Agenda Document Pack - Midlothian Integration Joint Board - 11_06_2026
Midlothian Council · 11 June 2026
Back to Midlothian Integration Joint Board — 11 June 2026 and its agenda
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Normandy Court/ Hybrid, Normandy Court, Normandy Drive, Dalkeith, EH22 1GJ Date: Thursday, 11 June 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 382
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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 5 - 14 15 - 30 4.2 31 - 42 4.3 43 - 56 5 Minutes of previous Midlothian IJB Board Meeting held on 26th March 2026 Minutes of previous Midlothian IJB Board Meeting held on 2nd April 2026 Minutes of Strategic Planning Group held on 29th January 2026 Minutes of Audit and Risk Committee held on 5th March 2026 Standing Items and Public Reports 5.1 5.2 57 - 64 5.3 5.4 5.5 65 - 74 5.6 75 - 114 5.7 115 - 242 5.8 243 - 318 5.9 Chair’s Update – Val de Souza, Chair Chief Officers Report – Morag Barrow, Chief Officer Strategic Planning Group Update – Gill Main, Integration Manager Audit and Risk Committee Update– Councillor Connor McManus For Decision Health & Care Staffing Act Report Paper presented by Nick Clater, Chief Social Work Officer and Head of Adult Services Midlothian IJB Draft Annual Accounts Paper presented by Ele Ho, Chief Finance Officer Midlothian IJB Members Induction Handbook Paper presented by Lisa Cumming, Business Support Manager Midlothian IJB Draft Annual Performance Report Paper presented by Gill Main, Integration Manager & Elouise Johnstone, Programme Manager Midlothian Integration Authority Statutory Climate Reporting Paper presented by Gill Main, Integration Manager 319 - 324 Page 2 of 382
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5.10 Midlothian IJB Performance Update Paper presented by Elouise Johnstone, Programme Manager 325 - 336 5.11 Unscheduled Care Workstream Update Presentation by Grace Cowan, Head of Primary Care and Older People’s Services 5.12 Midlothian IJB Risk Register Update Report presented by Ele Ho, Chief Finance Officer 337 - 350 5.13 Midlothian IJB Medium Term Financial Strategy Paper submitted by Ele Ho, Chief Finance Officer 351 - 382 6 Private Reports 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on: Thursday 20th August 2026, from 14.00 – 16.00. This meeting will be held at Normandy Court Note: Midlothian Integration Joint Board (Special Board) will be held on Thursday 24th September 2026, from 12.30 – 16.00, this has been extended to accommodate a 90-minute development session prior to Special Board. Page 3 of 382 For Discussion For Noting
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Special Meeting Thursday 26 March 2026 14.00 Normandy Court / MS Teams Present (voting members): Val de Souza, NHS Lothian, (CHAIR) Councillor Connor McManus (Virtual) Councillor Kelly Parry (Virtual) Councillor Derek Milligan Councillor Pauline Winchester Dr Amjad Khan, NHS Lothian (Virtual) Heather Campbell, NHS Lothian (Virtual) George Gordon, NHS Lothian (Virtual) Present (non-voting members): Morag Barrow, Director of Health and Social Care Partnership and Chief Officer to the Midlothian Integration Joint Board Nick Clater, Head of Adult Services and Chief Social Work Officer Chris King, Midlothian Integration Joint Board Chief Finance Officer Fiona Stratton, Chief Nurse (NHS) Claire Ross, Chief Allied Health Professional, (NHS) Dr Paul Bailey, GP Representative (NHS) (Virtual) Grace Chalmers, Partnership Representative (Midlothian Council) Sheree Muir, Lived Experience Member Magda Clark (Virtual), Third Sector Representative Member Midlothian Integration Joint Board Thursday 11 June 2026 Item No 4.1 Page 5 of 382
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In attendance: Gill Main, Midlothian Health, and Social Care Partnership Integration Manager Fiona Kennedy, Group Service Manager Grace Cowan, Head of Primary Care and Older People Sandra Bagnall, Executive Business Manager Dr Anna Beaglehole, Clinical Director (HSCP) Hannah Forbes, Democratic Services Officers Maria Perez, Democratic Services Officer 1. Welcome, Introductions and apologies The Chair welcomed everyone to the special meeting of the Midlothian Integration Joint Board (IJB). The Chair welcomed Paul Bailey, GP Representative, who is joining the IJB for the first time, as well as the attendees joining virtually. There were no apologies submitted to Democratic Services ahead of this special meeting. 2. Public Reports 5.1 Midlothian Integration Joint Board Financial Budget Setting and Financial Recovery Actions 2026/2027, Report presented by Chris King, Midlothian IJB Chief Finance Officer. The Midlothian IJB Chief Finance Officer presented the report for decision. The purpose of this paper is to outline the budget offers received from Midlothian IJB’s partners, update members on the 2026/27 financial position, and propose financial recovery actions for 2026/27 in the context of Page 6 of 382
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Midlothian Health and Social Care Partnership’s ongoing transformation plans and operational delivery. It is a requirement for Midlothian IJB to set a balanced budget before the start of each financial year. This report outlines the proposed 2026/27 budget contributions delegated to Midlothian IJB by Midlothian Council and National Health Service (NHS) Lothian. Sufficient resources are essential for the Board to deliver the three strategic aims of the Midlothian IJB Strategic Plan 2025-2035: The report also presents the 2026/27 budget plan, highlighting the projected budget shortfall. Midlothian faces unprecedented challenges to the financial and operational sustainability of the health and care system. These challenges stem from increasing demand due to a growing and ageing population, a rise in the complexity of care required, and resource constraints in both workforce and finances. Members are asked to: • Accept Midlothian Council’s formal budget offer for 2026/27. • Note NHS Lothian’s indicative budget offer for 2026/27. • Note the development of the 2026/27 budget setting process. • Consider the proposals that support the development of a balanced budget for 2026/27. • Agree to set a balanced budget for 2026/27 on the presumption of the delivery of the recovery programmes including working with the other IJBs and NHS Lothian to deliver a balanced position for the Set Aside budget. • Note the risks outlined in the paper, including the financial risk associated with the Council’s charging proposal, noting that the final decision will be taken by the Council after the IJB is required to set a balanced budget. The Chief Finance Officer advised that Midlothian’s Council Base Budget was approved on 24 February 2026, and under this budget Midlothian IJB’s funding offer was confirmed as £75.122 million. As well as this, the Council agreed to the use of Scottish Government funding for policy commitments: £2.523 million to fund the increased in the real living wage in adult social care workers, £0.111 million free personal nursing Page 7 of 382
