IJB Special Board Meeting March 2026
Midlothian Council · 26 March 2026
Back to Midlothian Integration Joint Board — 26 March 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Midlothian Integration Joint Board Thursday, 26th March 2026, 14:00 – 15:00 Special Board Agenda 1. Welcome, Introductions and Apologies – Val de Souza. Democratic Services will give a list of apologies. 2. Items 2.1 Midlothian IJB Financial Budget Setting and Financial Recovery Actions 2026/2027 Presented by Chris King, Midlothian IJB Chief Finance Officer 2.2 Midlothian IJB Medium Term Financial Strategy Presented by Chris King, Midlothian IJB Chief Finance Officer 2.3 Midlothian IJB Directions 2026/2027 Presented by Gill Main, Midlothian HSCP Integration Manager 3. Close – Val de Souza. 14:00 – 14:05 14:05 - 14:35 14:35 - 14;45 14:45 – 14:55 14:55 - 15:00 1
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Midlothian Integration Joint Board Thursday, 26th March 2026, 14:00-15:00 Midlothian IJB Budget Setting 2026/27 Executive summary Midlothian IJB is required to set a balanced budget before the start of each financial year. The IJB’s budget is funded by its partners, Midlothian Council and NHS Lothian. Both partners have now made budget proposals for the 2026/27 financial year. Midlothian Council’s offer is final, as it has already set its 2026/27 budget. NHS Lothian will formally set its budget at its April 2026 Board meeting but has provided the IJB with an indicative budget offer. Discussions outlining the financial challenges facing the IJB have routinely been presented at IJB development sessions. Since then, further work has been undertaken to finalise financial projections and develop a Financial Recovery Programme. While the programme carries inherent risks, it is underpinned by key principles: prioritising essential statutory duties, safeguarding those most in need, and ensuring the IJB operates effectively within available resources. The proposed programme represents the lowest impact approach to achieving a balanced budget, ensuring short term financial stability, and enabling a continued focus on service transformation. Members are asked to: • Accept Midlothian Council’s formal budget offer for 2026/27. • Note NHS Lothian’s indicative budget offer for 2026/27. • Note the development of the 2026/27 budget setting process. • Consider the proposals that support the development of a balanced budget for 2026/27. • Agree to set a balanced budget for 2026/27 on the presumption of the delivery of the recovery programmes including working with the other IJBs and NHS Lothian to deliver a balanced position for the Set Aside budget. • Note the risks outlined in the paper, including the financial risk associated with the Council’s charging proposal, noting that the final decision will be taken by the Council after the IJB is required to set a balanced budget. Item number: 2.1 2
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Report Midlothian IJB Budget Setting 2026/27 1 Purpose 1.1 The purpose of this paper is to outline the budget offers received from the IJB’s partners, update members on the 2026/27 financial position, and propose financial recovery actions for 2026/27 in the context of Midlothian Health and Social Care Partnership’s ongoing transformation plans and operational delivery. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Accept Midlothian Council’s formal budget offer for 2026/27. • Note NHS Lothian’s indicative budget offer for 2026/27. • Note the development of the 2026/27 budget setting process. • Consider the proposals that support the development of a balanced budget for 2026/27. • Agree to set a balanced budget for 2026/27 on the presumption of the delivery of the recovery programmes including working with the other IJBs and NHS Lothian to deliver a balanced position for the Set Aside budget. • Note the risks outlined in the paper, including the financial risk associated with the Council’s charging proposal, noting that the final decision will be taken by the Council after the IJB is required to set a balanced budget. 3 Background and main report 3.1 This report outlines the proposed 2026/27 budget contributions delegated to Midlothian IJB by Midlothian Council and NHS Lothian. Sufficient resources are essential for the Board to deliver the three strategic aims of the Midlothian IJB Strategic Plan 2025-2035: • Aim Number 1: People feel able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. • Aim Number 2: People access the care and support they need when they need it in the community and at home. • Aim Number 3: People's human, social, and economic rights are protected and promoted in how we design and deliver our services. 3.2 The report also presents the 2026/27 budget plan, highlighting the projected budget shortfall. 3.3 Midlothian faces unprecedented challenges to the financial and operational sustainability of the health and care system. These challenges stem from increasing demand due to a growing and ageing population, a rise in the complexity of care required, and resource constraints in both workforce and finances. 3
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3.4 Ultimately, resource availability can no longer keep pace with rising demand. These challenges are being experienced across Scotland and the wider UK. National publications from Audit Scotland have highlighted that, to ensure long term sustainability, transformation and service redesign are essential. 3.5 Despite the significant progress made during 2025/26, the scale of the IJB’s projected budget gap requires a substantial financial recovery programme. This programme is necessary both to restore financial balance and to support the continued transformation of services, ensuring that resources are directed towards models of care that are sustainable, effective and focused on prevention and community-based support. 3.6 Midlothian Council Budget Offer Midlothian Council approved a balanced revenue budget for 2026/27 in February 2026. This approval included a specific recommendation that the level of resources allocated to services delegated to the IJB in 2026/27 is £75.122m, representing an increase in funding for the IJB of £4.036m (equating to a 6% increase). 3.7 As part of the budget offer to the IJB, Midlothian Council agreed to pass through funding received from the Scottish Government for the following policy commitments: • Increase in the real living wage to adult social care workers in the third and private sectors to £13.45 per hour - £2.532m. • Free personal nursing care uplift - £0.111m. 3.8 In addition, recognising the significant financial challenges faced by the IJB and reaffirming its commitment to integration, Midlothian Council agreed to provide additional funding for: • A 3.5% pay increase - £0.999m • Recurring support for transition pressures - £0.803m • Pass through of share of £20m national funding - £0.310m 3.9 In 2025/26 Midlothian Council provided non-recurring support of £1.100m funding to enable transformation. This funding is not available in 2026/27. However, has enabled the IJB to develop its recovery and transformation programme for future years. 3.10 The Midlothian Council budget contribution to the IJB complies with the Scottish Government’s conditions regarding budget contributions to IJBs. The Scottish Government funding outlined above has been fully allocated to the IJB and is in addition to the recurring 2026/27 budget. 3.11 A copy of the budget offer letter can be seen in Appendix 1. 3.12 NHS Lothian Budget Offer The NHS Lothian financial plan is scheduled to be presented to the NHS Lothian Board for approval on the 22nd of April 2026. Until the plan is approved, the budget contribution to the IJB remains indicative. The proposed contribution is based on the latest NHS Lothian budget assumptions. 4
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3.13 The indicative budget offer from NHS Lothian for services delegated to the IJB in 2026/27 is £110.786m, representing an increase in funding for the IJB of £5.552m (equating to a 5% increase). 3.14 The total recurring funding for delegated services, excludes non-recurring funding allocated to the IJB annually. Additionally, the £110.786m does not account for the pay award uplift or the pass-through of the non-pay uplift from NHS Lothian (2%). Both elements have been included in the current working assumptions at the following values: • Pay award - £2.132m • Non-Pay - £0.739m 3.15 The uplift for General Medical Services (GMS) is excluded from the budget offer, as it has not yet been confirmed by the Scottish Government for 2026/27. However, it is expected to be uplifted, and the associated funding to be passed through to the IJB. 3.16 A copy of the indicative budget offer letter can be seen in Appendix 2. 3.17 Financial Plan Projections The scale of the financial challenge facing the IJB was highlighted at each IJB development session from late 2025 into early 2026. At that stage, the figures represented working projections, as both partners were still finalising their local budget assumptions and formal budget offers. 3.18 The position has now been finalised, and all partner budget offers have been received. At the Midlothian IJB development session held on the 5th of February 2026, an opening gap of £8.915m was presented prior to the implementation of financial recovery actions. Following confirmation of the partner settlements and updated financial assumptions, the final projected gap is now £6.797m, with the breakdown set out below: 3.19 Table 1: Financial Plan Opening Gap 2026/27 Financial Plan 2026/27 Position £m Adult Social Care Services (3.904) Core Health Services (1.117) Share of Pan Lothian Hosted Services (0.506) Share of Acute Set Aside Services (1.270) Total (6.797) 3.20 Financial planning for health and social care services is inherently subject to risk, as assumptions made in the financial modelling can change due to a range of unpredictable factors. Some of the key financial risks are detailed below: • Prescribing Costs – Medication costs remain volatile due to global market conditions and demographic pressures in Midlothian. As seen previously, the introduction of new medications also creates significant financial pressures. • Demographic Growth – As outlined, Midlothian’s population is both growing and ageing, increasing the risk that demand, and associated costs will surpass projected levels. This was a key driver of the Adult Social Care position in 2025/26. 5
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• National Policies – The introduction of new national policies that increase IJB expenditure without corresponding funding pose financial risk. 3.21 Should any of these financial risks materialise, they will be actively managed through ongoing engagement with key partners, including Midlothian Council, NHS Lothian, and the Scottish Government. In addition, the IJB will receive regular financial reports, enabling timely identification of emerging pressures and the development of appropriate mitigation actions. 3.22 Financial Recovery Programme Midlothian IJB is required to set a balanced budget for 2026/27. To achieve this there is a requirement to identify and agree financial recovery actions equating to £6.797m to bridge the projected financial gap. 3.23 Over the past year, extensive work has been carried out to develop financial recovery actions. Engagement sessions have taken place with key stakeholders, including Midlothian Council, NHS Lothian, elected members, the Third Sector, and external providers. 3.24 The financial recovery process has focused on identifying solutions that balance the need to close the budget gap while prioritising essential statutory duties, safeguarding those most in need of support, and ensuring the IJB can operate effectively within the available resources. 3.25 The current level of expenditure is unsustainable, as evidenced by the 2025/26 IJB financial outturn projection, and failure to address this issue risks compromising the future provision of critical services and support. 3.26 At the IJB development session in November 2025, members agreed to adopt a more focused approach to financial recovery, reflecting learning from the experience of the 2025/26 financial year and the challenges associated with delivering a large number of recovery schemes simultaneously. It was recognised that management capacity is limited, with teams balancing the delivery of recovery programmes alongside the ongoing requirement to maintain service provision. As a result, the IJB agreed to prioritise a smaller number of key areas of spend where the greatest impact could be achieved. 3.27 The financial recovery programme has two components: • Operational Recovery Actions – These are smaller scale recovery actions designed to identify efficiencies, facilitate redesign, and strengthen financial management. This component also includes recovery actions approved and implemented in 2025/26. While some financial benefits were realised in 2025/26, the full benefits are expected to be realised in 2026/27. These actions do not require IJB approval as do not impact the ability to deliver the strategic objectives of the Board. • Strategic Redesign Recovery Actions – These are larger scale recovery actions that have been developed and require approval from the IJB. 6
