Public reports pack
Argyll and Bute Council · 31 January 2024
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 31 January 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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24 January 2024 NOTICE OF MEETING A meeting of the ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) will be held BY MICROSOFT TEAMS on WEDNESDAY, 31 JANUARY 2024 at 1:00 PM, which you are requested to attend. BUSINESS 1. APOLOGIES FOR ABSENCE 2. MINUTES (Pages 3 - 8) Argyll and Bute Integration Joint Board held on 29 November 2023 3. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Audit and Risk Committee held on 29 November 2023 (Pages 9 - 10) (b) Argyll and Bute HSCP Audit and Risk Committee held on 19 December 2023 (Pages 11 - 14) (c) Argyll and Bute HSCP Clinical and Care Governance Committee held on 6 December 2023 (Pages 15 - 20) (d) Argyll and Bute HSCP Finance and Policy Committee held on 24 November 2023 (Pages 21 - 24) (e) Argyll and Bute HSCP Strategic Planning Group held on 7 December 2023 (Pages 25 - 28) (f) Argyll and Bute HSCP Finance and Policy Committee held on 26 January 2024 (to follow) 4. CHIEF OFFICER'S REPORT (Pages 29 - 34) Report by Chief Officer 5. APPOINTMENT OF NHS HIGHLAND NON-EXECUTIVE MEMBERS TO THE IJB AND REPRESENTATION ON THE IJB COMMITTEE STRUCTURE (Pages 35 - 38) Report by Business Improvement Manager 6. DIRECTOR OF PUBLIC HEALTH ANNUAL REPORT (APPENDIX TO FOLLOW) (Pages 39 - 44) Report by Director of Public Health 7. FINANCE Reports by Head of Finance and Transformation (a) Budget Monitoring - 9 months to 31 December 2023 (Pages 45 - 58) Public Document Pack
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(b) Budget and Medium Term Financial Plan 2024-2027 (Pages 59 - 82) 8. STRATEGIC RISK REGISTER REVIEW (Pages 83 - 100) Report by Head of Finance and Transformation 9. SPOTLIGHT - CHILDREN, FAMILIES AND JUSTICE (Pages 101 - 110) Report by Head of Children, Families and Justice 10. HEALTH AND SOCIAL CARE PARTNERSHIP - PERFORMANCE REPORT FQ2 (JULY-SEPT 2023/24) (Pages 111 - 128) Report by Head of Strategic Planning, Performance and Technology 11. 2024/25 SOCIAL WORK FEES AND CHARGES (Pages 129 - 172) Report by Principal Accountant 12. CATEGORY 1 RESPONDER ASSURANCE AND DEVELOPMENT (Pages 173 - 182) Report by Business Improvement Manager 13. CONSUMER SCOTLAND DUTY (Pages 183 - 186) Report by Business Improvement Manager 14. DATE OF NEXT MEETING 27 March 2024 Argyll and Bute HSCP Integration Joint Board (IJB) Contact: Hazel MacInnes Tel: 01546 604269
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MINUTES of MEETING of ARGYLL AND BUTE HSCP INTEGRATION JOINT BOARD (IJB) held BY MS TEAMS on WEDNESDAY, 29 NOVEMBER 2023 Present: Councillor Amanda Hampsey, Argyll and Bute Council (Chair) Councillor Kieron Green, Argyll and Bute Council Councillor Gary Mulvaney, Argyll and Bute Council Councillor Dougie Philand, Argyll and Bute Council Sarah Compton-Bishop, NHS Highland Graham Bell, NHS Highland (Vice-Chair) Susan Ringwood, NHS Highland Gaener Rodger, NHS Highland Attending: Fiona Broderick, Argyll and Bute HSCP Geraldine Collier, Argyll and Bute HSCP Linda Currie, NHS Highland Fiona Davies, Argyll and Bute HSCP David Gibson, Argyll and Bute HSCP James Gow, Argyll and Bute HSCP Dr Rebecca Helliwell, Argyll and Bute HSCP Elizabeth Higgins, NHS Highland Kenny Mathieson, Public Representative Julie Hodges, Independent Sector Representative Alison McGrory, Argyll and Bute HSCP Angus MacTaggart, Argyll and Bute HSCP Kirstie Reid, NHS Highland Takki Sulaiman, Argyll and Bute Third Sector Interface Fiona Thomson, NHS Highland Karl McLeish, Argyll and Bute HSCP Caroline Cherry, Argyll and Bute HSCP Charlotte Craig, Argyll and Bute HSCP David Ritchie, Argyll and Bute HSCP Evan Beswick, NHS Highland Jillian Torrens, Argyll and Bute HSCP James Crichton, Argyll and Bute HSCP Kristin Gillies, Argyll and Bute HSCP Shona Barton, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE There were no apologies for absence intimated. 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. Page 3 Agenda Item 2
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3. MINUTES The Minutes of the Meeting of the Argyll and Bute HSCP Integration Joint Board held on 27 September 2023 were approved as a correct record. 4. MINUTES OF COMMITTEES (a) Argyll and Bute HSCP Finance and Policy Committee held on 29 September 2023 The Minutes of the Argyll and Bute HSCP Finance and Policy Committee held on 29 September 2023 were noted. (b) Argyll and Bute HSCP Clinical and Care Governance Committee held on 5 October 2023 The Minutes of the Argyll and Bute HSCP Clinical and Care Governance Committee held on 5 October 2023 were noted. 5. CHIEF OFFICER REPORT The Board gave consideration to a report from the Chief Officer which included information on the following headlines: Cowal GP Relocation Project; Challenging Weather Conditions; Scottish Health Awards; Patient Safety Commissioner Bill. Decision The Integration Joint Board noted the content of the report by the Chief Officer. (Ref: Report by Chief Officer dated 29 November 2023, submitted) 6. FINANCE (a) Budget Monitoring - 7 Months to 31 October 2023 The Board gave consideration to a report providing a summary of the financial position of the Health and Social Care Partnership as at the end of month seven. The report also provided information in respect of the year to date position which showed a small forecast overspend, progress with the savings plan and reserves spend. Decision The Integration Joint Board – 1. Noted that there is a relatively small forecast revenue overspend of £847k as at the end of month 7; 2. Noted that savings of £6.8m have been delivered, 76% of target; 3. Noted that reserves of £6m have been committed to date; and 4. Noted that additional formula funding has been allocated to Health Boards to improve financial sustainability and that NHS Highland intend to recover this funding from the IJB (£2.3m). Page 4
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(Ref: Report by Head of Finance and Transformation dated 29 November 2023, submitted) (b) Audited Annual Accounts 2022/23 The Board gave consideration to the Annual Report and Audited Annual Accounts for 2022/23. The Integration Joint Board – 1. Noted that Mazars have completed their audit of the annual accounts for 2022-23 and have issued an unqualified Independent Auditor’s Report; 2. Considered the 2022/23 Annual Audit Report prepared by Mazars and management responses to the recommendations; 3. Approved the draft letter of Management Representation; and 4. Approved the Audited Accounts for signature and publication. (Ref: Report by the Head of Finance and Transformation dated 29 November 2023, submitted) 7. INTERNAL AUDIT CONTRACT The Board gave consideration to a report which outlined the options for securing an internal audit service from 1 April 2024 and recommended an extension of the existing arrangement for three years. Decision The Integration Joint Board – 1. Considered the contents of the report and noted that the Audit & Risk Committee endorsed the recommendation to extend the current Internal Audit Contract; and 2. Approved the extension of the Internal Audit Contract with the Argyll & Bute Council Internal Audit Service for a period of 3 years from 1 April 2024 to 31 March 2027. (Ref: Report by the Chair of the Audit & Risk Committee dated 29 November 2023, submitted) 8. WORKFORCE REPORT QUARTER 2 (2023/24) The Board gave consideration to the workforce report which is part of the staff governance suite of reports and focuses on work force data for financial quarter 2 (1 July to 30 September 23). Decision The Integration Joint Board - Page 5
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1. Noted the content of the quarterly workforce report. 2. Asked questions on issues that were interest or concern; and 3. Discussed the overall direction of travel, including future topics that they would like further information on. (Ref: Report by People Partner, A&B HSCP dated 29 November 2023, submitted) 9. ARGYLL AND BUTE WINTER PLAN 2022-23 The Board gave consideration to a summary of the overall winter plan for the Argyll and Bute Health and Social Care Partnership (HSCP) which spanned the period from 30 November 2023 to 1 April 2024. Decision The Integration Board considered and noted the winter plan for Argyll and Bute HSCP. (Ref: Report by Head of Service, Health and Community Care and Unscheduled Care Programme Lead dated 29 November 2023, submitted) 10. PUBLIC HEALTH HIGHLIGHTS FROM 2022-2023 The Board considered a report which outlined public health activity in Argyll and Bute to prevent ill-health and improve health and wellbeing outcomes for the population. The detail of the report also covered the Public Health Team Annual Report for 2022-2023. Decision The Integration Joint Board – 1. Noted the report on Public Health Team activity in 2022-2023; 2. Noted the wider prevention activity including the merger of the Public Health Living Well Board and the Prevention Board; and 3. Endorsed the role of the IJB in providing leadership to prevent health and social care problems from arising. (Ref: Report by Associate Director of Public Health dated 29 November 2023, submitted) 11. SERVICE SPOTLIGHT ACUTE AND COMPLEX CARE The Board gave consideration to the neurodiversity strategy together with a report which gave an update on some key areas of priority within Complex Care including Mental Health, Learning Disabilities, Neurodiversity and Adult Support and Protection. Decision The Integration Board, discussed, considered and noted the service spotlight report. (Ref: Report by Head of Adult Services Acute and Complex Care dated 29 November 2023, submitted) Page 6
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(a) NEURODIVERSITY STRATEGY The Integration Joint Board heard a presentation on the Neurodiversity Strategy which was noted. 12. IJB DATES 2024-2025 The Board gave consideration to the proposed dates for the annual programme of meetings to meet the requirements of the Scheme of Integration and support good financial management. Decision The Integration Joint Board approved the planned dates as outlined in the programme. (Ref: Report by Business Improvement Manager dated 29 November 2023, submitted) 13. CLIMATE CHANGE REPORTING 2022-23 The Board gave consideration to a report which advised of the proposed submission and a brief overview of how the HSCP is responding to Climate Change and Sustainability agenda in partnership with Argyll and Bute Council and NHS Highland. Decision The Integration Joint Board – 1. Noted that the IJB is required to submit a Climate Change Duties Report by 30 November 2023; 2. Approved the proposed submission attached as Appendix 1 to the report; and 3. Endorsed the partnership approach taken by the HSCP in respect of its Climate Change Duties. (Ref: Report by Head of Finance and Transformation dated 29 November 2023, submitted) 14. SG CALL FOR EVIDENCE - REMOTE AND RURAL HEALTHCARE RESPONSE The Board gave consideration to a call for evidence remote and rural health and social care note of the submission on behalf of the IJB. Decision The Integration Joint Board noted the submission. (Ref: Report by Business Improvement Manager dated 29 November 2023, submitted) 15. DIRECTIONS LOG UPDATE - 6 MONTHLY REPORT The Board gave consideration to the directions log update 6 monthly report. Decision Page 7
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The Integration Joint Board noted the submission. (Ref: Update by the Business Improvement Manager dated 29 November 2023, submitted) 16. DATE OF NEXT MEETING The date of the next meeting was noted as Wednesday 31 January 2024. Page 8
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MINUTES of the SPECIAL MEETING of ARGYLL AND BUTE HSCP AUDIT AND RISK COMMITTEE held BY MICROSOFT TEAMS on WEDNESDAY, 29 NOVEMBER 2023 Present: Councillor Kieron Green (Chair) Gaener Rodger Susan Ringwood Councillor Dougie Philand Attending: Fiona Davies, Chief Officer, Argyll and Bute HSCP James Gow, Head of Finance and Transformation, Argyll and Bute HSCP Caroline Cherry, Head of Adult Services – Health and Community Care, Argyll and Bute HSCP Jillian Torrens, Head of Adult Services – Acute and Complex Care, Argyll and Bute HSCP Evan Beswick, Head of Primary Care, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Paul MacAskill, Chief Internal Auditor, Argyll and Bute Council Mhairi Weldon, Senior Audit Assistant, Argyll and Bute Council Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council Gregory Odour, Audit Manager, Mazars LLP 1. APOLOGIES FOR ABSENCE There were no apologies for absence. 2. DECLARATIONS OF INTEREST (IF ANY) There were no declarations of interest intimated. 3. AUDITED ANNUAL ACCOUNTS 2022/23 The Committee gave consideration to a report presenting the Audited Annual Accounts of the Integration Joint Board for 2022-23. The report noted that the accounts had been subject to independent audit by the external auditors, Mazars, who had issued an unqualified audit report. Decision The Audit and Risk Committee – 1. Noted that Mazars had completed their audit of the annual accounts for 2022-23 and had issued an unqualified Independent Auditor’s Report. Page 9 Agenda Item 3a
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2. Considered the 2022/23 Annual Audit Report prepared by Mazars and management responses to their recommendations. 3. Approved the draft Letter of Management Representation and the Audited Accounts in advance of formal approval by the IJB. (Reference: Report by Head of Finance and Transformation, dated 29 November 2023, submitted) 4. DATE OF NEXT MEETING The Audit and Risk Committee noted that their next meeting was scheduled to take place on Tuesday, 19 December 2023. Page 10
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MINUTES of MEETING of ARGYLL AND BUTE HSCP AUDIT AND RISK COMMITTEE held BY MICROSOFT TEAMS on TUESDAY, 19 DECEMBER 2023 Present: Councillor Kieron Green (Chair) Gaener Rodger Susan Ringwood Councillor Dougie Philand Attending: Fiona Davies, Chief Officer, Argyll and Bute HSCP James Gow, Head of Finance and Transformation, Argyll and Bute HSCP Jillian Torrens, Head of Adult Services – Acute and Complex Care, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Paul MacAskill, Chief Internal Auditor, Argyll and Bute Council Mhairi Weldon, Senior Audit Assistant, Argyll and Bute Council Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council Gregory Odour, Audit Manager, Mazars LLP 1. APOLOGIES FOR ABSENCE The Chair welcomed everyone to the meeting. There were no apologies for absence intimated. 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. 3. MINUTES (a) Minute of the previous meeting of the Argyll and Bute Audit and Risk Committee, held on 19 September 2023 The Minute of the meeting of the Argyll and Bute HSCP Audit and Risk Committee, held on 19 September 2023, was approved as a correct record. (b) Minute of the Special Meeting of the Argyll and Bute Audit and Risk Committee, held on 29 November 2023 The Minute of the Special meeting of the Argyll and Bute HSCP Audit and Risk Committee, held on 29 November 2023, was approved as a correct record. Page 11 Agenda Item 3b
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4. INTERNAL AUDIT UPDATE The Committee gave consideration to a report which provided an update on the work carried out by Argyll and Bute Council’s Internal Audit Team on audits which are of operational relevance to the Committee. The report also provided an update on actions from audit reports already presented to the Committee which were still open as at 30 September 2023. Decision The Audit and Risk Committee reviewed and considered the progress on completion of the internal audit recommendations. (Reference: Report by Chief Internal Auditor, dated 19 December 2023, submitted) 5. HSCP 2024/25 INTERNAL AUDIT PLAN Consideration was given to a report which presented the 2024/25 HSCP Internal Audit Plan and provided an indicative audit plan for 2025/26 and 2026/27. Decision The Audit and Risk Committee: 1. Noted the Internal Audit Strategic Planning process covering 2024-27. 2. Endorsed the 2024/25 HSCP Internal Audit Plan. (Reference: Report by Chief Internal Auditor, dated 19 December 2023, submitted) 6. STRATEGIC RISK REGISTER REVIEW Having noted that an important aspect of the approach to Risk Management is to regularly review the Strategic Risk Register, the Committee gave consideration to a report which summarised the outcome of the recent management team review of the Strategic Risk Register and the outcome of the risk appetite workshop held in October 2023. Decision The Audit and Risk Committee: 1. Noted that the Strategic Risk Register has been reviewed by the Strategic Leadership Team in December 2023. 2. Reviewed and approved the outcomes of the Risk Appetite workshop and requested that the Risk Appetite in relation to Development and Innovation be increased from 3 to 3.5. 3. Reviewed and approved the proposed changes to the Strategic Risk Register. Page 12
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(Reference: Report by Head of Finance and Transformation, dated 19 December 2023, submitted) 7. COUNTER FRAUD REPORTING Consideration was given to a report which provided a summary on anti and counter fraud activities. The report noted the overall level of identified public sector fraud and error in Scotland and outlined the National Fraud Initiative (NFI) outcomes and their impacts on different parts of the public sector. Decision The Audit and Risk Committee noted partner arrangements as part of the anti-fraud strategy. (Reference: Report by Head of Finance and Transformation, dated 19 December 2023, submitted) 8. AUDIT SCOTLAND PUBLICATIONS Consideration was given to a report which provided an overview of relevant recent Audit Scotland publications. Decision The Audit and Risk Committee noted that Audit Scotland had recently published a series of reports which may be of interest to members of the Committee. (Reference: Report by Head of Finance and Transformation, dated 19 December 2023, submitted) 9. DATE OF NEXT MEETING The Audit and Risk Committee noted that their next meeting was scheduled to take place on Tuesday, 20 February 2024. The Chair, having noted the Chief Officer’s apologies for the next meeting, took the opportunity to congratulate Ms Davies on her successful recruitment to the post of Chief Executive of NHS Highland. On behalf of the Committee, Councillor Green thanked Ms Davies for her hard work and wished her well for the future. Page 13
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MINUTES of MEETING of ARGYLL AND BUTE HSCP CLINICAL AND CARE GOVERNANCE COMMITTEE held BY MICROSOFT TEAMS on WEDNESDAY, 6 DECEMBER 2023 Present: Graham Bell (Chair) Elizabeth Higgins Fiona Broderick Councillor Amanda Hampsey Councillor Dougie Philand Gaener Rodger Alison McGrory Attending: Jillian Torrens, Head of Adult Services – Acute and Complex Care, Argyll and Bute HSCP Evan Beswick, Head of Primary Care, Argyll and Bute HSCP Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP Fiona Thomson, Associate Director of Pharmacy, NHS Highland Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Donald Watt, Senior Manager, Health and Community Care, Argyll and Bute HSCP Tommy Stephenson, Senior Manager, CAMHS, Argyll and Bute Council Shona Williams, Senior Manager, Justice, Argyll and Bute Council Catriona Dreghorn, Midwifery Manager, Argyll and Bute HSCP Christiane Tanner Clinical Governance Support Manager, Argyll and Bute HSCP Justin McDonald, Clinical Governance Administrator, Argyll and Bute HSCP Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council 1. WELCOME AND APOLOGIES The Chair welcomed everyone to the meeting. Apologies for absence were intimated on behalf of:- Fiona Davies, Chief Officer, Argyll and Bute HSCP Dr Rebecca Helliwell, Associate Medical Director, NHS Highland Caroline Cherry, Head of Adult Services – Health and Community Care, Argyll and Bute HSCP David Gibson, Head of Children, Families and Justice, Argyll and Bute Council 2. MINUTES The Minute of the meeting of the Argyll and Bute HSCP Clinical and Care Governance Committee held on 5 October 2023, was approved as a correct record. Page 15 Agenda Item 3c
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3. ACTION LOG Having given consideration to the Action Log, the following was agreed:- Action 1 Having noted that this was now complete, it was agreed that this item be removed from the Action Log. 4. CLINICAL GOVERNANCE GROUP (a) Minute of Clinical and Care Governance Group meeting, held on 19 October 2023 The minute of the Clinical Governance Group, held on 19 October 2023 was noted. 5. PERFORMANCE AND RISK - CHILDREN, FAMILIES AND JUSTICE The Committee gave consideration to a report which provided an update on the work being carried out across integrated Children, Families and Justice Services. The report also included information on a number of challenges and responses already instigated. Decision The Clinical and Care Governance Committee noted the contents of the report. (Reference: Report by Head of Children, Families and Justice, dated 6 December 2023, submitted) 6. PERFORMANCE AND RISK - ACUTE AND COMPLEX CARE Consideration was given to a report which provided an update noting assurance and the structure and oversight in place for this across Acute and Complex Care services. It also noted where performance had been discussed and improvement actions already identified. Decision The Clinical and Care Governance Committee noted the progress in supporting clinical and care governance across Mental Health and Acute Services. (Reference: Report by Head of Adult Services – Acute and Complex Care, dated 6 December 2023, submitted) 7. PERFORMANCE AND RISK - HEALTH AND COMMUNITY CARE Consideration was given to a report which provided an overview of key risks and issues and gave a level of assurance on services under health and community care. Decision Page 16
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The Clinical and Care Governance Committee noted the report indicating assurance in relation to services under health and community care. (Reference: Report by Head of Adult Services – Health and Community Care, dated 6 December 2023, submitted) 8. PERFORMANCE AND RISK - PRIMARY CARE The Committee gave consideration to a report which summarised key development and risks across the wide range of services that comprise primary care. Decision The Clinical and Care Governance Committee noted the progress around clinical governance across Primary Care. (Reference: Report by Head of Primary Care, dated 6 December 2023, submitted) 9. PERFORMANCE AND RISK - STRATEGIC PLANNING, PERFORMANCE, TECHNOLOGY AND TRANSFORMATION Consideration was given to a report which provided an update on the progress of the Eclipse implementation which included current issues. The report also provided a look forward to Phase 2 of the implementation. Decision The Clinical and Care Governance Committee:- 1. Noted the update on the Eclipse implementation. 2. Noted the requirement for MAPPA information to be accessible by the Children and Families Out of Hours Management Team. (Reference: Report by Head of Strategic Planning, Performance and Technology, dated 6 December 2023, submitted) 10. DASHBOARD REPORT Consideration was given to the dashboard report, which provided information on stage 2 complaints over the last 13 months; adverse events recorded over the last 13 months; the total number of incidents recorded over the last 13 months; the total number of incidents recorded by site over the last 13 months; the number of Significant Adverse Event Review (SAER) information declared in Argyll and Bute for same period; the total number of hospital inpatient falls and falls with harm over the last 13 months; the total number of grade 2-4 pressure ulcers over the last 13 months; data in relation to medication errors in the last 13 months and violence and aggression incidents by location. Decision The Clinical and Care Governance Committee considered and noted the information provided within the dashboard report. Page 17
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(Reference: Report by Lead Nurse, NHS Highland, submitted) 11. COMPLAINT TREND REPORT Having noted that the HSCP are currently reviewing the reporting of information in relation to complaints, the Committee gave consideration to a report which sought to identify where there are trends in complaints and how improvements are delivered and monitored. Decision The Clinical and Care Governance Committee noted the current position and supported improvement activity. (Reference: Report by Business Improvement Manager, dated 6 December 2023, submitted) 12. COWAL COMMUNITY HOSPITAL CLINICAL BENEFITS Consideration was given to a report which provided an update on the levels of assurance in relation to the clinical benefits of the Cowal Community Hospital project. Decision The Clinical and Care Governance Committee:- 1. Noted the benefits of the Cowal Community Hospital Redesign as outlined in the approved business case. 2. Noted that these benefits remain consistent at this stage of the project. (Reference: Report by Head of Primary Care, dated 6 December 2023, submitted) 13. POLICE CARE HEALTHCARE AND FORENSIC MEDICAL SERVICES The Committee gave consideration to a report which provided an update on the provision of Police Care Healthcare and Forensic Medical Services together with key risks and mitigations. Decision The Clinical and Care Governance Committee:- 1. Noted the provision for Police Care Healthcare and Forensic Medical Services. 2. Noted the risks around these services and monitoring/mitigation. (Reference: Report by Associate Medical Director and Business Improvement Manager, dated 6 December 2023, submitted) Page 18
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14. DATE OF NEXT MEETING The Clinical and Care Governance Committee noted that their next meeting was scheduled to take place at 2:00pm on Thursday, 1 February 2023. Page 19
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held BY MICROSOFT TEAMS on FRIDAY, 24 NOVEMBER 2023 Present: Councillor Amanda Hampsey (Chair) Graham Bell Councillor Gary Mulvaney Fiona Thomson Attending: Fiona Davies, Chief Officer, Argyll and Bute HSCP James Gow, Head of Finance and Transformation, Argyll and Bute HSCP Alison McGrory, Associate Director of Public Health, Argyll and Bute HSCP Caroline Cherry, Head of Adult Services – Health and Community Care, Argyll and Bute HSCP Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP Belen Ramos, Programme Manager, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Geraldine Collier, People Partner, Argyll and Bute HSCP Lynsey Innis, Senior Committee Assistant, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE The Chair welcomed everyone to the meeting. Apologies for absence were intimated on behalf of:- Sarah Compton-Bishop Kenny Matheson Fiona Broderick 2. DECLARATIONS OF INTEREST There were no declarations of interest intimated. 3. MINUTES The Minute of the meeting of the Finance and Policy Committee, held on 29 September 2023, was approved as a correct record. 4. BUDGET MONITORING - 7 MONTHS TO 31 OCTOBER 2023 The Committee gave consideration to a report which provided a summary of the financial position of the HSCP as at 31 October 2023. The report also provided Page 21 Agenda Item 3d
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information in respect of the year to date position, the forecast outturn, the progress with the savings plan and reserves spend. The Head of Finance and Transformation provided a verbal update on recent discussions with officers from NHS Highland on their proposals to clawback sustainability funding from the IJB. Decision The Finance and Policy Committee:- 1. Noted that there is a relatively small forecast revenue overspend of £847k as at 31 October 2023. 2. Noted confirmation that savings of £6.8m have been delivered, 76% of target. 3. Noted that reserves of £6m have been committed to date. 4. Noted that additional formula funding has been allocated to Health Boards to improve financial sustainability and that NHS Highland intent to recover this funding from the IJB (£2.3m). (Reference: Report by Head of Finance and Transformation, dated 24 November 2023, submitted) 5. PLANNED USE OF RESERVES Consideration was given to a report which outlined the planned use of existing general reserves held by the HSCP. Decision The Finance and Policy Committee:- 1. Noted that the HSCP has provisionally allocated £8.4m of its general reserves to specific projects and to fund its current year deficit. 2. Noted that £3.0m is still subject to contact or in the decision making process and not fully committed. 3. Noted that earmarked reserves continue to be allocated to spend on their intended purposes. (Reference: Report by Head of Finance and Transformation, dated 24 November 2023, submitted) 6. TRANSFORMATION TRACKER UPDATE Consideration was given to a report which presented the monthly Transformation Tracker. The Tracker provided a progress overview on key transformation projects within the HSCP. Decision Page 22
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The Finance and Policy Committee noted the Transformation Tracker update for November 2023. (Reference: Report by Head of Strategic Planning, Performance and Technology, dated 24 November 2023, submitted) 7. MANAGING USER'S SERVICE MONEY - POLICY APPROVAL Having noted that the HSCP does not currently comply with best practise in providing support to adults who lack capacity to make decisions in relation to their personal finances, which has resulted in ad-hoc arrangements in some local areas which presents a risk to the HSCP and those involved in administering the finances of vulnerable individuals, consideration was given to a report which outlined and sought approval for new processes that have been developed. Decision The Finance and Policy Committee:- 1. Noted that the HSCP has developed a new approach to Managing User’s Service Money, which aligns with legislative framework and sector norms and best practice. 2. Approved the policy and associated operational procedures. (Reference: Report by Head of Finance and Transformation, dated 24 November 2023, submitted) 8. CONSULTATION TRACKER The Committee gave consideration to the Consultation Tracker, which highlighted current and ongoing Scottish Government Consultations. Decision The Finance and Policy Committee noted the Consultation Tracker. (Reference: Consultation Tracker, dated 24 November 2023, submitted) 9. DATE OF NEXT MEETING The Finance and Policy Committee noted that their next meeting was scheduled to take place on Friday, 26 January 2024. Page 23
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MINUTES of MEETING of ARGYLL AND BUTE HSCP STRATEGIC PLANNING GROUP held BY MICROSOFT TEAMS on THURSDAY, 7 DECEMBER 2023 Present: Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP (Chair) Graham Bell, NHS Highland Non-Executive Board Member and Member of IJB Fiona Broderick, Staffside Lead (Health), Argyll and Bute HSCP Samantha Campbell, Health Improvement Lead Caroline Cherry, Health of Adult Services, Argyll and Bute HSCP Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP James Crichton, Programme Manager (Neurodiversity, Learning Disability & Autism), Argyll and Bute HSCP Linda Currie, Associate AHP Director, NHS Highland Nicola Gillespie, Service Manager for Mental Health and Addictions James Gow, Head of Finance, Argyll and Bute HSCP Councillor Amanda Hampsey, Argyll and Bute Council (Chair of IJB) Rebecca Helliwell, Associate Medical Director, Argyll and Bute HSCP Margaret Jacobsen, Chair of Dochas Centre Alison McGrory, Associate Director of Public Health Kirsty MacKenzie, Carers Act Support Duncan Martin, Public Representative Michelle Mundie, Chief Executive, ACHA Councillor Dougie Philand, Argyll and Bute Council (Co-Chair) Anke Roexe, Senior Service Planning Manager, Argyll and Bute HSCP Alison Ryan, Service Planning Manager, Argyll and Bute HSCP Saskia Schmitz, Health Intelligence Officer, Argyll and Bute HSCP Takki Sulaiman, Chief Executive, TSI Fiona Thomson, Associate Directory of Pharmacy Jillian Torrens, Head of Adult Services – Acute and Complex Care, Argyll and Bute HSCP 1. WELCOME, INTRODUCTIONS AND APOLOGIES The Chair welcomed everyone to the meeting and introductions were made. Apologies for absence were intimated on behalf of the following: Fiona Davies, Chief Officer, Argyll and Bute HSCP Julie Hodges, Scottish Care Inspectorate 2. MINUTES AND MATTERS ARISING The Minute of the Strategic Planning Group held on 7 September 2023 was approved as a correct record. There were no matters arising. Page 25 Agenda Item 3e
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3. NEURODEVELOPMENTAL STRATEGY UPDATE Consideration was given to a report and presentation outlining the work being undertaken to develop a Neurodevelopmental Strategy for Argyll and Bute, the associated work streams and leadership arrangements. The Strategic Planning Group agreed to: 1. note the progress to date; 2. consider the proposal scope of the strategy and consultation approach; 3. consider the timeline for delivery and establishment of the Neurodevelopmental Strategy and Planning Group and appended Terms of Reference; and 4. have an update report brought to March meeting. (Reference: Report by Programme Manager dated 7 December 2023, submitted) 4. WOMEN'S HEALTH PLAN (2021 - 2024) A report advising on progress with implementation of the Women’s Health Plan following recommendations agreed by the Strategic Planning Group at its meeting on 16 March 2023 was considered. A SLWG was set up in September 2023 and the first meeting took place on 24 October 2023. The group was chaired by the Associate Director of Pharmacy who has been identified as one of the Women’s Health Champions for the HSCP. The Midwifery Operational Manager has also been identified as a Women’s Health Champion. The group identified the role of the SLWG as providing recommendations to quality improve existing services to meet the priorities of the national strategy. A staff and public survey was carried out to identify needs and barriers to access for each of the priority area and this was shared with the group at the October meeting. Decision The Strategic Planning Group noted the update on the Women’s Health Plan. (Reference: Report by Service Planning Manager dated 7 December 2023, submitted) 5. ISLANDS STRATEGY A report providing an update on development of the Islands Strategy was considered. A SLWG has been established with all stakeholders involved in the island services and solutions. The purpose of this group is to establish a high level strategy for the short, medium and long term with key principles and island solutions. The first meeting of the SLWG took place in September 2023 where data collated on services, staffing and budgets were shared. The group will now work to establish benchmarking standards of quality health and social care with an asset based approach Page 26
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and set key principles and recommendations. The Island Strategy will be developed over the next few months and will be launched in April 2024. Decision The Strategic Planning Group noted the update on the Islands Strategy. (Reference: Report by Service Planning Manager dated 7 December 2023, submitted) 6. JOINT STRATEGIC NEEDS ASSESSMENT 2024 Argyll and Bute HSCP’s last adult Joint Strategic Needs Assessment (JSNA) was conducted in 2019 and informed the Joint Strategic Plan and Joint Strategic Commissioning Strategy. This JSNA is now due for refresh and a paper outlining the process being followed to ensure the updated framework meets the needs of the HSCP and communities was considered. Decision The Strategic Planning Group agreed: 1. the process to update the adult Joint Strategic Needs Assessment; and 2. the timeline to present this work to the Strategic Planning Group throughout 2024. (Reference: Report by Health Intelligence Officer dated 7 December 2023, submitted) 7. TRENDS IN MORTALITY AND LIFE EXPECTANCY IN NHS HIGHLAND Consideration was given to a report published by the Public Health Intelligence Team in February 2023 on Trends in Mortality and Life Expectancy in NHS Highland. Decision The Strategic Planning Group agreed to:- 1. note the burden of stalled life expectancy and increased mortality and morbidity in the population, with these changes more pronounced in the most deprived areas compared to the least deprived areas; 2. recognise the impact this information has on service delivery and demand, acknowledging the need for a preventative and anticipatory approach; 3. recognise the importance of this information in the strategic planning cycle; and 4. note the need for ongoing surveillance, research and reporting of life expectancy, mortality and measures of population health. (Reference: Report by Health Intelligence Officer dated 7 December 2023 and Report by Specialist Registrar in Public Health dated February 2023, submitted) Page 27
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8. SHAPING PLACES ASSESSMENT Consideration was given to a report of a Place and Wellbeing Assessment held in April 2023 to review the Argyll and Bute Health Care Partnership Joint Strategic Plan and Joint Commissioning Strategy. The Improvement Service facilitated this place-based assessment which focussed on Dunoon with any tests of change and practice potentially for consideration across Argyll and Bute. Decision The Strategic Planning Group agreed to: 1. adopt the report as a guiding document in the renewed Strategic Planning Process; 2. give consideration to the recommendations highlighted in the assessment report; and 3. give consideration to how place based actions could be integrated into strategic and transformational work and any opportunities for Locality Planning. (Reference: Report by Business Improvement Manager dated 7 December 2023, submitted) 9. LOCALITY PLANNING GROUP UPDATE Consideration was given to a report providing an update on recent meetings of the Local Planning Groups of the Integration Joint Board. Decision The Strategic Planning Group noted the update from the Local Planning Groups. (Reference: Report by Business Improvement Manager dated 7 December 2023, submitted) 10. DATE OF NEXT MEETING The Strategic Planning Group noted that their next meeting was scheduled to take place on 14 March 204 at 2.00 pm by Microsoft Teams. Page 28
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1 Integration Joint Board Agenda item: Date of Meeting: 31 January 2024 Title of Report: Chief Officer Report Presented by: Fiona Davies, Chief Officer The Integration Joint Board is asked to: • Note the following report from the Chief Officer Introduction I would like to welcome you to my Chief Officer Report for January 2024 and as usual I would be delighted to receive feedback on the report and how we can develop it further to ensure that it continues to reflect the work that is taking place across the organisation. In my report this month I have included details of the recent announcement from NHS Highland, which many of you may have seen already, which highlights that I have been appointed as the next Chief Executive of NHS Highland and will take up the role on 1 April when Pam Dudek, the current post holder, retires. I am looking forward to widening my ongoing commitment to working with our partnership staff and members of the community in my new role and I look forward to continuing these working relationships and building many more over the coming years. The IJB has an approved recruitment process for a new Chief Officer and I will ensure that there are regular updates on the progress with this and any requirement for interim leadership. The Integration Joint Board was briefed on 11 December on the update to National Care Service planning provided by Maree Todd MSP. This letter is available to read at the following link: National Care Service (parliament.scot) We will continue to update the Integration Joint Board and communicate any potential change noting impacts in our public meeting. Page 29 Agenda Item 4
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2 The Scottish Government also set out its 2024-25 budget on the 19 December and we are currently reviewing the implications of this for us as a partnership and how this will affect our joint financial planning. It has been acknowledged that the government has been “compelled to take painful and difficult decisions in order to prioritise funding in the areas which have the greatest impact on the quality of life for the people of Scotland”. This will increase our challenge in Argyll & Bute and a further analysis will be provided to the board. Other topics outlined in my report including information on a recent webinar arranged by the public health team for HSCP staff and workplaces. This event provided more information on the good work carried out by the national Breathing Space service and more information is included below. I am also delighted to highlight the work that our Screening Engagement Officer is carrying out across Argyll and Bute. This is a vital role and helps raise awareness and uptake of the various national screening programmes. Finally, and as usual, I have also included some of the key updates announced recently by the Scottish Government including a number of formal consultations and details of a campaign that has been launched to support the recruitment of more adult social care workers. HSCP Updates Appointment of new NHS Highland Chief Executive Following a competitive recruitment process I have been appointed as the next Chief Executive of NHS Highland and will take up post on 1 April 2024, when the current post holder, Pamela Dudek, will retire. View the full media release from NHS Highland here HSCP Chief Officer Recruitment We will shortly be starting the recruitment process for a new Chief Officer for the HSCP and will ensure that there are regular updates on the progress with this. Breathing Space Webinar Public Health colleagues arranged a webinar in December for HSCP staff and workplaces in Argyll and Bute to find out more about the services offered by the national Breathing Space service. The webinar was well attended on the day and our thanks go to colleagues from Breathing Space for delivering a webinar which was informative, engaging and very interesting. Breathing Space provides a free, confidential, phone and webchat service for anyone in Scotland over the age of 16 experiencing low mood, depression or anxiety. They are here in times of difficulty to provide a safe and supportive space by listening, offering advice and providing information. The service was launched in 2002 to address serious concerns about the mental wellbeing of people in Scotland. It became a national phoneline in 2004 and will celebrate its 20th anniversary later this year. Breathing Space complements the Page 30
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3 work of other phonelines and agencies which are endeavouring to reduce suicide rates in Scotland. More information is available here. Dental Team Nominated for National Award The HSCP’s dental team have been nominated for a Celebrating Forces Families Award for their work to care for the dental health of children of naval families based in Helensburgh and surrounding areas. It's a very exciting time for the dental team and they are delighted to have been nominated for this award. Further information on the awards can be found here. Screening Engagement Officer To assist with the uptake of the national screening programmes the HSCP introduced the post of a Screening Engagement Officer and Angela Anderson, who is based in Oban, took up the role in February 2023. The focus of the role is to improve awareness and understanding of the screening programmes by delivering training and taking part in outreach work with those groups that have in the past been less likely to take part. This also improves awareness of the barriers faced by certain groups and helps address health inequalities. Angela has delivered training to groups such as Argyll Wellbeing Hub, Jean's Bothy in Helensburgh, Mull Safe & Sound, Argyll & Bute Rape Crisis, Refugee resettlement at Argyll and Bute Council amongst others. The most novel ideas have been a collaboration with "My Tribe" who deliver period products throughout Argyll - they agreed to put cervical screening posters in with each period product pack they send out within Argyll. There has also been an eye- catching "crochet uterus" on the popular post-box topper in Oban which has received a lot of great comments on social media with over 300 "likes" and over 50 "shares". It is a good conversation starter for screening! In December Angela also delivered training on cervical screening to a group of GP Specialty Trainees from Oban and Connel and in January she delivered training to Community Link workers who work within GP surgeries across the HSCP. Palm Court Update In October 2023, the HSCP was formally informed by the owners of Palm Court, a residential care home for older people on Bute, that due to personal reasons they were planning to close the facility. The HSCP and Argyll and Bute Council worked with the owners of the home and families during this time. The home has now closed and all residents have been found alternative accommodation. We would like to thank the owners and the staff for all their hard work over the last few years to the care of older people. National Updates Consultation on Learning Disabilities, Autism and Neurodivergence Bill Page 31