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As well as the above, Midlothian Council also agreed to provide additional funding to fund a 3.5% pay increase (£0.999 million), a share of the £20 million national funding (£0.310 million) and recurring support for transition pressures (£0.803 million) The Chief Finance Officer advised the budget offer from NHS Lothian is yet to be approved as the meeting to agree budget offer is to take place on 22 April 2026. NHS Lothian’s contribution to Midlothian IJB therefore remains indicative, but it is based on the latest NHS Lothian budget assumptions, and it amounts to £110.786 million. The Chief Finance Officer advised both funding offers meet the Scottish Government criteria of being fair, reflective of national commitments and pressures. Nevertheless, the financial position remains challenging. Midlothian IJB is facing a revised financial gap of £6.9 million. While considerable, this is better than initial projections which forecast a gap of over £8 million. To address this gap, there has been a financial recovery program with two strands, operational recovery actions, and strategic redesign recovery actions. Operational recovery actions do not require approval, but strategic redesign recovery actions will need to obtain approval from Midlothian IJB Members. These strategic redesign recovery actions have been developed with strategic teams and target three areas: Care at home, Learning Disabilities, and Midlothian Community Hospital. The Chief Finance Officer stressed that while at this scale it is not possible to identify recovery actions without impact, the options proposed were identified as the least impactful, leading to the best solution available to deliver a balanced budget. Work is ongoing to explore other options leading to reduce the gap even further, and the numbers presented show a continued commitment towards integration. A Care Charges proposal will be considered for approval at Midlothian Council’s meeting of 31 March 2026, and although this has been included in the plan with approval from Midlothian Council, the Chief Finance Officer cautioned it has not been approved yet. The Chief Finance Officer reiterated the challenging financial position and noted Health Boards across Scotland are finding themselves in a similar position but advised it is now possible to present a balanced budget for approval and invited questions from the IJB Members. Councillor Milligan expressed appreciation to the Chief Financial Officer and all staff involved in preparing the budget, acknowledging the significant challenges of balancing the current financial pressures with the need to continue delivering essential services to the most vulnerable members of the community. Councillor Milligan cautioned that approving the budget would also mean accepting its associated impacts, some of which they described as potentially severe. Councillor Milligan noted concerns that several proposals described as transformational changes may, in practice, represent reductions in service provision. In particular, they highlighted that the proposed savings relating to Midlothian Community Hospital would lead to the closure of Page 8 of 382
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a ward and a reduction in palliative and complex care beds, affecting individuals with the highest level of need. Councillor Milligan emphasised that patients are only retained in hospital when clinically necessary. They further raised concerns that proposals involving the removal of paid travel time for care workers could reduce the time available for direct care and may result in private providers passing on the financial impact to their staff. Councillor Milligan suggested this could create additional challenges in recruiting and retaining care workers. Councillor Milligan stated that, given these implications, they could not support the budget as presented and encouraged IJB Members to consider carefully the potential consequences of the proposed savings. They advised that it may be possible for the Council to revisit its funding position and identify additional resources to mitigate some of the impacts. Councillor Milligan confirmed they would not be voting in favour of approving the budget. Councillor Winchester indicated her agreement with the points raised by Councillor Milligan, stating that the potential impact of the proposed budget was, in her view, unacceptable. She expressed concern that the budget had been presented as the least detrimental option, noting that this suggested even more challenging alternatives had been considered. Councillor Winchester seconded Councillor Milligan’s position not to approve the budget and supported the suggestion that the matter be referred back to Midlothian Council to explore whether additional funding could be identified for Midlothian IJB. Councillor Parry acknowledged the concerns raised by other Elected Members, however advised that the budget presented represents the least detrimental option available. Councillor Parry highlighted that the recent development session provided Elected Members with an opportunity to consider the budget in detail and engage with officers. Reassurance was drawn from officers’ detailed understanding of the potential impacts of the proposals. It was further noted that Midlothian IJB is not in as severe a financial position as some other IJBs across Scotland, and on this basis, it would be preferable to approve the budget rather than defer consideration. IJB Member George Gordon expressed his confidence on the work undertaken by the officers who had set the budget and noted that there may be funding forthcoming from the Scottish Government. While there are clear financial pressures across the board it is necessary to move forward and approve the budget rather than get involved in protracted negotiations. Councillor McManus advised that pausing the discussion at this stage would not be appropriate and confirmed their intention to vote in favour of approving the proposed budget. Page 9 of 382
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Dr Amjad Khan praised the work carried out by officers who presented the budget and thanked other IJB Members for their contributions to the discussion. Dr Khan noted that in an ideal world it may be possible to avoid savings measures, but this is not a realistic scenario given the financial circumstances. Although there are savings proposals, the decisions regarding these proposals have been taken in a sensitive manner. Dr Khan stated delaying the decision on the budget would not be positive, and that approving the budget would not preclude Midlothian IJB from continuing to lobby the Scottish Government and NHS Lothian to direct more money towards the IJB’s. Dr Khan advised they would vote to move the paper in its current form. Heather Campbell acknowledged the work that has gone into producing a detailed and comprehensive budget and agreed that the development session had given IJB Members a chance to interrogate proposals in detail. Heather Campbell sympathised with Councillor Milligan and Councillor Winchester’s concerns however noted the savings also aim to bring care closer to home, which is one of the aims of the IJB. Heather Campbell noted they