Agenda Document Pack - Moray Integration Joint Board - 24/09/2026
Moray Council · 24 September 2026
Back to Moray Integration Joint Board — 24 September 2026 and its agenda
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Moray Integration Joint Board Thursday, 24 September 2026 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, 24 September 2026 at 13:30 to consider the business noted below. AGENDA 1. Welcome and Apologies 2. Declaration of Member's Interests 3. Minute of meeting of 25 June 2026 5 - 10 4. Action Log of 25 June 2026 11 - 14 5. Minutes - for noting 5a. Minute of meeting Audit Performance and Risk Committee of 26 February 2026 15 - 20 Page 1
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5b. Minute of meeting Clinical and Care Governance Committee of 28 May 2026 21 - 24 6. Moray Integration Joint Board Meeting Schedule 25 - 30 7. Board Membership and Stakeholder Member Governance Arrangements 31 - 40 8. Revenue Budget Monitoring Quarter 1 for 2026-27 41 - 86 9. External Auditors Report to Those Charged with Governance 87 - 150 10. 2025-26 Audited Annual Accounts 151 - 224 11. Moray Integration Joint Board Draft Strategic Risk Register 225 - 254 12. Moray Integration Joint Board Risk Management Policy 255 - 266 13. Strategic Plan Refresh - Approach 267 - 272 14. Childrens Services Plan 2023-2026 - Year 3 Annual Report and Introduction to the Childrens Services Plan 2026– 2029 273 - 320 15. The Moray Alcohol and Drug Partnership (MADP) – Scottish Government Annual Reporting Survey 321 - 352 Page 2
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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 3
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MORAY INTEGRATION JOINT BOARD SEDERUNT Mr Dennis Robertson (Chair) Councillor Peter Bloomfield (Voting Member) Councillor John Divers (Voting Member) Councillor Scott Lawrence (Voting Member) Mr Derick Murray (Voting Member) Councillor Bridget Mustard (Voting Member) Mr Sandy Riddell (Voting Member) Mr Alex Stephen (Voting Member) Ms Karen Greaves (Ex-Officio) Ms Laura Skaife-Knight (Ex-Officio) Professor Duff Bruce (Non-Voting Member) Mrs Sheila Brumby (Non-Voting Member) Mr Sean Coady (Non-Voting Member) Ms Miriam Connor (Non-Voting Member) Ms Sonya Duncan (Non-Voting Member) Ms Jane Ewen (Non-Voting Member) Dr Robert Lockhart (Non-Voting Member) Ms Aimee McIntosh (Non-Voting Member) Mr Stephen Morgan (Non-Voting Member) Ms Deborah O'Shea (Non-Voting Member) Ms Judith Proctor (Non-Voting Member) Mr Michael Ritchie (Non-Voting Member) Ms Elizabeth Robinson (Non-Voting Member) Mrs Christine Stevens (Non-Voting Member) Clerk Name: Caroline O'Connor Clerk Telephone: 07779 999296 Clerk Email: committee.services@moray.gov.uk Page 4
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MINUTE OF MEETING OF THE MORAY INTEGRATION JOINT BOARD Thursday, 25 June 2026 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mrs Sheila Brumby, Ms Miriam Connor, Councillor John Divers, Ms Sonya Duncan, Councillor Scott Lawrence, Dr Robert Lockhart, Mr Derick Murray, Councillor Bridget Mustard, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Mr Michael Ritchie, Mr Dennis Robertson, Ms Elizabeth Robinson, Mr Alex Stephen, Mrs Christine Stevens APOLOGIES Councillor Peter Bloomfield, Professor Duff Bruce, Mr Sean Coady, Ms Jane Ewen, Ms Karen Greaves, Mr Jim Lyon, Ms Aimee McIntosh, Ms Laura Skaife-Knight IN ATTENDANCE Deputy Head of Service; Clinical Director Mental Health; Service Manager, Moray Mental Health and Drug and Alcohol Services; Self-Directed Support and Unpaid Carers Team Manager; Alcohol and Drug Partnership Co-ordinator; Interim Strategic Lead; Kevin Todd, UNISON (observer) and Caroline O'Connor, Committee Services Officer SUBSTITUTE Councillor Amber Dunbar (for Councillor Peter Bloomfield) ALSO IN ATTENDANCE Councillor Tracy Colyer 1. Chair The meeting was chaired by Mr Dennis Robertson. 2. Declaration of Member's Interests Item 3. Page 5
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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 26 March 2026 The minute of the meeting of 26 March 2026 was submitted and approved. 4. Action Log of 26 March 2026 The Action Log of the meeting of 26 March 2026 was discussed and updated accordingly. 5. Minute of meeting Clinical and Care Governance Committee of 26 February 2026 The Board noted the minute of the meeting of the Clinical and Care Governance Committee of 26 February 2026. 6. Revenue Budget Outturn for 2025-26 The meeting had before it a report by the Chief Financial Officer informing the Board of the unaudited financial outturn for 2025/26 for the core budgets and the impact this outturn will have on the 2026/27 budget. During consideration points were raised regarding the fluctuation in the outturn position in terms of being lower than forecast in January to being higher than forecast in June, a higher overspend than noted in the table at paragraph 4.3 when taking account of the £1.7m funding from partners, the relationship between the underspend and overspend referenced in para 8.12, the carry forward of earmarked reserves, achievability of the admin and vacancy target in paras 5.13 and 5.14 and the vacancy management controls referred to para 8.2 not inadvertently causing delays to recruitment. Following consideration the Board unanimously agreed to:- i) note the unaudited revenue outturn position for the financial year 2025/26; ii) note the impact of the 2025/26 outturn on the 2026/27 revenue budget; and iii) approve for issue, the Directions shown in Appendix 4 to NHS Grampian and Moray Council. 7. Unaudited Annual Accounts The meeting had before it a report by the Chief Financial Officer informing the Board of the Unaudited Annual Accounts of the Moray Integration Joint Board for the year ended 31 March 2026. Councillor Scott Lawrence joined the meeting during discussion of this item. Following consideration the Committee unanimously agreed to:- Page 6
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i) approve the unaudited Annual Accounts to be submitted to the external auditor, noting that all figures remain subject to audit, in Appendix 1; ii) approve the updated Local Code of Corporate Governance which supports the Annual Governance Statement, in Appendix 2; iii) note the accounting policies applied in the production of the unaudited Annual Accounts, pages 48 to 49 of the accounts; iv) note the Annual Governance Statement contained within the unaudited Annual Accounts and in Appendix 3; and v) approve the Best Value Statements as detailed in Appendix 4. 8. External Audit Plan for the Year Ending 2025-26 and Update on Recommendations from 2024-25 The meeting had before it a report by the Chief Financial Officer informing the Board of the Audit's Annual Plan for 2025/26 and update on the recommendations following last years audit. Following consideration the Committee unanimously agreed to note the contents of the External Auditor's Annual Plan for 2025/26 and update on audit recommendations for 2024/25. 9. Moray Adult Mental Health Strategic Group Performance 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. Mr Alex Stephen joined the meeting during discussion of this item. Following consideration the Board unanimously agreed to:- i) note the progress towards achievement of the Moray Mental Health and Wellbeing Strategy 2016 – 2026; ii) acknowledge the performance of Moray Mental Health services in relation to seven key performance measures; and iii) endorse the development of a new Moray Mental Health Strategy 2026/27. 10. Annual Update on the Delivery of the Unpaid Carers Strategy 2023-28 The meeting had before it a report by the Service Manager Provider Services providing the Board with an annual update on the progress of delivery of the Moray Unpaid Carers Strategy 2023/2028. Following consideration the Board unanimously agreed to:- Page 7
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i) note the progress made during 2025–26 in delivering the objectives of the Unpaid Carers Strategy; ii) note how engagement activity, surveys and evaluations have informed the revised implementation plan and commissioned service outcomes; and iii) instruct the Lead Officer for Unpaid Carers to provide 6-monthly updates to the Audit, Performance & Risk Committee, with annual reports to Moray Integration Joint Board (MIJB). 11. Moray Alcohol and Drug Partnership - Strategic Delivery Plan 2026-29 The meeting had before it a report by the Moray Drug and Alcohol Coordinator presenting the Moray Alcohol and Drug Partnership (MADP) Strategic Delivery Plan 2026- 29 to the Board for approval. Following consideration the Board unanimously agreed to:- i) note the continued commitment of the Moray Alcohol and Drug Partnership to delivering a rights-based, trauma-informed, recovery focused, and partnership- led approach to preventing harm, reducing inequalities, promoting recovery, and improving outcomes for individuals, families, and communities affected by alcohol and drugs; ii) note that the Strategic Delivery Plan has been informed through national and local consultation activity, lived and living experience engagement, partnership review, governance discussions, and wider stakeholder feedback throughout development of the plan; iii) approve the Moray Alcohol and Drug Partnership Strategic Delivery Plan 2026– 2029 (Appendix 1); and iv) note that progress against the Strategic Delivery Plan and associated action plans will be monitored through MADP governance arrangements, with ongoing assurance and progress reporting provided to the Board and Annual Performance Report (APR) processes thereafter. 12. Hosted Services Service Level Agreements The meeting had before it a report by the Interim Strategic Lead seeking approval of the implementation of Service Level Agreements and accompanying governance and reporting arrangements for the 12 Hosted Services in Grampian. Following consideration the Board unanimously agreed to:- i) approve the implementation of the Service Level Agreements contained in Appendices 1 to 13, noting the developments highlighted in paragraph 4.6; ii) approve the approach to agreeing transformation activity detailed in paragraph 4.8; and iii) instruct the Chief Officer to submit baseline data reports to the Board meeting on 28 January 2027. Page 8
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13. Moray Annual Performance Report 2025-26 The meeting had before it a report by the Chief Officer presenting the Board with the draft Annual Performance Report 2025/26. Following consideration the Board unanimously agreed to:- i) note the draft Annual Performance Report 2025/26 at Appendix 1; ii) note that the information for national indicators will be added once published in early July, and that these additions will be approved by the Chair and Vice Chair of the Board prior to publication; and iii) approve the draft Annual Performance Report 2025/26 for publication by 31 July 2026, subject to the inclusion of the outstanding indicators. 14. Thanks The Board, in noting that Mr Jim Lyon, Interim Chief Social Work Officer was not present however it would have been his last meeting, joined the Chair in paying tribute to Mr Lyon for his contributions and wished him well for the future. Page 9
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MEETING OF MORAY INTEGRATION JOINT BOARD Thursday 25 June 2026 ACTION LOG ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 24 SEPTEMBER 2026 1. Moray Adult Mental Health Strategic Group Progress Report 29/05/25 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. 2026 IM/ER The survey will be actioned later in the year. 2. Revenue Budget Monitoring Quarter 2 for 2025-26 27/11/25 Chief Financial Officer to review report format in liaison with CFOs of Moray Council and NHS Grampian to improve assurance and accountability. Update 29/01/26: consider including activity data to evidence demand and challenges ASAP DO Report will be updated on a phased basis from Q3. Progressing. Item 4. Page 11
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 24 SEPTEMBER 2026 3. MIJB Draft Strategic Risk Register 26/03/26 When reviewed at Development Session, consideration to be given to:- i) suggested amended wording in Risk 2 from “directly impact” to indirect impact; ii) adding more information about the impact of the demographic change on services; and iii) adding more detail about the financial risk to the IJB. TBC JP/SD Development session completed August 2026. Wording updated. Action partially complete. Remaining actions to be incorporated into full refresh of register following agreed Risk Appetite 2026. 4. Revenue Budget and Recovery Plan 2026/27 26/03/26 Integrated Impact Assessments contained in Appendix 2A related to savings approved by the Board are to be updated and resubmitted for consideration by the Board as and when changes are made TBC DO Ongoing 5. Medium Term Financial Framework 2026/27-2030/31 26/03/26 i) Future reports to be considered at June Board meetings to allow March Board to focus on budget report. ii) Ensure budget is included as part of the Carers Strategy June 2027 DO Due June 2027 6. Unaudited Annual Accounts 25/06/26 Suggest adding standing Item to be added to Audit, Performance and Review Committee agendas to monitor progress of audit actions for additional scrutiny in terms of assisting auditor come to better outcomes. Ongoing DO New Corporate Assurance group report to APR Sept 2026. Also discussed at Board Development Session in August 2026. Action closed. Page 12
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ITEM NO. TITLE OF REPORT ACTION REQUIRED DUE DATE ACTION BY UPDATE FOR 24 SEPTEMBER 2026 7. Moray Adult Mental Health Strategic Group Performance Report 25/06/26 i) Expected outcomes and timescales in plan to be sharpened ii) Report on bed base review to be included on next IJB agenda iii) Strengthen narrative in future reports to ensure explanations for performance indicator figures iv) Format of future IJB development sessions to be reviewed to allow for increased interaction/engagement with Board members. ASAP 24 Sept 2026 TBC ASAP IM IM IM JP Deferred to 26 Nov 2026 8. Annual Update on the Delivery of the Unpaid Carers Strategy 2023-28 25/06/26 Review to ensure next iteration of action plan uses appropriate methodology to ensure accurate evidence of progress and identification of gaps, suggestion of adding thresholds to Pentana system. TBC MF Feedback taken and will be incorporated into next report. Action Closed. 9. Hosted Service Level Agreements 25/06/26 Discuss adopting proportionate risk based approach with COs of Aberdeenshire and Aberdeen City HSCPs November 2026 JP Report scheduled. Page 13
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MINUTE OF MEETING OF THE AUDIT, PERFORMANCE AND RISK COMMITTEE Thursday, 26 February 2026 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Mr Sean Coady, Ms Sonya Duncan, Councillor Scott Lawrence, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Mr Sandy Riddell, Councillor Ben Williams APOLOGIES Ms Aimee McIntosh, Mr Michael Ritchie IN ATTENDANCE Deputy Head of Service; Interim Head of Service and Chief Social Work Officer; Chief Internal Auditor, Self-Directed Support and Unpaid Carers Team Manager; Service Manager Provider Services; Service Manager Primary Care Contracts; Andrew Wallace, Grant Thornton and Caroline O'Connor, Committee Services Officer 1. Chair The meeting was chaired by Councillor Ben Williams. 2. Declaration of Member's Interests The Committee noted there were no declarations of member's interests. 3. Minute of meeting of 29 October 2025 The minute of the meeting of 29 October 2025 was submitted and approved. 4. Action Log of 29 October 2025 The Action Log of the meeting of 29 October 2025 was discussed and updated accordingly. Item 5a. Page 15
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5. Quarter 2 (July-September 2025) Performance Report - Adult Services The meeting had before it a report by the Corporate Programme Manager updating Committee on performance as at Quarter 2 2025 (July - September). Councillor Lawrence asked for more detailed information regarding the high numbers of cases awaiting assessments for Attention Deficit Hyper Disorder (ADHD) referenced in para 4.13 including the numbers of people being diagnosed and numbers receiving clinical interventions in order to provide a wider understanding of the increasing numbers of people seeking ADHD diagnosis. In response, the Depute Chief Officer advised information would be contained in the report on the development of mental health services due to be presented to the Board in March 2026, however noted the report would now be reported to the Board in May 2026. In the meantime a development session would be held with the Board to provide more in depth details of the improvement work being undertaken and how that sits from a national perspective. Mr Riddell queried why the long awaited report on the development of mental health services was now not to be considered at the March Board meeting. In response, the Chief Officer advised the March meeting was the budget setting meeting and, while there may be an option to hold a Special meeting of the Board in late April, a development session would provide an update and deeper dive before the paper comes to the Board in May. Noting the Board's significant concerns regarding mental health and, while an informal briefing to confirm what is being delivered and the changes being made would be helpful in advance of the formal report, Mr Riddell noted the importance of timescales in relation to mental health as there were likely to be some formal processes involved. Following consideration the Committee unanimously agreed to note the performance of local indicators for Quarter 2 (July to September 2025), against for 2025/26, as presented in the report. 6. Quarter 2 (July to September 2025) Performance Report for Children and Families and Justice Social Work The meeting had before it a report by the Interim Chief Social Work Officer/Head of Service informing the Committee on Children and Families and Justice Social Work performance as at Quarter 2 (July to September 2025). In introducing the report the Interim Chief Social Work Officer acknowledged the report was lengthy, containing very detailed information and sought guidance from the meeting as to whether they would wish future reports to be reduced in terms of the detail provided. During discussion members of the Committee agreed shorter, more focussed reports be prepared for future meetings. Following consideration the Committee unanimously agree to note:- i) the performance of local indicators for Quarter 2 as presented in the Performance Report at Appendix 1; and ii) the analysis of the local indicators as detailed in Appendix 1. Page 16
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7. Internal Audit Section - Update Report The meeting had before it a report by the Chief Internal Auditor providing Committee with an update on the work of the Internal Audit Section. Following consideration the Committee unanimously agreed to note the audit update. 8. Internal Audit Section Completed Projects Report The meeting had before it a report by the Chief Internal Auditor providing an update on audit work completed since the last meeting of the Committee. Mr Riddell expressed concern at the findings of the Absence Management audit in Appendix 1, specifically the numbers of managers who had undertaken training relating to the Health and Work Policy, the high numbers of those audited who were not complying with policies and the long hours worked by some staff and risk and legal responsibilities/liabilities regarding how absence is managed. He suggested that the agreed actions which stated staff were to be "reminded" were insufficient and training should be mandatory rather than voluntary. In response the Chief Internal Auditor confirmed the indicators of serious concerns had been contained in the report had been presented to the Council's Corporate Leadership Team who had recognised the issues to be addressed were adopting a transformational project to address the issues. The Chief Officer noted the audit undertaken was a Council audit and whilst half of the IJB employees were Council staff, further work was required to understand how to manage it for all staff with the health and social care partnership and would be reported back to this Committee to provide assurance. Councillor Lawrence, as Chair of the Council's Audit and Scrutiny Committee, confirmed the report had been discussed in detail with similar concerns expressed at that Committee and initiatives had been introduced to address the issues and lessons learned from the Council would be shared with the partnership. Following consideration the Committee unanimously agreed to note the audit update. 9. Update on the Delivery of the Unpaid Carers Strategy The meeting had before it a report by the Service Manager, Provider Services providing Committee with an update on the progress in delivering the Moray Unpaid Carers Strategy highlighting key activities, developments, and outcome achieved during the reporting period. Mr Murray suggested it would have been useful to have heard the unpaid carers representatives views on the report however noted they were not members of this Committee. In response, the Corporate Manager confirmed consideration was being given to including the unpaid carer representatives on the Committee whilst also ensuring the Board were not placing undue pressure on stakeholder members and a report would come back to a future meeting of the Board. Following consideration the Committee unanimously agreed to note:- Page 17
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i) the progress made to date in delivering the objectives of the Unpaid Carers Strategy; and ii) the findings of the evaluation of the Maryhill Practice Unpaid Carer Project (Appendix A). 10. Moray Integration Joint Board Draft Strategic Risk Register The meeting had before it a report by the Chief Officer presenting the Committee with the updated draft Moray Integration Joint Board Strategic Risk Register, providing a clear overview of current strategic risks, their assessments and mitigating actions which supports information decision-making, strengthens planning and reinforces effective risk governance aligned with the Strategic Plan. Mr Murray asked firstly whether changes to the Risk Register could be highlighted in future to easily identify changes made and secondly, queried whether the Committee were willing to accept Risk 2 as being a moderate risk for Risk Appetite given the financial pressures both NHS Grampian and Moray Council were facing. In response to the first point, the Corporate Manager advised consideration would be given on how best to highlight changes in the Risk Register and in relation to the second query, confirmed the Risk Appetite had been agreed by the Board in October 2025 however it may now be appropriate to review the Board's risk statement given the challenging financial circumstances of both partners. The Chief Officer agreed it was important to review in terms of how that would impact the Risk Appetite for change and transformation and would therefore arrange to schedule a session to discuss the Board's Risk Appetite statement. Following consideration the Committee unanimously agreed: i) to note the Board Strategic Risk Register; and ii) the mitigating controls and assurance arrangements are adequate. 11. Internal Audit Plan Year Ending 31 March 2027 The meeting had before it a report by the Chief Internal Auditor providing the Committee with information on the proposed internal audit coverage for the 2026/27 financial year. Following consideration the Committee unanimously agreed to note:- i) the proposed internal audit coverage for the 2026/27 financial year; and ii) the proposed Internal Audit Plan for 2026//27 attached as Appendix 1. 12. Payment Verification The meeting had before it a report by the Head of Service / Deputy Chief Officer providing an update on the review of the Payment Verification Assurance Service provided by National Services Scotland Practitioner Services Divisions, on behalf of NHS Grampian. Following consideration the Committee unanimously agreed to:- Page 18
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i) note the arrangements in place in Grampian for the management of the payment verification process; and ii) note the actions already taken to address outstanding issues, with plans for future action to include an update on progress to this Committee annually. 13. Unscheduled Care - Home Assessment Pathway The meeting had before it a report by the Head of Service informing Committee of the successful bid to implement a Moray Home Assessment Pathway, highlighting how the development supports the delivery of the Moray Integration Joint Board's strategic priorities as outlined in the Strategic Plan, as well as contributing to the nine national Health and Wellbeing Outcomes. Councillor Lawrence asked whether key performance indicators would allow evaluation of the effectiveness of the pathway as opposed to the work already being done that was described in the performance report to evidence the successfulness of the funding received. In response, the Chief Officer confirmed the key performance indicators were included in the application for funding and would be used to evidence the quantitative impact and outcomes. Following consideration the Committee unanimously agreed:- i) to note the content of the report; and ii) that the pathway aligns with and supports the aspirations of the Moray Integration Joint Board's Strategic Plan in relation to Home First. 14. Items for Escalation to MIJB The Committee noted that there were no items for escalation to the Moray Integration Joint Board. 15. Thanks The Committee, in noting that Councillor Ben Williams was standing down from the Moray Integration Joint Board following the March meeting of the Board, joined the Chief Officer in pay tribute to Councillor Williams for his contribution as Chair of this Committee and wished him well for the future. Page 19
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MINUTE OF MEETING OF THE CLINICAL AND CARE GOVERNANCE COMMITTEE Thursday, 28 May 2026 Council Chambers, Council Office, High Street, Elgin, IV30 1BX PRESENT Councillor Peter Bloomfield, Mrs Sheila Brumby, Ms Helen Chisholm, Ms Miriam Connor, Councillor Scott Lawrence, Dr Robert Lockhart, Ms Aimee McIntosh, Mr Derick Murray, Ms Deborah O'Shea, Ms Judith Proctor, Ms Elizabeth Robinson, Mrs Christine Stevens APOLOGIES Professor Duff Bruce, Mr Sean Coady, Mr Jim Lyon, Mr Alex Stephen IN ATTENDANCE Chief Nurse; Public Health Consultant, NHS Grampian and Caroline O'Connor, Committee Services Officer SUBSTITUTES Mr Sandy Riddell (for Mr Alex Stephen) 1. Chair The meeting was chaired by Mr Derick Murray. 2. Declaration of Member's Interests There were no declarations of Member's interests in respect of any item on the agenda. 3. Minute of meeting of 26 February 2026 The minute of the meeting of 26 February 2026 was submitted and approved. Item 5b. Page 21
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4. Action Log - 26 February 2026 The Action Log of the meeting of 26 February 2026 was discussed and updated accordingly. 5. Health and Social Care Moray Clinical and Care Governance Group Escalation Report The meeting had before it a report by the Chief Nurse - Moray informing Committee of progress and exceptions reported to the Clinical and Care Governance Group since the last report to Committee in February 2026. Following consideration the Committee unanimously agreed to note the contents of the report. 6. Complaints Report for Quarter 4 2025-2026 The meeting had before it a report by the Chief Nurse - Moray informing the Committee of complaints and feedback reported and closed during Quarter 4 (1 January 2026 - 31 March 2026). Following consideration the Committee unanimously agreed to note the totals, lessons learned, response times and action taken for complaints completed within the last quarter of 2025/26. 7. Grampian Vaccination and Immunisation Annual Report 2025 The meeting had before it a report by the Vaccination Planning Manager and Public Health Consultant informing the Committee of the Annual Vaccination and Immunisation Report for NHS Grampian to provide an annual monitoring report of vaccine preventable disease surveillance data, along with uptake data for each vaccine delivered within NHS Grampian. Following consideration the Committee unanimously agreed to:- i) note the findings of the Vaccination and Immunisation Annual Report 2025 attached as Appendix 1; ii) acknowledge the importance of vaccination in primary prevention for the citizens of Moray; iii) acknowledge the requirement for a longer-term premises to ensure delivery and continued uptake of the vaccination programme in Moray; iv) acknowledge that a process will be established to review vaccination activity against vaccination staffing resource so that vaccination funding aligns with vaccination activity; v) acknowledge the Directions 2025 which once again confirm design and delivery of vaccination services is a responsibility of NHS Grampian; and vi) instruct the Chief Officer to provide an annual monitoring report to the Committee in 2027. Page 22
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8. Items for Escalation to MIJB The Committee noted that there were no items for escalation to the Moray Integration Joint Board. Page 23
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: MORAY INTEGRATION JOINT BOARD MEETING SCHEDULE BY: INTERIM CORPORATE MANAGER 1. REASON FOR REPORT 1.1 To ask the Board to agree a change to the current meeting schedule for 2026/27 and to agree the meeting dates for 2027/28. 2. RECOMMENDATION 2.1 It is recommended the Board: i) agrees that the scheduled Moray Integration Joint Board (MIJB) development session on 26 November 2026 be redesignated as a formal MIJB meeting, with the development session instead taking place on 28 October 2026; ii) agrees that the scheduled MIJB development session on 17 February 2027 be redesignated as a formal MIJB meeting, with the development session instead taking place on 28 January 2027; and iii) endorses the schedule of meetings for the MIJB, the Audit, Performance and Risk (APR) Committee and the Clinical and Care Governance (CCG) Committee for 2027/28, noting meetings scheduled from January to March 2028 are endorsed in principle 3. BACKGROUND 3.1 Meetings of the MIJB, APR Committee and CCG Committee utilise a hybrid model of, in person and remote attendance. The Council’s committee meeting system 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. 3.2 At their meeting on 19 June 2025 (para 7 of minute refers) the MIJB approved the proposed reduction in the number of formal meetings from 18 to 15 per year, and Item 6. Page 25
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agreed to meetings starting at 1000hrs on days where only one meeting is being held. 3.3 To enable APR Committee to recommend the submission of the unaudited annual accounts and audited annual accounts to MIJB for approval, the June and September APR Committee meetings take place in the morning and the MIJB in the afternoon. 4. KEY MATTERS RELEVANT TO RECOMMENDATIONS 4.1 The proposed change to the current timetable reflects the timing of key performance reporting, as the data required for discussion and scrutiny will not be available in time for an October or January Board meeting. 4.2 A proposed timetable of Board and Committee meetings for 2027/28 including MIJB development sessions is attached at Appendix 1. 4.3 The meeting schedule is established with the intention to ensure key dates for formal business are accounted for and to avoid the creation of Special meetings and conducting formal business during development sessions. 4.4 The draft schedule of Council committees from May to December 2027 is being presented to Moray Council for approval on 30 September 2027, following the Local Government Elections in May 2027 to allow the new Council to complete a Committee cycle prior to agreeing a timetable until April 2032. As the period covers the budget setting process and any Council meetings in connection with the budget would take precedence, the MIJB schedule of meetings from January to March 2028 requires to be approved in principle until the Council timetable for the same period is agreed. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The scheduling of appropriate meetings facilitates good governance arrangements and supports the delivery of the Strategic Plan. The proposal demonstrates a proactive approach to governance improvement, supporting transparency, efficiency and member wellbeing. (b) Policy and Legal In terms of the Standing Orders section 4.1, approved by the Board at its meeting on 28 June 2018 (para 5 of the Minute refers), the Board is to approve annually a forward schedule of meeting dates for the following year. (c) Financial implications 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. Page 26
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(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 no implications in terms of Council or NHS property directly arising 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 The 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. (i) Directions None directly arising from this report. (j) Consultations Consultations have been undertaken with the following who agree with the content of this report where it relates to their area of responsibility: • Corporate Manager (Interim) • Chief Officer • Chief Financial Officer • Caroline O’Connor, Committee Services Officer • MIJB Internal Auditor 6. CONCLUSION 6.1 The MIJB is asked to agree the change to the current timetable and to endorse the schedule of meetings, as attached at Appendix 1. Authors of Report: Isla Whyte, Corporate Business Support Manager, HSCM Background Papers: Ref: Page 27
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APPENDIX 1 Proposed Meeting Dates 2027/28 DATE MEETING TYPE TIMES 29 April 2027 Moray Integration Joint Board Development Session 10:00 to 12:30 27 May 2027 Clinical & Care Governance Committee 10:00 to 12:30 24 June 2027 Audit, Performance and Risk Committee 09:30 to 12:00 24 June 2027 Moray Integration Joint Board 13:30 to 16:00 19 August 2027 Moray Integration Joint Board Development Session 10:00 to 12:30 26 August 2027 Clinical & Care Governance Committee 10:00 to 12:30 30 September 2027 Audit, Performance and Risk Committee 09:30 to 12:00 30 September 2027 Moray Integration Joint Board 13:30 to 16:00 28 October 2027 Moray Integration Joint Board Development Session 10:00 to 12:30 25 November 2027 Moray Integration Joint Board 10:00 to 12:30 27 January 2028 Moray Integration Joint Board Development Session 10:00 to 12:30 17 February 2028 Moray Integration Joint Board 10:00 to 12:30 24 February 2028 Audit, Performance and Risk Committee 09.30-12:00 Page 28
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APPENDIX 1 24 February 2028 Clinical & Care Governance Committee 13:30 to 16:00 30 March 2028 Moray Integration Joint Board 10:00 to 12:30 Page 29
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: BOARD MEMBERSHIP AND STAKEHOLDER MEMBER GOVERNANCE ARRANGEMENTS BY: INTERIM CORPORATE MANAGER 1. REASON FOR REPORT 1.1 To inform the Board of legislative changes introducing voting rights for stakeholder members of the Moray Integration Joint Board (MIJB). To seek agreement to the proposed membership arrangements required to implement those changes and inform the Board of changes to Membership of the Moray Integration Joint Board (MIJB), Audit, Performance and Risk (APR) Committee and Clinical and Care Governance (CCG) Committee. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) notes the introduction of voting rights for stakeholder members through the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025; ii) agrees that the existing arrangement for two Unpaid Carer Stakeholder representatives will continue as a single stakeholder member role on a job-share basis; iii) agrees that, where the Unpaid Carer Stakeholder role is fulfilled on a job-share basis, only one designated representative may participate as the voting member at any Board meeting; iv) approves the Stakeholder Member Role Profile attached at Appendix 1, and; v) notes the updated membership of the Board and its Committees attached at Appendix 2, including the changes identified in the notes column, these are summarised for transparency and audit trail purposes. Item 7. Page 31
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3. BACKGROUND 3.1 The Public Bodies Joint Working (Scotland) Act 2014 (“the Act”) and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (“the Order”) make provision for the operation, governance and membership of the MIJB. As a minimum this must comprise voting members nominated from the NHS Board and Council; co-opted non-voting members who are holders of key posts with the NHS and Council or the MIJB; and co-opted non-voting members who are representatives of groups who have an interest in the MIJB. There is flexibility to appoint additional non-voting members as the Board sees fit. The Moray Health and Social Care Integration Scheme (“Integration Scheme”) outlines certain agreed provisions re membership (and includes the specific provisions taken from the Act and the Order). 3.2 Following the conclusion of the previous term of office, Shona Scott has been nominated through the agreed Moray Council staff representative nomination process and will join the MIJB as Staff Representative with effect from 24 September 2026. 3.3 At its meeting on 27 November 2025 (para 9 of minute refers), the Board agreed to increase the number of Unpaid Carer Stakeholder representatives from one to two, at a time when stakeholder members were non-voting members of the Board. 3.4 Following recent legislative changes, stakeholder members of IJBs will be granted voting rights, placing them on an equal footing with existing voting members and introducing collective responsibility for Board decisions. This change is introduced through the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Amendment Order 2025. 3.5 This represents a significant shift from previous arrangements and requires existing membership structures to be reviewed to ensure they remain appropriate and governance compliant. 3.6 It is proposed that the two unpaid carer representatives continue to fulfil a single stakeholder member role on a job‑share basis, ensuring continuity of representation while maintaining clarity in relation to: • voting rights; • quorum; and • collective accountability. 3.7 This approach reflects the original intention to broaden representation while aligning with the requirements of decision‑making as a voting member of the Board. 4. KEY MATTERS RELEVANT TO RECOMMENDATIONS 4.1 Staff Representative nomination Page 32
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Shona Scott has been nominated as the Moray Council Staff representative to the Board and its associated committees. This is a routine membership change and supports continued staff representation within the Board’s governance arrangements. Governance implications of voting status 4.1 The introduction of voting rights requires clarification of: • membership status; • participation in committees; • voting arrangements; and • accountability as members of a public body. 4.2 Stakeholder members will be expected to participate as full members of the Board. Arrangements for participation in committees, attendance, proxies and voting will be formalised through revised Standing Orders, committee Terms of Reference and associated governance documentation. Stakeholder Member Role Profile 4.3 The introduction of voting rights represents a significant change to the role of stakeholder members. A revised Stakeholder Member Role Profile has therefore been developed to clarify the purpose of the role, governance responsibilities, collective accountability, conduct expectations and role boundaries. The profile reflects stakeholder members' status as full voting members of the MIJB whilst recognising the distinct perspectives they bring through lived experience, unpaid caring responsibilities and third sector engagement. The profile has been reviewed by Legal Officers and shared with stakeholder members and is attached at Appendix 1 for approval. Committee participation 4.4 Committee membership reflects the current approved position. Further changes to committee membership including stakeholder member representation, will be brought forward separately following confirmation of the revised membership arrangements. Job-share arrangements 4.5 To support the continuity and sustainability of the unpaid carer role: • the position will constitute a single Board membership; • both individuals will share the responsibilities associated with the role; and • only one designated representative will participate in proceedings and exercise voting rights at any Board meeting. Alignment with previous Board decision 4.6 The proposed approach ensures that: • the original intent to broaden unpaid carer representation is retained; • governance clarity is maintained under the new voting framework; and • the number of voting positions is not increased beyond those previously agreed. 5. SUMMARY OF IMPLICATIONS Page 33
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(a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032” Effective governance arrangements support the development and delivery of priorities. (b) Policy and Legal The report reflects legislative changes relating to IJB membership. Consequential amendments to Standing Orders and associated governance documentation will be brought forward separately to support implementation and provide clarity regarding committee participation and governance arrangements. (c) Financial implications There are no financial implications arising as a direct result of this report. (d) Risk Implications and Mitigation There are no significant risk implications arising directly from this report. Governance risks associated with the introduction of voting rights for stakeholder members will be mitigated through updated Standing Orders, Committee Terms of Reference and associated governance documentation. (e) Staffing Implications There are no staffing implications arising as a direct result of this report. (f) Property There are no property implications arising as a direct result of this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required as the report relates to governance and membership arrangements and does not propose a change to service delivery. The proposed arrangements support inclusive decision making by recognising stakeholder perspectives, including lived experience. (h) Climate Change and Biodiversity Impacts None arising from this report. (i) Directions None arising from this report. (j) Consultations Consultation on this report has taken place with the MIJB Chief Officer, the Legal Officer to the Board and Caroline O’Connor, Committee Services Officer, Moray Council. 6. CONCLUSION Page 34
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6.1 This paper sets out the required changes to membership and governance arrangements in light of the introduction of voting rights for stakeholder members, and provides a clear and proportionate approach to implementing these changes within the existing governance framework. Author of Report: Sonya Duncan, Interim Corporate Manager Background Papers: None Ref: Page 35
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APPENDIX 1 Draft Voting Stakeholder Member Role Profile Role Title IJB Stakeholder Member – Voting Member Purpose of the Role Stakeholder voting members are full members of the Moray Integration Joint Board (MIJB) with equal voting rights and collective responsibility for MIJB decisions. They contribute lived experience, Third sector, carer and community perspectives to support informed, balanced and lawful decision-making in pursuit of improved outcomes for people and communities. Status This represents a change from previous stakeholder member status, where individuals contributed to discussions but did not hold voting rights or collective decision-making accountability. • Appointed as a full voting member of the IJB in accordance with the Public Bodies (Joint Working) (Scotland) Act 2014 as amended. • Act in the best interests of the people of Moray, supporting decisions that contribute to the overall strategic objectives of the IJB. • Not an employee of the IJB, Local Authority or NHS Board. • Holds the same voting rights and collective accountability as other voting members. Key Responsibilities • Decision-making and accountability o Participate fully in IJB meetings and decision-making, including voting on matters before the Board. o Share collective responsibility for decisions taken by the IJB as a public body. • Governance and conduct o Act in accordance with the IJB’s Code of Conduct, Standing Orders and relevant statutory duties. o Declare interests and manage conflicts appropriately. o Respect confidentiality and information governance requirements. • Perspective and insight o Bring insight informed by lived experience, caring roles, or third sector knowledge to Board discussions. o Contribute constructively, recognising the strategic and corporate nature of MIJB decision-making. • Engagement (non-mandated) o Maintain awareness of issues affecting relevant communities and groups. Engagement may include listening exercises, events or informal networks, to support understanding of emerging themes and experiences. Page 36
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APPENDIX 1 o Stakeholder members contribute a collective and strategic perspective, informed by lived experience and engagement with relevant communities (e.g. unpaid carers). The role is to reflect a broad range of views and experiences, identifying common themes and system issues to inform Board discussion and decision-making. o There is no mandate to act as a delegate or spokesperson for specific individuals or organisations. Stakeholder members do not represent individual cases but instead contribute insight to support collective decision making at Board level. o This is not an advocacy or casework role. Stakeholder members are not involved in operational decision making. The role is to inform and influence at a strategic level, rather than to represent or resolve individual cases. Commitment and Support • Attendance at MIJB meetings, including appropriate preparation and consideration of Board papers in advance. • Participation in induction, governance training and ongoing development, including support linked to the transition to voting membership. Page 37
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APPENDIX 2 Moray Integration Joint Board – as at 24 September 2026 Moray Integration Joint Board 4 Council voting members Bridget Mustard (Vice-Chair) John Divers Peter Bloomfield Scott Lawrence 4 NHS Grampian voting members Dennis Robertson (Chair) Derick Murray Sandy Riddell Alex Stephen Third Sector Stakeholder (now voting member) Aimee McIntosh Unpaid Carer Stakeholders (now voting member) Miriam Connor Christine Stevens People Receiving Services Stakeholder (now voting member) Sheila Brumby NHS Grampian Staff Representative Michael Ritchie Moray Council Staff Representative Shona Scott (appointed to vacancy) Chief Officer Professional Judith Proctor Chief Social Work Officer Stephen Morgan (replacing Jim Lyon) Lead Nurse Jane Ewen GP Lead Dr Robert Lockhart Non Primary Medical Services Lead Mr Duff Bruce Additional Member Elizabeth Robinson Audit, Performance and Risk Members (note chair needs to be alternate partnership member to the Chair of MIJB) 2 Council voting members Scott Lawrence (Chair) John Divers 2 Health Board voting members Sandy Riddell Derick Murray Third Sector Stakeholder Aimee McIntosh NHS Grampian Staff Representative Stakeholder Member Michael Ritchie Clinical and Care Governance Members 2 Council voting member Cllr Peter Bloomfield Cllr Scott Lawrence 2 Health Board voting member (Chair) Derick Murray (Chair) Alex Stephen (Sandy Riddell 25/1/24 temporary) Unpaid Carer Stakeholders Miriam Connor Christine Stevens People Receiving Services Stakeholder Sheila Brumby Third Sector Stakeholder Aimee McIntosh Page 38
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APPENDIX 2 Moray Council Staff Representative Shona Scott Chief Officer Professional Judith Proctor Chief Social Work Officer Stephen Morgan Lead Nurse Jane Ewen GP Lead Dr Robert Lockhart Non Primary Medical Services Lead Prof Duff Bruce Additional Member Elizabeth Robinson Page 39
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DRAFT REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: REVENUE BUDGET MONITORING QUARTER 1 FOR 2026/27 BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To update the Moray Integration Joint Board (MIJB) of the current Revenue Budget reporting position as at 30 June 2026 for the MIJB budget. 2. RECOMMENDATIONS 2.1 It is recommended that the Board: i) Note the financial position of the Board as at 30 June 2026 is showing an overspend of £1,615,394 on core services; ii) Note the first provisional forecast position for 2026/27 of an overspend of £8,975,832 on total budget, which is within the parameters of the additional £9m of funding from the partners as part of budget setting; iii) Note the progress against the approved savings plan in paragraph 7, and Appendix 4; iv) Note the budget pressures and emerging budget pressure as detailed in paragraph 8; v) Note the revisions to staffing arrangements dealt with under delegated powers and in accordance with financial regulations within the Council (MC) and NHS Grampian (NHSG) for the period 1 April to 30 June 2026 as shown in Appendix 3; and vi) Note the Health and Social Care Scotland paper on IJB Financial position across Scotland, as detailed in Appendix 5. Item 8. Page 41
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3. BACKGROUND 3.1 The financial position for the MIJB services at 30 June 2026 is shown at Appendix 1. The figures reflect the position in that the MIJB core services are currently overspent by £1,615,394. This is summarised in the table below: Annual Budget £ Budget to date £ Expenditure to date £ Variance to date £ MIJB Core Service 200,124,119 49,757,477 51,372,871 (1,615,394) MIJB Strategic Funds 12,963,207 1,202,279 1,560,182 (357,903) Set Aside Budget 20,092,000 - - - Total MIJB Expenditure 233,179,326 50,959,756 52,933,053 (1,973,297) 3.2 The first provisional forecast outturn to 31 March 2027 is included in Appendix 1. The figures reflect the overall position in that the MIJB core services are forecast to be overspent by £7,018,313 by the end of the financial year. This is summarised in the table below: Annual Budget £ Forecast expenditure to 31 Mar 27 £ Variance to 31 Mar 27 £ MIJB Core Service 200,124,119 207,142,432 (7,018,313) MIJB Strategic Funds 12,963,207 14,920,726 (1,957,519) Set Aside Budget 20,092,000 20,092,000 0 Total MIJB Expenditure 233,179,326 242,155,158 (8,975,832) 3.3 A list of services that are included in each budget heading are shown in Appendix 2 for information. 4. KEY MESSAGES 4.1 The MIJB position as at 30 June 2026 is £1.97m overspend with a first provisional forecast year end out turn of £8.97m. This position is within the parameters of the funding from the partners agreed as part of the budget setting for 2026/27. £9m additional funding was agreed in the budget, which is not included in the above figures. If this funding is included, then the position at 30 June 2026 would be a slight underspend of £0.27m and year end forecast of £0.024m. The June reported financial position for the 3 months of the financial year shows: • MIJB is overspent by £1.97m for the first 3 months of the financial year (Q1 in 2025/26 MIJB was overspent by £2.02m); • The forecast outturn for the year is currently within the £9m provision in the partners accounts and a range of actions to continue to mitigate this risk and deliver further cost reductions are being progressed; • Estimated savings delivered to date total £0.661m against planned full year savings of £5.7m. • New cost pressures, not reflected in the budget, totalling £0.161m have been identified in the first 3 months of the financial year; Page 42
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2026/27 Revenue Position 4.2 MIJB is reporting a forecast position for the year end of an overspend of £8.98m, which is within the parameters of the partners additional funding. Table 1: Movement in Forecast Outturn 2026/27 2025/26 Outturn 2026/27 At Q1 (June) Core services (£5.35m) (£7.02m) Strategic funds (£1.85m) (£1.96m) MIJB Total Outturn (£7.2m) (£8.98m) Savings programme 4.3 Both year to date and forecast, savings delivery have been reviewed based on June delivery. Some savings have been delayed until later in the year resulting in a potential reduction achieved in this financial year of £1.6m. Most of the savings proposals this year will be reduction in overspends as budget realignment has not been possible this year and not all proposals are expected to have an impact in the first quarter. All savings proposals are being reviewed and new savings being identified to progress in this financial year. Progress against the total savings programme for the year to date and current forecast full year savings are summarised in the table below. Table 2: Savings and budget reductions Full year plan Full Year forecast Year to date plan Year to date savings SAVINGS £5.7M £4.1M £0.7M £0.7M Both the saving forecast and the overall financial forecast continue to be reviewed in detail on a monthly basis and it is anticipated that the forecast financial outturn will improve as further assurance is gained on savings delivery for higher risk schemes along with the ongoing grip and control measures put in place last financial year. Further details on the savings can be found in Appendix 4 and details are found in para 7 below. 4.4 Health and Social Care Scotland have published a report on the IJB Financial position update 2026/27, this is attached at Appendix 5. The key messages continue from the previous years report which shows an unsustainable position for 2026/27 with a financial pressure of £475m across all Scotland’s health and social care systems. Without any additional recurring funding, high impact reductions will be felt in year, with savings being directly felt as service Page 43
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reductions and the impact of this will not be contained within IJB budgets but also across the whole system. Whilst this is good to know that Moray is not an outlier, it does not resolve the significant pressure on the MIJB budget. 5. KEY MATTERS/SIGNIFICANT VARIANCES FOR 2026/27 Community Hospitals 5.1 The Community hospital budget is overspent by £245,432 to 30 June 2026. This relates to Seafield hospital £53,053; Turner hospital £22,593; Forres £15,007; and Stephen hospital £15,539 relating to property, medical supplies and energy costs. Overspend in nursing costs at Seafield and Turner hospital (partly due to surge costs) and Grampian Vaccination Improvement Programme (GVIP) £114,765 and admin costs £28,814 with some minor underspends totalling £4,339. 5.2 This budget is forecast to be £892,048 at the end of the year due to a continuation of the above nursing and property cost overspends. Currently forecasted overspend will be in line with the prior year. Mental Health 5.3 The mental health budget is overspent by £306,026 to 30 June 2026. This relates to staff overspend of £251,477 primarily due to the continued use of locum consultants, overspend related to Mental Health Act activity including Admin, Occupational Therapy and Psychology and an overspend of £54,549 in Assessment and Care packages. 5.4 The Certificate of Eligibility for Specialist Registration (CESR) fellows unfortunately did not provide a solution to service medical staffing challenges and as such have not allowed the expected financial savings to be achieved in 2025/26. One CESR fellow has left in July 2025 and a NHS locum is still in place. Alternatives are currently being investigated to reduce this cost further in this financial year. The centralisation of the Grampian mental health and learning disabilities medical budget, overseen by the Associate Medical Director for Mental Health, will allow for greater oversight of the financial position and shared decision making in relation to future recruitment. 5.5 This budget is forecast to be £762,405 overspent by the end of the financial year, due to the above issues continuing. Older People and Physical Sensory Disability (Assessment & Care) 5.6 This budget is overspent by £640,041 to 30 June 2026. This primarily relates to overspend in permanent care home placements of £176,115. This is due to most placements now being for nursing care and this is charged at a higher rate rather than residential care, and external care at home and short breaks £452,256 in the West team. There are also other minor variances of £11,670 relating to rent and rates and materials. The variances within this overall budget reflect the shift in the balance of care to enable people to remain in their homes for longer. 5.7 External care purchasing remains a high cost due to several operating factors including rising wages and energy costs, and this impacts the overall cost of care. Page 44
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The population is ageing and more people are living with complex needs, leading to a higher number of individuals requiring care, and requiring greater levels of care. 5.8 This budget is forecast to be £797,830 overspent by the end of the financial year, due to the above-mentioned issues expected to continue to the end of the year. These are demand led services where slowing spend would have an impact on people and organisational performance. Primary Care Prescribing 5.9 This budget is underspent by £418,597 at 30 June 2026, this position is based on only one month’s actuals for April and an accrued position for May and June as information is received 2 months in arrears. The underspend is primarily driven by a lower per-item cost of £11.20 and lower than expected growth in prescribing activity compared with February and March 2026. The position has also benefited from the reintroduction of the discount from the start of the financial year alongside lower prescribing growth in April. The emerging volume pattern for 2026/27 will require to be monitored. An average anticipated growth in prescribing volume of 0.15% and an average item price of £11.26 has been used to estimate position to June. This is a volatile budget and until more actuals are available the forecast position remains at breakeven. 6. STRATEGIC FUNDS 6.1 Strategic Funds are additional funding 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 the overall MIJB financial position at year end which then needs to be earmarked as a commitment for the future year). • Provisions for earmarked reserves have been made to fund unscheduled care funding and GP Walk-in centres funding, additional investment funding and others in 2025/26, identified budget pressures, new burdens, savings and general reserve that were expected at the start of the year. 6.2 Within the strategic funds are earmarked reserves totalling £3,010,434. However, there will not be enough reserves to cover the overspend in total if the level of spend continues until 31 March 2027. 6.3 Also within strategic funds are provisions for known budget pressures at the start of the financial year including a provision for recurring budget over and underspends totalling £19,053,686. 6.4 By the end of the financial year, the Strategic Funds will reduce as the commitments and provisions materialise, and the core budgets will increase correspondingly. 7. PROGRESS AGAINST THE APPROVED SAVINGS PLAN Page 45
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7.1 The Revenue Budget 2026/27 was presented to the Board on 26 March 2026 (para 11 of the minute refers). The paper presented a balanced budget through the identification of efficiencies through savings and the use of reserves. 7.2 The progress against the recovery plan is detailed in Appendix 4 and summarised in the table below and will continue to be reported to the Board during the 2026/27 financial year. The table details progress during the first quarter against the original savings plan. A significant number relate to reductions in overspending rather than being actual savings to be taken. Efficiencies Para Ref Full Year Target Savings expected progress at 30 June 2026 Savings actual progress at 30 June 2026 Reduction in overspend expected at 30 June 2026 Full Year Forecast £’000 £’000 £’000 £’000 £’000 Building Resilience 7.3 1,957 76 76 77 1,464 Home first 7.4 279 17 17 5 79 Partners in Care 7.5 1,197 68 68 85 640 Already implemented/ enablers 7.6 2,285 311 311 22 1,935 Total Projected Efficiencies 5,718 472 472 189 4,118 7.3 There are 10 projects under the heading of building resilience, of which 5 will achieve a budget saving with the other 5 being a reduction in overspend. 4 of the projects are forecast to have potentially slipped: 2 have a red Red/Amber/Green (RAG) status relating to removal of locum costs and review of care and care commissioning with the other 2 having an amber RAG status relating to cessation of leases and Children, Families and Justice review of service, with work ongoing looking into these areas. The potential impact could be a £493,000 saving not achieved in year with slippage into next financial year of £453,000. 7.4 There are 4 projects under the heading for Home First, of which 2 will achieve a budget saving and 2 being a reduction in overspend. 3 of the projects are on target to be achieved during the year with one potentially not being achieved during the year relating to short breaks provision, with a red RAG status. The potential impact could be savings of £200,000 not being achieved. 7.5 There are 14 projects under the heading of Partners in Care, of which 9 will achieve a budget saving and the other 5 being a reduction in overspend. 7 of the projects are forecast to have potentially slipped: 5 have a red RAG status relating to transport contract, review of palliative care services, review of nursing equipment, GMED skill mix review and minor surgery; 2 have an Amber RAG status, relating to review of step down building based facilities and review of Page 46
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very sheltered housing. Work is ongoing to clarify these during the next quarter. The potential impact could be slippage of £557,000. 7.6 There are 6 projects under the heading of already implemented/ enablers, of which 2 will achieve a savings and 4 will achieve a reduction in overspend. 2 of the projects have potentially slipped with 1 red RAG status relating to review of contributions policy and charges and 1 amber RAG status relating to cessation of interim placements. The potential impact could be slippage of £350,000 7.6 Projects are detailed in Appendix 4, all projects have been reviewed for progress and have been appropriately Red/Amber/Green (RAG) status for risk of achieving the savings on target. Updates to projects since the budget was set are in red for ease of reading. When the budget was set there was a risk of not achieving the savings within this financial year of £1.074m. At quarter 1, the potential risk of not achieving savings in this financial year is £1.6m. There will be an in-depth review for quarter 2 and any new or additional savings will be identified in the report to MIJB in November 2026. 7.7 Within the savings detailed above, 4 of them are non-recurring totalling £740,000, 3 of which will be achieved, with 1 project potentially partially slipped into the next financial year. The potential impact is £150,000 not being achieved until 2027/28. This project is included in the figures above for already implemented/enablers. 7.8 The Budget Savings Oversight Group continues to meet regularly to strengthen governance, provide support to the Senior Responsible Officers (SRO) and provide a project management approach. The Group is chaired by the Chief Officer and comprises of members of the Senior Management Team (SMT). 7.9 Grip and control measures remain in place which includes, Budget Saving Oversight Group. High-cost packages and Resource Management Group meetings also support grip and control. In addition, monthly meetings for SMT operational finance performance monitoring have also been set up to support this process. 7.10 The current forecast position includes the provisional position of the savings slippage and is included in the £8.9m position which is within the partners parameters. Work is on-going to identify in year opportunities for savings and where any savings can be expediated this financial year. 8. BUDGET PRESSURES 8.1 Budget pressures recognised when the budget was approved on 26 March 2026 are released when the pressure crystallises to the extent that it can be accurately quantified. Provisions to meet budget pressures totalling £7,589,000 have been released in quarter 1. 8.2 Provisions still held centrally at the end of quarter 1 total £11,465,000 and are detailed in the table below. Page 47
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Description Para Ref £’000 Non pay uplift/growth 8.3 909 Recurring deficit 8.4 4,393 Learning Disability & Mental Health Clients 8.3 1,896 Direct payments & shared lives 8.3 333 SLW uplift 8.3 2,838 Suicide prevention funding 8.3 56 Occupational Therapy equipment 8.3 42 MS Nurse 8.3 12 Continuing care & fostering placements 8.3 870 Other 116 TOTAL BUDGET PRESSURES 11,465 8.3 These budget pressures have not yet been drawn down as they have not yet materialised in the budgets. At this stage they are intended to be fully required in this financial year. 8.4 These budget pressures have not been drawn down in the year but will be used to offset overspends during the financial year. 8.5 Emerging budget pressures have materialised since the budget was set and these are detailed in the table below: Description Para Ref £’000 High-cost care packages 8.6 87 Increase in mileage rates 8.7 74 Total emerging budget pressures 161 8.6 Emerging budget pressures during quarter 1 were £87,000 for high-cost care packages relating to older people, learning disability, mental health and children, families and justice, have been approved at the High-Cost care packages meeting and Resource Management Group meetings. These costs relate to 13 cases that required an increase in packages £81,000 and 3 one off assessments which total £6,000 up to quarter 1. All these packages will be reviewed regularly. 8.7 Moray Council agreed the increase in HMRC mileage rates of 10p a mile. There is no additional funding available to deal with this change. Based on previous years mileage claims there will be an additional pressure of £60,000 on adult services and £14,000 on children, families and justice services. Travel expenses will be scrutinised by all managers and ensure use of pool cars and virtual meetings where relevant to reduce this pressure during the year. 9. CHANGES TO STAFFING ARRANGEMENTS Page 48
