Public reports pack
Argyll and Bute Council · 27 November 2024
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 27 November 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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20 November 2024 NOTICE OF MEETING A meeting of the ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) will be held BY MICROSOFT TEAMS on WEDNESDAY, 27 NOVEMBER 2024 at 1:00 PM, which you are requested to attend. BUSINESS 1. APOLOGIES FOR ABSENCE 2. DECLARATIONS OF INTEREST (IF ANY) 3. MINUTES (Pages 3 - 10) Argyll and Bute Integration Joint Board held on 25 September 2024 4. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Finance and Policy Committee held on 27 September 2024 (Pages 11 - 16) (b) Argyll and Bute HSCP Finance and Policy Committee held on 22 November 2024 - to follow 5. CHIEF OFFICER REPORT (Pages 17 - 24) Report by Chief Officer 6. INTEGRATION JOINT BOARD MEMBERSHIP AND ADVISORY (Pages 25 - 28) Report by Business Improvement Manager 7. FINANCE Reports by Head of Finance (a) Budget Monitoring - 7 months to 31 October 2024 (Pages 29 - 42) (b) Budget Update 2025/26 (Pages 43 - 58) (c) Climate Change Reporting 2023/24 (Pages 59 - 80) 8. Q2 WORKFORCE REPORT 2024/25 (Pages 81 - 96) Report by Deputy Director of People 9. ARGYLL AND BUTE HSCP PERFORMANCE REPORT FQ1 2024/25 (Pages 97 - 112) Report by Head of Strategic Planning, Performance and Technology 10. INTEGRATED DISCHARGE - TO FOLLOW Report by Head of Adults – Health and Community Care Public Document Pack
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11. PUBLIC HEALTH ANNUAL REPORT 2023 TO 2024 (Pages 113 - 142) Report by Associate Director of Public Health 12. UPDATE - RENEWAL OF JOINT STRATEGIC PLAN (Pages 143 - 148) Report by Head of Strategic Planning, Performance and Technology 13. DRAFT PROGRAMME OF MEETINGS 2025/26 (Pages 149 - 150) Report by Business Improvement Manager 14. DATE OF NEXT MEETING Wednesday 29 January 2025 Argyll and Bute HSCP Integration Joint Board (IJB) Contact: Hazel MacInnes, Senior Committee Officer Tel:01546 604269
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MINUTES of MEETING of ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) held BY MICROSOFT TEAMS on WEDNESDAY, 25 SEPTEMBER 2024 Present: Councillor Dougie McFadzean, Argyll and Bute Council (Chair) Councillor Kieron Green, Argyll and Bute Council Graham Bell, NHS Highland Non-Executive Board Member (Vice Chair) Emily Austin, NHS Highland Non-Executive Board Member Karen Leach, NHS Highland Non-Executive Board Member Susan Ringwood, NHS Highland Non-Executive Board Member Evan Beswick, Chief Officer, Argyll and Bute HSCP Fiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health) Linda Currie, Associate Director AHP, NHS Highland David Gibson, Chief Social Worker / Head of Children and Families and Justice, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Rebecca Helliwell, Associate Medical Director, Argyll and Bute HSCP Elizabeth Higgins, Associate Nurse Director, Argyll and Bute HSCP Kenny Mathieson, Public Representative Alison McGrory, Associate Director of Public Health, Argyll and Bute HSCP Angus McTaggart, GP Representative, Argyll and Bute HSCP Kirstie Reid, Carers Representative, NHS Highland Fiona Thomson, Lead Pharmacist, NHS Highland Tracey White, Carers Representative, NHS Highland Attending: Gareth Adkins, Director of People and Culture Gaye Boyd, Deputy Director of People and Culture Caroline Cherry, Head of Adult Services, Argyll and Bute HSCP Fiona Duff, Interim Head of Primary Care Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP Tracy McFall, Chair, Argyll and Bute Alcohol and Drugs Partnership Hazel MacInnes, Senior Committee Officer, Argyll and Bute Council Katie McKenzie, Committee Services Officer, Argyll and Bute Council David Ritchie, Communications Manager, Argyll and Bute HSCP Mandy Sheridan, Service Improvement Officer, Argyll and Bute HSCP Angela Tillery, Principal Accountant, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE Apologies for absence were received from Councillor Gary Mulvaney, Councillor Ross Moreland, Julie Hodges, Kevin McIntosh, Takki Sulaiman and Charlotte Craig. 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. Page 3 Agenda Item 3
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3. MINUTES The Minutes of the meeting of the Argyll and Bute Integration Joint Board held on 29 May 2024 were approved as a correct record. 4. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Strategic Planning Group held on 13 June 2024 The Minutes of the meeting of the HSCP Strategic Planning Group held on 13 June 2024 were noted. In the absence of the Chair, Ross Moreland, the Co-Chair, Kristin Gillies advised that the Minutes were an accurate representation of the meeting and that the Performance Report would be presented to the IJB later in the meeting. (b) Argyll and Bute HSCP Audit and Risk Committee held on 18 June 2024 The Minutes of the meeting of the HSCP Audit and Risk Committee held on 18 June 2024 were noted. The Chair, Councillor Kieron Green, advised that a number of agreed actions had been repeatedly delayed but the Committee have received assurances from officers on their capacity to take them forward. (c) Argyll and Bute HSCP Finance and Policy Committee held on 28 June 2024 The Minutes of the meeting of the HSCP Finance and Policy Committee held on 28 June 2024 were noted. (d) Argyll and Bute HSCP Clinical and Care Governance Committee held on 15 August 2024 The Minutes of the meeting of the HSCP Clinical and Care Governance Committee held on 15 August 2024 were noted. The Chair, Graham Bell, advised there had been two further meetings of the Committee scheduled this year but this had now been reduced to one meeting in November to give a more realistic timescale for actions to be completed. (e) Argyll and Bute HSCP Strategic Planning Group held on 12 September 2024 The Minutes of the meeting of the HSCP Strategic Planning Group held on 12 September 2024 were noted. The Chair, Kristin Gillies, advised that this had been a productive meeting with items including the Joint Strategic Needs Assessment, the Islands Strategy and the Engagement Progress Report being presented. There had been discussion around the needs assessment for haemodialysis in Argyll and Bute. (f) Argyll and Bute HSCP Audit and Risk Committee held on 17 September 2024 Page 4
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The Minutes of the meeting of the HSCP Audit and Risk Committee held on 17 September 2024 were noted. 5. INTEGRATION JOINT BOARD MEMBERS The Chair welcomed Tracey White to her first meeting and offered his congratulations on her appointment following the interview process. The Board then gave consideration to a report advising of the requirement to periodically review and recruit new members. Decision The Integration Joint Board – 1. appointed Tracey White to the Integration Joint Board as the second unpaid carer representative following an interview process; 2. welcomed the nomination of and confirmed appointment of Dr Duncan Scott as Secondary Care Medical representative by NHS Highland; 3. appointed Dr Scott to the Clinical and Care Governance Committee; 4. appointed Ms White to the Finance and Policy Committee; and 5. appointed Ms Reid to the Strategic Planning Group. (Reference: Report by Business Improvement Manager dated 15 September 2024, submitted) Kirstie Reid joined the meeting during consideration of the following item of business. 6. CHIEF OFFICER'S REPORT The Chair offered his congratulations to the Chief Officer following his recent appointment. The Board then gave consideration to the first report from the Chief Officer which included detail under the following headings – Launch of Carers Strategy for 2024-2027, Health & Care Staffing Act, Safe Quality Care Programme, Social Work Review, Releasing Time to Care in Argyll and Bute, Planet Youth in Argyll and Bute, Care at Home Services Inspection, Neurodevelopmental Paediatric Service, Protecting Infants from Severe Lung Disease, Supporting People with High Blood Pressure, National Engagement on NHS Reform, New Training Facility for NHS Scotland Workforce, Lochgilphead Medical Centre Receives MOD Award, Technology Enabled Care Team awarded Bronze Digital Award, Furnace and Inveraray Medical Practice, Health and Care Experience Survey, Three Month Drone Trial, Interim Head of Primary Care and Senior Manager Strategic Estates Development & Sustainability. Decision The Integration Joint Board noted the content of the report from the Chief Officer. (Reference: Report by Chief Officer dated 25 September 2024, submitted) Page 5
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7. FINANCE (a) Budget Monitoring - 4 months to 31 July 2024 The Board gave consideration to a report providing a summary of the financial position as at the end of month 4 and a forecast for the year. Decision The Integration Joint Board – 1. noted that the HSCP had overspent its budget by £0.8m; 2. noted that an overspend of £2.3m was forecast; 3. noted actions were required to reduce spend and additional funding was likely to be required from Argyll & Bute Council who hold pension saving resource on behalf of the IJB; 4. noted that savings of £4.2m had been delivered, 64% of target; 5. noted that reserves of £10.1m had been allocated including the £4.7m sustainability funding; and 6. noted the risks associated with the financial position and challenges across the Health and Care Sector. (Reference: Report by Head of Finance dated 25 September, submitted) (b) Budget Outlook 2025-26 and Update The Board gave consideration to a report detailing an estimate of the budget gap for 2025/26 and a summary of progress made in developing plans to achieve a balanced budget. Decision The Integration Joint Board – 1. noted that budget planning for 2025/26 was on-going and national budgeting intentions were not yet available; 2. noted the HSCP was not currently operating on a financially sustainable basis; 3. noted the estimated budget gap and provisional savings target of £11.5m for 2025/26; and 4. noted the on-going work and next steps in the budget preparation process. (Report by Head of Finance dated 25 September 2024, submitted) 8. STRATEGIC RISK REGISTER Page 6
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The Board gave consideration to a report recommending changes to the Strategic Risk Register to reflect perceived increasing risk. The report also sought to reduce the overall number of risks described within the Register. Decision The Integration Joint Board – 1. noted that the Strategic Risk Register had been reviewed by the Leadership Team and the Audit and Risk Committee; 2. noted that it was recommended that Infrastructure Risk was added to the very high Strategic Risks; and 3. reviewed and approved the Strategic Risk Register and Risk Appetite. (Reference: Report by Head of Finance dated 25 September 2024, submitted) 9. ARGYLL AND BUTE HSCP ANNUAL PERFORMANCE REPORT 2023/24 The Board gave consideration to a report detailing the Annual Performance Report (APR) which set out how the HSCP were improving on the National Health and Wellbeing Outcomes. The APR also included a core suite of national indicators which contextualised the data and provided a comparative and broader picture of local performance. Decision The Integration Joint Board noted the Annual Performance Report for the Health and Social Care Partnership for the year 2023/24. (Reference: Report by Head of Strategic Planning, Performance and Technology dated 25 September 2024, submitted) 10. Q1 WORKFORCE REPORT 2024/25 The Board gave consideration to a report detailing workforce data of the HSCP as at 30 June 2024 and providing the current demographic position, highlighting trends and advising of changes and progress made, as well as actions taken to address areas of concern. Decision The Integration Joint Board noted the content of the report. (Reference: Report by Deputy Director of People and Culture dated 25 September 2024, submitted) 11. ANNUAL WHISTLEBLOWING REPORT 2023-2024 The Board gave consideration to a report detailing the 3rd Annual Whistleblowing Report which would be submitted to the Independent National Whistleblowing Officer following board approval. Decision Page 7
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The Integration Joint Board approved substantial assurance based on the content and format of the annual whistleblowing report, which demonstrated compliance with the reporting requirements under the standards. (Reference: Report by Deputy Director of People and Culture dated 25 September 2024, submitted) 12. CHIEF SOCIAL WORK OFFICER REPORT 2023 - 2024 The Board gave consideration to a report outlining the requirement for the Chief Social Work Officer to provide an annual report to Scottish Government. It was due in the autumn and related to the previous financial year. Decision The Integration Joint Board noted the content of the Chief Social Work Officer Report 2023/2024. (Reference: Report by Chief Social Work Officer dated 25 September 2024, submitted) 13. CHILD POVERTY ACTION PLAN REVIEW 2023-24 The Board gave consideration to a report reviewing the Child Poverty Action Plan as required by the 2017 Child Poverty (Scotland) Act. Decision The Integration Joint Board – 1. considered the report; and 2. noted and acknowledged the route through Council for approval. (Reference: Report by Head of Children, Families and Justice, CSWO dated 25 September 2024, submitted) 14. ARGYLL AND BUTE ALCOHOL AND DRUG PARTNERSHIP ANNUAL REPORT AND SCOTTISH GOVERNMENT ANNUAL SURVEY 2023 TO 2024 The Board gave consideration to an annual report detailing a wide range of work delivered by the Argyll and Bute Alcohol and Drug Partnership. The report followed the development session held in May where the IJB had been given an opportunity to explore the work of the Partnership in more detail. Decision The Integration Joint Board – 1. noted the content of the Argyll and Bute Alcohol and Drug Partnership Annual Report (2023-2024); and Page 8
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2. noted the Scottish Government Annual Survey 2023 – 2024 and formally approved it in retrospect. (Reference: Report by Associate Director of Public Health dated 25 September 2024, submitted) 15. ENGAGEMENT AND COMMUNICATIONS ANNUAL REPORT The Board gave consideration to an annual report outlining how the HSCP had been communicating timely, relevant and accurate information over the last year and how this linked in with the HSCP’s visions, aims and priorities for health and social care services in Argyll and Bute as detailed in the Joint Strategic Plan 2022-25. Decision The Integration Joint Board – 1. noted the engagement and communications activity delivered by the HSCP; 2. noted the engagement activity in line with national guidance Planning with People; and 3. noted the 35 areas of engagement were service change rather than major service change in accordance with Planning with People. (Reference: Report by Associate Director of Public Health, and Communications Manager dated 25 September 2024, submitted) 16. DATE OF NEXT MEETING The Integration Joint Board noted the date of the next meeting as Wednesday 27 November 2024. Page 9
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held BY MICROSOFT TEAMS on FRIDAY, 27 SEPTEMBER 2024 Present: Councillor Dougie McFadzean (Chair) Graham Bell (Vice Chair) Kenny Mathieson Karen Leach Fiona Thomson 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 David Gibson. Chief Social Worker / Head of Children and Families and Justice, Argyll and Bute HSCP Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Hazel MacInnes, Senior Committee Officer, Argyll and Bute Council Alison McGrory, Associate Director of Public Health, Argyll and Bute HSCP Katie McKenzie, Committee Services Officer, Argyll and Bute Council Angela Tillery, Principal Accountant, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE Apologies for absence were received from Councillor Gary Mulvaney. 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. 3. MINUTES The Minutes of the Meeting of the Finance and Policy Committee held on 28 June 2024 were approved as a correct record. The Head Strategic Planning, Performance and Transformation noted that she had not been present at the meeting therefore the Head of Finance had presented her report at Item 9 – Transformation Board Update. Kenny Mathieson joined the meeting during consideration of the following item of business. Page 11 Agenda Item 4a
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4. BUDGET MONITORING - 5 MONTHS TO 31 AUGUST 2024 The Committee gave consideration to a report providing a summary of the financial position as at the end of month 5 and a forecast for the year. Decision The Finance and Policy Committee – 1. noted that the HSCP had overspent its budget by £961k; 2. noted that an overspend of £2.1m was forecast; 3. noted actions were required to reduce spend and additional funding was likely to be required from Argyll & Bute Council who hold pension saving resource on behalf of the IJB; 4. noted that savings of £4.4m had been delivered, 67% of target; 5. noted that reserves of £10.2m had been allocated; and 6. noted the risks associated with the financial position and challenges across the Health and Care Sector. (Reference: Report by Head of Finance dated 27 September 2024, submitted) 5. BUDGET OUTLOOK AND BUDGET 2025/26 UPDATE The Committee gave consideration and had a robust discussion around the report detailing an estimate of the budget gap for 2025/26 and a summary of progress made in developing plans to achieve a balanced budget. Decision The Finance and Policy Committee – 1. noted that budget planning for 2025/26 was on-going and national budgeting intentions were not yet available; 2. noted the HSCP was not currently operating on a financially sustainable basis; 3. noted the estimated budget gap and provisional savings target of £11.5m for 2025/26; and 4. noted the on-going work and next steps in the budget preparation process. (Report by Head of Finance dated 27 September 2024, submitted) 6. INTEGRATION JOINT BOARDS - FINANCE AND PERFORMANCE 2024 Following Audit Scotland’s annual report on Integration Joint Boards (IJBs), the Committee considered a report providing an overview of the challenges and Page 12
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performance of IJBs, with a particular focus on finance based upon the annual accounts for the year ended 31 March 2023. Decision The Finance and Policy Committee – 1. noted the contents of the report published by Audit Scotland; and 2. noted that the HSCP would seek to address the recommendations made by Audit Scotland. (Reference: Report by Head of Finance dated 27 September 2024, submitted) 7. FINANCIAL RISKS 2024-25 The Committee gave consideration to a report summarising the key perceived financial risks facing the Health and Social Care Partnership in the current year. There were 4 risks identified with a potential adverse impact of £2.1m not included in the budget or forecast. Decision The Finance and Policy Committee considered the 2024/25 financial risks identified and noted the mitigations. (Reference: Report by Head of Finance dated 27 September 2024, submitted) 8. TRANSFORMATION BOARD REDESIGN - UPDATE The Committee gave consideration to a report detailing the latest update against the seven agreed key transformation projects for 2024/25. In addition there was a brief update on the 18 week Meridian Productivity work which has begun across the HSCP with the aim of improving person-centred health and social care services by providing practical steps, tools, and models to enhance service delivery. Decision The Finance and Policy Committee – 1. acknowledged the latest update with regards to the seven Transformation Projects for 2024/25; and 2. acknowledged Health and Social Care Partnership engagement with Meridian Productivity with regards to Releasing Time to Care. (Reference: Report by Head of Planning, Performance and Technology dated 27 September 2024, submitted) Page 13
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9. FUTURE OF LONG-TERM CARE IN SCOTLAND The Committee gave consideration to a wide-ranging strategic report by the Commission on the Future of Long-Term Care in Scotland, sponsored by Alzheimer Scotland on the future of long-term care. Decision The Finance and Policy Committee – 1. noted the contents of the report by the Commission on the Future of Long-Term Care in Scotland; and 2. noted that its recommendations would be considered by the Care Home and Housing Project Board as part of the development of the Older People Strategy. (Reference: Report by Head of Finance and Head of Adult Services dated 27 September 2024, submitted) 10. EXTERNAL PLACEMENTS FOR CHILDREN The Committee gave consideration to a report detailing external placements for children and the associated budgetary pressures. Decision The Finance and Policy Committee – 1. noted the current number and cost of external placements; 2. noted the rising level of need since the pandemic lockdown period; 3. noted the current and anticipated budget gap for external placements and that previous overspends had been accommodated within the Children & Families budget; 4. noted that this expenditure was intrinsically intertwined with Education resources, budgets and spending; 5. noted the magnitude of overall underspend in the Children & Families budget in the previous two financial years and that this had not been able to be invested in the service; 6. supported a fundamental review of the ‘models of care’; and 7. understood the outcomes of this review would require short to medium term investment in prevention and early intervention to achieve a long term downturn in the use of external resources. (Reference: Report by Head of Children, Families and Justice dated 27 September 2024, submitted) Page 14
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11. DATE OF NEXT MEETING The Finance and Policy Committee noted the date of the next meeting as Friday 22 November 2024. Page 15
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1 Integration Joint Board Agenda item: Date of Meeting: 27 November 2024 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 I would like to start by paying tribute to our Integration Joint Board colleague Betty Rhodick who passed away recently. Betty was a valued IJB member and had been the Service User Representative since 2016. In this role she served as the spokesperson for service users, effectively shaping and promoting the IJB’s policies, strategies, decisions, and achievements to service users across Argyll and Bute. On behalf of the HSCP I would like to extend our heartfelt condolences to her family and friends. I would like to update you about some of the things that are happening across our organisation. We are continuing to face significant financial challenges across our health and social care services and a recent Audit Scotland report into IJB finances and performance demonstrated that Argyll and Bute is among many HSCPs in Scotland having to meet this challenge. We have introduced a number of measures across the HSCP to help us try and mitigate some of these complex financial challenges and we will continue with our service transformation approach. This will help make us more efficient and productive as an organisation so that we can continue to deliver a high standard of health and social care service to the people of Argyll and Bute within the staffing and financial resources available to us. I also wrote to staff recently about culture and that, when times are tough, it is more important than ever that we treat each other with respect and foster an environment where the rigorous challenge and prioritisation we require can be done in a safe and constructive way. The way we treat each other has a direct impact on the way we treat patients and service users. Page 17 Agenda Item 5
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2 In this communication to staff I also highlighted the recent anti-racism statement from Neil Gray, Cabinet Secretary for Health and Social Care, where he emphasised that the Scottish Government has been working closely with NHS Boards, experts, patients and staff to develop targeted and meaningful changes to make sure that everyone receives the treatment they deserve. As an HSCP we also have a role to play and it is important that we are all working within a culture of transparency and also meeting our core values. I emphasised to staff that we would listen to them if they had any issues or concerns and that both employing organisations have mechanisms in place where staff can seek further assistance and support. My own personal reflection, having been in the Chief Officer role for nearly eight months now, is that there is nothing I’ve done that is as complex, challenging and rewarding. The current context presents us with the most difficult set of revenue and capital financial circumstances most of us will have seen; complex workforce issues which disproportionately impact rural settings and rising demand across all services. These are all challenges that we need to meet for the benefit of the people of Argyll and Bute and I am constantly impressed by the way our teams are tackling them. We are also continuing to work to reduce the number of people spending a night in our hospitals when they could be at home – often referred to as delayed discharge. This has been achieved through rigorous focus on a whole system discharge planning approach that puts our strategic principles of independence and reablement at its heart. I am really grateful for the work of our community, social work, social care and hospital teams in this regard. I’m also able to report on the implementation of our new commissioning approach for home care services, a huge £12m project, which has been delivered via collaboration and listening to our vital independent sector. Over the coming weeks my team will be working together to refine a challenging programme of savings and efficiency and also to define an operating model for us that recognises the constraints of the context we are working in. This will mean that some of our services over the months to come may look different for the people who use them. We will define a clear strategic focus based on the learning and work from the nearly three years of the current joint strategic plan. I can also give confidence that our decision making around this places patients and service users at the forefront. Our formal governance is key to providing the assurance that this is the case. It is important that we retain a focus on some of the successes our teams are driving across the system. I would like to firstly highlight the good news regarding the significant level of investment that has been secured to upgrade Thomson Court Care Home on Bute. This is a great facility and the funding of £980,000 which has been provided by the HSCP, Argyll and Bute Council and the Scottish Government will allow us to increase capacity at the facility and will enable more residents on Bute to stay on the island. Earlier this month (7 November) we had the Awards Ceremony for this year’s Scotland’s Health Awards and I was really delighted that the Argyll and Bute Alcohol and Drug Partnership Team was shortlisted for the Top Team Award and the Mid Argyll Virtual Award Team shortlisted for the Integrated Care Award. The teams Page 18
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3 from Argyll and Bute just missed out on winning an award on the night however I would like to congratulate them on making it to the finals. We are also continuing our work with Meridian Productivity on an efficiency and productivity project across the HSCP, which is part of an overall NHS Highland piece of work. We are now more than halfway through and my thanks go to all the staff, who have been working with Meridian, for their engagement and commitment to what is a really important initiative. I have also highlighted in my report the recent consultation with our island communities, colleagues and partners to find out their views to help us develop our Draft Island Strategy. We provide health and social care services to our 23 inhabited islands and this Strategy is a really important element to help us in the delivery of services for our island communities. Just this month two senior colleagues from my team, Kristin Gillies (Head of Strategic Planning, Performance and Technology) and Linda Currie (Associate AHP Director), have been successful in other appointments. This is testament to the environment that Argyll and Bute provides in enabling people who work here to flourish and I wish them well in their new endeavours. Finally, I would to thank you for reading my Chief Officer Report and please feel free to contact me if you have any suggestions or ideas for inclusion in future reports. HSCP Updates Betty Rhodick I was deeply saddened by the news that Betty Rhodick, Service User Representative on the IJB since 2016, recently passed away. She was a long- standing and valued board member and on behalf of the HSCP I would like to extend our heartfelt condolences to her family and friends. In her role with the IJB Betty served as the spokesperson for service users, effectively shaping and promoting the IJB’s policies, strategies, decisions, and achievements to service users across Argyll and Bute. Funding Secured to Upgrade Thomson Court Care Home Investment from the HSCP, alongside partners, will help increase capacity at Thomson Court Care Home on Rothesay, enabling more residents on Bute to stay on the island and access health and social care. The HSCP will invest £573,000 of reserves in the project, with Argyll and Bute Council investing £250,000. Working with the Council we successfully secured £157,265 from the Scottish Government’s Islands Programme to help deliver the first phase of major renovation works at the care home to create additional spaces for residents. The total amount for the renovations now stands at £980,000. This is a real positive investment in Thomson Court and is great news for the people of Bute as it will allow us to increase the number of residents we can provide for Page 19
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4 within a much loved and needed facility on the island. We would also like to thank our partners, Argyll and Bute Council and the Scottish Government, for their support and their investment in this project. Further information is available here. Scotland’s Health Awards The Awards Ceremony for this year’s Scotland’s Health Awards was held on 7 November in Edinburgh and the winners across the various categories were announced on the night. The Argyll and Bute Alcohol and Drug Partnership Team had been shortlisted for the Top Team Award with the Mid Argyll Virtual Award Team shortlisted for the Integrated Care Award. The teams from Argyll and Bute just missed out on winning an award on the night however we would like to congratulate them on making it to the finals. Scotland’s Health Awards celebrates the extraordinary achievements of those individuals and teams who go above and beyond to deliver compassionate, high quality health and social care to the people of Scotland. Releasing Time to Care in Argyll and Bute As I mentioned in my Chief Officer in September we have been working with an external consultancy called Meridian Productivity on the ‘Releasing Time to Care’ work which is an efficiency and productivity project that is taking place across the NHS Highland Board area. We are now more than halfway through the planned schedule and I would like to thank all the HSCP staff who have been involved in the project for their engagement, dedication and commitment to what is an important initiative. Care Home Olympics Ardnahein Care Home in Dunoon recently won the Care Home Olympics Challenge Award for the best overall care home in the NHS Highland Board area. The Care Home Olympics were held during the summer to coincide with the Paris Olympics and care homes across the Board area were invited to compete in a range of activities with prizes awarded across a number of categories. Residents, families and staff at Ardnahein really got immersed in the Olympic challenge and printed their own Olympic tee shirts, decorated the home, had French themed food, held an opening and closing ceremony and had a piper to start proceedings. They also arranged activities for families (particularly children) and made all aspects of the 17 days the Olympics were on accessible for all residents regardless of ability. The HSCP’s Associate Nurse Director presented staff and residents with a trophy in recognition of their achievement. Page 20