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3.28 Given the scale of the financial challenge, some recovery actions will impact services, the performance of Midlothian IJB, people and communities in Midlothian, and the health and social care workforce. While these impacts are acknowledged, the financial recovery programme has taken care to consider these risks with the objective of presenting the lowest risk and lowest impact options to Midlothian IJB for approval. A detailed risk assessment has been undertaken for each of the strategic redesign recovery actions to identify and mitigate for potential risks as far as is practicably possible at this stage of planning. 3.29 A significant contributor to the success of this planning process has been a commitment to work alongside the Midlothian Health and Social Care Partnership Executive Leadership Team Heads of Service and Professional Leads in order to have achieved their full endorsement of the proposals to achieve financial balance. 3.30 The impact of the financial recovery programme on the financial plan is shown below: 3.31 Table 2: Financial Recovery Actions Financial Recovery Actions Health Social Care IJB Total £m £m £m Opening Gap (2.893) (3.904) (6.797) Recovery Actions: Operational Recovery Actions 2.333 2.007 4.340 Strategic Redesign Recovery Actions 0.275 1.945 2.220 Total (0.285) 0.048 (0.237) 3.32 Pending the finalisation of the NHS Lothian financial plan, the 2026/27 budget is £0.237m out of balance. This financial pressure remaining is in relation to Health Set Aside services which are currently projected to be £1.083m overspent. 3.33 Officers have worked closely with colleagues from NHS Lothian regarding the management of the financial position for delegated health services. NHS Lothian has reiterated its commitment to work collaboratively with Integration Authorities to achieve financial balance. This approach is dependent on NHS Lothian delivering a break-even position overall. Discussions will continue throughout the year to ensure the position is managed collaboratively, however, for the purposes of setting a balanced budget, NHS Lothian has confirmed that the IJB can proceed on this basis. 3.34 This approach from NHS Lothian also recognises the need to support the continued shift in the balance of care away from inpatient settings towards care delivered closer to home in community settings. 3.35 A breakdown of the Financial Recovery Programme is provided in Appendix 3. 3.36 One operational recovery action to highlight is the Adult Social Care charging proposal. This function is not delegated to the IJB and remains a decision for Midlothian Council. In previous years, recommendations from the Health and Social Care Partnership have been considered as part of the wider Council budget setting process. However, due to timing constraints this has not been possible this year, and a separate Council discussion is scheduled for the 31st of March. Therefore, at the 7
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time of writing, the level of additional income associated with the charging proposals has not been formally confirmed. Officers have worked closely with Council colleagues on how this should be reflected within the IJB’s financial planning. It has been agreed that the projected income should be included within the financial plan, however, it must be recognised that if the proposals are not approved by Council, the IJB would need to identify approximately £0.9m of additional recovery actions. This therefore represents a financial risk within the budget setting process. 3.37 If approved, the outlined financial recovery programme and the additional support from NHS Lothian in relation to Set Aside services will allow for the IJB to set a balanced budget for 2026/27. This approach will allow for financial stability in the short term and enable a shift to a more strategic focus on transformation for future years 3.38 Looking Forward As referenced in the Audit Scotland IJB Finance Bulletin 2024/25 published on 24th February 2026, Integration Authorities across Scotland are experiencing significant financial challenges. The bulletin highlights the need for IJBs to work collaboratively with each other and with their NHS and Council partners to identify opportunities to transform services and ensure long-term sustainability. It also emphasises the importance of investment in prevention and early intervention to help manage rising demand for services, the increasing cost of more complex care, and to improve outcomes and experiences for people. 3.39 Midlothian IJB has made a significant commitment to collaborative, cross system working and to strengthening early intervention and prevention within its Strategic Plan 2025-2035. Consideration has also been given to how these ambitions can be progressed through a set of draft Directions for 2026/27. Progress towards these ambitions will continue to be monitored through a revised Midlothian IJB Performance Framework, Midlothian IJB Directions reporting, and through evaluation of nationally validated data within the Midlothian IJB Annual Performance Report. 3.40 The Midlothian Operational Transformation and Change Programme Board, chaired by the Midlothian IJB Chief Officer / HSCP Joint Director, has identified a number of key priorities for future transformation work. 3.41 These workstreams include initiatives such as establishing a community front door, redesign of the day service provision, community nursing review, palliative care pathway development, and a wider social work and occupational therapy review. These programmes are currently underway and will return to the IJB periodically throughout 2026/27 for consideration. It should be acknowledged that progress in some areas may be slower than initially anticipated due to the requirement to prioritise delivery of the financial recovery programme. 4 Policy Implications 4.1 This report does not have any direct impact on policy. However, decisions taken by the Board may impact on the ability to progress the ambitions of the Midlothian IJB Strategic Plan 2025-2035 and may have an impact on operational policies. 8
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5 Directions 5.1 The content of this report does not have any direct impact on existing Directions. 5.2 However, any decisions taken by the board in relation to Financial Recovery Planning must be set out in a Direction to the relevant Partner(s). The Midlothian IJB Strategic Plan 2025-2035 sets out a clear vision for the next 10 years and draft Directions for 2026/27 support the next steps in its delivery. 5.3 This report is closely aligned with the draft Directions for 2026/27 that clearly set out the financial recovery and transformation ambitions of Midlothian IJB in Section 9 ‘Our Resources’. 5.4 The draft Midlothian IJB Directions for 2026/27 are also presented to the Board in this Special Board Meeting by the Integration Manager. 6 Equalities Implications 6.1 An Equalities and Children’s Rights Impact Assessment (ECRIA) Screening Tool has been submitted with this paper. This report itself does not have any direct impact on equalities. However, all new or revised strategies, plans, provisions, or activities that include significant change require a full Equalities and Children’s Rights Impact Assessment (ECRIA) to be undertaken as early as possible in the development stage to assess the impact of propositions on people, or groups of people, with protected characteristics. 6.2 An Equalities and Children’s Rights Impact Assessment (ECRIA has been undertaken for each of the strategic redesign recovery actions and reviewed by Midlothian IJB board members as part of the planning and decision-making process. 6.3 In line with statutory requirements, the ECRIAs that accompany all financial recovery schemes approved by Midlothian IJB will be published on the Midlothian Health and Social Care website as soon as practicably possible following a decision. 7 Resource Implications 7.1 The financial implications of this report are laid out above. 8 Risk 8.1 Achieving a balanced financial position is contingent upon the full implementation of the Financial Recovery Programme. Any significant deviation from the programme will result in financial pressures emerging in the 2026/27 financial year. 8.2 Beyond the financial challenges, the scale of the Financial Recovery Programme presents substantial risks to Midlothian IJB’s ability to fulfil the ambitions outlined in its Strategic Plan. 9
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8.3 The requirement to deliver the Financial Recovery Programme may hinder or delay progress towards achieving the nine National Health and Wellbeing Outcomes for individuals and communities. However, the indicators that populate the 9 National Health and Wellbeing outcomes are lagging indicators and the impact may not be seen until the July 2028 national indicator publication. Strategic Planning and Performance continue to develop and refine local data provision to ensure the board is provided with local data and information support good decision making. 8.4 A detailed risk assessment has been undertaken for each of the strategic redesign recovery actions and been reviewed by Board members as part of the planning and decision-making process, all risks associated with the Financial Recovery Programme for approved schemes will be closely monitored and managed in a timely and appropriate manner. 8.5 The Health and Social Care Partnership Executive Leadership Team will oversee emerging risks through established governance frameworks, ensuring that mitigation strategies are effectively implemented. Any significant issues requiring escalation will be directed through the IJB’s governance structures, including the Audit and Risk Committee and, where necessary, the Board, to ensure appropriate scrutiny and decision making. This approach will support financial sustainability while safeguarding the delivery of essential health and social care services. 8.6 A comprehensive review of Midlothian IJB’s risk register will be conducted as part of the June 2026 Audit and Risk Committee meeting before being presented to the Board for further consideration. 9 Involving people 9.1 This report has been written following consultation with our NHS Lothian and Midlothian Council financial Partners, officers of Midlothian IJB, and with the Midlothian HSCP Executive Leadership Team. 10 Background Papers 10.1 There are no background papers. AUTHOR’S NAME & DESIGNATION Chris King, Chief Finance Officer CONTACT INFO Chris.King@nhs.scot DATE 20/03/2026 Appendices: Appendix 1: Midlothian Council Budget Offer Appendix 2: NHS Lothian Indicative Budget Offer Appendix 3: Overview of Financial Recovery Programme 10
