Agenda Document Pack - Midlothian Integration Joint Board - 09/10/2025
Midlothian Council · 9 October 2025
Back to Midlothian Integration Joint Board — 9 October 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Normandy Court/ Hybrid, Normandy Court, 20 Normandy Dr, Dalkeith, EH22 1JG Date: Thursday, 09 October 2025 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Democratic Services Clerk Telephone: 0131 271 3160 Clerk Email: democratic.services@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 236
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1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting 4.1 Minutes of previous Midlothian IJB Board Meeting held on 21st August 2025 (14:05-14:10) 5 - 22 4.2 Minutes of Strategic Planning Group on 24th July 2025 23 - 30 4.3 Minutes of Audit and Risk Committee held on 4th September will be presented to Board in December 2025 5 Public Reports 5.1 Chair’s Update – Val de Souza, Chair (14:10-14:20) 5.2 Chief Officer Report – Morag Barrow, Chief Officer (14:25-14:50) 31 - 36 5.3 Strategic Planning Group Update – Andrew Fleming, Strategic Planning Group Chair (14:50-14:55) 5.4 Audit and Risk Committee Update – Councillor Connor McManus 5.5 Midlothian IJB Membership Recommendations - Democratic Services (for noting and approval) (14:55-15:00) 37 - 42 For Decision 5.6 Midlothian IJB Strategic Plan 2025-2035: Final recommendation to approve and publish - Paper presented by Morag Barrow, Chief Officer (15:00-15:05) 43 - 120 For Discussion 5.7 Midlothian IJB draft Participation and Engagement Statement 2025-2028 - Paper presented by Gill Main, Integration Manager (15:05-15:10) 121 - 140 Page 2 of 236
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5.8 Midlothian IJB Performance Update – Paper presented by Gill Main, Integration Manager (15:10-15:20) 141 - 180 5.9 Midlothian Integrated Assurance Report - Paper by Fiona Stratton, Chief Nurse, Claire Ross, Chief AHP, Nick Clater, Head of Adult Services and Chief Social Work Officer & Roxanne King, Executive Business Manager, presented by Fiona Stratton, Chief Nurse (15:20-15:30) 181 - 224 5.10 Midlothian and East Lothian Drug and Alcohol Partnership Annual Report - Presentation by Nick Clater, Head of Adult Services and Chief Social Work Officer (15:30-15:50) 5.11 Public Health Update – Weight Stigma and Bias Training Programme - Paper presented by Jacqueline Kirkland, Public Health Practitioner (15:50-15:55) 225 - 232 5.12 Midlothian HSCP Unscheduled Workstream Update - Presentation by Morag Barrow, Chief Officer on behalf of Grace Cowan, Head of Older People and Primary Care Services (15:55- 16:00) For Noting 5.13 East Lothian and Midlothian Public Protection Committee Annual Report - Paper provided by Nick Clater, Head of Adult Service and Chief Social Work Officer, Midlothian HSCP 233 - 236 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on Thursday 11th December 2025, from 14:00-16:00. This meeting will be held at Normandy Court. Please note that this meeting will follow an IJB Board Development session held on Thursday 13th November 2025 from 14:00-16:00 at Normandy Court. This meeting is for Board Members only. Page 3 of 236
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 21 August 2025 14:00 Virtual Meeting, Microsoft Teams Present (voting members): Val de Souza (Chair, NHS) Councillor McManus (Vice Chair) Dr Amjad Khan (NHS Lothian) Councillor Parry Councillor Milligan Councillor Winchester Heather Campbell (NHS Lothian) Present (non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Nick Clater (Head of Adult Services and Chief Social Work Officer) Fiona Stratton (Chief Nurse) Claire Ross (Chief Allied Health Professional) Dr Rebecca Green (Clinical Director) Grace Chalmers (Partnership Representative) Magda Clark (Third Sector Representative) Dr Wendy Metcalfe (Medical Practitioner) Keith Chapman (Lived Experience Member) Jay Johnson (Lived Experience Member) / Leigh Thomson (Jay’s Support Worker) Midlothian Integration Joint Board Thursday 9 October 2025 Item 4.1 Page 5 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Apologies: Jim Sherval (Consultant in Public Health) Fiona Kennedy (Group Service Manager) Andrew Fleming (NHS Lothian) 1. Welcome and Introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB). 2. Order of Business The order of business was confirmed as outlined in the agenda previously circulated. The Chair noted the apologies submitted by The Strategic Planning Group Chair, Group Service Manager and Consultant in Public Health. 3. Declarations of Interest The Chief Officer welcomed Heather Campbell, Jay Johnson and Leigh Thomson to the meeting. Keith Chapman made a declaration of interest as the Co-Chair for Alzheimer Scotland. In attendance: Gill Main (Integration Manager) Roxanne King (Executive Business Manager) Elouise Johnstone (Performance Manager) Hannah Forbes (Democratic Services) Louise Middleton (Democratic Services) Page 6 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board 4. Minute of Previous Meetings 4.1 The Minute of previous Midlothian IJB Meeting held on 12th June 2025 was approved as an accurate record. 4.2 The Minute of the meeting of the MIJB – Strategic Planning Group held on 22nd May 2025 was noted by the Board. 4.3 The Minute of the meeting of the MIJB – Audit and Risk Committee: There have been no meetings since the last Midlothian IJB Board meeting. 5. Public Reports Decision Action Owner Date to be Completed/ Comments 5.1 Midlothian IJB Member Appointment - Democratic Services, presented by Louise Middleton Democratic Services presented the report. The purpose of this report is to note and approve the appointment of Val de Souza as Chair of the Midlothian Integration Joint Board following their nomination at the meeting of NHS Lothian Board on 27 June 2025 and the nomination of Councillor Connor McManus, as the Vice Chair of the Midlothian IJB following their nomination at the meeting of Midlothian Council on 24 June 2025. This report also asks Board members to note and endorse the reappointment of Dr Rebecca Green as a non-voting member of Midlothian IJB. The report was noted and approved by the Board. Page 7 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments As a result of this report, members were asked to: • Note and endorse the appointment of Val de Souza as Chair of the Midlothian IJB from the tenth anniversary of the establishment of the Integration Joint Board in August 2025 until the twelfth anniversary of the Integration Joint Board, • Note and endorse the appointment of Councilor Connor McManus as Vice-Chair of Midlothian IJB from the tenth anniversary of the establishment of the Integration Joint Board in August 2025 until the Local Government Elections in May 2027, and • Note and endorse the reappointment of Dr Rebecca Green as a Non-Voting Member of Midlothian IJB, from 18 July 2025 for a further 3-year term. The Board noted and approved the recommendations/nominations in the report. 5.2 Chair’s Update – Val De Souza, Chair The Chair opened the meeting by noting the Development Session and the Special Integration Joint Board that is due to take place on Thursday 18th of September 2025, will be held in Normandy Court with the option of joining virtually. It was noted that the Development Session is an opportunity for NHS Lothian and Midlothian Council to discuss issues and risks to non-delegated functions that may impact on the delegated functions. The Chair also noted the Non-Executive Directors NHS development day on Thursday 2nd of October 2025. The purpose of this meeting is to review the 4 new polices from the Scottish Government regarding the Health and Social Care Reform and Public Sector Reform. It has been requested that a report on primary and community care to be included, this is to highlight the importance of priorities, pressures, challenges and opportunities in the community and to inform any transformational policies or the national direction of the Scottish Government. Page 8 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 5.3 Chief Officers Report – Morag Barrow, Chief Officer The Chief Officer presented the report and advised the paper sets out the key strategic updates for the August 2025 MIJB meeting. As a result of this report Members were asked to: • Note the content of the report. The Chief Officer highlighted the 3 key points of the report. The first key point to highlight was the continuation of Gold and Silver infrastructure around mental health services, focusing on the Royal Edinburgh Hospital as part of the system wide improvement programme. There are challenges for all areas around the complex accommodation that is referred to as “grade 5 accommodation” that has been highlighted, with a system wide piece of work that has been picked up as part of the Gold infrastructure being led by the Chief Officer from Edinburgh Integration Joint Board to look at the accommodation opportunities across the region. The Second point that was highlighted to the Board was in relation to the request from the Scottish Government to adopt the use of the Midlothian IJB’s Strategic Governance Map as part of the Scottish learning approvement framework. The Chief Officer recognised the good work that has been undertaken by officers of Midlothian Health and Social Care Partnership (HSCP) to develop this governance structure. The last point was in relation to the successful funding bid from the Dietetics Service to a national programme to develop a digital triage and assessment tool for the support of the weight management pathway. The Chair thanked the Chief Officer for the report and opened to any questions from the Board. After some detailed discussion the Board noted weight bias and the action that has been taken to reduce the stigma. The Board hoped that it can be publicised to make it clear to the community and staff that the Page 9 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Board acknowledge the ongoing issue with stigma towards weight loss. Frailty was highlighted by the Board, noting work to support people continuing to live well at home. The upcoming ‘community appointment days’ were highlighted by the Board, noting the ambition to move from ‘consultation to conversation’ and it was asked if that is a message we are trying to get out to every team. The Clinical Director advised the Board that the interventions that are being put in place are all evidence based. The Chief AHP explained that learning and evaluation following the community appointment day is front and centre, and that it is critical to take any learning forward. What has been evidenced already is many professionals and individuals are recognising the difference that they can create for themselves. It was lastly noted this work is part of the transformation and change agenda, and that community assets are the foundation of that work. The Board continued their discussion, and it was queried whether the “café drop-in” described in the service update was in replacement of a methadone clinic. The financial pressures in Local Authorities and the impact of Midlothian Council’s financial position on future budget offers to the IJB were often not well understood and the public may not be aware of the pressures Midlothian Council faces to fund the IJB. It was highlighted by the Board the pressures on Officers, noting that there is a need for regular communication with the Scottish Government regarding the immense pressure for funding. The Head of Adult Services and Chief Social Work Officer explained that the “café drop-in” is the provision of treatment that supports people to stop drug use. Generally, the café drop-ins are peer-led and are there to support people with treatments like Buvidal. It was explained to the Board that although Buvidal is more expensive, it is far more effective than methadone. Page 10 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chief Finance Officer noted the requirement to publish the financial pressures and the challenges the IJB are facing, and noted the strong and collaborative relationship between the IJB and Midlothian Council. Additionally, the national data has been reviewed and Officers are working with partners to test local assumptions that factor in the demographic growth we can predict. The Chief Officer noted that a paper is being developed by the Chief Finance Officer and the Integration Manager with projections that highlight the challenges the IJB are facing. The Chief Finance Officer also proposed an action to work with Midlothian Council’s Director of Finance to review these challenges. The Chief Officer explained that the HSCP team has received recent information that will be included in the new Midlothian Local Development Plan (MLDP). The team will report back regarding the demographic impact in terms of cost. In terms of linking up the governance, Midlothian Council now report on the IJB’s financial position through the key finance papers that are presented at the Midlothian Council meeting. The Chair suggested that a development session to review the financial position in light of demographic pressures and potentially ‘transitions’ may be helpful to facilitate consistent discussion that can be updated when necessary. The Board discussed the prescribing of weight management medications and that the costing of the medication that has risen by 170% noting that this will have an impact on how much can be prescribed and the prescribing budget. The Board asked if the impact of early discharge on primary care teams is being considered. The Chief Officer explained the cost of the weight management drugs is significant, and that the early intervention and prevention is key to shift the balance of care and the resource. NHS Lothian are developing a pathway that is being reviewed by the relevant governance structures and making good progress. The Clinical Director added that there have been a few anecdotal reports where tasks have been The Chief Finance Officer to work with the Council Director of Finance to gain an understanding and how the IJB can address challenges that are being faced. provide the IJB with a presentation on finance and demography Chief Finance Officer Integration Manager and Chief Finance Officer Ongoing November 2025 Page 11 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments passed back to General Practitioners (GPs), however it was noted that this is just early learning and unlikely to continue over time. The discussion then moved to the timeline of when the Scottish Government allocate their budgets which coincides with Midlothian Council’s December meeting. It was noted that Midlothian Council generally receive indicators in November. The Chair noted an action for themselves, the Chief Officer and the Chief Finance Officer to take matter away for further discussion and development. The Chair also recognised the additional financial support that Midlothian Council contributed last year to the IJB. Lastly, the meeting discussed the national suggestion to engage with the Third sector and move towards peer connecting. Work is ongoing with the Scottish Recovery Network promoting the peer sessions. However it was noted that where peer connecting is effective and is imbedded in communities, national trends show there still needs to be an financial support to see positive results. The Chair asked if this conversation could be continued at the next meeting of Strategic Planning Group (SPG), as this would be helpful to bring back to the Board. The Chair thanked the Board for the discussion. The Chair, Chief Office and Chief Finance Officer to discuss further Midlothian Councils Budget allocation. Chair Page 12 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 5.4 Strategic Planning Group Update – Andrew Fleming, Strategic Planning Group Chair, presented by the Integration Manager. The Integration Manager presented the main activity of the SPG since the last Board. In the absence of the SPG Chair, the Integration Manager provided a brief update to the Board confirming that much of the work of SPG is presented as part of the agenda today. However, it was also noted that the work on the Midlothian IJB Carers Strategy 2025-2028 is well underway and should be presented to the Board in December for approval following SPGs review in September and November 2025. 5.5 Audit and Risk Committee Update – Val de Souza, Chair The Chair advised that there are no updates due to no meetings having been held since the Board last met. For Decision 5.6 Midlothian IJB draft Strategic Plan 2025-2035: Review of Final Draft and full suite of statutory publications - Paper presented by Gill Main, Integration Manager The Integration Manager advised that this report sets out the actions and progress to date in relation to the development of Midlothian Integration Joint Board’s draft Strategic Plan for 2025-2035 and presents a revised fourth draft plan (appendix 1) following public consultation and feedback from Partners, in line with the Strategic Plan Statutory Guidance. As a result of this report, Members are asked to: The Board noted and approved the report. Page 13 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments • Review and provide feedback on the draft Midlothian draft Strategic Plan 2025-2035 and suite of statutory publications, and • Subject to any amendment, approve this draft plan and the accompanying statutory documents to progress through the final stages of governance. The Chair noted that this has been such a long journey and commended the Integration Manager on the report. The chair opened to any questions from the Board. A detailed discussion took place in which the Board raised questions relating to the housing contribution statement. They asked whether the IJB makes any direct contributions to private developments, whether it is possible to request specific types of properties such as bungalows and whether measures should be in place to ensure that more adaptable properties are available. The Chair highlighted the Mental Health Pathway and accommodation that is detailed in the report and noted that there could be a small list of things the IJB could helpfully discuss with the Council Housing and Transformation members. The Integration Manager clarified to the Board that the IJB have no direct role in housing other than aids and adaptation but Officers have worked alongside the Midlothian Council Spatial Planning team to provide evidence as part of the Midlothian Land Development Plan (MLDP2) . A shortlist of housing types of builds has been released and the Integration Manager will continue to highlight the challenges that this significant increase in population will bring. In relation to the Chair’s point of the Mental Health Pathway, it was noted to the Board that the Head of Adult Services and Chief Social Work Officer are bringing an item to the agenda in October to discuss the work that is ongoing around the residential pathway. Page 14 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Board continued their discussion, and it was highlighted that only 37% of the public were receiving access to the services that they require. It was asked what the opportunities are in the transformation plan are to improve that statistic. The performance indicators were noted, the Board expressed that there is limited information about General Practices and queried if there was an opportunity there to look at how well Midlothian are doing. The Clinical Director advised the Board that Midlothian are moving forward, and the situation is improving. It was highlighted that the data Midlothian have is limited, as we do not have access to the local data that is still under development. The Chief Officer highlighted to the Board one of key fundamentals to the transformation is the development of a Community Front Door (CFD), the aspiration for developing the CFD is to develop a multi- agency front door, where we can provide access for people to self-present or professionals to refer at an early stage before they need the statuary care. The Integration Manager noted that in relation to early intervention and prevention, integrated data to establish what can we best do now is being developed following the Board commission in April 2024 subsequent issue of Directions in this regard. Currently the work is in the final stage of quality planning and anticipated to provide predictions and projections that will use integrated data in new ways. The Chair advised of some small edits to the Strategic Plan that that they would submit in writing to the Integration Manager. The Board noted and approved the report. Page 15 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 5.7 Midlothian IJB Annual Performance Report (APR) - Paper by Gill Main, Integration Manager, presented by Elouise Johnstone, Programme Manager for Performance and Improvement The Programme Manager for Performance and Improvement presented the report. This report presents a final draft of the Midlothian Integration Joint Board (IJB) Annual Performance Report (APR) 2024/25), and includes the validated data released by Public Health Scotland (PHS) in July 2025. As a result of this report, Members are asked to: • Review this final draft of the Midlothian IJB Annual Performance Report (APR) 2024/25, • Subject to any amendments, approve the Midlothian IJB Annual Performance Report (APR) 2024/25, and • Give delegated authority to the Integration Manager to publish the Midlothian IJB Annual Performance Report (APR) 2024/25 by Friday 29th August 2025. Due to time constraint of the Agenda, the Chair requested agenda items 5.7 and 5.8 be discussed together. The Board and Programme Manager agreed to this request. The Chair thanked the Programme Manager for the report and opened for any questions from the Board. It was highlighted by the Board, in the executive summary Midlothian’s data is not always in line with national data averages and asked if there was an opportunity to add more information on why this is the case. It was further noted by the Board that the 9 National Health and Wellbeing outcomes consist of several national indicators with individual performance, and asked if there was a collective score. The Programme Manager for Performance and Improvement noted that due to the way the metrics are gathered, it is difficult to be clear why Midlothian’s data does not always follow the national average data. Approved to Publish To provide more Integration Manager Heads of Service, 30/08/2025 August 2026 Page 16 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments However, to try and make clearer the opportunities for change, a sub set of statements that describe the expected experiences within each outcome have been included in the APR and mirrored in the annual survey. The Integration Manager also noted that the aggregation of each Health and Wellbeing Outcomes was presented in the appendix of item 5.8 within Column 6 of the Midlothian IJB Strategic Governance Map ‘What Difference Does This Make’ for the Board’s consideration. The Chief Officer advised that Officers will consider the comments made by the Board and provide further operational detail in the Annual Performance Report 2025/26. The Board noted and approved the recommendations in the report. information on where Midlothian’s performance is lower than National averages. Programme Manager for Performance and The Chief Officer For Discussion 5.8 Midlothian IJB Performance Update - Paper by Gill Main, Integration Manager and Elouise Johnstone, Programme Manager for Performance and Improvement, presented by Elouise Johnstone, Programme Manager for Performance and Improvement The Programme Manager for Performance and Improvement detailed the purpose of this report is to provide an update on progress towards the Midlothian IJB performance goals set for the period 2023-2025 and Column 6 of the Midlothian IJB Strategic Governance Map; ‘What Difference Does This Make’. As a result of this report, members were asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023-25, • Note the inclusion of the narrative under each of the 9 National Health and Wellbeing Outcomes discussed in the Midlothian IJB Annual Performance Report 2024/25 within Column 6 of the Midlothian IJB Strategic Governance Map ‘What Difference Does This Make’ Page 17 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments • Review and endorse the overall progress rating proposed for the 9 stepping stones within Column 6 of the Midlothian IJB Strategic Governance Map ‘What Difference Does This Make’ The Chair thanked the Programme Manager for both of the reports. The chair opened to any questions or comments from the Board. The Chair noted that some members of the Board have had difficulty opening the Annual Performance Report that was attached to the agenda. Democratic Services have re-circulated this to Board Members, however if any Board Members have not had the opportunity to read, any comments can be sent to the Programme Manager for Performance and Improvement within the next 2 days. The Board noted the recommendations in the report. 5.9 Midlothian IJB Finance Update - Paper presented by Chris King, Chief Finance Officer The Chief Finance Officer presented the report detailing the purpose of the paper is to update members on the 2025/26 financial position including both the financial forecast for quarter one and the progress against the agreed financial recovery actions. As a result of this report, members were asked to: • Note the delivery of financial recovery actions in 2025/26, • Note the quarter one 2025/26 forecast financial position, and • Consider the risks laid out in Section 8. The Chair thanked the Chief Finance Officer for the report and opened to the Board for any questions. Page 18 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Board had a discussion highlighting a recent open letter in a national newspaper that stated many Third Sector organisations have utilised reserves to balance the budget and noted the risk for providers. The Board discussed the 3rd sector providers and noted the financial position. The Chief Officer expressed the paper states the main financial pressure in the social care budget is the resource panel. The HSCP team are meeting tomorrow to review the projected pressures and the financial recovery plan. The Board acknowledged the work of the HSCP Officers in challenging circumstances. The Board noted the recommendations in the report. The HSCP team to review the financial recovery plan. Chief Finance Officer November 2025 5.10 Midlothian Unscheduled Care Workstream Update - Presentation by Morag Barrow, Chief Officer on behalf of Grace Cowan, Head of Older People and Primary Care Services The Chief Officer noted the time constraints for this meeting and asked the Board if they would approve the presentation to be carried forward to the next Board Meeting. The Chief Officer will still share key updates from the presentation with the Board today. The Board agreed to proceed with the key updates and to be shown the presentation at the next Board Meeting. The Chair added that it would be more helpful to defer this to the next meeting to allow time for discussion. The Chief Officer noted that Lothian’s performance is improving around delayed discharges, unscheduled care, occupied bed days and people who live with frailty being discharged from hospital within 48 hours as evidenced in the presentation. The Chief Officer detailed Midlothian’s performance advising that the number of unscheduled care patients that have been discharged within 72 hours has improved, discharge Page 19 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments of patients from the acute medical unit within the 72 hours has increased, and the daily occupied bed days are reducing. The Chief Officer lastly highlighted to the Board the performance position detailed in the presentation, acknowledging the significant improvement over the summer period. 5.11 Midlothian and East Lothian Drug and Alcohol Partnership Annual Report - Presentation by Nick Clater, Head of Adult Services and Chief Social Work Officer The Chair asked if the Head of Adult Services and Chief Social Work Officer would be happy to defer this presentation to the next meeting due to time constraints. The Head of Adult Services and Chief Social Work Officer agreed to defer the presentation and added that by the next meeting of Midlothian IJB, they would hope to have the 2024 drug death figures published and that will allow more discussion around that topic. For Noting 5.12 Midlothian IJB Annual Review of IJB Governance Position - Paper provided by Gill Main, Integration Manager The Integration Manager advised that the report outlines the key actions required to ensure the statutory governance obligations of Midlothian Integration Joint Board are fulfilled. A range of statutory governance requirements activities are being progressed throughout 2025/26. The Midlothian Integration Joint Board will continue to monitor governance arrangements, undertaking review and update as necessary. As a result of this report Members were asked to: Page 20 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments • Note the key areas of progress and proposed ongoing actions. • Highlight any areas of concern and propose any required amendments. The Chair thanked the Integration Manager for the report and opened to any questions from the Board. The Chair drew attention to the Register of Interest, noting the ongoing difficulty in securing responses. The Integration Manager advised that there remains a minor discrepancy between Chief Interal Auditors view of the requirements and that of Audit Scotland. Work is being taken forward by the Audit and RiskCommittee to resolve this issue and will result in either two, or four registers of interest remaining outstanding. The Chair took an action to support conversations with members to progress the completion of the registers of interests. The Chair further highlighted the Carers Strategy, noting concern that it may not be delivered by the end of 2025, it was requested than an action to be taken forward to bring a report back to the IJB outlining the reasons for the delay and the challenges encountered. The Chair queried whether the Audit and Risk Committee had sufficient capacity to manage its allocated workload. The Integration Manager assured the Chair that the work is distributed appropriately across the Strategic Planning Group and the Audit and Risk Committee confirming that the Audit and Risk Committee is Governance Committee of the Board with all tasks well in hand. The Chief Finance Officer agreed that there is a large volume of work for the Audit and Risk Committee to get through however, the workload is achievable. Any issues arising these will be reported back to the IJB. The Chair to follow up with members of the Board on completing the registers of interest. The Audit and Risk Committee to provide a report if registers of Interest have not been received . Chair Chief Finace Officer October 2025 December 2025. Page 21 of 236
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Thursday 21st August 2025 Midlothian Integration Joint Board 5 Private Reports No items for discussion. 6 Any Other Business No items for discussion. 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board is a Special Board meeting and will be held on: Thursday 18th September 2025, from 15.00 – 16.00. This meeting will be held at Normandy Court. Please note: that this meeting will follow an IJB Board Development Session also Thursday 18th September 2025 from 14.00 – 15.00 (at Normandy Court) that is for Board Members only. Meeting concluded at 15:57pm Page 22 of 236
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Midlothian Integration Joint Board Midlothian Integration Joint Board Thursday 9 October 2025 Item No 4.2 Meeting Date Time Venue Special Strategic Planning Group Thursday 24 July 2025 13.30 PM MS Teams Meeting Present (Midlothian IJB Members): Andrew Fleming (Chair) Morag Barrow, (Chief Officer) Chris King, (Chief Financial Officer) Dr Amjad Khan Colin Small Keith Chapman Present (Health and Social Care Partnership (HSCP) and Partners): Gill Main, Midlothian HSCP (Integration Manager) Elouise Johnstone, Midlothian HSCP Programme Manager (Performance) Dr Rebecca Green, Midlothian HSCP (Clinical Director) Fiona Kennedy, Midlothian HSCP (Group Service Manager) Roxanne King, Midlothian HSCP (Executive Business Manager) Nick Clater, Midlothian HSCP (Head of Adult Services & Chief Social Work officer) Claire Ross, Midlothian HSCP Chief Allied Health Professional (AHP) Jim Sherval, NHS Lothian (Consultant in Public Health) Page 23 of 236
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Laura Hill, (VOCAL) Lara Williams, Midlothian HSCP (Assistant Strategic Program Manager) Maria Perez, (Democratic Services) Apologies: Councillor Connor McManus Councillor Pauline Winchester Fiona Stratton, Midlothian HSCP (Chief Nurse) Magda Clark, Third Sector Representative Annette Lang, Midlothian Council (Group Service Manager) 1. Welcome and Introductions The Chair welcomed everyone to this special meeting of the Midlothian Integration Joint Board (IJB) Strategic Planning Group (SPG) and noted the apologies for the meeting. The Chief Allied Health Professional noted they would be leaving the meeting after one hour due to another engagement. Keith Chapman and Laura Hill, (Vocal) reported that they had not received papers ahead of the meeting. 2. Order of Business The Chair advised that the order of business was as set out in the agenda. 3. Minutes of Previous Meeting and Action Log 3.1 The minutes of the Strategic Planning Group of 22 May 2025 were approved as an accurate record. Page 24 of 236
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3.2 Action log The action log was presented by the Assistant Strategic Programme Manager and members reviewed the outstanding and completed actions. Members agreed for completed actions to be moved to closed. The Chief Finance Officer provided an update in relation to Action no. 17 on the revised risk register including additional risk and mitigation updates. This will be submitted to the SPG meeting on 25 September and every second meeting thereafter. 4. Updates Report Title/Summary Decision Action Owner Date to be Completed/Commen ts 4.1 Chair’s Update The Chair provided a verbal update and advised that the Vice Chair role will be filled by Magda Clark, Third Sector Representative. It was recognised that this will allow closer collaboration between the IJB and the third sector and better outcomes. The Chair advised that the SPG hybrid meetings are expected to resume from September 2025 at Normandy Court. Instructions on location and access will be shared with SPG members once arrangements have been finalised. 5. Public Reports Page 25 of 236
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Report Title/Summary Decision Action Owner Date to be Completed/Commen ts 5.1 Design and Development Strategic Plan 2025-2035 – Gill Main, Integration Manager. The Integration Manager gave a short verbal update on the Midlothian IJB draft Strategic Plan 2025-2035 and noted recent feedback from Midlothian Council Corporate Management Team (CMT) had been considered and incorporated. The Integration Manager highlighted the Midlothian IJB draft Market Facilitation Plan 2025-2028, noting this being the first Market Facilitation Plan produced by Midlothian IJB and the links in this plan to the HSCP Commissioning and Third Sector Transformation workstream. The Integration Manager further highlighted the Midlothian IJB draft Housing Contribution Statement 2025-2028 in the context of Midlothian IJB’s delegated responsibility for aids and adaptations only. The Integration Manager highlighted the extensive consultation and engagement activity described in the Consultation and Engagement Statement. The Chair thanked the Integration Manager and invited feedback. Members were unanimous in recommending the Midlothian IJB draft Strategic Plan 2025-2035 and accompanying statutory documents to the Board for review. The Chair noting the significant Midlothian IJB draft Strategic Plan 2025-2035 and accompanying statutory documents Integration Manager 21 August 2025 Page 26 of 236
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amount of work that has gone into writing the plan and thanked all involved. Two SPG members had not received a paper pack ahead of the meeting and the Chair asked for any feedback or comments to be submitted to the Integration Manager by 31 July 2025. recommended to Midlothian IJB SPG members who did not receive papers ahead of the meeting will review the Midlothian IJB Draft Strategic Plan 2025-2035 and submit comments. Lived Experience Representa tive Member/ VOCAL representati ve 31 July 2025 5.2 Implementation HSCP Transformation Planning: Bed Based Model – Fiona Kennedy, Interim Head of Service. The Interim Head of Service presented the report and noted the first section focuses on transformation while the second describes the review of the bed-based model. The following transformation enablers have been identified as key to the plan: • Finance and Resource • Strategic Planning and Performance • Business and Workforce • Carers • Sustainability The Interim Head of Service advised the plan will be delivered by June 2026 and the Chief Officer requested an update be presented at the SPG meeting on 25 September. Chair also requested this be Update at September 2025 SPG and ECRIA to be completed and presented to September 2025 SPG Interim Head of Service To be presented at SPG meeting 25 September 2025 Page 27 of 236
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accompanied by an Equality and Children’s Rights Impact Assessment (ECRIA). 5.3 Reporting and Evaluation Midlothian IJB draft Annual Performance Report (APR) 2024/25 – Elouise Johnstone, Programme Manager (Performance). The Programme Manager (Performance) presented the Midlothian IJB draft Annual Performance Report (APR) 2024/25. Members discussed and raised a query relating to GP satisfaction scored. The Programme Manager (Performance) reiterated that although we work closely with General Practice colleagues, GPs are independent contractors and not a delegated function of the IJB. However, the Integration Manager noted that the APR has incorporated feedback on GP activity provided by the Clinical Director to ensure a rounded view of activity in Midlothian and in relation to the Health and Care Experience (HACE) survey data. The group agreed to recommend this report to Midlothian IJB for approval. Chair confirmed the Midlothian IJB draft Annual Performance Report (APR) 2024/25 would be presented to Midlothian IJB on 21st August prior to publication by 29 August 2025. Review section on GP activity Annual Performance Report to be presented to the IJB for approval. Programme Manager (Performan ce) / Clinical Director Programme Manager (Performan ce) 31 July 2025 29 August 2025 5.4 Governance Midlothian IJB Draft Carers Strategy – Shelagh Swithenbank, Planning Officer for Carers, presented by Nick Clater, Head of Adult Services. The Head of Adult Services presented a report detailing the work to date to update the Carers Strategy, last updated in 2022. This update Page 28 of 236
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includes support for unpaid carers and the intended plan to synergise between commissioning and strategy. The Carers Planning Group conducted a workshop with stakeholders and 5 priorities were identified: • Promoting Rights & Information • Provision of Individual Advice & Support • Supporting Carer Economic Wellbeing • Supporting Health & Wellbeing • Support Carer Involvement in Care Planning Chair requested the first draft of the Midlothian IJB draft Carers Strategy be presented on 25 September. Chair also requested this be accompanied by an Equality and Children’s Rights Impact Assessment (ECRIA). First draft and ECRIA to be reviewed at September’s SPG. Head of Adult Services 25 Septemebr 2025 5.5 Emerging Risks and Risk Register – Andrew Fleming, Chair The Chair asked members to identify potential emerging risks. The Chief Officer noted the risk concerning the ability to deliver the bed-based model transformational work, identified during the discussion of item 5.2. Members queried whether the pace of the Strategic Plan delivery should be reviewed and presented to the IJB Audit and Risk committee. The Chief Finance Officer noted this was already recorded in the Midlothian IJB Risk Register which is reviewed by the Midlothian IJB Audit and Risk Committee but will be presented to SPG quarterly for feedback and input. 5.6 Reflections & Key Messages for Midlothian IJB Sharing – Andrew Fleming, Chair Page 29 of 236
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The Chair encouraged members to celebrate the work involved in the completion of the Draft Strategic Plan, and its component parts. 6. AOCB The Chair advised there were no other items of business to discuss. 7. Date of Next Meeting The next meeting of the MIJB SPG will be held on 25 September 2025, 14.00-16.00, in person at Normandy Court and virtually by MS Teams. The meeting terminated at 15.20. Page 30 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14:00-16:00 Chief Officer Report October 2025 Item number: 5.2 Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting October 2025. Board members are asked to: • Note the content of the report. # Page 31 of 236
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Midlothian Integration Joint Board Report Chief Officer Report October 2025 1 Purpose The paper sets out the key strategic updates for Midlothian IJB Board meeting October 2025. 2 Recommendations 2.1 As a result of this report Members are asked to: • Note the content of the report. 3 Background and main report 3.1 Chief Officer As part of the 2025/26 budget process, financial recovery actions were proposed within older people’s day services. Following further discussions with providers, a review of the IJB report highlighted that information on contracted services, expected delivery, and current provision had been combined, making it difficult to present an accurate picture. As a result, the figures considered did not fully reflect the position for older people’s day service providers. At the same time, the wider review of day services, designed to support service redesign within a reduced budget, has been delayed due to workforce absence, leaving providers without clear guidance. Therefore, funding for older people’s day services has been reinstated from 1 July 2025 until 31 March 2026. This will provide stability while the review is completed and mitigate risks linked to reporting issues, delays in redesign, and the current reliance on reserves to maintain provision. During this period, work will continue with providers to update contractual arrangements, so they better reflect current expectations, eligibility criteria, and levels of support, creating a clearer basis for future service redesign. Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Head of Adult Services Contracts and Commissioning Work is being progressed to review the overall status of contracts and develop plans in relation to commissioning. Initially this work will focus on updating the contracts register and ensuring there is clarity on the status of existing contracts and any actions that may be required in relation to individual contracts. Page 32 of 236
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Midlothian Integration Joint Board The work on commissioning will also lead to an updated commissioning strategy. This strategy will be informed by an analysis of the contract register, individual meeting with care providers and priorities for each service area. Given the financial pressures being experienced by both the Health and Social Care Partnership and care providers it is expected that development of commissioning strategy is likely to highlight a number of operational and financial risks. Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Head of Primary Care and Older People Intermediate Care - Highbank to Midlothian Life Intermediate care services are provided to people, usually older people, after leaving hospital, or when they are at risk of being admitted to hospital. The services offer a link between places such as hospitals and people's homes, and between different areas of the health and social care system - hospitals, community services, GPs and social care. Rehabilitation, reablement and intermediate care aims to enable individuals to live independent lives with meaning and purpose, to empower individuals to be self- determined and avoid dependency on health and social care (Scottish Government, 2007). The 2020 vision aimed to promote everyone’s ability to live longer, healthier lives at home or in a homely setting. Intermediate care therefore aims to support people to live at home for as long as possible Midlothian Health and Social Care Partnership identified the need to re provision our Highbank Intermediate care facility. Highbank provides bed based intermediate care, where there is provision for Assessment, Rehabilitation, Interim Care and Respite for up to 40 older people The current building has been assessed as not fit for purpose and fails to meet the Care inspectorate standards in several areas including provision of en-suite bathrooms and the need for improvements so that the environment is equipped to deliver intermediate care services including rehabilitation and carer respite service. A new purpose-built facility was commissioned from the Capital Fund and is due to be completed in December 2026. The new service which sits as part of the Polton Street site, has been named Midlothian Life. The new building (Midlothian Life) has : • 10 flats the design of which were intended to provide rehabilitation services • 30 single en-suite rooms The HSCP has established a Polton Street Board that has oversight of the logistics, practical, strategic and operational elements of the move from Highbank to Polton Street. This Board chaired by Fiona Kennedy feeds directly into the Council’s Polton Street Programme Board. Page 33 of 236
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Midlothian Integration Joint Board Unscheduled Care The Unscheduled Care (USC) workstream to reduce acute bed occupancy by shifting the balance of care to the community continues. Throughout mid-August and into early September, Midlothian HSCP demonstrated improved bed occupancy performance, largely sitting at less than 15 to target: our most consistent improvement since starting this work. Home First Review The new Home First staffing model has been through the relevant governance channels and has been approved to progress to implementation. Consultation is underway with relevant staff, supported by professional leads and partnership representation. The new model aims to streamline, reduce duplication and improve efficiency through new ways of working, skill mix and redefining roles and remits. It is also anticipated that a significant financial saving will be made. Fiona Kennedy, Interim Head of Service - fiona.kennedy2@midlothian.gov.uk 3.4 Strategic Planning Outcome based practice The Integration Manager is an invited speaker at the ALLIANCE event titled “We should measure success in health and care with personal and rights-based outcomes, not just short-term targets. Effective measurement helps us to understand if we have a health and social care system with people and wellbeing at the centre.”. This event will be held on Wednesday 22 October 2025 and is part of their Integration in Action series with International Federation of Integrated Care (IFIC) Scotland. Gill Main, Integration Manager – gill.main3@nhs.scot 3.5 Chief Allied Health Professional Falls Awareness Week Falls Awareness Week (15-19 September 2025) created an opportunity for focused engagement around falls and supported self-management resources. Part of this year’s plan includes a Falls Celebration and Learning Conference. Taking place on 17th September, this will create opportunity to promote developments across the system. For Midlothian HSCP this will focus on learning from planning and stakeholder engagement for our Community Appointment Day alongside collaborative work testing assessment tools with our Falls Responders and planned next steps around risk stratification. Digital Maturity Assessment The Digital Maturity Assessment has been underway across Scotland since July. Creating opportunity to evaluate the use of digital technologies within health and social care. Focused on three core themes: readiness, capabilities and infrastructure, the assessment covers twenty sections and aims to provide insights into our HSCP digital maturity. This year, a collective approach was undertaken. Learning from the previous two years, this singular approach to this assessment still allows for insights Page 34 of 236