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9.1 At the meeting of the Board on 29 May 2025, the Financial Regulations were approved (para 13 of the minute refers). All changes to staffing arrangements with financial implications and effects on establishment are to be advised to the Board. 9.2 Changes to staffing arrangements as dealt with under delegated powers through appropriate Council and NHS Grampian procedures for the period 1 April to 30 June 2026, are detailed in Appendix 3. 10. UPDATED BUDGET POSITION 10.1 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. 10.2 In addition, the MIJB, are still waiting for some funding yet to come through that was included in the budget and that is reconciled at the bottom of the table below. £’s Approved Funding 26.3.26 213,674,282 Set Aside Funding 20,092,000 Balance of IJB reserves c/fwd to 25/26 2,747,434 Amendment to NHS Grampian core & Moray Council 100,887 Revised funding at the start of Qtr 1 236,614,603 Budget adjustments M01-M03 Hosted services (120,557) Blood plasma 1,349 GVIP 1,135,747 PCIF allocation 3,132,249 Moray ADP funding 26/27 651,193 RWW funding 929,439 GP Walk-in centres 4,787,603 RWW allocation 47,576 Res Dr Uplift del services 5,501 Alcohol 12,426 Antic Allocation 240,366 Additional funding not yet received (401,779) Social work regrading 621,351 CareFirst replacement funding 329,000 NHS core uplift adjustment 6,930 Revised Funding to quarter 1 247,992,996 Exclude savings (5,718,000) Excluding deficit funding (9,000,000) Revised Funding to quarter 1 233,274,996 Page 49
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10.3 In accordance with the updated budget position, but due to funding not fully being received there will be no revised Directions issued this quarter. 11. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan ‘Partners in Care 2022 – 2032’ This report is consistent with the objectives of the Strategic Plan and includes budget information for services included in the MIJB Revenue Budget 2026/27. (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 12.8 of the 2015 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 The financial details are set out in sections 3-9 of this report and in Appendix 1. For the period to 30 June 2026, an overspend is reported to the Board of £1,973,297 in totality. A provisional forecast to end March 2027 has been included in section 3 and Appendix 1, which gives the first provisional year end position of £8,975,832. There is also the assumption at this stage that some savings RAG status of red and amber will not be achieved within this financial year. The monitoring of the savings plan will continue to be brought to all future meetings of this Committee. The staffing changes detailed in paragraph 9 have already been incorporated in the figures reported. The movement in the 2026/27 budget as detailed in paragraph 10 have already 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. There are earmarked reserves brought forward in 2026/27. Additional savings continue to be sought, and service redesign are under regular Page 50
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review. Progress reports will be presented to this Board throughout the year in order to address the financial implications the MIJB is facing. The level of reserves carried forward into 2026/27 was £3,010,434. As well as additional pressures arising from the cost-of-living crisis, increasing energy bills, emerging budget pressures and inflation puts a risk on the budget. The initial provisional forecast is an overspend position, this has been communicated to both partners and is within their parameters of £9m. The savings plan will be closely monitored as well as additional savings identified to counteract and reduce this position as much as possible during the year as both partners are under severe financial pressures. The Budget Saving Oversight group continues to support the delivery of projects and look at savings for the next financial year. There is a risk of the red and amber RAG savings not achieving in this financial year, and work is ongoing looking at savings for the current and next financial year. (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 There are no direct equality/socio economic implications as there has been no change to policy. (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 There are no amendments to Directions as part of this report. (j) Consultations The Chief Officer, the Health and Social Care Moray Senior Management Team and the Finance Officers from Health and Social Care Moray have been consulted and their comments have been incorporated in this report where appropriate. 12. CONCLUSION 12.1 The MIJB Budget to 30 June 2026 has an overspend of £1,615,394 on core services and £1,973,297 in totality. Taking into account the additional funding agreed by the partners the overall position is £276,703 underspend. The Senior Managers will continue to monitor the financial position closely and continue to report on the savings and transformation plan. Page 51
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12.2 The first initial provisional financial position for the overall MIJB to 31 March 2027, is an overspend of £8,975,832, Taking into account the additional funding agreed by the partners, the outturn position will be a break-even position. Author of Report: D O’Shea Chief Financial Officer Background Papers: Papers held by respective Accountancy teams Ref: Page 52
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APPENDIX 1 JOINT FINANCE REPORT APRIL 2026 - JUNE 2026 Para Annual Budget (Net) Actual Most recent Variance Forecast Ref Net Budget To Date To Date Variance Variance Forecast To Budget Variance £'s £'s £'s £'s % £'s £'s % 2026-27 2026-27 2026-27 2026-27 2026-27 2026-27 2026-27 2026-27 Community Hospitals 5.1 7,671,469 1,895,447 2,140,879 (245,432) (3) 8,563,517 (892,048) (12) Community Nursing 6,905,737 1,641,008 1,787,660 (146,652) (2) 7,150,641 (244,904) (4) Learning Disabilities 21,126,171 4,753,594 4,828,176 (74,582) (0) 21,347,315 (221,144) (1) Mental Health 5.3 12,416,300 3,103,731 3,409,757 (306,026) (4) 13,178,705 (762,405) (6) Addictions 1,369,915 340,802 392,300 (51,498) (4) 1,511,196 (141,281) (10) Adult Protection & Health Improvement 293,058 67,846 66,826 1,020 (1) 288,978 4,080 1 Care Services provided in-house 26,299,548 6,288,349 6,487,807 (199,457) (1) 27,097,378 (797,830) (3) Older People & PSD Services 5.6 28,911,522 6,921,592 7,561,634 (640,041) (2) 31,471,688 (2,560,166) (9) Intermediate Care & OT 2,214,962 545,939 684,119 (138,180) (7) 2,814,269 (599,307) (28) Other Community Services 10,960,007 2,592,906 2,667,345 (74,439) (1) 10,923,381 36,626 0 Admin & Management 4,350,624 1,387,681 1,511,547 (123,866) (3) 4,790,246 (439,623) (10) Other Operational Services 1,411,766 319,757 330,018 (10,261) - 1 1,320,070 91,696 6 Primary Care Prescribing 5.9 22,827,127 5,559,887 5,141,290 418,597 2 22,827,127 0 0 Primary Care Services 22,763,657 5,690,914 5,771,148 (80,234) (0) 22,948,429 (184,772) (1) Hosted Services 5,899,635 1,550,448 1,533,396 17,052 0 6,173,871 (274,236) (5) Out of Area 1,780,000 419,118 378,812 40,306 2 1,633,000 147,000 0 Improvement Grants 950,804 169,896 170,216 (320) (0) 950,804 0 0 Childrens & Justice Services 21,971,817 6,508,561 6,509,943 (1,381) (0) 22,151,817 (180,000) (1) Total Moray IJB Core 200,124,119 49,757,477 51,372,871 (1,615,394) (1) 207,142,432 (7,018,313) (4) Other non-recurring Strategic Funds in the ledger 4,874,329 1,465,775 1,527,199 (61,424) 0 5,331,849 (457,520) (9) Total Moray IJB Including Other Strategic funds in the ledger 204,998,448 51,223,252 52,900,070 (1,676,818) 212,474,281 (7,475,833) (4) Other resources not included in ledger under core and strategic: 6 8,184,549 (263,496) 32,983 (296,479) 0 9,684,548 (1,499,999) (18) Total Moray IJB (incl. other strategic funds) and other costs not in ledger 213,182,997 50,959,756 52,933,053 (1,973,297) 0 222,158,829 (8,975,832) (4) 0 Set Aside Budget 20,092,000 - 20,092,000 0 0 Overall Total Moray IJB 233,274,997 50,959,756 52,933,053 (1,973,297) ,0 242,250,829 (8,975,832) (4) Funded By: NHS Grampian 138,285,912 Moray Council funding 94,989,085 Total funding 233,274,997 Page 53
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APPENDIX 2 Description of MIJB Core Services 1. Community Hospitals includes community hospitals, community administration, vaccination centre 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 54
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APPENDIX 2 10. 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). 11. Admin & Management budget comprises of :- • Admin & Management staff infrastructure, • Commissioning and Performance team, • Carefirst team, • Older People development, • Community Care finance, • Self Directed support & Carers • Target for staffing efficiencies from vacancies 12. 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) 13. Primary Care Prescribing includes cost of drugs prescribed in Moray. 14. Primary Care Services relate to General Practitioner GP services in Moray. 15. 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 • HMP Grampian – provision of healthcare to HMP Grampian. Page 55
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APPENDIX 2 16. 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. 17. Improvement Grants managed by Council Housing Service, budget comprises of:- • Disabled adaptations • Private Sector Improvement grants • Grass cutting scheme 18. 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) Corporate Parenting 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 - Cala 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 • Trauma Informed Practice Page 56
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APPENDIX 2 • Community Mental Health and Wellbeing Supports and Services • Target for staffing efficiencies from vacancies i) Additional grant funding • Unaccompanied asylum seeking children • Corra Foundation 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 57
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APPENDIX 3 HEALTH & SOCIAL CARE MORAY DELEGATED AUTHORITY REPORTS - PERIOD April - June 2026 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding 231401 Band 8a, 37hrs Senior Advanced Nurse Practitioner- Mental Health Permanent 12/06/2026 MH re-design/re-alignment 231439 Band 8a, 37hrs Senior Advanced Nurse Practitioner- Mental Health (Older Adults) Permanent 12/06/2026 MH re-design/re-alignment 237851 Band 6, 21.6hrs TL137097 - Specialist Physiotherapist - Community Temporary 12 Months 17/04/2026 241621 Band 5, 14.5hrs RWW BF- Community Nurse Permanent 02/04/2026 243488 Band 3, 36hrs Admin Support Worker Fixed term 1 year (31/03/2027) 17/04/2026 ? 243858 Band 4, 17.5hrs B4 OT Assistant Practitioner - Primary Care Permanent 20/05/2026 Convert 9hrs B7 hrs to B4 + RWW Allocation 245001 Band 3, 21.6hrs B3 Dental HCSW Permanent 14/05/2026 243695 Band 7, 28.8hrs Health Visitor Permanent 23/04/2026 244960 Band 7, 18hrs RWW BF - Nursing and Midwifery Template Permanent 23/04/2026 RWW BF - Nursing and Midwifery Template 245299 Band 6, 36hrs Specialist Speech and Language Therapist - Adult Permanent 17/04/2026 Page 58
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APPENDIX 3 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding 245303 Band 2, 21.6hrs B2 Clinical and Clerical Support Worker Permanent 17/04/2026 245843 Band 8b, 36hrs Interim Strategy, Performance and Transformation Lead Permanent 17/04/2026 Needs a full time interim post for 6 months. Funding is available and has been agreed at Moray Resource management group. 246103 Band 3, 6hrs Band 3 Permanent 21/04/2026 RWW BF HCSW 246444 Band 3, 22hrs RWW-Healthcare Support Worker, Community Permanent 21/04/2026 RWW BF HCSW/11hrs from Suzanne Asher 246450 Band 5, 15hrs RWW-Community Nurse Permanent 23/04/2026 RWW 246486 Band 5, 33hrs B5 Nurse Permanent 21/05/2026 247324 Band 5, 36hrs NR241651 - Physiotherapist Permanent 01/05/2026 247591 Band 5, 28hrs Band 5 Community Staff Nurse Fixed- term/second ment 12 months 08/05/2026 247959 Band 7, 21.6hrs B7 Community Hospital Pharmacist Permanent 08/05/2026 248109 Band 5, 30hrs B5 Nurse Permanent 22/05/2026 248874 Band 5, 36hrs Trainee Podiatrist Permanent 19/05/2026 Trainee apprentice funded by B6 money 249341 Band 7, 18.5hrs LR249341 - Walk In Centre - Advanced Nurse Practitioner Fixed-term 26/05/2026 GP WALK IN SERVICE 249424 Band 5 22.5hrs B5 District Nurse Permanent 04/06/2026 RWW Page 59
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APPENDIX 3 Title of DAR Summary of Proposal Post(s) Permanent/ Temporary Duration (if Temporary) Effective Dates Funding 2026-07 MOSAIC Project Team – Training & Development officer MOSAIC Project Team – Training & Development officer Temporary 12 – 18 months 22/05/2026 Transformation funding from Moray Council 2026-08 East Social Work Redistribution East Social Work Redistribution Permanent 25/05/2026 Redistribute existing hours between posts 2026-09 Create a job share of grade 4 administrative post 36.25 Create a job share of grade 4 administrative post 36.25 Permanent 15/05/2026 Split existing post of 36.25 hrs into 2 posts of 18.125 hrs 2026-10 Support package for MM (- J3081675 ) in her own home Support package for MM (- J3081675 ) in her own home Permanent 11/05/2026 Moray Council 2026-11 Performance Support Officer (extension of temp 1 year) Performance Support Officer (extension of temp 1 year) Temporary 12 months 26/05/2026 Use existing budget moved from Carefirst Senior Social Worker Bairns Hoose & SCIM Senior Social Worker Grade 10 Temporary 12 months 01/04/2026 Bairns Hoose Page 60
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APPENDIX 4 MIJB Budget 2026/25 MIJB proposed savings Ref Service Brief Description Full year effect £000s Saving expected for 2026/27 Saving likely to be achieved in 2026/27 Saving likely to be achieved in 2027/28 Saving likely to be achieved in 2028/29 Planned Implementation Date Risk Level Commentary BR 4 &5 Removal of locum costs Cease the use of locums 950.00 450.00 250.00 500.00 200.00 Oct-26 Red Amendments to coding of costs in relation to partners has reduced overspend. Various posts are out for recruitment which, if successful, will reduce the locum and associated costs. BR 8 GMED redesign GMED redesign of clinical & admin staffing model 110.00 28.00 28.00 82.00 Dec 26 Green The phasing of the amount to be achieved has had to be adjusted due to the timescales required for going through appropriate goverance routes. BR 9 Pool car vs expenses review Review into all teams transport and expenses to evalaute best options 20.00 20.00 20.00 Apr-26 Green BR 10,12 Cessation of leases and relocation Cessation of Strathisla dental practice lease 6.00 6.00 3.00 3.00 Oct-26 Amber This element is dependent on NHS Grampian Estates having capacity to progress. It has been escalated to senior estate management, however the amount is small so may not feature in their priorities at this stage. BR 14 & 15 Review of Care and Care Commissioning spot purchasing & review care packages 750.00 750.00 600.00 150.00 Apr-26 Red There are signs of reduction in overspend in Qtr 1. A programme of work is being developed to manage several inter-related projects to be able to have clearer oversight and prioritisation. BR 42 SDS recovery (non recurring) Review packages to increase recovery 250.00 250.00 250.00 Apr-26 Green BR 53* New Redesign Complex & Challenging Behaviour Review of Adults Out of Area and Ordinary Residence 200.00 200.00 200.00 Apr-26 Green BR 61* new Children, Families and Justice review of service Redesign service delivery 223.00 223.00 113.00 100.00 Apr-26 Amber The reduction in locum costs in West team (£88k)have been achieved along with a reduction in a contract £25k. The service redesign has been delayed due to staff vacancies and changes in key roles required to progress the organisational change. BR 62* new Children, Families and Justice review of service Review of family contact accommodation 30.00 30.00 - Apr-26 Red Following further analysis it was determined that this saving could not be realised. Alternative proposals being considered for presentation to next MIJB HF 16 Short Breaks provision Review into planned and emergency short breaks - change in model 200.00 200.00 - Apr-26 Red The change in Unpaid carer legislation and a need to have clear definition from Scottish Government of entitlements and theassociated periods. Until this clarification is provided by Scottish Government we cannot be clear of any saving potential HF 20 Community hospital redesign Redesign of inpatient services supporting Home First 50.00 50.00 50.00 50.00 700.00 Apr-26 Green HF 18 Night Time Responder Overnight Support (LD) Redesign LD nighttime model of care delivery 20.00 20.00 20.00 Apr-26 Green HF 51* new Operational model redesign Review of purchasing end of life palliative care equipment 9.00 9.00 9.00 Apr-26 Green Page 61
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APPENDIX 4 PIC 21,24 Day Services review Review of day service provision 151.00 151.00 151.00 Apr-26 Green PIC 28 Review of step down building based facilities Review into model of care 49.00 49.00 - 49.00 Apr-27 Amber Due to the pressures in the unscheduled care needs of the system the reduction in use of this facility has taken longer than anticipated. Efforts are underway to close as soon as possible, once existing occupiers move out. PIC 30 Prescribing efficiencies -GP Medication cessation,switches within GP services and work with Care Homes 65.00 65.00 65.00 Apr-26 Green PIC 55*new Nutritional prescribing - dietetic led Transformation of oral nutrititional support (ONS) pathways in Moray 50.00 50.00 50.00 Apr-26 Green PIC 33 Transport contract Review contracts and policy for transport for childrens and adult services 212.00 212.00 78.00 400.00 Apr-26 Red The value of saving against the contract was not as anticipated due to increases in fuel and maintenance costs and necessary changes to routes. PIC 46 Review of palliative care services Review of provision of palliative care in Moray to improve outcomes 44.00 44.00 - 44.00 Apr-26 Red Options appraisal progressed - meeting with Aberdeenshire to finalise approach. Governance routes for all IJB means the timescale needs to be extended. PIC 52* new Review of very sheltered housing Review of provision of very sheltered housing 153.00 153.00 21.00 132.00 Apr-26 Amber One contract released £49k and one will cease in July 2026. PIC 50 Review of North East Sensory Services contract Bringing service in house 130.00 130.00 130.00 Apr-26 Green Complete PIC 56* new Review of nursing equipment Review of Nursing equipment/stock to rationalise/centralise 100.00 100.00 - Apr-26 Red Changes to stock levels held and process implemented which will achieve some savings which will be forecast next quarter. The review of nursing structures was impacted by the unintended consequences of the national regrading. PIC 57* new GMED skill mix review Review of skill mix within GMED 38.00 38.00 10.00 Apr-26 Red Amount to be realised has been reduced due to the need to apportion across Grampian PIC 58* new Review of clinical leadership provision Review of provision 60.00 40.00 40.00 20.00 Aug-26 Amber Reduction of one clinical lead and reduction of clinical lead responsiblities has been implemented and the impact will be assessed at Qtr 2 PIC 59* new Minor Surgery Review of provision 70.00 70.00 - 30.00 40.00 Apr-26 Red Delivery not achievable in year due to the amount of Pan-Grampian work required. Phasing to be adjusted over the next two years PIC 60* new Redesign of Children, Families and Justice Review of Commissioned contracts 25.00 25.00 25.00 Apr-26 Green Completed PIC 63* new Redesign of Children, Families and Justice Review of out of area care and return to local community including emergency transport arrangements 70.00 70.00 70.00 Apr-26 Green AI 44 Reduction in overtime reduce the amount spent on overtime during the year 50.00 50.00 50.00 Apr-26 Green AI 38 No non-essential travel (non recurring) Non essential travel ban (out of area) 30.00 30.00 30.00 Apr-26 Green Page 62
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APPENDIX 4 AI 38 No non-essential training (non recurring) Non essential training ban (conference attendance etc) 10.00 10.00 10.00 Apr-26 Green AI 41 Vacancy target NHS & increase on Council in line with pay award increase Already implemented 1,245.00 1,245.00 1,245.00 Apr-26 Green AI 64* new Cessation of interim placements (non recurring) Stop all interim arrangements and review staffing for integrated working 450.00 450.00 300.00 150.00 Apr-26 Amber Organisational change and appointment of HofS / CSWO timelines have impacted on amount to be realised this year so phasing adjusted. AI 54* new Review of contributions policy & charges Review of policies & income maximisation 500.00 500.00 300.00 Apr-26 Red Timeline to amend policies and conduct appropriate consultation and engagement and progress through MC and MIJB governance will impact on phasing of this saving. TOTAL 6,320.00 5,718.00 4,118.00 1,710.00 940.00 KEY BR BUILDING RESILIENCE 2,539.00 1,957.00 1,464.00 835.00 200.00 HF HOME FIRST 279.00 279.00 79.00 50.00 700.00 PIC PARTNERS IN CARE 1,217.00 1,197.00 640.00 675.00 40.00 AI ALREADY IMPLEMENTED 2,285.00 2,285.00 1,935.00 150.00 - 6,320.00 5,718.00 4,118.00 1,710.00 940.00 ** ** Of which 3 proposals are non recurring, valuing £590,000 Page 63
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Health and Social Care Scotland JULY 2026 IJB Financial Position FINANCE UPDATE 2026/27 Page 64
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OFFICIAL 1 OFFICIAL Contents Key Messages 2 Purpose 3 Introduction 4 Financial Position 6 Cost Pressures 9 Recovery Actions 11 Implications for Services and Outcomes 14 Conclusions and Next Steps 19 Page 65
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OFFICIAL 2 OFFICIAL Key messages ⚠ URGENT The 2026/27 position is unsustainable: £475m of financial pressure is now being managed across Scotland’s health and social care system, with limited reserves remaining and a growing reliance on one-off measures. ⏱ IN-YEAR IMPACT Without additional recurring funding, high-impact reductions will be felt in-year, not at some future point. Recovery actions will reduce care at home, care home placements, packages of care, staffing, early intervention and prevention support. ↔ WHOLE-SYSTEM PRESSURE The impact will not be contained within IJB budgets. Reduced social care capacity will increase pressure across the whole system, including unpaid carers, hospital discharge, primary and community care, councils, NHS partners and commissioned providers. ↓ SERVICE REDUCTION IJB savings are more directly felt as service reductions. With fewer internal efficiency levers than NHS Boards and Councils, financial plans are more likely to have a direct impact on frontline care and support. ✚ PREVENTION AT RISK Prevention is being squeezed at the point it is most needed. As resources are redirected to statutory and crisis services, investment in early intervention and prevention is reduced, weakening long-term sustainability and storing up greater demand and cost for future years. ⚖ REALISTIC EXPECTATIONS National expectations and available resources are no longer aligned. Without sustainable funding and realistic national expectations, IJBs will continue to reduce services and shift risk onto people, unpaid carers, providers and partners. Page 66
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OFFICIAL 3 OFFICIAL Purpose This report sets out the financial position of Integration Joint Boards for 2026/27, highlighting the scale of the financial challenges facing Scotland’s health and social care system. It aims to provide a clear understanding of key cost pressures, the actions being taken to manage these, and the impact on services and outcomes. Transformation, prevention and service redesign are essential parts of the solution, and work is already underway across IJBs to change models of care and support. However, the scale of the redesign required is not deliverable at the pace needed to close the recurring financial gap in-year. The report is intended to support informed decision-making by outlining the implications of current funding levels and identifying the risks to the sustainability of health and social care services. The challenge is no longer simply one of financial sustainability. Integration Authorities are increasingly required to choose between maintaining essential statutory services and delivering national policy ambitions. Without additional recurring investment, both cannot be achieved. The report seeks to inform discussions between government, partners and stakeholders on what can be realistically delivered within available resources, and the changes required to ensure long-term sustainability. Page 67
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OFFICIAL 4 OFFICIAL Introduction Integration Joint Boards (IJBs) are the public bodies responsible for planning how local health and social care resources are used. In simple terms, they sit between NHS boards and councils and direct how available funding should be used to deliver community health services, adult social care and, in some areas, children’s services. Most of the money used by IJBs comes from NHS boards and councils, with services then delivered either directly or through commissioned providers. This means the system is interconnected: when costs rise or savings are required in one part of health and social care, the consequences are often felt elsewhere in the wider system as well. That wider system context is important for interpreting this report. If an IJB reduces care at home, delays a package of care, limits care home placements or scales back preventative services, the effect is not confined to one budget line. It can increase pressure on unpaid carers, make discharge from hospital more difficult, place additional strain on primary care and community services, and create financial and operational risk for commissioned providers. Equally, when funding is absorbed by rising demand, inflation, workforce costs and new policy commitments, there is less available to invest in early intervention and prevention that could reduce demand in future years. The risks if no action is taken are illustrated below: In its most recent national bulletin, Audit Scotland stated that Scotland's IJBs are in a "critical financial position", with financial pressures and demand for services continuing to outstrip funding growth and savings achieved. Audit Scotland said IJBs will need to make "difficult decisions" about service delivery, including redesigning, reducing or discontinuing services, and should be transparent with the public about the consequences. The central issue in 2026/27 is therefore not simply that IJBs face financial pressure, but that the level of pressure requires substantial savings, service change and non- recurring measures to keep budgets in balance. A significant proportion of those Page 68
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OFFICIAL 5 OFFICIAL actions relate to social care. For external stakeholders, the key question is what level of savings is being taken out of the system this year, where those savings are falling, and what impact that will have on people, carers, providers and the wider public sector. Health and Social Care Scotland commissioned this analysis of the 2026/27 budget position. All 31 IJBs provided information which has been reviewed to show the scale of the financial challenge, the actions being taken to address it, and the likely implications for services and outcomes across the system. Page 69
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OFFICIAL 6 OFFICIAL Financial Position Key Point: IJBs face a £475m funding pressure with depleted reserves (67% hold no contingency reserves) leaving very limited capacity to absorb risk or sustain services. This is a recurring pressure with more than £1.3bn of recurring pressure managed over the last three years alone. IJBs receive funding annually as agreed contributions from council and NHS board partners. Each year the level of funding received depends on the financial position and budget decisions of those partners. While Scottish Government have provided additional investment for social care in 2026/27, the funding is primarily for the Real Living Wage policy. This funding is passed on to the commissioned providers to ensure their staff are paid at least the living wage and does not provide for any additional investment in social care to meet increased demand as more people need support and have more complex needs or to support the development of more sustainable models targeting early intervention and prevention. The budget for 2026/27 totals £12.2bn and includes financial pressure across the 31 IJBs of £474.87m. This pressure equates to 3.86% of the total budget, with individual pressures ranging from 1.7% to 12.73%. The financial challenge facing Integration Authorities is not a one-year issue. More than £1.3bn of recurring financial pressure has been managed over the last three years and medium-term projections indicate continued growth in demand, workforce costs and complexity of need. Although there is variation in the proportion of the pressure in each IJB area because this pressure has built over the years and IJBs have taken significant actions to reduce spend and find alternative funding, such as the use of reserves, transformation of services, and the reduction of serves, all areas face considerable challenges in sustaining delivery while meeting the needs of local communities. Exhibit 1 Financial pressure as percentage of budget 0.00% 2.00% 4.00% 6.00% 8.00% 10.00% 12.00% 14.00% Aberdeen City Aberdeenshire Angus Argyll and Bute City of… Clackm anna… Dum fries and… Dundee City East Ayrshire East… East Lothian East… Falkirk Fife Glasgow City Highland Inverclyde M idlothian M oray North Ayrshire North… Orkney Perth and… Renfrewshire Scottish Borders Shetland South Ayrshire South… W est… W estern… W est Lothian Page 70
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OFFICIAL 7 OFFICIAL Reserves are a key component of overall funding strategy to ensure long term financial stability and sustainability. Contingency reserves are a critical part of this and are extra funds set aside to deal with unexpected costs and financial risks. General practice advises that contingency reserves should be held at 2 to 4% of the funding available. In the absence of a contingency reserve, IJBs must consider their Integration Authorities Integration Scheme and will need to rely on additional contributions from partners to address unfunded cost pressures. In recent years reserve balances have been used to offset the financial pressure facing IJBs leading to a depleted position. 67% of IJBs now have no contingency reserve balance with the remaining contingency reserves totalling £102.39m or 0.84% of budget, far below the best practice level. Exhibit 2 Contingency reserve balance as percentage of funding 0.00% 1.00% 2.00% 3.00% 4.00% 5.00% 6.00% 7.00% Aberdeen City Aberdeenshire Angus Argyll and Bute City of Edinburgh Clackmannanshire and Stirling Dumfries and Galloway Dundee City East Ayrshire East Dunbartonshire East Lothian East Renfrewshire Falkirk Fife Glasgow City Highland Inverclyde Midlothian Moray North Ayrshire North Lanarkshire Orkney Perth and Kinross Renfrewshire Scottish Borders Shetland South Ayrshire South Lanarkshire West Dunbartonshire Western Isles/Nan Eilean Siar West Lothian Contingency Reserve As Percentage of Budget Page 71
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OFFICIAL 8 OFFICIAL Financial sustainability risks have been recognised by a majority of auditors in their reporting on the annual audit of IJBs. IJBs have a strong understanding of the drivers causing the cost and demand pressures and the steps which should be taken to improve sustainability - including building reserve balances and investing in early intervention and prevention - however without additional investment this is not possible. Page 72
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OFFICIAL 9 OFFICIAL Cost Pressures Key Point: Costs are rising as more people need care and their needs are more complex, compounded by workforce costs and inflation, this is expected to worsen as the population ages. The financial challenge is recurring rather than short-term or exceptional. Existing cost pressures are described below: (i) by service area and (ii) by cost driver. Analysis of the total pressure by service area is available from 28 of the 31 IJBs. Providing insight into £442m of the £475m or 93% of the total. Exhibit 3 Financial pressure by service While Older People is the single largest category, when considered as a whole, the services which support the adult population exceed this area of pressure. Services such as those supporting people with learning disabilities for example can be lower volume but very high-cost packages of care. When evaluated by cost driver, demand and complexity of need is the highest category of pressure, responsible for over 21% of the total value, this considers the number of people who need services and the level and range of support those people require. Followed by staffing pressures at 18%, related to employee cost pressures, values are shown in exhibit 4. 1.04 2.02 3.24 4.10 5.66 12.86 15.36 18.99 33.84 34.96 51.32 51.90 101.40 138.20 0.00 20.00 40.00 60.00 80.00 100.00 120.00 140.00 160.00 Homeless Services FHS Criminal Justice Addiction Services Hosted Services Physical Disability Resources Children's Services Mental Health Adult Community Services Learning Disability Prescribing Other Older People Page 73
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OFFICIAL 10 OFFICIAL The ‘other’ category includes a range of drivers including inflationary pressures, non- pay cost increases and pension related costs, while the non-delivery of savings category relates primarily to savings programmes due to be delivered in 2025/26. Prescribing is a significant pressure in each presentation of data, when viewed by cost driver the lower figure - £47.54m to the £51.90m in Exhibit 3 – is due to inclusion of some prescribing related costs within the non-delivery of savings category. Exhibit 4 Financial pressure by cost driver The projected population change facing Scotland, according to the National Records of Scotland, is one which over the 25 years to mid-2049 sees a growing population 75 years and older and a falling population in general with particular drops in children and young adults. This shift in demographics is likely to exacerbate the current pressures with additional support required due to age related conditions and a falling working age population. 1.56 7.47 42.97 45.35 47.54 69.37 74.16 85.79 100.67 0.00 20.00 40.00 60.00 80.00 100.00 120.00 Reserves Delays in Demand/Packages Commencing Prices Demographics Prescribing Non-delivery of savings Other Staffing pressures Demand/Complexity of Need Page 74
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OFFICIAL 11 OFFICIAL Recovery Actions Key Point: Recovery actions rely heavily on reducing services, particularly in social care, alongside workforce reductions and the use of reserves because IJBs have limited ability to achieve savings through internal efficiencies alone. Reserves account for almost 10% of the funding solution, nearly double the 5% reliance previously highlighted by Audit Scotland as a concern, while contingency reserves are depleted. The data submitted included approximately 150 individual lines describing how IJBs are planning to address the 2026/27 financial challenge. These actions are not all the same. Some are direct savings from reducing, redesigning or constraining services; some are workforce or efficiency measures; and some reflect additional funding, transfers or the use of reserves rather than savings released from the system. While IJBs have a range of delegated health and social care services, savings being taken out of the system fall disproportionately on social care. Across the country, the most significant area of direct savings is service and care delivery. This shows the effect of balancing budgets through reduced activity, fewer placements, care package reviews and a reduction in preventative services. It is worth noting that NHS Boards face financial challenges and associated recovery and savings plans as set out in ‘the Grid’. However, a significant proportion of NHS Boards savings programmes are typically focused on areas such as corporate services, asset management, energy efficiency, procurement and large-scale digital initiatives. While these measures can be complex and challenging to deliver, their impact on service users/patients may be less immediately visible than reductions in commissioned services. By contrast, as commissioning bodies, IJBs have more limited opportunities to achieve savings through internal efficiencies alone and therefore need to reduce the level, scope, or volume of services commissioned in order to achieve financial balance. While pressures arise from NHS services, e.g. prescribing pressures, savings being taken out of the system to restore overall balance primarily relate to social care. Exhibit 5 A summary of savings and actions to meet the financial pressure Page 75
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OFFICIAL 12 OFFICIAL Contract Management includes £22.04m of actions identified as contract reductions. Workforce and Staffing actions account for £47.95m of savings related to the reduction of staffing levels, controls on additional staffing costs, a review of staffing and vacancy management actions. While workforce related actions account for a significant proportion of recovery actions it is becoming increasingly challenging due to recruitment pressures, workforce shortages and changes to employment legislation. The Employment Rights Act 2025 strengthens workforce protections, consultation requirements and redundancy obligations. While these developments are important protections for employees, they increase complexity, implementation timescales and financial risks associated with workforce reduction programmes. Other Efficiencies at £81.54m includes many small local projects and reductions in non-pay costs, travel, general efficiencies etc. Service and Care Delivery changes deliver £116.30m and represent the most direct reduction in activity and support across the system. Many of these actions fall on social care and include: • Reduced care at home activity • Reduction in the purchase of care home placements • Reductions in early intervention services • Reviews of packages of care • Service review/redesign • Prescribing savings 22.04 47.95 81.54 116.30 100.08 45.60 61.36 474.87 0.00 50.00 100.00 150.00 200.00 250.00 300.00 350.00 400.00 450.00 500.00 Page 76
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OFFICIAL 13 OFFICIAL Income and Funding at £145.68m includes: • Additional partner funding • Funding passthrough and budget transfers • Increased charging and income maximisation Reserves to the value of £45.6, or 9.7% of actions to bridge the funding gap. This has increased from 5% in 24/25 which at that level was raised as a concern by Audit Scotland. The increase is reflective of the continued and cumulative pressure being faced by IJBs. A Residual balance of £61.36m remains with actions of recovery to be determined. Page 77
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OFFICIAL 14 OFFICIAL Implications for Services and Outcomes Key Point: The scale of the savings required mean less care and support is available. This will lead to longer waits, unmet need and more pressure on families, carers, hospitals and other services. The most important issue for 2026/27 is the scale of savings and recovery measures now being required to keep health and social care budgets in balance. While the current financial pressure amounts to £474.87m in 2026/27, the equivalent figures were £457m in 2024/25 and £449m in 2025/26. This means that more than £1.3bn of pressure has had to be managed over the last three years. Given that much of this challenge is recurring, the effect compounds year after year, requiring repeated savings, service redesign and the removal of capacity from the system. The scope for further efficiencies without service impact is now very limited. As a result, a significant part of the 2026/27 response is being delivered through actions that affect service capacity and access, especially in social care. The national picture includes the following reductions: • £33.82m Reduced care at home activity, the equivalent to more than 1.2m hours of homecare activity • £9.27m Reduction in the purchase of care home placements, the equivalent of over 250 care home beds • £41.42m Reduced staffing, the equivalent of 840 band 5 nurses These reductions sit alongside wider redesigns and reviews of services and packages of care. They illustrate that the response to financial pressure is increasingly about reducing activity, narrowing access to services, slowing service growth and limiting preventative support. The requirement to deliver recurring savings has implications both for the internal operations of the IJB and for the services experienced by service users, carers and communities. Internally the savings identified reduce staffing levels, placing additional pressure on workforce capacity for business support services and directly provided care services. A reliance on vacancy management and tighter controls on expenditure can also impact the pace of service development and improvement activity and continuing to operate services in this way has a profound impact on the workforce. For service users and communities, reductions in care at home activity, care home placements and early intervention services increase the likelihood of longer waits, unmet need and higher levels of crisis. The consequences are then felt elsewhere: Page 78
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OFFICIAL 15 OFFICIAL unpaid carers carry greater pressure, hospital discharge can become more difficult, community and primary care services can face additional demand, and councils and NHS partners can experience increased operational and financial strain. Savings programmes will have a direct impact on commissioned providers, with organisations such as the Coalition of Care and Support Providers in Scotland (CCPS) advising the funding position has already pushed the sector to the brink. IAs are committed to working with our providers but must do so within the resources available, without additional investment in Health and Social Care there is a risk to the ability of providers to continue delivering services which would reduce choice for service users, risk continuity and stability of care and expose Local Authorities and IJBs to additional operational and financial risk as providers of last resort. Alongside transformation and the reduction of existing services the current financial pressures have a significant impact on how IJBs can effectively invest in services which will deliver long term improvements and protect the future of health and care in Scotland. Investment in early intervention and prevention is critical to improve outcomes, support independence, reduce pressure on unpaid carers and avoid higher-cost demand elsewhere in the system. However, when budgets are under severe strain, these services are often the part of the system with least protection once legal responsibilities and crisis responses have been prioritised. The 2026/27 actions identify £7.29m of savings from early intervention and preventative services, which risks storing up future demand and weakening the long-term sustainability of health and social care. These decisions are not taken lightly but rather are a direct result of the scale of the challenge presented to IJBs and the requirement to deliver a balanced budget which meets all legal responsibilities. An increase in overall resources is required to allow for investment in prevention while ensuring services are delivered which meet the needs of those most at risk currently. As outlined above, IAs face significant challenges in meeting current levels of demand with the funding available. However, maintaining the status quo is not sufficient to meet Scotland’s future health and social care needs. As such, IAs remain committed to continuous improvement and transformation, including supporting the delivery of Scottish Government policy ambitions. While funding is at times provided to support new policies and service developments, this is not always consistent and rarely meets the full cost of implementation. This creates an ongoing tension between the ambition to fully deliver national policy Page 79
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OFFICIAL 16 OFFICIAL objectives and the requirement to maintain a balanced budget while continuing the provide essential care and support services. Financial sustainability and delivery of national policy ambitions are increasingly disconnected with raised public expectations on a range of new developments for example; Care Reform which, if not fully funded, will significantly increase the funding gap. The current financial environment affects the ability of IAs to invest at the scale required to support national ambitions. Without sufficient recurring resources, there is increasing tension between responding to current statutory demand and keeping operational services safe, and investing in the approaches required to deliver long- term policy ambitions. Integration Authorities are increasingly being required to choose between: Maintaining Essential Services Delivering National Ambitions Meeting statutory demand Prevention and early intervention Protecting social care capacity Population Health Framework Supporting unpaid carers Care Reform Managing hospital discharge Community-based care expansion and reducing delayed discharge Maintaining provider sustainability Public Service Reform While Integration Authorities (IAs) remain committed to maximising the impact of existing resources, efficiency measures alone are unlikely to deliver the pace and scale of change required to secure long-term sustainability. The Public Bodies (Joint Working) (Scotland) Act 2014 established a clear ambition for integration: to improve outcomes through the strategic planning and delivery of services around the needs of individuals and communities, supported by a progressive shift in the balance of care from institutional and acute settings towards prevention, early intervention and community-based support. Central to this ambition was the concept of set-aside acute resources, intended to provide Integration Authorities with meaningful influence over the planning and deployment of hospital resources and to support the reallocation of investment towards community-based models of care. However, despite progress in integration and a continued commitment to its underlying principles, the practical mechanisms required to enable significant resource transfer from acute services into communities have remained limited. As a result, many Integration Authorities continue to carry responsibility for delivering transformational change without having sufficient control over, or access to, the resources needed to accelerate that change. Page 80
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OFFICIAL 17 OFFICIAL Delivering the ambitions of integration requires the effective use of existing resources alongside targeted investment to support service redesign, transitional double-running costs, workforce development and the strengthening of community capacity. Without this, Integration Authorities are increasingly required to balance the delivery of new policy commitments against meeting the wider needs of their populations, creating a risk that progress in one area is achieved only at the expense of another. A sustainable and preventative health and social care system will require both renewed commitment to the principles of integration and the investment necessary to make the intended shift in resources a practical reality. This tension also seen for example in the work relating to the Coming Home agenda and wider aim of supporting people within their communities. While there is agreement with the principles and a desire to ensure people are where they want to be, with their support structures around them living as full and independent a life as possible, this creates significant additional financial pressure. Below is an example from one IJB area In year one this is an increase of £0.54m from the current NHS cost and a £1.22m additional cost for the IJB as the budget used to support the service user does not transfer from the inpatient to community setting. With inflation and increased costs related to Fair Work commitments this cost will continue to increase. While it is recognised this is the correct action for the service users a consequence is the reduction of the overall pool of funding available to support the wider community. Key Point: Shifting support from inpatient settings to community-based care does not necessarily mean this care is delivered at lower cost. In some cases, the community model is the right outcome for the person but costs more to deliver, Page 81
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OFFICIAL 18 OFFICIAL particularly where the funding associated with the inpatient placement does not transfer with the individual. This means IJBs can be asked to absorb a higher cost while the original hospital cost is not released to fund the new community support. In circumstances where funding does transfer this is typically less than the required amount, reducing the size of the deficit but not fully offsetting the pressure to be absorbed locally. Each increase in costs, whether from prescribing, increasing population, inflation, increasing staff costs or new policy commitments that are not fully funded, further narrows the room to invest in reform and prevention. The result is a cycle in which resources are repeatedly redirected towards immediate pressures to deliver on legal responsibilities, while opportunities to reduce future demand across hospitals, community services and social care are squeezed out. Page 82
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OFFICIAL 19 OFFICIAL Conclusions and Next Steps The 2026/27 position should be understood not simply as a statement of financial pressure, but as a statement of the scale of savings, service change and non- recurring measures now required across Scotland’s health and social care system. With £474.87m of pressure, very limited contingency reserves and a continued reliance on one-off solutions, the current approach is becoming increasingly difficult to sustain. A significant proportion of the response year on year falls on social care through reduced care at home activity, fewer care home placements, staffing reductions, package reviews and reduced preventative support. These actions will have tangible implications for people who need support, unpaid carers, staff, commissioned providers and partner organisations across the wider system. The impact of the actions to deliver savings are not contained to IJB budgets alone and will reach across the system in terms of redirected pressures, sector performance and a shift towards more reactive and potentially more costly interventions further down the line. IJBs remain committed to delivering high-quality care and supporting people to live independently in their communities and are proactively seeking every opportunity to maintain and protect essential services whilst seeking out more sustainable options through various initiatives; • Service prioritisation and review to ensure continued ‘fit for purpose’ and evidencing maximum impact against strategic objectives • Strengthening community led approaches, maximising capacity and local opportunities • Exploring opportunities in digital innovation and technology enabled care • Exploring opportunities in collective commissioning However, capacity to resource the above is constrained with recurring pressures and without more sustainable recurring funding IJBs will continue to make difficult decisions, increasingly focused on maintenance of essential only statutory services. While difficult decisions are required to achieve financial sustainability, the evidence shows that investment in social care is cost-effective and helps reduce demand on acute services. Recent work with Health Improvement Scotland on their Return on Investment (ROI) Project clearly demonstrated directing unscheduled care funding towards social care had a positive impact on demand and capacity within the acute sector. The Independent Review of Adult Social Care Services in Scotland highlighted that ‘strong and effective social care support is foundational to the flourishing of everyone in Scotland and a good investment in our economy and in our citizens’ but in order to Page 83
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OFFICIAL 20 OFFICIAL maximise the potential of social care support, a paradigm shift was required where new thinking and decision making was based on; • Social care being seen as an investment • Social care workforce having parity with public sector partners in terms of workforce pay, terms and conditions, career path and progression • An approach that is preventative and anticipatory • Enabling rights and capabilities rather than managing need • Commissiong and procurement based on collaboration rather than competition The current funding available for the delivery of social care services and consequential financial and service delivery decisions being made by IJBs does not align with the ambition of “parity of esteem” as a vital foundational principle of social care reform. The financial challenges outlined in this report are likely to continue in the absence of additional funding, required to maintain existing service levels, reflecting the combined impact of demographic growth, increasing complexity of need, inflationary pressures and other unavoidable costs. It will therefore be increasingly important to work in partnership with government and other stakeholders to develop a shared and realistic understanding of what can be sustainably delivered within available social care resources. This will provide an opportunity to align public expectations with the realities of current and future service provision, ensuring services remain effective and sustainable, and protecting the future of Scotland’s health and social care system. Looking ahead, there is a need for: • Sustainable recurring funding, protecting the future of social care and recognising that this will positively impact on longer term pressures in other areas including acute health services • Investment in prevention and early intervention activities, which is not only the right thing to do but is the most cost-effective model for the longer term future of public services • Continued service transformation, to drive forward efficiencies and ensure services continue to be fit for purpose while maximising the use of digital innovations • Collaborative working with partners and Scottish Government, as the impact of reduced community health and social care services impacts across the whole system and the achievement of government ambitions • Nationally supported and driven change on expectations, considering the expectations of citizens, what a sustainable funding model may look like and where funding will be generated Page 84
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OFFICIAL 21 OFFICIAL The question facing us all is no longer whether Integration Authorities can continue finding savings. The question is whether the current level of health and social care support expected by the public can continue to be delivered within the resources available. The Community Health and Care system has moved beyond a discussion about efficiencies and transformation. The scale of recurring financial pressure now requires decisions about what level of social care Scotland can realistically afford and what national ambitions can realistically be delivered. Page 85
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: EXTERNAL AUDITORS’ REPORT TO THOSE CHARGED WITH GOVERNANCE BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To request the Moray Integration Joint Board (MIJB) consider the reports to those charged with governance from the Board’s External Auditor for the year ended 31 March 2026. 2. RECOMMENDATION 2.1 It is recommended that the MIJB considers and notes the reports from the External Auditor within Appendices 1 and 2. 3. BACKGROUND 3.1 The responsibilities of Audit Scotland as the independent auditor are established by the Local Government (Scotland) Act 1973, the code of Audit Practice (2021), which can be found at Code of Audit Practice and supplementary guidance, and are supported by the auditing profession’s ethical guidance. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The work carried out by Grant Thornton during 2025/26 has produced two reports that are subject to the consideration of those charged with governance. The reports are attached as follows: • Independent Auditors Report to those charged with governance (Appendix 1) • The Annual Audit Report 2025/26 (Appendix 2) 4.2 The audit opinions expressed were all unqualified and are reported within the ‘independent auditors report’ included within Appendix 1. Item 9. Page 87
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4.3 The Annual Audit Report included at Appendix 2 provides an Action Plan where recommendations for improvement are made, based on the findings of the review. These recommendations have been discussed with management and corresponding actions have been agreed, together with timescales for completion. 4.4 The Annual Audit Report provides a summary of the significant audit risks identified during planning. The results and conclusions of this work are noted within the report. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The work of the external auditor and the production of these reports for those charged with governance have been completed within the specified timescales agreed. (b) Policy and Legal The Public Bodies (Joint Working ) (Scotland) Act 2014 requires that the Moray Integration Joint Board (MIJB) is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973. (c) Financial implications There are no direct financial implications arising from this report. (d) Risk Implications and Mitigation The external auditor, Grant Thornton, through the audit process, provides assurance to the Board that the Annual Accounts for 2025/26 give a true and fair view of the financial position. The Annual Audit Report highlights risks identified during the audit process and recommendations for action that have been agreed by management. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report (g) Equalities/Socio Economic Impact None arising directly from this report as there has been no resultant policy change. (h) Climate Change and Biodiversity Impacts There are no direct climate change and biodiversity implications as there has been no change to policy. (i) Directions None arising directly from this report Page 88
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(j) Consultations Consultation has taken place between Grant Thornton and the Chief Financial Officer of the MIJB in preparation of the Annual Audit Report. Any comments received have been considered in writing this report. 6. CONCLUSION 6.1 The External Auditor has issued an unqualified opinion for the 2025/26 Annual Accounts. The Annual Audit Report, Independent Auditors’ Report and the Letter of Representation present the full findings. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: with author Ref: Page 89
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APPENDIX 1 Independent auditor’s report to the members of Moray Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements We certify that we have audited the financial statements in the annual accounts of Moray Integration Joint Board for the year ended 31 March 2026 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, the Balance Sheet and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26 (the 2025/26 Code). In our opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the Board as at 31 March 2026 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2025/26 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion We conducted our audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. our responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of our report. We were appointed by the Accounts Commission on 18 May 2022. Our period of appointment is five years, covering 2022/23 to 2026/27. We are independent of the Board in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the Board. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Conclusions relating to going concern basis of accounting We have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Page 90
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APPENDIX 1 Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on the Board’s current or future financial sustainability. However, we report on the Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement We report in our Annual Audit Report the most significant assessed risks of material misstatement that we identified and our judgements thereon. Responsibilities of the Chief Financial Officer and Moray Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the Board’s operations. The Moray Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using our understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the Board; Page 91
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APPENDIX 1 • inquiring of the Chief Financial Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the Board; • inquiring of the Chief Financial Officer concerning the Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among our audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which our procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report We have audited the parts of the Remuneration Report described as audited. In our opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Other information The Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. Our responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this Page 92
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APPENDIX 1 gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Our opinion on the financial statements does not cover the other information and we do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In our opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which we are required to report by exception We are required by the Accounts Commission to report to you if, in our opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • We have not received all the information and explanations we require for our audit. We have nothing to report in respect of these matters. Conclusions on wider scope responsibilities In addition to our responsibilities for the annual accounts, our conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in our Annual Audit Report. Page 93
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APPENDIX 1 Use of our report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, we do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Angela Pieri, (for and on behalf of Grant Thornton UK LLP), 120 Bothwell Street, Glasgow, G2 7JS Date: Page 94
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Moray Integration Joint Board Annual Audit Report Financial year ending 31 March 2026 9 September 2026 Prepared for those Charged with Governance and the Accounts Commission APPENDIX 2 Page 95
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow GUIDANCE NOTES: Table of contents does not update automatically • Please delete or factor in any instruction slides at the start of the deck before pagination • Please populate the page numbers manually before distributing Table of contents 2 01 Headlines 03 02 Introduction 07 03 Audit of the annual report and accounts 09 04 Wider scope and best value conclusions 22 Appendices A Audit adjustments 43 B Follow up of prior year audit recommendations 44 C Audit fees, ethics and independence 51 D Client Service Review 53 E Communication of audit matters 54 Tip – Select View/Outline View, Right click and select "Collapse" and copy slide titles then paste into your table of conents Don’t forget to change the footer The contents of this report relate only to the matters which have come to our attention, which we believe need to be reported to you as part of our external audit process. It is not a comprehensive record of all the relevant matters, which may be subject to change, and in particular we cannot be held responsible to you for reporting all of the risks which may affect the Council or all weaknesses in your internal controls. This report has been prepared solely for your benefit and Audit Scotland (under the Audit Scotland Code of Audit Practice 2021). We do not accept any responsibility for any loss occasioned to any third part acting, or refraining from acting on the basis of the content of this report, as this report was not prepared for, nor intended for, any other purpose.Page 96
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Headlines01 Page 97
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Headlines (1)
Financial statements
Under International Standards of Audit (UK) (ISAs) and Audit Scotland’s Code of
Audit Practice ('the Code'), we are required to report whether, in our opinion:
• the IJB’s financial statements give a true and fair view of the state of affairs
of the IJB as at 31 March 2026 and of the income and expenditure of the
organisation for the year then ended;
• the IJB’s financial statements have been properly prepared in accordance
with UK adopted international accounting standards, as interpreted and
adapted by the 2025/26 CIPFA Code of Practice on Local Authority
Accounting;
• the IJB’s financial statements have been prepared in accordance with the
requirements of the Local Government (Scotland) Act 1973, The Local
Authority Accounts (Scotland) Regulations 2014, and the Local Government
in Scotland Act 2003; and
• the audited part of the Remuneration Report has been properly prepared in
accordance with The Local Authority Accounts (Scotland) Regulations 2014.