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Midlothian Council Midlothian House Buccleuch Street Dalkeith EH22 1DN David Gladwin – Chief Financial Officer & Section 95 Officer Your Ref: Our Ref: www.midlothian.gov.uk Midlothian 27 February 2026 Morag Barrow Chief Officer Midlothian Integration Joint Board Fairfield House 8 Lothian Road DALKEITH EH22 3AA Dear Morag ALLOCATION TO MIDLOTHIAN INTEGRATION JOINT BOARD 2026-27 Following the Council meeting on Tuesday 24th February I am writing to confirm that Council agreed an allocation to the Integration Joint Board of £75.122 million. This offer is made up as follows:- £m Approved Requisition 2025/26 71.086 Additional 2025/26 funding for pay costs 0.361 Revised 2025/26 funding 71.447 Funding for 3.5% pay increase in 26/27 0.999 Removal of one-off funding in 25/26 to support transformation (1.100) Additional recurring funding for Transtions Other minor changes New Scottish Government Funding 0.803 0.020 £13.45 per hour living wage payment for private, voluntary and independent commissioned providers 2.532 Uplift to Free Personal & Nursing Care rates Anticipated share of additional £20m Funding 0.111 0.310 2026/27 MIJB Requisition 75.122 I would be grateful if you could confirm Midlothian Integration Joint Board’s acceptance of the 2026-27 allocation. Yours sincerely David Gladwin 11
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2 Chief Financial Officer & Section 95 Officer David.Gladwin@midlothian.gov.uk cc Chris King, Chief Finance Officer, Midlothian Integration Joint Board Ruth Nichols, Senior Finance Business Partner 12
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Lothian NHS Board Finance Director’s Office NHS Lothian Mainpoint 102 West Port Edinburgh EH3 9DN Date 5 March 2026 Enquiries to Craig Marriott Email craig.marriott@nhs.scot Dear Chris, MIDLOTHIAN IJB – INDICATIVE BUDGET FOR 2026/27 Further to NHS Lothian’s Finance and Resources (F&R) Committee on February 11th, I write to update you on the position relating to Midlothian IJB budget position for 2026/27. We continue to update our financial plan, and will look to take a final iteration of the Plan through our F&R Committee on the 25th of March, with final sign off at our Board meeting on the 22nd April. The figures shared with you at this stage are therefore indicative until the final plan has been agreed. Further to the Scottish Government Budget announcement on 13th January 2026, 2% uplift for Health Boards in 2026/27 was set out. We will look to pass through to each IJB, based on budget shares, the baseline uplift settlement we receive. Currently the budget resource for Midlothian IJB is £111m before the 2% 2026/27 uplift is applied. This budget figure does include GMS budgets which although are non recurring in nature are assumed at this stage as part of the budget offer to be consistent with previous years. This figure does not include GMS uplift, nor does it include other allocations received non-recurrently from the Scottish Government. Table 1 shows the breakdown. Table 1 - Midlothian IJB Delegated Budget Status Allocation Midlothian IJB £'000 Delegated Core 60,852 Hosted 15,550 Set Aside 19,922 Recurring Budget 96,325 GMS 14,461 Total 110,786 (Based on recurring budget as at Feb'26, with budgets subject to change as SG Allocations are received) 13
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The final review of the NHS Lothian Financial Plan will conclude shortly, and a further update on 2026/27 delegated budgets will be provided to you at this time. NHS Lothian is committed to working collaboratively with its IJB partners and therefore we would look to target this funding at financial pressure which sit across both delegated and non delegated health budgets. As previously highlighted, I am keen to understand from Midlothian IJB how its Directions will shape the delivery of financial recovery savings in 2026/27 and the application of resources in support of financial balance. I would be happy to have further discussion with your IJB in advance of the final confirmation on the application of health resources in 2026/27, and we are keen to work together to ensure ongoing support to achieve an overall balanced health position. Yours sincerely CRAIG MARRIOTT Director of Finance 14
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Appendix 3 – Overview of Financial Recovery Programme Grouping No Title/Theme Value £m Financial Risk Rating Operational 1 Prior Year Recovery Actions 0.151 Low 2 Workforce Redesign 1.058 Low 3 Prescribing Efficiency 1.083 Medium 4 Income Maximisation 0.967 Medium 5 Astley Ainslie Reprovision 0.114 Low 6 Extra Care Housing 0.225 Low 7 Contracts & Commissioning 0.114 Medium 8 Property Rationalisation 0.031 Low 9 Hosted Services Actions 0.410 Low 10 Set Aside Actions 0.187 Low Sub Total 4.340 Strategic 11 Care at Home 0.905 Medium 12 Learning Disabilities 0.765 Medium 13 Midlothian Community Hospital 0.550 Medium Grand Total 6.560 16
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Midlothian Integration Joint Board Thursday, 26th March 2026, 14:00-15:00 Draft Midlothian IJB Medium Term Financial Strategy Executive summary This report presents the Midlothian IJB draft Medium Term Financial Strategy 2025-2028 (appendix 1) for review and comment. The Medium Term Financial Strategy sets out how the IJB will plan for and manage the financial challenges facing health and social care services over the next three years. Demand for support continues to rise, the complexity of care is increasing, and costs are growing at a pace that exceeds available resources. The strategy provides a forward looking view of what the IJB will need in order to remain financially sustainable, and sets out the priorities, planning assumptions and actions required to manage these pressures. The strategy recognises the financial risks the IJB faces, including the absence of reserves, ongoing demographic pressures and the need for sustained transformation. It outlines how the IJB will strengthen financial monitoring, improve forecasting, and ensure resources are directed to the areas where they add the greatest value. As a result of this report, Members are asked to: • Review the draft Midlothian IJB Medium Term Financial Strategy. • Note the scale of the financial gap over the 3-year period 2026/27 to 2028/29. • Support the ongoing development of the medium-term financial strategy, improving alignment with the strategic plan. • Agree to receive an update on progress on a regular and appropriate basis throughout the year. • Subject to any further amendments, approve this strategy. Item number: 2.2 17
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Report Draft Midlothian IJB Medium Term Financial Strategy 1 Purpose 1.1 This paper presents the IJB’s Medium Term Financial Strategy for 2025 to 2028. It sets out the financial context, key risks, planning assumptions, and the actions required to support sustainable health and social care services in Midlothian. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Review the draft Midlothian IJB Medium Term Financial Strategy. • Note the scale of the financial gap over the 3-year period 2026/27 to 2028/29. • Support the ongoing development of the medium-term financial strategy, improving alignment with the strategic plan. • Agree to receive an update on progress on a regular and appropriate basis throughout the year. • Subject to any further amendments, approve this strategy. 3 Background and main report 3.1 The IJB must develop a Medium Term Financial Strategy to provide a clear, forward looking view of the resources needed to meet future demand. The strategy has been developed alongside the IJB Strategic Plan and sets out how resources will be prioritised, how financial risks will be managed and how transformation will be supported. 3.2 The financial environment remains challenging. Demand for services continues to rise, costs continue to increase, and the IJB has no general reserves to offset unexpected pressures. The strategy responds to these challenges and outlines two financial priorities. These focus on strengthening financial monitoring and forecasting and ensuring that resources are directed to the areas where they will have the greatest impact. 3.3 The strategy also sets out the planning assumptions that underpin the financial outlook and summarises the national and local pressures facing the IJB. A three-year financial projection is included, however, the impact of the proposed financial recovery programme has not yet been factored into these projections. Should the IJB approve the budget proposals, the financial modelling will be updated to reflect the impact of the recovery actions. These actions will reduce the projected financial gap in future years. 18
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3.4 Delivery of the strategy will require continued joint working with NHS Lothian and Midlothian Council, supported by strong governance and ongoing oversight through the Audit and Risk Committee and the Strategic Planning Group. 4 Policy Implications 4.1 The Midlothian IJB draft Medium Term Financial Strategy 2025-2028 aligns with the following statutory guidance • Health and social care integration finance guidance • Health and social care strategic plans: statutory guidance • Directions from integration authorities to health boards and local authorities: statutory guidance 4.2 This report will also be relevant to all delegated functions of Midlothian IJB who may need to consider the implications of financial allocation and revise local policies and / or processes as a result. 5 Directions 5.1 This strategy does not directly impact on existing Directions. However, the implementation of the strategy may influence future Directions issued to NHS Lothian and Midlothian Council. 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 as this strategy is one of the suite of statutory publications to accompany the Midlothian IJB Strategic Plan 2025-2035. An ECRIA has been published in relation to the Midlothian IJB Strategic Plan 2025-2035 and is available on the Midlothian Health and Social Care website. 6.2 However, further consideration to the completion of additional ECRIAs will be considered as part of the implementation of service redesign, transformation work. 7 Resource Implications 7.1 There are no direct resource implications arising from this report. However, the implementation of the actions described in this strategy plan will generate actions that carry resource implications. These will be assessed and presented to the Board as required. 8 Risk 8.1 There is a risk that funding available to the IJB is not sufficient to deliver the ambitions of the Midlothian IJB Strategic Plan 2025-2035. 19
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8.2 There is a risk that if funding offers from Partners for 2026/27 are reduced from 2025/26 levels, this may not be sufficient to deliver a balanced budget for 2026/27 despite financial recovery planning. 8.3 There is a risk that the nature of year on year budget offers may derail the 3-year vision for this Midlothian IJB draft Medium-Term Financial Strategy 2025-2028. 9 Involving people 9.1 This report has been written following consultation with 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 Midlothian IJB Strategic Plan 2025-2035 10.2 Scottish Government Medium Term Financial Strategy AUTHOR’S NAME & DESIGNATION Chris King, Chief Finance Officer CONTACT INFO Chris.King@nhs.scot DATE 20/03/2026 Appendices: Appendix 1: Midlothian IJB draft Medium Term Financial Strategy 20
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Midlothian Integration Joint Board Medium Term Financial Strategy 2025-2028 21
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Contents Introduction ..................................................................................... 3 Statutory requirements .................................................................... 5 Key issues and risks ........................................................................ 9 Our annual budget ......................................................................... 12 Our Financial Outlook .................................................................... 14 Planning assumptions ................................................................... 16 Our strategy for change ................................................................. 18 Financial priority No.1 .................................................................... 19 Financial priority No. 2 ................................................................... 22 Appendices ................................................................................... 25 22
