Agenda Document Pack - Midlothian Integration Joint Board - 02/04/2026
Midlothian Council · 2 April 2026
Back to Midlothian Integration Joint Board — 2 April 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Normandy Court/ Hybrid, Normandy Court, 20 Normandy Dr, Dalkeith, EH22 1JG Date: Thursday, 02 April 2026 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Democratic Services Clerk Telephone: 0131 271 3160 Clerk Email: democratic.services@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 208
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1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting 4.1 Minute of Midlothian IJB Board meeting held on 19th February 2026, submitted for approval 5 - 22 4.2 Minutes of Strategic Planning Group meeting held on 29th January 2026, submitted for noting 23 - 34 4.3 Minutes of Audit and Risk Committee meeting held on 27th November 2025, submitted for noting 35 - 42 5 Public Reports 5.1 Chair’s Update – Val de Souza, Chair (Verbal Update) 5.2 Chief Officer's Report - Paper presented by Morag Barrow, Chief Officer 43 - 50 5.3 Strategic Planning Group Update – Gill Main, Integration Manager, Strategic Planning Group Chair (Verbal Update) 5.4 Audit and Risk Committee Update – Councillor Connor McManus (Verbal Update) For Decision 5.5 Midlothian IJB Appointments, Nomination & Resignation - Paper presented by Democratic Services 51 - 54 For Discussion 5.6 Midlothian IJB Performance Update - Paper presented by Elouise Johnstone, Programme Manager 55 - 66 5.7 East Lothian and Midlothian Public Protection Team Presentation, presented by Keith Mackay, East Lothian and Midlothian Public Page 2 of 208
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Protection Chair and Kirsty McDermott, Public Protection Manager (Presentation) 5.8 Audit Scotland Briefing Report: ‘Community Health and Social Care Performance 2025’ and Midlothian Performance - Paper presented by Gill Main, Integration Manager and Elouise Johnstone, Programme Manager 67 - 84 5.9 Midlothian Unscheduled Care Workstream Update, presented by Grace Cowan, Head of Primary Care and Older Peoples Services (Presentation) 5.10 Midlothian Integrated Assurance Report Report - Paper presented by Fiona Stratton, Chief Nurse, Claire Ross, Chief AHP, Nick Clater, Head of Adult Services and Chief Social Worker, Grace Cowan, Head of Primary Care and Older People’s Services, Fiona Kennedy, Interim Head of Services and Sandra Bagnall, Executive Business Manager 85 - 106 For Noting 5.11 Midlothian IJB Performance Framework 2025-2028 (Year 2) - Paper presented by Elouise Johnstone, Programme Manager 107 - 148 5.12 Midlothian Health and Social Care Partnership Transformation and Change Programme Update - Paper presented by Morag Barrow, Chief Officer 149 - 164 5.13 NCS National Care Service Charter of Rights - Paper presented by Morag Barrow, Chief Officer 165 - 208 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on Thursday 11th June 2026,14.00 – 16.00 at Normandy Court/Ms Teams. Please note that this meeting will follow an IJB Board Development Session Thursday 7th May 2026, 14.00 – 16.00 held on Ms Teams, this is for Board Members only. Page 3 of 208
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 19 February 2026 14:00 Normandy Court/Virtually via Microsoft Teams Present (voting members): Val de Souza (Chair, NHS) Councillor McManus (Vice Chair) (Virtual) Councillor Milligan Councillor Parry Councillor Winchester Heather Campbell (NHS Lothian) George Gordon (NHS Lothian) Andrew Cogan (NHS Lothian) Present (non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Nick Clater (Head of Adult Services and Chief Social Work Officer) Fiona Stratton (Chief Nurse) Claire Ross (Chief Allied Health Professional) Magda Clark (Third Sector Representative) Sheree Muir (Lived Experience Representative Member) In attendance: Gill Main (Integration Manager) Fiona Kennedy (Interim Head of Service) Elouise Johnstone (Performance Manager) Laurie Eyles (NHS Lothian) Grace Cowan (Head of Primary Care and Older Dr Anna Beaglehole (Clinical Director) Midlothian Integration Joint Board Thursday 2 April 2026 Item No 4.1 Page 5 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Apologies: Grace Chalmers (Partnership Representative) Dr Amjad Khan (NHS Lothian) 1. Welcome and Introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB). Apologies were received from Grace Chalmers (Partnership Representative) and Dr Amjad Khan (NHS Lothian). 2. Order of Business The order of business was confirmed as outlined in the agenda previously circulated. 3. Declarations of Interest There were no declarations of interests noted to the Board. 4. Minute of Previous Meetings 4.1 The Minute of the previous Midlothian IJB Meeting, held on 11th December 2025, was approved as an accurate record. 4.2 The Minute of the meeting of the MIJB – Strategic Planning Group, held on 20th November 2025, was noted by the Board. 4.3 The Minutes of Audit and Risk Committee: There have been no minutes approved since September 2025 which were presented to December Board. Peoples Services) Alan Turpie (Standards Officer) Louise Middleton (Democratic Services Officer) Hannah Forbes (Democratic Services Officer) Page 6 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board 5. Public Reports Decision Action Owner Date to be Completed /Comments 5.1Chair’s Update – Val de Souza, Chair The Chair provided an update on the legislative change to extend voting right to Lived Experience members of IJBs. A short consultation was undertaken before Christmas, during which a range of views were expressed, though overall support was positive. Scottish Government have now completed this consultation and, following challenges raised during the consultation having since been withdrawn, the legislation has been changed and to be implemented by September 2026. A Short Life Working Group, established by the Scottish Government with broad representation, has been convened to consider and address the issues highlighted through the consultation process. The Chair noted the attendance of David Gladwin, Chief Financial Officer/ Section 95 Officer for Midlothian Council and further noted the attendance of Dr Grace Vickers, the Chief Executive for Midlothian Council at the last Development Session of Midlothian IJB. Their participation was noted as constructive, enabling discussion on potential approaches to financial flexibility to support the IJB through the current year and into the next. The Chair also highlighted the value of hearing clear and positive messages regarding collaboration between Midlothian Council and NHS Lothian. The Chair highlighted that the Leader of the Council, Councillor Kelly Parry wrote a comprehensive letter outlining the position of Midlothian Council and the significant pressures on Adult Social Care within Midlothian IJB. A response has been received from the Cabinet Secretary; however no further substantive information was provided at this stage. Page 7 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments Councillor Kelly Parry noted that a recent meeting with the Scottish Government had been constructive. The Scottish Government have announced an additional £20million for Adult Social Care. Councillor Kelly Parry confirmed that any further developments or communications will be reported back to Midlothian IJB. The Chair notified the Board that Heather Campbell will be taking up the position of Chair of the Strategic Planning Group (SPG) following a review of the group’s activity. 5.2 Chief Officers Report – Morag Barrow, Chief Officer The Chief Officer presented the report which sets out the key strategic updates for Midlothian IJB Board meeting February 2026. As a result of this report Members are asked to: • Note the content of the report. The Chair asked for an update on the planned closure of the Midlothian and East Lothian Drug (MELD) service and the arrangements that are being put in place to support vulnerable people who access the service. The Head of Adult Services and Chief Social Work Officer reported that the service is being taken forward towards its planned conclusion on 31 March 2026. Procurement activity for the replacement service is underway, led by colleagues in East Lothian, as part of the joint contractual arrangements between both councils, and the required legal processes are progressing. They noted that MELD currently functions as the primary access point for substance use services. Work is ongoing to assess the service gap during the transition period, which is currently estimated at a minimum Page 8 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments of 6–8 weeks. While the situation is challenging, particularly given the vulnerability of the client group, they expressed confidence that the recommissioned service will be better aligned to future needs. The intention is for the new service to be fully operational by early June. The Chair thanked the Head of Adult Services and Chief Social Work Officer for the update, expressing appreciation for the commitment shown by staff who are managing significant pressures during this period of transition. 5.3 Strategic Planning Group Update – Gill Main, Strategic Planning Group Chair The Chair of the Strategic Planning Group (SPG) reported that the most recent meeting focused on progress with the development of Directions, noting that this work remains on track. The Group also scrutinised the annual update of the Joint Strategic Needs Assessment (JSNA), which is now available on the website. This update was highlighted as an important resource for all Board members, officers and services as it provides refreshed data to inform planning and decision-making. SPG had also reviewed an update on the Transformation and Change Programme, with members noting that this programme is driven by the priorities set out in both the Midlothian IJB Strategic Plan, Midlothian IJB Directions, and other board strategies i.e., the Midlothian IJB Unpaid Carer Strategy and the Midlothian IJB Participation and Engagement Statement. The SPG Chair highlighted the main risks are the challenge to progress business as usual alongside the transformation agenda and the financial planning recovery that is currently underway. The key learning identified was that the HSCP Executive Team will continue to oversee this work and raise risks as appropriate. 5.4 Audit and Risk Committee Update – Councillor Connor McManus, Vice Chair Page 9 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Chair advised the Board there has not been a meeting and therefore this item will be deferred to the next meeting. For Decision 5.5 Midlothian IJB Meeting Schedule 2026-2027 - Paper presented by Democratic Services Officer Democratic Services presented the report that sets the dates for meetings, development sessions, and Committees of Midlothian Integration Joint Board for 2026/27, as prescribed by the Midlothian Integration Joint Board Standing Orders (5.2). As a result of the report, Members are asked to: • Review and note the revised dates for 2026 set out in Appendix 1. • Approve the meeting schedule, development session, and Committee dates for 2027 as set out in Appendix 2. • Note that service visits will be scheduled as required or at the request of Members of the Midlothian Integration Joint Board. The Chief Officer added that Midlothian IJB Board Special Meeting that will be held on the 26th of March 2026 is the budget setting meeting and the 2nd of April meeting is scheduled earlier due to the Easter Holidays. The Board noted and approved the recommendations in the report. Approved Democratic Services 5.6 Midlothian IJB Appointments, Nomination & Resignations - Paper presented by Democratic Services Officer Approved Page 10 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments Democratic Services presented that this report is to note and endorse the appointment of George Gordon, Non-Executive Board Member as a voting member of Midlothian Integration Joint Board for a 12-month term (from 1 January 2026 to 31 December 2026) (appendix 1). Note and endorse the appointment of Sheree Muir, Lived Experience Member, as a non-voting member of the Midlothian Integration Board. Note and endorse the appointment of Paul Bailey, Registered Medical Practitioner, as a non-voting member of Midlothian Integration Joint Board with immediate effect (for a 3-year term up to 4th February 2029). This report asks Board Members to note the removal of Andrew Fleming, Non-Executive Board Member and Vice-Chair, as a voting member of Midlothian IJB (from 31 December 2025) and the resignation of Dr Rebecca Green and the subsequent requirement to fill the GP non-voting member position on the Midlothian Integration Board. This report asks Board Members to note rescinding of the decision taken on 3rd December 2025 to appoint Dr Anna Beaglehole, Registered Medical Practitioner, as a non-voting member of Midlothian Integration Joint Board (appendix 2). As a result of this report, Board Members are asked to: • Note and endorse the appointment of George Gordon, Non-Executive Board Member as a voting member of Midlothian Integration Joint Board for a 12-month term (from 1 January 2026 to 31 December 2026). • Note and endorse the appointment Sheree Muir, Lived Experience Member, as a non-voting member of the Midlothian Integration Board from 1st January 2026. Page 11 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments • Note the removal of Andrew Fleming, Non-Executive Board Member and Vice-Chair, as a voting member of Midlothian IJB (from 31 December 2025). • Note the resignation of Dr Rebecca Green, Registered Medical Practitioner non-voting member of Midlothian Integration Board. • The rescinding of the decision taken on 3 December 2025 to appoint Dr Anna Beaglehole as a non- voting member of the Midlothian Integration Joint Board. The appointment of Dr Paul Bailey, as a non-voting member of the Midlothian Integration Joint Board and specifically as the “registered medical practitioner whose name is on the list of primary medical services performers” with immediate effect (for a three-year term). The Board noted and approved the recommendations in the report. 5.7 Midlothian IJB Carers Strategy 2025-2028 - Paper presented by Nick Clater, Head of Adult Services and Chief Social Work Officer The Head of Adult Services and Chief Social Work Officer advised that this report sets out the Midlothian IJB Draft Unpaid Carer Strategy 2025-2028. The strategy, accompanying report and ECRIA were discussed at the Midlothian Strategic Planning Group on 29th January 2026, and agreement given for recommendation to Midlothian IJB for approval. As a result of this report, Members are asked to: • Note recommendation from Midlothian Strategic Planning Group (29/01/26) for submission of this Midlothian IJB draft Unpaid Carers Strategy 2025-28 to Midlothian IJB for approval. Approved Head of Adult Services and the Chief Social Worker will present the proposal to Children’s Services to seek approval for progressing through the full governance route. Once approval is Head of Adult Services and Chief Social Worker June 2026 Page 12 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments • Seek approval for Midlothian IJB draft Unpaid Carers Strategy 2025-2028 to be published on Midlothian HSCP/IJB webpage. The Chair thanked the Head of Adult Services and Chief Social Work Officer for the report, acknowledging the significant work involved in its development. The Board noted that the 5 priorities set out in the report are well considered and commended the substantial effort reflected throughout. Members expressed their appreciation to all Officers and staff for their continued hard work and commitment. The Head of Adult Services and Chief Social Work Officer formally recognised the contribution of Shelagh Swithenbank, Carers Planning Officer, noting the extensive work undertaken over several iterations of the report and thanking colleagues who supported the process. It was highlighted that, as the work also relates to young carers, some aspects of the strategy will require approval through the governance routes of Children’s Services, and are out with the governance of Midlothian IJB. The Head of Adult Service will inform Midlothian IJB when the Strategy has been reviewed by Children’s Services and any changes that impact on the delegated Adult Carers actions will be brought back to the IJB for review. As a result, the Midlothian IJB Unpaid Carer Strategy cannot be published at this time and Midlothian IJB await update from the Head of Adult Services. The Chair formally recorded thanks to Shelagh Swithenbank for this significant and valuable piece of work. The Board noted the recommendations in the report. confirmed, the Strategic Planning and Performance will be notified so the information can be published on the website. Any changes impacting on adult services to be brought back to Midlothian IJB for discussion and approval 5.8 Midlothian IJB Standing Orders, Scheme of Administration and Scheme of Delegation - Paper presented by Alan Turpie, Standards Officer Approved Page 13 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Standards Officer detailed the report sets out outcome of the review exercise of the Board’s Standing Orders carried out by the Standards Officer. The Board is entitled to amend its Standing Orders. This review was considered appropriate to ensure the Standing Orders remained relevant and fit for purpose. As a result of this report, Members are asked to: note the outcome of the Review of the Standing Orders. The Standards Officer advised that the Standing Orders would require review in September to reflect the forthcoming legislative changes to extend voting rights to Lived Experience members, which are due to come into force in September 2026. The Chair thanked the Standards Officer for the report, the Board noted the recommendation in the report. For Discussion 5.9 Midlothian IJB Finance Update - Paper presented by Chris King, Chief Finance Officer The Finance Officer presented the report detailing the purpose of this paper is to update Members on the 2025/26 financial position including both the financial forecast for quarter three and the progress against the agreed financial recovery actions. As a result of this report, Members are asked to: • Note the delivery of financial recovery actions in 2025/26. • Note the quarter three 2025/26 forecast financial position. • Consider the risks laid out in Section 8 Recommendations noted Page 14 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Chair thanked the Chief Finance Officer for the report and invited questions and comments from Board Members. The Board queried the significant shift in the Core Health Services position and asked if there were any specific drivers for this. The Chief Finance Officer reported a significant shift in prescribing costs, highlighting that the main challenge relates to how prescribing data is retrieved, as there is consistently a two-month delay. The Chief Officer assured the Board that they have met with the Chief Executives of both partner organisations and have contacted the Scottish Government to set out Midlothian IJB’s financial position and the scale of the challenges for next year. This engagement has been well received, and it was noted that the pressures are not unique to Midlothian but reflect a national issue requiring a national response. Board members welcomed the financial briefing but expressed concern that the implications for services at risk are still not clearly understood. Members asked what representation has been made to local MSPs and whether they are aware of the seriousness of the situation for Health and Social Care in Midlothian. The Chief Finance Officer explained that the finance paper does not outline the impact of operational schemes, as these are currently assessed as low risk. The 2026/27 budget-setting paper will provide clear detail on risks and service impacts. It was confirmed that there has been no direct contact with MSPs to date, but the Chief Finance Officer is willing to discuss this further outside the meeting if it would be helpful. The Board advised that MSPs should be contacted to ensure they are fully aware of Midlothian’s position and the severity of the challenges faced. Page 15 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Chief Officer noted that the Head of Adult Services and Chief Social Work Officer has been gathering case examples that illustrate the real-life impact of the current pressures. These examples will be shared as part of wider communications to Board Members after the meeting today for information. The Chief Officer confirmed they are content to review the letters previously sent to the Scottish Government and consider how these could be used to engage with MSPs. The Chair emphasised the importance of clearly demonstrating the impact of the proposed financial savings. The Chair suggested revisiting the earlier letter sent to Shona Robison MSP and ensuring that any future correspondence sets out the panel’s role, the decision-making process, and the consequences of reduced resources for individuals in the community. Councillor Kelly Parry advised that the Midlothian Council Draft Budget has now been published on the Council’s website. It was noted that this is an Officer draft and will not be formally agreed until the meeting of Midlothian Council on Tuesday 24 February 2026, but it does provide an indication of the current position. Councillor Parry also confirmed that Midlothian Councillors are aware of the implications of the decisions being taken. The Board noted the recommendations set out in the report. Chief Officer to look at the letters that have been sent to Scottish Government and to link in with MSPs. Chief Officer 5.10 Midlothian IJB Directions Reporting and Performance Update - Paper presented by Gill Main, Integration Manager. The Integration Manager presented the report that provides an update on the final end of year progress position on Midlothian IJB Directions 2025/26 and the progress against the Midlothian IJB Performance Framework 2025-2028. Recommendations Noted Page 16 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments As a result of this report, Members are asked to: • Review the synthesis and insight reports generated in columns 4 and 5 of the Midlothian IJB Strategic Governance Outcomes Map (appendix 1), and • Note performance against the Midlothian IJB performance Framework 2025-2028 (appendix 2). The Board highlighted the number of Directions being carried forward and sought clarity on the level of risk involved, as well as where resource constraints have limited progress. Members also questioned whether the current projections are realistic, noting the risk of over-promising and under-delivering. The Integration Manager noted that this report was a retrospective review of performance relating to Directions set in March 2025. As such, significant learning has been taken and resulted in the current draft of Directions reflecting the challenges anticipated across 2026/2-28. The Integration Manager outlined the development process to date, noting that the Directions have been presented to the Board in January 2026 with a number of drafts were informed by ongoing discussion at Executive Leadership Team, considered twice by the SPG, and then brought to the January 2026 development session. Over this period, several Directions have been amended, with some combined and others removed. The Board’s earlier feedback in January 2026 had been to shorten timescales rather than extend them. The Chief Officer acknowledged the significant work undertaken to review and balance the timelines. They noted that some of the timescales for 2025-26 were ambitious and noted the dynamic position of health and social care which could mean further recommendations on revised timelines may be required. The Board noted the recommendations in the report. Page 17 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments 5.11GLP-1 Medication Update - Paper presented by Chris King, Chief Finance Officer The Chief Finance Officer presented the report endorsed by the Strategic Planning Group and seeking to provide an update to the Integrated Joint Board on the development of a Specialist Initiation Pathway for obesity medicines (GLP-1/GIP RA) as instructed by NHS Lothian Corporate Management Team. Governance has been via monthly Chief Officer and Chief Finance Officer Business Meeting. This paper forms part of the system wide engagement on this work. As a result of this report, Members are asked to: • Consider the Specialist Initiation Pathway for obesity medicines within the Dietetic led weight management service in collaboration with independent prescribers and medical oversight to support the initial cohorts of patients. • Consider the resource implications. • Support the proposal to return with the evaluation findings from this work in nine to twelve months. The Board welcomed the report and expressed strong support for it, noting its significance and the positive, life-changing impact it will have for people. The Chief Officer thanked the Chief Finance Officer, the Chief Allied Health Professional, and Laurie Eyles, Dietetic Service Lead, for the significant time, effort, and work invested in developing the report. It was noted that the report will be presented to all four Integration Joint Boards. The Board noted that this development represents the beginning of a cost pressure for the health system and asked what arrangements are in place to track the costs being incurred. Recommendations Noted Page 18 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Chief Finance Officer advised that discussions have taken place within NHS Lothian, and the intention is to establish a baseline spend for 2025/26 on the relevant medications. This will allow comparison against what should be expected. Although prescribing data is subject to a two-month delay, close monitoring of the figures will provide opportunities to identify trends early and take mitigating action where possible. The Board asked whether there would be opportunities for shared learning between the obesity pathway and the Ovation programme, and whether insights could also be drawn from the extensive private prescribing taking place. The Chief Officer confirmed that there are opportunities across several aspects of obesity work that will support the development of local pathways, and that learning from these areas will continue to inform future improvement. The Board were happy and noted the recommendations in the report. 5.12Audit Scotland Publications January 2026 - Report presented by Gill Main, Integration Manager The Integration Manger presented the report which highlights the two key Audit Scotland documents published in January 2026. As a result of this report, Members are asked to: • Note the Audit Scotland reports in appendices 1 and 3. • Note the Midlothian response to the performance audit on ‘Delayed discharges: A symptom of the challenges facing health and social care’ in appendix 4. Noted Page 19 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments • Note a Midlothian response to the briefing paper ‘Community health and social care: Performance 2025’ will be presented to members on 2nd April 2026. The Chief Officer explained that the purpose of the report was to benchmark Midlothian’s performance and highlighted that the learning shows the issues are system-wide, influenced by factors such as culture, behaviour, deprivation, social care capacity, and admission practices. Work undertaken across NHS Lothian has demonstrated that some of the assumptions previously used are not the most useful measures to drive improvement. Midlothian is performing well in reducing length of stay and in lowering delayed discharge numbers, and there has been significant improvement in unscheduled care, with further work underway to build on this progress. The Board commended the report and acknowledged the substantial improvements achieved across several areas. The Chief Finance Officer noted that achieving further financial improvement would require direct action in relation to bed capacity. The Chair recommended that a further discussion on the balance of care should take place outside the meeting. Further discussion on balance of care to take place outside of Midlothian IJB meeting For Noting 5.13 Justice Annual Report - Paper provided by Fiona Kennedy, Interim Head of Service The Interim Head of Service advised the paper sets out the main findings of the Audit Scotland performance audit ‘Delayed discharges: A symptom of the challenges facing health and social care.’ This Page 20 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board 5 Private Reports No items for discussion. 6 Any Other Business No items for discussion. Decision Action Owner Date to be Completed /Comments also includes the Midlothian Health and Social Care Partnership most recent available local data to provide Midlothian IJB members with an update on local performance, ongoing improvement activity, and opportunities for improvement. As a result of this report, Members are asked to: • Note the key findings and recommendations of the Audit Scotland report ‘Delayed discharges: A symptom of the challenges facing health and social care.’ • Note the progress made within Midlothian and the areas of ongoing focus. The Chair sought clarification on staffing consistency and asked whether Section 27 funding would be ring-fenced going forward. The Interim Head of Service explained that Section 27 funding is not linked to ring-fencing but to the formula used to determine allocations for each Local Authority, and there is currently uncertainty around how that formula is being applied. The Chief Officer acknowledged the report, noting the strong performance set out throughout, and congratulated the Interim Head of Service and the wider team for their work. Page 21 of 208
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Thursday 19th February 2026 Midlothian Integration Joint Board 7 Date of Next Meeting The next meeting of Midlothian Integration Joint Board will be a Special Board Meeting held on Thursday 26th March 2026, from 15:00-16:00. This meeting will be held at Normandy Court/Hybrid. Please note that this meeting will immediately follow an IJB Special Development Session from 14:00-15:00. This meeting will be held at Normandy Court/Hybrid, this is for Board Members only. Meeting concluded at 15:52pm. Page 22 of 208
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Midlothian Integration Joint Board Thursday 2 April 2026 Item 4.2 Midlothian IJB Strategic Planning Group Meeting Date Time Venue Strategic Planning Group Thursday 29 January 2026 14:00pm MS Teams Present (MIJB Members): Gill Main, HSCP (Integration Manager) (Chair) Chris King, Chief Finance Officer Councillor Pauline Winchester Magda Clark, Third Sector Member Representative (Vice Chair) Sheree Muir, (Lived Experience Representative Member) Dr Amjad Khan, NHS Lothian Non-Executive Director Heather Campbell (NHS Lothian) Present (HSCP and Partners): Laura Hill, (VOCAL) Elouise Johnstone, HSCP (Programme Manager Performance) Fiona Kennedy, HSCP (Interim Head of Service) Colin Small, (Volunteer Representative) Jim Sherval, NHS Lothian (Consultant in Public Health) Nick Clater, HSCP (Head of Adult Services & Chief Social Work Officer) Claire Ross, HSCP (Chief Allied Health Professional) Rebecca Miller, NHS Lothian (Deputy Director of Strategy) Dr Anna Beaglehole, HSCP (Clinical Director) Fiona Stratton, HSCP (Chief Nurse) Grace Cowan, HSCP (Head of Primary Care & Older People) Keith Chapman, (Lived Experience Representative Member) Attendees: Laurie Eyles, NHS Lothian (Dietetics Weight Loss Service Lead) Lara Williams, HSCP (Assistant Strategic Programme Manager) Hannah Forbes, Democratic Services Page 23 of 208
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Strategic Planning Group Thursday 29 January 2026 Bruce Dickie, HSCP (Project Officer) Apologies: Dr Wendy Metcalfe, (Medical Practitioner Representative Member) 1. Welcome and introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB) Strategic Planning Group (SPG) and noted the apologies for the meeting. The Chair noted that they will be undertaking the role of Chair on an interim basis until a new Chair is appointed. The Chair welcomed Sheree Muir, who will officially be nominated to the Board as a Lived Experienced member at February’s IJB, and Dr Anna Beaglehole, who is the newly appointed Clinical Director in the HSCP and joining SPG as an Officer of the HSCP and member of the Executive Leadership Team. 2. Order of Business The Chair advised that the order of business was as set out in the agenda. 3. Minutes of Meeting 3.1 The minutes of the Strategic Planning Group of 20 November 2025 were approved as an accurate record. 3.2 Action log - The action log was presented by the Assistant Strategic Programme Manager; the Group reviewed the outstanding actions and closed the completed actions. Page 24 of 208