We are required to report whether the information given in the Management
Commentary is consistent with the financial statements and has been prepared
in accordance with statutory guidance issued under the Local Government in
Scotland Act 2003.
We are also required to report on whether the information given in the Annual
Governance Statement is consistent with the financial statements and
prepared in accordance with the Delivering Good Governance in Local
government: Framework (2016).
We have concluded that the Remuneration Report has been prepared in
accordance with requirements.
We have concluded the work on the Governance Statement has been prepared in
accordance with the relevant guidance.
We have concluded that the other information to be published alongside the
financial statements is consistent with our knowledge of the IJB.
Draft financial statements
The draft financial statements were presented for audit by the deadline of 30 June
2026. We have been supported by Moray IJB’s officers during the audit process
with effective working relationships and commitment to the audit process.
We have completed our audit work and subject to the satisfactory completion of
outstanding items outlined at page 6, we anticipate issuing an unmodified opinion.
The working papers presented for audit were a good quality, and any
supplementary working papers, sample requests and queries were responded to
effectively.
We have not identified any misstatements to primary statements, with very minor
disclosure issues amended by management, that did not warrant detailed
reporting, as noted in Appendix 1.
We have not identified any financial statements recommendations for management
as a result of our audit work on the financial statements, and there were no
recommendations for follow up from the previous audit.
We would like to take this opportunity to record our appreciation for the assistance
provided by the Chief Financial Officer and the wider IJB team, in completing the
external audit.
4
This table summarises the key findings and other matters arising from the external audit of Moray Integration Joint Board (IJB) and the preparation of the
financial statements for the year ended 31 March 2026 for those charged with governance (the Board) and the Accounts Commission.
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Headlines (2) Wider scope Under the Audit Scotland Code of Audit Practice (‘the Code’), the scope of public audit extends beyond the audit of the financial statements. The Code requires auditors to consider the IJB’s arrangements in respect of financial management, financial sustainability, vision leadership and governance and use of resources to improve outcomes. In our External Audit Plan for the year ended 31 March 2026, we documented our assessment of the wider scope risks and planned audit work. At the planning stage, we identified one risk in respect of financial sustainability. We outline our work undertaken in response to the arrangements in place and the risks identified and conclude on the effectiveness and appropriateness of the arrangements in place based on the work carried out. There remains a significant risk in respect of financial sustainability given the significant financial challenges the IJB faces over the longer term. Further details of the work undertaken on wider scope are outlined on pages 22 to 41. We have raised not raised any new recommendations for management as a result of our audit work on wider scope. We have followed up the 2 recommendations raised in our previous audit report in 2024/25 and the 6 outstanding recommendations that were not yet actioned from our 2023/24 audit report. Out of those 8 recommendations, 5 have been cleared with 3 remaining open. The results are set out at Appendix B. The clearance of the remaining recommendations will be followed up in 2026/27. Some recommendations are from the 2024/25 audit and prior and should be implemented by management. This is the fifth consecutive year that Internal Audit has issued a limited assurance opinion, reflecting ongoing weaknesses in the framework of governance, risk management and control. Five consecutive years of limited assurance is unusual, and underlying issues have not yet been fully resolved despite the steps taken so far. Several internal audit recommendations remain outstanding across multiple years. While management has taken some action, and the Audit, Performance and Risk Committee has continued to provide challenge and scrutiny, the pace of resolution has not been sufficient to close these out. The IJB should consider a refreshed approach to clearing outstanding actions with clearer ownership and realistic timescales to help ensure recommendations are actioned more promptly going forward. Integration Joint Board’s have a statutory duty to have arrangements to secure Best Value. The IJB have adequate arrangements in place to meet the Best Value obligations, and a review of Best Value has been undertaken and reported in year. This was a recommendation in our report last year to undertake this assessment, and the recommendation has now been closed. 5 Page 99
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Headlines (3) Status of Audit Work Our work is substantially complete, and at this stage there are no matters of which we are aware that would require modification of our audit opinion. This is subject to the finalisation of the following outstanding matters : • finalisation of review of disclosures and accounting policies within the financial statements and annual report In addition, the usual closing processes at the final stages of the audit process will need to be performed as listed below: • receipt of management representation letter • review of the final set of financial statements • receipt of final signed financial statements • final sign off by the engagement lead • receipt of management’s updated going concern and post balance sheet events assessment at the date of sign off. 6 Page 100
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Introduction02 Page 101
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Introduction Scope of our audit work Our work has been undertaken in accordance with International Standards of Auditing (ISAs) (UK) and the Code. This report is addressed to the IJB and the Accounts Commission and will be published on Audit Scotland's website www.audit-scotland.gov.uk in due course. This report is a summary of our findings from our external audit work for the financial year at Moray IJB. The scope of our audit was set out in our External Audit Plan dated 24 March 2026. The core elements of our audit work in 2025/26 have been: • An audit of the IJB’s annual report and accounts for the financial year ended 31 March 2026 [findings reported within this report]; • Consideration of the wider dimensions that frame the scope of public audit as set out in Audit Scotland’s Code of Audit Practice 2021 (‘the Code’) [within this report]; • Any other work requested by Audit Scotland. Responsibilities The IJB has primary responsibility for ensuring the proper financial stewardship of public funds. This includes preparing annual accounts in accordance with proper accounting practices. The IJB is also responsible for compliance with legislation, and establishing arrangements over governance, propriety and regularity that enable it to successfully deliver its objectives. Our responsibilities as independent auditors, appointed by the Accounts Commission, are set out in the Local Government in Scotland Act 1973, the Code and supplementary guidance, and International Standards on Auditing in the UK. The recommendations or risks identified in this report are only those that have come to our attention during our normal audit work and may not be all that exist. Communication in this report of matters arising from the audit or of risks or weaknesses does not absolve officers from their responsibility to address the issues raised and to maintain an adequate system of control. Adding value through our audit work We aim to add value to the IJB throughout our audit work. We do this through using our wider public sector knowledge and we invited IJB officers to our annual local government accounting workshop. Through our expertise, we provide constructive, forward-looking recommendations where we identify areas for improvement and encourage good practice around financial management and financial sustainability, risk management and performance monitoring. In so doing, we aim to help the IJB promote improved standards of governance, better management and decision making, and more effective use of resources. 8 Page 102
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Audit of the annual report and accounts 03 Page 103
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Audit of the annual report and accounts Approach to the audit of financial statements Key audit matters and significant risks The following significant risks have been identified: • Management override of controls (significant risk). No key audit matters have been identified. Internal control environment In accordance with ISA requirements, we have developed an understanding of the IJB’s control environment. Our audit is not controls based and we have not placed reliance on controls operating effectively as our audit is substantive in nature. In accordance with ISAs, over those areas of significant risk of material misstatement we consider the design of controls in place. However, we do not place reliance on the design of controls when undertaking our substantive testing. We identified no material weaknesses or areas of concern from this work which would have caused us to alter the planned approach as documented in our plan. Recap of our audit approach and key changes in our audit strategy We have not identified any changes in our approach since our Audit Plan was presented to the Audit, Performance and Risk Committee on 25 June 2026. The risks identified remain the same. 10 Key audit matters Scoping Materiality Page 104
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Our application of materiality We apply the concept of materiality both in planning and performing the audit, and in evaluating the effect of identified misstatements on the audit and of uncorrected misstatements, if any, on the financial statements and in forming the opinion in the auditor’s report. The concept of materiality is fundamental to the preparation of the financial statements and the audit process and applies not only to the monetary misstatements but also to disclosure requirements and adherence to acceptable accounting practice and applicable law. Our audit approach was set out in our audit plan. • We reviewed and updated our assessment of materiality from planning based upon your 2025/26 draft financial statements and concluded that materiality is £5.657 million (PY £5.257 million), which equates to approximately 2.5% (PY 2.5%) of 2025/26 gross expenditure. • Performance materiality was set at £4.243 million (PY £3.943 million) representing 75% of our calculated materiality (PY 75%). • We report to Officers (Management) any difference identified over £0.282 million representing 5% of our calculated materiality (PY £0.263 million). • Due to the public interest in senior officer remuneration disclosures, we apply specific audit procedures to this work and set a lower materiality level for this area of £25,000 (PY £25,000). We design our procedures to detect errors in specific accounts at a lower level of precision which we have determined to be applicable for senior officer remuneration disclosures. We evaluate errors in the remuneration report for both quantitative and qualitative factors against this lower level of materiality. We will apply heightened auditor focus on the completeness and clarity of disclosures in this area and will request amendments to be made if any errors exceed the threshold we have set or would alter the bandings reported for any individual. There is a change in materiality values since our final audit plan was communicated to you on 24 March 2026 as final gross expenditure for 2025/26 was used as the basis of the calculation. The percentage chosen for higher materiality, performance materiality and triviality remains unchanged. 11 Page 105
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Detecting irregularities, including fraud Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities, to detect material misstatements in respect of irregularities, including fraud. Owing to the inherent limitations of an audit, there is an unavoidable risk that material misstatements in the financial statements may not be detected, even though the audit is properly planned and performed in accordance with the ISAs (UK). The extent to which our procedures are capable of detecting irregularities, including fraud is detailed below: • We obtained an understanding of the legal and regulatory frameworks that are applicable to Moray IJB and determined that the most significant which are directly relevant to specific assertions in the financial statements are those related to the reporting frameworks; International Financial Reporting Standards and the 2025/26 Local Government CIPFA Code of Accounting Practice. • We enquired of Senior Officers and the Chair of the Audit, Performance and Risk Committee, concerning the IJB’s policies and procedures relating to the identification, evaluation and compliance with laws and regulations; the detection and response to the risks of fraud; and the establishment of internal controls to mitigate risks related to fraud or non-compliance with laws and regulations. • We enquired of Senior Officers and the Chair of the Audit, Performance and Risk Committee, whether they were aware of any instances of non-compliance with laws and regulations or whether they had any knowledge of actual, suspected or alleged fraud. • We assessed the susceptibility of the IJB’s financial statements to material misstatement, including how fraud might occur, by evaluating officers’ incentives and opportunities for manipulation of the financial statements. This included the evaluation of the risk of management override of controls. We determined that the principal risks were in relation to journal entries that altered the IJB’s financial performance for the year and potential management bias in determining accounting estimates. Our audit procedures are documented within our response to the significant risk of management override of controls below. These audit procedures were designed to provide reasonable assurance that the financial statements were free from fraud or error. However, detecting irregularities that result from fraud is inherently more difficult than detecting those that result from error, as those irregularities that result from fraud may involve collusion, deliberate concealment, forgery or intentional misrepresentations. Also, the further removed non-compliance with laws and regulations is from events and transactions reflected in the financial statements, the less likely we would become aware of it. The team communications in respect of potential non-compliance with relevant laws and regulations, included the potential for fraud in in certain account balances and significant accounting estimates. In assessing the potential risks of material misstatement, we obtained an understanding of: − Moray IJB’s operations, including the nature of its operating revenue and expenditure and its services and of its objectives and strategies to understand the classes of transactions, account balances, expected financial statement disclosures and business risks that may result in risks of material misstatement. − The IJB’s control environment, including the policies and procedures implemented by the organisation to ensure compliance with the requirements of the financial reporting framework. 12 Page 106
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Overview of audit risks The table below summarises the key audit matters, significant and other risks discussed in more detail on the subsequent pages. Significant risks are defined by ISAs (UK) as an identified risk of material misstatement for which the assessment of inherent risk is close to the upper end of the spectrum due to the degree to which risk factors affect the combination of the likelihood of a misstatement occurring and the magnitude of the potential misstatement if that misstatement occurs. A significant risk can be a significant risk due to error or due to fraud. For the purposes of the ISAs (UK), the auditor is concerned with fraud or suspected fraud that causes a material misstatement in the financial statements. Two types of intentional misstatements are relevant to the auditor – misstatements resulting from fraudulent financial reporting and misstatements resulting from misappropriation of assets. As part of our consideration of risks relating to fraudulent financial reporting, we consider the potential for override of controls or other inappropriate influence over the financial reporting process, such as efforts by management to manage income and expenditure in order to influence the IJB’s year-end performance. 13 Risk title Risk level Change in risk since audit plan Fraud risk Key audit matter Level of judgment or estimation uncertainty Testing approach Status of work to date Management override of controls Significant ✓ Low Substantive Green ↑ Assessed risk increased since Audit Plan Assessed risk consistent with Audit Plan ↓ Assessed risk decreased since Audit Plan Not considered likely to result in material adjustment or change to disclosures within the financial statements Potential to result in material adjustment or significant change to disclosures within the financial statements Likely to result in material adjustment or significant change to disclosures within the financial statements. Page 107
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Significant risks and key audit matters (1) Responding to significant financial statement risks Significant risks are defined by ISAs (UK) as risks that, in the judgement of the auditor, require special audit consideration. In identifying risks, audit teams consider the nature of the risk, the potential magnitude of misstatement, and its likelihood. Significant risks are those risks that have a higher risk of material misstatement. This section provides commentary on the significant audit risks communicated in the External Audit Plan. Key audit matters Key audit matters are those matters that, in our professional judgement, were of most significance in our audit of the IJB’s financial statements of the current year and include the most significant assessed risks of material misstatement (whether or not due to fraud) that we identified. These matters include those that had the greatest effect on: • the overall audit strategy; • the allocation of resources in the audit; and • directing the efforts of the engagement team. These matters were addressed in the context of our audit of the financial statements as a whole, and in forming our opinion thereon, and we do not provide a separate opinion on these matters. There were no key audit matters identified. Other risks Other risks are, in the auditor's judgement, those where the risk of material misstatement is lower than that for a significant risk, but they are nonetheless an area of focus for our audit. There were no other risks identified as part of our procedures. 14 Description Audit reponse Disclosures Key observations KAM Page 108
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Significant risks and key audit matters (2) 15 Significant risks identified in our Audit Plan Commentary Management override of controls Under ISA (UK) 240 there is a non- rebuttable presumed risk that the risk of management override of controls is present in all entities. Our risk focuses on the areas of the financial statements where there is potential for management to use their judgement to influence the financial statements alongside the potential to override the entity’s internal controls, related to individual transactions. We have therefore identified management override of controls as a significant risk of material misstatement. This relates to the elements involving consolidation, after the information is extracted from partner ledgers, to produce the financial statements for Moray IJB. We have considered the design of controls in place over key accounting estimates and judgements through performance of walkthrough procedures and planning inquiries with management. In doing this work, we have concluded there are no significant estimates and judgements within the Annual Report and Accounts. This is appropriately disclosed within the IJB’s accounting policies and in line with our understanding of an IJB organisation. Across our public sector clients, we look to understand and test the control environment over journals including target testing journals on a risk assessment basis to ensure no management override of control that could result in fraud or material error. Therefore, we have: • documented our understanding of and evaluated the design effectiveness of management’s key controls over journals within Moray Council and NHS Grampian; • considered our journals testing within the NHS and the Council (as the external auditor of both organisations); • understood how the IJB accounts were produced and whether there is an opportunity or incentive for management to override controls to show an improved IJB financial performance through financial reporting; • gained an understanding of the critical judgements applied by management in the preparation of the financial statements and considered their reasonableness; • gained an understanding of the key accounting estimates made by management and • evaluated the rationale for any changes in accounting policies, estimates or significant unusual transactions Conclusion Through our audit procedures performed, we found that there was no evidence of management override of controls. We have placed reliance upon the journals work completed on the Moray Council and NHS Grampian audits where recommendations were made on each around the journal authorisation process. As the IJB’s financial statements are prepared by merging the relevant transactions from Moray Council and NHS Grampian, we have agreed the figures to underlying joint ledger reports to confirm accuracy and completeness. We did not identify indication of fraud or inappropriate management bias that could result in a material misstatement.Page 109
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Significant risks and key audit matters (3) 16 Significant risks identified in our Audit Plan Commentary The revenue cycle includes fraudulent transactions As set out in ISA (UK) 240 (Revised May 2021), there is a rebuttable presumed risk that revenue may be misstated due to the improper recognition of revenue. This presumption can be rebutted if the auditor concludes that there is no risk of material misstatement due to fraud relating to revenue recognition. (rebutted) Auditing standards require us to consider the risk of fraud in revenue. This is considered a presumed risk in all entities. Having considered the risk factors set out in ISA 240 and the nature of the revenue streams at Moray IJB, we have determined that the risk of fraud arising from revenue recognition can be rebutted as there is deemed to be little incentive to manipulate revenue recognition and opportunities to manipulate revenue recognition are deemed to be limited. As part of our work on material transactions and balances, we have agreed revenue balances to assurance letters provided confirming the balances at NHS and Council level as well as an assessment of the income recognition accounting policies and relevant disclosures. Conclusion Our work has not identified any issues to raise in relation to revenue recognition. Risk of fraud in expenditure As set out in practice note 10 (Revised 2022) ‘The Audit of Public sector Financial Statements’, issued by the Public Audit Forum, which applies to all public sector entities, we consider there to be an inherent risk of fraud in expenditure recognition. (rebutted) Having considered the risk factors set out in PN10 and the nature of the expenditure streams at Moray IJB, we have determined that the risk of fraud arising from expenditure recognition can be rebutted as opportunities to manipulate expenditure recognition are deemed to be limited. As part of our work on expenditure, we have agreed revenue balances to assurance letters provided confirming the balances at NHS and Council level. We have also reviewed expenditure recognition accounting policies and relevant disclosures. Conclusion Our work has not identified any issues to raise in relation to expenditure recognition. Page 110
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Financial statements – key judgements and estimates 17 As required in the IJB’s accounting policies, officers outline critical judgements in applying accounting policies and in addition, assumptions about the future and other sources of estimation uncertainty. In particular, where estimates and judgements are identified, these should be quantified. This section provides commentary on key estimates and judgments in line with the enhanced requirements for auditors. Significant judgement or estimate Summary of management’s approach Audit Comments Assessment None The note within the IJB accounting policies (Note 2 Critical Judgements and Estimation Uncertainty) confirms there are no judgements or estimates within the IJB accounts. We have confirmed there are no significant estimate or judgements within the IJB annual reports and accounts. Not Applicable Page 111
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Other key elements of the financial statements (1) 18 There were other key areas of focus during our audit. Whilst not considered a significant risk, these are areas of focus either in accordance with the Audit Scotland Code of Audit Practice (2021) or ISAs or due to their complexity or importance to the user of the accounts: Issue Commentary Matters in relation to fraud and irregularity It is the IJB’s responsibility to establish arrangements to prevent and detect fraud and other irregularity. As auditors, we obtain reasonable assurance that the financial statements as a whole are free from material misstatement, whether due to fraud or error. We obtain annual representation from officers and those charged with governance regarding the IJB’s assessment of fraud risk, including internal controls, and any known or suspected fraud or misstatement. We have also made inquires of internal audit around internal control, fraud risk and any known or suspected frauds in year. We have not been made aware of any incidents in the period and no issues in relation to these areas have been identified during the course of our audit procedures that are outside of the usual expected investigations. Accounting practices We have evaluated the appropriateness of Moray IJB’s accounting policies, accounting estimates and financial statement disclosures. There are no issues to raise. Matters in relation to related parties We are not aware of any other related parties or related party transactions which have not been disclosed. The principal related parties are Moray Council and NHS Grampian. Matters in relation to laws and regulations You have not made us aware of any significant incidences of non-compliance with relevant laws and regulations and we have not identified any incidences from our audit work. We have not identified any cases of money laundering or fraud at the IJB. Other information We are required to give an opinion on whether the other information published together with the audited financial statements (including the Annual Report), is materially inconsistent with the financial statements or our knowledge obtained in the audit or otherwise appears to be materially misstated. Minor amendments have been made to the Annual Report that do not warrant further detail. We are satisfied that there are no material inconsistencies to report. Page 112
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Other key elements of the financial statements (2) 19 Issue Commentary Governance statement We are required to report on whether the information given in the Annual Governance Statement is consistent with the financial statements and prepared in accordance with the Delivering Good Governance in Local government: Framework (2016). No inconsistencies have been identified; we plan to issue an unmodified opinion in this respect. Matters on which we report by exception We are required by the Accounts Commission to report to you if, in our opinion: adequate accounting records have not been kept; or the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or we have not received all the information and explanations we require for our audit or there has been a failure to achieve a prescribed financial objective. We have nothing to report in respect of these matters. Written representations A letter of representation has been requested from the Integration Joint Board as required by auditing standards. We have not requested any additional specific representations in this letter. Going Concern In performing our work on going concern, we have had reference to Statement of Recommended Practice – Practice Note 10: Audit of financial statements of public sector bodies in the United Kingdom (Revised 2022). The Financial Reporting Council recognises that for particular sectors, it may be necessary to clarify how auditing standards are applied to an entity in a manner that is relevant and provides useful information to the users of financial statements in that sector. Practice Note 10 provides that clarification for audits of public sector bodies. Practice Note 10 states that if the financial reporting framework provides for the adoption of the going concern basis of accounting on the basis of the anticipated continuation of the provision of a service in the future, the auditor applies the continued provision of service approach set out in Practice Note 10. The financial reporting framework adopted by the Integration Joint Board meets this criteria, and so we have applied the continued provision of service approach. In accordance with Audit Scotland guidance: Going concern in the public sector, we have therefore considered management’s (senior officer’s) assessment of the appropriateness of the going concern basis of accounting and conclude that: – a material uncertainty related to going concern has not been identified – management’s (senior officer’s) use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Page 113
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Other responsibilities under the Code 20 Issue Commentary WGA return For local government audits, we are required to complete Whole of Government Accounts (WGA) work and provide an assurance statement on the WGA return as mandated by National Audit Office. The IJB will fall under its parents return (Moray Council). We will complete the relevant specified procedures and prepare and submit a partial assurance statement once we have completed all our work on Moray Council’s financial statements, and when the final guidance is received. Health board consolidation For health boards, we are required to under the Code of Audit Practice to examine and report on the consolidation schedules. The IJB expenditure for NHS Grampian was included within the health board consolidation process and this was submitted as part of our work on NHS Grampian’s financial statements in June 2026. Other returns to Audit Scotland In accordance with the Audit Scotland Planning Guidance, as appointed auditors we have prepared and submitted Fraud Returns and Current Issues Returns to Audit Scotland, sector annual reports, shared intelligence on health and social care, sector meetings and Technical Guidance Notes. There is nothing we need to bring to your attention in this respect. Page 114
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Other findings – information technology Any IT findings are reported to Moray Council and NHS Grampian as part of their Annual Audit Reports. Assessment - Significant deficiencies identified in IT controls relevant to the audit of the financial statements. - Non-significant deficiencies identified in IT controls relevant to the audit of the financial statements / significant deficiencies identified with sufficient mitigation of risk. - IT controls relevant to the audit of financials statements judged to be effective at the level of testing in scope. - Not in scope for testing 21 This section provides an overview of results from our assessment of Information Technology (IT) environment and controls which included identifying risks from the use of IT related to business process controls relevant to the financial audit. This includes an overall IT General Control (ITGC) rating per IT system and details of the ratings assigned to individual control areas. IT application Level of assessment performed Overall ITGC rating ITGC control area rating – security management ITGC control area rating – technology acquisition, development and maintenance ITGC control area rating – technology infrastructure Related significant risks / other risks Advance Business Solutions e5 system – Moray Council’s general ledger ITGC assessment (design and implementation effectiveness only) Green Green Green Green All significant risk areas eFinancials – NHS Grampian’s general ledger ITGC assessment (design and implementation effectiveness only) Green Green Green Green All significant risk areas Page 115
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope and best value arrangements Our responsibilities under the Code extend beyond the audit of the financial statements. The Code sets out four audit areas that frame wider scope into specified reporting criteria. These are as set out below: 23 Financial management Has the body got sound budgetary process, financial capacity and the control environment and internal controls are operating effectively. Financial Sustainability How the body looks forward to the medium and longer term to consider whether the body is planning effectively to deliver its services or the way in which they should be delivered. Vision, Leadership and Governance How effective are the body’s scrutiny and governance arrangements, leadership and decision making, and transparent reporting of financial and performance information. Use of Resources to Improve Outcomes How the body makes best use of their resources to meet stated outcomes and improvement objectives, through effective planning and working with strategic partners and communities. This includes demonstrating economy, efficiency and effectiveness through the use of financial and other resources and reporting performance against outcomes. Page 117
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope conclusions This section of our report documents our conclusions from audit work on the wider scope areas set out in the Code. We take a risk-based audit approach to wider scope work. Within our audit plan we identified one significant risk in respect of financial sustainability. Wider scope area Our risk considerations and focus Significant risk identified - final stage Wider scope conclusion Financial Management The arrangements in place at the IJB to ensure sound financial management, accountability and the arrangements to prevent and detect fraud, error and other irregularities No Due to costs pressures and the non-delivery of all required savings during 2025/26, both partner organisations required to provide significant additional funding contributions totalling £7.2 million to enable the IJB to achieve financial balance. The IJB were transparent on the expected outturn, with monitoring reports highlighting the expected overspend position, ensuring the partner authorities were aware they would need to provide additional funding. The IJB have made improvements to the year end reporting of savings by including a full analysis on the outcome of the in-year savings plan, alongside confirmation of whether savings have been recurring or non-recurring in nature. Financial Sustainability The projected financial position of the IJB in the medium to longer term and the relevance and appropriateness of assumptions applied to financial plans that will allow the council to effectively deliver services in the future Yes The 2026/27 budget, approved in March 2026, included upfront deficit funding from both partner authorities and enabled the IJB to set a balanced budget. The balanced budget includes an expectation that the IJB will deliver a significant level of savings totalling £5.718 million. Looking ahead, the IJB forecasts a funding gap of £39 million by 2030/31, representing a significant increase from previous projections. As the IJB currently holds no general reserve balance, future financial shortfalls would require additional support from partner authorities. In this context, the successful delivery of transformation and service redesign will be critical to addressing the projected funding gap and supporting the IJB's long-term financial sustainability. Vision, Leadership and Governance The effectiveness of the IJB’s governance arrangements and the arrangements in place to deliver the vision, strategy and priorities set by the IJB No The IJB have governance arrangements in place that are appropriate and operate effectively however, for the fifth consecutive year, Internal Audit has issued a limited assurance opinion, indicating that weaknesses in governance, risk management and internal control arrangements remain. While progress has been made in addressing these issues, the IJB should look to address known issues which will strengthen the overall control environment and achieve a higher level of assurance in future years. The IJB is progressing the implementation of an organisational restructure, which includes the appointment of a permanent Chief Social Worker from August 2026. Use of Resources to Improve Outcomes How the IJB demonstrates economy, efficiency and effectiveness through its use of financial and other resources No The IJB’s performance is showing a general trend of improvement against the national indicators with many indicators also performing above the Scottish average. However the majority of local indicators are below the IJB’s own set target. The IJB have performed a review of progress against the Scottish Government’s Best Value Framework during 2025/26 which provided assurance that the IJB were meeting their Best Value obligations. No risks identified Other risks identified. Significant risk identified. 24 Page 118
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial management (1) 25 Wider scope area Wider scope audit response and findings Conclusion Financial management No risk identified Financial Performance The 2025/26 budget and savings plan was approved by the IJB Board on 27 March 2025, in line with required timescales. The final revenue Budget for 2025/26 was £213.843 million which included £15.638 million for set aside services. The funding provided totalled £212.843 million and built into the 2025/26 funding assumptions is projected savings of £9.469 million. The IJB expect £8.279 million of these savings to be recurring in nature. Overall, the IJB predicted an overall budget deficit of £1.000 million, with the intention to fund the deficit from earmarked reserves. Throughout 2025/26, there were several adjustments to the 2025/26 Revenue Budget. All budget revisions were reported to the IJB. The table below shows the IJB’s outturn position for the year. It is important to note this outturn position is after the IJB received additional funding from the two partner authorities, plus further funding from the Scottish Government which is included within earmarked reserves at year end. Prior to receiving the additional funding from partner authorities, the IJB had a £7.2 million deficit for 2025/26. As a result, the final revised budget position for 2025/26 was £229.318 million. The IJB had total expenditure of £226.308 million, resulting in an underspend against the final budget of £3.010 million. Note: Strategic Funds relate to additional Scottish Government funding for Integrated Joint Boards. For Moray IJB, this generally relates to additional funding received via NHS Grampian and Moray Council. The IJB required significant additional funding contributions from both partners in order to achieve the year-end outturn position. The IJB was predicting a significant overspend throughout 2025/26, which peaked at £8.78 million. The overspend of £7.2 million was fully funded by the partner authorities, with Moray Council providing £3.4 million and NHS Grampian £3.8 million. 2025/26 Financial Outturn Revised Budget (£m) Actual (£m) Variance (£m) Core Services 194.859 200.211 (5.352) Strategic Funds & Other Resources 14.367 6.005 8.362 Set Aside 20.092 20.092 - Total 229.318 226.308 3.010 Page 119
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial management (2) 26 Wider scope area Wider scope audit response and findings Conclusion Financial management (continued) Financial Performance (continued) The main overspends within core services were as follows: • Mental Health - The service was overspent by £0.654 million due to the ongoing use of agency locums, additional purchase of care costs within care homes and care at home and unachieved savings. • Older People Services and Physical & Sensory Disability – The overspend of £1.933 million primarily related to overspends for home care and permanent care due to the increase in clients receiving nursing care rather than residential care. • Admin and Management- The admin and management budget reported an overspend of £1.030 million, mainly due to interim staffing arrangements and the vacancy target for Moray Council not being met Financial Performance - Savings To balance the 2025/26 budget, the IJB intended to make savings of £9.469 million in 2024/25, with progress on the savings plan reported as part of the budget monitoring reports presented to the IJB Board. Each saving is broken down by project and continues to be reported on a RAG basis. Throughout the year, the IJB made it clear they would not achieve all planned savings and where savings were not fully achieved, it was expected that partner authorities would need to provide additional funding to meet any in year deficits. The year-end outturn report, presented to the IJB Board on 25 June 2026, provides an overview on the savings delivered during 2025/26: The monitoring reports taken to the Board made it clear early in the year that savings would not be delivered. The IJB must ensure that its savings plans are realistic and based on what is able to be delivered. The IJB did not deliver all planned savings in 2025/26 and required additional funding from partners to meet the in- year funding deficit. Actual (£m) Savings delivered 4.343 Savings delivered through reduction in overspends 1.031 Savings not delivered 4.095 Page 120
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial management (3) 27 Wider scope area Wider scope audit response and findings Conclusion Financial management (continued) Financial Performance – Savings (continued) Of the £4.343 million of savings delivered in year, the IJB expect £3.660 million to be recurring in nature, with the remaining £0.683 million being non-recurring savings. In response to our previous audit recommendation, the IJB now include confirmation on whether savings were recurring or non-recurring in the both the Annual Accounts and the year-end outturn report. We have also confirmed that the year-end outturn report has been updated to include an appendix showing the complete 2025/26 savings plans, confirmation of the amount of savings achieved in 2025/26 and final RAG rating for the delivery of the savings. This is the same level of detail that is included in the quarterly monitoring reports and enables a full comparison to be drawn across the financial year. Financial Management Arrangements The IJB’s financial performance is monitored through regular budget monitoring reports to the Board, which provides members and senior management with timely and accurate information on the current and projected year-end financial position. The monitoring report clearly sets out any budget revisions, the forecast outturn position and any significant variances. Members are provided with opportunities to review, challenge and scrutinise financial performance, supported by real-time financial information from Moray Council and NHS Grampian systems. The IJB continues to commission services from both partner organisations, with the management of services operating under their respective financial governance arrangements. The IJB’s Financial Regulations were reviewed and approved by the Board on 29 May 2025. The IJB has established a Budget Savings Oversight Group, chaired by the Chief Officer and supported by the senior management team and project management officers. The Group meets monthly to monitor progress against savings programmes, with a particular focus on high-risk and high-value savings initiatives. The individuals responsible for preparing and reporting financial information are qualified, experienced and have significant knowledge of the organisation. However, due to the small size of the finance team, staff absences could create capacity pressures. The IJB have responded to our previous audit recommendation, with the year end outturn report showing a final savings analysis for the financial year, alongside confirmation of whether savings have been recurring or non- recurring in nature. Page 121
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial sustainability (1) 28 Wider scope area Wider scope audit response and findings Conclusion Financial sustainability Significant risk: There is a risk that transformation and savings plans to address financial pressures for medium to longer term are not sufficient to address future funding gaps and increasing deficits. Short Term Financial Planning – Budget Setting 20267/27 The IJB’s main source of funding comes from the contributions received from the two partner authorities. The IJB undertakes an annual budget process which forms part of the wider medium term strategy process. This includes discussions taking place between management, Moray Council and NHS Grampian regarding funding requirements. The 2026/27 Revenue Budget was presented to the Board in March 2026 alongside an updated Medium Term Financial Framework covering 2026/27 – 2030/31. The budget for 2026/27 is £233.766 million which included £20.092 million for set aside services. The 2026/27 budget is £7.458 million higher than the final outturn position for 2025/26. The funding provided from the partner authorities totalled £228.048 million. Built into the 2026/27 funding assumptions is projected savings of £5.718 million. The budget include details of all savings on a project-by-project basis, and the expected savings to be delivered for each project. The budget confirms the IJB expect £5.428 million of these savings to be recurring in nature. The budget is reflected in the table below: For 2026/27, the IJB has adopted a revised funding approach that includes £9.0 million of planned deficit funding from Moray Council and NHS Grampian. In contrast to previous years, where deficit support was considered during the financial year if required, funding has been provided at the outset of the financial year and enabled the IJB to set a balanced budget. The approach acknowledges the recurring nature of current financial pressures and provides greater financial stability to both the IJB and partner authorities. The IJB agreed the 2026/27 budget in line with required timescales. The upfront deficit funding provides short-term financial stability, enabling the IJB to set a balanced budget while progressing savings and transformation initiatives to support longer-term sustainability. 2026/27 Budget £m Total Budget 233.766 Total Funding (228.048) Savings Identified (5.718) Total - Page 122
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial sustainability (2) 29 Wider scope area Wider scope audit response and findings Conclusion Financial sustainability (continued) Short Term Financial Planning – Budget Setting 2026/27 (continued) The level of savings the IJB require to produce in year is significant. As outlined, the IJB did not deliver all planned savings for 2025/26 and were the full £5.718 million of savings not fully achieved during 2026/27, it is expected that partner authorities will need to provide additional funding to meet any in year deficits. The IJB will need to closely monitor savings delivery during 2026/27 via the Budget Savings Oversight Group. The savings programme focuses on the IJB's strategic themes of Building Resilience, Home First and Partners in Care, alongside a number of already implemented cost reduction measures. Key savings include reviews of care packages and commissioning arrangements, review of out-of-area placements, vacancy management and reductions in overtime. The savings programme is intended to support financial sustainability while progressing service transformation and redesign. 2026/27 Revenue Budget Monitoring The IJB will present the Quarter 1 revenue monitoring report to the September 2026 Board Meeting. We have been provided early sight of the report which provides an update on the IJB’s performance against the 2026/27 budget and shows detailed forecast projections for the remainder of 2026/27. Important context for the report is that it has been prepared without recognising the additional £9 million of planned deficit funding agreed by the partner authorities. The budget position at the end of June 2026 is an overspend to date on the Core Services budget of £1.615 million, and an overspend on the Strategic Funds budget of £0.358 million. Looking ahead, the IJB are forecasting a budget deficit of £8.975 million (3.8% of the IJB budget) for financial year 2026/27. This position is within the parameters of the deficit funding from the partners authorities, meaning the IJB are projecting to break even when including the anticipated £9 million of funding. The progress towards the IJB’s savings plans is included as part of the monitoring report and is reported on a RAG basis. At the end of June 2026, the IJB were predicting: - Expect to achieve £4.1 million of savings (rated green) - £1.6 million of savings are at risk of not being achieved (rated amber or red). As all intended savings will not be delivered in 2026/27, the IJB are in the process of identifying new savings which will help to reduce the overall projected deficit. The IJB will need to deliver significant savings to address the projected funding gap in 2026/27. The IJB are projecting to break-even in 2026/27 when additional deficit support funding is included in the current projections. It is unlikely that the IJB will deliver all required savings in 2026/27 and will review alternative options to help reduce the projected deficit. Page 123
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial sustainability (3) 30 Wider scope area Wider scope audit response and findings Conclusion Financial sustainability (continued) Medium Term Financial Strategy The updated Medium Term Financial Framework (MTFF) 2026/27 – 2030/31 was approved at the IJB Board meeting on 26 March 2026. The financial pressures for 2026/27 and beyond are significant, with the total funding gap for the period currently projected to be £39.020 million. The summary position reflected in the table above highlights the significant financial challenges facing the IJB and the need for continued close monitoring of its financial position. Future funding assumptions are dependent on the successful delivery of recurring savings and transformational service redesign to ensure services remain affordable, sustainable and aligned to the IJB’s strategic priorities. The MTFF assumes that current financial pressures will be mitigated through these measures; however, ongoing economic uncertainty, including potential reductions in future funding, pay award pressures, inflation, cost of living impacts and supply chain challenges, could increase the projected cumulative funding gap and place further pressure on the IJB’s financial sustainability. To achieve long-term financial sustainability, the IJB must successfully deliver its savings and transformation programme to reduce funding gaps and support the continued delivery of key services and strategic priorities. Failure to achieve planned savings and transformation outcomes could result in significant financial pressures and increase the risk to the IJB's financial sustainability in the short to medium term. 2026/27 £m 2027/28 £m 2028/29 £m 2029/30 £m 2030/31 £m Estimated Budget Requirement 228.048 240.001 243.344 247.257 251.615 Total Funding (228.048) (230.656) (233.453) (237.446) (242.642) Budget Deficit - (9.344) (9.891) (9.811) (9.973) Page 124
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial sustainability (4) 31 Wider scope area Wider scope audit response and findings Conclusion Financial sustainability (continued) Reserves Reserves are an important indicator of an organisation's financial resilience and overall financial health. As at 31 March 2026, the IJB held £3.010 million in reserves, all of which were earmarked for specific purposes. During 2025/26, earmarked reserves increased by £1.560 million. The IJB general reserves balance is nil, meaning future overspends would need to be fully met by the partner authorities, as all available reserves are earmarked. There is no general reserves balance available which would provide flexibility or resilience against unforeseen financial pressures. While the 2026/27 budget does not rely on the use of general reserves, the absence of an uncommitted reserve balance limits the IJB's ability to respond to emerging risks and funding uncertainties. The IJB should therefore seek to rebuild a sustainable level of general reserves over the medium term to strengthen its financial resilience and support long-term financial sustainability. The IJB does not hold any general reserve balance at 31 March 2026, and the level of reserves is at an unsustainable level. Therefore, any overspend in 2026/27 will need be met by partner bodies. Page 125
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial sustainability (5) 32 Wider scope area Wider scope audit response and findings Conclusion Financial sustainability (continued) Transformation Plans The IJB faces a significant and growing cumulative funding gap over the next four years, with the latest MTFF identifying a substantially larger shortfall than the previous iteration. This increases the financial challenge facing the IJB over the medium term, will require continued focus on delivering sustainable savings and operating within available resources. As a result, the IJB must balance the need to achieve financial sustainability with its responsibility to deliver quality and safe services and meet its strategic priorities. As part of the management restructure, the IJB is establishing a Transformation Board to strengthen oversight of service redesign and delivery of the savings programme. This work is being aligned with the Budget Savings Oversight Group and reflects the significant financial challenges facing the sector, including the wider financial pressures across Integration Joint Boards and the limited prospect of additional funding. The Transformation Board will oversee a programme of longer-term change, with a focus on identifying sustainable efficiencies and alternative models of service delivery. Key areas under consideration include workforce planning and organisational structures, opportunities for greater multidisciplinary and integrated working, the future configuration of bed-based services, and a review of care allocation and eligibility thresholds. The programme will also support a strategic shift towards prevention and early intervention, with particular emphasis on reducing demand for higher-cost services and supporting more individuals, including children and young people, to receive care and support within Moray wherever appropriate. These changes are intended to improve outcomes while ensuring services remain financially sustainable. Given the scale of the financial challenge, continued progress in delivering transformation and service redesign will be essential to achieving planned financial benefits and reducing future funding pressures to support medium to long term financial sustainability. Members should maintain oversight of the transformation programme to monitor progress and ensure planned benefits are realised. Page 126
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – financial sustainability (6) 33 Wider scope area Wider scope audit response and findings Conclusion Financial sustainability (continued) Audit Scotland - Review of Integration Joint Boards In February 2026, Audit Scotland published Integration Joint Boards: Finance Bulletin 2024/25 which provided an independent analysis over the finances of Integration Joint Boards for financial year 2024/25. Key findings from the report included: • Financial pressures across IJBs continue to outstrip funding growth, requiring difficult decisions on service redesign, reduction and prioritisation. • Reserve levels across the sector continue to decline, with many IJBs holding little or no contingency reserves to manage emerging financial pressures. • Reliance on partner funding to support deficits is increasing, despite partners facing significant financial challenges of their own. Several items raised in the Audit Scotland report are consistent with the issues that Moray IJB are facing and there is an understanding that shape of service delivery will have to change in order to deliver services in a more sustainable manner. Moray IJB are facing several of the issues raised in the Audit Scotland report and are reviewing how they can provide services in a more sustainable manner. Page 127
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – vision, leadership and governance (1) 34 Wider scope area Wider scope audit response and findings Conclusion Vision, leadership and governance No risk identified Governance Arrangements The IJB has established governance arrangements in place and operates through a committee-based governance structure, with delegated responsibilities assigned to a number of committees to support the oversight and delivery of services. The governance framework currently comprises three committees: the Integration Joint Board, the Audit, Performance and Risk Committee, and the Clinical and Care Governance Committee. The IJB have also established an Operational Governance Group to strengthen operational oversight. We have attended all Audit, Performance and Risk Committee meetings during 2025/26. The IJB is progressing the implementation of an organisational restructure. The restructure is intended to provide greater clarity in senior management roles and increase organisational stability through the creation of permanent posts where appropriate. Recruitment is underway for a Head of Strategic Planning, Commissioning and Transformation to strengthen leadership capacity in this area, and a new Chief Social Work Officer has been appointed from August 2026. There are transition arrangements in place to support a smooth handover from the outgoing Chief Social Work Officer, who has been carrying out the role on an interim basis from May 2024. Governance Statement The Governance Statement details the composition and governance structure of Moray IJB and how that supports the achievement of the organisation’s priority themes. From review of the Statement, we are satisfied that it reflects the key findings from audit, scrutiny and inspection, including details of the limited assurance Internal Audit opinion issued for 2025/26 (see Internal Audit section at page 36 for further detail). We conclude that the Audit, Performance and Risk Committee effectively challenge and scrutinize reports presented and ensure effective decision making. The Council have appointed a permanent Chief Social Work Officer from August 2026. Page 128
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – vision, leadership and governance (2) 35 Wider scope area Wider scope audit response and findings Conclusion Vision, leadership and governance (continued) Risk Management The Strategic Risk Register was subject to review during 2025 and the updated version formally approved by the Board in May 2025. It is reviewed monthly by the Senior Management Team. Following agreement by the Board on 25 September 2025, the Strategic Risk Register is subject to review by the Audit, Performance and Risk Committee before being submitted to the Board for approval, providing additional scrutiny and assurance within the governance process. The most recent risk register presented to the Board in March 2026 included one “very high” risk identified by the IJB as follows: • 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. This risk and the mitigating actions the IJB are implementing in response are in in line with our findings reported in the financial sustainability section of this report. The IJB are reporting risk management updates to the Audit and Risk Committee on a regular basis, with effective scrutiny and challenge provided. The very high level risk is consistent with previous years and continue to be assessed and reported at regular intervals. Page 129
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – vision, leadership and governance (3) 36 Wider scope area Wider scope audit response and findings Conclusion Vision, leadership and governance (continued) Internal Audit Internal audit services for the IJB are provided by Moray Council's Audit and Risk Manager, who has held this role since 2022 and has been reappointed to continue providing services until 31 March 2028. The Audit, Performance and Risk Committee receives quarterly internal audit reports, including audit findings and follow-up reviews, providing members with assurance over the effectiveness of internal controls. Since 2021/22, internal audit have provided the IJB with a limited assurance audit opinion. This has continued to be the case for 2025/26, with the internal audit opinion confirming that “while progress has been made in strengthening governance and internal control arrangements within the MIJB, the outcomes of the audit work undertaken identified significant findings. In addition, several recommendations from previous reviews remain outstanding. After careful consideration of these factors, the Chief Internal Auditor has provided limited assurance that the MIJB had adequate systems of governance and internal control in place for the year ended 31 March 2026.” Therefore, this is the fifth year in succession that Internal Audit have provided a limited assurance opinion to the IJB. Fundamentally, this indicates there are weaknesses in the framework of governance, risk management and control. We note that the Chief Internal Audit has confirmed that “significant progress has been made in strengthening governance and internal controls within the MIJB and it is anticipated that this will support the delivery of required improvements going forward”. However internal audit reviews have continued to identify significant findings, with several recommendations outstanding and requiring revised implementation timescales or further follow-up. Furthermore, the development of a single case recording system also remains a key priority for the Service. Given the continued limited assurance opinion, outstanding audit recommendations and ongoing replacement of the CareFirst system, our previous audit recommendation relating to internal audit activity remain valid until there is clearer evidence of sustained improvement. The IJB have an effective internal audit function in place to assist with assurance over governance framework, risk and internal controls. This is the fifth consecutive year in which Internal Audit has issued a limited assurance opinion. While progress has been made in addressing these issues, the IJB should establish and deliver definitive improvement plans to strengthen its control environment and achieve a higher level of assurance in future years. Effective Audit, Performance and Risk Committee challenge and scrutiny is paramount when dealing with five years limited opinions Internal audit recommendations have accumulated over a number of years, highlighting the need for the IJB to ensure that agreed actions are implemented promptly and effectively. As progress remains outstanding in several areas, our previous recommendation remains valid. Page 130
