Agenda Document Pack - Moray Integration Joint Board - 27/03/2025
Moray Council · 27 March 2025
Back to Moray Integration Joint Board — 27 March 2025 and its agenda
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Moray Integration Joint Board Thursday, 27 March 2025 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, 27 March 2025 at 09:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 30 January 2025 5 - 10 4. Action Log of 30 January 2025 11 - 12 5. Minutes - for noting 5a Minute of meeting Audit Performance and Risk Committee of 26 September 2024 13 - 18 5b Minute of meeting Clinical and Care Governance Committee of 28 November 2024 19 - 22 6. Chief Officer Report 23 - 28 7. Revenue Budget and Recovery Plan 2025-26 29 - 94 8. Medium Term Financial Framework 2025-26 - 2029-30 95 - 112 Page 1
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9. Health and Social Care Moray Strategic Delivery Plan 2025-28 113 - 142 10. Equalities Mainstreaming Progress Report 2021-2024 143 - 162 Item(s) which the Committee may wish to consider with the Press and Public excluded 11. CONFIDENTIAL Care at Home • 9. Information on terms proposed or to be proposed by or to the Authority; Watching the Meeting You can watch the webcast live by going to: http://www.moray.gov.uk/moray_standard/page_43661.html Webcasts are available to view for 1 year following the meeting. You can also attend the meeting in person, if you wish to do so, please come to the High Street entrance door and a member of staff will be let into the building. Page 2
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Dennis Robertson (Chair) Councillor Peter Bloomfield (Voting Member) Councillor Elaine Kirby (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Derick Murray (Voting Member) Mr Sandy Riddell (Voting Member) Mr Alex Stephen (Voting Member) Councillor Ben Williams (Voting Member) Dr Adam Coldwells (Ex-Officio) Ms Karen Greaves BEM (Ex-Officio) Mr John Mundell (Ex-Officio) Mr Ivan Augustus (Non-Voting Member) Professor Duff Bruce (Non-Voting Member) Mrs Sheila Brumby (Non-Voting Member) Mr Sean Coady (Non-Voting Member) Ms Sonya Duncan (Non-Voting Member) Ms Jane Ewen (Non-Voting Member) Dr Robert Lockhart (Non-Voting Member) Mr Jim Lyon (Non-Voting Member) Ms Deirdre McIntyre (Non-Voting Member) Ms Deborah O'Shea (Non-Voting Member) Ms Judith Proctor (Non-Voting Member) Ms Elizabeth Robinson (Non-Voting Member) Dr Malcolm Simmons (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 3
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MINUTE OF MEETING OF THE MORAY INTEGRATION JOINT BOARD Thursday, 30 January 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Ivan Augustus, Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Dr Adam Coldwells, Ms Sonya Duncan, Ms Jane Ewen, Councillor Elaine Kirby, Councillor Scott Lawrence, Mr Jim Lyon, Ms Deirdre McIntyre, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Mr Dennis Robertson, Ms Elizabeth Robinson, Dr Malcolm Simmons, Mr Alex Stephen, Mr Kevin Todd, Councillor Ben Williams APOLOGIES Professor Duff Bruce, Dr Robert Lockhart, Mr John Mundell IN ATTENDANCE Planning, Innovation and Programmes Directorate, NHS Grampian; Programme Manager (NHS Grampian General Practice Vision Programme); Consultant in Public Health Medicine/Immunisation Coordinator and Vaccination Planning Manager, both Public Health, NHS Grampian; Corporate Programme Manager; Head of Governance, Strategy and Performance and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Dennis Robertson. 2. Declaration of Member's Interests The Board noted there were no declarations of member's interest. 3. Minute of meeting of 28 November 2024 The minute of the meeting of 28 November 2024 was submitted and approved. Item 3. Page 5
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4. Action Log of 28 November 2024 The Action Log of the meeting of 26 November 2024 was discussed and updated accordingly. 5. Minute of Special Meeting of 20 November 2024 The minute of the Special Meeting of 20 November 2024 was submitted and approved. 6. Minute of meeting Clinical and Care Governance Committee of 29 August 2024 The Board noted the minute of the meeting of the Clinical and Care Governance Committee of 27 June 2024. 7. Chief Officer Report The meeting had before it a report by the Chief Officer informing the Board of the Chief Officer activities that support the delivery against the Moray Integration Joint Board's (MIJB's) strategic priorities articulated in the Strategic Plan, and the delivery against the 9 Health and Wellbeing outcomes. During discussion Mr Todd asked for more detail on the positive changes made by the Discharge to Access Team joining forces with the START team (care at home enablement team) referenced in paragraph 3.1 in order to provide assurance discharges are safe. In response the Chief Officer offered to arrange a development session on the positive change work being done in relation to discharges with a further report to come back to the Board. Following consideration the Board unanimously agreed:- (i) to note the content of the report; (ii) that transforming services to meet the aspirations of the MIJB's Strategic Plan remains a priority; and (iii) that the Chief Officer arrange a development session on the positive change work being done in relation to discharges with a further report to come back to the Board. 8. Revenue Budget Monitoring Quarter 3 for 2024-25 The meeting had before it a report by the Chief Financial Officer updating the Moray Integration Joint Board (MIJB) of the current Revenue Budget reporting position as at 31 December 2024 for the MIJB budget. Following consideration the Board unanimously agreed to:- (i) note the financial position of the Board as at 31 December 2024 is showing an overspend of £4,841,788 on core services; (ii) note the provisional forecast position for 2024/25 of an overspend of £5,889,502 on total budget for core services; Page 6
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(iii) note the progress against the approved savings plan in paragraph 6, and Appendix 4; (iv) note the budget pressures and emerging budget pressure as detailed in paragraph 7; (v) note the revisions to staffing arrangements dealt with under delegated powers and in accordance with financial regulations within the Council (MC) and NHS Grampian (NHSG) for the period 1 October to 31 December 2024 as shown in Appendix 3; and (vi) approve Directions for issue as set out at Appendix 5 to NHS Grampian and Moray Council. 9. North East Route Map for Strategic Change The meeting had before it a report by the Chief Officer providing a brief overview of the North East Route Map for Strategic Change. Following consideration the meeting unanimously agreed to:- (i) provide comment on the Grampian Strategic Change Board terms of reference at Appendix 1; (ii) endorse the establishment of the Grampian Strategic Change Board; (iii) endorse the collaborative approach proposed to develop a Route Map for Strategic Change; and (iv) agree that the IJB Chief Officers should actively participate in the development and implementation of the Route Map for Strategic Change and work collaboratively with other partners to ensure the success of this crucial transformation program. 10. General Practice Vision and Objectives Update The meeting had before it a report by the Programme Manager, GP Vision Programme updating the Board on the outcomes and recommendations of the NHS Grampian General Practice (GP) Vision programme and seeking endorsement of the vision and SMART objectives related to the programme. In relation to Demand Measurement through GP Systems referenced at paragraph 4.9, Councillor Kirby asked for more detailed information, specifically how and when it would be done and whether it would involve patient engagement. In response, the Programme Manager (NHSG General Practice Vision Programme) advised she would provide a written answer for Board members. Following consideration the Board unanimously agreed:- (i) to note the content of the report as an update on current progress on the GP Vision Programme; and (ii) a report be brought back to the Board with a further annual update in spring 2026. Page 7
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11. Grampian Vaccination and Immunisation Annual Report 2024 The meeting had before it a report updating the Board with an annual monitoring report of vaccine preventable disease surveillance data, along with uptake data for each vaccine delivered within Grampian to provide assurance. Following consideration the Board unanimously agreed:- (i) to note the findings of the Vaccination and Immunisation Annual Report 2024 attached as Appendix 1; and (ii) annual monitoring reporting continues to the Board. 12. Charging for Services The meeting had before it a report by the Chief Financial Officer asking the Board to consider the charges for services for the 2025/26 financial year. Following consideration the Board unanimously agreed to:- (i) adhere to the request of the Moray Council that the MIJB recommend to them, the charges for the services delivered within the delegated functions; (ii) approve the charges set out at Appendix 1 for recommendation to Moray Council for approval and inclusion into their budget setting processes; and (iii) note the recommended charges will be subject to assessment for the socio- economic impact and reported back to the MIJB where there is significant impact and no mitigation. 13. Children’s Services Plan 2023-2026 - Annual Report for 2023-2024 The meeting had before it a report by the Interim Chief Social Work Officer presenting the draft Children's Services Plan 2023-24 Annual Report to the Board. Following consideration the Board unanimously agreed to:- (i) approve the Children’s Services Plan 2023-2024 Annual report attached as Appendix 1; and (ii) note when both the Community Planning Board and the Moray Integrated Joint Board have approved the report, a finalised version will be submitted to the Scottish Government and published on the Community Planning Board website. 14. Carefirst Replacement - Update The meeting had before it a report by the Interim Head of Service and Chief Social Work Officer informing the Board of the progress of the replacement Social Work and Social Care case management system and outline business case. Following consideration the Board unanimously agreed to:- (i) approve the outline business case at Appendix 1; Page 8
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(ii) note the amended project timescales at Appendix 2; and (iii) note approval for funding will be subject of a future report following the outcome of the tender process and further details are known. 15. Getting it Right for Everyone The meeting had before it a report by the Deputy Head of Service informing the Board of progress of the national Getting it Right for Everyone (GIRFE) programme, the involvement of Health and Social Care Moray (HSCM) as a GIRFE partner, and the collaborative GIRFE approaches being taken by partners in Grampian. Following consideration the Board unanimously agreed to:- (i) consider and note the content of the report; (ii) endorse the collaborative whole system approach being taken in Moray and by partners across Grampian; and (iii) receive further reports detailing how GIRFE is being embedded in Moray. 16. Chair of Moray Integration Joint Board The meeting had before it a report by the Standards Officer asking the Board to agree a temporary change to the arrangements for Chair of the Moray Integration Joint Board (MIJB), as set out in the Moray Integration Scheme. Following consideration the Board unanimously agreed:- (i) to a temporary deviation from the Moray Integration Scheme allowing Mr Dennis Robertson to continue to undertake the role of Chair of the Board until 31 March 2025; and (ii) that Councillor Elaine Kirby take on the role of Chair of the Board from 1 April 2025 until 30 September 2025, following which the role of Chair will revert back to a Health Board Member in line with the Integration Scheme. 17. Code of Conduct Update The meeting had before it a report by the Standards Officer asking the Board to adopt the Standards Commission's Model Code of Conduct for Members of Devolved Bodies replacing the Code of Conduct previously agreed by the Board in June 2016. In response to an offer from the Head of Governance, Strategy and Performance to provide additional training, the Chair stated it would be helpful for refresher training in terms of the enhanced Code to be scheduled for one of the Board's development sessions. Following consideration the Board unanimously agreed to adopt the Standards Commission's Model Code of Conduct for Members of Devolved Bodies (Appendix 1) as the Code of Conduct for the Moray Integration Joint Board. Page 9
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 30 January 2025 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 27 MARCH 2025 1. Options for Ward 4 Inpatient Unit for Patients with Mental Illness Further development work to be undertaken in order to prepare a full detailed report which would be brought back to the Board for consideration in approximately 3 months. Update 28/11/24: Development session to be scheduled to be held before the strategic delivery plan progress update comes back to the Board in 6 months, to provide more details on progress and engage with members of the Board. TBC TBC SC/KK JP There will be a Grampian wide mental health inpatient bed base review and any recommendations in relation to Ward 4 will be included within this Item 4. Page 11
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 27 MARCH 2025 2. Chief Officer Report 26/09/24 • Interim Chief Officer provide an update in relation to progress made resulting from the external inspection of Children's Services in relation to children and young people at risk of harm, through the governance structures of the MIJB; • Interim Chief Officer would provide a report in relation to how the rights and supported needs of unpaid carers are met in Moray; • Interim Chief Officer would arrange a development day for a demonstration in relation to Digital Health and Care TBC JP Partially Complete / In Progress 3. Chief Officer Report 30/01/25 Chief Officer to arrange development session on the positive change work being done in relation to discharges, with a further report to come back to the Board. JP 4. GP Vision and Objectives Update Written answer to be provided to Board members providing more detailed information on Demand Measurement through GP Phone systems, specifically how and when it will be done and whether there will be patient engagement. AC 5. Code of Conduct Update Refresher training in terms of the enhanced Code to be scheduled for one of the Board's development sessions. SD/AMcE Timetabled Summer 2025 Page 12
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MINUTE OF MEETING OF THE AUDIT, PERFORMANCE AND RISK COMMITTEE Thursday, 26 September 2024 Remote Locations via Connect Remote, PRESENT Mr Sean Coady, Councillor Scott Lawrence, Mr Derick Murray, Mrs Jeanette Netherwood, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell APOLOGIES Ms Deirdre McIntyre, Ms Janette Topp, Councillor Ben Williams IN ATTENDANCE Interim Chief Officer, Angela Pieri, Engagement Lead and Andrew Wallace, Audit Manager, both of Grant Thornton, Service Manager (Primary Care Contracts), Carl Campbell, Service Manager (Education and Social Care), Social Work Service Manager, Chief Internal Auditor, Chief Financial Officer, Corporate Programme Manager, Ms L Van Zyl, Service Manager and Mrs L Rowan, Committee Services Officer as Clerk to the Committee. 1 Chair Mr Sandy Riddell chaired the meeting. 2 Declaration of Member's Interests Mr Riddell stated for transparency that he was Chair of the Mental Welfare Commission Scotland. The Committee noted that there were no other declarations of member's interests. 3 Minute of meeting of 27 June 2024 The minute of the meeting of 27 June 2024 was submitted and approved. Item 5a Page 13
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4 Action Log of Meeting of 27 June 2024 The Action Log of the meeting of 27 June 2024 was discussed and updated accordingly. 5 External Auditors Report to Those Charged with Governance The meeting had before it a report by the Chief Financial Officer asking the Committee to consider the reports to those charged with governance from the Board's External Auditor for the year ended 31 March 2024. The Committee joined the Chair in thanking those involved in providing the External Auditor's Report and thereafter unanimously agreed to note the reports from the External Auditor as set out in Appendices 1 and 2 of the report and recommended them for approval by the Moray Integration Joint Board. 6 2023-24 Audited Annual Accounts The meeting had before it a report by the Chief Financial Officer presenting to the Committee the Audited Annual Accounts for the year ended 31 March 2024. Following consideration, the Committee agreed to note the Audited Annual Accounts for the financial year 2023/24 and the letter of Representation and recommended them to the Moray Integration Joint Board for approval. 7 Quarter 1 (April-June 2024) Performance Report Mr Coady, Head of Service joined the meeting during discussion of this item. The meeting had before it a report by the Corporate Programme Manager updating the Committee on performance as at Quarter 1 2024 (April-June). During discussion, it was noted that there were several areas where it was acknowledged that performance is poor, and it was queried whether future reports could include narrative explaining what measures are being taken to improve performance in these areas. In response, the Interim Chief Officer agreed to include narrative explaining what measures are being taken to improve performance in areas of poor performance in future reports. During further discussion, the Chair noted that the report stated that there was no need for an Equality Impact Assessment as there would be no impact on people with protected characteristics as a result of the report and sought assurance that the Committee was complying with it's legal responsibilities in relation to equalities and suggested that this section be expanded in future reports. In response, the Interim Chief Officer assured the Committee that the Board is committed to acknowledging any inequality in minority groups and advised that it was her intention to refresh equalities training in the near future. Following consideration, the Committee unanimously agreed to note: Page 14
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(i) the performance of local indicators for Quarter 1 (April to June 2024) as presented in the Performance Report at Appendix 1; (ii) the analysis of the local indicators that have been highlighted and actions being undertaken to address performance that is outside of acceptable target ranges as detailed in Appendix 1 of the report; (iii) the performance for 2023/24 against the national indicators, where data is published, as set out in Appendix 2 of the report; (iv) that future performance reports would include narrative explaining what measures are being taken to improve performance in areas of poor performance; and (v) that the Interim Chief Officer intended to refresh equalities training in the near future. 8 Quarter 1 Performance Report for Childrens Social Work and Justice Services The meeting had before it a report by the Chief Social Work Officer/Head of Service informing the Committee on Children and Families and Justice Social Work performance as at Quarter 1. During discussion surrounding the activity that had taken place within Children and Families and Justice Social Work Section it was queried whether future reports could include narrative in relation to outcomes resulting from the activity. In response, the Service Manager agreed to take this point forward and include narrative in relation to outcomes resulting from the activity in future performance reports. During further discussion, the Chair again noted that the Equalities paragraph in the Summary of Implication Section stated that there was no equality impact as a result of the report when he was aware of some good work that had taken place in this area and suggested that this section be expanded to reflect this. In response, the Service Manager agreed to expand the paragraph in relation to equalities in future reports. Following consideration, the Committee unanimously agreed to note the: (i) performance of local indicators for Quarter 1 as presented in the Performance Report at Appendix 1; and (ii) analysis of the local indicators as detailed in Appendix 1 of the report; (iii) that future reports would: • include narrative in relation to outcomes resulting from the activity in future performance reports; • expand the equalities paragraph within the Summary of Implications section of the report. Page 15
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9 Internal Audit Section - Completed Projects The meeting had before it a report by the Chief Internal Auditor providing an update on audit work completed since the last meeting of the Committee. Following consideration, the Committee agreed to note the audit update. 10 Public Sector Internal Audit Standards - External Quality Assessment of Internal Audit The meeting had before it a report by the Chief Internal Auditor providing the Committee with details of a recent external quality assessment undertaken of the Council's Internal Audit Service. The Committee joined the Chair in commending all involved in the recent external quality assessment and thereafter unanimously agreed to note the report and the Action Plan prepared to address the issues raised in the external quality assessment of internal audit. 11 Payment Verification The meeting had before it a report by the Head of Service/Depute Chief Officer providing an update on the review of the Payment Verification (PV) Assurance Service provided by National Services Scotland (NSS) Practitioner Services Division (PSD), on behalf of NHS Grampian. Following consideration, the Committee unanimously agree to note: (i) the arrangements in place in Grampian for the management of the payment verification process; (ii) that the payment verification process has now fully restarted after pausing during COVID-19; and (iii) the actions already taken to address the outstanding issues, with plans for future action to include an update on progress to this committee in January 2025. 12 Annual Performance Report 2023-24 The meeting had before it a report by the Interim Chief Officer presenting the draft Annual Performance Report 2023/24. The Chair thanked the Corporate Programme Manager for circulating the revised Annual Performance Report for 2023/24 after several typos had been noted following publication of the agenda. Following consideration, the Committee unanimously agreed to: (i) note the draft Annual Performance Report 2023/24 at Appendix 1 and subsequent amendments previously circulated; and (ii) recommend to the Moray Integration Joint Board for approval and publication of the Annual Performance Report 2023/24 by 30 September 2024. Page 16
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13 Internal Audit Section - Update Report [Para 6.2.5] The meeting had before it a report by the Chief Internal Auditor providing an update on the work of the Internal Audit Section. Following consideration, the Committee unanimously agreed to note the contents of the report. 14 Internal Audit Section - Completed Project - Email Security [Para 6.2.5] The meeting had before it a report by the Chief Internal Auditor providing an update on audit work completed since the last meeting of the Committee. Following consideration, the Committee unanimously agreed to note the audit update. 15 Update on Improvement Plan for Adult Social Care Commissioning [Para 6.2.2] The meeting had before it a report by the Head of Service/Chief Social Work Officer updating the Committee about progress regarding the Improvement Plan for Adult Social Care Commissioning. Following consideration, the Committee unanimously agreed to note: (i) the progress of the Improvement Plan as set out in Appendix 1 of the report; (ii) the progress within the report as at the end of July 2024 in relation to the recommendations detailed in the Improvement Plan; and (iii) that the updated report includes details of contract values, timelines, and risks. Page 17
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MINUTE OF MEETING OF THE CLINICAL AND CARE GOVERNANCE COMMITTEE Thursday, 28 November 2024 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Ivan Augustus, Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Ms Elizabeth Robinson APOLOGIES Professor Duff Bruce, Ms Helen Chisholm, Dr Malcolm Simmons, Mr Alex Stephen, Mr Kevin Todd, Ms Janette Topp IN ATTENDANCE Allied Health Professional, Sector Lead Moray; Corporate Manager; Business Manger, Mental Health and Drug and Alcohol Services; Consultant Practitioner, Adult Support and Protection Lead; Integrated Service Manager, Community Learning Disability Service; Lesley Attridge, Locality Manager and Caroline O'Connor, Committee Services Officer. SUBSTITUTES Mr Sandy Riddell (for Mr Alex Stephen) ALSO IN ATTENDANCE Councillor Elaine Kirby 1. Chair The meeting was chaired by Mr Derick Murray. 2. Welcome and Apologies The Committee joined the Chair in thanking Mr Sandy Riddell for continuing to substitute for Mr Alex Stephen and welcomed Cllr Kirby to her first meeting of the Committee. Item 5b Page 19
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3. Order of Business In terms of Standing Order 2.2, the meeting agreed to vary the order of business as set down on the Agenda and take Item 7 "Health and Social Care Moray Clinical and Care Governance Group Escalation Report" after Item 5 "Complaints Report for Quarter 2 2024-25" followed by Item 6 "Drug Related Deaths in Moray" in order to allow the Allied Health Professional, Sector Lead Moray to vacate the meeting at the earliest opportunity. 4. Declaration of Member's Interests There were no declarations of Member's interests in respect of any item on the agenda. 5. Minutes of meeting of 29 August 2024 The minutes of the meeting of 29 August 2024 were submitted for approval. In respect of Item 9 "Inspection of the Moray Supported Lodgings Project in May 2024", Mr Riddell noted the wording in the third paragraph should read "progressed" rather than "progress". Subject to the amendment above, the Committee agreed the minutes of the meeting. 6. Action Log - 29 August 2024 The Action Log of the meeting of 29 August 2024 was discussed and updated accordingly. 7. Complaints Report for Quarter 2 2024-25 The meeting had before it a report by the Allied Health Professional - Sector Lead, Moray informing the Committee of complaints reported and closed during Quarter 2 (1 July 2024 - 30 September 2024). Following consideration the Committee unanimously agreed to note the totals, lessons learned, response times and action taken for complaints completed within the last quarter. 8. Health and Social Care Moray Clinical and Care Governance Group Escalation Report The meeting had before it a report by the Chief Nurse, Moray informing the Committee of progress and exceptions reported to the Clinical and Care Governance Group since the last report to Committee in August 2024. Following consideration the Committee unanimously agreed to note the contents of the report. 9. Drug Related Deaths in Moray The meeting had before it a report by the Business Manager, Mental Health and Drug and Alcohol Services updating the Committee about drug-related deaths in Moray. Page 20
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Following consideration the Committee unanimously agreed to note:- (i) the drug related death figures for Moray; (ii) the ongoing work of the service in relation to the Multi Agency Risk System (MARS) process; (iii) the National Benchmarking report on the implementation of the Medication Assisted Treatment (MAT) Standards: Scotland 2023/24; (iv) the work being done on the Moray residential rehabilitation pathway; and (v) the development of a strategic group and lived experience panel to align the Moray strategy and the National Mission. 10. Joint Inspection of Adult Support and Protection - Progress Review Summary and Findings The meeting had before it a report by the Consultant Practitioner, Adult Support and Protection Lead Officer providing a summary and overview of the findings of the Moray Joint Inspection of Adult Support and Protection - Progress Review that took place between August - October 2024. The Board joined the Chair in commending the work of the team and partners in relation to the significant progress highlighted in the Progress Review. Following consideration the Committee unanimously agreed to:- (i) note the Joint Inspection of Adult Support and Protection - Progress Review Report; and (ii) acknowledge the hard work and commitment demonstrated by the Moray Adult Protection Committee, Leaders and Front-Line Practitioners throughout the Partnership in supporting people at risk in the Moray community. 11. Adult Support and Protection Multi Agency Improvement Plan The meeting had before it a report by the Consultant Practitioner, Adult Support and Protection Lead Officer updating the Committee on progress against the Adult Support and Protection Multi-Agency Improvement Plan since the last update provided in March 2024. Following consideration the Committee unanimously agreed to:- (i) note the Multi-Agency Improvement Plan and progress to date; and (ii) note the systems in place to monitor and progress actions within the plan. 12. Learning Disability Services Dynamic Support Register - Update The meeting had before it a report by the Integrated Service Manager, Community Learning Disability Service informing the Committee of the requirements of the Scottish Government directive relating to the Coming Home Report, and of the actions and progress made by the Learning Disability Service in response to the Page 21
