Agenda Document Pack - Moray Integration Joint Board - 19/06/2025
Moray Council · 19 June 2025
Back to Moray Integration Joint Board — 19 June 2025 and its agenda
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Moray Integration Joint Board Thursday, 19 June 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, 19 June 2025 at 14:00 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 29 May 2025 5 - 10 4. Action Log of 29 May 2025 11 - 14 5. Revenue Budget Outturn for 2024-25 15 - 34 6. Unaudited Annual Accounts 35 - 112 7. Proposed Revision to the Moray Integration Joint Board Meeting Schedule 113 - 118 8. Annual Performance Report 2024-25 119 - 204 9. Annual Progress Update on the Delivery of the Unpaid Carers Strategy 205 - 236 Page 1
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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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MORAY COUNCIL Minute of Meeting of the Moray Integration Joint Board Thursday, 29 May 2025 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Ivan Augustus, Councillor Peter Bloomfield, Mrs Sheila Brumby, Mr Sean Coady, Ms Jane Ewen, Councillor Elaine Kirby, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Jim Lyon, Ms Deirdre McIntyre, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Ms Elizabeth Robinson, Mr Alex Stephen, Councillor Ben Williams APOLOGIES Professor Duff Bruce, Dr Adam Coldwells, Ms Sonya Duncan, Ms Karen Greaves BEM, Mr Dennis Robertson IN ATTENDANCE Corporate Business Support Manager; Corporate Programme Manager; Iain Macdonald, Deputy Head of Service; Interim Service Manager, Moray Mental Health and Drug and Alcohol Services; Moray Alcohol and Drug Partnership Coordinator and Caroline O'Connor, Committee Services Officer. ALSO IN ATTENDANCE Councillor Tracy Colyer, Councillor Sandy Keith, Councillor Sonya Warren 1. Chair The meeting was chaired by Councillor Elaine Kirby. 2. Declaration of Member's Interests Mr Riddell stated for transparency that he was Chair of the Mental Welfare Commission for Scotland. The Board noted there were no other declarations of member's interests. 3. Minute of meeting of 27 March 2025 The minute of the meeting of 27 March 2025 was submitted and approved. 4. Action Log of 27 March 2025 The Action Log of the meeting of 27 March 2025 was discussed and updated accordingly. 5. Minute of meeting Audit Performance and Risk Committee of 30 January 2025 Item 3. Page 5
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The Board noted the minute of the meeting of the Audit, Performance and Risk Committee of 30 January 2025. 6. 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 response to a question from Councillor Bloomfield asking for details on available services at Dr Grays Hospital which had previously been the subject of update reports from the General Manager of Dr Grays, the Chief Officer confirmed an update report relating to the work being undertaken in relation to strategic change at Dr Grays will be prepared for a future meeting of the Board. Following 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. 7. Membership of Board and Committees The meeting had before it a report by the Corporate Business Support Manager informing 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. The Board joined the Chair in paying tribute to the members of the Board who had recently left for their valuable contributions to the Board and wished them well for the future. Following consideration the Board unanimously agreed to note:- (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. 8. 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. Page 6
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In response to suggested amendments to the wording of the Strategy from Mr Murray to provide clarity, the Corporate Programme Manager asked Mr Murray to forward on his comments and she would ensure the wording was adjusted accordingly. In response to a question from Councillor Bloomfield asking the source of the percentages detailed in 2.1 of Appendix 1, the Corporate Programme Manager advised the figures had been taken from the Joint Strategic Needs Assessment, the link to which she would add to the Strategy. In terms of the Collaboration and Partnership Working referenced at Number 6 of Strategic Theme - Building Resilience, and following attendance at the recent opening of the Erskine Veterans Centre in Forres, Councillor Lawrence made reference to the specialist care on offer however noted the manager had advised there were no links to the NHS and Health and Social Care Moray (HSCM). In response to a question from Councillor Lawrence asking whether HSCM are working well in collaboration and partnership with military personnel and veterans in Moray as or if there was potential to do more, Mr Lockhart agreed veteran care was important and undertook to consider how to promote through general practice. The Chief Officer referenced the Armed Forces Covenant, the aim of which is to encourage local communities to support the service community in their area and promote understanding and awareness among the public of issues affected the armed forces community. The Deputy Head of Service further undertook to extend an invitation to Erskine to be part of the Forres locality planning group which meets bi-monthly to enable them to engage with third sector providers in the area and connect to a wider strategic plan. The Chair asked an update be provided to the next meeting of the Board to provide assurance of progress. Following consideration the Board unanimously agreed to:- (i) 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. 9. Moray Integration Joint Board Strategic Risk Register The meeting had before it a report by the Chief Officer providing the Board with a comprehensive overview of the strategic risks currently facing the organisation including risk identification, risk assessment and mitigating actions, aligned with the Strategic Plan. Mr Riddell noted a gap in assurance in terms of youth representation referencing insights young people have and asked that consideration be given to how establish a robust process to include youth representation. In response the Chief Officer confirmed discussions have been taking place with the Interim Chief Social Work Officer on how best to include young people's voices. The Interim Chief Social Work Officer agreed it was important to not only effectively evidence young people's voices but also detail what action has been taken and the best means of achieving it was through the Champions Board which he would follow up on. Page 7
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In response to a question from Mr Augustus asking for reference to what is being done to support unpaid carers be included in Risk 3 on Appendix 1, the Chief Officer agreed to include in the narrative. Following consideration the Board unanimously agreed to:- (i) note the continued development of the Moray Integration Joint Board Risk Register; (ii) note the updated Strategic Risk Register (Appendix 1) and the adequacy of the mitigating controls identified; and (iii) approve the new format of the register. 10. Moray Adult Mental Health Strategic Group Progress Report The meeting had before it a report by the Deputy Head of Service and Consultant in Public Health providing the Board with assurance on progress towards delivery of the Moray Mental Health and Wellbeing Strategy 2016-2026. With reference to the first outcome detailed under Mental Health Quality Standard 4: Workforce in Appendix 1, namely the workforce feels valued and respected, Mr Augustus asked that unpaid carers be included in the workforce survey planned for later in the year as although not paid, they are still part of the workforce and it was important to acknowledge their contributions and the pressures they are under. In response the Consultant in Public Health agreed to include carers as it would be beneficial to understand direct what their issues are in order to feed into development of the workforce plan. Following consideration the Board unanimously agreed to:- (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) endorse the Moray Mental Health and Wellbeing Strategic Performance Framework (Appendix 3). Ms Ewen left the meeting at this juncture. 11. Equalities Mainstreaming Report 2025-2029 including progress against Outcomes 2021-2024 The meeting had before it a report by the Corporate Manager and Public Health Consultant providing 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 seeking approval of the final progress report. During the course of discussion and noting that he made a suggestion at the last Board meeting, Mr Riddell asked, in order to mainstream equalities as part of the Board's vision and culture and encourage discussion, that reference to equalities be included within the body of reports to the Board rather than only in the Summary of Implications section. In response the Public Health Consultant Page 8
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agreed it would be beneficial for prompts to be added to report templates to remind authors of the need to include specific reference to equalities in the body of reports. Following consideration the Board unanimously agreed to:- (i) approve the final MIJB Equality Mainstreaming Progress Report 2021-2024 (Appendix 1); (ii) 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) approve mainstreaming of the Equality Duty; and (iv) instruct the Corporate Manager to publish the reports on the Health and Social Care Moray webpage and develop an accessible user friendly summary for publication. 12. Moray Alcohol and Drug Partnership - Scottish Government Annual Reporting Survey The meeting had before it a report by the Moray Alcohol and Drug Partnership Coordinator informing the Board of the progress made by the Moray Drug and Alcohol Partnership (MADP) in delivering its strategic priorities for the period 2024/25, as captured ion the Scottish Government's Annual Report Survey, and seeking approval for submission to the Scottish Government in line with national reporting requirements. Following consideration the Board unanimously agreed to:- (i) note the completed 2024/25 Annual Reporting Survey and agree to its submission to the Scottish Government as required; (ii) note 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) support ongoing work to address remaining challenges, including workforce capacity, rural service access and the sustainability of family support services; and (iv) note the progress of the Moray Drug and Alcohol Partnership in delivering services to Moray as documented in Appendix 1. 13. Review of Financial Regulations The meeting had before it a report by the Chief Financial Officer seeking the approval of the Board to update the Financial Regulations in line with the proposed amendments contained within Appendix 1. Following consideration the Board unanimously agreed:- Page 9
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(i) to approve the proposed changes to the Moray Integration Joint Board Financial Regulations as set out in Appendix 1; and (ii) that the reviews will be done biannually. Page 10
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 29 May 2025 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 19 JUNE 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 11
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 19 JUNE 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. 30/10/25 JP Scheduled for October’s Development Session 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. 31/05/25 AC GP Lead discussed with Chair Action closed 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 12
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 19 JUNE 2025 6. 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. Update 29/05/25: Prompts to be added to report template to remind authors of need to include specific reference to equalities in body of report. Ongoing ALL IW In progress 7. Chief Officer Report 29/05/25 i) Update report relating to the work being undertaken in relation to strategic change at Dr Grays to be prepared for future meeting of the Board. ii) Strategic awareness of unpaid carers capacity to be considered at next IJB Development Session. TBC JP JP In progress Topics for future development sessions being considered 8. HSCM Strategic Delivery Plan 2025-2028 Erskine / Veteran Care i) Mr Lockhart agreed veteran care was important and undertook to consider how to promote through general practice. ii) Deputy Head of Service to extend an invitation to Erskine to be part of the Forres locality planning group which meets bi- monthly to enable them to engage with third sector providers in the area and connect to a wider strategic plan. iii) The Chair asked an update be provided to the next meeting of the Board to provide assurance of progress. 19/06/25 19/06/25 19/06/25 RL IMcD IMcD/RL Page 13
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 19 JUNE 2025 9. MIJB Strategic Risk Register i) Youth representation – consideration to be given to a robust process to include youth representation. ii) Risk 3 – add reference to what is being done to support unpaid carers. JP/JL JP 10. Moray Adult Mental Health Strategic Group Progress Report Mental Health Quality Standard 4: Workforce in Appendix 1, Outcome namely the workforce feels valued and respected, unpaid carers to be included in the workforce survey planned for later in the year. IM/ER Page 14
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 19 JUNE 2025 SUBJECT: REVENUE BUDGET OUTTURN FOR 2024/2025 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of the unaudited financial outturn for 2024/25 for the core budgets and the impact this outturn will have on the 2025/26 budget. 2. RECOMMENDATIONS 2.1 It is recommended that the Board: i) consider and note the unaudited revenue outturn position for the financial year 2024/25; ii) consider and note the impact of the 2024/25 outturn on the 2025/26 revenue budget as detailed in paragraph 7; and iii) approve for issue, the Directions shown in Appendix 4 to NHS Grampian and Moray Council. 3. BACKGROUND 3.1 The overall position for the Moray Integration Joint Board (MIJB) is that core services were overspent by £7,420,760 as at 31 March 2025. The MIJB’s unaudited financial position for the financial year ending 31 March 2025 is shown at Appendix 1. This is summarised in the table below. Annual Budget £ Actual Expenditure £ Variance to date £ MIJB Core Service 181,234,848 188,655,608 (7,420,760) MIJB Strategic Funds & other resources 10,633,832 7,470,144 3,163,689 Set Aside Budget 15,639,000 15,639,000 0 Total MIJB Expenditure 207,507,680 211,764,752 (4,257,072) A list of services that are included in each budget heading are shown in Appendix 2 for information. Item 5. Page 15
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4. KEY MATTERS/SIGNIFICANT VARIANCES FOR 2022/23 Learning Disabilities 4.1 The Learning Disability (LD) service is overspent by £2,272,694 at the year- end. The overspend is essentially due to the purchase of care for people with complex needs which resulted in an overspend of £2,806,801 and client transport of £13,781. This is offset by more income received than expected of £524,800 (income due from another authority and Change Fund funds from NHS) and other small underspends of £18,619 which primarily relate to property costs. There was a minor underspend of £4,469 in other Learning Disabilities clinical services. 4.2 This budget has been under pressure for a number of years due to demographic pressures, transitions from Children’s services and people living longer and getting frailer whilst staying at home. The biggest overspends was for services provided to individuals in their own homes to support their daily living needs which enables people to stay living at home or in a homely setting for as long as possible and day care which provides activities during the day in the community. 4.3 The outturn for the LD service is as previously forecast. Forecasting is difficult to do on this volatile budget as client needs can change and therefore costs can fluctuate. Care Services Provided In-House 4.4 This budget is underspent by £1,988,757 at the end of the year. This relates to underspend in staffing across all the services in this budget totalling £2,291,755 and other minor underspends of £8,275 which is being reduced by overspends relating to transport costs £97,970; insurance costs £29,047, utility costs £62,430 and less income than expected £121,826. 4.5 Unfilled vacancies have been the main reason for the underspend throughout the year and the issue of recruitment has been an ongoing problem. 4.6 The outturn for this budget is £74,855 better than previously forecast which is due to the ongoing vacancies and recruitment challenges. Older People and Physical Sensory Disability (Assessment & Care) 4.7 This budget is overspent by £2,259,056 at the end of the year. This primarily relates to overspends for home care in the area teams £539,818, permanent care £1,766,157 due to the increase in the number of clients receiving nursing care rather than residential care and respite care £105,776 this is being reduced by an underspend for day care £152,695. The variances within this overall budget heading reflect the shift in the balance of care to enable people to remain in their homes for longer. 4.8 Due to the increase in need and complexity – increase in double up care at home packages. Limited resource availability through our internal provider and limited availability with CQS partnership provider means a reliance on external providers to continue to support the demand/need. The overspend on this budget is related to the underspend in Care Services provided in-house budget above. Page 16
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4.9 The outturn for this budget is £666,291 more overspent than the previous forecast due to less income than expected and more spend on care than expected. Primary Care Prescribing 4.10 The primary care prescribing budget is reporting an over spend of £3,189,386 for the twelve months to 31 March 2025. The overall average price has remained relatively consistent and includes cost reduction savings identified by Pharmacy implemented countered by the impact of short supply causing an increase in costs. This is spread across a range of products and is ongoing. This overall volume increase at 3.5% is less than previously anticipated. 4.11 This impact on estimated outcome and outturn is £14,386 more than previously forecast for this budget. This takes into account volume increase continuing at reduced level and price remaining stable in the final months of the year. Out of Area Placements 4.12 This budget is overspent by £1,250,899 at the year end. This is due to the continuing number of high cost individual specialised placements. 4.13 The outturn for this budget is £191,030 more overspent than previously forecast mainly due to increased costs from another board area being passed through to NHS Grampian for placements made. 5. STRATEGIC FUNDS 5.1 Strategic Funds relate to additional Scottish Government funding for Integrated Joint Boards. For the MIJB, they include: • Additional funding received via NHS Grampian and Moray Council (this may not be fully utilised in the year resulting in a contribution to overall MIJB financial position at year-end, which then needs to be earmarked as a commitment for the future year); and • Provisions for earmarked reserves has been made to fund unutilised allocation for Primary Care Improvement Funds, Action 15 additional investment funding, identified budget pressures, new burdens, and savings that were expected at the start of the year. 5.2 At the end of the financial year there was slippage on Strategic Funds of £3,163,689 which, when set against the overspend in core services, has resulted in an overall overspend of £4,257,072. 5.3 During the 2024/25 financial year, Scottish Government continued to commit on the national investment in health and social care. Allocations made during the year, which remain unspent are considered as earmarked funding and to be used for these specific purposes in future years. This has contributed to the MIJB reserves. 5.4 After consideration of funding received, earmarked reserves and application of slippage on Strategic Funds, the final MIJB financial position resulted in an overspend of £4,257,072. As set out in the Integration Scheme, NHS Grampian and Moray Council, as the funding partners make additional funding available to support the MIJB break even. The reserves are detailed below in paragraph 9. Page 17
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6. CHANGES TO STAFFING ARRANGEMENTS 6.1 At the meeting of the Board on 30 November 2023, the Financial Regulations were approved (para 12 of the minute refers). All changes to staffing arrangements with financial implications and effects on establishment are to be advised to the Board. 6.2 The staffing arrangements are noted in Appendix 3 as dealt with under delegated powers for the period 1 January to 31 March 2025. 7. IMPACT ON 2025/26 BUDGET AND RISK 7.1 The actual out-turn for the 2024/25 Core Services budget year is an overspend of £7,420,760. However, the variances against the budget have been reviewed and classified as one-off or likely to be recurring. Impact in 2025/26 will be monitored continuously and reported regularly to the MIJB. The overall position is summarised below: Area Para Ref Recurring Non-Recurring £ £ OVERSPEND Staff 7.2 (1,272,664) (872,706) Purchasing of Care 7.3 (6,506,534) (733,059) Income 7.4 (285,047) 0 Supplies & Services 7.5 (92,504) 0 Property costs 7.6 (482,038) (271,734) Transport 7.7 (192,483) 0 Aids & Adaptations 7.8 (260,544) (151,709) Prescribing & hosted 7.9 (3,175,000) (14,386) Other 7.10 (51,660) (271,997) Sub-total (12,320,475) (2,315,591) UNDERSPEND Staff 7.2 4,166,537 578,486 Purchasing of Care 7.3 967,091 0 Income 7.4 782,822 0 Supplies & Services 7.5 15,666 72,041 Property costs 7.6 25,840 0 Transport 7.7 133,753 45,615 Aids & Adaptations 7.8 9,306 186,411 Other 7.10 231,737 0 Sub-total 6,332,753 882,553 TOTAL (5,987,722) (1,433,038) Net Overspend (7,420,760) 7.2 Staff turnover can incur both under and overspends. Underspends can be attributed to the process of recruitment, which adds a natural delay, with posts being filled by new staff at lower points on the pay scale and in some circumstances the nature of the positions have been challenging to recruit to. The Council has recognised this turnover and had set as part of the budget process a vacancy factor saving, which has been met for numerous years. NHS Grampian also put in a vacancy factor saving in 2024/25. Overspends Page 18
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can be due to the use of bank staff/locum to provide required cover for vacancies/sickness and from the historic incremental drift and efficiency targets imposed. 7.3 The purchasing of care overspend relates to the purchase of home care by the area teams. There is a direct correlation with the underspend in internal care at home service. The demographics show that Moray has an ageing population and the spend on external domiciliary care is increasing in relation to both increasing hours of commissioned care, the number of packages of care and complexity. This also reflects the shift in the balance of care to enable people to remain in their own homes for longer. 7.4 The under recovery of income budgets is apparent across a number of service headings. It is exceedingly difficult to predict the level of income accurately as client income is subject to the contributions policy which is based on a client’s financial assessment. Income recovery on all care at home services continues to reduce. The income will continue to reduce due to the legislation in relation to the Carers Act and free personal care for under 65’s as well as the impact of Covid. The Independent Review of Adult Social Care will likely impact in the longer term. During 2024/25 additional income was received from permanent care placements, Community alarm, change fund payment for Learning Disability service and income recoveries from the review of Direct Payments/ SDS contingency funds for clients. 7.5 The Supplies and services in total is almost break even. Overspend includes purchases of medical supplies, medical equipment, uniforms, system licenses and maintenance cost of equipment which is expected to be recurring. The non-recurring underspend relates to refund received for software maintenance, catering for day services and telephones which are not expected to continue. 7.6 The recurring overspend in property costs primarily relates to the rising cost of energy, non pay costs for domestics and community alarm equipment. The non recurring overspend relates to Jubilee Cottages which was a savings proposal, and the recurring underspend relates to other savings proposals approved in 2024/25. . 7.7 Transport costs include both staff and clients which in total is a recurring overspend of £58,730 which primarily relates to internal day services transport. The non recurring underspend is due to variances in area teams, which is not expected to continue. 7.8 Aids and Adaptations overspend relates to Occupational therapy aids, servicing and stair lifts. There is also a non recurring underspend in the improvement grants, due to the timing of works. 7.9 Prescribing costs relate to the increased volumes and price factors which are expected to be sustained alongside increased cost for Moray shares of hosted services and others which again are mainly expected to recur. 7.10 Other category relates to minor variances across the services but also includes recurring overspends relating to admin costs, recurring underspends relating to admin costs and primary care services. The non recurring overspend relates to an increase in the bad debt provision for 2024/25. Page 19
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7.11 The financial results for 2024/25 show that underlying financial pressures on both the NHS and Council budgets remain, with the MIJB assuming responsibility for the budgets of the delegated functions and are expected to prioritise services within the budgets directed to it by Moray Council and NHS Grampian. 7.12 Through in-year reporting of the savings plan progress it was evident that the saving of £8,298,000 for 2024/25 would be partly achieved, £2,302,000 was saved at the end of the financial year, with expected reduction in overspends totalling £2,331,000. The MIJB has committed to continue to identify further efficiencies that will be reported throughout the year, recognising the significant pressure on the budget and the required transformation and disinvestment to allow the programmes of transformation to develop. Efficiencies Para Ref Full Year Target Savings expected progress at 31 Mar 2025 Savings actual progress at 31 Mar 2025 Reduction expected in budget at 31 Mar 2025 £’000 £’000 £’000 £’000 Building Resilience 6.3 3,300 146 146 562 Home first 6.4 685 100 100 0 Partners in Care 6.5 2,713 840 1,254 1330 Already implemented 6.6 1,600 1161 802 439 Total Projected Efficiencies 8,298 2,247 2,302 2,331 7.13 The 2025/26 revenue budget position as reported to the Board on 27 March 2025 (para 8 of the minute refers) presented a balanced budget position, through the use of reserves, and a challenging savings plan, which addressed the recurring overspend. The outturn position was £1,257,240 better than the forecast, partly due to savings proposals relating to reduction in spend in the last quarter. 7.14 This additional cost reduces the level of reserves going into 2025/26. There are minimal reserves of £2,151,636 for ear marked reserves and no general reserve. With no general reserves the additional cost and any emerging budget pressure will have to be funded from additional savings or from recommissioning other activities. The Senior Management Team are actively addressing the situation to implement alternative measures to limit the financial pressure. Updates on the recovery and transformation process and further savings will be provided to the Board for approval during 2025/26 through the financial reporting processes. 8. UPDATED BUDGET POSITION 8.1 During the financial year, budget adjustments arise relating in the main to the allocation of non-recurring funding that is received via NHS Grampian. In order to establish clarity of these budget allocations a summary reconciliation has been provided below. Page 20
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8.2 The MIJB, for the 2024/25 has concluded the financial year in an overspend position. The additional funding contributions during the year are also show in the table below: £’s Approved Funding 30.5.24 176,332,256 Set aside funding 14,665,000 IJB reserves c/fwd to 24/25 used to balance 1,346,552 Balance of IJB reserves c/fwd to 24/25 639,629 Amendment to NHS Grampian core 728,471 Adjustments in Q1 (1,833,389) Revised funding at start of Quarter 2 191,878,519 Adjustments in Qtr2 13,614,559 Revised funding at start of Qtr 3 205,493,078 Adjustments in Qtr 3 5,969,742 Revised funding at start of Qtr 4 211,462,820 Budget adjustments M10-M12 Ncare Allocation 1,208,733 IJB outcomes 126,275 Flu allocation 99,169 RWW 26,673 Open University 25,000 Realign PC 21,339 Emhof adjustment 20,110 Blood plasma 1,292 NMF 1,086 IFRS 16 (14,952) Leavers (22,572) Improvement grant (46,715) LD Healthchecks (75,701) Prescribing (76,237) Hosted recharge (277,902) Recurring deficit removal - year end allocation (6,056,566) RLW funding adjustment 93,828 Increase to set aside 974,000 Appropriate adult funding 18,000 Revised 2024/25 Financial Year Funding 207,507,680 8.3 In accordance with the updated budget position, revised Directions have been included at Appendix 4 for approval by the Board to be issued to NHS Grampian and Moray Council. 9. RESERVES 9.1 The MIJB Reserves Policy, was most recently approved on 25 January 2024 (para 16 of the minute refers). The policy was reviewed in January 2025 but there were no amendments made, so the policy remains valid and will be reviewed again no later than March 2026. The closing financial position on Reserves for 2024/25 is £2,151,636. This reserve is wholly for earmarked reserves, there is no usable general reserve to carry forward. The earmarked Page 21
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reserve will be called upon during the year in line with their specific purpose. The earmarked reserves detail is provided in the table below: Reserve Detail Type £000’s GP Premises Earmarked 39 National Drugs MAT Earmarked 250 OOH Winter Pressure funding Earmarked 172 Moray Cervical screening Earmarked 35 Moray hospital at home Earmarked 5 Moray Psychological Earmarked 315 MHO Funding Earmarked 138 Adult protection funding for CA Earmarked 18 Adult disability payment Earmarked 45 National Trauma training services Earmarked 62 Moray School Nurse Earmarked 32 Moray Winter Fund HCSW & MDT Earmarked 182 LD Annual Health Checks Earmarked 69 Community Planning partnership Earmarked 2 Moray District Nurses Earmarked 56 OOH Dev Fellowship scheme Earmarked 30 Asylum Seekers Grant Earmarked 701 TOTAL 2,152 10. 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’ This report is consistent with the objectives of the Strategic Plan and includes budget information for services included in the MIJB Revenue Budget 2024/25. (b) Policy and Legal It is the responsibility of the organisation receiving the direction to work with the Chief Officer and Chief Financial Officer to deliver services within the resources identified. The Moray Integration Scheme (para 12.7 of the 2023 Integration Scheme) makes provision for dealing with in year variations to budget and forecast overspend by reference to agreed corrective action and recovery plans. It also makes provision for dealing with year-end actual overspend where such action and plans have been unsuccessful in balancing the relevant budget by reference to use of MIJB reserves and additional payments from NHS Grampian and Moray Council. (c) Financial implications Page 22
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The unaudited financial outturn for 2024/25 for the MIJB core budgets is £7,420,760 overspend. The financial details are set out in sections 3- 9 of this report and in Appendix 1. The estimated recurring overspend of £5,987,722 as detailed in para 7 was taken into account when setting the 2025/26 budget. The movements in the 2024/25 budget as detailed in paragraph 8 have been incorporated in the figures reported. (d) Risk Implications and Mitigations The most significant risk arising from this report is the control and management of expenditure to provide the Health and Social Care services required for the Moray Area, within budget. Due to the ongoing financial challenges, the financial circumstances of the partners and Scottish Government, the amount of reserves have reduced. There is significant pressure on the budget for 2025/26 along with increasing demands on the services and cost of living pressures. Considerations are being given to alternative measures that can be established to support the recurring overspends and to achieve the savings target set for 2025/26. There is a big risk for 2025/26 onwards to achieve a financial balance. There is a need for constant scrutiny around this rapidly changing situation and reporting to the Board will inform throughout 2025/26. (e) Staffing Implications There are no direct implications in this report. (f) Property There are no direct implications in this report. (g) Equalities/Socio Economic Impact An Equality Impact Assessment is not required because there are no changes to policy resulting from 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 Directions are detailed in para 8 above and in Appendix 4. (i) Consultations The Chief Officer, the Senior Management Team, Corporate Manager, Service Managers, Chief Finance Officer (Moray Council) and the Finance Officers from Health and Social Care Moray have been consulted and their comments have been incorporated in this report as appropriate. 11. CONCLUSION 11.1 This report identifies MIJB’s unaudited final out-turn position on the Core Budget of an overspend of £7,420,760 at 31 March 2025 and Page 23
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identifies major areas of variance between budget and actual for 2024/25. 11.2 The impact of the provisional outturn on the 2025/26 budget, of a recurring overspend of £5,987,722 is detailed in paragraph 7. 11.3 NHS Grampian and Moray Council have both carried forward ear marked reserves into 2025/26 which total £2,151,636. Author of Report: D O’Shea Chief Finance Officer Background Papers: Papers held by respective Accountancy teams. Ref: Page 24
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MORAY INTEGRATION JOINT BOARD JOINT FINANCE REPORT APRIL 2024 - MARCH 2025 Para Annual Budget (Net) Actual Ref Net Budget To Date To Date Variance Variance £'s £'s £'s £'s % 2024-25 2024-25 2024-25 2024-25 2024-25 Community Hospitals 7,700,440 7,700,440 8,328,651 (628,211) (8) Community Nursing 5,978,919 5,978,919 6,166,085 (187,166) (3) Learning Disabilities 4.1 17,701,958 17,701,958 19,973,763 (2,271,805) (13) Mental Health 12,139,599 12,139,599 12,054,656 84,943 1 Addictions 1,906,785 1,906,785 1,729,248 177,537 9 Adult Protection & Health Improvement 249,241 249,241 273,198 (23,957) (10) Care Services provided in-house 4.4 24,742,881 24,742,881 22,739,366 2,003,515 8 Older People & PSD Services 4.7 24,774,802 24,774,802 27,033,858 (2,259,056) (9) Intermediate Care & OT 1,771,186 1,771,186 1,972,424 (201,238) (11) Care Services provided by External Contractors 1,835,976 1,835,976 1,816,689 19,287 1 Other Community Services 10,383,145 10,383,145 10,280,261 102,884 1 Admin & Management 3,333,376 3,333,376 3,114,694 218,682 7 Other Operational Services 1,377,377 1,377,377 1,534,989 (157,612) (11) Primary Care Prescribing 4.10 18,748,115 18,748,115 21,937,501 (3,189,386) (17) Primary Care Services 21,427,317 21,427,317 21,331,070 96,247 0 Hosted Services 5,712,884 5,712,884 5,665,086 47,798 1 Out of Area 4.12 720,131 720,131 1,971,030 (1,250,899) (174) Improvement Grants 1,207,037 1,207,037 1,020,626 186,411 15 Childrens & Justice Services 19,523,679 19,523,679 19,598,094 (74,415) (0) Total Moray IJB Core 181,234,848 181,234,848 188,541,288 (7,306,441) (4) Other non-recurring Strategic Funds in the ledger 6,204,515 6,204,515 6,308,250 (103,735) (2) Total Moray IJB Including Other Strategic funds in the ledger 187,439,363 187,439,363 194,849,538 (7,410,176) (4) Other resources not included in ledger under core and strategic: 4,429,317 4,429,317 1,161,894 3,267,424 74 Total Moray IJB (incl. other strategic funds) and other costs not in ledger 191,868,680 191,868,680 196,011,432 (4,142,752) (2) Set Aside Budget 15,639,000 15,639,000 15,639,000 - Overall Total Moray IJB 207,507,680 207,507,680 211,650,432 (4,142,752) (2) Funded By: NHS Grampian 120,864,389 Moray Council 86,643,291 IJB FUNDING 207,507,680 APPENDIX 1 Page 25
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APPENDIX 2 Description of MIJB Core Services 1. Community Hospitals includes community hospitals, community administration and community Medical services in Moray. 2. Community Nursing related to Community Nursing services throughout Moray, including District Nurses and Health Visitors. 3. Learning Disabilities budget comprises of:- • Transitions, • Staff – social work and admin infrastructure, • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • Medical, Nursing, Allied Health Professionals and other staff. 4. Mental Health budget comprises of:- • Staff social work and admin infrastructure, • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • In patient accommodation in Buckie & Elgin. • Medical, Nursing, Allied Health Professionals and other staff. 5. Addictions budget comprises of:- • Staff – social work and admin infrastructure, • Medical and nursing staff • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care, • Moray Alcohol & Drugs Partnership. 6. Adult Protection and Health Improvement 7. Care Services provided in-house Services budget comprises of:- • Employment Support services, • Care at Home service/ re-ablement, • Integrated Day services (including Moray Resource Centre), • Supported Housing/Respite and • Occupational Therapy Equipment Store. 8. Older People & Physical Sensory Disability (PSD) budget comprises of:- • Staff – social work infrastructure (including access team and area teams), • External purchasing of care for residential & nursing care, • External purchasing of care for respite, day care and domiciliary care and • Residential & Nursing Care home (permanent care), 9. Intermediate Care & Occupational Therapy budget includes:- • Staff – OT infrastructure • Occupational therapy equipment • Telecare/ Community Alarm equipment, • Blue Badge scheme Page 26
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APPENDIX 2 10. The Care Services provided by External Contractors Services budget includes:- • Commissioning and Performance team, • Carefirst team, • Social Work contracts (for all services) • Older People development, • Community Care finance, • Self Directed support. 11. Other Community Services budget comprises of:- • Community services for each locality (Allied Health Professionals (AHP’s), Dental services, Public Health, Pharmacy and other specialist nursing roles). 12. Admin & Management budget comprises of :- • Admin & Management staff infrastructure • Target for staffing efficiencies from vacancies 13. Other Operational Services - range of operational services including – • Community Response Team • Child Protection • Winter Pressures • Clinical Governance • International Normalised Ratio (INR) blood clotting test Training • Moray Alcohol and Drug Partnership (ADP) 14. Primary Care Prescribing includes cost of drugs prescribed in Moray. 15. Primary Care Services relate to General Practitioner GP services in Moray. 16. Hosted Services, comprises of a range of Grampian wide services. These services are hosted and managed by a specific IJB on a Grampian wide basis and costs are re-allocated to IJB budgets. These services include:- Moray IJB Hosted & Managed services: • GMED out of Hours service. • Primary Care Contracts Team Aberdeen City/Aberdeenshire IJB Hosted & Managed services: • Intermediate care of elderly & rehab. • Marie Curie Nursing Service – out of hours nursing service for end of life patients • Continence Service – provides advice on continence issues and runs continence clinics • Sexual Health service • Diabetes Development Funding – overseen by the diabetes Network. Also covers the retinal screening service • Chronic Oedema Service – provides specialist support to oedema patients • Heart Failure Service – provided specialist nursing support to patients suffering from heart failure. • Police Forensic Examiner Service Page 27
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APPENDIX 2 • HMP Grampian – provision of healthcare to HMP Grampian. 17. Out of Area Placements for a range of needs and conditions in accommodation out with Grampian. These are managed centrally within NHS Grampian and charged to IJB’s. 18. Improvement Grants managed by Council Housing Service, budget comprises of:- • Disabled adaptations • Private Sector Improvement grants • Grass cutting scheme 19. Children Services & Criminal Justice budget includes the following areas: a) Children Services area teams budget includes:- • Staff – social work (including access team, area teams, disability team, SCIM and Child Protection Unit) • Self directed support • Fostering home to school transport • Support to families b) Quality Assurance team budget includes:- • Staff – social work • Locality management groups funding c) Reviewing Team d) Commissioned Services budget includes:- • Commissioning team • Contracts for all services e) Placement Services budget includes:- • Staff – social work (including fostering, adoption and throughcare/aftercare) • Continuing care payments, income maintenance, supported lodgings and throughcare/aftercare grants • Fostering/kinship fees and allowances. Placements with external fostering agencies. • Adoption allowances • Adoption fees to other local authorities f) Children Services Residential Unit g) Justice Services budget includes:- • Staff – social work • Youth Pod • Out of Hours team • Community Justice Reform • Criminal Justice Services h) Children Services Strategy and Support budget comprises of:- • Central management staffing Page 28
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APPENDIX 2 • Target for staffing efficiencies from vacancies i) Additional grant funding • Unaccompanied asylum seeking children • Corra Foundation • Trauma Informed Practice Other definitions: Tier 1- Help to help you (information and advice), universal services to the whole community and an emphasis on prevention. Tier 2- Help when you need it (immediate help in a crisis, re-ablement) and regaining independence. Tier 3- Ongoing support for those in need through the delivery of 1 or more self- directed support options. Page 29
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APPENDIX 3 HEALTH & SOCIAL CARE MORAY DELEGATED AUTHORITY REPORTS - PERIOD January to March 2025 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding Pharmacy Moray The hours: this is the minimum level that we could operate the post with in order to deliver an effective service in all Moray Care Homes. Moray Care Homes Pharmacist Fixed-term or Secondment 12 months Apr-25 to Mar’26 THIS IS ADD COST offset by savings to be achieved in medicines used in Care homes Support package for MR in his own home To support MR in his own tenancy upon leaving Linn Moor Children’s Services. 7.35FTE Grade 4 1FTE Grade 6 Permanent N/A As appointed Budget from budget pressures Support package for MH in his own home To support MH in his own tenancy upon leaving Linn Moor Children’s Services. 6.69FTE Grade 4 1FTE Grade 6 Permanent N/A As appointed Budget from budget pressures Page 30
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Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding Day Service Infrastructure Budget YF705/MRC Catering Staff Budget Remove vacant positions under Infrastructure and Moray Resource Centre Catering for saving 0.27FTE Grade 3 0.80FTE Grade 4 0.34FTE Grade 4 0.68FTE Grade 5 0.30FTE Grade 4 0.74FTE Grade 3 Permanent N/A ASAP This is a saving Page 31
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APPENDIX 4 MORAY INTEGRATION JOINT BOARD DIRECTION Issued under Sections 26-28 of the Public Bodies (Joint Working) (Scotland) Act 2014 1. Title of Direction and Reference Number 20250619MC15 20250619GHB15 2. Date Direction issued by the Moray Integration Joint Board 19.06.2025 3. Effective date of the Direction 01.04.2024 4. Direction to: NHS Grampian and Moray Council 5. Does the Direction supersede/update a previous Direction? If yes, include the reference number(s) of previous Direction Yes budget report for 24/25 to MIJB on 30.05.2024 6. Functions covered by Direction All functions listed in Annex 1, Part 1 of the Moray Health and Social Care Integration Scheme and all functions listed in Annex 2, Part 1 of the Moray Health and Social Care Integration Scheme. 7. Direction Narrative Directed to deliver for the Board, the services noted below in pursuance of the functions noted below and within the associated budget noted below 8. Budget Allocation by MIJB to deliver on the Direction Moray Council associated budget - £96.9 million, of which £0.5 million is ring fenced for Housing Revenue Account aids and adaptations and £3.3m for Children Services joint out of area budget. NHS Grampian associated budget - £93.4 million, of which £5.7 million relates to Moray’s share for services to be hosted and £21,4 million Page 32
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relates to primary care prescribing. An additional £15.6 million is set aside for large hospital services . All details contained in APPENDIX 1 to the report 9. Desired Outcomes The direction is intended to update and reflect the budget position for 2024/25 10. Performance monitoring arrangements and review Directions will be reviewed by the Audit Performance & Risk Committee on a six monthly basis for assurance. Any concerns should be escalated at the first available opportunity to the MIJB. An annual report of all current Directions will be presented to the MIJB Page 33
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 19 JUNE 2025 SUBJECT: UNAUDITED ANNUAL ACCOUNTS BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To inform the Board of the Unaudited Annual Accounts of the Moray Integration Joint Board (MIJB) for the year ended 31 March 2025. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and approve the unaudited Annual Accounts to be submitted to the external auditor, noting that all figures remain subject to audit, in Appendix 1; ii) note the Annual Governance Statement contained within the unaudited Annual Accounts and in Appendix 3; iii) note the accounting policies applied in the production of the unaudited Annual Accounts, pages 47 to 48 of the accounts; and iv) approve the updated Local Code of Corporate Governance which supports the Annual Governance Statement, in Appendix 2. 3. BACKGROUND 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 requires that an integration joint board is subject to the audit and accounts regulations and legislation of a body under Section 106 of the Local Government (Scotland) Act 1973. 3.2 The Local Authority Accounts (Scotland) Regulations 2014 (2014 Regulations), places a statutory obligation on the MIJB to submit draft Annual Accounts for the year ended 31 March 2025 to its external auditors by 30 June 2025 and the audited annual accounts are required to be approved by the MIJB and published by 30 October each year. 3.3 A copy of the unaudited accounts is attached at Appendix 1. Item 6. Page 35
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3.4 The MIJB has a statutory duty to conduct a review at least once in each financial year of the effectiveness of its system and to include a statement reporting the review within its Statement of Accounts. The MIJB does this through its Annual Governance Statement which is published as part of its Annual Accounts. 3.5 The MIJB has established arrangements and continues to develop its governance framework which includes the system of internal control. This system is intended to manage risk and support the achievement of the MIJB’s policies, aims and objectives. Reliance is placed on NHS Grampian and Moray Council systems of internal control that support compliance with both organisations’ policies and promotes achievement of each organisation’s aims and objectives; to the extent that these are complementary to those of the MIJB. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Annual Accounts have been prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 (the Code) which is underpinned by the International Financial Reporting Standards (IFRS). 4.2 Grant Thornton, under the Local Authority Accounts (Scotland) Regulations 2014 is required to complete their audit by 30 September 2025, as reported previously, Grant Thornton is unable to meet this deadline. The audited accounts and the External Auditor’s report will be submitted to the MIJB at a Special Meeting on 30 October 2025 prior to publication. 4.3 The Comprehensive Income and Expenditure Statement shows a deficit of £0.536m on the provision of services for the year. As at 31 March 2025, the Balance Sheet showed total Reserves of £1.45m. This increase is primarily due to transfer of reserves from Moray Council to MIJB relating to Asylum seekers grant,during the year. Note 7 within the unaudited accounts breaks down the Reserves between what is General Reserve and available for utilisation and supporting the budget and what is earmarked for specific purposes. 4.4 The unaudited accounts are given at Appendix 1 and consist of the following: Management Commentary – provides the context through narrative that supports the financial statements. It describes the strategic intent of the MIJB, together with its performance through the year, highlighting areas of risk. It also provides some forward thinking on the forthcoming year and planned developments. Remuneration Report – details the pay and pension benefits accrued by the MIJB senior officers during 2024/25. Annual Governance Statement – is a means of reporting publicly on the MIJB’s governance arrangements, and seeks to provide assurance that its business is conducted in accordance with law, regulations and proper practices and that public money is safeguarded and properly accounted for. Page 36