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4 Views are being sought on proposals to better protect, respect and champion the rights of people with learning disabilities, autistic and neurodivergent people. The Learning Disabilities, Autism and Neurodivergence Bill consultation includes proposals that would provide benefits in many areas of life, including more inclusive communications and mandatory training in the public sector to address the stigma and barriers people often face. Further information is available here. Alcohol marketing consultation The Scottish Government will hold more talks with public health stakeholders and the alcohol industry early next year to discuss ways of limiting young people’s exposure to alcohol promotions. The development comes following publication of the Scottish Government’s recent consultation analysis on restricting alcohol advertising and promotions. Further information is available here. A first Self-Harm Strategy for Scotland and the World A new strategy focused on supporting people who self-harm is being launched, backed by new investment from the Scottish Government of £1.5 million. The strategy - developed jointly with the Convention of Scottish Local Authorities (COSLA) and informed by people with lived experience - is believed to be the first of its kind in the world. It includes a three-year action plan which will prioritise tackling stigma and discrimination and improving support for people who have self-harmed – particularly those known to be at higher risk. Further information is available here. Expanding Scotland’s Medical Workforce Record levels of investment will see an additional 153 trainee doctor posts created next year in what will be the largest annual expansion on record. This level of expansion represents a 2.3% increase above the current whole time equivalent workforce of 6570 trainees. The additional posts, costing £42m over the next four years, are being funded by the Scottish Government to help meet growing demand in a number of key specialties. Further information is available here. Campaign highlights Rewarding and Varied Social Care Careers A campaign has been launched to support the recruitment of more adult social care workers and help address vacancies. The new Adult Social Care recruitment drive, ‘You can make the difference’ includes TV, radio, outdoor and digital advertising. The campaign focuses on the difference someone working in adult social care can make to people’s lives, highlighting the rewarding relationship between carer and care receiver. Further information is available here News Page 32
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5 Safety and Protection of Women and Girls against Violence The HSCP was pleased to support the 16 Days of Action against Gender-Based Violence (VAWG) campaign. Buildings throughout Argyll and Bute and across Scotland were illuminated in green, white, purple and orange to support the campaign which runs from the 25 November to 10 December every year. The National Violence Against Women Network (NVAWN) promoted the theme of "Imagine a Scotland without gender-based violence" and the campaign called on citizens worldwide to share the actions they are taking to create a world free from violence towards women and girls. Each of the 32 Council areas in Scotland hosts a Violence against Women and Girls Partnership and they all link to the NVAWN. They exist to ensure both local and national coordination and promotion of efforts to tackle gender-based violence against women and girls, including domestic violence. Argyll and Bute has an active partnership that meets regularly and is made up of a wide range of key partners across both the public and Third Sector. Cowal Community Hospital Nurse Wins National Award Advanced Nurse Specialist Lorraine Carey-Gardner, who is based at Cowal Community Hospital and covers the Cowal and Bute area, has won a national award from the Pumping Marvellous heart failure charity for supporting people living with heart failure. Lorraine was nominated for a ‘You’re Simply Marvellous’ award by one of her patients who said that without her input, care and compassion they would be lost. They added that Lorraine gives them time to talk, always listens and is reassuring. The Pumping Marvellous annual awards showcase the outstanding individuals and teams who provide passion, commitment, and excellence of care to patients and their caregivers. Staffing Updates Clinical Governance Manager We want to congratulate Lucy Dornan who has been seconded into the role of Clinical Governance Manager until the end of 2024 and we wish Lucy every success in her new role. Dental Outreach Tutor We are delighted to welcome back Bobby Pendreigh as Outreach Tutor for the Undergraduate Dental Student Outreach Programme, which is based at Campbeltown Dental Centre. Bobby took up his post on 08 January. New Management Trainee Joanna Ross, a national management trainee, started working with the HSCP’s Primary Care Team in December and will be working closely with our salaried GP Practices to assist and support improvement and redesign within those teams. Page 33
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6 Vaccination Service Manager Retiral Margaret MacFarlane, physio and vaccination service manager, retired in December after more than 40 years in the NHS. We would like to thank Margaret for her many years of service and for her leadership and support in helping develop the HSCP’s vaccination service. Elijah Mushaninga, vaccination service manager for North Highland HSCP, will be extending his role to cover Argyll and Bute on a trial basis. We are delighted to welcome Elijah to the team. Area Manager for Kintyre and Islay We are delighted to announce that Gillian Neal has been appointed as the Area Manager for Kintyre and Islay. Gillian, who started in post on 3 January 2024, is an experienced manager who brings with her a lot of leadership and management experience. We wish her well in her new role. Page 34
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1 Integration Joint Board Date of Meeting: 31 January 2023 Title of Report: Appointment of NHS highland Non-Executive Members to the IJB and representation on the IJB Committee Structure Presented by: Charlotte Craig The Board is asked to: ▪ Note changes in the membership of the IJB and impact on the representation throughout the Committee structure. ▪ Approve the appointment of new members to the committees ▪ Formally thank Sarah Compton-Bishop and Dr Gaener Rodger for their service to the IJB. 1. EXECUTIVE SUMMARY Following the appointment of new Non Executive members Karen Leach and Emily Woolard to the Integration Joint Board by NHS Highland there is a requirement to appoint new members to ensure representation across the committee structure. Each committee/group requires two non-executive members either in the chair or vice chair role of the committees and as a member of the Strategic Planning Group. The chair/vice chair of the Finance and Policy Committee should not be the chair/vice chair of the Audit and Risk Committee 2. INTRODUCTION This report outlines the requirement for the IJB to make new appointments to each of the three committees and to the Strategic Planning Group. 3. DETAIL OF REPORT 3.1 The Terms of reference indicate the current requirement of members for the committee structures, this also includes professional advisors and wider partners on the Strategic Planning Group. The tables below indicate they required IJB membership and current gaps for non-executive members. Page 35 Agenda Item 5
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2 Two members are required for each committee and one for the Strategic Planning Group. Clinical & Care Governance Committee Role Current Membership Chair IJB Member (Council or NHS) Graham Bell Member Vice Chair IJB Member (Council or NHS) Amanda Hampsey Member IJB Member Dougie Philand Member IJB Member Proposed Karen Leach Member Audit & Risk Committee Role Current Membership Chair IJB Member Keiron Green Member Vice Chair IJB Member Susan Ringwood Member IJB Member Dougie Philand Member IJB Member Proposed Emily Woolard Member Finance & Policy Committee Role Current Membership Chair Amanda Hampsey Member Vice Chair Graham Bell Member IJB Member Gary Mulvaney Member IJB Member Proposed Karen Leach Member SPG Role Current Member Role Co chair Kristin Gillies Head of Strategic Planning and Performance Co chair (IJB member) Dougie Philand Non Executive Director NHS Highland IJB Member Council Amanda Hampsey Chair, Integrated Joint Board IJB Member NHS Graham Bell Vice Chair Integrated Joint Board IJB Member Vacancy *note third and independent members attend independently of their IJB role. Other than changes to the NHS Non-Executive member representation on these committees the membership is assumed to be unaffected and will be reviewed in line with the requirements of the Terms of Reference. The IJB would also like to formally offer its thanks to members Dr Gaener Rodger and Sarah Compton-Bishop for their substantial service to the Integration Joint Board. 4. RELEVANT DATA AND INDICATORS Not applicable 5. CONTRIBUTION TO STRATEGIC PRIORITIES The IJB require to have appropriate arrangements in place to provide robust governance and partner representation on the IJB. Page 36
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3 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact None 6.2 Staff Governance None 6.3 Clinical Governance Appointment of appropriate membership to ensure oversight for the safe and effective delivery of care, professional standards and practice. 7. PROFESSIONAL ADVISORY None required specifically for this report 8. EQUALITY & DIVERSITY IMPLICATIONS The governance structure of the IJB supports scrutiny of equalities issues. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. 10. RISK ASSESSMENT Risk of non-compliance with the Terms of Reference and agreed representation on Committees if new elected members are not nominated. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT None for this report. 12. CONCLUSIONS The IJB welcomes new members and are required to nominate new member representatives to the IJB Committees to replace the non-executive members no longer part of the Integration Joint Board. These arrangements would be effective immediately. 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 REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll-bute.gov.uk. Page 37
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1 Date of Meeting: 31st January 2024 Title of Report: Director of Public Health Annual Report: Medication and Public Health – Do the Right Thing Presented by: Dr Tim Allison, Director of Public Health & Policy The Health and Social Care Partnership is asked to: ▪ Note ▪ Discuss 1. EXECUTIVE SUMMARY Directors of Public Health are required to produce an annual report concerning the state of health of their local population. There is no set format for the report and in recent years the reports have tended to focus on individual themes rather than acting as a repository for population health intelligence. The report for 2023 is presented to the Argyll and Bute Health and Social Care Partnership. 2. INTRODUCTION The Annual Report of the Director of Public Health for 2023 is presented. 3. DETAIL OF REPORT The theme for the report is medication and public health; the key discussion point is about doing the right thing. Public Health challenges cannot be solved simply by prescribing medication. There are areas of public health where medication plays a huge role in improving health but conversely it is important to be aware and take action where medication causes harm such as impacts on the environment. The report presents information about the health of the population of NHS Highland then gives examples of how medication affects public health. The areas selected for this report are not intended to provide a comprehensive picture of the relationship between medication and public health but rather serve as examples of wider themes. The report contains six chapters as follows: Page 39 Agenda Item 6
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2 Chapter 1: Demography and health inequalities • Information on NHS Highland’s population is essential for planning health and care services across the life course. • An ageing population is increasing the demand on health and care services as more people are living with one or more long-term health conditions and with increasingly complex needs. • Population data from Scotland’s Census 2022 will provide a detailed picture of the characteristics of our people and communities, including information on: ethnic group, armed forces veterans, sexual orientation and trans status or history; health, disability and unpaid care. • Improving the health of our population requires a fundamental shift towards prevention and mitigating the underlying issues that can impact on health, such as poverty and deprivation. Chapter 2: The Environment: How medication can make our environment sicker • There is growing evidence of the negative effects of medicines on our environment. When medicines are excreted from our body or flushed down toilets or sinks, they can end up in our water environment and soils. They can have negative effects on aquatic organisms and end up in the crops we eat. • NHS Highland is at the forefront of research and action to reduce the impact of the medicines we use on the environment and is a co-founder of the One Health Breakthrough Partnership (www.https://ohbp.org). • There is something that everyone can do to help reduce pollution of our environment with medicines. Chapter 3: Hepatitis C: How medication is transforming treatment and prevention • Hepatitis C (HCV) is a blood borne virus (BBV) which can lead to cirrhosis of the liver and hepatocellular carcinoma. • The management of HCV has been revolutionised in recent years by the introduction of new therapies. This development has played a significant role in the increase in treatment initiatives and the potential across Scotland to achieve HCV elimination. • The availability of effective treatment that can be taken over a short period of time with few side effects should encourage more people to come forward for testing for Hepatitis C and provide a major step towards elimination of the virus. Chapter 4: Social Prescribing: How an alternative to medication can work • It is estimated that 20% of people visit their GP with non-medical needs and up to one fifth of GPs’ time is spent on issues related to social needs. • Social prescribing provides an evidence-based potential to complement management of a wide range of health conditions through providing a Page 40
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3 holistic person-centred model of care to improve health and wellbeing and reduce reliance on medication and health services. • The social determinants of health play an important role in the development of risk factors for a range of diseases and the health outcomes that people experience throughout life. Supporting people with wider social and environmental issues is important for improving health and wellbeing and reducing demand on health and care services. • There is promising evidence that social prescribing provides a positive return on investment from between £2.30 and £7.08 for every £1 invested. Chapter 5: Analgesics and Opioids: How medication can have long lasting effects on public health • There is little doubt that analgesics and opioid use can bring great benefits to individual but there are serious disadvantages as well. • There are negative impacts of opioid prescribing, particularly the management of chronic pain. Alternatives are available such as social prescribing programmes, psychologically based interventions and physical therapies. • Leadership and support for the continued implementation of the Medicines Assisted Treatment Standards, and in particular the use of Opioid Substitution Therapy, is vital in assisting individuals with problematic drug use to turn their lives around. Recommendations for action for Argyll and Bute Health and Social Care Partnership (and NHS Highland) NHS Highland and its partners should ensure that planning addresses the change in demography and ageing population. NHS Highland and it partners should prioritise tackling health inequalities and the causes of those inequalities. NHS Highland and those prescribing medicines should prioritise actions which will reduce the impact of medicines on the environment. Citizens should take up actions which will reduce the impact of medicines on the environment. NHS Highland work to eliminate Hepatitis C should promote the effectiveness of new medication and so encourage more people to be tested and successfully treated. NHS Highland should increase the number of health and social care staff who are aware of social prescribing by developing and promoting a social prescribing network and a Directory of Services and by creating targeted messaging through staff and service newsletters, bulletins and social media. Page 41
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4 NHS Highland and partners should improve the knowledge and skills of health and social care staff in relation to social prescribing by providing learning and development opportunities. NHS Highland and partners should improve the infrastructure and availability of social prescribing by embedding link workers in a range of health and social care services and increasing use of the community benefits gateway through public sector procurement and commissioning processes. Alcohol and Drug Partnership members should support further work relating to opioid and analgesic prescriptions, including needs assessment and development of alternative programmes for chronic pain. Alcohol and Drug Partnership members should continue to support the delivery of the Medicines Assisted Treatment standards and the increased choices offered to individuals through the Opioid Substitution Therapy programme. 4. RELEVANT DATA AND INDICATORS Relevant information is contained within the report. 5. CONTRIBUTION TO STRATEGIC PRIORITIES This report provides information that will contribute in some way to all of the Health and Social Care Partnerships strategic objectives but particularly to the priority to: • Promote health and wellbeing across all communities and age groups 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact There are no direct financial implications from the paper. A focus on prevention, for example, social prescribing, would incur costs, but net savings are possible from NHS budgets for many prevention initiatives. Some could also be cash releasing. Adherence to prescribing and therapeutic guidance should ensure effective and safe use of medicines. 6.2 Staff Governance There are no specific workforce implications from this paper. A focus on prevention such as social prescribing has the potential to improve the health of the workforce through job satisfaction and staff being recipients of interventions. 6.3 Clinical Governance Prevention, for example, social prescribing is an important part of both quality and patient care, and it is recommended that it is included in appropriate pathways. Argyll and Bute HSCP should continue supporting all staff in adhering to the principles of realistic medicine, and safe and effective prescribing. Page 42
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5 7. PROFESSIONAL ADVISORY This is an independent report from the Director of Public Health. 8. EQUALITY & DIVERSITY IMPLICATIONS The report addresses equality issues. The chapter on demography clearly outlines, for the Argyle and Bute populations, trends in health inequalities for selected health outcomes. This chapter also discusses the need for a fundamental shift towards prevention and mitigating the underlying issues that can impact on health such as poverty and deprivation. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE The report complies with NHS Highland data protection principles. 10. RISK ASSESSMENT Risks are managed in line with NHS Highland policy. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT The principles of public and user involvement and engagement are embedded in public health actions. This is an independent report from the Director of Public Health. 12. CONCLUSIONS Members are asked to note and comment on the report. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name: Dr Tim Allison, Director of Public health Email: Tim.Allison@nhs.scot Page 43
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1 Integration Joint Board Date of Meeting: 31 January 2024 Title of Report: Budget Monitoring – 9 months to 31 December 2023 Presented by: James Gow, Head of Finance The IJB is asked to: • Note that there is a relatively small forecast revenue overspend of £442k as at the end of month 9. • Note that savings of £6.9m have been delivered, 78% of target. • Note that reserves of £6.3m have been committed to date. • Note that additional funding has been allocated totalling £2.3m and that NHS Highland have recovered this from IJB reserves. 1. EXECUTIVE SUMMARY 1.1 This report provides a summary financial position, which has improved, as at the end of month nine. The HSCP is now reporting a small forecast overspend of £442k against its budget of £354m. Some additional NHS funding has been allocated by the Scottish Government and this improves the underlying position by £2.3m. However, NHS Highland have confirmed that they intend to recover this from reserves. This report also updates on the delivery of the savings programme and use of reserves. It has also been considered by the Finance & Policy Committee earlier in January. 1.2 Cost pressures identified relate to medicines, agency nursing and locum medical costs. Some additional funding has been announced to assist with drugs costs and the process of moving agency nursing away from non- framework contracts is starting to impact favourably on pay rates but usage of agency staff remains high. Overspending on Older Adult Social Care services is a further area of concern, this is due to increasing demand and use of agency staff to cover service gaps and address delayed discharges. The HSCP planned to utilise reserves to cover its budget gap and the reported position is broadly in line with the approved budget in this regard. The main risks relate to the impact of continued inflation and the impact of the draft budget for 2024/25. 2. INTRODUCTION 2.1 This report provides a summary of the financial position of the HSCP as at end of December 2023. Information is provided in respect of the year to date position, forecast outturn, progress with the savings plan and reserves spend. Page 45 Agenda Item 7a
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2 3. DETAIL OF REPORT 3.1 9 Months to 31 December 2023 The table below provides the year to date for the first nine months. Council services report on a cash basis whereas the Health figures are on an accruals basis. Appendix 1 provides an analysis of the variances. The year to date position has improved since the last report. Service Actual £000 Budget £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 60,983 60,897 -86 -0.1% HEALTH SERVICES TOTAL 193,488 193,258 -230 -0.1% GRAND TOTAL 254,471 254,155 -316 -0.1% 3.1.1 For Social Work budgets, the area of concern is pressure on older adults budgets, now £1.8m overspent in total across internal and external residential care and care at home services. This is due to increasing demand and on- going use of agency staff. These pressures are being offset by savings in other services. 3.1.2 Health Service budgets also continue to be under pressure, although the position has improved over November and December. An overspend of £230k is reported and concerns relate to: • Medicines – national tariffs have been increased and the current overspend is estimated at £1.7m or 10% of the budget. The national systems data issue is continuing, this is making it difficult to analyse the drivers for this overspend and limits confidence in the reported spend. Progress has been made in recent weeks and analytical work is underway, but accurate data is still only available for the first quarter of the financial year; • Spend on agency staff also continues above budget, particularly relating to Lorn & Islands Hospital medical staffing; and • Slippage on the savings programme. The national initiative to end the use of non-framework providers to reduce agency nursing spend is having a positive impact on cost per hour but utilisation of agency staff remains high due to vacancies. 3.2 3.2.1 Forecast Outturn The forecast outturn has also improved and is summarised below, detail is provided in appendix 2. A deficit budget was set and the actual deficit will be funded by the reserves earmarked for this purpose. It was expected that the Scottish Government would be under pressure to provide additional funding for NHS Boards due to systemic deficits, this has happened and NHS Highland have been allocated £2.3m based on the Argyll & Bute NRAC formula allocation. However, NHS Highland have communicated that they are expected to improve their overall position by the full value of this allocation and have Page 46
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3 requested the return of these funds on a non-recurring basis from HSCP reserves. Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 91,088 91,087 1 0% HEALTH SERVICES TOTAL 262,620 263,063 -443 -0.2% GRAND TOTAL 353,708 354,150 -442 -0.1% 3.2.2 Within Social Work, the older adult budget is overspending with a £2.4m expected overspend. This is as a result of increasing demand for care home placements and care at home demand and costs. Additionally, use of agency staffing in HSCP operated homes and care at home services is adding to the overspend. Specifically, the budgets that are of concern are: Adult Services Annual Budget Forecast Spend Forecast Overspend External Residential Placements – demand led @ national care home contract rate £10.0m £11.1m £1.1m Care @ Home Service £15.6m £17.1m £1.5m Internal Care Home Placements £7.0m £7.2 £0.2 Overspending reflects the additional costs relating to interim arrangements in the care at home service while the new contract process is being progressed including uplifts to improve terms and conditions for staff to assist with the sustainability of the service and reduce unmet need. The overspends are being offset by savings in other areas including Children’s services and Learning Disability budgets. Overall the Social Work budget is forecast to balance by the year end but this includes an assumption that reserves totalling £620k will be allocated to balance as planned: Social Work £’000 Assumed reliance on reserves 623 Forecast revenue budget variance 1 Forecast reserves funding requirement 622 The Local Authority pay settlement has now been resolved, it is anticipated that the funding for this will be passed to the HSCP. 3.2.3 Within the NHS, indications are that medicine costs have materially increased. This is being investigated with national agencies as drug tariffs have been amended with costs increasing substantially and in excess of new funding. A £2.2m overspend is projected, as noted above, there is limited confidence in spend figures at present due to a national systems issue. Spend on agency and locum medical staff remains high to ensure service continuity, this is contributing to the overspend. Page 47
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4 NHS Services £’000 Budgeted reliance on reserves 3,500 Add forecast overspend 443 Less new NRAC parity and sustainability funding (2,297) Potential reserves funding requirement 1,646 The additional sustainability funding improved the underlying position, however it has been agreed that NHS Highland will recover existing HSCP reserves to offset the sustainability allocation for 2023/24. The level of financial pressure across the NHS is significant at present due to inflation and service pressures, the HSCP is managing its budget relatively effectively in this context although it is still likely to be reliant on its reserves in the current year. 3.2.4 It is expected that the position will improve further in the last quarter of the year. The severe financial pressures facing NHS Highland remains a significant risk to the HSCP and the availability of resources for local spend or investments. The implications of the budget for 2024/25 are also potentially serious and are more adverse than expected. The HSCP is participating in expenditure control measures which are currently in the process of being implemented by NHS Highland, although it is progressing these in a way which is locally appropriate. This includes additional scrutiny of large orders, supplementary staffing requests and vacancies. The outlook for 2024/25 is even more challenging than expected and therefore beginning to implement these measures now will help change behaviours and expectations. 3.3 Savings Delivery 3.3.1 3.3.2 3.3.3 The service improvement team, finance teams and management continue to progress, monitor and report on savings projects. As at the end of Month 9, £6.9m (78%) of the £8.9m target has been declared: 2023/24 Savings Year to 31 December 2023 Target Achievement Balance % £' 000 £' 000 £' 000 Fully Achieved 6,302 6,302 0 Partially Complete 2,259 295 1,964 Non-recurring 349 349 0 Total 8,910 6,946 1,964 78% Appendix 3a lists the projects that have been fully delivered and 3b provides detail on the remaining balance of £2.0m, risk rated: Savings regarded as low risk £558k Savings unlikely to be achieved in full in 2023/24 £340k Savings unlikely to be deliverable at all in 2023/24 £1066k It is not proposed that projects are removed from the plan at present, the finance teams have projected savings delivery in the forecasts. Progressing the Cowal Community Hospital project has been challenging and progress reported in detail to the Finance & Policy Committee in November. Page 48
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5 3.4 3.4.1 3.4.2 4 4.1 5 5.1 6 6.1 The project is being managed in partnership with NHS Highland and unfortunately is now subject to further uncertainty as the draft Scottish Budget for 2024/25 implies that all such projects across Scotland are currently subject to further review, even where funding has been previously agreed. It is anticipated that decisions, which rest with Scottish Government and NHS Highland, will be taken in the coming weeks, the project is therefore subject to further delay. This has a range of potential implications for the project, its cost, the delivery of the savings plan and planned use of reserves. The amber and red rated savings projects represent a financial risk in the current year, this has been incorporated in the forecast. Reserves Earmarked reserves of £17m were carried forward. To date £6.3m has been committed to spend, summarised in Appendix 5. This includes the £4.1m initially allocated to fund the deficit and return £2.3m to NHS Highland. The IJB holds general reserves and is in the process of allocating these to projects. This is reported periodically to the Finance & Policy Committee. However the draft budget for 2024/25 puts some of these plans at risk as capital spend is likely to be severely restricted for the coming years. The main projects being taken forward are: • £600k for the Prevention project over 3 years; • £1.5m to support the Cowal Community Hospital project; • £220k to replace hospital beds (complete); • £160k to remodel the medical records space in LIH, now nearing completion; • £300k match funding to support the Islands Programme bid to facilitate the remodelling of the Tigh a Rudha Care Home on Tiree; and • £105k match for energy efficiency and the empty homes project. Additionally, strategic development work is on-going, again the budget for 2024/25 means that the timing of this work is also subject to review. It was anticipated that £300k will be needed to fund business case development over 3 years. Reserves are reducing and this in turn limits flexibility going forward and the HSCP is seeking to balance committing funds to critical projects and retaining flexibility as it seeks to balance it budget in future years. 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 this is aligned to the Strategic Plan. It is required to ensure that financial decisions are consistent with strategic priorities. GOVERNANCE IMPLICATIONS Financial Impact – the forecast outturn position is an overspend of £0.4m. It is anticipated that the HSCP will be able to manage this during the Page 49
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6 6.2 6.3 remainder of the year. The request for the return of funds from NHS Highland has been considered by the Finance & Policy Committee. Staff Governance – None directly from this report but there is a strong link between HR management and delivering a balanced financial position. Clinical Governance – the in-year reduction in resources to support Primary Care Improvement has Clinical Governance implications. 7. 7.1 8. PROFESSIONAL ADVISORY Professional Leads have been consulted with in respect of 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: • Continuing impact of high inflation and service demand; • Recovery of reserves held; and • Delivery of the balance of the savings programme. The risk is therefore that the HSCP will be required to utilise more of its reserves than planned to balance the current year financial position if the overspend cannot be managed in year. There are also a number of additional risks in the event that planned projects do not proceed. 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. 12. CONCLUSIONS 12.1 This report provides a summary of the financial position as at the end of the first nine months of the year. The forecast has improved and a relatively small overspend, 0.1%, against budget is forecast. Additional financial sustainability and drugs funding has been announced and NHS Highland have confirmed that they wish to recover the value of this funding. The national work on agency staff is helping to manage agency staffing costs down but use of expensive supplementary staff is continuing at a high level. It is expected that the financial position overall will require to be managed through additional funding allocations and reduced spend on controllable costs and agency staffing. Increasing spend on services to support Older Adults is a further cost pressure. Page 50
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7 12.2 Good progress has been made with 78% of the savings programme delivered. However, there are a number of projects that still need to be completed. Detailed reporting on these is provided to the Finance & Policy Committee. 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 APPENDICES: Appendix 1 – Year to Date Position Appendix 2 – Forecast Outturn for 2023-24 Appendix 3a and 3b – Savings Programme Appendix 4 – Earmarked Reserves AUTHOR NAME: James Gow, Head of Finance and Transformation EMAIL: james.gow@argyll-bute.gov.uk Page 51
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ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 1 REVENUE BUDGET MONITORING SUMMARY - YEAR TO DATE POSITION AS AT 31 DECEMBER 2023 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 42 487 445 91.4% Saving due to vacancy savings combined with underspends on centrally held funding. Service Development 337 343 6 1.7% Outwith reporting criteria. Looked After Children 5,608 5,842 234 4.0% Saving is as a result of demand for fostering, kinship and adoption placements and over-recovery of income for nursery meals. This is combined with payroll underspends due to vacancies and long term absence. Child Protection 2,327 2,508 181 7.2% Saving as a result of vacancies combined with demand for services across contact & welfare. Children with a Disability 697 664 (33) (5.0%) Outwith reporting criteria. Criminal Justice 192 193 1 0.5% Outwith reporting criteria. Children and Families Central Management Costs 2,312 2,368 56 2.4% The YTD variance is as a result of the receipt of grant income in advance of budget profile. Older People 31,696 29,916 (1,780) (6.0%) Overspend reflects demand within the care home placement and homecare budgets and overspends on employee costs due to use of agency staff in residential units and homecare. Physical Disability 2,539 2,485 (54) (2.2%) Variance reflects demand for service within the supported living and overspends on purchases within the IES store. Learning Disability 12,208 12,641 433 3.4% Saving reflects demand for residential placements partially offset by demand for supported living. Mental Health 2,433 2,393 (40) (1.7%) Outwith reporting criteria. Adult Services Central Management Costs 592 1,057 465 44.0% Underspends on centrally held funds. COUNCIL SERVICES TOTAL 60,983 60,897 (86) (0.1%) HEALTH SERVICES: Explanation Health & Community Care Services 33,818 33,846 28 0.1% Saving due to reduced cost per case activity with other Health Boards Acute & Complex Care Services 30,386 29,790 (596) (2.0%) Overspend due to agency nursing, medical & AHP costs in both LIH & Mental Health Services Children & Families Services 7,536 7,668 132 1.7% Saving due to vacancies Commissioned Services - NHS GG&C 58,490 58,490 0 0.0% Assumed no adverse impact from SLA uplifts. Commissioned Services - Other 3,402 3,587 184 5.1% The variance is influenced by patients delayed on waiting lists with other NHS Scotland providers. Further detail has been requested from the provider Boards on expected surgery dates for these high cost, low volume procedures Primary Care Services inc Dental 21,127 21,340 213 1.0% Vacancies, mainly in Dental Services Other Primary Care Services 7,488 7,488 0 0.0% Outwith reporting criteria. Prescribing 18,444 16,771 (1,673) (10.0%) Increasing cost of drugs and amendments to drug tariff. Whilst data is being made available, there is still a backlog in prescribing data and a requirement to rely on estimates for more than 2 months costs. Public Health 1,599 1,624 25 1.5% Saving due to service vacancies. Lead Nurse 1,228 1,369 141 10.3% Saving due to service vacancies. Management Service 850 972 121 12.5% Saving due to service vacancies. Planning & Performance 2,003 1,916 (87) (4.6%) Unachieved savings Budget Reserves 0 1,425 1,425 0.0% Anticipated slippage on reserves and SG allocations. Income (1,527) (1,420) 107 (7.5%) Seasonal income, variance is reducing now tourist season is dwindling. Estates 8,641 8,391 (250) (3.0%) Unachieved savings HEALTH SERVICES TOTAL 193,488 193,258 (230) (0.1%) GRAND TOTAL 254,471 254,155 (316) (0.1%) Page 53
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ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 2 REVENUE BUDGET MONITORING FORECAST OUTTURN - AS AT 31 DECEMBER 2023 Reporting Criteria: +/- £50k or +/- 10% Service Annual Budget £000 Forecast Outturn £000 Variance £000 % Variance Explanation COUNCIL SERVICES: Chief Officer 934 473 461 49.4% Underspend due to an over-recovery on vacancy savings (£248k) combined with underspends on centrally held funds. Service Development 480 472 8 1.7% Outwith reporting criteria. Looked After Children 7,844 7,518 326 4.2% Forecast underspend is as a result of demand for fostering, kinship and adoption placements and supporting young people leaving care. There is also an over-recovery on income from the Home Office for unaccompanied asylum seeking children. This is partially offset by demand for external residential placements and payroll overspends in the children's houses. Child Protection 3,675 3,394 281 7.6% Underspend is as a result of demand for contact and welfare services as well as forecast underspends in the Area Teams on payroll costs and payments to other bodies. Children with a Disability 999 1,042 (43) (4.3%) Outwith reporting criteria. Criminal Justice 224 172 52 23.2% The forecast underspend is due to vacancies within the Criminal Justice team. Children and Families Central Management Costs 3,709 3,682 27 0.7% Outwith reporting criteria. Older People 44,503 46,856 (2,353) (5.3%) Overspend reflects demand driven overspends within the care home placement budgets (£1.1m) and homecare (£1.6m). High staff costs across HSCP residential units due to agency cover. These overspends are partially offset by staffing underspends across ACM teams and underspends on payments to other services from the delayed discharge budgets. Physical Disability 3,527 3,605 (78) (2.2%) Overspend reflects higher than budgeted demand for Supported Living and higher than budgeted equipment purchasing in the Integrated Equipment Service. These are offset slightly by a forecast underspends in the Residential Care budgets. Learning Disability 19,368 18,786 582 3.0% Underspend reflects known demand for Residential Placements partially offset by overspends on Supported Living and Respite due to demand. Mental Health 3,594 3,635 (41) (1.1%) Outwith reporting criteria. Adult Services Central Management Costs 2,231 1,452 779 34.9% The forecast underspend is mainly due to underspends on centrally held funds and vacancies. COUNCIL SERVICES TOTAL 91,088 91,087 1 0.0% HEALTH SERVICES: Explanation Health & Community Care Services 45,143 45,301 (158) (0.4%) The adverse forecast variance is due to the cost of agency staffing in nursing and GP out of hours services Acute & Complex Care Services 39,519 40,526 (1,007) (2.5%) The adverse forecast variance is due to the cost of agency staffing covering consultant and nursing vacancies and leave Children & Families Services 10,229 10,079 150 1.5% The favourable forecast variance is due to vacancies Commissioned Services - NHS GG&C 79,320 79,256 64 0.1% Outwith reporting criteria. Commissioned Services - Other 4,584 4,400 184 4.0% Reduced activity due to delays in patients on Golden Jubilee waiting list Primary Care Services inc Dental 27,230 27,080 150 0.6% Underspend due to vacancies. Other Primary Care Services 10,609 10,609 0 0.0% Outwith reporting criteria. Prescribing 22,326 24,526 (2,200) (9.9%) The adverse forecast variance is due to the impact of increased drug pricing & changes to the drug tariff. Due to issues with the implementation of a new national system, robust prescribing data cannot be produced and the forecast is based on limited actual data Public Health 2,196 2,196 0 0.0% Outwith reporting criteria. Lead Nurse 1,844 1,654 190 10.3% The favourable forecast variance is due to vacancies Management Service 1,608 1,476 132 8.2% The favourable forecast variance is due to vacancies Planning & Performance 2,345 2,443 (98) (4.2%) The adverse forecast variance is due to unachieved savings targets. Budget Reserves 6,293 3,993 2,300 36.5% The favourable forecast variance is due to expected slippage on reserves and SG allocations. Income (1,894) (1,994) 100 (5.3%) Seasonal patient activity. Estates 11,268 11,518 (250) (2.2%) The adverse forecast variance is due to unachieved savings targets. HEALTH SERVICES TOTAL 262,620 263,063 (443) (0.2%) GRAND TOTAL 353,708 354,150 (442) (0.1%) Page 54
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Appendix 3a - 2023/24 Fully Complete Savings Target Ref. Savings Description £' 000 Social Work 2122-02 Carry out hostel review to achieve best value in admin and catering - declared non-recurring as contract changes required. 23 2122-11 Remove funding for all lunch clubs 7 2223-18 Increased utilisation of new housing capacity for service users. 18 2223-19 Implement reviews of care packages to ensure these are equitable across the area and transition to older adult care packages were appropriate 80 2223 / 2324-12 MH/LD/PD High Cost Care Package Reviews 325 2324-01 Allocate centrally held growth budgets to cost pressures 1,300 2324-02 Allocate £500k of transformation budget to cost pressures 500 2324-03 Remove Programme Manager & travel budget (SIO team) 85 2324-05 Increase Income Budgets - fees and occupancy increases 268 2324-06 Uplift vacancy target by inflation 200 2324-08 Unscheduled Care Funding for cost pressures 200 2324-09 Carer services budget review 320 2324-10 LD Day Services Staffing 62 2324-11 Reduce sleepovers and use of TEC 80 2324-13 External funding for service improvement LD 30 2324-15 Income from Unacompanied asylum seeking children 250 2324-16 Remove interim care budget as funding ended 366 2324-18 End Guardian Service for Council Staff 25 2324-17 Whole Family Wellbeing (potentially non-recurring) 120 Health AB1819-32 General Catering & Domestic services efficiency target 20 AB2021-2 Standardise procurement of food across all sites Council Shared Service Model 69 AB2122-43a/b Oban staff travel £10k 10 AB2122-42 Islay: saving on local outreach clinics and accommodation 15 AB2122-60 Near Me Consultant Travel £10k 2 AB2223-1 Review of GP Prescribing practice - reduce volume and price 194 AB2223-7 P&P Switchboard Service 54 AB2021-29 GUM Clinic 20 2324-19a Reallocation of NI increase budget not required 888 2324-19b Review of prior year reserves 200 2324-20 Remove vacant Project Manager Role 60 2324-21 Remove Depute Chief Officer Role 105 2324-23 Energy Efficiency Measures 80 2324-25 Remove Analyst Role 54 2324-27 Mental Health Package Reviews 150 AB2324-22 Revised charging policy - staff accommodation 25 AB2324-29 Public Health - general 6 AB2324-29 Public Health - grants 16 AB2324-29 Public Health - salary costs 20 AB2324-30 Resuscitation Training Income 5 2324-32 Patient Services Additional Income 50 Total Fully Complete 6,302 Declared on non-recurring basis at present: 1920-35 Bed reduction savings : Cowal Community Hospital 150 2324-31 Non-recurring saving - AHP investment 150 AB2021-1 Redesign of dementia services 24 1819-33 Catering, Cleaning and other Ancillary Services 25 Non-recurring savings 349 Page 55