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5 Excellence in Care Programme The Excellence in Care (EiC) national programme is expanding its scope beyond nursing and midwifery to include Allied Health Professionals (AHPs). This strategic move aims to provide comprehensive care assurance across healthcare disciplines. I am therefore pleased to announce that our own Associate AHP Director, Linda Currie, has been successfully appointed as the EiC national Clinical Lead for Allied Health Professionals. This 0.4 WTE (whole time equivalent) secondment role, based with Healthcare Improvement Scotland, will run until March 2025. Linda will provide leadership, clinical advice, and guidance to territorial boards, supporting the implementation of EiC in AHP practice. Key responsibilities include contributing to Quality of Care reviews, the Leading Excellence in Care Leadership programme, and the development of quality measures. This appointment strengthens the HSCP’s involvement in national quality improvement initiatives and reinforces our commitment to delivering excellence in care across all healthcare professions. Suitable backfill will also be arranged in due course. Colonoscopy in Lorn and Islands District General Hospital People between the ages of 50 and 74 are invited to take part in the national screening programme for bowel cancer every two years. In around 3% of people, the test is positive and they are referred for further tests. This does not necessarily mean they have cancer as there are more common and less serious causes resulting in a positive test. However a colonoscopy investigation of the bowel will be carried out to check for any abnormalities. Since the summer people are now able to have this colonoscopy done within Lorn and Islands District General Hospital (LIDGH). Appointments were previously done within hospitals in the NHS Greater Glasgow and Clyde area. This change has come about as a result of changes to patient databases and how they communicate with each other. There are a range of benefits from this new way of working as people are likely to get their colonoscopy done quicker in Oban than Glasgow; having the test done in Oban also results in less travelling for hospital appointments and the theatres in LIDGH are now better utilised. Please note that people living in the east of Argyll and Bute will continue to be invited to be seen in Glasgow. Service Updates Consultation on Draft Island Strategy The HSCP provides health and social care services to our 23 inhabited islands and while each island is unique we wanted to set out a high level vision and a list of actions and recommendations which aims to ensure good health and social care outcomes across all islands. Page 21
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6 To assist with this vision the HSCP’s Draft Island Strategy, which reflects our overall strategic ambitions, was developed over the past year and as part of the development we consulted with our island communities, colleagues and partners to find out their views. A live webinar was also held on 23 October to provide more information on the Strategy. The consultation closed on the 7 November 2024 and an updated Strategy and a report on the feedback from the consultation will be published and presented to a future IJB meeting. Screening Programmes Building upon work previously undertaken, the Public Health team have applied for national funding to continue the screening engagement work. This work focuses on certain groups who face additional barriers to accessing screening programmes, such as cervical and bowel, helping to reduce health inequalities. It improves awareness of screening programmes within these groups to support people to engage with them and improve their health outcomes. The HSCP’s Screening Engagement Officer will be offering training on the national screening programmes to organisations throughout Argyll and Bute who work with those eligible for screening in an effort to break down barriers that exist to people accessing these vital services and increase uptake. Art of Hosting Training The HSCP’s Living Well Strategy aims to enable people to live healthy and good lives and to reduce long term health conditions. Part of this work is about how the communities we live in contribute to our quality of life. This is called the Community Assets Programme. As the cost of living challenges continue to bite, it is more important than ever to consider how we all build strong, safe and vibrant communities. The HSCP has a role to play in this through the Community Assets Programme along with our Community Planning Partners. In June and October of this year, Art of Hosting training took place with Argyll and Bute Council, the Third Sector Interface and a range of third sector partners to look at big issues like health, the economy and the climate and build our collective skills to have meaningful community conversations. Investment in this programme of work has been sourced from Macmillan Cancer Support and NHS Charities Together. A film of the June event can be viewed here National Updates Improved Recording of A&E Activity A new methodology to accurately capture all emergency care activity in weekly and monthly Public Health Scotland statistical publications will be applied from 4 February 2025. Page 22
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7 The move, backed by the Royal College of Emergency Medicine, means published statistics will now include ‘planned’ A&E attendances. This is where a patient is given a specific time slot to attend a minor injury unit or A&E department to receive emergency care. Further information is available here. New Scottish Benefit for Pensioners A new disability benefit for people of State Pension age opened on 21 October for new applications from people living in the following five local authority areas: Argyll & Bute, Highland, Aberdeen City, Orkney and Shetland. The payment will be available across Scotland by 22 April next year. It is not means-tested and is worth between £290 and £434 a month depending on the needs of the person who gets it. Pension Age Disability Payment is replacing Attendance Allowance in Scotland, which is delivered by the Department for Work and Pensions (DWP). Further information is available here. Improving Palliative Care Views are being sought by the Scottish Government on a new strategy Palliative Care Matters for All. Palliative care is holistic care that prevents and relieves suffering through the early identification, assessment and management of pain and other problems – whether physical, mental, social or spiritual. An ageing population that is living longer, with more complex needs, means more people will need access to palliative care in the future. The draft strategy has been developed in collaboration with the palliative care community and people who have experience of palliative care. Further information is available here. Minimum Unit Price Rises The minimum price per unit of alcohol increased by 15 pence from 30 September. MSPs previously voted to continue the public health measure which had been scheduled to end automatically on 30 April as part of a ‘sunset clause’ when Minimum Unit Pricing (MUP) legislation was introduced in 2018. They also voted to introduce a price increase, with a rise to 65p per unit chosen as the Scottish Government seeks to increase the positive effects of the policy and to take account of inflation. Further information is available here. Preparing Health and Social Care for Winter A record number of NHS 24 call handlers will support the public to access the most appropriate care this winter as services deal with increased demand. Through the Scottish Government and COSLA’s joint Winter Preparedness Plan, continued investment for NHS 24 will increase service capacity to provide clinical Page 23
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8 supervision for at least 150,000 additional calls per year and help prevent unnecessary A&E attendances. Further information is available here. News NHS Highland Annual Review NHS Highland’s 2024 annual review was held on 19 November in Lochgilphead with the public invited to attend the afternoon session either online or at Argyll and Bute Council chambers in Kilmory. Annual Reviews are an opportunity for Health Boards to reflect on their performance over a 12-month period and for the public to ask questions of the executive management and NHS Board leadership. Back Care Awareness Week The HSCP recently promoted Back Care Awareness Week (2-8 October) by highlighting Phio, a digital musculoskeletal (MSK) support app, which helps to empower individuals with MSK conditions by offering them an interactive digital tool that steers them toward the appropriate healthcare pathway. The app is part of a clinically validated trial available to residents living in Argyll and Bute and is free to use. It is available to all individuals aged 16 or over who are registered with a GP practice and have an MSK condition and it is accessible 24 hours a day on any device that has an internet connection. Further information is available here. Staffing Updates Interim Head of Strategy and Transformation for NHS Highland Following a competitive recruitment process Kristin Gillies has been appointed as Interim Head of Strategy and Transformation for NHS Highland. Kristin is currently Head of Strategic Planning, Performance and Technology for the HSCP where she has worked since 2009. Kristin has been a great asset for the HSCP and has been very passionate in serving the local communities across Argyll and Bute and I would like to congratulate her on this appointment and wish her well in her new role. Kristin commenced in her new post on 4 November, although there will be a short transition period (max 3 months) during which she will retain the role of Head of Strategic Planning, Performance and Technology for the HSCP. This will allow us to identify and recruit a suitable replacement for the vacant HSCP post. Page 24
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1 Integration Joint Board Date of Meeting: 27 November 2024 Title of Report: Integration Joint Board Membership and advisory Presented by: Dougie McFadzean, IJB Chair The Board is asked to: ▪ Note the death of Elizabeth Rhodick and thank her for her service to the board ▪ Note the term end for Ms Susan Ringwood and thank her for her service to the board and ▪ note NHS Highlands arrangements for a replacement non-executive member. ▪ Consider the nomination of Kirstie Reid and Kenny Matheson for a further term of 3 years in line with the Standing orders. ▪ Appoint members to the relevant committee vacancies 1. EXECUTIVE SUMMARY The Integration Joint Board is invited to note and consider the outlined actions as detailed in the report in respect of the continued membership and advisory to the IJB. 2. RECOMMENDATIONS Appointments have followed the requisite process and the recommendation is to appoint. 3. DETAIL OF REPORT The Integration Joint Board would like to formally note the death of our member Elizabeth “Betty” Rhodick and offer thanks for her public service. Betty had undertaken the role of service user/public representative from the inception of the Integration Joint Board and provided a strong voice of support for communities and individuals in Argyll & Bute in the strategic planning and delivery of health and social care services. The IJB would also like to offer its thanks to Susan Ringwood who has been an active member of the IJB and vice chair of the Audit and Risk Committee during her tenure. Ms Ringwood has been a committed member on behalf of NHS Highland and has brought a wide perspective, not least her insight as an islander. NHS Highland is currently recruiting a new NHS non-executive and will advise of appointment on completion of this process. Page 25 Agenda Item 6
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2 The Integration Joint Board periodically reviews and recruits new members to the board. The standing orders require that on completion of the 3 year tenure board members have the opportunity to put themselves forward for consideration of a further term. In line with this the IJB is asked to consider the nomination of existing members Kirstie Reid and Kenny Matheson for a further term with the Integration Joint Board. If approved, it would seek to maintain carers representative Mrs Reid to the Strategic Planning Group, and Mr Matheson to the Finance and Policy Committee. The IJB is also required to seek recruitment to the vacant service user/public member vacancy, and this will commence early December 2024. The IJB is also advised that due to development opportunities the posts of Head of Primary Care will be advertised as a permanent post and Head of Strategy, Planning, Performance and Technology will be advertised as a fixed term/secondment opportunity. Fiona Duff will remain interim head of Primary Care until March 2025 and Kristin Gillies will retain a watching brief until 4 February 2025 or until completion of recruitment, which ever completes first. 4. RELEVANT DATA AND INDICATORS None for this report 5. CONTRIBUTION TO STRATEGIC PRIORITIES Unpaid carer and service user/public representation supports the strategic planning of the IJB. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact - none 6.2 Staff Governance - none 6.3 Clinical and Care Governance – improved oversight through representation. 7. PROFESSIONAL ADVISORY Appointments are commensurate with required IJB membership and will ensure that the IJB has full capacity in its advisory. 8. EQUALITY & DIVERSITY IMPLICATIONS Recruitment for public members of the board is an open public process. Professional advisors are nominated through the respective partners. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE N/A 9. RISK ASSESSMENT Increased oversight and mitigation of professional advisory supports reduction of risk for the IJB. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Page 26
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3 Recruitment of the public unpaid carer’s member was through a public process. 11. CONCLUSIONS The IJB is asked to provide thanks to members who have served their communities through the board, confirm nomination and appointment to the IJB and committees, note mitigation of professional advisory and the subsequent support of the ongoing advisory and good governance. 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 27
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1 Integration Joint Board Date of Meeting: 27 November 2024 Title of Report: Budget Monitoring – 7 months to 31 October 2024 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 £2.9m 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 that savings of £4.7m have been delivered, 72% of target. 1. EXECUTIVE SUMMARY 1.1 This report provides a summary of the financial position as at the end of month 7 and a forecast for the year. The forecast has deteriorated further and remains of concern as costs within social work services in particular are 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 costs within Older Adult Services. 1.2 The forecast is currently an overspend against budget estimated at £2.9m. The approach to managing this will be to: • Increase scrutiny of spend and vacancy management. • Progress the savings programme. • Implement additional controls to reduce spend within Social Care. • Request Argyll & Bute Council make available additional resourcing from the pension fund savings. It is the case that the Health and Social Care sector continues to be in a very difficult and unsustainable financial position. 2. Recommendations 2.1 • Note that the HSCP has overspent its budget by £1.6m. • Note that an overspend of £2.9m is forecast. Page 29 Agenda Item 7a
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2 • 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 that savings of £4.7m have been delivered, 72% of target. 3. DETAIL OF REPORT 3.1 7 Months to 31 October 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 49,138 48,052 (1,086) (2.3%) HEALTH SERVICES TOTAL 152,482 151,887 (595) (0.4%) GRAND TOTAL 201,620 199,939 (1,681) (0.8%) 3.1.1 For social care budgets there are several areas of concern: • Number of external placements for children; • Demand for older adult care and management of delayed discharges; • Spend on agency staff remains too high, the 10% planned reduction is not being achieved. Absence is particularly problematic as services are often paying staff plus an enhanced rate for agency cover which can amount 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. It is recognised that agency staff are only employed to cover for essential posts which are either vacant or there is an absence. 3.2 3.2.1 Forecast Outturn The forecast is of concern, particularly for social work services where there are several services overspending. In addition to the implications in the current year, the budget is already reliant upon reserves which are reducing and largely committed. Forecast spend is summarised below with 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. Page 30
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3 Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 91,795 93,845 (2,050) (2.2%) HEALTH SERVICES TOTAL 277,477 278,288 (811) (0.3%) GRAND TOTAL 369,272 372,133 (2,861) (0.8)% 3.2.2 Within Social Work, children’s and families, mental health and older adult budgets are all overspending and a £2.0m adverse variance forecast. The main driver relating to Children’s Services is the increased number of children in out of area placements. These are considered to have been unavoidable and each one is carefully reviewed and considered before being contracted. This cost pressure was not foreseen at the time the budget was prepared. The forecast overspend on this heading is £0.6m on a budget of £6.7m. A detailed report on this aspect of the underspend was provided to the Finance & Policy Committee in September. Spend on older adults is also 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 £2.1m for 7 months. The cost of accommodation for agency staff on islands is adding to costs. Alternative arrangements on Isla will be available in the coming weeks to reduce this. Adult Services Budget Forecast Spend Variance External Residential Placements – demand led @ national contract rate £11.4m £12.3m (£0.9m) Care @ Home Service £19.6m £20.5m (£0.9m) Internal Care Home Placements £7.5m £ 7.2m £0.3m Total £38.5m £40.0m (£1.5m) The new Care at Home contract has been implemented in and will reduce costs in the last half of the year, the savings have been built into the forecast. 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 demand. Recovery actions are now required for the HSCP and care at home activity is an area of focus. To date no action has been taken to restrict provision of care for financial reasons. A recovery plan is under development for the current and future years as the outlook remains difficult. The Social Work budget assumed that £1.3m of the pension fund saving (£3.5m 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 additional support from this funding, now close to the full £3.5m available. 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: Page 31
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4 Social Work £m Budgeted Reliance on Pension Fund Savings 1.3 Forecast revenue budget variance (M4) 2.0 Underlying budget gap 3.3 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 remodelling. 3.2.3 NHS services are likewise reporting an increasing overspend of £0.8m. The main concerns are: - Agency staff – agency, locum and bank staff costs continue to be the single largest cost pressure. The gross spend on agency, locum and bank staffing across all services is £7.1m. LIH is currently the highest spending service area, reporting a gross cost of £3.12m most of which relates to medical staffing. - 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 – the 8 admitted patients have created a cost pressure of £454k at the end of October. - GP prescribing – costs are expected to be £350k or around 1.4% higher than budgeted at present. Some excess costs will continue to be offset by vacancies. However, the Health budget is already dependent upon the use of reserves and there is little scope to increase reliance on reserves. The plan was to utilise £4.3m of reserves to fund the revenue spend. 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 this overspend and the HSCP is continuing to work towards bringing the 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, in writing, that the UK budget announcement does not make any additional funding available for the NHS in the current financial year. The national context within the NSH is that Boards are collectively projecting a £464m overspend this year. 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. Page 32
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5 • 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 more of the pension fund saving held by council to balance the revenue budget; • 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); • Recovery of direct payment balances where these are not being fully spent (non recurring); • Prioritising of care to priority 1 to reduce care at home hours to be managed within each area; • Reconsideration of assessment thresholds and; • Assessments to ensure other care provision (eg family in receipt of carers allowance) are taken into account in assessments. These measures are likely to result in some reduction in service and increase in unmet need or waiting times for care packages. It is not possible to bring spend back into line with budget without impact on service. The position is consistent with the national situation in the Health and Social Care sector with many IJBs taking similar action. Concerns about financial sustainability was highlighted again this year by Audit Scotland but there has not been a Government response to address the issue. There are a number of risks including: • The Council pay award has been implemented but not yet 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 may be viewed as a risk for 3rd sector and commissioned service providers in the short term while funding is uncertain; • There are staff re-grading exercises underway which could result in increased pay costs; and • Demand for services, impact of winter pressures and the priority given to managing delayed discharges remain risks in the current year. 3.3 Savings Delivery 3.3.1 The service improvement team, finance teams and management continue to progress, monitor and report on savings projects. As at Month 5, £4.7m (72%) of the £6.6m target has been declared: Page 33
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6 3.3.2 3.3.3 3.4 3.4.1 3.4.2 2024/25 Savings Year to 31 October 2024 Target Achievement Balance % £' 000 £' 000 £' 000 Fully Achieved 4,091 4,091 0 Partially Complete 2,522 228 2,294 Non Recurring - 425 (425) Total 6,613 4,744 1,869 72% Appendix 3a lists the fully delivered savings and 3b summarises the remaining savings, risk rated: Savings regarded as low risk £456k Savings unlikely to be achieved in full in 2024/25 £1,100k 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 to progress. 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 purposes. The Scottish government have suggested that there is some scope for reallocating reserves to help fund cost pressures. The IJB is in the process of allocating reserves 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 • £800k for the Tigh a Rudha renovation and remodelling (Reserves are match for Council capital 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 balance the revenue position 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. Page 34
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7 4 4.1 5 5.1 6 6.1 6.2 6.3 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 costs 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. 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. It does not expect to return to a position where it requires additional funding that it will need to repay as a result of its overspending in 2024/25. Page 35
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8 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 7. The forecast is of concern and the management team are seeking to manage spend down during the remainder of the year. The reliance upon non-recurring resourcing is an increasing problem for 2025/26 and future years. 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. 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 M7 20/09/24 TBC SLT Budget Monitoring M7 22/09/24 TBC APPENDICES: Appendix 1 – Year to Date Position Appendix 2 – Forecast Outturn for 2024-25 Appendix 3a and 3b – Savings Programme Appendix 4 – Reserves AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk Page 36
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APPENDIX 1 # ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP REVENUE BUDGET MONITORING SUMMARY - YEAR TO DATE POSITION AS AT 31 OCTOBER 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 641 726 85 11.7% Variance is due to vacancy savings offset by spend on agency staff and charges from housing services Service Development 231 231 0 0.0% Outwith reporting criteria. Looked After Children 4,205 3,865 (340) (8.8%) Overspend due to an increase in the demand in the number of residential placements partially offset by underspends in fostering and adoption. Child Protection 1,674 1,800 126 7.0% Small saving based on known demand for the service coupled with deferred income received from previous years. Children with a Disability 543 574 31 5.4% Outwith reporting criteria. Criminal Justice 167 156 (11) (7.1%) Outwith reporting criteria. Children and Families Central Management Costs 1,736 1,774 38 2.1% Outwith reporting criteria. Older People - Homecare 10,958 9,962 (996) (10.0%) Overspend reflects increased payments to commissioned service providers and use of agency workers. Older People - Internal Residential 3,788 3,450 (338) (9.8%) The variance is due the use of agency staff to cover sickness, holidays and vacancies. Older People - External Residential 5,483 5,909 426 7.2% The variance is due to timing difference with third party payments. Older People - Other 5,054 4,714 (340) (7.2%) The YTD variance is due to timing of re-charges to NHS and timing of payments to third parties. Physical Disability 2,144 2,284 140 6.1% The favourable variance is due to re-assessed care packages. Learning Disability 9,983 10,248 265 2.6% Variance reflects current demand levels for this service area. Mental Health 2,175 1,952 (223) (11.4%) The YTD variance is due to increases in assessed packages and associated costs. Adult Services Central Management Costs 356 407 51 12.5% The favourable variance is mainly due to YTD underspends on centrally held funds. COUNCIL SERVICES TOTAL 49,138 48,052 (1,086) (2.3%) HEALTH SERVICES: Explanation Health & Community Care Services 26,604.072 26,747.027 143 0.5% Saving is due to vacancies across a number of services Acute & Complex Care Services 24,786.579 23,435.234 (1,351) (5.8%) Overspend due to agency locum usage to cover medical & nursing vacancies in LIH & Mental Health, high cost out of area private sector mental health placements Children & Families Services 6,041.851 6,003.583 (38) (0.6%) Outwith reporting criteria. Commissioned Services - NHS GG&C 45,361.207 44,857.808 (503) (1.1%) Overspend due to cost per case activity within GGC relating to drug treatment prescribing Commissioned Services - Other 2,662.150 2,560.696 (101) (4.0%) High cost other Scottish Board services charge for emergency care on a cost per case basis Primary Care Services inc Dental 17,198.025 17,282.121 84 0.5% Saving is due to vacancies Other Primary Care Services 6,168.037 6,168.037 0 0.0% Outwith reporting criteria. Prescribing 14,544.348 14,264.139 (280) (2.0%) Unachieved Savings Public Health 1,274.053 1,321.825 48 3.6% Outwith reporting criteria. Lead Nurse 1,055.203 1,122.850 68 6.0% The YTD variance is due to vacancies/ secondments Management Service 300.697 383.240 83 21.5% The YTD variance is due to vacancies/ secondments Planning & Performance 1,413.569 1,414.475 1 0.1% Outwith reporting criteria. Budget Reserves 0.000 1,250.000 1,250 100.0% Slippage on reserves due to delays in implementation, generally due to recruitment Income (1,385.928) (1,280.225) 106 (8.3%) Additional income from seasonal increase in activity, longer stay Mental Health patient Estates 6,458.364 6,356.491 (102) (1.6%) Inflationary pressures and increased demand for maintenance due to limited availability of capital funding, unachieved savings HEALTH SERVICES TOTAL 152,482 151,887 (595) (0.4%) GRAND TOTAL 201,620 199,939 (1,681) (0.8%) Page 37
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APPENDIX 2 # ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP REVENUE BUDGET MONITORING FORECAST OUTTURN - AS AT 31 OCTOBER 2024 Reporting Criteria: +/- £50k or +/- 10% Service Annual Budget £000 Outturn £000 Variance £000 % Variance Explanation COUNCIL SERVICES: Chief Officer (688) (434) (254) 36.9% The forecast variance reflects an under recovery in vacancy savings due to either posts being filled or cost centres not open for savings due to agency costs being incurred. Service Development 459 459 0 0.0% Outwith reporting criteria. Looked After Children 6,696 7,258 (562) (8.4%) The forecast overspend reflects current known demand for the service. Currently have 15 children in residential placements with potentially more under consideration along with an overspend on staff costs due to a re-grading process (£250k) partially offset by underspends in Adoption and Fostering. Child Protection 3,607 3,420 187 5.2% The underspend is as a result of demand for contact and welfare services and deferred income. Children with a Disability 1,053 1,032 21 2.0% Outwith reporting criteria. Criminal Justice 174 78 96 55.2% The forecast underspend reflects additional grant funding received along with vacant posts. Children and Families Central Management Costs 3,740 3,702 38 1.0% Outwith reporting criteria. Older People - Homecare 19,550 20,462 (912) (4.7%) The overspend reflects the latest assessed needs packages for the homecare service with an increasing reliance on agency staff to cover the service. The forecast overspend on agency staff is curently £2.2m however this is partially offset by underspend in staffing budgets and third party payments. Older People - Internal Residential 7,501 7,221 280 3.7% The 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 11,385 12,321 (936) (8.2%) The 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 9,398 9,707 (309) (3.3%) The forecast overspend is predominatly due to the costs associated with delayed discharge service and reflects the trend over previous financial years. Physical Disability 3,854 3,622 232 6.0% The saving is due to a combination of re-assessed needs packages and attritions. Learning Disability 20,315 19,864 451 2.2% Forecast 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 3,939 4,321 (382) (9.7%) The forecast overspend is based on assessed care needs and agreed packages. Adult Services Central Management Costs 812 812 0 0.0% Outwith reporting criteria. COUNCIL SERVICES TOTAL 91,795 93,845 (2,050) (2.2%) HEALTH SERVICES: Explanation Health & Community Care Services 47,182 47,102 80 0.2% Saving is due to vacancies across a number of services Acute & Complex Care Services 40,921 42,985 (2,064) (5.0%) 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 10,718 10,718 0 0.0% Outwith reporting criteria. Commissioned Services - NHS GG&C 76,899 77,294 (395) (0.5%) Cost per case activity within GGC relating to homecare drug prescribing 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 29,875 30,386 (511) (1.7%) 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 25,142 (350) (1.4%) Overspend due to anticipated additional costs of prescribing, PSD reporting on the detail of costs runs two months in arrears Public Health 2,532 2,512 20 0.8% Outwith reporting criteria. Lead Nurse 1,988 1,924 64 3.2% The forecast variance is due to vacancies/secondments Management Service 1,568 1,390 178 11.3% The forecast variance is due to vacancies Planning & Performance 2,458 2,484 (26) (1.1%) Unachieved Savings Budget Reserves 14,198 11,998 2,200 15.5% Slippage on reserves due to delays in implementation, generally due to recruitment Income (1,944) (2,111) 167 (8.6%) Additional income from seasonal increase in activity, longer stay Mental Health patient Estates 11,227 11,252 (25) (0.2%) Inflationary pressures and increased demand for maintenance due to limited availability of capital funding, unachieved savings HEALTH SERVICES TOTAL 277,477 278,288 (811) (0.3%) GRAND TOTAL 369,272 372,133 (2,861) (0.8%) Page 38
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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 39
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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 now starting to deliver savings - further progress expected during year 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 Some achievement expected in year as new contract implemented in October 2024 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 52 98 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 AB2021-64 FME (Dunoon) 50 50 Stable staffing at CCH required to enable saving to be delivered AB2223-9 Forensic Service Contracts 20 20 Stable staffing at CCH required to enable saving to be delivered AB2021-19 Hotel Services redesign to reflect reduction in inpatient numbers 99 30 69 Project underway and some savings delivered, more is anticipated AB2021-23 Catering & Domestic Underspends 30 30 £25k declared on a non-recurring basis 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 little progress 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 6 144 Work on-going - some oportunties identified 2,522 228 2,294 560 104 456 1,224 124 1,100 738 0 738 Page 40