would be voting to accept the proposed budget. The Chair acknowledged the views expressed by Midlothian IJB Members and confirmed their support for the majority position to approve the proposed budget. The Chair noted that, while the decisions before Members were challenging, the budget also enabled progress towards service change and a greater focus on community-based care. The Chair further highlighted the assurances provided by the Midlothian Chief Financial Officer/Section 95 Officer and the Midlothian Chief Executive that no additional funding was available to be allocated to the IJB, and that the budget had been developed on that basis. The Chair emphasised the importance of continued engagement with the Scottish Government regarding future funding and suggested that, in the next budget cycle, proposals could be shared with the community through a consultation process to help ensure the budget reflects local priorities. Councillor Milligan requested IJB Members vote on the proposed budget for the sake of transparency, noting that the focus should be the decisions made for the Midlothian IJB and their impact on residents, rather than the national picture. Following a roll call vote, the motion to approve the Midlothian IJB Budget 2026/27 in its substantive form was carried by 6 votes to 2. Page 10 of 382
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5.2 Midlothian IJB Medium Term Financial Strategy. Report presented by Chris King, Midlothian IJB Chief Finance Officer The Midlothian IJB Chief Finance Officer presented the report for review and comment. This paper presents the IJB’s draft Medium Term Financial Strategy (MTFS) for the period 2025/2028. It sets out the financial context, key risks, planning assumptions, and the actions required to support sustainable health and social care services in Midlothian. The IJB must develop a Medium-Term Financial Strategy to provide a clear, forward-looking view of the resources needed to meet future demand. The strategy has been developed alongside the IJB Strategic Plan and sets out how resources will be prioritised; how financial risks will be managed and how transformation will be supported. As a result of this report, Members are asked to: • Review the draft Midlothian IJB Medium Term Financial Strategy. • Note the scale of the financial gap over the 3-year period 2026/27 to 2028/29. • Support the ongoing development of the medium-term financial strategy, improving alignment with the strategic plan. • Agree to receive an update on progress on a regular and appropriate basis throughout the year. • Subject to any further amendments, approve this strategy. IJB Members were asked to note the paper is not a detailed delivery plan, and that there will be subsequent documents that supplement the strategy. Another caveat is that the financial projections included in the strategy do not reflect the impact of the recovery program that has been discussed earlier in the meeting, and following the budget approval those numbers will need to be revised. Heather Campbell queried the feedback loops noted in the report, and how those would play out during the financial year, as well as what the IJB can do to track progress. The Chief Financial Officer advised that reports would be brought to the IJB every quarter with an update on performance against the MTFS and delivery of agreed savings. The Midlothian Health and Social Care Partnership (HSCP) Integration Manager highlighted the IJB has developed the ability to plan and direct strategy and manage operational risks and strategic risks, which are the ones that require most Page 11 of 382
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involvement. The Midlothian HSCP Integration Manager noted that the MTFS sits alongside the strategic plan which is what the IJB has identified as its hopes and ambitions for Midlothian. Every paper should be treated as a strategic opportunity to consider if direction is needed. Officers can take that direction and then work out an implementation plan. The Midlothian HSCP Integration Manager advised that a progress reassurance update will be provided at summer but noted that progress is not always linear. George Gordon highlighted the lack of general reserves in the MTFS, as there are only earmarked reserves available which would be an obstacle in delivering plans in the strategy. The Chair noted the concerns and stated that the IJB will be working to build a general reserve again. The Chair noted the report asks that IJB Members review the MTFS, note the scale of the financial gap, support ongoing development of the strategy, and receive regular update on progress. Members noted the content of the MTFS and unanimously approved the recommendations in the report. 5.3 Midlothian IJB Directions 2026/2027 Report presented by Gill Main, Midlothian HSCP Integration Manager The Midlothian HSCP Integration Manager presented the report for decision. This report presents the proposed Midlothian Integration Joint Board (IJB) Directions for 2026/27. In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014, Directions are the key mechanism by which an Integration Authorities’ strategic plan is actioned. Directions must be issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how the functions delegated to the IJB are to be delivered and funded via the integration budget made available by NHS Lothian and Midlothian Council Partners. Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. Midlothian IJB’s financial position has become increasingly challenging across 2025/26 with many services operating within new financial models because of grip and control measures, transformation, and choices. However, Midlothian IJB continue to commission services in new and increasingly innovative ways while continuing to provide safe, high-quality care and support in line with the Strategic Plan. To ensure Midlothian IJB can appropriately direct Partners in a way that aligns with the Midlothian Page 12 of 382
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IJB Strategic Plan 2025-2035, clear instructions are required for key delivery priorities in 2026/27 to continue to embed the integration practice and collaborative working that improves outcomes for people and communities. As a result of this report, Members are asked to: • Note the final position for Directions 2025/26 (appendix 1), • Consider and approve the presented Directions for 2026/27 (appendix 2), and • Subject to confirmation of the budget offers, give delegated authority to the Chief Officer to issue these Directions to the Chief Executives of NHS Lothian and Midlothian Council before 31st March 2026. As there were no questions, the Chair noted the IJB’s agreement with the above recommendations, including the recommendation to delegate authority to the Joint Director of Health and Social Care Partnership and Chief Officer to the Midlothian Integration Joint Board to issue the approved Directions to the Chief Executives of NHS Lothian and Midlothian Council before the 31st March 2026. 3. Close The Chair noted that this would be the final meeting for Chris King in the role of Chief Financial Officer. The Chair commended the significant contribution made during Chris King’s tenure with Midlothian IJB, highlighting a strong ability to broker balanced and pragmatic solutions, and noting that this is a particularly valuable quality within financial leadership. The IJB Members joined the Chair in congratulating Chris King for the support given to the IJB and the Midlothian HSCP and wished them well on their new post. Chris King acknowledged the challenges posed by the post and thanked everyone for their support over the past 18 months. The Chair noted that the next meeting of the IJB is scheduled for Thursday 2 April. This meeting will be held on Normandy Court and virtually by Teams. The meeting concluded at 14.57 pm. Page 13 of 382
