided that two thirds of the members of the Integration Joint Board present and voting shall so decide. Any motion to suspend Standing Orders shall state the number or terms of the Standing Order(s) to be suspended. 14. Motions, Amendment and Debate 14.1 It will be competent for any Member of the Integration Joint Board at a meeting of the Integration Joint Board to move a motion directly arising out of the business before the meeting. 14.2 No member, with the exception of the mover of the motion or amendment, will speak supporting the motion or amendment until the same will have been seconded. Page 158
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14.3 Subject to the right of the mover of a motion, and the mover of an amendment, to reply, no member will speak more than once on the same question at any meeting of the Integration Joint Board except:- • On a question of Order • With the permission of the Chairperson • In explanation or to clear up a misunderstanding in some material part of his/her speech. In all of the above cases no new matter will be introduced. 14.4 The mover of an amendment and thereafter the mover of the original motion will have the right of reply for a period of not more than 5 minutes. He/she will introduce no new matter and once a reply in commenced, no other member will speak on the subject of debate. Once these movers have replied, the discussion will be held closed and the Chairperson will call for the vote to be taken. 14.5 Amendments must be relevant to the motions to which they relate and no member will be at liberty to move or second more than one amendment to any motion, unless the mover of an amendment has failed to have it seconded. 14.6 It will be competent for any member who has not already spoken in a debate to move the closure of such debate. On such motion being seconded, the vote will be taken, and if a majority of the members present vote for the motion, the debate will be closed. However, closure is subject to the right of the mover of the motion and of the amendment(s) to reply. Thereafter, a vote will be taken immediately on the subject of the debate. 14.7 Any member may indicate his/her desire to ask a question or offer information immediately after a speech by another member and it will be the option of the member to whom the question would be directed or information offered to decline or accept the question or offer of information. 14.8 When a motion is under debate, no other motion or amendment will be moved except in the following circumstances: • to adjourn the debate; or • to close the debate. 14.9 A motion or amendment once moved and seconded cannot be altered or withdrawn unless with the consent of the majority of those present. 14.10 Any member who wishes to propose a motion for consideration by the Integration Joint Board shall give written notice of that motion to the Chairperson, at least 10 full working days prior to the meeting. 15. Voting 15.1 The IJB operating principle is partnership, cooperation and collaboration and members’ task will be to ensure that the IJB operates by consensus in its decision making where possible. 15.2 Only the four members nominated by the NHS Board, and the four members appointed by the Council shall be entitled to vote. Voting shall be by show of hands. Page 159
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15.3 In the case of an equality of votes the Chairperson shall not have a second or casting vote. Where there is more than one amendment then the voting will proceed until one proposition has obtained an overall majority of the members taking part in the vote. In such a circumstance the proposition with the fewest votes will drop out and a further vote or votes will be taken on those that remain until the overall majority is achieved or there is only a motion and amendment before the meeting in which case the proposition with the most votes will prevail. If the voting members do not agree at the time on a proposed means of resolving a dispute at a meeting of the Integration Joint Board the matter will be continued to the next meeting of the Integration Joint Board and if there is no resolution at that further meeting then the matter shall be dealt with in terms of the formal dispute resolution mechanism specified in the Integration Scheme. Standing Order 12 shall not preclude reconsideration of any such item within the 6 month period following the meeting which failed to reach a decision. 16. Minutes 16.1 The names of the members and others attending a meeting of the Integration Joint Board shall be recorded in the minutes of the meeting. 16.2 The minutes of the proceedings of each meeting of the Integration Joint Board or a committee, including any decision or resolution made by that meeting, shall be drawn up and submitted to the next ensuing meeting of the Integration Joint Board or the committee after which they must be signed by the person presiding at that meeting. A minute purporting to be so signed shall be received in evidence without further proof. 17. Committees and Working Groups 17.1 The Integration Joint Board may establish any committee or working group as may be required from time to time but each working group shall have a defined time span as may be determined by the Integration Joint Board. 17.2 The membership, Chairperson, remit, powers and quorum of any committee or working groups will be determined by the Integration Joint Board. Any committee established must include voting members, and must include an equal number of the voting members appointed by the Health Board on the one hand and the Council on the other hand. Any decision relating to the carrying out of functions under the Act or to integration functions taken by a committee established under 17.1 must be agreed by a majority of the votes of the voting members who are members of the committee 17.3 Agendas for consideration at a committee or working group will be issued by electronic means to all members no later than five days (not including Saturday and Sunday) prior to the start of the meeting. Page 160
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Model Code of Conduct for Members of Devolved Public Bodies December 2021 Page 161
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2 CONTENTS Section 1: Introduction to the Model Code of Conduct My Responsibilities Enforcement Section 2: Key Principles of the Model Code of Conduct Section 3: General Conduct Respect and Courtesy Remuneration, Allowances and Expenses Gifts and Hospitality Confidentiality Use of Public Body Resources Dealing with my Public Body and Preferential Treatment Appointments to Outside Organisations Section 4: Registration of Interests Category One: Remuneration Category Two: Other Roles Category Three: Contracts Category Four: Election Expenses Category Five: Houses, Land and Buildings Category Six: Interest in Shares and Securities Category Seven: Gifts and Hospitality Category Eight: Non–Financial Interests Category Nine: Close Family Members Section 5: Declaration of Interests Stage 1: Connection Stage 2: Interest Stage 3: Participation Section 6: Lobbying and Access ANNEXES Annex A Breaches of the Code Annex B Definitions Page 162
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3 Section 1: Introduction To The Model Code Of Conduct 1.1 This Code has been issued by the Scottish Ministers, with the approval of the Scottish Parliament, as required by the Ethical Standards in Public Life etc. (Scotland) Act 2000 (the “Act”). 1.2 The purpose of the Code is to set out the conduct expected of those who serve on the boards of public bodies in Scotland. 1.3 The Code has been developed in line with the nine key principles of public life in Scotland. The principles are listed in Section 2 and set out how the provisions of the Code should be interpreted and applied in practice. My Responsibilities 1.4 I understand that the public has a high expectation of those who serve on the boards of public bodies and the way in which they should conduct themselves in undertaking their duties. I will always seek to meet those expectations by ensuring that I conduct myself in accordance with the Code. 1.5 I will comply with the substantive provisions of this Code, being sections 3 to 6 inclusive, in all situations and at all times where I am acting as a board member of my public body, have referred to myself as a board member or could objectively be considered to be acting as a board member. 1.6 I will comply with the substantive provisions of this Code, being sections 3 to 6 inclusive, in all my dealings with the public, employees and fellow board members, whether formal or informal. 1.7 I understand that it is my personal responsibility to be familiar with the provisions of this Code and that I must also comply with the law and my public body’s rules, standing orders and regulations. I will also ensure that I am familiar with any guidance or advice notes issued by the Standards Commission for Scotland (“Standards Commission”) and my public body, and endeavour to take part in any training offered on the Code. 1.8 I will not, at any time, advocate or encourage any action contrary to this Code. 1.9 I understand that no written information, whether in the Code itself or the associated Guidance or Advice Notes issued by the Standards Commission, can provide for all circumstances. If I am uncertain about how the Code applies, I will seek advice from the Standards Officer of my public body, failing whom the Chair or Chief Executive of my public body. I note that I may also choose to seek external legal advice on how to interpret the provisions of the Code. Enforcement 1.10 Part 2 of the Act sets out the provisions for dealing with alleged breaches of the Code, including the sanctions that can be applied if the Standards Commission finds that there has been a breach of the Code. More information on how complaints are dealt with and the sanctions available can be found at Annex A. Page 163