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Financial Statements – provides detail of the main financial transactions through the Comprehensive Income & Expenditure Statement, Movement in Reserves Statement, and Balance Sheet. Notes to the Accounts – explains the use of accounting policies and provides supporting information to the main financial statements. 4.5 As at 31 March 2025 there were significant variances between budget and actual on several services. These are evident in the summary on the major variances included within the Management Commentary on pages 16 to 17. More details are included in the separate report, Revenue Budget Outturn for 2024/25, on this Boards agenda. 4.6 In April 2016 an updated CIPFA/SOLACE ‘Delivering Good Governance in Local Government: Framework’ was published. The framework, whilst written in a local authority context, is applicable to integration authorities particularly as legislation recognises an IJB as a local government body under part VII of the Local Government (Scotland) Act 1973. 4.7 The Framework defines the principles that should underpin the governance arrangements and provides a structured approach. On 24 June 2021, the MIJB approved an updated Local Code of Corporate Governance based on the Framework and adopting the principles by which to evaluate performance (para 8 of the minute refers). The principles as set out in the CIPFA/SOLACE Framework are: a. Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law, b. Ensuring openness and comprehensive stakeholder engagement, c. Defining outcomes in terms of sustainable economic, social and environmental benefits, d. Determining the interventions necessary to optimise the achievement of intended outcomes, e. Developing the entity’s capacity, including the capability of its leadership and the individuals within it, f. Managing risk and performance through robust internal control and strong public financial management; and g. Implementing good practices in transparency, reporting and audit to deliver effective accountability 4.8 The term ‘Local Code’ refers to the governance structure in place and is a statement of the policies and procedures by which functions are directed and controlled and how engagement with service users, the local community and other stakeholders is carried out. The collective policies and procedures of the MIJB constitute a Local Code of Corporate Governance. 4.9 The MIJB can achieve good governance by demonstrating that its governance structures comply with the principles as set out in the Framework. Regular review is carried out to assess the MIJB’s performance against the principles, identify areas for development and inform the Annual Governance Statement. Appendix 2 displays the sources utilised in assessing MIJB’s compliance against each governance principle. With regard to the partnership model of operation, reliance is also placed on the systems and procedures of Moray Page 37
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Council and NHS Grampian and so for completeness, assurance sources are listed for these organisations. 4.10 Whilst the MIJB has received limited assurance from Internal Auditor, again for 2024/25 progress is being made to rectify this. Procedures are in place to ensure all audit recommendations and dates are not only achievable but are on the agendas for internal meetings, with oversight by the Senior Management Team. The replacement of the social care information system is in progress, although will take 18 months to 2 years to fully implement. The governance statement from NHS Grampian is attached at Appendix 3, gives assurance there are no significant control weaknesses. 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 unaudited Annual Accounts have been completed and are available for audit inspection within the specified timescale. (b) Policy and Legal The Public Bodies (Joint Working) (Scotland) Act 2014 requires that the MIJB is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973. The MIJB’s accounts are prepared in accordance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25 which is underpinned by IFRS. (c) Financial implications The unaudited Annual Accounts provide all required information about the MIJB in relation to its financial position at 31 March 2025. The overriding principle in relation to annual accounts preparation is to provide a true and fair view. (d) Risk Implications and Mitigation There are no risk issues arising directly from this report. The unaudited Annual Accounts will be subjected to audit by external auditors, Grant Thornton, which will provide assurance that the Accounts for 2024/25 give a true and fair view of the financial position and expenditure and income of the MIJB for the year ended 31 March 2025. Effective governance is essential in providing the framework for the MIJB to conduct its business. The annual review of governance arrangements aims to ensure that internal controls, risk management and associated governance arrangements are being constantly developed with the aim of providing reasonable assurance on the framework as a whole. Regular review and application of a Local Code of Corporate Governance supports this process. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. Page 38
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(g) Equalities/Socio Economic Impact None arising directly from this report as there has been 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. (i) Directions None arising directly from this report. (j) Consultations In preparation of the unaudited Annual Accounts, consultations have taken place between finance staff of both Moray Council and NHS Grampian. The Chief Officer and other key senior officers have been consulted for comment where appropriate 6. CONCLUSION 6.1 The Annual Accounts, subject to audit, show an overspend on the provision of services of £0.536m for MIJB for the year ending 31 March 2025. At the beginning of the year the MIJB, held in its reserves £1.986m. The closing balance on the reserves as at 31 March 2025 is £1.45m, consisting wholly of reserves earmarked for specific purposes as detailed in the unaudited annual accounts 2024/25. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 39
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APPENDIX 1 UNAUDITED ANNUAL ACCOUNTS FOR THE YEAR ENDED 31 MARCH 2025 Moray Integration Joint Board Page 41
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Moray Integration Joint Board Annual Accounts 2024/25 If you need information from the Moray Council in a different language or format, such as Braille, audio tape or large print, please contact: ياروم سلجم لᘘق نم تامولعم ᣠإ ةجاح ᢝᡧᣚ متنك اذإ نوكتو ةغلᗷ وأ ويدوأ ةناوطسأ ،يا ᢔᣂلا لثم فلتخم لᜓش ᣢعوأ ةفلتخم نوكت نأ مط ب لاصّتﻹا ءاجّرلاف ةظᘭلغ فورح لامعتساᗷ ةعوب Jei pageidaujate tarnybos Moray tarybos teikiamą informaciją gauti kitokiu formatu, pvz., Brailio raštu, garso įrašu ar stambiu šriftu, kreipkitės: Jeśli potrzebują Państwo informacji od Rady Okręgu Moray w innym formacie, takim jak alfabet Braille'a, kasety audio lub druk dużą czcionką, prosimy o kontakt: Se necessitar de receber informações por parte do Concelho de Moray num formato diferente, como Braille, cassete áudio ou letras grandes, contacte: Ja Jums vajadzīga informācija no Marejas domes (Moray Council) citā valodā vai formātā, piemēram, Braila rakstā, audio lentā vai lielā drukā, sazinieties ar: اي نابز رگيد یسک ےس لسنوک ےروم وک پآرگاتروص راکرد تامولعم ںيم ﻼثم ںوہ ˝ ،فورح ےڑب اي پيٹ ويڈآ ،ےليربںيئامرف ہطبار رک امرف ینابرہم وت: Chief Finance Officer to the Moray Integration Joint Board, High Street, Elgin, IV30 1BX accountancy.support@moray.gov.uk Page 42
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Moray Integration Joint Board Annual Accounts 2024/25 Table of Contents MORAY INTEGRATION JOINT BOARD MEMBERS 2024/25 .............................................. 1 MANAGEMENT COMMENTARY .......................................................................................... 2 STATEMENT OF RESPONSIBILITIES ............................................................................... 27 REMUNERATION REPORT ............................................................................................... 29 ANNUAL GOVERNANCE STATEMENT ............................................................................. 33 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT ..................................... 44 MOVEMENT IN RESERVES STATEMENT ........................................................................ 45 BALANCE SHEET .............................................................................................................. 46 NOTES TO THE FINANCIAL STATEMENTS ..................................................................... 47 Note 1 Significant Accounting Policies ............................................................................. 47 Note 2 Critical Judgements and Estimation Uncertainty .................................................. 48 Note 3 Events after the Reporting Period ........................................................................ 49 Note 4 Expenditure and Income Analysis by Nature ........................................................ 49 Note 5 Taxation and Non-Specific Grant Income ............................................................. 50 Note 6 Debtors ................................................................................................................ 50 Note 7 Usable Reserve: General Fund ............................................................................ 51 Note 8 Agency Income and Expenditure .......................................................................... 52 Note 9 Related Party Transactions .................................................................................. 53 Note 10 VAT .................................................................................................................... 55 Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted .... 55 Page 43
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Moray Integration Joint Board Annual Accounts 2024/25 1 MORAY INTEGRATION JOINT BOARD MEMBERS 2024/25 Voting Members Dennis Robertson (Vice Chair) Grampian Health Board Tracy Colyer (Chair) Moray Council (Resigned 26/09/2024) Elaine Kirby (Chair) Moray Council (Joined 21/11/2024) Sandy Riddell Grampian Health Board Derick Murray Grampian Health Board Alex Stephen Grampian Health Board (Joined 1/7/2024) Cllr. Peter Bloomfield Moray Council Cllr. Scott Lawrence Moray Council Cllr Ben Williams Moray Council Non-Voting Members Simon Bokor-Ingram Chief Officer (left 31/5/2024) Judith Proctor Chief Officer (Joined 15/7/2024) Jim Lyon Interim Chief Social Work Officer (Joined 3/6/2024) Jane Ewen Lead Nurse Professor Duff Bruce Non Primary Medical Service Lead Dr Robert Lockhart GP Lead Dr Malcolm Simmons GP Lead (left 31/3/2025) Janette Topp Third Sector Stakeholder (19/4/2024 – 11/2/2025) Sheila Brumby Service User Representative (Joined 19/4/2024) Ivan Augustus Carer Representative Kevin Todd Moray Council Staff Representative Elizabeth Robinson Public Health Representative Deirdre McIntyre Grampian Health Board Staff Partnership Page 44
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Moray Integration Joint Board Annual Accounts 2024/25 2 MORAY INTEGRATION JOINT BOARD MEMBERS 2023/24 Continued Co-opted Members Sean Coady Head of Service and Deputy Chief Officer Deborah O’Shea Chief Finance Officer Adam Coldwells Interim Chief Executive Grampian Health Board John Mundell Interim Chief Executive, Moray Council (3/6/2024 – 14/3/2025) Karen Greaves Chief Executive, Moray Council (Joined 17/3/2025) Sonya Duncan Interim Corporate Manager . MANAGEMENT COMMENTARY The Role and Remit of the Moray Integration Joint Board The Public Bodies (Joint Working) (Scotland) Act 2014 required that Moray Council and Grampian Health Board prepared an Integration Scheme for the area of the local authority detailing the governance arrangements for the integration of health and social care services. This legislation resulted in the establishment of the Moray Integration Joint Board (MIJB) that became operational from 1 April 2016. Moray Council and Grampian Health Board, as the parties to the Integration Scheme, each nominate voting members to the MIJB, currently, four elected members from Moray Council and four Grampian Health Board members. Under the Public Bodies (Joint Working) (Scotland) Act 2014, a range of health and social care functions have been delegated from Moray Council and Grampian Health Board to the MIJB who has assumed responsibility for the planning and operational oversight of delivery of integrated services. MIJB also has a role to play in the strategic planning of unscheduled acute hospital based services provided by Grampian Health Board as part of the ‘set aside’ arrangements. Hosted services also form part of the MIJB budget. There are a number of services which are hosted by one of the three IJB’s within Grampian Health Board area on behalf of all the IJBs. Responsibilities include the planning and operational oversight of delivery of services managed by one IJB on a day to day basis. MIJB has responsibility for hosting services relating to Primary Care Contracts and the Grampian Medical Emergency Department (GMED) Primary Care Out of Hours service. Page 45
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Moray Integration Joint Board Annual Accounts 2024/25 3 MANAGEMENT COMMENTARY (continued) Key Purpose and Strategy Following review and consultation, the refreshed Strategic Plan (2022-2032) is a continuation of the 2019 Strategic Plan. The current plan emphasises the strength of integration and in addition to our two main Partners – Moray Council and Grampian Health Board - the MIJB recognises the importance of the Third and Independent Sectors and Unpaid Carers, in facilitating the successful operation of the partnership of Health & Social Care Moray. As with all health and social care systems Moray is facing increasing demand for services at the same time as resources – both funding and workforce availability - are under pressure. These challenges will intensify in the coming years as our population ages and more people with increasing complex needs require support to meet their health and care needs. The MIJB sets the direction and strategic intent through the development and implementation of the Strategic Plan and seeks assurance on the management and delivery of services through Board level performance reporting which ensures an appropriate level of scrutiny and challenge. The Strategic Plan identifies priority areas to support strategic direction and vision. STRATEGIC PLAN KEY THEMES BUILDING RESILIENCE – Taking greater responsibility for our health and wellbeing HOME FIRST – Being supported at home or in a homely setting as far as possible PARTNERS IN CARE – Supporting citizens to make choices and take control of their care and support WE ARE PARTNERS IN CARE OUR VISION: “We come together as equal and valued partners in care to achieve the best health and wellbeing possible for everyone in Moray throughout their lives.” OUR VALUES: Dignity and respect; person-led; care and compassion; safe, effective and responsive OUTCOMES: Lives are healthier – People live more independently – Experiences of services are positive – Quality of life is maintained/improved – Health inequalities are reduced – Carers are supported – People are safe – The workforce continually improves – Resources are used effectively and efficiently Page 46
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Moray Integration Joint Board Annual Accounts 2024/25 4 MANAGEMENT COMMENTARY (continued) The Plan purposefully places an emphasis on prevention and early intervention activities and seeks to prioritise these activities as a long term goal, actively pursuing good health and wellbeing for the population, with increased investment in this area of work. It highlights the Home First approach and the rationale for this is to assist people in understanding that “hospital is not always the best place for people”, a statement frequently used and in particular if you are frail and elderly can be counter intuitive to a successful recovery. Initiatives to transform services in response to high levels of demand continue. The Moray Strategic Plan was refreshed in 2022 and along with the associated delivery plan, which was updated in May 2025, highlights key priorities for transformation. Population Moray is a largely rural area covering a land mass of 2,238 sq. km. It has a long coastline on the Moray Firth with harbours, fishing villages and world-class beaches. From the 2022 census, the area’s population is 93,4001, which is an increase of 0.1% since 2011. The population growth in Moray is slowing and it is projected that the population in Moray will start to decline by 2030. This trend is forecast to continue. The main centre of population is Elgin, which is home to more than one quarter of the people living in Moray. Other towns of population between 4,000 and 10,000 are Forres, Buckie, Lossiemouth and Keith. The table below sets out projected population growth based on the 2022 baseline, which has not changed from the 2018 publication. Across Scotland there is a projected reduction in those in the 0-15 age group, limited change in the working age population, but significant growth in adults of pensionable age. By comparison it is projected that Moray will have a greater decrease in children, a marked decrease in those of a working age, but a significantly higher change in those of a pensionable age2. 1 Scotland's Census 2022 - Rounded population estimates - data | Scotland's Census 2 Population Projections for Scottish Areas 2018-based - National Records of Scotland (NRS) -22.2% -9.0% 30.8% -10.5% -0.2% 23.2% -30.0% -20.0% -10.0% 0.0% 10.0% 20.0% 30.0% 40.0% Children (0-15) Working Age Pensionable age and overProjected change (%) Age Group Projected percentage change in population (2018- 2043) by age Moray Scotland Page 47
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Moray Integration Joint Board Annual Accounts 2024/25 5 MANAGEMENT COMMENTARY (continued) Performance Reporting Performance is reported quarterly to the Audit, Performance and Risk Committee of the MIJB. In addition to the quarterly reporting, there is a requirement under the Public Sector (Joint Working) (Scotland) Act 2014 for the MIJB to produce and publish an Annual Performance Report setting out an assessment of performance in planning and carrying out the delegated functions for which they are responsible. The Annual Performance Report is due to be published by 31 July this year and will be published on the Health & Social Care Moray website, once approved by the MIJB. One of the major aims of integration and a key measurable target for MIJB is to reduce the number of Moray residents that are ready to be sent home from hospital but have been delayed in this process. This is referred to as a ‘delayed discharge’. Delayed discharge can occur due to many reasons but quite often involves the onward provision of social care which can be complex in nature and/or finite in its availability. Figures 1 and 2, below, notes Moray’s performance over a six-year period showing the number of delayed discharge bed days occupied varying significantly and with minimal seasonal pattern up to March 2025. Delayed discharges reduced during the COVID pandemic and the lock down periods, as people stayed in their own homes as per advice at the time and there was more availability of family members to support care needs. Notably, delayed discharges began to rise in Moray and across the country in March 2022 and work commenced across the three partnerships in Grampian to address the issue. Results in this activity can be seen from March 2023 onwards. However, winter 2023 saw delayed discharges increasing, in Moray and across the country and continues at an increased level. Figure 1 Page 48
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Moray Integration Joint Board Annual Accounts 2024/25 6 MANAGEMENT COMMENTARY (continued) Figure 2 There continues to be a focus on ensuring people are getting home quickly and can maintain their independence. In figures 3 and 4, below, the rate of emergency occupied bed days for over 65 years of age per 1000 population has increased since 2021/22 with a slow decrease since March 2023. With an ageing population the number of people delayed at any one time could increase again unless viable, sustainable alternative community provision is developed. Presentations to hospital from an older population have more acuity and complexity, exacerbating the issue of delays. The Scottish Government have now set targets for delayed discharges per 100,000 and for Moray the target is 26. This presents a challenge, but efforts continue to review and streamline processes and improve flow across the system. The importance of integration across the system is key to making progress, and over the year teams have enhanced communication and decision making as a Moray system. There has been further redesign of pathways and dedicated resource assigned to supporting critical decision making in social care. This has all supported the steady progress that is evident from the national comparisons of Moray’s performance 0 200 400 600 800 1000 1200 1400 1600 Jun Sep Dec Mar Number of bed days occupied by delayed discharges 18+ at census date 2020/21 2021/22 2022/23 2023/24 2024/25 Page 49
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Moray Integration Joint Board Annual Accounts 2024/25 7 MANAGEMENT COMMENTARY (continued) Figure 3 Figure 4 1500 1700 1900 2100 2300 2500 2700 2900 Jun Sep Dec Mar Rate of Emergency Occupied Bed Days for over 65s per 1000 population 2020/21 2021/22 2022/23 2023/24 2024/25 Page 50
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Moray Integration Joint Board Annual Accounts 2024/25 8 MANAGEMENT COMMENTARY (continued) Moray Integration Joint Board (MIJB) The MIJB has scrutinised and directed the delivery of services in line with the Integration Scheme and Strategic Plan while recognising that the cost base has to change as the level of available budget in real terms is reducing. Both funding partners (Moray Council and NHS Grampian) have significant savings to achieve, and against this backdrop the MIJB directed a series of workshops during the year to support officers in their work. The focus has continued to be on achieving the highest quality and safety possible within a diminished budget, while being most efficient, and achieving the best possible outcomes for our residents. The Strategic Plan aspires to increasing spend on preventative work, “upstream” to tackle issues earlier, preventing crises where possible and reducing demand. However, a key challenge going forwards will be to continue that focus at a time when budgets are under so much pressure and people are presenting with increasingly complex needs. . Performance The MIJB, its committees and the Health and Social Care Partnership Senior Management Team receive regular assurance reports and updates on how the Strategic Plan commitments are being progressed through work streams and individual service plans, as well as detailed financial and performance updates. The strategic risk register was reviewed by the Moray Integration Joint Board and Senior Management Team. It was approved in May 2025 and will form part of a robust risk monitoring framework in order to identify, assess and prioritise risks related to the delivery of services, particularly any which are likely to affect the delivery of the Strategic Plan. The inherent risks being faced by the MIJB, together with a current assessment on the level of the risks and mitigating actions being taken to reduce the impact of the risks, is reported to biannually to the Audit Performance and Risk Committee for oversight and assurance. Management teams and the Care and Clinical Governance Group review and respond to any reports produced by Audit Scotland, Healthcare Improvement Scotland, the Care Inspectorate, and the Mental Welfare Commission for Scotland. Quarterly performance reports are produced for Health and Social Care Moray (HSCM) management to review performance and to determine actions required to address areas for concern or to highlight areas showing improvement. This information is further scrutinised by the Senior Management team and then reported to the MIJB’s Audit, Performance and Risk Committee. There are many initiatives and ongoing projects being undertaken by HSCM that are seeking to reduce the delays in hospitals and to meet unmet needs. For example, ensuring the provision of care at home is maximised within available budget is a key aspect of the Strategic Care at Home workstream. Page 51
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Moray Integration Joint Board Annual Accounts 2024/25 9 MANAGEMENT COMMENTARY (continued) Research into the type of equipment, benefits and impacts is being undertaken by the Digital Health Institute as part of the Growth Deal which will inform our Technology Enabled Care and Digital strategy which will provide other options for supporting people to live independently in their own homes. The collaborative initiative Discharge Without Delays being undertaken by partners across NHS Grampian, is aiming to reduce delays currently experienced by people who are medically fit to return home and is being facilitated by Health Intelligence Scotland. Whole system outcomes have been determined which will be incorporated into the revised performance report to this committee for 2025/26 The integration of Children & families and Justice services into Health & Social Care Moray under the direction of the MIJB is not yet reflected in the Board’s Strategic Plan. Work in ongoing to ensure appropriate governance of performance reporting so that it can be included in future MIJB Annual Performance Reports. Strategy and Plans The MIJB is required to review its Strategic Plan every three years as per the legislation. The Strategic Plan 2022-2032 places an emphasis on prevention and early intervention with the aim of building resilience for individuals and communities. The Plan identified key aims of the MIJB and directed HSCM to work closely with communities and key partners to reform the system of health and social care in Moray. It was also recognised that progress has been made against the three strategic themes and the review of the Plan focused on what already has been achieved the long-term strategic objectives make room for adapting to challenges and developments in health and social care over the coming years. The current Strategic Plan sets out the following vision and priorities for health and social care services in Moray. Health and Social Care Moray’s strategic plan sets out the 3 key themes and the objectives; Building Resilience – supporting people to take greater responsibility for their health and wellbeing. Home First – supporting people at home or in a homely setting as far as possible. Partners in Care – supporting citizens to make choices and take control of their care and support. Page 52
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Moray Integration Joint Board Annual Accounts 2024/25 10 MANAGEMENT COMMENTARY (continued) Staff Wellbeing Health & Social Care Moray’s Health Improvement Team has achieved the Paths for All Walk at Work Award for its innovative efforts to promote physical activity in the workplace and encourage colleagues to boost their health and wellbeing through daily walking. Morgan McKay, Health Walk Coordinator, led the team in developing initiatives to get colleagues moving more. She carried out a travel survey to identify how staff travel to and from work and used the data to develop a plan to increase workplace activity. The team mapped convenient walking routes from two key work locations in Elgin – the Moray Council Annexe and Dr Gray's Hospital – offering both 30-minute and 15- minute options. To encourage staff to keep walking no matter the weather, Morgan arranged for umbrellas to be available for borrowing and designated areas for drying wet outdoor gear. Staff engagement was further boosted through participation in the Paths for All step count challenge, a twice-yearly walking initiative that connects Scottish workplaces in friendly competition. The Walk Moray project supports a network of trained volunteers to deliver a variety of weekly low-level, accessible and friendly health walks in communities across Moray which are a great way to increase your activity levels. Promoting Health and Wellbeing Health & Social Care Moray (HSCM) teamed up with community partners to highlight the importance of eating well and staying hydrated during Nutrition and Hydration Week. The national campaign aims to highlight how proper food and drink intake plays a vital role in overall health, particularly for people in care settings such as hospitals and care homes. Malnutrition and dehydration are often overlooked but can have serious consequences, leading to hospital admissions, longer hospital stays, delayed recovery, and a decline in overall wellbeing. HSCM is tackling this issue head-on with an exciting lineup of activities designed to educate, engage, and inspire action by colleagues and the wider public. Throughout the week, HSCM’s Health Improvement Team has been helping local partners host a variety of activities including information stands; launch of new food and drink initiatives; daily themed food days; poster displays; themed drinks trollies; and tea parties Page 53
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Moray Integration Joint Board Annual Accounts 2024/25 11 MANAGEMENT COMMENTARY (continued) Service Delivery/Business as Usual HSCM continues to invest in the delivery of high-quality services through commissioning activity across mental health, advocacy, and primary care. Following a competitive procurement process, Scottish mental health charity SAMH (Scottish Action for Mental Health) has been awarded contracts to deliver adult mental health community support services in Moray until 2029. SAMH will provide two key services: an intensive recovery service for individuals with higher-level mental health needs, and a new community support service, which includes delivery of the Distress Brief Intervention (DBI) programme. The intensive recovery service will continue to support people receiving care from hospital or community mental health teams, offering enhanced, community-based outreach to promote recovery and independent living. The new community support service will provide short-term, practical assistance to help individuals access appropriate support and tackle factors affecting their mental wellbeing. DBI will offer a rapid response to individuals in emotional distress, particularly those presenting to emergency or crisis services As part of ongoing efforts to support people to have their voices heard, HSCM has commissioned VoiceAbility as its new independent advocacy service provider. Launched in October 2024, this free and confidential service is available to adults accessing social care services in Moray, including those with mental health conditions, learning disabilities, autism, dementia, physical and sensory disabilities, as well as unpaid carers. VoiceAbility's trained advocates support individuals to understand their rights, express their views, and take an active role in decisions affecting their health and wellbeing. A new contract has also been awarded to secure the future of GP services in Aberlour Medical Practice, with Speyside Medical Group appointed as the new provider from April 2025. The experienced partnership of eight GPs currently operates Grantown-on-Spey and Glenlivet Medical Practices and will bring its expertise to serve the 3,000 patients in Aberlour. The practice had been under interim management by HSCM and NHS Grampian since February 2024, following the withdrawal of the previous sole GP contractor. Page 54
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Moray Integration Joint Board Annual Accounts 2024/25 12 MANAGEMENT COMMENTARY (continued) The aim of a Community Appointment Day (CAD) is to create the right conditions to allow clinicians to support people with their condition and beyond, lean into the local community services, embed personalised care and focus on prevention. With the intention of addressing increasing waiting lists by trialling a new model of care, NHS Grampian delivered their first CAD in Moray for MSK Physiotherapy and Podiatry patients. This was a new way of working, moving away from treatment led health and delivering services differently by strengthening local partnerships, particularly with communities, to enhance both patient and practitioner experience. There were 210 patients on the waiting list who were all invited, with 162 opted to attend and 120 attending on the day. Patients were linked their own online Personal Health Passport, which was completed by them as they moved around the zones. Patients received a one-to-one consultation with the appropriate clinician and were encouraged to have meaningful conversations about what matters most to them. The CAD followed Realistic medicine principles, focusing on personalised and values-based care. The voice of lived experience was heard throughout the planning process by involving the local Versus Arthritis Chronic Pain Group who offered valuable feedback and guidance. 19 community groups and partner services were in attendance to provide information about the support available within the local community. Bringing health and community organisations together under one roof, allowed people’s health and wellbeing to be viewed in full totality Preliminary Feedback was largely positive, indicating that patients felt the day had been ‘enlightening’, benefited greatly from having services available in one place and found out about what is available in communities Page 55
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Moray Integration Joint Board Annual Accounts 2024/25 13 MANAGEMENT COMMENTARY (continued) Longer Term Changes to Strategies and Plans Moray Community Justice Partnership The Moray Community Justice Partnership has formally launched its new improvement plan, which will bring together local agencies and communities to strengthen efforts to make Moray a safer place to live and work. The five-year plan focuses on rehabilitation and public safety. It builds on existing work to reduce reoffending and minimise the number of victims by offering individuals who have offended support to make positive life changes. The local priorities for improving justice outcomes were identified through engagement with community justice stakeholders and residents, and a strategic assessment of Moray's strengths and needs By 2029, the Moray Community Justice Partnership aims to: Strengthen engagement with communities to reduce stigma, increase understanding and support for community justice, and embed lived experience within its work; Improve access to support for individuals leaving prison to aid reintegration; Expand access to employability skills and employment opportunities for those with convictions; Enhance support for individuals in police custody; Develop more community-based restorative justice options. Significant progress in reducing drug and alcohol-related harms and improving lives across communities has been achieved through the work of the Moray Alcohol and Drug Partnership (ADP). Moray ADP has made notable progress in implementing the national Medication Assisted Treatment (MAT) standards, which are a key part of Scotland’s response to the ongoing drug related deaths crisis. The standards provide a framework ensuring treatment is safe, person-centred and effective. Improved referral pathways, delivered through a third sector direct access service, have reduced waiting times for people and enabled faster access to support. Feedback from lived experience groups has shaped pathways into and through Page 56
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Moray Integration Joint Board Annual Accounts 2024/25 14 MANAGEMENT COMMENTARY (continued) services to better reflect the realities of people’s lives, leading to improved outcomes, while frontline staff have benefitted from continued training on rights awareness, trauma informed practice and crisis response. Strategic Delivery Plan A revised Strategic Delivery Plan for 2025 to 2028 was approved in draft by MIJB in March 2025 and final version in May 2025. This plan incorporates the developments required to enhance our ability to meet predicted future demands for services, whilst undertaking reviews of existing models of care to ensure that the services provided are sustainable and fit for purpose. There are also projects to implement more efficient ways of working, to aid in meeting the financial challenge that is impacting on all public sector organisations. A robust governance framework will be essential to ensure that projects can be delivered within available resources and have a clear focus on outcomes Joint Inspection Moray's multi-agency Public Protection Partnership has evidenced substantial improvement in supporting and protecting adults at risk of harm The positive impact achieved by local authority, health and police colleagues in their work to keep people safe, has been acknowledged with publication in October 2024 of the Joint Inspection of Adult Support and Protection in Moray. The progress review by the Care Inspectorate and its scrutiny partners was a follow-up to a joint inspection carried out in 2022. On their return, inspectors found significant progress had been achieved across all seven priority areas identified for improvement. Mental Health Strategic Delivery Plan The Moray Mental Health and Wellbeing Delivery Plan 2024-2026 was approved by the MIJB in September 2024 and was updated in May 2025, which underpins the work required to progress the Moray Mental Health and Wellbeing Strategy 2016- 2026. 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 Page 57
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Moray Integration Joint Board Annual Accounts 2024/25 15 MANAGEMENT COMMENTARY (continued) 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 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 Financial Review and Performance Financial performance forms part of the regular reporting cycle to the MIJB. Throughout the year the Board, through the reports it receives, is asked to consider the financial position at a given point and any management action deemed as necessary to ensure delivery of services within the designated financial framework. From the first quarter in the financial year, the Board was presented with financial information that included a forecast position to the end of the year. In November 2024 the Board received a financial report which forecast an expected overspend to the end of the financial year of £5.58m. This forecast remained consistent throughout the remainder of the year and in January 2025, MIJB were forecasting an overspend to the end of the year of £5.51m, the MIJB actually out turned at £4.26m overspent. Both partners in line with the Integration Scheme, put in additional funding to cover this overspend, so with the use of ear marked reserves totalling £0.536m, this leaves a balance of £1.45m in ear marked reserves to be carried forward into 2025/26. In May 2024, the MIJB agreed a savings plan of £8.297m, with a mixture of recurring savings and recurring reductions in spend. At the end of the financial year, this had been achieved in part, with recurring savings of £2.302m and £2,331m reduction in overspend. Given the uncertainties associated with funding and the emerging overspend position at the early stage of the financial year, it was necessary to update the Board regularly on the emerging financial position. This was done formally through MIJB meetings and informally through development sessions. Page 58
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Moray Integration Joint Board Annual Accounts 2024/25 16 MANAGEMENT COMMENTARY (continued) Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 7,700 8,328 (628) Community Nursing104,360 5,979 6,166 (187) Learning Disabilities 17,702 19,975 (2,273) 1 Mental Health 12,140 12,055 85 Addictions 1,907 1,763 144 Adult Protection & Health Improvement 249 273 (24) Care Services Provided In-House 24,743 22,754 1,989 2 Older People Services & Physical & Sensory Disability 24,775 27,034 (2,259) 3 Intermediate Care & OT 1,771 1,972 (201) Care Services Provided by External Contractors 1,835 1,816 19 Other Community Services 10,383 10,280 103 Administration & Management 3,333 3,152 181 Other Operational Services 1,377 1,535 (158) Primary Care Prescribing 18,748 21,937 (3,189) 4 Primary Care Services 21,427 21,331 96 Hosted Services 5,713 5,665 48 Out of Area Placements 720 1,971 (1,251) 5 Improvement Grants 1,207 1,021 186 Children’s & Justice Services 19,523 19,625 (102) Total Core Services 181,235 188,656 (7,421) Strategic Funds & Other Resources 14,891 6,020 8,871 TOTALS (before set aside) 196,126 194,676 1,450 Set Aside 15,639 15,639 - TOTAL 211,765 210,315 1,450 The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year. Page 59
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Moray Integration Joint Board Annual Accounts 2024/25 17 MANAGEMENT COMMENTARY (continued) Significant variances against the budget were notably: Note 1 Learning Disabilities (LD) – The LD service is overspent by £2,272,694 at the year-end. The overspend is essentially due to the purchase of care for people with complex needs which resulted in an overspend of £2,806,801 and client transport of £13,781. This is offset by more income received than expected of £524,800 (income due from another authority and Change Fund funds from NHS) and other small underspends of £18,619 which primarily relate to property costs. There was a minor underspend of £4,469 in other Learning Disabilities clinical services. This budget has been under pressure for a number of years due to demographic pressures, transitions from Children’s services and people living longer and getting frailer whilst staying at home. The biggest overspends was for services provided to individuals in their own homes to support their daily living needs which enables people to stay living at home or in a homely setting for as long as possible and day care which provides activities during the day in the community. Note 2 Care Services Provided In-House – This budget is underspent by £1,988,757 at the end of the year. This relates to underspend in staffing across all the services in this budget totalling £2,291,755 and other minor underspends of £8,275 which is being reduced by overspends relating to transport costs £97,970; insurance costs £29,047, utility costs £62,430 and less income than expected £121,826. Unfilled vacancies have been the main reason for the underspend throughout the year, and the issue of recruitment has been an ongoing problem Note 3 Older People Services and Physical & Sensory Disability - This budget is overspent by £2,259,056 at the end of the year. This primarily relates to overspends for home care in the area teams £539,818, permanent care £1,766,157 due to the increase in the number of clients receiving nursing care rather than residential care and respite care £105,776 this is being reduced by an underspend for day care £152,695. The variances within this overall budget heading reflect the shift in the balance of care to enable people to remain in their homes for longer. The ageing population requiring more complex care and local demographics also contributes to this overspend as well as the correlation between the recruitment and retention of the internal home care service provision. Note 4 Primary Care Prescribing - The primary care prescribing budget is reporting an over spend of £3,189,386 for the twelve months to 31 March 2025. The overall average price has remained relatively consistent and includes cost reduction savings identified by Pharmacy implemented countered by the impact of short supply causing an increase in costs. This is spread across a range of products and is ongoing. This overall volume increase at 3.5% is less than previously anticipated. Note 5 Out of Area Placements – This budget is overspent by £1,250,899 at the year end. This is due to the continuing number of high cost individual specialised NHS placements. Page 60
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Moray Integration Joint Board Annual Accounts 2024/25 18 MANAGEMENT COMMENTARY (continued) MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 44. At 31 March 2025 there were ear marked reserves of £1.451m available to the MIJB, compared to £1.986m at 31 March 2024. These remaining reserves of £1.451m are for various purposes as described below: Earmarked Reserves Amount £000’s GP Premises 39 National Drugs MAT 250 OOH Winter Pressure funding 172 Moray Cervical screening 35 Moray hospital at home 5 Moray Psychological 315 MHO Funding 138 Adult protection funding for CA 18 Adult Disability payment 45 National Trauma Training services 62 Moray School Nurse 32 Moray Winter Fund HCSW & MDT 182 LD Annual Health Checks 69 Community Planning partnership 2 Moray District Nurses 56 OOH Dev Fellowship scheme 30 Total Earmarked 1,450 General Reserves 0 TOTAL Earmarked & General 1,450 GP Premises – balance of funding for improvement grants including the making of premises improvement grants to GP contractors. The continued digitalisation of paper GP records. Modifications for the purposes of improving ventilation and increase to the space available in NHS owned or leased premises for primary care multi- disciplinary teams. Page 61
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Moray Integration Joint Board Annual Accounts 2024/25 19 MANAGEMENT COMMENTARY (continued) National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). National Drugs Mission Moray – balance of funding for range of activities including: drug deaths, taskforce funding, priorities of national mission, residential rehabilitation, whole family approach, outreach, bear fatal overdose pathways and lived and living experience. Out of Hours Winter Pressure funding – balance of funding to sustain GO out of hours and to support resilience to explore operational solutions. Moray Cervical Screening – balance of funding for smear test catch up campaign. Moray Hospital at home – development of Hospital at Home provides Acute hospital level care delivered by healthcare professionals, in a home context for a condition that would otherwise require acute hospital inpatient care. Moray Psychological – funding streams for mental health, psychological wellbeing, facilities, post diagnostic support and psychological therapies. Mental Health Officer (MHO) funding – funding to support additional mental health officer capacity. Adult protection funding for care at home– balance of funding to build capacity in care at home community based services. Adult Disability payment – funding to assist with the implementation of the adult disability payments. National Trauma Training services – training for dealing with people affected by trauma and adversity. Moray School nurse – funding to support NHS Grampian to retain school nurse posts. Moray Winter Fund Health Care Social Workers (HCSW) – additional funding for further HCSW in both the IJB and Emergency department. Moray Winter fund Multi Disciplinary Team – additional funding for service pressures includes Discharge to Assess, Home First Frailty team and volunteer development. Learning Disability Annual Health Checks – to implement the annual health checks. Community Planning Partnership – funding towards community planning partnership. Moray District Nurses – allocation to support recruitment and training of District Nurses. Page 62
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Moray Integration Joint Board Annual Accounts 2024/25 20 MANAGEMENT COMMENTARY (continued) Out of Hours (OOH) Development Fellowship Scheme – scheme to keep GPs within clinical practice, increase GP’s confidence and competence in OOHs work All reserves are expected to be utilised for their intended purpose during 2025/26. Set Aside – Excluded from the financial performance table above on page 16 but included within the Comprehensive Income & Expenditure Account is £15.639m for Set Aside services. Set Aside is an amount representing resource consumption for large hospital services that are managed on a day to day basis by the NHS Grampian. MIJB has a responsibility for the strategic planning of these services in partnership with the Acute Sector. Set Aside services include: Accident and emergency services at Aberdeen Royal Infirmary and Dr Gray’s inpatient and outpatient departments; Inpatient hospital services relating to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine, learning disabilities, old age psychiatry and general psychiatry; and Palliative care services provided at Roxburgh House Aberdeen and The Oaks Elgin. The budget allocated to Moray is designed to represent the consumption of these services by the Moray population. The figures for 2024/25 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2020/21 (3.00%), 2021/22 (3.36%) ,2022/23 (6.70%), and 2023/24 (5.35%) and 2024/25 (6.64%): 2024/25 2023/24 2022/23 2021/22 2020/21 Budget 15.639m 14.665m 13.92m 13.04m 12.62m Page 63
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Moray Integration Joint Board Annual Accounts 2024/25 21 MANAGEMENT COMMENTARY (continued) Risks, Uncertainties and Future Developments The MIJB Chief Officer has a responsibility to maintain a risk strategy and risk reporting framework. Risks inherent within the MIJB are monitored, managed and reported at Audit, Performance and Risk Committee. In addition, a risk action log is monitored and managed by the Senior Management Team. The key strategic risks of the MIJB classed as ‘High’ and ‘Very High’ are presented below, the risk number relates to the MIJB internal risk numbering: VERY HIGH 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. Managing the risk – current controls in place – 1. Medium Term Financial Framework (MTFF) approved by MIJB on 27 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. 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. Page 64