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Introduction This Medium Term Financial Strategy has been developed alongside our Strategic Plan for 2025-2035 and sets out how we will prioritise, allocate and best utilise our integrated resources. We have agreed that achieving the ambitions of our Strategic Plan will bring the change we want to see in our communities. We allocate funding from our integrated budget to the services delivered by Midlothian Health and Social Care Partnership and, in some cases, by our partners NHS Lothian and Midlothian Council. However, without significant change, we know that our current resources will not be sufficient to meet the needs of Midlothian’s growing population. This plan is effective from December 2025 until November 2028, but we will review our planning if national funding or local budget offers change. 23
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Who we are Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in this Strategic Plan will guide how we allocate the money we receive. Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships; Midlothian, East Lothian, West Lothian, and City of Edinburgh. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act, 2014. We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. 24
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Statutory requirements We are required to develop a Medium Term Financial Strategy and must only spend the resources that have been made available to us by our Partners, Midlothian Council and NHS Lothian. 25
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Statutory requirements Like all Integration Authorities in Scotland, we must develop and deliver a strategic plan that sets out how we will contribute to people and communities of Midlothian living in good health and wellbeing. The Midlothian IJB Strategic Plan 2025-2035, describes how we will work with our Partners Midlothian Council and NHS Lothian, people, communities, the Third and Independent Sector, and the services who provide care and support to agree how we can best contribute to people in Midlothian living well in their community. Our Strategic Plan helps us prioritise how we will allocate and best utilise those resources and how we have allocated funding to the services that Midlothian Health and Social Care Partnership is set out in this strategy this plan. However, we know we don’t have enough resources to meet all the needs of the growing population in Midlothian. Statutory financial guidance We must • set out how the resources made available to us will be deployed, set a balanced budget at the start of each financial year, and ensure corrective action is taken to avoid spending out with its means • describe how the resources made available to us are being used most effectively to see the fastest possible progress towards improved health and well-being in the lives of the people and communities of Midlothian. • publish a financial statement every year that describes the total resources we intend to allocate to deliver the strategic plan. • have financial governance systems in place to oversee our financial management and ensure we are meeting the duties of Best Value, risk management, and internal audit arrangements. • demonstrate how we have utilised its Joint Strategic Needs Assessment (JSNA) to determine how we have made decisions about the allocation of our resources. How we receive our funding Our resources are allocated to us by Midlothian Council and NHS Lothian each year and we are then responsible for the integrated budget. The budget offer we receive from both our Partners changes from each year and may not be enough to deliver everything we want to. We can only use the resources that are made available to us. We work closely with both Partners but often don’t know exactly what our budget offers will be until February or March each year. This is because of how our Partners receive funding from Scottish Government. 26
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Future funding decisions that impact on our Partners are likely to also impact on the resources we have. This makes it very difficult to plan ahead in a meaningful way as we don’t have firm offers from both Partners until after the start of the financial year. The result of year-on-year budget offers means that strategic planning and progress towards our strategic aims can slow down, or we may need to revise this plan and our medium-term financial strategy to ensure we are prioritising the right actions. The decisions taken by our Partners will impact on our capacity and ability to respond to changing needs in our communities. Setting a balanced budget As mentioned, we must operate within the resources available to us. While we have supportive partners, it is widely recognised that public sector finances are constrained, and the level of funding we receive is not keeping pace with increasing demand, inflation, and demographic change. To meet our statutory duties, we must therefore make difficult decisions about how and where we allocate our resources. This means carefully prioritising the services that deliver the greatest impact for the people of Midlothian, while ensuring that we continue to meet our core legal responsibilities for care and support. Each year, financial recovery measures are developed and presented to the IJB for final approval. These proposals are fully assessed to understand the financial, operational, and equality impacts of any change. The focus is always on identifying the least impactful changes, improving efficiency, and exploring opportunities for transformation rather than simple reductions in service. Through this approach, we aim to balance the budget responsibly while maintaining quality, safety, and sustainability across health and social care services. Best Value The Local Government in Scotland Act 2003 and the Public Finance and Accountability (Scotland) Act 2000 require Integration Authorities to ensure the principles of Best Value are built into all financial planning and decisions. The decisions we make must be based on what we have learned through continuous improvement. Best value is about ensuring that we effectively manage the resources available to us and focus on improvement to deliver the best possible outcomes for people and communities. To achieve Best Value, we must work alongside our Partners to regularly evaluate our Performance. We do this using our Best Value Framework and record progress in our Strategic Governance Outcomes Map. This helps us continually improve and describe our work across 7 key areas. • Vision and leadership • Governance and accountability • Effective use of resources • Partnership and collaborative working • Working with communities • Sustainability • Fairness and equality 27
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How we fund ‘Transformation’ The financial resources available to us are agreed when we set our annual budget. This is usually in March. Sometimes further resources are made available by the Scottish Government. Working this way makes thinking about our strategy difficult. By law, we have to review our Strategic Plan every 3 years but also know that change doesn’t happen quickly. We will review and refresh this plan in 3 years, but we only have the budget confirmed for one year at a time. We also know that our population is changing, and we need to plan for this by thinking much further ahead. This Strategic Plan asks the services in Midlothian Health and Social Care Partnership to redesign in specific ways over the next 10 years. New legislation, national policies, or other national changes may also require services to do things differently. When this happens, it often needs additional investment, but we don’t always receive more money. We have spent several years improving and making our services as efficient as they can be. This means we are no longer able to do more with less to achieve saving targets. We are now working towards total system transformation, and work at this scale requires a huge amount of planning, testing, learning, and retesting on top of our day- to-day business of supporting people and communities. We must balance our financial decisions with safety, efficiency, and effectiveness, and use opportunities to redesign to deliver a new and sustainable future for health and social care. Our ‘reserve’ budget All Integration Authorities should have reserves as this is part of good financial management. There are two types of reserves: general reserves, and earmarked reserves. General reserves are funds which have been built up from surpluses in previous financial years. The main purposes of general reserves are to help support unexpected financial pressures through the year. In 2023/24 we had to spend all of our general reserve to pay for services. Although this was planned, it means we no longer have any general reserves to support lead times associated with recovery plans or to invest in service transformation. Earmarked reserves are funds that we may have carried forward one year to the next for specific and allocated services or projects. We have earmarked reserves for this purpose. 28
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Key issues and risks Integrated health and social care is changing. This is because of the way our communities are growing, the types of support that people need, and other influencing factors like legislation, national policy, and Scottish Government priorities. We will have to be ready to adapt and work in new ways as we learn more about the key issues and risks that will impact on our ability to deliver our strategic plan. 29
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Our changing population Between 2001 and 2023, National Records of Scotland recorded that the population of Midlothian has increased by 21.4%. This is the 2nd highest percentage change out of the 32 council areas in Scotland and Midlothian is set to see further population increases over the next 10-15 years. Life expectancy is falling, and healthy life expectancy in Scotland has fallen to a near ten-year low. This means that people are living less of their lives in good health and are likely to need more care and support earlier in their lives. In the population predictions for Midlothian in Figure 1 below, the blue line shows the predicted population from National Records of Scotland. Nationally provided figures only predict population increases as far as 2028 and are based on what we know about birth rate, mortality and migration. These three factors are the most significant elements of population prediction. In Midlothian birthrate is falling, mortality is relatively stable, but migration is significantly changing. Population projections that include the known planned housing development outlined in the Midlothian Land Development Plan (MLDP2), have informed locally estimated data up to 2037. It is not possible to predict the rate at which each house will be built and occupied, so the data has been applied equally over time. However, it is unlikely that population growth will be spread evenly across the years. The orange line in figure 1 shows the approximately 7,000 additional people moving to Midlothian as a result of the new proposed housing developments across 2025 – 2033 at roughly 1,000 per year. Similarly, the approximately 13,500 additional people moving to Midlothian as a result of the new proposed housing developments are spread from 2033 – 3037 at roughly 3,300 per year. Figure 1: Midlothian population growth 2018 - 2037 We know that unless there are changes to how we are funded, we will be unable to provide all the care and support that our growing population will need. This is a significant risk, and we are working with our Midlothian Council and NHS Lothian Partners on how to plan ahead. 80,000 100,000 120,000 140,000 2018 2020 2022 2024 2026 2028 2030 2032 2034 2036 2038 Midlothian Population Prediction NRS Population Housebuilding Projection 30