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Appendix 3b - LIVE SAVINGS PROGRAMME Target Declared M9 Remaining RISK NOTES Ref. Savings Description £' 000 £' 000 £' 000 Social Work 1819-33 Catering, Cleaning and other Ancillary Services 46 46 Shared service model with council now in place, project progressing £25k declared on non-recurring basis 2324-04 Remove contract & demand officer post 49 33 16 under review due to requirement for contract / procurement expertise - non recurring 2324-07 Care at Home / Smarter Commissioning Savings 400 400 Sustainability of providers remains a risk - unlikely to be achieved in 2023/24 2324-14 Reduce external placement budget by 1 - C&F 160 160 Expect to declare saving during year Health AB1920-4 Review of Service Contracts (Bute Dialysis) 20 20 Detailed review of contractual arrangements required AB2021-19 Hotel Services redesign to reflect reduction in inpatient numbers 99 99 Shared service model with council now in place, project expected to progress in 23/24 AB2021-23 Catering & Domestic Underspends 30 30 Shared service model with council now in place, project expected to progress in 23/24 AB2021-4a/b Admin & Clerical 127 127 Work underway to establish opportunities for this once 2021-20 is complete AB2021-20 Centralised booking of medical records - reduction in admin costs 97 97 Good progress made - expect to declare in 23/24 AB2021-3 AHP Workforce Review 11 11 Expect to declare on a non-recurring basis as a minimum AB2021-1 Redesign of dementia services (excludes commissioned services) 36 36 0 Bulk of saving declared last year, remaining balance declared on non-recurring basis at present AB2122-30 re-use of walking frames / improved procurement of musculo-skeletal supplies 20 17 3 Review of Integrated Equipment Store now underway AB2122-33 centralise lab ordering £20k and theatre stock ordering £5 20 20 New contract in place, savings to be confirmed (NHSH project) AB2223-5 Estates Staffing Structure 129 129 HR support in place, litlle progress being made AB2223-8 1% reduction in hospital budgets 306 175 131 Work on-going in most localities AB2324-24 Review telecom lines and switchboard saving 32 30 2 AB2324-26 Childrens & Families Staffing and service re-modelling 250 250 Non recurring savings being achieved AB2324-28 Medicines / prescribing 150 4 146 Drugs spend significantly higher than budget at present AB2324-30 Reduction in training SLA with UWS 5 5 AB2324-30 Marie Curie Contract underspend 10 10 AB2021-16 Dunoon Medical Services (CCH Project) 120 120 Will not be achieved until 2025/26 at earliest AB2021-64 FME Dunoon (CCH Project) 50 50 Will not be achieved until 2025/26 at earliest AB2223-9 Forensic Service Contracts (CCH Project) 20 20 Will not be achieved until 2025/26 at earliest AB2122-66 Savings from building rationalisation (CCH Project) 72 72 Will not be achieved until 2025/26 at earliest 2,259 295 1,964 641 83 558 548 208 340 1,070 4 1,066 Page 56
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Appendix 4 - Earmarked Reserves Reserve Balance 31 March 23 £ Allocated Month 9 £ Remaining Balance £ Primary Care Improvement fund 609,522 377,600 231,922 Other Primary Care Projects 108,507 21,012 87,495 Technology Enabled Care (Near Me) 118,202 52,535 65,667 Additional ADP Funding 430,763 430,763 Best Start - Maternity Services (Board re-provision) 82,451 32,400 50,051 Supporting Improvements to GP Premises 178,441 178,441 0 Scotgem Funding 14,000 14,000 Covid-19 support 8,356 8,356 0 Childrens Mental Health Services (CAHMS) 645,170 645,170 Community Living Change Fund 239,688 41,689 197,999 Primary Care OOH Funding 139,394 139,394 Insulin Pumps correction including VAT 69,720 69,720 0 ASC Nurse Director Support IPC 61,066 48,400 12,666 Trauma Network Tranche 1 (70%) / Tranche 2 (30%) 36,825 36,825 PFG School Nursing Tranche 2 166,783 166,783 District Nurse Posts 127,015 127,015 E-health Strategy Funding 137,580 17,600 119,980 Perinatal MH Funding 19,887 19,887 Mental Health Officer Training / Recovery 63,953 3,320 60,633 Type 2 Diabetes Framework (70%) & (30%) 66,972 21,593 45,379 Trauma Training Programme 90,567 30,093 60,474 Wellbeing Funding 77,428 37,900 39,528 Oban Accomodation 145,000 145,000 Primary Care Education Fund 250,000 250,000 Fleet Decarbonisation 86,520 86,520 Additional Band 2-4 Staffing 636,213 636,213 Nursing Support for Care Homes 151,386 151,386 Remobilisation of Dental Services 89,604 89,604 Mental Health Facilities 285,284 285,284 Diabetic Technologies 205,114 168,180 36,934 Waiting Times Funding & Cancer Waiting Times Funding 190,583 190,583 0 Interface Care Programme 133,032 133,032 Medical Assisted Treatment Standards 55,052 55,052 Psychological Therapies 55,923 55,923 Inequalities Project 23,000 23,000 0 Dementia Post Diagnostic Support 102,469 37,100 65,369 Medical Equipment - Dental 84,285 84,285 Eating Disorders 59,238 59,238 0 Ventilation Improvement 29,200 29,200 Mental Health Recovery Services 38,931 18,355 20,576 Whole Family Wellbeing Fund 278,737 278,737 Care at Home Funding 417,896 151,671 266,225 Multi Disciplinary Teams 84,000 40,000 44,000 Interim Care 229,123 25,968 203,155 General Reserves - Service Transformation & Estates 2,925,789 75,720 2,850,069 General Reserves - Social Work Budget Gap 2023/24 630,000 630,000 0 allocated to cover Year End SW Budget Gap Social Work Workforce 103,990 65,000 38,990 Nurse Director Support for Care Homes 62,386 62,386 GDS element of the Public Dental Service 278,500 278,500 Hospital at Home Project 250,000 101,000 149,000 Learning Disability Health Checks 37,640 37,640 Mental Health after Covid Hospitalisation - Long Covid 26,348 26,348 0 Recovery Children's Oral Hlth & Dent(Childsmile) 10,827 10,827 General Reserves - 23/24 Budget Gap Health 3,500,000 3,500,000 0 allocated to cover Year End NHS Budget Gap and £2.3m return to NHS Highland General Reserves - Estates Projects 1,000,000 15,100 984,900 General Reserves - Hospital Bed Replacement Programme 212,200 212,200 0 General Reserves - Prevention Programme 600,000 600,000 General Reserves - Transformation Reserve 229,972 229,972 Total 16,990,533 6,280,122 10,710,411 Held by NHS 11,884,231 5,195,770 6,688,461 Held by Argyll & Bute Council 4,979,743 1,023,461 3,956,282 Held by Both 126,558 60,891 65,667 Total 16,990,533 6,280,122 10,710,411 Page 57
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1 Integration Joint Board Date of Meeting: 31 January 2024 Title of Report: Budget and Medium Term Financial Plan 2024-2027 Presented by: James Gow, Head of Finance The Integration Joint Board is asked to: • Consider the budget outlook for 2024-25 to 2025-26 and note the high level of risk and uncertainty. • Note the forecast budget gap totalling £11.4m for 2024-25. • Note that indicative savings targets have been allocated to services. • Note that oversight of the budget process will continue to be undertaken by the Finance & Policy Committee. • Note that additional expenditure control measures are being put in place in partnership with NHS Highland as a response to the financial context. 1. EXECUTIVE SUMMARY 1.1 1.2 This report provides the Integration Joint Board with an updated budget outlook for the 2024/25 financial year and the following two years. It takes into account the Scottish Government’s draft budget published in December 2023 and forms the basis for detailed financial planning, the value for money strategy and savings targets. The financial plan will continue to evolve as funding allocations are confirmed by partners and clarity in respect of the capital programme. The outlook aims to provide a framework for the development of the 2024/25 budget whilst placing it in a medium term context. However, the Scottish Government draft budget creates a number of challenges which are still to be fully understood. The most recent 3 year spending review document is now of limited relevance due to changes driven by inflation, pay increases and re-prioritisation of spend. The Draft Budget commits the Government to publishing a new 3 year spending review in May 2024. At a high level there is still a commitment to protect Health and Social Care budgets relative to the rest of the public sector, however, the previous commitment to real terms funding increases is not feeding into formula funding allocations when the impact of actual inflation is taken into account. 1.3 The HSCP is operating broadly in line with its financial plan for 2023/24. However, the planned use of reserves reduces financial flexibility. The situation across the NHS in Scotland remains unsustainable with many Health Boards forecasting significant deficits (£363m forecast deficit in 2023/24). This situation continues to result in the allocation of funding to support deficits thereby reducing resources Page 59 Agenda Item 7b
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2 available for formula funding allocations. This disadvantages the HSCP in its efforts to deliver services in a sustainable way. Overall, the financial context is deteriorating and further efficiency and cost savings are required across the system. Financial planning is based upon a mid-range scenario which estimates the budget gap at £11.4m or 3.2% of spend for 2024/25. Work is underway to develop firm savings proposals to seek to balance the budget with the expectation that enhanced financial control measures will also be required. 2. INTRODUCTION 2.1 The purpose of this report is to update the medium term financial plan. It summarises the context and aims to ensure that the HSCP is operating in a financially responsible way. It includes the following sections: • Financial & Strategic Context • Current Financial Position • Revenue budget modelling & assumptions • Budget Gap and Savings Target • Transformation & Investment • Reserves • Scenarios and Risks 3. 3.1 DETAIL OF REPORT Financial & Strategic Context • The Government remains committed to the National Care Service (NCS), the timetable has been delayed and the scale of change for IJBs is expected to be more limited than initially anticipated. • The sector continues to experience workforce shortages, increasing demand, high delayed discharges, long waiting times and unmet need. The Health and Social Care system continues to be under severe pressure. • The Health and Care (Scotland) staffing act is due to become law in April 2024. Preparatory work is on-going, in pragmatic terms the implementation of is likely to be costly and will require to be phased. There is no financial allowance for additional staffing or for additional management and administrative support to enable its requirements to be met. • Inflation has reduced, RPI is 4.2%. The impact has been significant and funding uplifts have not been sufficient to compensate, the cumulative effect of 2021/22 and 2022/23 inflation is 23.7%. There are risks associated with inflation assumptions built into financial plans, particularly in respect of public sector pay where national assumptions have been used. The Government have indicated that the number of public sector employees is expected to reduce and that the pay metrics for 2024/25 (public pay policy) will be published after the UK Government Budget in March 2024. • The Budget provides a £230m funding allocation for the minimum pay rate for health and social care staff to increase from £10.90 to £12 per hour from 1 April 2024. Page 60
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3 The Scottish Government continues to prioritise the sector with 33% of the total budget allocated to NHS Recovery, Health and Social Care (£19.5bn). The Draft Budget is available at: https://www.gov.scot/publications/scottish-budget-2024-25/ Additional management letters have been issued to the NHS and Local Government following publication of the budget. These provide further information and are attached as appendixes: • The NHS uplift includes funding already allocated in 2023/24, Boards are asked to assume future pay increases will be funded and that the increase in NHS superannuation costs will be funded; • There is zero uplift for non-pay costs and Boards are expected to manage non-staff inflation within existing budgets; • There is an implication that capital funding has been transferred to revenue and that some capital schemes will be subject to delay or cancellation; and • Further information on the approach to capital investment and business case development will be forthcoming in January. Separately, Boards have been asked to manage within set brokerage limits. It is apparent that the budget allocation for the NHS does not align with current spend patterns and does not represent a sustainable funding settlement. This is a concern for the IJB as brokerage totals are not included in formula allocations and therefore, in relative terms, it is disadvantaged by this approach. NHS Highland is facing a reduced brokerage total for next year. It does not appear that the budget available to the HSCP will increase in real terms in 2024/25 per the spending review and previous planning assumptions. Further, the NRAC formula will not be reviewed to take account of the census population data. This also disadvantages the HSCP as the level of population decline (relative to Scotland) is less than modelled. It is expected that this will be addressed in 2025/26. 3.2 Current Financial Position The HSCP ended 2022/23 in a favourable position. It repaid its debt, generated a surplus and held reserve funds. Total revenue spend on services was £332m and £17m was held in earmarked and general reserves at the year end. However, the HSCP was not able to identify sufficient savings to balance its budget in 2023/24 and planned on using £4.1m of reserves. The Scottish Government allocated additional funding as expected and this is recurring in 2024/25 and improves the underlying position which is now a £1.8m shortfall. This has not reduced reliance on reserves in 2023/24 as an equivalent value has been clawed back by NHS Highland. It is anticipated that the HSCP will operate within its plan and will end the year with reduced reserves balances but will still have some resource to progress key projects. The HSCP does not have delegated responsibility for asset ownership or capital spend. Backlog maintenance and asset replacement needs have been identified and require to be addressed in partnership with NHS Highland and Argyll & Bute Page 61
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4 Council. The 2024/25 Draft Budget indicates a shift towards maintenance rather than replacement of assets within the NHS and implies some existing projects will be cancelled or postponed. Business case development is also subject to review. This is a risk to the ability of the HSCP to deliver on its strategic objectives in the longer term. 3.3 Revenue Budget 2024/25 to 2026/27 3.3.1 Services provided by the HSCP are largely funded by allocations made by the Scottish Government to Local Authorities and NHS Boards. They then pass on funding for delegated services. Allocations are predominantly based upon formulae which take into account factors such as population demographics, levels of deprivation and rurality. Planning assumptions are based upon the draft Scottish Budget and associated letters and are still to be confirmed at the time of writing. The draft budget is still to progress through parliamentary processes. The following sections outline the forecast position within each service. 3.3.2 Social Work The draft budget allocates additional funding for: • an uplift in free personal and nursing care £292k • additional funding for kinship care £207k; and • funding for the uplift in minimum pay from £10.90 to £12 per hour, to be confirmed and estimated at £4.4m. These pay for known cost increases and will come though the national care home contract rate increase, inflation on care packages across all services and the new care at home service rates. The HSPC will request all of its commissioned service providers comply with the £12 per hour minimum pay rate. It is assumed the Council will pass through funding for pay inflation. The table below summarises the cost and demand pressures within Social Work Budgets based on a mid- range scenario. The assumptions used generally align with those of the Council: Social Work Cost and Demand Pressures 2024-25 £000 2025-26 £000 2026-27 £000 Pay inflation @ 3.5% for 2024/25 and 2% thereafter 1,085 2,065 2,879 Incremental increases 152 304 456 Non-Pay Inflation 1,095 2,082 3,055 Older Adults Demand – Residential Care 1,370 1,870 2,370 Older Adults – Personal & Nursing Care uplift - as funded 292 292 292 Childrens and Families – as funded 207 207 207 Physical Disability – Demand Pressure 60 60 60 Mental Health Services Demand Pressure 50 50 50 Potential transfer of Kintyre Care at Home 160 160 160 Older People Demand Growth 445 897 1,356 New Care @ Home Contract 900 900 900 Estimated Impact of minimum pay rate increase – contracts (10.1% then 3.5%) 4,400 6,000 7,800 Estimated Impact of ending of Smarter Commissioning (1,200) (1,700) (1,700) Total Social Work Cost and Demand Pressures 9,016 13,187 17,885 Offset by additional funding: Page 62
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5 3.3.3 Free personal nursing and nursing care 292 292 292 Kinship Care 207 207 207 Minimum pay rate uplift (TBC) 4,400 6,000 7,800 Pay increase funding (TBC) 1,140 1,140 1,140 Total Additional Funding (6,039) (7,639) (9,439) Net Pressures 2,977 5,548 8,446 Add underlying deficit 630 630 630 Budget Gap 3,607 6,178 9,076 There are some initial budget saving adjustments available to reduce the gap: Allocate uncommitted budget to savings (420) (420) (420) Right size LD budget to reflect current demand (370) (370) (370) Revert to national minimum pay rate (110) (110) (110) Total Budget Savings (900) (900) (900) Revised Social Work Budget Gap 2,707 5,278 8,176 Pension Scheme Local authority employed staff are auto-enrolled in the Strathclyde Pension Fund (SPF). The employer pays 19.3% of pensionable salary and the cost is built into service budgets. The SPF is currently funded to a higher level than it anticipated and has announced reductions in employer contribution rates as a response: 2023/24 2024/25 2025/26 2026/27 SPF Employer Contribution Rate 19.3% 6.5% 6.5% 17.5% HSCP estimated total saving @23/24 payroll rates - £3.8m £3.8m £0.5m Recurring - £0.5m £0.5m £0.5m Non-recurring - £3.3m £3.3m - Discussions are on-going with the Council about the extent to which the saving is available to the HSCP. It would not be prudent to rely on this to balance the budget but the resource provides some flexibility to enable key projects to proceed and make resource available for service transformation. Health Budget The approach being taken with NHS budgets has changed. The Scottish Government request that Boards make the following assumptions as they develop their financial plans: • 0% uplift in baseline funding (likely for 3 years); • future pay increases will be fully funded; • the superannuation increase will be fully funded; • plan for the delivery of 3% annual efficiency savings; and • assume 2024/25 funding will be same as 2023/24 unless told otherwise. There is a cost pressure associated with the employer superannuation rate increasing from 20.9% to 22.5% of pay. Advice from Scottish Government is to Page 63
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6 3.3.4 assume that there will an allocation via UK consequential funding. The implication of this is circa £1.5m plus the impact on SLA costs. The normal approach is to assume that internal (NHS) SLA cost increases will be fully funded as part of the pay funding. The budget planning, summarised below, reflects these assumptions. Growth and inflation increases are kept to an absolute minimum as these add to the savings requirement. No allowance for additional staffing for the Staffing Act has been made. NHS Cost and Demand Pressures 2024-25 £000 2025-26 £000 2026-27 £000 Pay Inflation Uplift – assume fully funded - - - Pay Increments 100 200 300 Current year recurrent cost pressure - prescribing 1,500 1,500 1,500 New prescribing & Hospital Drugs Inflation – 8% 1,802 3,744 5,836 Inflation on GCC SLA – assume fully funded - - - Inflation Commissioned Services & SLAs – assume funded - - - Resource Transfer Inflation (2% PA) 283 572 866 Inflation on PFI Contract (RPI assumption) 263 518 760 Energy, Estates & Utilities Inflation (8%) 261 544 851 Allowance for new drug approvals (oncology) 250 500 750 Care Packages and other commissioning inflation 2% 87 176 266 New High Cost Care Package 400 400 400 Vaccination funding shortfall 245 245 245 NSD – Regional Car-T 308 610 861 NSD Topslice – Foxgrove 28 28 28 NSD Cost Pressures share 200 400 600 LIH Pharmacy 30 30 30 Other current cost pressures 150 150 150 MS 365 Licenses 85 135 185 Allowance for unknown cost and demand pressures 150 500 1000 Depreciation 218 484 759 Total Health Cost and Demand Pressures 6,360 10,736 15,387 Add 23/24 Recurring Deficit 1,084 1,084 1,084 Current Savings Shortfall 1,057 1,057 1,057 Estimated Budget Gap 8,501 12,877 17,528 The NHS gap includes the current anticipated shortfall in savings delivery which sits at £1.1m, some of these are dependent upon capital investment now under review. Previously made funding commitments are at risk of being reversed. Implications will include local and national challenges with communication in respect of specific services and potentially cancelled projects. IJB reserves are at increasing risk in this context as balancing the overall budget is a relatively short term challenge for Government and NHSiS management. Summary Budget Gap and Savings Target As stated previously, this report provides an indicative budget gap for planning purposes. Between now and budget approval in March management will be Page 64
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7 working on plans to address the gap outlined below as far as possible. The Transformation programme is also currently under review in this context. Revenue Budget Summary 2024- 25 £m 2025-26 £m 2026-27 £m Opening Recurring deficit 1.8 1.8 1.8 NHS Cost & Demand Pressures 6.4 10.7 15.4 Social Work Cost & Demand Pressures (net) 3.0 5.5 8.4 Allowance for unachieved savings 1.1 1.1 1.1 Initial Social Work Savings (0.9) (0.9) (0.9) Budget Gap 11.4 18.2 25.8 New Savings Target as % of spend 3.2% 5.1% 7.3% Based on a mid-range scenario, the budget gap is estimated at £11.4m which is the savings target for 2024/25. This is relative to an anticipated budget of circa £360m (plus the NHS pay uplift). The HSCP is in the process of developing a Value for Money Strategy and savings plan which will seek to address the shortfall at this level as far as is reasonable and responsible. However, taking into account the wider financial challenge within the NHS, it is not clear how a budget gap at this level can be delivered in the context of service pressures and systemic constraints on implementing change quickly. The approach to budgeting continues to be largely incremental in nature. More fundamental reviews of budgets and transformation of service delivery is required in the medium term as it is increasingly challenging to identify new savings within existing service delivery structures. Progress with the development of savings plans will be reported to the Finance & Policy Committee which will meet twice prior to the final budget proposals being made to the IJB in March 2024. 3.4 Transformation and Investment The budget assumes that £400k will be held to enable transformation projects to proceed. This is critical in enabling the HSCP to develop longer term plans to operate in a more sustainable way and provides some flexibility. Infrastructure investment is required as a consequence of many years of underinvestment. The shift toward maintenance rather than replacement may enable refurbishment of existing assets which are assessed as not being fit for purpose, assuming funds are allocated on a needs rather than formula basis. The challenge relates to both physical and digital infrastructure which in turn impacts on the ability of the HSCP to effectively transform the way in which it operates. Page 65
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8 3.5 Reserves The plan does not set a target for increasing reserves, it is anticipated that reserves will diminish as projects proceed and balances are likely to be used to address IJB or partner budget shortfalls. The short term pension cost benefit is intended to enable key projects to proceed. Reserves carried forward into 2023/24 are intended to be spent during the period of this plan and balances will reduce. 2023/24 £m 2024/25 £m 2025/26 £m 2025/26 £m Opening Balance 9.1 4.1 1.5 0.8 Reserves Spend (2.7) 2.6 0.7 0.3 Clawback (2.3) Closing Balance 4.1 1.5 0.8 0.5 3.6 Scenarios and Risk 3.6.1 Identified risks are summarised below, using the standard assessment of probability and impact: Risk Like. Impact Mitigations HSCP unable to identify and deliver sufficient savings in 2024/25 to balance the budget. 5 5 25 Development of and consultation on value for money strategy. Implementation of additional expenditure control measures. Demographic or population changes reduce the formula funding to the HSCP. 3 4 12 The Census data indicates that the formula is already disadvantaging A&B based on population numbers, this should be reviewed for the 2025/26 budget cycle. One or both of the partners do not pass on anticipated funding allocated to Health and Social Care. 5 4 20 On-going partnership working and consultation. Increased risk reflects scale of challenge NHS Highland are facing. Cost and Demand pressures increase further or are not funded to the extent assumed in the model. 4 4 16 Engagement in sector networks, modelling based on Spending Review figures and draft Budget. Increases in pay rates or employer on-costs are in excess of those allowed for in the budget. 4 4 16 Monitor progress with pay negotiations, commitment to fund within NHS. Nationally agreed assumptions used. These may not be realistic or SG may not have sufficient funds to resource 2024/25 Page 66
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9 3.6.2 agreements still to be negotiated. Implementation of NCS diverts attention from operational priorities and financial management. 3 3 9 Seek to resource NCS project appropriately, however implementation is subject to delay and scale of anticipated change is reduced. Service costs increase due to providers withdrawing from the market and / or ongoing workforce shortage. 4 4 16 Commissioning strategy and engagement with partners and care providers. Workforce planning and management of agency / locum contracts and additional funding to improve terms and conditions. Funding reduced due to reserves held by HSCP and/or across sector. 4 5 20 Opportunity reduced as sector reserves are reducing. Progress key projects as quickly as possible. System wide challenges result in decisions to control recruitment and spend being made outwith the control of the HSCP. 3 5 15 Ensure that implications of such decisions are communicated and understood. Ensure spend plans align with Strategic Plan. There are service and financial risks related to both partners. NHS Highland have a significant structural deficit to address which has been exacerbated by the zero uplift planning assumption. Argyll & Bute Council are also having to identify savings, again due to funding allocations growing at a much slower pace than costs. This presents risk to HSCP financial plans and to the level of service the HSCP and communities receive from partners. There is also an expectation that real terms cuts for other services and investment including housing and Further & Higher education may have an impact on local communities. Scenarios The figures presented are based upon modelling of the mid-rage outlook. A worst case scenario for health assumes a 1% additional efficiency saving is required. For Social Work the table below summarises a potential worst case which reflects increased risk: 2024-25 £m 2025-26 £m 2026-27 £m Mid-Range Budget Gap 11.4 18.2 25.8 Health Worst Case Additional 3.0 6.0 9.0 Social Work Worst Case Additional 2.0 4.4 7.0 Worst Case Budget Gap 16.4 28.6 41.8 Page 67
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10 In the event that the outlook improves or if the final Scottish Budget allocates additional resource the HSCP would scale back its savings target. 3.6.3 Workforce Workforce risks are considered in detail in the Workforce Plan. Labour shortages are likely to constrain the ability of the HSCP to deliver services and improvement. The financial plan no longer assumes a net growth in workforce numbers, the Scottish Government is clear that the size of the workforce needs to reduce and it is not going to be possible to deliver balanced budgets and efficiency improvement without an impact on staffing structures. The shift from growth in recent years to retraction has been swift. However it is hoped that the HSCP will be able to reduce the vacancies it has within existing structures and significantly reduce its reliance on agency and locum staff to implement more cost effective, stable, safe and sustainable staffing. 3.7 4. Alignment with Strategic Planning The medium term financial plan sits alongside a range of HSCP strategic and operational planning documents. These include the Joint Strategic Plan and Commissioning Strategy. The Transformation programme and the budget to support it are important in facilitating some of the objectives set out in these documents, particularly in respect of service redesign and beginning the process of shifting of resources towards prevention. RELEVANT DATA AND INDICATORS 4.1 The budget outlook is based on a number of assumptions. These are drawn from the Scottish Government’s Draft Budget, local modelling and guidance provided by policy teams. The assumptions used are considered carefully and will be reviewed and updated. There will be variations between the assumptions made at this stage of the budget planning process and the eventual funding allocations and cost and demand pressures. 5. CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 The Integration Joint Board has a responsibility to set a budget which is aligned to the delivery of the Strategic Plan and to ensure the financial decisions are in line with priorities and promote quality service delivery. This requires to be considered when options are developed to balance the budget and address the funding shortfall. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – There is expected to be a significant budget gap that requires to be addressed, the HSCP is required to set a balanced budget. 6.2 Staff Governance – None directly but there is a strong link between HR management and delivering financial balance. 6.3 Clinical Governance – None. Page 68
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11 7. 7.1 8. PROFESSIONAL ADVISORY There are no recommendations in this report which require to be consulted on with Professional Advisory leads. The development of the savings plan is being progressed in consultation with Professional Advisory Leads and the full leadership team. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 None directly from this report, some of the proposals to address the estimated budget gap will require equality impact assessments. 9. 9.1 10. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. RISK ASSESSMENT 10.1 There are risks associated with medium term financial planning. To some extent these are quantified within the worst case scenario and further detail is provided within the report. Financial sustainability risks are increasing as a consequence of the budget outlook for 2024/25 and beyond. Management of finance by the HSCP and partners is expected to be an increasing priority in the coming period. The consequential impact on service delivery, industrial relations and infrastructure are amongst other strategic risks that are perceived to be increasing at present. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 Public engagement and consultation relating to the HSCP’s financial planning is being progressed using existing engagement frameworks such as the locality planning groups. Additionally the HSCP is utilising new on-line budget consultation software and is planning its engagement with the wider public from late January until the end of February 2024. It is hoped that this will help us understand better the priorities of the communities served by the HSCP. Engagement processes will continue as savings proposals are developed to address the budget shortfall. It is also likely that the HSCP will require to manage engagement and communications carefully as decisions to reverse previously made commitments may be made by either the HSCP, NHS Highland or the Scottish Government. Budget proposals will be available as part of the IJB public papers for public comment and accompanied by Equality Impact Assessments for review by the IJB. 12. CONCLUSIONS This document provides an updated budget outlook for 2024/25 to 2026/27. It outlines the key assumptions, cost pressures and risks. It also provides an indication of the scale of the budget gap facing the HSCP. The current financial context for the HSCP is that it is in a healthy financial position with reserves available but faces severe challenges in operating within a balanced budget in 2024/25 and beyond. Page 69
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12 The identified budget gap requires to be addressed through the development of a Value for Money Strategy and savings plan. Work on this underway and it is also expected that additional expenditure control measures will be put in place in partnership with NHS Highland. The scale of the challenge for 2024/25 is estimated at £11.4m or 3.2% of the budget. It is intended that the IJB will be asked to approve a balanced budget alongside savings proposals and equality impact assessments where appropriate at its March meeting. The budget is likely to be reliant on the use of the reserves to some extent or NHS brokerage. 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 AUTHOR NAME: James Gow, Head of Finance and Transformation james.gow@argyll-bute.gov.uk Appendix 1 – Budget Letter NHS Appendix 2 – Budget Letter Local Authority Page 70
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1 Directorate for Health and Social Care Finance, Digital and Governance Richard McCallum, Director T: 0131-244 3464 E: richard.mccallum@gov.scot Chief Executives, NHS Scotland Copy to: NHS Chairs NHS Directors of Finance Integration Authority Chief Officers Integration Authority Chief Finance Officers Issued via email 19 December 2023 Dear Chief Executives Scottish Government Budget 2024-25 Following the announcement of the Scottish Government’s Budget for 2024-25 by the Deputy First Minister in Parliament today, I am writing to provide details of the indicative funding settlement for Health Boards. A breakdown of the total is provided in Annex A to this letter. The Deputy First Minster noted in her response to the UK Government’s Autumn Statement that it delivered a worst-case scenario for Scotland’s finances. The financial pressures across health and social care are, by far, the most challenging since devolution. We have worked to protect NHS Budgets and social care funding where other parts of the public sector have faced reductions. All health consequentials have been passed through to the Portfolio, but these were not at a level expected by the Scottish Government, particularly given the non-recurring nature of 2023-24 pay consequentials, and we recognise the continued pressures health and social care services face in the aftermath of the pandemic and changing demographic profiles. As in previous years, the budget announced will be subject to any amendments agreed through the Scottish Parliament’s Budget Bill process. In addition, we will undertake further work with you specifically in relation to pay costs and waiting times funding. I will keep you up to date with any changes to our planning assumptions. Budget Uplift Compared to 2023-24 budgets, territorial NHS Boards will receive a total increase of 4.3% for 2024-25 to cover costs related to the 2023-24 pay deals, as well as the baselining of £100 million sustainability and NRAC funding provided in 2023-24. For clarity, the 4.3% uplift relates to 2023-24 non-recurring funding now being made on a recurring basis. National Boards will receive a 3.8% uplift to fund 2023-24 pay deals. In terms of pay, funding arrangements for Boards will be revisited by the Scottish Government following the outcome of the pay negotiations in the new financial year. As part of Boards recurring adjustments for 2023-24, amounts have been included based on pay offers for Agenda for Change and Medical and Dental staffing in 2023- 24. Pay for NHS staff remains subject to agreement for 2024-25, and we will work with Directors of Finance to finalise this position once the outcome is known. We will write to Boards in 2024 to confirm finalised baseline budgets following the conclusion of this work, but at this stage it should be assumed that additional funding will be allocated to support a deal. We have committed the £100 million sustainability funding for non-pay costs, but beyond this and the NRAC funding provided in 2023-24, Boards will be expected to manage pressures within existing envelopes. Funding ensures no Territorial Board is further than 0.6% from parity. Page 71
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2 Covid-19 Funding Whilst the scale of Covid-19 costs has reduced significantly in 2023-24, we recognise there are specific legacy costs that will require additional funding support in the new financial year. This includes funding for: - Vaccinations staffing and delivery. - Test & Protect activities including Regional Testing facilities. - Additional PPE requirements; and - Some specific Public Health measures. Following today’s budget, we will seek to provide early clarity as to the total funding to be provided to support these costs. However, beyond the above, NHS Boards and Integration Authorities should expect to meet remaining costs from baseline funding and should continue to drive these costs down as far as possible. Policy Funding In addition to the baseline uplift outlined, funding aligned to policy commitments and recovery of health and social care services will be allocated to Boards and Integration Authorities in 2024-25. It is our intention to provide early indication of allocations where possible, and to align this to the planning guidance that will be issued in relation to Annual Delivery Plans, setting out the priorities for health and social care in the coming year. We are aware there has been a rise in the volume of allocations over the past few years and we are committed to reducing this. We are also aware timing of some allocations being later in the year leads to uncertainty and difficulties in service planning without funding certainty. We are committing to putting out 80% of allocations in the first quarter, where necessary these may be a % of the full allocation value. Health and Social Care Integration Formal notification of the terms and approach to the Local Government funding settlement will be given in the Circular and Local Government Budget Letter. The Health and Social Care Portfolio will transfer net additional funding of £241.5 million to Local Government to support social care and integration. The overall transfer to Local Government includes additional funding of £230 million to deliver a £12 per hour minimum pay settlement for adult social care workers in private and third sectors, in line with the Real Living Wage Foundation rate. In addition, an inflationary uplift on Free Personal Nursing Care rates (£11.5 million) is provided. The funding allocated to Integration Authorities for Free Personal and Nursing Care and adult social care pay in third and private sectors should be additional and not substitutional to each Council's 2023-24 recurring budgets for adult social care services that are delegated. This means that, when taken together, Local Authority adult social care budgets for allocation to Integration Authorities must be £241.5 million greater than 2023-24 recurring budgets to ensure funding from Health and Social Care Portfolio contributes to meeting outcomes in this area. Where there is evidence funding is not passed across to be used for the policy intent, the Scottish Government reserves the right to look at reclaiming funding allocated. We have progressed baselining prior year Real Living Wage funding totalling £333.5 million to Local Government. A further £52.3 million has been baselined for other commitments including uprating free personal nursing care. Capital a. Capital Budget The health capital budget increases from £578 million to £754 million, however if the health research element is excluded (which is a ring-fenced budget that cannot be used for capital investment), the budget reduces by £59 million from £373 million to £314 million. This is lower than our planning assumptions, which were shared with Chief Executives, Chairs and Directors of Finance in August. The settlement allows for formula capital to be maintained at 2023-24 levels, all major projects in construction to be completed (Baird and Anchor, Parkhead Health Centre, QEUH rectification and Jubilee Phase 2), as well as support for the national replacement programmes for Ambulances and Radiotherapy equipment. Beyond these Page 72
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3 core areas outlined above, we will not be providing any funding, including in relation to our intention to increase formula capital so that it doubles over the Capital Spending Review period (2021-22 to 2025-26). In respect of 2023-24, we are asking all Boards to review their capital expenditure for the remainder of the year and to defer any areas where spend is discretionary. b. New Developments and Capital Planning We are aware that most Boards are developing infrastructure plans and individual projects which will require Scottish Government funding to progress. Given the challenging settlement we are managing, we will not be funding development costs for any new projects, as we do not anticipate starting construction of any new project over the next two years at least. We understand the local challenges this will present in some instances, so the Health Capital Finance team will arrange a discussion with all affected Boards in the New Year to confirm arrangements. However, in the meantime, NHS Boards should immediately stop any project development spend, otherwise these costs may need to be funded from local formula capital budgets which should instead be directed towards maintenance of the existing estate and essential equipment and digital replacement. Now that we have clarity on the capital funding position, a Directors’ Letter on Whole System Planning that focusses on maintaining your current estate, will be issued in the New Year. c. Small Scale Projects The Scottish Government has always looked to provide capital support for relatively small scale, but essential investments, that could not be funded through formula capital. At this point, our ability to fund such investments is extremely limited and Boards should not anticipate receiving additional funding in 2024-25, even if funding has previously been agreed. It is clear that there is significant financial challenge in 2024-25 above levels we have seen before and we will continue to work closely with Chief Executives to address this. I thank you again for your support to date and your continued engagement moving into the next financial year. 2024-25 Financial Planning I wrote to all Boards previously outlining my expectations for 2024-25 plans, being: • a clear programme of work and supporting actions to achieve the target of 3% recurring savings on baseline budgets,; and • an improved forecast outturn position compared to your forecast outturn position reported at the start of 2023-24. Further to this, I confirmed for Boards in receipt of brokerage in previous years that this would be capped for 2024- 25. There is no central budget available for brokerage and any funding given for this limits investment in other areas. Financial savings I am aware the 3% savings target alone will not be enough to return to breakeven or in some cases the brokerage cap. There are a number of areas of work underway to support NHS Boards and collectively improve the financial position as set out below. 15 box grid I have communicated previously the 15 box grid approved by Board Chief Executive on 14 November. This sets out 15 areas of focus for Boards to progress. There are various national programmes of work supporting these areas to be implemented at a local level. The Financial Delivery Unit will continue to co-ordinate and assist Boards to identify further actions or areas that will support delivery of your 3% recurring savings target. Page 73
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4 NHS Scotland Planning and Delivery Board (NHSSP&DB) The NHSSP&DB has been established to direct and co-ordinate a range of national work including strategic planning, national programmes and national improvement. Work will continue to rationalise national programmes and agree priorities to simplify the landscape and have a stronger focus on affordability. As agreed, decisions will be taken on a Once for Scotland basis working alongside Board Chief Executives and the other functional professionals groups. CHOICES As set out at the Board Chief Executive meeting on 12 December, we will progress the development of the CHOICES options which will provide the framework in which decisions around the following key areas will be made: • Workforce • Innovation • Service and infrastructure optimisation Further guidance will follow in respect of the above and will take account of the discussions you have been having with the NHS Scotland Chief Operating Officer and members of my team. It is clear that there is significant financial challenge in 2024-25, above levels we have seen before, and we will continue to work closely with Chief Executives and colleagues across the whole system. I thank you again for your support to date and your continued engagement moving into the next financial year. Yours sincerely, RICHARD MCCALLUM Director of Health and Social Finance, Digital and Governance Page 74
