Agenda Document Pack - Midlothian Integration Joint Board - 11/12/2025
Midlothian Council · 11 December 2025
Back to Midlothian Integration Joint Board — 11 December 2025 and its agenda
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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, 11 December 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 180
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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 9th October 2025 submitted for approval (14:05-14:10) 5 - 28 4.2 Minutes of Strategic Planning Group held on 25th September 2025 submitted for noting 29 - 40 4.3 Minutes of Audit and Risk Committee held on 4th September 2025 submitted for noting 41 - 50 5 Public Reports Standing Items and Public Reports 5.1 Chair’s Update - Val de Souza, Chair 5.2 Chief Officer's Report - Paper presented by Morag Barrow, Chief Officer (14:10-14:25) 51 - 64 5.3 Strategic Planning Group Update - Andrew Fleming, Strategic Planning Group Chair (14:25-14:40) 5.4 Audit and Risk Committee Update - Councillor Connor McManus (14:40-14:45) For Discussion 5.5 Midlothian IJB Finance Quarter Two 2025/26 Update - Paper presented by Chris King, Chief Finance Officer (14:45-15:00) 65 - 70 5.6 Midlothian IJB Performance Update - Paper presented by Elouise Johnstone, Programme Manager (15:00-15:05) 71 - 110 5.7 Midlothian and East Lothian Drug and Alcohol Partnership - Residential Rehabilitation Pathway - Presentation by Nick Clater, Head of Adult Services and Chief Social Work Officer (15:05- 15:30) Page 2 of 180
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5.8 Chief Social Work Officer Annual Report 2024/2025 - Presentation by Nick Clater, Head of Adult Services and Chief Social Work Officer (15:30-15:50) 5.9 Midlothian HSCP Unscheduled Workstream Update - Presentation by Grace Cowan, Head of Older People and Primary Care Services (15:50-16:00) For Noting 5.10 Midlothian IJB Annual Complaints Report 2025 - Paper provided by Lisa Cumming, Midlothian HSCP Business Support Manager 111 - 116 5.11 Health and Care (Staffing) (Scotland) Act 2019 2024/25 Ministerial Annual Report - Paper provided by Morag Barrow, Chief Officer 117 - 180 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting of Midlothian Integration Joint Board will be held on Thursday 19 February 2026, from 14:00-16:00. This meeting will be held at Normandy Court/Hybrid. Please note that this meeting will follow an IJB Development Session on Thursday 15 January 2026, from 14:00-16:00. This meeting will be held at Normandy Court/Hybrid, this is for Board Members only. Page 3 of 180
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 9 October 2025 14:00 Normandy Court / Hybrid via Microsoft Teams Present (voting members): Val de Souza (Chair, NHS) Councillor McManus (Vice Chair) (Virtual) Dr Amjad Khan (NHS Lothian) Councillor Parry Councillor Milligan (Virtual) Councillor Winchester Heather Campbell (NHS Lothian) (Virtual) Andrew Fleming (Strategic Planning Group Chair) 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) In attendance: Midlothian Integration Joint Board Thursday 11 December 2025 Item No 4.1 Page 5 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Apologies: Jay Johnson (Lived Experience Member) Roxanne King (Executive Business Manager) 1. Welcome and Introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB). The Chair wished to formally acknowledge and extend sincere thanks to Keith Chapman, who has stepped down as a long-standing member of the Midlothian Integration Joint Board (IJB). Keith has made a significant and valued contribution to the work of the IJB over the years. It was noted that Keith will continue to serve as a member of the Midlothian Strategic Planning Group (SPG), ensuring his expertise remains part of the broader strategic conversation. The Chair further noted that this meeting marks the final attendance of Dr Rebecca Green, in her capacity as Clinical Director. The Chair thanked Dr Green for their valuable contributions towards the work of Midlothian IJB and extended best wishes for success in their new role in NHS Borders. 2. Order of Business The order of business was confirmed as outlined in the agenda previously circulated. Gill Main (Integration Manager) (Virtual) Jim Sherval (The Public Health Consultant) (Virtual) Elouise Johnstone (Performance Manager) (Virtual) Hannah Forbes (Democratic Service Officer) Louise Middleton (Democratic Service Officer) Fiona Kennedy (Interim Head of Service) Grace Cowan (Head of Primary Care and Older Peoples Services) Page 6 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board The Chair noted the apologies submitted by Jay Johnson, Lived Experience Member and Roxanne King, Executive Business Manager. 3. Declarations of Interest There was no declaration of interests noted to the Board. 4. Minute of Previous Meetings 4.1 The Minute of the previous Midlothian IJB Meeting, held on 21st August 2025, was approved as an accurate record. 4.2 The Minute of the meeting of the MIJB – Strategic Planning Group, held on 24th July 2025, was noted by the Board. 4.3 The Minute of the meeting of the MIJB – Audit and Risk Committee, held on 4th September 2025, will be presented to the Board in December 2025. 5. Public Reports Page 7 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 5.1 Chair’s Update – Val de Souza, Chair The Chair provided a verbal update, reminding the Board that the next Development Session will be held on Thursday the 13th of November 2-4pm at Normandy Court, with the option to attend virtually via Microsoft Teams. The Development Session will focus on the current financial position. The Chair also informed the Board of their attendance at the NHS Lothian Development Session held the 2nd of October 2025. During this session, a dedicated slot was allocated to the Midlothian Integration Joint Board (MIJB), during which key themes were discussed, including strategic priorities, system-wide pressures, and the imperative for transformation across NHS services. The Chief Officer highlighted that this was a valuable opportunity to share Midlothian’s perspective and ongoing work. They noted that while the challenges are well understood locally, this forum allowed for broader engagement and awareness among colleagues who may not be as familiar with the specific issues and initiatives underway. 5.2 Chief Officers Report – Morag Barrow, Chief Officer The Chief Officer presented the report noting that the paper sets out the key strategic updates of the Midlothian IJB Board meeting October 2025. As a result of this report Members are asked to: Note the content of the report. The Chief Officer informed the Board that the Chief AHP and their team successfully hosted a Community Appointment Day in late September, which was attended by 221 individuals. The event focused on falls prevention and management. The Chief Officer noted that a comprehensive evaluation of the initiative is Page 8 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments underway. The concept behind the event was to enable members of the public, including patients and carers, to self-present and be appropriately signposted to relevant services based on their needs. The Chief AHP noted it was an effective experience with positive feedback. One of the key outcomes identified through the wider frailty programme was the proposal to develop a self-management passport— an accessible resource designed to support individuals in navigating self-directed care. An additional benefit of the event was to intentionally create a welcoming environment to address social isolation. Attendees were encouraged to stay for refreshments, including tea, coffee, and home baking, providing an informal space for individuals to share and reflect on the information they had received. The Chief AHP confirmed that a full Evaluation Report is currently in development, with completion anticipated by the end of the year. The Board engaged in a discussion regarding rehabilitation services, during which members sought further clarification from the Chief Officer. Specifically, the Board requested additional information on whether these services are contributing to earlier hospital discharge or if they are primarily targeted towards older adults’ population. The Chief Officer explained that the initiative is designed to support patient flow from hospital and facilitate early discharge. It extends beyond rehabilitation alone, focusing also on assessing an individual’s ability to safely return to and live in their own home environment. It was noted that ten rehabilitation units have been established, which will be supported by community teams to ensure a smooth transition for individuals back into their homes. The Board raised several questions regarding the financial recovery actions, specifically seeking clarity on Page 9 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments how the Integration Joint Board (IJB) intends to manage the short-term financial implications associated with these measures. In addition, Polton Street was highlighted during the discussion, and the Board requested an update on the current status of the Equality and Children’s Rights Impact Assessment (ECRIA), including any regulatory considerations relevant to the IJB’s responsibilities. With regards to the Care Home relocation, the Chief Officer advised that an ECRIA is not suggested as there is no change to the model of care. The Chief Officer also provided an overview of the extra care housing component, noting that the facility comprises three floors. Two of these are designated for extra care provision, while the third floor presents an opportunity to address other service gaps. For example, Midlothian currently lacks a complex Grade 5 facility for individuals with mental health needs. Work is ongoing to determine the most appropriate and effective use of the third floor in response to such challenges. The Board concluded with a question regarding discharge pathways, specifically seeking clarity on the expected length of stay for individuals residing in the rehabilitation flats, and whether there are risks associated with delayed progression in rehabilitation. In response, the Group Service Manager advised that the current model in place at Highbank is operating effectively. It was noted that length of stay is determined on a case-by-case basis, with some individuals requiring extended support within the rehabilitation flats. This approach enables a thorough, independent assessment of each person’s needs, facilitating either a return home or a transition to extra care housing. The extra care facility offers enhanced support for individuals who are unable to return home but can be safely accommodated within an alternative tenancy arrangement. Page 10 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chair thanked the Chief Officer for the report and opened to questions and comments from the Board. 5.3 Strategic Planning Group Update – Andrew Fleming, Strategic Planning Group Chair The Chair of the Strategic Planning Group (SPG) reported that the Group last convened on 25 September 2025, noting that the meeting was not quorate. It was further noted that Magda Clark, representing the Third Sector, was nominated as Vice Chair—an encouraging development that reflects a commitment to collaborative partnership working. The Chair also confirmed that several of the papers included in today’s agenda have previously been considered by the SPG and welcomed further discussion from Board members. The Chair congratulated Magda Clark on the position of Vice Chair of Strategic Planning Group. 5.4 Audit and Risk Committee Update– Councillor Connor McManus Councillor Connor McManus advised the Board this was their first meeting as Chair for the Audit and Risk Committee, with Dr Amjad Khan appointed as Vice Chair. The meeting took place on 4th September 2025. At that meeting, the Committee discussed the Annual Accounts, which have since been formally approved by the Board. The Chief Internal Auditor attended to provide a refresher on key audit principles and Page 11 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments processes. Additionally, the Standards Officer led a review of the Standing Orders, Scheme of Delegation, and Scheme of Administration, with full sign-off of these governance documents anticipated by 2026. 5.5 Midlothian IJB Membership Recommendations - Democratic Services (for noting and approval) Democratic Services presented a report outlining proposed changes to the voting and non-voting membership of the Midlothian Integration Joint Board (IJB). The report seeks the Board’s formal endorsement of the membership nomination as detailed within its contents. As a result of this report, Members are asked to: • Review and endorse NHS Lothian 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 The Chair thanked Democratic Services for the report. The Board formally noted its contents and approved the recommendations as outlined. Approved For Decision 5.6 Midlothian IJB Strategic Plan 2025-2035: Final recommendation to approve and publish - Paper presented by Morag Barrow, Chief Officer The Chief Officer presented the report noting that this report sets out the final actions in the development of the Midlothian Integration Joint Board (IJB) Strategic Plan for 2025-2035. Mid IJB Strategic Plan Approved. Mid IJB Strategic Plan to be published on HSCP Integration Manager 31st October 2025 Page 12 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 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. The Chair thanked the Chief Officer for the report and opened for questions and comments by the Board. The Board acknowledged the significant volume of work undertaken in the development of the Midlothian Integration Joint Board Strategic Plan, particularly recognising the meaningful involvement of people and communities throughout the consultation process. The Integration Manager was formally thanked for their leadership and dedication in coordinating the development of the Plan, which was commended for being truly person-centred—shaped by the individuals who both access and deliver services. The Chair also extended appreciation and congratulations to the entire Health and Social Care Partnership (HSCP) for their collective efforts, noting that the Strategic Plan represents a substantial achievement and is something the IJB can take great pride in. Midlothian HSCP Website. Page 13 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments For Discussion 5.7 Midlothian IJB draft Participation and Engagement Statement 2025-2028 - Paper presented by Gill Main, Integration Manager The Integration Manager presented the Midlothian Integration Joint Board (IJB) draft Participation and Engagement Statement 2025-2028 (appendix 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. The Chair thanked the Integration Manager for the report and opened to questions and comments from the Board. The Board highlighted that this was discussed at the last SPG meeting, and the issue identified was around how the IJB engage with the community, it was noted that the IJB need to go to the community to improve visibility and engagement within the community. The Chair recommended that the Integration Joint Board (IJB) actively pursue all available opportunities to engage with individuals and communities through face-to-face interactions, in order to strengthen visibility and build meaningful connections. Page 14 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chair also raised a concern regarding the current documentation, noting the absence of any reference to Social Work within the Health and Social Care narrative. It was emphasised that Social Work plays a critical and statutory role in the delivery of IJB functions, and its omission from the narrative does not reflect the integral contribution it makes. The Chair underscored the importance of ensuring that Social Work is appropriately recognised and represented in all strategic documentation moving forward. The Integration Manager noted the valuable contribution of Social Work at the centre of what the IJB do. The Integration Manager also noted that not all professional groups are referred to specifically in the board publications asked the Board if they would like Social Work to specifically mentioned, suggested there could be a statement added into the document detailing what Health and Social Care is and the elements it includes. The Head of Adult Services and Chief Social Work Officer advised that they were happy to have a look at making the distinction between Social Care and Social Work. It was stated that it would be helpful for Social Work to be more prominent in these documents. The Chair agreed that the Head of Adult Services and Chief Social Work Officer and the Integration Manager would look to discuss this further offline. The Board reflected on the Integration Joint Board’s (IJB) approach to public engagement and queried whether there was an intention to convene a collective forum involving all IJBs, noting that other Boards may also wish to participate in coordinated engagement efforts. The Head of Adult Services and Chief Social Work Officer and the Integration Manager will discuss making Social Work more prominent in the document. The Chief Officer to meet with other officer to discuss if there would be an opportunity to have all IJBS together regarding public engagement. Page 15 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments In response, the Chief Officer acknowledged that this had not yet been considered but committed to raising the matter with fellow Chief Officers to explore the potential for a collaborative approach. Feedback will be provided either virtually or at the next scheduled meeting. The Board agreed the recommendations in the report. For Discussion 5.8 Midlothian IJB Performance Update – Paper presented by Gill Main, Integration Manager The Integration Manager advised the Board that the 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. 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. The Chair thanked the Integration Manager for the report and opened to questions and comments from the Board. Recommendations noted Page 16 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chief Officer provided an overview of the broader system pressures, noting that partner services—such as the ambulance service—are experiencing significant increases in demand. Lothian hospital admissions are currently up by 25%, and the ambulance service is operating at 20% above typical activity levels. The Chief Officer highlighted that responsibility for addressing challenges in unscheduled care has been refocused towards Health and Social Care Partnership (HSCP) teams. Analysis has identified that delays within the system are a key contributing factor. These pressures are having a notable impact on the four- hour emergency department target. While efforts are underway to mitigate the effects, the system is also working to identify the underlying, as yet unresolved, factors preventing a reduction in overall demand. Current work is focused on understanding bed turnover rates and the drivers behind increased admission and attendance levels. The Performance Manager acknowledged the scale of ongoing work and agreed with the Chief Officer’s assessment. In relation to delayed discharges, it was noted that there is considerable variation, and the current data presentation makes it challenging to identify consistent patterns. Work is ongoing to improve the clarity and interpretability of the data visualisations. The Board requested any available data or evidence from primary care settings to determine whether similar increases in demand are being observed at the community level, in line with the trends highlighted by the Chief Officer. The Chief Officer informed the Board that there remains a degree of uncertainty regarding the current activity figures. The Head of Primary Care and Older People’s Services added that a review of acute care attendances is scheduled to take place the following day, as part of a planned Day of Care audit. This audit will involve a Page 17 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments detailed assessment of every patient who attended an emergency department on that day, examining whether each presentation met the criteria for hospital admission and identifying the route by which the patient arrived—such as through the inflow navigation centre. The purpose of this exercise is to determine whether there are any issues within the inflow navigation process, including how patients are screened or triaged, or whether attendance was based on individual decision-making. The findings will support efforts to improve system flow and ensure appropriate use of emergency care pathways. The Clinical Director responded to the comment made by the Board in relation to the data that may suggest that primary care is becoming quieter and advised that this reflects capacity and not demand. The Clinical Director highlighted issues with general practices that are operating at reduced income and not being able to fill all their clinical slots with some practices running under capacity that reflects in the data as reduced activity. However, it was added the Accident and Emergency attendance per practise, there is not an increase from practices. The Integration Manager detailed the challenge on the MSG rate as rate is not always the most helpful measure for this type of data. Additionally, it was noted that the Midlothian’s contribution is difficult to identify as a small percentage of the whole of Lothian. The Integration Manager added it would be helpful to identify a different measure of success. The Board acknowledged the progress made on the strategic directions for 2025–2026 and the proposed reporting framework. Members sought clarification on the use of green, amber, and red indicators, specifically querying whether there were any areas of concern and how performance against these Page 18 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments indicators will be reported. The Board also asked whether any corrective actions have been identified or are being considered in response to areas flagged for improvement. The Chief Officer advised that there are currently no concerns. However, in relation to business-as-usual (BAU) reporting, it was noted that a mechanism is required to ensure this information is appropriately integrated. This would enable Midlothian IJB to gain a clearer understanding of the proportion and impact of BAU activity within overall performance reporting. The Chair requested confirmation that a forthcoming Development Session would provide dedicated time to address areas of Directions as the mechanism to deliver the Strategic Plan where actions are currently underdeveloped. Additionally, the Chair sought further information regarding the strategic focus on unscheduled care, specifically in relation to efforts aimed at reducing demand and the potential impact on the capacity to deliver other components of the programme. The Chief Officer acknowledged the ongoing challenges related to service reduction and capacity constraints. While recognising the significant progress and commendable work being undertaken, it was noted that the substantial time and resources currently allocated to unscheduled care are beginning to affect the delivery of mental health services. The Chair acknowledged that there is a clear understanding of Midlothian IJB’s current position. However, it was emphasised that maintaining an appropriate balance across priorities is essential. Should pressures escalate to a concerning level, the Board must be promptly informed to ensure full awareness of system dynamics and emerging challenges. The Board noted the recommendations on the report. Future development session to focus on Directions. Integration Manager January 2026 Page 19 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 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 The Chief Nurse presented the report noting that this is the Integrated Assurance report provided by the Midlothian HSCP to the Midlothian Integration Joint Board (IJB). As a result of this report, Members are asked to: • Discuss and approve the content of this report. The Chair thanked the Chief Nurse for the report and opened to questions and comments from the Board. The Board requested clarification on the anticipated timescale for the alignment and implementation of revised Social Work structures. In addition, members raised a query regarding the Scottish Public Services Ombudsman (SPSO) report, seeking insight into the current processes in place and how existing systems might be adapted to adopt a more preventative, upstream approach. The Chief Officer outlined the challenges currently facing district nursing services, noting that local pressures during the summer period were largely due to staff absences and school holidays. Reference was made to the recently published Scottish Public Services Ombudsman (SPSO) report, which highlighted unacceptable standards of care dating back three years. While the report did not comment directly on the quality of care delivered, the majority of feedback related to deficiencies in documentation. It was acknowledged that district nursing is under considerable system-wide pressure. In response, targeted work has been initiated to address broader issues, including improvements in diabetes management for Page 20 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments older adults and the implementation of electronic case records. This programme of work has been ongoing for the past year. A local improvement plan was introduced over the summer, aligning performance enhancements with the recommendations outlined in the SPSO report. Weekly audits of case notes are now being conducted, supported by additional staff training. The Chief Officer further advised that they had been invited to present progress to the NHS Lothian Performance, Scrutiny and Oversight Board. The Executive Team expressed satisfaction with the reporting provided and, as a result, no further attendance has been requested to date. However, an update on the Pan-Lothian improvement work is expected to be submitted to the Oversight Board within the next three weeks. The Chief Officer provided assurance that there are plans in place and the improvements identified have been completed, however remain in a difficult position in Lothian around District Nursing where there is work needed around criteria and case load safety tools and would be happy to bring back updates on the work that is taking place. The Chief Nurse noted that the development of a care assurance system represents an additional strand of work within community nursing. This system is designed to provide early indicators of positive performance, while also enabling targeted attention on areas requiring improvement. The Head of Adult Services and Chief Social Work Officer advised there was an agreement at the Corporate Management Team to take a Council wide approach in relation to bring all the adverse event policies together for Social Work that can be developed centrally and has since proven that it can’t, therefore there will be internal resource within Social Work for development. It was stated that there is no timeframe at the The Chief Officer to provide the IJB with an update on the work that is needed around District Nursing relating to criteria and case load safety tools. Page 21 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments moment as this is an in-depth large piece of work however, once the work is complete there will be a discussion held to identify how to integrate that into our structures within Midlothian HSCP. The Board referenced the complaints outlined in section 3.23 of the report and requested clarification on the associated learning pathways. Members sought to understand how insights from these complaints are being translated into tangible service improvements. Additionally, with reference to section 3.27 of the meeting papers concerning future-proof workforce planning, the Board queried how the Third Sector could contribute to the development and integration of volunteering roles within the broader strategic framework. The Chief Officer advised that, in relation to complaints, there is no specific learning required regarding the process itself, which is functioning effectively. However, given the varied nature of complaints received, there are ongoing opportunities for learning and service improvement. The team continues to work closely with Elected Members, recognising that, within the context of local politics, Members often bring forward concerns raised by constituents within their wards. The Chief Officer also emphasised the critical role of the Third Sector in future workforce planning and welcomed continued collaboration and support in shaping and delivering sustainable service models. The Board noted and approved the Recommendations in the report. Page 22 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 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 The Head of Adult Services and Chief Social Work Officer presented a presentation to the Board that details the Midlothian and East Lothian Drug and Alcohol Partnership Annual Report. It was noted that this item had been carried forward from the previous meeting of the Midlothian Integration Joint Board. The Chair thanked the Head of Adult Services and Chief Social Work Officer for the report and commended the detail within the report; the Chair opened for any comments or questions from the Board. The Board noted from the report, the resources for alcohol related issues in comparison to drugs. The Board asked if there have been any issues in Midlothian relating to new alcohol licences. The Public Health Consultant explained that it is difficult to meet the levels of proof and evidence that are required to turn down an application or uphold the amount that has been asked for. It was also noted that Midlothian do not receive many licensing applications. The Board requested information on the correlation between near-fatal overdoses, individuals currently engaged in treatment, and drug-related deaths. Specifically, members sought to understand how many individuals with a history of treatment or prior near-fatal overdose may be represented within the drug death statistics. The Head of Adult Services and Chief Social Work Officer explained that drug-related deaths can be broadly categorised between those who are actively engaged in treatment and those who are no longer receiving support but have previously accessed services. It was noted that the majority of deaths involve individuals who were previously known to services. The importance of sustained engagement was emphasised, with evidence suggesting that individuals who remain connected to support services are at reduced risk of drug-related harm. However, it was acknowledged that not all cases can be Page 23 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments effectively managed, and outcomes may vary depending on the substances involved. Forecasting drug- related deaths for the coming year remains complex and uncertain due to these variables. The Group Service Manager explained there is a proactive in reach model in relation to non-fatal overdose that identifies individuals that have had a non-fatal overdose and a bespoke service to support the individuals to ensure they are brought further into services. An individual would then be supported through the various pathways to ensure they are receiving the required support. The Chair confirmed that there will be another invitation to visit number 11 for the Board. The Board noted the report. 5.11 Public Health Practitioners Update – Weight Stigma and Bias Training Programme - Paper presented by Jacqueline Kirkland, Public Health Practitioner The Public Health Practitioner presented the report noting that this report sets out an update on the Weight Stigma and Bias Training Programme. 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. The Chair thanked the Public Health Practitioner for the report and opened to any questions or comments from the Board. The Public Health Practitioner/the Chief Officer to have a discussion Page 24 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chief Officer noted that they are Co-Chairing a new oversight group for NHS Lothian for healthy weight and type 2 diabetes management. Currently the group are looking at some digital opportunities, where the group will be focusing on what they can do for Lothian. The Board raised a query in relation to the NHS Lothian charity that are involved in prevention work and asked whether it would be beneficial to submit a bid for funding following completion of the current evaluation. It was noted that this may present an additional opportunity to support and enhance preventative work within the system. The Chair agreed that the proposal should be taken forward to have a discussion with NHS Lothian Charity to discuss potential funding opportunities. The Board noted the recommendations in the report. with the NHS Charity to discuss the possibility of funding. 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 The Chair noted the Chief Officer’s suggestion to circulate the presentation after the meeting, as there has been little change since this was last presented to the IJB. The Board agreed to have the presentation circulated. Midlothian HSCP Unscheduled Workstream Presentation to be circulated to Board Members Democratic Services Page 25 of 180
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Thursday 9th October 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments For Noting 5.13 East Lothian & Midlothian Public Protection Committee Annual Report - Paper provided by Nick Clater, Head of Adult Services and Chief Social Work Officer, Midlothian HSCP The Head of Adult Services and Chief Social Work Officer, Midlothian HSCP presented the report introducing the East Lothian and Midlothian Public Protection Committee Annual Report 2024/25. As a result of this report, Members are asked to: • Note the contents of this report. The Chair thanked the Head of Adult Service, Chief Social Work Officer, Midlothian HSCP for the report and opened to questions and comments from the Board. The Chair proposed that it would be beneficial for Keith Mackay to attend a future meeting of the Integration Joint Board (IJB) to deliver a brief presentation, given the volume and complexity of information contained within the report. The Head of Adult Services and Chief Social Work Officer supported the proposal, further recommending that both Keith Mackay and Kirsty McDermott be invited to attend in order to facilitate a more focused discussion on the report’s content. The Board endorsed the suggestion and agreed that Public Protection Officers will be invited to a future IJB meeting to present and discuss the report in greater detail. Public Protection Officers to attend a future IJB to provide more information around recommendations and actions that are outlined in the report. Business Support Manager / Integration Manager Page 26 of 180
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Thursday 9th October 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 will be held on Thursday 11th December 2025, from 14.00 – 16.00. This meeting will be held at Normandy Court and online. Please note: The IJB Board Development Session scheduled for Thursday 13th November 2025 from 14.00 – 16.00 at Normandy Court is for Board Members only. Meeting concluded at 16:01pm Page 27 of 180
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Midlothian Integration Joint Board Thursday 11 December 2025 Item No 4.2 Midlothian IJB Strategic Planning Group Meeting Date Time Venue Strategic Planning Group Thursday 25 September 2025 14:00pm Normandy Court/MS Teams Present (MIJB Members): Andrew Fleming, NHS Lothian Non-Executive Director (Chair) Magda Clark, Third Sector Member Representative (Vice Chair) Morag Barrow, HSCP (Joint Director) Chris King, (Chief Finance Officer) Present (HSCP and Partners): Gill Main, HSCP (Integration Manager) Elouise Johnstone, HSCP (Programme Manager Performance) Dr Rebecca Green, HSCP (Clinical Director) Colin Small, (Volunteer Representative) Jim Sherval, NHS Lothian (Consultant in Public Health) (Virtual) Nick Clater, HSCP (Head of Adult Services & Chief Social Work Officer) Claire Ross, HSCP (Chief Allied Health Professional) Fiona Stratton (HSCP Chief Nurse) Lara Williams, HSCP (Assistant Strategic Programme Manager) Hannah Forbes, Democratic Services Maria Perez, Democratic Services Bruce Dickie, HSCP (Project Officer) Rosie McLoughlin, CEO of VOCAL Apologies: Page 29 of 180
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Strategic Planning Group Roxanne King, HSCP (Executive Business Manager) Councillor Pauline Winchester Heather Campbell, NHS Lothian Non- Executive Director Dr Amjad Khan, NHS Lothian Non-Executive Director 1. Welcome and introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB) Strategic Planning Group (SPG) and noted the apologies for the meeting. The Chair noted that the Group is not quorate today and actions will need to be circulated to the Group after the meeting has ended. The Chair asked for the Group to introduce themselves. 2. Order of Business The Chair advised that the order of business was as set out in the agenda. 3. Minutes of Meeting 3.1 The minutes of the Strategic Planning Group of 24 July 2025 were approved as an accurate record. 3.2 Action log The action log was presented by the Assistant Strategic Programme Manager, and the Group reviewed the outstanding actions and closed the completed actions. Page 30 of 180