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Moray Integration Joint Board Annual Accounts 2024/25 22 MANAGEMENT COMMENTARY (continued) HIGH 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. Managing the risk – Current controls in place 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. Assurances: Operational oversight by Moray Workforce Forum. The HSCM Response Group continues to focus on leadership around emerging issues and resolving them, including staffing. Risk 5 - There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Managing the risk – Current controls in place: 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 – action plans and performance measures monitored by OMT with oversight by SMT. 4. HSCM Civil Contingencies group review specific risks and 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 65
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Moray Integration Joint Board Annual Accounts 2024/25 23 MANAGEMENT COMMENTARY (continued) HIGH (continued) 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 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. 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 oversee and manage risks in care homes. 7. Children and Adult Protection services report to their respective committees. Governance Structure and Process (Senior Leadership Team meetings, Operational Team Meetings, Daily Huddles). 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 Page 66
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Moray Integration Joint Board Annual Accounts 2024/25 24 MANAGEMENT COMMENTARY (continued) HIGH (continued) Risk 7 - There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Managing the risk – Current controls in place: 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 regard significant service changes are presented to all three MIJB’s for approval. 4. Internal Audit of MIJB Hosted Services. 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 three Health and Social Care Partnerships and the Acute Sector. Development Aims for 2025/26 Discharge without Delay & Frailty at the Front Door Health and Social Care Moray is taking part, supported by the MIJB, in the National Collaborative to support Discharge without Delay. This approach supports us in undertaking mapping and self-assessment work and understanding where the application of best practice and learning from other areas can help us improve locally and get people home from an acute setting as quickly and safely as possible. By taking part in this collaborative, we aim to reduce further the number of people delayed in our system and to ensure we apply optimum practice across acute and community setting to do so. Page 67
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Moray Integration Joint Board Annual Accounts 2024/25 25 MANAGEMENT COMMENTARY (continued) Realignment of Organisational Structures Since its inception the MIJB has sought to ensure the most effective and efficient structures are in place to support the delivery of its strategic aims and overall strategic plan. Over the course of 2025/26 a review of the HSCM organisational structure will take place that will support these aims and ensure that both HSCM and the MIJB have the right resources in place, and the right operational structure to enact our plans, deliver the best outcomes for people and operate sustainably within the current challenging financial conditions. Our organisational structure supports how we deliver our ambitions in our communities and directly with people and is a key enabler in driving progress against our priorities. Strengthening Integration and Oversight of Children, Families and Justice within our system Children, Families and Justice Services were delegated formally to the MIJB in 2023/24 under the integration scheme and there is now reporting of these services within the Clinical and Care Governance structures in place. Moray Council and Councillors retain statutory responsibilities for outcomes for Children and also remain Corporate Parents in respect of those Children and Young People who are cared for or accommodated out with their families. MIJB is committed to ensuring robust reporting across the system that ensures all partners can fulfil their statutory obligations while focussing on improving outcomes for our young people. A review of current reporting arrangements will take place to reduce any duplication in reporting whilst strengthening oversight of performance and delivery. Strengthening Performance Oversight The MIJB approved its Strategic Delivery Plan at its meeting in May 2025, and this now provides a clear line of sight from Strategic Plan to the impact of the programmes, services and initiatives in place to deliver it. Over the course of this year, we aim to further strengthen this line of sight, aligned to the Board’s Risk Appetite Statement, to ensure that our programmes of work are effective in achieving their objectives and represent value for money. Page 68
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Moray Integration Joint Board Annual Accounts 2024/25 26 MANAGEMENT COMMENTARY (continued) In addition, we will seek to: Maintain our focus on early intervention and prevention, reducing demand and supporting the resilience of people and communities. We’ll undertake learning from the successful Community Appointment Day which took place in Elgin as a possible model to support this; Continue to develop how we care for our staff well-being, with staff our most valuable asset; Provide leadership and participation as key partners in the NHS Grampian led Strategic Change Programme and ensure we explore effective joint working; Focus our budget setting efforts in the context of the Medium Term Financial Strategy and longer term sustainability. ………………………… ……………………… ……………………… Elaine Kirby Judith Proctor Deborah O’Shea Chair of Moray IJB Chief Officer Chief Financial Officer Page 69
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Moray Integration Joint Board Annual Accounts 2024/25 27 STATEMENT OF RESPONSIBILITIES Responsibilities of the MIJB To make arrangements for the proper administration of its financial affairs and to secure that one of its officers has the responsibility for the administration of those affairs. In Moray Integration Joint Board, that officer is the Chief Financial Officer; To manage its affairs to achieve best value in the use of its resources and safeguard its assets; Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014) and so far as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003); and To approve the Annual Accounts. Signed on behalf of the Moray Integration Joint Board Elaine Kirby Chair of Moray IJB Page 70
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Moray Integration Joint Board Annual Accounts 2024/25 28 STATEMENT OF RESPONSIBILITIES (continued) Responsibilities of the Chief Financial Officer The Chief Financial Officer is responsible for the preparation of the Moray Integration Joint Board’s statement of accounts in accordance with proper practices as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (the Code). In preparing the Annual Accounts the Chief Financial Officer has: Selected suitable accounting policies and applied them consistently; Made judgements and estimates that were reasonable and prudent; Complied with legislation; and Complied with the local authority code (in so far as it is compatible with legislation). The Chief Financial Officer has also: Kept proper accounting records that were up to date; and Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that the financial statements give a true and fair view of the financial position of the Moray Integration Joint Board as at 31 March 2025 and the transactions for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 71
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Moray Integration Joint Board Annual Accounts 2024/25 29 REMUNERATION REPORT Introduction This Remuneration Report is provided in accordance with the Local Authority Accounts (Scotland) Regulations 2014 (SSI2014/200) as part of the MIJB annual accounts. This report discloses information relating to the remuneration and pension benefits of specified MIJB members. All information disclosed in the tables is subject to external audit. Other sections within the Remuneration Report will be reviewed for consistency with the financial statements. Moray Integration Joint Board The voting members of MIJB are appointed through nomination by Moray Council and Grampian Health Board. There is provision within the Order to identify a suitably experienced proxy or deputy member for both the voting and non-voting membership to ensure that business is not disrupted by lack of attendance by any individual. MIJB Chair and Vice-Chair Nomination of the MIJB Chair and Vice-Chair post holders alternates every 18 months between a Councillor and a Health Board non-executive member. The MIJB does not provide any additional remuneration to the Chair, Vice-Chair or any other board members relating to their role on the MIJB. The MIJB does not reimburse the relevant partner organisations for any voting member costs borne by the partner. The MIJB does not have responsibilities in either the current or in future years for funding any pension entitlements of voting MIJB members. Therefore, no pension rights disclosures are provided for the Chair or Vice-Chair. Taxable Expenses 2023/24 Name Position Held Nomination By Taxable Expenses 2024/25 £ £ - Dennis Robertson Vice-Chair 01/04/24 – 26/09/24; 01/04/2025 to date Chair 27/09/24 to 31/03/25 Grampian Health Board - - Cllr Tracy Colyer Chair 01/04/24 – 26/09/24 Moray Council - - Cllr Elaine Kirby Vice-Chair 21/11/24 – 31/03/25 Chair 1/04/25 to date Moray Council - Page 72
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Moray Integration Joint Board Annual Accounts 2024/25 30 REMUNERATION REPORT (continued) Officers of the MIJB The MIJB does not directly employ any staff in its own right; however specific post- holding officers are non-voting members of the Board. Chief Officer Under section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 a Chief Officer for the integration joint board has to be appointed and the employing partner has to formally second the officer to the Board. The employment contract for the Chief Officer will adhere to the legislative and regulatory framework of the employing partner organisation. The remuneration terms of the Chief Officer‘s employment are approved by the Board. Other Officers No other staff are appointed by the MIJB under a similar legal regime. Other non- voting board members who meet the criteria for disclosure are included in the disclosures below. Total 2023/24 Senior Employees Salary, Fees & Allowances Total 2024/25 £ £ £ 122,460 Simon Bokor-Ingram Chief Officer (1/04/24- 31/05/24) 20,268 20,268 - Judith Proctor (from 25/07/24) 95,673 95,673 83,476 Deborah O’Shea Interim Chief Financial Officer 90,729 90,729 In respect of officers’ pension benefits, the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis there is no pensions liability reflected on the MIJB balance sheet for the Chief Officer or any other officers. The MIJB however has a responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the MIJB. The following table shows the MIJB’s funding during the year to support the officers’ pension benefits. The table also shows the total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. Page 73
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Moray Integration Joint Board Annual Accounts 2024/25 31 REMUNERATION REPORT (continued) NOTE: no bonuses, expenses allowances, compensation for loss of office or any taxable benefits were made in 2024/25 In Year Pension Contributions Accrued Pension Benefits Year to 31/03/24 Year to 31/03/25 As at 31/03/2025 Difference from 31/03/2024 £ £ £ 000’s £ 000’s Simon Bokor- Ingram, Chief Officer (*) 24,346 4,378 Pension 40 (6) Lump Sum 101 (22) Judith Proctor, Chief Officer - 21,526 Pension 36 9 Lump Sum 99 21 Deborah O’Shea Chief Financial Officer 7,179 20,339 Pension 9 (19) Lump Sum 31 - (*) Simon Bokor-Ingram figures included in the table above, relate to the full year and employment after Chief Officer, as figures are unable to be apportioned. Page 74
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Moray Integration Joint Board Annual Accounts 2024/25 32 REMUNERATION REPORT (continued) Disclosure by Pay bands As required by the regulations, the following table shows the number of persons whose remuneration for the year was £50,000 or above, in bands of £5,000. Number of Employees in Band 2023/24 Remuneration Band Number of Employees in Band 2024/25 1 £80,000 - £84,999 - - £85,000 - £89,999 1 1 £120,000 - £124,999 - £130,000 - £134,999 1 Exit Packages There were no exit packages agreed by the MIJB during 2024/25 financial year, or in the preceding year. ……………………….. ……………………… Elaine Kirby Judith Proctor Chair of Moray IJB Chief Officer Page 75
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Moray Integration Joint Board Annual Accounts 2024/25 33 ANNUAL GOVERNANCE STATEMENT The Annual Governance Statement describes the Moray Integration Joint Board’s (MIJB) governance arrangements and reports on the effectiveness of the MIJB’s system of internal control. Scope of Responsibility The MIJB is responsible for ensuring that its business is conducted in accordance with the law and appropriate standards, and that public money is safeguarded and used efficiently and effectively in pursuit of best value. In discharging its responsibilities, the MIJB has established arrangements for its governance which includes the system of internal control. This system is intended to manage risk and support the achievement of the MIJB’s policies, aims and objectives. The system provides reasonable but not absolute assurance of effectiveness. The MIJB places reliance of the systems of internal control of NHS Grampian systems and Moray Council, which supports organisational compliance of policies and procedures in addition to those of the MIJB. Assurances are required on the effectiveness of the governance arrangements of all three organisations, meaning a significant failure in one of the three Partners may require to be disclosed in the annual accounts of all three Partners. The Governance Framework The CIPFA/SOLACE framework for ‘Delivering Good Governance in Local Government’ last updated in 2016 remains current and provides a structured approach in defining seven principles that underpin effective governance arrangements. Whilst the framework is written specifically for Local Government, the principles apply equally to integration authorities, and while the MIJB continues to evolve as an entity in its own right. It continues to draw on the governance assurances of NHS Grampian and Moray Council as its principal funding partners. Given the scope of responsibility within the MIJB and the complexities surrounding the assurance arrangements, a Local Code of Corporate Governance was developed and the MIJB assesses the effectiveness of its governance arrangements against the principles set out in the document. The Code outlines the seven governance principles from the CIPFA/SOLACE guidance (as referenced below) and provides the sources of assurance for assessing compliance relative to the MIJB, Moray Council and NHS Grampian. These assurances include referencing the governance arrangements of NHS Grampian and Moray Council which are summarised annually and published in their respective Annual Governance Statements which form part of the annual accounts of each organisation. The respective governance statements can be found on the individual organisations websites: Moray Council: Annual Accounts - Moray Council and NHS Grampian: https://www.nhsgrampian.org/about-us/annual- accounts/. Page 76
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Moray Integration Joint Board Annual Accounts 2024/25 34 ANNUAL GOVERNANCE STATEMENT (continued) Key Governance Arrangements All of the scheduled Audit Performance and Risk and Clinical Care Governance Committee meetings were held as timetabled during 2024/25. Health and Social Care Moray (HSCM) established an emergency response group that has been operational since the end of March 2020, this has now transformed into a Daily Response meeting. Representation on the response groups of the Partner organisations is provided by HSCM staff, ensuring the necessary links and flow of information to ensure a co-ordinated response on a pan Grampian basis and locally within Moray. There continues to be governance standards and collaborative working across the whole system, both across the NHS Portfolios and Grampian wide system. The use of a Grampian Operation Performance Escalation System (GOPES) was established to enable senior leaders to have oversight of where pressures were located in the system and to direct responses accordingly. This development has also strengthened the identification of key metric thresholds to inform the levels for escalation. Evaluation of the Effectiveness of Governance Governance Principle 1 – Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law Assessment of Effectiveness The activities of the MIJB are governed by a Board comprising both voting and non-voting members, drawn from a diverse range of backgrounds to ensure broad representation. The Board meets bi-monthly and is supported by regular development sessions that allow for in depth exploration of key strategic and operational issues. Governance is further strengthened through the work of two committees: the Audit, Performance and Risk Committee, and a Clinical and Care Governance Committee, each with clearly defined remits to support effective governance and assurance. The MIJB operates in accordance with Standing Orders, which set out the rules governing the proceedings of the Board and its Committees. These include the Scheme of Administration which defines the structure and remit of the Board’s committees, ensuring clarity and consistency in governance arrangements. To uphold high standards of ethical conduct, the MIJB has appointed a Standards Officer. This role supports compliance with the Ethical Standards in Public Life etc. (Scotland) Act 2000, which requires members of devolved public bodies to comply with Codes of Conduct approved by Scottish Ministers. The Standards Officer also ensures alignment with guidance issued by the Standards Commission for Scotland, reinforcing the Board’s commitment to integrity, accountability, and ethical governance. Page 77
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Moray Integration Joint Board Annual Accounts 2024/25 35 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 2 – Ensuring openness and comprehensive stakeholder engagement Assessment of Effectiveness MIJB’s Standing Orders provide for public and press access to meetings and reports, supporting transparency and accountability. In response to positive feedback and to enhance accessibility, hybrid meetings continued throughout 2024/25. A dedicated website was developed for Health and Social Care Moray and is continuously monitored for improvement, and about to transition to a new platform to further improve the accessibility and quality of information. Agendas, reports and minutes for all committees can be accessed via Moray Council website, alongside links to all relevant strategies of the MIJB. Both the voting and non-voting membership arrangements of the MIJB are in line with the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. There are eight voting members, four are elected members appointed by Moray Council and four are non-executive members of NHS Grampian Board. The non-voting membership comprises six professional members and five stakeholder members representing: staff, third sector bodies carrying out activities in relation to health and social care, service users and unpaid carers, and six additional non-voting members which include the Chief Executives of Moray Council and NHS Grampian in an Ex-officio capacity. The broad membership of the MIJB ensures valued input and engagement from a wide range of stakeholders. The Community Empowerment (Scotland) Act 2015 places a statutory duty on MIJB and its Community Planning Partners to engage with communities on the planning and delivery of services and securing local outcomes. The MIJB has an approved Communications and Engagement Strategy which recognises and promotes the active and meaningful engagement with all stakeholders. Governance Principle 3 – Defining outcomes in terms of sustainable economic, social and environmental benefits Assessment of Effectiveness The MIJB Strategic Plan 2022-2032 building on the foundations of the 2019 plan, sets out long-term strategic objectives that are flexible and responsive to emerging challenges and developments in health. To support the delivery of these objectives a 3 year delivery plan was approved by MIJB in May 2025, underpinned by a medium-term financial framework. The strategic plan is supported by a comprehensive suite of documents, including a performance framework, workforce plan, and a communications, engagement and participation plan. These documents are currently under review, with a focus on enabling service transformation within existing financial constraints. These documents collectively provide a structured approach to defining and achieving outcomes, with a clear focus on medium term priorities. The outcomes are directly aligned with the delivery of health and social care services and are aimed at driving measurable improvements for the population of Moray. Page 78
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Moray Integration Joint Board Annual Accounts 2024/25 36 ANNUAL GOVERNANCE STATEMENT (continued) In support of environmental sustainability, a climate change duties report is compiled and submitted annually on behalf of the MIJB, demonstrating the Board’s commitment to meeting its statutory environmental responsibilities Governance Principle 4 – Determining the interventions necessary to optimise the achievement of intended outcomes Assessment of Effectiveness The MIJB’s decision making processes are designed to ensure that Board members receive clear, objective and comprehensive analysis of available options. Each proposal outlines how intended outcomes will be achieved, supported by detailed assessments of associated risks and opportunities. Board papers reflect the broad range of strategic and operational matters under consideration. These include regular updates from the Chief Officer on current developments, as well as agenda items covering both opportunities and challenges, particularly those arising from reconfiguration and transformation of services. The MIJB recognises the importance of sound financial governance and has adopted the Financial Management Code promoted by CIPFA as a guiding framework for effective financial administration. A Medium-Term Financial Strategy, approved in March 2025, supports this approach and will be reviewed regularly to ensure alignment with the Strategic Plan, Delivery Plan and the integration of delegated children’s services. Governance Principle 5 – Developing the entity’s capacity, including the capability of its leadership and the individuals within it Assessment of Effectiveness The Senior Management Team (SMT) and Officers and have developed a programme of Development sessions with Board members with a focus on the challenging financial position and exploring opportunities for service transformation. Officers present a range of proposals aimed at delivering the MIJB’s strategic objectives whilst also contributing to the necessary financial savings for the upcoming year. The MIJB continues to prioritise leadership development and collaborative working through the regular development sessions with Officers. These sessions provide valuable opportunities for shared learning, strategic dialogue, and constructive challenge, helping to strengthen leadership capabilities and organisational resilience. Page 79
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Moray Integration Joint Board Annual Accounts 2024/25 37 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 6 – Managing risk and performance through robust internal control and strong public financial management Assessment of Effectiveness As part of a robust risk monitoring framework the Strategic Risk Register was co-developed with Board members during a dedicated development session in October 2024 and was formally approved by the Board in May 2025. This updated register will be reviewed monthly by the Senior Management Team and updated and presented biannually to Audit, Performance and Risk Committee, and annually to MIJB. A related action log was created for monitoring purposes and is owned and monitored by the Senior Management Team. The committee agreed in October that the register would be presented biannually with the caveat that any emerging or increasing risks would be presented as required. The Performance Management Framework has currently under review. Performance reporting falls within the scope of the Audit, Performance and Risk Committee and reporting is quarterly. This now includes reporting by the delegated Children’s & Families Services. The internal control system is closely aligned with those of MIJB’s Partner organisations, reflecting their operational responsibility for service delivery under direction of the MIJB. The Audit, Performance and Risk committee through its consideration of reports monitors the effectiveness of internal control procedures. The MIJB Chief Internal Auditor undertakes an annual review of the adequacy of internal controls and the opinion is included within this statement. The MIJB benefits from the oversight of an independent S95 Officer, who is a member of the Board. This Officer provides expert advice on all financial matters and ensure timely preparation and reporting of budget estimates, monitoring reports and annual accounts. Governance arrangements have been developed and maintained to comply with the core functions of various good framework guidelines including Code of Practice on Managing the Risk of Fraud and Corruption, Public Sector Internal Audit Standards (incorporating the principles of the Role of the Head of Internal Audit), Audit Committees: Practical Guidance for Local Authorities and Police. These frameworks support the MIJB’s commitment to strong financial stewardship and effective internal control. Page 80
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Moray Integration Joint Board Annual Accounts 2024/25 38 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 7 – Implementing good practices in transparency, reporting and audit to deliver effective accountability Assessment of Effectiveness MIJB business is conducted through an approved cycle of Board meetings. To promote openness and accessibility, recordings of Board meetings are made available to the public. In addition, agendas, reports and minutes are published and accessible for the public to inspect. There is a standardised reporting format in place to ensure consistency, clarify and transparency in decision making processes. The MIJB demonstrates its commitment to accountability through publication of both its Annual Accounts and Annual Performance Report. Following formal approval by the Board. The Chief Internal Auditor reports independently to the Audit, Performance and Risk committee with direct access to the Chief Officer, Chief Financial Officer and Chair of the Audit, Performance and Risk committee on any matter of concern. Throughout 2024/25, the Chief Internal Auditor has continued to provide regular reports to the Committee, supporting effective oversight of internal accounts and assurance processes. Review of Adequacy and Effectiveness The MIJB has a responsibility for conducting, at least annually, a review of the effectiveness of the governance arrangements, including the system of internal control. The review is informed by the work of the Senior Management Team (which has responsibility for the development and maintenance of the internal control framework environment), the work of the Internal Auditors and the Chief Internal Auditor’s annual report and the reports from the External Auditor and other review agencies and inspectorates. Internal Audit Opinion Moray Council’s Internal Audit Section delivers the Internal Audit Service for the Moray Integration Joint Board (MIJB), and the Council’s Audit and Risk Manager holds the Chief Internal Auditor appointment to the MIJB until the 31st of March 2026. The Council’s Internal Audit Section has adopted the Public Sector Internal Audit Standards (PSIAS), which requires the Chief Internal Auditor to deliver an annual internal audit opinion and report, which has also been used to inform this governance statement. The Chief Internal Auditor’s evaluation of the adequacy and effectiveness of the MIJB framework of governance, risk management and internal control includes consideration of the findings from the audit work undertaken by the Chief Internal Auditor in his role as the Audit and Risk Manager for the Moray Council. Assurance is also sought from the Internal Audit Service Provider for NHS Grampian of the governance processes adopted by that organisation. This includes the Chief Internal Auditor now being provided with internal audit reports by the Internal Audit Service Provider for NHS Grampian of interest to the MIJB. In addition, reports issued by other Page 81
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Moray Integration Joint Board Annual Accounts 2024/25 39 ANNUAL GOVERNANCE STATEMENT (continued) external review agencies are considered in the opinion provided by the Chief Internal Auditor. Internal Audit operates independently within the organisation, with no management- imposed limitations on the scope of audit work performed. In accordance with PSIAS, the Chief Internal Auditor prepares a risk-based Audit Plan for the MIJB, considering the internal audit arrangements of both Moray Council and NHS Grampian functions. The Annual Audit Plan for 2024/25 agreed to the following audits to be undertaken: Out of Area Placements- A review of the systems and procedures of people receiving adult social care services who are out of the Moray area. Residential Care- A review to assess the adequacy of procedures and administrative arrangements for third-party suppliers that provide care home services. The audit also included testing to verify the accuracy of financial assessments and the charging of residential care for both respite and permanent care residents. Fostering and Kinship- An audit to review fostering and kinship payments of fees and allowances, ensuring they comply with agreed policies and procedures. The audit review of out of area placements identified significant concerns regarding the progress in determining the ordinary residence status of individuals receiving adult social care services, contractual arrangements with care providers, and budgetary control arrangements. A review of residential care highlighted the need for improved administrative processes and the potential for further digitalisation. The fostering and kinship payments audit was found to be well managed within the scope of the review, though some administrative control improvements were noted. In addition to the projects outlined in the Audit Plan, governance arrangements were reviewed to prevent fraud and corruption. The audit found that further improvements are needed to enhance the effectiveness of counter fraud measures. Internal Audit has also undertaken follow-up reviews to evidence the implementation of recommendations from previously issued audit reports. The follow-up audits undertaken of Self-Directed Support and the Moray Integrated Community Store found several recommendations where revised timescales for implementing recommendations were required. A previous review of social care information governance noted a need for a single case recording system. The Service is seeking a replacement for the current arrangements for recording social care information, but there is a need for this to be progressed in a timely manner. Implementation of recommendations is a key element in determining the adequacy and effectiveness of governance and internal control systems. If recommendations are not implemented in a timely manner, then weaknesses in control and governance frameworks will remain. Page 82
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Moray Integration Joint Board Annual Accounts 2024/25 40 ANNUAL GOVERNANCE STATEMENT (continued) The Chief Internal Auditor, after considering the results of the work carried out by Internal Audit, together with other sources of assurance, has provided limited assurance that the Moray Integration Joint Board had adequate systems of governance and internal control for the year ended 31 March 2025. Prior Year Governance Issues The Annual Governance Statement for 2023/24 highlighted a number of areas for development in looking to secure continuous improvement. An assessment of progress is provided below: Area for Improvement Identified in 2023/24 Action Undertaken / Progress Made in 2024/25 GP visioning programme to deliver resilience and sustainability. Financial Sustainability with best value and outcomes. Assurance and reporting for Children’s Social Work and Justice Services. Progress within the agreed priority workstreams has been made across the year and there have been regular updates to the IJB on the programme. A Visioning refresh event was held in March 2025 and further work to strengthen the programme deliverables will be taken forward from that into the next financial year. The Chief Officer has put in place a Budget Savings Oversight Group (BSOG) which supports oversight of the delivery of the savings programme on a monthly basis. A Programme Management Office (PMO) has been established to support this work and our senior responsible officers for each savings programme. In addition, regular tri- partite meetings between the Chief Officer, Chief Finance Officer and the Director and Head of Finance in NHS Grampian and Moray Council take place to ensure shared visibility on financial matters for all partners. Assurance and reporting for CF&J continues to take place in both the IJB and its committees and within Moray Council Structures. Resource has now been secured to support a review of this across 2025/26 to ensure robust and proportionate reporting that is cognisant of the statutory roles of partner organisations. Page 83
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Moray Integration Joint Board Annual Accounts 2024/25 41 Area for Improvement Identified in 2023/24 Action Undertaken / Progress Made in 2024/25 Improvement in compliance with audit recommendations. Improvements continue to be made in this area with a process now in place to review audit actions in both the Operational Management Team (OMT) and within the Chief Officer’s Senior Management Team (SMT). This provides visibility on the delivery of actions within agreed timescales and on those actions that remain open and overdue so that a focus can be put upon those and ensure their closure. Improvement on progress has been evidenced; however, this area of improvement requires further development and will be included for developments in 2025/26. Further Developments Following consideration of the review of adequacy and effectiveness, the following action plan has been established to ensure continual improvement of the MIJB’s governance arrangements and progress against the implementation of these issues will be assessed as part of the next annual review. Areas of focus for 2025/26 1. Developing further our approaches to frailty and Discharge without Delay. 2. Realigning our organisational structure to ensure effective delivery of strategy and transformation. 3. Integration of Children’s Social Work and Justice Services governance and oversight within the IJB. 4. Further strengthen performance oversight of the Board’s key strategies and priorities. 5 Continue to improve on the progress for compliance with audit recommendations. ANNUAL GOVERNANCE STATEMENT (continued) Page 84
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Moray Integration Joint Board Annual Accounts 2024/25 42 ANNUAL GOVERNANCE STATEMENT (continued) Key Governance challenges going forward will involve: Providing capacity to meet statutory obligations and ambitions to transform services, whilst managing expectations, increasing complexity and rising demand for services and the wider societal economic challenges now presented that also potentially drive demand. As a Board, difficult decisions will be required in balancing how we meet the needs of our community whilst operating within the available resource envelope, this will be supported by our approach to risk as set out in our risk appetite statement. Continuing to address our work force challenges in respect of recruitment and retention and where persistent vacancies will necessitate the need for redesign of roles and/or services. Continuing to work closely with NHS Grampian, Moray Council and Moray Community Planning Partnership to build on existing relationships and establishing collaborative leadership, and to maximise the opportunities from an expanded health and social care remit within the revised Portfolio approach, including Dr Grays hospital, and how the IJB contributes to the wider community planning agenda in Moray and the North East. Continuing to implement the recommendations of internal and external audit, including learning from national reviews. Continuing work with teams to provide assurance to MIJB as we develop the governance structures for Children’s Social Work and Criminal Justice Services that support decision making on how best to tackle poverty and inequalities. There have been no significant events up to the authorised for issue date. Page 85
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Moray Integration Joint Board Annual Accounts 2024/25 43 ANNUAL GOVERNANCE STATEMENT (continued) Statement In our respective roles as Chair and Chief Officer of the MIJB, we are committed to ensuring good governance and recognise the contribution it makes to securing delivery of service outcomes in an effective and efficient manner. This annual governance statement summarises the MIJB’s current governance arrangements and affirms our commitment to ensuring they are regularly reviewed, developed and fit for purpose. Whilst recognising that improvements are required, as detailed earlier in the statement, it is our opinion that a reasonable level of assurance can be placed upon the adequacy and effectiveness of the MIJB’s governance arrangements. The ongoing challenge will be to meet all operational demands and pressures as we continue to operate within the legacy of the Covid 19 pandemic and global financial pressures, both of which have impacted at a socioeconomic level on our region and the community. Pressure on financial settlements is increasing for all partners, and we will continue to engage with them, the Scottish Government and the wider community to agree plans and outcomes that are both sustainable and achievable within this context. Taking that forward will be challenging as we aim to fulfil the nine Health and Wellbeing national health and well-being outcomes, and the strategic priorities identified and detailed in our Strategic Plan. Good governance remains an essential focus in delivering services in a way that both meets the needs of communities and discharges statutory best value responsibilities. These were arrangements in place for 2024/25 and up to the date of authorised for issue. ………………………… ……………………… Elaine Kirby Judith Proctor Chair of Moray IJB Chief Officer Page 86
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Moray Integration Joint Board Annual Accounts 2024/25 44 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT This statement shows the cost of providing services for the year ended 31 March 2025 according to generally accepted accounting practices. 2023/24 2024/25 Net Expenditure Net Expenditure £ 000 £ 000 7,942 Community Hospitals 8,328 5,702 Community Nursing 6,166 18,366 Learning Disabilities 19,975 11,506 Mental Health 12,055 1,726 Addictions 1,763 213 Adult Protection & Health Improvement 273 23,044 Care Services Provided In-House 22,754 25,191 Older People & Physical & Sensory Disability Services 27,034 1,881 Intermediate Care and Occupational Therapy 1,972 1,808 Care Services Provided by External Providers 1,817 10,012 Other Community Services 10,280 2,828 Administration & Management 3,152 1,299 Other Operational services 1,535 21,339 Primary Care Prescribing 21,937 19,939 Primary Care Services 21,331 5,936 Hosted Services 5,665 1,777 Out of Area Placements 1,971 949 Improvement Grants 1,021 19,762 Children & Justice Services 19,625 6,898 Strategic Funds & Other Resources 6,020 14,665 Set Aside 15,639 202,783 Cost of Services 210,315 (200,086) Taxation and Non-Specific Grant Income (note 5) (209,779) 2,697 Deficit on provision of Services 536 2,697 Total Comprehensive Income and Expenditure 536 There are no statutory or presentational adjustments which reflect the MIJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. Children & Justice Services were integrated into the MIJB from 2023/24, with the first year being the shadow year meaning all financial responsibilities remained with the Council but from 2024/24 the MIJB has full control over the finances. Page 87
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Moray Integration Joint Board Annual Accounts 2024/25 45 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the Moray Integration Joint Boards (MIJB) reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices. Additional detail included within note 7 on page 51. Movement of Reserves During 2023/24 General Fund Balance £000 Opening Balance at 1 April 2024 (1,986) Total Comprehensive Income and Expenditure 536 (Increase) in 2024/25 536 Closing Balance at 31 March 2025 (1,450) Movement of Reserves During 2023/24 General Fund Balance £000 Opening Balance at 1 April 2023 (4,683) Total Comprehensive Income and Expenditure 2,697 Decrease in 2023/24 2,697 Closing Balance at 31 March 2024 (1,986) Page 88
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Moray Integration Joint Board Annual Accounts 2024/25 46 BALANCE SHEET The Balance Sheet shows the value of the Moray Integration Joint Board’s (MIJB) assets and liabilities as at the balance sheet date. The net assets of the MIJB (assets less liabilities) are matched by the reserves held by the MIJB. 31 March 2024 £000 Notes 31 March 2025 £000 1,986 Short Term Debtors 6 1,450 Current Assets - Short Term Creditors - Current Liabilities - Provisions - Long Term Liabilities 1,986 Net Assets 1,450 1,986 Usable Reserve General Fund 7 1,450 1,986 Total Reserves 1,450 The unaudited annual accounts were issued on 19 June 2025. The Annual Accounts present a true and fair view of the financial position of the MIJB as at 31 March 2025 and its income and expenditure for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 89
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Moray Integration Joint Board Annual Accounts 2024/25 47 NOTES TO THE FINANCIAL STATEMENTS Note 1 Significant Accounting Policies General Principles The Financial Statements summarise the Moray Integration Joint Board’s (MIJB) transactions for the 2024/25 financial year and its position at the year-end of 31 March 2025. The MIJB was established under the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. The Financial Statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25, supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. The accounts are prepared on a going concern basis, which assumes that the MIJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: Expenditure is recognised when goods or services are received, and their benefits are used by the MIJB. Income is recognised when the MIJB has a right to the income, for instance by meeting any terms and conditions required to earn the income, and receipt of the income is probable. Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet. Where debts may not be received, the balance of debtors is written down. Funding The MIJB is primarily funded through funding contributions from the statutory funding partners, Moray Council and Grampian Health Board. Expenditure is incurred as the MIJB commissions’ specified health and social care services from the funding partners for the benefit of service recipients in Moray area. Cash and Cash Equivalents The MIJB does not operate a bank account or hold cash. Transactions are settled on behalf of the MIJB by the funding partners. Consequently, the MIJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. The funding balance due to or from each funding partner as at 31 March is represented as a debtor or creditor on the MIJB’s Balance Sheet. Page 90
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Moray Integration Joint Board Annual Accounts 2024/25 48 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 1 Significant Accounting Policies (continued) Employee Benefits The MIJB does not directly employ staff. Staff are formally employed by the funding partners who retain the liability for pension benefits payable in the future. The MIJB therefore does not present a Pensions Liability on its Balance Sheet. The MIJB has a legal responsibility to appoint a Chief Officer. More details on the arrangements are provided in the Remuneration Report. The charges from the employing partner are treated as employee costs. Where material the Chief Officer’s absence entitlement as at 31 March is accrued, for example in relation to annual leave earned but not yet taken. Charges from funding partners for other staff are treated as administration costs. Reserves The MIJB’s reserves are classified as either Usable or Unusable Reserves. The MIJB’s only Usable Reserve is the General Fund. The balance of the General Fund as at 31 March shows the extent of resources which the MIJB can use in later years to support service provision. Indemnity Insurance The MIJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board members. Grampian Health Board and Moray Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. Unlike NHS Boards, the MIJB does not have any ‘shared risk’ exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The MIJB participation in the CNORIS scheme is therefore analogous to normal insurance arrangements. Note 2 Critical Judgements and Estimation Uncertainty In applying the accounting policies, the MIJB has had to make certain judgements about complex transactions or those involving uncertainty about future events. There are no material critical judgements or estimation uncertainty. Page 91
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Moray Integration Joint Board Annual Accounts 2024/25 49 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 3 Events after the Reporting Period The unaudited accounts were issued by Deborah O’Shea, Chief Financial Officer on 19 June 2025. Events taking place after this date are not reflected in the financial statements or notes. Note 4 Expenditure and Income Analysis by Nature 2023/24 2024/25 £000 £000 95,500 Services commissioned from Moray Council 98,216 107,247 Services commissioned from Grampian Health Board 112,061 36 Auditor Fee: External Audit Work 38 202,783 Total Expenditure 210,315 (200,086) Partners Funding Contributions and Non- Specific Grant Income (209,779) 2,697 Deficit on the Provision of Services 536 Page 92
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Moray Integration Joint Board Annual Accounts 2024/25 50 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 5 Taxation and Non-Specific Grant Income 2023/24 2024/25 £000 £000 84,615 Funding Contribution from Moray Council 88,442 115,471 Funding Contribution from Grampian Health Board 121,337 200,086 Taxation and Non-specific Grant Income 209,779 The funding contribution from Grampian Health Board shown above includes £15.639m in respect of ‘set aside’ resources relating to acute hospital and other resources. These are provided by Grampian Health Board who retains responsibility for managing the costs of providing the services. The MIJB however has responsibility for the consumption of, and level of demand placed on, these resources. Note 6 Debtors 31 March 2024 31 March 2025 £000 £000 1,723 Grampian Health Board 1,187 263 Moray Council 263 1,986 Debtors 1,450 Amounts owed by the funding partners are stated on a net basis. Creditor balances relating to expenditure obligations incurred by the funding partners but not yet settled in cash terms are offset against the funds they are holding on behalf of the MIJB. Page 93
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Moray Integration Joint Board Annual Accounts 2024/25 51 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 7 Usable Reserve: General Fund The MIJB holds a balance on the General Fund for two main purposes: To earmark, or build up, funds which are to be used for specific purposes in the future, such as known or predicted future expenditure needs. This supports strategic financial management. To provide a contingency fund to cushion the impact of unexpected events or emergencies. This is regarded as a key part of the MIJB’s risk management framework. The table below shows the movements on the General Fund balance: Earmarked Reserves General Reserves PCIP & Action 15 Other Earmarked Total £000 £000 £000 £000 Balance at 1 April 2023 - 937 3,746 4,683 Transfers (out) 2023/24 - (904) (1,793) (2,697) Balance at 31 March 2024 - 33 1,953 1,986 Transfer (out) 2024/25 - (33) (503) (536) Balance at 31 March 2025 - - 1,450 1,450 Primary Care Improvement Fund (PCIP) - The purpose of this fund is to ring fence funding received from the Scottish Government as part of its Primary Care Transformation Plan; this includes Action 15 funding as part of this plan. Other earmarked reserves are noted in detail on pages 18 to 20. Page 94