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#Appendix 4 - Reserves 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 11,300 268,198 Perinatal MH Funding 19,887 19,887 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 26,200 573,800 General Reserves - Revenue Funding 4,266,000 4,266,000 0 General Reserves - Estates & Transformation Projects 950,537 950,537 Total 19,878,849 10,664,220 0 9,214,629 Held by NHS 16,489,832 10,638,286 0 5,851,546 Held by Argyll & Bute Council 3,389,017 25,934 0 3,363,083 Total 19,878,849 10,664,220 0 9,214,629 Page 41
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1 Integration Joint Board Date of Meeting: 27 November 2024 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 and national budgeting intentions are not yet published. • Note the HSCP is not currently operating on a financially sustainable basis. • Note the potential budget gap of £15.0m for 2025/26. • Note the on-going work and next steps in the budget preparation process. • Note that the HSCP does not expect to be able to propose a balanced budget for NHS services based on current planning assumptions. 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 summarises the current context and highlights that the position has been developed without the assistance of firm budgeting assumptions from the Scottish Government, now expected in December. Public finances are under severe pressure and the Health and Social Care sector as a whole is not sustainable. Additional funding has been committed by the UK Government, along with new system cost pressures, but it is not yet clear how this will impact in Scotland. Assumptions will continue to be refined as the budget cycle progresses. 1.2 The budget gap for 2025/26 is estimated at £15m, assuming the HSCP has access to £2.5m of non-recurring pension fund savings. It is anticipated that some of this gap will be addressed through increased funding. The cost and demand pressures are significant and take some account of Social Care cost pressures experienced in the current year. It is not anticipated that the HSCP will be able to develop savings plans which address this gap without impacting on access, availability or quality of service provision. The savings proposals will be progressed on the basis that it will seek to minimise adverse impacts on the most vulnerable. The estimated budget gap will be refined as improved planning information becomes available. Based on current assumptions, additional resourcing via NHS Highland will be required to enable the HSCP to set a workable budget. Page 43 Agenda Item 7b
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2 2. Recommendations • Note that budget planning for 2025/26 is on-going and national budgeting intentions are not yet available. • Note the HSCP is not currently operating on a financially sustainable basis. • Note the estimated budget gap of £15m for 2025/26. • Note the on-going work and next steps in the budget preparation process. • Note that the HSCP does not expect to be able to propose a balanced budget for NHS services based on current assumptions. 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 they have these) to achieve financial balance and fund increasing operating costs. 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 main disadvantage with commencing the process early is that there is limited planning information available. Since the last update report, the UK level budget has been delivered, however the likely impact on the Scottish Government Budget is not confirmed (other than to say there is no more funding for 2024/25). The UK budget does appear to allocate additional funds for the NHS but will also result in additional employer costs for the HSCP and all of the partners it commissions services from. • The Scottish Government have not published an updated Spending Review or draft budget. • The UK Government budget increases public spending (revenue and capital), some of which will flow to Scotland but it has also increased employer NI contributions. • The UK minimum wage is to increase to £12.21 per hour (6.7%) which is above the current health and social care minimum pay rate (£12.00). • The Scottish Government Health Finance team have written to all boards confirming there is no more funding available in 2024/25 as a consequence of the budget. Boards are to operate within previously agreed targets and have been issued planning assumptions which suggest zero general uplift in the funding allocation. • The Scottish Government have cut Multi-Disciplinary Teams (MDT) funding which was allocated to help focus on redesign and to manage delayed discharges. • The 2024/25 Agenda for Change pay increase has been agreed and fully funded (5.5%) and will come with a further 30-minute reduction in Page 44
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3 3.2 the working week with a further 30 minutes reduction to be implemented in 2025/26. • The Local Authority pay offer for 2024/25 has been implemented but not accepted by all relevant staff side unions. • The Scottish Government have again made in-year reductions to a number of budgets, including Health and Social Care. • Audit Scotland have reported that funding allocated to IJB’s has been reduced in real terms, contrary to previous planning assumptions. Assumptions The HSCP is assuming that Government will fund in full the impact of the minimum wage increase and the direct increase in employers National Insurance. It is assumed that the indirect impact of NI increases will be funded or absorbed by service providers, this is a material risk to finance and / or commissioned service providers. The lack of firm planning information makes it difficult to model the budget gap accurately at present and the HSCP has focussed efforts on developing potential solutions, it is assumed that: • Current and future pay uplifts in the NHS will be fully funded and NHS re-grading costs (particularly nursing) will be fully funded. • Direct employer NI increases will be fully funded as will the impact of the increase in the national living wage / minimum pay rate for care staff. • The excess (above 3%) for the 2024/25 local authority pay award will be largely funded. • The non-recurring pension fund saving from the Strathclyde Pension Fund will be available to the HSCP in 2025/26. • The HSCP will no longer hold material levels of general reserves it can use to contribute to the budget gap. It is assumed that other cost pressures, driven by inflation and demand for service remaining high or increasing will not be funded. The Government level assumptions is that these will require to be offset by savings, including service cuts or additional funding where this is not possible in the timeframe. 3.3 NHS Formula Funding (NRAC) Analysis was undertaken recently to understand how the NHS resourcing model (NRAC) operated. The model is population based and takes into account a range of factors including rurality, demographics and the health of the population. Funding for the HSCP had been reduced due to an estimated decline in the population. Recent Census data indicated this population reduction was overestimated. The NRAC funding shares for 2025/26 are available and the national share for the HSCP has increased from 1.87% to 1.91% (2.1% increase). The cash impact of this is to be confirmed, a £1.5m recurring improvement is assumed. Estimated Budget Gap – 2025/26 The first element of the gap is the underlying budget deficit, funded by non- recurring resourcing and reserves. Page 45
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4 Social Care Gap £1.3m NHS Gap £4.3m Opening Underlying Gap £5.6m The HSCP methodology for the medium-term plan is to look ahead 3 years using a best case, mid-range and worst-case modelling of cost and demand pressures. These align with planning assumptions used by both partners. The mid-range cost and demand pressures are summarised below, appendix 1 provides detail. These make some allowance for recurring elements of overspending this year. Very limited allowance is made for further increases to staffing (for example relating to the Health and Care Staffing Act). Social Care Net Cost & Demand Pressures £4.0m NHS Cost & Demand Pressures £9.4m Total New Pressures £13.1m Financial Planning Estimate 2025/26 NHS £m Social Care £m IJB Total £m 2024/25 Underlying Gap 4.3 1.3 5.6 Estimated Cost & Demand Pressures 9.4 4.0 13.4 Total Gap 13.7 5.3 19.0 Funding Contributions NRAC Improvement (estimate) (1.5) - (1.5) Reliance on Pension Saving (non-recurring) - (2.5) (2.5) Savings Target / Additional Funding Requirement 12.2 2.8 15.0 The overall position has worsened due to Scottish Government provided planning assumptions (NHS) which include a 3% SLA uplift and a 10% drugs cost uplift with no funding. These items add circa £5.9m to anticipated spend with no attached funding. It is not tenable to assume the HSCP can make compensating savings at this level in 2025/26 and it is therefore assumed that another solution will require to be found (additional funding / share of brokerage). As a consequence, the overall budget gap has increased to £15m, equivalent to 4%. It must be understood that the reliance on the pension fund saving presents an additional recurring problem in 2026/27 and beyond, a period in time where demographic change can be expected to increase pressure on services further. It is difficult to assess that the HSCP can realistically achieve savings at this level next year. A balanced budget cannot be delivered without impact on provision which would result in significant service change and require extensive consultation. This is a common situation across the system at present. Some of the challenges in planning for this scale of saving include: • Budgets where savings cannot be realised - Service Level Agreements including the one with Glasgow, much of the Primary Care budget, Justice services and the Mid-Argyll PFI contract to highlight the main examples. Page 46
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5 3.4 3.4.1 3.4.2 3.4.3 • Inability to reduce small scale provision in remote communities. • Staffing and accommodation challenges to achieve reductions in supplementary staffing costs. • Organisational change constraints which make it difficult to implement change where it has an impact on employees or communities. The main issues to be addressed in the planning and budgeting cycle for 2025/26 include: • Expected budget shortfall. • Increasing / continued high levels of demand. • Reducing or constrained workforce. • Appetite for service reduction and in effect cuts of service provision. Transformation & Strategic Planning The Transformation Programme is in place and projects are designed to achieve longer term change rather than short term savings. The requirement to focus on the short term is having an impact on capacity for longer term change. Investment is also required to make change happen; it is unlikely to be deliverable within existing resource. The use of reserves to support revenue spend is making it difficult to commit to further investment in transformation. There is a severe shortage of the capital resource required to enable digital transformation as one example. Development of Savings Proposals The HSCP is working through the agreed process for the development of 2025/26 budget proposals. The scale of the challenge has been understood for some time and it was intended that the process would commence earlier than normal to allow for better consultation on proposals with communities, staff and the IJB. It is important that the savings programme is well understood and deliverable. Public Consultation 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). Staff Consultation Engagement has taken place with staff asked to make suggestions for savings opportunities. 18 members of staff took the time to respond, some of which overlapped, and some respondents made multiple suggestions. These were reported at the last meeting and are being incorporated in the Page 47
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6 plan where appropriate. It is of note that several members of staff indicated a frustration at the on-going cost of locum and agency staffing and suggestions that staff retention and development should be prioritised. 3.4.4 3.4.5 3.4.6 Service Planning Work is underway to develop savings options, the process is challenging as most of the plans have an impact on service delivery. Service management are also in the process of reviewing budgets and spend in detail to seek to identify ‘housekeeping’ savings which will contribute to the final savings programme. This process has been on-going for many years now, however, there are new opportunities as spend patterns, trends and managers change over time. These savings would not normally require stakeholder consultation but can make a valuable financial and cultural contribution. Examples include: • Public Health commissioning • Removal of vacant posts • Rationalisation of telecom lines • Increased charging for telecare services At present these add up to £285k and some will require EQIAs to be completed. The more strategic priorities under consideration are summarised for each of the main services below. These provide an early indication of the changes suggested by management to deliver cost savings. It is not likely that these will result in sufficient savings to balance the budget. 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 of the services that sit 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 any savings derive from this work it will be reported in the 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 currently undergoing change as the new contract is introduced in November 2024. Challenges include: Page 48
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7 3.4.7 • Continuing high demand and unmet need. • Increasing use of agency staff within social care. • Lack of housing options for workers (Islands & Oban). • Pressure to minimise hospital delays. • Full organisational redesign of the Argyll and Bute service is underway. The care at home 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, mobile teams and the responder contract due for renewal in early 2025. • 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; and • Reviewing of assessment thresholds and governance of care package implementation. Some allowance has been made in the cost pressures 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 costs, 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. A strategic development process is 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. A working group has now been established to review the responder service contract and how it relates to the range of services and staffing models within the service. This includes the review of activity data and any change will require the completion of an EQIA. The contract has a £1.8m value. Options range from continuation, through a reduction in scope to cancellation. It is perceived as the main opportunity to achieve a reduction in the Social Care budget gap in 2025/26. A minimum savings target is still to be established but this is clearly an opportunity to achieve a cost reduction. 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 Page 49
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8 3.4.8 3.4.9 3.4.10 people at team leader and management levels. Staff engagement and communications continue. There are some opportunities for efficiencies being identified, however this does not necessarily mean it will be easy to realise savings. The main part of the project is scheduled to complete in November and it should then be possible to quantify the potential financial saving that can be attributed to it. Organisational change processes are likely to be a barrier to delivering savings should efficiencies be identified. The project could help to identify some early opportunities to reduce supplementary staffing. 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 some expensive out of hours arrangements in place and there appears to be 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; and • Identify areas of unnecessary duplication. It is expected that this work will identify potential savings but should be considered to be a longer-term transformation project to sustain services. However, there may be specific services where shorter term change is required due to the staffing challenges. 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. Page 50
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9 3.4.11 3.4.12 3.5 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. Contract Management and Inflation Cost and demand pressures have been scaled back slightly to reflect lower inflation. It is intended that the HSCP will seek to arrange contract renewals on a flat cash basis except where specific funding is received to provide for uplifts or where contract rates are set nationally. It is unclear if funding for NI increases will be made available for 3rd sector / commissioned service providers operating in the health and social care sector. It is anticipated that the living wage will increase and the HSCP would expect to receive funding for this and would intend to pass this to providers where appropriate. The process of contract management reviews will continue and managers will continue to scrutinise all contracts in terms of the value for money they provide. Service Transformation The Transformation Programme has been recently reviewed and the new structure in place around this piece of work is still under development. Important themes for strategic transformation in addition to the projects summarised above include: • Digital Transformation. • Care Homes and Housing. • Community Hospitals. • Strategic Workforce Development and Accommodation; and • Fleet Management. The Transformation programme overlaps with the main savings projects, but it is recognised that the demographic, finance and staffing challenges are set continue for many years and longer term transformation is therefore needed in addition to shorter term savings projects. This work will also seek to look at areas where there have been long term challenges with recruitment and staffing. It is anticipated that there will be circumstances where the HSCP must consider if it can continue to provide the current range of services in all the locations that it does at present. On-going reliance on temporary staffing presents clinical risk as well as being costly. 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. Page 51
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10 • Changes to PECOS approval processes to stop unnecessary spend. • Tightening of care package approval processes; and • Review of grant and commissioning commitments and renewals. The process 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/or partner approaches to HR management. Engagement with staff and the IJB and Finance and Policy Committee will continue throughout the process. Discussions with both partners will continue, based on current planning assumptions the HSCP does not believe it can achieve financial balance in 2025/26 in respect of its NHS budget and will require resourcing above the level assumed. It does expect to be able to develop plans which could enable it to operate Social Work / Social Care services within available resources in 2025/26 assuming the non-recurring pension fund saving is passed on and pay increases above 2% are funded. However, getting to this position will require reductions in service provision. November – December 2024 -Firm up savings plans and agree target savings -Develop engagement plans for staff and communities where appropriate November – December 2024 Review Scottish Government Draft Budget and planning assumptions to refine estimated budget gap January 2025 IJB Approval for Operational Savings identified to date January – February 2025 Conduct engagement and detailed planning in respect of proposals March 2025 Approval of Budget and savings by IJB The table below summarises the current areas of focus: Service(s) Project Approx Service Budget Children & Families Maternity Services Review £5.7m Adult Services – Care @ Home Review of service and contracts £20m Adult Services – NHS and Social Care Time to Care project - Meridian TBC Acute & Complex Care Rural General Hospital model review with NHSH £17m All Services Mid Argyll & Kintyre Service Review TBC Page 52
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11 Adult services and Acute and Complex Care Structures Care Package Reviews £30m All Services Contract Management and Restrict inflation £6m The next steps are to identify project leads where these are not yet in place and estimate realistic savings targets and timelines. 3.6 4 4.1 5 5.1 Medium Term Planning The medium-term plan will be updated in detail once the Scottish Government have published their budget for 2024/25. The table below provides an indicative analysis of the potential scale of the challenge. NHS Social Care Total £m £m £m 2025/26 Estimated Gap 12.2 2.8 15.0 2026/27 Remove non-recurring funding 0.0 2.5 2.5 New Cost & Demand Pressures 8.5 3.4 11.9 Potential additional 26/27 Budget Gap 8.5 5.9 14.4 2027/28 New Cost & Demand Pressures / Gap 8.1 3.8 11.9 Cumulative Annual Gap 28.8 12.5 41.3 The table indicates an increasing budget gap, it is not clear at present to what extent the HSCP will be required to deliver savings as additional resource is likely to be allocated. Savings of this magnitude would require service closures. These figures will be remodelled as soon as long-term budget assumptions are provided by the Scottish Government. It is not expected that there will be an opportunity to access funding for major capital programmes during this period. The focus will be on addressing backlog maintenance and funding transformational projects where possible. 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 53
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12 6 6.1 6.2 6.3 GOVERNANCE IMPLICATIONS Financial Impact – the budget gap is significant and plans to reduce spend are required. It is expected that the HSCP will require additional resource in 2025/26 to fund NHS related spend in particular. 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 costs savings are required there will be implications for care provision. 7. 7.1 8. PROFESSIONAL ADVISORY The budget planning process for 2025/26 ensures that Professional Leads are fully engaged. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 None directly from this report, service changes will require impact assessments to be completed. 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. • 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. 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 this report is publicly available. The Page 54
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13 HSCP does not intend to re-run the public consultation due to the cost of the software, it will however continue to communicate and engage with all partners in respect of the financial challenge it faces. 12. CONCLUSIONS 12.1 12.2 This report provides an indicative estimate of the scale of the HSCP budget gap and savings target for 2025/26. The budget gap for next year is estimated at £15m or 4% of spend. Work is on-going throughout the management team to develop savings proposals. This process has commenced earlier than in recent years due to the scale of the challenge. However, it not realistic to assume that the HSCP can deliver a balanced NHS 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. 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 TBC Finance & Policy Committee Budget Update 22/11/24 TBC APPENDICES: Appendix 1a & 1b – Cost & Demand Pressures AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk Page 55
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# Appendix 1a - Social Care Cost and Demand Pressures Service Cost/Demand Pressure 2025-26 £000 2026-27 £000 2027-28 £000 All Social Work Estimated Pay inflation reflecting a mid-range of 2%. Adjusted for the impact of the reduction in the employer's pension contribution rate changes. 798 1,625 2,468 All Social Work Estimated Pay increments 172 344 516 All Social Work Non-pay inflation, best and worst case based on unavoidable/inescapable inflation and worst case. 875 1,830 2,844 Adult Care Older People Demand Growth: due to demographic change, 3% growth in homecare and care home placements over 3 years. 1,250 1,950 2,950 Adult Care Younger Adults Demand Growth - Physical Disability. Any growth to be managed within existing budget 0 121 305 Adult Care Mental Health Demand Growth - to be managed within existing budget in 2024/25 0 131 330 Children and Families Looked After Children Demand Growth - there is a continuing demand for placements of children who are cared for by the HSCP. The mid case reflects that additional demand in 24/25 be funded from existing resource with £250k per annum thereafter. 0 107 300 Children and Families Looked After Children Budget Adjustment - to reflect significant increase in demand for placements in external residential care facilities. Assumed this will continue but not increase further. 750 750 750 Adult Care Mental Health Budget Adjustment - The Mental Health Supported Living and Residential budgets are carrying a recurring unbudgeted commitment and increasing demand. Care. 100 265 345 All Social Work Allowance for unknown cost and demand pressures which could arise. 100 300 400 TOTAL UNFUNDED COST AND DEMAND PRESSURES 4,045 7,423 11,208 Mid Range Page 57
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Appendix 1b - NHS Cost and Demand Pressures Cost/Demand Pressure 2025-26 £000 2026-27 £000 2027-28 £000 Pay increments 100 200 300 Inflation on Resource Transfer 289 583 883 Estates & Fleet cost increases 500 500 500 Prescribing - 10% per SG planning assumption with no additional funding confirmed. 2,518 4,765 7,186 Estates - Mid Argyll PFI 175 360 554 Estates - energy & utilities 81 349 556 Staffing Act Implementation 300 300 300 Oncology medicines demand for new drugs 200 400 600 Depreciation & IFRS16 170 341 514 MS365 Licenses - contract increases 50 100 150 NSD Car-T Regional Centre 302 553 804 NSD topslice - additional services & current pressures 200 400 600 SLA Inflation - 3% increae assumption per SG - no funding confirmed 2,873 5,823 8,861 West Scotland Heart & Lung Services - revised model 500 500 500 Mental Health Out of Area Placements 500 500 500 Labs Managed Service Contract 110 110 110 Patient Transport increase - renal 100 100 100 Allowance for unknown cost and demand pressures 400 2,000 3,000 9,368 17,884 26,018 It is assumed that other NHS cost pressures, such as pay and NI increase, will be fully funded Mid Range Page 58
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1 Integration Joint Board Date of Meeting: 27 November 2024 Title of Report: Climate Change Reporting 2023/24 Presented by: James Gow / Malcolm McMillan The Integration Joint Board is asked to: • Note that the IJB is required to submit a Climate Change Duties Report by 30 November 2024; • Approve the proposed submission attached as Appendix 1; and • Endorse the partnership approach taken by the HSCP in respect of its Climate Change Duties. 1. EXECUTIVE SUMMARY 1.1 Climate Change legislation introduced by the Scottish Government requires all public bodies to report on their carbon emissions and provide information on how carbon reduction and climate change is governed. This report provides members of the Integration Joint Board (IJB) with an opportunity to review and approve the report for financial year 2023/24 in advance of its submission to the Sustainable Scotland Network. 1.2 Integration Joint Boards are unusual public bodies as they do not directly own assets or employ staff and therefore submit nil returns. This ensures IJB returns do not double count emissions reported by Health Boards and Local Authorities. However, the submission does provide the opportunity to highlight some of the actions, projects and challenges in delivering carbon reduction. This report also summarises some of the proposed developments which will improve HSCP’s approach to this agenda. It is apparent that there were increasing expectations from the Scottish Government that IJBs will take a more pro-active role in this policy area, however the Scottish Government have not provided direct access to funding to facilitate this and have closed the scheme which would have enabled the HSCP to bid for capital funding following the completion of the pre- capital work during 2023/24. 2. RECOMMENDATIONS 2.1 The IJB is recommended to: • Note that it is required to submit a Climate Change Duties Report; • Approve the proposed submission attached as Appendix 1; and • Endorse the partnership approach taken by the HSCP in respect of its Climate Change Duties. Page 59 Agenda Item 7c
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2 3. DETAIL OF REPORT 3.1 The draft submission for 2023/24 is attached as appendix 1. As stated above, this is a nil return in respect of the calculation of carbon emissions as these are reported by NHS Highland and Argyll & Bute Council. The IJB is therefore placing significant reliance on the actions of both partners. 3.2 Argyll & Bute Council have a section on their web site which provides details on their approach to sustainability and carbon reduction: https://www.argyll-bute.gov.uk/sustainable-development-and-climate-change They report a 33% reduction in emissions since 2015/16 and lay out a £1.2m investment plan to progress towards net zero. Several of the projects undertaken by the council will have a positive impact on emissions generated by HSCP activities. For example, these seek to reduce energy consumption and emissions relating to office accommodation, invest in the electric fleet and charging points and in renewable energy sources to power ICT infrastructure. 3.3 NHS Highland have also reported reduced carbon emissions. A recent Scottish Government summary indicates building related carbon emissions reported by NHS Highland reduced by 23% between in 2015/16 and 2022/23. The most recent NHS Scotland report is available from the link below, this outlines carbon emissions across from a range of emissions drivers including buildings, medical gasses, prescribing, waste and fleet: https://www.gov.scot/publications/annual-nhs-scotland-climate-emergency- sustainability-report-2024 The NHS Highland carbon reduction strategy is incorporated in the Together We Care document. 3.4 The Argyll & Bute IJB and HSCP does not have responsibility or delegated budget for capital investment. This has made it difficult for it to prioritise carbon reduction projects. Carbon emissions predominately relate to energy usage within buildings with travel and transport being the second focus of attention. Insufficient investment in the estate overall has impacted on the suitability and standard of buildings as well as their energy efficiency performance. The HSCP has taken a lead in progressing a number of projects including: • Electrification of the vehicle fleet; • Direct funding secured for increasing electric vehicle charging points; • Innovative project to pilot the use of drones in remote and island areas; • Supporting increased use of remote / home working for patients, clients and staff; • Purchase of new Electric vehicles for delivery in early 2025; and • Completion of the pre-capital project to develop options for building related carbon reduction. The HSCP has improved its approach to the management of its infrastructure and estate as planned. The Senior Estates Development and Sustainability Manager has been appointed and an Infrastructure Board has been established to oversee the development of the Estates Strategy and ensure projects are appropriately prioritised. The return seeks to outline some of the pro-active Page 60
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3 steps being taken by the HSCP. The HSCP has also highlighted to Scottish Government that it is not able to access funding directly and is not resourced to undertake review or adaptation work. Capital funding for carbon reduction has been reduced substantially which does create a risk that the work completed in 2023/24 will become obsolete and require to be re-visited before any projects are progressed. The scale of backlog maintenance requirements also means that it will be difficult to fund carbon reduction projects to change sources of energy. However, a fabric first approach to carbon reduction does align with firstly addressing backlog maintenance to reduce energy consumption and heat loss. 4. RELEVANT DATA AND INDICATORS 4.1 Carbon emissions reporting places reliance on data provided by Argyll and Bute Council and NHS Highland. 5 CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 Addressing climate change is a Scottish Government priority and their declaration of a climate emergency underlines their commitment. Specific and ambitious targets have been set and the HSCP is seeking to contribute to these where it can with the resources it has available. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – the HSCP has very limited financial resources available to it to progress this agenda. It does not have delegated responsibility for capital budgets or investment. 6.2 Staff Governance – None 6.3 Clinical Governance – None 7. 7.1 PROFESSIONAL ADVISORY There are no recommendations which require to be consulted on with Professional Advisory leads. 8. EQUALITY & DIVERSITY IMPLICATIONS 8.1 None 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 None 10. RISK ASSESSMENT 10.1 The steps outlined in this report are intended to provide assurance of the actions being taken by the HSCP to reduce emissions, comply with the requirement to submit a climate change report and ensure it is perceived as being pro-active within the resources available. There remains a risk that the HSCP and / or its partners are perceived as not taking sufficient action to address climate change. Likewise there is a risk that the focus of financial and Page 61