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4 Section 2: Key Principles Of The Model Code Of Conduct 2.1 The Code has been based on the following key principles of public life. I will behave in accordance with these principles and understand that they should be used for guidance and interpreting the provisions in the Code. 2.2 I note that a breach of one or more of the key principles does not in itself amount to a breach of the Code. I note that, for a breach of the Code to be found, there must also be a contravention of one or more of the provisions in sections 3 to 6 inclusive of the Code. The key principles are: Duty I have a duty to uphold the law and act in accordance with the law and the public trust placed in me. I have a duty to act in the interests of the public body of which I am a member and in accordance with the core functions and duties of that body. Selflessness I have a duty to take decisions solely in terms of public interest. Imust not act in order to gain financial or other material benefit for myself, family or friends. Integrity I must not place myself under any financial, or other, obligation to any individual or organisation that might reasonably be thought to influence me in the performance of my duties. Objectivity I must make decisions solely on merit and in a way that is consistent with the functions of my public body when carrying out public business including making appointments, awarding contracts or recommending individuals for rewards and benefits. Accountability and Stewardship I am accountable to the public for my decisions and actions. I have a duty to consider issues on their merits, taking account of the views of others and I must ensure that my public body uses its resources prudently and in accordance with the law. Openness I have a duty to be as open as possible about my decisions andactions, giving reasons for my decisions and restricting information only when the wider public interest clearly demands. Honesty I have a duty to act honestly. I must declare any private interests relating to my public duties and take steps to resolve any conflicts arising in a way that protects the public interest. Leadership I have a duty to promote and support these principles by leadership and example, and to maintain and strengthen the public’s trust and confidence in the integrity of my public body and its members in conducting public business. Page 164
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5 Respect I must respect all other board members and all employees of my public body and the role they play, treating them with courtesy at all times. Similarly, I must respect members of the public when performing my duties as a board member. Page 165
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6 Section 3: General Conduct Respect and Courtesy 3.1 I will treat everyone with courtesy and respect. This includes in person, in writing, at meetings, when I am online and when I am using social media. 3.2 I will not discriminate unlawfully on the basis of race, age, sex, sexual orientation, gender reassignment, disability, religion or belief, marital status or pregnancy/maternity; I will advance equality of opportunity and seek to foster good relations between different people. 3.3 I will not engage in any conduct that could amount to bullying or harassment (which includes sexual harassment). I accept that such conduct is completely unacceptable and will be considered to be a breach of this Code. 3.4 I accept that disrespect, bullying and harassment can be: a) a one-off incident, b) part of a cumulative course of conduct; or c) a pattern of behaviour. 3.5 I understand that how, and in what context, I exhibit certain behaviours can be as important as what I communicate, given that disrespect, bullying and harassment can be physical, verbal and non-verbal conduct. 3.6 I accept that it is my responsibility to understand what constitutes bullying and harassment and I will utilise resources, including the Standards Commission’s guidance and advice notes, my public body’s policies and training material (where appropriate) to ensure that my knowledge and understanding is up to date. 3.7 Except where it is written into my role as Board member, and / or at the invitation of the Chief Officer, I will not become involved in operational management of my public body. I acknowledge and understand that operational management is the responsibility of the Chief Officer and Executive Team. 3.8 I will not undermine any individual employee or group of employees, or raise concerns about their performance, conduct or capability in public. I will raise any concerns I have on such matters in private with senior management as appropriate. 3.9 I will not take, or seek to take, unfair advantage of my position in my dealings with employees of my public body or bring any undue influence to bear on employees to take a certain action. I will not ask or direct employees to do something which I know, or should reasonably know, could compromise them or prevent them from undertaking their duties properly and appropriately. 3.10 I will respect and comply with rulings from the Chair during meetings of: a) my public body, its committees; and b) any outside organisations that I have been appointed or nominated to by my public body or on which I represent my public body. Page 166
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7 3.11 I will respect the principle of collective decision-making and corporate responsibility. This means that once the Board has made a decision, I will support that decision, even if I did not agree with it or vote for it. Remuneration, Allowances and Expenses 3.12 I will comply with the rules, and the policies of my public body, on the payment of remuneration, allowances and expenses. Gifts and Hospitality 3.13 I understand that I may be offered gifts (including money raised via crowdfunding or sponsorship), hospitality, material benefits or services (“gift or hospitality”) that may be reasonably regarded by a member of the public with knowledge of the relevant facts as placing me under an improper obligation or being capable of influencing my judgement. 3.14 I will never ask for or seek any gift or hospitality. 3.15 I will refuse any gift or hospitality, unless it is: a) a minor item or token of modest intrinsic value offered on an infrequent basis; b) a gift being offered to my public body; c) hospitality which would reasonably be associated with my duties as a board member; or d) hospitality which has been approved in advance by my public body. 3.16 I will consider whether there could be a reasonable perception that any gift or hospitality received by a person or body connected to me could or would influence my judgement. 3.17 I will not allow the promise of money or other financial advantage to induce me to act improperly in my role as a board member. I accept that the money or advantage (including any gift or hospitality) does not have to be given to me directly. The offer of monies or advantages to others, including community groups, may amount to bribery, if the intention is to induce me to improperly perform a function. 3.18 I will never accept any gift or hospitality from any individual or applicant who is awaiting a decision from, or seeking to do business with, my public body. 3.19 If I consider that declining an offer of a gift would cause offence, I will accept it and hand it over to my public body at the earliest possible opportunity and ask for it to be registered. 3.20 I will promptly advise my public body’s Standards Officer if I am offered (but refuse) any gift or hospitality of any significant value and / or if I am offered any gift or hospitality from the same source on a repeated basis, so that my public body can monitor this. 3.21 I will familiarise myself with the terms of the Bribery Act 2010, which provides for offences of bribing another person and offences relating to being bribed. Page 167
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8 Confidentiality 3.22 I will not disclose confidential information or information which should reasonably be regarded as being of a confidential or private nature, without the express consent of a person or body authorised to give such consent, or unless required to do so by law. I note that if I cannot obtain such express consent, I should assume it is not given. 3.23 I accept that confidential information can include discussions, documents, and information which is not yet public or never intended to be public, and information deemed confidential by statute. 3.24 I will only use confidential information to undertake my duties as a board member. I will not use it in any way for personal advantage or to discredit my public body (even if my personal view is that the information should be publicly available). 3.25 I note that these confidentiality requirements do not apply to protected whistleblowing disclosures made to the prescribed persons and bodies as identified in statute. Use of Public Body Resources 3.26 I will only use my public body’s resources, including employee assistance, facilities, stationery and IT equipment, for carrying out duties on behalf of the public body, in accordance with its relevant policies. 3.27 I will not use, or in any way enable others to use, my public body’s resources: a) imprudently (without thinking about the implications or consequences); b) unlawfully; c) for any political activities or matters relating to these; or d) improperly. Dealing with my Public Body and Preferential Treatment 3.28 I will not use, or attempt to use, my position or influence as a board member to: a) improperly confer on or secure for myself, or others, an advantage; b) avoid a disadvantage for myself, or create a disadvantage for others or c) improperly seek preferential treatment or access for myself or others. 3.29 I will avoid any action which could lead members of the public to believe that preferential treatment or access is being sought. 3.30 I will advise employees of any connection, as defined at Section 5, I may have to a matter, when seeking information or advice or responding to a request for information or advice from them. Page 168