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Moray Integration Joint Board Annual Accounts 2024/25 52 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 8 Agency Income and Expenditure On behalf of all IJB’s within Grampian Health Board, the MIJB acts as the lead manager for Grampian Medical Emergency Department (GMED) and Primary Care Contracts. It commissions services on behalf of the other IJBs and reclaims the costs involved. The payments that are made on behalf of the other IJBs, and the consequential reimbursement, are not included in the Comprehensive Income and Expenditure Statement (CIES) since the MIJB is not acting as principal in these transactions. The amount of expenditure and income relating to the agency arrangement is shown below: 2023/24 2024/25 £000 £000 10,615 Expenditure on Agency Services 10,680 (10,615) Reimbursement for Agency Services (10,680) - Net Agency Expenditure excluded from the CIES - Page 95
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Moray Integration Joint Board Annual Accounts 2024/25 53 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions The MIJB has related party relationships with Grampian Health Board and Moray Council. In particular the nature of the partnership means that the MIJB may influence, and be influenced by, its partners. The following transactions and balances included in the MIJB’s accounts are presented to provide additional information on the relationships. Transactions with Grampian Health Board 2023/24 2024/25 £000 £000 (115,471) Funding Contributions received from the NHS Board (121,338) 107,064 Expenditure on Services Provided by the NHS Board 111,864 183 Key Management Personnel: Non-Voting Board Members 197 (8,224) Net Transactions with Grampian Health Board (9,227) Key Management Personnel: The Chief Officer and Chief Financial Officer are non- voting Board members and are both employed by Grampian Health Board and recharged to the MIJB. Details of the remuneration of both officers are provided in the Remuneration Report. The Chief Officer is a joint appointment made by Moray Council and Grampian Health Board and is jointly accountable to the Chief Executives of both organisations, as such this post is jointly funded. The Chief Financial Officer, whilst a Board appointment, does not share this arrangement of funding. Balances with Grampian Health Board 31 March 2024 31 March 2025 £000 £000 1,723 Debtor balances: Amounts due from Grampian Health Board 1,187 1,723 Net Balance due from Grampian Health Board 1,187 Page 96
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Moray Integration Joint Board Annual Accounts 2024/25 54 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions (continued) Transactions with Moray Council 2023/24 2024/25 £000 £000 (84,615) Funding Contributions received from the Council (88,441) 95,455 Expenditure on Services Provided by the Council 98,178 81 Key Management Personnel: Non-Voting Board Members 75 10,921 Net Transactions with Moray Council 9,812 Balances with Moray Council 31 March 2024 31 March 2025 £000 £000 263 Debtor balances: Amounts due from Moray Council 263 263 Net Balance due from Moray Council 263 Page 97
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Moray Integration Joint Board Annual Accounts 2024/25 55 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 10 VAT The MIJB is not registered for VAT and as such VAT is settled or recovered by the partners. The VAT treatment of expenditure in the MIJB accounts depends on which of the partners is providing the services as each of these partners are treated differently for VAT purposes. VAT payable is included as an expense only to the extent that it is not recoverable from His Majesty’s Revenue and Customs. VAT receivable is excluded from income. Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted The Code requires the MIJB to identify any accounting standards that have been issued but have yet to be adopted and could have material impact on the accounts. This applies to the adoption of the following new or amended standards within the 2024/25 Code: IAS 21 The Effects of Changes in Foreign Exchange Rate (Lack of Exchangeability) issued in August 2023; IFRS 17 Insurance Contracts issued in May 2017; and Changes to the measurement of non-investment assets within the 2025 to 2026 Code include adaptations and interpretations of IAS16 Property, Plant and Equipment, and IAS 38 Intangible Assets. The Code requires implementation from 1 April 2025 and there is, therefore, no impact on the 2024/25 financial statements. The above amendments are not anticipated to have a material impact on the information provided in the financial statements. Page 98
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LOCAL CODE OF CORPORATE GOVERNANCE APPENDIX 2 GOVERNANCE PRINCIPLES Principle A Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Code of Conduct (Jan 2025) Codes of Conduct Codes of Conduct Financial Regulations (May 2025) Financial Regulations & Authorisation policy Standing Financial Instructions Standards Officer Appointment (April 2024) Scheme of Administration Schedule of Reserved Decisions Standing Orders (May 2022) Standing Orders Operational Scheme of Delegation Register of Interests (annually) Human Resources Policies Standing Orders Scheme of Administration (June 2018) Scheme of Delegation Human Resources Policies ( and Once for Scotland policies around Employee Conduct) Integration Scheme (Mar 2023) Register of Interests Staff Governance Committee Updated IJB Report Format (Sept 2022) Integrity Group Register of Interests Information Commissioners Officer Registration Employee Induction Process Feedback Service Duty of Candour Arrangements Computer Use Policy Staff Surveys Whistleblowing Standards Duty of Candour Arrangements Employee Induction Process Members handbook (2020) Monitoring Officer Annual Report SLT Compliance Sub Group Care for People Plan (under review 2025) Staff Engagement Programme Duty of Candour Arrangements E-Learning module on GDPR Policy for the Prevention, Detection and Investigation of Suspected Fraud, Theft or Corruption Whistleblowing policy Whistleblowing Policy Page 101
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LOCAL CODE OF CORPORATE GOVERNANCE GOVERNANCE PRINCIPLES Principle B Ensuring openness and comprehensive stakeholder engagement SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Strategic Plan (2022-2032) Community Consultation & Engagement Annual Delivery Plan (includes Financial Plan) Performance Management Framework (under review) Complaints Procedures & Responses Performance Management Framework Annual Performance Report (annually) Use of Social Media Freedom of Information Compliance Communications & Engagement Strategy (under review) Freedom of Information Compliance Feedback Service Community Consultation Locality Planning Population Health Committee Third Sector Involvement Community Asset Transfers Grampian Clinical Strategy IJB Membership – Broad Range of Stakeholders Participatory Budgeting Plans NHS Grampian Area Partnership Forum Use of Social Media Equality, Diversity and Human Rights Policy Freedom of Information Compliance Stakeholder Engagement Framework Workforce Forum Complaints Handling Policy Staff Surveys Governance Framework Community Risk Register (2021) IJB & Committee meetings held in public Unpaid Carers Strategy Moray Mental Health and Wellbeing Strategy 2016- 2026 Locality Planning Page 102
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LOCAL CODE OF CORPORATE GOVERNANCE GOVERNANCE PRINCIPLES Principle C Defining outcomes in terms of sustainable economic, social and environmental benefits SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Strategic Plan (2022-2032) Moray 2027 – a Plan for the Future Annual Delivery Plan (includes Financial Plan) Annual Performance Report (annually) Corporate Plan – currently being updated Governance Framework Performance Management Framework (under review) Community Planning Board Performance Management Framework Climate Change Duties and Responsibilities (annually) Local Outcome Improvement Plans – Updated with Partner Agencies Population Health Committee Climate Change Duties and Responsibilities (annually) Governance Framework Grampian Clinical Strategy Equalities Outcomes (April 2025) Performance Management Framework Equality & Diversity: Outcomes Best Value Report & Action Plan Improvement and Transformation Plans Page 103
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LOCAL CODE OF CORPORATE GOVERNANCE GOVERNANCE PRINCIPLES Principle D Determining the interventions necessary to optimise the achievement of intended outcomes SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Risk Management Processes Risk Management Processes Risk Management Processes Audit Planning (Internal & External) Audit Planning (Internal & External) Audit Planning (Internal & External) Performance Management Framework Performance Management Framework Performance Management Framework Budget Monitoring Processes Budget Monitoring Processes Budget Monitoring Processes Financial Planning Financial Planning – in line with Cipfa’s FM Code Principles Financial Planning MIJB Committee Structure Moray Council Committee Structure Health & Safety Committee Governance Framework Asset Management Group Annual Accountability Review Health and Safety Arrangements Guide to Scrutiny at Moray Council Asset Management Group Business Continuity Planning Workforce and ICT Strategies Ministerial Strategic Group – Self Assessment May 2019 Ministerial Strategic Group – Self Assessment – May 2021 Grampian Clinical Strategy Clinical Governance Committee Page 104
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LOCAL CODE OF CORPORATE GOVERNANCE GOVERNANCE PRINCIPLES Principle E Developing the entity’s capacity, including the capability of its leadership and the individuals within it. SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Workforce Planning and Organisational Development Workforce Planning Employee Induction Processes Workforce Forum Elected Member Induction / Development Board Member Induction MIJB Voting Member Briefings Employee Development Team Staff Partnership Representation MIJB Development Sessions Moray Management Methods Leadership Schemes Board Member Induction Employee Induction Processes Staff Governance Committee System Leadership Programme Employee Review and Development Programme ‘’ We Care’’ programme Strategic Transformation Plan 2023-25 Staff Leadership Forum NHSG 3 Year Delivery Plan 2023-26 Best Value Action Plan developed Page 105
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LOCAL CODE OF CORPORATE GOVERNANCE GOVERNANCE PRINCIPLES Principle F Managing risk and performance through robust internal control and strong public financial management. SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Financial Regulations (May 2025) Financial Regulations (update 29.6.23) Standing Financial Instructions Risk Management Strategy and Risk Reporting Risk Management Policy & Strategy Budget Monitoring & Financial Planning Governance Framework Following the Public Pound – ALEO Funding Risk Management Framework & Reporting Budget Monitoring & Financial Planning Performance Management Framework Audit Planning (Internal & External) Production of Annual Accounts Scheme of Delegation Policy for the Prevention, Detection and Investigation of Suspected Fraud, Theft or Corruption Audit Planning (Internal & External) Section 95 Officer Appointment Schedule of Reserved Decisions Business Continuity & Incident Response Plans Fraud, Theft, Bribery & Corruption Policy Operational Scheme of Delegation Performance Management Framework Participation in National Fraud Initiative Annual Report and Accounts (including annual governance statement) Clinical & Care Governance Committee Information Assurance Group Performance, Assurance, Infrastructure and Finance Committee Moray Performance Review (Chief Executive) Budget Monitoring & Financial Planning Clinical Risk Management Group Internal and External Audit Plans Audit Planning (Internal & External) Business Continuity & Incident Response Planning Integration Scheme (Mar 2023) Procurement Regulations & Training Audit, Performance and Risk Committee Business Continuity Plans – to be revisited post pandemic Risk Policy (Sept 2020) Clinical Risk Management Group Page 106
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LOCAL CODE OF CORPORATE GOVERNANCE Financial Recovery Plan Reserves Policy 2024 Internal Auditor Reappointment 2024 GOVERNANCE PRINCIPLES Principle G Implementing good practices in transparency, reporting and audit to deliver effective accountability. SOURCES OF ASSURANCE MIJB MORAY COUNCIL NHS GRAMPIAN Committee Reporting Framework Committee Reporting Framework Board sub-Committee Reporting Framework Financial Reporting – Budget Monitoring Financial Reporting – Budget Monitoring Financial Reporting – Budget Monitoring Production & Approval of Annual Budget Production & Approval of Annual Budget Production of Annual Report and Accounts Production of Annual Accounts Production of Annual Accounts Audit Planning (Internal & External) Audit Planning (Internal & External) Audit Planning (Internal & External) Assurance Framework Consultation Statutory Returns Public Sector Reform Act disclosure Governance Framework Consultation Annual Complaints Report Externally commissioned review of Commissioned services Chief Social Work Officer Annual Report Annual Duty of Candour Report Locality Plans Scottish Public Services Ombudsman – Complaints Reporting and Responses Climate Change Reporting Annual Complaints Report Annual Duty of Candour Report Page 107
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APPENDIX 3 1 NHS Grampian Board Secretariat Summerfield House 2 Eday Road Aberdeen AB15 6RE Ms Deborah O’Shea Chief Finance Officer Moray Health and Social Care Partnership Date 12 June 2025 Our Ref GB/JA Enquiries to Julie Anderson Email jule.anderson24@nhs.scot Dear Ms O’Shea, Governance Statement 2024/25 The Chief Executive is required to prepare a Governance Statement which forms part of the Accountability Report in the Integrated Joint Board’s annual report and accounts as part of the Health and Social Care partnerships. The Governance Statement requires each Chief Executive, in their capacity as Accountable Officer, to report that they have maintained sound and effective systems of internal control, performance and risk management across all of the Board’s activities. In preparing the Governance statement, the Chief Executive is required to seek assurance from a range of sources to evidence the organisation’s performance, risk management and internal control framework, including responses to actual and emerging risks. NHS Grampian is due to report its annual accounts by 27th June 2025 and a draft governance statement has been appended to aid in the preparation of the Integrated Joint Board’s draft accounts for the year ended 31st March 2025. Should you require any clarification on the above or need guidance on matters that need to be considered or reported in the formal statement please do not hesitate to contact myself at julie.anderson24@nhs.scot. Yours sincerely Julie Anderson Assistant Director of Finance Page 109
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2 Draft NHS Grampian Governance Statement 2024/2025 NHS Grampian is required to operate within the aspects of the Scottish Public Finance Manual (SPFM) which are set out within the guidance issued to Chief Executives and more generally to all Board members by the Scottish Government Health and Social Care Directorates as being applicable to NHS Boards. The SPFM is issued by Scottish Ministers to provide guidance to the Scottish Government and other relevant bodies on the proper handling and `reporting of public funds. The SPFM sets out the relevant statutory, parliamentary and administrative requirements, emphasises the need for efficiency, effectiveness and economy, and promotes good practice and high standards of propriety. As Accountable Officer, the Chief Executive is responsible for maintaining an adequate and effective system of internal control that identifies, prioritises and manages the principal risks facing the organisation, promotes achievement of the organisation’s aims and objectives and supports compliance with the organisation’s policies and safeguarding public funds. The Board continually monitors and reviews the effectiveness of the system of internal control with a specific focus on the delivery of safe and effective patient care, achievement of national and local targets and demonstrating best value and the efficient use of resources. Key elements of the system of internal control include: A Board which meets regularly to discharge its governance responsibilities, set the strategic direction for the organisation and approve decisions in line with the Scheme of Delegation. The Board comprises the Executive Directors and Non- Executive members. The Board activity is open to public scrutiny with minutes of meetings publicly available; Scheme of Delegation, Standing Orders and Standing Financial Instructions approved by the Board are subject to regular review to assess whether they are relevant and fully reflective of both best practice and mandatory requirements; Mature and organisation wide risk management arrangements built on localised risk registers and processes which ensure, as appropriate, escalation of significant instances of non-compliance with applicable laws and regulations that exceed our risk appetite; Dedicated full-time members of staff for key statutory compliance functions including Information Governance, Health and Safety, fire and asbestos, tasked with ensuring they are up to date with all relevant legislation and are responsible for co-ordinating management action in these areas; A focus on best value and commitment to ensuring that resources are used efficiently, effectively and economically taking into consideration equal opportunities and sustainable development requirements; Each key governance committee is supported by a designated lead Executive Director who has the delegated management accountability for statutory and regulatory matters; Page 110
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3 Regular review of financial performance, risk management arrangements and non- financial performance against key service measures and standards by the Performance, Assurance, Finance and Infrastructure Committee; Regular review of service quality against recognised professional clinical standards by the Clinical Governance Committee; Regular review of workforce arrangements and implementation of the NHS Scotland Staff Governance standard by the Staff Governance Committee; An active joint management and staff partnership forum (Grampian Area Partnership Forum) with staff side representation embedded in all key management teams and a dedicated full-time Employee Director who is a member of the Board; Regular review of priorities for infrastructure investment and progress against the agreed Asset Management Plan by an Asset Management Group chaired by a Board Executive Director and including management representatives from all operational sectors and representation from the clinical advisory structure; Clear allocation of responsibilities to ensure we review and develop our organisational arrangements and services in line with national standards and guidance including consultation with all stakeholders on service change proposals to inform decision making; Promotion of effective cross-sector governance arrangements through participation by the IJB Board members and the Chief Executives of each of the partner organisations in the regular meetings between the Chief Executives of all Public Sector organisations in Grampian and performance review meetings with each IJB Chief Officer to further develop and drive improvement through integrated service delivery; A patient feedback service to record and investigate complaints and policies to protect employees who raise concerns in relation to suspected wrongdoing such as clinical malpractice, fraud and health and safety breaches; and Separate governance arrangements for the NHS Grampian Charity including a Chair of the Trustees elected from within the body of the Trustees, an annual general meeting of all Trustees to agree all policy matters and an NHS Grampian Charity sub-committee with delegated authority to manage the day to day operational matters of the charity. Based on the evidence considered during the review of the effectiveness of the internal control environment NHS Grampian has confirmed that there are no known outstanding significant control weaknesses or other failures to achieve the standards set out in the guidance on governance, risk management and control. Page 111
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 19 JUNE 2025 SUBJECT: PROPOSED REVISION TO THE MORAY INTEGRATION JOINT BOARD MEETING SCHEDULE BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present the Board with a revised meeting schedule for Moray Integration Joint Board (MIJB) and its Committees, with the aim of reducing the number of meetings held on the same day, minimising member fatigue, and enhancing the strategic focus of meetings. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) approves the proposed reduction in the number of formal meetings from 18 to 15 per year as per Appendix 1; ii) notes that the number of Development Sessions will remain at a minimum of four per year; iii) agrees that the Standing Orders and Scheme of Administration be amended to reflect the revised schedule, subject to approval; and iv) notes that the revised schedule has been reviewed and agreed, in principle, by the Chairs of the MIJB and its Committees, Legal Services, and the Internal Auditor. 3. BACKGROUND 3.1 Following the Covid-19 pandemic, meetings of the MIJB, Audit, Performance and Risk Committee and Clinical and Care Governance Committee have been a hybrid model of, in person and remote attendance. The Council’s committee meeting system, Connect Remote, allows the meetings to be webcast live to members of the public, also allowing members to watch the meeting at a later date if required. There have been no requests to change this system. This hybrid system supports sustainability, reduces costs, and travel time for staff and members of the public who may need to travel to attend the meetings. Item 7. Page 113
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3.2 The 2025-26 timetable was previously approved by the Board on 28 November 2024 (para 13 of the minute refers). 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 A proposed revised schedule of Board and Committee meetings for 2025/26 including MIJB Development Sessions is attached at Appendix 1. 4.2 The current annual meeting schedule includes: • 6 MIJB meetings • 4 Clinical and Care Governance Committee meetings • 4 Audit, Performance and Risk Committee meetings • 4 MIJB Development Sessions 4.3 This results in a total of 18 meetings per year (over 10 months). Several of these meetings are scheduled on the same day, which has raised concerns around member fatigue and reduced capacity for strategic focus. 4.4 The revised schedule proposes the following: • MIJB meetings reduced from 6 to 4 per year • Clinical and Care Governance Committee meetings reduced from 4 to 3 • Audit, Performance and Risk Committee meetings reduced from 4 to 3 • MIJB Development Sessions maintained at 4 per year minimum. • One month remains open for a formal meeting or a further Development Session, with a likely focus on financial matters. 4.5 This results in a total of 15 meetings annually; a reduction of 3 meetings. 4.6 The revised schedule has been designed to: • Minimise meetings taking place on the same day • Allow more focused and strategic discussion at MIJB meetings • Maintain compliance with statutory reporting requirements, particularly in June and September. Governance Implications 4.7 To implement the revised schedule, amendments will be required to the MIJB’s Standing Orders and Scheme of Administration. These changes will reflect the updated frequency of meetings and ensure continued compliance with the governance and statutory obligations. 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” This report forms part of the governance arrangements of MIJB Strategic Plan. The proposal demonstrates a proactive approach to governance improvement, supporting transparency, efficiency and member wellbeing. (b) Policy and Legal Amendments to the MIJB’s Standing Orders and Scheme of Administration will be required to reflect the revised meeting frequency. (c) Financial implications Page 114
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There may be minor savings realised through reduced administrative and operational costs associated with fewer meetings. There may also be minor savings realised through fewer travel expenses. (d) Risk Implications and Mitigation The revised schedule maintains statutory compliance and ensures that key reporting deadlines are met. The provision for special Board meetings remains within the Standing Orders. (e) Staffing Implications Reduced meeting frequency will ease administrative and preparatory work for officers and committee support staff. The reduced frequency will also allow for improved planning for officers. (f) Property There are none arising directly from this report. (g) Equalities/Socio Economic Impact There is no negative impact identified as a result of this report. The revised schedule continues to support inclusive participation and accessibility. The hybrid facility will remain for all formal meetings. (h) Climate Change and Biodiversity Impacts Reducing attendance at meetings lowers the organisations travel related carbon emissions, particularly from car travel. As each meeting is hybrid the reduction in hybrid meetings means less reliance on energy intensive digital infrastructure, such as video conferencing services and data transmission. Together, these changes contribute to a smaller overall environmental footprint, supporting more sustainable operational practices. (i) Directions There are no Directions as a result of this report. (j) Consultations Consultations have taken place with the following: MIJB Internal Auditor Legal Services Committee Services Chief Officer Health and Social Care Moray (HSCM) Senior Management Team HSCM Operational Management Team Who are in agreement with the contents of this report. 6. CONCLUSION 6.1 The proposed revision to the meeting schedule supports improved governance by making efficient use of members’ and officers’ time, reducing the intensity of meeting days, and allowing for more focused and strategic discussions at meetings. The revised schedule maintains statutory compliance, enhances efficiency, and has been developed collaboratively with key stakeholders to ensure it meets both operational and governance needs. Page 115
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Author of Report: Sonya Duncan, Corporate Manager Isla Whyte, Corporate Support Manager Page 116
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APPENDIX 1 Moray Integration Joint Board and Committees – Revised Meeting Schedule MIJB – Moray Integration Joint Board APR – Audit, Performance and Risk Committee CCG – Clinical and Care Governance Committee Quarter 1: April – June Month Current Meetings Proposed Meetings Notes April 24 Apr – MIJB Development 24 Apr – MIJB Development No Change May 29 May – MIJB (AM) 29 May – CCG (PM) 29 May – CCG (AM) Remove MIJB June 19 Jun – APR (AM) 19 Jun – MIJB (PM) 19 Jun – APR (AM) 19 Jun – MIJB No Change Quarter 2: July – September Month Current Meetings Proposed Meetings Notes July None – Summer Recess None – Summer Recess No Change August 28 Aug – CCG (AM) 28 Aug – MIJB Development (PM) 21 Aug – MIJB Development 28 Aug – CCGC Development earlier to avoid clash September 25 Sep – APR (AM) 25 Sep – MIJB (PM) 25 Sep – APR 25 Sep – MIJB No Change Quarter 3: October – December Month Current Meetings Proposed Meetings Notes October 30 Oct – MIJB Development 30 Oct – MIJB Development No Change November 27 Nov – MIJB (AM) 27 Nov – CCGC (PM) 27 Nov – MIJB Remove Committee December None None No Change Quarter 4: January – March Month Current Meetings Proposed Meetings Notes January 29 Jan – MIJB (AM) 29 Jan – APR (PM) 29 Jan – MIJB Development Change MIJB to Development Remove Committee Option for MIJB if needed February 26 Feb – MIJB Development (AM) 26 Feb – CCGC (PM) 19 Feb – MIJB Development 26 Feb – APR 26 Feb – CCGC Add APR Move Development to earlier date March 26 Mar – MIJB (AM) 26 Mar – APR (PM) 26 Mar – MIJB Committee moved to February Page 117
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 19 JUNE 2025 SUBJECT: ANNUAL PERFORMANCE REPORT 2024/25 BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present the Board with the draft Annual Performance Report 2024/25. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) consider and note the draft Annual Performance Report 2024/25 at Appendix 1; ii) note National Indicator information will be updated in July; and iii) approve the publication of the Annual Performance Report 2024/25 by 31 July 2025, following approval of the final version by Chair and Vice Chair. 3. BACKGROUND 3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 specifies that a performance report must be produced by an Integration Authority (IA) to ensure that performance is open and accountable and sets out an assessment of performance in planning and carrying out the integration functions for which they are responsible. This is to be produced for the benefit of Partnerships and their communities. 3.2 The required content of the Annual Performance Report (APR) is set out in the Public Bodies (Joint Working) (Content of Performance Report) (Scotland) Regulations 2014. 3.3 APRs should demonstrate how the partnership has performed against the National Health and Wellbeing Outcomes, within the context of the Strategic Plan and Financial Statement. To support this, a set of Core Integration Indicators have been developed by the Scottish Government and the Board is expected to report upon performance using these and other locally specified indicators. Item 8. Page 119
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3.4 The Act places a statutory responsibility on the IA to publish an annual Performance Report for the previous reporting year, by the end of July each year. This report incorporates national indicator information, however the information relating to 2024/25 will not be published until early July. This means we are unable to produce a final report until after that date so a draft version is attached to this report. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The APR provides an opportunity to present the story of the partnership’s overall performance over the 12 month period, including progress against the nine National Health and Wellbeing Outcomes and the commitments contained within the 2022-32 Strategic Plan. 4.2 The items for focus were identified by staff and managers following a call for submissions. There is a continued effort to strengthen the links between the Strategic Plan, service delivery plans and related performance monitoring reports, to facilitate production of future APRs. This will be taken forward as part of the governance process for monitoring progress towards achieving outcomes identified in the Strategic Delivery Plan approved by the Board on 29 May 2025 (para 8 of the minute refers), that incorporates projects from the Financial Delivery Plan in relation to the review and redesign of service models in response to the significant financial pressures being experienced by Health and Social Care Moray (HSCM. 4.3 The integration of Children & Families and Justice Services into HSCM under the direction of the MIJB is not yet reflected in the Board’s Strategic Plan. Work is ongoing to ensure appropriate governance of performance reporting so that it can be included in the MIJB Annual Performance Report for future years. 4.4 The draft APR attached at Appendix 1 will be updated for national indicators 11-18 and Ministerial Strategic Group indicators in July when they are published, prior to final approval of the Annual Performance Report for publication by the Chair and Vice Chair of MIJB. 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” As defined within the Moray Integration Scheme values and meeting the strategic aims contained within the MIJB Strategic Plan; Moray Partners in Care 2022-32. Annual performance reports will be of interest to Grampian Health Board and Moray Council in monitoring the success of the integrated arrangements that they have put in place and in considering whether or not there is a need to review the Integration Scheme. (b) Policy and Legal IJBs have a legal obligation to produce an annual performance report in line with The Public Bodies (Joint Working) (Content of Performance Reports) (Scotland) Regulations 2014 and the Scottish Government Guidance: Health and Social Care Integration Partnerships: reporting Page 120
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guidance. This includes reporting on the national Core Suite of Integration Indicators provided by Public Health Scotland, using these to support reporting on how well we are progressing the nine National Health and Wellbeing Outcomes which apply to integrated health and social care. The Moray APR complies with all the requirements with the exception of a breakdown of spend per locality. Systems to facilitate a robust report on this have not yet been implemented. (c) Financial implications None directly associated with this report. (d) Risk Implications and Mitigation IJBs have a legal obligation to produce an annual performance report which meets the requirements set by Scottish Government. Should an APR not be provided there would be a failure to meet legislation and it would be difficult for the Moray IJB to confirm it undertakes its duties related to accountability and good governance. (e) Staffing Implications None directly associated with this report. (f) Property None directly associated with this report. (g) Equalities/Socio Economic Impact An Equality Impact Assessment is not required as there are no changes to policy arising from this report and therefore there will be no differential impact on people with protected characteristics. However, individual strategies will comply with the need for an Equalities Impact Assessment and is considered as part of our service planning process. (h) Climate Change and Biodiversity Impacts None directly associated with this report. (i) Directions None directly associated with this report. (j) Consultations Chief Officer; Heads of Services; Chief Financial Officer; Service Managers and Caroline O’Connor, Committee Services Officer, Moray Council, have been consulted for their areas of responsibility and comments have been incorporated into this report and Appendix. 6. CONCLUSION 6.1 HSCM’s Annual Performance Report is an opportunity to reflect on the varied activities and improvements that have been achieved over the year and consider how well the Partnership is delivering the Strategic Plan. 6.2 The draft report is presented to the Board for comment and approval to publish, subject to final approval by the Chair and Vice Chair, by 31 July 2025. Page 121
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Author of Report: Jeanette Netherwood, Corporate Programme Manager, HSCM Background Papers: Ref: Page 122
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Annual Performance Report 2024/25 APPENDIX 1 APPENDIX 1 Moray Integration Joint Board Annual Performance Report 2024/25 DRAFT Page 123
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Annual Performance Report 2024/25 2 Moray Integration Joint Board Contents 1. Foreword ............................................................................................................. 3 2. Introduction ......................................................................................................... 4 3. Our board and partnership .................................................................................. 5 4. Our Strategic Plan vision and priorities ............................................................... 7 5. Our continuing challenges ................................................................................. 12 6. Measuring our performance .............................................................................. 15 7. Our performance in 2024/25 ............................................................................. 17 8. Our progress and achievements in 2024/25 ..................................................... 22 9. Working with communities across our localities ................................................ 49 10. Financial performance and best value ............................................................... 52 11. Looking forward – priorities for 2024/25 ............................................................ 58 Appendix A: Moray area profile ................................................................................ 60 Appendix B: Core suite of national indicators ........................................................... 61 Appendix C: Local indicators .................................................................................... 71 Appendix D: IJB decisions and directions ................................................................ 73 Appendix E: Changes to Membership of Moray Integration Joint Board during 2024/25 .................................................................................................................... 75 Appendix F: Inspections of services ......................................................................... 76 Page 124
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Annual Performance Report 2024/25 3 Moray Integration Joint Board 1. Foreword On behalf of the Moray Integration Joint Board, we are pleased to present our Annual Performance Report for the financial year 2024/25. This year has been one of continued determination, transformation, and collaboration. As we navigated the complexities of a changing financial landscape and increasing demand for services, our commitment to delivering person-centred, high-quality care has remained steadfast. Throughout 2024/25, we have taken significant steps toward long-term sustainability by developing and beginning to implement our financial savings plan. These efforts have required careful prioritisation and a willingness to make difficult decisions, always guided by the principle of protecting and supporting the most vulnerable members of our communities. The report that follows offers an honest and comprehensive reflection of our performance against key national indicators, alongside real-world examples that highlight how we are adapting our services to meet the evolving needs of the people of Moray. Our focus has remained on improving outcomes, promoting independence, and ensuring that people can access the right support at the right time. None of this would be possible without the dedication of our health and social care workforce. Their professionalism, compassion, and adaptability have once again proven to be the foundation of our progress. We are equally grateful to our partners across the third and independent sectors, whose collaborative spirit and innovative approaches continue to strengthen our shared response to complex challenges. We extend our heartfelt thanks to our unpaid carers and volunteers. Their vital contributions underpin the resilience of our communities, and we recognise the invaluable role they play in supporting health and wellbeing across Moray. As ever, we remain mindful that there is more work to do. The coming year will bring further change and challenge, and we must continue to improve where we fall short, listen to and learn from feedback, and work closely with individuals, families, communities, and partners to co-design better, more sustainable services. This report reflects not just the achievements of the past year, but also the values that guide us — integrity, collaboration, and a deep sense of responsibility to the people we serve. We invite you to read this report and learn more about our journey. Together, we will continue to strive toward our vision of a Moray where everyone can start well, live well, and age well. Councillor Elaine Kirby, Chair, Moray Integration Joint Board Dennis Roberston, Vice-chair, Moray Integration Joint Board Page 125
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Annual Performance Report 2024/25 4 Moray Integration Joint Board 2. Introduction All Integration Joint Boards (IJBs) in Scotland are required to publish annual performance reports to inform the public of progress in delivering their strategic intent and against the National Outcome Indicators. This is the ninth annual report of the Moray Integration Joint Board (MIJB) which is a Statutory Public Body under the Public Bodies (Joint Working)(Scotland) Act 2014. The MIJB has a broad range of health and social care services delegated to it by NHS Grampian and Moray Council and has responsibility to undertake the strategic planning and commissioning of those services for the benefit of the population of Moray. Operationally, these services are then delivered by Health and Social Care Moray (HSCM) which is the partnership entity which brings together and delivers care across the region. This report is the MIJB’s assessment of performance in carrying out its delegated functions. This has been scrutinised against national performance (Appendix B) and Ministerial Strategic Group indicators identified by the Scottish Government to measure progress in delivering the National Health and Wellbeing Outcomes and local key performance indicators (Appendix C). It also describes the progress of services managed and delivered by Health & Social Care Moray in delivering on the vision and commitments set out in the MIJB’s Strategic Plan, Partners in Care 2022-32, which was approved in November 2022 and the delivery plan which was approved in October 2023. Also included in this report is an assessment of the board’s financial performance. Page 126
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Annual Performance Report 2024/25 5 Moray Integration Joint Board 3. Our board and partnership Our board The Public Bodies (Joint Working) (Scotland) Act 2014 established a legal framework for the integration of health and social care services in Scotland. The purpose of integrating health and social care is to improve the experience of people who use these services, and to make it easier for them to get the care and support they need. This should be at the right time and in the right setting at any point in their care journey, with a focus on community-based and preventative care. Since it was established in April 2016, the Moray Integration Joint Board (MIJB) has been responsible for a range of functions delegated to it by Moray Council and NHS Grampian. These are set out in the Scheme of Integration. There are eight voting members on the MIJB – four appointed by Moray Council and four appointed by NHS Grampian. They are supported by non-voting members made up of leading officers from the council and NHS, and representatives of the third sector, people who receive services and unpaid carers. The MIJB’s role is to set the strategic direction for community health and social care services and to deliver the priorities set out in its Strategic Plan through the local partnership of Health & Social Care Moray (HSCM). The board receives payments from Moray Council and NHS Grampian to enable delivery of local priorities for health and social care. It gives directions to the local authority and health board as to how they must carry out their business to secure delivery of the strategic plan. Our partnership Services are commissioned and delivered through the partnership of HSCM which brings together staff employed by the local authority and by the NHS. The partnership is led by the Chief Officer supported by a Senior Management Team and Operational Management Team. The Chief Officer reports to the Chief Officers of Moray Council and NHS Grampian. In addition to directly providing services, the partnership also contracts for health and social care services from a range of partner organisations in the Third and Independent sectors. Within primary care services, a range of independent contractors including GPs, dentists, optometrists, and pharmacists, are also contracted by the Health Board under national frameworks. Services delegated to the MIJB and which are managed on its behalf by HSCM include: Page 127
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Annual Performance Report 2024/25 6 Moray Integration Joint Board • Social work and social care (older people’s services, mental health services, learning disability services, physical and sensory disability services) • Primary care services including GPs and community nursing • Allied health professions including occupational therapy and physiotherapy • Community hospitals • Health improvement • Community dental, ophthalmic and pharmaceutical services • Aspects of acute services (hospitals) relating to unscheduled care • Support for unpaid carers. Children and families health services hosted within the MIJB’s Scheme of Integration include: • Health visiting • School nursing • Allied health professions. Grampian-wide services hosted by Moray on behalf of all three health and social care partnerships are: • Primary care contractors • The GMED out of hours primary care service. In 2022, Moray Council, NHS Grampian Board and the MIJB agreed to progress with delegation of Children & Families and Justice Services to the MIJB. The Moray Integration Scheme was revised to reflect these changes and was approved by Scottish Ministers on 16 March 2023. Page 128
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Annual Performance Report 2024/25 7 Moray Integration Joint Board 4. Our Strategic Plan vision and priorities A key statutory duty of the Moray Integration Joint Board (MIJB) is to develop a Strategic Plan which must be reviewed every three years. A refreshed strategic plan was approved by the Board in November 2022. The integration of Children & Families and Justice Services into Health & Social Care Moray under the direction of the MIJB is not yet reflected in the board’s Strategic Plan. Work is ongoing to ensure appropriate governance of performance reporting so that it can be included in future MIJB Annual Performance Reports. The strategic plan sets the vision and local priorities that will help improve the health and wellbeing of the people of Moray. It outlines how services will be delivered to meet the National Outcomes for Health and Wellbeing, and achieve the core aims of integration. Our Moray vision: “We come together as equal and valued partners in care to achieve the best health and wellbeing possible for everyone in Moray throughout their lives.” The plan has three strategic priorities to be delivered on. Building Resilience – supporting people to take greater responsibility for their health and wellbeing by: • focusing on prevention and tackling inequality; • nurturing and being an integral part of communities that care for each other. Home First – supporting people at home or in a homely setting as far as possible by: • working to give citizens of Moray the right care in the right place at the right time; • building communities where people are safe. Partners in Care – supporting people to make choices and take control of their care and support by: • working in partnership with all; • listening to what citizens are telling us and being transparent in our decision making and communications; • ensuring we make a positive impact beyond the services being delivered. The strategic intentions continue to focus on the triple aim of the national Health and Social Care Delivery Plan which is summarised as: • Better Care: improving the quality of care by targeting investment at improvement and delivering the best, most effective support; Page 129
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Annual Performance Report 2024/25 8 Moray Integration Joint Board • Better Health: improving health and wellbeing through support for healthier lives through early years, reducing health inequalities and focusing on prevention and self-management: • Better Value: increasing value and sustainability of care by making best use of available resources, ensuring efficient and consistent delivery, investing in effectiveness, and focusing on prevention and early intervention. The Strategic Delivery Plan was updated in May 2025 and sets out the actions that will be taken forward to deliver on the strategic priorities. Transformation and improvement priorities A revised Strategic Delivery Plan for 2025 to 2028 was approved by MIJB in May 2025. This plan incorporates the developments required to enhance our ability to meet predicted future demands for services, whilst undertaking reviews of existing models of care to ensure that the services provided are sustainable and fit for purpose. There are also projects to implement more efficient ways of working, to aid in meeting the financial challenge that is impacting on all public sector organisations. A robust governance framework will be essential to ensure that projects can be delivered within available resources and have a clear focus on outcomes. The work being progressed through the Rural Centre of Excellence led by the Digital Health Institute (DHI) on research and development projects, and local delivery of national programmes such as the Primary Care Improvement Plan (PCIP) and Discharge without Delay (DwD) are key focuses and are incorporated into the delivery plan. DwD will encompass workstreams relating to frailty, delayed discharges, and Getting it Right for Everyone (GIRFE) that are already underway. Rural Centre of Excellence Moray is leading the way in the development and testing digital solutions that could transform how health and social care services are delivered and received nationally and globally. The Rural Centre of Excellence (RCE) is a £5 million UK Government project, based in Moray and led by the Digital Health & Care Innovation Centre as part of the Moray Growth Deal. It brings together partners including Health and Social Care Moray and local citizens to find better ways to support people’s health, wellbeing and independence — especially in a rural setting like Moray — by creating digital tools and services that are easy to use and accessible to everyone, regardless of income, location or digital skills. The RCE is focused on solutions to everyday challenges identified by health and social care staff, people who receive services and families. Early developments include: Page 130