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Strategic Planning Group 4. Updates Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 The Chair’s Update The Chair announced to the Group the nomination of Magda Clark, Third Sector Member, for Vice Chair. This was seconded by Gill Main, Integration Manager. Due to this meeting not being quorate, Chair has requested this be brought to the next meeting. The Chair welcomed the Group to the first meeting at Normandy Court. 5. Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1 Design and Development Strategic Plan 2025/2035 – Gill Main, Integration Manager The Integration Manager presented the report and noted that it sets out the final actions for the development of the Midlothian Integration Joint Board (IJB) Strategic Plan 2025-2035. As a result of this report, Members are asked to: Recommended to the Board Integration Manager 9th October 2025 Page 31 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments • Note the small edits and design changes made following the August IJB meeting noted in the change log (appendix 2), and • Subject to any amendments, recommend the Midlothian IJB draft Strategic Plan 2025-2035 to the Midlothian IJB for final approval on 9th October 2025. The Chair thanked the Integration Manager for the report and opened to any questions or comments from the Group. The Group noted the recommendations in the report and thanked the team for the huge amount of work which underpinned the strategy. 5.2 Implementation Bed Based Model verbal update – Bruce Dickie, Project Officer The Project Officer provided an update to the Group around the Bed Base Model and highlighted some key updates. The Chair thanked the Project Officer for the verbal update on what is a complex and important programme of work, with 8 workstreams. He asked for a regular report to be brought to SPG to ensure the group remains appraised of the programme of work, ensure the Board is assured of its planning and governance, and provide an opportunity for the programme to bring asks to the Group. He noted that this need not be a special report but rather an existing report used as part of the programme’s current governance. It was noted that the title “bed based model” perhaps was not the most appropriate title for this item and that a better title might be “bed based care”. The Group asked a question regarding discharge through the British Red Cross pathway and asked what mechanisms are in place to track carer support through the discharge process. The Project Officer to create a report that details the scope of work around the Bed Base Model. The Chief Officer to provide details on the mechanisms in place to track the carer matrix through the discharge process. Page 32 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Integration Manager highlighted to the Group that Direction 6.1 relates to services that are involved in moving the balance of care from hospital to home, and that consideration to unpaid carers is essential to review within the Directions work. The Integration Manager noted that community feedback from consultation on the Strategic Plan told us people don’t want the board or HSCP to talk about “pathway” or “model” as these words don’t mean anything to them and instead want to hear in plain language how we plan to deliver change. The Integration Manager offered support to the Project officer to align language and ambition with the IJB Strategic Plan if required. The Group highlighted the communication and engagement work that is ongoing in relation to planning and commended the work around the re-design of teams and that change will happen with them, not to them. 5.3 GP Cluster Lead Work – Rebecca Green, Clinical Director (Presentation) The Clinical Director gave the presentation to the Group. The Clinical Director noted that the presentation can be circulated to the Group. The Integration Manager noted the ambition in the April 2024 IJB paper to address ways in which community services could support general practice, noting that when people can’t access community services they are significantly more likely to access 3 x more GP appointments than age matched controls. The importance of the relationship between Health and Social Care and general practice was noted. The Presentation was noted by the Group. Page 33 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chief Officer thanked the Clinical Director for the leadership and noted to the Group that this will be the last Strategic Planning Group (SPG) meeting for the Clinical Director. The Chair asked what the journey consists of in relation to the digital front door and the use of digital platforms. The Clinical Director explained the operational delivery and that clinical time is safe guarded for patients. It was also noted that while e-consult forms do not work for every patient and are an expensive commitment for practises, they are a necessary part of moving healthcare forward. The Third Sector Rep asked the Clinical Director how communities were made aware of the cost of medication. The Clinical Director advised that strategies on stopping the prescription of certain medications, and inviting patients to buy medications like paracetamol themselves, have been explored but that no decision has been made at this time. The Clinical Director noted they would be happy to work on this further with Third Sector colleagues. 5.4 Reporting and Evaluation Midlothian IJB Directions Part Year Reporting – Gill Main, Integration Manager The Integration Manager presented the report and provided an overview of the process undertaken to deliver Midlothian IJB Directions 2025/26 Part Year Reporting. The Group Service Reports were collated by the Strategic Planning and Performance Service to describe the progress generated from service plan updates and Head of Service or Professional Lead Assurance (appendix 1) which were subject to a Quality Assurance exercise. This led to the synthesis and insight Heads of Service to present highlights of BAU supplemental to Directions at Next SPG Heads of Service 20h November 2025 Page 34 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments report generated in the Midlothian IJB Strategic Governance Outcomes Map (appendix 2). The Integration Manager noted that while the focus of the report relates to Directions and column 4, it should be noted that column 5 is the baseline position of progress towards the strategic aims and is currently limited without a mechanism to include the Business as Usual (BAU) of operations. As a result of this report, Members are asked to: • Note the activity undertaken and progress reported by Heads of Service and Professional Leads, • Review the Group Service Outcome Reports for each Group Service area, • 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, and • Provide feedback to inform the early development of Midlothian IJB Directions for 2026/27. The Chair thanked the Integration Manager and credited the team for all the work around this; the Chair opened to any questions or comments from the Group. The Chair noted that there was a lot of detail in this paper. He further noted the aggregate position provided in the IJB Strategic Governance Map Annex, and particularly the positive progress made, as reported on page 3 & 4. He also noted the section reporting “slower progress” and “other challenges and opportunities” and sought comment on this. The Chief Officer advised they are comfortable where there has been progress and advised that they are currently 3 months into a 10-year plan and there will be an improving picture moving forward. Page 35 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Integration Manager highlighted the improvement in the process for reporting on Directions, and the aim to significantly reduce the reporting burden. However, the Integration Manager also noted that Directions are a small subset of actions that are designed to progress the ambitions of the strategic aims. The Operational colleagues detailed that there have been challenges such as absence leading to a difficult summer period but advised they are clearer on reporting and expectations. Chair acknowledged the challenges of current pressures in operational services and further acknowledged that Directions reporting is rightly focused on Directions, but this does miss the significant contribution of BAU in relation to progressing the Board’s strategic aims. Chair therefore requested that operational leads to consider and share with the Group how this could be augmented so that SPG could better understand the totality of operational delivery. The Group endorsed the Chief Officer’s view that they are content with the progress reporting for Directions 2025/26. The Integration Manager also noted the ask of the Group to provide any comments proposing changes to be incorporated in Directions for 2026/27 i.e., what should we stop, start, do more, or do less of that will then be collated and discussed more specifically at the next SPG. The SPG to forward comments suggesting change or to start/stop something new regarding the part year reporting. The Strategic Planning Group. Before the Strategic Planning Group, 20 November 2025. 5.5 Annual Performance Report 25/26 Q1 Update – Lara Williams, Assistant Strategic Programme Manager. The Assistant Strategic Programme Manager presented the report populated with activity and data generated from the Q1 reporting quarter including Midlothian Council Q1 Performance data, Care Inspectorate Reports from April to August The Strategic Planning Group to review and provide feedback or amendments on the draft Q1 APR content. The Strategic Planning Group. 20th November 2025 Page 36 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments 2025, and any IJB activity and Governance decisions made in board meetings from April to August 2025. As a result of this report, Members are asked to: • Review the Q1 draft of the Midlothian IJB draft Annual Performance Report (APR) 2025/26, • Provide feedback and identify any required amendments, and • Provide any additional content identified. 5.6 Governance Midlothian IJB Participation and Engagement Statement 2025–2028 – Gill Main, Integration Manager The Integration Manager presented the report to the group. As a result of this report, Members are asked to: • Review and provide feedback on the draft Midlothian Participation and Engagement Statement 2025-2028, and • Subject to any amendment, recommend this draft plan to Midlothian IJB for approval at the 9th October 2025 Board meeting. • Review the Midlothian IJB participation and engagement activity recorded in the IJB Strategic Governance Outcomes Map Column 2 ‘Who with’ scheduled for Board review in December 2025. The Integration Manager highlighted that this statement is a statutory publication for the IJB and sets out how the Board will ensure it works alongside people and communities through participation and engagement activity in relation to Board Page 37 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments activity e.g., the IJB Strategic Plan, IJB Equality Outcomes, IJB Housing Statement etc. It was noted that there is also an ongoing action to recruit and support representative members to join the SPG and the IJB. The group discussed the action plan, and particularly Board member activity. It was agreed that this should be specifically flagged at the next IJB meeting. The Chair noted that SPG is not quorate so a decision to recommend this plan to the board could not be taken but suggested the Group forward any concerns to the Integration Manager as soon as possible to reach agreement offline. The Integration Manager to contact members requesting comments / suggestions to ensure the paper can be presented to October IJB Board meeting. The Strategic Planning Group/The Integration Manager. 29th September 2025. 5.7 Midlothian IJB Draft Carers Strategy – The Head of Adult Services & Chief Social Work Officer. The Head of Adult Services & Chief Social Work Officer presented the report setting out the progress being made to revise and update the Midlothian IJB draft Carers Strategy 2025-2028 in preparation for the recommissioning of support for unpaid carers. The draft strategy identifies some of the initial findings that will be developed in consultation with unpaid carers. As a result of this report, Members are asked to: • Note the progress and actions to be taken in the review and update of the Midlothian IJB draft Carers Strategy 2025-2028, • Provide feedback and note any recommended amendments, and • Note that the revised strategy will inform the recommissioning of the support for unpaid carers. The report was noted. A revised draft and ECRIA will be presented in the November SPG Head of Adult Services 20th November 2025 Page 38 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Head of Adult Services & Chief Social Work Officer advised there is a budget specifically set aside for carers, alongside other budget areas. It was highlighted that a potential risk lies around an increase in length of waits for people requiring assessments or support. The CEO of VOCAL explained the carers commissioning is around preventative support and early identification and that success should reach people early to prevent the crisis point while encouraging supports in the community. The Integration Manager noted that as a strategy of the board, Strategic Planning and Performance will provide support in developing the Carers Strategy in regard to format, connection to strategic aims, and accessibility, to ensure the draft meets the duties of the scheme of publication, equality act, and is in line with the wider suite of IJB Publications. Time with the Planning Officer for carers has been scheduled. 5.8 Emerging Risks and Key Messages for Sharing - Andrew Fleming, Chair The Chair noted to the Group that there were no emerging risks or key messages that they wish to share. The Integration Manager highlighted to the Group the development of the Participation and Engagement Statement and any comments should be received by return to enable the document to be reviewed by IJB. The Integration Manager also was requested that SPG consider any suggested amendments for Directions 2026 -2027 ahead of the November SPG to ensure efforts to achieve the strategic aims of the Strategic Plan can be included in planning. Page 39 of 180
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Strategic Planning Group 6. Date of next meeting The date of the next meeting will be Thursday 20th November 2025, 14:00- 16:00, Normandy Court or Online via MS Teams. The meeting terminated at 16:00pm. Page 40 of 180
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MIJB - Audit and Risk Committee Meeting Date Time Venue Audit and Risk Committee Thursday, 4 September 2025 2.00pm Virtual Meeting via MS Teams Present (IJB voting members): Councillor McManus (Chair, Midlothian Council) Dr Amjad Khan (Vice Chair) Councillor Parry (Midlothian Council) Councillor Milligan (Midlothian Council) Present (IJB non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Alan Turpie (Standards Officer) Present (Officers): Claire Gardiner (External Audit, Audit Scotland) Duncan Stainbank (Chief Internal Auditor) Roxanne King (Executive Business Manager) In attendance: Hannah Forbes (Democratic Services Officer) Apologies: Gill Main (Integration Manager) Antony Clark (Independent Member) Midlothian Integration Joint Board Thursday 11 December 2025 Item No 4.3 Page 41 of 180
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MIJB - Audit and Risk Committee 1. Welcome and Introductions The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Audit and Risk Committee (A&R). Apologies were received from Antony Clark (Independent Member) and Gill Main (Integration Manager). 2. Order of Business The Order of Business is as outlined in the agenda. There were no matters arising to be discussed. 3. Declarations of Interest No declarations of interest were received. 4. Minute of Previous Meetings 3.1 The Minute of the Audit and Risk Committee meeting held on 5th June 2025 was submitted and approved. 3.2 Action Log - The Action Log was noted by the Committee. 4.1 Audit & Risk Refresher presented by Duncan Stainbank, Chief Internal Auditor (Verbal Update) The Chief Internal Auditor provided a verbal update to the Committee relating to the Audit and Risk Refresher which was requested now that Councillor McManus is the new Chair of the Audit and Risk Committee. The Committee welcomed the Chair to the meeting. The Chief Internal Auditor presented the Terms of Reference (ToR), reflected on the good practice of the Chair, Committee Members and noted the Position Statement of the Audit and Risk Committee. Page 42 of 180
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MIJB - Audit and Risk Committee The Chair thanked the Chief Internal Auditor for the refresher. 4.2 IJB Complaints, presented by Roxanne King, Executive Business Manager (Verbal Update) The Executive Business Manager provided a verbal update, confirming that one complaint had been received during the reporting period relating to a funding decision, which was managed in line with the existing policy. Work is underway to revise the Complaints Policy, led by the Executive Business Manager, Chief Finance Officer, Business Support Manager and Midlothian Council. As the IJB’s record keeping partner, Midlothian Council is exploring use of an in-house system to improve accessibility and resilience in managing complaints. An updated policy and approach are expected to be presented to the Committee once developed. 5 Public Reports Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.1 Risk Register Update 2025/26, presented by Chris King, Chief Finance Officer The Chief Finance Officer presented the Risk Register noting the purpose of this paper is to present the updated Midlothian Integration Joint Board (MIJB) Risk Register for review and update at quarter two 2025/26. As a result of this report, Members are asked to: Consider whether any further risks should be added, or existing entries amended. Review, and subject to any required amendments, agree the updated Risk Register at quarter two 2025/26. Consider and approve the proposal to remove the risk register from Datix. The Chair thanked the Chief Finance Officer for the report and opened to the Committee for questions. Update risk register – risk 3 and 5 Chief Finance Officer December 2025 Page 43 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Committee discussed Risk 3, questioning whether the current scoring reflected the level of exposure. The Chief Officer and Chief Finance Officer agreed that the scoring should be increased. Risk 5 was also considered, with members referring to previous discussions on cumulative growth pressures and whether a separate risk should be created to capture these. The Chief Finance Officer advised that a new risk was not recommended but agreed that the narrative for Risk 5 could be made more explicit, particularly in relation to financial pressures. The Committee agreed to increase the scoring of Risk 3 on the Risk Register and supported strengthening the financial elements within Risk 5. 5.2 Draft Audited Annual Accounts 2024/25, presented by Chris King, Chief Finance Officer The Chief Finance Officer presented the report. The report presents the Midlothian IJB draft audited annual accounts for 2024/25 (appendix 1) for review and comment ahead of recommendation to Midlothian IJB for approval. As a result of this report, Members are asked to: Note the report of the independent auditor Recommend the 2024/25 annual accounts to the IJB The Chair thanked the Chief Finance Officer for the report and opened to the Committee for questions. There were no comments or questions from the Committee. The committee supported the accounts being submitted to the IJB for full sign off. Approved Page 44 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.3 External Audit Opinion: Draft Audited Annual Accounts 2024/25, presented by Claire Gardiner, Audit Scotland Audit Scotland presented two reports to the Committee. The first, a covering letter, set out conclusions from the audit of the financial statements and confirmed Audit Scotland’s intention to issue an unmodified audit opinion. It was noted that no unadjusted errors had been identified and that outstanding items referred to assurance from Council Auditors, which has since been received with no issues arising. Appendix B was noted, containing the Letter of Representation to be signed by the Accountable Officer on behalf of the IJB, providing assurance on key judgements within the Annual Accounts. The Committee was asked if there were any issues to raise; none were identified. Audit Scotland then presented the second report, covering the financial statements audit, again confirming the intention to issue an unmodified opinion. Audit Scotland highlighted the exhibits within the report and acknowledged the challenges facing the IJB, noting the local actions underway to address risks, including the Transformation Programme. They thanked IJB officers for their support throughout the audit process. The Chief Officer raised the matter of Best Value 4 relating to the annual performance report and noted that the statutory publication date had not been achieved due to the unavailability of national data. Correspondence has been sent to the Scottish Government seeking guidance on this issue. In response to a question from the Chair regarding the implications of missing the publication deadline, Audit Scotland advised that this does not affect the audited accounts or audit opinion. However, it remains a statutory deadline. Audit Scotland confirmed that they have a duty to Noted Page 45 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments report any missed deadlines but recognised there are reasonable explanations where national data is delayed. 5.4 IJB Records Management Policy, presented by Roxanne King, Executive Business Manager The Executive Business Manager noted to the committee the purpose of this paper is to present the IJB Audit and Risk Committee with the updated Midlothian IJB Record Management Plan. As a result of this report, Members are asked to: Note the contents of the Records Management Plan. Support the recommendation that the plan is submitted to Midlothian Integration Joint Board (MIJB) for sign off and submission to the National Records of Scotland. The Executive Business Manager sought clarification from the Chief Internal Auditor on whether the recommendation should be submitted to the IJB in the first instance. The Chief Internal Auditor confirmed that it should first be submitted to the record keeper and then to the IJB. The Chair thanked the Executive Business Manager for the report and invited questions. The Chair asked whether the IJB is currently using artificial intelligence (AI) technology, as referenced in the report, or if there are plans to do so in the future. The Executive Business Manager advised that AI technology is currently being used on a limited basis. Co-Pilot and ChatGPT licences are available but require approval prior to use. Co- Pilot, which is part of Microsoft 365, has recently had some trial licences approved. It was noted that Midlothian Council is more advanced in this area than NHS Lothian and is in the early stages of drafting an AI Policy, which will be incorporated into the Record Management Plan. Approved. Page 46 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.5 Draft IJB Reserve Policy, presented by Chris King, Chief Finance Officer The Chief Finance Officer advised the Committee that this report presents the Midlothian IJB draft Reserves Policy (appendix 1) for review and comment ahead of recommendation to Midlothian IJB for approval. As a result of this report, Members are asked to: Review the amended Midlothian IJB draft Reserves Policy Subject to any further amendments, recommend this policy to Midlothian IJB for approval. The Chair thanked the Chief Finance Officer for the report and invited questions. The Committee noted that both Partners are currently holding 2% reserves. It was highlighted that Midlothian Council holds 2% reserves on the full allocation of its finances, while the MIJB also holds 2%, and a query was raised as to why both Partners maintain this level when it might be expected to apply only once. The Chief Finance Officer explained that each Partner is a separate legal entity and that, nationally, guidance indicates that a 2% reserve is considered the optimal level to ensure financial resilience. The Chief Officer agreed to discuss the matter further with the Chief Finance Officer/Section 95 Officer from Midlothian Council. The Chief Internal Auditor confirmed that the current position aligns with national guidance but noted it would be helpful to seek clarification from the Scottish Government on whether reserves should be held separately or collectively. The Chief Finance Officer asked the Committee to endorse the policy in its current form, noting that this position would be clearly referenced in the IJB paper. The Committee agreed to endorse the policy as it currently stands. Approved. Additional clarification on Council reserve policy Chief Finance Officer December 2025 Page 47 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.6 Midlothian Council Internal Audit Report, presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor noted the purpose of this paper is to inform the Audit and Risk Committee of the Midlothian Council Internal Audit Report on Revenue Financial Budget Monitoring providing Reasonable Assurance. As a result of this report, Members are asked to: Note the findings of the Midlothian Council Internal Audit on Revenue Financial Budget Monitoring. The Committee queried the section of the report rated as limited, relating to revenue monitoring reports, and asked whether any further actions could be taken to improve this to a reasonable rating. The Chief Internal Auditor advised that the necessary actions have now been implemented. The limited rating related to the adequacy of revenue budget reporting, as verbal updates were previously not reflected within the overall Council spend. This has been addressed for the 2025/26 financial year, ensuring that revenue reporting is now fully incorporated within the total Council expenditure and subject to appropriate scrutiny. Noted 5.7 Review of Standing Orders, Scheme of Administration, and Scheme of Delegation, presented by Alan Turpie, IJB Standards Officer (Verbal Update) The IJB Standards Officer reminded the Committee that a review of the Standing Orders and Scheme of Administration had been undertaken in 2022, concluding in February 2023, when Page 48 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments proposed changes were approved and the Scheme of Administration was accepted with no further amendments required. Following a recent review, only minor amendments were identified within the Scheme of Administration, with no changes proposed to the Standing Orders. The IJB Standards Officer provided a high-level overview of both documents and invited Committee members to provide feedback either during the meeting or subsequently by December. The Committee agreed to the review and noted the IJB Standards Officer’s summary. It was confirmed that no instances had arisen since 2023 that would require further amendment and that the existing Standing Orders remain fit for purpose. A minor typing error was noted in the Scheme of Administration, where the reference to “Audit and Performance” should read “Audit and Risk”. The current quorum arrangements were discussed, and the Committee agreed that a requirement for at least one voting member from each partner to be present within the quorum of three members would be appropriate, reflecting the spirit of integration. The Committee reviewed Paragraph 13 outlining the specific powers and remit of the Committee and agreed that members would consider whether any additional powers may be required and feed back to the IJB Standards Officer. The Scheme of Delegation, detailing actions delegated to the Joint Director, Chief Finance Officer, Chief Internal Auditor and IJB Standards Officer, was also noted to remain sufficient. The Chair requested that members review the documents discussed and submit any further feedback to the IJB Standards Officer. It was also noted that ensuring representation from both partners at all meetings would help maintain fairness and prevent potential conflicts. The Audit and Risk Committee to revise the Standing Orders, Scheme of Administration and Scheme of Delegation. The Audit and Risk Committee. December 2025. Page 49 of 180
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MIJB - Audit and Risk Committee 5. Private Reports No items for discussion. 6. Any Other Business No items for discussion. 8. Date of Next Meeting The meeting terminated at 15:00pm. The next meeting will be held on Thursday 27 November 2025 at 14:00-16:00 via MS Teams. Page 50 of 180
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Midlothian Integration Joint Board Thursday, 11 December 2025, 14:00-16:00 Chief Officer Report December 2025 Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting December 2025. Board members are asked to: • Note the content of the report. # Item number: 5.2 Page 51 of 180
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Report Chief Officer Report December 2025 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting December 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 Unscheduled Care The Unscheduled Care focus on system wide improvement to reduce acute bed occupancy by shifting the balance of care to the community continues by: • Maximising capacity for supported discharge • Increasing admission prevention • Earlier identification of Midlothian residents in acute who require HSCP support • Improving downstream flow System wide improvements continue to be identified, with actions underway across many of our teams. This includes a body of work in Midlothian Community Hospital, which will be implemented in 3 phases. The initial phase is focussing on good discharge planning, flow in and out of the hospital, ward improvement plans, training (multi agency focussed), and data gathering. Hospital at Home have implemented actions to increase referrals into service and are reviewing processes to enable more people to be supported at home, as an alternative to hospital admission. Many of our teams are also working in collaboration with the British Red Cross, to facilitate good conversations around third sector support for discharge planning and by putting third sector support in place to enable Midlothian residents to come home from hospital earlier. Page 52 of 180
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Through the work underway, Midlothian HSCP have demonstrated improved acute bed occupancy performance, which has been sustained over a number of weeks now. In addition, there is early data emerging which suggests a significant and sustained improvement in patient journey for our over 75 cohort of patients. This includes decreased LOS and reduced delays. This is important due to the health inequalities this group of patients often face. Voting Rights for Lived Experience on Integration Joint Board Members Scottish Ministers are exploring amending regulations to extend voting rights to Lived Experience members of Integration Joint Boards within this parliamentary session. This would see an amendment to the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (the 2014 Order). In this context, ‘Lived Experience’ applies to board members with lived experience of services, unpaid carers, Third and voluntary sector representatives). As with all proposed changes, there are a range of views across Scotland on this matter that recognise the benefits and practical challenges. Scottish Government have consulted on this matter with IJB Chairs, Vice Chairs and Chief Officers and we submitted our collective response on the 5th December 2025. Midlothian Federation of Community Councils The Midlothian Federation of Community Councils have invited members of Midlothian IJB supported by officers of the HSCP to be guest speakers at their meeting on 21st January 2026. This will be attended by Midlothian IJB Chair, Vice Chair, Chief Officer and other members of the HSCP Executive Team. Should other Board members wish to join this meeting or play a more active role in the discussion, please contact Jac Kinnard (jacqueline.kinnaird@nhs.scot). Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Head of Adult Services Welfare Rights Service The Welfare Rights Service is based within the Health and Social Care Partnership and provide welfare benefits advice to individuals within Midlothian including advice to cancer patients in partnership with MacMillan Cancer Support. The team is comprised of four staff who offer support and advice to many of the most vulnerable presidents of Midlothian who may have a disability, be at state pension age or over, receiving a social work service (Child or Adult Services). Referrals are received from across the Council and HSCP; No 11, Children Services, Adult Health and Social Care Services, Housing, Revenues, Midlothian Community Hospital and GP Surgeries. In addition to the referrals from partner agencies, the team operate a telephone advice line that supports members of the public to make a self-referral or to seek advice only. Due to increase in the number of referrals we have been able to recruit an additional part-time member of staff on a fixed term contract. The successful candidate is currently completing pre-employment checks, and we look forward to welcoming them to the team soon. Page 53 of 180
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During Quarter 2 the work that the team completed generated over £1 million pounds in additional income for the individuals they supported. Learning Disabilities In this quarter, Care Inspectorate inspections have been completed for Penumbra (Park Cottage) Mental health service, and Midlothian Council Community Access Teams. Both these services improved their grades with Penumbra being awarded two ‘excellent’ grades which is a great achievement. Justice Service The Justice Service continues to work with partners to ensure that, alongside the statutory provision of services to the courts and management of men and women on community-based supervision, we are able to provide a robust level of early intervention and prevention services. From the 1st November 2025 the provision of Diversion from Prosecution will be available locally. Prio to this people from Midlothian received this service from Edinburgh Justice Service. Diversion from Prosecution is a process by which the Crown Office and Procurator Fiscal Service (COPFS) are able to refer a case to social work as a means of addressing the underlying causes of alleged offending when this is deemed the most appropriate course of action. There are three benefits from successful diversion: 1. It allows the individual an opportunity for support to deal with the issues personal to them in the context of the alleged offence (from a desistance perspective); 2. Avoiding unnecessary contact with the criminal justice system; and 3. The individual does not receive a conviction for the alleged offence, which can impact on their longer-term employment opportunities. You may have read in the news that the prison population in Scotland has reached an all-time high. On the 21st October the total number of people in prison was 8,430 (the official operating capacity is 7,805); 11 out of 17 prison establishments are at Red Rag Status which means they are unable to deliver a full regime, including delivery of rehabilitative work. The Justice Team Leads and the Community Justice Partnership Co-ordinator, have been working collaboratively with colleagues from Scottish Prison Service, Scottish Government and Social Work Scotland to consider all steps that can be taken to reduce the pressures. This includes pre-planning for the potential release of prisoners as part of Emergency Early Release. Should Parliament vote to pass this legislation the release for prisoners will commence from mid November 20025. We have reflected on the learning from the successful release of prisoners from the previous Emergency Early Release (summer 2024) and the release of prisoners following the changes to the time served for Short Term Prison Sentence (February 2025). As such we are confident that we will meet the needs of those being released. Public Health: Green health prescribing update – Midspace, Green health week and Deep Green pilot The Green Health Prescribing Group has continued to meet to work towards its objectives of aiming to embed green health prescriptions into existing systems in an equitable and sustainable way. Page 54 of 180
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The Green Health Group consists of providers who provide green health activities to the public and prescribers who may prescribe green health activities with people who access their services. The group is made up of Health in Mind, MAEDT, Bugslife, Loanhead community garden, Cyrenians, Woman’s AID, Thistle Foundation, Cycling UK, Archaeology Scotland, Newbattle College, Vocal, Sport and Leisure, Active travel, Mental Health, Physiotherapist, Occupational therapists and public health. The group worked on a project with NHS Lothian Charity and Health in Mind to improve the green health prescriptions pages on Midspace and ensure consistency across NHS Lothian. The group user tested the new pages [Midspace | Green Social Prescriptions] and also provides regular updates to ensure the information stays up to date. During Q1/2 we have been promoting the new Midspace webpages, both with staff and the public. In May 2025, we promoted national green health week. The aim nationally was to raise awareness of green health in general and also the Green Health Learning Network (which Midlothian is a member of). Our local aims were to raise the profile of the Midspace pages. We utilised the HSCP & council social media channels between Monday and Friday of Green Health Week. Posts on Facebook performed better for than those on Twitter/X as it has a larger and more engaged user base. The group also promoted the pages at ‘Vogrie Porgie’ in Dalkeith and the community Falls prevention day in Lasswade. Subsequently, we have seen an increase of views of the pages and increased membership of the working group. The Green Health Group has also engaged with researchers from Edinburgh University who are carrying out research looking at ‘Developing and pilot testing a primary care- based toolkit to improve engagement with green health prescribing of older people living in deprived areas.’ The Green Health Prescribing group members in Midlothian have been inputting into this research and giving feedback at various stages. This accumulated in an event in September aimed at reviewing and providing feedback to the toolkit they have developed called ‘Deep Green’ https://www.deepgreen.scot/ . The toolkit is designed to help GPs and other health and social-care practitioners working in primary care to prescribe outdoor, nature-based activities. The toolkit provides support, information and evidence about Green Social Prescribing. It can be used by practitioners looking for help to add or expand Green Social Prescribing in their practice. It can also be used for people interested in the subject more generally. The toolkit is currently being piloted in 4 medical practices in Edinburgh. Following this engagement event, we have shared the research with the primary care planning team and will look for opportunities to develop further pathways and champion green health locally. The Public Health team have also attended national webinars, one was run by Public Health Scotland’s Green Health Network which looked at strengthening practice through shared learning. The other was through Stirling University looking at the findings of a research project using green health to support people with mental health and substance abuse dependence. Learning from the events has been shared with the Green Health Group and further actions will be developed to embed the learning into future work. Page 55 of 180