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Midlothian Integration Joint Board at an HSCP level but aimed to provide clarity for participants around the purpose and approach, avoiding duplication of effort. All responses will be validated by 30th September 2025 to enable reporting of findings. Claire Ross, Chief AHP – claire.ross4@nhs.scot 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. 5 Directions 5.1 The report reflects the ongoing work in support of the delivery of the current Directions issued by Midlothian IJB. 6 Equalities Implications 6.1 There are no specific equalities issues arising from this report. 7 Resource Implications 7.1 There are no direct resource implications arising from this report. 8 Risk 8.1 The key risks associated with the delivery of services and programmes of work are articulated and monitored by managers and, where appropriate, reflected in the risk register. 9 Involving people 9.1 There continues to be ongoing engagement and involvement with key stakeholders across the Partnership to support development and delivery of services. 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE October 2025 Page 35 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14:00-16:00 Midlothian IJB Membership Recommendations Executive summary This report provides information about changes to voting and non-voting membership of the Midlothian Integration Joint Board (IJB) and seeks the Board’s formal endorsement of the membership nomination detailed in the report. Members are asked to: • Review and endorse NHS Lothians nomination of Heather Campbell, NHS Lothian Non-Executive Director as a voting member of the Midlothian Integration Joint Board for a 3-year term. • Review and endorse the appointment of Jay Johnson as a non-voting Lived Experience member to the Midlothian IJB # Item number: 5.5 Page 37 of 236
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Midlothian Integration Joint Board Report Midlothian IJB Membership Recommendations 1 Purpose This report provides information about changes to voting and non-voting membership of the Midlothian Integration Joint Board (IJB) and seeks the Board’s formal endorsement of the membership nomination detailed in the report. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Review and endorse NHS Lothians nomination of Heather Campbell, NHS Lothian Non-Executive Director as a voting member of the Midlothian Integration Joint Board for a 3-year term from 13th August 2025. • Review and endorse the appointment of Jay Johnson as a non-voting Lived Experience member to the Midlothian IJB 3 Background and main report 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 determines the membership of Integration Joint Boards. This details the requirement to ensure members are representative of service users in the local authority, staff engaged in the provision of services, and third sector bodies carrying out activities related to health and social care in the local authority. 3.2 Following a recruitment process, the Midlothian IJB Chair, Chief Officer, and the Midlothian HSCP Integration Manager are recommending the appointment of Jay Johnson as a non-voting representative member for Lived Experience on Midlothian IJB. 3.3 NHS Lothian Board met on 13th August 2025 and agreed the appointment of Heather Campbell as a voting member of Midlothian IJB in her capacity as an NHS Lothian Non-Executive Director. The Board is requested to endorse this appointment as a new voting member of Midlothian IJB from 13th August 2025 for a 3-year term. 4 Policy Implications Page 38 of 236
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Midlothian Integration Joint Board 4.1 The creation of Integration Joint Boards is intended to rebalance care towards community-based health and social care services. In keeping with the Christie Report on the Future Delivery of Public Services, the IJB membership will be expected to continue to develop approaches which are more effective in promoting good health, wellbeing, and recovery wherever possible. 5 Directions 5.1 There are no implications for Directions arising from this report. 6 Equalities Implications 6.1 There is no direct impact on inequalities arising from this report although it is important to note that a primary objective of Midlothian IJB is to addressing health inequalities. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 Failure to appoint Integration Joint Board members would result in the Integration Joint Board being unable to meet the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. 9 Involving people 9.1 The regulations accompanying the Public Bodies Act (2014) are clear about the importance of working with people and communities in a meaningful way. In line with these regulations, Midlothian IJB has established a Strategic Planning Group, and all board members are invited to join this Committee of the Board. 10 Background Papers 10.1 N/a AUTHOR’S NAME Nicola Thorburn DESIGNATION Democratic Services CONTACT INFO Democratic.services@midlothain.gov.uk Page 39 of 236
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Midlothian Integration Joint Board DATE 05 August 2025 Appendix 1: NHS Lothian Board Confirmation of appointment of voting member Page 40 of 236
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Lothian NHS Board Corporate Governance www.nhslothian.scot Sent by Email Lisa Cumming Business Support Manager Fairfield House 8 Lothian Road Dalkeith EH22 3AA Date Our Ref Enquiries to Email 02 September 2025 IJBs/Appointments Chris Graham chris.graham@nhs.scot Dear Lisa, VOTING MEMBER APPOINTMENT TO MIDLOTHIAN INTEGRATION JOINT BOARD At the Lothian NHS Board meeting held on 13 August 2025. The following was agreed: • Appointment of Heather Campbell as a Voting Member of the Midlothian IJB, from 13 August 2025. (for a three-year term). Yours sincerely Chris Graham Manager – Corporate Governance Team Heather can be contacted on heather.campbell10@nhs.scot Page 41 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14.00-16:00 Midlothian IJB Draft Strategic Plan 2025-2035 Executive summary This report sets out the final actions in the development of the Midlothian Integration Joint Board (IJB) Strategic Plan for 2025-2035 (appendix 1). On 28th August 2025, Midlothian IJB reviewed the Midlothian IJB draft Strategic Plan 2025- 2035 and suite of statutory accompanying documents and agreed for a fourth draft of the strategic plan to progress through the final stages of governance with Midlothian Council and NHS Lothian. Following the 28th August Midlothian IJB meeting, final edits from Board members and Midlothian IJB Chair have been adopted and format and design revisions undertaken. All changes can be reviewed in the change log (appendix 2). The Midlothian IJB draft Strategic Plan for 2025-2035 was reviewed and endorsed by Midlothian Council on 9th September 2025 and is scheduled to be reviewed by the NHS Lothian Board on 8th October 2025. The Midlothian IJB Strategic Planning Group reviewed this final draft on 25th September and recommended the plan for Midlothian IJBs approval. As a result of this report, Members are asked to: • Note the small edits and the design changes made following the 28th August 2025 IJB Board meeting noted in the change log (appendix 2), • Subject to any amendments, approve the Midlothian IJB Strategic Plan 2025-2035, and • Give delegated authority to Morag Barrow in her capacity as Chief Officer to publish this strategic plan on the Midlothian Health and Social Care website before 31st October 2025. Item number: 5.6 Page 43 of 236
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Midlothian Integration Joint Board Report Midlothian IJB Draft Strategic Plan 2025-2035 1 Purpose 1.1 This report sets out the final actions in the development of the Midlothian Integration Joint Board (IJB) Strategic Plan for 2025-2035. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the small edits and the design changes made following the 28th August 2025 IJB Board meeting noted in the change log (appendix 2), • Subject to any amendments, approve the Midlothian IJB Strategic Plan 2025- 2035, and • Give delegated authority to Morag Barrow in her capacity as Chief Officer to publish this strategic plan on the Midlothian Health and Social Care website before 31st October 2025. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Scotland) Act, 2014 places a duty on Integration Authorities to plan and direct delegated health and social services through the development of a Strategic Plan. Stakeholders must be fully engaged in the preparation, publication, and review of the plan, in order to ensure a meaningful co- productive approach. 3.2 A Strategic Plan must relate to the functions delegated to the integration Authority, and outlining how the resources at its disposal intend to be utilised to deliver on statutory aims and objectives. 3.3 The logic of the Act, supporting regulations, and guidance is that the Strategic Plan should be the basis for Directions issued to the Health Board and the Local Authority over the lifespan of that Plan. With this in mind, the Act also includes the provision that each Health Board and Local Authority must be consulted on the content of the Strategic Plan, and that if the Health Board and/or Local Authority believe that the Strategic Plan would interfere with the delivery of their functions they can, together, reject the Strategic Plan and ask that the plan be re-written. Page 44 of 236
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Midlothian Integration Joint Board 3.4 The long history of strong and productive relationship between Midlothian IJB and both Midlothian Council and NHS Lothian has ensured close working across the development of this plan and alignment to both Partners strategic ambitions. 3.5 Midlothian IJB has developed is strategic plan in line with statutory Strategic Plan Statutory Guidance. Strategic proposals were developed in in January 2024 following a stakeholder and public consultation from September to December 2023. These proposals were developed into a first draft of the Strategic Plan by the Strategic Planning Group (SPG) and reviewed by Midlothian IJB before undertaking an assessment of Place and Wellbeing by Public Health Scotland and the Improvement Service. 3.6 Following incorporation of feedback and recommendations, a second draft of this plan was approved by Midlothian IJB on 22nd August 2024 for statutory public consultation between 30th August and 30th November 2024. The views in response to this consultation supported a third revision of the Strategic Plan reviewed by the SPG on 16th January 2025. On 20th February 2025 Midlothian IJB approved the draft plan to commence a formal governance process with both Midlothian Council and NHS Lothian Partners. 3.7 The draft Strategic Plan was reviewed by NHS Lothian’s Strategic Planning and Performance Committee, Midlothian Council Elected Members, and Midlothian Council Corporate Management Team (CMT), and feedback was incorporated into a fourth draft reviewed by the Strategic Planning Group on 24th July 2025. 3.8 On 28th August 2025, Midlothian IJB reviewed the Midlothian IJB draft Strategic Plan 2025-2035 and suite of statutory accompanying documents and agreed for the fourth draft of the strategic plan to progress through the final stages of governance with Midlothian Council and NHS Lothian. 3.9 Following the 28th August Midlothian IJB meeting, final edits from Board members and Midlothian IJB Chair have been adopted and format and design revisions undertaken. The Midlothian IJB Strategic Planning Group reviewed this final draft on 25th September and recommended the plan for Midlothian IJBs approval. 3.10 The Midlothian IJB draft Strategic Plan for 2025-2035 was reviewed and endorsed by Midlothian Council on 9th September 2025 and is scheduled to be reviewed by the NHS Lothian Board on 8th October 2025. All changes can be reviewed in the change log (appendix 2). 3.11 This revised fifth draft plan is now presented to Midlothian IJB for final approval. 4 Policy Implications 4.1 There are no direct policy implications as a result of this report. However, the new Midlothian IJB Strategic Plan 2025-2035 will influence all future service delivery, redesign, and commissioning. Page 45 of 236
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Midlothian Integration Joint Board 5 Directions 5.1 This report does not have a direct impact of Directions at this time. However, the strategic plan is the mechanism for Integration Authorities to action its strategic plan and therefore the content of the Midlothian IJB draft Strategic Plan 2025-2035 have informed the development of Directions for 2025/26. 5.2 Directions performance reporting includes an insight report and gap analysis. The result of this reporting may require corrective action and planning to revise Directions for 2026/27. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. An ECRIA on the Midlothian IJB Draft Strategic Plan 2025-2035 has been completed as part of the strategy’s development and is published on the Midlothian Health and Social Care Website. 6.2 In the implementation of this work, Midlothian Health and Social Care Partnership will be required to complete an ECRIAs for all new or revised strategies, plans, policies, practices and provisions as set out in the Public Sector Equality Duty (PSED). 7 Resource Implications 7.1 There are no new direct financial implications as a result of this report. 7.2 The Midlothian IJB Medium Term Financial Strategy for 2025-2030 is under development and will outline how the resources made available by NHS Lothian and Midlothian Council will be allocated by Midlothian IJB to deliver the ambitions of the Midlothian IJB draft Strategic Plan 2025-2035. 7.3 Following the publication of the Midlothian IJB Strategic Plan 2025-2035, the Midlothian IJB Medium Term Financial Strategy will be finalised, reviewed by the Midlothian IJB Audit and Risk Committee and the Strategic Planning Group before recommendation to Midlothian IJB for approval and publication. 8 Risk 8.1 There is a risk that, should the Board choose not to approve the Midlothian IJB draft Strategic Plan 2025-2035, Midlothian IJB will not publish this plan within the required statutory time period. 8.2 With limited opportunities for Board review, and a complex timetable of Midlothian IJB, Council and NHS Board and Committee meetings set over a year in advance, any delay at this stage is likely to cause significant delay to the final publication date. Page 46 of 236
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Midlothian Integration Joint Board 9 Involving people 9.1 Board members, officers of the HSCP, services, partner organisations, and people and communities have been involved in the process to establish this Midlothian IJB draft Strategic Plan 2025-35. Over 1000 voices have been included in the development of this plan. 10 Background Papers 10.1 None Author’s Name Morag Barrow Designation Chief Officer Contact Information Morag.Barrow@nhs.scot Date 26/09/2025 Appendices: Appendix 1: Midlothian IJB draft Strategic Plan 2025-2035 Appendix 2: Midlothian IJB draft Strategic Plan 2025-2035 Change Log Page 47 of 236
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Midlothian Integration Joint Board Strategic Plan 2025-2035 Page 49 of 236
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2 Contents Foreword ......................................................................................... 3 Introduction ..................................................................................... 5 Our approach ................................................................................. 11 Working together ............................................................................ 13 Our strategy on a page .................................................................... 16 Information, evidence, and insight .................................................. 17 Our strategic aims .......................................................................... 29 Strategic aim 1 ............................................................................... 30 Strategic aim 2 ............................................................................... 39 Strategic aim 3 ............................................................................... 45 Making this a reality ........................................................................ 52 Monitoring and evaluation .............................................................. 55 Budget and financial plan ............................................................... 58 Appendices .................................................................................... 63 Page 50 of 236
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3 Foreword Welcome to this, our fourth Midlothian IJB Strategic Plan 2025-2035 that looks to the future of integrated health and social care in Midlothian with a10-year plan. As a board, we have learned together over the past years 10 years what it means to plan and direct integrated health and social care. We have worked hard to bring together the two equally vital elements of social work and health care to best serve the people who live in our communities. We know we cannot be truly strategic in a 3-year plan, so have looked ahead to understand the health and social care system we will need for the next 10 years. We have intentionally set expectations in the short term aims of this plan to ensure the foundational capabilities are in place for real transformation, not marginally improving an outdated system. We have already set our plan in motion with the action described in our Directions for 2025/26 issued in March 2025. This strategy is meant to be bold. It is not intended to be either optimism dressed up as strategy, or a reduction of strategic planning to a series of incremental tasks. In developing this plan, the question most important to us was 'what kind of future health system do we need to build?' and 'how do we get there?'. Being a meaningful part of our communities and contributing to people achieving what matters to them is at the centre of all we do. We have been listening to people and communities for over 2 years in the preparation of this strategy and will continue to do so as we learn, plan, and change together. We have always understood that people, not services, are at the centre of our decisions and the new Scottish Government Health and Social Care Service Renewal Framework helps make that agenda a national ambition. Our first concern is planning for that new future; one where we meaningfully contribute to our growing population experiencing better health and wellbeing. This is a complex task, and one made more difficult by available funds being unable to keep pace with the speed of demographic changes. Environmental issues and how we can support our Partners to be more sustainable are also a key consideration as our communities continue to grow. Page 51 of 236
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4 We have made good progress in our Financial Recovery Plans and have planned how we will allocate resources to drive our Transformation and Change programme. Despite this, we are under no illusion that without significant change to how our Partners are funded, they will be unable to offer us the resources we need to meet future demands. Digital transformation is one of our biggest challenges and must be more central to our planning. We know digital is not a department or a dashboard, but instead the intelligence layer of the future we have planned. As we have no control over the systems our Partners adopt, we will continue to maximise the skills we have at our disposal to find solutions, think differently about the whole system, and build a dynamic, adaptive, real- time information infrastructure. As we work through the first 3 years of this 10-year plan, we will continue to set a bold vision with serious strategic design. We will continue to enable learning and focus on coordination, collaboration, prevention and personalisation to happen in real time, to ensure we build the capabilities that will determine the next 50 years of health and wellbeing in Midlothian. Val de Souza Morag Barrow Councillor Connor McManus Chair, Midlothian IJB Chief Officer, Midlothian IJB Vice Chair, Midlothian IJB Page 52 of 236
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5 Introduction This Strategic Plan has been developed by Midlothian Integration Joint Board (IJB). The purpose of this plan is to describe how we will work with our Partners Midlothian Council and NHS Lothian, people, communities, the Third and Independent Sector, and the services who provide care and support to agree how we can best contribute to people in Midlothian living well in their community. This plan is effective from 1st November 2025 until 31st October 2035, but we will review and update this plan every three years. Page 53 of 236
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6 Who we are Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in this Strategic Plan will guide how we allocate the money we receive. Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships; Midlothian, East Lothian, West Lothian, and City of Edinburgh. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act, 2014. We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. Scottish Government asks us to take the action required by law and in national policies when deciding what our local priorities should be. Some of these policies and national drivers are in appendix 5. Page 54 of 236
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7 National ambitions for local action Like all Integration Authorities in Scotland, our role is to plan and deliver the services that support better health and wellbeing in our communities. We are asked by the Scottish Government to work with our Partners to plan across the whole system using the National Health and Wellbeing Outcomes Framework. the Scottish Government measure our performance through our work to evaluate and report on how we are contributing to the 9 National Health and Wellbeing Outcomes becoming a reality for more people in Midlothian. This plan has also been written in line with the Principles for Planning and Delivering Integrated Health and Social Care which are the driving force behind our planned activity to successfully and improve outcomes. These national ambitions are the same for every Integration Authority in Scotland and they will be our ultimate aim for as long as we are asked to work in this way. The action we choose to take, and the pace at which we are able to make progress, is unique to Midlothian. What people told us As we prepared this plan, we spoke to over 1000 people involved in delivering care, and people who experience our services, their families, and carers. Between September 2023 and September 2025, we undertook a range of consultation activities to ask what mattered, how people wanted things to change, and for feedback on our plan. We also listened to our Partners and local providers to better understand what is already working well and where they are opportunities to improve how we work together to see people in Midlothian living good lives and achieving the things that matter most to them. You can read more about how we listened to and consulted with people and Partners over the past 2 years to develop this plan in our Consultation and Engagement Statement 2025-2028 that accompanies this strategy. People want to be reassured we are prepared for the future During our consultation, there was a clear message that our ambitions and aims still felt like the right ones, but that strategies and plans can feel like words that don’t mean anything. The consultation challenged us to look at our plans and be clear about what we want to change. Some people were concerned with the rate of housing expansion in Midlothian and were unsure that local services would cope unless we do things differently in the future. People want us to simply tell them what we are going to do The challenges for health and social care are understood by our communities and they don’t want a well-rehearsed list of reasons and explanations why things are difficult like increased demand, demographic changes, funding issues or the pandemic. They told us they don’t want to read about our future ambitions and if those ambitions are out of reach in the coming years. People asked us to be clear and realistic. Page 55 of 236
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8 What we will do Being a meaningful part of our communities and contributing to people achieving what matters to them is at the centre of all we do. Over 1000 voices have been included in the development of this strategy and we want to keep the conversation going as we learn, plan, and change together. Our Participation and Engagement Statement 2025-2028 sets out how we will do this. Strategy isn’t always new or exciting. Strategies find solutions to the challenges we face and are a choice in direction that others may disagree with. Because we still have to find sustainable ways of working to meet all of our challenges, you might have heard some of this before. That doesn’t mean we will stop trying to find ambitious solutions to these issues. Our job is to write a strategic plan that sets out our ambitions and the approach we will take, allocate available funding to the services that we are responsible for, and issue Directions to our Midlothian Council and NHS Lothian Partners that describe how we want them to support us achieve the ambitions of this plan. The Public Bodies (Joint Working) (Scotland) Act, 2014 asks us to plan for each function that is delegated to us, but we know that services cannot be either planned or delivered in isolation. As a result, we have chosen to plan and talk about our services in an integrated way, while taking care to ensure that have carried out our duty to plan and direct all the functions we are responsible for. Funding and resources Our Partners have supported us with the best funding offer they can, but it is not enough to keep pace with increases in our population or the changing health and social care needs of people and communities. We can only spend the resources that are made available to us from our Partners. This may mean our progress slows down or that some services will stop. Hard choices lie ahead, but we will always make decisions that aim to ensure the services you need most are available when you need them. Sometimes we will not be able to deliver everything we want to provide with the resources we have, but that doesn’t mean we won’t keep working hard to support people with what they need or keep improving what we can offer. Page 56 of 236
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9 A new future for health and social care In January 2025 the Government announced 3 publications that will shape the future of health and social care in Scotland. NHS Scotland Operational Improvement Plan, the Health and Social Care Service Renewal Framework and Scotland’s Population Health Framework. The 5 principles of the service renewal framework focus on prevention, people, community, population planning and digital innovation. This echoes the 3 recommendations for strategic change proposed by Lord Darzi in his 2024 Independent report in the National Health Service in England, a shift from hospital to community, the move from analogue to digital and a shift from focusing on sickness to delivering prevention. Scotland’s Public Reform Strategy also asks us to think and act strategically, focus on the ‘bigger picture’ and have ensure our leadership supports and requires joint working. We have recognised the importance of this in our strategy and taken the bold move to plan for the next 10 years to build the foundations of a new, shared future in Midlothian. While we would have liked to have seen more recognition of the vital role of social work and social care within these publications, we are confident this strategic plan aligns with national ambitions. National Care Service for Scotland Our role in a National Care Service remains unclear. Plans and are progressing for a National Care Service, but in a new way. The Care Reform (Scotland) Act 2025 sets out the foundations for change and some previously proposed policies will have to be delivered in different ways to originally planned. Until the Scottish Government provide further details, we do not know how we will be asked to plan and direct care in the future. Scottish Government publications • NHS Scotland Operational Improvement Plan - March 2025 This plan builds on the planning of individual Health Boards. • Health and Social Care Service Renewal Framework – June 2025 This sets out a 10-year plan to improve outcomes for the people and communities of Scotland. • Scotland’s Population Health Framework – June 2025 This framework sets out the long- term approach to improve Scotland’s health and reduce health inequalities. • Scotland’s Public Service Reform Strategy – Delivering for Scotland - June 2025 This is clear about the change we must deliver through integrated solutions and local action. We must ensure we create lasting change that focuses on people, communities and places. Page 57 of 236
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10 Transformation Health and social care is changing. This is because of the way our communities are growing, the types of support that people need, and other influencing factors like legislation, national policy, and Scottish Government priorities. The change required is not small and gradual change over time. We must completely redesign how we deliver treatment, care, and support in new, and previously unimagined ways. This is called transformation. We continue to believe that our services are best placed to work with people and communities to design the care and support people want and need. We know this can’t happen as quickly as we would like and that we won’t always get it right. However, we will always do our best to support positive change and always put our communities at the centre of our decisions. This Strategic Plan sets out an ambitious but realistic programme of transformation and we have asked Midlothian Health and Social Care Partnership to start the work required to redesign health and social care as part of a new, sustainable financial plan. We know we will need a range of people and groups of professionals to contribute to the success of this work. We have identified a number of enabling factors which including finance and resource; business, intelligence, and insight; workforce; sustainability (including digital), and unpaid carers. We will continue to work with Midlothian Health and Social Care Partnership, Midlothian Council, and NHS Lothian to ensure we have the right support to make our plans a reality. Transformation and change The Midlothian Health and Social Care Partnership Transformation and Change Programme Board has 8 workstreams. These are • Palliative care • Bed based care • Unscheduled care and Home First services • Primary, community and social care • Commissioned services and the Third Sector • Community assets, wealth and capacity • Mental health and dementia • Multiagency Single Point of Access (community front door) Page 58 of 236
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11 Our approach If we are serious about building a sustainable health and social care future, it’s important we recognise that the most powerful and cost-effective interventions are ones with a shared purpose and grounded in relationships. Only by people and communities being seen, heard, and leading the change can we unlock the kind of action that will change the future of health and wellbeing in Midlothian. Page 59 of 236
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12 Our commitment We have asked Midlothian Health and Social Care Partnership to base their transformation plans on developing relational ways of working, breaking down the silos of diagnosis or age-based care and focus on a new person-led, outcome-focused approach. It’s time for us to be a part of making a relational way of working become the reality for people and communities. In the face of rising demand and very real capacity pressures, we must support services to stop saying ‘no’ and start asking ‘how’. This is much more than structural reform and based in a change of culture where compassion is the driving force and relationships are at the centre of how we care for our workforce and the people we are here to serve. The future must be deeply human. Our capabilities Planning is important, but we know it is the actions we choose to take that matter. Our strategy will continue to evolve, and we will adapt as we learn. To do this, we must continue to support Midlothian Health and Social Care Partnership to have the skills and capabilities to redesign and respond to financial challenges, population growth, and increasing demand. The rest of this plan sets out the areas of focus and ambitions that we believe will allow services to continue to provide high quality care and support while also taking significant steps forward towards local health and social care reform. Our commitment to the people and communities of Midlothian is to • Keep it simple. We will avoid strategies and plans that add nothing new or add no value to people and communities. • Do things differently. Just because something is statutory it doesn’t mean we shouldn’t think about planning and delivering that service in new and radical ways. • Take a ‘once for Midlothian’ approach and avoid siloed planning. • Focus on impact by understanding what our collective contribution is to personal outcomes and positive change. • Have better conversations with our communities, be visible, and be part of the work. • Be ambitious, ready to change, and ready to adapt. Page 60 of 236
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13 Working together The aim of integrated health and social care is to ensure that everyone in Midlothian has joined up care and support. We know the decisions we make influence how people live and the choices they make about what they do and where they go within our communities. We also know that we can’t design services that rely on communities to take action without contributing to community resilience. The decisions our Partners make will also influence people’s choices and ultimately how well we are able to achieve the ambitions in this plan. We must work with all our Partners to avoid this plan unintentionally making it harder for people to live well in their community. We will always share our plans, successes, and challenges so we can support people to live well. Page 61 of 236
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14 Working with our Partners When people need services, it is important to get support quickly. We want to have different conversations and create new relationships with our Partners so that together, all our offers collectively support more people. We will work with our Partners where it is possible to jointly develop plans across the whole system and use mechanisms like our Market Facilitation Plan to drive change. We have started this work in key areas, e.g., workforce planning, and will continue to find opportunities to work and find solutions together. Where it makes sense to do so, we will explore ways to create more opportunities to have shared goals and outcomes, jointly fund services, and share our data. For example, services like mental health, substance use, primary care, housing, employability, and welfare support can all contribute to preventing some of the causes of poor or deteriorating mental health. We must avoid limiting what we can do with unnecessary ‘red tape’ while also meeting our duties to keep people safe. Where people live can have a significant impact on health and health inequalities. An emerging threat to heath and health inequalities is climate change. Environmental issues and how we can support our Partners to be more sustainable are key considerations as our communities continue to grow. We have a duty to report on how we are working with our Partners in this regard, and we must find the shared opportunities within all our strategies to underpin the principles of equality, net zero emissions, and sustainability. We will continue to support ‘Green Health Prescribing’ and work with others to ensure the health and social care needs of people are considered as part of proposed local development plans. Public transport provides opportunities for active travel and this has a direct positive impact on health. If we want to provide more community-based treatment, care, and support, Midlothian needs to have good transport links that help people travel locally and sustainably. We will prioritise working with all our Partners to help reduce poverty because we know there is a strong relationship between money, income and wealth, and health and wellbeing. We will ask services to make sure that every contact counts and we actively connect people to the support they need, rather than expecting them to navigate complex systems alone. Where we can help, we will work with our Partners so people can access specialist welfare and debt advice. This might be through our local services in venues that are easy to access, for example, day services, community venues, and our Community Hospital. We want to see more fair work for local people. In addition to income, good employment also provides social connections and can support people to improve their mental and physical health and wellbeing. We don’t employ anyone, but we will continue to build on the work with our Partners and do all we can to support local employment opportunities in health and social care. Secure, quality, and affordable housing is another foundation of good health and wellbeing that has a significant positive impact on people’s lives. We want to ensure we coordinate health and social care support with people’s housing options. We don’t have any direct responsibility for housing matters other than aids and Page 62 of 236
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15 adaptations but can support the work of others to improve housing stability and security and prevent homelessness. Our Housing Contribution Statement sets out how we will work with all our Partners but particularly Midlothian Council to ensure people live in safe and quality housing within their community. This plan is closely aligned to the work of both our Partners, and the Third Sector. We have ensured we have woven these shared ambitions throughout this plan so we can work together to contribute to positive change for people and communities. NHS Lothian The NHS Lothian Strategic Development Framework (LSDF) sets out what needs to happen across Lothian’s Health and Care system over the next 5 years. The LSDF is a joint plan between the all the Health and Social Care Partnerships in the Lothians. The vision is that • Citizens live longer, healthier lives, with better outcomes from the care and treatment we provide’. • We connect health and social care services seamlessly, wrapping around the citizen in their home. • We improve performance across our system, with better experiences for citizens. Midlothian Council and Community Planning The Midlothian Council Plan 2025/30 sets the ambition to grow and transform by harnessing opportunities. The strategic objectives and key priorities align with the Scottish Government’s Economic Strategy and link to the Midlothian Community Planning Partnership vision. Prioritising our work with the Community Planning Partnership is one of the best ways to ensure all the strategies and plans for services across Midlothian are joined up. We lead 'Midlothian will be healthier' and ‘Midlothian will be safer’ thematic areas of the Midlothian Community Planning Partnership Single Midlothian Plan 2023/27 and work together to achieve more than health and social care can do alone. The Third Sector The Third Sector is a vital part of health and social care in Midlothian. There are at least 700 voluntary sector group and organisations in Midlothian, and 228 registered charities (voluntary organisations or community groups) who identify their main operating area to be Midlothian. Approximately 40 organisations are commissioned by Midlothian Health and Social Care Partnership to provide services and support for people and communities. The Midlothian Third Sector Interfaces (TSIs) plays a key role and provides a range of supports and advice. Page 63 of 236
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16 Our strategy on a page Our Vision People in Midlothian lead longer and healthier lives. Our Mission We will provide the right support at the right time in the right place. Our Values Respect. Compassion. Quality. Our Strategic Aims 1. People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. 2. People are able to access the care and support they need when they need it in the community and at home. 3. People's human, social, and economic rights are protected and promoted in how we design and deliver our services. Page 64 of 236
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17 Information, evidence, and insight This section sets out the information and evidence we have used to determine our strategic aims. Before writing this plan, we undertook a review of a wide range of information, local data, the views of people, and local community data to help us identify the areas where we want to make the biggest difference over the next 10 years. The most significant piece of evidence we have used is our Joint Strategic Needs Assessment (JSNA). This brings together coordinated information from local, regional, and national sources to help us understand the health and social care issues for people living in Midlothian. Page 65 of 236
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18 Information, evidence and insight Health and social care services collect and report on a huge amount of information. The way we are asked to do this means the data we collect is often about one part of the system or a single issue. We are working hard to improve the data and evidence we use so we can be more confident about the decisions we make and how the whole system fits together. We have reviewed all our data and information to make sure it is accurate and available to us at the right time to make good decisions. We have also looked at a wide range of other information and evidence, so we can be as sure as we can that the priorities in this plan will help us make the fastest progress towards achieving the 9 National Health and Wellbeing Outcomes for everyone who lives in Midlothian. Our communities are more than numbers and statistics to us. To best understand the experience of local people we have combined number data with descriptive data, people’s stories, and their experiences to ensure this plan helps everyone in Midlothian achieve what matters most to them. When a new source of data has become available, we have connected it with existing information in new ways. Seeing the links between existing and new information across the whole system has given us better insight into where real change can be achieved. We have examined the information, evidence, and insight from all of these sources to help us make decisions about our plan. As more data becomes available across time, we will review this alongside information from Midlothian Health and Social Care Partnership services to help identify emerging risks and inform our decisions when we need to change our approach. Our data sources We have considered a wide range of information and evidence so we can be as sure as we can that the priorities in this plan will help us make the fastest progress towards achieving the 9 National Health and Wellbeing outcomes for everyone that lives in Midlothian. • The National Indicators and our performance on these as described in our Annual Performance Report 2024/25. • The Ministerial Steering Group indicators. • Our Joint Strategic Needs Assessment (JSNA). • The Midlothian Citizens Panel. • Our Annual Midlothian Survey. • Local service performance data. • Feedback from local providers, people, and communities. Page 66 of 236
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19 Information and support In our recent Citizens’ Panel survey, we asked residents of Midlothian to tell us how they find information about services in their community. People told us that one of the top sources of information they use is word of mouth (56%), and we also know that providing information in person is not everyone’s preferred option. People told us that they use social media (56%) just as much as seeking information face to face. We know our services provide a variety of in-person advice and information, but we must do more to ensure information is available and accessible to all people and communities across Midlothian. There is much we can learn from other national examples of good information sharing, e.g., community pharmacies. Digital skills and confidence, along with access to devices and data, are becoming increasingly essential to life in the UK. People should be able to use digital technologies in ways that enhance their lives and contribute to helping them overcome other disadvantages which they might face. Digital exclusion (limited or no access to internet connection, devices, skills) creates digital inequalities, which are strongly linked to wider social and economic disadvantage. In Scotland, areas of higher economic deprivation have lower levels of internet use. The evidence tells us that we must improve the information we provide and ensure it is useful, easily available, and accessible to everyone in a range of places and formats. Digital skills and confidence People in Midlothian have access to digital tools, but not everyone is able to make best use of them. • 97% of people in Midlothian have report having access to the internet at home. • The average internet speed in Midlothian is 15% lower than then UK average. • 31% of Midlothian’s population experience slow or very slow internet connections. • Older people are less likely to own smartphones or connect to the internet. • People with lower incomes are less likely to have access to smartphones and be on pay monthly data plans. Pharmacy First Pharmacy First Scotland is a service for people living in Scotland, registered with a Scottish GP Practice, residents in care homes and care settings, people who are experiencing homelessness, and the traveler community. Across Scotland: • Across all age groups women use Pharmacy First more than men. • Children aged 0-9 are the largest group by age who use Pharmacy First. • Children living in areas of highest economic deprivation are more likely to use Pharmacy First than those living in the areas of least economic deprivation. Page 67 of 236
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20 What matters most to people and communities We know that good conversations are vital in understanding how to support someone to achieve their personal goals. This can be difficult to measure as it is often a combination of factors that people describe having made a positive difference in their lives. We need to ensure that people are supported to achieve the things that matter most to them and our services are confident of what our contribution is to their success. This means taking the time to have good conversations with people, to understand what is working well, what could be better, and who might be able to help. We call this The MidWay, and all staff are supported with training. We want to be able to provide people with meaningful support to live the lives they choose in good health and wellbeing. To be confident we are continuously learning and improving, we want our services to be able describe their contribution to people achieving the outcomes that matter to them. Outcome Mapping is a useful way to describe what we do, who with, what people learn and gain as a result, how this makes them feel, and the difference this makes in their lives. We have already made good use of this approach to understand our progress towards achieving our Directions and the national indictors reported in our Annual Performance Report 2024/25. We believe this methodology will also help our services to understand their contribution and make more targeted, locally informed decisions about how to design, deliver or commission services. We will build on our application of Outcome Mapping to support services as they develop meaningful action plans for change based on the triangulation of three types of data: service data (activity), system data (population experience), and what matters to people (outcome mapping). What is important Respondents to our Citizens’ Panel survey told us that the 3 most important things for health and care professionals to do are: • Start with asking about what matters to me (68%). • Ask me what I think would make a difference (63%). • Ask about other areas of my life where I might need some help (55%). Page 68 of 236