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Annual Performance Report 2024/25 9 Moray Integration Joint Board • Community Connections Moray: an easy to use online service directory to help people find local support and information. • Personal Data Store (PDS): a secure way for people to store and share their health story with services, if they choose, so they only need to tell it once. In 2024/25, five ‘Living Lab’ projects have progressed. These are practical, real-world trials where local people, staff, digital specialists and researchers work together to design and test new ideas that improve care and free up resources. • Supported Self-Management & Long-Term Conditions Management: Focused on healthy weight and diabetes, these projects have come together to create the ‘Heart of Moray’ wellness community—a new approach to healthy living supported by digital tools. • Community Occupational Therapy Lab: Developing online tools to help people find the right equipment and support more quickly, including a self- assessment tool, and options for more efficient digital referrals and assessments. • Care in Place: Testing how the Community Connections and personal data store tools can make life easier for unpaid carers, starting in Forres and Lossiemouth. • Smart Housing, Smart Communities Lab: Exploring how home sensors and digital tech can help people stay safe and well at home, and alert carers or services early if something seems wrong. Testing starts in Buckie in summer 2025. • Mental Wellbeing: Now underway, this project focused on making it easier to find mental health and wellbeing information and support through Community Connections. Primary Care Improvement Plan Implementation of the Moray Primary Care Improvement Plan, in response to the 2018 General Practitioner (GP) Contract and accompanying Memorandum of Understanding (MOU), is continuing. A key aspect of the Plan is to provide support to GPs by expanding the Multi-Disciplinary Team. Key areas of progress through 2024/25 were: • Pharmacotherapy – established; every Moray GP Practice has some access to all 3 levels; Level 1 (core), Level 2 (additional advanced) and Level 3 (additional specialist). • Vaccination transformation programme – established; all eligible vaccinations have moved from GP practices to HSCM. GP practices continue to assess patients’ eligibility for certain vaccinations. Travel vaccinations and all travel health advise has now transferred to HSCM. • Community Treatment and Care, Primary Care Occupational Therapy (Urgent Care and intervention for prevention), Mental Health & Wellbeing Practitioners Page 131
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Annual Performance Report 2024/25 10 Moray Integration Joint Board and First Contact Physiotherapy Services are all available at each Moray GP practice. In addition to the Moray Primary Care Improvement Plan, the Grampian GP Strategic Vision programme 2024-2030 brings together the three HSC partnerships and NHS Grampian to address challenges around transforming general practice into the sustainable service, which enables people in their communities to stay well through the prevention and treatment of ill health. The Vision programme focuses on a 10-point plan including a focus on modern premises, integrated IT systems, data driven decisions and a robust education and workforce development plan. A Progress review recently undertaken shows that the 5 prioritized objectives are progressing well (Data; Digital; Multi-Disciplinary Team; Models of contract; Premises). Consideration is now being given to the remaining objectives. An action plan outlining changes to the delivery of the objectives, the steps and resources needed to move forward is being progressed Discharge Without Delay (DWD) NHS Grampian and the three Health and Social Care Partnerships (Aberdeen City, Aberdeenshire and Moray) are participating in the Scottish Government programme that aims to reduce hospital length of stay and improve the overall patient journey by facilitating timely and efficient discharge from hospital, through early and effective planning for discharge and promotion of a “Home First” ethos. The 4 workstreams of this national programme are: • Planned date of discharge/integrated discharge hub – from point of admission to hospital a realistic date and plan for discharge should be set by the multi- disciplinary team to provide a focus • Frailty at the front door – involves early comprehensive geriatric assessment for identified frail older people as early as possible to ensure informed discharge planning. • Discharge to assess (D2A)/Homefirst – provision of responsive community- based home care support that enables patients to return home without unnecessary delays. • Community hospital/step down rehabilitation units – to care for frail individuals who require rehabilitation and extended assessments as part of their discharge process, ensuring no delays. The benefits will be reduced length of stay in hospital, improved patient experience, improved hospital capacity and provision of appropriate care in a person’s preferred setting. 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 develop action plans for planned work which will be fed back to all groups. Page 132
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Annual Performance Report 2024/25 11 Moray Integration Joint Board This is a collaborative approach in Moray and local leads for each of the workstreams will work together with teams from DGH and HSC Morayto achieve the goals set and it will build on the work already undertaken for the Frailty Pathway. Moray’s DWD self-assessment has been submitted and has been added into a single submission to Scottish Government from NHSG and will inform next steps. Frailty Pathway The 'Focus on Frailty' collaborative, facilitated by Health Improvement Scotland took place between May 2023 and Nov 2024. Moray was one of six Health and Social Care Partnerships who participated within the national collaborative. A combination of national events and webinars took place which led to Moray designing a local frailty plan covering community and primary care through to acute services. A Moray Frailty Strategic Group was put in place to oversee the delivery, monitoring and evaluation of the local plan. The Moray group worked closely with Grampian colleagues and developed a Grampian Frailty Board to align planning across the three health and social care partnerships. Much of the national collaborative work has now been subsumed into the national Discharge Without Delay work. The Moray and Grampian Frailty groups continue to meet periodically to continue to develop on the good work that took place during the national collaborative. Areas of progress during 2024/25 include: • MEOC and Rockwood combined document used in a variety of community settings such as vaccination clinics, health centres and community hubs. Several other teams have now implemented this across Scotland. Promoting a positive approach to aging well. • Identification of severe frail patients in two primary care settings; Culbin Medical Practice and Maryhill Medical Practice. • Primary Care Occupational Therapy – EQ5D & Falls/Frailty programme 69% improvement. Integration of Tai Chi into treatment programmes for patients who are starting to become frail. • Polypharmacy reviews by clinical pharmacist led to reduction in prescribed medications, resulting in reduced risks of falls, • A dedicated frailty ward is now in place at Dr Gray’s Hospital; Ward 7. • Education and awareness sessions in Dr Gray’s Hospital ward areas and Emergency Department led by front line staff. • Physiotherapist now full time permanent in the Emergency Department – increased assessment of frailty, turn around and admission avoidance. • Increased use of data from Health Intelligence to display at department level. • Application of “Super 6” to these patients. • Document created and shared with the public regarding services available to them in Moray – very well received and positive feedback gained. This Page 133
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Annual Performance Report 2024/25 12 Moray Integration Joint Board is now also available in the Emergency Department and shared with patients identified as frail regardless of where they sit on the frailty scale. • The licensing of an NHS Grampian version of the ‘The Broons’ frailty comic strip first developed by NHS Highland. • The introduction of a Frailty Icon has progressed but has not been completed as yet. • Bench marking of the Frailty Standard which were published in November 2024 A quality improvement approach has been taken to this work, with successful tests of change then being scaled up. Early evidence indicates a reduction in people being admitted to hospital, a reduction in the length of time people are in hospital and a reduction in readmissions. Getting It Right for Everyone (GIRFE) Health & Social Care Moray became a partner within the national Getting it Right for Everyone (GIRFE) programme in October 2023. GIRFE is a multi-agency approach for health and social care services from young adulthood to end of life care. It builds on the previous Scottish Government policy Getting it Right for Every Child (GIRFEC). 10 partnerships were involved in work to co-design and test the principles which will support the national approach to GIRFE and the development of a toolkit to support staff to roll out and embed the approach. This work concluded in early 2025 and has been recently published. A Moray GIRFE Strategic Group has been formed and will continue to oversee the embedding of GIRFE within Moray. Key achievements in 2024/25 include: • Agreement that all newly commissioned services will require to demonstrate how they will adhere to the GIRFE principles • Ensuring GIRFE principles are embed in all new and updated polices and strategic plans • Promotion of GIRFE to health and social care practitioners and members of the public • Benchmarking of locality practice and performance against the GIRFE principles • Alignment of GIRFE plans across Grampian 5. Our continuing challenges Like all our community planning partners, we are ambitious for Moray. Already a great place to live, work, grow and enjoy life in wonderful surroundings, we recognise the importance of continued collaborative working with public sector bodies, third and independent sector organisations, other key groups and agencies, to tackle inequalities across Moray and improve the lives of residents and the services they receive. Page 134
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Annual Performance Report 2024/25 13 Moray Integration Joint Board Our progress in improving health and wellbeing outcomes continues to be challenged in many areas. Year on year, we have reported on the same issues of an ageing population, inequalities in health, workforce shortages, growing pressures on primary care and acute hospitals, and increasing reliance on unpaid carers. The cost of living crisis continues to impact on the health and wellbeing of children, families and more vulnerable people. We are challenged to balance providing statutory services to meet people’s assessed needs, offer choice and control in how their support needs are met and to keep them safe in times of crisis, with also supporting them to manage their own health and wellbeing and increase their independence to reduce their reliance on formal support services. One of our greatest challenges remains our funding position. The MIJB is delegated funding by both NHS Grampian and Moray Council to deliver the services for which it has responsibility. There are increasing pressures on the budgets of both partners, with NHS Grampian under increased level of financial scrutiny. The increasing costs of delivery of health and care (e.g. wage growth, national increases, costs of medicines etc) mean that budgets continue to be under significant pressure. The Financial Delivery Plan was implemented in 2024/25 where actions to achieve savings and reductions in overspends were identified to ensure that the Board can operate within its financial resources. Added to this, we continue to see growing demand for services as the population grows and as more people live with and experience ill health, frailty or other health and social care needs. The 2024/25 Annual Accounts, subject to audit, show an overspend on the provision of services of £4.26m for the year ending 31 March 2025. Our financial performance is detailed in section 10 of this report. It is recognised by the MIJB that there will be difficult decisions on how to allocate resources to meet the need to streamline pathways or transform the way supports and services are provided to make them sustainable and fit to meet future challenges. Our key challenges identified in our Joint Strategic Needs Assessment include: Population projections. 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. Across all the over 65 age groups, the percentage growth in both males and females is expected to be higher in Moray than Scotland. There is the potential for increased demand for health and social care services with a limited workforce. Inequalities Page 135
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Annual Performance Report 2024/25 14 Moray Integration Joint Board Although life expectancy is comparatively higher than the Scottish average, 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. Demand Some services have struggled to manage increase in demand due to a multitude of factors such as the impact of the pandemic on health and wellbeing, staff fatigue, and workforce challenges. Workforce We have an aging workforce with a sizable proportion of staff potentially nearing retirement as well as ongoing issues around recruitment and retention. Mental health Data from General Practices in Moray shows depression is the second most prevalent long-term condition recorded (4,005 patients) after hypertension. The prevalence of depression risen between 2017/18 and 2022/23. The rate per 1,000 population in Moray has increased from 42.5 to 53.7. 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. Behavioural risk factors The three leading groups of causes of ill-health and early death in Moray are cancers, cardiovascular diseases and neurological disorders. These groups of causes account for 50% of the total burden of health loss. The largest differences in burden - compared to Scotland - occur due to substance use disorders, digestive diseases and cancers. A large proportion of cancer and cardiovascular disease is preventable. Overweight, obesity and poor diet impact on health and wellbeing in a major way, affecting 67% of people in Scotland. Obesity is now the leading cause of death in Scotland and is linked to 23% of all deaths. Smoking is the single biggest avoidable risk factor for cancer and remains a leading cause of preventable disease and premature death. Alcohol is also recognised as a contributory factor in many other diseases including cancer, stroke and heart disease. Armed Forces veterans Veterans and service personnel have higher rates of certain health conditions, giving rise to greater need for services than in the general population. These conditions include mental health problems (e.g. PTSD, suicide, substance misuse); severe and enduring physical health conditions (e.g. multiple, complex injuries; ongoing support Page 136
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Annual Performance Report 2024/25 15 Moray Integration Joint Board through the national trauma network); impaired mobility and musculoskeletal disorders; chronic pain. The Moray area profile is included at Appendix A. 6. Measuring our performance Performance management arrangements established within the partnership facilitate overview and scrutiny of performance in relation to delivery of our Strategic Plan and against a range of local and national key performance indicators. Quarterly performance reports are produced for HSCM management to review performance and to determine actions required to address areas for concern or to highlight areas showing improvement. This information is further scrutinised by the Senior Management Team and then reported to the MIJB’s Audit, Performance and Risk Committee on a quarterly basis. National context The Scottish Government measures the performance of all health and social care partnerships against a set of high-level statements of what we should be aiming to achieve through integration and ultimately through the pursuit of quality improvement across health and social care. The National Health and Wellbeing Outcomes provide a strategic framework for the planning and delivery of health and social care services and they focus on the experiences and quality of services for people receiving these services, carers and their families. We have used this framework as the basis for our performance report. National Health and Wellbeing Outcomes 1 Icon Health & wellbeing People are able to look after and improve their own health and wellbeing and live in good health for longer. 2 Icon Living in the community 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. 3 Icon Positive experiences People who use health and social care services have positive experiences of those services, and have their dignity respected. 4 Icon Quality of life Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services. 5 Icon Health inequalities Page 137
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Annual Performance Report 2024/25 16 Moray Integration Joint Board Health and social care services contribute to reducing health inequalities. 6 Icon Support for carers 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 well- being. 7 Icon Safe from harm People using health and social care services are safe from harm. 8 Icon Workforce 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. 9 Icon Use of resources Resources are used effectively and efficiently in the provision of health and social care. Our 2024/25 performance report looks at each of the Health & Wellbeing Outcomes alongside national indicators. National Indicators (to be updated in July when figures are published) The Core National Indicators (Appendix B) have been developed from national data sources to enable comparisons between Integration Authority areas and with Scotland. Each indicator acts as a measure of progress against at least one outcome. There are 23 indicators in total with four (10, 21,22 and 23) still to be defined. Indicators 1-9 are taken from the Health and Care Experience (HACE) Survey which is carried out nationally every two years. They were provided in 2023/24 therefore they are not due to be updated until 2025/26, so will remain the same as reported last year. Page 138
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Annual Performance Report 2024/25 17 Moray Integration Joint Board 7. Our performance in 2024/25 Moray Core Suite of National Integration Indicators (to be updated in July when stats are published) Health & Social Care Moray was in the top 50% for eight of the 19 reported indicators for this reporting period. This was a decrease from the previous reporting period where 11 were in the top 50%. Areas of particular strength were in relation to lower premature mortality rate, emergency admissions, emergency bed days, readmissions within 28 days and falls. There has been a significant reduction in the premature mortality rate (NI-11) and emergency admission rate (NI-12) (per 100,000 population) in comparison to the Scottish rate, with reductions of 25% and 29% respectively. Overall, we performed the same or better than Scotland for 12 of the 19 national indicators, with seven performing worse than Scotland. This is the same as the previous reporting period. In the 2023/24 report we highlighted areas where there were reductions in performance such as the percentage of adults supported at home who agree that they are supported to live as independently as possible (NI-2) reduced by 7% and the percentage of adults supported at home who agree they had a say in how their help, care or support was provided (NI-3) which reduced by 10%. Although the difference between years cannot be directly compared due to the changes in wording of the survey, and we were in line with Scotland, it was concerning that these indicators seemed to have declined. In addition, the fact that unpaid carers did not feel adequately supported is very concerning. These indicators are only collated every two years so there is no update this year, however there is a focussed effort to improve choice and control for people in how their support is provided through increasing knowledge of and use of conversations based on the principles of self-direct support (SDS), increasing knowledge of and access to opportunities in the communities and through progression of the plan for development of supports for the unpaid carers, described in the following pages. The detail of each of the indicators is included in Appendix B. Page 139
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Annual Performance Report 2024/25 18 Moray Integration Joint Board Summary of our performance at a glance - National Indicators (HACE ones (1-9) will remain the same as the survey is only conducted every second year) GREEN Our performance has improved compared to last year. AMBER Our performance is similar to last year. RED Our performance has got worse compared to last year. Please note that National Indicators 1-9 are based on the HACE survey which is undertaken every two years. 2024/25 figures remain the same as reported in 2023/24 Annual Performance Report. Results for 2, 3, 4, 5,7 and 9 are not comparable to previous years due to changes in survey wording. Outcome indicators National Indicator Scotland Our result Our progress 1 Percentage of adults able to look after their health very well or quite well 91% 92% 2 Percentage of adults supported at home who agree that they are supported to live as independently as possible 72% 72% 3 Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided. 60% 59% 4 Percentage of adults supported at home who agree that their health and care services seemed to be well co-ordinated 61% 66% 5 Percentage of adults receiving any care or support who rate it as excellent or good 70% 69% 6 Percentage of people with positive experience of the care provided by their GP practice 68% 69% 7 Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life. 70% 69% 8 Percentage of carers who feel supported to continue in their caring role 31% 28% 9 Percentage of adults supported at home who agree they felt safe 73% 70% Page 140
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Annual Performance Report 2024/25 19 Moray Integration Joint Board National Indicator(will be updated in July) Scotland Our result Our progress Data indicators 11 Premature mortality rate (rate for 2023 not yet available) 442 (for 2022) 330 (for 2022) 12 Emergency admission rate 11707 8338 13 Emergency bed day rate 112883 87123 14 Readmission to hospital within 28 days 104 77 15 Proportion of last 6 months of life spent at home or in a community setting 89% 91% 16 Falls rate 23 17.7 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections 77 81.1% 18 Percentage of adults with intensive care needs receiving care at home 65% 61% 19 Number of days people spend in hospital when they are ready to be discharged 902 980 20 Percentage of health and care resource spent on hospital stays where the patient was admitted in an emergency Not yet available Not yet available Moray Local Indicators Performance in on target or within agreed tolerance in five of the 11 indicators. The following is an assessment of performance in the areas not meeting target. The rate for attendance at the Emergency Department (ED) (Accident and Emergency) is only slightly over target in March 2025. The number of people waiting to be discharged from hospital at census date (DD-01) fluctuated through the year but ended with a high figure of 40. The number of bed days occupied (DD-02) fluctuated through the year but was 1149 at Quarter 4 which was a reduction in comparison to the same period in the previous year. The contracted partner struggled throughout this year to accept new people for care packages, but through working collaboratively with partner changes to funding arrangements have been implemented recently resulting in recruitment of more staff leading to an increase in hours available for new people requiring care, which will contribute to reducing delays in discharges. Page 141
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Annual Performance Report 2024/25 20 Moray Integration Joint Board Readmissions to hospital at 7 days of discharge has fluctuated through the year and is just over target. It is anticipated that the continuation of the focussed work around frailty at both the national and Moray levels will provide a reduction in presentation to Hospital, within the frailty age groups. The percentage of patients starting psychological therapy within 18 weeks is not achieving target. Some people remain in treatment for extended periods due to the complexity of their illness and there are increased people requiring mental health support that means that demand continues to outstrip resource with ongoing uncertainty in relation to primary care funding for psychological therapies delivery. Group sessions are held, where appropriate, and further development should ensure a greater throughput of people and ongoing job planning with professional leads ensures that capacity is maximised across services. Moray is continuing to progress well with the implementation of the Medication Assisted Treatment Standards (MATS) and early feedback indicates Moray continues to meet the benchmarks set. NHS employed staff sickness absences have reduced significantly to 4.9%, the lowest figure since April 2023. Council employed staff sickness has increased to 8.2%. The NHS figures is getting closer to the target of 4% but Council figures remain well above target. Staff absences continue to be at a high level with mental health and muscular-skeletal injuries being the most common reasons. Mitigations to be added Page 142
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Annual Performance Report 2024/25 21 Moray Integration Joint Board The detail of each of the Local Indicators is included in Appendix C. Summary of our performance at a glance – Local Indicators GREEN Moray is performing better than target. AMBER Moray is performing worse than target but within agreed tolerance. RED Moray is performing worse than target by more than agreed tolerance. Indicator 2024/25 (Q4) Target Progress against target A&E attendance rate per 1000 population all ages 22.0 21.9 Number of Delayed Discharges (including code 9) at census point 40 26 Number of bed days occupied by delayed discharges (incl. code 9) at census point 1149 850 Rate of emergency occupied bed days for over 65s per 1000 population 2681 2320 Emergency admission rate per 1000 population for over 65’s 187 177 Number of people over 65 years admitted as an emergency in the previous 12 months per 1000 population 131 121 % Emergency readmissions to hospital within 7 days of discharge 3.7% 3.9% % Emergency readmissions to hospital within 28 days of discharge 7.9% 8.4% % of patients commencing Psychological Therapy Treatment within 18 weeks of referral 65% 90% NHS Sickness Absence (%of hours lost) 4.9% 4% Council Sickness Absence (% of calendar days lost) 8.2% 4% Page 143
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Annual Performance Report 2024/25 22 Moray Integration Joint Board 8. Our progress and achievements in 2024/25 Outcome 1: Health & wellbeing People are able to look after and improve their own health and wellbeing and live in good health for longer. National Indicators used to measure this outcome Indicator Title 2022 2023/24 2024/25 NI - 1 Percentage of adults able to look after their health very well or quite well 92.2% NI - 11 Premature mortality rate per 100,000 persons 330 NI - 12 Emergency admission rate (per 100,000 population) 8,338 Comment to be added –and updated when figures received Community Appointment Day The aim of a Community Appointment Day (CAD) is to create the right environment to enable clinicians to support people with their condition on the day and beyond, learn about available local community services, embed personalised care and focus on prevention. With the intention of addressing increasing waiting lists by trialling a new model of care, NHS Grampian delivered their first CAD in Moray for MSK Physiotherapy and Podiatry patients. This was a new way of working, moving away from treatment led health and delivering services differently by strengthening local partnerships, particularly with communities, to enhance both patient and practitioner experience. There were 210 patients on the waiting list who were all invited, 162 opted to attend and 120 actually attended on the day. Patients were linked their own online Personal Health Passport, which they completed as they moved around the zones. Patients received a one-to-one consultation with the appropriate clinician and were encouraged to have meaningful conversations about what matters most to them. The CAD followed Realistic medicine principles, focusing on personalised and values-based care. The voice of lived experience was heard throughout the planning process by involving the local Versus Arthritis Chronic Pain Group who offered valuable feedback and guidance. 19 community groups and partner services were in attendance to provide information about the support available within the local community. Bringing health and community organisations together under one roof, allowed people’s health and wellbeing to be viewed in full totality Preliminary Feedback was largely positive, indicating that patients felt the day had been ‘enlightening’, benefited greatly from having services available in one place and found out about what is available in communities. Page 144
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Annual Performance Report 2024/25 23 Moray Integration Joint Board High level analysis showed that patients particularly valued the focused time given to them, being listened to what matters to them, having access to a one-stop-shop, patient centred care and feeling informed. Included in the patient evaluation was the Collaborate tool; 78% reported that every effort was made to help them understand their health issue, 74% reported that every effort was made to include what mattered to them in choosing what they do next, 79% reported that every effort was made to listen to things that mattered to them most about their health issues. Overall, patients rated the experience 4.5 out of 5. 60% of patients were either recommended a Patient Initiated Reviews within 6 months or fully discharged from the service. Additionally, waiting lists dropped by 124 over a four-month period following CAD implementation, indicating a tangible impact on service demand. Follow up interviews are ongoing in partnership with Health Intelligence colleagues, and a final evaluation report is expected June 25. The MSK CAD recently featured as a good practice example in the Scottish Government’s Realistic Medicine Casebook Heart of Moray The majority of people in Moray are living with excess weight and a problem of this scale needs a whole system approach which focuses on: • Children, to give them the best start in life - they eat well and have a healthy weight • The food environment so it supports healthier choices • Ensure people have access to effective weight management services that meets their needs • Leaders across all sectors promote healthy weight and diet • Diet-related health inequalities are reduced During 2024/25 the Dietetic team worked collaboratively with NHS Grampian, Moray Leisure Centre and the Rural Centre of Excellence/ Digital Health and Care Innovation Centre (DHI) to develop a whole system approach to addressing obesity. HSCM received some Scottish Government funding to enable better detection, early intervention and management of overweight and obesity. The Heart of Moray launched in February 2025 and will build on pan Grampian weight management work which has significantly increased weight management provision in Moray through a range a interventions which span from Community Connections/Heart of Moray (Heart of Moray – Improving health and wellbeing together), Counterweight Core and exercise at Moray Leisure Centre, digital weight management services with Second Nature and a new NHS Grampian Specialist Weight Management Service. Public health teams will also be involved to deliver the whole systems approach to obesity across all localities in Moray. Page 145
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Annual Performance Report 2024/25 24 Moray Integration Joint Board Heart of Moray – Improving health and wellbeing together The Heart of Moray makes it easier to improve our health and wellbeing. It’s now at Moray Leisure Centre, a community place with friendly staff, social spaces and ways to be more active, learn about food and lifestyle and be supported for healthy weight management. heartof.co.uk Making Every Opportunity Count (MeOC) Using the making every opportunity count (MeOC) approach to have light touch early intervention and prevention conversations with people on lifestyle and life circumstances is a key focus to help people manage their own health and wellbeing. This year saw the launch of updated booklet and accompanying digital resource (webpage) for contact information for a variety of support services. Over 185 people have been trained and 812 conversations were recorded during 2024/25, with people accessing the supports they identified that met their needs. Ageing Well - Supporting older people to maintain their independence The Realistic Medicine Wellbeing Coordinators adapted existing resources to create a tool with a focus on older people’s health concerns. It support individuals to check in on their health and be more aware of available support services. The MeOC self-check tool links with the Realistic Medicine approach, which supports people using healthcare services to feel empowered to discuss their treatment, test or procedure fully with healthcare professionals. The aim of this discussion is to ensure people are aware that suggested treatment might come with side effects – or even negative outcomes - and also to reduce harm, waste and unwarranted variation. Community Justice Groups The Community justice social work team support the Ladies’ group RISE (Recovery Inclusion Support & Energy) and the Men’s group: SWITCH (Skills Wellbeing Inclusion Thrive Connection Hope) to meet weekly to progress a health & wellbeing programme that compliments the ongoing support provided by the social work team. The programme offers a holistic approach to health and wellbeing, introducing new experiences and instilling confidence, motivation and encouraging access to services. Those who attend these groups are currently under a supervision order and attendance at the groups is voluntary and participation is growing with a steady attendance throughout the year for RISE (with 36-40 attendees), and SWITCH has seen an increase from 15 to 41 attendees. Overall, 18 health and wellbeing sessions have been facilitated through a collaboration of participants, social work team and public health co-ordinator with a range of local third sector partners to help build the programme. Feedback from participants has been very positive and a particular highlight was a fencing session. Page 146
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Annual Performance Report 2024/25 25 Moray Integration Joint Board "we all had lots of fun fencing today and making music and photography a great variety where everyone was able to get involved, total escapism". This session was very much enjoyed by all, the coach leading was enthusiastic and motivated all participants to give this a try and others who were unable to physically take part were encouraged to be part of this. Other general feedback; “good guys, very engaging, easy to talk to” “Really useful session, friendly trainer and a relaxed atmosphere let people feel ok to give it a go” "Very interesting & helpful. Enjoyed it though it felt a bit scary to start with" Leading healthy, active lives The Community Wellbeing and Development Team exists to prevent, reduce, and significantly delay the need for long-term and residential care by enabling people to maintain their independence and lead healthy, active lives. The team supports a range of community health and wellbeing groups across Moray: o 18 x B.A.L.L. Groups (Be Active Life Long Learning) These active ageing groups are designed for older people and aim to support mobility, reduce the risk of falls, and combat isolation and loneliness through regular physical activity and social engagement. o 4 x S.E.T. Groups (Seated Exercise and Tea A natural progression for some B.A.L.L. participants, S.E.T. groups offer adapted seated exercises in a welcoming setting, encouraging continued movement and community integration. o Health and Wellbeing Groups Specialist groups that support and improve physical, emotional, and mental wellbeing. Delivered in partnership with health professionals, these groups offer a follow-on option after rehabilitation sessions, helping individuals build confidence, self-manage their health, and form new community connections. The team currently supports over 1,300 older people each week through these activities, enabling them to stay active and connected in their communities. Throughout the year, the team also works with external partners such as Wild Things Environmental Education in Action to deliver inclusive “green space” activities that promote mental health and wellbeing in nature. In 2024, a key focus was engaging with the wider community to identify local service gaps. One such gap was found in Portknockie, where—after multiple engagement events—a new community-led social group, “Knockin-on Abit,” was established. Run by the community, for the community, the group is helping reduce isolation and bring people together in a rural location. Through the team's Information and Activities Booklet, people are supported to access relevant local resources that promote wellbeing and independence. Over the Page 147
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Annual Performance Report 2024/25 26 Moray Integration Joint Board past year, the Community Wellbeing and Development Team supported more than 2,500 older people to stay connected and active in their communities. <Photos and permissions to be obtained > Social prescribing Whilst social prescribing continues to be delivered in Forres and Lossiemouth locality the good progress in 2023/24 was impacted in 2024/25 by the Community Connector services experiencing reducing staffing capacity which impacted the number of referrals accepted and the data returned. The Listening Service also ceased in April 2024 but restarted in Forres in March 2025. The impact of the staff reduction meant that there was a decrease of referrals of 210 (73% from previous year) from Forres and a decrease of 334 (57%) from Moray Coast. The majority of referrals were for smoking and weigh management, followed by benefits advice, carer’s information, physical activity, mental health, Clan and local support services. The aim is to scale up and implement social prescribing across other GP practices in Moray and to explore digital possibilities to facilitate earlier intervention and prevention, whilst acknowledging limited resources. Page 148
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Annual Performance Report 2024/25 27 Moray Integration Joint Board Outcome 2: Living in the community People, including those with disabilities, long-term conditions, or who are frail, are able to live as far as reasonably practicable, independently at home, or in a homely setting, in their community. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 2 Percentage of adults supported at home who agree that they are supported to live as independently as possible 71.9% NI - 3 Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided 59.5% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 68.7% NI - 12 Emergency admission rate (per 100,000 population) 8,338 NI - 15 Proportion of last 6 months of life spent at home or in a community setting 91.1% Commentary on national PI Care at Home Service Care at Home is one of the key services which enables people to live independently in their own home for longer. As at March 2025, the planned weekly hours of care being delivered by the internal Moray Council service and CQS our external partner, were 4,672. Number of planned weekly hours (March 2024) Number of planned weekly hours (March 2025) Change in hours % Internal Care at Home 3,692 4008 +316 +8.56% Partner provider 660 664 +4 -0.61% TOTAL 4,352 4,672 -244 +7.35% A weekly care at home hub meeting is in place to manage performance and ongoing challenges faced for each locality, to keep track of care provision. Understanding risks faced by those using services and providers assists with development of strategies for improvement across the service. Performance information from these meetings is submitted weekly to the Collaborative Care Home Support Team Meeting which oversees provision of care at home and care homes by internal and external services. A Strategic review of the approach for Care at Home service was undertaken and the MIJB decided in March 2025 to develop a flexible framework approach intended to grow availability of care provision. Page 149
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Annual Performance Report 2024/25 28 Moray Integration Joint Board Self-Directed Support The Self-Directed Support (SDS) team within HSCM continue to demonstrate a strong and continued commitment to the principles of Self-Directed Support, ensuring that people in Moray are empowered to live the lives they choose through collaboration, innovation, and person-centred approaches. A key milestone has been the establishment of the SDS Standards Steering Group, created to support the consistent embedding of the National SDS Framework of Standards across local practice relating to children and young people, adults and unpaid carers. This group brings together key stakeholders to ensure that the principles of SDS are reflected in every aspect of support planning and delivery as we progress. There has been a notable increase in the uptake of SDS Option 1 (Direct Payments) enabling families to have more flexibility in managing their own support. This has been achieved through effective recruitment of Personal Assistants (PA’s) supported by the SDS team, expanding the local workforce and providing individuals with greater flexibility and control when choosing who supports them for personal care, social support and support for unpaid carers to get a break from their caring role. Currently there are approximately 450 PA’s in Moray (increased from 415 last year), supporting 284 people (compared to 301 individuals last year). There was a vacancy for a Social Worker for Unpaid Carers for most of the year which had an impact on the number of people that could be supported to receive SDS as a Carer. The SDS Enablers ensure the SDS approaches are being used to support individuals in achieving their personal outcomes through low-cost or no-cost interventions wherever possible. This strength and asset, community based, resource-conscious approach has helped individuals access support that is both meaningful and sustainable. Ongoing efforts to develop a local framework of supports are progressing well. This framework aims to ensure that everyone eligible for SDS has access to a wide range of flexible, locally available options, strengthening true choice and control in line with SDS legislation. The Framework of Support will give transparency relating to cost and service availability across Moray for those individuals who require support funded through the four options of SDS. Communities and volunteer teams In 2024–25, 107 Health and Social Care Moray volunteers, coordinated by the Communities and Volunteering Team, gave over 9,000 hours of their time to support people across Moray. The service is open to adults aged 18 and over, with the majority of referrals relating to older people at risk of isolation and loneliness, delayed discharge, or loss of independence. As demand continues to exceed capacity, the team has been reshaping volunteer roles to deliver more responsive, place-based support that promotes early intervention, prevention, and self-management. This includes two key pilot Page 150
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Annual Performance Report 2024/25 29 Moray Integration Joint Board projects: the Welcome Home Service, offering short-term support following hospital discharge, and Community Responder Teams, who provide practical help for people with no local support. These responders play a key role in supporting the Home First approach—helping to prevent unnecessary hospital admissions and enabling faster, safer discharges. To better manage referrals and increase reach, the team is developing localised cohorts of Volunteer Responders, moving away from one-to- one matching. This shift enables faster, more responsive and flexible support where it’s needed most. To help manage waiting times for the befriending service, the Moray Caller Volunteer Service was expanded to offer regular phone contact for individuals awaiting a befriender, where appropriate. This interim support ensures that those referred continue to receive meaningful connection while awaiting face-to-face visits. Meanwhile, Befriending Volunteers continue to provide in-person visits, with a strengthened focus on helping individuals move from crisis to confidence, reconnect socially, and participate more fully in their communities. <Photos and permissions can be obtained if needed> “Moving with Dignity” – Proportionate Care Using a person-centred approach, respecting an individual’s abilities and preferences, whilst minimising the need for multiple people to be involved in moving and lifting is being adopted across services in HSCM. Currently there are a number of people with mobility issues, who currently require support from two people to safely move them, and discharges from hospital can be delayed whilst awaiting availability of carers to support them at home. A first cohort of staff have been trained in using specialist equipment, aids and techniques and meet regularly to practice their skills and problem solve for individual circumstances. There is a plan to cascade training out to the wider assessment teams and community hospitals in early 2025/26. Whilst a handful of cases are underway at present it is anticipated that adoption of these principles will assist with discharges from hospital, as part of the discharge process an assessment will be undertaken and individuals will have access to hoists and other necessary equipment, which will also reduce the requirement for two carers, releasing capacity for others. The Project team are focussing on rolling out training to local care teams to meet the need of specific clients and more broadly across all care teams including other partner care agencies. Page 151
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Annual Performance Report 2024/25 30 Moray Integration Joint Board Outcome 3: Positive experiences People who use health and social care services have positive experiences of those services, and have their dignity respected. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 4 Percentage of adults supported at home who agree that their health and social care services seemed to be well co-ordinated 65.7% NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 68.7% NI - 6 Percentage of people with positive experience of care at their GP practice 68.6% NI - 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections (to be updated) 81.1% Inspections Many of our services are assessed by the Care Inspectorate to ensure that services provided meet the required standards and peoples outcomes are being met. Appendix F provides details of all the inspections during 2024/25. Learning from complaints and feedback We place huge importance on using the comments and feedback we receive to continuously improve the quality and safety of services. As well as the feedback received directly by services and gathered via surveys conducted as part of monitoring the quality of services and service redesign, another source of information and learning is obtained from complaints received. A total of 138 complaints were received by Health and Social Care Moray in 2024/25. We record all complaints received onto either the DATIX system for health related services or LAGAN for social work and social care related services. It should be noted the figures reported for 2023/24 onwards include Children & Families and Justice Social Work Services, as these services were delegated to the Moray Integration Joint Board on 16 March 2023. This accounts for the increase in complaints recorded on Lagan from 2023/24 onwards. The number of complaints recorded in DATIX include the Out of Hours Primary Care Service (known as GMED) for the whole of Grampian, not just Moray. This is because the Moray Integration Joint Board host this service for the whole Grampian. The GMED service cares for patients who have urgent care needs and cannot wait until their GP Practice is open. GMED operates 18:00 until 08:00 each weekday, all weekends and each public holiday including the festive period. The services has on average 90,000 contacts annually (1/6 of the Grampian population). Page 152