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9 Appointments to Outside Organisations 3.31 If I am appointed, or nominated by my public body, as a member of another body or organisation, I will abide by the rulesof conduct and will act in the best interests of that body or organisation while acting as a member of it. I will also continue to observe the rules of this Code when carrying out the duties of that body or organisation. 3.32 I accept that if I am a director or trustee (or equivalent) of a company or a charity, I will be responsible for identifying, and taking advice on, any conflicts of interest that may arise between the company or charity and my public body. Page 169
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10 Section 4: Registration Of Interests 4.1 The following paragraphs set out what I have to register when I am appointed and whenever my circumstances change. The register covers my current term of appointment. 4.2 I understand that regulations made by the Scottish Ministers describe the detail and timescale for registering interests; including a requirement that a board member must register their registrable interests within one month of becoming a board member, and register any changes to those interests within one month of those changes having occurred. 4.3 The interests which I am required to register are those set out in the following paragraphs. Other than as required by paragraph 4.23, I understand it is not necessary to register the interests of my spouse or cohabitee. Category One: Remuneration 4.4 I will register any work for which I receive, or expect to receive, payment. I have a registrable interest where I receive remuneration by virtue of being: a) employed; b) self-employed; c) the holder of an office; d) a director of an undertaking; e) a partner in a firm; f) appointed or nominated by my public body to another body; or g) engaged in a trade, profession or vocation or any other work. 4.5 I understand that in relation to 4.4 above, the amount of remuneration does not require to be registered. I understand that any remuneration received as a board member of this specific public body does not have to be registered. 4.6 I understand that if a position is not remunerated it does not need to be registered under this category. However, unremunerated directorships may need to be registered under Category Two, “Other Roles”. 4.7 I must register any allowances I receive in relation to membership of any organisation under Category One. 4.8 When registering employment as an employee, I must give the full name of the employer, the nature of its business, and the nature of the post I hold in the organisation. 4.9 When registering remuneration from the categories listed in paragraph 4.4 (b) to (g) above, I must provide the full name and give details of the nature of the business, organisation, undertaking, partnership or other body, as appropriate. I recognise that some other employments may be incompatible with my role as board member of my public body in terms of paragraph 6.7 of this Code. Page 170
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11 4.10 Where I otherwise undertake a trade, profession or vocation, or any other work, the detail to be given is the nature of the work and how often it is undertaken. 4.11 When registering a directorship, it is necessary to provide the registered name and registered number of the undertaking in which the directorship is held and provide information about the nature of its business. 4.12 I understand that registration of a pension is not required as this falls outside the scope of the category. Category Two: Other Roles 4.13 I will register any unremunerated directorships where the body in question is a subsidiary or parent company of an undertaking in which I hold a remunerated directorship. 4.14 I will register the registered name and registered number of the subsidiary or parent company or other undertaking and the nature of its business, and its relationship to the company or other undertaking in which I am a director and from which I receive remuneration. Category Three: Contracts 4.15 I have a registerable interest where I (or a firm in which I am a partner, or an undertaking in which I am a director or in which I have shares of a value as described in paragraph 4.19 below) have made a contract with my public body: a) under which goods or services are to be provided, or works are to be executed; and b) which has not been fully discharged. 4.16 I will register a description of the contract, including its duration, but excluding the value. Category Four: Election Expenses 4.17 If I have been elected to my public body, then I will register a description of, and statement of, any assistance towards election expenses relating to election to my public body. Category Five: Houses, Land and Buildings 4.18 I have a registrable interest where I own or have any other right or interest in houses, land and buildings, which may be significant to, of relevance to, or bear upon, the work and operation of my public body. Page 171
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12 4.19 I accept that, when deciding whether or not I need to register any interest I have in houses, land or buildings, the test to be applied is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as being so significant that it could potentially affect my responsibilities to my public body and to the public, or could influence my actions, speeches or decision- making. Category Six: Interest in Shares and Securities 4.20 I have a registerable interest where: a) I own or have an interest in more than 1% of the issued share capital of the company or other body; or b) Where, at the relevant date, the market value of any shares and securities (in any one specific company or body) that I own or have an interest in is greater than £25,000. Category Seven: Gifts and Hospitality 4.21 I understand the requirements of paragraphs 3.13 to 3.21 regarding gifts and hospitality. As I will not accept any gifts or hospitality, other than under the limited circumstances allowed, I understand there is no longer the need to register any. Category Eight: Non–Financial Interests 4.22 I may also have other interests and I understand it is equally important that relevant interests such as membership or holding office in other public bodies, companies, clubs, societies and organisations such as trades unions and voluntary organisations, are registered and described. In this context, I understand non- financial interests are those which members of the public with knowledge of the relevant facts might reasonably think could influence my actions, speeches, votes or decision-making in my public body (this includes its Committees and memberships of other organisations to which I have been appointed or nominated by my public body). Category Nine: Close Family Members 4.23 I will register the interests of any close family member who has transactions with my public body or is likely to have transactions or do business with it. Page 172
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13 Section 5: Declaration Of Interests Stage 1: Connection 5.1 For each particular matter I am involved in as a board member, I will first consider whether I have a connection to that matter. 5.2 I understand that a connection is any link between the matter being considered and me, or a person or body I am associated with. This could be a family relationship or a social or professional contact. 5.3 A connection includes anything that I have registered as an interest. 5.4 A connection does not include being a member of a body to which I have been appointed or nominated by my public body as a representative of my public body, unless: a) The matter being considered by my public body is quasi-judicial or regulatory; or b) I have a personal conflict by reason of my actions, my connections or my legal obligations. Stage 2: Interest 5.5 I understand my connection is an interest that requires to be declared where the objective test is met – that is where a member of the public with knowledge of the relevant facts would reasonably regard my connection to a particular matter as being so significant that it would be considered as being likely to influence the discussion or decision-making. Stage 3: Participation 5.6 I will declare my interest as early as possible in meetings. I will not remain in the meeting nor participate in any way in those parts of meetings where I have declared an interest. 5.7 I will consider whether it is appropriate for transparency reasons to state publicly where I have a connection, which I do not consider amounts to an interest. 5.8 I note that I can apply to the Standards Commission and ask it to grant a dispensation to allow me to take part in the discussion and decision-making on a matter where I would otherwise have to declare an interest and withdraw (as a result of having a connection to the matter that would fall within the objective test). I note that such an application must be made in advance of any meetings where the dispensation is sought and that I cannot take part in any discussion or decision- making on the matter in question unless, and until, the application is granted. 5.9 I note that public confidence in a public body is damaged by the perception that decisions taken by that body are substantially influenced by factors other than the public interest. I will not accept a role or appointment if doing so means I will have to declare interests frequently at meetings in respect of my role as a board member. Similarly, if any appointment or nomination to another body would give rise to objective concern because of my existing personal involvement or affiliations, I will not accept the appointment or nomination. Page 173