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21 Supporting local people We know that people generally access health and care close to home, rather than where they work. This means that our services need to support people who commute to work outside of Midlothian, those who work locally, those who are unable to work, and those who have caring responsibilities. People who live in Midlothian and that are in employment consistently earn less than the Scottish median earnings per week. Midlothian full-time employed residents in 2022 earned on average £622.90 per week compared to the Scottish equivalent of £640.30. Midlothian’s largest employer is Midlothian Council with 3,990 employees. However, over 50% of the working age population work for Edinburgh City based employers. Along with services being easy to find, and ensuring Good Conversations take place, we need to ensure that service offers and supports are designed around how people live their lives. In our recent Citizens’ Panel survey, only 37% of people thought “it is easy to get the support I need when I need it”. It’s important we take action to address this for the health and wellbeing of people in Midlothian now and in the future. The Scottish Burden of Disease study monitors the diseases, injuries and risk factors which prevent people living longer lives in better health and estimates that two thirds of increases in disease will be cardiovascular diseases, cancers, and neurological conditions. This study predicts that the burden of disease will increase in Scotland by 21% over the next 20 years. Local economic activity • In 2024, the economically active population of Midlothian was 81.5% of the total working age population. • 11,200 people were classed as economically inactive. • 29.2% were inactive due to long-term sickness (this has been relatively consistent over the past 10 years). • 25.6% of people were retired, an increase from 17.6% in the past 10 years. • In March 2025, 1,405 Midlothian residents, were receiving out of work benefits. This included a greater number of males than females, at 805 and 595, respectively. • In October 2023, 2.2% of Midlothian residents aged 16-64 were claiming Universal Credit - male (2.6%), female (1.8%). Page 69 of 236
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22 Staying well, independent, and active Less than half of adults in Midlothian meet the physical activity recommendation of more than 2.5 hours of activity per week. Adults in the most deprived areas are less likely to meet these guidelines compared to those in the least deprived. Maintaining a healthy weight is important to avoid increased risk of illness and diseases which can lead to premature death or reduced quality of life. 2 out of 3 adults in Midlothian are overweight or obese. This means people are living less of their lives in good health, so we need to make it easier for people to access services to help them stay well, independent, and active. One of the ways to measure overall health is by looking at information about life expectancy. Healthy life expectancy is the average number of years that a new-born can expect to live in “full health”. Improving outcomes There are areas where Midlothian is making sustained improvements in improving outcomes for people. • Hospitalisations for asthma and COPD are both at their lowest in Midlothian since 2002. • Emergency admissions for people aged 65 and over are reducing overall. • Deaths from suicide are also reducing and currently below the national average. • The number of babies reported by their parent as being exposed to second-hand smoke at the 6-8 week review has fallen significantly from 38.46% in 2002, to 6.82% in 2023. Life expectancy • Since 2019, the gap between life expectancy and healthy life expectancy has increased by 0.9 years for both men and women in Midlothian. • Life expectancy at birth in Midlothian is slightly better than the Scottish average (2019/21) for both males and females. • Women’s overall life expectancy is higher than men’s in Midlothian. • Life expectancy varies by up to 10 years across different parts of Midlothian, because of poverty and social disadvantage. • Early deaths of people aged under 75 years from cancer and chronic heart disease have both been reducing over time. Some areas with higher deprivation are experiencing increasing rates. Early death from chronic heart disease varies across areas. Dalkeith had the highest rate of early deaths with the next highest rate in Easthouses, whilst Pentland had the lowest rate. Page 70 of 236
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23 Where we live Midlothian’s population has grown every year since 2006. At the 2022 Census there were 96,600 people living in Midlothian and the most recent population estimate is 98,260. Midlothian is the fastest growing Council area in Scotland. The local birth rate and the number of people either moving to, or leaving, Midlothian each year combined with plans for new houses means the population of Midlothian could increase by over 40% by 2036. It is not clear how the economic profile of Midlothian may change in future years, and what the impact on access to community services might be. We anticipate a population increase in Midlothian of approximately 40% over the next 10 years. This is largely due to large, planned housing developments. It is likely that the health and care needs of these new families will be different to those of the people already living in the area or close by in neighboring housing developments. The challenge facing health and social care providers is not only an increasing population. The profile of the people who live in Midlothian is also changing, and the impact of this is difficult to predict with certainty. We know we have more babies being born, more people moving into the area, and more people living into older age. If more affluent families, who often have higher levels of health literacy, move into Midlothian, there is a risk that residents in areas of existing economic deprivation may find it harder to access the support they need. This is sometimes called the inverse care law, where those who need care the most are least able to access it. The evidence tells us we must plan for the future with different types of health and care services, in different numbers, and in new locations to avoid existing health inequalities widening, particularly for the most vulnerable people. Changes in population • Midlothian has the highest standardised birth rate of all council areas in Scotland. • Midlothian is projected to see the largest increase in Scotland due to people moving into the area from other council areas in Scotland (11.6%). • Midlothian is predicted to see the number of children grow by 11.2%, the largest increase across Scotland. • Most council areas are projected to see an increase in their working age population over the next 10 years. The highest increase is projected in Midlothian (16.1%). Page 71 of 236
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24 Services in our communities The data tells us we must focus on prevention activities to improve population health outcomes, reduce health inequalities and support the long-term sustainability of health and social care services When we asked people to tell us about the health and care services they had accessed recently, the most frequent responses were all community- based: • GP team (64%) • Pharmacy (61%) • Dentist (30%) • Optician (21%) The impact of planned housing development is likely to be most significant for General Practice, Pharmacies, Health Visiting and Community Health and Social Care services that support people to live in good health for longer in the place of their choosing. We must work together to ensure that people can access the services they need in their own community and recognise people are the experts in their own health and wellbeing. It is vital that people are involved in planning services and that their contribution is valued. Less than half of the Citizens’ Panel respondents agreed that they “feel confident about getting involved in decision-making in my community” when thinking about health and social care. One of the reasons people told us that makes it difficult to get involved is having enough free time. Free time can be limited by several factors, but one of the most common is having caring responsibilities. Unpaid carers tell us that it can be difficult to arrange cover, or respite care, for the person they look after. Many carers do not identify what they do as being an “unpaid carer”. Some groups are more affected than others e.g., more women identifying as carers, and 28% of carers live in the 20% most deprived data zones. Journey times to appointments (home to health and social care appointments) • 58% of respondents travel by car to appointments at a GP practice, hospital, or vaccination clinics. • 23% walked, 11% used public transport. • 64% travelled less than 15 minutes. • 29% travelled 15 to 30 minutes. • 8% travelled more than 30 minutes. Page 72 of 236
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25 Flexible and adaptable care and support The Health and Social Care Standards in Scotland are designed to ensure that everyone receives high-quality, person-centred care and support. These standards are grounded in principles of dignity, compassion, inclusion, and respect, and they apply across all health and social care services in Scotland. These standards support people to have control over their care, to ensure care is flexible and responsive to changing circumstances, and to promote equality and fairness, especially for vulnerable groups. In line with these ambitions, the Scottish Government published the Health and Social Care Service Renewal Framework 2025–2035 in June 2025 which focuses on: • Prevention and early intervention • Community-based care • Digital-first approaches • Tackling health inequalities The profile of Midlothian’s population in almost all age groups is changing. As people’s lives change, their needs for support change too. As people grow older, they often require more practical support to help them live well for longer. The number of people who are of pensionable age in Midlothian is projected to increase by 8.9% between mid-2018 and mid-2028. The proportion of people aged 75 and over is predicted to grow by over 40%. Midlothian’s total population includes 4.53% of minority ethnic populations, which is an increase from the 2011 Census figure (1.77%). We have already seen an increase in the number of people employed to provide this support, and health and social care is the largest employment sector in Scotland. There is also a thriving local Third Sector in Midlothian, supported by the Midlothian Third Sector Interface. Core principles The Health and Social Care standards are built around five core principles: • Dignity and Respect: People are treated with dignity and respect at all times. Their human rights are upheld. • Compassion: Care is delivered with kindness and understanding. • Be Included: People are supported to be part of their community and involved in decisions that affect them. • Responsive Care and Support: Services adapt to people’s changing needs, choices, and decisions. Individuals can lead and direct their own care if they choose. • Wellbeing: People experience high-quality care that supports their physical, emotional, and mental wellbeing. Page 73 of 236
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26 Most of the people working in Midlothian work full-time. There has been a slight decrease in the full-time workforce and an increase in the number of self-employed, part-time, and retired individuals from 2012-2019. In order to ensure that care and support can be adapted when needed, we must make sure we have a workforce that is developing the right people, with the right skills. Given that the population of Midlothian is changing, the need for social care services is likely to increase, but there may be a lack of people who are qualified or wish to be employed in these roles. The national Health and Care Experience Survey 2023/24 asked people about the impact of having caring responsibilities: The data for Midlothian told us that • 37% agreed “I have a say in services provided for the person I look after” • 35% agreed “I feel supported to continue caring” • 64% agreed “I have a good balance between caring and other things in my life” • 33% agreed “Local services are well coordinated for the person I look after” It is vital we support carers in Midlothian and take action to ensure that working towards our ambition of shifting the balance of care closer to home does not put unpaid carers are under additional pressure as a result. Our Carers Strategy 2025-2028 sets out how we will achieve this and improve the experience of carers in Midlothian. Caring 12.5% of the Midlothian population are carers. In the 2023 survey of carers in Midlothian: • 80% reported effects on their mental health, 66% on their physical health. • More than half said caring responsibilities reduced their ability to see health professionals. Caring has a significant impact on employment and income: • 28% of survey respondents have left the workforce. • 27% have reduced their hours at work. • 14% have lost pension and National Insurance contributions. • 24% of carers have used personal savings for care. • 13% have relied on food banks. Public Sector staff • In 2021 there were 1,100 staff employed by the Public Sector in Social Care Services and 45 registered care services in Midlothian. • This is an increase of 32.5% more staff working in the public sector for Social Care Services from 2012. • In 2021 employees were mostly between the ages of 35 and 64. • The rate of 16-19 years olds in employment is higher in Midlothian than in Scotland. Across Scotland the majority of 16-19 year olds are in education, with a slightly lower rate for Midlothian. Page 74 of 236
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27 There are at least 500 formal groups or voluntary associations and other Community Planning Partners and approximately 56% of the population volunteer informally. The data tells us we must continue to work in closely with our Partners to plan for a workforce fit for the future. This includes building on the value we know volunteers add to care and support. The Volunteer Charter, developed by Volunteer Scotland, outlines 10 key principles that promote good practice and protect the rights of volunteers. It is designed to ensure volunteering is safe, fair, and meaningful, and to prevent exploitation. Volunteering • 92% of respondents to our Citizens Panel survey who provide support as a formal volunteer stated that it makes a positive difference to their health/wellbeing. • 90% of respondents to our Citizens Panel survey who receive support from an informal group stated that it makes a positive difference to their health/wellbeing. Page 75 of 236
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28 Sharing information safely We work with a number of organisations to provide the health and social care services in Midlothian, all with different structures: e.g., hospitals, GP practices, care at home, and social work all have their own specialised multidisciplinary teams. These teams often need to work together to support people, especially when their needs change. This might be a single event, like an admission and discharge from hospital, or it might be support provided over a period of time that increases as the person’s needs change. 56% of respondents asked us to “contact other support or services that might help me on my behalf”. When we share information safely, it reduces duplication and means people don’t have to repeat their story multiple times. People benefit from co-ordinated care, with professionals from different services working together differently to meet an individual’s needs. This will help us adopt a way of working where we can pull in the right team of professionals to meet the individual needs of people rather than pushing referrals to multiple services and organisations. Safe sharing of relevant information helps to identify risks (e.g. safeguarding concerns, medication issues), and supports early intervention, preventing problems from getting worse. Services can provide personalised care, based on a better understanding of someone’s needs, preferences, and history, which leads to increased trust, and improved outcomes. To do this well, we need to improve how we share information safely. The information held about people can sit in the systems of our Partners, but they aren’t connected to each other. In Midlothian, a person could have their health and care data saved in at least ten separate electronic systems. The Care Reform (Scotland) Act, 2025 has made provision for change, but we don’t know how long it will take before solutions are developed. The evidence is clear that must continue to work with our Partners to ensure agreements in place that allow us to connect their information safely to deliver more person-led health and care. Data Protection Safe information sharing must follow laws including the Data Protection Act 2018. We can only share information safely when it is: • Proportionate (only what’s needed) • Purposeful (to support care) • Consent-based where possible • Secure (protected from misuse) Page 76 of 236
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29 Our strategic aims We have identified 3 strategic aims that we think can make the biggest impact in the shortest time possible. These focus on the national ambition to provide the right care, at the right time, and in the right place. Each of the strategic aims support at least one of the 9 National Health and Wellbeing outcomes and our Directions for 2025/26 are structured this way too. We have intentionally designed our planning this way to help people see how our ambitions for change are linked to the way we make decisions about funding and the action we ask our Partners to take. Page 77 of 236
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30 Strategic aim 1 People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health What we are trying to achieve 1.1 People can easily find the information they need to make good decisions. 1.2 People achieve the things that matters most to them, and our services are confident of what our contribution is to their success. 1.3 People access services and support designed around how they live their lives. Page 78 of 236
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31 What we are trying to achieve We know that our service offers and supports are only one part of what helps people and communities stay well and feel connected to the place where they live. The only way we can be sure that we are offering the services that support people to stay well is to be confident that people and communities are alongside us when we plan and discuss the future. As we developed this plan, people have told us we should spend more time having conversations with communities to understand what matters to them and help them take action to see that become a reality. Our Participation and Engagement Statement 2025-2028 sets out how we will keep the conversation going and work alongside people and communities to drive meaningful change. We know when communities are involved in designing services, they better understanding their own health and wellbeing and plan ahead using the resources that already exist in their community. We also know we need to ensure people who experience disadvantage have a voice in how we work towards a more equal future. Most people wanted us to stop talking about models and pathways because these words don’t mean anything to them. People said it would be more helpful to have information that was easy to find, and services that were easy to access. By working together and being clear, we think everyone will have a better understanding of what we can offer, and what people can do for themselves. Short-term aims 1.1 People can easily find the information they need to make good decisions Information is easy to find and accessible When strategies, plans, and service information are not designed to be accessible, people get left behind without alternatives. We reviewed the information we provide and found there was work to do to improve our published documents and information about the services Midlothian Health and Social Care Partnership provides. Page 79 of 236
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32 We know we have work to do to better understand the preferred formats and methods of communication for people living in Midlothian. This includes both how and when we present information, as well as how useful the information is. Our information needs to be equally available to everyone, which means everything is easy to read, in plain English, and compatible with text to speech technology. Our Participation and Engagement Statement 2025-2028 describes how we will have better conversations with people and communities then act on the things that are most important to them. Our work with the Community Planning Partnership is an important part of how we stay connected with local Partners. Early intervention and prevention We must not let the challenges in some areas take our attention away from the need to develop our early intervention and prevention offer. We know that the best way to prevent people needing our services in the future is to improve our population health. Breast feeding has a range of health benefits, including infants maintaining a healthy weight and supporting healthy weight in childhood. Midlothian Health Visitors are working with the NHS Lothian Public Health team who are leading on how a whole system approach to tackling childhood obesity and type 2 diabetes could be taken forward. Currently this work is underway in Easthouses and Mayfield with plans to expand to other areas in Midlothian. Speech, language, and communication is a key part of a child’s social, emotional and educational development. Language What we will do • Our 'Bump Buddies' group and telephone helpline will continue to provide vital antenatal and post-natal support for women who breastfeed. The groups are designed to support women make informed choices around infant feeding, increase the numbers of women who choose to breastfeed, and enable more women to breastfeed successfully for longer • Antenatal visits to identify children with speech or language difficulties will follow on from the three visits delivered by midwives. Sessions have been developed in collaboration with colleagues from NHS Lothian Speech and Language Therapy and Public Health teams as part of the 'prevent' agenda and will continue with targeted follow-up and evaluation to monitor the effectiveness of this prevention activity. What we will do • Work is underway to improve how we share printed materials and our website. We will work closely with Midlothian Council and NHS Lothian to help people find the information they need, and ensure information is up to date on all our webpages. We aim to have this completed by early 2026. • We have asked Midlothian Health and Social Care Partnership to develop a Public Communication Strategy and Action Plan to help as many people as possible access the information they need. Page 80 of 236
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33 difficulties have a long-term impact on children and can result in poorer outcomes in adulthood. A review of children’s speech and language development at the 27-30 month review is an important way to identify children with signs of speech or language difficulties and ensure they receive the support they need. More children are showing difficulties with speech and language at this important development milestone, and this prompted Health Visiting in Midlothian to take a proactive approach to prevention and early intervention alongside Speech and Language Therapy and Public Health teams. As part of our programme of transformation and change, the Midlothian Health and Social Care Partnership Public Health Practitioners coordinate several early intervention and prevention initiatives across Midlothian. This includes getting information and support to people as early as possible and working with our Partners to ensure people have good quality housing, education, and employment. Justice Services We must meet the challenges of the rising prison population. An important part of the Justice Service is ensuring that people can access appropriate information and resources at each stage of their Justice journey. We will continually improve the ways we do this by continuing to work collaboratively with key stakeholders including people impacted by, or involved in, the Justice system. For example, the Women’s Justice Network is a national forum established in 2023 by the Midlothian Health and Social Care Partnership. As national innovators, the Midlothian Justice Services are coordinating a programme of learning with subject matter leaders to help practitioners share learning and support women at risk. What we will do The Women’s Justice Network is a national forum to support all social work staff working with women who have a history of trauma and complex needs by sharing best practice, developing local resources, and advocating for women’s issues. Ongoing work includes identifying common behavioural patterns that can be identified by professionals to support women at risk in cases of coercive control and stalking. Page 81 of 236
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34 1.2 People achieve the things that matter most to them, and our services are confident of what our contribution is to their success Self-Management Self-management is a way of living that helps people feel more in control of their long- term conditions, health and wellbeing. This can be through access to information or developing the skills and confidence people need to manage their own health and wellbeing on their own terms. ‘Green prescribing’ is a way professionals can support people to improve their wellbeing e.g., Health Visitors encourage mums to go for ‘pram walks’ to help maintain good mental health. Some people told us they found it difficult to understand what self-management means and wanted clarity before deciding if this was the right approach for them to support their health and wellbeing. People told us they wanted to be more informed about their condition(s), be better prepared for when they feel less well, and know how to access support when it is needed. When people’s circumstances change, understanding how to access the right support is an important part of self-management. We will continue to develop ways of working that support people through times of change so they can continue to live well, for longer. Personal outcomes “What matters to you?” cannot only be a slogan, it must be the core of compassionate, relational, and person-led health and social care. It’s time for us to lead the shift and see relational working become a reality. We need to ensure outcomes, trust, and neighbourhood working are our priority. Our good relationships with Midlothian Council and their commitment to place based working will be key to delivering real change. What we will do • We have asked Midlothian Health and Social Care Partnership to develop a self-management strategy that defines self-management and sets out how we will support people to manage their own conditions. • Midlothian Health and Social Care Partnership is developing its use of an evidence-based frailty scale to help people navigate self- management. This also helps us understand the types of care that make the biggest difference and how to improve care in the future. Page 82 of 236
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35 As we continue to work towards people achieving what matters most to them, it is important that we understand what our contribution is that process is. To do this, we have not simply taken an old process and made it electronic, we have adopted new ways to describe our impact in Midlothian. This is called Outcome Mapping. We began developing our approach in 2021/22 with a framework that describes how we contribute to improving outcomes. Based on this learning, we have developed this work over the last three years that provides a way for services to tell their story and describe the contribution we make to changing outcomes. The stories of the people who experience our services are an important part of showing and evidencing how people feel and the difference we have helped make in their lives. This approach is most developed in our Strategic Governance Outcome Map that describes how we operate and gives assurance on the progress we are making towards our three strategic aims and the 9 National Health and Wellbeing Outcomes. This information also helps us learn, continually improve, and share this with our Partners. Medium-term aims 1.3 People access services that are designed around how they live their lives Whole system Transformation System transformation is more than service redesign. We are already developing our ability to understand the relationship and connections between services to help us make good decisions and are continually developing intelligence and data that helps us make the right changes in health and social care. We have worked with Midlothian Health and Social Care Partnership to start planning a programme of whole system transformation. This work will help us deliver care and support in ways that will completely redesign how we think about health and social care. It’s important that we keep early intervention and prevention at the centre of our planning and decisions. Our ongoing partnership with the Third Sector, Independent Sector, and community groups will remain at the heart of our work with people and communities. What we will do We have asked Midlothian Health and Social Care Partnership to work towards every service area reporting their contribution to outcomes for people, and to our strategic aims using an outcomes-focused approach. We have also asked services to ensure they are able to describe how they are contributing to personal outcomes and continually improving how they support people achieve what matters most to them. Page 83 of 236
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36 Primary care and connected community services As we develop our Primary Care services as close to home as possible, this might change the number of hospital beds we need. We will monitor this closely as we transform and continually review how we allocate the resources made available to us by Midlothian Council and NHS Lothian. We are hopeful that by investing in community services and working with our GP colleagues, fewer people will need to go to hospital. One way we think we can improve how people access the care and support they need quickly, is to develop a Community Front Door Multiagency Single Point of Access to reach any of our services across Midlothian. This will take time and require all of our Partners across the system to work together. Unscheduled care We are responsible for a range of health services called unscheduled care. Another way to describe this is the care that people need quickly because it is unexpected and unplanned. This includes some services from GP practices, pharmacies, and teams like district nursing, emergency departments, acute medical wards, and medical wards for older people. We must ensure that people are only directed to Accident and Emergency (A&E) when they need this type of care. Our work to better understand the system tells us that this is more likely if we invest in social care. We believe we can improve outcomes for people with early intervention and prevention activity that avoids people having to go to hospital when they could be at home. We are continuing to work in a ‘whole system’ way with the Scottish Government, NHS Lothian, Midlothian Council and local providers to develop new ways of working that improve the experience of people in hospital when the care they need cannot be provided at home. This includes making sure people are not in hospital for any longer than they need to be and the services they need work together and feel joined up. What we will do We know the Third Sector is particularly well placed to help us think differently about how we provide first contact services. We will work closely with our Third Sector colleagues to develop our Community Front Door as part of our transformation plan. What we will do Midlothian Health and Social Care Partnership has reviewed how ‘Home First’ services are delivered. This has included considering how we ensure the care people need closer to home e.g., at Highbank Intermediate Care service. Alongside our ambitions to deliver Hospital at Home where it is possible, we will redesign our community and bed-based services as part of our transformation planning. Page 84 of 236
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37 Digital Using digital tools is an important part of how we help people to live the lives they choose. This means considering where digital tools and options play a meaningful part of our service offers. We understand that digital has to be a choice and needs to be an appropriate part of safe and effective care. Digital tools and lifestyle monitoring technology help us to better understand the support people need and want to live the life they choose. Scotland is moving from an analogue to digital service for telecare support to keep people safe and well at home and alert professionals when people need help. We are also continuing to increase the number of ways that people can access our services e.g., digital consultations, telephone review, text message reminders, and Artificial Intelligence (AI). These services provide information on what to expect, how to prepare for the group, and provide signposting to other online resources to help people to ‘wait well’ for care and support. Longer-term aims Living well with multiple conditions One of the ways we think we can make a big difference is how we support people with more than one health condition (known as multimorbidity). In the UK, one in four people live with at least two health conditions. We know that people often have several long-term conditions and working on how we predict who is most likely to have multiple long-term conditions and frailty is the obvious thing to do. We are working to improve care for people with multiple health and social conditions and know the right mix of services working together has made a real difference to people and communities. This has been particularly successful with the Health and Social Care Partnership’s use of ‘No.11’ which houses a range of integrated Mental Health, Substance Use, Justice Services, and the Third Sector. That doesn’t mean we can simply recreate this success by asking services to work in the same building. To be well connected services need more than a shared working location or to be reorganised in a single management structure. Without creating the time and resources for Midlothian Health and Social Care Partnership to think through the practicalities of how to join What we will do • We will work with Midlothian Council and NHS Lothian to ensure we are safely gathering and using data and technology where it can improve outcomes for people and support the workforce. • We are expanding our digital offers and utilising NearMe online consultations to support more people attend weight management groups run by a specialist team of dietitians. Page 85 of 236
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38 up their work around people and communities, plans will not be successful. We know improving coordination is about relationships between people, not just the building they work in. As we collect local evidence about how and where we could better coordinate and link service and supports for people with complex needs, we will be able to connect services and multidisciplinary teams in new ways. We will look for opportunities to build new relationships and work more closely with our Partners. Falls and frailty Falls, and illnesses associated with frailty remain common reasons for people in Midlothian being admitted to hospital. Reducing falls and the number of people who need to go to hospital will help people stay well, improve wellbeing, and reduce pressure on the wider system. For older people, we know that falls can be associated with being unwell. However, falls are not an inevitable consequence of getting older. Building new relationships and working more closely with a range of organisations will better coordinate services for people with multiple conditions, including frailty. What we will do We are taking a multi-agency approach to make sure people are able to take action and bring to life the outcomes and ambitions of national direction, the Health Improvement Scotland’s Ageing and Frailty Standards, and the NHS Lothian Falls Prevention and Management Framework. Page 86 of 236
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39 Strategic aim 2 People access the care and support they need when they need it in the community and at home What we are trying to achieve 2.1 People easily access the services that help them stay well, independent, and active. 2.2 People have access to services in their own community. 2.3 People are living in the place of their choosing for longer. Page 87 of 236
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40 People told us that they know there is not enough money or staff in the health and social care system to do everything for everyone. One of the things we can do to help people continue to live in the place of their choosing for longer is ensure we are providing care, support, and rehabilitation that supports people to make good choices that prevent difficulties in the future. Activities, interventions, or information resources that support people to recover, adapt, and achieve their full potential are all types of ‘rehabilitation’. If we have the right service offers and supports in place, people will recover faster and fewer people will need support from health and social care services. This includes supported self-management, and information that helps people take action to stay well. Working with our Partners to ensure it is possible to provide what people need in our communities is a priority . Of course, this means making sure the right health and social care is available, but it also requires the availability of transport and other services that help people access the support they need locally. Short-term aims 2.1 People easily access services that help them stay well, independent, and active. The right approach We want to focus on providing the support people want, when they need it, and in a way that people can best manage their own health and wellbeing. As we work to build new, more relational services we have asked Midlothian Health and Social Care Partnership to move away from planning our services in categories e.g. by age or diagnosis. An ‘ageless’ provision of care and support must be a personalised approach, agreeing together the purpose of working together, and tailoring care and support to each individual’s specific circumstances. We know that equality means providing what individuals need to success, not rolling out the same set of offers to everyone. What we will do Midlothian Health and Social Care Partnership is working closely with Midlothian Council and others to develop a shared Transitions Policy. This work will take a phased approach and move away from single service provision to a holistic and whole-system approach as the support people need adapts from child, to young person, and adulthood. New approaches and their application to our traditional service design of learning disability and physical disability will help us transform. Learning from this process will help us implement this work in other key areas like Justice, Mental Health, and Dementia Services. Page 88 of 236
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41 As part of our commitment to work with neighbourhoods and communities, we will invest in a social care led approach to building bespoke support offers. We want to move away from simply trying to connect all the services people experience, to agreeing what the purpose of our work together will be and ‘pulling in’ the right professionals to make this a reality. We have asked our Strategic Planning Group to coordinate this work and suggest the corrective action we may need to take. We will communicate this through the Directions that we issue to Midlothian Council and NHS Lothian. The right support We want to provide the right support at the right time then continue to support people to thrive while stepping back. Having the right service offers and support to supplement what people can do for themselves is crucial and we know our Third Sector colleagues and other providers will be the key to success. We want everyone in Midlothian to have equal opportunities to improve their health and wellbeing and this will mean the services we commission over time might change. In order to make the fastest progress possible towards our strategic aims, we have already started work to review the services we commission and are using the learning from this process to ensure that we are using the resources we have to provide the most effective range of services in the future. Our Market Facilitation Plan 2025-2028 sets out how we want to work collaboratively with local providers. We don’t have any more funds, but we can make sure we are using the resources we do have in the most effective way. What we will do We have asked NHS Lothian and Midlothian Council to work alongside us to ensure the right services are available, in the right numbers, from a range of providers so we can work towards a future where everyone in Midlothian has good health and wellbeing outcomes. This will mean developing a new relationship with providers to ensure everything we commission is strategically chosen to see the most progress for people and communities in the shortest possible time. What we will do Over the next two years we will set out more clearly how we want Midlothian Health and Social Care Partnership to adopt a more person-led approach to service design. Rather than ‘pushing out’ referrals to multiple services across the system, we want to develop a system that ‘pulls in’ the right professionals to support individuals. We need to evaluate and learn from the progress of our short-term priorities and information sharing, feedback, engagement, embedding outcomes-based approaches, and our early transformation work to know how best to proceed. Page 89 of 236
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42 Support is easy to access Ensuring people can easily access the right help when they need it is vital to improve health and wellbeing. However, we know that some of our services are not as easy to access as we would like. People have to wait longer than we would like for some services, and others don’t have enough staff to offer the flexibility and adaptability that we would like to offer. We want our services to be available at the heart of our communities and help people focus on what is already strong, what could be even better, and how we can take the next steps together. Midlothian Health and Social Care Partnership’s Social Work and Occupational Therapy teams are reviewing the way they plan and deliver support. This review will consider the current legislative requirements for Social Work alongside a range of key information and help us support people more effectively and efficiently while still retaining specialist knowledge and skills within the service. Staying active Wellness is influenced by so many things, but we know staying active and making good choices is one of the best ways to contribute to good health and wellbeing. Our work with Midlothian Active Choices and our Allied Health Professional teams are good examples of when this works well and has helped us support more people in the community, create opportunities for people to design the support they need, and develop more links with services. We will learn from the successes and challenges of working in this way and develop more opportunities for people to improve their health and wellbeing e.g., the Weight Management Physical Activity programme. What we will do A review of weight management services is already underway by Midlothian Health and Social Care Partnership. We know that people are often impacted by weight stigma. The Health Inclusion Team, Public Health and Dietetics are working together to develop new ways to support both professionals and families. This includes reviewing the options and types of support available and improving the effectiveness of weight management programmes as part of a whole systems approach. What we will do We have asked Midlothian Health and Social Care Partnership to introduce Community Appointment Days. By asking people to attend a session in their own community supported by a range of professionals across health and social care, people will more quickly find the help they need. Page 90 of 236
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43 Medium-term aims 2.2 People have access to services in their own community Better choices, better care We know that providing care in the community is preferable to people being in hospital whenever it is possible, and this means we must invest in our community services. We know that people who go to hospital when it could have been avoided often have poorer outcomes and that it is an expensive way to provide care. Moving care from hospital- based to community-based settings is better for people, but very rarely less expensive. We must link what we know about high quality care, outcomes for people, and the resources made available to us by Midlothian Council and NHS Lothian. Bed based care Bed based care is a term we use to describe care received by someone in a hospital or care facility. NHS Lothian is developing a predictive system for bed-based care to understand how best to use the resources available across the system. We are working with NHS Lothian to make sure this will help us understand the factors unique to Midlothian. This digital tool will help us predict the availability of bed-based care across the whole system bed and record and forecast how capacity is affected under a variety of conditions. This will help us plan for seasons pressures throughout the year, winter pressures and outbreaks of disease, and understand what the impact of changes in other sectors might mean for Midlothian. e.g., private nursing homes. Planning for the future Programmes of work are influenced by national ambitions, including realistic care and support as well as local need. We want to build on what we already know about the quality of care and support provided by services, build a better understanding of the relationship between these care and support options, and look for opportunities to help people to live in their community for longer. What we will do We will undertake a review of all our bed-based care to support people to be as independent as possible by maximising what they can do for themselves. As part of our Transformation Programme, our bed-based review will include. • Midlothian Community Hospital, • Highbank Intermediate Care Facility, • Newbyres Care Village, • Extra Care Housing, and • our Care at Home service. We have asked Midlothian Health and Social Care Partnership to develop a new strategy and workforce plan to ensure people can access bed-based care when they need it. Page 91 of 236