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directive. Assurance is also given that planning and development continues which will address future anticipated needs associated to the directive. Following consideration the Committee unanimously agreed to:- (i) note the requirements of the Scottish Government in relation to the Coming Home Report and Dynamic Support Register and the actions taken by the Learning Disability Service to respond to the Scottish Government Directive as set out in paragraphs 4.1-4.6, and in doing so; (ii) continue to support the housing projects that are to be utilised by adults with a Learning Disability which is integral to meeting the requirements of the register and which was previously agreed at the Moray Integration Joint Board on 30 March 2023 (para 12 of the minute refers). 13. End of Life Care Home Beds The meeting had before it a report by the Locality Manager informing the Committee of the termination of block funded End of Life Beds within Moray. Following consideration the Committee unanimously agreed to:- (i) homologate the termination of End of Life (EOL) Care Bed block funded contract from March 2024; and (ii) the new EOL Care Bed Provision Strategy; transitioning to a spot-purchase through the Resource Allocation meeting (RAM) process, ensuring continued access to EOL care for Moray residents. 14. Items for Escalation to MIJB The Committee noted there were no items for escalation to the Moray Integration Joint Board. Page 22
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 MARCH 2025 SUBJECT: CHIEF OFFICER REPORT BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of the Chief Officer activities that support the delivery against the Moray Integration Joint Board’s (MIJB’s) strategic priorities articulated in the Strategic Plan, and the delivery against the 9 Health and Wellbeing outcomes. 1.2 Strategic planning needs to maintain a focus on transformational change to deliver services to our community within the resources we have available. 2024/25 is a very challenging year for delivering within the budget, with our two funding partners, Moray Council and NHS Grampian, under considerable financial pressure as well. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and note the content of the report; and ii) agree that transforming services to meet the aspirations of the MIJB’s Strategic Plan remains a priority. 3. BACKGROUND Home First/Discharge without Delay 3.1 The number of patients whose discharge is delayed remains stable. At time of report, there are 37 delayed discharges and our target remains 26. Work has continued to ensure that patient flow is optimised, daily meetings continue to collectively deploy available resource to avoid admissions or ensure a safe early discharge. The START/Discharge to Assess (D2A) pilot continues to ensure a collaborative re-enablement approach to complex discharges and a review of Multi-Disciplinary Team (MDT) working is ongoing. 3.2 In response to National concern relating to the number of delayed discharges, a new national collaborative has been developed focusing on Discharge without Delay (DWD). This collaborative has four work streams:- Item 6. Page 23
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• Frailty at the Front Door • Planned Date of Discharge and integrated discharge hubs • Community Hospitals and step-down rehabilitation units • Discharge to Assess and Home First 3.3 Moray will be part of the Grampian regional DWD group and be represented locally, regionally and nationally by designated leads for each of the work streams. There is also a Moray Programme Manager and a Clinical Lead who will facilitate this work alongside the leads. This collaborative links to the national frailty collaborative and the whole system unscheduled care work that have been underway for some time. 3.4 Phase one required the completion of a self-assessment tool developed by NHS Tayside which was submitted to the Grampian group for submission on the 5 March. Work is underway to complete the needs assessment from the self-assessment tool and this will form the actions for Moray going forward. Vaccination Programme 3.5 The winter vaccination programme continues. The COVID-19 offer ended on 31 January, and Flu vaccine continues to be offered to all those eligible until 31 March. The Shingles and Pneumococcal vaccination programme are ongoing along with all other routine vaccination programmes for preschool, and school aged children. Non routine vaccination continues. Planning is in place for other routine programmes including RSV and the Spring Covid-19. 3.6 Notice has been given to vacate the current Moray Vaccination Centre at Southfield, Elgin, no later than 23 April 2025. NHS Grampian colleagues are supporting Health and Social Care Moray (HSCM) to identify a short-term accommodation solution at pace, in order to maintain vaccine delivery. This is likely to be a mixed model of delivery, utilising some of the venues that are already used for pop up clinics, and options are being explored to provide a hub for fridges, records, vaccine delivery and admin / management staff. A solution for longer-term delivery is also being considered. Some local comms will be worked up in due course to update the local populace about the changes which will include information briefing sheets to go to councillors, local groups etc, press releases, social media posts and posters to go out to local venues. Mental Health Bed Base Review 3.7 The Mental Health Bed Base Review group reported to the Mental Health and Learning Disability Programme Board (MHLDPB) on the 25 February 2025. The MHLDB considered the outputs of the Bed Base Review alongside seven proposed priority actions and agreed that the Programme can move to an implementation phase and that the priority actions can be taken forward. 3.8 Priority action number six referred to the redesign of mental health inpatient beds and the development of a community treatment model within Moray. 3.9 The Mental Health Bed Base Review group will now be tasked with progressing these priorities through specific work streams. 3.10 The Moray Mental Health Strategic Group will provide a detailed report to the MIJB on 29 May 2025. Page 24
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GMED 3.11 The GMED service continues to observe recurring difficulties in staffing shifts across its centres. Rota cover is impacted by seasonal illness, school holidays and other unplanned absences. 3.12 Early in 2024, Chief Officers for Moray, Aberdeen City and Aberdeenshire health and social care partnerships requested a review of the GMED model. The review, led by a programme board, aims to enhance the quality, safety and efficiency of the service while ensuring sustainable workforce levels and promoting staff wellbeing. 3.13 The review was completed at the end of January 2025. A programme of engagement and consultation is being developed as guided by Health Improvement Scotland and the national Planning with People guidance. Further details will be shared when the next steps have been formally agreed. 3.14 Work continues on salaried GP service model via Local Negotiating Committee where terms and conditions for salaried medical staff are negotiated in partnership between NHSG, British Medical Association, HR, Staff and Service representation. Review of Social Work Governance & Assurance Arrangements across Scotland 3.15 The Scottish Government undertook a review on social work governance and assurance in Scotland between July to December 2024, carried out by the Care Inspectorate on their behalf. The review sought to address, nationally, how well social work governance and assurance arrangements support leaders. The report’s findings shall be considered in the development of our local social work governance arrangements which are currently under review. 3.16 The review report is due to be published nationally in March 2025 and from our regular Link Inspector meeting, as of 4 March 2025, there was no indication of slippage at this time. A report on this will come to a future MIJB or relevant committee. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 To support the acceleration of the MIJB ambitions set out in the Strategic Plan the Delivery plan is currently being refreshed to support next steps. 4.2 The challenge of finance persists and there remains the need to address the underlying deficit in core services. The development of a Programme Management Office is in progress to support our financial savings. 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 – 2032” Working with our partners to support people so they can cope with, and where possible, overcome the health and wellbeing challenges they may face. Page 25
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Ensuring that the right care is provided at the right place at the right time when people are in need. Ensuring that our systems are as simple and efficient as possible. (b) Policy and Legal The Chief Officer continues to operate within the appropriate level of delegated authority, ensuring that the MIJB is sighted on key issues at the earliest opportunity, and continues to influence and agree the strategic direction. (c) Financial implications There are no financial implications arising directly from this report. The Chief Finance Officer continues to report regularly. There is an ongoing requirement to find efficiencies and to demonstrate best value for money. (d) Risk Implications and Mitigation The risk of not redesigning services will mean that HSCM and the Moray Portfolio cannot respond adequately to future demands. (e) Staffing Implications Staff remain the organisation’s greatest asset, and engagement with all sectors must continue to ensure full involvement, which will create the best solutions to the challenges faced. HSCM staff are facing continued pressures on a daily basis, and effort into ensuring staff well-being must continue. (f) Property There are no issues arising directly from this report. (g) Equalities/Socio Economic Impact Any proposed permanent change to service delivery will need to be impact assessed to ensure that HSCM are not disadvantaging any section of our community. HSCM will continue to work closely with all our partners to ensure that we contribute to the health and well-being of the community and support the recovery phase of the Covid-19 pandemic. (h) Climate Change and Biodiversity Impacts Care closer to and at home, delivered by teams working on a locality basis, will reduce HSCM’s reliance on centralised fixed assets and their associated use of utilities. (i) Directions There are no directions arising from this report. (j) Consultations The Moray Portfolio Senior Management Team, the Legal Services Manager and Caroline O’Connor, Committee Services Officer have been consulted in the drafting of this report. Page 26
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6. CONCLUSION 6.1 The MIJB are asked to acknowledge the significant efforts of staff, across in-house providers, externally commissioned services, the Independent and Third Sector, who are supporting the response to the recovery, and the drive to create resilience and sustainability through positive change. 6.2 The size of the financial challenge facing the MIJB, and also its two funding partners, means that redesign and transformation is not an option but a necessity. HSCM’s approach will be to prioritise quality, safety and good outcomes in all service redesigns. Author of Report: Judith Proctor, Chief Officer, Moray Portfolio Page 27
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 MARCH 2025 SUBJECT: REVENUE BUDGET AND RECOVERY PLAN 2025/26 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To outline the budget allocations to the Moray Integration Joint Board (MIJB) and to consider the revenue budget for 2025/26, the estimated funding gap and the charges. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) notes the funding allocations proposed by NHS Grampian and Moray Council, detailed at 4.6; ii) notes the anticipated budget pressures detailed in 4.10; iii) approves the 2025/26 proposed savings plan at 4.24 and detailed in Appendix 2; iv) formally approves the Revenue Budget for 2025/26 as detailed in Appendix 1, following consideration on risks highlighted in 4.34; and v) approves Directions for issue as set out at Appendix 5 to NHS Grampian and Moray Council. 3. BACKGROUND 3.1 On 4 December 2024 following the announcement of the Scottish Government’s indicative budget for 2025-26 by the Cabinet Secretary for Finance and the Director of Health Finance and Governance wrote to Health Board Chief Executives providing details of the funding settlement for Health Boards. In Parliament on 4 December, the Cabinet Secretary set out that 2025/26 continues to present a challenging fiscal environment across all public services. He added that it was the intent of the Scottish Government budget to deliver progress for Scotland. The budget is set out to deliver on those priorities and on the issues people care about most. It also seeks to lay the foundation Item 7. Page 29
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for Scotland’s future success, putting in place the investment that will help deliver the public services people need and deserve. 3.2 The letter outlined that NHS payment uplifts to Integration Authorities for delegated health functions must deliver an uplift of 3% over the 2024/25 agreed recurring budgets. 3.3 In addition and separate to Health Board funding uplifts, the health and social care portfolio will transfer additional funding of £125 million to Local Government for Adult services and £25.7 million for children’s services to support retention by beginning to embed improved pay and conditions for care workers, with Scottish Government considering that this funding requires local government to deliver a £12.60 minimum pay settlement for social care workers in commissioned services, in line with the equivalent commitment being made in the public sector pay policy. In addition to this, further additional funding of £10 million will support the uprating of Free Personal and Nursing Care rates. 3.4 Scottish Government have stipulated that the funding allocation to Integration Authorities should be additional and not substitutional to each Council’s 2024/25 recurring budgets for adult social care services and therefore, Local Authority adult social care budgets for allocation to Integration Authorities should be £150.7 million greater than 2024/25. 3.5 The settlement outlined does not make provision for the UK Government’s increases to employers National Insurance Contributions (NIC). Work is constructively on going with the Convention of Scottish Local Authorities (COSLA) to ensure that the UK Government provide the funding necessary to support public services in Scotland. The latest indication is that there will be a further £300 million from the UK Government to support the impact of its decision to raise employer NIC on the public sector. However it is clear that the impact on Scotland’s public sector, including local government, as well as commissioned services and third sector organisations which provide statutory services, could well be in excess of £700 million. 4. KEY MATTERS RELEVANT TO RECOMMENDATION MIJB Budget 4.1 The MIJB is required to consider its budget in the context of economic uncertainty in relation to the ongoing increase in the cost of living and high interest rates. It is fair to say that the impact of these circumstances remains a challenge and cannot yet be fully assessed. 4.2 Following the announcement of the Scottish Budget, NHS Grampian and Moray Council have notified the MIJB Chief Officer and Chief Financial Officer of the funding allocation for the forthcoming financial year. 4.3 On 26 February 2025, a meeting of Moray Council agreed its 2025/26 budget for the forthcoming financial year (para 3 of draft minute refers). The Local Government settlement is for one year only, but the budget was set in the context of longer-term planning. The funding to the Council included £289 million for local priorities / to preserve the settlement in real terms. The Scottish Government are also providing funding for up to 60% towards the costs of the increase in employers’ National Insurance Contributions (eNIC) and so apart Page 30
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from these funds which are to be passported through to the MIJB, there will be no further uplift passed on to the MIJB. The paper presented referred to the Moray share of the additional funding that is required to be passed through from the Council to the MIJB. This is the Moray share of the reported national investment in health and social care (adult and children’s services) of £231.5 million and £10 million relating to free nursing and personal care, which equates to a £2.845 million share for Moray. In addition there is £0.198 million relating to Children and Young People community mental health services and £0.05 million for trauma informed training, both of which are directed funding from Scottish Government. 4.4 The NHS Grampian budget setting process is based on the principle that funding allocations to the 3 Grampian IJB’s will be uplifted in line with the increase in baseline funding agreed through the Scottish Government budget settlement, with the total to each IJB being made on the National Resource Allocation Committee (NRAC) share. The draft Scottish Government budget was announced on 4 December 2024. It provides for a minimum baseline funding uplift of 3% for 2025/26. The 3% uplift provides MIJB with an increased funding allocation on the recurring budget of £2.262 million. Formal agreement of the 2025/26 NHS Grampian financial plan will be sought at its Board on 10 April 2025. 4.5 The table below summarises the additional funding provided to Integration Authorities by Scottish Government that is passported through both Moray Council and NHS Grampian. Route Scotland Wide Allocation Moray IJB Share £m £m £12.60 – uplift for Adult Social Care Staff * Council (full year effect) 125.0 2.098 £12.60 – uplift for Children’s Social Care Staff Council (full year effect) 25.7 0.254 Free Personal & Nursing Care * Council 10.0 0.197 Directed funding for caseload reduction in Children’s social work Council 0.296 Children and Young People community mental health services (directed funding) Council 0.198 Trauma informed training (directed funding) Council 0.050 NHS increase in base funding by 3% NHS 2.262 60% funding for the eNIC Council & NHS 1.392 Total Additional Allocation 6.747 Page 31
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MIJB Funding 2025/26 4.6 The MIJB has a responsibility under the Public Bodies (Joint Working) (Scotland) Act 2014 to set its revenue budget by 31 March each year. The funding of the MIJB revenue budget in support of the delivery of the Strategic Plan is delegated from NHS Grampian and Moray Council. The allocated funding is summarised below: £’000 NHS Grampian (recurring 2025/26) 94,724 NHS Grampian – Set Aside Services 15,638 NHS Grampian – 3% increase in base 2,262 NHS Grampian – additional funding for eNIC *** 592 Moray Council – Core ** 85,161 Moray Council Children’s Social Work - Community Mental Health Services 198 Moray Council Trauma informed training 50 Moray Council – Improvement Grants* 1,060 Moray Council – SG additional funding (share of £160.7M) 2,845 Moray Council – SG additional funding for eNIC *** 800 PARTNER MIJB FUNDING 2025/26 203,330 * Improvement Grants includes £0.707 million which requires to be ring- fenced as it relates to council house tenants. ** Children’s services includes £3.279 million which required to be ring-fenced as it relates to the joint Out of Area budget which remains in the Council. *** Estimated additional grant funding from Scottish Government in respect of direct costs relating to the implementation of eNIC Hosted Services 4.7 Within the scope of services delegated to the MIJB are hosted services. Budgets for hosted services are primarily based on NRAC. Hosted services are operated and managed on a Grampian-wide basis. Hosting arrangements mean that one IJB within the Grampian Health Board area would host the service on behalf of all 3 IJB’s. Strategic planning for the use of the hosted services is undertaken by the IJB’s for their respective populations. 4.8 The 2025/26 budget for Moray’s share of all hosted services is £5.907 million as detailed below. £’000 Hosted by Aberdeen City IJB Intermediate Care 990 Sexual Health Services 571 Hosted by Aberdeenshire IJB Marie Curie Nursing 201 Heart Failure Service 70 Continence Service 149 Diabetes MCN including Retinal Screening 246 Chronic Oedema Service 49 HMP Grampian 606 Police Forensic Examiners 381 Page 32
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Hosted by Moray IJB GMED Out of Hours 2,522 Primary Care Contracts 122 TOTAL MORAY HOSTED SERVICES 5,907 Large Hospital Services (Set Aside) 4.9 Budgets for Large Hospital Services continue to be managed on a day-to-day basis by the NHS Grampian Acute Sector and Mental Health Service, however the MIJB has an allocated set aside budget, designed to represent the consumption of these services by the Moray population. The MIJB has a responsibility in the joint strategic planning of these services in partnership with the Acute Sector. £’000 General Medicine 7,880 Geriatric Medicine 1,228 Rehabilitation Medicine 100 Respiratory Medicine 252 Palliative Care 32 A & E Inpatient 69 A & E Outpatient 5,172 Learning Disabilities 53 Psychiatry of Old Age 113 General Psychiatry 739 TOTAL SET ASIDE BUDGET 15,638 Budget Pressures 4.10 Budget pressures are a major consideration for the MIJB and are an intrinsic part of the budget setting process. The additional funding highlighted in the Scottish Government budget for health and social care is welcomed and will be required to support expected budget pressures arising for adult and children’s social care uplift of £12.60 for externally commissioned services and free personal and nursing care. In previous years, both Moray Council and NHS Grampian would have supported some elements of inflation through their budget setting process, taking cognisance of the budget setting protocol agreed by the MIJB on 14 December 2017 (para 15 of the minute refers). Given the difficult budget settlement for Local Authorities, there has been no additional funding aligned to MIJB for adult social care in addition to the requirement to transfer the share of the additional investment as determined by Scottish Government. Following the financial pressures facing NHS Grampian, there is a Scottish Government requirement to increase base funding for pay and non pay inflation of 3% for the IJB. There is also an expectation as MIJB continue to re-mobilise and transform, there will be budget pressures arising in relation to what is described as the recurring deficit. There will be budget pressures arising during the year that are not yet known and these will be reported upon once quantified. It is important that any investment in building capacity is viewed in the context of historical cost pressures. The identified cost pressures below are based on estimates and remains an ongoing consideration in the financial planning. The table below Page 33
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outlines the anticipated budget pressure the MIJB needs to address in the forthcoming financial year: £’000 BUDGET PRESSURES Pay Inflation 2,758 Contractual Inflation & Scottish Living Wage 2,796 Prescribing & Community Pharmacy 1,153 Children in Transition 771 Mental Health complex clients 270 Recurring Deficit 5,988 Hosted services 122 National Care Home Contract (NCHC) uplift 902 Free Personal & Nursing Care (FPNC) uplift 205 Occupational therapy equipment 100 Children with disabilities placement 180 Continuing Care placements 626 Other 41 eNIC pressure 2,505 TOTAL BUDGET PRESSURES 18,417 4.11 In March 2024 following agreement at COSLA Leaders, the Scottish Government wrote to Integration Authorities providing details of the pay uplift that would apply to staff providing direct care within Adult and Children’s Social Care in commissioned services. The Scottish Government settlement for 2025/26 includes funding to support retention and to continue to embed improved pay and conditions for care workers, requiring local government to deliver a £12.60 minimum pay settlement for adult and children social care workers in commissioned services. This will cost in the region of £2.428 million and is included within the budget pressures for the forthcoming year in the table above. 4.12 £0.902 million is included as a budget pressure for the NCHC however it is not yet finalised as Scottish Government and COSLA are still in negotiations around the increase for 2025/26. This will be partly funded from the additional funding mentioned above for the £12.60 per hour. The latest proposal includes an element of increase for the eNIC increases. 4.13 Budget pressure for FPNC is also to be funded from the Scottish Government as part of the £10 million additional funding agreed as part of the settlement for 2025/26. 4.14 With funding being provided by Scottish Government for some elements listed above, totalling £6.203 million, which gives a net budget pressure of £12.214 million. 4.15 Prescribing pressures continue to grow, with a current 5% increase in overall costs. Details of this budget for 2025/26 is attached at Appendix 3. Savings Plan 4.16 The MIJB strategy sets out the programme of transformation, operation and improvement. The vision for MIJB Strategy is that “we come together as equal Page 34
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and valued partners in care to achieve the best health and wellbeing possible for everyone in Moray throughout their lives. The 3 themes within the strategy are: • Homefirst – developing locality planning approach with the development of multidisciplinary teams and initiatives including discharge to assess, crises support, rehabilitation, re-ablement and recovery, housing, adaptations and technology. Building based to community services. • Building resilience – developing Making Every Opportunity Count, self management, prevention, personal responsibility, social prescribing. • Partners in care- developing care and support planning, support for unpaid carers, self directed support, realistic medicine, long term conditions, palliative/end of life, market – shaping strategies. 4.17 Our outcomes continue align with the National Health and Wellbeing Outcomes (9): • 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 4.18 The Moray Joint Strategic Needs Assessment (JSNA) has been refreshed to analyse the needs of the local population to inform and guide the commissioning of health, wellbeing and social care services within Moray. The main goal of the JSNA is to accurately assess the care needs of a local population in order to improve the physical, mental health and wellbeing of individuals and communities. 4.19 MIJB understand that the building blocks of health and wellbeing include: employment, housing, education and skills, childhood experiences, economic stability, healthcare, social and community requirements. MIJB also are working with competing priorities - cost savings, reducing demand on hospitals, better experiences and outcomes for people who use health and care services, improved service alignment/integration, developing population health and prevention at scale, including wellbeing and tackling inequalities. 4.20 A change in focus for Moray is required to deliver improved care and better outcomes, ensuring sustainability for the future, rather than to deliver cost savings only in the short term. The health and care system is often seen as hospital focused, however an integrated and holistic response is required that encompasses community assets. This requires a system with increased generalism and multidisciplinary teamworking, with practitioners able to hold risk and enable people to live healthily in their communities, with a focus on prevention and reablement. A community focused health and care system prioritised to local need and individualised support is most effective where that support maximises independence. Page 35
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4.21 The budget setting for 2025/26 includes the continuation of the 2024/25 saving plan, which was initially set over 2 financial years, this gives a total of £5.556 million that is planned to be achieved in 2025/26. This was not enough to cover all the budget gap in 2025/26, so ongoing meetings of the Chief Officer and the Senior Management Team, along with service managers have taken place, and given savings identified to date, it remains extremely challenging to identify additional savings to support the 2025/26 budget setting process. The proposed savings being presented today are provided following discussion at the recent MIJB Development session on 27 February 2025. Given that each separate decision made when setting the budget may impact on the lives of people with protected characteristics, the importance of the cumulative impact on the decisions being taken is recognised, including the cumulative impact of service changes and unintended consequences on communities where multiple organisations might have reduced savings. 4.22 There is still a focus and commitment around identifying further in-year savings and savings for future years that will be brought back before the MIJB for approval to ensure future years budgeting is robust. MIJB is acutely aware of the challenges it faces surrounding both its people and financial resources which remains a focus within its decision making. Financial and staffing impacts will be monitored on an individual savings basis and scrutiny will be provided through the agreed governance structure. The savings have been RAG-rated (i.e. provided with a Red, Amber, Green risk level) on the basis of the savings being achieved with particular reference to political environment; staff and changes in services; capacity; engagement and processes i.e. HR, procurement etc. With this in mind, 25 are green status, 8 are amber status and 3 are red status. 4.23 The table below summarises the progress made by the Health and Social Care Moray management team in identifying opportunities for efficiency/savings, which fall under the 3 themes of the MIJB strategy and a 4th heading of savings already implemented. Areas under each theme are detailed in Appendix 2. Close monitoring of progress will be undertaken via a range of operational financial governance controls, including the Budget Savings Oversight Group and will be reported on a quarterly basis during 2025/26. Page 36