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Annual Performance Report 2024/25 31 Moray Integration Joint Board In 2024/25, 23% (27) complaints were upheld fully, with the remainder being partially or not upheld. Aspects of services leading to complaints were around processes not being clear or not being followed appropriately by staff, communication issues relating to messages or guidance not being sufficiently clear for people and the right people not having been informed at the right time. HSCM governance structures allow ongoing review of complaints and incidents to identify areas for improvement and learning opportunities, to drive positive change. It is positive to note that complaints regarding provision of care are small in number and that very positive feedback is regularly received from people receiving support from services When a complaint is straightforward and does not require investigation, we aim to respond within 5 working days (often called frontline or early resolution complaints) but when an investigation is required, we aim to respond to complaints within the target of 20 working days. Performance during 2024/25 did not always achieve these targets. An average of 25 working days for frontline complaints and 51 working days 0 20 40 60 80 100 120 140 160 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 2024/25 Complaints Received by Year Datix Lagan Combined Year Number recorded in DATIX Number recorded in LAGAN Total complaints 2019/20 62 25 87 2020/21 33 32 65 2021/22 68 24 92 2022/23 78 30 108 2023/24 67 80 147 2024/25 71 67 138 Page 153
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Annual Performance Report 2024/25 32 Moray Integration Joint Board for investigative complaints for social work and social care services were recorded. For health related services there was an average of 3 working days for early resolution complaints and 45 working days for investigative complaints. This is an area for improvement and processes internally have been reviewed to ensure they are as streamlined as possible. Outcome 4: Quality of life Health and social care services are centred on helping to maintain or improve the quality of life of service users. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 6 Percentage of people with positive experience of care at their GP practice 68.6% NI - 7 Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life 69.3% NI - 12 Emergency admission rate (per 100,000 population) 8,338 Narrative to be added – when figures received Day opportunities The Day Opportunities Team continues to play a vital role in enhancing quality of life for individuals and their carers. By facilitating access to social activities and meaningful engagement, the team has supported both individuals and unpaid carers in achieving greater wellbeing. These opportunities have also provided much-needed respite for carers, contributing to their ongoing sustainability and resilience. The work of the Day Opportunities SDS Enablers has received regular and positive feedback from families and individuals who have benefited from their support. This feedback reflects a high level of satisfaction and underlines the impact of enabling roles in promoting choice, independence, and tailored outcomes. Such feedback includes “so happy with the supports put in place, feel like my wishes were listened to” highlighting the value individuals place on being fully engaged in the creation of their support. Further feedback includes “in the short time I have known you I can’t believe how much you have done for us which has really benefitted my mental health and wellbeing. B loves the Bosie, the choir and hopefully she will get to the darts club and craft group shortly. All supported by you” and "I'd be lost without the support, it's fine to get out of these 4 walls. It’s nice to get a chance to go to places in Elgin, as I don't have a chance otherwise". Housing developments Our strategic vision for LD housing in Moray is clearly articulated in the strategic plan. We are committed to sustainable accommodation through continued Page 154
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Annual Performance Report 2024/25 33 Moray Integration Joint Board collaboration with partners to develop long-term supported housing for individuals with learning disabilities. Additionally, we aim to provide tenancy support to help individuals and families establish and maintain tenancies in appropriate settings, thereby reducing the risk of inappropriate placements or care breakdowns. We are also working to integrate LD housing needs into the broader housing policy, specifically the Local Housing Strategy (SHIP). Over the previous year, the Partnership, led by the LD service, has been collaborating with Moray Council Housing Dept, Grampian Housing Association, and Springfield. Together, we have been planning and building flats and bungalows specifically for people with Learning Disabilities. Excitingly, the bungalows are due for occupation in July 2025. Outcome 5: Health inequalities Health and social care services contribute to reducing health inequalities. National Indicators used to measure this outcome Indicator Title 2022 2023/24 2024/25 NI - 11 Premature mortality rate per 100,000 persons 330 NI - 12 Emergency admission rate (per 100,000 population) 8338 Narrative for indicator to be provided once update in The Joint Strategic Needs Assessment, which helps us understand the current and future health and wellbeing needs of the local population and identify future priorities, was completed and approved in September 2024. Throughout 2024/25, HSCM continued to prioritise actions to address health inequalities and improve equity of access to care for all population groups, in alignment with the Public Sector Equality Duty and our Strategic Plan. Our Healthpoint service expanded its outreach activity, delivering 2,363 individual contacts across Moray through community-based campaigns and pop-up events. Key campaigns included Nutrition and Hydration Week, which engaged older adults in supported housing and care settings, and Ageing Well presentations delivered to 10 community groups with 237 attendees. These initiatives not only promoted physical wellbeing but also tackled social isolation which is a key determinant of poor health. Smoking cessation services reached increasing numbers of individuals. • 104 smoking quit attempts were recorded in 2024/25, with 24 successful 12- week quits. Page 155
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Annual Performance Report 2024/25 34 Moray Integration Joint Board The Walk Moray programme continued to improve physical activity and reduce isolation. In 2024/25, 19 health walks, including evening and dementia-friendly walks, attracted 122 new walkers and maintained an average of 100 participants per week thanks to the support of 101 volunteer walk leaders. Feedback highlighted improvements in confidence, mobility, and social connectedness. A multiagency assessment tool that identifies neglect and promotes early intervention to improve outcomes for families has been implemented. The Health Visiting and Family Nurse Partnership (FNP) teams are referring families to the council’s income maximisation team to ensure they are accessing the financial support they are entitled to. Through current Scottish Government funding, a local plan is in place to increase the qualified school nursing staffing establishment. The school nursing role focuses on prevention, early intervention, and support for the most vulnerable children over five years old. The School Nurse Pathway in Moray includes specific measures to identify and support young carers. Nurses respond to referrals, contribute to the child's chronology, and carry out wellbeing assessments using the GIRFEC National Practice Model. They coordinate health-related aspects of the child’s plan, alert relevant professionals, and link families to appropriate children’s and adult services. Making Every Opportunity Count (MeOC) is a health promotion approach that encourages colleagues to leverage everyday interactions to support individuals in making positive changes to their physical and mental health. In 2024/25, 185 new starts with the Care at Home Service received MeOC training as part of their induction. We extended our support to unpaid carers through development of Adult Carer Support Plans and embedded young carers into the School Nurse Pathway. Funding mechanisms such as the Health Improvement Fund and Third Sector Winter Support Fund provided nearly £25,000 in 2024/25 to community-led projects focused on healthy eating, financial inclusion, and local wellbeing initiatives. Service users with lived experience played a central role in shaping mental health service improvement. The Making Recovery Real partnership and collaboration with Moray Wellbeing Hub led to peer integration in mental health wards and influenced contract awards. Through participation in the National Frailty Collaborative, HSCM co-developed a Frailty Action Plan to promote early identification and prevention, and support people to age well in their communities. Over the past year, we have made significant strides in the delivery and development of the Learning Disability Annual Health Checks programme across Moray. Following the resounding success of an initial small-scale trial in Aberlour, of one nurse a day a week over six weeks, a proposal was taken forward to fund a community-based model by recruiting a nurse within the Learning Disability Team. This nurse is now Page 156
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Annual Performance Report 2024/25 35 Moray Integration Joint Board rolling out the Health Check to everyone with a diagnosed Learning Disability, ensuring that all are offered a check. Looking forward The 2025-2029 Equality Outcomes have now been set by the Board. 1. Provide accessible services that support people to remain safe in their own homes through person-centred care and digital transformation. 2. 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. 3. Support people with learning disabilities and their families in maintaining their health and wellbeing and establishing tenancies in new supported accommodation. 4. Continue to embed LD Annual Health Checks with a focus on early detection of health issues, improved health outcomes, enhanced access to healthcare, personalised health action plans, and reducing health inequalities for individuals aged 16+ with learning disabilities. 5. 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. 6. 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. 7. 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. 8. 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 157
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Annual Performance Report 2024/25 36 Moray Integration Joint Board Outcome 6: Carers are supported 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. National Indicators used to measure this outcome Indicator Title 2023/24 2024/25 NI - 8 Percentage of carers who feel supported to continue in their caring role 28.2% NI - 18 Percentage of adults with intensive care needs receiving care at home 60.6% Narrative to be added re indicators The work that is described below is intended to improve these results, however given the increasing older people population in Moray, the level of need is likely to increase significantly, with no additional funding available to increase capacity for support, being able to provide support everywhere it is needed, will be an increasing challenge. Unpaid carers Unpaid carers can be any age, from young people to older people, with Carers UK predicting 3 in 5 of us will be a carer at some point in our lives. There are an estimated 16,200 unpaid carers in Moray. Not all unpaid carers in Moray require formal support from statutory services to assist them to meet the demand of the role, or to receive formal support for the person they care for, however, carers legislative rights are enshrined by the Carers (Scotland) Act 2016. During the 2024–2025 period, there has been steady, positive progress in the development and implementation of Moray’s Unpaid Carers Strategy. The focus has remained on enhancing awareness and recognition of unpaid carers across Moray. A key initiative is the ongoing promotion of the Moray Carer Aware campaign. This campaign aims to improve the identification and recognition of unpaid carers and includes the development of a proposed badge and ID card. Public engagement is planned to gather feedback and ensure the initiative aligns with carers' needs and preferences. A pilot project with Elgin Health Centre has introduced a carer awareness training programme. This bespoke training was aimed at increasing staff knowledge and ability to identify unpaid carers and has led to a rise in the number of carers recorded in the GP system. This programme is part of a broader unpaid carer pathway designed to enhance identification, recording, and referrals to appropriate support services. As of March 2025, there were:- Page 158
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Annual Performance Report 2024/25 37 Moray Integration Joint Board • 1188 adult carers registered with the service, of which there were 58 new adult carers referred to the service between Jan -March 25. 19 carers are receiving intensive support during this period. • 198 young carers registered with the service, of which there were 45 new young carers referred to the service between Jan-March 25. 1 young carer is receiving intensive support during this period. The Unpaid Carers Team also participated in the most recent Moray Integrated Joint Board (MIJB) development session. In collaboration with Quarriers, the commissioned carer support service, and with contributions from two young carers and an adult carer, the session provided valuable insights from lived experience and further supported awareness raising efforts. Access to day opportunities for cared-for individuals continues to be a vital form of support for unpaid carers, offering them essential breaks from their caring role. These opportunities help unpaid carers manage their mental health by giving them time to focus on their own well-being, reducing feelings of stress and isolation. The Day Opportunities team supports both the unpaid carer and the cared-for person in engaging with the community and creating space for meaningful breaks. This dual approach positively impacts the mental health and well-being of both parties. A testimonial from an unpaid carer supported by the Day Opportunities SDS Enablers in January 2025 stated: "Everything’s fine since Day ops 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 my wife is safe when I am not here.” The Day Opportunities team continues to offer weekly support through a person- centred, strengths-based approach aimed at delivering positive outcomes. Quarriers, as the commissioned carer support provider, plays a central role in promoting the mental health and well-being of unpaid carers through a wide range of tailored support services. These include: • Free professional counselling services to help unpaid carers manage stress, anxiety, and emotional strain related to their caring roles. • Sound therapy and art therapy sessions, which offer creative and holistic approaches to relaxation and mental health support. • Time to Live Short Break Awards, which allow unpaid carers to take restorative breaks tailored to their personal needs. • Respite break options, such as vouchers for activities like afternoon tea or play sessions, offering informal and enjoyable respite. • Hand massage workshops, which teach practical relaxation techniques to help carers manage day-to-day stress. • Monthly carer drop-in sessions, which provide a welcoming space for carers to connect, share experiences, and receive advice and support. Together, these services and initiatives represent positive steps toward improving the recognition, support, and well-being of unpaid carers across Moray. Page 159
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Annual Performance Report 2024/25 38 Moray Integration Joint Board Outcome 7: People are safe People who use health and social care services are safe from harm. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 9 Percentage of adults supported at home who agree they felt safe 70% NI - 11 Premature mortality rate per 100,000 persons 330 NI - 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 77 NI - 16 Falls rate per 1,000 population aged 65+ 17.7 Add narrative once data updated Falls Pathway To continue the focus and significance of addressing falls risks, a review of falls pathway was undertaken in collaboration with Scottish Ambulance Service. A test of change is planned to ensure multifactorial falls screening takes place at the earliest opportunity. Falls awareness and prevention groups have been held and run by the Primary Care Occupational Therapy service in sheltered housing and at The Oaks. Adult Support and Protection In 2024 a progress review by the Adult Support and Protection Joint Inspection Team was undertaken in Moray. The progress review was a follow up from our 2022 Joint Inspection where a number of improvement areas were highlighted as part of the report. Moray made significant progress in all the identified areas for improvement within the progress review. Inspectors also told us that in some areas of work, for example in the use of chronologies, we had made some of the best progress that they had seen across the country. The significant level of improvements made are testament to the hard work, dedication and expertise of frontline staff, managers and leaders across Moray Council, Police Scotland, NHS Grampian and our Voluntary Sector Partners who make up the Adult Protection Partnership in Moray and who form the governing body of Moray’s Adult Protection Committee (APC). Page 160
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Annual Performance Report 2024/25 39 Moray Integration Joint Board The Review found that Moray had made significant progress in all seven areas recommended in the 2022 joint inspection. The full report from the Care Inspectorate was published on 29th October 2024 and can be found here. Key findings included: • Consistent application and delivery of key processes. Practitioners were noted to be confident and highly professional and followed the multi- agency adult support and protection procedures meticulously • Investigations were carried out for all adults at risk who required them. Almost all Investigations were rated good or better (85%). • Adults at risk of harm had in place a Chronology. 80% of Chronologies were rated good or better, which is a significant improvement from 39% in 2022. • The Quality of Risk Assessments and Protection Plans had improvement significantly • Case Conferences were found to be carried out effectively. The right people from partner agencies prioritised attendance. Almost all Case Conferences were rated good or better for quality. • Initial Referral Discussions (IRDs) were found to be of an exemplar for the sector • The Adult Protection Committee (APC) and Chief Officers Group (COG) exercised sound and effective multi-agency governance over the delivery of improvements to adult support and protection • The partnership had a cohesive programme of multi-agency audits and quality assurance activities. These included involvement from front line practitioners. The below table evidences the significant progress Moray has made in relation to key processes comparing the findings of the 2022 Joint Inspection to the Progress Review 2024. Process 2022 Inspection 2024 Progress Review Chronology presence 27% 100% Chronology quality – good or better 39% 80% Risk Assessment presence 56% 68% Risk assessment quality – good or better 75% 100% Protection plan presence 68% 90% Protection plan quality – good or better 64% 80% Page 161
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Annual Performance Report 2024/25 40 Moray Integration Joint Board Investigation presence 48% 100% Investigation quality – good or better 52% 85% Case Conference quality – good or better 83% 91% The direction of the APC over the next two years will be based on the below main areas for development alongside activities within our Multi-Agency Improvement Plan. As a partnership, we recognise that we still have a distance to travel. However, we are proud of the journey thus far and the progress made over the last two years and know that adults at risk of harm are safer as a result of the work we undertake. The table below highlights areas of work we will focus on in the coming two years. Area for Development Where We Want To Be How Will We Get There? Involving the Adult in a Trauma Informed Way Have in place a trauma informed workforce for ASP in Moray Grampian wide programme of work for Trauma Informed ASP activity currently in progress. Chronologies All practitioners carry out good quality chronologies and discuss information within meetings alongside the Adult Suite of multi-agency training and guidance devised and carried out. Strategic Resourcing ASP in Moray to be fully resourced On going discussion at COG and APC to highlight risk. Quality Assurance Activity Have in place a clear suite of multi-agency and single agency audit activities that support in monitoring evaluating and improving ASP in Moray Audit and Quality Assurance yearly timetable devised and followed – with full participation of all partners Monitoring of commissioned services A particular strength of the Adult Social Care Commissioning team continues to be the proactive and reactive monitoring of contracts. The team have developed the monitoring process in the last financial year by including a second formal contract meeting for each provider as well as a monthly informal meetings. This ensures that relationships with providers remain strong, and they are well supported. The Page 162
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Annual Performance Report 2024/25 41 Moray Integration Joint Board commissioning team also lead a Learning Disability Provider Forum that meets 4 times a year with specific themes and guest speakers. In 2024/25 the themes were recruitment, care inspections, advocacy and staffing structures, including the Support Worker role. In 2024/25, the Commissioning Team were required to respond effectively to undertake enhanced monitoring for 5 external services and one internal service. These were required as a result of concerns raised by social work teams, from an annual site visit or a poor Inspection from the Care Inspectorate. Each of these enhanced monitoring programmes ensured a return to the required standards and resulted in delivery of services to meet outcomes for people, improved Care inspections or improved processes for the provider. Urgent health care out of hours GMED is the Grampian-wide out of hours primary care service that cares for patients who have urgent but non-life threatening health needs that cannot wait until their GP practice is open. GMED is not an emergency service, a minor injury service or a walk-in service. To access urgent care services, patients need to call 111 (NHS 24) who will triage the patient and refer to the most appropriate service, including GMED. Community pharmacies, Scottish Ambulance Service (SAS), community nursing, social work and some other services can refer patients directly to the dispatch hub via the professional-to-professional telephone line. In 2024, GMED dealt with 107,608 cases which was a 4% decrease in demand compared to the previous year (112,148). There were: • 58,634 advice calls, • 34,656 centre consultations, • 11,128 home visits and • 3,190 mental health advice calls However, if we compare the activity levels from 2020 (pre-Covid) there has been in increase in activity of 35.6% or 79,358 cases which is significant. GMED Activity Heat Map The heat map shows the demand in all locations across NHS Grampian in 2024. Elgin, Forres and Buckie are the busiest locations in Moray. . In 2024 the service had 24,329 contacts in Moray which represents 22.6% of all GMED activity, compared to 2020 (pre-COVID), when there were 19,488 contacts (24.6%) of all GMED activity. This demonstrates that even though the number of overall contacts has increased in Moray, as a percentage of GMED activity it has slightly reduced. Page 163
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Annual Performance Report 2024/25 42 Moray Integration Joint Board GMED is a successful gatekeeper for secondary care services. In 2024, we have admitted 6049 patients to the hospital, this shows a decrease of 19.5% compared to the previous year (7510) and by 31.4% pre-Covid (8822). 8822 7510 6049 0 2000 4000 6000 8000 10000 Hospital Admissions 2024 2023 2019 Page 164
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Annual Performance Report 2024/25 43 Moray Integration Joint Board Outcome 8: Engaged workforce People who work in health and social care services are supported to continuously improve the information, support, care and treatment they provide, and feel engaged with the work they do. National Indicators used to measure this outcome There are no National Indicators to measure our progress towards this outcome. Our performance is in part measured using staff surveys. Feedback from Inspections The feedback from Care Inspectorate highlights how engaged staff are in the support and care they provide, as evidenced in section 8 of this report, examples:- ASP inspection - “Robust measures were in place to identify concerns early and promptly implement remedial action. Operational managers worked diligently and effectively to bring about necessary improvements to adult support and protection”. START – “People enjoyed support which was dignified and respectful. Staff felt supported by their supervisors and colleagues”. Moray Supported Lodgings project – “Young people benefit from leading and directing their own support within a multi-agency approach to care planning” Community Support Services – “People were supported by staff who were kind and caring” Staff survey The iMatter is an annual staff survey sent to all employees across health and social care in Grampian. During 2024/25 there was 56% response rate showing an employee engagement index of 77, and overall score of 7.1 which were similar to the previous year. Responses with the lowest scores were: “I feel the board members who are responsibility for my organisation are sufficiently visible”, “I have confidence and trust in Board members who are responsible for my organisation”, “I have sufficient support to do my job well” and “I am confident performance is managed well within my organisation”. There has been more information shared via newsletters and briefings during 2024/25 so it is hoped that this will have an impact on future scores. Feedback for the current year survey is expected in June 2025 which will inform priorities for our Workforce Plan. Workforce Forum Page 165
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Annual Performance Report 2024/25 44 Moray Integration Joint Board The Workforce Forum provides an opportunity for open dialogue between workforce, partnership and health and safety representatives, and enables colleagues to discuss and raise issues and best practice. Attendance at these meetings has increased significantly which is positive as more teams are now represented and engaged. During 2024/25 several discussions have been around difficult to fill vacancies and how these are managed. Personal & Social Care was the only job family to fall below the 90% stability target, with a stability rate of 83.3%. Alongside Admin services this is an area where we would anticipate there to be greater turnover as people develop experience and skills and then seek higher grade jobs. More stringent vacancy controls have been implemented across NSHG and this has led to fewer new starts during January 2024 to January 2025 which therefore increases figures of stability as there are less workforce with less than one year service. Workforce Stability across NHS employed teams Between February 2024 and January 2025, Moray H&SCP experienced a turnover rate of 9.18%, higher than the NHSG turnover rate of 7.46% for the same period. A turnover rate of around 10% is typically expected, suggesting that lower figures indicate a stable workforce. Absence actions and Wellbeing Initiatives Absence is monitored by all teams across the partnership and is governed by the application of the attendance policies of NHS Grampian and Moray Council. Across Health and Social Care Moray, sickness absence occurs across all staff groups, however there are elevated rates in nursing and social work, and provider services in particular. This is in part due to workload, exposure to infection and travel impact on an ageing work population. The most common long term sickness are related to Mental Health or Muscular-skeletal injuries and we have a number of wellbeing initiatives to help combat and recognise stress and general physical wellbeing. Page 166
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Annual Performance Report 2024/25 45 Moray Integration Joint Board • Wellbeing features as a regular standing item at our Workforce and Health and Safety groups where two way flow of information is encouraged with peer to peer support and appropriate escalation where necessary. Moray Council has mental health first aiders which have proved a very useful resource. • Peer to peer support has been established and some teams have a wellbeing weekly get- together, known as ‘Wellbeing Friday’. Other teams such as our AHP services operate a 30 minute ‘wellbeing window’ weekly where they will actively take a break and do something physical such as walking or stretching or yoga. • Collaboration with Moray Council and NESTRAN Health & Transport Action Plan for Grampian in promoting ‘active travel’ campaigns. • Promotion of the ‘At your best with Rest’ campaign to encourage staff to take their allocated breaks to increase efficiency and reduce fatigue and burn out. Some services have dedicated break areas and set times which allow the whole team to take a break together. Other teams have established a virtual tea break which has been very successful. We are very well supported by our Wellbeing colleagues in Grampian and the ‘We Care’ resources. • Promotion of flexible and hybrid working where appropriate. • Through ‘We Care’ we have a Covid Reflection listening service available as well as Recovery in Mental Health, Relaxation workshops and stress awareness training available to all. • We have an active Menopausal awareness programme, which offers training and tea and talk sessions. Page 167
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Annual Performance Report 2024/25 46 Moray Integration Joint Board Outcome 9: Use of resources Resources are used effectively and efficiently in the provision of health and social care. National Indicators used to measure this outcome Indicator Title 2023/24 NI - 4 Percentage of adults supported at home who agree that their health and social care services seemed to be well co- ordinated 65.7% NI - 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) 77 NI - 15 Proportion of last 6 months of life spent at home or in a community setting 91.1% NI - 16 Falls rate per 1,000 population aged 65+ 17.7 NI - 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) 980 Commentary to be provided once data updated. Indicators 14-19 to be updated in July. Vaccination uptake The World Health Organisation (WHO) describes vaccines as one of the two public health interventions that have the greatest impact on the world’s health, the other being clean water. It is also considered as one of the most impactful and cost- effective public health interventions available to communities and populations across the world. Vaccination can prevent or reduce the severity of disease, minimise disability and save lives, often in many of the most disadvantaged people in society. It offers excellent value for money by reducing current and future public expenditure on health and social care provision. Uptake of seasonal flu and covid-19 vaccinations in Winter 2024/25 was similar in Grampian to elsewhere in Scotland and highest in the oldest age groups, and the Spring 2025 programme continues to perform well. Uptake shows a socioeconomic gradient with highest uptake amongst least deprived. COVID 19 Cohort % uptake 2023 % uptake 2024 Age 65 to 74 77.0% 65% Aged 75+ 83.9% 75% All social care workers 14.5% 6% At risk age 5 to 11 7.3% 7% At risk age 6 months to 4 years 13.6% 13% At risk age 12 to 64 35.8% 25.2% Page 168
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Annual Performance Report 2024/25 47 Moray Integration Joint Board Frontline health care workers 30.2% 19% Older people care home residents 87% 83% Weakened immune system 59% 38% TOTAL 60% 50% Influenza Cohort % uptake 2023 % uptake 2024 Age 50 to 64 43.1% Not offered Age 65 to 74 77.1% 70% Aged 75+ 84% 80% All health care workers 24.7% 25% All social care workers 13.1% 8% At risk age 18 to 64 44.2% 34% Older people care home residents 91% 85% Weakened immune system 63.9% 46% TOTAL 58.3% 55.6% The uptake of vaccinations amongst frontline health and social care staff continues to be lower than the partnership would like it to be, despite significant work by the Moray Immunisation Team to increase uptake. Several extra clinic dates were put on to increase numbers, with very little interest. There has been a marked decrease among most of the other cohorts too. It has been found that the lower uptake rates this year, compared to previous years, seem to be due to vaccine fatigue within the population. Improved access to medications for patients Moray Pharmacotherapy team undertook a cost efficiency project during 2024/25 that achieved £660k savings through working collaboratively with GP practices. A Specialist Pharmacy Technician (SPT) was appointed ‘Savings Champions’ in each practice cluster to motivate and guide and met with all GP practices teams/prescribers/clinicians to discuss project and effective methods re cost efficiency. A variety of methods were implemented including use of system tools to ensure most efficient prescribing, generic medications prescribed rather than branded, ensuring regular medication reviews of repeat prescriptions to ensure still relevant and regular care home polypharmacy reviews to look at stock levels held in care homes. Significant savings occurred in relation to inhaler switches, skin dermatology prescribing reviews, Diabetes blood monitoring testing aspects, dosage forms and changes in pack size and dosage reviews. Many of the changes benefited individuals through a reduction in the amount of prescriptions or the frequency of dose. Page 169
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Annual Performance Report 2024/25 48 Moray Integration Joint Board Due to the success of the project a further project is being taken forward in 2025 with GP practices but another project is underway with local Care Homes and it is anticipated savings will be in the region of £450k. Commissioning of services In the last year the commissioning team have been focusing on various workstreams that are linked with exploring and widening the provider market in Moray. Care at Home are progressing well with a test of change to give advance payment that provides greater stability for the provider enabling recruitment to meet their commitments. The result is a strengthening of the relationship and increased confidence and assurance that the hours can be provided, by staff working to the required standards. Quality of service provision has increased, with the most recent Care Inspectorate inspection reporting good and very good grades across all areas. This approach will be further progressed in 2025/2026. In June 24, the Learning Disability Service secured 13 flats and 4 bungalows in partnership with Springfield and Grampian Housing Association. The service provider was procured through a competitive tendering process with family members scoring the presentation element. This is the first time that family members have had autonomy like this in a tendering process and the feedback from them and from the presenting providers was that it was an experience that was valuable. The families also influenced the appointment of the successful provider, Community Integrated Care and this has ensured that all parties have a good understanding of expectations. The Service is due to open in August 25. The Commissioning Team worked closely with external providers to progress the Financial Delivery Plan project and efficiencies within contracts. This was undertaken by a joint review of service provision, management structures and capacity. By working in partnership with each provider and alongside Social Work colleagues, the saving achieved through contracts was £184,269 for 24/25. This will continue throughout 25/26 where significant savings are predicted to be realised. The Commissioning Team have awarded 21 contracts and undertaken nine letters of extension. The team are currently working on 19 contracts which are at various stages of the commissioning cycle. Within this, the voice of the citizens of Moray and learning from the Western Village tender will be embedded into practice so that the Health and Social Care Moray Adult Commissioning Team continue to promote and guide colleagues through Ethical Commissioning practices. Page 170
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Annual Performance Report 2024/25 49 Moray Integration Joint Board 9. Working with communities across our localities For service planning and delivery purposes, the four localities in Moray are: Forres and Lossiemouth; Elgin; Buckie, Cullen and Fochabers; Keith and Speyside Locality managers are leading on the development and delivery of locality plans to respond to local needs and reflect the priorities of communities. First drafts were published in 2022 and updated plans for 2023-2026 were approved by the MIJB in March 2023. Elgin Locality Multidisciplinary Team developments This is a continuing piece of developmental work for the Elgin locality. Following feedback form “How Good is our MDT” survey there is further work to ensure all professionals are represented at local MDT’s. Recently the Local Authority Occupational Therapy service has been attending the MDT’s with an understanding of how they can best support the MDT’s moving forward. Social Prescribing The Elgin locality if starting to focus on social prescribing and working firstly with the Maryhill Practice to trail this. It will then be extended to Linkwood practice once we have a model and services that suit the Elgin population to support social prescribing. The aim of the model is to support health and social acre professional to connect individuals to non-clinical support and community activities. The aim to support their health and wellbeing. The Health Improvement Team are supporting the development of this alongside the Locality manager. The next phase of the development will be to meet with the Practice and ascertain which are the top key areas of focus for the practice population that would benefit for the social prescribing model. Community Appointment Day (CAD)- Chronic Obstructive Pulmonary Disease (COPD) 16th April 2025 Preparations were carried out for this event following on the success of the CAD held for MSK in September 2024 with the purpose of inviting people with COPD registered with the Maryhill and Linkwood GP practices. Keith and Speyside Locality The Fleming Health Hub now has over 30 services that are able to provided appointments, classes and drop ins and that can be used by anyone across Moray who finds it easier and closer to home to access, in the Keith and Speyside Locality we have been forging working relations with other HSCM teams operating in and around the Locality and with third sector and local groups to look at what we can do in collaboration to support the health and wellbeing needs of our communities. Page 171
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Annual Performance Report 2024/25 50 Moray Integration Joint Board This has included intergenerational work where services on offer ranging from birth through to our older population . We have been around our secondary schools hosting 'Lets talk Health, Wellbeing and your Community' events and have had various educational events for staff and drop ins for the local population including Realistic Medicine and MEOC training and Dental Care guidance and demonstrations. We have a room specifically set up at the Fleming Health Hub for Moving With Dignity (proportionate care) training for our own staff and where appropriate other organisations and Care Homes, which will reduce the number of care staff required for visits to certain people. We are now also able to host annual health checks for people with Learning Difficulties and our OT teams have been able to introduce several new sessions around falls prevention. We have also been utilising space at our hospital sites in Dufftown and Keith to introduce specialist third sector services as appropriate, to encourage and make easier, access to these services. <Photos – Fleming Hospital Health Hub signage> We are also in discussions with our GP Practices and other professionals around what services they would like to see introduced to meet local identified need and we will be taking this forward in the coming year. Our online Professionals directory continues to support MDT working across the Locality and we are utilising this to share updates and information across our teams. This does not replace the many other MDT meetings that take place regularly across our GP practices and Community Hospitals but does support staff in ensuring the right people are involved and around any specific discussions at the right time and as required in support of a person, which should be at the heart of all MDT working. With Keith and Speyside being in places very rural, we have been working hard to ensure that we can raise awareness of services and support available that people can access in support of their own and their families health and wellbeing. Information areas in GP practices have been updated, HSCM teams have access to an online Health and Wellbeing directory and some teams have identified a Wellbeing Champion who is now taking the lead on ensuring their teams are able to look after their own wellbeing, this is supported by our Locality Health Improvement Coordinator. Poverty and the rising cost of living is something that impact us all and to support this we have also ensured that all GP practices are able to order and hand out free period products and condoms to patients and staff and that this is promoted. All of the above will support us encouraging and equipping people to start taking responsibility for their health and wellbeing and awareness of alternatives to medication where appropriate or in addition to medication as part of a more holistic approach. This aligns with Social Prescribing and something we will be championing more in the coming years. Page 172
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Annual Performance Report 2024/25 51 Moray Integration Joint Board Forres and Lossiemouth Locality The Forres and Lossiemouth Locality Steering Group continued to meet on a bi- monthly basis during 2024/25 to review performance data and progress in relation to their Locality Action Plan. The group continues to have public, health and social care and third sector representation. The group also has active involvement from Children Service Locality Planning and the Moray Council Community Support Team to avoid duplication and ensure alignment of various plans. Of particular note over the past year was the ongoing engagement activity that took place; this included pop up engagement clinics in health and care centres, engagement activity in local schools, and events in community settings. Events were facilitated by Health and Social Care, Children's Services, Moray Council Community Support Unit and GP staff. Work has continued to take place to strengthen MDT working and development of virtual wards to ensure the most vulnerable receive support when and where they require. Forres and Lossiemouth have supported the work of the Digital Health Design and Innovation Centre (DHI) and in particular the development of Living Lab 3 - the Personal Data Store and Community Connections Moray platform. In terms of overarching performance against the 17 indicators within the Moray Locality Dashboard, Forres and Lossiemouth Locality have performed better than the Moray Average in all but one of the indicators, and better than the National Average in all but two. Of particular note is the low rates of delayed discharges, low rates of emergency hospital admissions, and low rates of mental health unscheduled bed days. Page 173
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Annual Performance Report 2024/25 52 Moray Integration Joint Board 10. Financial performance and best value Financial Review and Performance Financial performance forms part of the regular reporting cycle to the MIJB. Throughout the year the Board, through the reports it receives, is asked to consider the financial position at a given point and any management action deemed as necessary to ensure delivery of services within the designated financial framework. From the first quarter in the financial year, the Board was presented with financial information that included a forecast position to the end of the year. In November 2024 the Board received a financial report which forecast an expected overspend to the end of the financial year of £5.58m. This forecast remained consistent throughout the remainder of the year and in January 2025, MIJB were forecasting an overspend to the end of the year of £5.51m, the MIJB actually out turned at £4.26m overspent. Both partners in line with the Integration Scheme, put in additional funding to cover this overspend, so with the use of ear marked reserves totalling £0.535m, and a transfer into ear marked reserves for the Asylum seekers grant of £0.701m, this leaves a balance of £2.152m in ear marked reserves to be carried forward into 2025/26. In May 2024, the MIJB agreed a savings plan of £8.297m, with a mixture of recurring savings and recurring reductions in spend. At the end of the financial year, this had been achieved in part, with recurring savings of £2.302m and £2,331m reduction in overspend. Given the uncertainties associated with funding and the emerging overspend position at the early stage of the financial year, it was necessary to update the Board regularly on the emerging financial position. This was done formally through MIJB meetings and informally through development sessions. Page 174
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Annual Performance Report 2024/25 53 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 7,700 8,328 (628) Community Nursing104,360 5,979 6,166 (187) Learning Disabilities 17,702 19,975 (2,273) 1 Mental Health 12,140 12,055 85 Addictions 1,907 1,763 144 Adult Protection & Health Improvement 249 273 (24) Care Services Provided In-House 24,743 22,754 1,989 2 Older People Services & Physical & Sensory Disability 24,775 27,034 (2,259) 3 Intermediate Care & OT 1,771 1,972 (201) Care Services Provided by External Contractors 1,835 1,816 19 Other Community Services 10,383 10,280 103 Administration & Management 3,333 3,152 181 Other Operational Services 1,377 1,535 (158) Primary Care Prescribing 18,748 21,937 (3,189) 4 Primary Care Services 21,427 21,331 96 Hosted Services 5,713 5,665 48 Out of Area Placements 720 1,971 (1,251) 5 Improvement Grants 1,207 1,021 186 Children’s & Justice Services 19,523 19,625 (102) Total Core Services 181,235 188,656 (7,421) Strategic Funds & Other Resources 14,891 5,318 9,573 TOTALS (before set aside) 196,126 193,974 2,152 Set Aside 15,639 15,639 - TOTAL 211,765 209,613 2,152 The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year. Page 175
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Annual Performance Report 2024/25 54 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) Significant variances against the budget were notably: Note 1 Learning Disabilities – The Learning Disability (LD) service is overspent by £2,272,694 at the year-end. The overspend is essentially due to the purchase of care for people with complex needs which resulted in an overspend of £2,806,801 and client transport of £13,781. This is offset by more income received than expected of £524,800 (income due from another authority and Change Fund funds from NHS) and other small underspends of £18,619 which primarily relate to property costs. There was a minor underspend of £4,469 in other Learning Disabilities clinical services. This budget has been under pressure for a number of years due to demographic pressures, transitions from Children’s services and people living longer and getting frailer whilst staying at home. The biggest overspends was for services provided to individuals in their own homes to support their daily living needs which enables people to stay living at home or in a homely setting for as long as possible and day care which provides activities during the day in the community. Note 2 Care Services Provided In-House – This budget is underspent by £1,988,757 at the end of the year. This relates to underspend in staffing across all the services in this budget totalling £2,291,755 and other minor underspends of £8,275 which is being reduced by overspends relating to transport costs £97,970; insurance costs £29,047, utility costs £62,430 and less income than expected £121,826. Unfilled vacancies have been the main reason for the underspend throughout the year and the issue of recruitment has been an ongoing problem Note 3 Older People Services and Physical & Sensory Disability - This budget is overspent by £2,259,056 at the end of the year. This primarily relates to overspends for home care in the area teams £539,818, permanent care £1,766,157 due to the increase in the number of clients receiving nursing care rather than residential care and respite care £105,776 this is being reduced by an underspend for day care £152,695. The variances within this overall budget heading reflect the shift in the balance of care to enable people to remain in their homes for longer The ageing population requiring more complex care and local demographics also contributes to this overspend as well as the correlation between the recruitment and retention of the internal home care service provision. Note 4 Primary Care Prescribing - The primary care prescribing budget is reporting an over spend of £3,189,386 for the twelve months to 31 March 2025. The overall average price has remained relatively consistent and includes cost reduction savings identified by Pharmacy implemented countered by the impact of short supply causing an increase in costs. This is spread across a range of products and is ongoing. This overall volume increase at 3.5% is less than previously anticipated. Note 5 Out of Area Placements – This budget is overspent by £1,250,899 at the year end. This is due to the continuing number of high cost individual specialised placements. Page 176