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44 We hope that more people will be able to benefit from care in their own home and that when people do need to go to hospital, it will be for shorter periods of time. How we use Midlothian Community Hospital, Highbank Intermediate Care Facility, Newbyres Care Village, and our Care at Home service is vital to this ambition. Continually improving To make positive changes to health and social care in Midlothian as safely, equitably, and as quickly as possible, we need to be confident that we are continually improving. Better understanding the relationships between our services and how we can improve is one way we can support people to take action to prevent, ill or worsening health and stay well. Longer-term aims 2.3 People are living in the place of their choosing for longer Thriving communities We want our communities to thrive, and for people to live well and as independently as possible for longer in the place of their choosing. We need to strike the right balance between health and social care supporting population approaches to improve health and wellbeing, the care and support delivered locally by our services, and the action individual people need to take to stay well. We want to get this right because we know how important it is to improve health equality across our communities. The progress we make in the next 10 years towards the 9 National Health and Wellbeing outcomes will contribute to seeing strong and resilience communities in Midlothian take action to prevent ill or worsening health. We want to bring health and social care together with local communities and community organisations to make a real difference in people’s lives through the Midlothian Community Planning Partnership. Effective community planning and working with all our Partners will achieve more than we can through health and social care alone. What we will do We have asked Midlothian Health and Social Care Partnership to continually evolve and adapt using the available resources. This includes all services adopting a culture of continuous improvement, so they are confident they are support people to achieve what matters to them most. What we will do As the lead organisation for the ‘Midlothian will be healthier’ and ‘Midlothian will be safer’ components of the Single Midlothian Plan, Midlothian Health and Social Care Partnership will work alongside people, communities, and community groups to co-design and co-deliver the right support to help communities thrive. Page 92 of 236
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45 Strategic aim 3 People’s human, social and economic rights are protected and promoted in how we design and deliver our services What we are trying to achieve 3.1 People are recognised as experts in their own lives, are involved in planning services, and feel valued. 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want. 3.3 People benefit from organisations working together and sharing information safely. Page 93 of 236
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46 We believe that everyone should have equal opportunities and that no one should have less life chances because of their sex or gender, what they believe, or whether they have a disability. It is important that we work together with all our Partners to improve outcomes for everyone in Midlothian. Equality does not mean that everybody should be treated in the same way. Equality means services should be provided in different ways to meet the different needs of people. We are committed to working to advance equality in Midlothian. We believe that equality has to be at the centre of all our decisions and have ensured that this strategy is closely aligned with our Equality Outcomes for 2025-2029 which sets out our priorities for the next 4 years and how we will work together for a fairer and more equal Midlothian. Short-term aims 3.1 People and their carers are recognised as experts in their own lives, are involved in planning services, and feel valued. Midlothian has built a long-term commitment to strength based, and community led health and social care and have taken a "good conversations" approach, for over a decade. More recently this has grown in a system wide approach in Midlothian – The Midway. This is not just about how we welcome people into our services and work alongside them, but also how we lead and plan, talk about health and social care, and work with each other. The Midway has provided us with a solid foundation to build relationships and understand what matters most to people and communities. However, we need to do more than talk about the case for change. Part of this work will be how we ask Midlothian Health and Social Care Partnership to take action to redesign services. Our commitment to transforming service offers and supports around the way people live their lives means we will need to do things very differently. What we will do Midlothian Health and Social Care Partnership is reviewing and refreshing the Midway. This includes a focus on the trauma informed and inequalities informed elements of this work. It is anticipated that this work will be completed in 2025. Page 94 of 236
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47 Shared decision making, representation, inclusion, and action People told us they want to see be included in decisions, treated with dignity and as individuals, and that they value meaningful face-to-face interactions and feedback. We want to plan for the future alongside people and have person-led service officers and supports. This means listening to what matters most to people and then working with them to make what they care about become a reality. As part of the process to review our Participation and Engagement Statement, we undertook the Healthcare Improvement Scotland Quality Framework for Community Engagement Self-Assessment. This informed how we want to practically support people and communities to be part of service design and planning. Our Participation and Engagement Statement 2025-2028 sets out the agreement we have made with people and communities about how we will work together. It also sets out how we will ensure people who experience our services, their carers, and families are represented and included in service design and planning. Mental health, illness and wellbeing We want to support everyone in Midlothian to experience the best mental health they can. This is particularly true for people who are experiencing poor health or conditions that are medically classified as mental illness. Our focus is to support the priority work of NHS Lothian through the LSDF and actively contribute to the programme of work agreed with the 4 Lothian Health and Social Care Partnerships. This will include local work to reduce waiting times and improve the experience of people who access our service offers and supports by working closely with all our Partners. When the care we provide is person led, we know we are helping people achieve the outcomes that matter most to them. For people with dementia, support delivered in a coordinated way can help people live in their community for a long as possible during the moderate to severe stages of the illness. It is important to consider all the factors that impact on overall health and wellbeing to provide the right care and support for each person. Examples Midlothian Health and Social Care Partnership is undertaking work to ensure that everyone with a diagnosis of dementia can be offered Post- Diagnostic Support for the first year of their diagnosis and has access to the 8 Pillars of Community Support. This includes learning from our work on transitions and recognising the increasing number people being diagnosed with dementia at a younger age. Page 95 of 236
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48 Carers We will continue to invest supporting carers, raising awareness of the important role of carers, support people to identify when they are providing a caring role, and then ensure they can easily access the services that will best meet their needs. As we work to deliver more care as close to home as possible, we understand this could impact on our unpaid carers. We know that carers are a vital part of the support people need to stay well and remain at home. We have work to do to support our carers and ensure they can continue delivering care and support for as long as they are able and willing to do so. Work is continually underway to better understand how we can support carers in Midlothian. This includes working with our commissioned partner VOCAL to consider how the information, advice and support that matters most to carers could be improved. Our Carers Strategy 2025-2028 (in development) sets out how we plan to work with carers, the people they care for, and all of our Partners to improve carers support, the accessibility of services, and support the ambition for carers to receive appropriate remuneration and experience fairer working conditions. Doing more of what people value More than half of the population of Midlothian volunteer informally in their community by doing things like supporting others or participating in local projects and groups. People told us that they benefit from volunteering, they value receiving support from volunteers, and that this support makes a positive difference to their health and wellbeing. Where possible, we want volunteers to be part of our plans and continue to build on our good relationships with volunteers, volunteering groups, and Third Sector organisations. As care and support services improve and evolve, services are considering how volunteers can work alongside services. This includes considering where there could be opportunities for Voluntary Service Managers to help coordinate this work in a way that is sustainable, safe, and meaningful for both volunteers and people who access this type of support. What we will do We have asked the Midlothian Health and Social Care Partnership services involved in shifting the balance of care from hospital at home to ensure the potential impact on unpaid carers is considered. We know that appropriate support is a central part of how we keep people safe and well, and at home. Our Community Hospital has a thriving volunteer programme with over 35 volunteers making a difference to people who are in hospital. As part of the NHS Lothian Volunteer Service, volunteers are supporting patients and their families through a shared love of music. Opportunities to listen to music together or share a favourite song are led by volunteers to make connections, reduce isolation, and improve wellbeing. The Volunteer Service is exploring guidance from the dementia care charity ‘Playlist for Life’ and hoping to create personalised playlists for people living with dementia. Page 96 of 236
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49 Medium-term aims 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want We want to make sure that when people’s needs, choices, or decisions change, we can respond quickly and help people take as much control of their care as they would like to. We will continue to work with our Partners to ensure this happens consistently and as easily as possible when needs or choices change. Self-Directed Support We know the importance of choice, independence and good conversations to support people who want to manage their own self-care. Self-Directed Support (SDS) is a Scottish Government policy that supports people to access the care that they want to help them live the life they choose. We want to make it as easy as possible for people to make the choices that matter most to them, but we know that people are sometimes uncertain about what is available through social care SDS options. We have asked Midlothian Health and Social Care Partnership to ensure services support people to understand and access the right amount of support. Choice and opportunity We want people in Midlothian to live independently as possible, with choices and opportunities, and in a safe environment. We are already working with our Partners to provide more opportunities and choices to support this. We are learning from where we have had success in supporting other groups of people to live well in the community, e.g., Primrose Lodge. Primrose Lodge in Loanhead is a development of four tenancies with a ‘short breaks’ service for two people next door. The development will become available in 2025 and be What we will do We have asked Midlothian Health and Social Care Partnership to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms this means • ensuring all the teams who work with people, including the teams of our Partners, understand what SDS is and how to signpost this information at the right time, • providing training for staff in sensory awareness, • supporting people to request and access accessible information, • ensuring the information we provide about SDS is accessible so those who may benefit from different options are able to make informed choices. Page 97 of 236
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50 is part of the strategic redesign of Learning Disability services in Midlothian. The building has been designed to be accessible and barrier free with provided 24 hours a day, seven days a week, by highly trained staff that are supported by specialist disciplines such as nursing, physiotherapy, speech and language therapy, dietetics, and occupational therapy. What we know already works well, and identifying what we need to do differently is helping us plan for new developments. For example, we are already planning a new development to support older people have more choices and opportunities to stay at home for longer and receive the care and support they need. Changing needs People’s needs can change for a number of reasons and at any time. When this happens, we want to be able to respond as quickly as possible and provide the right care. This is important for everyone but can significantly improve the experience of care for people at the end of their life. As part of the transformation programme, we have asked Midlothian Health and Social Care Partnership to ensure people can access co-ordinated, timely and high-quality palliative care, care around death, and bereavement support based on their needs and preferences. This must include support for both families and carers as they deal with loss and grief, and for staff to manage the emotional impact of caring for people at the end of life. What we will do We will build into our Transformation Programme more opportunities for people to live in the place of their choosing for longer with the right care and support. We will review how we provide support for people with complex needs. The Adults with Complex and Exceptional Needs (ACENS) service will continue to provide person-led care as we work with both of our Partners to develop a whole system approach that can cope with increasing demand and provide the right support to those who need this specialist service. Page 98 of 236
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51 Longer-term aims 3.3 People benefit from organisations working together and sharing information safely People have access to their own health and social care information People told us they want information about their care to be shared more easily between services. People also want to be able to share information themselves and on their own terms e.g., linked health and social care records. Integrated care records could help avoid people having to repeat their story, help them better manage their care, and support discussion and shared decision-making. Effective digital systems and linked technologies could lead to better and more consistent care, but this is not yet available. In Scotland, we are some way off from having the data sharing agreements between organisations that would need to be in place for linked records. However, this remans a key objective for Scottish Government, and we will continue to work with our Partners to make sure we are able to adopt new ways of working as soon as it is possible. By doing this we will save time for people and staff and create new opportunities to do things differently. Bringing data together in new ways Our experience tells us that there are some services that people are more likely to need at the same time. If we could reliably predict in Midlothian, we would be able to reorganise health and social care around what people most frequently need, rather than individual diseases. Understanding the local patterns of health and wellbeing would help us redesign our services around how people live their lives. Currently, due to the way national information is collected, there is no data that can tell us the most commonly occurring clusters of health and social care need in Midlothian. We must develop this ourselves and consider how we use the data we already have to better understand how people access our services in Midlothian. What we will do We are working with local Partners and data specialist to bring together health and social care data in ways that have never been done before. This will help us create new ways of safely storing, sharing, and connecting information so that people only need to tell their story once. What we will do By creating the conditions for the safe sharing of information between organisations and connecting systems, we are confident we will be able to plan and design more person-led approaches and improve how we support people who need health and social care services. Page 99 of 236
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52 Making this a reality Other key documents and information In developing this Strategic Plan, Scottish Government require us to produce a number of documents alongside it: • Medium Term Financial Strategy (due December 2025) • Joint Strategic Needs Assessment • Consultation and Engagement Statement 2025-2028 • Housing Contribution Statement 2025-2028 • Market Facilitation Plan 2025-2028 • Performance Framework • Equality and Children’s Rights Impact Assessment on the Strategic Plan You can find all of these documents on our Midlothian Health and Social Care website. Page 100 of 236
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53 Our priorities The priorities set out in this plan describe the action we will take to make our ambitions a reality. Every year, as close to the start of the new financial year as practicably possible, we issue written instruction to NHS Lothian and Midlothian Council. These instructions are called Directions and are the mechanism to deliver the ambitions of this strategic plan. Directions are legally binding and instruct NHS Lothian and Midlothian Council to do the things we think are the highest priority, describes what they need to deliver, and the budget that they have been allocated to do this with. Our Directions are written in a way that aligns them with both the strategic aims in this plan and the National 9 Health and Wellbeing Outcomes. This allows us to be clear what we are doing, why, and what we hope to see as a result. Directions for 2025/26 were issued in March and September 2025 and provide a formal record and audit trail of our decisions and the responsibilities of our Partners. We looked ahead to the publication of this plan and set out the priority actions for 2025/26 and transformation plans as part of planning how to use our resources. We review progress made towards our Directions regularly and report on this twice a year. We can issue a new Direction at any time or revise a Direction if we think we need to take corrective action e.g., if we make a decision that changes service delivery, or if we receive new funding across the year. Midlothian Health and Social Care Partnership uses Directions to ensure operational planning has a clear connection between our strategy and delivery. Page 101 of 236
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54 How services plan People told us they believed our ambitions were the right ones, but they also wanted to know what we were going to do and that we have carefully considered how we ask Partners to take forward key actions and priorities in our Directions. Our strategic plan has to be a deliberate choice in direction, and not an operational ‘to do’ list for Midlothian Health and Social Care Partnership and others to execute. We continue to believe that those delivering care and support are best placed to make the right decisions about the care and support they deliver. Midlothian Health and Social Care Partnership has annual Service Plans for each operational area that set out the detail of how this Strategic Plan will be brought to life in our communities. These operational plans are based on our strategy, the realistic possibilities with the resources that have been made available to us by our Partners, and our Directions as well as national priorities and drivers, and what we know about people and communities. This includes initiatives like the Framework for Community Health and Social Care Integrated Services and the proposed multi-agency Getting Right for Everyone approach are both central to how Midlothian Health and Social Care Partnership plans its services. The Midlothian Heath and Social Care Partnership Service Plans will be published on our website. Our workforce We do not directly employ any staff. The health and social care workforce are employed through Midlothian Council, NHS Lothian, and organisations in the Independent and Third sector alongside our unpaid carers and volunteers. However, we know that this combined workforce is the single biggest asset available to us in progressing the ambitions of this plan and improving outcomes for people and communities. We know the needs of our workforce are changing and dependent on many new factors. In 2022, we published our Integrated Workforce Plan 2022-2025 which focused on the 5 pillars of workforce planning set by Scottish Government to support recovery, growth, and transformation of health and social care. In response to this, Midlothian Health and Social Care Partnership developed a staff Communication, Engagement and Experience Delivery Plan. We have continued to develop our skills in this area and worked with Midlothian Health and Social Care Partnership to develop an Integrated Workforce Plan for 2025-2028. This plan describes how we will plan, attract, train, and support the development of the workforce required to deliver the ambitions of this strategy. Our Integrated Workforce Plan has been submitted to Scottish Government for review. Page 102 of 236
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55 Monitoring and evaluation There are a number of ways we work with our Partners, people, and communities to monitor and evaluate the progress we are making toward the ambitions of this plan. Page 103 of 236
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56 Measuring performance We measure our performance to see what is working well, what can be improved, and how well we are meeting the key aims of integration and strategic aims of our strategic plan. We do this through evaluation and reporting methods that can be found on the Midlothian Health and Social Care Website. • Our Performance Framework that uses quantitative (number) and qualitative (narrative) information, • Our Annual Performance Report, • Bi-annual reports on progress against our Directions, • Our Equality Outcomes, and Mainstreaming Equality report and action plan, and • Quarterly reports from Midlothian Health and Social Care Partnership’s services. Our performance framework Our Performance Framework sets out the ways in which we review, monitor and evaluate the impact we are making in people’s lives. There are some elements of this framework that use nationally validated data i.e., the national indicators connected to the 9 National Health and Wellbeing Outcomes, and the Ministerial Steering Group (MSG) Indicators. Other parts of our framework include data on progress towards our Directions and the progress towards the operational plans of Midlothian Health and Social Care Partnership. Page 104 of 236
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57 Tracking outcomes Our Strategic Governance Outcome Map is an important part of how we evaluate our performance and how we monitor progress towards our strategic aims. Outcome maps are a way to understand how services contribute to people achieving the outcomes that matter to them. We are using this unique approach to provide a real time picture of the progress we are making towards our strategic aims and the nine National Health and Wellbeing Outcomes across the whole system. We do this by linking to service outcome maps and other national and local data. Our Strategic Planning Group reviews the data and evidence we collect at every meeting. This group oversees the quality of the data we use and scrutinises the interpretation of our analysis. Where there are data that need further examination, the group asks the senior leaders in Midlothian Health and Social Care Partnership to help us understand where we can learn from areas of success as well find opportunities for change. As part of our Performance Framework, this helps us better understand the contribution we are making to personal outcomes for people. Working this way means Midlothian Health and Social Care Partnership services can quickly learn from what has worked well, identify what needs to improve, and use this information to make more targeted, locally informed decisions about how to design, deliver, or commission services. This approach allows services to describe what they do, who with, what people learn and gain as a result, how this makes them feel, and the difference this makes in their lives. Page 105 of 236
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58 Budget and financial plan We must only spend the resources that have been made available to us by our Partners, Midlothian Council and NHS Lothian. This Strategic Plan helps us prioritise how we will allocate and best utilise those resources. We have agreed that achieving the ambitions of this plan will bring the change we want to see in our communities. The way we allocate funding to the services that Midlothian Health and Social Care Partnership manage is based on this plan. However, we know we don’t have enough resources to meet all the needs of the growing population in Midlothian. Page 106 of 236
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59 As we monitor our progress towards the 9 National Health and Wellbeing Outcomes, we will consider if the plans are delivering change in the way we hoped. We might not have resources available to us to make as much progress as quickly as we’d like, but our strategy will continue to aim to improve outcomes for everyone in Midlothian. Midlothian Health and Social Care Partnership operationalises this plan and uses the money allocated to its services to plan, deliver, monitor, and evaluate the services it provides and commissions. The actions services take, and how they use the resources allocated to them will determine how much progress we make, and how quickly. We monitor these plans and will ask Midlothian Health and Social Care Partnership to do things differently when we think there is a need to do so. Annual Budget Setting We can only use the resources that are made available to us. These resources are allocated to us by Midlothian Council and NHS Lothian each year and we are then responsible for the integrated budget. The budget offer we receive from both of these Partner’s changes from each year and may not be enough to deliver everything we want to. We work closely with both Partners but often don’t know exactly what our budget offers will be until February or March each year. This is because of how our Partners receive funding from Scottish Government. Future funding decisions that impact on our Partners are likely to also impact on the resources we have. This makes it very difficult to plan ahead in a meaningful way as we don’t have firm offers from both Partners until after the start of the financial year. The result of year-on-year budget offers means that strategic planning and progress towards our strategic aims can slow down, or we may need to revise this plan and our medium-term financial strategy to ensure we are prioritising the right actions. The decisions taken by our Partners will impact on our capacity and ability to respond to changing needs in our communities. Best Value Best value is about ensuring that we effectively manage the resources available to us and focus on improvement to deliver the best possible outcomes for people and communities. To achieving Best Value, we must work alongside our Partners. To help us do this, we monitor our actions using a Best Value Framework and record our progress in the Strategic Governance Outcomes Map. This helps us continually improve and describe our work across 7 key areas. • Vision and leadership • Governance and accountability • Effective use of resources • Partnership and collaborative working • Working with communities • Sustainability • Fairness and equality Page 107 of 236
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60 Our annual budget Our annual budget for 2025/26 is £177.528m. £73.191m - Health Core Services (from NHS Lothian). These are local health services which are delegated to the Health and Social Care Partnership. These include primary care services like GPs and Pharmacists, and other community services like district nursing, community mental health teams, community learning disability teams, and the local community hospital. £14.975m - Health Hosted Services (from NHS Lothian) Some services are managed on a pan-Lothian basis. We manage a share of the total budget for these services based on its population. Midlothian hosts Dietetics and Adults with Complex and Exceptional Needs and provide services for people across Lothian on behalf of all four Health and Social Care Partnerships - Midlothian, East Lothian, West Lothian, and City of Edinburgh £18.276m - Health ‘Set Aside’ budgets (from NHS Lothian). Unscheduled care services (Accident and Emergency and unplanned admissions) are managed by NHS Lothian’s Acute Hospital system. The IJB’s budget includes a share of these services, based broadly on our population size. The budget is ‘set aside’ by NHS Lothian on the IJB’s behalf. These services are Accident and Emergency, Cardiology, Diabetes, Endocrinology, Gastroenterology, General Medicine, Geriatric Medicine, Rehabilitation Medicine, Respiratory Medicine, and various ancillary support services for the above. They are delivered at the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital. £71.086m - Social work and Social Care (from Midlothian Council). This is for the adult social care services in Midlothian. These services are managed operational by the Midlothian Health and Social Care Partnership. Page 108 of 236
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61 How we fund ‘Transformation’ The financial resources available to us are agreed when we set our annual budget. This is usually in March. Sometimes further resources are made available by the Scottish Government. Working this way makes thinking about our strategy difficult. By law, we have to review our Strategic Plan every 3 years but also know that change doesn’t happen quickly. We will review and refresh this plan in 3 years, but we only have the budget confirmed for one year at a time year. We also know that our population is changing, and we need to plan for this by thinking much further ahead. This Strategic Plan asks the services in Midlothian Health and Social Care Partnership to redesign in specific ways over the next 10 years. New legislation, national policies, or other national changes may also require services to do things differently. When this happens, it often needs additional investment, but we don’t always receive more money. We have spent several years improving and making our services as efficient as they can be. This means we are no longer able to do more with less to achieve saving targets. We are now working towards total system transformation, and work at this scale requires a huge amount of planning, testing, learning, and retesting on top of our day-to-day business of supporting people and communities. We are working with Midlothian Health and Social Care Partnership to ensure they have the right capacity in the early planning and implementation stages of this work. We only have 3 options available to us to fund additional services. This means we will not be able to truly transform without one of these options being made available to us. New resources from Scottish Government. These are generally agreed as part of the budget setting process each year. A transfer of resources from elsewhere in the system. As we provide more care in communities and avoid people going to hospital unnecessarily, more resources should be released from hospitals to support community services. However, in practice this is difficult to achieve and can impact on our ability to do more of the work that we think would make the biggest difference in our communities. A reorganisation of how we allocate our own budgets. We can choose to fund areas differently but giving more to one area means giving less to another. Sometimes this means we have to stop providing some services and we will always discuss these options with all Partners, people, and communities before making any permanent decisions. Page 109 of 236
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62 Our ‘reserve’ budget All Integration Authorities should have reserves as this is part of good financial management. There are two types of reserves: general reserves, and earmarked reserves. General reserves are funds which have been built up from surpluses in previous financial years. The main purposes of general reserves are to help support unexpected financial pressures through the year. In 2023/24 we had to spend all of our general reserve (c. £6.2m) to pay for services. Although this was planned, it means we no longer have any reserves to support recovery plans or to investment in service transformation. Earmarked reserves are funds that we may have carried forward one year to the next for specific and allocated services or projects. We have earmarked reserves for this purpose. Our medium-term financial strategy Although our financial position is more unpredictable now than it has ever been, we are developing our medium-term financial strategy. We will ensure our medium-term financial planning supports the delivery of this strategic plan for 2025-2035 and closely links with our workforce plan for 2025-2028. This 5-year financial plan will be published in December 2025. We will review this regularly and adapt and change to meet the challenges. Financial risks We are currently facing a number of serious financial risks. The main risk is that our Partners may not be able to provide the necessary levels of funding to support our aims. The financial pressures we face are the same all across Scotland: the costs of changes relating to staff pay, terms and conditions, the changing cost of existing drugs and the cost of new drugs and rising costs due to inflation. NHS Lothian and Midlothian Council have supported us with the best funding offer they can in the circumstances. However, in the future they may have to prioritise funding their own services first. This would mean less money was available for community health and social care. There is also a risk that future Scottish Government policy decisions could impact on the way we have to use the money we have available to us. For example, it is not clear how the National Care Service will impact of the funding we receive of the services we will be asked to plan for. Page 110 of 236
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63 Appendices Page 111 of 236
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64 Appendix 1: Our responsibilities Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). We meet regularly and include members from NHS Lothian and Midlothian Council, the Third and Independent Sector, staff, and people who represent their community, people who experience our services, their families, and carers. Midlothian Health and Social Care Partnership oversees more than 60 services on behalf of Midlothian IJB. All people who work in Midlothian Health and Social Care Partnership are employed by either Midlothian Council or NHS Lothian. You can find the full list of services the IJB is responsible for in the Midlothian Scheme of Integration. This includes 2 hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the 4 Health and Social Care Partnerships. Some of the services include: NHS Lothian • Care in Hospitals which isn’t planned (unscheduled care) including Accident and Emergency, Minor Injuries, Acute wards • Midlothian Community Hospital • Community based health care (Primary care) including GPs, District Nurses, Dentists, Pharmacists, Mental Health services, Substance Use Services, Community Respiratory Team • The following Health services for children and young people under 18: Health Visiting, School Nurses, Vaccinations of children • Allied Health Professionals – including physiotherapists, dietitians, podiatrists • Palliative and End of Life Care Midlothian Council • Social Work support for adults including adults with dementia, learning disabilities and older people • Care at Home services • Day services for older people and people with learning disabilities • Services to support unpaid carers and breaks from caring. • Health services for people who are homeless • Extra Care Housing for people who need housing with extra support • Care Homes • Services to address health and care needs of people in the Justice system Page 112 of 236
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65 Appendix 2: Locality planning The Public Bodies Act requires that each Integration Authority area is split into at least two localities. However, the numbers in the available validated data that would support this are often too small to be reported. There is no natural split into two or more areas across Midlothian and the population isn’t large enough to make a locality approach viable for commissioning services. As the smallest mainland authority in Scotland, we do not consider this is a meaningful approach. Instead, we work with the local Community Planning Partnership and Neighbourhood Plans to work with our 15 natural communities to identify what is working well and plan areas for development. The voluntary sector has strong roots in local areas and supports a system wide understanding of community intelligence that is invaluable. Our ongoing partnership with the third sector is at the core of our work in communities. This approach has been particularly effective during civil emergencies such as extreme weather conditions and the pandemic. More information on the health and social care needs of the Midlothian adult population can be found in our Joint Strategic Needs Assessment. Page 113 of 236
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66 Appendix 3: Policy and drivers Some of the most important national policies that have contributed to this plan are • National Performance Framework • Principles for Planning and Delivering Integrated Health and Social Care • Best Value in Public Services • NHS Scotland Operational Improvement Plan • Health and Social Care Service Renewal Framework • Scotland’s Population Health Framework • Health and Social Care Standards (2017) • National Health and Wellbeing Outcomes Framework • Delivering Value Based Health and Care: a Vision for Scotland (2022) • Framework for Community Health and Social Care Integrated Services • Fair Work Action Plan (2021) • Housing to 2040 (2021) • National Workforce Strategy for Health and Social Care (2022) • My Health, My Care, My Home - Healthcare Framework for Adults living in Care Homes (2022) • National Clinical Strategy for Scotland (2016) • NHS Recovery Plan 2021-2026 • Getting it Right for Everyone • Getting it Right for Every Child Policy Statement 2022 • National Carers Strategy (2022) • Self-Directed Support: framework of standards (2021) • Rehabilitation and Recovery: a person-centred approach (2022) • National Mental Health Strategy 2017-2027 • National Drug Mission Plan 2022-2026 • Creating Hope Together – Suicide Prevention Strategy 2022-2032 • General Medical Services Contract in Scotland (2018) • Primary Care Improvement Programme • Diabetes Improvement Plan (2014) • Palliative and End of Life Care Strategic Framework for Action (2015) • Palliative and End of Life Care by Integration Authorities: advice note (2018) • Learning / intellectual disability and autism transformation plan (2021) • See Hear – A strategic framework for meeting the needs of people with a sensory impairment in Scotland (2014) • Enabling, Connecting and Empowering: Care in the Digital Age – Scotland’s Digital Health and Care Strategy (2021) • Greater access, better insight, improved outcomes: a strategy for data-driven care in the digital age (2023) Page 114 of 236
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Section ID Comment / Request Edit Requested by Actioned 1.1 Link more closely with the LSDF close working with NHSL strategy team to 1. ensure wording through reviewed and edited to ensure close links 2. reference in 'Working with our partners' section IJB Aug-24 1.2 What is the details of what we are going to do to achieve these aims? Outcomes? these will bedefined as operational trandformation programme developes over 2024. Specifics will sit in the HSCP transformation plans but high level outcomes have been added to the plan throughout IJB Jan-25 1.3 Carers are a key theme throughout the draft plan. However, there is currently no clear reference/link to the local carer strategy The Midlothian Carers Strategy 2022-25 is available on the website and a link should be added to the strategic plan. The Carers Strategy should also refreshed in line with this new strategic plan and would be anticipated for publication in 2025. Reference to this has be added to the plan in Strategic Aim No 3. IJB Jan-25 1.4 Annual Delivery Plans: Service plans referenced in section ‘making this a reality’ sub section how services plan Workforce Plan: clearly referenced Medium Term Operational Plans: less clear Revised ‘Operational planning’ and ‘How services plan’ sections with ‘Making this a reality’ to distinguish the strategic plan for operational planning cycles IJB Aug-24 1.5 The NCS is only referenced in passing in the finance section. Should this be strengthened? At the time of producting the v1.2 draft following public consultation and completion of the ECRIA, scottsih govenrment had paused the NCS. This will be reviewed as the plan goes through governance and additions considered as the future plans for progressing this legislation become clear IJB Jan-25 1.6 Strengthen contribution of storytelling as one of the elements of evidence of improved outcomes, including the use of OutNav, the framework to facilitate contribution analysis approach to outcome evaluation. Strengthened the wording in 1.2 relating to outcomes IJB Jan-25 1.7 Ensure the document reflects the focus on relational not transaction working throughout 1. Strengthed narrative to support relational working 2. Added reviewof the midway to Strategic aim No.3 3. Reitereated the importance of following an outcomes measurement approach across services IJB Aug-24 1.8 replace the word 'honest' replaced with 'clear' IJB Aug-24 1.9 replace 'because we have not found ways to meet all our challenges, . . .' replaced with 'because we still have to find sustainable ways of working to meet all of our challenges, . . .' IJB Aug-24 1.10 don’t use superlatives next to 'helpful' one use found in document, now removed IJB Aug-24 1.11 replace ' understanding the true cost' Now reads ‘Focus on impact by understanding what our collective contribution is to personal outcomes and positive change’ IJB Aug-24 1.12 Not keen on “designed around” – what about informed by, influenced by services designed around how people live their lives' tested well in publc consultation and has therefore been retained Public Consultation Dec-24 1.13 Outcome mapping – will this be understood by the reader revised IJB Aug-24 1.14 Multiple requests to review the language relating to patients, service users, clients, people, residents, citizens, in light of often conflicting opinions/preferences from board members. added questions to public consultation. Returned opinion from the public responses 1. want to be referred to as 'people' 2. 'people who experience our services' Public Consultation Dec-24 1.15 Strengthen wording about best use of resources to include desciption of spending only what is available wording added to 'what we do' and 'Our resources' MLC Chief Exec Feedback Feb-25 Midlothian IJB Draft Strategic Plan 2025-2035 Change Log 1. General 1. General Page 115 of 236
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1.16 Reflect the current position following the recent update from SG and the uncertainty for integrated health and social care added paragraph to 'What we will do' on the NCS and an extra bullet point to 'be ready to change and adapt' MLC Chief Exec Feedback Feb-25 1.17 clarify the core of the strategy is redesign, and responsiveness in the context financial difficulties wording reviewed in 'What we do' MLC Chief Exec Feedback Feb-25 1.18 update to reference the midlothian Ecomonic plan 2025/30 updated wording MLC Chief Exec Feedback Feb-25 1.19 Throughout: clarification of use of Blue Boxes Section text and Blue Boxes revised to ensure Blue Boxes consistently describe activity that is either * New * Do more/less/differently * Stopped Service Feb-25 1.20 Add section to the Introduction to introduce the redesign and transfomration work added to introduction section including the 8 workstreams set out in 'Our resources' section of Directions 2025/26 SPG Mar-25 1.21 Add section to redesign and transformation work about enablers updated wording HSCP ELT Mar-25 1.22 note role of community focused 'ageless' approach in transformation updated wording MLC CMT May-25 1.23 Reference the Scottish Government publication of the trology of reform products Referenced and described HSCP Integration Manager Jun-25 1.24 Reference the Scottish Government publication Scotlands Public Service Reform Strategy Referenced and described HSCP Integration Manager Jun-25 1.25 Highlight references to the Housing Contribution Statement Edited and highlighted IJB Chair Sep-25 1.26 Removal of 'model' following public consultation feedback Edited HSCP Integration Manager Sep-25 1.27 Remocal of word 'system' in 'People want to be reassured we are prepared for the future' section Edited to read 'Some people were concerned with the rate of housing expansion in Midlothian and were unsure that local services would cope unless we do things differently in the future' IJB Chair Sep-25 1.28 Emphasise ongoing conversations Paragraph added to 'What we will do' IJB Chair Sep-25 1.29 Define transformation Paragraph added to 'Transformation' IJB Chair Sep-25 1.30 Define Midway Paragraph added to 'What matters msot to people and communites' IJB Chair Sep-25 1.31 Small, nonmaterial edits to wording to accommodate design change and formatting Edited HSCP Integration Manager Sep-25 1.32 Remove some appendices that were now duplication following development of the statutory suite of accompanying docuements Market Facilitaton Plan, Housing Contribution Statement, Consultaton and Engagment Statement). Edited HSCP Integration Manager Sep-25 1.33 Throughout: redesign and formating of documents Completed and resulting in small non-matierail chages to working to suport format changes HSCP Integration Manager Sep-25 1.34 Update population number infographic updated HSCP Integration Manager Sep-25 2. Plan on a page 2.1 to reorder from previous 2022/25 plan to include Vision Mission Values Aims Values added following conclusion ofstaff consultation IJB/HSCP Aug-25 1. General 3. Information, Evidence and Insight 2. Plan on a page Page 116 of 236
