Agenda Document Pack - Moray Integration Joint Board - 29/05/2025
Moray Council · 29 May 2025
Back to Moray Integration Joint Board — 29 May 2025 and its agenda
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Moray Integration Joint Board Thursday, 29 May 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, 29 May 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 27 March 2025 5 - 8 4. Action Log of 27 March 2025 9 - 12 5. Minutes - for noting 5a Minute of meeting Audit Performance and Risk Committee of 30 January 2025 13 - 16 6. Chief Officer Report 17 - 22 7. Membership of Board and Committees 23 - 28 8. Health and Social Care Moray Strategic Delivery Plan 2025-28 29 - 66 9. Moray Integration Joint Board Strategic Risk Register 67 - 96 10. Moray Adult Mental Health Strategic Group Progress Report 97 - 136 Page 1
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11. Equalities Mainstreaming Report 2025-2029 including progress against Outcomes 2021-2024 137 - 198 12. Moray Alcohol and Drug Partnership - Scottish Government Annual Reporting Survey 199 - 238 13. Review of Financial Regulations 239 - 260 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 attend in person, please come to the High Street entrance door and a member of staff will let you into the Chamber. Page 2
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MORAY INTEGRATION JOINT BOARD SEDERUNT Councillor Elaine Kirby (Chair) Councillor Peter Bloomfield (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Derick Murray (Voting Member) Mr Sandy Riddell (Voting Member) Mr Dennis Robertson (Voting Member) Mr Alex Stephen (Voting Member) Councillor Ben Williams (Voting Member) Dr Adam Coldwells (Ex-Officio) Ms Karen Greaves BEM (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) 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, 27 March 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Ivan Augustus, Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Ms Sonya Duncan, Ms Jane Ewen, Councillor Elaine Kirby, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Mr Dennis Robertson, Ms Elizabeth Robinson, Dr Malcolm Simmons, Mr Kevin Todd, Councillor Ben Williams APOLOGIES Professor Duff Bruce, Dr Adam Coldwells, Ms Karen Greaves BEM, Ms Deirdre McIntyre, Mr John Mundell, Mr Alex Stephen IN ATTENDANCE Self-Directed Support and Unpaid Carers Team Manager; Corporate Programme Manager; Service Manager - Provider Services; Senior Commissioning Officer (HSCM) and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Dennis Robertson. 2. Declaration of Member's Interests Mr Riddell stated for transparency that he was Chair of the Mental Welfare Commission Scotland. With regard to Item 11 "Care at Home", Mr Todd stated, for transparency, that although he was a Care Manager he would be taking part in the debate as the Moray Council Staff Representative. The Board noted there were no other declarations of member's interests. 3. Minute of meeting of 30 January 2025 Item 3. Page 5
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The minute of the meeting of 30 January 2025 was submitted and approved. 4. Action Log of 30 January 2025 The Action Log of the meeting of 30 January 2025 was discussed and updated accordingly. 5. Minute of meeting Audit Performance and Risk Committee of 26 September 2024 The Board noted the minute of the meeting of the Audit, Performance and Risk Committee of 26 September 2024. 6. Minute of meeting Clinical and Care Governance Committee of 28 November 2024 The Board noted the minute of the meeting of the Clinical and Care Governance Committee of 28 November 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. In relation to the relocation of the Vaccination Centre reference at paragraph 3.6, Councillor Bloomfield asked for details of what the costs were to set up the current centre at Southfield and also what the costs would be to set up the short-term solution. In response, the Chief Officer advised she did not have the costs to hand however undertook to circulate a written response following the meeting. Following various concerns raised by members of the Board relating to the pace and outcome of the Mental Health Bed Base Review and the potential impact on service users and staff, the Chair, noting a detailed report would come to the Board in May, asked that communication be considered during the intervening period to ensure the public are aware of the status and what provision is currently available. Following lengthy consideration the Board unanimously agreed to:- (i) 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. 8. Revenue Budget and Recovery Plan 2025-26 The meeting had before it a report by the Chief Financial Officer outlining 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. Mr Murray expressed his thanks to the Chief Financial Officer for the email response received to a number of questions posed by him, which it was agreed would be circulated to Board members. Page 6
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Following consideration the Board unanimously agreed to:- (i) note the funding allocations proposed by NHS Grampian and Moray Council, detailed at 4.6; (ii) note the anticipated budget pressures detailed in 4.10; (iii) approve the 2025/26 proposed savings plan at 4.24 and detailed in Appendix 2; (iv) formally approve the Revenue Budget for 2025/26 as detailed in Appendix 1, following consideration on risks highlighted in 4.34; and (v) approve Directions for issue as set out at Appendix 5 to NHS Grampian and Moray Council. 9. Medium Term Financial Framework 2025-26 - 2029-30 The meeting had before it a report by the Chief Financial Officer asking the Board to approve the updated Medium Term Financial Framework 2025/26 to 2029/30. Mr Murray expressed his thanks to the Chief Financial Officer for the email response received to a number of questions posed by him, which it was agreed would be circulated to Board members. Following consideration the Board unanimously agreed:- (i) to approve the updated Medium Term Financial Framework at Appendix 1; and (ii) that a review of the Framework be carried out on an annual basis. 10. Health and Social Care Moray Strategic Delivery Plan 2025-28 The meeting had before it a report by the Corporate Programme Manager asking the Board 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. Following consideration the Board unanimously agreed:- (i) to note the progress in development of Health and Social Care Moray's Delivery Plan (2025-2028) attached as Appendix 1; and (ii) that the finalised Delivery Plan be presented to the Board in May 2025. 11. Equalities Mainstreaming Progress Report 2021-2024 The meeting had before it a report by the Corporate Manager and Public Health Consultant seeking approval of the draft Moray Integration Joint Board (MIJB) Equality Mainstreaming Progress Report 2021-2024. During the course of discussion Mr Riddell suggested, in order to mainstream equalities as part of the Board's vision and culture and encourage discussion, that reports to the Board should include reference to equalities within the body of the report rather than only in the Summary of Implications section. The Chair agreed, Page 7
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regardless of the subject of the report, equalities should be referenced in the body of future reports to the Board. Following consideration the Board unanimously agreed to: (i) 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". 12. Thanks The Board, in noting that Dr Malcolm Simmons was attending his last meeting following his resignation, joined the Chair in paying tribute to Dr Simmons for his valuable contributions to the Board and wished him well for the future. 13. Care at Home [Para 6.2.1] The meeting had before it a report by the Strategic Care at Home Group seeking approval from the Board regarding the strategic review of Care at Home provision in Moray and options to progress in order to provide a sustainable care at home service for Moray. During the course of discussion concern was expressed by Board members on the quality of information contained in the report and requested more clarity in the progress report to come back to the Board in 6 months time. Following lengthy consideration the Board unanimously agreed:- (i) to note the scope of the strategic review in relation to the future provision of Care at Home in Moray; (ii) to approve the strategic objectives of the group; (iii) to consider the Options set out in para 5.22 and Appendix and approve to progress the recommendation Option; and (iv) progress will be reported back to the Board in 6 months. Page 8
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 27 March 2025 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 29 MAY 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 Bed base review ongoing and date with Board to be scheduled. 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 9
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 29 MAY 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. TBC JP Date to be confirmed 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. TBC 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. Summer 2025 SD/AMcE Timetabled August 2025 Page 10
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 29 MAY 2025 6. Chief Officer Report 27/03/25 Chief Officer to provide written response setting out costs of setting up Vaccination Centre at Southfield and the short-term solution. ASAP JP In progress now move has been completed 7. Equalities Mainstreaming Progress Report 2021-24 Future reports to the Board, regardless of subject, to include reference to equalities within the body of the report rather than only in the Summary of Implications section. Ongoing ALL Report on today’s agenda regarding mainstreaming of the Equality Duty Page 11
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MINUTE OF MEETING OF THE AUDIT, PERFORMANCE AND RISK COMMITTEE Thursday, 30 January 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Sean Coady, Councillor Scott Lawrence, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Councillor Ben Williams APOLOGIES Ms Deirdre McIntyre, Mrs Jeanette Netherwood IN ATTENDANCE Corporate Manager; Angela Pieri, Engagement Lead, Grant Thornton; Interim Chief Social Work Officer/Head of Service; Chief Internal Auditor; Service Manager, Primary Care Contracts; Lizette Van Zyl, Social Work Service Manager and Caroline O'Connor, Committee Services Officer. 1. Chair The meeting was chaired by Mr Sandy Riddell. 2. Declaration of Member's Interests The Committee noted there were no declarations of member's interests. 3. Minute of meeting of 26 September 2024 The minute of the meeting of 26 September was submitted and approved. 4. Action Log of Meeting of 26 September 2024 The Action Log of the meeting of 26 September 2024 was discussed and updated accordingly. 5. Quarter 2 (July to September 2024) Performance Report Item 5a Page 13
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The meeting had before it a report by the Corporate Programme Manager updating the Committee on performance as at Quarter 2 2024 (July-September). With reference to the graphs contained in Emergency Admissions in Appendix 1, Mr Murray noted the significant increase in targets and asked whether the targets are set locally or nationally and if there was any specific reason for the increase. In response, the Chief Officer advised the figures are set nationally however suggested the red line may be a trend line rather than a target line as targets are not shifted routinely. She further stated it could be that they are targets and the trajectories have been adjusted based on understanding of the intelligence, and therefore agreed to provide Committee with an email update. The Chair expressed concern in relation to paragraph 5.2 which detailed recruitment in care had reached maximum number of hours available for provision and if care was not available, noting this would impact on other system pressures. In response, Mr Coady confirmed there required to be a system approach and while there have been difficulties recruiting internally to the care at home service, the recruitment situation was improving and by the end of March predicted the service will be 224 hours under 6,368 hours that they actually have. He advised this was mainly due to improved attrition as a result of improved terms and conditions and positive development and training of staff. External partners CQS have also provided assurances they will be able to increase their hours as a result of a block contract from January to end of February. Further work is being done in terms of the proportionate care programme to review those who have two carers, four times per day with a view to reducing where possible. In response to a question from Councillor Lawrence relating to the increase in National Insurance contributions which would affect the private providers more than internal employee, the Chief Financial Officer advised that this would be a budget pressure for next year and whilst more information is to come on the funding being provided by the Scottish Government, indications were that this would only cover half. Information from providers is being collated from providers to assess the implications. Following consideration the Committee unanimously agreed to:- (i) note the performance of local indicators for Quarter 2 (July to September 2024) as presented in the Performance Report at Appendix 1; and (ii) note the analysis of the local indicators highlighted and actions being undertaken to address performance that is outside of acceptable target ranges as detailed in Appendix 1. 6. Quarter 2 (July to September) Performance Report for Children and Families and Justice Social Work The meeting had before it a report by the Interim Chief Social Work Officer/Head of Service informing the Committee on Children and Families and Justice Social Work performance as at Quarter 2. In relation to Child Protection Activity referenced at paragraph 4.5(a), Mr Murray asked whether there were figures for August 2024 that could be compared rather than having to wait until after August 2025 when the national data was available. In response the Interim Chief Social Work Officer advised comparator and benchmark Page 14
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work is done on a regular basis and confirmed local comparator information could be shared should there be another report prior to release of the national information. Thanking the Interim Chief Social Work Officer for the work done by the team in preparing the report, the Chief Officer asked that future reports set out the key messages with how the information details what is being done well in terms of looking after children and young people and what the information details in terms of areas of concern where support or service change may be appropriate. Following consideration the Committee unanimously agreed to:- (i) note the performance of local indicators for Quarter 2 as presented in the Performance Report at Appendix 1; and (ii) note the analysis of the local indicators as detailed in Appendix 1. 7. Internal Audit Section - Update Report The meeting had before it a report by the Chief Internal Auditor providing Committee with an update on the work of the Internal Audit Section. The Chief Internal Auditor confirmed that an agreement has now been obtained for the reporting of internal audit reports from the NHS Grampian Internal Audit Provider, of interest to the MIJB, to future Audit, Performance and Risk Committees. Following consideration the Committee unanimously agreed to note the contents of the report. 8. Internal Audit Section Completed Projects Report 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. 9. Children’s Services Joint Inspection Improvement Plan 2024 The meeting had before it a report by the Interim Chief Social Work Officer/Head of Service providing the Committee with an overview of the governance arrangements for the Joint Inspection Improvement Plan which was submitted to the Care Inspectorate on 5 March 2024. The Chair, recognising the extremely complex governance arrangements and the capacity required to support the groups, asked if there was any overview to ensure the structure is working effectively. In response the Interim Chief Social Work Officer advised he was unaware of issues of non-attendance however where there is a pattern of non-attendance, it is incumbent on chairs of groups to raise with the appropriate partners as well as the individuals. The Chief Officer advised she is a member of the Chief Officers Groups in relation to services she is responsible for and confirmed conversations are held at those meetings in terms of the ability of agencies to support and there is open challenge and commitment of all chief officers to ensure the correct people attend the group to provide assurance. Following consideration the Committee unanimously agreed to:- Page 15
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(i) note the content of the improvement plan produced in response to the joint inspection, attached as Appendix 1; and (ii) note the governance arrangements in place for child protection in Moray, attached as Appendix 2. 10. Payment Verification The meeting had before it a report by the Head of Service / Deputy Chief Officer providing an update on the review of the Payment Verification Assurance Service provided by National Services Scotland Practitioner Services Divisions, on behalf of NHS Grampian. Following consideration the Committee unanimously agreed to:- (i) note the arrangements in place for Grampian for the management of the payment verification process; (ii) note that the payment verification process has now fully restarted after pausing during Covid-19; and (iii) note the actions already taken to address the outstanding issues, with plans for future action to include an update on progress to this Committee in 2025. 11. Update on Improvement Plan for Adult Social Care Commissioning [Para 6.2.2] The meeting had before it a report by the Interim Head of Service / Chief Social Work Officer updating the Committee of progress on the Improvement Plan for Adult Social Care Commissioning. Following consideration the Committee unanimously agreed to:- (i) note the progress of the Improvement Plan attached as Appendix 1; (ii) note the progress within this report as at the end of November 2024 in relation to the recommendations detailed in the Improvement Plan; and (iii) approve the extension required to bring contracts into date to April 2025. Page 16
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 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 was a very challenging year for delivering within the budget, with our two funding partners, Moray Council and NHS Grampian, who remain 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. 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 (DWD) 3.1 The number of patients whose discharge is delayed has risen with a likely upward trajectory for a short time. There are many contributing factors to this rise, with waiting for care the most likely reason for delay. Teams are seeking innovative solutions to tackle this issue and continue to meet daily to monitor the delays and to encourage collective decision making to support discharge. At time of report, there are 37 delayed discharges and our target remains 26. 3.2 The National DWD programme has completed phase one, which included the completion of a National self-assessment tool, the creation of actions and the identification of leads to represent Moray locally, regionally and nationally. The Moray leads are now attending local, national and regional meetings and will Item 6. Page 17
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develop action plans for planned work which will be fed back to all groups. This is a collaborative approach in Moray and teams from Dr Gray’s Hospital and Health and Social Care Moray (HSCM) will be working together to achieve the goals set. 3.3 Moray’s DWD self-assessment has been submitted and has been added into a single submission to Scottish Government from NHS Grampian. Vaccination Programme 3.4 The spring COVID-19 vaccination programme commenced on 31 March 2025. The eligibility remains the same as spring 2024 and the vaccine is offered to: residents in care homes for older adults; all those aged 75 years of age or over; all those aged 6 months and over with a weakened immune system. The Shingles and Pneumococcal vaccination programmes 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 Respiratory Syncytial Virus (RSV) and winter 2025/26. 3.5 Following notice to vacate the site at Southfield, Elgin by 23 April 2025, the vaccination centre has moved, within a very tight timescale, into short term, temporary accommodation at Beechbrae. The team have been supported by health and social care partnership and NHS colleagues to facilitate the move, and with exceptional effort on all parts, the vaccination centre is up and running. This has ensured vaccine delivery has been maintained. A solution for longer-term delivery is currently being developed with the new site to be operational no later than December 2025. 3.6 The vaccination programme continues with a mixed model of delivery with outreach and ad-hoc/pop up clinic delivery planned alongside the main centre at Beechbrae. GMED 3.7 The GMED review was completed at the end of January 2025 with recommendation approval by the GMED Redesign Programme Board. 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. GMED SMT has met with the three Health and Social Care Partnerships Senior Leadership Teams and GP Sub-committee to present recommendations in March 2025. HSCM Moray Corporate Team is supporting GMED in setting up and rolling out the engagement and consultation plan. 3.8 GMED closed financial year 2024/25 with a £3118 underspend, a nearly break even position. Work continues on improving financial efficiency of the service regarding non-pay elements. Review of Social Work Governance & Assurance Arrangements across Scotland 3.9 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 seeking to address, nationally, how well social work governance and assurance arrangements support leaders. The report’s Page 18
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findings are being considered in the development of HSCM’s local social work governance arrangements which are being completed. 3.10 The review report was due to be published in March and was eventually published in May 2025. The findings were reassuring and although social work governance arrangements were complex, they were mostly effective and social work leaders were making these work. Social work was not always seen as an equal partner within partnership arrangements in several areas. It was not consistently and robustly represented in some partnerships. A report on this and our local social work governance arrangements will come to a future meeting of the Board or relevant committee. Strategic Change Board Update 3.11 The MIJB approved partnership working across the North-East in relation to the Strategic Change Board (SCB) at its meeting in January 2025. The SCB has been set up to drive transformational change and recognises the importance of this being done across NHS Grampian and its partner IJBs in order to ensure an alignment of ambition. At its May meeting, the SCB reflected on the need to recalibrate our collective approach to transformation in light of the current pressures facing the entire health and care system. The discussion acknowledged the risk of becoming stuck in short-term responses (known in the 3 Horizon model as Horizon 1) and emphasised the importance of shifting toward longer-term, system-wide change (Horizons 2 and 3). Key themes included the need for a shared model of change, clearer articulation of system priorities, and stronger engagement with staff and partners. This work was further supported by the first of three cross-system workshops on 16 May 2025, co-led with Healthcare Improvement Scotland (HIS), which brought together colleagues from across health and care – including Third Sector Interfaces (TSIs) – to begin co-designing a shared vision, guiding principles, and cultural shifts to underpin transformation. There was strong consensus that now is the time to move from intent to impact, with a focus on practical steps, shared ownership, and honest conversations about what change will mean in practice. 3.12 A consolidated update is currently in development and will be brought to the Grampian IJBs in the coming period to support further discussion and alignment. 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” Page 19
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Working with our partners to support people so they can cope with, and where possible, overcome the health and wellbeing challenges they may face. 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 Board 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 Page 20
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HSCM Senior Management Team, the Legal Services Manager and Caroline O’Connor, Committee Services Officer have been consulted in the drafting of this report. 6. CONCLUSION 6.1 The Board 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 21
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 2025 SUBJECT: MEMBERSHIP OF BOARD AND COMMITTEES BY: CORPORATE BUSINESS SUPPORT MANAGER 1. REASON FOR REPORT 1.1 To inform the Board of changes to Membership of the Moray Integration Joint Board (MIJB), Audit, Performance and Risk (APR) Committee and Clinical and Care Governance (CCG) Committee. 2. RECOMMENDATION 2.1 It is recommended that the Moray Integration Joint Board (MIJB) notes: i) the resignation of a GP Lead from 31 March 2025; ii) the resignation of Third Sector Stakeholder Representative from 11 February 2025; iii) the resignation of Moray Council Staff Representative from 19 May 2025; iv) the notice of resignation of Unpaid Carer Representative; and v) the updated membership of Board and committees attached at Appendix 1. 3. BACKGROUND 3.1 The Public Bodies Joint Working (Scotland) Act 2014 (“the Act”) and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (“the Order”) make provisions about various matters including the membership of the MIJB. As a minimum this must comprise voting members nominated from the NHS Board and Council; co-opted non-voting members who are holders of key posts with the NHS and Council or the MIJB; and co-opted non-voting members who are representatives of groups who have an interest in the MIJB. There is flexibility to appoint additional non-voting members as the Board sees fit. The Moray Health and Social Care Integration Scheme (“Integration Scheme”) outlines certain agreed provisions re membership (and includes the specific provisions taken from the Act and the Order). Item 7. Page 23
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4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 Dr Malcolm Simmons, GP Lead, stood down from the Board on 31 March 2025. This vacancy will not be recruited to. Dr Robert Lockhart, GP Lead, will continue as member of the MIJB and Clinical and Care Governance Committee. 4.2 Kevin Todd, Moray Council Staff Representative, stood down from his role on the Board on 19 May 2025. Unison will advise who will attend future meetings in due course. 4.3 Janette Topp, Third Sector Stakeholder, resigned from the Board on 11 February 2025. 4.4 Ivan Augustus, Unpaid Carer Representative, has intimated his intention to resign from the Board when a replacement has been found to take up the position. 4.5 The Chair and Vice-Chair have suggested aligning upcoming recruitment efforts into a single process. As such, a joint recruitment campaign will be carried out seeking applicants for the Third Sector Representative and Unpaid Carer Representative roles, with recruitment proceeding concurrently for both positions. 4.6 The Board agreed at its meeting on 30 January 2025 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. Cllr Elaine Kirby took up the role of Chair of the Board on 1 April 2025. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-32” Effective governance arrangements support the development and delivery of priorities and plans. (b) Policy and Legal The Board, through its approved Standing Orders for Meetings, established under the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014, ensures that affairs are administered in accordance with the law, probity and proper standards. (c) Financial implications There are no financial implications arising as a direct result of this report. (d) Risk Implications and Mitigation There are no risk implications arising as a direct result of this report. (e) Staffing Implications There are no staffing implications arising as a direct result of this report. (f) Property Page 24
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There are no property implications arising as a direct result of this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required as the report is to inform the Board of changes required to membership of the Board and CCG Committee. (h) Climate Change and Biodiversity Impacts None arising from this report. (i) Directions None arising from this report. (j) Consultations Consultation on this report has taken place with Corporate Manager and Communications & Engagement Officer, HSCM, and Caroline O’Connor, Committee Services Officer, Moray Council, who are in agreement with the report. 6. CONCLUSION 6.1 This paper sets out the position in relation to the membership of MIJB. Author of Report: Isla Whyte, Corporate Business Support Manager Background Papers: None Ref: Page 25
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APPENDIX 1 Moray Integration Joint Board – as at 19 May 2025 Moray Integration Joint Board 4 Council voting members Elaine Kirby (Chair) Ben Williams Peter Bloomfield Scott Lawrence 4 NHS Grampian voting members Dennis Robertson (Vice- Chair) Derick Murray Sandy Riddell Alex Stephen Third Sector Stakeholder Vacancy NHS Grampian Staff Representative Stakeholder Member Deidre McIntyre Carer Stakeholder Ivan Augustus Service User Stakeholder Sheila Brumby Moray Council Staff Representative Kevin Todd Chief Officer Professional Judith Proctor Chief Social Work Officer Jim Lyon (interim) Lead Nurse Jane Ewen GP Lead Dr Robert Lockhart Dr Malcolm Simmons Non Primary Medical Services Lead Mr Duff Bruce Additional Member Elizabeth Robinson Audit, Performance and Risk Members (note chair needs to be alternate partnership member to the Chair of MIJB) 2 Council voting members Ben Williams Scott Lawrence 2 Health Board voting members Sandy Riddell (Chair) Derick Murray Third Sector Stakeholder Vacancy NHS Grampian Staff Representative Stakeholder Member Deirdre McIntyre Clinical and Care Governance Members 2 Council voting member Cllr Peter Bloomfield Cllr Scott Lawrence 2 Health Board voting member (Chair) Derick Murray (Chair) Alex Stephen (Sandy Riddell 25/1/24 temporary) Carer Stakeholder Ivan Augustus Service User Stakeholder Sheila Brumby Third Sector Stakeholder Vacancy Moray Council Staff Representative Kevin Todd Chief Officer Professional Judith Proctor Page 26
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APPENDIX 1 Chief Social Work Officer Jim Lyon (interim) Lead Nurse Jane Ewen GP Lead Dr Robert Lockhart Dr Malcolm Simmons Non Primary Medical Services Lead Prof Duff Bruce Additional Member Elizabeth Robinson Page 27
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 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 and approve the final draft of the Strategic Delivery Plan (2025-2028) attached at Appendix 1; and ii) note a report will be submitted to Audit Performance and Risk Committee in September 2025 with proposals for future reporting of key performance indicators. 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 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. 3.3 The Board considered the first draft of the revised Strategic Delivery Plan for 2025-2028 on 27 March 2025 (para 10 of the minute refers) and agreed the final draft should be presented to this Board. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The content of the final 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, to redesign of models of service delivery to improve outcomes and efficiency. This work will continue to be Item 8. Page 29
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informed through collaboration with our partners and will be shaped to align with the evolving Health and Social Care Reform in Scotland, (Scottish Government renewal framework to be published in late June 2025) and the NHS Grampian Route Map for Strategic Change (led by the Grampian Strategic Change Board) so HSCM continue to strengthen our collective approach to provide the best care for the people of Moray, within the resources available. 4.2 Further consultation has taken place with the Senior Management and Operational Management Team to confirm the priority work streams, leads and timescales for the next three years of the Strategic Plan to 2028 and required amendments and comments received have been incorporated. 4.3 The final draft SDP (Appendix 1) provides an overview of the agreed priority work streams and associated actions for HSCM. The Plan will require 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. Key to the successful delivery of the outcomes will be a robust governance framework that will ensure regular monitoring and reporting of progress. Work has commenced on a review of the performance framework that will underpin reporting at all levels in HSCM, and a report will be submitted to Audit and Performance Committee in September 2025 with the proposals for future reporting of key performance indicators. 4.4 Once the SDP is approved, work will progress to ensure that there are links with service and team plans to ensure that there is clear focus on the agreed priorities throughout HSCM. 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” 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 Page 30
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(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. (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. Page 31
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6. CONCLUSION 6.1 This SDP is a key document for the Partnership which, when approved, sets out agreed priorities to be delivered over the next three years, within the capacity and resources currently available. Progress will be monitored on a regular basis and progress on delivery of objectives and impacts on performance will be reported in the Annual Performance Report. Author of Report: Jeanette Netherwood, Corporate Programme Manager Background Papers: 20250327 HSCM Strategic Delivery Plan 2025-28 and Appendix 1 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 32
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APPENDIX 1 Page | 1 | 1 Health & Social Care Moray Strategic Delivery Plan 202 5 - 2028 Page 33
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APPENDIX 1 Page | 2 Contents Foreword ..............................................................................................................................................................................................3 1 Introduction .......................................................................................................................................................................................4 2 Moray Health & Social Care Partnership ...................................................................................................................................5 2.1 Joint Strategic Needs Assessment .........................................................................................................................................5 2.2 Establishing Sustainable Models of Care ...............................................................................................................................7 2.3 Relationships and Collaboration ............................................................................................................................................8 3 Key Enablers ....................................................................................................................................................................................9 4 Performance and Governance .........................................................................................................................................................9 5 Strategic Delivery Plan ................................................................................................................................................................... 10 5.1 STRATEGIC THEME - BUILDING RESILIENCE ...................................................................................................................... 11 Objective 1: We focus on prevention and tackling inequality ................................................................................................... 11 Objective 2: We nurture and are part of communities that care for each other ....................................................................... 12 5.2 STRATEGIC THEME - HOME FIRST ...................................................................................................................................... 17 Objective 3: We work together to give you the right care in the right place at the right time ................................................... 17 OBJECTIVE 4: We help build communities where people are safe ......................................................................................... 20 5.3 STRATEGIC THEME - PARTNERS IN CARE ......................................................................................................................... 24 Objective 5: We are an ambitious and effective partnership ................................................................................................... 24 Objective 6: We are transparent and listen to you .................................................................................................................. 24 5.4 STRATEGIC LEADERSHIP, PLANNING AND PERFORMANCE ............................................................................................ 30 Page 34
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APPENDIX 1 Page | 3 Foreword As Chair of the Moray Integration Joint Board, I am pleased to present our Strategic Delivery Plan for 2025–2028. This plan represents our shared commitment to transforming health and social care services in Moray − ensuring they are sustainable, person-centred, and responsive to the needs of our communities. The plan sets out how Health & Social Care Moray will deliver on the ambitions of our Strategic Plan, Partners in Care, over the next three years. It connects strategic objectives with the activity we need to deliver and provides a framework for how we make the best use of our integrated resources. It outlines the key areas of work that will help us improve health and wellbeing outcomes for the people of Moray through our focus on preventing ill-health, reducing health inequalities, promoting independence, and supporting resilient communities. This is not a static document. It will be reviewed regularly through our Strategic Planning and Commissioning Group to ensure that actions are progressing, priorities remain relevant, and improvements are made where needed. It will also serve as a key tool in monitoring how well our Strategic Plan is working in practice. We are under no illusion about the real and growing pressures on the health and care system. An ageing population, increasing levels of poor health, workforce challenges, and financial constraints, all mean we must think differently, work differently, and continue to build on the strength of our partnerships. I would like to thank everyone who has contributed to shaping this plan. It is only through collective effort − across our communities, our workforce, and our partners − that we will succeed. I am confident that, together, we can deliver meaningful, lasting improvements for the people of Moray. Councillor Elaine Kirby Chair, Moray Integration Joint Board Page 35
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APPENDIX 1 Page | 4 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 36
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APPENDIX 1 Page | 5 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 37
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APPENDIX 1 Page | 6 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 38
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APPENDIX 1 Page | 7 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 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. Page 39
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APPENDIX 1 Page | 8 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 health and care across the North East, coupled with the practical steps required to create a sustainable health and care system. Page 40
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APPENDIX 1 Page | 9 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 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. Page 41
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APPENDIX 1 Page | 10 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 42
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APPENDIX 1 Page | 11 5.1 STRATEGIC THEME - BUILDING RESILIENCE Objective 1: We focus on prevention and tackling inequality Years 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 LD Health Checks Annual Health Checks for People 16+ with Learning Disabilities LD Service Manager X X Apr-26 Evaluation completed and learning shared 1.2 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 X Apr-26 To improve health and well- being by connecting individuals to community resources and activities that address their social, emotional and practical needs. To reduce unnecessary pressure on clinical healthcare services 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 Contribute to Fairer Moray Forum in order to develop Localities Manager (West) X Sep-25 Moray-wide strategy and action plan in place to tackle Page 43
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APPENDIX 1 Page | 12 Moray wide poverty Strategy and Action Plan Moray-wide poverty strategy and action plan. poverty, and in progress by March 2025 2.2 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 Unpaid Carers delivery plan Implement the 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. 3.2 Produce & plan implementation of the Unpaid Carers Strategy for 2027-2030 Unpaid Carers Strategy for 2027-2030 Review and update Unpaid Carers Strategy, to determine the effectiveness of a new Unpaid Carers Strategy Group X Mar-27 Published strategy implementation plan actioned Page 44
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APPENDIX 1 Page | 13 strategy to determine if an extension and review of the current strategy is more beneficial. Develop implementation plan 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 Support the delivery of GP VISION aims and objectives for GPs and Primary Care improvement Plan (PCIP) across Moray The VISION is supported by 10 Key themes, with the agreed initial focus on 5 areas:- Data; Digital; Multi-Disciplinary Team; Models of Contracts; Premises To provide support and guidance to PCIP works- streams and GP practices through transformation and delivery of the key theme changes To provide support and guidance to GP practice to safeguard sustainability Primary Care Development Manager GP Clinical Lead X Jul-25 Sept-25 Ongoing Ensure delivery Moray PCIP within budget through implementation of a Financial plan Workstream service plans for Moray PCIP reviewed and updated by Sept 2025 Page 45
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APPENDIX 1 Page | 14 To support the delivery of the 2018 GMS contract and Memorandum of Understanding (MOU) for PCIP To develop and support opportunities for flexibility in the contract Mar-26 Ongoing Vision programme progressing towards aims and objectives of 2018 contract and MoU and implementation of the improvement plan 5 Mental Health Services Intact the Moray Good Mental Health for All Strategy (2016-2026) and the underpinning Mental Health Delivery Plan 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 - developed social connections, tackled isolation, - increased individuals resilience, - strengthened use of community assets. 5.2 To deliver services in line with the Mental health Quality Standards; 1: Access 2: Assessment 3: Transitions 4: Workforce 5: Governance & Accountability A focus on Mental Health Standard 1: Access Develop mechanisms so 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 / Mental Health Strategic Lead X X Oct-26 - improved responses to people in distress - creation of a shared understanding of mental health pathways in Moray - increased staff recruitment and retention Page 46
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APPENDIX 1 Page | 15 6 Collaboration & Partnership Working 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 and community partners 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 Increase resilience, sustainability and growth of our own groups and third and community led groups across Moray Work alongside our own groups, and other community and third sector groups as capacity allows, to provide support and equip them with the tools to enable independence and sustainability of groups. Continue to grow and strengthen collaborative and partnership working opportunities. Community Wellbeing Development Team X X Jun-26 Increased number of resilient community led groups and partnerships supporting mental and physical wellbeing, prevention and enablement in Moray Page 47
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APPENDIX 1 Page | 16 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) 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. Locality Managers Sept-25 Sept-26 Jun-26 Locality Plan in place Multi-Disciplinary Teams embedded in all localities Communities involved in monitoring effectiveness of local service delivery Page 48
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APPENDIX 1 Page | 17 5.2 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) & Home First 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. Head of Service X Dec-25 Reduction in delayed discharges 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 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 Page 49
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APPENDIX 1 Page | 18 communities via agreed PDD process, both without delay. 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. Head of Service 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 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) Page 50
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APPENDIX 1 Page | 19 10.1 Develop SDS Framework for options 1, 2 & 3 providers Develop SDS framework for option 1, 2 & 3 providers. Collaborate with In-Control Scotland and CCPS to ensure the model is sustainable and has longevity taking into consideration national developments 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 10.2 Self-evaluation against national SDS framework of standards to inform future requirements to improve performance and delivery Benchmark local practise against the national SDS Framework of Standards (rev. May 2024) through self- evaluation against the core components and practice statements. SDS Steering Group X Aug-25 Utilising the self-evaluation, identified areas of improvement are 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 and Commissioning activity aligns with the principles of SDS. 10.3 Continue promotion of independent support and advise for SDS options Continue to promote the use of Moray's Support in the Right Direction (SiRD) funded projects to promote independent support and advice relating to the options of SDS (Cornerstone) and independent SDS Advocacy (Circles) 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. Page 51