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14 Section 6: Lobbying And Access 6.1 I understand that a wide range of people will seek access to me as a board member and will try to lobby me, including individuals, organisations and companies. I must distinguish between: a) any role I have in dealing with enquiries from the public; b) any community engagement where I am working with individuals and organisations to encourage their participation and involvement, and; c) lobbying, which is where I am approached by any individual or organisation who is seeking to influence me for financial gain or advantage, particularly those who are seeking to do business with my public body (for example contracts/procurement). 6.2 In deciding whether, and if so how, to respond to such lobbying, I will always have regard to the objective test, which is whether a member of the public, with knowledge of the relevant facts, would reasonably regard my conduct as being likely to influence my, or my public body’s, decision-making role. 6.3 I will not, in relation to contact with any person or organisation that lobbies, do anything which contravenes this Code or any other relevant rule of my public body or any statutory provision. 6.4 I will not, in relation to contact with any person or organisation that lobbies, act in any way which could bring discredit upon my public body. 6.5 If I have concerns about the approach or methods used by any person or organisation in their contacts with me, I will seek the guidance of the Chair, Chief Executive or Standards Officer of my public body. 6.6 The public must be assured that no person or organisation will gain better access to, or treatment by, me as a result of employing a company or individual to lobby on a fee basis on their behalf. I will not, therefore, offer or accord any preferential access or treatment to those lobbying on a fee basis on behalf of clients compared with that which I accord any other person or organisation who lobbies or approaches me. I will ensure that those lobbying on a fee basis on behalf of clients are not given to understand that preferential access or treatment, compared to that accorded to any other person or organisation, might be forthcoming. 6.7 Before taking any action as a result of being lobbied, I will seek to satisfy myself about the identity of the person or organisation that is lobbying and the motive for lobbying. I understand I may choose to act in response toa person or organisation lobbying on a fee basis on behalf of clients but it is important that I understand the basis on which I am being lobbied in order to ensure that any action taken in connection with the lobbyist complies with the standards set out in this Code and the Lobbying (Scotland) Act 2016. Page 174
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15 6.8 I will not accept any paid work: a) which would involve me lobbying on behalf of any person or organisation or any clients of a person or organisation. b) to provide services as a strategist, adviser or consultant, for example, advising on how to influence my public body and its members. This does not prohibit me from being remunerated for activity which may arise because of, or relate to, membership of my public body, such as journalism or broadcasting, or involvement in representative or presentational work, such as participation in delegations, conferences or other events. Page 175
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16 Annex A: Breaches Of The Code Introduction 1. The Ethical Standards in Public Life etc. (Scotland) Act 2000 (“the Act”) provided for a framework to encourage and, where necessary, enforce high ethical standards in public life. 2. The Act provided for the introduction of new codes of conduct for local authority councillors and members of relevant public bodies, imposing on councils and relevant public bodies a duty to help their members comply with the relevant code. 3. The Act and the subsequent Scottish Parliamentary Commissions and Commissioners etc. Act 2010 established the Standards Commission for Scotland (“Standards Commission”) and the post of Commissioner for Ethical Standards in Public Life in Scotland (“ESC”). 4. The Standards Commission and ESC are separate and independent, each with distinct functions. Complaints of breaches of a public body’s Code of Conduct are investigated by the ESC and adjudicated upon by the Standards Commission. 5. The first Model Code of Conduct came into force in 2002. The Code has since been reviewed and re-issued in 2014. The 2021 Code has been issued by the Scottish Ministers following consultation, and with the approval of the Scottish Parliament, as required by the Act. Investigation of Complaints 6. The ESC is responsible for investigating complaints about members of devolved public bodies. It is not, however, mandatory to report a complaint about a potential breach of the Code to the ESC. It may be more appropriate in some circumstances for attempts to be made to resolve the matter informally at a local level. 7. On conclusion of the investigation, the ESC will send a report to the Standards Commission. Hearings 8. On receipt of a report from the ESC, the Standards Commission can choose to: • Do nothing; • Direct the ESC to carry out further investigations; or • Hold a Hearing. 9. Hearings are held (usually in public) to determine whether the member concerned has breached their public body’s Code of Conduct. The Hearing Panel comprises of three members of the Standards Commission. The ESC will present evidence and/or make submissions at the Hearing about the investigation and any conclusions as to whether the member has contravened the Code. The member is entitled to attend or be represented at the Hearing and can also present evidence and make Page 176
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17 submissions. Both parties can call witnesses. Once it has heard all the evidence and submissions, the Hearing Panel will make a determination about whether or not it is satisfied, on the balance of probabilities, that there has been a contravention of the Code by the member. If the Hearing Panel decides that a member has breached their public body’s Code, it is obliged to impose a sanction. Sanctions 10. The sanctions that can be imposed following a finding of a breach of the Code are as follows: • Censure: A censure is a formal record of the Standards Commission’s severe and public disapproval of the member concerned. • Suspension: This can be a full or partial suspension (for up to one year). A full suspension means that the member is suspended from attending all meetings of the public body. Partial suspension means that the member is suspended from attending some of the meetings of the public body. The Commission can direct that any remuneration or allowance the member receives as a result of their membership of the public body be reduced or not paid during a period of suspension. • Disqualification: Disqualification means that the member is removed from membership of the body and disqualified (for a period not exceeding five years), from membership of the body. Where a member is also a member of another devolved public body (as defined in the Act), the Commission may also remove or disqualify that person in respect of that membership. Full details of the sanctions are set out in section 19 of the Act. Interim Suspensions 11. Section 21 of the Act provides the Standards Commission with the power to impose an interim suspension on a member on receipt of an interim report from the ESC about an ongoing investigation. In making a decision about whether or not to impose an interim suspension, a Panel comprising of three Members of the Standards Commission will review the interim report and any representations received from the member and will consider whether it is satisfied: • That the further conduct of the ESC’s investigation is likely to be prejudiced if such an action is not taken (for example if there are concerns that the member may try to interfere with evidence or witnesses); or • That it is otherwise in the public interest to take such a measure. A policy outlining how the Standards Commission makes any decision under Section 21 and the procedures it will follow in doing so, should any such a report be received from the ESC can be found here. 12. The decision to impose an interim suspension is not, and should not be seen as, a finding on the merits of any complaint or the validity of any allegations against a member of a devolved public body, nor should it be viewed as a disciplinary measure. Page 177