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – use of resources (1) 37 Wider scope area Wider scope audit response and findings Conclusion Use of resources to improve outcomes No risk identified Strategic Planning The IJB have an approved Strategic Plan (2022-2032) which sets out the ten-year vision, priorities and direction for health and social care services across Moray. The Strategic Plan is the IJB's overarching strategic document that sets out what it wants to achieve, why change is needed, and how health and social care services will be delivered and transformed across the life of the plan. The IJB will be undertaking a review and refresh of the Strategic Plan during 2026/27, with an aim to approve the updated version in March 2027. To supports the delivery of the Strategic Plan, the IJB have an approved Strategic Delivery Plan 2025-2028 which sets out the key transformation and improvement activities required to achieve its strategic priorities. The Plan links actions to the IJB's strategic themes and objectives, identifies lead officers and timescales, and is regularly monitored by management and governance groups. Progress is reported to both the Board (every six months) and the Audit, Performance and Risk Committee (quarterly). Performance Reporting A performance report is published annually which outlines the IJB’s annual performance against the strategic priorities of the Health and Social Care Partnership and evidencing some of the key achievements and challenges faced by the IJB. Furthermore, the report provides details on the IJB’s performance in relation to the Scottish Government’s core suite of national integration indicators which allows comparisons to be made over time and against Scotland as a whole. Our review of the 2025/26 performance report highlights that out of the 19 national indicators reported: • 15 indicators were showing as green (IJB performance has improved from last year), • one indicator was showing as amber (performance is similar to last year) • two indicators were showing as red (performance is worse than previous year. • there was one indicator that data is not available for reporting. The table on the following page provides detail on the IJB’s performance across several of the national indicators. There are clear links between the Strategic Plan and Strategic Delivery Plan with a clear set of actions laid out in the Strategic Delivery Plan. We have obtained assurance that appropriate performance monitoring and reporting arrangements are in place at the IJB, and where indicators are worsening, the IJB then agree upon actions that need to be taken to improve performance. Page 131
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – use of resources (2) 38 Wider scope area Wider scope audit response and findings Conclusion Use of resources to improve outcomes (continued) Performance Reporting (continued) Source: 2025/26 Annual Performance Report Moray continues to face significant demographic, workforce and financial pressures. An increasing older population, coupled with a declining working-age population, ongoing recruitment challenges and limited housing availability, is placing growing demand on services. Although pressures within adult social care are evident across the local government sector and are not specific to the IJB, these factors increase the risk of difficulties in maintaining sustainable service provision within the area. The IJB will need to ensure that it is able to continue to deliver safe and effective adult services considering the challenging financial background faced alongside a growing aging demographic. This will require wider transformation of the IJB which is outlined within the Financial Sustainability section of this report. National Indicator Scotland Avg. (25/26) 2024/25 2025/26 Trend 1. Percentage of adults able to look after their health very well or quite well 91% 92% 93% 2. Percentage of adults supported at home who agree that they are supported to live as independently as possible 74% 72% 75% 3. Percentage of adults supported at home who agree that they had a say in how their help, care or support was provided 64% 59% 65% 8. Percentage of carers who feel supported to continue in their caring 32% 28% 29% 9. Percentage of adults supported at home who agree they felt safe 75% 70% 77% 12. Emergency admission rate 11,470 6,096 7,434 14. Readmission to hospital within 28 days 104 61 72 17. Proportion of care services graded 'good' (4) or better in Care Inspectorate inspections 83% 73.8% 86% Page 132
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – use of resources (3) 39 Wider scope area Wider scope audit response and findings Conclusion Use of resources to improve outcomes (continued) Performance Reporting (continued) The IJB have an agreed set of local performance indicators, with updates reported to the Audit, Performance and Risk Committee. Performance is reported in a RAG status, and all but one indicator (A&E attendance rate) has been assessed as red at Quarter 4, meaning the IJB is performing worse than target by more than the agreed tolerance. The table below shows the performance of each indicator as at March 2026: Source: Quarter 3 and 4 – Performance Report (Adult Services) Overall, performance during Quarters 3 and 4 of 2025/26 was mixed. Encouraging progress was evident in reducing delayed discharges, unmet care needs and advancing key strategic priorities. However, significant challenges remain in relation to hospital readmissions, access to psychological therapies, workforce absence and ongoing demand pressures. Despite these challenges, progress across the Strategic Delivery Plan and a number of measurable service improvements demonstrate continued efforts to improve outcomes and support sustainable service delivery. The IJB's performance is below target across all reported local indicators. Although there are some emerging improvements, significant challenges continue to impact performance and achievement of expected outcomes. Target 2024/25 2025/26 Trend A&E attendance rate per 1000 population all ages 21.4 22.0 21.9 Number of Delayed Discharges (including code 9) at census point 26 40 34 Number of bed days occupied by delayed discharges (incl. code 9) at census point 850 1,149 1,004 % Emergency readmissions to hospital within 7 days of discharge 3.7% 3.9% 5.2% % Emergency readmissions to hospital within 28 days of discharge 7.4% 7.4% 10.4% % of patients commencing Psychological Therapy Treatment within 18 weeks of referral 90% 65% 41% NHS Sickness Absence (% of hours lost) 4% 4.9% 6.6% Council Sickness Absence (% of calendar days lost) 4% 8.2% 8.5% Page 133
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Wider scope audit – use of resources (4) 40 Wider scope area Wider scope audit response and findings Conclusion Use of resources to improve outcomes (continued) Performance Framework Development The IJB have undertaken a review of the performance management framework during 2026 and is nearing completion. The revised performance framework has been strengthened through enhanced performance and budget scrutiny arrangements. A key change has been the focus to shift towards more integrated reporting across all delegated services, rather than individual service level reports, to provide a more cohesive view of system performance. Reporting will be presented three times per year to the Audit, Performance and Risk Committee. The IJB have also introduced quarterly meetings with the Chief Executive and Section 95 Officer at Moray Council and Chief Executive and Director of Finance at NHS Grampian with a focus on Performance and budgets. The ongoing refresh of the Strategic Plan is expected to support the development of SMART objectives and associated performance measures, which will be incorporated into future reporting. A refreshed performance management framework has been undertaken with enhanced performance and budget reporting and scrutiny. Page 134
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Best value conclusions 41 Under the Code of Audit Practice, the audit of Best Value in Integration Joint Boards is fully integrated within the annual audit work performed by appointed auditors and their teams. As part of our integrated wider-scope annual audit work, we as appointed auditors use a risk-based approach to assess and report whether the IJB has made proper arrangements for securing Best Value and how the body demonstrates that it is meeting Best Value responsibilities. The principles of best value are embedded within the wider scope work we perform, and the judgements made within the wider scope work allow us to make an assessment over Best Value. Conclusion Integration Joint Board’s have a statutory duty to have arrangements to secure Best Value. To achieve this, Integration Joint Boards should have effective processes for scrutinising performance, monitoring progress towards the strategic objectives and holding partners to account. The IJB have arrangements in place to secure Best Value, as demonstrated in the Annual Governance Statement. We consider these arrangements as part of our regular wider scope work and have provided our conclusions. In our previous audit, we recommended that the IJB should undertake a formal review of the Best Value assurance framework and complete an assessment of the arrangements to secure Best Value, with the outcome of the assessment reported to the Audit, Performance and Risk Committee. During 2025/26 a review of progress against the Scottish Government’s Best Value Framework was undertaken and provided assurance that the IJB were meeting their obligations. This was reported to the Audit and Risk Committee in June 2026. Page 135
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|© 2025 Grant Thornton UK LLP Commercial in Confidence Appendices 42 Page 136
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow A. Audit adjustments (1) Impact of adjusted misstatements During the course of the audit, there were no adjusted non-trivial misstatements which were made that require reporting within our Annual Audit Report. Impact of unadjusted misstatements During the course of the audit, there were no unadjusted non-trivial misstatements which were made that require reporting within our Annual Audit Report. Impact of unadjusted misstatements in the prior year There was no unadjusted misstatement identified in the prior year audit. 43 We are required to report all non-trivial misstatements to those charged with governance, whether or not the accounts have been adjusted by management. Misclassification and disclosure changes The table below provides details of substantive misclassification and disclosure changes identified during the audit which have been made in the final set of financial statements. This list of misclassification and disclosure changes reflects presentational adjustments to the financial statements which have no impact on the Council’s reported financial position. Page 137
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow B. Follow up of prior year recommendations (1) 44 We have identified the following issues in our prior year wider scope work, which resulted in eight recommendations being reported in our 2024/25 Annual Audit Report. We have performed additional work in year to obtain assurance whether the recommendations have been closed and resolved in the current year or whether the issue still exists and the recommendation remains open and/or in progress. Five out of eight recommendations have been cleared with three remain open. Recommendations from the wider scope audit Assessment Issue and risk previously communication Management update on actions taken to address the issue Auditor conclusion Closed Financial Sustainability – Reserves The IJB intend to utilise £1.346 million of earmarked reserves to bridge the budget deficit in 2024/25. There is a risk that continued reliance on reserves to bridge funding gaps will create financial sustainability issues for the IJB. Recommendation: The IJB will need to continue to monitor the percentage level of adequate reserves as funding gaps continue to grow and the IJB looks to transformation in future years to ensure reserves do not dip to an unsustainable level. 2026/27 budget has been agreed without the use of any reserves to balance the budget. There is no general reserve but there is ear marked reserves totalling £3m The IJB continues to have no general reserve balance and all reserves held at 31 March 2026 are earmarked for specific purposes. No reserves balances are being used in 2026/27 to balance the budget. In the absence of general reserves balances, the IJB are looking at alternative mechanisms to balance the budget, via savings delivery and transformation. Whilst the IJB would like to build up a working general reserves balance, we acknowledge that this is unrealistic in the medium term, and immediate focus is on managing future predicted deficits. Recommendation closed. [Red] Recommendation is open [Amber] Recommendation is in progress [ Green] Recommendation is closed Page 138
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow B. Follow up of prior year recommendations (2) 45 Recommendations from the wider scope audit Assessment Issue and risk previously communication Management update on actions taken to address the issue Auditor conclusion Closed Senior Management Team Following the retirement of the previous Chief Officer, the current Chief Officer has been appointed on an interim basis. Furthermore, the Chief Social Worker at the Council is also appointed on an interim basis. Recommendation: The IJB and Council need to secure permanent positions for the both posts to provide certainty over the future direction of the IJB. Recruitment has been successful for the appointment of a permanent Chief Social Work Officer, The candidate will be commencing in the role in August 2026. The IJB have now appointed both a permanent Chief Officer and Chief Social Work Officer. The IJB have transition arrangements in place to support a smooth handover from the outgoing Chief Social Work Officer, Recommendation closed. Page 139
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow B. Follow up of prior year recommendations (3) 46 Recommendations from the wider scope audit Assessment Issue and risk previously communication Management update on actions taken to address the issue Auditor conclusion Open Internal Audit Limited Assurance Opinion This is the third year in succession that Internal Audit have provided a limited assurance opinion. Fundamentally, this indicates there are weaknesses in the framework of governance, risk management and control. Recommendation: The IJB should have definitive plans in place to avoid further limited assurance opinions. Significant progress has been made, however there are still concerns with the recommendations being implemented following audits and progress on CareFirst (system is currently being replaced with a go live date of 31 March 2027), resulting in the Internal Audit Manager giving a limited assurance opinion. This is the fifth year in succession that Internal Audit have provided a limited assurance opinion. We note that the Chief Internal Audit has confirmed that “significant progress has been made in strengthening governance and internal controls within the MIJB and it is anticipated that this will support the delivery of required improvements going forward”. However internal audit reviews have continued to identify significant findings, with several recommendations outstanding and requiring revised implementation timescales or further follow-up. Furthermore, the development of a single case recording system also remains a key priority for the Service. Given the continued limited assurance opinion, outstanding audit recommendations and ongoing replacement of the CareFirst system, this recommendation remains valid until there is clearer evidence of sustained improvement. Recommendation remains valid. Revised Target Date: 31 March 2027 Page 140
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow B. Follow up of prior year recommendations (4) 47 Recommendations from the wider scope audit Assessment Issue and risk previously communication Management update on actions taken to address the issue Auditor conclusion Closed Performance Report - Recommendation: Management should review the format of the Performance Report and content to ensure it is succinct, focuses on the IJB’s performance and outcomes, and supports the user of the financial statements to understand the IJB’s purpose and achievements in year. The performance reporting was reviewed during 2025/26 following the approval of the Strategic Delivery Plan approved by the IJB Committee on 27 March 2025. Format was updated from the Q3 report The IJB have updated their performance reporting during 2025/26, and performance indicators give a clear reflection of current performance. Performance information is also clearly set out in the Annual Accounts. Recommendation closed. Open – ongoing work Financial Sustainability - Transformation - Recommendation: A depth of pace will need to be undertaken on the transformation programme to ensure the IJB can bridge the significant funding gap in a short space of time, to ensure that not only efficiencies can be delivered but that financial sustainability can be achieved. To ensure financial sustainability for the medium to longer term, the IJB will need to ensure that it is able to deliver increased productivity and efficiency initiatives to reduce costs and deliver financial benefits. The IJB will need to upscale the pace and delivery of transformation to achieve and mitigate the risk of becoming financially unsustainable. Savings plan in place for 2025/26 covered two financial years and the savings plan in place for 2026/27 will again be over more than one financial year. Transformation plans are also part of the savings plan for future years in conjunction with the Medium Term Financial Framework. The IJB has developed savings plans that incorporate a programme of transformation and efficiency measures to help address its financial challenges. Continued focus on accelerating the pace of transformation, alongside robust delivery and monitoring of savings plans, will be critical to achieving financial balance and reducing the risk of financial instability in the medium to longer term. Recommendation remains valid. Revised Target Date: 31 March 2027 Page 141
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow B. Follow up of prior year recommendations (5) 48 Recommendations from the wider scope audit Assessment Issue and risk previously communication Management update on actions taken to address the issue Auditor conclusion Open Vision, Leadership and Governance – Internal Audit – Recommendation: Moray IJB should ensure audit recommendation dates are realistic when set and are monitored for implementation. Where dates are moved or not met, a thorough understanding and follow up of these should be sought and explanations provided. A mechanism should be implemented to follow up on officers should missing recommendation deadlines becomes regular. Significant progress has been made, however there are still concerns with the recommendations being implemented following audits. Internal audit reviews have continued to identify significant findings, with several recommendations outstanding and requiring revised implementation timescales or further follow-up. The implementation of recommendations is a key determinant in assessing the adequacy and effectiveness of the internal control system. If recommendations are not implemented in a timely manner, then weaknesses in control and governance frameworks will remain. The lack of response to previous recommendations is one of the reasons for the limited audit assurance opinion issued by Internal Audit. Whilst we recognise the IJB have agreed an approach to monitoring existing recommendations, focus must be given to implementing these recommendations. Recommendation remains valid. Revised Target Date: 31 March 2027 Page 142
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow B. Follow up of prior year recommendations (6) 49 Recommendations from the wider scope audit Assessment Issue and risk previously communication Management update on actions taken to address the issue Auditor conclusion Closed. Financial Management – Reporting of savings The budget and financial reports presented to the Board and Audit, Risk and Performance Committee do not detail whether savings are expected to be recurring in nature. Adding this context into both documents would provide a clear indication as to whether savings are expected to be one off savings or whether the benefit will continue in future years. The IJB prepare a year-end outturn which includes the final high-level savings position. However, this report does not include the appendix presented as part of the in-year monitoring reports detailing the final delivery position. It would be good practice to provide this same level of detail as part of the year-end outturn report which allows a comparison across the full financial year. Recommendation: The IJB should indicate whether savings are expected to be recurring or non-recurring in nature. The IJB should prepare a report showing a breakdown of savings delivered on a project basis as part of the year-end outturn report. Recurring and non recurring savings have been reported throughout 2025/26. The outturn report includes savings details. The IJB’s savings tracker now clearly indicates whether savings are non- recurring in nature, with all other identified savings assessed as recurring. This can be seen in the 2026/27 savings tracker reported as part of the 2026/26 budget paper. The 2025/26 outturn report, which was presented to the June 2026 Board meeting, provided a full breakdown of the savings delivered on a project basis, reflecting the same information that has been presented in the monitoring report during the year. This reflects an improvement in the reporting of the savings position. Recommendation closed. Page 143
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow B. Follow up of prior year recommendations (7) 50 Recommendations from the wider scope audit Assessment Issue and risk previously communication Management update on actions taken to address the issue Auditor conclusion Closed Assessment over the arrangements to secure Best Value We have noted that the IJB have no mechanism for formally reviewing and reporting on the arrangements to secure best value. Recommendation: The IJB should undertake a formal review of the Best Value assurance framework and complete an assessment of the arrangements to secure best value. The outcome of the assessment should be reported to the Audit, Performance and Risk Committee. Self assessment reported to Audit, Performance & Risk 25 June 2026. During 2025/26 a review of progress against the Scottish Government’s Best Value Framework was undertaken and provided assurance that the IJB were meeting their obligations. This was reported to the Audit and Risk Committee in June 2026. Recommendation closed. Page 144
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow C. Audit fees, ethics and independence 51 Independence and ethics We confirm that there are no significant facts or matters that impact on our independence as auditors that we are required or wish to draw to your attention and consider that an objective reasonable and informed third party would take the same view. We have complied with the Financial Reporting Council's Ethical Standard and confirm that we, as a firm, and each covered person, are independent and are able to express an objective opinion on the financial statements. We confirm that we have implemented policies and procedures to meet the requirement of the Financial Reporting Board’s Ethical Standard. Ethical Standards and ISA (UK) 260 require us to give you timely disclosure of all significant matters that may bear upon the integrity, objectivity, and independence of the firm or covered persons (including its partners, senior managers, managers and network firms). In this context, there are no independence matters that we would like to report to you. As part of our assessment of our independence, we note the following matters: Matter Conclusion Relationship with Grant Thornton We are not aware of any relationships between Grant Thornton and Moray IJB that may reasonably be thought to bear on our integrity, independence and objectivity Relationships and investments held by individuals We have not identified any potential issues in respect of personal relationships with the Entity or investments in the organisation held by individuals Employment of Grant Thornton staff We are not aware of any former Grant Thornton partners or staff being employed, or holding discussions in respect of employment, by the IJB as a director or in a senior management role covering financial, accounting or control related areas. Business relationships We have not identified any business relationships between Grant Thornton and Moray IJB. Contingent fees in relation to non-audit services No contingent fee arrangements are in place, note that there are no non-audit services provided. Gifts and hospitality We have not identified any gifts or hospitality provided to, or received from, a member of the organisation's board, senior management or staff. Page 145
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow C. Audit fees, ethics and independence (2) 52 Fees and non-audit services The tables below set out the total fees for audit and other services charged from the beginning of the financial year to the current date, as well as the threats to our independence and safeguards have been applied to mitigate these threats. None of the below services were provided on a contingent fee basis. For the purposes of our audit we have made enquiries of all Grant Thornton teams within the Grant Thornton International Limited network member firms providing services to Moray IJB. The table summarises all non-audit services which were identified. The Annual Audit Report will be considered by the Audit, Performance and Risk Committee on 24 September 2026. The fee has not changed from the amount set out and agreed in our Audit Plan. External audit fee Fees for other non-audit services Service Planned Fees Final Fees External Auditor Remuneration - Baseline £37,830 £37,830 Pooled Costs £1,300 £1,300 Contribution to Performance Audit and Best Value £7,050 £7,050 Sectoral cap adjustment (£10,700) (£10,700) 2025/26 Audit Fee £35,480 £35,480 Service Fees £ We confirm that for 2025/26 we did not receive any fees for non-audit services Nil The fees reconcile to the financial statements (round £’000 in the financial statements): • Fees per financial statements £35,000 • Total fees as above £35,480 This covers all services provided by us and our network to Moray IJB, its directors and senior management and its affiliates, that may reasonably be thought to bear on our integrity, objectivity or independence. Page 146
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow D. Client Service Review 53 Client service We take our client service seriously and continuously seek your feedback on our external audit service. Should you feel our service falls short of expected standards please contact Joanne Brown, Head of Public Sector Assurance Scotland in the first instance who oversees our portfolio of Audit Scotland work (joanne.e.brown@uk.gt.com). Alternatively, should you wish to raise your concerns further please contact Mark Stocks, Partner, 8 Finsbury Circus, London, EC2M 7EA. If you feedback relates to audit quality and we have not successfully resolved your concerns, your concerns should be reported to John Gilchrist, Audit Scotland Quality and Appointments in accordance with the Audit Scotland audit quality complaints process. Transparency Grant Thornton publishes an annual Transparency Report, which sets our details of the action we have taken over the past year to improve audit quality as well as the results of internal and external quality inspections. For more details see 2025-transparency-report.pdf. Grant Thornton publishes an annual Audit Quality Report, which sets out details of the actions we have taken over the past year to meet our audit quality framework and provides a forward look on our plans for the future. For more details see audit-quality-report-2026-final.pdf. Page 147
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow E. Communication of audit matters with those charged with governance The Audit Findings Report 54 RECOMMENDED CONTENT – entities OTHER THAN PIEs Guidance note The requirements here are relevant to entities that are not PIEs. For PIEs, delete the slide. Red text may not be applicable and should be either deleted or amended as appropriate. ISA (UK) 260, as well as other ISAs (UK), prescribe matters which we are required to communicate with those charged with governance, and which we set out in the table here. This document, the Audit Findings, outlines those key issues, findings and other matters arising from the audit, which we consider should be communicated in writing rather than orally, together with an explanation as to how these have been resolved. Respective responsibilitiesAs auditor we are responsible for performing the audit in accordance with ISAs (UK), which is directed towards forming and expressing an opinion on the financial statements that have been prepared by management with the oversight of those charged with governance. The audit of the financial statements does not relieve management or those charged with governance of their responsibilities. Distribution of this Audit Findings report Whilst we seek to ensure our audit findings are distributed to those individuals charged with governance, as a minimum a requirement exists for our findings to be distributed to all the company directors and those members of senior management with significant operational and strategic responsibilities. We are grateful for your specific consideration and onward distribution of our report, to those charged with governance. Our communication plan Audit Plan Audit Findings Respective responsibilities of auditor and management/those charged with governance Overview of the planned scope and timing of the audit, form, timing and expected general content of communications including significant risks Confirmation of independence and objectivity A statement that we have complied with relevant ethical requirements regarding independence. Relationships and other matters which might be thought to bear on independence. Details of non-audit work performed by Grant Thornton UK LLP and network firms, together with fees charged. Details of safeguards applied to threats to independence Significant matters in relation to going concern Significant findings from the audit Significant matters and issue arising during the audit and written representations that have been sought Significant difficulties encountered during the audit Significant deficiencies in internal control identified during the audit Significant matters arising in connection with related parties Page 148
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|© 2026 Grant Thornton UK LLP Commercial in Confidence Core Core Purple Core White Primary Bright Purple Dark Purple Secondary Teal Coral Neutral Dark Mid Light Yellow Our communication plan Audit Plan Audit Findings Identification or suspicion of fraud involving management and/or which results in material misstatement of the financial statements Non-compliance with laws and regulations Unadjusted misstatements and material disclosure omissions Expected modifications to the auditor's report, or emphasis of matter E. Communication of audit matters with those charged with governance The Audit Findings 55 RECOMMENDED CONTENT – entities OTHER THAN PIEs Guidance note The requirements here are relevant to entities that are not PIEs. For PIEs, delete the slide. Red text may not be applicable and should be either deleted or amended as appropriate. ISA (UK) 260, as well as other ISAs (UK), prescribe matters which we are required to communicate with those charged with governance, and which we set out in the table here. This document, the Annual Audit Report, outlines those key issues, findings and other matters arising from the audit, which we consider should be communicated in writing rather than orally, together with an explanation as to how these have been resolved. Respective responsibilities As auditor we are responsible for performing the audit in accordance with ISAs (UK), which is directed towards forming and expressing an opinion on the financial statements that have been prepared by management with the oversight of those charged with governance. The audit of the financial statements does not relieve management or those charged with governance of their responsibilities. Distribution of this Annual Audit Report Whilst we seek to ensure our audit findings are distributed to those individuals charged with governance, as a minimum a requirement exists for our findings to be distributed to all members and those members of senior management with significant operational and strategic responsibilities. We are grateful for your specific consideration and onward distribution of our report, to those charged with governance. Page 149
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© 2026 Grant Thornton. All rights reserved. ‘Grant Thornton’ refers to the brand under which the Grant Thornton member firms provide assurance, tax and advisory services to their clients and/or refers to one or more member firms, as the context requires. Grant Thornton International Ltd (GTIL) and the member firms are not a worldwide partnership. GTIL and each member firm is a separate legal entity. Services are delivered by the member firms. GTIL does not provide services to clients. GTIL and its member firms are not agents of, and do not obligate, one another and are not liable for one another’s acts or omissions. GUIDANCE NOTES: Please ensure every presentation has a back page with disclaimer Page 150
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: 2025/26 AUDITED ANNUAL ACCOUNTS BY: CHIEF FINANCIAL OFFICER 1. REASON FOR REPORT 1.1 To submit to the Moray Integration Joint Board (MIJB) the Audited Annual Accounts for the year then ended 31 March 2026. 2. RECOMMENDATION 2.1 It is recommended that the Board consider and approve the Audited Annual Accounts for the financial year 2025/26 and the letter of Representation. 3. BACKGROUND 3.1 The Unaudited Annual Accounts for 2025/26 were submitted to the meeting of the Moray Integration Joint Board (MIJB) on 25 June 2026 prior to submission to external audit (paragraph 7 of the Minute refers). 3.2 The Annual Accounts have been prepared in accordance with International Financial Reporting Standards and the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014 and the Local Government in Scotland Act 2003. 4 KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The audit undertaken by the Board’s External Auditors, Grant Thornton is now complete. The External Auditors have expressed unqualified opinions in respect of the financial statements, the remuneration report, the management commentary and the annual governance statement. The Independent Auditor’s Report to the Members of the MIJB and the Accounts Commission is included within the audited Annual Accounts and can be found on page 58. The audited Annual Accounts are attached at Appendix 1. Item 10. Page 151
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4.2 Attached at Appendix 2 is the letter of representation to the External Auditors from the members of the MIJB, for approval by Committee to be signed following this meeting. 4.3 The audit process highlighted changes to be made to the accounts which in the main were presentational and in parallel with expectation following external audit inspection. 4.3 The Auditor’s Annual Audit Report to the MIJB and the Accounts Commission is the subject of a separate report to this meeting. The report sets out the responsibilities of Grant Thornton as the independent auditor and presents a summary of the findings arising from the 2025/26 audit. The report confirms there are no unadjusted misstatements in the annual accounts to report to those charged with governance. 4.4 The Audited Annual Accounts are presented to this meeting for consideration and approval. Thereafter, the Chief Officer, Chief Financial Officer and the Chair of the Board will sign the accounts prior to submission to Grant Thornton prior to publication. 5 SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The Audited Annual Accounts have been completed within the statutory timescales and are being presented for consideration and sign off. (b) Policy and Legal The Public Bodies (Joint Working) (Scotland) Act 2014 requires that the MIJB is subject to the audit and accounts provisions of a body under Section 106 of the Local Government (Scotland) Act 1973. (c) Financial implications The adjustments and revisions made to the Annual Accounts following the external audit had no financial impact on the MIJB. (d) Risk Implications and Mitigation There are no risk issues arising directly from this report. The work undertaken by Grant Thornton provides assurance to the Board that the Annual Accounts for 2025/26 give a true and fair view in accordance with applicable law and the 2025/26 Code of the state of affairs of the MIJB as at 31 March. (e) Staffing Implications None arising directly from this report. (f) Property None arising directly from this report. (g) Equalities/Socio Economic Impact Page 152
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None arising directly from this report as there is no resultant change in policy. (h) Climate Change and Biodiversity Impacts There are no direct climate change and biodiversity implications as there has been no change to policy. (i) Directions None arising directly from this report (j) Consultations In preparation of the Annual Accounts, consultations have taken place between finance staff of both Moray Council and NHS Grampian who are in agreement within their areas of responsibility. The Chief Officer has been consulted and comments have been considered. 6 CONCLUSION 6.1 Following a completed external audit process and an unqualified opinion being received. The Audited Annual Accounts are presented here for approval and formal sign off. Author of Report: Deborah O’Shea, Chief Financial Officer Background Papers: With author Ref: Page 153
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Moray Integration Joint Board Annual Accounts 2025/26 Moray Integration Joint Board APPENDIX 1 Page 154
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Moray Integration Joint Board Annual Accounts 2025/26 If you need information from the Moray Council in a different language or format, such as Braille, audio tape or large print, please contact: ياروم سلجم لبق نم تامولعم لىإ ةجاح ي ف متنك اذإ نوكتو ةغلب وأ ويدوأ ةناوطسأ ،يا ربلا لثم فلتخم لكش لىعوأ ةفلتخم نوكت نأ مط ب لاصّتلإا ءاجّرلاف ةظيلغ فورح لامعتساب ةعوب Jei pageidaujate tarnybos Moray tarybos teikiamą informaciją gauti kitokiu formatu, pvz., Brailio raštu, garso įrašu ar stambiu šriftu, kreipkitės: Jeśli potrzebują Państwo informacji od Rady Okręgu Moray w innym formacie, takim jak alfabet Braille'a, kasety audio lub druk dużą czcionką, prosimy o kontakt: Se necessitar de receber informações por parte do Concelho de Moray num formato diferente, como Braille, cassete áudio ou letras grandes, contacte: Ja Jums vajadzīga informācija no Marejas domes (Moray Council) citā valodā vai formātā, piemēram, Braila rakstā, audio lentā vai lielā drukā, sazinieties ar: ای نابز رگید یسک ےس لسنوک ےروم وک پآرگاتروص راکرد تامولعم ںیم لاثم ںوہ ˝ ،فورح ےڑب ای پیٹ ویڈآ ،ےلیربںیئامرف ہطبار رک امرف ینابرہم وت: Chief Finance Officer to the Moray Integration Joint Board, High Street, Elgin, IV30 1BX accountancy.support@moray.gov.uk Page 155
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Moray Integration Joint Board Annual Accounts 2025/26 Table of Contents MORAY INTEGRATION JOINT BOARD MEMBERS 2025/26 .............................................. 1 MANAGEMENT COMMENTARY .......................................................................................... 2 STATEMENT OF RESPONSIBILITIES ............................................................................... 28 REMUNERATION REPORT ............................................................................................... 30 ANNUAL GOVERNANCE STATEMENT ............................................................................. 34 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT ..................................... 46 MOVEMENT IN RESERVES STATEMENT ........................................................................ 47 BALANCE SHEET .............................................................................................................. 48 NOTES TO THE FINANCIAL STATEMENTS ..................................................................... 49 Note 1 Significant Accounting Policies ............................................................................. 49 Note 2 Critical Judgements and Estimation Uncertainty .................................................. 50 Note 3 Events after the Reporting Period ........................................................................ 51 Note 4 Expenditure and Income Analysis by Nature ........................................................ 51 Note 5 Taxation and Non-Specific Grant Income ............................................................. 52 Note 6 Debtors ................................................................................................................ 52 Note 7 Usable Reserve: General Fund ............................................................................ 53 Note 8 Agency Income and Expenditure .......................................................................... 54 Note 9 Related Party Transactions .................................................................................. 55 Note 10 VAT .................................................................................................................... 57 Note 11 Accounting Standards That Have Been Issued but Have Yet To Be Adopted .... 57 INDEPENDENT AUDITORS REPORT…………………………………………………………...58 Page 156
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Moray Integration Joint Board Annual Accounts 2025/26 1 MORAY INTEGRATION JOINT BOARD MEMBERS 2025/26 Voting Members Dennis Robertson (Chair) Grampian Health Board (Vice Chair 01/04/2025 to 30/09/2025. Chair from 01/10/2025) Cllr. Elaine Kirby (Chair) Moray Council (21/11/2024 to 31/07/2025) Cllr. Bridget Mustard (Vice-Chair) Moray Council (Chair 1/08/2025 to 30/09/2025. Vice Chair from 01/10/2025) Sandy Riddell Grampian Health Board Derick Murray Grampian Health Board Alex Stephen Grampian Health Board Cllr. Peter Bloomfield Moray Council Cllr. Scott Lawrence Moray Council Cllr Ben Williams Moray Council (Left 27/03/2026) Cllr John Divers Moray Council (Joined 27/03/2026) Non-Voting Members Judith Proctor Chief Officer Jim Lyon Interim Chief Social Work Officer Jane Ewen Lead Nurse Professor Duff Bruce Non-Primary Medical Service Lead Dr Robert Lockhart GP Lead Sheila Brumby People Receiving Services Representative. Ivan Augustus Carer Representative (left 27/11/2025) Kevin Todd Moray Council Staff Representative (left 19/05/2025) Elizabeth Robinson Public Health Representative Deirdre McIntyre Grampian Health Board Staff Partnership (left 19/06/2025) Michael Ritchie Grampian Health Board Staff Partnership (Joined 16/07/2025) Page 157
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Moray Integration Joint Board Annual Accounts 2025/26 2 MORAY INTEGRATION JOINT BOARD MEMBERS 2025/26 Continued Miriam Connor Unpaid Carer Representative (Joined 28/11/2025) Christine Stevens Unpaid Carer Representative (Joined 28/11/2025) Aimee McIntosh Third Sector Representative (joined 01/10/2025) 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 (Left 01/10/2025) Laura Skaife-Knight Chief Executive Grampian Health Board (Joined 01/10/2025) Karen Greaves Chief Executive, Moray Council 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. . Page 158
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Moray Integration Joint Board Annual Accounts 2025/26 3 MANAGEMENT COMMENTARY (continued) 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. 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 Moray Health & Social Care Partnership (Moray HSCP). 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. 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 159
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Moray Integration Joint Board Annual Accounts 2025/26 4 MANAGEMENT COMMENTARY (continued) STRATEGIC PLAN KEY THEMES 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) 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 Page 160
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Moray Integration Joint Board Annual Accounts 2025/26 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 was due to be published by 31 July this year and has been published on the Moray HSCP website, following approved by the MIJB. There is continued focus on one of the major aims of integration and a key measurable target for MIJB, 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. . .MSG indicator 4 – Number of Delayed Discharge Bed Days3 Year Q1 Q2 Q3 Q4 2021/22 592 784 1,142 1,294 2022/23 1,207 1,197 1,063 751 2023/24 732 845 1,162 1,501 2024/25 922 1,115 981 1,149 2025/26 1,015 1,217 1,141 1,004 Table 1 3 https://publichealthscotland.scot/publications/delayed-discharges-in-nhsscotland-annual/delayed- discharges-in-nhsscotland-annual-annual-summary-of-occupied-bed-days-and-census-figures-data- to-march-2025/ About this release - Delayed discharges in NHS Scotland monthly - Figures for April 2026 - Delayed d… -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 161
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Moray Integration Joint Board Annual Accounts 2025/26 6 MANAGEMENT COMMENTARY (continued) Figure 1 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 set targets for delayed discharges per 100,000 and for Moray the target is 26. This is a continuing challenge, but focussed efforts to review and streamline processes and improve flow across the system are being undertaken through the “Home Assessment Pathway” project, utilising Scottish Government additional funding to reduce unscheduled care. . Delayed Discharges National Indicator 19 - Number of days people spend in hospital when they are ready to be discharged (per 1,000 population). Figure 2 below shows Moray’s performance over a five-year period showing the number of delayed discharge bed days, which fluctuates through the year, however during the last two quarters of 2025/26 there has been a sustained reduction, resulting in the lowest number of days at Q4 in the five-year period. The ongoing scrutiny of delays to find solutions, progress of projects to improve efficient use of care and support resources and embedding of the Self Direct Support (SDS) framework will be contributing to this reduction. 0 500 1,000 1,500 2,000 Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar 2021/22 2022/23 2023/24 2024/25 2025/26 MSG Indicator 4 - Number of delayed discharge bed days Page 162
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Moray Integration Joint Board Annual Accounts 2025/26 7 MANAGEMENT COMMENTARY (continued) Figure 2 Within Children and Families and Justice Social Work, there is a continued focus on the provision of early family support, aiming to keep children in their families, when that is safe to do so. Amongst the supports and actions working towards this outcome is the provision of commissioned services deigned to deliver early and preventative support. The three commissioned prevention and early intervention services—Aberlour Youth Point, Families Together, and Functional Family Therapy—provided support to numerous families in the 2025/2026 financial year, as noted in the graph below. The supports provided included one to one and group sessions, family centred money advice service, practical assistance, family group decision making and functional family therapy focusing on improving communication and relationships. The impact of these supports is evidenced via regular contract monitoring mechanisms. Page 163
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Moray Integration Joint Board Annual Accounts 2025/26 8 MANAGEMENT COMMENTARY (continued) . Another area of focus is to reduce the number of children in care and specifically in out-of-area care. This financial year showed a continuation of the longer-term direction of travel towards safely reducing reliance on care with the number of children looked after away from or at home reducing from 167 in October 2025 to 164 at the end of March 2026. However, this improvement is somewhat offset by a significant pressure point: a higher proportion of newly accommodated children required out-of-area care, increasing both operational complexity and financial pressure. Whilst the overall number of children entering out-of-area care can be considered low against the total number of looked after children, by the end of the financial year, this kind of care accounted for 63% of commissioned services spend, up from 53% at the start of the financial year. The Service continues to work towards the reduction of the overall number of children entering care, inclusive of the following actions planned for the next financial year: - Exploration of intensive family support service, - Services commissioned to provide early and preventative support, - The development of the Early Pathway and the refresh of GIRFEC in Moray. 112 115 131 126 100 105 110 115 120 125 130 135 Q1 Q2 Q3 Q4 Number of children 2025/2026 financial year Number of children and families supported by the 3 preventative commissioned services 3 2 8 4 0 1 2 3 4 5 6 7 8 9 Q1 Q2 Q3 Q4 Number of children 2025/2026 financial year Total new entries to out-of-area care Page 164
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Moray Integration Joint Board Annual Accounts 2025/26 9 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 must 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 forward 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 MIJB and Senior Management Team (SMT). It was approved in March 2026 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 biannually to the Audit Performance and Risk Committee for oversight and assurance. Management teams and the Clinical and Care 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. Where appropriate, progress against agreed actions and assurance regarding improvement activity are subsequently reported through the Clinical and Care Governance Committee, Audit, Performance and Risk Committee and the MIJB. Quarterly performance reports are produced for Moray HSCP 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 Moray HSCP that are seeking to reduce the delays in hospitals and to meet unmet needs. For Page 165
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Moray Integration Joint Board Annual Accounts 2025/26 10 MANAGEMENT COMMENTARY (continued) example, ensuring the provision of care at home is maximised within available budget is a key aspect of the Strategic Care at Home workstream. Funding has also been provided to NHS Grampian to support improvement in Unscheduled care across Grampian. Moray HSCP secured £1.38m to develop a Home Assessment Pathway (HAP) which focusses on prevention of admission to acute hospital and supported, timely discharge to assess. The programme was fully launched in May 2026 and as well as reporting through the HSCP and IJB structures, reports into the pan Grampian Unscheduled Care Delivery Board. 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. In addition to the Home Assessment Pathway work, the HSCP is also engaged with the collaborative initiative Discharge Without Delays which is also a Grampian wide initiative. This programme aims to reduce delays 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. This will also inform and contribute to the development of the Home Assessment Pathway work. The integration of Children & Families and Justice services into Moray HSCP 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 and the refresh of the Strategic Plan which will take place across 2026/27 will include these delegated services. Strategy and Plans The MIJB is required to review its Strategic Plan every three years as per the legislation and this is now planned to take place over 2026/27. 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 Moray HSCP 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 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 166
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Moray Integration Joint Board Annual Accounts 2025/26 11 MANAGEMENT COMMENTARY (continued) Staff Wellbeing Moray HSCP, in partnership with Third Sector organisation Moray Wellbeing Hub, launched a new initiative designed to reduce barriers to accessing mental health support for the health and social care workforce. Funded through NHS Grampian Charity, the digital tools project offered one-to-one personal support sessions to help individuals manage and improve their wellbeing, as well as team awareness talks to build skills in peer support and colleague signposting. Through improving digital skills and fostering peer-led approaches, the initiative aimed to promote inclusion and resilience, challenge the stigma associated with accessing help, and create a more connected and supportive working environment. Promoting Health and Wellbeing Moray HSCP's commitment to promoting healthy and independent ageing was recognised on an international stage in July 2025, when Alice Illingworth, Realistic Medicine Wellbeing Co-ordinator with the Health Improvement Team, was invited to present at the End Pyjama (PJ) Paralysis global online summit. The two-day conference brought together health and care professionals from across the world who are working to reduce immobility, muscle deconditioning, and dependency in care settings, whilst protecting cognitive function, social interaction, and dignity. Alice presented on the Ageing Well work being undertaken in Moray as part of the partnership’s wider focus on preventing deconditioning – the decline in physical function experienced during periods of inactivity, which is of particular concern for less mobile older people and those experiencing extended hospital stays. Central to the presentation was the Moray Ageing Well Tool, an innovative digital self- check resource developed as part of the Making Every Opportunity Count (MeOC) programme. The tool supports older people to take control of their own health and wellbeing by encouraging individual reflection on personal needs and priorities, completing a health assessment, and connecting with relevant local services and support networks. The tool is currently in use across a range of settings, including GP practices, hospitals, social care, and the wider community. Building on the success of the initial Community Appointment Day (CAD) model piloted for musculoskeletal (MSK) Physiotherapy and Podiatry patients in Moray, the partnership and NHS Grampian continued to develop this innovative approach to service delivery during 2025/26. In October, we partnered with the Digital Health & Care Innovation Centre's (DHI) Rural Centre for Excellence to deliver an Occupational Therapy (OT) Community Appointment Day in Elgin. The event provided attendees, including those awaiting an OT assessment, with the opportunity to explore AskSARA, an online self-management tool offering personalised advice on equipment and home adaptations. Participants Page 167
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Moray Integration Joint Board Annual Accounts 2025/26 12 MANAGEMENT COMMENTARY (continued) received hands-on support from Moray HSCP's Occupational Therapy Team to navigate the tool and review practical recommendations for remaining safe and independent at home. In July 2025, the Moray Be Active Life Long (BALL) wellbeing groups which are supported by Moray HSCP, marked a significant milestone. A celebration of their 20th anniversary brought together nearly 300 community members at a special event in Hopeman. The event recognised two decades of friendship, physical activity, and support for healthy ageing across Moray. BALL groups were developed following extensive community engagement with older people, who identified a need for greater opportunities to stay physically active and socially connected later in life. From an initial group of ten participants in 2005, the programme – which is unique to Moray – has grown into a network of 18 user-led groups welcoming more than 1,000 attendees each week. Our collaborative approach to prescribing improvement was showcased at the annual Scottish Practice Pharmacy and Prescribing Advisers (SP3A) conference in Glasgow, where Fiona Duncan, Primary Care Advanced Pharmacist, and Mandy Nascimento, Specialist Pharmacy Technician, presented on a significant joint initiative. Working in partnership, Pharmacy, Dietetics, and Health Visiting teams undertook a review of baby milk prescribing, with the aim of improving practice and reducing spend through consistent adherence to established clinical guidelines. Through targeted training, improved data sharing, and a refreshed rollout of guidance, the initiative has improved education for parents and carers on the appropriate use of baby milks and the milk ladder, supporting better clinical outcomes and more consistent practice across primary care, as well as achieving financial benefits. In June 2025, Moray HSCP launched a pilot project in partnership with Elgin Health Centre, aimed at proactively identifying unpaid carers and connecting them with appropriate support. It is estimated that approximately 16,200 adults and children in Moray provide some form of unpaid care; however, only around 13% are currently in contact with the Quarriers Carer Support Service, which is commissioned by the partnership to support adult and young carers across the area. A significant barrier to accessing support is identification – both by professionals and by carers themselves, many of whom do not recognise the care they provide as placing them in the role of a carer. Page 168
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Moray Integration Joint Board Annual Accounts 2025/26 13 MANAGEMENT COMMENTARY (continued) The Unpaid Carers Team, working alongside Elgin Health Centre, is addressing this through staff training in carer identification and signposting to services, including Quarriers and Moray HSCP teams. The project establishes a clear carer pathway within GP practice settings, promotes annual health checks, and supports contingency planning to ensure carers receive timely information and support. The model is now being extended to other GP practices and education settings across Moray. In partnership with a range of statutory, community, and Third Sector organisations, Moray HSCP has continued to develop a Whole Systems Approach to improving healthy weight across Moray. Recognised as a key priority within Scotland’s Population Health Framework and the Board’s Strategic Plan, this collaborative model looks beyond individual choice to address the wider environmental, social, and economic factors that shape health outcomes. During the year, three interactive workshops brought together partners from across health, local authority, environmental health, children’s services, transport, education, community, and Third Sector organisations. These workshops produced a shared understanding of the causes and drivers of unhealthy weight in Moray, mapped existing provision, identified gaps and priorities for action, and generated a draft vision statement and systems map. A local action plan will be launched in 2026/27. Service Delivery/Business as Usual Moray HSCP has continued to invest in improving digital services and infrastructure for the benefit of citizens and staff. The partnership website has been migrated to a new platform, delivering improvements in accessibility, security, and user experience. The new multi-agency website, Getting It Right for Every Child (GIRFEC) in Moray (www.girfecinmoray.co.uk), was also launched as a central information resource for families, young people, and practitioners. Developed in partnership with NHS Grampian, Moray Council, and Third Sector organisations, the site includes dedicated sections on GIRFEC, the Child’s Plan, children’s rights, and a range of support services, as well as a local events calendar. Content was co-produced with local families and young people, with engaging graphics designed by a former pupil of Speyside High School during a digital media placement with Children's Services. Moray HSCP has achieved significant milestones in the national programme to transition community alarm and telecare services from analogue to digital technology, ahead of the UK-wide switchover deadline in January 2027. Page 169
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Moray Integration Joint Board Annual Accounts 2025/26 14 MANAGEMENT COMMENTARY (continued) With approximately 1,500 community alarm and telecare devices in use by Moray residents, the Analogue to Digital Telecare (A2DT) programme represents one of our most significant transformation workstreams. Moray HSCP has been awarded both the Gold Level One and Gold Level Two Digital Telecare Implementation Awards from Digital Telecare for Scottish Local Government. The Gold Level Two award, which recognises partnerships that have delivered a live digital service to at least half of their users with a minimum of six weeks of safe, reliable operation, reflects the substantial progress achieved. At the time of the award, 56% of Moray's telecare devices were digital-ready Moray Community Justice Partnership hosted the local launch of Upside, a Scotland- wide service funded by the Scottish Government to support individuals as they leave prison and return to community life. Delivered in Moray by Turning Point Scotland, as part of a national partnership of eight leading charities, Upside provides support with housing, health, finances, substance use, and the rebuilding of family connections, with a focus on developing trusting relationships and connecting individuals with local services. The launch event also highlighted the work of Moray HSCP’s Voluntary Throughcare Service, which provides up to twelve months of support for individuals released from prison who are not subject to licence conditions. The service assists with accommodation, benefits, mental health support, addiction recovery, employment, and rebuilding family relationships, with the aim of empowering individuals to make positive and lasting change. In November 2025, Moray Council and MIJB hosted a civic reception to honour local foster carers, recognising their dedication, compassion, and the life-changing impact of their commitment to children and young people in Moray. Page 170
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Moray Integration Joint Board Annual Accounts 2025/26 15 MANAGEMENT COMMENTARY (continued) The event brought together foster carers, elected members, board members, and officers to celebrate the remarkable contribution foster carers make to the lives of children and to communities across the area. The occasion also served to raise awareness of fostering and encourage those in Moray who may be able to offer a safe, stable, and nurturing home to a child or young person to come forward. Over the past year, Moray HSCP has made progress in strengthening and stabilising mental health services, although recognising the need for greater urgency in delivering meaningful improvements for people who have experienced long-standing gaps in support. Gaps have placed sustained pressure on GP practices, where clinicians have been supporting adults and children with complex mental health needs without consistent access to specialist services. It is acknowledged that individuals and families have waited too long for services that fully meet their needs. A number of key developments have helped improve service resilience. These include the appointment of a new Clinical Director for Moray Mental Health Services (Adult and Older Adult), the stabilisation of Consultant Psychiatry cover across Moray, the introduction of a dedicated email advice service enabling GPs to access psychiatric expertise, enhanced out-of-hours on-call arrangements through support from Royal Cornhill Hospital in Aberdeen, and an increased Community Mental Health Team presence within primary care settings. In addition, three Scottish Action for Mental Health (SAMH)-delivered services – the Distress Brief Intervention Service, Intensive Recovery and Community Support Service, and Suicide Prevention Service – are now fully staffed and operational across Moray. Mental Health and Wellbeing Practitioners based in GP practices also continue to strengthen early intervention, providing 255 appointments during August 2025 and supporting improved triage and faster responses for patients. Performance has improved in some areas of the Psychological Service, with 100% of Secondary Care referrals meeting national waiting time targets in September 2025. However, significant challenges remain within the Primary Care Psychological Service, where only 15% of referrals met the national standard and this will be prioritised for improvement. Page 171