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Financial risks We are currently facing a number of serious financial risks. The main risk is that our Partners may not be able to provide the necessary levels of funding to support our aims. The financial pressures we face are the same all across Scotland: the costs of changes relating to staff pay, terms and conditions, the changing cost of existing drugs and the cost of new drugs and rising costs due to inflation. Our changing population is also a financial risk. National funding formulas for both Local Authorities and NHS Boards aim to reflect population change, but these mechanisms face two key limitations: • The total funding available has increased but not at a level sufficient to fully meet the scale of the pressures identified • Declining populations in other areas do not automatically result in proportionate reductions in service delivery costs, which limits the system's ability to redistribute resources effectively. NHS Lothian and Midlothian Council have supported us with the best funding offer they can in the circumstances. However, their resources are also limited, and this could mean less money is available for community health and social care. There is also a risk that future Scottish Government policy decisions could impact on the way we have to use the money we have available to us. For example, it is not clear how the National Care Service will impact on the funding we receive or the services we will be asked to plan for. Financial Risk The demand for health and social care services in Midlothian continues to grow every year. More children with complex needs are moving into adult services, more people are needing care and support, and the level of care required for existing individuals is becoming more complex. This increasing demand puts real pressure on both budgets and the workforce, making it harder to meet everyone’s needs within the money available. Financial Risk The IJB currently has no financial reserves to manage unexpected costs. Any new pressures, such as higher care costs or increased demand, must be met within existing budgets, leaving little flexibility to respond quickly or protect services from sudden financial pressures. Financial Risk The financial challenge is so significant that the IJB’s immediate focus must be on financial recovery to ensure stability. While this is essential, it limits the ability to invest in the service changes and transformation projects needed to achieve longer term sustainability. 31
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Our annual budget We must only spend the resources that have been made available to us by our Partners, Midlothian Council and NHS Lothian. Our Strategic Plan helps us prioritise how we will allocate and best utilise those resources. We have agreed that achieving the ambitions of our strategic plan will bring the change we want to see in our communities. 32
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Our annual budget Our annual budget for 2026/27 is £185.908m. £76.865m - Health Core Services (from NHS Lothian). These are local health services which are delegated to the Health and Social Care Partnership. These include primary care services like GPs and Pharmacists, and other community services like district nursing, community mental health teams, community learning disability teams, and the local community hospital. £13.999m - Health Hosted Services (from NHS Lothian) Some services are managed on a pan-Lothian basis. We manage a share of the total budget for these services based on its population. Midlothian hosts Dietetics and Adults with Complex and Exceptional Needs and provide services for people across Lothian on behalf of all four Health and Social Care Partnerships - Midlothian, East Lothian, West Lothian, and City of Edinburgh. £19.922m - Health ‘Set Aside’ budgets (from NHS Lothian). Unscheduled care services (Accident and Emergency and unplanned admissions) are managed by NHS Lothian’s Acute Hospital system. The IJB’s budget includes a share of these services, based broadly on our population size. The budget is ‘set aside’ by NHS Lothian on the IJB’s behalf. These services are Accident and Emergency, Cardiology, Diabetes, Endocrinology, Gastroenterology, General Medicine, Geriatric Medicine, Rehabilitation Medicine, Respiratory Medicine, and various ancillary support services for the above. They are delivered at the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital. £75.122m - Social work and Social Care (from Midlothian Council). This is for the adult social care services in Midlothian. These services are managed operationally by the Midlothian Health and Social Care Partnership. 33
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Our Financial Outlook Each year, the IJB updates its financial plan to reflect the most up to date information available. The plan combines current financial data with future projections to estimate the likely financial position over the next three to five years. This allows the IJB to understand how changing demand, costs, and funding levels may impact services over time. This approach ensures we are always looking forward and clearly understand the resources we need to provide the right treatment, care, and support in Midlothian. By planning over several years, the IJB can accurately plan ahead, see trends, and identify financial risks early. This will ensure we make informed decisions about where to invest, redesign, or disinvest by aligning our financial planning with wider strategic priorities, such as prevention, early intervention, and sustainable models of care. 34
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Medium Term Financial Plan – 3 Year Outlook Figure 2: Midlothian Financial Projections 2026/27 – 2028/29. Financial Year: 2026/27 £m Financial Year: 2027/28 £m Financial Year: 2028/29 £m Social Care (3,904) (5,704) (7,504) Health (2,893) (3,343) (6,176) Total (6,797) (9,047) (13,680) The financial projections above set out the projected funding shortfall facing the IJB. Given the dynamic nature of health and social care finances, these projections are updated routinely to reflect any new developments. However, the figures illustrate the scale of the financial challenge facing Midlothian. These projections assume the following in relation to income: • Funding will be provided for the Real Living Wage uplift. • Funding will be provided for the uplifts associated with Free Personal and Nursing Care. • Pay awards will be funded in full. • No additional funding will be provided to meet demographic or other demand led growth. The figures presented show the financial position before any financial recovery actions have been developed or implemented. Our Focus Care at Home We will strengthen our reablement approach to ensure individuals receive the right level of support while maximising independence. Alongside this, we will work with providers to ensure Care at Home contracts deliver sustainable, high quality services that represent best value. Midlothian Community Hospital We will review the inpatient bed model to ensure capacity reflects patient need and supports the shift towards providing more care closer to home. This will help ensure hospital resources are focused on those who require inpatient care most. Learning Disabilities We will review care packages to ensure support remains aligned with individual needs while exploring opportunities to deliver services differently. This will include greater use of technology enabled care to support independence and improve outcomes. 35
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Planning assumptions The Scottish Government has published its Medium Term Financial Strategy, an important document that provides insight into the challenges and opportunities we are likely to face in the years ahead. It sets out the national financial context within which all public sector bodies, including Integration Joint Boards, must plan and operate. We work closely with both of our Partners, NHS Lothian and Midlothian Council, to have the right information to plan well. This shared approach helps us to be confident we have a financial strategy that reflects both the national outlook and the reality of what people and communities need in Midlothian. 36
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What shapes our financial planning We work closely with NHS Lothian and Midlothian Council to identify local issues, pressures, and opportunities that shape our financial planning. Through regular joint planning sessions, shared data analysis, and open conversations, we are confident that local intelligence drives our financial planning and decision making. At a national level, Scotland’s public finances remain under sustained pressure. The Scottish Government’s 2025–2028 financial outlook describes a funding gap between projected spending commitments and available resources. This gap has significant implications for Integration Authorities, as health and social care budgets continue to be a large proportion of total public expenditure. Future funding is expected to focus on maintaining front line services, meeting national pay commitments, and investing in reform through the National Care Service. However, without significant investment, small local health and social care systems like Midlothian are unlikely to be able to deliver the change needed. We will continue to engage with national and local partners to ensure our financial strategy accurately reflects our position and provides the best options available to us for sustainable service delivery. Planning Principle 2 Financial planning decisions should support sustainable service delivery in the medium to long term. This means prioritising actions that keep us in financial balance, deliver value for money, and reduce future demand through prevention, early intervention, and efficient use of resources. Planning Principle 3 All our financial plans are developed in partnership with NHS Lothian, Midlothian Council, and our wider partners to ensure our priorities are shared. Joint planning and open communication are key to ensuring our collective resources have the greatest impact of across the whole system. Planning Principle 1 Financial planning will be informed by the most accurate and up to date information available and take account of the rapidly changing health and social care landscape. Clear reporting, consistent data, and open communication will ensure that plans are fit for purpose. 37
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Our strategy for change We know we need to do things differently. The scale of transformation required means we must deliver care and support in new ways. When we have to deliver differently, we also need to monitor, evaluate and report differently. We have agreed two main strategic financial priorities to help us develop new and effective ways to improve our financial planning and reporting. 38
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Financial priority No.1 We use a new financial evaluation framework to monitor our financial performance in a dynamic and changing system What we are trying to achieve 1.1 We use System Thinking to design new feedback loops that help us make good decisions as health and social care transforms. 1.2 We use financial forecasting to plan ahead and anticipate change. 1.3 We take corrective action when our funding decisions are no longer helping us achieve the priorities of our Strategic Plan. 39