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4.24 Para Ref 2025/26 2026/27 £ 000’s £ 000’s Projected Efficiencies/Savings approved May 2024 Building resilience 4.25 2,276 261 Home first 4.26 1,445 Partners in care 4.27 1,635 354 Savings already implemented 4.28 200 Subtotal Projected Efficiencies 5,556 615 Projected Efficiencies 2025/26 Building resilience 4.29 350 Partners in care 4.30 386 Savings already implemented 4.31 3,175 Subtotal Projected Efficiencies 3,911 Total Projected Efficiencies 9,467 615 4.25 Building resilience covers 11 proposals, predominantly with a RAG status of green. These proposals cover review and redesign of services: Internal care at home; Ward 4; GMED (hosted service for Grampian, led by Moray); relocation/ reduction of lease of buildings and use of pool cars. There are 2 proposals that have a RAG status of red for the review of care and care purchasing, this is, reviewing all care packages and the use of spot purchasing. These proposals although challenging will be achievable, a total of £2.537 million is the expectation over the next 2 financial years, with £2.276 million being achievable in 2025/26. 4.26 Home first covers 4 proposals; all these proposals have a RAG status of amber and relate to the review of respite provision; use of proportionate care model ; the review/redesign of the Learning disability nighttime model of care delivery and in conjunction with our home first priority to ensure people are looked after in their own homes as safely as possible and relates to redesign of community hospitals, to ensure services are fit for purpose. These proposals although challenging will be achievable, a total of £1.445 million is the expectation over the next financial year. 4.27 Partners in care covers 10 proposals, 7 of which have a RAG status of green and relate to review of service for day services and adult services; review of complex and challenging behaviour units; review of step down building based facilities, prescribing efficiencies, use of digital support and review of contracts There are 3 proposal that have an amber RAG status which relates to review of Learning disability service and review of care home bed usage for Learning disability and the review of the transport contract for children’s and justice service and adult services. These proposals although challenging will be achievable, a total of £1.989 million is the expectation over the next 2 financial years, with £1.635 million being achievable in 2025/26. 4.28 There are 3 plans that have already been implemented and savings taken in 2025/26. They were for 1 year initially, and have been reviewed for the next financial year to continue, which relate to no non-essential travel, no non- essential training and no backfill for secondments. These proposals total £0.2 million all achievable in 2025/26. Page 37
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4.29 Building resilience covers 1 proposal which has a green RAG status and relate to the continuation of the SDS recovery spend to save proposal. This proposal totals £0.350 million expected to be achieved in 2025/26. 4.30 Partners in care covers 3 proposals, majority of which have a green RAG status, these relate to the pharmacy spend to save for medicine reviews in care homes and a reduction in overtime payments across all. There is 1 amber RAG status relating to the review of the palliative care service in Moray. These proposals total £0.386 million. 4.31 Already implemented covers 3 proposals, which are green RAG status that relates to the continuation of the vacancy factor for NHS services and an increase for Council services in line with the increase for the pay award, a refund expected for a contract and a 3.4% cut against a number of services where there are no other savings proposals which will entail service redesign but is expected to be achievable during 2025/26.These proposals total £3.175 million. Budget Overview 4.32 The MIJB Revenue Budget for 2025/26 is £214.254 million which includes £14.665 million Set Aside. The detail is provided in Appendix 1 and summarised below: £’000 BUDGET Recurring Budget 179,244 Inflationary and Demand Led Pressures 6,021 Recurring Deficit 5,988 Scottish Living Wage (SLW), FPNC & NCHC 3,903 eNIC pressure 2,505 Set Aside 15,638 Additional commitments 544 Use of reserves TOTAL BUDGET 213,843 FUNDED BY NHS Grampian Recurring (inc. Set Aside) 110,362 Moray Council (inc. Improvement Grants) 86,222 Scottish Government Additional Funding (£241.5m) 2,549 Children’s & Justice services Additional Funding 544 NHS Grampian 3% Additional Funding 2,262 Reserves balance 45 Scottish Government additional funding for eNIC 1,392 Savings identified 9,467 TOTAL FUNDING 212,843 BUDGET DEFICIT (1,000) FUNDED FROM EARMARKED RESERVES 1,000 Page 38
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4.33 Earmarked reserves estimated to be carried forward into 2025/26 are £1.647 million, this included reserves relating to Primary Care Improvement Fund (PCIF) and Moray Action 15 which will be exhausted by the end of 2024/25. The balance on the remaining reserves will be reviewed after the 2024/25 year end. Financial Risks 4.34 The budget assumptions made within this report carry a degree of financial risk, meaning that variations that may arise will impact on financial performance. Acceptance of risk is a necessary part of the budget setting process. The main risks are summarised: • Financial Settlement – the 2025/26 financial settlement is for one year only and the increased level of funding is required to meet policy commitments as determined by Scottish Government. There is no inflationary increase for children’s or adult social care provided by Moray Council, but for NHS Grampian there is the agreement of a 3% increase in pay and non pay inflation. Whilst a provision has been made for Local Authority and NHS Grampian pay increases, the NHS Public Sector Pay Policy and Local Authority pay award negotiations has not yet been agreed and there is a risk that this will exceed the provision. Whilst the benefits of longer-term financial planning are well documented in assisting the delivery of strategic priorities, at this stage, financial planning is subject to continuous change and there is a need to adapt to the changing landscape. • The budget pressures identified in paragraph 4.10 are based on continued discussion and assessment and through monitoring, this process is reasonably accurate. However, there remains the risk in the event that inflationary increases and demand driven pressures may exceed the anticipated cost. There is no provision for increases over and above the SLW payments for providers. • Prescribing costs are a large and volatile part of the MIJB budget with demographic changes a material contributing factor. Whilst the decisions to prescribe are made locally, the costs of drugs and agreements to introduce new drugs are made on a national basis. Provision in the budget has been made based on analysis undertaken by NHS Grampian with a range of options provided from Best Case to Best Prediction and Worst-Case scenario. MIJB are proposing the inclusion of the Best Prediction scenario with the associated pressure of this option. There is a risk associated with this option and the IJB will closely monitor this budget through regular reporting to the IJB throughout financial year 2025/26 and appropriate action taken to mitigate the pressure in year through continued close working with NHS Grampian, this is being reviewed not only across Grampian but nationally. • Demographic changes - the demographic profile of Moray continues to show a general rise in population with a specific increase in the age profile of the population. The associated challenges of providing care for a rising population where people live with multiple conditions are well known. These challenges manifest themselves in a financial sense when we experience issues such as rising numbers for social care packages Page 39
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and rising demand for aids, adaptations, and equipment. The increasing level of complexity of need for some of our clients means that high-cost care packages may arise during the year for which we have not budgeted. The same applies to patients who need out of area care and where a clinical decision has been made that this is in their best interests. • In Primary Care there continues to be a number of continuing challenges around sustainability of some of our GP Practices with inability to recruit General Practitioners a common issue. This has necessitated the Partnership providing support and investment to maintain GP services in some parts of Moray. We will continue to use the Primary Care Improvement Fund and other funding streams to support General Practices and wider Primary Care teams across Moray. • The MIJB must also ensure preparedness for the implementation of national policy and legislation in particular the Health and Care (Staffing) (Scotland) Act 2019 ensuring safe and appropriate staffing with implementation from 1 April 2024 and full compliance by March 2025. • The savings identified are challenging to achieve fully in the year - the risk of achieving the savings has been calculated based on the RAG status, with green assuming will be 90% achieved, amber 80% and red 70% respectively. Using this assumption the savings for 2025/26 could be £7.961 million, leaving a risk of a potential funding gap, which would have to be borne by the partners of £1.507 million. All endeavours will be undertaken to ensure delivery where possible and the Chief Officer and Chief Financial Officer will continue to work within the tri-partite approach with finance colleagues in both Moray Council and NHS Grampian. The implementation of savings also presents an opportunity to redesign services collaborating with staff and communities. 4.35 Accounts Commission have released an IJB Finance bulletin 2023/24 on 6 March 2025 which was prepared by Audit Scotland. This summarises the position for all the IJB’s in Scotland and is attached at Appendix 4. This provides background information and clarification that the issues facing MIJB are affecting all IJB’s. One of the key messages from this publication is around the need to work collaboratively with IJB’s and partners to find ways to transform services so that they are affordable. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan 2022 – 2032, ‘Partners in Care’ The approval of a balanced budget for the MIJB is key to the delivery of health and social care services in Moray in accordance with the Strategic Plan. (b) Policy and Legal In accordance with the Public Bodies (Joint Working) (Scotland) Act 2014, MIJB is subject to the audit and accounts regulations and legislation of a body under Section 106 of the Local Government Page 40
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(Scotland) Act 1973 and is classified as a local government body for accounts purposes by the Office for National Statistics. (c) Financial implications The 2025/26 revenue budget (excluding Set Aside) as detailed in Appendix 1 is £198.205 million. The funding allocated to the MIJB by Moray Council and NHS Grampian and through the Partner bodies from Scottish Government totals £187.737 million (excluding Set Aside). In addition, the indicative savings plan for the forthcoming year totals £9.467 million. The notional Set Aside budget for Moray’s share of the Large Hospital Services is currently £14.665 million. The Set Aside budget is provided by NHS Grampian. A balanced budget is presented displaying use of slippage in ear marked reserves of £1 million, this will need to be funded in 2026/27. (d) Risk Implications and Mitigation The revenue budget for 2025/26 is subject to the following risks: • GP Prescribing – represents around 10% of the MIJB core budget. It is well documented that the Prescribing budget can be extremely volatile in nature with volume and price increases potentially leading to substantial adverse variances. • Growth and demand in the system, together with service users with complex care needs are attracting additional financial challenge. These issues require to be managed within the overall resource of the MIJB. • The need to transform at pace and drive forward opportunities arising through changes to working practice experienced through the pandemic. The risk being the ability to capture and embed in a timely manner. • National Care Home Contract for 2025/26 has not yet been agreed and whilst this will be partly funded from Scottish Government funding for the £12.60 per hour, this will not fully fund the increase once agreed. • The implications of the cost-of-living crisis and current levels of inflation, which although are now forecast to decrease continuing cost increases may mean the provision for inflation may not cover all the calls upon it. Price inflation may impact on areas where no provision has been made for inflationary increases and this will add pressure to budgets. Budget managers will need to control their expenditure to absorb such pressure if possible and may have to reduce service levels or identify further savings. • This report highlights the anticipated budget pressures at paragraph 4.10. It will be necessary to note that budget Page 41
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pressures may exceed allocation. This will be closely monitored and reported accordingly to the MIJB as part of the budget monitoring reports. • With the level of savings required to balance the budget there is a risk that the budget may not be achieved in line with expectations for 2025/26. Based on the rag status as in para 4.22, there is a risk of not achieving the savings in this financial year of £1.507 million, which will require to be borne by the partners of the MIJB. (e) Staffing Implications There are no direct implications in 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 change to policy. Any subsequent changes to policy arising from proposals made within this paper will be considered and Impact assessed as appropriate. (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 Directions are detailed in para 4.32 above and in Appendix 5. (j) Consultations The Chief Officer, Health and Social Care Moray Senior Management Team, Operational Management Team, Corporate Manager, Chief Finance Officer (Moray Council), Deputy Director of Finance NHS Grampian, the finance teams of both Moray Council and NHS Grampian, and Caroline O’Connor, Committee Services Officer. 6. CONCLUSION 6.1 Legislation requires the MIJB to set its Revenue Budget for the forthcoming year by 31 March each year. The budget displays a balanced position. The Section 95 Officer as Chief Financial Officer to the Board recommends the budget as presented at Appendix 1. 6.2 Close monitoring of the continuing effects of the increasing demands on services will be required in order to ensure the MIJB can remain within the funding allocation provided by NHS Grampian and Moray Council. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 42
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APPENDIX 1MORAY INTEGRATION JOINT BOARD JOINT FINANCE REPORT APRIL 2025 -MARCH 2026 Para Approved Annual Ref Net Budget £'s 2025-26 Community Hospitals 6,600,692 Community Nursing 6,484,911 Learning Disabilities 17,865,037 Mental Health 11,945,985 Addictions 1,221,222 Adult Protection & Health Improvement 265,307 Care Services provided in-house 25,594,449 Older People & PSD Services 25,172,334 Intermediate Care & OT 1,904,400 Care Services provided by External Contractors 2,203,164 Other Community Services 10,220,408 Admin & Management 1,401,173 Other Operational Services 1,253,043 Primary Care Prescribing 18,727,506 Primary Care Services 20,020,057 Hosted Services 5,906,873 Out of Area 720,131 Improvement Grants 1,060,200 Childrens Services 19,482,682 Total Moray IJB Core 178,049,572 Other recurring Strategic Funds in the ledger 1,194,806 Total Moray IJB Including Other Strategic funds in the ledger 179,244,378 Other resources not included in ledger under core and strategic: 18,960,862 Total Moray IJB (incl. other strategic funds) and other costs not in ledger 198,205,240 Set Aside Budget 15,638,000 Overall Total Moray IJB 213,843,240 Funded By: NHS Grampian 113,215,806 Moray Council 90,159,571 Savings identified 9,467,863 Use of ear marked reserves 1,000,000 IJB FUNDING 213,843,240 Item 7. Page 43
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Progress to MIJB proposed savings APPENDIX 2 100% Ref Service Brief Description Full year effect £000s Saving expected for 2025/26 Saving confident to be achieved in 2025/26 Progress towards Implementation Planned Implementation Date Implementation Date Risk Level Risk Description BUILDING RESILIENCE 3,409.00 2,626.00 2,626.00 1 Internal Care at Home review Review of Internal care at home including redesign 122.00 122.00 122.00 1/4/2025 Green Timeline Continuation of 24/5 saving 4 &5 Ward 4 redesign of service Cease locum use - gradual & implement 2 CESR fellows 1,044.00 261.00 261.00 Jan-26 Green Recruitment Taking longer than expected and not both vacancies at the same time continuation of 24/5 saving 6,7,8 GMED redesign & health village relocation Relocation from Health Village, redesign of clinical & admin staffing model, Ad astra Ehealth system 110.00 110.00 110.00 Apr 25 Green Workforce Impact Parking Footfall dependent on location Delayed for 3 months 9 Pool car vs expenses review Review into all teams transport and expenses to evalaute best options 20.00 20.00 20.00 0% Apr-25 Green Time and capacity – will be spend to save in the first instance 10,12 Cessation of leases and relocation Southfield, Strathisla dental practice 63.00 63.00 63.00 61% Apr-25 Green none Lease cessation delayed by a month 14 &15 Review of Care & Care Purchasing spot purchasing & review care packages 1,700.00 1,700.00 1,700.00 Apr-25 Red Reviews commenced in Jan 2025 and this is the continuation of that work already started 42 *new SDS recovery Review packages to increase recovery 350.00 350.00 350.00 Apr-25 Green Reviews are not completed timeously HOME FIRST 1,445.00 1,445.00 1,445.00 16 Respite provision Review into planned and emergency respite - change in model 413.00 413.00 413.00 0% Apr-25 Amber Time to implement fully Care home bed shortage Care Home Provider monopoly Competition from other boards Time heavy paperwork for care homes 17 Proportionate care Redesign model 555.00 555.00 555.00 0% Apr-25 Amber Time to fully implement Needs full EQIA Service user safety Internal progressing slower than expected and external delayed until next financial year Item 7. Page 45
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18 Night Time Responder (LD) Redesign LD nighttime model of care delivery 277.00 277.00 277.00 0% Apr-25 Amber Organisational change More complex than expected and delayed from 24/25 20 Community hospital redesign Redesign of inpatient services supporting Home First 200.00 200.00 200.00 0% Apr-25 Amber Contentious – public opinion Reputational damage Impact on secondary care Progressing but other pressures on the budget PARTNERS IN CARE 3,459.00 2,021.00 2,021.00 23 Commissioning and contracts review Review of all contracts and redesign of provisions 350.00 350.00 350.00 Apr-25 Green Time and capacity, reputational damage Balance of needs versus costs Continuation of last years work with providers 21,24 Day Services review Review into day services and provsion, including building based: co-location options, MRC catering & infrastructure 220.00 220.00 220.00 Apr-25 Green Reputational damage Impact on Unpaid carers Downstream impact Impact on MH of service user 25 Complex & challenging behaviour unit Review Review into Woodview and change management 657.00 159.00 159.00 Apr-25 Green Organisational change, continuation of 24/5 proposal 26,27 LD review & review of care home bed usage Internal review and redesign, review care home bed utilitsation 736.00 491.00 491.00 Apr-25 Amber Any care package savings has implications for safety. Requires care home registration change and agreed costings . Continuation of 24/5 saving 28 Review of step down building based facilities Review into model of care 118.00 69.00 69.00 Apr-25 Green Lack of step down facility Impact on acute /secondary care/ primary care Continuation of 24/5 saving 30, 43*new Prescribing efficiencies Medication cessatio,switches within GP services and work with Care Homes 669.00 169.00 169.00 Apr-25 Green Pan Grampian approach may take tme to implement Progressing but other pressures on the budget Continuation of 24/5 saving 31 Digital Support efficiencies - NO TEMPLATE REQUIRED As part of DHI (Moray Growth Deal and Analogue To Digital Proposal) 100.00 100.00 100.00 Apr-25 Green Pan Grampian approach may take time to implement 33 Transport contract Review fo how we contract for transport for childrens and adult services 292.00 146.00 146.00 Oct-25 Amber Time and resources 44 *new Reduction in overtime reduce the amount spent on overtime during the year 200.00 200.00 200.00 Apr-25 Recruitment levels 46 *new Review of palliative care services Review of provision of palliative care in Moray to improve outcomes 117.00 117.00 117.00 Apr-25 Amber Contentious – public opinion Reputational damage Impact on secondary care Page 46
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ALREADY IMPLEMENTED 3,376.00 3,376.00 3,376.00 38 No non-essential travel (I year) Non essential travel ban (out of area) 30.00 30.00 30.00 Apr-25 Green Impact on staff development 38 No non-essential training (I year) Non essential training ban (conference attendance etc) 20.00 20.00 20.00 Apr-25 Green Impact on staff development 38 No backfill for secondments (1 year) Maternity leave- case by case consideration via RMG 150.00 150.00 150.00 Apr-25 Green Displacement of some staff, service pressures 41 *new Vacancy target NHS & increase on Council in line with pay award increase Already implemented 1,135.00 1,135.00 1,135.00 Apr-25 Apr-25 Green continuation of previous year 47* new Healthcare system reduced payment Refund due for system 20.00 20.00 20.00 Apr-25 Green Implemented - refund expected 48* new 3.42% budget cut on other services not included above 3.42% reduction in expenditure across a variety of budget headings 2,021.00 2,021.00 2,021.00 75% Mar-24 Mar-24 Green Implemented - Physio wait list TOTAL 11,689.00 9,468.00 9,468.00 Page 47
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APPENDIX 3 Predicted Prescribing Budget Resource Requirements 2025-2026 Prescribing pressures continue to grow, with a current 5% increase in overall costs. There is a net predicted need for a budget resource of £23,824m, for 2025-26. This paper provides information on the predicted prescribing budget resource requirements for 2025-206, alongside key drivers of growth and mitigations regarding costs. Current forecasting indicates that Moray will end the 2024-25 year with a prescribing deficit of -£3,131,000 which will be further affected by identified factors and estimates for these factors. Historic limited budget uplifts have resulted in significant historic overspends. Appendix A highlights a trend of increasing void between actual budget and actual spend.2024-25 spend has not accurately reflected estimates due to factors such as stabilisation of growth, multiple medicines shortages and price changes. Medicines shortages present unpredictable risk to expenditure estimates and cannot be mitigated for. There has been unprecedented growth in items and costs across all boards in Scotland (Appendix B). This has been further impacted also by the increase in Acute prescription requests by patients. There are wide ranging factors affecting performance. Resource assessment for prescribing has been undertaken for 2025-26. This was done using the approach adopted in previous years, which estimates growth in volume and spend in the coming year, and also offsets these with generic savings and approved efficiency plans. The key themes and data presented here are taken from the more comprehensive ‘Health and Social Care Prescribing Budget Supporting Information and Data for 2025/2026’, which has been scrutinised and approved by the multidisciplinary / cross sector Grampian Area Drug and Therapeutics Committee (GADTC) and NHS Grampian Primary Care Prescribing Group. A breakdown of the components of the Moray requested budget for 2025-26 is provided in Appendix C. A growing and ageing population demographic has had an effect on prescribing volumes and subsequent costs as cost per patient rises with age: • NRS figures now show that 23% of Moray population are now over age 65 which carries much higher cost per patient (Appendix D). Mitigation is to offer Primary and continue to offer Secondary prevention and adopt Realistic Medicine approaches to care. Item 7. Page 49
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Volume growth for 2024-25 was still highly variable due to multiple factors out with our control, including changes in volumes and treatments and continuing post-Covid variation in operating levels across Primary and Secondary care. In 2024-25 we had unprecedented growth in items and costs exceeding traditional pre-pandemic rates of growth Following Grampian’s increasing trend over time, the number of items and cost trends per financial quarter show an increase, as does the cost per item (detailed in Appendix E). The need for sustainable and environmentally friendly prescribing is a consideration. The following are the main financial risks: Scottish Drug Tariff Pricing and Medicine Shortages: Volatility within pricing of several widely used medications means that prices are likely to remain high in 2025-26. There remains scope to ensure that all new medicines are prescribed generically even before generic availability to ensure smooth transition and cost effectiveness. There is a risk in that the future prices for generic medicines, and associated reimbursement levels set within the Scottish Drug tariff, remain high and difficult to predict. The Scottish Government sets the Scottish tariff prices. They are committed to rebalancing Community Pharmacy contractor payments by reducing the emphasis on margin share and moving these payments to within the guaranteed global sum. Generic shortages arise from increase in demand, lack of active ingredient, quality control and manufacturing delay, etc. These result in more costly prescribing e.g. more expensive sometimes unlicensed medication choices, as well as impacting pharmacy admin and clinician time required. The global supply chain of medication remaining fragile continues to be a significant sourcing problem for Community Pharmacy within a wide range of medicines for a variety of conditions. Such shortages can lead to unpredictability in the cost per item during the year. The growth in consumption of medicines, strengthened approaches to medication review and associated reductions in polypharmacy. The variations in volume are partially related to changes in patient behaviours, as well as changes in capacity within Primary Care. Repeat prescribing increase has continued, and acute prescribing and outpatient/medication requests are variable corresponding to service provision and patient flow. In terms of Primary Care rebates, a patient access scheme system provides the NHS in Scotland with post-use discounts on spend on specific medicines has remained generally stable, but there remains a risk that these rebates may change or be removed. N.B. these discounts accrue to the individual Health and Social Care Partnerships (HSCPs) based on spend and so are offset within prescribing expenditure estimates. Page 50
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Sustained and increased pressures within GP practices and requirement of Pharmacotherapy teams to deliver Pharmacotherapy Memorandum of Understanding (MOU) work has reduced time availability for medicines management cost efficiency work by Pharmacists and GPs. National/international research, change to evidence based guidance or change to government policy. Many new medicines and new indications/licensing change for existing medications, from new protocols, are likely to have a significant clinical and subsequent financial impact e.g. Rimegepant in management and prevention of Migraine, and Attention Deficit Hyperactivity Disorder (ADHD ) treatment in adults. Appendix F highlights examples of medicines predicted to cause significant cost impact in Grampian. The list is not exhaustive and difficult to predict so will continue to be monitored. Changes in delivery of local services and patient pathways, have the potential to affect medicine use e.g. transfer of prescribing from secondary care to primary care has a financial impact. Extended hospital procedure waiting lists also requires extended prescribing time and increased prescribing costs while patients are on the waiting list. Summary of Risk Mitigation Patent Expiry On expiry of a drug patent, increasing competition can drive down market prices where there are alternative manufacturers’ competition. This relies on manufacturers to manufacture the newly off patent medicine. On patent expiry there is also opportunity to review the preparation prescribed and change to generic or more cost effective drug. Prescribing Cost Efficiencies and Cost Avoidance There is an urgent need and opportunity to deliver several cost efficiencies. An actionable tracker (in line with Grampian Primary Care Prescribing Group) holds some appropriate cost efficiency work for the pharmacy team to complete. Moray Pharmacotherapy staff annotate work when completed. This work has been challenging in terms of workforce capacity and workload pressures. Spend to Save Initiative Following a brief intervention in 2023-24 Considerable cost savings work has now been undertaken in 2024-25 under a Moray Pharmacy Spend to Save Prescribing Cost Effectiveness Strategy. This involved some GP practice Clinician collaboration as well as seconded Specialised Pharmacy Technician input to drive progress. Recent program of cost efficiency work from June 2024 to end Feb 2025 has provided annualised prescribing savings of £648,242. The work involved visits to GP practices and also some secondary care discussions and managed interventions via dedicated focused work. Prescribing reports were utilised. As well as therapeutic switches, prescribing of non-formulary and low clinical value items was scrutinised and discussions were had Page 51