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3.1 Additional data from JSNA Added: info on physical activity and healthy weight SPG/IJB Jan-25 3.2 Additional data from JSNA Added: Information on early deaths (moritality) SPG/IJB Jan-25 3.3 Additional data from JSNA Added: information on local variation and impact on health inequalities SPG/IJB Jan-25 3.4 Additional data from JSNA Added: information on local carers SPG/IJB Jan-25 3.5 Additional data from JSNA Added: info on 16-19 years olds in employment SPG/IJB Jan-25 3.6 Additional data following wider review Added: new subsection "In Person Support and Information" SPG Jun-25 3.7 Additional data following wider review Added: Thistle Wellbeing data (local) SPG Jun-25 3.8 Additional data following wider review Added: Pharmacy First data (national) SPG Jun-25 3.9 Additional data following wider review Added: Employment data updates to economic activity, out of work benefits, MLC employee numbers SPG Jun-25 3.10 Additional data following wider review Added: new narrative on "Burden of Disease" prediction SPG Jun-25 3.11 Additional data following wider review Added: Population data updates to overall increase, children, working age, pensionable age, ethnicity SPG Jun-25 3.12 Additional data following wider review Added: Impact of caring - VOCAL 2023 survey data SPG Jun-25 3.13 Additional data following wider review Added: Carer data updates to impact on health, employment, income, Child Disability Payments SPG Jun-25 3.14 Additional data following wider review Added: Workforce data update to Health & Care sector numbers SPG Jun-25 4.1 Strengthen message relating to connectivity and interreliabltiy Reviewed and updated with 1. IJB Memebrship at represnetatives at development session 2. MLC reprensetation at SPG , 3. NHS Lothian Strategy 4. NHS Lothian Public Health Stakeholders Sep-24 4.2 Do we need to reference work on climate change and the role of the IJB? Wording revised to note duty of IJB and requirement to work with parnters to achieve ambitions IJB Jan-25 5.1 Review wording of aim Previously: People access the right support to stay well, prevent ill or worsening health, and plan ahead because we make shared decisions and plan together Now: People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health IJB Oct-24 5.2 Provision of services should follow provision of information Additional commentary and actions of provison of good qualtiy information HoS Aug-24 5.3 Support to self manage that is tailored to the person Short term aim added for MHSP to develop a self management startegy IJB Aug-24 5.4 How do we measure: Accessing the right support, preventing something that doesn't happen, shared decisions? Noted. The IJB has a Performance Measurement Framework and a Strategic Governance Map based on Outcome-mapping in place. Work to embed these approaches in the Performance Reporting of the board will be prioritised. IJB Oct-24 5.5 ACPs are now called future care plans Strategic Plan edited to reflect Service Aug-24 5.6 Ensure the section on 'support should be easy to access' is moved to be in a short term aim Short term aims updated to actions relaed to easy access. Longer term aims related to living well with multiple conditions IJB Aug-24 5.7 in 1.1: 1. Recognise the role of our partners relating to information sharing to support people making informed decisions in relation to health and wellbeing. 2. Reinforce commitment to provision of clear, accessible information updated wording IJB Jan-25 5.8 in 1.1: Request for a Public Communication Strategy and Action Plan added the action of developing a Public Communication Strategy and Action Plan IJB Jan-25 5.9 in 1.1: include some words specifically on early intervention and prevention updated wording IJB Jan-25 3. Informatio n, Evidence and Insight 5. Strategic Aim No.1 4. Working with our partners Strategic Aim No. 1 4. Working with our partners Page 117 of 236
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5.10 in 1.1: include Justice services work within information provision Additional wording provided by Group Service Manager HSCP ELT Mar-25 5.11 In 1.3: Requirement to reword the blue-box section relating to integrated working across multiple health conditions wording reviewed to better refect work/professions at no.11 HoS Jan-25 5.12 do we mention Green Prescribing Green prescribing is now an example of an intervention in 1.2 SPG Feb-25 5.13 more clearly describe the whole system transformation planning Section added to 1.3 on • Transformation Planning • Primary care and connected community services • Unscheduled care • Lothian USC test of change with SG • Blue Box on Mulitagency Single Point of Access SPG Feb-25 5.14 note Digital section added to 1.3 for further review SPG Feb-25 5.15 Improve description of unscheduled care and relationship to medium term actions / transformation planning Added to 1.3 under 'Unscheduled Care' SPG Feb-25 5.16 Add innovation within HV team regarding early intervention updated wording HSCP ELT Mar-25 5.17 In 1.2: Add to what is underway and next in self management regarding frailty Added section on use of clinical frailty scale HSCP ELT Mar-25 5.18 In 1.3: consider Digital innovation described lifestyle monitoring technology ambitions HSCP ELT Mar-25 5.19 In 1.1 Consider earlierst intevention with reference to the delgated Health Visting services Added two sections; one on 27-30 month visit and one on breastfeeding interventions HSCP ELT Mar-25 5.20 In 1.2: Ensure links to place based policy Noted Midlothian Councils commitment to place based working as keyenabler for new models of care MLC CMT May-25 6.1 Review wordding of aim Previously: People are able to access care, support and rehabilitation and recovery offers in more community and home based settings Now: People are able to access the care and support they need when they need it in the community and at home IJB Aug-24 6.2 Clarify examples of action in Short, Medium and Long Term aims Consultation with Heads of Service to determine what deatil of action in relation to strategic aims as development of transformation planning progresses HoS Jan-25 6.3 Long term aims - What do these look like? Consultation with Heads of Service to determine what deatil of action in relation to strategic aims as development of transformation planning progresses HoS Jan-25 6.4 Reducing hospital admissions Moved to a medium term aim and strengthened with details of transformation programme activty IJB Jan-25 6.5 In No 2: Highlight the importance of transport as an enabler of this strategic aim. Address in 'working with our parnters' but also noted in the narrative at the top of aim No. 2 IJB Jan-25 6.6 In 2.1: Requirement to reword the blue-box section referencing social work / OT review wording reviewed to better refect actions required HoS Jan-25 6.7 In 2.1: How does our commissioning model relate to this aim? Addition of reference to work required on Market Faciitation and devleoping a 'Partner Provider Statement' in 2025/26 that supports more tailored commissioning of services aligned to the strategic aims IJB Jan-25 6.8 In 2.1: Revision of wording in weight management example wording reviewed by project team IJB Jan-25 6.9 in 2.3: need to develop a community asset based ppraoch including changing how we work with the Midlothian Community Planning Partnership adddition of ambition to more effectively support the Midlothian Community Planning Partnership IJB Jan-25 6.10 In 2.1: describe action around Community Appointment days narrative added HSCP ELT Mar-25 6. Strategic Aim No.2 5. Strategic Aim No.1 6. Strategic Aim No.2 Page 118 of 236
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6.11 In 2.1: describe ageless care commitment narrative added MLC CMT Jun-25 7.1 Edits proposed to strategic aim Previously: People's human rights, including economic rights are protected and promoted through choice and flexibility in our services and supports Now: People's human, social, and economic rights are protected and promoted in how we design and deliver our services IJB Aug-24 7.2 Move Service redesign from Long term aims to Short term aims to STA wording reviewed IJB Jan-25 7.3 Palliative care: We must discuss the palliative care we provide outside of a hospital setting section added to 3.2 IJB Jan-25 7.4 People have access to their own health and social care information / Data sharing agreements' what are we doing in this area? Section reworked in 3.3 with reference to current position and work underway nationally and locally IJB Jan-25 7.5 in 3.1: Ensure the review of the MidWay is linked to the ambitions of the plan. Strengthened wording and added a blue-box action IJB Jan-25 7.6 In 3.1: carers are well reference throughout the plan, subaim 3.1 specifically mentions carers. Should this be removed or should we reference carers along side people at every mention? Carers removed as a specific reference in this subaim. Reference to Carers Strategy added with link. IJB Jan-25 7.7 In 3.1: Reinforce the potential negative impact on unpaid carers as more care moves closer to home. Strengthened wording IJB Jan-25 7.8 In 3.1: Requirement to reword the blue-box referencing VOCAL activity due to a change in commissioning priority wording reviewed to better refect actions required HoS Jan-25 7.9 In 3.3: Emphasise impact of current limitations to the safe sharing of organisational information. Strengthened wording HoS Jan-25 7.10 In 3.2: Audit against statutory guidance highlighted requirement to have short section on palliative care as a delegated function (provision outwith hospital) Short section and description of transformation work action added SPG Jan-25 7.11 Include ACENS service and desire to develop a whole system approach In 3.2: now included SPG Jan-25 7.12 include narrative to support Direction 9.3.7 and link to LDSF programme In 3.1: linking to the LSDF and describing local prioirty to provide care in lline ith the 8 Pillars model. HSCP ELT Mar-25 7.13 In 3.1: update Equaltiy Section in relation to new Equlaity Outcomes revised HSCP ELT Mar-25 7.14 In 3.1: add section on volunteer led suport section on MCH volunteers added HSCP ELT Mar-25 7.15 In 3.1: Link Midway to transformation revised SPG May-25 7.16 In 3.1: Note incrasing numebrs of people diagnosed with dementia at a younger age now included CSWO Jun-25 8.1 Make it clearer how Directions support the delivery of our priorities in 'Making this a reality' a section of 'our priorities' has been added that describes Directons as the mechanism by which the Strategic Plan is actioned and are the priorities of the IJB. IJB Feb-25 8.2 Finance sections to be updated following March 2025 Budget meeting updated with input from CFO IJB Mar-25 8.3 Reference to Medium Term Financial Strategy along with other key documentation updated CFO Jun-25 8.4 additional reference to the delivery of ambitions to be 'within resources made available' added where relevant MLC CMT Jun-25 8.5 update finance information updated information provided and edited CFO Sep-25 8. Making this a reality 7. Strategic Aim No.3 6. Strategic Aim No.2 8. Making this a reality 7. Strategic Aim No. 3 Page 119 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14:00-16:00 Midlothian IJB draft Participation and Engagement Statement 2025-2028 Item number: 5.7 Executive summary This report presents the Midlothian Integration Joint Board (IJB) draft Participation and Engagement Statement 2025-2028 (appendix 1). Midlothian IJB has a statutory duty to involve people and communities in the planning and development of care services, and in decisions that will significantly affect how services are run. A Participation and Engagement Statement is a statutory document that must set out how the principles of public engagement will be applied in practice and the responsibility of the Board to work with a range of stakeholders to improve outcomes for people. Across 2024, Strategic Planning and Performance supported Midlothian IJB to undertake the Healthcare Improvement Scotland Quality Framework for Community Engagement Self- Assessment. The Midlothian IJB Strategic Planning Group (SPG) reviewed this assessment on 22nd May 2025, and feedback has informed the development of the Midlothian IJB draft Participation and Engagement Statement 2025-2028 and the associated action plan. The Midlothian IJB Strategic Planning Group (SPG) subsequently reviewed the second iteration of the Midlothian IJB draft Participation and Engagement Statement 2025-2028 and action plan on 25th September 2025. In compliance with the Public Sector Equality Duty, an Equality and Children’s Rights Impact Assessment (ECRIA) has been completed as part of the development of this Statement and has been reviewed by the Midlothian IJB Strategic Planning Group (SPG). As a result of this report, Members are asked to: • Review and provide feedback on the Midlothian draft Participation and Engagement Statement 2025-2028, and • Subject to any amendment, approve the Midlothian draft Participation and Engagement Statement 2025-2028 and give delegated authority to the Integration Manager to publish this as soon as practicably possible. Page 121 of 236
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Midlothian Integration Joint Board Report Midlothian IJB draft Participation and Engagement Statement 2025-2028 1 Purpose 1.1 This report presents the Midlothian Integration Joint Board (IJB) draft Participation and Engagement Statement 2025-2028 (appendix 1). 2 Recommendations 2.1 As a result of this report, Members are asked to: • Review and provide feedback on the Midlothian draft Participation and Engagement Statement 2025-2028, and • Subject to any amendment, approve the Midlothian draft Participation and Engagement Statement 2025-2028 and give delegated authority to the Integration Manager to publish this as soon as practicably possible. 3 Background and main report 3.1 Midlothian Integration Joint Board (MIJB) has a statutory duty to involve people and communities in the planning and development of care services, and in decisions that will significantly affect how services are run. 3.2 The Public Bodies (Joint Working) (Scotland) Act, 2014 sets out the principles which describe how integrated care should be planned and delivered. These integration principles set out the expectation of genuine engagement in the planning and delivery of person-centred, high quality integrated care, by explaining the behaviours and priorities expected of organisations and people planning and delivering care and support. 3.3 A Participation and Engagement Statement is a statutory document in which Integration Authorities sets out how the principles of public engagement will be applied in practice and the joint responsibility of the Board to work with a range of stakeholders to improve outcomes for people. 3.4 Across 2024, Strategic Planning and Performance supported Midlothian IJB to undertake the Healthcare Improvement Scotland Quality Framework for Community Engagement Self-Assessment. The Midlothian IJB Strategic Planning Group (SPG) reviewed this assessment on 22nd May 2025, and feedback informed the development Page 122 of 236
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Midlothian Integration Joint Board of the Midlothian IJB draft Participation and Engagement Statement 2025-2028 and associated action plan. 3.5 The Midlothian IJB Strategic Planning Group (SPG) subsequently reviewed the second iteration of the Midlothian IJB draft Participation and Engagement Statement 2025- 2028 and action plan on 25th September 2025, recommending this document for Board approval. 4 Policy Implications 4.1 There are no policy implications as a direct result of this report. 4.2 However, there are two key activities for which the Midlothian IJB draft Participation and Engagement Statement 2025-2028 will be of interest; • Midlothian IJB Board Member Self Development Plan, and • Midlothian HSCP Integrated Public Communication Strategy. 5 Directions 5.1 The Midlothian IJB draft Participation and Engagement Statement 2025-2028 will be relevant to all Directions, but particularly in relation to: • Direction 1.3 • Direction 1.4 • Direction 3.3 • Direction 3.4 • Direction 4.1 • Direction 7.4 • Direction 8.1 • Directions 9.3.1 to 9.3.8 6 Equalities Implications 6.1 Developing a Participation and Engagement Statement is intended to support better engagement and identification of the issues that matter most to the people who live in our communities. Completing the self-evaluation process also supports the identification of equality issues by providing a catalyst for reflection, discussion, and commitment to a human rights approach to public and community participation and engagement. 6.2 The principles underpinning Healthcare Improvement Scotland’s Quality Framework for Community Engagement, and its self-evaluation process focus on improving equality through: • Including the voices of people with protected characteristics. • Providing a foundation for truly inclusive co-design of services, strategies, and policies. Page 123 of 236
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Midlothian Integration Joint Board 6.3 In compliance with the Public Sector Equality Duty, an Equality and Children’s Rights Impact Assessment (ECRIA) has been completed as part of the development of the Midlothian IJB Draft Participation and Engagement Statement to identify any potential impact on protected characteristics and incorporate mitigations. The ECRIA has been reviewed by the Midlothian IJB Strategic Planning Group (SPG) and is available on the Midlothian Health and Social Care website. 7 Resource Implications 7.1 There are no direct resource implications in relation to the report. 7.2 However, the Midlothian IJB draft Participation and Engagement Statement 2025-2028 acknowledges the duty to provide reasonable reimbursement for people who particulate in consultation and engagement activities. The Midlothian Council Volunteer Policy sets out the process by which reasonable reimbursement is requested and provided. 8 Risk 8.1 There is a risk that in not progressing this work, Midlothian IJB will be being unable to meet its legislative duties. 8.2 There is also a risk that without effective public participation and engagement, Midlothian IJB will not meaningfully understanding of the needs of the changing population. 9 Involving people 9.1 This work will be undertaken with input from board members, officers of the HSCP, services, partner organisations, and people and communities. 9.2 Evidence of current Midlothian IJB participation and engagement can be found within the Midlothian IJB Strategic Governance Outcomes Map Column 2 ‘who with’ scheduled to be reviewed by Midlthain IJB in December 2025. 10 Background Papers 10.1 n/a Appendix 1: Midlothian IJB draft Participation and Engagement Statement 2025-2028. Page 124 of 236
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1 Midlothian Integration Joint Board Participation and Engagement Statement 2025 – 2028 Page 125 of 236
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2 Contents Introduction ........................................................................ 3 Participation and engagement in Midlothian .......................... 6 Assessment of our participation and engagement ................ 10 Our improvement plan ........................................................ 12 Page 126 of 236
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3 Introduction We are a planning and decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. Each of these services must, by law, be planned and led locally alongside people and the communities. We believe that people and communities are the experts in their own health and wellbeing make their own choices about their health and wellbeing. To make sure we are working towards a future where everyone in Midlothian has better health and wellbeing, we want to work with people and communities and do more than talk about engagement. We want to have meaningful conversations with about the things that matter in Midlothian. Sometimes we will not be able to deliver everything people ask of us with the resources we have, but that doesn’t mean we won’t keep working hard to listen to what people need or keep improving what we can offer. This Participation and Engagement Statement sets out the ways what people can expect from us, how we are working with our communities, and how we receive assurance that Midlothian Health and Social Care Partnership (HSCP) are planning with people and communities across Midlothian. The actions identified in this statement and accompanying action plan will be reviewed every year in our Annual Performance Report. Page 127 of 236
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4 Who we are Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in our Strategic Plan 2025-2035 will guide how we allocate the money we receive. Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships; Midlothian, East Lothian, West Lothian, and City of Edinburgh. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act, 2014. We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. Page 128 of 236
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5 Working together We want to work in partnership with people and communities and already undertake a range of participation and engagement activities. However, It is important to us that we have better conversations with people who live in our communities about the things that matter and then help make what they care about a reality. Sometimes we will not be able to deliver everything we want to provide with the resources we have, but that doesn’t mean we won’t keep working hard to listen to what people need or keep improving what we can offer. We know it is important to be clear with people about and the range of opportunities available to them the type of participation on offer to help people make an informed choice about how and when they choose to work alongside us. We follow the Scottish Government Planning with people guidance that defines community engagement as “A purposeful process that develops a working relationship between communities, community organisations and public and private bodies to help them to identify and act on community needs and ambitions. It involves respectful dialogue between everyone involved, aimed at improving understanding between them, and taking joint action to achieve positive change.” People need to be confident that their engagement will make a difference and that they are genuine partners. We have used resources like International Association of Public Participation (iap2) Spectrum of Public Participation to help us develop an effective participation strategy and how to ensure we are informing, consulting, involving, collaborating with, and empowering people. Ongoing engagement • Our annual Midlothian Survey • Participation at events and networks Involving people • Representative Members on the Midlothian Integration Joint Board (IJB) and Strategic Planning Group (SPG) • Regular support through Reference Groups • Public engagement opportunities for all our strategies and plans • Opportunities to join Midlothian Health and Social Care Partnership Planning Groups and Lived Experience Panels Governance and Leadership • Annual Board Development Plan • Provision of resources for engagement activities Page 129 of 236
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6 Participation and engagement in Midlothian Over 1000 voices were included In the development of our Strategic Plan 2025-2035, and we want to keep the conversation going. We want to have good conversations with people and communities in Midlothian and include more people in how we plan and direct health and social care. Page 130 of 236
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7 National Standards for Community Engagement The National Standards for Community Engagement guide the process of community engagement. They describe what good engagement looks like, and how to do it well. • Inclusion Identify and involved the people and organisations that are affected by the focus of engagement • Support Identify and overcome any barriers to participation • Planning Ensure a clear purpose for any engagement, based on a shared understanding of community needs and ambitions • Working together Work effectively together to achieve the aims of the engagement • Methods Use methods of engagement that are fit for purpose • Communication Communicate clearly and regularly with the people, organisations and communities affected by the engagement • Impact Assess the impact of the engagement and use what has been learned to improve future engagement. Page 131 of 236
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8 Our resources for engagement Advice and practical support We work with officers of Midlothian Health and Social Care Partnership and both Partners to ensure we have the right support to engage with people and communities well. Officers within the Midlothian Health and Social Care Partnership Strategic Planning and Performance service support our engagement activity and Midlothian Council and NHS Lothian support us with specialist skills e.g., Equality Leads and Communication teams. Working with our Partners Our Strategic Planning Group is the main forum for leading our participation and engagement activity and connecting with our Partners. Equally, the workforce in Third and independent sectors have experience and knowledge of the local landscape and of the challenges faced in delivering services and support People and Communities We work with people who live in our communities as well as those who directly experience services, their family, friends, carers and staff who provide health or social care. We know people who have experienced our services, their families, and carers are often best places to describe what support, or services would make their lives better, what works well, and what could be improved. Financial Support Volunteer members of our Board and Strategic Planning Group are not paid but they can claim for costs directly related to their role. This includes travel to meetings, training, printing etc., and replacement care. The Midlothian Volunteer policy set out how people can access this financial support. Tools We use a range of methods to stay in conversation with people and communities e.g., surveys, meetings, drop ins, our website, and printed materials. Venues and online venues We use venues around Midlothian and Microsoft Teams for events and ‘town hall’ meetings. Page 132 of 236
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9 How we engage with people In 2024/25 we used the Healthcare Improvement Scotland Quality Framework for Community Engagement and Participation and Self Evaluation Tool to consider how well we were working alongside people and communities, and the impact of this on strategy development and service improvement. The self-evaluation tool has the three areas of focus, or domains, set out within the framework with two quality indicator statements within each of the domains. Ongoing engagement and involvement of people • The organisation undertakes ongoing engagement with people and communities to ensure that services meet their needs, identify sustainable service improvements and to develop trust. • The approach to engagement is inclusive, meaningful and is evaluated to identify learning and the impacts. Involvement of people in service planning strategy and design • The involvement of people and communities has had a positive impact on service change and strategy development and has been planned as part of the organisation’s wider engagement strategy. • People representing communities have been involved throughout the development, planning and decision-making process for service change and strategy development. Governance and leadership • Robust corporate governance arrangements are followed for involving people; founded on mutuality, transparency, equality, diversity and human rights principles. • To engage effectively and inform decision-making, the organisation supports and improves the participation of people by dedicating resources (both in people, time and budget). Page 133 of 236
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10 Assessment of our participation and engagement We used the Healthcare Improvement Scotland quality indicators within the Quality Framework for Community Engagement and Participation and Self Evaluation Tool to evaluate our performance against the three areas of focus, or domains, set out within the framework. We concluded we had areas of strength in Involvement of people in service planning, strategy and design, and that we were improving in areas of ‘Governance and leadership’. We also identified ‘Ongoing engagement and involvement of people’ as an area for improvement. Page 134 of 236
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11 Our assessment Domain Quality Indicators Assessment Domain 1: Ongoing engagement and involvement of people The organisation undertakes ongoing engagement with people and communities to ensure that services meet their needs, identify sustainable service improvements and develop trust. Underdeveloped Domain 1: Ongoing engagement and involvement of people The approach to engagement is inclusive, meaningful and is evaluated to identify learning and the impacts. Underdeveloped Domain 2: Involvement of people in service planning, strategy and design The involvement of people and communities has had a positive impact on service change and strategy development and has been planned as part of the organisations wider engagement strategy Developed Domain 2: Involvement of people in service planning, strategy and design People representing communities have been involved throughout the development, planning and decision-making process for service change and strategy development. Developed Domain 3: Governance and leadership – supporting community engagement and participation Robust corporate governance arrangements are followed for involving people; founded on mutuality, transparency, equality, diversity and human rights principles Developing Domain 3: Governance and leadership – supporting community engagement and participation To engage effectively and inform decision making the organisation support and improves the participation of people by dedicating resources (both in people, time and budget). Developing Page 135 of 236
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12 Our improvement plan We also used the Healthcare Improvement Scotland quality indicators within the Quality Framework for Community Engagement and Participation and Self Evaluation Tool to recognise what was already working well and identify opportunities for improvement. Our improvement plan outlines the action we will take across 2025-2028 to improve how we work alongside people and communities in Midlothian. Page 136 of 236
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13 Ongoing engagement and involvement of people Aim Activity Involve people at an early stage in policy / service development and ensure proportionate representation of stakeholders. • Undertake an annual survey to understand local experience • Hold biannual ‘Townhall’ meetings in person and online • Host quarterly themed ‘drop in’ sessions • Follow Planning with people guidance regarding consultation activity Communicate how engagement has made a difference to policy including decisions and new models. • Communicate how engagement has influenced strategies, plans, and policies in our Annual Performance Report Engage with groups to identify barriers to engagement and evaluate engagement activity. • Strengthen participation in networks to reach more seldom heard groups e.g., minority ethnic population, speakers of other languages, people experiencing homelessness, and people living in residential care or prisons Page 137 of 236
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14 Involvement of people in service planning, strategy and design Aim Activity Ensure representation at all stages of service planning, strategy and design • Recruit and support Representative members of the Integration Joint Board and Strategic Planning Group • Host reference groups for Representative members before each meeting of the Integration Joint Board Share learning from engagement and explanation of decision-making. • Explain, and publish how engagement has influenced decision making in our: - Reports and papers for meetings of the Integration Joint Board and its Committees - Strategies and Plans • Develop a Participation and Engagement section of our website Attendance at engagement events by Board members and senior leaders • Identify more opportunities for Board members and senior leaders to attend community and engagement events i.e., Third Sector Summit and local Confederation of Community Council meetings Page 138 of 236
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15 Governance and Leadership Aim Activity Ensure we have robust governance for engagement, and we meet our statutory duties. • Evaluate our engagement activity by developing, testing and improving a process to - identify engagement opportunities - undertake engagement activities - record engagement outcomes - evaluate the impact of engagement • Update our Strategic Governance Map with our public Participation and engagement activity Receive assurance from Midlothian Health and Social Care Partnership on their Participation and Engagement activity • Receive assurance from Midlothian Health and Social Care Partnership on: - Progress towards their Communication and Engagement Strategy, - Service engagement and participation activities - Third Sector and Community membership on Planning Groups - Service feedback engagement mechanisms - Information about how feedback has led to improvement Support Board members and staff with engagement • Provide training on public participation and engagement to Board members and staff who work within Midlothian Health and Social Care Partnership Evaluate/review our engagement resources • Report the effectiveness of engagement activities in our Annual Performance Report • Oversee our available resources and monitor the budget required to meet statutory duties for engagement i.e., volunteer expenses, venue hire, production of alternative formats Page 139 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14:00-16:00 Midlothian IJB Performance Update Executive summary This report provides an update on the progress towards the Midlothian IJB performance goals set for the period 2023-2025 and an overview of progress towards the Midlothian IJB Directions 2025/26. A report describing progress against each improvement goal is attached in appendix 1. Due to the processes required to validate statutory IJB performance goal data, there is an inbuilt reporting delay. More recent management data are available for a number of the improvement goals but cannot be published as these data are not validated and for management purposes only. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided. Midlothian IJB issued Directions for 2025/26 on 28th March 2025. Following the completion of Midlothian Health and Social Care Partnership service reporting a synthesis and insight report has been produced within the Midlothian IJB Strategic Governance Outcomes Map (appendix 2). This is a new and innovative response to the challenges of linking strategy to delivery and provides a clear mechanism to connect assurances of progress with safe and effective care and support. Integration Authorities, Health Boards and Local Authorities have a legal obligation to both issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. As a result of this report, Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1), • Review the synthesis and insight reports generated in columns 4 and 5 of the Midlothian IJB Strategic Governance Outcomes Map for recommendation to Midlothian IJB (appendix 2), and • Provide feedback to inform the early development of Midlothian IJB Directions for 2026/27. Item number: 5.8 Page 141 of 236
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Midlothian Integration Joint Board Report Midlothian IJB Performance Update 1 Purpose 1.1 This report provides an update on the progress towards the Midlothian IJB performance goals set for the period 2023-2025 and an overview of progress towards the Midlothian IJB Directions 2025/26. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1), • Review the synthesis and insight reports generated in columns 4 and 5 of the Midlothian IJB Strategic Governance Outcomes Map for recommendation to Midlothian IJB (appendix 2), and • Provide feedback to inform the early development of Midlothian IJB Directions for 2026/27. 3 Background and main report 3.1 The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. They are based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care). 3.2 An updated report describing progress against each improvement goal is attached in appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. Members are asked to specifically note data completeness. Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. This means that we are not yet able to calculate the full year performance for some measures. 3.3 More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided below. Page 142 of 236
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Midlothian Integration Joint Board 3.4 A&E Attendances 2022/23 Target Rate per 100,000 people 2,629 / month 2024/25 Running Average 2,684 / month The validated data are available up to March 2025. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed September 2025) indicate the target is currently being met. 3.5 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2024/25 Running Average 733 / month The validated data are only available up to December 2024. Based on this information, the target is currently being met. The most recent non-validated management information data (accessed September 2025) indicate the target is not currently being met. 3.6 Unplanned Bed Days (Acute) 2022/23 Target Rate per 100,000 5,074 / month 2024/25 Running Average 5,076 / month The validated data are only available up to December 2024. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed September 2025) indicate the target is not currently being met. 3.7 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2024/25 Running Average 1117 / month The validated data are only available up to March 2025. Based on this information, the target is currently not being met. The most recent non-validated management information data (accessed September 2025) indicate that the target is not currently being met. 3.8 End of Life – Percentage of Last Six Months Spent in Large Hospitals 2022/23 Target Rate <8.7% 2022/23 Rate 8.2% This indicator was not updated in the latest release of published data from Public Health Scotland. It is not possible to refer to management information as these data are not held locally. 3.9 Balance of Care 2022/23 Target Rate >96.4% This indicator was not updated in the latest release of published data from Public Health Scotland. It is not possible to refer to management information as these data are not held locally. 3.10 At the IJB meeting in June 2023 the Performance Assurance and Governance Group recommended that the improvement goals for 2023-25 were set to prioritise an Page 143 of 236
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Midlothian Integration Joint Board increase in system stability, focussing on workforce recovery and wellbeing. Following the anticipated publication of the Midlothian IJB Strategic Plan 2025-2035, future performance updates will report on progress using measures detailed in the Midlothian IJB Performance Framework 2025-2028. 3.11 Directions Reporting Directions are how Integration Authorities action their strategic plan. In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014, Directions are the key mechanism by which Midlothian IJB’s strategic plan is actioned. 3.12 Directions are issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how all functions delegated to the IJB and operationally managed predominantly by Midlothian Health and Social Care Partnership (HSCP) are to be delivered and funded via the integrated budget. Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. 3.13 Integration Authorities, Health Boards and Local Authorities have a legal obligation to both issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. Following the development of the Midlothian Integration Joint Board (IJB) draft Strategic Plan 2025-2035, a collaborative process to develop Directions for 2025/26 was undertaken from September 2024 to February 2025. Midlothian IJB then issued Directions for 2025/26 to both Partners on 28th March 2025. 3.14 For Directions 2025/26, Midlothian IJB looked forward to its new Strategic Plan 2025- 2035 and set Directions that would establish the foundational capabilities to deliver the transformation and service redesign to deliver a new and sustainable future for health and social care in Midlothian. 3.15 In response to this, the Midlothian Health and Social Care Partnership (HSCP) Heads of Service and Professional Leads of the Executive Leadership Team commenced a period of strategic operational planning to determine the overarching objectives within their Group Service that would collectively deliver the desired outcomes. 3.16 Heads of Service and Professional Leads were asked to communicate their strategic vision to service areas and work together to create a linked set of service plans to create the condition for positive change. Group Service plans were developed and signed off by Heads of Service and Professional Leads, and Service Plans were collaboratively developed by the end of April 2025. 3.17 The Part Year Reporting period for Directions 2025/26 includes reporting up to 22nd August 2025. Heads of Service and Professional Leads submitted updates from service to their action plans and an overview of Group Service progress. The Strategic Planning and Performance Group Service then undertook a Quality Assurance process and additional financial information was provided by the Chief Finance Officer to develop Group Service Outcome Reports. Page 144 of 236
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Midlothian Integration Joint Board 3.18 The overall Group Service progress for each stepping stone were informed by both the progress rating of Head of Service or Professional Lead and confidence in the strength of evidence presented in service plans. The Midlothian IJB Strategic Planning Group (SPG) scrutinised both these reports and the reporting mechanism on 25th September 2025. 3.19 The Group Service Outcome Reports were then utilised to generate a whole-system synthesis and insight report on progress towards Midlothian IJB Directions 2025/26 recorded in column 4, and Midlothian IJB’s Strategic Aims for 2025-2035 in column 5 of the Midlothian IJB Strategic Governance Outcome Map (appendix 2). This is a new and innovative response to the challenges of linking strategy to delivery and providing a clear mechanism that connects assurances of progress with safe and effective care and support. 3.20 It should be noted that operational services have experienced unprecedented levels of service pressure across quarter 1 (Q1) of 2025/26 in addition to already challenging circumstances. Absence, extended leave, extenuating personal circumstances and increasing service demand have significantly reduced the ability of some service areas to respond to either Directions or the Group Service planning and reporting process as fully as might ordinarily be expected. 3.21 Additionally, due to unexpected senior leadership absence, the whole system aggregation has not included the 4 services that are part of the Primary Care and Older People's Group Service. Strategic Planning and Performance have taken advice on how to reduce the risk of missing data sets potentially skewing the overall aggregated outcomes. All services will report in December 2025 at the Full Year Reporting period which will be reviewed by the Midlothian IJB Strategic Planning Group in January 2026 and Midlothian IJB in February 2026. 3.22 The process of creating clear links from the strategy of the IJB to opportunities for operational action and evaluation of progress towards the outcomes that matter to people and communities has been developed over the past 3 years. A combination of Strategic Planning and Performance expertise has been utilised to deliver on the commission from Midlothian IJB to improvement transparency of reporting to provide Board members with higher confidence, in assurances that services were effective, efficient, and delivering both Best Value and sustainability. 3.23 Some service areas have been able to demonstrate effective planning, connected oversight, and levels of progress well utilising this new reporting system. Other service areas have demonstrated they may benefit from targeted support to strategically connect coordinated actions with evaluation mechanism built into their design. This is highly relevant for the IJB as the ability to plan, deliver, improve, and share learning is vital to the success of any transformation and change programme. 3.24 Overall progress evaluations are also set within the context of two key factors; • At the Part Year Reporting period, it would be unlikely for progress to be complete and could be expected to improve between August and December 2025 when the Full year Reporting is collated. • Directions must be issued every year but may have a delivery window that runs across the life of the Midlothian IJB draft Strategic Plan 2025-2035. Page 145 of 236
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Midlothian Integration Joint Board 3.25 Work to commence the development of Directions for 2026/27 will be undertaken by the Midlothian IJB Strategic Planning Group in November 2025 and informed by feedback from both this reporting period and consolidated feedback from Midlothian Health and Social Care Partnership Executive Leadership Team following a Corporate Management Planning session on 22nd October 2025. Midlothian IJB will be presented with draft Directions for 2026/27 in January 2026 for ongoing development ahead of approval and issue to Partners in March 2026. 4 Policy Implications 4.1 This paper describes the process undertaken to deliver Directions reporting set out in the Midlothian IJB Directions Policy 4.2 The statutory duties relating to Directions reporting are set out in • Public Bodies (Joint Working) (Scotland) Act 2014. (section 26 and 26) and the requirement for Directions from Integration Authorities to Health Boards and Local Authorities. • Statutory Guidance (2020) on Directions from Integration Authorities to health boards and local authorities on how to improve practice in the issuing and implementation of Directions issued under the Public Bodies (Joint Working) (Scotland) Act 2014. 5 Directions 5.1 This report provides reporting on progress towards the Midlothian IJB Directions for 2025/26 and can be used to start provisional planning for the development of Directions for 2026/27. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake and ECRIA as a result of this report. 6.2 All Directions are designed to progress the ambitions of the 3 strategic aims of the Midlothian IJB draft Strategic Plan 2025-2035. An ECRIA has been published in relation to this plan. 7 Resource Implications 7.1 There are no resource implications as a result of this report. Page 146 of 236
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Midlothian Integration Joint Board 8 Risk 8.1 IJBs, Health Boards and Local Authorities have a legal obligation to issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. There is a risk that not complying will pose legislative risks and it will be more difficult for the IJB to undertake its duties related to accountability and good governance. 9 Involving people 9.1 This report has been written following consultation with officers of Midlothian IJB, and with the Midlothian HSCP executive management team 10 Background Papers 10.1 There are no background papers Appendices: Appendix 1: Local Intelligence Support Team (LIST) Report Appendix 2: Midlothian IJB Strategic Governance Outcomes Map Column 4 ‘What they learn and gain’, and Column 5 ‘What they do differently’ Authors name and designation Gill Main, Integration Manager Elouise Johnstone, Programme Manager for Performance and Improvement Contact info gill.main3@nhs.scot elouise.johnstone@nhs.scot Date 19/05/2025 Page 147 of 236
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Midlothian HSCP MSG Indicators Performance from April 2019 to March 2025, with 2020/21 MSG targets and trends Local Intelligence Support Team (LIST), July 2025 Page 149 of 236
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Contents 2 1. Methodology 2. 2020/21 MSG targets and actuals 3. A&E attendances a) monthly 5. Emergency admissions 6. Unplanned bed days: a) Acute b) Mental Health 7. Delayed discharges occupied bed days Page 150 of 236
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2020/21 MSG Targets - Methodology • The MSG Objectives Performa was submitted in February 2020 which specified the 2020/21 targets and an action plan on how those targets were to be achieved • 2017/18 MSG data was used as the baseline to calculate the 2020/21 targets 3Page 151 of 236
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Data completeness Source: MSG data release Jun-25, PHS 4 Indicator Published until Provisional until Data completeness issues 1. A&E attendances Mar-25 - 2. Emergency admissions Dec-24 Mar-25 (SMR01) Feb-25=89%, Mar-25=74% 3a. Unplanned bed days (acute) Dec-24 Mar-25 (SMR01) Sep-24=99%, Dec-24=98% 3c. Unplanned bed days (MH) Mar-24 Mar-25 4. Delayed discharges occupied bed days Mar-25 - 5. Last 6 months of life (% in community setting) 2023/24 2023/24 6. Balance of care (% at home) Not currently published - Page 152 of 236