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APPENDIX 1 Page | 20 OBJECTIVE 4: We help build communities where people are safe Key Heading Description Lead 1 2 3 Timescale Outcomes 11 Managing frailty in the community To create the conditions for a whole system frailty pathway within Moray encompassing community approaches to promoting aging well, and early identification. Reduction in presentation / readmission rate of frail patients 11.1 Identification and assessment of frailty within primary care over 65s The early identification and assessment of frailty in primary care, to support proactive case management in order to prevent deterioration and hospital attendance GP Strategic Lead / Moray Frailty Lead X X X Jun-27 - Active engagement with the public, health and social care staff and third sector / community groups to promote healthy ageing - a proactive integrated planning and management approach in place to ensure best outcomes for the Individual - maximise the potential for digital innovation; from a prevention and early intervention approach, through to condition monitoring and self- management 12 Protecting People in Moray In the community, we are committed to keeping people safe, through our Public Protection agenda, the services supported by the Alcohol and Drug Page 52
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APPENDIX 1 Page | 21 Partnership (ADP), our Justice Services and contributing to the community safety agenda, including the Violence Against Women Partnership. We will take a trauma-informed approach across these services. 12.1 Preventing Suicide and Self Harm Deliver the Moray Suicide Prevention Action Plan 2025-28 (in draft pending approval) Working in partnership so that People: • in distress experience timely, compassionate and trauma informed responses. • who have self-harmed receive effective treatment and aftercare • are prevented from future suicide attempts and/or self- harm. HSCM Mental Health Strategic Group Moray Suicide Prevention Group X X X 2028 (SP1) More people in our communities have a clear understanding of suicide, risk factors and its prevention (SP2) People experiencing suicidal crisis are kept safe and their situations do not further escalate (SP3) More people are supported through Distress Brief Interventions 12.2 Reducing drug and alcohol related harm Deliver the Moray Alcohol & Drug Partnership Strategic Delivery Plan 2025-28 (in draft pending approval) Working in partnership so that People: • who take harmful drugs are offered evidence-based harm reduction and advice • can access the services they need to support their recovery. remain in treatment for as long as they need to. Moray Integrated Drug and Alcohol Service (MIDAS) Moray Alcohol & Drug Partnership X X X 2028 (ADP1) More people receive overdose awareness advice and provision of take-home naloxone (ADP2) People wait no more than three weeks for specialist drug and alcohol treatment (ADP3) More people have access to Residential Rehabilitation placements (ADP4) Fewer people disengage from specialist drug and alcohol treatment Page 53
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APPENDIX 1 Page | 22 12.3 Protecting Children and Young People Deliver the Moray Children’s Services Plan 2023-26 (Priority - Keeping Children & Young People Safe) Working in partnership so that children and young people: • are safer because risks have been identified early and responded to effectively. • lives improve with high quality planning and support experience sustained loving and nurturing relationships to keep them safe from further harm. Moray Children & Families Social Work and Community Child Health Services Moray Child Protection Committee X X X 2026 (CPC1) More children and young people are supported to develop healthy relationships with peers, online and in the community (CPC2) More children and young people are protected from harm because of improved home circumstances (CPC3) Children who have experienced or witnessed abuse are supported through recovery and do not experience further trauma. 12.4 Protecting Adults at risk of harm Deliver the Moray Adult Support and Protection Self Evaluation Improvement Action Plan 2024-2026 Working in partnership so that Adults at risk of harm: • are safer because risks have been identified early and responded to effectively. • lives improve with high quality planning and support Moray Adult Social Care Services Moray Adult Protection Committee X X X 2026 (ASP1) More Adults are protected from harm due to a reduction of risk (ASP2) Adults at risk of harm report feeling safer because of their adult support and protection plan (ASP3) Adults at risk of harm experience improvement to their health, wellbeing and overall quality of life 12.5 Reduce reoffending Deliver the Moray Working in partnership so that: • People can access the services they need to support desistance • People have access to Moray Justice Social Work Service Moray X X X 2027 (CJP1) More people successfully complete their community payback or drug testing and treatment orders (CJP2) Less homelessness Page 54
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APPENDIX 1 Page | 23 Community Justice Outcome Improvement Plan 2024-27 suitable accommodation following release from a prison sentence People in police custody receive support to address their needs Community Justice Partnership applications are made by people released from prison (CJP3) More people are referred onto support services by custody centres 12.6 Eradicating Violence against Women & Girls Deliver the Moray Violence against Women and Girls Partnership Delivery Plan 2025-28 (In draft/pending approval) Working in partnership so that: • People in Moray are equally safe and respected • Survivors of VAWG have access to trauma-informed recovery, support and justice. • Children affected by domestic abuse are supported to stay safe and remain in the care of their non-offending parent Perpetrators are held to account and supported to change their behaviour Moray Children & Families and Justice Social Work Community Child Health Services Moray Violence against Women & Girls Partnership X X X 2028 (VAWG 1) More people in our communities understand the causes and consequences of VAWG (VAWG 2) Women and children report feeling safer as a result of the specialist support they have received. (VAWG 3) Fewer children and young people are placed in care due to domestic abuse (VAWG 4) More people successfully complete specialist perpetrator interventions Page 55
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APPENDIX 1 Page | 24 5.3 STRATEGIC THEME - PARTNERS IN CARE Objective 5: We are an ambitious and effective partnership Objective 6: We are transparent and listen to you Ref Key Heading Description Lead 1 2 3 Timescale Outcomes 13 Redesigning Models of Care 13.1 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 13.2 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 13.3 Care at Home - Strategic Review and redesign of care at home service 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 X Nov-25 Increased capacity for provision of care at home at a financially sustainable cost. Page 56
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APPENDIX 1 Page | 25 13.4 Review and Redesign of Adults Day Care services A full redesign and modernisation of Adult day services where individuals are able to access sustainable 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, and where this is not possible the review of the transportation policy will provide clarity of what support will be available. Service Manager - Provider Services X Mar-26 Redesign model agreed and implemented Transportation policy revised and adopted 14 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. 14.1 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 Service Manager Learning Disabilities / Localities Manager Elgin 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 Page 57
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APPENDIX 1 Page | 26 partners to develop sustainable accommodation provision within Moray 14.2 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 14.3 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 15 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. 15.1 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 Page 58
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APPENDIX 1 Page | 27 16 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. 16.1 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 - Moray Heart, with future focus around Respiratory and Heart Failure services Lead Dietician X X Sep-26 Improvement in health of participants in the programme Increased number of participants accessing the services 16.2 Initial review of palliative models of care for cancer services in line with the National Palliative Care Framework Cancer Journey- Initial review of palliative cancer services in Moray, including engagement with stakeholders, to develop a model for Moray Chief Nurse X Dec-25 Sustainable model of care in place Support available to those who need it 16.3 Establishment of a Moray Dementia Strategy & Moray Dementia Pathway in line with Grampian and National dementia delivery plans. Dementia- 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 Page 59
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APPENDIX 1 Page | 28 16.4 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) Technology Enabled Care 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 Lead X X X Mar-28 Increase in use of TEC to support people to live independently 17 Moray Growth Deal - Researching sustainable services 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. (including Community Connections, Personal Data Store, Smart Housing) Increase ratio of those supported to live at home, independently, with technology enabled care rather than in person care Manage the impact of demographic growth on care at home provision via hybrid approaches to care, such as social prescribing, as opposed to in person care 17.1 Partnership working to support the research and development initiatives led by DHI To support the research and development of the 5 Living Lab research and design projects:- 1. LL1 Supported Self Management DHI / Digital Health Lead X Mar-26 Reduced dependency on HSCM Services through: - Increased access to community spaces. - Development of a Page 60
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APPENDIX 1 Page | 29 2. LL2 Long Term Condition Management 3. LL3 Care in Place 4. LL4 Smart Housing / Smart Communities 5. LL5 Mental Wellbeing community occupational health pathway - Development of a Personal Data Store and the Community Connections Moray digital platform - Increased access to SMART housing and remote monitoring within the community Page 61
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APPENDIX 1 Page | 30 5.4 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 Technology Enabled Care (TEC) Implementation of the Analogue to Digital plan for community alarms 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 X Dec-25 Mar-26 First phase of transfer completed by December 2025 Model of support is in place and shared widely Page 62
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APPENDIX 1 Page | 31 E1.2 New Social Work and Social Care Information Management System (SWIMS) 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 Head of Service /CSWO X X Mar-27 Procurement completed and tender awarded. System implemented services migrated and operational E1.3 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 X X Ongoing Implementation of use of artificial intelligence in various functions to release capacity for other tasks. E2 Strategic Commissioning In collaboration with stakeholders, develop a Strategic Commissioning Strategy and Market position statement that underpins the MIJB Strategic Plan SMT / Strategic Planning and Commissioni ng Group X 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 Page 63
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APPENDIX 1 Page | 32 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 X X X Dec-25 Apr-26 Apr-27 Apr-28 Apr-28 Annual Report (via NHSG) Workforce plan implemented Increase in Volunteer numbers and roles Improved retention rates Succession Planning embedded 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 and establish the Infrastructure plan for HSCM Moray X X X Apr-27 Dec-27 Accommodation assessed as suitable for service delivery Infrastructure plan developed and adopted E6 Performance and Quality Assurance & Improvement Frameworks Develop framework to further support informed decision making Deputy Head of Service / Corporate Programme manager X X Dec-26 Performance framework updated and implemented Quality Assurance Framework embedded Page 64
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APPENDIX 1 Page | 33 E7 Embed Robust Governance systems With partners develop good governance protocols based on up to date policies that support delivery of efficient, effective and quality services. Streamlining the decision making structure to enable the organisation to be agile in responding to emerging pressures, whilst also ensuring learning from Audits and inspections are actioned and embedded Implementation of learning from audits and inspections SMT X X X X Ongoing Dec-25 Ongoing Policy and protocol are updated and implemented Review to streamline meeting structures and confirm appropriate delegation completed and implemented. Positive inspection and audit reports received E8 Finance Develop and monitor the Financial Recovery Plan that will enable the delivery of the Strategic Plan objectives whilst maintaining Financial Sustainability. Chief Finance Officer X X X ongoing Budget savings plan approved and delivered Medium term financial plan approved by MIJB Page 65
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 2025 SUBJECT: MORAY INTEGRATION JOINT BOARD STRATEGIC RISK REGISTER BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To provide the Board with a comprehensive overview of the strategic risks currently facing the organisation. This includes Risk Identification, Risk Assessment and Mitigating Actions, aligned with the Strategic Plan. The report aims to support informed decision-making by the Board, enhance strategic planning and reinforce the commitment to effective risk management and governance. 1.2 To present to the Board the Risk Appetite Statement, included within the updated Risk Register, developed with members at the development session on 31 October 2024. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) note the continued development of the Moray Integration Joint Board (MIJB) Risk Register; ii) consider the updated Strategic Risk Register (Appendix 1) and assess the adequacy of the mitigating controls identified; and iii) approve the new format of the register. 3. BACKGROUND 3.1 The Strategic Risk Register is reviewed regularly by the Senior Management Team as part of a robust risk monitoring framework, to identify, assess and prioritise risks related to the delivery of services in relation to delegated functions, particularly any which are likely to affect the delivery of the Strategic Plan. Item 9. Page 67
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3.2 The MIJB Strategic Risk Register is attached to this report at Appendix 1 and sets out the risks being faced by the MIJB, together with a current assessment on the level of the risks and mitigating actions being taken to reduce the impact of the risks. 3.3 Risk scores are weighted, based on assessment according to their likelihood and corresponding impact, as per Section 5 of the MIJB Risk Policy. 3.4 As agreed at Audit, Performance and Risk Committee 26 October 2023 (para 8 of the minute refers), amendment was approved to report on the Strategic Risk Register from quarterly to biannually unless any significant change is required to be informed to committee. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Risk Management Framework review was completed, and the outcome was approved by the Board on 25 June 2020 (para 9 of the minute refers). The approved Risk Appetite Statements have been included in Appendix 1. 4.2 The updated Strategic Risk Register reflects the comprehensive review and updates risks identified during the hybrid development session with Board members in October 2024. This session facilitated a collaborative approach to risk identification and assessment, ensuring that the register is robust and aligned with the current strategic priorities of the Board and operational realities of Health and Social Care Moray (HSCM). 4.3 Board members agreed a Risk Appetite Statement to support the Strategic Risk Register. The approved Risk Appetite Statements, included in Appendix 1, provide a structured approach to understanding and managing the levels of risk the Board is willing to accept in pursuit of its strategic objectives. These statements guide decision-making and risk mitigation strategies, balancing innovation and transformation with the need for regulatory compliance and service continuity. 4.4 The financial position of the Board poses significant complexity to service planning. The updated risk register highlights the financial pressures experienced by funding partners and their potential impact on strategic planning and decision-making. The MIJB must operate within the resources allocated by partner bodies, and it is essential to set a balanced budget at the start of each financial year. The risk register includes detailed assessments and mitigations to address these financial challenges. 4.5 The workforce strategy is critical to maintaining the quality of paid and unpaid Health and Social Care. The risk register identifies potential risks related to workforce strategy delivery, including recruitment difficulties, staffing instability, and the need for significant organisational transformation. Mitigations and current controls are outlined to address these challenges and ensure the sustainability of the workforce. 4.6 Effective governance and compliance with legislative and regulatory requirements are paramount. The risk register includes risks related to governance functionality, stakeholder engagement, and compliance with Page 68
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statutory obligations. Mitigations and assurances are provided to ensure robust governance structures and processes are in place. 4.7 The Board’s strategic aspirations must be sufficiently transformative to deliver sustainable outcomes for people. The risk register addresses the challenges of maintaining service delivery, including resource constraints, system pressures, and the need for service redesign. Mitigations focus on aligning financial decisions with strategic goals and implementing proactive risk strategies. 4.8 The Board must exert influence on services delegated but hosted within another organisation. The risk register includes risks related to systemic support service failures and resource allocation limitations. Mitigations involve collaborative approaches with partner organisations and regular oversight by the Board. 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” The MIJB requires effective governance arrangements for those services and functions delegated to it and Risk Management systems are integral to this. (b) Policy and Legal As set out in the terms of reference, the Board has responsibility to provide assurance of the adequacy of the risk management framework. There are no legal implications arising from this report. (c) Financial implications There are no direct financial implications arising from this report however the Board should note the failure to manage risks effectively could have a financial impact for the MIJB. (d) Risk Implications and Mitigation This report forms part of the governance arrangements for identifying and managing strategic risks of the MIJB. The risks are outlined in the body of the report in section 4. (e) Staffing Implications There are no additional staffing implications arising from this report. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required because there are no service, policy or organisational changes being proposed. However, Impact Assessments will be core to any decision making process. (h) Climate Change and Biodiversity Impacts Page 69
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There are no impacts arising from this report. (i) Directions None arising from this report. (j) Consultations Consultation on this report has taken place with the Board members, Chief Finance Officer and Senior Management Team. 6. CONCLUSION 6.1 The updated Strategic Risk Register provides a comprehensive overview of the current risks faced by the MIJB, along with detailed assessments and mitigation strategies. This update reflects the collaborative efforts of Board members and the Senior Management Team, ensuring alignment with strategic priorities and operational realities. 6.2 The Board is asked to consider and approve the updated register, reinforcing the commitment to effective risk management and governance. Author of Report: Sonya Duncan, Corporate Manager Background Papers: held by HSCM Ref: Page 70
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RISK SUMMARY – May 2025 APPENDIX 1 Risk Assessment Table – Multiply likelihood score by impact score to determine the risk rating (score). Risk No Risk Risk Owner Current Risk Rating Last Reviewed Position Change 1 There is a risk that the MIJB does not function as set out within the Integration Scheme, Strategic Plan and in-line with its Governance Framework and fails to deliver its objectives or expected outcomes. Chief Officer Contributor: Senior Leadership Team Medium 2 The MIJB must operate within the resources allocated to it by the partner bodies and it is good financial practice to set a balanced budget at the start of each financial year. There is a risk that Financial pressures being experienced by the funding partners will directly impact the MIJB’s strategic planning of services and its decision-making Chief Officer Contributor: Chief Finance Officer/ Heads of Service/ Chief Nurse Very High 3 There is a risk that the MIJB’s workforce strategy is not delivered, affecting the quality of paid and unpaid Health & Social Care. Chief Officer Contributor: Heads of Service/ Chief Nurse High 4 There is a risk that the MIJB is unable to operate effectively as a Public Body. Chief Officer Contributor: Corporate Manager/ Chief Finance Officer Medium 5 There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Chief Officer Contributor: Senior Leadership Team High 6 There is a risk that the MIJB’s strategic aspirations are not sufficiently transformative and as a result, that it is unable to deliver outcomes for people in a sustainable way. Chief Officer Contributor: Senior Leadership Team High Page 71
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7 There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Chief Officer Contributor: Heads of Service High Page 72
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Risk 1: There is a risk that the MIJB does not function as set out within the Integration Scheme, Strategic Plan and in-line with its Governance Framework and fails to deliver its objectives or expected outcomes. Consequence: Legal and Regulatory Implications, Reputational Damage, Loss of Stakeholder Trust, Resource Challenges, Service Disruption, Failure to deliver Health Outcomes Risk Rating: Medium Risk Appetite: Moderate-High Risk Movement: Rationale for Risk Appetite as reflected by MIJB in Appendix 2: • Strategic Priorities require innovative approaches to integration that may involve governance development • Outcomes depend on our ability to make timely decisions through efficient governance structures • The board recognises that complete risk aversion would prevent necessary transformation of services • A Moderate appetite allows for controlled governance exploration while maintaining core statutory compliance Rationale for Risk Rating: MIJB is committed to maintaining appropriate standards of care and governance through: • Proactive regulatory compliance • Robust operational policies • Adaptive approach to emerging healthcare challenges MIJB will only accept regulatory risks after: • Thorough consultation with regulatory bodies • Comprehensive risk assessment • Development of clear mitigation strategies • Ensuring minimal potential for service disruption Risk scoring before mitigations/controls Mitigations / Current controls in place Risk scoring after mitigations/controls 4 5 20 1. Integration Scheme is in place, reviewed *** 2. Consultation with legal representative for all reports to committees and attendance at committee for key reports. 3. Induction sessions are held for any new MIJB members. Conduct and Standards training held for MIJB Members in June 2022 and February 2024 provided by Legal Services. 4. Programme of Development Sessions held throughout the year with all MIJB members and 2 3 6 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 73
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Assurances: Audit, Performance and Risk Committee provides quarterly scrutiny of governance compliance with minutes to the Board. Internal Audit conducts reviews with formal recommendations and monitoring to APR Budget Savings Oversight Group monitors financial governance monthly with escalation pathways to SMT and MIJB. Service Reporting to Board for strategic decisions and updates. The Moray Transformation Board and Strategic Planning and Commissioning Group provides oversight of planned business across HSCM. Budget Savings Oversight Group on monthly basis. Monthly Tri-partite partnership performance meetings with partner CEOs, Finance Directors and Chair/Vice Chair of MIJB Care Inspectorate assessment of services, including governance impact on service delivery. Annual governance statement for external audit. Gaps in Assurance: The new strategic delivery plan will incorporate the work being taken forward across all areas of the MIJB’s Strategic Plan priorities. Mapping of the recently delegated services will take place to ensure the statutory governance requirements and those of MIJB are robust. Current Performance: The Scheme of Administration is reported when any changes are required. The Governance Framework was approved by MIJB on 28 January 2021. Re-appointment of Standards Officer agreed by MIJB 28 March 2024. Members Handbook updated and circulated to 100% of members in June 2022. Quarterly performance to APR including benchmarking and targets. All committees submitted required reports on schedule in 2024/25 100% of new members received induction on appointment Standards training was delivered to all members in **** 2024 Development sessions: 5 planned for 2025/26, 2 completed to date, with another scheduled for April 2025. Further Controls Required Further Controls Owner Full integration of Childrens, Families and Justice services to be realised CSWO 3/4/25 Ongoing development of the Strategic Delivery plan – draft presented to MIJB March 2025. CO 20/5/25 Review of MIJB Members Handbook Required Corporate Manager 31/10/25 MIJB Scheme of Integration Legal Advisor 31/12/25 Officers 5. Regular Senior Management Team (SMT) and Operational Management Team (OMT) meetings to provide direction and support to managers and teams, with agreed focus and priorities aligned to the Strategic Delivery Plan 6. Regular updates via OMT on Audit Plans Target Date Page 74
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Risk 2: The MIJB must operate within the resources allocated to it by the partner bodies and it is good financial practice to set a balanced budget at the start of each financial year. There is a risk that Financial pressures being experienced by the funding partners will directly impact the MIJB’s strategic planning of services and its decision-making Consequence: Inability to deliver strategic priorities, potential statutory service cuts. Reduced service capacity, financial instability, compromised care delivery Risk Rating: Very High Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: February 2025 Rationale for Risk Appetite (as detailed in Appendix 2) • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Rationale for Risk Rating: The Board’s financial risk management approach emphasises: • Absolute commitment to financial sustainability • Minimising wherever possible risk to essential service delivery • Protecting vulnerable persons using services Financial risks will only be tolerated when: • A comprehensive business case demonstrates clear, measureable benefits (i.e. spend to save initiatives) • The initiative directly supports long-term health and social care sustainability • Robust risk mitigation strategies are in place • Stakeholder consultation ensures transparency and collective understanding • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Unprecedented financial pressures on public sector funding: • Challenging economic environment • Rapidly increasing service demand Strategic financial principles and prioritisation: • Sustainable Financial Planning • Develop robust, realistic financial plans • Align budgets with long term sustainability • Focus on highest and best value initiatives • Align financial decisions with strategic goals Comprehensive Risk Mitigation: • Implement proactive financial risk strategies • Protect critical service delivery Page 76
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Stakeholder Engagement: • Transparent financial communication • Collaborative decision making processes • MIJB Board Members Development Sessions Assurances: Quarterly Budget monitoring reporting to APR and MIJB Financial Reporting through MIJB, NHS Grampian and Moray Council The Project Management Office will support the Financial Recovery Savings presented as part of the budget setting for 2025/26. Financial Development Sessions with MIJB members. Internal Audit quarterly reporting to APR External Audits presented to MIJB/ Committees as appropriate. Six weekly Tri-partite partnership performance meetings with partner CEOs, Finance Directors and regular meetings with the Chair/Vice Chair of MIJB Gaps in Assurance: Senior Management Team (SMT) is working to identify capacity within the current workforce to support the planning, consultation and implementation required to deliver the financial savings. Many of the identified benefits may improve system processes or potentially improve outcomes but do not realise actual cash savings. Increased financial pressure due to partial funding of rising costs of Employer National Insurance Contributions. Regular reporting on MIJB Strategic Delivery Plan. Current Performance: The Revenue Budget Outturn for 2025/26 was presented with a balanced budget and agreed by MIJB on 27 March 2025 A Financial Savings Plan for 2025/26 was agreed by MIJB on 27 March 2025. Comments: Further Controls Required Further Controls Owner Target Date MIJB to receive final Strategic Delivery Plan May 2025. CO May 2025 APR committee to receive biannual updates on Strategic Delivery Plan September 2025 CO September 2025 Review Date Review Notes / Decisions Managing the risk - Current controls in place 5 5 25 1. Medium Term Financial Framework (MTFF) approved by MIJB on 30th March 2025. 2. Additional resource to support services a Programme Management Office agreed until September 2025. 3. Tri-partite partnership performance meetings with partner CEOs, Finance Directors and Chair/Vice Chair of MIJB. 4. Operational financial monitoring undertaken by Chief Finance Officer (CFO), Heads of Service (HOS) and Budget Managers. 5. Budget Savings Oversight Group chaired by Chief Officer, attended by HOS, CFO and Service Managers as appropriate. 6. Review of MIJB Strategic Delivery Plan ensuring all projects are aligned with savings plans. 4 5 20 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 77
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Risk 3: There is a risk that the MIJB’s workforce strategy is not delivered impacting the quality of paid and unpaid Health & Social Care. Consequence: Service disruption and reduced capacity, Increased Workload and staff burnout, Significant Financial impact, Deteriorating Staff and Unpaid Carers Morale and Engagement, Compromised Patient Safety and Care Quality, Negative Public Perception and Reputation Damage Risk Rating: High Risk Appetite: Moderate (as per Appendix 2) Risk Movement: - Historical Risk Rating: - Rationale for Risk Appetite (as detailed in Appendix 2) MIJB will only accept minimal risk to service users, unpaid carers or staff when the comparative risk of doing nothing is higher than the risk of intervention. Safety risks inherent in Health and Social care services demand exceptional management and clinical care standards. The Board recognises that: • Individual safety is paramount • Person-centred care involves supporting informed decision-making, which may introduce nuanced risk scenarios A balanced approach is critical, considering both individual and community safety risks Rationale for Risk Rating: Recruitment Difficulties: • Persistent challenges in recruiting skilled professionals in critical areas: o Allied Health Professions o Social Work o Dental Services Pandemic-Induced Complications: • Reduced graduate numbers due to Covid-19 disruptions • Ongoing strain on partnership resources across frontline and support functions • Staffing Instability • High proportion of fixed term and seconded contracts due to financial constraints • Potential workforce instability as temporary contracts conclude • Need for significant organisational transformation • High proportion of an aging workforce by NHSG and MC is increasing with more staff opting to retire early or requests for reduced working hours. Geographical and Structural Barriers: • Lack of suitable housing for healthcare professionals in Moray • Challenges in Care Homes recruitment and retention Strategic Workforce Transformation: • Capacity constraints in delivering financial recovery initiatives • Potential requirement for internal role allocation • Alignment needed between workforce strategy and financial sustainability National Context: • Ongoing GP sustainability challenges Managing the risk - Current controls in place Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 78
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Assurances: • Operational oversight by Moray Workforce Forum. • The HSCM Response Group continues to focus on leadership around emerging issues and resolving them, including staffing. Gaps in Assurance: • Further capacity will be required to develop and implement workforce plans to reflect updated delivery plans to reflect the financial savings required. • Due to the various scrutiny of vacancies, there continues to be a delay in recruitment processes often taking in excess of 8 weeks, which causes additional pressure on staff and service delivery. • There is often a lack of suitable applicants for various posts, which affects the ability to appoint to some roles. • Work is required to develop and include support to the large workforce of unpaid carers within Moray as outlined in the Carers Strategy Current Performance: Due to ongoing financial position all vacancies are considered by the Resource Management Group (RMG) before being considered for external advertisement. Comments: Staffing issues are monitored by the Operational Management Team (OMT) working collaboratively to seek opportunities to make jobs more attractive where it has proven difficult to recruit in the past. There is the risk that staff move from one position to another within HSCM, as in unintended consequence creating a vacancy elsewhere in the system. This needs to be considered when fixed term contracts and secondments are planned; consideration needs to be given to the whole of HSCM and not services in isolation. Many of our staff may have transferrable skills and experience. 5 5 25 1. Management structure currently under review. 2. Moray Council are aware of the housing issues and are conducting an assessment of needs, including people working in the Health and Care sector. 3. Staff wellbeing is a key focus and there are many initiatives across both parent organisations offering information, support and access to activities. 4. Collaborative approaches with educational institutions e.g. intakes and programmes for future workforce development. 5. Professional Development and retention programmes; Incentives have been secured to attract additional NHS dentists and dental practices to Moray. The Scottish Dental Access Initiative includes Moray, with grants of £50,000 and above available to allow dental practices to be established or extended– provided there is a seven- year commitment to providing NHS treatment. A recruitment and retention bonus is also being offered to eligible new dentists in Moray 6. GP sustainability Group and Primary Care Vison for the Future Groups now progressing across Grampian. 7. iMatter reports are used to develop actions plans for teams. 3 4 12 Page 79
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Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions Page 80
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Risk 4: Inability to demonstrate effective governance and effective communication and engagement with stakeholders. Consequence: Suboptimal outcomes for people, Erosion of organisational trust and credibility, Increased legal and regulatory compliance risks Workforce demotivation and disengagement, missed strategic opportunities and collaborative potential, reduced organisational responsiveness and adaptability Risk Rating: Medium Risk Appetite: Low-Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: - Rationale for Risk Appetite (as detailed in Appendix 2) The Board acknowledges the critical importance of: • Robust stakeholder relationships • Effective collaboration and co-production • Adaptive partnership working • Recognising diverse stakeholder capacities and readiness for change Strategic principles guiding stakeholder engagement: • Maintaining constructive, transparent relationships • Balancing organisational objectives with collaborative dynamics • Ensuring inclusive and meaningful engagement processes • Protecting long-term partnership sustainability Continous Improvement in communication processes Rationale for Risk Rating: Comprehensive Governance and Engagement Challenges: Stakeholder Feedback and Engagement Gaps • Potential weaknesses in: o Communication clarity issues o Engagement process inefficiencies o Unclear outcome expectations o Perceived disconnect between organisational intentions and practical implementation o Cost of living and digital exclusion are potentially additional barriers for engagement Governance and Communication Structural Challenges • Potential weaknesses in: o Interdepartmental communication channels – staff communications across two different parent organisations o Stakeholder consultation mechanisms o Transparent reporting and accountability processes o Strategic alignment communication Collaborative Partnership Dynamics o Varied stakeholder readiness and capacity for change o Potential misalignment of expectations o Complex interdependencies across different organisational contexts Risk of Disengagement • Inadequate communication may lead to: o Reduced stakeholder trust o Diminished collaborative potential Page 81
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Increased resistance to organisational initiatives Assurances: • Oversight and scrutiny by Clinical and Care Governance Committee, Audit Performance and Risk Committee and MIJB • Strategic Planning & Commissing Group (SPCG) • MIJB Audit, Performance and Risk Committee • 3rd Sector and Stakeholder Representatives on MIJB and committees • Local Outcome Improvement Plan (LOIP). • Community Planning • ADP • Locality Reporting to MIJB • Primary Care Visioning Patient Stakeholder Group (check with Robert) • Summary reports of MIJB submitted to Moray Council and NHSG committees Gaps in Assurance: • MIJB to consider Young Persons representatives in 2025 • Seek to improve the level of engagement across Moray • Communication and Engagement Strategy was approved in 2019 and requires updating. • More systematic approach to stakeholder consultation required. • Establish a more robust process for youth representation Current Performance: • SPCG meets quarterly • Locality Plans are being reviewed alongside the revision of the strategic delivery plan • LOIP plans linked to MIJB Strategic Plan • Annual Performance Report for 2023/24 published in September 2024. • Community engagement in place for key projects areas such as Forres, Keith and Lossiemouth with information made available to stakeholders and the wider public via HSCM website. Comments: • A communication cell is now established as part of the Local Resilience Managing the risk - Current controls in place • Strategic Planning & Commissioning Group (SPCG) now operational to support locality engagement. • Continued working with Community Planning colleagues to oversee the development of locality planning. • Commencement of a Grampian Joint Strategic Needs Assessment Group, including participation from community groups. • Engagement with diverse groups across Moray e.g. Alcohol & Drug Partnership, School Nurses, Moray Maternity (check name) • Continued development of HSCM/MIJB webpages and Facebook • ‘Planning with People’ principles adopted as per Healthcare Improvement Scotland (HIS) Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 82
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Partnership response with representation from Emergency Services, Councils, HSCP and NHSG. This forum provides assurance that messages to all stakeholders are consistent. • Early conversations are planned to discuss a Grampian partnership communications group to ensure consistent messaging regards service redesign and changes, ensuring a consistent message to all citizens of Grampian, in particular for area wide changes. Further Controls Required Further Controls Owner Target Date Update Communication and Engagement Strategy Improve Stakeholder Consultation Review Date Review Notes / Decisions Page 83
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Risk 5: There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Consequence: Significant service disruption and operational instability, critical resource allocation challenges, substantial financial and operational strain, increased vulnerability for citizens and staff, potential compromise of statutory Category One Response obligations, reduced organisational resilience Risk Rating: High Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Rationale for Risk Appetite (as detailed in Appendix 2) The MIJB has minimal tolerance of harm happening to people as a result of its actions, recognising the need to balance the risk of doing nothing and the risk of action or intervention. The Moray Integration Joint Board (MIJB) recognises the statutory obligations under the Civil Contingencies Act 2004, including Category 1 Responder responsibilities (since March 2021) Rationale for Risk Rating: Performance Indicators: There are a variety of performance standards set both by national and regulatory bodies as well as those determined locally and there are a range of factors which may impact on service performance against these. Poor performance will in turn impact both on the outcomes for service users and on the reputation of the MIJB/partnership. Given current situation with increased demand and staffing pressures there might be times that the likelihood of services not meeting standards is possible. Critical performance standards are monitored across regulatory, national and local frameworks to ensure service quality and statutory compliance. Some of the key risk areas include: 1. Service Delivery 2. Quality Metrics 3. Resource Management 4. Equality and Impact Assessments 5. Civil Contingencies Category 1 Responder status Managing the risk - Current controls in place 5 5 25 1. NHS Grampian Resilience Standards Action Plan approved (3 year). New standards are being drafted by Scottish Government and these are expected in 2025 and will replace the current standards. 2. Continuous emergency preparedness awareness with partners under GLRP – including exercises and debriefs. 3. Learning from Inspection Reports, Adverse Events, Complaints – actions plans and performance measures monitored by OMT with oversight by SMT. 4. HSCM Civil Contingencies group review specific risks and 4 3 12 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 84
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Assurances: • Quarterly reporting to Clinical and Care Governance and Audit, Performance and Risk Committees • Annual Performance Report – published September 2024 • Chief Social Work Officers Report • Internal and External Audits • Senior Management Meetings fortnightly • Joint meeting of MIJB Chief Officer with two Partner Body Chief Executives. • Annual report on MIJB activity developed and reported to Moray Council and NHSG • All Inspection reports reported to APR Committee with action plans developed and monitored Gaps in Assurance: Due to current financial constraints – staffing/oversight Business Continuity (BC) Planning – work is underway to ensure HSCM has a register of all plans and timescales – to be monitored by OMT and escalations to SMT. MIJB does not have an emergency planner or subject matter expert. Current Performance: Critical inpatient facilities have BC plans. Annual Performance Report for 2023/24 was approved by the MIJB on the 30 November 2024 The ‘Care for People’ strategic document was approved by HSCM SLT and CMT and presented to MIJB in September 2023. A further delivery response plan was presented to MIJB in November 2023. The strategic document is currently under review. Senior Managers on the SMoC rota have and continue to be encouraged to undertake ‘Strategic Leadership in a Crisis’ training since 2020. All Category One Responder duties covered by Corporate Manager. Comments: Restructure of HSCM to mitigate the governance risk of services not meeting standards and adequate service delivery The replacement of the Care First database is crucial to the development of an improved PARD process. The Manchester Arena and Grenfell Inquiry has resulted in a focus on Category 1 responders’ responsibilities, together with an increase of additional policies/procedures to be developed, implemented and exercised with no additional resource. MIJB does not have a subject matter expert. Further Controls Required Further Controls Owner Target Date Transformation of On Call to ensure sufficient cover of all services – in progress. Heads of Service 30/6/25 Business Continuity Planning Corporate Manager October 2025 Review Date Review Notes / Decisions Risk 6: There is a risk that the MIJB’s strategic aspirations are not transformative and as a result, we are unable to deliver outcomes for people in a sustainable way. action plans to mitigate, developing plans and testing arrangements in partnership with NHSG and Council. 5. Annual review of internal resilience and emergency processes with Senior Managers on Call. Page 85