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What we are trying to achieve 1.1 We use System Thinking to design new feedback loops that help us make good decisions as health and social care transforms Financial strategy We know that financial strategy is more than how to get from A to B within budget. We must learn from the past, plan for a new future, and overcome obstacles along the way that haven’t emerged yet. If integrated health and social care is being asked to redesign how it delivers treatment, care and support, it’s not unreasonable to expect to have to redesign how we monitor and evaluate our performance. Of course, getting our financial strategy right is fundamental to contributing our very best to people and communities achieving what matters to them most. This means we need to design new ways to understand how efficiently resources are being used, and how effective this is in achieving our goals. We have asked the Midlothian Health and Social Care Partnership Strategic Planning and Performance service to work closely with our Chief Finance Officer to ensure we have the right information to make the best decisions we can. We have had to prioritise this work for the areas of our budget where we want to see the fastest change in 2025/26 but will regularly review this. 1.2 We use financial forecasting to plan ahead and anticipate change What we will do Phase 1 (November 2025 -January 2026) Resource Panel Review • Examine current activity to provide context to dynamically changing financial data • Identify historic patterns, trends, and variation for further examination Dual design audit (NHS Lothian and Midlothian Council) • Identify high intensity system activity • Provide insight to inform system understanding of intersections and relationships between areas • Continue to seek agreement integrate health and social care data 40
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Financial forecasting Developing reliable forecasting and projections is a complex task. As we refine the information we want to use to develop more powerful predictive data tools, we will share our learning with services and our Partners. 1.3 We take corrective action when our funding decisions are no longer helping us achieve the priorities of our Strategic Plan Evaluation and re-evaluation Our Strategic Planning Group oversees our performance in progress towards our Strategic Plan 2025-2035, and Audit and Risk Committee reviews our financial performance. We must ensure that these committees are working together to join up the information that informs our Directions. We will continue to develop how we talk about resource alongside our Directions and publish this information on the Midlothian Health and Social Care website. We normally issue Directions in March and September each year but can issue a Direction at any time. As we understand the impact of our transformation programme, it is likely we will issue Directions more frequently as we gain more insight into the successes and opportunities of the changes we have implemented. What we will do Phase 2 (February – April 2026) Test of Framework and initial reporting • Map new intelligence to Midlothian population predictions • Reflect on learning • Implement improvements and adjust indicators as required What we will do Phase 1 (November 2025 -January 2026) Develop the evaluation framework • Agree clearly defined parameters • Agree feedback loops and success parameters • Populate framework • Test process and output What we will do Phase 3 (April 2026 and ongoing) Implementation • Develop optimised data visualisation • Connect (financial) activity, experience, and outcome • Test predictive functions 41
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Financial priority No. 2 As the system changes and transforms, we are confident we are investing in the right places to deliver change in the shortest time possible. What we are trying to achieve 2.1 We have effective feedback loops that accurately describe the financial position as the system transforms. 2.2 We have identified where investment will make the biggest impact. 2.3 We can evidence how we are delivering care and support more efficiently and effectively. What we are trying to achieve 42
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1.1 We have effective feedback loops that accurately describe the financial position as the system transforms Information, intelligence and insight As we transform and redesign, we will need to develop new effective ways to evaluate how effective our choices about resource allocation. This will help us plan for future decisions to deliver the right treatment, care, and support in the future. This work may influence the longer-term financial decisions relating to wider system resources to achieve our strategic aims and the ambitions of the Transformation and Change Programme Board. 1.2 We have identified where investment will make the biggest impact System Thinking How we understand the relationship, connections and interdependencies of the actions taken across the whole System is key to making good decisions. This is complex and there are opportunities to do this better and use what we learn to connect people and the services they need in a more meaningful way. We need to evaluate and learn from our early transformation work to know how best to proceed. What we will do Over the next two years we will set out more clearly how we want Midlothian Health and Social Care Partnership to adopt a more person-led approach to service design. We believe that our work here will support us to develop a system that ‘pulls in’ the right professionals to support individuals rather than ‘pushing out’ referrals to multiple services across the system. What we will do We must develop a more granular understanding of allocation of resource as part of • the Midlothian Health and Social Care Resource Panel, • process, barriers, and opportunities for change • Variance, and • the insight capabilities of our social care record management system 43
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1.3 We can evidence that how we allocate our resources is supporting more efficiently and effectively Driving Transformation and Change Delivering transformation is essential to building a sustainable health and social care system for the future. The scale of change required cannot be achieved through short term measures alone; it needs clear vision, partnership working, and investment in new ways of delivering care and support. Over the next five years, our focus will be on redesigning services around people and communities, strengthening early intervention and prevention, and reducing duplication across the system. We will continue to learn from our transformation programmes, using data and evidence to guide decisions, track progress, and adjust our approach as needed. By working collaboratively with our partners, staff, and communities, we will ensure that change is both meaningful and achievable. What we will do • Develop clear metrics that link financial input, activity levels, and service outcomes, allowing us to assess value for money across all major service areas. • Introduce benchmarking against other IJBs to assess productivity, efficiency, and outcome performance. • Use data from the new social care reporting framework to better understand patterns of demand and service utilisation. • Review and align our performance reporting and financial monitoring cycles to ensure decision making is based on timely, accurate information. • Publish annual summary reports to demonstrate how investment decisions are improving outcomes for people and communities in Midlothian. 44
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Appendices 45
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Appendix 1: Our responsibilities Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). We meet regularly and include members from NHS Lothian and Midlothian Council, the Third and Independent Sector, staff, and people who represent their community, people who experience our services, their families, and carers. Midlothian Health and Social Care Partnership oversees more than 60 services on behalf of Midlothian IJB. All people who work in Midlothian Health and Social Care Partnership are employed by either Midlothian Council or NHS Lothian. You can find the full list of services the IJB is responsible for in the Midlothian Scheme of Integration. This includes 2 hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the 4 Health and Social Care Partnerships. Some of the services include: NHS Lothian • Care in Hospitals which isn’t planned (unscheduled care) including Accident and Emergency, Minor Injuries, Acute wards • Midlothian Community Hospital • Community based health care (Primary care) including GPs, District Nurses, Dentists, Pharmacists, Mental Health services, Substance Use Services, Community Respiratory Team • The following Health services for children and young people under 18: Health Visiting, School Nurses, Vaccinations of children • Allied Health Professionals – including physiotherapists, dietitians, podiatrists • Palliative and End of Life Care Midlothian Council • Social Work support for adults including adults with dementia, learning disabilities and older people • Care at Home services • Day services for older people and people with learning disabilities • Services to support unpaid carers and breaks from caring • Health services for people who are homeless • Extra Care Housing for people who need housing with extra support • Care Homes • Services to address health and care needs of people in the Justice system 46
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Appendix 2: Policy and drivers Some of the most important national policies that have contributed to this strategy are • National Performance Framework • National Health and Wellbeing Outcomes Framework • Principles for Planning and Delivering Integrated Health and Social Care • Health and social care integration: finance guidance • Best Value in Public Services • Delivering Value Based Health and Care: a Vision for Scotland (2022) • NHS Scotland Operational Improvement Plan • Health and Social Care Service Renewal Framework • Scotland’s Population Health Framework • Framework for Community Health and Social Care Integrated Services 47
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Midlothian Integration Joint Board Thursday, 26th March 2026, 14:00-15:00 Midlothian IJB Directions for 2026/27 Item Number 2.3 Executive summary This report presents the proposed Midlothian Integration Joint Board (IJB) Directions for 2026/27. Integration Authorities, Health Boards and Local Authorities have a legal obligation to both issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. Midlothian IJB Directions are issued to the Chief Executives of Midlothian Council and NHS Lothian. Directions are the mechanism by which Midlothian IJB directs the actions it believes are required to progress the ambitions of its Strategic Plan. The proposed Midlothian IJB Directions for 2026/27 continue to be structured within the framework of the 9 National Health and Wellbeing Outcomes and linked to the 3 strategic aims and 9 sub aims of the draft Strategic Plan 2025-2035. Directions for 2026/27 have been developed with input from Board Members, the Strategic Planning Group, both Partners, and the HSCP Executive Leadership Team (ELT) taking account of feedback across 2025/26 and in the context of local financial challenges. Midlothian IJB is required to review progress towards it’s Directions and ensure the necessary decisions are taken to facilitate the whole system change required to deliver transformation. A programme of reporting on a biannual basis will continue to support this duty. Directions for 2026/27 were drafted in consultation with the Midlothian HSCP Executive Leadership Team (ELT), reviewed by the Strategic Planning Group at its 20th November 2025 meeting, and scrutinised by Midlothian at the Midlothian IJB Development Session on 15th January 2026 before final consideration at this Special Midlothian IJB Board. As a result of this report, Members are asked to: • Note the final position for Directions 2025/26 (appendix 1), • Consider and approve the presented Directions for 2026/27 (appendix 2), and • Subject to confirmation of the budget offers, give delegated authority to the Chief Officer to issue these Directions to the Chief Executives of NHS Lothian and Midlothian Council before 31st March 2026. 48