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with GPs, practice clinicians and patients. From discussions with prescribing staff within practice and secondary care indirect savings were achieved by changing prescribing processes. Reducing over ordering and medicines wastage also helped maximise prescribing cost efficiency. A Grampian primary care prescribing efficiencies agreement was also put in place for GPs with the aim of medication review interventions involving drug therapeutic switches and generic switches. There were 3 levels of work stream and GPs suitably actioned some level 3 aspects. Medicines management team have provided guidance and support for prescribers re delivery of cost efficient prescribing in GP practices which has been a huge benefit to our intervention also. A Grampian Primary Care Prescribing group workbook has been developed which details information to guide efficiency, generic, preferred brand switches and a stop list with or without alternative re low clinical value prescribing. Scriptswitch This is a communication tool providing electronic advice messages to the prescriber. We continually review these messages to ensure that Scriptswitch underpins and delivers many cost saving initiatives. This can be in the form of a targeted therapeutic drug switch, reducing waste by dose optimising, as well as safety alerts. In 12 months, Moray generates approximately £85,000 savings via Scriptswitch, as well as adding influences prescribing for future. Generic Savings Work On our actionable tracker, we include work from the Practice Generic Savings Quarterly Report, and all teams are given details on medications not prescribed generically and the costs involved, although admittedly this is less than previous impact. The teams are requested to review and annotate changes made. Extraordinary Prescribing Report Moray Pharmacotherapy Team Management check reports and request copies of prescriptions in order to identify where pricing and reimbursement overpayments may require to be claimed. This can be from specials medications or normal prescribing. Time capacity more recently prevents us collating much of this work, however as an example in 2022, we claimed back £23,545 via pricing recovery. Tighter Control of Specials Items Automatic authorisation of specials items of £100 or less has been removed to allow more scrutiny of the specials prescribing and payments. Medicine Care and Review – Serial Prescribing Use of this serial prescription service, and now also in care homes, has the potential to reduce wastage as prescriptions are issued at correct intervals, which prevents any unnecessary stock piling. The Grampian Formulary Page 52
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A Grampian Formulary tool is installed in all Moray GP Practices to steer the appropriate cost-effective prescribing choices. There remains opportunity to identify and amend non formulary prescribing. Page 53
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Appendix A – Moray Budget Predictions, Budget Allocation and Actual Spend Page 54
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Appendix B – NHS Grampian vs Other Health Boards Figure 1 – Items Trends, NHS Scotland Mainland Health Boards Page 55
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Figure 2 – Cost Trends, NHS Scotland Mainland Health Boards Page 56
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Appendix C – Moray Health and Social Care Partnership: Summary and Budget Estimates Tables A and B: Estimates for Prescribing Table A: Growth, Expenditure and Savings – Primary Care Prescribing Factor Low estimate Medium estimate High estimate £000’s £000’s £000’s Level of Level of Level of Add over accrual impact from 2024/25 129 129 129 Demographic impact 0 0 0 Volume estimate movement 661 770 881 Price impact from 2024/25 39 39 39 Price impact further movement 0 231 346 ScriptSwitch allocation and communications 44 44 44 Discount income -12 -16 -18 New Medicines affecting Primary care 0 0 0 Existing Medicines affecting Primary Care 544 543 544 Scottish Tarriff discount % reduction 0 0 0 Further Prescribing Efficiencies 0 0 0 Total Movements 1404 1740 1965 Page 57
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Table B: Overall Moray HSCP Suggested Primary Care Prescribing Budget Requirement 2025/26 Factor Low Estimate Medium Estimate High estimate £000’s £000’s £000’s Full year Budget 2024/25 18728 18728 18728 Predicted Year End Out- turn 2024-25 21859 21859 21859 Total Movements 1404 1740 1965 Suggested Total budget 2025/26 23263 23599 23824 % increase on 2024/25 budget 24.2 26.0 27.2 % increase on predicted 2024/25 expenditure 6.4 8.0 9.0 Table C: Moray HSCP Suggested Primary Care Core HSCP Service Requirements 2025/26 Full year budget 2025/26 £000’s Estimated Out-Turn 2025/26 £000’s Suggested Budget 2025/26 £000’s Uplift on 2025/26 Budget % Uplift on 2025/26 Out-turn % 264 323 363 37.3% 12.3% Table D: Hosted Services Impact by IJB Hosted Sector 2025/26 Total uplift £000’s Moray IJB impact 2025/26 £000’s Moray IJB % shares City Sexual Health -17 -3 18 City Intermediate Care 46 2 4 Moray GMED 66 12 18 Shire HMP Grampian* 634 112 18 Shire Police Custody 0 0 18 Total 730 122 *Under review pending investigation into HepC medicine recharges. Page 58
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Appendix D – Population Calculations Rationale for Financial Updates Associated for Population Changes The age profile of each HSCP is different, this will result in different needs and therefore different prescribing patterns. Aberdeenshire and Moray have a greater proportion of their population aged 65 and over. The age structure of council areas, mid-2023, can be seen to the right. Page 59
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Table 1 – Moray Estimated Costs based on Population Predictions using Cost per Patient per Age Band Page 60
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Appendix E – Items and Cost Performance Trends Figure 1 – Number of Items Prescribed in General Practice (GP10, GP10N, GP10P (practice pharmacist) & GP10A) Page 61
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Figure 2 – Cost of Items Prescribed in General Practice (GP10, GP10N, GP10P (practice pharmacist) and GP10A) Page 62
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Appendix F – Primary Care Growth of Medicines Predictions (existing and new medicines) Page 63
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Integration Joint Boards Finance bulletin 2023/24 Prepared by Audit Scotland March 2025 APPENDIX 4Item 7. Page 75
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Integration Joint Boards | 2 Contents Key messages 3 Introduction 5 Context 6 Financial performance 7 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility Page 76
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Key messages | 3 Key messages 1 Integration Joint Boards’ (IJBs) finances continue to be precarious. IJBs 2023/24 funding has increased in real terms compared to 2022/23 but there is a concerning picture of continued overspending, depletion of reserves and required savings being met through one-off rather than recurring savings. 2 The majority of IJBs reported a deficit on the cost of providing services requiring unplanned use of reserves and additional contributions from partner bodies: • Total reserves held by IJBs have reduced by 40 per cent in 2023/24. Contingency reserves have almost halved, limiting IJBs ability to address future deficits. Nine IJBs now do not hold any contingency reserves reducing their financial flexibility and increasing the risk to their financial sustainability. • NHS boards and councils face significant financial challenges themselves and IJBs cannot continue to rely on their partners being able to find additional money to support them during the year. IJBs need to agree budgets that are realistic and transparent and to have strategies in place to manage in-year risks. 3 The majority of the total planned savings were achieved, but a substantial proportion were achieved on a one-off basis meaning these non-recurring savings need to be carried forward and covered each year to balance future budgets. 4 The financial position is set to worsen with a projected funding gap of £457 million in 2024/25. The budget process needs collaboration with partners and candid conversations with communities about the impact of the savings needed to set a balanced budget. The budgets and proposed savings need to be realistic and achievable. 5 A continued high turnover of chief officers and chief finance officers adds to the risks around effective strategic planning and decision-making. Page 77
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Key messages | 4 6 IJBs need to be working collaboratively with each other and with their NHS and council partners to find ways to transform services so that they are affordable. Investment in prevention and early intervention is needed to help slow the ever-increasing demand for services, the cost of more complex care and, improve the experience and outcomes for people. Page 78
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Introduction | 5 Introduction 1. Integration Joint Boards (IJBs) are responsible for the governance, planning and resourcing of social care, primary and community healthcare and unscheduled hospital care for adults in their local area. The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) requires the 32 Scottish councils and 14 territorial NHS boards to work together in partnerships to integrate how social care and community healthcare services are provided. IJBs were created as part of the Act. More information about the role of IJBs is set out in a short video available on our website What are Integration Joint Boards? 2. On behalf of the Accounts Commission, Audit Scotland has undertaken an analysis of the IJB annual accounts for 2023/24 and the annual audit reports produced by local auditors. The data and analysis is published on the Audit Scotland website as an interactive online tool – The IJB Finance bulletin 2023/24. 3. The interactive online tool allows users to explore the financial performance of their local IJB, as well as compare individual IJBs. We anticipate this will be a useful resource for IJBs, their stakeholders and members of the public. It includes data on the funding and income and reserves position, outturn budget position, savings performance and financial outlook. The tool also includes local and national contextual data from the 2022 census that illustrates the increasing population pressures nationally and the significant variation across Scotland. Accompanying guidance on how to use the online tool is also available on the Audit Scotland website. 4. This document provides a summary of the national level messages from the online Finance bulletin. 5. Our findings are based on the 2023/24 annual accounts for 29 IJBs (27 audited and two unaudited), 2023/24 annual audit reports, as well as IJB budget documentation. The accounts for East Dunbartonshire IJB were unavailable at the time of publication. 6. We have published the Finance bulletin as early as possible to help inform budget-setting discussions. Further information will be added to the data tool as it becomes available. By Autumn 2025, it will also include performance and outcome data. Page 79
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Context | 6 Context Demographic shifts are driving an increase in the demand and complexity of health and care needs 7. The pressures on Scotland's social care and healthcare services are escalating, with higher demand, workforce difficulties, and financial strains, further aggravated by inflationary cost pressures. 8. Scotland’s wide-ranging population density also presents different logistical and workforce challenges, along with associated cost pressures, to providing services. 9. The 2022 Census sets out how the underlying factors impacting on the demand for social care and healthcare services have changed since 2011. 2022 Census data Movement since 2011 census/range Population 5.4 million 2.7% increase Proportion of population aged over 65 20% Increasing from 17% Population density (residents per km2) 70 Varying from 9 (Eilean Siar) to 3,555 (Glasgow) Percentage of people who reported having bad or very bad health 7% 27% increase Percentage of people with a long-term illness, disease or condition 21% Increasing from 19% Percentage of population that provide unpaid care 12% 28% increase Source: Scotland’s Census 2022 10. These societal changes result in an increased resource demand for social care and healthcare services and impact on the financial sustainability of these services as we set out later in this report. Page 80
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Financial performance | 7 Financial performance The financial health of IJBs continues to weaken and there are indications of more challenging times ahead IJB funding has increased in real terms compared to 2022/23 11. IJBs receive their funding as annually agreed contributions from their council and NHS board partners. Funding is largely received to cover in- year expenditure on providing services but can also be received for specific services and national initiatives to be funded in future years. The funding split between NHS and council partners remains around 70 per cent from NHS boards and 30 per cent from councils. 12. There has been a four per cent real-terms increase in IJB funding between 2022/23 to 2023/24 (Exhibit 1). Exhibit 1 IJB Funding and income 2020/21 – 2023/24 Funding increased by four per cent in real terms in the past year Note: * Position/movement excluding East Dunbartonshire IJB as accounts are unavailable. Source: Audited accounts £10,577 £10,792 £9,996 £11,841 £507 £960 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 11,000 12,000 2020/21 2021/22 2022/23 2023/24* £ million Partner contributions Covid-19 funding Page 81
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Financial performance | 8 The majority of IJBs reported a deficit on the cost of providing services requiring additional contributions from partner bodies and the unplanned use of reserves 13. Twenty-four IJBs reported a deficit on the cost of providing services with the majority (18) reporting a deficit between zero and three per cent (Exhibit 2, page 9). 14. Of the 24 IJBs reporting an operating deficit, 11 received additional contributions from partner bodies to cover the year end overspend and 16 made an unplanned drawdown from reserves. A number of IJBs will have received additional partner contributions during the year that will not be captured by this analysis. These additional in-year contributions can arise for a variety of reasons, including specific one-off cost pressures not anticipated during budget-setting. 15. Five IJBs reported an operational surplus, down from 19 in 2022/23. Reasons reported for surplus’ included delays in the launch of some transformation and improvement projects and challenges in health and social care recruitment. 16. Recruitment and retention issues facing the sector persist, but the related savings from holding vacancies, that contributed to the majority of operational surpluses in 2022/23, are being outstripped by inflationary cost pressures and, reflecting the workforce pressures, a higher spend on agency/locum/bank staff. Other financial pressures driving the increase in the costs of providing services include increasing demand for services, prescribing costs and pay inflation. Page 82
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Financial performance | 9 Exhibit 2 Operational surplus/deficit as a proportion of the 2023/24 net cost of service The majority of IJBs reported a deficit on the cost of providing services in 2023/24 requiring additional contributions from partner bodies and the unplanned use of reserves. Note: * Comparable data for 2022/23 was not available for these IJBs. ** East Dunbartonshire IJB accounts unavailable. Source: Audited accounts, auditor returns The majority of the total planned savings were achieved, but a substantial proportion was achieved only on a one-off basis 17. There was a 154 per cent increase in the savings target between 2022/23 and 2023/24, increasing to £214 million. Overall, IJBs achieved 79 per cent of their planned savings targets in 2023/24. This was down -10% -5% 0% 5% 10% Shetland Orkney* Dumfries & Galloway* Falkirk Eilean Siar Midlothian Aberdeen East Renfrewshire Fife Aberdeenshire Scottish Borders East Ayrshire Perth and Kinross North Ayrshire Moray East Lothian Glasgow Dundee Clackmannanshire & Stirling Edinburgh* West Dunbartonshire Inverclyde West Lothian Renfrewshire East Dunbartonshire** Argyll & Bute South Lanarkshire Angus North Lanarkshire South Ayrshire 2022/23 2023/24 Page 83
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Financial performance | 10 from 84 per cent in 2022/23. Only seven IJBs achieved all of their savings target with three IJBs achieving less than half their target (Exhibit 3, page 11). 18. Fifty-seven per cent of savings were achieved on a recurring basis with the remaining 43 per cent being achieved on a non-recurring basis. The non-recurring savings will be carried forward to be found again in future years. Page 84
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Financial performance | 11 Exhibit 3 2023/24 Savings performance 79 per cent of total planned savings were achieved in 2023/24, compared to 84 per cent in 2022/23. Note: * In the absence of the 2023/24 East Dunbartonshire IJB accounts, the 2022/23 Net Cost of Service was used. Source: 2023/24 Audited accounts, auditor returns 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% North Lanarkshire Angus Inverclyde Perth and Kinross Renfrewshire Clackmannanshire & Stirling South Ayrshire Orkney Scottish Borders East Ayrshire East Dunbartonshire* Glasgow North Ayrshire Moray East Renfrewshire Fife Dundee Shetland Aberdeen West Lothian Argyll & Bute Edinburgh West Dunbartonshire Eilean Siar Falkirk Dumfries & Galloway Savings target as a proportion of the net cost of service Savings achieved Savings target + target amount £23.2m £1.4m £13.5m £7.9m £20.7m £8.9m £6.6m £9.4m £2.0m £5.1m £21.4m £7.1m £4.1m £5.0m £21.5m £3.9m £5.2m £2.5m £2.4m £2.4m £2.5m £3.3m £4.4m £1.3m £0.9m £2.7m 85% 59% 146% 71% 106% 83% 97% 79% 57% 100% 53% 39% 66% 94% 100% 64% 61% 100% 85% 31% 95% 85% 75% 100% 100% 57% 100% Page 85
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Financial performance | 12 19. IJBs achieved 79 per cent of their planned savings target in 2023/24. Over two-fifths of this were achieved on a non-recurring basis. This means that these savings will be carried forward to be found again in future years. Identifying and achieving savings every year on a recurring basis, and moving away from relying on one-off savings, is essential for IJBs to maintain financial sustainability. Total reserves held by IJBs have reduced by 40 per cent in 2023/24. 20. By the end of 2023/24, IJBs reported a reduction in their total level of reserves, decreasing by 36 per cent between 2022/23 and 2023/24 (40 per cent real-terms reduction). Part of the reduction relates to the use of ringfenced reserves to support Scottish Government national policy objectives (Exhibit 4). Exhibit 4 Total reserves by year Total reserves held by IJBs have reduced by 40 per cent in real terms in 2023/24. Note: * 2023/24 position/movement excludes the East Dunbartonshire IJB position. Source: Audited accounts £- £200.00 £400.00 £600.00 £800.00 £1,000.00 £1,200.00 £1,400.00 2020/21 2021/22 2022/23 2023/24 Millions Ringfenced/Earmarked reserves Contingency reserves Covid reserves Page 86
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Financial performance | 13 Contingency reserves have almost halved, limiting IJBs ability to address future deficits 21. Contingency reserves have almost halved (49 per cent real-terms reduction) and now represent 0.8 per cent of the total Net Cost of Services (down from 1.6 per cent). These are reserves that are held but have not been earmarked for a specific purpose and are often used to mitigate the financial impact of unforeseen circumstances (Exhibit 5). Exhibit 5 2023/24 year end IJB reserves as a proportion of the net cost of services Over half of all IJBs had contingency reserve levels of less than one per cent of net cost of services. Source: Audited and unaudited accounts 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% Aberdeenshire Midlothian Fife East Lothian Shetland Edinburgh East Renfrewshire Moray Perth and Kinross North Ayrshire Dumfries & Galloway Aberdeen West Lothian East Ayrshire Clackmannanshire & Stirling Scottish Borders Argyll & Bute Dundee Glasgow Orkney South Lanarkshire South Ayrshire Renfrewshire Falkirk West Dunbartonshire North Lanarkshire Angus Inverclyde Eilean Siar Ringfenced/Earmarked reserves Contingency reserves Page 87
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Financial performance | 14 22. One IJB (Aberdeenshire) utilised all their reserves in year, meaning that any future overspend position would require additional funding from partner bodies. 23. Four IJBs utilised all their contingency reserve in year, bringing the total number of IJBs without any contingency reserves, at the end of 2023/24, to nine. Financial sustainability risks have been identified by auditors in the vast majority of IJBs 24. The majority of auditors raised financial sustainability risks as part of their annual audits of IJBs. The risks identified included the reliance on non-recurring sources of income, such as reserves and one-off savings, to meet overspends. 2023/24 Audit Financial management risks identified* 22% Financial sustainability risks identified* 96% Medium-term financial plan in place** 90% Accounts presented within agreed timetable** 83% Unmodified opinion* 100% IJBs reporting turnover in senior officer roles (CO/CFO)** 57% IJBs who agreed their 2024/25 budget prior to the start of the financial year** 87% Note: * Based on 27 IJBs, where Annual Audit Reports were available. ** Based on all IJBs. Turnover figures include IJBs with interim Chief Officers (CO)/Chief Finance Officers (CFO) in place. Source: Annual Audit Reports, IJB budget papers, Medium-term financial plans 25. Other financial sustainability risks highlighted by auditors included: • Reserves level falling below minimum required as per their individual reserves policies. In one case, the general reserve has been depleted in full. • Undeveloped/underdeveloped plans for the achievement of recurring savings to allow IJBs to reach a balanced financial position. Page 88
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Financial performance | 15 • Additional contributions being required from IJB partners to meet cost pressure. • Inability to reduce reliance on agency and locum staff due to ongoing recruitment challenges. 26. Financial management risks identified included: • Inaccurate information provided or not presented in line with regulations. • Insufficient detail provided to allow the reader to fully assess the board’s overall performance. • Financial forecasting requiring more accuracy. • Requirement to enhance the reporting to provide greater clarity regarding the underlying IJB budget and performance against the budget during the year. Instability of leadership continues to be a challenge for IJBs 27. Over half of IJBs reported a change of Chief Officer or Chief Finance Officer in 2023/24. We previously reported that half of IJBs reported a change in senior leadership across 2021/22 and 2022/23. 28. The leadership and strategic vision of senior officers is crucial in the strategic planning and decision making required to drive much needed transformation change. Instability in leadership teams has the potential to disrupt strategic planning and the leadership capacity to bring about the fundamental change required to address the growing scale of challenges facing IJBs. The projected financial position is set to worsen 29. 2024/25 budget-setting revealed that the projected funding gap for IJBs has increased again to £457 million (£357 million for 2023/24) (Exhibit 6, page 16). 30. For 2024/25, 16 of the 30 IJBs agreed a balanced budget before the start of the financial year. Delays in the agreement of savings plans and NHS partner funding were the most common reasons for balanced budgets not being agreed at the start of the financial year. Page 89
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Financial performance | 16 Exhibit 6 IJB funding gaps as a proportion of 2023/24 net cost of services IJB annual accounts and budget papers identify a 28 per cent increase in the overall projected funding gap between 2023/24 and 2024/25. Note: * In the absence of the 2023/24 East Dunbartonshire IJB accounts, the 2022/23 Net Cost of Service was used. Source: IJB budget papers, auditor returns Reliance on non-recurring sources of income is not sustainable 31. At the time of the 2024/25 budget-setting, nine per cent of the projected funding gap was planned to be bridged using non-recurring reserves (Exhibit 7, page 17). 0% 2% 4% 6% 8% 10% 12% Scottish Borders South Ayrshire Angus West Lothian North Ayrshire Perth and Kinross Argyll & Bute East Dunbartonshire* West Dunbartonshire Orkney East Lothian Fife Falkirk Moray Eilean Siar 2024/25 gap as proportion of Net Cost of Service 2023/24 gap as proportion of Net Cost of Service Page 90
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Financial performance | 17 32. A proportion of the funding gap did not have planned savings agreed against it at the time of budget-setting. These unidentified savings made up 13 per cent of the total projected funding gap and were the result of 12 IJBs starting the 2023/24 financial year with an unbalanced budget. Exhibit 7 2024/25 IJB funding gap planed action The use of non-recurring reserves makes up nine per cent of plans to bridge the funding gap. Source: IJB budget papers, auditor returns 33. The proposed savings contain both recurring and non-recurring savings. The reliance on non-recurring sources of income to fund recurring budget pressures is unsustainable in the medium to long term. The identification and delivery of recurring savings and a reduced reliance on drawing from reserves to fund revenue expenditure will be key to ensuring long-term financial sustainability. Agreed savings 76% Use of reserves 9% Other 2% Remaining gap 13% Agreed savings Use of reserves Other Remaining gap Page 91
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Integration Joint Boards Finance bulletin 2023/24 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot ISBN 978 1 915839 65 7 AS.5.0 Page 92
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APPENDIX 5 MORAY INTEGRATION JOINT BOARD DIRECTION Issued under Sections 26-28 of the Public Bodies (Joint Working) (Scotland) Act 2014 1. Title of Direction and Reference Number MIJB 2025.26 Budget 20240327GHB/MC14 2. Date Direction issued by the Moray Integration Joint Board 27.03.2025 3. Effective date of the Direction 01.04.2025 4. Direction to: NHS Grampian and Moray Council 5. Does the Direction supersede/update a previous Direction? If yes, include the reference number(s) of previous Direction No new budget for 2025/26 6. Functions covered by Direction All functions listed in Annex 1, Part 1 of the Moray Health and Social Care Integration Scheme and all functions listed in Annex 2, Part 1 of the Moray Health and Social Care Integration Scheme. 7. Direction Narrative Directed to deliver for the Board, the services noted below in pursuance of the functions noted below and within the associated budget noted below 8. Budget Allocation by MIJB to deliver on the Direction Moray Council associated budget - £96.5 million, of which £0.6 million is ring fenced for Housing Revenue Account aids and adaptations and £3.3 for Children Services & Criminal Justice OOA ring fenced shared budget. NHS Grampian associated budget - £82.8 million, of which £5.9 million relates to Moray’s share for services Item 7. Page 93
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to be hosted and £18.7 million relates to primary care prescribing. An additional £15.6 million is set aside for large hospital services . All details contained in APPENDIX 1 to the report 9. Desired Outcomes The direction is intended to reflect the budget position for 2025/26 10. Performance monitoring arrangements and review Directions will be reviewed by the Audit Performance & Risk Committee on a six monthly basis for assurance. Any concerns should be escalated at the first available opportunity to the MIJB. An annual report of all current Directions will be presented to the MIJB Page 94
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 MARCH 2025 SUBJECT: MEDIUM TERM FINANCIAL FRAMEWORK 2025/26 – 2029/30 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 The Board is asked to approve the updated Medium Term Financial Framework 2025/26 to 2029/30. 2. RECOMMENDATION 2.1 It is recommended the Board: i) consider and approve the updated Medium Term Financial Framework as set out below and at Appendix 1; and ii) agree that a review of the Framework be carried out on an annual basis. 3. BACKGROUND 3.1 The current Medium Term Financial Framework covers the period 2023/24 to 2027/28 and was presented to the Board on 30 March 2023 (para 7 of the minute refers). 3.2 Scottish Government stipulated that the funding allocation to Integration Authorities should be additional and not substitutional to each Council’s 2024/25 recurring budgets for social care services and therefore, Local Authority social care budgets for allocation to Integration Authorities should be £115 million greater than 2024/25 recurring budgets. 3.3 The Audit Scotland annual audit report, presented to the Board on 26 September 2024 (para 11 of the minute refers) as part of the report for those charged with governance made a recommendation that the Board’s medium- term financial plan should be reviewed as it is considered out of date, alongside the suite of supporting documents that support the Strategic Plan. The latest Strategic Plan was approved by the Board on 24 November 2022 (para 14 of the minute refers) for the delegation of Childrens Services and Criminal Justice. Item 8. Page 95