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4 management resource on carbon reduction adversely impacts on resources available for other priorities. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 11.1 All public sector climate change submissions are publicly available. 11. CONCLUSIONS 11.1 This report provides a draft Climate Change report and seeks IJB approval for its submission. It outlines the reliance that the IJB places on both of its partners and the positive steps being taken by the HSCP to contribute to carbon reduction within the resources available. 12. 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) N/A AUTHOR NAME: Malcolm McMillan, Strategic Estates & Sustainability & James Gow, Head of Finance and Transformation EMAIL: malcolm.mcmillan2@nhs.scot / james.gow@argyll-bute.gov.uk APPENDICES: Appendix 1: Draft Climate Change Report Page 62
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# Public Bodies Climate Change Duties Compliance Reporting Financial Year Template 2023/24 1. Overview This template is provided for public bodies required to report annually in accordance with the Climate Change (Duties of Public Bodies Reporting Requirements) (Scotland) Order 2015, as amended by the Climate Change (Duties of Public Bodies: Reporting Requirements) (Scotland) Amendment Order 2020 which took effect for reporting periods commencing on or after 1 April 2021. Reports must be submitted to ccreporting@ed.ac.uk by 30th November. Late submissions will not be accepted for analysis and may be deemed non-compliant with Public Bodies Duties reporting requirements. 2. Guidance 1. Please do not delete any cells, rows or columns. This may corrupt the template/data and compromise analysis. You can hide any extra rows within tables. 2. Please complete the new "Boundary info" tab. This will enable improved assessment of data coverage and inform SSN analysis. 3. The "Profile of Body" tab must be completed before proceeding to add any other data. 4. To ensure that the correct emission factors are applied please ensure that you are using the correct template for the reporting year type under Q1f. If your organsiation reports according to the academic year, usually August to July, you must use the Academic Year template. 5. If you need to add more rows in any table please email the file to ccreporting@ed.ac.uk 6. In Q3b emissions sources can be filtered by type in Column C. The list of available factors is visble on the Emission Factors tab. Please do not edit this list, use "other" if an EF is not available. 7. Only use the "other" rows when there is no relevant emission source available in the dropdown list or if you have bespoke data/emission factors. Please provide a brief explanation in the comment. 8. Water supply and treatment (sewage) emission factors are based on Scottish Water's carbon intensities for service supply. If you wish to use UK factors you need to enter manually in an "Other" row. 9. More detailed guidance is available on the SSN website 3. Colour Coding used in the template Dropdown box - select from list of options Uneditable/fixed entry cell Editable cell Page 63
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# Public Bodies Climate Change Duties Compliance Reporting Template 2023/24 FY Please answer all questions below with respect to the public body's reporting boundary for the reporting period. The information is intended to improve data coverage and inform analysis, in particular, to help identify data gaps. There are 3 response options: YES - where data is available and is reported NA - where a category is relevant but no data is available NO - the category is not relevant Any points of clarification can be added in the comments field for the corresponding emission source(s) in Table 3b on the Emissions tab. Category Select from dropdown list Owned estate Are any buildings owned by the public body? No Managed services Are building services managed on behalf of another public body that shares or leases space? No Leased premises -public Are building services managed and provided by another public body? Yes Leased premises - private Are building services managed and provided by a private landlord? No Streetlighting Are streetlights owned or operated? No Fleet and equipment Are any vehicles or fossil-fueled machinery or equipment owned or leased, excludes short-term or infrequent hires? No Refrigerants/F-gases Are there any air conditioning or refrigeration systems that require refrigerant gas top-ups? No Medical gases Are medical gases used? Yes Business travel - private Do staff undertake business travel by private car? Yes Business travel - flights Do staff undertake any business travel by plane? No Homeworking Do staff work from home - including hybrid? Yes Supply chain Are any goods or services purchased? Yes Land use Are more than 10 hectares of land owned or managed for public services provision, including for research or recreation? No Waste services Is the public body responsible for collecting household or municipal waste? No Page 64
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# PART 1 Profile of Reporting Body 1a Name of reporting body Provide the name of the listed body (the "body") which prepared this report. Argyll & Bute IJB / HSCP 1b Type of body Select from the options below Integration Joint Boards 1c Highest number of full-time equivalent staff in the body during the report year 2 1d Metrics used by the body Metric Units Value Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) Other (please specify in comments) 15 Other (please specify in comments) 1e Overall budget of the body Specify approximate £/annum for the report year. Budget Budget Comments £362,564,000 Budget delegated by Argyll & Bute Council and NHS Highland 1f Report type Check the report year type is correct. The alternative template must be used for academic year reporting. Reporting type Report year comments Financial/Calendar/Other 1st April 2023 to 31st March 2024 1g Context Public Sector Report on Compliance with Climate Change Duties 2024 Template FY Specify the metrics that the body uses to assess its performance in relation to climate change and sustainability. Provide a summary of the body's nature and functions that are relevant to climate change reporting. The Argyll & Bute Integration Joint Board has delegated responsibility for all Health and Social Care Service delivery within the Argyll & Bute area. As with all Integration Joint Boards, the Health and Social Care Partnership does not directly employ staff or own assets and therefore it submits a 'nil' return to avoid double counting. It has two 'officers' who are employed by partners, the Chief Officer and the Chief Finance Officer - these are noted as the two staff. Its carbon emissions are reported by its two partners, NHS Highland and Argyll & Bute Council. The HSCP is the delivery function and recognises that its activities contribute to carbon emissions and is pro-active in taking steps to manage down emissions relating to travel, transport and buildings in partnership with its two partners. The HSCP has indicated that it would be helpful if it was able to access carbon reduction funding directly in its own right. The 2 individuals technically employed by the IJB are reported within the reporting provided by Argyll and Bute Council and NHS Highland. Page 65
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# PART 2 Governance, Management and Strategy Governance and management 2a 2b Strategy 2c Provide a brief summary of objectives if they exist. Wording of objective Implement the new Eclipse IT System Join up HSCP Teams by improving data sharing and e Expand Electric Vehicle Charging points by 30 Complete final phase of Drone Pilot Identify Estate Rationalisation opportunties as part o Create additional management capacity relating to E 2d 2e Provide the name of any such document and the timeframe covered. Topic area Name of document Link Time period covered Comments Adaptation Business travel Joint Strategic Plan 2022-25 Staff Travel Joint Strategic Plan 2022-25 Energy efficiency Fleet transport Joint Strategic Plan 2022-25 ICT Digital Strategy 2022-25 Renewable energy Sustainable/renewable heat Waste management Water and sewerage Land Use Other (please specify in comments) Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 2f What are the body’s top 5 priorities for climate change governance, management and strategy for the year ahead? Provide a brief summary of the body’s areas and activities of focus for the year ahead. Not at present, it is currently placing reliance upon the plans of NHS Highland and Argyll & Bute Council and the legal duties placed upon them to manage and report on carbon emissions. The HSCP has appointed a Senior Manager for Strategic Estates & Sustainability and is in the process of developing its Estates strategy this will incorporate actions for addressing climate change and the sustainable development goals. However, it is clear that the funding envolope available for critical maintenance is insufficient and, at present, there are no resources available to progress investment in practical terms. The HSCP recently received pre-capital funding for carbon reduction projects but is now unable to access capital funding to progress any of the projects highlighted in that piece of work funded by SG. Does the body have any plans or strategies covering the following areas that include climate change? Does the body have a climate change plan or strategy? If yes, provide the name of any such document and details of where a copy of the document may be obtained or accessed. Joint Strategic Plan 2022-25 https://www.nhshighland.scot.nhs.uk/media/phxd2/bgi/argyll-and-bute-joint-strategic-plan-15-06-2022.pdf Joint Strategic Plan 2022-25 https://www.nhshighland.scot.nhs.uk/media/phxd2/bgi/argyll-and-bute-joint-strategic-plan-15-06-2022.pdf https//www.nhshighland.scot.nhs.uk/about/argyll-and-bute-social-care-partnership/publications/joint-strategic-plan-2022-2025/ Joint Strategic Plan 2022-25 https://www.nhshighland.scot.nhs.uk/media/phxd2/bgi/argyll-and-bute-joint-strategic-plan-15-06-2022.pdf Joint Strategic Plan 2022-25 https://www.nhshighland.scot.nhs.uk/media/phxd2/bgi/argyll-and-bute-joint-strategic-plan-15-06-2022.pdf Does the body have specific climate change mitigation and adaptation objectives in its corporate plan or similar document? Name of document Document Link Joint Strategic Plan 2022-25 https://www.nhshighland.scot.nhs.uk/media/phxd2/bgi/argyll-and-bute-joint-strategic-plan-15-06-2022.pdf Provide a summary of the roles performed by the body’s governance bodies and members in relation to climate change. If any of the body’s activities in relation to climate change sit outside its own governance arrangements (in relation to, for example, land use, adaptation, transport, business travel, waste, information and communication technology, procurement or behaviour change), identify these activities and the governance arrangements. Provide a diagram / chart to outline the governance structure within the body. The governance associated with climate change is delivered through the partnership and is primarily led by NHS Highland and Argyll & Bute Council. The key identified drivers of carbon emissions associated with HSCP activities are those which relate to energy consumption at our premises and carbon emissions relating to our staff travel and our vehicle fleet. These are included within the totals reported by NHS Highland and Argyll & Bute Council. Responsibility for capital assets and investment in these sits with the partners. The HSCP is pro active in contributing to carbon reduction projects and is taking a lead particularly with the electrification of the fleet, installation of electric vehicle charging points. The feasibility of using drones to transport items such as laboratory samples and drugs to remote locations and islands sites is progressing. The IJB considers the climate change report and relevant reporting from partners. The HSCP is developing its own strategic approach to management of its Estate with a view to increasing investment allocated to HSCP used premises and improving their environmental performance. The IJB have also approved the Digital Strategy which includes specific targets in respect of Technology Enabled Care and increased use of remote working. This relates to both how we engage with and deliver services to people in the communities we serve as well supporting remote and hybrid working for our corporate and governance support services. It has established an Infrastructure Transformation Group to add to the governance and oversight of estates operation and investment priorities. It has also invested in additional management capacity and successfully applied for pre-capital funds to look at how it might most effectively reduce carbon emissions associated with the estate. How is climate change action managed and embedded in the body? Provide a summary of how decision-making in relation to climate change action by the body is managed and how responsibility is allocated to the body’s senior staff, departmental heads etc. If any such decision- making sits outside the body’s own governance arrangements (in relation to, for example, land use, adaptation, transport, business travel, waste, information and communication technology, procurement or behaviour change), identify how this is managed and how responsibility is allocated outside the body. Provide a diagram to show how responsibility is allocated to the body’s senior staff, departmental heads etc. As above, the main drivers of climate emissions relate to our buildings and infrastructure, our fleet and staff travel. The HSCP has appointed a Senior Manager for Strategic Estates & Sustainability. Their responsibilities include the development of an integrated HSCP estates strategy in partnership with Argyll & Bute Council and NHS Highland. In addition to this the remit of the Strategtic Estates and Sustainability function is responsible for the HSCP fleet of vehicles and development of the EV charging infrastructure. While these are led within the HSCP, they are still heavily dependent upon both partners for investment. These strands seek to minimise staff and patient travel where appropriate, partly to reduce carbon emissions. The HSCP is progressing well in the electrification of its vehicle fleet to reduce the carbon emissions associated with essential travel and transport. The Head of Finance & Transformation has responsibility for the local Estates Function to ensure that the Estate is well utilised and development and maintenance plans are in place which are aimed at ensuring building performance is being managed and improved. Investment and the strategic management of the Estate was not delegated to the IJB and therefore it is required to work in partnership with NHS Highland and Argyll and Bute Council in this regard. Public Sector Report on Compliance with Climate Change Duties 2024 Template FY How is climate change governed in the body? Joint Strategic Plan 2022-25 https://www.nhshighland.scot.nhs.uk/media/phxd2/bgi/argyll-and-bute-joint-strategic-plan-15-06-2022.pdf Page 66
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# 2g If yes, please provide details of the key findings and resultant action taken. (a) This refers to the tool developed by Resource Efficient Scotland for self-assessing an organisation’s capability / performance in relation to climate change. Further information 2h Supporting information and best practice The IJB requires additional specific funding to enable it to respond to the Climate Change / Sustaiable Development agenda in a strategic way. This is required to improve governance, planning and reporting and would also accelerate carbon reduction priorities. The pre-capital work completed during the year has identified several projects that would be effective in reducing emissions in the event that funding became available. Development of an Estates Strategy Disagregation of NHS Highland & Argyll & Bute Carbon Reporting Data Improved reporting to IJB Increased funding for investment in electric fleet Increase in management capacity for Estates Sustainability Projects and Developments Complete Care Home strategic assessment and business case work Has the body used the Climate Change Assessment Tool (a) or equivalent tool to self-assess its capability / performance? No - it is not resourced to do this at present. Provide any other relevant supporting information and any examples of best practice by the body in relation to governance, management and strategy. Page 67
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# PART 3 Corporate Emissions, Targets and Project Data Emissions 3a Emissions from the start of the year which the body uses as a baseline (for its carbon footprint) to the end of the report year Reference year Year Year type Scope 1 Scope 2 Scope 3 Total Units Comments Baseline Year Please select from drop down box Financial/Calendar/Other - tCO2e 3 Year 1 carbon footprint 0 Financial/Calendar/Other - tCO2e 4 Year 2 carbon footprint 0 Financial/Calendar/Other - tCO2e 5 Year 3 carbon footprint 0 Financial/Calendar/Other - tCO2e 6 Year 4 carbon footprint 0 Financial/Calendar/Other - tCO2e 7 Year 5 carbon footprint 0 Financial/Calendar/Other - tCO2e 8 Year 6 carbon footprint 0 Financial/Calendar/Other - tCO2e 9 Year 7 carbon footprint 0 Financial/Calendar/Other - tCO2e 10 Year 8 carbon footprint 0 Financial/Calendar/Other - tCO2e 11 Year 9 carbon footprint 0 Financial/Calendar/Other - tCO2e 12 Year 10 carbon footprint 0 Financial/Calendar/Other - tCO2e 13 Year 11 carbon footprint 0 Financial/Calendar/Other - tCO2e 14 Year 12 carbon footprint 0 Financial/Calendar/Other - tCO2e 15 Year 13 carbon footprint 0 Financial/Calendar/Other - tCO2e 16 Year 14 carbon footprint 0 Financial/Calendar/Other - tCO2e 17 Year 15 carbon footprint 0 Financial/Calendar/Other - tCO2e 18 Year 16 carbon footprint 0 Financial/Calendar/Other - tCO2e 19 Year 17 carbon footprint 0 Financial/Calendar/Other - tCO2e 20 Year 18 carbon footprint 0 Financial/Calendar/Other - tCO2e 3b Breakdown of emissions sources Please refrain from deleting rows or columns anywhere in this template. This workbook is password protected to prevent this and should not be unlocked. Emission Factor Year 2023 You can filter emission sources by "type" in column C to enable quicker selection of emission source in column D. See the list in the Emissions Tab. User defined emission sources can be entered in rows 131 onwards. Please only use these if you cannot find a relevant emission source in the dropdown list or you have a bespoke emission factor or non-standard derivation of emissions e.g. based on a survey/consumption data. If you require extra rows in the table please send the template to ccreporting@ed.ac.uk. Emission Type Emission source Scope Consumption data Units Emission factor Units Emissions (tCO2e) Comments Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Please select from drop down box Please select from drop down box Please select from drop down box 0.00000 Please state in comments if this value is 0 because no emissions exist or if emissions likely exist, but are unknown Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - (a) Emissions factors are published annually by the UK Department for Energy Security & Net Zero Public Sector Report on Compliance with Climate Change Duties 2024 Template FY Complete the following table using the greenhouse gas emissions total for the body calculated on the same basis as for its annual carbon footprint / management reporting or, where applicable, its sustainability reporting. Include greenhouse gas emissions from the body’s estate and operations (a) (measured and reported in accordance with Scopes 1 &2 and, tothe extent applicable, selected Scope 3 of theGreenhouse Gas Protocol (b). If data is not availablefor any year from the start of the baselineyear to the end of the report year, providean explanation in the comments column. (a) No information is required on the effect of the body on emissions which are not from its estate and operations. (b) This refers to “The greenhouse gas protocol. A corporate accounting and reporting standard (revised edition)”, World Business Council for Sustainable Development, Geneva, Switzerland / World Resources Institute, Washington DC, USA (2004), ISBN: 1- 56973-568-9. Complete the following table with the breakdown of emission sources from the body’s most recent carbon footprint (greenhouse gas inventory); this should correspond to the last entry in the table in 3(a) above. Use the ‘Comments’ column to explain what is included within each category of emission source entered in the first column. If there is no data consumption available for an emission sourceenter theemissions in kgCO2e in the‘Consumption’ column of oneof the“Other”rows and assign thescopeand an emission factor of 1. SELECT APPROPRIATE BASELINE YEAR. TOTAL EMISSIONS IN THE MOST RECENT FOOTPRINT YEAR IN THIS QUESTION SHOULD EQUAL TOTAL EMISSIONS IN Q3B Page 68
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# Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - Other Other (please specify in comments) Please select from drop down box - 121 - 3c Generation, consumption and export of renewable energy Provide a summary of the body’s annual renewable generation (if any), and whether it is used or exported by the body. Total consumed by the body (kWh) Total exported (kWh) Total consumed by the body (kWh) Total exported (kWh) Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Targets 3d Organisational targets Name of target Type of target Target Units Boundary/scope of target Year used as baseline Baseline figure Units of baseline Target completion year Progress against target Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please 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down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Total - 3f Project name Funding source First full year of CO2e savings Are these savings figures estimated or actual? Capital cost (£) Operational cost (£/annum) Project lifetime (years) Primary fuel/emission source saved Estimated carbon savings per year (tCO2e/annum) Estimated costs savings (£/annum) Behaviour Change Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box Please select from drop down box Please select from drop down box Please select from drop down box Please select from dropdown box 3g Emissions source Total estimated annual emissions (tCO2e) Increase or decrease in emissions Comments Estate changes Please select from drop down box Service provision Please select from drop down box Technology Renewable Electricty Renewable Heat List all of the body’s targets of relevance to its climate change duties. Where applicable, targets for reducing indirect emissions of greenhouse gases, overall carbon targets and any separate land use, energy efficiency, waste, water, information and communication technology, transport, travel and heat targets should be included. Where applicable, you should also providethe body’s target date for achieving zero direct emissions of greenhouse gases, or such other targets that demonstrate how the body is contributing toScotlandachieving its emissions reductiontargets. Estimated total annual carbon savings from all projects implemented by the body in the report year If no projects were implemented against an emissions source, enter "0". If thebody does nothaveany information for an emissions source, enter “Unknown”. If the body does notincludetheemissions source in its carbon footprint, enter “N/A”. Detail the top 10 carbon reduction projects to be carried out by the body in the report year Provide details of the 10 projects which are estimated to achieve the highest carbon savings during report year. Estimated decrease or increase in the body’s emissions attributed to factors (not reported elsewhere in this form) in the report year If the emissions increased or decreased due to any such factor in the report year, provide an estimate of the amount and direction The HSCP is placing reliance on Climate Change reporting by its two partners, NHS Highland and Argyll & Bute Council. It is seeking to develop its own approach as described in the Governance section but is facing financial constraints which are now making this ob How will the body align its spending plans and use of resources to contribute to reducing emissions and delivering its emission reduction targets? Provide any relevant supporting information that is not already included elsewhere in this report. The HSCP secured £493,812 to provide additional Electric Vehicle charging stations at key sites and to support the lease of Zero Emission Vehicles. It secured £60k in pre-capital funding to establish the most effective ways of reducing property related carbon emissions, consultancy work to identify projects was completed during the year, however no capital funding is now available to progress of the projects. How will the body publish, or otherwise make available, it's progress towards achieving its emissions reduction targets? Provide any other relevant supporting information. In the event that the body wishes to refer to information already publshed, provide information about where the publication can be accessed. Simply referencing this report or it's availabilty on the SSN website is insufficient information. Page 69
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#
Staff numbers Please select from drop down box
Other (please specify in comments) Please select from drop down box
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3h Anticipated annual carbon savings from all projects implemented by the body in the year ahead
Emissions source Total estimated annual carbon savings (tCO2e) Comments
Electricity
Natural gas
Other heating fuels
Waste
Water and sewerage
Travel
Fleet Transport
Other (please specify in comments)
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3i
Emissions source Total estimated annual emissions (tCO2e) Increase or decrease in emissions Comments
Estate changes Please select from drop down box
Service provision Please select from drop down box
Staff numbers Please select from drop down box
Other (please specify in comments) Please select from drop down box
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3j
Total savings Total estimated emissions savings (tCO2e) Comments
Total project savings since baseline year
Further information
3k
Current local projects include:
Attempt to secure capital funding to implement pre-capital proposals if possible.
Electrificationof thevehiclefleet
Complete business case work on Care Home investment and renewal
Argyll& Bute Council and NHS Highland undertakinganumber of additional projects to reduce emissions across the area, including introduction of solar panels and other energy efficiency schemes. The impact of these projects is reported by the partners.
Estimated decrease or increase in emissions from other sources in the year ahead
If the body’s corporate emissions are likely to increase or decrease for any other reason in the year ahead, provide an estimate of the amount and direction.
Total carbon reduction project savings since the start of the year which the body used as a baseline for its carbon footprint
If the body has data available, estimate the total emissions savings made from projects since the start of that year ("the baseline year").
Supporting information and best practice
Provide any other relevant supporting information and any examples of best practice by the body in relation to corporate emissions, targets and projects.
If no projects are expected to be implemented against an emissions source, enter “0”.
If theorganisation does not haveany information for an emissions source, enter “Unknown”.
If the organisation does not include the emissions source in its carbon footprint, enter “N/A”.
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# PART 4 Adaptation - please do not include information in this part on measures that solely reduce emissions with no implications for climate adaptation. These are climate mitigation measures which should be reported in the Emissions tab. Assessing and managing risk 4a Has the body assessed current and future climate-related risks? 4b Taking action 4c What action has the body taken to adapt to climate change? 4d Where applicable, what contribution has the body made to helping deliver the Programme? Provide any other relevant supporting information Review, monitoring and evaluation 4e What arrangements does the body have in place to review current and future climate risks? 4f What arrangements does the body have in place to monitor and evaluate the impact of the adaptation actions? Future priorities for adaptation 4g Further information 4h None Supporting information and best practice Provide any other relevant supporting information and any examples of best practice by the body in relation to adaption. None None at present - there are no resources available to undertake this work. Please provide details of monitoring and evaluation criteria and adaptation indicators used to assess the effectiveness of actions detailed under Question 4(c) and Question 4(d). None What are the body’s top 5 climate change adaptation priorities for the year ahead? Provide a summary of the areas and activities of focus for the year ahead. At present the IJB is reliant upon Argyll & Bute Council and NHS Highland, it is not presently resourced to undertake adaptation work. Provide details of arrangements to review current and future climate risks, for example, what timescales are in place to review the climate change risk assessments referred to in Question 4(a) and adaptation strategies, action plans, procedures and policies in Question 4(b). None at present Include details of work to increase awareness of the need to adapt to climate change and build the capacity of staff and stakeholders to assess risk and implement action. The body may wish to make reference to the Scottish Climate Change Adaptation Programme (“the Programme”). None Public Sector Report on Compliance with Climate Change Duties 2024 Template If yes, provide a reference or link to any such risk assessment(s). Not specifically - weather and climate related factors are included in Estates development plans aimed at ensuring properties remain fit for purpose and safe clinical environments. Immediate backlog maintenance, addressing fire related risk along with a lack of capital funding are more urgent concerns. What arrangements does the body have in place to manage climate-related risks? Provide details of any climate change adaptation strategies, action plans and risk management procedures, and any climate change adaptation policies which apply across the body. Page 71
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# PART 5 Procurement 5a How have procurement policies contributed to compliance with climate change duties? 5b How has procurement activity contributed to compliance with climate change duties? Further information 5c Supporting information and best practice Public Sector Report on Compliance with Climate Change Duties 2024 Template The IJB has sought to encourage shared use of vehicles and premises with key partners, partly to manage carbon emissions. Provide any other relevant supporting information and any examples of best practice by the body in relation to procurement. Provide information relating to how the procurement policies of the body have contributed to its compliance with climate changes duties. The IJB seeks to comply fully with Scottish Public Sector Procurement legislation and guidance. It places reliance upon the systems and processes of Argyll & Bute Council and NHS Highland. It seeks to use national frameworks and contracts wherever possible to ensure appropriate consideration has been given to environmental sustainability. Provide information relating to how procurement activity by the body has contributed to its compliance with climate changes duties. Page 72
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# PART 6 Validation and Declaration 6a Internal validation process Briefly describe the body’s internal validation process, if any, of the data or information contained within this report. 6b Peer validation process Briefly describe the body’s peer validation process, if any, of the data or information contained within this report. 6c External validation process Briefly describe the body’s external validation process, if any, of the data or information contained within this report. 6d No Validation Process If any information provided in this report has not been validated, identify the information in question and explain why it has not been validated. 6e Declaration Name: James Gow Role in the body: Head of Finance & Transformation Date: 30/11/2024 Date in format (dd/mm/yyyy) Public Sector Report on Compliance with Climate Change Duties 2024 Template The HSCP is not resourced to undertake any validation work. I confirm that the information in this report is accurate and provides a fair representation of the body’s performance in relation to climate change. The HSCP places reliance on NHS Highland and Argyll & Bute Council as they report carbon emissions on behalf of the HSCP. The HSCP places reliance on NHS Highland and Argyll & Bute Council as they report carbon emissions on behalf of the HSCP. The HSCP places reliance on NHS Highland and Argyll & Bute Council as they report carbon emissions on behalf of the HSCP. Page 73
