Agenda Document Pack - Moray Integration Joint Board - 26/10/2023
Moray Council · 26 October 2023
Back to Moray Integration Joint Board — 26 October 2023 and its agenda
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Moray Integration Joint Board Thursday, 26 October 2023 Council Chambers NOTICE IS HEREBY GIVEN that a Meeting of the Moray Integration Joint Board, Council Chambers, Council Office, High Street, Elgin, IV30 1BX on Thursday, 26 October 2023 at 11:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. External Auditors Report to Those Charged with Governance 3 - 62 4. 2022-23 Audited Annual Accounts Report 63 - 134 5. Membership of Board and Committees 135 - 140 Page 1
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Dennis Robertson (Chair) Councillor Tracy Colyer (Vice-Chair) Mr Derick Murray (Voting Member) Mr Sandy Riddell (Voting Member) Councillor Peter Bloomfield (Voting Member) Councillor Scott Lawrence (Voting Member) Councillor Ben Williams (Voting Member) Professor Caroline Hiscox (Ex-Officio) Mr Roddy Burns (Ex-Officio) Mr Ivan Augustus (Non-Voting Member) Mr Sean Coady (Non-Voting Member) Ms Jane Ewen (Non-Voting Member) Mr Stuart Falconer (Non-Voting Member) Mr Graham Hilditch (Non-Voting Member) Dr Paul Southworth (Non-Voting Member) Mrs Val Thatcher (Non-Voting Member) Mr Simon Bokor-Ingram (Non-Voting Member) Professor Duff Bruce (Non-Voting Member) Ms Sonya Duncan (Non-Voting Member) Dr Robert Lockhart (Non-Voting Member) Ms Deborah O'Shea (Non-Voting Member) Ms Elizabeth Robinson (Non-Voting Member) Dr Malcolm Simmons (Non-Voting Member) Ms Tracy Stephen (Non-Voting Member) Mr Kevin Todd (Non-Voting Member) Clerk Name: Caroline O'Connor Clerk Telephone: 07779 999296 Clerk Email: committee.services@moray.gov.uk Page 2
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 26 OCTOBER 2023 SUBJECT: EXTERNAL AUDITORS’ REPORT TO THOSE CHARGED WITH GOVERNANCE BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To request the Moray Integration Joint Board (MIJB) consider the reports to those charged with governance from the Board’s External Auditor for the year ended 31 March 2023. 2. RECOMMENDATION 2.1 It is recommended that the MIJB considers and notes the reports from the External Auditor within APPENDICES 1 and 2. 3. BACKGROUND 3.1 The responsibilities of Audit Scotland as the independent auditor are established by the Local Government (Scotland) Act 1973, the code of Audit Practice (2021), which can be found at Code of Audit Practice and supplementary guidance, and are supported by the auditing profession’s ethical guidance. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The work carried out by Grant Thornton during 2022/23 has produced two reports that are subject to the consideration of those charged with governance. The reports are attached as follows: • Independent Auditors Report to those charged with governance (APPENDIX 1) • The Annual Audit Report 2022/23 (APPENDIX 2) 4.2 The audit opinions expressed were all unqualified and are reported within the ‘independent auditors report’ included within APPENDIX 1. 4.3 The Annual Audit Report included at APPENDIX 2 provides an Action Plan where recommendations for improvement are made, based on the findings of the review. These recommendations have been discussed with management Item 3. Page 3
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and corresponding actions have been agreed, together with timescales for completion. 4.4 The Annual Audit Report provides a summary of the significant audit risks identified during planning. The results and conclusions of this work are noted within the report. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Moray Partners in Care 2019 – 2029” The work of the external auditor and the production of these reports for those charged with governance have been completed within the specified timescales agreed. (b) Policy and Legal The Public Bodies (Joint Working ) (Scotland) Act 2014 requires that the Moray Integration Joint Board (MIJB) is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973. (c) Financial implications There are no direct financial implications arising from this report. (d) Risk Implications and Mitigation The external auditor, Audit Scotland, through the audit process, provides assurance to the Board that the Annual Accounts for 2022/23 give a true and fair view of the financial position. The Annual Audit Report highlights risks identified during the audit process and recommendations for action that have been agreed by management. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report (g) Equalities/Socio Economic Impact None arising directly from this report as there has been no resultant policy change. (h) Climate Change and Biodiversity Impacts There are no direct climate change and biodiversity implications as there has been no change to policy. (i) Directions None arising directly from this report (j) Consultations Consultation has taken place between Audit Scotland and the Chief Financial Officer of the MIJB in preparation of the Annual Audit Report. Any comments received have been considered in writing this report. Page 4
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6. CONCLUSION 6.1 The External Auditor has issued an unqualified opinion for the 2022/23 Annual Accounts. The Annual Audit Report, Independent Auditors’ Report and the Letter of Representation present the full findings. Author of Report: Deborah O’Shea, Interim Chief Financial Officer Background Papers: with author Ref: Page 5
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APPENDIX 1 Independent auditor’s report to the members of Moray Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements We certify that we have audited the financial statements in the annual accounts of Moray Integration Joint Board for the year ended 31 March 2023 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2022/23 (the 2022/23 Code). In our opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the body as at 31 March 2023 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2022/23 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion We conducted our audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. Our responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of our report. We were appointed by the Accounts Commission on 18 May 2022. Our period of appointment is five years, covering 2022/23 to 2026/27. We are independent of the body in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the body. We Item 3. Page 7
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APPENDIX 1 believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Conclusions relating to going concern basis of accounting We have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the body’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on the body’s current or future financial sustainability. However, we report on the body’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement We report in our Annual Audit Report the most significant assessed risks of material misstatement that we identified and our judgements thereon. Responsibilities of the Interim Chief Financial Officer and Moray Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Interim Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Interim Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Interim Chief Financial Officer is responsible for assessing the body’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the body’s operations. The Moray Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Page 8
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APPENDIX 1 Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using our understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the body; • inquiring of the Interim Chief Financial Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the body; • inquiring of the Chief Financial Officer concerning the body’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among our audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which our procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the body’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. Page 9
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APPENDIX 1 A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report We have audited the parts of the Remuneration Report described as audited. In our opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Interim Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. Our responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Our opinion on the financial statements does not cover the other information and we do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In our opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in Page 10
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APPENDIX 1 accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which we are required to report by exception We are required by the Accounts Commission to report to you if, in our opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • we have not received all the information and explanations we require for our audit. We have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to our responsibilities for the annual accounts, our conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in our Annual Audit Report. Use of our report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, we do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Angela Pieri, (for and on behalf of Grant Thornton UK LLP), 110 Queen Street Glasgow G1 3BX Date……………………………………………………………. Page 11
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Commercial in confidence 163,507 168,636 173,830 179,230 184,769 162,139 164,820 167,520 170,377 173,325 (1,368) (3,816) (6,310) (8,853) (11,444) Page 35
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Commercial in confidence 48 International Standard on Auditing ISA (UK) 260, as well as other ISAs, prescribe matters which we are required to communicate with those charged with governance. These are set out in the table below. Our communication plan Audit Plan Annual Report (our ISA 260 Report) Page 60
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 26 OCTOBER 2023 SUBJECT: 2022/23 AUDITED ANNUAL ACCOUNTS BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To submit to the Moray Integration Joint Board (MIJB) the Audited Annual Accounts for the year then ended 31 March 2023. 2. RECOMMENDATION 2.1 It is recommended that the MIJB consider and approve the Audited Annual Accounts for the financial year 2022/23 and the letter of Representation. 3. BACKGROUND 3.1 The Unaudited Annual Accounts for 2022/23 were submitted to the meeting of the Moray Integration Joint Board (MIJB) on 29 June 2023 prior to submission to external audit (paragraph 7 of the Minute refers). 3.2 The Annual Accounts have been prepared in accordance with International Financial Reporting Standards and the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014 and the Local Government in Scotland Act 2003. 4 KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The audit undertaken by the Board’s External Auditors, Grant Thornton is now complete. The External Auditors have expressed unqualified opinions in respect of the financial statements, the remuneration report, the management commentary and the annual governance statement. The Independent Auditor’s Report to the Members of the MIJB and the Accounts Commission is included within the audited Annual Accounts and can be found on page 55. The audited Annual Accounts are attached at APPENDIX 1. 4.2 Attached at APPENDIX 2, is the letter of representation to the External Auditors from the members of the MIJB, for approval by Committee to be signed following this meeting. Item 4. Page 63
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4.3 The audit process highlighted changes to be made to the accounts which in the main were presentational and in parallel with expectation following external audit inspection. 4.3 The Auditor’s Annual Audit Report to the MIJB and the Accounts Commission is the subject of a separate report to this meeting. The report sets out the responsibilities of Grant Thornton as the independent auditor and presents a summary of the findings arising from the 2022/23 audit. The report confirms there are no unadjusted misstatements in the annual accounts to report to those charged with governance. 4.4 The Audited Annual Accounts are presented to this meeting for consideration and approval. Thereafter, the Chief Officer, Interim Chief Financial Officer and the Chair of the Board will sign the accounts prior to submission to Grant Thornton prior to publication. 5 SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Moray Partners in Care 2019 – 2029” The Audited Annual Accounts have been completed within the statutory timescales permitted under the Coronavirus (Scotland) Act 2021 and are being presented for consideration and sign off. (b) Policy and Legal The Public Bodies (Joint Working) (Scotland) Act 2014 requires that the MIJB is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973. In addition, the Coronavirus (Scotland) Act 2021 has been adhered allowing statutory reporting deadlines to be flexed. (c) Financial implications The adjustments and revisions made to the Annual Accounts following the external audit had no financial impact on the MIJB. (d) Risk Implications and Mitigation There are no risk issues arising directly from this report. The work undertaken by Audit Scotland provides assurance to the Board that the Annual Accounts for 2022/23 give a true and fair view in accordance with applicable law and the 2022/23 Code of the state of affairs of the MIJB as at 31 March. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact None arising directly from this report as there is no resultant change in policy. Page 64
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(h) Climate Change and Biodiversity Impacts There are no direct climate change and biodiversity implications as there has been no change to policy. (i) Directions None arising directly from this report (j) Consultations In preparation of the Annual Accounts, consultations have taken place between finance staff of both Moray Council and NHS Grampian who are in agreement within their areas of responsibility. The Chief Officer has been consulted and comments have been considered. 6 CONCLUSION 6.1 Following a completed external audit process and an unqualified opinion being received. The Audited Annual Accounts are presented here for approval and formal sign off. Author of Report: Deborah O’Shea, Interim Chief Financial Officer Background Papers: With author Ref: Page 65
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 Item 4. Page 67
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 If you need information from the Moray Council in a different language or format, such as Braille, audio tape or large print, please contact: ياروم سلجم لبق نم تامولعم لىإ ةجاح ي ف متنك اذإ نوكتو ةغلب وأ ويدوأ ةناوطسأ ،يا ربلا لثم فلتخم لكش لىعوأ ةفلتخم نوكت نأ مط ب لاصّتلإا ءاجّرلاف ةظيلغ فورح لامعتساب ةعوب Jei pageidaujate tarnybos Moray tarybos teikiamą informaciją gauti kitokiu formatu, pvz., Brailio raštu, garso įrašu ar stambiu šriftu, kreipkitės: Jeśli potrzebują Państwo informacji od Rady Okręgu Moray w innym formacie, takim jak alfabet Braille'a, kasety audio lub druk dużą czcionką, prosimy o kontakt: Se necessitar de receber informações por parte do Concelho de Moray num formato diferente, como Braille, cassete áudio ou letras grandes, contacte: Ja Jums vajadzīga informācija no Marejas domes (Moray Council) citā valodā vai formātā, piemēram, Braila rakstā, audio lentā vai lielā drukā, sazinieties ar: ای نابز رگید یسک ےس لسنوک ےروم وک پآرگاتروص راکرد تامولعم ںیم لاثم ںوہ ˝ ،فورح ےڑب ای پیٹ ویڈآ ،ےلیربںیئامرف ہطبار رک امرف ینابرہم وت: Interim Chief Financial Officer to the Moray Integration Joint Board, High Street, Elgin, IV30 1BX accountancy.support@moray.gov.uk Page 68
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 Table of Contents MORAY INTEGRATION JOINT BOARD MEMBERS 2022/23 .............................................. 1 MANAGEMENT COMMENTARY .......................................................................................... 2 STATEMENT OF RESPONSIBILITIES ............................................................................... 25 REMUNERATION REPORT ............................................................................................... 27 ANNUAL GOVERNANCE STATEMENT ............................................................................. 31 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT ..................................... 43 MOVEMENT IN RESERVES STATEMENT ........................................................................ 44 BALANCE SHEET .............................................................................................................. 45 NOTES TO THE FINANCIAL STATEMENTS ..................................................................... 46 Note 1 Significant Accounting Policies ............................................................................. 46 Note 2 Critical Judgements and Estimation Uncertainty .................................................. 47 Note 3 Events after the Reporting Period ........................................................................ 48 Note 4 Expenditure and Income Analysis by Nature ........................................................ 48 Note 5 Taxation and Non-Specific Grant Income ............................................................. 49 Note 6 Debtors ................................................................................................................ 49 Note 7 Usable Reserve: General Fund ............................................................................ 50 Note 8 Agency Income and Expenditure .......................................................................... 51 Note 9 Related Party Transactions .................................................................................. 52 Note 10 VAT .................................................................................................................... 54 Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted .... 54 INDEPENDENT AUDITOR'S REPORT…………………………………………………………..55 Page 69