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Consequence: Persistent health inequalities, erosion of public trust and organisational reputation, potential legal challenges, significant reputational damage to MIJB, potential long-term negative impacts on community health outcomes, reduced effectiveness of healthcare resource allocation Risk Rating: High Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Rationale for Risk Appetite (as detailed in Appendix 2) The Moray Integration Joint Board (MIJB) faces significant challenges in maintaining service delivery across its delegated services from NHS Grampian and Moray Council. These challenges stem from three key areas: Resource Constraints Budgetary pressures are leading to reduced staffing resources, affecting service delivery capacity and quality. This situation requires careful management to maintain essential services while operating within financial constraints. System Pressures The healthcare system continues to experience significant strain from high levels of unplanned admissions and delayed discharges. While teams across the care pathway are working collaboratively to address these issues, the complexity of the situation, combined with limited community care availability, makes sustainable improvement challenging. Service Redesign The financial recovery plan necessitates fundamental service redesign to deliver outcomes more efficiently. While the aim is to enhance service quality through these changes, public expectations may need to adjust to align with what is deliverable within budget constraints. This requires careful management of both service transformation and stakeholder expectations. The Moray Integration Joint Board (MIJB) is committed to: • Maintaining exemplary standards of governance • Balancing innovative approaches with robust regulatory compliance • Proactively managing emerging risks in a dynamic healthcare landscape • Prioritisation of Moray’s unique community needs Regulatory risks will only be considered with: 1. Comprehensive consultation with relevant regulatory bodies 2. Clearly defined and documented defensible risk mitigation strategies 3. Transparent decision-making processes 4. Thorough impact assessments MIJB will only take regulatory risks knowingly, following consultation with the relevant regulatory body and where we have clear risk mitigation in place. Potential impacts to the wide range of services in NHS Grampian and Moray Council commissioned by the MIJB arising from reductions in available staff resources as budgetary constraints impact. Unplanned admissions and delayed discharges place additional cost and capacity burdens on the service. The level of delayed discharges has remained challenging, reflecting the sustained pressure in the system and the lack of availability of care in the Page 86
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community. There are sustained focussed and collective efforts by all those working in the pathway. However, this is a complex area and will require continued effort to realise reductions and maintain them. The financial recovery plan will require some service redesign to meet outcomes in alternative ways. It is hoped that this will always provide an improved service but it must be recognised that public expectations may differ to what can be delivered within budget. The Moray Integration Joint Board (MIJB) faces significant challenges in maintaining service delivery across its commissioned services from NHS Grampian and Moray Council. Rationale for Risk Rating: Contributing Factors: • Systemic resource constraints across internal and external services • Complex regulatory environment • Increasing expectations from external inspection bodies • Rapid evolution of healthcare delivery models • Predicted demographic changes • Financial Challenges, including cost of living • Increasing demand and staffing challenges are likely to impact transformational projects and plans Mitigating Strategies: • Regular compliance audits • Continuous staff training on regulatory requirements • Robust documentation and decision-making frameworks • Proactive engagement with regulatory bodies • Risk reassessment Resources are stretched thin across all services, both internal and external, which may result in the inability to meet expected standards despite the best efforts of everyone involved. Managing the risk - Current controls in place 1. Clinical and Care Governance (CCG) Committee. Clinical Risk Management and Practice Governance group has oversight of their respective professional standards and links into Clinical and Care Governance Group, which escalates to CCG Committee as necessary. 2. High and Very High operational health service risks are reviewed by HSCM Clinical Risk Management (CRM) Group and also NHS Grampian CRM Group. 3. Annual Performance Reports 4. Internal and External Audit 5. Internal/External Inspection reports are scrutinised by appropriate operational groups and by exception to SLT for subsequent reporting to CCG or APR Committee as appropriate. 6. Care Home Collaborative Support Group meets to Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 87
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Assurances: Audit, Performance and Risk and Clinical and Care Governance Sub- Committees oversight and scrutiny. The Clinical and Care Governance Framework was refreshed and presented to CCG Committee in November 2023. Gaps in Assurance: Process for highlighting recurring themes or strategic expectations from external inspections requires further development to ensure Committee has sight of significant issues. Current Performance: External inspection reports are scrutinised and actions arising are allocated to responsible officers. A summary of inspections is included in the Annual Performance report. Risk Management session delivered for managers in HSCM in September 2023, by the NHSG Risk Advisor. Work is ongoing to update the Strategic Delivery Plan, reflecting the impacts of the ongoing financial challenges. Comments: No major concerns identified for HSCM services in any audits or inspections during 2023/24. Learning points from Healthcare Improvement Scotland of Dr Gray’s Hospital shared across nursing services in Moray. An inspection of Childrens Services commenced in August 2023, the final report was presented to the board and a Service Improvement plan commenced and reported to APR on a quarterly cycle. The current financial pressures will impact HSCM’s ability to deliver on the priorities set out in the strategic plan and requires a level of transformation to match this. Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions oversee and manage risks in care homes. 7. Children and Adult Protection services report to their respective committees. 8. Governance Structure and Process (Senior Leadership Team meetings, Operational Team Meetings, Daily Huddles) Page 88
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Risk 7: There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Consequence: Legal challenge from Moray citizens and staff, potential intervention or censure from Scottish Government, systemic service failures, particularly in areas such as IT, Human Resources, Legal and compliance services Risk Rating: High Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Rationale for Risk Appetite (as detailed in Appendix 2) Extremely low tolerance for: • Systemic support service failures • Potential compromise of organisational effectiveness • Risk of legal and regulatory non-compliance • Diminished service delivery capacity Low tolerance in relation to not meeting requirements. Rationale for Risk Rating: Parent organizations experiencing: • Significant financial constraints • Staffing challenges • Potential resource allocation limitations The projected overspend in hosted services sits within each MIJB and HSCM is one of the partners who can influence decisions. Assurances: These largely come from the systems, process and procedures put in place by NHS Grampian, which are still being operated, along with any new processes which are put in place by the lead MIJB. North East System Wide Transformation Group (Officers only) led by the 4 pan- Grampian chief executives. The aim of the group is to develop real top-level leadership to drive forward the change agenda, especially relating to the delegated hospital-based services. Both the CEO group and the Chairs & Vice Chairs group meet quarterly. The meetings are evenly staggered between groups, giving some six weeks between them, allowing progressive work / iterative work to be timely between the forums. The Portfolio approach and wider system approach demonstrates closer joint working across the 3 Health and Social Care Partnerships and the Acute Sector. Gaps in Assurance: Ongoing implementation of internal audit recommendations. Managing the risk - Current controls in place 5 4 20 1. Chief Officer regularly meets with Chief Officers of Aberdeen City Health and Social Care Partnership and Aberdeenshire Health and Social Care Partnership. 2. Significant changes to service delivery are discussed across all three HSCP’s 3. Agreement that proposals regards significant service changes are presented to all three MIJB’s for approval. 4. Internal Audit of MIJB Hosted Services 3 5 15 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 89
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Current Performance: Officers are currently implementing the recommendations from the Audit on Hosted Services. Standardised service templates have been implemented and sent to all hosted services and information is being gathered in preparation to presenting proposals to the Chief Officers, MIJB’s and NHS Grampian. Comments: Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions Page 90
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MIJB Risk Appetite Statement The Moray MIJB recognizes that effective risk management is fundamental to achieving its strategic objectives in delivering integrated health and social care services. This statement defines the level and type of risk the MIJB is willing to accept in pursuit of achieving the outcomes defined in the strategic plan, Partners in Care 2022-2032. Moray MIJB adopts a balanced approach to risk-taking, acknowledging that transformation, innovation and service improvement often require managed risk-taking while ensuring the safety and wellbeing of its staff and the public remains paramount. Strategic Risk: MODERATE-HIGH • Higher appetite for strategic initiatives supporting integration • Willingness to innovate in service delivery • Acceptance of calculated risks in pursuit of transformation • Support for pilot projects with clear business case and evaluation criteria At this appetite level, the board is willing to accept some uncertainty in governance processes where: - Clear oversight mechanisms remain in place - Core statutory obligations continue to be met - Potential benefits to service delivery are significant - Learning opportunities from governance adjustments can be captured Financial Risk: MODERATE • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Clinical Safety Risk: LOW • Minimal appetite for risks affecting patient/service user safety • Strong controls and monitoring required for all clinical activities • Zero tolerance for non-compliance with clinical governance standards • Comprehensive risk assessments required for any service changes • Operational Risk: MODERATE • Moderate tolerance for operational changes that improve efficiency • Willing to consider new service delivery models • Acceptance of short-term disruption for long-term benefits • Regular monitoring and review of operational changes Reputational Risk: LOW-MODERATE • Conservative approach to actions that could damage public trust • Proactive stakeholder engagement in major decisions • Low tolerance for activities that could undermine partnership working • Emphasis on transparent decision-making Page 91
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Workforce Risk: MODERATE • Moderate appetite for workforce development initiatives • Innovation in recruitment and retention strategies • Support for new ways of working • Low tolerance for risks affecting staff wellbeing Risk Governance • Regular review of risk appetite by the MIJB Board • Clear escalation procedures for risks exceeding appetite levels • Integration of risk appetite into decision-making processes • Regular reporting on risk profile against appetite Implementation • Risk appetite to be considered in all significant decisions • Regular training for staff on risk management • Clear communication of risk appetite across the organization • Annual review and update of risk appetite statement Monitoring and Review • Bi-annual review of risk register against appetite levels • Annual review of risk appetite statement • Regular reporting to Audit and Risk Committee • Adjustment of appetite levels based on changing context This statement will be reviewed annually and updated as required to reflect changes in the operating environment and strategic priorities. Page 92
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Likelihood – What is the likelihood of the risk occurring? Assess using the criteria below. Rare (1) Unlikely (2) Possible (3) Likely (4) Almost Certain (5) Don’t believe this event would happen Will only happen in exceptional circumstances Not expected to happen but definite potential exists Unlikely to occur May occur occasionally Has happened before on occasions Reasonable chance of occurring Strong possibility that this could occur Likely to occur This is expected to occur frequently/ in most circumstances more likely to occur than not Impact – What could happen if the risk occurred? Assess for each category and use the highest score identified. The impact scale is from an organisational level perspective. It reflects the key areas that if impacted could prevent the organisation achieving its priorities and objectives. The scale is a guide and cannot cover every type of impact therefore judgement is required. Category Negligible (1) Minor (2) Moderate (3) Major (4) Extreme (5) Patient or Service user Experience Reduced quality patient experience/clinical outcome not directly related to delivery of clinical care Unsatisfactory patient experience/clinical outcome directly related to care provision – readily resolvable Unsatisfactory patient experience/ clinical outcome, short term effects – expect recovery less than 1wk Unsatisfactory patient experience /clinical outcome, long term effects - expect recovery over more than 1week Unsatisfactory patient experience/clinical outcome, continued ongoing long term effects Objectives/ Project Barely noticeable reduction in scope/quality/ schedule Minor reduction in scope/quality/schedule Reduction in scope/quality/project objectives or schedule Significant project overrun Inability to meet project/corporate objectives, reputation of organisation seriously damaged Injury /illness (physical and psychological) to Adverse event leading to minor injury not Minor injury or illness, first aid treatment required Agency reportable, e.g. Police (violent and aggressive acts) Major injuries/long term incapacity /disability (e.g. loss of limb), Incident leading to death(s) or major permanent incapacity Page 93
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patient/service user/visitor/staff/carer requiring first aid Significant injury requiring medical treatment and/or counselling requiring, medical treatment and/or counselling Complaints/Claims Locally resolved verbal complaint Justified written complaint peripheral to clinical care Justified complaint involving lack of appropriate care Claim above excess level. Multiple justified complaints Multiple claims or single major claim Complex Justified complaint Service/ Business Interruption Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide service Short term disruption to service with minor impact on patient care/service provision Some disruption in service with unacceptable impact on patient care Temporary loss of ability to provide Service. Sustained loss of service which has serious impact on delivery of patient care resulting in major contingency plans being invoked Permanent loss of core service/ facility Disruption to facility leading to significant “knock on” effect -- to function Staffing and Competence Short term low staffing level temporarily reduces service quality (less than 1 day) Short term low staffing level (>1 day), where there is no disruption to patient care Ongoing low staffing level reduces service quality Minor error due to lack of/ ineffective training/ implementation of training Late delivery of key objective/service /care due to lack of staff Moderate error due to lack of/ ineffective training / implementation of training Ongoing problems with staffing levels Uncertain delivery of key objective/service/care due to lack of staff Major error due to lack of/ ineffective training / implementation of training Non-delivery of key objective/ service/care due to lack of staff. Loss of key staff Critical error due to lack of/ ineffective training/ implementation of training Financial (including Damage/Loss/Theft/ Fraud Negligible organisational/ personal financial loss up to £1k Minor organisational/ personal financial loss of £1-10K Significant organisational/personal financial loss of £10- 100k Major organisational/personal financial loss of £100k- 1m) Severe organisational financial loss of more than £1m Page 94
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Inspection/ Audit Small number of recommendations which focus on minor quality improvement issues Recommendations made which can be addressed by low level of management action Challenging recommendations that can be addressed with appropriate action plan Improvement Notice Enforcement/prohibition action Low Rating Critical report Prosecution Zero rating Severely critical report Adverse Publicity/ Reputation Rumours, no media coverage Little effect on staff morale Local media coverage – short term. Some public embarrassment Minor effect on staff morale/public attitudes Local media – long term adverse publicity Significant effect on staff morale/public perception of the organisation National media adverse publicity less than 3 days Public confidence in the organisation undermined Use of services affected National/International media/ adverse publicity, more than 3 days MSP/MP/SEHD concern (Questions in Parliament) Court Enforcement/Public Enquiry/FAI Risk Scoring Consequences/Impact Likelihood Negligible Minor Moderate Major Extreme Almost Certain Medium High High V High V High Likely Medium Medium High High V High Possible Low Medium Medium High High Unlikely Low Medium Medium Medium High Rare Low Low Low Medium Medium Review Timescales – When a risk rating has been assigned the criteria below should be used to assess the review timescales. Very High or High Requires monthly monitoring and updates. Medium Requires quarterly monitoring and updates. Low Requires 6 monthly monitoring and updates. Page 95
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 2025 SUBJECT: MORAY ADULT MENTAL HEALTH STRATEGIC GROUP PROGRESS REPORT BY: DEPUTY HEAD OF SERVICE AND CONSULTANT IN PUBLIC HEALTH 1. REASON FOR REPORT 1.1 To provide the Board with assurance on progress towards delivery of the Moray Mental Health and Wellbeing Strategy 2016 - 2026. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) note the progress towards achievement of the Moray Mental Health and Wellbeing Strategy 2016 – 2026; ii) endorse the updated Moray Mental Health and Wellbeing Strategy Delivery Plan 2024 – 2026 (Appendix 1); and iii) discuss and endorse the Moray Mental Health and Wellbeing Strategic Performance Framework (Appendix 3). 3. BACKGROUND 3.1 At the MIJB Development Session on 26 October 2023, discussion took place regarding the Moray Mental Health and Wellbeing Strategy and associated Moray mental health pathways. A report was subsequently submitted to the Board on 28 March 2024 describing the mapping work that was due to take place with regard to Moray Mental Health Services (para 10 of minute refers). A further, more detailed, report was requested. 3.2 Three Moray Adult Mental Health Service development sessions then took place, the detail from which formed the basis of a report which was presented to the Board on the 26 September 2024 (para 13 of minute refers). The report included a Delivery Plan which would underpin the work required to progress the Moray Mental Health and Wellbeing Strategy 2016 – 2026. The MIJB approved all recommendations and requested six monthly progress reports. Item 10. Page 97
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3.3 The Moray Adult Mental Health Strategic Group subsequently met on a monthly basis to facilitate progress of the Delivery Plan. All key stakeholders have engaged to ensure a whole system approach is taken, with a focus from early intervention and prevention through to secondary Care. 3.4 The chairpersons of the Moray Adult Mental Health and Wellbeing Strategic group are members of the Grampian Cross System Strategic Delivery Team (CSSDT) and the Grampian Mental Health and Learning Disability Board (MHLD Board) thus ensuring good governance and a synergy of the work taking place in Moray with that of Grampian and nationally. 3.5 Scotland is currently facing a growing mental health crisis, with challenges including rising demand for services, increased complexity of cases, and persistent inequalities in access and support. While there is a focus on developing and expanding services, significant workforce challenges, and funding shortfalls continue to hinder progress. Many of these challenges are amplified in Moray due to the rural nature of many of our communities, difficulties in the recruitment and retention of staff, and access to specialist tertiary services. 3.6 The Moray Adult Mental Health and Wellbeing Strategic group aim to ensure that the collective voice of lived and living experience influences the way that we design services and responses to address the challenges facing individuals and families affected by mental health in Moray. The group work closely with Moray Wellbeing Hub, Making Recovery Real Partnership and tsiMoray to achieve this; for example, the involvement of lived experience in service development, commissioning, implementation and evaluation of the recently commissioned SAMH projects. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Moray Mental Health and Wellbeing Delivery Plan 2024 – 2026 is included in Appendix 1. The Delivery Plan is laid out in 6 sections: • Early intervention, prevention and self-management • Mental Health Quality Standard 1: Access • Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support Mental Health Quality Standard 3: Moving between and out of services • Mental Health Quality Standard 4: Workforce • Mental Health Quality Standard 5: Governance & accountability 4.2 The Delivery Plan has evolved over the past 6 months with some of the original desired outcomes being merged and a small number of additional desired outcomes being added. The Delivery plan includes some brief comments on progress. Examples of this include: • Increase in community/third sector provision through the utilisation of the Community Mental Health Funding • Increase in public awareness and practitioner knowledge of suicide prevention through a wide range of community/capacity building events • Adaptation of the role of the community based Mental Health and Wellbeing Practitioners to better align with the Primary Care pathway Page 98
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• Broadening the spectrum of referral routes into the SAMH Distress Brief Intervention and Intensive Support projects to strengthen the ‘no wrong door’ approach • The establishment of a daily huddle for all Moray secondary care mental health services which aligns with wider Moray and Grampian huddles thus allowing escalation and offers of assistance as required Progress on some key areas has been outlined in greater detail in Appendix 2. 4.3 The Moray Mental Health Strategic Performance Framework, included in Appendix 3, has been developed to sit alongside the Moray Mental Health and Wellbeing Delivery Plan 2024 – 2026. Data on key performance indictors is being collated, bench-marked and referenced against the mental health and wellbeing standards. The performance framework will provide the Moray Adult Mental Health Strategic group and the Board with longitudinal performance data, both quantitative and qualitative, to demonstrate outcomes and impact. Case studies and personal stories will form part of this framework and will articulate the progress and challenges from an individual/patient perspective. 4.4 The principles underpinning Getting it Right for Everyone (GIRFE) emphasise a person-centred approach, focusing on individual needs and experiences. This includes ensuring individuals have information to make decisions, are listened to and understood, and treated with dignity and respect. We aim to embed these principles across all mental health services and policies to ensure a consistent and holistic approach to mental health support. All newly commissioned services will be required to reference how they will adhere to the GIRFE principles, and all new or updated policies will link to GIRFE. An example of this in practice is the change in delivery of the Healthpoint service to oversee the delivery of a Moray wide social prescribing model at the centre of which is the GIRFE community connector role. 4.5 Health and Social Care Moray and NHS Grampian staff continue to work closely with the Mental Welfare Commission, Health Improvement Scotland, and other national organisations to improve practice through specific case reviews, shared reflection, and inspections of wider service provision. Updates are reported periodically to Moray Adult Mental Health Strategic Group to ensure the learning informs discussions and service design. 4.6 The alignment of Children’s Services and Adults Services mental health strategic planning and delivery is essential. Within Moray there is currently a Children’s Mental Health and Wellbeing Partnership and there is the Moray Mental Health and Wellbeing Strategic Group. There is a degree of cross representation between both groups to ensure shared planning however, there remains the medium term vision for there to be a single strategic group for children and adult mental health services in Moray. 4.7 There remain significant challenges in delivering the Moray Mental Health and Wellbeing Strategy 2016 – 2026 due to: • Financial pressures • Recruitment and retention of staff in public, private and third sector • Capacity to lead the changes required whilst sustaining management and delivery of clinical services • Availability of good quality and timely dataPage 99
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• Supporting increased and meaningful inclusion of lived and living experience for service design and delivery Work has begun to overcome these challenges by ensuring: • Strong leadership at all levels • Having a clear vision and delivery plan for mental health services in Moray • Working closely with third sector and community partners • Developing an evidence based, and trauma informed approach • Supporting staff wellbeing and development • Good communication and engagement with public and staff 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” The approach set out in this report is consistent with the MIJB Strategic Plan. (b) Policy and Legal There are no implications for policy or legal. (c) Financial implications None at present; however, delivery of the plan may require some reprioritisation or shifting of resource. (d) Risk Implications and Mitigation Risks are recorded on the Health and Social Care Moray Risk Register; actions plans are in place and are routinely monitored. (e) Staffing Implications None arising directly from this report. (f) Property There are no implications on property provision. (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 from this report. (j) Consultations The following people were consulted during the writing of this report: Elidh Brown – Partnership Development Lead, tsiMoray Sean Coady, Head of Service, Health and Social Care Moray Bruce Davidson – Clinical Lead and Consultant Psychiatrist in Adult Mental Health and Addictions Page 100
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Lynne Clark - Service Manager, Moray Mental Health and Drug and Alcohol Services Tracy Grant – Service Manager, SAMH Justin Jansen – ADP Coordinator, Moray Alcohol and Drug Partnership Emma Johnston – Public Protection Lead Officer, Moray Public Protection Team Corrine Lackie, Lead Nurse, Mental Health and Substance Misuse Service, Moray Robert Lockhart – GP Clinical Lead for Moray Karim Mahmoud – Innovation Lead, DHI Lindsay Nelson – Improvement Officer Mental Wellbeing, Children’s Services Partnership Kirsteen Pyett – Social Work Team Manager, Mental Health Liz Russell - Trauma Informed Practice Development Officer, Children & Families and Criminal Justice Social Work Bridget Stone - Consultant Practitioner Adults with Incapacity and Mental Health Lead Heidi Tweedie – Champion and Director, Moray Wellbeing Hub Chris Wiles – Consultant Clinical Psychologist, CAMHS Tracie Wills – Senior Commissioning Officer Lizette Van Zyl – Service Manager, Policy Development and Commissioning 6. CONCLUSION 6.1 The Board are asked to note the updated Mental Health Service Delivery Plan 2024-26 and note the Moray Mental Health and Wellbeing Strategy Outcomes Framework. Author of Report: Iain Macdonald: Deputy Head of Service Elizabeth Robinson: Consultant in Public Health Background Papers: 1. Good Mental Health for all in Moray 2016-2026 2. 20240530 FINAL General Adult Mental Health Secondary Care Pathway Review Report (cmis.uk.com) 3. Mental health and wellbeing strategy - gov.scot (www.gov.scot) 4. Mental health and wellbeing strategy: delivery plan 2023-2025 - gov.scot (www.gov.scot) 5. Core Mental Health Quality Standards (www.gov.scot) 6. Mental health and wellbeing in primary care services: planning guidance 7. Resources for Mental Health and Wellbeing in Primary Care Services (www.gov.scot) 8. Primary care - mental health and wellbeing: outcomes and measures - gov.scot (www.gov.scot) 9. Mental Health and Wellbeing in Primary Care Services Logic Model 10. Report of the Short Life working group for Mental Health in Primary Care Page 101
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11. Audit Scotland Report into Adult Mental Health 2023 12. Scottish_Recovery_Network_Strategic_Plan_202124.pdf 13. Partners in Care - Strategic Plan for Health and Social Care, Moray (2022- 2023) and the associated Strategic Delivery Plan Document.ashx (cmis.uk.com). 14. Creating Hope Together: suicide prevention strategy 2022 to 2032 Page 102
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APPENDIX 1 1 Appendix 1: Moray Mental Health Strategy Delivery Plan This delivery plan reflects the Moray Good Mental Health for All Strategy (2016-2026)i, and relevant national strategies and guidance documents, including ‘Scotland's Mental Health and Wellbeing Strategy 2023’ii which aims to: • Promote positive mental health and wellbeing for the whole population, improving understanding and tackling stigma, inequality and discrimination • Prevent mental health issues occurring or escalating and tackle underlying causes, adversities and inequalities wherever possible • Provide mental health and wellbeing support and care, ensuring people and communities can access the right information, skills, services and opportunities in the right place at the right time to meet their needs. The Delivery Plan is presented under the following headings: • Early intervention, prevention and self management • Mental Health Quality Standard 1: Access • Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support • Mental Health Quality Standard 3: Moving between and out of services • Mental Health Quality Standard 4: Workforce • Mental Health Quality Standard 5: Governance & accountability This plan purely focusses on adult services at present; the medium term ambition is to merge the strategic planning processes for child and adult mental health services so that we see children as being clearly embedded within families and communities, enable seamless transitions from child to adult services (at whatever age and stage they occur) and can take a holistic approach to prevention of poor mental health. Throughout implementation of the plan we aim to embed the principles of prevention of poor mental health, and the Scottish Recovery Network which are to: Page 103
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APPENDIX 1 2 • Take a whole person approach • Champion and value lived experience by integrating it into all parts of the system • Embed peer support approaches and roles in mental health services and supports • Offer more community-based supports and choices so everyone can be supported when and where they need it • Work with others to create a more equal society where good mental health and wellbeing can flourishiii Section 1: Early intervention, prevention and self management: Underlying this section is the necessity of a move towards a preventative, population health model which promotes and sustains good mental health and wellbeing. Strategic Outcomes: • Communities, families and individuals are better equipped to support and protect people’s mental health and wellbeing and provide opportunities to connect with others. • More effective cross-policy action is in place to address the wide ranging factors that impact people’s mental health and wellbeing Outcome Actions Lead Timescale Progress Underlying determinants of good mental health are tackled, including financial inclusion, nurturing early years, healthy environments, active citizenship and participation and wellbeing of diverse communities. Work with Community Planning Partners to ensure cross policy actions that more effectively address the wide ranging social, economic and environmental factors that impact people’s mental health and wellbeing, including poverty, stigma, discrimination and injustice. CiPH Dec 25 This work is taking place via the Community Planning Partnership, Community Planning Officers Group, GIRFEC Leadership Group, Fairer Moray Forum Page 104
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APPENDIX 1 3 Positive attitudes to mental health and to people with mental illness are promoted; we have raised awareness of mental health issues, reduced stigma and discrimination and promoted inclusion, including better access to mainstream services. Work with CPP and other anchor organisations to adopt a ‘mental health in all policies approach.’ Continue to tackle mental health stigma and ensure people can talk about their mental health and wellbeing, linking with See Me as appropriate. • Clear outcomes eg have worked with a minimum of 2 workplaces in each locality in Moray to implement mentally healthy Workplace policies. • The voice of lived experience has contributed to promotion of positive mental health within workplaces. HITL MRRP March 26 We have promoted mental health, wellbeing and resilience through work; and addressed employability issues, including for those affected by mental ill health. Ensure that Employability Action Plan includes positive approaches to mental health & wellbeing. EP HITL Oct 25 Health Improvement Team Lead is now the representative of the Moray Mental Health Strategic Group on the Employability partnership. We have developed social connections, tackled isolation, built resilience, strengthened use of community assets, including social prescribing, Roll out of social prescribing across Moray, building on existing Link Worker/ community connector roles Work with partners including Moray Wellbeing Hub to support the development of community hubs and building of community connections HITL Sep 25 Forres & Lossiemouth Social Prescribing model is now well established (1215 referral within Forres & 1013 within Lossiemouth Dec 24). Model is in the process of being introduced in all Moray Locality areas. Page 105
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APPENDIX 1 4 strengthening self care and peer support We have promoted holistic health for people with long term conditions, promoting recovery approaches and social inclusion Review and Recommission: 1. Intensive Support Service – a high level support and recovery outreach service 2. Distress Brief Intervention Service – direct access self referral or via Health and Wellbeing Practitioners – for short term practical support for people not requiring secondary care DHoS MRRP MADP Coordinator Jan 25 Both services have now been commissioned for 4 years with potential for 2 further 12 month extensions 1. Intensive Recovery Service – SAMH 2. Distress Brief Intervention – SAMH Contract monitoring is now in place, with quarterly reporting to the Mental Health Strategic Group. We have improved responses to people in distress – both from services and the wider community, including action to prevent suicide and better support people who self harm. People experiencing crisis are kept safe and their situations do not further escalate Continue to commission Distress Brief Interventions – time limited and supported problem solving contact with people in distress for up to 14 days. DHoS MRRP PPLO Dec 24 Distress Brief Intervention Service has been commissioned as per item above. Trauma is recognised, responded to appropriately Ensure that all staff, operational and senior management, are trained in trauma- DHoS TIPDO Sept 25 NHS Turas trauma informed practice training modules are Page 106
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APPENDIX 1 5 and prevented where possible. informed practice in line with Quality Standards. being shared with the Moray Council Clive platform. 47 Council/HSCM teams are being supported by Trauma Informed Practice Development Officer. Current processes and procedures are being reviewed to highlight good practice and areas which require further training. Page 107
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APPENDIX 1 6 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. Outcome Actions Lead Timescale Progress People can access the person- centered support they require. Regardless of where contact is first made, patients will be supported to get the right help from the right source. We will have maximised the potential for digital innovation, tackling digital exclusion and literacy where it exists. Patients are able to easily access & understand information about who services are for, what is provided and how they can be referred to these. Staff feel more knowledgeable about other services in local area and how to link patients in to them. Develop an integrated mental health and wellbeing pathway, from community and self help, support for distress and crisis through to complex, severe and enduring and including a focus on recovery. This will include a business case for dynamic direct access assessment, easily accessi- ble information about supports available and an effective method of (patient held?) information sharing between dif- ferent services. DHoS Sep 25 Currently building on work that was developed through Alcohol and Drug services and the commissioning of the Arrows Service to promote ‘no wrong door’ approach. Facilitated session planned with Primary and Secondary Care. Page 108
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APPENDIX 1 7 Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support: People with mental health conditions, including those with co-existing health conditions, experience improved quality and length of life, free from stigma and discrimination Mental health policies, support, care and treatment are better informed and shaped by people with lived experience of mental health issues and staff practitioners, with a focus on high quality provision that is recovery oriented. Outcome Actions Lead Timescale Progress Help and support will be centred around the person, respectful of their choices and based on evidence about what is most likely to help them. It will be focused on supporting them into independence and recovery. Comprehensive support and support that promote and support people’s mental health and wellbeing are available in a timely way that meets and respects individual needs. Identify and implement three projects to embed principles of realistic medicine and care in mental health service practice. For example: 1. Directory of services 2. Building a personalised approach to care 3. Implement shared decision making DHoS Sept 25 1. Community Connections Moray platform continues through the development and testing stages 2. Embedding GIRFE principles in health and social care planning 3. Increased focus of secondary care services interface with Primary Care. Benchmarking MDT working and reviewing through the How good is our MDT tool. Patients have a choice of how they access care and support; digitally or face to face. Expand offer of Near Me appointments MHSM Sept 25 Current face to face contact data demonstrates Moray is lower than other areas of Grampian. We require to expand opportunities for both in person and digital contact rather than telephone. Strengthened support, care and treatment pathways for neurodiverse Utilising adult National Neurodevelopmental Service MHSM Mar 26 Current ADHD and Autism pathways have been clarified. The Page 109
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APPENDIX 1 8 adults who require a diagnosis and support. Specification once it is available, strengthen, clarify and develop support and care pathways for people requiring neurodevelopmental support, working in partnership with health, social care, third sector and other delivery partners. Identify appropriate and accessible supports for potentially neurodiverse adults who are awaiting assessment, aren’t functionally affected, or have lower-level needs. This may involve peer support. current staffing resource cannot meet the demands of the service. We will continue to utilise signposting and early intervention and support through the Moray Wellbeing Hub, Social Prescribing, Mental Health and Wellbeing practitioners, and Community Connections Moray platform. Public information and awareness campaign planned. Parity of services for older adults Understand the gaps in older adult services and develop plan to address these. MHSM Sept 25 Workshop planned to focus on this specific topic. Focus on recovery Continue to work with Scottish Recovery Network to develop and support the establishment of peer support networks in the settings where these will have most impact. DHoS MRRP Sept 25 Options are being currently explored through Partnership projects led by Moray Wellbeing Hub, including partners such as SAMH. Ward 4/availability of an appropriate acute facility Respond to review of bed base being undertaken at Grampian wide level Establish a Moray group to ensure that local needs are considered, taken into account and fed back into overall Grampian review. DHoS Mar 25 Phase 1 on Bed Base Review completed and Implementation Plan for Phase 2 presented to and approved by the Mental Health and Learning Disability Board on 29 04 2025. Grampian wide meetings to progress Phase 2 are planned for late May and early June. Community Treatment & Support Model Explore and develop community-based models of psychiatric care and Psychiatric Assessment Suite MHSM Sept 25 This will be incorporated into the Mental Health Bed Base Review Priority 6. Page 110
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APPENDIX 1 9 Increased availability of timely, effective support, care and treatment that promotes and supports people’s mental health and wellbeing, meeting individual needs. Strengthen stepped care approach - develop business case for posts (potentially Band 7 Mental Health Practitioner) to work across Moray GP practices to provide thorough assessment of presentation/ problem, risk and identification of suitable options for care. Conduct self-assessment of specialist services and primary care, based on The National Confidential Inquiry into Suicide and Safety in Mental Health- Safer Services Toolkit. MHSM MHSM /PPLO Sept 25 Dec 25 New action agreed - this will inform a number of improvement activities outlined within this plan. Strengthened support, care and treatment pathways for adults with dementia. Develop a Moray Dementia Plan in line with the Grampian Dementia Strategy. Establish a Moray Dementia Working Group. MHSM Sept 25 Moray Dementia Pathway developed and aligned with Grampian Dementia Pathway. Moray working group established which links to the Grampian Dementia group. Page 111
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APPENDIX 1 10 Mental Health Quality Standard 3: Moving between and out of services Outcome Actions Lead Timescale Progress Ability to escalate or de-escalate treatment or support is as easy as possible; patient does not need to repeat their story and is supported in a seamless way. Remove barriers to accessing the right care, right place, right time and develop discharge and shared care arrangements with primary care, individuals and families. Implement dynamic case management, with the aim being to improve capacity but provide ease of access back into service if required. MHSM Sept 25 Focus of this work will be the strengthening of the interface between Secondary Care and Primary Care creating more opportunity for staff to crossover and the development of more effective MDT working. Flexible and supportive structures are in place to support effective discharge – negotiated pathways to ensure patient’s needs are met, making patient movement up and down the pathway less complex. Introduce co-produced written care plans for transitions between services or discharge from services, which detail how to re-engage. Any risks should be clearly identified and documented, and the flexibility of transfer time and handover of care should be considered. Introduce case-based discussion regarding thresholds between primary and secondary care. Dynamic caseload management Community mental health staff to increase the level of working within community settings in order to strengthen relationships across the service. Understand what is required to strengthen effective MDTs within MHSM Sept 25 A Community Mental Health Nurse training plan and Commu- nity Mental Health Team service operating procedure (SOP) is in the process of being developed. An audit is currently being under- taken to evaluate the effective- ness of current pathways, and case flow, between primary and secondary care. The audit will provide baseline in- formation that can be used as a performance indicator for future audits of referral paths. Page 112
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APPENDIX 1 11 localities and implement action to ensure maximum effectiveness. Develop an effective process for ensuring that when people with long term complex needs return to Moray, they have appropriate supports in place; this may include the use of core and cluster supported housing opportunities for people with severe and enduring mental health conditions. DHoS Mar 26 Currently reviewing all out of area cases. Page 113