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Annex A – Board Funding Uplifts Page 75
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Deputy First Minister and Cabinet Secretary for Finance Shona Robison MSP F/T: 0300 244 4000 E: scottish.ministers@gov.scot Councillor Morrison COSLA President Verity House 19 Haymarket Yards Edinburgh EH12 5BH Copy to: Councillor Steven Heddle The Leaders and Chief Executives of all Scottish local authorities ___ 19 December 2023 LOCAL GOVERNMENT SETTLEMENT 2024-25 Today I formally set out the Scottish Government’s proposed Budget for 2024-25 to the Scottish Parliament. Further to the budget statement I write now to confirm the details of the local government finance settlement for 2024-25. This draft budget prioritises supporting people through the cost-of-living crisis, investing in our frontline public services, and tackling the climate emergency head-on. It focuses on our three missions: • Community - Delivering efficient and effective public services • Equality - Tackling poverty and protecting people from harm • Opportunity - Building a fair, green and growing economy This Budget comes at a difficult fiscal period for Scotland. The economic conditions for the 2024-25 Scottish Budget are set to remain challenging as inflationary and pay pressures continue to impact on households, businesses and public bodies. The funding provided by the UK Government in the Autumn Statement fell far short of what we needed. Scotland needed more money for infrastructure, public services and fair pay deals. Instead, the Autumn Statement delivered a real terms reduction in the total block grant. The UK Government have not inflation-proofed their Capital Budget which is forecast to result in a 9.8% real terms cut in our UK capital funding over the medium term between 2023-24 and 2027-28. It is also important to recognise the positive change in the relationship between the Scottish Government and local government. On 30 June of this year we signed the Verity House Agreement which set out our vision for a more collaborative approach to delivering our shared priorities for the people of Scotland. We agreed to change the way we work together, building a relationship on mutual trust and respect; focusing on achievement of better Page 77
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot outcomes; and consulting and collaborating as early as possible in policy areas where local government has a key interest. We committed to regularly reviewing councils’ powers and funding, with the expectation that services will be delivered at a local level unless agreed otherwise; and to develop a framework for collecting and sharing evidence to ensure progress is maintained. We also undertook to agree a new Fiscal Framework governing how local authorities’ funding is allocated, reducing ring-fencing and giving greater control over budgets to meet local needs. On Thursday 14 December we jointly published an update on the development of this fiscal framework and our officials will continue to work together to develop this further. We also wish to work with COSLA through the development of that Fiscal Framework to ensure the distribution arrangements for the settlement continue to meet the needs of our remotest communities and changing population. In this regard, I am open to considering adjusting the funding floor percentage ahead of the Local Government Order and would welcome any views on this or other elements of distribution as part of the consultation to the order due to publish on Thursday 21 December.” As part of our discussions with you on the new fiscal framework we will also seek to increase discretion for local authorities to determine and set fees and charges locally. This will include continuing our joint work to agree next steps following the recently closed consultation on building warrant and verification fees, and a consultation on planning fees to launch in early 2024. We also intend to explore with local government options in respect of other fees and charges which are currently levied locally but set nationally, with a view to further empowering councils in these areas. The intention is that the indicative allocations to individual local authorities for 2024-25 will be published in a Local Government Finance Circular on Thursday 21 December. That circular will begin the statutory consultation period on the settlement. The total funding which the Scottish Government will make available to local government in 2024-25 through the settlement will be over £14 billion for the first time should all 32 councils agree to freeze council tax. This includes: • An additional £6m to support the expansion of Free School Meals; • An additional £11.5m to support the uprating of Free Personal and Nursing Care rates; • Additional funding of £230m to deliver a £12 per hour minimum pay settlement for adult social care workers in commissioned services via agreed contract uplifts; • An additional £6.8m for Discretionary Housing Payments • £145.5m to continue to maintain teachers and support staff (on which further detail will follow) as well as £242m to support teacher pay uplifts; This excludes funding for teacher pension contributions. As you are aware there will be an increase in the employer contribution rate in the Scottish Teachers’ Pension Scheme. The rate is set to increase from 23% to 26% from 1 April 2024, following the conclusion of the 2020 scheme valuation. The UK Government have publicly stated that the funding will be allocated to individual UK Government departments in Spring 2024. Scottish Ministers will make decisions on funding allocations once the UK Government funding position is clearer and the implications for consequentials are understood. Page 78
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Discussions with COSLA are also underway to finalise the costs of delivering the £12 per hour minimum pay commitment for PVI providers delivering children’s social care, bringing this in line with ELC and adult social care. Following discussions with COSLA, and approval through the formal financial governance process, our aim is to provide additional funding in 2024-25 for children’s social care. The funding allocated to Integration Authorities for Free Personal and Nursing Care and adult social care pay in commissioned services should be additional and not substitutional to each Council's 2023-24 recurring budgets for adult social care services that are delegated. This means that, when taken together, Local Authority adult social care budgets for allocation to Integration Authorities must be £241.5 million greater than 2023-24 recurring budgets to ensure funding from Health and Social Care Portfolio contributes to meeting outcomes in this area. Where there is evidence funding is not passed across to be used for the policy intent, the Scottish Government reserves the right to look at reclaiming this. Within the Verity House approach, Scottish Government and Local Government are committed to developing a joint overarching framework of outcomes, accountability and monitoring. It is envisaged that this framework will be finalised by spring 2024. In the meantime, this settlement includes almost £1 billion of funding which has been baselined into the General Revenue Grant, as part of our commitment under the Verity House Agreement to remove ring-fencing and increase funding flexibilities to local authorities, subject to agreeing the detail set out below. As I have advised the COSLA President, Vice President and Resources Spokesperson in our pre-budget engagement, the baselining exercise has required us to restate the fiscal position for prior years to meet Parliamentary expectation on budget presentation. In light of this restatement, I have asked my officials to provide the necessary data to ensure that the reconciliations are clearly understood by COSLA. The baseline proposals will deliver flexibilities across Social Care, Education, Social Justice, Net Zero and Justice. The detail of the individual lines is set out in the Annex to this letter. In return, our expectation is that Councils will continue to deliver all statutory and contractual commitments associated with the relevant funding. In relation to the funding for Social Care being baselined we expect the continued payment of the living wage to adult social care staff in commissioned services, with Councils benefitting from flexibility on how that is delivered locally. Alongside this, we expect that local government will continue in good faith to engage in a range of discussions about future policy direction. Given the joint work required to progress the delivery of the National Care Service, and the positive progress made so far, we expect this to continue, with every effort being made to reach agreement on outstanding matters in relation to arrangements for the chairs of local boards, direct funding and consistency of delegation. Our offer to baseline £564.1m of education funding is conditional upon the agreement that, by the end March 2024, the assurance framework being sought by the Cabinet Secretary for Education and Skills is in place and that the new joint Education Assurance Board has been Page 79
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot established. In light of the £521.9 million of early learning and childcare (ELC) funding which is being baselined, I am also seeking your agreement to commit publicly to exploring options for a national indicative rate or range of rates for the ELC PVI sector to secure their financial sustainability in future years. Further discussion on flexibility on other Education funding lines will take place within the Education Assurance Board once it is operational. Our expectation is also that Councils will continue to honour the existing joint agreement on provision of free school meals on a universal basis to primary 4, 5 and special school pupils, building upon our earlier agreement with respect to universal provision to primary 1 to 3 pupils. This baselining is an initial step in the process of embedding the Verity House Agreement and is not a one-off event. I have emphasised the need for further movement in Budget 2025-26 to my Cabinet colleagues and over the coming months we will be identifying further lines which could be considered and put forward for baselining supported by the outcomes, accountability and monitoring framework to be agreed in the coming months. The Scottish Government is committed to working in partnership with Local Government to deliver a national freeze on Council Tax in 2024-25. We have engaged closely with you to discuss the parameters and principles for identifying funding to support this commitment and will continue discussions during the coming months to reach agreement. Consequently, we have set aside £144 million to fund a freeze in Council Tax across each of Scotland’s 32 local authorities. The funding earmarked is equivalent to a 5% increase in Council Tax nationally, taking into account the average rise to Council Tax in 2023-24, whilst recognising that inflationary pressures have eased in the last 12 months. The funding represents the Council Tax revenue that might have been raised (net revenue), and excludes the forgone revenue associated with the increased cost of the Council Tax Reduction scheme, and other deductions (gross revenue), which Council Tax rises would have caused. On this basis we will seek the agreement of councils to freezing their Council Tax in 2024-25, and as I have indicated this week, I remain open to continued dialogue as to how we might best achieve that. In respect of the statutory accounting framework and discussions on its robustness over the past number of years, I can also confirm that I have no plans in the immediate future to commence the Capital Accounting Review which was proposed in the Resources Spending Review in May 2022. Should all councils agree to freeze Council Tax, the 2024-25 Local Government Settlement of over £14 billion offers an increase equivalent to 6.0% in cash terms since the 2023-24 budget. It continues to provide local government with a funding settlement that is both fair and affordable, under the most challenging of circumstances. Critically, in the face of a worst-case scenario Autumn Statement and amongst all the difficult decisions in the Budget, we have increased the Local Government Settlement’s share of the discretionary budget. I acknowledge that this Budget cannot deliver the resources all our partners will want. I am under no illusions about the challenging fiscal environment we face across all of our public services, not only this year but in years to come. This Budget addresses key priorities, targets resources on low-income households and paves the way for future investment in this Page 80
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Parliament. It treats local authorities fairly and consistently with other portfolios. Scottish Ministers have had to take difficult decisions which have allowed us to prioritise funding and invest in the areas which have the greatest impact on the quality of life for the people who call Scotland home. I look forward to working with COSLA in the year ahead to deliver our shared priorities and to continue to fully implement the Verity House Agreement. SHONA ROBISON Page 81
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot ANNEX A FUNDING BASELINED IN 2024-25 Funding Line Proposal (£m) Local Heat and Energy Efficient Strategies 2.4 Community Justice Partnership Funding 2.0 Living Wage 333.5 Blue Badge 0.72 Free Personal and Nursing Care 42.3 Former Housing Support Grant 1.0 Free period products in schools and public places 4.9 Early Learning and Childcare Specific Revenue Grant 521.9 Free School Meals 42.2 Total (£m) £950.92 Page 82
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1 Integration Joint Board Date of Meeting: 31 January 2024 Title of Report: Strategic Risk Register Review Presented by: James Gow, Head of Finance and Transformation The Integration Joint Board is asked to: Note that the Strategic Risk Register has been reviewed by the Audit & Risk Committee and Strategic Leadership Team in December 2023. Review and approve the Risk Appetite. Review and approve the Strategic Risk Register. 1. EXECUTIVE SUMMARY 1.1 An important aspect of effective Risk Management is to regularly review the Strategic Risk Register. The Audit & Risk Committee undertake this on behalf of the IJB and reviewed the Strategic Risk Register at its meeting on 19th December 2023. This report summarises the outcome of that review and provides the IJB with an opportunity to further scrutinise the register as part of its commitment to do this twice per year. The IJB is also asked to approve the risk appetite for the HSCP which was developed during the workshop held in October 2023 and then reviewed by the Audit & Risk Committee. 1.2 The environment continues to be relatively high risk. Following review by the Audit & Risk Committee, the Scottish Government published its draft budget for 2024/25, this outlines a more challenging situation than anticipated. As a consequence, several risks are perceived to be increasing whilst accepting that further analysis of the implications of the budget is required. The financial challenge relates to local pressures in some services, pressures in NHS Highland which are impacting on resources available to the HSCP and the potential withdrawal of capital resource. As is normal over the winter, systems pressures are also increased. The risks associated with the sustainability of service providers and socio-economic situation also continue to be of concern, it is anticipated that some commissioned support services will close in early 2024 and service providers continue to be under financial pressure. This situation has multiple strands, many of which are not within the control or influence of the HSCP. 1.3 This report also summarises the outcome of the risk appetite workshop. Once agreed, further work is required to map the risk appetite to the risks on the register. It is also suggested that there may be some scope to streamline the Strategic Risk Register and reduce the number of risks being reported. Page 83 Agenda Item 8
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2 2. INTRODUCTION 2.1 The purpose of this report is to provide the Integration Joint Board with the opportunity to review the Strategic Risk Register and consider suggested changes. The report also seeks approval for the risk appetite. 3. DETAIL OF REPORT 3.1 The Risk Register is used to identify risks and assess their perceived likelihood and impact. It is a dynamic document and is reviewed by the IJB at least twice per year. The current version is attached as appendix 1. The Strategic Risk Register describes 23 strategic risks facing the HSCP and the table below summarises the perceived residual risk relating to these: Residual Risks Very High High Medium Total May 2021 2 9 9 20 December 2021 4 13 6 23 June 2022 4 14 6 24 November 2022 7 12 5 24 June 2023 4 13 7 24 January 2024 4 14 5 23 Following consideration by the leadership team and Audit and Risk Committee it was agreed that the specific Covid-19 risk should be removed. This is due to reduced prevalence, the vaccination programme and the current national approach which means that there is limited surveillance in place. General winter planning risks are adequately covered in the Safety of Services and Business Continuity and Resilience risks. The draft Scottish Budget was published in December 2023, there are a number of risks are likely to be revised upwards as the implications become clearer. These include: Financial Sustainability - the uplifts are less than previously communicated for the NHS in particular; Industrial Relations and Workforce – the budget indicates reductions in the public sector workforce and restricted funds for 2024/25 pay awards; Sustainability of Partners – funding settlements across the public sector are challenging with some sectors facing cash terms cuts and there are no uplifts for NHS non-staff costs; and Infrastructure – the capital programme is being reduced, there are suggestions that existing projects may be cancelled or delayed and business case work should cease. At the time of writing the implications for the HSCP are not entirely clear but are adverse. 3.2 In respect ‘Very High’ risks: Financial Sustainability (SSR01) The budget gap for next year is substantial and the most recent financial planning outlines a series of risks relating to funding and costs as well as Page 84
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3 severe challenges facing public funding, the outlook has been described as ‘bleak’. It is recommended that this risk remains very high. A separate risk, SSR019(b) has been added to reflect the slightly more favourable short term assessment due to reserves generated during 2022/23. The financial position of NHS Highland also remains a risk to the HSCP. The Audit & Risk Committee expressed a concern that the mitigations in place relating to the budget and financial risk require to be strengthened further. A series of actions are now being put in place to introduce new controls on spend along with the financial planning processes that are now underway for 2024/25. The HSCP is working with NHS Highland in this regard. Sustainability of Commissioned Service Providers (SSR7) This risk remains very high as a number of service providers continue to struggle to recruit staff and deliver the services they are contracted to. Several are also requesting unaffordable uplifts in contract values. Work is on-going to provide additional support and change ways of working, particularly for care at home services. There are service providers who have indicated that services are at risk in the near term, service management are considering the potential implications. Workforce Recruitment and Retention (SSR10) The HSCP continues to experience difficulty in recruiting staff to a wide variety of roles. Staffing resource is the main constraint on service delivery in many areas. This risk is both a local and a national issue but the ageing and reducing population and the housing emergency provide a particularly difficult local context. The Workforce Strategy group is in place and is in the process of implementing the Workforce Strategy. Socio-Economic Situation (SSR24) It is suggested that this risk also remains ‘Very High’. It has multiple strands and is largely outwith the influence of the HSCP. It is expected that high inflation will continue to increase poverty and service demand. The HSCP is also experiencing increased costs and reduced real terms value of resourcing. The ability of the Scottish Government to fund these pressures is a concern. Recent public health publications support this evaluation of the risk. 3.3 Trend arrows indicate the management perception in respect of the scoring of the risks, these do not necessarily mean the risk rating has changed. There are a number of risks which are perceived to be increasing following the publication of the draft budget. 3.4 Risk management within the HSCP relies heavily upon processes and procedures within the partner organisations, particularly in respect of cyber security, data protection and financial processes and systems. It is also recognised that further work is required to ensure that the Strategic Risk Register is integrated effectively with service owned risk registers. Work on this aspect of risk management and training is progressing with oversight by the Strategic Leadership team and the Contingency Risk and Resilience Committee. Page 85
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4 3.5 Risk Appetite An IJB development workshop was held in October 2023 specifically to develop a risk appetite for the HSCP. The main purpose is to ensure that the management understanding of risk appetite aligns with the IJB’s. Once the Risk Appetite is approved, the next stage will be to align this with the strategic risks. Appendix 2 provides the risk appetite framework and summaries where members of the IJB who took part in the workshop considered the risk appetite to sit. The Audit & Risk Committee reviewed this in December 2023 and requested that the appetite for Development and Innovation be increased from 3 to 3.5 and is summarised below: RISK APPETITE RATING Risk Grouping 0 1 1.5 2 2.5 3 3.5 4 Operational Risks Strategic Risk Legal / Regulatory Financial Development & Innovation Clinical & Care People & Workforce Reputational The risk appetite ratings quantitively indicate that there is a willingness within the board to accept higher levels of risk relating to strategic change, innovation and workforce. This reflects a recognition through the IJB and HSCP that there are significant drivers for change and transformation. It is also clear that the IJB has a lower appetite for clinical, legal / regulatory and financial risks. Subject to approval, the risk appetite framework contributes to a shared understanding of where there is a willingness to accept risk to enable change. 4. RELEVANT DATA AND INDICATORS 4.1 The identification and rating of risk is based on internal and external data and indicators as well as a wider environmental scan. 5 CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 Robust risk management is an important aspect of the overall strategic management of the HSCP. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – None 6.2 Staff Governance – None 6.3 Clinical Governance – None Page 86
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5 7. EQUALITY & DIVERSITY IMPLICATIONS 7.1 None arising directly from the contents of this report. 8. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 8.1 None. 9. RISK ASSESSMENT 9.1 This report provides a detailed review of the perceived strategic risks facing the HSCP. 10. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 10.1 None arising directly from this report. 11. CONCLUSIONS 11.1 Overall the risk environment facing the HSCP remains extremely challenging and the draft Scottish Budget increases a number of risks further. It is suggested that the Strategic Risk Register is reviewed by the IJB once the implications of the budget are confirmed and there is greater certainty in respect of capital investment and funding for pay settlements. The financial outlook combined with service pressures and workforce challenges continue to create significant risk. There are system wide drivers for change which are, if anything, more acute locally due to demographic change. The draft risk appetite hopefully helps to set out a tolerance for increased risk to help enable change and innovation. Recent communication in respect of the National Care Service suggests that the level of structural change within the health and social care system is likely to be less than initially proposed. 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 AUTHOR NAME: James Gow, Head of Finance and Transformation EMAIL: james.gow@argyll-bute.gov.uk APPENDICES: Appendix 1: Strategic Risk Register Appendix 2: Risk Appetite Page 87
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Strategic Risk Register IJB Jan 24 ARGYLL & BUTE INTEGRATION JOINT BOARD STRATEGIC RISK REGISTER UPDATED JANUARY 2024 Risk Ref and xRef to Strategic Objectives Description Of Risk Consequence Likelihood Impact Risk Rating /Score Mitigations/ Control Measures 2023/24 Likelihood Impact Risk Rating /Score Proposed New Control Measures Risk Owner(s) SSR01 links to B,E,F,J Medium Term Financial Sustainability - risk of financial failure arising from costs and demand for services outstripping funding. This could be as a result of demand, cost pressures and inflation, failure to deliver savings or as a result of the level of delegated resource to the IJB from Scottish Government and / or partners being insufficient to deliver on strategic objectives. Inability to deliver on the Strategic Plan, reduction in performance, progress not being made in respect of national priorities and targets, reputational damage to IJB and partners and the requirement to implement service changes or reductions that don't line with strategy. Possibility of intervention in management of HSCP. 4- Likely 5 - Extreme VERY HIGH 20 o Financial information reported to Finance & Policy Cttee and IJB for current year and the 3 year budget outlook o Review of funding allocations and settlements from government and partners and engagement with sector networks oFinance & Policy Committee scrutiny financial performance, risk management, savings programme and financial planning oFocus on delivery of Savings, project management approach to monitor and record progress oDevelopment of financial governance, integrated financial reporting, financial risk register, operational and strategic reporting along with modelling of cost pressures. oindependent external audit of accounting and financial planning and reporting process of partners and HSCP oEngagement with budget holders, SIO's and finance teams to improve financial forecasting. oIncrease in general reserves due to better than expected financial performance in 2022/23 4- Likely 5- Extreme VERY HIGH 20 o Detailed plans under development for use of reserves and refresh of Transfromation Programme o Review of medium term financial plan to be completed & NRAC funding allocations to be investigated further oexternal audit reports highlights that this is a risk oanalysis of December draft busget underway odevelopment of both short term and long term savings plans being prioritised oHSCP inclusion in NHSH enhanced expenditure control processes being implemented opotential reallocatation of resource from development of capital projects Chief Finance Officer / Chief Officer / SLT ↑ SSR01 (b) Going Concern Status - Risk of financial failure within a 1 year time horizon due to overspending of service budgets, inflation and cost pressures or reductions in funding Inability to deliver on the Strategic Plan, reduction in performance, progress not being made in respect of national priorities and targets, reputational damage to IJB and partners and the requirement to implement service changes or reductions that dont align with the strategic objectives. Possibility of external intervention in management. 4- Likely 5 - Extreme VERY HIGH 20 Mitigations are as above. Budget for 2023/24 has a significant gap, however the HSCP has reserves in place which will able it to fund the anticipated budget gap arising during the year. 3 - Possible 5- Extreme HIGH 15 Level of reserves currently in place mitigate but clawback of funding by partners, spend of reserves and draft Scottish Budget are all increasing this risk at present. Chief Financial Officer / SLT ↑ SSR02 links to A,B,C,D,E,F, G,H,I,J,K Delivery of Strategic Objectives - Lack of resources to deliver transformational change could lead to a failure to deliver on strategic outcomes and the Strategic Plan. The pace of change to re-design services might not keep up with the demographic pressures of an ageing population. Inability to engage with the workforce and communities on the need for change could lead to reputational damage and the increased fragility of health and social care services and poorer health outcomes for local people. 4- Likely 4- Major HIGH 16 ○Locality Planning Groups with agreed terms of reference and engagement strategy guidelines ○Delivery of the annual Savings Plan with EQIAs produced to highlight impacts where appropriate ○Medium term budget planning integrated with strategy development ○Performance reporƟng - management informaiton and transparent reporting to IJB ○CommunicaƟons and engagement strategies ○Improved governance for IJB and commiƩees ○SMT reporƟng structure and links with partner organisaƟons, including Chief Officer representation on partner senior management teams ○Engagement with staff representaƟves ○Clearly arƟculated impact on Quality and Performance in all service redesign plans 4- Likely 4 - Major HIGH 16 o New Strategic Plan and Commissioning Strategy consulted widely upon and approved, this re-states and validates strategic objectives o Roll out of new Integrated Performance & Reporting Regime in 2023/24 o Locality Planning Groups o Review of transformation programme structure and increased resourcing to projects Chief Officer / SLT ↑ SSR03 Links to B,E,G,H,I Demographic Changes - failure to implement strategies and actions to address future demographic challenges of declining population, reduced working age population and an increase in older people. Failure to accurately forecast the impact on services including shifting the balance of care and implementing new models of care. This could lead to service failure to meet needs of service users and deliver against the Strategic Plan objectives. 4- Likely 4 - Major HIGH 16 ○Strategic Plan and role of Strategic Planning Group ○IncorporaƟon of demographic forecasts into Strategic Planning and Locality Planning ○Locality Planning Groups to inform service re-designs in each locality in line with needs of the population OStrategic Workforce Planning Group established to share data and good practice and develop 3 year workforce plans ○Demand pressures for services incorporated into budget process ○NaƟonal awareness of demographic changes been driver for change in the way services are delivered ○Ongoing engagement with Community Planning Partners and joint planning 4- Likely 4- Major HIGH 16 ○Resourcing and commencement of prevenƟon agenda and co-production work ○Planning for future workforce demographic changes in Workforce Plan OUpdated Adult Health Strategic Needs Assessment OReview of Transformation and change programme and re-commencement of transformation activities OEstablishment of Prevention Transformation Programme OReview of NRAC formula and updated population modelling OIndication of increasing demand for Older Adult Services during 2023 Chief Officer / SLT ↑ Gross Risk Residual Risk Page 89
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Strategic Risk Register IJB Jan 24 SSR04 links to J Governance and Leadership - IJB arrangements are not conducive to effective working and lead to poor decision making and lack of strategic direction. Service and reputational damage, lack of confidence in the IJB and inability to deliver on strategic objectives in a consistent manner. 3 - Possible 4 - Major HIGH 12 ○Appropriate representaƟon on the IJB. ○Programme of development sessions for IJB members. ○IntegraƟon Scheme reviewed March 2021, Strategic Plan, Standing Orders and Code of Conduct in place. ○EffecƟve sub-commiƩee structure in place ○Internal Audit review of governance arrangements and recommendations implemented. ○External Audit review of governance and annual governance statement ORegular engagement with Standards Officer and regulatory bodies OFull engagement of Board in development of Strategic Plan and Commissioning Strategy 3 - Possible 3 - Moderate MEDIUM 9 O Development of continuous improvement to achieve an holistic approach to the overall Governance of the IJB and regular review of performance O Implementation of governance improvement actions and audit recommendations O Increased stability in senior leadership team O New Strategic Plan approved and in place Chief Officer ↔ SSR05 links to G,H Partnership Working - service delivery failure due to inadequate relationships with partners including the Council and Health Board and commissioned service providers including NHS GG&C and the third sector. May lead to duplication of effort, poor relationships and the inability to effectively negotiate the IJB's position. The partnership may be viewed as failing or not achieving objectives, leading to reputational damage and loss of confidence in IJB. Could also result in a reduction or loss of services to the community and failure to exploit opportunities for joint working, innovation and efficiencies. 4 -Likely 4 - Major HIGH 16 ○IntegraƟon Scheme recently reviewed outlining roles and responsibilities ○Independent scruƟny arrangements in place and work of internal audit, including assurance mapping. ○RepresentaƟon on IJB from partners, community representaƟves and third sector representatives. ○Clear channels of communicaƟon and informaƟon sharing protocols in place ○DirecƟons are issued to partners in line with strategic direcƟon and operational delivery of services. ○Strategic Planning work with Commissioned Service providers and new Commissioning Strategy ○Third Sector representaƟon on the IJB & commitment to co- production ORegular engagement with key partners 3 - Possible 3 - Moderate MEDIUM 9 ○Alignment of roles and responsibiliƟes through the code of corporate governance and induction training for new members of the IJB OApproval of Commissioning Strategy following extensive consultation with partners OShift from annual grant funding to longer term contracts to facilitate longer term security / planning OResourcing and Commencement of Prevention and Co- Production work and activities and integration of these within Transformation programme OReinvigoration of locality planning groups and engagement with the Local Area Group. ORe-establishment of regular meetings with GGCHB OImproved engagement mechanisms and establishment of prevention and co-production workstreams OImproved engagement with RSLs and the Housing Crisis agenda. ODiscussions with partners over funding becoming increasingly challenging. Chief Officer ↑ SSR06 links to E,J Infrastructure and Assets - Assets are owned by the Council and Health Board. Risk that these do not meet the current and future requirements due to underinvestment in maintenance, equipment and ICT or that assets are not being used or managed efficiently and effectively. Risk assets not being maintained / replaced or being otherwise appropriate to support the IJB's strategic outcomes and do not enable efficient, safe and effective service delivery. Properties will fail to meet standards required by regulators and fail to deliver on carbon reduction commitments. Equipment will become unreliable with additional downtime and ICT infrastructure will not support Digital Transformation ambitions. 4 - Likely 4 - Major HIGH 16 O Progressing co-location options with Argyll & Bute Council O Represented on Council and NHS Highland Asset Management Boards O Partnership working to reflect joint planning approach with membership of both partner asset groups ○ Appointment of new senior management post to increase capacity O securing of additional external resource for investment in Tiree and in carbon reduction. 4- Likely 4 - Major HIGH 16 oHSCP Digital / IT strategy now complete help enable TEC / remote working oDevelopment of a strategic approach to the HSCP estate and the identification of priorities for investment and replacement of infrastructure assets. oNew Strategic Estates & Sustainability Post and establishment of Infstructure Transfromation Board. oDecember 23 Budget suggests NHS capital replacement projects will be halted, costs of projects increasing. oresourcing of key infrastrucutre projects to link with strategic and transformation objectives oStrategic Assessment work underway to try and get replacement assets in capital pipeline at Scottish Government level - this work may now require to be halted. oRisk increasing due to implications of SG draft budget for capital investment and business case development. Focus to shift to maintenance of existing assets and rationalisation. Chief Officer, Head of Strategic Planning and Performance, Head of Finance & Transformation ↑ Page 90
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Strategic Risk Register IJB Jan 24 SSR07 links to B,D,E,H Sustainability of commissioned service providers - financial and operational sustainability of care at home and care home commissioned service providers deteriorates as a result of financial and workforce pressures. Market failure would lead to disruption of service, the implementation of contingency plans, increased costs and an adverse impact on individuals and their families. Would also impact on the ability of the IJB to deliver on the planned shift in the balance of care. 5 - Almost Certain 5 -Extreme VERY HIGH 25 ○Commissioning team supplier relaƟonship and market management, including contract management and review processes and solvency checks as part of contract management ○AddiƟonal funding for providers to facilitate the implementaƟon of wage increases and Fair Work Practices ○Engagement with naƟonal work supporƟng the NaƟonal Contracting OContingency planning in localities for care at home during the pandemic. Care Home and Care at Home Assurance Group for Argyll and Bute to identify and manage local and short term risks. OStrategically the Care Home Programme Board will assist planning ahead with forecasting demand. ○Engagement with naƟonal workforce planning and local training providers around promotion of care professions. 5 - Almost Certain 4- Major VERY HIGH 20 ○ ConƟnuing work with providers in partnership O Ongoing engagement nationally with financial sustainability plans and flexible approach to local support where necessary ○ ImplementaƟon of Strategic Commissioning Plan based on Joint Strategic Needs Assessment O Engagement with key providers and project planning to address issues as they arise. O Regular management escalation where issues arise O Effective use of additional winter planning funding to try and improve sustainability of providers O Positive internal audit review provides assurance risk is being managed appropriately O contingency planning where there are specific known issues Onew care at home contract being developed in a consultative way Heads of Adult Care, Head of Strategic Planning and Performance ↔ SSR08 links to A Equalities - services are not delivered in a way that addresses inequality or takes into account the needs of those with protected characteristics. Service users are put at unnecessary risk of harm and people with poorer life chances may have their health and wellbeing impacted. Groups with protected characteristics may be perceived to be impacted unfairly. 4 - Likely 3- Moderate HIGH 12 ○EqualiƟes Outcomes Framework in place ○EqualiƟes impact considered as part of IJB decision making and service change. ○CommunicaƟon with service users as part of implementaƟon of service change using engagement and communication strategies. ○Adjustments to implementaƟon plans are acƟoned where appropriate to mitigate any potential negative impact. ○Service changes not implemented where this would consƟtute unlawful discrimination. 3 -Possible 3 - Moderate MEDIUM 9 o EQIA process are improving but provider sustainability issues have a significant impact on those with protected characteristics Reciew of Equality outcomes in line with policy Chief Officer ↔ SSR09 links to B.C,D,E,F,I,J Scottish Government Policies - risk of further legislative, policy developments or change which impacts on the IJBs ability to deliver on the current Strategic Plan. Inability to deliver SG policies alongside the Strategic Plan and IJB's agreed objectives and the impact of additional unfunded cost pressures. 5 - Almost Certain 4 - Major VERY HIGH 20 ○Horizon scanning for policy developments through partners and SMT network groups ○Regular liaison with senior officers in the Scoƫsh Government and through Cosla Groups ○Respond to Scoƫsh Government informaƟon requests on impact of future policies ○Early impact assessment locally for naƟonal policies, including any impact in budget outlook ○Implement and adopt innovaƟve ways of implemenƟng policies ○Role of Elected Members and IJB members to influence Scoƫsh Government decision making through political routes OOn-going monitoring of developments with NCS 4- Likely 3 - Moderate HIGH 12 o Engagement in sector developments and networks relating to the implementation of the National Care Service and Single Authority Model proposals o Engagement continuing through professional networks to respond to NCS proposals oSpending Review published in May 22 outlines prioritisation for Health and Care sector oEngagement with governement officials including visits to area and meetings to discuss local impacts of NCS oRespond to requests for evidence from parliametary committees oPositive relationships with key partners, civil servants and politicians oWork on-going to consider implementation of Staffing Act oPerceived disconnect between policy landscape and available resources (staff and finance) Chief Officer, Heads of Service ↑ SSR10 links to B,C,E,H,I,J Workforce Recruitment and Retention - inability to recruit and retain the required workforce because of local or national workforce shortages. This may result in increased costs, increased risk or reduced service. Applies to commissioned services as well as direct provision. Service users needs for particular disciplines or in particular areas may not be met if workforce is not in place. 5 - Almost Certain 5 - Extreme VERY HIGH 25 ○Joint and integrated Workforce Plan ○Strategic Workforce Planning Group to ensure overall visibility of recruitment, retention and development challenges across HSCP ○#abplace2b campaign framework for aƩracƟng people into area. OContingency plans for clinical posts to reduce reliance on locums OService re-designs to plan for changes to services in line with workforce capacity OTargets for new Modern Apprentices to reduce average age of workforce ○Support commissioned service providers with recruitment and retention, for example supporting implementation of Living Wage and pay rate increases. O Links with Open University assisting recruitment of students for social work and nursing O Programme for delivering SVQs for social care O Development and roll out of community team standards 5 - Almost Certain 4 - Major VERY HIGH 20 ○Strategic Workforce Planning group to implement Workforce Strategy ○Heads of Service and Managers acƟvely engage in workforce planning ○Explore further opportuniƟes for Growing our Own including MAs in NHS ○Promote ABC and NHSH as employers of choice and ensure all vacancies promoted using abplace2b.com. OWork to reduce reliance on locum and agency staff OEnsure on-going support for CPD Oidentification of options within current estate in HSCP to address housing shortages and progress key worker housing in partnership with Housing Associations, Shelter Scotland and Argyll & Bute Council. OInternal audit review Oindustrial action remains a risk and may impact negatively on workforce retention and recrutiment SLT / Head of People, Planning and Reward / People Partner ↔ Page 91