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 1 MORAY INTEGRATION JOINT BOARD MEMBERS 2022/23 Voting Members Dennis Robertson (Chair) The Grampian Health Board Tracy Colyer (Vice-Chair) Moray Council Sandy Riddell The Grampian Health Board Derick Murray The Grampian Health Board Professor Siladitya Bhattacharya The Grampian Health Board Cllr. Peter Bloomfield Moray Council Cllr. Scott Lawrence Moray Council Cllr. John Divers Moray Council Non-Voting Members Simon Bokor-Ingram Chief Officer Professional Tracy Stephen Chief Social Work Officer Jane Ewen Lead Nurse Professor Duff Bruce Non Primary Medical Service Lead Dr Robert Lockhard GP Lead Dr Malcolm Simmons GP Lead Graham Hilditch Third Sector Stakeholder Val Thatcher Public Partnership Forum Representative Ivan Augustus Carer Representative Stuart Falconer Grampian Health Board Staff Partnership Kevin Todd Moray Council Staff Representative Elizabeth Robinson Public Health Representative Co-opted Members Sean Coady Head of Service and IJB Hosted Services Deborah O’Shea Interim Chief Finance Officer Professor Caroline Hiscox The Grampian Health Board Roddy Burns Moray Council Sonya Duncan Corporate Manager Page 70
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 2 MANAGEMENT COMMENTARY The Role and Remit of the Moray Integration Joint Board The Public Bodies (Joint Working) (Scotland) Act 2014 required that Moray Council and the Grampian Health Board prepared an Integration Scheme for the area of the local authority detailing the governance arrangements for the integration of health and social care services. This legislation resulted in the establishment of the Moray Integration Joint Board (MIJB) that became operational from 1 April 2016. Moray Council and Grampian Health Board, as the parties to the Integration Scheme, each nominate voting members to the MIJB, currently, four elected members from Moray Council and four Grampian Health Board members. Under the Public Bodies (Joint Working) (Scotland) Act 2014, a range of health and social care functions have been delegated from Moray Council and Grampian Health Board to the MIJB who has assumed responsibility for the planning and operational oversight of delivery of integrated services. MIJB also has a role to play in the strategic planning of unscheduled acute hospital based services provided by Grampian Health Board as part of the ‘set aside’ arrangements. Hosted services also form part of the MIJB budget. There are a number of services which are hosted by one of the 3 IJB’s within the Grampian Health Board area on behalf of all the IJBs. Responsibilities include the planning and operational oversight of delivery of services managed by one IJB on a day to day basis. MIJB has responsibility for hosting services relating to Primary Care Contracts and the Grampian Medical Emergency Department (GMED) Out of Hours service. Key Purpose and Strategy Following review and consultation, the refreshed Strategic Plan (2022-2032) is a continuation of the 2019 Strategic Plan. The current plan emphasises the strength of integration and in addition to our two main Partners – Moray Council and the Grampian Health Board - the MIJB recognises the importance of the Third and Independent Sectors in facilitating the successful operation of the partnership of Health & Social Care Moray. As with all health and social care systems Moray is facing increasing demand for services at the same time as resources – both funding and workforce availability - are under pressure. These challenges will intensify in the coming years as our population ages and more people with increasing complex needs require support to meet their health and care needs. The MIJB sets the direction and strategic intent through the development and implementation of the Strategic Plan and seeks assurance on the management and delivery of services through Board level performance reporting which ensures an appropriate level of scrutiny and challenge. The Strategic Plan identifies priority areas to support strategic direction and vision. Page 71
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 3 MANAGEMENT COMMENTARY (continued) STRATEGIC PLAN KEY THEMES The Plan purposefully places an emphasis on prevention and early intervention activities and seeks to prioritise these activities as a long term goal, actively pursuing good health and wellbeing for the population, this will mean hair in this area of work. It highlights the Home First approach and the rationale for this is to assist people in understanding that “hospital is not always the best place for people”, a statement frequently used and in particular if you are frail and elderly can be counter intuitive to a successful recovery. The response to Covid 19 has escalated elements of the Home First approach. Through 2022/23 the recovery from the pandemic has continued to drive a level of transformational change. This pace will need to continue in the next year and beyond as we face significant levels of demand. Our Strategic Plan was refreshed in 2022/23 and a delivery plan is now being produced to reflect the recovery phase that will be needed to deal with day to day demand and a backlog that has accumulated. BUILDING RESILIENCE – Taking greater responsibility for our health and wellbeing HOME FIRST – Being supported at home or in a homely setting as far as possible PARTNERS IN CARE – Supporting citizens to make choices and take control of their care and support WE ARE PARTNERS IN CARE OUR VISION: “We come together as equal and valued partners in care to achieve the best health and wellbeing possible for everyone in Moray throughout their lives.” OUR VALUES: Dignity and respect; person-led; care and compassion; safe, effective and responsive OUTCOMES: Lives are healthier – People live more independently – Experiences of services are positive – Quality of life is improved – Health inequalities are reduced – Carers are supported – People are safe – The workforce continually improves – Resources are used effectively and efficiently Page 72
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 4 MANAGEMENT COMMENTARY (continued) Population Moray is a largely rural area covering a land mass of 2,238 sq. km. It has a long coastline on the Moray Firth with harbours, fishing villages and world-class beaches. The area’s projected population for 2023 is 95,749. The main centre of population is Elgin, which is home to more than one quarter of the people living in Moray. Other towns of population between 5,000 and 10,000 are Forres, Buckie, Lossiemouth and Keith. Moray’s population has grown significantly in recent years from 87,160 in 1997. The population growth in Moray is slowing and it is projected that against the 2018 baseline1 Moray will be one of the 14 councils in Scotland who will have had a population decline by 2030. This trend is forecast to continue. The table below sets out projected population growth based on the 2018 baseline. Across Scotland there is a projected reduction in children, limited change in the working age population, but significant growth in adults of pensionable age. By comparison it is projected that Moray will have a greater decrease in children, a marked decrease in those of a working age, but a significantly higher change in those of a pensionable age. 1 https://www.nrscotland.gov.uk/files//statistics/nrs-visual/sub-nat-pop-proj-18/pop-proj-principal-2018- infographic.pdf Page 73
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 5 MANAGEMENT COMMENTARY (continued) Performance Reporting Performance is reported quarterly to the Audit, Performance and Risk Committee of the MIJB. In addition to the quarterly reporting, there is a requirement under the Public Sector (Joint Working) (Scotland) Act 2014 for the MIJB to produce and publish an Annual Performance Report setting out an assessment of performance in planning and carrying out the delegated functions for which they are responsible. The Annual Performance Report is due to be published by 31 July this year and will be published on the Health & Social Care Moray website. One of the major aims of integration and a key measurable target for MIJB is to reduce the number of Moray residents that are ready to be sent home from hospital but have been delayed in this process. This is referred to as a ‘delayed discharge’. Delayed discharge can occur due to several reasons but quite often involves the onward provision of social care which can be complex in nature. The table below notes performance over a six year period showing the number of delayed discharge bed days occupied varying significantly and with minimal seasonal pattern up to March 2023. There was a significant reduction in delayed discharges in April to June 2020 onwards as the focus of the Covid 19 response in Moray was assessing and finding suitable support for those in hospital (specifically those ready for discharge) to allow for the anticipated influx of Covid 19 patients. Whole system Moray Portfolio meetings, which occur daily, have been taking place with operational staff from all services to ensure system wide awareness of the pressures that might cause issues with patient flow. The meeting begins with an overview of the current status of all services and then provides a platform to support staff with problems that might interrupt flow. It is also an opportunity to deploy available resource to the most critical areas. This has resulted in improved communication, quicker placement and improved flow. In addition to this more care home beds have been made available due to an agreement to pay from offer of care home bed to ensure beds are free on discharge date. This reduction is also in part due to the new classification of delays to discharge in the NHS system introduced across Scotland in February 2023. The new Planned Discharge Date (PDD) system changed the criterion from ‘medically fit’ to ‘clinically fit’. When we declare a person is clinically fit it allows time for occupational therapy, physio-therapy and social work to carry out their assessments before the person is categorised as a delay, and this measure has reduced delays slightly. While this has resulted in longer stays prior to an agreed discharge date it has aligned Moray practice with the rest of Scotland Additionally, the Hospital Discharge Team continues to scrutinise all delays daily and ensure they are still relevant, more people have been recruited into the Care at Page 74
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 6 MANAGEMENT COMMENTARY (continued) Home team enabling more rotas to be opened and there are fewer people requiring double-up care than in recent months Th The Number of Bed Days Occupied by Delayed Discharges 18+ per 1,000 population Jun 22 Sept 22 Dec 22 Mar 23 1,207 1,197 1,063 751 Jun 21 Sept 21 Dec 21 Mar 22 592 784 1,142 1,294 Jun 20 Sept 20 Dec 20 Mar 21 242 803 672 496 Jun 19 Sept 19 Dec 19 Mar 20 768 751 971 1,208 Jun 18 Sept 18 Dec 18 Mar 19 1,008 1,276 1,070 926 Jun 17 Sept 17 Dec 17 Mar 18 1,161 749 823 1,089 e Nu of Bed Days Occupied by Delayed Discharges (inc code 9) 18+ per 1,000 po In relation to Emergency occupied bed days, there continues to be a focus on ensuring people are getting home quickly and can maintain their independence. This had resulted in a long-term downward trend in the rate of emergency occupied bed days for over 65’s per 1,000 population from June 2017 to March 2021. However, since Mar 21 there has been a consistent quarter on quarter increase in the rate resulting in a 51% increase as of March 2023. This reflects the system still under pressure despite the gains made in other measures. The numbers of admissions has not increased along with this and would suggest people are spending more time in hospital impacting this figure. A number of surge beds (ability to house and treat patients above the normal safely staffed bed occupancy when facing extreme pressure) being made available in Moray have contributed to this increase due to increased capacity. Moray’s aging population will also be a factor in this increase as patients over 65 are disproportionately likely to spend time in hospital after the point at which they are ‘fit’ to be transferred or discharged from an acute care setting. This primarily due to the historical lack of capacity in community settings to meet patient needs. Some of the ‘excess’ is also likely to be attributed to access to diagnostics or acute interventions that are not available at Dr Gray’s. For example, Dr Gray’s in-patients routinely wait longer for cardiac angiography than similar cohorts of patients who are initially admitted to ARI. This is only delivered in ARI and Dr Gray’s patients need to be allocated a bed in ARI before transfer for the diagnostic. It is hoped that with the reduction in delayed discharges this figure will decrease in the coming months. As it is a rolling 12 month figure it will therefore have a lag in any improvements made in the system. Page 75
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 7 MANAGEMENT COMMENTARY (continued) Rate of Emergency Occupied Bed Days for over 65’s per 1000 Population Jun 22 Sept 22 Dec 22 Mar 23 2,320 2,469 2,547 2,749 Jun 21 Sept 21 Dec 21 Mar 22 1,859 1,934 2,045 2,140 Jun 20 Sept 20 Dec 20 Mar 21 2,087 2,040 1,840 1,780 Jun 19 Sept 19 Dec 19 Mar 20 2,117 2,097 2,112 2,173 Jun 18 Sept 18 Dec 18 Mar 19 2,380 2,375 2,344 2,274 Jun 17 Sept 17 Dec 17 Mar 18 2,558 2,531 2,495 2,444 Covid 19 Pandemic Recovery Continues During 2022-23 Moray Health and Social Care Partnership (HSCM) remained in a pandemic recovery phase, flexing and stepping up quickly to respond to spikes in Covid 19 infection rates. It was clear it would not be possible in all cases to restore services to pre-pandemic levels as long as enhanced public health measures remained in place. It was further evident that what could be delivered from within existing resources (workforce, infrastructure, and finance) was diminished. Even at this level, the requirement to operate core services alongside the additional measures in place to support the pandemic response meant there was an immediate and ongoing resource impact. The health and social care system was challenged by some significant periods of demand. A pan-Grampian approach was taken in how surge and flow through the system was managed to ensure people in the community and in hospital received the care they required. Moray Integration Joint Board (MIJB) MIJB continues to oversee the delivery of services in line with the Integration Scheme and Strategic Plan. Service have begun to recover from the many challenges created by the coronavirus (Covid 19) pandemic. Service models and methods of delivery have continued to flex and adapt rapidly during this period of transition whilst working with a finite budget allocation. Some services continued to adapt their delivery methods but some continue to face challenges as they continue to implement new ways of working and engaging with our citizens. Services also continue to face the challenges with recruitment to the area and increased staff absences. Page 76
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 8 MANAGEMENT COMMENTARY (continued) Performance The MIJB, its committees and Senior Management Team receive regular assurance reports and updates on how the Strategic Plan commitments are being progressed through work streams and individual service plans, as well as detailed financial and performance updates. The strategic risk register is also reviewed regularly by the Senior Management Team as part of a robust risk monitoring framework in order to identify, assess and prioritise risks related to the delivery of services, particularly any which are likely to affect the delivery of the Strategic Plan. The inherent risks being faced by the Moray MIJB, together with a current assessment on the level of the risks and mitigating actions being taken to reduce the impact of the risks, is reported to each meeting of the Audit Performance and Risk Committee for oversight and assurance. Management teams and the Care and Clinical Governance Group review and respond to any reports produced by Audit Scotland, Healthcare Improvement Scotland, the Care Inspectorate, and the Mental Welfare Commission for Scotland and the Ministerial Strategic Group for Health and Care. Page 77