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 2nd April 2026 14:00 Normandy Court/Virtually via Microsoft Teams Present (voting members): Val de Souza (Chair, NHS) Councillor McManus (Vice Chair) (Virtual) Councillor Parry Councillor Winchester Heather Campbell (NHS Lothian) George Gordon (NHS Lothian) Dr Amjad Khan (NHS Lothian) Councillor Milligan Present (non-voting members): Nick Clater (Head of Adult Services and Chief Social Work Officer) in place of Morag Barrow Eleanora Ho (Chief Finance Officer) Grace Chalmers (Partnership Representative) Sheree Muir (Lived Experience Representative Member) Claire Ross (Chief Allied Health Professional) Magda Clark (Third Sector Representative) Fiona Stratton (Chief Nurse) In attendance: Gill Main (Integration Manager) Fiona Kennedy (Interim Head of Service) Elouise Johnstone (Performance Manager) Lisa Cumming (NHS Lothian) Grace Cowan (Head of Primary Care and Older Peoples Services) Dr Anna Beaglehole (HSCP Officer on behalf of Paul Bailey, Medical Representative) Hannah Forbes (Democratic Services Officer) Louise Middleton (Democratic Services Officer) Midlothian Integration Joint Board Thursday 11 June 2026 Item No 4.1 Page 15 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Apologies: Morag Barrow (Chief Officer) Dr Paul Bailey (NHS Lothian) Claire Gardiner (Audit Scotland) 1. Welcome and Introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB). 2. Order of Business The order of business was confirmed as outlined in the agenda previously circulated. 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 19th February 2026, was approved as an accurate record. 4.2 The Minute of the meeting of the MIJB – Strategic Planning Group, held on 20th January 2026, was noted by the Board. 4.3 The Minutes of Audit and Risk Committee – held on 27th November 2025, was noted by the Board. Page 16 of 382
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Thursday 2nd April 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 noted their thanks to Chris King for his time as Chief Finance Officer and also thanked Jay Johnson for their time on Midlothian Integration Joint Board. The Chair updated that, following last week’s Special IJB meeting they had issued directions to NHS Lothian and Midlothian Council and had received an acknowledgment from both partners. There is an IJB Strategic Planning Group meeting scheduled for the 21st May to consider how the group can be reviewed or refreshed and consider the possibility of taking on more commissioning within its remit.All Board Members are invited to that. The Chair thanked everyone who had provided comments on the National Performance Framework (NPF) noting that these had been compiled and returned to Scottish Government. The Chair congratulated Sheree Muir, Lived Experience Representative Member, on being nominated for and receiving the Midlothian Wonder Woman Award. Sheree Muir advised that they had also been invited by MP Kirsty McNeill to attend an event for International Women’s Day and had received 15 nominations for an award in recognition of their contribution and work undertaken. 5.2 Chief Officers Report – Nick Clater, Head of Adult Services and Chief Social Work Officer, Acting Chief Officer The Head of Adult Services and Chief Social Work Officer provided an update on behalf of Morag Barrow, Page 17 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments Chief Officer. They noted the Chief Officer’s thanks to Chris King for their work as Chief Finance Officer and also welcomed Eleonora Ho as a non-voting member of Midlothian IJB. The Head of Adult Services and Chief Social Work Officer highlighted the following: The MAPPA Annual Report was presented to the most recent Council meeting. A visit took place on 12 February by the Cabinet Secretary for Justice to a project in Mayfield; they expressed a strong interest in the work being undertaken in relation to unpaid work. The report highlights positive work undertaken in relation to falls prevention. The report also outlines work within Primary Care to strengthen asthma diagnosis for those aged 60 and over. The Chair highlighted the section on Community Payback Orders, noting the value of the data presented and the importance of continuing to monitor outcomes and impact. The content of the update was noted. 5.3 Strategic Planning Group Update – Gill Main, Strategic Planning Group Chair The Chair of the Strategic Planning Group (SPG) reported that the Group had met on two occasions since the last update. A helpful focus had been on reviewing the Lothian Strategic Development Framework (LSDF). It was noted that the Strategic Plan aligns closely with Midlothian Council’s 5 year plan and the LSDF, and the Group has sought to incorporate key priorities from partner strategies into Midlothian IJB’s strategy. This work will inform the forthcoming refresh of the Strategic Plan for 2028–2031, including consideration of links to Midlothian Council’s wider strategic planning. Page 18 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Group has also considered initial scoping for the Strategic Plan refresh, including statutory guidance, in advance of its next meeting in May. In addition, the SPG reviewed the Risk Register, with members emphasising the importance of maintaining it as a live document and escalating risks where appropriate. 5.4 Audit and Risk Committee Update – Councillor Connor McManus, Vice Chair The Vice Chair reported that the Audit and Risk Committee had met on 5 March 2026. At that meeting, the Risk Register was updated, incorporating comments from members. The Committee also considered the updated Member’s Induction handbook, noting it to be a strong and well-developed piece of work. Overall, governance arrangements were reported to be in a good position, with the majority of actions completed; however, ongoing financial challenges were noted. For Decision 5.5 Midlothian IJB Appointments, Nomination & Resignation- Paper presented by Democratic Services Officer Democratic Services presented the report that 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 were asked to: Note the resignation of Chief Finance Officer, Chris King from 28th March 2026. Board noted and approved recommendations Page 19 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments 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. The Board noted and approved the recommendations in the report. For Discussion 5.6 Midlothian IJB Performance Update - Paper presented by Elouise Johnstone, Programme Manager The report presented 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 August 2026 with an interim report presented to the IJB in June 2026. Board noted and approved recommendations Page 20 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments 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 were asked to: Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1). The Board noted and approved the recommendations in the report. 