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# Recommended Reporting: Reporting on Wider Influence Wider Impact and Influence on GHG Emissions Q1) Historic Emissions (Local Authorities Only) Please indicate emission amounts and unit of measurement (e.g. tCO2e) and years. Please provide information on the following components using data from the links provided below. Please use (1) as the default unless targets and actions relate to (2). Please note : territorial emissions of carbon dioxide (CO2), methane (CH4) and nitrous oxide (N2O) are provided, but not fluorinated gases, which are also included in the UK territorial greenhouse gas emissions statistics. Prior to the 2005 to 2020 publication the statistics covered emissions of carbon dioxide only (1) UK local and regional CO2e emissions: subset dataset (emissions within the scope of influence of local authorities): (2) UK local and regional CO2e emissions: full dataset: https://data.gov.uk/dataset/723c243d-2f1a-4d27-8b61-cdb93e5b10ff/emissions-of-carbon-dioxide-for-local-authority-areas Local Authority:(Please State) Please select from drop down box DESNZ Dataset:(full or sub-set) Please select from drop down box Source Sector 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 Units Comments Total Emissions - - - - - - - - - - - - ktCO2e 1 Industry and Commercial ktCO2e 2 Domestic ktCO2e 3 Transport total ktCO2e 5 Per Capita ktCO2e Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 2a) Targets Please detail your wider influence targets Sector Type of Target (units) Baseline value Start year Target Target/End year Saving in latest year measured Latest Year Measured Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 2b) Does the organisation have an overall mission statement, strategies, plans or policies outlining ambition to influence emissions beyond your corporate boundaries? If so, please detail this in the box below. Q3) Policies and Actions to Reduce Emissions Please detail any of the specific policies and actions which are underway to achieve your emission reduction targets Sector Start year for policy/action implementation Year that the policy/action will be fully implemented Annual CO2 saving once fully implemented (tCO2) Latest Year measured Saving in latest year measured (tCO2) Delivery Role During project/policy design and implementation, has ISM or an equivilent behaviour change tool been used? Please give further details of this behaviour change activity. Value of Investment (£) Ongoing Costs (£/year) Primary Funding Source for Implementation of Policy/Action Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box 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Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please provide any detail on data sources or limitations relating to the information provided in Table 3 Q4) Partnership Working, Communications and Capacity Building Please detail your Climate Change Partnership, Communication or Capacity Building Initiatives below. Organisation's project role Lead Organisation (if not reporting organisation) Private Partners Public Partners 3rd Sector Partners Outputs Comments Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Q5) Please detail key actions relating to Food and Drink, Biodiversity, Water, Procurement and Resource Use in the table below Key Action Type Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box DESNZ Sectors Other Sectors Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Key Action Type Description Please select from drop down box Please select from drop down box Comments CommentsImpacts Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Q6) Please use the text box below to detail further climate change related activity that is not noted elsewhere within this reporting template Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box CommentsDescription Status Please select from drop down box Please select from drop down box Please select from drop down box Key Action Description Metric/indicators for monitoring progress Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Other Notable Reportable Activity Organisation's Project Role Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Please select from drop down box Page 74
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# Scope Level 1 Level 2 Level 3 UOM GHG Conversion Factor 2023 (kgCO2e/unit) Scope 1 Bioenergy Biogas Biogas kWh 0.00022 Scope 1 Bioenergy Biogas Biogas tonnes 1.23595 Scope 1 Bioenergy Biogas Landfill gas kWh 0.0002 Scope 1 Bioenergy Biomass Wood chips kWh 0.01074 Scope 1 Bioenergy Biomass Wood chips tonnes 40.58114 Scope 1 Bioenergy Biomass Wood pellets kWh 0.01074 Scope 1 Bioenergy Biomass Wood pellets tonnes 51.56192 Scope 1 Fuels Liquid fuels Aviation spirit kWh 0.24382 Scope 1 Fuels Liquid fuels Aviation spirit litres 2.33116 Scope 1 Fuels Liquid fuels Aviation turbine fuel kWh 0.24758 Scope 1 Fuels Liquid fuels Aviation turbine fuel litres 2.54269 Scope 1 Fuels Liquid fuels Burning oil (Kerosene) kWh 0.24677 Scope 1 Fuels Liquid fuels Burning oil (Kerosene) litres 2.54016 Scope 1 Fuels Liquid fuels Burning oil (Kerosene) tonnes 3165.04181 Scope 1 Fuels Solid fuels Coal (industrial) tonnes 2396.47994 Scope 1 Fuels Liquid fuels Diesel (100% mineral diesel) litres 2.65937 Scope 1 Fuels Liquid fuels Diesel (average biofuel blend) litres 2.51206 Scope 1 Fuels Liquid fuels Fuel oil kWh 0.26813 Scope 1 Fuels Liquid fuels Fuel oil litres 3.17492 Scope 1 Fuels Liquid fuels Fuel oil tonnes 3228.89019 Scope 1 Fuels Liquid fuels Gas oil kWh 0.2565 Scope 1 Fuels Liquid fuels Gas oil litres 2.75541 Scope 1 Fuels Liquid fuels Gas oil tonnes 3226.57859 Scope 1 Fuels Gaseous fuels LPG kWh 0.21450 Scope 1 Fuels Gaseous fuels LPG litres 1.55713 Scope 1 Fuels Liquid fuels Marine fuel oil litres 3.10202 Scope 1 Fuels Liquid fuels Marine gas oil litres 2.77139 Scope 1 Fuels Gaseous fuels Natural gas kWh 0.18293 Scope 1 Fuels Liquid fuels Petrol (100% mineral petrol) litres 2.34503 Scope 1 Fuels Liquid fuels Petrol (average biofuel blend) litres 2.09747 Scope 1 Fuels Gaseous fuels Propane kWh 0.2141 Scope 1 Fuels Gaseous fuels Propane litres 1.54358 Scope 1 Fuels Liquid fuels Waste oils kWh 0.25641 Scope 1 Fuels Liquid fuels Waste oils litres 2.74924 Scope 1 Fuels Liquid fuels Waste oils tonnes 3219.37916 Scope 1 Medical gas (Process) Other products Desflurane kg 2540 Scope 1 Medical gas (Process) Other products Sevoflurane kg 130 Scope 1 Medical gas (Process) Other products Isoflurane kg 510 Scope 1 Medical gas (Process) Other products Anaesthetic Nitrous Oxide kg 298 Scope 1 Refrigerants Other products HFC-134a kg 1300 Scope 1 Refrigerants Other products HFC-32 kg 677 Scope 1 Refrigerants Blends R404A kg 3943 Scope 1 Refrigerants Blends R407C kg 1624 Scope 1 Refrigerants Blends R410A kg 1924 Scope 1 Refrigerants Blends R422D kg 2473 Scope 1 Refrigerants Blends R422E kg 2350 Scope 1 Refrigerants Blends R423A kg 2274 Scope 1 Refrigerants Blends R424A kg 2212 Scope 1 Refrigerants Blends R425A kg 1431 Scope 1 Refrigerants Blends R426A kg 1371 Scope 1 Refrigerants Blends R427A kg 2024 Scope 1 Refrigerants Blends R428A kg 3417 Scope 1 Refrigerants Blends R429A kg 13.8 Scope 1 Refrigerants Blends R430A kg 106 Scope 1 Refrigerants Blends R431A kg 40 Scope 1 Refrigerants Blends R432A kg 1.8 Scope 1 Refrigerants Blends R433A kg 0.64 Scope 1 Refrigerants Blends R433B kg 0.16 Scope 1 Refrigerants Blends R433C kg 0.55 Scope 1 Refrigerants Blends R434A kg 3075 Scope 1 Refrigerants Blends R435A kg 28.4 Scope 1 Refrigerants Blends R436A kg 1.35 Scope 1 Refrigerants Blends R436B kg 1.47 Scope 1 Refrigerants Blends R437A kg 1639 Scope 1 Refrigerants Blends R438A kg 2059 Scope 1 Refrigerants Blends R439A kg 1828 Scope 1 Refrigerants Blends R440A kg 156 Scope 1 Refrigerants Blends R441A kg 0 Scope 1 Refrigerants Blends R442A kg 1754 Scope 1 Refrigerants Blends R443A kg 1 Scope 1 Refrigerants Blends R444A kg 89 Scope 1 Refrigerants Blends R445A kg 118 Scope 1 Refrigerants Blends R500 kg 7564 Scope 1 Refrigerants Blends R501 kg 3870 Scope 1 Refrigerants Blends R502 kg 4786 Scope 1 Refrigerants Blends R503 kg 13299 Scope 1 Refrigerants Blends R504 kg 4299 Scope 1 Refrigerants Blends R505 kg 7956 Scope 1 Refrigerants Blends R506 kg 3857 Scope 1 Refrigerants Blends R507A kg 3985 UK Government GHG Conversion Factors for Company Reporting Factors by Category Category Page 75
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# Scope 1 Refrigerants Blends R508A kg 11607 Scope 1 Refrigerants Blends R508B kg 11698 Scope 1 Refrigerants Blends R509A kg 5758 Scope 1 Refrigerants Blends R510A kg 1.24 Scope 1 Refrigerants Blends R511A kg 7 Scope 1 Refrigerants Blends R512A kg 196 Scope 1 Refrigerants Other products R600 = butane kg 0.006 Scope 1 Refrigerants Other products R600A = isobutane kg 3 Scope 1 Refrigerants Other products R601 = pentane kg 5 Scope 1 Refrigerants Other products R601A = isopentane kg 5 Scope 2 Heat and steam Heat and steam District heat and steam kWh 0.17965 Scope 2 Heat and steam Heat and steam Onsite heat and steam kWh 0.17965 Scope 2 Electricity Electricity generated Electricity: UK kWh 0.20707 Scope 2 Renewables Renewable Elec Purchase DiRenewable Elec Purchase Direct Supply kWh 0 Scope 2 Renewables Renewable Heat Purchase D Renewable Heat Purchase Direct Supply kWh 0 Scope 2&3 Transport - car Cars (by size) Average business travel car - Battery Electric Vehicle km 0.05480 Scope 2&3 Transport - car Cars (by size) Average business travel car - Battery Electric Vehicle miles 0.08819 Scope 2&3 Transport - car Cars (by size) Average business travel car - Plug-in Hybrid Electric Vehicle km 0.09392 Scope 2&3 Transport - car Cars (by size) Average business travel car - Plug-in Hybrid Electric Vehicle miles 0.15113 Scope 3 Electricity T&D- UK electricity Transmission and distribution - Electricity: UK kWh 0.01792 Scope 3 Heat and steam Heat and steam Transmission and distribution - district heat & steam, 5% loss kWh 0.00945 Scope 3 Homeworking Homeworking (office equipmeHomeworking (office equipment + heating) FTE Working Ho 0.33378 Scope 3 Hotel stay Hotel stay Hotel stay - UK Room per night 10.4 Scope 3 Hotel stay Hotel stay Hotel stay - UK (London) Room per night 11.5 Scope 3 Material use Construction Aggregates - Primary material production tonnes 7.75138 Scope 3 Material use Construction Aggregates - Recycled source tonnes 3.19491 Scope 3 Material use Construction Aggregates - Re-used tonnes 2.21 Scope 3 Material use Construction Asphalt - Primary material production tonnes 39.21249 Scope 3 Material use Construction Asphalt - Recycled source tonnes 28.65491 Scope 3 Material use Construction Asphalt - Re-used tonnes 1.73826 Scope 3 Material use Construction Average construction - Primary material production tonnes 80.21282 Scope 3 Material use Electrical items Batteries - Alkaline - Primary material production tonnes 4633.47826 Scope 3 Material use Electrical items Batteries - Li ion - Primary material production tonnes 6308 Scope 3 Material use Electrical items Batteries - NiMh - Primary material production tonnes 28380 Scope 3 Material use Construction Bricks - Primary material production tonnes 241.75138 Scope 3 Material use Other Clothing - Primary material production tonnes 22310 Scope 3 Material use Other Clothing - Re-used tonnes 152.25 Scope 3 Material use Organic Compost derived from food and garden waste - Primary material protonnes 114.83405 Scope 3 Material use Organic Compost derived from garden waste - Primary material production tonnes 112.01742 Scope 3 Material use Construction Concrete - Primary material production tonnes 131.75138 Scope 3 Material use Construction Concrete - Recycled source tonnes 3.19491 Scope 3 Material use Electrical items Electrical items - fridges and freezers - Primary material production tonnes 4363.33333 Scope 3 Material use Electrical items Electrical items - IT - Primary material production tonnes 24865.47556 Scope 3 Material use Electrical items Electrical items - large - Primary material production tonnes 3267 Scope 3 Material use Electrical items Electrical items - small - Primary material production tonnes 5647.94563 Scope 3 Material use Other Food and drink - Primary material production tonnes 3701.40359 Scope 3 Material use Other Glass - Primary material production tonnes 1402.76667 Scope 3 Material use Other Glass - Recycled source tonnes 823.18954 Scope 3 Material use Construction Insulation - Primary material production tonnes 1861.75138 Scope 3 Material use Construction Insulation - Recycled source tonnes 1852.08125 Scope 3 Material use Metal Metal: aluminium cans and foil (excl. forming) - Primary material prodtonnes 9108.72731 Scope 3 Material use Metal Metal: aluminium cans and foil (excl. forming) - Recycled source tonnes 990.4781 Scope 3 Material use Metal Metal: mixed cans - Primary material production tonnes 5254.64731 Scope 3 Material use Metal Metal: mixed cans - Recycled source tonnes 1461.67759 Scope 3 Material use Metal Metal: scrap metal - Primary material production tonnes 3669.43615 Scope 3 Material use Metal Metal: scrap metal - Recycled source tonnes 1620.27606 Scope 3 Material use Metal Metal: steel cans - Primary material production tonnes 3086.72731 Scope 3 Material use Metal Metal: steel cans - Recycled source tonnes 1726.72731 Scope 3 Material use Construction Metals - Primary material production tonnes 4005.13777 Scope 3 Material use Construction Metals - Recycled source tonnes 1558.94894 Scope 3 Material use Construction Mineral oil - Primary material production tonnes 1401 Scope 3 Material use Construction Mineral oil - Recycled source tonnes 676 Scope 3 Material use Paper Paper and board: board - Primary material production tonnes 801.52177 Scope 3 Material use Paper Paper and board: board - Recycled source tonnes 699.88184 Scope 3 Material use Paper Paper and board: mixed - Primary material production tonnes 868.06994 Scope 3 Material use Paper Paper and board: mixed - Recycled source tonnes 718.56937 Scope 3 Material use Paper Paper and board: paper - Primary material production tonnes 910.4781 Scope 3 Material use Paper Paper and board: paper - Recycled source tonnes 730.4781 Scope 3 Material use Construction Plasterboard - Primary material production tonnes 120.05 Scope 3 Material use Construction Plasterboard - Recycled source tonnes 32.17 Scope 3 Material use Plastic Plastics: average plastic film - Primary material production tonnes 2560.25566 Scope 3 Material use Plastic Plastics: average plastic film - Recycled source tonnes 1890.70135 Scope 3 Material use Plastic Plastics: average plastic rigid - Primary material production tonnes 3263.92202 Scope 3 Material use Plastic Plastics: average plastic rigid - Recycled source tonnes 2744.09248 Scope 3 Material use Plastic Plastics: average plastics - Primary material production tonnes 3102.44851 Scope 3 Material use Plastic Plastics: average plastics - Recycled source tonnes 2322.22425 Scope 3 Material use Plastic Plastics: HDPE (incl. forming) - Primary material production tonnes 3255.9298 Scope 3 Material use Plastic Plastics: HDPE (incl. forming) - Recycled source tonnes 2346.68907 Scope 3 Material use Plastic Plastics: LDPE and LLDPE (incl. forming) - Primary material product tonnes 2586.72731 Scope 3 Material use Plastic Plastics: LDPE and LLDPE (incl. forming) - Recycled source tonnes 1793.29541 Scope 3 Material use Plastic Plastics: PET (incl. forming) - Primary material production tonnes 4018.48341 Scope 3 Material use Plastic Plastics: PET (incl. forming) - Recycled source tonnes 3121.34429 Scope 3 Material use Plastic Plastics: PP (incl. forming) - Primary material production tonnes 3090.8179 Scope 3 Material use Plastic Plastics: PP (incl. forming) - Recycled source tonnes 2537.386 Scope 3 Material use Plastic Plastics: PS (incl. forming) - Primary material production tonnes 3764.03981 Scope 3 Material use Plastic Plastics: PS (incl. forming) - Recycled source tonnes 3187.08199 Scope 3 Material use Plastic Plastics: PVC (incl. forming) - Primary material production tonnes 3399.17507 Scope 3 Material use Plastic Plastics: PVC (incl. forming) - Recycled source tonnes 2485.74317 Page 76
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# Scope 3 Material use Construction Soils - Recycled source tonnes 0.98491 Scope 3 Material use Construction Tyres - Primary material production tonnes 3335.5719 Scope 3 Material use Construction Tyres - Re-used tonnes 731.21789 Scope 3 Material use Construction Wood - Primary material production tonnes 312.61178 Scope 3 Material use Construction Wood - Recycled source tonnes 112.96968 Scope 3 Material use Construction Wood - Re-used tonnes 38.54288 Scope 3 Transport - car Cars (by size) Average car - Diesel km 0.16983 Scope 3 Transport - car Cars (by size) Average car - Diesel miles 0.27332 Scope 3 Transport - car Cars (by size) Average car - Hybrid km 0.11898 Scope 3 Transport - car Cars (by size) Average car - Hybrid miles 0.19147 Scope 3 Transport - car Cars (by size) Average car - Petrol km 0.16391 Scope 3 Transport - car Cars (by size) Average car - Petrol miles 0.26379 Scope 3 Transport - car Cars (by size) Average car - Unknown km 0.16664 Scope 3 Transport - car Cars (by size) Average car - Unknown miles 0.26817 Scope 1 Transport - car Cars (by size) Average fleet car - Battery Electric Vehicle km 0 Scope 1 Transport - car Cars (by size) Average fleet car - Battery Electric Vehicle miles 0 Scope 1 Transport - car Cars (by size) Average fleet car - Plug-in Hybrid Electric Vehicle km 0.06588 Scope 1 Transport - car Cars (by size) Average fleet car - Plug-in Hybrid Electric Vehicle miles 0.10601 Scope 2&3 Transport - car Cars (by size) Large business travel car - Battery Electric Vehicle km 0.05797 Scope 2&3 Transport - car Cars (by size) Large business travel car - Battery Electric Vehicle miles 0.09330 Scope 2&3 Transport - car Cars (by size) Large business travel car - Plug-in Hybrid Electric Vehicle km 0.10158 Scope 2&3 Transport - car Cars (by size) Large business travel car - Plug-in Hybrid Electric Vehicle miles 0.16349 Scope 3 Transport - car Cars (by size) Large car - Diesel km 0.20859 Scope 3 Transport - car Cars (by size) Large car - Diesel miles 0.33570 Scope 3 Transport - car Cars (by size) Large car - Hybrid km 0.15244 Scope 3 Transport - car Cars (by size) Large car - Hybrid miles 0.24530 Scope 3 Transport - car Cars (by size) Large car - Petrol km 0.27224 Scope 3 Transport - car Cars (by size) Large car - Petrol miles 0.43812 Scope 3 Transport - car Cars (by size) Large car - Unknown km 0.22612 Scope 3 Transport - car Cars (by size) Large car - Unknown miles 0.36389 Scope 1 Transport - car Cars (by size) Large fleet car - Battery Electric Vehicle km 0 Scope 1 Transport - car Cars (by size) Large fleet car - Battery Electric Vehicle miles 0 Scope 1 Transport - car Cars (by size) Large fleet car - Plug-in Hybrid Electric Vehicle km 0.07082 Scope 1 Transport - car Cars (by size) Large fleet car - Plug-in Hybrid Electric Vehicle miles 0.11397 Scope 2&3 Transport - car Cars (by size) Medium business travel car - Battery Electric Vehicle km 0.05257 Scope 2&3 Transport - car Cars (by size) Medium business travel car - Battery Electric Vehicle miles 0.08458 Scope 2&3 Transport - car Cars (by size) Medium business travel car - Plug-in Hybrid Electric Vehicle km 0.08501 Scope 2&3 Transport - car Cars (by size) Medium business travel car - Plug-in Hybrid Electric Vehicle miles 0.13680 Scope 3 Transport - car Cars (by size) Medium car - Diesel km 0.16716 Scope 3 Transport - car Cars (by size) Medium car - Diesel miles 0.26902 Scope 3 Transport - car Cars (by size) Medium car - Hybrid km 0.10904 Scope 3 Transport - car Cars (by size) Medium car - Hybrid miles 0.17549 Scope 3 Transport - car Cars (by size) Medium car - Petrol km 0.17819 Scope 3 Transport - car Cars (by size) Medium car - Petrol miles 0.28676 Scope 3 Transport - car Cars (by size) Medium car - Unknown km 0.17246 Scope 3 Transport - car Cars (by size) Medium car - Unknown miles 0.27754 Scope 1 Transport - car Cars (by size) Medium fleet car - Battery Electric Vehicle km 0.00000 Scope 1 Transport - car Cars (by size) Medium fleet car - Battery Electric Vehicle miles 0.00000 Scope 1 Transport - car Cars (by size) Medium fleet car - Plug-in Hybrid Electric Vehicle km 0.06144 Scope 1 Transport - car Cars (by size) Medium fleet car - Plug-in Hybrid Electric Vehicle miles 0.09887 Scope 3 Transport - car Motorbike Motorbike - Average km 0.11367 Scope 3 Transport - car Motorbike Motorbike - Average miles 0.18294 Scope 2&3 Transport - car Cars (by size) Small business travel car - Battery Electric Vehicle km 0.04823 Scope 2&3 Transport - car Cars (by size) Small business travel car - Battery Electric Vehicle miles 0.07763 Scope 2&3 Transport - car Cars (by size) Small business travel car - Plug-in Hybrid Electric Vehicle km 0.05402 Scope 2&3 Transport - car Cars (by size) Small business travel car - Plug-in Hybrid Electric Vehicle miles 0.08694 Scope 3 Transport - car Cars (by size) Small car - Diesel km 0.13931 Scope 3 Transport - car Cars (by size) Small car - Diesel miles 0.22420 Scope 3 Transport - car Cars (by size) Small car - Hybrid km 0.10150 Scope 3 Transport - car Cars (by size) Small car - Hybrid miles 0.16336 Scope 3 Transport - car Cars (by size) Small car - Petrol km 0.14080 Scope 3 Transport - car Cars (by size) Small car - Petrol miles 0.22660 Scope 3 Transport - car Cars (by size) Small car - Unknown km 0.14037 Scope 3 Transport - car Cars (by size) Small car - Unknown miles 0.22591 Scope 1 Transport - car Cars (by size) Small fleet car - Battery Electric Vehicle km 0.00000 Scope 1 Transport - car Cars (by size) Small fleet car - Battery Electric Vehicle miles 0.00000 Scope 1 Transport - car Cars (by size) Small fleet car - Plug-in Hybrid Electric Vehicle km 0.02163 Scope 1 Transport - car Cars (by size) Small fleet car - Plug-in Hybrid Electric Vehicle miles 0.03481 Scope 3 Transport - public Bus Average local bus passenger.km 0.10215 Scope 3 Transport - public Taxis Black cab km 0.30604 Scope 3 Transport - public Taxis Black cab passenger.km 0.20402 Scope 3 Transport - public Bus Coach passenger.km 0.02718 Scope 3 Transport - public Ferry Ferry - Average (all passenger) passenger.km 0.11270 Scope 3 Transport - public Ferry Ferry - Car passenger passenger.km 0.12933 Scope 3 Transport - public Ferry Ferry - Foot passenger passenger.km 0.01871 Scope 3 Transport - public Flights Flights - Domestic, to/from UK - Average passenger passenger.km 0.27258 Scope 3 Transport - public Flights Flights - International, to/from non-UK - Average passenger passenger.km 0.17580 Scope 3 Transport - public Flights Flights - International, to/from non-UK - Business class passenger.km 0.39044 Scope 3 Transport - public Flights Flights - International, to/from non-UK - Economy class passenger.km 0.13464 Scope 3 Transport - public Flights Flights - International, to/from non-UK - First class passenger.km 0.53854 Scope 3 Transport - public Flights Flights - International, to/from non-UK - Premium economy class passenger.km 0.21542 Scope 3 Transport - public Flights Flights - Long-haul, to/from UK - Average passenger passenger.km 0.26128 Scope 3 Transport - public Flights Flights - Long-haul, to/from UK - Business class passenger.km 0.58029 Scope 3 Transport - public Flights Flights - Long-haul, to/from UK - Economy class passenger.km 0.20011 Scope 3 Transport - public Flights Flights - Long-haul, to/from UK - First class passenger.km 0.80040 Scope 3 Transport - public Flights Flights - Long-haul, to/from UK - Premium economy class passenger.km 0.32016 Scope 3 Transport - public Flights Flights - Short-haul, to/from UK - Average passenger passenger.km 0.18592 Scope 3 Transport - public Flights Flights - Short-haul, to/from UK - Business class passenger.km 0.27430 Page 77
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# Scope 3 Transport - public Flights Flights - Short-haul, to/from UK - Economy class passenger.km 0.18287 Scope 3 Transport - public Rail International rail passenger.km 0.00446 Scope 3 Transport - public Rail Light rail and tram passenger.km 0.02860 Scope 3 Transport - public Bus Local bus (not London) passenger.km 0.11836 Scope 3 Transport - public Bus Local London bus passenger.km 0.07832 Scope 3 Transport - public Rail London Underground passenger.km 0.02780 Scope 3 Transport - public Rail National rail passenger.km 0.03546 Scope 3 Transport - public Taxis Regular taxi km 0.20806 Scope 3 Transport - public Taxis Regular taxi passenger.km 0.14861 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Average (up to 3.5 tonnes) - Battery Electric Vkm 0.07346 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Average (up to 3.5 tonnes) - Battery Electric Vmiles 0.11824 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Class I (up to 1.305 tonnes) - Battery Electric km 0.03850 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Class I (up to 1.305 tonnes) - Battery Electric miles 0.06197 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Class II (1.305 to 1.74 tonnes) - Battery Electrkm 0.05932 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Class II (1.305 to 1.74 tonnes) - Battery Electrmiles 0.09547 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Class III (1.74 to 3.5 tonnes) - Battery Electric km 0.08967 Scope 2&3 Transport - van/HGV Vans Business Travel Van - Class III (1.74 to 3.5 tonnes) - Battery Electric miles 0.14430 Scope 1 Transport - van/HGV Vans Fleet Van - Average (up to 3.5 tonnes) - Battery Electric Vehicle km 0 Scope 1 Transport - van/HGV Vans Fleet Van - Average (up to 3.5 tonnes) - Battery Electric Vehicle miles 0 Scope 1 Transport - van/HGV Vans Fleet Van - Class I (up to 1.305 tonnes) - Battery Electric Vehicle km 0 Scope 1 Transport - van/HGV Vans Fleet Van - Class I (up to 1.305 tonnes) - Battery Electric Vehicle miles 0 Scope 1 Transport - van/HGV Vans Fleet Van - Class II (1.305 to 1.74 tonnes) - Battery Electric Vehicle km 0 Scope 1 Transport - van/HGV Vans Fleet Van - Class II (1.305 to 1.74 tonnes) - Battery Electric Vehicle miles 0 Scope 1 Transport - van/HGV Vans Fleet Van - Class III (1.74 to 3.5 tonnes) - Battery Electric Vehicle km 0 Scope 1 Transport - van/HGV Vans Fleet Van - Class III (1.74 to 3.5 tonnes) - Battery Electric Vehicle miles 0 Scope 1 Transport - van/HGV HGV (all diesel) HGV (all diesel) - All artics - Average laden km 0.90644 Scope 1 Transport - van/HGV HGV (all diesel) HGV (all diesel) - All artics - Average laden miles 1.45877 Scope 1 Transport - van/HGV HGV (all diesel) HGV (all diesel) - All HGVs - Average laden km 0.87205 Scope 1 Transport - van/HGV HGV (all diesel) HGV (all diesel) - All HGVs - Average laden miles 1.40341 Scope 1 Transport - van/HGV HGV (all diesel) HGV (all diesel) - All rigids - Average laden km 0.82313 Scope 1 Transport - van/HGV HGV (all diesel) HGV (all diesel) - All rigids - Average laden miles 1.32470 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) HGVs refrigerated (all diesel) - All artics - Average laden km 1.04867 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) HGVs refrigerated (all diesel) - All artics - Average laden miles 1.68766 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) HGVs refrigerated (all diesel) - All HGVs - Average laden km 1.02098 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) HGVs refrigerated (all diesel) - All HGVs - Average laden miles 1.64310 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) HGVs refrigerated (all diesel) - All rigids - Average laden km 0.98025 Scope 1 Transport - van/HGV HGVs refrigerated (all diesel) HGVs refrigerated (all diesel) - All rigids - Average laden miles 1.57754 Scope 1 Transport - van/HGV Vans Vans - Average (up to 3.5 tonnes) - Diesel km 0.23128 Scope 1 Transport - van/HGV Vans Vans - Average (up to 3.5 tonnes) - Diesel miles 0.37224 Scope 1 Transport - van/HGV Vans Vans - Average (up to 3.5 tonnes) - Petrol km 0.20132 Scope 1 Transport - van/HGV Vans Vans - Average (up to 3.5 tonnes) - Petrol miles 0.32400 Scope 1 Transport - van/HGV Vans Vans - Average (up to 3.5 tonnes) - Unknown km 0.23037 Scope 1 Transport - van/HGV Vans Vans - Average (up to 3.5 tonnes) - Unknown miles 0.37075 Scope 1 Transport - van/HGV Vans Vans - Class I (up to 1.305 tonnes) - Diesel km 0.14212 Scope 1 Transport - van/HGV Vans Vans - Class I (up to 1.305 tonnes) - Diesel miles 0.22875 Scope 1 Transport - van/HGV Vans Vans - Class I (up to 1.305 tonnes) - Petrol km 0.18217 Scope 1 Transport - van/HGV Vans Vans - Class I (up to 1.305 tonnes) - Petrol miles 0.29318 Scope 1 Transport - van/HGV Vans Vans - Class II (1.305 to 1.74 tonnes) - Diesel km 0.17405 Scope 1 Transport - van/HGV Vans Vans - Class II (1.305 to 1.74 tonnes) - Diesel miles 0.28013 Scope 1 Transport - van/HGV Vans Vans - Class II (1.305 to 1.74 tonnes) - Petrol km 0.19594 Scope 1 Transport - van/HGV Vans Vans - Class II (1.305 to 1.74 tonnes) - Petrol miles 0.31534 Scope 1 Transport - van/HGV Vans Vans - Class III (1.74 to 3.5 tonnes) - Diesel km 0.25346 Scope 1 Transport - van/HGV Vans Vans - Class III (1.74 to 3.5 tonnes) - Diesel miles 0.40792 Scope 1 Transport - van/HGV Vans Vans - Class III (1.74 to 3.5 tonnes) - Petrol km 0.31444 Scope 1 Transport - van/HGV Vans Vans - Class III (1.74 to 3.5 tonnes) - Petrol miles 0.50605 Scope 3 Waste Construction Aggregates - Landfill tonnes 1.23401 Scope 3 Waste Construction Aggregates - Recycled tonnes 0.98491 Scope 3 Waste Construction Asbestos - Landfill tonnes 5.91332 Scope 3 Waste Construction Asphalt - Landfill tonnes 1.23401 Scope 3 Waste Construction Asphalt - Recycled tonnes 0.98491 Scope 3 Waste Construction Average construction - Combustion tonnes 21.28081 Scope 3 Waste Construction Average construction - Recycled tonnes 0.98491 Scope 3 Waste Electrical items Batteries - Landfill tonnes 8.88413 Scope 3 Waste Electrical items Batteries - Recycled tonnes 21.28081 Scope 3 Waste Other Books - Combustion tonnes 21.07310 Scope 3 Waste Other Books - Landfill tonnes 1164.09963 Scope 3 Waste Other Books - Recycled tonnes 21.0731 Scope 3 Waste Construction Bricks - Landfill tonnes 1.23401 Scope 3 Waste Clinical Clinical Waste - Orange Stream tonnes 273 Scope 3 Waste Clinical Clinical Waste - Other tonnes 1000 Scope 3 Waste Clinical Clinical Waste - Red Stream tonnes 1000 Scope 3 Waste Clinical Clinical Waste - Yellow Stream tonnes 297 Scope 3 Waste Other Clothing - Combustion tonnes 21.28081 Scope 3 Waste Other Clothing - Landfill tonnes 496.68331 Scope 3 Waste Other Clothing - Recycled tonnes 21.28081 Scope 3 Waste Refuse Commercial and industrial waste - Combustion tonnes 21.28081 Scope 3 Waste Refuse Commercial and industrial waste - Landfill tonnes 520.33474 Scope 3 Waste Construction Concrete - Landfill tonnes 1.23401 Scope 3 Waste Construction Concrete - Recycled tonnes 0.98491 Scope 3 Waste Other Glass - Combustion tonnes 21.28081 Scope 3 Waste Other Glass - Landfill tonnes 8.88413 Scope 3 Waste Other Glass - Recycled tonnes 21.28081 Scope 3 Waste Refuse Household/Municipal/Domestic waste - Combustion tonnes 21.28081 Scope 3 Waste Refuse Household/Municipal/Domestic waste - Landfill tonnes 497.04471 Scope 3 Waste Refuse Mixed dry recyclates - Recycled tonnes 21.28081 Scope 3 Waste Construction Insulation - Landfill tonnes 1.23401 Scope 3 Waste Construction Insulation - Recycled tonnes 0.98491 Scope 3 Waste Metal Metal: aluminium cans and foil (excl. forming) - Combustion tonnes 21.28081 Page 78