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18 Annex B: Definitions “Bullying” is inappropriate and unwelcome behaviour which is offensive and intimidating, and which makes an individual or group feel undermined, humiliated or insulted. "Chair" includes Board Convener or any other individual discharging a similar function to that of a Chair or Convener under alternative decision-making structures. “Code” is the code of conduct for members of your devolved public body, which is based on the Model Code of Conduct for members of devolved public bodies in Scotland. "Cohabitee" includes any person who is living with you in a relationship similar to that of a partner, civil partner, or spouse. “Confidential Information” includes: • any information passed on to the public body by a Government department (even if it is not clearly marked as confidential) which does not allow the disclosure of that information to the public; • information of which the law prohibits disclosure (under statute or by the order of a Court); • any legal advice provided to the public body; or • any other information which would reasonably be considered a breach of confidence should it be made public. "Election expenses" means expenses incurred, whether before, during or after the election, on account of, or in respect of, the conduct or management of the election. “Employee” includes individuals employed: • directly by the public body; • as contractors by the public body, or • by a contractor to work on the public body’s premises. “Gifts” a gift can include any item or service received free of charge, or which may be offered or promised at a discounted rate or on terms not available to the general public. Gifts include benefits such as relief from indebtedness, loan concessions, or provision of property, services or facilities at a cost below that generally charged to members of the public. It can also include gifts received directly or gifts received by any company in which the recipient holds a controlling interest in, or by a partnership of which the recipient is a partner. “Harassment” is any unwelcome behaviour or conduct which makes someone feel offended, humiliated, intimidated, frightened and / or uncomfortable. Harassment can be experienced directly or indirectly and can occur as an isolated incident or as a course of persistent behaviour. Page 178
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19 “Hospitality” includes the offer or promise of food, drink, accommodation, entertainment or the opportunity to attend any cultural or sporting event on terms not available to the general public. “Relevant Date” Where a board member had an interest in shares at the date on which the member was appointed as a member, the relevant date is – (a) that date; and (b) the 5th April immediately following that date and in each succeeding year, where the interest is retained on that 5th April. “Public body” means a devolved public body listed in Schedule 3 of the Ethical Standards in Public Life etc. (Scotland) Act 2000, as amended. “Remuneration" includes any salary, wage, share of profits, fee, other monetary benefit or benefit in kind. “Securities” a security is a certificate or other financial instrument that has monetary value and can be traded. Securities includes equity and debt securities, such as stocks bonds and debentures. “Undertaking” means: a) a body corporate or partnership; or b) an unincorporated association carrying on a trade or business, with or without a view to a profit. Page 179
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20 Classification: OFFICIAL © Crown copyright 2021 This publication (Model Code of Conduct for Devolved Public Bodies) is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG ISBN: 978-1-80201-741-0 (web only) Published by The Scottish Government, December 2021 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS987066 (12/21) Page 180
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1 Integration Joint Board Date of Meeting: 29 January 2025 Title of Report: Category 1 Responder Assurance Update Presented by: Charlotte Craig The Board is asked to: ▪ Review progress against the recommendations made in last year’s report ▪ Be advised of assurance in the delivery of the duty ▪ Note that Strategic/operational Risk Registers inform capacity to respond 1. EXECUTIVE SUMMARY The role and duties of the Integration Joint Board are contained in appendix 1. The IJB receives an annual report for assurance with six monthly reporting to the Audit and Risk Committee. The HSCP participate in local and regional resilience partnerships and benefit from partnership professional advisory on the HSCP support and role in response. The HSCP is an active participant and using the recommendations has sought to embed its role in the resilience partnership. While there has been some development over the course of the year in the planning and delivery of exercises it remains imperative that the HSCP staff continue to play an active role, are active in training and exercises and ensure that the partnership approach provides the best opportunity for response for communities in Argyll & Bute in shared resource. The proposal into the next year would be to maintain the approach in supporting planning, planned exercises and indeed in response and learning from response. The HSCP will ensure it remains an active partner. 2. RECOMMENDATIONS The IJB is invited to review progress for assurance noting six monthly reporting to the Audit and risk Committee. 3. DETAIL OF REPORT The report will seek to provide an update for assurance on the delivery of the IJB’s duty in partnership. Page 181 Agenda Item 14
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2 In January 2024 the IJB was presented with an initial assurance update which made a range of recommendations for activity over the course of the next twelve months in relation to the IJB’s duties (link below). ARGYLL & BUTE CHP FINANCE DEPARTMENT The IJB while a public body with operational and strategic responsibility does not employ health and social care staff and as such responding staff are the same resource available to partners who also are Category 1 responders. This report will address the previous recommendations and note any additional activity. 1. The HSCP will work closely within Local Resilience Partnership (LRP) to ensure that it fully represents risk within health and social care services as part of the wider response The HSCP continues to attend as an active partner of the Local Resilience Partnership supporting delivery of the workplan. It has contributed feedback when requested and proactively in planning. 2. Monitoring of staff training completion, participation in exercises to support and evidence locality capacity, plan, do and review process to ensure continual improvement. Training in Emergency Centre response and Incident Management was completed in May 2024, several staff were trained in supporting a Casualty Bureau for an exercise in November 2024. Staff have also participated in a number of exercises and events which has delivered excellent learning opportunities. The HSCP has participated in exercise planning with Oban Airport exercises and worked in conjunction with Police Scotland and the Wider LRP to deliver a draft Sever weather plan for Argyll and Bute with additional professional advisory from the Head of Resilience NHS Highland and West of Scotland LRP. Initial conversations have taken place in respect of shared practice in developing Caring for People response. In addition the HSCP co-hosted with NHS Highland a master’s level student in Emergency Planning for University of Stirling who undertook a review of integrated approach. 3. Develop an HSCP assurance framework supported by the partnership for consideration at Audit and Risk Committee and reported to the to the IJB At this stage the assurance is measured by the assurance frameworks applied to existing Category 1 responders. This is being reviewed at national level for a cross cutting standard. Further update to the IJB in 2026. 4. Review HSCP warning and informing routes and ensure that senior leadership teams are aware of the need to develop and disseminate risk-based community information in line with national guidance provided in response. HSCP on call staff are shared with a wider group of stakeholders and the development of multi-agency relationships and communication networks has improved warning and informing networks – particularly in relation to severe weather. Communications are tested regularly through events and staff are Page 182