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 9 MANAGEMENT COMMENTARY (continued) Strategy and Plans The MIJB is required to review their Strategic Plan every three years as per the legislation. The Strategic Plan 2019-2029 was widely consulted to create an ambitious 10-year Plan for Moray. It was recognised that the health and social care landscape has changed but the 2019 Plan purposefully placed an emphasis on prevention and early intervention with the aim of building resilience for individuals and communities. The Plan identified key aims of the MIJB and directed HSCM to work closely with communities and key partners to reform the system of health and social care in Moray. It was also recognised that progress has been made against the three strategic themes and the review of the Plan focused on what already has been achieved. Therefore, the MIJB Strategic Plan 2022-2032 is a continuation of the 2019 Plan and the long-term strategic objectives make room for adapting to challenges and developments in health and social care over the coming years. The current Strategic Plan sets out the following vision and priorities for health and social care services in Moray. Health and Social Care Moray’s strategic plan sets out the 3 key themes and the objectives; • Building Resilience – supporting people to take greater responsibility for their health and wellbeing • Home First; supporting people at home or in a homely setting as far as possible. • Partners in Care – supporting citizens to make choices and take control of their care and support. Longer Term Impact of Covid 19 and Staff Wellbeing There remains real concern that after such a sustained period of additional pressure on staff that their own resilience has been badly hit. This is reflected in the increased staff absence figures in both health and social care staff. NHS Grampian and Moray Council recognise the need to support staff and in order to find the reserves required to continue to respond to the ongoing and future challenges. There has also been a rise in the number of staff choosing to either leave the service or take early retirement. Promoting Health and Wellbeing The We Care staff health and wellbeing programme aims to deliver, co-ordinate and enhance staff wellbeing across NHS Grampian and the Health and Social Care Partnerships. The website has a hub where people can access information, help and advice related to their own and or their team’s physical and mental wellbeing. The Health Improvement Team leads on a number of staff wellbeing initiatives, such as healthy weight, mental health and smoking cessation. They also provide onsite and outreach sessions to staff teams on request. Page 78
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 10 MANAGEMENT COMMENTARY (continued) Moray Council became a Living Wage Accredited employer in September 2022. Additionally, the council holds the Armed Forces Covenant Silver award and are awaiting the outcome of their gold award application. Additionally, to support the age profile and in line with good practice, a Menopause Policy was introduced in April 2023. Recovery and Re-mobilisation Hybrid working The pandemic required HSCM to rapidly embrace new ways of working. This resulted in some staff suddenly working from home on a full-time basis. HSCM faced a huge challenge to ensure all staff had the appropriate equipment to allow this to happen, whilst still supporting staff remotely. A huge benefit from this is the progress we have made in digital technology and skills in a very short time. However, staff can feel isolated and less supported working from home, so we are now concentrating on how we work towards a true hybrid model, where appropriate. Moray Council updated their Flexible Working policy in 2022 to reflect the new ways of working and promotes a high number of flexible working options to help employees balance their work life commitments which supports health and wellbeing Service Delivery/Business as Usual Locality planning resumed with intelligence gathering to build locality profiles. Locality managers continue to develop approaches to community engagement to identify local health and wellbeing priorities for improvement. Locality engagement work continues in the Lossiemouth area to consider future health and wellbeing provision and the impact on patients of the continued closure of the GP branch surgery buildings in Hopeman and Burghead. Vaccination Programme The Vaccination team continue to work hard to ensure the safe and effective delivery of the Vaccination Transformation Programme across Moray. The Spring Booster campaign commenced in March 2023 with a good update across Care Home residents and with the lowered age of 75+ from 80+, increased outreach clinics have been implemented across Moray, delivering vaccines closer to the communities resulting in positive feedback. Pre School-Vaccination data shows Moray update is above the Grampian rates. Page 79
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 11 MANAGEMENT COMMENTARY (continued) The Health Improvement Team continue to work with our partners to support the citizens of Moray to look after their own wellbeing. This includes the information sharing platform on the Facebook page, together with sessions such as hands-on cookery sessions, promoting healthy eating, particularly in low-income communities with vulnerable groups. Baby Steps is a multi-agency, midwife led, interactive programme run in Moray. The sessions provide women with the knowledge and skills to improve their Health and Wellbeing. Baby Steps actively supports women to take small steps towards a healthier pregnancy. The programme has supported 14 women since restarting in July 2022. Care homes in Moray were given the opportunity for supporting services to visit their sites, using the Mobile Information Bus (MIB) to show-case the range of services available locally and nationally that staff can access to enable themselves to support their health and wellbeing. Each session was positively evaluated and interest has now been expressed from other care homes across Moray. At Maryhill surgery there is a new Mental Health and Wellbeing Practitioner. The service has been used to work with individuals suffering with a number of mental health issues, from mood depression, addiction to chronic health conditions. The aim is to use a range of interventions such as reflective listening, mindfulness and teaching coping skills to empower people to meet their needs. Referrals can be made from a range of people and if a referral is not suited to this service contact will still be made with the patient to connect them with a suitable resource. The Learning Disability Service had plans to develop two housing projects. However, due to the increased costs post pandemic, these did not progress as planned. Work is ongoing to try and identify a feasible plan to continue with the project. This remains an important element of service transformation and will allow people to be returned to Moray as per the recent ‘Coming Home’ report guidance. A Social Prescribing test of change is ongoing within the Forres Locality at Forres Health Centre, supported by the Prevention and Self-Management working group. A process is in place which enables all health and social care practitioners to signpost patients to local community supports. Health point, Citizens Advice Bureau, Mental Health & Wellbeing Practitioner and the Listening Service are the main referral services for the test of change, signposting individuals on to local opportunities. A total of 424 referrals have been made to a broad range of community programmes. The Resettlement and Refugee Team have provided support to a total of 133 people (84 adults and 49 children) from Ukraine across Moray. The families were helped to integrate into their communities and also supported into education and employment, with 58% currently employed or in college education. Page 80
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 12 MANAGEMENT COMMENTARY (continued) Longer Term Changes to Strategies and Plans Transformation HSCM continue to progress the Home First approach to supporting people to avoid unnecessary hospital admission and to return home, wherever possible, without delay. This work continues to follow an ambitious model of care, involving all aspects of Home First alongside unscheduled care, primary/secondary care and acute services. The Discharge to Assess (D2A) programme is one of several initiatives that was developed within the Operation Home First Programme. The programme aims are: - • To maintain people safely at home • To avoid unnecessary hospital attendance or admission • To support early discharge back home after essential specialist care D2A aims to impact on the following: • Avoiding unnecessary admission • Reducing length of hospital stay • Lowering re-admission rates • Reducing the requirement for care packages Whilst the driver for this change in practice was embedded in improved patient care and patient outcomes, there was a clear financial benefit. The average length of treatment once discharged home with support from the D2A team was 11 days, calculating into a cost per day, per patient of £169, compared with £262-570 a day for a hospital bed. This showed an increase in early supported discharge from hospital to D2A, resulting in improved flow and capacity of the hospitals. Data also shows that over 50% discharged to the D2A team are also less likely to be readmitted at 7 and 28 days. The success of the D2A programme will likely bring unintended challenges, in that the increase in acuity of the patients being referred, often requiring more input and are slightly more likely to require care now than during the pilot. This is due to the increased complexity and multimorbidities of the patients we are now seeing post pandemic. Page 81
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 13 MANAGEMENT COMMENTARY (continued) Self-Directed Support (SDS) The most commonly assessed need in Moray is for Personal Care, it represents 88% of support required (2021/22).The Self-Directed Support (SDS) team within HSCM currently support 288 individuals who are in receipt of a Direct Payment (Option 1) to meet their care and support needs. The majority of those in receipt of a Direct Payment opt to use their budget to employ their own team of carers (Personal Assistants). Currently there are approximately 380 Personal Assistants (PA’s) working in Moray. In order for the PA profession to be more visible, work is underway at a national level through a PA Programme Board. Carers Strategy Health and Social Care Moray recognise the vital support unpaid carers provide to the person they care for. It is vital that unpaid carers have a life outside of their caring role and are supported to carry on caring as long as they wish to do so. In recognition of his Health and Social Care Moray has recently published the new local Moray Carers Strategy, Recognised, Valued and Supported following engagement with unpaid carers. A local implementation plan has recently been developed to deliver on the key themes and objectives of the strategy. Looking to the future The Scottish Government continues to work towards a National Care Service for Scotland following the recommendation of the Independent Review of adult social care. The National Care Service would operate as a new body to oversee social care, similar to how the National Health Service oversees health, enabling social care to have a more equal footing with health care. It proposes that Local Integration Authorities would have more powers and would be directly funded by national government, rather than receiving their funding from local authorities and Health Boards as they do currently The Scottish Government has now agreed the delegation of Moray Children’s Social Work and Criminal Justice to MIJB. This will be reported on in 2023/24. Page 82
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 14 MANAGEMENT COMMENTARY (continued) Financial Review and Performance Financial performance forms part of the regular reporting cycle to the MIJB. Throughout the year the Board, through the reports it receives is asked to consider the financial position at a given point and any management action deemed as necessary to ensure delivery of services within the designated financial framework. From the mid-point in the financial year, the Board was presented with financial information that included a forecast position to the end of the year. In November 2022 the Board received a financial report which forecast an expected underspend to the end of the financial year of £3.2m. This forecast reduced throughout the remainder of the year and in December 2022, MIJB were forecasting an underspend to the end of the year of £4.6m, the MIJB actually outturned at £4.7m underspent. In March 2022, the MIJB agreed a savings plan of £0.110m. At the end of the financial year, this had been fully achieved. . Given the uncertainties associated with Covid 19 and additional funding, it was necessary to update the Board regularly on the emerging financial position. This was done formally through MIJB meetings and informally through development sessions. To support the response to Covid 19, the Scottish Government continued with the process put in place last year to assess the impact of Covid 19 on Integration Authorities’ budgets. They did this through the local mobilisation plans for each health board area, which in turn captured each Integration Authority. The objective was to demonstrate the impact on IJB budgets and provide appropriate financial support. The local mobilisation plans were updated regularly throughout the year and funding claw back was made by the Scottish Government on the basis of these updates. At the end of the financial year, the cost of the mobilisation plan for Moray was £1.6m. The largest element of spend was £0.664m which was used to support sustainability payments to external providers of care. All unspent funds were returned to the Scottish Government via a negative allocation to NHS Grampian as at 31 March 2023 Additional detail on the areas of spend supported through Covid 19 funding is highlighted in the table below: Description Spend to 31 March 2023 £000’s Additional Staffing Costs 628 Provider Sustainability Payments 664 Remobilisation 119 Cleaning, materials & PPE 7 Elgin Community Hub 181 Total 1,599 Page 83
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 15 MANAGEMENT COMMENTARY (continued) Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 5,743 5,990 (247) Community Nursing104,360 5,626 5,163 463 Learning Disabilities 9,149 12,626 (3,477) 1 Mental Health 10,076 10,295 (219) Addictions 1,611 1,588 23 Adult Protection & Health Improvement 164 167 (3) Care Services Provided In-House 21,193 18,486 2,707 2 Older People Services & Physical & Sensory Disability 20,467 23,441 (2,974) 3 Intermediate Care & OT 1,609 1,768 (159) Care Services Provided by External Contractors 8,882 8,084 798 4 Other Community Services 9,241 9,208 33 Administration & Management 2,786 2,425 361 Other Operational Services 1,355 1,286 69 Primary Care Prescribing 17,322 19,283 (1,961) 5 Primary Care Services 19,048 19,058 (10) Hosted Services 4,844 5,018 (174) Out of Area Placements 669 1,232 (562) 6 Improvement Grants 940 888 52 Total Core Services 140,725 146,006 (5,280) Strategic Funds & Other Resources 18,822 8,858 9,963 TOTALS (before set aside) 159,547 154,864 4,683 Set Aside 13,917 13,917 - TOTAL 173,464 168,781 4,683 The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year Page 84
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 16 MANAGEMENT COMMENTARY (continued) Significant variances against the budget were notably: Note 1 Learning Disabilities – The Learning Disability (LD) service was overspent by £3.5m at the end of 2022/23. This consists of a £3.6m overspend, primarily relating to the purchase of care for people with complex needs, staff transport and less income received than expected. Adults with learning disabilities are some of the most vulnerable people in our community and need a high level of support to live full and active lives. The overspend was offset in part by an underspend of £0.1m, relating primarily to staffing in speech and language and psychology services. The transformational change programme in learning disabilities helps to ensure that every opportunity for progressing people’s potential for independence is taken, and every support plan involves intense scrutiny which in turn ensures expenditure is appropriate to meeting individual outcomes. In the last year we have seen an increase in demand and an increase in the level of cases requiring exceptionally high amounts of care. Note 2 Care Services Provided In-House – This budget was underspent by £2.7m at the end of the year. The most significant variances relate to the Care at Home services for all client groups which are underspent predominantly due to vacancies and issues with recruitment and retention. This is reduced by overspends in internal day services mainly due to transport costs and less income received than expected. Note 3 Older People Services and Physical & Sensory Disability - This budget was overspent by £3m at the end of the year. The final position includes an overspend for domiciliary care in the area teams, which incorporates the Hanover complexes for very sheltered housing in Forres and Elgin and for permanent care due to more clients receiving nursing care than residential care. The ageing population requiring more complex care and local demographics also contributes to this overspend as well as the correlation between the recruitment and retention of the internal home care service provision. Note 4 Care Services provided by External Contractors – This budget was underspent by £0.8m at the end of the year. This predominantly relates to underspends on contracts for Mental Health and Learning Disabilities as contracts have ended and alternative services procured. Note 5 Primary Care Prescribing - This budget was overspent by £2m. The actual data to March indicates that the average item price has increased significantly since June 2022, this has been attributed in part to the continuing impact of short supply causing an increase in prices and general inflationary cost increase. Medicines management practices continue to be applied on an ongoing basis to mitigate the impact of external factors as far as possible and to improve efficiency of prescribing both from clinical and financial perspectives. Note 6 Out of Area Placements – This budget was overspent by £0.56m at the end of the year. This relates to an increase in patients requiring high cost individual placements. Page 85