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Strategic Planning Group Thursday 29 January 2026 4. Updates Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 The Chair’s Update – Gill Main, HSCP (Integration Manager), Chair The Chair provided a verbal update to the Group noting that Audit Scotland published two documents on the 8th of January. The first publication concerned Delayed Discharges and a Midlothian HSCP response paper will be presented to the Board in February. The second publication was a review on the Community Health and Social Care Performance and a similar response paper will be presented to the Board in April. The Chair highlighted that these publications directly impact the work of this Group and the work of the Board. The Chair highlighted that Scottish Government are progressing the amendment to the Public Bodies Joint Working Act to extend voting rights to Lived Experienced Members with the expectation that this will be implemented by September this year. The Head of Adult Services and Chief Social Work Officer informed the Group that COSLA are not in support of the change to voting rights for Lived Experienced Members. It was noted that there is a COSLA leaders meeting tomorrow and they hope to have further clarification thereafter. The Chair thanked the Head of Adult Service and Chief Social Work Officer for this update and noted that despite this, the amendment to the legislation is expected to be passed and there will be a duty for IJBs to implement. It was noted at the last Development Session on the 15 January 2026 that the Board were happy with the draft Directions. Page 25 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chair closed the update by reminding the Group to consider new or emerging risks as the meeting continues, and to ensure they are recorded on the IJB’s Risk Register. 5. Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1(Implementation) Midlothian IJB Development of Directions 2026/27, report by Elouise Johnstone, Programme Manager (Performance and Improvement) The Programme Manager (Performance and Improvement) presented the report which provides an update and second draft of Directions for 2026/27 following members’ consideration and response to feedback from the previous Strategic Planning Group on November 20th and the subsequent Development Session on January 15th. As a result of this report, Members are asked to:- • Review and agree a proposed 2025/26 Midlothian IJB Directions final position for Board review (appendix 1), and • Review, discuss, and develop the draft Directions for 2026/27 (appendix 2) for recommendation to Midlothian IJB in the 26th March 2026 Special Board meeting. The Group noted the Direction 9.3.8 on Single Point of Access and asked for clarification on the meaning behind it. Page 26 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chair confirmed that sitting behind this Direction is the operational plan to scope and explore what this work will be a produce a blueprint for SPGs comment and the IJBs approval. The Group noted they were supportive of the Directions and queried why some of the timelines stated in the report were long, with focus on Direction 1.3 (Communication and Engagement Strategy) and requesting progress within 2026/2027. The Chair noted the challenge with Direction 1.3 is that ELT operational lead best placed to take it forward is currently vacant. The new Executive Business Manager will be starting on the 1st of February and will be able to progress this work. The Chair took an action to discuss the timeline of this Direction with the Chief Officer and propose a shorter lead time. The Chair and the Chief Officer to review the timeline of 1.3 The Chair. 12/03/2026 5.2 The Midlothian IJB Annual Survey 2026/27, report by Elouise Johnstone, Programme Manager (Performance and Improvement) The Programme Manager (Performance and Improvement) presented the report that sets out the proposed questions and timeline to support the delivery of an updated Midlothian Survey data set for 2026/27. As a result of this report, Members are asked to: • Discuss and approve the draft questions, and • Note the timeline for delivery and dissemination of the Midlothian Survey 2026/27. The Group discussed the draft questions and asked about the reasoning behind the first question and queried if the wording of question 40 was creating a narrative of services being unsafe. Page 27 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments The Programme Manager (Performance and Improvement) clarified that the 1st question is designed to gain a sense of how much people value the services that lead to a good life. Question 40 was noted as challenging and is due to how the HACE Survey is written. The Programme Manager (Performance and Improvement) advised that the Group’s feedback will be considered. The Chair advised the Group that a key element of the HACE Survey is asking the correct questions, identifying what we need to commission and in what quantity. The Group asked The Programme Manager (Performance and Improvement) how the survey is promoted. The Programme Manager (Performance and Improvement) advised that there are multiple opportunities to promote the Survey. Last year there were online sources available through QR codes and online links, this year will include promotion through community partners such as Libraries and GP surgeries to broaden the reach of the survey. The Volunteer Representative raised some queries relating to wording and the Chair requested this discussion be taken offline, asking the Programme Manager Performance and Improvement) to convene a meeting with those who had raised questions and queries The Programme Manager (Performance and Improvement) agreed to meet with Lived Experience members and the Third Sector Rep to discuss potential changes and additions to the survey questions to better represent the community and to gather the information needed. Programme Manager to meet with Lived Experience Members and Third Sector Rep to discuss changes to survey questions. Programme Manager 12/03/26 5.3 Midlothian IJB Financial Recovery Action Planning (Verbal) presented by Chris King, Chief Finance Officer Page 28 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chief Finance Officer provided a brief verbal update, noting that in December there was a development session that proposed reviewing and discussing the approach to financial recovery and the initial areas of focus. Further Finance Sessions are planned for February 5th and March 19th head of the Special Board Meeting on the 26th of March where it is hoped a balanced budget can be set. 5.4 (Reporting and Evaluation) Midlothian IJB Directions 2025/26 Full Year Reporting, report by Elouise Johnstone, Programme Manager (Performance and Improvement) The Programme Manager (Performance and Improvement) presented the report that provides the Midlothian IJB Strategic Planning Group (SPG) with an update on the progress to deliver Midlothian IJB Directions 2025/26 including the Group Service Full Year Reports (appendix 1), and the synthesis and insight report generated in the Midlothian IJB Strategic Governance Outcomes Map (appendix 2). As a result of this report, Members are asked to: • Review the Group Service Outcome Reports for each Group Service area, • Review the synthesis and insight reports generated in columns 4 and 5 of the Midlothian IJB Strategic Governance Outcomes Map for recommendation to Midlothian IJB, • Note the recommendations for further improvement and future development set out in section 3.16- 3.19, and • Provide feedback to inform the ongoing development of Midlothian IJB Directions for 2026/27. The Group acknowledged the volume of work that had been delivered and asked if all the risks are being captured in terms of delivery, noting it may be worth reviewing what the low progress areas are and if there are mitigation plans. Page 29 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments The Head of Adult Services & Chief Social Work Officer noted the difficult issue around managing business as usual whilst managing the strategic agenda. The core business is managing risk and improving outcomes for people, while the saving plans are also taking up significant time. The Head of Primary Care & Older People that there is a need to balance the pressures with how services can move forward strategically, deliver safely, and fulfil our statutory obligations. The Chair highlighted that this reporting year was significantly more comprehensive than the previous year, and thanked Heads of Service for their approach to providing more detail in a connected way across these Directions. The Volunteer Representative noted the lack of returned reporting for two services areas and queried why this had been the case. The Head of Primary Care & Older People took an action to have a discussion offline regarding the low progress markers for addressing in the next round of reporting. The Head of Primary Care & Older People to have an offline discussion regarding the low progress markers. The Head of Primary Care & Older People. 30/07/2026 5.5 Obesity Medicines Specialist Initiation Pathway, report by Claire Ross, Chief AHP The Chief AHP presented the report that provides an update on the development of a Specialist Initiation Pathway for anti-obesity medicines (GLP-1/GIP RA) as instructed by NHS Lothian CMT and informed by subsequent monthly discussions within the Chief Officer and Chief Finance Officer Business Meeting. This forms part of our system wide communication on this work. As a result of this report, Members are asked to: Page 30 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments • Consider the Specialist Initiation pathway for obesity medicines within the Dietetic led weight management service in collaboration with Independent Prescribers and medical oversight to support the initial two cohorts of patients, • Consider the resource implications, • Support the progress of this work to the IJB. The Chief AHP shared a presentation to provide context to the report submitted to the Group. The Group highlighted a concern around the cost of the medication, noting the current overspend. The Chief AHP highlighted the shared care agreements and how we operationalise drugs that have been added to the formulary also noting the difficulty referenced in the paper being the inability of the GP subcommittee to support the shared care agreement. The Chief Finance Officer added there are financial implications due to no specific funding for the medication. There is work ongoing with NHS Lothian on the costing and a potential to offset the medication costs through NHS Lothian offering a 2% non-pay uplift as part of their budget offer for 2026/27. The Group asked if there could be more information around any effects of medication withdrawal. It was also asked what the timeline is to implement the pathway and what work is being done around the cost benefit on the medication being an alternative to a gastric sleeve. Lastly it was asked if there were barriers in terms of enhancement needed in the weight management service. The Chief AHP advised that the model supports prevention and early intervention and that lifestyle behaviours can have a significant impact in terms of clinical outcomes. Timelines were discussed and it was highlighted that there needs to be Page 31 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments support to progress with the test population. There is positive work underway in terms of the economical evaluation being led by National Endowment for Science, Technology and the Arts (NESTA) with work commissioned at the University of Glasgow. Local data is being explored which recognises that obesity has huge implications for our Health and Social Care system. Lastly it was highlighted that Midlothian’s Weight Management Service’s work is recognised nationally, although there are wider workforce pressures. The Dietetics Service Lead advised that there is more long-term data relating to bariatric surgery and it remains the most cost-effective treatment for obesity, though this is likely due to no long-term data held on the impact of GLP-1s. The Group agreed for the paper to be presented to IJB in February. 5.6 Midlothian HSCP Transformation and Change Board Update, report by Bruce Dickie, Project Officer The Project Officer presented the report updating on the work within the Transformation and Change Programme Board, chaired by the Chief Officer and further to the presentation given in the November Midlothian IJB SPG meeting. As a result of this report, Members are asked to: • Note progress of this Programme of work as detailed in the report found in appendix 1, • Note the update and range of work streams and actions that are being developed by the Programme Board, • note the ongoing and continuing financial challenges, the impact on services and the range of actions being undertaken by Midlothian HSCP, and • note the growing demand and complexity on care provision and its impact on budgetary pressures. Page 32 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chair thanked the Planning Officer for the report and noted there were no questions from the Group. 5.7 Governance and Approval Midlothian IJB Unpaid Carer Strategy 2025/2028, presented by Shelagh Swithenbank, Planning Officers Carers Shelagh Swithenbank, Planning Officers for Carers, presented the report that sets out the progress made in the development of the Midlothian IJB draft Unpaid Carers Strategy 2025-2028. An ECRIA and public consultation on the priorities has been completed and the strategy and action plan updated accordingly. As a result of this report, Members are asked to: • Note updates and requested amendments to the Midlothian IJB draft Unpaid Carer Strategy 2025-2028, and • Subject to any amendments, recommend this draft Midlothian IJB Unpaid Carer Strategy 2025-2028 to Midlothian IJB for approval. The Chair thanked the Planning Officer for Carers for the significant work that had gone into writing the strategy before opening to questions. The Group expressed they were impressed with the alignment of the strategy with the Strategic Plan and the recommendations of the carers feedback. It was queried if health care throughout the strategy could be specify whether Primary or Secondary health care. Furthermore, the group asked that wording could reflect the delegated nature of this strategy rather than refer to the Local Authority. In addition, two small pieces of text box formatting were noted as required to meet the accessibility duties. The Chair thanked the group for their comments and suggested that as the changes requested were largely minor, non-material wording amends, these Minor amends ahead of presentation the Midlothian IJB. The Chair and The Planning Officer for Carers. 31/01/26 Page 33 of 208
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Strategic Planning Group Thursday 29 January 2026 Report Title/Summary Decision Action Owner Date to be Completed/Comments should be actioned ahead of presentation to the IJB with support from Strategic Planning and Performance, including the Public Involvement Officer to support with accessibility edits required. The Group agreed. 5.8 Emerging Risks and Key Messages for Sharing (Verbal) presented by Gill Main, Chair No new risks were identified; therefore, the Chair closed the meeting. 6. Date of next meeting The date of the next meeting will be Thursday 12th March 2026, 14:00- 16:00, Normandy Court/Hybrid. The meeting terminated at 16:01pm. Page 34 of 208
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MIJB - Audit and Risk Committee Meeting Date Time Venue Audit and Risk Committee Thursday, 27 November 2025 2.00pm Virtual Meeting via MS Teams Present (IJB voting members): Councillor McManus (Chair, Midlothian Council) Dr Amjad Khan (Vice Chair) Present (IJB non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Present (Officers): Hilary Way (External Audit, Audit Scotland) Duncan Stainbank (Chief Internal Auditor) In attendance: Louise Middleton (Democratic Services Officer) Apologies: Gill Main (Integration Manager) Antony Clark (Independent Member) Councillor Derek Milligan (Midlothian Council) Roxanne King (Executive Business Manager) Claire Gardiner (External Audit, Audit Scotland) Midlothian Integration Joint Board Thursday 2 April 2026 Item No 4.3 Page 35 of 208
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MIJB - Audit and Risk Committee 1. Welcome and Introductions The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Audit and Risk Committee (A&R). Apologies highlighted to the group. The Chief Officer noted at this point that the Executive Business Manager was on a period of leave and would not be returning to this group for a period of 12 months. 2. Order of Business The Order of Business is as outlined in the agenda. There were no matters arising to be discussed. Declarations of Interest No declarations of interest were received. 3. Minute of Previous Meetings 3.1The Minute of the Audit and Risk Committee meeting held on 4th September 2025 was submitted and approved. 3.2 Action Log - The Action Log was noted by the Committee. 4. Discussion Topic 4.1 IJB Complaints – Roxanne King, Executive Business Manager (verbal update) The Chief Finance Officer provided an update in the absence of the Executive Business Manager. There have been no further complaints since the IJB session and work is ongoing to refine the process, this work should be completed at the start of 2026. Page 36 of 208
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MIJB - Audit and Risk Committee 5 Public Reports Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.1 Risk Register Update 2025/26, presented by Chris King, Chief Finance Officer The Chief Finance Officer presented the Risk Register update. The report detailed all current risks. It was noted that two amendments had been made since the previous meeting. The Chief Finance Officer asked members to confirm whether these amendments appropriately reflected the prior discussion and whether any additional changes were required. The Integration Manager proposed a number of amendments: Under Risk 1, the title should refer to “Strategic Planning and Performance” rather than “Planning, Performance and Programme.” The reference within Risk 1 to redesign and transformation activity should reflect that this work is currently paused. Under Risk 3, the role should be amended from “Risk Holder” to “Risk Handler.” Consideration should be given to whether Risk 3 should sit jointly with the Chief Finance Officer and Chief Officer rather than solely with the Integration Manager. Under Risk 5, references to Scottish Government decisions should be expanded to reflect relevant policy documentation, including the Service Renewal Framework The Chair noted that Risk 3 contained both strategic and financial elements. It was agreed that the Chief Finance Officer would be Risk Owner, with the Integration Manager acting as Risk Handler. Amendments made to all risks are brought to the next IJB Audit and Risk Committee Chief Finance Officer March 2026 Page 37 of 208
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Independent Member supported the proposed ownership change for Risk 3 and agreed that Risk 5 should be updated to reflect recent policy developments. The Chief Officer highlighted that, at the Strategic Planning Group meeting on 20 November, discussion had taken place regarding transformation capacity, the volume of work underway, financial recovery priorities and the need for potential reprioritisation. It was noted that this pressure on organisational capacity may require further reflection within the Risk Register. The Chief Officer also advised that the forthcoming departure of the Chief Finance Officer in April would require interim arrangements and engagement with Partners. Members agreed that this should be reflected within the financial risk. The Independent Member commented on the overall risk profile, noting that the most significant risks relate to financial sustainability and capacity, with direct implications for service delivery and strategic objectives. The Chief Finance Officer acknowledged that financial risk is increasing across IJBs nationally and referenced recent Development Sessions which had focused on financial sustainability and strategic delivery. In response to a query regarding national mitigation, the Chief Officer outlined engagement at national level through the Chief Officers Group, Chief Finance Officers Group and Strategic Planning Group. Collaborative work across Lothian IJBs was also noted. The Chief Finance Officer highlighted national commentary from COSLA and Audit Scotland regarding social care investment and transformation pressures. Concern regarding the potential impact of new sub-national planning arrangements was raised with the suggestion this be reflected as a risk. It was agreed this could be incorporated within Risk 4, with clearer reference to legislative and structural change. Page 38 of 208
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Chair requested that all agreed amendments be incorporated and the updated Risk Register brought back to the March meeting. 5.2 Strategic Planning Process Internal Audit Review, presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report and advised that the NHS internal audit resource, although contracted through NHS management arrangements, operates under the direction of the Chief Internal Auditor. It was noted that the Internal Audit Review received a satisfactory rating across all areas assessed. The Chief Internal Auditor commended the Integration Manager and the wider team for their work in relation to the Strategic Planning process. The audit process has now been completed and approved for publication. The Strategic Planning process was assessed as providing the highest level of assurance. The Chair and the Independent Member also recorded their congratulations to all those involved. Noted/Supported. 5.3 Internal Audit Recommendations Follow Up, presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the bi-annual update report and confirmed that all previous audit recommendations have now been fully implemented. The only outstanding matter relates to the completion and publication of the Register of Interests for Board Members. It was noted that Board Members are required to complete a Add Register of Interest to the website. Integration Manager Next Page 39 of 208
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments Register of Interests, and that the Chief Officer and Chief Finance Officer are also required to submit declarations. These are currently in progress and will be published on the website in due course. The Integration Manager clarified that only Board Members had been asked to complete a Register of Interests at this stage. Once the Standards Officer provides the completed registers, they will be uploaded to the website. The Integration Manager confirmed they were content to remain the Accountable Officer for the Audit Plan; however, responsibility for progressing the Registers of Interests sits with the Standards Officer. The Chief Internal Auditor agreed to liaise with the Standards Officer to ensure the completed registers are forwarded appropriately. The Chair requested that periodic reminders be issued during the year to Board Members to update their Register of Interests should their circumstances change. The Chief Internal Auditor agreed to raise this with the Standards Officer. The Independent Member asked whether Registers of Interests are formally reviewed on an annual basis. The Chief Internal Auditor indicated this was believed to be the case but will confirm with the Standards Officer. Send a reminder throughout the year to Board Members to update Register of Interest. Ensure Register of Interest in reviewed annually. Chief Internal Auditor/ Standards Officer Chief Internal Auditor/ Standards Officer meeting (March 2026) Next meeting (March 2026) 5.4 Review of Standing Orders, presented by Alan Turpie, IJB Standards Officer The Chief Finance Officer presented the report and advised that the Standards Officer had been asked to review the Standing Orders following the September IJB Audit and Risk Committee meeting. The Standards Officer concluded that no amendments were required and that the Standing Orders remain fit for purpose. The Integration Manager noted that the Terms of Reference had been updated and approved by the Board in 2024. It was also highlighted that the SPG Terms of Reference had not been included in the documentation. The Integration Manager agreed to circulate the relevant documents to the group and progress this matter. Update the Terms of Reference in the review of the Standing Orders Chief Internal Auditor Next meeting (March 2026) Page 40 of 208
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MIJB - Audit and Risk Committee 5. Private Reports No items for discussion. 6. Any Other Business No items for discussion. 8. Date of Next Meeting The meeting terminated at 2.35pm. The next meeting will be held on Thursday 5 March 2026 at 14:00-16:00 via MS Teams. Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Independent Member noted that a thorough review of the Terms of Reference had been undertaken in 2023 and emphasised the importance of ensuring that the most up-to-date version is used. The Chief Internal Auditor agreed to liaise with the Standards Officer regarding the update of the Terms of Reference. The Committee agreed to approve the document via email once the necessary amendments have been made, without the need to return it to a future meeting. Page 41 of 208
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Midlothian Integration Joint Board Thursday, 2nd April 2026, 14:00-16:00 Chief Officer Report April 2026 Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting April 2026. Board members are asked to: Note the content of the report. # Item number: 5.2 Page 43 of 208
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Midlothian Integration Joint Board Report Chief Officer Report April 2026 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting on 2nd April 2026. 2 Recommendations 2.1 As a result of this report Members are asked to: Note the content of the report. 3 Background and main report 3.1 Chief Officer Chris King has now left Midlothian in his role as Chief Finance Officer (CFO). Ele Ho will replace him for an interim period of 12 months from 1st April. The team would like to thank Chris for all his work over the last few years and wish him well in his new role in NHS Lothian. Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Head of Adult Services Dementia Implementation and Evaluation Framework 2026–2029 The Adult Mental Health and Substance Use Service (SUS) team led on the development of Midlothian HSCP Dementia Implementation and Evaluation Framework 2026–2029. This sets out how Midlothian HSCP will deliver on Scotland’s Dementia Strategy (Everyone’s Story 2023–2033) locally, aligned with the National Delivery Plan. This framework is the first of its kind in Lothian, and Midlothian is leading on the response to the increasing dementia prevalence, and projected population growth. It establishes a clear implementation, governance, and evaluation structure to ensure delivery of the five national dementia outcomes. The Framework provides a single, integrated structure for delivering Scotland’s Dementia Strategy which is explicitly designed to translate national ambition into defined local objectives, measurable indicators, and accountable delivery across the full dementia pathway. The framework expects to demonstrate the achievement against each objective, including earlier diagnosis, improved post diagnostic continuity, reduced inequality of Page 44 of 208
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Midlothian Integration Joint Board access, increased advocacy and anticipatory care planning uptake, and a skilled, confident workforce. Crucially, the objectives function as the primary assurance mechanism for Midlothian HSCP. They provide a clear line of sight from national strategy, through local action, to measurable outcomes and future commissioning decisions. This is a welcomed and positive workstream for Midlothian and has engaged a wide range of stakeholders across the HSCP and third sector. This including those with Lived experience and their carer’s. The HSCP recognises their perspectives are integral to the development of local objectives, evaluation, and future service delivery and improvement to provide the best person-centred care for those living with Dementia and their carers. Justice Service In February 2026, the 2024-2025 MAPPA Annual Report was presented to Midlothian Council and made publicly available. The report outlines the complex work undertaken by agencies to manage individuals who present the highest risk of harm to our communities. Working together and effective collaboration of partners; social work, housing, police prisons and health services is key to effective risk management. On 12th February, the positive work of the service delivering Unpaid Work requirements of Community Payback Orders (CPO), was highlighted when Angela Constance, Cabinet Secretary for Justice and Home Affairs, visited Mayfield and Easthouses Development Trust to meet with individuals undertaking Unpaid work, and met with the HSCP team. The visit was broadcast on local and national media and showed the transformative work achieved by those subject to a CPO, with a requirement of Unpaid Work, and the impact it has on the individual and the community. In addition to how the local community benefits from unpaid work, latest statistics show the reconviction rate for people sentenced to a CPOs is 28.4%, compared to 52.6% for those completing short prison sentences of one year or less. Sharon Hill, Manager at Mayfield & Easthouses Development Trust manager said: “Our work with the Community Payback Team helps us by giving us access to folks who can help us in a practical way - whether that be by building, painting, moving, or digging. The Community Payback Team benefit from seeing the positive impact of what they have done. It can give a sense of pride and purpose to everyone involved.” Weight Stigma The HSCP weight stigma pilot project is on track to complete by March 31st. This was a jointly funded pilot between Midlothian HSCP and NHS Lothian Public Health. The aim of the pilot was to increase skills and confidence of staff and volunteers in Lothian to have conversations on obesity and address the issues of weight stigma. To date 19 sessions have taken place, reaching 193 staff. The training has targeted Primary Care teams, including GPs, School nursing and Health Visiting teams, Allied Health Professionals and Active Schools. Page 45 of 208
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Midlothian Integration Joint Board A module for education staff is also under development and will be complete by end of March. This will be available to all Education staff across Midlothian and Lothian on Google classroom. Feedback from the sessions has been positive with 93% giving the training 4 or 5 stars. The HSCP team are keen to understand what people might do differently because of the training and we have had very positive responses: “It made me challenge my thoughts more on why I was hesitant when addressing the subject, when I would not hesitate to address a heart condition for example. Made me rethink my tone, body language and language used whilst approaching parents.” School Nurse “Change language, consider bias and ask permission is main take home.” GP “Look at equipment and find a central place for large BP cuffs.” GP “Think more about the art of how to approach these conversations and avoiding over- simplified advice while ignoring what matters to the individual” PN. There will be a full evaluation report by the end of the financial year, which we will share. Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Head of Primary Care and Older People Midlothian HSCP, in partnership with the Midlothian GP Forum, has implemented a test-of-change introducing Fractional exhaled Nitric Oxide (FeNO) testing within Primary Care to strengthen Asthma diagnosis for people aged 16 and over. FeNO is a non-invasive biomarker of type-2 airway inflammation and is recommended within BTS/NICE/SIGN guidance as part of an objective diagnostic pathway. The pilot, which commenced in early 2026, is delivered at Bonnyrigg Health Centre, enabling timely, community-based access to diagnostic testing and representing a significant step in bringing care closer to home for Midlothian residents. Referrals are made directly from GP practices for testing, with results returned via the GP clinical inbox. Uptake and utilisation of the service will be monitored throughout the pilot period to inform decision-making on potential expansion across Midlothian and the wider NHS Lothian HSCPs. Grace Cowan, Head of Primary Care & Older People - grace.cowan@nhs.scot Page 46 of 208