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New developments and successes The Mental Health Social work and MHO team is continuing to focus on developing resilience across all workstreams. In particular we are continuing to expand MHO capacity across adult services and will soon be starting 2 MHO trainees within the team. We also have a newly qualified MHO seconded to the team for a few months who is using the time to consolidate her training and learn new skills that she can bring back to her specialist team. Midlothian Substance Use Services Bloodborne viruses (BBV) is a significant health concerns for individuals who access Substance Use Services due to the potential for transmission through contact with infected blood or bodily fluids. Within substance use the main risk of transmission is through the use of sharing of injecting equipment. The lack of awareness and testing can lead to undiagnosed infections which can result in serious health complications. To address the issue of BBVs in substance use services, it is essential to implement comprehensive testing and treatment programs. This includes offering testing and referral for treatment for hepatitis B, hepatitis C and HIV, as well as vaccination for hepatitis B. By ensuring that individuals inservice are tested and receive appropriate treatment, the risk of transmission can be significantly reduced, thereby improving the health and safety of all individuals in the service. In July 2024 we recognised the need to look at different ways to engage individuals who access the Midlothian Substance Use Services as BBV testing had a small uptake. The overall percentage of uptake was 18.5%, over the next year the service worked alongside the harm reduction team to look at ways to improve engagement through awareness sessions and communication with those who access the service. An improvement plan was developed and implemented which has been successfully completed. There was a review of the improvements on uptake of BBV and we are pleased to advise the service performance more than doubled and in July 2025 was 41.6% and continues to grow. Midlothian Substance use service continue to progress the committed improvement work to ensure every individual who is receiving Opiate replacement therapy is supported, educated and has access to BBV testing. Staff Wellbeing, Experience and Engagement The HSCP Staff Wellbeing support system develops, implements, and evaluates a range of high-quality and research-based wellbeing, experience, and engagement processes, in order to enable, empower, sustain, and retain health and social care staff. One size doesn’t fit all, we therefore endeavour to offer tailored support to individuals, teams, and services. To achieve this Midlothian HSCP embeds five foundational pillars – The Midway. Wellbeing: We seek to create a positive state of mind and body which is underpinned by social and psychological wellbeing. Equity: We strive for equity recognising that we must adjust to reduce imbalance. Page 56 of 180
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Learning: We offer opportunities to learn. Furthering our knowledge and developing our skills. Leadership: We encourage individual and group involvement to positively influence, guide, and improve. Communication: We communicate information, intentions, and emotions in a way that is clear, respectful, and understood. Numerous factors influence the health and wellbeing of our health and social care staff. Some of these, such as physical health are well understood, however, there are other influencers such as psychological burden, relationships, management skills, and the environment that are fundamental to the wellbeing of our workforce. This report spotlights activities undertaken this quarter and the underpinning evidence to support the health and wellbeing of Midlothian HSCP staff. The staff of Midlothian HSCP are all working towards the same goal, that everyone working here is equally valued and supported to succeed. We believe that whoever you are, whatever you do, and wherever you work in the partnership, you can make a valued contribution and feel included. To achieve this, we implement actions which positively influence the 4 key drivers (p10-11) outlined within our Staff Wellbeing, Experience and Engagement Delivery Plan 2025-2028. The National Workforce Wellbeing week took place from the 1st to the 7th September. The week-long programme designed for health, social work, and social care staff offered 35 free online sessions to support meaningful conversations and promote wellbeing within the workplace. Midlothian offered 5 National sessions across the week. Topics included how to use cognitive behavioural approaches to manage stress, menopause, and mindful movement and meditation. Over 200 people attended the Midlothian HSCP sessions. The National Workforce Wellbeing week inspired the planning and delivery of a HSCP Wide wellbeing event held on Friday 5th Sept. All staff were invited to visit Midlothian Community Hospital to share the Staff Wellbeing, Experience, and Engagement strategy and delivery plan, and to participate in the programme of activities. Activities included access to the team building box, ebikes, silent disco, and hand massage. In addition, stands were provided by Midlothian Council, NHS Lothian, and Third sector. The event was attended by over 60 staff with prizes being won by several teams through the contribution of ideas and personal and/or team nomination. The new strategy outlines our vision and objectives and guides our priorities over the next three years. Through the delivery of the plan, we have the opportunity to celebrate our strengths, improve, and understand what matters to staff. By bringing the programme of support to staff and sharing the priorities of the delivery plan we have the opportunity to create greater awareness, communicate ideas, and engage with the issues which matter to staff. A significant priority this quarter has been engaging with national and local wellbeing events aligned to the National Workforce Wellbeing week and effectively communicating the new Staff Wellbeing Experience and Engagement Strategy. To enable this the HSCP requires full commitment from the Senior and Extended management team. Page 57 of 180
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Throughout August scripts were created, outlining the aims and objectives of the strategy. To reinforce our managers commitment to this work, four senior managers kindly promoted the principles of health, meaning, leadership and listening within a series of promotional videos. Links were distributed at the start National Wellbeing Week (1st Sept), and culminated on the 3rd of October as we completed ‘ Speak Up week. During this period the HSCP worked closely with the communications team to offer a multimode approach to the sharing of the strategic plan. The design team created pull-up banners, table tents, and A6 postcards outlining the four drivers. The postcards not only allow us to promote our aims but offers us a new method of capturing staff thoughts and experience during local engagement sessions and through site feedback boxes. Work has meaning and a positive impact, Interim Head of Service Fiona Kennedy https://youtu.be/xIhifZzaldY Work if a healthy place to be, Chief Nurse Fiona Stratton https://youtu.be/jMkSY5wjsgc We are all able to show leadership, Head of Adult Services & Chief Social Work Officer, Nick Clater https://youtu.be/xXw8EwGWp0k We are listened to and feel heard, Director of Midlothian Health and Social Care Partnership, Morag Barrow https://youtu.be/nuzcNnSgiRk Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Head of Primary Care and Older People Community Nursing A review of community nursing services in Midlothian is now underway, following the first staff engagement session held in October 2025. A core group and a review delivery group have been established to lead this work, with the intention of producing a final report by May 2026. The report will set out proposals for a sustainable, person- centred and integrated model of community nursing aligned to the recommendations of the Pan-Lothian Community Nursing Review. At present, the outputs of the Pan- Lothian Review, launched in January 2024 in recognition of shared challenges across all four Lothian Health and Social Care Partnerships, are still awaited. The future model will need to respond to current and emerging population health needs and support long-term workforce sustainability, care quality and improved outcomes. Vaccination Programme In response to the national call for urgent action to increase flu vaccination uptake, issued by the Cabinet Secretary for Health and Social Care and the Chief Medical Officer on 10 November 2025, Midlothian Health and Social Care Partnership has revised its delivery plans for the winter vaccination programme. This action is driven by surveillance data showing the highest infection positivity rates to date, with a particular focus on children aged five to fourteen and frontline NHS and social care staff. The revised plan has been approved by NHS Lothian’s Vaccination Programme Board and will be implemented from the week beginning 17 November. This acceleration will place additional pressure on local delivery teams over the winter period, and resilience will need careful monitoring as activity increases at pace. Page 58 of 180
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Midlothian Community Hospital Work continues on Phase 1 of the Midlothian Community Hospital review, commissioned through the Transformational Programme Board. This phase aims to develop a refreshed redesign of inpatient and outpatient services that reflects predicted future demand and aligns with key programmes including Home First, Hospital at Home, the social care review and third sector commissioning. The core objectives include completing a full DCAQ analysis, reviewing referral and discharge processes, planning workshops to support development of the future model, and identifying critical interfaces with community services. Early findings indicate that future inpatient capacity is likely to be lower than current levels, with the possibility of reinvesting resources into community-based support models. This shift will require coordinated planning to ensure that community capacity can meet anticipated demand. Primary Care National developments in primary care funding are also of significance. The BMA Scotland Practice Committee has ended its trade dispute with the Scottish Government, following acceptance of an investment package for general practice totalling £531 million over three years. Subject to parliamentary approval of the 2026– 27 budget, implementation will begin in April 2026, with £98 million allocated in the first year, rising to £183 million in 2027–28 and reaching a recurring £249 million in 2028–29. This investment builds on the additional £15 million allocated in 2025–26 to strengthen workforce capacity. While detailed allocations against the six identified priority areas are still to be provided, it is notable that no reference has been made to drop-in GP centres. This creates some uncertainty for local planning until further clarification is available. Grace Cowan, Head of Primary Care & Older People - grace.cowan@nhs.scot 3.4 Strategic Planning and Performance Unscheduled Care Data and Insight Support Strategic Planning and Performance have begun a programme of work to support data interrogation and insight in relation to the impact the Midlothian unscheduled care improvement work. This includes understanding the impact over time of the interventions already underway as well as where there may be additional opportunities to improve. Some of this work will be presented in the December IJB meeting. Financial Planning and Insight Support Strategic Planning and Performance have also commenced a significant programme of work to support the delivery of the Medium-Term Financial Strategy that will improve the ability of the IJB to access more elements of real time financial data. This work is set out in the draft Medium-Term Financial Strategy and is supported by an overarching project brief and 4 interconnected workstreams of activity. The priority focus is currently to understanding specific components of the social care data and will expand to include health data when data sharing agreements are in place. This work is being led by the Integration Manager and the Chief Finance Officer. Page 59 of 180
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Gill Main, Integration Manager – gill.main3@nhs.scot 3.5 Chief Allied Health Professional Ministerial visit: ANIA Midlothian HSCP facilitated a Ministerial visit on Tuesday 28th October. Jenni Minto, Public Health Minister met with patients and service users within our hosted Dietetic Service, specifically Weight Management and Type 2 Prevention Team. The visit was prevention focused recognising that over the past five years, the service has successfully delivered both the diabetes remission programme and our award- winning prevention programme, supported by permanent Scottish Government funding. The positive impact of these programmes has led to further investment in digital expansion through the Accelerated National Innovation Adoption (ANIA) pathway, with nearly £10 million committed nationally to enhance and complement board-level delivery. The ANIA digital programme will support prevention by empowering people with pre- diabetes to make meaningful lifestyle choices that will significantly reduce their risk of developing type 2 diabetes. This evidence-based approach will support individuals over a nine-month period to sustain changes whilst reducing demand on services and improve patient outcomes. NHS Lothian is championing innovation and prevention as strategic priorities, and these new digital services will improve access and outcomes for patients across the region with direct referral from primary care into the programmes without long waiting times. Weight Management Design Accelerator UK Research and Innovate supported a three-month design project within our Weight Management and Type 2 Prevention Service. This work, in collaboration with Digital Health and Care Innovation Centre (DHI) aimed to support a Once for Scotland approach to equitable, scalable obesity care. Alongside five other Health Boards, the design work focused on the full obesity/weight management pathway. Our accelerator project focused on digital triage. The aims were to ensure consistent triage of referrals, reduced inefficiencies in terms of data gathering, improved risk stratification, enabling integration with psychology screening and that the solution was scalable. The project closed in October and has enabled a conceptual design of a digital triage system, integrating personal and clinical data. In additional it has demonstrated that this method enables high risk patients to be identified earlier and that pathways have been optimised. This work has formed a fundamental component in a recent grant application to the Obesity Pathway Innovation Programme (OPIP.) The application to this three-year funding opportunity includes operationalising the components of this digital design work from across all six participating health boards into a fully digital pathway. This will support service delivery, respond to demand and create opportunity to test additional pathways for anti-obesity medicines (GLP-1.) Successful grants are expected to be announced in March 2026. Page 60 of 180
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Community Appointment Day A Falls Prevention Community Day was held on 24th September 2025 creating opportunity for Midlothian citizens to have access to a range of professionals, third and voluntary sector organisations to support self-management. Designed to support falls, bone health and frailty and creating a space for conversation over consultation, our early analysis tell us • In total 221 people attended the Midlothian Community Falls CAD (NB an extensive communications plan supported this work) • 208 were attending as falls participants (M59:F149) • 13 people attended as carers • 34 of the falls participants also recorded themselves as carers for others • The main age ranges were 70 – 79 years old (n = 91) and 80 – 89 years old (n = 63) • Overall, there was high satisfaction from people attending the event, and supporting the event • Participants could access anyone of their choice on the day. Ageing well recorded their highest number of functional fitness testing MOT’s – 103. • A falls passport was developed and tested based on the findings of the 2024/5 MHSCP Frailty Programme The full evaluation report will be completed by January 2026 including patient experience questionnaire, focus groups, communication strategy evaluation and professional and organisational feedback. Given the early date, two further sessions are in planning for 2026. This is enabled by the production of a planning tool, describing the resource requirements for the session and critical steps in the planning process. A three- year research grant is also being explored to enable this work to be facilitated across the Lothian Health and Care system alongside rigorous evaluation. Orthopaedic Rehabilitation A recent feasibility trial has been undertaken In collaboration with Royal Infirmary Edinburgh (RIE) Orthopaedic physiotherapy rehabilitation team (June to September 2025.) This work has enabled orthopaedic rehabilitation of Midlothian residents within Midlothian Community Hospital. Previously such rehabilitation was only provided within RIE and so our data demonstrates improved choice for patients, reduced health miles, optimising and augmenting local rehabilitation facilities and supporting staff development. Scottish Health Awards Claire Yerramasu, our Community Respiratory Team Lead has been awarded the national AHP Health Hero Award in the Scottish Health Awards 2025. Recognising Claire’s work with community respiratory teams across the health and care system, utilisation of digital and data, contribution to research, digital and data capabilities and contribution to third sector and wider general respiratory teaching and education throughout Scotland and the UK. We are thrilled that Claire’s efforts, professionalism and passion have been recognised on a national level Claire Ross, Chief AHP – claire.ross4@nhs.scot Page 61 of 180
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3.6 Chief Nurse Palliative Care The National Palliative Care Strategy ‘Palliative Care Matters for All’ was published in September Palliative Care - Publications. The strategy has two overarching aims: Enabling people and communities : Scotland is a place where people of all ages and their communities can help and support each other to live as well as possible with life shortening conditions, dying, death and bereavement. Strengthening palliative care: People of all ages with life shortening conditions and their families and carers receive palliative care, care around dying and bereavement support based on what matters to them. The overarching aims are underpinned by eight outcomes that set out the changes the Strategy is intended to deliver and the associated delivery plan has 23 actions and describes the steps and governance needed to deliver them Palliative Care Matters for All - Palliative care strategy initial delivery plan (2025-28). The MHSCP Palliative and End of Life care group is actively taking forward work to address actions relevant to the delivery plan and the wider intent of the strategy, and to respond to a local self-assessment of services as it progresses work to design a transformed model of palliative care. The group has recognised significant opportunity and potential to improve service offers, practice and outcomes, but recognises that Midlothian’s delivery of palliative care sits within the context of the recognised need for transformation at national and Lothian levels as well as within our locally delivered services. NHS Lothian Community Nursing review The Pan Lothian Community Nursing Review is expected to be shared imminently and work continues to drive early recommendations forward to support service improvement and redesign, whilst addressing key pressures. A workplan is in development to support the delivery of the review recommendations taking into account local drivers, challenges and opportunities in order to configure local services that are relevant to the needs of local people and communities. Fiona Stratton, Chief Nurse – Fiona.stratton@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. Page 62 of 180
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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 December 2025 Page 63 of 180
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Midlothian Integration Joint Board Thursday, 11 December 2025, 14:00-16:00 Finance Quarter Two 2025/26 Update Executive summary This paper provides an update on the financial position of Midlothian Integration Joint Board (IJB) for 2025/26, incorporating the quarter two financial forecast and progress against the agreed financial recovery plan. The quarter two financial position for 2025/26 highlights a deterioration in the IJB’s position, with the current forecast showing an overspend of £3.258 million. This reflects the combined impact of rising demand, increasing complexity of care, and wider inflationary and workforce pressures across the health and social care system. Although significant progress has been made in delivering the agreed financial recovery actions, £4.181 million forecast against a target of £5.801 million, several key strategic redesign programmes will not deliver their full benefit within this financial year. These programmes remain essential for financial sustainability, but the revised timelines limit their contribution in 2025/26. Adult Social Care continues to be the primary area of financial pressure. The Resource Panel is now routinely considering more than 40 requests per week, with data showing that cost growth is driven not only by new demand but also by increasing complexity for people already receiving support. In response, a series of immediate management actions have been implemented, including strengthened vacancy controls, targeted sickness management, a focused review of internal Care at Home services, and work to improve income recovery systems and data quality. These actions aim to stabilise the position, slow further deterioration, and support a more sustainable position. Despite these interventions, the risk of the IJB being unable to achieve financial balance in 2025/26 remains significant. Any overspend would revert to Partners under the Integration Scheme, presenting both operational and financial challenges at a time when NHS Lothian and Midlothian Council are each facing their own substantial pressures. Members are asked to: • Note the delivery of financial recovery actions in 2025/26, • Note the quarter two 2025/26 forecast financial position, and • Consider the risks laid out in Section 8. Item number: 5.5 Page 65 of 180
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Report Finance Update: Quarter Two 2025/26 1 Purpose 1.1 The purpose of this paper is to update members on the 2025/26 financial position including both the financial forecast for quarter two and the progress against the agreed financial recovery actions. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the delivery of financial recovery actions in 2025/26, • Note the quarter two 2025/26 forecast financial position, and • Consider the risks laid out in Section 8. 3 Background and main report 3.1 2025/26 IJB Financial Position This report sets out the financial performance of the IJB for 2025/26, including the forecast outturn position based on six months of financial data to the end of September 2025. Financial reporting continues to align with both the IJB’s Financial Regulations and the requirements of the Midlothian Integration Scheme. 3.2 On the 27th of March 2025, Midlothian IJB approved a balanced budget for 2025/26, based on a suite of financial recovery actions. Significant progress has been made against the identified actions – a summary of the progress is shown in the table below. Table 1 - 2025/26 Recovery Progress Target Forecast Delivery Progress £’000 £'000 % Operational Recovery Actions 4,989 3,829 76% Strategic Redesign Recovery Actions 812 352 43% Total 5,801 4,181 3.3 Several the key strategic redesign recovery actions are now not expected to deliver their full planned benefit within the current financial year. This includes the reinstatement of the Older People Day Care commissioning (£0.136m), the Adult Day Service Review (£0.2m), and the Transport Review led by Midlothian Council (£0.1m). While these programmes remain critical to achieving medium-term sustainability, the revised timelines mean their in-year financial contributions will be lower than originally planned. Work is already underway to identify and implement mitigation measures to Page 66 of 180
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maximise the level of savings that can still be delivered in 2025/26 and to ensure these programmes remain aligned to the broader transformation agenda. 3.4 As highlighted at quarter one, despite ongoing efforts to improve the financial position, the updated financial modelling undertaken by both Midlothian Council and NHS Lothian continues to indicate a significant overspend for the 2025/26 financial year. The position has further deteriorated between quarter one and quarter two, with the revised forecast now showing an anticipated overspend of £3.258 million. 3.5 The table below reflects the 2025/26 forecast outturn against budget: Table 2 - 2025/26 Forecast Outturn Budget Forecast Variance: £’000 £'000 £'000 Adult Social Care Services 71,517 73,693 (2,176) Core Health Services 85,088 85,001 87 Share of Pan Lothian Hosted Services 19,317 19,630 (313) Share of Acute Set Aside Services 21,364 22,219 (856) Total 197,286 200,543 (3,258) 3.6 The financial environment remains highly challenging with high inflation, constrained funding, rising demand, and national decisions all directly impacting the cost of service provision. Collectively, these factors are placing significant pressure on the ability to deliver health and social care services within the available budget. 3.7 The table below reflects the 2025/26 forecast movement from quarter one to quarter two: Table 3 - 2025/26 Forecast Movements Q1 Q2 Movement: £’000 £'000 £'000 Adult Social Care Services (1,429) (2,176) (747) Core Health Services 6 87 81 Share of Pan Lothian Hosted Services (489) (313) 176 Share of Acute Set Aside Services (1,127) (856) 271 Total (3,039) (3,258) (219) 3.8 As noted above, the Social Care position has been the main driver of movement between the quarter one and quarter two forecasts. The resource panel is consistently seeing very high levels of activity, often receiving more than forty requests per week. What has become evident is that the increase in spend is not solely due to new demand. There has been a matching rise in the complexity of care required for people already receiving support. This pattern is reflected clearly in the Mosaic movements: • Learning Disabilities: overall increase of £1.03 million, made up of £0.26 million for new requests and £0.77 million relating to increased needs for existing service users. • Physical Disabilities: overall increase of £0.56 million, made up of £0.44 million for new requests and £0.12 million relating to increased needs for existing service users. Page 67 of 180
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3.9 Response to Financia Challenge A number of immediate measures have been implemented in response to the challenge, these include: • Vacancy Management: The vacancy panel that has operated since April will apply stricter criteria to recruitment. Several posts previously approved have been paused, including three planning officer roles. This approach carries operational risk, as these posts support redesign work, but the financial risk was assessed to be greater at this time. • Sickness Management: Targeted work is underway with all teams that have sickness levels above 6%. The focus is on reducing short term absence and limiting the need for higher cost backfill arrangements. Managers will receive closer oversight and support to deliver improved attendance levels. • Care at Home: An intensive four-week review of internal care at home services has been commissioned. This piece of work will be led by the Head of Service for Older People. The aim is to identify immediate efficiencies and longer-term redesign opportunities that protect care quality while reducing cost. • Income Recovery: Work has commenced to strengthen the income recovery process, with a focus on reviewing charging practices, improving accuracy, and enhancing supporting systems. Establishing a clear and reliable picture of current income levels remains challenging and continues to impact financial planning. The improvement actions underway are designed to ensure that all chargeable income is identified, billed, and collected appropriately. Progress is being closely monitored, and the scope of this work will continue to expand as further opportunities for improvement are identified. 3.10 Given the seriousness of the situation, a financial briefing was presented at the IJB Development Session on the 13th of November to ensure early visibility and understanding of the issues. A further session is scheduled for the 10th of December to consider the strategic choices available and the potential implications in more depth. Alongside this, further internal engagement work has progressed. A workshop held on the 11th of November brought together service managers, planning officers and team leaders to explore opportunities for recovery and redesign. The session was structured around three core questions, what can we do less of, what can we do differently, and what can we stop doing, and the outputs will inform the discussion at the development session in December. 3.11 There is a significant risk that the IJB will be unable to achieve financial balance in 2025/26. Failure to deliver a balanced position will place considerable strain on both Partners, as under the terms of the Integration Scheme any overspend must be returned to the respective Partner bodies for resolution. This creates a material financial exposure for both NHS Lothian and Midlothian Council and heightens the importance of early intervention, robust financial management and clear recovery planning. 3.12 There are ongoing communication and dialogue with both of the IJB’s Partners, NHS Lothian and Midlothian Council, to clearly articulate the challenges being faced and to work collaboratively in managing the financial position. Page 68 of 180
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4 Policy Implications 4.1 This report does not have any direct impact on policy. However, decisions taken by the Board will impact on the viable content of the Midlothian IJB Strategic Plan 2025-2035 and this is likely to impact on a number of operational policies. 5 Directions 5.1 The content of this report does not have any direct impact on existing Directions. However, any further strategic financial decisions taken by the board in relation to Financial Recovery Planning must be set out in a Direction to Partners. 6 Equalities Implications 6.1 An Equalities and Childrens Rights Impact Assessment (ECRIA) Screening Tool has been submitted with this paper. This report does not have any direct impact on equalities, but highlights the decision required as a consequence of this paper will require further investigation and the completion of an ECRIA a part of early operational planning. 6.2 All new or revised strategies, plans, provisions, or activities that include significant change require a full ECRIA to be completed as early as possible in the development stage to assess the impact of propositions on people, or groups of people, with protected characteristics. 6.3 ECRIAs will be required to inform and enable the development of system wide Financial Recovery Planning, transformation, and change and will be presented to the Board on 19th February 2026. 7 Resource Implications 7.1 The financial implications of this report are laid out above. 8 Risk 8.1 There is a significant risk that the IJB will be unable to achieve financial balance in 2025/26. Any resulting overspend would revert to the respective Partners under the Integration Scheme, placing additional pressure on both organisations. 8.2 There is an inherent risk in forecasting based on limited financial information. Given the dynamic nature of the health and social care sector, not all future costs can be fully anticipated at this stage for example, the potential introduction of new medications or changes in service demand. This risk will be managed through routine local monitoring and regular reporting to the IJB. Page 69 of 180
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8.3 The impact of the UK Government’s increase in National Insurance contributions for employers is still being assessed. Several providers are actively working with the Health and Social Care Partnership to explore ways of managing the rising cost of service delivery. There is a genuine and significant risk that some providers may no longer have a financially sustainable operating model, presenting both operational and financial challenges. In extreme cases, this could result in care packages or service provision being handed back to the Midlothian Health and Social Care Partnership for direct delivery. This issue is receiving close attention; however, as the IJB has not received any additional funding from the Scottish Government to mitigate these pressures, identifying sustainable solutions remains a significant challenge. 8.4 The impact of demography and increased dependency especially on the Social Care budget is significant and expressed through the overspend in both 2024/25, and the projection for 2025/26. 8.5 There is a risk that the future financial position of Midlothian IJB will be impacted by the speed of progress towards transformational change. The ambitions of the draft strategic plan for 2025-2035 clearly describe the need for a whole-system approach to transformation in order to achieve a new and sustainable future for health and social care. The current operational pressures and limited capacity to undertake the scale of transformation required may result in slower progress that could lead to the need for further financial mitigations in the short and medium term. 9 Involving people 9.1 This report has been written following consultation our NHS Lothian and Midlothian Council financial Partners, officers of Midlothian IJB, and with the Midlothian HSCP executive management team. 10 Background Papers 10.1 There are no background papers. AUTHOR’S NAME & DESIGNATION Chris King, Chief Finance Officer CONTACT INFO Via email or MS Teams DATE 27/11/2025 Appendices: none Page 70 of 180
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Midlothian Integration Joint Board Thursday, 11 December 2025, 14:00-16:00 Midlothian IJB Performance Update Executive summary This report provides an update on the progress towards the indicators described in the Midlothian IJB Performance Framework 2025-2028, which was published with the Midlothian IJB Strategic Plan 2023-35. It sets out the statutory reporting requirements of the IJB, with measures, data sources, and reporting frequency to provide evidence of progress towards: • Strategic Aims, • Directions, • National Health and Wellbeing Outcomes, and • Ministerial Group Indicators. Progress towards the Strategic Aims is recorded using the Midlothian IJB Strategic Governance Outcomes Map. A report has been produced within Column 2 (appendix 1) that provides evidence of progress in relation to ‘People living in Midlothian and who use our services and their unpaid carers’, ‘HSCP officers, partners, and providers’, and ‘IJB’. Directions year-end reporting is scheduled for February 2026. The National Health and Wellbeing Outcomes will be reported within the Annual Performance Report 2025/26. A report describing progress towards the Ministerial Group Indicators is attached in this report (appendix 2). Due to the delay relating to validation processes, this data still relates to the Midlothian IJB Improvement Goals for 2023-25. More recent management data are available for a number of indicators but cannot be published as these data are not validated. In order to support the Board’s understanding of the current position, a brief summary is provided. As a result of this report, Members are asked to: • Review the Board’s progress and supporting evidence in Column 2 of the Midlothian IJB Strategic Governance Outcomes Map (appendix 1), • Endorse the suggested progress and confidence rating for Column 2, and • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 2). Item number: 5.6 Page 71 of 180
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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 (appendix 1) and an overview of progress in column 2 ‘who with’ as detailed in the Strategic Governance Outcomes Map (appendix 2). 2 Recommendations 2.1 As a result of this report, Members are asked to: • Review the Board’s progress and supporting evidence in Column 2 of the Midlothian IJB Strategic Governance Outcomes Map (appendix 1), • Endorse the suggested progress and confidence rating for Column 2, and • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 2). 3 Background and main report 3.1 Midlothian IJB Strategic Governance Map A regular update on the impact of Midlothian IJB’s contribution to the health and wellbeing of local people and communities is also provided in this report through the Midlothian IJB Strategic Outcomes Governance Map. This map is a contribution analysis tool that hosts all Midlothian IJB governance activity and evidence across a 6- column logic model; what we do, who with, how they feel, what they learn and gain, what they do differently, and what difference does this make. Each column hosts key areas of practice that align with legislated duties of Integration Authorities and capture both compliance with statutory obligations and the depth and breadth of activity undertaken by Midlothian IJB. 3.2 A development session for Board members to update their knowledge on the latest content in the Midlothian IJB Strategic Governance Outcomes Map, the format, and process, took place in November 2025. This session supported discussion about the ask of Board members when reviewing this work and outlined the main requests as follows • consider the information and evidence detailed in the presented column of the outcomes map, • review the data sources and success criteria, and Page 72 of 180