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 17 MANAGEMENT COMMENTARY (continued) MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 43. At 31 March 2023 there were usable reserves of £4.683m available to the MIJB, compared to £17.02m at 31 March 2022. These remaining reserves of £4.683m are for various purposes as described below: Earmarked Reserves Amount £000’s Primary Care Improvement Plan & Action 15 937 GP Premises 229 Community Living Change Fund 319 National Drugs MAT 61 National Drugs Mission Moray 186 OOH Winter Pressure funding 182 Moray Cervical screening 36 Moray hospital at home 50 Moray interface discharge 139 Moray Psychological 279 MHO Funding 69 Care at Home Investment funding 720 Interim Care Funding 216 Moray Workforce well being 26 Adult Disability payment 45 National Trauma Training services 50 Social Work Capacity in Adult Services 145 Additional investment in H&SC 591 Moray Winter Fund HCSW & MDT 323 LD Annual Health Checks 35 Realistic Medicine 40 Community Planning partnership 5 Total Earmarked 4,683 General Reserves 0 TOTAL Earmarked & General 4,683 Page 86
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 18 MANAGEMENT COMMENTARY (continued) Action 15 – as part of the Mental Health Strategy 2017-2027, Scottish Government Ministers made a commitment to provide funding to support employment of 800 additional mental health workers to improve access. Primary Care Improvement Plan – Scottish Government investment to support the GP contract that was agreed in 2018. Covers 6 priority areas identified by Government. GP Premises – balance of funding for improvement grants including the making of premises improvement grants to GP contractors. The continued digitalisation of paper GP records. Modifications for the purposes of improving ventilation and increase to the space available in NHS owned or leased premises for primary care multi- disciplinary teams. Community Living Change Fund – funding to be used over a three year period (2021- 2024) to support reducing delayed discharge of those with complex needs, repatriate people inappropriately placed outside Scotland and to redesign the way service are provided for people with complex needs. National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). National Drugs Mission Moray – balance of funding for range of activities including: drug deaths, taskforce funding, priorities of national mission, residential rehabilitation, whole family approach, outreach, bear fatal overdose pathways and lived and living experience. Out of Hours Winter Pressure funding – balance of funding to sustain GO out of hours and to support resilience to explore operational solutions. Moray Cervical Screening – balance of funding for smear test catch up campaign. Moray Hospital at home – development of Hospital at Home provides Acute hospital level care delivered by healthcare professionals, in a home context for a condition that would otherwise require acute hospital inpatient care. Moray Interface Care & Discharge without Delay (DWD) - interface care programme is part of the urgent and unscheduled care programme. DWD programme is to prevent delay and reduce length of stay. Moray Psychological – funding streams for mental health, psychological wellbeing, facilities, post diagnostic support and psychological therapies. Mental Health Officer (MHO) funding – funding to support additional mental health officer capacity. Care at Home investment funding – balance of funding to build capacity in care at home community based services. Page 87
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 19 MANAGEMENT COMMENTARY (continued) Interim Care funding – balance of non-recurring funding basis to enable patients currently in hospital to move into care homes and other community settings. Moray Workforce Wellbeing – funding to the health and wellbeing of those working in health and social care. Adult Disability payment – funding to assist with the implementation of the adult disability payments. National Trauma Training services – training for dealing with people affected by trauma and adversity. Social Work Capacity in Adult Services – support measures that general additional adult social care workforce. Additional investment in H&SC – to be invested in front line health and social care. Moray Winter Fund Health Care Social Workers (HCSW) – additional funding for further HCSW in both the IJB and Emergency department. Moray Winter fund Multi Disciplinary Team – additional funding for service pressures includes Discharge to Assess, Home First Frailty team and volunteer development. Learning Disability Annual Health Checks – to implement the annual health checks. Realistic Medicine – investment in the realistic medicine based approach. Community Planning Partnership – funding towards community planning partnership . All reserves are expected to be utilised for their intended purpose during 2023/24. Set Aside – Excluded from the financial performance table above on page 15 but included within the Comprehensive Income & Expenditure Account is £13.92m for Set Aside services. Set Aside is an amount representing resource consumption for large hospital services that are managed on a day to day basis by the NHS Grampian. MIJB has a responsibility for the strategic planning of these services in partnership with the Acute Sector. Set Aside services include: • Accident and emergency services at Aberdeen Royal Infirmary and Dr Gray’s inpatient and outpatient departments; • Inpatient hospital services relating to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine, learning disabilities, old age psychiatry and general psychiatry; and • Palliative care services provided at Roxburgh House Aberdeen and The Oaks Elgin. Page 88
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 20 MANAGEMENT COMMENTARY (continued) The budget allocated to Moray is designed to represent the consumption of these services by the Moray population. As a result of prioritising resources to support the Covid 19 pandemic Public Health Scotland have not produced activity data for Set Aside services since 2019/20 financial year. The figures for 2022/23 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2020/21 (3.00%), 2021/22 (3.36%) and 2022/23 (6.70%): 2022/23 2021/22 2020/21 2019/20 Budget 13.92m 13.04m 12.62m 12.252m Risks, Uncertainties and Future Developments The MIJB Chief Officer has a responsibility to maintain a risk strategy and risk reporting framework. Risks inherent within the MIJB are monitored, managed and reported at each meeting of the Audit, Performance and Risk Committee. In addition, a risk action log is monitored and managed by the Senior Management Team. The key strategic risks of the MIJB classed as ‘High’ and ‘Very High’ are presented below: VERY HIGH Risk 2 - There is a risk of MIJB financial failure in that the demand for services outstrips available financial resources. Financial pressures being experienced both by the funding Partners and Community Planning Partners will directly impact on decision making and prioritisation of MIJB. Mitigating Actions - Risk remains of the challenge that the MIJB can deliver transformation and efficiencies at the pace required whilst dealing with the emerging financial pressures. Financial information is reported regularly to both the MIJB, Senior Management Team and System Leadership Group. The Chief Officer and Interim Chief Financial Officer (CFO) continue to engage in finance discussions with key personnel of both NHS Grampian and Moray Council. The Chief Officer and Interim CFO will continue to engage with the partner organisations in respect of the financial position throughout the year. Cross partnership performance meetings are in place with partner CEOs, Finance Directors and the Chair/Vice Chair of the MIJB. The CFO and Senior Management Team continue to work together to address further savings which will be presented to the Board for approval during 2023/24. This should be a focus of continuous review to ensure any investment is made taking cognisance of existing budget pressures. Page 89
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 21 MANAGEMENT COMMENTARY (continued) HIGH Risk 3 - Inability to recruit and retain qualified and experience staff to provide and maintain sustainable, safe care, whilst ensuring staff are fully able to manage change resulting from response to external factors such as the impact of Covid 19 and the actions that arose from the recommendations from the Independent Review of Adult Social Care 2021. Mitigating Actions - System re-design and transformation. Organisational Development Plan and Workforce plan were updated and approved by MIJB in November 2019 The updated Workforce plan has been submitted to Scottish Government and comments were received by the HSCP in October 2022. Staff Wellbeing is a key focus and there are many initiatives being made available to all staff including training, support, information and access to activities. Locality Managers are developing the Multi-disciplinary teams in their areas and some project officer support has been provided to develop the locality planning model across Moray. Lead Managers are involved in regional and national initiatives to ensure all learning is adopted to improve this position. . Lead Managers and Professional Leads are linked to University Planning for intakes and programmes for future workforce development. Risk 5 - Inability to cope with unforeseen external emergencies or incidents as a result of inadequate emergency and resilience planning. Mitigating Actions – Information from the updated Business Impact Assessments /Business Continuity Plans has informed elements of the Winter Preparedness Plan. A Friday huddle continues, this allows the status of services across the whole system to provide information and contact details to the Senior Manager on Call (SMOC) over the weekend. If any potential issues are highlighted the relevant Persons at Risk Data is compiled and if appropriate, shared with relevant personnel. NHS Grampian have introduced system wide daily huddles to manage the flow and allocation of resources which require attendance from Dr Grays and HSCM. Practitioner group established for Moray with representation from HSCM, Dr Grays, Moray Council and NHS Grampian to discuss matters arising from the Local Resilience Forum and within our respective organisations. In addition it will provide a forum for discussion of the linkages between organisational response plans to ensure there are no gaps or over reliance on particular local resources. Page 90
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 22 MANAGEMENT COMMENTARY (continued) HIGH (continued) HSCM continues to monitor the local situation regarding impacts on staffing and is engaged with NHSG emergency planning arrangements and Council Response and Recovery management team to be ready to escalate response if required. Work was undertaken within NHSG, Aberdeenshire HSCP and Aberdeen City HSCP to look at Surge flows and establish a mechanism that will provide easy identification of “hot spots” across the whole system in Grampian, to facilitate a collaborative approach to addressing the issues through the use of a common Operational Pressure Escalation approach. This work could underpin surge responses in winter and at other times of pressure and having a standard approach across Grampian could aid communication and understanding. Risk 7 - Inability to achieve progress in relation to national Health and Wellbeing Outcomes. Performance of services falls below acceptable level. Mitigating Actions – Service managers monitor performance regularly within their teams and escalate any issues to the System Leadership Group (SLG) for further discussion to provide wider support, developing shared ownership and a greater understanding across the whole system. Key operational performance data is collated and circulated daily to all managers. A Daily dashboard is held on illuminate for managers to access to ensure any potential issues are identified quickly so action can be taken. This dashboard is being reviewed and will be further developed with the intention of further dashboards to provide a whole system overview. This has been discussed at SLG and agreed. Performance information is presented to the Performance sub group of Practice Governance Group to inform Social Care managers of the trends in service demands so that resources can be allocated appropriately. Risk 8 - Inability to progress with delivery of Strategic Objectives and Transformation projects Mitigating Actions - Integrated Infrastructure Group previously established, with ICT representation from NHS Grampian and Moray Council, to consider and provide solutions to data sharing issues and ICT infrastructure matters which is an area that will be taken forward alongside the Moray Growth Deal projects. The Moray Transformation Board has recently restarted and will link to all relevant groups Page 91
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 23 MANAGEMENT COMMENTARY (continued) HIGH (continued) Risk 9 - Requirements for support services are not prioritised by NHS Grampian and Moray Council. Mitigating Actions – Membership of the Board was reviewed and revised to ensure representation of all existing infrastructure processes and funding opportunities. Process for ensuring infrastructure change/investment requests developed. Dr Gray’s strategy (vision for the future) is being produced collaboratively with input from NHSG and HSCM management Development Aims for 2023/24 Home First Home First continues to be a key strategic theme in Moray and has led to changes in the way we provide health and social care safely. Most notable are the developments within frail elderly work stream and delays in discharge. Moray is now part of the National Frail Elderly Collaborative and Hospital at Home Collaborative, the later has the potential to secure short term funding for targeted project enablement. Delayed discharges are lower than they were prior to Covid 19 in Moray, we are one of the few partnerships who have achieved this. Further work will focus on embedding a seamless, responsive, co-ordinated and multi-disciplinary approach and will be driven by participation in the National programmes. Prevention will become a priority, replacing reactive models by ensuring early identification, intervention and planning to prevent poorer outcomes for those living with frailty and multi-morbidity. Home First is linked into regional unscheduled care programmes, primary care plans and acute services to prevent duplication and to ensure joint working that creates the right culture and leadership to create sustainable positive change. Page 92
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 24 MANAGEMENT COMMENTARY (continued) The Strategic Plan 2019-29 was refreshed and adopted in November 2022, Partners in Care 2022-32. The Medium Term Financial Strategy and other supporting plans were reviewed in 2022/23. As the organisation continues to remobilise following the impacts of response, new, transformational ways of working are being adopted and are informing our approach to the delivery of the strategic objectives outlined in the plan. In addition we will seek to: • Continue to develop the system wide daily portfolio meeting to ensure system wide oversight for operational staff at all points of the patient journey • Ensure assurance and governance is part of everything we do • Make links with Community Treatment and Care Service (CTAC), Vaccination Transformation Programme (VTP), Community Response Team (CRT) and Primary Care Improvement Plan (PCIP), in order to ensure a co-ordinated workforce that is reactive to changes in activity. ………………………… ……………………… ……………………… Dennis Robertson Simon Bokor-Ingram Deborah O’Shea Chair of Moray IJB Chief Officer Interim Chief Financial Officer Page 93
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 25 STATEMENT OF RESPONSIBILITIES Responsibilities of the MIJB • To make arrangements for the proper administration of its financial affairs and to secure that it has an officer responsible for the administration of those affairs. In Moray Integration Joint Board, that officer is the Interim Chief Financial Officer; • To manage its affairs to achieve best value in the use of its resources and safeguard its assets; • Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014) and the Local Authority (Capital Financing and Accounting) (Scotland) (Coronavirus) Amendment Regulations 2021, and so far as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003); and • To approve the Annual Accounts. I confirm that the Annual Accounts were approved by the MIJB at its meeting on 26 October 2023. Signed on behalf of the Moray Integration Joint Board Dennis Robertson Chair of Moray IJB Page 94