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3.4 In October 2018, the Scottish Government published it’s medium term financial framework for health and social care (Scottish Government Medium Term Health and Social Care Financial Framework). This framework outlined the future shape of demand and expenditure for health and social care services and included cost and demand projections from work undertaken by the Institute of Fiscal Studies which outlines that UK expenditure on healthcare would require to increase by an average of 3.3% per annum over the next 15 years to maintain NHS levels at 2018 levels. The report also set out that spending on social care services would require to increase by 3.9% per annum to meet the needs of an increasingly elderly population and an increasing number of younger adults living with disabilities. The Scottish Government updated its medium term financial framework in May 2022, Scotland’s Fiscal Outlook: The Scottish Government’s Medium-Term Financial Strategy, then again in May 2023, Scotland's Fiscal Outlook: The Scottish Government's Medium-Term Financial Strategy 3.5 The Medium Term Health and Social Care Financial Framework was updated in March 2022, due to the recognition that there have been significant developments since the original Framework was published in October 2018, most notably the ongoing impact and future implications of the Covid-19 pandemic. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The current Medium Term Financial Framework covers the period 2023/24 – 2027/28 and is overdue for review. A commitment was made to ensure a revised framework would be before the Board on 31 March 2025. 4.2 The Joint Strategic Needs Assessment (JSNA) was updated and presented to the Board on 26 September 2024 (para 14 of the minute refers). The main goal of the JSNA is to accurately assess the care needs of local in order to improve the physical and mental wellbeing of individuals and communities. This information will be used to inform the reviews of the Strategic Plan. The latest Strategic plan was approved by Board on 24 November 2022 (para 14 of the minute refers) and the Strategic Delivery Plan is a separate item on this agenda. 4.2 The review of the MIJB Medium Term Financial Framework takes account of information currently available, however it is recognised that assumptions and applied methodology will be subject of ongoing review and refinement as additional information becomes available (notably the updated Scottish Government Medium Term Health and Social Care Financial Framework) and information relating to the National Care Service / Independent Review of Adult Social Care. Given the current uncertainty, it is therefore considered necessary to review the medium term financial framework on an annual basis. The updated Medium Term Financial Framework is included at Appendix 1. 4.3 There is a summary of the key information contained within the report relating to financial information and the table on page 7 details the budget pressures estimated to be required for the next 5 financial years, with assumptions detailed in the paragraphs after the table. Page 96
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4.4 There are 2 tables on page 8, which shows the funding forecast for the next 5 years, this is based on flat cash settlement from the Council and a 3% increase on base funding each year for NHS Grampian. The key table is the one that gives the summary position and the level of savings required for the MIJB to achieve. Summary Position 2025/26 2026/27 2027/28 2028/29 2029/30 £000’s £000’s £000’s £000’s £000’s Estimated Budget Requirement 204,375 212,158 215,950 220,268 224,715 Total Funding 203,375 207,390 211,525 215,784 220,170 Use of ear marked reserves 1,000 Budget Surplus/(Deficit) - (4,768) (4,425) (4,484) (4,545) 4.5 The predicted rise in costs over the term of this framework is £18.222 million, which will require significant transformation to achieve financial balance. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan 2022 – 2032, ‘Partners in Care’ The approval of a balanced budget for the MIJB is key to the delivery of health and social care services in Moray in accordance with the Strategic Plan. (b) Policy and Legal In accordance with the Public Bodies (Joint Working) (Scotland) Act 2014, MIJB is subject to the audit and accounts regulations and legislation of a body under Section 106 of the Local Government (Scotland) Act 1973 and is classified as a local government body for accounts purposes by the Office for National Statistics. (c) Financial implications Financial implications are contained throughout the report. (d) Risk Implications and Mitigation The revenue budget for 2025/26 onwards is subject to the following risks: • GP Prescribing – represents around 13% of the MIJB core budget. It is well documented that the Prescribing budget can be extremely volatile in nature with volume and price increases potentially leading to substantial adverse variances. • Growth and demand in the system, together with service users with complex care needs are attracting additional financial challenge. These issues require to be managed within the overall resource of the MIJB. Page 97
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• The need to transform at pace and drive forward opportunities arising through changes to working practice experienced through the pandemic. The risk being the ability to capture and embed in a timely manner. • The implications of the cost of living crisis and current levels of inflation, which are still forecast to rise may mean the provision for inflation may not cover all the calls upon it. Price inflation may impact on areas where no provision has been made for inflationary increases and this will add pressure to budgets. Budget managers will need to control their expenditure to absorb such pressure if possible and may have to reduce service levels or identify further savings (e) Staffing Implications There are no direct implications in 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 change to policy. Any subsequent changes to policy arising from proposals made within this paper will be considered appropriately. (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 Consultations have taken place with the Senior Management Team, the finance teams of both Moray Council and NHS Grampian, Caroline O’Connor, Committee Services Officer and the Corporate Manager. 6. CONCLUSION 6.1 The Medium Term Financial Framework for 2025/26 to 2029/30 is presented at Appendix 1. 6.2 There will be close monitoring and review of the Medium Term Financial Framework on an annual basis. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 98
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APPENDIX 1 MEDIUM TERM FINANCIAL FRAMEWORK 2025/26 – 2029/30 MORAY INTEGRATION JOINT BOARD Item 8. Page 99
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Table of Contents Introduction ........................................................................................... 2 Context .................................................................................................. 3 Purpose ................................................................................................. 4 Influencing Factors ............................................................................... 5 Demographics .......................................................................................................................... 5 Costs ........................................................................................................................................ 7 Funding .................................................................................................................................... 8 Risk and Sensitivity Analysis ................................................................................................... 10 Legislative & Policy Changes ................................................................................................... 11 Demand ................................................................................................................................. 12 Risk ........................................................................................................................................ 12 Page 100
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 1 Introduction Moray Integration Joint Board (MIJB) has been operating since April 2016 following the introduction of new legislation - the Public Bodies (Joint Working) (Scotland) Act 2014. The legislation was developed with the aim of reshaping the health and care system in Scotland to ensure sustainability of good quality services through a time of change where demand continues to grow, our population is ageing and our budgets are reducing. It changed the way in which health and social care services were planned and delivered by introducing a single integrated system in creating Integration Authorities. The MIJB is funded through allocations made by NHS Grampian and Moray Council. MIJB has set out its approach for transforming the health and care system over the long term in its Strategic Plan 2022-32 and has defined its priorities for the next ten years through its Transformation Plan. The Strategic Plan is underpinned by three Strategic Outcomes This Medium Term Financial Framework (MTFF) is designed to assist the MIJB from a planning perspective based on the totality of its financial resource across health and social care in meeting the needs of the people of Moray. It will support the delivery of the Strategic Plan within the context of the significant financial challenge being faced and the continuing pressure being driven by growing demand and complexity, higher costs and increasing expectations. BUILDING RESILIENCE – Taking greater responsibility for our health and wellbeing HOMEFIRST – Being supported at home or in a homely setting as far as possible PARTNERS IN CARE – Making choices and taking control over decisions Page 101
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 2 Context There are 31 Integration Authorities established between 14 health boards and 32 councils across Scotland. 30 of the Integration Authorities are separate legal entities and operate through a body corporate (Integration Joint Boards) and one area operates a Lead Agency model. Scottish Government has been clear in that health and social care integration remains a key priority. From the outset of integration, the aim has been to shift the balance of care from large hospital settings into community based care. In May 2024, the Institute for Financial Studie1s reported in 2019 that UK spending on healthcare would require to increase in real terms by an average of 3.3% per year over the next 15 years in order to maintain NHS provision at current levels. However, latest plans imply average growth of 2.7% per year between 2019/20 and 2024/25. The Office for Budget Responsibility (OBR) estimate that health spending will have to rise further to meet demographic and cost pressures There are numerous measures being used to monitor the local and national progress of Integration. The Scottish Government’s Ministerial Strategic Group for Health and Community Care have identified six priority areas against which progress against integration is being measured: • Acute Unplanned Bed Days • Emergency Admissions • A&E Attendances • Delayed Discharge Bed Days • End of Life Spent at Home or in the Community • Balance of Care percentage of population in a Community or Institutional Setting 1The past and future of UK health spending | Institute for Fiscal Studies Page 102
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 3 Purpose MIJB is focussed on improving the health and wellbeing of the people in Moray. It seeks to reduce health inequalities and drive transformational change through innovative approaches. Medium term financial planning is an essential part of the strategic planning process that supports the MIJB to develop plans which consider the financial climate and broader economic impacts. A robust medium term financial framework will provide transparency and support informed decision making. Inherent within the MTFF is a significant degree of uncertainty. Scottish Government funding settlements to our funding partners, Moray Council and NHS Grampian are currently on a one year only basis and have a direct impact on the funding to the MIJB. The MTFF sets out anticipated cost pressures and future funding projections based on planning assumptions and advice from our funding partners. This is an evolving model and it will be essential to refine and update at regular intervals. This review of the framework follows the updated Strategic Plan and the full delegation of Children’s Services from 1 April 2024. Given the level of uncertainty and potential for variability, it is essential that the MIJB plans for a range of potential outcomes, ensuring sufficient flexibility to manage in a sustainable manner over the course of this plan. The MTFF Framework seeks to support the understanding surrounding the broader climate within which the MIJB will operate in over the medium term. There are wide- ranging factors which encompass the complexity that impacts on the financial pressures of the MIJB. The main objectives of the MTFF are: • To look to the longer term to help plan sustainable services, estimating the level of resources required to operate these services and deliver on the MIJB’s strategic ambition. • To estimate the level of increasing demand on services and provide a single document to communicate the financial context to all stakeholders and support partnership working. • The MTFF includes a five-year budget forecast that will be reviewed annually to ensure our strategic priorities remain the focus in a challenging financial climate. Page 103
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 4 Influencing Factors Demographics Moray’s population has grown significantly in the past 20 years from 87,000 in 2001 to an 93,400 in 2022; an increase of 7.4%. However, the population growth in Moray is slowing and it is projected that against the 2022 baseline, Moray will be one of the 14 councils in Scotland who will have had a population decline by 2028. Between 2022 and 2028 the age group +75 is projected to see the largest percentage increase at 32.4%. The largest percentage decrease is projected to be in the 0 to 15 years age group (table 1 below). Given the most significant population growth is projected to occur amongst older adults, this will have a significant impact on demand for our services and creates a challenging environment in which to operate whilst transforming our services and delivering on national and local priorities. The table 2 below illustrates the % change across the main population groups by 2028.12 However, the 2024 census data will provide a more accurate reflection of the current population in Moray and once published will enable more accurate projections to be calculated. The census data are expected to be available in May 2025.3 . 2 https://www.scotlandscensus.gov.uk/documents/scotlands-census-2022-rounded-population-estimates-data/ 3 https://www.scotlandscensus.gov.uk/census-blog/looking-ahead-to-census-releases-in-2024/ DEMOGRAPHICS COSTS FUNDING POLICY DEMAND RISKS Page 104
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 Table 1: Moray Population by Age Group – Comparison Between 2022 Estimate and 2028 Projection (NRS data) Table 2: Percentage Change in Projected Population for Moray, by Age Group, (NRS data) This MTFF has been updated following the revised Strategic Plan; allowing our local systems to develop plans within the overall, agreed financial position and alongside service and workforce considerations. Page 105
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 During 2024/25, the Joint Strategic Needs Assessment (JSNA) was produced to inform and support the production of the Strategic Plan for 2024 and beyond. The SNA was developed through a short-life working group comprising of representatives from Health and Social Care Moray, The Moray Council, the Moray Health and Wellbeing Forum, NHS Information Services Division Scotland, and NHS Grampian. The SNA focused on the collation and analysis of data from a range of sources to inform the identification of priorities, and subsequent decision-making regarding service provision. It also contributes to longer term planning undertaken by the Moray Community Planning Partnership and the updating of the Moray Local Outcomes Improvement Plan (LOIP).There are seven relevant areas for Moray. The SNA highlighted seven areas to be considered: • Population demographics – these are the basis of the JSNA and includes population projections, which is an increasingly ageing population in Moray along with a reducing birth rate. Deprivation in Scotland, where Moray is showing a low level of deprivation but child poverty is rising faster than Scotland as a whole. • Social, clinical and behaviour risk factors – there are a number of risk factors which are known to influence health, societal, behavioural and clinical. These risk factors are strongly influenced by the environments we live in and the commodities that we are able to access.Clinical risk factors may be associated with an increased risk of certain diseases or death. • Population health – the diseases, illnesses and risk factors faced by the population of Moray, with a purpose to not only understand future services but what can be done to prevent, treat or support in different ways. • Secondary care services – increasing hospital admissions, including emergency admissions, preventable admissions, unintentional injuries and falls and delayed discharges in Moray. • Social care – long stay residents supported in care homes is increasing and above the Scottish average as well as demand for care at home support. Most common client type for care at homes services in Moray are elderly and frail individuals. • Finance and workforce – Staff headcount has increased within Health & Socal Care Moray, however, the workforce is becoming older, with increases in retirement and part time working. Increasing funding gap for Health & Social care since 2024/25 onwards . • Different ways of working – looking at partnerships with people and other transformations to meet the outcomes of people. Page 106
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 In response to the SNA, the MIJB Strategic Plan was developed and set the direction and approach to prevention in addressing what is required in order to build resilience in individuals and communities to be able to maximise their health and wellbeing potential whilst ensuring services are available and fit for purpose when required. Costs There is a predicted rise in costs over the term of this framework of over £18 million. The key elements are in relation to pay and price inflation and the increasing number of complex care packages and the pressures on the prescribing budget. Budget Pressures 2025/26 2026/27 2027/28 2028/29 2029/30 £000’s £000’s £000’s £000’s £000’s Pay 2,758 2,841 2,926 3,014 3,105 Non pay inflation 960 843 855 880 907 SG investment ie RLW, FPNC 3,084 2,088 2,150 2,215 2,280 Learning Disability – High Cost 1,076 700 700 700 700 Transitioning Children 771 800 800 800 800 Prescribing 1,153 1,000 1,000 1,000 1,000 Other 666 126 130 134 138 Recurring Deficit 5,988 eNIC pressure 2,505 Total Budget Pressures 18,961 8,398 8,561 8,743 8,931 Assumptions embedded within Budget Pressures: Pay – 3%, in each year for both Council and NHS staffing. Funding will be provided for the health staff increase with the assumption is that this will continue to be the case. Non pay inflation –3% in each of the following years for non pay external purchasing but includes £141,000 one off expenditure for 2025/26. Scottish Government investments – this relates to the Real Living wage increase for adult and Children’s social care, National Care Home Contract and the Free Personal and Nursing Care, for 2025/26 includes increases of 5% and 6.7% but is assumed it will reduce to 3% in each of the following years Funding is received towards the majority of this pressure. High Cost Individuals – there are significant packages expected in 2025/26 but beyond then we will need to consider different care models in order to ensure we can manage the related budget pressure Transitioning Children – work has been on going to deal with the expected increase for clients coming into the service. There is expected to be a constant increase over the next few financial years, for which the service is monitoring and reviewing to ensure the budget pressures can be managed. Page 107
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 Prescribing – pressure continues on this budget for the foreseeable future, due to increase in both demand and prices. eNIC pressure – relates to the UK Government’s increases to employers National Insurance Contributions (eNIC). This pressure includes both directly employed staff and commissioned provider contracts. Funding is expected to provide 60% of the directly employed pressure with the balance having to be met by the IJB’s. Funding The two main sources of funding for the MIJB are provided by NHS Grampian and Moray Council. In recent years, additional investment for health and social care has been provided by the Scottish Government and this is passported through either the local authority or the health board. Any future funding will be impacted by the respective financial planning processes of both organisations and the funding settlements they receive. The MTFF makes assumptions regarding future funding contributions from both Partners based on information which is currently available. Outlined below is the potential funding that will be provided over the term of this plan. Funding Forecast 2025/26 2026/27 2027/28 2028/29 2029/30 £000’s £000’s £000’s £000’s £000’s NHS Grampian Recurring 94,724 97,578 99,908 102,308 104,780 NHS Grampian Uplift (3%) 2,262 2,330 2,400 2,472 2,546 NHS Grampian eNIC 592 Moray Council Recurring 86,221 90,159 91,844 93,579 95,366 Moray Council eNIC 800 Additional SG investment 3,138 1,685 1,735 1,787 1,840 Set Aside 15,638 15,638 15,638 15,638 15,638 Total Funding Estimated 203,375 207,390 211,525 215,784 220,170 *assumes budget protocol principles are reinstated Summary Position 2025/26 2026/27 2027/28 2028/29 2029/30 £000’s £000’s £000’s £000’s £000’s Estimated Budget Requirement 204,375 212,158 215,950 220,268 224,715 Total Funding 203,375 207,390 211,525 215,784 220,170 Use of ear marked reserves 1,000 Budget Surplus/(Deficit) - (4,768) (4,425) (4,484) (4,545) Page 108
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 10 The summary position tabled above highlights that the MIJB will be required to continue to closely observe the financial constraints within which it is operating. Future funding assumes a level of savings will be achieved each year, together with transformational redesign that we know we need to make in order to provide affordable sustainable services within the resources available. It assumes that the existing financial pressure will be addressed through savings alongside the need to transform the way we provide services across our whole system in an innovative way. With this in mind and assuming this can be achieved over the short-term, there still remains a deficit that will require to be addressed, again reinforcing the need to review this framework on a regular basis, updating it with the most current information available and creating a focus on the period ahead. Risk and Sensitivity Analysis The MTFF is a financial model based on the best available planning assumptions at the time and accordingly, has related risks associated with it. The main risks associated with this framework are: • Impact of MIJB decisions on Partner bodies and Vice-versa • Failure to identify a future budget pressure • Under estimation of the cost pressures • Under estimation of demand pressures • Public expectation of delivered services • Over /under estimated impact of local and national factors • Failure to accurately forecast income sources It is important that the MIJB is aware of these risks in determining its appetite to risk as it considers its Strategic Plan. The MIJB recognises strategic risks through its Risk Register. This is used to ensure that significant risks are identified and mitigating actions are effective in reducing these risks to an acceptable level. Sensitivity Analysis is used to test the major assumptions being made and what the implications would be, should those assumptions change. The Financial Projections outlined in this framework are based on what is determined to be a medium case scenario for future funding. In addition to the funding element, there are risks aligned to other assumptions made in the framework around future budget pressures for the MIJB. It is important that the MIJB regularly reviews this framework. Page 109
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 11 Legislative & Policy Changes Integration Authorities are operating within a complex and changing environment where national issues are likely to have an impact on the services provided and how we deliver them locally. This environment has changed significantly following the Covid 19 pandemic and the ongoing effect of public health and the economic impact. Some of the recent legislative changes impacting on integration authorities are: • Free Personal Care for the Under 65’s – the Scottish Government has committed to the extension of Free Personal Care to those under the age of 65 who require it, regardless of condition. This became effective from 1 April 2019. This represents a significant change to how personal care is funded and is likely, over time to increase demand for personal care across Scotland. • Carers Act (Scotland) Act 2016 – This legislation came in to effect on 1 April 2018 and is designed to support the health and wellbeing of carers by supporting sustainability. It places a duty on Local Authorities to provide support for carers, based on the carer’ identified needs which meet local eligibility criteria. • Scottish Living Wage – there is a continued commitment from Scottish Government to support the payment of the Scottish Living Wage to improve people’s lives and help build a fairer society. Scottish Government has continued to provide funding to support this commitment. For the 2025/26 financial year, the uplift is set to increase to a minimum of £12.60 per hour. • Delayed Discharge – a Scottish Government priority to reduce the number of people who are delayed from being discharged from hospital. Work is on going on a whole system approach to reduce this. • National Care Service – the recommendations arising from the Independent Review of Adult Social Care which concluded in January 2021 are likely to have a major impact on how Integration Authorities are governed and how services are delivered. Confirmation and further detail are awaited Page 110
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 12 Demand The recovery from the impact of the Covid 19 pandemic continues to create increased pressure and demand on our health and social care system. The full extent of this impact remains unknown but we are acutely aware of the current impact on the citizens of Moray in respect of the level of unmet need we are experiencing in both assessment and delivery of care. We understand that in order to address increasing demand it will require the whole health and social care system to work together to redesign to create truly transformational services. The landscape is constantly changing as we progress through the recovery stage. We must ensure we have robust plans in order to maintain delivery of our strategic aims whilst being mindful of the flexibility that will be required as we continue to understand the broader impacts that we face as we recover and remobilise following the pandemic. Risk We are experiencing challenging economic conditions. The effects of the global economy in turn is impacting on the Moray population through taxation, inflation and level of earnings. The broader impact is on the funding being made available to support public spending. Scotland’s funding is largely dependent on funding being received from the UK Government. The most recent ‘State of the Economy’ report4 from Scotland’s Chief Economic Advisor was published in May 2024 and highlighted the following: • Scotland’s GDP grew in the three months to February 2024 by 0.4% in February, and is likely that the economy will show growth in the first quarter of 2024, confirming that the Scottish economy has avoided a recession; • Scotland’s labour market continues to be robust, with the unemployment rate falling to 4% and the number of payrolled employees remaining close to its series high. Earnings also continue to grow faster that inflation, with annual earnings growth of 6.3% in March, 3.1% faster than inflation; • Economic growth is expected to strengthen across 2024 and 2025, as lower inflaction supports real earnings growth, with interest rates also expected to fall with will support a pick-uo in consumption. Howeverm the path for inflation, earnings and interest rates remain uncertain and will be an important determinant of the economic outlook. 4 https://www.gov.scot/publications/scottish-economic-bulletin-2024/ Page 111
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Draft Medium Term Financial Framework 2022/23 - 2026/27 Page 13 The MIJB is facing new risks which may impact on its budget over the next few years: • Significant financial pressures – the funding challenges are not only affecting the IJB’s but also both of the partners are under significant pressure too; • Health Debt – we are acutely aware of what is being described as the health debt, resulting from services which were paused during the pandemic and in some instances have not fully resumed. • National Care Service – this will have a major impact on services and how they are delivered in the coming years, the full extent of which is still uncertain. It is important that the MIJB understands its appetite to risk to enable effective management and mitigation of the inherent risks. Page 112