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• assess whether the evidence and data sources provide sufficient assurance in relation to the proposed multifactor evaluation against the evidence standards. 3.3 Board members are therefore asked to review the evaluation of progress in relation to Column 2: “Who With?” This column for the logic model describes the work undertaken by Midlothian IJB in three distinct sections which are • People living in Midlothian and who use our services and their unpaid carers, • HSCP officers, partners, and providers, and • IJB members. 3.4 ‘People living in Midlothian and who use our services and their unpaid carers’ describes progress in relation to statutory activities and the ambitions of the Midlothian IJB Participation and Engagement Statement 2025-2028. Of note in column 2 is the Board’s progress and compliance with the statutory duties and national guidelines relating to co-production and design, as well as providing evidence of local activities. These include the • Midlothian Citizen’s Panel 2024 • Midlothian Survey 2025 • Midlothian IJB Carers Strategy development • Midlothian IJB’s Consultation and Engagement Statement for the Strategic Plan 2025-2035, and • Midlothian IJB’s Equality Outcomes. 3.5 ‘HSCP officers, partners, and providers’ sets out the detail of relevant activities which include HSCP Officer Attendance at the Integration Joint Board, Strategic Planning Group, and Audit and Risk, as well as engagement in National Forums. It also includes information relating to our Partner organisations (Midlothian Council and NHS Lothian) and their attendance at Integration Joint Board and Strategic Planning Group. The Third Sector and the Transforming Together programme are included, as well as a record of IJB attendance at Third Sector Summits. 3.6 The final section of written evidence relates specifically to Midlothian IJB and includes evidence of Board membership, attendance, and governance. 3.7 The data sources and success criteria are followed by the evidence standards used to evaluate progress. Board members are asked to review the information provided and endorse the suggested progress and confidence rating for Column 2 or provide feedback for action and amendment. 3.8 Since the production of the Midlothian IJB Strategic Governance Outcomes Map Column 2 report, Matter of Focus who developed the OutNav software have ceased trading. This will necessarily result in Strategic Planning and Performance working differently to maintain the governance reporting of the board in an outcomes-focused way. Work is already underway to ensure none of the learning is lost and an internal resilience plan is in place. The Board can be assured that Strategic Planning and Performance will ensure that the provision of information and evidence in relation to Board activity will continue to demonstrate the high levels of quality and rigorous assurance, despite the loss of the electronic repository to connect this information. Page 73 of 180
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3.9 Directions year-end reporting is scheduled for February 2026. 3.10 The National Health and Wellbeing Outcomes will be reported within the Annual Performance Report 2025/26. 3.11 The IJB had previously identified performance goals to monitor progress on reducing unscheduled hospital activity and use of institutional care, based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care). 3.12 An updated report describing progress against Ministerial Group Indicators is attached in appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. 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 and this data still relates to the Midlothian IJB Improvement Goals for 2023-25. 3.13 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, a brief summary is provided below. 3.14 A&E Attendances 2022/23 Target Rate per 100,000 people 2,629 / month 2024/25 Running Average 2,820 / month The validated data are available up to April 2025. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed November 2025) indicate the target is currently being met. 3.15 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2024/25 Running Average 770 / month The validated data are only available up to April 2025. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed November 2025) indicate the target is not currently being met. 3.16 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 April 2025. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed November 2025) indicate the target is not currently being met. 3.17 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2024/25 Running Average 1117 / month Page 74 of 180
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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 November 2025) indicate that the target is not currently being met. 3.18 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. 3.19 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. 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 This report does not directly impact upon service ability to deliver existing Directions or require new Directions to be considered. Ongoing review and revision to the Performance Report will align with any revisions to existing Directions / issue of new Directions at any stage in the reporting period. 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 There are no equality implications from focussing on these goals but there may be implications in the actions that result from work to achieve them. 6.3 The focus of most of the goals is on reducing hospital activity and hospitals are not used equally by the population. There are groups of people that make more use of hospitals than others – for example older people, people living in areas of deprivation or people who live alone. Page 75 of 180
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7 Resource Implications 7.1 There are no resource implications as a result of this report. 8 Risk 8.1 The risk of not finding solutions to address complex performance measurement challenges is that we are underinformed in relation to increases in complexity, acuity and the resulting additional pressures these create for our workforce; and what this may mean for wellbeing, retention and recruitment. 9 Involving people 9.1 The role of data assurance is performed by Strategic Planning Group which has a wider membership including representation of Board members, Officers of the HSCP, the Third and Independent sector, Public Health, and representative members from our communities. 10 Background Papers 10.1 There are no background papers. Appendices: Appendix 1: Midlothian IJB Strategic Governance Outcomes Map Column 2 ‘Who With’ Appendix 2: Local Intelligence Support Team (LIST) Report 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 25/11/2025 Page 76 of 180
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25th November 2025 This report has been created using OutNav developed by Matter of Focus. Midlothian Integration Joint Board Strategic Governance Outcomes Map 25/26 Column 2: ‘Who with’ Page 77 of 180
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Contents 1. IJB Strategic Governance Progress 2. IJB Strategic Governance Column 2: Who with 3. IJB Strategic Governance Column 2: Data sources and success criteria 4. Our evidence standards Page 78 of 180
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IJB Strategic Governance Progress Page 79 of 180
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IJB Strategic Governance Column 2: Who with People living in Midlothian and who use our services and their unpaid carers Progress: Some Confidence: High Planning with People Planning with People sets out the responsibilities of NHS Boards, local authorities and Integration Joint Boards in relation to community engagement when health and social care services are being planned, or when changes to services are being considered. This supports us to involve people meaningfully. Planning with People was updated in 2024 to take into consideration the current challenges being faced by NHS Boards and ensure that all parties are clear on respective roles, responsibilities and processes and reinforce the statutory duties for engagement regardless of financial pressures. We have a statutory duty to involve people in the design and delivery of care services and our engagement and participation duties are set out clearly in the Public Bodies (Joint Working) (Scotland) Act 2014 the Community Empowerment (Scotland) Act 2015. Participation is also a key element of a Human Rights based approach, which requires that people are supported to be active citizens and that they are involved in decisions that affect their lives. We are expected to demonstrate how we are engaging with communities, and to evidence the impact of engagement and work our Partners to share learning and develop best practice. Page 80 of 180
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Our Participation and Engagement Statement We want to listen to people and communities and work with them to ensure that the services we commission are what people need and want. It should be easy for people to tell us what they think of our services, what they would like to change, and be as involved in making this a reality. We must, by law, plan and lead integrated health and social care services in a way which is engaged with the community. Our Participation and Engagement statement 2025-2028 sets out our engagement plans and also requests we receive assurance that services provided by Midlothian Health and Social Care Partnership are working with local communities. Ongoing engagement We involve people when planning services and developing strategic plans. This includes: • All our strategies and plans, e.g., our Strategic Plan 2025-2025, Equality Outcomes 2025-2029 • Annual Survey – every year • Third sector summit – every 6 months • Participation at events and networks Involving people We ensure Midlothian Health and Social Care Partnership involves people who experience services to make sure services meet their needs. This includes: • 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 81 of 180
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Our Participation and Engagement Statement closely follows Scottish Government guidance and explains who we engage with, our main methods of engagement and our resources to do so. We undertook a process of consultation as part of the development of this plan as we undertook the Healthcare Improvement Scotland Quality Framework for Community Engagement Self-Assessment HIS Quality Framework for Community Engagement Self-Assessment In 2025 we used the Quality Framework for Community Engagement and Participation created by Healthcare Improvement Scotland and the Care Inspectorate to evaluate our community engagement and how people’s involvement has a positive impact on service change and strategy development. We involved people who design and deliver services, people who experience our services, our NHS Lothian and Midlothian Council Partners, and our partners in the Third and independent sectors. We will report on our progress every year in our Annual Performance Report and carry out another self-evaluation before our next Strategic Plan is created. We looked at: Statutory duties and national guidelines: • We take account of statutory requirements. • We implement relevant legislation. • We ensure everyone can be involved and take steps to remove barriers to participation. • We have a clear rationale for making decisions and provide regular feedback. • We support communities to take greater control. • We have effective processes. Co-production and design: • We take a proactive approach to engaging with people and encourage and empower groups to be involved. • We work with stakeholders to develop and deliver person-focused services. • We can demonstrate how collaborative working leads to improved outcomes in a person-centred way. • We involve the public in line with the Gunning Principles. Page 82 of 180
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• We are clear and open about our approach to community engagement and provide regular information to communities that is understandable, jargon-free, and accessible. Support/Equalities: • We encourage staff to demonstrate positive attitudes and behaviour towards those who are socially or culturally excluded. • We address health inequalities. • The public has confidence in the effectiveness of service and strategy development. We concluded that we had areas of strength in ‘Involvement of people in service planning, strategy and design’, that we were improving in areas of ‘Governance and leadership’ but had areas for improvement in ‘Ongoing engagement and involvement of people’ Our findings played a key role in developing the Participation and Engagement Statement and its action plan. Midlothian Citizen’s Panel 2024 During 2024, we gathered information on a local basis using the Midlothian Citizen’s Panel, which is designed to record and reflect the views of people living in a specific area. It brings together the views of around 1,000 residents of Midlothian and asks their views about health and social care issues. Of the 1,000 panel members we asked, 573 returned completed surveys. This means the response rate was 57%, which is the same as other Citizen’s Panel surveys, and higher than the Midlothian response rate to the national Health and Care Experience Survey. The Midlothian Citizen’s Panel membership reflects the diversity of the Midlothian population better than the Health and Care Experience Survey. This is because there are similar proportions of people on the citizens panel to the Midlothian population, for example in relation to sex, age, and deprivation. This helps ensure that we are hearing the views of more people living in Midlothian and be more confident in the data we use to help us make good decisions for local people. Midlothian Survey 2025 During 2025 it was not possible to repeat the Citizen’s Panel so Midlothian IJB undertook an online survey of peoples’ views on health and social care in Midlothian. This was promoted using established communication channels and by sharing publicity materials Page 83 of 180
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through a range of local Third sector organisations and groups. The survey ran from June to August 2025 and a total of 169 survey responses were received. This is less than previous Citizen’s Panel-based surveys, but remains a positive response given the digital approach taken. Importantly, the level of response allowed for some new analysis of results within specific groups, such as age, disability or health condition, household type, and housing tenure. The report highlighted notable variation in responses across these groups, but lower overall number of survey responses means that these findings are indicative only. Our Carers Strategy Our Carers Strategy 2022-2025 is available on our website. This strategy is currently being developed and was reviewed by the Strategic Planning Group in November 2025. The final draft will return to the Strategic Planning Group in January 2026 ahead of recommendation to the Board. It is anticipated that this strategy will be published in February 2026. Our Consultation and Engagement Statement for our Strategic Plan 2025-2035 Our Consultation and Engagement Statement is a summary of the consultation and engagement activities carried out to shape the development of our Strategic Plan for 2025-2035. Our Strategic Planning Group developed a consultation and engagement plan that set out a range of different activities and events that began in September 2023 and concluded in October 2025. This plan used a number of different approaches to ensure we could reach as many people as possible with the resource we have available. This included surveys, planned consultation events, and widely distributed promotional material. We spoke to more than 300 internal and external stakeholders so they could share their views and share the consultation activities with their communities. Over 1,000 voices were included in the development of the Strategic Plan. People told us they don’t want to have to rely on services to live the life they choose. People don’t want services; they want a good life. People want support, relationships, and most of all, to be understood. Page 84 of 180
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People who do need our support, care, or treatment told us they want practical help, not to be reliant on services and feel trapped in ‘the system.’ People told us they want us to honest and realistic about we can do as well as what we can’t and come alongside them as they take action to stay well or prevent ill or worsening health and wellbeing. Our Equality Outcomes Our work must not unlawfully discriminate against someone because of any of these characteristics and it must advance equality of opportunity and foster good relations between groups of people who share these characteristics and those who do not. We have a duty to make reasonable adjustments for people with protected characteristics. This requires us to take positive steps to ensure that people can access our services. It is a cornerstone of the Equality Act 2010 and goes beyond avoiding discrimination. We are required to anticipate the needs of people using our services and to make sure the access they enjoy is as near as possible to that enjoyed by the rest of the public. We must publish a set of specific outcomes every 4 years that will help us achieve targeted change. In 2025 we worked with equality leads in NHS Lothian, Lothian local authorities and Health and Social Care Partnerships to identify the most important equality issues. We looked at our previous outcomes, current data and spoke to staff, people who use our services and community organisations. We chose 4 outcomes that linked closely to the aims in our Strategic Plan 2025-2035, and people told us they were important to them in our consultation: 1. People have a choice about how they access information and support from integrated services. 2. People who want to choose Self Directed Support have better information about which option is right for them. 3. Older people have a reduced risk of admission and readmission to hospital. 4. Unpaid carers feel supported to continue in their caring role. We will report on our progress every year in our Annual Performance Report. Page 85 of 180
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HSCP officers, partners, and providers Progress: Great Confidence: High Officers of the HSCP The Officers of Midlothian Health and Social Care Partnership provide support to Midlothian IJB and its committees. This is primarily through the operational assurance and oversight provided by Joint Director of Health and Social Care, Integration Manager, Chief Finance Officer, Programme Manager for Performance and Improvement, Assistant Strategic Programme Manager, and Business Support Manager. HSCP Officer Attendance • at the Integration Joint Board The Integration Joint Board meets 11 times each year, with 6 Board meetings, 2 Special Boards, and 5 Development Sessions. The two Special Board meetings both immediately follow a Development Session. Some officers of the HSCP are also non-voting Board members in a Professional Advisory role and attend the IJB as Board members. The IJB is also attended by the Integration Manager, Performance and Improvement Programme Manager, Group Service Manager, Head of Primary Care and Older People’s Services, and Executive Business Manager, as Officers of the HSCP. • at the Strategic Planning Group The Strategic Planning Group meets 6 times each year. In this meeting the officers of the HSCP attend in their operational capacity. This meeting is attended by the Joint Director of Health and Social Care, Chief Financial Officer, Integration Manager, Performance and Improvement Programme Manager, Head of Adult Services, Group Service Manager, Chief Nurse, Chief Allied Health Professional, Head of Primary Care and Older People’s Services, Executive Business Manager, and Assistant Strategic Programme Manager. • at Audit and Risk The Audit and Risk Committee meets four times a year and is attended by Officers of the HSCP including Chief Officer, Chief Finance Officer, Integration Manager, and Executive Business Manager. Page 86 of 180
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HSCP Officer Engagement in National Forums The Chief Officer regularly attends the National Chief Officers Group and is connected with the Chief Officers across Scotland. The Chief Finance Officer regularly attends the National Chief Finance Officers Group. The Integration Manager is Vice Chair of the National Strategic Planning and Performance Officers Group to support and provide feedback to Scottish Government on the development of relevant policy or processes, connect with the Strategic Planning and Performance Officers across Scotland, and maintain close links with Health and Social Care Scotland. Our Partners 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 make choices 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 live well. Midlothian Council 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. Community Planning Partnership and the Single Midlothian Plan 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 together than health and social care can do alone. Page 87 of 180
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NHS Lothian The Lothian Strategic Development Framework sets out what needs to happen across Lothian’s Health and Care system over the next 5 years. It is a joint plan between the five 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 and those who work for and with us. The Framework supports bring together the five interdependent Lothian Health and Care Systems bodies and sets out a basis to collectively contribute to improving outcomes for people and communities. It represents the high-level thinking with a flexible and adaptive approach around key principles, assumptions, and fixed points. Together, we contribute to improve the health and wellbeing of a population of nearly one million people across Lothian. The aims and objectives of the LSDF for the next five years are • An improvement to population health. • Outcomes we aim for in how we will work with citizens and with patients. • To deliver nationally prevailing performance measures. Partner Attendance • at the Integration Joint Board Midlothian Council and NHS Lothian representation on the IJB is through the 4 voting members of each organisation. • at the Strategic Planning Group The Strategic Planning Group also offer membership to officers of our operational Partners Midlothian Council and NHS Lothian to ensure we are taking account of their strategies and priorities in our planning. Page 88 of 180
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The Midlothian Council Representatives are: • James Hill • Saty Kaur • Annette Lang The NHS Representatives are: • Laura Hutchison • Jim Sherval • Rebecca Miller Third Sector We consider the Third Sector to be equal partners in health and social integration. 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. Third Sector Interfaces (TSIs) also play a key role as a single point of access for support and advice. In Midlothian there is a long history of strong collaborative working with the Third Sector. The Third Sector Representative on the Board is Magda Clark who is also the Vice Chair of our Strategic Planning Group. Midlothian Health and Social Care Partnership contracts services from approximately 40 organisations to support people and communities. This is approximately 33% of the total Adult Social Care budget. Third Sector Summit Midlothian Third Sector Summits were established in 2018 to strengthen a relationship of equal partnership, explore opportunities for collaboration, and improve outcomes for people living in Midlothian. Biannual Third Sector Summits have created opportunities for Page 89 of 180
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practitioners from the Third Sector and Midlothian Health and Social Care Partnership (HSCP) to come together, share practice, and strengthen our relationship of partnership. The Third Sector Summit has continued in a biannual format with a combination of presentations on ongoing work and time to network and share ideas. This has built on existing good relationships and created an appetite for more collaborative working and finding solutions together. Plans for developing a more interactive format that supports the progression of shared ambitions to improve health and wellbeing in Midlothian are underway. The Spring 2025 Third Sector Summit was held in May. The theme of the summit focused on the financial challenges faced by the Health and Social Care Partnership (HSCP) and offered valuable insights into the current and future landscape of service provision within the third sector. The importance of proactive planning was emphasised. Further themes included the need for improved procurement processes, more accurate data on service needs, and the application of models such as PESTEL to guide transformation. Market facilitation—identifying current service gaps, market conditions, and evolving needs—was highlighted as crucial for commissioning success. National insurance increases, forecasted to raise costs by 3–5%, add to the financial burden facing employers. The Autumn Third Sector Summit was held in November and provided a useful forum to share the work of successful local initiatives and discuss how the Third Sector and Midlothian Health and Social Care Partnership can work differently together to best support people and communities. Transforming Together We are working with Midlothian Community Action closely to ensure the Third Sector are an equal partner in our transformation planning. To ensure that we are supporting the Third Sector to have the capacity and resource to participate fully, we are undertaking a trial period of outcomes focused action accompanied by resource to fund additional capacity. Page 90 of 180
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The additional capacity this provides will allow Midlothian Community Action to work alongside local Third Sector partners and providers, encourage active participation, represent their views and highlight local challenges and opportunities, and play a key role in the Midlothian Health and Social Care Partnership Transformation and Change Programme Board and related workstreams. This project will be evaluated in February 2026. Board attendance at Third Sector Summits Midlothian IJB has asked to be more involved in the Third Sector Summits. Invitations are now regularly extended to Board members, and a record of attendance is recorded to support evaluation of this ambition. In 2024/25, 4 board members attended the Third Sector Summit on 13th November 2024 In 2025/26, there have been two Third Sector Summit, • 4 Board members attended on 21st May 2025. • TBC Board members attended on 26th November 2025 Providers Most of the work alongside providers is undertaken by the planning officers and commissioning services of the Midlothian Health and Social Care Partnership. However, VOCAL are a member of our Strategic Planning Group and our Third Sector Representative meets regularly with providers to ensure their views are heard and incorporated into our decision making. Our local providers and the local 'market' As described in the Procurement of Care and Support Services Best Practice Guidance, we are not able to contract or hold contracts with third parties. The guidance advises that contractual arrangements should remain with either the local authority or the NHS Board. However, we are responsible for the development of a Strategic Plan which provides the direction for what we need to commission in Page 91 of 180
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Midlothian and an overview of what should be procured. Our Market Facilitation Plan supports the delivery of our strategy to improve outcomes for people and communities. Ethical Commissioning The Care Reform (Scotland) Act 2025 requires Ministers to produce national guidance on ethical commissioning and set out how this will be consistently applied across Scotland. To ensure we are doing all we can to prepare for the Care Reform (Scotland) Act 2025, we are committed to working towards delivering on all 8 ethical commissioning principles set out in the Scottish Procurement Policy note: SPPN 7/2021. Workforce We do not employ any staff directly. However, as part of our commitment to fair work for local people, our Market Facilitation Plan outlines how we plan to support local providers, and we have asked Midlothian Health and Social Partnership to develop a Partner Provider Statement (commissioning strategy) as part of their work to commission services. We must provide assurance to Scottish Government that the providers we work with are compliant with the duties of the Health and Care (Staffing) (Scotland) Act. We submitted our annual assurance to Scottish Government on 28th May 2025. We have also asked Midlothian Health and Social Partnership to support the Local Employability Partnership and ensure that local people are supported to gain the skills and experience to return to meaningful employment. Our Integrated Workforce Plan 2025-2028 The Scottish Government has requested that all Integration Authorities and their Health and Social Care Partnerships develop 3-year workforce plans aligned with the key policy commitments. We have supported Midlothian Health and Social Care Partnership to assess upcoming workforce demand and need in a 3-year Integrated Workforce Plan including • the current workforce including a gap analysis to understand workforce demand in relation to service demand, • an assessment of the workforce required to fill any gaps, and • an action plan to progress the ambitions of the Five Pillars of the National Workforce Strategy. Page 92 of 180
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Our Integrated Workforce Plan was for 2025-2028 was submitted to Scottish Government for review on 21st February 2025. We must wait for feedback and take any required action before we can publish this plan. Our Integrated Workforce Plan for 2022-2025 remains available on our website. As a strategic planning body who do not employ any staff directly, many of the levers and mechanisms required to drive an effective workforce plan are not ultimately decided or controlled by us. We can issue Directions to the employing partners, but Midlothian Council and NHS Lothian may take decisions that impact on the ability of Midlothian Health and Social Care Partnership to achieve the ambitions of this Integrated Workforce Plan. For example, a Direction to the employing partners to employ additional workers cannot be actioned if the employing Partner has implemented a recruitment freeze. As Midlothian Health and Social Care Partnership is a directorate of both NHS Lothian and Midlothian Council, the workforce plan of both our Partners describe the staff that they employ and therefore all the staff that work within the Health and Social Care Partnership. Delivering a meaningful Integrated Workforce Plan is a complex ask where there is more than one local authority or Health and Social Care Partnership within the geographical footprint of the Health Board. This is the case for Midlothian Health and Social Care Partnership, and we continue to work closely with all our partners to deliver the best workforce planning re can with the resource available. However, a lack of data sharing agreements that would allow us to consider the workforce of integrated teams as an integrated workforce continues to present challenges. Although there is a national ambition to establish an integrated social care and health record although, there is currently no detail of how this will be achieved, and no mention of workforce data sets. Page 93 of 180
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IJB Progress: Great Confidence: High Board Membership The voting Membership of Midlothian Integration Joint Board (IJB) is made up of eight members: four elected councillors and four NHS Lothian Non-Executive Directors. Of the eight voting members, four are male and four are female. Midlothian IJB also appoints a range of non-voting members. Collectively, the Board membership should include • four elected councillors who are then appointed to the IJB as voting members. • four non-executive Directors appointed to the NHS Board who are then appointed to the IJB as voting members. • a range of professional advisors. In Midlothian, these roles are fulfilled by Midlothian Council or NHS Lothian employees who are appointed to the IJB as non-voting members due to their professional leadership roles. • a range of other representatives including people who experience services, carers, volunteers, the Third Sector, and trade union representatives. From 27th June 2025, Councillor Connor McManus, 2-year term as Chair of Midlothian IJB came to an end. Councillor McManus stepped down from the role of Chair to Vice Chair. NHS Lothian Non-Executive Director, Val de Souza was appointed as Chair from 27th June 2025 for 2 years. NHS Non-Executive Directors Currently all 4 Non-Executive Director members of Midlothian IJB are appointed. Elected Members Currently all 4 Elected Members of Midlothian IJB are appointed. Page 94 of 180
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Professional Advisors There are currently Professional Advisors on the Board in the following areas • Social work • Nursing • Allied Health Professionals • Partnership / Trade Union • General Practice • Acute Medicine Board Membership (to end August 2025) Page 95 of 180
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Board Member Attendance A record of attendance for all Midlothian Board Members in 2022/23, 2023/24, 2024/25 and 2025/26 can be found in the evidence section of this report. Community Voices There is currently the following representation on our Board membership: • Third Sector • Lived Experience There is a thriving local Third Sector in Midlothian, supported by the Midlothian Third Sector Interface (TSI). There are at least 500 formal groups or voluntary associations and other Community Planning Partners and approximately 56% of the population volunteer informally. People with lived experience join our formal planning groups to help us work alongside our communities to be better partners in their futures. Despite proactively recruiting to these key Board positions, we have a vacancy for both Volunteer and Carers Representatives. We continue to have an advert on our website and the myjobscotland site and are working with our Midlothian Community Action (MCA) and VOCAL colleagues to help find the right representation. We are also taking positive action to ensure we have the right voices on the Board. We are planning to distribute promotional materials in local community areas i.e., surgeries, leisure centres and libraries where carers and those they care for are likely to visit. We know how important it is to listen to our communities, and we want to ensure anyone who wishes to share their experiences has the opportunity to do so. Page 96 of 180
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Board Membership Governance There are a range of governance activities that support Midlothian IJB provide assurance on the appropriate appointment of members to the Board, their roles and remit, and ongoing activity. Register of Interest In accordance with the Ethical Standards in Public Life (Scotland) Act 2000 (Register of Interests) Regulations 2003, Board Members of devolved public bodies are required to give notice of their interests under the seven categories of renumeration; related undertakings; contracts; houses, land, and buildings; interest in shares and securities; gifts and hospitality; non-financial interests. All members of Midlothian IJB (voting and non-voting) are required to complete a declaration form. This is a living document and should be updated by Members as and when circumstances change. The acceptance of office and the disqualification statements equally do not have one specific date as they have been submitted by each Board Member as appropriate to individual circumstance. The Standards Officer ensures all current members of Midlothian Integration Joint Board have signed a declaration form in relation to the Midlothian IJB Register of Interest and liaise with the Integration Manger to ensure that Scottish Government is informed of the location of these published records on the IJB pages of the website. There are currently 4 outstanding registers of interest to be completed, and the Standards Officer has written to these members to request completion. Code of Conduct The Ethical Standards in Public Life (Scotland) Act 2000 requires each Integration Joint Board to produce a Code of Conduct for members in line with the Model Code. Some members may have already signed similar codes of conduct i.e., Code of Conduct for Councillors; however, they are still required to sign the Integration Joint Board's code of conduct as their duties as Integration Joint Board members should be independent of the responsibilities that they may have by virtue of other posts. Page 97 of 180
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Midlothian IJB reviewed and approved its revised Code of Conduct in 2022 on 16th June 2022. The Code of Conduct applies to all IJB members who are subject to the Code by virtue of their appointment. The Standards Officer continues to ensure that a declaration of acceptance of office is received from all members. As no changes have been made to the Model Scheme since I was reviewed in 2022, there is currently no requirement to update our Code of Conduct. Page 98 of 180
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IJB Strategic Governance Column 2 sources and success criteria This table lists the sources of evidence and success criteria referred as part of the analysis presented in this report. Who with Steppingstone Source People living in Midlothian and who use our services and their unpaid carers Midlothian IJB Carers Strategy Midlothian IJB ECRIAs Midlothian IJB Equality Outcomes Midlothian IJB Participation and Engagement Statement Midlothian IJB Strategic Plan 2025-2035 Consultation and Engagement Statement Success Criteria There is effective engagement with local people, people who experience services, their family, and unpaid carers in development and review of the strategic plan We can assure that engagement has reached an appropriate balance of people, and that people are Page 99 of 180
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not excluded due to protected characteristics We have published a Participation and Engagement Statement We have published our Carers Strategy We published our Equality Outcomes every 4 years and a Mainstreaming Equality Report and updates at least every 2 years HSCP officers, partners, and providers Board meeting papers Lothian Strategic Development Framework Midlothian IJB attendance at Third Sector Summit Midlothian IJB Integrated Workforce Plan Single Midlothian Plan Success Criteria All appropriate officers of the HSCP attend Board meetings Board members attend the Third Sector Summit Officers are engaged in National discussion at appropriate forums The Board is appropriately engaged in the Community Planning Partnership We have an Integrated Workforce Plan and Page 100 of 180