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Strategic Risk Register IJB Jan 24 SSR11 links to B,E,F,J,K Communications and Engagement with Communities - risk of inadequate arrangements in place to communicate with stakeholders, communities and partners. Could result in failure to gain community support for service changes and ineffective partnership working with communities. Reputational damage from failure to adequately consult and engage. Could result in failure to deliver planned change. 5 - Almost Certain 4- Major VERY HIGH 20 ○CommunicaƟon and Engagement Strategies delivered but require to monitor practice through assurance frameworks. ○Openness and transparency of publicly available informaƟon ○CommunicaƟons events and informaƟon widely available to engage stakeholders in conversations about service changes and the need for change. ○Engagement with poliƟcians to ensure the Argyll and Bute position is shared and understood. ○Locality Planning Groups and other forums are used to communicate with communities and explore new ways of getting the IJB message across ○CommunicaƟon plans developed as part of implementaƟon of service changes 4- Likely 4- Major HIGH 16 ○Support local ownership of communicaƟons and engagement ○ConƟnue roll out of social media use at a local level ○Ongoing review of CommunicaƟons and Engagement Strategy and framework. O Deliver communication and engagement plans within guidelines. Ensure conforms to SG guidance "Planning with People" and standards for community engagement. OEffective engagement on strategic plan, commissioning strategy and co-production work. OLocality Planning groups meeting regularly OSupport from Health Improvement Scotland and staff training and awareness raising Associate Director Public Health, Communications team ↑ SSR12 links to B,E,F,J,K Workforce Shift - risk that there is not appropriate engagement with staff groups, particularly over the need for service changes and the requirement to work in a different way. There may be professional concerns about inter-disciplinary working and cultural barriers will prevent effective integration. This would result in poor morale and the failure to gain staff support for the workforce shift and culture change required. Resistance from the staff group would in turn limit the flexibility required to deploy the workforce in line with changed models of care, full integration will not be achieved and teams will be disjointed. Ultimately impacting on the service provided to communities. 4 - Likely 4 - Major HIGH 16 ○Joint Partnership Forum and Staff side Liaison facilitate communications and information flow between management to staff side and Trade Unions ○CommunicaƟons plan for each service change project, including staff as stakeholders ○Support from staff side partnership to support staff with new ways of working with an integrated partnership approach. ○Compliance with terms and condiƟons of employment for both staff groups ○Individual staff development plans and training programmes ○Workforce Planning ○Staff surveys used to inform targeted improvement work with individual teams ○Strengthened communicaƟon and cascade of informaƟon from Chief Officer 4- Likely 4- Major HIGH 16 OClarity over role and function of teams working in our communities.OD support will be offered to Area Managers to support teams. OOngoing work of the culture and staff wellbeing workstreams OImplementation of the Workforce strategic plan OImprove management of redeployment Ostaff side involvment in SLT meetings and Transfromation Board Chief Officer ↔ SSR13 links to A,B,H,J Safety of Services - inability to maintain the safety of services due to demographic changes, increasing need and complexity and the ability to recruit staff for direct employment and for delivery partners May result in harm to service users or patients, the failure to provide appropriate care and reputational damage to the IJB and partners. 4-Likely 5 - Extreme VERY HIGH 20 ○Clinical and Care Governance CommiƩee and professional leadership ○Risk Management Strategy recently updated and operaƟonal risk management arrangements ○On-going recruitment, retenƟon and training of staff ○Triggers for service re-designs including ensuring clinical safety is not compromised ○PrioriƟsaƟon of need frameworks in place to determine need for access to services ○Develop and implement conƟngency arrangements for localiƟes and services 4-Likely 4- Major HIGH 16 ○ Increased focus on training and development of staff and improved flexibility ○ Increased engagement with commissioned service providers ○ New ConƟngency, Risk and Resilience group Oimproved Health & Safety Training and governance arrangements Lead Nurse/Chief Social Worker ↔ SSR14 links to A,B,H,I Waiting Times -failure to meet waiting times targets and treatment times guarantees for treatment in specialities in NHS GG&C and outreach clinics in Argyll and Bute. Waiting times have already increased due to Covid-19 pandemic and disruption and pressures within the Health system continue. Poor level of service for patients, the potential to have to travel further for appointments, and is not in line with the anticipatory and preventative approach to care. 4-Likely 4 - Major HIGH 16 ○ ConƟnued engagement with NHS GG&C to agree a strategic jointly planned approach to outreach services ○ Monitoring and reporƟng of waiƟng Ɵmes ○ Development of new delivery models such as specialist nurses, tele-consultation and direct or follow up referral to primary care or AHP professionals O Plans for use of Waiting List and winter planning funding 4- Likely 4- Major HIGH 16 OInclusion in NHS Highland Remobilisation plan to request additional funding to redesign services and address backlog. Initiatives include increasing virtual clinics/services, digital and appointment modernisation, enhanced role of AHPs and waiting times initiatives additional clinics. OUse and expansion of Near Me and Outreach Clinics. OEvidence of continuing disruption to services and staffing shortages throughout local and national healthcare system continuing to make it challenging to address increased waiting times. This is a serious national issue at present. Pass through of funding is essential to progress. Heads of Service ↔ SSR15 links to A,B,C,D,E,F, G,H,I,J,K Support Services - risk that support services do not adequately support front line service delivery. Inability to integrate support services which are not fully delegated to the IJB. Continued reliance on two systems, processes and approaches may lead to confusion and ongoing inefficiency. Risk that partners will not support changes to current arrangements. Could adversely affect services experienced by patients and service users if support services cannot fully support front line services. Wasteful duplication and inefficient use of resource. 4-Likely 4- Major HIGH 16 ○Co-locaƟon of staff ○Some IT systems integrated and further plans to review this and to facilitate access to joint systems ORollout of MS Teams - IT services and remote working are much improved as a result OCommittee support arrangements in place OContinuous improvement in support service provision 4- Likely 4- Major HIGH 16 ○Replacement programmes for new systems Social work (eclipse), Hospital Telecoms, and portal (link systems) funded and in place. O Office 365 implementation ○Development of corporate services agreement with partners O Work to improve recruitment processes on-going O Implementation of staffing act presents an additional pressure on support services, particularly HR Heads of Service ↑ Page 92
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Strategic Risk Register IJB Jan 24 SSR16 links to A,B,C,D,E,F, G,H,I,J,K New General Medical Services Contract - risk that the HSCP are not in a position to support the implementation of the new GP contract as a result of availability of funding and capacity for the HSCP to deliver services transferred from GPs. Higher risk of implementation across remote and rural areas. Could adversely affect services experienced by patients as gaps in service may arise. Potential for negative impact on relationships with Primary Care practitioners. 4-Likely 4 - Major HIGH 16 ○Ongoing collaboraƟon between the HSCP and Primary Care to support practices ○Primary Care ModernisaƟon Board with prioriƟes established and Programme Manager in place ○Regular updates on progress to TransformaƟon Board and the IJB, constructive progress being made pharmacotherapy, physiotherapy and mental health workstreams 4- Likely 4- Major HIGH 16 ○Head of Primary Care in place to add management capacity. OEngagement with Scottish Government in respect of funding to enable permanent workforce structures to be developed and implemented and agreement of some concessions within Argyll and Bute OFunding for Primary Care improvement reduced substantially by Scottish Government, risk therefore continues to increase at present Associate Medical Director ↑ SSR17 links to A,B,C,D,E,F, G,H,I,J,K Contingency and Resilience risks including responding to winter pressures, service pressures and emergencies Adversely affecting service delivery and waiting times performance, and ability to deliver planned transformation 4 - Likely 5 - Extreme VERY HIGH 20 oRegular testing of emergency scenarios oAdditional management post created and improvement leadership of winter planning. 4- Likely 4- Major HIGH 16 oDigital / IT & Telecoms infrastructure enhanced oContingency, Risk and Resilience Management group established including representation from partners oon going high demand for services combined with workforce issues oSystem under increasing pressure as winter approaches and evidence of increased delayed discharges locally - winter plan in place. All SLT ↑ SSR18 links to A,B,C,D,E,F, G,H,I,J,K Culture - risk that perception of negative culture results in increased difficulties in recruting and retraining staff, staff wellbeing and wider repiutation of the HSCP. Adverse impact on reputation and ability to recruit. Also impacts on service delivery if teams are unhappy or short staffed as a consequence 4-Likely 5 - Extreme VERY HIGH 20 o Wellbeing groups and workforce strategy group in place o Whistleblowing process in operation o Guardian Service in operation - independent and confidential o extensive roll out of courageous conversations training 3 - Possible 3 - Moderate MEDIUM 9 oindications of improving culture Chief Officer ↔ SSR19 Statutory/Mandatory Training - risk that patient / service user harm could result directly from, or be attributed to, a failure to comply with statutory and mandatory training requirements. This could result in harm to an individual or group of service users, members of staff and could result in financial claims and reputational damage. Adverse effect on quality and safety of care and service delivery. -Potential to result in Adverse Events with harm to service users and staff which could result in civil claims being made with a risk of high financial cost. -Potential for enforcement action being taken against the HSCP by the HSE with severe financial and reputational consequence 5-Almost certain 5- Extreme VERY HIGH 25 - Stat/Man training policy in place. -Training programmes in place via on-line training and face to face -Induction programme 3-Possible 5- Extreme HIGH 15 •Head of Service/senior managers to compile service improvement plans with local delivery based on individual service position. Specific plans put in place for online training and for face to face training. •Heads of Service to ensure there is a regular forum for reviewing the plan, ensuring implementation and escalating barriers. •All staff to receive a communicaƟon from the Chief Officer on responsibilities for undertaking mandatory training. •Managers to ensure that they are up to date with their own training. •Managers to monitor compliance, support staff to access computers and have time to bring their mandatory training up to date. •Managers to support staff who are falling behind with their compliance with mandatory training and follow up until the training has been completed. •The Health & Safety CommiƩee and Strategic Leadership Team will review compliance performance regularly, compliance is improving as a result. Chief Officer ↓ SSR20 Vaccine Delivery - Whilst responsibility for the delivery of the vaccination programme sits with NHS Highland, there is a risk that locally the vaccine programme may not be delivered as quickly as communities and government wish, -Reputational damage may arise as a result of the local management of the vaccination programme -communities may not benefit from the impact of the vaccination programme to the maximum possible extent 4-Likely 4 - Major HIGH 16 oEngagement with Highland Health Board to ensure that the vaccination is programme is delivered as quickly and efficiently as possible oRecruitment of vaccination staff on a permanent basis oEffective communication with local communities 3-Possible 3-Possible MEDIUM 9 oPermanent recruitment of vaccination staff oGood local performance levels to date Extended messaging on all vaccination programmes for all ages Chief Officer ↓ SSR 21 Climate Change - risk that the HSCP will not achieve the climate change decarbonisation and emissions targets set for it. This is likely to result in reputational damage at both a community and political level as well as a financial cost. -Perception that the HSCP is not fully committed to delivering on the Scottish Government Climate Change targets as a result of lack of capital and revenue funding or management capacity to prioritise this work. 4-Likely 3- Moderate HIGH 12 oOn-going engagement and participation with A&B council, NHS Highland and Scottish Government partners in respect of all health and care areas producing CO2 emissions including procurement decisions, estate, travel and transport. Services provided by the HSCP. - Access to funding revenue and capital to undertake CO2 reduction projects e.g. zero emission NHS fleet by 2025 4-Likely 3- Moderate HIGH 12 oSecured funding for carbon reduction consultancy oDevelopment of capital and revenue investment plans in HSCP, Argyll and Bute Council and NHS Highland . oLocal projects underway, climate change report submitted and potential for case study oNew Estates and Sustainability manager now in post and funds available for investment Head of Finance / Senior Managemer Estates and Sustainability ↓ Page 93
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Strategic Risk Register IJB Jan 24 SSR 22 Socio-Economic Situation - multiple risks relating to the current socio economic situation. Risk is driven by direct and indirect implications of high inflation, expected increase in poverty, increasing interest rates and tightening public funding position. Consequences may include: -increased staff and non-staff costs reducing real terms values of budget and reserves. -potential for strike action within HSCP, partners and in other services and industries. -additional service demand arising from cost of living crisis, increased poverty levels, increased pressure on mental health services may be a particular pressure. -shortages of supplies and services which could include supplies of drugs and other critical supplies and care provision. 4-Likely 5 - Extreme VERY HIGH 20 o recognition that this is a national socio-economic issues and local mitigations and influence is limited o resilience and contingency planning o remobilisation of services o involvement in sector discussions in respect of strike exemptions o may need to consider prioritisation of services and resources 4-Likely 5 - Extreme VERY HIGH 20 o HSCP planning sensitive to issues facing local communities o awareness of pressures and careful financial and service planning to mitigate impact particularly on most vulnerable o largely outwith the control of the HSCP Chief Officer & SLT ↔ Deleted from Strategic Risk Register SSR18 links to A,B,C,D,E,F, G,H,I,J,K Covid-19 and other respiratory illnesses- risks of further waves of covid and other infections with more people becoming ill and requiring health care Adversely affecting service delivery and waiting times performance, and ability to deliver planned transformation. Risk would result on further pressure on available workforce. 5 - Almost Certain 5 - Extreme VERY HIGH 25 o there is an effective vaccination programme in place. o experience and project planning of previous mobilisation from first and second waves 3-Possible 3 - Moderate MEDIUM 9 oRisk perceived to be reducing at present - no current testing regime - suggested that this risk can be removed as is covered by Contingency, Risk and Resilience risk. All SLT ↓ Page 94
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Appendix 2 RISK APPETITE – December 2023 Draft Risk Appetite Level Risk Types 0 – Averse Avoidance of risk is a key organisational objective 1 – Minimal Preference for very safe delivery options that have a low degree of inherent risk and only a limited reward potential 2 – Cautious preference for safe delivery options that have a low degree of inherent risk and only a limited reward potential 3 – Open willing to consider all potential delivery options and choose while also providing an acceptable level of reward 4 – Eager Eager to be innovative and to choose options offering higher business rewards (despite greater inherent risk) 1. Operational Risks Defensive approach to operational delivery - aim to maintain/protect, rather than create or innovate. Priority for close management controls and oversight with limited devolved authority. Innovations largely avoided unless essential. Decision making authority held by senior management. Tendency to stick to the status quo, innovations generally avoided unless necessary. Decision making authority generally held by senior management. Management through leading indicators. Innovation supported, with clear demonstration of benefit / improvement in management control. Responsibility for non- critical decisions may be devolved. Innovation pursued – desire to ‘break the mould’ and challenge current working practices. High levels of devolved authority – management by trust rather than close control. Page 95
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2. Strategic Risks Guiding principles or rules in place that limit risk in organisational actions and the pursuit of priorities. Organisational strategy is refreshed at 5+ year intervals Guiding principles or rules in place that minimise risk in organisational actions and the pursuit of priorities. Organisational strategy is refreshed at 4-5 year intervals Guiding principles or rules in place that allow considered risk taking in organisational actions and the pursuit of priorities. Strategy is refreshed at 3-4 year intervals Guiding principles or rules in place that are receptive to considered risk taking in organisational actions and the pursuit of priorities. Strategy is refreshed at 2-3 year intervals Guiding principles or rules in place that welcome considered risk taking in organisational actions and the pursuit of priorities. Organisational strategy is refreshed at 1-2 year intervals 3. Legal/ Regulatory Risks Play safe and avoid anything which could be challenged, even unsuccessfully. Want to be very sure we would win any challenge Want to be reasonably sure we would win any challenge. Challenge will be problematic; we are likely to win and the gain will outweigh the adverse impact. Chances of losing are high but exceptional benefits could be realised. 4. Financial Risks Avoidance of any financial impact or loss, is a key objective. Priority for close management controls and oversight with limited devolved authority. Only prepared to accept the possibility of very limited financial impact if essential to delivery. Appetite for risk taking limited to low scale procurement activity. Decision making authority held Seek safe delivery options with little residual financial loss only if it could yield upside opportunities. Tendency to stick to the status quo, innovations generally avoided unless necessary. Decision making authority Prepared to invest for benefit and to minimise the possibility of financial loss by managing the risks to tolerable levels. Innovation supported, with demonstration of benefit / improvement in service delivery. Responsibility for non- Prepared to invest for best possible benefit and accept possibility of financial loss (controls must be in place). Innovation pursued – desire to ‘break the mould’ and challenge current practices. High levels of devolved authority – management Page 96
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by senior management. generally held by senior management. critical decisions may be devolved. by trust rather than close control. 5. Developmental / Innovation Risks Avoidance of any financial impact or loss, is a key objective. Priority for close management controls and oversight with limited devolved authority. Only prepared to accept the possibility of very limited financial impact if essential to delivery. Appetite for risk taking limited. Decision making authority held by senior management Seek safe delivery options with little residual financial loss only if it could yield upside opportunities. Tendency to stick to the status quo, innovations generally avoided unless necessary. Decision making authority generally held by senior management. Prepared to invest for benefit and to minimise the possibility of financial loss by managing the risks to tolerable levels. Innovation supported, with demonstration of benefit / improvement in service delivery. Responsibility for non- critical decisions may be devolved Prepared to invest for best possible benefit and accept possibility of financial loss (controls must be in place). Innovation pursued – desire to ‘break the mould’ and challenge current working practices. High levels of devolved authority – management by trust rather than close control. 6. Clinical and Care Risks Defensive approach to clinical delivery - aim to maintain/protect, rather than create or innovate. Priority for close management controls and oversight Focus on delivering core clinical services safely. Innovations largely avoided unless essential. Decision making authority held by senior management. Focus on delivering core clinical services safely. Tendency to stick to the status quo, innovations generally avoided unless necessary. Decision making authority generally Focus on delivering core clinical services safely and effectively. Innovation in service delivery supported, with clear demonstration of benefit / improvement in patient outcomes. Innovation pursued – desire to ‘break the mould’ and challenge current working practices. Delivery of core clinical services safely and effectively still paramount Page 97
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with limited devolved authority held by senior management. Management through leading indicators Responsibility for non- clinical decisions may be devolved 7. People/ Workforce Risk Avoidance of decisions that could have a negative impact on workforce development, recruitment and retention. Sustainability is primary interest Avoid all risks relating to the workforce unless absolutely essential. Innovative approaches to workforce recruitment and retention are not a priority and will only be adopted if established and proven to be effective elsewhere Prepared to take limited risks with regards to the workforce. Where attempting to innovate, would seek to understand where similar actions have been successful elsewhere before taking any decision Prepared to accept the possibility of some workforce risk, as a direct result from innovation as long as there is the potential for improved recruitment and retention and development opportunities for staff Eager to pursue workforce innovation. Willing to take risks which may have implications for the workforce but could improve the skills and capabilities of our staff. Recognise that innovation is likely to be disruptive in the short term but with the possibility of long term gains 8. Reputational Risks Zero appetite for any decisions with high chance of repercussion for organisations’ reputation. Appetite for risk taking is limited to those events where there is no chance of significant repercussions Prepared to accept the possibility of limited reputational risk if appropriate controls are in place to limit any fallout Willing to take decisions that are likely to bring scrutiny of the organisation. Outwardly promote new ideas and innovations where potential benefits outweigh the risks Appetite to take decisions which are likely to bring additional governmental / organisational scrutiny only where potential benefits outweigh risks. Page 98
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1 Integration Joint Board Date of Meeting: 31 January 2024 Title of Report: Service Spotlight – Children, Families & Justice Presented by: David Gibson, Head of Service The IJB is asked to: ▪ Note content of report. 1. EXECUTIVE SUMMARY Children Family and Justice staff have continued to maintain and develop services throughout the last year. This report spotlights examples of these developments across the breadth of service provision. 2. INTRODUCTION Children’s, Families and Justice staff cover a range of services and initiatives. Statutory duties have continued to be fulfilled throughout a period of unprecedented uncertainty, financial cuts and staff shortages. This spotlight report touches on a number of developments, a selection of feedback and particular projects which health, social work and administrative colleagues have been involved in. 3. DETAIL OF REPORT Updated National Child Protection Guidance The updated National Child Protection Guidance was introduced in 2021 with a two year implementation period, allowing local partnerships time to update local procedures, guidance and protocols to reflect the significant changes to practice outlined in the guidance and to complete training for all staff. The Argyll and Bute Child Protection Committee has revised and relaunched its website reflecting the changes, and in person training was rolled out across all areas throughout 2023. This saw very significant partnership engagement at each of ten events. Work is continuing at both a local level and in partnership with West Dun and L Division of Police Scotland, to improve the functioning of the Initial Referral Discussion (IRD) process, again to reflect the widening definition of significant harm, and to facilitate the move to shared responsibility for chairing of IRDs across Social Work, Police and Health. Page 101 Agenda Item 9
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2 Scottish Child Interview Model (SCIM) Argyll and Bute Council continues to work in partnership with West Dunbartonshire Council and Police Scotland L Division in implementing the Scottish Child Interview Model. There are significant challenges in implementing this model in, particularly our remote and island geography, however we managed to start the evolution of our practice in 2023. A successful bid was made for a second social worker from Argyll to undertake the five-week training, which is now taking place and continues on a modular basis over the next four months. The current candidate is based in the Oban, Lorn and Isles team and will begin to undertake interviews after the third module is completed in March. This will double the social work capacity and reduce challenges of geography, with one social worker now covering both in the East and West. From a social work perspective it should become possible for the majority of joint interviews to have a SCIM trained worker available. All partners continue to jointly develop data recording and reporting methods and capacity, which will provide quality assurance and improvement data previously unavailable with the Stepwise (5 day) model. SCIM involves us working in an integrated fashion with Police Scotland L Division and as a result working very closely with West Dunbartonshire colleagues. Both areas of improvement work outlined above will see a greater number of children and young people receiving support through child protection processes; improved consistency in decision making at each stage of the child protection process; greater access for children to the SCIM joint interview with its improved response to trauma, and better outcomes in terms of both welfare and criminal convictions. Family Placement The Family Placement Team have continued to build on our commitment of becoming a Trauma Informed workforce. One of our Team identified and took part in training to deliver a Nurturing Attachment’s course to our carers. An 18 week intensive course available to Kinship, Foster and Adoptive carers, the first block is part way through and the feedback is unanimously positive. At the heart of the feedback is the sense of community which has developed among the participants, who report to feeling less isolated in their caring role. This ethos of developing supportive communities has rolled into our wider support services and at our most recent Foster Carers Day a bi-annual event, we took the decision to bring Kinship carers and foster carers together, where they were able to access first aid training, promote self-care and get updates on National Support services. The feeling of coming together again central to the feedback. Kinship care continues to grow in focus and our support services extend year on year. The Family Placement Team employed staff to focus on this new area of work and one of the team completed the Relative Matters Kinship post graduate qualification, disseminating the learning among the wider team, to better understand the complexities of this area of work. As a service we are mindful that Fostering recruitment has been a national issue which in turn has made us look at innovative ways to bring this to the public eye. This has not always a success, such as when our Gazebo blew away at an event, however thus are the challenges of the west coast! Page 102
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3 Key, however is recognising that in turn our existing foster carers continue to be the heart of our service, continually stretching themselves to ensure the best outcomes for our most vulnerable young people and at this time of year it is always heart-warming to hear the many stories of continued connections or a place at the Christmas table, for young people who once lived with our foster families, and still consider this home. In 2023 we raised the raised the financial support for Foster Carers beyond the rate of inflation. Our rates of financial support are higher than the newly agreed national rates for foster carers. CAMHS Developing a process of integration and building a model of mental health and wellbeing for children and young people which builds on a collective responsibility has taken further steps forward despite a challenging year. Partners in education, health and social care have incrementally developed actions and goals which align, developing the foundations of single point of access for example, which will lead to project driven activity to test modelling e.g. neuro-diversity. This year provides the opportunity to build, detail and influence with the aim of maximising current resource and be clear about investment which brings maximum return at a time of significant financial challenges. The integration opportunity has been evidenced in particular through cross agency activity associated with trauma informed practice and CAMHS Care Experienced Team activity, linking with Through Care Team, joint training, and building capacity across system. In addition, the Care Experienced Team recent engagement with parenting support and targeted education has been successful with excellent feedback from families. These are examples when we align, we can build confidence and positive outcomes. Child Health Child Health are celebrating Health Visiting Careers by inputting to Careers week; by creating a short video with NHS Scotland Academy, showcasing one of our Health Visitor’s career journey we endeavour to promote roles within NHSH and Argyll and Bute HSCP. It has also been a great time for furthering our partnership with Greater Glasgow and Clyde with the development of our Family Nurse Partnership Implementation. The Family Nurse Partnership is a person-centred, preventative intervention programme offered to young first time parents. It is an evidence based change programme that is delivered in the parents’ own homes. It is designed to cover the first 1001 days of life, from early pregnancy until the child reaches the age of 2 years old. Louise Bussell will be our Project Sponsor, Beth Wiseman as FNP Lead and our FNP preferred candidate Kirsty Beattie due to start Mid February. School nursing has seen success in the self-referral vaccine implementation project from our young people across A+B from the age of 12yrs. We will continue to monitor and evaluate this over the coming immunisation period. With the poverty agenda on the forefront of our minds, the health visitors on the Helensburgh and Lochside have commenced a weekly drop in session for parents that will focus on feeding, weaning and providing support, advice and signposting to relevant organisations. Page 103
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4 Maternity Across Argyll & Bute maternity worked with GGC to implement routine oxygen saturation testing for babies to screen for cardiac defects. We have more midwives visiting GGC to consolidate their 'examination of the newborn' qualification which again allows for babies born here to have the same screening as those in big units. The mid-Argyll team is being supported by other areas while they do not have a team lead in place, including midwives covering on-call commitments for them. There was a flurry of local births over the holiday period, with Campbeltown, Mid Argyll and Oban having two births each around Christmas and New Year. Tackling Child Poverty The Argyll and Bute Child Poverty Action Group has continued to meet throughout 2023 to look at ways of tackling child poverty, as has the Financial Advice and Inclusion Group. Both groups have been instrumental in tackling the impacts and causes of child and family poverty at a time of cost of living crisis and the ongoing effects of Covid19 recovery, Brexit and the war in Ukraine. Actions and successes are numerous and have involved staff across many departments and agencies. Successes conclude: • Housing Team – who have continued to support people at a time of Housing Crisis, including young people leaving care, women and children fleeing domestic violence and refugees. • Benefits Team – worked tirelessly to deliver benefits and ensure the best possible take up, delivering the Flexible Food and Fuel Fund. • This year’s Child Poverty Action Plan 2022-2023 was produced and reflects a broad range of effective work taking place. • The third sector have been instrumental in supporting and helping families in many ways (ALIenergy, TSI, Bute Advice Centre, The Food Forum and its members etc). • Work is being carried out to ensure infant food security. • Challenge Poverty Week was promoted and media posts put out to show people what is being done and where they can get help and advice. • Training has been ongoing throughout 2023 for staff on “Money Counts” and how they can advise and support people. The Argyll and Bute “Money Worries” leaflet was updated and distributed widely. • Over £16,000 was obtained from the Child Poverty Practice Accelerator Fund to further data analysis work which will lead to the better identification of people requiring support and advice. United Nations Charter on the Rights of the Child (UNCRC) Implementation Group On 7 December MSPs voted unanimously to pass the UNCRC (Incorporation) (Scotland) Bill. Scotland has become the first nation of the UK to vote to incorporate the United Nations Convention on the Rights of the Child into domestic law, with implications for all public bodies. Information on those duties and obligations for public bodies can be found here: Page 104
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5 Getting Ready for UNCRC Incorporation Framework: A Practical Resource for Public Bodies in Scotland to prepare for UNCRC Incorporation https://www.improvementservice.org.uk/__data/assets/pdf_file/0020/43382/Getti ng-Ready-for-UNCRC-Incorporation-Framework.pdf An Argyll and Bute UNCRC Implementation Group was formed to look at these requirements and what actions were required to: • Allow our organisations and partners to be compliant with the new legislation and duties. • Increase the awareness of staff and help them to understand what changes they and their departments needed to achieve. • Work with children, young people and their parents to improve their understanding of children’s rights and ensure that they are involved in the work and decision making. To this end, progress has been made in a number of areas including: • Work with Youth Voice and other groups with regards to future coproduction and involving them in decision making. • Obtaining £53,000 from the UNCRC Innovations Fund for a series of face to face and other engagements with children and young people across Argyll and Bute in the coming year. This will also include promoting children’s rights and understanding across a wide range of hard to reach groups. As well it will involve children and young people in creating and delivering an awards scheme for staff and departments as they work towards being UNCRC compliant. • Setting up information and training pages for children, young people and parents on Children’s Rights. Also a Training and Information Page for staff as well as an e-learning module to be available on LEON and TURAS. • Updating the Argyll and Bute Children’s Rights Report 2020-2023. Justice Services We do not celebrate the work of Justice Social Work and the positive impact on individuals and our communities enough. As such we give some space to that in this report. Despite some severe staffing challenges over the past nine months Justice social work has continued to provide a high quality service to the communities of Argyll & Bute. Our Unpaid Work scheme has undertaken a diverse range of projects in all localities of Argyll and Bute and include gardening, path and cycle path maintenance, painting, litter picking and fly tipping, building maintenance and clearing, repair and replace community benches, upkeep of war memorials. Some examples of this are: Cowal Hub – unpaid work squads assisted in helping this community asset be set up by painting the venue. The Hub offers invaluable help to the area by signposting people to the help, guidance and advice that they may need Arrochar Community Development Trust – there are three core paths in this area that are used for cycling and walking and enjoying the surroundings. Unpaid work maintain the paths by keeping them clear of litter and cutting back if necessary Arrochar Primary School – tidied infant garden area by removing broken apparatus, furniture and repairing child’s pirate ship. Page 105
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6 Ardentinny walled garden - a community garden where the community learn to grow their own vegetables which we attend every week and help to upkeep the garden. As well as community based projects, unpaid work can include individualised placements. One service user attended three recovery groups per week and they then supported the setting up of group work and the smooth running of these groups. Due to their continued enthusiasm and good recovery practice we have offered them a place on a volunteer training programme. Taking part in this programme will continue to support the client to grow and develop in their recovery and day to day life with the option at the end to go into employment in the field of recovery if they choose too. Feedback on the service received from the recipients of Unpaid Work continues to be positive: “Just wanted to drop you a short email to say thank you for all your help in painting the Cowal Hub. Can you extend our thanks to everyone involved - they did an excellent job and couldn't have been more helpful. The Cowal Hub now looks great and hopefully we will open at the end of March” “As the Friends of Duchess Wood Helensburgh, we are very pleased to work with this scheme and most grateful for the work they do which benefits the Helensburgh & Lomond community” “The team perform a tremendously useful service helping our conservation charity, the Friends of Loch Lomond and The Trossachs, keep on top of the litter situation along the A82 corridor between Arden and Tarbet. I know they also work further afield up the A82 and throughout this area. Their work is so successful that I recently heard the A82 was being held up as one of the cleanest trunk roads in the country!” Service users have fed back: “I never expected to receive this kind of service. Everyone treated me with such respect” “it’s been really helpful getting me back on my feet” “I found it really helpful talking to ‘my worker’ it’s helped me cope with things better.” “the changes I have made to my alcohol use is down the support JSW offered. It’s helped my mental health in dealing with the separation from my wife and kids. My worker has always been there whenever I asked for help” Argyll & Bute Community Justice Partnership The Community Justice Partnership is a multi-agency strategic group chaired by Argyll and Bute Chief Executive with representation from all named Statutory Partners within the Community Justice (Scotland) Act 2016). The refreshed national strategy for Community Justice provides the following definition: “Community justice is principally about organisations working together to ensure that people who have offended address the underlying causes of their behaviour, and pay back to the community where appropriate. It aims Page 106
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7 to encourage rehabilitation, reduce reoffending, and protect the public, leading to fewer victims and safer communities. This requires a strong partnership-working approach at each point of the justice system, from the point of arrest, through to integration into the community. Public protection remains our first priority, with robust risk management systems in place to ensure that, where appropriate, those who have committed offences can be managed safely and effectively in the community. In the long term, our ambition is to use prison only for those who pose a risk of serious harm.” The national strategy has 4 Aims and 13 Priority Actions, Argyll & Bute CJP is in the final stages of developing our local Community Justice Plan 2024-2027 and has ongoing improvement activity across all Aims and Actions. The key highlights being: Aim 1: Optimise the use of diversion and intervention at the earliest opportunity • Ongoing local review (2023-2025) of the delivery of Diversion, to be aligned to the Scottish Government national improvement group, Crown Office and Procurator Fiscal Regional Forum and Social Work Scotland • Creating an improved understanding of the delivery of multi-agency services at Police Scotland Custody Suites, aligned to the national Police Scotland improvement group Aim 2: Ensure that robust and high quality community interventions and public protection arrangements are consistently available across Scotland • Further develop and improve Justice Social Work Bail Supervision & Support provision through commitment to increasing multi-agency referral pathways and support Aim 3: Ensure that services are accessible and available to address the needs of individuals accused or convicted of an offence (upon prison release and employability access on community sentences) • The commissioning and implementation of a Justice Advocacy Service with Lomond and Argyll Advocacy Service that will be supported by a multi- agency steering group including housing, addictions and Justice Social Work and others as required. This third sector 1 year pilot will proactively offer engagement and support those who are released from prison having served a sentence of below 4 years. The intended outcomes are all connected to reducing the risks of reoffending. Aim 4: Strengthen the leadership, engagement, and partnership working of local and national community justice partners • Commitment to reviewing the domestic abuse research in partnership with the VAWGP and developing the Argyll & Bute responses. • Strengthening strategic planning links across a range of policy areas including alcohol and drugs, violence against women and girls, public protection and community planning Page 107
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8 Violence Against Women and Girls Partnership The Argyll and Bute Violence Against Women and Girls Partnership is a multi- agency organisation. It reports to the COGPP (Chief Officers Group for Public Protection) and comes under the umbrella of the CPP (Community Planning Partnership). It is part of a network of partnerships throughout Scotland who work to tackle and prevent domestic abuse and other forms of gender based violence against women and girls. There is a National VAWG Network which brings local partnerships together and acts as a focus for decision making. Some of the work it has engaged in this year has included: • Delivering 13 training events including; Domestic Abuse Awareness Raising, Dealing with Disclosure of Sexual Assault, How the Police Work with Domestic Abuse, Routine Enquiry, Domestic Abuse and Trauma. • Working to forward the roll out of Safe and Together across Argyll and Bute by getting staff to undertake the Core and Management training. • Promoting the 16 Days of Action against Gender Based Violence (number of events). • Reviewing the Argyll & Bute access to a Sexual Assault Referral Centre (S.A.R.C.) Work for the Coming Year Includes: • Making more progress on the roll out of the Safe and Together Model across Argyll and Bute; • Youth Work; • Updating the Equally Safe Strategy and Plan; • Improving engagement with lived experienced women and making communities more aware of the work of the VAWGP; • Exploring more effective ways of using local data; • Ensuring that more local authority staff have at least basic domestic abuse awareness training; • Look at the issue of a Routine Enquiry Policy for the Argyll and Bute HSCP. Children, Families and Justice Services also includes all administrative support of Council Services within the HSCP. Of particular note within this area of practice: Managing Service User’s Money After significant work across many services we now have a Policy for Managing Service User’s Money which brings together our obligations under new rules for Corporate Appointeeship and Access to Funds. We have clear guidance and processes in place for locality teams to request either corporate appointeeship or access to funds to allow Social Workers to manage the money of those service users who lack capacity to do this themselves. A small team of two has been appointed within the Social Work Admin Service to manage the bank accounts associated with these two processes and support teams with applications. Page 108