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 26 STATEMENT OF RESPONSIBILITIES (continued) Responsibilities of the Interim Chief Financial Officer The Interim Chief Financial Officer is responsible for the preparation of the Moray Integration Joint Board’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (the Code). In preparing the Annual Accounts the Interim Chief Financial Officer has: • Selected suitable accounting policies and applied them consistently; • Made judgements and estimates that were reasonable and prudent; • Complied with legislation; and • Complied with the local authority code (in so far as it is compatible with legislation). The Interim Chief Financial Officer has also: • Kept proper accounting records which were up to date; and • Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that the financial statements give a true and fair view of the financial position of the Moray Integration Joint Board as at 31 March 2023 and the transactions for the year then ended Deborah O’Shea FCCA Interim Chief Financial Officer Page 95
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 27 REMUNERATION REPORT Introduction This Remuneration Report is provided in accordance with the Local Authority Accounts (Scotland) Regulations 2014 (SSI2014/200) as part of the MIJB annual accounts. This report discloses information relating to the remuneration and pension benefits of specified MIJB members. All information disclosed in the tables is subject to external audit. Other sections within the Remuneration Report will be reviewed for consistency with the financial statements. Moray Integration Joint Board The voting members of MIJB are appointed through nomination by Moray Council and the Grampian Health Board. There is provision within the Order to identify a suitably experienced proxy or deputy member for both the voting and non-voting membership to ensure that business is not disrupted by lack of attendance by any individual. MIJB Chair and Vice-Chair Nomination of the MIJB Chair and Vice-Chair post holders alternates every 18 months between a Councillor and a Health Board non-executive member. The MIJB does not provide any additional remuneration to the Chair, Vice-Chair or any other board members relating to their role on the MIJB. The MIJB does not reimburse the relevant partner organisations for any voting member costs borne by the partner. The MIJB does not have responsibilities in either the current or in future years for funding any pension entitlements of voting MIJB members. Therefore no pension rights disclosures are provided for the Chair or Vice-Chair. Taxable Expenses 2021/22 Name Position Held Nomination By Taxable Expenses 2022/23 £ £ - Dennis Robertson Vice-Chair 29/04/21 – 01/10/22 Chair 1/10/22 to date Grampian Health Board - - Cllr Tracy Colyer Chair 15/05/22 – 01/10/22 Vice-Chair 01/10/22 - date Moray Council - Page 96
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 28 REMUNERATION REPORT (continued) Officers of the MIJB The MIJB does not directly employ any staff in its own right; however specific post- holding officers are non-voting members of the Board. Chief Officer Under section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 a Chief Officer for the integration joint board has to be appointed and the employing partner has to formally second the officer to the Board. The employment contract for the Chief Officer will adhere to the legislative and regulatory framework of the employing partner organisation. The remuneration terms of the Chief Officer‘s employment are approved by the Board. Other Officers No other staff are appointed by the MIJB under a similar legal regime. Other non- voting board members who meet the criteria for disclosure are included in the disclosures below. Total 2021/22 Senior Employees Salary, Fees & Allowances Total 2022/23 £ £ £ 109,826 Simon Bokor-Ingram Chief Officer 111,100 111,100 - Deborah O’Shea Interim Chief Financial Officer 80,207 80,207 93,904 Tracey Abdy Chief Financial Officer (until 31.3.22) - - In respect of officers’ pension benefits, the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis there is no pensions liability reflected on the MIJB balance sheet for the Chief Officer or any other officers. The MIJB however has a responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the MIJB. The following table shows the MIJB’s funding during the year to support the officers’ pension benefits. The table also shows the total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. Page 97
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 29 NOTE: no bonuses, expenses allowances, compensation for loss of office or any taxable benefits were made in 2022/23 REMUNERATION REPORT (continued) In Year Pension Contributions Accrued Pension Benefits Year to 31/03/22 Year to 31/03/23 As at 31/03/2023 Difference from 31/03/2022 £ £ £ 000’s £ 000’s Simon Bokor- Ingram, Chief Officer 22,954 23,220 Pension 47 4 Lump Sum 88 1 Deborah O’Shea Interim Chief Financial Officer - 11,716 Pension 25 25 Lump Sum 29 29 Tracey Abdy Chief Financial Officer (until 31.3.22) 18,562 - Pension - - Lump Sum - - Disclosure by Pay bands As required by the regulations, the following table shows the number of persons whose remuneration for the year was £50,000 or above, in bands of £5,000. Number of Employees in Band 2021/22 Remuneration Band Number of Employees in Band 2022/23 - £80,000 - £84,999 1 1 £90,000 - £94,999 - 1 £105,000 - £109,999 - - £110,000 - £114,999 1 Page 98
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 30 REMUNERATION REPORT (continued) Exit Packages There were no exit packages agreed by the MIJB during 2022/23 financial year, or in the preceding year. ……………………….. ……………………… Dennis Robertson Simon Bokor-Ingram Chair of Moray IJB Chief Officer Page 99
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 31 ANNUAL GOVERNANCE STATEMENT The Annual Governance Statement describes the Moray Integration Joint Board’s (MIJB) governance arrangements and reports on the effectiveness of the MIJB’s system of internal control. Scope of Responsibility The MIJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, and that public money is safeguarded and used efficiently and effectively in pursuit of best value. In discharging its responsibilities, the MIJB has established arrangements for its governance which includes the system of internal control. This system is intended to manage risk and support the achievement of the MIJB’s policies, aims and objectives. The system provides reasonable but not absolute assurance of effectiveness. The MIJB places reliance of the systems of internal control of NHS Grampian systems and Moray Council, which supports organisational compliance of policies and procedures in addition to those of the MIJB. Assurances are required on the effectiveness of the governance arrangements of all three organisations, meaning a significant failure in one of the three Partners may require to be disclosed in the annual accounts of all three Partners. The Governance Framework The CIPFA/SOLACE framework for ‘Delivering Good Governance in Local Government’ last updated in 2016 remains current and provides a structured approach in defining seven principles that underpin effective governance arrangements. Whilst the framework is written specifically for Local Government, the principles apply equally to integration authorities, and while the MIJB continues to evolve as an entity in its own right. It continues to draw on the governance assurances of NHS Grampian and Moray Council as its principal funding partners. Given the scope of responsibility within the MIJB and the complexities surrounding the assurance arrangements, a Local Code of Corporate Governance was developed and the MIJB assesses the effectiveness of its governance arrangements against the principles set out in the document. The Code outlines the seven governance principles from the CIPFA/SOLACE guidance (as referenced below) and provides the sources of assurance for assessing compliance relative to the MIJB, Moray Council and NHS Grampian. These assurances include referencing the governance arrangements of NHS Grampian and Moray Council which are summarised annually and published in their respective Annual Governance Statements which form part of the annual accounts of each organisation. The respective governance statements can be found on the individual organisations websites: Moray Council: Annual Accounts - Moray Council and NHS Grampian: https://www.nhsgrampian.org/about-us/annual- accounts/ . Page 100
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 32 ANNUAL GOVERNANCE STATEMENT (continued) Key Governance Arrangements Covid 19 had a significant impact on the MIJB and its approach to during the pandemic involved the use of amended governance arrangements granted under delegated powers. Work is now underway to revisit these arrangements to either reinstate them or redesign them, depending on the new ways of working. Consideration will also be given to how they integrate with the other Portfolios across the network in Grampian. Any decisions or changes will be presented to the leadership groups and relevant committees. All of the scheduled Audit Performance and Risk Committee meetings were held as timetabled during 2022/23. An interim arrangement (which is no longer in place at the end of the year) was agreed for the operation of the Clinical and Care Governance Committee whereby the Chair of the Committee received monthly updates on the key issues arising during the pandemic response. This related principally to the provision of care, care home oversight and child and adult protection matters. In addition the Chief Officer committed to providing weekly updates on the emerging situation to IJB Members, elected Members and staff. Health and Social Care Moray (HSCM) established an emergency response group that has been operational since the end of March 2020, with the frequency of meetings being adapted throughout the year dependent on the stage of response. Representation on the emergency response groups of the Partner organisations is provided by HSCM staff, ensuring the necessary links and flow of information to ensure a co-ordinated response on a pan Grampian basis and locally within Moray. The collaborative working across the whole system has continued during the Covid 19 recovery. The use of a Grampian Operation Performance Escalation System (GOPES) was established to enable senior leaders to have oversight of where pressures were located in the system and to direct responses accordingly. This development has also strengthened the identification of key metric thresholds to inform the levels for escalation. Page 101
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 33 ANNUAL GOVERNANCE STATEMENT (continued) Evaluation of the Effectiveness of Governance Governance Principle 1 – Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law Assessment of Effectiveness • The activities of the MIJB are directed by a Board comprising voting and non- voting members. The Board meets every two months and draws its membership from a broad range of sources. Formal Board meetings are augmented by regular development sessions that focus in detail on specific areas. The Board is also supported by an Audit, Performance and Risk Committee, and a Clinical and Care Governance Committee, each with a specific remit to support effective governance arrangements. • The MIJB operates in line with Standing Orders that govern proceedings of the Board and its Committees, and which incorporates the Board’s Scheme of Administration that deals with the Board’s committee structure and working groups. • The MIJB has appointed a Standards Officer to support compliance with an ethical standards framework in line with the Ethical Standards in Public Life etc. (Scotland) Act 2000 whereby members of devolved public bodies such as the MIJB are required to comply with Codes of Conduct, approved by Scottish Ministers, together with guidance issued by the Standards Commission. Page 102
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 34 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 2 – Ensuring openness and comprehensive stakeholder engagement Assessment of Effectiveness • Provision is made within MIJB’s Standing Orders for public and press access to meetings and reports. During the 2022/23 year there was a move to hybrid meetings the need to broadcast live Board meetings continued. A specific web-site has been developed for Health and Social Care Moray and is continuously monitored for improvement. Agendas, reports and minutes for all committees can be accessed via Moray Council website, in addition to all the linked strategies of the MIJB. • Both the voting and non-voting membership arrangements of the MIJB are in line with the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. There are eight voting members, four are elected members appointed by Moray Council and four are non-executive members of the NHS Grampian Board. The non-voting membership comprises six professional members and five stakeholder members representing: staff, third sector bodies carrying out activities in relation to health and social care, service users and unpaid carers, and six additional non-voting members which include the Chief Executives of Moray Council and NHS Grampian in an Ex-officio capacity. The broad membership of the MIJB ensures valued input and engagement from a wide range of stakeholders. • The Community Empowerment (Scotland) Act 2015 places a statutory duty on MIJB and its Community Planning Partners to engage with communities on the planning and delivery of services and securing local outcomes. The MIJB has an approved Communications and Engagement Strategy which recognises and promotes the active and meaningful engagement with all stakeholders. Governance Principle 3 – Defining outcomes in terms of sustainable economic, social and environmental benefits Assessment of Effectiveness • The MIJB refreshed the 2019-2029 Strategic plan in 2022/23, which is supported by various documents including a medium term financial framework. The MIJB Strategic Plan 2022-2032 is a continuation of the 2019 plan and the long-term strategic objectives make room for adapting to challenges and developments in health and social care over the coming years. To deliver on these objectives a 12-month delivery plan is under development. • The plan is underpinned by a performance framework, workforce plan, organisational development strategy, and a communications, engagement and participation plan. Work is ongoing to update the workforce plan, whilst considering how services can transform. • The suite of documents are designed to identify outcomes and forward-thinking on direction over the medium term. Outcomes are closely linked to the delivery of health and social care and the planned improvements for the population of Moray. • A climate change duties report is collated and submitted annually on behalf of the MIJB. Page 103
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 35 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 4 – Determining the interventions necessary to optimise the achievement of intended outcomes Assessment of Effectiveness • The MIJB’s decision making process ensures that the members of the Board receive objective and robust analysis of a variety of options indicating how the intended outcomes will be achieved, providing information on the associated risks and opportunities. • Board papers reflect the broad range of matters under consideration including regular update reports by the Chief Officer on topical matters and agenda items covering opportunities and challenges arising from reconfiguration of services. • The Financial Management Code promoted by CIPFA is recognised as a means of assisting in ensuring good financial administration. A medium term financial strategy was approved by the MIJB in March 2023 and will be reviewed by September 2023 to ensure alignment with the strategic plan, delivery plan and to incorporate the delegation of children’s services. Governance Principle 5 – Developing the entity’s capacity, including the capability of its leadership and the individuals within it Assessment of Effectiveness • The Senior Management teams participated, in a two day Systems Leadership Event led by The Kings Fund. The Systems Leadership Programme to support the leadership teams was paused due to the Covid 19 response. During the Covid 19 response there has been increased opportunity to work collaboratively across organisations through use of new technology. • The MIJB has met with Officers regularly for development sessions to increase the opportunity for shared learning and constructive challenge. Page 104