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Annual Performance Report 2024/25 55 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 42. At 31 March 2025 there were ear marked reserves of £2.152m available to the MIJB, compared to £1.986m at 31 March 2024. These remaining reserves of £2.152m are for various purposes as described below: Earmarked Reserves Amount £000’s GP Premises 39 National Drugs MAT 250 OOH Winter Pressure funding 172 Moray Cervical screening 35 Moray hospital at home 5 Moray Psychological 315 MHO Funding 138 Adult protection funding for CA 18 Adult Disability payment 45 National Trauma Training services 62 Moray School Nurse 32 Moray Winter Fund HCSW & MDT 182 LD Annual Health Checks 69 Community Planning partnership 2 Moray District Nurses 56 OOH Dev Fellowship scheme 30 Asylum Seekers grant 701 Total Earmarked 2,152 General Reserves 0 TOTAL Earmarked & General 2,152 GP Premises – balance of funding for improvement grants including the making of premises improvement grants to GP contractors. The continued digitalisation of paper GP records. Modifications for the purposes of improving ventilation and increase to the space available in NHS owned or leased premises for primary care multi-disciplinary teams. Page 177
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Annual Performance Report 2024/25 56 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). National Drugs Mission Moray – balance of funding for range of activities including: drug deaths, taskforce funding, priorities of national mission, residential rehabilitation, whole family approach, outreach, bear fatal overdose pathways and lived and living experience. Out of Hours Winter Pressure funding – balance of funding to sustain GO out of hours and to support resilience to explore operational solutions. Moray Cervical Screening – balance of funding for smear test catch up campaign. Moray Hospital at home – development of Hospital at Home provides Acute hospital level care delivered by healthcare professionals, in a home context for a condition that would otherwise require acute hospital inpatient care. Moray Psychological – funding streams for mental health, psychological wellbeing, facilities, post diagnostic support and psychological therapies. Mental Health Officer (MHO) funding – funding to support additional mental health officer capacity. Adult protection funding for care at home– balance of funding to build capacity in care at home community based services. Adult Disability payment – funding to assist with the implementation of the adult disability payments. National Trauma Training services – training for dealing with people affected by trauma and adversity. Moray School nurse – funding to support NHS Grampian to retain school nurse posts. Moray Winter Fund Health Care Social Workers (HCSW) – additional funding for further HCSW in both the IJB and Emergency department. Moray Winter fund Multi Disciplinary Team – additional funding for service pressures includes Discharge to Assess, Home First Frailty team and volunteer development. Learning Disability Annual Health Checks – to implement the annual health checks. Community Planning Partnership – funding towards community planning partnership. Moray District Nurses – allocation to support recruitment and training of District Nurses. Page 178
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Annual Performance Report 2024/25 57 Moray Integration Joint Board MANAGEMENT COMMENTARY (continued) Out of Hours (OOH) Development Fellowship Scheme – scheme to keep GP’s within clinical practice, increase GP’s confidence and competence in OOHs work Asylum Seekers Grant – funding received from the Home Office to support young people who have travelled to the UK alone. All reserves are expected to be utilised for their intended purpose during 2025/26. Set Aside – Excluded from the financial performance table above on page 15 but included within the Comprehensive Income & Expenditure Account is £15.639m for Set Aside services. Set Aside is an amount representing resource consumption for large hospital services that are managed on a day to day basis by the NHS Grampian. MIJB has a responsibility for the strategic planning of these services in partnership with the Acute Sector. Set Aside services include: • Accident and emergency services at Aberdeen Royal Infirmary and Dr Gray’s inpatient and outpatient departments; • Inpatient hospital services relating to general medicine, geriatric medicine, rehabilitation medicine, respiratory medicine, learning disabilities, old age psychiatry and general psychiatry; and • Palliative care services provided at Roxburgh House Aberdeen and The Oaks Elgin. The budget allocated to Moray is designed to represent the consumption of these services by the Moray population. The figures for 2024/25 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2020/21 (3.00%), 2021/22 (3.36%) ,2022/23 (6.70%), and 2023/24 (5.35%) and 2024/25 (6.64%): 2024/25 2023/24 2022/23 2021/22 2020/21 Budget 15.639m 14.665m 13.92m 13.04m 12.62m Page 179
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Annual Performance Report 2024/25 58 Moray Integration Joint Board 11. Looking forward – priorities for 2024/25 Health and Social Care Moray is in a period of change. With the appointment of Judith Proctor as Chief Officer the senior management team have led a review of the Strategic Delivery plan and set clear objectives with a focus on delivering improvements to services for people, whilst ensuring efficient and effective use of resources, ever mindful of the severe financial constraints that are affecting all Health and Social Care Partnerships, Local Authorities and NHS services. Key priorities will be:- Realignment of Organisational Structures - A review of the HSCM organisational structure will take place to ensure that the right resources are in place and the governance structure to support implementation of plans is clear to ensure we drive progress to achieve our priorities. This will also include strengthening the integration and oversight of Children, Families and Justice services within our system to ensure that all partners fulfil their statutory obligations, whilst a review of current reporting arrangements will reduce any duplication in reporting whilst strengthening oversight of performance and delivery. Strengthening Performance Oversight - With the approval of the revised Strategic Delivery Plan in May 2025 work is underway to review the performance framework and improve line of sight from the plan through to programmes and services who will deliver it so that we can clearly evidence the intended and actual impacts on outcomes for people. Discharge without Delay (DWD) – there have been clear objectives set out at a National level for this programme of work and resources have been allocated to take this forward for Moray in collaboration with NHS Grampian and Scottish Government. Digital solutions – Evaluation and implementation of digital tools, new systems and solutions will help in the provision of efficient and effective services. Research being led by DHI and the living labs will inform options for expanding the use of Technology enabled care information and tools available for people to be able to live at home and feel safe and supported and the Smart Housing that will help people to live independently whilst ensuring they are save. The developments of the Community Connections tool, and the Personal Data Store will be integrated into business as usual pathways so people have ownership of their information but can share it with those directly involved in their support to prevent having to repeat it. Implementation of a new Social Work and Social Care Information Management system will enable services to utilise a modern system that is fit for the future and which will be able to link to other emerging technologies, ensuring we can provide responsive and well co-ordinated supports to people. Expanding the principles of Self-Directed Support into all aspects of service provision and development of flexible frameworks to provide people with more choice and control over who provides support for them is underway. Page 180
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Annual Performance Report 2024/25 59 Moray Integration Joint Board The redesign of the Care at Home service will be implemented in the coming year with the aim of expanding capacity to meet the growing need, whilst continuing to further develop pathways to increase provision of care at home. The Grampian wide pathway redesign of Mental Health Services is in progress and HSCM will be heavily involved to establish a sustainable service for Moray that ensures access to services needed. A new website is under construction that is aimed to aid Communication and Engagement to provide more information about services and how to access them and a new system will be implemented that will facilitate engagement and two way communication with various groups. Through the implementation of a communication strategy, we will provide regular updates for staff on the financial delivery plan and strategic delivery plan progress, and key aspects of the organisation. We aim to deliver more direct, honest and open messaging with people to manage expectations and to ask for help and support from individuals and communities on identifying ways we can support them better. Page 181
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Annual Performance Report 2024/25 60 Moray Integration Joint Board Appendix A: Moray area profile • Moray spans 864 square miles in North East Scotland • Comprising mainly coastal and rural communities • Rounded Population 93,400 (Scotland’s Census 2022 – Rounded population estimates, 2023), 1.72% of Scotland’s total population. • Population predicted to fall by 2.6% in next 10 years according to publicly available data last updated in 2022. Moray age profile 0-14 year olds 15 -64 year olds People aged 65 and over Moray 14,500 57,500 21,400 Scotland 21,400 3,153,300 1,091,100 Community • In 2023 it was estimated that there were 43,891 households in Moray. • 62.2% of adults living in Moray rate their neighbourhood as a good place to live (Scotland 59.1%) • The crime rate in Moray is 41 per 1,000 population (Scotland 55) • The rate of non-accidental fires in Moray is 13 per 10,000 population (Scotland 28) • In Moray, 45 drug crimes are recorded per 10,000 population (Scotland 97) Economic status • 12.5% of Moray households are estimated to be workless (Scotland 17.8%) • 20.1% of children aged under 16 within Moray are living with low income families (UK 20.1%) • In May 2023, 11.6% of all Moray households were on Universal Credit - 5,103 households (Scotland 18.7%) • 63.6% of homes were in Council Tax Bands A-C, 7.34% were in Council Tax Bands F-H, compared to 60.0% and 14.2% respectively in Scotland. Deprivation • Moray is the second least deprived mainland local authority in Scotland • (SIMD 20) • 2.7% of Moray population live within the highest of the Scottish Index of Multiple Deprivation (SIMD) quintiles (most deprived) • 13.3% live in the least deprived quintile. Page 182
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Annual Performance Report 2024/25 61 Moray Integration Joint Board Appendix B: Core suite of national indicators Source information from Public Health Scotland Survey fieldwork was carried out between October and December in the financial year presented and respondents were asked about their experiences over the previous 12 months. Please note results for indicators 2, 3, 4, 5, 7 and 9 for 2023/24 are not comparable to previous years due to changes in survey wording. Also results for 2019/20 and 2021/22 for indicators 2, 3, 4, 5, 7 and 9 are comparable to each other, but not directly comparable to figures in previous years due to changes in survey wording and methodology. Calendar year 2023 is used here as a proxy for 2023/24 due to the national data for 2023/24 being incomplete. We have done this following guidance issued by Public Health Scotland which was communicated to all Health and Social Care Partnerships. Using more complete calendar year data for 2023 should improve the consistency of reporting between Health and Social Care Partnerships. update Page 183
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Annual Performance Report 2024/25 62 Moray Integration Joint Board National Indicator 1 2023/24 Percentage of adults able to look after their health very well or quite well 92.2% Note – Health and Care Experience Survey is a sample survey of people aged 17 and over registered with a GP practice in Scotland. A change in survey wording between 2019/20 to 2023/24 has resulted in a small sampling error so care needs to be taken when comparing results. .Indicator Title 2023/24 NI - 2 Percentage of adults supported at home who agree that they are supported to live as independently as possible 71.9% Moray’s results for 2023/24, whilst very slightly reduced from the previous year, remain above the Scottish rate. Whilst there has been a reduction in this indicator over the period, the change in wording of the survey means we cannot compare previous years. It is however in line with the Scottish rate. This may reflect how people in the community feel, where there are continued levels of unmet need, following assessment. This remains a key focus to address and it is hoped that the work being undertaken in areas such as social prescribing, community health and wellbeing teams support and investigations into utilising developing digital technology to support people in their own homes may help release some capacity so that available care can be directed to those who these other solutions will not be suitable for. Page 184
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Annual Performance Report 2024/25 63 Moray Integration Joint Board Indicator Title 2023/24 NI - 3 Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided 59.5% Indicator Title 2023/24 NI - 4 Percentage of adults supported at home who agree that their health and social care services seemed to be well co-ordinated 65.7% This is another indicator in which HSCM are in line with national trends. It is disappointing that despite efforts to ensure that people are involved in how their support is provided, that people do not feel that they are. In relation to the care provided at home by our internal service the results from the recent care inspectorate report were excellent and the feedback from other inspections would indicate that the majority of people in receipt of services are happy and feel supported. Progress in this indicator is above the national rate. A direct comparison is not possible with previous years due to the change in wording of the survey. Page 185
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Annual Performance Report 2024/25 64 Moray Integration Joint Board Indicator Title 2023/24 NI - 5 Percentage of adults receiving any care or support who rate it as excellent or good 68.7% Indicator Title 2023/24 NI - 6 Percentage of people with positive experience of care at their GP practice 68.6% This indicator is now nearer the Scottish rate than it was previously. With the positive feedback from survey’s undertaken locally for various inspections it was anticipated that there would be an improvement in this indicator. It may be that the positive results will be shown in next year, but in any case, feedback is actively sought and acted on to enable improvements to be made. There has been a significant increase in the percentage of people with a positive experience of care at their GP practice and Moray is now in line with the Scottish rate. Whilst the figures are below where we would want to be it reflects the ongoing challenges of providing care and support in the community, for an increasingly older population who have more complex health issues. Page 186
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Annual Performance Report 2024/25 65 Moray Integration Joint Board Indicator Title 2023/24 NI - 7 Percentage of adults supported at home who agree that their services and support had an impact in improving or maintaining their quality of life 69.3% Indicator Title 2023/24 NI - 8 Percentage of carers who feel supported to continue in their caring role 28.2% Due to the change in wording of the survey we cannot draw a direct comparison to previous years, however it is encouraging that we are in line with the Scottish rate and whilst the percentage has dropped, it was not as big a drop as the Scottish rate. Given the impact of the financial constraints on all health and care services, NHS and Local Authorities budgets it is likely that this indicator will not improve in the short term, and may in fact decrease, because the equivalent services and support are not available to the same amount of people as before. Efforts are being directed to encourage early intervention and prevention to assist people to take more ownership of their health and wellbeing. This result is below where HSCM would want it to be. Unpaid carers are an essential element of the provision of support and care in the community and it is a strategic priority for HSCM to support them. A new carers strategy was implemented during 2023/24 and work will continue to address the areas identified to try to have a positive impact on how carers feel. Page 187
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Annual Performance Report 2024/25 66 Moray Integration Joint Board Indicator Title 2023/24 NI - 9 Percentage of adults supported at home who agree they felt safe 70.0% Indicator Title 2023 NI - 11 Premature mortality rate per 100,000 persons Again, this is an indicator that we can’t compare with previous years however there is less of a gap between the Scottish rate and Moray’s position, which is positive. There is some way to go to get to the pre- Covid position but it is hoped that there will be a positive impact of the work that is being undertaken to conduct reviews to ensure people receive the support they need whilst drawing on the connections and relationships that people already have in their communities which is hoped will assist in establishing an increase in their feeling of safety. Page 188
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Annual Performance Report 2024/25 67 Moray Integration Joint Board Indicator Title 2024/25 NI - 12 Emergency admission rate (per 100,000 population) Indicator Title 2024/25 NI - 13 Emergency bed day rate (per 100,000 population) Page 189
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Annual Performance Report 2024/25 68 Moray Integration Joint Board Indicator Title 2024/25 NI - 14 Emergency readmissions to hospital within 28 days of discharge (rate per 1,000 discharges) Indicator Title 2024/25 NI - 15 Proportion of last 6 months of life spent at home or in a community setting Page 190
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Annual Performance Report 2024/25 69 Moray Integration Joint Board Indicator Title 2024/25 NI - 16 Falls rate per 1,000 population aged 65+ Indicator Title 2024/25 NI - 17 Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections Page 191
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Annual Performance Report 2024/25 70 Moray Integration Joint Board Indicator Title 2024/25 NI - 18 Percentage of adults with intensive care needs receiving care at home Indicator Title 2024/25 NI - 19 Number of days people spend in hospital when they are ready to be discharged (per 1,000 population) Page 192
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Annual Performance Report 2024/25 71 Moray Integration Joint Board Appendix C: Local indicators Indicator 2020/21 (Q4) 2021/22 (Q4) 2022/23 (Q4) 2023/24 (Q4) 2024/25 (Q4) Target A&E attendance rate per 1000 population all ages 17.8 20.2 20.6 22.6 22.0 21.9 Throughout 2024/25 the figure has hovered around the target of 21.9 and whilst there was a slight increase in numbers presenting the last two quarters of the year it was still below the high in March 2024. Emergency Departments are under considerable pressure and whilst considerable efforts have been made to inform people about alternative sources of emergency care such as pharmacies, dentists, opticians and NHS24 further detailed work will be undertaken to try to understanding why and how people access emergency care, to help us develop intelligence about avoidable attendances, and how we can intercept them through alternative early prevention and intervention work. Number of Delayed Discharges (including code 9) at census point 17 46 26 43 40 26 Delayed discharges continue to fluctuate despite significant efforts from across many teams and services to reduce the delays and the potential negative impacts for people. There has been sustained focus of daily multi-disciplinary meetings with colleagues in Dr Grays and ARI to support collaborative decision making and improve system flow. All delayed discharges over 90 days are subject to enhanced scrutiny and actions to facilitate discharge prioritised. Challenges with provision of care at home in rural locations and increased complexity of needs of frail, elderly patients requiring discharges whilst maintaining choice and control for individuals need to be addressed. It is hoped that initiatives such as “Moving with Dignity”(proportionate care) will help discharges through the use of equipment and tools to assist those with mobility issues and reduce the need for double up care (two carers). The nationally led programme Discharge Without Delay is being taken forward across Grampian in collaboration with NSH Grampian and Health Intelligence Scotland to progress system wide actions to reduce delays and the clear performance targets identified will provide oversight of the progress being made over the next year. Number of bed days occupied by delayed discharges (incl. code 9) at census point 496 1294 751 1501 1149 850 The number of bed days has decreased from the high in March 2024 but is still sitting well above target and showing an increasing trend. The initiatives and focus on delayed discharges should reduce this number over the next year. Rate of emergency occupied bed days 1773 2140 2749 2509 2412 2681 Page 193
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Annual Performance Report 2024/25 72 Moray Integration Joint Board for over 65s per 1000 population The figures are showing a reducing trend and have been below target throughout the year. Emergency admission rate per 1000 population for over 65’s 174.8 183.0 185.8 179.7 177.8 187 This year the rates have been significantly lower than the previous year, with the exception of the period October to December, where there was peak in previous year’s which indicates it may be a seasonal variation. Number of people over 65 years admitted as an emergency in the previous 12 months per 1000 population 119.3 125.2 129.2 125.8 125.7 131 This rate is well below the target albeit there is slight increasing trend. % Emergency readmissions to hospital within 7 days of discharge 5.0% 3.4% 3.6% 4.4% 3.9% 3.7% This indicator has fluctuated during the year with a high in September, and although it has just gone over target it is below the March 2023/24 figure and overall is stable % Emergency readmissions to hospital within 28 days of discharge 9.8% 8.0% 7.5% 8.3% 7.4% 7.9% This rate has been showing a slight decreasing trend and with the exception of a high in September 2024 has been below target. The increase in September figures has been reflected over several years so may be a seasonal variation. % of patients commencing Psychological Therapy Treatment within 18 weeks of referral 100% 33% 73% 57% 65% 90% This indicator has reflected the challenge the service is experiencing with significantly increased demand and despite initiatives to undertake group work (where appropriate) to increase throughput and maximise capacity it has not been possible to generate the capacity required to meet the standard and achieve the target. NHS Sickness Absence (%of hours lost) 3.1% 4.7% 5.9% 5.7% 4.9% 4% Council Sickness Absence (% of calendar days lost) - 8.9% 9.7% 9.7% 8.2% 4% Page 194
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Annual Performance Report 2024/25 73 Moray Integration Joint Board Application of the appropriate absence monitoring procedures are monitored closely and support provided to individuals as required to ensure that absences are minimised. There are various wellbeing initiatives and supports available to staff and managers, such as vaccination campaigns for flu and Covid-19 to reduce severity and duration of illness, work station assessments where ergonomic equipment is needed and access to Occupational Health Service to provide support for both physical and mental health issues. Appendix D: IJB decisions and directions Agendas and reports for all MIJB meetings during 2023/24 are set out in the papers which are published on the Moray Council website. Board meetings are open to the public and webcast, meaning they can be watched remotely as they happen or the recording viewed at a later time. Governance considerations and decisions made by the MIJB have included: May 2024 • Agreed to note the expected financial position at the end of the current financial year and the implications for 2024/25 and noted the recovery action plan and the intent to progress the savings highlighted. • Agreed to note the updated Financial Strategic Risk Register which provides an overview of the strategic financial risks, along with a summary of actions which are in place to mitigate those risks. • Formally approved the revenue budget for 2024/25, following consideration of the risks highlighted in the report. June 2024 • Approved the unaudited Annual Accounts to be submitted to the external auditor, noting all figures remain subject to audit. Noted the Annual Governance Statement and accounting policies applied in the production of the unaudited Annual Accounts. • Approved the updated Local Code of Corporate Governance which supports the Annual Governance Statement. • Approved the MIJB Directions Policy. September 2024 • Approved the Audited Annual Accounts for the financial year 2023/24. • Approved the Moray Mental Health and Wellbeing Delivery Plan 2024- 2026 and approved the proposed governance structure in Moray. • Approved the Adult Joint Strategic Needs Assessment 2024 for Moray. • Approved the publication of the Health and Social Care Moray Annual Performance Report 2023/24. • Approved the publication of the Health and Social Care Moray Annual Complaints report 2023/24. Page 195
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Annual Performance Report 2024/25 74 Moray Integration Joint Board November 2024 • Approved the draft Public Sector Climate Change submission to Sustainable Scotland Network for the reporting year 2023/24. January 2025 • Endorsed the establishment of the Grampian Strategic Change Board. • Endorsed the collaborative approach proposed to develop a Route Map for Strategic Change. • Agreed that the IJB Chief Officers should actively participate in the development and implementation of the Route Map for Strategic Change and work collaborative with other partners to ensure the success of this crucial transformation program. • Approved the charges for services for the 2025/26 financial year for recommendation to Moray Council for approval and inclusion into their budget setting processes. • Approved the Children’s Services Plan 2023/24 annual report. • Approved the outline business case for the replacement of the Social Work and Social Care case management system. • Endorsed the collaborative whole system approach being taken in Moray and by partners across Grampian with regards to the Getting in Right for Everyone (GIRFE) programme. • Agreed to adopt the Standards Commission’s Model Code of Conduct for Members of Devolved Bodies as the Code of Conduct for the Moray IJB. March 2025 • Approved the 2025/26 proposed savings plan. • Formally approved the Revenue Budget for 2025/26. • Approved the updated Medium Term Financial Framework. • Approved the draft Moray IJB Equality Mainstreaming Progress Report 2021- 2024 for publication by April 2025. • Approved the strategic objectives of the Strategic Care at Home Group. Page 196
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Annual Performance Report 2024/25 75 Moray Integration Joint Board Appendix E: Changes to Membership of Moray Integration Joint Board during 2024/25 Changes to membership of MIJB during the year: Councillor Tracy Colyer became MIJB Chair on 1 April 2024. She resigned from the Board in September 2024. Denis Robertson, Vice-chair, took over the role of Chair until the end of 2024/25. Councillor Elaine Kirby takes on the role of Chair of the Board from 1 April 2025 until 30 September 2025, following which the role of Chair will revert back to a Health Board Member in line with the Integration Scheme. Following an open recruitment process, Sheila Brumby was appointed as Service User Stakeholder and Janette Topp as Third Sector Stakeholder in May 2024. Ms Topp resigned from the Board on 11 February 2025. NHS Grampian nominated Alex Stephen, Director of Finance, to MIJB, as of 1 July 2024. June Brown, Executive Nurse Director, is Mr Stephen’s nominated substitute. 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. Judith Proctor was appointed Chief Officer of the MIJB and HSCM in November 2024, having served as Interim Chief Officer for the previous five months. She succeeded Simon Bokor-Ingram who stepped down from the position at the end of May 2024 due to health reasons. Jim Lyon was appointed Interim Chief Social Work Officer and Head of Service in June 2024. He succeeded Tracey Stephen who stepped down from the MIJB on her relocation to take up a role with a local authority in England. Agendas and reports for all MIJB meetings during 2024/25 are set out in the document packs which are published on the Moray Council website. Hybrid board meetings combine in-person attendance with remote participation, via video conferencing. They are open to the public to attend and are also webcast, meaning they can be watched remotely as they happen or the recording viewed at a later time. Page 197
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Annual Performance Report 2024/25 76 Moray Integration Joint Board Appendix F: Inspections of services The annual performance report requires the IJB to report on inspections by external bodies. Joint Inspection Adult Support and Protection Moray's multi-agency Public Protection Partnership has evidenced substantial improvement in supporting and protecting adults at risk of harm. The positive impact achieved by local authority, health and police colleagues in their work to keep people safe, has been acknowledged with publication in October 2024 of the Joint Inspection of Adult Support and Protection in Moray. The progress review by the Care Inspectorate and its scrutiny partners was a follow- up to a joint inspection carried out in 2022. On their return in August, inspectors found significant progress had been achieved across all seven priority areas identified for improvement. Key accomplishments identified in the progress report include: • Consistent application and delivery of key processes: Frontline staff were confident and highly professional. The partnership overall followed its comprehensive multi-agency adult support and protection procedures rigorously. • Improved investigations: Full adult support and protection investigations were now carried out for all adults at risk of harm who required them. The quality of these investigations had significantly improved, with almost all rated as good or better. This was described by inspectors as “another impressive improvement.” • Enhanced management of risk: The quality of chronologies (recording the order of events), risk assessments, and protection plans had greatly improved. Presence of risk assessments required further improvement, so that all adults at risk of harm had one. • Effective case conferences: Case conferences were now clearly defined and held for all adults at risk of harm who required them. There were competent and well-executed, with almost all rated good or better for quality. The partnership was actively working to support people to participate in their own case conferences. • Strategic leadership: The partnership had rigorously implemented its improvement plan following the 2022 inspection and taken forward a range of notable improvement focused activities. • Strengthen governance: Robust measures were in place to identify concerns early and promptly implement remedial action. Operational managers worked diligently and effectively to bring about necessary improvements to adult support and protection. • Multi-agency self-evaluation: The partnership had achieved significant progress and its cohesive programme of multi-agency audits and quality Page 198
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Annual Performance Report 2024/25 77 Moray Integration Joint Board assurance activities was successful. Frontline staff were involved in informing the improvement work. Care Inspectorate The following services managed by the HSCM were inspected in 2024/25. Short Term Assessment and Reablement Team (START) - Support Service Key messages: • People enjoyed support which was dignified and respectful. • Staff felt supported by their supervisors and colleagues. • Staff recruitment was managed well by the service. • People's reablement benefitted from good links between the service and other health and social care colleagues. • Improvements were required to ensure people benefitted from safe medication procedures. • Care plans required more detail and more regular review. Evaluation of service How well do we support people's wellbeing? 4 - Good How good is our leadership? 4 - Good How good is our staff team? 5 – Very good How well is our care and support planned? 3 - Adequate Moray Supported Lodgings Project – Adult Placement Services Key messages: • The management team evidenced insight to service gaps and provided a service improvement plan, which is in the early stages of implementation. • The impact of a six-month vacancy of the only supervising social worker post has had a negative impacted on predictable support for caregivers and taking forward service improvement plans. • Supported lodging caregivers provide young people with a safe and stable home base. • Young people are supported to reconnect with family and establish a positive network of support that aligns with their ethnicity, culture, traditions, and beliefs. • Educational attainment is a high priority with young people, who are enrolled in 'English as an additional language' lessons, and secondary and further education provisions. • Young people benefit from leading and directing their own support within a multi-agency approach to care planning. Evaluation of service Page 199
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Annual Performance Report 2024/25 78 Moray Integration Joint Board How well do we support people's wellbeing? 3 - Adequate How good is our leadership? 3 - Adequate How good is our staff team? 2 - Weak How well is our care and support planned? 4 - Good Community Support Service - Housing Support Service Key messages: • People were supported by staff who were kind and caring. • People were supported to access health care, meaning their care and support benefitted their health. • Improvements were required to ensure people benefitted from safe medication procedures. • Quality assurance checks and audits, that should improve people's care, required further development. • People did not know who was supporting them and were not confident that they received the correct amount of support. • People's care, and care plans, had not been reviewed regularly. Evaluation of service How well do we support people's wellbeing? 3 - Adequate How good is our leadership? 3 - Adequate How good is our staff team? 3 - Adequate How well is our care and support planned? 3 - Adequate Mental Welfare Commission for Scotland Muirton Ward, Seafield Hospital, Buckie An announced visits was carried out on 11 July 2024 to Muirton Ward at Seafield Hospital, Buckie, which is an older adult assessment unit for people with dementia. Key positive findings: • Compassionate Care: Individuals and most relatives described staff as caring, approachable, and experienced. The ward atmosphere was calm and settled. • Environment: The ward offered spacious and dementia-friendly areas, with good use of garden and communal spaces. Privacy was respected, and signage aided navigation. • Care records: Files were well organised, and care plans addressed both physical and mental health needs. Covert medication and legal documents were appropriately documented. • Physical health monitoring: There was consistent attention to physical health alongside mental health needs. Page 200
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Annual Performance Report 2024/25 79 Moray Integration Joint Board • Rights awareness: Advocacy services were engaged, and information on rights was visible and included in carers’ information packs. The Commission made five recommendations: • Ensure a formal process is in place to regularly review risk assessments and risk management plans. • Provide dedicated psychology support to inform care and assist with recovery, particularly in managing complex or distressed behaviours. • Review and improve the system for obtaining updates from community services (e.g. social work) to support timely discharge planning. • Ensure all psychotropic medications are legally authorised and that a regular audit process is implemented to maintain compliance. • Appoint a dedicated activity therapist to support a structured and meaningful activity programme tailored to individual and group needs. Ward 4, Dr Gray's Hospital, Elgin An announced visit was carried out on 16 October 2024 to Ward 4, Dr Gray’s Hospital, Elgin, which is an18-bedded adult acute psychiatric admission ward for adults. Key positive findings: • Staff dedication: Most individuals spoke positively about the caring and helpful nature of staff. • Patient involvement: People felt involved in decisions about their treatment and had regular access to their consultant psychiatrist. • Improved discharges: There has been some progress in discharging long-stay patients, although challenges remain due to delays in arranging community support. • Electronic records: The introduction of the TRAKCare healthcare information system has improved record-keeping, with more consistent and detailed updates. • Multidisciplinary team (MDT) records: MDT meeting documentation has significantly improved, providing clear, detailed summaries of care and treatment decisions. The Commission made 10 recommendations, including: • Better risk assessment and care planning. • Improving the quality of care plans • Ensuring access to psychology and pharmacy support. • Developing a seven-day activity programme. • Addressing outstanding environmental safety issues. • Improving legal compliance and promoting patient rights. HSCM submitted an improvement action plan to address the recommendations. Page 201
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Annual Performance Report 2024/25 80 Moray Integration Joint Board Care Inspectorate – inspections of externally commissioned services Care and support is commissioned from independent and third sector providers and these services are subject to contract monitoring by the Commissioning service to ensure that services are safe, effective and that they meet people’s needs. Performance is monitored through formal contract meetings, review of compliments, complaints and feedback from staff, carers and people who use services. Visits to providers involve observing care and support and looking at records and documents. The team also work closely with the Care Inspectorate. The following services commissioned by the partnership were inspected by the Care Inspectorate in 2024/25. Name of service Service provider How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is our care and support planned? Wakefield Nursing Home, Cullen Parklands Group 4 4 4 4 4 Abbeyside Care Home, Elgin Abbeyside Care Group 4 Not assessed 4 Not assessed Not assessed Spynie Care Home, Elgin Intobeige 3 4 3 4 4 Moray Services (Housing Support) Cornerstone 4 3 3 Not assessed 3 The Grove Care Home, Elgin Abbeyside Care Group 4 5 5 Not assessed Not assessed Meadowlark Care Home, Forres Renaissance Care 4 5 5 4 5 Ark Moray support service, Forres Ark Housing Association 3 4 3 Not assessed Not assessed Care at Home Care Quality Services Limited - Moray 3 3 3 Not assessed Not assessed Cathay Nursing Home, Forres Wallace Management Services Limited 4 4 4 4 4 Wakefield House Care Home Parklands Group 4 4 4 4 4 Page 202
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Annual Performance Report 2024/25 81 Moray Integration Joint Board Name of service Service provider How well do we support people's wellbeing? How good is our leadership? How good is our staff team? How good is our setting? How well is our care and support planned? Greyfriars Close, Elgin Turning Point Scotland 4 4 4 NA 4 Moray Services Cornerstone 4 3 3 NA 3 SAMH Housing support service SAMH 5 6 NA 5 5 Parkholme, Lossiemouth Cornerstone 3 3 3 3 3 RLO, Elgin Real Life Options 5 5 NA 5 5 Chandlers Rise, Elgin Hanover Housing Support Service - Care (North) 4 4 NA 4 4 Cornerstone Buckie Cornerstone 5 5 NA 5 5 The six-point scale 6 Excellent Outstanding or sector leading 5 Very good Major strengths 4 Good Important strengths, with some areas for improvement 3 Adequate Strengths just outweigh weaknesses 2 Weak Important weaknesses - priority action required 1 Unsatisfactory Major weaknesses - urgent remedial action required Page 203
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Annual Performance Report 2024/25 82 Moray Integration Joint Board 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 Page 204
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REPORT TO: MORAY INTEGRATED JOINT BOARD ON 19 JUNE 2025 SUBJECT: ANNUAL PROGRESS UPDATE ON THE DELIVERY OF THE UNPAID CARERS STRATEGY BY: SERVICE MANAGER, PROVIDER SERVICES 1. REASON FOR REPORT 1.1 This report provides an annual update on the implementation of the Moray Unpaid Carers Strategy. 1.2 It is intended to inform the Board of the progress made against the Strategy’s objectives and highlight key developments, challenges and next steps. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) acknowledge the progress made in delivering the Strategy’s objectives; ii) note the capacity challenges that have impacted delivery; iii) instruct the Lead Officer for Unpaid Carers to provide 6-monthly updates to the Audit, Performance & Risk Committee, with annual reports to the Moray Integrated Joint Board (MIJB); following discussion with Chair and Vice-Chair on 16 January it was agreed for updates to go to Audit, Performance & Risk Committee moving forward; and iv) approve a two-year extension to the current Moray Carers Strategy 2023-2026 extending its term to March 2028. 3. BACKGROUND 3.1 Unpaid carers provide vital support to Moray’s health and social care system, supporting family members, friends, or neighbours who are unable to manage independently. Item 9. Page 205
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3.2 It is estimated that unpaid carers contribute £162 billion annually within the UK, with Carers UK estimating this equates to £15.9 billion in Scotland, equating to £1.9 billion per hour. 3.3 There are approximately 16,200 individuals in Moray providing some form of unpaid care which contributes to approximately £20,000 per year per carer. 3.4 The Board at the meeting on 30 March 2023 (para 11 of minute refers) approved the launch of the Moray Carers Strategy (Appendix 1) on 1 April 2023 which aligns with the national vision of "Valuing, Recognising, and Supporting Carers." The strategic outcomes for Scotland include: • Carers are recognised and their contributions are understood and valued by society. • Carers' voices are heard, and their views are considered in decisions that impact them. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Promoting Early Identification and Recognition 4.1 The Carer Aware Moray campaign has been initiated to improve identification and recognition of unpaid carers. It includes a proposed badge and ID card, with public engagement planned to gather feedback (Appendix 2). 4.2 In line with the “Carer Aware Moray” campaign, engagement has also commenced with local businesses. This enables collaborative work with local businesses to offer discounts to carers presenting their Carer Aware card/badge. This not only supports to identify carers but also recognises the valuable contribution they are making to Moray. 4.3 Work continues with the Elgin Health Centre Project, where it can be reported that following on from bespoke training, there has been an increase in the number of unpaid carers recorded on their system. A publicity campaign is due to go out shortly to raise public awareness of the project and to encourage unpaid carers to make this known on their next contact with the GP practice. 4.4 The Unpaid Carers team took part in the most recent MIJB development session in collaboration with Quarriers, Health and Social Care Moray’s commissioned carer support service, alongside the valuable input from two young carers and an adult carer sharing their lived experience. The session further supported the awareness raising of unpaid carers. Enhance Access to Support and Information 4.5 A review of the current access pathways to Adult Carer Support Plans and Young Carer Statements identified improvements to increase awareness and reduce delays for unpaid cares requiring support. As a result of successful recruitment to the post of Social Worker for Unpaid Carers, revised paperwork, aligned to the local carers eligibility criteria, with supporting guidance and audit framework is being developed. The new documentation will be piloted in June 2025, obtaining feedback from the Social Worker and the unpaid carers who have utilised the new support plan to support the creation of a user-led document that is person centred and supports timely access to supports. Page 206
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Staffing 4.6 Interviews for the Young Carer Strategy Officer post were held on 23 May. Appointing to this post will support the team to deliver the key priorities within the Strategy directly relating to young carers and enables strong links with education to be made to promote the identification and awareness raising for young carers in Moray Carers Week 9 June - 15 June 4.7 The Unpaid Carers team attended an event at the Laichmoray Hotel to celebrate the graduation of unpaid carers who have completed the “From Recognition to Rights” leadership training which was delivered by the Coalition of Carers. The training covered a wider range of topics that affect unpaid carers. Next Steps 4.8 While positive progress has been made towards achieving strategic outcomes, staffing capacity remained a challenge throughout the last year. This has impacted the delivery of the Year 1 and 2 priorities outlined in the Strategy. As a result, it is proposed that the current Moray Carers Strategy 2023-26 is extended until March 2028. The current underpinning implementation plan will be revised with key target dates amended to ensure resources are allocated to the relevant actions. 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” Supporting carers aligns with the ambitions outlined in the Moray IJB Strategic Plan, Corporate Plan, and LOIP. It will contribute to Outcome 6 of the National Health and Wellbeing Outcomes by improving health, wellbeing, and outcomes for both carers and the people they care for. When unpaid carers, the individuals they care for, and health and social care professionals collaborate as partners, they enhance the likelihood of achieving better outcomes for everyone involved. This approach aligns with Realistic Medicine, which emphasizes placing people at the heart of decisions regarding care and support, in line with the key priorities identified by EPiC. (b) Policy and Legal The local carer strategy meets the legal requirements set out in the Carers (Scotland) Act 2016, ensuring that carers have access to: • Information and advice services • Hospital discharge involvement • Adult Carer Support Plans or Young Carer Statements • Support for eligible needs (c) Financial implications Funding through the annual Carers Act allocation supports the delivery of the Strategy. Actions outlined in the Strategy and Action Plan, Page 207