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Midlothian Integration Joint Board 3.4 Strategic Planning National Performance Framework Midlothian HSCP Strategic Planning and Performance team have supported the collation of Midlothian feedback to Scottish Government on the draft proposals to refresh the National Performance Framework. Directions 2026/27 Following Midlothian IJBs Special Board on 26th March 2026, Directions for 2026/27 will be issued to the Chief Executives of Midlothian Council and NHS Lothian on 31st March 2026. Biannual reporting will continue to evaluate and monitor progress towards Midlothian IJBs strategic aims as set out in the Midlothian IJB Strategic Plan 2025-2035. Community Health and Social Care Briefing Paper and Insight Support Midlothian HSCP Strategic Planning and Performance team continue to develop Midlothian IJB’s Performance Framework to encompass all statutory reporting requirements of the Board and supplement this data with local intelligence to support decision making. This has included undertaking some benchmarking against the findings of the Audit Scotland briefing paper ‘Community Health and Social Care: Performance 2025’. This work will be presented in the April IJB meeting. Agenda for Change Reform and Reduced Working Week In 2024, Scottish Government it was been agreed with trade unions that a review of the Agenda for Change (AfC) in NHS Scotland would be undertaken to modernise the system. As part of the pay settlement for staff in 2023-24, the working week for staff employed under Agenda for Change (AfC) reduced from 37.5 to 37 hours per working week. Work has been underway to ensure the further reduction of the working week to 36 hours, and assurance provided to NHS Lothian that all staff employed under Agenda for Change (AfC) have moved to new agreed hours pro rata by the Scottish Government deadline of 1st April 2026. Gill Main, Integration Manager – gill.main3@nhs.scot 3.5 Chief Allied Health Professional Community Engagement Day (formerly referred to as Community Appointment Day) Falls in older adults increase with age alongside deterioration in bone health. Injury risk is multifactorial with strategies such as strength and balance programmes having high efficiency. A successful application to the NHS Education for Scotland AHP Career Fellowship Scheme enabled a nine-month project which aimed to provide an integrated approach to falls prevention in Midlothian. This project and associated funding have not ceased however we have two further Community Engagement Days are in planning for 2026 (16th April and October.) A falls prevention community engagement day in September enabled over 200 citizens in Midlothian to speak to Health Care Professionals and voluntary and third sector Page 47 of 208
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Midlothian Integration Joint Board organizations with signposting advice and resources. Participants were given a falls passport to help capture and reflect supported self-management advice. Falls TEC Pathfinder The HSCP are working in collaboration with Edinburgh HSCP to progress the Midlothian initiated work with Digital Health and care Innovation Centre (DHI.) This website development will integrate with the national Digital Front Door, MyCare and enables early and consistent assessment of falls, navigation of services and supported self-management. The April Falls Prevention Community Engagement Day will support part of the data validation requirements of this development and will also help attendees to navigate the event based on their identified needs. Falls Ecosystem Mapping System wide work is being facilitated in March to enable a better understanding of the stakeholders and pathways supporting falls prevention and management across our health and care system in Lothian. This will enable the delivery of the ambitions described within the Lothian Falls Prevention and Management Framework. In addition, to support our falls Prevention TEC Pathfinder work, local mapping is underway to help us better understand our local system and how this aligns to our frailty scale. This will enable us to progress the work from our frailty programme and ensure readiness for the Falls TechPathfinder. Claire Ross, Chief AHP – claire.ross4@nhs.scot 3.6 Chief Nurse Members of the Midlothian Health Visiting team were invited to attend a Ministerial Round Table Event on 25th February to share the work they have been undertaking with Speech and Language therapy colleagues. The 27–30-month Health Visiting review undertaken as part of the Universal Health Visiting Pathway has highlighted increasing numbers of children experiencing speech, language, and communication delays. Recognising that early intervention is key to reducing these delays, Health Visiting and Speech and Language Therapy colleagues devised a joint initiative to deliver an additional Antenatal Session for parents focused around increasing parental awareness of early brain development and communicating with their baby. Public Health Scotland were involved to support the strategic oversight of the project and assist with data collection. The sessions are delivered as a fourth antenatal session, held at the same location and time as existing midwife-led antenatal classes to provide consistency for parents. They offer guidance for expectant parents, focusing on early interactions with their baby and how these link to brain development and speech and language outcomes. Sessions are co-delivered by Nursery Nurses within Health Visiting Teams and Speech and Language Therapists. Cost-effective play strategies are shared, alongside Page 48 of 208
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Midlothian Integration Joint Board increased awareness and signposting to the BBC CBeebies Parenting Network (previously known as Tiny Happy People). The sessions have been delivered using existing resources (such as staffing and venues), supported by goodwill across the system. Parents have been invited to opt in to providing telephone feedback, with responses to date being very positive. Eighty-one per cent of respondents reported enjoying the sessions, and 91 per cent stated they felt more confident communicating with their bump and baby. A formal evaluation is also being undertaken by Sarah Paterson, Speech and Language Therapy Lead, funded through the National Early Language and Communication Project. Findings will be available in June 2026 and shared with strategic management to inform decisions regarding continuation of the antenatal sessions following the one-year pilot. Future 27–30-month review data will also be examined to assess whether speech, language and communication delays are declining. Potential inequalities in access have been identified, as attendance relies on parents engaging with antenatal classes and may not reach the most vulnerable families. To address this, options are being explored to integrate this content into Health Visitor antenatal contacts for children and families identified as having additional support needs. Integrated working with Early Years settings is being explored as a way of supporting delivery of the key messages. Feedback has highlighted several additional benefits. Awareness of library membership has increased, including the offer available at birth registration within Midlothian. Parents reported opting into library membership following information shared during the antenatal session. Fathers have specifically reported increased confidence in talking with their babies, noting that they had not previously realised the importance of this during the antenatal period and early weeks. The programme has also contributed positively to staff development through the upskilling of Nursery Nurses to deliver these sessions. The members of the Midlothian Health Visiting team who attended the Round Table event found their work was received enthusiastically with helpful discussion about the key issues raised by the work they presented. Fiona Stratton, Chief Nurse – fiona.stratton@nhs.scot 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. 5 Directions Page 49 of 208
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Midlothian Integration Joint Board 5.1 The report reflects the ongoing work in support of the delivery of the current Directions issued by Midlothian IJB. 6 Equalities Implications 6.1 There are no specific equalities issues arising from this report. 7 Resource Implications 7.1 There are no direct resource implications arising from this report. 8 Risk 8.1 The key risks associated with the delivery of services and programmes of work are articulated and monitored by managers and, where appropriate, reflected in the risk register. 9 Involving people 9.1 There continues to be ongoing engagement and involvement with key stakeholders across the Partnership to support development and delivery of services. 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE April 2026 Page 50 of 208
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Midlothian Integration Joint Board Thursday, 2nd April 2026, 14:00-16:00 Midlothian IJB Membership Recommendations Executive summary This report provides information about changes to non-voting membership of Midlothian Integration Joint Board (IJB) and seeks the Board’s formal endorsement of the membership nomination detailed in the report. Members are asked to: Note the resignation of Chief Finance Officer, Chris King from 28th March 2026. Note the successful appointment of a Chief Finance Officer. Endorse the nomination of Eleonora Ho as a non-voting member of Midlothian IJB in their capacity as Chief Finance Officer for a fixed term of 1 year from 2nd April 2026. Note the resignation of Jay Johnson, Lived Experience Member from 26th February 2026. Item number: 5.5 Page 51 of 208
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Midlothian Integration Joint Board Report Midlothian IJB Membership Recommendations 1 Purpose 1.1 This report seeks the Board’s endorsement for the nomination of a new non-voting member in capacity as Chief Finance Officer to the Midlothian IJB, following the resignation of Chris King, Chief Finance Officer, effective 28th March 2026. A recruitment process has since been undertaken, resulting in the appointment of Eleonora Ho as Chief Finance Officer on a fixed-term basis for one year from 2nd April 2026. The Board is invited to endorse her nomination for membership. 1.2 Note the resignation of non-voting member Jay Johnson, Lived Experience Member. 2 Recommendations 2.1 As a result of this report, Members are asked to: Note the resignation of Chief Finance Officer, Chris King from 28th March 2026. Note the successful appointment of a Chief Finance Officer. Endorse the nomination of Eleonora Ho as a non-voting member of Midlothian IJB in their capacity as Chief Finance Officer for a fixed term of 1 year from 2nd April 2026. Note the resignation of Jay Johnson, Lived Experience Member from 26th February 2026. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 determines the membership of Integration Joint Boards. This details the requirement to ensure members are representative of people who experience our services in the community, staff engaged in the provision of services, and third sector bodies carrying out activities related to health and social care in the community. 3.2 The Midlothian IJB was informed of the resignation of the previous Chief Finance Officer, Chris King, at the Midlothian IJB meeting of 2nd April 2026. A recruitment process began to fill this role. Eleonora Ho was successful in being appointed as Chief Finance Officer for a fixed term of 1 year. Page 52 of 208
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Midlothian Integration Joint Board 3.3 Midlothian IJB was advised on the 2nd April 2026 that Eleonora Ho had been successful in recruiting to the Chief Finance Officer role, and a paper would is being submitted to the Board meeting on 2nd April 2026, to endorse Board membership nomination. 3.4 Midlothian IJB was advised by Jay Johnson, Lived Experience Member on 23rd February 2026, of his intention to resign as a non-voting Board Member. 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 There are no implications for Directions arising from this report. 6 Equalities Implications 6.1 There is no direct impact on inequalities arising from this report. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 Failure to appoint Integration Joint Board members would result in the Integration Joint Board being unable to meet the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. 9 Involving people 9.1 The regulations and guidance accompanying the Public Bodies (Joint Working) Act (2014) requires the IJB membership to be reflective of those working in the delivery of health and social care in the community and should include representation from all key stakeholders. This includes staff, service users, voluntary bodies and independent organisations related to health and social care in the local authority. 10 Background Papers Page 53 of 208
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Midlothian Integration Joint Board 10.1 N/A AUTHOR’S NAME AND DELEGATION Democratic Services Officer, Democratic Services AUTHOR’S CONTACT DETAILS democratic.services@midlothian.gov.uk DATE 13th March 2026 Page 54 of 208
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Midlothian Integration Joint Board Thursday, 2nd April 2026, 14:00-16:00 Midlothian IJB Performance Update Executive summary This report provides an update on the progress towards the indicators described in the Midlothian IJB Performance Framework 2025-2028, which was published with the Midlothian IJB Strategic Plan 2023-35. It sets out the statutory reporting requirements of the IJB, with measures, data sources, and reporting frequency to provide evidence of progress towards: Strategic Aims, Directions, National Health and Wellbeing Outcomes, and Ministerial Group Indicators. Progress towards the Strategic Aims is recorded using the Midlothian IJB Strategic Governance Outcomes Map. Directions half-year reporting is scheduled for August 2026, and full year for February 2027. The National Health and Wellbeing Outcomes will be reported within the Annual Performance Report 2025/26 in July 2026. A report describing progress towards the Ministerial Group Indicators is attached in this report (appendix 1). Due to the delay relating to validation processes, this data still relates to the Midlothian IJB Improvement Goals for 2023-25. More recent management data are available for a number of indicators but cannot be published as these data are not validated. In order to support the Board’s understanding of the current position, a brief summary is provided. As a result of this report, Members are asked to: Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1). Item number: 5.6 Page 55 of 208
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Midlothian Integration Joint Board Report Midlothian IJB Performance Update 1 Purpose 1.1 This report provides an update on the progress towards the Midlothian IJB performance goals set for the period 2023-2025 (appendix 1) within the Midlothian IJB Performance Framework 2025-2028. 2 Recommendations 2.1 As a result of this report, Members are asked to: Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1). 3 Background and main report 3.1 Midlothian IJB Strategic Governance Map A regular update on the impact of Midlothian IJB’s contribution to the health and wellbeing of local people and communities is also provided in this report through the Midlothian IJB Strategic Outcomes Governance Map. This map is a contribution analysis tool that hosts all Midlothian IJB governance activity and evidence across a 6- column logic model; what we do, who with, how they feel, what they learn and gain, what they do differently, and what difference does this make. 3.2 Progress towards the Strategic Aims is recorded using the Midlothian IJB Strategic Governance Outcomes Map. Directions half-year reporting is scheduled for August 2026, and full year for February 2027. The National Health and Wellbeing Outcomes will be reported within the Annual Performance Report 2025/26 in July 2026. 3.3 Midlothian IJB Performance Framework 2025-2028 The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. They are based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care). 3.4 An updated report describing progress against Ministerial Group Indicators is attached in appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. This means that we are not yet able to Page 56 of 208
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Midlothian Integration Joint Board calculate the full year performance for some measures and this data still relates to the Midlothian IJB Improvement Goals for 2023-25. 3.5 More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided below. 3.6 A&E Attendances Target per 100,000 people 2,629 / month Position at December 2025 2,732 / month The validated data are available up to December 2025. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed March 2026) indicate the target is currently being met. 3.7 Emergency Admissions Target per 100,000 767 / month Position at March 2025 761 / month The validated data are only available up to March 2025. Based on this information, the target is currently being met. The most recent non-validated management information data (accessed March 2026) indicate the target is currently not being met. 3.8 Unplanned Bed Days (Acute) Target per 100,000 5,074 / month Position at September 2025 4,384 / month The validated data are only available up to September 2025. Based on this information, the target is currently being met. The most recent non-validated management information data (accessed March 2026) also indicate the target is currently being met. 3.9 Delayed Discharge Occupied Bed Days Target per 100,000 820 / month Position at March 2025 866 / month The validated data are only available up to December 2025. Based on this information, the target is currently not being met. The most recent non-validated management information data (accessed March 2026) indicate that the target is currently not being met. 3.10 End of Life – Percentage of Last Six Months Spent in Large Hospitals 2022/23 Target Rate <8.7% 2022/23 Rate 8.2% This indicator was not updated in the latest release of published data from Public Health Scotland. It is not possible to refer to management information as these data are not held locally. 3.11 Balance of Care 2022/23 Target Rate >96.4% Page 57 of 208
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Midlothian Integration Joint Board This indicator was not updated in the latest release of published data from Public Health Scotland. It is not possible to refer to management information as these data are not held locally. 3.12 Despite the lag in validated data, Board members will note that significant improvement has been made in Midlothian across the last 3 years as a result of strategic performance scrutiny and targeted action from operational services. Of the 6 indicators reported, validated performance data shows: 2 indicator targets are being met 2 indicator targets are not being met, although the level of improvement required is within a margin of 5%, and 2 indicator targets have not been updated by Public Health Scotland. 4 Policy Implications 4.1 This paper describes the wider performance of Midlothian IJB against its Performance Framework for 2025-2028. There are no policy implications arising from this report. 5 Directions 5.1 This report does not directly impact upon service ability to deliver existing Directions or require new Directions to be considered. Ongoing review and revision to the Performance Report will align with any revisions to existing Directions / issue of new Directions at any stage in the reporting period. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake and ECRIA as a result of this report. 6.2 There are no equality implications from focussing on these goals but there may be implications in the actions that result from work to achieve them. 6.3 The focus of most of the goals is on reducing hospital activity and hospitals are not used equally by the population. There are groups of people that make more use of hospitals than others – for example older people, people living in areas of deprivation or people who live alone. 7 Resource Implications 7.1 There are no resource implications as a result of this report. Page 58 of 208
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Midlothian Integration Joint Board 8 Risk 8.1 The risk of not finding solutions to address complex performance measurement challenges is that we are underinformed in relation to increases in complexity, acuity and the resulting additional pressures these create for our workforce; and what this may mean for wellbeing, retention and recruitment. 9 Involving people 9.1 The role of data assurance is performed by Strategic Planning Group which has a wider membership including representation of Board members, Officers of the HSCP, the Third and Independent sector, Public Health, and representative members from our communities. 10 Background Papers 10.1 There are no background papers Appendices: Appendix 1: Local Intelligence Support Team (LIST) Report Authors name and designation Elouise Johnstone, Programme Manager for Performance and Improvement Contact info elouise.johnstone@nhs.scot Date 16/03/2026 Page 59 of 208
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Midlothian HSCP MSG Indicators Local Intelligence Support Team (LIST), Data Workbook accessed March 2026 Page 61 of 208
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Contents 2 1. A&E attendances 2. Emergency admissions 3. Unplanned bed days (Acute) 4. Delayed Discharges Occupied Bed Days Page 62 of 208
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3 A&E Attendances Number of ED Attendances 2,619 1,491 1,735 2,910 2,280 2,831 2,307 3,001 2,732 Apr-19 Jun-19 Aug-19 Oct-19 Dec-19 Feb-20 Apr-20 Jun-20 Aug-20 Oct-20 Dec-20 Feb-21 Apr-21 Jun-21 Aug-21 Oct-21 Dec-21 Feb-22 Apr-22 Jun-22 Aug-22 Oct-22 Dec-22 Feb-23 Apr-23 Jun-23 Aug-23 Oct-23 Dec-23 Feb-24 Apr-24 Jun-24 Aug-24 Oct-24 Dec-24 Feb-25 Apr-25 Jun-25 Aug-25 Oct-25 Dec-25 3,500 3,000 2,500 2,000 1,500 1,000 500 0 Page 63 of 208
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Emergency Admissions 4 Number of Admissions 782 930 502 781 685 847 573 848 841 570 761 Apr-19 Jun-19 Aug-19 Oct-19 Dec-19 Feb-20 Apr-20 Jun-20 Aug-20 Oct-20 Dec-20 Feb-21 Apr-21 Jun-21 Aug-21 Oct-21 Dec-21 Feb-22 Apr-22 Jun-22 Aug-22 Oct-22 Dec-22 Feb-23 Apr-23 Jun-23 Aug-23 Oct-23 Dec-23 Feb-24 Apr-24 Jun-24 Aug-24 Oct-24 Dec-24 Feb-25 1,000 900 800 700 600 500 400 300 200 100 0 Page 64 of 208
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Unplanned Bed Days - Acute 5 Number of bed days (acute, unscheduled) 5,468 4,409 3,302 5,091 4,085 5,890 4,159 5,667 4,632 5,454 4,025 4,384 Apr-19 Jul-19 Oct-19 Jan-20 Apr-20 Jul-20 Oct-20 Jan-21 Apr-21 Jul-21 Oct-21 Jan-22 Apr-22 Jul-22 Oct-22 Jan-23 Apr-23 Jul-23 Oct-23 Jan-24 Apr-24 Jul-24 Oct-24 Jan-25 Apr-25 Jul-25 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Page 65 of 208
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Delayed Discharges Occupied Bed Days (18+) 6 Number of Delayed Discharge Occupied Bed days (18+) 1,028 704 964 199 849 395 979 355 780 1,042 592 866 Apr-19 Jul-19 Oct-19 Jan-20 Apr-20 Jul-20 Oct-20 Jan-21 Apr-21 Jul-21 Oct-21 Jan-22 Apr-22 Jul-22 Oct-22 Jan-23 Apr-23 Jul-23 Oct-23 Jan-24 Apr-24 Jul-24 Oct-24 Jan-25 Apr-25 Jul-25 Oct-25 1,200 1,000 800 600 400 200 0 Page 66 of 208
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Midlothian Integration Joint Board Thursday, 2nd April 2026, 14:00-16:00 Audit Scotland Briefing Report: ‘Community Health and Social Care Performance 2025’ and Midlothian Performance Item number: 5.8 Executive summary This report sets out the main findings of the Audit Scotland briefing paper ‘Community Health and Social Care Performance 2025’. The report published by Audit Scotland on 8th January 2026 is an assessment of the quality of the information available to Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) in relation to their statutory performance reporting. The briefing paper is intended to support Integration Authorities to fully understand their performance, support effective decision-making, benchmark against others, and provide transparent public performance reporting. In their briefing paper, Audit Scotland explores the lack of comprehensive and consistent national performance information about community health and social care demand, workload, quality of care, and outcomes. The limitations of the performance information is recognised by Audit Scotland for IAs to make a full assessment of their performance and progress towards improving the quality of life for people using health and social care services. Audit Scotland state that Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) should use the data dashboard tool they have created, alongside other local data available to them, to support benchmarking, self-assessment, and the development of improvement plans. This report details the Midlothian position in relation to the indicators provided, and demonstrates where the Midlothian IJB Annual Performance Report already includes many examples of the use of wider data sets recommended by Audit Scotland. As a result of this report, Members are asked to: Note the key findings and recommendations of the Audit Scotland briefing paper ‘Community Health and Social Care Performance 2025’ Note the progress made by Midlothian IJB and the areas of ongoing focus, and Note the work of Midlothian IJB to connect statutory performance requirements with Strategic Planning and local management data to build a more comprehensive understanding of performance. Page 67 of 208
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Midlothian Integration Joint Board Report Audit Scotland Report: ‘Community Health and Social Care Performance 2025’ and Midlothian Performance 1 Purpose 1.1 This report sets out the main findings of the Audit Scotland briefing paper ‘Community Health and Social Care Performance 2025’ published by Audit Scotland on 8th January 2026. Audit Scotland undertook an assessment of the quality of the information available to Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) in relation to their statutory performance reporting and made key recommendations. 1.2 This report details the Midlothian position in relation to the indicators provided (see Appendix 1) and demonstrates where the Midlothian IJB Annual Performance Report already includes many examples of the use of wider data sets as recommended by Audit Scotland. 2 Recommendations 2.1 As a result of this report, Members are asked to: Note the key findings and recommendations of the Audit Scotland briefing paper ‘Community Health and Social Care Performance 2025’ Note the progress made by Midlothian IJB and the areas of ongoing focus, and Note the work of Midlothian IJB to connect statutory performance requirements with Strategic Planning and local management data to build a more comprehensive understanding of performance. 3 Background and main report 3.1 The briefing paper published by Audit Scotland on 8th January 2026 is an assessment of the quality of the information available to Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) to fully understand their performance, support effective decision-making, benchmark against others, and provide transparent public performance reporting. 3.2 The Audit Scotland briefing paper identified four key priority areas: Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) are “struggling” to meet increasing demand across health and social care Insufficient progress shifting the balance of care to the community and to prevention Page 68 of 208
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Midlothian Integration Joint Board variation in levels of choice and control reported by people living in Scotland, and the “gap between the ambitions to address health inequalities and progress with improvement”. 3.3 Audit Scotland state that Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) should use the data dashboard tool they have created, alongside other local data available to them, to support benchmarking, self- assessment, and the development of improvement plans. 3.3 The data included in the Audit Scotland briefing paper are drawn from sources that include the Core Suite of Integration Indicators. These national indicators are gathered, analysed, and published by Public Health Scotland, with some available on an annual basis, and others on a biannual basis. This means that some of the data being discussed by Audit Scotland are more than a year old (covering the financial year 2024/25, published in July 2025), and others are over two years old (collected as part of the Health and Care Experience Survey fieldwork which took place in October and November 2023, published in July 2024). 3.4 Audit Scotland note the lack of comprehensive and consistent national performance information about community health and social care demand, workload, quality of care, and outcomes. They recognise that the limitations of the performance information make it difficult to fully assess the performance and progress of Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) towards improving the quality of life for people using health and social care services. 3.5 To support Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) to use the data and indirect measures that are currently available, Audit Scotland developed an interactive data tool to allow comparisons to be made. Many of the indicators in this dashboard are duplicates of data that are already available from Public Health Scotland, and the Improvement Service, as well as being published in individual IJB Annual Performance Reports in accordance with statutory duties. From this data, Audit Scotland state they have found a general long-term picture of declining performance and satisfaction. 3.6 Audit Scotland have set an expectation that Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs)use the data tool to compare their performance with other areas, and to ensure that they understand and can explain their performance in terms of local context and priorities. It is also noted that the range of publicly available national data is limited and does not provide a full picture of the performance of services or outcomes for people. 3.7 It should be noted that Audit Scotland do not set out any solutions or make any recommendations relating to the need for improvements to outcome reporting. Over a number of years, Midlothian IJB have made a significant commitment to build the necessary infrastructure to report on activity, experience, and outcomes. Overall progress towards outcomes is captured in the Midlothian IJB Strategic Governance Map, which is populated using contribution analysis. This approach to evaluation has been recognised as innovative by Scottish Government who have adopted the Page 69 of 208
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Midlothian Integration Joint Board Midlothian IJB Strategic Governance Outcomes Map as the IJB standard within the Scottish Learning and Improvement Framework (SLIF). 3.8 Midlothian IJB’s Annual Performance Report organises information under each of the nine national Health and Wellbeing Outcomes, including the Scottish Government expectations for each Outcome. The statutory, nationally validated Core Suite of Integration Indicators are complemented by activity, experience, and outcome data that are gathered and analysed at local level. This includes the half year and year end Directions reports, which provide evidence of progress towards the IJB’s Strategic Plan 2025-35. This wider approach to performance reporting supports the inclusion of locally selected indicators that are designed to be reflective of the services and support within the IJB’s oversight. 3.9 Audit Scotland recognise that unlike secondary care, where waiting lists and times are regularly monitored nationally, it is not easy to define or measure demand for community health and social care. As an alternative, they provide proxy measures that they state, ‘clearly indicate that pressure on services has increased’. These proxies are: an ageing population, growing numbers of people with one or more health conditions, an increased impact of long-term conditions on the population, and widening health inequalities. 3.10 The metrics that Audit Scotland identify as providing evidence that Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) are struggling to meet increasing demand across health and social care are: Population increase Proportion of people aged 65+ Proportion of people that are unpaid carers Proportion of people living in Midlothian with long-term health conditions Proportion of people living in Midlothian with mental health issues. 3.11 Following an examination of the data currently available, Midlothian tracks the national average on every metric listed above except population increase. During the period 2014 - 2024 the population in Midlothian increased by almost 15%, compared with a 4% increase across Scotland (Chart 1, Appendix 1). This presents a challenge of scale to Midlothian IJB that is significantly above the average. 3.12 However, evidence of an overall increase in number does not necessarily provide the level of insight required to understand changes in demand, without knowing more about how the profile of the population may be changing. These metrics are broad and there is no system to describe complexity: for example, when someone is aged 65+, living with a long-term condition, and supporting someone as an unpaid carer. The development of the ability to demonstrate data intersectionality is key to understanding complexity and vulnerability. 3.13 The increased impact of disease on the population is forecast to increase by 21% by 2043 (Public Health Scotland Burden of Disease 2022). The potential impact of this Page 70 of 208