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Action Plan IJB Board meeting papers Midlothian IJB Board Member Attendance Midlothian IJB Code of Conduct Midlothian IJB Membership Midlothian IJB Register of Interest Success Criteria Appropriate due diligence has been carried out on all IJB members IJB members are fully engaged in their roles There is appropriate representation on the Board for professional advisors There is appropriate representation on the Board from Elected Members and NHS Non- Executives There is representation on the Board from appropriate community voices We have a Code of Conduct based on the Model Scheme and approved by Scottish Government We have a signed Register of Interest for each board member Page 101 of 180
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Our evidence standards PROGRESS STATEMENT CRITERIA Great progress • Enough people and groups experience this in the timescale you have defined • Risks have been mitigated and assumptions achieved Some progress • Some people and groups experience this in the timescale you have defined • Some risks have been mitigated and some assumptions achieved Low progress • Not enough people and groups experience this in the timescale you have defined • Risks have not been mitigated and assumptions found to be unrealistic CONFIDENCE ASSESSMENT CRITERIA High confidence Most of these criteria apply • more than one source of evidence with appropriate balance of types • evidence collected purposefully and for this purpose • reasonable number of responses • no disagreement between evidence sources • backed up by other research • analysis is clear and purposeful (someone else could replicate and get broadly the same results) Some confidence Some of these criteria apply Page 102 of 180
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• more than one source of evidence with appropriate balance of types of evidence • evidence is collected purposefully and for this purpose • reasonable number of responses • no disagreement between evidence sources • backed up by other research • analysis is clear and purposeful (someone else could replicate and get broadly the same results) And / or • there is some disagreement or lack of clarity of the findings • the data is mostly gathered opportunistically Low confidence Few of the above criteria apply AND / OR • there is disagreement within the data • assessments are based solely on an individual's perspectives Page 103 of 180
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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 104 of 180
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Midlothian HSCP MSG Indicators Local Intelligence Support Team (LIST), Dashboard accessed November 2025 Page 105 of 180
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Contents 2 1. A&E attendances 2. Emergency admissions 3. Unplanned bed days (Acute) 4. Delayed Discharges Occupied Bed Days Page 106 of 180
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3 A&E Attendances Page 107 of 180
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Emergency Admissions 4 Page 108 of 180
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Unplanned Bed Days - Acute 5Page 109 of 180
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Delayed Discharges Occupied Bed Days (18+) 6Page 110 of 180
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Midlothian Integration Joint Board Thursday, 11 December 2025, 14:00-16:00 Midlothian Integration Joint Board Annual Complaints Report 2025 Executive summary The purpose of this report is to provide the Board with a clear and comprehensive overview of complaints received in 2025 in relation to Midlothian Integration Joint Board. As a result of this report, Members are asked to: • Note the number of complaints received, the summary of themes, and outcomes, and • Give delegated authority to Morag Barrow in her capacity as Chief Officer to publish an annual report of complaints received on the Midlothian Health and Social Care website. Item number: 5.10 Page 111 of 180
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Report Midlothian Integration Joint Board Annual Complaints Report 2025 1 Purpose 1.1 The purpose of this report is to provide the Board with a clear and comprehensive overview of complaints received in relation to Midlothian Integration Joint Board. 1.2 The report covers the total number of complaints received within the reporting period, the summary of themes, and the steps taken to address them. It also outlines the processes followed in line with statutory requirements and organisational policy. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the number of complaints received, the summary of themes, and outcomes, and • Give delegated authority to Morag Barrow in her capacity as Chief Officer to publish an annual report of complaints received on the Midlothian Health and Social Care website. 3 Background and main report 3.1 Complaints provide valuable feedback and opportunities for improvement. By recording and analysing complaints data, we can identify and address the causes of complaints and, where appropriate, identify training opportunities and introduce improvements. 3.2 This summary report has been produced in line with the Scottish Public Services Ombudsmen Model Complaints Handling Procedure (SPSO MCHP). The SPSO MCHP states that all organisations, even in the case of low complaint numbers or a nil return, must report at least quarterly to their Senior Management on the KPIs and analysis of the trends and outcomes of complaints; publish on a quarterly basis information on complaints outcomes and actions taken to improve services, and publish an annual complaints performance report on their website. 3.3 An overview of complaints received between January and December 2025 is provided for Board members to review. Page 112 of 180
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3.4 Total number of complaints received • Stage 1 Complaints: 5 recorded cases • Escalations to Stage 2: 1 case progressed 3.5 Outcomes Complaints Upheld None of the complaints received during the reporting period were upheld. 3.6 Timely Resolution All complaints were managed in accordance with the Board’s established procedures and statutory obligations. Each case was addressed within the prescribed timescales, ensuring compliance with SPSO MCHP and the Midlothian Integration Joint Board Complaint’s Handling Procedure 2021. 3.7 Responses Issued Formal written responses were issued to all complainants, setting out the rationale for the decisions taken and demonstrating transparency in the decision-making process. 3.8 Right of Appeal In line with best practice and regulatory requirements, complainants were advised of their right to appeal where a complaint was not upheld. This ensured that due process was observed and that all parties were afforded a fair and equitable opportunity to challenge decisions, thereby reinforcing the Board’s commitment to accountability, openness, and continuous improvement in service delivery. 3.9 Summary of Themes During the reporting period, the complaints received were primarily concerned with financial decisions taken by Midlothian Integration Joint Board. These complaints reflected feedback from stakeholders and individuals who access these services regarding the allocation of resources and the wider implications of financial planning decisions. Concerns were raised about the potential impact of these decisions on service delivery and, in particular, on individuals who rely upon these services. 4 Policy Implications 4.1 In line with the SPSO MCHP, complaints relating to the actions and processes of the Integration Joint Board itself, IJBs should adopt the MCHP for the Scottish Government, Scottish Parliament and Associated Public Authorities. 4.2 The Midlothian Integration Joint Board Complaints Handling Procedure April 2021 is available on the Midlothian Health and Social Care website. 5 Directions 5.1 The report does not directly impact on Midlothian IJB Directions 2025/26. Page 113 of 180
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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 an ECRIA as a result of this report. 7 Resource Implications 7.1 Work is underway to revise Midlothian IJB Complaints Policy. As the IJB’s record keeping partner, Midlothian Council and Midlothian HSCP Business Support Team are exploring use of an in-house system to improve accessibility and resilience in managing complaints. 8 Risk 8.1 There is a risk that statutory deadlines may be breached due to insufficient governance arrangements and the absence of a robust electronic systems to effectively manage complaints within the required timeframe. 8.2 Appendix 1 outlines the current procedure for reporting and managing Midlothian IJB Complaints. Implementation is contingent upon the availability of the designated individual(s). 9 Involving people 9.1 Not applicable. 10 Background Papers 10.1 None. Author’s Name Lisa Cumming Designation Business Support Manager Contact Information lisa.cumming@nhs,scot Date 25.11.25 Appendix 1: Midlothian IJB Complaints Flowchart Page 114 of 180
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Midlothian IJB complaints procedure Is the complaint about Financial Allocation? Business Support Manager reviews complaint NO YES Admin receive complaint Via FFH.Admin Is the complaint about Directions? Is the complaint about the Strategic Plan? NO NO Business Support Manager returns complaint YES Business Support Manager sends to Integration Manager YES NO Business Support Manager requests further information from relevant HSCP Officer Is the response complete? HSCP Officer provides additional information YES Is the response approved? Business Support Manager sends to Integration Manager Business Support Manager sends to Chief Finance Officer HSCP Business Manager sends to Chief Officer for approval YES NO Business Support Manager edits response Business Support Manager sends response to customer Page 115 of 180
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Health and Care (Staffing) (Scotland) Act 2019 2024/25 Ministerial Annual Report SG/2025/211 November 2025 Midlothian Integration Joint Board Thursday 11 December 2025 Item No 5.11 Page 117 of 180
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Document No: SG/2025/211 2 TABLE OF CONTENTS GLOSSARY OF TERMS ............................................................................................ 4 FOREWORD .............................................................................................................. 7 INTRODUCTION ........................................................................................................ 9 Guiding Principles of the Act ............................................................................................................. 10 PART 1: HEALTHCARE: DUTIES ON HEALTH BOARDS .................................... 11 Purpose ............................................................................................................................................. 11 Reporting Process ............................................................................................................................. 11 Overall Assessment of Board Compliance ........................................................................................ 12 Assurance Level Definitions .............................................................................................................. 13 Compliance With Individual Duties ................................................................................................... 14 Section 12IA Duty to ensure appropriate staffing ........................................................................ 14 Section 12IC Duty to have real-time staffing assessment in place ............................................... 16 Section 12ID Duty to have risk escalation process in place .......................................................... 17 Section 12IE Duty to have arrangements to address severe and recurrent risks ......................... 18 Section 12IF Duty to seek clinical advice on staffing .................................................................... 19 Section 12IH Duty to ensure adequate time given to clinical leaders .......................................... 20 Section 12II Duty to ensure appropriate staffing: training of staff ............................................... 21 Section 12IJ Duty to follow the common staffing method ........................................................... 22 Section 12IL Duty to train staff in the use of the common staffing method and to seek views on its application ................................................................................................................................ 24 Section 2 Duty for the planning and securing of services ............................................................. 25 Key Themes Summary ....................................................................................................................... 26 eRostering ..................................................................................................................................... 26 Reduced Working Week................................................................................................................ 27 Recruitment .................................................................................................................................. 27 Retention ...................................................................................................................................... 28 Rural and Islands Health and Social Care Recruitment ................................................................. 28 Workforce Planning ...................................................................................................................... 29 Protected Learning Time ............................................................................................................... 30 Staffing Level Tools (SLTs) & The Common Staffing Method........................................................ 30 Further Guidance on Planning and Securing Services .................................................................. 31 PART 2: HEALTHCARE: DUTIES ON SCOTTISH MINISTERS ............................ 32 Page 118 of 180
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Document No: SG/2025/211 3 Purpose ............................................................................................................................................. 32 Assessment of Compliance ............................................................................................................... 32 Section 12IG Duty to ensure there is a sufficient number of registered Nurses, Registered Midwives and Medical Practitioners ............................................................................................. 32 Section 12IB Duty to publish information from Health Boards on the amount spent on all agency workers ......................................................................................................................................... 35 PART 3: CARE SERVICES REPORTING PROCESS ............................................ 36 Duties on Local Authorities and Integration Authorities .................................................................. 37 Purpose ............................................................................................................................................. 37 Reporting....................................................................................................................................... 38 Overall Assessment of Local Authority and Integration Authority Compliance ............................... 38 Overview of steps taken ............................................................................................................... 39 Ongoing risks ................................................................................................................................. 39 Duties On Providers .......................................................................................................................... 40 Care Inspectorate Safer Staffing Programme ............................................................................... 40 Compliance With Individual Duties ................................................................................................... 42 Section 3 Duty to have regard to guiding principles for health and care staffing ........................ 42 Section 7 Duty to ensure appropriate staffing.............................................................................. 45 Section 8 Duty to ensure training of staff ..................................................................................... 48 PART 4 MINISTERIAL DUTIES FOR CARE SERVICES ........................................ 52 Section 9 (1) (b) & (c): Effect of staffing levels and Supporting Staffing Levels ................................ 52 Section 9 (1) (d) Considerations for determining future supply of care professionals .................... 56 Section 9 (1) (e) Ministerial steps taken to ensure availability of funding ....................................... 58 PART 5: CONCLUSION .......................................................................................... 61 Page 119 of 180
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Document No: SG/2025/211 4 GLOSSARY OF TERMS HCSA/ “the Act” Health and Care (Staffing) (Scotland) Act 2019 – legislation providing a statutory basis for appropriate staffing in health and care services. Boards Health Boards – A Health Board is a formal body, such as a statutory committee or a direct service provider, responsible for improving health and wellbeing, delivering NHS services, and reducing health inequalities in a local population. RAG Status A traffic-light system (Red, Amber, Green) used to indicate levels of assurance or compliance. eRostering An overarching term that encompasses the electronic rostering system and its associated modules used to manage staffing schedules and ensure appropriate staffing. SafeCare A module within the Allocate Optima system that supports real-time staffing decisions based on patient acuity. Allocate Optima NHS Scotland’s national eRostering software suite used to manage workforce deployment. SSTS Scottish Standard Time System – a system used for recording staff time and absence. The data captured feeds into the NHS payroll system and provides essential workforce information for management reporting. TURAS NHS Education for Scotland’s digital platform for learning and workforce development. LearnPro Online learning platform used for statutory and mandatory training in NHS Scotland. CSM Common Staffing Method – a structured approach to workforce planning using validated staffing level tools and professional judgement. SLTs Staffing Level Tools – specialty-specific tools used to calculate appropriate staffing levels. SOPs Standard Operating Procedures – documented processes to guide consistent practice. PDP Personal Development Plan – a tool used to support staff development and training. Page 120 of 180
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Document No: SG/2025/211 5 PLT Protected Learning Time – dedicated time allocated for staff training and development. AfC Agenda for Change – NHS pay system covering most staff except doctors, dentists, and senior managers. RWW Reduced Working Week – policy initiative to reduce contracted hours for AfC staff. WTE Whole Time Equivalent – a unit that indicates the workload of an employed person in a way that makes workloads comparable across various contexts. HIS Healthcare Improvement Scotland – the national improvement organisation for health and care services in Scotland. NSS NHS National Services Scotland – provides national strategic support services to NHS Scotland. IJB Integration Joint Board – responsible for planning and commissioning health and social care services. ELC Early Learning and Childcare – subcategory of Social Care. Authorities Refers to both Local and Integrated Authorities. Both are local bodies responsible for local service delivery including social care. CI Care Inspectorate – the independent regulator of social care and social work services in Scotland. CPL Continuous Professional Learning – term used to describe the training and workforce development of SSSC registered workforce. SSP Safe Staffing Programme – the Care Inspectorate team dedicated to work on the implementation of the Act. SSSC Scottish Social Services Council – regulates the social service workforce in Scotland. SVQ Scottish Vocational Qualification – the qualification level for several social care roles. SACC School Age Childcare – subcategory of Social Care. Page 121 of 180
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Document No: SG/2025/211 6 NMT National Nursing and Midwifery Taskforce – a Scottish Government initiative to improve Nursing and Midwifery workforce sustainability. RLW Real Living Wage – independently calculated based on the cost of living. GP General Practitioner – a medical doctor who treats acute and chronic illnesses and provides preventive care and health education. Page 122 of 180
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Document No: SG/2025/211 7 FOREWORD The Health and Care (Staffing) (Scotland) Act 2019 (“the Act”) is the UK’s first multidisciplinary staffing legislation and Scotland became world leading by enshrining such legislation which applies across our entire health and care system. This legislative step reflected our unwavering commitment to delivering high-quality care and improving outcomes for service users. The core aim of the Act, to enable better care through appropriate staffing, has been the subject of much focus in its first year of implementation. Early evidence indicates that the Act is fostering greater transparency in staffing decisions and cultivating a culture of openness and honesty. Staff are increasingly empowered to participate in decision-making processes and to raise concerns safely and constructively. This engagement is not only vital for maintaining adequate staffing levels but also for aiding in more robust staffing decisions. Health Boards, Local Authorities and Integration Joint Boards commissioning are services required to publish and submit annual reports to Scottish Ministers detailing how they have carried out their statutory duties under the Act. This Ministerial report provides a comprehensive summary and analysis of the findings from those annual reports, alongside data from the regulators of care services, highlighting the progress made, areas of success, and areas for further development when implementing the Act across Scotland’s health and care services. It also describes the practical steps the Scottish Government is taking to satisfy its legal obligations under the Act. For health services, the majority of Boards indicated either reasonable or substantial assurance in terms of their compliance with the duties contained in the Act in the first year following commencement. The Common Staffing Method and real-time staffing assessment are recognised features of the way we plan for services and a range of other governance structures, systems and processes have also been introduced to ensure staff are supported to deliver high quality treatment. We are supporting Health Boards in their compliance through active collaboration and support. Through our expansion of medical undergraduate places and specialty training roles we are building capacity across our medical workforce to ensure it is able to meet the future demands we face. In support of Nursing and Midwifery we are working to implement Phase Two of the Nursing & Midwifery Taskforce (NMT) and the package of support we provide for Scottish Nursing and Midwifery students is at its highest level, unmatched across the UK. In addition, In October the formation of a new Scottish Maternity and Neonatal Taskforce was announced which will provide strategic and national leadership over issues reported in these services. For care services, all Local and Integration Authorities set out the structured and proactive steps they have taken to embed the Act’s requirements into their processes in their annual reports, to demonstrate compliance with the Act’s duties following implementation in April 2024. With regard to care services, in 2021, we committed to increasing social care spending by 25% (over £800 million) by 2026–27. This target was achieved two Page 123 of 180
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Document No: SG/2025/211 8 years ahead of schedule, as confirmed in April 2024, with the Scottish Budget for 2024–25 delivering the full uplift. Programmes such as the Joint Social Services Taskforce, Earn and Learn Blueprint, Programme for Scotland’s Childminding Future, and the National Induction Framework are helping to attract, retain and develop a skilled workforce. These targeted steps should be viewed alongside broader plans to reform our health and social care system in order to ensure our services and the people who deliver them are well placed to meet the future demands we face. Through our Public Service Reform strategy, we have set out the way in which all public services must evolve if they are to meet our future needs. Our Service Renewal Framework (SRF) describes how we will give effect to these ambitions for health and social care. The SRF recognises that our workforce will be deployed differently in the future to achieve improved outcomes for the people of Scotland. We will work with partners to strengthen workforce planning for services which will be increasingly designed based on population needs. The day-to-day experience of the workforce in delivering those services will also improve through better use of digital systems to streamline support and reduce the administrative workload, freeing up capacity so staff can spend more time with individual patients and people, supporting us to deliver the aspirations of the Act. Our efforts in this space will be shaped by the feedback we are gathering through our Future Medical Workforce project which will be considered alongside the outputs of the NMT. We will also explore further opportunities to support our workforce through the establishment of NHS Delivery, a new national organisation tasked with driving innovation and delivering more on a Once for Scotland basis While the full impact of the Act will be realised gradually, the foundations laid in its inaugural year are promising. The annual reports submitted by health and care providers offer valuable insights into how the legislation is being embedded in practice and highlight areas of success and ongoing development The Scottish Government remains committed to working collaboratively with health and care providers, Local and Integration Authorities, professional bodies and Trade Unions, Health Improvement Scotland and the Care Inspectorate to build on this momentum. Together, we will ensure that the principles of the Act continue to be upheld and strengthened, year on year, delivering lasting benefits for both staff and service users across Scotland’s health and care system. Page 124 of 180
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Document No: SG/2025/211 9 INTRODUCTION The Health and Care (Staffing) (Scotland) Act 2019 1(the Act) commenced in April 2024 and provides a statutory basis for the provision of appropriate staffing in health and care services, enabling safe and high-quality care and improved outcomes for service users. This requires the right people, in the right place, with the right skills, at the right time. The legislation does not prescribe minimum staffing levels or fixed ratios and does not advocate a ‘one size fits all’ ratio, which would be inflexible to local needs, based on a fixed point in time, and not consistently reflective of workforce, case mix or dependencies. It builds on existing policies and procedures within both health and care services and effective implementation aims to embed a culture of openness and transparency, ensuring staff are informed about decisions relating to staffing and able to raise concerns. For health services, the Act places duties on Health Boards to ensure that at all times suitably qualified and competent individuals are working in such numbers as are appropriate for the health, wellbeing and safety of patients, the provision of high- quality care and the wellbeing of staff. Furthermore, Boards are required to put in place the systems and processes to enable real-time assessment of staffing on the day which will keep patients safe now, and in years to come through better workforce planning and reform. For care services, the Act replaces obligations introduced through the Social Care and Social Work Improvement Scotland (Requirements for Care Services) Regulations 2011 to ensure staffing arrangements in care settings are appropriate for the health, welfare and safety of service users. This report covers the period of 1st of April 2024 to 31st of March 2025 and sets out the extent and nature of compliance with the Act by Health Boards and care providers, as well as setting out the steps taken by Scottish Ministers to aid with Health Board and care compliance. The report satisfies a legal Duty placed on Ministers under sections 12IG(3) and 12IM(2) of the National Health Service (Scotland) Act 1978, introduced under section 4 of the Act. The report comprises of: • Part 1: Health care: Duties on Health Boards • Part 2: Health care: Duties on Scottish Ministers • Part 3: Care Services • Part 4: Care Services: Duties on Scottish Ministers • Part 5: Conclusion 1 Health and Care (Staffing) (Scotland) Act 2019 Page 125 of 180
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Document No: SG/2025/211 10 The individual legislative duties that are described and evidenced within the ensuing report are summarised from the Health and Care (Staffing) (Scotland) Act 2019 and the Health and Care (Staffing) (Scotland) Act 2019: statutory guidance 2 and therefore these documents should be read in conjunction with this. Guiding Principles of the Act The Act states that the main purposes of staffing for healthcare and care services are: • to provide safe and high-quality services; and • to ensure the best healthcare or (as the case may be) care outcomes for service users. The Act then lists principles to be met, insofar as they are consistent with the main purposes, when relevant organisations are arranging staffing. 2 Health and Care (Staffing) (Scotland) Act 2019: statutory guidance - gov.scot Page 126 of 180
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Document No: SG/2025/211 11 PART 1: HEALTHCARE: DUTIES ON HEALTH BOARDS Purpose Section 12IM of the Act, Reporting on staffing, requires relevant organisations to publish and submit an annual report to the Scottish Ministers detailing how they have carried out their duties under the Act. The purpose of the annual reporting requirement is to: • Enable monitoring of the impact of the legislation on quality of care and staff wellbeing. • Identify areas of good practice that can be shared. • Identify challenges relevant organisations are facing in meeting requirements of the Act and what steps they have taken/are taking to address these. • Identify any improvement support required. • Inform Scottish Government policy on workforce planning and staffing in the health service, alongside other sources of information and data. Section 12IM also places responsibilities on Scottish Ministers, and states that following the receipt of such reports from Health Boards, Scottish Ministers are then Duty bound to: • Collate the reports submitted to them into a combined report for the year to which the reports relate (published alongside this report), • Lay that combined report before the Scottish Parliament, and • Lay an accompanying statement (the foreword) setting out how they have taken into account/plan to take into account, in their policies for the staffing of the health service, the information included in the combined report. Also under Section 12IM, the Act places a Duty on Scottish Ministers to publish a report setting out how each Health Board and the Agency has carried out its duties under the Act and lay said report before Parliament. This report satisfies those legislative duties within section 12IM of the Act and will be used to inform future policy and strategic objectives. Reporting Process Health Boards were provided with an annual reporting template to complete and submit to Scottish Ministers. The template evaluates systems, processes, and governance structures in place to meet the legislative requirements by requesting detail on: Page 127 of 180
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Document No: SG/2025/211 12 • Evidence of their compliance with the duties under the Act, including a RAG status on their level of assurance of their compliance. • Areas of success, achievement and learning associated with the particular Duty or requirement, along with indicating how this could be used in the future. • Areas of risk and escalation where they have been unable to achieve or maintain compliance with a particular Duty or where they have faced any challenges and what actions have been or are being taken to address this. Health Boards were also asked to provide a declaration of the level of assurance they have regarding compliance with their responsibilities under the Act. Collated Health Board Reports have been published alongside this report and can be accessed here: Health Board Annual Reports3. Overall Assessment of Board Compliance At the beginning of the reporting template, Boards answered 3 overarching questions offering an overview of how their approach to implementation of the Act has influenced their processes, resulted in achievements and highlighted risks. With specific regard to workforce planning, the template also asked how the information provided in the report had been used or would be used to inform workforce plans. The evidence provided indicates that Boards have integrated data and insights from the Health and Care (Staffing) (Scotland) Act 2019 into their workforce planning processes, aligning staffing decisions with statutory duties, operational requirements, and strategic objectives. This includes the use of evidence-based methodologies such as the Common Staffing Method, SafeCare, and the Six Steps Workforce Planning Methodology. Governance structures have also been strengthened through regular reporting to internal boards and committees, ensuring oversight and accountability. Cross-functional collaboration and shared learning have enhanced the effective use of data, while the first year of implementation has highlighted areas for further improvement in data capture and compliance. Boards are actively adapting their systems to embed the Act’s principles into routine practice, supporting sustainable workforce planning and the delivery of safe, high-quality care. The overall level of assurance reported by Boards with regard to compliance with their Duties under the Act is summarised in table 1 followed by detail on what constitutes each assurance level. 3 https://www.gov.scot/publications/health-and-care-staffing-act-2019-duty-12im-health-board-annual- reports Page 128 of 180
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Document No: SG/2025/211 13 Figure 1: Breakdown of Health Board Overall Assurance Levels 73.7% indicate reasonable assurance, 15.8% indicate substantial assurance and 10.5% indicate limited assurance. Assurance Level Definitions Substantial assurance Definition: A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited. Controls: Controls are applied continuously or with only minor lapses. Reasonable assurance Definition: There is a generally sound system of governance, risk management and control in place. Some issues, non-compliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited. Controls: Controls are applied frequently but with evidence of non- compliance. Limited assurance Page 129 of 180
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Document No: SG/2025/211 14 Definition: Significant gaps, weaknesses or non- compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited. Controls: Controls are applied but with some significant lapses. No assurance Definition: Immediate action is required to address fundamental gaps, weaknesses or non-compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited. Controls: Significant breakdown in the application of controls. Compliance With Individual Duties Section 12IA Duty to ensure appropriate staffing The Duty to ensure appropriate staffing is designed to enable the provision of safe and high-quality services which meet the needs of service users through having appropriate staffing, with the right person, with the right skills, available in the right place, at the right time, to provide care. This Duty outlines that staffing must be appropriate to ensure the health and wellbeing and safety of patients, the provision of safe and high-quality healthcare and the wellbeing of staff. The following must also be considered when determining what constitutes appropriate levels of staffing: • The nature of the particular kind of healthcare provision • The local context in which it is being provided • The number of patients being provided for • The needs of patients being provided for, and • Appropriate clinical advice. Key findings Almost half (47%) of Boards indicated reasonable assurance with regard to this Duty whilst 37% advised of substantial assurance and 16% of limited assurance. Achievements, Successes and Learning The reports published suggest Health Boards are making strong progress in ensuring compliance with the Duty at section 12IA. Most have established dedicated Programme Boards with multi-professional input, ensuring collaborative and informed decision-making. The rollout and expansion of eRostering, particularly via Page 130 of 180