5.7 East Lothian and Midlothian Public Protection Team Presentation, presented by Keith Mackay, East Lothian and Midlothian Public Protection Chair and Alan Laughland, Public Protection Manager (Presentation) Keith Mackay, East Lothian and Midlothian Public Protection Chair, and Alan Laughland delivered a presentation providing an update on the EMPPC structure and governance arrangements. The presentation will be circulated with the minutes. The Chair thanked Keith and Alan for the presentation. The Board noted their interest in the work with staff and volunteers and if feedback contributes towards the improvement of service and also asked if, whilst staff benefit from learning opportunities, this was open to volunteers. The Board were also interested in the Adult Care conference and if involvement with adult case was something newly introduced and led by new legislation informed by practice. Alan Presentation to be circulated with the minutes of meeting Democratic Services June 2026 Page 21 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments Laughland noted this didn’t come from legislation and the code of practice looked at the voice of adults and recognised the need to get adults involved. Keith Mackay added that learning and practice subgroups have volunteer workers and there are different training courses noted on the website that are offered to all staff across the partnership. The Board asked if operational services were part of the group or a partner. Alan Laughland confirmed that operational staff in Midlothian are aware of services and all are welcome to attend the ‘Role and Responsibilities’ training. The Chair highlighted that domestic violence, domestic abuse, gender-based violence and violence against women and girls was highlighted but asked where the men and boys were mentioned, noting that domestic abuse is not gender specific. Keith Mackay added that they had questioned this as someone with a background in the Police and having worked in the domestic violence area of policing. They added that the way committees are run comes down from national forums and comes down through the Scottish Government but added that they do take on domestic abuse against men and boys as well. Keith and Alan ended their presentation adding that they would like to come back to the Board again should there be any other topics, trends, risks or gaps that could be discussed further. 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 The Integration Manager and Programme Manager detailed the report which 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 Page 22 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments 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. It was noted that Audit Scotland discuss the perceived lack of comprehensive and consistent national performance information about community health and social care demand, workload, quality of care, and outcomes. Audit Scotland also stated 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. The response paper for discussion detailed 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 were 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. The Integration Manager noted that their approach when writing the response was to address the four key priorities that Audit Scotland identified. Page 23 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Chair emphasised that the report is taken seriously, noting Audit Scotland’s strong reputation and its value as an organisation. However, the Chair expressed disappointment with aspects of the Audit Scotland report and welco,es the response from officers of Midlothian HSCP Strategic Planning and Performance. The Chair described the Audit Scotland Report as, at times, discouraging, and raised concerns regarding certain statements. It was noted that some points made by Audit Scotland fell outwith the responsibility of the IJB, and that some data appeared to be inaccurate. The Chair proposed writing to Audit Scotland using the four key points and provide a Midlothian perspective, and to invite Audit Scotland representatives to a future discussion to support mutual understanding of how such reports are interpreted and used. The Board concurred with the points raised by the Chair, noting that the Audit Scotland report did not highlight any new issues and that the impact of waiting times is already well understood. Dr Amjad Khan welcomed the inclusion of the impact on Primary Care, observing that this is not always reflected in Board discussions, which tend to focus on Secondary Care. Dr Khan also suggested that it would be helpful for Audit Scotland to provide potential solutions, noting that while it is straightforward to be critical, it is more challenging to offer constructive recommendations. The Board noted they enjoyed the response to the report and queried how we benchmark against other Integration Authorities noting the key performance indicators do not recognise differences between Local Authorities and local areas. Member agreed it would be helpful to have a meeting with Audit Scotland. The Integration Manager noted that significant time had been spent reviewing the underlying assumptions within the report and assessing Midlothian’s performance in that context. They expressed thanks to the Board for its direction and ambition, and hoped that members could recognise the local narrative alongside the national dataset. It was further noted that the review of the National Performance Draft a letter to Audit Scotland to ask for them to attend a Board meeting to help address some areas of concern from the report. Integration Manager 30/04/2026 Page 24 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments Framework does not include the national indicators that sit under the Health and Wellbeing Framework, and a missed opportunity. The Chair sought assurance that the national indicator reporting remains up to date and relevant. The Performance Manager noted that Audit Scotland’s report references a recommendation to undertake a 12-month programme of work by Public Health Scotland to review existing indicators and develop a revised suite of KPIs. It was suggested that this presents an opportunity for further discussion with Audit Scotland regarding engagement with Public Health Scotland in progressing this work. The Performance Manager also highlighted Audit Scotland’s recommendation for an annual review of indicators to ensure they remain fit for purpose. The Chair proposed writing to Audit Scotland to invite representatives to attend a future Board meeting to discuss the issues raised in the report, with the aim of developing a more balanced and coherent