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Midlothian Integration Joint Board projected increase is challenging to predict at local level, as it requires resource and governance for detailed data analysis and modelling. 3.14 Health inequalities persist in national datasets, but health life expectancy data are not currently available by SIMD, so it is not currently possible to make comparisons at locality level. The National Records of Scotland (NRS) plan to include estimates by area deprivation and urban and rural areas in their next Healthy Life Expectancy publication. 3.15 Since September 2019 longer waits for secondary care have increased significantly. By June 2025, the increase in Midlothian was over 700%. The increase across Scotland as a whole was more than 2000% (Chart 5, Appendix 1). Without further investigation into this data, it is very difficult to draw any local conclusions. 3.16 Audit Scotland state that longer waits for secondary care increase the demand for primary health and social care services. Existing Information Governance limitations within Midlothian prevent the integration of health and social care data, so it is not currently possible to investigate, analyse, and visualise any possible relationship between long waits for secondary care and increases in requirements for social care services. 3.17 The Royal College of GPs noted in February 2026 that about a quarter of working time for general practice doctors in Scotland is spent supporting patients who are waiting for specialist appointments, placing a "significant and unsustainable pressure" on staff. General practice services are provided within an independent contract model, and Midlothian IJB has therefore proposed a Direction to work with the NHS Lothian Primary Care Board to scope and recommend viable opportunities for collaborative change, focusing on jointly agreed priorities with a shared commitment to change financial flow from acute hospital services to the community designed to sustain and expand general practice alongside local community Primary Care services. 3.18 In the ‘Integration Joint Boards (IJBs): Finance and Performance 2024’ briefing, the Accounts Commission concluded that ‘data quality and availability is insufficient to fully assess the performance of IJBs and inform how to improve outcomes for people who use services with a lack of joint data sharing’. Audit Scotland state that this continues to be the case, and the following examples must be addressed: a consistent method for recording unmet need data about the impact and use of eligibility criteria for social care services across the country the impact of muti-disciplinary teams in primary care the quality of data on levels of self-directed support a coordinated approach to anticipating future demand for and costs of delivering services value for money assessments of local and national initiatives. 3.19 In the six month time lapse since the publication of this report, Audit Scotland have not made any progress in developing clear solutions to the performance measurement challenges they set out, other than having produced their data dashboard of existing metrics. Page 71 of 208
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Midlothian Integration Joint Board 3.20 Multiple IT systems, information governance barriers, inconsistent data quality, and limited digital infrastructure to gather data remains a system wide challenge. In addition, and in the context of significant commissioning budgets, this information is often absent from contract reporting from many independent and Third Sector service providers who provide commissioned services on behalf of the HSCP. Without complete whole system information there will remain barriers to the ability to gather the comprehensive and consistent information needed to fully assess performance across the country. 3.21 The Scottish Government, alongside COSLA, have committed to address consistent information provision and the Health and Social Care Service Renewal Framework states that ‘We will build on the work already undertaken to identify gaps in our data landscape and make improvements’. It also states ‘We will work with partners across Local Government and more widely to adopt the use of Community Health Index number (CHI) in Local Government, ensuring that there is a common identifier for verification and data matching to support better information sharing across organisations’. 3.22 However, the use of CHI is currently protected by legislation so this will not be an immediate solution to the challenge of integrating health and social care data. Viable local solutions in line with national ambitions have been proposed and await a decision from the Chief Social Work Officer as Data Controller on how to proceed. 3.23 Audit Scotland state that there is a ‘long-term picture of generally declining performance and satisfaction’. The data have been examined and are presented in detail within the Data Appendix (Appendix 1). Key points are set out below: 3.24 Audit Scotland state that there has been insufficient progress shifting the balance of care to the community and to prevention. There is however no discussion regarding the resource needed to achieve this, the new metrics required to measure it, and the research that would create the evidence base for changes to practice. There is no recognition of the need for linked datasets, to establish whether it is population growth, increased transfer of the balance of care, or both that are driving service demand. 3.25 The metrics that Audit Scotland identify as providing evidence of insufficient progress shifting the balance of care to the community and to prevention are: Falls rate Telecare Emergency Admissions Delayed Discharges (75+) Wait for Social Care Assessment Wait for Package Of Care Percentage of adults with intensive care needs receiving care at home Proportion of the last six months of life is spent either at home or in a community setting. Page 72 of 208
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Midlothian Integration Joint Board 3.26 These metrics are limited in their ability to inform meaningful performance due to a number of factors. The Falls rate is actually a measure of falls-related emergency hospital admissions for people aged 65+. Emergency Admissions and Delayed Discharges are both measures of hospital activity. Telecare, and waits for assessment and packages of social care can only be counted in isolation, rather than being linked to health that would inform faster risk stratification and appropriate resource allocation. The final two metrics are process measures that do not reflect individual preferences and decisions about care. 3.27 Audit Scotland state that the amount of choice and control service users feel they have remains variable, and notes that the Social Care (Self-Directed Support) (Scotland) Act 2013 set out how councils should offer people options for how their social care is managed. However, four out of the six metrics they provide as evidence relate directly to care provided by General Practice. 3.28 The metrics that Audit Scotland identify as providing evidence of variable choice and control are: Adults supported at home agreed that they had a say in how their help, care or support was provided The proportion of respondents to the Health and Care Experience Survey indicating it is easy to contact their general practice Satisfaction with the care that people receive from their general practices The proportion of people provided with advanced booking of a GP appointment (three or more working days in advance) The proportion of people that agreed they were given enough time at their GP practice The majority of carers do not feel supported to continue in their caring role – national challenge 3.29 As set out in 3.16, General Practice is delivered within an independent contract model, meaning the metrics are of limited value to IJBs when considering Board performance. The metric that relates to adults being supported at home is taken from the biannual Health and Care Experience Survey, which is only sent to a sample of people living in Midlothian, based on their GP registration. The impact of this is that the sample size of respondents is very small: for the Midlothian level 2024 data, there were 100 responses to this question. This risks the score being given a disproportionately high profile, because there is no context provided, for example the overall number of adults being supported at home. 3.30 Audit Scotland state that there is a gap between the ambitions to address health inequalities and progress with improvement. Audit Scotland note the health inequality gap in the total life expectancy between Scotland’s most and least deprived areas, and that areas with higher levels of deprivation are more likely to have higher levels of emergency bed day rates than areas that are more affluent. The challenges created by economic deprivation, both at individual and community level, are already very well- understood across Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs). Page 73 of 208
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Midlothian Integration Joint Board 3.31 Integration Authorities (IAs) and Health and Social Care Partnerships (HSCPs) have limited mechanisms available to them to reduce poverty, which is the single largest driver of health inequality. The majority of services known to have a positive impact on the social determinants of health are delivered by Local Authorities (housing, education, access to green spaces, etc). However, the inability to link data across organisations continues to limit the ability to understand the impact of contributions at system level. 3.32 Audit Scotland recommend that Public Health Scotland should over the next year, agree a comprehensive suite of indicators that draws on and modifies existing measures as appropriate and addresses current gaps in information. Audit Scotland recommend this is done in consultation with Integration Authorities (IAs), Health and Social Care Partnerships (HSCPs),and other stakeholders, such as the Care Inspectorate, Healthcare Improvement Scotland and the Improvement Service, to agree and roll out a programme to assess the current measures for monitoring performance across community health and social care. The suite should support performance monitoring and decision-making at a national and local level. 3.33 The suggested approach of drawing on and modifying existing measures carries a significant risk that the creativity required to generate a meaningful measurement framework will remain limited by historic reliance on secondary care datasets. It is also not known whether Public Health Scotland have been consulted or have the capacity to support this ask. It will be vital as part of this work to consider the value currently placed on retrospective evaluations using lagging indicators, which play a key role in assurance, but are frequently descriptive, rather than directive. To ensure that IJBs are well-informed in relation to their strategic planning duties, there is an opportunity to identify a set of leading indicators that can better direct decision- making and actions. 3.34 Audit Scotland also recommend that Public Health Scotland should centrally manage the collection, cleansing and management of the data, and organise the performance information into a publicly accessible dashboard. The Audit Scotland recommendation is that the suite of indicators should be maintained on an ongoing basis and annually reviewed to ensure the measures and the definitions of each remain relevant to supporting planning, monitoring and evaluation of delivery. 3.35 However, Public Health Scotland, the Improvement Service, NRS, Local Authorities, Health Boards, and HSCPs have already built / provide access to a significant number of data dashboards. It is vital that any new work to develop further products includes a mapping activity to reduce the significant duplication of effort across the system that is currently occurring. 3.36 Audit Scotland recommend that over the next six months Integration Authorities (IAs), Health and Social Care Partnerships (HSCPs) should use the interactive data tool to compare performance with other areas. Please see the Data Appendix (Appendix 1) for the results of this exercise. 3.37 Midlothian IJB already publishes a range of documents that satisfy the Audit Scotland recommendation to ensure Midlothian IJB both understands and explains in public reports their relative performance in terms of local context, priorities, policy and Page 74 of 208
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Midlothian Integration Joint Board operational decisions, and provide a performance analysis alongside local data to support benchmarking, self-assessment and the development of improvement plans. 3.38 These key documents meet statutory duties and comply with accessibility legislation, and include (but are not limited to): Our Strategic Plan, Directions, and Impact Assessment Housing Contribution Statement Market Facilitation Plan Consultation and Engagement Statement Performance Framework Participation and Engagement Statement Carer's Strategy and Impact Assessment Annual Performance Report Equality Outcomes Impact Assessments Annual Accounts Integrated Workforce Plan Health and Care Staffing Act Annual Report 3.39 The Data Appendix (Appendix 1) contains a summary of Midlothian performance against the indicators in the Audit Scotland dashboard. However, these indicators have never been effective measures of integration, of prevention, or of the transfer of the balance of care from hospitals to the community. 3.40 The performance metrics that integration authorities are evaluated against are not outcomes measures, nor do they capture prevention or population health impact, and simply provide a read on productivity through a specific lens rather than the whole picture. 3.41 Conclusions Performance evaluation should be about more than just numbers. A focus on the interpretation required for us to be curious and consider the local consequences of action or inaction, should drive the strategic changes to the board's path as a result. For example, is activity growing faster than cost in real terms? What would our activity look like if it were cost-weighted, or inflation-adjusted? Can we see appropriate shifts in activity like increased community care linked directly to decreased hospital occupancy? 3.42 Thoughtful interpretation can support better board-level dialogue about value as ultimately what matters. The questions members may wish to consider include exploring include examining the thread between strategy, decisions, and outcomes. Used well, this can sharpen conversations about operational delivery and financial grip and control. 3.43 The legislation relating to IJB reporting requirements will require to be reviewed in the event of any changes. Midlothian HSCP officers currently undertake the activities associated with gathering, analysing, and reporting on local supplementary / complementary data, within the limitations of local resource. This needs to be a consideration if the statutory reporting duties increase. Page 75 of 208
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Midlothian Integration Joint Board 4 Policy Implications 4.1 In January 2025 the Government announced 3 publications that will shape the future of health and social care in Scotland; the NHS Scotland Operational Improvement Plan, the Health and Social Care Service Renewal Framework and Scotland’s Population Health Framework. The 5 principles of the Service Renewal Framework focus on prevention, people, community, population planning and digital innovation. Midlothian IJB have always understood that people, not services, are at the centre of our decisions and the Health and Social Care Service Renewal Framework is in alignment with the Board’s vision. 4.2 Scottish Government are in the process of conducting a review of the National Performance Framework. Initial communications have suggested that the 81 existing indicators within the Framework are not currently within the scope of the review. As Audit Scotland have been clear in their findings that current health and social care indicators are not fit for purpose, Midlothian IJB may wish to raise this with Scottish Government as an opportunity to align these ambitions within a single, coordinated, national workstream with dedicated resources, and commitment to make any required changes to legislation. 5 Directions 5.1 There are no direct implication for Directions as a result of this report. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. 6.2 As this report is a response to the Audit Scotland briefing paper that assesses the national performance in relation to Community Health and Social Care Performance, there is no requirement to undertake an ECRIA as a result of this report. 7 Resource Implications 7.1 There are no resource implications as a direct result of this report. 8 Risk 8.1 There is a risk that failure to build credible data to evidence community health and social care activity, experience, and outcome, will contribute to the continued inability to accurately report Integration Authority (IA), Health and Social Care Partnership (HSCP) progress towards the national health and wellbeing outcomes. Page 76 of 208
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Midlothian Integration Joint Board 9 Involving people 9.1 This report has been written in consultation with officers of Midlothian IJB, and with the Midlothian HSCP Executive Leadership Team. 10 Background Papers 10.1 Author’s Name and Designation Elouise Johnstone, Programme Manager Performance and Improvement Gill Main, Integration Manager Contact Information Via email or MS Teams Date 17 March 2026 Appendices Appendix 1: Data Appendix Page 77 of 208
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Chart 1: Growing Population (% increase) Following an examination of the data currently available to Midlothian IJB, it can be evidenced that during the period 2104 - 2024 the population in Midlothian increased by almost 15%, compared with a 4% increase across Scotland (Chart 1, Appendix 1). This presents a challenge of scale to Midlothian IJB that is significantly above the average. Evidence of an overall increase in number does not necessarily provide the level of insight required to understand changes in demand, without knowing more about how the profile of the population may be changing. Chart 2: Ageing population: During the period 2014 - 2024 the proportion of people aged 65+ increased in Midlothian (1.3 percentage points) at a similar rate to Scotland (2.3 percentage points (Chart 2, Appendix 1). Midlothian tracks the national average for this indicator. % Increase in proportion of people aged 65+ 18.2 20.5 18.1 19.4 Scotland Midlothian 21 20 19 18 17 16 2014 2024 Percentage increase 4 14.96 Scotland Midlothian 16 14 12 10 8 6 4 2 0 Page 80 of 208
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Chart 3: More unpaid carers: By 2022 the proportion of people that are unpaid carers in Midlothian was 12%, which is the same as Scotland (Chart 3, Appendix 1). Midlothian tracks the national average for this indicator. Chart 4: More people with long-term health conditions and mental health issues 2011–22: From 2011 - 2022 the proportion of people living in Midlothian with long-term health conditions increased by 2.3 percentage points to 20.7%, which was slightly below the Scotland figure of 21.4% (Chart 4, Appendix 1). Midlothian tracks the national average for this indicator. From 2011 - 2022 the proportion of people living in Midlothian with mental health issues increased by 6.6 percentage points to 10.7%, which was slightly below the Scotland figure of 11.3% (Chart 4, Appendix 1). Midlothian tracks the national average for this indicator. Proportion of people that are unpaid carers (%) 9.4 12 9.9 12 Scotland Midlothian 14 12 10 8 6 4 2 0 2011 2022 Proportion of people with long-term health conditions and mental health issues (%) 18.7 18.4 4.4 4.2 21.4 20.7 11.3 10.7 Long term illness Mental health condition Long term illness Mental health condition 2011 2022 45 40 35 30 25 20 15 10 5 0 Scotland Midlothian Page 81 of 208
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Chart 5: Longer waiting times for secondary care 1,640 36,694 166 1,337 40,000 35,000 30,000 25,000 20,000 15,000 10,000 5,000 0 Scotland Midlothian Sept 2019 Jun 2025 Since September 2019 longer waits for secondary care have increased significantly. By June 2025, the increase in Midlothian was over 700%. The increase across Scotland as a whole was more than 2000% (Chart 5, Appendix 1). Without further investigation into this data, it is very difficult to draw any local conclusions. Audit Scotland note the ‘rate of falls for individuals over 65’* has remained generally consistent nationally since 2018/19 but the rate varies significantly across the country. In 2023/24 the Midlothian rate was 24.1, which was the largest national increase from the previous year (24.6%). *Please note: this indicator is not a rate of falls for individuals over 65. It is a rate of patients aged 65 plus, who are discharged from hospital with an emergency admission code 33 - 35 and ICD10 codes W00 - W19. Audit Scotland note the number of people with community alarms and/or telecare is lower nationally than before the pandemic. Midlothian data showed a similar pattern, however more recent data for 2024/25, the Midlothian data reported via the SOURCE return (to PHS) showed a slight increase. Audit Scotland note the rate of emergency admissions is nationally slightly below pre- pandemic levels but there were recent increases across the majority of IA areas. From 2018/19 to 2023/24, Midlothian emergency admissions have decreased. Audit Scotland note the continued challenge in relation to delayed discharges from hospital has remained challenging. This is an area of sustained improvement in Midlothian, with a reduction of 55% in the number of days spent in delay for people aged 75+ (from 2018/19 to 2023/24). Page 82 of 208
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Audit Scotland note the data suggests that between April 2024 and the end of March 2025, the number of individuals waiting for a social care assessment and those waiting to receive a care at home package reduced. In Midlothian the total hours waiting has reduced by approximately 31% in the last 5 months. Audit Scotland note that progress to increase the percentage of adults with intensive care needs receiving care at home is limited. Since 2018, the level has increased by only 2.5 percentage points to 64.7 per cent in 2024. Midlothian performance against this indicator fell by 10 percentage points between 2018/19 and 2023/24. Audit Scotland note that a significant proportion of the last six months of life is spent either at home or in a community setting. In 2023/24, an estimated 88.9 per cent of the last six months of peoples’ lives were spent either at home or in a community setting. Midlothian are close to the national average on this indicator, and there is minimal variation across Scotland. The latest data available shows that the percentage of people who have a choice of how they receive social care services and support, through self-directed support options, is increasing but the levels are variable across the country. For 2024/25 Midlothian reported via the SOURCE return that 1,485 clients were receiving care via SDS. (The approach of recording SDS across Local Authorities varies greatly, so any national comparison should be done with caution.) In 2023/24, 60 per cent of adults supported at home agreed that they had a say in how their help, care or support was provided, leaving two in five adults feeling they had less influence. Midlothian performance against this indicator fell by 17.8 percentage points between 2017/18 and 2023/24. The proportion of respondents to the Health and Care Experience Survey indicating it is easy to contact their general practice has dropped nationally from 87 per cent in 2017/18 to 76 per cent in 2023/24. Midlothian’s performance against this indicator has improved, with a 6 percentage point increase over the same time period. Satisfaction with the care that people receive from their general practices has decreased nationally compared with 2017/18. In 2023/24, 69 per cent of survey respondents said the care was excellent or good, but this is 14 percentage points lower than in 2017/18. The corresponding fall in Midlothian was smaller at 8 percentage points over the same time period. Page 83 of 208
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The proportion of people provided with advanced booking of a GP appointment (three or more working days in advance) has decreased nationally by 18 percentage points compared to pre- pandemic levels. Midlothian performance against this indicator fell by 12 percentage points between 2019/20 and 2023/24. The proportion of people that agreed they were given enough time at their GP practice has increased nationally by two percentage points between 2021/22 to 2023/24 but remains below pre-pandemic levels. Midlothian performance against this indicator fell by 2 percentage points between 2017/18 and 2023/24. The majority of carers do not feel supported to continue in their caring role. The proportion that feel supported has increased very slightly nationally between 2021/22 and 2023/24 (two percentage points) but since 2017/18, has decreased by over five percentage points to 31.2% of respondents. Midlothian performance against this indicator fell by 2.5 percentage points between 2017/18 and 2023/24. Page 84 of 208
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Midlothian Integration Joint Board Thursday, 2nd April 2026, 14:00-16:00 Midlothian Integrated Assurance Report Executive summary This report is presented to provide the Midlothian Integration Joint Board with assurance around the processes in place to deliver clinical and care governance and risk and resilience management by the Midlothian Health and Social Care Partnership. The Board is asked to take moderate assurance that relevant policies and robust mechanisms are in place to assess and manage risk and ensure service safety and resilience. Midlothian HSCP promotes a culture of shared learning and improvement. The Executive Leadership Team of the HSCP reviewed its approach to the oversight of safe, effective, and person-centred care and professional governance in December 2025 and decided that a refreshed approach to Clinical and Care Governance will be developed in 2026. The Clinical and Care Governance Group (CCGG) now has a streamlined membership and is chaired by the Joint Director. Group Service Quality Management Groups (QMGs) have been introduced to the CCGG structure. Heads of Service/ equivalent will now bring the quarterly assurance report for their services. The Governance and Assurance Framework (GAF) continue to be a core element of assurance reporting in the HSCP. Specialist groups meet to focus on professional and subject-specific oversight including attention to identified risks and most common reported harms. The Social Work Assurance group (SWAG) provides a locus for the delivery of assurance for all Social Work Services in the HSCP. Service Managers will present a summary report at an annual CCGG review convened to share learning, celebrate success, and identify themes for improvement work. Item number: 5.10 Page 85 of 208
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Midlothian Integration Joint Board Aligned to Directions and the Strategic Plan, Group Service, Service, and Team Plans are in place across the HSCP, and operational and professional escalation routes are in place to ensure appropriate action is taken to address identified risks. The Partnership’s structures and processes for risk management, resilience and major incident planning meet the requirements of Midlothian Council and the Lothian NHS Board. This includes the maintenance of the Partnership’s Risk Register and processes which support the appropriate escalation of identified risks. As a result of this report, Members are asked to: To discuss and approve the contents of this report. Page 86 of 208
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Midlothian Integration Joint Board Report Midlothian Integrated Assurance Report 1 Purpose 1.1 This is the Integrated Assurance report provided by the Midlothian HSCP to the Midlothian Integration Joint Board (IJB). 2 Recommendations 2.1 As a result of this report, Members are asked to: To discuss and approve the contents of this report. 3 Background and main report 3.1 This report updates the IJB on the activity undertaken to provide assurance around the delivery of safe, effective, and person-centred care in Midlothian and the processes in place to cover risk and resilience. 3.2 5 Governance Groups report to the Senior Management Team (SMT) and Executive Leadership Team (ELT): Clinical and Care Governance, Finance and Performance, Business Governance, Digital Programme Board, and the Partnership Forum. Work continues to ensure that areas highlighted as medium or low assurance by services in the Governance and Assurance Framework are additionally reviewed by the relevant Governance Group (see Appendix 1). Risk is a standing item within the terms of reference of all six groups. Workforce Governance is addressed within SMT and ELT business and is a key element of the monthly Integrated Partnership Forum. 3.3 Clinical and Care Governance and Assurance Structure and Processes Midlothian HSCP promotes a culture of shared learning and improvement. The Executive Leadership Team of the HSCP reviewed the approach regarding oversight of safe, effective, and person-centred care and professional governance in December 2025 and decided that a refreshed approach to Clinical and Care Governance will be developed in 2026. 3.4 The Clinical and Care Governance Group (CCGG) meets quarterly to maintain oversight of the safety, effectiveness, and person centredness of Midlothian Health and Social Care Partnership (MHSCP) services. This group has previously taken assurance reports on a quarterly basis from 13 Service level Quality Management Groups (QMGs). Page 87 of 208
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Midlothian Integration Joint Board Going forward, the Clinical and Care Governance Group (CCGG) will be chaired by the Joint Director and have a streamlined membership to receive assurance and have oversight and scrutiny of quality and safety across all MHSCP services. A Group Service Quality Management Groups (QMGs) convened by Heads of Service/ equivalent Professional Leads has been introduced to the structure. These groups will receive reports from service level QMGs. Heads of Service/ equivalent will attend the CCGG to deliver the quarterly assurance report for their services. Rather than attending the quarterly CCGG, Service Managers will present an annual summary at an Annual Review Meeting where there will be opportunities to share learning, celebrate success and identify themes for improvement work. Healthcare Improvement Scotland (HIS) recently published Clinical Governance Standards for the NHS in Scotland, and this was accompanied by a self-assessment tool. This offers the HSCP opportunity to self-assess and benchmark its approach to Clinical and Care Governance and identify areas for improvement. 3.6 Group Service, Service and Team Plans have been in place across the HSCP since April 2023. The associated implementation of the Governance and Assurance Framework (GAF) and the governance structure described in para 3.2 and illustrated in (Appendix 1) aim to provide the ELT with a complete picture of the assurance being provided and any identified risks to the delivery of clinical services and social care being reported across all services at every meeting of the CCGG. Escalation protocols are in place to ensure that emerging risks are identified and addressed in a timely and appropriate manner. 3.7 Group Service level Quality Management Groups (QMGs) report to the CCGG on the systems, processes, and evidence of clinical and care governance, risk management, and quality management activity. The QMGs are expected to meet at least four times per year and submit a quarterly Governance and Assurance Framework submission and completed CCGG template. The quarterly reporting template collates evidence for assurance and provides information about actions in place relating to the learning arising from investigation of adverse events and complaints, implementation of actions around safety alerts, specific standards and guidance, improvement work, action plans arising from audit and inspection activity and any other service-specific issues which could have impact on the quality and safety of care the service provides. 3.8 The GAF continues to evolve, reflecting learning across our system, changes in our structures and modifications to the digital application. This continues to drive a culture of learning alongside the provision of oversight of assurance levels across the system. 3.9 Completion rates for the GAF continue to be monitored. Simple digital reminders ensure teams collate system data and use the framework to facilitate discussions across the safe, effective, person centred and regulatory domains. The digital application is used to input the consensus reached in terms of impact, assurance, and overall governance across the measures within the domain areas. Tableau interfaces with the GAF application to provide a digital dashboard for oversight across the HSCP (Appendix 2) Quarterly reporting to the Executive Leadership Team provides oversight of the assurance levels across all areas of responsibility. Service Managers have responsibility to follow up the progress of their action plans through line management processes and within Clinical and Care Governance mechanisms for good practice and learning to be shared. Page 88 of 208