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Moray Integration Joint Board Annual Accounts 2025/26 16 MANAGEMENT COMMENTARY (continued) Longer Term Changes to Strategies and Plans A new initiative to strengthen and protect the ongoing relationships at the heart of care for young people leaving the care system has been launched in Moray. Care-experienced young people and practitioners co-designed the Maintaining Relationships Project to ensure that vital connections – with social workers, teachers, residential staff, and others – can be maintained safely and respectfully even after formal care arrangements have ended. The project responds directly to the experiences of young people who have described feeling “forgotten” or “abandoned” following transitions out of care. Members of the Moray Champions Board called on Moray HSCP to develop guidance enabling staff to maintain these important relationships in a way that places young people’s wishes at the centre. Launched ahead of Care Leavers Month, the project reflects Moray’s commitment to the national Promise – ensuring all of Scotland’s children and young people grow up loved, safe, and respected. The project is already attracting national interest and has the potential to provide a model for other areas across Scotland. Positive progress continues to be made in the delivery of the Children’s Services Plan 2023–2026. The annual report highlighted the difference being made by community planning partners – including Moray HSCP, Moray Council, NHS Grampian, and Third Sector organisations – working together and with local communities to safeguard, support, and promote child and family wellbeing. The next Children’s Services Plan is under development. Good progress has also been achieved in delivering the Moray Unpaid Carers Strategy, with a range of developments helping to strengthen support and improve the experiences of unpaid carers across Moray. The Strategy, which runs until 2028, is built around three strategic priorities – recognising, valuing, and supporting carers – and is underpinned by a delivery plan supported by annual Carer Act funding. Moray Alcohol and Drug Partnership (ADP) has continued to make significant progress in reducing drug and alcohol-related harms and improving outcomes for individuals and communities across Moray. Notable progress has been achieved during the year in implementing the national Medication Assisted Treatment (MAT) standards, which form a key part of Scotland's response to the ongoing drug-related deaths crisis. The standards provide a framework for ensuring that treatment is safe, person-centred, and effective. Page 172
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Moray Integration Joint Board Annual Accounts 2025/26 17 MANAGEMENT COMMENTARY (continued) Improved referral pathways, delivered through a third sector direct access service, have reduced waiting times and enabled faster access to support, whilst frontline staff have continued to benefit from training in rights awareness, trauma-informed practice, and crisis response. In August 2025, a Recovery Together community event was held in Lossiemouth, marking International Overdose Awareness Day. The event provided an opportunity to remember those lost to substance use, support those still affected, and celebrate the strength and resilience found in recovery. The Rose Remembrance Walk and programme of activities reinforced the community's commitment to tackling stigma and promoting open conversation around recovery. 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 2025 the Board received a financial report which forecast an expected overspend to the end of the financial year of £8.78m. This forecast remained fairly consistent throughout the remainder of the year and in January 2026, MIJB were forecasting an overspend to the end of the year of £8.23m, the MIJB actually out turned at £7.20m overspent. Both partners in line with the Integration Scheme, put in additional funding to cover this overspend. There was the use of ear marked reserves totalling £0.14m during the year, with new ear marked reserves totalling £1.70m leaving a balance of £3.01m in ear marked reserves to be carried forward into 2026/27. In March 2025, the MIJB agreed a savings plan of £9.47m, 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 £3.66m, £0.68m non-recurring savings and £1.03m 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 173
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Moray Integration Joint Board Annual Accounts 2025/26 18 MANAGEMENT COMMENTARY (continued) Service Area Budget £000’s Actual £000’s Variance (Over)/ under spend £000’s Note Community Hospitals & Services 8,033 7,932 101 Community Nursing104,360 6,244 6,670 (426) 1 Learning Disabilities 20,913 21,230 (317) 2 Mental Health 12,227 12,881 (654) 3 Addictions 1,871 1,817 54 Adult Protection & Health Improvement 278 279 (1) Care Services Provided In-House 25,190 25,495 (305) Older People Services & Physical & Sensory Disability 28,090 30,023 (1,933) 4 Intermediate Care & OT 1,845 2,039 (194) Care Services Provided by External Contractors 2,084 2,072 12 Other Community Services 10,117 10,310 (193) Administration & Management 2,056 3,086 (1,030) 5 Other Operational Services 1,413 1,351 62 Primary Care Prescribing 21,441 21,312 129 Primary Care Services 22,830 22,954 (124) Hosted Services 6,131 5,987 144 Out of Area Placements 1,780 1,834 (54) Improvement Grants 1,060 889 171 Children’s & Justice Services 21,256 22,050 (794) 6 Total Core Services 194,859 200,211 (5,352) Strategic Funds & Other Resources 14,367 6,005 8,362 7 TOTALS (before set aside) 209,226 206,216 3,010 Set Aside 20,092 20,092 - TOTAL 229,318 226,308 3,010 The table above summarises the financial performance of the MIJB by comparing budget against actual performance for the year. Page 174
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Moray Integration Joint Board Annual Accounts 2025/26 19 MANAGEMENT COMMENTARY (continued) Significant variances against the budget were notably: Note 1 Community Nursing - This budget is overspent by £425,978 at the year end. This is predominantly due to staffing, with overspends in District nurses £431,715 (including Acute nursing at Varis, Forres and Buckie), £102,136 overspend in Health visitors, which is being reduced by an underspend in Maryhill of £107,873. The overspend is largely due to staffing as detailed above. District nurses had a budget realignment in 2025/26 of £313,982 and savings of £121,095, this was not achieved due to recruitment being successful for vacant posts that have been vacant for a significant time during which time bank staff have had to be used as well as the regrading of nurses from a band 6 to a band 7. Health visitors were expected to come in on budget after realignment and savings however the school nurses were regraded in the last quarter of the year resulting in an overspend in the budget. Note 2 Learning Disabilities (LD) – The Learning Disability (LD) service is overspent by £316,736 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 £428,087, client and staff transport of £25,640 and property cost overspend of £23,588. This is offset by underspend of £100,173 for clinical, nursing and other services relating to consultant and management psychiatry staffing vacancies, more income received than expected of £34,358 and other small underspends of £1,239. 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. Work continues to progress savings plans across the LD service; however, this is being offset by ongoing demand pressures. In particular, more individuals with complex needs moving through transitions from children to adult services and also people moving into the area who require high-cost packages of care, which is impacting on the overall financial position. Note 3 Mental Health – This budget is overspent by £654,343 at the year end. This is due to overspends in clinical, nursing and other services as a result of ongoing use of agency locums of £302,457; purchase of care £195,385 relating to purchase of care in care homes and care at home; £144,810 relating to unachieved savings and £11,691 other minor overspends. This budget is currently under pressure due to the recruitment issue for consultants and an increase in demand for services, including out of area packages as there is a lack of resource locally especially around autism and neurodiversity. Work is currently ongoing reviewing out of area packages to repatriate them to Moray. Note 4 Older People Services and Physical & Sensory Disability - This budget is overspent by £1,933,488 at the end of the year. This primarily relates to overspends for home care in the area teams £575,752, permanent care £1,328,598 due to the increase in the number of clients receiving nursing care rather than residential care, short breaks £242,362 and self-directed support of £260,758. Bad debt provision for unpaid fees was £117,582 overspent, which is particularly high this year and other Page 175
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Moray Integration Joint Board Annual Accounts 2025/26 20 MANAGEMENT COMMENTARY (continued) minor overspends of £18,000. This is being reduced by income received during the year above budget by £609,564. 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, when people are living longer with more complex care needs. Due to the increase in need and complexity along with increasing levels of growth and demand are having an impact on this budget. There are increases in permanent care which is seeing the move to nursing placements rather than residential placements. The demographics are showing we have an increasing elderly population who are living longer and requiring more complex care. Note 5 Admin and Management - This budget is overspent by £1,029,617 at the year end. This is due to interim staffing arrangements and the vacancy target for the Council side not being met by £933,334. There was a non-recurring increase in target for 2025/26 of £750,000 that was not achievable. Note 6 Children, Families and Justice Services – This budget is overspent by £793,663 at the year end. This is due to overspends in residential continuing care placements £418,127, external fostering placements £495,610, out of area residential placements £297,272, home to school taxis £28,201, no recourse to public funds costs £15,600 and self-directed support payments of £68,245. This overspend is being reduced by an underspend on mental health & wellbeing £156,041, trauma informed training £30,517, refund on Intensive Family Support contract £31,492, Criminal Justice £64,759, an overachievement of £246,097 against the vacancy target and minor underspends of £486. These overspends are related to the number of children requiring to be accommodated through the Children’s Hearing system, family breakdown, and the need to keep children safe from familial harm while living at home. The costs of care have been rising significantly, availability of the correct care provision is a national challenge, and the market is under scrutiny with consultation for possible legislation on excessive profiteering. A long and immediate term strategy has been approved by the IJB to address: the need to reduce the flow-into care, develop small group family living models in Moray with support from Housing Services, strengthen early support, prevention and diversion, and have a more local provision in the Northeast across the three Grampian local authority areas, which can more effectively contribute to the flow-out of care. Note 7 Strategic Funds and Other Resources – This budget is underspent by £8.362m as it relates to savings achieved during the year, any unallocated funding and reserves balances. MIJB’s financial performance is presented in the comprehensive income and expenditure statement (CIES), which can be seen on page 45. At 31 March 2026 there were ear marked reserves of £3.01m available to the MIJB, compared to £1.45m at 31 March 2025. These remaining reserves of £3.01m are for various purposes as described below: Page 176
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Moray Integration Joint Board Annual Accounts 2025/26 21 MANAGEMENT COMMENTARY (continued) Earmarked Reserves Amount £000’s GP Premises 21 National Drugs MAT 250 OOH Winter Pressure funding 172 Moray Cervical screening 36 Moray hospital at home 4 Moray Psychological 275 MHO Funding 138 Adult protection funding for CA 72 National Trauma Training services 53 Moray School Nurse 32 Moray Winter Fund HCSW & MDT 182 LD Annual Health Checks 69 Community Planning partnership 2 Moray District Nurses 111 Moray Alcohol & Drug Partnership 48 GP Walk-in Service 165 Moray Unscheduled Care Improvement Plan 1,380 Total Earmarked 3,010 General Reserves 0 TOTAL Earmarked & General 3,010 Page 177
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Moray Integration Joint Board Annual Accounts 2025/26 22 MANAGEMENT COMMENTARY (continued) 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. National Drugs Medication Assisted Treatment (MAT) for embedding and implementation of the standards will he be overseen by the MAT implementation support team (MIST). 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. 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. Moray Alcohol & Drug Partnership -funding to support local alcohol and drug issues. Page 178
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Moray Integration Joint Board Annual Accounts 2025/26 23 MANAGEMENT COMMENTARY (continued) GP Walk-in Service – Scottish Government funding to expand walk-in GP services. Moray Unscheduled Care Improvement Plan – funding to enhance the delivery of unscheduled care services. All reserves are expected to be utilised for their intended purpose during 2026/27. Set Aside – Excluded from the financial performance table above on page 18 but included within the Comprehensive Income & Expenditure Account is £20.092m 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 and Mental Health Service. 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 MIJB integration scheme outlines that the method of establishing the set aside budget will take account of hospital activity data and cost information. Hospital activity data will reflect actual occupied bed day and admissions information, together with any planned changes in activity and case mix. This information was originally provided by Information Services Division, although this information hasn’t been updated since 2019/20. In the absence of updated information from Information Services Division, uplifts based on the baseline uplift was applied to the set aside budget calculation on an annual basis throughout the period up to 2024/25. During 2025/26 it was accepted that this did not provide an accurate reflection of the consumption by Moray residents within the Unplanned Care pathways and work was undertaken to update the set aside calculation. The updated set aside budget has been calculated using hospital activity data and cost information. The hospital activity data is taken from the SMR01 dataset for general/acute inpatient and day case and reflects inpatient stays and day case and outpatient activity. Costs are taken from the 2023/24 NHS Grampian cost book and uplifted by the baseline uplift amounts for 2024/25 and 2025/26 to reflect pay award Page 179
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Moray Integration Joint Board Annual Accounts 2025/26 24 MANAGEMENT COMMENTARY (continued) and inflationary uplifts since 23/24. The set aside budget is the total of IJB activity multiplied by unit cost. The figures for 2021/22 to 2024/25 have been derived by uplifting 2019/20 figures by baseline funding uplift in 2021/22 (3.36%) ,2022/23 (6.70%), 2023/24 (5.35%) and 2024/25 (6.64%): 2025/26 2024/25 2023/24 2022/23 2021/22 Budget 20.092m 15.639m 14.665m 13.92m 13.04m 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: Page 180
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Moray Integration Joint Board Annual Accounts 2025/26 25 MANAGEMENT COMMENTARY (continued) 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 26 March 2026. 2. Additional resource to support the Budget Savings Delivery has been extended until March 2026. 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. Monitoring of MIJB Strategic Delivery Plan ensuring all projects are aligned with savings plans. 7. Extended Resource Management Group – including financial recovery action plan. 8. SMT are actively monitoring and responding to the grip and control measures as they arise, ensuring robust oversight and challenge, ensuring that no critical issues are overlooked. 9. Financial pressures have been escalated to the Chief Executives of Moray Council and NHS Grampian, discussions continue as per the tri-partite arrangements. 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 2026/27 onwards. • Ongoing Financial Development Sessions with MIJB members. • Internal Audit quarterly reporting to APR. • External Audits presented to MIJB/ Committees as appropriate. Page 181
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Moray Integration Joint Board Annual Accounts 2025/26 26 MANAGEMENT COMMENTARY (continued) • Six weekly Tri-partite partnership performance meetings with partner CEOs, Finance Directors and regular meetings with the Chair/Vice Chair of MIJB. • Strategic Delivery Plan (approved June 2025) incorporates the work being driven across all areas of the MIJB’s Strategic Plan priorities and will be reported regularly to AP&R Committee. • Finance workshops took place with Board members in December 2025 and February 2026. • Risk 2 presented to MIJB in January 2026 with Q3 report. Development Aims for 2026/27 Unscheduled Care Improvement Building on the work done on the National Collaborative to support Discharge without Delay and the wider Grampian performance challenges around Unscheduled Care, the IJB will maintain its focus on ensuring the services delegated to it deliver agreed targets. This will be done under the current actions in the delivery plan, and these will be refreshed as part of the development of the new Strategic Plan. Included in this work is the Home Assessment Pathway programme which will be reviewed across the year in relation to its contribution to achieving and sustaining agreed outcomes. Implementation 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 was undertaken. This was a collaborative piece work and engaged and involved staff. A consultation took place and, following this, the focus will be on implementing the new structure and realising the opportunities and benefits set out in the initial proposals. Developing further our Children, Families and Justice priorities and strategy 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 it plans and commissions services that are appropriate to meet the growing demand and which focus as far as practicable on early intervention and prevention and which reduce the need for a crisis response and costly out of area placements. The IJB agreed a strategic direction in November 2025 and this, under the direction of the new, permanent Head of Service and Chief Social Work Officer (starting August 2026) will be a focus for delivery over the course of the year. Page 182
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Moray Integration Joint Board Annual Accounts 2025/26 27 MANAGEMENT COMMENTARY (continued) Strategic Plan Review The MIJB approved its Strategic Delivery Plan at its meeting in May 2025, and this now provided a refresh of delivery under the current 10-year Strategy. However, recognising the need to ensure all services delegated to it are reflected in the Strategic Plan, and that it needs to reflect the financial reality set out in the Medium-Term Financial Framework, we plan to undertake a review of the Strategic Plan by the end of the financial year. In addition, we will seek to: • Continue to develop how we care for our staff well-being, with staff our most valuable asset, through the development of our Workforce Plan; • Set out clear ambitions under a Digital and TECH programme; • Provide leadership and participation as key partners in the pan Grampian North East Strategic Transformation Group (NESTG); • Focus our budget setting efforts in the context of the Medium-Term Financial Strategy and longer-term sustainability. ………………………… ……………………… ……………………… Dennis Robertson Judith Proctor Deborah O’Shea Chair of Moray IJB Chief Officer Chief Financial Officer Page 183
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Moray Integration Joint Board Annual Accounts 2025/26 28 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 secure economic, efficient and effective use of 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 Dennis Robertson Chair of Moray IJB Page 184
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Moray Integration Joint Board Annual Accounts 2025/26 29 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) 2025/26. 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 2026 and the transactions for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 185
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Moray Integration Joint Board Annual Accounts 2025/26 30 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. No taxable benefits were paid to the Chair or Vice-Chair during the year and therefore, no disclosure is required. 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. Page 186
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Moray Integration Joint Board Annual Accounts 2025/26 31 REMUNERATION REPORT (continued) 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 2024/25 Senior Employees Salary, Fees & Allowances Total 2025/26 £ £ £ 20,268 Simon Bokor-Ingram Chief Officer (1/04/24- 31/05/24) - - 95,673 Judith Proctor (from 25/07/24) 140,031 140,031 90,729 Deborah O’Shea Chief Financial Officer 95,135 95,135 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 187
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Moray Integration Joint Board Annual Accounts 2025/26 32 REMUNERATION REPORT (continued) NOTE: no bonuses, expenses allowances, compensation for loss of office or any taxable benefits were made in 2025/26. In Year Pension Contributions Accrued Pension Benefits Year to 31/03/25 Year to 31/03/26 As at 31/03/2026 Difference from 31/03/2025 £ £ £ 000’s £ 000’s Simon Bokor- Ingram, Chief Officer (*) 4,378 0 Pension - - Lump Sum - - Judith Proctor, Chief Officer 21,526 31,507 Pension 43 5 Lump Sum 111 8 Deborah O’Shea Chief Financial Officer 20,339 21,309 Pension 4 2 Lump Sum 31 - (*) Simon Bokor-Ingram figures included in the table above, relate to the full year 2024/25 including employment after Chief Officer, as figures are unable to be apportioned. 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 2024/25 Remuneration Band Number of Employees in Band 2025/25 1 £85,000 - £89,999 - - £90,000 - £94,999 1 1 £130,000 - £134,999 - - £135,000 - £139,999 1 Page 188
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Moray Integration Joint Board Annual Accounts 2025/26 33 REMUNERATION REPORT (continued) Exit Packages There were no exit packages agreed by the MIJB during 2025/26 financial year, or in the preceding year. ……………………….. ……………………… Dennis Robertson Judith Proctor Chair of Moray IJB Chief Officer Page 189
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Moray Integration Joint Board Annual Accounts 2025/26 34 ANNUAL GOVERNANCE STATEMENT Executive Summary This Annual Governance Statement outlines the governance framework operated by the Moray Integration Joint Board (MIJB) during the financial year and the assurances received regarding its effectiveness. During the year, Internal Audit concluded that only limited assurance could be provided on the MIJB’s governance, risk management and control environment. This represents the fifth consecutive year in which a limited assurance opinion has been reported. Whilst governance arrangements remained in place throughout the year, a number of significant weaknesses continue to impact the overall effectiveness of the control environment. The recurring issues relate primarily to the implementation of recovery plans, completion of agreed implementation actions and the consistency of assurance reporting. Although progress has been achieved in several areas, improvements have not yet been sufficient to support a higher level of assurance. The MIJB recognises that continued limited assurance over an extended period presents a significant governance concern. Consequently, the MIJB is unable to conclude that governance arrangements were operating effectively in all material aspects during the year. A strengthened governance improvement programme has been established with clear accountability, milestones and reporting arrangements. A significant element of this improvement programme has been the establishment of the Corporate Assurance and Governance Group (CAG). Approved by the Senior Management Team in June 2026, CAG provides corporate oversight of governance, risk management and internal control arrangements, including monitoring progress against internal audit recommendations, identifying cross-cutting risks and barriers to improvement, and supporting a more structured approach to organisational assurance and escalation. Regular scrutiny will be undertaken by the Audit, Performance and Risk Committee to ensure sustained progress throughout 2026/27. 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. Page 190
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Moray Integration Joint Board Annual Accounts 2025/26 35 ANNUAL GOVERNANCE STATEMENT (continued) 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 May 2025 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 191
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Moray Integration Joint Board Annual Accounts 2025/26 36 ANNUAL GOVERNANCE STATEMENT (continued) Key Governance Arrangements All scheduled meetings of the Audit Performance and Risk Committee and the Clinical Care Governance Committee were held as timetabled during 2025/26. Moray HSCP established an emergency response group in March 2020, which has since transitioned into a Daily Response meeting. Representation from partner organisations continues through Moray HSCP staff, maintaining effective links and information flow to support a co-ordinated response across Grampian and within Moray. Governance standards and collaborative working continue to operate across the wider system, including NHS Grampian Directorates and pan Grampian partnership arrangements. The Grampian Operation Performance Escalation System (GOPES) supports senior leaders to have oversight of system pressures and coordinate responses. This has strengthened the use of defined performance thresholds escalation levels and decision making. 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 support inclusive and informed decision making. The Board meets bi-monthly and is supported by regular development sessions, providing dedicated time 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 the Clinical and Care Governance Committee, each operating with clearly defined remits to provide assurance and support effective scrutiny. • The MIJB operates in accordance with Standing Orders, which set out the rules governing the proceedings of the Board and its Committees. These are supported by the Scheme of Administration, which defines the structure and remit of the Board’s committees, ensuring clarity, consistency and transparency 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 adhere to 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, ethical governance and supporting members to maintain high standards of conduct in decision making. Page 192
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Moray Integration Joint Board Annual Accounts 2025/26 37 ANNUAL GOVERNANCE STATEMENT (continued) Governance Principle 2 – Ensuring openness and comprehensive stakeholder engagement Assessment of Effectiveness • The MIJB’s Standing Orders provide for public and press access to meetings and reports, supporting transparency and accountability. Hybrid meeting arrangements continued throughout 2025/26 in response to positive feedback and to enhance accessibility for members and the public. • A dedicated Moray HSCP website supports access to Board information, including key strategies and supporting documentation and is subject to ongoing review and improvement. Agendas, reports and minutes for all committees are publicly available via the Moray Council website. • 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. The Board comprises eight voting members, with equal representation from Moray Council and NHS Grampian Board, alongside a range of non-voting members including professional advisors and stakeholder representatives. These arrangements ensure input from key stakeholder groups, including staff, third sector partners, people who use services and unpaid carers, supporting inclusive engagement and a broad range of perspectives in decision making. • 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’s approved Communications and Engagement Strategy supports active and meaningful engagement with all stakeholders and communities, ensuring that their views inform planning, delivery and continuous improvement of services. 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 designed to be flexible and responsive to emerging challenges across health and social care. • To support delivery of a 3-year Delivery Plan was approved by MIJB in May 2025, underpinned by a medium-term financial framework. Together these provide a structured approach to translating strategic priorities into deliverable actions, aligned to available resources and focused on sustainable service delivery. • The strategic plan is supported by a comprehensive suite of documents, including a performance framework, workforce plan, and a communications, engagement and participation plan. The strategic plan and supporting documents will be prioritised for a refresh during 2026/27. • Collectively, these arrangements provide a clear and structured approach to defining, monitoring and delivering outcomes, with a clear focus on medium term priorities and measurable improvement. The outcomes are aligned to the Page 193
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Moray Integration Joint Board Annual Accounts 2025/26 38 ANNUAL GOVERNANCE STATEMENT (continued) delivery of integrated health and social care services and are intended to improve population health, wellbeing and service sustainability within Moray. • In support of environmental sustainability, a Climate Change Duties report is prepared and submitted annually on behalf of the MIJB, demonstrating compliance with statutory environmental responsibilities and supporting continued progress against natural climate change objectives. 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. Proposals set out how intended outcomes will be delivered, supported by proportionate assessment of risks, opportunities and implications. This supports informed and transparent decision making and enables the Board to determine appropriate interventions aligned to strategic priorities. • Board papers reflect the broad range of strategic and operational pressures under consideration. These include regular updates on current developments, alongside agenda items addressing opportunities and challenges, particularly those associated with transformation. • The MIJB recognises the importance of strong financial governance and has adopted the CIPFA Financial Management Code as a guiding framework for effective financial management. A Medium-Term Financial Strategy, approved in March 2026, supports this approach and is subject to regular review to ensure alignment with the Strategic Plan, Delivery Plan and the integration of delegated children’s services. These arrangements have operated effectively during the year, supporting the Board to determine and implement appropriate interventions and respond to emerging challenges. 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 established a programme of development sessions with Board members, with a focus on the challenging financial position and opportunities for service transformation. These sessions provide a structured forum to explore strategic challenges, consider options and support collective understanding of priorities. • Officers present a range of proposals through this process aimed at delivering the MIJB’s strategic objectives whilst contributing to the achievement of required financial efficiencies. • The MIJB continues to prioritise leadership development and collaborative working through regular development sessions involving Board members and h Officers. These sessions enable shared learning, strategic dialogue, and constructive challenge, supporting continuous development of leadership capability across the organisation. Page 194
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Moray Integration Joint Board Annual Accounts 2025/26 39 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 formally approved by the Board in May 2025. This updated register is reviewed monthly by the Senior Management Team and updated and presented at least biannually to Audit, Performance and Risk Committee, and annually to MIJB. The Committee agreed that emerging or escalating risks would be reported in line with business need. A further Board development session to review and refresh the register is planned for November 2026. • The operational Performance Management Framework has been reviewed and is nearing completion. A key improvement has been the focus to shift towards more integrated reporting across all delegated services, rather than individual service level reports, to provide a more cohesive view of system performance. Reporting is presented three times per year to the Audit, Performance and Risk Committee. • The system of internal control system remains 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 continues to receive assurance through regular reporting on the effectiveness of internal control arrangements. • During 2025/26, targeted improvement work has been undertaken in partnership with Internal Audit and the Operational Management team to strengthen arrangements for audit planning, coordination and delivery. This has included improving oversight of the full audit plan, clarifying ownership of actions, and strengthening processes to support the timely and consistent implementation of audit recommendations. This work has provided greater visibility of progress, supported more effective management control, and is beginning to address a number of legacy actions, some of which require review to ensure continued relevance within the current operating context. • The MIJB Chief Internal Auditor undertakes an annual review of the adequacy and effectiveness of internal controls, with the opinion incorporated 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 continue to reflect recognised good practice frameworks, including the 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) and 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 195
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Moray Integration Joint Board Annual Accounts 2025/26 40 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 and Committee 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 scrutinise. There is a standardised reporting format in place to ensure consistency, clarity and transparency how information is presented and decision-making processes. • The MIJB demonstrates its commitment to accountability through publication of its Annual Accounts and Annual Performance Report, both of which are subject to formal Board approval. These reports provide a clear account of financial stewardship, performance and progress against strategic priorities. • The Chief Internal Auditor reports independently to the Audit, Performance and Risk committee and has direct access to the Chief Officer, Chief Financial Officer and Chair of the Audit, Performance and Risk committee on any matter of concern. Throughout 2025/26, regular reporting has supported effective scrutiny of internal control arrangements, risk management and the delivery of the internal audit plan, strengthening overall assurance to the Board. 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). The Council’s Service Manager Internal Audit and Risk (Chief Audit Executive (CAE)) has recently been re-appointed as the Chief Internal Auditor to the MIJB until 31 March 2028. The Internal Audit Section has adopted the Global Internal Audit Standards (GIAS), which requires the Chief Internal Auditor to deliver an annual internal audit opinion and report. This report has been used to inform this governance statement. The Chief Internal Auditor’s evaluation of the adequacy and effectiveness of governance, risk management and the internal control framework is informed by the findings of audits undertaken on services operating under the direction of the MIJB. Additional assurance is obtained from the Internal Audit Service Provider for NHS Grampian regarding governance processes within that organisation. This includes the provision of relevant internal audit reports to the Chief Internal Auditor. In addition, reports issued by other external review agencies are considered as part of the overall assurance assessment. Page 196
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Moray Integration Joint Board Annual Accounts 2025/26 41 ANNUAL GOVERNANCE STATEMENT (continued) Internal Audit operates independently within the organisation, with no management- imposed limitations on the scope of work undertaken. In accordance with GIAS, the Chief Internal Auditor prepares a risk-based Audit Plan for the MIJB. The Annual Audit Plan for 2025/26 included the following reviews: • Complex and Challenging Behaviour Services– A review of systems and procedures within Complex and Challenging Behaviour Services. • Social Care (Short Breaks)– A review of the governance, administrative and financial arrangements supporting the delivery of Social Care (Short Breaks), with particular regard to eligibility determination, record‑keeping and financial control processes. • Non-Payroll Expenditure–A review of non-payroll expenditure to test compliance with Financial Regulations, procurement requirements and payment-processing procedures. The audit of the Complex and Challenging Behaviour Service highlighted sustained levels of overtime worked by some officers, which, while demonstrating strong commitment, raises concerns about long-term service sustainability. Management has established a short-life working group to address these staffing pressures. The audit review of Social Care (Short Breaks) identified a need to consider the development of a charging policy for accommodated respite short breaks. This reflects findings from another audit review, which also suggested exploring charging arrangements for non-residential care services. The review of payments made through the Council’s Financial Management System identified instances where financial controls were not operating effectively, resulting in transaction processing errors and the need to recover expenditure from a service provider. While the majority of transactions tested were compliant and appropriately authorised, these findings, together with those from the Complex and Challenging Behaviour Service, highlight the need for improved compliance with Financial Regulations to ensure effective financial management, safeguard resources, and maintain robust governance. Follow-up reviews undertaken by the Internal Audit Section identified that several previously agreed recommendations remain outstanding, with revised implementation timescales required. Timely implementation of audit recommendations is critical to strengthening internal controls; delays increase the risk that control weaknesses persist. However, the MIJB has made notable progress in strengthening governance arrangements. Improvements include regular reporting on the implementation of audit recommendations to Senior Management and the Practice Governance Board, as well as more structured engagement with the Internal Audit Section. This includes attendance by the Chief Internal Auditor at Senior Management Team meetings to support the decision-making framework and the timely resolution of audit findings. Page 197
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Moray Integration Joint Board Annual Accounts 2025/26 42 ANNUAL GOVERNANCE STATEMENT (continued) It was also noted that a replacement for the existing social work and social care case management system has been approved, with implementation planned by March 2027. As this system is the core database for highly sensitive social work information and supports the administrative and financial management of social care packages, its replacement represents a significant step towards strengthening information governance, improving operational resilience and enhancing overall service assurance. While progress has been made in strengthening governance and internal control arrangements within the MIJB, the outcomes of the audit work undertaken identified significant findings. In addition, several recommendations from previous reviews remain outstanding. After careful consideration of these factors, the Chief Internal Auditor has provided limited assurance that the MIJB had adequate systems of governance and internal control in place for the year ended 31 March 2026. Prior Year Governance Issues The Annual Governance Statement for 2024/25 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 2024/25 Action Undertaken / Progress Made in 2025/26 Developing further our approaches to frailty and Discharge without Delay. Realigning our organisational structure to ensure effective delivery of strategy and transformation. Progress has been made across the year in relation to improving the Partnership’s Delayed Discharge (DD) performance. Central to this has been the development of the Home Assessment Pathway (HAP) and its Discharge to Assess and Discharge without Delay Principles. The IJB retains a target of 26 DDs and, through the Grampian wide Unscheduled Care Programme, a target of no more than 5 delays in Dr Gray’s. Whilst overall DDs have reduced over the course of the year and we have, at times achieved the target, this has not yet been sustained. Work is ongoing to deliver that sustained improvement. Significant progress has been made in developing the organisational restructure. This has been a highly collaborative process with our teams. The structure will be implemented over 2026/27. Page 198
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Moray Integration Joint Board Annual Accounts 2025/26 43 Area for Improvement Identified in 2024/25 Action Undertaken / Progress Made in 2025/26 Integration of Children’s Social Work and Justice Services governance and oversight within the IJB. Further strengthen performance oversight of the Board’s key strategies and priorities. Continue to improve on the progress for compliance with audit recommendations. Governance arrangements in these services have been set out and reporting is in place. In addition, a review of governance of the joint (IJB and Moray Council) Whole Family Wellbeing Fund (WFWF) took place and was agreed by partners, giving greater clarity on the oversight, decision making and reporting of this fund. An agreed performance structure is in place for the MIJB and has operated over the year. In addition, Moray HSCP has set out a revised structure for governance of the delivery plan and key strategic change, as well as in relation to Budget Savings Delivery. Progress has been made in strengthening arrangements. A dashboard of all audits and actions has been developed that enables a new Corporate IA Group to track progress and report / escalate issues. IA reports to the Moray HSCP every month and this enables positive dialogue with the Chief Internal Auditor. Page 199
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Moray Integration Joint Board Annual Accounts 2025/26 44 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 2026/27 1. Review of the IJB’s Strategic Plan. 2. Implement new arrangements for lived experience members’ voting rights and support them in this transition. 3. Continue to implement strengthened arrangements for implementing Internal Audit actions. 4. Continued focus on budget savings delivery and medium-term financial challenge. 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 a pan Grampian approach and contribute to the emerging work of the North East Strategic Transformation Group (NESTG). • Continuing to implement the recommendations of internal and external audit, including learning from national reviews. • There have been no significant events up to the authorised for issue date. ANNUAL GOVERNANCE STATEMENT (continued) Page 200
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Moray Integration Joint Board Annual Accounts 2025/26 45 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 2025/26 and up to the date of authorised for issue. ………………………… ……………………… Dennis Robertson Judith Proctor Chair of Moray IJB Chief Officer Page 201
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Moray Integration Joint Board Annual Accounts 2025/26 46 COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT This statement shows the cost of providing services for the year ended 31 March 2026 according to generally accepted accounting practices. 2024/25 2025/26 Net Expenditure Net Expenditure £ 000 £ 000 8,329 Community Hospitals 7,932 6,166 Community Nursing 6,670 19,975 Learning Disabilities 21,230 12,055 Mental Health 12,881 1,763 Addictions 1,817 273 Adult Protection & Health Improvement 279 22,754 Care Services Provided In-House 25,495 27,034 Older People & Physical & Sensory Disability Services 30,023 1,972 Intermediate Care and Occupational Therapy 2,039 1,817 Care Services Provided by External Providers 2,072 10,280 Other Community Services 10,310 3,152 Administration & Management 3,086 1,535 Other Operational services 1,351 21,937 Primary Care Prescribing 21,312 21,331 Primary Care Services 22,954 5,665 Hosted Services 5,987 1,971 Out of Area Placements 1,834 1,021 Improvement Grants 889 19,626 Children & Justice Services 22,050 6,020 Strategic Funds & Other Resources 6,005 15,639 Set Aside 20,092 210,315 Cost of Services 226,308 (209,779) Taxation and Non-Specific Grant Income (note 5) (227,868) 536 Deficit/(Surplus) on provision of Services (1,560) 536 Total Comprehensive Income and Expenditure (1,560) There are no statutory or presentational adjustments which reflect the MIJB’s application of the funding received from partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. Page 202
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Moray Integration Joint Board Annual Accounts 2025/26 47 MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the MIJB’s 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 52. Movement of Reserves During 2025/26 General Fund Balance £000 Opening Balance at 1 April 2025 (1,450) Total Comprehensive Income and Expenditure (1,560) (Increase) in 2025/26 (1,560) Closing Balance at 31 March 2026 (3,010) Movement of Reserves During 2024/25 General Fund Balance £000 Opening Balance at 1 April 2024 (1,986) Total Comprehensive Income and Expenditure 536 Decrease in 2024/25 536 Closing Balance at 31 March 2025 (1,450) Page 203
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Moray Integration Joint Board Annual Accounts 2025/26 48 BALANCE SHEET The Balance Sheet shows the value of the MIJB’s 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 2025 £000 Notes 31 March 2026 £000 1,450 Short Term Debtors 6 3,010 Current Assets - Short Term Creditors - Current Liabilities - Provisions - Long Term Liabilities 1,450 Net Assets 3,010 1,450 Usable Reserve General Fund 7 3,010 1,450 Total Reserves 3,010 The unaudited annual accounts were issued on 25 June 2026 and the audited annual accounts were authorised for issued on 24 September 2026. The Annual Accounts present a true and fair view of the financial position of the MIJB as at 31 March 2026 and its income and expenditure for the year then ended. Deborah O’Shea FCCA Chief Financial Officer Page 204
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Moray Integration Joint Board Annual Accounts 2025/26 49 NOTES TO THE FINANCIAL STATEMENTS Note 1 Significant Accounting Policies General Principles The Financial Statements summarise the MIJB’s transactions for the 2025/26 financial year and its position at the year-end of 31 March 2026. 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 2025/26, 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 205
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Moray Integration Joint Board Annual Accounts 2025/26 50 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 206
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Moray Integration Joint Board Annual Accounts 2025/26 51 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 25 June 2026 and the audited accounts issued on 24 September 2026. Events taking place after this date are not reflected in the financial statements or notes. Note 4 Expenditure and Income Analysis by Nature 2024/25 2025/26 £000 £000 98,217 Services commissioned from Moray Council 106,355 112,061 Services commissioned from Grampian Health Board 119,918 37 Auditor Fee: External Audit Work 35 210,315 Total Expenditure 226,308 (209,779) Partners Funding Contributions and Non- Specific Grant Income (227,868) 536 Deficit on the Provision of Services (1,560) Page 207
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Moray Integration Joint Board Annual Accounts 2025/26 52 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 5 Taxation and Non-Specific Grant Income 2024/25 2025/26 £000 £000 88,441 Funding Contribution from Moray Council 94,522 121,338 Funding Contribution from Grampian Health Board 133,346 209,779 Taxation and Non-specific Grant Income 227,868 The funding contribution from Grampian Health Board shown above includes £20.092m 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 2025 31 March 2026 £000 £000 1,187 Grampian Health Board 2,747 263 Moray Council 263 1,450 Debtors 3,010 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 208
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Moray Integration Joint Board Annual Accounts 2025/26 53 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 2024 - 33 1,953 1,986 Transfers (out) 2024/25 - (33) (503) (536) Balance at 31 March 2025 - - 1,450 1,450 Transfer in/(out) 2025/26 - - 1,560 1,560 Balance at 31 March 2026 - - 3,010 3,010 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. This reserve is now depleted. Other earmarked reserves are noted in detail on pages 21 to 23. Page 209
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Moray Integration Joint Board Annual Accounts 2025/26 54 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: 2024/25 2025/26 £000 £000 10,680 Expenditure on Agency Services 11,266 (10,680) Reimbursement for Agency Services (11,266) - Net Agency Expenditure excluded from the CIES - Page 210
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Moray Integration Joint Board Annual Accounts 2025/26 55 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 2024/25 2025/26 £000 £000 (121,338) Funding Contributions received from the NHS Board (133,346) 111,864 Expenditure on Services Provided by the NHS Board 119,691 197 Key Management Personnel: Non-Voting Board Members 227 (9,227) Net Transactions with Grampian Health Board (13,428) 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 2025 31 March 2026 £000 £000 1,187 Debtor balances: Amounts due from Grampian Health Board 2,747 1,187 Net Balance due from Grampian Health Board 2,747 Page 211
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Moray Integration Joint Board Annual Accounts 2025/26 56 NOTES TO THE FINANCIAL STATEMENTS (continued) Note 9 Related Party Transactions (continued) Transactions with Moray Council 2024/25 2025/26 £000 £000 (88,441) Funding Contributions received from the Council (94,522) 98,179 Expenditure on Services Provided by the Council 106,294 75 Key Management Personnel: Non-Voting Board Members 96 9,813 Net Transactions with Moray Council 11,868 Balances with Moray Council 31 March 2025 31 March 2026 £000 £000 263 Debtor balances: Amounts due from Moray Council 263 263 Net Balance due from Moray Council 263 Page 212
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Moray Integration Joint Board Annual Accounts 2025/26 57 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 2026/27 Code: • Amendments to FRS 102 The Financial Reporting Standard applicable in the UK and Republic of Ireland (Amendments to Heritage assets) issued in March 2024; • Amendments to the Classification and Measurement of Financial Instruments (Amendments to IFRS 9 and IFRS 7) issued in May 2024; • Annual improvements to IFRS accounting standards – Volume 11 issued in July 2024; and • Contracts Referencing Nature-dependent Electricity (Amendments to IFRS 9 and IFRS 7) issued in December 2024. The Code requires implementation from 1 April 2026 and there is, therefore, no impact on the 2025/26 financial statements. The above amendments are not anticipated to have a material impact on the information provided in the financial statements. Page 213
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Moray Integration Joint Board Annual Accounts 2025/26 58 INDEPENDENT AUDITOR’S REPORT Independent auditor’s report to the members of Moray Integration Joint Board and the Accounts Commission Reporting on the audit of the financial statements Opinion on financial statements We certify that we have audited the financial statements in the annual accounts of Moray Integration Joint Board for the year ended 31 March 2026 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, the Balance Sheet and notes to the financial statements, including material accounting policy information. The financial reporting framework that has been applied in their preparation is applicable law and UK adopted international accounting standards, as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26 (the 2025/26 Code). In our opinion the accompanying financial statements: • give a true and fair view of the state of affairs of the Board as at 31 March 2026 and of its income and expenditure for the year then ended; • have been properly prepared in accordance with UK adopted international accounting standards, as interpreted and adapted by the 2025/26 Code; and • have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003. Basis for opinion We conducted our audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)), as required by the Code of Audit Practice approved by the Accounts Commission for Scotland. our responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of our report. We were appointed by the Accounts Commission on 18 May 2022. Our period of appointment is five years, covering 2022/23 to 2026/27. We are independent of the Board in accordance with the ethical requirements that are relevant to our audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and we have fulfilled our other ethical responsibilities in accordance with these requirements. Non-audit services prohibited by the Ethical Standard were not provided to the Board. We believe that the audit evidence we have obtained is sufficient and appropriate to provide a basis for our opinion. Conclusions relating to going concern basis of accounting We have concluded that the use of the going concern basis of accounting in the preparation of the financial statements is appropriate. Page 214
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Moray Integration Joint Board Annual Accounts 2025/26 59 INDEPENDENT AUDITOR’S REPORT (continued) Based on the work we have performed, we have not identified any material uncertainties relating to events or conditions that, individually or collectively, may cast significant doubt on the Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from when the financial statements are authorised for issue. These conclusions are not intended to, nor do they, provide assurance on the Board’s current or future financial sustainability. However, we report on the Board’s arrangements for financial sustainability in a separate Annual Audit Report available from the Audit Scotland website. Risks of material misstatement We report in our Annual Audit Report the most significant assessed risks of material misstatement that we identified and our judgements thereon. Responsibilities of the Chief Financial Officer and Moray Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless there is an intention to discontinue the Board’s operations. The Moray Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements Our objectives are to obtain reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes our opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the decisions of users taken on the basis of these financial statements. Page 215
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Moray Integration Joint Board Annual Accounts 2025/26 60 INDEPENDENT AUDITOR’S REPORT (continued) Irregularities, including fraud, are instances of non-compliance with laws and regulations. We design procedures in line with our responsibilities outlined above to detect material misstatements in respect of irregularities, including fraud. Procedures include: • using our understanding of the local government sector to identify that the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003 are significant in the context of the Board; • inquiring of the Chief Financial Officer as to other laws or regulations that may be expected to have a fundamental effect on the operations of the Board; • inquiring of the Chief Financial Officer concerning the Board’s policies and procedures regarding compliance with the applicable legal and regulatory framework; • discussions among our audit team on the susceptibility of the financial statements to material misstatement, including how fraud might occur; and • considering whether the audit team collectively has the appropriate competence and capabilities to identify or recognise non-compliance with laws and regulations. The extent to which our procedures are capable of detecting irregularities, including fraud, is affected by the inherent difficulty in detecting irregularities, the effectiveness of the Board’s controls, and the nature, timing and extent of the audit procedures performed. Irregularities that result from fraud are inherently more difficult to detect than irregularities that result from error as fraud may involve collusion, intentional omissions, misrepresentations, or the override of internal control. The capability of the audit to detect fraud and other irregularities depends on factors such as the skilfulness of the perpetrator, the frequency and extent of manipulation, the degree of collusion involved, the relative size of individual amounts manipulated, and the seniority of those individuals involved. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of our auditor’s report. Reporting on other requirements Opinion prescribed by the Accounts Commission on the audited parts of the Remuneration Report We have audited the parts of the Remuneration Report described as audited. In our opinion, the audited parts of the Remuneration Report have been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. Page 216
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Moray Integration Joint Board Annual Accounts 2025/26 61 INDEPENDENT AUDITOR’S REPORT (continued) Other information The Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the Management Commentary, Annual Governance Statement, Statement of Responsibilities and the unaudited part of the Remuneration Report. Our responsibility is to read all the other information and, in doing so, consider whether the other information is materially inconsistent with the financial statements or our knowledge obtained in the course of the audit or otherwise appears to be materially misstated. If we identify such material inconsistencies or apparent material misstatements, we are required to determine whether this gives rise to a material misstatement in the financial statements themselves. If, based on the work we have performed, we conclude that there is a material misstatement of this other information, we are required to report that fact. We have nothing to report in this regard. Our opinion on the financial statements does not cover the other information and we do not express any form of assurance conclusion thereon except on the Management Commentary and Annual Governance Statement to the extent explicitly stated in the following opinions prescribed by the Accounts Commission. Opinions prescribed by the Accounts Commission on the Management Commentary and Annual Governance Statement In our opinion, based on the work undertaken in the course of the audit: • the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and • the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016). Matters on which we are required to report by exception We are required by the Accounts Commission to report to you if, in our opinion: • adequate accounting records have not been kept; or • the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or • We have not received all the information and explanations we require for our audit. We have nothing to report in respect of these matters. Page 217
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Moray Integration Joint Board Annual Accounts 2025/26 62 INDEPENDENT AUDITOR’S REPORT (continued) Conclusions on wider scope responsibilities In addition to our responsibilities for the annual accounts, our conclusions on the wider scope responsibilities specified in the Code of Audit Practice, including those in respect of Best Value, are set out in our Annual Audit Report. Use of our report This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 108 of the Code of Audit Practice, we do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties. Angela Pieri, (for and on behalf of Grant Thornton UK LLP), 120 Bothwell Street, Glasgow, G2 7JS Page 218
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Moray Integration Joint Board Annual Accounts 2025/26 63 Page 219
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The integrated health & social care partnership of
Moray Council and NHS Grampian
Moray Council Offices, High Street, Elgin IV30 1BX
Judith Proctor
Chief Officer
Moray Council Offices
High Street
Elgin
Moray
IV30 1BX
Email: hscmchiefofficer@moray.gov.uk
Website: www.hscmoray.co.uk
10 September 2026
Confidential
Grant Thornton UK LLP
Level 8
120 Bothwell St
Glasgow
G2 7JS
Dear Grant Thornton UK LLP
Moray Integration Joint Board
Financial Statements for the year ended 31 March 2026
This representation letter is provided in connection with the audit of the financial
statements of Moray Integration Joint Board (the “IJB”) for the year ended 31 March
2026 for the purpose of expressing an opinion as to whether the IJB’s financial
statements give a true and fair view in accordance with International Financial
Reporting Standards and the CIPFA/LASAAC Code of Practice on Local Authority
Accounting in the United Kingdom 2025/26 and applicable law.
We confirm that to the best of our knowledge and belief having made such inquiries
as we considered necessary for the purpose of appropriately informing ourselves:
Financial Statements
i. We have fulfilled our responsibilities for the preparation of the IJB’s financial
statements in accordance with the International Financial Reporting
Standards and the CIPFA/LASAAC Code of Practice on Local Authority
Accounting in the United Kingdom 2025/26 ("the Code"); in particular the
financial statements are fairly presented in accordance therewith.
ii. We have complied with the requirements of all statutory directions affecting
the IJB and these matters have been appropriately reflected and disclosed in
the financial statements.