understanding. The Chair also suggested requesting further information on the breadth and depth of the NHS Primary Care Programme, including current priorities, and that this be incorporated into the correspondence to Audit Scotland. Feedback from NHS Lothian Primary Care Programme Board on works undertaken Chief Officer August 2026 Page 25 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments 5.9 Midlothian Unscheduled Care Workstream Update, presented by Grace Cowan, Head of Primary Care and Older Peoples Services (Presentation) The Head of Primary Care and Older People provided a presentation which will be circulated with the minutes. The Head of Primary Care and Older People noted there were 139 beds occupied, the target is 115. There were 10 health delays and 45 delays in total in Social Care. There are 20 beds at the Community Hospital and 25 in acute settings. If those bed delays are taken off the number drops below 115. How do we focus on delays and how do colleagues in acute focus on people who don’t need us are discharged timeously. The Chair suggested the need for a Development Session to present information in a different format as it is important for Board members to see this is a whole system approach that Midlothian plays a part in. The Board queried the cohort of 45-64 and asked why they did not interact with social services and also felt it would be helpful to know if they were repeat patients or new people in the system to consider the shift in balance and change in behaviour and consider pathways for those particular patients. The Chair suggested brining more information on this cohort back to the Development Session and also asking if East and West are having the same issue. The Head of Primary Care and Older People noted they were also interested in the 45-64 cohort as they have had a granular look at the district nurse service and a younger age group are coming through the service. The Board agreed a Development Session should be set up to allow for further discussion. Presentation to be circulated with minutes Date to be allocated for Development Session for Cohort of 45-64 year olds Democratic Services Business Support to liaise with Integration Manager, Chair and Chief Officer June 2026 2026 Page 26 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments 5.10 Midlothian Integrated Assurance 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 The Chief Nurse presented the report 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. 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 agreed to develop a refreshed approach to Clinical and Care Governance across 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. Page 27 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board Decision Action Owner Date to be Completed /Comments The Chair suggested carrying this report over the next meeting to allow time for further discussion. For Noting 5.11Midlothian IJB Performance Framework 2025-2028 (Year 2) - Paper presented by Elouise Johnstone, Programme Manager The Programme Manager presented the report The Board were happy and noted the recommendations in the report. Board noted and approved recommendations 5.12 Midlothian Health and Social Care Partnership Transformation and Change Programme Update Paper provided by Morag Barrow, Chief Officer The Chief Officer presented the report which 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 were 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. Board noted the recommendations Page 28 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board 5 Private Reports No items for discussion. 6 Any Other Business No items for discussion. 7 Date of Next Meeting 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. The next meeting of the IJB SPG will be held on 21st May 2026, 1400 – 1600 and is an in person only meeting at St Johns Church, 31 Eskbank Road, Dalkeith, EH22 1HJ. All Board members are invited to attend. Decision Action Owner Date to be Completed /Comments The Board noted the recommendations in the report. 5.13 NCS National Care Service Charter of Rights - Paper provided by Morag Barrow, Chief Officer The paper was provided by Chief Officer for noting at meeting. The Board noted the recommendations in the report. Board noted the recommendations Page 29 of 382
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Thursday 2nd April 2026 Midlothian Integration Joint Board 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. Meeting concluded at 16.00pm Page 30 of 382
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Midlothian Integration Joint Board Thursday 11 June 2026 Item No 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 31 of 382
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DRAFT 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 32 of 382
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DRAFT 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 33 of 382
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DRAFT 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 34 of 382
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DRAFT 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 35 of 382
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DRAFT 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 36 of 382
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DRAFT 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 37 of 382
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DRAFT 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 38 of 382
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DRAFT 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 39 of 382
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DRAFT 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 40 of 382
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DRAFT 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 41 of 382
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DRAFT 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 42 of 382
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MIJB - Audit and Risk Committee Meeting Date Time Venue Audit and Risk Committee Thursday, 5 March 2026 2.00pm Virtual Meeting via MS Teams Present (IJB voting members): Councillor McManus (Chair, Midlothian Council) Heather Campbell (Depute Vice Chair) Present (IJB non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Antony Clark (Independent Member) Councillor Derek Milligan (Midlothian Council) Councillor Kelly Parry (Midlothian Council) Present (Officers): Claire Gardiner (External Audit, Audit Scotland) Duncan Stainbank (Chief Internal Auditor) Gill Main (Integration Manager) In attendance: Louise Middleton (Democratic Services Officer) Apologies: Dr Amjad Khan Wendy Metcalfe Midlothian Integration Joint Board Thursday 11 June 2026 Item No 4.3 Page 43 of 382