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Midlothian Integration Joint Board 3.10 The role of Chief Social Work Officer, which carries statutory functions sits within the HSCP with the Head of Adult Services as Chief Social Work Officer for Midlothian Council. The CSWO is a member of the IJB. 3.11 QMG processes are integrated, and managers’ report on all HSCP business, thus providing assurance regarding social work services. The oversight of the Social Work Assurance Group (SWAG) combines with the Governance and Assurance Framework and QMG/CCGG processes to provide assurance for all Social Work services in the HSCP. The SWAG meets fortnightly and is chaired by the CSWO with attendance from the Deputy CSWO and the Group Service Manager for the HSCP. It provides leadership and assurance regarding statutory/regulatory improvement activity (i.e. Mental Welfare Commission and Care Inspectorate inspections of internally provided services). 3.12 All new Policies and Procedures for Social Work services are approved at SWAG, and it has a role in overseeing audit and quality assurance work. SWAG covers all social work services in Midlothian including those services which are outwith the delegated functions of the Midlothian IJB. 3.13 Clinical and Care Governance Group The Clinical and Care Governance Group meets on a quarterly basis and is now chaired by the Joint Director/Chief Officer. Since the last report to the IJB, two meetings have taken place. 3.14 Midlothian HSCP will provide its Annual Assurance Report to the NHS Lothian Healthcare Governance Committee in September 2026. In 2025, the Committee accepted moderate assurance that Midlothian HSCP has comprehensive systems in place to deliver safe, effective and person - centred care. 3.15 Investigating and Learning from Adverse Events and Complaints 3 groups provide oversight of all significant adverse events reported within NHS Lothian services delivered by Midlothian HSCP. Specific groups address in-patient falls at Midlothian Community Hospital, and pressure ulcers which are two of the most common reported harms. A Morbidity and Mortality Review group is established at Midlothian Community Hospital to undertake multidisciplinary review of unexpected in-patient deaths as a further measure to develop learning to improve the delivery of safe care. 3.16 The Midlothian Safety and Experience Action Group (MSEAG) has oversight of all significant adverse events (adverse events which result in harm assessed as moderate or above), including the death or suicide of patients engaged with mental health and substance use services or unexpected medical deaths. This group commissions external reviews of major harm or death significant events in line with NHS Lothian protocols. The MSEAG minutes are submitted to the MHSCP Senior Management Team, and all Serious Adverse Events approved as complete in Midlothian require the approval of the NHS Lothian Medical Director and Executive Nurse Director before final closure. Page 89 of 208
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Midlothian Integration Joint Board 3.17 Midlothian HSCP Senior Management Team (SMT) receives a monthly report of performance in the management of complaints and the reporting and management of adverse events on the Datix system. Datix is a web-based tool which can be accessed by all NHS Lothian staff to report and learn from safety concerns, adverse events with harm and near misses. It supports the collection and analysis of information to inform action plans which support safety and quality improvement. The system also provides modules to support the administration of Complaints, Claims and Risk Registers, to provide an integrated information system. MSEAG undertakes quarterly review of themes and learning arising from complaints and adverse events, which are also addressed at quarterly NHS Lothian performance meetings chaired by the NHS Lothian Deputy Chief Executive. 3.18 At the time of writing 11 Significant Adverse Event (SAEs) are open in Midlothian HSCP; 2 have been approved locally and are being managed towards final sign off by NHS Lothian Quality Improvement Support Team (QIST). External independent review of on SAE is being progressed for 2 and the remaining 7 are under local investigation. Chart 1 shows Midlothian Significant Adverse events reported over the last 18 months. Chart 2 shows SAE closures over the same period. The fortnightly Midlothian Safety and Experience Action Group maintains an overview of work to progress Serious Adverse Event reviews, supporting reviewers to progress investigations, complete review documentation to agreed standards and managing performance against KPIs. A backlog in pressure ulcer reviews which developed due to demand pressures in District Nursing has been addressed, and one Local Management Review is significantly beyond the 70-day target for completion pending finalisation of an agreed action plan; support is being provided to complete the plan although assurance is provided that all immediate actions required to ensure service safety were implemented swiftly.. Work continues to support actions that will enable local teams to address all adverse events within the Healthcare Improvement Scotland performance indicators and assure the quality of the reviews and the implementation of learning gained. Ongoing review of learning needs is undertaken and the SMT works with the NHS Lothian QIST to discuss actions required and to enable appropriate learning opportunities to be identified and delivered. 3.19 Outstanding actions from previously investigated Significant Adverse Events are recorded on Datix and continue to be monitored by the MSEAG to ensure that they are completed. Page 90 of 208
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Midlothian Integration Joint Board Chart 1: Midlothian Serious Adverse Events reported at 9th March 2026 Sep-24 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May- 25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 6 5 4 3 2 1 0 Midlothian HSCP SAEs Reported within the last 18 months Data Mean Line chart titled ‘Midlothian HSCP SAEs Reported within the last 18 months’, showing monthly SAE counts from September 2024 to March 2026. Values vary between 1 and 5 with frequent rises and falls. A horizontal mean line sits just under 3, showing no clear upward or downward trend over the period. Chart 2: Midlothian Serious Adverse Events closed at 9th March 2026 Oct-24 Nov-24 Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May- 25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Dec-25 Jan-26 Feb-26 Mar-26 6 5 4 3 2 1 0 Midlothian HSCP SAEs Closed within the last 18 months Data Mean Page 91 of 208
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Midlothian Integration Joint Board Line chart titled ‘Midlothian HSCP SAEs Closed within the last 18 months’, showing monthly SAE closures from October 2024 to March 2026. Values range from 0 to 6, with peaks in December 2024, March 2025, October 2025, and February 2026. Lowest values of 0 occur in February 2025 and January 2026. A horizontal mean line sits just under 3. Overall, the data fluctuates with no clear upward or downward trend. 3.20 It has previously been acknowledged that processes for the reporting of adverse event management and oversight for Midlothian Council services within the HSCP currently remain less mature than for Health. A paper was agreed at Council Corporate Management Team in March 2025. This paper set out recommendations for the progress of a short life working group (from the three Council Directorates) to take forward the development of a Council Policy and Procedure relating to Adverse Events. Within the HSCP, governance for this will be provided by Social Work Assurance Group (SWAG). 3.21 Well established incident reporting and investigation processes are in place in regulated social care services (e.g. Home Care, Care Homes, and Day Services) operated by Midlothian HSCP. Registration of these services makes them subject to routine external scrutiny by the Care Inspectorate, and external inspection mechanisms include assessment of risk assessment and risk management processes. Electronic reporting mechanisms are in place ensure that the Care Inspectorate is informed of, and has the opportunity to review, the investigation and actions arising from all reported adverse events involving the safety and wellbeing of service users, with benchmarking undertaken to assess the level of reporting activity against industry norms. 3.22 The Social Work Assurance Group (SWAG) provides a route for the governance of all Council Social Work and Social Care services and, has proven to be key in providing assurance that services are operating well and safely. The Chief Social Work Officer chairs this group and standing agenda items include strategic inspections, registered services inspections, Mental Welfare Commission Reports, learning review outcomes and shared policy and procedure developments. SWAG also provides a forum for sharing learning arising from adverse events within Social Work services. 3.23 Complaints are generally managed through the respective organisations’ complaints handling processes, although efforts are made to respond in an integrated way where required and appropriate. Elected Member, MP, and MSP enquiries tend to be channelled through a Council route and are usually managed by respective Heads of Service. 3.24 Performance against KPIs and an analysis of themes and learning from complaints received in relation to NHS Lothian services delivered within the MHSCP is monitored by MSEAG and reported to quarterly NHS Lothian performance review meetings. Data up to November 2025 from the report received from the NHS Lothian Patient Experience team on 16th January 2026 are presented here. 3.25 Charts 3 and 4 illustrate the numbers of complaints received via the NHS complaints processes which relate to services delivered within the Midlothian HSCP. Page 92 of 208
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Midlothian Integration Joint Board Chart 3: Number of Stage 1 complaints received Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 3 2 1 0 Stage 1 Complaints by Month Midlothian HSCP Line chart titled ‘Stage 1 Complaints by Month’, showing monthly complaint volumes from December 2024 to November 2025. Complaints peak at 3 in January and February 2025, fall to 0 in April and June, and otherwise range between 1 and 2 per month. Overall, the trend shows fluctuations with no sustained increase or decrease across the year Chart 4: Number of Stage 2 complaints received Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May-25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 5 4 3 2 1 0 Stage 2 Complaints by Month Midlothian HSCP Page 93 of 208
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Midlothian Integration Joint Board Line chart titled ‘Stage 2 Complaints by Month’, showing monthly complaint volumes from December 2024 to November 2025. Complaints peak at 5 in February, June, July, and November 2025. Volumes fall to 1 in December 2024 and May 2025 and otherwise range between 2 and 4 across the remaining months. Overall, the trend shows recurring fluctuations with no consistent upward or downward pattern throughout the year. 3.26 Chart 5 & 6 illustrates performance regarding Stage 2 complaints responses and shows that over the period October – November 2025 the 20-day target for the provision of a response was not met for 5 complaints. Key contributing factors to delayed responses included service pressures (including non-availability of staff due to absence and annual leave), and the co-ordination of complex complaints across different services /directorates/ HSCPs. Chart 5: Number of Stage 2 responses exceeding 20-day KPI Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May- 25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 5 4 3 2 1 0 Stage 2 Complaints > 20 days by Month Midlothian HSCP Line chart titled ‘Stage 2 Complaints > 20 days by Month’, showing monthly counts from December 2024 to November 2025. Values remain at 0 for most months, with small increases to 1 in March 2025 and 2 in April 2025. A sharp rise occurs in November 2025, reaching 5. Overall, the chart shows minimal activity until a significant spike at the end of the period. Page 94 of 208
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Midlothian Integration Joint Board Chart 6: % achievement of Stage 2 responses within 20-day KPI Line chart titled ‘Stage 2 Complaints < 20 days (%) by Month’, showing monthly percentages from December 2024 to November 2025. Most months sit at 100%, with drops to 50% in March and April 2025, a decline to 67% in October 2025, and a low of 20% in November 2025. Overall, performance is consistently high except for three notable dips mid-year and at the end of the period. 3.27 Work continues to share learning from the investigation of adverse events and complaints and to improve local services in line with findings and recommendations. 3.28 Clinical and Professional Oversight of Care Homes The Scottish Government published My Health, My Care, My Home - Healthcare Framework for Adults Living in Care Homes in June 2022. An Advice Note on Enhanced Collaborative Clinical and Care Support for Care Homes issued on 14 December 2022 provides guiding principles and a framework to continue cross sector work to continue to improve the health and wellbeing of people living in care homes. Work is continuing in Midlothian and on a pan-Lothian basis to ensure these recommendations are met and that partners involved in the delivery of care home services are engaged in shaping the model going forward. The approach recognises that the role of the HSCP is different 100% 100% 100% 50% 50% 100% 100% 100% 100% 100% 67% 20% Dec-24 Jan-25 Feb-25 Mar-25 Apr-25 May- 25 Jun-25 Jul-25 Aug-25 Sep-25 Oct-25 Nov-25 Stage 2 Complaints < 20 days (%) by Month Page 95 of 208
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Midlothian Integration Joint Board to that of the inspection and regulation responsibilities exercised by the Care Inspectorate. 3.29 Inspections The Clinical and Care Governance Group and the SWAG maintain oversight of the inspections undertaken by regulatory bodies, including the monitoring of action plans for improvements. Managers log service inspection reports with their QMG submissions. 3.30 Midlothian HSCP services are subject to external inspections from statutory bodies. This includes Healthcare Improvement Scotland, the Mental Welfare Commission, and the Care Inspectorate. These reports are lodged at SMT, and actions plans monitored operationally and reported through the QMGs, CCGG, The East and Midlothian Public Protection Committee, and the Social Work Assurance Group. Immediate action is taken when internal concerns or external inspections identify improvements which are required to address standards of care. Operational and professional leads have shared oversight of action plans. Implementation is led by Service Managers and progress monitored and supported through operational and care and clinical governance routes, ensuring the implementation of actions deliver sustainable improvement. 3.31 The Social Work and Occupational Therapy review commenced at the end of 2024. Five workstreams have been identified including ‘communication and engagement,’ ‘data, performance, and practice,’ ‘learning and development’ and ‘organisational structure.’ A working group has been convened with good representation from all professional areas impacted by the review and this group is instrumental in progressing the identified workstreams. To date, key progress has been made in reviewing the underpinning policies and procedures, Mosaic data has been scrutinised and roles and remits consulted on. This workstream sits as a Direction within the Strategic Plan and as a project within the Transformation agenda. 3.32 Through the QMGs, a more systematic approach to managing recommendations from Mental Welfare Commission themed reports has been developed. Generally, such reports have a range of actions for Scottish Government, NHS Boards and HSCPs. These are worked into an Action Plan for later submission back to the Mental Welfare Commission. Governance is provided by reports coming to the HSCP SMT and the Social Work Assurance Group (where appropriate). 3.33 Risk Management Midlothian HSCP is compliant with the NHS Lothian Risk Management Policy and Midlothian Council Risk Management Policy and Strategy. The Risk Management process within Midlothian was audited in 2021 and the finalised report confirmed that the Risk Management processes within Midlothian provided high assurance and demonstrated best practice in several areas: Midlothian HSCP Senior Management Team meets monthly, and risk is a standing agenda item. Service level risks registers are locally managed, and oversight is held by Heads of Service for review and escalation to the Senior Management Team (if required). Page 96 of 208
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Midlothian Integration Joint Board Risks are routinely monitored through these escalating levels with additional risk oversight held by Midlothian Council and Midlothian IJB both strategically and operationally. Each risk recorded either operationally or strategically have actions associated to mitigate the risk, these are routinely monitored through the appropriate level of monitoring as mentioned above. Each risk has a risk owner identified who is the accountable person for managing the related actions and providing routine updates on the status of the risk. 3.34 Resilience and Major Incident Planning Midlothian Health and Social Care Partnership support its partner organisations, NHS Lothian and Midlothian Council, to deliver their obligations to respond to incidents as Category 1 Responders under the Civil Contingencies Act (2004). 3.35 Midlothian Health and Social Care Partnership acts on behalf of Midlothian IJB to fulfil the Board’s role as a Category 1 Responder and works in cooperation with our partners Midlothian Council and NHS Lothian to meet this legal duty. 3.36 The Civil Contingencies Act (2004) places 7 legal duties upon Category 1 Responders: Duty of assess risk Duty to maintain emergency plans Duty to maintain business continuity plans Duty to promote business continuity Duty to communicate with the public Duty to share information Duty to co-operate 3.37 Midlothian Health and Social Care Partnership maintains major incident plans in line with NHS Lothian’s Resilience Policy and provides assurance through NHS Lothian’s reporting cycle on resilience, major incident planning, and business continuity. A virtual control room is in place for incident management along with physical control rooms in both Midlothian Community Hospital and Fairfield House. Service Managers are required to review and update their service-specific resilience and business continuity plans annually and these feed into the overarching Midlothian Health and Social Care Partnership Resilience Plan. 3.38 Training and staff awareness sessions are planned for 2025 – 2026 and lessons learned from resilience incidents are incorporated into future resilience preparedness and demonstrate the Partnership’s focus on continuous improvement. 3.39 Standard resilience exercises have taken place, both exercise and real events, as well as the preparations for winter planning. Annual callout and plan maintenance was completed in October 2025. In addition, there have been two resilience weather related incidents and a power cut incident in Dalkeith. Page 97 of 208
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Midlothian Integration Joint Board 3.40 Risk Register Operational risks are captured in the Partnership Risk Register, which is held on Datix. The risk register is reviewed and updated quarterly at Senior Management Team meetings, and risks are escalated when required to the NHS Lothian Corporate Risk Register and Midlothian Council Strategic Risk Profile. The Midlothian HSCP Risk Management Process is illustrated in (Appendix 3). 3.41 Midlothian HSCP mitigation plans contribute to the overarching corporate risk registers held by NHS Lothian and Midlothian Council. 3.42 The following risks on the NHS Lothian Corporate Risk Register are relevant to the Midlothian HSCP: 4 Hours Emergency Access Target Hospital Bed Occupancy 4 Policy Implications 4.1 The Board is asked to take moderate assurance that relevant clinical and care governance policies are implemented appropriately in Midlothian, and that robust mechanisms are in place to assess and manage risk and ensure service resilience. 5 Directions 5.1 Clinical and care governance, risk management, and resilience planning are implicit in various directions that relate to the delivery of care. 6 Equalities Implications 6.1 In supports of Midlothian HSCP’s compliance its equality duties, the Governance and Assurance Framework require services to provide assurance of compliance with Equalities duties, including the completion of Integrated Impact Assessments (ECRIA’s) where necessary. 7 Resource Implications 7.1 Resource implications are identified by managers as part of service development. and additional resource may at times be required to ensure required standards of clinical and care governance, risk management and resilience planning are met. The expectation is that these activities are embedded in service areas and teams and that staff have time built in to attend the relevant oversight groups and undertake the associated responsibilities. Page 98 of 208
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Midlothian Integration Joint Board 8 Risk 8.1 This report is intended to keep the IJB informed of governance arrangements and any related risks and to provide assurance to members around improvement and monitoring activity. 8.2 All risks associated with the delivery of services are monitored by managers and where appropriate they are reflected in the risk register. 9 Involving people 9.1 Midlothian staff are involved in the development and ongoing monitoring of processes related to clinical and care governance and risk identification, assessment, and management. 9.2 Public representatives on the IJB will have an opportunity to provide feedback and ideas. 10 Background Papers 10.1 N/A AUTHOR’S NAME Fiona Stratton, Claire Ross, Nick Clater, Dr Anna Beaglehole and Sandra Bagnall DESIGNATION Chief Nurse, Chief AHP, Head of Adult Services/Chief Social Work Officer, Clinical Director and Interim Executive Business Manager CONTACT INFO fiona.stratton@nhs.scot claire.ross4@nhs.scot nick.clater@midlothian.gov.uk anna.beaglehole@nhs.scot sandra.bagnall@nhs.scot DATE 13th March 2026 Appendices: Appendix 1: Governance and Assurance Framework Appendix 2: Midlothian HSCP Quarterly Governance Report January 2026 Appendix 3: Midlothian HSCP Risk Management Process Page 99 of 208
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Appendix 2: Midlothian HSCP Governance Structure Page 101 of 208
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Midlothian HSCP Quarterly Governance Report Quarter: Q3 2025/6 Prepared by: Claire Ross, Chief AHP 1. Overview Of the 20 service areas reflected in the Governance and Assurance Framework (GAF) across the six operational areas (Adults, AHP, Business Support, Nursing, Performance and Primary Care & Older People), this quarter we had an 85% compliance rate. It is noted that operational gaps prevented full reporting this quarter. 2. Assurance Levels For Q3 the overall levels of assurance across the four domain areas (safe, effective, person centered and regulatory) are high (86%.) The following Tableau Dashboard excerpt summarises the Q3 position (Figure 1.) Figure 1 – Q3 25/26 MHSCP GAF Summary In relation to the domains by operational management area, there are some medium levels of assurance. In the main, these are a combination of minor impact and mostly compliant with identified actions and escalations logged at an operational level. There is one reported moderate impact within AHP services, and this relates to AHP Workforce within the safe domain (MCH OT Capacity.) Appropriate mitigations and escalations were in place for a temporary period, and it is expected that Q4 will reflect an improved position. Additional actions are noted within Primary Care and Older People and are reflected within risk registers. The following Tableau Dashboard excerpt reflects the impact and assurance levels across the domains by operational area (Figure 2.) Page 103 of 208
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Figure 2 – Q3 25/26 MHSCP GAF Assurance levels 3. Achievements This Quarter MHSCP GAF Application, MHSCP GAF Standard Operating Procedure and MHSCP Governance and Assurance Framework resource updated to reflect operational changes across the system. GAF Application supporting system learning as its now available for ongoing use. This has enabled collective review and resubmission which I the past has been challenging. Admin inputting team findings into the application to reduce workload in operational teams. Page 104 of 208
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Appendix 4: Midlothian HSCP Risk Management Process Page 105 of 208
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Midlothian Integration Joint Board Performance Framework 2025 – 2028 (Year 2) Midlothian Integration Joint Board Thursday 2 April 2026 Item No 5.11 Page 107 of 208
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Contents National Health and Wellbeing Outcomes ....................3 Midlothian IJB Strategic Aims 2025-2035 ..................... 13 Midlothian IJB Strategic Governance Map ................... 15 Midlothian IJB Directions 2025/26 .............................. 17 Ministerial Steering Group Indicators 2025/26 ............. 41 Page 108 of 208
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National Health and Wellbeing Outcomes Page 109 of 208
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1 Health and Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. Expectations: • I am supported to look after my own health and wellbeing • I am able to live a healthy life for as long as possible • I am able to access information. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicators Adults are able to look after their health very well or quite well. Premature Mortality Rate (People under 75) Emergency Admission Rate Page 110 of 208
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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. National Indicator Adults with intensive care needs are receiving care at home. The number of days people aged over 75 spend in hospital when they are ready to be discharged. Health and Care resource spent on hospital stays where the person was admitted as an emergency. Expectations: • I am able to live as independently as possible for as long as I wish • Community based services are available to me • I can engage and participate in my community. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicator Adults supported at home agreed that they are supported to live as independently as possible. Adults supported at home agreed they had a say in how their help, care or support was provided. Emergency Admission Rate. Emergency Bed Day Rate. Readmission to hospital within 28 days. Proportion of the last 6 months of life spent at home or a community setting. Falls Rate (People over 65 admitted to hospital as an emergency). 2 Page 111 of 208
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Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected Expectations: • I have my privacy respected • I have positive experiences of services • I feel that my views are listened to • I feel that I am treated as a person by the people doing the work - we develop a relationship that helps us to work well together • Services and support are reliable and respond to what I say. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicator Adults supported at home agreed they had a say in how their help, care or support was provided. Adults supported at home agreed that their health and social care services seemed to be well coordinated. Adults receiving care or support rated it as excellent or good. Adults had a positive experience of the care provided by their GP practice. Readmission to hospital within 28 days. Proportion of the last 6 months of life spent at home or a community setting. The number of days people aged over 75 spend in hospital when they are ready to be discharged. 3 Page 112 of 208
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Quality of life Health & social care services help to maintain or improve the quality of life of people who use those. Expectations: • I'm supported to do the things that matter most to me • Services and support help me to reduce the symptoms that I am concerned about • I feel that the services I am using are continuously improving • The services I use improve my quality of life. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicator Adults receiving care or support rated it as excellent or good. Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life. Emergency Bed Day Rate Readmission to hospital within 28 days Falls Rate (People over 65) The number of days people aged over 75 spend in hospital when they are ready to be discharged. Health and Care resource spent on hospital stays where the person was admitted as an emergency. 4 Page 113 of 208
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Health Inequalities Health & social care services contribute to reducing health inequalities. Expectations: • My local community gets the support and information it needs to be a safe and healthy place to be • Support and services are available to me • My individual circumstances are taken into account Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicator Premature Mortality Rate (People under 75) Emergency Admission Rate 5 Page 114 of 208
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Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Expectations: • I feel I get the support I need to keep on with my caring role for as long as I want to do that • I am happy with the quality of my life and the life of the person I care for • I can look after my own health and wellbeing. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicator Carers feel supported to continue in their caring role. 6 Page 115 of 208
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Safe from Harm People using health & social care services are safe from harm. Expectations: • I feel safe and am protected from abuse and harm • Support and services I use protect me from harm • My choices are respected in making decisions about keeping me safe from harm. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicator Adults supported at home agreed they felt safe. Emergency Admission Rate Emergency Bed Day Rate Readmission to hospital within 28 days. Falls Rate (People over 65) Care services graded Good or better in Care Inspectorate Inspections. Health and Care resource spent on hospital stays where the person was admitted as an emergency. 7 Page 116 of 208
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Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. There are no National Indicators to measure our progress towards this outcome, so we use staff surveys and other local information to evaluate our performance. Expectations: • I feel that the outcomes that matter to me are taken account of in my work • I feel that I get the support and resources I need to do my job well • I feel my views are taken into account in decisions. Data Source Frequency iMatter Annual 8 Page 117 of 208
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Use of resources Resources are used effectively and efficiently. Expectations: • I feel resources are used appropriately • Services and support are available to me when I need them • The right care for me is delivered at the right time. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Citizen’s Panel Survey Annual National Indicator Adults supported at home agreed that their health and social care services seemed to be well coordinated. Emergency Admission Rate Proportion of the last 6 months of life spent at home or a community setting. Falls Rate (People over 65) The number of days people aged over 75 spend in hospital when they are ready to be discharged. Health and Care resource spent on hospital stays where the person was admitted as an emergency. 9 Page 118 of 208
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Midlothian IJB Strategic Aims 2025-2035 Page 119 of 208
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Aim Data Source Frequency Direction 1 People feel able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. MIJB Strategic Governance Outcomes Map Annual 1 People can easily find the information they need to make good decisions. Service outcome data End of Strategic Plan 1 1 People achieve the things that matters most to them, and our services are confident of what our contribution is to their success. Service outcome data End of Strategic Plan 4 1 People access services that are designed around how they live their lives. Service outcome data End of Strategic Plan 5 2 People access the care and support they need when they need it in the community and at home. MIJB Strategic Governance Outcomes Map Annual 2.1 People easily access the services that help them stay well, independent, and active. Service outcome data End of Strategic Plan 2 2.2 People have access to services in their own community. Service outcome data End of Strategic Plan 2 2.3 People are living in the place of their choosing for longer. Service outcome data End of Strategic Plan 2 3 People's human, social, and economic rights are protected and promoted in how we design and deliver our services MIJB Strategic Governance Outcomes Map Annual 3.1 People are recognised as an expert in their own experiences, and are involved in planning services, and feel valued. Service outcome data End of Strategic Plan 3 and 6 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want. Service outcome data End of Strategic Plan 7 3.3 People benefit from organisations working together and sharing information safely. Service outcome data End of Strategic Plan 8 and 9 * Not all services are currently using outcome mapping so local service outcome data will also be used. Page 120 of 208