iii. The IJB has complied with all aspects of contractual agreements that could
have a material effect on the financial statements in the event of non-
APPENDIX 2
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compliance. There has been no non-compliance with requirements of any regulatory authorities that could have a material effect on the financial statements in the event of non-compliance. iv. We acknowledge our responsibility for the design, implementation and maintenance of internal control to prevent and detect fraud. v. We are satisfied that the methods, the data and the significant assumptions used by us in making accounting estimates and their related disclosures are appropriate to achieve recognition, measurement or disclosure that is reasonable in accordance with the Code and adequately disclosed in the financial statements. vi. Except as disclosed in the financial statements: a. there are no unrecorded liabilities, actual or contingent; b. none of the assets of the IJB has been assigned, pledged or mortgaged; and c. there are no material prior year charges or credits, nor exceptional or non-recurring items requiring separate disclosure. vii. Related party relationships and transactions have been appropriately accounted for and disclosed in accordance with the requirements of International Financial Reporting Standards and the Code. viii. All events subsequent to the date of the financial statements and for which International Financial Reporting Standards and the Code require adjustment or disclosure have been adjusted or disclosed. ix. The financial statements are free of material misstatements, including omissions. x. Actual or possible litigation and claims have been accounted for and disclosed in accordance with the requirements of International Financial Reporting Standards. xi. We have no plans or intentions that may materially alter the carrying value or classification of assets and liabilities reflected in the financial statements. xii. We have updated our going concern assessment. We continue to believe that the IJB’s financial statements should be prepared on a going concern basis and have not identified any material uncertainties related to going concern on the grounds that: a. the nature of the IJB means that, notwithstanding any intention to cease its operations in their current form, it will continue to be appropriate to adopt the going concern basis of accounting because, in such an event, services it performs can be expected to continue to be delivered by related public authorities and preparing the financial statements on a going concern basis will still provide a faithful representation of the items in the financial statements b. the financial reporting framework permits the IJB to prepare its financial statements on the basis of the presumption set out under a) above; and Page 221
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c. the IJB’s system of internal control has not identified any events or conditions relevant to going concern. We believe that no further disclosures relating to the IJB's ability to continue as a going concern need to be made in the financial statements. xiii. The IJB has complied with all aspects of ring-fenced grants that could have a material effect on the IJB’s financial statements in the event of non- compliance. Information Provided xiv. We have provided you with: a. access to all information of which we are aware that is relevant to the preparation of the IJB’s financial statements such as records, documentation and other matters; b. additional information that you have requested from us for the purpose of your audit; and c. unrestricted access to persons within the IJB from whom you determined it necessary to obtain audit evidence. xv. We have communicated to you all deficiencies in internal control of which management is aware. xvi. All transactions have been recorded in the accounting records and are reflected in the financial statements. xvii. We have disclosed to you the results of our assessment of the risk that the financial statements may be materially misstated as a result of fraud. xviii. We have disclosed to you all information in relation to fraud or suspected fraud that we are aware of and that affects the IJB and involves: a. management; b. employees who have significant roles in internal control; or c. others where the fraud could have a material effect on the financial statements. xix. We have disclosed to you all information in relation to allegations of fraud, or suspected fraud, affecting the financial statements communicated by employees, former employees, analysts, regulators or others. xx. We have disclosed to you all known instances of non-compliance or suspected non-compliance with laws and regulations whose effects should be considered when preparing financial statements. xxi. We have disclosed to you the identity of the IJB's related parties and all the related party relationships and transactions of which we are aware. xxii. We have disclosed to you all known actual or possible litigation and claims whose effects should be considered when preparing the financial statements. Page 222
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Annual Governance Statement xxiii. We are satisfied that the Annual Governance Statement (AGS) fairly reflects the IJB's risk assurance and governance framework and we confirm that we are not aware of any significant risks that are not disclosed within the AGS. Management Summary xxiv. The disclosures within the Management Summary fairly reflect our understanding of the IJB's financial and operating performance over the period covered by the IJB’s financial statements. Approval The approval of this letter of representation was minuted by the IJB’s Board at its meeting on 24 September 2026. Yours sincerely Judith Proctor Chief Officer (Signed on behalf of Moray Integration Joint Board) Page 223
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: MORAY INTEGRATION JOINT BOARD DRAFT STRATEGIC RISK REGISTER BY: CHIEF OFFICER 1. REASON FOR REPORT 1.1 To present the Draft Strategic Risk Register for approval, following scrutiny by the Audit, Performance and Risk (APR) Committee prior on 24 September 2026, and to provide assurance regarding the Board’s current strategic risk profile. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) notes the scrutiny undertaken by the Audit, Performance and Risk Committee and its recommendation that the Strategic Risk Register be approved; and ii) approves the Strategic Risk Register attached at Appendix 1, noting the current risk ratings, controls, assurances and areas of ongoing exposure; and 3. BACKGROUND 3.1 The Board Risk Policy review was approved by the Moray Integration Joint Board (MIJB) at their meeting on 25 June 2020 (para 9 of the minute refers). Risk Appetite Statements are included in Appendix 1. 3.2 Risk scores are determined using the MIJB Risk Policy (Section 5), based on likelihood and impact. 3.3 As agreed at Audit, Performance and Risk Committee on 26 October 2023 (para 8 of the minute refers), the reporting frequency was amended from quarterly to biannually unless significant changes arise. Item 11. Page 225
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3.4 The MIJB Chief Internal Auditor issued a ‘Limited Assurance’ rating for MIJB for 2025/26 to the meeting of Audit, Performance and Risk Committee on 25 June 2026 (para 11 of the minute refers), and is reflected in Strategic Risk 8. 3.5 As agreed at the MIJB meeting on 25 September 2025 (para 11 of minute refers), the Strategic Risk Register is subject to scrutiny by the Audit, Performance and Risk Committee, with escalation to the Board for oversight and approval. 3.6 Since the last formal review, a number of refinements have been made to the Strategic Risk Register, including updates to risk narratives, controls, assurances and governance arrangements to reflect organisational developments, legislative change and emerging assurance activities. These changes do not alter the overall strategic risk profile of the Board. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The Strategic Risk Profile The overall strategic risk profile remains unchanged, with one risk remaining assessed as Very High and the remaining risks assessed as Medium. No changes are proposed to the overall risk ratings. 4.2 Governance and Assurance Updates The Strategic Risk Register has been updated to reflect: • governance changes arising from the introduction of voting rights for stakeholder members; • member governance and induction arrangements • development of the Corporate Assurance and Governance Group (CAG); • updated workforce, engagement and strategic planning assurances; • strengthened references to internal audit, hosted service assurance and organisational risk management arrangements; and • updated controls, assurance mechanisms and explanatory narratives across individual risks. 4.3 Risk Appetite The Strategic Risk Register continues to reflect the Board's approved Risk Appetite Statement. Members participated in a dedicated Board Development Session on risk management in August 2026, which included discussion regarding risk appetite, risk tolerance and the relationship between the Risk Appetite and the Strategic Risk Register. A separate report on the updated Risk Management Policy is presented on today’s agenda for consideration by the Moray Integration Joint Board. No changes to the Risk Appetite Statement are proposed within this report. However, should the Board subsequently agree any amendments to its risk appetite, the implications for the Strategic Risk Register will be considered as part of the next review cycle and reflected in future reports as appropriate. 4.4 Internal Audit and Governance Strategic Risk 8 continues to reflect the Internal Audit opinion of Limited Assurance and the actions being taken to strengthen governance, assurance and audit tracking arrangements. The register has been updated to reflect Page 226
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progress made through management oversight, internal audit engagement and the Corporate Assurance and Governance Group. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032” The MIJB requires effective governance arrangements for those services and functions delegated to it and Risk Management systems are integral to this. (b) Policy and Legal As set out in the terms of reference, the Board has responsibility to provide assurance of the adequacy of the risk management framework. There are no legal implications arising from this report. (c) Financial implications There are no direct financial implications arising from this report however, the Board should note the failure to manage risks effectively could have a financial impact for the MIJB. (d) Risk Implications and Mitigation The Strategic Risk Register remains the Board's primary mechanism for monitoring strategic risks. The updated register reflects changes to controls, assurances and governance arrangements whilst maintaining the current overall risk profile. The Audit, Performance and Risk Committee scrutinised the register and recommended it to the Board for approval. Members should note that a separate report on the Risk Management Policy and Framework is also being considered at this meeting, following a Board Development Session on risk management held in August 2026. Whilst no changes to the Board's approved Risk Appetite Statement have been proposed through the Strategic Risk Register, any amendments agreed by the Board following consideration of the Risk Policy will be reflected through future reviews of the Strategic Risk Register where appropriate. (e) Staffing Implications There are no additional staffing implications arising from this report. The workforce risk narrative has been updated to reflect current workforce assurances and organisational review activity. (f) Property There are no property implications arising from this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required, as no service, policy or organisational changes being proposed. (h) Climate Change and Biodiversity Impacts Page 227
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There are no impacts arising from this report. (i) Directions None arising from this report. (j) Consultations Consultation on the Strategic Risk Register has taken place with the Board members, and Senior Management Team. Board Members also participated in a Development Session on risk management in August 2026. The Strategic Risk Register was scrutinised by the Audit, Performance and Risk Committee prior to submission to the Board. 6. CONCLUSION 6.1 The Strategic Risk Register continues to provide a comprehensive overview of the Board's strategic risks, controls and assurances. Whilst a number of updates have been made to reflect organisational developments, governance changes and assurance activities, the overall strategic risk profile remains unchanged. Following scrutiny by the Audit, Performance and Risk Committee, the Board is asked to approve the updated Strategic Risk Register attached at Appendix 1. Author of Report: Sonya Duncan, Interim Corporate Manager Background Papers: held by MHSCP Ref: Page 228
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MIJB RISK REGISTER SUMMARY – March 2026 APPENDIX 1 Risk Assessment Table – Multiply likelihood score by impact score to determine the risk rating (score). Risk No Risk Risk Owner Previous Risk Rating Last Reviewed Change Current Rating 1 There is a risk that the MIJB does not function as set out within the Integration Scheme, Strategic Plan and in-line with its Governance Framework and fails to deliver its objectives or expected outcomes. Chief Officer Contributor: Senior Leadership Team Error! Reference source not found. September 2026 Medium 2 The MIJB must operate within the resources allocated to it by the partner bodies and it is good financial practice to set a balanced budget at the start of each financial year. There is a risk that financial pressures being experienced by the funding partners will indirectly impact the MIJB’s strategic planning of services and its decision-making Chief Officer Contributor: Chief Finance Officer/ Heads of Service/ Chief Nurse Very High September 2026 Very High 3 There is a risk that the MIJB’s workforce strategy is not delivered impacting the quality of paid and unpaid Health & Social Care. Chief Officer Contributor: Chief Finance Officer/ Heads of Service/ Chief Nurse Medium September 2026 Medium 4 There is a risk that the MIJB is unable to operate effectively as a Public Body. Chief Officer Contributor: Corporate Manager/ Chief Finance Officer Medium September 2026 Medium 5 There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Chief Officer Contributor: Senior Leadership Team Medium September 2026 Medium 6 There is a risk that the MIJB’s strategic aspirations are not sufficiently transformative and as a result, that it is unable to deliver outcomes for people in a sustainable way. Chief Officer Contributor: Senior Leadership Team Medium September 2026 Medium 7 There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Chief Officer Contributor: Heads of Service Medium September 2026 Medium 8 There is a risk that the MIJB’s internal control and governance arrangements are not sufficiently robust, as evidenced by the 2024/25 Internal Audit opinion of ‘limited assurance’ Chief Officer Contributor: Senior Leadership Team Medium September 2026 Medium Page 229
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Risk 1: There is a risk that the MIJB does not function as set out within the Integration Scheme, Strategic Plan and in-line with its Governance Framework and fails to deliver its objectives or expected outcomes. Consequence: Legal and Regulatory Implications, Reputational Damage, Loss of Stakeholder Trust, Resource Challenges, Service Disruption, Failure to deliver Health Outcomes Risk Rating: Medium Risk Appetite: Moderate-High Risk Movement: Historical Risk Rating: Medium September 2025 Rationale for Risk Appetite as reflected by MIJB in Appendix 2: • Strategic Priorities require innovative approaches to integration that may involve governance development • Outcomes depend on our ability to make timely decisions through efficient governance structures • The board recognises that complete risk aversion would prevent necessary transformation of services • A Moderate appetite allows for controlled governance exploration while maintaining core statutory compliance Rationale for Risk Rating: The risk remains Medium because, although core governance elements (Integration Scheme, Governance Framework, Scheme of Administration, member induction and Standards training) are in place and routinely used, the breadth of delegated functions and ongoing structural change still create exposure to [inconsistent application of governance requirements across services]. [Whilst the extension of voting rights to stakeholder members introduces new governance arrangements, revised role profiles, training and updated guidance are being implemented to support effective decision making]. Risk scoring before mitigations/controls Mitigations / Current controls in place Risk scoring after mitigations/controls 4 5 20 1. Integration Scheme approved March 2023. 2. Consultation with legal representative for all reports to committees and attendance at committee for key reports. 3. Induction sessions are held for new MIJB members. 4. Conduct and Standards training held for MIJB Members in June 2022, February 2024 [and August 2026] provided by [The Standards Officer]. 2 3 6 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 230
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Assurances: • Scheme of Integration • Programme of Development Sessions held throughout the year with all MIJB members and Officers • Audit, Performance and Risk Committee (APR) provides quarterly scrutiny of governance compliance with minutes reported to the Board. • Internal Audit conducts reviews with formal recommendations and monitoring to APR • Budget Savings Oversight Group monitors financial governance monthly with escalation pathways to SMT and MIJB. • Service Reporting to Board for strategic decisions and updates. • Monthly Tri-partite partnership performance meetings with partner CEOs, Finance Directors and Chair/Vice Chair of MIJB • Care Inspectorate assessment of services, including governance impact on service delivery. • Annual governance statement for external audit. • Strategic Delivery Plan (approved June 2025) incorporates the work being driven across all areas of the MIJB’s Strategic Plan priorities and will be reported bi- annually to AP&R Committee • [SMT Operational Finance Performance meetings scrutinise areas of concern and performance issues]. • [Updated standards training delivered to stakeholder members to support their transition into voting roles]. • [Extension of voting rights to stakeholder members to be formally presented, approved and incorporated into governance arrangements, including amendments to role profiles, committee memberships, appointment documentation and Member Handbook]. Gaps in Assurance: As part of HSCM structural review, mapping of the delegated Children’s, Families and Justice services will take place to ensure the statutory governance requirements and those of MIJB are robust. [The Strategic Planning and Commissioning Group is currently being refreshed and will provide oversight of planned business across HSCM. The process is underway to recruit a Head of Strategy, Performance and Commissioning]. Current Performance: • The Scheme of Administration is updated as required. • The Governance Framework was approved by MIJB on 28 January 2021. 5. Regular Senior Management Team (SMT) and Operational Management Team (OMT) meetings to provide direction and support to managers and teams, with agreed focus and priorities aligned to the Strategic Delivery Plan 6. The Corporate Assurance and Governance Group scrutinises progress on audit actions, operational risks, and inspection findings, reporting to SMT Operational Finance Performance Group Page 231
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• Re-appointment of Standards Officer agreed by MIJB [29 January 2026]. • [Member Handbook updated and is scheduled for circulation to members in October 2026 following approval of formal process by the Board]. • Quarterly performance to APR including benchmarking and targets. • All committees submitted required reports on schedule in [2025/26] • 100% of new members received induction on appointment • [Engagement with existing stakeholder members to confirm their willingness to continue in role under revised responsibilities.] Further Controls Required Further Controls Owner Complete integration of Children’s, Families and Justice. Organisational Review and Change process underway. [Due to organisational policies, this is being taken forward in stages]. HoS/CO [March 2027] Target Date Page 232
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Risk 2: The MIJB must operate within the resources allocated to it by the partner bodies and it is good financial practice to set a balanced budget at the start of each financial year. There is a risk that Financial pressures being experienced by the funding partners will indirectly impact the MIJB’s strategic planning of services and its decision-making. Consequence: Inability to deliver strategic priorities, potential statutory service cuts. Reduced service capacity, financial instability, compromised care delivery Risk Rating: Very High Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Very High January 2026 Rationale for Risk Appetite (as detailed in Appendix 2) • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Rationale for Risk Rating: The risk remains rated at Very High due to in year pressures, savings slippage and recurrent cost growth outpacing available funding, including high-cost care packages and demand growth in adults and children’s services. While the grip/control, oversight and escalation processes are in place, residual exposure to overspend and delivery risk remains high. Managing the risk - Current controls in place 5 5 25 1. Medium Term Financial Framework (MTFF) approved by MIJB on [26 March 2026]. 2. Some additional resource to support the Budget Savings Delivery has been extended to [December] 2026. 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. Monitoring of MIJB Strategic Delivery Plan ensuring all projects are aligned with savings plans. Extended Resource Management Group [oversees all staffing and any financial implications. Also, all High Cost Packages are scrutinised by the group]. 7. [SMT Operational Finance Performance meetings scrutinise areas of concern and performance issues]. 8. SMT are actively monitoring and responding to the grip and control measures as they arise, ensuring robust oversight 4 5 20 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 233
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Assurances: • Quarterly Budget monitoring reporting to MIJB • Financial Reporting through MIJB, NHS Grampian and bv Moray Council • The Project Management Office continues to support the Budget Savings Delivery as part of the budget setting for 2026/27 onwards. • Ongoing 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 • [Strategic Delivery Plan progress continues to be reported to APR Committee on a bi-annual basis]. • Finance workshops took place with Board members in December 2025 and Feb 2026 [and another is scheduled for January 2027]. Gaps in Assurance: Slippage in savings programme for 2025/26 was presented to MIJB in January 2026. Unprecedented growth and demand across adults and childrens services, adding significant pressure to all budgets and delivery of savings previously identified. Current Performance: [The Revenue Budget Outturn for 2025/26 was presented and a balanced budget for 2026/27 was agreed by MIJB on 26 March 2026. A Financial Savings Plan for 2026/27 was agreed by MIJB on 26 March 2026. Quarter 1 budget monitoring report will be presented to MIJB on 24 September 2026. Approved Audited accounts for 2025/26 will be presented to APR for scrutiny by APR committee 24 September 2026 and to MIJB for approval on 24 September 2026. APR committee presented with biannual update on Strategic Delivery Plan 29 October 2025]. Comments: Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions Risk 3: There is a risk that the MIJB’s workforce strategy is not delivered, impacting the quality of paid and unpaid Health and Social Care. Consequence: Service disruption and reduced capacity, Increased Workload and staff burnout, Significant Financial impact, Deteriorating Staff and Unpaid Carers Risk Rating: Medium and challenge, ensuring that no critical issues are overlooked. 9. Financial pressures have been escalated to the Chief Executives of Moray Council and NHS Grampian, discussions continue as per the tri-partite arrangements. Page 234
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Morale and Engagement, Compromised Patient Safety and Care Quality, Negative Public Perception and Reputation Damage Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) MIJB will only accept minimal risk to people accessing services, unpaid carers or staff when the comparative risk of doing nothing is higher than the risk of intervention. Safety risks inherent in Health and Social care services demand exceptional management and clinical care standards. The Board recognises that: • Individual safety is paramount • Person-centred care involves supporting informed decision-making, which may introduce nuanced risk scenarios A balanced approach is critical, considering both individual and community safety risks Rationale for Risk Rating: The risk remains Medium because recruitment and retention challenges, geography and housing constraints continue to affect capacity and service resilience. Residual risk remains until workforce plans are refreshed and resourced. Managing the risk - Current controls in place 5 5 25 1. Ongoing review of HSCM Structure to identify areas for consideration, development, reconfiguration. 2. Moray Council conducted 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 Group now progressing across Grampian. 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 235
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Assurances: • The Operational Moray Workforce Forum meets quarterly. • The HSCM Response Group continues to focus on leadership around emerging issues, including staffing. • The Carers Strategy extension was approved by MIJB June 2025, extending to March 2028. The focus is on developing support to the large, valued workforce of unpaid carers within Moray. • The Resource Management Group (RMG) scrutinises all vacancies before being considered for external advertisement. • The HSCM organisational review takes account of recruitment challenges and consultation with staff will be key to developing any changes. • [Clinical teams use national workforce model tools in operational planning]. Gaps in Assurance: • [Further capacity is required to develop and implement workforce plans aligned to the refreshed Strategic Delivery Plan and associated financial savings requirements]. • [The Workforce plan will be developed alongside the refresh of the Strategic Plan]. Current Performance: Comments: [Staffing issues are monitored by the Service Managers] working collaboratively to seek opportunities to make jobs more attractive where it has proven difficult to recruit in the past. There is the risk that staff move from one position to another within HSCM, as in unintended consequence creating a vacancy elsewhere in the system. This needs to be considered when fixed term contracts and secondments are planned; consideration needs to be given to the whole of HSCM and not services in isolation. Many of our staff may have transferrable skills and experience. Further Controls Required Further Controls Owner Target Date [Review and update of the Workforce Plan alongside the Strategy and refresh and Scottish Government guidance] Head of Strategy TBC Review Date Review Notes / Decisions Risk 4: There is a risk that the MIJB is unable to operate effectively as a Public Body. Consequence: Suboptimal outcomes for people, Erosion of organisational trust and credibility, Increased legal and regulatory compliance risks. Risk Rating: Medium 7. iMatter reports provide an opportunity for staff [to share their views on the MIJB and wider organisation. There was a slight increase in participation and team action plans in 2026]. Page 236
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Workforce demotivation and disengagement, missed strategic opportunities and collaborative potential, reduced organisational responsiveness and adaptability Risk Appetite: Low-Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) The Board acknowledges the critical importance of: • Robust stakeholder relationships • Effective collaboration and co-production • Adaptive partnership working • Recognising diverse stakeholder capacities and readiness for change Strategic principles guiding stakeholder engagement: • Maintaining constructive, transparent relationships • Balancing organisational objectives with collaborative dynamics • Ensuring inclusive and meaningful engagement processes • Protecting long-term partnership sustainability Continuous Improvement in communication processes Rationale for Risk Rating: The risk remains Medium because engagement and communications processes are variable across a complex landscape, and the current Communication & Engagement Strategy (2019) is being updated. Whilst SOCG locality work, and adoption of ‘Planning with People’ principles, and strengthened digital channels are in place, assurance on consistency and outcome capture needs to improve within the limited capacity. Assurances: • Oversight and scrutiny by Clinical and Care Governance Committee, Audit Performance and Risk Committee and MIJB • Strategic Planning & Commissioning Group (SPCG) • 3rd Sector and Stakeholder Representatives on MIJB and committees • Local Outcome Improvement Plan (LOIP). • Community Planning Managing the risk - Current controls in place 4 4 16 • [Refocus of Strategic Planning & Commissioning Group (SPCG) to support locality engagement]. • Continued working with Community Planning colleagues to oversee the development of locality planning. • Grampian Joint Strategic Needs Assessment Group, including participation from community groups. • Engagement with diverse groups across Moray e.g. Moray Alcohol & Drug Partnership (ADP), School Nurses. • ‘Planning with People’ principles adopted as per Healthcare Improvement Scotland (HIS) 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 237
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• ADP • Stakeholder Representative on GP Vision Board • Summary reports of MIJB submitted to Moray Council and NHSG committees. • The Programme Management Office ensures that all programmes of work incorporate appropriate engagement as standard business as usual practice. Gaps in Assurance: • Seek to improve the level of engagement across Moray. • Communication and Engagement Strategy was approved in 2019 and is currently being updated. • More systematic approach to stakeholder consultation required. • Establish a more robust process for youth representation pathways. • [Refocus of Strategic Planning & Commissioning Group (SPCG) to support locality engagement]. Current Performance: • Locality Plans reviewed with the Strategic Delivery Plan • LOIP plans linked to MIJB Strategic Plan • [Annual Performance Report for 2025/26 published in July 2026]. Comments: • Communications & Engagement will be factored into the ongoing structural review, providing a more systematic approach to engagement in localities. Further Controls Required Further Controls Owner Target Date Update MHSCP Communication and Engagement Strategy Corporate Manager December 2026 Review Date Review Notes / Decisions Page 238
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Risk 5: There is a risk that the MIJB does not comply with the necessary legislative and regulatory requirements in which it operates. Consequence: Significant reputational impact and potential resource allocation challenge and possible financial and operational strain, potential impact on communities and staff. [Potential regulatory intervention, reputational damage, financial consequences, governance failure and ability to meet statutory obligations]. Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) The MIJB has minimal tolerance of harm happening to people as a result of its actions, recognising the need to balance the risk of doing nothing and the risk of action or intervention. The Moray Integration Joint Board (MIJB) recognises its statutory obligations under the Civil Contingencies Act 2004, including its Category 1 Responder responsibilities introduced through the Civil Contingencies Act 2004 (Contingency Planning) (Scotland) Regulations 2021. Rationale for Risk Rating: The risk remains Medium as regulatory requirements span multiple domains (performance, finance, resilience, decision making), and system pressures raise the likelihood of standards not being met at times. Controls exist (learning loops, statutory reporting, resilience planning), but full assurance depends on Business Continuity planning being complete and visible across both parent bodies. Managing the risk - Current controls in place 5 5 25 1. Continuous emergency preparedness awareness with partners in Grampian Local Resilience Partnership (GLRP) – including exercises and debriefs. 2. Learning from Inspection Reports, Adverse Events, Complaints, actions plans and performance measures monitored by Clinical Risk Management (CRM), Clinical and Care Governance Group (CCGG) and Operational Management Team (OMT) with oversight by SMT. 3. HSCM Civil Contingencies group review specific risks and action plans to mitigate, developing plans and testing arrangements in partnership with NHSG and Council. 4. Annual review of internal resilience and emergency processes with Senior Managers on Call. 5. Timetable of statutory reporting across the financial year. 6. Implementation of [Corporate Assurance and Governance Group, scrutinising audit, operational risks, inspection reports etc., reporting to SMT Operational Finance Performance Group]. 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 239
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Assurances: • Quarterly reporting to Clinical and Care Governance and Audit, Performance and Risk Committees • Annual Performance Report – published July [2026] • Chief Social Work Officer’s Report • Internal and External Audits • Senior Management Meetings fortnightly • Joint meeting of MIJB Chief Officer with two Partner Body Chief Executives. • Annual report on MIJB activity developed and reported to Moray Council and NHSG • All Inspection reports reported to APR Committee with action plans developed and monitored Gaps in Assurance: Business Continuity (BC) Planning work is underway to ensure HSCM has a register of all plans and timescales – to be monitored by OMT and escalations to SMT. Current Performance: There are Resilience and Business Continuity processes in place, and these are reviewed regularly. Annual Performance Report for [2025/26] was approved by the MIJB and published in July [2026]. [Audited annual accounts will be presented to MIJB in September 2026]. Category One Responder duties incorporated in the role of Corporate Manager. Comments: Structure review of HSCM to mitigate the governance risk of services not meeting standards and adequate service delivery. The Manchester Arena Inquiry and Grenfell Inquiry has resulted in a focus on Category 1 responders’ responsibilities, together with an increase of additional policies/procedures to be developed, implemented and exercised with no additional resource. Implementation plan for new Scottish Government Resilience Standards will be required once received. Further Controls Required Further Controls Owner Target Date Business Continuity Planning Senior Management Team April 2027 Review Date Review Notes / Decisions Page 240
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Risk 6: There is a risk that the MIJB’s strategic aspirations are not transformative and as a result, it is unable to deliver outcomes for people in a sustainable way. Consequence: Persistent health inequalities, erosion of public trust and organisational reputation, potential legal challenges, significant reputational damage to MIJB, potential long-term negative impacts on community health outcomes, reduced effectiveness of healthcare resource allocation Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) The Moray Integration Joint Board (MIJB) faces significant challenges in maintaining service delivery across its delegated services from NHS Grampian and Moray Council. These challenges stem from three key areas: Resource Constraints Budgetary pressures are leading to reduced staffing resources, affecting service delivery capacity and quality. This situation requires careful management to maintain essential services while operating within financial constraints. System Pressures The healthcare system continues to experience significant strain from high levels of unplanned admissions and delayed discharges. While teams across the care pathway are working collaboratively to address these issues, the complexity of the situation, combined with limited community care availability, makes sustainable improvement challenging. Service Redesign The financial recovery plan necessitates fundamental service redesign to deliver outcomes more efficiently. While the aim is to enhance service quality through these changes, public expectations may need to adjust to align with what is deliverable within budget constraints. This requires careful management of both service transformation and stakeholder expectations. The Moray Integration Joint Board (MIJB) is committed to: • Maintaining exemplary standards of governance • Balancing innovative approaches with robust regulatory compliance • Proactively managing emerging risks in a dynamic healthcare landscape • Prioritisation of Moray’s unique community needs Regulatory risks will only be considered with: 1. Comprehensive consultation with relevant regulatory bodies 2. Clearly defined and documented defensible risk mitigation strategies 3. Transparent decision-making processes 4. Thorough impact assessments MIJB will only take regulatory risks knowingly, following consultation with the relevant regulatory body and where we have clear risk mitigation in place. Page 241
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Potential impacts to the wide range of services in NHS Grampian and Moray Council commissioned by the MIJB arising from reductions in available staff resources as budgetary constraints impact. Unplanned admissions and delayed discharges place additional cost and capacity burdens on the service. The level of delayed discharges has remained challenging, reflecting the sustained pressure in the system and the lack of availability of care in the community. There are sustained focussed and collective efforts by all those working in the pathway. However, this is a complex area and will require continued effort to realise reductions and maintain them. [The future savings plan will require significant service transformation to meet outcomes that are financially sustainable. It is recognised that public expectations may differ to what can be delivered within budget]. The Moray Integration Joint Board (MIJB) faces significant challenges in maintaining service delivery across its commissioned services from NHS Grampian and Moray Council. Rationale for Risk Rating: The risk remains at a Medium rating due to persistent system pressures, including high levels of unplanned admissions, delayed discharges, and constrained community capacity, all of which limit the Partnership’s ability to progress transformation at the intended pace. Significant financial constraints and limited workforce capacity continue to impact the feasibility and timing of redesign work. Public expectations also remain higher than what can be delivered within current resources. Although strong governance arrangements, performance oversight, and collaborative work across the pathway are in place, these structural challenges continue to create a sustained risk that the MIJB may be unable to deliver all strategic aspirations in a sustainable way. Managing the risk - Current controls in place 5 4 20 1. Clinical and Care Governance (CCG) oversight is provided through the CCG Committee, supported by the Clinical and Care Governance Group, Clinical Risk Management (CRM) and Practice Governance structures, ensuring professional standards are monitored and risks escalated appropriately. 2. HSCM Clinical Risk Management (CRM) Group and NHS Grampian CRM Group review High and Very High operational health service risks. 3. Annual Performance Reports provide assurance across services delivered in Moray. 4. Regular Internal and External scrutiny is provided through inspections. 5. Internal/External Inspection reports are scrutinised by appropriate operational groups with actions tracked and monitored through the appropriate governance groups. 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 242
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Assurances: Audit, Performance and Risk and Clinical and Care Governance Sub-Committees oversight and scrutiny. The Clinical and Care Governance Framework was refreshed and presented to CCG Committee in November 2023. The Strategic Delivery Plan was approved by MIJB June 2025 Gaps in Assurance: Process for highlighting recurring themes or strategic expectations from external inspections requires further development to ensure Committee has sight of significant issues. Current Performance: External inspection reports are scrutinised and actions arising are allocated to responsible officers. A summary of inspections is included in the Annual Performance report. Risk Management session delivered for managers in HSCM in September 2023, by the NHSG Risk Advisor. Comments: No major concerns identified for HSCM services in any audits or inspections during 2024/25. The current financial pressures will impact HSCM’s ability to deliver on the priorities set out in the strategic plan and requires a level of transformation to match this. Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions 6. Care Home Collaborative Support Group provides oversight, ensuring risks in care homes are monitored and mitigated through partnership working. 7. Children and Adult Protection Committees provide specialist scrutiny and ensure statutory safeguarding duties are met. 8. Robust governance arrangements such as SMT, OMT and daily operational huddles ensure regular oversight, co- ordinated decision making and early escalation of system pressures. 9. Organisational Review of HSCM structures is underway to strengthen strategic capacity and ensure the organisation is equipped to deliver transformation and ability to respond to increasing demands across the system. Page 243
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Risk 7: There is a risk that the MIJB is unable to exert influence on services delegated but hosted within another organisation. Consequence: Legal challenge from Moray citizens and staff, potential intervention or censure from Scottish Government, systemic service failures, particularly in areas such as IT, Human Resources, Legal and compliance services Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) Extremely low tolerance for: • Systemic support service failures • Potential compromise of organisational effectiveness • Risk of legal and regulatory non-compliance • Diminished service delivery capacity Low tolerance in relation to not meeting requirements. Rationale for Risk Rating: The risk remains Medium because hosted services are subject to partner governance, financial constraints and workforce pressures outside MIJB’s direct control. The tri-partite working forums improve visibility and influence but cannot fully eliminate dependency risks. Parent organisations experiencing: • Significant financial constraints • Staffing challenges • Potential resource allocation limitations The projected overspend in hosted services sits within each MIJB and HSCM is one of the partners who can influence decisions. Assurances: These largely come from the systems, process and procedures put in place by NHS Grampian, which are still being operated, along with any new processes which are put in place by the lead MIJB. [The North East System Transformation Group brings together NHS Grampian, Aberdeen City, Aberdeenshire and Moray Councils, and their respective IJBs to identify and develop whole-system transformation and efficiency opportunities Managing the risk - Current controls in place 5 4 20 1. Chief Officer regularly meets with Chief Officers of Aberdeen City Health and Social Care Partnership and Aberdeenshire Health and Social Care Partnership. 2. Significant changes to service delivery are discussed across all three HSCPs. 3. Agreement that proposals regarding significant service changes are presented to all three MIJB’s for approval. 4. Internal Audit review of MIJB Hosted Services and monitoring of agreed recommendations. 3 3 9 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 244
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that improve outcomes and make best use of collective resources across Grampian]. Gaps in Assurance: Implementation of the Internal Audit recommendations relating to Service Level Agreements remains in progress. Current Performance: Comments: Further Controls Required Further Controls Owner Target Date Review Date Review Notes / Decisions Page 245
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Risk 8: There is a risk that the MIJB’s internal control and governance arrangements are not sufficiently robust to provide full assurance, as evidenced by the [2025/26] Internal Audit Annual Opinion of ‘Limited Assurance’ Consequence: • Weaknesses in internal controls may lead to financial mismanagement, service delivery failures, reputational damage, and non-compliance with statutory duties. • Delays in implementing audit recommendations may result in prolonged exposure to known risks and inefficiencies. • A continued ‘limited assurance’ position may reduce stakeholder confidence in the MIJB’s governance and oversight arrangements. Risk Rating: Medium Risk Appetite: Moderate (as per Appendix 2) Risk Movement: Historical Risk Rating: Medium November 2025 Rationale for Risk Appetite (as detailed in Appendix 2) • The MIJB recognises the importance of strong internal controls and governance to support safe, effective, and sustainable service delivery. • While some risk is accepted in the pursuit of transformation, assurance processes must be timely, transparent, and responsive to audit findings. Rationale for Risk Rating: The risk remains Medium because the [2025/26] Internal Audit Annual Opinion was ‘Limited Assurance’ with delays in recommendations and weaknesses noted in contract management, digital and tracking arrangements. Controls have strengthened (end to end audit tracking, SMT engagement, governance statement) but residual risk persists until audit actions are closed and key enablers are delivered. Assurances: • Internal Audit Annual Report presented to APR Committee [June 2026]. • Internal Audit Quarterly reporting of audit progress and follow-up to APR Committee. Managing the risk - Current controls in place 4 5 20 1. ‘End to end’ process for agreeing, implementing and tracking audits is now established with regular OMT/SMT oversight. 2. Governance statement prepared in line with CIPFA/SOLACE guidance. 3. Internal audit attending regular SMT meetings to discuss audit plan work and any emerging risks. 4. Financial resource from HSCM to MIJB Internal Audit team to improve capacity for collaboration and oversight. 5. [The Corporate Assurance and Governance Group scrutinises progress on audit actions, operational risks, and inspection findings, reporting to SMT Operational Finance Performance Group]. 2 3 6 Untreated Likelihood Untreated Impact Untreated Score Current Likelihood Current Impact Current Score Page 246
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• Oversight by SMT. • [Additional Internal assurance arrangements implemented (CAG) to provide support and operational assurance to SMT in accordance with agreed timescales]. Gaps in Assurance: [Updated operational Risk Policy framework is out for consultation with Services]. Current Performance: • [The audit of Adult Social Care Commissioning audit (2022) has concluded. • Audit plan for 2026/27 includes follow-up reviews to verify progress. • Continued collaborative partnership working with Internal Audit and SMT]. Comments: Further Controls Required Further Controls Owner Target Date • [Continue to identify capacity to progress the Digital work stream, including digitalisation where possible. This timescale is under discussion with service and Internal Audit due to delays out with MHSCP control]. • Progress development of unified case recording system. [As above]. • HSCM Risk Framework currently being updated. CFO/HoS HoS SMT [December 2027] [September 2027] November 2026 Review Date Review Notes / Decisions Page 247
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MIJB Risk Appetite Statement The Moray MIJB recognizes that effective risk management is fundamental to achieving its strategic objectives in delivering integrated health and social care services. This statement defines the level and type of risk the MIJB is willing to accept in pursuit of achieving the outcomes defined in the strategic plan, Partners in Care 2022-2032. Moray MIJB adopts a balanced approach to risk-taking, acknowledging that transformation, innovation and service improvement often require managed risk-taking while ensuring the safety and wellbeing of its staff and the public remains paramount. Strategic Risk: MODERATE-HIGH • Higher appetite for strategic initiatives supporting integration • Willingness to innovate in service delivery • Acceptance of calculated risks in pursuit of transformation • Support for pilot projects with clear business case and evaluation criteria At this appetite level, the board is willing to accept some uncertainty in governance processes where: - Clear oversight mechanisms remain in place - Core statutory obligations continue to be met - Potential benefits to service delivery are significant - Learning opportunities from governance adjustments can be captured Financial Risk: MODERATE • Willing to accept moderate financial risks in pursuit of strategic objectives • Conservative approach to core budget management • Higher tolerance for innovative projects with clear benefits • Low tolerance for financial decisions that could threaten long-term sustainability Clinical Safety Risk: LOW • Minimal appetite for risks affecting patient/service user safety • Strong controls and monitoring required for all clinical activities • Zero tolerance for non-compliance with clinical governance standards • Comprehensive risk assessments required for any service changes • Operational Risk: MODERATE • Moderate tolerance for operational changes that improve efficiency • Willing to consider new service delivery models • Acceptance of short-term disruption for long-term benefits • Regular monitoring and review of operational changes Reputational Risk: LOW-MODERATE • Conservative approach to actions that could damage public trust • Proactive stakeholder engagement in major decisions Page 248
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• Low tolerance for activities that could undermine partnership working • Emphasis on transparent decision-making Workforce Risk: MODERATE • Moderate appetite for workforce development initiatives • Innovation in recruitment and retention strategies • Support for new ways of working • Low tolerance for risks affecting staff wellbeing Risk Governance • Regular review of risk appetite by the MIJB Board • Clear escalation procedures for risks exceeding appetite levels • Integration of risk appetite into decision-making processes • Regular reporting on risk profile against appetite Implementation • Risk appetite to be considered in all significant decisions • Regular training for staff on risk management • Clear communication of risk appetite across the organization • Annual review and update of risk appetite statement Monitoring and Review • Bi-annual review of risk register against appetite levels • Annual review of risk appetite statement • Regular reporting to Audit and Risk Committee • Adjustment of appetite levels based on changing context This statement will be reviewed annually and updated as required to reflect changes in the operating environment and strategic priorities. Page 249
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Likelihood – What is the likelihood of the risk occurring? Assess using the criteria below. Rare (1) Unlikely (2) Possible (3) Likely (4) Almost Certain (5) Do not believe this event would happen Will only happen in exceptional circumstances Not expected to happen but definite potential exists Unlikely to occur May occur occasionally Has happened before on occasions Reasonable chance of occurring Strong possibility that this could occur Likely to occur This is expected to occur frequently/ in most circumstances more likely to occur than not Impact – What could happen if the risk occurred? Assess for each category and use the highest score identified. The impact scale is from an organisational level perspective. It reflects the key areas that if impacted could prevent the organisation achieving its priorities and objectives. The scale is a guide and cannot cover every type of impact therefore judgement is required. Category Negligible (1) Minor (2) Moderate (3) Major (4) Extreme (5) Patient or Service user Experience Reduced quality patient experience/clinical outcome not directly related to delivery of clinical care Unsatisfactory patient experience/clinical outcome directly related to care provision – readily resolvable Unsatisfactory patient experience/ clinical outcome, short term effects – expect recovery less than 1wk Unsatisfactory patient experience /clinical outcome, long term effects - expect recovery over more than 1week Unsatisfactory patient experience/clinical outcome, continued ongoing long term effects Objectives/ Project Barely noticeable reduction in scope/quality/ schedule Minor reduction in scope/quality/schedule Reduction in scope/quality/project objectives or schedule Significant project overrun Inability to meet project/corporate objectives, reputation of organisation seriously damaged Page 250
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Injury /illness (physical and psychological) to patient/service user/visitor/staff/carer Adverse event leading to minor injury not requiring first aid Minor injury or illness, first aid treatment required Agency reportable, e.g. Police (violent and aggressive acts) Significant injury requiring medical treatment and/or counselling Major injuries/long term incapacity /disability (e.g. loss of limb), requiring, medical treatment and/or counselling Incident leading to death(s) or major permanent incapacity Complaints/Claims Locally resolved verbal complaint Justified written complaint peripheral to clinical care Justified complaint involving lack of appropriate care Claim above excess level. Multiple justified complaints Multiple claims or single major claim Complex Justified complaint Service/ Business Interruption Interruption in a service which does not impact on the delivery of patient care or the ability to continue to provide service Short term disruption to service with minor impact on patient care/service provision Some disruption in service with unacceptable impact on patient care Temporary loss of ability to provide Service. Sustained loss of service which has serious impact on delivery of patient care resulting in major contingency plans being invoked Permanent loss of core service/ facility Disruption to facility leading to significant “knock on” effect -- to function Staffing and Competence Short term low staffing level temporarily reduces service quality (less than 1 day) Short term low staffing level (>1 day), where there is no disruption to patient care Ongoing low staffing level reduces service quality Minor error due to lack of/ ineffective training/ implementation of training Late delivery of key objective/service /care due to lack of staff Moderate error due to lack of/ ineffective training / implementation of training Ongoing problems with staffing levels Uncertain delivery of key objective/service/care due to lack of staff Major error due to lack of/ ineffective training / implementation of training Non-delivery of key objective/ service/care due to lack of staff. Loss of key staff Critical error due to lack of/ ineffective training/ implementation of training Page 251
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Financial (including Damage/Loss/Theft/ Fraud Negligible organisational/ personal financial loss up to £1k Minor organisational/ personal financial loss of £1-10K Significant organisational/personal financial loss of £10- 100k Major organisational/personal financial loss of £100k- 1m) Severe organisational financial loss of more than £1m Inspection/ Audit Small number of recommendations which focus on minor quality improvement issues Recommendations made which can be addressed by low level of management action Challenging recommendations that can be addressed with appropriate action plan Improvement Notice Enforcement/prohibition action Low Rating Critical report Prosecution Zero rating Severely critical report Adverse Publicity/ Reputation Rumours, no media coverage Little effect on staff morale Local media coverage – short term. Some public embarrassment Minor effect on staff morale/public attitudes Local media – long term adverse publicity Significant effect on staff morale/public perception of the organisation National media adverse publicity less than 3 days Public confidence in the organisation undermined Use of services affected National/International media/ adverse publicity, more than 3 days MSP/MP/SEHD concern (Questions in Parliament) Court Enforcement/Public Enquiry/FAI Risk Scoring Consequences/Impact Likelihood Negligible Minor Moderate Major Extreme Almost Certain Medium High High V High V High Likely Medium Medium High High V High Possible Low Medium Medium High High Unlikely Low Medium Medium Medium High Rare Low Low Low Medium Medium Review Timescales – When a risk rating has been assigned the criteria below should be used to assess the review timescales. Page 252
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Very High or High Requires monthly monitoring and updates. Medium Requires quarterly monitoring and updates. Low Requires 6 monthly monitoring and updates. Page 253
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: MORAY INTEGRATION JOINT BOARD RISK MANAGEMENT POLICY BY: INTERIM CORPORATE MANAGER 1. REASON FOR REPORT 1.1 To present the revised Moray Integration Joint Board (MIJB) Risk Management Policy for approval. The revised policy clarifies the Board's approach to strategic risk management, risk appetite, assurance, escalation and reporting arrangements and provides the governance framework underpinning the Strategic Risk Register. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) seeks assurance that the proposed policy provides an appropriate framework for the oversight and management of strategic risks; and ii) approves the revised MIJB Risk Management Policy attached at Appendix 1. 3. BACKGROUND 3.1 The MIJB Risk Management Policy was first approved in March 2016 and has been reviewed periodically to reflect changes in governance and risk management arrangements. The most recent approved version was agreed by the MIJB in September 2020. 3.2 As part of ongoing governance improvement work, officers have undertaken a review of the policy to ensure it remains fit for purpose and reflects the Board's current approach to strategic risk management, assurance and oversight. 3.3 The revised policy is intended to provide a clear, proportionate and practical framework for the management and reporting of strategic risks affecting delivery of the MIJB Strategic Plan, delegated functions, statutory duties, financial sustainability and public accountability. Item 12. Page 255
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3.4 As part of the policy review, Board Members participated in a dedicated Development Session on 20 August 2026 to consider the proposed approach to strategic risk management, risk appetite and risk tolerance. The session involved detailed discussion and constructive challenge regarding the balance between supporting innovation, transformation and strategic decision-making whilst maintaining appropriate governance, assurance and accountability. A range of views were expressed regarding the level of strategic risk the Board should be willing to accept in pursuit of its objectives, and Members explored the relationship between risk appetite, risk tolerance, strategic decision making and the Strategic Risk Register. Whilst no amendments to the policy were proposed, Members recognised the value of continued discussion and reflection regarding risk appetite and risk tolerance as the Board's approach to strategic risk management continues to evolve. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The revised policy establishes a Board-level framework for strategic risk management and clarifies the respective responsibilities of the MIJB, APR Committee, Chief Officer, Chief Financial Officer, Board Members and Senior Officers. 4.2 The policy recognises that NHS Grampian and Moray Council retain responsibility for operational risk management within their own governance arrangements, whilst ensuring that strategically significant risks are escalated appropriately to the MIJB. 4.3 The policy introduces a clearer description of the Board's approach to risk appetite and supports consistent decision-making through consideration of risk, assurance and materiality. 4.4 The policy sets out arrangements for escalation and reporting, including the scrutiny role of the APR Committee and the oversight role of the Board in relation to strategic risks. 4.5 The policy provides the governance framework for the continued development, maintenance and reporting of the MIJB Strategic Risk Register. 4.6 The Board’s risk appetite may be reviewed and amended from time to time without requiring amendment of the Risk Management Policy. Members discussed the current Risk Appetite Statement in detail during the August 2026 Development Session and recognised that further consideration may be beneficial as part of the Board's ongoing approach to risk management and strategic decision making. 4.7 Subject to Board approval, the policy will be implemented through existing governance arrangements and will inform future reviews of strategic risks and risk appetite. 5. SUMMARY OF IMPLICATIONS Page 256
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(a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022-2032” Effective risk management is an essential component of good governance and supports delivery of the MIJB Strategic Plan through the identification, management and oversight of risks which may affect strategic objectives and delegated functions (b) Policy and Legal The policy establishes the governance framework for strategic risk management within the MIJB and supports the Board in fulfilling its responsibilities for risk management, assurance and accountability. There are no direct legal implications arising from approval of the policy. (c) Financial implications There are no financial implications arising as a direct result of this report. However, effective risk management supports financial sustainability and assists the Board in identifying and managing risks that may affect the use of public resources. (d) Risk Implications and Mitigation The revised policy strengthens arrangements for identifying, managing, escalating and reporting strategic risks. The policy supports effective oversight of the Strategic Risk Register and provides a clear governance framework for strategic risk management, assurance and escalation. (e) Staffing Implications There are no staffing implications arising as a direct result of this report. Responsibilities relating to risk management and reporting are incorporated within existing governance and management arrangements. (f) Property There are no property implications arising as a direct result of this report. (g) Equalities/Socio Economic Impact An Equalities Impact Assessment is not required as the report relates to governance arrangements and does not propose any service change. Impact assessments will continue to be undertaken where required as part of future decision-making processes. (h) Climate Change and Biodiversity Impacts There are no direct climate change or biodiversity implications arising from this report. (i) Directions None arising from this report. (j) Consultations The revised policy was reviewed and endorsed by the MHSCP Senior Management Team on 8 July 2026. The draft policy was also considered at Page 257
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a MIJB Development Session on 20 August 2026 in advance of formal consideration by the Board. 6. CONCLUSION 6.1 The revised Risk Management Policy provides a clear and proportionate framework for strategic risk management within the Moray Integration Joint Board. It clarifies responsibilities for risk oversight, strengthens arrangements for assurance and escalation, and provides the governance framework underpinning the Strategic Risk Register. Author of Report: Sonya Duncan, Interim Corporate Manager Background Papers: Ref: Page 258
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APPENDIX 1 RISK POLICY Version Creation /Review date Approved by MIJB Date Implemented Review Date 1.1 March 2016 31 March 2016 1 April 2016 April 2018 1.2 July 2018 APR 26/7/18 1 August 2018 July 2020 1.3 September 2020 MIJB 24/9/20 1 October 2020 April 2022 1.4 July 2026 Page 259
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Version 1.4 July 2026 RISK POLICY ....................................................................................................................................... 1 Introduction and Purpose .................................................................................................................... 3 Scope ..................................................................................................................................................... 3 Definition of Risk and Risk Management .......................................................................................... 3 Roles and Responsibilities .................................................................................................................. 4 Moray Integration Joint Board ........................................................................................................ 4 Audit, Performance and Risk Committee ..................................................................................... 4 Chief Officer ...................................................................................................................................... 4 Chief Financial Officer ..................................................................................................................... 4 Voting and Non-Voting Members ................................................................................................... 4 Senior Officers .................................................................................................................................. 4 NHS Grampian and Moray Council ............................................................................................... 5 Risk Management Approach .............................................................................................................. 5 Risk Appetite ......................................................................................................................................... 5 Escalation and Reporting .................................................................................................................... 6 Strategic Risk Register Governance ................................................................................................. 6 Review of this Policy ............................................................................................................................ 7 Page 260
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Version 1.4 July 2026 Introduction and Purpose The purpose of this policy is to support clear, proportionate and consistent oversight of risk by the Moray Integration Joint Board. It sets out the Board’s approach to strategic risk management, risk appetite, escalation, assurance and reporting. Effective risk management supports good governance, informed decision-making and delivery of the MIJB Strategic Plan. It helps the Board understand risks that may affect its statutory responsibilities, delegated functions, directions, financial sustainability, performance, quality of care and public accountability. This is a Board-level policy focused on MIJB governance, assurance and strategic risk. It does not replace the operational risk management policies, systems or responsibilities of NHS Grampian or Moray Council. Scope This policy applies to the Moray Integration Joint Board, its committees, voting and non-voting members, the Chief Officer, Chief Financial Officer and senior officers supporting the Board’s governance and assurance arrangements. The policy applies to strategic risks that may affect delivery of the MIJB Strategic Plan, statutory responsibilities, delegated functions, directions, financial sustainability, public accountability and the Board’s ability to provide effective oversight and assurance. Day-to-day operational risks are managed through the relevant risk management policies, systems and governance arrangements of NHS Grampian and Moray Council. Operational risks should be escalated for MIJB oversight where they have a material impact on the Board’s strategic objectives, delegated functions, resources, statutory duties, performance, quality of care or public confidence. Definition of Risk and Risk Management For the purposes of this policy, risk means the effect of uncertainty on objectives. Risk may relate to a threat, an opportunity, or a combination of both. Risk management is the process of identifying, assessing, managing, monitoring and reporting risks in a way that supports informed decision-making and effective governance. The MIJB’s approach is informed by recognised risk management principles, including ISO 31000:2018, and is applied proportionately to the Board’s strategic governance role. Page 261
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Version 1.4 July 2026 Roles and Responsibilities Moray Integration Joint Board The MIJB is responsible for approving this policy and maintaining oversight of strategic risks that may affect delivery of its Strategic Plan, delegated functions, directions, financial sustainability and statutory responsibilities. It is also responsible for: • Agreeing the Board’s risk appetite and use it to support decision-making. • Receiving assurance that strategic risks are being identified, reviewed and managed. • Considering risks escalated through agreed governance routes where they have a material impact on MIJB objectives or public accountability. • Using risk information to support scrutiny, prioritisation, resource decisions and the Annual Governance Statement. Audit, Performance and Risk Committee • Scrutinise the MIJB Strategic Risk Register and seek assurance on controls, actions and movement in risk levels. • Consider whether risks are appropriately described, scored, owned and reviewed. • Escalate matters to the MIJB where further Board oversight, decision or assurance is required. Chief Officer The Chief Officer is accountable to the MIJB for ensuring that appropriate arrangements are in place to identify, manage and report strategic risks to the Board. The Chief Officer is responsible for ensuring that relevant operational risks are considered for escalation where they may materially affect MIJB objectives, delegated functions, resources, statutory duties, performance, quality of care or public confidence. Chief Financial Officer The Chief Financial Officer provides advice and assurance on financial risk, financial controls, financial sustainability and the use of resources. The Chief Financial Officer also supports the Board’s internal control and annual accounts processes. Voting and Non-Voting Members Members are responsible for considering risk as part of Board and committee business. This includes seeking assurance, asking appropriate questions and taking account of risk when making decisions. Senior Officers Senior officers are responsible for identifying, reviewing and contributing to strategic risks within their area of responsibility. They must ensure controls, actions, target dates and assurance sources are clear and kept up to date. Page 262
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Version 1.4 July 2026 NHS Grampian and Moray Council NHS Grampian and Moray Council retain responsibility for operational risk management within their respective policies, systems and governance arrangements. Partner risks should be brought to the attention of the MIJB where they may materially affect delivery of delegated functions, strategic objectives or public accountability. Risk Management Approach The MIJB will maintain a Strategic Risk Register to record, review and report the most significant risks to delivery of its objectives. Risks should be described clearly, assigned to a risk owner, scored consistently and supported by proportionate controls, actions and assurance. The risk management approach should support practical discussion about what could prevent delivery, what controls are in place, what further action is needed, and what assurance is available to the Board. Risk scoring should consider both likelihood and impact. The scoring matrix below should be used as a guide to support consistency, but professional judgement and the wider context should also be considered. Likelihood Consequence / Impact Negligible Minor Moderate Major Extreme Almost Certain Medium High High V High V High Likely Medium Medium High High V High Possible Low Medium Medium High High Unlikely Low Medium Medium Medium High Rare Low Low Low Medium Medium Risk Appetite Risk appetite describes the level of risk the MIJB is prepared to accept in pursuit of its strategic objectives. It supports consistent decision-making and helps clarify when further action or escalation is required. The MIJB’s risk appetite may vary depending on the type of risk and the level of assurance available. The Board may be prepared to accept managed risk where it supports innovation, improvement and delivery of the Strategic Plan, but will normally have a lower appetite for risks relating to safety, statutory duties, financial sustainability, governance or public confidence. • Strategic change and improvement: a balanced appetite where risk is understood, benefits are clear and controls are in place. Page 263