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APPENDIX 1 12 Mental Health Quality Standard 4: Workforce: The mental health and wellbeing workforce is diverse, skilled, supported and sustainable, trauma & inequality informed Outcome Actions Lead Timescale Progress Workforce feels valued and respected and is more likely to want to work in Moray and remain here. Develop workforce plan for mental health services in Moray, linking to Grampian wide development and clearly aligning Moray services as part of wider Grampian mental health service offer MHSM Sept 25 The intention is to carry out a workforce survey later in the year. In parallel to this we will also routinely gather workforce data – retirement, sickness rates etc Undertake a needs analysis of current service in line with ‘Report of the Short Life Working Group into Primary Mental Healthcareiv’, considering the potential utilisation of Multidisciplinary Teams/extended roles. MHSM Dec 25 Embedding mental health professionals, support workers and others with appropriate skills into Primary Care multidisciplinary teams within clusters or localities. Robust, resilient and effective Mental Health Officer (MHO) service is in place Redesign of MHO provision within current financial constraints to provide sufficient capacity while allowing other MHOs with substantive posts opportunities to have sufficient MHO work to maintain their skills. MHSM AWI Lead MHSW Lead June 25 Draft report in place to go to SMT/RMG. Review capacity of Out of Hours Social Work function in relation to mental health and develop to address any needs. DHoS June 25 All out of hours staff are MHO qualified. Reduction in use of temporary and costly staffing Implement CESR model for psychiatry. Understand the workforce required to reduce or remove the need for locums and other temporary staffing solutions. MHSM Mar 25 CESR fellows in place within Adult and Older Adult teams. Plan in place to fill current locum vacancies by Oct 2025 at latest. Page 114
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APPENDIX 1 13 Work with cross Grampian system to build stronger relationships and sustainability so that Grampian system can provide support and cover when necessary. Workforce is informed, trained and confident in supporting self-care and recommending digital MH resources Develop and implement training and CPD plan for Mental Health service staff, recognising new developments in digital supports but also the challenges that some people face in accessing and using digital facilities. MHSM June 25 Digital Skills Survey currently live with Health and Social Care staff. Closing date June 2025. Page 115
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APPENDIX 1 14 Mental Health Quality Standard 5: Governance & accountability Outcome Actions Lead Timescale Progress Clear and effective governance in place Review of adult and older adult mental health governance, strategic and delivery elements, including provision of reassurance to IJB, and strengthening the role of Making Recovery Real partnership and the voice of lived experience. Align governance between the strategic groups which oversee: • Children and Young People’s Mental Health, • Moray Alcohol and Drug Partnership, • Suicide Prevention Strategic Group and • Adult Mental Health DHoS Dec 24 Clear Governance arrangements now in place within Moray and links with wider Grampian Mental Health arrangements. Decision makers, service users and practitioners are better able to access the evidence, and data to provide assurance and adapt services to meet local needs. Work with, and learn from colleagues, including data analysts and Alcohol and Drug Development Team, to maximise use of data, evidence and evaluation in targeting and improving our work. Create performance dashboard and actively participate in Scottish Benchmarking Network DHoS Mar 25 Work progressing but not completed as yet. Understand financial structures of mental health provision in Moray and identify & align short- and long-term funding opportunities. DHoS Mental Health Strategic Group Mar 25 Financial structures for Mental health clarified. Funding gaps escalated as appropriate at Moray, Grampian and National level. Page 116
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APPENDIX 1 15 Undertake self-assessment against Core Mental Health Quality Standardsv , ensuring the collective voice of lived experience and staff MHSM Sept 25 Bench marking will take place in September 2025. AWI Lead Adults with Incapacity Lead CiPH Consultant in Public Health DHoS Deputy Head of Service EP Employability Partnership HITL Health Improvement Team Lead MADP Co Moray Alcohol and Drug Partnership Coordinator MHSM Mental Health Service Manager MHSW Lead Mental Health Social Work Lead MRRP Making Recovery Real Partnership PPLO Public Protection Lead Officer TIPDO Trauma Informed Practice Development Officer i Good Mental Health for All in Moray ii Mental health and wellbeing strategy - gov.scot (www.gov.scot) iii Scottish_Recovery_Network_Strategic_Plan_202124.pdf iv REPORT OF THE SHORT LIFE WORKING GROUP FOR MENTAL HEALTH IN PRIMARY CARE (www.gov.scot) v https://www.gov.scot/binaries/content/documents/govscot/publications/strategy-plan/2023/09/core-mental-health-standards/documents/core-mental-health- quality-standards/core-mental-health-quality-standards/govscot%3Adocument/core-mental-health-quality-standards.pdf Page 117
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APPENDIX 2 Moray Adult Mental Health Strategic Group Progress Report This paper provides the Moray Integration Joint Board with a more detailed update on key areas of progress over the report period 26 09 2024 to 26 05 2025. Collective Voice Moray Wellbeing Hub continue to provide invaluable support to people who are struggling to manage their mental health and wellbeing. Their Discover Pathways toolkit is often a first point of contact for those individuals. Discover Pathways Moray | Mental Health Support Moray Wellbeing Hub continue to engage effectively with patients placed in mental health inpatient beds in Moray to ensure their experience informs future service development and delivery. Moray Wellbeing Hub are members of the Moray Mental Health and Strategic Group and continue to champion the Collective Voice of lived and living experience within this forum. We have taken the model developed through joint work between the Moray Wellbeing Hub and the Moray Alcohol and Drug Partnership and broadened it to include wider mental health and wellbeing. Challenges remain to effectively fund this work on an ongoing basis. Communities Mental Health and Wellbeing Funding The Scottish Government’s Communities Mental Health and Wellbeing Fund launched in 2021 in response to the significant adult mental health needs arising from the pandemic. The Fund is now helping local communities across Scotland, take further steps to improve mental health and wellbeing, with a focus on improving awareness and prevention. The funding is allocated annually through local third sector interfaces. tsiMoray distribute this funding within Moray. In total £257,989 funding was allocated within Moray for 2025/26 through a combination of 14 small grants and 24 large grants. Further detail can be viewed here: Moray Communities Mental Health and Wellbeing Fund - tsiMORAY. This funding reaches the heart of communities and extends the range of prevention and early intervention services available. Health and Social Care Moray have worked closely with tsiMoray throughout the process of the allocation of this funding, and we continue to work with the funded groups to support delivery of their services. We have also worked with those organisations who we unsuccessful to strengthen future applications & to consider how we can support with alternative funding applications. The range of community bids for this funding demonstrated the potential offered by community groups and third sector organisations and the important role they can play in supporting the mental health and wellbeing of the people of Moray. The Scottish Government has confirmed this fund again for Year 5 and 6, and that will include some grants made during Year 5 for up to 2 years as part of the Scottish Government's Fairer Funding pilot initiative, providing some groups the ability to plan over a slightly longer period. Page 118
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APPENDIX 2 Suicide Prevention In 2023, the suicide rate in Moray, per population, was the fifth highest in Scotland. National figures for 2024 are not yet published. The Moray Suicide Prevention Group has been strengthened following a period of transition. The group is now chaired by the Lead for Public Protection therefore ensuring good links to the Child Protection and Adult Protection Committees. Detailed performance information is reported directly to the Chief Officers Group and to the Moray Mental Health and Wellbeing Strategic Group. The Moray Suicide Prevention Group have a Delivery Plan that has five key priority areas; these align with Grampian/National Priorities. All priority areas are progressing well. • Priority 1: Building Community Capacity • Priority 2: Lived Experience • Priority 3: Data Analysis and the reduction of risk • Priority 4: Children & young people • Priority 5: Bereavement Support Progress on Priority 1, 2 and 4 has been particularly good with a very wide range of community information events and training sessions being provided for the public and for staff during 2024/25. The work of the Moray Mental Health Strategic Group will directly support and be influenced by progress on Priority 3. Moray Suicide Data Suicides per Calendar Year (Jan- Dec) Area 2021 2022 2023 2024 2025 to April 30 Moray 15 18 21 17 3 Grampian 73 83 82 66 23 2021, 2022 and 2023 official data on suicides published by the National Records of Scotland 2024 and 2025 unofficial Police Scotland data on suspected suicides Seventeen people died by suicide in Moray in 2024: • Five females and twelve males • Nine people were aged between 20-39 years • Eight people were aged above 40 years In 2024 the most common method of suicide was ligature, which was recorded for 13 of the 17 deaths in Moray. Page 119
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APPENDIX 2 There have been 3 suicides and 36 attempted suicides in Moray between the beginning of January and the end of April 2025. There have been 23 suicides and 150 attempted suicides in Grampian over the same time period. North East Suicide Prevention Service Health and Social Care Moray, along with Aberdeen City Health and Social Care Partnership, recently committed to extending the current Grampian Suicide Prevention Service contract with Scottish Action for Mental Health (SAMH) for a further year until May 2026, with the option for an additional further year extension. The 2025/26 contract, which is hosted by Aberdeen City, has three key components • to oversee delivery of the North East Suicide Prevention Oversight Group • to increase capacity for suicide prevention activity through raising awareness and delivering training • to work with each Health and Social Care Partnership to support the development and delivery of their own identified delivery plans/outcomes. Prevent Suicide North East Scotland App Health and Social Care Moray also remain committed to supporting the funding of the Prevent Suicide North East Scotland App Prevent Suicide Northeast Scotland - App and Website (preventsuicideapp.com) The App continues to record high usage numbers and records positive feedback from individuals accessing information and support. User numbers and feedback are reported through the Grampian Suicide Prevention Group. Applied Suicide Intervention Skills Training (ASIST) Two members of Health & Social Care Moray staff have recently completed an intensive 5 day residential course to become ASIST trainers. This will enable greater and more sustainable capacity to deliver this specialist level training locally. Until more recently, there was an 8 year gap in ASIST training in Moray. A targeted training program will be developed as part of Moray Mental Health Strategic Group’s workforce development activity. Unpaid Carers • Over a quarter of carers (28%) said their mental health is bad or very bad, rising to 37% for carers on Carer’s Allowance. • A third (36%) of carers said that they had thoughts related to self-harm or suicide. (Carers Scotland, State of Caring 2023, a Health and Social Care Crisis for Unpaid Carers in Scotland, 2023) Page 120
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APPENDIX 2 Day opportunities for the cared-for individual can be a crucial way to support unpaid carers' mental health by providing them with much-needed respite. These opportunities allow carers to take breaks, focus on their own well-being, and reduce feelings of overwhelm and isolation. The Day Opportunities team support unpaid carers and the person they care for to both engage within their community and to support the carer to have a meaningful break. Through utilising an approach whereby both the cared for and unpaid carer’s outcomes are met through the same support there is a positive impact on both of their mental health and wellbeing. Feedback from an unpaid carer who was supported by the Day Opportunities SDS Enablers in January this year stated “everything’s fine since Dayops got involved. I can go to Elgin or Tesco. I can get a haircut without worrying. The care side of support is good but when the social side of it started, I felt a bit free. I know Marlene is safe when I am not here” (feedback attached). The Day Opportunities team support unpaid carers on a weekly basis to ensure they have access to meaningful breaks using a person centred, strength and asset-based approach to achieve a positive outcome. Quarriers, our Commissioned Carer Support Service supports the mental health and wellbeing of unpaid carers by offering a range of tailored support options designed to enhance well-being and provide respite. Key Support Services include: Free Counselling Support Professional counselling services help unpaid carers manage stress, anxiety, and emotional challenges associated with their caring responsibilities. Sound therapy and art therapy sessions Provide creative and holistic approaches to mental health support, promoting relaxation. Respite & Short Breaks The Time to Live Short Break Awards enable unpaid carers to take a break from their responsibilities in a way that suits their personal needs. Respitality break options, For example, vouchers for afternoon tea or play sessions. Skill Development & Well-being Activities Hand massage workshops equip unpaid carers with practical relaxation techniques, enhancing their ability to manage stress. Monthly carer drop-in sessions provide a supportive space for unpaid carers to connect, share experiences, and access guidance. Supporting Unpaid Carers mental health and wellbeing remains a priority. The Interface between Substance Use and Mental Health Services Page 121
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APPENDIX 2 The Moray Alcohol and Drug Partnership (MADP) continues to progress key developments that strengthen the interface between substance use and mental health services. Recognising the interconnection between these areas, the ADP is embedding trauma-informed, rights-based approaches into local service delivery. While collaborative working with mental health services remains an identified challenge, steps have been taken to improve integration. Notably, a Band 8A Psychologist has recently taken up post, funded directly by the ADP, to provide dedicated psychological input across substance use pathways. In addition, a newly funded pharmacist post, shared between the ADP and mental health services, has been introduced to support the safe and effective use of medication within MAT pathways and improve alignment across services. All individuals engaging with specialist and third sector substance use services are now routinely screened for mental health needs, with appropriate follow-on care included as part of their support planning. The ADP is actively progressing work on Medication-Assisted Treatment (MAT) Standards 6, 9 and 10—ensuring delivery of psychological and social support (Standard 6), access to mental health care at the point of MAT (Standard 9), and provision of trauma-informed care (Standard 10). Community-based services such as Arrows continue to offer counselling and psychosocial interventions, as well as peer-led wellbeing groups including Men’s Talk and Women’s Support. The ADP also works closely with the Moray Wellbeing Hub and other community partners to support recovery and improve mental health outcomes through lived experience engagement and holistic support. These developments align with the Moray ADP Strategic Delivery Plan (2025–2028) and contribute to broader priorities around integrated care, early intervention, and reducing health inequalities. The Mental Health and Wellbeing Practitioner Service The Mental Health and Wellbeing Practitioner service continues to be busy with a steady flow of requests for appointments. There are some variations across Moray and appointments are delivered either face to face or by phone/online. The longest wait times average 2-3 weeks. Practices have been advertising the service via their websites and conversations are underway to explore MHWB Practitioners assisting with triage of low level mental health queries coming into the practices. The desired outcome for this is to redirect patient traffic away from GP if not required and when other appropriate support is available. Primary Care Psychological Therapies Service Primary Care Psychological Therapies Service also remains in high demand and in the first quarter of 2025 has averaged 58.25 self-referrals per month. The facility to self-refer for assessment alleviates workload pressure on GPs who historically would have made these referrals. There are some staffing pressures as funding is coming to an end for the Enhanced Psychology Practitioner role which supports the Tier 1 Page 122
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APPENDIX 2 cases within service. There is also a gap in provision for Tier 3 cases in Moray as these fall below the threshold for secondary care service but would ordinarily be considered too complex for primary care. Systems are in place however to discuss ‘step up and step down’ processes between secondary and primary care to improve patient pathways and reduce bounce back to the GP for onward referral. Staff are working at capacity to triage referrals and offer initial assessment. This is of benefit to both the individual (as they will receive information and signposting appropriate to their circumstances) and to the service as this ensure only those appropriate for psychological intervention are placed on the waiting list for therapy. It should be noted that the demand however does outstrip supply of resources currently funded. Newly Commissioned Mental Health Services Recent commissioning and procurement work has been undertaken to secure key mental health contracts. In scope for this work was the existing SAMH contract aligned to secondary adult mental health, existing Distress Brief Intervention (DBI) provision delivered by Penumbra, and the budget line that previously funded the Wellness Centre on Batchen Street which closed in March 2022. New service specifications were developed collaboratively including input from people with lived and living experience of mental health challenges which was extremely beneficial. This involvement translated all the way through to having panel members with lived experience for the evaluation process and scoring of tenders. Feedback from all concerned has been positive with excellent support provided from commissioning and procurement and the Moray Wellbeing Hub to facilitate this process of inclusion. Two contracts were ultimately commissioned. The Distress Brief Intervention contract focuses support for those in acute distress and adheres to the ‘DBI’ model e.g. contact within 24 hours and up to 14 days of support for those in acute distress. The work also looks to expand on collaborative working, developing relationships and maximising impact of lived and living experience through community-based peer support. This will include in due course expanding access pathways beyond the existing four routes (police, ambulance service, A+E and primary care). The Intensive Support contract is a targeted resource for those aged 18-65 who meet the eligibility threshold for secondary care and are experiencing difficulties arising as a result of various mental disorders. This includes interventions to avoid unnecessary admissions to hospital, facilitate timely and safe discharge from hospital and ongoing support in the community. Preventative intervention is included within this and all Multi Disciplinary Team members can refer into the service for short term support to prevent deterioration in a person’s health and circumstances. SAMH were successful in being awarded both contracts which we believe will result in smooth transitions and a strong Moray wide provision. There are long established Page 123
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APPENDIX 2 robust working relationships with SAMH and a history of flexible and adaptive provision to emergent local need. These contracts form an important part of the broader mental health context and will work alongside other existing resources such as the Primary Care Psychological Therapies Service and the Mental Health and Wellbeing Practitioners that align with GP practices. The goal is more cohesive supports in line with the ‘no wrong door’ principle and increasing access to appropriate support. Grampian Bed Base Review The Grampian Mental Health Bed Base Review is ongoing. The most recent progress was the submission to the Mental Health and Learning Disability Board on the 29th April 2025 of a Close Out Report for Phase 1 and a Programme Initiation Document for Phase 2 and associated papers. The recommendation of the covering report was that the Board ‘Approve the Programme Mandate and Programme Initiation Documents, noting that the Programme Initiation Document has indicative timescales for completion of milestones’ and ‘Note that the space between Phase 1 completing and the start of Phase 2 has not halted ongoing work on some of the Priority Actions. The Mental Health and Learning Disability Board approved the recommendations. The Mental Health Bed Base Review contains seven priorities all of which to varying degrees will have an impact on how we deliver services within Moray. Priority 6: ‘To link the need for more efficient use of beds in Royal Cornhill Hospital with the scenario that Ward 4 at Dr Grays Hospital can no longer be maintained as an inpatient service. This will require the development of a community response in Moray, which the whole system will support, and a model of care that predicates a number of beds at RCH that will be required to accommodate Moray patients’. Priority 7: ‘Use a joined up approach to reviewing the Older Adults pathway for dementia, defining the use of inpatient beds badged as “dementia”, and utilise the learning from South Aberdeenshire as a test of change to a community based model, managing risk across the Grampian system as a generic pathway is developed’. This may have an impact on how the bed base at Muirton Ward, Buckie, is utilised. Health and Social Care Moray will be represented in progressing all seven Priorities and will provide the Lead Officer role for Priority 6. Neurodiversity Pathways In 2021, the Scottish Government highlighted a need to improve experiences and outcomes for autistic adults, adults with ADHD and those with co-occurring neurodevelopmental conditions in Scotland. A report titled ‘Adult Neurodevelopmental Pathways’ was published by the Scottish Government in 2023 Page 124
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APPENDIX 2 updating on progress and providing further recommendations. Since publication there has been much discussion nationally regarding the development of Neurodiversity Pathways within each Health and Social Care Partnership and the challenge in doing this when no additional national funding is provided. Autism Pathway Health and Social Care Moray continue to contribute funding towards the Grampian Adult Autism Assessment Team (AAAT). Services and individuals can refer to the service. Most (87%) of referrals are self referrals with around 3% of referrals from GPs and 3% from Mental Health Teams. The referral rate is on par with other health and social care partnerships of a similar size. ADHD Pathway Within Moray individuals seeking an ADHD assessment are directed towards their registered GP for screening and if appropriate they are then referred to the Secondary Care Mental Health Service for assessment. Referrals need to meet the criteria as laid out in the Moray referral criteria document and are reviewed by the Secondary Care Mental Health Team on a weekly basis. Priority is given to those referrals presenting with a co-morbid mental illness, or whose functioning is significantly impaired by their condition. Referrals are allocated, assessed and reviewed through the out-patient consultant clinic. Approximately 30 ADHD cases are held by each Consultant Psychiatrist at any one time. ADHD cases not allocated at the weekly Mental Health Team meeting are placed on the Moray ADHD assessment waiting list. There are 420 people on this waiting list at the current time. All individuals placed on the ADHD waiting list are also signposted to the Moray Wellbeing Hub. The Moray Wellbeing Hub provide a range of support and signposting options. The Moray Wellbeing Hub online neurodiversity pathway NEURODIVERSITY PATHWAYS | Discover Pathways Moray provides links to useful resources and self help materials. The current waiting list time for individuals on the ADHD assessment waiting list is significantly protracted due to the lack of financial resource available and locally and nationally current waiting times can extend to several years, which is beyond the National Autism Implementation Team (NAIT) recommended wait time of 255 days. Recently a nurse practitioner within the Moray Mental Health Team has been identified to review the Moray ADHD assessment waiting list on a case by case basis. However significant additional funding is required to make a sizeable impact. Digital Innovation The Digital Health and Care Innovation Centre (DHI) Living Lab 3 (Care in Place) has focused on supporting Unpaid Carers to access a broad range of support Page 125
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APPENDIX 2 through the Community Connections Moray platform. Feedback from unpaid carers has been very positive and we aim to scale this work up. Living Lab 5 focuses specifically on the area of mental wellbeing. Work is currently being undertaken to build on the existing functionality and content of the Community Connections Moray platform which currently signposts the viewer to a wide range of community and statutory services, including mental health and wellbeing supports. Scoping to extend the innovation envelope for this Living Lab is being finalised. Among the main priorities and options identified are the opportunity to enhance digital tools that have been through initial research and development in other health board areas. The aim would be to extend the scope of the existing functionality (through R&D) and integrate as much as possible in to the existing Community Connections platform. There is also the opportunity to create a personalised experience within Community Connections to tailor the content users see and help streamline self-directed interaction and professionally-supported recommendations for mental health and weelbeing. Consultant Psychiatrists Challenges remain in recruiting Consultant Psychiatrists within Adult and Older Adult Mental Health, we therefore remain reliant of utilising locum posts in the short term. This is the case across NHS Grampian. A plan is in place to recruit to all the vacant consultant psychiatrist posts in Moray within the next six months and also to recruit to the soon to be vacated Moray Clinical Lead post. CSER fellows have been recruited, one in Adult and one in Older Adult mental health. The next stage will then be to look at how we balance the consultant role alongside the increased use of nurse practitioners, and increased cross over from secondary care services into the primary setting. Dementia Pathway The Moray Dementia Pathway has recently been updated to better align service delivery in Moray and to have a more common wider Grampian Dementia Pathway across all three health and social care partnerships. This work is due to be completed in the very near future. Psychological Therapies The Psychological Therapies performance remains a challenge. In quarter 4 there was an improvement in the number of people being treated within 18 weeks of referral; 57% up from 51% in Q3. Continuation of group delivery has contributed to this improvement with further groups scheduled in the coming months and discussions taking place regarding further group availability in primary care where demand is highest. However referrals into services continue to increase, particularly in primary care, Waiting times and referrals are regularly reviewed and monitored to ensure that people are seen in the most appropriate part of the service, and regular Page 126
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APPENDIX 2 primary/secondary care psychological therapies interface meetings ensure this is done as seamlessly as possible for people in line with the no wrong door approach. Mental Health Officers Mental Health Officers assess individuals experiencing mental disorder who may need compulsory measures of care and treatment. The role carries considerable autonomy and responsibility, and involves working alongside medical and legal professionals in order to safeguard the health, safety, wellbeing and rights of people. One aspect of the MHO role is to consider alternatives to detention in hospital and alternatives to guardianship powers. Only sufficiently experienced and qualified Social Workers can train as MHOs. There are significant challenges in the capacity of the MHO workforce to fulfil the local authority’s statutory duties and future forecast indicate a further contraction of the workforce. This holds system wide implications and risks. Temporary funding from the Scottish Government of a 0.8wte social worker has boosted the available resource and plans are in place to redistribute local budgets to make this post permanent. Trauma Informed Practice Trauma-informed practice in mental health recognises the widespread impact of trauma on an individual's physical, emotional, and psychological well-being. It is a framework that recognises the knowledge gained though learning and identifies pathways of integrating that knowledge into ensuring that policies, processes and procedures are created and developed in a person centred way. This work recognises that staff, at all levels within an organisation, may also be impacted by trauma within their own lives or as a result of the work they are required to undertake. Training for NHS staff is included within the suite of options on the TURAS staff digital education platform and plans are in place to cross these training modules onto the Moray Council CLIVE staff digital education platform. There is also the Scottish Trauma Informed Leadership Training programme, which focusing on how leadership can create the pathways to a trauma informed organisation. The Trauma Informed Practice Development Officer supports teams throughout Moray Council and Health and Social Care Moray to take a trauma informed approach. This is done by visiting teams, introducing the Scottish government’s vision of a trauma informed and responsive workforce, ‘walking through’ their processes at a team level and developing an action plan to support the implementation of trauma informed practices. Forty seven teams are being supported to date. The next steps are to facilitate sessions with strategic management/leadership teams, which includes facilitating access to the Scottish Trauma Informed Leadership Training programme. Page 127
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APPENDIX 3 1 Appendix 3 Moray Adult Mental Health and Wellbeing Strategic Group Performance and Indicators Report Page 128
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APPENDIX 3 2 Population level Mental health data for Grampian and Moray: This is the data which helps to describe the overarching picture of mental health in Moray. It is useful to see this over a longer time period, to understand improving or deteriorating trends. It also helps to inform the designing and commissioning of services now and in the future. Adult Mental Wellbeing Score Based on the Warwick-Edinburgh Mental Wellbeing Scale, for adults aged 16+ years. There are marginal differences between Moray at 49.9, NHS Grampian at 49.3 and Scotland at 48.7, although there has been a slight decrease for all three over time from 2012. A higher score is better. Adults with common mental health problems The percentage of adults (16+ years) with a possible common mental health problem has remained lower in Moray (15%) and Grampian (17%) than in Scotland (21%). All percentages have risen by around 5% since 2012. Dementia Prevalence Rate 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. Conversely the rate for Scotland fell from 5.5 to 5.0 over the same period. This may illustrate increased case finding in Moray. Depression Prevalence Rate The prevalence of Depression in both Moray and Scotland rose between 2017/18 and 2022/23. The rate per 1,000 population in Moray increased from 42.5 to 53.7, while the corresponding Scottish rate increased from 52.2 to 59.7. Mental Health Primary Care prevalence The prevalence rate per 1,000 population for mental health problems rose by 0.9 in both Moray and Scotland over the period 2017/18 to 2022/23. Although rising, the rate for Moray remains consistently below Scotland during this period, reaching 6.4 per 1,000 in 2022/23 (compared to 7.5 for Scotland). Page 129
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APPENDIX 3
3
Percentage of population prescribed drugs for Anxiety/Depression/Psychosis
In 2023/24, an estimated 20% of Moray’s population were prescribed drugs for anxiety, depression or psychosis. This was above the Grampian
average of 18.1%, but below the Scottish value of 20.9%. For each geography this figure has generally increased over time.
S1 Suicide rates per 100,000 population over a 5 year period
Based on five-year rolling averages, the rates of death by intentional self-harm and by undetermined intent ('probable suicides'), per 100,000
adults were Moray 20.7, NHS Grampian 15.8, and Scotland 17.5 for 2018 – 22.
Deaths from suicide in young people
Deaths from suicide in young people aged 11-25 years; 5-year rolling average number and crude rate per 100,000 people aged 11-25 years:
Moray 16, NHS Grampian 10.5, and Scotland 10.9 for the period 2018 – 2022.
Psychiatric patient hospitalisation
The rates of patients discharged from psychiatric hospitals has been falling steadily since recording started in 2002: 3-year rolling average
number and directly age-sex standardised rate per 100,000 population. Moray (141.9 per 100,000) has a lower rate than Scotland (216.1) and
NHS Grampian (166.4).
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APPENDIX 3 4 Section 1: Early intervention, prevention and self management: Underlying this section is the necessity of a move towards a preventative, population health model which promotes and sustains good mental health and wellbeing. Strategic Outcomes: • Communities, families and individuals are better equipped to support and protect people’s mental health and wellbeing and provide opportunities to connect with others. • More effective cross-policy action is in place to address the wide ranging factors that impact people’s mental health and wellbeing Indicators The following are under development: % of People with mental health problems who feel able to participate in their communities Numbers of people with mental health concerns who have been supported via Employability pathway % of workplaces in Moray with positive mental health policies in place Numbers of people as a percentage of those presenting with mental health problems being supported through social prescribing across Moray % of people with mental health problems in Moray who are financially secure and have good quality housing. Page 131
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APPENDIX 3 5 Mental Health Quality Standard 1: Access: What evidence do we have that people in Moray have equitable and non discriminatory access to effective and relevant support for their mental health, within appropriate timescales? Indicators: Psychiatry Outpatient Appointments General psychiatry outpatient attendances have decreased significantly over the last ten years, with new attendances staying relatively stable over this period. Referrals number for psychological therapies (PT) in NHS Grampian by month: Between October 23 and February 24, referrals to psychological therapies remained fairly steady at around 800 per month. In March 2024 the numbers jumped up, rising to 1400 in May 24, and rarely falling below 1200 per month since then. Of these referrals, around 100 per month are not accepted onto the waiting list. T1 Wait distribution (%) of patients who started treatment for Psychological Therapies (PT) in NHS Grampian by month: By December 2024, around 83% of referrals into Psychological Therapies were being seen within 18 weeks, and under 10% were waiting for 19 to 35 weeks and 36 – 52 weeks respectively. DBI Access Data for new service not yet available Page 132
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APPENDIX 3 7 Mental Health Quality Standard 2: Assessment, Care Planning, Treatment & Support: What evidence do we have that people with mental health conditions, including those with co-existing health conditions, experience improved quality and length of life, free from stigma and discrimination? What evidence do we have that mental health policies, support, care and treatment are better informed and shaped by people with lived experience of mental health issues and staff practitioners, with a focus on high quality provision that is recovery oriented? P1 Carers for people with mental health problems In Scotland during 23/24, 27% of carers for people with mental health problems reported feeling supported to continue in their caring role. P2 Adults with mental health problems supported at home In Scotland during 23/24, 55% of adults with mental health problems who were supported at home agreed that their services and support had an impact in improving or maintaining their quality of life P3 People with mental health problems who felt that people took account of things that mattered to them In Scotland, during 23/24, 56% of people with mental health problems agreed that “people took account of the things that mattered to me” in Health and Social Care Experience Survey Ef5 Non-attendance at appointments for community based services of people with mental health problems This figure has stayed relatively steady across Grampian at around 15% patients per quarter not attending community based appointments since October 2022. The actual number of appointments missed was 8190 out of 54982 for the three months from October to December 2024. Page 134
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APPENDIX 3 8 Mental Health Quality Standard 3: Moving between and out of services What evidence do we have that people in Moray are able to access the right care, right place, right time, and that discharge and shared care arrangements are in place with primary care, individuals and families? Indicators Arrangements for getting to speak to a Mental Health Professional Out of 230 respondents, 41% reported a positive response to the arrangements for getting to speak to a mental health professional in Moray. 22% of responses were neutral, and 37% reported a negative experience. This data is taken from the Health and Care Experience Survey 2023 – 2024. S2 % Discharged psychiatric inpatients followed-up by community mental health services within 7 calendar days Between October – December 2024, 55.05% of all discharged psychiatric inpatients were followed-up by community mental health services across Grampian within 7 calendar days. This figure has been steadily rising from 42.6% in December 2022. Delayed discharges within mental health specialties The number of days spent in hospital within mental health specialties, when patients are ready to be discharged, was 18.58 per 1,000 population for Grampian in 2023/24, compared to 26.76 for Scotland and 50.85 for Dumfries and Galloway. The total number of days for Moray patients during this period was 1316, a rate of 17.2 per 1,000 population, compared to 9.88 for Aberdeen City and 23.87 for Aberdeenshire. Page 135
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APPENDIX 3 9 Mental Health Quality Standard 4: Workforce: What evidence do we have that the mental health and wellbeing workforce is diverse, skilled, supported and sustainable, trauma & inequality informed? Indicators The following indicators are under development: Sickness/absence levels of mental health staff across Moray Reduction in use of locums and agency staff in Mental Health services over a period of time % of HSCM and Moray Council Workforce confident in delivering Trauma informed practice 47 teams have been supported to date across Moray Council and HSCM. % of HSCM workforce which is suicide informed and confident Page 136
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 2025 SUBJECT: EQUALITIES MAINSTREAMING REPORT 2025-2029 INCLUDING PROGRESS AGAINST OUTCOMES 2021-2024 BY: CORPORATE MANAGER AND PUBLIC HEALTH CONSULTANT 1. REASON FOR REPORT 1.1 To provide an update on the Equality Outcomes Progress Report presented to Moray Integration Joint Board (MIJB) on 27 March 2025 (para 11 of the minute refers) and to seek approval of the final progress report. 1.2 To seek approval of the MIJB Equality Outcomes and Mainstreaming of the Equality Duty set for the period 2025-2029. 2. RECOMMENDATION 2.1 It is recommended that the Board: - i) consider and approve the Final MIJB Equality Mainstreaming Progress Report 2021-24 (Appendix 1); ii) consider and approve the MIJB Equality Outcomes for the period 2025-2029 (APPENDIX 2), aligned with the strategic priorities outlined in MIJB Strategic Plan “Partners in Care 2022 – 2032”; iii) approves mainstreaming of the Equality Duty; and iv) instructs the Corporate Manager to publish the reports on the HSCM webpage and develop an accessible user-friend summary for publication. 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 11. Page 137
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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 and further work was required (para 8 of the minute refers) with a final report being 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 of it 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 their 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 138
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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 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 their meeting on 29 April 2021 (para 5 of the minute refers). 3.12 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 our commitment to do so as soon as possible. 3.13 HSCM presented a Draft Progress Report to the Board on 27 March 2025 (para 11 of the minute refers) which was approved and published in March, as per the statutory obligations. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 This report has not been developed under the governance of the Strategic Planning and Commissioning Group (SPCG), but has been completed collaboratively with its members and will be implemented by Health and Social Care Moray (HSCM). 4.2 There are 7 new proposed equality outcomes: i) Provide accessible services that support people to remain safe in their own homes through person-centred care and digital transformation. ii) Paid and unpaid carers will be given choice, opportunities, and support to care for their loved ones, ensuring their well-being enabling them to balance their caring responsibilities with their personal lives. iii) Support people with learning disabilities and their families in maintaining their health and wellbeing, and establishing tenancies in new supported accommodation. iv) Support children and young people affected by their own or someone else’s drug or alcohol use. Ensure they can easily access support from their school and other services, and that families are supported to find their own recovery. v) Support hub and outreach efforts in disadvantaged communities through tackling poverty, income levels, poor housing, and disadvantage to help individuals avoid substance use. Expand efforts to other areas, including school talks, online conversation café, education and drug awareness, and Naloxone training. vi) A full redesign of adult day services will enable individuals to access day support that is person-centred and meets their agreed outcomes and aspirations. Where appropriate, day services will be provided within people’s own communities. vii) Prioritise the health and well-being of all staff by providing opportunities for personal well-being, development, and learning in a supportive and inclusive work environment. Page 139
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4.3 Further information for each of the outcomes is available in the Outcomes report (see Appendix 1), including evidence to support why each outcome has been identified as a priority, actions to deliver the outcomes and lead service areas. Each outcome has also been aligned to the relevant element of the Equality Act 2010’s General Duty and to a Priority in the MIJB Strategic Plan. 4.4 HSCM endeavours to mainstream equality for all by using a holistic approach, demonstrating equality in all that they do, ensuring that all functions consider equalities when assessing and reviewing policies and practice. 4.5 The SPCG will be responsible for monitoring and reviewing the equality outcomes, to ensure alignment with the priorities outlined in the MIJB Strategic Plan “Partners in Care 2022 – 2032”. 4.6 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 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 There are risks associated with non-compliance and/or non-achievement of the outcomes e.g. breaching our statutory duty to promote equality, increased health inequalities and worse health outcomes for people with protected characteristics. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact The work outlined in this report is directly linked to advancing equalities across each of the protected characteristics. This is outlined within the body of the report. It is anticipated there will be positive impacts across the protected characteristics. No Equality Impact Assessment is required. Page 140
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Compliance of the Fairer Scotland Duty has been taken into consideration throughout this process, in particular as compounding inequalities faced by protected groups. This will continue through to the implementation of the Outcomes and Actions, with Fairer Scotland forming a core part of reporting. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising from this report. (j) Consultations Consultations have been undertaken with Service Managers (Operational Management Team), HSCM Senior Management Team, Legal Team. 6. CONCLUSION 6.1 This report demonstrates progress against the Equalities Outcomes set in 2021 and outlines mainstreaming achievements to date. 6.2 The Board is asked to approve the proposed equality outcomes for the period 2025-2029, which are 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 Background Papers: Moray Strategic Plan - HEALTH & SOCIAL CARE MORAY moray_joint_strategic_needs_assessment_2024.pdf Page 141