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 MARCH 2025 SUBJECT: HEALTH AND SOCIAL CARE MORAY STRATEGIC DELIVERY PLAN 2025-2028 BY: CORPORATE PROGRAMME MANAGER 1. REASON FOR REPORT 1.1 To ask the Moray Integration Joint Board (MIJB) to review the progress and agree the approach to finalise the Delivery Plan that supports meeting the aims and objectives of the Moray Integration Joint Board Strategy. 2. RECOMMENDATION 2.1 It is recommended that the Board:- i) consider the progress in development of Health and Social Care Moray’s Delivery Plan (2025-2028), attached as Appendix 1; and ii) instruct that the finalised Delivery Plan be presented to the Board in May 2025. 3. BACKGROUND 3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 places a duty on Integrated Authorities to develop a Strategic Plan for delegated functions under their direction. As reported to the Board on 24 November 2022 (paragraph 13 of the minute refers), the revised strategic plan ‘Partners in Care 2022-2032’ was approved to allow for the Strategic Delivery Plan (SDP) to be developed. 3.2 At the meeting of the Board on 29 June 2023 (para 10 of the minute refers) the priorities for the strategic plan were agreed as follows: • Transformation priority 1 - Supported self-management • Transformation priority 2 - Long term condition management • Transformation priority 3 - Care in place • Transformation priority 4 - Smarter Homes / Smarter Communities • Transformation priority 5 - Mental wellbeing • Improvement priority 1 – Primary Care Improvement Plan • Improvement priority 2 – Frailty Pathway 3.3 The Strategic Delivery Plan 2023 to 2026 was agreed by the Board on 28 September 2023 (para 12 of the minute refers) and set out how the Strategy will be delivered, highlighting the key improvements and transformational change which will be required. Item 9. Page 113
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4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The past two years have seen significant changes in the financial landscape for Health and Social Care Partnerships (HSCP), Local Authorities and the National Health Service. The challenges of an aging population and increasing multi-morbidity are placing growing pressure on maintaining existing services along with increasing demands for care in a period of financial constraints. In addition, there have been significant changes in the Senior Management Team (SMT) with the appointments of a new Chief Officer, Chief Financial Officer and Interim Head of Service/Chief Social Work Officer. The Joint Strategic Needs Assessment was also reviewed and approved by the Board on 26 September 2024 (para 14 of the minute refers). Given all these changes, it was felt appropriate to review and reset the SDP, whilst retaining the key areas of focus previously agreed. 4.2 The content of the draft Delivery Plan reflects the work necessary to meet national objectives, shared objectives in collaboration with Health and Social Care Moray’s (HSCM) partners, Moray Council and NHS Grampian and with Aberdeen City and Aberdeenshire HSCPs and with redesigns of models of service delivery to improve outcomes and efficiency. An example of this will be the work that will progress in collaboration with our partners through the Grampian Strategic Change Board (established in November 2024) that will develop and implement the NHS Grampian’s Route Map for Strategic Change in collaboration with IJBs to create a future sustainable health and care system. 4.3 Consultation has taken place with the Senior Management and Operational Management Team to build on progress already made and to confirm the priority work streams for the next three years of the Strategic Plan to 2028. Following the development of the draft Plan, there has been consultation with the MIJB at the development session in February and discussion at the Strategic Planning and Commissioning Group (SPCG) on 4 March 2025 and comments received have been addressed. 4.4 The draft SDP (Appendix 1) provides an overview of the agreed priority work streams and actions for HSCM. The Plan requires to be flexible and responsive ensuring the complex range of work streams are prioritised and progressed within meaningful timescales and within capacity and resources available. Given the recent requirement to review budgets and identify additional savings for 2025/26, it would be prudent to provide managers with a further opportunity to consult on the draft SDP, prior to finalisation, to ensure resources are available and timescales are achievable. A focussed session with service managers will be held at the end of April, where the draft SDP will be considered alongside the proposed performance framework, with a final draft presented to the Board in May 2025. 4.5 Regular monitoring of progress of the SDP will be undertaken by SMT and SPCG, with a summary report to the Board every 6 months. The performance reporting framework is being refreshed and will set the governance arrangements for reporting on key performance indicators related to achieving aims set out in the delivery plan to Audit, Performance and Risk Committee. 4.6 The SDP provides that overarching assurance of how projects that are agreed will also support the delivery of both the HSCP’s Medium Term Financial Page 114
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Strategy and the Workforce Plan. The project documentation also encompasses the work toward delivery of the Equality Outcomes set by the partnership as well as capturing links other plans and strategies as relevant. This provides a cohesive and co-ordinated approach to the delivery of the current Strategic Plan. 4. 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 – 2032” The SDP underpins the named plans and supports achieving better outcomes for citizens in Moray. (b) Policy and Legal The implementation and publication of the delivery plan will ensure that the MIJB complies with legal requirements. (c) Financial implications Pivotal to the effective delivery on the actions in the strategic delivery plan are the financial resources available to MIJB. To assist with the planning process, a Medium Term Financial Framework supports the delivery of the strategic plan to aid decision making. This is scrutinised regularly by Senior Management and reported quarterly to MIJB. The Budget Savings Oversight Group will regularly monitor the progress of projects regarding delivery of budget savings to ensure anticipated savings are achieved. (d) Risk Implications and Mitigation Risks to achieving the deliverables in the plan will be highlighted through the Strategic Risk Register and monitored by the Audit Performance and Risk Committee. The immediate risk to successfully delivering the Plan could be defined as Intensification – trying to do more with the same (e.g. financial resources, workforce availability). To mitigate against this, the MIJB agreed the 3 year transformation priorities and improvement projects in 2023; to offer a clear focus for HSCM staff and these priorities are incorporated in this iteration of the SDP. Each service/team will have or will develop service plans that encompass their responsibilities contained in the SDP. This supports good governance, risk and issue escalation if required. (e) Staffing Implications With any changes in ways and models of working, there may be implications for staff in how they go about their work and how supported they are within a pressured and changing environment. Staff side, Unions and Human Resources will be working alongside SMT in delivering change, observing the associated policy and procedures of the Council and NHS. The SDP will be delivered using existing staffing. That said, as a saving target has been agreed though vacancy management, the MIJB must be cognisant of the health and wellbeing of the workforce as they continue to deliver and transform in a resource constraint environment. Page 115
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(f) Property The Moray Infrastructure Board offers oversight and scrutiny to service delivery, linking into the assets management arrangements for NHS Grampian and Morays Council. Service specific infrastructure and property issues will be detailed in service plans and risks raised through the Infrastructure board and Strategic Risk register is appropriate. (g) Equalities/Socio Economic Impact An Equality Impact Assessment (including assessment against Fairer Scotland Duty) was undertaken in line with statutory obligations. This has been reviewed and there were no changes identified. The EIA was included as part of the submission for the Strategy on 29 November 2022 and are available publicly on HSCM website. As projects progress, they will undertake Integrated Impact Assessments that will be reported and published as necessary. (h) Climate Change and Biodiversity Impacts There are no direct impacts arising from the recommendations of this report. Climate change impacts are considered and incorporated into project documentation and business plans as we work towards reducing carbon footprint and delivering on net zero emissions targets. (i) Directions No direction requires to be issued to Moray Council or NHS Grampian as a result of this report. (j) Consultations Consultations have been undertaken with Senior Management Team, Operational Management Team and Caroline O’Connor, Committee Services Officer, Moray Council, and comments have been incorporated in this report. 5. CONCLUSION 5.1 The SDP is a key document for the Partnership which, when approved, will set out the agreed priorities to be delivered over the next three years, within the capacity and resources available, and progress will be monitored on a regular basis and reported in the Annual Performance Report. Author of Report: Jeanette Netherwood, Corporate Programme Manager Background Papers: 20250130 North East Route Map for Strategic Change Report and Appendix 20230928 Strategic Delivery Plan 2023-26 and Appendix 20230629 Strategic Transformation Plan Report 20221124 Strategic Plan 2022-2032 Report and Appendix Page 116
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APPENDIX 1 Page | 1 | 1 Health & Social Care Moray Strategic Delivery Plan 202 5 - 2028 Item 9. Page 117
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APPENDIX 1 Page | 2 Contents 1 Introduction .......................................................................................................................................................................................3 2 Moray Health & Social Care Partnership .......................................................................................................................................4 2.1 Joint Strategic Needs Assessment .........................................................................................................................................4 2.2 Establishing Sustainable Models of Care ...............................................................................................................................6 2.3 Relationships and Collaboration ............................................................................................................................................7 3 Key Enablers ....................................................................................................................................................................................8 4 Performance and Governance .........................................................................................................................................................8 5 Strategic Delivery Plan .....................................................................................................................................................................9 Building Resilience ………………………………………………………………………………………………………………………………………………………….10 - 15 Home First ………………………………………………………………………………………………………………………………………………………..16 - 18 Partners in Care …………………………………………………………………………………………………………………………………………………19 - 24 Strategic Leadership, Planning and Performance …………………………………………………………………………………………………….25 - 27 Page 118
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APPENDIX 1 Page | 3 1 Introduction This Strategic Delivery Plan should be read alongside the Moray Health and Social Care Partnership (HSCM) Strategic Plan which was agreed by the Moray Integration Board (MIJB) in November 2022. This delivery plan sets out the programme of transformational and improvement work underway to enable the HSCM to meet its strategic priorities. The Strategic Plan itself is also supported by the HSCM’s Workforce Plan, Medium Term Financial Strategy and Commissioning and Procurement Plan. The work of the HSCM also supports, in part, the delivery of Moray Council’s Plan and NHS Grampian’s Plan for the Future. Our key focus continues to be progressing the integration agenda by increasing access to community-based health and social care services, shifting the balance of care from hospital to more homely settings, and supporting our most vulnerable citizens. Whilst setting out our vision, which remains “We come together as equal & valued partners in care to achieve the best health & wellbeing possible for everyone in Moray throughout their lives”. We continue to deliver on our three strategic themes by setting clear strategic objectives which can lead us to improving outcomes over the next ten years. BUILDING RESILIENCE HOME FIRST PARTNERS IN CARE Page 119
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APPENDIX 1 Page | 4 2 Moray Health & Social Care Partnership Many of the pressures and challenges being faced within Moray are reflected across Scotland. The joint strategic needs assessment was updated as part of refreshing and continuingly informing the development of the delivery plan. There is a changing dynamic over the last 20 years where the population is becoming healthier and living longer but we appreciate that an increasing number of people experience the burden of long-term medical conditions. Moray is a large rural area where the average life expectancy is above the Scottish average. However, due to socio-economic factors and population spread, there are different rates of life expectancy and healthy life expectancy across Moray. 2.1 Joint Strategic Needs Assessment The revised Joint Strategic Needs Assessment was approved by MIJB on 26 September 2024. The key aspects identified in the assessment for Health and Social Care Needs in Moray identify the specific challenges and pressures on the health and care system within Moray, and are set out below:- Ageing Population Moray is projected to have an increasingly ageing population structure. Between 2023 and 2038 it is projected that the number of 5- 17 year-olds in Moray will decline by 19% (-11% for Scotland). Conversely, those aged 85 and over will increase by 63% in Moray and 47% in Scotland. Above average limiting long term illnesses Approximately 40% of Moray residents live with limiting long term illnesses, above the Scottish average of 36%. Moray has a higher prevalence for all diseases when compared to Scotland as a whole, the only exception being COPD. The prevalence of Dementia Within the Moray population has increased from 4.9 per 1,000 population in 2017/18 to 5.6 in 2022/23. The prevalence of Depression In both Moray and Scotland has risen between 2017/18 and 2022/23. Page 120
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APPENDIX 1 Page | 5 Above average smokers In the 2018-2022 aggregate time period, 18% of Moray adults aged 16 years and over were smokers, above the Scottish average of 13%. A&E attendances at Dr Gray’s Hospital There were 28,402 attendances in 2022/23, an 11.2% increase on the previous financial year and reaching a value above pre- pandemic levels (in contrast to Aberdeen Royal Infirmary). High intensity use is greatest in areas of deprivation, and across all age groups it is associated with issues such as homelessness, being out of work, mental health conditions, drug and alcohol problems, criminality, and loneliness and social isolation. Care Homes Moray has higher rates of 65-84 year olds than Scotland Care at Home A decrease in the number of people supported with care at home provided/funded by Moray Health and Social Care Partnership for the fourth consecutive year. Moray’s Care at Home Service recipients have high levels of A&E attendances as a rate per 1,000 at 189.6 (Jan-Mar 2023) compared to 155.6 for Scotland. Access to GPs 52% report they cannot get a GP appointment within 3 days. Cancer Screening GPs in Moray report that they are seeing and referring more people with cancer symptoms, but less cancer is being diagnosed and it is being diagnosed later. This is a concern as there will be increasing 'unfound' cancers, and later diagnosis means less will be treatable. Inequalities Clear inequalities are present: females in the most deprived areas of Moray have a 3% lower life expectancy than Moray as a whole; males in the most deprived areas have a 5% lower life expectancy than Moray as a whole. Page 121
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APPENDIX 1 Page | 6 Fuel Poverty 32% of Moray residents faced fuel poverty, far higher than the overall Scottish figure of 24% over the same period. Extreme fuel poverty in Moray (2017-2019) was estimated to be 19%, higher than Scotland’s 12% over the same period. Cost of Living - almost 40% of Moray households (39%) describe themselves as experiencing problems with meeting housing payments, which ranges from 42% in Buckie to 33% in Speyside. 15% of Moray households describe themselves as having financial difficulties now, in comparison to 4% pre COVID. One in five households in Keith were currently experiencing financial difficulties (20%). Increasing child poverty 24.1% children (4,228 individuals) were in poverty in 2021/22 in Moray, a rise in percentage from 20.8% in 2014/15 (3896 individuals). Food insecurity has increased in Moray: in the 2018-2022 period 8% of residents were worried that they would run out of food, up from 7% in 2017-2021, and 6% in 2016-2019 Veterans - There are two large military bases in Moray: RAF Lossiemouth and Kinloss Barracks, which employ around 4000 people at present. We also need to consider the health needs of veterans of the armed forces; where the population often differs in structure to the non-veteran population; usually older and more males than females. Unsuitable housing The Moray HDNA 2022 estimated 2,160 households across Moray (which equates to 5% of the total households in Moray of 43,995) require to move to alternative housing to address housing unsuitability. Delayed Discharges On average, 39 beds were occupied by delayed discharges each day in Moray in the 2022/23 financial year. This is a 34.5% increase on the 2021/22 value of 29 beds. 2.2 Establishing Sustainable Models of Care As a partnership, we are cognisant of the financial constraints we, and our partners, are working within. The existing available budget does not meet the demand for services being delivered at the current rate, and in order to be sustainable Page 122
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APPENDIX 1 Page | 7 we will have to make difficult choices and continue with designing services through transformational change where the person receiving the service remains at the heart of the conversation. The future of Health and Social Care delivery very much depends on the decisions that will require to be made, as the option to remain as we are is not viable. Therefore, there is a strengthened focus on prevention and early intervention to promote good, positive physical and mental health and wellbeing for all people across all ages and client groups. We know 70 to 80% of people with long term health conditions could manage their conditions themselves with support from informal health systems, and a number of identified projects will seek to explore the options to maximise every opportunity for informal supports. We must continue to work with our communities as we move forward, placing communities at the heart of public health can reduce health inequalities, engage those most at risk of poor health, empower individual and communities, and build resilience. That also involves supporting people to enable them to be responsible for their own health, and to work with health and care professionals to manage existing conditions. HSCM is responsible for almost 1,795 staff members employed by NHS Grampian or Moray Council. Not only do we recognise the tremendous amount of effort and work undertaken each day in Moray to support people in our communities, but we also recognise the role of ‘communities’ themselves, in supporting the most vulnerable and providing resilience. We have to change, we have to deliver differently, we have to focus on what we can support, what we ask people to do and how we ask communities support us. 2.3 Relationships and Collaboration Our partner organisations, Moray Council and NHS Grampian are facing similar financial challenges along with our neighbouring Health and Social Care partnerships in Aberdeen City and Aberdeenshire. There is agreement that we need to work together to ensure we maximise every opportunity whilst minimising any negative impact of change across our whole health and social care systems. We are committed to sharing best practice and learning from each other and a Grampian Health and Care Strategic Change Board was established in November 2024. As the Board develops it will be responsible for developing and implementing the NHS Grampian’s Route Map for Strategic Change in collaboration with Integration Joint Boards (IJB), which will be a key document outlining our shared strategic priorities for the future of Page 123
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APPENDIX 1 Page | 8 health and care across the North East, coupled with the practical steps required to create a sustainable health and care system. 3 Key Enablers The delivery of the strategic plan is underpinned by key workstreams shown under the theme of Strategic Leadership, Planning and Performance. This workstream encompasses the development and implementation of strategies that will set the culture and standards for HSCM in relation to Finance, Communications, Workforce, Performance and Quality Assurance, Commissioning, Infrastructure, Digital Health Care and Governance. These elements combined will form the basis and structure for the delivery of the specific priorities outlined under the Strategic Objectives and our strategic themes of Building Resilience, Home First and Partners in Care. 4 Performance and Governance The Strategic Planning and Commissioning Group (SCPG) has responsibility for oversight of the development work streams arising from the HSCM’s Strategic Delivery Plan and will consider options appraisals and key project documentation as progress is made. HSCM Senior Management Team will lead the implementation of the delivery plan and the definition of SMART objectives, against which progress will be measured. Progress of the actions within this delivery plan will be overseen and scrutinised by the Senior Management team and Strategic Planning and Commissioning group and will be reported to the MIJB on a six monthly basis. An annual review process will provide the opportunity for the MIJB to review both the progress of the projects during the previous year as well as the focus for the forthcoming year. In developing this approach, we aim to remain cognisant of prioritising areas of change and transformation that will enable the delivery of our strategic priorities in an environment which very much requires a flexible approach Page 124
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APPENDIX 1 Page | 9 The performance reporting framework is being revised and will be implemented for reporting in 2025. To provide assurance and oversight a high-level summary of performance against the outcomes of the Strategic Delivery Plan will be reported to the Audit, Performance and Risk (APR) Committee on a quarterly basis. Outcomes to be achieved will be set against each project, along with key milestones for delivery, and the performance indicators that will provide assurance that the required changes and improvements are taking place. The Strategic Delivery Plan will be closely aligned with the HSCM Medium Term Finance Strategy (MTFS) and Workforce Plan, as the three main levers through which we will deliver the HSCM Strategic Plan. 5 Strategic Delivery Plan As previously described, this Strategic Delivery Plan sits within a wide and complex planning and policy environment where the HSCM plays a critical role in working collaboratively with partners to deliver on whole system priorities and work streams, including supporting delivery of the NHS Grampian Plan for the Future and Moray Council Plan. It is therefore not exhaustive of all areas of HSCM activity where we are a key partner, for example: in delivery of the Moray Children’s Services Plan to improve the wellbeing of children and young people in line with the GIRFEC (Getting It Right For Every Child) philosophy; in the initiative Discharge Without Delays, to develop improve the integrated model across the whole- system for frail older people accessing hospitals; and in developments around population health initiatives to support prevention and early intervention for all. The plan below reflects the key actions being driven by HSCM over the next three years. The Strategic Delivery Plan will remain a live document to ensure we can be agile and responsive to new or emerging priorities whilst ensuring a focus on delivery of the HSCM’s own strategic priorities. This Strategic Delivery plan provides high level information about each action, links to strategic objective and strategic themes including a key summary and the priority tasks that will be undertaken. Some of the projects identified will go beyond the duration of this Strategic Delivery Plan due to their nature and complexity. Page 125
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APPENDIX 1 Page | 10 STRATEGIC THEME - BUILDING RESILIENCE YEARS Objective 1: We focus on prevention and tackling inequality Key Heading Description Lead 1 2 3 Timescale Outcomes 1 Early Intervention and Prevention We aim to provide support to the citizens aimed at improving outcomes and preventing escalating need or risk 1.1 Community Appointment Days (CAD) Test out Community Appointment Days in three areas of Moray, focussing on areas of inequality/accessibility, utilising learning to adapt ways of working to become more inequalities sensitive. To help people to self-manage their own conditions Health Improvement Team Leader X Mar-26 Three events held, learning synthesised and recommendations for future approaches agreed. 1.2 LD Health Checks Annual Health Checks for People 16+ with Learning Disabilities LD Service Manager X Mar-26 Evaluation completed and learning shared 1.3 Social Prescribing To scale up the current test of change and deliver a social prescribing model across all Moray localities Health Improvement Team Leader X Mar-26 reducing in targeted service waiting lists 2 Poverty Strategy To work with partners to raise awareness and to work to reduce the impact of poverty on people’s health and wellbeing in Moray 2.1 Contribute to development of Moray wide poverty Strategy and Action Plan Localities Manager (West) X Jun-25 Moray-wide strategy and action plan in place to tackle poverty, and in progress by March 2025 2.2 Implement HSCM actions of Moray Wide Poverty Action Plan Senior Management Team X April 2025 to March 2026 To be determined from the actions Page 126
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APPENDIX 1 Page | 11 2.3 Implement actions from the Children’s Plan Child Poverty - - Implement actions from the Children Services Plan - Establish a Child Poverty Data Set Service Manager C&F X Jun-25 Actions implemented Child Poverty Dataset in place 2.4 Raising awareness of the Impact of Poverty on health Develop and deliver training to front line staff and decision makers in order to raise awareness & understanding of impact of poverty on health and ability to access health services/comply with treatment HI Team Leader X X Sep-26 Increased number of frontline staff trained & confident in speaking about poverty/referring on for appropriate support OBJECTIVE 2: We nurture and are part of communities that care for each other Key Heading Description Lead 1 2 3 Timescale Outcomes 3 Supporting Unpaid Carers Continue to work collaboratively with partners to achieve a support network and deliver high level services to ensure unpaid carers are supported to meet their own individual needs and the needs of the person they care for 3.1 Review mechanism for assessment of support provided to unpaid carers, to meet statutory requirements in Carers (Scotland) Act 2016 Implement revised mechanism Unpaid Carers Strategy Group X X Nov-24 Revised mechanism identified, consulted on and approved for adoption. Revised mechanism implemented across all teams. 3.2 Implement actions outlined in the Unpaid Carers delivery plan Unpaid Carers Strategy Group X Mar-26 Increased awareness of unpaid carers with professionals across health and social care and within the community. Page 127
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APPENDIX 1 Page | 12 3.3 Produce and plan implementation of the Unpaid Carers Strategy for 2027-2030 Unpaid Carers Strategy Group X Mar-27 Published strategy implementation plan actioned 4 Primary Care Sustainability Aiming for sustainable General Practices across Grampian that enables people to stay well in their communities through the prevention and treatment of ill health through the VISION aims and objectives (Hosted Services) 4.1 Lead and Deliver the VISION objectives for GPs across Moray Focus on 5 areas 2025/26: Data Digital Multi-Disciplinary Team Models of contract Premises Primary Care Development Manager X X Mar-26 Delivery of the VISION objectives on time and within budget. 4.2 GP Sustainability Delivering the contract within the available funds Reviewing the directives within the MOU Primary Care Development Manager /Clinic al Leads X Jun-25 Programmes of work are evaluated as “well“ by the PCIP board by June 2025 4.3 Deliver the Primary Care Improvement Plan Delivery of the MOU and develop opportunities for flexibility in the contract Primary Care Development Manager /Clinical Leads X X X ongoing Improvement plan implemented 5 Mental Health Services Intact the Moray Good Mental Health for All Strategy (2016-2026) and the underpinning Mental Health Delivery Plan Page 128