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Midlothian IJB Strategic Governance Map Page 121 of 208
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What we do Who with How they feel What they learn and gain What they do differently What difference this makes Develop, agree and oversee implementation of a three-year strategic plan People living in Midlothian and who use our services and their unpaid carers Agree and provide clear Directions and associated resource allocation to our LA and NHS partners that are operationally overseen by Midlothian HSCP HSCP officers, partners and providers Establish and maintain robust governance arrangements IJB members People are 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 We transform services to make effective use of resources People's human, social, and economic rights are protected and promoted in how we design and deliver our services Health and Wellbeing: People are able to look after and improve their health and wellbeing and live in good health for longer 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 Positive Experiences and Dignity: People who use health & social care services have positive experiences of services, and have their dignity respected Quality of Life: Health &social care services help to maintain or improve the quality of life of people who use them Health Inequalities: Health & social care services contribute to reducing health inequalities Safe from Harm: People using health & social care services are safe from harm Workforce: Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Resources are used effectively and efficiently Support for Carers: People who provide unpaid care are supported to look after their health and wellbeing IJB members feel supported, informed and confident in their role Assurance and oversight on the progress towards achieving our Directions Assurance that our services are safe, effective, aligned to our strategic priorities and continually improving Page 122 of 208
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17 Midlothian IJB Directions 2026/27 Page 123 of 208
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18 1 Health and Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 1.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by March 2027. Completion of integrated Public Communication Strategy and Action Plan. By March 2027, Midlothian HSCP will publish an integrated Public Communication Strategy and Action Plan. HSCP Governance Documentation HSCP website 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 to the Equality Act, 2010 and accessibility standards by March 2027. Completion of review Completion of the redesign and / or refresh of all publicly available information Number of web pages reviewed Number of web pages redesigned Number of webpages refreshed By March 2027, 100% of Midlothian HSCP’s webpages will meet the following standards: • Compliance with Midlothian IJB ‘Writing for Publication Style Guide’ • Compliance with the Equality Act 2010 and accessibility standards HSCP Website Action Tracker HSCP Website Change Log Page 124 of 208
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19 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Development, approval and implementation of a Midlothian HSCP Dementia Framework. By July 2027, Midlothian HSCP will provide assurance of a delivery plan that has translated the five national outcomes into local actions, measures, and governance. HSCP Governance Documentation Page 125 of 208
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20 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. No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. The development of a set of focused ambitions for change within the ‘Midlothian will be healthier’ component of the Single Midlothian Plan. By July 2027, Midlothian HSCP will provide assurance of: • a focus on services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible, • 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. HSCP Governance Documentation Single Midlothian Plan 2 Page 126 of 208
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21 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Completion of review. By December 2026, Midlothian HSCP will provide assurance that they have undertaken a review of Social Work and Occupational Therapy teams. HSCP Service records HSCP Governance Documentation 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. Midlothian HSCP delivery on the duty of the Care Reform (Scotland) Act to ensure that all commissioned activity has been aligned with our Strategic Plan 2025-2035. By December 2027, Midlothian HSCP will provide assurance that all commissioned activity has been aligned with our Strategic Plan 2025-2035. HSCP Commissioning and Procurement records HSCP Governance Documentation Page 127 of 208
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22 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Development, approval and implementation of a Midlothian HSCP shared Transitions Policy. By December 2026, Midlothian HSCP will provide assurance that they have: • Taken a phased approach • Moved to a holistic and whole-system approach • Delivered a shared Transitions Policy. HSCP operational service data HSCP Governance Documentation Page 128 of 208
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23 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Percentage of operational services who are able to demonstrate evidence of community engagement. Percentage of operational services who are able to demonstrate use of feedback from people who experience services as part of continuous improvement and service design. By July 2026, and December 2026, all operational services will provide assurance that they are able to demonstrate evidence of community engagement and their use of feedback as part of continuous improvement and service design. HSCP operational service data 3.5 NHS Lothian and Midlothian Council will support Midlothian HSCP to 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. Development, approval and implementation of a Midlothian HSCP Commissioning Framework. By July 2028, Midlothian HSCP will provide assurance that all commissioning decisions are made with consideration given to the human, social and economic rights of people who access our services. HSCP operational service data HSCP Governance Documentation HSCP commissioning and procurement records 3 Page 129 of 208
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24 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Development and approval of a Midlothian HSCP Palliative Care Delivery Plan. By December 2026, Midlothian HSCP will provide assurance that they have established a local delivery plan that: • supports the ambitions of the national Palliative Care Strategy Delivery Plan 2025 – 2028 • identifies achievable priority areas for implementation. HSCP operational service data HSCP Governance Documentation Page 130 of 208
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25 Quality of life Health & social care services help to maintain or improve the quality of life of people who use those. No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Number and percentage of services contributing to the development of an integrated self-management framework. By December 2027, people will be more informed about their condition(s), be better prepared for when they feel less well, and know how to access the right support when it is needed. Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers HSCP website 4 Page 131 of 208
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26 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Agreement of action plan 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. By July 2027, Midlothian HSCP will provide assurance of NHS Lothian Primary Care Programme Board activities to develop 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. NHS Lothian Primary Care Programme Board minutes and action plans. Page 132 of 208
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27 Health Inequalities Health & social care services contribute to reducing health inequalities No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Percentage of electronic systems that have capacity to record HSCP area and protected characteristics. Percentage of electronic systems that support extraction and disaggregation when reporting data. Percentage of services with data quality assurance processes and structures in place. Increase in completion of key data fields. By December 2026, HSCPs have timely, credible, disaggregated data to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. By July 2027, Midlothian HSCP will provide assurance that 100% of services have data quality assurance processes and structures in place. By December 2027, Midlothian HSCP will provide assurance of activities to support an This is new and will need to be designed with NHS Lothian and Midlothian Council. 5 Page 133 of 208
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28 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? increase in completion of key data fields (e.g. protected characteristics). 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. Monitor activities of appropriate existing forum and / or establish short-life working group to explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities. The Digital Oversight Programme Board will provide assurance on progress towards its aims and objectives. By July 2028, a Joint Plan will be in place that describes the priority actions agreed between NHS Lothian and Midlothian Council. This should include, but not be limited to: Timeline Allocation of tasks Integrated Impact Assessment Stakeholder Engagement Governance structures (HSCP, NHS Lothian eHealth, Midlothian Digital Services). Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers Digital Oversight Programme Board Documentation 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, Development and agreement of data sets for inclusion. Creation and approval of all required DPIAs and DSAs to initiate data gathering / transfer. By December 2027, Midlothian HSCP will provide assurance relating to the development of a minimum viable product, HSCP Information Management records HSCP Performance & Improvement Action Tracker Page 134 of 208
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29 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? identification, and planning of changing demographic profile to support dynamic whole system change. Design and test of prototype. Approval of final design. Development and agreement of a measurement and evaluation plan. Explore opportunities to validate data. Test and evaluate the usefulness and relevance of the data in multiple contexts. that combines existing risk prediction data with agreed key health and social care data sets. SPG papers and minutes IJB papers and minutes Page 135 of 208
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30 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Midlothian HSCP will provide assurance on the content of relevant Service Plans to support consideration of the impact on unpaid carers of the movement of care from hospital to home. Midlothian HSCP will provide assurance on the content of relevant Service Reports to demonstrate evidence of appropriate supportive actions. By July and December 2026, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support consideration of the impact on unpaid carers of the movement of care from hospital to home. By July and December 2026, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans includes evidence of planned appropriate supportive actions. HSCP Governance Documentation Health and Care Experience Survey** 6 Page 136 of 208
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31 Safe from Harm People using health & social care services are safe from harm. No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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 Midlothian HSCP will provide assurance of: • the percentage of teams who work with people who understand what SDS is and how to signpost this information at the right time, • the percentage of relevant staff who have received training in sensory awareness and understanding how to support people to request and access accessible information, • the percentage of the information we provide about SDS that is accessible, By December 2026, Midlothian HSCP will provide assurance that all staff are appropriately trained, that all information is accessible, and that any financial impact of changes in options is clearly evidenced and reported. HSCP Staff Training Records HSCP Service Records HSCP Service Budget Updates 7 Page 137 of 208
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32 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. • any changes in uptake between one option and another, • any increase in budget, • any HSCP financial impact. Page 138 of 208
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33 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Midlothian HSCP will provide assurance on the progress towards the IJB’s ability to comply with the Heath and Care (Staffing) (Scotland) Act in relation to assurance reporting on the workforce provision for services planned and secured by HSCP managed services and delivered by third parties through commissioning. By March 2027, Midlothian IJB will be able to comply with the Heath and Care (Staffing) (Scotland) Act in relation to assurance reporting on the workforce provision for services planned and secured by HSCP managed services and delivered by third parties through commissioning. Procurement and contract management documentation Heath and Care (Staffing) (Scotland) Act submissions 8 Page 139 of 208
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34 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Biannual reports in place (July and December2026). By July and December 2026, Midlothian HSCP will provide assurance of progress towards the ambitions of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2024-27, and provide evidence of the impact of this on staff experience and wellbeing. HSCP Governance Documentation Page 140 of 208
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35 Use of resources Resources are used effectively and efficiently. No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. NHS Finance colleagues attending *agreed key meetings, including but not limited to: Midlothian Integration Joint Board Strategic Planning Group Planning and Transformation HSCP Performance Leads Steering Group Relevant Service Working Groups. By March 2027, HSCPs are provided with consistent, clear information relating to the use of the set aside budget and associated services. By March 2027, HSCPs can provide consistent, clear information to demonstrate the impact of community prevention and early intervention activity across the whole system. Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers 9.3 All delegated functions will continue to participate in review of service provision driven by a 5-year operational transformation 9 Page 141 of 208
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36 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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 Completion of a review of services provided by Midlothian Community Hospital, a review of Hospital at Home, and a clearly defined operational strategy for delivery including workforce planning. By July 2027, Midlothian HSCP will provide assurance that people are enabled to access appropriate levels of care when their needs change and return to living well in the community in a safe and timely manner. HSCP operational service data HSCP Governance Documentation Page 142 of 208
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37 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? i) a review of services provided by Midlothian Community Hospital, ii) a review of Hospital at Home, 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. Completion of a review of commissioning spend that includes Care at Home externally contracted provision, commissioning of Care Home places, Newbyres Care Village, and the Learning Disability service. Establishment of a new partner provider model. Midlothian HSCP will provide assurance that the partner provider model is closely aligned with the strategic aims of the IJB, supports the delivery of key ambitions and increases opportunities for health equality across Midlothian in relation to commissioned spend. HSCP operational service data HSCP Governance Documentation HSCP commissioning and procurement records Page 143 of 208
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38 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Production of a blueprint for transformation. Design and implementation pf Midlothian Single Point of Access (SPOA). By December 2026, Midlothian HSCP will provide a report on the progress and learning with services, people and communities. By December 2028, Midlothian HSCP will provide assurance that a Midlothian SPOA is in place that has shifted from a traditional model to a new integrated health and social care provision. HSCP operational service data HSCP Governance Documentation Page 144 of 208
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39 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Number of reports submitted by NHS Lothian and Midlothian Council to Midlothian IJB. Midlothian IJB are well- informed in relation to NHS Lothian and Midlothian Council issues and risks relating to non-delegated functions that will impact on delegated functions. Midlothian IJB minutes. 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. Percentage of operational services delivering within allocated budgets. Midlothian HSCP will provide assurance that operational services are delivered safely and effectively within allocated budgets, aligned to the principles of Best Value. Annual Accounts. 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 Reporting on progress, issues, and risks should be considered biannually by the Audit and Risk Committee. Reporting on progress, issues, and risks should be considered biannually by the Audit and Risk Committee. Audit and Risk minutes. Page 145 of 208
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40 No Direction What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? 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. Page 146 of 208
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41 Ministerial Steering Group Indicators 2026/27 Page 147 of 208
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42 Indicator Data Source Frequency Accident and Emergency Attendance Local Intelligence Support Team Release Quarterly Annual Emergency admissions into hospital Local Intelligence Support Team Release Quarterly Annual Number of unplanned hospital bed days: acute specialties (all ages) Local Intelligence Support Team Release Quarterly Annual Number of unplanned geriatric long-stay beds (all ages) Local Intelligence Support Team Release Quarterly Annual Number of unplanned mental health beds (all ages) Local Intelligence Support Team Release Quarterly Annual Delayed Discharges Occupied Bed Days Local Intelligence Support Team Release Quarterly Annual End of Life - Percentage of Last Six Months Spent in Large Hospitals Local Intelligence Support Team Release Annual Balance of Care - Percentage of 65+ Population Living at Home (supported and unsupported) Local Intelligence Support Team Release Annual Page 148 of 208
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Midlothian Integration Joint Board Thursday 2nd April 2026, 14:00-16:00 Midlothian Health and Social Care Partnership (HSCP) Transformation and Change Programme Update Executive summary This report provides an update on the work taking place within Transformation and Change Programme Board, chaired by the Chief Officer. It is an update of the presentation given in the November SPG and a report provided to the SPG in January 2026. As a result of this report, Members are asked to: Note the attached report and the progress of this programme of work. Note the update and range of work streams and actions that are being developed by the Programme Board. The ongoing and continuing financial challenges, the impact on services and the range of actions being undertaken by Midlothian Health and Social Care Partnership (HSCP). The growing demand and complexity on care provision and its impact on budgetary pressures. Item number: 5.12 Page 149 of 208
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Midlothian Integration Joint Board Report Midlothian Health and Social Care Partnership (HSCP) Transformation and Change Programme Update 1 Purpose 1.1 This report provides an update on the work taking place within Transformation and Change Programme Board, chaired by the Chief Officer. 2 Recommendations 2.1 As a result of this report, Members are asked to: Note the attached report and the progress of this programme of work. Note the update and range of work streams and actions that are being developed by the Programme Board. The ongoing and continuing financial challenges, the impact on services and the range of actions being undertaken by Midlothian HSCP. The growing demand and complexity on care provision and its impact on budgetary pressures. 3 Background and main report 3.1 The Transformation and Change Programme Board (The Transformation Board) is taking forward a range of works streams. 3.2 A presentation was provided to the Midlothian Strategic Planning Group (SPG) in November, outlining the ongoing work of the Transformation Board. A further written report was subsequently produced and presented to SPG in January 2026. 3.3 The Chair of Midlothian Integration Joint Board (IJB) has requested that an update report be provided. This report will offer the IJB a clear overview of current progress and key developments. 3.4 Work has been undertaken on the development of the Transformation model which helps drive the direction of the work and explain and underpin the changes that will take place across Midlothian and including the bed-based work. The Transformation Model provides a high-level pictorial showing the 3 phases of work over the next 5 years, highlighting the development of a staff model to support a Midlothian Community Front Door and the range of Transformation workstreams. Page 150 of 208
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Midlothian Integration Joint Board 3.5 The Midlothian HSCP Executive Leadership Team has mapped out the following project work streams to take forward in 2025/26 to 2028. It is expected that these will change over time. The work streams identify Senior Responsible Officers to lead on the work and these will be taken forward through the Midlothian Transformation and Change Programme Board in 2025-28 3.6 Shift the focus away from more specialist services to a wider range of community- based services across health, social and primary care, focusing upon an asset-based approach centred on individuals. Our Transformation model promotes this shift from specialist to community based and investing in early intervention and self- management. 3.7 Shift the focus towards investing more in early intervention, self-management, education, and primary care/community services, with a potential to link this to models, for example the Lifecurve Model. 3.8 Refocus on highlighting an asset-based approach (Garven F., McLean J., and Pattoni L., (2016) Asset-Based Approaches: Their Rise, Role and Reality Liverpool University Press), addressing the balance between deficit-based approaches and enhancing the well-being of individuals, families and communities and focusing upon outcomes. An asset-based approach looks at the range of assets or resources a person has as an individual (skills, capacity, knowledge, interests), organisational (networks and local connections) or community level (economic resources available from organisations, public, private Third Sector, local places to enhance wellbeing). 3.9 Moving towards more personalised and flexible services planned around the person. With a focus on shifting from acute care towards care provided at home or in the community. Public Bodies (Joint Working) (Scotland) Act 2014). 3.10 Individuals are expert in their own lives and have a range of assets and skills to help to support themselves. Self Directed Support (SDS) helps provide choice and control. (Social Care (Self Directed Support) (Scotland) Act 2013). 3.11 We will develop a Community Front Door (sometimes called a single point of access) to support navigation of services, and invest in early support. 3.12 As part of the Transformation and future planning work streams means there will be services that we will require to disinvest from and look to divert resource elsewhere in the system. We will have to deliver the transformation model within the allocated resources we get from Midlothian Council and NHS Lothian. For example, we will be looking at how we use all our institutional bed base for both health and social care and look at ways we can provide this differently in future, such as the further development of hospital at home (virtual beds) or helping to increase more community based assets in supporting people to stay at home or in a more homely environment for as long as possible. Page 151 of 208
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Midlothian Integration Joint Board 3.13 Given the size and scale of the Financial Recovery Programme in 2025/26 and 26/27 and the need to continue with the development of the Transformation and Change actions, the challenges remain with the reduced capacity to take forward these programmes of work: Limited management capacity and operational resource. Recognition and realism of outputs and timeframes. Balance between short term, medium term and long-term planning – some changes and results will take a long time. Commitment and support for the transformation programme. Consideration to income streams. 4 Policy Implications 4.1 There are no policy implications from this reporting update. 5 Directions 5.1 This report responds to Directions 9.3.2, 9.3.5 and 9.3.8. 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, however, further consideration to the completion of additional ECRIAs will be considered as part of the implementation of this work. 7 Resource Implications 7.1 This paper does not have any resource implications, however as the transformation and bed-based work develops there will be resource implications, and these will be presented when appropriate. 8 Risk 8.1 The risk of not delivering the transformation programme in a timely manner will have implications for the operational sustainability of services. Page 152 of 208
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Midlothian Integration Joint Board 9 Involving people 9.1 The senior leadership officers and their teams have been involved in developing this plan. 9.2 The wider public will be involved at an appropriate stage of consultation for each workstream. 10 Background Papers 10.1 The Operational Transformation and Change Programme Briefing Update January 2026 (Appendix 1), is an annual summary and provides strategic direction and programme overview, high level summary of progress across key workstreams in past 12 months, a programme-wide summary and outlook and an overall direction. Author’s Name Morag Barrow Designation Director of Health & Social Care. Contact Information Morag.Barrow@nhs.scot Date 17.03.26 Appendices: Appendix 1: Operational Transformation and Change Programme Briefing Update January 2026 Page 153 of 208
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1 2026 April Operational Transformation and Change Programme Board Annual Summary 1. Strategic Direction and Programme Overview Over the past 12–18 months, Midlothian’s Health and Social Care Partnership (HSCP) has driven significant progress in delivering its Operational Transformation and Change Programme. This includes a major Financial Savings Programme—previously reported to the IJB—which now sits firmly under the governance and oversight of the Operational Transformation and Change Programme Board (“the Programme Board”). The programme provides a clear, structured framework for redesigning services in response to rising population needs, increasing demand and case complexity, workforce pressures, the shift toward prevention and community-based care, and ongoing financial constraints across the HSCP, Midlothian Council, and NHS Lothian. The Transformation Programme is in line with the IJB Strategic Plan and aligns to NHS Scotland Operational Improvement Plan (March 2025), the Health and Social Care Service Renewal Framework (June 2025) and Scotland’s Population Health Framework (June 2025). Also, we ensure it is also legislatively aligned with The Public Bodies (Joint Working) (Scotland) Act 2014 and the Social Care (Self Directed Support) (Scotland) Act 2013. Transformation activity continues to embed the Transformation core principles: shift in focus and transition from reliance on specialist services (including bed-based services) towards community-based services across health, social care, and primary care; asset- based approach; early intervention and investment in prevention, improved access and building sustainable delivery models. Strengthened governance through the Programme Board, chaired by the Chief Officer, has enabled robust oversight, effective risk management, and ongoing prioritisation across all workstreams. The scale of the transformation agenda remains substantial. Despite the continuing pressures of financial sustainability and operational delivery, the Programme Board has brought clarity, direction, and focus to all areas of redesign and change. In Quarters 3 and 4, the Partnership concentrated on developing and implementing the Financial Savings Programme for the IJB. Although the Programme Board considered whether a financial savings programme should sit within the Transformation Programme, it agreed this was the most pragmatic approach. Given the relatively small management team and the need to prioritise competing demands, aligning savings work with transformation ensures the necessary governance, oversight, and redesign required to deliver these savings while supporting progress across all programme portfolios. Page 155 of 208
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2 2. High level summary of Progress Across Key Workstreams (Past 12 Months) 2.1 Social Work & Occupational Therapy Review Purpose: To streamline and identify gaps and effective working in Social Work and Occupational Therapy practice within Midlothian Council and to better meet the needs of the population of Midlothian and improve resilience, consistency, statutory compliance, and workforce sustainability. Progress Achieved This Year: Time-in-motion study completed with a strong 70% staff response, providing the first comprehensive workload/demand baseline since 2017. Significant MOSAIC data cleansing and a design for a new data dashboard, improving visibility of demand, flow, case allocation, and statutory performance. Ongoing streamlined policy and procedure library created—simplified, accessible, and reducing variation across teams. Revised SDS and support-planning processes, reducing duplication and improving clarity for staff and service users. Strengthening Community Contact Centre interface, identify areas of improvement in the workflow between the Contact Centre and practice teams. A Learning & Development Framework being developed to improve induction, supervision, and continuous practice improvement. Large scale staff survey completed to gather views around structure, practice, pathways, and service user outcomes. Design, evaluation and implementation of a Social Work Governance Framework that will underpin practice across the profession. This will be used to format a Practice Standards framework. Impact: On the work to date, staff report improved clarity, reduced ambiguity, and more consistent processes, with better alignment to national policy and best value principles. 2.2 Midlothian Community Hospital (MCH) Review Purpose: Whole-system redesign of bed-based and community pathways, supporting flow, reducing length of stay, and aligning with Home First principles. Achievements Over the Last 12 Months: Admission criteria strengthened using “criteria to reside.” Planned Date of Discharge (within 72 hours) introduced and now routinely applied with 90% compliance. Page 156 of 208