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2020/21 targets and actuals Source: MSG objectives 2020-21 template - Midlothian IJB; MSG data release Mar-25, PHS 5 Indicator 2020/21 target Annual Monthly Annual Monthly 1. A&E attendances Maintain 32,614 2,718 26,391 2,199 ✓ 2. Emergency admissions 5% decrease 9,520 793 9,211 768 ✓ 3a. Unplanned bed days (acute) 10% decrease 62,963 5,247 57,462 4,789 ✓ 3c. Unplanned bed days (MH) Decrease 15,712 1,309 12,544 1,045 ✓ 4. Delayed discharges occupied bed days 20% decrease 13,886 1,157 9,779 815 ✓ 5. Last 6 months of life (% in large hospital) Decrease <8.7% - 7.5% - ✓ 2020/21 target (rate per 100,000) 2020/21 (rate per 100,000) Target met Page 153 of 236
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Data Sources 2020/21 MSG Targets • Source: MSG data release v1.71, Jun-25; Public Health Scotland • These are official monthly figures released by PHS and will be nationally published (some data is provisional and not yet published) • Next data release: September-25 6Page 154 of 236
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A&E Attendances Source: MSG data release Jun-25; data published up to Mar-25 7 Year Annual Monthly 2020/21 Target Rate (per 100,000) 32,288 2,691 2019/20 Rate (per 100,000) 32,977 2,748 2020/21 Rate (per 100,000) 26,102 2,175 2021/22 Rate (per 100,000) 32,812 2,734 2022/23 Rate (per 100,000) 32,459 2,705 2023/24 Rate (per 100,000) 32,047 2,671 2024/25 Rate (per 100,000) 32,202 2,684 Page 155 of 236
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Emergency Admissions Source: MSG data release Jun-25; data published up to Dec-24 8 Year Annual Monthly 2020/21 Target Rate (per 100,000) 9,425 785 2019/20 Rate (per 100,000) 10,863 905 2020/21 Rate (per 100,000) 9,141 762 2021/22 Rate (per 100,000) 9,546 796 2022/23 Rate (per 100,000) 8,272 689 2023/24 Rate (per 100,000) 9,108 759 2024/25 Running Average (Dec) 733 Page 156 of 236
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Unplanned Bed Days - Acute Source: MSG data release Jun-25; data published up to Dec-24 9 Year Annual Monthly 2020/21 Target Rate (per 100,000) 62,333 5,194 2019/20 Rate (per 100,000) 64,113 5,343 2020/21 Rate (per 100,000) 56,988 4,749 2021/22 Rate (per 100,000) 57,426 4,785 2022/23 Rate (per 100,000) 62,679 5,223 2023/24 Rate (per 100,000) 57,975 4,831 2024/25 Running Average (Dec) 5,076 Page 157 of 236
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Delayed Discharges Occupied Bed Days (18+) Source: MSG data release Jun-25; data published up to Mar-25 10 Year Annual Monthly 2020/21 Target Rate (per 100,000 18+) 13,661 1,138 2019/20 Rate (per 100,000) 14,080 1,173 2020/21 Rate (per 100,000) 9,598 800 2021/22 Rate (per 100,000) 8,100 675 2022/23 Rate (per 100,000) 12,226 1,019 2023/24 Rate (per 100,000) 9,515 793 2024/25 Rate (per 100,000) 13,401 1,117 Page 158 of 236
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8th September 2025 This report has been created using OutNav developed by Matter of Focus. IJB Strategic Governance Map 25/26 Column 4 and 5 Directions part-year reporting and progress towards strategic aims Page 159 of 236
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Page 2 of 22 IJB Strategic Governance Progress Page 160 of 236
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Page 3 of 22 IJB Strategic Governance Column 4: What they learn and gain Assurance and oversight on the progress towards achieving our Directions Progress: Some Confidence: High Progress Towards Directions 2025/26 The use of the integrated Midlothian IJB Strategic Governance Map allows for an aggregated and synthesised account of the progress, challenges and opportunities identified through Group Service level reporting. The progress ratings are an aggregation of information that considers both the progress rating of Head of Service or Professional Lead and confidence in the strength of evidence presented in service plans. This is held in Group Service Reporting Frameworks which have collectively formed the basis of this organisation level analysis of progress. The operational challenges experienced across Midlothian Health and Social Care Partnership (HSCP) have limited the ability of some services to engage in work beyond the continued delivery of existing service provision or deliver ringfence-funded priority improvement projects. The imperative to achieve significant Financial Recovery Actions across 2023/24 and 2024/25 has also resulted in residual capacity in some areas being utilised to achieve a balanced budget position i.e., the successful resource panel review. Priority, but ringfence-funded improvement projects i.e. the Unscheduled Care Improvement Project, have also resulted in limited capacity to undertake additional actions. Great progress The Directions where most progress has been made are the actions most proximal to operational delivery where there is an additional external driver and a well understood imperative to deliver change with strong consensus agreement. This is most frequently related to capacity, demand, or financial recovery targets. Examples of great progress includes • the completion of the Home First review, • a successful review of Resource Panel processes and expenditure Page 161 of 236
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Page 4 of 22 • changes to the coordination delivery of care between acute and community services to improve the experience of people leaving hospital and returning home safely, • delivery of the Midlothian HSCP Staff Communication and Engagement Delivery plan, • Lived Experience Panels commenced for the Community Justice Service and Mental Health and Substance Use Service, • Adult Support and Protection duties have been fully implemented in the services that have a responsibility to deliver this, • progress towards achieving financial recovery plans, • targeted work to improve the quality of care for people living with frailty by involving them in decisions about their care and future plans, • developing the Midlothian IJB Strategic Plan 2025-2035 and accompanying suite of statutory publications, • the submission to Scottish Government of the Midlothian IJB Integrated Workforce Plan 2025-2028, and • the development of the Midlothian IJB Participation and Engagement Statement. Recommendations are for Midlothian IJB to consider and identify where increased progress would be most desirable in the development of Directions for 2026/27 Slower progress The areas where there has been least progress are the foundational or complex change required to deliver the whole system transformation required to reimagine health and social care as part of a new and sustainable future. Some examples where progress has been slower are • some workstreams of the Midlothian HSCP Transformation and Change Programme Board, • areas of work that are to improve the access to information for services or people and communities where there is an element of digital transformation required, • the ability of all services to report on their contribution to outcomes for people and communities (not service outputs), • whole system understanding of the Midway and the availability of training opportunities, • work where partners are required to provide and change or improvement to systems or data input i.e., availability of protected characteristics, feedback mechanisms, • limited assurance that objectives have been set to explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to traditional referral pathways, Page 162 of 236
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Page 5 of 22 • developing a meaningful response to achieve the ambition of the ‘Midlothian will be healthier’ thematic area of the Midlothian Community Planning Partnership, and • limited assurance that objectives have been set, or a realistic plan has been developed to ensure consideration of the potential impact on unpaid carers of shifting the balance of care from hospital to home. Midlothian IJB may wish to consider how to set clearer expectations of both Midlothian HSCP and Partners regarding the pace required to achieve these foundational but potentially slower stream actions. Other challenges and opportunities For some Directions, Midlothian HSCP has been unable to influence Partner organisations to take the action required in order to see change. Additionally, work that relied on the availability of the specialist support to interpret complex data, the exploration of potential solutions that require a System Thinking approach to exploring, redefining, co-creating and catalysing change as part of redesign and renewal, or where there are dependencies on skills or data that are not currently available. Some examples of where other challenges and opportunities have been identified are • the Social Work and Occupational Therapy service review, • Hosted Services reporting, • the Partners' ability to support the technical provision of professional software, • the Information Management and Governance of Partners’ data, • improving the quality of data input of protected characteristics, • the provision of consistent feedback mechanisms and analysis to understand and improve people’s experiences, and • initiatives that may not be a priority for one or both Partners i.e., meaningful outcome measurement at service level or new digital innovation. Midlothian IJB may wish to consider how it can support the ability of Midlothian HSCP to address these challenges and ensure the right systems, skills, and support is made available. There are opportunities for Midlothian HSCP to improve both efficiency and effectiveness of Group Service reporting by establishing a clear and coordinated approach to progressing the Group Service priorities. It is likely that a more coordinated approach would lead to Page 163 of 236
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Page 6 of 22 faster and more focused collective progress and shared learning. A key enabler of whole system reporting starts the with contribution made by effectively planned and evaluated Service plans and clear data sources. Midlothian IJB may wish to consider asking Midlothian HSCP to provide ongoing assurance of • consistent progress ratings that reflect the level of evidence provided by services, • improved identification of variation between the progress of individual services and the overall organisations progress, • shared decision making with service areas collectively to establish priority service actions that will achieve the Group Service objective, • evaluation methods being embedding at the quality planning stage, and • discussion and regular review to support early identification of any planning, data or evaluation needs. Midlothian IJB should note that Directions are a small subset of instructions that direct Partners on the priority action required to see progress towards achieving the strategic aims of the Midlothian IJB Strategic Plan 2025-2035. They are strategic in nature and cannot describe the entirety of 'Business as Usual' across the whole of integrated health and social care. For the purposes of Part Year reporting period ending 8th August 2025, only progress noted by Group Services in relation to their service plans have been included in this analysis. In future, to ensure that the contributions across all of Midlothian HSCP are included in the IJB evaluation of progress towards each strategic aim, information could also be utilised from a range of other sources e.g., Quarterly Reporting to Midlothian Council and NHS Lothian and outcome reporting from Service level outcome maps (where available). By addressing these data gaps, it will be possible to have increased confidence in the decision making at Service, Group Service, HSCP and IJB level in regard to financial and operational redesign and transformation. Directions under Strategic Aim 1: People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health Sub-aim 1.1: People can easily find the information they need to make good decisions Direction 1.3: NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by December 2025. Page 164 of 236
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Page 7 of 22 Progress: An HSCP project lead has been identified to lead the development of the Strategy, but work has not yet commenced. Group Services are awaiting guidance from the lead in Executive Business Management to progress this. The Nursing Group Service has reviewed and updated information available to service users. The AHP Group Service are beginning a test of change to trial a self-referral option for patients. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: Adult services, AHP, Nursing, Executive Business Management, Strategic Planning and Performance. Direction 1.4: 1.4 Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review to inform the redesign and/or refresh of all publicly available information to support self-management, early intervention and prevention in a way that is compliant with our duties relating to accessibility by December 2025. This should include the alignment with the Model Publication Scheme and specifically include: • consistent use and application of the Midlothian IJB ‘Writing for Publication Style Guide’, • assurance all service information is person-centred and meaningful from the perspective of those it is intended to support, • a review of the Midlothian Health and Social Care website pages to ensure compliance the Equality Act 2010 and accessibility standards, • the development of consistently presented online and paper service information resources, and • links with both partners website, information, and signposting provisions. Progress: A preferred option for the website has been agreed with the HSCP ELT, and timelines are being revised in line with the ongoing service review within the Executive Business Management Group Service. Other Group Services are committed to supporting this process and awaiting further co-ordination of this work. During this period, service information has been updated on public facing websites by the Adult Services and AHP Group Services, and the Strategic Planning and Performance Group service have produced and revised a 'writing for publication style guide'. Rating of progress and confidence: Some progress; some confidence. Group services with identified objectives: Adult services, AHP services, Nursing, Executive Business Management, Strategic Planning and Performance. Page 165 of 236
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Page 8 of 22 Sub aim 1.2: People achieve the things that matters most to them, and our services are confident of what our contribution is to their success. Direction 4.1: NHS Lothian and Midlothian Council will support the HSCP integrated services to demonstrate how feedback informs service continual improvement redesign by December 2025. Progress: The Adult Services Group Service have undertaken a range of activities related to this Direction, for example, the Justice Service is routinely using Forms to seek feedback from service users, and lived experience panel reporting has been circulated to groups and stakeholders. While this indicates progress, there has not been a formal review to provide a guiding structure for this area of work. The AHP Group Service has made ongoing improvements to the functionality and security of the GAF application, including a live dashboard and data visualisations for real-time insights, with ongoing workforce development around contributing to this and drawing from it at service level. Actions are progressing to establish Community Appointment Days (CAD) across AHP services. The Nursing Group Service are focusing on feedback around antenatal services, using QR codes to gather patient feedback. The Group Service has identified a challenge around identifying and capturing feedback, as regular discussion about the service is integral to day-to-day conversations with patients. Rating of progress and confidence: Some progress; some confidence. Group services with identified objectives: Adult services, AHP, Nursing. Direction 4.2: NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated self-management framework that sets out an expectation of how services will work with people to be more informed about their condition(s), be better prepared for when they feel less well, and describes how to access the right support when it is needed by December 2025. Progress: The HSCP project lead has not commenced the quality planning phase of this work, and group services are awaiting requests to participate. However, group services have taken some individuals actions to promote self-management. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: Adult services, AHP, Nursing, Executive Business Management, Strategic Planning and Performance, General Practice. Page 166 of 236
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Page 9 of 22 Direction 4.4: NHS Lothian and Midlothian Council will support operational services for all functions delegated to Midlothian IJB to record the impact of their contribution to health and wellbeing outcomes, and evidence how they have used this information to inform service design by December 2025. Progress: The Strategic Planning and Performance Group Service has led work to iteratively develop outcomes-focused reporting through the IJB Strategic Governance Outcome map in OutNav and the documentation that supports it. This has included the development of an improvement plan and reporting template to support outcomes-based reporting capabilities across services. The Integration Manager has worked closely with Scottish Government to inform their wider work on evaluation. The quality of the Midlothian IJB Strategic Governance Framework has been recognised. Some Adult, AHP and Nursing Group Services have noted objectives to support this process through maximisation of the use of OutNav although at service level this has not progressed due to capacity pressures and limited organisational support. All services are required under this Direction to establish a mechanism for reporting on outcomes. To mitigate on slower progress, the Strategic Planning and Performance and Group Services have developed and tested the use of an Excel reporting template during H1 reporting. Rating of progress and confidence: Some progress; some confidence. Group services with identified objectives: Adult services, AHP, Nursing, Strategic Planning and Performance. Sub aim 1.3: People access services and support designed around how they live their lives Direction 5.1: NHS Lothian and Midlothian Council must ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring that • systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics • health and social care workforce are suitably trained and skilled to gather and input this data, and • data quality assurance, by December 2025. Progress: The Strategic Planning and Performance Group Service has an objective to support delivery of this Direction by building understanding of the opportunities, risks and dependencies for developing data collection and visualisation, resulting in an options appraisal. Early engagement and discussions have taken place, but the work is on hold following the addition of new organisational priorities to the Service's portfolio. Page 167 of 236
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Page 10 of 22 Operational services have identified some actions to improve data capabilities, for example through updates to data sharing agreements by the General Practice Group Service, and a focus on encouraging use of the eEES system for recording of personal data and completion of equality and diversity learning modules on TURAS within the AHP Group Service. Rating of progress and confidence: Some progress; low confidence. Group services with identified objectives: Strategic Planning and Performance, General Practice, AHP. Direction 5.2: NHS Lothian and Midlothian Council will explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by December 2025. Progress: Of the three Group Services with objectives related to this Direction, two have identified initial actions. The AHP Group Service planned a development session to explore digital priorities in alignment with the National Care Service's transformation agenda, although it anticipates challenges around conflicting priorities and system gaps. The Nursing Group Service reports good progress on the use of digital approaches in Health Visiting, but the Adults with Complex and Exceptional Needs Service will require support to progress further given an ongoing reliance on paper-based solution and challenges with digital literacy among staff. Adult services have identified objectives to progress this work, but there is no report of progress. All service would benefit from timely support from NHS Lothian ehealth and Midlothian Council Digital Services to progress this Direction. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: Nursing, AHP, Adult services. Direction 5.3: NHS Lothian and Midlothian Council will support Midlothian HSCP to develop integrated data at population level to support the prediction, identification, and planning of changing demographic profile and need to support dynamic whole system change across time and report on progress by December 2025. Progress: Nursing and Adult Group Servies have an objective to support Strategic Planning and Performance with regards to this Direction, including developing strategies to apply the iteratively improving information, once the work reaches a stage where service input is required. The Strategic Planning and Performance Group Service have initiated work to develop a Midlothian HSCP Information Management Strategy that can be used to enable the development of priority data dashboards. Following initial meetings, draft project briefs, Page 168 of 236
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Page 11 of 22 workstream overviews and options appraisals have been produced. There are ongoing challenges to secure the required software, information management, and governance to deliver integration data solutions. Rating of progress and confidence: Some progress; some confidence. Group services with identified objectives: Strategic Planning and Performance, Nursing, Adult Services. Strategic Aim 2: People access the care and support they need when they need it in the community and at home Sub aim 2.1: People easily access the services that help them stay well, independent and active Direction 2.4: NHS Lothian and Midlothian Council will support Midlothian HSCP to undertake a review of Social Work and Occupational Therapy teams by December 2025. Progress: Staff across the Adult Services Group Service are contributing to the review of Social Work and Occupational Therapy, including actions around MOSAIC data cleansing, an update to the process referral forms and the progression of a Time in Motion study. Further actions may be identified by the Group Service as the work progresses. The AHP Group Service report that the Occupational Therapy Clinical Lead is connecting to outputs from the workstream, but no further information has been provided about how this is being taken forward. Additionally, Strategic Planning and Performance have been asked to prioritise new work to support the provision of a Social Work Dashboard which will support the Adult Services Group Service to make professional decisions relating to the review. Rating of progress and confidence: Low progress; low confidence Group services with identified objectives: Adult Services, AHP. Sub aim 2.2: People have access to services in their own community Direction 2.3: NHS Lothian and Midlothian Council will support Midlothian HSCP to develop or redesign services to consider and evidence services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible by December 2026. Progress: AHP and Nursing Group Services have identified four objectives in relation to this Direction. Two of these relate to Health Visiting, where the service is fully engaged with all Community Planning Partners to support the development and progress of universal and Page 169 of 236
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Page 12 of 22 targeted services including the Universal Health Visiting Pathway. Some progress is reported against the remaining two objectives, but it is not clear that the actions underway will be sufficient to achieve them. Group Services report challenges with access to training and balancing operational workloads with strategic activities, as well as limited ability address challenges relating to the Community Planning Partnership Single Midlothian Plan and asset-based approaches. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: AHP, Nursing. Sub aim 2.3: People are living in a place of their choosing for longer Direction 2.3: NHS Lothian and Midlothian Council will support Midlothian HSCP to develop or redesign services to consider and evidence services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible by December 2026. Progress: Group Service reports provide a mixed picture of progress towards this Direction. The AHP Group Service reports initial progress around the Home First review, with the Programme Board supportive of its findings and governance underway to enable new service design. The Nursing Group Service report generally positive ongoing progress in providing care close to home. Some services have been clinic-based due to challenges with resources and short-term staffing gaps, risk assessed and escalated. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: Services Strategic aim 3: People's human, social and economic rights are protected in how we design and deliver our services. Sub aim 3.1: People and their carers are recognised as expert in their own experiences, and feel valued Direction 3.2: NHS Lothian and Midlothian Council will support operational services for all relevant functions delegated to Midlothian IJB to develop and demonstrate an increase in the effective and proactive outreach to people living with frailty, by December 2025. Progress: There is an HSCP wide project underway to deliver on this Direction. The GP Cluster has committed to focusing on improving the care of Frail and Elderly patients in collaboration with wider HSCP stakeholders and have completed 3606 Rockwood clinical frailty assessments since 1st April. The AHP Group Service is contributing to this Direction through specific initiatives, and the Page 170 of 236
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Page 13 of 22 Musculoskeletal Physiotherapy Service continues to effectively contribute to this work. Adult Services have identified objectives to progress this work, but there is no report of progress. Both The GP cluster and AHP Group Service have identified resource challenges as a risk to the sustainability of this work. Rating of progress and confidence: Some progress; some confidence. Group services with identified objectives: Adult, AHP, Clinical Director Direction 3.3: NHS Lothian and Midlothian Council will support Midlothian HSCP to revise and update ‘The Midway’ by October 2025. Progress: Of the three Group Service areas with actions related to this Direction, none have identified clear actions that contribute to the revision and updating of 'The Midway' by October 2025. No other updates have been provided. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: AHP, Adult Services, Chief Nurse. Direction 3.4: NHS Lothian and Midlothian Council will support operational services for all functions delegated to Midlothian IJB to embed and evidence community engagement and feedback from people who experience services as part of continuous improvement and service design by December 2025. Progress: The Strategic Planning and Performance Group Service have undertaken considerable work towards this Direction, completing the Midlothian IJB Community Engagement Self Assessment that informed the development of the Midlothian IJB Participation and Engagement Statement. The Participation and Engagement Statement will be presented to the IJB Strategic Planning Group and Midlothian IJB in Autumn 2025. At a service level work has progressed within AHP and Adult Services to improve collection of feedback, including through the formation of Lived Experience Panels for Community Justice and Mental Health and Substance Use. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: Executive Business and Management, Nursing, AHP, Strategic Planning and Performance and Adult. Page 171 of 236
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Page 14 of 22 Direction 6.1: All functions delegated to Midlothian IJB that aim to move care from hospital to home will ensure consideration of the potential impact of planned interventions on unpaid carers, and evidence appropriate supportive actions, by December 2025. Progress: Returns from the Group Service Areas suggest progress towards this Direction is limited. Within Adult Services individual case oversight is ongoing through the 'Coming Home' reporting. Within AHP the Home First review implementation plan is still awaiting governance approvals and no update has been provided by the Chief Nurse Group Service. It is not clear whether the objectives that have been set to meet this Direction constitute a realistic plan to achieve this. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: AHP, Chief Nurse, Adult. Direction 6.3: NHS Lothian and Midlothian Council will support Midlothian HSCP to develop a Carers' strategy for 2025-28 by December 2025. This must specifically outline the action to be taken in collaboration with our Partners, VOCAL, to consider how the information, advice and support improve to see improved outcomes for carers. Progress: The Adult Group Service is leading on the update of the Midlothian IJB Carers Strategy 2025-2028. Work to progress the strategy is ongoing. Additionally, services have taken some actions that contribute to the spirit of the Direction, including gathering feedback from the Care Group. Strategic Planning and Performance and Executive Business and Management both have objectives under this Direction, and their involvement is pending a request for support from Adult Services. Rating of progress and confidence: Some progress; low confidence. Group services with identified objectives: Executive Business and Management, Strategic Planning and Performance and Adult Services Page 172 of 236
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Page 15 of 22 Sub-aim 3.2: People's care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want Direction 7.1: All relevant functions delegated to Midlothian IJB will explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to traditional referral pathways, by December 2025. Progress: The AHP Group Service is making good progress towards this Direction. The Adult Service Group Service has identified a range of objectives but has not made progress towards them. A number of service areas have no identified actions. Rating of progress and confidence: Low progress; low confidence. Group services with identified objectives: Adult, AHP, Clinical Director Direction 7.2: Where there is a statutory responsibility to manage harmful behaviours, all functions must communicate the impact of action taken to maximise people's safety in our communities, by December 2025. Progress: Adult Support and Protection duties have been fully implemented in Mental Health and Substance Use and ongoing monitoring is in place for the Disabilities Service. No information is provided for other services within the Group. Rating of progress and confidence: Some progress; some confidence Group services with identified objectives: Adult services Direction 7.4: Midlothian Health and Social Care Partnership will support services to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms, this includes establishing (and taking action where necessary) by June 2025, that all the teams who work with people, including the teams of our Partners, understand what SDS is and how to signpost this information at the right time, that all relevant staff have received training in sensory awareness and understanding how to support people to request and access accessible information, that all the information we provide about SDS is accessible so those who may benefit most are able to make informed choices. Page 173 of 236
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Page 16 of 22 that comprehensive system evidence is gathered on all changes in uptake between one option and another, any increase in budget, and any HSCP financial impact. Progress: Among Group Services providing direct services and support to people, reported progress against this Direction is positive and ongoing. The Adult Group Service continue to monitor the progress of the Self-Directed Support (SDS) workplan. There may be opportunities to identify additional actions for this Group Service to support progression towards this Strategic sub-aim as work evolves. For the Executive Business Management Group Service, the objective against this Direction is linked to progress on Direction 1.4 regarding the Midlothian Health and Social Care webpages. The ongoing Business Service Review within this Group Service is presenting a challenge for timelines, which are being monitored. The Strategic Planning and Performance Service are also committed to supporting this process and are awaiting further instruction. Rating of progress and confidence: Some progress; low confidence. Group services with identified objectives: Adult services, Executive Business Management, Strategic Planning and Performance. Sub-aim 3.3: People benefit from organisations working together and sharing information safely Direction 8.1: NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2025-26 by June 2025. Progress: The Midlothian HSCP Staff Communication, Experience and Engagement Plan has been developed, and Adult Services have undertaken some actions towards implementing this. All services have participated in the iMatter annual survey and team plans are being developed. Within the Chief Nurse Group Service, the Adults with Complex and Exceptional Needs Service reports that they use digital approaches to support remote staff in their engagement and wellbeing. This service has highlighted the challenges of sustaining engagement and planning of staff working at night and in people's homes. Rating of progress and confidence: Great progress; high confidence Group services with identified objectives: Adult services, Nursing, AHP, Executive Business Management, Strategic Planning and Performance. Page 174 of 236
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Page 17 of 22 Direction 8.2: NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the Midlothian IJB Integrated Workforce Plan 2025-28 by June 2025. Progress: The Strategic Planning and Performance Group Service led the statutory requirement to develop the Midlothian IJB Integrated Workforce Plan 2025-28. This was completed and submitted to the Scottish Government in February 2025 for feedback ahead of permission to publish. No feedback has been received from the Scottish Government to date. Within AHP, the Dietetics Workforce Plan is drafted and governance arrangements are in place. There are no reports of progress with service specific actions to deliver on this Direction for the other Group Service areas. Rating of progress and confidence: Great progress; high confidence Group services with identified objectives: Strategic Planning and Performance, AHP, Nursing, Adult Services. Direction 8.3: NHS Lothian and Midlothian Council must ensure provision in procurement and contract management support to ensure Midlothian IJB is able to report on its duties to comply with the Heath and Care (Staffing) (Scotland) Act in relation to assurance reporting on the workforce provision for services planned and secured by HSCP managed services and delivered by third parties through commissioning by December 2025 Progress: The 2024/25 statutory report to Scottish Government regarding the assurance relating to the compliance of third parties who deliver registered care services on behalf of Midlothian HSCP was submitted by the Strategic Planning and Performance Group Service in June 2025. This responsibility has been transferred to the Executive Business and Management Group Service to complete reporting for 2025/26. Rating of progress and confidence: Great progress; high confidence Group services with identified objectives: Executive Business Management Page 175 of 236
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Page 18 of 22 Column 5: What they do differently (Strategic aims) People are able to make good decisions that help them stay well, plan ahead and prevent ill or worsening health (SA1) Progress: Some Confidence: Some Strategic Sub-Aim 1.1 'People can easily find the information they need to make good decisions' The IJB have set two Directions to support achievement of this sub-aim. Actions towards elements of these have been taken forward by five of the six Group Service Areas. Key elements of this work are the development of an Integrated Public Communication Strategy and Action Plan and the refresh of information to support self-management on the website. Both of these actions are to be delivered by December 2025 and whilst plans are in place, reports on progress suggest delays in implementation are likely. Actions to improve the use of feedback to inform service design are being progressed by Adult Services, AHP and Nursing. There are good examples of progress across service areas, however, this work is somewhat fragmented. Taking a joined up approach to sharing learning and progressing areas of challenge would support a more streamlined and coherent approach across the organisation. Strategic Sub-Aim 1.2 'People achieve the things that matters most to them, and our services are confident of what our contribution is to their success' The IJB have set 3 Directions to support achievement of this sub-aim. Actions towards elements of this sub-aim have been taken forward by six Group Service Areas. Actions to improve the use of feedback to inform service design are being progressed by Adult Services, AHP and Nursing. Key elements of this work are sustaining existing mechanisms for feedback i.e., Lived Experience Panels, and developing new innovative ways to gather this information i.e., Health Visiting using QR codes. However, this work is somewhat fragmented and a more intentional approach to evidencing how feedback in contributing to specific elements of service improvement and redesign is required to support a Page 176 of 236
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Page 19 of 22 more streamlined and coherent approach across the organisation. Targeted work is required to achieve Direction 4.4 to ensure all services can consistently report on outcomes. Strategic Sub-Aim 1.3 'People access services and support designed around how they live their lives' The IJB have set 3 Directions to support achievement of this sub-aim. Actions towards elements of this sub-aim have been taken forward by five of the six Group Service Areas but progress is limited. The dependency on Partners' systems has presented some challenges and changes in data input practice are difficult to embed. Progress is also limited by a lack of resource and planning in relation to digital provision and skills. Services have noted the requirement for whole system improvements with a coordinated response from all Partners. People access the care and support they need when they need it in the community and at home (SA2) Progress: Low Confidence: Low Strategic Sub-Aim 2.1 'People easily access the services that help them stay well, independent and active' The IJB have set 1 Direction to support this sub-aim. Two of the six Group Service areas have identified Group Service objectives relating to this Direction and one further Group Service is now also providing support. Strategic Sub-Aim 2.2 'People have access to services in their own community' The IJB have set 1 Direction to support this sub-aim. Two of the six Group Service areas have identified Group Service objectives relating to this Direction. Strategic Sub-Aim 2.3 'People are living in a place of their choosing for longer' Page 177 of 236
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Page 20 of 22 The IJB have set 1 Direction to support this sub-aim. Two of the six Group Service areas have identified Group Service objectives relating to this Direction. The three sub-aims of this Strategic Aim are dependent on the work of the HSCP Transformation and Change Programme Board to set the overarching plans for system redesign that will allow services to determine their contribution to this change. The IJB may wish to consider how it can support progress through strategically setting new Directions for 2026/27. People's human, social, and economic rights are protected and promoted in how we design and deliver our services (SA3) Progress: Some Confidence: Some Strategic Sub-Aim 3.1 'People and their carers are recognised as expert in their own experiences, and feel valued' The IJB has set five Directions to support this sub-aim. Actions have been identified by six of the six Group Service areas. Achievements include the development of the Midlothian IJB Participation and Engagement Statement and good progress towards improving the experience of people who live with frailty. The Midlothian IJB Carers Strategy for 2025-2028 is also anticipated to be approved in December 2025. There are opportunities for Midlothian HSCP to develop a coordinated plan that will allow services to plan and undertake more targeted action. Strategic Sub-Aim 3.2 'People's care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want' The IJB has set three Directions to support this sub-aim. Actions have been identified by five of the six Group Service areas although progress is difficult to evaluate due to limited information provided in Service progress updates. Group Services have noted there are opportunities to identify additional action to develop how services can support people to make the right decision for them in relation to the type of care they receive. Page 178 of 236
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Page 21 of 22 Strategic Sub-Aim 3.3 'People benefit from organisations working together and sharing information safely' The IJB has set three Directions to support this sub-aim. Actions have been identified by five of the six Group Service areas. All of the planned activities for 2025/26 have been achieved and this presents an opportunity for Midlothian IJB to consider how it might want to advance the ambition of this sub-aim further in 2026/27. We transform services to make effective use of resources Progress: Low Confidence: Some Eleven Directions have been set by Midlothian IJB to support the transformation of health and social care to make more effective use of resources. Actions in relation to these Directions are being delivered across all Group Service Areas and analysis of the information provided shows that there is some progress. One Direction has been delivered and now ongoing (9.4) and there is good progress in the quality planning phase relation to the review of commissioning (9.3.5). There has been some progress made in relation to all other transformation Directions with the exception of 9.3.6 effective working with Community Planning partners. Across the other Directions there is some good progress in relation to some specific actions within specific services, but there is little evidence of a joined-up approach to delivering on these transformation objectives. Moving forward Midlothian IJB may wish to consider requiring a more detailed update on progress towards Directions that relate to transformation and change, i.e., a report from the Midlothian HSCP Transformation and Change Programme Board on action undertaken and financial implications. Reporting from the Midlothian HSCP Transformation and Change Programme Board would provide better intelligence on the pace of progress as well as better oversight of where there are challenges requiring Midlothian IJB support. This will provide Midlothian IJB with assurance on the coordinated approach to transformation planning that can complement this coordinated whole system approach to evaluation. Developing a consistent approach will also support informed planning for Directions 2026/27. Page 179 of 236
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Page 22 of 22 As part of the work to align finance with Directions, an exercise was undertaken to map all individual budgets to the relevant service plans, for which the operational and professional leads are accountable. While progress has been made, it has become clear that further work is required to fully reconcile the two systems. In particular, reporting mechanisms need to be synchronized to ensure that all funding and budgets are consistently and accurately captured within each service plan. This report has been created using Developed by Matter of Focus. OutNav supports initiatives with a vision for social change to understand and track how their work makes a difference. The cloud-based tool enables teams to apply a practical and meaningful approach to outcomes-focused monitoring and evaluation, developed by Matter of Focus. https://www.matter-of-focus.com Page 180 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14.00-16.00 Midlothian Integrated Assurance Report Executive summary This report provides assurance to the Midlothian Integration Joint Board on the governance, risk, and resilience processes within the Midlothian Health and Social Care Partnership (MHSCP). Clinical and care governance is overseen by the Clinical and Care Governance Group (CCGG), service-level Quality Management Groups (QMGs), and the Social Work Assurance Group (SWAG), supported by specialist subgroups for risk management and shared learning. The Governance and Assurance Framework (GAF) continues to develop. Areas of medium and low assurance are reviewed by relevant groups: • Clinical and Care Governance • Integrated Workforce Governance Board • Finance and Performance • Business Governance • Digital Programme Board • Partnership Forum Service plans are in place across HSCP services. Upcoming reports will address risks and support development of a Quality Management System (QMS), integrating governance with performance and resource management. No new strategic inspections have occurred since the last report. The Annual Assurance Report was presented to NHS Lothian’s Healthcare Governance Committee on 23 September 2025, which accepted moderate assurance of MHSCP’s systems for safe, effective and person-centred care (Appendix 3). MHSCP structures meet the requirements of both Midlothian Council and NHS Lothian, including risk register maintenance and major incident planning. As a result of this report, Members are asked to: • discuss and approve this report. Item number: 5.9 Page 181 of 236
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Midlothian Integration Joint Board Report Integrated Assurance Report 1 Purpose 1.1 This is the Integrated Assurance report provided by the Midlothian HSCP to the Midlothian Integration Joint Board (IJB). 2 Recommendations 2.1 As a result of this report, Members are asked to: • Discuss and approve the content of this report. 3 Background and main report 3.1 This report updates Midlothian IJB on the activity undertaken to provide assurance around the delivery of safe, effective, and person-centred care in Midlothian and the processes in place to cover risk and resilience. 3.2 Six Governance Groups report to the Senior and Executive Leadership Teams: • Clinical and Care Governance • Integrated Workforce Governance • Finance and Performance • Business Governance • Digital Programme Board • Partnership Forum 3.3 Areas rated medium or low assurance in the Governance and Assurance Framework are reviewed by the relevant group (Appendix 1). Risk is a standing item in all six groups’ terms of reference. 3.4 Clinical and Care Governance and Assurance Structure and Processes The Clinical and Care Governance Group (CCGG) meets quarterly to oversee the safety, effectiveness, and person-centredness of services within the Midlothian Health and Social Care Partnership (MHSCP). Since the last report to the IJB, two meetings have taken place. 3.5 Since April 2023, Group Service, Service, and Team Plans have been in place. The Governance and Assurance Framework (GAF) and revised meeting structures now give CCGG a full view of assurance and risks across services (Appendix 1). Page 182 of 236