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Document No: SG/2025/211 15 the SafeCare module, is enhancing real-time staffing visibility and supporting more responsive workforce management. Boards are also supporting staff in their development with the help of TURAS learning modules and internal training to build awareness and understanding of the Duty. Workforce planning is being strengthened through the use of the Common Staffing Method (CSM) and staffing level tools (SLTs), as well as through existing resources such as the Six Step Methodology to workforce planning. Importantly, staff wellbeing remains a key focus, with flexible working options, retire-and-return schemes, and comprehensive wellbeing strategies being actively promoted. Challenges (escalation issues, risks) The Reduced Working Week (RWW) for Agenda for Change (AfC) staff - as agreed to as part of the 2023–24 pay negotiations - is a factor across several Boards, impacting rosters, staffing levels, and rollout of digital systems. Boards have noted that implementing the RWW has required changes to roster planning and shift patterns, which has increased the workload for eRostering teams and service leads. These adjustments have also influenced the pace of rolling out systems like SafeCare and eRostering, which support compliance with the Act. Boards, particularly those that face rural issues, have highlighted that further reductions in working hours may present challenges in maintaining compliance due to existing workforce limitations. Boards are working to balance safe staffing levels while accommodating the new working time arrangements. Financially, Boards are reviewing their service and workforce plans to align with the RWW within current budgetary frameworks. Looking ahead to the next planned reduction in April 2026, many boards are reflecting on current experiences to inform future planning and to ensure a smooth transition. Noting the benefits of systems such as eRostering and SafeCare mentioned above, Boards are at varying stages of implementing these systems. Many have discussed variation of reporting mechanisms across services which means that they are not fully compliant. Many also advise that for Nursing the systems are more robust than in other services (i.e. through the use of CSM & SLTs). The absence of validated SLTs for some professional groups makes it difficult to benchmark and demonstrate compliance with staffing requirements. Budgetary considerations are also limiting the ability of boards to implement necessary systems and expand the workforce in some settings. Elsewhere, recruitment and retention is an issue raised particularly in rural areas. Page 131 of 180
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Document No: SG/2025/211 16 Section 12IC Duty to have real-time staffing assessment in place The purpose of the duties under sections 12IC, 12ID and 12IE of the Act is to ensure that relevant organisations have in place robust arrangements to deliver the Duty to ensure appropriate staffing in the day-to-day running of all NHS services. This will be assessed through effective identification, reporting, escalation and mitigation of risks caused by staffing numbers and skill mix that are required to meet patient or service user need. Whilst these duties will help inform longer term planning of staffing and ultimately inform workforce planning at a local and national level, this is not the sole aim. The duties are also intended to go beyond an annual setting of staffing, to support a dynamic, real-time staffing response to emerging and actual risks to the safety and quality of care being provided to patients and service users. This is essential if the legislation is to have the desired effect. Under section 12IC, relevant organisations have a Duty to put in place arrangements for the real-time assessment of its compliance with the section 12IA Duty to ensure appropriate staffing. Key findings The majority of Boards indicated reasonable assurance in relation to their compliance with this Duty (63%) followed by substantially assured (21%) and limited assurance (16%). Achievements, Successes and Learning Many Health Boards have made steady progress in implementing the digital system eRostering, which supports staffing assessments, risk identification, and escalation in line with Duty set out under section 12IC. In areas where these systems are not yet fully in place, Boards have adopted effective local governance processes, including safety huddles, standard operating procedures (SOPs), and direct engagement with clinical leaders to manage staffing risks and discuss staffing matters. Staff engagement and training has been central to these efforts, with many Boards incorporating eRostering and the broader Health and Care Staffing Act into induction materials and awareness campaigns. Governance and monitoring are also well established, with regular internal self-assessments reported to executive leadership Page 132 of 180
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Document No: SG/2025/211 17 to ensure oversight. Additionally, clear escalation pathways, both through formal digital systems and informal management channels, are in place to address staffing concerns promptly and effectively. Challenges (escalation issues, risks) Again, in addition to being an area of success, the implementation of digital process were also highlighted as key area of challenge to Health Boards. Many Boards stated that continued reliance on interim or legacy systems had created administrative burden for some staff groups, and carries additional risks for data accuracy. This is due to the ongoing risk of double keying as there is an absence of a direct interface between eRostering and either Scottish Standard Time System (SSTS) or payroll. Consequently, staff rosters need to be manually keyed from the eRostering system into SSTS, to allow staff to be paid accurately. Health Boards have cited engagement and training of staff as a mitigation. Notwithstanding this, some indicate their preference to focus training for newly recruited staff only on newly implemented systems given ongoing work to phase legacy systems out. The unknown impact of the further reductions to the working week was highlighted as a risk by many Boards. As advised in relation the Duty under section 12IA, for many the impact will be on the implementation of electronic rostering systems, as any reductions in the working week affect the build of new service area rosters. Section 12ID Duty to have risk escalation process in place Under section 12ID, Boards have a Duty to put in place arrangements for the escalation of risks identified during real-time assessment of staffing levels, that were not possible to mitigate. Key findings The majority of Boards indicated reasonable assurance with regard to the Duty under section 12ID (58%) followed by 26% advising of substantial assurance and 16% of limited assurance. Achievements, Successes and Learning Health Boards have made good progress in embedding risk escalation processes in line with the Duty included at section 12ID. Many Boards have implemented structured frameworks supported by digital reporting systems available through eRostering, enabling real-time staffing assessments and robust documentation of unmitigated risks. SOPs have been developed to help guide more consistent Page 133 of 180
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Document No: SG/2025/211 18 escalation practices, and multidisciplinary safety huddles are widely used to facilitate timely decision-making. Boards that have demonstrated substantial assurance have systems such as SafeCare in place across several functions and professional groups. Challenges (escalation issues, risks) A key risk is the variability in application and documentation of risk escalation processes, particularly in areas where digital systems are not yet fully implemented. Many Boards continue to rely on informal communication methods, such as verbal or email reporting, which limits traceability and auditability. Additionally, the lack of a unified approach across all services and professions has led to variability in compliance levels, as indicated by some Boards still operating under limited assurance. Section 12IE Duty to have arrangements to address severe and recurrent risks Under section 12IE, Boards have a Duty to put in place arrangements for collating information on escalated risks and identifying and addressing risks considered to be severe and/or recurrent. Key findings The majority (47%) indicated reasonable assurance with regard to the Duty at section 12IE followed by 37% advising of substantial assurance and 16% of limited assurance. Achievements, Successes and Learning As above, most Boards report reasonable to substantial assurance, with digital systems being widely used to record, monitor, and escalate risks. Many Boards have developed locally agreed definitions, SOPs, and dashboards to support consistent risk identification and trend analysis. Governance structures, including daily safety huddles and executive-level oversight, ensure that severe risks are escalated and reviewed appropriately. Challenges (escalation issues, risks) Despite the achievements mentioned above with regards to local measures being implemented, Boards advise of variability, both in terms of their application and of the recording of information. The reports signal that more could be done to ensure consistent application and documentation of risk escalation processes across services and professional groups, particularly in areas where SafeCare are not yet fully implemented. Some Boards report variability in defining and recording severe or Page 134 of 180
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Document No: SG/2025/211 19 recurrent risks, leading to gaps in data collection and trend analysis. The reliance on manual or informal processes in certain areas limits auditability and may obscure emerging risks. Additionally, resource constraints, system interoperability issues, and varying levels of staff training contribute to uneven implementation. Section 12IF Duty to seek clinical advice on staffing This Duty requires Boards to put and keep in place arrangements for: • Seeking and having regard to appropriate clinical advice in making decisions and putting in place arrangements in relation to staffing under sections 12IA to 12IE and 12IH to 12IL. • Recording and explaining decisions which conflict with that advice. Key findings The majority (63%) of Boards provided reasonable assurance regarding this Duty, followed by 21% indicating limited assurance and 16% indicating substantial assurance. Achievements, Successes and Learning Several of the Boards report that professional leads are in place for the majority of services to support or provide professional advice with real-time staffing decisions, address any risk escalation and provide representation on workforce planning groups. Daily or shift-based huddles are widely used to discuss staffing levels, escalate concerns, and seek clinical input. Several Health Boards have established dedicated working groups to raise awareness and deliver targeted training on this Duty. These groups play a key role in supporting staff in understanding their responsibilities under the legislation and in embedding best practices across services. Communication strategies such as intranet updates, newsletters, and direct engagement sessions are being actively used to inform and empower staff at all levels. Similarly, a number of Boards are developing SOPs to clarify roles and responsibilities in the provision and receipt of clinical advice, particularly within multidisciplinary teams. These SOPs aim to ensure consistency, accountability, and timely decision-making in the management of staffing-related risks, thereby strengthening clinical governance and compliance with the Act. Challenges (escalation issues, risks) There is scope for improved consistency in how clinical advice and conflicts are documented. Clinical advice can be recorded in varying formats such as emails, verbal discussions, clinical notes, or huddle records, making it difficult to audit. Page 135 of 180
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Document No: SG/2025/211 20 SafeCare Implementation is seen as the future standard for documenting clinical advice, conflicts, and mitigations. However, further work is required to roll out this system. In addition, pressures on services on occasion results in clinical leaders being pulled in to provide direct care, negatively affecting their ability to perform duties under the Act. To counter this, some Boards explicitly mention that non-patient facing responsibilities related to section 12IF are included in job plans. They will also ensure appropriate governance procedures are in place and that training and awareness activity is ongoing to assist clinical leads. Again, eRostering, once fully implemented, are expected to streamline documentation and reduce the time burden on clinical leads by automating parts of the compliance process. Section 12IH Duty to ensure adequate time given to clinical leaders This Duty is intended to ensure that clinical leaders receive the right amount of time and resources to discharge their responsibilities under the Act to ensure appropriate staffing, alongside all the other professional duties and responsibilities they have. These include the clinical leadership and management functions that support the delivery of high-quality care. Key findings The majority (63%) of Boards indicated reasonable assurance with regards to this Duty, followed by 21% advising of limited assurance and 16% of substantial assurance. Achievements, Successes and Learning The continued rollout and implementation of digital systems and process was a common area of success reported. Several Health Boards cited that these systems allow for the identification of protected clinical leadership time for the identified staff and allows for more easily demonstrative data to evidence compliance to Health Board monitoring groups. Staff engagement via personal development plans (PDP), appraisals and managerial one-to-ones was another area of success, as they allow for localised monitoring and assurance reporting. Consideration of job plans, and role descriptions furthers this engagement ensuring that the appropriate staff are aware of their responsibilities under the Act. Challenges (escalation issues, risks) A key theme across all Health Boards regardless of assurance level was the level of variation across all staff groups in the time taken to undertake clinical leadership Page 136 of 180
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Document No: SG/2025/211 21 duties, and what constitutes sufficient time. The balancing of leadership duties and clinical activity was highlighted as a key barrier. Several Boards highlighted that wider staffing issues such as unexpected absences can result in clinical leaders foregoing their protected leadership time to undertake clinical patient activity. Wider workforce planning and recruitment strategies were highlighted as mitigation for this challenge. This included targeted staff recruitment campaigns, staff skill mixes for rosters, and building of clinical leadership time into rotas, all with the aim of ensuring those with leadership roles have opportunity to carry them out. Some Health Boards were not able to evidence the effectiveness of these at time of report submission due to these planning and recruitment workstreams being in the early stages of development or implementation. Additionally, monitoring and escalation through preexisting managerial PDP, appraisals and managerial one-to-ones, was highlighted as key mitigation against foregoing leadership activity. The RWW and its impact on the availability of protected clinical leadership capacity was also highlighted as a risk to Duty compliance. Section 12II Duty to ensure appropriate staffing: training of staff This Duty requires relevant organisations to ensure that, in complying with the Duty imposed by section 12IA (the Duty to ensure appropriate staffing), employees receive appropriate and relevant training. This is to ensure that suitability qualified and competent individuals from such a range of professional disciplines, as necessary, are working in such numbers as are appropriate for the health, wellbeing and safety of patients and the provision of safe and high-quality health care. Section 12II also requires that adequate time and resource is provided to undertake that training. Key findings The majority (53%) of Boards indicated reasonable assurance with regards to this Duty followed by 42% advising of substantial assurance and 5% of limited assurance. Achievements, Successes and Learning As the assurance levels above demonstrate, Boards have demonstrated significant progress in meeting the requirements of this Duty, with the majority implementing structured training frameworks supported by platforms such as TURAS and LearnPro. Boards have established clear governance and oversight mechanisms, including Staff Governance Committees and Programme Boards, to monitor compliance with statutory and role-specific training. Many have embedded training into workforce planning through job planning, PDPs, and appraisal systems, with Page 137 of 180
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Document No: SG/2025/211 22 some Boards achieving substantial assurance ratings. Innovative practices such as hybrid learning models, protected learning time initiatives, and apprenticeship programmes have enhanced accessibility and sustainability of training. Some Boards have been particularly successful in aligning training with service needs and professional development goals, fostering a strong culture of continuous learning. Challenges (escalation issues, risks) There is some evidence of variability in the application of training policies across professional groups and clinical settings, often exacerbated by staffing shortages and operational pressures. Protected Learning Time, while recognised as essential, is not yet uniformly implemented, with many Boards citing difficulties in releasing staff due to service demands and reduced working hours. Low completion rates for appraisals and PDPs in some areas hinder the identification of training needs, while financial constraints and limited training capacity further restrict access to development opportunities. Additionally, gaps in data integration and real-time monitoring limit Boards’ ability to track compliance effectively. Section 12IJ Duty to follow the common staffing method Section 12IK of the Act sets out the type of healthcare, the locations, and the employees that the CSM applies to. Relevant organisations must apply the CSM where they operate health care. Services described in section 12IK and are required to report on this internally. Section 12IJ sets out the Duty to follow the CSM. The CSM sets out a process, including the use of speciality-specific staffing level and professional judgement tools and a range of other considerations, which must be applied rigorously and consistently. Table 3 below outlines what is included within the CSM. The application of the CSM will support relevant organisations to ensure appropriate staffing for the health, wellbeing and safety of patients and the provision of safe and high-quality care. It forms part of the evidence that relevant organisations submit to demonstrate how they have complied with the Act. Page 138 of 180
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Document No: SG/2025/211 23 Figure 2: The Common Staffing Method Visual of the factors to consider when applying the Common Staffing Method (CSM). Key findings The majority (56%) of Boards indicated substantial assurance with regards to this Duty followed by 31% advising of reasonable and 13% of limited assurance. Achievements, Successes and Learning As the assurance levels indicate, Boards have made strong progress in embedding the CSM into their processes. They have established annual schedules for running specialty-specific staffing level tools and for most boards, training is provided before and after tool runs. The use of TURAS, Healthcare Improvement Scotland (HIS) resources, and local SOPs are in place to help to guide staff, and some Boards have dedicated teams or leads to support implementation of this Duty. Boards are effectively using triangulation, combining staffing tools, professional judgement, and quality indicators to inform evidence-based staffing decisions. Staff and patient feedback is actively incorporated, and systems such as HealthRoster and SafeCare support real-time monitoring and reporting. Page 139 of 180
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Document No: SG/2025/211 24 Challenges (escalation issues, risks) Despite these strengths, several Boards face ongoing challenges in fully implementing the CSM. Some services report inconsistent application, with variations in adherence across departments and specialties. There is a lack of staffing tools for certain professions, such as psychology and mental health AHPs, where small team sizes and lack of templates hinder progress. Operational pressures and competing clinical priorities often limit the time available for preparation and participation in CSM activities. Section 12IL Duty to train staff in the use of the common staffing method and to seek views on its application Section 12IL of the 1978 Act (as inserted by the Health and Care (Staffing) (Scotland) Act 2019) places a responsibility on relevant organisations to encourage and support employees to give views on staffing arrangements for the types of health care covered by the CSM, and to take account of and use such views. In addition, staff who use the CSM must be trained in its use, they must be provided adequate time to use it, and staff must be informed on how the method has been used in their area. Key findings This Duty is not applicable to NHS 24, the Scottish Ambulance Service or National Services Scotland. The majority (56%) of Boards indicated substantial assurance followed by 31% advising of reasonable and 12.5% of limited assurance. Achievements, Successes and Learning As the assurance levels detailed above show, the majority of Health Boards are making good progress in relation to the training of staff in the Common Staffing Method. Boards have adopted a dual approach, combining national resources such as TURAS with locally developed materials to ensure comprehensive training. Many Boards reported success in engaging staff through effective communication strategies and structured training schedules aligned with staffing tool runs. This approach has enabled clinical leaders to fully consider CSM outputs and incorporate staff feedback through standardised templates. The use of self-assessments and local record keeping has further supported assurance processes, with many Boards integrating these into quarterly governance reporting. These practices have not only strengthened compliance with the Duty under section 12IL but have also informed the transition of CSM related responsibilities into business-as-usual operations. Page 140 of 180
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Document No: SG/2025/211 25 Challenges (escalation issues, risks) Boards reported challenges in balancing the demands of the Act with clinical pressures and competing policy initiatives. In some cases, limited capacity and resource constraints have hindered the delivery of training, especially where it relies on a single staff member or team. While many Boards are actively reviewing their organisational structures to embed CSM responsibilities into BAU, these transitions are ongoing and may affect assurance levels in the short term. Section 2 Duty for the planning and securing of services Section 2 (2) of the Act outlines that when a Health Board is planning or securing the provision of healthcare from a third party, it has regard to the guiding principles of the Act and the need for that third party from whom the provision is being secured to have appropriate staffing arrangements in place. Key findings The majority (63%) indicated reasonable assurance followed by 21% advising of substantial and 16% of limited assurance. Achievements, Successes and Learning Many Boards have updated tender documentation, service specifications, and Service Level Agreements (SLAs) to include references to appropriate staffing arrangements, with procurement teams actively engaged in implementation. Some Boards have demonstrated structured approaches, including the use of national frameworks, standardised question sets, and collaborative working groups to ensure compliance. Several Boards have also introduced mechanisms for monitoring patient outcomes and contractor performance, such as quarterly feedback reports and contract review processes. Engagement with stakeholders, including finance and commissioning teams, has supported awareness-raising and the transition of these duties into business-as-usual operations. These efforts collectively support the delivery of safe, high-quality care and demonstrate a commitment to continuous improvement. Challenges (escalation issues, risks) A common issue is the lack of statutory authority to require staffing information from independent contractors, particularly in dental, optometry, and general practice services, which has led to limited assurance ratings in some areas. Continued collaboration, national guidance, and targeted support will be essential to strengthen compliance and ensure equitable service provision across Scotland. Page 141 of 180
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Document No: SG/2025/211 26 Key Themes Summary In the above summaries, a number of key themes arise that impacted several Boards in ensuring compliance with their duties under the Act. The Scottish Government, through working closely with Boards and HIS, have been proactively working to address these throughout the first year following commencement of the Act. This section provides further details of that work. eRostering In October 2020, NHS Scotland Board Chief Executives signed a national contract to implement the Allocate Optima system and its associated modules across all NHS Scotland health boards over a 10-year period. This collective package is referred to as eRostering. Allocate Optima is the UK and Ireland’s most widely used health and care e-rostering software. It enables organisations to ensure the right staff are in the right place at the right time, supporting efficient workforce deployment across all non-medical and dental staff groups. SafeCare, a key module within the suite, is a mobile acuity-based staffing tool that compares actual staffing levels to patient demand in real time. It supports live decision-making, enhances productivity, and safeguards patient safety. The eRostering solution will serve as a centralised workforce management system across NHS Scotland, enabling the creation of staff rosters, management of leave, and accurate recording of time worked for all staff groups. This modern digital platform is designed to enhance rostering practices, align staffing levels with patient care needs, and ultimately support the delivery of high-quality healthcare services across the country. The eRostering solution - particularly the SafeCare module - plays a key role in supporting NHS Boards in meeting their statutory obligations under the Act. It promotes a unified and streamlined approach to compliance, monitoring, and reporting. Considering the importance these systems have in enabling NHS Boards to meet their legislative duties under the Health and Care (Staffing) (Scotland) Act 2019, the Scottish Government will continue to work closely with NHS Boards, National Services Scotland (NSS), and other stakeholders to support the effective rollout and integration of eRostering. This will include providing strategic oversight and ensuring alignment with wider digital transformation programmes such as payroll and HR system replacements. By maintaining a coordinated approach, the Scottish Government aims to maximise the benefits of eRostering, reduce variation in implementation, and ensure that all Boards are equipped to deliver safe, effective, and person-centred care. Page 142 of 180
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Document No: SG/2025/211 27 Reduced Working Week As part of the pay settlement for Agenda for Change (AfC) staff in 2023/24, the Scottish Government committed to modernising a range of priority areas which included the establishment of a working group to explore the reduction of the hours in the working week, with the aim of getting to a 36-hour working week without the loss of earnings. The agreed timescale took account of matters including, but not limited to, service provisions, safe staffing levels, staff wellbeing, and costs. The first half hour reduction in working time for AfC staff was delivered from 1 April 2024 with the further hour reduction in the standard working week to be effective from 1 April 2026. Final implementation plans have been agreed by Area Partnership Forums. A healthy work life balance is essential for our staff who provide high quality of care to the people of Scotland. It is vital that staff feel valued and rewarded for the work they do, and that NHS Scotland remains an employer of choice. It is also crucial that we deliver this change in a way that is safe for patients and staff, supports the continued recovery of services and avoids any extra burden for our workforce. Boards are working to balance safe staffing levels while accommodating the new working time arrangements, implementing service redesign where necessary. Financially, Boards continue to review their services and workforce plans to align with further hour reduction in the standard working week that becomes effective 1 April 2026. Recruitment We continue to take forward a number of initiatives designed to support us in the attraction and retention of highly skilled and qualified staff across our system. With regards to the medical workforce, we have funded the creation of hundreds of additional posts across all specialities and have increased investment in speciality medical training by 43% since the beginning of this parliament In addition, since 2016, the Scottish Government has increased the annual medical undergraduate intake from 848 to 1,149 (67% increase). The 25/26 budget saw record levels of investment, supporting greater foundation year places and additional specialty training places with an emphasis on training more General Practitioners (GPs). The medical education and training pipeline aims to ensure that there are a sufficient number of trainees coming through the system/pipeline to deliver and sustain the medical workforce with the right skills for the future while meeting patient and service need in the present. It takes approximately 7 years to train a registered doctor (and longer for consultants and GPs) and therefore the policies and choices now are shaping the workforce we will have in 15 to 20 years’ time. Notwithstanding this, we are committed to further improving workforce planning and our recently announced Future Medical Workforce project will allow us to hear directly from doctors in order to make improvements to the medical education Page 143 of 180
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Document No: SG/2025/211 28 pipeline, ensuring we can continue to deliver the medical workforce Scotland needs. Additionally, a number of initiatives and policies are underway for Nursing and Midwifery, including ongoing efforts to implement the recommendations of our Nursing and Midwifery Taskforce (NMT). The aim of the Taskforce was to work collaboratively, bringing in a range of expertise and knowledge, and to listen to Nursing and Midwifery staff to identify what was important for them, all with a view to developing a workplan of recommended actions to deliver sustainable changes and build on efforts to make Scotland the best place for Midwives and Nurses to thrive at work. A key priority of the Taskforce was engagement with frontline staff which took place through the Listening Project. In person staff engagement events were held in all Health Board areas across Scotland in a range of acute and community settings to hear from staff representing all areas of Nursing and Midwifery. The NMT published their final report: Ministerial Scottish Nursing and Midwifery Taskforce: Report and Recommended Actions 4 in February 2025. The Scottish Government’s Chief Nursing Officer will lead on phase 2 of the Taskforce which will focus on implementation of the recommended actions, overseen by a Ministerially chaired implementation board. Retention The Scottish Government recognises that it’s more important than ever to retain experienced staff with the skills needed to deliver high quality care in Scotland. Supporting employees with flexible, multi-stage career paths can benefit both the NHS and improve patient care. We continue to work in partnership with NHS Scotland employers and trade unions to develop and evolve national staff policies to aid in the retention of experienced staff such as flexible working patterns/locations, and career development and advancement. Resources are available to support this with the Centre for Workforce Supply, commissioned by the Scottish Government and hosted by NHS Education for Scotland, working closely with Health Boards across Scotland to share best practice in retention. This is undertaken via webinars, bespoke workshops, pastoral care accreditations and best practice guidance which are available to all NHS Scotland staff via a dedicated online hub. Rural and Islands Health and Social Care Recruitment The Scottish Government recognises that recruitment interventions for rural and 4 Delivering Together for a Stronger Nursing & Midwifery Workforce Page 144 of 180
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Document No: SG/2025/211 29 island communities need to be dynamic and tailored to these unique communities if they are to have an impact. This Government had previously committed to develop a remote and rural workforce recruitment strategy by the end of 2024 in the 2021 National Workforce Strategy for Health and Social Care 5. However, following extensive engagement with key stakeholders and policy colleagues it was the view that a standalone, static recruitment strategy was not conducive to a whole system approach. Rather than a published strategy, it was agreed that a direct support model would be developed. This model takes a sustained whole-system approach to provide rural and island health and social care employers with the help they need to overcome recruitment challenges. The Centre for Workforce Supply (CWS) and the National Centre for Remote and Rural Health and Care (NCRRHC), both hosted by NHS Education for Scotland (NES), have been commissioned by the Scottish Government to develop this sustained model of direct support that will provide rural and island health and social care employers with the help they need to improve recruitment success. The Direct Support Model seeks to achieve this through the establishment of a Rural and Island Recruitment Network, a Support Toolkit to inform local decision-making and a library of evidence to support Boards in understanding what has worked well elsewhere. This long-term, dynamic and connective model of support will enable the whole- system approach which is necessary to provide employers with the help they need to overcome recruitment challenges. Work is also underway to provide additional support for the delivery of healthcare in our island and rural communities. As set out in the Programme for Government 2023-2024, the Scottish Government has committed £3.03m in 2023-2026 to progressing the National Centre for Remote and Rural Health and Care. The National Centre for Remote and Rural Health and Care, which was launched in October 2023, is providing specific support to primary and community healthcare workers in our island communities. The work of the Centre focuses on four pillars, education and training, research and evaluation, recruitment and retention and leadership and best practice. Workforce Planning Looking towards the future, it will be important to ensure our approach to workforce planning, recruitment and retention reflects our broader aspirations for NHS Scotland as described in our Health & Social Care Service Renewal Framework. That Framework describes how our workforce will be supported to work in more collaborative, flexible ways across territorial and organisational boundaries. It will 5National Workforce Strategy for Health and Social Care in Scotland Page 145 of 180
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Document No: SG/2025/211 30 mean working more with people as partners in the delivery of care and having improved access to information about the people they support. We recognise the vital role of effective workforce planning in supporting the renewal of our health services. Work is underway to develop a comprehensive plan that strengthens workforce planning across Scotland, ensuring it is fit for the future and aligned with the ambitions of the Service Renewal Framework. Protected Learning Time The Protected Learning Time (PLT) Implementation Group is working to enhance learning and development across NHS Scotland through three key workstreams. The group was established to support the implementation of the Agenda for Change (AfC) Review Recommendations, confirmed by the Cabinet Secretary on 1 March 2024. These include a consistent approach to Protected Learning Time across all NHS Scotland Boards, ensuring that statutory, mandatory, and profession-specific training is completed within working hours. The Protected Learning Time objectives are to standardise statutory and mandatory training, support consistent identification of core mandatory learning by job family, ensure systems are integrated and accessible, and establish clear measures of success to support consistent implementation and continuous improvement. A key aim of this work is to reduce duplication, promote standardisation, and deliver training on a Once for Scotland basis - ensuring all staff have access to the same high-quality learning, regardless of location. A set of Once for Scotland statutory and mandatory training modules are due to be launched for consistent adoption in early 2026. Staffing Level Tools (SLTs) & The Common Staffing Method The CSM provides a structured and consistent approach to local workforce planning across NHS Scotland. It incorporates the use of specialty-specific staffing level tools and professional judgement tools, alongside key contextual factors such as current staffing levels and vacancies, staff skills and experience, local service context, patient needs, and appropriate clinical advice. This process supports Boards in identifying and mitigating staffing risks and determining whether changes to staffing are required. The CSM must be applied at least once per financial year and forms a core component of the evidence submitted by Boards to demonstrate compliance with the Health and Care Staffing Act. Central to the CSM are the staffing level tools developed and maintained by HIS, which use validated formulae to calculate workload and determine Whole Time Equivalent (WTE) staffing requirements based on clinical need, throughput, and care quality. HIS are responsible under the Act for reviewing these tools and making recommendations to Ministers, subject to parliamentary scrutiny. The Act also enables Ministers to expand the scope of the CSM to include additional healthcare services and staff groups as new tools are developed, ensuring the method remains responsive to evolving service needs. Page 146 of 180