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Version 1.4 July 2026 • Quality, safety and safeguarding: low appetite for unmanaged risks that may cause harm or reduce standards of care. • Financial sustainability and use of public funds: low appetite for risks that threaten financial control, value for money or statutory duties. • Governance, compliance and reputation: low appetite for risks that weaken accountability, transparency, public confidence or legal compliance. • The Board should review risk appetite periodically and apply it when considering strategic decisions, major changes, resource allocation and risk escalation. The Board may review and amend its risk appetite from time to time in response to changes in strategic priorities, operating conditions, assurance, legislation or the wider internal and external environment. Changes to the agreed risk appetite do not, in themselves, require amendment of this Policy. Escalation and Reporting Risks should be managed at the most appropriate level. Escalation to the MIJB should be based on strategic significance, materiality and the level of assurance required. • The Strategic Risk Register should be reported to the Audit, Performance and Risk Committee for scrutiny and assurance. Matters requiring wider consideration, decision or escalation should be reported to the MIJB. • Risks should be escalated where they may materially affect delivery of the MIJB Strategic Plan, delegated functions or directions. • Risks should be escalated where they may affect statutory duties, financial sustainability, performance, quality of care, public confidence or the Annual Governance Statement. • Risks should be escalated where existing controls are not effective, assurance is limited, or further Board-level decision-making is required. Risk reporting should be clear, concise and focused on movement in risk score, key controls, gaps in assurance, overdue actions and decisions required. Strategic Risk Register Governance The MIJB Strategic Risk Register is the main tool for recording and reporting the Board’s strategic risks. Each risk should include: • a clear risk description; • a named risk owner; • current and target risk scores; • existing controls and sources of assurance; • planned actions, responsible leads and timescales; • review dates and any change in risk position. Page 264
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Version 1.4 July 2026 The Strategic Risk Register should be reviewed regularly by risk owners and reported through agreed governance routes. The frequency of reporting should be proportionate to the level of risk and the level of assurance required. Risks should be updated when there is a significant change in context, controls, performance, legislation, finance, service delivery, inspection findings or assurance. The Strategic Risk Register should support the preparation of the Annual Governance Statement by providing evidence of how significant risks have been identified, managed, scrutinised and reported. Review of this Policy This policy should be reviewed at least every three years, or sooner where there are significant changes to legislation, governance arrangements, the Integration Scheme, Standing Orders, the Strategic Plan or the Board’s risk management arrangements. Page 265
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: STRATEGIC PLAN REFRESH - APPROACH BY: INTERIM CORPORATE PROGRAMME MANAGER 1. REASON FOR REPORT 1.1 To update the Board on the approach and timeline for the Strategic Plan refresh. 2. RECOMMENDATION 2.1 It is recommended that the Board consider and note the approach and timescales outlined in this report for the refresh of the Strategic Plan. 3. BACKGROUND 3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 put in place the framework for integrating health and social care. The Act places a duty on Integration Authorities to create a Strategic Plan for the integrated functions and budgets they control and requires a review of the Strategic Plan every 3 years. 3.2 The Moray Integration Joint Board (MIJB) is required under the legislation to have in place an established Strategic Planning and Commissioning Group which must be involved in all stages of developing and reviewing plans. The Act prescribes certain groups/persons that must be represented in the membership of this group which places a responsibility on MIJB to consult widely on the development of the Strategic Plan ensuring the health and social care services that are commissioned are in the best interests of the local population. 3.3 The current Strategic Plan “Moray Plan for the Future 2022-2032” was approved by the Board at their meeting on 24 November 2022 (para 14 of the minute refers) with a focus on early intervention and prevention and building resilience of the individual and communities which was presented in three themes, Building Resilience, Home First and Partners in Care. 3.4 The Strategic Delivery Plan 2023-26 transformation and improvement priorities were approved by the Board at their meeting on 29 June 2023 (para 10 of the minute refers) with final approval of the delivery plan by the Board at their meeting on 28 September 2023 (para 12 of the minute refers). 3.5 The Join Strategic Needs Assessment (JSNA) was reviewed and approved by the Board on 26 September 2024 (para 14 of the minute refers). This document highlighted the challenges of an aging population and increasing multi-morbidity and increasing demands for care which are placing growing pressure on Item 13. Page 267
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maintaining existing services within the finances available. This led to a refresh and refocus of the Strategic Delivery Plan for the period of 2025-28, which was approved by the Board at their meeting on 29 May 2025 (para 8 of the minute refers) which also incorporated aspects of the Children Services Plan, following the formal delegation of Children and Families and Justice Services in March 2023. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 There have been some significant changes in the strategic landscape since the previous strategic plan was developed and integration of the following aspects will inform the refresh for the strategic plan:- Children, Families and Justice Services 4.2 Children and Families and Justice Services were formally delegated to the MIJB in March 2023 so plans were already in established for all services. Work is already underway on the new Children’s Services Plan and there is an excellent opportunity to strengthen alignment and develop a plan for the whole life span of individuals and families in the communities that support them. National Direction 4.3 Scottish Government published the documents Scotland’s Population Health Framework to improve population health, reduce inequalities and support data- driven planning, and the Health and Social Care Service Renewal Framework with a focus on system reform and sustainability, promoting person centred care and the need for integrated services for, both for the period 2025-2035. These documents provide clear direction of intent for Health and Social Care Partnerships and strategic leadership. 4.4 The Health and Care Improving Flow Plan 2026-2031 was published on 31 August 2026 setting out the Scottish Government 5-year strategy with the focus on from managing hospital pressures to creating a single, connected health and care system that helps people access the right support at the right time and in the right place. Looking through Moray lens for Strategic Planning and financial sustainability work this aligns strongly with: Flow Plan Priority Potential Moray HSCP Focus More care at home TEC expansion, Hospital at Home, community support Reduced delays Home care capacity, discharge coordination, reablement Better navigation Community hubs, integrated access arrangements Prevention Prevention and wellbeing advice, early detection, frailty identification and early intervention to prevent crisis Integrated working NHS Grampian, Moray Council, third sector collaboration Sustainable services Reducing reliance on acute beds and high-cost care Development of Partner Strategy documents Page 268
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4.5 Moray Council is co-ordinating the development of the Local Outcome Improvement Plan (LOIP) with community planning partners and NHS Grampian are also refreshing their strategic plan “Plan for the Future”. Their timelines align with the proposals for development of the MIJB strategic plan, which will present an ideal opportunity to ensure areas for prioritisation will be incorporated into the most appropriate plan. 4.6 Appendix 1 shows the stages and anticipated timeline for identification of transformational changes to service delivery , required to ensure development of sustainable services that are fit for purpose. It will be essential to involve staff, partners and people who use our services to hear what they feel is most important to delivery, but to also develop the understanding that Moray Health and Social Care Partnership cannot meet all demands received, so there is a need to prioritise and ensure all the tools and resources available are utilised to best effect to deliver services for the people of Moray. 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” Performance management reporting is a legislative requirement under section 42 of the Public Bodies (Joint Working) (Scotland) Act 2014. (b) Policy and Legal There are no new policy or legal implications arising directly from this report. The report is consistent with existing statutory duties and governance arrangements. (c) Financial implications There are no direct financial implications associated with this report. However, identification of refreshed strategic objectives will be based on delivery of sustainable services within the available financial envelope. Performance insights may inform future resource planning and prioritisation to align with the defined strategic objectives. (d) Risk Implications and Mitigation The report itself does not create new risks; however, the Risk appetite of the Board will direct the development of the plan and strategic risks relating to delivery will be identified and presented for consideration by the Board. In addition, the announcement of the Scottish Government “Programme for Government 2026” that outlines the intention to reduce the number of NHS Boards and reduce the number of public bodies over the next five years, presents a level of uncertainty regarding strategic direction. However, the strategic plan process is necessary to identify the key priorities required to meet the needs of the future population of Moray which will underpin the direction for any public body in relation to health and social care services. Page 269
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Strategic risks are monitored through existing governance and performance arrangements and are escalated where required. (e) Staffing Implications While there are no direct staffing implications arising from this report, it is important to acknowledge in transforming service delivery there will be a need to review the skills required and staff resource capacities as services transition from existing models to future models of service delivery. Ongoing challenges with recruitment, retention and staff absence across health and social care services will be considered as part of the development of the workforce plan to underpin the Strategic Plan and associated Delivery plan. (f) Property There are no property implications directly associated with this report. (g) Equalities/Socio Economic Impact An Equality Impact Assessment (EIA) is not required for this report, as it does not introduce or amend any policy or service that would directly affect individuals with protected characteristics. However, the strategic plan will have an assessment which will be presented to the Board for consideration alongside the plan prior to final approval and adoption. (h) Climate Change and Biodiversity Impacts There are no direct climate or biodiversity implications arising from this report. However, it is recognised that extreme weather events and rising energy costs may increasingly impact service delivery, particularly in rural areas. These factors will be considered as part of the strategic planning process. (i) Directions No new directions are required as a result of this report. (j) Consultations Senior Management Team, Service Managers, Caroline O’Connor, Committee Services Officer, Moray Council and their comments are incorporated in the report. 6. CONCLUSION 6.1 This report provides the Board with an overview of the approach and timescale for the refresh of the Strategic Plan for 2027 to 2037, that will incorporate National direction, addressing the needs highlighted by the joint strategic needs assessment and will align with the priorities of the LOIP. Author of Report: Jeanette Netherwood, Interim Strategic Lead Background Papers: Available on request Ref: Page 270
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APPENDIX 1 Timeline for Strategic Plan Refresh Phase Key Actions Timescale 1. Mobilisation & Governance confirm scope, programme plan, governance, decision-making routes, and reporting to SMT/SPCG/APR/MIJB. July–August 2026 2. Evidence & Strategic Context Establish Strategic Plan Commissioning Steering Group (SPCG), review JSNA findings (Children and Adults), financial outlook, workforce challenges, service demand, housing strategy, national policy changes, and key performance trends. August–September 2026 3. Current State Review Review progress against "Partners in Care", Strategic Delivery Plan, transformation priorities, workforce plan, digital strategy, commissioning intentions, and Medium-Term Financial Strategy. August–October 2026 4. Stakeholder & Community Engagement – identification of opportunities Staff engagement, partner workshops, third sector, care providers, carers and lived-experience engagement. Ensure compliance with Planning With People requirements. September–December 2026 Page 271
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APPENDIX 1 Phase Key Actions Timescale 5. Future Vision & Strategic Ambitions Develop future vision, outcomes, strategic priorities and design principles. Consider relationship between Strategic Plan and Target Operating Model. October–December 2026 6. Draft Strategic Framework Draft strategic themes, outcome framework, delivery model, performance measures and supporting plans. January–February 2027 7. Consultation Draft SMT review, IJB development session, wider consultation on draft Strategic Plan. March–May 2027 8. Finalisation Incorporate feedback, equality impact assessment, financial assessment, governance review and final approval process. June–August 2027 9. Approval & Launch APR Committee review, IJB approval, publication and communications campaign. September 2027 10. Implementation Planning Develop supporting Strategic Delivery Plan 2028–2031, performance framework and reporting arrangements. September–December 2027 Page 272
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: CHILDREN’S SERVICES PLAN 2023–2026: YEAR 3 ANNUAL REPORT AND INTRODUCTION TO THE CHILDREN’S SERVICES PLAN 2026– 2029 BY: DAWN PARKER, GIRFEC AND PROMISE STRATEGIC LEAD 1. REASON FOR REPORT 1.1 To present the concluding Year 3 Annual Report for Moray’s Children’s Services Plan 2023–2026, Our Promise to the Children of Moray, and introduce the emerging vision, priorities and workstreams for Moray’s new Children’s Services Plan 2026–2029. 1.2 The report provides assurance on progress made across the five Promise foundations and identifies the key learning, continuing pressures and areas for further development which will shape the 2026–2029 Plan. 2. RECOMMENDATION It is recommended that the Board: i) notes the progress and key messages contained within the Year 3 Annual Report for the Children’s Services Plan 2023–2026 (Appendix 1); ii) notes the transition from the 2023–2026 Plan to the new Children’s Services Plan 2026–2029; iii) notes the proposed strategic direction, vision, priorities and workstream approach for the 2026–2029 Plan, recognising that detailed delivery plans and measures will continue to be developed with children, young people, families and partners; and iv) notes the importance of continued partnership working across health, social care, education, housing, community planning, justice, third sector and other services to deliver the new Plan. 3. BACKGROUND Item 14. Page 273
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3.1 Moray’s Children’s Services Plan 2023–2026, Our Promise to the Children of Moray, incorporates the Child Poverty Plan, Children’s Rights and Participation Plan, Corporate Parenting Plan and Child Protection Improvement Plan. The Plan has been structured around the five foundations of The Promise, with children’s rights underpinning every foundation. 3.2 The five foundations are Voice, Family, Care, People and Scaffolding. They describe, respectively, how children and young people’s voices will influence decisions; how families will be supported; how looked after and care-experienced children and young people will be supported; how the workforce will be developed; and how strategic leaders will work together so that the system enables improvement. 3.3 During the lifetime of the Plan, Moray experienced significant changes in the context in which children’s services operate, including the cost-of-living crisis, reduced attendance at schools, rising neurodiversity and additional support needs and increased demand for care. 3.4 In the final year, the partnership streamlined priorities, introduced a temporary reduced governance structure, strengthened training and quality assurance, used learning from smaller projects to inform wider system improvement, and increased the use of data. Listening to children, young people, families and the workforce has also been central to shaping the next Plan. 4. KEY MATTERS RELEVANT TO RECOMMENDATION 4.1 The concluding Year 3 Annual Report shows progress across participation, family support, child protection, inclusion, care, workforce development and partnership working. Significant pressures remain in care capacity, attendance and attainment, post-school destinations, poverty, mental wellbeing and assessment timescales. Year 3 progress – Voice 4.2 The partnership has strengthened how children and young people influence decisions. Participation is becoming more young person led and coordinated, with increased involvement of care-experienced young people and improved approaches for children with additional communication needs. Our Youth Moray is bringing different participation approaches together, while Moray Engage has provided a central platform for consultation and engagement. Since its launch in August 2025, 38 engagement projects were live in the first month, with over 35,500 visits and 8,000 contributions. 4.3 A large-scale consultation to inform the next Children’s Services Plan took place in February and March 2026. It involved 700 participants, including more than 300 children and young people ranging from those in early years to care leavers. The activity included focus groups and generated 241 online survey responses from young people. Year 3 progress – Family Page 274
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4.4 Across family support, Moray has moved towards a more coordinated whole- system approach, with stronger universal and early-help provision alongside targeted and intensive support. There is a clearer shared understanding of family need, stronger multi-agency working, more embedded financial support pathways and increased employability support. 4.5 Child poverty work has benefited from improved local evidence, including mapping across all 126 neighbourhood zones. Financial inclusion pathways have strengthened, and employability support reached 355 young people and 130 parents during the year, with positive outcomes across employment, education, training, volunteering and apprenticeships. 4.6 Mental and emotional wellbeing support has also developed, including the Moray Parent Project, improved workforce development and coordination, and a new community mental health service for children and young people commissioned through Scottish Action for Mental Health (SAMH) which launched in February 2026. 4.7 Family support has expanded across universal, targeted and intensive levels, with more consistent child planning, improved information, and stronger transition arrangements into early learning. The direction of travel is towards earlier preventative support rather than waiting for crisis. Year 3 progress – Safety, disability and neurodiversity 4.8 Child protection practice has become more consistent and embedded, with stronger workforce capability, participation, advocacy and trauma-informed practice. Key developments include strengthened multi-agency training, learning reviews, improved participation in protection processes, a new Child Protection Voice Toolkit and continued development of Bairns Hoose. 4.9 Support for children with disability and neurodiversity has improved through new education provision, enhanced communication support and increased inclusive activity. However, high demand timescales in relation to assessment and diagnosis remain significant pressures. Year 3 progress – Care 4.10 Progress has been made in relational, stable and trauma-informed support for looked after and care-experienced children and young people. The introduction of a Virtual School Head Teacher, a Corporate Parenting data set, improved health assessment timeliness, increased advocacy and work on maintaining relationships are positive developments. 4.11 Significant pressures remain around care capacity, out-of-area care, sibling groups, educational attainment and post-school destinations. A system change plan is focused on expanding Moray-based provision, strengthening family support at the edge of care, joint commissioning, combined education and care resources and housing options for larger sibling groups. Year 3 progress – People and Scaffolding Page 275
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4.12 The workforce has benefited from a more coordinated, system-wide learning and development offer, with increased trauma-informed, relational and strengths- based practice. More than 300 staff attended multi-agency training, 350 attended specialist training, and four shared workforce priorities were identified: mental health, parenting, substance use, and vulnerability and exploitation. 4.13 Partnership working has strengthened through locality networks, third sector involvement, shared data, lived experience, aligned funding and a developing self- evaluation and continuous improvement framework. The next phase will build on these foundations while further reducing silo working and strengthening system- wide learning and improvement. Learning and context for 2026–2029 4.14 The concluding report demonstrates tangible progress, but demand and complexity continue to increase, and some outcomes require sustained attention. Care capacity, attendance and attainment, post-school destinations, poverty and mental wellbeing remain priorities for continued partnership action. Taken together, the evidence supports a shift from individual service initiatives towards whole-system, preventative and place-based approaches. 4.15 The next Plan will be informed by updated strategic needs assessments, the school health and wellbeing survey, consultation and lived experience. Moray has agreed a place-based approach to help mobilise the workforce within communities and ensure that work is driven by families and the communities in which they live. Locality planning is to be strengthened further, with greater integration of different locality planning models and networks and increased opportunities for whole-family approaches. 5. Proposed Vision for the Children’s Services Plan 2026-2029 In Moray, every child and young person grows up feeling loved, safe, heard and valued. They are confident in their rights and supported to thrive in families and communities where they feel a strong sense of belonging. 5.1 The proposed vision is to build on the learning of the 2023–2026 Plan and create a children’s services system in Moray in which children, young people and families experience support that is early, relational, inclusive, rights-based and rooted in their communities. 5.2 The vision places children’s rights and participation at its centre and seeks to move further towards prevention, whole-family support and place-based delivery. It also recognises that better outcomes require the whole system to work together: services, communities, families, the third sector and children and young people themselves. 6. Proposed strategic priorities for 2026–2029 6.1 The proposed priorities are intended to provide a clear strategic framework while allowing associated workstreams to respond to emerging evidence and local need: Page 276
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The priorities are: 1. Promoting Inclusion and Improving Outcomes for children and young people with complex and additional support needs 2. Improving Children and Young Peoples Mental Health and Emotional Wellbeing 3. Keeping Children and Young People Safe from Harm 4. Strengthening Early Help and Family Support 5. Delivering The Promise across Moray 7. Proposed workstream approach 7.1 The priorities will be delivered through five cross-cutting workstreams. The workstreams will be jointly owned across the partnership and will be expected to demonstrate the contribution of different agencies and community partners. Proposed workstreams are: • Workstream 1 – Right Help at the Right Time • Workstream2 – Safe, Included and Supported • Workstream3 – Strong Relationships and Family Support • Workstream 4 – Fairer Access and Improved Outcomes • Workstream 5 – Participation and Co-production 8. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The proposed Children’s Services Plan supports an integrated, preventative and place-based approach and complements the wider partnership focus on improving outcomes and reducing inequalities. The detailed alignment will be confirmed as the 2026–2029 Plan is finalised. (b) Policy and Legal The Plan provides the strategic framework for Moray’s children’s services partnership and continues the rights-based approach underpinning the current Plan. It also builds on the linked Child Poverty, Children’s Rights and Participation, Corporate Parenting and Child Protection Improvement work. (c) Financial implications Delivery will require prioritisation of existing resources and continued alignment of partnership funding around shared priorities. The current report demonstrates the value of external and partnership funding, including Whole Family Wellbeing Funding, in accelerating innovation and joined-up delivery. Detailed resource requirements, affordability, funding dependencies and any financial risks will be identified through the Page 277
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development of delivery plans and reported through the appropriate governance arrangements. (d) Risk Implications and Mitigation Key risks include increasing demand and complexity, workforce capacity, care setting capacity, delays in assessment and diagnosis, poverty and inequality, and the sustainability of preventative provision. Mitigation will include early intervention, place-based planning, partnership commissioning, workforce development, improved use of data and continuous improvement. (e) Staffing Implications The Plan will continue to require a skilled, relational and trauma-informed workforce across partner organisations. The current Plan has established a stronger learning and development infrastructure, which will provide a platform for the next phase. (f) Property No specific property implications are identified at this stage. Any requirements arising from locality, care capacity or combined education and care provision will be considered through relevant workstreams. (g) Equalities/Socio Economic Impact Reducing inequality is central to the proposed Plan. The current evidence identifies particular impacts for families experiencing poverty, disability and for children and young people with complex additional support needs and neurodiversity. Equality and socio-economic considerations will be embedded in workstream design and impact assessment. (h) Climate Change and Biodiversity Impacts No specific climate or biodiversity implications are identified within this report. Relevant implications will be considered within individual workstreams where appropriate. (i) Directions Any Directions required in relation to specific health and social care functions will be considered through implementation and commissioning arrangements. (j) Consultations The Moray Children’s Services Planning Partnership (CSPP) and the Chief Social Work Officer/Head of Service were consulted and their comments are incorporated in the report. 9. CONCLUSION 9.1 The Year 3 Annual Report demonstrates progress across Moray’s Children’s Services Plan 2023–2026. The partnership has strengthened participation, early help, family support, child protection, inclusion, care, workforce development and partnership improvement. Page 278
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9.2 The next Children’s Services Plan 2026–2029 provides an opportunity to consolidate this progress and respond to the changing context by strengthening prevention, whole-family and place-based approaches. The proposed vision, priorities and workstreams provide a framework for continued partnership action, with detailed delivery plans and measures to be developed through co-production and ongoing evidence gathering. Author of Report: Dawn Parker GIRFEC and Promise Strategic Lead Background Papers: 2. CSP-Annual-Report-Appendixes-All.pdf Ref: Page 279
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2 Table of Content Introduction……………………………………………………………………………………………………………………….3 Promise foundations.…………………………………………………………………………………………………………..4 Voice………………………………………………………………………………………………………………………………….5 Family………………………………………………………………………………………………………………………………. 9 Tackling Child Poverty 11 Improving the mental and emotional well-being of children young people and their families 15 Keeping children and young people safe 18 Strengthening family support 22 Supporting children and families who experience challenges due to disability or neurodiversity 25 Care………………………………………………………………………………………………………………………………… 29 People………………………………………………………………………………………………………………………………34 Scaffolding………………………………………………………………………………………………………………………..36 Next Steps…………………………………………………………………………………………………………………………39 Glossary…………………………………………………………………………………………………………………………… 40 Appendix links to additional reports………………………………………………………………………………………41 Introduction Page 281
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3 Welcome to Moray’s Children's Services Plan, Our Promise to the Children of Moray, the 3rd annual progress and concluding report for the 2023-26 plan. The same format has been followed in each of our reports, with The Promise foundations used to divide the priorities. Moray’s Children Services Plan 2023-2026 incorporates the following plans, • Child Poverty Plan • Children's Rights and Participation Plan • Corporate Parenting Plan • Child Protection Improvement Plan Moray formally launched our Promise to the Children of Moray in October 2023, with a launch event that included a partnership-based marketplace showcasing the various organisations working in Moray. In September 2024 we followed up and shared progress at a “Family Festival”, which provided a timetable of free family activities to try, alongside a more focused marketplace of financial supports for families. In the final year of this plan, we streamlined our priorities to focus our resources and introduced a temporary reduced governance structure. Highlights include piloting a new performance and self-evaluation framework, improved training with quality assurance underway, learning taken from smaller projects has led to upscaling and wider system improvements. Data is being used more effectively across our systems. During this final year, we have focused on hearing from children, young people, their families and our workforce, their reflections of the plan and our progress, and listening to what matters most to our families currently to shape our next steps. During the lifetime of this plan, we experienced a shift regarding: • The cost-of-living crisis • Reduction in meaningful engagement and attendance at schools • Increased violence within homes, schools and community settings • Specific age groups continued to show COVID related impact • Rise in neurodiversity, with class membership in many schools having more than 50% of pupils having an additional support need • Rise in demand of children requiring care • Rise in contextual safeguarding concerns, with risks of exploitation, especially in regard drug and alcohol use • Advancement of thinking in regarding the manosphere Both our action plans and progress reports are structured around the five foundations of The Promise with children’s rights underpinning every foundation. Page 282
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4 Voice Explains how we will seek out and act on the voice of children, young people and their families Family Details the actions we will take to; tackle child poverty, improve the mental wellbeing of children, young people and families, keep children and young people safe, strengthen support for families and meet the challenges children, young people and families face due to disability and neurodiversity Care Outlines how we will support our looked after and care experienced children and young people to reach their full potential People Describes how we will support the workforce to listen and be compassionate in their decision making, develop trusting relationships with our children, young people and families and deliver the services and supports they need Scaffolding Outlines the key actions strategic leaders will take together to ensure that the ‘system’ supports the delivery of improvements outlined within this plan. Page 283
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5 Hearing children and young people’s voices This year at a glance • We strengthened how children and young people influence decisions. • Participation is becoming more youth-led and better coordinated. • More children, including those with additional needs, are being heard in ways that work for them. Summary of progress Over the course of this plan, it became clear that children and young people wanted their voices to lead to real change, not just be heard in disconnected ways. Earlier attempts at participation lacked a shared framework and struggled to maintain momentum. This is now improving. A developing participation approach, known as Our Youth Moray, is bringing different types of engagement together and placing young people in leadership roles. While this work is still at an early stage, we are beginning to see clearer direction, stronger coordination and greater influence. During this reporting period: • The Champions Board became more visible and proactive, using podcasts and advocacy to represent care-experienced young people. • Third-sector and Community Learning and Development Networks worked more closely together. • Care-experienced children and young people played a stronger role in shaping change. • New tools and platforms were developed to capture and coordinate young people’s views. Page 284
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6 The next stage is to fully bring these approaches together into one participation framework and clearly show how children’s views lead to decisions and improvements. Outcome: The voice of children and young people is evident in decisions that affect them Moray continues to improve how children’s views influence services, policy and practice. Key developments have included: • Adapting the Infant Voice Toolkit for use within children’s health services. • Developing and rolling out a child protection voice toolkit, supported by training. • Introducing Better Meetings Guides, designed with young people. • Involving young people in staff recruitment and service commissioning. • Supporting youth groups to run their own forums that directly influence youth work provision. Care-experienced young people played a particularly strong role: • The Champions Board produced podcasts sharing lived experience. Accessible through the Champions Board Moray Engage hub: https://engage.moray.gov.uk/moray-champions-board • Young people lobbied for extending free bus travel to age 26 Alongside this, partners continued to embed children’s rights and Article 12 of the UNCRC across practice. Youth workers supported participation in formal and informal ways, recognising that listening often happens outside meetings or surveys. For more details see Moray Children Rights Report –2026, which will be published on girfecinmoray.co.uk What this means is that children and young people are increasingly shaping services that matter to them, not just feeding back on decisions already made. Page 285
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7 Outcome: Engagement is better coordinated, reducing the risk of over-consultation A major step forward this year was the launch of Moray Engage, a central platform for consultations and engagement. Since its launch in August 2025: • 38 engagement projects were live in the first month. • The platform received over 35,500 visits and 8,000 contributions. • Engagement covered issues such as unpaid carers, short breaks and healthy weight. This approach reduces duplication, improves transparency and helps children and young people see how their input leads to change. Alongside digital engagement, participation remains central to youth work practice. Examples include: • Promise Groups designing and running a five-week summer programme for peers. • Young people leading peer engagement projects through Our Youth Moray. • Targeted engagement with young people where safety concerns were higher, including use of the Active Youth Engagement (AYE) Bus. AYE Bus Launch Press Article The developing participation framework will bring these approaches together to maximise impact and avoid unnecessary repeat consultation. Outcome: Adults hear the voices of children of all abilities Progress has continued in making sure children with different communication needs are heard. This includes: • Using the Infant Voice Toolkit in practice. • Launching a voice toolkit for child protection processes. • Sharing practice on hearing the voices of children with complex disabilities. • Using the Lundy Model of Participation across children’s services. Page 286
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8 A large-scale consultation to inform the next Children’s Services Plan took place in February & March this year. Over 300 children and young people took part, including 241 surveys completed, covering early years children through to care-experienced young adults. The partnership is increasingly confident in using a range of approaches to include children of all abilities and backgrounds. A link to a fully priority progress report in within Appendix 1. What Difference is This Making? Children and young people have a stronger, more visible influence on decisions, with participation increasingly shaping services rather than simply gathering views. Participation is more youth-led and better co-ordinated, reducing duplication and helping young people see how their input leads to change. Page 287
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9 Moray is working to improve support for families by: • Tackling child poverty • Improving the mental and emotional wellbeing of children, young people and their families • Keeping children and young people safe • Strengthening family support • Overcoming challenges faced by children, young people and families who experienced disability or neurodiversity These areas are strongly connected, with improvements to one priority impacting another. We have produced more detailed reports for each priority with links within Appendix 1 . Below is a summary of the progress being made. This year at a glance A clearer, shared understanding of family need is shaping how support is designed and delivered. • Family support continues to expand with increasing universal offers and early help options available, as well as an increase in intensive support for those at risk of becoming care experienced. • Multi-agency working has strengthened across poverty, wellbeing, safety and inclusion. • Financial support pathways are more embedded, and practical action has reduced some of the immediate impacts of poverty on families. • Increased employability support is helping more young people and parents progress into education, employment and training. • Parents’ confidence and access to non-stigmatised support has improved. Page 288
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10 Summary of progress Across the course of this plan, Moray has strengthened how families are supported, moving from a more fragmented, service-led approach towards a more coordinated, whole-system approach. Improved understanding of need in areas of poverty, mental wellbeing, safety and disability has been reshaping how support is designed and targeted when required. There is clear evidence of an expanding universal support offer and targeted support reaching families earlier. Workforce confidence is improving through a wider training offer, and there is increased access to mental wellbeing supports, including to parents. Supporting them to support their families. We are focused on creating safer and more inclusive environments for children and young people of all abilities. While demand and complexity of need has widened, there is growing evidence that families are accessing support earlier, from a more diverse support offer. The Whole Family Wellbeing Fund is contributing to the expansion of the offers. With details contained within Moray’s Whole Family Wellbeing Fund progress report, included within the appendix. Page 289
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11 Tackling Child Poverty A more detailed Child Poverty Report which examines progress in more details can be found in the Appendix. Moray now has a stronger shared understanding of child poverty, including who is most affected, where poverty is experienced and the role of in-work poverty, low income, and housing costs. To inform delivery, partners are using a stronger shared evidence base, combining local analysis, Public Health Scotland aligned indicators and lived experience. Progress includes: • Poverty is now mapped across all 126 neighbourhood zones, rather than through SIMD alone, enabling more targeted approaches. • Understanding is developing of our most at risk families. With this evidence we are reaching more single parent families, families affected by disability, larger families and younger mothers. • Community engagement has added practical insight into barriers linked to transport, cost of activities, access to essentials and mental wellbeing Outcome: Parents claim all the welfare benefits they are entitled too Income maximisation systems and routine financial support pathways across services have been strengthened. Our workforce is having more financial conversations with families, referral routes are now clearer and trusted delivery models are helping families access direct financial support. Progress has included: • A multi-agency Financial Inclusion Pathway is embedded across Health Visiting and Midwifery. • Analysis showed 94% of families with early years children were routinely asked about money worries. • Scottish Welfare Funding awards have increased from 270 to 610, with approval rates improving from 54% to 64%. Page 290
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12 • Family awareness of where to seek help increased from 86% to 89%. • Children First supported 211 families to access financial help, securing £21,375.14 in financial gains and £44,932.66 in direct assistance for 71 families, an example of how financial support is being embedded within whole family support. • The Money Advice Moray Team supported 199 families, securing £201,104 in financial gains and reducing £95,319 of debt Outcome: The impact of poverty on children, young people and their families is minimised Immediate harm associated with poverty is being reduced through practical support, reduced costs and improving front line knowledge and understanding. • An Infant Feeding in a Crisis pathway is embedded and was used 10 times in the last financial year. • The Moray Poverty Toolkit and Moray Money Counts training have strengthened frontline confidence and consistency in asking about families about finances and being able to assist with access to support. • School holiday payments supported 1,461 children in summer and 1,425 over October this year. • Education Maintenance Allowance uptake has increased from 169 to 203. • Housing action delivered affordable homes, homelessness prevention and energy-efficiency improvements. http://www.moray.gov.uk/downloads/file162828.pdf • Transport work improved childcare access in Duffus and uptake of free bus travel increased. • PeriodPlus expanded to 147 community outlets and engaged through more than 40 events, supporting access to free period products. The Period Project Story Outcome: Young people and parents experience no barrier to entering and sustaining training and employment Employability support for young people and parents is embedded, with clear progression into employability, education, training and volunteering. • 355 young people received employability support. 249 positive outcomes have been achieved, including employment, progression into further or higher education, volunteering and into apprenticeships. 72 young people have participated in training. Page 291
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13 • 130 parents started support this year. 102 positive outcomes have been achieved, this includes 40 entering employment or self-employment, 14 volunteering and 8 progressing to further or higher education and 40 parents participating in training. • Parent employability groups and a pilot upskilling offer supported parents to build confidence is enhancing their skills to engage with new opportunities including employment (see spotlight on…below). Targeted external funding is supporting delivery in priority areas already identified through local evidence and partnership learning sources. Funding strengthened local action on child poverty and supported cross-service collaboration • This is helping accelerate work linked to early years support, childcare access and improved identification of family need. • This is supporting services and partners to test approaches, build learning and strengthen joined-up delivery. Page 292
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14 What difference is this making? Our services are planning from a more realistic and shared understanding of need, which is leading to improved more responsive, targeted support. Families are more likely to be identified early, supported through trusted routes and connected to practical financial help. Work is reducing immediate cost pressures and support is reducing the day-to-day impact of poverty. Young people and parents have access to structured employability support which includes building confidence prior to moving into work, learning, training and volunteering. The barriers to employment for families are much more understood. Funding streams are acting as catalyst for delivery, innovation and shared learning to tackle child poverty in Moray. Spotlight: Progress for Parents Progress for Parents is an award-winning family learning programme delivered by Moray Pathways, working in partnership with Moray Council’s Employability Team and Community Learning and Development. It supports parents facing barriers linked to poverty, confidence and wellbeing, offering a safe, supportive route back into learning and future opportunities. The strongest impact of the programme is heard directly from parents themselves. One parent described the experience as “life-changing”, explaining that before joining the group she would never have spoken out in public. Now, she says, “I feel I can speak to anyone… I speak more to my neighbours, on the phone and to people in the street.” She also highlighted practical changes, such as gaining the confidence to set up internet access at home, something that had previously felt out of reach. Another parent spoke about improved mental wellbeing and self-belief, saying: “My mental health has improved. I’m realising my potential — I’m more capable than I thought.” Parents report feeling less isolated, more confident in their abilities, and better able to recognise their skills and experiences as strengths for learning and work. In recognition of this impact, Progress for Parents won the Family Learning Award at the 2026 Scotland’s Learning Partnership Awards, celebrating its person-centred approach and positive outcomes for families across Moray. Page 293
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15 Improving Mental and Emotional Wellbeing This year at a glance • We improved our support available to children and young people within the community by commissioning a new service. • Developed Moray’s Parent project, widening the offer to support more parents, addressing more concerns. • Upskilling the Mental Health workforce and improving processes to better co-ordinate the support provided. Outcome: Parents are confident and supported to promote family wellbeing Parent support has become more preventative, accessible and responsive, with improved confidence and skills reported by parents. Key progress includes: • The Parent Project, developed in partnership HCSM and Health is One, has provided parent-centred support focused on the needs of parents to a total of 418 parent/carers since its launch. It has now been replicated in other areas of Scotland. • The support available is developed through learning from individual parent consultations, parent surveys and engagement work with schools. Developments this year has included enhancing provision for families with neurodiverse children. • The service is having a strong impact: - 87% of parents report increased knowledge and 92% report their skills and strategies to support their child have improved. - 84% report increased self-esteem about their role as a parent with 88% feeling more confident to support their children. - 72% report improvement in empathy and connection to their child. - 6 monthly follow up engagement has shown the improvement to be long lasting. Page 294
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16 The project has developed overtime. Starting from a small focus on supporting mental wellbeing-based concerns like anxiety, to increasing the support for parents to understand their own mental wellbeing, and the impact this has on their family. The project now covers a range of topics including issues like sleep and emotional regulation, as well as creating peer support groups and a focus on parental self- care. For a detailed report see the Appendix. Outcome: The right mental wellbeing support is available at the right time Mental wellbeing support is better coordinated, with clearer pathways and earlier help. Key progress includes: • Learning from projects and pilots on school avoidance, counselling for children under 10, addressing low-level anxiety and increased parental support has helped shape service redesign and commissioning. • Partners are working more closely together experiencing; more shared training, wider workforce support from more specialist staff and improved processes for co-ordinating support between services. • Support is now offered in more ways, including parent peer groups, digital and online services, and wider workforce guidance to better support neurodiverse young people. • Staff awareness and confidence have increased through the Moray-wide workforce event, Mental Health is Everyone’s Business, attended by 160 professionals. See the appendix for the event evaluation report. • Waiting times have reduced through improvement work and a whole-system approach to mental wellbeing. • A new community mental health service for children and young people has been commissioned through SAMH, launched in February 2026. This will enable the further development of social prescribing to support young people’s mental wellbeing. • Mental Health focused services are showing strong impact, with improvement rates consistently at 82% and over. Page 295
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17 Outcome: Community-based wellbeing support is strengthened Community capacity to support mental wellbeing has increased across schools, services and community providers. Key progress includes: • Staff confidence has improved through shared training and engagement on suicide prevention, neurodiversity and supporting children and young people who are anxious. • Schools, services and community groups now offer more support for low-level anxiety and wellbeing, including skills groups, events and opportunities to connect with local support. • There is a stronger focus on social prescribing and helping community groups build their knowledge so support is more inclusive. • All services focused on mental health are trained in suicide prevention and safety planning. This training took place alongside community partners. What difference is this making? Mental Health services continue to show consistently high impact despite increase in demand and complexity of needs. Parents consistently demonstrate improved confidence, skills and ability to support their children’s mental wellbeing after engaging with the supports available. Through the developing whole-system approach to mental health, services can now collectively work together to address capacity challenges, identify emerging concerns and respond quicker to need. Despite demand, capacity has been created across the system to enable a focus going forward on community capacity building. Page 296
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18 Keeping Children and Young People Safe This year at a glance • Clear shift from training and delivery to quality improvement and evaluation. • Workforce development and children’s participation have strengthened significantly. • Key services (online safety, recovery, advocacy) are now well embedded and sustained. • Increasing focus on impact, evidence, and future sustainability. Summary of progress Across the course of the plan, child protection practice has moved from early improvements to more consistent and embedded practice. Workforce capability has strengthened through training, refreshed guidance and learning reviews. Children’s participation, advocacy and trauma-informed practice have all improved, supported by new tools and services. Key systems to support prevention, early identification of risk and co-ordinated response are now more established, with longer-term development continuing into the next planning period. Outcome: Workers are confident and able to identify risk early Workforce confidence and capability in child protection have strengthened. Key progress includes: • Expanded multi-agency training and refreshed child protection guidance and procedures. • Learning reviews embedded, with two reviews concluded this year, informing updated protocols. • Staff feedback showing 96% understand expected standards and 89% feel supported by guidance and supervision. Page 297
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19 Outcome: Children and families are heard and involved in protection processes Participation within child protection processes is more consistent and meaningful. Key progress includes: • 101 Scottish Child Interview Model (SCIM) interviews completed (2024/25). • 100% of children aged 13+ reported feeling safe and able to trust interviewers. • 290% increase in advocacy referrals following commissioning of a new independent Children’s Rights service, with access extended to parents and carers. This is now an independent advocacy service, unlike previous arrangements where this was incorporated into a wider service offer. • A new Child Protection Voice Toolkit agreed in December 2025, aligned to the Lundy Model of Participation and UNCRC. Outcome: Children and young people feel safer and develop healthy relationships Prevention and early intervention activity has strengthened across schools and communities. Key progress includes: • Whole-school and community approaches to online safety and healthy relationships. • 128 S4 pupils engaged in sextortion prevention sessions. • Equally Safe at School and Mentors in Violence Prevention embedded in all secondary schools. • Community engagement activity reaching 359 families. Page 298
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20 Outcome: Risks are identified early and responded to effectively Early identification and response to risk continue to improve. Key progress includes: • Implementation of the Protection from Serious Harm Protocol (2024). • Agreement of a co-designed Inter-agency Assessment Protocol, with roll out beginning, • Continued use of Graded Care Profile 2® and Safe and Together. • Contextual safeguarding embedded within IRD processes. Outcome: Children affected by serious harm are supported through recovery More integrated, trauma-informed responses are developing. Key progress includes: • 100% delivery of SCIM for Joint Investigative Interviews continued to be maintained. • Funding secured to progress Bairns Hoose, including specialist roles and alignment with the national programme. What difference is this making? Children are more likely to be identified early, feel safe during protection processes, and have their views heard and acted upon. Practice is more consistent and coordinated across services, with clearer pathways, stronger advocacy and improved trauma-informed responses supporting better experiences for children and families. Page 299
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21 Spotlight on… “Understanding the Manosphere” The Moray Child Protection Committee (MCPC), working with the Violence Against Women and Girls (VAWG) Partnership, developed a Programme addressing harmful online ideologies linked to the manosphere, increasing understanding of misogynistic online subcultures, identifying risk factors associated with potential harm and peer to peer harm, and the impact on young people. Feedback on the training has been overwhelmingly positive, delivered to practitioners, to parents, 29 Police Scotland Officers and 150 UN HeForShe delegates at their request, demonstrating its transferability and effectiveness across diverse professional and international contexts. Page 300
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22 Strengthening Family Support This year at a glance • Early help and child planning processes are more consistent and relational. • Access to non-stigmatised family support has expanded. • Universal, targeted and intensive support offers have strengthened. • Transitions into early learning are better planned and supported. Summary of progress Over the course of the plan, Moray has strengthened early intervention by standardising child planning processes, improving access to information with the launch of our GIRFEC and Moray Protects websites and expanded family support across universal, targeted and intensive levels. Workforce practice has developed through increased solution-focused, multi-agency training. While capacity and sustainability pressures remain, families are increasingly accessing support earlier and experiencing more co-ordinated responses. Outcome: Children and families receive early and coordinated support through effective planning Child planning and early help processes are more consistent and accessible. Key progress includes: • Standardised child planning guidance and documentation rolled out across services. • Increased solution-focused, multi-agency training, supporting more relational planning. • Launch and improvement of both the GIRFEC and Moray Protects websites to provide clear information for practitioners and families. • Adoption of ALISS across children’s and adult services, strengthening access to community support listings. Page 301
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23 Outcome: Families can access clear, non-stigmatised support pathways Family support is more visible, accessible and joined-up. Alongside other 3rd sector provision, financial investment from across the sector has expanded universal, targeted and intensive family support programmes. These include PEEP, Moray Parent Project, AB56 Futures, Families Together and Functional Family Therapy. • Universal level - Our PEEP partnership delivery model has led to a growth from 6-8 groups per quarter to a peak of 31 groups in November 2025. 962 parents have registered with our PEEP team, issuing 1,434 invitations with over 1000 attendances over the last year. Feedback gathered from parents shows increased child development knowledge, parental confidence and the development of social networks that are developing into long term friendships and support. We have showcased our approach nationally including at the national midwife conference. • Targeted help - 298 parents engaged with the Moray Parent Project this year, accessing both preventative and early help focused on mental wellbeing support delivered through a whole family lens, exploring both parental and child mental wellbeing (as often co-dependent). AB56 continues to support early years families, with a strong emphasis on improving emotional awareness, increasing coping strategies and day to day management. • Intensive support – Moray Health & Social Care Partnership (MHSCP) funded intensive support offers include Families Together, delivered by Children First and Functional Family Therapy provided by Action for Children. 170 families have connected to these services this year for support, and 47 families have taken part in Family Group Decision Making. • Ongoing development of community led hub and spoke models is informed by locality planning and forming part of our work to shift to a placed based approach going forward. When combined our family support offers are responding to the requests of parents, with a strong mental and emotional wellbeing lens applied. Page 302
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24 Outcome: Children experience positive transitions into early learning Transitions into nursery are better planned and supported. Key progress includes: • Early years transitions guidance is now more consistent across services. • Children with additional needs benefit from improved planning and communication before nursery starts. • Partners are working more closely together to improve the experience of children and families during transition points. What overall difference is this making for children, young people and families? Families have an increased range of support available including more prevention and early help. Moray is progressing shifting the offer of support a crisis point, to earlier preventative support, meaning more families can access the right support before they experience a crisis. Investment in universal provision is ensuring unstigmatised access to support. Services and support are increasingly being driven and developed with families. Page 303
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25 Supporting Children with Disability and Neurodiversity and their families This year at a glance • Education support has improved, with new services in place to better meet children’s needs. • More support is available for children with complex needs within education. • Schools are working to reduce the number of children on reduced timetables. • More children are getting assessments, but long waiting times remain due to high demand. • Work is underway to improve diagnosis pathways long-term across the whole region. Summary Progress over the final year has been steady, with earlier analysis and review work having led to education system re-design with new provision now in place. Improved understanding of children’s needs and increased engagement with parents is shaping development, however long-term improvement is required. Diagnostic pathways are not yet embedded Grampian-wide, leading to previous approaches being temporarily reinstated. Meeting demand for diagnosis and support remains an ongoing concern for all. Outcome: Children’s education and care needs are met regardless of need Steady progress is being made, with time taken to fully understand need and opportunities to system wide improvements. Key progress includes: • The Moray Adapted Curriculum and a new Head Teacher of Inclusion support bespoke provision. • A Scottish Government investment of £485K supports early support workers, outreach teams and enhanced communication provision. • Over 150 non-verbal children benefit from increased communication support. Page 304
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26 Outcome: Families can access early help and community-based support Parents and children have increased access to practical, inclusive and peer support. Key progress includes: • 83% and above of parents attending newly introduced neurodiversity support reported increased confidence and positive impact. • Participation in Active Schools increased from 39% to 47%, including 66 young people with additional support needs (ASN) who became young leaders in 2024/25. Moray Active Schools Report 2024-25 • Inclusive sport and youth work expanded, with over 1,600 ASN participants in Active Schools activity. Outcome: Families can access assessment and diagnosis Action has been taken to maintain access to diagnosis despite increasing demand and delays to a Grampian-wide pathway Key progress includes: • Local diagnostic pathways reinstated to prevent bottlenecks. • Priority routes developed for time sensitive cases, such as school leavers. • Regional pathway developments underway, informed by evidence from pilot models reducing waits from 34 to 6 weeks elsewhere in Grampian Page 305
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27 What overall difference is this making for children, young people and families? Improved education support and inclusive services are helping more children with additional needs to participate in education and community provision like sport, with more tools in place to ensure their views are heard and able to influence ongoing change. However, delays in assessment and diagnosis continue to limit timely access to support, creating pressure on families and services. Overall, while children and families are experiencing tangible benefits from enhanced support, sustained system-wide improvements are needed to ensure consistent and timely impact for all. Page 306
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28 Spotlight on… Young Carers support in 2025/2026 Moray has strengthened its support for young carers through a range of improvements designed to: • Identify children earlier • Listen more effectively to their experiences • Provide more joined-up support Overview of work undertaken: • Redesigning the Young Carer Statement into more age-appropriate primary and secondary versions. • Introducing a more child-centred and strengths-based approach and creating an “All About Me” section to help children begin conversations with trusted adults in school. • Processes for sharing information with schools have also been improved, with clearer consent-based arrangements supporting more timely and coordinated responses. • Awareness-raising activity in schools, including training, Young Carer Champions and peer support, has increased understanding of young carers’ needs and helped reduce stigma. • Engagement with social work teams has also supported more consistent recognition of young carers and stronger joint working across services. What difference is being made? Together, these developments are helping children and young people feel better understood, more able to share their views, and more likely to receive the right support at an earlier stage. Feedback from young carer surveys is also directly informing service planning, helping ensure that support is shaped by children lived experience and focused on what matters most to them. Page 307
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29 Improving Outcomes for Looked After and Care-Experienced Children and Young People This year at a glance • Relationships, stability and trauma-informed practice have strengthened • Governance, tracking and participation are improving how care experienced children & young people are supported • Access to health and mental wellbeing services are improving • Attainment, post-school destinations and access to care settings remain key concerns Summary of progress Over the course of this plan, progress has been made in strengthening relational practice, stability and rights-based support for looked after and care-experienced children and young people. Participation improves year on year, and earlier identification of need is increasing. Work is ongoing to improve our tracking and monitoring arrangements further. While outcomes in education and transitions require further work, the foundations for more consistent, trauma-informed support are now in place. Outcome: The gap in educational outcomes of looked after and care experienced young people are reduced Oversight and relational support within education have improved. Key progress includes: • Introduction of a Virtual School Head Teacher role to strengthen tracking and support. • Roll-out of a Corporate Parenting self-evaluation toolkit in secondary schools. • 57% reduction in exclusions sustained year on year. • Increased participation in sport through Active Schools, rising from 50 to 78 care experienced participants between 2022/23 and 2024/25. Page 308
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30 While progress is being made, work remains to improve attendance and attainment for some young people which is impacting their future destinations. Outcome: Young people enter and sustain education, training or employment More relational and trauma informed practice is supporting key transition stages, however positive destinations outcomes have fallen below national levels and is a focus of work going forward. Work is continuing to: • Improve tracking and monitoring within education and beyond • A multi-agency group established to focus on transitions and destinations. Outcome: The health needs of looked after and care experienced young people are met Access to health and wellbeing support is improving, key area of progress has been: • The increase in the number of completed Initial Health Assessments taking place within four weeks of becoming care- experienced, rising from 47% to 81%. These ensure health needs are quickly identified, with those not completed reflecting young people exercising their rights not to have one. • Increased uptake of community mental health and counselling services. • Ongoing CAMHS support to local residential care settings, with regular positive carer feedback provided • Funding for a transition worker role supporting wellbeing at key life stages. Outcome: Young people feel heard and supported through advocacy Care experienced young people are having their voices heard and are influencing decisions that affect then shown by: • 34% increase in advocacy uptake for care-experienced young people in year two of the new Children Rights Service. • Children & young people’s view are now consistently represented at reviews and children’s hearings. Page 309
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31 • Young people are influencing change through making podcasts about their experiences, involved in staff recruitment decisions and service redesign. Outcome: The number and range of care settings available meet the needs of children and young people Quality of care remains high in Moray as demonstrated by recent inspections, however system wide capacity pressures are a major challenge. Praise for Moray's Supported Lodgings Internal fostering and residential provision are at capacity. This is increasing our reliance on out-of-area placements which is impacting our ability to maintain our higher than the Scottish average rate in keeping siblings together, as well as the support required to maintain those relationships. Larger sibling groups are requiring care. A system change plan has been agreed which will focus on expanding Moray based provision and family support. Key progress has included: • Increased numbers of foster carers (34→39), kinship households (28→30) and supported lodgings (4→7). • The system change plan includes actions looking at joint commissioning, developing combined education and care resources, enhancing family support at the edge of care further and exploring different housing options for larger sibling groups. Chief Social Worker's Report 2024/25 Outcome: Transitions feel and are experienced as integrated, with maintaining relationships being paramount. Care experienced young people are increasingly supported to move through and beyond care in ways that prioritise relationships and emotional safety Evidence of progress includes: • The co-produced Maintaining Relationships guidance, officially launched in October with 70+ professionals and young people in attendance through work funded by the CORRA Foundation. Moray Launches Maintaining Relationships Project Page 310
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32 • Examples of good practice are being shared alongside the guidance, increasing the confidence of the workforce to maintain relationships where there were previous perceived barriers to doing so • Piloting of a dedicated transitions role by Action for Children for 2 years through external funding Outcome: looked after and care experienced young people are not overrepresented in the justice system Increased partnership working, more trauma-informed practice and earlier intervention is having a positive impact. Key progress includes: • An 8% reduction in justice involvement in the earlier stage of this reporting period. Despite a small increase recently, Moray levels remain below the national average of 12%. • No under-11s are involved in the justice system. • Reduced restraints are being used across our partnership, with none in our Moray based care settings. Linked to our trauma-informed practice. • Investment in the expansion of the Police Scotland Prevention and Intervention Team to deliver more early intervention. A recent example of a more placed based response to a mix of exploitation and anti-social behaviour concerns was provided through group work in Buckie High School. What difference is this making? Care-experienced children and young people are more likely to experience stable, relational and trauma-informed support, with stronger advocacy and improved access to health and wellbeing services. While challenges remain in attainment and post school destinations, and more flexibility is needed in our care provision, there is evidence of a more joined-up, rights-based and relationship focus is improving experiences and long-term outcomes. Page 311
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33 Spotlight on… Promise Groups Moray’s Champions Board is well established, however overtime had become focused on older young people no longer in education. As part of plans to develop a youth participation model, CORRA foundation funding was secured to help develop Promise Groups, to be forums for younger care experienced young people to share their experience and influence decision making. Each group decides its own activities and priorities. The collective voice of the groups is coordinated and amplified to the wider Champions Board and other emerging youth voice forums. There have been 10 groups established, each of varying size, across primary and secondary schools and within Moray UHI. The Moray UHI Promise Group created the following film in partnership with Wildbird to share the message that a challenging school experience does not need to define a young person’s future. The film was shared in the council chambers on Care Day. https://vimeo.com/1088269656/b0d780eb47?ts=0&share=copy. During the summer holidays, members of the groups came together with their peers to try a range of fun activities, building new positive childhood experiences. “I didn’t think I’d have any friends, and I made a friend today.” Young person, making friends “I can do 6 hula hoops at the same time!” Young person, trying new skills. Influencing Change… family time The necessary move of our family time provision created an opportunity to do things differently, with members of the Promise Groups and Champions Board helping shape the new Rose Cottage family space. Working alongside staff and drawing on family views, they influenced key decisions about the environment, helping create a warm, welcoming and trauma-informed setting for family time, developing the look and layout of the rooms to what would help children and families feel safe, calm and connected during contact. Feedback since the refurbishment has been positive, with families describing the space as more child-centred, welcoming and supportive of better family time experiences. This highlights how involving young people leads to better, more relational and rights- respecting provision, in line with The Promise. Page 312