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Equalities Progress Report 2021-2024 Appendix 1 MORAY INTEGRATION JOINT BOARD APPENDIX 1 Page 142
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APPENDIX 1 Progress against the Equality Outcomes set 2021 for the period 2021-2024. Equality Outcome 1 Everyone across Moray (including those who share a protected characteristic and those who do not) has the opportunity for good health and wellbeing across their lifespan. This outcome seeks to empower individuals to take charge of their own health and wellbeing; be active, make positive choice and feel connected within their communities; But also recognises that wider inequalities that effect health and wellbeing as well as the need for prevention and early intervention to mitigate health consequences. Strategic Theme: Building resilience – Taking greater responsibility for our own health and wellbeing. Evidence from the strategic needs assessment: • There are continuing inequalities in health status in Moray, with evident association between level of neighbourhood affluence and morbidity and mortality • There is significant demand for health and social care services arising from chronic disease and comorbidity • There is significant morbidity and mortality due to mental health problems • There is significant morbidity and mortality due to lifestyle exposures smoking, alcohol and drug misuse Strategic Outcomes: • Lives are healthier • People live more independently • Quality of Life is improved • Health inequalities are reduced • People are safe Key Focus HSCM will mitigate health inequalities across the life span Measures Participation numbers Participant Feedback Staff Feedback key protected characteristics Age Disability Lead Actions a) Health point – the provision of advice, information and signposting. Utilising the Making Every Opportunity Count (MEOC) approach. Page 1 of 31 Page 143
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APPENDIX 1 Update 2025: 2019/2020: Outreach events across Moray engaged with 1,306 people, predominantly those of working age and older. 2020/2021: Due to the Covid-19 pandemic, no outreach events were delivered. The team were redeployed to support the pandemic response, and the Health point was closed to walk-in members of the public. Although MS Teams appointments were offered, there was no uptake. However, 168 telephone consultations were recorded, primarily providing motivational support and arranging Nicotine Replacement Therapy treatments as part of the smoking advice service. These calls also often resulted in signposting to other services and websites related to self-management of stress, healthy eating, and local financial support services. 2021/2022: The pandemic response continued, and no outreach events were delivered. 731 telephone enquiries were recorded. 2022/2023: Outreach events across Moray resumed, engaging predominantly with people of working age. 2,081 contacts recorded 2023/2024: 4,140 contacts and engagements. Locality events, outreach, and campaigns also restarted, including the Winter Health Campaign, Buckie Community Lunches, Forres Church of Scotland events, Aberlour Community Day, Keith Tuesday Table, and a REAP visit. Additionally, there were 506 enquiries via the Dr Gray’s Healthpoint site. 2024/25: There were 2,363 Contacts/Engagements recorded. Locality Events, Outreach, and Campaigns: Forres: Pop-up event at Findhorn Eco-Village in collaboration with Community Connectors Elgin: Blue Light Festival, Workforce Mocktail session, and information session at The Oaks Keith & Speyside: Speyside High School Health Fair Buckie: Community Lunch New Elgin: Community Days, Long Covid event, World Hepatitis Day at The Bow, Community Appointment Day, Freshers Fayre Nutrition and Hydration Week Campaign: 13 campaign events focusing on nutrition and hydration, particularly for older people. Sessions at three supported housing Page 2 of 31 Page 144
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APPENDIX 1 establishments and one care home, engaging 50 residents. Five sessions were delivered to HSCM staff within GP practices and Dr Gray’s Hospital. Presentations focusing on "Ageing Well" were delivered to 10 community groups, with 237 attendees. Feedback included: "I’m glad you talked about 'It’s Okay to Ask.' I’m going to ask my doctor about the side effects of a medication I’m on." "When you go to the GP, you don't get any of this information or leaflets. This was very interesting and informative." b) Update 2021 Our Housing Support Service covering Woodview and Woodview Children and Young People implemented an activity programme as an alternative to high school education. This was due to the young person’s reluctance to attend in conjunction with being anxious around COVID-19. These activities include outings in the local community as well as activities further afield. Any activities are discussed and planned with the young person and their family to ensure their views and choices are promoted. Regular meetings and reviews are held with young person, family and professionals Disability c) Update 2021 Within our Care at Home Service, at the commencement of the COVID-19 period, health services were established to support people in their own homes who tested positive and did not require hospital admission. The Care at Home Service withdrew provision of support at this time. As the period of COVID-19 extended, the Care at Home Service was required to support service users with their support needs regardless of whether they were positive for COVID-19 or not. Outcomes of remaining at home as opposed to having a hospital admission were met and peoples choices were supported Age All d) Update 2021 Alcohol and Drug Services remained open although groups were not functioning. Arrows continued to provide a walk in service; along with increased phone support. MIDAS focussed on those at the highest risk, ensuring that prescriptions were Quarterly agency reporting. SDMD/DAISY Page 3 of 31 Page 145
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APPENDIX 1 delivered along with increased proactive phone contacts Carers and Advocacy services have remained open, with pro-active phone contacts reporting. Staff feedback Key Focus 1.2 HSCM enables individuals to self-manage their conditions Ref Actions Measures key protected characteristics a) Update 2021: Respiratory Conditions Programme – virtual and face to face exercise classes to support individuals to self-manage their condition. Participation Nos.& Feedback pre/post participation Staff Feedback Age Disability Update 2025: In 2021/22, funding was received through the Respiratory CEL to deliver the Physical Activity for Health programme, initially targeting COPD patients. Sixteen patients participated in the pilot programme, which was delivered virtually in partnership with NHSG Physiotherapy Pulmonary Rehab and MC Sport and Leisure. A referral pathway and process were established, with the team serving as the point of contact for all referrals, utilising the MEOC approach. A total of 24 referrals were received In 2022/23, the programme expanded, receiving 227 referrals for Physical Activity for Health. Since 2023, referrals are now made through an online portal, managed by the Wellbeing Officer in the local authority. b) Update 2021: In our Short Term Assessment and Re-ablement Team [START] the Social Care Assistants [Carers] took part in a Care Inspectorate initiative called Care About Physical Activity [CAPA] which was to promote better movement and mobility in our older People. Training and guidance was delivered to the staff group who then set up goals and programmes for people to follow and monitor progress. This was to support improved mobility, increase confidence and better overall health. Measures were gathered weekly and input into a Web based programme to gather evidence. All Key Focus 1.3 HSCM supports individuals to make positive Health & Wellbeing choices Page 4 of 31 Page 146
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APPENDIX 1 Ref Actions Measures key protected characteristics a) Update 2021: Routine Enquiry of domestic abuse was introduced in 2008 following the issue of Chief Executive Letter 41: Gender Based Violence Action Plan. This details the actions required from Health to improve NH Scotland’s response to gender based violence (GBV). Routine enquiry involves asking all women at assessment about abuse regardless of whether there are any indicators or suspicions of abuse. It was established in maternity, sexual health, health visiting, substance misuse and mental health settings. This was due to the disproportionate number of women accessing these services who have experience of abuse. Routine enquiry is embedded in the Universal Health Visiting Pathway and is continued rollout is a key component of the Equally Well Delivery Plan. Pregnancy Maternity Sex Update 2025: Antenatal/Postnatal Visits: We conduct routine enquiries of domestic abuse during the antenatal visit to ensure early identification and support. We continue these enquiries between the 3-week and 3-month visits, using professional judgement to determine the safest timing. This ensures that we can identify and address domestic abuse early, providing timely support and intervention. Monitoring: If abuse is disclosed, we monitor the situation for any escalation in frequency or severity. By using the Domestic Abuse Risk Assessment Checklist (DASH RIC), we can reassess and follow appropriate guidance to provide ongoing support. Guidelines: Health Visitors adhere to the Scottish Government’s guidelines for responding to domestic abuse. This ensures that the approach is consistent and based on best practices. If abuse is disclosed, the DASH RIC is completed and can and offer support and referrals to Multi-Agency Risk Assessment Case Conferences or other services as needed. Support & Safety Planning: We provide information on local services and discuss safety planning in all cases, regardless of the risk level. This empowers individuals to make informed decisions about their safety and wellbeing. Child protection To improve data collection the service transitioned to an electronic system called MORSE in November 2024. This enhances the service ability to monitor and address domestic abuse more effectively, providing a tool to gather accurate data Page 5 of 31 Page 147
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APPENDIX 1 procedures are implemented if required. For other forms of gender-based violence, we refer to the latest evidence updates to ensure comprehensive support. Universal Health Visiting Pathway in Scotland: pre-birth to pre-school - gov.scot School Nurse Pathway: To further support individuals, we have integrated domestic abuse considerations into the School Nurse Pathway: Domestic Abuse at Home: If a child or young person is confirmed to be experiencing domestic abuse at home, the School Nurse follows child protection procedures to ensure their immediate safety. This is crucial for protecting vulnerable individuals and providing timely intervention. Suspected or Disclosed Abuse: When abuse is suspected or disclosed, the School Nurse follows the Scottish Government School Nurse Pathway for Domestic Abuse. They contact the child, discuss the referral, and follow child protection procedures as appropriate. Support from the Team Leader or Child Protection Specialist Nurse is accessed to aid decision-making. This ensures that the child receives appropriate support and protection. Guidance Document: The service is preparing to implement an NHS Grampian School Nurse Pathway guidance document to standardise the approach and ensure consistent support. This will help to provide clear and effective interventions. Measures: Data collection helps monitoring and informs on the effectiveness of interventions and continuous improvement to support services. Accurate data collection is essential for evaluating our impact and making informed decisions. Specialist School Nursing Contribution Data is collected on the number of referrals to School Nurses in regards to the domestic abuve pathway b) Update 2021: Baby Steps – the programme focused on the risks related to adverse effects of maternal obesity on both the mother and the child. Participation Numbers Feedback from mothers Pregnancy /Maternity Age, Disability Update 2025: 2021/22: The programme remained paused, with three online meetings held to engage with women, attended by eight participants. The Facebook page continued to be the primary platform for sharing key health messages. With changes in restrictions, the Page 6 of 31 Page 148
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APPENDIX 1 Health Walk component resumed in September, with weekly walks attended by 11 participants. Key health messages were delivered during these walks. Feedback: "I have become more active knowing that it is safe to do so and indeed recommended to remain active during pregnancy." "I thought now that I’m pregnant, I can eat what I like. By discussing the key messages and accessing the Facebook page, I realise that’s not the healthiest approach!" 2022/23: One regular walker attended the weekly Health Walk. In Q2 June, Baby Steps delivered its first full programme cycle, including a Confidence to Cook session, since the lifting of restrictions. A total of 24 women joined across three cycles. Feedback: "I now have a good idea of where hidden sugars and fats are in food." "Initially, I had no idea how to read food labels. Now, I look at them all in the supermarket." 2023/24: Based on participant feedback, each cycle length was reduced to six weeks as a test of change. A total of 22 women joined the programme over five cycles. Facebook followers increased to over 600. Feedback: "I’ve been able to make healthier food choices now I understand the food label system." 2024/25: The programme was paused due to low uptake and referrals. Digital delivery is being explored following patient engagement and feedback. There has been a consistent increase in Facebook followers. A refreshed digital programme is planned for launch in Spring 2025. c) Update 2021: Alcohol Brief Interventions – the use of a short, evidence-based, structured conversation about alcohol consumption. It seeks to motivate and support the individual to consider a change in their drinking behaviour in order to reduce their risk of harm. Participation numbers Participant Feedback Staff Feedback Age Disability Page 7 of 31 Page 149
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APPENDIX 1 Update 2025: 2019/20:443 ABI conversations recorded 2020/21:0 ABI conversations recorded (PHS suspended the GP contract during the pandemic from March 2020 to March 2022. 2021/22: 321 ABI conversations recorded 2022/23: 684 ABI conversations recorded 2023/24: 1122 ABI conversations recorded d) Update 2021: Tobacco - delivery of smoking advice service. Uptake and quit rates are currently good Participation numbers Quit rates, Feedback Staff Feedback Age Disability Update 2025: 2019/20:Quit attempts 85, 12 week quits 76 = 89.4% 2020/21: Quit attempts 15, 12 week quits 15 = 100% 2021/22: Quit attempts 17, 12 week quits 17 = 100% 2022/23: Quit attempts 71, 12 week quits 24 = 33.8% 2023/24: Quit attempts 105, 12 week quits 55, = 52.3% 2024/25: Quit attempts 104, 12 week quits 24 = 23.07% e) Update 2021: In our Children’s Residential Service at CALA, we have supported a young person (aged 17) to access, through self-referral, mental wellbeing supports. Additional training and webinars for staff to enhance their knowledge of local resources Age and ethnicity f) Update 2021: Walk Moray – the promotion of physical activity through Walk Moray. Participation numbers & Feedback Age Disability Update 2025: 2019/20: 91 new walkers 2020/21: 18 Heath Walks delivered across Moray. Average 100 walkers per week. 60 new walkers registered. Programme partially paused due to Covid-19 restrictions. 2021/22:15 Health Walks were running. Average 100 walkers per week. 92 new walkers Page 8 of 31 Page 150
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APPENDIX 1 registered. 30 new volunteer walk leaders trained including 3 dementia friendly walk leaders. Successful funding bid allowed delivery of a short Strength and Balance programme. 8 outdoor sessions, 22 regular attendees supported by 8 volunteers. 2022/23: 18 Health Walks (1 dementia friendly health walk). Average 100 walkers per week. 61 new walkers registered. 2023/24: 18 Health Walks (1 dementia friendly health walk). Average 100 walkers per week. 78 new walkers registered. Addition of 2 weekly evening Health Walks in Aberlour and Buckie following conversations and engagement within these communities. Feedback: “Thanks to Walk Moray health walks, I now have the confidence to leave my house" “It is now the best part of my week" 2024/25: 19 Health Walks including 2 evening walks and 1 supported housing walk and 1 dementia friendly health walk. Average 100 walkers per week. 122 new walkers registered. 101 Active Walk Leaders. Feedback: “I have more confidence in walking greater distances, my legs feel stronger and my breathing is better” “I have made friends and feel more connected into my local community” g) Alcohol and drug, Carers and Advocacy services. See above. Participation numbers Participant Feedback Staff Feedback Age Disability Staff Wellbeing: Moray Pharmacotherapy staff undertook sessions led by Staff Physio Service including workstation assessments, working safely with display screen equipment, desk exercises, keeping fit for work and stress management . Key Focus 1.4 Individuals are connected with communities / locality planning Ref Actions Measures key protected characteristics Page 9 of 31 Page 151
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APPENDIX 1 a) Update 2021: Community Resilience – the provision of small grants and funds to improve community health and wellbeing in line with Public Health Outcomes. Participation numbers Participant Feedback Staff Feedback Age Disability Update 2025: 2019-22: Team redeployed 2022/23: £1337 Funding of resources. Toolkit designed to support Moray schools tackle rising issue of tobacco and vaping. Mobile Information Bus training to Moray Vaccination Centre staff. Resource used to target ‘Cold Spots’ and deliver outreach vaccinations. 2023/24: Healthier Futures Funding received to deliver targeted Healthy Eating Active Living programmes: Refresh and kick start delivery of Grow Well Choices programme to Early Years Establishments in Moray Counterweight Core Funding (delivery of weight management programme by MLC) 2024/25: Healthier Futures Funding: Delivery of Grow Well Choices Programme, Counterweight Core Funding (delivery of weight management programme by MLC) b) Update 2021: Poverty Agenda - the provision of small grants and funds, via the Health Improvement Fund and the Improvement Fund to improve the outcomes of the most vulnerable groups living in poverty in Moray. Participation numbers Participant Feedback Staff Feedback Age Disability Update 2025: 2019/20: Health Improvement Fund – Programmes and Projects £32,920 2020/21: Health Improvement Fund – 10 Programmes and Projects funded £26,526 2021/22: Health Improvement Team – redeployed and reduced capacity 2022/23: Health Improvement Fund – 4 programmes and projects funded £3017 Third Sector Winter Support Fund - In January 2023, Health and Social Care Moray Health Improvement Fund received £40k funding from the PH Directorate to support Third Sector organisations during the cost-of-living crisis. tsiMoray supported with process planning. 43 of 46 applications went through to the decision-making panel following the initial criteria screening. The decision-making panel included 3 x community groups representatives and Page 10 of 31 Page 152
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APPENDIX 1 x2 Health Improvement Team representatives, independently facilitated by tsiMoray. A total of 29 bids were approved (£38,908.74) 22/23 - 14 programmes/projects supported £18,502 2023/24: Third Sector Winter Support Fund - 15 programmes/projects supported £20,406 Health Improvement Fund – 4 programmes and projects funded £4675 2024/25 Health Improvement Fund – 4 programmes and projects funded £4678 c) Update 2021: In our Short Term Assessment and Re-ablement Team and Care at Home Teams we follow the MEOC initiative (Making Every Opportunity Count), by signposting and supporting Service Users to access services or opportunities in the local community, such as ball groups, tea dances, coffee mornings etc. Increasing these opportunities and helping to alleviate social isolation. These conversations are recorded by Social Care Assistants and submitted to be added to records All d) Update 2021: Our Housing Support Service at Woodview set service aims against a quality framework for support services (care at home, including supported living) The aims have been embedded into the Service Plan under “Peoples health and well-being benefit from their care and support”. Support Plans are put together and implemented to incorporate activities in the local community working with individuals and families/guardians to achieve identified outcomes. Care Treatment and Support Plan Service Support Plan Outcomes Reviewed through service user and staff feedback Disability e) Update 2021: Moray Alcohol and Drugs Partnership (MADP) support small community projects through tsiMoray and participatory budgets project, to improve the outcomes for communities and enable local groups to develop and engage with local populations. tsiMoray reports and liaison with community projects. Disability Page 11 of 31 Page 153
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APPENDIX 1 Equality Outcome 2 Everyone across Moray (including those who share a protected characteristic and those who do not) has the opportunity for equitable access to Health and Social Care Services. This includes :- • having access to person led Health and Social Care Services; • being supported to make informed decisions about their care, and • feeling they have more control of their lives • being supported to live as independently as possible and to remain in their home or a homely setting for as long as possible. Strategic Theme: Partners in care- Making choices and taking control over decisions affecting our care and support Home First- Being supported at home or in a homely setting as possible Evidence from the strategic needs assessment: • Moray is characterised as remote and rural, and there are significant access challenges for some in the population to access services. • Moray’s military and veteran population constitute a significant group, requiring general health services and specific services • Population is ageing, with a growing proportion represented by adulate over the age of 65, and growing numbers of adults aged over 80, with implications for increasing morbidity • Care activity is highly demanding of informal carers, and there is evidence of distress in the informal carer population Strategic Outcomes • Experience of services are positive Lives are healthier • People live more independently • Quality of Live is improved • Health inequalities are reduced • People are safe • Carers are supported Key Focus 2.1 Service users and their carers, are supported in accessing services. Services work proactively to develop ways for people to access services remotely, reducing the need for people to travel. Ref Actions Measures key protected characteristics Page 12 of 31 Page 154
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APPENDIX 1 a) Update 2021: HSCM will continue to improve the Digital Health and Telecare Services available in Moray for those people with a disability or who are elderly and cannot physically access their local health services e.g. Use of Near me in consultations Community Development Team have supported 80 people with protected characteristics to access devices and training, to enable them to make use of digital services and video consultations an essential aspect of this work. Devices have also been supplied to care homes. Numbers of consultations undertaken using near me Satisfaction of patients/clients All characteristics b) Update 2021: Implementation of telephone triage and near me (video assessment) in March 2020 – easier access to the OOH Primary Care service to patients Update 2025: GMED continues to offer telephone advice as a nationally agreed case type. Advice calls constitute the highest number of cases dealt with by the service as opposed to the pre-pandemic levels, where Centre Consultations case type was most utilised. ‘Near me’ use within the service is not monitored, however, clinicians are encouraged to use the tool in supporting assessment and treatment. GMED is currently going through redesign whose aim is to enhance efficiency and quality through streamlining of processes, developing and optimising resources to deliver an efficient, person-centred and financially viable service delivery model, through innovative approaches and restructuring of workflows. The vision of the redesign is fully aligning with the Equality outcome 2 particularly with work on reviewing pathways, access and capacity to support patients in rural and remote locations in Moray No. of consultations completed using virtual assessment tool All characteristics c) Update 2021: In our Residential Children’s Service at CALA the Young People in our service have been supported to use the Near Me Service and other virtual means of accessing Weekly consultations for some young people, Age, disability and ethnicity. Page 13 of 31 Page 155
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APPENDIX 1 health care and support. as required. d) Update 2021: Frequently, the older people the our Shared Lives Service support do not have family members who live nearby and they struggle to access various services including Opticians – eye tests and hearing tests including fitting of glasses and hearing airs, dentists, Chiropodist, Specialists appointments etc. They may also lack capacity to notice that their quality of life has become diminished e.g. hearing problems affecting their ability to hear and interact with peers. Carers provide flexible support to take users to appointments Age Disability Key Focus 2.2 Services support individuals to identify and achieve their support outcomes using a variety of options. Self- Direct Support is promoted Ref Actions Measures key protected characteristics a) Update 2021: In the START service all service users are asked to participate in their service looking at choices, preferences, ability to maintain their independence, health and wellbeing. This is recorded in their personal plan. On the review document there are questions relating to their feedback on how we can improve the service and their involvement Reviews and feedback are taken during and when the service ceases. All b) Update 2021: In our Community Support Service users take part in the support planning and reviews, they are encouraged to make their own recording (where possible) on the service they received and whether their goals and outcomes were met. Through review process Mental Health Disability Age c) Update 2021: In our Housing Support Service at Woodview liaising with other health professional, individuals, families and guardians to identify individuals requiring person led Health and Social Care Services to transition into their own home with person centred support packages tailored to meet the individual’s needs. Number of transitions achieved. Disability d) Update 2021: Updates and regular Disability Page 14 of 31 Page 156
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APPENDIX 1 The multi-disciplinary team in our Housing Support Service covering Woodview and Woodview Children and Young People meet in collaboration with other services to identify children’s needs for provision of a person centred Health and Social Care Service. Identified staff then work alongside young person, family, professionals and others to plan the process for transition into a person centred environment. meetings e) Update 2021: The Care at Home Service is available to all people with an assessed need for support. The service agrees how it will be delivered to meet with the person’s individual choices to remain safely at home for as long as possible. Part of the assessment includes risk assessment and ensuring the service supports both reducing risk and making informed choices about positive risk taking, if the person makes that decision. Reviews at 6 weeks and 6 monthly thereafter include feedback on the service and how improvements can be made. Reviews and feedback are taken to identify improvement. All Age f) Update 2021: Informal carers are supported to undertake their Adult Carer Support Plan to identify their own support needs and if they have entitlement to Self- Direct Support Increase in positive responses for Carers feeling supported All Key Focus 2.3 Service users should have a say in local service delivery services and more in involvement in designing and delivering these services Ref Actions Measures key protected characteristics a) Update 2021: The IJB has an agreed communication, engagement and participation framework which guides all activity. The Board has endorsed the National Standards for Community Engagement which sets the best practice principles for the way public bodies engage with communities. Stakeholders are engaged in identifying and assessing needs and priorities, developing strategies and plans, designing pathways and services, examples such as; • Making Recovery Real Partnership in mental health – carer groups for Ward 4 and Muirton Number of people getting involved in service design through co-production and engagement opportunities Increase in positive responses relating to satisfaction with services provided All Page 15 of 31 Page 157
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APPENDIX 1 • Keith & East Locality Project – prior to Covid • Engagement group for Moray Transformation Board Services seek feedback on existing services from service users/patients and carers through a variety of means including conversations, monitoring surveys and feedback forms • Engagement with unpaid carers (Jan/Feb 2021) Update 2025: The IJB actively encourages stakeholder engagement at every opportunity, ensuring that service users have a meaningful say in local service delivery. This includes representation on the board to foster inclusive decision-making. Additionally, the IJB adheres to the 'Planning with People' guidance, emphasising collaborative approaches in designing and delivering services. Key Focus 2.4 HSCM Services understand and support the needs of communities and individuals Ref Actions Measures key protected characteristics a) Update 2021: Collation of the Joint Strategic Assessment and using information to base decisions for service delivery across Moray Joint Strategic Needs Assessment updated bi-annually All Update 2025: The Joint Strategic Needs Assessment was completed and approved in September 2024. HSCM is collaborating with NHSG to produce a JSNA for Grampian. Add link b) Update 2021: Improving early assessment and responses to child neglect and poverty across Children and Families Health Services. A shared method has been identified and confirmed, through this, conditions for change have been created and there is an understanding of the current system, early assessments and response undertaken with improved outcomes for people involved Age Page 16 of 31 Page 158
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APPENDIX 1 including where there may be gaps. This includes adoption of NHS Grampian Neglect 7 Minute Brief and development of Moray Child Poverty 7 Minute Brief that support discussions to ascertain current levels of knowledge and understanding on neglect / poverty respectively and what would support practitioners to improve/build on an early assessment and response to this. Update 2025: Implementation of the GCP2 in 2023: The Graded Care Profile 2 (GCP2) has been implemented to support a multiagency assessment tool that identifies neglect and promotes early intervention to improve outcomes for families. This tool provides an evidence-based assessment for Health Visitors and School Nurses to identify and document neglect effectively. It is planned to repeat the training in the future. Early Identification and Intervention: The GCP2 supports early identification and intervention of neglect in families. Although the training is currently on hold due to staff not implementing this tool in practice, it remains a critical component of the strategy to provide evidence-based assessments. Poverty: The financial inclusion pathway is being updated and will be relaunched, and plans are in place to embed a referral to the income maximisation form onto MORSE. Confirmation is awaited to enable direct referrals from MORSE to the Income Maximisation Team. Monitoring Referrals: The Income Maximisation Team is now monitoring referrals sent from Health Visiting and Family Nurse Partnership (FNP) teams. This measure aims to improve the referral process and ensure that families receive the financial support they need. c) Update 2021: SDMD data based, DAISY system, Recovery Outcomes Tool, MADP quarterly reporting and MADP delivery plan. Agency and MADP quarterly reporting Update 2025: All patients registered in a Moray GP practice have access to a Medication Review. Page 17 of 31 Page 159
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APPENDIX 1 Key Focus 2.5 Informal carers are treated with values and principles of HSCM. They are supported and respected Ref Actions Measures key protected characteristics a) Update 2021: Dedicated social worker assigned to providing assistance and support to informal carers including the development of their Adult Carer Support Plan that helps identify any additional support they require in their own right. No. of Adult Carer Support Plans completed Carers are supported Age, Disability Update 2025: Young Carers in the School Nurse Pathway: The needs of young carers are embedded in the School Nurse Pathway to ensure they receive the support and respect they deserve. Response to Requests: The School Nurse responds to requests for assistance from the Named Person and contributes to the child's chronology, ensuring a comprehensive understanding of the young carer's situation. Wellbeing Assessment: The School Nurse performs a wellbeing assessment using the GIRFEC (Getting It Right For Every Child) National Practice Model, which helps to identify and address the specific needs of young carers. Coordination of Health Aspects: The School Nurse coordinates the health aspects of the child’s plan, ensuring that young carers receive appropriate health support. Alerting Professionals: The School Nurse alerts other professionals to the specific needs of young carers, ensuring continuous support. Linking with Services: The School Nurse links with specialist children and adult services as appropriate, providing a network of support. Guidance Document: An NHS Grampian School Nurse Pathway guidance document is awaiting implementation to standardise and enhance the support provided to young carers. Data Collection: Data is collected on the number of referrals to School Nurses and the pathways young carers follow within the School Nurse Pathway. This helps to monitor the effectiveness of the support provided and identify areas for improvement. Page 18 of 31 Page 160
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APPENDIX 1 Specialist School Nursing Contribution – Priority Areas Of Intervention - Specialist school nursing: priority areas and pathways - gov.scot b) Update 2021: The MADP contract with Quarriers Carers and Arrows to support carers and families. Outcomes written into contracts. Services provide quarterly performance reports. All Equality Outcome 3- Health and Social Care staff understand the needs of people with different protected characteristics, are able to support them and promote diversity in the work they do. Strategic Theme: Partners in care, Building resilience Evidence: from Workforce Planning and Employee Information held by partner organisations (Moray Council and NHS Grampian) Strategic Outcomes: • Staff and Carers are supported · • The Workforce continually improves · • Resources are used effectively and efficiently Key Focus 3.1 All staff to receive feedback and are given development opportunities aligned to the common values and principles of HSCM Ref Actions Measures key protected characteristics a) Update 2021: In our Housing Support Service at Woodview which is an expanding service, a keyworker development programme and pack was implemented to aid career Number of Support Workers participating along with reviews Disability Page 19 of 31 Page 161
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APPENDIX 1 progression/aspirations. The programme/pack was designed and put together to help support staff gain the skills, knowledge and understanding to progress to Keyworker job role as opportunities arose. This enhances staff skills within this role and is beneficial in ensuring a consistent approach for individual service users. and feedback. b) Update 2021: The Staff team at our Residential Service at CALA have been supported in enhancing their knowledge of local resources and enhancing practice skills through attending training, mainly by virtual means (i.e., mental health awareness training, ABI training). Training records, feedback from staff as to how training impacts practice Age All c) Update 2021: The MADP Workforce programme was put on hold at the start of the pandemic, but was re-established with courses being provide using IT and video systems. This has continued to develop with a full programme now running. Training records and feedback. All Key Focus 3.2 All staff are aware of issues affecting health equalities and receive training, appropriate for their roles Ref Actions Measures key protected characteristics a) Update 2021: Through the working leadership collaborative development of a programme to help health care support workers to have difficult conversations with patients/individuals. Participation numbers Feedback from participants. Age (vulnerable families). b) Update 2025: Specialist School Nursing: Priority Areas and Pathways: The refocused School Nurse role (for 5-19 years old) concentrates on ten priority areas and represent public health priority areas and interventions which have been found to be effective in preventing adverse childhood experiences (ACEs), the impacts of which not only effect health and development potential in childhood, but can also persist deep in to adulthood. Data is collected on the number of referrals to School Nurses and the pathways young people follow within the School Nurse Age (vulnerable families) Sex Page 20 of 31 Page 162
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APPENDIX 1 Ten Supporting Pathways have been developed and implemented. Through current Scottish Government funding a local plan is in place to increase the qualified school nursing staffing establishment and via local investment, increase the number of school nurses to complete an MSc Advancing Practice programme at Robert Gordon University in Aberdeen to become qualified School Nurses. Pathway. Update 2025: Specialist School Nursing: Priority Areas and Pathways: Prevention and Early Intervention: The school nursing role focuses on prevention, early intervention, and support for the most vulnerable children over five years old. This includes concentrating on ten priority areas under the headings of vulnerable children and families, mental health and wellbeing, and risk-taking behaviour. Effective Interventions: Interventions in these areas have been found effective in preventing ACEs and alleviating their short- and long-term effects. School nurses play a crucial role in both preventing ACEs and mitigating their impacts when they occur. Staffing and Training: In 2024, Moray had one School Nurse qualify, with two more due to qualify in 2025. However, there is insufficient funding to train another School Nurse in 2025/2026. Data Collection: This helps monitor the effectiveness of interventions and identify areas for improvement. Data is collected on the number of referrals to School Nurses and the pathways young people follow within the School Nurse Pathway. c) Making Every Opportunity Count Training 2019/20: 113 practitioners from 23 organisations trained 2020/21: No training delivered due to team redeployment 2021/22: MeOC training adapted and delivered virtually. 170 practitioners from a range of services attended MeOC training Bespoke training was provided to the Moray Covid Vaccination administration team. Feedback from the team stated that they have increased confidence in providing accurate signposting to services. Participation numbers Feedback from participants. Age Disability Page 21 of 31 Page 163
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APPENDIX 1 2022/23: 26 practitioners trained 2023/24: 25 practitioners trained. 2024/25: MeOC session embedded in Moray Council Care at Home Induction. 185 practitioners trained. Realistic Medicine and Shared Decision Making incorporated into MeOC training. Feedback: “We weren't sure what MeOC was before the training session but now feel confident using this in the community” “Really good to have clarification of trusted places to refer clients to” MeOC Ageing Well tool developed in partnership with HIS Frailty Collaborative. Feedback: “This is a great tool to have in my job role and in other community roles I am in” d) Alcohol Brief Interventions Training 2019/21: 105 practitioners completed the ABI training session 2021/22: 127 Practitioners completed the ABI training session 2022/23: 57 practitioners completed the ABI training session 2023/24: 33 practitioners completed the ABI training session There is a notable increase in confidence of raising the issue of alcohol following the training: 25% increase reporting feeling extremely confident to raise the issue of alcohol 39% increase reporting feeling confident to raise the issue of alcohol 0% reporting as feeling average in confidence to raise the issue of alcohol 0% reporting feeling not confident to raise the issue of alcohol 2024/25: Q1 – 2 sessions delivered, 15 participants Participation numbers Feedback from participants. Age Disability e) Update 2021: In our Housing Support Service covering Woodview and Woodview Children and Young People they implemented a document to record sensitive information the young person wished to share with staff members. Staff were instructed and Review documents and records regularly. Disability Page 22 of 31 Page 164
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APPENDIX 1 shown how to use the system, record the information and when to report concern to senior staff. g) Update 2021: (See references above to MADP workforce programme). The new DAISY (Drug and Alcohol Information System) was introduced in December 2020. Staff have been trained and supported in using the system. Contracted agencies have workforce development and staff support systems in place. Agency and MADP quarterly reports and agencies contract reviews. All Key Focus 3.3 The health and wellbeing of staff is prioritised and supported. Opportunities for personal well-being, development and learning are provided for all employees. Ref Actions Measures key protected characteristics a) Update 2021: Health and Wellbeing – key health messages delivered via video and QR codes. Telephone and MS Teams appointments for staff and staff supported via virtual t breaks Participation numbers Feedback from participants. Age Disability 2019/20: HealthPoint staff continued to support colleagues via phone, email, and in person. The Public Health Directorate organised various short, virtual stress awareness and management courses, along with other public mental health training for health, social care, and Third Sector staff. 2020/21: HealthPoint closed for walk-ins, and outreach services ceased due to team redeployment. Telephone enquiries were welcomed. A Staff Health and Wellbeing Group was established in response to Covid-19, with representatives from NHSG and HSCM. HealthPoint supported staff health and wellbeing through accessible information and supportive telephone appointments, prioritising shielding individuals and those working remotely. In July, HealthPoint reopened at designated times for staff only, offering general health and Page 23 of 31 Page 165
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APPENDIX 1 wellbeing support, including healthy eating advice and smoking cessation. 2021/22: HealthPoint continued to support staff, handling 105 enquiries, many related to Covid-19, vaccination, and testing procedures. HealthPoint participated in virtual tea breaks for staff who were shielding or working from home, providing practical advice on healthy eating, mental wellbeing, and sleep. Eight virtual tea breaks were delivered. Short information videos on key health topics were shared with staff and the public via social media. The Health Improvement Team delivered a live presentation on promoting positive health and wellbeing during Health Information Week. 2022/23:The HSCM Staff Health and Wellbeing newsletter, "We Care, Let's Share," was created, with August and September briefings receiving 99 and 261 views, respectively. The We Care website was updated, and the newsletter was discontinued. The Staff Health and Wellbeing Working Group was disbanded due to poor attendance, with updates shared via an MS Teams channel. 2023/24: Monthly Monday drop-in sessions at Dr Gray’s Hospital focused on women’s health topics, including menopause, providing peer support. Approximately 18 staff members attended over 12 weeks. The sessions ended due to reduced engagement, but continued support via HealthPoint was encouraged. 2024/25: Health and wellbeing support was incorporated into The Moray Vaccination Team study day, attended by 35 staff members. Staff were supported in creating a team We Care information board. Update 2025: Wellbeing at Team Meetings: Regular team meetings include discussions on wellbeing to ensure staff feel supported and valued. Supervision for Qualified Staff: Qualified staff receive supervision to provide guidance, support, and opportunities for professional development. Wellbeing Resources: Wellbeing resources are shared on Teams, offering easy Page 24 of 31 Page 166