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Midlothian Integration Joint Board 3.6 The evolving GAF reflects system learning, structural changes, and digital updates, promoting a learning culture and system-wide assurance. Completion rates are monitored via digital reminders, and data is input into the GAF app to assess impact, assurance, and governance. Tableau provides a dashboard for oversight (Appendix 2). Quarterly reports go to the Executive Leadership Team, and Service Managers track action plans through line management and CCGG. 3.7 Quality Management Groups (QMGs) report quarterly to CCGG, providing evidence of governance, risk, and quality management. They meet at least four times a year and submit a GAF report and CCGG template, detailing actions from adverse events, complaints, safety alerts, standards, audits, inspections, and other service-specific issues. Each QMG also presents an annual summary to CCGG and service managers. QMGs cover all HSCP business, ensuring social work service assurance. 3.8 The Chief Social Work Officer (CSWO) role, held by the Head of Adult Services, is a statutory responsibility and is a member of Midlothian Integration Joint Board (IJB). The Social Work Assurance Group (SWAG), chaired by the CSWO, meets fortnightly with the Deputy CSWO and Group Service Manager. It leads statutory/regulatory improvement (e.g. Mental Welfare Commission, Care Inspectorate inspections). SWAG approves new policies and oversees audits and quality assurance for all Midlothian social work services, including those outside Midlothian IJB-delegated functions. 3.9 MHSCP delivered its Annual Assurance Report to the NHS Lothian Healthcare Governance Committee on 23rd September 2025. The Committee agreed to accept moderate assurance that MHSCP has comprehensive systems in place to deliver safe, effective and person - centred care. (Full report included in Appendix 3). 3.10 Investigating and Learning from Adverse Events and Complaints The regular meetings within the governance structure described above enable reporting and analysis of care quality. Midlothian HSCP values integration relationships and fosters both formal and informal escalation methods through both management and professional lines. 3.11 Adverse Events Governance groups oversee significant adverse events within NHS Lothian services delivered by Midlothian HSCP. Dedicated working groups focus on the most common reported harms , including in-patient falls at Midlothian Community Hospital (MCH) and pressure ulcers. A MCH Morbidity and Mortality Review group conducts multidisciplinary reviews of in-patient deaths to support learning and improve patient safety. 3.12 The Midlothian Safety and Experience Action Group (MSEAG) has oversight of the investigation of all significant adverse events, i.e. those graded as moderate or major harm and death, including suicides, and unexpected deaths of patients known to mental health and substance use services. It commissions external reviews in line with NHS Lothian protocols. MSEAG minutes are submitted to the MHSCP Senior Management Team, and final closure of serious adverse events requires approval from the NHS Lothian Medical Director and Executive Nurse Director. Page 183 of 236
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Midlothian Integration Joint Board 3.13 The HSCP Senior Management Team (SMT) receives monthly reports on complaints and adverse events via Datix, a web-based system used by NHS Lothian staff to report safety concerns, incidents, and near misses. Datix supports data collection and analysis to inform safety and quality improvement plans. It also includes modules for managing Complaints, Claims, and Risk Registers. Themes and learning from complaints and adverse events are reviewed quarterly by MSEAG and discussed at NHS Lothian performance meetings. 3.14 At the time of writing 11 major harm Significant Adverse Event (SAEs) are open and under investigation. 3.15 Figure 1 shows data from Datix on reported SAEs over the past 18 months. Monthly figures remain stable, with normal variation around a consistent median. This data is reviewed quarterly at MSEAG, with fortnightly updates on new SAERs. 3.16 In June 2025, an increase in overall adverse events was noted. Further analysis found no rise in SAEs (moderate and major harm or death), but increased reporting of falls without significant harm at Midlothian Community Hospital and of pressure ulcers and staffing concerns in District Nursing were identified as contributing to the overall increase. Figure 2 shows the most recent data on all reported adverse events (all levels of harm). Figure 2: 0 1 2 3 4 5 6 Figure 1: SAEs by Reported (Month/Year) within the last 18 months 26/09/2025 Data Mean Page 184 of 236
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Midlothian Integration Joint Board 3.17 Major harm and death events in Mental Health and Substance Use Services are reported separately to highlight trends and distinguish them from other services. SAER numbers in mental health, substance use, and other services remain static (Figure3). Updated figures on drug-related deaths were unavailable at the time of writing. The HSCP and MELDAP continue to prioritise activity to engage and support harm reduction for people who use substances. Figure 3: 3.18 Midlothian HSCP maintains strong performance on SAE review completion KPIs. Most breaches are beyond the control of HSCP processes (Figure 4). Complaints handling performance also remains steady. The HSCP prioritises investigation quality over meeting completion deadlines alone, encouraging Service Managers to include information on risk assessments and safety mitigations in Local Case Reviews to support confident decisions on whether further review is needed. Figure 4: Status of non-level 1 reviews reported each month 0 20 40 60 80 100 120 Aug 2024 Sep 2024 Oct 2024 Nov 2024 Dec 2024 Jan 2025 Feb 2025 Mar 2025 Apr 2025 May 2025 Jun 2025 Jul 2025 Aug 2025 Figure 2: All Adverse Events by Reported (Month/Year) - SPC Chart Data Mean Page 185 of 236
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Midlothian Integration Joint Board 3.19 Ongoing review of learning needs is undertaken and the SMT works with the Quality Improvement Support Team of NHS Lothian to discuss actions required and to enable appropriate learning opportunities to be identified and delivered. 3.20 Outstanding actions from previously investigated Significant Adverse Events are recorded on Datix and continue to be monitored by the MSEAG to ensure that they are completed. 3.21 Midlothian Council services within the HSCP have less mature adverse event processes. In acknowledgement, the Council Corporate Management Team approved a paper (March 25) recommending a short-life working group, involving all three Council Directorates, to develop a Council-wide Adverse Events Policy and Procedure. Governance within the HSCP will be provided by the Social Work Assurance Group (SWAG). 3.22 SWAG oversees governance for all Council Social Work and Social Care services. Chaired by the Chief Social Work Officer, it plays a key role in ensuring safe and effective service delivery. Standing agenda items include strategic and registered service inspections, Mental Welfare Commission reports, learning reviews, and shared policy development. 3.23 Complaints Complaints are usually handled through each organisation’s process, with integrated responses provided when appropriate. Enquiries from Elected Members, MPs, and MSPs are typically routed through the Council and managed by relevant Heads of Service. 3.24 MSEAG monitors performance against KPIs and analyses complaint themes related to NHS Lothian services within the MHSCP, reporting quarterly to NHS Lothian performance reviews. This report covers the most recent data available up to May 2025 from the report received from NHS Lothian. The number of stage 1 & 2 complaints received between June 2024 and May 2025 appears to be within previously observed patterns, with no apparent new trends or shifts since the last integrated assurance report (Figure 4). Page 186 of 236
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Midlothian Integration Joint Board Figure 4: 3.25 At the time of writing Midlothian is involved in responding to 6 open complaints, all of which are currently within the 20-day KPI for response. Work continues to share learning from the investigation of adverse events and complaints and to improve local services in line with findings and recommendations. 3.26 Safe & Effective District Nursing Service – SPSO Findings & Improvement Work District Nursing in Midlothian has faced sustained demand and staffing pressures, notably since April 2025. A similar situation in 2023 led to a Joint Director and Executive Nurse Director commissioning a review, initially for Midlothian and later expanded across Lothian. Midlothian HSCP remains engaged in this Pan-Lothian review. 3.27 Rising complexity led to a revised staffing model with skill mix, agreed in November 2024 by the Nursing and Midwifery Workforce Thematic Group. Implementation is underway, with productivity initiatives focused on “right person, right care, right time.” A new referral system has improved consistency. A paper-lite pilot was paused by NHS Lothian due to safety concerns related to in-patient ward to community information transfer, pending further review and an additional pilot in West Lothian. Staff education has improved, though study leave is often disrupted due to service pressures. Work continues to finalise skill mix and future-proof workforce planning. 3.28 On 27 July 2025, NHS Lothian received an SPSO report upholding a complaint about care provided to a Midlothian resident in 2022 by the District Nursing service and the Royal Infirmary of Edinburgh. The report found the District Nursing care and treatment documents to be unreasonable, citing failures to: 1. Complete timely assessments 2. Reassess patients within a reasonable timescale 3. Conduct Waterlow (pressure ulcer risk) assessments correctly 4. Create person-centred care plans 5. Plan two-person visits for basic care, particularly skin checks 6. Avoid reliance on patient self-reporting when inappropriate. Page 187 of 236
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Midlothian Integration Joint Board 3.29 Midlothian HSCP began addressing these issues upon receiving the draft report in May 2025. An apology was issued to the complainant, and actions are included in Midlothian’s local District Nursing improvement plan. An independent audit of documentation in June 2025 showed progress but highlighted the need for further improvements. Staff wellbeing measures are in place, and the Pressure Ulcer Collaborative is supporting this work. A weekly oversight group monitors staffing, workload, absence, and prioritisation. Collaboration with the Sustainability and Value team is helping develop a staffing dashboard. 3.30 Documentation issues identified by the SPSO and the audit have been shared with teams. Improvements focus on patient safety, care quality, and NMC standards. Regular casenote audits have resumed, and training includes examples of good documentation. Efforts include better risk identification, training, wellbeing support, and recruitment of six newly qualified nurses (NQRNs). Induction planning and staff engagement events are underway. Progress is being tracked via the Service Improvement Plan and governance frameworks. 3.31 Similar themes in two other SPSO reports led to a Short Life Working Group reporting to the Nursing and Midwifery Care Assurance Board. At the Lothian level, the Community Nursing Review is supporting improvements in electronic records. A new care assurance system which mirrors LACAS is in development. Person Centred Care Plans (PCCPs) on TRAK have been suspended pending the development of new care plans better tailored to District Nursing. These are being mapped to TRAK and will be tested on paper before rollout. 3.32 A weekly Pan-Lothian huddle addresses system-wide pressures and coordinates actions across HSCPs. Priorities include insulin administration for older adults, IT infrastructure, care assurance, education, and recruitment. 3.33 Clinical and Professional Oversight of Care Homes The Scottish Government’s My Health, My Care, My Home framework (June 2022) and the subsequent Advice Note (December 2022) outline principles for improving health and wellbeing in care homes through cross-sector collaboration. Midlothian and pan- Lothian partners are working to implement these recommendations and shape future care models. The approach acknowledges the distinct role of HSCPs compared to the regulatory functions of the Care Inspectorate. 3.34 Inspections The Clinical and Care Governance Group (CCGG) and the Social Work Assurance Group (SWAG) oversees inspections by regulatory bodies and monitors related action plans. Managers submit inspection reports via QMGs and attendance at SWAG. 3.35 MHSCP services undergo external inspections by Healthcare Improvement Scotland, the Mental Welfare Commission, and the Care Inspectorate. Reports are submitted to SMT, with action plans monitored through QMGs, CCGG, the East and Midlothian Public Protection Committee, and the Social Work Assurance Group. Immediate action is taken when concerns arise, with operational and professional leads jointly overseeing implementation, led by Service Managers and supported through governance structures to ensure sustainable improvement. Page 188 of 236
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Midlothian Integration Joint Board 3.36 No new strategic inspections have occurred since the last report. However, in July 2024, the Care Inspectorate began a review of social work governance under Section 53 of the Public Services Reform (Scotland) Act 2010. The review, concluding in December 2024, aims to assess how governance supports leaders in fulfilling statutory duties, supporting staff, and upholding social work values. It covers all statutory social work areas across Scotland and includes document reviews, a national survey, interviews, and focus groups. A final report was published in June 2025 was considered at SWAG. 3.37 A Social Work and Occupational Therapy review began in late 2024, with four workstreams: communication and engagement, data/performance/practice, learning and development, and organisational structure. A representative working group is progressing these areas, reviewing policies, analysing Mosaic data, and consulting on roles. This sits within the Strategic Plan and Transformation agenda. 3.38 QMGs have developed a systematic approach to managing Mental Welfare Commission themed report recommendations. These reports often include actions for the Scottish Government, NHS Boards, and HSCPs, which are incorporated into action plans and submitted to the Commission. Governance is maintained through reporting to HSCP SMT and the Social Work Assurance Group. 3.39 Risk Management Midlothian HSCP is compliant with the NHS Lothian Risk Management Policy and Midlothian Council Risk Management Policy and Strategy. The Risk Management process within Midlothian was audited in 2021 and the finalised report confirmed that the Risk Management processes within Midlothian provided high assurance and demonstrated best practice in several areas: • Midlothian HSCP Senior Management Team meets monthly, and risk is a standing agenda item. • Service level risks registers are locally managed, and oversight is held by Heads of Service for review and escalation to the Senior Management Team (if required). • Risks are routinely monitored through these escalating levels with additional risk oversight held by Midlothian Council and Midlothian IJB both strategically and operationally. • Each risk recorded either operationally or strategically have actions associated to mitigate the risk, these are routinely monitored through the appropriate level of monitoring as mentioned above. • Each risk has a risk owner identified who is the accountable person for managing the related actions and providing routine updates on the status of the risk. 3.40 Resilience and Major Incident Planning Midlothian Health and Social Care Partnership supports NHS Lothian and Midlothian Council in fulfilling their duties as Category 1 Responders under the Civil Contingencies Act (2004). Acting on behalf of the Midlothian IJB, the Partnership collaborates with both organisations to meet these legal obligations. The Act outlines seven key duties for Category 1 Responders: • Risk assessment • Emergency planning • Business continuity planning Page 189 of 236
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Midlothian Integration Joint Board • Promoting business continuity • Public communication • Information sharing • Cooperation 3.41 The Partnership maintains major incident plans aligned with NHS Lothian’s Resilience Policy and reports regularly on resilience and continuity. Incident management is supported by a virtual control room and physical sites at Midlothian Community Hospital and Fairfield House. Service Managers update their resilience and continuity plans annually, feeding into the overarching Partnership Resilience Plan. 3.42 Staff training and awareness sessions are scheduled for 2025–2026, with lessons learned from past incidents informing ongoing improvements. 3.43 Risk Register Operational risks are captured in the Partnership Risk Register, which is held on Datix. The risk register is reviewed and updated quarterly at Senior Management Team meetings, and risks are escalated when required to the NHS Lothian Corporate Risk Register and Midlothian Council Strategic Risk Profile. The Midlothian HSCP Risk Management Process is illustrated in Appendix 4. 3.44 HSCP mitigation plans contribute to the overarching corporate risk registers held by NHS Lothian and Midlothian Council. One new risk was identified this year and due to the high-risk level, recorded by NHS Lothian, relating to the financial recovery planning. However, this risk remains under local mitigations. 3.45 The following risks on the NHS Lothian Corporate Risk Register are relevant to the Midlothian HSCP: • 4 Hours Emergency Access Target • Hospital Bed Occupancy (previously Timely Discharge of Patients) • HSCP may not achieve financial balance 4 Policy Implications 4.1 This report should provide moderate assurance to Midlothian IJB that relevant clinical and care governance policies are appropriately implemented in Midlothian, and that appropriate mechanisms are in place to assess and manage risk and ensure service resilience. 5 Directions 5.1 Clinical and care governance, risk management and resilience planning are implicit in various Directions that relate to the delivery of care. 6 Equalities Implications Page 190 of 236
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Midlothian Integration Joint Board 6.1 The Governance and Assurance Framework requires services to provide assurance that they are complying with the Equalities duties including the completion of Integrated Impact Assessments (IIA’s) where necessary. This supports the HSCP to comply with its equality duties. 7 Resource Implications 7.1 Resource implications are identified by managers as part of service development. and additional resource may at times be required to ensure required standards of clinical and care governance, risk management and resilience planning are met. The expectation is that these activities are embedded in service areas and teams and that staff have time built in to attend the relevant oversight groups and undertake the associated responsibilities. 8 Risk 8.1 This report is intended to keep the IJB informed of governance arrangements and any related risks and to provide assurance to members around improvement and monitoring activity. 8.2 All risks associated with the delivery of services are monitored by managers and where appropriate they are reflected in the risk register. 9 Involving people 9.1 Midlothian staff are involved in the development and ongoing monitoring of processes related to clinical and care governance and risk identification, assessment and management. 9.2 Public representatives on the IJB will have an opportunity to provide feedback and ideas. 10 Background Papers 10.1 N/A AUTHOR’S NAME Fiona Stratton, Claire Ross, Nick Clater, Dr Rebecca Green, and Roxanne King DESIGNATION Chief Nurse, Chief AHP, Head of Adult Services & Chief Social Work Officer, Clinical Director, and Executive Business Manager CONTACT INFO fiona.stratton@nhs.scot claire.ross4@nhs.scot nick.clater@midlothian.gov.uk rebecca.green@nhs.scot Page 191 of 236
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Midlothian Integration Joint Board roxanne.king@nhs.scot DATE 23rd September 2025 Appendices: Appendix 1: Midlothian HSCP Governance Structure Appendix 2: Midlothian Integrated Governance and Assurance Framework Q1overview July 2025 Appendix 3: Midlothian HSCP Annual Report (2025) to NHS Lothian Healthcare Governance Committee Appendix 4: Midlothian HSCP Risk Management Process Page 192 of 236
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Appendix 1: Midlothian HSCP Governance Structure Page 193 of 236
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Appendix 3A MHSCP Governance and Assurance Report Q1 2025~26 75% completion rate (improved from Q4) High levels of overall assurance (88%) Actions in place around Staffing levels and experience data Page 195 of 236
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NHS Lothian Meeting: Healthcare Governance Committee Meeting date: 23 September 2025 Title: Midlothian HSCP Annual Report to healthcare Governance Committee Responsible Executive: Morag Barrow, Joint Director Report Author: Fiona Stratton, Chief Nurse 1 Purpose This report is presented for: Assurance ☒ Decision ☐ Discussion ☐ Awareness ☐ This report relates to: Annual Delivery Plan ☐ Local policy ☐ Emerging issue ☐ NHS / IJB Strategy or Direction ☒ Government policy or directive ☐ Performance / service delivery ☒ Legal requirement ☐ Other [please describe] ☐ This report relates to the following LSDF Strategic Pillars and/or Parameters: Improving Population Health ☒ Scheduled Care ☐ Children & Young People ☒ Finance (revenue or capital) ☐ Mental Health, Illness & Wellbeing ☒ Workforce (supply or wellbeing) ☒ Primary Care ☒ Digital ☒ Unscheduled Care ☒ Environmental Sustainability ☐ This aligns to the following NHSScotland quality ambition(s): Safe ☒ Effective ☒ Person-Centred ☒ Any member wishing additional information should contact the Responsible Executive (named above) in advance of the meeting. Page 197 of 236
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2 2 Report summary 2.1 Situation The purpose of this report is to provide the committee with an assessment of the safety, effectiveness and person centredness of care provided in Midlothian Health and Social Care Partnership (MHSCP) and to advise of work being undertaken to address risks and improve quality and safety. The committee is recommended to accept moderate assurance that MHSCP has comprehensive systems in place to deliver safe, effective and person - centred care. 2.2 Background The Midlothian Health and Social Care Partnership (MHSCP) oversees delegated community health and social care services in Midlothian, as well as two pan-Lothian hosted services: Dietetics and the Adults with Complex and Exceptional Needs Service (ACENS). Details are in Appendix 1. Services provided by independent contractors (GPs, dentists, optometrists, pharmacies) and commissioned external providers (e.g. private care homes, home care) are excluded from this report. 2.3 Assessment Structures and Processes for Management and Oversight of Safe, Effective and Person-centred Care Midlothian HSCP has a clear governance framework overseeing the safety, effectiveness, and person-centredness of care across its clinical services. Governance is maintained through key meetings that provide oversight and documentation, as shown in Figure 1. While Workforce Planning and Staff Governance meetings are paused due to capacity issues, their functions continue via the Workforce Governance Board and Executive Leadership Team. Page 198 of 236
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3 Figure 1: Midlothian HSCP Governance Structure Page 199 of 236
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4 Management and Governance Processes Governance structures and data review processes are outlined below and summarised in the Service Assurance Mapping Table (Appendix 2). Senior Management & Executive Leadership Teams The Senior Management Team (SMT) and Executive Leadership Team (ELT) meet monthly to oversee clinical and care strategic and operational workstreams. Urgent issues can be escalated informally at any time. Agendas ensure regular reporting on safety, performance, and quality. Meetings are minuted and actions tracked. Clinical and Care Governance Support Groups A range of groups with remits for specific issues relating to clinical and care governance support the SMT and ELT to deliver oversight of clinical and care quality and are described below. • Midlothian Safety and Experience Action Group (MSEAG) Chaired by the Chief Nurse/Clinical Director, MSEAG meets fortnightly to oversee the management of Significant Adverse Events (where moderate and major harm death are reported), complaints, and Duty of Candour decisions. It commissions reviews and tracks improvement actions, and analyses data on common harms and complaints. Operational leads can raise emerging issues. Meetings are minuted. MSEAG also reviews service-level safety activities including complaints, adverse events, safety huddles, inspections, and specific harms (e.g. falls, pressure ulcers, medication errors, infections). • Quality Management Groups (QMGs) QMGs, chaired by Integrated Service Managers, meet quarterly to assess safety, effectiveness, and person-centred care. They complete a standard report (Appendix 3) and review it with Heads of Service before submission. QMGs also oversee inspections of commissioned services, monitor improvement action plans for inspections, update risk registers, and escalate concerns as needed. The GP Cluster Quality Network also submits quarterly reports to the CCGG. • Clinical and Care Governance Group (CCGG) Meeting quarterly, the CCGG provides biannual assurance to the Integration Joint Board (IJB). Chaired by the Chief Nurse, it includes senior clinical and operational staff. Services must submit quarterly QMG reports and present a summary annually. Verbal updates on risks and actions are provided, by exception. CCGG reports inform the Healthcare Governance Committee annual report and IJB integrated assurance report. Meetings are minuted. • Oversight of Common Harms Working groups at Midlothian Community Hospital focus on Medicines Management, Falls, Nutrition, and Infection Control. Infection Control is a standing item at the Senior Charge Nurse meeting and links are maintained, with the specialist Infection Page 200 of 236
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5 Prevention and Control Nurses. Pressure ulcer reviews are conducted separately to recommend improvements (discussed in detail later in this report, on pages 10-11). • Governance and Assurance Framework (GAF) The GAF is a quarterly digital reporting tool assessing services under Safe, Effective, Person Centred, and Regulatory domains to support the measurement of assurance. It also supports risk assessment and action planning. Recently upgraded to a dot.net platform, it offers improved functionality for submission and reporting, as well as enhanced security. Tableau provides oversight of GAF status across the HSCP (Quarter 1 report is shown in Appendix 3a). Service Managers track action plans, and meetings support shared learning. GAF completion rates reveal operational gaps, with actions underway to improve engagement and confidence in reported assurance levels. • NHS Lothian Accreditation and Care Assurance Standards (LACAS) LACAS provides a framework to ensure consistent delivery of person-centred nursing care across NHS Lothian hospitals. It supports quality assurance and improvement aligned with NHS Lothian’s strategy. At Midlothian Community Hospital (MCH), LACAS cycles are integrated into the Quality Management Group (QMG) assurance reporting, with recent findings detailed in this report on page 14. • MCH Morbidity & Mortality (M&M) Group Senior medical staff conduct monthly reviews of all inpatient deaths at MCH. Unexpected deaths with learning potential are escalated via the MCH QMG. Psychiatry of Old Age and Hospital at Home teams now also contribute, promoting cross-specialty learning. Meetings are minuted and overseen by the Clinical Care Governance Group (CCGG). • Care Home Rundown The weekly rundown supports care homes in meeting clinical and the professional standards via the Healthcare Framework for Care Homes. Chaired by the Chief Nurse, it reviews staffing, training, infection control (using data provided by NHS Lothian Health Protection Team), and adverse events. The Care Home Support Team (CHST) has advanced training delivery, including the rollout of the digital tool Restore 2 for early detection of deterioration and management aligned to residents’ Future Care Plans. CHST also leads competency assessments for third-party providers, improving care in areas like catheterisation, syringe driver use, and recognition of the deteriorating patient. Escalation Processes The regular meetings within the governance structure described above enable reporting and analysis of care quality. Midlothian HSCP values integration relationships and fosters both formal and informal escalation methods through both management and professional lines. An MS Teams channel allows urgent Executive Leadership Team meetings and debriefs following resilience events to support shared learning and improvement. Page 201 of 236
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6 2.3.1 Service Quality and Safety Assessment Safe Care In Midlothian HSCP, safe care focuses on: • Deploying appropriately appropriate numbers of appropriately skilled staff where they most needed • Identifying, assessing, recording, and managing key risks (e.g. TRAK, patient- specific assessments, public protection, person-centred care plans, Infection Prevention & Control, falls prevention) • Recognising and responding to (acute) deterioration across settings, including care homes, and listening and addressing family concerns when they are voiced • Supporting adherence to medicines management guidelines and pharmaceutical care policies • Promoting Realistic Medicine and increasing coverage and communication of Future Care Planning (e.g. DNACPR, eKIS) • Learning from adverse events and complaints to minimise or mitigate against avoidable harm • Taking proactive and assertive outreach approaches with individuals at high risk of harm from substance use. Governance groups (described in section 2.3) use the safety indicators outlined in the Assurance Mapping Document (Appendix 2). Current evidence about safety Significant Adverse Events (SAEs) Figure 1 shows data from Datix on reported SAEs over the past 18 months. Monthly figures remain stable, with normal variation around a consistent median. This data is reviewed quarterly at MSEAG, with fortnightly updates on new SAERs. Figure 1: Page 202 of 236
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7 In June 2025, an increase in overall adverse events was noted (Figure 2). Further analysis found no rise in SAEs (moderate and major harm or death), but more falls without harm at Midlothian Community Hospital and increased reporting of pressure ulcers and staffing concerns in District Nursing, were thought to be contributing to the overall increase. (Further details are provided in Appendix 2a). Figure 2: SAER numbers in mental health, substance use, and other services remain static. Updated figures on drug-related deaths were unavailable at the time of writing. The HSCP and MELDAP continue prioritising engagement and harm reduction for people who use substances. Major harm and death events in Mental Health and Substance Use Services are reported separately to highlight trends and distinguish them from other services. As shown in Appendix 2a, Indicators 5–8, Midlothian HSCP maintains strong performance on SAE review completion KPIs. Most breaches are beyond the control of HSCP processes. Complaints handling performance (Indicator 10) also remains steady. The HSCP prioritises investigation quality over meeting completion deadlines alone, encouraging Service Managers to include information on risk assessments and safety mitigations in Local Case Reviews to support confident decisions on whether further review is needed. Review Outcomes – Mental Health and Substance Use Services Appendix 2a summarises the Quality Improvement Support Team (QIST) data on adverse event review outcomes (Indicators 5 & 6). One Level 1 review in the past year found care/service delivery issues contributed to the event. Two local reviews also identified care/service delivery issues but these were unlikely to have affected the outcome. Page 203 of 236
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8 All harm-related events offer learning opportunities. Midlothian HSCP has implemented specific action plans based on review findings. Communication—both within teams and with families—is a recurring theme. This remains a focus, alongside maintaining patient confidentiality. QIST prepares data for a Lothian-wide biannual meeting reviewing deaths of patients under NHS Lothian Mental Health (MH) and Substance Use (SU) Services at the time of or immediately preceding their death. The meeting includes managers and professional leads from the four HSCPs and REAS (Table 1). Table 1: All Mental Health and Substance Use Deaths reported 01/04/2024 – 31/03/2025 - review type by HSCP Local case Review (Mental Health) Expanded Local Case Review (Mental Health) Level 1 Review Total Edinburgh HSCP 61 0 0 61 East Lothian HSCP 23 0 0 23 Midlothian HSCP 20 2 0 22 REAS 33 6 1 40 West Lothian HSCP 44 2 0 46 Total 177 10 1 192 In 2024, Midlothian HSCP commissioned more Level 1 Significant Adverse Event (SAE) reviews for MH & SU than other partnerships, but with all Local Case Reviews (LCRs) not requiring further investigation concluding appropriate care (Outcome 1). This year, no Level 1 reviews have been commissioned. Our focus remains on improving the quality of initial LCRs to identify care and service delivery issues early and inform appropriate commissioning of additional review only when it is necessary. In two cases with Outcome 2, where learning points were identified, actions were identified, implemented, and completed. Comparison with other partnerships and REAS (Table 2) confirms that Midlothian applies a suitably sensitive threshold for commissioning Expanded LCRs. Table 2: Review outcome by HSCP Table 2: Review Outcome LCRs/Expanded LCRs closed 01/04/2024 – 31/03/2025 1 2 3 Total Edinburgh HSCP 87 5 0 92 East Lothian HSCP 15 9 0 24 Midlothian HSCP 15 4 0 19 REAS 29 7 0 36 West Lothian HSCP 39 8 1 48 Total 185 33 1 219 Page 204 of 236
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9 Evidence about safety - External inspections – Midlothian Community Hospital Midlothian Community Hospital has not been subject to any external inspections since the 2024 annual report to the Healthcare Governance Committee. The last unannounced visit by Healthcare Improvement Scotland was in September 2020, with all follow-up actions were completed. Evidence about Safety - Joint Inspections – Midlothian HSCP MHSCP services are subject to external inspections by statutory bodies including Healthcare Improvement Scotland, the Mental Welfare Commission, and the Care Inspectorate. Reports are reviewed at SMT, with action plans monitored through QMGs, CCGG, East & Midlothian Public Protection Committee, and the Social Work Assurance Group (SWAG). Where concerns arise, immediate action is taken to address standards of care. Service Managers lead implementation, supported by operational and governance structures, to ensure sustainable improvements. A Social Work Governance Review was carried out under Section 53 of the Public Services Reform (Scotland) Act 2010 by the Care Inspectorate and was completed in May 2025, followed by feedback sessions. The review concluded that statutory duties are met safely and effectively, and that social work staff are generally well supported. Discussions with Social Work Scotland on follow-up actions are ongoing. Points about the Social Work role within Health and Social Care Partnerships were also raised. Service Improvement Work to Address Safety Issues In addition to specific learning from individual adverse events and known risks, improvement work is undertaken to address the most common reported harms. Common Reported Harms Since 2021, pressure ulcers have consistently been the most common cause of moderate or major patient harm and death (Table 3). In Mental Health and Substance Use Services, unexpected deaths and self-harm remain the leading cause. In-patient falls and medication errors are discussed later, while Violence and Aggression events are managed through NHS Lothian’s Health and Safety systems. Appendix 2a, Indicator 9, provides a more detailed analysis of MHSCP’s common reported serious harms. Page 205 of 236
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10 Table 3: Top 5 Common Harms, 2021-2025: Top 5 common harms 2021-2024 2023-24 2024-25 1 Pressure ulcer Pressure ulcer Pressure Ulcer 2 Patient fall Unexpected death (MH/SU services) Unexpected death 3 Unexpected death Patient falls (MCH) Patient fall (MCH) 4 Violence/ aggression/ abuse/ harassment Violence/ aggression/ abuse/ harassment Medication error 5 Medication error Self-harm Violence/aggression/ harassment Pressure Ulcers Pressure ulcers are the most commonly reported healthcare-associated harm in Midlothian HSCP, as reported for the rest of Scotland by Healthcare Improvement Scotland. Locally, they occur more frequently in people’s own homes than in hospitals or care homes. Reporting on avoidable harm remains a challenge for NHS Lothian but Appendix 2a (Indicator 13) provides current data on incidence and severity. NHS Lothian’s updated Pressure Ulcer Policy (currently under consultation) mandates systematic patient assessment and the implementation of effective preventative strategies to reduce the risk of skin breakdown and facilitate healing of tissue damaged by pressure, shear, friction and moisture. Incidents are recorded via Datix, with revised pathways aimed at improving data quality. The Tissue Viability Service (TVS) offers specialist support and education. Progress has been made in enabling digital image sharing for wound monitoring in community hospitals, pending information governance approval of a nationally developed app, although some progress has been made but IT software changes that support the use of NHS mobile devices. Traditional support remains available for MCH in-patients. The Tissue Viability Lead Nurse reviews all major harm cases, which are mostly reported by District Nursing Teams (Appendix 2a, Indicator 13). Independent assessment of major pressure ulcers, provision of support, and identification of learning remains a priority. The team supports grading and validation through E-clinic and Datix, with additional training enabling quality improvement projects. As reported to the Committee elsewhere, NHS Lothian received notification of two Scottish Public Service Ombudsman (SPSO) complaints which were upheld in the past year, highlighting deficiencies in the delivery of pressure ulcer care by the District Nursing Service. One specifically involved a Midlothian patient in 2022 and is discussed later in this report. The SPSO highlighted the need for improvement in the prevention, identification, grading and management of pressure ulcers across NHS Lothian. In response, the Pressure Ulcer and Management Policy has been updated and training has been refreshed. Work is progressing to ensure all staff within the District Nursing Service have undertaken training in Waterlow Risk Assessment and in the identification, grading and management of pressure ulcers. A Short Life Working Group has been Page 206 of 236
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11 formed to address the SPSO recommendations, with oversight by the Nursing and Midwifery Care Assurance Board. A Pan-Lothian Pressure Ulcer Collaborative and a Midlothian Oversight Group (Appendix 4) has also been established. Despite regular fortnightly review meetings to quality-assure pressure ulcer adverse event reviews and share learning, data evidence to support assurance of the implementation of the NHS Lothian policy remains limited. The Collaborative (Appendix 4) aims to improve reporting, grading, and communication across settings, supporting a data-informed approach to to the prevention, identification and management of healthcare acquired pressure ulcers. There is intention that these refreshed structures, the profile and the visibility of this work will support whole system improvement and learning and deliver and improved quality of care and outcomes, and assurance about the systems and processes in place to deliver safe and effective care. Unexpected Deaths in Mental Health and Substance Use Services The National annual drug-related death figures were unavailable at the time of reporting. But Appendix 2a, Indicators 2 & 3, detail unexpected deaths in Mental Health and Substance Use Services. Locally led T chart and run chart analyses indicate a stable position. In-patient Falls Midlothian Community Hospital (MCH) has one rehabilitation ward, one NHS Lothian step-down ward, one palliative/continuing care ward, and two older adult mental health wards. Most patients are assessed as high fall risk on admission. Relevant data are in Appendix 2a Indicator 15. Data-driven improvements across all wards, led by the Lead Nurse for Quality and aligned with Lothian Accreditation and Care Assurance Standards (LACAS), have resulted in sustained reductions in fall rates, including falls with harm. The MCH Falls Prevention and Safer Mobility Group, chaired by a Senior Charge Nurse, meets bi-monthly with representation from all wards. Data is provided by the Lead Nurse QI & Standards and shared with the Pan-Lothian Adult Inpatient Falls Delivery Group. The project follows the Scottish Patient Safety Programme (SPSP), using measures to: • Identify system/process variation • Assess impact of changes • Communicate improvement progress. Staff promote patient activity—even for those at high fall risk—to support recovery of strength, balance, confidence, and mobility. Fall risk is balanced against inactivity risk to support rehabilitation objectives. Page 207 of 236
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12 The Driver Diagram outlines ongoing drivers and change ideas: The 12-month median falls rate at MCH is 10.08% (Appendix 2a Indicator 15). A downward shift was observed with 9 data points below the median, though falls spiked in March–May 2025. Following analysis and action planning, rates declined again in June and July, with July at 9.43%. The national benchmark for all falls is 4.7%. This benchmark includes intentional falls, affecting data—particularly in mental health wards where patient behaviour contributes to high fall rates. National criteria for defining falls remain under review. Falls with harm (FWH) are tracked monthly. While fewer patients are sustaining harm, this remains a key focus. Senior Charge Nurses meet monthly to review significant adverse events and share learning through the MSEAG-led review process. MCH continues to prioritise falls prevention to improve patient outcomes. Significant Adverse Events - Infections No infection-related major harm events have been recorded in Midlothian Community Hospital in the year covered in this report. MCH receives support from the Infection Prevention and Control Team, and infection control remains a standing item for discussion at the MCH Senior Charge Nurse meeting and a dimension of the LACAS framework for which a standard attainment averaging 89% was achieved across the hospital in the July 2025 cycle providing moderate assurance on the Infection Prevention and Control standard. Medication Administration Errors Medication errors again feature among the 5 most common harms reported in Midlothian. An analysis is provided in Appendix 2A Indicator 9. Page 208 of 236
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13 In MCH in-patient areas, the Pharmacy team collaborates with the multi-disciplinary team to review medication errors, identify root causes, and implement learning actions. Senior Charge Nurses conduct peer reviews to support risk analysis and implement mitigations. The absence of Hospital Electronic Prescribing and Medicines Administration (HEPMA) at MCH contributes to these errors and remains on Midlothian’s risk register. District Nursing reports the highest number of medication errors within NHS services in the HSCP. Each incident is investigated. As noted in Appendix 2A, Indicator 14, insulin dosing errors are most common, largely due to service demand and capacity issues. Time pressures are cited as a contributing cause in the majority of investigations. A rise in the number of older patients with Type 2 Diabetes on low-dose insulin has increased workload and risk, as well as increasing patients’ risk of falls and delirium due to hypoglycaemia. Improvement opportunities have been proposed and the need for support to implement these has been escalated to the Executive Medical Director. This issue is Pan Lothian. District Nursing Clinical Nurse Managers, led by Edinburgh HSCP’s Lead Nurse for Adults, are gathering data and reviewing clinical strategies and policies (including Realistic Medicine) to develop options that balance individual, organisational, and professional risks. Recognition of the Deteriorating Patient Early recognition and escalation of the deteriorating patient continues to be a key element of the work to address patient safety at Midlothian Community Hospital. In the July 2025 LACAS cycle, MCH achieved 90% compliance, indicating moderate assurance (Figure 3). The introduction of NEWS recording on TRAK has supported this through: 1. Complete observations – NEWS2 requires full data entry to generate a score. 2. Improved accuracy – Automated scoring reduces human error. 3. Timely monitoring – Alerts prompt timely or over-due observations. 4. Clear escalation documentation – The escalation tab auto-populates progress notes. 5. Enhanced oversight – Ward, clinician, and site-level tracking via floor plans and overview boards. 6. Better information sharing – NEWS graphs and boards are accessible remotely, aiding off-site teams (e.g., Hospital @ Night, Hospital @ Home). Note: Appropriate mitigations are in place to support Lothian Unscheduled Care GPs without TRAK access. Page 209 of 236
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14 Figure 3 :LACAS Standard 5: Deteriorating patient July 2025 Healthcare Governance level of assurance GOLD All HCSWs at MCH have been offered Vital Signs and NEWS 2 training and 71% of all HCSW have these competences at present. This figure is lower than reported last year due to changes in personnel. A further 6 HCSWs will shortly complete the training taking the compliance to 79%. Management of safety and risk – Midlothian Community Hospital- Lothian Accreditation and Care Assurance Standards (LACAS) The most recent cycle of LACAS was completed in July. All 5 in-patient areas at Midlothian Community Hospital submitted a completed LACAS self-assessment for this cycle. Awards are detailed in Table 4. Table 4: Midlothian Community Hospital LACAS The findings demonstrate quality care from bedside to Board. The summary report (18 August 2025) confirms a continued position of ‘Moderate Assurance’ for the LACAS Programme at Midlothian Community Hospital, indicating systems are in place to support delivery. It also maintains ‘Moderate Assurance’ for consistent, high-quality, person-centred care across all Adult Inpatient Areas, as reported in July 2024. This review cycle continues to highlight good practice and areas for improvement, guiding ward and site-level quality priorities. Ward Observations again showed high standards of care. There is scope to share learning from teams meeting moderate assurance in specific standards. Each ward will develop an improvement plan based on LACAS results, supported by the Lead Nurse. Management of Safety and Risk – Clinical and Care Governance Processes Service Managers highlight recruitment, retention, and staff sickness as major risks to safe, effective care in quarterly QMG submissions. Ongoing risk assessment and escalation of staffing concerns remain essential under Health and Care Staffing legislation. Page 210 of 236