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# Scope 3 Waste Metal Metal: aluminium cans and foil (excl. forming) - Landfill tonnes 8.88413 Scope 3 Waste Metal Metal: aluminium cans and foil (excl. forming) - Recycled tonnes 21.28081 Scope 3 Waste Metal Metal: mixed cans - Combustion tonnes 21.28081 Scope 3 Waste Metal Metal: mixed cans - Landfill tonnes 8.88413 Scope 3 Waste Metal Metal: mixed cans - Recycled tonnes 21.28081 Scope 3 Waste Metal Metal: scrap metal - Combustion tonnes 21.28081 Scope 3 Waste Metal Metal: scrap metal - Landfill tonnes 8.88413 Scope 3 Waste Metal Metal: scrap metal - Recycled tonnes 21.28081 Scope 3 Waste Metal Metal: steel cans - Combustion tonnes 21.28081 Scope 3 Waste Metal Metal: steel cans - Landfill tonnes 8.88413 Scope 3 Waste Metal Metal: steel cans - Recycled tonnes 21.28081 Scope 3 Waste Construction Metals - Landfill tonnes 1.26435 Scope 3 Waste Construction Metals - Recycled tonnes 0.98491 Scope 3 Waste Construction Mineral oil - Combustion tonnes 21.28081 Scope 3 Waste Construction Mineral oil - Recycled tonnes 21.28081 Scope 3 Waste Refuse Organic: food and drink waste - Anaerobic digestion tonnes 8.91242 Scope 3 Waste Refuse Organic: food and drink waste - Combustion tonnes 21.28081 Scope 3 Waste Refuse Organic: food and drink waste - Composting tonnes 8.91242 Scope 3 Waste Refuse Organic: food and drink waste - Landfill tonnes 700.20988 Scope 3 Waste Refuse Organic: garden waste - Anaerobic digestion tonnes 8.91242 Scope 3 Waste Refuse Organic: garden waste - Combustion tonnes 21.28081 Scope 3 Waste Refuse Organic: garden waste - Composting tonnes 8.91242 Scope 3 Waste Refuse Organic: garden waste - Landfill tonnes 646.60659 Scope 3 Waste Refuse Organic: mixed food and garden waste - Anaerobic digestion tonnes 8.91242 Scope 3 Waste Refuse Organic: mixed food and garden waste - Combustion tonnes 21.28081 Scope 3 Waste Refuse Organic: mixed food and garden waste - Composting tonnes 8.91242 Scope 3 Waste Refuse Organic: mixed food and garden waste - Landfill tonnes 655.98717 Scope 3 Waste Paper Paper and board: board - Combustion tonnes 21.28081 Scope 3 Waste Paper Paper and board: board - Composting tonnes 8.91242 Scope 3 Waste Paper Paper and board: board - Landfill tonnes 1164.39042 Scope 3 Waste Paper Paper and board: board - Recycled tonnes 21.28081 Scope 3 Waste Paper Paper and board: mixed - Combustion tonnes 21.28081 Scope 3 Waste Paper Paper and board: mixed - Composting tonnes 8.91242 Scope 3 Waste Paper Paper and board: mixed - Landfill tonnes 1164.39042 Scope 3 Waste Paper Paper and board: mixed - Recycled tonnes 21.28081 Scope 3 Waste Paper Paper and board: paper - Combustion tonnes 21.28081 Scope 3 Waste Paper Paper and board: paper - Composting tonnes 8.91242 Scope 3 Waste Paper Paper and board: paper - Landfill tonnes 1164.39042 Scope 3 Waste Paper Paper and board: paper - Recycled tonnes 21.28081 Scope 3 Waste Construction Plasterboard - Landfill tonnes 71.95000 Scope 3 Waste Construction Plasterboard - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: average plastic film - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: average plastic film - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: average plastic film - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: average plastic rigid - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: average plastic rigid - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: average plastic rigid - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: average plastics - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: average plastics - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: average plastics - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: HDPE (incl. forming) - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: HDPE (incl. forming) - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: HDPE (incl. forming) - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: LDPE and LLDPE (incl. forming) - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: LDPE and LLDPE (incl. forming) - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: LDPE and LLDPE (incl. forming) - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: PET (incl. forming) - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: PET (incl. forming) - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: PET (incl. forming) - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: PP (incl. forming) - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: PP (incl. forming) - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: PP (incl. forming) - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: PS (incl. forming) - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: PS (incl. forming) - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: PS (incl. forming) - Recycled tonnes 21.28081 Scope 3 Waste Plastic Plastics: PVC (incl. forming) - Combustion tonnes 21.28081 Scope 3 Waste Plastic Plastics: PVC (incl. forming) - Landfill tonnes 8.88413 Scope 3 Waste Plastic Plastics: PVC (incl. forming) - Recycled tonnes 21.28081 Scope 3 Waste Construction Soils - Landfill tonnes 19.51734 Scope 3 Waste Construction Soils - Recycled tonnes 0.98491 Scope 3 Waste Construction Tyres - Recycled tonnes 21.28081 Scope 3 Waste Electrical items WEEE - fridges and freezers - Landfill tonnes 8.88413 Scope 3 Waste Electrical items WEEE - large - Combustion tonnes 21.28081 Scope 3 Waste Electrical items WEEE - large - Landfill tonnes 8.88413 Scope 3 Waste Electrical items WEEE - mixed - Combustion tonnes 21.28081 Scope 3 Waste Electrical items WEEE - mixed - Recycled tonnes 21.28081 Scope 3 Waste Electrical items WEEE - mixed - Landfill tonnes 8.88413 Scope 3 Waste Electrical items WEEE - small - Combustion tonnes 21.28081 Scope 3 Waste Electrical items WEEE - small - Landfill tonnes 8.88413 Scope 3 Waste Construction Wood - Combustion tonnes 21.28081 Scope 3 Waste Construction Wood - Composting tonnes 8.91242 Scope 3 Waste Construction Wood - Landfill tonnes 925.2445 Scope 3 Waste Construction Wood - Recycled tonnes 21.28081 Scope 3 Water Water supply Water supply cubic metres 0.1 Scope 3 Water Water supply Water supply million litres 110.0 Scope 3 Water Water supply Water treatment cubic metres 0.19 Scope 3 Water Water supply Water treatment million litres 190 Page 79
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Integration Joint Board Agenda item: Date of Meeting: November 2024 Title of Report: Q2 Workforce Report (2024/25) Presented by: Gaye Boyd, Deputy Director of People The Integrated Joint Board is asked to: • Note the content of the report. 1. EXECUTIVE SUMMARY This workforce report details the workforce data of the HSCP as at 30th September 2024 and provides the current demographic position, highlighting trends and advising of changes and progress made, as well as actions taken to address areas of concern. 2. RECOMMENDATIONS To note and discuss the workforce data contained within the report. 3. DETAIL OF REPORT The attached information is provided in relevant sections with observations and actions advised and provides data on the following: • Headcount and WTE • Workforce Profile • Time to Fill (recruitment) • Vacancies • Sickness Absence • Employee Relations • Mandatory Training • Appraisals Page 81 Agenda Item 8
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Some Council information was not available this quarter due to the change in systems, where this is the case only NHS data has been included. 4. RELEVANT DATA AND INDICATORS - 51.6% of the NHS workforce and 49% of Council workforce within HSCP are over 50 (for Council employees this % has reduced) - 2% of the NHS workforce and 4% of the Council workforce is under 25 (no change) - 3% of contracts in NHS are fixed term with 5% in the Council (no change) - Council Modern apprenticeship retention remains higher than the council wide figure at 82% vs 74% - Time to fill for vacancies in the HSCP has reduced significantly for Council and NHS. The Council average in the HSCP is now 74 days compared to 110 days last quarter and for NHS it has reduced to 118.5 compared to 144.6 days last quarter. The national KPI is 116 days. - Sickness absence has decreased to 5.75%, from 6.01%, at 30th September. - The total of Employee Relations cases in NHS has increased from 20 to 24; 13 related to Bullying and harassment cases, 6 related to Conduct and 6 Grievances. - The NHS appraisal completion rate has decreased since the last report from 31% to 26.1%. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The information within this report contributes to the strategic priorities by informing decision making at all levels aligned to the delivery plan objectives, supporting best value and evidencing performance and progress. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact A reduction in sickness absence will reduce costs and can evidence a direct saving. 6.2 Staff Governance The workforce report is part of the suite of staff governance reports which evidence contribution to the Staff Governance Standard; Well Informed, Appropriately Trained and Developed, Involved in Decisions, Treated Fairly and Consistently and Continuously 7. PROFESSIONAL ADVISORY None 8. EQUALITY & DIVERSITY IMPLICATIONS E&D data is contained within the report. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE No personal or sensitive information is contained within the report 2 Page 82
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10. RISK ASSESSMENT Workforce associated risks are contained within the risk register 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT No public or user involvement to report within this current report 12. CONCLUSIONS It is recommended that the Integration Joint Board: • Note the content of this quarterly workforce report. • Take the opportunity to ask any questions on issues that may be of interest or concern; • Discuss the overall direction of travel, including future topics that they would like further information on. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required X Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT NIL REPORT AUTHOR AND CONTACT Officers that contributed information to the report are: Jo McDill, HR&OD Officer, Argyll and Bute Council hr-hscp@argyll-bute.gov.uk Maria Rose, Workforce Planning Manager, NHS Highland, nhsh.workforceplanning@nhs.scot 3 Page 83
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WORKFORCE REPORT Argyll & Bute IJB November 2024 Page 85
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CONTENT •Introduction •Headcount and WTE •Workforce Profile •Vacancies •Sickness Absence •Employee Relations •Redeployment •Mandatory Training •Appraisals 20XX 2 Page 86
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INTRODUCTION The Workforce Report considers the workforce position as of 30th September 2024, providing high level information for A&B HSCP. Some sections may represent an alternative timeline and will be highlighted. The report has been developed in partnership and aims to shows the current position, trends and highlights where there have been changes and progress from previous periods as well as actions that are being taken to address some of the areas of concern. The Workforce Systems Teams proactively assesses data quality based on agreed data quality principles that are part of the data quality framework and addresses data quality issues at source to ensure that our workforce data is of high quality, reliable, and valuable to NHS Highland, and its stakeholders. Work continues on developing integrated (NHS and Council) data sets where possible. NHS Workforce dashboards are available at Operational levels as well as Job Families and continue to be developed. Council Health of the Organisation (HOO) reports are distributed to each service lead on a quarterly basis and Absence summaries are distributed monthly. A&B Council have implemented a new system and as a result have been unable to provide some data for this report (absence, statutory/mandatory training and appraisals). 20XX 3 Page 87
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NHS HEADCOUNT AND WTE NHS: 0.74% increase of workforce in the last 12months • September 2024 in post figure of 1,629 (headcount) of Substantive Staff an increase of 0.31% in the last 3 months • 97% of our contracts are permanent and this has been a consistent position since December 2022 • Council:-little change in headcount since last report 4 Council Headcount Page 88
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WORKFORCE PROFILE SAMPLE FOOTER TEXT 5 Key points (NHS): • 831 employees (51% of the workforce) are over 50, 304 (18.7%) over 60 years, 70 (4.3%) over 65 • 36 (2.2%) employees are under 25 • 1382 (84.8%) employees are female • 834 (51.4%) employees are part time • 51 (3.1%) contracts are fixed term • Monthly Turnover (0.50%) has decreased 0.31% since May and is lower than the Board figure of 0.78%. Retirement continues to be the main reason (30.7%) for leaving. • As of the 30th September 2024 there were 31 employees on the redeployment register – a decrease in 1 from last report. Key points (Council): • 49% of the workforce are over 50 with 5% over 65 • 84% of our workforce is female. • 44% of our workforce are part time • 5% of our workforce are temporary (37) • Voluntary Turnover rate remains 5% • No temporary employees leaving prior to end of contract • Modern apprenticeship retention remains higher than the council wide figure at 82% vs 74% Page 89
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TIME TO FILL Time to fill presents a count of days between post added to the recruitment system and the start date of the candidate. The fill period is therefore reliant on timely and accurate data input. To support the progression of vacancies in the system, hiring managers can help by ensuringthat they have time arranged to review applications and undertake the process of shortlisting as soonafter the closing date as possible and interview dates arearranged well in advance. The council posts take an average of 63 days to fill compared to 110 days in June while the NHS Argyll & Bute average is 118.51 days in September compared to 144.6 for June. This can be accounted for by a number of factors, of which, notice period is just one. Time to fill is higher in professional positions and high bands which can be attributed to longer notice periods. Time to fill has been reducing for board posts. Scotland wide benchmarking is also being sought and will be used for comparison when available. Council time to fill has decreased during this quarter, from 110 days last quarter to 74 days, with a slight increase in the numbers of vacancies advertised. At the end of September there were 24 positions that remained unfilled Both recruitment systems have the capability of reporting at each stage of the recruitment process and Recruitment Metrics is being finalised for future reporting. This will assist in identifying the source of delays. 6 Council NHS Status Posts at 30/09/2024 Conditional 65 Generic/Cohort 1 Interview 31 Live Advert 31 Redeployment 1 Shortlisting 18 Shortlisting Complete 17 Unconditional 46 Total 210 Average time to Fill (days) 118.51 Page 90
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HSCP CURRENT VACANCIES 7 NHS Vacancies 30/09/24 Council Vacancies This slide provides a detailed breakdown of the vacant posts at the end of September. Information relating to re- advertising and posts vacant for a long period of time is being further developed and will be provided when available Division Number of Vacancies A&B Children Families & Justice 40 Administrative Services 2 Allied Health Professions 9 Medical and Dental 1 Nursing and Midwifery 21 Other Therapeutic 5 Personal and Social Care 2 A&B MH LD & Addiction Services 30 Allied Health Professions 3 Medical and Dental 1 Nursing and Midwifery 25 Other Therapeutic 1 A&B Older Adults & Hospital Services 115 Administrative Services 11 Allied Health Professions 27 Healthcare Sciences 3 Medical and Dental 8 Nursing and Midwifery 42 Other Therapeutic 2 Support Services 22 A&B Primary Care 12 Administrative Services 4 Medical and Dental 1 Nursing and Midwifery 3 Other Therapeutic 4 Argyll & Bute Central 13 Administrative Services 8 Allied Health Professions 1 Nursing and Midwifery 0 Personal and Social Care 1 Support Services 3 Grand Total 210 Page 91
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NHS SICKNESS ABSENCE 8 The graph presents absence rates across Argyll & Bute Divisions. The table presents the average absence rates of the HSCP in comparison with NHS Highland as a whole and the NHS Scotland national average per month. A&B HSCP has, in the main, a consistently lower absence rate than the board wide and National averages. * We await NHS Scotland average rates for September 2024. 0.00 1.00 2.00 3.00 4.00 5.00 6.00 7.00 Sep- 23 Oct-23 Nov- 23 Dec- 23 Jan-24 Feb- 24 Mar- 24 Apr- 24 May- 24 Jun-24 Jul-24 Aug- 24 Sep- 24 A&B HSCP 4.58 5.16 5.56 5.53 6.66 5.54 5.27 5.21 5.29 6.01 5.14 4.99 5.75 NHS Highland 6.68 6.70 6.60 6.50 7.39 6.51 6.16 5.94 5.92 6.00 5.99 5.58 5.79 NHS Scotland Average 5.94 6.31 6.45 6.52 6.99 6.17 6.07 6.19 6.39 6.22 6.67 6.04 % Absence Rate A&B HSCP NHS Highland NHS Scotland Average Page 92
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NHS SICKNESS ABSENCE REASONS 9 Top 20 Absence reasons presented for 12 month to 30th September 2024. Absences with an unknown cause/not specified remaining high (27%). Managers continue to be asked to ensure that an appropriate reason is recorded and continuously updated. System solutions and prompts are also being investigated. Manger attendance is required on Once for Scotland courses Reports are now distributed to SLTs, via the People Partners to demonstrate attendance at the Once for Scotland courses, both online and eLearning. For committee purposes absence reason is reported at HSCP level. Heads of Services receive their own divisional information. The top 3 reasons for absence are: 1. cold, cough, flu 2. gastro-intestinal 3. Anxiety/ stress /depression /other Covid-related illness is increasing Board wide and was 6.63% of absences for A&B HSCP during the 12 months to September 2024. Top 20 Absence Reasons % for 12-months period to September 2024 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% % of Total Absences Page 93
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EMPLOYEE RELATIONS Summary of activity between March 2023 and September 2024. In NHS Bullying and Harassment cases have been increasing over the last year with a high of 14 reported in June. 10 NHS Council Council Disciplinary and Grievance cases continue to remain relatively low. During FQ2 , there were 2 new Disciplinaries, 1 carried forward and 2 concluded. There was 1 new Grievance, 2 carried forward and 2 concluded. Mar-23 Jun-23 Sep-23 Dec-23 Mar-23 Jun-24 Sep-24 B&H 1 2 8 9 8 14 13 Disciplinary 2 2 2 1 1 2 5 Grievance 3 4 3 4 7 6 6 Capability 0 0 0 0 3 - - Total 6 8 13 14 19 20 24 Page 94
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MANDATORY TRAINING - NHS In September 2024, the Mandatory Training completion rate is 67% overall for eLearning modules, a decrease since June 2024 when 69.7% was reported. This decrease is linked to the launch of a new Violence & Aggression course in July 2024 that is now included in these figures. Over the course of the year there has been focused attention on statutory mandatory training resulting in incremental improvement across all statutory mandatory training course. There remains low levels of compliance in Staying Safe Online eLearning, but it is improving. There is now an established Statutory Mandatory monitoring and training implementation programme, with focused attention on improvement through Chief officers and HOS. This includes a 6-month improvement plan with targets for RAG rating, which require to be met by all services in each month. 11 30.00% 40.00% 50.00% 60.00% 70.00% 80.00% 90.00% 100.00% Trajectory (% Completed) Equality and Diversity Fire Safety Hand Hygiene Information Governance Moving and Handling Module A Public Protection Staying Safe Online Violence and Aggression Why Infection Prevention Matters Target Page 95
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NHS APPRAISALS The table shows the appraisal completion percentage, recorded on the Turas Appraisal system for NHS employees as of 30/09/2024. The chart represents the overall appraisal completion percentage over the last 12 months recorded on the Turas Appraisal system for NHS employees. Improvement of appraisal rates and quality is a Board priority, and this will be an area of focus for the year ahead. Training for reviewees is available on the Turas Learn system 12 0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% Appraisal % Completed Page 96
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1 Integration Joint Board Date of Meeting: 27th November 2024 Title of Report: Health & Social Care Partnership - Performance Report – FQ1 2024/25 (Apr – Jun) Presented by: Kristin Gillies - Head of Strategic Planning, Performance & Technology The Board is asked to: • Acknowledge performance for FQ1 2024/25 (April - June) • Acknowledge performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 1) • Note Delayed Discharge Sitrep as of 01 July 2024 (Appendix 2) EXECUTIVE SUMMARY This report details performance for Financial Quarter (FQ)1 2024/25 (April – June), 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 FQ1 notes 42 of 84 measures reporting as on target (50%). The report details performance against each of the service areas and the 84 supporting Key Performance Indicators. 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 FQ1 24/25 performance. 3. DETAIL OF REPORT The report details the HSCP (Health and Social Care Partnership) performance for FQ 1 2024/25 (April - June) 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 97 Agenda Item 9
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2 4. RELEVANT DATA & INDICATORS 4.1 FQ1 2024/25 (April - June) Performance Summary Overall performance for FQ1 notes that 84 KPI’s are scoring against target, with 42 (50%) reporting as on-track and 42 (50%) off-track. 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) and performance commentary is provided by Heads of Service and Service Leads as part of their one-to-one sessions with analysts. 4.2.1 Children & Families Performance across 7 Key Performance Indicators (KPIs) for Children & Families & Justice shows 2 KPIs (29%) on track, with 5 KPIs (71%) reported as off track against the targets set in FQ1 24/25. Performance on or above target: • Child Protection Register with an allocated worker met the target of 100% • Child Health assessments started within 4 weeks of coming into care exceeded the target of 96% in FQ1 (100%) Page 98
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3 Performance below target & areas for improvement: • CAHMS referrals seen within 18 weeks of referral fell short of the target of 75% by 15% (Actual: 60%) • Universal Health Visiting Pathway fell short of the target of 75% by 14% (Actual: 61%) • Violence Against Women & Girls basic training failed to meet the target of 30 by 2 (Actual: 28) • Criminal Justice social work reports submitted on time failed to reach the target of 90% by 3% (Actual: 87%) • Child Protection Planning Meetings held within 28 days of referral failed to meet the target of 90% with Actual of 0% 4.2.2 Telecare and Digital Performance across 13 Key Performance Indicators (KPIs) for Strategic Planning, Performance & Technology Services shows 4 KPIs (31%) on track, with 9 KPIs (69%) reported as off track against the targets set for FQ1 24/25. 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: • Significant progress has been made in the digitalisation of telecare equipment, now reaching 52%. • Implementation of Just Checking activity monitoring equipment has been successfully carried out in six homes during Q1. • Usage of digital blood pressure monitoring in Primary Care has seen a consistent rise, increasing from 36 to 40 users. • E-health service successfully resolved 100% of support requests this quarter. Performance below target & areas for improvement: • The number of new telecare clients reduced from 203 in Q4 to 198, narrowly missing the increased target of 200. • Consultations delivered via Near Me missed the target by 10 consultations, showing little growth over the last four quarters. • The number of telecare clients overdue for their annual review continues to increase, now at 63%. • Silvercloud referrals missed the target again, though referral rates remain stable compared to the decreases in previous quarters with 57 referrals this quarter. • Two FOI requests were not submitted within the statutory timescale, achieving only 93%. However, the total number of FOIs was 29, a higher-than-normal volume of requests. • Currently, 42% of telecare clients have enhanced packages, below the desired target. • Waiting Times for Cancer Appointments at 31 & 62 Days reports 1 against target of zero. • New Outpatient Waiting Times breaches over 12 weeks noted 51% against 46% target. • Outpatient Long waiting over 52 weeks noted3.7% against a 2.8% target 4.2.3 Primary Care Performance across 10 Key Performance Indicators (KPIs) for Primary Care shows 6 KPIs (60%) on track, with 4 KPIs (40%) reported as off track against the targets set for FQ1 24/25. Page 99
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4 Performance on or above target: • 80% of children who received Fluoride Varnish treatment did not require be referred for further dental treatment. • 66% of eligible residents received their Spring Covid 19 booster. This is 3% higher than the national average. • HSPC run practices met their target of 14 by recording on 7 instances practices had to operate under contingency measures. • No GP practices were returned to HSCP Control during Q1 • GP practices remained at level zero during Q1 resulting in no reduction in services provided. • Primary Care Out-of-Hours Services covered 62% of all recorded out of hour consultations during Q1 exceeding their 45% target. Performance below target & areas for improvement: • The Oral Health Improvement Team only managed to deliver 95% of their planned activity. • HSCP Dental services only utilised 52% of clinic appointments missing their 90% target. • 4.7% of consultations by GPs and other HSCW within the primary care setting were done digitally, narrowly missing the 5% target. • 93% of children at 12 months of age received their 6 in 1 vaccination missing the 95% national target (data for this indicator is 1 quarter behind due to availability of statistics) 4.2.4 Public Health Performance across 5 Key Performance Indicators (KPIs) for Public Health shows 4 KPIs (80%) on track, with 1 KPI (20%) below the rolling target against the targets set for FQ1 24/25 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 was slightly above target, achieving 11 quit dates set against a target of 10. • Increase the number of engagement activities delivered in communities and supported through Living Well Networks. Performance was slightly above target, with an actual of 23 against a target of 20. • Increase the number of referrals to community link workers supported by “We Are with You”. Performance exceeded itself this quarter by achieving approximately 49% above the target, with an actual performance of 150 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. We surpassed expectations with 11 instances of working with Scottish Government or National Agencies on National Strategy and Policy development. Page 100
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5 Performance below target & areas for improvement: • Increase the number of people in Argyll and Bute attending training in the following areas, Money Counts, Behaviour Change, Mental Health and Suicide Prevention. The rolling target from 23/24 continues into 24/25, with the expectation of 17 additional clients each quarter. We fell marginally short, with an actual of 83 against a target of 85, approximately 2.35% below the target. 4.2.5 Finance Performance across 6 Key Performance Indicators (KPIs) for Finance shows 3 KPIs (50%) on track, with 3 KPIs (50%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • GP prescribing expenditure with actual spend being 1% lower than target. • Older People External Residential actual spend being 18% below target. • Older People Homecare actual spend being 2% below target. Performance below target & areas for improvement: • Cost of Hospital Delayed Discharges actual spend being 29% above target. • Staffing expenditure with actual spend (11%) being 1% above target. • Older People Internal Residential actual spend being 21% above target. 4.2.6 Carers Performance across 4 Key Performance Indicators (KPIs) for Carers Services shows 4 KPIs (100%) on track, against the targets set for FQ1 24/25. Performance on or above target: • Adult Carer Support Plans continues to be on target, with 137 completed against target of 133 • Young Carer Statements completed continues to be above target, with 26 completed in FQ1. • The number of Unpaid Carers Supported across A&B’s Carers Centres was reported at 3296 for FQ1 and continues to exceed the target of 3000. • The ACSP reviews completed now include welfare contacts and these continue to be above target of 700, with 913 completed in FQ1. Performance below target & areas for improvement: N/A 4.2.7 Allied Health Professionals Performance across 7 Key Performance Indicators (KPIs) for Allied Health Professionals shows 4 KPIs (57%) on track, with 3 KPIs (43%) reported as off track against the targets set for FQ1 24/25. 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 Page 101
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6 Performance on or above target: • MSK Outpatient Referral waits breaching >4 weeks are down significantly this quarter to 1118 (-9%) and meeting target of 1120. • AHP Outpatient Completed Waits are now on target this quarter with 977 reported against the 945 target. • Community Patient Discharges continue increasing this quarter to 1878, against the target of 1672. • The percentage of New versus Return Outpatient Physio AHP Referrals remains above the 30% target, with 31% noted in FQ1. Performance below target & areas for improvement: • Outpatients waiting over 12 weeks for AHP services have increased this quarter – these had been decreasing over recent quarters, with FQ1 reporting 552 against a target of 500. • The AHP Priority 1&2 referrals breaching > 4 weeks in FQ1 reported 58 against a target of 48. • Community Patient Referrals breaching over 12 weeks have been increasing quarter on quarter, with FQ1 reporting 558 against a target of 400. 4.2.8 Delayed Discharges Performance across 6 Key Performance Indicators (KPIs) for Delayed Discharges shows 1 KPI (17%) on track, with 5 KPIs (83%) reported as off track against the targets set for FQ1 24/25. For FY 2024/25 Delayed Discharges KPIs, we are using a count at the end of quarter census point instead of full month data. Cleansing of data at the census point is improving the accuracy of the delay codes recorded, and this also aligns better with national reporting. It should be acknowledged nationally, Delayed Discharges are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients showing as a Delayed Discharge. Performance on or above target: • Reduce the Number of people delayed in hospital with AWI code at Monthly Census Point. Performance was above target having achieved actual of 4 against a target of 6. We set the target based on the average over the last four quarters of 23/24, where the actual ranged between 3 and 9. In this quarter, the number of people delayed with AWI code increased from 4 in April to 7 in May, then returned to 4 in June. Performance below target & areas for improvement: • The number of overall people delayed in hospital at Monthly Census Point as at the end of Q1 was 39, compared to a target of 31. The target was set based on the average over the Page 102
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7 last four quarters of 23/24, where client numbers ranged between 29 and 34. Notably, there has been an increase this quarter, especially in May and June, with client numbers rising to 41 and 39 respectively, up from 32 in April. • At the end of Q1 census point, the overall length of stay in a hospital (Delayed Discharge Bed Days) at Monthly Census Point was 820, exceeding the target of 634. The target was set based on the average bed days over the past four quarters of 23/24, which ranged from 598 to 695. This quarter saw an 18% increase in bed days between May and June (694 to 820) reflecting the rise in client numbers during the same period. • The number of people delayed awaiting a Care Home Placement was 8, representing 21% of census clients, compared to a target of 4. The target was set based on the average from the previous four quarters of 23/24, which ranged from 0-5. In March 24, we reported zero people delayed awaiting place availability, which is unusual and may suggest a recording issue. This quarter delays were consistently 5 in both April and May, increasing to 8 in June. • At the end of Q1, the number of people delayed in hospital awaiting care at home availability was 16, representing 31% 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. May reported the highest number of delays at 18, 38% increase from April, before decreasing by 12.5% to 12 in June. • At the end of Q1, the number of people delayed in hospital awaiting assessment (Codes 11A and 11B) was 13, which is 33% 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 quarter, the reported increase was from 9 in April to 18 in May before reducing to 13 in June. 4.2.9 Adult Social Care Performance across 4 Key Performance Indicators (KPIs) for Adult Social Care shows 3 KPIs (75%) on track, with 1 KPI (25%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • The number of Unplanned Admissions to A&B hospitals directly from a care home in FQ1 was reported at 36, exactly on target. • FQ1 Performance on increasing the occupancy rates across A&B Care Homes was above target, achieving 96% occupancy against a target of 95%. This KPI is now measured against available places (previously all empty beds). • The FQ1 performance looking to reduce the value of assessed unmet need for care at home was £11,409.72, which is 12% below the target of £12,991.74. Target is set as previous quarter’s value. Performance below target & areas for improvement: • Performance in FQ1 for increasing the % of Older People who had their homecare monitoring review completed within 6 months was 31% against a target of 49%. This KPI was briefly above target in FQ3 2023/24 but has otherwise remained below target across the previous year. Page 103