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3 more aware of the balance of national and agency led communications pre, during and post response. Regular updates are provided to the LRP Emergency Directory. 5. Include this within the assurance framework for the IJB to ensure that plans are in place to communicate the appropriate hazards and threats faced by the local community. Testing and participating in local plans enables communication with consistent key messages disseminated for developing preparedness. The ability of the IJB/HSCP to influence at the planning stage impacts on the messaging positively. This is reported six monthly to the Audit and Risk Committee and annually to the IJB. 6. Review best practice in the inclusion of IJB alongside HSCP representatives within Local and Regional Resilience Partnerships The annual review of IJB preparedness was undertaken with the Argyll & Bute HSCP supporting this exercise as part of the Scottish Government working group. Officers continue to participate on behalf of IJB’s as required. Officers continue to attend network groups for shared practice. 7. Review availability of senior managers within the HSCP to take part within a Resilience Partnership during an extended response Review and confirm the role of the IJB during an incident Active participation in exercises has seen a measured approach to response however the review of the on call function is likely to yield a clearer identification of need, training requirements and allocation of resource during response and potential for prolonged response. There is an on call review ongoing. 8. Completion of the planned PARD approach to the management of vulnerable people data both before and during an incident PARD was tested during the Evening Star exercise. Data and GIS mapping is available but still some work required in finessing it alongside the weekly vulnerable people updates and reading the data provided alongside other agencies who may present data in different ways. 9. Invite feedback from agency partners on any improvement and information sharing not already governed. Scottish Government conducted its annual review of IJB’s as previously noted to look at the embed of the Category 1 responder duty and were content with development to date. Participation in exercises is highly beneficial and hugely enjoyable for staff also giving the opportunity to create and consolidate multi agency relationships supporting relational practice. 10. Review of the on call pack and approach to response utilising current planning and identified need. The on call function and pack is under review with a small working group of senior on call. An analysis of activity will be completed in February 2025 which will aim to elicit where activity is generated, what it is and whether this can be addressed by training or standard operating procedures. This will be the first building block for the review. Page 183
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4 4. RELEVANT DATA AND INDICATORS Eclipse has capacity to identify PARD data for GIS mapping. 5. CONTRIBUTION TO STRATEGIC PRIORITIES Supports meeting a duty allocated to the IJB and supports partnership working and wider resilience. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact - none 6.2 Staff Governance - none 6.3 Clinical and Care Governance – considered as response requires 7. PROFESSIONAL ADVISORY Officers of the HSCP meet on an informal basis fortnightly with the Council and NHS resilience managers to share risk, practice, local intelligence and support relational practice. This offers the benefit to the IJB of regular professional advisory. 8. EQUALITY & DIVERSITY IMPLICATIONS The diverse needs of communities and communities of interest require to be considered in the planning of response. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE PARD data sharing is supported by inter agency data sharing agreements and specific guidance during response. 9. RISK ASSESSMENT The LRP have considered the National Risk Register applying the identified risks to Argyll & Bute. Resilience partnerships also have a Community Risk Register which is updated by partners. National Risk Register 2025 - GOV.UK Community Risk Register | Ready Scotland Risk Assessments and Legislation On 16 January the Scottish Government also issued a response to the UK Covid-19 inquiry’s first set of recommendations. There are 10 recommendations for the four UK nations including risk assessment and improving pandemic response. Work underway to strengthen response to civil emergencies - gov.scot Ensure that business continuity and response is taking cognisance of the wider strategic and operational risk and potential impact on response. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT None specific to this report however the IJB should note that Communities are encouraged to have their own resilience plans supported by Local Authorities. Page 184
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5 11. CONCLUSIONS The IJB continues to develop its capacity in delivering this duty. It requires to continue to resource and work in partnership with Local Authority and NHS and the wider resilience partnership to ensure it can participate in multi- agency response. 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 185
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6 Appendix 1 Role of Integration Joint Boards (IJBs) IJBs are identified as Category 1 responders under Schedule 1 Part 2 17A of the Civil Contingencies Act (2004). IJBs employ no specific staff and own no facilities, and their business-as-usual function is to offer strategic direction to Health Boards through Health and Social Care Partnerships (HSCPs). They primarily operate a strategic and planning role in their relationships with Health Boards and Local Authorities. This strategic function should be recognised in emergency planning, where IJBs should play a key role in preparing the strategy for responses. Part of this strategic planning should involve considerations of service recovery at the appropriate stage of the emergency response. By contributing a strategic view to emergency response, IJBs can identify solutions to be delivered during an emergency, but their primary function should be the strategic planning of emergency responses, supporting and co-ordinating with Health Board and Local Authority preparations. Duties 1. Carry out a risk assessment and contribute to the development of a community risk register. 2. Plan for emergencies, including training and exercising. 3. Ensure robust business continuity arrangements are in place to maintain service delivery. 4. Ensure arrangements are in place to warn & inform the public both before and during emergencies. 5. Co-operate with partner agencies. 6. Share information with partner agencies Page 186
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OFFICIAL NHS Highland Meeting: Board Meeting Meeting date: 24 September 2024 Title: Quarter 1 Whistleblowing Report Responsible Executive/Non-Executive: Gareth Adkins, Director of People & Culture Report Author: Gareth Adkins, Director of People & Culture 1 Purpose This is presented to the committee for: Assurance This report relates to a: Legal requirement This report will align to the following NHSScotland quality ambition(s): Safe, Effective and Person Centred This report relates to the following Strategic Outcome(s) Start Well Thrive Well Stay Well Anchor Well Grow Well Listen Well X Nurture Well Plan Well Care Well Live Well Respond Well Treat Well Journey Well Age Well End Well Value Well Perform well X Progress well Page 187 Agenda Item 15
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OFFICIAL 2 Report summary 2.1 Situation This report is for Quarter 1 covering the period 1st April – 30th June 2024. This is provided to give assurance to the Board of our performance against the Whistleblowing Standards which have been in place since April 2021. 2.2 Background All NHS Scotland organisations including Health and Social Care Partnerships are required to follow the National Whistleblowing Principles and Standards which came into effect from 1 April 2021. Any organisation providing an NHS service should have procedures in place that enable their staff, students, volunteers, and others delivering health services, to access the National Whistleblowing Standards. As part of the requirements, reports are required to be presented to the Board and relevant Committees and IJBs, on an annual basis, in addition to quarterly reports. The Staff Governance Committee plays a critical role in ensuring the Whistleblowing Standards are adhered to in respect of any service delivered on behalf of NHS Highland. Both quarterly and annual reports are presented at the meetings and robust challenge and interrogation of the content takes place. The Guardian Service provide our Whistleblowing Standards confidential contacts service. The Guardian Service will ensure: that the right person within the organisation is made aware of the concern that a decision is made by the dedicated officers of NHS Highland and recorded about the status and how it is handled that the concern is progressed, escalating if it is not being addressed appropriately that the person raising the concern is: - kept informed as to how the investigation is progressing - advised of any extension to timescales - advised of outcome/decision made - advised of any further route of appeal to the Independent National Whistleblowing Office (INWO) that the information recorded will form part of the quarterly and annual board reporting requirements for NHS Highland. Staff can also raise concerns directly with: their line manager The whistleblowing champion The executive whistleblowing lead Page 188