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Document No: SG/2025/211 31 In their annual reports, Boards detailed difficulty with the consistent application of the CSM and inconsistencies in the use of SLTs. On 25 April, HIS published their annual report 6setting out how they have complied with their duties under the Act. Within that report, HIS similarly advised of the challenges Boards were encountering with regard to application of the CSM and SLTs. Considering the relatively short period which has passed since the Act was commenced, it is not surprising that work is ongoing across Boards to develop and implement the necessary systems and processes required to aid and ensure compliance. Acknowledging the challenges which have been highlighted, HIS confirmed they will undertake a thematic review into Board compliance with the CSM and a review into its effectiveness in the 2025-26 reporting period. Similarly, they say there is an identified need to develop further resources to support Boards in the provision of training on application of the CSM. The Scottish Government will work with HIS and representatives of Boards to achieve this. Further Guidance on Planning and Securing Services As outlined earlier in this report, some Boards have advised that they have encountered difficulty in evidencing how they have satisfied the requirements of the Act in instances where they are contracting services from third parties. In particular, Health Boards must have regard to the guiding principles of the Act and the need to ensure appropriate staffing in respect of any contracted services. The Scottish Government has worked with Health Boards to explore these issues in more depth and to provide additional guidance to inform local approaches. In the context of primary healthcare, the requirements of the Act can generally be met by recognising that care is typically delivered on a one-to-one basis; one healthcare professional providing care to one patient at a time. In dentistry, this is usually two professionals (such as a Dentist and a Dental Nurse) caring for one patient. Provided that care is delivered to the required standards and by suitably skilled professionals, it can be considered safe. Boards may also take reassurance from the fact that, once a contract or agreement is in place, any concerns about care standards can be addressed through existing regulatory frameworks. These include legislation governing dentistry, optometry, general practice, and pharmacy, as well as the oversight provided by professional regulators who can intervene if necessary. Taking account of the above, work is now underway to review existing national guidance on this section of the Act to reflect the position outlined above. 6 HSP-HIS-functions-in-relation-to-staffing-Annual-Report-24-25-april-2025.pdf Page 147 of 180
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Document No: SG/2025/211 32 PART 2: HEALTHCARE: DUTIES ON SCOTTISH MINISTERS Purpose Section 12IG of the National Health Service (Scotland) Act 1978, introduced under section 4 of the Health and Care (Staffing) (Scotland) Act, requires that Scottish Ministers ensure there is a sufficient number of registered Nurses, registered Midwives and Medical Practitioners to enable Health Boards and NHS National Services Scotland to comply with their Duty to ensure appropriate staffing. As soon as reasonably practicable after the end of each financial year, Scottish Ministers must lay before the Parliament a report setting out how they have complied with the above Duty and the extent to which their actions have enabled Boards to comply with their Duty to ensure appropriate staffing. Assessment of Compliance Section 12IG Duty to ensure there is a sufficient number of registered Nurses, Registered Midwives and Medical Practitioners The Scottish Government is fully committed to a sustainable NHS supported by a committed workforce which demonstrates the necessary skills and knowledge to deliver high quality care to the people of Scotland. In pursuit of this aim, the NHS Scotland workforce has grown for 13 consecutive years and at the time of writing stand at 161,333.8 Whole Time Equivalent (WTE) staff, having increased by 23,735.3 WTE (17.2%) in the last decade. 7 Individual decisions regarding the recruitment and deployment of NHS staff are in the first instance, a matter for Boards. However, the Scottish Government has an important role to play in shaping the workforce in order to ensure we have the right number of people with the rights skills in the right place at the right time. The Scottish Government controls the numbers of undergraduate places for Dentistry, Medicine, Nursing & Midwifery, Optometry and Paramedicine and has engaged widely as it has set controlled intakes. In 2024 the Advisory Panel for Workforce Projections and Controlled Student Intakes was created to align the controlled intake process across professions, providing a unified view of controlled places and working towards a more holistic view of the needs of the health and social care workforces as intakes are set. Alongside this internal Panel, sits the External Student Intake Education and Training Advisory Group, which includes NHS workforce planners, ensuring their voice is heard when student intake places are set. 7 Figure refers to staff directly employed by NHS Health Boards, and not inclusive of General Practitioners (GPs) Page 148 of 180
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Document No: SG/2025/211 33 Nursing and Midwifery The Scottish Government continues to prioritise the sustainability and inclusiveness of the Nursing and Midwifery workforce, which currently stands at 67,714.6 WTE— an increase of 14.4% over the past decade. Notwithstanding this, the Scottish Government recognises that to have a sustainable Nursing and Midwifery workforce supply, consideration must be given to widening access across Scotland to encourage and allow people from all walks of life to have the opportunity to gain Nursing and Midwifery qualifications, which in turn will feed in to the diversity and inclusiveness of the Nursing and Midwifery workforce. During the process for considering student intake numbers, both Nursing and Midwifery professions are considered separately with discussion at workshops and feedback from stakeholders setting out the circumstances across the four fields of practice for Nursing and the bespoke situation regarding Midwifery. In addition to maintaining the current Nursing and Midwifery student intake numbers, the Scottish Government is collaborating with higher education institutions to establish alternative models of programme delivery to widen access for potential students who may not be able to access undergraduate Midwifery and Nursing programmes through traditional routes. This work directly links to our ongoing efforts to implement Phase 2 of the Nursing and Midwifery Taskforce recommendations, which include recommendations around widening participation, attraction and retention. The Scottish Government package of support for Scottish student Nurses and Midwives is currently at its highest level and is the highest level of support available to Nursing and Midwifery students across the UK. The annual £10,000 bursary is non-means tested and non-repayable. Eligible students receive free tuition, free uniforms, free disclosure and health checks as well as the reimbursement of clinical placement expenses (travel and accommodation). Qualified Nurses Currently, the Qualified Nursing workforce in NHS Scotland is 46,277.4 WTE, an increase of over 5,000 WTE (13.4%) in the last decade. To further enhance access to Nursing education, the Scottish Government is collaborating with the Scottish Qualifications Authority, Council of Deans Health Scotland, NHS Education Scotland, and other stakeholders to develop a Next Generation HNC in Healthcare Practice. This qualification is designed to facilitate direct entry into Year 2 of Nursing degree programmes, particularly for students who may not otherwise be able to access undergraduate education. This initiative supports the broader goal of diversifying the Nursing workforce and ensuring that educational pathways are flexible and inclusive. Qualified Midwives Page 149 of 180
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Document No: SG/2025/211 34 Currently, the Qualified Midwifery workforce in NHS Scotland is 2,632.2 WTE, an increase of almost 200 WTE (7.9%) in the last decade. In recognition of the unique requirements of Midwifery education, work is underway to develop a Next Generation HNC tailored specifically for Midwifery. This work is still in development; however, good progress has been made through collaborative working with the Lead Midwives for Education from the 3 HEIs responsible for the delivery of pre- registration Midwifery education. Mindful that articulation into year 2 is not possible for Midwifery, the requirement for practice learning hours to feature in this Next Generation HNC for Midwifery is not as critical for Midwifery, however, it is recognised that it would be beneficial for students to be exposed to some practice learning in a Maternity setting during this course. The Scottish Government recognises the advent of a better work/life balance and the reduction of working hours has led to an increase in part time working, thus decreasing whole time equivalent numbers and this is particularly evident in Midwifery. This is considered when making decisions around the student intake numbers for Midwifery. In October this year, the Cabinet Secretary for Health and Social Care announced the establishment of a new Scottish Maternity and Neonatal Taskforce which will provide strategic and national leadership over issues reported in these services. Alongside the Taskforce, full compliance with the Act’s general duties across all staff groups, supported by the specific Common Staffing Method obligations in maternity (midwives) and neonatal (nurses & midwives), will be instrumental in providing more robust staffing considerations. Medical Practitioners The number of doctors employed by NHS Scotland has increased by 28.4%, or by 3,371.6 WTE members of staff over the last decade. As a result of the considerable time it takes to train a doctor, planning for the future medical workforce is complex as we need to make assumptions about a range of factors including population need, future service delivery models, training capacity, and workforce demographics. In this context, the Scottish Government has followed a policy of medical workforce expansion since 2016. As above, this has involved annual increases in the medical undergraduate intake from 848 to 1,417 (67%). Whilst pursuing this expansion we have also sought to increase the amount of widening access places available from 60 per year to 110; making higher education and medical careers more accessible to people from under-represented groups and more diverse social backgrounds. We invest over £600m a year across the training pipeline, supporting undergraduate medical education and resident doctors undertaking foundation training and specialty training who are important for the delivery of services in NHS Scotland. This is an increase of 42% since the beginning of this parliament. The 2025/26 budget has seen record levels of investment, supporting more foundation year Page 150 of 180
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Document No: SG/2025/211 35 places and additional specialty training places – with an emphasis on training more General Practitioners. As outlined elsewhere in this report, we want to improve workforce planning further and our recently commenced Future Medical Workforce project will allow us to hear directly from doctors in order to make improvements to the medical education pipeline, ensuring we can continue to deliver the medical workforce Scotland needs. Phase 1 of the project, focussing on engagement and workforce modelling will report by the end of 2025, with Phase 2, exploring potential reforms, starting in 2026. Section 12IB Duty to publish information from Health Boards on the amount spent on all agency workers Spend on agency staffing is published through annual statistics detailing usage of agency staffing across the Medical and Nursing and Midwifery workforces. This information can be found at: Dashboards | Turas Data Intelligence8. We have engaged closely with delivery partners across NHS Scotland to strengthen our approach to agency staffing. In particular, through the establishment of a Supplementary Staffing Task and Finish Group we worked with colleagues to design and implement new controls which ensure agency Nursing staff are only used in exceptional circumstances. Instead, the preference should always be to utilise substantive staff or, alternatively, workforce accessed via the staff bank where there is a need for a flexible solution. This allows us to ensure that staff have the necessary familiarity with the systems, processes and colleagues who work alongside them, benefitting not only those who are receiving care or treatment but also the wider workforce. These steps enabled NHS Scotland Boards to deliver a 62% reduction in Nurse agency usage alongside a 16.7% reduction in medical agency reliance across 2024/25. 8 https://turasdata.nes.nhs.scot/ Page 151 of 180
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Document No: SG/2025/211 36 PART 3: CARE SERVICES REPORTING PROCESS Section 9 of the Act places a Duty on Scottish Ministers to publish, and lay before Parliament an annual report setting out; a) How Local Authorities and Integration Authorities have carried out their duties under sections 3, 7 and 8 of the Act when providing, planning or securing care services, b) The effect that staffing levels in care services have on the discharge of those duties, c) The steps that Ministers have taken to support staffing levels in care services in order to assist the discharge of those duties, d) How the matters detailed above will be taken into account in determining the future supply of registered nurses, medical practitioners and any other care professionals who fall within the scope of the duties imposed by sections 3 and 7, and e) The steps that Ministers have taken to ensure that funding is available to any person who provides a care service in order to assist the discharge of those duties. This section of the Ministerial report sets out a summary of how the duties imposed in Part 1 and Part 3 of the Act have been taken into account by those providing, planning and securing care services, and the steps taken by Ministers considering the information set out above. It sets out the extent and nature of compliance with the Act by Local Authorities, Integration Authorities, and care services whilst having regard to: • The guiding principles for health and care staffing. • The guiding principles etc. in care service staffing and planning. • The Duty on care service providers to ensure appropriate staffing. • The Duty to ensure appropriate training of staff. The care services referenced in the Act relate to care homes (including care homes for children and young people), school care accommodation, nurse agencies, secure accommodation, offender accommodation, adoption, fostering, adult placements, childminders, day care of children services (such as nurseries, playgroups, out-of- school care, and holiday clubs), housing support and support services (such as care at home). It is important to note that whilst the Scottish Ministers have overall national policy responsibility for Social Care in Scotland, Scottish Ministers do not commission or provide care services. As a result, the Scottish Government does not hold the data required to report on how the duties of the Act have been taken into account and has gathered this data from Local Authorities, Integration Authorities, the Care Inspectorate and from relevant publicly available data relating to the sector and its workforce. Page 152 of 180
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Document No: SG/2025/211 37 The Act states Scottish Ministers must have regard to a number of reports and information. Some examples include reviews and reports from the Care Inspectorate, information from people who provide and plan care services such as Local Authorities and Integration Authorities, and any report of information provided to Ministers from external bodies including the Scottish Social Services Council (SSSC). To support relevant organisations in fulfilling their care reporting duties, Scottish Ministers published statutory guidance to accompany the Act and relevant secondary legislation. This guidance was developed in close collaboration with NHS and care staff; Health and Care (Staffing) (Scotland) Act 2019: statutory guidance - gov.scot9 Duties on Local Authorities and Integration Authorities Purpose Section 3 of the Act, Guiding principles etc. in care service staffing and planning, places duties on Local Authorities and Integration Authorities (“Authorities”). Section 3(2) of the Act requires that in planning or securing the provision of a care service from another person under a contract, agreement or other arrangements, every Local Authority and every Integration Authority must have regard to: a) The guiding principles for health and care staffing. b) The duties relating to staffing imposed on persons who provide care services a) by virtue of subsection (1) and sections 7 to 10, and b) by virtue of Chapters 3 and 3A of Part 5 of the Public Services Reform (Scotland) Act 2010. Section 3(6) of the Act also requires every Local Authority and Integrated Authority to publish and submit an annual report to Scottish Ministers detailing how they have carried out their duties under the Act when planning or securing provision of a care service from another person. In the first year of implementation, Authorities had to publish their reports by 30 June 2025; and moving forward reports must be published by 30 June each year. The purpose of the annual reporting requirements is to: • Identify steps taken by the organisation to comply with the duties in the Act. • Identify areas of good practice that can be shared. • Identify any challenges or ongoing risks which may affect the organisations' ability to comply with duties in the Act. 9 Health and Care (Staffing) (Scotland) Act 2019: statutory guidance - gov.scot Page 153 of 180
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Document No: SG/2025/211 38 Reporting Authorities were provided with an annual reporting template to complete and submit to Scottish Ministers. The template asked Authorities to answer two questions, offering an overview of how they have adapted their approach to implement the Act, by requesting detail on: • the steps taken as an organisation to comply with section 3(2) of the Health and Care (Staffing) (Scotland) Act 2019. • any ongoing risks that may affect the organisation’s ability to comply with the Duty set out in section 3(2). The annual reporting template included guidance and specific criteria for specific elements within each of the individual duties of the Act. Overall Assessment of Local Authority and Integration Authority Compliance To comply with their duties set out in the Act, all Authorities have completed and published their annual reporting template, as well as submitting a copy to Scottish Ministers. These reports will allow for the implementation of the Act to be assessed and monitored going forward, provides data on both good practice within Authorities and providers and sets out risks and challenges within the sector that could impact on the Act. This valuable data and sector insight will inform policy development and exploring opportunities to deliver care more effectively and efficiently through the Service Renewal Framework.10 The level of detail shared by Authorities in this first year of reporting varied widely. Scottish Government officials will work with Authorities and the Care Inspectorate ahead of the next reporting year to consider improvements to the reporting template based on lessons learned in the first reporting year. It is worth noting that not all care services are commissioned by Authorities and so their reports will only cover part of the services that are in scope of the duties of the Act. The evidence provided by Authorities, indicates that all local areas have taken structured and proactive approaches to embed the Act’s requirements into their processes when planning and securing care services. Some Local Authorities and Integration Authorities, covering similar geographic locations, submitted combined reports to the Scottish Government for this reporting year. This has meant that the total number of reports submitted and included in this section’s analysis is 41, as opposed to the potential total of 64 reports. In addition, 10 Service Renewal Framework. Page 154 of 180
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Document No: SG/2025/211 39 due to the open nature of the questions asked of Authorities in this first reporting year and the resulting varied responses received, we believe that not all reports have explicitly outlined all of the specific steps that the Authorities may have taken. Therefore, this section of the document only reports on specific steps that were outlined by Authorities, which could likely represent an undercount of the true number of areas that have taken these steps. Overview of steps taken Around three quarters of Authorities have reported that they have taken measures to review and revise their procurement and contract frameworks and procedures, to ensure they reflect the requirements of the Act and that providers are fully aware of their duties under the Act when commencing a service. Just over half of Authorities have also reported they are ensuring providers compliance with the Act through contract monitoring mechanisms that they have put in place. Authorities reported they have approached contract monitoring in a number of different ways and steps include assurance meetings and visits with providers, as well as the use of provider surveys and end of year reports to provide additional assurance around compliance. Authorities also reported they had conducted training with their own staff to ensure they had the relevant skills to undertake these contract monitoring duties. Over a quarter of Authorities reported they now require care service providers to produce information on their workforce policies and to demonstrate how they have given regard to Act principles in how they staff their services and on staff training. In setting out the steps taken to comply with the Act, just over a quarter of Authorities have also reported that they conduct due diligence checks on providers including ensuring compliance with Care Inspectorate registration, SSSC registration and Codes of Practice, as well as compliance with the Protecting Vulnerable Groups (PVG) scheme and Health and Social Care Standards. Nearly a quarter of Authorities have advised that they used Scotland Excel Frameworks when securing care services and flagged the Scotland Excel undertake quality assurance checks to ensure compliance with the Act. Several Authorities have also reported that they had not commissioned any new services in the 2024/25 financial year. However, they advised that steps have still been taken to ensure they are complying with the Act. Ongoing risks Authorities were also required to report on any ongoing risks that may affect their ability to comply with the duties set out in the Act. Whilst no Authority reported that they were unable to comply, a number of common risks were identified across the reports which include: Page 155 of 180
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Document No: SG/2025/211 40 • Recruitment and retention challenges which were raised by nearly three quarters of Authorities as potentially impacting providers ability to comply with the Act. Authorities have reported that they continue to monitor this and respond appropriately. • Financial pressures were raised by nearly half of Authorities as a potential risk. Authorities raised that this could limit resources for implementing the Act’s requirements and increase pressure on their own staff. The impact financial pressures are having on providers was also raised as a risk, with nearly a quarter of Authorities highlighting the UK Government’s increase in employer National Insurance Contributions as putting additional pressures on providers. • Several Authorities reported a potential risk in accessing data from providers on how they are complying with their duties in the Act. However, solutions to this risk were being actively sought. • Nearly a quarter of Authorities reported that limited numbers of care providers could affect their ability to comply with their duties in the Act, particularly in more rural areas. • A number of Authorities also asked for further guidance to support their Health and Care Staffing Act reporting duties around care services. Duties On Providers Whilst the Act places duties on anyone providing a care service (“providers”) to have regard to the guiding principles for health and care staffing and to ensure that at all times they have suitably qualified, competent and appropriately trained individuals working in services, these individual providers do not have to officially report on these duties. To understand how individual care providers are discharging their duties, the Scottish Government have sought insight from the Care Inspectorate as the care regulator of the sector. Care Inspectorate Safer Staffing Programme The Care Inspectorate regulates and supports improvement in care services in Scotland to ensure high standards and improve outcomes for people experiencing care. As of 31 December 2024 there were 10,811 registered care services in Scotland. The Care Inspectorate Safe Staffing Programme (SSP) was established in response to a commission from the Chief Nursing Officer Directorate to support the transition from the Public Service Reform Act 2010 and the commencement of the Health and Care (Staffing) (Scotland) Act 2019. Page 156 of 180
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Document No: SG/2025/211 41 The SSP, funded by Scottish Government, have been supporting the care sector in relation to the enactment of the Health and Care (Staffing) (Scotland) Act 2019 and working in collaboration with service providers, people who experience care and all other relevant stakeholders. SSP activity has included; • Extensive engagement and consultation with the sector to gather insight and data which has been used to develop Act support and guidance as well as reporting. • Development of several guidance tools for providers and Local and Integrated Authorities, including; o Creation of the SSP Hub on the Care Inspectorate website, which includes a range of guidance in different formats and relevant signposting. o Frequently asked questions document . o Bitesize guidance video . o One to one and group information and guidance sessions. o Recorded Webinars and Podcasts. o National in person events. • Development of inspector induction sessions with SSP packs to ensure active learning for new staff. • Commissioned a Provider Survey to gather valuable insight from providers who have no obligation to report under the Act. • Extensive support to Scottish Government reporting via use of Annual Return, consultation and survey data. More detail can be found on all SSP work in their annual reports on their Safe Staffing Project Hub.11 Each year the Care Inspectorate asks all registered care providers in Scotland to complete an annual return. The Care Inspectorate publishes several annual statistical publications and shares some data with other organisations. The intelligence gathered through the annual return helps the Care Inspectorate: target improvement activity; identify, drive and track improvement; and identify trends and topics to see where best to focus improvement support work. The deadline for most recent annual return submissions was 2 March 2025 and covered the period of 1st January 2024 to 31st December 2024 and 89.9% of registered care providers responded to the 2024 annual return question: “Are you complying with the Health and Care (Staffing) (Scotland) Act 2019?” The overall level of assurance self-reported by care providers with regard to compliance with their duties under the Act is summarised in figure 3 below. 11 Safe Staffing Project Hub Page 157 of 180
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Document No: SG/2025/211 42 Figure 3: Overall assurance levels indicated by care providers 91.7% indicate yes-complying, 4.6% indicate unsure and 3.7% indicate no-not complying. Limitations of this data: The Act came into effect on 1 April 2024, therefore it should be noted that for the first three months of the annual return reporting year, the Act was not yet in place. This may affect the relevance and accuracy of responses returned during this period. Additionally, compliance figures are based on provider self-reporting, with no external validation of the figures provided. Furthermore, organisations were not asked about their understanding of the Act or their responsibilities under it, so providers may have varied levels of understanding which could have influenced how they interpreted and responded to this question. Compliance With Individual Duties Section 3 Duty to have regard to guiding principles for health and care staffing The Act requires anyone who provides a care service, and every Authority when they are planning or securing the provision of a care service, to have regard to the guiding principles of the Act. Page 158 of 180
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Document No: SG/2025/211 43 That the main purpose of the Act is to: • Provide safe and high-quality services, and • Ensure the best health care or care outcomes for service users. The Act then lists principles to be met, insofar as they are consistent with the main purposes, when relevant organisations are arranging staffing including: • improving standards and outcomes for service users. • taking account of the particular needs, abilities, characteristics and circumstances of different service users. • respecting the dignity and rights of service users. • taking account of the views of staff and service users. • ensuring the wellbeing of staff. • being open with staff and service users about decisions on staffing. • allocating staff efficiently and effectively. • promoting multi-disciplinary services as appropriate. Key findings As there is no Duty on providers to report on how they are having regard to the guiding principles of the Act, the data Scottish Government has to report on how this is being discharged is limited in this first year of reporting. Scottish Government officials are currently exploring how this data could be gathered for future reports. Through the data received from the Authorities we understand that around three quarters of local areas, when planning and securing services, have reviewed and revised their procurement procedures and contract frameworks and nearly a quarter have made specific mention to the guiding principles of the Act. One example given was requiring providers bidding to deliver services to answer mandatory questions on their awareness of duties of the Act and to abide by the guiding principles of the Act. Achievements/Successes and Learning Nearly a quarter of Authorities reported steps have been taken to review that services align with the Act’s guiding principles once a care contract is being delivered. One example given was updating service review tools to capture how providers align with the Act’s guiding principles, especially around staffing and outcomes. To understand how individual care providers are having regard to the guiding principles of the Act, the Scottish Government sought insight from the Care Inspectorate as the regulator of the sector. Page 159 of 180
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Document No: SG/2025/211 44 To support their work around the Act, in March 2025 the Care Inspectorate commissioned a survey of care service providers, as part of their ‘Safe Staffing Programme End of Year Report Survey’.12 Respondents to this survey highlighted some measures they have in place to support the health and wellbeing of their workforce, which is a key aspect in the guiding principles of the Act. These measures included: • Supervision and check-ins: regular supervision, appraisals and one-to-one check-ins that are used to monitor wellbeing, provide feedback and identify any support needs early. • Open communication and listening: an emphasis on open communication and the importance of open-door policies encouraging staff to raise concerns freely. • Wellbeing initiatives and activities: Wellbeing focused activities such as coffee mornings and wellbeing days to foster a positive work environment and provide staff with opportunities to relax, connect and feel valued outside of their routine duties. • Training and development: including induction programmes, continuous learning opportunities and targeted training such as emotional regulation and menopause awareness as ways to build staff confidence and competence, which in turn supported their overall wellbeing. • Work-life balance and flexibility: the use of flexible working and leave policies where there is capacity to provide this to promote work-life balance and to helped reduce stress and improve staff satisfaction. • Mental health and emotional support: resources providing access to counselling, trauma-informed practices, and wellbeing champions to help staff manage stress and maintain emotional resilience. Challenges (risks) As providers are not required to report on how they are discharging their duties regarding the guiding principles of the Act, the data available to Scottish Government on this is limited. We understand from Authorities reports there are challenges employers face that could impact the guiding principle of the Act including recruitment and retention challenges that could have potential impacts on workforce wellbeing. However, Authorities have also reported of measures being taken to mitigate against such potential impacts including updating contracts to include reference to the wellbeing of staff, evaluating staffing plans to ensure they support staff wellbeing and local assurance checks with providers. 12 Safe Staffing Programme End of Year Report Survey’ Page 160 of 180
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Document No: SG/2025/211 45 Workforce insights Between January and February 2025, the SSSC conducted their first annual ‘Have Your Say Workforce Wellbeing Survey 2025’.13 It should be noted this survey falls outside of the reporting timeframe for the Health and Care Staffing Act 2024 Ministerial Report. However, it provides valuable insight from people working in the social work, social care and children and young people workforces, and covered topics including wellbeing, access to training and qualifications as well as general experiences of working in the sector. The report found that overall, just over half of respondents said they were satisfied with their current job (56%) and just over a third were dissatisfied (35%). The majority said they felt safe in their work environment (60%), while just under half said they would recommend their organisation as a great place to work (47%). Around two thirds of respondents agreed that they feel able to meet the needs of people they support (65%). However, some issues with wellbeing at work were suggested: 60% said they find it difficult to switch off when they leave work, only 43% said they have enough time to do their job well, and just 30% said enough support is in place for dealing with stress. Section 7 Duty to ensure appropriate staffing The Duty to ensure appropriate staffing in care services is designed to enable the provision of safe and high-quality services which meet the needs of service users through having appropriate staffing, with the right people, with the right skills, available at the right place, at the right time, to provide care. The Act is not prescriptive in stipulating numbers or skill mix of professions, does not prescribe minimum staffing levels or fixed ratios and does not seek to preclude the use of innovative new models of care delivery. Rather it seeks to support local decision-making, flexibility and the ability to redesign and innovate across multi- disciplinary and multi-agency settings. In considering whether providers are ensuring appropriate staffing, the Care Inspectorate published guidance for providers on the assessment of staffing levels in 2021 and updated in 2022 ; Safe Staffing Project | Care Inspectorate Hub.14 This framework provides guidance for assessing what the appropriate staffing level is for the individuals supported by them. The necessary staffing levels and training requirements will change as a result of the individual needs, numbers, and risk assessments, of those receiving care. 13 Have Your Say Workforce Wellbeing Survey 2025’ 14 Safe Staffing Project | Care Inspectorate Hub Page 161 of 180
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Document No: SG/2025/211 46 The Section 7 Duty outlines that staffing must be appropriate for the health, wellbeing and safety of service users, the provision of safe and high-quality care, and in so far is it affects either of those matters, the wellbeing of staff. The following must be considered by providers when determining what constitutes appropriate numbers of staffing: • The nature of the care service. • The size of the care service. • The aims and objectives of the care service. • The number of service users. • The needs of service users. It should be noted that day care of children settings must be staffed according to specific ratios to ensure the safety and wellbeing of the children according to their age and developmental stage. These ratios are set by the Care Inspectorate and are a regulatory issue, and the Act does not confer any change to the operation of ratios in these settings. Key Findings As there is no Duty on individual providers to report on how they are ensuring that at all times suitably qualified and competent individuals are working in care services in appropriate numbers, the data that the Scottish Government has to report on how this is being discharged is limited in this first year of reporting. Scottish Government officials are currently exploring how this data could be gathered for future reports. A number of Authorities specifically advised they have embedded the requirement of the Act to ensure appropriate staffing into procurement and commissioning procedures and documentation when services are being planned and secured. Authorities reported of requiring providers to demonstrate compliance with appropriate staffing duties through contract terms, service specifications, and method statements during tendering. Staffing levels across the care sector are determined using a combination of factors, including service user needs, geographical considerations and complexity of care. Providers often rely on feedback from service users, carers, and professionals, alongside internal audits and Care Inspectorate guidance to inform staffing decisions. Authorities have reported that many providers are using structured staff rotas and risk assessments to maintain appropriate staffing levels Overall, while approaches vary slightly across regions, Authorities have reported there is a consistent emphasis on aligning staffing decisions with the Act’s guiding principles - ensuring safe, high-quality care and positive outcomes for service users, while also supporting staff wellbeing and sustainability. Page 162 of 180