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3 Length of stay reduced. Consolidated central dataset and improved data capture. Established third sector partners within pathways (Red Cross, VOCAL) Improved AHP workforce alignment and training New Standard Operating Procedures being drafted across wards. Progress on staff/family communication plan This work supports. Development of system-wide bed optimisation plan Initial mapping of eligibility criteria and admission/discharge operating model Alignment work underway with care homes, palliative care, intermediate care, and Hospital at Home Impact: A more efficient, consistent, and predictable hospital environment, with improved flow and reduced delays. 2.3 Polton Street Development Purpose: Expansion of community-based alternatives to institutional care. Progress: The site is now scheduled to open in summer 2026, revised from the original target date of 31 March 2026, because of construction and commissioning challenges at the Polton Street location. This delay will have operational and financial implications for the HSCP, particularly in relation to ongoing recruitment and the planning of short breaks (respite). We will confirm additional cost pressures in due course. In the meantime, we are working closely with colleagues across Midlothian Council to manage and mitigate the impact of these changes. Major Milestones This Year: (as at 17.03.26 scheduled for summer 2026). Midlothian Life Care Facility - new Highbank Reprovision (40-bed facility including rehabilitation flats). Midlothian Life Health & Social Care Hub (Old School House) design phase completed – further development of community hub-based facility. Bill Prentice Court Extra Care Housing (45 flats) - development of allocations panel with HSCP and Housing, with agreed eligibility criteria. Impact: A significant step toward a modern, community-centred estate that supports independence, rehabilitation, and prevention in line with the strategic planning principles across the HSCP. Page 157 of 208
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4 2.4 Home First Review Purpose: Redesign of pathways including Discharge to Assess, Respiratory Team, Rehabilitation, Flow/SPOA, and Hospital at Home. Progress: Completed full pathway mapping and data collection and analysis. Identified opportunities for redesign including triage, and screening processes, and efficiencies relating to travel. Workforce redesign proposals developed, including strengthening Assistant Practitioner roles. A new, future-focused Home First model endorsed through governance structures. Implementation planning underway across 2026. Impact: A clearer, less fragmented, more efficient pathway aligned to admission avoidance, reducing delayed discharge, length of stay and support pathways out of hospital. 2.5 Commissioning & Third Sector Reform Purpose: Undertake a review of commissioning spend and establish a new partner provider model A partner provider model aligned with IJB strategic aims. Data driven modelling linking spend to population outcomes (by August 2027) A full review of contract compliance Development of a new overarching commissioning strategy Impact: Movement toward transparent, outcome-driven, financially sustainable commissioning. 2.6 Palliative Care Transformation Purpose: To review evidence and best practice and propose a transformed model for the delivery of palliative and end of life care by the services directly delivered by MHSCP by June 2026 Progress: A new model of palliative and end-of-life care will be developed by June 2026, aligned to: Pan Lothian commissioning of specialist Palliative Care services (hosted by Edinburgh HSCP), The Midlothian bed-based review Page 158 of 208
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5 Care home commissioning. Community nursing transformation The Scottish Government’s 2025–2030 Strategy “Palliative Care Matters for All”. Impact: A more joined-up and sustainable approach to end-of-life care across several settings. 2.7 Mental Health & Dementia Frameworks Purpose: Develop a Mental Health and Dementia Strategic Framework: Link to NHS Lothian REH Bed trajectory plans as part of the NHS Lothian Mental Health Transformation Improvement Programme Consider potential (local) accommodation options for discharge of long-term patients currently residing in REH rehabilitation beds – complex and multi- factorial challenges for. Assess current service provision across mild, moderate to severe (and enduring) needs. Produce potential service developments for mental health and dementia provision. Achievements: Completed benchmarking for Dementia Framework and set local improvement targets. Developed a three-year continuous improvement cycle, reporting to IJB twice yearly on the Dementia Framework. Draft Mental Health Framework aligned to national strategy and local pressures. Impact: Clearer direction and better measurement of service performance and outcomes to meet national priorities at a Midlothian level. 2.8 Community Front Door (CFD) - Single Point of Access Purpose: To enable earlier intervention, helping to prevent escalation, avoid unnecessary primary care access, social work and care needs and hospital admissions. Progress: This is at an early stage of development and thinking but with the ambition to establish a physical and virtual “community front door” — a welcoming, accessible access point where people can quickly obtain information, advice, support, and onward direction to the services best suited to their needs. We believe this to be a key pillar of our Transformation Programme. Page 159 of 208
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6 The Community Front Door (CFD) will provide a clear, simple, and consistent route of access for all these tiers for the public, carers, and professionals. This front door will be physical and virtual. By acting as a single point of access, the CFD will streamline information, advice, triage, and referral pathways across life cycle and layers. This will reduce duplication, minimise service fragmentation, and improve equity of access. Developing early design principles for a community-led, prevention-first access model. Focusing upon strengthening digital triage/signposting capability Looing to embed early intervention pathways to reduce statutory referrals. Impact: It will enable earlier intervention, helping to prevent escalation, avoid unnecessary primary care access, social work and care needs and hospital admissions, with the aim of promoting health and independence for as long as possible. 2.9 Frailty Programme Purpose: Professional leads for Medicine, Nursing, and AHPs began an ambitious and collaborative programme of work to shape a new system-wide Frailty pathway for Midlothian. Progress: Co-designed a Frailty Scale for Midlothian HSCP. Informed by the evidence base but translatable across our health and care system and supporting communities to identify themselves on this scale. Mapping of services and resources to frailty scale tested in GP Advanced Practice Physiotherapy and MSK services. This will form the basis for our care bundles work to align falls and frailty with risk stratification. This will ensure activity mapping is consistent, optimisation of resources and gap analysis as well as system readiness for Techpathfinder. Through the NHS Lothian Falls Prevention and Management Framework and specifically the community networks baselining to this framework, we will progress the Collaboration and Prevention pillars via this network as a priority for 2026. Community Appointment Days will continue in 2026, enabling two further sessions which will complement the Ageing Well programme for Midlothian. The falls passport will be progressed in this space to support self-management. Work has now been transitioned successfully to the NHS Lothian Frailty Board following project resourcing changes. The use of the frailty scale will be Page 160 of 208
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7 progressed and reported via LES and NHS Lothian Frailty Programme Board to address the front door interface. 2.10 Community Nursing Review Purpose: To look at a wider community nursing services including, District Nursing (incorporating the outputs from the recent review), Hospital at Home, Care Home Team, Community Treatment access centre (CTAC) and adult vaccination teams. Progress: A workshop was delivered in October 2025 to launch the workstream, engaging staff to consider the purpose, reputation and vision of the service and ideas to take forward. The workstream has several interdependencies which will influence its progress and delivery. It is linked with parallel workstreams including bed-based transformation, palliative care, and Home First. Aligned redesign planning with Home First, palliative care and bed-based transformation. Impact: A more integrated vision of future community nursing capacity and skill mix Update: During Executive Leadership Team discussions, it was agreed that, given the ongoing Community Nursing Review now taking place across NHS Lothian, it would not be appropriate to progress a full local review at this stage. We will ensure we are working with the NHS Lothian review. 2.11 Community Assets, Engagement & Self-Management Achievements This Year: Engaging the Be Healthier thematic group to support reporting requirements within Community Planning partnership and ensuring readiness for the next Single Midlothian Plan Successful design and delivery of a Falls Community Engagement Day with 220+ attendees Development of a Supported Self-Management Framework (scoping has been undertaken system wide. This demonstrates many approaches to support self- management across our system. Work is underway to ensure readiness for the Falls Techpathfinder which includes falls self-assessment, professional falls assessment and a self-management platform. Page 161 of 208
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8 Impact: This work seeks to support communities to thrive through better navigation of our systems and access to information to enable healthier choices, supported self- management and primary prevention. 2.12 Data & Digital Transformation (iSTAT & Innovation Projects) Progress: iSTAT platform paused due to data-sharing governance challenges, but: o Unscheduled care analysis o Financial modelling o Social Work data improvements are moving forward in preparation. Digital innovation projects being advanced, including: o FLOK (brand name) Health Artificial Intelligence musculoskeletal triage o ANIA (Accelerated National Innovation Adoption) diabetes prevention pathway. o OPIP (Obesity Pathway Innovation Programme) digital triage redesign for obesity pathway o Falls digital triage (Tech Pathfinder) o New MOSAIC (brand name: Social Work case management system) digital tools including dictation & mobile recording Impact: Modernisation of digital triage, analytics, and frontline recording. 3. Programme-wide Summary and Outlook Across the past 12 months, the HSCP has delivered considerable progress across all major transformation areas despite challenges posed by: Ongoing financial pressures and need to divert focus in Quarters 3 and 4 on Financial Savings Plans, Continued high demand and ongoing workforce shortages and challenges. Operational pressures and competing Business-as-Usual priorities. What the past year demonstrates: A clear, consistent delivery model with strong governance within the Programme Board Robust evidence-based change A maturing system-wide change/redesign/transformation approach Page 162 of 208
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9 Increasing alignment between bed-based care, community services, digital systems, and commissioning A shift toward prevention, independence, and sustainable models of care Overall Direction: While considerable progress has been made, it is important to reaffirm the range of challenges highlighted at the start of this report. The scale of the overall programme is still substantial, and the demands across financial sustainability, day-to-day operations, and wider change, redesign and transformation continue to be considerable. Given this, some workstreams will, by necessity, progress in a stop–start manner as we balance competing priorities. The Programme Board will continue to actively manage these challenges through robust discussion at both Programme Board and Executive Leadership Team meetings, strong governance, and clear prioritisation of activity over the next 12 months to ensure the Partnership is well-positioned to meet its obligations. Finally, although the programme has already delivered positive work and encouraging early progress, it is important to recognise that this remains a long-term transformation effort, and we are still at an early stage of development. Page 163 of 208
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1National Care Service Charter of Rights www.mygov.scot/ncs-charter National Care Service Charter of Rights Your rights and what to expect from social care, social work and community health support Midlothian Integration Joint Board Thursday 2 April 2026 Item No 5.13 Page 165 of 208
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www.mygov.scot/ncs-charter 2National Care Service Charter of Rights 01 Introduction 5 02 Equality, dignity and respect 14 03 Your support network, home, unpaid carers and independent advocacy 19 04 Involvement, participation and choice 25 05 Upholding your rights: feedback and complaints 31 06 Glossary 40 07 Useful contacts 43 Contents Page 166 of 208
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3National Care Service Charter of Rights www.mygov.scot/ncs-charter What you will find in each section 01 Introduction This section gives an introduction to the Charter of Rights. 02 Equality, dignity and respect You have rights to: • be treated without discrimination and in a way that supports you to have equal opportunities to other people • respect for your private and family life, home and correspondence • be protected from harm, neglect and abuse • be safe in your home and community, including if you live in a care home or other facility This part of the Charter explains how you should expect those involved in your care to treat you with dignity, respect, warmth and compassion. 03 Your support network, home, unpaid carers and independent advocacy You have rights to: • involve your support network in your support • get support in a way that respects your private and family life, home and correspondence You should be supported to look after the relationships that are important to you, and to be part of your community. This part of the Charter explains how you can involve your support network in decisions and how to access independent advocacy. This section also provides information for unpaid carers. Page 167 of 208
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4National Care Service Charter of Rights www.mygov.scot/ncs-charter 04 Involvement, participation and choice You have rights to: • be given information about the support that is available to help you make decisions • be listened to and have your views respected and responded to • be as involved as possible in planning and decisions about your support and how it is delivered • involve a member of your support network in your assessment and in planning your support • access the personal information that is held about you and to be informed about how your information will be processed This part of the Charter explains how you should expect those involved in your care to work with you to help you get the best support available. 05 Upholding your rights: feedback and complaints You have rights to: • express your views on your care and support You should expect that your views will be listened to and respected. This part of the Charter tells you how you can give feedback or make a complaint if your rights are not met. 06 Glossary 07 Useful contacts Page 168 of 208
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5National Care Service Charter of Rights 5National Care Service Charter of Rights www.mygov.scot/ncs-charter 01 Introduction Page 169 of 208
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6National Care Service Charter of Rights www.mygov.scot/ncs-charter 6National Care Service Charter of Rights 6National Care Service Charter of Rights Introduction About this Charter This Charter gives you information on your rights and what you should expect from social care, social work and community health support. It tells you about your rights which exist as at 25 March 2026. The Charter does not create any new rights or alter any existing ones. It gives you information about what to do if you think your rights or expectations are not being met. You may not need to read the whole Charter to find the information you need; you can look at the parts that matter to you. Descriptions of the terms social care, social work and community health are available in the glossary on page 40. Who this Charter is for This Charter is for anybody who is accessing or waiting to access social care, social work or community health support. This Charter is also for anybody with a personal interest in the wellbeing of someone accessing support. For example, if you are: • an unpaid adult, kinship, parent or young carer • a friend or family member • a guardian or someone who holds power of attorney People who provide support to you can also use the Charter to help them deliver your rights. If you are not sure whether you need support you can speak to your local council, the NHS or access www.careinfoscotland.scot. Page 170 of 208
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7National Care Service Charter of Rights www.mygov.scot/ncs-charter How this Charter was created This Charter was created by: • people who have accessed care and support • unpaid adult and young carers • members of the health and social care workforce • organisations that support people who access care and support • the Scottish Government About community health, social work and social care services Local councils and health boards are required by law to work together to plan and deliver adult community health, social work and social care services. This is called ‘health and social care integration’. In some areas integration also includes children’s services, homelessness and justice social work services. In most areas of Scotland, decisions about how these services are run are made by Integration Joint Boards (IJB). These boards include people from the NHS, the local council, people with lived experience and unpaid carers. Integrated health and social care services are sometimes provided directly by the NHS or local councils, and sometimes they are provided on their behalf by the voluntary, independent or private sectors. For more information about Health and Social Care integration go to hscscotland.scot. Page 171 of 208
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8National Care Service Charter of Rights www.mygov.scot/ncs-charter Other resources that tell you about your rights You can find further information on your rights when you access NHS services or NHS care in the Charter of Patient Rights and Responsibilities. • www.gov.scot/patient-rights-charter There are other Charters that outline your rights when you access public services. These include: • Carers Charter www.gov.scot/carers-charter • Charter of Rights for People Affected by Substance Use www.alliance-scotland.org.uk • Charter of Rights for People with Dementia and their Carers in Scotland www.alliance-scotland.org.uk This Charter is available in other formats, including: • a summary version • an Easy Read version • a webpage • alternative community languages • a version in BSL with audio To access these versions go to www.mygov.scot/ncs-charter. This Charter includes contact telephone numbers for different organisations and services. If you are a British Sign Language (BSL) user, you can use Contact Scotland BSL. This is a video relay service that provides instant BSL video interpreting for all calls in Scotland. • contactscotland-bsl.org Page 172 of 208
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9National Care Service Charter of Rights www.mygov.scot/ncs-charter The rights and expectations in this Charter The Charter summarises: • your rights • what you should expect from the support you receive Your rights Where the Charter says ‘you have rights to’, it means: • there are laws in Scotland that protect these rights in certain situations • or there are laws which impose duties on public authorities and others in these situations • people that work in social care, social work and community health must respect these rights when the law says they apply • you can ask a court to enforce these rights These rights apply to everyone, including unpaid carers, unless otherwise stated. For more information about the rights in the Charter, you can read the ‘Charter and the Law’ document at www.gov.scot/isbn/9781806437665. What you should expect The Charter also tells you about what you should expect from your care and support. When the Charter says ‘you should expect’, it means: • this is what you should expect to happen for you when you access care and support • people that work in social care, social work and community health should meet these standards These expectations are based on: • agreed standards for health and social care, including the Health and Social Care Standards • recommendations from international human rights standards Because these standards are not found in domestic law, you cannot ask a court to enforce them but you should still expect these standards to be met. What to do if these rights and expectations are not met You can make a complaint if any of the rights or expectations in the Charter are not met. Section 5 of this Charter includes information on how to make a complaint. Page 173 of 208
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10National Care Service Charter of Rights www.mygov.scot/ncs-charter International human rights The Scottish Government is committed to following international human rights standards. Although some human rights, including the ones referenced in this section, are not yet enforceable in Scottish courts, the government still has a responsibility to respect, protect and fulfil them. The United Nations monitors Scotland’s progress in meeting these human rights as part of its review of the UK’s overall performance. Everyone can help promote human rights by raising awareness and campaigning to ensure that rights are recognised, respected and protected in both law and everyday life. These are some of the key international human rights that relate to social care and health, and information about how they are understood in international law. Right to the highest attainable standard of health (Article 12 of the International Covenant on Economic, Social and Cultural Rights) This right means that you should have access to support for your physical and mental health. This is relevant to all health and care services. It also means you should be able to access help with other aspects of your life which affect your health and wellbeing. Right to an adequate standard of living (Article 11 of the International Covenant on Economic, Social and Cultural Rights) This right means being able to access things which support you to live with dignity. This includes having enough food, clothing and housing. Right to living independently and being included in the community (Article 19 of the United Nations Convention on the Rights of Persons with Disabilities) This right means disabled people should have equal rights to other people to live independently and to participate in the community, with choices equal to others. There are lots of other international human rights which are relevant to social care, social work and community health. There are also specific rights and protections for women, disabled people and people from ethnic minority groups. You can find more information in the ‘Human Rights and the Charter’ document at www.gov.scot/isbn/9781806437672. Page 174 of 208
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11National Care Service Charter of Rights www.mygov.scot/ncs-charter 11National Care Service Charter of Rights 11National Care Service Charter of Rights The Health and Social Care Standards There are lots of standards and guidance that say how social care, social work and community health services should be delivered. The Health and Social Care Standards set out what you should expect when using these services in Scotland. All services should use them to help provide high-quality care. The Standards are based on 5 principles: • dignity and respect • compassion • being included • responsive care and support • wellbeing The Standards are rights-based and provide examples of how your rights including those in this Charter can be met. However, not every statement will be relevant for all of the care and support you receive. The Care Inspectorate and Health Improvement Scotland inspect care providers to check that they are delivering the Health and Social Care Standards. Page 175 of 208
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www.mygov.scot/ncs-charter Children’s rights Children can use this Charter as well as adults. If you are a child, you have some extra rights that are now part of the law in Scotland. Many of these rights are reflected in this Charter. You should be treated fairly, and you have rights that should be respected, protected and fulfilled. You should feel safe, respected and listened to. This Charter tells you what to do if these things aren’t happening. The trusted adults in your life should be able to help you to understand your rights, and what you should expect from public services. People working in social care, social work and community health should listen to you. Your best interests should be a primary consideration in all decisions and actions that affect you. If you do not think that has happened or you have any other concerns about your rights, you can let someone know. Information about your rights as a child and what to do if you think these have not been respected is available on the Young Scot ‘Activate Your Rights’ webpage at www.young. scot/rights. If you are a child and you feel you are in danger or risk of harm you should tell a trusted adult. This could be your teacher, social worker, youth worker or any other adult that you know and trust. You could also tell the Police. Childline offers support and you can talk to them about anything, big or small. Contact Childline at any time: • phone: 0800 1111 • online chat: www.childline.org.uk 12National Care Service Charter of Rights Page 176 of 208
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13National Care Service Charter of Rights www.mygov.scot/ncs-charter Times when rights can be restricted Some rights may apply differently or may be restricted in certain situations. For example, to keep you safe or to protect other people’s rights. Also, some rights in this Charter may apply differently or may be restricted if you have a court order, licence or treatment order. If this happens there must be good reasons for this that are set out in law. Any restrictions should be explained to you, and they should be both necessary and proportionate. Contact your social worker, local council or medical professional to find out more information. Refugees and people seeking asylum If you are a refugee living in Scotland, you can get support if you need it. You may also get support if you are seeking asylum, even if the Home Office is not helping you, or your asylum claim has been refused. For more information, visit NHS inform at www. nhsinform.scot/healthcare-for-refugees-and-asylum-seekers. Page 177 of 208
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14National Care Service Charter of Rights 14National Care Service Charter of Rights www.mygov.scot/ncs-charter 02 Equality, dignity and respect Page 178 of 208
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www.mygov.scot/ncs-charter 15National Care Service Charter of Rights Equality, dignity and respect You have rights to: • be treated without discrimination and in a way that supports you to have equal opportunities to other people • respect for your private and family life, home and correspondence • be protected from harm, neglect and abuse • be safe in your home and community, including if you live in a care home or other facility Discrimination and equal opportunity You must not be treated unfairly due to your: • age • disability • race • sex • sexual orientation • gender reassignment status • pregnancy and maternity • religion or belief These are protected characteristics. Public authorities like local councils and health boards must consider properly how their decisions and actions can help remove discrimination, advance equality, and support good relations between people who share a relevant protected characteristic and those who do not. ‘Advance equality’ means considering how to: • remove or reduce disadvantages • take steps to meet people’s needs • encourage people to participate fully ‘Support good relations’ means considering how to reduce prejudice and increase understanding between different groups of people. Page 179 of 208
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16National Care Service Charter of Rights www.mygov.scot/ncs-charter Dignity and respect You have rights to respect for your private and family life. This protects your physical and moral integrity and your right to make decisions about your own life. Public authorities like local councils and health boards must provide support in a way that respects these rights. You should also expect to be treated with dignity, respect, warmth and compassion. This can include respect for your: • medical condition(s) • background • identity • choices Equality and access to support You should expect your support to be provided in a way that recognises your experience and the impact this has had on you. Some experiences or life circumstances may mean it is more difficult to access support. For example, this could include: Psychological trauma Psychological trauma can have an impact on people’s ability to feel safe, to manage strong emotions, and to have self-worth, which can make it harder to seek and access support. Drugs and alcohol People who have, or have had, problems with drugs or alcohol, and their families, often face discrimination and may be judged unfairly by others. This can make it difficult to seek and access support. Living in a rural area Where you live can also affect access to support. In rural areas, including Scottish islands, there may be fewer services and transport options available. It may be harder to use services privately without other people knowing, which may prevent people from seeking support. Page 180 of 208
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17National Care Service Charter of Rights www.mygov.scot/ncs-charter Being treated fairly To make sure you are treated fairly, there are lots of things that you should expect to happen. For example, you should expect: • the people who provide your support to work with you and offer you choice where possible, in a way that makes you feel safe and in control • the people who provide your support to understand the impact that psychological trauma may have on those who have experienced it • your support to enable you to observe religious, spiritual or cultural practices • to be supported to express your identity and for this to be respected • your support to be delivered in a way that helps address challenges of living in a rural area • your support to be provided in accessible places • to be given accessible information about your support, in a language or format you understand • to be helped to get the support you need People who provide your support should ask you what you need. Please tell them, so that they can try to get this for you. Public authorities like local councils and health boards must make reasonable changes that help to remove barriers to support for disabled people. Page 181 of 208
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18National Care Service Charter of Rights www.mygov.scot/ncs-charter Protection from harm You have rights to not be treated in an inhuman or degrading way and to be protected from harm, neglect and abuse. You have rights to be safe in your home and your community, including if you live in a care home or other facility. Adults at risk of harm There is a law to help keep adults safe when they might be at risk of harm and unable to protect themselves. The law focuses on people who may be more vulnerable to harm because of things like illness, disability or mental health challenges. Harm can be accidental or intentional. It can also be as a result of self-neglect or self-harm. You should expect professionals – like social workers, health staff, and the police – to work together to look into concerns, offer support, and take action to prevent harm if needed. They should aim to prevent and reduce harm in a way that respects the person’s rights and choices. You should expect people who provide care and support to: • recognise and respond to signs that you may be at risk of harm • listen to you and take you seriously if you are concerned about the safety of yourself or others If you are concerned about someone who may be at risk of harm or you are an adult at risk of harm, you can contact your local social work department in confidence. In an emergency call 999. To find your local social work department contact Care Information Scotland: • www.careinfoscotland.scot • phone: 0800 011 3200 Information about what to do if you are a child who may be at risk of harm or if you are concerned about a child at risk of harm is in the ‘Children’s Rights’ section of this Charter on page 12. Mutual respect Everyone who uses and provides social care, social work and community health support should be treated with dignity and respect. Like everyone, people who provide social care, social work and community health support have rights to be protected from harm. To make sure this happens, your support should be provided in a way that prevents stress and distress and keeps everyone safe. Page 182 of 208