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 36 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 6 – Managing risk and performance through robust internal control and strong public financial management Assessment of Effectiveness • As part of a robust risk monitoring framework, the Strategic Risk Register is reviewed and updated regularly and presented to every Audit, Performance and Risk Committee. A related action log was created for monitoring purposes and is owned and monitored by the Senior Management Team. • A Performance Management Framework has been developed. Performance reporting falls within the scope of the Audit, Performance and Risk Committee and reporting is quarterly. • The internal control system links closely with those of the Partners, given their operational remit for delivery of services under direction of the MIJB. The Audit, Performance and Risk committee through its consideration of reports monitors the effectiveness of internal control procedures. The MIJB Chief Internal Auditor undertakes an annual review of the adequacy of internal controls and the opinion is included within this statement. • The MIJB has an independent S95 Officer who is a member of the MIJB, providing advice on all financial matters and ensure timely production and reporting of budget estimates, budget monitoring reports and annual accounts. • Governance arrangements have been developed and maintained to comply with the core functions of various good framework guidelines including Code of Practice on Managing the Risk of Fraud and Corruption, Public Sector Internal Audit Standards (incorporating the principles of the Role of the Head of Internal Audit), Audit Committees: Practical Guidance for Local Authorities and Police, etc. Governance Principle 7 – Implementing good practices in transparency, reporting and audit to deliver effective accountability Assessment of Effectiveness • MIJB business is conducted through an approved cycle of Board meetings. During the year, recordings of Board meetings were made available to the public. Agendas, reports and minutes are available for the public to inspect. There is a standard reporting format in place to ensure consistency of approach and consideration by Members to provide transparency in decision making. • The MIJB publishes both Annual Accounts and an Annual Performance Report following Board approval. • The Chief Internal Auditor reports directly to the Audit, Performance and Risk committee with the right of access to the Chief Officer, Interim Chief Financial Officer and Chair of the Audit, Performance and Risk committee on any matter. The Chief Internal Auditor has continued to report to Committee during 2022/23. Page 105
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 37 ANNUAL GOVERNANCE STATEMENT (continued) Review of Adequacy and Effectiveness The MIJB has a responsibility for conducting, at least annually, a review of the effectiveness of the governance arrangements, including the system of internal control. The review is informed by the work of the Senior Management Team (which has responsibility for the development and maintenance of the internal control framework environment); the work of the Internal Auditors and the Chief Internal Auditor’s annual report and the reports from the External Auditor and other review agencies and inspectorates. Internal Audit Opinion Moray Council’s Internal Audit Section delivers the Internal Audit Service for the Moray Integration Joint Board (MIJB), and the Council’s Audit and Risk Manager holds the Chief Internal Auditor appointment to the MIJB until the 31st of March 2024. The Council’s Internal Audit Section has adopted the Public Sector Internal Audit Standards (PSIAS), which require the Chief Internal Auditor to deliver an annual internal audit opinion and report, which has also been used to inform this governance statement. The Chief Internal Auditor’s evaluation of the adequacy and effectiveness of the MIJB framework of governance, risk management and internal control includes consideration of the findings from the audit work undertaken by the Chief Internal Auditor in his role as the Audit and Risk Manager for the Moray Council. Assurance is also sought from the Internal Audit Service Provider for NHS Grampian of the governance processes adopted by that organisation. In addition, reports issued by other external review agencies are considered in the opinion provided by the Chief Internal Auditor. Internal Audit operates independently within the organisation. While there have been challenges due to changes in working practices with officers working from home, management has imposed no limitations on the scope of audit work. In accordance with PSIAS, the Chief Internal Auditor prepares a risk based Audit Plan for the MIJB, which has regard to the internal audit arrangements of both the Moray Council and NHS Grampian functions. The Annual Audit Plan for 2022/23 agreed to the following audits to be undertaken: • Care First System- An exercise to assess system management, security and resilience of the Care First System used for the recording and management of service user’s data. • Self-Directed Support- Review of Self Directed Support financial monitoring arrangements regarding Option 2/3, where care support packages to service users are managed by Health and Social Care Moray or an Individual Service Fund (ISF) Provider. • Information Management- Ensure appropriate system exists in the management, security and transfer of data between the Council and care providers, including NHS Grampian. Page 106
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 38 ANNUAL GOVERNANCE STATEMENT (continued) It is pleasing to report that all audits were undertaken and reported to the MIJB Audit, Performance and Risk Committee. Findings from the reviews detailed significant issues concerning the administrative arrangements in managing service users social care packages, compliance with regulations and recording service user information. In addition to the planned audits, reviews of Moray Council’s financial and administrative systems were also reported to the MIJB Audit, Performance and Risk Committee. This included testing a sample of creditor payments generated under the direction of the Moray Integration Joint Board. The purpose of this audit was to confirm that effective controls are operating to ensure all payments are appropriately authorised, accurate and paid in accordance with regulations and agreed terms and conditions. Findings noted further improvements required in the recording and processing of invoices. Internal Audit reports are regularly presented to members detailing not only findings but also the responses by management to the recommendations with agreed implementation dates. It was decided during the year that Internal Audit would also report the findings from the follow up audits undertaken to confirm the implementation of these recommendations. The follow up reviews completed into the financial monitoring arrangements within the Self Directed Support Team for direct payments made to service users and how Health and Social Care Officers manage income held for individuals under Corporate Appointeeship Arrangements found a number of the recommendations had not been implemented that required revised dates of implementation to be agreed. The Chief Internal Auditor has previously raised concerns regarding an audit report to the Audit, Performance and Risk Committee on 30 March 2023 that detailed the outcome of a review undertaken by a private firm of auditors into how Health and Social Care Moray Commissioning Service manages adult social care contracts. The audit report detailed findings relating to governance, roles and responsibilities, strategy/processes and contract management. A future report will be required by the Chief Internal Auditor to confirm implementation The Chief Internal Auditor, after consideration of the results regarding the work carried out by Internal Audit, taken together with other sources of assurance, with specific reference to the external assessment into how the Commissioning Service manages adult social care contracts; only limited assurance can be provided that the Moray Integration Joint Board has adequate systems of governance and internal control, for the year ended the 31st of March 2023 Page 107
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 39 ANNUAL GOVERNANCE STATEMENT (continued) Prior Year Governance Issues The Annual Governance Statement for 2021/22 highlighted a number of areas for development in looking to secure continuous improvement. An assessment of progress is provided below: Area for Improvement Identified in 2021/22 Action Undertaken / Progress Made in 2022/23 Extending the Hospital Without Walls model to move care closer to home, with a shift to earlier intervention that reduces the demands on acute hospital care. Developing the Portfolio approach for the Moray Portfolio, and the interlink with the other Portfolios in Grampian, along with developing the governance framework for this whole system approach Refresh the Strategic Plan during 2022, building on the learning of the last 2 years of the pandemic, and the transformational change that has begun Using the 2022/23 to 2026/27 Medium Term Financial Framework to match the ambitions of the Strategic Plan so that services are sustainable Work with the Digital Health and Care Innovation Centre as part of the Moray Growth Deal to test new ways of working that benefit the Moray population and bring improvements to the delivery of health and social care Development of Unscheduled Care Action Plan with support from NHS Grampian Transformation Team, with more focus on front door of Dr Grays for earlier intervention. Put in place ambulatory emergency medical capacity in Dr Grays. Joint work with Scottish Ambulance Service around alternatives to conveyance to hospital Continued to develop the local governance with a Portfolio Board approach. Links with other Portfolios strengthened through participation in their Portfolio Boards. Pan Grampian governance approach continues to be developed. IJB Strategic Plan refresh completed. Reflects transition to post pandemic recovery, recognising that we cannot return to pre-pandemic way of delivery. Strategy delivery plan in development Efficiency programme set out with ambition for achieving best outcomes within available resources Creation of 5 living labs to find digital health solutions to health and social are challenges. Aligned to SG Digital Strategy. Includes workforce development, supporting skills and curriculum development Page 108
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 40 Area for Improvement Identified in 2021/22 Action Undertaken / Progress Made in 2022/23 Continue to extend the reach of Self Directed Support with an ambition for Moray to be an exemplar in this arena of supporting our residents in innovative ways that promote independence and choice With the potential delegation of Children’s Social Work and Criminal Justice to the Moray IJB, better align service delivery in the Portfolio to the benefit of our residents, where care is seamless and access is clear Continue to explore innovative solutions to meet personal outcomes through a strength and asset based approach. The development of the Day Opportunities team and SDS Enablers supports this shift and has been recognised for its innovative approach throughout Scotland. This includes an IMPACT story by Health Improvement Scotland and sharing of this at the Carers Leads Meetings and Social Work Scotland. Development plans to be developed in line with audit recommendations and the national SDS Improvement plan to further embed the SDS Standards. Revised Scheme of Integration approved by Scottish Government on March 16th 2023, and now working closely with Moray Council to ensure that governance remains robust during the transition Further Developments Following consideration of the review of adequacy and effectiveness, the following action plan has been established to ensure continual improvement of the MIJB’s governance arrangements and progress against the implementation of these issues will be assessed as part of the next annual review. Areas of focus for 2023/24 1. Assurance and reporting for Children’s Social Work and Justice Services 2. Performance reporting at management level and to IJB APR Committee 3. Development of Strategic Risk Register for the IJB 4. IJB Category 1 responder status and Care for People Plan 5. Delivery against the strategic objectives in IJB Strategic Plan 6. Compliance with audit recommendations and completion of outstanding actions Page 109
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 41 ANNUAL GOVERNANCE STATEMENT (continued) Key Governance challenges going forward will involve: • Providing capacity to meet statutory obligations whilst managing expectations and rising demand for services, with a backlog of demand post Covid 19 pandemic, and the wider societal economic challenges now presented that also potentially drive demand; • As a Board, difficult decisions will be required in balancing how we meet the needs of our community whilst operating within the available resource envelope; • Continue to address our work force challenges in respect of recruitment and retention and where persistent vacancies will necessitate the need for redesign; • Continuing to work closely with NHS Grampian, Moray Council and Moray Community partnership to build on existing relationships and establishing collaborative leadership, and to maximise the opportunities from an expanded health and social care remit with the Portfolio approach, including Dr Grays hospital, and how the IJB contributes to the wider community planning agenda in Moray and the North East; • The challenges being faced from the legacy of the Covid 19 pandemic are expected to be a continued focus for additional scrutiny for an extended period of time, and how well we manage the recovery of service delivery. • Continue to implement the recommendations of internal and external audit, including learning from national reviews. • Work with teams to provide assurance to MIJB that we have clear governance structures for the integration of Children’s Social Work and Criminal Justice Services into the partnership. • Work with teams to ensure governance arrangements adopted during the pandemic and restored to either pre pandemic arrangements or are replaced with new business as usual processes. • Contribute effectively to the national and UK Covid 19 enquiries, recognising the demand on staff time. Page 110
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 42 ANNUAL GOVERNANCE STATEMENT (continued) Statement In our respective roles as Chair and Chief Officer of the MIJB, we are committed to ensuring good governance and recognise the contribution it makes to securing delivery of service outcomes in an effective and efficient manner. This annual governance statement summarises the MIJB’s current governance arrangements, and affirms our commitment to ensuring they are regularly reviewed, developed and fit for purpose. Whilst recognising that improvements are required, as detailed earlier in the statement, it is our opinion that a reasonable level of assurance can be placed upon the adequacy and effectiveness of the MIJB’s governance arrangements. The immediate challenge will be to continue to meet all operational demands as we continue to recover from the Covid 19 pandemic and the legacy that has impacted at a socioeconomic level on our community. Pressure on financial settlements is increasing, and we will continue to engage with our Partners and the wider community to agree plans and outcomes that are both sustainable and achievable. Taking those forward will be challenging as we aim to fulfil the nine Health and Wellbeing national health and well-being outcomes, and the strategic priorities identified and detailed in our Strategic Plan. Good governance remains an essential focus in delivering services in a way that both meets the needs of communities and discharges statutory best value responsibilities. . ………………………… ……………………… Dennis Robertson Simon Bokor-Ingram Chair of Moray IJB Chief Officer Page 111
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 43 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT This statement shows the cost of providing services for the year ended 31 March 2023 according to generally accepted accounting practices. 2021/22 2022/23 Net Expenditure Net Expenditure £ 000 £ 000 5,477 Community Hospitals 5,990 4,932 Community Nursing 5,163 9,691 Learning Disabilities 12,626 9,542 Mental Health 10,295 1,259 Addictions 1,588 158 Adult Protection & Health Improvement 167 16,238 Care Services Provided In-House 18,486 20,536 Older People & Physical & Sensory Disability Services 23,441 1,828 Intermediate Care and Occupational Therapy 1,768 8,271 Care Services Provided by External Providers 8,084 8,460 Other Community Services 9,208 2,404 Administration & Management 2,425 1,192 Other Operational services 1,286 18,310 Primary Care Prescribing 19,283 18,307 Primary Care Services 19,058 4,632 Hosted Services 5,018 832 Out of Area Placements 1,232 758 Improvement Grants 888 7,937 Strategic Funds & Other Resources 8,858 13,044 Set Aside 13,917 153,808 Cost of Services 168,781 (164,487) Taxation and Non-Specific Grant Income (note 5) (156,443) (10,679) (Surplus) or Deficit on provision of Services 12,338 (10,679) Total Comprehensive Income and Expenditure 12,338 There are no statutory or presentational adjustments which reflect the MIJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. Page 112
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 44 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the Moray Integration Joint Boards (MIJB) reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. Additional detail included within note 7 on page 50. Movement of Reserves During 2022/23 General Fund Balance £000 Opening Balance at 1 April 2022 (17,021) Total Comprehensive Income and Expenditure 12,338 (Increase) or Decrease in 2022/23 12,338 Closing Balance at 31 March 2023 (4,683) Movement of Reserves During 2021/22 General Fund Balance £000 Opening Balance at 1 April 2021 (6,342) Total Comprehensive Income and Expenditure (10,679) (Increase) or Decrease in 2021/22 (10,679) Closing Balance at 31 March 2022 (17,021) Page 113
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 45 BALANCE SHEET The Balance Sheet shows the value of the Moray Integration Joint Board’s (MIJB) assets and liabilities as at the balance sheet date. The net assets of the MIJB (assets less liabilities) are matched by the reserves held by the MIJB. 31 March 2022 £000 Notes 31 March 2023 £000 17,021 Short Term Debtors 6 4,683 Current Assets - Short Term Creditors - Current Liabilities - Provisions - Long Term Liabilities 17,021 Net Assets 4,683 17,021 Usable Reserve General Fund 7 4,683 17,021 Total Reserves 4,683 The unaudited annual accounts were issued on 30 June 2023 and the audited annual accounts were authorised for issue on 26 October 2023. . The Annual Accounts present a true and fair view of the financial position of the MIJB as at 31 March 2023 and its income and expenditure for the year then ended. Deborah O’Shea FCCA Interim Chief Financial Officer Page 114