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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. 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 27 November 2025 was submitted and approved. The Chief Officer introduced Sandra Bagnall, Executive Business Manager who will be replacing Roxanne King in in the interim. 3.2 Action Log - The Action Log was noted by the Committee. The Integration Manager highlighted the last action on the action log on the Register of Interest. The Register of Interest is held by Alan Turpie, Legal and Governance Manager and Monitoring Officer and the Chief Internal Auditor has passed on the action to them to bring back a process on how the Register of Interest stays up to date. The action log will be updated to note the Legal and Governance Manager and Monitoring Officer as responsible for this. The integration Manger can be removed from this action. Page 44 of 382
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MIJB - Audit and Risk Committee 4. Discussion Topic 4.1 IJB Complaints – Roxanne King, Executive Business Manager (verbal update) The Executive Business Manager gave an update which had been provided by Lisa Cummings. The Executive Business Manager noted there had not been progress in establishing the formal system and appreciated there is a gap there and will pick this up to identify work done to date and any work that needs carried out. The Executive Business Manager noted that, as we head into some difficult financial decisions there may be a rise in the number and complexity of complaints so there is a need for a resilient process. In the meantime, complaints will be dealt with, and tracking will continue to ensure deadlines are met and an update will be given as work progresses. The Integration Manager noted that the next meeting of this group is in June, and this may be challenging as last year complaints came in in April and May. The Integration Manager had asked that Midlothian Council pick up complaints on the Council complaints system, but this has not happened. The Chief Internal Auditor will follow up on this following an offline discussion with the Integration Manager, however it was suggested this may need added to the Risk Register. The Depute Vice Chair enquired if the issue with the complaints system was impacting the performance on the standard of response and queried why complaint come in bulk. The Integration Manager noted that, last year, the complaints were managed within timeframes and only one complaint went to a stage 2, however felt there may be more complaints this year due to the financial challenges. In terms of the timing for complaints, they tend to come in when financial allocations were agreed. 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. This report presents the Integration Joint Board’s (IJB) Risk Register for review at quarter four 2025/26. Page 45 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments Midlothian IJB maintains a Strategic Risk Register in line with governance best practice, capturing key risks that may affect the development or delivery of the Strategic Plan. The register was last formally reviewed and updated in November 2025. Following the discussions at the Audit and Risk Committee meeting in November, the full risk register has been reviewed and updated. The revisions incorporate the Committee’s comments and reflect the agreement that the risks should be updated in light of recent local and national developments. A full version of the updated register, including risk descriptions, mitigations and ratings, is provided in Appendix 1. Committee Members are asked to: • Consider whether any further risks should be added, or existing entries amended. • Review, and subject to any required amendments, agree the updated Risk Register at quarter four 2025/26. The Chief Finance Officer noted that a long discussion took place at the last meeting of the Committee and a number of risks have been updated, specifically risk 4 and 5, and asked if the Committee were happy with the detail and had anything they wished added, or removed. Discussed at last meeting on updating the risk, largely around risk 4 and 5. The Chief Finance Officer noted that, should there be no resolution on the complaints system, this could be added as a separate risk. The Integration Manager highlighted another risk to consider. The council are upgrading their website and, as the partner that provides the Galaxy site, which holds the HSCPs and the IJBs pages, which contains all publications that are a statutory duty to publish, this should be Page 46 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments highlighted. The Integration Manager noted there had not been any discussions about the needs and requirements for the IJB so thought it something to monitor. The Independent Member asked if the departure of the Chief Finance Officer should be noted as a risk. The Chief Finance Officer noted that there was some movement on the possibility of someone taking over this role, so the risk was reduced. The Chief Officer said they were nearly in a position to confirm someone coming but that passing on knowledge and understanding would take time, and the new appointment may take time to get up to speed. The Chief Internal Auditor asked if someone was in place would this be the end of a formalised recruitment process, the Chief Officer confirmed this was the case. The Independent Member enquired about the extent to which some of the risks in the risk register aren't crystallising as there are risks that seem to have been on there for a long time, such as the impact on partners of the Scott Government's decision around strategic planning. Are they real live risks or are they on the risk register as assurance that they are at the correct risk rating. The Integration Manager noted this point adding this is part of the risk 5 partner decisions. The IJB has to resubmit its scheme of integration and partners will need to review this, specifically, what the partners wishes are, do they want to continue with the scheme as is with the statutory delegated functions plus minus. The scheme of integration must be reviewed by September to include the new change to the Public Bodies Joint Working Act on lived experience membership and their voting rights. 5.2 MLIJB and Associated Committees Handbook Update 2026, presented by Gill Main, Integration Manager The Integration Manager presented the report. Page 47 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments This report outlines the improvements and updates made to the existing Midlothian Integration Joint Board (IJB) Members’ Handbook and the rationale for producing and issuing the updated version to all new members as part of their induction. The Handbook has been reviewed and refreshed to ensure it remains accurate, relevant, and aligned with current statutory guidance, with updates introduced to strengthen clarity, governance expectations, and member support. The Public Bodies (Joint Working) (Scotland) Act 2014 and associated statutory guidance on Roles and Responsibilities (Appendix 2) set out clear requirements for IJB membership. Section 2.4 specifies that appointed members must be provided with the resources and support necessary to fulfil their responsibilities, and that stakeholder members must receive appropriate training to enable them to contribute effectively. The Midlothian IJB Members’ Handbook forms a key element of this support and will be used as part