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9 This will enable the HSCP to support many more individuals within our communities who struggle to manage their own finances. It is notable that as new rules and regulations evolve it often requires increased administrative commitments. Eclipse Following the implementation of Eclipse we set up an Eclipse Working Group for Children & Families to manage requests for changes to the system. This group is a mixture of Team Managers, Social Workers and Admin staff who use the system day to day. Issues have already been identified and changes are underway to ensure that The system supports practice. Some areas we are looking at are for example: IRD, child’s plan and child protection. The Justice Module of eclipse is the first such one in Scotland. As with any pilot this has meant a significant investment of staff time. It is clear that the administrative support for Eclipse is significant and will be ongoing for some time to come. 4. RELEVANT DATA AND INDICATORS Contained, where relevant, within the body of the report. 5. CONTRIBUTION TO STRATEGIC PRIORITIES Contained, where relevant, within the body of the report. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact Each development could have an impact, however further more in depth reporting will be offered in such cases. This report is to provide exemplars of practice and to assure the Board developmental work is taking place. 6.2 Staff Governance Each development could have an impact, however further more in depth reporting will be offered in such cases. This report is to provide exemplars of practice and to assure the Board developmental work is taking place. 6.3 Clinical and Care Governance Each development could have an impact, however further more in depth reporting will be offered in such cases. This report is to provide exemplars of practice and to assure the Board developmental work is taking place. 7. PROFESSIONAL ADVISORY None 8. EQUALITY & DIVERSITY IMPLICATIONS None 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None Page 109
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10 10. RISK ASSESSMENT None 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT None 12. CONCLUSIONS We ask the Board to recognise the range and depth of work going on within Children, Families and Justice Services. The Board is asked to note this ‘spotlight’ report. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required x Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name: David Gibson Email: david.gibson@agyll-bute.gov.uk Page 110
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1 Integration Joint Board Date of Meeting: 31st January 2024 Title of Report: Health & Social Care Partnership- Performance Report- FQ2 (July - Sept 2023/24) Presented by: Kristin Gillies- Head of Strategic Planning, Performance & Technology The Board is asked to: ▪ Acknowledge performance for FQ2 (July - September 2023/24) and improvement against the previous quarter, which is the second full quarter of data for the Integrated Performance Management Framework (IPMF). ▪ Acknowledge supporting performance commentary from Heads of Service and Service Leads ▪ Acknowledge performance update on the National Health & Wellbeing Outcomes and Ministerial Steering Group Integration Indicators (Appendix 1) ▪ Note System Pressure Report for August 2023 (Appendix 2) ▪ Note Delayed Discharge Sitrep for August 2023 (Appendix 3) 1. EXECUTIVE SUMMARY This report details performance for FQ2 (July – September) 2023/24, the performance outputs are taken from the new Integrated Performance Management Framework (IPMF) reporting Dashboard with the focus on the eight key service areas. Overall performance for FQ2 notes an increase in performance measures reporting as on target against the previous quarter. Some commentary does note discrepancy with some indicators and this is expected over the period of implementation of the IPMF. The report details performance against each of the service areas and the 93 supporting Key Performance Indicators. Analysis of the KPI’s is supported by performance commentary from the Heads of Service and Service Leads. It should be noted that where risks and issues are identified these are supported by operational governance to ensure mitigation and action. It should be further noted that the performance scrutiny is undertaken by the Clinical and care Governance Committee to ensure any actions required are noted to the IJB. National Health & Wellbeing Indicators performance is included alongside performance and trend overview with regards to System Pressures and the National Delayed Discharge Sitrep. Page 111 Agenda Item 10
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2 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. INTRODUCTION The Integrated Performance Management Framework and associated Performance Dashboard has been collaboratively developed with the Strategic Leadership Team. The format of the IPMF Performance Dashboard covers all the areas previously reported to both the Clinical & Care Governance Committee and Integration Joint Board and recognises the need to ensure that local performance and improvement activity is reported within the new digital dashboard. This report includes an overview of the previous Health & Wellbeing Outcome Indicators and Ministerial Steering Group- Integration measures. To support the use of the Dashboard, HSCP Performance & Information Team analysts have been identified for each of the Heads of Service and Service Leads to support and check performance across the eight key service areas. This bespoke and individual analyst input and support will be available during each quarter going forward and will work to build more robust performance reporting with management commentary. Performance at this stage is monitored as either red or green to support performance delivery within the new system. 3. DETAIL OF REPORT The report details the HSCP (Health and Social Care Partnership) performance for Financial Quarter 2 (July - Sept 2023/24) highlighting key performance trends across the 93 Key Performance Indicators. In addition, the report includes performance updates from Heads of Service and Service Leads across the eight service areas. Also included is an update with regards to System Pressures (Appendix 2) and Delayed Discharges (Appendix 3). Children & Families The number of children recorded as looked after away from home is influenced by the high rate of young people coming to us under the National Transfer Scheme for Unaccompanied Asylum-Seeking Children. This currently does not have a separate indicator in the IPMF which may be addressed after annual review. If considered separately the young people being transferred from Kent through this scheme and the number of young people resident in Argyll & Bute in residential care is in fact two thirds of what it was 2 years ago. Work needs to be carried out to report on this KPI in a more sophisticated fashion and removal of young people transferred to us under the NTS will demonstrate we are comfortably on track. Page 112
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3 Progress on ‘money matters’ training has been slow but steady. It requires to be recognised that Q2 is reporting the period which covers the summer holidays and training activity routinely quietens at this time. Progress on CAMHS (Children & Adolescent Mental Health Services) waiting lists has been slow but steady. There is a significant amount of training in relation to Violence Against Women and Girls. Q2 reflects the quieter summer holiday period. It may be in the future we will need to consider clearer phasing of targets within training related KPIs (Key Performance Indicators). We are also addressing the effective counting of those undertaking such training via e-modules. The Autumn training period will see this KPI on target. Progress on this KPI relating to Community Payback Orders has been impacted by an increase in Court activity coupled with absence and vacancies within the Justice Social Work team. These gaps in staffing have, to some extent, been filled over the last few weeks and we should see an improvement on performance in this area. Across 11 KPI, C&F services performance notes 2 (18%) on track, with 9 (82%) off track against the targets set in Q2 23/24. This is a decrease from 27% on track reported (-9%) variance on the previous quarter performance. Performance on or above target: • Number of care experienced children placed at home or in Kinship or Fostering Care is on track, noting 17% above target performance. • The percentage of panel Reports completed for Scottish Children’s Reporter Administration (SCRA) with 28 Days noted an increase to 100% against 80% target. Performance below target & areas for improvement: • Performance around reducing numbers of care experience children looked after living in residential care commissioned out with A&B has declined due to noted increased this quarter from 5% to 7% of all children looked after. The number of children cared for in ‘external placements’ is small and as such consideration must be given when reviewing a percentage shift across a small population. • With regards to the number of children seen within 18 weeks for Child & Adolescent Mental Health Services remains off track, with FQ2 noting 79.3% against a 90% target. This is however an increase of 17.2% on previous quarter’s performance and demonstrates steady longer-term progress in this area. • The percentage of 27-30 month reviews completed out with agreed time period remains off track, with FQ2 noting 30.8% against 90% target, an increase of 5.8% on the previous quarter. Telecare and Digital The process for reviews was changed this year to incorporate the offer of a postal review prior to face to face or telephone. We can say that 580 clients were sent a postal review, 411 returned and were marked as complete. 169 were sent to Page 113
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4 Carr Gomm/TEC Team either at the request of the client after a postal review or because the form was not returned and 130 have been completed. Therefore, a total of 541 reviews have been undertaken this year. The transition to Eclipse has impacted on tracking reviews and as such we have identified a risk that our information is not yet accurate and complete. We have noted outstanding reviews as a risk, currently addressing this manually and managing the ongoing risk. The TEC Team is actively promoting Just Checking where possible but relies on requests from operational staff for the equipment to go in. Opportunities for systems training are being heavily promoted. Just Checking has an opportunity to play an active and standardised part of the Assessment process, especially for those on the Unmet Need list however we require increased engagement from staff across the HSCP to take this forward and will be pursuing this. Buddi Hubs are an excellent means of ensuring a service user is discharged from hospital with a means of calling for help if required without there needing to be a full Telecare set up in place. While usage of the Hubs has dropped over Q2 we are continuing to promote this with staff teams. Benchmarked performance across the 8 Key Performance Indicators against target notes a significant increase in the number of KPI’s reporting on-track with Q1 noting (3) 37.5% on track against FQ2 reporting (5) 62.5% on-track and increase of (25%) 3 KPI’s remain off –track against target for FQ2. Performance on or above target: • Digitalisation of Telecare Devices: Substantial progress has been made and the 25% end-of-year target has almost been achieved in FQ2. • 'Near Me' Clinics: A significant 18% increase from the last quarter suggests that virtual appointments are becoming more widely accepted and may be a lasting trend beyond the decline post-COVID. • SilverCloud: referrals remain on target with a 6% increase in referrals from last Quarter. • A 5% increase in new telecare clients from last quarter • 100% of Reponses to Freedom of Information requests have continued to meet the statutory timescales. Performance below target & areas for improvement: • There has been an issue surrounding licensing of Just Checking equipment which has prevented new equipment going out during Q2. There has also been no new Buddi equipment issued. • Telecare referrals being completed on time is an ongoing issue, the ability to keep track of outstanding referrals via a CMS has been lost during the migration to Eclipse but this is currently being tracked manually with a planned resolution within Eclipse. Telecare has robust supporting governance to plan and resolve risks and consider issues. Page 114
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5 Public Health and Primary Care Smoking Cessation measured by ‘Increase the number of quit dates’, noted the 67% variance Q2 from Q1. Data in Q1 was incomplete as only 1 month data indicating not on target. Work is ongoing to see if the data can be collected and if so, this would change the variance in Q2 and possibly the overall target performance in Q1. Monitoring Contracts and KPIs of all PH commissioned services. Noted this should always be 100%. Increasing the number of engagement activities delivered: On target in Q2. Discussion around target of 1. Noted this is new measurement and no one knew what to expect when target set. Planning a review of the target when we have more experience at end of year. Increase number of people attending training in money matters/behaviour training is on target. Increase number of referrals to community link workers. This is on target with baseline but slightly lower number of referrals in Q2 from Q1. This isn’t significant and expected to be slightly lower with holiday season. Primary Care is on target for all current Key Performance Indicator’s (KPI). Vaccine delivery on target for Autumn/Winter campaign with positive feedback from communities. Transfer of vaccinations from GP practices now complete with no need to continue monitoring this. Ongoing excellent performance around oral health improvement, as described above. Our dashboard data for Community Treatment Assessment Centres (CTAC) establishment not accurate as we have two practices outside rural flexibility receiving no CTAC. Flagged with performance team to adjust performance monitoring. Work ongoing to establish data collection for CTAC activity. Community Link Worker service up and running according to business case. Ongoing contingency measures in general practice 2C practices (managed by HSCP). Further work required to measure/monitor this in a more detailed way. Maintaining Level 1 provision across all General Practice, with communication out to practices to support ongoing monitoring during the winter pressures period. Work is required to scope dental KPIs for next iteration of developing our use of the IPMF. Benchmarked performance across the 13 Key Performance Indicators against target notes a sustained increase in the number of KPI’s reporting on-track with Q2 noting (13) on track against FQ1 reporting (11) on-track. Across 5 KPI’s, Public Health performance notes 5 (100%) are on track set against the targets in Q2 2023/24. This is an increase of 20% on the previous quarter performance. Performance on or above target: • Increasing the monthly number of quit dates is on target in Q2. There is a variance of 67%. It is noted that the “actual” reported in Q1 was incomplete as only had 1 month’s data. • Monitoring contracts and KPIs of all PH commissioned contracts is 100% on track in Q2. This follows a 100% trend from Q3 of 2022/23. Page 115
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6 • Increasing the number of engagement activities delivered in communities is on target in Q2 and shows an increase in performance each quarter. There is a variance of 10% in Q2 from Q1. • Increasing the people in A&B attending training in Money Counts, Behaviour change is on target in Q2 and shows an increase in attendance each quarter. There is a variance of 21% in Q2 from Q1. • Increasing the number of referrals to community link workers is on track in Q2. Referrals have dropped slightly this quarter with a (-3%) variance. (see feedback below) • In the current fiscal year, primary care in Argyll and Bute has effectively introduced several new services, achieving notable success. • In the five most deprived areas—Helensburgh, Campbeltown, Dunoon, Rothesay, and Oban—GP practices now can refer their patients to a community link worker for either in-person or remote appointments. • Community treatment centres (CTAC) are now accessible throughout Argyll and Bute, extending their availability to include island communities. • The ChildSmile programs have returned to levels seen before the impact of the COVID-19 pandemic in both the toothbrushing and fluoride application programmes. • The HSPC has taken over the delivery of both scheduled and non- scheduled vaccination programs in all non-rural areas, alleviating some pressure from practices. Monitoring the autumn and spring booster programs has presented challenges due to the timing misalignment with IPMF publications. However, progress and performance can be observed on the Discovery platform, indicating that Argyll and Bute are performing above the national average in the delivery of seasonal vaccinations. • Analysts and the primary care team have initiated collaboration to establish more meaningful KPIs. These aim to effectively monitor the performance of services in the upcoming fiscal year. Performance below target & areas for improvement: • Q2 reported no KPI below target and all Public Health & Primary Care KPI recorded as on or above target. Hospital Care & Delayed Discharge Falls remains a key cross service focus for the HSCP. There is a new falls lead in post and a specific focus on promoting meaningful activity within hospital settings for older people. Discharge without delay has a focus on reducing length of stay within hospital, looking at processes which may slow down length of stay in hospital. Page 116
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7 Adults With Incapacity, which can delay discharge has challenges, not least gaps in Mental Health Officer staffing and capacity. This continues to be a live issue. Across 17 KPI’s, Hospital Care performance notes 7 (41%) on track, with 10 (59%) off track against the targets set in Q2 23/24. This is an increase from 27% on track reported (+14%) variance on the previous quarter performance. Discharge performance notes 3 (50%) on track, with 3 (50%) off track against the targets set in Q2 23/24. There is no variance from (50%) reported on track on the previous quarter performance. Performance on or above target: • Reducing the number of people delayed in hospital is on track, with a (- 11%) variance on Q1. We are 100% on target on this quarter performance. • Reducing the number of occupied bed days for people delayed in hospital awaiting a care home placement is on track. Note an increase of (11%) bed days on previous quarter performance. • The number of inpatients 18+ who are discharged without delay is on track, with a (-1%) variance on Q1. • Reducing the average Length of Stay for inpatients in A&B hospitals is on track, having dropped by 25% since Q1, and is exactly on target. • Unplanned admissions to hospital reported as a result of a Fall in Q1 (Q2 is proxy data) dropped back below target, showing an 11% improvement. • Medication errors in hospital remain below target. Waiting times for cancer appointments at the 31 and 62 day targets have dropped to zero, following a continuing trend. Performance below target & areas for improvement: • Overall length of stay (bed days) in hospital is below target and showing a (14%) increase from Q1. (37%) below Q2 target. • The number of occupied bed days for people delayed in hospital due to AWI has fallen below target in Q2 with a (23%) increase in bed days from Q1. (10%) above Qtr 2 target. • Reducing the number of people delayed in hospital due to care at home availability has slightly improved since Q1 (-14%). (16%) above Q2 target. Unplanned admissions to hospital for 65+ remain slightly above target and showing a 2% increase on Q1. • The number of Falls being reported in hospital setting shows a 20% increase in performance on Q1. • Instances of tissue viability continues to be above target and is up by 24% in Q2. • Outpatient waiting times continues to be off track, with breaches >12 weeks up 22% and long waits >52 weeks up 151%. Page 117
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8 Care at Home and Care Home Staffing levels affect occupancy in Argyll and Bute Council registered Care Homes, we may have the beds but insufficient staff available. Occupancy of care home beds overall in Argyll and Bute remains high. The issue for reviews overall is being scrutinised by the social work short life working group, these have been de-prioritised because of staffing pressures but alternative models need to be developed. There is specific work with care homes and hospitals (as part of unscheduled care) to reduce unplanned admissions. Across 7 KPIs, Care at Home/Care Homes performance notes 2 on track, with 5 off track against the targets set in Q2 23/24. This is an overall increase of 29% as all KPI in Q1 were reported as off track. Performance on or above target: • Percentage of Priority 1 & 2 referrals for a Care at Home service completed within the target response timescales • Percentage of Older people in receipt of a Care at Home service with a Universal Adult Assessment competed at their 6 week point (Please note that both these indicators will be further developed as part of the annual KPI review process, this is a result of the move to Eclipse Case Management and a different process to count and record assessments and referrals. The annual KPI review will begin in FQ3 2023/24) Performance below target & areas for improvement: • The % of Older People who waited > 6 months for their homecare monitoring review to be completed has continued to increase slightly – Q2 is 2% up on Q1 – and is now 22% above target. • Performance on % of Older People receiving nursing care home service has remained static over a year and is still 9% below target. • The % of Older People in receipt of Care at Home receiving >15 hours per week have dropped again by 1% and is now 3% below target. • Occupancy rates across A&B care homes continue to improve (4% up on Q1) but still 5% below target. Learning Disability & Mental Health There continues to be increased activity across all services with workforce challenges presenting as the biggest factor in terms of meeting and improving on overall performance. The Acute and Complex Care Senior Management Team (SMT) are keen to focus on better understanding the directorate’s KPIs and our performance in relation to these. The IPMF was the focus of their SMT meeting on 6 November 2023 and each KPI was discussed at length with a view to developing an action plan to improve performance. They have pulled together a list of issues to discuss with the planning and performance team in relation to the KPIs and hope that these will underpin an initial data cleanse and improve their overall data capture and use. Page 118
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9 The SMT have had the first of their regularly scheduled support meetings with their allocated data analysts on 29th Nov 2023. This was useful in terms of drilling down into the data that sits behind the dashboards, and this will be used to underpin service developments and improvements. The SMT also plan to compile variance reports for each KPI that is showing as red. This will start in quarter 3. Across 21 KPI, Learning Disability / Mental Health/ ASP (Adult Support and Protection) / ADP performance notes 14 (67%) on track, with 7 (33%) off track against the targets set. This is an increase from 52% on track reported (+15%) variance on the previous quarter’s performance. Performance on or above target: • There has been a gradual increase recently in the number of people with dementia supported by a Care at Home service. Since the last quarter it has risen by 11 (30%) to 48. • The Dementia teams have also increased the number of people with needs assessed via Universal Adult Assessments. This has increased from 15 to 24 over the quarter (+60%). • The number of referrals received for Post Diagnostic Support has also significantly increased this quarter rising from 26 to 62 (+138%). Performance below target & areas for improvement: • The number of people waiting more than 12 weeks for a new Mental Health Outpatient service has been increasing slightly over recent quarters. At Q2 2023/24 there were 440 waiting, an increase of 5% on previous quarter. • Carers & Allied Health Professionals (AHP’s) The number on Young Carers (YC) statements was lower this quarter. Q2 2023/24 brings in the school holiday period when YC will have been away, but also at a time when increased number of activities were taking place over the summer months for YC. The teams were busy with group work, YC festival and residential trips. We need to look at the Target next year for Young Carers Statements but looking at the figures for the year the average is 39.75 which is over the 34 quarterly target. Across 11 KPI, Carers / AHP services performance notes 7 (64%) on track, with 4 (36%) off track against the targets set. This is an increase from 36% on track reported (+28%) variance on the previous quarter performance. Performance on or above target: • The number of Unpaid Carers Supported / Registered across A&B’s Carers Centres continues to increase. As reported last quarter, there has been a change to the data collection from the Carers Centres. For consistency the numbers used to define performance are those that are currently registered by the Carers Centres. In the new financial year the Target will be revised to reflect this change in reporting. Page 119
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10 • There has been a slight increase in the number of completed Adult Carer Support Plans this quarter and this is now on target. • AHP Outpatient Completed Waits have increased 5% this quarter. • The rate of New Outpatient AHP referrals seen as a proportion of all referrals seen continues to be on track. The current rate of 30% well above target set (25%). Performance below target & areas for improvement: • Young Carers Statements Completed have decreased recently although up on last quarter. Relative to retrospective quarterly data in 2021/22 and 2022/23 the current quarterly figure is consistent or slightly higher. This target will need to be revised due to the unique aspects of gathering information from Young Carers. • AHP Outpatient Referral Waits breaching 4 weeks for MSK (Muscular Skeletal) have increased again this quarter – up 19% from last quarter. Those breaching 12 weeks is also off-track this quarter. Finance Some attrition has resulted in improvement on the indicator for High-Cost Care Packages. The HSCP introduced ‘smarter commissioning’ early in 2023 at address unmet need, the objective of this was to better manage care at home resources and productivity. It was also designed to help commissioned service providers improve recruitment and retention and their sustainability. The main objective from our perspective was to better meet the assessed care needs of older adults. Therefore, a reduction in unmet need is a positive. The number of discharges with delay has increased and therefore the indicator reflects this. Spend is related to delays and it is a current management priority to manage down delays. Spend on prescribing / drugs is red as prices have increased and costs have increased. This is of significant concern and work will commence to better understand the price and volume effect. There is currently a national data system issue which means that there is uncertainty at present, but it appears this is a major area of overspending within the HSCP. It is hoped that spend on agency staffing will reduce, this will be driven by the move away from off-contract providers (agency nursing) and hopefully improved recruitment. It will take some time to get a sufficient data set over time to properly establish whether this is having an impact. The new staffing legislation in early 2024 should also help reduce the hourly rate (to no more than 150%) of a payroll post. Data set to be checked to ensure that it is the full quarterly cost that is reported. Page 120
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11 Across 5 KPIs, Financial services performance notes 1 (20%) on track, with 4 (80%) off track against the targets set in Q2 23/24. This is a decrease from 40% on track reported (-20%) variance on the previous quarter performance. Performance on or above target: • There is currently 1 KPI on or above target. • The performance on reducing the percentage of clients with high-cost packages of care KPI is improving at 3% above target performance. Performance below target & areas for improvement: • Reduction in value of assessed unmet need for care at home remains off track with costs increased this quarter on previous quarter. • Performance with regards to reducing the cost of hospital stays as a result of delayed discharge remains off track, with FQ2 noting 24% above the target, and an increase of 13% on previous quarter’s performance. • The cost on pharmacy expenditure remains off track, with FQ2 noting 16% above target, matching 16% above target on the previous quarter. NATIONAL HEALTH & WELLBEING OUTCOMES (HWBOI) and MINISTERIAL STEERING GROUP (MSG) INTEGRATION INDICATORS The National Health and Wellbeing Outcomes provide a strategic framework for the planning and delivery of health and social care services. This suite of outcomes serves to focus on improving the experiences and quality of services for people using those services, carers, and their families. These indicators form the basis of the annual reporting requirement for Health and Social Care Partnerships across Scotland. The national indicators will be updated and reported within A&B HSCP’s Integrated Performance Management Framework to provide the national performance position alongside the local service Key Performance Indicators suite. The latest data in relation to 26 HWBOI and MSG Indicators reports 42% on track, with 11 on track and 15 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. The next update for this data will be reported at FQ3. Page 121
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12 4. RELEVANT DATA AND INDICATORS 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 Clinical and Care Governance Clinical Governance and patient safety remain at the core of prioritised service delivery against the new IPMF Dashboard and National Health & Wellbeing Outcomes Indicators. The new governance structure supporting the IPMF ensures that the Clinical & Care Governance Committee remain central to performance improvement. The development of the IPMF is focussed on moving away from previous traditional styles of reporting to a fully collaborative approach with Head of Service and Service Lead commentary. 7. PROFESSIONAL ADVISORY Data used within the performance dashboard is fully accessible in SharePoint with data trends and forecasting are identified to give wider strategic context. This provides the HSCP professional advisors with self –service performance information to inform their role in maintaining professional standards and outcomes. 8. EQUALITY & DIVERSITY IMPLICATIONS The Integrated Performance Management Framework captures relevant indictors used to inform the HSCP E&D work. 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 Page 122
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13 Risks and mitigations associated with performance data sources and reporting are managed and identified within the monthly Performance & Improvement Team- Work Plan. 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 is via Argyll and Bute Council and NHS Highland websites. The IPMF dashboard utilises SharePoint to support manager and staff access across the HSCP. 12. CONCLUSIONS The Integration Joint Board is asked to considerer and acknowledge FQ2 (July- September) 2023/24 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 REPORT AUTHOR AND CONTACT Author Name: Douglas Hunter- Senior Manager Performance & Improvement Email: douglas.hunter@argyll-bute.gov.uk Page 123
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14 Appendix 1 – HWBOI & MSG Integration Indicators – Latest Available (as at 30 Jun 2023, due to national data lag the next update will be available for FQ3) National Indicator No. Measure Type No Measure Detail Target Actual Status 1 HWBOI Outcomes 1 % of adults able to look after their health very well or quite well 90.9% 90.8% R 2 HWBOI Outcomes 2 % of adults supported at home who agree they are supported to live as independently 78.8% 75.0% R 3 HWBOI Outcomes 3 % of adults supported at home who agree they had a say in how their support was provided 70.6% 66.9% R 4 HWBOI Outcomes 4 % of adults supported at home who agree that their health & care services seemed to be well co-ordinated 66.4% 66.0% R 5 HWBOI Outcomes 5 % of adults receiving any care or support who rate it as excellent or good 75.3% 68.6% R 6 HWBOI Outcomes 6 % of people with positive experience of their GP practice 66.5% 77.6% G 7 HWBOI Outcomes 7 % of adults supported at home who agree their support had impact improving/maintaining quality of life 78.1% 76.7% R 8 HWBOI Outcomes 8 % of carers who feel supported to continue in their caring role 29.7% 38.0% G 9 HWBOI Outcomes 9 % of adults supported at home who agree they felt safe 79.7% 76.4% R National Indicator No. Measure Type No Measure Detail Target Actual Status 11 HWBOI Data 1 Rate of premature mortality per 100,000 population 466 386 G 12 HWBOI Data 2 Rate of emergency admissions per 100,000 population for adults 11629 11916 R Page 124
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15 13 HWBOI Data 3 Emergency Admissions bed day rate 11263 7 112371 G 14 HWBOI Data 4 Readmission to hospital within 28 days per 1,000 admissions 107 91 G 15 HWBOI Data 5 Proportion of last 6 months of life spent at home or in a community setting 89.8% 92.6% G 16 HWBOI Data 6 Falls rate per 1,000 population aged 65+ 22.6 30 R 17 HWBOI Data 7 % of SW care services graded ‘good’ '4' or better in Care Inspectorate inspections 75.8% 80.0% G 18 HWBOI Data 8 % of adults with intensive needs receiving care at home 64.6% 72.2% G 19 HWBOI Data 9 No of days people [75+] spent in hospital when ready to be discharged, per 1,000 population 748 764 R National Indicator No. Measure Type No Measure Detail Target Actual Status 19 MSG 1.1 Number of emergency admissions - A&B 8505 8386 G 20 MSG 2.1 Number of unplanned bed days acute specialties - A&B 63655 70189 R 21 MSG 2.2 Number of unplanned bed days MH specialties - A&B 12475 9344 G 22 MSG 3.1 Number of A&E attendances - A&B 16120 20285 R 23 MSG 3.2 % A&E attendances seen within 4 hours - A&B 95.0% 83.3% R 24 MSG 4.1 Number of DD bed days occupied - A&B 7528 11098 R Page 125
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16 25 MSG 5.1 % of last six months of life by setting community & hospital - A&B 89.8% 90.8% G 26 MSG 6.1 % of 65+ population at Home (unsupported) - A&B 92.3% 92.6% G Page 126
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17 Appendix 2- System Pressures Reporting- October 2023 Page 127
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18 Appendix 3- Delayed Discharge Sitrep – 23rd October 2023 Page 128
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Integration Joint Board Agenda Item: Date of Meeting: 30 January 2024 Title: 2024/25 Social Work Fees and Charges Presented by: Roy Swales 1. EXECUTIVE SUMMARY 1.1 1.2 This report provides details of the proposed annual Social Work Fees and Charges uplifts for 2024/25. In accordance with normal practice, a standard uplift percentage has been applied to all of the department’s fees and charges with several exceptions which are explained in the detail of the report. A standard rate of 6% has been applied for 2024/25 to reflect the current level of cost inflation which is 6.7% - Consumer Price Inflation (CPI) for the 12 months to September 2023. Members are asked to consider an amendment to the Non-Residential Care Charging Policy in relation to the application of a standard weekly allowance rate, called the Non-Dependent Rent Allowance, to be applied for all clients who reside with family members. A copy of the updated guidance is attached as appendix 2 to the report. 1.3 Members are reminded that decisions on changes to the partnership’s Non-Residential Care Charging Scheme are reserved to Argyll and Bute Council (the Council) and that members of the IJB are asked to review and, if so minded, endorse the proposed changes to the scheme ahead of a formal submission to the Council’s 2024/25 budget meeting to seek ratification for their implementation from April 2024. 2. INTRODUCTION 2.1 This report sets out the schedule of proposed fees and charges for Social Work services for the 2024/25 financial year. The detailed list of proposed The board is asked to: ▪ Review and endorse the appended 2024/25 Social Work Fees and Charges proposals so that the proposals can be submitted to Argyll and Bute Council for ratification at its 2024/25 budget meeting. ▪ Review and endorse a change to the means test within the Non-Residential Care Charging Policy in relation to the Non-Dependent Rent Allowance afforded to clients who live with family members. Page 129 Agenda Item 11
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charges, including the 2023/24 rates for comparison, is attached as appendix 1 to the report. 3. DETAIL 3.1 Appendix 1 to this report provides the list of uprated fees and charges for 2024/25 after the application of a 6% annual inflationary uplift – there may be some minor variations due to rounding in the smaller charges. 3.2 The proposed charges for the following service areas are not calculated by applying a standard 6% uplift: 3.2.1 Local Authority Residential Care Provision (Older People) Charges for the provision of residential care are based on the budgeted cost of the service for 2024/25 which takes account of a number of inflationary assumptions across the range of costs incurred by the homes. The overall uplift for 2024/25 is 3%. The proposed rate will be charged to other health and social care partnerships and local authorities with clients placed in the HSCP’s care homes and to local people residing in the homes who own capital and assets exceeding £32,750 (threshold as at 2023/24). As at December 2023, there are 13 self-funding clients out of 58 residents in the HSCP’s care homes (equivalent to 22% of the current residents). The majority of residents, 78% of the current residents, pay substantially less based on their ability to pay as assessed under the National Assistance (Assessment of Resources) Regulations issued by the Scottish Government. 3.2.2 Local Authority Nursing Care Provision (Older People) The charge for the provision of nursing care at Kintyre Care Centre has been set at the same rate as the residential rate across the authority, an increase of 3%. The additional cost of nursing provision is offset by its significant economies of scale, it being a 40-bed unit compared to residential units ranging from 9 to 22 beds. In the unlikely event of residential care being provided at Kintyre Care Centre, a residential rate has been set at 85.8% of the Nursing rate based on the same prorate seen in the National Care Home Contract rates. 3.2.3 Sleepovers The sleepover charge is based on £12 per hour minimum pay rate for staff working in adult social care as confirmed by the Scottish Government in their Budget Announcement in December. The overall increase in the sleepover rate is 5%. 3.2.4 Domestic Home Care, Housing Support and Employment Support Provision Page 130
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The hourly charges for domestic home care, housing support and employment support are all affected by the same changes to pay rates described in 3.2.3 above for sleepovers and are also impacted by inflation on non-pay costs in line with the Consumer Price Index. The overall increase in these charges is 9%. 3.2.5 Children and Families Local Authority Residential Care Provision 4. 4.1 4.2 4.3 4.4 4.5 As above at 3.2.1, the proposed charges for Dunclutha, Shellach View and East King Street reflect the budgeted cost for 2024/25 and are affected by the same payroll and inflationary cost pressures explained previously. The charges for the three units would only be payable by other councils placing clients in the HSCP’s children’s houses. None of the children or their families would be charged for the service provided at the three houses. Non-Dependent Rent Allowance The current Non-Residential Care Charging Policy includes provision for a standard Non-Dependent Rent Allowance which is a disregard applied where clients reside with their parents. The allowance leaves clients with an amount equivalent to the weekly contribution which a non-dependent in receipt of IS/ESA would be expected to make towards the family home rent costs under Housing Benefit legislation. It is proposed to update the Policy to widen the scope of the allowance to include clients who reside with any family member and not limit it to clients residing with their parents. The current Policy includes provision to meet additional rental costs where a formal tenancy agreement exists between the client and their parent. Following discussions with colleagues in Legal Services, this provision is being removed as, although an agreement can be set up, there is no legal obligation for such an agreement to be drawn up where a client resides with their parents or other family members. The HSCP recognises that housing costs may exceed the Non- Dependent Rent Allowance, for example where an extension or modifications have had to be made to a property to enable the client to reside there. It is therefore proposed that, where a client’s actual housing costs exceed the standard allowance, a waiver or abatement be considered under the existing Waivers and Abatements Policy. This will ensure that the Charging Policy is fair and does not interfere with a client’s choice of where and with whom they wish to live. The section of the Policy which it is proposed is changed has been highlighted on page 33 of the appended 2024/25 Proposed Non- Residential Care Charging Policy. Page 131
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5. RECOMMENDATION 5.1 It is recommended that the proposed rates increases and amendment to the Non-Residential Care Charging Policy are endorsed by the IJB and the proposals submitted to the Council for ratification at its 2024/25 budget meeting ahead of implementation of the new rates and policy from April 2024. 6. CONTRIBUTION TO STRATEGIC PRIORITIES 6.1 The HSCP faces a combination of increasing demand and service costs which is outstripping the funding available to sustain service delivery in its current form. The annual adjustment to fees and charges ensures that charges remain relevant to service costs which enables the IJB to maintain income at levels proportionate to service costs in order to sustain services and avoid potential service reductions. 7. GOVERNANCE IMPLICATIONS 7.1 Financial Impact The annual adjustment to fees and charges ensures that charges remain relevant to service costs which enables the IJB to maintain proportionate income levels in order to sustain services and avoid potential service reductions. 7.2 Staff Governance Updated fees and charges lists will be provided to staff and built into revised 2024/25 versions of the Social Work service’s charge calculation templates once the rates have been ratified by the Council. 7.3 Clinical Governance Not applicable. 8. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 The proposed changes apply equally to everyone who receives a service which the partnership will continue to charge for. Subsequently, there are no anticipated adverse equality or diversity issues arising from this report. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 Not applicable. 10. RISK ASSESSMENT 10.1 The key risk arising from the above proposal relates to service users who are unable to afford to pay increased charges. To ensure that charges are levied fairly and that service users are not placed into financial hardship, the Council’s Non-Residential Care Charging Policy is reviewed annually in line with changes to state benefits rates and other related guidance Page 132
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issued by the Scottish Government and COSLA – a single change to the Non-Dependent Rent Allowance is proposed for 2024/25. In addition, staff are able to signpost service users to local advice services and the Council’s Welfare Rights Team to ensure that their benefit entitlements have been maximised and for help and advice with managing their money. Finally, a waivers and abatement procedure is in place which provides service managers with discretion to adjust charges where necessary. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 Not applicable. 11. CONCLUSIONS 12.1 This report sets out the proposed annual increases to the Social Work fees and charges rates, which reflect the increased cost of delivering social care services in Argyll and Bute, and an amendment to the Non- Residential Care Charging Policy to ensure that the Policy is fair and correct. Members are asked to endorse the proposals for submission to the Council for ratification at the Council’s 2024/25 budget meeting. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: Tick No directions required Argyll and Bute Council ✓ NHS Highland Health Board Argyll and Bute Council and NHS Highland Health Board REPORT AUTHOR AND CONTACT Author Name: Roy Swales Email: Roy.Swales@argyll-bute.gov.uk Page 133
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APPENDIX 1 – 2023/24 SCHEDULE OF PROPOSED FEES AND CHARGES FOR SOCIAL WORK SERVICES Page 134
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Revision Date: 22/01/2024 APPENDIX 2 – PROPOSED 2024/25 NON-RESIDENTIAL CARE CHARGING POLICY Argyll and Bute Health & Social Care Partnership Social Work – Adult Care Community Based Care Charging Scheme Page 136