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19National Care Service Charter of Rights 19National Care Service Charter of Rights www.mygov.scot/ncs-charter 03 Your support network, home, unpaid carers and independent advocacy Page 183 of 208
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www.mygov.scot/ncs-charter 20National Care Service Charter of Rights Your support network, home, unpaid carers and independent advocacy You have rights to: • involve your support network in your support • get support in a way that respects your private and family life, home and correspondence Your support network and community You have rights to involve your support network in your support. Your support network might include trusted people you know. These could be: • people that are involved in providing your support • family members, friends and neighbours • spiritual or religious representatives • an independent advocate • an unpaid adult carer, kinship carer, parent carer or young carer You should be supported to look after the relationships that are important to you, and you should be supported to be part of your community. Community means different things to different people. Community might include: • a spiritual, religious, cultural or ethnic community • a national, local or island community • people with similar life experiences or circumstances • people with similar conditions or receiving similar support Your home If you receive support in your own home or in a residential setting such as a care home your right to a private and family life will be respected. The rights of other people that live with you or visit you will also be respected. Your privacy will be respected. You can say who you want or do not want to be involved in conversations about your support. Sometimes people with legal authority will be involved in conversations about your support too. You can also say who you do or do not want to visit. Page 184 of 208
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21National Care Service Charter of Rights www.mygov.scot/ncs-charter If your home is a care home If you live in a care home, this is your home and you will be supported to spend time with the people that are important to you, including people sometimes staying over. The people who provide your support will ask you who you want to spend time with and how you want to spend time with them. They will record this in your care plan, and they will support you to connect with people in the ways that are right for you. Essential Care Supporter If you live in a care home, from 31 March 2026 you also have a right to choose at least one person who can act as your Essential Care Supporter, if that is your wish. This Essential Care Supporter: • will be supported to see you day to day by the care home • may be involved directly in providing you with care, support and companionship In rare situations there may be a risk to the life, health or wellbeing of care home residents. The care home may need to suspend visits to keep people safe. This will only happen if absolutely necessary and for as short a time as possible. If this happens, visits in some circumstances must still go ahead, for example in end of life situations and in certain circumstances where there will be serious harm to your health or wellbeing if the visit does not go ahead. This may mean that the Essential Care Supporter can carry on their role. Page 185 of 208
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22National Care Service Charter of Rights www.mygov.scot/ncs-charter Unpaid carers Unpaid carers, including young carers, have a right to: • a personalised support plan, prepared within a reasonable time – this can be an adult carer support plan or a young carer statement • carer support, which may include support to enable breaks from caring • be involved in decisions about support provided to them and the person they care for • access to a local carer information and advice service All unpaid carers, including young carers, have the right to a support plan or young carer statement identifying their needs and what support is available to them to help meet their eligible needs. This will also take into account how much care they are willing and able to provide. This should also include a discussion on whether an unpaid carer needs a break from caring. Carers also have rights to be involved in decisions about their own support and in assessing the needs of the person they are caring for. All carers should have access to locally-based information and advice on issues such as carers’ rights, income maximisation and local carer support. You can find out more in the Carers’ Charter at www.gov.scot/carers-charter. Page 186 of 208
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23National Care Service Charter of Rights www.mygov.scot/ncs-charter Independent advocacy Independent advocacy can help you understand: • your rights • your situation • how to access support Independent advocacy helps everyone. But it can be even more important for people who feel like their voice is not being heard and for people whose rights are not being met. This includes people with support needs and unpaid carers. An independent advocate can help you to: • understand your rights and any information about your support • express your views and have your views heard • raise concerns about your support • be more involved in the process if your support is being reviewed or changed Independent advocates are separate from the organisations that provide your support. This means their only responsibility is to represent you and help you express your views, wishes and concerns. Independent advocates do not provide advice. The support you might be offered by an independent advocate may depend on your circumstances and needs and the availability of independent advocacy in your area. People providing your support should be willing to work with you and your independent advocate and recognise the role of your independent advocate in supporting you. How to find an independent advocacy service The Scottish Independent Advocacy Alliance has more information about how to find these services. They do not provide advocacy themselves. You can: • use the ‘Find an Advocate’ tool at www.siaa.org.uk/find-an-advocate • phone: 0131 510 9410 Page 187 of 208
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24National Care Service Charter of Rights www.mygov.scot/ncs-charter Types of independent advocacy There are two main types of independent advocacy: 1. Collective or group independent advocacy - when people with similar life experiences support each other and work together to improve services and campaign for their rights. 2. Individual independent advocacy - when someone supports you one-to-one. This can include: • issue-based or professional advocacy: an advocate helps you understand your choices and speak up about a decision that affects you • citizen advocacy: a volunteer uses their skills to support you for as long as needed, helping you take part in your community • peer advocacy: your advocate has similar life experiences, which can make it easier to talk and be understood Who can get independent advocacy Anyone can request information on how to access independent advocacy or ask for an independent advocate to help. There are some times when independent advocacy must be provided by law: • people with a mental illness, learning disability, or personality disorder have a right of access to independent advocacy • disabled people have a right of access to independent advocacy to help them through the Scottish social security system, where this is needed • children and young people, or their parents, have rights to an advocate in certain situations, for example, when they are going to a Children’s Hearing Page 188 of 208
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25National Care Service Charter of Rights www.mygov.scot/ncs-charter 04 Involvement, participation and choice Page 189 of 208
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www.mygov.scot/ncs-charter 26National Care Service Charter of Rights Involvement, participation and choice You have rights to: • be given information about the support that is available to help you make decisions • be listened to and have your views respected and responded to • be as involved as possible in planning and decisions about your support and how it is delivered • involve a member of your support network in your assessment and in planning your support • access the personal information that is held about you and to be informed about how your information will be processed Information You have rights to information about the support that is available to help you make decisions. The Support in the Right Direction programme provides local independent support, advice and advocacy. You can find further information at www.inspiringscotland.org.uk. If your support has to change for any reason you should expect to be given information about the change. You should expect people to communicate with you in a way that you can understand. This may include getting information in: • plain language • a language you can understand, including British Sign Language • an audio format • large print • braille • Easy Read If you need it you can get information through an interpreter, guide/communicator or communication support worker. Page 190 of 208
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27National Care Service Charter of Rights www.mygov.scot/ncs-charter Assessing your needs and planning your support Those involved in your care will work with you to understand your needs, strengths and how they can support you. This is called your assessment. Your rights to accessing and using NHS services are set out in the Charter of Patient Rights and Responsibilities at www.gov.scot/patient-rights-charter. Local councils have a duty to assess your care and support needs and decide if they need to arrange any services for you. To request an assessment of your needs, you can contact your local council. You can find out more about what to expect from your assessment at www.careinfoscotland.scot. You have rights to be listened to and have your views respected and responded to. You have rights to be as involved as possible in planning and decisions about your support and how it is delivered. There may be times when your control or choice may be restricted, for example to protect your safety or the safety of others. This must be: • kept to a minimum • justified • compliant with the law • explained to you so that you know why the decision has been made You have rights to involve a member of your support network in your assessment and in planning your support. With your consent, their views about the best way to support you will be considered. Page 191 of 208
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28National Care Service Charter of Rights www.mygov.scot/ncs-charter Choice and control in social care – Self-directed Support Self-directed Support (SDS) is the way social care and support is delivered in Scotland for adults, children and unpaid carers. If you get social care support, your social worker should help you choose how much control you want over your care. You can decide to manage it yourself or let the local council do most of it. Your local council must provide you with information about your options and how to manage your support. There are 4 ways to get support, and each offers a different level of choice and control. You can discuss and agree the option which will work best for you with your social worker. Your social worker should also help you make a care and support plan. Together, you should agree what a ‘good life’ looks like for you, and what support you need to achieve or maintain it. Your care will then be arranged to help meet those goals. You can find out more about Self-directed Support and what you should expect from social care in the SDS Framework of Standards. The SDS Handbook also gives you further information on choice. It provides a step-by-step guide which aims to make it easier to access social care and support. Go to handbook.scot/sds-handbook. Supported decision-making There may be times when you need support to make a decision about your care and treatment. Decisions should be based on your: • legal rights • will and preference • needs You should expect to get help to make decisions about the support available to you and what those decisions mean. This is called supported decision-making and can come from: • a trusted person – this can include professionals as well as family and friends • peer support – from friends or other individuals with similar lived experience • independent advocacy • community and neighbourhood support Page 192 of 208
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29National Care Service Charter of Rights www.mygov.scot/ncs-charter Here are some steps that you can follow to get support when making a decision: • you find someone that you want to support you and build up trust with them • you decide what support you need to make a decision – some people may need help with communication aides or technology support • you discuss what you want to happen and what the consequences might be • you review the final decision and confirm what happens next Substitute decision-making If an adult is incapable of making a decision about their own welfare, someone else can be given the power to make decisions on their behalf. This is substitute decision-making. Substitute decision-making for an adult should only happen where there is specific legal authority to do so. When decisions are made by a substitute, it is important to take into account an individual’s known will and preference. Power of attorney and guardianship A power of attorney is a document that is drawn up when you have capacity to provide full consent. It allows another person to make decisions on your behalf when you are no longer able to do so for yourself, including about support and personal welfare. If someone has not appointed anyone as power of attorney but needs someone to make decisions for them, a guardian can be appointed by the court. You can find out more about power of attorney and guardianship on mygov.scot: • setting up power of attorney: www.mygov.scot/power-of-attorney • setting up guardianship: www.mygov.scot/guardianship To find out more about your rights under Adults with Incapacity law, Adult Support and Protection law and Mental Health law, contact the Mental Welfare Commission: • www.mwcscot.org.uk • phone: 0800 389 6809 National information and advice services Sometimes you might need help to make a choice. For support, you can speak to your local council, the NHS or access information from Care Information Scotland. Care Information Scotland is a phone, webchat and website service providing information about care services for people living in Scotland. It has information about a range of topics and lists contact details for many services. • www.careinfoscotland.scot • phone: 0800 011 3200 Page 193 of 208
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30National Care Service Charter of Rights www.mygov.scot/ncs-charter Your rights over the information held about you You have rights in relation to the personal information held about you. The rights listed below apply in social work and social care settings. Your rights related to the personal information held about you by NHS services are set out in The Charter of Patient Rights and Responsibilities at www.gov.scot/patient-rights-charter Your personal information could include your: • name, age or other characteristic • address or contact information • health conditions or test results Your rights include the right to: • be informed about how your data is being used • access your personal data • have incorrect data updated • have data erased • stop or restrict the processing of your data • data portability (allowing you to get and reuse your data for different services) • object to how your data is processed in certain circumstances Organisations need to hold personal information about you in order to give you the best available support. Organisations will only ask you for information that they need to know and the information you give will be kept safe. You can access personal information the organisation holds about you by contacting them directly. Sometimes organisations may not be able to give you all of your personal information, for example to protect the privacy or safety of you or someone else. If this happens the organisation will explain this to you. If you are concerned about how an organisation is handling your personal data, contact the Information Commissioner’s Office for advice or to make a complaint: • www.ico.org.uk • ICO helpline: 0303 123 1113 Page 194 of 208
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31National Care Service Charter of Rights www.mygov.scot/ncs-charter 05 Upholding your rights: feedback and complaints Page 195 of 208
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www.mygov.scot/ncs-charter 32National Care Service Charter of Rights Upholding your rights: feedback and complaints You have rights to: • express your views on your care and support Giving feedback on your care You have rights to express your views on your care and support. You should expect that your views will be listened to and respected. Your feedback helps to improve services for you and others. Family or others in your support network can give feedback for you, if you agree. You can give feedback on: • what went well – this helps services know what to keep doing • what did not go well – this helps services learn and improve You can give feedback to anyone involved in your care or their manager. Some services use Care Opinion, where you can give feedback anonymously. • www.careopinion.org.uk • phone: 0800 122 3135 Getting support to make a complaint It is normal to feel unsure about complaining, especially if you still receive, or are waiting to receive, care from the service. But services should see complaints as a chance to learn and improve. If you are worried, you can: • ask someone you trust to help you • get support and advice from an independent service • ask a councillor or MSP to make a complaint for you Page 196 of 208
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33National Care Service Charter of Rights www.mygov.scot/ncs-charter Support and advice services Independent Advocacy An independent advocate can help you share your views and wishes. They may be able to help sort out problems before they become a complaint. You can find out more in the section ‘Your support network, community and independant advocacy’. Citizens Advice Scotland Citizens Advice Scotland offers free, impartial and confidential advice. They can help you to make a complaint. • www.citizensadvice.org.uk/scotland • phone: 0800 028 1456 • open: Monday to Friday 9am to 5pm Care Information Scotland Care Information Scotland can provide information and advice on social care, including how to make a complaint. • www.careinfoscotland.scot • phone: 0800 011 3200 • open: Monday to Friday 9am to 5pm Page 197 of 208
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34National Care Service Charter of Rights www.mygov.scot/ncs-charter Making a complaint You can make a complaint for any reason you want. Such as: • your rights in this Charter are not being met • your support does not meet the Health and Social Care Standards • you are not happy with the service you are getting or have had in the past When making a complaint you should expect to be: • listened to with empathy and treated with dignity and compassion • told when you should expect to receive a response • kept informed about the progress of your complaint and told the outcome There are different ways to make a complaint depending on what service you want to complain about. You may wish to speak to someone involved in your care or their manager first. This is often the quickest way to resolve any issues. If you are concerned about your own or someone else’s safety, please read the ‘Protection from harm’ section of this Charter for advice on page 18. All care services must have a complaints procedure in place and must provide details of this when requested. They have a duty to ensure any complaint raised under their complaints procedure is fully investigated. All public sector care services must follow the Scottish Public Services Ombudsman (SPSO) rules for handling complaints. These set out what organisations and their staff should do when a complaint is made and the steps they need to follow. You can find out more about this by visiting: • www.spso.org.uk/the-model-complaints-handling-procedures The SPSO also provides information about how to make a complaint about a public service and what to do if you find it hard to move your complaint forward. To find the SPSO information leaflets you can visit: • www.spso.org.uk/information-leaflets Page 198 of 208
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35National Care Service Charter of Rights www.mygov.scot/ncs-charter * There are some limits on what the SPSO can consider in complaints about the Care Inspectorate – please contact the SPSO for more information. Health and Social Care Partnerships If you want to complain about a service provided through a Health and Social Care Partnership, you should contact the service that gave you the care. This could be the NHS, your local council or another organisation. If the service is registered with the Care Inspectorate, you can also complain to them. Concern about your support or care Concern not resolved? Concern not resolved? Concern not resolved? Concern not resolved? Speak to someone involved in your care All care services registered with the Care Inspectorate (including local council services) You can complain to your service provider You can complain to the Care Inpectorate You can complain to the Care Inpectorate You can complain to your service provider You can complain to the Scottish Public Services Ombudsman* Local Council services or NHS Community Health services Page 199 of 208
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36National Care Service Charter of Rights www.mygov.scot/ncs-charter Local council care service You can contact your local council to find out how to make a complaint. Councils follow a two-stage complaints process: Stage 1: Frontline response In this stage: • the council will aim to reply within 5 working days • if you are not happy with the response, you can ask for your complaint to move to Stage 2 Stage 2: Investigation In this stage: • the council will aim to reply within 20 working days • if they need more time, they will let you know Some complaints may go straight to Stage 2. If you are not satisfied with the outcome, you can ask the SPSO to review your complaint (see the section below). The Care Inspectorate The Care Inspectorate checks and regulates registered care services in Scotland. You can complain to the Care Inspectorate about a registered care service. You can complain about things like: • care that does not meet expected standards • people’s rights not being respected • unsafe care practices • problems with staff, staff training or staffing levels The Care Inspectorate encourages you to raise your complaint with the service first, but you can also complain to them directly. You can complain confidentially: this means that you share your identity with the Care Inspectorate but they will not share it with the service without your consent. This means you can get feedback on the outcome of your complaint. You can complain anonymously: this means you don’t share your identity with the Care Inspectorate. But this means the Care Inspectorate can’t check information with you or tell you about the outcome of your complaint. The Care Inspectorate may still investigate if the risk is high, even if you withdraw your complaint. Page 200 of 208
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37National Care Service Charter of Rights www.mygov.scot/ncs-charter How long you have to make a complaint It is best to complain as soon as possible. You usually need to complain within 6 months of the issue. They may consider complaints after this in exceptional cases. Contact details • www.careinspectorate.com • email: concerns@careinspectorate.gov.scot • phone: 0345 600 9527 • open Monday, Tuesday, Thursday and Friday, 9am to 4pm; Wednesday, 9am to 2pm Social workers or social care workers Social workers and many types of social care worker are registered with the Scottish Social Services Council (SSSC). All social service workers in Scotland are expected to follow the SSSC codes of practice. The SSSC can investigate complaints about an individual worker who is registered. For example, the SSSC can investigate complaints about: • a worker’s behaviour • a worker’s professional practice They cannot look at complaints related to a care service. How long you have to make a complaint It is best to complain as soon as possible. You should complain within 6 months of the issue or when you became aware of it. They may accept complaints after this if you give a good reason. SSSC contact details • www.sssc.uk.com • phone: 0345 60 30 891 • open: Monday to Friday 9am to 4pm If you employ care workers directly If you employ a Personal Assistant (PA) directly through Self-directed Support, you can find information about managing this relationship in the PA Employer Handbook. You may also be able to get help from your insurance provider. • handbook.scot/the-pa-employer-handbook Page 201 of 208
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38National Care Service Charter of Rights www.mygov.scot/ncs-charter Community health services If you’re complaining about a community health service provided by the NHS, you can complain to the NHS Board. If your complaint is about a service provided on behalf of the NHS, such as your GP practice, a pharmacy, dentist or optician, you should complain to the service provider first. If you are not happy with the response, you can ask the Scottish Public Services Ombudsman to review your complaint. Further information about the NHS complaints procedure can be found in the Charter of Patient Rights and Responsibilities at www.gov.scot/patient-rights-charter. The Scottish Public Services Ombudsman The SPSO is the final stage for complaints about public services in Scotland. This includes: • care services provided by local councils • NHS community health services You need to complain to the service first before going to the SPSO. If you are not happy with the outcome of a complaint after this, you can contact the SPSO. How long you have to make a complaint with the SPSO It is best to complain as soon as possible. You need to complain within 12 months of the issue or when you became aware of it. The SPSO may accept complaints after 12 months if you give a good reason. Contact details • www.spso.org.uk/spso • phone: 0800 377 7330 Open: • Monday, Wednesday and Friday 9am to 1pm • Tuesday and Thursday 1pm to 5pm Page 202 of 208
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39National Care Service Charter of Rights www.mygov.scot/ncs-charter How to write a complaint letter When writing a complaint letter, it can be useful to add the following information: • explain what went wrong – include what happened, who was involved, when and where it happened, and how it affected you • describe any steps you have already taken to try to resolve the issue • ask the organisation to explain how they made their decision Other information you can include: • link your complaint to a specific legal right or to the Health and Social Care Standards, if you can • be clear about what you want to happen next and how the service can put things right • give your name and contact details if you want a response. You can ask for your details to be kept confidential Legal challenges This Charter explains your legal rights but does not provide legal guidance. If you believe your legal rights are not being upheld, or you disagree with a public body’s decision, you may have the option to apply to go to court and ask a judge to decide on your case. If you are thinking of taking legal action you should seek independent legal advice. You can get help with legal problems on the Scottish Government website such as finding out if you can get legal aid and finding a solicitor. • go to www.mygov.scot/legal-advice Page 203 of 208
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40National Care Service Charter of Rights www.mygov.scot/ncs-charter 06 Glossary Page 204 of 208
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www.mygov.scot/ncs-charter 41National Care Service Charter of Rights Glossary Community health Community health covers a wide range of health care services that are delivered in your local area. Community health can be delivered in a range of settings such as: • people’s homes • residential homes • health and care sites Both this Charter and the ‘NHS Charter of Patients Rights and Responsibilities’ apply when you are using community healthcare services. Kinship carer A person who cares for a child who is unable to live with their birth parent. The kinship carer is related to the child (through blood, marriage or civil partnership) or a has a pre- existing relationship with them. Legal authority A legal power or right that an individual or entity has to make decisions or take actions on behalf of others. National Care Service ‘National Care Service’ is a term that describes work to improve social care, social work and community health support across Scotland. This includes the National Care Service Advisory Board, actions we are taking and projects we are delivering. This Charter is one of these projects. Psychological trauma Traumatic experiences affect most people at some stage and their impact is unique to each person. Some people have experiences that are physically or emotionally harmful or life threatening. Psychological trauma can impact people’s ability to feel safe in relationships and to manage strong emotions. Many settings can remind people of the trauma they have experienced. Trauma can create invisible barriers to some services and can mean that people are not able to access the care and support they need. Page 205 of 208
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42National Care Service Charter of Rights www.mygov.scot/ncs-charter Social care Social care support helps people to live safely, stay as independent as possible and improve their quality of life. It is designed to meet each person’s needs and is usually provided at home, in the community or in a homely place. Social care support includes a wide range of personal and practical support services, including: • care homes • care at home • day centres or day opportunities • community alarms and telecare systems • equipment and home adaptations, including ramps and stairlifts • support for unpaid carers in their caring roles • supported accommodation • respite services Social care workers support adults and young people, children and their families. Services are delivered by health and social care partnerships, voluntary sector organisations, independent providers or private companies. Social work Social work services help people to live independently. They also support people who may be at risk of harm. The role of social work is to: • help people live healthy lives • keep people safe • promote human rights • make sure people are treated fairly and have equal choices and chances • challenge discrimination Social workers Social workers work in our communities, including in schools, in hospitals, in prisons and in lots of services that support people. They work with children and their families, and with young people and adults. They must have a social work degree and they must be registered with the Scottish Social Services Council or equivalent regulator. Page 206 of 208
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43National Care Service Charter of Rights www.mygov.scot/ncs-charter 07 Useful contacts Page 207 of 208
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www.mygov.scot/ncs-charter 44National Care Service Charter of Rights Useful contacts Care Information Scotland www.careinfoscotland.scot phone: 0800 011 3200 Care Inspectorate www.careinspectorate.com phone: 0345 600 9527 Care Opinion www.careopinion.org.uk phone: 0800 122 3135 Citizen’s Advice Scotland www.citizensadvice.org.uk/scotland phone: 0800 028 1456 Find an Advocate tool www.siaa.org.uk/find-an-advocate Health and Social Care Partnerships in Scotland hscscotland.scot/hscps Mental Welfare Commission www.mwcscot.org.uk phone: 0800 389 6809 NHS Inform www.nhsinform.scot phone: 0800 22 44 88 Scottish Social Services Council www.sssc.uk.com phone: 0345 60 30 891 Scottish Public Services Ombudsman www.spso.org.uk phone: 0800 377 7330 National Care Service Charter of Rights www.mygov.scot/ncs-charter Page 208 of 208