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APPENDIX 1 access to information and tools that promote personal health and wellbeing. Regular Breaks and Timely Leave: Staff are encouraged to take regular breaks and leave work on time to maintain a healthy work-life balance. b) Update 2025: Walk Moray – promotion of physical activity through Walk Moray. 2019/20: Health Walk for NHS Staff and Partners commenced 2022/23: NHSG Winter Step Count Challenge supported by Paths for All 2023/24: NHSG Winter Step Count Challenge supported by Paths for All 2024/25: NHSG Winter Step Count Challenge supported by Paths for All - Over 370 active teams and over 1,800 hundred active participants Health Walk Coordinator achieved the Walk at Work Award through Paths for All, promoting walking in the workplace Walk at Work Award | Paths for All. Participation numbers Feedback from participants. Age Disability c) Update 2021: taking lessons and experiences of staff who are shielding and working from home at the same time, the service will continue with the home working model to enable staff remain in the workplace. This would be done in conjunction with OHS and GP to ensure staff are fit to work in some capacity within the home environment. OHS assessments, feedback from staff disability/age/ pregnancy/race Update 2025: Following the pandemic recovery, staff have returned with a hybrid model of working, where applicable. Hybrid working is beneficial for staff wellbeing as it offers greater flexibility, allowing employees to balance work and personal life more effectively. This approach also reduces commuting stress and time leading to improved mental health and productivity. d) Update 2021: Within all Provider Service Teams, the Time for Talking service was added in updates for people who felt they needed confidential advice and support for any personal issues they were going through. Voluntary and Confidential All Protected characteristics are included e) Update 2021: Feedback from All Page 25 of 31 Page 167
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APPENDIX 1 In all of our Provider Service Teams, regular updates on COVID-19 communicated to the workforce as they become available. This included information from HSCM, Moray Council, the Care Inspectorate, Health Protection Scotland and NHS Grampian. Social Care Assistants kept service users updated on issues which were relevant to them to maintain appropriate protection for employees and people using services No update for 2025 due to end of pandemic response. employees f) Update 2021: All teams within our Independent Living Service were given information on Health and wellbeing. This included emails with information on looking after yourself and your mental health also, invitations to webinars discussing Health and wellbeing. It was voluntary participation All Protected Characteristics are be included g) Update 2021: In all of our Provider Service Teams, staff support during the pandemic has been maintained by; Daily, weekly, monthly oversight meetings; • regular updates and new or amended information immediately; • Having access to a central point to discuss any processes or fears; • Having access to appropriate PPE; • Early access to vaccination programmes; • Access to Lateral Flow testing; Access to Time for talking which is a confidential advice service available to council employees. Feedback from employees All h) Update 2021: See references to MADP workforce development above. Contracted agencies have staff support systems in place. Quarterly contract review meetings Page 26 of 31 Page 168
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APPENDIX 1 Review of Equality Outcomes set out in 2021-2024 report 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 also explore how our commissioning activity, both internal and external, can better support the delivery of equality outcomes. Moray Community Appointment Day To address post-Covid waiting times, HSCM organised an event for people with joint, bone, and muscle problems. Over 120 attendees received support from physiotherapists, podiatrists, occupational therapists, nutritionists, and dietitians at Moray Sports Centre in Elgin. Charities and community groups also provided advice on mental health, cost of living, arthritis, home energy costs, and general fitness. A video link to the event is available here. Day Opportunities Team The pandemic led to the closure of building-based day services, prompting service transformation. Extensive engagement revealed a need for person-centered, flexible support options. Self-Directed Support (SDS) Enablers and the Social Work team developed individualised support plans, benefiting around 100 carers and care recipients. The approach focused on communication, relationship building, and supporting unpaid carers to achieve 'a good life.' Following a successful pilot, MIJB approved the permanent implementation in June 2022, with three additional SDS Enablers recruited by October 2022. Positive feedback from service users highlights the impact, such as improved mental health and wellbeing. 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.'" Engagement with Equality Groups What we said: We recognise 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. Page 27 of 31 Page 169
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APPENDIX 1 Carers Strategy – Engagement/Feedback In January 2021, during the COVID-19 pandemic, engagement sessions were held with unpaid carers to explore what a meaningful break would look like for them. This feedback was incorporated into wider engagement sessions for developing the Moray Carers Strategy "Recognised, Valued, Supported" (2023-2026). Wider Engagement Sessions Focus groups were conducted in August 2021, followed by an online survey launched on 1st October 2021, which remained open for four weeks. The survey received 181 responses, with 85% identifying as female and 15% as male. Nearly half of the respondents provided care for more than 50 hours per week. Key Findings Time for Self: Carers expressed the need for "time for me" and "a few hours to myself—a whole day would be bliss" to support their health and wellbeing. Pursuing Hobbies: Carers wanted "time out for myself to pursue hobbies whilst my partner was cared for in my absence" to maintain a life alongside their caring role. Rest and Relaxation: Carers highlighted the importance of "catching up on sleep" and "a day out of the house relaxing" as essential components of a meaningful break. Making Recovery Real (MRR) Partnership Value of Lived Experience in Service Improvements HSCM values the contributions of those with lived and living experience in enhancing service improvements. The MRR Partnership, established in 2014/15, exemplifies this by balancing lived experience with professional expertise to deliver the local mental health and wellbeing strategy. The partnership, which meets both offline and online, follows a strengths-based approach underpinned by the CHIME recovery framework. It emphasises sharing skills, knowledge, and resources in a mutually supportive manner. Collaboration with Moray Wellbeing Hub HSCM collaborates with the Moray Wellbeing Hub, a local social enterprise, on the 'Collective Voice' initiative. This initiative gathers and shares feedback from individuals with lived mental health experiences. It has led to the integration of lived experience peers in inpatient mental health wards and influenced the procurement of mental health support contracts in late 2024. The Hub also facilitates peer support and training events across Moray and undertakes specific projects funded by organisations like the Drug and Alcohol Partnership. Page 28 of 31 Page 170
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APPENDIX 1 Co-Production in Commissioning and Procurement In recent commissioning and procurement efforts, HSCM and representatives with lived experience co-produced the service specifications. Community members with lived experience participated in the evaluation panel, scoring submissions and influencing the awarding of contracts. Horizon Scanning What we said: Future Planning We are enhancing our ability to identify potential inequalities early, especially for vulnerable groups, to take timely action and access resources. The Independent Review of Adult Social Care in Scotland will guide our approach as we implement its key recommendations. Service Development The new Self-Directed Support (SDS) standards will expand understanding of SDS options and focus on personal outcomes through our 3 Conversations model. We are also updating the Moray Carer Strategy to support the increasing number of unpaid carers for our aging population and those with long-term conditions. Additionally, we are monitoring the impact of new legislation, including Human Rights in Scots Law, on our services. Self-Directed Support (SDS) The SDS Framework of Standards (2024) aligns with the Social Care (Self-Directed Support) (Scotland) Act 2013. The 12 standards and practice statements support system changes to implement SDS principles, improve practice, and ensure consistency for care recipients. A self-evaluation will benchmark progress against these standards. The re-established SDS Steering Group will provide governance and oversight. 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) The bill has not yet been formally introduced to Parliament. Page 29 of 31 Page 171
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APPENDIX 1 New Scots Moray has welcomed 19 asylum-seeking young people via the National Transfer Scheme, adopting the term 'New Scots' instead of 'Unaccompanied Asylum Seeking Children' (UASC). Upon arrival, they are supported by the Throughcare & Aftercare Team as Looked After Children and provided accommodation based on their needs. To date, 12 New Scots have been granted asylum, with some moving to their own tenancies or starting courses, while others relocated to cities like Glasgow and London to be closer to their communities. For example, two young people have moved to their own tenancies in Moray and one young person started a course at Dundee College. 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 30 of 31 Page 172
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APPENDIX 1 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. Frailty Over the past 18 months, Health and Social Care Moray participated in the National Frailty Collaborative, resulting in a Frailty Action Plan aligned with Grampian initiatives. Key outcomes include: Creating conditions for a whole-system approach to frailty, encompassing community initiatives, early identification in Primary Care, and various interventions. Early identification of frailty in primary and secondary care settings. Proactive integrated planning and case management for optimal individual outcomes. Engaging the public, health and social care staff, and third sector/community groups to promote healthy aging practices. Collaborating with the Digital Health Institute to maximise digital innovation for prevention, early intervention, condition monitoring, and self-management. Integrating Moray’s frailty initiatives with the broader NHS Grampian Frailty Network. The Moray Frailty Delivery Group continues to progress this work, collaborating closely with leads in Aberdeen City and Aberdeen Shire through the Grampian Frailty Group. Page 31 of 31 Page 173
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Find out more about the Moray Integration Joint Board and Health & Social Care Moray on our website: https://hscmoray.co.uk/index.html Follow us on social media Facebook @hscmoray Instagram @hscmoray For further information contact: Health & Social Care Moray Moray Council Offices High Street Elgin Moray IV30 1BX Gram.hscmcorporate@nhs.scot MORAY INTEGRATION JOINT BOARD Equality Progress Report 2021-2024 Appendix 1 Page 174
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Equality Mainstreaming & Outcomes MORAY INTEGRATION JOINT BOARD Report for 2025-2029 APPENDIX 2 Page 175
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Page 2 Contents This report provides an overview of progress made in achieving Moray Integration Joint Board’s equality outcomes over the last five 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. Executive Summary Legal Context Strategic Context Our Approach to Equality Protected Characteristics Key Findings from Equality Data Engagement Mainstreaming Equality in MIJB Equality Impact Assessments Leadership and Structure Getting It Right for Everyone (GIRFE) Governance and Accountability Monitoring and Reporting Equality Outcomes 2025-2029 Conclusion Equalities Outcomes for 2025-2029 3 4 4 4 5 6 9 10 11 12 12 13 13 14 15 16 Page 176
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Page 3 This report presents the equality outcomes Health and Social Care Moray (HSCM) aims to achieve between 2025 and 2029. Our objectives align with the Strategic Delivery Plan, meet statutory duties under the Equality Act 2010, and support Scotland’s National Health and Wellbeing Outcomes. We have identified seven key equality outcomes (Appendix 1) aimed at reducing and enhancing services for Moray’s residents, particularly those with protected characteristics and socio-economic disadvantages. The seven key equality outcomes include: • Enhancing equity in service access and delivery • Supporting carers with flexible and inclusive services • Providing sustainable housing solutions for individuals with learning disabilities. • Supporting children and young people affected by substance use. • Promoting inclusive workforce development. • Strengthening community engagement and participation. • Redesigning adult day services to be person-centred and community-based Through these outcomes, we aim to create a fairer, more inclusive health and social care system in Moray. Executive Summary Page 177
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Page 4 HSCM operates within a complex legislative framework, including: • Equality Act 2010: Places general and specific duties on public bodies to eliminate discrimination, advance equality, and foster good relations • Public Bodies (Joint Working) (Scotland) Act 2014: Establishes integration authorities and sets requirements for service planning and delivery • Fairer Scotland Duty: Requires consideration of how to reduce inequalities of outcome resulting from socio-economic disadvantage • Human Rights Act 1998: Ensures public services respect and protect fundamental human rights This Report supports: • HSCM Strategic Delivery Plan 2025-2028 • Moray Integration Joint Board Strategic Plan ‘Partners in Care 2022-2032’ • Scotland’s nine National Health and Wellbeing Outcomes • Grampian-wide equality initiatives Vision for Equality: “People in Moray experience fair access, respectful services, and equitable outcomes regardless of their personal characteristics or circumstances.” Principles • Involvement: Ensuring those affected by our work can meaningfully shape it. • Evidence-based: Using data and lived experience to identify and address inequalities. • Mainstreaming: Embedding equality in everything we do, not treating it as an add- on. • Partnership: Working across agencies to address complex inequality issues. • Intersectionality: Recognising people may experience multiple forms of disadvantage. Legal Context Strategic Context Our Approach to Equality Page 178
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Page 5 We recognise our specific duties toward people with the following protected characteristics: • Age • Disability • Gender reassignment • Marriage and civil partnership • Pregnancy and maternity • Race • Religion or belief • Sex • Sexual orientation Socio-Economic Duty We acknowledge that poverty often overlaps with other disadvantages, worsening health inequalities. Our equality outcomes therefore also consider socio-economic disadvantages in health and social care. Protected Characteristics Page 179
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Page 6 Our equality outcomes are informed by: • Joint Strategic Health Needs Assessment (2024) • Service usage patterns across different groups • Health inequality data for Moray • Feedback from people and community members • National evidence on healthcare disparities Where we do not have detailed HSC Moray data, we have liaised with our partners (Moray Council and NHS Grampian) to identify issues of relevance to our local area. Examples from across Grampian include a piece of work to understand ways of increasing uptake of screening amongst vulnerable groups, a Health Needs Assessment for Asylum Seekers across Grampian, and the specific needs of people with drug and alcohol issues when they are accessing hospital services within Grampian. Key findings include: • Age: Aging population in Moray creating increased demand for services. • Disability: Higher barriers to accessing mental health services. • Rurality: Geographic isolation compounds issues for those with protected characteristics. • Digital Access: Digital exclusion affecting older people and those on low incomes. Population Health: The assessment highlighted an aging population in Moray, with a significant increase in the number of residents aged 65 and over. This demographic shift is expected to increase demand for health and social care services (see Outcomes 1 and 5). Chronic Conditions: There is a rising prevalence of chronic conditions such as diabetes, cardiovascular diseases, and respiratory illnesses. The JSNA emphasized the need for enhanced preventive measures and enhanced management strategies to address these conditions (see Outcomes 1 and 3). Mental Health: Mental health issues, particularly among younger populations, were identified as a growing concern. The report called for improved mental health services and support systems to cater to this demographic (see Outcomes 4 and 6). Unpaid Carers: The assessment acknowledged the critical role of unpaid carers in the community, noting that there are between 700,000 and 800,000 unpaid carers across Scotland. It stressed the importance of providing adequate support and resources to these individuals (see Outcomes 2 and 7). Key Findings from Equality Data Page 180
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Page 7 Service Integration: The JSNA underscored the need for better integration of health and social care services to ensure seamless and efficient delivery of care. This includes enhancing communication and coordination between different service providers (see Outcomes 1 and 5). Resource Allocation: The report highlighted the necessity of optimizing resource allocation to meet the growing and changing needs of the population. This involves strategic planning and investment in key areas such as workforce development and infrastructure (see Outcomes 1 and 7). 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 that is poorly recorded. We will be undertaking further work over the next couple of years to understand the needs and views of particularly vulnerable populations in Moray 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. These findings aim to guide the strategic planning and decision-making processes of the Moray IJB to improve health and social care outcomes for the local population. Page 181
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Page 8 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 new datasets and data Spotlight Page 182
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Page 9 Engagement is crucial for ensuring that our services meet the needs of the community. Although we were unable to conduct formal engagement for this report, we utilised data from the 2024 Joint Strategic Needs Assessment and the recent Strategic Delivery Plan to inform our report. This approach ensures alignment with our service delivery plan, prevents duplication of efforts, and addresses the needs identified in the strategic needs assessment. We prioritised collaboration with services that had already engaged in their planning processes to ensure comprehensive and inclusive outcomes. We also considered the Joint Delivery Plan of NHS Grampian, our key partner, to ensure cohesive and integrated service delivery Engagement 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. Page 183
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Page 10 Mainstreaming equality for the Moray Integration Joint Board (MIJB) means integrating equality considerations into every aspect of their work. This approach ensures that equality is embedded in all aspects of the IJB and Health and Social Care Moray (HSCM) operations, from strategic planning to service delivery. The goal is to make equality and fairness an integral part of the IJB’s culture, rather than treating them as additional considerations. For instance, during budget planning, the IJB evaluates how funding decisions might impact groups identified under protected characteristics and those facing economic challenges. HSCM is dedicated to embedding equality in every part of our operations. We will set clear equality outcomes, monitor progress regularly, and ensure accountability. We prioritise inclusive policy-making by actively involving stakeholders in decision-making processes. NHS Grampian and Moray Council provide training for staff on equality and diversity to foster a more inclusive workplace culture. By embedding these practices, HSCM strives to create a more equitable and responsive health and social care system. To ensure equality is embedded rather than seen as an add-on, we will: • Conduct Integrated Impact Assessments (IIAs): Prioritise IIAs for all service changes and policies to identify and address potential inequalities. • Engage Stakeholders: Actively involve stakeholders in the development and review of policies and services to ensure diverse perspectives are considered. • Provide Training: Offer ongoing training for staff on equality and diversity to enhance their understanding and ability to implement inclusive practices Mainstreaming Equality in MIJB Page 184
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Page 11 Equality Impact Assessments (EIAs) are essential for ensuring that all policies, practices, and decisions are inclusive and equitable. HSCM uses Integrated Impact Assessments (IIAs), which combine elements from NHS Grampian and Moray Council. IIAs help to identify and address potential inequalities affecting staff, service users, and the wider community. Systematic evaluation of actions on different protected characteristics allows HSCM to prevent discrimination, promote fairness, and enhance service effectiveness. This commitment to equality fosters a culture of respect and inclusivity, leading to better health and wellbeing outcomes. The process involves: • Identifying Potential Inequalities: Assessing how proposed changes may impact different protected characteristics. • Mitigating Adverse Effects: Developing strategies to address and mitigate any identified inequalities. • Promoting Inclusivity: Ensuring that all policies and practices promote inclusivity and respect. • Enhancing Service Effectiveness: Continuously improving services based on feedback and systematic evaluation. Equality Impact Assessments Page 185
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Page 12 MIJB Structure and Staff The MIJB includes residents with experience using health and care services, local councillors, NHS Board members, staff from the Health and Social Care Partnership, and a representative from voluntary organizations. The board convenes monthly, alternating between formal meetings, where decisions are made (these meetings are web-cast and accessible to the public, with recordings available online for six months), and informal development sessions for in-depth discussions on specific issues such as finance, strategy, and current topics. Organisations or groups can make deputations to the formal meetings through a spokesperson. All MIJB papers are accessible on the Council website. The MIJB has two sub-committees: Audit, Performance and Risk, and Clinical and Care Governance. The MIJB employs only two staff members, the Chief Officer and the Chief Finance Officer, and is therefore not required to publish gender pay gap information or statements on equal pay. The MIJB continues to collaborate with its partners to ensure that the Moray Health and Social Care Partnership benefits from a diverse workforce that reflects the residents of Moray and promotes fairness. Additional workforce information is available in reports from Moray Council and NHS Grampian, which can be found online. 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. Leadership and Structure Getting It Right for Everyone (GIRFE) Page 186
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Page 13 Responsibility for delivering these equality outcomes is structured as follows: MIJB: Ultimate accountability for equality outcomes • Chief Officer: Executive leadership • Strategic Planning Group: Ensuring alignment with strategic priorities • Service Managers: Implementation within service areas • All Staff: Contributing to equality in daily practice Our parent organisations, as the employing bodies, NHS Grampian and Moray Council have detailed specific outcomes detailed within their plans for staff with protected characteristics. The ethos of these plans is strongly reinforced within HSCM. To ensure accountability and continuous improvement, progress will be monitored through the following mechanisms: • Bi-annual progress reports to the MIJB: Detailed updates on the implementation of equality outcomes. • Service user feedback mechanisms: Regularly collecting and analysing feedback from service users. • Staff equality surveys: Gathering insights from staff about workplace equality and inclusivity. • Integrated Impact Assessments (IIAs): Evaluating the impact of policies and practices on different protected characteristics. Governance and Accountability Monitoring and Reporting Page 187
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Page 14 Based on our evidence review and aligned with both our Strategic Delivery Plan and National Health and Wellbeing Outcomes, we have established seven equality outcomes for 2025-2029, see Appendix A. National Health and Wellbeing Outcomes The Equality Outcomes have been developed to align with the nine National Health and Wellbeing Outcomes that have been set by the Scottish Government. Each Integration Joint Board (IJB) uses these outcomes to set their local priorities. Equality Outcomes 2025-2029 People are able to look after, improve their own health and wellbeing, and live in good health for longer. People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. People who use health and social care services have positive experiences of those services, and have their dignity respected. Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Health and social care services contribute to reducing health inequalities. People who provide unpaid care are supported to look after their own health and wellbeing, including reducing any negative impact of their caring role on their own health and well-being. People who use health and social care services are safe from harm. People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. Resources are used effectively and efficiently in the provision of health and social care services. Page 188
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Page 15 These equality outcomes demonstrate HSCM’s dedication to fostering a fairer, more inclusive health and social care system in Moray. Our alignment with the Strategic Delivery Plan and the National Health and Wellbeing Outcomes ensures that equality is embedded in all our activities. This approach enables us to deliver services that meet the diverse needs of Moray’s population, ensuring that everyone, regardless of their background or circumstances, can access high-quality care. We invite all stakeholders to join us in this commitment to equality and inclusivity, working together to build a healthier, more equitable community. Conclusion Page 189
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Page 16 Equalities Outcomes for 2025-2029 Page 190
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Page 17 Outcome Statement: Provide accessible services that support people to remain safe in their own homes through person-centred care and digital transformation. Protected Characteristic: Age/Disability Ensuring that all individuals, regardless of their background or personal circumstances, have equal access to high quality, person-centred home care services. This approach promotes inclusivity, reduces inequalities, and enhances the overall well-being of people, enabling them to remain safe and independent in their own homes. Strategic Theme: Home First/Partners in Care National Health and Wellbeing Outcomes: Outcome 2: People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. Outcome 7: People who use health and social care services are safe from harm. Key Actions: 1. Person-Centred Care: • Conduct comprehensive assessments to understand the individual needs and preferences. • Develop personalised care plans prioritising safety and well-being. • Offer flexible care options that adapt to changing needs. 2. Digital Transformation: • Implement digital tools and technologies, such as telehealth consultations and remote monitoring systems. • Provide training and support to individuals and caregivers to ensure they can effectively use digital tools. 3. Safety Measures: • Equip homes with safety devices and technologies, such as fall detectors and emergency alarms. • Offer regular check-ins and monitoring for ongoing safety of individuals living independently. 4. Community-Based Support: • Engage with community organisations to create a network of support services. • Promote awareness of available services within the community. 5. Monitoring and Evaluation: • Regularly monitor the effectiveness of services. • Collect feedback to continuously improve quality and accessibility. Performance Indicators: • Increased satisfaction levels among individuals. • Higher engagement in digital care services and remote monitoring. • Improved well-being and safety outcomes. Page 191
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Page 18 2. Outcome Statement: Paid and unpaid carers will be given choice, opportunities, and support to care for their loved ones, ensuring their well-being enabling them to balance their caring responsibilities with their personal lives. Protected Characteristic: Age/Disability/Gender/Race Carers can be of any age, gender, and racial background and many provide care for those with disabilities. Addressing these characteristics ensures that all carers receive equal support and opportunities. National Health and Wellbeing Outcomes: Outcome 6: People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Health & Social Care Strategic Priority : Building Resilience/Home First/ Partners in Care Key Actions: 1. Choice and Flexibility: • Develop flexible care plans for carers and those they care for. • Provide options for short breaks and respite care to ensure they are person centred. 2. Opportunities for Development: • Offer training and development programs for staff to promote awareness raising and early identification of carers. • Develop and roll out Care Aware Campaign to support awareness raising • Create pathways for employment opportunities within the health and social care sector, recognising their valuable experience. 3. Support Systems: • Establish support groups and networks for carers. • Develop access to mental health services and counselling. 4. Financial and Practical Assistance: • Provide financial support and benefits to unpaid carers. • Work with local businesses to offer discounts to unpaid carers as part of the Carer Aware campaign. • Offer practical assistance, such as transportation services and home modifications. 5. Inclusive Policies: • Develop policies that recognise the diverse needs of carers. • Promote awareness of the role of carers within the community. Performance Indicators: • • Increased satisfaction levels among carers. • • Higher participation rates in training programs. • • Improved mental health and well-being outcomes. • • Enhanced financial stability for unpaid carers. • • Greater inclusivity in policy-making and service delivery. Page 192
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Page 19 3. Outcome Statement: Support people with learning disabilities and their families in maintaining their health and wellbeing, and establishing tenancies in new supported accommodation. Protected Characteristic: Disability/Age Ensuring that all individuals with learning disabilities, regardless of their background or personal circumstances, have equal access to sustainable accommodation and support services. This approach promotes inclusivity, reduces inequalities, and enhances the overall well-being. National Health and Wellbeing Outcomes: Outcome 2: People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Health & Social Care Strategic Priority : Home First Key Actions: 1. Collaboration with Partners: • Contribute to a Grampian wide Health Needs Assessment of adults with learning disabilities. • Work with housing associations, local authorities, and support organisations. • Establish regular communication with partners. 2. Establishing Tenancies: • Assist in navigating the tenancy process. • Provide support during the transition to new accommodation. 3. Sustainable Accommodation Projects: • Continue and develop new LD Housing Projects. • Expand the availability of supported accommodation within Moray. 4. Support Services: • Offer ongoing support services, including access to healthcare, and community activities. • Provide training and resources to families and caregivers. 5. Monitoring and Evaluation: • Regularly monitor housing projects and tenants well-being. • Collect feedback to improve housing provision. Performance Indicators: • Increased number of successful tenancies. • Higher satisfaction levels among tenants and families. • Successful continuation and expansion housing projects. • Improved well-being and quality of life for individuals. Page 193
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Page 20 4. Outcome Statement: Support children and young people affected by their own or someone else’s drug or alcohol use. Ensure they can easily access support from their school and other services, and that families are supported to find their own recovery. Protected Characteristic: Age/Disability/Race/Gender/Religion or Belief/ Sexual Orientation Ensuring that all children and young people, regardless of their background or personal circumstances, have access to support services. This approach promotes inclusivity, reduces inequalities, and enhances their overall well-being. National Health and Wellbeing Outcomes: Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer Outcome 5: Health and social care services contribute to reducing health inequalities. Strategic Theme : Aligned to the Alcohol & Drug Partnership LOIP Key Actions: 1. Targeted Support Programs: • Implement the Aberlour YP Corra funded project. • Continue the Arrows Corra funded Promising Futures family support program. 2. Rights-Based Services: • Collaborate with Children’s 1st and Quarriers. • Partner with Action for Children and children’s residential services. 3. School-Based Support: Ensure access to support within schools. • Train school staff to recognise and respond to substance use. 4. Family Recovery Support: • Provide resources and support to help families find recovery. • Ensure access to support for children and parenting assistance. 5. Community Outreach: • Conduct outreach programs to raise awareness. • Engage with community organisations to identify and address barriers. 6. Monitoring and Evaluation: • Regularly monitor the effectiveness of support programs. • Collect feedback to improve support services. Performance Indicators: • Increased access to support services. • Higher satisfaction levels among families. • Successful implementation of targeted support programs. • Positive feedback from schools and community partners. • Improved well-being and recovery outcomes. Page 194
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Page 21 5.Outcome Statement: Support hub and outreach efforts in disadvantaged communities through tackling poverty, income levels, poor housing and disadvantage to help individuals avoid substance use. Expand efforts to other areas, including school talks, online conversation café, education and drug awareness, and Naloxone training. Protected Characteristic: All Ensuring that all individuals, regardless of their background or personal circumstances, have equal access to prevention and education efforts. This approach promotes inclusivity, reduces inequalities, and enhances the overall well-being of individuals in disadvantaged communities. National Health and Wellbeing Outcomes: Outcome 1: People are able to look after and improve their own health and wellbeing and live in good health for longer. Outcome 5: Health and social care services contribute to reducing health inequalities. Strategic Theme : Building Resilience/Partners in Care Key Actions: 1. Community Hubs and Outreach: • Establish and maintain community hubs in Buckie and Forres. • Implement outreach programs such as ‘Operation Protector’ to engage with disadvantaged communities. 2. School-Based Prevention: • Conduct regular school talks in Moray to provide education about the risks of substance use and promote healthier lifestyles. • Collaborate with schools to integrate substance use prevention into the curriculum. 3. Online Support and Education: • Develop an online conversation café to provide a platform to discuss substance use prevention and access support. • Offer education and drug awareness training to services. 4. Naloxone Training: • Provide Naloxone training to individuals and services. • Expand Naloxone training efforts to other areas. 5. Expansion of Efforts: • Identify additional areas for support and outreach. • Collaborate with local authorities and community organisations. 6. Monitoring and Evaluation: • Regularly monitor the effectiveness of hub and outreach efforts. • Collect feedback to improve prevention and education initiatives. Performance Indicators: • Increased access to support and resources in disadvantaged communities. • Higher engagement rates in school talks and online café. • Successful implementation of Naloxone training programs. • Positive feedback from community hubs and outreach programs. • Improved awareness and prevention outcomes in targeted areas. Page 195
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Page 22 6.Outcome Statement: A full redesign of adult day services will enable individuals to access day support that is person-centred and meets their agreed outcomes and aspirations. Where appropriate, day services will be provided within people’s own communities. Protected Characteristic: All Ensuring that all individuals, regardless of their background or personal circumstances, have equal access to high quality, person-centred day services. This approach promotes inclusivity, reduces inequalities, and enhances the overall well-being of individuals. National Health and Wellbeing Outcomes: Outcome 3: People who use health and social care services have positive experiences of those services, and have their dignity respected. Outcome 4: Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. Strategic Theme : Partners in Care Key Actions: 1. Person-Centred Approach: • Conduct comprehensive assessments to understand the individual needs and aspirations. • Develop personalised care plans that reflect these assessments tailored to meet each individual’s goals. 2. Modernisation of Services: • Integrate technology and innovative practices to improve service quality and efficiency. 3. Community-Based Support: • Expand the choice of day opportunity activities within local communities to ensure that individuals can access support close to home. • Collaborate with community organisations and local authorities to create a network of support services that are easily accessible, reducing the need to travel and pay for transport. 4. Staff Training and Development: • Provide ongoing training and professional development for staff. • Foster a culture of continuous improvement and innovation. 5. Monitoring and Evaluation: • Regularly monitor the effectiveness of services to ensure they meet the needs and aspirations of people. • Collect feedback to improve the quality and accessibility of services. Performance Indicators: • Increased satisfaction among people regarding the services. • Higher engagement in day service/day opportunities within communities. • Positive feedback from staff on training and development programs. • Improved well-being and outcomes for individuals. Page 196
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7.Outcome Statement: Prioritise the health and well-being of all staff by providing opportunities for personal well-being, development, and learning in a supportive and inclusive work environment. Protected Characteristic: All Ensuring that all employees, regardless of their background or personal circumstances, have access to opportunities that enhance their well-being. This approach promotes inclusivity, reduces inequalities, and supports the overall health and happiness of staff. National Health and Wellbeing Outcomes: Outcome 8: People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide. Outcome 9: Resources are used effectively and efficiently in the provision of health and social care services Strategic Theme : Workforce Well-being and Development Key Actions: 1. Well-being Initiatives: • Well-being activities such as mindfulness sessions, and stress management workshops. • Provide access to mental health resources, including counselling services and support groups. • Encourage staff to take regular breaks and leave work on time to maintain a healthy work-life balance. • Encourage staff to ensure they have breaks between teams’ calls. 2. Healthy Work Environment: • Foster a culture of open communication where staff feel comfortable discussing their well-being needs and concerns. 3. Professional Development: • Offer training and courses that support personal growth and professional development. • Provide opportunities for mentorship and coaching to help staff achieve their career goals. • Continue to provide training sessions focused on Gender Based Violence, unconscious bias, bystander awareness, and inclusivity via parent organisations • Promote cultural awareness training to enhance understanding and respect for diverse backgrounds and perspectives. 4. Inclusive Policies: • Enforce policies that promote equality and prevent discrimination, ensuring all staff feel valued and respected. • Regularly contribute to the review and update of policies to reflect the evolving needs of the workforce. 5. Monitoring and Evaluation: • Conduct iMatter and feedback sessions to assess staff well-being and identify areas for improvement. Performance Indicators: • Increased staff satisfaction and engagement levels. • Improved retention rates and reduced absenteeism. • Positive feedback from staff on the support and resources provided.Page 197
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Page 24 Find out more about the Moray Integration Joint Board and Health & Social Care Moray on our website: https://hscmoray.co.uk/index.html Follow us on social media Facebook @hscmoray Instagram @hscmoray For further information contact: Health & Social Care Moray Moray Council Offices High Street Elgin Moray IV30 1BX Gram.hscmcorporate@nhs.scot MORAY INTEGRATION JOINT BOARD Equality Mainstreaming & Outcomes Report for 2025-2029 Page 198
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 2025 SUBJECT: THE MORAY ALCOHOL AND DRUG PARTNERSHIP (MADP) – SCOTTISH GOVERMENT ANNUAL REPORTING SURVEY BY: MORAY ALCOHOL AND DRUG PARTNERSHIP COORDINATOR 1. REASON FOR REPORT 1.1 To inform the Board of the progress made by the Moray Alcohol and Drug Partnership (MADP) in delivering its strategic priorities for the period 2024/25, as captured in the Scottish Government’s Annual Reporting Survey, and seek approval for submission to the Scottish Government in line with national reporting requirements. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) considers and notes the completed 2024/25 Annual Reporting Survey and agrees to its submission to the Scottish Government as required; ii) notes the progress of the MADP in delivering services, including the development of the Moray Charter of Rights toolkit, improvements to the Medication Assisted Treatment (MAT) Standards, actions taken to reduce stigma, increased support for those with lived and living experience, and expanded harm reduction initiatives; iii) supports ongoing work to address remaining challenges, including workforce capacity, rural service access, and the sustainability of family support services; and iv) notes the progress of the Moray Drug and Alcohol Partnership in delivering services to Moray as documented in Appendix 1. 3. BACKGROUND 3.1 The Scottish Government’s Annual Reporting Survey is a tool for tracking progress against the National Mission to reduce drug-related deaths and Item 12. Page 199
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improve lives. It captures data and insights on local service delivery, strategic developments, and cross-sector collaboration. The Moray ADP’s response reflects significant work across its outcomes and cross cutting priorities, including enhancing pathways into, through, and out of residential rehabilitation, embedding rights-based approaches, and supporting a skilled and resilient workforce. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Lived and Living Experience Engagement 4.1 In 2024/25, the MADP has continued to strengthen the involvement of lived and living experience within its structures and decision-making processes, ensuring that services are grounded in real-world insights. Key achievements include: • Moray Charter of Rights Toolkit: Ongoing development of this toolkit, co- designed with people with lived experience to drive rights-based, trauma- informed practice. This toolkit is in the early stages of implementation, with initial training and awareness-raising underway, helping to shape a more respectful, person-centred system of care. • Independent Lived Experience Panel: This panel provides strategic insight, shapes service design, and supports commissioning processes. It plays a critical role in ensuring services reflect the real-world needs and experiences of those they support. • Peer Support and Workforce Integration: Over 80% of staff in direct access services have lived or family experience of substance use, enhancing the authenticity and empathy of frontline support. • Real-time Insights and Collective Voice: Continued use of Collective Voice reports and experiential interviews to inform continuous improvement and strategic development, ensuring lived experience shapes decision- making at all levels. • Community Engagement and Education: Peer-led talks in schools and community settings continue to challenge stigma and build understanding, supporting a more compassionate approach to substance use. Medication-Assisted Treatment (MAT) Standards 4.2 Moray ADP has made significant progress in implementing the MAT standards, reflecting a person-centred, flexible approach to care. Highlights include: • RAGB Success: Moray ADP achieved a successful Full Green and Blue RAGB rating in this year's MAT submission, reflecting the impact of its flexible, person-centred approach to MAT delivery. • Streamlined Access: Improved referral pathways through a third sector direct access service, reducing waiting times and ensuring faster access to support for those in need. • Flexible, Person-Centred Pathways: Pathways are designed around the realities of people’s lives, reflecting feedback from lived experience groups to reduce barriers and improve outcomes. • Workforce Development: Ongoing training on rights awareness, trauma- informed practice, and crisis response to strengthen frontline support and improve service outcomes. Page 200