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 46 NOTES TO THE FINANCIAL STATEMENTS Note 1 Significant Accounting Policies General Principles The Financial Statements summarise the Moray Integration Joint Board’s (MIJB) transactions for the 2022/23 financial year and its position at the year-end of 31 March 2023. The MIJB was established under the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. The Financial Statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2022/23, supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. The accounts are prepared on a going concern basis, which assumes that the MIJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: • Expenditure is recognised when goods or services are received and their benefits are used by the MIJB. • Income is recognised when the MIJB has a right to the income, for instance by meeting any terms and conditions required to earn the income, and receipt of the income is probable. • Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet. • Where debts may not be received, the balance of debtors is written down. Funding The MIJB is primarily funded through funding contributions from the statutory funding partners, Moray Council and the Grampian Health Board. Expenditure is incurred as the MIJB commissions’ specified health and social care services from the funding partners for the benefit of service recipients in Moray area. Cash and Cash Equivalents The MIJB does not operate a bank account or hold cash. Transactions are settled on behalf of the MIJB by the funding partners. Consequently the MIJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. The funding balance due to or from each funding partner as at 31 March is represented as a debtor or creditor on the MIJB’s Balance Sheet. Page 115
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 47 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 1 Significant Accounting Policies (continued) Employee Benefits The MIJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The MIJB therefore does not present a Pensions Liability on its Balance Sheet. The MIJB has a legal responsibility to appoint a Chief Officer. More details on the arrangements are provided in the Remuneration Report. The charges from the employing partner are treated as employee costs. Where material the Chief Officer’s absence entitlement as at 31 March is accrued, for example in relation to annual leave earned but not yet taken. Charges from funding partners for other staff are treated as administration costs. Reserves The MIJB’s reserves are classified as either Usable or Unusable Reserves. The MIJB’s only Usable Reserve is the General Fund. The balance of the General Fund as at 31 March shows the extent of resources which the MIJB can use in later years to support service provision. Indemnity Insurance The MIJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board members. The Grampian Health Board and Moray Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. Unlike NHS Boards, the MIJB does not have any ‘shared risk’ exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The MIJB participation in the CNORIS scheme is therefore analogous to normal insurance arrangements. Note 2 Critical Judgements and Estimation Uncertainty In applying the accounting policies, the MIJB has had to make certain judgements about complex transactions or those involving uncertainty about future events. There are no material critical judgements or estimation uncertainty. During the overall Covid 19 response, a number of additional costs have been incurred beyond business as usual. The MIJB has followed national guidance regarding these and a range of additional costs are included in the MIJB’s accounts reflecting the MIJB acting as principal in the transactions including:- • social care sustainability costs; • all increase direct care Covid 19 costs; Page 116
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 48 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 2 Critical Judgements and Estimation Uncertainty (continued) A further range of Covid 19 related costs and associated funding have not been recognised in the MIJB’s accounts in accordance with national accounting guidance. In these cases Moray Council is acting as principal and MIJB as the agent. This includes:- • £0.527m related to PPE and testing kits provided by NHS National Services Scotland to Moray for social care services. Note 3 Events after the Reporting Period The unaudited accounts were issued by Deborah O’Shea, Interim Chief Financial Officer on 29 June 2023 and the audited accounts were authorised for issue on 26 October 2023. Events taking place after this date are not reflected in the financial statements or notes. Note 4 Expenditure and Income Analysis by Nature 2021/22 2022/23 £000 £000 65,020 Services commissioned from Moray Council 71,899 88,760 Services commissioned from The Grampian Health Board 96,852 28 Auditor Fee: External Audit Work 30 153,808 Total Expenditure 168,781 (164,487) Partners Funding Contributions and Non- Specific Grant Income (156,443) (10,679) (Surplus) or Deficit on the Provision of Services 12,338 Page 117
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 49 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 5 Taxation and Non-Specific Grant Income 2021/22 2022/223 £000 £000 50,549 Funding Contribution from Moray Council 59,517 113,938 Funding Contribution from The Grampian Health Board 96,926 164,487 Taxation and Non-specific Grant Income 156,443 The funding contribution from The Grampian Health Board shown above includes £13.917m in respect of ‘set aside’ resources relating to acute hospital and other resources. These are provided by The Grampian Health Board who retains responsibility for managing the costs of providing the services. The MIJB however has responsibility for the consumption of, and level of demand placed on, these resources. Note 6 Debtors 31 March 2022 31 March 2023 £000 £000 15,739 The Grampian Health Board 2,846 1,282 Moray Council 1,837 17,021 Debtors 4,683 Amounts owed by the funding partners are stated on a net basis. Creditor balances relating to expenditure obligations incurred by the funding partners but not yet settled in cash terms are offset against the funds they are holding on behalf of the MIJB. Page 118
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 50 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 7 Usable Reserve: General Fund The MIJB holds a balance on the General Fund for two main purposes: • To earmark, or build up, funds which are to be used for specific purposes in the future, such as known or predicted future expenditure needs. This supports strategic financial management. • To provide a contingency fund to cushion the impact of unexpected events or emergencies. This is regarded as a key part of the MIJB’s risk management framework. The table below shows the movements on the General Fund balance: Earmarked Reserves General Reserves PCIP & Action 15 Covid 19 Other Earmarked Total £000 £000 £000 £000 £000 Balance at 1 April 2021 1,598 1,667 2,725 352 6,342 Transfers (out)/in 2021/22 (341) 664 6,291 4,065 10,679 Balance at 31 March 2022 1,257 2,331 9,016 4,417 17,021 Transfer out 2022/23 (1,257) (1,394) (9,016) (671) (12,338) Transfers in 2022/23 - - - - - Balance at 31 March 2023 - 937 - 3,746 4,683 Primary Care Improvement Fund (PCIP) - The purpose of this fund is to ring fence funding received from the Scottish Government as part of its Primary Care Transformation Plan, this includes Action 15 funding as part of this plan. Covid 19 – are funds received by Scottish Government during 2021/22 being held in an earmarked reserve to support the MIJB through the pandemic and remobilisation.The balance of which was repaid back to Scottish Government. NOTES TO THE FINANCIAL STATEMENTS (continued) Page 119
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 51 Note 8 Agency Income and Expenditure On behalf of all IJB’s within The Grampian Health Board, the MIJB acts as the lead manager for Grampian Medical Emergency Department (GMED) and Primary Care Contracts. It commissions services on behalf of the other IJBs and reclaims the costs involved. The payments that are made on behalf of the other IJBs, and the consequential reimbursement, are not included in the Comprehensive Income and Expenditure Statement (CIES) since the MIJB is not acting as principal in these transactions. The amount of expenditure and income relating to the agency arrangement is shown below: 2021/22 2022/23 £000 £000 9,136 Expenditure on Agency Services 10,139 (9,136) Reimbursement for Agency Services (10,139) - Net Agency Expenditure excluded from the CIES - Page 120
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 52 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions The MIJB has related party relationships with The Grampian Health Board and Moray Council. In particular the nature of the partnership means that the MIJB may influence, and be influenced by, its partners. The following transactions and balances included in the MIJB’s accounts are presented to provide additional information on the relationships. Transactions with the Grampian Health Board 2021/22 2022/23 £000 £000 (113,938) Funding Contributions received from the NHS Board (96,926) 88,558 Expenditure on Services Provided by the NHS Board 96,695 202 Key Management Personnel: Non-Voting Board Members 157 (25,178) Net Transactions with The Grampian Health Board (74) Key Management Personnel: The Chief Officer and Chief Financial Officer, are non- voting Board members and are both employed by The Grampian Health Board and recharged to the MIJB. Details of the remuneration of both officers are provided in the Remuneration Report. The Chief Officer is a joint appointment made by Moray Council and The Grampian Health Board and is jointly accountable to the Chief Executives of both organisations, as such this post is jointly funded. The Chief Financial Officer, whilst a Board appointment, does not share this arrangement of funding. Balances with the Grampian Health Board 31 March 2022 31 March 2023 £000 £000 15,739 Debtor balances: Amounts due from The Grampian Health Board 2,846 15,739 Net Balance due from The Grampian Health Board 2,846 Page 121
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 53 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions (continued) Transactions with Moray Council 2021/22 2022/23 £000 £000 (50,549) Funding Contributions received from the Council (59,517) 64,970 Expenditure on Services Provided by the Council 71,852 78 Key Management Personnel: Non-Voting Board Members 77 14,499 Net Transactions with Moray Council 12,412 Balances with Moray Council 31 March 2022 31 March 2023 £000 £000 1,282 Debtor balances: Amounts due from Moray Council 1,837 1,282 Net Balance due from Moray Council 1,837 Page 122
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 54 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 10 VAT The MIJB is not registered for VAT and as such VAT is settled or recovered by the partners. The VAT treatment of expenditure in the MIJB accounts depends on which of the partners is providing the services as each of these partners are treated differently for VAT purposes. VAT payable is included as an expense only to the extent that it is not recoverable from Her Majesty’s Revenue and Customs. VAT receivable is excluded from income. Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted The Code requires the MIJB to identify any accounting standards that have been issued but have yet to be adopted and could have material impact on the accounts. There are no accounting standards issued but not yet adopted that impact on the 2022/23 financial statements. Page 123
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 55 INDEPENDENT AUDITOR’S REPORT Independent auditor’s report to the members of Moray Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements We certify that we have audited the financial statements in the annual accounts of Moray Integration Joint Board for the year ended 31 March 2023 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the financial statements, including significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2022/23 (the 2022/23 Code). In our opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the body as at 31 March 2023 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2022/23 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion We conducted our audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. Our responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of our report. We were appointed by the Accounts Commission on 18 May 2022. Our period of appointment is five years, covering 2022/23 to 2026/27. We are independent of the body in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. Non- audit services prohibited by the Ethical Standard were not provided Page 124
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 56 INDEPENDENT AUDITOR’S REPORT (Continued) to the body. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Conclusions relating to going concern basis of accounting We have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the body’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on the body’s current or future financial sustainability. However, we report on the body’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement We report in our Annual Audit Report the most significant assessed risks of material misstatement that we identified and our judgements thereon. Responsibilities of the Interim Chief Financial Officer and Moray Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Interim Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Interim Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Interim Chief Financial Officer is responsible for assessing the body’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the body’s operations. The Moray Integration Joint Board is responsible for overseeing the financial reporting process. Page 125
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 57 INDEPENDENT AUDITOR’S REPORT (Continued) Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using our understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the body; • inquiring of the Interim Chief Financial Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the body; • inquiring of the Chief Financial Officer concerning the body’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among our audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which our procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the body’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override Page 126
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 58 INDEPENDENT AUDITOR’S REPORT (Continued) of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report We have audited the parts of the Remuneration Report described as audited. In our opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Interim Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. Our responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Our opinion on the financial statements does not cover the other information and we do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Page 127
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 59 INDEPENDENT AUDITOR’S REPORT (Continued) Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In our opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which we are required to report by exception We are required by the Accounts Commission to report to you if, in our opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • we have not received all the information and explanations we require for our audit. We have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to our responsibilities for the annual accounts, our conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in our Annual Audit Report. Page 128
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APPENDIX 1 Moray Integration Joint Board Annual Accounts 2022/23 60 INDEPENDENT AUDITOR’S REPORT (Continued) Use of our report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, we do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Angela Pieri, (for and on behalf of Grant Thornton UK LLP), 110 Queen Street Glasgow G1 3BX Date……………………………………………………………. Page 129
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APPENDIX 2
Health & Social Care Moray
Simon Bokor-Ingram
Chief Officer
Health & Social Care Moray
Moray Council HQ
High Street
ELGIN IV30 1BX
01343 563552
hscmchiefofficer@moray.gov.uk
www.hscmoray.co.uk
Grant Thornton UK LLP
110 Queen Street,
Glasgow
G1 3BX
Dear Sirs
Moray Integration Joint Board
Financial Statements for the year ended 31 March 2023
This representation letter is provided in connection with the audit of the financial
statements of Moray Integration Joint Board (the “IJB”) for the year ended 31 March
2023 for the purpose of expressing an opinion as to whether the IJB’s financial
statements are presented fairly, in all material respects in accordance with
International Financial Reporting Standards, and the CIPFA/LASAAC Code of
Practice on Local Authority Accounting in the United Kingdom 2022/23 and
applicable law.