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Document No: SG/2025/211 47 Achievements/Successes and Learning A number of Authorities advised that collaboration with providers is central to ensuring appropriate staffing and set out that their commissioning teams are working closely with care providers to ensure services with safe and effective staffing are in place are procured. Ongoing contract management and quality assurance frameworks support this, with regular engagement, supervision and reporting mechanisms in place. Authorities have reported that they are using monitoring processes, and some have added specific questions to contract review processes to assess ongoing compliance including assessing appropriate staffing ratios where appropriate. One example given included requiring providers of care to submit quarterly Quality Assurance reports, containing information on the number of service users, turnover rates, recruitment activity and a plan for managing risks to provide assurance that they have an appropriate staffing tool in place, as well as a process for escalating workforce risks to prevent service disruption. Other examples of measures used by Authorities to support appropriate staffing include; • Embedding mandatory questions in tender documentation requiring providers to confirm awareness of staffing duties under the Act. • Establishing short life working groups and workforce plan groups focused on recruitment, training, development, succession planning, and staff wellbeing. These structures are transitioning into permanent governance mechanisms. • Appointment of leads within Authorities to support provider compliance, delivered training to providers, and embed staffing requirements into procurement and commissioning frameworks. • Ongoing contract monitoring actions with providers in relation to their compliance with the Act. Challenges (Risks) Staffing levels are a critical determinant of whether Authorities and providers can meet their statutory duties under the Act. Insufficient staffing can compromise care quality, staff wellbeing and service sustainability. To understand how individual care providers are having regard to the guiding principles of the Act, the Scottish Government sought insight from the Care Inspectorate as the regulator of the sector. The Care Inspectorate’s commissioned survey of care service providers, undertaken in March 2025 as part of their ‘Safe Staffing Programme End of Year Report Survey’15, does provide some insight into staffing challenges in the sector. This sets out that 64% of respondents identified recruitment and sector workforce shortages 15 Safe Staffing Programme End of Year Report Survey’ Page 163 of 180
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Document No: SG/2025/211 48 as a key risk encountered when implementing the Act into everyday practice. Common concerns included lack of staff, difficulty in balancing shift cover with staff training and development, and financial constraints. A number of Authorities reported that they face challenges in assuring appropriate staffing at the point of planning and securing services. However, it is clear from their reports that they have taken significant steps to address this including through procurement, commissioning and monitoring processes. Section 8 Duty to ensure training of staff This Duty requires providers to ensure that, in complying with the Duty imposed by section 8, individuals working in a care service receive appropriate training for the work they are to perform. Section 8 also requires that adequate time and assistance is provided for individuals to undertake training. The SSSC is the regulator in Scotland for social work, social care and children and young peoples’ workforces and has responsibility for registering professionals and regulating education and training in the sector. As part of this, to be registered with the SSSC and work in the sector, staff are required to complete an annual declaration which confirms they have kept a record of their learning and that they have completed mandatory learning on trauma awareness, protection of children and protection of adults. Through its Continuous Professional Learning (CPL) offer and Learning Zone service, the SSSC provides access to a host of learning opportunities (including a range of relevant NHS Education for Scotland learning resources available on TURAS) designed to support providers and staff to ensure workforces are equipped with the correct training and skills to carry out their roles. It should be noted that a condition of registration with the SSSC is that a member of the workforce is either already holding or working towards specific qualifications depending on their role, and a condition of maintaining that registration is engaging with and evidencing CPL each year. The reports received from Authorities gave an insight into how providers and workforces are accessing these resources and the wider measures being taken to support the appropriate staff training. Key findings As with the other sections of the Act, there is no Duty on individual providers to report on how they are ensuring that individuals working in their care service receive appropriate training and suitable assistance to obtain further qualifications appropriate to their work. Page 164 of 180
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Document No: SG/2025/211 49 In their annual reports, Authorities cited various measures providers are taking to support their staff in accessing training resources and develop their skills in response to service demand. Achievements, Successes and Learning A number of Authorities have reported that to ensure appropriate training, providers are offering structured training to their staff including comprehensive induction programmes, ongoing professional development (including SVQs), and shadowing and mentoring support. Several Authorities require providers to maintain training records and records on support for staff development, with providers reporting on this to Authorities annually. One Authority has reported that some providers in their local area work with external partners including placements with universities to enhance service delivery and staff development. Authorities reported that providers are making use of national tools including the Portable National Induction Framework developed by SSSC and NES and the use of MyTuras which brings together a host of learning tools and resources for social care staff. It was also reported that this is often supported by shadowing and mentoring offers to new staff, with ongoing support for staff in working towards the attainment of SVQs and other qualifications. Several Authorities reported that they require providers to report on training completion and qualifications as part of contract monitoring and this is also reported on in Care Inspectorate Annual Returns In addition, the SSSC hosts a CPL portal offering access to a range of learning opportunities for the Children’s and Young People’s workforce, including online modules on topics like child development, additional support needs, and parental engagement. Practitioners can also access further resources through platforms like Education Scotland’s National Improvement Hub and the Care Inspectorate’s Hub, which offer self-directed learning materials and professional learning programmes. These national tools are used by Authorities to provide assurance of consistency in approach to staff training and development. Challenges (risks) As part of the Care Inspectorate’s commissioned survey of care service providers as part of their ‘Safe Staffing Programme End of Year Report Survey’16, 43% of the providers surveyed reported that allowing staff appropriate time to complete training and development was a key risk in their ability to implement the Act’s principles into everyday practice. 16 Safe Staffing Programme End of Year Report Survey’ Page 165 of 180
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Document No: SG/2025/211 50 The reports from Authorities flagged that many providers have structured training programmes in place, but there are some difficulties in ensuring staff in some areas are appropriately skilled and qualified. However, it is clear that many Authorities are taking steps to ensure appropriate training for staff including building compliance with this Duty into providers contracts and through contract monitoring processes. A number of Authorities have set out that high turnover rates reduce continuity of staff and limits the ability to invest in long-term training and shortages of qualified staff means that some providers often rely on agency or bank staff, who may not have access to the same training pathways. Workforce insights Data from the SSSC ‘Have Your Say Workforce Wellbeing Survey 2025’17, indicate generally positive attitudes from the social work, social care and children and young people’s workforces around training and learning opportunities. The 2025 report was the first time the SSSC conducted this survey and whilst this was carried out from January to February 2025 – which falls outside of the reporting timeframe for the Health and Care Staffing Act 2024 Ministerial Report – this provides valuable insight from the 6,581 registered and some non-registered workers who responded. This set out that: • 85% of respondents expressed a desire to improve their knowledge and skills. • 73% said there are training and learning opportunities available to them. • 69% said they have enough training/learning opportunities to fulfil their CPL requirements. • 69% said they get the right training to do their job well. • 65% agreed they are supported to gain qualifications for registration purposes. • 61% know how/where to look for a new role to match their skills and experience. • 51% need more training to progress their career/get promoted . Whilst three in ten of respondents said that there are no barriers to training, the report does highlight some of the challenges experienced by other respondents to training. The most commonly mentioned barriers to training reported were lack of time (29%), employers not allowing time off for training (24%) and availability of courses (24%). 17 SSSC ‘Have Your Say Workforce Wellbeing Survey 2025’ Page 166 of 180
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Document No: SG/2025/211 51 The SSSC Workforce Skills Report 202518, looks at the current provision of qualifications for the adult social care, children's residential care and early years workforces and provides a snapshot of the SSSC register on 1 October 2024. The report splits into two subsections - adult social care and children’s services – and as part of this report, in February 2025 the SSSC surveyed services to ask managers their views on staff accessing qualifications. The SSSC have flagged that there were low response rates to this survey and low focus group attendance which means that the findings are not statistically representative of all services. Nevertheless, 36% of day care of children managers who responded to the survey, and 22% of managers in residential care services for children, said it was ‘impossible’ to undertake qualifications in work time. These challenges were also indicated by managers surveyed working within adult social care services, with around 20% of care at home, housing support and care home respondents reporting undertaking qualifications in work time was ‘impossible’. 18 SSSC Workforce Skills Report 2025 Page 167 of 180
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Document No: SG/2025/211 52 PART 4 MINISTERIAL DUTIES FOR CARE SERVICES As set out earlier in this report, the Act places certain duties on Scottish Ministers to report annually on specific aspects of the Act. In the above summaries, a number of key themes arise that impact several providers in ensuring compliance with their duties under the Act. Although the Scottish Government is not a care employer, through working with Local Authorities, Integration Authorities and the Care Inspectorate, the Government are taking measures where they can to support the system in achieving a more sustainable and skilled workforce. This section providers further details of that work. Section 9 (1) (b) & (c): Effect of staffing levels and Supporting Staffing Levels Staffing Levels Section 9(1)(b) requires Scottish Ministers to set out the effect that staffing levels in care services have on providers meeting their duties of the Act. Assessment of Effect In this first year of reporting, it has been difficult to set out the effect that staffing levels in care services have had on providers meeting their duties of the Act. Scottish Government officials will review this with the aim to ask further questions about this ahead of future Ministerial reports. However, as recognised elsewhere in this report, the Scottish Government are aware that providers and Authorities have experienced challenges with ensuring appropriate staffing levels, but no Authorities have indicated they are not meeting their duties under the Act. In addition, of the 89.9% of registered care providers who responded to the Care Inspectorate’s 2024 Annual Return, 3.7% self-assessed as not meeting their duties within the Act. Scottish Ministers note the limitations of this self-assessed data, as set out earlier in the report. We expect providers not meeting the duties within the Act will be considered and managed by Local Authorities who commission services, through contract management arrangements. The Care Inspectorate’s scrutiny and improvement work focuses on outcomes for people. The Care Inspectorate works with services to support improvements for people experiencing care. If they find outcomes and experiences are not being met, they will take action to address this. The SSSC ‘2024 Workforce Data Report’19 shows that at the end of 2024, the size of Scotland’s care services workforce, measured in terms of headcount, increased 19 SSSC ‘2024 Workforce Data Report’ Page 168 of 180
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Document No: SG/2025/211 53 slightly to 195,490 (this excludes social work services); an increase of 0.9% since 2023. The overall increase in 2024 was driven by an increase in the care home for adults workforce, which saw an increase of nearly 2,000 additional workers. The report also sets out that there was a decrease in nurse agencies with just over 1,300 fewer workers reported in 2024 than in 2023. However, this reduction could in part be due to changes in the way providers record these workers. The report provides details on headcount by Local Authority areas and shows that out of the 32 Local Authority areas, 21 (66%) reported an increase in headcount in 2024 compared to 2023. The largest percentage increases were in Aberdeen City, Scottish Borders and Renfrewshire. It is worth noting that of the care services workforce, 71.9%% in 2024 worked within the private and voluntary sectors which are often commissioned by Authorities to deliver services. The report also sets out a number of challenges in the sector in 2024 including: • The difficult wider economic and financial context impacting on budgets for Local Authorities and social care • Financial challenges including the UK Government’s increase in employer National Insurance Contributions, ongoing high costs of fuel, increases in inflation and the general cost of living pressures which cause challenges for both Local Authorities and providers • Changes to UK immigration policies, including the ban on newly arriving care workers bringing immediate family The SSSC ‘Have Your Say Workforce Wellbeing Survey 2025'20 highlighted that the most common reason for workforce leaving the sector were that they were overworked (24%). The other main reasons raised related to the worker retiring (23%), poor employment and working conditions (22%), and/or relationships with managers/senior staff (21%). A review of recent Care Inspectorate inspection reports across children’s secure care services, adoption services, fostering services, and school care accommodation services stated the main reasons by providers in the difficulty of filling vacancies were: too few applicants; too few applicants with experience; and too few qualified applicants. Having vacancies does not mean that there are not appropriate numbers of staff within services but could mean that services are unable to expand. Considering the information provided within the Authorities reports, it is clear that although staffing level challenges were raised, no Authority reported that they were unable to comply with the duties within the Act. In addition, of the 89.9% of registered care providers who responded to the Care Inspectorate’s 2024 Annual Return, 3.7% self-assessed as not meeting their duties within the Act. Scottish Ministers note the limitations of this self-assessed data, as set out earlier in the report. We expect providers not meeting the duties within the Act will be considered and managed by Local Authorities who commission services, through contract management arrangements. 20 SSSC ‘Have Your Say Workforce Wellbeing Survey 2025' Page 169 of 180
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Document No: SG/2025/211 54 The Care Inspectorate’s scrutiny and improvement work focuses on outcomes for people. The Care Inspectorate works with services to support improvements for people experiencing care. If they find outcomes and experiences are not being met, they will take action to address this. Looking towards the future, it will be important to ensure the approach to workforce planning, recruitment and retention reflects our broader aspirations for Scotland’s care services, as described in our Health and Social Care Service Renewal Framework21. The Health and Social Care Service Renewal Framework provides a high-level guide for change, to ensure the sustainability, efficiency, quality, and accessibility of health and social care services in Scotland. The National Care Service interim Advisory Board was also established in May 2025 and is taking an evidence-based approach to help drive meaningful improvements across social care, social work and community health services. The Board’s role will include working with people and organisations to understand what needs to be improved and why, exploring options for making improvements that are needed in the delivery of care services. Scottish Ministers, Council Leaders, Integrated Joint Boards and Health Boards are the people who might receive advice from the National Care Service Advisory Board because they are the people with legal responsibilities and powers under the existing legislation. Supporting Staffing Levels Section 9(1)(c) requires Scottish Ministers to set out the steps taken to support staffing levels in care services to support providers to meet the duties under the Act. Summary of Support Whilst Scottish Ministers have to report annually to Parliament on staffing in care services, they do not provide or commission care services directly. Therefore, Scottish Ministers are not responsible for employing staff within care services and have no direct role in the staffing of services. However, the Scottish Government plays a critical role in enabling and shaping the workforce through funding, regulation and policy, recognising that a critically important driver of quality in experience and improved outcomes is a dedicated, highly skilled, and well- qualified workforce. The Scottish Government is fully committed to enabling sustainable care services supported by committed professionals who demonstrate the necessary skills and knowledge to delivery high quality care to the people of Scotland. 21 Health and Social Care Service Renewal Framework Page 170 of 180
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Document No: SG/2025/211 55 The Scottish Government continue to take forward a number of initiatives designed to support the attraction and retention of a highly skilled and qualified workforce across our care system. These initiatives are described below. Social Care The Scottish Government have continued funding to enable all social care providers to advertise vacancies on the MyJobScotland recruitment website at no cost. My Job Scotland hosts an interactive map, enabling prospective users to find location specific posts and there are 529 unique employers using the website to advertise positions in adult social care. Between February 2021 and April 2025, 32,299 adult social care jobs have been posted on MyJobScotland under this contract and this has saved providers £2,635,460. Additionally, the Scottish Government funds the caretocare.scot website which provides information and tools on careers in the adult social care sector, including a free career guide, information and stories on different roles and information on qualification and interview questions. The caretocare website includes a stakeholder toolkit, which enables providers to use a range of materials to support their own local recruitment efforts. Jointly with COSLA, the Scottish Government recognise the value of the workforce and are fully committed to working collaboratively to improve the experience of the social care and social work workforce. The Joint Social Services Taskforce (JSST) was established to address priority issues affecting Social Care and Social Work workforces in the short to medium term, focusing on supporting recruitment and retention and providing an enhanced working experience. Workstreams have included; development of a Portable National Induction Framework, pilot of a Care Technologist Role, development of Social Care Career Options Tool, Earn and Learn workstream and a Funding Landscape workstream making it easier for staff to apply for funding to pay for mandatory qualifications. Childminding The Scottish Government have funded the Scottish Childminding Association (SCMA) to deliver a new national 3-year programme of childminder recruitment and retention, known as the Programme for Scotland’s Childminding Future, which launched in June 2024. From launch until March 2025, the programme supported the creation of over 40 new childminding businesses, with a further 144 potential new childminders completing their training and now being supported with Care Inspectorate Page 171 of 180
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Document No: SG/2025/211 56 registration. Backed by a further £1.6m in Scottish Government funding, the Programme will expand in 2025-26, with the recruitment programme now available in 27 Local Authority areas. Fostering services Through the Future of Foster Care work and the forthcoming Children (Care, Care Experience and Services Planning) (Scotland) Bill, the Scottish Government is exploring further measures to support the fostering workforce, which could include improved training pathways, support networks, and national oversight mechanisms. This includes exploring a national register of foster carers and options to strengthen the status and support provided to the fostering workforce across Scotland. Childcare Standards for the Scottish Childcare profession are among the best in the world. The minimum qualification requirements for staff are greater than other UK nations at all levels. This has led to Scottish childcare staff being the most qualified across all care services. They also have fewer fitness to practice issues than any other part of the register. Section 9 (1) (d) Considerations for determining future supply of care professionals Section 9(1) (d) requires Scottish Ministers to set out how the matters relating to section 9, mentioned above, will be taken into account when determining the future supply of care professionals such as: • Registered nurses • Medical practitioners • Other care professionals as relevant to the discharge of duties of sections 3 and 7 of the Act. Assessment of future supply of workforce Under the Health and Care (Staffing) (Scotland) Act 2019, Scottish Ministers are required to set out how they are determining the future supply of care professionals. While this Duty remains, the context in which workforce planning takes place has evolved. Developments since the Act was established include: • the impact of UK Government legislation changes on international social care visas which has drastically reduced the availability of social care workforce in some regions. Page 172 of 180
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Document No: SG/2025/211 57 • the introduction of the Care Reform Scotland Act which repeals the uty of national workforce planning from the Scottish Social Services Council (SSSC) and introduces the National Care Service interim Advisory Board. • the introduction of the Service Renewal Framework and Population Health Framework which sets out Minister’s vision for preventative care and a 10- year reform of service delivery. Therefore, to meet their obligations under the Act, through the Service Renewal Programme, Ministers will take a broader, integrated approach to workforce capacity planning, which looks beyond modelling of workforce numbers. The Health and Social Care Renewal Programme, and its resulting changes to service design and skill mix, means it is not sensible to produce workforce projections at this point. Workforce planning assumptions will provide parameters under which the renewal agenda and service planners can operate as they re-design services. This work will include improving the quality and use of workforce data, integrating local workforce plans with financial plans, strengthening collaboration with partners across the sector, enhancing reporting mechanisms, addressing skills gaps through targeted initiatives, and supporting the adoption of technology-enabled care solutions. This workforce capacity planning will also deliver on the National Workforce Strategy22 commitments, a joint strategy committed to by both COSLA and the Scottish Government which sets out the visions for ‘a sustainable, skilled workforce with attractive career choices where all are respected and valued for the work they do’. The Strategy recognises that although we have seen continued growth in our workforce, we know that increasing the workforce alone will not deliver the services the people of Scotland need now and will need into the future. It should be noted that the National Workforce Strategy does not cover all care services covered in this Ministerial report. In relation to Early Learning and Childcare (ELC) and School Age Childcare (SACC), the Scottish Government are working with Local Government and our partners in the sector to support the development of long-term workforce plans that address workforce issues and ensure sustainable delivery of the 1,140 hours of funded ELC, and wider critical childcare services which support employment for families. The ELC 1140 policy has been in place in Scotland for all eligible 3- and 4-year-olds, and some 2-year-olds, since August 2021 and provides free early learning and childcare, typically 30 hours a week in term-time, to give children a strong start and to support 22 National Workforce Strategy Page 173 of 180
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Document No: SG/2025/211 58 families. The programme is fully funded by the Scottish Government and delivered by Local Authorities. Section 9 (1) (e) Ministerial steps taken to ensure availability of funding Section 9 (1) (e) requires Scottish Ministers to describe the steps taken to ensure funding is available to any person who provides a care service, in order to assist the discharge of those duties. This section sets out funding which has been provided by Scottish Government over the period of 1 April 2024 to 31 March 2025 and planned funding for 1 April 2025 to 31 March 2026. Summary of available funding The Scottish Government invested significant levels funding in the 2024/25 financial year to support the care sector. Real Living Wage pay policy Since 2016, the Scottish Government has provided funding to enable adult social care workers, delivering direct care in the third and private sectors, to be paid at least the Real Living Wage (RLW) rate. This was expanded to workers delivering funded ELC services in 2018, and to workers delivering children’s social care in the 2024-25 financial year In the 2024-25 financial year, the Scottish Government made a significant investment of over £265 million to ensure that adult and children’s social care workers, as well as workers in ELC, in commissioned services were paid at least the RLW rate. In adult social care, the uplift to the RLW rate of £12 per hour from April 2024 cost the Scottish Government £230 million, whilst for children’s social care the cost was £20 million and for workers in commissioned ELC this uplift cost £16 million. As a result of how funding for the RLW uplift is delivered for workers in the adult and children’s social care sectors, many providers may have funding remaining once the policy intent to enable an uplift for the lowest paid workers providing direct care is fully delivered. The Scottish Government have stipulated that any additional funds that remain must be spent on uplifting pay for the directly employed workforce working within services, which could be used to contribute towards stabilising or maintaining differentials. Adult Social Care The Scottish Government invested over £2 billion in the 2024/25 financial year for adult social care and integration, delivering on a commitment to increase spending in Page 174 of 180
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Document No: SG/2025/211 59 this area by 25% two years ahead of target. As well as funding for the Real Living Wage pay uplift for these workers, this funding included up to £9 million to re-open the Independent Living Fund (ILF), to enable up to 1,000 additional disabled people with the most complex needs to access the support they need and deserve to live independent lives, and £11.5 million to support the inflationary uplift in Free Personal Nursing Care. For the 2025/26 financial year, the Scottish Government are continuing to invest in the adult social care sector, with almost £2.2 billion in investment in social care and integration. This has included an additional £125 million to continue funding the Real Living Wage uplift for adult social care workers, a further £13.4 million to support growth in the ILF, £5.9 million of additional investment into the Care Inspectorate, over £88 million in local carer support through council Carers Act funding and £13 million for voluntary sector short breaks in 2025-26. Early Learning and Childcare (ELC) and School Age Childcare (SACC) In the 2024-25 financial year the Scottish Government provided around £1 billion to support the delivery of funded ELC. In addition to funding for the Real Living Wage pay uplift, this included over £8 million to Skills Development Scotland to support Modern Apprenticeships in childcare in 2024-25, as well as £1.6 million to fund the Programme for Scotland’s Childminding Future In addition, the Scottish Government continues to provide baselined funding to all 32 Local Authorities to recruit additional graduate level posts for ELC settings in Scotland’s most disadvantaged communities. In 2024-25, a nominal £23.4 million was provided to Local Authorities to cover funding for Equity and Excellent Lead posts based on 491 SIMD 1 settings. Over the 2024/25 and 2025/26 financial years, the Scottish Government has provided £16 million funding to design and deliver additional funded childcare for priority families within six ‘Early Adopter Communities’ (EACs) – aligned with our fairer futures partnerships and offering easier access to the support families need. The EACs are working with communities to understand families’ needs (with children from early years to the end of primary); develop better local systems of childcare to meet those needs; and support parents to better access existing entitlements to childcare subsidies through Universal Credit and Tax-Free Childcare. Early delivery has been focused on SACC services. For the 2025/26 financial year, the Scottish Government is continuing to invest around £1 billion to support the delivery of funded ELC, with an additional £9.7 million being made available to Local Authorities to fund the uplift in the Real Living Wage for funded providers. The Scottish Government have also invested £3 million in 2025/26 to expand and enhance breakfast club provision across Scotland through our Bright Start Breakfasts fund – to help deliver 9,000 new breakfast club places for primary school children. The fund was open to a range of breakfast club providers including schools, Local Authorities, registered childcare services, childminders, and third sector Page 175 of 180
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Document No: SG/2025/211 60 delivery partners. School Care Accommodation Local Authorities have responsibility for the provision of education in their areas, and this includes school care accommodation connected to education authority schools. Care workers in the residential special school care accommodation sector will benefit from a pay uplift so that they are paid at least the Real Living Wage as set out above. Whilst Scottish Ministers have responsibility for the regulation of independent schools, this role is limited. These are independent businesses, and Scottish Ministers have no role for directing or providing funding for independent schools. Offender Accommodation The model for community justice allows for decisions around services to be taken locally. This includes prioritising funding to deliver justice statutory services and local priorities aimed at reducing reoffending. Direct grant funding from the Scottish Government is provided to one offender accommodation service. Page 176 of 180
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Document No: SG/2025/211 61 PART 5: CONCLUSION The first year of implementation of the Health and Care (Staffing) (Scotland) Act 2019 has seen Health Boards across Scotland take significant steps to embed the principles and duties of the legislation into their operational and strategic frameworks. The evidence presented in this report demonstrates an ongoing commitment to ensuring safe and high-quality care through appropriate staffing decisions, supported by the implementation of robust governance, professional judgement, and the progressive adoption of digital systems. Boards have made notable progress in integrating the Common Staffing Method and staffing levels tools into their workforce planning activity. The development of local governance structures, the expansion of eRostering and the associated SafeCare module, and the strengthening of clinical leadership arrangements have all contributed to improved visibility, responsiveness, and assurance in staffing decisions. Notwithstanding this, since this is the first year of the Act being in place, naturally there are some challenges to full implementation. Whilst they are key enablers and useful tools, rolling out digital systems across Health Boards is complex and takes time. As set out in this report, this challenge and the others mentioned are being addressed both locally and nationally. The reporting responsibilities introduced under the Act ensure transparency and accountability which will further aide in addressing common difficulties. With this in mind, Health Boards have shown resilience and adaptability, with many actively reviewing their systems and structures to better support the delivery of the Act’s duties. The Scottish Government recognises the importance of these efforts and remains committed to supporting Boards through strategic oversight and continued engagement. The Scottish Government will continue to work in partnership with Health Boards, Healthcare Improvement Scotland, and other stakeholders to ensure that the principles of the Act are fully embedded in practice. The progress made to date provides a strong foundation for this work, and the Scottish Government remains committed to a sustainable and resilient workforce for the future of healthcare in Scotland. This report also demonstrates the progress made by Local Authorities, Integration Authorities, and care service providers in embedding the duties of the Health and Care (Staffing) (Scotland) Act 2019 into their planning, commissioning, and delivery of care services. While there is clear evidence of proactive compliance and innovation across the care sector, persistent challenges remain, particularly around recruitment, retention, training capacity, and financial sustainability. Page 177 of 180
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Document No: SG/2025/211 62 Considering the information provided within the Authorities reports, it is clear that although staffing level challenges were raised, no Authority reported that they were unable to comply with the duties within the Act. In addition, of the 89.9% of registered care providers who responded to the Care Inspectorate’s 2024 Annual Return, 3.7% self-assessed as not meeting their duties within the Act. Scottish Ministers note the limitations of this self-assessed data, as set out earlier in the report. We expect providers not meeting the duties within the Act will be considered and managed by Local Authorities who commission services, through contract management arrangements. The Care Inspectorate’s scrutiny and improvement work focuses on outcomes for people. The Care Inspectorate works with services to support improvements for people experiencing care. If they find outcomes and experiences are not being met, they will take action to address this. While the Scottish Government has overall responsibility for health and social care support policy in Scotland, statutory responsibility for delivering, commissioning, providing appropriate care capacity and charging for services at a local level lies with Local Authorities, NHS boards and Integrated Joint Boards (IJBs), and private providers themselves. The Scottish Government continues to take steps to support the sector through targeted funding, strategic workforce initiatives, and collaborative policy development. Looking ahead, ensuring a sustainable, skilled, and valued care workforce will be critical to delivering high-quality services and achieving the ambitions set out in the Service Renewal Framework and National Workforce Strategy23. 23 National Workforce Strategy Page 178 of 180
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© Crown copyright 2025 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG ISBN: 978-1-80643-471-8 (web only) Published by The Scottish Government, November 2025 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS1678126 (11/25) w w w . g o v . s c o tPage 179 of 180
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