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15 Population growth and ageing in Midlothian continue to outpace available resources, creating service demand pressures. In response, the HSCP is advancing Digital Strategy and Transformation Programmes. GPs cite rising activity, reduced revenue, and a freeze on capital spending as threats to sustainable General Medical Services. More widely, Service Managers report that financial uncertainty and potential service redesign are also affecting staff morale. The CCGG supports appropriate use of risk registers and escalation thresholds for issues beyond Service Managers’ control. Recent quarterly submissions highlight safety initiatives across services: • Pharmacy: Medicines Reconciliation Hub fully implemented with visible performance metrics; implementation of high-risk medicines support continues. • Vaccination Service: SOP developed for Adults with Incapacity, ensuring safe consent and service delivery for care home residents and housebound patients. • Dietetics: Collaboration with Diabetic Specialist Nurses on Insulin Pump Titration Protocol (pending approval); inpatient e-referrals implemented. Delivery of a Safe & Effective District Nursing Service – SPSO findings & improvement work District Nursing in Midlothian has consistently reported ongoing demand and staffing pressures, most significantly since April 2025. Similar issues in 2023 led to a Joint Director and Executive Nurse Director commissioning a review, initially for Midlothian and later expanded across Lothian. Midlothian HSCP continues to engage in this Pan- Lothian review. Increased demand and complexity led to a revised staffing model with a skill mix to provide care within the financial resource available. This was agreed in November 2024 by the Nursing and Midwifery Workforce Thematic Group and is now largely implemented and under evaluation. Productivity initiatives aim to free up time for care, guided by the principle of right person, right care, right time. A new referral system has improved consistency and decision tracking. Midlothian piloted a paper-lite approach, but this was paused by NHS Lothian due to safety concerns around ward-to-community information transfer, pending a wider pan-Lothian review and results from a further pilot in West Lothian. Education for staff has improved, although service pressures often disrupt study leave. Underpinning all this, work continues to reach a final recommendation on skill mix and future-proofed workforce planning. On 27 July 2025, NHS Lothian received a Scottish Public Service Ombudsman (SPSO) report upholding a complaint related to shortcomings in the care provided to a Midlothian resident in 2022 by the District Nursing service and the Royal Infirmary of Edinburgh. The report found the District Nursing care and treatment documents to be unreasonable, citing failures to: 1. Complete timely assessments 2. Reassess patients within a reasonable timescale 3. Conduct Waterlow (pressure ulcer risk) assessments correctly Page 211 of 236
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16 4. Create person-centred care plans 5. Plan two-person visits for basic care, particularly skin checks 6. Avoid reliance on patient self-reporting when inappropriate. Midlothian HSCP began addressing these findings immediately upon receiving the draft report in May 2025. The HSCP acknowledges the service fell short of the standards expected and is committed to making sustainable improvements and providing robust quality assurance. Data for monitoring and assurance remains underdeveloped and is part of the ongoing Pan-Lothian community nursing review. An apology has been issued to the complainant (the patient’s daughter), and actions to address the SPSO recommendations are included in Midlothian’s local District Nursing improvement plan (Appendix 5). Following the draft report and SPSO recommendations, an independent audit of documentation for a sample of Midlothian District Nursing wound care patients was conducted in June 2025. The independent auditor acknowledged progress but highlighted the need for further sustainable improvements. These efforts are ongoing amid staffing pressures and rising demand, with staff wellbeing measures in place. The Pressure Ulcer Collaborative is also supportiing SPSO-related improvements across NHS Lothian. A new weekly oversight group in Midlothian, attended by the Joint Director, Head of Service, Chief Nurse, Service Manager and Clinical Nurse Manager, monitors ‘safe’ staffing levels, predicted and actual workload, absence, and prioritisation decisions. Collaboration with the Sustainability and Value team is underway to analyse staffing rotas and develop a staffing dashboard. Both the SPSO report and independent audit identified shortcomings in documentation. Findings have been shared with teams, with improvements framed around patient safety, care quality, and the Nursing and Midwifery Council (NMC) Code. Regular casenote audits have resumed, and training has been provided, including examples of good documentation. Improvement efforts include better risk identification in relation to pressure ulcers, training, wellbeing support, and recruitment, including six newly qualified nurses (NQRNs). Induction planning is underway with support from Clinical Education, and staff engagement events are scheduled. Progress will be tracked via the Service Improvement Plan and governance frameworks. The Executive Nurse Director noted similar themes in two other SPSO reports on nursing care. A Short Life Working Group has been formed to oversee SPSO-related improvements, reporting to the Nursing and Midwifery Care Assurance Board. At the Lothian level, the Community Nursing Review continues to provide scrutiny, support and assurance of improvements in electronic records and documentation. A new care assurance system is being developed to mirror LACAS. A risk with District Nursing using Adult Person-Centred Care Plans (PCCPs) on TRAK led to their suspension, prompting development of new care plans better tailored to District Nursing. These are being mapped to TRAK with eHealth support and will be tested on paper before full rollout. Until then, care assurance remains informal and audit- dependent. Page 212 of 236
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17 A weekly Pan-Lothian District Nursing huddle has been established to address system-wide pressures, support risk management, and coordinate actions across the four HSCPs. Priority areas include insulin administration for older adults with Type 2 diabetes, IT infrastructure, care assurance systems, education delivery, and recruitment and retention. Effective Care Midlothian HSCP’s Clinical and Care Governance Framework, in place since July 2023, supports evidence-based care delivery. The Partnership continues to improve the quality of evidence provided by shifting from descriptive narratives to data on activity and impact. Key challenges reported include demand exceeding capacity, leading to waiting lists and service pressures. Action plans are in place for Weight Management (Dietetics), Adult ADHD Diagnosis, and Musculoskeletal Physiotherapy. QMG templates enable services to document and demonstrate improvements in care effectiveness. Developments in Mental Health and Substance Use Services - Joint Group interventions Group interventions are a vital part of mental health treatment, offering individuals a supportive environment for person-centred recovery. Evidence shows they enhance self-awareness, confidence, and overall well-being. A key benefit is reducing isolation by fostering a sense of community and belonging. Shared experiences help participants develop coping strategies and interpersonal skills, empowering them to manage their mental health and build relationships. Midlothian Mental Health and Substance Use Services offer a range of group interventions tailored to individual needs, including: • Creative Group – Encourages self-expression, belonging, and understanding of mental well-being. • Decider Group – Focuses on developing 12 core life skills. • Cooking Group – Builds skills in healthy eating and meal preparation, promoting independence. • Gym Group – Supports holistic care and positive mental health through physical activity. Participant feedback is essential for evaluating outcomes, improving services, and ensuring groups meet the needs of target individuals. Falls – a public health Issue Falls are a leading cause of injury, hospitalisation, and death among older adults. Midlothian HSCP, led by the Chief AHP, is prioritising prevention and early intervention to reduce falls. Page 213 of 236
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18 Community Appointment Days are being tested to support falls prevention, frailty, and bone health. These events shift from consultation to conversation, offering a non- medicalised space where individuals can access professionals, third sector partners, and resources to support self-management. Aligned with National Falls Prevention Week, this initiative enhances the existing multi-disciplinary pathway and integrates the Frailty Scale at every intervention. The target group is older adults, with a person- centred approach tailored to individual needs. A full evaluation report is expected in early 2026. The NHS Lothian Falls Prevention and Management Framework (2025– 2028) outlines commitments to reduce falls risk across the health and care system. It is built on pillars of prevention, collaboration, person-centred care, education, and data. A system-wide implementation group supports delivery and local ownership, including a measurement framework to track impact and outcomes. MHSCP has broadened its multi-disciplinary approach, increasing professional input, and supporting inclusive self-management. Development of the falls responder role through the Home First service includes training in the abbreviated multi-factorial falls assessment to identify risks and prevent recurrence. Functional Fitness MOTs, delivered via Midlothian Active Choices, promote proactive fall prevention and awareness. The NHS Lothian Falls Dashboard provides HSCP-level oversight of A&E and falls- related activity (Figure 4) and Falls-related activity trends (Figure 5). Further work is underway to analyse costs and inpatient trends. Figure 4: Falls related activity trends, MHSCP 2024-25 Page 214 of 236
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19 Figure 5: Recurrent falls seen in A&E, MHSCP 2024-25 Frailty During 2024/5 the Professional Leads have continued to drive a system-wide focus on Frailty, grounded in Realistic Medicine. Using a Quality Management approach, we’ve worked with stakeholders to identify barriers to safe care and change. Ecosystem mapping and engagement helped co-create a shared vision. Midlothian promotes a whole-life approach to ageing well, with prevention and early intervention enabling recognition of Frailty risk and access to coordinated support. Key focus areas include: 1. Functional Frailty Scale • Identifies individuals at risk of or living with Frailty • Aligns services to frailty stage, not age • Enables tailored access to resources, with weighting towards prevention, supported self-management and early intervention • Supports communication and planning across care settings (as this is the same assessment scale as used in the Acute site Frailty Units and in-patient areas) 2. Deep Generalism • Agile, inclusive services with no wrong door • Optimal use of professionals and resources • Linked to Community Nursing and Social Work reviews • Exploring collaborative, best-value models 3. Public Engagement • Outreach via clinics, community engagement events, and social spaces • Promotes Future Care Planning and Power of Attorney Page 215 of 236
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20 • Proposed annual birthday communications to raise awareness and support self-management (not yet implemented) 4. Digital Support • Tech support for older/frail individuals • Tools for self-management and monitoring • Proposed development of a universal Frailty Passport to link scores with personalised resources (not yet implemented) Other examples of Effective Care The most recent quarterly CCGG templates provide some examples of the work being undertaken across services in Midlothian HSCP to deliver improving and effective services: • Disabilities: Continued development of transition pathway and Positive Behavioural Support Service. • Homefirst: Service model review includes scheduling, risk threshold review, MDT opportunities, and links to bed-based care review. • Vaccinations: Adjusted scheduling for care home and housebound patients; process mapping of unscheduled vaccinations to support digital planning and Trak use. • Health Visiting: Using Child Health Assessment data to improve the proportion of assessments deemed ‘meaningful’ in scope and depth. • Physiotherapy: Chronic pain pathway introduced with wellbeing team; falls bundle implemented for Advanced Physiotherapy Practitioners. • Dietetics: Updated care home referral pathway to improve quality and support first-line actions; enhanced enteral feeding approaches in REAS. Person Centred Care Complaints All Midlothian HSCP services follow a formal complaints procedure, available on request, with standardised processes ensuring responses within set timescales. Oversight systems aim to meet Scottish Public Services Ombudsman (SPSO) targets, with performance data in Appendix 2a (Indicators 10–12). Independent contractors (e.g. GP practices) manage their own complaints, and those submitted via Midlothian Council are not included in NHS Lothian data. The Director and Chief Nurse receive weekly updates on complaint handling. Delays are addressed promptly, and SMT reviews performance at each meeting. MSEAG provides quarterly overviews to SMT and ELT. Following a rise in complaints in 2023–24, the median has stabilised at five complaints per month. Themes remain consistent: treatment, staff behaviour, and communication. Ongoing concerns include ADHD diagnosis/treatment in Mental Health Services and access to weight management medications in Dietetics—both Page 216 of 236
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21 of which are acknowledged to be influenced by media coverage. A new issue has emerged around written communication of discharge from Consultant Psychiatrist care, with actions now in place to improve this. The escalation of one complaint to the Scottish Public Service Ombudsman (SPSO) about the refusal of a second opinion for mental health diagnosis and/or treatment has led to the development of a Lothian-wide policy. An analysis of complaints handling performance data is provided in Appendix 2a Indicators 10, 11 and 12. An upheld SPSO report in relation to Midlothian District Nursing is discussed earlier in this report. Staff behaviour complaints are addressed individually. Work is underway to refresh ‘The Midway’, supporting staff through supervision, development planning, and wellbeing initiatives to improve both staff and patient experience. Person centred approaches in Midlothian – examples: Service Managers continue to report initiatives aimed at improving patient experience and promoting person-centred care via their quarterly QMG templates. Mental Health & Substance Use Services Midlothian funds the Mental Health Lived Experience Panel, in partnership with the Community Advocacy Project (CAP), to ensure service planning reflects the voices of those with lived experience and their families. Peer workers from Health in Mind support individuals during appointments and throughout their recovery journey. They are co-located with health and social care teams. Musculoskeletal Physiotherapy Services PREM data is collected via JISC surveys to inform service delivery. Key findings from 2024–25 include: • 99% felt involved in care decisions • 99% felt listened to • 89% felt care was well-coordinated • 89% received lifestyle advice (e.g. exercise, smoking cessation, diet, alcohol, mental wellbeing) Areas for improvement include access and booking processes, with 12% reporting difficulty arranging appointments. GP Quality Cluster Since April 1, 2025, 1,118 eKIS Future Care Plans have been created or updated for moderately to severely frail patients under the GP Frailty LES. 2.3.2 Workforce Oversight of Staffing Having the right number and mix of clinical and care staff, along with staff wellbeing, is essential for safe, effective, person-centred care. Page 217 of 236
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22 Midlothian Community Hospital (MCH) holds daily safety huddles led by the Coordinating Charge Nurse to assess staffing across the multi-disciplinary team. This informs the Safecare tool, linked to Healthroster, with compliance consistently above 90%. Safecare supports the common staffing method and is monitored by the nursing team and reported to the Chief Nurse. Other service areas lack real-time staffing tools, but community teams use methods like Prepstat to monitor staffing and demand. The District Nursing Service uses RAG ratings and workload measures each shift. Health and Care (Staffing) (Scotland) Act 2019 Midlothian HSCP continues to develop workforce plans to ensure safe staffing across all directly provided services. Reduced Working Week Implementation for Agenda for Change staff is ongoing, following NHS Lothian guidance. TURAS Appraisals MHSCP is committed to improving appraisal quality to boost engagement, satisfaction, and retention. Completion rates rose to 71.7% in July 2025, with a target of 80%. Monthly reports are reviewed by the Executive Leadership Team. Sickness Absence Absence levels are closely monitored. A spike in early 2025 stabilised within four weeks, though rates remain higher than last year. Specialist training was delivered Jan–July 2025, and a multi-level absence panel approach will launch by Nov 2025. Staff Wellbeing In 2025, MHSCP merged wellbeing and engagement strategies into a 3-year plan focused on four drivers: meaningful work, healthy environments, leadership opportunities, and staff voice. These are supported by the five pillars of ‘The Midway’: wellbeing, equity, learning, leadership, and communication. Tailored wellbeing support is offered to individuals, teams, and services. Initiatives include Soup Stops, wellbeing spaces, and peer support. Over the past year, 25 staff received personalised coaching (avg. 3 sessions each), mainly for psychological distress (58%) and relational issues (15%). Six mental wellbeing workshops were held, with 68 attendees and 95% content usability. Next steps include evaluating long-term impact and offering team support and top-up sessions. Listening to Feedback Staff involvement is supported through team meetings, service visits, iMatter, and ‘stay’ questionnaires, offering both formal and informal ways to shape services and influence direction. NHS Lothian and Midlothian Council staff representatives continue to contribute to the Senior Management Team. In 2025, Partnership Forums were Page 218 of 236
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23 unified across organisations to align focus on staff experience. The updated Staff Experience, Engagement, and Wellbeing strategy was approved in March and backed by the new Midlothian Joint Partnership Forum in July. Reflection, both formal and informal, is a recognised method of listening. While integral to some roles, its benefits may not be fully accessible to all. MHSCP is working with the Spiritual Care Team and project leads to expand Reflective Practice and Values- Based Reflective Practice across relevant areas. Communication and Engagement Staff remain our greatest asset. Their dedication enables us to deliver services to thousands across Midlothian, despite rising demand, complex needs, and financial pressures. Supporting staff requires honest, validating, and inclusive communication from leadership. Communication preferences vary, so our approach is flexible—offering verbal, written, in-person, and remote options to share views. MHSCP continues to explore new engagement methods, including community chat boards, feedback books, and formal tools like iMatter. The July 2024 iMatter survey showed a score of 78, with improved response rates. Last year, the Senior Leadership Team committed to fostering psychological safety, encouraging open dialogue and partnership. In 2024, following guidance from the National Office for Whistleblowing, MHSCP trialled the validated Edmonson Psychological Safety Questionnaire during Speak Up Week, receiving 150 responses. This initiative sparked meaningful conversations and led to the development of local guidance to embed psychological safety in daily practice. 2.3.3 Financial There are no financial impacts arising from this report, however the committee should note the challenging financial position related to budget allocation, demand and demography in Midlothian, and the subsequent anticipated impact on performance and delivery. 2.3.4 Risk Assessment/Management Midlothian Health and Social Care Partnership (HSCP) has a robust risk management process, with regular oversight by the Senior Management Team and Executive Leadership Team. This ensures risks are identified appropriately and senior managers maintain a clear view of significant risks. Risk mitigation is aligned with NHS Lothian’s corporate risk register for a coordinated approach. No local risks have been escalated to NHS Lothian’s Corporate Risk Register this year. Operational risks are recorded in the Midlothian Partnership Risk Register, which is routinely updated. High-level risks are escalated when necessary. Page 219 of 236
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24 One new high-level risk was identified this year, but due to effective local mitigation, it was not escalated: Risk 3612: HSCP may not achieve financial balance Midlothian HSCP risks missing financial targets due to underperforming recovery plans and unexpected pressures, especially in Prescribing. This could negatively impact services and patient care. Mitigations are in place, and controls are currently rated satisfactory. The financial position of the Midlothian IJB remains critical, with a projected £3 million overspend for 2025/26. Key overspends are in Hosted (£0.5m) and Set Aside services (£1.1m). The absence of general reserves limits flexibility to manage in-year pressures, reinforcing the need for robust recovery plans and service transformation to maintain sustainability and high quality of care. Recovery planning is ongoing, but rising demand requires further actions. All plans are assessed for impact on staff, patients, and service delivery, with mitigation strategies developed to minimise disruption. HSCP mitigation plans also continue to contribute to the following ongoing risks on the NHS Lothian Corporate Risk Register: Risk 5186 – Emergency Access Midlothian HSCP has implemented strategic and operational measures to reduce access delays. The Flow App provides real-time oversight of all Midlothian residents in Emergency Departments or hospital beds. Actions are coordinated to ensure care is delivered in the most appropriate setting, as close to home as possible, with local efforts supporting emergency access across the system. Risk 5187 – Hospital Bed Occupancy (Previously Timely Discharge of Inpatients) Midlothian continues to invest in infrastructure supporting ‘Home First’ pathways, promoting care close to home and reducing inappropriate hospital bed use. The area remains committed to NHS Lothian’s Unscheduled Care programme, delivered through integrated, multiagency collaboration including third sector and carer support. The Flow App has strengthened the MHSCP Flow Team’s ability to track acute admissions and support timely progression through care pathways. This includes identifying patients suitable for treatment at home (D2A, H@H), or in local facilities like Midlothian Community Hospital or Highbank Intermediate Care. The Discharge Without Delay (DWD) workstream is active in Midlothian Community Hospital, with daily MDT rundowns and discharge planning boards facilitating timely discharge. A continuous improvement approach supports ongoing service development, with effective communication and expectation-setting for patients and families contributing to reduced length of stay. Page 220 of 236
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25 Midlothian’s progress aligns with national targets set by the Collaborative Response and Assurance Group (CRAG). Risk 3829 – Sustainability of General Practice Model A detailed review of the sustainability of General Practice in Midlothian has been completed under the Integrated Joint Board’s oversight. The Primary Care Improvement Plan (PCIP) is also overseen by NHS Lothian’s Director of Primary Care and the GP Subcommittee of the LMC. The latest PCIP revision was reviewed earlier this year, with funding aligned to Scottish Government priorities in MOU2. Vaccinations have been fully transferred to the HSCP. All 11 practices now access the Midlothian Pharmacy Hub, with over 95% of hospital discharge letters processed within 48 hours, improving patient safety. All practices also benefit from CTAC and phlebotomy services, subject to staffing availability. Following a medication-related incident, a CTAC service review is underway and progress against the improvement plan is being monitored by HSCP leads via MSEAG and CCGG. Although MSK-APPs are not a government priority, HSCP continues commit funding due to their evidenced value to both patients and GP teams—93% of cases are resolved without further GP input. PCIP funding (60% supplemented by Action-15) supports a Mental Health Nurse in each practice, enabling direct patient access for assessment and triage, alongside Wellbeing Workers commissioned via Thistle Foundation. Midlothian’s population growth and aging profile exceed national averages, posing long- term demand-capacity challenges. An operational plan and sustainability risk matrix (factoring list size, aging, deprivation, workforce, and premises) guide support and additional resource allocation, including GMS-funded LEGUP grants. A premises impact assessment focussing on Shawfair and South Bonnyrigg/Rosewell, is addressing the current pause in capital funding. A standardised business continuity plan has been developed to ensure consistent support to practices and safe patient access during premises or other disruptions. Primary Care sustainability remains a key risk on the Midlothian HSCP register due to rising demand from population growth, age, and frailty. Two moderate, unresolved risks remain at Midlothian Community Hospital (MCH): • 5652 – No HEPMA • 5430 – OOH medical cover MCH is the only NHS Lothian community hospital without the Hospital Electronic Prescribing Management Administration (HEPMA) system, due to lack of central funding. This creates a risk of medication errors during transcription from HEPMA to paper kardexes when patients transfer from acute sites, or if no kardex is provided. Staff are briefed and encouraged to double-check, but this control is not fully reliable, as evidenced by reported errors. Daytime/evening out-of-hours (OOH) cover is provided by LUCS GPs, and overnight by the Hospital At Night (HAN) service. LUCS GPs may not be on site, lack access to TRAK records, and may not be able to deliver certain treatments, risking delays for Page 221 of 236
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26 deteriorating patients. To mitigate this, admission criteria based on LUCS competencies are now used by the Midlothian Flow Hub to manage and limit patient acuity for MCH transfers. All other key risks have been reviewed in the past year and have appropriate mitigations and governance in place. 2.3.5 Equality and Diversity, including health inequalities There are no new actions arising from this report which would require the completion of an impact assessment. 2.3.6 Other impacts Not applicable 2.3.7 Communication, involvement, engagement, and consultation There are no changes proposed within this paper which would have a negative impact upon people who use our services. The committee should take assurance that the HSCP maintains an active dialogue with key stakeholders and consult on service changes as required. 2.3.8 Route to the Meeting This has been previously considered by the following groups as part of its development. The groups have either supported the content, or their feedback has informed the development of the content presented in this report. • Midlothian HSCP Core Management Team 27th August 2025 • The Executive Leadership Team reviewed this paper ahead of submission but meeting cycles did not support full discussion ahead of the deadline. 2.4 Recommendation Assurance – The Committee is asked to accept moderate assurance that MHSCP has systems in place to deliver safe, effective, person-centred care. Based on the evidence, key controls are generally well-designed and applied. Some residual risk remains, with clear actions and plans in place to address areas requiring further attention. In some cases, residual risk exceeds “insignificant.” Page 222 of 236
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TEAM/SERVICE LEVEL Possible risk identified, assessed and discussed at Team level and reviewed by Service Manager, can risk be mitigated and managed at Service Level? Yes No Place on Service Risk Register Managed locally by team/Service Present risk assessment and proposed mitigation action plan to Head of Service including all local efforts to mitigate risk taken to date and impacts. HEAD OF SERVICE Can the risk be managed within the Head of Service area? Yes No Risk is placed on Head of Service Risk Register (Held on Datix) - Managed by Service Managers - Oversight Head of Service Present risk assessment and proposed mitigation action plan to Senior Management Team (SMT) including all local efforts to mitigate risk taken to date and impacts SENIOR MANAGEMENT TEAM Can the risk be managed within the HSCP Management risk register? Yes Risk is placed on Midlothian HSCP Management risk register (Held on Datix) - Reviewed quarterly - Oversight by SMT PARTNER ESCALATION Pathway to this level requires either SMT agreement and/or Director agreement -Risk owner presents risk for review and discussion by Executive Leadership Team (ELT) - Risk is taken to appropriate partner Corporate Management Team (CMT) No NHS Lothian Midlothian Council Midlothian HSCP Each service should maintain a local risk register incorporating risks applicable to their teams. Midlothian HSCP Service managers should ensure all risks escalated from Team/Service level are recorded on the Head of Service risk register. All risks should be discussed and escalation agreed with Head of Service. Risks at this level are presented at and managed by Business Governance Board Midlothian HSCP Midlothian HSCP Management risk register. Corporate Partners Midlothian Council NHS Lothian Page 223 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14:00-16:00 Public Health Update – Weight Stigma and Bias Training Programme Executive summary This report sets out an update of the Weight Stigma and Bias Training Programme. Weight stigma has been defined as negative attitudes towards, and beliefs about others because of their weight.1 These negative attitudes are manifested by stereotypes and/or prejudice towards people with overweight and obesity. This twelve month pilot project (February 2025 – February 2026) targets healthcare professionals, teaching and support staff who are in contact with people living with overweight or obesity. The training aims to: • improve awareness, knowledge and understanding about the impact of weight bias and stigma • improve confidence and skills to have conversations about healthy weight and to challenge stigma • encourage participants to reflect on and modify their own practice as appropriate The training programme has been developed with professional guidance to ensure we are delivering the most up to date evidence on the issue. We have also had ‘lived experience’ input keeping people living with overweight and obesity at the heart of our programme. The delivery phase started in August 2025, and a number of sessions are planned. As a result of this report, Members are asked to: • Note this update and promote the programme to relevant staff groups • Continue to endorse initiatives that impact positively on NHS Lothian’s obesity position 1 Weight bias and obesity stigma: considerations for the WHO European Region (2017) Item number: 5.11 Page 225 of 236
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Midlothian Integration Joint Board Public Health Update – Weight Stigma and Bias Training Programme 1 Purpose This report sets out an update on the Weight Stigma and Bias Training Programme. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note this update and promote the programme to relevant staff groups • Continue to endorse initiatives that impact positively on NHS Lothian’s obesity position 3 Background and main report 3.1 Weight stigma is a key barrier to reducing and prevention obesity. It has been defined as negative attitudes towards, and beliefs about others because of their weight.1 2These negative attitudes are manifested by stereotypes and/or prejudice towards people with overweight and obesity. Weight stigma often results from weight bias and can happen across different sectors, such as healthcare, education, employment, the media, in the community and at home2. Added to this, self-stigma where an individual endorses the negative messages can exacerbate the situation. Today, the majority (67% 3) of the adult population in Scotland is living with overweight or obesity particularly so for those living in our more deprived areas. In Scotland’s adult population, socio-economic inequalities in obesity have persisted over time. In children, the socio-economic inequalities related to obesity are increasing. Almost 1 in 5 children4 are at risk of living with overweigh/obesity by the age the time the start primary school (22% for Scotland). There are many complex factors relating to Obesity. This can be clearly seen in the Foresight Tackling Obesities Future Choices – Project Report5 systems map which is made up of a series of interconnected ‘sub-systems’: which highlights the complexity and suggests that whole systems approaches could help tackle complex health conditions like obesity. 1 Weight bias and obesity stigma: considerations for the WHO European Region (2017) 2 Flint SW. Weight stigma and discrimination: Time for change! Nutrition Bulletin. 2019;44(3):249–53. 3 Scottish Health Survey (2023) 4 Primary 1 Body Mass Index (BMI) statistics Scotland – School year 2022 – 2023 – Public Health Scotland 5 Tackling Obesities: Future Choices. Foresight, October 2007, Page 226 of 236
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Midlothian Integration Joint Board 3.2 Size and Scale of Problem We know that overweight and obesity is a significant issue for the population but from the evidence base we don’t really know to what extent stigmatising and discriminatory attitudes and behaviour impact on people locally. In August 2024, Obesity Action Scotland Factsheet reported3 • 58% of the adult population in Lothian are living with overweight and obesity – 24% have obesity • 52% of pregnant women were living with overweight and obesity - 23.3% had obesity (year ending March 2023) • Approx 40,000 people in Lothian (2021) had been diagnosed with type 2 diabetes and this is increasing. Prevalence in Lothian - 5.9% (Scotland 5.4%). In July 2017, 5,533 Midlothian residents had been diagnosed with Type 2 diabetes, 65% of whom are males (SCI Diabetes, 2021) • 19.1% of primary 1 children in Lothian are at risk of overweight and obesity 2023/247 • In 2023, the Lothian Public Healthy Survey 8 asked 14,825 adults (aged 16 and over) across Lothian, including 2,961 from Midlothian, for their height and weight measurements. The self-reported data showed that the most common weight category for people in Midlothian to fall into is the “Pre-obesity” (also known as “overweight”) category. 3.3 The Training Programme This twelve month pilot project will contribute towards Midlothian’s Whole System Approach relating to wider obesity work happening at NHS Lothian board level. It focuses on building the skills and confidence of healthcare and education professionals and support staff who are in contact with people living with overweight or obesity. The training and education programme will raise awareness of the impact of weight stigma and bias and teach participants to have constructive, non- stigmatising or discriminatory conversations with people, families and colleagues around weight. It will also support participants to challenge stigmatising attitudes and behaviour. The training programme has been developed and designed to be flexible and adaptable to suit the needs of specific target groups and delivered via TEAMS or face to-face in bite size sessions lasting 30 minutes up to longer in-depth sessions lasting up to two hours. The training has been designed to be engaging, interactive and thought provoking. A full content plan has been developed with a range of topics covered including: • What is weight stigma and bias • Size and scale of the problem • How and where it may manifest itself 3Obesity Action Scotland Factsheet. Obesity Prevalence Lothian Health board Area. August 2024 7Primary 1 Body Mass Index (BMI) statistics Scotland – School year 2022 – 2023 – Public Health Scotland 8The Lothian Public Health Survey 2023 Page 227 of 236
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Midlothian Integration Joint Board • Why it’s important for staff in education and healthcare settings to be aware, understand and have skills and confidence to address situations • Impact/consequences for people living with overweight and obesity including mental health • Importance of physical environments • Having an appropriate conversation – importance of language • Strategies to reduce weight bias • Signposting 3.4 Deliverables to date The programme is now in the delivery phase, and this will last between August – mid December 2025. Presentations that have helped raise awareness include: • Allied Health Professionals leads meeting • Dietitians Joint Service and Team Leads meeting • Bariatric Care Forum • GP Lead Reps Meeting • GP Quality Improvement Lead The following training sessions have been confirmed to date with more anticipated: • 5 x GP Practices • 1 x Practice Nurse Leads • 1 x School Nurse and support team • 1 x CTAC nurses • 1 x CPD session with Chalmers sexual health team • 1 x Physios and OT group • 1 x Corporate Parenting Event 3.5 Monitoring and Evaluation The pilot programme will be monitored and evaluated to establish if the work that has been delivered has made a difference. A quality improvement approach will be used where possible, learning as we progress and amending the content and approach as required based on feedback. To date, evaluation from one event has been analysed and can be summarised as follows: • 100% of participants agreed or strongly agreed that the content was relevant to their role • 100% of participants agreed or strongly agreed that the training had given them increased confidence to have a non-stigmatising conversation about weight Participants were asked to provide examples of how they felt about the training and things they would do differently as a result of attending including: “ I will be more conscious of the words I use” Page 228 of 236
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Midlothian Integration Joint Board “I feel I could start a conversation more confidently with a parent if I had concerns about their child’s weight” “I think I will feel more confident when speaking to others about weight stigma issues” “it made me challenge my thoughts on why I was hesitant when addressing conversations about weight. Made me think about my tone, body language and general language when approaching parents” Quantitative and qualitative methods will be used and results from the evaluation will feature in the final project report: . • Formative Evaluation – used to assess progress and effectiveness of the programme while it is still being implemented. It will be used for quality improvement purposes and to assess if the project is aligned to intended goals. • Summative Evaluation – used to determine whether the project has achieved it’s intended goals and objectives by assessing the overall effectiveness on completion. This work will help inform whether the project should continue or end. • Process Evaluation – used to assess how the project has been implemented including whether it has reached the intended audience, participation rates, quality of delivery and degree to which the project has been implemented as intended. • Outcome Evaluation – used to assess whether the project has made a difference. We will establish where feasible whether participants knowledge, skills and intended behaviours have changed as a result of the training. 4 Policy Implications 4.1 This project is part of the Type 2 Diabetes prevention programme and is supported by current national and local policy direction • Prevention and early intervention • Supporting management of long-term conditions • Dignity and respect • Reducing health inequalities 5 Directions 5.1 This report Links to 2023/2024 Directions: (Public Health Team Plan) 1 – Health and Wellbeing 2 – Positive experience and dignity 3 – Health inequalities Page 229 of 236
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. It is proposed that the Project Steering Group will undertake an ECRIA at their next meeting in late October. 7 Resource Implications 7.1 The project has been jointly funded by NHSL Public Health and MLHSCP for 12months. 7.2 Before the project ends, a report will recommend whether the work is viable, sustainable and has been effective in reaching the intended target group, while achieving agreed outcomes. Without specific ongoing funding, the exit strategy will consider delivering ‘train the trainer sessions’ so that existing staff can continue the work if there is capacity. 8 Risk 8.1 There is a risk that the work will not be continued even if the project evaluates positively due to lack of budget or staff capacity to promote and deliver future sessions. 8.2 To mitigate this risk the Steering Group and project manager (prior to end of contract) will: • Engage regularly with key stakeholders to anticipate barriers • Provide opportunities for training until mid December 2025 • Explore whether ‘train the trainer’ sessions should be offered – design and deliver these if required • Produce a final report that strategic groups can review and refer too 9 Involving people 9.1 A focus group discussion was arranged through the Lothian – South East Eating Disorders Scotland Service inviting participants to share their experiences of stigmatising or discriminatory attitudes and behaviour regarding their weight. Their feedback and responses were an integral part of the programme and with consent were used as scenarios and case studies to raise awareness and highlight key issues such as the importance of using appropriate language and phrases, how to ask the right questions, understanding what matters to the individual and what support they may need. Page 230 of 236
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Midlothian Integration Joint Board 3 participants took part in a discussion facilitated by the Project Manager for the Weight Stigma Training Programme that lasted just under 1.5 hours. Feedback from participants to date confirmed that lived experience was key to their overall learning. 10 Background Papers 10.1 Author’s Name Lisa Cohen Jacqueline Kirkland Designation Project Manager Public Health Practitioner Contact Information Lisa.Cohen2@nhs.scot Jacqueline.Kirkland@nhs.scot Date 22.9.25 Appendices: Page 231 of 236
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Midlothian Integration Joint Board Thursday, 9 October 2025, 14:00 – 16:00 East Lothian and Midlothian Public Protection Committee Annual Report Executive summary The purpose of this report is to introduce the East Lothian and Midlothian Public Protection Committee Annual Report 2024/25. East Lothian and Midlothian Public Protection Committee (‘the Committee’) is the strategic partnership that is responsible for the overview of policy and practice in relation to Adult Support and Protection, Child Protection and Violence Against Women and Girls. The primary aim of the Committee is to provide leadership and strategic oversight of Public Protection Committee and performance across East Lothian and Midlothian. An annual report of the work of the Committee is completed each year and was presented to its governance group, the Critical Services Oversight Group, on 12th August 2025. The annual report provides an opportunity to give a high-level overview of all areas of the business and illustrate their connectivity and intersectionality within the context of a lifespan approach. As a result of this report, Members are asked to: • Note the contents of this report. Item number: 5.13 Page 233 of 236
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Midlothian Integration Joint Board Report East Lothian and Midlothian Public Protection Committee Annual Report 2024/25 1 Purpose 1.1 The purpose of this report is to introduce the East Lothian and Midlothian Public Protection Committee Annual Report 2024/25. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the contents of this report. 3 Background and main report 3.1 East Lothian and Midlothian Public Protection Committee (‘the Committee’) is the strategic partnership that is responsible for the overview of policy and practice in relation to Adult Support and Protection, Child Protection and Violence Against Women and Girls. The primary aim of the Committee is to provide leadership and strategic oversight of Public Protection and performance across East Lothian and Midlothian. An annual report of the work of the Committee is completed each year and was presented to its governance group, the Critical Services Oversight Group, on 12th August 2024. 3.2 Although Midlothian IJB has no governance over the work of EMPPC, there are significant areas of connectivity and common of responsibility. The Head of Adult Social Care/Chief Social Work Officer and Chief Nurse are members of EMPPC, and other Health and Social Care Partnership staff are members of the EMPPC Sub-groups and contribute to the delivery of EMPPC’s business plan. Staff from the partnership work to EMPPC’s Procedures and Guidance and benefit from EMPPC’s learning and development programme. The Annual Report is therefore of interest to IJB members. 3.3 The Annual Report demonstrates the strength of the partnership working arrangements in East Lothian and Midlothian and celebrates the Committee’s achievements in the year. 3.4 Keith Mackay, Independent Chair of the Committee, introduces the report in his forward. Section 1 of the Annual Report sets out the Public Protection Partnership Page 234 of 236
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Midlothian Integration Joint Board structure and arrangements for delivering on its responsibilities, through a number of Sub-groups. 3.5 Section 2 of the Annual Report sets out the progress of the work of the Committee against the five priorities in its Business Plan. The Business Plan is structured around five priorities, and highlights what the Committee achieved in the year, and next steps to progress those areas of business: 1. We will continue to strengthen our leadership arrangements in Public Protection. 2. We will provide and support the implementation of multi-agency procedures and guidance for staff working in Public Protection. 3. We will continue to develop our performance framework and approach to quality improvement. 4. We will promote a learning culture by providing staff with multi-agency learning and development opportunities in Public Protection. 5. We will raise awareness of Public Protection through communications and engagement with staff and communities. 3.6 Section 3 provides an overview of data and performance information, in relation to Adult Support and Protection, Child Protection and Violence Against Women and Girls. 3.7 The report concludes with a brief overview of priorities for 2025/26. It should be noted that the EMPPC Business Plan for 2025/26 will include a sixth priority: We will ensure that our improvement work is informed by the lived experience voice of children and adults who are involved in Public Protection processes. 4 Policy Implications 4.1 None 5 Directions 5.1 Not appliable 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake and ECRIA as a result of this report. 7 Resource Implications 7.1 None. Page 235 of 236
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Midlothian Integration Joint Board 8 Risk 8.1 None. 9 Involving people 9.1 Not appliable. 10 Background Papers 10.1 None Author’s Name Kirsty MacDiarmid Designation Public Protection Manager, East Lothian and Midlothian Public Protection Office Contact Information kmacdiarmid@eastlothian.gov.uk Date 22/09/2025 Appendices: Link to Website version of EMPPC Annual Report 2024-25 Page 236 of 236