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8 4.2.10 Community Hospitals Performance across 5 Key Performance Indicators (KPIs) for Community Hospitals shows 2 KPIs (40%) on track, with 3 KPIs (60%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • FQ1 A&E Attendances in A&B Community Hospitals meeting the 4 hrs wait target reported 97% performance which is 2% above 95% target. This measure was above target throughout the previous reporting year. • Maintaining A&B Community Hospitals Bed Occupancy Rates reported below 80% target, with FQ1 actual noted as 73.6% occupancy. Performance below target & areas for improvement: • Reduce the rate of unplanned admission to Community Hospitals for 65+ population. The FQ1 total of 467 admissions is 3% off track and above the target of 452. • Reduce the average Length of Stay for inpatients in A&B Community Hospitals. Performance for FQ1 was 8.7 days average across the whole quarter, against a target of 7.8 days. • Reduce the number of Falls being reported in a Community Hospital setting in A&B. This KPI remains above target for the second quarter, with FQ1 at 63 falls against a target of 54. 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 3 KPIs (38%) on track, with 5 KPIs (62%) reported as off track against the targets set for FQ1 24/25. It should be acknowledged that nationally waiting time breaches for New Mental Health Outpatients (12 weeks) and Psychological Therapy (18 Weeks) are measured against a zero target. Local targets have been set to monitor progress and improvements to reduce the number of patients on waiting lists across varied health specialties Performance on or above target: • 12 Adults reported on the dynamic support register with a category red or amber status • 383 Adults are waiting for a Mental Health outpatient service achieving the target of 390 or less. • 164 Adults are waiting for a psychological therapy service achieving the target of 175 or fewer Performance below target & areas for improvement: • 7% of 18-64 people with a Learning Disability were reported as overdue an Adult Review against 3% target • 56% of Adult Support and Protection 'duty to inquire' procedures were completed within the 5 working day target. Page 104
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9 • 65% of Adult Support and Protection inquiries requiring investigative powers were completed within the 15 working day target. • 70% of Case Conferences began within 20 days of referral or within 12 weeks of the initial conference for review. • 80% of individuals referred to Alcohol and Drug treatment services were seen within the target waiting period. 4.2.12 Rural General Hospitals (Lorn & Island Hospital) Performance across 9 Key Performance Indicators (KPIs) for Rural General Hospitals (LIH) shows 6 KPIs (67%) on track, with 3 KPIs (33%) reported as off track against the targets set for FQ1 24/25. Performance on or above target: • Reduce the rate of unplanned admissions to LIH 65+ population. For FQ1, the actual number of unplanned admissions was 341, with performance below the target by 4 (1.16%). The target set for this KPI was 345 based on average from 23/24. • Reduce the total number of unplanned bed days in LIH. The actual number of unplanned bed days reported was 3076, with 247 (7.43%) unplanned bed days below the target of 3323, based on the 23/24 average. • Reduce the Average Length of Stay for inpatients in LIH. FQ1 Performance noted we achieved an actual rate of 4.0. This was 0.8 better than the target of 4.8. • Maintain LIH Bed Occupancy Rates below 90% target. FQ1 performance noted an actual rate of 81.8%, bettering the target by 8.2%. • Reduce the number of LIH A&E Attendances that result in an unplanned admission. The FQ 1 performance for reducing unplanned admission from A&E attendances was 17.9 against a target of 19.2 and approximately 6.8% better than target. • 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 1 we achieved an actual of 3. Performance below target & areas for improvement: • Our FQ1 target is for 95% of A&E attendances to meet the 4-hour target. Actual FQ1 performance noted 93.8%, only 1.2% off the 95% target. • Reduce the number of falls being reported in a hospital setting in LIH. FQ1 target was to reduce reported falls to no more than 26 per quarter, however the actual recorded was 45. This indicates the number of falls was higher than expected. • 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 9. However, FQ1 performance on actual instances was 16. 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 Page 105
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10 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 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. Page 106
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11 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 FQ1 2024/25 (April - June) 2024 performance as detailed in the IPMF Dashboard 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 Page 107
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12 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 108
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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 109
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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 110
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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 111
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16 Appendix 2 - Delayed Discharge Sitrep – 1st July 2024 Page 112
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1 Integration Joint Board Agenda item: Date of Meeting: 27th November 2024 Title of Report Public Health Annual Report 2023 to 2024 Presented by: Alison McGrory, Associate Director of Public Health The Integrated Joint Board/Committee is asked to: ▪ Note the report, “Health and Wellbeing in Argyll and Bute” covering Public Health activity for the year 2023 to 2024. ▪ Note the strategic approach to prevention in Argyll and Bute. ▪ Endorse the role of the IJB in providing leadership to prevent health and social care problems from arising. ▪ Note the forthcoming Population Health Framework for Scotland expected in early 2025 1. EXECUTIVE SUMMARY This paper outlines public health activity in Argyll and Bute to prevent ill-health and improve health and wellbeing outcomes for the population. The detail of the paper covers the Public Health Team Annual Report for 2023 to 2024 2. INTRODUCTION Argyll and Bute Health and Social Care Partnership (HSCP) has a Public Health Team that works towards improving the health and wellbeing outcomes of the population of Argyll and Bute. This team is part of a wider NHS Highland directorate. The steer for this Public Health work comes from different directions, for example: national strategy; national Public Health priorities; HSCP strategic priorities; and community led aspirations. The Christie Commission of 2011 estimated that 40% of public sector spending is on problems that could be avoided given earlier intervention. Prevention of health problems can take place at three levels: Primary Prevention: This is about stopping health problems from occurring. It includes measures like vaccinations, healthy eating, physical activity, and avoiding harmful behaviours like smoking. By focusing on primary prevention, we can reduce the incidence of many diseases and conditions. Page 113 Agenda Item 11
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2 Secondary Prevention: This involves early detection and intervention. Screening programmes, such as those for cancer or diabetes, help identify health issues at an early stage when they are more treatable. Secondary prevention aims to halt or slow the progression of disease. Tertiary Prevention: This level focuses on managing and improving the quality of life for those with existing health conditions. It includes rehabilitation/reablement, support groups, or ongoing medical care to prevent complications and improve overall well-being. The foundation of the prevention pyramid is improving the social determinants of health. Preventing health problems takes place within the context of understanding the wider determinants of health, these include, the communities and homes we live in; the jobs we do and how much we earn; and the political and social factors that affect our quality of life. Over the course of 2023 and into 2024, our team have worked tirelessly to balance national requirements with those of the HSCP while continuing to put local people at the heart of everything we do. 3. DETAIL OF REPORT 3.1 Public Health Team Annual Report for 2023 to 2024 The Public Health Team in Argyll and Bute includes health improvement, health intelligence and the Alcohol and Drug Partnership support team. A work plan sets out the work of the team and this is reported at the end of each year. Page 114
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3 The full report provides detail on the range of activity delivered. The report sets out how prevention is key to our population living longer, healthier lives, and how the work of the team contributes to prevention. It also sets out the vision and mission of the team which is the driving force behind the work we do. Highlights of this work include: • The Living Well Strategy • Activity delivered by Living Well Networks • Community Link Workers and the impact they have had • Our Smoke Free team • Smoke free education in primary and secondary schools • Screening Inequalities and the work of our Screening Engagement Officer • Contribution to strategic priorities such as Suicide Prevention action plan • Cool2talk – an online resource providing health information and advice to young people • Mental Health First Aid for Young People training provision • Child poverty work • Money counts income advice training provision • Heartstart • Equality outcomes and mainstreaming – reporting on activity in Argyll and Bute • Health Psychology and weight management • MAP of health behaviour change training provision • Alcohol and Drug Partnership support team activity, including progress on MAT standards, residential rehabilitation provision, Planet Youth and ADP support grant provision 3.2 New Population Health Framework for Scotland The health of the population of Scotland is declining; life expectancy is falling for the first time since WWII and levels of ill-health are projected to rise by 21% in the next 20 years. This ill-health is not experienced equally by everyone in Scotland and disadvantaged groups are more likely to become ill and die early. More ill-health in the population, on an already stretched health and social care system will jeopardise the future sustainability of the NHS. It is imperative we put preventative approaches front and centre to how we operate. A new Population Health Framework is in development for Scotland. This is expected early next year. The Framework will be jointly endorsed by Cosla, Public Health Scotland, territorial health boards and the Scottish Government. There will be four areas of focus in the Framework, illustrated in the diagram below: Page 115
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4 4. RELEVANT DATA AND INDICATORS Full details of the outputs of Public Health activity is published in the report. 5. CONTRIBUTION TO STRATEGIC PRIORITIES The work of the Public Health Team is linked to: Argyll and Bute HSCP Joint Strategic Plan 2022-2025 priorities • Prevention, early intervention and enablement • Living well and active citizenship • Community coproduction 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact The Public Health Team is resourced from core HSCP funds and in-year Scottish Government allocations to the sum of approximately £2.5 million. This paper is not asking for additional investment in Public Health. However, it is a topic for debate to recognise early upstream intervention can avoid the need for downstream service delivery. 6.2 Staff Governance No issues in this paper. 6.3 Clinical Governance No issues in this paper. 7. PROFESSIONAL ADVISORY No issues in this paper. The Associate Director of Public Health works closely with the other professional advisors, in particular the Associate Director for Allied Health Professions and NHS Highland Director of Public Health. 8. EQUALITY & DIVERSITY IMPLICATIONS Page 116
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5 No issues in this paper. Equality and diversity are key principles of Public Health work and interventions and strategies are designed to ensure those most in need will benefit the most. This is with the intention of reducing the gap between the most well off and the worst off in our communities. The report also has a section on Equality Outcomes and Mainstreaming Reporting, this covers work undertaken in the HSCP to work towards the outcomes set. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE No issues in this paper. 10. RISK ASSESSMENT No immediate risks in this paper although there are risks to the sustainability of health and social care service from rising demand. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Community engagement is a core principle of Public Health and interventions and programmes always include engagement to ensure effectiveness and suitability. The Living Well strategy was developed following comprehensive community and stakeholder engagement. 12. CONCLUSIONS The paper provides an update on ongoing wellbeing and prevention activity overseen and delivered by the Public Health Team in Argyll and Bute. There is a compelling need to prevent health and social care problems before they arise. The HSCP is well placed to both continue and expand upon the recent successes outlined in the detail of this report. 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 REPORT AUTHOR AND CONTACT Author Name Alison McGrory, Associate Director of Public Health Email alison.mcgrory@nhs.scot Page 117
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Health and Wellbeing in Argyll and Bute Annual Report 2023/24 www.ablivingwell.org Page 119
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CONTENTS Introduction 1 Argyll and Bute - The Context 2 5 Useful Contacts and Links Page 4Living Well Strategy 8 Living Well Networks (LWNs) 18 Public Health Topics The Argyll and Bute Public Health Team 17 Health Psychology 21 16 Alcohol and Drug Partnership Page 120
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Alison McGrory Associate Director of Public Health Argyll and Bute HSCP NHS Highland INTRODUCTION Best regards, Hello everyone, Welcome to the 2023-2024 Annual Report for Public Health in Argyll and Bute. This year, more than ever, we need to focus on the importance of preventing health problems before they occur. The challenges are clear, with more people experiencing ill health and longer waits for specialist services, it’s clear we need to act now for our people and communities. The Public Health Team works at many levels to improve health, we: 1. Deliver national strategies for Scotland across our remote and rural communities. 2. Work with our communities so their views shape what we do. 3. Work in partnership with other organisations, for example in the Community Planning Partnership to develop health improvement plans. 4. Gather and make sense of information to shape how we deliver health and social care services. Most health problems are preventable, but our systems are geared up to responding once the problem is already there. By focusing on prevention, we can reduce the burden on our healthcare services, improve quality of life, and ensure that everyone has the opportunity to live their best life. Prevention is urgent because the longer we wait, the more difficult and costly it becomes to address the problem. Prevention takes place at different levels: Primary Prevention: This is all about stopping health problems from occurring. It includes measures like vaccinations, healthy eating, physical activity, and avoiding harmful behaviours like smoking. By focusing on primary prevention, we can reduce the incidence of many diseases and conditions. Secondary Prevention: This involves early detection and intervention. Screening programmes, such as those for cancer or diabetes, help identify health issues at an early stage when they are more treatable. Secondary prevention aims to halt or slow the progression of disease. Tertiary Prevention: This level focuses on managing and improving the quality of life for those with existing health conditions. It includes rehabilitation/reablement, support groups, and ongoing medical care to prevent complications and improve overall well-being. When we plan prevention activities it is important to be aware of the underpinning factors that influence health, these include societal and political factors like how much money people have, the houses they live in, access to education and having a good job. However, we know that these factors are not equal across Scotland, and sadly this results in lots of inequalities in how healthy or unhealthy people are. Over the course of 2023 and into 2024, our team have worked tirelessly to balance national requirements with those of the HSCP while continuing to put local people at the heart of everything we do. There is no doubt that the potential for good health lies within our communities and I am proud to live and work in an area with so much community action and desire to make things better. Page 121
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Strategic Plan 2022-2025 View the full document and the Plan on a Page at: bit.ly/JSP-ABHSCP-2022-25 The Argyll and Bute Joint Strategic Needs Assessment (JSNA) included in this document provides detail on; Demographics, Life Circumstances; Health and Wellbeing status of the population, challenges etc. ARGYLL AND BUTE - THE CONTEXT The Public Health Team works within Argyll and Bute HSCP. To get a deeper insight into the characteristics of Argyll and Bute's population and economy which impact the context of how we work, see the documents below: Plan on a Page 2 Page 122
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Public Health - Vision and Mission The Public Health Team in Argyll and Bute held several sessions in Inveraray where we explored our shared values and discussed what our mission and vision is as a team. Community Engagement Engagement of people and partners goes to the heart of how the Public Health Team operates. We always aim for the voices of people in our communities to inform how we work. We do this via our local Living Well Networks and also in more structured ways in Locality Planning and Community Planning. The Public Health Team co-ordinates the HSCP’s strategic approach to engagement. In 2023 we led the updating of the HSCP’s Engagement Framework and published it here: nhshighland.scot.nhs.uk/about/argyll-and-bute- health-and-social-care-partnership/argyll-and- bute-hscp-publications/public-engagement/ The Public Health Team collates the HSCP’s annual engagement plan and liaises with Healthcare Improvement Scotland to ensure the national engagement standards inform service review and service improvement. 3 Page 123
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ARGYLL AND BUTE LIVING WELL PROGRAMME BOARD Over 2022 to 2023, the Living Well Strategy group merged with the Prevention Programme Board and is now known as the Living Well Programme Board. This refresh has enabled a refocus on activity at two levels: Community rehabilitation and wellbeing - Community Rehabilitation and Wellbeing Service has been developed to deliver physical activity and behaviour change programmes within the community. These programmes will include physical rehabilitation, strength and balance, frailty and education classes. This service will begin in 2024/2025. Community assets for Living Well – main aims of this work include identifying existing assets and resources within local communities to support Living Well intentions. Recognising the power of local people in making their communities good places to live. Supporting community action on shared priorities for Living Well. Workforce - Staff are able and motivated to support the people they see to Live Well The Living Well Strategy 2019 – 2024 is Argyll and Bute’s showcase strategy to support people to live well with long term health conditions - Living Well Strategy — Living Well (ablivingwell.org). The Strategy also recognises that it is possible to prevent ill-health, for example, strong and vibrant communities enable people to live good lives and to have better health and wellbeing outcomes. This engagement resulted in a Living Well Implementation Plan which was aligned to Argyll and Bute HSCP strategic intentions under four themes: People – People living in Argyll and Bute have the tools and support they need to support them to Live Well Community – There are a wide range of local services to support people to Live Well Leadership – Effective leadership is in place to support the delivery of the Living Well strategy ALIGNS TO 4 THEMES OF THE HSCP STRATEGY The four themes: LIVING WELL STRATEGY Our showcase strategy focusing on wellbeing, prevention and self- management to enable our people to live a healthier life. There are a wide range of actions included under each of the above themes and the full strategy, engagement report and implementation plan can be access on the Living Well website. Development of new community rehabilitation service: 5 new practitioner posts have been developed to deliver the service within the community. New Development Manager post developed to take forward Community Assets for Living Well in partnership with Argyll and Bute Third Sector Interface, MacMillan and the HSCP. 4 Page 124
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In developing their workplan for 2023/24, the Living Well Networks were asked to identify local priorities for activities. Each LWN could choose 3 key priorities: 1 from the Living Well Strategy action plan; 1 from the Argyll and Bute ADP Strategy; and 1 of the Network’s own choice based upon the Public Health team's workplan. LIVING WELL NETWORKS (LWN) Building capacity for health and wellbeing in our local communities. The Living Well Networks (LWN) are for people with an interest in building healthy communities. They provide an opportunity for people to come together to find out what issues matter to local communities; to plan activities and events together; and to network with individuals, services and organisations with an interest in improving health. The Public Health team currently fund a LWN coordinator for each locality, each has 1-2 days per week. A new model of delivery was piloted in 2022, this model was successful and was implemented in April 2023. There are Coordinators in place in each locality and a new admin role to deliver the valuable engagement and capacity building work of the networks by working in partnership with a range of stakeholders, community members and Locality Planning Groups. Funding for the networks is secure until March 2025. Further information and contact details for the networks can be found here: https://www.ablivingwell.org/living-well-networks The Living Well Network Coordinators for each area are: Mid Argyll, Kintyre and Islay - Mid Argyll Youth Development Service (MAYDS), Oban, Lorn and Isles - Carol Flett, Helensburgh and Lomond - Veronica Ferguson, and Bute and Cowal - Dee James. We would like to extend our thanks to Tracy Chambers for her dedication to the Coordinator role in Kintyre who left in March 2024. LWN Priorities in Argyll and Bute, 2023/24: Living Well Networks (LWN) across Argyll and Bute Facilitating local partnership working and planning for health improvement activity 5 Page 125
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Dee James 16 LWN Newsletters produced. A showing of “One Last Spin” was arranged and shown in the Burgh Hall in Dunoon to highlight the harms of gambling. Dee James Cowal and Bute LWN Coordinator: Highlights 2023/24 COWAL AND BUTE LWN 07384463473 Guest speakers at LWN meetings included: Breathing Space, Dunoon Community Development Trust, ALIenergy, Refugee Support Worker, Peer Recovery Advocates, Social Security Scotland, MECOPP, Heartstart Cowal, SupportED, Trauma Training Coordinator and ABRC. 897LWN members Health Improvement Team contact: angela.coll@nhs.scotAngela Coll bit.ly/MidArgyllLWN-Facebook Lynne Johnstone Mid Argyll: Over 100 people attended LWN “Live Better in 2024” at MacPool in January. This included information stalls by WithYou, Dochas Carers Centre, Community Shop, Smoking Cessation etc., along with free snacks, swimming sessions, personal training and health check sessions etc. Thanks to the Living Well Network, groups that provide food parcels & food share schemes within Mid Argyll have amalgamated to provide a more streamlined approach. Mid Argyll, Kintyre and Islay LWN Coordinator: Highlights 2023/24 200 LWN members livingwell@mayds.org.uk Jointly covered by Fiona Kalache and Lynne Johnstone 01546 603231 MID ARGYLL, KINTYRE AND ISLANDS LWN Fiona Kalache Health Improvement Team contact: angela.coll@nhs.scotAngela Coll 127Facebook followers 179Facebook followers LWN had a table the Rotary Club Community Showcase Event on 9th March to connect/network with community members, voluntary organisations, and charities. Over 20 Community groups in attendance. facebook.com/CowalLWN facebook.com/ButeLWN hwnbute@ab-rc.org.uk livingwellcowal@ab-rc.org.uk Two Living Well Network events were held on Islay and Jura in February providing a great opportunity for agencies to network. Organisations attending included Islay Podcast, Sidekick, Dochas Centre, MYCOS etc. The Kintyre Living Well event was held in March, with 14 partners providing information and an opportunity to network to the community. Approximately 35 people attended with some valuable connections being made and collaboration work discussed. 20 people were trained in the use of Naloxone, 12 people were trained about Eating Disorder Awareness, and 20 people were trained in Scotland’s Mental Health First Aid. 6 Page 126
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Veronica FergusonA warm weclome to Veronica, who started in post as LWN Coordinator in August 2023. Veronica Ferguson Helensburgh and Lomond LWN Coordinator: Highlights 2023/24 HELENSBURGH AND LOMOND LWN 07799031649 LWN now has a monthly Living Well Column in the Helensburgh & Lomond Community Advertiser. 160LWN members Health Improvement Team contact: angela.coll@nhs.scotAngela Coll Oban, Lorn and The Isles Coordinator: Highlights 2023/24 274 LWN members OBAN, LORN, AND THE ISLES LWN Fiona Kalache Health Improvement Team contact: angela.coll@nhs.scotAngela Coll 127Facebook followers 154Facebook followers APD grant funding allocated through the LWN to local organisations: Welcome In- Recovery Cafe, Route 81, Cove & Kilcreggan Youth Cafe, LiveArgyll, Helensburgh & Lomond Foodbank and Enable. facebook.com/https://www.facebook.com/ LWNHelensburgh The LWN supported the ADP grants process, ADP grants were awarded to Lorn and Oban Healthy Options, Hope Kitchen and Hebridean Pursuits through the LWN. A ‘Living Well on Coll Event’ held on the Isle of Coll community on 16th August. 15 mainland-based charities and organisations attended to share information about the support they provide. Four workshops held: Mindful Mandala Making (North Argyll Carers Centre), How to get help to complete applications (Social Security Scotland Benefits), Cyber Scam Prevention and Health Screening. The LWN produced an information leaflet with useful numbers, such as: helplines; emergency numbers; GP Practices; support groups; community spaces etc. including a QR code to https://destinationhelensburgh.org/ tcmhwn@gmail.com bit.ly/ObanAndLornLWNFacebook Carol Flett 07753218327 Carol Flett Signposting across the Network increased by producing a document with information about 21 charities and organisations who provide support in communities. 22 LWN Members now included in the Mull and Iona, Tiree, Coll telephone directories. helensburghlivingwellnetwork@btinternet.com Veronica attended a two day art of hosting workshop at Barmolloch as part of Community Assets workstream. Attended the welcoming of Ukrainian families to Helensburgh and supplied information leaflets. 7 Page 127
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ANCHOR ACTIVITY IN LOCAL COMMUNITIES Public Sector organisations play an important role in supporting environments and conditions that are conducive to health and wellbeing, for example by employing staff, buying services, owning buildings etc. Dunoon was selected as a one-off demonstrator town in Scotland for learning about how the Place Standard Tool can encourage the public sector to take a place based approach to planning. This work concluded in 2024 and is informing national place based and equity strategies. HIGHLIGHTS The team contributed to NHS Highland’s Anchor Strategy required by the Scottish Government. The team contributed to research into how Community Wealth Building can be adopted as a Community Planning strategy in Argyll and Bute. This was led by the Third Sector Interface and is informing Argyll and Bute Council’s economic strategy. The premise of this work is to keep the wealth generated in Argyll in our local communities. The team supports the Climate Action steering group in Argyll and Bute and jointly funds a development worker in Community Planning to co-ordinate and develop strategies to mitigate and adapt to the climate emergency. An important part of this work is working with our communities. Dunoon was chosen as a pilot town for the Shaping Places for Wellbeing programme, which focused on enhancing wellbeing by addressing inequalities. The team played a key role in exploring the experience of place has on those living and working in Dunoon and examining how local plans and strategies can shape the overall experience of the community. 8 Details of how recommendations from the Levelling Up Bid Assessment led to the creation of the Active Travel Behaviour Change Plan and the partnership work involved, can be found at: https://bit.ly/GettingMovingInDunoon-AnImpactStory Place and Wellbeing Outcomes, Getting Moving In Dunoon: An Impact Story Page 128
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The Links Worker was my lifeline. I have Dr X to thank for the best referral any doctor has given me. The CLW allowed me to talk, get upset, and be nonjudgemental. I’d never have thought 4 months ago I’d have improved so much. I felt that pills on their own were not the answer to my problems. Community Link Workers use ‘social prescribing’ to connect people to sources of support or resources within their community. Issues that CLWs can support with include the social determinants of health and wellbeing such as debt, relationships, employment, housing, loneliness etc. This approach recognises that addressing these issues can improve health and wellbeing. In 2023/2024, the Community Link Worker service could be accessed through referral from 12 GP practices across Argyll and Bute. This service provision targeted the practices with the highest percentage of patients living in the more socio-economically deprived areas. We Are With You, are contracted to provide the CLW service for Argyll and Bute. This third sector partner has been working in Argyll and Bute since 2015 and has a strong understanding of the needs of our remote and rural area. A comprehensive review of the service was undertaken in 2024, reviewing feedback about the service and outcomes for the people of Argyll and Bute between December 2021 and March 2024. Highlights of this review are included below. The outputs and outcomes from the service are extremely positive and demonstrate how the service can contribute to the HSCP strategies priorities of prevention, early intervention and enablement; living well and active citizenship; building capacity within the 3rd sector and targeting resources where they have the most impact. COMMUNITY LINK WORKING Community Link Workers are based in GP practices and connect people to support or resources in their local area. Social issues such as debt, relationships, and loneliness affect people’s health and wellbeing. Link workers work in a person-centred way to help people find the best support for their problems. HIGHLIGHTS 812 referrals over the first two years of the contract, with a 72% attendance rate. Those who have used the service reported: It was easy to get an appointment. They felt listened to, treated with respect and compassion. They felt connected with the right sources of support. 94% felt their health and wellbeing had improved. 91% of those who had left the service and completed the Short Edinburgh Short Warwick- Edinburgh Mental Wellbeing Scale reported a positive change in their wellbeing. The level of positive change across all respondents is high, at +5.17 on the wellbeing scale. Studies have shown that a change of between 1 and 3 points on this scale meets the threshold for statistically important change and that for each point increase, there is a reduction in required healthcare costs. The Community Link Worker (CLW) service can be accessed through referral. For more details ask your GP practice or email: argyllbutelinks@wearewithyou.org.uk CLIENT FEEDBACK Read our CLW reports here If it wasn’t for the [service], I wouldn’t be on this journey to better myself and move on from the past [..] that has been haunting me for years Definitely feel that having the link worker support me and help me find the correct resources has made a huge difference and achieved so much. I am very grateful for the time, effort and compassion that was shown to me and I feel like a lot of people would really benefit from the same experience I had 9 Page 129