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1 Contents Section Page Introduction 2 Charging Structure 3 Charging Process 8 Personal Care 9 Domestic Care 10 Housing Support 11 Means Test Mechanism 13 Income 15 Capital 24 Applicable Housing Costs 33 Applicable Disregard 33 Income Thresholds 34 Residual Income and Taper 34 Final Charge 35 Lunch Clubs 35 Transport 35 Telecare 36 Page 137
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2 Introduction The following charging scheme applies to all adults who reside within Argyll and Bute, or are deemed to be ordinarily resident within Argyll and Bute in accordance with the Scottish Government’s Ordinary Residence guidelines, who are assessed as requiring and subsequently benefit from community based care services provided, commissioned or funded by Argyll and Bute Council on behalf of the Argyll and Bute Health Social Care Partnership. Community based care services are deemed to comprise one or a combination of the services listed below: • Homecare; • Housing Support; • Supported Living; • Sleepover Services; • Employment Support; • Daycare (including travel to and from day care units and meals and refreshments); • Respite, at home or in a care home; • Lunch clubs; • Community Alarm and Telecare services; • Occupational Therapy equipment and adaptations, and; • Progressive Care. The following charging scheme will apply equally to all service users regardless of the delivery mechanism(s) deployed to most appropriately and effectively meet the needs and aspirations of individuals, which include: • Direct service delivery by Council staff; • Indirect service delivery through services commissioned from the private and voluntary sectors by the Council on the service user’s behalf, and; • Direct payments to service users to enable them to arrange their own care through the employment of their own assistants or by purchasing care from the private and voluntary sectors. This scheme is founded upon the following list of principles; that: • Personal Care services will be provided free of charge to all adults who have been assessed as needing it and who meet the local eligibility criteria to receive services; • All clients in receipt of community based care services will undergo a financial assessment and will be charged according to their ability to pay; • Service users will not be charged more than it costs to provide the services(s) for which their contribution has been assessed; • Service users will not be charged more than £125 per week for their care and support services, which includes all of the above community based care services except for Lunch Clubs, Community Alarm and Telecare services and Transport to Care services. Page 138
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3 • Services will, at all times, be provided in accordance with service users’ assessed needs and not their ability to pay; • No charges will be levied where: o The primary reason for service provision is to monitor children under “supervision” or children and families in crisis; o Services are provided to adults with mental health problems who are subject to measures under the Mental Health (Care and Treatment) (Scotland) Act 2003; o Services fall within the scope of Criminal Justice Social Work Services; o Services are provided to adults subject to measures under the Adult Support and Protection (Scotland) Act 2007, or; o Services are provided to support a carer, either directly to the carer or as replacement care to enable a carer to take a break from their caring role, where the carer’s assessed needs meet the local eligibility criteria to receive services under the Carers (Scotland) Act 2016. Charging Structure Charges for community based services will be levied in accordance with the structure defined in the table below: Service Charging Method Home Care Means tested weekly charge based on an approved hourly charge – see below for domestic only homecare services Housing Support Means tested weekly charge based on an approved hourly charge Supported Living Means tested weekly charge based on an approved hourly charge Sleepover Services Means tested weekly charge based on an approved nightly charge Employment Support Means tested weekly charge based on an approved hourly charge Day Care Means tested weekly charge based on an approved hourly charge for care services and flat rate charges for meals and refreshments provided Lunch Clubs Flat rate charge for each meal provided Community Alarm and Telecare Services Flat rate weekly charge Transport to Care Flat rate weekly charge Page 139
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4 All charges will be reviewed annually as part of the Council’s budget setting process and will be subject to approval by the Council Members. The means test mechanism used by the Council to determine service users’ charges will be reviewed annually to ensure that it reflects any changes in: • Government legislation or regulation relevant to charging for the services for which charges are assessed under the means test; • The guidance issued by COSLA upon which the means test mechanism is based, and; • The allowances and premiums calculated by the Department for Work and Pensions which underpin the affordability test within the means test mechanism. Where a service user receives more than one service which is assessed for charging using the means test mechanism, a consolidated assessment will be undertaken to ensure that service users are not charged more than they can afford for the package of care services which they receive. Older People Leaving Hospital Adults leaving hospital who are assessed as requiring support should receive this service free, for up to 42 days, if they have been in NHS inpatient care for more than one day (24 hours) for treatment, assessment or rehabilitation, or had surgery as an NHS day case. Relief from charging should not apply to discharges following admission on a regular or frequent basis as part of the person’s ongoing care arrangements. This would cover, for example, admissions for respite care or ongoing but episodic treatment. Only new or additional services provided after a person comes out of hospital will be free and services that were in place pre-admission and continue after discharge will continue to be chargeable. Domestic Only Homecare Services Domestic only homecare services will be charged for at a flat rate equal to the Council’s standard charge for homecare and will not be means tested. This is to ensure that service users who receive domestic only homecare services from the Council are charged in the same way as service users whose service provision has been transferred from the Council to external providers who charge at a flat rate. Breaks in Service Where a service user’s service is suspended, the service user will not be charged for the services which have not been provided. Charging should resume when services are reinstated. Financial Re-assessment The charges payable by service users will be reviewed on an annual basis, to reflect the annual changes in charges and service users’ income and capital. Page 140
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5 The contribution payable by service users should be reviewed in the event of a change in the service provided or such other change in the service user’s circumstances as would affect their ability to contribute towards the cost of their care. Couples Where a service is provided to a service user who is married or lives with a partner as a couple, the charge assessment should include the income and capital of both the service user and their partner. To ensure that the assessed charge is fair, the upper and lower capital allowance for couples will be equal to double the single person’s capital allowances which would be used for the elder partner. Tariff increments are also doubled. The income threshold to be included in the charge assessment for couples should be based on the age of the elder partner. Income disregards will be applied to couples in the same way as individuals; the disregards are not doubled but are applied to both individuals on the basis of their respective incomes. Where a service user’s partner receives disability benefits, including disability and/or severe disability allowances within Income Support or Pension Credit, but does not receive any care services or funding for care services from the Council, the partner’s disability benefits should be disregarded in full. Where there is any doubt or dispute regarding whether or not two people are living together as a couple, the Council will defer to the decision made by the Department for Work and Pensions when assessing the two people’s entitlement to state benefits. Where two service users reside together but are not a couple, they should be assessed individually for charges. Independent Living Fund Service user’s eligible to claim financial assistance towards the cost of their care from the Independent Living Fund will be subject to charging for chargeable services under this scheme. Adults with Incapacity Where a service user is unable to deal with their own financial affairs due to incapacity, the department will liaise with another appropriate person, or persons, in order to gather information about the service user’s financial affairs and to arrange for the collection of charges. Appropriate persons would include: • Power of Attorney; • Financial guardian, appointed in accordance with the Adults with Incapacity (Scotland) Act 2000; Page 141
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6 • An individual permitted to act on the service user’s behalf under an intervention order granted by a Sheriff Court under the Adults with Incapacity (Scotland) Act 2000; • Department for Work and Pensions benefits appointee, or; • A relative, friend or advocate of the service user who assists the service user, with the service user’s knowledge and agreement, to manage their financial affairs. Incapacitated adults will be charged for the chargeable elements of their service in accordance with this scheme. Where the Council is unable to collect a service user’s charges because they have no one to manage their financial affairs and it is not financially viable to pursue a financial guardianship through the courts, a claim will be lodged against the service user’s estate following their death to recover the accrued unpaid care charges. Age Definition Due to the changes currently affecting the state retirement age for women, the age definitions applied in this scheme have been amended to classify service users as either: • Working age – for service users aged below state retirement age, or; • Pension age - for service users aged at or above state retirement age. Where a service user is aged between 60 and 65, staff should check the service user’s retirement age status. This can be done via the Gov.UK website. Charge Waivers Service users may apply for a partial or full charge waiver if they meet the following criteria: • The service user has been diagnosed as terminally ill and has been issued with a DS1500 Form by their doctor and/or BASRiS Form. In this case charges will be waived in full; • The service user feels that they can’t afford to pay their charge due to financial hardship; • The service users incurs costs for specialist therapies, supplies or services because they are disabled and which have not been taken into account in their charge assessment; • The service user has rejected a service because they don’t want to pay for it but without which they will be at substantial risk of harm; or • The Council has redesigned how it delivers the type of support the service user and other similar customers need, resulting in an increase in charge for the service user. For further details and how to apply for a charge waiver, please refer to the separate Social Work Waivers Scheme Procedures. Page 142
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7 Charge Collection Charges will be collected via 4 weekly Direct Debit unless there are extenuating circumstances which negate the client or the Council’s ability to collect payment in this manner. Extenuating circumstances would include, for example: • The client does not have access to a suitable bank account from which a Direct Debit can be paid (eg they only have a savings account and no current account); • The client does not have capacity to give instruction to their bank to set up the Direct Debit and does not have a Power of Attorney, Financial Guardian or other suitable representative to act on their behalf; or • The client struggles to manage their funds and the operation of a Direct Debit from their account could make their situation worse, potentially resulting in bank charges and placing the client in financial hardship. Page 143
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8 Charging Process The process of assessing, checking and collecting a service user’s care charges is set out below: Step Description Responsible Person 1 Following the completion of the service user’s needs assessment, a CBC Form is completed detailing the services required by the service user, the service’s costs and the service user’s and, where relevant, their partner’s financial circumstances. The CBC Form will calculate any charges payable by the service user towards their service. Please note that the financial circumstances of the service user and their partner are not required where the service user’s service consists entirely of personal care and/or services charged for at a flat rate, such as lunch clubs, Telecare or transport or the service is provided for the sole benefit of an informal carer (includes direct support to the carer and/or replacement care to provide respite to the carer). Case Manager 2 The case manager passes the completed CBC Form to their manager for checking and approval. Case Manager 3 The Team Leader / vetting manager should check to ensure that the CBC Form has been completed appropriately, based on the service user’s age and service needs, that the relevant evidence of the service user’s financial circumstances have been provided with the form and that the relevant budget codes(s) has been added to the form before approving it / passing to the relevant manager for approval. Team Leader 4 The authorising manager should forward the completed CBC Form with service approval to the local social work finance team. Approving Manager 5 The social work finance team will check to ensure that the charge assessment is correct and that all relevant evidence has been provided by the case manager. Social Work Finance 6 The social work finance team will check to ensure that the service user is set up on the Council’s Corporate Debtor’s System and will liaise with the Case Manager regarding any reason why payment by Direct Debit would not be appropriate for the client. Social Work Finance 7 The social work finance team will add the service user’s debtors, personal and charge details onto the area debtors upload spreadsheet and will process the service users billing via the standard 4 weekly billing cycle. Social Work Finance 8 Where the case manager becomes aware of a change in the service user’s service, financial or personal circumstances, they should inform the social work finance team so that the service user’s billing can be amended or stopped. Case Manager Page 144
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9 Personal and Domestic Care The following services can be broken down into personal, domestic or other support services: • Homecare, including homecare provided on a respite basis; • Supported Living, and; • Daycare. Since the Council is required to ensure that adult service users are not charged for personal care, it is essential to define which tasks would be considered to be personal care and subsequently excluded from charging. The following definitions provide a model to be used by assessment staff to classify the tasks required to meet service user needs into personal or domestic care. Personal Care Definition Classification Task Personal Hygiene ▪ Shaving ▪ Oral hygiene ▪ Nail care ▪ Toileting (assisting the person with going to the toilet or with using a bedpan or other receptacle) ▪ Catheter/stoma care (ensure cleanliness and that skin is kept in a favourable hygienic condition) ▪ Where the person is incontinent: o The consequential making of the person’s bed and consequential changing and laundering of the person’s bedding and clothing; o Caring for the person’s skin to ensure that it is not adversely affected Food and Diet ▪ Eating ▪ Meal preparation Mobility ▪ Dealing with the consequences of not being able to move ▪ Moving and handling Simple Treatments – if the person requires medical treatment, assisting with medication for example by:- ▪ Applying creams or lotions ▪ Administering eye drops ▪ Applying dressings in cases where this can be done without the physical involvement of a registered nurse or medical practitioner ▪ Assisting with the administration of oxygen as part of a course of therapy Page 145
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10 Classification Task General Well-Being ▪ Assisting with getting dressed ▪ Assisting with surgical appliances, prosthesis and mechanical and manual equipment ▪ Assisting with getting up and going to bed ▪ The provision of devices to help memory and of safety devices (see note 1) ▪ Behaviour management and psychological support Note 1 Only memory and safety devices which help individuals to manage their own personal care needs are included (eg the use of personal reminder systems to allow individuals to manage their medicines or the use of sound/movement alarms linked to light controls to guide people with dementia to the toilet and minimise the risks related to wandering at night). Community alarms and other associated devices are not included. Domestic Care Definition Classification Task Personal Laundry ▪ Carrying out personal laundry (excluding incontinence laundry) Ironing ▪ Carrying out ironing Clothing Repairs ▪ Carrying out clothing repairs Nutrition ▪ Management of food stores/fridges etc (including shopping) ▪ Menu planning ▪ Supervision at mealtimes Pet Care ▪ Coping with domestic pets including day to day care and feeding Page 146
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11 Housing Support From 1 April 2011, Housing Support services became subject to charging under this scheme. To provide a single charging framework, Housing Support services will be charged for subject to the standard means test. The cost of housing Support services will be calculated using the standard homecare hourly charge. Housing Support services are defined in the following table. Housing Support Definition Classification Task Life Skills – worker provides life skills training to the service user in maintaining the dwelling and curtilage (ie close, stairs, paths, bin area, garden pertaining to the service user’s accommodation) in appropriate condition. Worker assists and advises service user on: ▪ Kitchen/food hygiene ▪ Kitchen routines eg cleaning, washing up, bin emptying ▪ Personal laundry routines, ironing ▪ Cleaning (hovering, dusting, window cleaning, floor cleaning, kitchen and bathroom cleaning ▪ Appropriate personal routines ▪ Appropriate clothing/footwear ▪ Appropriate personal hygiene ▪ Prompting re the above ▪ Prompting re medication routines ▪ How to keep garden, close, stairs, bin areas etc in appropriate condition Service User Welfare – Worker assists the service user to engage with individuals, professionals and other bodies with an interest in the welfare of the service user to: ▪ Arrange and attend doctors/hospital etc (including escort) ▪ Attend day care (including escort) ▪ Attend groups, social activities and reviews (including escort) ▪ Maintain contact with friends and family (including escort) Adaptations – Worker arranges adaptations to enable the service user to cope with disability. ▪ Assist service user to make referral to OT department or make referral for service user ▪ Arrange appointments and attend appointments with or for the service user in relation to adaptations ▪ Arrange to be present when adaptations are being carried out in the service user’s home ▪ Remind the service user of the safe use of adaptations Page 147
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12 Classification Task Budgeting/Debt Management – Worker advises or assists the service user with personal budgeting and debt counselling. ▪ Collect benefits with or for the service user ▪ Advise and assist the service user to budget income ▪ Advise and assist service user to pay bills ▪ Enable service user to access debt counselling services ▪ Enable service user to access advocacy services ▪ Enable service user to access legal services ▪ Advise and assist service user to set up and maintain bank account appropriately, including direct debits, standing orders etc ▪ Advise and assist the service user to plan/save for future expenditure (eg furniture purchases, holidays etc) Relationships/Neighbour Disputes – Advising or assisting the service user in dealing with relationships and disputes with neighbours ▪ Advise and assist the service user to sustain appropriate relationships with neighbours, friends and family ▪ Advocate and negotiate appropriately with or on behalf of the service user in disputes Benefits/Correspondence – Advising or assisting the service user in dealing with benefit claims and other official correspondence relevant to sustaining the occupancy of the dwelling. ▪ Assist the service user to access the benefits agency ▪ Assist the service user to read and understand correspondence ▪ Assist the service user to complete forms ▪ Assist the service user to provide evidence of income and/or savings ▪ Liaise/advocate for the service user with Housing and Council Tax Benefit ▪ Liaise/advocate for the service user with the landlord ▪ Assist the service user to access welfare rights services Page 148
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13 Means Test Mechanism The means test mechanism described below is based upon the model recommended by COSLA as representing best practice in finding the balance between maximising income generation and minimising reduced opportunity and financial hardship for service users. To ensure parity between service users who contribute towards their care costs in the community and in care homes, the Scottish Government’s Charging for Residential Accommodation Guidance (CRAG) has been used extensively to ensure equal treatment of income, capital and assets. The means test will be used to assess charges for the following services: • Homecare; • Housing Support; • Supported Living; • Sleepover Services; • Employment Support; • Daycare (care elements of service), and; • Respite at home (including sleepover services). Means Test Qualification Service users who own capital and assets, excluding their home, equivalent or greater in value to the upper capital limit contained within CRAG will be excluded from relief under the means test and will be charged the standard cost of their care. This limit will be doubled where a couple is being assessed. Service users who are eligible for relief under the means test will pay either: • The standard cost of their care up to a maximum of £125 per week, or; • The maximum that they can afford to pay, as determined using the means test. Means Test Calculation To determine the maximum amount the service user can afford to contribute towards their care package, the following calculation will be completed: Total Assessed Income (A) Less Applicable Housing Costs (B) Less Applicable Disregards (C) Less Relevant Income Threshold (D) Equals residual income (E) Maximum charge (F) is equal to residual income (E) multiplied by a taper of 80%. Page 149
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14 A detailed explanation of each of the above steps is provided in the following section. The section on income has been split into income and capital and includes the rules for how different types of income and capital are to be treated in the means test mechanism. Page 150
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15 Income Income is a payment which: • Is made in respect of a period, and; • Forms part of a series of payments (whether or not payments are received regularly). A payment of income is taken into account for a period equivalent to that which it represents, e.g. a payment due to be made weekly is taken into account for a week, a payment due to be made calendar monthly is taken into account for a month, but a weekly rate is calculated before assessment. Treatment of Income Income is treated in one of three ways: • Taken into account in full; • Partly disregarded, or; • Fully disregarded. Income Taken Fully into Account The following types of income are taken into account in full: • Most Social Security Benefits, including: o State Retirement Pension; o Attendance Allowance; o Disability Living Allowance (care component); o Disability Working Allowance; o Job Seekers Allowance; o Income Support; o Pension Credit; o Industrial Death Benefit; o Incapacity Benefit; o Employment and Support Allowance; o Maternity Allowance; o Severe Disablement Allowance; • Annuity Income (see Annuity Income section below); • Occupational Pensions; • Refund of Income Tax; • Trust Income (see Income from certain disregarded capital below); • War Orphan’s Pension; • Income from an insurance policy (except mortgage protection insurance); • Income from certain sub-lets; • Income from certain disregarded capital Page 151
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16 The above list has been extracted from CRAG and is not exhaustive. Where a service user receives an income from a source the treatment of which is not mentioned explicitly in this guidance, advice should be sought before completing the financial assessment. Deductions from Benefits Where any Social Security benefit is being subjected to a reduction (other than a reduction because of voluntary unemployment) e.g. because of an earlier overpayment, the amount to be taken into account should be the gross amount of benefit before reduction Annuity Income An annuity is a fixed sum payable at specified intervals (normally annually), in return for a premium payable either in instalments or as a single payment. The annuity income is payable for a specified period, such as the recipient's lifetime. Income from an annuity is to be taken fully into account except when the annuity is: • Purchased with a loan secured on the service user’s home, or; • A gallantry award (eg Victoria Cross Annuity, George Cross Annuity) Income from certain disregarded capital Income from capital will generally not be treated as income. However, income which comes from certain forms of disregarded capital is taken fully into account as income for as long as the capital is disregarded. This will be the case where the capital is: • The normal dwelling of a temporary resident; • Business assets which the resident is taking steps to dispose of, or; • Any capital held in trust which is as a result of personal injury. Income from certain sub-lets When a resident sub-lets a part of their property which is not part of the living accommodation, for example the garage or the garden, the income from that sub-let is taken fully into account. Income Partly Disregarded The following types of income attract a £10 disregard: • Payments to victims of National Socialist persecution (paid under German or Austrian law); • Civilian war injury pension; or • War widow’s and war widower’s pension. Page 152
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17 Overall disregard Where more than one payment qualifies for a £10 disregard, the amount disregarded overall is £10. Other Disregarded Sums Income from boarders A boarder is someone for whom at least one cooked meal is provided. Where a resident has income from a boarder (whether paid by the boarder or a third party) the first £20 of the income should be ignored plus half of any balance over £20. Earnings from Employment/Self-Employment Where a service user is in receipt of earned income, the first £20 of their net earnings should be disregarded. Where a service user’s partner is in receipt of earned income, 50% of the partner’s net earnings should be disregarded. For couples, where both have earnings from employment, both of the above treatments are applied and aggregated to produce an overall earnings disregard for the couple. High Rate Attendance Allowance/DLA Care Component Where a client is receiving the higher rate of Attendance Allowance or the higher rate of the Care Component of Disability Living Allowance and is not provided with a night time service, that is a service between 10:00pm and 6:00am, they should be assessed as receiving the lower rate of Attendance Allowance or the middle rate of the Care Component of Disability Living Allowance. Page 153
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18 Income Fully Disregarded The following types of income are fully disregarded: • Disability benefits and/or allowances paid for service user’s partners who are disabled but who do not receive care services or funding for care services from the Council; • Direct payments made by a local authority under Section 12B of the Social Work (Scotland) Act 1968 to individuals in respect of a care service that they or a dependent child have been assessed as requiring; • Child Support Maintenance Payments and Child Benefit; • Child Tax Credit; • Guardian’s Allowance; • Where the service user is a student, any grant payment from a public source intended for the childcare costs of a child dependant; • Christmas bonus; • Carers Allowance; • Carers Premiums within Income Support/ Job Seekers Allowance or the guarantee element of Pension Credit; • Any payment made under the Age-Related Payments Act 2004; • Any payment from: o the Macfarlane Trust; o the Macfarlane (Special Payments) Trust; o the Macfarlane (Special Payments) (No 2) Trust; o the Fund (payments to haemophiliacs infected with HIV); o the Eileen Trust; o The value of any ex-gratia payments from the Skipton Fund to people infected with Hepatitis C as a result of NHS treatment with blood or blood products; o the Independent Living (Extension Fund); o the Independent Living (1993) Fund (8.042); o the Thalidomide Trust • Council Tax Benefit; • Housing Benefit; • Disability Living Allowance (Mobility Component); • Disabled Students Allowances; • Therapeutic Earnings; • Mobility supplement; • Dependency increases paid with certain benefits ; • Gallantry awards; • Income frozen abroad; • Income in kind; • Social Fund payments (including winter fuel payments); • Certain payments made to trainees; • War disablement pension; • Armed Forces Compensation Scheme; • War widows and widowers special payments; Page 154
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19 • Statutory Redress Scheme and Advance Payment Scheme– Survivors of Historical Child Abuse; • Future Pathways – Discretionary Fund; • Child Disability Payment (CDP) and Short-Term Assistance (STA); • Scottish Infected Blood Scheme (SIBSS) (and equivalent UK schemes e.g. England Infected Blood Support Scheme); • Victims Payment Regulations 2020; • Redress Board (Northern Ireland); • Payment Scheme for Former British Child Migrants; • Windrush Compensation Scheme; • UK Energy Bills Support Scheme; • Homes for Ukraine Payments; • Work expenses paid by employer, and expenses paid to voluntary workers, and; • Any payment made section 51A of the Adoption (Scotland) Act 1978. Christmas Bonus A Christmas Bonus is paid each year in the week starting the first Monday in December. It is paid to people who are entitled to specified benefits, for example: • Attendance Allowance; • Retirement Pension; • Widow's and War Widow's and widower’s Pensions; • War Disablement Pension; • Armed Forces Compensation Scheme; • Incapacity Benefit or Severe Disablement Pension. The Christmas bonus is fully disregarded in assessing the charge. Payments from any of the Macfarlane Trusts, The Fund or the Independent Living Funds Payments from the Macfarlane Trust, the Macfarlane (Special Payments) Trust, the Macfarlane (Special Payments) (No 2) Trust, the Eileen Trust, the Fund, the Independent Living (Extension) Fund or the Independent Living (1993) Fund do not have to be declared if they are kept in a separate bank or building society account from the service user’s other resources. All payments are fully disregarded. Gallantry awards Gallantry awards are: • Victoria Cross Annuities; • George Cross Annuities, or; • Analogous awards e.g. one from another country. These payments are fully disregarded. Page 155
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20 Income Frozen Abroad Income paid outside the UK which cannot be transferred to the UK should be fully disregarded so long as it continues to be frozen outside the UK. Income in kind Income in kind means income received in the form of food, clothing, cigarettes, etc. The value of such income is disregarded in full. Payments made to trainees Trainees on certain employment schemes may receive a training premium and reimbursement of travelling expenses. These should be fully disregarded. The actual training allowance should be taken into account. War widows and war widowers’ special payments War widows and war widowers’ special payments are made to the widows of men or widowers of women who died from injuries or illness which resulted from service ending before 31 March 1973. The special payments are intended to compensate those widows and widowers who did not benefit from the amendments to the Armed Forces Pension Scheme. These payments, which are made under the legislation, are fully disregarded. Work expenses paid by employer Where a person who is in paid employment receives a payment from the employer in respect of expenses which are incurred in the course of the employment that payment is fully disregarded. The payments must be for expenses incurred exclusively and necessarily in the course of work. Expenses paid to voluntary workers Where a person works for a charitable or voluntary body or as a volunteer, and receives no other payment as a result of the employment, any payment in respect of expenses which are actually incurred is fully disregarded. Income Available Upon Application General Subject to certain exemptions, income which the local authority is satisfied would be available to the service user if an application were made, but which has not yet been acquired, is to be treated as belonging to that service user. Page 156
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21 Amount of income Payments of the following cannot be taken into account as notional income: • Income payable under a discretionary trust; • Income payable under a trust derived from a payment made in consequence of a personal injury; • Working Families Tax Credit; • Disability Working Allowance, and; • Rehabilitation Allowance. Also income which would be fully disregarded should not be included as notional income, for example Housing Benefit and DLA (mobility). Income which is subject to the awarding authority's discretion, ie the resident has no right to payment shall also not be taken into account. Any potential entitlement to Severe Disablement Allowance should not be taken into account. This is because entitlement to this benefit is based on medical conditions which the local authority cannot assume are satisfied. All other income should be considered. Examples of income which may be treated as belonging to the claimant are: • unclaimed councillors attendance allowance; • unclaimed Social Security benefits (but not Severe Disablement Allowance), and; • occupational pension not claimed. Date taken into account The income should be taken into account from the date it could be expected to be acquired if an application was made. In considering the earliest date that account can be taken of the income the local authority should: • assume the application was made on the date the local authority first became aware of the possible income; and • take into account any time limits which might limit the period the period of arrears. Deprivation of Income A service user is to be treated as possessing income of which he has deprived himself for the purpose of paying a reduced charge. Meaning of deprive A person will have deprived himself of a resource if, as a result of his own act, he ceases to possess that resource. Page 157
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22 Questions for consideration: Where the service user appears to have deprived himself of income the local authority should consider the questions covered in the following paragraphs: Was it the service user’s income? Where a person, before he deprived himself of an income, was in receipt of that income it is reasonable to assume that the resource belonged to him. Sometimes there will be other evidence such as a letter or documentation which shows that the income was properly payable to the resident. Has deprivation occurred? Deprivation will have occurred if a person relinquishes, or transfers to another person, an income which: • he has been receiving or was due to receive and: • would have continued to receive had he not relinquished or transferred it. It is up to the service user to prove that he no longer has the income. If he cannot prove that the income has been disposed of, the local authority should treat the service user as still possessing the actual income. Purpose of the disposal of income There may have been more than one purpose of the disposal of income only one of which is to avoid a charge, or a lower charge. This may not be the service user’s main motive but it must be a significant one. Timing of the disposal of income Consideration should be given to the timing of the disposal of the asset when deciding whether the purpose of disposing of the asset was to avoid a charge for the service. The local authority should make a judgement as to the purpose of the disposal of income only after balancing all the person's motives, explicit and implicit, and the timing behind the action. The local authority should bear in mind, however, that deprivation can be considered for resources disposed of at any time. Conversion of income to a capital asset Where, for the purposes of paying a reduced charge or no charge, the right to receive an income resource has been sold, and therefore converted from income to a capital asset, the local authority should consider taking account of: • the amount of the former income resource or Page 158
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23 • if the newly acquired capital gives rise to a tariff income or an increase in tariff income, the difference between the former income resource and the tariff income, or the increase in tariff income, arising from that capital asset. Deprivation decided If it is decided that the service user has disposed of income in order to avoid a charge or to reduce the charge payable, the local authority will need to assess the charge payable using the service user’s notional income. If the service user is unable to pay the assessed charge, the relevant Service Manger has delegated authority to waive or abate all or part of the charge Non-disclosure of Income Where the service user refuses to fully disclose their or their partner’s income, they will be excluded from the means test and will be required to meet the standard charge for their care. Page 159
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24 Capital A service user’s resources are either capital or income. It may not always be obvious whether a payment should be treated as capital or income, but generally, a payment of capital is one which is: • Not in respect of a specified period, and; • Not intended to form part of a series of payments. Examples of capital are shown in the following list. The list is intended as a guide and is not exhaustive. • Buildings; • Land; • National Savings Certificates and Ulster Savings Certificates; • Premium Bonds; • Stocks and shares; • Capital held by the Court of Protection or a Receiver appointed by that Court; • Any savings held in: o building society accounts - income which is paid into an account becomes capital once the period over which it is taken into account as income expires; o bank current accounts, deposit accounts or special investment accounts. This includes savings held in the National Savings Bank, Girobank and Trustees Savings Bank - income which is paid into an account becomes capital once the period over which it is taken into account as income expires; • SAYE schemes; • Unit Trusts; • Co-operative share accounts; • Cash; • Trust funds; Page 160
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25 The Effect of Capital • A service user with capital of more than £32,750 is liable to meet the standard charge for the chargeable services provided to them; • Where the service user is of working age, the first £6,000 of the capital they own is disregarded, this is the lower capital allowance; • Where the service user is of pension age, the first £10,000 of the capital they own is disregarded, this is the lower capital allowance; • Capital owned over the lower capital allowance and up to £32,750 is taken into account in full for the purposes of calculating the service user’s weekly tariff income: o For service users of working age, a weekly tariff income is calculated as £1.00 per week for every £250.00, or part thereof, owned by the service user between £6,000 and £32,750. o For service users of pension age, a weekly tariff income is calculated as £1.00 per week for every £500.00, or part thereof, owned by the service user between £10,000.00 and £32,750. Note The upper capital threshold of £32,750 above is taken from the Scottish Government’s Charging for Residential Accommodation Guidance (CRAG). This rate will be reviewed annually to ensure that it matches the CRAG threshold. The lower capital thresholds and tariff charge increments are taken from the Department for Work and Pension’s (DWP) Council Tax Benefit and Housing Benefit assessment rules. These rates will be reviewed annually to ensure that they match any changes in the DWP’s rules. Tariff Income Tariff income is meant to represent an amount that a service user with capital over a certain limit should be able to contribute towards their service costs, not the interest earning capacity of that capital. Beneficial Ownership of capital A capital asset normally belongs to the person in whose name it is held. The following paragraphs provide guidance on how to establish beneficial ownership where there is a dispute. Ownership disputed Where ownership is disputed, ask for written evidence to prove ownership. Where a service user is said to be holding capital for another person, obtain evidence of the arrangement and the origin of the capital, and evidence to show the intentions for its future use and for its return to the rightful owner. Page 161
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26 Joint Beneficial Ownership of Capital Where a service user has joint beneficial ownership of capital, unless it is an interest in land with someone else, divide the total value equally between the joint owners, and treat the service user as owning an equal share. This method of treatment avoids administrative difficulties. Once the service user is in sole possession of their actual share, treat them as owning that actual amount. Valuation For the purposes of valuation only the value of a capital asset (for example property) other than National Savings Certificates (see specific section below) is the current market or surrender value, whichever is higher, less: • 10% of that value if there would be any expenses involved in selling the asset only where there will be actual expenses. The expenses must be connected with the actual sale, and not simply the realisation of an asset, e.g. the cost of fares to withdraw money from a bank are not expenses of sale. The deduction is always 10% even if it is known from the outset that the actual expenses will be more or less than 10%; and • any outstanding debts secured on the asset, e.g. a mortgage. A capital asset may have a current market value (e.g. stocks and shares) or a surrender value (e.g. premium bonds). The current market value will be the price a willing buyer would pay a willing seller. The way the market value is obtained will depend on the type of asset held, e.g. the values of stocks and shares or unit trusts which are quoted in newspapers. If the service user and the assessing officer both agree that, after deducting the amounts in the paragraph above (where appropriate), the total value of the service user’s capital will be: • more than £32,750; or • £6,000 or less it is not necessary to obtain a precise valuation. If there is any dispute, obtain a precise valuation. In the case of land, buildings or a house, where it is necessary to obtain a precise valuation because of a dispute, a professional valuer should be asked to provide a current market valuation. Expenses of sale Once the asset has been sold (e.g. a property), the capital to be taken into account is the actual amount realised from the sale less the actual expenses incurred during the sale. Debt secured on asset "Secured on" means a legal charge or mortgage must be made on the actual capital asset. Page 162