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OFFICIAL Trade union representatives also provide an important route for raising concerns. In the context of whistleblowing standards the trade union representatives can assist staff in deciding if: an appropriate workforce policy process could be used including early resolution whistleblowing policy and procedures could be used to explore and resolve concerns that involve wrongdoing or harm Information is also included in the NHS Highland Induction, with training modules still available on Turas. The promotion and ongoing development of our whistleblowing, listening and speak up services is a core element of the Together We Care Strategy and Annual Delivery Plan. 2.3 Assessment In the Q1 Whistleblowing reporting period 1st April – 30th June 2024: 1 new case has been raised 1 new concern was raised with the whistleblowing executive lead but not progressed under the standards 1 Monitored referral was closed 4 cases remained open and under investigation One new case was raised in relation to issues that are well known to the board and the challenges associated with delivering a service sustainably including long waiting lists. The individuals raising the concerns wanted the concerns investigated under the whistleblowing standards. Whilst it could have been considered not in the public interest to investigate the concerns under the standards it was decided to formally respond under the standards to acknowledge, uphold the concerns and communicate the actions the board were taking to address the well-known concerns. This was discussed with the whistleblowers and they agreed that the outcome they were seeking was acknowledgement of the concerns and information on what action the board was taking. The final response remained under discussion at the end of the quarter but has since been concluded at the time of this report. One new concern was raised in relation to issues that are well known to the board and the challenges associated with delivering a service sustainably. Discussions with the individual raising the concerns resulting in arranging further discussions with senior management to ensure they were engaged in the ongoing work to find a solution to the service sustainability issues. This was not progressed under the standards. This was discussed with the individual they Page 189
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OFFICIAL agreed that the outcome they were seeking was acknowledgement of the concerns and information on what action the board was taking. These two cases were discussed at the Staff Governance Committee in relation to the process and not the details in line with protecting confidentiality. The discussion raised important questions around responding to concerns that are well known to the board and whether further investigation is required. In these cases it was agreed with the whistleblowers that this was not necessary and the outcome they were seeking was assurance that plans were in place to address the concerns. This has been a useful learning experience within the context of administering the standards and highlighted that concerns can be raised and acknowledged under the standards without necessarily undertaking lengthy or complex investigations where this detail is already known. The important point here is that the whisteblowers have had an opportunity to ensure the concerns are known about and we have been prompted to review action plans in place and provide that information back to the whistleblowers. Two monitored referrals were received in quarter 2. These were two linked cases where the individuals chose to contact INWO as they were not satisfied that their issues had been resolved through a previous Whistleblowing Case investigated through National Education for Scotland. The whistleblowing standards were raised through a grievance raised in October 2022 and specifically referenced issues that dated back a number of years. The executive lead reviewed these cases and decided to time bar them based on the 6 month time period for reporting issues unless there are exceptional circumstances. In addition a significant amount of work had been undertaken to address issues following the NES investigation. However, the individuals were offered the opportunity to submit a new account of concerns under the standards if they felt that there were issues they were still encountering now or had happened in the last 6 months. There has been no further contact from one of the individuals since the referrals were not accepted. However, one individual contacted INWO to raise concerns with the referral not being accepted. INWO has requested we provide further information on the range of work undertaken to address the issues raised in the original grievance. Further information has been collated and will be discussed with the individual. There has been no direct contact with the individual and delays are occurring due to difficulties contacting the complainant via their trade union representative. A follow-up contact with the complainant’s trade union representative has not resulted in any further action. INWO have written to us to close the monitored referral given there has been no further contact with them or with us for many months. 4 cases remain under investigation at the end of the quarter with one concluded at the time of this report. Page 190
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OFFICIAL Compliance with the timescales within the standards remains a challenge due to the complexity of the investigations required. However, since our improvement action plan was implemented we have improved our administration of the process including ensuring regular updates to the complainants. The nomination of investigators has improved with the introduction of the triage stage with the Director of Nursing and AHPs and the medical director as it enables quick identification of the person with the most relevant experience and skills to the case. The quality of the investigations as well as the expertise and commitment of the investigators in the cases investigated this calendar year should be noted and commended. 2.4 Proposed level of Assurance This report proposes the following level of assurance: Substantial Moderate X Limited None Comment on the level of assurance The committee is asked to take moderate assurance on basis of robust process but noting the challenge of meeting the 20 working days within the standards. 3 Impact Analysis 3.1 Quality/ Patient Care The Whistleblowing Standards are designed to support timely and appropriate reporting of concerns in relation to Quality and Patient Care and ensure we take action to address and resolve these. 3.2 Workforce Our workforce has additional protection in place under these standards. 3.3 Financial The Whistleblowing Standards also offer another route for addressing allegations of a financial nature 3.4 Risk Assessment/Management The risks of the implementation have been assessed and included. 3.5 Data Protection The standards require additional vigilance on protecting confidentiality 3.6 Equality and Diversity, including health inequalities No issues identified currently Page 191
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OFFICIAL 3.7 Other impacts None 3.8 Communication, involvement, engagement and consultation N/A 3.9 Route to the Meeting N/A 4 Recommendation Moderate Assurance – To give confidence of compliance with legislation, policy and Board objectives noting challenges with timescales due to the complexity of cases and investigations. 4.1 List of appendices The following appendices are included with this report: Page 192
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OFFICIAL NHS Highland Meeting: NHS Highland Board Meeting date: 26 November 2024 Title: Quarter 2 Whistleblowing Report Responsible Executive/Non-Executive: Gareth Adkins, Director of People & Culture Report Author: Gareth Adkins, Director of People & Culture 1 Purpose This is presented to the committee for: · Assurance This report relates to a: · Legal requirement This report will align to the following NHSScotland quality ambition(s): Safe, Effective and Person Centred This report relates to the following Strategic Outcome(s) Start Well Thrive Well Stay Well Anchor Well Grow Well Listen Well X Nurture Well Plan Well Care Well Live Well Respond Well Treat Well Journey Well Age Well End Well Value Well Perform well X Progress well OFFICIAL Page 1 of 7 Page 193
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OFFICIAL 2 Report summary 2.1 Situation This report is for Quarter 2 covering the period 1st July – 30th September 2024. This is provided to give assurance to the Board of our performance against the Whistleblowing Standards which have been in place since April 2021. 2.2 Background All NHS Scotland organisations including Health and Social Care Partnerships are required to follow the National Whistleblowing Principles and Standards which came into effect from 1 April 2021. Any organisation providing an NHS service should have procedures in place that enable their staff, students, volunteers, and others delivering health services, to access the National Whistleblowing Standards. As part of the requirements, reports are required to be presented to the Board and relevant Committees and IJBs, on an annual basis, in addition to quarterly reports. The Staff Governance Committee plays a critical role in ensuring the Whistleblowing Standards are adhered to in respect of any service delivered on behalf of NHS Highland. Both quarterly and annual reports are presented at the meetings and robust challenge and interrogation of the content takes place. The Guardian Service provide our Whistleblowing Standards confidential contacts service. The Guardian Service will ensure: · that the right person within the organisation is made aware of the concern · that a decision is made by the dedicated officers of NHS Highland and recorded about the status and how it is handled · that the concern is progressed, escalating if it is not being addressed appropriately · that the person raising the concern is: - kept informed as to how the investigation is progressing - advised of any extension to timescales - advised of outcome/decision made - advised of any further route of appeal to the Independent National Whistleblowing Office (INWO) · that the information recorded will form part of the quarterly and annual board reporting requirements for NHS Highland. Staff can also raise concerns directly with: · their line manager · The whistleblowing champion · The executive whistleblowing lead OFFICIAL Page 2 of 7 Page 194