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including the commissioning of local information and advice services, must be managed within the existing resources and additional funding streams. (d) Risk Implications and Mitigation Demand for support is likely to increase as more carers are identified. A local eligibility criteria is in place to ensure appropriate support is provided. (e) Staffing Implications The delivery of the Strategy relies on a collaborative workforce, including unpaid carers, the public, third-party organisations, and the wider community. The impact of vacant posts has slowed progress towards Year 1 and 2 priorities. (f) Property No direct implications from this report. (g) Equalities/Socio Economic Impact Carers are more likely to experience inequality of outcome and poor health. The Strategy aims to enhance opportunities for all carers, ensuring equitable access to support. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions For the Board to consider and agree a 2-year extension to the current Moray Carers Strategy (j) Consultations Consultations have taken place with the Carer Representative on the Board, Assistant SDS & Carers Officer, Provider Service Manager, Carers Strategy Implementation Group, Operational Management Team (OMT). 6. CONCLUSION 6.1 Progress continues to be made in supporting unpaid carers in Moray, through improvements in recruitment, service delivery, public awareness campaigns, and partnerships with local businesses. Continued efforts are needed to maintain this momentum and ensure carers receive the recognition and support they deserve. 6.2 This report outlines key updates to the Strategy and highlights ongoing developments that will contribute to improved support and recognition for unpaid carers in Moray. 6.3 The report highlights the ongoing challenges to deliver the objectives of the current Strategy, requesting consideration given to a two-year extension. Page 208
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Author of Report: Michelle Fleming, Self-Directed Support & Unpaid Carers Team Manager (SDS & Carers Lead Officer) Background Papers: Ref: Page 209
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Health & Social Care Moray Recognised, Valued, Supported Moray Carers Strategy 2023-2026 Health & Social Care Moray’s approach to improving outcomes for adult and young carers APPENDIX 1 Page 210
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Moray Carers Strategy 2023-2026 2 1. Foreword Dear fellow carers On behalf of the Moray Integration Joint Board, I am pleased to introduce this new strategy for unpaid carers in Moray. Carers play an essential role in society, often without recognition of the commitment they make and the impact it can have on them. The Board would like to express its gratitude to carers across Moray and publicly recognise the outstanding contribution they make to our health and care system and to our communities. The Covid pandemic has been hard on everyone but carers have shouldered more of the burden than most. Many took on a caring role for the first time or saw their caring responsibilities increase. Carers have told us they are worn down and struggling to have a life of their own. They tell us the challenges they experience are made worse because of the frustrations of trying to navigate a health and social care system which does not seem to be on their side. They do not feel listened to or valued as equal and expert partners in care. Yet caring is everyone’s business. The majority of us will become carers at some point in our lives, or we may need care ourselves. It is a role that can develop gradually or may happen unexpectedly and is one for which we are rarely given a choice. For many, supporting friends, families and communities can provide a sense of well-being. For others, caring responsibilities can have a substantial impact on every aspect of their lives and additional support is needed to manage the demands of the role and reduce the negative impact. Our new strategy, Recognised, Valued and Supported, is grounded in the lived experience of unpaid carers and my thanks goes to everyone who has been involved. It reflects what carers say matters to them. It recognises where we are now and where we want to get to over the next three years to improve the experiences of carers. The strategy and supporting implementation plan will guide the work of health, social care and community partners towards a better Moray where carers of all ages are recognised, valued and supported to enjoy healthier and more fulfilled lives. I look forward to continuing to work with fellow carers and partners to turn our priorities into positive action to ensure Moray’s unpaid carers are Recognised, Valued and Supported. Ivan Augustus Carer Representative Moray Integration Joint Board Page 211
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Moray Carers Strategy 2023-2026 3 2. Contents 1. Foreword ............................................................................................................. 2 2. Contents .............................................................................................................. 3 3. Summary ............................................................................................................. 4 4. Introduction .......................................................................................................... 5 5. Why supporting carers matters ............................................................................ 6 6. Carers in Scotland ............................................................................................... 7 7. Carers in Moray ................................................................................................... 8 8. Listening to and learning from carers ................................................................. 11 9. Supporting carers – where we are now ............................................................. 13 10. Priorities for 2023-2026 – making a difference going forward ........................ 15 11. Making it happen ............................................................................................ 19 Appendix 1 – Who the strategy is for........................................................................ 20 Appendix 2 - Strategic needs assessment of carers in Moray .................................. 21 Appendix 3 - National and local policy drivers .......................................................... 22 Appendix 4 – Guiding principles ............................................................................... 24 The Carers Strategy Development Group would like to thank all partners and every unpaid carer who has given their time to share their lived experience as part of the development of the strategy. Your input has been invaluable in improving our understanding of the challenges and priorities for carers, and has informed the actions that will guide the work we do for carers. Page 212
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Moray Carers Strategy 2023-2026 4 3. Summary The Carers Strategy sets out how Health & Social Care Moray plans to deliver on its commitment to support unpaid carers of all ages in Moray over the next three years. It will inform all other Health & Social Care Moray strategies and transformation plans so that meeting the needs and aspirations of carers is embedded in all services across the partnership, including those it commissions externally. The strategy will be underpinned by an implementation plan with clear actions setting out how we will take a human rights approach to working together to improve the health, wellbeing and experiences of carers. Our Carers Strategy has been shaped by the voice and experience of carers, and the organisations that support them, to ensure that the priorities for the future are based on what is most important. Our vision For carers in Moray to feel recognised, listened to and respected as equal and expert partners in care, and to be supported in their vital role so they can live well alongside caring. To achieve the vision, we will focus improvement actions for local carers under these three areas of strategic priority: Recognised Valued Supported By 2026, every unpaid carer in Moray should: Be able to identify themselves as a carer early in their caring journey Have timely access to the information and advice they need Know and understand their rights Feel listened to and valued as an equal and expert partner by people working in services Be fully engaged in the planning and delivery of services Be empowered to manage their caring role and have access to effective support which enables them to look after their own health and wellbeing Have access to regular and sufficient breaks from their caring role Be able to achieve their own goals, free from discrimination, and be able to maintain their education and/or employment as they wish. Page 213
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Moray Carers Strategy 2023-2026 5 4. Introduction Health & Social Care Moray wants to recognise the significant contribution unpaid carers make every day to ensuring that people in our communities in need of care continue to experience a good quality of life. It is estimated that three in five adults in the UK will become an unpaid carer at some point in their lives. In Moray, the 2011 census recorded just over 8,000 people identifying as a carer. However, we know many individuals providing care do not recognise themselves as a carer because it so easily becomes part of their everyday routine. Each year more people take on new or increased caring responsibilities and that number has increase since the start of the Covid-19 pandemic. Carers are valued for their vital role in enabling the people they care for to stay as well as possible and continue living at home. We recognise they are key to the sustainability of our health and care system but that their caring role is often at the detriment of their own health and wellbeing, education and employment opportunities, finances and aspirations to live the life they choose. We are committed to working with local carers and partners to create positive change which reduces the negative impact of the caring role and improve carers’ experiences. The Moray Carers Strategy 2023-2026 will build on the range of services currently in place, address gaps in provision and improve support to all carers in Moray. It has been informed by listening to the views and lived experiences of Moray’s carers. It provides clear direction to Health & Social Care Moray on where resources should be focused to meet the needs, aspirations and rights of carers. A strategy implementation group will be established to oversee a plan setting out clear actions, timescales and measures for monitoring progress. The plan will be developed through continued engagement with carers and strategic partners. It will evidence how funding allocated towards carers is being used by the partnership to support carers to live well and achieve their own improved health and wellbeing outcomes in line with the priorities set out in this strategy and the Moray Strategic Plan, and is enabling us to meet the requirements of the Carers (Scotland) Act 2016. Page 214
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Moray Carers Strategy 2023-2026 6 5. Why supporting carers matters People are living longer but often the increase in longevity comes at a cost of increased years in poor health with complex care needs. This is putting more pressure on the health and social care system. In response, Health & Social Care Moray is progressing initiatives to prevent unnecessary hospital admissions and premature admissions to long-term residential care, to reduce delays in discharge from hospital, reduce demand for formal support services, and to help people remain as independent as possible in their own home. Unpaid carers in Scotland represent a larger workforce than the paid health and social care support workforces combined. They are integral to good care and are often best placed to understand and advocate for the needs, rights and preferences of the person they support Although for many, caring can have positive and rewarding aspects, is it is profoundly challenging. Carers often put the interests of the person they care for ahead of their own needs. The care provided by unpaid carers is often physically and emotionally demanding, with consequences for the carer’s own health and wellbeing. Caring responsibilities can affect a carer’s own health and wellbeing, their relationships with others, their access to education, employment opportunities and finances, and limits the time and energy they have to do things for themselves. Our engagement work to develop this new strategy highlighted the toll caring can take. For many, the difficulties faced before Covid-19 have been exacerbated, but new challenges have also emerged. Hours spent caring have increased and carers have taken on more or different caring tasks. The increased caring responsibilities and lack of breaks has resulted in added pressure and impacted upon carers’ ability to continue to care. Carers are reporting fatigue and there has been an increase in reports of crisis interventions needed to respond to carer breakdown. We recognise the value carers bring and importance of ensuring they are included as equal partners in care. This strategy sets out our commitment to supporting carers in order to: Uphold their human rights Reduce the impact of their caring role Promote their health and wellbeing Sustain them in their caring role if they so wish Help people to continue to live in their own homes and communities Achieve better outcomes for carers Achieve better outcomes for the cared for person Sustain the health and social care system Page 215
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Moray Carers Strategy 2023-2026 7 6. Carers in Scotland This strategy is for anyone who supports another person on an unpaid basis – whether that be a family member, child with additional needs, relative, friend, or a combination of these people. This is not the same as someone who provides care professionally, or through a voluntary organisation. Anybody can become a carer at any time in their life. Someone can be a carer for more than one person at a time. Carers can be any age, from young children to older people. Carers UK predicts that 3 in 5 of us will be a carer at some point in our lives. Carers differ in age, the number of hours that they spend caring and in the number of people they care for. They may have their own health challenges and may be juggling their caring responsibilities alongside work, studies, and other family or community commitments. The actual number of carers is not known but it was estimated that there were 700,000 to 800,000 unpaid carers in Scotland before the COVID-19 pandemic. The 2020 Scottish Health Survey telephone survey results suggest there were 839,000 adult carers living in Scotland in August-September 2020. Young carers • There are an estimated 29,000 young carers in Scotland - 4% of the under 16 population • Many are doing jobs around the house that an adult would normally do. They may be providing emotional support • Their caring responsibilities are likely to impact on their education and stops them spending time with friends • Young carers are more likely to not be in education, training or employment Working age carers • Working age women are more likely to be carers than men • Over 250,000 people in Scotland are juggling paid work alongside their caring responsibilities • National research suggests 1 in 5 carers give up employment to care • The loss of earnings, savings and pension contributions can mean carers face long-term financial hardship into their retirement Older carers • Census data shows 11% of people aged 65 and over in Scotland are carers • Over half of older carers provide 35 hours of care a week or more • Older carers are more likely to have their own health and care needs and their caring role can impact on these • Nationally, one third of older carers say they have cancelled an appointment, treatment or operation because of their caring responsibilities Page 216
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Moray Carers Strategy 2023-2026 8 7. Carers in Moray Information from Scotland’s 2022 census, the official estimate of every person and every household, will start to be published from late 2023. The most recent information we have is from the 2011 census when 8.3% of the Moray population identified as being a carer compared to 9.3% in Scotland. Of the 7,809 people providing unpaid care, 59.9% were female; 21.2% were aged 65 and over; 3.6% were under the age of 16; and 52.9% were in employment.4.8% provided 1-19 hours of care a week; 0.7% provided 20-24 hours a week; 0.6% provided 35-49 hours a week; and 2.2% provided 50 or more hours of care a week. Carers Scotland has reported that approximately 17.5% of the adult population of Scotland are carers. In June 2020, Moray had an adult population of 79,673 (National Records of Scotland), giving an estimated 13,500 adult carers. Around 4% of the under 16 population are carers – in Moray this would equate to approximately 2,700 young carers. This would mean there are an estimated 16,200 carers in Moray – more than double the 2011 census figure. Not all may need formal support from statutory services to assist them to manage the demands of the role but carers legislative rights are enshrined by the Carers (Scotland) Act 2016 which recognises that preventative support at an early stage can reduce the risk of carers coming to crisis and help them to continue to manage their caring role. Experiences of caring and impact on wellbeing The biennial Scottish Health and Care Experience Survey (HACE) asks a sample of carers about their experiences of specific aspects of caring and the impact on their wellbeing. As with the previous survey, the responses in 2021/22 were mixed. However, overall locally and nationally the results were less positive than in previous years. Carers were most positive about the balance between caring and other things in their life with 60% responding positively to this question in 2021/22. Carers were least positive about local services being well coordinated for the person(s) they look after. 2021/22 Positive Neutral Negative I have a good balance between caring and other things in my life 60% (63% Scotland) 19% (20%) 21% (17%) I have a say in services provided for the person(s) I look after 44% (39%) 31% (36%) 24% (25%) Local services are well coordinated for the person I look after 31% (29%) 30% (39%) 39% (32%) I feel supported to continue caring 32% (30% 37% (43%) 31% (28%) Page 217
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Moray Carers Strategy 2023-2026 9 Carers feeling supported in their role is one of the national integration indicators against which Health & Social Care Moray measures its progress in relation to the national health and wellbeing outcomes. Our strategy engagement work saw 181 carers complete a questionnaire to share their lived experience of being a carer in Moray. 85% of people identified as female, and 15% identified as male. Most carers completing the survey were aged between 46-59 (40%), 60-74 (29%) and 30-45 (27%). The survey had a limited response from carers under the age of 30 or the 75s and over. Half of respondents indicated they themselves had a health condition or disability. More than half (96) were providing care to an adult person. 57 were caring for an adult aged 18-64 and 48 were caring for a child or young person. A quarter of carers were working full-time with 23% being retired. 21% worked part- time with the same unable to work because of their caring role. 11% were unable to work due to their own health issues. Almost half of respondents (46%) were caring for more than 50 hours a week. 42.90% 38.10% 39.50% 30.70% 32% 2013/14 2015/16 2017/18 2019/20 2021/22 NI-8 Carers felt supported in their role 45 42 38 37 19 14 1 3 0 10 20 30 40 50 Working full- time Retired Working part- time Unable to work because of my caring role Unable to work because of my own health Not working In education Other Employment or education Series1 Page 218
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Moray Carers Strategy 2023-2026 10 Carers were caring for people with a range of conditions. The survey had multiple options for respondents and many respondents indicated that more than one applied. Less than 50% of carers were fully aware of their rights under the Carers (Scotland) Act 2016. 0 10 20 30 40 50 60 70 80 90 Up to 4 hrs 5 and 19 hrs 20 and 34 hours 35 and 49 hrs 50+ hours Hours of care provided each week 0 10 20 30 40 50 60 Someone who is older and frail Someone with a neurological condition Someone with a learning disability Someone with an autism spectrum disorder Someone with a mental health issue Someone with dementia Someone with a life limiting illness Someone with a sight or hearing impairment Someone with alcohol and/or drug dependency The people who carers support 0% 20% 40% 60% 80% 100% 120% Right to receive information and advice Right to access an Adult Carer Support Plan or a Young… Right to be involved in the assessment of their own… Right to access support if their needs meet the local… Right to have their views taken into account when… Right to be involved in the hospital discharge planning Right to be involved in the planning of any carers’ … Awareness of carers rights Aware Not sure Not aware Page 219
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Moray Carers Strategy 2023-2026 11 8. Listening to and learning from carers Over 200 carers participated in some form of engagement through joining focus groups and responding to a questionnaire to inform the development of the strategy. Carers experienced many struggles before the pandemic and have faced new and additional challenges and pressures as a result of lockdowns, loss of informal support and disruption to services. Carers own health issues, as well as the declining health of the person they care for, has been a concern. The demands of the role impacts on both physical health and mental wellbeing. Carers spoke of the stress they were under, their lack of sleep and tiredness, isolation, anxiety and feelings of guilt which had made it more challenging to cope. The inability to have a break was the biggest challenge for most carers and had a negative impact on many aspects of their life including relationships. “Providing 24 hour care without any respite provision. Physical and mental exhaustion.” “Loss of a wife and partner. Physically having to do everything to keep the house going.” “My role as a carer is very physically and emotionally demanding on me. I too have disabilities so my physical and mental health is really suffering… I feel very lonely and isolated and don’t have much of a life outside of my caring role.” “If he doesn’t sleep at night then nor do I but I still have to work the following day.” Carers told us there is a lack of awareness of who is a carer and the role carers have in supporting the cared for person, the health and social care system and the wider community Many carers only become known when they reach a crisis There is a lack of understanding in schools and in health and social care about the impact of the caring role on all aspects of the carer’s life, particularly their health and wellbeing Many are reluctant to seek formal support but when they do they often do not feel listened to or heard “Health, Education and Social Work have no real understanding of my child's condition. This is a problem because suggested supports are almost always counterproductive.” Carers highlighted the importance of being made aware of available support. They want easy access to carer information and to health condition information and training They want to be able to access effective support when and where is right for them School holidays are very challenging for parent carers Page 220
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Moray Carers Strategy 2023-2026 12 Carers still face challenges in navigating the complex social care system and assessment process on behalf of the person they support. Processes and decision making is not always open and transparent Their involvement in the development of care, support and treatment plans for the cared for can be sporadic, depending on the professional. Communication from health and social care is said to be poor. Carers struggle to get hold of professionals and are often left waiting for updates “Red tape when trying to make life easier for my Mum.” “Lack of support and communication from social care.” “Not enough support from services. Phoning and phoning for my call to be answered weeks later. Chasing medications.” They are concerned by a lack of consistency in support staff and the quality of their training in some cases Timings of support services don’t meet the needs of working carers Carers have struggled with the pandemic changes to GP appointments Dealing with day to day challenges of their caring role make it difficult to plan for the future Carers welcome the opportunities to connect with other carers for peer support During the pandemic many embraced the use of digital technology Carers face additional financial challenges “Universal Credit covers my mortgage and nothing else: no bills, food, transportation, etc. My energy is limited so although I'm looking for part-time work, I am very concerned about being able to work AND continue caring for my child.” “It's also frustrating not being able to work due to being an unpaid carer and having to rely on benefits.” “Can’t find work around caring & can’t join in a lot of things as no respite e.g. no day care available after 3/3.30.” Achieving a good work/life balance is a challenge Carers need a regular break and what a break looks like depends on the carer. Carers do not always know what they are entitled to, what is available and how to access it. They want to see increased choice in what is available, including planned and emergency breaks, accommodated and non-accommodated respite Some people did not feel they had benefited as a result of having an adult carer support plan Carers expressed difficulty in prioritising their own health and wellbeing needs above those of the person they support Page 221
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Moray Carers Strategy 2023-2026 13 9. Supporting carers – where we are now There are services and support options available in Moray for carers, although we recognise we need to work together to improve these to ensure carers experiences are positive and that there are gaps which need to be addressed and Since the previous strategies for adult and young carers in Moray were published, the Carers (Scotland) Act 2016 has been introduced. It is designed to support carers’ health and wellbeing and help make caring more sustainable. Work was carried out across Moray in 2018 to publicise the Act and the rights of carers which include: 1. Adult carers have a right to an ‘Adult Carer Support Plan’. An Adult Carer Support Plan is the new name for the carer’s assessment. It is a conversation that identifies the extent to which the carer is able and willing to provide care and the ‘personal outcomes’ which matter to the carer in order to carry out their caring responsibilities, as well as any needs a carer may have. This will be arranged through Quarriers Carer Support Service, the local commissioned service provider. 2. Young carers have a right to a ‘Young Carer Statement’. A Young Carer Statement is a plan that sets out information about the young carer’s circumstances and caring role. The plan will set out a young carer’s ‘personal outcomes’, the goals which matter to the young carer in order continue to provide care, where that is appropriate, and have a life alongside caring. It will set out the needs a young carer may have and the support available to meet the carer’s needs. Adult Carer Support Plans and Young Carer Statements are prepared by Social Work and by Quarriers Carer Support Service. Recruitment to additional officer posts in Health & Social Care Moray has increased support to carers. There has been improved recording of carer support on the social care information system used by adult and children’s services. 3. Carers have a right to support to meet any ‘eligible needs’. The local eligibility criteria is a framework used to identify whether an adult or young carer should receive support from Moray Council and Health & Social Care Moray to meet their identified needs. Following consultation with carers, it was agreed that in Moray we would use the national eligibility framework. If a carer meets the local eligibility criteria, support may take the form of Self- Directed Support (SDS). Carers may also be offered support such as breaks from caring. If a carer’s identified needs do not meet the local eligibility criteria, support can still be provided for example, information and advice; education and training and/or general support available in the local community. Health & Social Care Moray publishes a Short Breaks Services Statement with information about short breaks services available for local carers. Page 222
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Moray Carers Strategy 2023-2026 14 4. Carers have a right to be involved in services. Health & Social Care Moray has a duty to consult with carers when shaping services which impact on their caring role. This includes preparing local carer strategies. Engagement with carers has informed the development of this strategy and carers will be offered opportunities to be involved in the planning and delivery of services, including the recommissioning of the carers support service. 5. Carers have a right to be involved in the hospital discharge process of the cared-for person. The health board must ensure it involves the unpaid carer in hospital discharge planning. 6. Information and advice for carers There is a duty on Health & Social Care Moray to have access for carers to information and advice services, covering a range of mandatory areas, including emergency planning Quarriers Carer Support Service is commissioned to provide information, advice and support to young carers and adult carers in Moray. Support is provided to carers of all ages by a team which includes family wellbeing workers and a young carer development worker who operate from the carers centre based in Elgin. The service also provides carers with learning opportunities for skills and confidence training, professional counselling and opportunities for peer support including carers’ cafes. Quarriers has been able to secure funding from Shared Care Scotland to enable some carers to benefit from small grants that help them take a break from their caring role. Partnership working has also included: delivery of awareness raising programmes to increase self-identification by carers; roll-out of carer awareness training to internal staff and external partner agencies; production of the Moray Carer Aware alert card for carers; organisation of multi-agency staff training sessions to raise awareness of the Carer Aware Card and promote the use of the carers’ emergency planning toolkit; annual celebration of National Carers Week to raise awareness of the role of carers and provide opportunities for peer support Information on support for carers can be found on the Moray Council website here: http://www.moray.gov.uk/moray_standard/page_77507.html or by calling the Access Care Team on 01343 563999. Information on Quarriers adult carer support service is available here and the young carer support service here or by calling 01343 556031. Quarriers Unpaid Carer Service - 44 High Street, Elgin, Moray, IV30 1BU Email: carersmoray@quarriers.org.uk Page 223
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Moray Carers Strategy 2023-2026 15 10. Priorities for 2023-2026 – making a difference going forward Through our engagement work the following 3 strategic priorities have been identified. Priority 1 – Recognition for carers We want carers to be able to say, ‘I can identify as a carer. I am able to access the information and advice I need as a carer and I know and understand my rights’. Our focus To raise the profile of all carers of all ages in Moray, and support individuals to both recognise carers, and be recognised as carers, as early as possible in their caring role as the first step to support. Our actions to improve recognition of carers Develop and deliver awareness raising programmes to NHS staff, Adult Social Care, Children’s Social Care, Schools and UHI, wider Moray Council and NHS staff, third sector and other community/business providers across Moray. Embed Turas Carer Aware training in the core skills requirement for all NHS staff. Progress and develop a Carer Positive approach in Health & Social Care Moray, Moray Council and within NHS Grampian in Moray. (The Carer Positive award is presented to employers in Scotland who have a working environment where carers are valued and supported.) Enable easy referral and registration for carers to the commissioned Carer Support service, including online, in-person and paper processes. Develop and make easily available a carers ID card, recognised across Moray Support carers during periods of transition: age and circumstance related. Improve identification and support for carers of family members with an alcohol and/or drug dependency, recognising the sensitivities around identifying as a carer and the impact of cared for non-engagement. How we will know this is working: Pre- and post-learning feedback will evidence increased understanding of carers and carer needs across all audiences. Achievement of level 2 Carer Positive award for Moray Council; evidence of Moray contribution to NHS Grampian Carer Positive award. Carers report easy access to the commissioned Carer Support Service, and response rates fall within agreed Key Performance Indicators (KPIs). Moray Carers ID card numbers increase year on year. Carers report improved experiences at transition points: Young carers moving to Secondary School are highlighted in advance of the move, Young carers moving into further/higher education report confidence in the process and Page 224
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Moray Carers Strategy 2023-2026 16 their ability to make the move, Young carers seeking employment are aware of their rights as carers and confident to present their skills and experience to prospective employers. Increased numbers of people who identify as carers of family members with an alcohol and/or drug dependency, complete an Adult Carer Support Plan/Young Carer Statement and are assessed for eligibility for additional supports in their own right. Priority 2 – Valuing carers We want carers to be able to say, ‘I am listened to and valued as an equal and expert partner by people working in health and social care. I am involved in the planning and delivery of services and support for myself and for the person/s I am caring for’. Our focus To involve, respect and listen to carers in planning the care and support of the person they care for, and themselves Our actions to improve how carers are valued Support the development of appropriate Carer Voice opportunities for carers of all ages, enabling effective feedback on strategic outcomes progress and carer experience in Moray. Build on the Test of Change work in hospitals in Moray, to seek Carer Champions on wards and easy links to the commissioned Carers Support Service. Develop and introduce a Carer Passport and Pathway of Support in Moray hospitals, to aid carer journey when the cared for is admitted, through to discharge and beyond. Adopt the Triangle of Care to support carers of people with poor mental health Ensure carers have access to skills development and training/awareness opportunities linked to the condition of the person they care for, to help them best support their care. Improve carer access to self-management support in their role. How we will know this is working: Moray has a recognised process for carers to regularly comment on their experience and support needs, providing feedback and informing service development and delivery across a broad spectrum of health and social care initiatives. More carers are actively involved in presenting lived experience to decision- makers, and indicate confidence to do so. Page 225
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Moray Carers Strategy 2023-2026 17 Every hospital in Moray is referring carers to the commissioned Carers Service, and has a process in place to ensure carers are supported on-site as necessary. Carers are involved in hospital discharge processes for the cared for. Every hospital in Moray recognises and responds appropriately to the Carer Passport and Carer Support Pathway. Carers of people with poor mental health are actively involved in planning and managing the care required, at every step of the process. Carers report increased confidence to manage the care they provide. Carers report increased confidence and ability to manage their caring role. Priority 3 – Supporting carers We want carers to be able to say, ‘I am able to manage my caring role and reduce any negative impact on my health and wellbeing. I can access the support and services which are right for me. I am able to take a break from my caring role when I need to. I am not disadvantaged because I am a carer. I am able to achieve my own goals and maintain my education and/or employment’. Our focus To empower carers to manage their caring role, to enable them to look after their own health and wellbeing, and maintain a life of their own alongside caring. For young carers, provide support to learn, develop and thrive, and where applicable maintain an appropriate caring role. Our actions to improve support for carers Provide a fully accessible Information and Advice service for carers of all ages. Review and improve the Adult Carer Support Plan and Young Carer Statement templates and process to best support identification of carer support needs and services/support required to achieve personal outcomes. Provide practical support to help carers manage the impact of their caring role. Ensure carers of all ages are supported to plan for the future (their own and that of the person they care for), by identifying them and working together to consider long term needs and preferences. Develop targeted Carer Respite policies, for adult, parent and young carers Facilitate carer breaks through a variety of models, including participation in the national Respitality programme. Participate in national programmes to improve schools’ awareness of, and support for, young carers in education. Adopt a continuous improvement approach to monitoring and evaluating carer experience in Moray, aiding consistent reporting to the Scottish Carers Census and informing commissioning and development activity to improve outcomes for carers. Page 226
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Moray Carers Strategy 2023-2026 18 How we will know this is working: The commissioned Carers Service is able to evidence satisfaction from carers accessing information and advice. Carers report increased confidence and ability to manage their caring role. The numbers of carers with Emergency/Contingency Plans in place, and sharing them with those who need to know, has increased. Carers will have clear information about their rights to respite, and the arrangements for achieving it. Carers will have access to a range of short breaks, including some facilitated by the commissioned Carers Service, and to information to help them plan and achieve the break of their choice. Schools in Moray will have an ongoing programme of awareness raising, increasing the numbers of young carers identified, referred to the commissioned Carers Service for support, and supported in school. Page 227
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Moray Carers Strategy 2023-2026 19 11. Making it happen The delivery of this strategy and associated implementation plans will only be achieved by working with carers themselves, alongside partners in the third sector, education, housing, employment support, and health and social care, to support and meet the needs of young carers and adult carers. In order to implement the Moray Carers Strategy over the next three years, we will work with carers, partners and stakeholders to form a strategy implementation group. This group will support the development of a detailed plan, push forward the priorities, agree how and when agreed actions will be delivered, and coordinate the work. We will actively involve carers, carers groups and partners in pieces of work that come from the implementation plan so that their lived experience, ideas and input continues to inform ongoing improvement work. This will include young carers, young adult carers, working carers and carers in different circumstances, as required for specific projects. The strategy document, implementation plan and updates on its progress will be published on the Health & Social Care Moray website. Opportunities for involvement will be shared by Health & Social Care Moray and partners through existing communication and engagement channels. The work being undertaken by the strategy implementation group will be monitored by the Clinical Care Governance Committee. Strategy progress reports will also be provided to the Moray Integration Joint Board to provide assurance that the rights of Moray’s unpaid carers are being upheld and health and wellbeing outcomes for carers are improving. To learn more please get in touch. Email: UnpaidCarers@moray.gov.uk Write: The Unpaid Carers Team, Moray Council Offices, 10 High Street, Elgin, IV30 1BX. Website: https://hscmoray.co.uk/index.html Follow us on social media: @HSCMoray Page 228
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Moray Carers Strategy 2023-2026 20 Appendix 1 – Who the strategy is for This strategy is for all unpaid carers who live in Moray. It is for carers who provide everything from a couple of hours of care a week to round the clock care for their child, parent, relative, friend or neighbour. For the purpose of this strategy we are using the Carers (Scotland) Act 2016 definition of a carer as “an individual who provides or intends to provide care for another individual (the cared-for-person).” Carers include: Young carers under the age of 18 who are in school, or further or higher education Young carers under the age of 18 who may be in or seeking employment Young carers under the age of 18 who may not be in education or employment Young adult carers aged 18-25, who have needs around the transition from children and young people’s services into adulthood and accessing age appropriate adult supports. Young adult carers also require support to create a life beyond caring and explore opportunities for employment, further education, or moving into their own homes; • Parent carers who are parents of children who have a disability or additional needs. Carers who are managing both a caring role and trying to start, sustain, or return to employment Mutual carers who require care and support and are also providing care and support (interdependent caring). Sandwich carers who have caring responsibilities for different generations, such as children and parents at the same time Older carers who in addition to caring for someone with support needs may also be managing their own health needs and impacts of ageing. Former carers who have ceased their caring role, usually because of a change in condition of the cared for person. This includes the death of the cared for person, the cared for person recovering and no longer needing care and support, the cared for person moving into long term residential/nursing care, or the carer choosing or having to stop providing care. It is important to distinguish unpaid carers from paid care workers. Carers provide unpaid care alongside their other responsibilities, with many putting their lives on hold to provide care for a friend, neighbour or relative. This care could be for a few hours a day or more and could be around the clock care. Page 229
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Moray Carers Strategy 2023-2026 21 Appendix 2 - Strategic needs assessment of carers in Moray Demographic context Between 1998 and 2020, the population of Moray increased by 10.3% to 95,170. In terms of overall size, the 45 to 64 age group was the largest in 2020, with a population of 27,544. In contrast, the 16 to 24 age group was the smallest, with a population of 9,019. The 75 and over age group saw the largest percentage increase (+62.4%). In Moray, life expectancy at birth is higher than at Scotland level for both females and males. The table below sets out projected population growth for Moray and Scotland. Across Scotland there is a projected reduction in children, limited change in the working age population, but significant growth in adults of pensionable age. By comparison it is projected that Moray will have marked decreases in children and those of a working age, and a significantly higher change in those of a pensionable age. Page 230
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Moray Carers Strategy 2023-2026 22 Appendix 3 - National and local policy drivers This strategy has been developed within the context of legislation, policy and strategic direction set nationally and locally. Key to these are the Carers (Scotland) Act 2016. The Act is designed to support carers’ health and wellbeing and help make caring more sustainable. Since April 2018 new duties for local authorities have included: The provision of support to carers, based on the carers’ identified needs which meet the local eligibility criteria. The offer and preparation of an adult carer support plan and young carer statement to identify carers’ needs and personal outcomes. The provision of an information and advice service for carers in areas such as; emergency and future care planning, advocacy, income maximisation and carers’ rights. The Carers' Charter1 has been drawn up to help carers understand their rights under the Carers (Scotland) Act. The Act supports Outcome 6 of the National Health & Wellbeing Outcomes - People who provide unpaid care are supported to look after their own health and wellbeing, 1 https://www.gov.scot/publications/carers-charter/pages/1/ Page 231
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Moray Carers Strategy 2023-2026 23 including to reduce any negative impact of their caring role on their own health and well-being. Under the Carers Act, Health & Social Care Moray’s Integration Joint Board is required to prepare and publish a local Carers Strategy setting out its plan for identifying and supporting carers in our community. Carers’ rights will continue to be upheld through the implementation of the Moray Carers Strategy 2023-2026 and in line with current and developing national and local policy and strategic ambition such as: The National Carers Strategy – published 21 December 2022. The strategy aims to support unpaid carers whilst recognising and valuing their contributions across five themes: Living with COVID-19; Recognising, valuing and involving carers; Health and social care support; Social and financial inclusion; Young carers. The Scottish Government Policy Getting it Right for Every Child (GIRFEC) that supports children and young people so that they can grow up feeling loved, safe and respected and can realise their full potential. The Education (Additional Support for Learning) (Scotland) Act 2009 Act requiring Education Authorities to provide additional support to young carers, who may be experiencing barriers to learning. Social Care (Self-directed Support) (Scotland) Act 2013 and the framework of standards which are intended to provide people with freedom, choice, dignity and control. Self-directed enables people to have more choice and control over some or all of the support they need to live as independently as they wish to. The Moray Integration Joint Board’s Strategic Plan 2019-2029 is being refreshed. The current priorities are: building resilience, home first and choice and control. NHS Grampian Plan for the Future 2022-2028 which is constructed around three pillars – people, places and pathways – to create sustainable health and care. The National Care Service (Scotland) Bill builds on the findings of the Independent review of Adult Social Care in Scotland which was published in 2021. The Bill allows Scottish Ministers to transfer social care responsibility from local authorities to a new, national service. The implications for Health & Social Care Moray and this strategy will be reviewed in response to this. Page 232
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Moray Carers Strategy 2023-2026 24 Appendix 4 – Guiding principles Equality, Diversity and Human Rights The principles of equality, diversity and human rights are the basic rights for all. We will work to ensure that carers’ are aware of their rights under the legislation and that no carer is disadvantaged owing to age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity, race; religion or belief; or sex or sexual orientation, in line with the Equality Act 2010. All children and young people have an established set of rights and principles based on the United Nations Convention on the Rights of the Child. These say that nobody should treat a child or young person unfairly and that when adults make a decision about a child or young person it is what's best for the child or young person that should be the most important thing to consider. The child or young person must have their say too. Awareness of their rights, and those of the person that they care for, can help adult and young carers’ get fair access to things that most people take for granted. Equal Partners in Care Underpinning this strategy are the Equal Partners in Care (EPiC) principles which mirror our priorities and outcomes. EPiC is a joint NHS Education Scotland (NES) / Scottish Social Services Council (SSSC) project which developed a learning resource for health and social care staff to support improved conversations and interactions with carers. The aim is to make a positive difference and improve outcomes for carers and the people they care for. The principles are: 1. Carers are identified. 2. Carers are supported and empowered to manage their caring role. 3. Carers are enabled to have a life outside of caring. 4. Carers are fully engaged in the planning and shaping of services. 5. Carers are free from disadvantage or discrimination relating to their role. 6. Carers are recognised and valued as equal partners in care. Page 233
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Moray Carers Strategy 2023-2026 25 Email: UnpaidCarers@moray.gov.uk Page 234
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APPENDIX 2 Carer Aware Branding Prototypes Page 235
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