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27 The value of the land to be taken into account is the market value of that piece of land, less 10% of that value for expenses of sale and the whole of the mortgage secured on the home and the extra land. National Savings Certificates The original purchase price should be used when valuing National Savings Certificates. Capital Disregarded Indefinitely The capital assets listed below are disregarded indefinitely: • Property in specified circumstances; • Surrender value of any: o Life insurance policy; o Annuity; • Payments of training bonus up to £200; • Payments in kind from a charity; • Any personal possession such as painting or antiques unless they were purchased with the intention of reducing capital for the purpose of reducing the local authority charge; • Any capital which is to be treated as income or student loans • Any payment made by or derived from: o the Macfarlane Trust; o the Macfarlane (Special Payments) Trust; o the Macfarlane (Special Payment) (No 2) Trust; o the Fund (payments to haemophiliacs infected with HIV); o the Eileen Trust; o The Independent Living Fund; o the Independent Living (Extension) Fund; o the Independent Living (1993) Fund; • The value of funds held in trust or administered by a court which derive from a payment for personal injury to the service user (e.g. vaccine damage, criminal injuries compensation funds); • The value of a right to receive: o Income under an annuity; o Outstanding instalments under an agreement to repay a capital sum; o Payment under a trust where the funds derive from a personal injury; o Income under a life interest or a life rent; o Income (including earnings) payable in a country outside the UK which cannot be transferred to the UK o An occupational pension; o Any rent • Any Social Fund payment • Refund of tax on interest on a loan which was obtained to acquire an interest in a home or for repairs or improvements to the home • Any capital resource which the service user has no rights to as yet, but which will come into their possession at a later date, e.g. on reaching a certain age (reversionary interest) Page 163
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28 • The amount of any bank charges or commission paid to convert capital from foreign currency to sterling • Payments from the Department for Work and Pensions to compensate for the loss of entitlements to Housing Benefits or Housing Benefit Supplement • Any payment made under the Age-Related Payments Act 2004. • Payments to jurors or witnesses for court attendance (but not compensation for loss of earnings or benefit) • Community charge rebate/council tax rebate • Money deposited with a Housing Association as a condition of occupying a dwelling • The value of any ex-gratia payments made on or after 1 February 2001 by the Secretary of State in consequence of a person’s or person's spouse's or civil partner’s imprisonment or internment by the Japanese during the Second World War. Disregarded for 52 weeks The following payments of capital are disregarded for a maximum period of 52 weeks from the date they are received. The balance of any arrears of, or compensation for arrears due to non-payment of: • Mobility Allowance; • Mobility Supplement; • Attendance Allowance; • Constant Attendance Allowance; • Disability Living Allowance; • Disability Working Allowance; • Exceptionally Severe Disability Allowance; • Severe disablement occupational allowance; • Armed forces service pension based on need for attendance; • Pension under the Personal Injuries (Civilians) Scheme 1983, based on the need for attendance; • Income Support/ Pension Credit; • Minimum Income Guarantee; • Working Families Tax Credit; • Disabled Person’s Tax Credit; • Working Tax Credit; • Child Tax Credit; • Housing Benefit, and; • Special payments to pre-1973 war widows. As the above payments will be paid for specific periods, they should be treated as income over the period for which they are payable; any money left over 52 weeks after the end of the period for which they are treated as income has elapsed should be treated as capital. Page 164
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29 Disregarded for 2 years Payments made under a trust established out of funds provided by the Secretary of State in respect of persons suffering from variant Creutzfeldt-Jakob disease to: • The victim’s parent (or guardian) for 2 years from the date of death of the victim (or from the date of payment from the trust, if later) or • A dependent child or young person until they cease to be a member of the family (i.e. until they leave school between ages of 16 and 19) – but with a minimum of 2 years. Income treated as capital The types of income in the following paragraphs should be treated as capital. Tax Refunds Any refund of income tax charged on profits of a business or earnings of an employed earner. Holiday Pay Any holiday pay paid by an employer more than 4 weeks after the termination or interruption of employment. Income from a capital asset Income derived from capital, e.g. building society interest or dividends from shares, should be treated as capital from the date it is normally due to be credited to the resident's account. This does not apply to income from disregarded capital. Bounty Payments Any bounty paid at intervals of at least one year from employment as: • A part time fireman • An auxiliary coastguard • A part time lifeboatman • A member of the territorial or reserve forces. Page 165
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30 Advance of earnings or loan from employer Any advance of earnings or loan made to an employed earner by the employer, should be treated as capital, if the service user is not still in work, as the payment does not form part of the employee’s regular income and would have to be repaid. Example A service user received £294 in one week but the pay slip showed that £200 of this was a loan made by the employer. The local authority should treat £94 as earnings and £200 as capital. Irregular charitable and voluntary payments Apart from certain exemptions (payments from AIDS trusts), charitable and voluntary payments which are neither made regularly nor due to be made regularly should be taken into account as capital in the normal way. Deprivation of Capital General The local authority may feel that a service user has deprived themselves of a capital asset in order to reduce their service charge. If this is the case the local authority may treat the service user as still possessing the asset. The following factors will need to be considered. Pension Credit includes slightly more relaxed notional capital rules compared with Income Support. In Income Support, individuals may be treated as if they still possess capital in circumstances where they have deliberately deprived themselves of it in order to maximize their benefit entitlement. Pension Credit specifies circumstances in which this would not apply. For example, individuals who choose to use their savings to reduce or clear a debt (including debts not immediately repayable) will no longer be considered as having deliberately deprived themselves to maximise entitlement. Pension Credit will also have slightly different rules for what resources an individual may be assumed to have when they apply for benefits. Forms of capital to be considered The local authority should only consider questions of deprivation of capital when the service user ceases to possess capital which would otherwise have been taken into account. E.g. a service user gives a diamond ring worth £2,000 to her daughter the week before her service starts. The local authority should not consider deprivation as, had the ring still been possessed, it would not be taken into account as capital. However, if the service user had purchased the ring immediately prior to giving it to her daughter with £2,000 which had previously been in a Building Society account, deprivation should be considered. Page 166
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31 Ownership The local authority should decide from available evidence whether the service user owned the capital. Has deprivation occurred? It is up to the service user to prove that they no longer has a resource. Failure to do so will result in the local authority treating the service user as if they still possess the actual capital. Examples of acceptable evidence of the disposal of capital would include • a trust deed • deed of gift • receipts for expenditure • proof that debts had been repaid. Examples of where a person has deprived themselves of capital (although not necessarily for the purposes of avoiding a charge for accommodation) • A lump-sum payment has been made to someone else (e.g. as a gift or to repay a debt) • Substantial expenditure has been incurred (e.g. on an expensive holiday) • The title deeds of a property have been transferred to someone else • Money has been put into a trust which cannot be revoked • Money has been converted into another form which would fall to be disregarded (e.g. personal possessions) • Capital has been reduced by living extravagantly (e.g. gambling or following a much higher standard of living than the service user could normally afford). • Capital has been used to purchase an investment bond with life insurance. Local authorities will wish to give consideration, in respect of each case, to whether deprivation of assets has occurred i.e. did the individual place their capital in such an investment bond so that it would be disregarded for the purposes of the charge assessment. Purpose of disposing of an asset There may be more than one purpose for disposing of a capital asset only one of which is to avoid a charge for services. Avoiding the charge need not be the service user’s main motive but it must be a significant one. If, for example, a person has used capital to repay a debt, careful consideration should be given to whether there was a need for the debt to be repaid at that time. If it seems unreasonable for the service user to have repaid that debt at that time, it may be that the purpose was to avoid a charge for services. Page 167
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32 Timing of the disposal The timing of the disposal should be taken into account when considering the purpose of the disposal. It would be unreasonable to decide that a service user had disposed of an asset in order to reduce his charge when the disposal took place at a time when he was fit and healthy and could not have foreseen the need for services. The local authority should bear in mind, however, that deprivation can be considered for resources disposed of at any time. Conversion of capital to personal possessions Where, for the purpose of avoiding or reducing the charge for services, capital which would not have been disregarded has been used to acquire personal possessions, the current market value of those possessions should be taken into account as an actual resource. Their market value should not be disregarded under these circumstances. If the service user, in depriving himself of an actual resource, converted that resource into another actual resource of lesser value, he should be treated as notionally possessing the difference between the value of the new resource and the one which it replaced e.g., if the value of personal possessions acquired is less than the sum spent on them the difference should be treated as a notional resource. Deprivation decided If the local authority decides that the service user has disposed of capital in order to avoid a charge or to reduce the charge payable, the local authority will need to decide whether to treat the service user as having the capital (notional capital) and assess the charge payable accordingly and then whether it is realistic to recover the assessed charge from the service user (bearing in mind that they may not have the means to pay the debt which will be accruing) Diminishing notional capital Calculation of the rate at which notional capital should reduce Where a service user has been assessed as having notional capital that capital will have to be reduced each week by the difference between the rate which he is paying for the service and the rate he would have paid if he was not treated as possessing the notional capital. Page 168
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33 Applicable Housing Costs Deductions will be made from the service user’s assessed income for the following net housing costs: • Rent; • Mortgage; • Council tax (including water and sewerage charges), and; • Interest payable on loans that have been taken out to improve, extend or adapt the service user’s home, as long as they are related to the service user’s disability. Non-Dependent Rent Allowance (NDRA) Where a service user resides with their parents and/or other family members, a weekly deduction will be made for rent equivalent to the non-dependant deduction applied in Housing Benefit for non-dependants receiving Income Support/ESA. Where the client’s housing costs exceed the standard allowance, for example as a direct consequence of their disability, an application for an additional disregard should be made through the waivers and abatements policy. Applicable Disregard The applicable disregard is the weekly equivalent total of all of the items of income which are partially or fully disregarded, as specified in the Income section of this scheme, and allowable expenses which includes: • Any personal contribution payable by the service user and/or their partner towards an Independent Living Fund funding package, and; • Any charges payable by the service user for other privately or separately arranged care which meets the following criteria: o The care delivered is assessed as P1 or P2 under the Council’s priority of need framework; o The care delivered is included within the client’s care plan, and; o The price being paid is the lowest available to the client (for example where a client purchases private physiotherapy which would be available to them free on the NHS, the council would not disregard the cost of this service in the client’s assessment as it does not meet the lowest cost criteria). Other Care Charges and Contributions Taper Adjustment To compensate for the effect of the 80% taper used to calculate the charge payable by the service user, a taper adjustment equal to one quarter of the total deduction allowed for the service user’s ILF contribution, partner’s assessed contribution and/or charges for other private or separately arranged care is applied. This ensures that the service user receives the full benefit of the allowable deductions for these expenses. Page 169
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34 Financial and charge assessments will be calculated on a gross basis and deductions detailed to ensure the transparency of the assessment for the service user and to avoid any confusion about how charges have been calculated. Income Thresholds Income thresholds represent the minimum amount of money which the Government, via the Department for Work and Pensions, determines that a service user of a particular age and circumstance requires to meet their weekly living costs. To ensure full compliance with the COSLA Guidance on Charging for Non-Residential Services, this scheme requires that the Council’s Income Thresholds are calculated using the allowances and premiums calculated by the Department for Work and Pensions for the purpose of determining minimum weekly living costs and that an additional 25% Buffer is added thereto to minimise service users’ exposure to financial hardship. Income thresholds will be calculated annually and published for use within the Social Work Service. Staff undertaking financial and charge assessments should select the most appropriate threshold to apply to individual assessments using the following criteria: • The age of the service user; whether the service user is of working or pension age, and; • Whether the service user is one of a couple or an individual. When assessing a couple, threshold selection should always be determined on the circumstances of the elder member of the couple. Residual Income and the Taper Residual income is the income which the service user has left over after deducting housing costs, disregarded income and weekly living costs (income threshold). The maximum charge that the service user can afford to pay is thereafter calculated on the basis of 80% of their residual income. The level of taper applied is at the Council’s discretion and will be reviewed on an annual basis to ensure that a balance between cost recovery and fair charging is maintained. Standard Charge The standard charge is equal to the lesser of the actual cost of the service user’s service or the maximum charge levied by the Council for the service (this represents a capped charge in order to protect individual service users from excessive charges due to higher than average care needs). The maximum Charge levied by the Council comes from the Council’s list of Fees and Charges, agreed annually by Council Members. Page 170
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35 Final Charge The final charge to be paid by the service user will be the lesser of the standard charge for the service user’s service or the maximum charge they can afford to pay or £125 per week. Collection Service user charges for homecare, housing support, supported living, employment support and day care will be collected on a 4 weekly in arrears basis. Service user charges for respite at home will be collected as soon as practically possible following the delivery of service. Lunch Clubs Charges of the Lunch Club service will be levied at a flat rate per meal provided to the service user. The Council will review the charge for the Lunch Club service on an annual basis to ensure that the charge levied is sufficient to recover the costs to the Council of providing the service. Collection Charges for the Lunch Club service will be collected at the point of delivery with the exception of Lunch Club services provided to service users suffering from Dementia, where charges will be collected on a 4 weekly in arrears basis. Transport Transport to and from day care facilities, including to resource centres, provided by the Council, directly using Council vehicles or indirectly by private transport companies including minicab companies, will charged for from 1 April 2011. It is hoped that by implementing this new charge, service users will be encouraged to use public transport, reducing the Council’s costs and carbon footprint. Where service users cannot or will not use public transport, implementation of a transport charge will enable the Council to recover some of its transport costs. Transport provided for excursions will be charged for in accordance with the mileage allowances set by Her Majesty’s Inland Revenue and Customs, The total charge will then be divided equally between all of the participating service users. Collection Charges for transport services will be collected weekly in arrears by the day care and resource centres delivering the users service. Page 171
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36 Telecare Charges for the Telecare service will be levied at a flat rate based on the type of service provided. The Council will review the charges for the Telecare service on an annual basis to ensure that the charge levied is sufficient to recover the costs to the Council of providing the service. Collection Charges for the Telecare service will be collected on a 4 weekly in arrears basis Page 172
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1 Integration Joint Board Date of Meeting: 22 January 2024 Title of Report: Category 1 Responder Assurance and Development Presented by: Charlotte Craig The SLT is asked to: ▪ Consider the review for assurance ▪ Support the proposed recommendations ▪ Note update to the Strategic Risk Register to reflect both response and continuity 1. EXECUTIVE SUMMARY On 24 March 2021 the Integration Joint Board agreed to accept the responsibility for compliance with the duties of a Category 1 Responder which had come into force on 17 March 2021. Amendment to Civil Contingencies Act 2004 to include Integration Joint Boards as Category 1 Responders argyll-bute.gov.uk) Integrated Joint Boards are not operational, do not employ staff and are dependent on the HSCP whose partner bodies who also share Category 1 Responder status to provide the physical response. The HSCP has a particular remit in delivering a Caring for People response (see guidance link appendix 2) and otherwise requires to meet the breadth of the duties noted below. The IJB has no dedicated resilience resource, however the Chief Officer has a responsible role with each partner and the HSCP and operational arrangements are in place utilising current strategic leadership and operational staffing to both prepare for and deploy a joint response. The IJB and HSCP has tested its capacity to respond in 2023. It evidences its planning through the documentation of each corresponding partner as the employing bodies. The IJB has representation within the resilience structures (appendix 1) through the HSCP staff and has good participation in the delivery of exercises and training. However it is not yet consistently involved in the breadth of planning exercised by partners. When an incident requires that the Argyll and Bute Local Resilience Partnership initiates an incident response, the IJB is represented by the Chief Officer, the on-call manager and the appropriate professional leadership/operational management from the wider senior leadership team. Page 173 Agenda Item 12
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2 Business Continuity Planning (a statutory duty) is undertaken at local level using templates provided by Argyll and Bute Council and NHS Highland, these are also informed by NHS Highland Service Impact Assessments. Service Continuity Plans are owned by the teams who develop and use them, with assurance provided by existing line management processes. Support and oversight is provided fortnightly by Resilience within Argyll and Bute Council and the Resilience Committee within NHS Highland. The Public Health response is explicit within plans. This approach was adopted to minimise duplication of effort however partner plans can be at differing stages of maturity and completion and some of the available templates do not map easily onto services or functions, their risks and needs. We would seek to work further with partners to ensure this can effectively be delivered as a single exercise for HSCP staff with ongoing review. Council resilience are undertaking the deployment of a new Business Continuity system in February across council services, Persons At Risk Database using geolocation which includes the sharing of data within a response has been actioned and is progressing well. We do not currently seek formal assurance through the board in terms of prevention. 2. INTRODUCTION Role of Integration Joint Boards (IJBs) IJBs are identified as Category 1 responders under Schedule 1 Part 2 17A of the Civil Contingencies Act (2004). IJBs employ no specific staff and own no facilities, and their business-as-usual function is to offer strategic direction to Health Boards through Health and Social Care Partnerships (HSCPs). They primarily operate a strategic and planning role in their relationships with Health Boards and Local Authorities. This strategic function should be recognised in emergency planning, where IJBs should play a key role in preparing the strategy for responses. Part of this strategic planning should involve considerations of service recovery at the appropriate stage of the emergency response. By contributing a strategic view to emergency response, IJBs can identify solutions to be delivered during an emergency, but their primary function should be the strategic planning of emergency responses, supporting and co-ordinating with Health Board and Local Authority preparations. Duties 1. Carry out a risk assessment and contribute to the development of a community risk register. 2. Plan for emergencies, including training and exercising. 3. Ensure robust business continuity arrangements are in place to maintain service delivery. 4. Ensure arrangements are in place to warn & inform the public both before and during emergencies. 5. Co-operate with partner agencies. 6. Share information with partner agencies. Page 174
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3 Figure 1 3. DETAIL OF REPORT Duty: Carry out a risk assessment and contribute to the development of a community risk register. How we do this: Operational risk assessment is undertaken as described in the summary, the IJB does have a responsibility to ensure participation at a strategic level. All Category 1 responders have a role developing their local Community Risk Register (West of Scotland Community Risk Register, 2022) by participating in the civil contingencies regional risk assessment process (Risk Assessment legislation). The Argyll and Bute Resilience Manager, in her role as Local Resilience Partnership chair, takes a leading role in this with NHS Highland supporting where needed. Currently the Argyll and Bute HSCP does not have a distinct role in the process and as such there is a risk that local health and social care issues may not be reflected in the outcome in line with their Category 1 responder duty. Recommendation: The HSCP will work closely within local LRP process to ensure that it fully represents risk within health and social care services as part of the wider response. Duty: Plan for emergencies, including training and exercising. How we do this: The HSCP takes advantage of the training and exercise opportunities offered by the Argyll and Bute Local Resilience Partnership, Argyll and Bute Council and NHS Highland. These are designed to support a generic response to local hazards and different specialist responses for known risks, for example an incident caused by a transport accident. Further work is needed to document the roles and responsibilities of both the HSCP and the IJB during the initial and longer-term response to an incident and ensure this is recorded in line with guidance. Planned training in 2024 will inform our understanding and participation in delivering the wider resilience response. Recommendation: monitoring of staff training completion, participation in exercises to support and evidence locality capacity, plan, do and review process to ensure continual improvement. Duty: Ensure robust business continuity arrangements are in place to maintain service delivery. As noted previously Business Continuity planning is undertaken at a Service and function level across the HSCP, and this is supported by both Argyll and Bute Council and NHS Highland. There is an opportunity for the IJB to continue to develop assurance processes around these to improve. • How teams consider and plan for service interruption risks and consequences Page 175
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4 • Opportunities for self-generated training and exercise • Information sharing about critical eHealth and digital services • Links between continuity planning and major incident response Recommendation: Develop an HSCP assurance framework supported by the partnership for consideration at Audit and Risk Committee and reported to the to the IJB Duty: Ensure arrangements are in place to warn and inform the public both before and during emergencies. How we do this: The HSCP/IJB has no independent communications facility and during an incident (once the Resilience Partnership is in place) fulfils this duty by informing and directing the activity of Communication Teams within both Argyll and Bute Council and NHS Highland. These teams, in turn co-ordinate public messaging through the West of Scotland Public Communications Group. Before an emergency, the HSCP can develop and share messaging independently again through Council and NHS communication teams. However, roles and responsibilities in this area are sometimes unclear and this could lead to the public not receiving important information. Recommendation: Review HSCP warning and informing routes and ensure that senior leadership teams are aware of the need to develop and disseminate risk-based community information in line with national guidance provided in response. Recommendation: Include this within the assurance framework for the IJB to ensure that plans are in place to communicate the appropriate hazards and threats faced by the local community. Duty: Co-operate with partner agencies. The Argyll and Bute Local Resilience Partnership (LRP) is the principal local mechanism for multi-agency co-ordination under The Civil Contingencies Act (2004). The LRP convenes regularly to promote co-operation between organisations and to develop local plans and procedures that can be used to respond to emergencies and major incidents within their boundaries. The Argyll and Bute LRP is also part of the wider West of Scotland Regional Resilience Partnership which is chaired by Police Scotland. The HSCP delivers the response on behalf of the IJB. During a response, the Resilience Partnership is chaired by Police Scotland and representatives are requested from the constituent organisations. If strategic representation is sought, then the representative should be able to commit their agency’s resources without referencing back to higher levels of management. Whilst the HSCP can provide this level of representation for short running incident, a more protected response would place considerable pressure on the Partnership. Local work is needed to document processes to ensure that the IJB remains up to date and influences decision making through the Chief Officer during an incident. Page 176
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5 Recommendation: Review best practice in the inclusion of IJB alongside HSCP representatives within Local and Regional Resilience Partnerships Recommendation: Review availability of senior managers within the HSCP to take part within a Resilience Partnership during an extended response Recommendation: Review and confirm the role of the IJB during an incident Duty: Share information with partner agencies. In both the planning for and responding to incidents there is a requirement for agencies to pay particular attention to those who may need more help than others, this is often referred to as the Vulnerable People’s list and referenced as PARD. The list should contain the details and needs of people who meet agreed local criteria and available in a format that be used to allow their home location to be mapped against the geography of the incident. The HSCP update vulnerable adults lists weekly in each locality and has facility for tracking children at risk. The ongoing work with Peaople at Risk Database recommendations will support a coordinated approach that includes thise vulnerable across disciplines. Data on some people whose support needs would put them into this category and this information can be prioritised and shared in the lead up and response to an emergency within current legislation. Recommendation: Completion of the planned PARD approach to the management of vulnerable people data both before and during an incident Recommendation: Invite feedback from agency partners on any improvement and information sharing not already governed. Corporate approach and operational resourcing, reporting and adherence to the duty. Following the initial report to the IJB, the role of the Chief Officer was outlined with supporting strategic leadership and operational input from Health and Community Care and the Business Improvement Manger. Appendix 1 notes the governance structure and the volume of activity required. While the Caring for People response is likely to be led by area-based managers this also reflects the person led approach. Increasing capacity in training incident officers enabled to make decisions with Chief Officer/on call manager led support, training support staff to support in delivering emergency centre responses would offer an HSCP wide capacity which can work alongside professional Social Work and Health input making effective locality focussed use of staffing. This would build locality-based resilience and allow for a planned staff response with outlined roles and ensure that staff could change shifts minimising clinical and care risks due to tiredness. Page 177
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6 Each response will require a tailored and individual requirement and the response will not necessarily be consistent across localities. There are noticeable impacts of climate change in respect of increased weather response highlighting the need to consider community resilience. Recommendation: Review of the on call pack and approach to response utilising current planning and identified need. 4. RELEVANT DATA AND INDICATORS Reporting on training, incident management and planning 5. CONTRIBUTION TO STRATEGIC PRIORITIES Assurance of delivering public duty. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – as per response requirements. 6.2 Staff Governance – Requirement to focus on staff wellbeing undertaking response, provide and record appropriate planning and training to function within the response. 6.3 Clinical and Care Governance – Requirement to address recommendations for a safe Caring for People response delivering the key components of Psychological First Aid and provide debrief and learning points from incident management. Key Components of Effective Psychological First Aid • provide immediate care for physical needs • protect from further threat and distress • provide comfort and consolation for people in distress • provide practical help and support for real-world-based tasks (e.g. arranging funerals, information gathering) • provide information on coping and accessing additional support • facilitate reunion with loved ones where possible and/or connection with social supports • provide education about normal responses to trauma exposure including two essential elements: o recognising the range of reactions o respecting and validating the normality of the post-trauma reaction The likelihood of a person developing more serious psychosocial problems or mental disorders will depend on many factors including the intensity and duration of their exposure to emergency-related stressors, certain prior experiences, and the availability, or otherwise, of social support. The stepped care model should be applied in ways that include a clear pathway for accessing specialist services for those people who are thought to be at particular risk. As with other aspects of caring for people and managing the recovery following an emergency, the best outcomes are likely to be achieved by working in partnership with the affected people Page 178
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7 and communities, and by facilitating a high level of self determination by those affected Figure 2 7. PROFESSIONAL ADVISORY Role of the Integration Joint Board is to provide strategic planning input and support the fulfilment of the duties in partnership. 8. EQUALITY & DIVERSITY IMPLICATIONS Argyll & Bute’s geography and settlements require different responses and each area can be impacted differently and is experiencing different impacts from weather through climate change. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Data sharing agreements are in place and provision is made to ensure wider data can be shared during a response period. 10. RISK ASSESSMENT Request to update Strategic Risk SS17 to reflect both response and business continuity and support activity for the relevant planning with partners. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT Community resilience is not an alternative to response but a supporting facet of the ongoing wellbeing of a community. At present Council resilience holds community resilience plans on a voluntary basis for communities but there is potential to explore a wider ongoing community resilience approach with partners for Argyll & Bute in general. 12. CONCLUSIONS The report notes a reasonable level of assurance for the board and demonstrates capacity for response and particpation. Business continuity and response is mainstreaming into operational workforce management by the nature of the professional approach and an assurance framework will provide a route to the IJB that evidences approach with this recommending this is reported annually with any continuous improvement recommendations addressed. 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 REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll-bute.gov.uk Appendix 1 Page 179
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8 • Regional Resilience Partnership: Chief Officer • West of Scotland RRP (quarterly plus topical/response): Chief Officer or delegated Strategic Lead and Associate Director for Public Health • Local Resilience Partnership (quarterly plus topical/response/contribution to plans): Chief Officer or delegated Strategic Lead* and Associate Director for Public Health • Care for People subgroup(quarterly): Senior Manager Health and Community Care • Exercises (as planned, operational staff): All identified relevant staff • Planning/Workplan: Chief Officer or delegated Strategic Lead and Associate Director for Public Health approved • Understanding the role of Public Health and Civil Contingencies Strategic Lead: • Corporate assurance: proposed governance moves to quarterly reporting to SLT unless otherwise required and annual assurance to the IJB via the Audit committee. • Systems – establish operational risk register • Communications – seek clarification on the communication routes of the HSCP within an emergency response setting, prevention and preparedness. • Staff Governance – monitoring of trained staff not currently undertaken – commence this with corporate reporting. • Action recommendation and improvement actions/learning The Cabinet Office Briefing Room (COBR) UK Scottish Government Resilience CSC (SGoR)/Scottish Government Resilience Room (SGoRR) Regional Resilience Partnership West of Scotland Resilience Partnership Local Resilience Partnership/Resilience Committee Exercises/Planning/ Workplan Care for People sub Group Tactical Page 180
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9 Appendix 2 Guidance for Emergency Response Advice for emergencies in Scotland (ready. Scot) care-for-people-affected-by-emergencies-november-2017.pdf (ready. Scot) Page 181
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1 Integration Joint Board Date of Meeting: January 2023 Title of Report: Consumer Scotland Duty Presented by: Charlotte Craig The Integration Joint Board is asked to: ▪ Note an additional public duty from 1 April 2024 ▪ Note that guidance has not yet been published ▪ Note that 2024-25 will be regarded as an implementation year. 1. EXECUTIVE SUMMARY Following the Consumer (Scotland) Act 2020, Consumer Scotland was set up as a new statutory and independent body in April 2022. The purpose of the body is to promote the interests of Consumers and is independent from the government and accountable to Parliament. The duties on public sector bodies under the act are detailed in the introduction. Guidance for public bodies will be available by 31 March 2024. The duty applies to strategic decisions of the board. Consumer Scotland is the statutory, independent body for consumers in Scotland. It was established by the Scottish Parliament under the Consumer Scotland Act 2020 to advocate on behalf of consumers and represent consumer interests. Consumer Scotland has a specific rural dimension and considers priority consumers. 2. INTRODUCTION This report seeks to alert the IJB to a further public duty of which we were notified on 8 November 2023 (see appendix 1) which will apply from 1 April 2024, guidance on meeting the duty will be in place by 31 March 2024. The report will explore where this potentially will require to be considered and evidenced as an IJB. 3. DETAIL OF REPORT Consumer Scotland has noted its initial focus in the following areas: Consumer Scotland will use data and analysis to prepare expert reports on key issues facing consumers. These reports will include recommendations to government on how to tackle them. Page 183 Agenda Item 13
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2 The body will engage with businesses, consumer, regulatory and enforcement bodies, the public sector and government at Scottish, UK and local level to ensure consumer rights and interests are at the heart of markets, services and policy development. Its remit will include consumers in vulnerable circumstances and putting consumers at the heart of the transition to Net Zero. The body’s initial focus will be on the key sectors of energy, water and postal services and the impact of the cost of living crisis as set out in its newly- published Workplan for Energy, Post and Water. Projects include improving fairness in the energy market and enabling greater choice in the parcels market. The body is developing its strategy for the medium to longer term through its Interim Strategic Plan, …. Consumer Scotland will build its capacity … and publish its Strategic Plan next Spring. Consumer Scotland has the power to conduct statutory investigations into the most serious issues of consumer harm in Scotland. The body stands ready to support the implementation of the new Consumer Duty on public bodies introduced under the 2020 Act. Integration Joint Boards were not initially considered within scope of the public bodies but given the wide remit of inclusion, fairness and prosperity this was reconsidered and applied. Guidance on application and evidence of meeting of the public duty will be published before 31 March 2024 with further assurance to the IJB on how this will be operationalised. 4. RELEVANT DATA AND INDICATORS None at present but Consumer Scotland activity and reporting will become pertinent in future. 5. CONTRIBUTION TO STRATEGIC PRIORITIES Supportive of approach to equity of service provision. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact None identified at present 6.2 Staff Governance None identified at present 6.3 Clinical and Care Governance None identified at present but may have impacts pending outcomes of Consumer Scotland activity in future. Page 184
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3 7. PROFESSIONAL ADVISORY Further to notification of the forthcoming duty a meeting was convened with the policy unit at Scottish Government to understand the implications and evidentiary requirements of meeting the duty as an IJB. This included the definition of a consumer given that health and social care services are primarily provided based on need as opposed to option. The discussion noted the wider environment impacting on health and social care consumers e.g. impacts of remote and rural service provision which provided relevant context. 8. EQUALITY & DIVERSITY IMPLICATIONS Consumer Scotland is the statutory body designed to promote the collective interests of consumers in Scotland. As an independent body, Consumer Scotland will work with policymakers and key organisations to put consumer rights and interests at the heart of markets and services. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE Not directly applicable to this report. 10. RISK ASSESSMENT This is a broad public duty across sectors. Consideration will be given as to how the IJB will be able to meet any proposed guidance and further dialogue has been offered to support this. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT This duty specifically focusses on the consumer and aligns with other guidance and duties for which the IJB has policy and framework support in place. 12. CONCLUSIONS The IJB is asked to note the additional public duty and the forthcoming guidance. Further assurance on meeting the guidance will be provided to the board. 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 REPORT AUTHOR AND CONTACT Author Name Charlotte Craig Email charlotte.craig@argyll.bute.gov.uk Page 185
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4 Appendix 1 -received by email 8 November 2024 Dear Chief Officer … As you may be aware, the Consumer Scotland Act 2020 established Consumer Scotland as the statutory body for consumer advice and advocacy in Scotland. As part of the process in establishing Consumer Scotland, stakeholder feedback identified the need for comprehensive change in how the interests of consumers are considered and integrated into policy and decision making to ensure that no detriment is brought to them as a result of strategic public body policy decisions. To this end, the Consumer Scotland Act 2020 requires that a relevant public authority must, when making decisions of a strategic nature about how to exercise its functions, consider the impact of those decisions on consumers in Scotland, and the desirability of reducing harm to them. A Consultation on a Consumer Duty for Public Bodies was carried out in 2021 seeking views on the public bodies this Duty should apply to. The Scottish Government published its analysis to this consultation, which can be viewed at A Consultation on a Consumer Duty for Public Bodies – Analysis of Consultation Responses - gov.scot (www.gov.scot). Overall, there was broad support for the Duty to apply to all public bodies in a proportionate manner. The Scottish Government will now progress the necessary legislation to allow this Duty to come into force on 1 April 2024. Consumer Scotland has the legislative responsibility for developing the guidance to support the Duty and will be meeting with stakeholders to seek views from public bodies which will inform the guidance. While the responsibility for issuing the guidance to the Duty sits with Consumer Scotland, Scottish Government officials are still very keen to discuss any issues or queries public bodies may have in relation to the legislation or key principles of the Duty. Should you wish to discuss this in more detail, or believe your organisation already has appropriate governance structures in place and/or covered by a wider corporate body, please let me know and we will discuss further with you. It would also be helpful if you could confirm receipt of this email. An information leaflet is attached which provides further details on the introduction of the Duty which I hope you find helpful. I look forward to hearing back from you. With kind regards Page 186