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Advisers have continued to deliver a quality service to help people to stop smoking with flexible client centred appointments offered face to face, by video conference or telephone. HIGHLIGHTS Working in all primary schools using a drama production to raise awareness of the dangers of smoking. In April 2023 the Smoke Free drama tour performed live for the first time since the COVID-19 pandemic. Raenbow Productions delivered Argyll and Bute’s bespoke engaging and interactive production to pupils in primary school across Argyll and Bute. SMOKE FREE TEAM Reducing the harms from smoking in Argyll and Bute by implementing NHS Highland's Tobacco Strategy, and working towards the Scottish Government aim of Scotland being smoke free by 2034. HIGHLIGHTS Advisers continued to support various health improvement events across the area in conjunction with other services e.g. Oral Health Week with Dental Services. 'SMOKE FREE' P7 EDUCATION PROGRAMME The “Smoke Free” drama tour performed live in 7 schools throughout Argyll and Bute and reached 200 pupils. The Smoke Free team and Argyll and Bute’s Education Department responded to feedback from schools to improve the P6/7 lesson plans last year. Current issues such as Black Lives Matter, vaping and the impact of smoking and vaping on the environment are now discussed by pupils. See also smokefreehighland.scot.nhs.uk Advisers took on extra training to allow them to have informed conversations with clients about Public Health screening, for example, for bowel cancer. The team developed health behaviours change skills allowing them to have better goal setting conversations. Advisers promoted “No Smoking” day with stalls across Argyll and Bute. The team meet biweekly to discuss clients and emerging trends and issues such as youth vaping. The Smoke Free team were delighted to have the support of Argyll and Bute’s Oral Health Team to support the delivery of the Smoke Free Tour and engage with pupils on the impact smoking has on oral health. Clockwise from top left: Caroline, Gerry, Iona, Kathy 10 Page 130
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HIGHLIGHTS SEXUAL HEALTH Improving sexual health and knowledge to minimise risk of Sexually Transmitted Infections (STIs), including HIV, and reducing health inequalities across Argyll and Bute via a contract with Waverley Care. Free condoms available by post: www.waverleycare.org/condoms-by-post Continued awareness raising of free condoms and the ability to order condoms by post for those living in Argyll and Bute. ONLINE RESOURCES https://www.nhsinform.scot/self-help-guides/ self-help-guide-emergency-contraception Waverley Care: https://www.waverleycare.org/support-and- advice/sexual-health NHS inform: HIGHLIGHTS Engaging with all Secondary Schools to deliver a drama production to address topical issues young people may have difficulty with. Our S3 Health Drama Programme, You Are Not Alone, jointly led with Education was delivered live in 8 schools across Argyll and Bute. 'SMOKE FREE' S3 HEALTH DRAMA: The health programme allows young people to discuss the issues raised in the drama, consider their own situations and supports, engage with service providers with a Q&A session and explore the issues further in class lessons. 949 pupils received the S3 Health Drama Programme. Many Third Sector organisations, NHS Colleagues and Council Colleagues supported the programme, informing young people about their services. 'YOU ARE NOT ALONE' The drama production consists of three vignettes that address issues including smoking and vaping, alcohol, sexuality, mental health, coercive relationships and sending nude photos. Support for people living or affected by HIV includes – physical health, discrimination and stigma Condoms by post provision via Wave website 46 orders from young people 190 orders from adults After feedback from services and the young people it was agreed to move the Drama to S2 pupils in Argyll and Bute, meaning 2024 performance would be a double performance for S2 and S3. Argyll and Bute residents were supported on their life journey living with, or affected by HIV HIV / syphilis point of care tests carried out 11 Page 131
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Argyll and Bute’s Screening Engagement Officer delivered screening awareness sessions to groups and organisations who support people less likely to participate in the NHS Health Screening Programmes. The sessions had good attendance and were positively evaluated. Bimonthly meetings continue with regular presentations given from guest speakers and representation and support from Public Health Scotland. SCREENING INEQUALITIES Raising awareness of the importance and benefits of health screening with particular attention on people less likely to participate in screening. HIGHLIGHTS The Screening Engagement Officer also attended many community health events including the Mull Pain and Wellbeing Roadshow where information on screening was discussed and shared. SUICIDE PREVENTION STRATEGIC GROUP Coordinating a partnership approach to suicide prevention in Argyll and Bute. HIGHLIGHTS Dunoon Burgh Hall and other buildings across Argyll and Bute were lit in purple to raise awareness of World Suicide Prevention day on 10th September 2023 Engagement identified why some groups and individuals perceived barriers to participating in screening. Some barriers were identified, Scottish Government received a report at the end of the project outlining these barriers. Following on from the new National Suicide Prevention Strategy and Action Plan Creating Hope Together, work has commenced to develop a local action plan for Argyll & Bute. This will involve utilising the knowledge and experience of partners, communities and individuals. Work continues on the development of a Turas Screening Training Module which will be available to anyone in Scotland working with groups or individuals less likely to participate in screening. After reviewing the way suicide prevention is delivered in Argyll and Bute, it was agreed a post would be hosted in public health from 2024. The post will be responsible for delivering on the actions in the creating hope together strategy at a local level. Photo by Ken Clark 12 Page 132
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19 people attended the online training from 8 different organisations. Those attending included staff from the HSCP, education and various third sector organisations. Confidence in asking if someone is having suicidal thoughts Understanding of their own mental health and wellbeing Confidence in challenging stigma Confidence in supporting someone to engage with appropriate services Confidence in approaching someone displaying mental health distress to offer support MENTAL HEALTH FIRST AID FOR YOUNG PEOPLE Delivering youth mental health and wellbeing training and how to support individuals to seek support and/or engage with services. HIGHLIGHTS 2 First Aid for Youth Mental Health courses were commissioned and delivered online in ach 3 x 3-hour sessions over a two-week period). Virtual delivery enabled participation from all over Argyll and Bute including Bute, Cowal and Mull among others. • What is First Aid for Youth Mental Health? • Identifying mental health conditions • Stress • Mental health conditions • First Aid for Mental Health action plan Participants reported increases in: Course content: Thanks to the following partners for their continued financial commitment to the health and wellbeing of young people in Argyll and Bute: ADP, Public Health, and HSCP Children and Families. COOL2TALK.ORG COOL2TALK Supporting young people to access local or national services, health information, and providing a forum for discussing health and wellbeing matters. HIGHLIGHTS Mid Argyll Youth Development Services (MAYDS) continued to deliver the service in 2023 to 2024. Cool2Talk is an online support service for young people aged 12-26. Young people post a question to the website then receive a bespoke answer within 24 hours, 361 days a year, signposting them to appropriate services including sexual health services, emotional support resources and other health related issues. The service is closed for public holidays at Christmas and New Year. 41 questions were asked about emotional health, 33 were about relationships. 98 questions answered in 2023-2024. Females between the ages of 14-16 make up the largest proportion of those who use the website. 13 Page 133
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MONEY COUNTS INCOME MAXIMISATION COURSE Attendance is increasing from staff working in partner agencies out with the NHS and HSCP CHILD POVERTY ACTION GROUP Tackling child and family poverty in line with Scottish Government targets to address child poverty by key dates of 2023 and 2030. HIGHLIGHTS Building the knowledge and confidence of staff and volunteers working with people that may benefit from support to maximise their income. HIGHLIGHTS The Money Counts Income Maximisation Course (Level 1) is a short awareness raising session to support staff working with people to discuss money worries and sources of support. It continues to be delivered in partnership with colleagues from Argyll and Bute Council and Health Improvement Staff from Argyll and Bute and North Highland. This gives staff throughout Argyll and Bute access to more sessions. 10 Money Counts information sessions were delivered in 2023 to 2024, 37 participants from Argyll and Bute attended these sessions. Attendees surveyed reported an increase in confidence in their ability to talk with someone about money issues after the session. A multi-agency group formed in 2019 with representatives of Argyll and Bute Council, NHS Highland, Third Sector and other partners looking at utilising resources to make a difference to those living in poverty. Who are the Argyll and Bute Child Poverty Action Group? Have an increased understanding of poverty and its impact; Gain knowledge of support services for money matters. Have increased confidence to ask about money worries Course Objectives: The Independent Food Aid Network Worrying about Money leaflets have been distributed to range of health settings and community events, including Chronic Pain workshops. In addition to the English language version, following consultation with attendees, versions of the Argyll and Bute leaflet have been developed in Easy Read, Polish, Ukrainian, Arabic and Gaelic – thanks to the Independant Food Aid Network https://www.worryingaboutmoney.co.uk/argyll-and-bute 14 Page 134
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Reporting on Equality Outcomes and Mainstreaming within Argyll and Bute as part of our statutory responsibilities. The report was approved at a meeting of the Integration Joint Board in July 2023 EQUALITIES Staff from the Health Improvement Team reported on work towards making Argyll and Bute Health and Social Care Partnership an inclusive place to work and live. 507 members of the public trained in the past year Significant increase in numbers trained (general public up by 109 and school pupils up by 290) Teaching basic emergency life support in the community and schools. HEARTSTART 19 schools participated with 677 pupils trained, almost a quarter of school in Argyll and Bute now receive Heartstart input. 10 more school have committed to receiving training. Volunteers given a certificate and badge in recognition of their support and years of volunteering. HIGHLIGHTS HIGHLIGHTS 18 new instructors trained, meaning there are now 58 active instructors Work outlined in the report included; money counts training delivery, screening inequalities work and the introduction of Planet Youth pilots in Argyll and Bute. The report is published on NHS Highland’s website. Available at: https://www.nhshighland.scot.nhs.uk/about/argyll- and-bute-health-and-social-care-partnership/argyll- and-bute-hscp-publications/equality/ A very strong, motivated group has been built up in Cowal. 15 staff at Rothesay Joint Campus have received the first half of their instructor training and in June Dunoon Grammar both staff and senior pupils are going to train as instructors. In Tobermory all primary and secondary pupils have been trained. The report is an interim report covering the period 2021 to 2023. Equality outcomes were reviewed via engagement with Locality Planning Groups. New outcomes will be developed and reported in 2025. 15 Page 135
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Delivering health behaviour change training across NHS Highland MAP OF HEALTH BEHAVIOUR CHANGE TRAINING All health and care staff have a unique opportunity to support people to make changes to their behaviour that can have a positive impact on their physical and mental health and wellbeing. The training increases confidence and capability in staff to provide behaviour change support to the people they care for. 2023/2024 was year two of this multidisciplinary Health Psychology pilot, developed in line with Scottish Government Type 2 Diabetes (T2D) Prevention Framework with the aim to improve effectiveness, equitability and consistency of weight management services for the people of rural Argyll and Bute Between February 2022 and February 2024, Argyll and Bute HSCP employed a trainee health psychologist to work jointly between Public Health and Dietetics. Their clinical role was developed within the Specialist Weight Management Service (and focused on developing and delivering specialised psychological support for the people of Argyll and Bute who met the criteria for tier 3 weight management intervention Participants reported significant reduction in frequency of thoughts around food, with noticeable increase in positive thoughts about food, significant reduction in overall psychological suffering, and significant reduction in anxiety and depression scores. Our Trainee health psychologist Giulia Spaltro successfully completed her training programme during this pilot, and is now a qualified Health Psychologist. We would like to thank Giulia for her time with us and wish her all the best in future. HIGHLIGHTS HIGHLIGHTS HEALTH PSYCHOLOGY AND WEIGHT MANAGEMENT Integrating health psychology theory and practice in the weight management service in Argyll and Bute. It provides a guide to structure behaviour change conversations and evidence-based behaviour change techniques (BCTs) which help people make changes This short video gives a summary of the Learning Programme In 2023/24, the team continued the pilot to employ evidence-based behaviour change tools and techniques, nutritional/psychological education and psychological interventions (e.g. acceptance and commitment therapy, compassion-focused therapy, motivational interviewing) within weight management services. In 2023/2024 we worked to increase our training capacity across NHS Highland and delivered 3 training courses to 27 participants from a range of professions. There are now 8 trainers across NHS Highland who will continue to increase training support in the coming years. I felt I got a better understanding how helping people to change their behaviour's by getting them to think about how they can makes the changes instead of me doing it for them. I found the content very good. The protocol taught is accessible and I can see its usefulness across lots of practice disciplines. I found this training very helpful; giving me a space to reflect on the way I interact with patients and it gave me a confidence to use more structure In my conversations when discussing behaviour change. Page 136
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The ADP committee continued to meet every two months, and a new independent chair was appointed in March. As part of the development of Local Early Warning Systems and Drug Intelligence a new multi-agency group to help prevent drug deaths was established. A new MAT 8 Group to take forward MAT Standard 8 was developed and produced a local MAT 8 leaflet and graphic for service pathways (https://www.argyllandbuteadp.info/img/MAT8_leaflet_version_5_(3).pdf). The resources will inform people affected alcohol and drugs of the supports available and how to access them. ARGYLL & BUTE ALCOHOL & DRUG PARTNERSHIP (ADP) Preventing and reducing alcohol and drug use, harms and related deaths in Argyll and Bute. The Argyll and Bute ADP Support Team supported a wide range of activity in the Argyll and Bute ADP strategy and four pillars of Early Intervention and Prevention, Recovery Orientated Systems of Care, Getting It Right for Everyone and Public Health Approach to Justice. HIGHLIGHTS More details can be seen within our Annual Report https://www.argyllandbuteadp.info/img/adp_annual_report_2023-24_final_for_circulation.pdf Image: Attendee’s enjoying some cold water therapy at Kintyre’s first ever Recovery Walk Leading on the MAT Standards Experiential Research which was delivered by Scottish Drugs Forum this peer research initiative gathered feedback from 46 people who have experienced MAT, families and services, providing valuable data for the MAT Improvement Plan. In partnership with the Smoke Free Team and Education the You Are Not Alone Drama Programme was delivered to 8 secondary schools. “Planet Youth” was implemented in 5 secondary schools and a review of the Alcohol and Drug School Support Services undertaken informing how the service should be shaped. Communities received small and medium sized grants to develop recovery and prevention throughout Argyll and Bute, highlights of which are within the ADP Annual Report. Training delivered by Scottish Recovery Consortium (SRC) as part of WithYou’s development of recovery communities lead to Kintyre hosting its very first Recovery Walk to make recovery visible, reduce the stigma and celebrate recovery. Around 30 people attended the community event in September; the day started with a memorial ceremony then some cold-water therapy and a recovery walk. Local MAT 8 leaflet: 17 Page 137
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THE ARGYLL AND BUTE PUBLIC HEALTH TEAM Cara Munro Personal Assistant to Associate Director of Public Health, Argyll and Bute HSCP (Part-time) Sam Campbell Health Improvement Principal samantha.campbell3@nhs.scot Health Improvement Team cara.munro1@nhs.scot Health Improvement Team Public Health Intelligence (PHI) Alcohol and Drug Partnership (ADP) Jenny Dryden Health Improvement Lead (Part-time) jennifer.dryden@nhs.scot A special note of appreciaton is given to those who have now moved on to new opportunities. We also extend congratulations to those promoted, and a warm welcome to the new additions to the team. For more information on any of the topics covered, please email: nhsh.abhealthimprovement@nhs.scot Alison McGrory Associate Director of Public Health, Argyll and Bute HSCP alison.mcgrory@nhs.scot Rory Munro Health Improvement Lead rory.munro@nhs.scot Page 138
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Health Improvement Team continued... Angela Coll Health Improvement Senior (Part-time) angela.coll@nhs.scot Caroline McArthur Health Improvement Senior (Part-time) caroline.mcarthur2@nhs.scot Suzanne Baird Administrative Assistant (Part-time) suzanne.baird3@nhs.scot joanne.loughlin@nhs.scot The 'Smoke Free' Team: JoAnne Loughlin Administrative Assistant (Part-time) Iona McMurdo Smoking Cessation Officer (Part-time) Caroline Glen Smoking Cessation Officer (Part-time) caroline.glen@nhs.scot Kathy Graham Smoking Cessation Officer (Part-time) kathleen.graham@nhs.scot Gerard Dougan Smoking Cessation Officer (Part-time) Areas covered: Helensburgh and Lomond gerard.dougan2@nhs.scot Healther McAdam Health Improvement Senior (Part-time) Giulia Spaltro Trainee Health Psychologist giulia.spaltro@nhs.scot heather.mcadam@nhs.scot iona.mcmurdo@nhs.scot Health Psychology Plus our Bank Health Improvement Seniors from Spring 2022, who have provided additional capacity to respond to changing Public Health demands. sarahgeorgina.marquis@nhs.scot Sarah Marquis Health Improvement Senior Area covered: Campbeltown, Bute and Mid Argyll Area covered: Oban Area covered: Cowal Page 139
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The ADP's presence online: @ArgyllandButeADP (facebook.com/ArgyllandButeADP) www.ablivingwell.org @HealthyArgyllandBute (facebook.com/HealthyArgyllandBute) NHSH.ABhealthimprovement@nhs.scot The Public Health Team's presence online NHSH.argyllandbuteadp@nhs.scot argyllandbuteadp.org.uk @ArgyllADP (twitter.com/ArgyllADP) Anne Ndlozi ADP Information, Research and Performance Officer Alcohol & Drug Partnership (ADP) Support Team Laura Stephenson Argyll and Bute ADP Coordinator laura.stephenson2@nhs.scot anne.ndlozi@nhs.scot Public Health Intelligence Saskia Schmitz Public Health Intelligence Specialist (Part-time) saskia.schmitz@nhs.scot (including data published by the Public Health Intelligence Team): Sophie Wallace ADP Administrator (Part-time) sophie.wallace8@nhs.scot asia.nicoletti2@nhs.scot Asia Nicoletti Health Improvement Adviser Page 140
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For urgent care advice, day or night, and health and dental support when your GP practice or dentist is closed. www.sdafmh.org.uk For latest health advice and everyday health concerns Freephone 0800 22 44 88 www.nhsinform.scot Tel. 0800 027 1234 Tel. 111 If life threatening call 999 www.abcab.org.uk Tel. 01546 605 550 For financial or legal concerns www.lgbt.foundation Tel. 0345 330 3030 www.gamcare.org.uk Free, confidential support to people experiencing issues with drugs, alcohol or mental health (and their friends and family). wearewithyou.org.uk Call free: 0808 8020 133 Gambling support at: If you are struggling or need advice you can contact any of the organisations below for help. USEFUL CONTACTS AND LINKS Page 141
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1 Integrated Joint Board Date of Meeting: 27 November 2024 Title of Report: Update - Renewal of Joint Strategic Plan Presented by: Kristin Gillies The IJB is asked to: ▪ Note and comment on the draft strategic priorities for the Joint Strategic Plan ▪ Note timelines 1. EXECUTIVE SUMMARY 1.1 IJB is asked to note and comment on the draft Strategic Priorities for the Joint Strategic Plan (JSP) to cover the period 1 April 2025 to 31 March 2030. 1.2 The Public Bodies (Joint Working) (Scotland) Act 2014 places a duty on Integration Joint Boards to develop a JSP for integrated functions and budgets that they control, reviewing the plan at least every three years. 1.3 The JSP is a high level strategy which sets out our vision, strategic objectives and priorities. The JSP is closely linked with the Joint Strategic Commissioning Strategy (JSCP) which sets out priorities for commissioning and market messages for providers. 1.4 The development of the JSP and JSCP is overseen by the Strategic Planning Group (SPG). 1.5 The new JSP will include the JSCP; there will be one combined document for the upcoming planning cycle. 1.6 The Joint Strategic Needs Assessment for the JSP is now close to being complete. 2. RECOMMENDATIONS 2.1 Note and comment on the draft strategic priorities for the Joint Strategic Plan. 2.2 Note timelines. 3. DETAIL OF REPORT 2.1 The Joint Strategic Plan (JSP) covers the below : • High level vision, strategic objectives and priorities that all services will work towards. Page 143 Agenda Item 12
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2 • How we will measure our performance. • How the HSCP will effectively use allocated resources, set budgets, and a financial strategy to meet what is outlined within the strategic plan. • What the current and future needs are as set out within a Joint Strategic Needs Assessment (JSNA). • How we engaged with the public, staff and other stakeholders and the results of the engagement. • How we plan to transform services over the next five years. 2.2 The JSCP sets out priorities to facilitate and encourage the flourishing of a sustainable, effective range of providers and types of support in an area. 2.3 The current JSP and JSCP expire on 31 March 2025 and work has begun on the new plans. 2.4 A Joint Needs Assessment, which is close to being finalised by Public Health colleagues, provides an overview of current population need and supports the forecasting of future needs. 2.5 The development of the JSP and JSCP is overseen by the SPG and regular updates are submitted. 2.6 At their meeting on 14 March 2024, SPG supported the idea that both JSP and JSCP should be combined into one document for the upcoming planning cycle. The group also supported a longer time frame, extending the duration of the JSP/JSCP from three to five years. 2.7 Two workshops have taken place with HSCP staff, including one with the SLT on 13 September to develop the overall strategic priorities for the plan. SLT members were keen to develop an ambitious plan and to spell out clearly that the HSCP will have to deliver significant transformative service change to be able to continue to deliver its remit. 2.8 There is also a recognition that the HSCP may have to stop services which are not a statutory requirement and which are assessed to be low value for money. 2.9 A plan on page has been developed to summarise the proposed strategic priorities and main themes. The priorities are being further sense checked currently. 2.10 See next page for the draft plan on a page. Page 144
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3 3. Draft Priorities 3.1 Living Well, Prevention, Early Intervention and Enablement: We will prioritise activity, interventions and services that: • Reduce the need for people having to access statutory/formal services in the first place. • Support people before their needs become more pronounced and require more complex intervention. • Support people to stay in their homes for longer or return home following treatment, and continue to look after themselves as much as possible. 3.2 Addressing inequalities and protecting the most vulnerable: We may not be able to continue to provide the range of activities, interventions and services that we currently do. When we have to change how we provide certain services, we will assess the impact on the most vulnerable people and work with our partners to mitigate any potential negative effect. We may also have to choose between providing services directed at the general population and more targeted services in accordance with where there is the greatest need. Most health and social care services are aimed at all social groups despite differences in need but are often disproportionately used by people whose needs are lower. People and communities with the greatest health and social care needs often experience poorer access to support. 3.3 Healthy and Engaged Workforce: Our workforce is our greatest asset and resource. If we are not able to attract and retain the right people, none of our priorities will be achievable. Page 145
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4 3.4 Ensuring service sustainability: This priority covers both financial sustainability and responding to the climate emergency. Some of our services in their current form are not sustainable in the long run for a number of reasons such as: workforce issues, increasing demand, and cost pressures. Individual services will need to develop more efficient delivery models ensuring they make best use of our resources. 3.5 Quality and Safety: The HSCP needs to ensure that our services continue to operate safely and provide high quality interventions. We will review our quality systems and ensure we have robust quality improvement and clinical governance structures in place. A focus on quality will also entail that we assess our services in terms of impact and effectiveness. The practice of realistic health and social care means that we need to direct resources away from interventions and services for which there is not good evidence that they are effective. 4. Drivers – How are we getting there? 4.1 Values: We commit to our organisational values: Compassion, Integrity, Excellence, Leadership and Continuous Learning. 4.2 Collaboration: Partnership working is central to improving our services. Key partners we will work with to plan and deliver our services include: • People with lived experience and local communities (individuals and community organisations and groups) • Voluntary/third sector organisations and service providers • Independent sector service providers • colleagues from the Council (education, transport, economic development and housing) We also know there is more work to be done internally in terms of applying a system-wide approach and integrating social work, social care and health services workflows. 4.3 Intelligence and Innovation: Many, if not all, of our services have evolved organically and over time, often without an evidence base. How we deliver our services has not always kept pace with patient need and other developments such technological change. In addition, there is not the workforce to continue some of the service models that we have currently in place. We will need to develop and implement new ways of working and collaborating across professional and locality boundaries. We will make decisions based on evidence and data. We will also use new systems and technology where appropriate to improve how we deliver services. 4.4 Transformation Board: Our Transformation Board will oversee our large service change projects. It will set the priority projects for each year and ensure the HSCP understands the progress that is being made. 4.5 Individual Service Plans and Commissioning Priorities: All services will have operational plans which will outline how each area plans to address the overall strategic priorities of the HSCP. 5. Timelines Page 146
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5 6. RELEVANT DATA AND INDICATORS 6.1 Joint Strategic Needs Assessment. 6.2 Data and indicators from the Integrated Performance Framework should be used to inform key priorities. 6.3 Financial Data: Analysis of budgets and actual expenditure; procurement information. 6.4 Service data. 6.5 User experience and provider feedback. 7. CONTRIBUTION TO STRATEGIC PRIORITIES 7.1 The plans set the strategic priorities for A&B HSCP. 8. GOVERNANCE IMPLICATIONS 8.1 Financial Impact The content of the strategy will shape the financial planning for 2025-30 and onwards. The financial planning will need to align with both plans and will be submitted to the IJB for approval each year. 8.2 Staff Governance No impact currently. There may be an impact on some staff. If so the change processes detailed in our staff governance arrangements will be applied working with our trade union partners. 8.3 Clinical and Care Governance No impact currently. There may be an impact on services. If so, clinical governance arrangements will be followed. 9. PROFESSIONAL ADVISORY Engagement with professional groups took place in plans for 2022-2025 and will be carried out for the new plans. 10. EQUALITY & DIVERSITY IMPLICATIONS An equality impact assessment will be carried out to cover both strategies. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Page 147
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6 No impact on GDPR or current data sharing agreements anticipated. 9. RISK ASSESSMENT Risks will be noted in the project plan and will be reviewed regularly. SPG, and if required, SLT and IJB, will be updated about any material risks to the delivery of the project. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Public engagement was carried out for the current plans and will be carried out for the new plan. Work is ongoing to mitigate against consultation fatigue and to ensure that engagement activities across the HSCP are coordinated. 11. CONCLUSIONS The delivery of both strategies will be a significant undertaking for the HSCP and partners. Regular updates will be provided to the SPG, SLT and IJB. 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) REPORT AUTHOR AND CONTACT Author Name: Anke Roexe Email: anke.roexe2@nhs.scot Page 148
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2025 2026 Committee Jan Feb March April May June July Aug Sept Oct Nov Dec Jan Feb March April IJB Public meeting PM Wed 29 Wed 26 Wed 28 *Wed 23 Wed 17 Wed 19 Wed 28 Wed 25 IJB Development Session AM Wed 29 Wed 26 Wed 26 Wed 23 Wed 28 Wed 11 *Wed 23 Wed 27 Wed 17 Wed 29 Wed 19 Wed 10 Wed 28 Wed 25 Wed 25 Wed 21 IJB Pre- agenda Finance and Policy AM Tues 21 **Tues 25 ***Tues 18 Tues 24 Tues 16 Tues 18 Tues 20 **Tues 24 ***Tues 17 Audit and Risk Tues 18 Tues 17 Tues 23 Tues 16 Tues 17 Clinical and care Governance Committee PM Thurs 6 Thurs 1 Thurs 14 Thurs 6 Thurs 5 Strategic Planning Group PM Thurs 13 Thurs 12 Thurs 11 Thurs 11 Thurs 12 Finance and Policy has potential to clash with NHSH Board Development Session but only if the session is extended for the whole day. *Hold in case a special meeting is required ** Hold for option of pre-budget meeting for Finance and Policy, all IJB members invited. *** Note this does not support standard reporting and would be pre-board budget prep Page 149 Agenda Item 13
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