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Report Midlothian IJB Directions for 2026/27 1 Purpose 1.1 This report presents the proposed Midlothian Integration Joint Board (IJB) Directions for 2026/27. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the final position for Directions 2025/26 (appendix 1), • Consider and approve the presented Directions for 2026/27 (appendix 2), and • Subject to confirmation of the budget offers, give delegated authority to the Chief Officer to issue these Directions to the Chief Executives of NHS Lothian and Midlothian Council before 31st March 2026. 3 Background and main report 3.1 In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014, Directions are the key mechanism by which an Integration Authorities’ strategic plan is actioned. 3.2 Directions must be issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how the functions delegated to the IJB are to be delivered and funded via the integrated budget made available by NHS Lothian and Midlothian Council Partners. 3.3 Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. 3.4 Midlothian IJB’s financial position has become increasingly challenging across 2025/26 with many services operating within new financial models as a result of grip and control measures, transformation, and choices. 3.5 However, Midlothian IJB continue to commission services in new and increasingly innovative ways while continuing to provide safe, high-quality care and support in line with the Strategic Plan. To ensure Midlothian IJB is able to appropriately direct Partners in a way that aligns with the Midlothian IJB Strategic Plan 2025-2035, clear instructions are required for key delivery priorities in 2026/27 to continue to embed the integrated practice and collaborative working that improves outcomes for people and communities. 49
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3.6 The proposed Directions for 2026/27 are structured within the framework of the 9 National Health and Wellbeing Outcomes and link to the 3 strategic aims and 9 sub aims of the Midlothian IJB Strategic Plan 2025-2035. These Directions also focus on the specific action required to achieve operational transformation and financial balance across the system. The proposed Directions also take into consideration feedback across 2025/26 and in the context of local financial challenges. 3.7 Directions for 2026/27 were drafted in consultation with the Midlothian HSCP Executive Leadership Team (ELT), reviewed by the Strategic Planning Group at its 20th November 2025 meeting, and scrutinised by Midlothian at the Midlothian IJB Development Session on 15th January 2026 before final consideration at this Special Midlothian IJB Board. 4 Policy Implications 4.1 This paper supports the strategic Direction of Midlothian IJB and relates to the • Public Bodies (Joint Working) (Scotland) Act 2014. (section 26 and 26) and the requirement for Directions from Integration Authorities to Health Boards and Local Authorities. • Statutory Guidance (2020) on Directions from Integration Authorities to health boards and local authorities on how to improve practice in the issuing and implementation of Directions issued under the Public Bodies (Joint Working) (Scotland) Act 2014. 5 Directions 5.1 This report proposes the Midlothian IJB Directions for 2026/27. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake and ECRIA as a result of this report. 6.2 All Directions are designed to progress the ambitions of the strategic aims of the Midlothian Integration Joint Board. An Equality and Children’s Right Impact Assessment (ECRIA) has been published in relation to the Midlothian IJB Strategic Plan 2025-2035. The recommendations of this ECRIA were noted, actioned and incorporated into the Midlothian IJB Strategic Plan 2025-2035. 6.3 However, further consideration to the completion of additional ECRIAs will be consider as part of the implementation of Directions as required. The operational plans of Midlothian Health and Social Care Partnership service strategy, policy, plans, provisions, practices, and activities that relate to these Directions and the Strategic 50
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Plan should ensure steps are taken to determine if an Equality and Children’s Right Impact Assessment (ECRIA) is required. 7 Resource Implications 7.1 Directions should include the financial resources available for carrying out delegated functions, including the allocated budget and how that budget is to be used, whether this is a payment, or a sum set aside and made available. This information can be found in the appendix of the draft Midlothian IJB Directions 2026/27 (Appendix 2). 7.2 Directions relating to Financial Recovery Planning must be clearly stated as such. Relevant Directions in the Midlothian IJB Draft Directions 2025/26 are closely aligned to the proposed transformation programme and included under Health and Wellbeing Outcome No.9: Use of Resources. 8 Risk 8.1 IJBs, Health Boards, and Local Authorities have a legal obligation to issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. There is a risk that non-compliance with this duty will pose legislative risks and be more difficult for the IJB to undertake its duties related to accountability and good governance. 8.2 Board members should routinely consider when Directions need to be revised, or new Directions are required to be issued issue to Partners. 9 Involving people 9.1 Board members, officers of the HSCP, services, partner organisations, and people and communities have been involved in the process to develop the Midlothian IJB Directions for 2025/26. 10 Background Papers Author’s Name Gill Main Designation Integration Manager Contact Information Via email or MS Teams Date 16/03/2026 Appendices: Appendix 1: Midlothian IJB Directions 2025/26 Final Position Appendix 2: Midlothian IJB Draft Directions 2026/27 51
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Midlothian Integration Joint Board Directions 2026/2027 52
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Introduction Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian in 2015. The IJB plans and directs health and social care services for the people of Midlothian using the integrated budget received from Midlothian Council and NHS Lothian. Directions are the mechanism by which Integration Authorities communicate their priority actions to both Midlothian Council and NHS Lothian. The Midlothian IJB Strategic Plan 2025-2035 set out our vision for health and social care over the next 10 years. Our 3 strategic aims for 2025-2035 are People feel able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health People access the care and support they need when they need it in the community and at home. People's human, social, and economic rights are protected and promoted in how we design and deliver our services. Our Directions are the priority actions we think will help us best progress towards our strategic aims and the 9 National Health and Wellbeing Outcomes within the financial resources made available to us by our Partners for 2026/2027. The financial position has become increasingly challenging across this time with many services operating within new financial models as a result of Grip and Control measures, Transformation, and Choices. However, Midlothian IJB must evolve and commission services in new and increasingly innovative ways while continuing to provide safe, high-quality care and support in line with its Strategic Plan. To ensure we are able to appropriately direct Partners in a way that aligns with our strategy and future ambitions, we recognise we must provide clear instruction on key actions for delivery in 2026/2027 that require services to continue to embed the integrated practice and collaborative working that improves outcomes for people and communities. We have worked closely with both Partner organisations in developing these Directions and will continue to monitor progress closely. We will also continue to consider when Directions need to be revised, or new Directions are required to be issued issue to partners across 2026/2027. The financial values (‘budgets’) attached to these Directions are based on • Midlothian Council’s budget proposition of £75.122m for 2026/2027 was accepted by Midlothian IJB at the Board meeting on 26th March 2026***TBC. • The indicative 2026/2027 NHS Lothian recurring budget from the February Finance and Resources committee is £110.786m. NHS Lothian will approve their 2026/2027 budget at the NHS Lothian Board scheduled for 22nd of April 2026. These values are therefore indicative***TBC Funding allocations can be found in Appendix 1 1 3 2 53
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1.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by March 2027. 1.4 Midlothian Council will support Midlothian HSCP as part of the redesign of the Midlothian Council website and ongoing provision of the Midlothian IJB and HSCP webpages in a way that ensures compliance with our duties in relation the Equality Act, 2010 and accessibility standards by March 2027. 1.5 NHS Lothian and Midlothian council will support Midlothian HSCP to improve the experience of people in Midlothian who are living with dementia by implementing a Dementia Framework in line with the Dementia Strategy for Scotland - Everyone’s Story (2023–2033), translating the five national outcomes into local actions, measures, and governance by July 2027. 2.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop a set of focused ambitions for change alongside the Community Planning Partnership as it reviews the Single Midlothian Plan. This should focus on services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible through co-design and partner agreement to co-deliver the ‘Midlothian will be healthier’ component of the Single Midlothian Plan alongside people, communities and community partners, by July 2027. 2.4 NHS Lothian and Midlothian Council will support Midlothian HSCP to undertake a review of Social Work and Occupational Therapy teams by December 2026. This will include supporting existing data sharing agreements, reaching agreement on necessary data sharing requirements, and the development of data insight and visualisation tools that combine key social work data with financial information to inform effective service decision making and financial management. 2.5 NHS Lothian and Midlothian Council will support Midlothian HSCP to deliver on the duty of the Care Reform (Scotland) Act that requires all commissioned activity to be aligned with our Strategic Plan 2025-2035 by December 2027. 2.6 Midlothian Council will continue to work alongside Midlothian HSCP to deliver a shared Transitions Policy by December 2026. This work should take a phased approach and move away from single service provision to a holistic and whole-system approach as the support people need adapts from child, to young person, into adulthood. 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. 54
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3.4 All relevant functions delegated to Midlothian IJB will report biannually in July and December 2026 on participation and engagement activity, noting where feedback from people and communities has informed service improvements or redesign. 3.5 NHS Lothian and Midlothian Council will support Midlothian HSCP develop a framework that describes how the human, social and economic rights of people who access our services are considered as part of commissioning decisions by July 2028. 3.6 NHS Lothian Midlothian Council will support Midlothian HSCP to support the ambitions of the national Palliative Care Strategy Delivery Plan 2025 – 2028 by establishing a local delivery plan with achievable priority areas for implementation by December 2026. 4.2 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated self- management framework that sets out an expectation of how services will work with people to be more informed about their condition(s), be better prepared for when they feel less well, and describes how to access the right support when it is needed by December 2027. 4.5 Midlothian Council and NHS Lothian will support Midlothian HSCP to work with the NHS Lothian Primary Care Programme Board to scope and recommend viable opportunities for collaborative change. This should focus on jointly agreed priorities with a shared commitment to change financial flows to best support the ambition to shift the balance of care and sustain and expand general practice alongside community Primary Care services at a local level by July 2027. The aim should be to increase the focus on preventative care and early intervention strategies which will be required to improve long-term health outcomes and improve patient access and safe, efficient, and person-centred quality of care close to home. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. 55