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OFFICIAL Trade union representatives also provide an important route for raising concerns. In the context of whistleblowing standards the trade union representatives can assist staff in deciding if: · an appropriate workforce policy process could be used including early resolution · whistleblowing policy and procedures could be used to explore and resolve concerns that involve wrongdoing or harm Information is also included in the NHS Highland Induction, with training modules still available on Turas. The promotion and ongoing development of our whistleblowing, listening and speak up services is a core element of the Together We Care Strategy and Annual Delivery Plan. 2.3 Assessment Summary of Q2 Whistleblowing reporting covering the period 1st July – 30th September 2024 · No new cases have been raised. · 1 case remains open and under investigation. · 1 concern remains under discussion with the individual to agree best way forwards · 3 cases were closed. One new case raised in quarter 1 in relation to issues that are known to the board has been formally responded to and closed. The concerns related to the challenges associated with delivering a service sustainably including long waiting lists. The outcome the individuals were seeking was assurance that actions were underway or would be progressed to address these challenges. The response outlined the actions the board are taking including ‘relaunching’ the programme board to engage wider stakeholders and move actions forwards in partnership. One new concern remains under discussion in relation to whether a whistleblowing investigation is required as there have been two separate reviews of the service that have acknowledged the concerns raised. Work has been underway associated with these reviews to explore with other NHS boards sustainable options for delivering the service. These discussions continue at a national level and the individual is involved in these discussions. The concerns relate to the pace of change and progress towards finding a solution and we continue to engage with the individual to provide assurance that this issue is being addressed. OFFICIAL Page 3 of 7 Page 195
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OFFICIAL 2 further cases were closed both with partially upheld outcomes in relation to the concerns raised. In one case we have had confirmation that the individual is content with the outcome. The other case the report has been provided to the individual and they have indicated they are considering whether to refer to INWO. 1 case remains under investigation at the end of the quarter. Compliance with the timescales within the standards remains a challenge due to the complexity of the investigations required. However, since our improvement action plan was implemented we have improved our administration of the process including ensuring regular updates to the complainants. The nomination of investigators has improved with the introduction of the triage stage with the Director of Nursing and AHPs and the medical director as it enables quick identification of the person with the most relevant experience and skills to the case. The quality of the investigations as well as the expertise and commitment of the investigators in the cases investigated this calendar year should be noted and commended. Following discussion at the last staff governance committee it was agreed that consideration would be given to how to provide feedback through governance mechanisms on the recommendations from concluded cases. The table in appendix 1 summarises the cases with recommendations that are still in progress and the governance arrangements. It is worth noting that recommendations are dependent on the specific context and circumstances and the associated governance arrangements will vary. However, a review date has been set for the whistleblowing function to check with those tasked with the recommendations on progress to date. This will include considering whether the work requires a further review date set. 2.4 Proposed level of Assurance This report proposes the following level of assurance: Substantial Moderate Limited None Comment on the level of assurance OFFICIAL Page 4 of 7 X Page 196
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OFFICIAL The Board is asked to take moderate assurance on basis of robust process but noting the challenge of meeting the 20 working days within the standards. 3 Impact Analysis 3.1 Quality/ Patient Care The Whistleblowing Standards are designed to support timely and appropriate reporting of concerns in relation to Quality and Patient Care and ensure we take action to address and resolve these. 3.2 Workforce Our workforce has additional protection in place under these standards. 3.3 Financial The Whistleblowing Standards also offer another route for addressing allegations of a financial nature 3.4 Risk Assessment/Management The risks of the implementation have been assessed and included. 3.5 Data Protection The standards require additional vigilance on protecting confidentiality 3.6 Equality and Diversity, including health inequalities No issues identified currently 3.7 Other impacts None 3.8 Communication, involvement, engagement and consultation N/A 3.9 Route to the Meeting Staff Governance Committee meeting 5 November 2024A 4 Recommendation The Board is invited to take Moderate Assurance and take confidence of compliance with legislation, policy and Board objectives noting challenges with timescales due to the complexity of cases and investigations. 4.1 List of appendices Appendix 1 – Case Recommendations and Governance Summary: OFFICIAL Page 5 of 7 Page 197
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OFFICIAL Appendix 1 – Case Recommendations and Governance Summary Case ID Summary Recommendations Actions Governance Arrangements Review date WB02 2022-23 INWO review · improve our concern handling · to apologise to complainant · carry out a review of specific patient feedback. · Improvements progressed as part of speaking up action plan · Apology issued · Review of patient feedback being progressed · Whistleblowing · Clinical Governance ·Complete ·Complete ·End of October 2024 WB09 2023-24 Concerns raised in relation to contractor use and procurement practices in a service · Review process for approving and engaging contractors to cover workforce shortages in specialist non-clinical roles · Review procurement processes in service area · SLWG setup to review contractor processes including senior sign off · Review of procurement processes by procurement team · Whistleblowing/St aff Governance ·End of February 2025 WB11 2023-24 Concerns raised in relation to: · organisational change policy implementation · Clinical practice and supervision · Undertake a review of service provision and produce recommendations on any changes required · Review training and competency framework · Adopt new organisational professional assurance framework · Undertake organisational development with teams to rebuild trust and promote psychologically safe workplace · SLWG to be set up to progress all actions · Organisational development support commissioned · Clinical Governance ·End of February 2025 WB12 2023-24 Concerns raised in relation to: · Service sustainability · Waiting lists · Staffing levels · Provide confirmation of actions underway and planned to address concerns · Include whistleblowers in stakeholder engagement and/or programme board/governance · Programme board relaunched · Whistleblowers invited to participate · Clinical Governance ·Complete OFFICIAL Page 6 of 7 Page 198
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OFFICIAL OFFICIAL Page 7 of 7 WB13 2023-24 Concerns raised in relation to a community hospital: · Raising concerns through clinical governance · Effective management of concerns raised through clinical governance · Communication and engagement of staff in clinical governance · Review and strengthen clinical governance arrangements within the hospital including raising concerns and involving staff in clinical governance activities locally · Improve communication to staff on clinical governance improvement plans · Strengthen multi-disciplinary working including MDT meetings, ward rounds and note keeping · Improve senior nursing staff visibility · Review opportunities to link with community dementia team and provide inreach to hospital · SLWG set up to progress actions including senior nursing leadership · Clinical Governance ·End of January 2025 Page 199
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ID Date of Meeting Title of Report EQIA Required Author/Contact Presented By Decision (with/without Direction) / Info Comments Date 10 27/03/2024 Budget Proposal Yes James Gow James Gow Instructed the Chief Officer to accept Funding Offers from NHS Highland and Argyll and Bute Council and issue formal directions as detailed in the draft of the submitted report with proposed amendment. Complete 27/03/2024 11 27/03/2024 Budget direction James Gow James Gow 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 2024 to 31 March 2025. 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 2024 to 31 March 2025 will be £275,475,000 Complete 22/04/2024 12 27/03/2024 Budget direction James Gow James Gow 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 2024 to 31 March 2025. 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 Complete 11/04/2024 Page 201 Agenda Item 16
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