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APPENDIX 1 Page | 13 5.1 Mental Health - Early intervention, prevention and self-management Move towards a preventative, population health model which promotes and sustains good mental health and wellbeing. Mental Health Services Manager / Health Improvement Team Leaders / Mental Health Strategic Lead X X Mar-26 We have developed social connections, tackled isolation, built resilience, strengthened use of community assets. We have improved responses to people in distress - both from services and the wider community 5.2 Mental Health Quality Standard 1: Access People in Moray have equitable and non- discriminatory access to effective and relevant support for their mental health, within appropriate timescales. Mental Health Services Manager Child Health Commissioner Strategic Lead Mental Health X X Oct-26 People can access the person- centred support they require. 5.3 Mental Health Quality Standard 2: Assessment People with mental health conditions, including those with co-existing health conditions, experience improved quality and length of life, free from stigma and discrimination Strategic Lead Mental Health Service Manager - Mental health X Mar-26 a Moray Dementia Plan is develop in line with Grampian Dementia Strategy 5.4 Mental Health Quality Standard 3 Moving between and out of services Strategic Lead Mental Health Service Manager - Mental health X Mar-26 Co-produced written care plans for transitions between services are in place 5.5 Mental Health Quality Standard 4: Workforce The mental health and wellbeing workforce is diverse, skilled, supported and sustainable, trauma & inequality informed Strategic Lead Mental Health Service Manager - Mental health X Mar-26 Workforce plan for Mental Health Services in Moray in place 5.6 Mental Health Quality Standard 5 Governance & accountability Strategic Lead Mental Health X Dec-25 Self-assessment against Core Mental Health Quality Standards completed 6 Promoting third sector and community services to enable people to manage their own physical, social and mental well-being Our communities and third sector partners provide a vital and valuable contribution to the levels of prevention, support and resilience that can be provided in and across Moray. This is an area we need to grow, encourage and nurture in order to meet increasing demand for low level needs appropriately. increase number of people being supported by third sector partners Page 129
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APPENDIX 1 Page | 14 6.1 Build the infrastructure and capacity in the community to support people to self- manage Invite third sectors representation in design of services and contracts, where there is an opportunity for working differently. All Service managers / Commissioning X Mar-26 Third Sector representation in all appropriate service redesign or contract reviews 6.2 Collaborative Working Increase resilience, sustainability and growth of third and community led groups across Moray Community Wellbeing Development Team X X Jun-26 Increase in number of community led groups supporting wellbeing in Moray Groups have increased resilience and are equipped to continue delivering services Increase and improve offer of services available in communities across Moray, to support wellbeing, resilience and enablement. 6.3 Partnership Working (a) SET group - review current delivery of seated exercise classes across Moray Community Wellbeing Development Team X X Jun-26 Sustainability and growth of groups across Moray Increase in capacity of classes for older people to support their physical and mental wellbeing 6.4 Partnership Working (b) Increase partnership working and opportunities in Moray Community Wellbeing Development Team X Mar-26 New nature and outdoor outings provided to support mental health for older people 6.5 Community Growth Development of Be Active Live Long (B.A.L.L) groups forum Community Wellbeing Development Team X X Sep-26 An overarching Forum to support and connect all BALL groups across Moray is established Increase ability to apply and attract funding to support groups Increase in membership numbers New BALL groups established in areas where need identified Page 130
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APPENDIX 1 Page | 15 7 Children Service plan 2023-2026 Plan aims to embed Corporate Parenting and implement the foundations of The Promise for Children, Young People and families of Moray) Head of Service / CSWO 7.1 Delivery of the 6 improvement priorities - Improving Outcomes for looked after and care experienced young people - Tackling child poverty - Supporting children and families who experience challenges due to disability/neurodiversity - Keeping children safe - Improving emotional and mental wellbeing - Strengthening family support Head of Service / CSWO X X delivery of the actions improvements in Key performance measures identified 8 Provision of a Sustainable Locality Model Rooted in the principles of proximity, accessibility, and community engagement, the locality model seeks to enhance the responsiveness, effectiveness, and relevance. of health and social care provision by decentralising services and fostering strong partnerships at the neighbourhood level. 8.1 To have an updated Locality Plan in place for each Moray Locality Development, monitoring and evaluation of Locality Plans Deputy Head of Service X Sep-25 Locality Plan in place 8.2 Further development of Locality MDTs and Virtual wards in community settings. Confirmation and implementation of sustainable model for multi-disciplinary working across all localities Deputy Head of Service X X Sep-26 MDT embedded in all localities 8.3 Development of Locality Dashboards which align with Moray wide performance dashboard Establish framework of performance monitoring within localities Deputy Head of Service X Sep-25 Locality Dashboard established Page 131
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APPENDIX 1 Page | 16 8.4 Involvement of community members, third sector members and locality practitioners in monitoring the effectiveness of local service delivery. Involvement of community members, third sector members and locality practitioners in engagement activity and monitoring the effectiveness of local service delivery. Deputy Head of Service X X Jun-26 Communities involved in monitoring effectiveness of local service delivery STRATEGIC THEME - HOME FIRST OBJECTIVE 3: We work together to give you the right care in the right place at the right time Key Heading Description Lead 1 2 3 Timescale Outcomes 9 Discharge Without Delay (DWD) Discharge without Delay (DWD) is a whole-system programme for frail older people currently accessing Scottish hospitals, pulling best practice, individual services and pathways into an integrated model that strives to deliver Comprehensive Geriatric Assessment (CGA) in the timeliest manner, while ensuring no negative impact from hospital induced harm or dependency to the person. 1. Reduce acute geriatric length of stay (LOS) by >20% by December 2026 2. Reduce community hospital/ step-down LOS to 20% by December 2026 3. Reduce total respective HSCP delayed discharges by >20% by December 2026 4. Less 25% of delayed discharges are in acute hospitals by December 2025 5. Aim acute hospital geriatric service and community hospital occupancy to 90% by December 2026 9.1 Discharge to Assess (D2A)/HomeFirst To discharge people home in a timely manner to minimise hospital induced dependency. With services providing a responsive community home care support to enable discharge without delay. tbc X Dec-25 Reduction in delayed discharges Page 132
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APPENDIX 1 Page | 17 9.2 Community Hospital and Step Down Rehabilitation Units Facilities should be staffed and empowered to take frail people required rehabilitation and more prolonged periods of assessment, ideally from frailty units and discharge back to communities via agreed PDD process, both without delay. Professional lead OT / Team Manager (Independent Living) X X Dec-26 “To be” status designed and action plan developed and approved Changes identified in plan are implemented Reduction in length of stay Avoidance of unnecessary admissions :- Reduction in unnecessary admissions from Emergency Department, AMAU and CDU Number (& %) of people re-abled through the D2A/START process within 12 week target 9.3 Frailty at Front Door Acute hospitals should deliver early comprehensive geriatric assessment (CGA) in specialist acute frailty units from point of acute admission. tbc X Mar-26 Pathways completed and communicated increase assessments for support (inc care) undertaken in the home 9.4 Planned Date of Discharge (PDD) process and Integrated Discharge Teams Acute hospitals should aspire to single point of referral for complex discharges with the process of discharge planning via MDT proactive advanced discharge date setting. Lead Nurse X X Dec-26 Increase in % (and number) of compliant PDD (target to be defined) 10 Promotion of Self Directed Support (SDS) Options Increase the promotion and use of SDS Options (from baseline) to meet individual needs. Increasing choice and control of individual needs and how their support and care needs are delivered. Quarterly Audits of use of SDS options (establish baseline) 10.1 Develop SDS Framework for options 1, 2 & 3 providers SDS Officer / Procurement Officer MC, Provider Services Manager X Dec-25 Framework for providers established for SDS options to promote choice and control driven by individual preference opposed to market availability. Social work processes and assessment align with the principles of SDS Page 133
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APPENDIX 1 Page | 18 10.2 Self-evaluation against national SDS framework of standards to inform future requirements to improve performance and delivery SDS Steering Group X Aug-25 Utilising the self-evaluation, identified areas of improvement can be identified and a robust implementation can be developed to improve practise and peoples lived experience of accessing SDS. Internal process will align with the national vision for SDS. Social work process and assessment align with the principles of SDS. Commissioning activity aligns with the principles of SDS. 10.3 Continue promotion of independent support and advise for SDS options SDS Steering Group X X X Mar-28 Individuals have access to independent support and advice enabling them to make informed decisions around the four options of SDS. Individuals have access to independent SDS Advocacy to support with accessing SDS. OBJECTIVE 4: We help build communities where people are safe 11 Managing frailty in the community Within the proactive care model, develop a test of change to integrate community and acute frailty teams, utilising the e-frailty tool to proactively identify and case manage frail patients in order to prevent deterioration and hospital attendance All GP practices have all patients identified as being frail are entered into e-frailty system People tracked by efrailty changes and plans put into place via proactive care function ( tracking and short term intervention and monitoring back to health and social care baseline) Reduction in presentations/readmission rate of frail patients 11.1 Identification and assessment of frailty within primary care over 65s E-frailty tool is rolled out across all GP practices GP Strategic Lead / Moray Frailty Lead X X Jun-27 % of MEOC conversations taken place within community 12 Public Protection Implementing the Public Protection plan 12.1 info to be provided Page 134
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APPENDIX 1 Page | 19 STRATEGIC THEME - PARTNERS IN CARE OBJECTIVE 5: We are an ambitious and effective partnership Key Heading Description Lead 1 2 3 Timescale Outcomes 13 Redesigning Models of Care summary description required 13.1 AHP transformation and redesign Support in the community is consolidated tbc X X Sep-26 Model of provision embedded 13.2 Community Hospital Redesign Review and redesign model for community hospitals using research undertaken in Moray, and learning from other areas. Engaging with stakeholders to consider options and ultimately establish the model for Moray Head of Service X X X Dec-27 Model for community hospitals in Moray agreed 13.3 Moving with Dignity (Proportionate Care ) Following pilot scheme, completion of evaluation and wider implementation and training plan to reduce requirement of care hours for those meeting criteria. Head of Service X X Jun-26 implementation plan completed reduction in care hours required for those meeting criteria 13.4 GMED - redesign Through the redesign, the service will find the balance between financial pressure, clinical governance and patient safety, staff governance with a focus on prevention Service Manager - GMED X Dec-26 Model of service delivery agreed and implemented 14 Care at Home Strategic review and redesign of the care at home service to create options and capacity within a sustainable model that will meet future needs Service Manager - Provider Services 14.1 Strategic Review and redesign of care at home service Service Manager - Provider Services X Sept-25 Redesigned model of care agreed with plan for implementation Page 135
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APPENDIX 1 Page | 20 14.2 Adoption of "Moving with Dignity" protocol across HSCM services and partner providers Implement protocols, train workforce and embed provision of Proportionate Care for those people for whom it is appropriate Service Manager - Provider Services X Mar-26 Increase efficiency by releasing care hours required for those who are able to utilise equipment. 15 Review and Redesign of Adults Day Care services A full redesign and modernisation of Adult day services which will see individuals being able to access day support which is person centred and meets their agreed outcomes and aspiration. Where appropriate day service will be provided within their own local communities Service Manager - Provider Services X Mar-26 Redesign model agreed and implemented Transportation policy revised and adopted 16 Suitable Housing - Strategic oversight of accommodation requirements In collaboration with partners in developing the Local Housing Strategy (SHIP), work with people and their families in establishing tenancies in appropriate accommodation to prevent inappropriate long-term placement and breakdown of care. Service Manager Learning Disabilities / Localities Manager Elgin 16.1 Learning Disability long term sustainable accommodation In collaboration with partners supporting people with learning disabilities and their families in establishing tenancies in new supported accommodation. Continuation of LD Housing Projects in collaboration with partners to develop sustainable accommodation provision within Moray Service Manager X X X ongoing Reduction in the out of area placements and associated costs Increase in the number of people with learning disabilities establishing tenancies 16.2 Older People - provision of sustainable supported accommodation Local Housing Strategy Priority 3 Partnership working maximises housing role in improving health and wellbeing Define model for mixed groups for extra care Local Housing Strategy Steering Group X Aug-25 Requirement defined for incorporating into the Local Housing Strategy Page 136
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APPENDIX 1 Page | 21 16.3 Mental health - provision of sustainable, appropriate supported accommodation Assessment of need within Moray and development of plan to address need Local Housing Strategy Steering Group X X Sep-26 Plan for provision of supported accommodation 17 Review Approaches for Social Work practice and process Review of approach and associated policies and guidance used across all teams to ensure consistency and equity of service provision. Head of Services and Chief Social Work Officer X Jun-26 Develop agreed pathways and process (inc SOP) for Assessment and Review (Care at Home, Care homes and other pathways from assessment process) Reduce waiting times for individuals requiring assessment and ensure where possible people are not dependent on formal care and support Reduction in unmet needs agreed single assessment and review pathways/ processes across both community and hospital 18 GIRFE Getting it Right For Everyone (GIRFE) will take a multi-agency approach to health and social care support and services from young adulthood to end of life. 18.1 To embed the GIRFE toolkit and principles into the planning and delivery of services. The promotion of GIRFE to key Moray stakeholder groups GIRFE lead officer X X Mar-26 GIRFE principles embedded in service delivery 19 Support for long term conditions Support people with long term conditions to stay well and independent for as long as possible through a variety of tools and models. 19.1 Heart of Moray - Making it easier to improve our health and wellbeing. - Diabetes Using research from DHI and working with partners to develop new range of services to help people improve their diet and lifestyle. Initial focus to work with people aged 40 and under who have type 2 diabetes Lead Dietician X X Sep-26 Improvement in health of participants in the programme Page 137
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APPENDIX 1 Page | 22 19.2 Consolidation of palliative cancer services Consolidation of palliative cancer services through engagement with stakeholders Chief Nurse X Dec-25 Sustainable model of care in place Support available to those who need it 19.3 Pharmacological Reviews Working in collaboration with GP practices to seek opportunities to make therapeutic and generic switches from high cost and high volume areas and overall to support cost effective prescribing culture Lead Pharmacist Primary Care X Mar-26 Reduction in cost of medications prescribed 19.4 Establishment of a Moray Dementia Strategy and Moray Dementia Pathway in line with Grampian and National dementia delivery plans. Establishment of a Moray Dementia Strategy and Moray Dementia Pathway in line with Grampian and National dementia delivery plans. Mental Health Services Manager X Sep-25 Moray Dementia pathway in place 19.5 Embed promotion of technology enabled care (TEC) options within assessment process to increase use and impact of TEC, supporting self- management (i.e. to support management of longer-term conditions) Embed promotion of technology enabled care (TEC) options within assessment process to increase use and impact of TEC, supporting self-management (i.e. to support management of longer-term conditions) Digital Health Lead X X X Mar-28 Increase in use of TEC to support people to live independently 20 Moray Growth Deal Working with DHI as part of the Moray Growth Deal to design the sustainable services for the future that enable people to live as independently as possible for as long as possible. (Community Connections, Personal Data Store, Smart Housing) Increase ratio of those supported at home with technology enabled care rather than in person care Impact of demographic growth on care at home provision - manage demographic growth via hybrid approaches to care as opposed to in person care 20.1 LL1 Supported Self- Management Improving the health and wellbeing of local people with friendly new uses of local community spaces. https://heartof.co.uk/ DHI / X Mar-26 Increase number onboarding and engaging with supports 20.2 LL2 Long-term Condition Co-management Development of a community occupational therapy digital pathway. DHI / X Mar-26 Pathway in place Increase in people using TEC Page 138
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APPENDIX 1 Page | 23 20.3 LL3 Care in Place Development of a Personal Data Store and the Community Connections Moray digital platform DHI / Deputy Head of Service X X Jun-25 Community connections available on Webpage 20.4 LL 4 Smart Housing/Smart Communities Development of a digital platform for smart housing and monitoring community patient health within a residential setting. DHI / X Mar-26 Digital platform defined 20.5 LL 5 Mental Wellbeing Development of Mental Health Pathway within the Community Connections Moray digital platform DHI / X Mar-26 Mental Health pathway in place Page 139
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APPENDIX 1 Page | 24 Strategic Leadership, Planning and Performance E N A B L E R S E1 Digital Health and Care To improve the care and wellbeing of people in Moray by making best use of digital technologies in the design and delivery of services Ensuring we utilise modern technologies, systems and tools that assist and empower our workforce to deliver high quality services Digital Health Project Board X X X Localisation of the National Digital Health and Care Strategy 2021. E1.1 Develop Strategy for TEC Developing and implementing a strategic approach and framework for TEC support, based on evidence, to provide sustainable options through collaboration with DHI Project Board A2D / DHI / Team manager (OT) X Mar-26 Model of support is in place and shared widely E1.2 Implementation of the Analogue to Digital Implementation Plan Senior Project Officer X Dec-25 All existing analogue customers transferred to digital equipment by December 2025 E1.3 New Social Work and Social Care Information Management System Procure and Implement a new Information Management system for Social Work and Social Care with the scope to develop and integrated information management system across wider services providing support to individuals and families CSWO / Senior Project Officer X X Mar-27 Procurement completed and tender awarded. System implemented services migrated and operational Page 140
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APPENDIX 1 Page | 25 E1.4 Solution for Care at Home scheduling Business Case, procurement and implementation of staff scheduling system for Care at home CSWO / Senior Project Officer X Aug-25 System implemented and operational E1.5 Incorporating new technologies Work in collaboration with partners to explore the opportunities of Artificial intelligence for performance of routine tasks to achieve efficiencies Digital lead X Mar-26 Implementation of use of artificial intelligence in various functions to release capacity for other tasks. E2 Strategic Commissioning Develop the strategic framework and governance to involve all stakeholders in being partners in provision of care and support in communities SMT / Strategic Planning and Commissioning Group X X Mar-27 Strategic Framework and governance approved and implemented E3 Communications Develop and embed a strategy to inform and engage with all stakeholders and to include management of expectations Corporate Manager / SMT X Sep-25 Communications Strategy approved E4 Workforce Ensuring we have a Workforce that is agile and motivated to meet the challenges presented and that is sustainable and safe with a focus on staff wellbeing. Our volunteers provide a vital and valuable contribution to the levels of support that can be provided to our communities. This is an area we need to grow in order to meet needs appropriately. SMT Sep-25 Annual Report (via NHSG) Workforce plan implemented Increase in Volunteer numbers and roles E5 Infrastructure Working with partners, review of occupancy and use of premises to seek opportunities for rationalisation or collaboration with partners to secure sustainable and efficient use of buildings and premises Infrastructure Board X X X ongoing Sustainable model for vaccination delivery Accommodation assessed as suitable for service delivery E6 Performance and Quality Assurance & Improvement Frameworks Develop framework to further support informed decision making Deputy head of service X X Dec-26 Performance framework updated and implemented Quality Assurance Framework embedded Page 141
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APPENDIX 1 Page | 26 E7 Governance SDS Framework Review of specific policies Implementation of learning from audits and inspections SMT X X X To March 2027 Policy and protocol are updated and implemented Positive inspection and audit reports received E8 Finance Recovery Plan, Mid Term Financial Plan Chief Finance Officer X X X ongoing Budget savings plan approved and delivered Page 142
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 27 MARCH 2025 SUBJECT: EQUALITIES MAINSTREAMING PROGRESS REPORT 2021-2024 BY: CORPORATE MANAGER AND PUBLIC HEALTH CONSULTANT 1. REASON FOR REPORT 1.1 To seek approval of the Draft Moray Integration Joint Board (MIJB) Equality Mainstreaming Progress Report 2021-2024. 1.2 To inform the Board of the intention to present the Final Report to the Board on 29 May 2025. 1.3 To inform the Board of the intention to present the Equalities and Mainstreaming and Outcomes for 2025-2029 to the Board on 29 May 2025. 2. RECOMMENDATION 2.1 It is recommended that the Board: - i) consider and approve the Draft MIJB Equality Mainstreaming Progress report 2021-24 (Appendix 1) for publication by April 2025; ii) request the further development of the report, with a Final version to be presented to the Board on 29 May 2025 for publication May 2025; and iii) request that the Final MIJB Equality Mainstreaming Report 2021-24 includes proposed equality outcomes for the period 2025-2029, aligned with the strategic priorities outlined in Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032”. 3. BACKGROUND The Public Sector Equality Duty 3.1 The Public Sector Equality Duty, laid out in the Equality Act 2010 (the Act), came into force in Scotland in April 2011. This equality duty is often referred to as the “general duty” and it requires public authorities to have “due regard” to the need to: Item 10. Page 143
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• Eliminate unlawful discrimination, harassment and victimisation and other conduct that is prohibited by the Act; • Advance equality of opportunity between people who share a relevant protected characteristic and those who do not; and, • Foster good relations between people who share a protected characteristic and those who do not. 3.2 The general duty covers the following protected characteristics: age; disability; sex; gender reassignment; pregnancy and maternity; sexual orientation; marriage and civil partnership; religion, belief, or lack of religion/belief; and race. Equalities Outcomes 3.3 Integration Joint Boards were added to the list of public authorities subject to the requirements of the Act in 2015 and were required to publish Equality and Mainstreaming Outcomes plans by the end of April 2016. 3.4 The first MIJB Equality Outcomes and Mainstreaming Equalities Framework was published in April 2016 following approval by the Board on 28 April 2016 (para 7 of the minute refers). The Equality Outcomes contained within the framework were subject to consultation, including representation from people who have protected characteristics, and were intended to contribute to the strategic priorities and shifts identified within the Strategic Commissioning Plan. A report on progress was submitted to the Board on 26 April 2018 advising further work was required (para 8 of the minute refers) with a final report agreed by the Board on 28 June 2018 (para 11 of the minute refers). 3.5 In the 2018 report it was identified that the wording of the outcomes was too specific to facilitate reporting of the progress made across the wider service. It was agreed that revised outcomes should be developed in tandem with the development of the new Strategic Plan and presented for consideration prior to March 2019. There were delays in the compilation and approval of the Strategic Plan and Transformation Plan which impacted on the ability to progress the revision of equality outcomes prior to the Coronavirus Pandemic. 3.6 The Pandemic impacted on all aspects of work for Health and Social Care Services and will continue to do so with regard to the health debt that has accrued, some of which is known but most of which is currently unquantified and some is not yet known. 3.7 There is a requirement to review Equality and Mainstreaming Outcomes at least every four years; meaning the first substantive review in Moray was due by 1 April 2020. A short life working group was established early 2021 to rework the outcomes and provide a basis for reporting performance and demonstrating implementation across the whole of Health and Social Care services, whilst ensuring alignment to the Strategic Plan. 3.8 The Board approved the revised MIJB set of equality outcomes and the specific focuses at its meeting on 29 April 2021 (para 5 of the minute refers). Equality Mainstreaming Progress Report 2021-24 3.9 The Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012 (the Regulations) impose “specific duties” on Scottish public authorities to publish a Page 144
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set of Equality Outcomes and a report showing progress being made in mainstreaming equality at intervals of not more than two years. 3.10 A progress report was submitted to the Board in April 2018 and following additional work, was approved at the Board meeting on 26 June 2018 (para 11 of the draft Minute refers). The next report was due to be submitted in April 2020, but this was delayed due to the priority of responding to the pandemic. 3.11 The Board approved the Equality Mainstreaming Progress Report 2019-2021 at its meeting on 29 April 2021 (para 5 of the minute refers). 3.12 Health and Social Care Moray (HSCM) did not publish a progress report against the outcomes in 2023. The Corporate Manager has discussed this with The European Human Rights Commission (EHRC) Office who have accepted HSCM’s position based on its commitment to do so as soon as possible. 3.13 The Regulations specify that Equality Mainstreaming Progress Reports must be clearly identifiable and accessible to the public. Following approval, the report will be: • Designed to meet accessibility standards • Published on the HSCM website • Made available in alternative formats upon request • Copies made available to relevant groups and organisations representing people with protected characteristics. 3.14 This approach ensures compliance with Equality and Human Rights Commission recommendations for accessible public information. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 This report has been developed under the governance of the Strategic Planning and Commissioning Group (SPCG) with the implementation support from HSCM. 4.2 The SPCG will be responsible for monitoring and reviewing the equality outcomes, to ensure alignment with the priorities outlined in the Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032”. 4.3 A comprehensive progress update on the Equality Outcomes implementation will be presented to the Board by April 2027, marking the midpoint of the 2025- 2029 outcomes period. 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 – 2032” This report forms part of the governance arrangements of MIJB Strategic Plan. (b) Policy and Legal It is recognised that the MIJB is directly subject to the Public Sector Equality Duty and therefore continues to address equalities matters Page 145