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5.1 NHS Lothian and Midlothian Council will ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring » systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics by December 2026, » data quality assurance, by July 2027 and » improvements in recording key data by December 2027. 5.2 NHS Lothian and Midlothian Council will explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by July 2028. 5.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop integrated data at population level by December 2027 in order to support the prediction, identification, and planning of changing demographic profile to support dynamic whole system change. 6.1 All functions delegated to Midlothian IJB that aim to move care from hospital to home will identify potential impacts of planned interventions on unpaid carers, describe service mitigations to support unpaid carers, and report biannually on impact in July and December 2026. 5 Health Inequalities Health & social care services contribute to reducing health inequalities 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. 56
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7.4 Midlothian Health and Social Care Partnership will support services to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms, this includes establishing (and taking action where necessary) by December 2026, » that all the teams who work with people, including the teams of our Partners, understand what SDS is and how to signpost this information at the right time, » that staff know how to support people to request and access accessible information, and all the information we provide about SDS meets accessibility standards so those who may benefit most are able to make informed choices. » that comprehensive system evidence is gathered on all changes in uptake between one option and another, any increase in budget, and any HSCP financial impact. 8.3 NHS Lothian and Midlothian Council must ensure commissioned partners and providers meet the duties of the Heath and Care (Staffing) (Scotland) Act. Specifically, NHS Lothian and Midlothian Council must ensure provision in procurement and contract management support to ensure Midlothian IJB report annually on its duty to comply with the Heath and Care (Staffing) (Scotland) Act reporting on the compliance of commissioned partners who deliver services on behalf of the HSCP. 8.4 NHS Lothian and Midlothian Council will support Midlothian HSCP to provide biannual reporting in July and December 2026 on the progress towards the ambitions of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2024-27 and the impact of this on staff experience and wellbeing. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide 57
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9.1 NHS Lothian will continue their work to iteratively improve their approach and methodology to better understand and evidence the use of the NHS Lothian ‘Set Aside’ budget and Unscheduled Care (USC) provision across 2026/27. As part of this work, NHS Lothian will provide quarterly ‘Set Aside’ performance and financial progress reports to the Midlothian IJB to inform local planning and enable the IJB to transparently share its overall position with Partners. 9.3 All delegated functions will continue to participate in review of service provision driven by a 5-year operational transformation programme to consider long term reform. In 2026/27, this will build on the 2025/26 change programme and continue to support achieving a balanced financial position across 3 work-streams. 9.3.2 Bed based provision Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign and ensure the most efficient and effective operational model of bed-based provision. This should be designed to enable people to access appropriate levels of care when their needs change within this model and enable the safe and timely return to living well in the community by July 2027. This work will have clear links to wider health and social care provision and include i) a review of services provided by Midlothian Community Hospital, ii) a review of Hospital at Home, and iii) a clearly defined operational strategy for delivery including workforce planning. 9.3.5 Commissioning and Third Sector Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review of commissioning spend and establish a new partner provider model that is closely aligned with the strategic aims of the IJB, supports the delivery of key ambitions and increases opportunities for health equality across Midlothian by December 2026. This should include a review of Care at Home externally contracted provision, commissioning of Care Home places, Newbyres Care Village, and the Learning Disability service. 9.3.8 Midlothian Single Point of Access (SPOA) Midlothian Council and NHS Lothian will support Midlothian HSCP to design and implement a multiagency solution to support all contacts across health and social care by December 2028. In 2026 this should focus on developing an integrated and shared understanding of the relational working to drive transformation and redesign in line with the Midway. Specifically, Midlothian HSCP should report on the progress and learning by December 2026 with services, people and communities and produce a blueprint for transformation that shifts from a traditional model to a new integrated health and social care provision. 9 Use of Resources Resources are used effectively and efficiently. 58
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9.4 NHS Lothian and Midlothian Council should report to Midlothian IJB on a biannual basis across 2026/27 on issues and risks relating to non-delegated functions that will impact on delegated functions. 9.5 NHS Lothian and Midlothian Council must ensure that all operational services delivering functions delegated to Midlothian IJB continue to provide assurance of high quality, safe, and effective service delivery within the allocated budget (appendix 1,) and with assurance of the principles of Best Value by December 2026. 9.5.1 NHS Lothian and Midlothian Council should support Midlothian HSCP to deliver the Midlothian IJB Medium-Term Financial Strategy and develop new ways of financial activity monitoring as services redesign and new methods of evaluation are required. Reporting on progress, issues, and risks should be considered biannually by the Audit and Risk Committee. 59
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This Direction describes the action required in relation to the other core and hosted functions delegated to Midlothian IJB. A number of these Directions 1 to 9 will require service redesign and transformation. Functions delegated to Midlothian IJB are detailed in the Midlothian Integration Scheme. All functions, including hosted functions, should be provided in accordance with legislation, policies, and procedures. Unless specified in the accompanying Directions, services should continue to be provided to high standards within the available budgets. All services should provide information on both activity and outcomes for service offers and supports delivered to improve the health, wellbeing and wellness of the people and communities of Midlothian. Functions delegated to the IJB from NHS Lothian within the Integration Scheme are detailed below Provision for people over the age of 18 1. Accident and Emergency services provided in a hospital. 2. Inpatient hospital services relating to the following branches of medicine a. general medicine b. geriatric medicine c. rehabilitation medicine d. respiratory medicine; and e. Psychiatry of learning disability 3. Palliative care services provided in a hospital 4. Inpatient hospital services provided by General Medical Practitioners. 5. Services provided in a hospital in relation to an addiction or dependence on any substance. 6. Mental health services provided in a hospital, except secure forensic mental health services. 7. District nursing services 8. Services provided out with a hospital in relation to an addiction or dependence on any substance. 9. Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 10. The public dental service. 11. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C(2) of the National Health Service (Scotland) Act 1978 12. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978(27). 13. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978(28). 14. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978 15. Services providing primary medical services to patients during the out-of-hours period. 16. Services provided outwith a hospital in relation to geriatric medicine. 17. Palliative care services provided outwith a hospital. 18. Community learning disability services. 19. Mental health services provided outwith a hospital. 20. Continence services provided outwith a hospital. 21. Kidney dialysis services provided outwith a hospital. 22. Services provided by health professionals that aim to promote public health 10 Delegated Functions Core and hosted services within the NHSL Lothian and Midlothian Council Integration Scheme are detailed below 60
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Provision for people under the age of 18 1. Primary medical services and general medical services (including generally practitioner pharmaceutical services) 2. General dental services, public dental services, and the services provided by the Edinburgh Dental Institute 3. General ophthalmic services 4. General pharmaceutical services 5. Out of hours primary medical services 6. Learning disabilities 7. Health visiting 8. School nursing Functions delegated to the IJB from Midlothian Council within the Integration Scheme are detailed below 1. Social work services for adults and older people 2. Services and support for adults with physical disabilities and learning disabilities 3. Mental health services 4. Drug and alcohol services 5. Adult protection and domestic abuse 6. Carers support services 7. Community care assessment teams 8. Support services 9. Care home services 10. Adult placement services 11. Health improvement services 12. Aspects of housing support, including aids and adaptations 13. Day services 14. Local area co-ordination 15. Respite provision 16. Occupational therapy services 17. Reablement services, equipment, and telecare 18. Justice social work services 61
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Appendix 1: Midlothian IJB Indicative Budgets for 2025/26 for Directions (noting health funding is indicative until the NHS Lothian April Board) Health Service ML IJB 26/27 Budget £000’s Core Community Equipment 607 Community Hospitals 7,056 Community Nursing 1,704 Diabetes & Endocrinology 242 District Nursing 6,652 Geriatric Medicine 1,222 GMS 16,012 Health Visiting 2,941 Learning Disabilities 428 Mental Health 2,851 ML Partnership Management 1,224 PC Management 7,818 PC Services 467 Pharmacy 20,147 Resource Transfer 4,671 Substance Misuse 154 Therapy Services 2,670 Core Total 76,865 Hosted Complex Care 196 Diabetes & Endocrinology 6 GMS -718 Hospices & Palliative Care 541 Learning Disabilities 1,278 LUCS 1,646 Mental Health 2,290 Oral Health Services 1,099 PC Services 687 Prescribing 73 Psychology Services 1,848 Public Health 253 Rehabilitation Medicine 987 Sexual Health 848 Substance Misuse 474 Therapy Services 1,833 UNPAC 657 Hosted Total 13,999 Acute (Set Aside) Acute Management Cardiology 840 62
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Children Therapies 13 Diabetes & Endocrinology 26 ED & Minor Injuries 581 General Medicine 3,444 Geriatric Medicine 7,487 Outpatients 3,517 Rehabilitation Medicine 152 Respiratory Medicine 397 Therapy Services 1,429 2,037 Acute Total 19,922 Total Health 110,786 Social Care Service ML IJB 26/27 Budget £000’s Core Addictions 48 Assessment and Care Management 4,429 Justice 116 Learning Disability Services 24,362 Management and Administration 128 MELDAP/Recovery Hub 323 Mental Health Services 1,426 Non-Specific Groups 1,208 Older People 36,000 People with AIDS/HIV -33 Performance and Planning 788 Physical Disability Services 4,669 Public Protection 859 Service Management 579 Strategic Commissioning 220 Total Social Care 75,122 185,908 Total IJB 63