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34 People: Supporting Our Workforce This year at a glance • Workforce development is more coordinated and system-wide. • Training is increasingly relational and trauma-informed • Cross-sector learning and reflective practice have expanded. • Confidence in compassionate, relationship-based practice has increased. Summary of progress Across the course of the plan, Moray has strengthened how the workforce is supported to deliver compassionate, relational and trauma-informed services. Investment in learning and development infrastructure, alongside a clearer multi-agency training offer, has improved consistency and shared understanding across services. Year three focused on refinement, evaluation and deeper cultural change, building on earlier system-building and expansion activity. Outcome: Integrated working practice is enhanced through joint development opportunities Shared learning and development are more consistent across the partnership. Key progress includes: • Completion of a multi-agency Learning and Development Strategy and training needs analysis. • Appointment of a Learning & Development Co-ordinator role to help support system-wide coordination. • Significant expansion of training, with 300+ staff attending multi-agency training and 350 attending specialist training. Page 313
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35 • Four shared workforce priorities identified: mental health, parenting, substance use, and vulnerability & exploitation. • Roll-out of targeted and specialist training, including online safety, county lines, common risk assessment principles and AIM assessments. Outcome: Staff facilitate and enable strong relationships with children, young people and families Practice is increasingly relational, compassionate and trauma-informed. Key progress includes: • Workforce development focused on trauma-informed, strengths-based and relational practice. • Reflective practice and audits looking at trauma-informed practice were delivered across 42 teams, with 12 teams engaging in deeper practice reviews. • 300+ staff completed trauma-informed training. • Increased use of reflective tools, walk-through lenses and trauma-informed action planning. • A shift in language and practice towards kindness, connection and child-centred decision-making What difference is this making? Children, young people and families are more likely to experience compassionate, consistent and relationship-based practice. The workforce is better equipped to work across organisational boundaries, respond to complexity and apply trauma-informed approaches. While capacity pressures remain, shared learning and cultural change is strengthening the quality and consistency of support that families experience across services. Page 314
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36 Scaffolding: Working in Partnership This year at a glance • We continue to strengthen our partnership-based governance which is supporting reduced silo working across services. • Using data, feedback loops and lived experience more to understand need better. • External funding has been better aligned to shared priorities. • A more consistent approach to self-evaluation and improvement is emerging. Summary of progress Over the course of the plan, the partnership has strengthened how it plans, delivers and improves services together. Governance arrangements, locality networks and third sector involvement have improved coordination and reduce silo working. Use of shared data, engagement and self-evaluation has increased, supporting more evidence-informed planning. While system pressures remain, foundations for more consistent partnership working and continuous improvement are now in place. Outcome: As a partnership, we are aware of the changing needs of children, young people and their families Our understanding of need is a shared one and more robust, this is due to: • Improved use of data to build a clearer picture of poverty and inequality at a local level. • Refreshing strategic needs assessments in partnership with health colleagues. • Delivering the largest Children’s Services Planning consultation in Moray to date, to inform future priorities. • Investment in Moray Engage to centralise consultation and engagement. Page 315
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37 • Ongoing engagement with families, parents and lived experience groups, including around additional support needs. Outcome: As a partnership, we maximise opportunities to align funding to shared priorities Funding is increasingly coordinated and outcomes-focused with more partnership funding application being made. Key progress includes: • Partnership-led funding applications are supporting work on poverty, mental wellbeing and neurodiversity. • Bairns Hoose developmental and test-of-change funding was secured, with implementation underway. • Support has been provided to third sector partners to access funding that jointly aligned to local priorities. • Pan-Grampian level funding secured through NHS Grampian is benefitting services in Moray. Outcome: The risk of silo working across services is minimised Joined up governance and locality arrangements have been increasing collaboration with: • Third sector representation now embedded across both strategic and locality groups. • Locality networks continue to be led by 3rd sector colleagues, with smaller, local providers having more influence • A third sector children and young people’s forum has been re-developed, strengthening two-way communication • Co-ordination between strategic groups is improving through shared learning and leadership links. Outcome: We more consistently measure impact and coordinate improvement A shared approach to learning and improvement is developing through: Page 316
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38 • the introduction of a self-evaluation and continuous improvement framework which is improving the coordination of improvement work. • Increased use of audits, learning from complaints and multi-agency learning activity. • There are plans to extend this approach more widely across children services planning. What difference is this making? Children and families are more likely to benefit from joined-up, evidence-led services, with reduced duplication and clearer shared priorities. Partnership working is more coordinated, funding is better aligned, and improvement activity is increasingly system-wide rather than service-led, supporting earlier and more consistent responses to need. Page 317
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39 Next Steps Our strategic needs assessments are currently being updated, and the health & wellbeing survey is being completed in school, as part of national updates. This alongside consultation and lived experience will provide the foundation of our next Children Services Plan. A placed based approach has been agreed going forward to help mobilise our workforce to embed in communities and for the focuses of our work to be driven by families and the communities they live in. Our locality planning model is to be strengthened further, with greater integration of our different locality planning models to improve participation and opportunities for whole family approaches to develop further. Spotlight on… Locality Networks The Locality Networks are multi-agency groups of practitioners, managers and team leaders who work with children, young people and families. They can be utilised to focus on a key theme, for example, a network has formed consisting of small, local organisations that have been established to support families who have children with Additional Support Needs. Through this work, the group have been able to reflect better the voice of parents on new policies being developed and introduced. This has led to a new consultation template being developed to ensure this becomes standardised practice. Examples of feedback provided by parents from this newly introduced jointly developed procedure are below: I was disappointed that there was no mention whatsoever of the inclusion of families/guardians. In part 6 (dissemination methodology) there could be mention of families/guardians being provided with a generic leaflet outlining what transition is and how it works. Stakeholders are discussed. I've focused on the first column (s23 CYP). Again, parents are continually told that they know their CYP the best however their roles and responsibilities aren't outlined here. Why not? There's no mention of them whatsoever. I understand that the transition is for the young person however if the parents/guardians are not familiar with the process, how can they support the young person to go through it or answer questions. From this feedback a parent section was included in the policy. Page 318
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40 Glossary • AB56 – Early Years Family Support service. Provided by Action for Children. • AIM – Assessment, Intervention, and Moving On, is a specialized framework used to evaluate children and adolescents who display Harmful Sexual Behaviour or have engaged in sexual assault • ALISS – A Local Information System for Scotland. A directory of community groups and other services. • ASN – Additional Support Needs. • AYE – Active Youth Engagement • CAMHS – Child and Adolescent Mental Health Services. • Champions Board - group that connects care experienced young people to share experiences and influence decision-makers • Contextual Safeguarding - an approach to child protection that expands traditional safeguarding to address harms that occur outside the family home • GIRFEC – Getting It Right For Every Child. • Graded Care Profile 2 - an evidence-based assessment tool licensed by the NSPCC, with the primary goal of identifying and preventing child neglect • IRD – Inter-agency referral discussion • Moray Adapted Curriculum – A personalised educational program managed by Moray Council. It supports primary and secondary pupils with complex ASN who are at risk of disengaging or unable to attend full-time mainstream classes. • NHS – National Health Service. • PEEP – Parent and Early Education Partnership, a family learning program. • Safe and Together - An evidence-based child protection framework that focuses on keeping children safely with their non- abusive parent, partnering with that parent, and holding the domestic abuse perpetrator accountable for their behaviour. • SCIM – Scottish Child Interview Model. • SIMD – Scottish Index of Multiple Deprivation. • UNCRC – United Nations Convention on the Rights of the Child. Page 319
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41 Appendix 1: Priority Areas Detailed Reports Voice & Participation report Local Child Poverty Action Plan Report Mental Wellbeing Priority Progress Report Safe Priority Progress Report Strengthening Family Support Progress Report Whole Family Wellbeing Fund Report Children with Disability & Neurodiversity Progress Report Corporate Parenting Report People (Learning & Development) Progress Report Appendix 2 Additional Reports Moray Parent Project Progress Report Children Mental Health is Everyone’s Business Event Report GIRFEC in Action, MYT Stories of Change Page 320
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REPORT TO: MORAY INTEGRATION JOINT BOARD ON 24 SEPTEMBER 2026 SUBJECT: THE MORAY ALCOHOL AND DRUG PARTNERSHIP (MADP) – SCOTTISH GOVERNMENT ANNUAL REPORTING SURVEY BY: MORAY ALCOHOL AND DRUG PARTNERSHIP COORDINATOR 1. REASON FOR REPORT 1.1 To inform the Board of the Moray Alcohol and Drug Partnership (MADP) Annual Reporting Survey 2025/26 and to provide an overview of progress, key developments and areas for continued improvement across alcohol and drug services and partnership activity in Moray. 2. RECOMMENDATION 2.1 It is recommended that the Board: i) Discuss and acknowledge the Moray Alcohol and Drug Partnership Annual Reporting Survey 2025/26 and the progress and developments outline within the return; and ii) Discuss and acknowledge the areas identified for continued development and improvement during 2026/27. 3. BACKGROUND 3.1 The Scottish Government requires Alcohol and Drug Partnerships (ADPs) to provide an annual reporting return outlining local delivery, progress and partnership activity across key national alcohol and drug priorities. 3.2 The MADP Annual Reporting Survey 2025/26 provides an overview of local arrangements and developments across a broad range of areas, including surveillance and emerging harms, workforce development, lived and living experience, equalities and human rights, stigma, prevention, harm reduction, the Medication Assisted Treatment (MAT) Standards, treatment and recovery, residential rehabilitation, support for children and young people, mental health and substance use, trauma-informed practice and whole family approaches. Item 15. Page 321
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3.3 The 2025/26 return has been completed through information gathered across the ADP and its partner organisations and reflects both progress made during the year and areas where further development is required. The completed return has already been submitted to the Scottish Government and is now being presented to the IJB for information and oversight. 4. KEY MATTERS RELEVANT TO RECOMMENDATION Lived and Living Experience, Human Rights and Stigma 4.1 Lived and living experience (LLE) continues to be embedded across MADP planning, governance and service improvement. During 2025/26, people with lived and living experience and family members contributed through the LLE Panel, Living Experience Management Group, Collective Voice reporting, experiential feedback, recovery communities and ADP governance. This feedback continues to inform service development, commissioning and improvement activity. 4.2 The Charter of Rights for People Affected by Substance Use has progressed from awareness raising towards practical implementation across policy, practice and partnership working. The locally developed Charter Implementation Toolkit, incorporating FAIR and Availability, Accessibility, Acceptability and Quality (AAAQ) approaches, supports services and partners to consider how rights are experienced in practice and identify areas for improvement. 4.3 Reducing stigma has remained a priority through Recovery Together, rights-based and community engagement events, feedback activity and International Overdose Awareness Day, including the rose remembrance event. Harm minimisation communications have also promoted compassionate, trauma-informed messages around emerging drug trends, overdose prevention, naloxone, safer use, recovery, rights and access to support. Harm Reduction, Emerging Trends and People at Risk 4.4 Harm reduction and surveillance arrangements continued to strengthen during 2025/26 through naloxone provision, near-fatal overdose responses, assertive outreach, daily high-risk meetings, drug death reviews, local early warning system (LEWS), Rapid Alcohol and Drug Alert Response (RADAR) and lived and living experience intelligence. 4.5 Emerging trends remain closely monitored, particularly ketamine use amongst younger people, cocaine and poly-substance use, alongside the potential risk from potent synthetic opioids. Ketamine has prompted targeted harm reduction activity and further work around associated bladder and urinary harms and appropriate pathways to support. 4.6 Reaching people at greatest risk who are not engaged with services remains a priority, alongside improving information sharing and strengthening referral pathways from primary and acute healthcare settings, including Accident and Emergency (A&E). Treatment, Recovery and Residential Rehabilitation Page 322
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4.7 Implementation and continuous improvement of the MAT Standards remained a key priority during 2025/26, with Moray receiving a favourable Red, Amber, Green, Blue (RAGB) B rating. Experiential feedback continues to inform improvement activity and provides insight into how the Standards are experienced by people accessing support. 4.8 The residential rehabilitation pathway was revised and published during the year, with direct access through Arrows, a dedicated Rehab Link Worker, use of the Scotland Excel National Flexible Framework and multi-agency oversight. These developments have supported increased access, with Moray meeting and exceeding national targets for residential rehabilitation admissions. 4.9 The pathway continues to evolve in response to local need. A case involving a 16- year-old requiring residential rehabilitation has prompted further development to ensure the pathway appropriately considers children and young people and strengthens links with children's services and family support. Children, Young People and Whole Family Approach 4.10 Work continued during 2025/26 to strengthen support for children, young people and families affected by substance use. This includes development of the Young People’s Substance Use Pathway and consideration of the national Standards for Young People Accessing Substance Use Services, supporting closer partnership working and more responsive pathways for young people and their families. 4.11 The Holistic Whole Family Approach continues to be progressed with partners, with family-inclusive practice embedded within commissioned service expectations and monitoring. Families are increasingly involved in engagement, service improvement and planning, alongside access to a broad range of family and community support. 4.12 Work will continue to strengthen links between alcohol and drug services, children’s services, education, health and third-sector partners, recognising the importance of earlier support and coordinated responses for children, young people and families affected by substance use. Workforce and Partnership Development 4.13 Workforce development remained a priority during 2025/26, with training across the partnership focused on areas including trauma-informed practice, motivational interviewing, human rights and advocacy, mental health and substance use, and emerging drug trends including ketamine. The ADP also continues to support training, leadership, peer support, volunteering and workforce opportunities for people with lived and living experience. 4.14 The new national Partnership Delivery Framework and Service Specification, alongside the MADP Strategic Delivery Plan 2026–2029, provide a clearer framework for partnership working, governance and expectations for local delivery. This reinforces that reducing alcohol and drug-related harm requires shared responsibility across the wider system and not solely specialist alcohol and drug services. Page 323
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4.15 Locally, the revised service specification and associated action plan provide clearer expectations for commissioned services around quality, partnership working, rights-based and trauma-informed practice, lived and living experience, family-inclusive approaches and continuous improvement. Areas for Continued Improvement 4.16 The Annual Reporting Survey demonstrates significant progress while identifying areas requiring continued focus. While Moray achieved a favourable RAGB B rating for the MAT Standards, continuous improvement remains important, particularly around access, primary care engagement, stabilisation and crisis support, and ensuring positive experiences of care. 4.17 Emerging substance use trends, particularly ketamine use amongst younger people, require continued prevention, harm reduction and workforce development. Strengthening pathways with primary care and acute settings, including A&E, and improving local information sharing also remain priorities. 4.18 Reaching people at greatest risk who are not currently engaged with services remains a key focus through assertive outreach, near-fatal overdose responses and early warning arrangements. Residential rehabilitation also continues to face challenges associated with rurality, transport, appropriate placements and waiting times despite significant improvements in access. 4.19 These areas will continue to inform delivery of the MADP Strategic Delivery Plan 2026–2029 and wider partnership improvement activity, using local intelligence, lived and living experience and learning from frontline services to respond to changing need. 5. SUMMARY OF IMPLICATIONS (a) Corporate Plan and 10 Year Plan (Local Outcomes Improvement Plan (LOIP)) and Moray Integration Joint Board Strategic Plan “Partners in Care 2022 – 2032” The Annual Reporting Survey demonstrates the MADP’s contribution to wider local priorities around improving health and wellbeing, reducing inequalities, prevention and early intervention, supporting people and families within their communities, and improving access to treatment, care and recovery. The activity reported during 2025/26 supports the direction of the MADP Strategic Delivery Plan 2026–2029 and its four priorities of Prevention and Early Intervention, Harm Reduction, Treatment and Care, and Wider Circle of Support. It also reflects the whole- system approach required across health, social care, children and families, justice, housing, third sector, communities and people with lived and living experience. The Annual Reporting Survey provides the IJB with assurance on progress across these areas, while also identifying where Page 324
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continued partnership focus and improvement are required to respond to local need, inequalities and emerging alcohol and drug-related harms. (b) Policy and Legal The Annual Reporting Survey reflects delivery within the current national alcohol and drug policy framework, including Preventing Harm, Promoting Recovery: Scotland’s Alcohol & Drugs Strategic Plan 2026–2035, the Partnership Delivery Framework for Alcohol and Drug Partnerships, the National Service Specification for Alcohol and Drug Services, the MAT Standards and the Charter of Rights for People Affected by Substance Use. These frameworks place increased emphasis on partnership accountability, consistent standards of care, human rights, lived and living experience and reducing inequalities. Local delivery continues to reflect wider statutory responsibilities relating to health and social care, children and families, equalities, human rights, safeguarding and public protection. The Annual Reporting Survey demonstrates how these national and legal expectations are being translated into local practice through rights-based and trauma-informed approaches, service specifications, partnership working and continuous improvement. (c) Financial implications There are no new financial implications arising directly from this report. Delivery of alcohol and drug priorities continues to be supported through existing Scottish Government Alcohol and Drug Partnership funding allocations and associated local partnership resources. (d) Risk Implications and Mitigation There are no additional risk implications arising directly from this report. Risks and areas for continued improvement identified through the Annual Reporting Survey will continue to be monitored and managed through existing MADP governance, partnership and escalation arrangements. (e) Staffing Implications There are no new staffing implications. (f) Property The are no property implications. (g) Equalities/Socio Economic Impact The Annual Reporting Survey reflects the MADP’s continued focus on reducing inequalities, improving accessibility and addressing stigma and discrimination experienced by people affected by alcohol and drug use. A rights-based and trauma-informed approach is supported through implementation of the Charter of Rights for People Affected by Substance Use, lived and living experience involvement and partnership activity aimed Page 325
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at improving access for people who may experience additional barriers to treatment and support. The survey also recognises the wider circumstances that can contribute to poorer outcomes, including poverty, homelessness, rural isolation, involvement with the justice system, health inequalities and multiple and complex needs. Continued improvement activity will seek to ensure services are accessible, inclusive and responsive to the needs of individuals, families and communities across Moray. No separate Equality Impact Assessment is required as the report is presented to the IJB for information and does not propose a new policy or service change. (h) Climate Change and Biodiversity Impacts None arising directly from this report. (i) Directions None arising directly from this report. (j) Consultations The Annual Reporting Survey has been informed through engagement and information gathered across MADP partner organisations, commissioned services, Health and Social Care Moray, statutory and third-sector partners, people with lived and living experience, family representatives, recovery communities and wider partnership and governance arrangements. The return also draws upon experiential feedback, Collective Voice reporting, local intelligence and ongoing engagement activity undertaken throughout 2025/26. 6. CONCLUSION 6.1 The 2025/26 Annual Reporting Survey demonstrates the continued progress made by the MADP across prevention, harm reduction, treatment and recovery, lived and living experience, human rights, workforce development and support for children, young people and families. 6.2 The return also identifies areas where continued improvement is required, particularly in responding to emerging harms, strengthening pathways and partnership working, reaching people who are not currently engaged with services, and addressing the challenges associated with delivering accessible support across a rural area. 6.3 The progress and learning captured through the Annual Reporting Survey will continue to inform delivery of the MADP Strategic Delivery Plan 2026–2029, supporting a responsive, rights-based, trauma-informed and partnership-led approach to improving outcomes for individuals, families and communities affected by alcohol and drugs. Page 326
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Author of Report: Justin Jansen, MADP Coordinator Background Papers: Preventing Harm, Promoting Recovery: Scotland's Alcohol & Drugs Strategic Plan 2026 – 2035 - gov.scot Alcohol and drugs: partnership delivery framework - 2026 - gov.scot Ref: Page 327
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Alcohol and Drug Partnership Survey 2026 APPENDIX 1 MORAY - Alcohol and Drug Partnership Survey 2026 Timescales - The deadline for returns is Friday 10 July 2026. 1. Which Alcohol and Drug Partnership (ADP) do you represent? Moray Alcohol and Drug Partnership Section 1 - Cross-cutting priority: Surveillance and Data Informed 2. Which groups or structures were in place at an ADP level to inform surveillance and monitoring of alcohol and drug harms or deaths? If drug and alcohol deaths are reviewed at a combined group, please select both ‘Alcohol death review group’ and ‘Drug death review group or similar’ X Alcohol Death Review Group X Alcohol Harms Group X Drug Death Review Group or similar X Drug Trend Monitoring Group / Early Warning System None of these X Other Multi-Agency Risk and Harm Group (MARS), Daily High-Risk Meetings, Grampian RADAR Group, Local Early Warning System (LEWS), Near Fatal Overdose Review Processes, Living Experience Management Group and ADP Strategic Governance Structures. 3. Do families have the option to be involved in alcohol and/or drug death review groups? Yes X No Don’t Know 4. Please provide further details? (4000 Word Limit) Families are not currently involved directly in alcohol or drug death review groups in Moray. However, support is available to families affected by alcohol or drug-related deaths through commissioned services and wider family support provision, including bereavement support. Learning from alcohol and drug death reviews is used to inform service improvement, prevention activity, workforce development, and strategic planning across the partnership. Family experiences and feedback are also captured through a range of engagement mechanisms, including family Page 328
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Alcohol and Drug Partnership Survey 2026 Page 2 of 24 support services, lived and living experience participation, experiential interviews, and wider feedback and consultation processes. Moray ADP recognises the importance of family voice and continues to work with partners to strengthen family involvement across planning, service improvement, and recovery-oriented systems of care. 5. Have you made specific revisions to any protocols in the past year in response to emerging threats (e.g. novel synthetics, trends in cocaine, new street benzos, nitazenes, xylazine etc.)? X Yes No 6. If yes, please provide details of any revisions. During 2025/26, Moray strengthened a number of local processes and responses in relation to emerging drug trends and risks. This included further development of the daily high-risk meetings between Arrows and MIDAS, helping identify people at increased risk and enabling rapid assertive outreach, fieldwork, welfare checks and harm reduction support. Local Early Warning System (LEWS) arrangements continued to develop, improving the sharing of information and intelligence between partners. Learning from drug death reviews, near fatal overdoses, RADAR alerts, lived and living experience feedback and local intelligence has informed our response to increasing concerns around ketamine, cocaine, poly-substance use and the potential risks associated with synthetic opioids such as nitazenes. We also strengthened our harm minimisation approach across partnership communications, social media and public awareness activity. This included sharing information on emerging drug trends, overdose risks, naloxone, safer use advice and the health harms associated with substances such as ketamine. This has helped ensure more consistent messaging across services and supported earlier awareness of emerging risks within communities. Section 2 - Cross-cutting priority: Resilient and Skilled Workforce 7. New drug and alcohol staffing resources were published in 2025. How useful if at all do you think each of the following workforce resources are for the development of the sector in your area? Not useful Moderately useful Very useful Don’t Know Drugs and alcohol workforce: Knowledge and skills framework X Page 329
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Alcohol and Drug Partnership Survey 2026 Page 3 of 24 Drug and alcohol workforce: Learning directory X Pathways to employment: Supporting people with lived and living experience of substance use in to work (employer toolkit) X Pathways to employment: Your guide to a career in substance use services (employee toolkit) X Substance use - supporting employees with lived and living experience: Guiding principles X 8. Please describe how these resources are currently being used in your ADP area, and/or how they may be used in future? Please specify which resource(s) you are referring to. (4000 Word Limit) Moray ADP welcomes the publication of the new workforce resources and recognises the important role they can play in supporting workforce development across the alcohol and drug sector. The Drugs and Alcohol Workforce Knowledge and Skills Framework is particularly useful in helping create a shared understanding of the knowledge, skills and values required across the workforce. As Moray implements the new Strategic Delivery Plan, National Service Specification and Partnership Delivery Framework, the framework provides a useful foundation for workforce planning, training and development. The Learning Directory is a useful resource for identifying available learning opportunities and training providers. However, as it primarily signposts to existing training and resources, there remains a risk of variation in workforce development across Scotland depending on local priorities, capacity, funding and availability of training. Whilst the directory supports access to learning opportunities, Moray ADP would welcome a more consistent and standardised national approach to workforce development linked to the Knowledge and Skills Framework. This would help ensure greater consistency in learning, practice and experience for people accessing support, regardless of where they live. The Pathways to Employment resources and Supporting Employees with Lived and Living Experience Guiding Principles align strongly with Moray's commitment to meaningful involvement of people with lived Page 330
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Alcohol and Drug Partnership Survey 2026 Page 4 of 24 and living experience. Lived and living experience continues to play an important role across governance, service design, peer support, recovery communities and commissioned services. These resources provide a useful framework for supporting people into employment, reducing stigma and creating inclusive workplaces. Looking ahead, Moray ADP will continue to use these resources to support workforce development, training, lived and living experience employment opportunities, and implementation of our Strategic Delivery Plan 2026–2029. Section 3- Cross cutting priorities: Lived and Living Experience (LLE) 9. Do you have a formal mechanism at an ADP level for gathering feedback from people with lived/living experience who are using services you fund? Select all that apply. X Engagement with recovery communities X Experiential data collected as part of the Medication Assisted Treatment (MAT) programme X Feedback / complaints process X Lived / living experience panel, forum and / or focus group X Through lived and living experience involvement in steering groups, working groups and/or boards X Questionnaire / survey No formal mechanism in place X Other (255 Word Limit) Other mechanisms include the Living Experience Management Group, Collective Voice reports, experiential interviews, recovery community events, rights-based engagement activity, and feedback gathered through commissioned services. Moray also uses lived and living experience as system intelligence through a range of feedback loops, helping inform service improvement, commissioning, strategic planning, workforce development, and implementation of the Charter of Rights. Work is currently underway with people with lived and living experience and partners to develop a digital data visualisation tool that brings together experiential feedback from multiple sources to support learning, quality improvement and decision-making. Gathered through the Living Experience Management Group, Collective Voice reports, experiential interviews, recovery events, rights-based engagement and commissioned services, informing improvement, commissioning, planning and the Charter of Rights. Page 331
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Alcohol and Drug Partnership Survey 2026 Page 5 of 24 10. Have people from any of the following groups with lived and/or living experience participated in any of the above engagement mechanisms? Select all that apply. X People who are current or former employees or volunteers at the ADP or drug and/or alcohol services X People who are not employed at the ADP or at drug and/or alcohol services X People who are currently accessing treatment or support for problem drug use X People who are currently accessing treatment or support for problem alcohol use X People with living experience of drug and/or alcohol use who are not currently receiving treatment or support X People who are experiencing homelessness X Women X Young people Other (255 Word Limit) Other groups engaged through Moray's lived and living experience structures include family members, parents, carers, people affected by another person's substance use, individuals with experience of residential rehabilitation, people involved in recovery communities, and people involved in the justice system. Feedback is gathered through a range of engagement and participation mechanisms and helps inform service development, commissioning, strategic planning and rights-based improvement activity across Moray. Other groups include family members, parents, carers, people affected by another person's substance use, people with experience of residential rehabilitation, recovery communities, and people involved in the justice system. 11. In what ways are people with lived and living experience and / or family members able to participate in ADP decision-making? Select all that apply. People with lived and living experience Family members Through ADP board membership X X Through a group or network that is independent of the ADP X X Through an existing ADP group/panel/reference group X X Through membership in other areas of ADP governance (e.g. steering group) X X Page 332
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Alcohol and Drug Partnership Survey 2026 Page 6 of 24 Not currently able to participate Section 4 - Cross cutting priorities: Equalities and Human Rights 12. In the past year, to what extent has your ADP used the Charter of Rights for People Affected by Substance Use to inform service design, delivery and monitoring? Not at all Planning to use it Some use in specific activities (e.g., staff training, service planning) X Regularly used in ADP policy, practice, and partnership working Other (255 Word Limit) Moray ADP has moved beyond using the Charter of Rights as an awareness-raising or training resource and is increasingly embedding it within planning, delivery, monitoring and improvement activity across the partnership. During 2025/26, the Charter continued to inform implementation of the Strategic Delivery Plan, MAT Standards, lived and living experience activity, workforce development, service improvement and partnership discussions. Moray has also developed a local Charter Implementation Toolkit, using FAIR and AAAQ rights-based approaches to support services and partners to review practice, identify areas for improvement and strengthen rights-based delivery. The Charter is increasingly being used alongside lived and living experience feedback to inform decision-making and quality improvement. This includes the development of a digital data visualisation tool designed to bring together experiential feedback from multiple sources and apply rights- based analysis to support learning and system improvement. Moray's approach continues to evolve from promoting awareness of rights towards operationalising and embedding human rights within local systems, services and governance arrangements. The Charter informs strategic planning, MAT Standards, lived and living experience activity, workforce development and service improvement. A local Charter Implementation Toolkit using FAIR and AAAQ supports rights-based practice and improvement. 13. Please indicate in which of the following areas the Charter of Rights for People Affected by Substance Use has been used to inform development in your ADP area (select all that apply): X Service design or commissioning X Staff training or professional development Page 333
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Alcohol and Drug Partnership Survey 2026 Page 7 of 24 X Engagement with people with lived and living experience X Complaints, advocacy, or rights based processes X Organisational policy or governance None of the above Other (255 Word Limit) The Charter has also informed strategic planning, service improvement, monitoring and performance activity across Moray ADP. During 2025/26, the Charter was embedded within the development of Moray's Strategic Delivery Plan and has informed the development of a local Charter Implementation Toolkit using FAIR and AAAQ rights-based approaches. The Charter has also been used to support lived and living experience participation, experiential feedback activity, and the development of rights-based approaches to learning and improvement. This includes ongoing work to develop a digital data visualisation tool that combines experiential feedback and rights-based analysis to support decision-making, quality improvement and system change. The Charter continues to support a whole-system approach to improving how people affected by substance use experience services, support and recovery within Moray. The Charter has also informed strategic planning, service improvement and performance activity. It supports Moray's Charter Implementation Toolkit, experiential feedback work and rights-based approaches to learning, improvement and decision-making. Section 5 - Cross cutting priorities: Reduce Stigma 14. Please describe what work has been carried out in 2025/26 in your ADP area to reduce stigma for people who use substances and/or their families. (4000 Word Limit) Reducing stigma remains a key priority for Moray ADP and has been embedded across a range of activities during 2025/26. A significant focus has been the continued implementation of the Charter of Rights for People Affected by Substance Use. The Charter has been used to support workforce development, service improvement, rights-based practice, and partnership discussions, helping to challenge stigma and promote a greater understanding of substance use as a health and human rights issue. Page 334
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Alcohol and Drug Partnership Survey 2026 Page 8 of 24 Moray has continued to strengthen lived and living experience involvement through the Moray Lived and Living Experience Panel, Living Experience Management Group, Collective Voice reports, experiential interviews, and wider engagement activity. People with lived and living experience, family members and carers have contributed to service improvement, strategic planning, workforce development, commissioning discussions and implementation of the Strategic Delivery Plan. This has helped ensure that decisions are informed by people's experiences and has provided opportunities to challenge stigma through meaningful participation and leadership. Throughout the year, Moray ADP supported and delivered a number of rights-based events, recovery events, feedback sessions and engagement activities which created opportunities for people to share their experiences, influence decision-making and help shape local services. Recovery Together, lived and living experience events, Charter of Rights activities and community engagement sessions have all contributed to creating safe spaces for discussion, learning and reducing stigma. Moray ADP also supported International Overdose Awareness Day, including a rose remembrance event to remember those who have died and acknowledge the impact on families, friends and communities. The event provided an opportunity to raise awareness, promote compassion and understanding, and challenge stigma associated with substance use and drug-related deaths. Work has also continued to support families affected by substance use through family support services, peer support opportunities and bereavement support. Family voice has informed local planning and improvement activity, recognising that stigma can affect not only individuals who use substances but also families and those who care about them. Across the year, Moray ADP strengthened its harm minimisation and public awareness approach through partnership communications, social media activity and awareness campaigns. This included sharing information on emerging drug trends, overdose prevention, naloxone, safer use advice, recovery, rights and support services. Communications were developed using trauma-informed and non- stigmatising language wherever possible. Training and awareness raising have also supported stigma reduction, including work linked to the Charter of Rights, trauma-informed practice, lived and living experience involvement, and rights-based approaches. This has helped promote more compassionate, person- centred approaches across services and partner organisations. Moray recognises that reducing stigma is an ongoing process and continues to work with people with lived and living experience, families, communities and partners to challenge stigma, improve experiences of support and strengthen rights-based approaches across the system. Page 335
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Alcohol and Drug Partnership Survey 2026 Page 9 of 24 15. Please describe any future plans in your ADP area to reduce stigma for people who use substances and/or their families. (4000 Word Limit) Reducing stigma will remain a key priority for Moray ADP over the coming year and is reflected throughout our Strategic Delivery Plan 2026–2029. We recognise that stigma remains one of the biggest barriers to people seeking support, accessing services, remaining engaged in treatment, and participating fully in their communities. Stigma can also affect families, carers and loved ones, often leading to isolation, shame and reduced access to support. We will continue to build on the work already underway through the Charter of Rights for People Affected by Substance Use, ensuring rights-based approaches remain central to service development, workforce development, lived and living experience involvement and partnership working. As part of this, Moray is exploring the development of a Rights Development Officer role to support implementation of the Charter, work alongside services and communities, and help identify opportunities to improve how rights are experienced in practice. Moray will continue to support meaningful involvement of people with lived and living experience, family members and carers through the Moray Lived and Living Experience Panel, Living Experience Management Group, Collective Voice reporting, experiential interviews, recovery communities and wider engagement opportunities. We will continue to create opportunities for people to influence decision- making, shape services and challenge stigma through sharing their experiences, knowledge and expertise. We are also committed to continuing to nurture and develop people with lived and living experience through training, learning, leadership and workforce opportunities. We recognise the value that lived and living experience brings to services, communities and decision-making and will continue to support opportunities for people to build confidence, develop skills, contribute to improvement activity and access volunteering, peer support, governance and employment opportunities where appropriate. This includes supporting pathways into the workforce and creating opportunities for people to use their experiences to influence change, challenge stigma and support others. Work will continue on the development of a digital data visualisation tool, co-designed with people with lived and living experience and community partners. The tool will bring together feedback from a range of sources and use rights-based approaches, including FAIR and AAAQ, to support learning, improvement and decision-making. This will help ensure that community voice remains visible, that people's experiences are not lost, and that feedback can be used to drive meaningful improvements across the system. Moray ADP will continue to support Recovery Together events, rights- based events, community conversations, feedback sessions and Page 336
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Alcohol and Drug Partnership Survey 2026 Page 10 of 24 awareness raising activities that bring people together, promote understanding and celebrate recovery. These events provide opportunities for people to share experiences, learn from one another, build connections and challenge negative perceptions associated with substance use. We will continue to create spaces where people feel safe to talk openly about their experiences and where recovery can be recognised and celebrated. We will also continue to support International Overdose Awareness Day and other opportunities to remember those who have died, acknowledge the impact on families and communities, and promote compassion and understanding. These events play an important role in reducing stigma by recognising the humanity of those affected and encouraging conversations about loss, recovery, hope and support. Family members, carers and loved ones will continue to be an important part of our approach. We will work alongside family support services and community partners to ensure family voices continue to influence planning, service development and improvement activity. We recognise that reducing stigma requires supporting not only individuals affected by substance use, but also the families and communities around them. Workforce development will remain a key part of our approach. We will continue to promote trauma-informed, rights-based and non- stigmatising practice across services and partner organisations. This includes supporting staff to better understand the impact of stigma, the importance of language, the role of human rights and the value of lived and living experience in shaping services and support. Reducing stigma cannot be achieved by services alone. It requires communities, organisations and individuals working together to challenge assumptions, create opportunities for meaningful participation and ensure people feel respected, listened to and valued. Moray ADP will continue to work with people with lived and living experience, families, communities and partners to create a culture where people affected by substance use are treated with dignity, where recovery is visible and celebrated, and where lived and living experience is recognised as a powerful source of leadership, learning and positive change. Reducing stigma will remain a key priority within Moray ADP's Strategic Delivery Plan 2026–2029. We recognise that stigma remains a significant barrier to accessing support, remaining engaged in treatment and participating fully in communities. It can also affect families, carers and loved ones. We will continue to build on the Charter of Rights for People Affected by Substance Use, ensuring rights-based approaches remain central to service development, workforce development, lived and living experience involvement and partnership working. As part of this, Moray Page 337
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Alcohol and Drug Partnership Survey 2026 Page 11 of 24 is exploring the development of a Rights Development Officer role to support implementation and strengthen rights-based practice. Moray will continue to support meaningful involvement of people with lived and living experience, family members and carers through the Moray Lived and Living Experience Panel, Living Experience Management Group, Collective Voice reporting, experiential interviews, recovery communities and wider engagement opportunities. We will continue to create opportunities for people to influence decision- making, shape services and challenge stigma through their experiences and expertise. We are committed to supporting training, learning, leadership, volunteering, peer support and workforce opportunities for people with lived and living experience, recognising the value they bring to services, communities and improvement activity. Work will continue on a digital data visualisation tool which will bring together experiential feedback from multiple sources and use rights- based approaches, including FAIR and AAAQ, to support learning, improvement and decision-making. Moray ADP will continue to support Recovery Together events, rights- based engagement activity, community conversations, International Overdose Awareness Day and other opportunities that promote understanding, celebrate recovery and challenge stigma. Family members, carers and loved ones will remain central to this work. Workforce development will continue to promote trauma-informed, rights-based and non-stigmatising practice across services and partner organisations, helping staff understand the impact of stigma, the importance of language and the value of lived and living experience. Through partnership working with communities, services, families and people with lived and living experience, Moray ADP will continue to promote dignity, inclusion, participation and recovery while challenging stigma and discrimination wherever it occurs. Section 6 - Fewer people develop problem substance use 16. Do you provide targeted prevention communications to the following groups of people at an ADP level (not at a service level)? This includes communications delivered in any format, for example in person, at events, leaflets and posters, and online content (e.g. websites and social media). Select all that apply. X People from minority ethnic groups X People who are non native English speakers X People from religious groups X People who are experiencing homelessness X People who are LGBTQI+ X People who are pregnant or peri-natal X People who engage in transactional sex Page 338
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Alcohol and Drug Partnership Survey 2026 Page 12 of 24 X People who have been involved in the justice system X People with hearing impairments and/or visual impairments X People with learning disabilities and literacy difficulties X People with physical disabilities X People with long-term health conditions X Veterans Women None of the above Other (255 Word Limit) Young People, Family members, carers and people affected by another person's substance use 17. Which of the following education or prevention activities were funded or supported by the ADP and which age groups were they targeted at? Select all that apply. Note: ‘supported’ refers to where the ADP provides resources of some kind (separate from financial, which is covered by “funded”). Some treatment and support options are not applicable for some age groups. 0-15 years (children) 16-24 years (young people) 25 years+ (adults) Campaigns / information X X X Harm reduction services X X X Learning materials X X X Mental wellbeing education/ activities X X X Peer-led interventions X X Physical health education/activities X X X Planet Youth Pregnancy & parenting X X Youth activities X X X Section 7 - Risk is reduced for people who use substances 18. Please select in which settings each of the following harm reduction initiatives are delivered in your ADP area. Select all that apply. Supply of naloxone Hepatitis C testing Injecting equipment provision Wound care Community pharmacies X X X Drug services (NHS, third sector, council) X X X X Family support services X X X General practices X X Page 339
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Alcohol and Drug Partnership Survey 2026 Page 13 of 24 Homelessness services X X Hospitals (incl. A&E, inpatient departments) X X X Justice services X X Mental health services X X Mobile/outreach services X X X Peer-led initiatives X Prison N/A Sexual health services X X Women support services Young people’s service X X 19. Is there demand for any specific harm reduction intervention/service not currently available in your ADP area? Please provide details. (4000-word limit) Emerging concerns relating to ketamine use have highlighted the need for increased prevention, harm reduction and treatment responses, particularly for younger people. Local intelligence, lived and living experience feedback and service observations have identified ketamine as an increasing concern within Moray, reflecting wider national trends. There is a need to continue developing awareness of ketamine-related harms amongst young people, communities and professionals, including the potential long-term impacts on bladder and urinary health. Opportunities also exist to strengthen clinical pathways, workforce knowledge and partnership responses to ensure people experiencing ketamine-related harms can access appropriate support and treatment as early as possible. There are also opportunities to further strengthen the identification and engagement of people at risk who are not currently known to services. Local drug death reviews continue to highlight that a significant proportion of people who die are not engaged with alcohol and drug services at the time of death. Continued development of assertive outreach, partnership working, data sharing arrangements and earlier identification pathways would help strengthen prevention and harm reduction activity. Moray would also welcome further development of harm reduction approaches within acute healthcare settings, particularly around identification, referral and follow-up opportunities for people presenting with substance-related harms. Strengthening pathways between services can help ensure that opportunities for intervention are not missed. Section 8 - People most at risk have access to treatment and recovery Page 340
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Alcohol and Drug Partnership Survey 2026 Page 14 of 24 20. Which partners within your ADP area have documented pathways in place to ensure people who experience a near-fatal overdose (NFO) are identified and offered support? Select all that apply. X Community recovery providers X Homeless services X Hospitals (including emergency departments) X Housing services X Mental health services X Police Scotland X Primary Care N/A Prison X Scottish Ambulance Service Scottish Fire & Rescue Service X Specialist substance use treatment services X Third sector substance use services Other (255-word limit) 21. Which, if any, of the following barriers to implementing NFO pathways exist in your ADP area? Select all that apply. Further workforce training required X High staff turnover X Insufficient funds X Issues around information sharing Lack of leadership Lack of ownership X Lack of physical infrastructure X Lack of staff to support out of hours or extended core business hours X Workforce capacity No barriers Other (255-word limit) 22. At which stages of the criminal justice system does your ADP support referrals to drug and alcohol treatment services? Select all that apply. X Pre-arrest X In police custody X In courts X In prison X Upon release None of the above 23. Do you have drugs and alcohol testing services in your ADP area for people going through the justice system on an order or licence? Select all that apply. Page 341
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Alcohol and Drug Partnership Survey 2026 Page 15 of 24 X Yes, for alcohol X Yes, for drugs No 24. Who provides testing services for drugs and/or alcohol for people going through the justice system on an order or license in your area? Select all that apply. Private provider NHS addiction services Local authorities Other local provider Other arrangement Alcohol Testing X X Drug Testing X X 25. What methods are used for drugs and/or alcohol testing for people going through the justice system on an order or license in your area? Select all that apply Alcohol Testing Drug Testing Handheld devices X X Spit tests X X Urine tests X Patches Not applicable Section 9 - People receive high quality treatment and recovery services 26. What screening options are in place to address alcohol harms? Select all that apply. X Alcohol hospital liaison X Arrangements for the delivery of alcohol brief interventions in all priority settings X Arrangement of the delivery of alcohol brief interventions in non- priority settings X Fibro scanning X Pathways for early detection of alcohol-related liver disease No screening options available Other (255-word limit) 27. What treatment options are in place to address alcohol harms? Select all that apply. X Access to alcohol medication (e.g. Antabuse, Acamprase, etc.) X Alcohol hospital liaison Page 342
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Alcohol and Drug Partnership Survey 2026 Page 16 of 24 X Alcohol-related cognitive testing (e.g. for alcohol related brain damage) X Community-based alcohol detox (including at-home) X In-patient alcohol detox X Pathways into mental health treatment X Psychosocial counselling X Residential rehabilitation No treatment options Other (255-word limit) 28. Which, if any, of the following barriers to residential rehabilitation exist in your ADP area? Select all that apply. Availability of aftercare Availability of detox services X Availability of stabilisation/crisis services Challenges accessing additional sources of funding Current models are not working Difficulty identifying all those who will benefit Further workforce training required X Geographic distance X Insufficient base funding Insufficient staff Lack of awareness of residential rehabilitation among potential clients and referrers X Lack of bed capacity within ADP area Lack of specialist providers X Lack of transport to travel to available capacity X Waiting times No barriers Other (255-word limit) 29. Have you made any revisions in your pathway to residential rehabilitation in the last year? No revisions or updates made in 2025/26 X Yes - Revised or updated in 2025/26 and this has been published Yes - Revised or updated in 2025/26 but not currently published 30. If yes, please provide brief details of the changes made and the rationale for the changes. (4000-word limit) Moray ADP has continued to review and strengthen its residential rehabilitation pathway during 2025/26 to improve accessibility, consistency and outcomes for people seeking support. Page 343
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Alcohol and Drug Partnership Survey 2026 Page 17 of 24 Building on work undertaken in previous years, the pathway has been further developed in line with the Scotland Excel National Flexible Framework, providing access to a wider range of residential rehabilitation providers and improving choice for individuals. The pathway continues to operate through a third sector direct access model via Arrows, Moray's commissioned direct access service, helping to reduce barriers to access and providing a single, consistent route into residential rehabilitation. A dedicated Residential Rehabilitation Link Worker remains in place to support individuals throughout the process, including assessment, preparation, referral, admission, transition into rehabilitation and return to the community. This has helped strengthen engagement, improve continuity of support and ensure people receive person-centred guidance throughout their rehabilitation journey. The pathway has also been strengthened through the establishment of a multi-agency Residential Rehabilitation Management Group, involving partners from health, social work, commissioned services, public protection and the ADP. This group provides oversight of referrals, pathway development, quality improvement activity and outcomes, helping ensure that access to residential rehabilitation remains transparent, equitable and responsive to local need. Healthcare Improvement Scotland's Residential Rehabilitation Quality Improvement Programme has informed local pathway development, including completion of self-assessment activity and implementation of improvement actions. Feedback from people with lived and living experience, families and practitioners has continued to shape pathway development and identify opportunities to improve access, communication and support. Significant work has also been undertaken to strengthen support before, during and after residential rehabilitation. This includes the development of pre-habilitation support, improved planning prior to admission, stronger links with community recovery supports and increased focus on aftercare and sustained recovery following discharge. The pathway recognises that successful rehabilitation extends beyond the residential placement itself and requires ongoing support within the community. The pathway continues to be reviewed and refined in response to emerging needs. During 2025/26, a referral involving a 16-year-old young person highlighted the need to further consider how the pathway supports younger people requiring access to residential rehabilitation. As a result, further revisions are underway to ensure the pathway better reflects the needs of children and young people, strengthens links with children's services and family support, and provides clearer guidance for partners when responding to complex cases involving younger people. These developments have been undertaken to ensure that people affected by substance use in Moray can access residential Page 344
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Alcohol and Drug Partnership Survey 2026 Page 18 of 24 rehabilitation through a clear, consistent and person-centred pathway that is informed by evidence, rights-based approaches and lived and living experience. The overall aim has been to reduce barriers, improve access, strengthen outcomes and ensure that residential rehabilitation forms part of a wider recovery-oriented system of care. 31. Which, if any, of the following barriers to implementing the Medication Assisted Treatment (MAT) standards exist in your area? Select all that apply. X Accommodation challenges (e.g. appropriate physical spaces, premises, etc.) X Availability of stabilisation/crisis services Burden of data collection and reporting X Challenges engaging with GPs Further workforce training is needed X Geographical challenges (e.g. remote, rural, etc.) X Insufficient funds X Insufficient staff Lack of awareness among potential clients Lack of capacity Scope to further improve/refine your own pathways Waiting times No barriers Other (255-word limit) 32. Which of the following treatment and support services are in place specifically for children and young people using alcohol and/or drugs? Select all that apply. Note: some treatment and support options are not applicable for some age groups. Up to 12 years (early years and primary) 13-15 years (secondary S1-4) 16-24 years (young people) Alcohol-related medication (e.g. acamprosate, disulfiram, naltrexone, nalmefene) X Diversionary activities X X Employability support X Family support services X X X Information services X X X Justice services X X Mental health services (including wellbeing) X X X Opioid Substitution Therapy X Page 345
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Alcohol and Drug Partnership Survey 2026 Page 19 of 24 Outreach/mobile (including school outreach) X X X Recovery communities X X Support/discussion groups (including 1:1) X X X No treatment and support services 33. How would you describe your ADP’s position as at end 2025/26 in relation to the Standards for young people accessing treatment or support for alcohol or drugs, published in December 2025? Not yet considered Awareness only (shared / circulated, no further consideration yet) Initial consideration or discussion has taken place X The Standards are beginning to inform thinking about pathways/priorities/commissioning frameworks Local arrangements already broadly align with the Standards Other (255 word limit) Section 10 - Quality of life is improved by addressing multiple disadvantages 34. Do you have specific treatment and support services in place for the following groups? (that are available in your ADP area). Select all that apply. X People who are non-native English speakers X People from minority ethnic groups X People from religious groups X People who are experiencing homelessness X People who are involved in the justice system X People who are LGBTQI+ X People who are neurodivergent X People who are pregnant or peri-natal X People who engage in transactional sex X People with hearing impairments and/or visual impairments X People with physical disabilities X People with long-term health conditions X People with learning disabilities and literacy difficulties X Veterans X Women None of the above Other (255 word limit) Page 346
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Alcohol and Drug Partnership Survey 2026 Page 20 of 24 35. Are there formal joint working protocols in place to support people with co- occurring substance use and mental health diagnoses to receive mental health care? X Yes No 36. What arrangements are in place within your ADP area for people who present at substance use services with mental health problems for which they do not have a diagnosis? Select all that apply. Dual diagnosis teams X Formal joint working protocols between mental health and substance use services specifically for people with mental health problems for which they do not have a diagnosis X Pathways for referral to mental health services or other multi- disciplinary teams X Pathways for referral to third sector services for mental health support X Professional mental health staff within services (e.g. psychiatrists, community mental health nurses, etc) Provision of joint appointments for those with co-occurring mental health problems and problem substance use X Provision of mental health assessments for people who are presenting with mental health problems No arrangements Other (255 Words) 37. Which of the following activities are you aware of having been undertaken in ADP funded or supported services to implement a trauma-informed approach? Select all that apply. X Engaging with people with lived/living experience X Engaging with third sector/community partners X Provision of trauma-informed spaces/accommodation Presence of a working group X Recruiting staff X Training existing workforce None of the above Other (255 Words) 38. Does your ADP area have specific referral pathways for people to access independent advocacy? X Yes No Don’t Know Page 347
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Alcohol and Drug Partnership Survey 2026 Page 21 of 24 39. If yes, are these commissioned directly by the ADP? X Yes No Don’t Know Section 11 - Children, families, and communities affected by substance use are supported 40. Which of the following treatment and support services are in place for children and young people affected by a parent’s or carer’s substance use? Note: Some treatment and support options are not applicable for some age groups. Select all that apply. Up to 12 years (early years and primary) 13-15 years (secondary S1-4) 16-24 years (young people) Advocacy X X X Carer support X X X Diversionary activities X X X Employability support X Family support services X X X First aid training X Information services X X X Mental health services X X X Outreach/mobile services (including school outreach) X X X Social work services X X X Support/discussion groups X 41. Which of the following support services are in place for adults affected by another person’s substance use? Select all that apply. X Advocacy X Commissioned services X Counselling X One to one support X Mental health support X Naloxone training X Support groups X Training None of the above Other (255 Words) Page 348
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Alcohol and Drug Partnership Survey 2026 Page 22 of 24 42. Do you have an agreed set of activities and priorities with local partners to implement the Holistic Whole Family Approach Framework in your ADP area? X Yes No Don’t Know 43. Please provide details of any new developments or changes to these activities and priorities for 2025/26. (4000 Word limit) Moray ADP continues to work closely with local partners to implement the Holistic Whole Family Approach Framework and strengthen support for children, young people, adults and families affected by substance use. During 2025/26, work has continued to build on existing family support arrangements, with a focus on improving partnership working, strengthening family-inclusive practice and ensuring that the voices of family members are reflected in local planning and service development. Family support remains available through commissioned services, including specialist family support and bereavement services, peer support opportunities and wider community-based support. A key priority during the year has been strengthening links between alcohol and drug services, children's services, education, health and third sector partners. This has included continued development of pathways and partnership arrangements to ensure that children, young people and families can access support at the earliest opportunity and receive coordinated responses across services. Moray has also continued to support Recovery Together events and wider engagement activities which bring together people with lived and living experience, family members, carers, community organisations and services. These events provide opportunities for learning, sharing experiences and identifying areas for improvement, whilst helping to ensure that family voice remains central to local development work. The implementation of the Charter of Rights for People Affected by Substance Use and the development of the Moray Charter of Rights Toolkit have further strengthened our rights-based approach to family- inclusive practice. Families and people with lived and living experience have contributed to the development of resources, events, service improvement activity and local priorities, helping to ensure that services are informed by real experiences. During 2025/26, Moray has also continued work to strengthen support for children and young people affected by substance use through implementation of the Young People's Substance Use Pathway and consideration of the Standards for Young People Accessing Substance Use Services. This has supported closer working between partners and a greater focus on ensuring services are responsive to the needs of young people and families. Page 349
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Alcohol and Drug Partnership Survey 2026 Page 23 of 24 A significant development during the year was the identification of a young person requiring consideration for residential rehabilitation. This highlighted the importance of ensuring that pathways adequately reflect the needs of children and young people and has informed ongoing review and development of local pathways, including closer links with children's services and family support. Family-inclusive practice continues to be embedded within commissioned service expectations, contract monitoring arrangements and service improvement activity. Partners continue to work together to identify opportunities to strengthen support for families, improve access to services and ensure that families are recognised as partners in recovery wherever appropriate. 44. Did your ADP conduct an audit or needs assessment of the support currently available in your area for children, young people and adults affected by a family member’s substance use in 2025/26? Yes No, and there are no plans to undertake one in 2026/27 X No, but there are plans to undertake one in 2026/27 45. Which of the following services supporting a Family Inclusive Practice or a Whole Family Approach are in place in your ADP area (for people with family members both in and not in treatment)? Select all that apply. X Advice X Advocacy X Benefits and debt advice X Mentoring X Peer support X Personal development X Social activities X Support for self-care activities X Support for victims of gender based violence and their families X Youth services None of the above Other (255 word limit) 46. What mechanisms are in place within your ADP area to ensure that services adopt a family inclusive practice? Select all that apply. X Asked about in their reporting X Prerequisite for our commissioning X Regular training provided to services Page 350
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Alcohol and Drug Partnership Survey 2026 Page 24 of 24 No mechanisms in place Other (255 word limit) Confirmation of sign off 47. Submissions should be signed off by the ADP. As the survey has been issued later than in previous years, we recognise this may affect the timing of approvals at ADP meetings, and that it may therefore not be feasible to obtain sign-off before the 10 July submission deadline. Please confirm whether your return has been signed off; if not, provide an expected sign-off date where possible at Q48. ADP IJB Signed off X Not yet signed off 48. Please provide sign off date or anticipated sign off date. (4000 word limit) 24th September for the IJB Page 351
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