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Residential Rehabilitation 4.3 In 2024/25, Moray ADP revised its residential rehabilitation pathway to align with the national flexible framework, significantly improving accessibility and reducing delays. Key developments include: • Third Sector-Led Model: The shift to a third sector-led model for assessment and referral has provided more personalised, trauma- informed care, reducing the time it takes to access rehabilitation. • National Drawdown Fund: Access to this fund has supported placements and improved aftercare planning, addressing one of the key barriers identified in earlier surveys. • Collaborative Pathway Development: Ongoing work with Healthcare Improvement Scotland to refine pathways, address workforce capacity, and improve stabilisation options, ensuring pathways are person-centred and responsive to local needs. • Lived Experience-Led Design: Enhanced engagement with lived and living experience in pathway design, ensuring services are responsive, trauma-informed, and reflective of community needs. Workforce Development and Wellbeing 4.4 Supporting a resilient, skilled workforce remains a critical priority for the MADP. Key initiatives include: • Comprehensive Training: Programmes covering trauma-informed practice, rights awareness, and crisis response are helping to build a skilled, compassionate workforce. • Peer Development: Ongoing professional development for peer support workers, enhancing their ability to provide meaningful, rights-based support. • Innovative Support Models: The ADP continues to explore new training and support approaches, ensuring frontline staff are equipped to respond to emerging challenges, including complex poly-substance use. Reducing Stigma and Improving Public Awareness 4.5 The MADP continues to prioritise stigma reduction through rights-based practice and public education. Key developments include: • Charter of Rights Toolkit: Currently being developed and tested with input from people with lived experience, this toolkit is designed to embed dignity, respect, and rights into service delivery. • Community Outreach and Awareness: Expansion of peer-led awareness and education, including lived experience talks in schools and community settings, challenging stigma and changing perceptions. • Innovative Harm Reduction Initiatives: Initiatives like the harm reduction drop-off at home service, the outreach and field working team, and the Lived Experience Development Worker who bridges the gap between people using services and support networks. These approaches ensure rapid, person-centred responses to those in greatest need. Family Inclusive Practice and Support 4.6 The MADP is committed to delivering family-inclusive practice and whole family support. Key activities in 2024/25 include: Page 201
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• Sustaining Family Support: Ongoing work to improve the sustainability of family support services, with a focus on embedding family voice and improving outcomes for children, young people, and families affected by substance use. • Cross-Sector Collaboration: Continued partnership with local agencies to provide comprehensive support, recognising the critical role of families in recovery and wellbeing. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Moray Partners in Care 2022-2032” The delivery plan for the MADP aligns to the MIJB Strategic Plan and the Local Outcomes Improvement Plan. (b) Policy and Legal The MADP works to both National and Local Policy and within the agreed Legal Framework. (c) Financial implications There are no financial implications arising from this report. (d) Risk Implications and Mitigation None arising directly from this report. (e) Staffing Implications There are no staffing implications. (f) Property There are no property implications. (g) Equalities/Socio Economic Impact This report does not require an EIA. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Consultations Judith Proctor, Chief Officer Emma Johnson, Public Protection Lead and Interim ADP Chair Children and Adult Social Work Service – Locality/Service and Team Managers Public Protection Areas Moray Drug and Alcohol Partnership and Strategic group members Lived and Living Experience Panel 6. CONCLUSION 6.1 The 2024/25 Annual Reporting Survey reflects the significant progress made by the MADP in delivering against its strategic priorities. The Board is asked to note this progress and approve the submission of the survey to the Scottish Government. Page 202
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Author of Report: Justin Jansen, MADP co-ordinator Background Papers: https://www.gov.scot/publications/national-drugs-mission-plan- 2022-2026/ Ref: Page 203
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1 Alcohol and Drug Partnership (ADP) Annual Reporting Survey: 2024/25 This survey is designed to collect information from all ADPs across Scotland on a range of aspects relating to the delivery of the National Mission to reduce drug deaths and improve lives, as well as activities relating to alcohol during the financial year 2024/25. This will not reflect the totality of your work but will cover areas where you do not already report progress nationally through other means. The survey is composed of single option and multiple-choice questions with a limited number of open text questions. We want to emphasise that the multiple-choice options provided are for ease of completion and it is not expected that every ADP will have all of these in place. This survey includes questions from across drug and alcohol policy areas. It has been designed to collate as many asks as possible from Scottish Government to minimise requests throughout the year. There is a combination of established questions which enable comparison year on year and new questions that reflect current and anticipated future data needs. We do not expect you to go out to services to respond to questions relating to activities undertaken by them in your area. Where questions refer to service level activities, we are interested in the extent to which you are aware of these as ADP. The data collected will be used to better understand progress at a local level and will inform: • National monitoring of the National Mission to reduce drug deaths and improve lives; • The work of the ongoing evaluation of the Nation Mission, including the economic evaluation; • The work of advisory groups including those supporting the programmes around Whole Family Approach, surveillance, and residential rehabilitation among others; • The work of national organisations which support local delivery; and • Future policy planning around drugs and alcohol. Findings will be published as Official Statistics in the autumn. The publication reporting on the 2023/24 ADP survey is available on the Scottish Government website. We plan to publish data from closed answer (quantitative) questions at an ADP level to enable best use of the survey data and ensure transparency. Data from closed answer (qualitative) questions will be shared with Public Health Scotland and their commissioned research teams to inform drug and alcohol policy monitoring and evaluation, where excerpts and/or summary data may be used in published reports, and will be subject to FOI requests. You may still wish to publish your return, as in previous years. The deadline for returns is Friday 13th June 2025. Your submission should be signed off by the ADP and the IJB. We are aware that there is variation in the timings of IJB meetings, so if sign off is not possible by the date of submission, please indicate this when you provide your return and advise an expected sign off date if possible. If you require clarification on any areas of the survey or would like any more information, please do not hesitate to get in touch by email at substanceuseanalyticalteam@gov.scot. APPENDIX 1 Page 204
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2 Cross-cutting priority: Surveillance and Data Informed Question 1 Which Alcohol and Drug Partnership (ADP) do you represent? Mark with an ‘x’. [single option] Aberdeen City ADP Aberdeenshire ADP Angus ADP Argyll & Bute ADP Borders ADP City of Edinburgh ADP Clackmannanshire & Stirling ADP Dumfries & Galloway ADP Dundee City ADP East Ayrshire ADP East Dunbartonshire ADP East Renfrewshire ADP Falkirk ADP Fife ADP Glasgow City ADP Highland ADP Inverclyde ADP Lothian MELDAP ADP X Moray ADP North Ayrshire ADP North Lanarkshire ADP Orkney ADP Perth & Kinross ADP Renfrewshire ADP Shetland ADP South Ayrshire ADP South Lanarkshire ADP West Dunbartonshire ADP West Lothian ADP Western Isles ADP Page 205
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3 Question 2 Which groups or structures were in place at an ADP level to inform surveillance and monitoring of alcohol and drug harms or deaths? Mark all that apply with an ‘x’ – if drug and alcohol deaths are reviewed at a combined group, please select both ‘Alcohol death review group’ and ‘Drug death review group’. [multiple choice] X Alcohol death review group X Alcohol harms group X Drug death review group X Drug trend monitoring group/Early Warning System None Other (please specify): MARS Group which Covers Alcohol and Substance use risk and harms Question 3 3a. Do Chief Officers for Public Protection receive feedback from drug death reviews? Mark with an ‘x’. [single option] X Yes No Don’t know 3b. If no, please provide details on why this is not the case. [open text – maximum 500 characters] Question 4 Please list what local and national structures are in place in your ADP area for the monitoring and surveillance of alcohol and drug harms and deaths. Please describe how these have been used to inform local decision making in response to emerging threats (e.g. novel synthetics) in the past year. [open text – maximum 2,000 characters] In Moray, we have a strong multi-agency framework in place for monitoring and responding to alcohol and drug-related harms and deaths. Key structures include: the Drug-Related Death (DRD) Review Group, DRD Data Review Group, Multi- Agency Risk and Harm Group, ADP Strategic Group, Grampian RADAR Group, Medication-Assisted Treatment (MAT) Implementation and Support Meeting, a Daily Huddle involving third sector and specialist services, the LLE Panel Advisory Group, and the Living Experience Group supported by SDF. These groups work collaboratively to provide a joined-up approach to local intelligence, ensuring that emerging threats—such as the presence of novel synthetic drugs—are identified and responded to quickly. Data and insight gathered Page 206
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4 through these structures directly inform Moray ADP’s strategy, commissioning decisions, and service improvements. Our Daily Huddle plays a critical role in proactive risk management by identifying individuals at highest risk and enabling fieldwork teams to prioritise real-time outreach, MAT engagement and support for NFOs. The partnership between statutory and third sector services ensures rapid, coordinated responses to those in greatest need. The LLE Panel and Living Experience Group have made a significant impact on local decision-making. Their real-time, frontline insights have shaped our understanding of community-level trends and barriers, leading to more targeted harm reduction efforts, better service access, and a more trauma-informed, person- centred system of care. This joined-up approach ensures that decisions are driven by evidence, grounded in lived experience, and responsive to changing patterns of harm across Moray. Question 5 5a. Have you made specific revisions to any protocols in the past year in response to emerging threats (e.g. novel synthetics, trends in cocaine, new street benzos, etc.) ? Mark with an ‘x’. [single option] X Yes No 5b. Please provide details of any revisions [open text – maximum 500 characters] We revised our outreach and risk management protocols to strengthen our response to emerging threats, including synthetic opioids and ketamine. This includes increased naloxone distribution, updated harm reduction messaging, and earlier identification of at-risk individuals through daily multi-agency huddles. Fieldwork teams now prioritise engagement based on drug trend data and LLE insights. Question 6 Please describe ways in which you routinely engage with commissioned services in your ADP area (e.g. through online surveys, reporting databases, email or phone communication, ADP representation on governance or advisory structures, events etc.). [open text – maximum 1000 characters] We engage routinely with commissioned services through ADP strategic and quarterly meetings, contract implementation meetings, and regular joint planning sessions. Services complete quarterly reports, contribute to ADP strategic groups, and use DAISy to report on outcomes. We maintain open channels via email, calls, and reflective learning. Experiential interviews and lived experience input are used to inform improvement. A new and innovative approach this year has been the introduction of the Moray Charter of Rights Implementation Toolkit, co-designed with Page 207
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5 people with lived and living experience. The toolkit is being used as a framework for embedding rights-based, trauma-informed practice and is now integrated into improvement planning and our 3 eyar strategic development plan. Cross-cutting priority: Resilient and Skilled Workforce Question 7 7a. What is the whole-time equivalent1 staffing resource routinely dedicated to your ADP Support Team as of 31 March 2025? 1 Note: whole-time equivalent (WTE) is a unit of measurement that indicates the total working hours of employees in relation to a full-time position. It helps to standardise and compare staffing resource across different teams or organisations. A full-time employee is equal to one whole-time equivalent. For part-time Page 208
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6 [numeric, decimal] Total current staff (whole-time equivalent including fixed-term and temporary staff, and those shared with other business areas) 2.00 Total vacancies (whole-time equivalent) 0 7b. Please list the job title for each vacancy in your ADP Support Team on the 31 March 2025 (if applicable). [open text – maximum 500 characters] There were no job vacancies in the ADP support team as of 31st March 2025 Question 8 Please select any initiatives you have undertaken as an ADP that are aimed at improving employee wellbeing (volunteers as well as paid staff). Mark all that apply with an ‘x’ [multiple choice] Training and awareness X Promotion of information and support initiatives X Provision of training on issues including trauma awareness and crisis management Other (please specify): Stigma training, rights based training and mental health and substance use training for anyone living or working in Moray Workplace support X Flexible working X Implementation of risk assessment for work at home and in the workplace X Inclusive workplace initiatives (including staff networks and wellbeing champions) X Provision of occupation health services X Staff recognition schemes Use of disability passports X Workload management Other (please specify): Both commisioned and statutory services have wellbeing leads in place. Institution-provided support X Provision of coaching and supervision for staff and volunteers employees, divide their hours by the whole-time equivalent. For example, if a part-time employee is required to work 7.5 hours per week and a ‘full-time’ position is considered to be 37.5 hours, the WTE would be 0.2 (7.5 hours / 37.5 hours). Page 209
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7 X Provision of counselling for staff and volunteers Other (please specify): Wellbeing activities Drug and/or alcohol death reflective sessions X Peer support groups X Provision of mindfulness courses/learning materials X Social and physical activities Other (please specify): Engagement Participation in local Clinical Care Governance Meetings X Undertaking of staff needs assessments and engagement to understand wellbeing needs X Regular meetings about staff pressures with senior and junior staff Other (please specify): Other initiatives which don’t fit in these categories (please specify): Development of coaching, reflective practice and trauma informed support. Page 210
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8 Cross cutting priorities: Lived and Living Experience Question 9 9a. Do you have a formal mechanism at an ADP level for gathering feedback from people with lived/living experience who are using services you fund? Mark all that apply with an ‘x’. [multiple choice] X Engagement with recovery communities X Experiential data collected as part of the Medication Assisted Treatment (MAT) programme X Feedback / complaints process X Lived / living experience panel, forum and / or focus group X Questionnaire / survey No formal mechanism in place Other (please specify): Use of Collective Voice report and newly developed Moray Charter of rights toolkit as mechanisms for gathering and acting on feedback. 9b. In the past year, have members of any of the following groups with lived and/or living experience participated in any of the above engagement mechanisms? Mark all that apply with an ‘x’. [multiple choice] X People who are current or former employees or volunteers at the ADP or drug and/or alcohol services X People who are not employed at the ADP or at drug and/or alcohol services X People who are currently accessing treatment or support for problem drug use (may include treatment for problem alcohol use) X People who are currently accessing treatment or support for problem alcohol use X People with living experience of drug and/or alcohol use who are not currently receiving treatment or support X People who are experiencing homelessness X Women X Young people Other (please specify): Family Member, People with Lived experience of the Justice sysytem, people engaged through outreach, Peer support workers and LLE involved in co-design and commisioning processes. Question 10 10a. In what ways are people with lived and living experience able to participate in ADP decision-making? Mark all that apply with an ‘x’. [multiple choice] X Through ADP board membership X Through a group or network that is independent of the ADP Page 211
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9 X Through an existing ADP group/panel/reference group X Through membership in other areas of ADP governance (e.g. steering group) Not currently able to participate Other (please specify): Co-design of services, participation in commisioning panels, and strategic input via the the Lived Experience Panel and collective voice mechanisms. 10b. In what ways are family members able to participate in ADP decision-making? Mark all that apply with an ‘x’. [multiple choice] X Through ADP board membership X Through a group or network that is independent of the ADP X Through an existing ADP group/panel/reference group X Through membership in other areas of ADP governance (e.g. steering group) Not currently able to participate Other (please specify): Family menbers are able to contribute and participate through commisioning, experiential interviews and have been involved in our Charter of rights work and toolkit voice. Question 11 What mechanisms are in place within your ADP to ensure that services you fund involve people with lived/living experience and/or family members in their decision-making (e.g. the delivery of the service)? Mark all that apply with an ‘x’. [multiple choice] X Asked about in reporting X Stipulated in our contracts None Other (please specify): LLE and Family experience is embedded in service reviews, contract implementation meetings, The Moray Charter of rights toolkit, and local outcome improvement planning. Page 212
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10 Cross cutting priorities: Stigma Reduction Question 12 Within which written strategies or policies does your ADP consider stigma reduction for people who use substances and/or their families? Mark all that apply with an ‘x’. [multiple choice] X ADP strategy, delivery and/or action plan X Alcohol deaths and harms prevention action plan X Communication strategy X Community action plan Drug deaths and harms prevention action plan X MAT standards delivery plan X Service development, improvement and/or delivery plan None Other (please specify): Moray Charter of rights implementation tookit Question 13 Please describe what work is underway in your ADP area to reduce stigma for people who use substances and/or their families. [open text – maximum 2,000 characters] Reducing stigma is a priority embedded throughout Moray ADP’s work. The Moray Charter of Rights Implementation Toolkit, co-developed with people with lived and living experience, is a new and innovative framework that will support services to embed rights-based, trauma-informed practice. Early implementation has focused on awareness-raising and training, with the toolkit being introduced to partners as a tool to reflect on and improve how services challenge stigma and uphold dignity. Stigma reduction features prominently in our training offer. We deliver co-produced, lived experience-led sessions across schools, partner agencies, and frontline services. These include trauma and substance use, rights awareness, and substance use education. Our direct access service prioritises employing people with lived or family experience—over 80% of staff are peers, ensuring authenticity and understanding in practice. Recovery talks in schools, led by lived experience facilitators, humanise substance use and challenge stereotypes. Our outreach model, delivered in community settings, ensures a no-barriers approach that supports people where they are. We have launched a new series of events under the banner Recovery Together, bringing together people with lived and living experience, families, and partners to explore and implement the Charter of Rights. Delivered in collaboration with the Scottish Recovery Consortium, SACRO, Moray Wellbeing Hub, and Community Justice, these events will foster inclusion, challenge stigma, and support a shared vision of rights-based recovery. Operation Protector, in partnership with Police Scotland, embeds lived experience into harm prevention work on county lines and cuckooing. Our recovery football Page 213
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11 project, developed in collaboration with peers and police, promotes connection, inclusion, and recovery. Families contribute to strategic planning and improvement processes,helping reduce the stigma experienced by loved ones. Page 214
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12 Fewer people develop problem substance use Question 14 How is information on local treatment and support services made available to different audiences at an ADP level (not at a service level)? Mark all that apply with an ‘x’. [multiple choice] In person (e.g. at events, workshops, etc) Leaflets / posters Online (e.g. websites, social media, apps, etc.) Non-native English speakers (English Second Language) People from minority ethnic groups X X X People from religious groups People who are experiencing homelessness X X X People who are LGBTQI+ X X X People who are pregnant or peri-natal X X X People who engage in transactional sex X X X People who have been involved in the justice system X X X People with hearing impairments and/or visual impairments People with learning disabilities and literacy difficulties X X X Veterans X X X Women X X X None of the above Other (please specify Page 215
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13 Question 15 Which of the following education or prevention activities were funded or supported2 by the ADP?3 Mark all that apply with an ‘x’. [multiple choice] 0-15 years (children) 16-24 years (young people) 25 years+ (adults) Campaigns / information X X X Harm reduction services X X Learning materials X X X Mental wellbeing X X X Peer-led interventions X X Physical health X X X Planet Youth Pregnancy & parenting X X Youth activities X X Other (please specify) None 2 Note: ‘supported’ refers to where the ADP provides resources of some kind (separate from financial, which is covered by “funded”). This could take the form of knowledge exchange, staffing, the supply of materials (e.g. learning templates, lending them a physical location), etc. 3 Note: activities which are not relevant for older age groups have been shaded out to avoid confusion on completion of this question. Page 216
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14 Risk is reduced for people who use substances Question 16 16a. Please select in which settings each of the following harm reduction initiatives are delivered in your ADP area. Mark all that apply with an ‘x’. [multiple choice] Supply of naloxone Hepatitis C testing Injecting equipment provision Wound care Community pharmacies X X X X Drug services (NHS, third sector, council) X X X X Family support services X X General practices X X X Homelessness services X X Hospitals (incl. A&E, inpatient departments) X X X Justice services X X Mental health services X X Mobile/outreach services X X X X Peer-led initiatives X X Prison X X Sexual health services X X X Women support services X Young people’s service X None Other (please specify) 16b. Please provide details about any changes to settings in which harm reduction initiatives have been delivered in the past year. Please describe the changes and any reasons for these changes. [Open text- maximum 2,000 characters] In the past year, we have expanded harm reduction delivery through outreach and peer-led approaches, especially in rural areas. Naloxone and injecting equipment are now distributed more consistently via mobile teams and peer workers. Our fieldwork teams have enhanced wound care access in non-clinical settings through partnership with health services. Hepatitis C testing has been offered in more accessible community venues. These developments reflect a trauma-informed, rights-based approach prioritising inclusion, rapid access, and equity of care. Page 217
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15 Question 17 17a. Which of the following harm reduction interventions are there currently a demand for in your ADP area? (Either where the intervention is not currently provided or where demand exceeds current supply). Mark all that apply with an ‘x’. [multiple choice] Drug checking X Drug testing strips X Harm reduction advice and support in relation to psychostimulants Heroin Assisted Treatment Naloxone availability in public facilities (e.g. pre-stationed naloxone, naloxone box etc.) X Provision of foil Safe supply of substances Safer drug consumption facility Safer inhalation pipe provision Other (please specify): 17b. Please provide any details (e.g. scale of demand, source of requests, whether current demand exceeds supply etc.). [open text – maximum 500 characters] There is growing demand for safer inhalation equipment and stimulant-specific harm reduction advice, particularly from outreach partners and lived experience networks. Feedback from third sector and health partners highlights the need for naloxone in public spaces. Current provision does not fully meet demand, especially in rural areas where access is limited and outreach teams have identified ongoing unmet need. Question 18 18a. Do you have an adequate supply of naloxone in your ADP area to meet general needs? Mark with an ‘x’. [single option] X Yes No Unsure 18b. Within the context of a more toxic and unpredictable drug supply which may require higher doses of naloxone to be administered, do you have adequate supply of naloxone in your ADP area to meet demand if a significant incident were to occur? Mark with an ‘x’. [single option] X Yes No Unsure Page 218
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17 People most at risk have access to treatment and recovery Question 19 Which partners within your ADP area have documented pathways in place, or in development, to ensure people who experience a near-fatal overdose (NFO) are identified and offered support? Mark all that apply with an ‘x’. [multiple choice] NFO pathway in place NFO pathway in development Community recovery providers X Homeless services Hospitals (including emergency departments) X Housing services X Mental health services X Police Scotland X Primary care X Prison X Scottish Ambulance Service X Scottish Fire & Rescue Service X Specialist substance use treatment services X Third sector substance use services X Other (please specify) Question 20 Which, if any, of the following barriers to implementing NFO pathways exist in your ADP area? Mark all that apply with an ‘x’. [multiple choice] X Further workforce training required High staff turnover X Insufficient funds X Issues around information sharing Lack of leadership Lack of ownership Lack of physical infrastructure Lack of staff to support out of hours or extended core business hours Workforce capacity None Other (please specify): Page 220
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18 Question 21 In what ways have you worked with justice partners4? Mark all that apply with an ‘x’. [multiple choice] Strategic level X ADP representation on local Community Justice Partnership X Contributed to strategic planning X Coordinated activities between justice, health or social care partners X Data sharing X Justice organisations represented on the ADP (e.g. COPFS, Police Scotland, local Community Justice Partnership, local Justice Social Work department, prison) X Provided advice and guidance Other (please specify): Operational level X Provided funding or staff for a specialist court (Drug, Alcohol, Problem Solving) X Raised awareness about community-based treatment options (partners involved in diversion from prosecution or treatment-based community orders) X Supported staff training on drug or alcohol related issues X Activities to support implementation of MAT standards Other (please specify): Service level Funded or supported: Navigators for people in the justice system who use drugs X Services for people transitioning out of custody X Services in police custody suites X Services in prisons or young offenders’ institutions X Services specifically for Drug Treatment and Testing Orders (DTTOs) X Services specifically for people serving Community Payback Orders with a Drug or Alcohol Treatment Requirement Other (please specify): 4 Note: ‘justice partners’ includes Community Justice Partnerships (CJPs), Justice Social Work departments, Prisons and Young Offender Institutes, Police, Crown Office and Procurator Fiscal Service (COPFS), Scottish Courts and Tribunals Service (SCTS), Sacro, and third sector organisations that specifically serve people involved with the criminal justice system. Page 221
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19 Question 22 Which activities did your ADP support at each stage of the criminal justice system? Mark all that apply with an ‘x’. [multiple choice] Pre- arrest5 In police custody6 In courts7 In prison8 Upon release9 Advocacy or navigators X X Alcohol interventions X X X X X Drug and alcohol use and treatment needs screening X X X X X Harm reduction inc. naloxone X X X X Health education & life skills X X X Medically supervised detoxification X X X X Opioid Substitution Therapy X X X X Psychosocial and mental health based interventions X X X X Psychological and mental health screening X X X X Recovery (e.g. café, community) X X X Referrals to drug and alcohol treatment services X X X X X Staff training X X X X None Other (please specify) 5 Pre-arrest: Services for police to refer people into without making an arrest. 6 In police custody: Services available in police custody suites to people who have been arrested. 7 In courts: Services delivered in collaboration with the courts (e.g. services only available through a specialist drug court, services only available to people on a DTTO). 8 In prison: Services available to people in prisons or young offenders’ institutions in your area (if applicable). 9 Upon release: Services aimed specifically at supporting people transitioning out of custody. Page 222
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20 Question 23 What barriers to accessing support, if any, are there in your area for people who are involved in the justice system? Mark all that apply with an ‘x’. [multiple choice] Lack of accessibility to mainstream alcohol and drug services and support services (such as lack of transport options) Lack of services tailored specifically to people who are on Community Payback Orders, Drug Treatment and Testing Orders, Supervised Release Orders and other community orders Lack of specific pathways for people who are involved in the justice system Lack of support for people who are involved in the justice system after receiving treatment X Services with entry requirements which exclude people convicted of specific offences (such as arson) Services with entry requirements which exclude people on Community Payback Orders, Drug Treatment and Testing Orders, Supervised Release Orders and other community orders None Other (please specify): Question 24 What types of residential services are available in your area which can be accessed by people who are subject to Community Payback Orders, Drug Treatment and Testing Orders, Supervised Release Orders and other community orders to access support? Mark all that apply with an ‘x’. [multiple choice] X Mainstream residential rehabilitation services (i.e. those who are open to anyone) X Mainstream residential services other than rehabilitation (e.g. recovery housing) X Residential services specifically targeted to people involved in the justice system, such as Turnaround or other service (please specify which services): Mainstream stabilisation/crisis services Other (please specify): Question 25 25a. Do you have drugs and alcohol testing services in your ADP area for people going through the justice system on an order or licence? Mark all that apply with an ‘x’. [multiple choice] X Yes, for alcohol X Yes, for drugs No Page 223
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21 Unsure 25b. Who provides testing services for drugs and/or alcohol? Mark all that apply with an ‘x’. [multiple choice] Alcohol testing Drugs testing Private provider X X NHS addiction services X X Other local provider (please specify) Other arrangement (please specify) Not applicable 25c. What methods are used for drugs and/or alcohol testing? Mark all that apply with an ‘x’. [multiple choice] Alcohol testing Drugs testing Handheld devices X X Spit tests X X Urine tests X Electronic monitoring Patches Other (please specify) Not applicable Page 224
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22 People receive high quality treatment and recovery services Question 26 What screening options are in place to address alcohol harms? Mark all that apply with an ‘x’. [multiple choice] X Alcohol hospital liaison X Arrangements for the delivery of alcohol brief interventions in all priority settings X Arrangement of the delivery of alcohol brief interventions in non-priority settings X Fibro scanning X Pathways for early detection of alcohol-related liver disease None Other (please specify): Question 27 What treatment options are in place to address alcohol harms? Mark all that apply with an ‘x’. [multiple choice] X Access to alcohol medication (e.g. Antabuse, Acamprase, etc.) X Alcohol hospital liaison X Alcohol-related cognitive testing (e.g. for alcohol related brain damage) X Community-based alcohol detox (including at-home) X In-patient alcohol detox X Pathways into mental health treatment X Psychosocial counselling X Residential rehabilitation None Other (please specify): Page 225
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23 Question 28 28a. Which, if any, of the following barriers to residential rehabilitation exist in your ADP area? Mark all that apply with an ‘x’. [multiple choice] X Availability of aftercare Availability of detox services X Availability of stabilisation/crisis services X Challenges accessing additional sources of funding Current models are not working Difficulty identifying all those who will benefit X Further workforce training required X Geographic distance X Insufficient base funding Insufficient staff Lack of awareness of residential rehabilitation among potential clients Lack of awareness of residential rehabilitation amongst referrers X Lack of bed capacity within ADP area Lack of specialist providers Lack of transportation to travel to available capacity X Scope to further improve/refine your own pathways Variation in prices from different providers X Waiting times None Other (please specify): 28b. What actions are your ADP taking to overcome these barriers to residential rehabilitation? [open text – maximum 500 characters] We have adopted the National flexible framework and changed the residential rehab pathway to route through a third sector direct access service. We accessed funding via the national drawdown fund and worked with Healthcare Improvement Scotland to develop and refine our pathway. While progress has been made, there is still no access to dedicated safety and stabilisation provision, which remains a significant barrier to equitable access. Question 29 29a. Have you made any revisions in your pathway to residential rehabilitation in the last year? Mark with an ‘x’. [single option] No revisions or updates made in 2024/25 Page 226
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24 X Yes - Revised or updated in 2024/25 and this has been published Yes - Revised or updated in 2024/25 but not currently published 29b. If yes, please provide brief details of the changes made and the rationale for the changes. [open text – maximum 500 characters] We revised and published our pathway in line with the national flexible framework. A third sector direct access service now leads on assessment and referral, increasing accessibility and reducing delays. The updated pathway includes clearer stages of support, wider provider options, and better aftercare planning. Changes were informed by HIS input and lived experience feedback on barriers including consistency, stigma, and lack of support before and after rehab. Question 30 Are there any specific groups in your ADP area who do not have their needs met by the current residential rehabilitation provision (for reasons such as lack of appropriate models of care, inadequate capacity, the location of services or any other factors)? Mark all that apply with an ‘x’. [multiple choice] Lesbian, gay or bisexual people People from minority religions People on OST People who are experiencing homelessness People who are involved in the justice system People who are pregnant or perinatal People with child dependents People with co-occurring mental health problems People with council tenancies People with specific physical health condition, including long term illness and disability Trans people Women X None Other (please specify): Moray ADP aims to provide access for all groups, though some external providers may have criteria that limit eligibility. We continue to work to reduce these barriers through flexible, person-centred approaches. Page 227
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25 Question 31 31a. Which, if any, of the following barriers to implementing the Medication Assisted Treatment (MAT) standards exist in your area? Mark all that apply with an ‘x’. [multiple choice] X Accommodation challenges (e.g. appropriate physical spaces, premises, etc.) X Availability of stabilisation/crisis services Burden of data collection and reporting X Challenges engaging with GPs Difficulty identifying all those who will benefit X Further workforce training is needed X Geographical challenges (e.g. remote, rural, etc.) X Insufficient funds X Insufficient staff Lack of awareness among potential clients Lack of capacity X Scope to further improve/refine your own pathways Waiting times None Other (please specify): 31b. What actions is your ADP taking to overcome these barriers to implementing MAT in your ADP area? [open text – maximum 500 characters] Workforce gaps, rural access, and unsuitable premises for MIDAS are key barriers. The MAT programme does not reflect the complexity of referrals in Moray, with increasing poly-substance use, alcohol, and ketamine. Safety and stabilisation options are limited, and stigma affects engagement. We’re addressing this through improved pathways, aftercare, lived experience input, and joint work with NHS Grampian and other ADPs. Question 32 Other than opioids, which substances are currently the highest priority in your ADP area for treatment and support? Please rank the substances of concern in your area in order of priority – add a number to all that apply, with 1 being highest priority. [ranking] 2 Alcohol 7 Cannabis/cannabinoids 5 Cocaine, and other stimulants 1 Ketamine 6 Pregabalin/gabapentin 4 Street benzos Page 228
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26 3 Polydrug use (please specify any most common combinations of drugs): Ketamine, alcohol, street benzo and cocaine Other (please specify): Question 33 Which of the following treatment and support services are in place specifically for children and young people using alcohol and/or drugs? Mark all that apply with an ‘x’.10 [multiple choice] Up to 12 years (early years and primary) 13-15 years (secondary S1-4) 16-24 years (young people) Alcohol-related medication (e.g. acamprosate, disulfiram, naltrexone, nalmefene) X Diversionary activities X X X Employability support X Family support services X X X Information services X X X Justice services X X Mental health services (including wellbeing) X X X Opioid Substitution Therapy Outreach/mobile (including school outreach) X X Recovery communities X School outreach X X X Support/discussion groups (including 1:1) X X Other (please specify) 10 Note that treatment and support services which are inappropriate for younger age groups have been shaded out to avoid confusion on completion of this question. Page 229
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27 Quality of life is improved by addressing multiple disadvantages Question 34 Do you have specific treatment and support services in place for the following groups? Mark all that apply with an ‘x’. [multiple choice] Yes No Non-native English speakers (English Second Language) X People from minority ethnic groups X People from religious groups X People who are experiencing homelessness X People who are involved in the justice system X People who are LGBTQI+ X People who are neurodivergent X People who are pregnant or peri-natal X People who engage in transactional sex X People with hearing impairments and/or visual impairments X People with learning disabilities and literacy difficulties Veterans X Women X Other (please specify) Question 35 35a. Are there formal joint working protocols in place to support people with co-occurring substance use and mental health diagnoses to receive mental health care? Mark with an ‘x’. [single choice] X Yes No 35b. Please provide details. [open text – maximum 500 characters] Yes, we have formal joint working protocols in place between substance use and mental health services, supported by strategic and operational forums. However, delivery can be inconsistent and further integration is needed. We are working to strengthen shared care planning, improve communication, and ensure access to mental health support for those not engaged with specialist services. Page 230
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28 Question 36 What arrangements are in place within your ADP area for people who present at substance use services with mental health problems for which they do not have a diagnosis? Mark all that apply with an ‘x’. [multiple choice] Dual diagnosis teams X Formal joint working protocols between mental health and substance use services specifically for people with mental health problems for which they do not have a diagnosis X Pathways for referral to mental health services or other multi-disciplinary teams X Pathways for referral to third sector services for mental health support X Professional mental health staff within services (e.g. psychiatrists, community mental health nurses, etc) X Provision of joint appointments for those with co-occurring mental health problems and problem substance use X Provision of mental health assessments for people who are presenting with mental health problems None Other (please specify): Question 37 How do you as an ADP work with support services not directly linked to substance use (e.g. welfare advice, housing support, etc.) to address multiple disadvantages? Mark all that apply with an ‘x’. [multiple choice] X By representation on strategic groups or topic-specific sub-groups X By representation on the ADP board X Through partnership working Via provision of funding Not applicable Other (please specify): Page 231
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29 Question 38 Which of the following activities are you aware of having been undertaken in ADP funded or supported11 services to implement a trauma-informed approach? Mark all that apply with an ‘x’. [multiple choice] X Engaging with people with lived/living experience X Engaging with third sector/community partners X Provision of trauma-informed spaces/accommodation X Presence of a working group X Recruiting staff X Training existing workforce None Other (please specify): Question 39 39a. Does your ADP area have specific referral pathways for people to access independent advocacy? Mark with an ‘x’. [single option] X Yes No Don’t know 39b. If yes, are these commissioned directly by the ADP? Mark with an ‘x’. [single option] X Yes No Don’t know 11 Note: ‘supported’ refers to where the ADP provides resources of some kind (separate from financial, which is covered by “funded”). This could take the form of knowledge exchange, staffing, the supply of materials (e.g. learning templates, lending them a physical location), etc. Page 232
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30 Children, families and communities affected by substance use are supported Question 40 Which of the following treatment and support services are in place for children and young people affected by a parent’s or carer’s substance use? Mark all that apply with an ‘x’.12 [multiple choice] Up to 12 years (early years and primary) 13-15 years (secondary S1-4) 16-24 years (young people) Advocacy X X X Carer support X X X Diversionary activities X X X Employability support Family support services X X X First aid training Information services X X X Mental health services X X X Outreach/mobile services X X X School outreach X X X Social work services X X X Support/discussion groups X X Other (please specify) Question 41 Which of the following support services are in place for adults affected by another person’s substance use? Mark all that apply with an ‘x’. [multiple choice] X Advocacy X Commissioned services X Counselling X One to one support X Mental health support X Naloxone training X Support groups X Training None Other (please specify): 12 Note support services which are likely to be inappropriate for younger age groups have been shaded out to avoid confusion on completion of this question. Page 233