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through integration arrangements to ensure compliance with the Equality Act 2010 (specific duties) (Scotland) Regulations 2012. (c) Financial implications None arising directly from this report. (d) Risk Implications and Mitigation Failure to comply with the commitments of the Public Sector Equality Duty would result in services delegated to the MIJB not meeting the needs of people who share protected characteristics, leading to poorer outcomes and a widening inequality gap. (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. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising directly from this report. (j) Consultations Consultations have been undertaken with Service Managers (Operational Management Team), HSCM Senior Management Team 6. CONCLUSION 6.1 This draft report demonstrates progress against the Equalities Outcomes and set in 2021 and outlines mainstreaming achievements to date. 6.2 A final version of the report will be presented to the Board in May 2025 for approval. 6.3 The Final MIJB Equality Mainstreaming Report 2021-24 will include proposed equality outcomes for the period 2025-2029 for approval by MIJB, ensuring continued aligned with the strategic priorities outlined in MIJB Strategic Plan “Partners in Care 2022 – 2032”. Author of Report: Sonya Duncan, Interim Corporate Manager Elizabeth Robinson, Public Health Consultant Isla Whyte, Corporate Business Support Manager Background Papers: with authors Ref: Page 146
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APPENDIX 1 1 MORAY INTEGRATION JOINT BOARD Equality Mainstreaming & Outcomes Draft Report 2021-2024 This report provides an overview of progress made in achieving Moray Integration Joint Board’s equality outcomes over the last three years. It identifies areas for improvement and priorities for the next four years in relation to equalities mainstreaming. The report is compliant with the Equality Act 2010, supplementary regulations and guidance issued by the Equality and Human Rights Commission. Item 10. Page 147
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APPENDIX 1 2 1. Introduction 2. Background 3. The Equality Act and Fairer Scotland Duty 4. Moray in the context of Equalities 5. Joint Strategic Needs Assessment 6. Mainstreaming • Leadership • Board Structure and Staff • Getting it Right for Everyone (GIRFE) • IIAs 7. Equality Outcomes set out in 2019-2021 report and progress report • Review of Equality Outcomes ➢ Moray Community Appointment Day ➢ Day Opportunities Team ➢ Engagement Equality Groups ➢ Carers Strategy – Engagement/Feedback ➢ Making Recovery Ream (MRR) Partnership ➢ New Scots ➢ Moray Mental Health Strategic Group • Working with Our Partners ➢ Frailty ➢ Links to Partners Plans • Horizon Scanning ➢ Self-Directed Support (SDS) ➢ The Human Rights Bill ➢ Asylum Seekers Health Needs Assessment 8. Priorities for 2025-2029 Appendix 1 – To follow. Page 148
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APPENDIX 1 3 1. Introduction The Moray Integration Joint Board (MIJB), as a public body, is responsible for the planning and oversight of health and social care services across Moray. These services are deleted to the MIJB by our partners, NHS Grampian, and Moray Council. They are delivered by the Moray Health and Social Care Partnership (HSCM). The Equality Act 2010 requires MIJB to: • Write a report which explains what it will do as part of its day to day working to ensure people are treated fairly and (Mainstreaming) • Public equality outcomes every 4 years. 2. Background MIJB’s strategic plan ‘Partners in Care, 2022-2032’ is the IJB’s third plan, and sets out MIJB’s strategic vision and priorities, and sets out how we will use our integrated resources to deliver outcomes for the citizens of Moray. The vision for MIJB is: ‘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.’ The 3 Strategic Themes: 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: Making choices and taking control over decisions affecting our care and support 3. The Equality Act and Fairer Scotland Duty The Equality Act 2010 states that MIJB must: • Write a report that explains what it will do as part of its day to day working to make sure that people are treated fairly and; • Publish equality outcomes every 4 years • Consider how their decisions affect different groups of people • Ensure equality is part of all planning and decision-making • Work to remove barriers that might stop people accessing services • Involve local communities and people with lived experience in their planning Page 149
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APPENDIX 1 4 Section 149 of The Equality Act 2010 imposes as duty on ‘public authorities and bodies’ to make sure all people are treated fairly. The three requirements of the general duty are: • Eliminate discrimination, harassment, victimisation, and any other conduct that is prohibited by the Act. • Advance equality of opportunity between persons who share a relevant protected characteristic and persons who do not share it • Foster good relations between persons who share a relevant protected characteristic and persons who do not share it. There are nine protected characteristics listed in the Act: • Age • Disability • Sex • Gender reassignment • Pregnancy and maternity • Sexual orientation • Marriage and civil partnership • Religion and belief or lack of religion/belief • Race The MIJB should also foster good relations between people from different protected characteristic groups. This will allow us all to recognise and understand the needs of different people. The Fairer Scotland Duty, which is part of the Equality Act, requires public bodies to consider how they can reduce inequalities caused by social and economic disadvantage when making decisions. People living in poverty or difficult social circumstances often experience poorer health and wellbeing outcomes. Page 150
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APPENDIX 1 5 4. Moray in the context of Equalities 5. Joint Strategic Needs Assessment Following the last Joint Strategic Needs Assessment being written in 2018, a revised version was developed during 2024. The Needs Assessment attempts to provide a profile of the health of the Moray population, including the building blocks of health – housing, income, environment – which most significantly influence health. It then goes on to consider which diseases and illnesses pose the greatest threat to population health and well-being. This information is designed to help the Health and Social Care Partnership to consider how to use limited resources for maximum benefit, planning interventions and delivering services to enhance prevention, improve disease outcomes, and reduce health inequalities. The following areas are highlighted from amongst the wealth of intelligence compiled. Page 151
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APPENDIX 1 6 1. There are continuing inequalities in health status across Moray, with an evident association between level of poverty and deprivation (including cost of living, poor housing, transport, employment) and ill health and death. 2. Lives are being cut short through suicide, drug and alcohol related deaths, conditions which are significantly affected by deprivation. In 2022, admissions for alcohol-related conditions were almost 4 times higher among those living in the most deprived areas in Moray as compared to the least deprived. 3. The population is predicted to continue ageing, with a growing proportion represented by adults over the age of sixty-five, and growing numbers of adults aged over eighty, with implications for increasing ill health. 4. Significant demand for health and social care services arise from sometimes preventable chronic disease, and a growing proportion of the population is experiencing more than one condition (“multi-morbidity”). 5. There is significant death and poor health due to often modifiable behaviours, such as lack of exercise, smoking, alcohol and drug use. 6. A small number of individuals, with higher numbers coming from more deprived areas, require significant amounts of healthcare spending. This warrants further detailed analysis. However, we recognise that there are gaps, for example, around the specific needs of people with learning disabilities, people who experience gender based violence, people who use services intensively and ethnicity data which is poorly recorded; it is recommended that further work takes place to understand the needs and views of particularly vulnerable populations in more depth. There are also limitations in the data; for example, service activity only tells us about those who use services and not about those who need services but are not able to access them. As such, the data used in this report must be interpreted with caution and used in conjunction with qualitative data from Moray residents and workforce. 6. Mainstreaming Mainstreaming quality for MIJB means that it considers equality in everything they do. Equality consideration is embedded in all aspects of how the IJB and HSCM works, from strategic planning to service delivery. The goal is to make equality and fairness a natural part of the IJB’s culture, rather than something that is considered as an add-on. An example of this would be the budget planning; the IJB analyses how funding decisions might affect groups from those listed in the protected characteristics and those facing economic challenges. Page 152
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APPENDIX 1 7 Leadership MIJB Structure and Staff The Scottish Government outlines who the members of the Moray Integration Joint Board should be. Membership of the MIJB includes citizens with experience of using health and care services alongside local councillors, NHS Board members, staff from the Health and Social Care Partnership and a representative from voluntary organisations. The board meets monthly. It alternates between formal meetings where decisions are made (those are web-cast and are accessible by the public), they are also recorded and available online for 6 months, and informal development sessions where the board have more in-depth discussions on specific issues and topics e.g. finance, strategy, current issues. Deputations can be made to the formal meetings by spokesperson of any organisation or group. All MIJB papers are available on the Council website. The MIJB has 2 sub-committees; Audit, Performance and Risk and Clinical and Care Governance. The MIJB has only two staff, the Chief Officer and the Chief Finance Officer and so is not required to publish gender pay gap information nor statements on equal pay. The MIJB continues to work alongside its partners, to ensure the Moray Health and Social Care Partnership benefits from a diverse workforce, which reflects the residents of Moray and promotes fairness. Reports from Moray Council and NHS Grampian are available online, detailing further information in relation to the workforce. Page 153
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APPENDIX 1 8 Getting It Right for Everyone (GIRFE) Moray Health and Social Care Partnership has committed to being a pathfinder for GIRFE. This involves co-designing the approach with Scottish Government. GIRFE represents a multi-agency approach to health and social care support and services spanning from young adulthood to end of life care. It will establish the future practice model for health and social care professionals in HSCM, and influence the design and delivery of services, ensuring people's needs are met appropriately. GIRFE aims to provide a more personalised pathway to access help and support when needed. It places individuals at the centre of all decision-making affecting them, with a meaningful and consistent approach regardless of the support required at any life stage. Moray Health and Social Care Partnership are currently embedding the GIRFE toolkit and principles into the planning and delivery of services. Why do an Integrated Impact Assessment (IIA) • Legal requirement and ensures we are adhering to the Equality Act 2010 and addressing impacts on protected characteristics • Increase collaboration with communities and partners who have experience of working with groups who have protected characteristics • Individuals with lived experience of inequality and exclusion will have the opportunity to share their views, concerns and suggestions for improvements • Improve understanding and build relationships between individuals and groups who share protected characteristics and those who do not • Develop better policies, procedures, strategies, and practices, based on evidence An equality impact assessment can identify the anticipated likely effects of a policy, procedure, strategy, or practice. The impacts should be reviewed and this may require the Equality Impact Assessment to be updated. 7. Equality Outcomes set out in 2019-2021 report and progress report Review of Equality Outcomes What we said: A key priority will be to continue the review work completed to date incorporating the potential health and social care debt impacts and consequences of Covid to ensure that key focus is directed to the greatest need. We will consult more widely with communities to ensure they reflect their desired outcomes and to further develop the reporting of data against the measures identified. This information will be reported to the Strategic Planning and Commissioning Group (SPCG) which will have oversight and be able to provide clear recommendations in relation to how Equality Issues are supported, governed, monitored and driven forward. SPCG will Page 154
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APPENDIX 1 9 also explore how our commissioning activity, both internal and external, can better support the delivery of equality outcomes. Examples of what we have been doing: Moray Community Appointment Day With a focus on addressing the lengthy post covid waiting times, HSCM organised an event to support people who were waiting for treatment. The event focused on supporting people with joint, bone and muscle problems. Over 120 people attended the event and were supported by a mix of physiotherapists, podiatrists, occupational therapists, nutrition and dietetic specialists in Moray Sports Centre in Elgin. The event was also supported by charities and community groups who also attended to advise people of how they can also provide support, with issues such as mental health, cost of living, arthritis, home energy cost and general fitness. A video link to the event is available here. Day Opportunities Team The COVID-19 pandemic necessitated the closure of building-based day services, which created an opportunity for service transformation. Following extensive engagement with people who access services, we identified a clear need for person- centred, flexible support options. In response, our Self-Directed Support (SDS) Enablers collaborated closely with the Social Work team to develop individualised support plans focused on meaningful outcomes. This approach successfully supported approximately 100 carers and care recipients during this challenging period. Our methodology centred on improved communication, relationship building, and working with unpaid carers to envision and achieve what constitutes 'a good life' for them. The team take a person centred, strength and asset-based approach that is community led supporting individuals to reconnect with their own communities wherever possible. Following a successful pilot program, the Moray Integration Joint Board (MIJB) approved the permanent implementation of this approach in June 2022. To meet growing demand, we three additional SDS Enablers were recruited, completing the team establishment by October 2022. The positive impact of this transformation is reflected in feedback from service users, including: 'I can't believe how much you have done for D, which has really benefitted her mental health and wellbeing.'" Page 155
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APPENDIX 1 10 Engagement with Equality Groups What we said: We recognize that people with protected characteristics must help shape our equality goals - this is both a legal requirement and essential for effective outcomes. Though COVID-19 limited our engagement efforts, we are forming a dedicated working group to Priorities identified in Equalities and Mainstreaming Report 2019/21 address this gap. This group will improve how we connect with diverse communities, making it easier for everyone to participate in developing and reviewing our services. We are committed to ensuring all voices are heard as we move forward Examples of what we have been doing: Carers Strategy – Engagement/Feedback Engagement sessions were held with unpaid carers in January 2021, during the COVID-19 pandemic to explore what a meaningful break would like for them, this feedback was collated and incorporated into wider engagement sessions with unpaid carers when developing the Moray Carers Strategy Recognised, Valued, Supported (2023-2026) The wider engagement sessions took place as focus groups in August 2021, with an on-line survey launched on 1st October 2021 and remained open for a four week period. There was a total of 181 responses to the survey, with 85% of those responding identifying as female, and 15% who identified as male. Almost half of those who responded were providing care for more than 50 hours per week. Carers reported having “time for me” and “having a few hours to myself- a whole day would be bliss” would support them to look after their own health and wellbeing. Carers responded that having “time out for myself to pursue hobbies whilst my partner was cared for in my absence” would support them to have a life alongside their caring role as “the relentless nature of caring is relentless”. Carers responded saying being able to “catch up on sleep” and having “a day out of the house relaxing” is what a meaningful break would look like for them. Page 156
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APPENDIX 1 11 Making Recovery Ream (MRR) Partnership HSCM recognises the value and added benefit that lived and living experience brings to ongoing service improvements and developments. Collaborative and co- productive working relationships have been established for some time in Moray via the MRR Partnership. MRR was established in 2014/15 to take a co-produced approach to the delivery of the local mental health and wellbeing strategy. The group is designed to be a meaningful and mutual balance of lived experience and professional expertise. The partnership meets in accessible spaces both off-line and online and takes a strengths-based approach underpinned by CHIME values. CHIME is an evidence-based framework for recovery. The partnership has a commitment to share skills, knowledge and resources in a mutually supportive way (recognising that we may have different levels of resource, but we are all assets). HSCM also work closely with a local social enterprise, The Moray Wellbeing Hub, who lead on a ‘Collective Voice’ initiative to gather, collate and feedback the views of members of the public with lived and living experience of mental health challenges. This has been instrumental in many ways, from establishing lived experience peers delivering support on our inpatient mental health ward to informing and shaping commissioned contracts for mental health support recently procured in late 2024. The Moray Wellbeing Hub facilitate peer support and training events all over Moray and have an ’always on’ listening ear. They have also undertaken specific pieces of work when funded to do so for example from the Drug and Alcohol Partnership. During recent commissioning and procurement work HSCM and lived experience representative co-produced the service specification that went out to market. Thereafter community members with lived and living experience participated on the evaluation panel to score the submissions received therefore ultimately influencing the successful awards of contract. New Scots In Moray there have been 19 asylum seeking young people via the National Transfer Scheme. There is now a care-based language approach used, where Moray has adopted the term ‘New Scots’ rather than ‘Unaccompanied Asylum Seeking Children’ (UASC). On arrival in Moray, New Scots are supported by the Throughcare & Aftercare Team as Looked After Children and are offered accommodation in either dual occupancy housing or Supported Lodgings, depending on their assessed needs. To date, 12 New Scots have been granted asylum and have been supported in making longer-term plans. For example, two young people have moved to their own tenancies in Moray and one young person started a course at Dundee College. Other young people have relocated to other areas in the United Kingdom including Glasgow and London. This has been in order to relocate closer to members of their community. Page 157
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APPENDIX 1 12 Moray Mental Health Strategic Group The Moray Mental Health Strategic Group, established in 2024 has delivered the following outcomes: Created a comprehensive Moray mental health service delivery plan with clearly defined development priorities, developed with direct input from people accessing services and operational staff. Established a multi-service governance framework that monitors, evaluates and reports on mental health service delivery across Moray, bringing together third sector and public sector services. Developed early intervention, prevention and self-management resources and protocols. Implemented a structured approach to mental health service improvement organised around five quality standards: 1. Mental Health Quality Standard 1: Access 2. Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support 3. Mental Health Quality Standard 3: Moving between and out of services 4. Mental Health Quality Standard 4: Workforce 5. Mental Health Quality Standard 5: Governance & accountability Created a regular reporting system with six-monthly progress updates to the MIJB. Achieved integration of perspectives across sectors, establishing a whole-system approach to mental health service delivery in Moray. Page 158
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APPENDIX 1 13 Working with our Partners What we said: We will work closely with our partners across the public sector to meet our equality duties, particularly in areas like employment practices and procurement. We will continue collaborating with Integrate Grampian to better understand our diverse population's needs and coordinate our equality efforts throughout the region. Examples of what we have been doing: Frailty Over the past 18 months, Health and Social Care Moray participated in the National Frailty Collaborative, facilitated by Health Improvement Scotland. This collaboration resulted in Moray establishing a Frailty Action Plan aligned with broader Grampian initiatives. The key outcomes from this work include: • To create the conditions for a whole system approach to frailty within Health and Social Care Moray encompassing community initiatives to promote aging well, early identification within Primary Care, the assessment of frailty at the front door, and a range of related interventions and responses. • The early identification of frailty in both primary and secondary care settings. • A proactive integrated planning and case management approach to ensure optimal outcomes for the individual. • Active engagement with the public, health and social care staff and third sector/community groups to promote healthy ageing practices. • Collaboration with the Digital Health Institute to maximise the potential for digital innovation; from a prevention and early intervention approach, through to condition monitoring and self-management. • Integration of Moray’s frailty initiatives with the broader NHS Grampian Frailty Network, creating a cohesive regional approach. A Moray Frailty Delivery Group, with an associated delivery plan, continues to progress the work developed through the national collaborative. The group works closely with leads in Aberdeen City and Aberdeen Shire through the work of the Grampian Frailty Group. Links to partners plans: Moray Council Equalities page - Equalities - Public Sector Duties - Moray Council NHS Anchors Grampian Plan - https://www.nhsgrampian.org/about- us/planforthefuture/what-we-intend-to-do/places/anchor/ NHS G Race Equality Scheme https://www.nhsgrampian.org/globalassets/foidocument/foi-public-documents1---all- documents/mainstreaming-report-april-2021-march-2023-as-at-12th-april-2023.pdf Page 159
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APPENDIX 1 14 Horizon Scanning What we said: Future Planning We are improving how we spot potential inequalities across our system. By identifying early signs of change in our communities, especially for vulnerable groups, we can take timely action and access available resources. The Independent Review of Adult Social Care in Scotland will significantly influence our approach as we implement its key recommendations. Service Development The recently approved Self-Directed Support standards will help us expand understanding of SDS options and focus on personal outcomes through our 3 Conversations model. We are also reviewing the Moray Carer Strategy to support the growing number of unpaid carers needed for our aging population and those with long-term conditions. Additionally, we are monitoring how new legislation, including Human Rights in Scots Law, will impact our services. Examples of what we have been doing: Self-Directed Support (SDS) The SDS Framework of Standards (2024) support the implementation of SDS in line with the statutory guidance which accompanies the Social Care (Self-Directed Support) (Scotland) Act 2013. The current 12 standards with accompanying practice statements and core components are designed to align with the statutory guidance to support the necessary system changes to assist with the implementation of the SDS principles, improve practice and provide consistency for individuals in receipt of care and support. Through the completion of a self-evaluation as a benchmark for embedding practice against the 12 standards, good practice can be embedded. The re-establishment of the SDS Steering group will provide the necessary governance and oversight, in embedding the SDS principles in line with the national SDS Framework of Standards. The Human Rights Bill The Human Rights Bill for Scotland is currently in development but has faced some delays. The Scottish Government has committed to introducing this legislation to incorporate: 1. The International Covenant on Economic, Social and Cultural Rights (ICESCR) 2. The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) 3. The Convention on the Elimination of Racial Discrimination (CERD) 4. The Convention on the Rights of Persons with Disabilities (CRPD) Page 160
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APPENDIX 1 15 The bill remains in development and at the time of writing this report, has not yet been formally introduced to Parliament Asylum Seekers Health Needs Assessment HSCM also participated in an exercise to understand the health needs of asylum seekers across Grampian. These recommendations arising from the needs assessment seek to ensure that asylum seekers receive the right care, at the right time, in the right place. 1. Information sharing A process of data sharing to understand the composition of the asylum seeker population has been established. This process must be adapted to fit the changing landscape of support for asylum seekers, including the withdrawal of the Aberdeen City health care navigator team. We need to acknowledge that the recommendations following this one will not succeed unless this data sharing is continued. 2. Enabling access Both in terms of language and systems, asylum seekers need assistance and support to navigate the health care system. This assistance would ideally take the form of consistent team, allowing asylum seekers to build trusting relationships with a single point of contact. The value of less tangible support (such as assistance with transport and route planning) provided by those who assist with navigation cannot be overestimated. Language support will require different parts of the health care system to provide information to asylum seekers in an accessible format. There needs to be recognition that an accessible format might require information to be provided in a language other than English, and may need to be verbal or recorded to avoid assumptions of literacy. 3. Health improvement We need to recognise that asylum seekers are entitled to the same health care provided to UK citizens living in Scotland. As such, there is an impetus to identify and remove barriers to engagement in relevant screening programmes, and other services that manage long-term conditions and risk factors, including dental and mental health care. 4. Protecting health In order to protect individual and population health, asylum seekers will need support to engage with care that protects health, including screening for relevant communicable diseases (TB, blood borne viruses) and vaccination to prevent disease. We need to ensure we can demonstrate people in the asylum seeker population have been given the opportunity to consent to care that protects health, or that they have had the chance to make a truly informed choice and have refused to consent to such care. This might rely on the utilisation of existing, or development of Page 161
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APPENDIX 1 16 new datasets and data collection procedures. Such datasets could be informed by a retrospective analysis of the asylum seeker population to establish which asylum seekers have already had TB screening, for example. Making this recommendation operational will require objectives to be specific, measurable, achievable, relevant and time-bound. 5. Learning lessons The lessons learnt from working with the asylum seeker population may be applicable to other vulnerable groups with complex needs across the health care system. Learning could be disseminated across the system to improve the care offered to these groups and prevent duplication of efforts to reach vulnerable people with complex needs. APPENDIX 1 - TO BE ADDED IN FINAL REPORT Page 162