We confirm that to the best of our knowledge and belief having made such inquiries
as we considered necessary for the purpose of appropriately informing ourselves:
Financial Statements
i. We have fulfilled our responsibilities for the preparation of the IJB’s financial
statements in accordance with International Financial Reporting Standards
and the CIPFA/LASAAC Code of Practice on Local Authority Accounting in
the United Kingdom 2022/23 ("the Code"); in particular the financial
statements are fairly presented in accordance therewith.
ii. We have complied with the requirements of all statutory directions affecting
the IJB and these matters have been appropriately reflected and disclosed in
the financial statements.
iii. The IJB has complied with all aspects of contractual agreements that could
have a material effect on the financial statements in the event of non-
Item 4.
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compliance. There has been no non-compliance with requirements of any regulatory authorities that could have a material effect on the financial statements in the event of non-compliance. iv. We acknowledge our responsibility for the design, implementation and maintenance of internal control to prevent and detect fraud. v. We are satisfied that the methods, the data and the significant assumptions used by us in making accounting estimates and their related disclosures are appropriate to achieve recognition, measurement or disclosure that is reasonable in accordance with the Code and adequately disclosed in the financial statements. In this context we confirm there are no significant assumptions and accounting estimates. vi. Except as disclosed in the financial statements: a. there are no unrecorded liabilities, actual or contingent b. none of the assets of the IJB has been assigned, pledged or mortgaged c. there are no material prior year charges or credits, nor exceptional or non-recurring items requiring separate disclosure. vii. Related party relationships and transactions have been appropriately accounted for and disclosed in accordance with the requirements of International Financial Reporting Standards and the Code. viii. All events subsequent to the date of the financial statements and for which International Financial Reporting Standards and the Code require adjustment or disclosure have been adjusted or disclosed. ix. Actual or possible litigation and claims have been accounted for and disclosed in accordance with the requirements of International Financial Reporting Standards. x. We have no plans or intentions that may materially alter the carrying value or classification of assets and liabilities reflected in the financial statements. xi. We have updated our going concern assessment. We continue to believe that the IJB financial statements should be prepared on a going concern basis and have not identified any material uncertainties related to going concern on the grounds that : a. the nature of the IJB means that, notwithstanding any intention to cease its operations in their current form, it will continue to be appropriate to adopt the going concern basis of accounting because, in such an event, services it performs can be expected to continue to be delivered by related public authorities and preparing the financial statements on a going concern basis will still provide a faithful representation of the items in the financial statements b. the financial reporting framework permits the entry to prepare its financial statements on the basis of the presumption set out under a) above; and c. the IJB system of internal control has not identified any events or conditions relevant to going concern. Page 132
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We believe that no further disclosures relating to the IJB’s ability to continue as a going concern need to be made in the financial statements xii. The IJB has complied with all aspects of ring-fenced grants that could have a material effect on the IJB’s financial statements in the event of non- compliance. Information Provided xiii. We have provided you with: a. access to all information of which we are aware that is relevant to the preparation of the IJB’s financial statements such as records, documentation and other matters; b. additional information that you have requested from us for the purpose of your audit; and c. access to persons within the Council and NHS via remote arrangements from whom you determined it necessary to obtain audit evidence. xiv. We have communicated to you all deficiencies in internal control of which management is aware. xv. All transactions have been recorded in the accounting records and are reflected in the financial statements. xvi. We have disclosed to you the results of our assessment of the risk that the financial statements may be materially misstated as a result of fraud. xvii. We have disclosed to you all information in relation to fraud or suspected fraud that we are aware of and that affects the IJB and involves: a. management; b. employees who have significant roles in internal control; or c. others where the fraud could have a material effect on the financial statements. xviii. We have disclosed to you all information in relation to allegations of fraud, or suspected fraud, affecting the financial statements communicated by employees, former employees, analysts, regulators or others. xix. We have disclosed to you all known instances of non-compliance or suspected non-compliance with laws and regulations whose effects should be considered when preparing financial statements. xx. We have disclosed to you the identity of the IJB’s related parties and all the related party relationships and transactions of which we are aware. xxi. We have disclosed to you all known actual or possible litigation and claims whose effects should be considered when preparing the financial statements. Page 133
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Annual Governance Statement xxii. We are satisfied that the Annual Governance Statement (AGS) fairly reflects the IJB’s risk assurance and governance framework and we confirm that we are not aware of any significant risks that are not disclosed within the AGS. Narrative Report xxiii. The disclosures within the Narrative Report fairly reflect our understanding of the IJB’s financial and operating performance over the period covered by the IJB’s financial statements. Approval The approval of this letter of representation was minuted by the IJB Board at its meeting on 26 October 2023. Yours faithfully Simon Bokor-Ingram Chief Officer, Moray HSCP and Moray Portfolio Lead Signed on behalf of the Moray Integration Joint Board Page 134
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 26 OCTOBER 2023 SUBJECT: MEMBERSHIP OF BOARD AND COMMITTEES BY: CORPORATE MANAGER 1. REASON FOR REPORT 1.1. To inform the Board of changes to Membership of the Moray Integration Joint Board (MIJB), Audit, Performance and Risk Committee and Clinical and Care Governance Committee (CCG). 2. RECOMMENDATION 2.1. It is recommended that the Board notes: i) the confirmation of appointment of a new member to the MIJB following changes to Moray Council’s committee appointments; ii) the vacancies in National Health Service (NHS) voting membership and Service User Stakeholder position; and iii) the updated membership of Board and committees attached at APPENDIX 1 3. BACKGROUND 3.1 The Public Bodies Joint Working (Scotland) Act 2014 (“the Act”) and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (“the Order”) make provisions about various matters including the membership of the MIJB. As a minimum this must comprise voting members nominated from the NHS Board and Council; co-opted non-voting members who are holders of key posts with the NHS and Council or the MIJB; and co-opted non-voting members who are representatives of groups who have an interest in the MIJB. There is flexibility to appoint additional non-voting members as the Board sees fit. The Moray Health and Social Care Integration Scheme (“Integration Scheme”) outlines certain agreed provisions re membership (and includes the specific provisions taken from the Act and the Order). 4. KEY MATTERS RELEVANT TO RECOMMENDATION Item 5. Page 135
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4.1. Following two resignations from the NHS Grampian Board a reshuffle of NHS Grampian members on Integration Joint Boards (IJBs) in Aberdeen City, Aberdeenshire and Moray took place to manage these vacancies in IJB membership until their replacements are appointed by Scottish Government. As of 17 October 2023, Professor Bhattacharya moved to Aberdeen City IJB. This means MIJB is currently reduced to 3 NHS voting members. 4.2. Cllr Ben Williams joins the MIJB, following changes to Moray Council’s committee appointments. 4.3. Ms Thatcher has resigned from her position as Service User Stakeholder. The recruitment process to fill the vacancy will be followed in due course. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-32” Effective governance arrangements support the development and delivery of priorities and plans. (b) Policy and Legal The Board, through its approved Standing Orders for Meetings, established under the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014, ensures that affairs are administered in accordance with the law, probity and proper standards. (c) Financial implications There are no financial implications arising as a direct result of this report. (d) Risk Implications and Mitigation There are no risk implications arising as a direct result of this report. (e) Staffing Implications There are no staffing implications arising as a direct result of this report. (f) Property There are no property implications arising as a direct result of this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required as the report is to inform the Board of changes required to membership of the Board and CCG Committee. (h) Climate Change and Biodiversity Impacts None arising from this report. (i) Directions None arising from this report. (j) Consultations Consultation on this report has taken place with Chief Officer – Health and Social Care Moray and Caroline O’Connor, Committee Services Officer, Moray Council, who are in agreement with the report. Page 136
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6. CONCLUSION 6.1. This paper sets out the position in relation to the membership of MIJB. Author of Report: Isla Whyte, Interim Support Manager Background Papers: None Ref: Page 137
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APPENDIX 1 Moray Integration Joint Board Vacancies – as at 18 October 2023 Moray Integration Joint Board 4 Council voting members Tracy Colyer (Vice-Chair) Ben Williams Peter Bloomfield Scott Lawrence 4 NHS Grampian voting members Dennis Robertson (Chair) Derick Murray Sandy Riddell Vacancy Third Sector Stakeholder Graham Hilditch NHS Grampian Staff Representative Stakeholder Member Stuart Falconer Carer Stakeholder Ivan Augustus Service User Stakeholder Vacancy Moray Council Staff Representative Kevin Todd Chief Officer Professional Simon Bokor-Ingram Chief Social Work Officer Tracy Stephen Lead Nurse Jane Ewen GP Lead Dr Robert Lockhart Dr Malcolm Simmons Non Primary Medical Services Lead Prof Duff Bruce Additional Member Elizabeth Robinson Audit, Performance and Risk Members (note chair needs to be alternate partnership member to the Chair of MIJB) 2 Council voting members Ben Williams Scott Lawrence (Chair) 2 Health Board voting members Sandy Riddell Derick Murray Third Sector Stakeholder Graham Hilditch NHS Grampian Staff Representative Stakeholder Member Stuart Falconer Clinical and Care Governance Members 2 Council voting member Cllr Peter Bloomfield Cllr Scott Lawrence 2 Health Board voting member (Chair) Derick Murray (Chair) Vacancy Carer Stakeholder Ivan Augustus Service User Stakeholder Vacancy Third Sector Stakeholder Graham Hilditch Moray Council Staff Representative Kevin Todd Chief Officer Professional Simon Bokor-Ingram Chief Social Work Officer Tracy Stephen Lead Nurse Jane Ewen Item 5. Page 139
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APPENDIX 1 GP Lead Dr Robert Lockhart and Dr Malcolm Simmons Non Primary Medical Services Lead Prof Duff Bruce Additional Member Elizabeth Robinson Page 140