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31 Question 42 42a. Do you have an agreed set of activities and priorities with local partners to implement the Holistic Whole Family Approach Framework in your ADP area? Mark with an ‘x’. [single option] X Yes No Don’t know 42b. Please provide details of these activities and priorities for 2024/25. [open text – maximum 500 characters] We are working with partners to embed the Whole Family Approach through improved pathways, Recovery Together events, and co-produced support. Family- inclusive practice is a core commissioning requirement. We receive around £60k to support this work, which is not sufficient to meet demand. Additional delivery is currently supported through Corra funding, but this ends next year and poses a risk to sustaining progress. Question 43 When did your ADP most recently conduct an audit or needs assessment of the support currently available in your area for children, young people and adults affected by a family member’s substance use? Mark with an ‘x’. [single option] 2020/21 2021/22 X 2022/23 2023/24 2024/25 None undertaken in the past 5 years There are plans to undertake one in 2025/26 Unsure Question 44 Which of the following services supporting a Family Inclusive Practice13 or a Whole Family Approach are in place in your ADP area (for people with family members both in and not in treatment)? Mark all that apply with an ‘x’. [multiple choice] 13 Family Inclusive Practice is a collaborative approach where professionals actively involve a person’s family and social networks in care, proactively ask about the needs of the whole family, to ensure all family members are supported. Page 234
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32 X Advice X Advocacy X Benefits and debt advice Mentoring X Peer support X Personal development X Social activities X Support for self care activities X Support for victims of gender based violence and their families X Youth services None Other (please specify): Question 45 What support would be helpful to facilitate the implementation of a Family Inclusive Practice or a Whole Family Approach? Mark all that apply with an ‘x’. [multiple choice] X Additional funding X Additional resources Advice to support setting up of lived and living experience forums/co-production methods X Guidance at a national level X Information shared from other services X Sharing of participation tools X Workforce training Analytical support (please specify any details): Other (please specify): Question 46 What mechanisms are in place within your ADP area to ensure that services adopt a family inclusive practice? Mark all that apply with an ‘x’. [multiple choice] X Asked about in their reporting X Prerequisite for our commissioning X Regular training provided to services None Other (please specify): Question 47 Page 235
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33 In what ways do you work with the Children's Service's Planning Partnership (CSPP) in your area? Mark all that apply with an ‘x’. [multiple choice] ADP representation on CSPP Co-location of services X Co-management of projects X Coordinated activities Coordinated living and lived experience co-production approaches X Co-ordination around staff training X CSPP representation on ADP X Data sharing Integrated planning X Joint interpretation of data and evidence at a strategic level X Joint referrals to relevant services Knowledge sharing Pooled funding Shared and joint outcomes X Shared assessment of local needs None Other (please specify): Page 236
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34 Finances Question 48 How much funding does the ADP receive from the following sources? Please mark all which apply with an ‘x’ and provide details on the amount of funding which is received. [multiple choice, numeric] Health board: £ 574 393.00 Local authorities: £ 933 206.00 Funding from other grant funder(s) (such as Corra and Inspiring Scotland Foundation): £ 250 000.00 Other (please specify source and how much funding) : £ Question 49 49a. How often do you provide financial reports for you ADP area? Mark all that apply with an ‘x’. [multiple choice] Monthly Quarterly X Six monthly Annually Other (please specify): 49b. Who is financial reporting provided to? Mark all that apply with an ‘x’. [multiple choice] X IJB/IA Chief Financial Officer IJB/IA Chief Officer ADP Chair Other (please specify): 49c. Do you have a dedicated finance officer or team within the ADP? Mark with an ‘x’. [single option] X Yes No, the ADP coordinator undertakes this as part of their role No, finances are managed externally to the ADP Other (please specify): Question 50 50. Please describe what financial system(s) are used to manage finances in your area (i.e. Oracle, Efin, Excel spreadsheets). [open text – maximum 500 characters] Page 237
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35 Confirmation of sign-off Question 51 Has your response been signed off at the following levels? Mark all that apply with an ‘x’. [multiple choice] ADP IJB Not signed off by IJB (please specify date of the next meeting in dd/mm/yyyy format): Thank you Thank you for taking the time to complete this survey, your response is highly valued. The results will be published in the 2024/25 ADP Annual Survey Official Statistics report, scheduled for publication in autumn 2025. Please do not hesitate to get in touch via email at substanceuseanalyticalteam@gov.scot should you have any questions. [End of survey] Page 238
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 29 MAY 2025 SUBJECT: REVIEW OF FINANCIAL REGULATIONS BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To seek the approval of the Board to update the Financial Regulations in line with the proposed amendments contained within Appendix 1. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) approves the proposed changes to the Moray Integration Joint Board Financial Regulations as set out in Appendix 1; and ii) agrees that the reviews will be done biannually. 3. BACKGROUND 3.1 Section 95 of the Local Government (Scotland) Act 1973 requires integration authorities to have adequate systems and controls in place to ensure the ‘proper administration of their financial affairs’, including the appointment of an officer with full responsibility for their governance. The Moray Integration Joint Board (MIJB) Financial Regulations detail those responsibilities. 3.2 The statutory guidance produced by the Scottish Government for integration authorities stipulates the requirement for the Chief Financial Officer of the MIJB to develop Financial Regulations to include a minimum set of controls. These were developed and approved at a meeting of this Board on 31 March 2016 (para 11 of the minute refers). 3.3 The Financial Regulations were subsequently reviewed and presented to a meeting of this Board for approval on 28 March 2019 (para 11 of the minute refers) and on 30 November 2023 (para 12 of the minute refers). 4. KEY MATTERS RELEVANT TO RECOMMENDATION Item 13. Page 239
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4.1 It is necessary to review the Financial Regulations at regular intervals to ensure they continue to reflect policy and practice adopted by the MIJB. The updated Regulations are attached at Appendix 1 and proposed changes have been highlighted in red for ease of reference. Mainly in paragraphs 4.11.2; 4.11.4; 6.2.4; 6.3.8 and 6.8. 4.2 It is proposed that the Financial Regulations are reviewed on a biannual basis to reflect the pace of change and support good governance practices surrounding the MIJB financial processes. 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’ Effective governance arrangements will support the MIJB in providing services in line with stated priorities as outlined in its Strategic Plan. (b) Policy and Legal Approved Financial Regulations form part of the constitutional documents that provide reasonable assurance in that the decision making of the MIJB is legal, clear, and accountable. Failure to observe Financial Regulations may be regarded as a breach of trust and potentially lead to disciplinary action or dismissal. (c) Financial implications None arising directly from this report. (d) Risk Implications and Mitigation Regular updating of Financial Regulations provides a reference point for staff working under the remit of the MIJB and supports the mitigation of risk in relation to inappropriate use of funds. Financial Regulations constitute an element of the governance arrangements of the MIJB, the absence of which would result in a lack of clarity regarding roles and responsibilities. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact An equality Impact Assessment is not needed because there is no change to policy as a result of this report. (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. Page 240
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(j) Consultations The Director of Finance NHS Grampian; the Chief Officer; the Senior Management Team, Chief Financial Officer (Moray Council) and the MIJB Chief Internal Auditor have been consulted and their comments incorporated into the updated Financial Regulations. 6. CONCLUSION 6.1 Financial Regulations support the Chief Financial Officer in ensuring the proper administration of the financial affairs of the MIJB. They are also an essential point of reference for service managers in assisting day-to-day operations. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 241
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APPENDIX 1 Owner of Policy Chief Financial Officer Author Deborah O’Shea Date of Review April 2025 Date of previous version 27 November 2023 Policy Approved 29 May 2025 Next Review Date May 2027 MORAY INTEGRATION JOINT BOARD FINANCIAL REGULATIONS Page 242
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APPENDIX 1 MORAY INTEGRATION JOINT BOARD FINANCIAL REGULATIONS INDEX 1. INTRODUCTION and INTERPRETATION 2. CORPORATE GOVERNANCE 3. ROLES and RESPONSIBILITIES 4. FINANCIAL PLANNING and MANAGEMENT 4.1 ANNUAL REVENUE BUDGET 4.2 CAPITAL PLANNING 4.3 CAPITAL EXPENDITURE 4.4 ACCOUNTING POLICIES 4.5 BUDGET MANAGEMENT & CONTROL 4.6 BUDGET MONITORING 4.7 VIREMENT 4.8 FINAL ACCOUNTS PREPARATION 4.9 TREASURY MANAGEMENT 4.10 RESERVES 4.11 GRANT FUNDING APPLICATIONS 5. FINANCIAL SYSTEMS and PROCEDURES 5.1 INCOME 5.2 AUTHORITY TO INCUR EXPENDITURE 5.3 PROCUREMENT & COMMISSIONING 5.4 IMPRESTS 6. FINANCIAL ASSURANCE 6.1 AUDIT COMMITTEE 6.2 EXTERNAL AUDIT 6.3 INTERNAL AUDIT – RESPONSIBILITY 6.4 INTERNAL AUDIT– AUTHORITY 6.5 FRAUD, CORRUPTION & BRIBERY 6.6 INSURANCE 6.7 VAT 6.8 GIFTS and HOSPITALITY / REGISTER of INTERESTS 7. REVIEW OF FINANCIAL REGULATIONS Page 243
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APPENDIX 1 1. INTRODUCTION and INTERPRETATION 1.1 The Public Bodies (Joint Working) (Scotland) Act 2014 was passed by the Scottish Parliament on 25 February 2014 and provides a framework for the effective integration of adult health and social care services. The Act required the submission of a partnership agreement, known as the Integration Scheme for approval by the Scottish Government. Following a detailed consultation process, the scheme was submitted for approval in December 2015. Following approval by the Cabinet Secretary for Health, Wellbeing and Sport an Order was laid before the Scottish Parliament on 8 January 2016 and the Moray Integration Joint Board (MIJB) was established as an autonomous legal entity with effect from 6 February 2016. 1.2 Moray Council and NHS Grampian recognise that they each have continuing financial governance responsibilities and operate under their own Financial Regulations / Standing Financial instructions in the operational delivery of services. As this service delivery will continue to be carried out within the Council and the Health Board, these Financial Regulations relate specifically to the affairs of the MIJB and are therefore limited and focussed in scope. 1.3 The main objective of these Financial Regulations is to detail the financial responsibilities, policies and procedures that govern the MIJB. Representatives and Committees of MIJB must comply with these Financial Regulations whilst dealing with the financial affairs of MIJB. 1.4 A Chief Officer will be appointed who will be the accountable officer of the MIJB in all matters except finance where there will be joint accountability with the Chief Financial Officer. 1.5 A Chief Financial Officer will be appointed who will be the proper officer for the purposes of Section 95 of the Local Government (Scotland) Act 1973. The Chief Financial Officer has a statutory duty to ensure that proper financial administration of the financial affairs of MIJB is maintained. The MIJB will have regard to the current CIPFA guidance on the role of the Chief Financial Officer in Local Government. http://www.cipfa.org/policy-and-guidance/reports/the-role-of-the-chief-financial- officer-in-local-government 1.6 Should any difficulties arise regarding the interpretation or application of these financial regulations, individuals must seek advice from the Chief Financial Officer before any action is taken. Page 244
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APPENDIX 1 1.7 The MIJB will commission services from Moray Council and NHS Grampian. The management of services within each of these organisations will continue to be governed by the existing Standing Financial Instructions, Financial Regulations, Schedule of Reserved Decisions, Operational Scheme of Delegation and any other extant financial procedures approved by their respective Governance structures. 1.8 Any breach or non-compliance with these Regulations must, on discovery, be reported immediately to the Chief Officer or the Chief Financial Officer of MIJB who, in consultation with others as appropriate shall decide on what action should be taken. 1.9 For the avoidance of doubt the breach of, or non-compliance with these Regulations may result in disciplinary action being taken against the relevant individuals in line with the policies of the employing organisation. 2. CORPORATE GOVERNANCE 2.1 Corporate Governance is about the structures and processes for decision making, accountability, controls and behaviour throughout the MIJB. The basic principles of corporate governance are as follows: 2.1.1 Openness – Anyone with an interest in the affairs of the MIJB should have confidence in the decision making and management processes and the individuals involved in them. This confidence is gained through openness in its affairs and providing full, accurate and clear information which leads to effective and timely action and scrutiny. 2.1.2 Integrity – There should be honesty, selflessness, objectivity and high standards of conduct in how the MIJB’s funds and affairs are managed. Integrity depends on the effectiveness of the control framework and on the personal standards and professionalism of members and officers involved in the running of its affairs. 2.1.3 Accountability – There needs to be a clear understanding by everyone involved in the MIJB’s affairs of their roles and responsibilities. There should also be a process which provides appropriate independent examination of the decisions and actions of those involved in the MIJB’s affairs, including how the funds and performance are managed. 2.2 These Financial Regulations are an essential part of the corporate governance of the MIJB. 2.3 Members of the MIJB are required to follow any applicable formally agreed national codes of conduct. Page 245
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APPENDIX 1 3. ROLES and RESPONSIBILITIES 3.1 INTEGRATION JOINT BOARD MEMBERS RESPONSIBILITY 3.1.1 The Board will continuously work to secure best value for money in how the organisation directs its resources, to ensure efficiency, effectiveness, safety and quality outcomes can be achieved. The Board are responsible for ensuring that proper accounting records are kept, which disclose at any time, the true and fair financial position and enable the preparation of financial statements that comply with the applicable Code of Practice. The Board are also responsible for ensuring that procedures are in place to ensure compliance with all statutory obligations. 3.2 CHIEF OFFICER RESPONSIBILITIES 3.2.1 The Chief Officer has a direct line of accountability to the MIJB and is jointly line managed by the Chief Executives of NHS Grampian and Moray Council for the delivery of integrated services. The Chief Officer is responsible for ensuring that progress is being made in achieving the national outcomes and for any locally delegated responsibilities for health and wellbeing and for measuring, monitoring and reporting on the underpinning measures and indicators (including financial) that will demonstrate progress. 3.2.2 The Chief Officer is responsible for ensuring that the decisions of the MIJB are carried out. 3.2.3 The Chief Officer shall ensure that the Financial Regulations and all associated procedure manuals and documents are made known to appropriate staff members and shall ensure full compliance with them. 3.2.4 The Chief Officer shall prepare budgets following consultation with the Chief Financial Officer. The Chief Officer is also responsible for the preparation of Service Plans and relevant business cases relating to the Services. The Chief Officer shall ensure that the Chief Financial Officer is informed of financial matters that will have a significant impact on the Services, seeking financial advice where necessary. 3.3 CHIEF FINANCIAL OFFICER RESPONSIBILITIES 3.3.1 The Chief Financial Officer is responsible for governance of the MIJB’s financial resources, ensuring the Partners utilise these in accordance with the Strategic Plan and the Directions issued and that the Strategic Plan delivers best value. 3.3.2 The Chief Financial Officer shall ensure that suitable accounting records are maintained and is responsible for the preparation of the MIJB’s Financial Statements following the Code of Practice on Local Authority Accounting in the UK. Page 246
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APPENDIX 1 3.3.3 The Chief Financial Officer shall ensure that these Financial Regulations are reviewed and updated as necessary. 3.3.4 The Chief Financial Officer shall provide the Chief Officer and the MIJB with an annual governance statement. 3.3.5 The Chief Financial Officer shall be entitled to report upon the financial implications of any matter coming before the MIJB. To allow the Chief Financial Officer to fulfil this obligation, the Chief Officer will consult with the Chief Financial Officer on all matters involving a potential financial implication that is likely to result in a report to the MIJB. 3.3.6 The Chief Financial Officer shall ensure that arrangements are in place to properly establish the correct liability, process and accounting for VAT. 3.3.7 The Chief Financial Officer will ensure that budget managers receive appropriate advice, guidance and support and appropriate information to enable them to affect control over expenditure and income. 4. FINANCIAL PLANNING and MANAGEMENT 4.1 ANNUAL REVENUE BUDGET 4.1.1 The Chief Financial Officer will report to the MIJB each year on the process, timetable, format and key assumptions in drafting the annual budget. 4.1.2 The Chief Financial Officer of MIJB, Section 95 Officer of Moray Council and the Director of Finance of NHS Grampian will agree a timetable for preparation of the annual budget of MIJB and the exchange of information between MIJB, Moray Council and NHS Grampian. This ensures that required deadlines set out within the Integration Scheme are met. 4.1.3 The MIJB will approve a Strategic Plan which sets out arrangements for planning and directing the functions delegated to it by Moray Council and NHS Grampian. The Strategic Plan will cover a three-year period and will determine the budgets required to deliver operational services in-line with the Plan, recognising the need to be indicative in years two and three. The Strategic Plan will be aligned to, and presented with alignment to the Medium Term Financial Strategy. 4.1.4 The Chief Officer and the Chief Financial Officer will develop a case for the Integrated Budget based on the Strategic Plan and present it to Moray Council and NHS Grampian for consideration and agreement as part of the annual budget setting process. 4.1.5 The Chief Financial Officer will prepare and issue guidance, instructions and a timetable to all involved in the preparation of the annual budget. Page 247
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APPENDIX 1 4.1.6 The method for determining the final payment i.e. the initial base budget as at 1 April will be contingent on the respective financial planning processes of Moray Council and NHS Grampian. The Integration Scheme stipulates that the baseline payment to the Board will be formally advised by the Partners by 28th February each year. 4.1.7 Following agreement of the Strategic Plan by the MIJB, and confirmation of the Integrated Budget by the Partners, the Chief Officer will provide the MIJB’s Directions in writing to the Partners regarding operational delivery of the Strategic Plan. The Directions will include the functions that are being directed, how they are to be delivered and the resources to be used in delivery of the Direction in accordance with the Strategic Plan. Directions will be confirmed by the Chief Officer by 31 March of the financial year proceeding the financial year under Direction. Updated Directions will be issued throughout the year. 4.1.8 The Chief Officer will hold an operational role in both Moray Council and NHS Grampian, for the management of the operational delivery of services as directed by the MIJB and a line of accountability to the Chief Executives of both organisations for the financial management of operational budgets. 4.2 CAPITAL PLANNING 4.2.1 The MIJB is not empowered to own capital assets, and accordingly the management of assets remains the responsibility of the Partner organisation. There is a need to ensure clear planning, scrutiny and governance of assets to ensure the appropriate assets are in place to allow for the delivery of the delegated functions. 4.2.2 The MIJB has in place an Infrastructure Programme Board who’s membership includes key officers from MIJB, NHS Grampian and Moray Council. The Infrastructure Programme Board reports to the Strategic Planning and Commissioning group. 4.3 CAPITAL EXPENDITURE 4.3.1 The MIJB does not receive a capital funding allocation. Capital projects are funded by either Moray Council or NHS Grampian and expenditure will be controlled in accordance with their respective financial regulations / standing financial instructions. 4.4 ACCOUNTING POLICIES 4.4.1 The MIJB is subject to the audit and accounts provisions of a body under section 106 of the Local Government (Scotland) Act 1973. The Chief Financial Officer is responsible for the preparation of the MIJB’s Financial Statements following the Code of Practice on Local Authority Accounting in the UK. Page 248
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APPENDIX 1 4.5 BUDGET MANAGEMENT & CONTROL 4.5.1 Budget holders/managers within Moray Council and NHS Grampian will be accountable for all budgets within their control as directed by the MIJB in line with its Strategic Plan. The MIJB will ensure appropriate arrangements are in place to support good financial management and planning. 4.5.2 It is the joint responsibility of the Chief Officer and Chief Financial Officer of the MIJB to report regularly and timeously on all budgetary control matters, comparing projected outturn with the approved financial plan to the MIJB. 4.5.3 The NHS Grampian Director of Finance and the Section 95 Officer of Moray Council shall, along with the MIJB Chief Financial Officer put in place a system of budgetary control which will provide the Chief Officer with management accounting information for both arms of the operational budget and for the MIJB in aggregate. 4.6 BUDGET MONITORING 4.6.1 It is the joint responsibility of the Chief Officer and the Chief Financial Officer to report to the MIJB regularly, timeously and accurately on all matters of budget management and control. The reports should include projections for the full financial year and any implications for the following financial years. These reports will include recovery action or corrective measures proposed where a year end budget variance is identified. 4.6.2 The Director of Finance, NHS Grampian and the Section 95 Officer, Moray Council will provide the Chief Financial Officer of the MIJB with information on a monthly basis regarding the costs incurred for the services directly managed by them. Information should be provided in an agreed format. 4.6.3 The Director of Finance, NHS Grampian will provide the Chief Financial Officer of MIJB with financial information on a monthly basis regarding the hosted services. Information should be in an agreed format and produced timely to enable inclusion in the financial monitoring reports. 4.6.4 The Director of Finance, NHS Grampian will provide the Chief Financial Officer of MIJB with information regarding the use of the amounts set aside for hospital services. Reporting updates will be provided in line with the provision of activity information from NHS Information Services Division. 4.6.5 The Chief Financial Officer will report monthly to the Chief Officer on the financial performance and position. These reports will be timely, relevant and reliable and will include information, analysis and explanation in relation to: Page 249
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APPENDIX 1 • Reviewing budget savings proposals • Actual income and expenditure • Forecast outturns and annual budget • Explanations of significant variances • Reviewing action required in response to significant variances • Identifying and analysing financial risks • Use of reserves • Any adjustments to the annual budget (e.g. new funding allocations) 4.6.6 The Chief Financial Officer will work with the Section 95 Officer of Moray Council and Director of Finance of NHS Grampian to ensure managers are provided with monthly financial reports that are timely, relevant and reliable. These reports will include information and analysis in relation to: • Budget available to managers • Actual income and expenditure • Forecast outturns. 4.6.7 The Chief Financial Officer will be consulted on all reports being submitted to the MIJB to ensure that any financial implications arising have been considered. Each MIJB report should include a Financial Implications section. 4.6.8 It is a requirement of the Public Bodies (Joint Working) (Scotland) Act 2014 that an annual performance report is presented to the MIJB and the financial contents therein should comply with the requirements as set out in the Act. 4.7 VIREMENT 4.7.1 Virement is defined by CIPFA as “the transfer of an underspend on one budget head to finance additional spending on another budget head, in accordance with and Authority’s Financial Regulations”. In effect virement is the process of transferring budget between budget headings with no change to the overall net budget. 4.7.2 The Chief Officer is expected to deliver the agreed outcomes within the total delegated budget. Any virement must not create additional overall budget liability. 4.7.3 Any proposal for virement involving a new policy, or variation of existing policy, which will impact upon the strategic plans of the MIJB, will be subject to the approval of the MIJB. 4.7.4 Virement can be used in the following situations and with reference to the flow chart at APPENDIX A; • The Chief Financial Officer has been notified; and Page 250
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APPENDIX 1 • The virement does not create an additional financial commitment into future financial years. 4.7.5 The virement process cannot be used in the following situations: • for transfers between IJB and non-IJB budgets; • for expected savings on finance costs or recharges; • for recurring items of expenditure in place of non-recurring savings; • for staffing changes that would increase the establishment; • for property items such as rates and utilities; • any savings against a property which has been declared surplus under the Council’s or NHS’s surplus asset procedure; • to reinstate an item deleted by the MIJB during budget considerations unless approved by the MIJB. 4.7.6 The Chief Financial Officer must maintain separate budgets for any hosted services managed on behalf of Grampian wide partners. Virement to and from these to Integration Joint Boards requires authorisation of all the three Integration Joint Boards before being implemented. 4.7.7 To the extent that any virement would transfer budget between Partners the Chief Financial Officer is required to notify the Partner bodies and send amended Directions. 4.8 FINAL ACCOUNTS PREPARATION 4.8.1 The Public Bodies (Joint Working) (Scotland) Act 2014 requires that the MIJB is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973 (Section 13). This will require audited annual accounts to be prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014, and so far as is compatible with that legislation, in accordance with proper accounting practices in Section 12 of the Local Government in Scotland Act 2003 and regulations under Section 105 of the Local Government (Scotland) Act 1973). 4.8.2 Financial statements will be prepared to comply with the Code of Practice on Local Authority Accounting and other relevant professional guidance. 4.8.3 The unaudited annual accounts shall be submitted to the External Auditors and to those members charged with governance for their consideration in accordance with the statutory regulations. 4.8.4 The audited annual accounts shall be submitted to those charged with governance for their consideration and approval and the Auditors report thereon shall be submitted to the MIJB for consideration in accordance with the statutory regulations Page 251
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APPENDIX 1 4.8.5 The timetable for audit and publication of MIJB’s annual accounts shall be agreed in advance with the external auditors of Moray Council and NHS Grampian. 4.9 TREASURY MANAGEMENT 4.9.1 The MIJB will not undertake any cash transactions but rather these will be on a notional basis through the Direction of expenditure undertaken by the Partners. Any cash correction arising as a result of the direction by the MIJB will be undertaken directly between the Partners. 4.9.2 The MIJB will not operate a bank account. 4.10 RESERVES 4.10.1 The Public Bodies (Joint Working) (Scotland) Act 2014 empowers the Integration Joint Boards to hold reserves, which should be accounted for in the financial accounts and records of MIJB. MIJB has a Reserves Policy that is held outwith these Financial Regulations and is reviewed regularly. 4.10.2 Unless otherwise agreed, any unspent budget will be transferred into the reserves of the MIJB at the end of each financial year. 4.11 GRANT FUNDING APPLICATIONS 4.11.1 Where opportunities arise to attract external funding, relevant officers shall consider the conditions surrounding the funding to ensure they are consistent with the aims and objectives of MIJB and the Strategic Plan. 4.11.2 All grant funding to be secured by the MIJB from external bodies is required to receive approval from the the Senior Management Team MIJB prior to an application being made by the accountable body to ensure financial implications and match funding requirements are considered. These will then be reported to MIJB as part of the budget monitoring reports. 4.11.3 The Chief Financial Officer shall ensure that arrangements are in place to:- • receive and properly record such income in the accounts of the accountable body; • ensure the audit and accounting arrangements are met; and • ensure the funding requirements are considered prior to entering into any agreements, both in the present and the future. 4.11.4 The Chief Officer of the service receiving grant funding must ensure that arrangements for receiving and recording income are complied with. Chief Officers shall ensure appropriate records are kept in relation to any grant funding activities, including, but not limited to, grant funding applications; grant funding Page 252
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APPENDIX 1 award and claims. They must also ensure that the project progresses in accordance with the agreed terms of the funding agreement and that claims are made from the funding body timeously and in accordance with any conditions of the grant award. 5. FINANCIAL SYSTEMS and PROCEDURES 5.1 INCOME 5.1.1 There is no income to the MIJB by way of cash transactions. Transfer of resources will be made by NHS Grampian and Moray Council in respect of the agreed delegated functions and will be reflected in the Directions. Payment will then be made by the MIJB for the delivery of these services. The accounting for these transactions will be via book entries in the ledgers of NHS Grampian and Moray Council. 5.2 AUTHORITY TO INCUR EXPENDITURE 5.2.1 The Chief Officer shall have the authority to incur expenditure within the approved delegated resources from MIJB to Moray Council and NHS Grampian in-line with any supplementary budget that has been approved by the MIJB, and subject to the provisions of these Financial Regulations. 5.2.2 Expenditure shall be aligned with the Strategic Plan. The Chief Officer and Chief Finance Officer will make sure that MIJB only commits to expenditure that it is legally able to commit to and is within scope of the approved Integration Scheme and Strategic Plan. Where this is not clear they will consult with the section 95 Officer of the Council and the Director of Finance of NHS Grampian and seek appropriate legal advice. 5.3 PROCUREMENT and COMMISSIONING 5.3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 provides that the MIJB may enter into a contract with any other person in relation to the provision to the MIJB of goods and services for the purposes of carrying out functions conferred on it by the Act. 5.3.2 Procurement activity in relation to operational delivery of services will be undertaken following the procurement procedures approved by the Partner organisations to which the MIJB has given operational Direction for the use of financial resources. Page 253
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APPENDIX 1 5.4 PETTY CASH IMPRESTS 5.4.1 There will be no facility for petty cash unless authorised by the MIJB Chief Financial Officer and the necessary security arrangements have been established and have been deemed adequate. 5.4.2 Petty cash imprest facilities will be operated within NHS Grampian and Moray Council and will be contained within their respective established arrangements. 6. FINANCIAL ASSURANCE 6.1 AUDIT COMMITTEE 6.1.1 MIJB is required to make appropriate and proportionate arrangements for overseeing the system of corporate governance and internal controls. This has resulted in the establishment of an Audit, Performance & Risk committee. The Audit, Performance& Risk Committee operates in accordance with Financial Reporting Council professional guidance for Audit Committees and has distinct, approved terms of reference set out within the MIJB’s Scheme of Administration. 6.2 EXTERNAL AUDIT 6.2.1 The Accounts Commission will appoint the external auditors to the MIJB. 6.2.2 External Audit are required to submit an annual plan to the MIJB and its Audit, Performance & Risk Committee. 6.2.3 External Audit are required to submit a final report to MIJB and its Audit, Performance & Risk Committee. 6.2.4 The External Auditor appointed to MIJB for the purposes of conducting their work, shall:- • Have a right of access to all records(electronic or manual), assets, personnel and premises, including those of partner organisations in carrying out their duties in relation to MIJB activity. • Have access to all records (electronic or manual), documents and correspondence relating to any financial and other transactions of the MIJB and those of partner organisations where it relates to their business with the MIJB. • Require and receive such explanations as are necessary concerning any matter under examination, in a timely manner. This has been established as responding within 5 working days for information requests. Page 254
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APPENDIX 1 6.3 INTERNAL AUDIT - RESPONSIBILITY 6.3.1 The role of Internal Audit is to understand the key risks faced by the MIJB and to examine and evaluate the adequacy and effectiveness of the system of risk management and internal control as in support of the governance arrangements operated by the MIJB. 6.3.2 The MIJB shall secure the provision of an internal audit service to provide an independent and objective opinion on the control environment comprising risk management, governance and control of the delegated resources. The delivery of internal audit services is currently undertaken by the Internal Audit Section of the Moray Council. . 6.3.3 The operational delivery of internal audit services within NHS Grampian and Moray Council will be contained within their respective established arrangements. 6.3.4 The Internal Audit Service provided to MIJB will undertake its work in compliance with the Public Sector Internal Audit Standards. 6.3.5 The MIJB Chief Internal Auditor, who is also the Audit and Risk Manager of the Moray Council, will prepare and submit a strategic risk based audit plan to the MIJB or Audit Performance and Risk Committee for approval on an annual basis. This audit plan will not include systems and practices within NHS Grampian that will be subject to separate audit arrangements. 6.3.6 The Chief Internal Auditor shall report to the Audit, Performance & Risk Committee throughout the year on the outcomes of audit work completed and on progress towards delivery of the agreed annual audit plan. The Chief Internal Auditor will also provide an annual opinion on the MIJB’s systems of governance and internal control based on the findings from work carried out by Internal Audit, taken together with other sources of assurance. 6.3.7 Such Internal Audit work shall not absolve senior management of the responsibility to ensure that all financial transactions are undertaken in accordance with the Financial Regulations/ Standing Financial Instructions and Standing Orders and that adequate systems of internal control exist to safeguard assets and secure the accuracy and reliability of records. 6.3.8 It shall be the responsibility of senior management to ensure that access to relevant officers and explanations requested by the Chief Internal Auditor or their representatives are provided in a timely manner. (Operational this has been established as responding within 20 working days to audit recommendations and 5 working days for information requests). 6.3.9 The Chief Internal Auditor has the right to report direct to the MIJB in any instance where he or she deems it inappropriate to report to the Chief Officer, Chief Financial Officer or Audit, Performance & Risk committee. 6.3.10 Where recommendations resulting from Internal Audit work have been agreed, the Chief Officer shall ensure that these are implemented within the agreed Page 255
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APPENDIX 1 timescale. Regular progress reports will be sought by the Chief Internal Auditor and it is the responsibility of the Chief Officer to ensure that these are provided when requested along with explanations of any recommendations not implemented within the agreed timescale. 6.4 INTERNAL AUDIT - AUTHORITY 6.4.1 The Chief Internal Auditor or their representatives shall have the authority, on production of identification to obtain entry at all reasonable times to any premises or land used or operated by MIJB in order to review, appraise and report on the areas detailed below:- • The adequacy and effectiveness of the systems of financial, operational and management control and their operation in practice in relation to the business risks to be addressed. • The governance arrangements in place by reviewing the systems of internal control, risk management practices and financial procedures. • The extent of compliance with policies, standards, plans and procedures approved by the MIJB and the extent of compliance with regulations and reporting requirements of regulatory bodies. • The suitability, accuracy, reliability and integrity of financial and other management information and the means used to identify, measure and report such information. 6.4.2 In addition, the Chief Internal Auditor or their representatives, for the purposes of conducting their work, shall:- • Have a right of access to all records (electronic or manual), assets, personnel and premises, when carrying out their duties in relation to Moray Integration Joint Board activity. • Have access to all records (electronic or manual), documents and correspondence relating to any activity, including financial and other transactions of the Board and those of partner organisations where it relates to their business with the Board. • Require and receive such explanations as are necessary concerning any matter under examination. 6.5 FRAUD, CORRUPTION & BRIBERY 6.5.1 Every member of MIJB and its representatives shall observe these Financial Regulations/ Standing Financial Instructions within the sphere of their responsibility. They have a duty to bring to the immediate attention of the Chief Internal Auditor any suspected fraud or irregularity in any matter that would contravene these regulations. Page 256
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APPENDIX 1 6.5.2 All suspected fraudulent activity should be reported to the Chief Internal Auditor. However, there are a range of confidential routes available to the MIJB and its representatives who wish to ask for advice regarding the reporting of an irregularity or a suspected fraud; • NHS Counter Fraud Services (CFS) Fraud Hotline on – 08000 15 16 28 • NHS Counter Fraud Services Website on: NHS CFS Website • NHS Grampian’s Fraud Liaison Officer – Assistant Director of Finance (Financial Services) on 07966 336548 • NHS Grampian’s Deputy Fraud Liaison Officer – Financial Governance Manager on 01224 556103 • The MIJB Chief Internal Auditor on Fraud Hotline 01343 563003 All information provided is treated in the strictest of confidence and individuals who raise genuine concerns are protected by law, regardless of the outcome of any investigation that they initiate. The fraud policies of both NHS Grampian and Moray Council are available via their respective Intranets. 6.5.3 When a matter arises where it is suspected that an irregularity exists in the exercise of the functions of MIJB, the Chief Internal Auditor in conjunction with the Chief Officer, will take such steps as may be considered necessary by way of investigation and report. 6.5.4 Both organisations have Whistleblowing policies and can be found on their websites here, Moray Council and NHS Grampian 6.6 INSURANCE 6.6.1 The Chief Officer in conjunction with the Chief Financial Officer will ensure that the risks faced by the MIJB are identified and quantified and that effective measures are taken to reduce, eliminate or insure against them. 6.6.2 As of 1 April 2016 the MIJB became members of the Clinical Negligence and Other Risks Scheme (CNORIS) scheme. The cover provided is in relation to indemnity for MIJB Members only. The cover provided is in respect of decisions made by Members in their capacity on the MIJB. All other cover required should be provided by NHS Grampian and Moray Council. 6.6.3 The Chief Officer is responsible for ensuring that there are adequate systems in place for the prompt notification in writing to the Chief Financial Officer of any loss, liability, damage or injury which may give rise to a claim, by or against the MIJB. Page 257
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APPENDIX 1 6.6.4 The Chief Officer in conjunction with the Chief Financial Officer shall annually or at such other period as may be considered necessary, review all insurances. Any required changes should be reported to MIJB. 6.6.5 The Chief Officer in conjunction with the Chief Financial Officer of MIJB will review the requirement for membership of the Scottish Government (CNORIS) on an annual basis. 6.7 VAT 6.7.1 HMRC have confirmed that there is no VAT registration requirement for Integration Authorites under the VAT act 1994 as it will not be delivering any services that fall within the scope of VAT. 6.7.2 Should the activities of the MIJB change in time and it becomes empowered to provide services, then it is essential the VAT treatment of any future activities or services delivered are considered in detail by the Chief Financial Officer to establish if there is a legal requirement for the Integration Authorities to register for VAT. 6.7.3 The Chief Officer and Chief Financial Officer must remain cognisant of possible VAT implications arising from the delivery of the Strategic Plan. The Partner organisations should be consulted in early course on proposals which may have VAT related implications for them. 6.8 GIFTS and HOSPITALITY / REGISTER of INTEREST 6.8.1 Members and employees must should comply with their respective codes of conduct when offered gifts, gratuities and hospitality. 6.8.2 A central register of gifts and hospitality will be maintained by the MIJB. For the offers of any hospitality or gift, approval must be sought from the relevant line manager prior to acceptance and for offers exceeding £30 details must be intimated in writing for including in the register. Reference must should be made to the respective codes of conduct. 6.8.3 A separate Register of Interests for members is maintained by the Clerk to the MIJB. 6.9 RETENTION OF FINANCIAL DOCUMENTS 6.9.1 The Chief Officer and Chief Financial Officer will ensure that arrangements are in place for the proper management of financial, legal and other documents and that these documents are retained in accordance with any specific statutory requirements, including the Data Protection Act (2018), the Freedom of Information (Scotland) Act (2002), and any approved MIJB management policies and procedures. The accounting records will be held by Moray Council on behalf of the MIJB. Page 258
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APPENDIX 1 7 REVIEW OF FINANCIAL REGULATIONS 7.1 These Financial Regulations shall be subject to review on a regular basis, and as a minimum of every two years by the MIJB Chief Financial Officer and where necessary, subsequent amendments will be submitted to MIJB for approval. Financial Regulations should be considered alongside other Governance documents. Page 259
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APPENDIX 1 APPENDIX A – MIJB VIREMENT APPROVAL RESPONSIBILITY CHART Does the virement involve a Y new policy or a variation of an existing policy that will MIJB to approve impact on the Strategic Plan N Y If under £20k, relevant Budget Managers& CFO to Is the virement between approve. If between £20k - Budget groupings within the £100k, Senior Same cost centre? Management Team to approve. If over £100k, Chief Officer to approve. N NOTES:- THE CFO SHOULD BE NOTIFIED OF ALL VIREMENTS 1. All budget virements should be advised to the relevant Finance team to ensure correct processing in the ledger. Is the virement between budget Y 2. Non-recurring savings cannot be vired to groupings within the same service fund recurring commitments. (i.e. all within Health or all within 3. Virement cannot be used to reinstate an Social Care?) item which has been previously excluded N from the MIJB Budget without agreement of the full MIJB. 4. Virements cannot be made from earmarked funding sources which are If under £20k, relevant Budget provided by the Scottish Government for Managers & CFO to approve. a specific service objective. If between £20k - £100k, Senior Management Team to approve. If over £100k, Chief Officer and the MIJB Chief Financial Officer to approve. 5. Adjustments required between MIJB and non MIJB budgets would be considered to be outside the scope of this virement process and require separate reporting to the MIJB and the Partners. 6. All virements will be reflected in monthly monitoring for reports for budget managers. 7. All virements over £100k will be reported in the financial monitoring reports to the MIJB. Page 260