of the induction process for all new members. As a result of this report, Members are asked to: • Note the content of Midlothian IJB Handbook, • Approve the Handbook’s use as the standard induction resource for all new members, and • Support resolution in relation to the appropriate process for members reasonable expenses. The Integration Manager noted the typing error on Page 11. The report has a template setting out accessibility criteria and the Integration Manager will ensure that, when the report goes to IJB, reports are written to a reading age between 9-11, no screenshots, pictures have alternative text and that contrast accessibility guidelines are met. The Independent Member felt the handbook was very easy to read and appreciated the combination of summary sections and more detail as well, noting the embedded question about the expenses policy. Page 48 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments The Integration Manager said the expenses policy was difficult as there is a small budget to recompense those for travel etc. The Integration Manager added the challenge was to establish which partner's policy we should be adopting or if we should write our own one as an IJB but previously we have been encouraged to take a policy of a partner. The Chair noted they were not sighted on other policies but noted the IJB is quite unique in the way that it's represented and has individuals with disabilities and the expenses were required to take that into account. The Integration Manager felt the IJB should write their own and will bring this back to the September meeting. Produce an expenses policy for IJB. Integration Manager September 2026 meeting. 5.3 External Audit: Annual Audit Plan 2025/26, presented by Audit Scotland Audit Scotland presented the report. The report is the plan for the 4th year of Audit Scotland’s audit appointment. Audit Scotland drew attention a couple of areas, the first being materiality, highlighted in exhibit one of the plan. This is the level on which Audit Scotland base their conclusions, anything over £4 million would require a change to be made to the accounts and if no change was made, it could result in a qualified audit opinion. Anything over £0.2 million is the level at which would be reported to members, anything below this number would be discussed with management but would not necessarily be included in audit report. Exhibit 2 has highlighted the significant risks of material misstatement, there is only one which is management override of control although this is not a specific risk to IJB and is a standard risk required by auditing standards. Audit Scotland highlighted best value, noting there were no best value risks identified but there was a risk identified in relation to financial sustainability and this reflects the financial challenges Page 49 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments across the year. There is also a risk highlighted over the departure of the Chief Financial Officer role due to the loss of expertise and the cruciality of that role. Audit Scotland have set out their timetable and are working towards the audit committee in September, which reflects the national deadlines and the statutory deadline to sign before the 30th of September. The final thing noted was the audit fee which is £35,500, this is the standard increase of 4.3% and has been applied across all audited bodies. The Chief Officer noted the increase in charges versus the financial position IJB are in we're in. 5.4 Midlothian Integration Joint Board Internal Audit Plan 2026/27, presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report The purpose of this report is to gain approval to the proposed Internal Audit Annual Plan 2026/27 for the Midlothian Integration Joint Board (MIJB) to enable the MIJB Chief Internal Auditor to prepare the annual opinion on the adequacy of the overall control environment of the Midlothian Integration Joint Board. As a result of this report, Members are asked to: Note the content of Midlothian IJB Internal Audit Annual Plan 2026/27 Approve the Midlothian IJB Internal Audit Annual Plan 2026/27 (Appendix 1). The Chief Internal Auditor noted that the key elements include the annual assessment of internal control and governance, which includes doing the annual governance statement for the IJB. Performance management is due as an audit and that will be done in line with other audits Page 50 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments that have been done on Edinburgh and West Lothian IJBs and similar audits to be done for Midlothian and East Lothian this year so that's been covered across a pan Lothian one and will be done in conjunction with the NHS audit team as part of their provision of internal audit service to the IJB for this year. Sit for Solace have issued new guidance in 2025 in relation to the annual governance statement, which specifically states to avoid impairments of professional independence, therefore the Head of Internal Audit should not draft the annual governance statement, but where the Head of Internal Audit does draft the annual governance statement, this should be identified as a role beyond internal auditing. The Chief Internal Auditor is identifying as such and safeguards should be agreed so asked for confirmation that the committee are quite happy with this. The Independent Member confirmed they were comfortable with the Chief Internal Auditor would be able to do that piece of work whilst maintaining their independence and professional integrity. The Independent Member also enquired about the piece of work on financial recovery, noting that Audit Scotland has identified financial health and sustainability as a risk and asked if there would be an opportunity for Audit Scotland and internal audit to liaise over the issues that they be covering in their audit work and your audit work. The Chief Internal Auditor noted they were happy to work with Audit Scotland to ensure they were not crossing over on work and provide appropriate assurance in the right areas. The Chief Finance Officer highlighted that a new Chief Finance Officer may have difficulty answering questions straight away and agreed to speak with the Chief Internal Auditor offline to clarify the process. The Integration Manager noted the internal audit action around performance and the need to pick up what the scope would be as there will be some other work in other areas in NHS Lothian. The Integration Manager will pick this up with the Chief Internal Auditor. Work with Audit Scotland to liaise over issues they would be covering in their Audit work. Discuss the process if the governance statement. Discuss the scope for Chief Internal Auditor Chief Finance Officer/ Chief Internal Auditor Integration Page 51 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments the internal audit action around performance. Manager/ Chief Internal Auditor 5.5 Midlothian IJB draft Performance Framework 2025-2028, presented by Gill Main, Integration Manager The Integration Manager presented this report. This report presents a revised Draft Performance Framework 2025/28 (appendix 1), realigned with draft Directions for 2026/27. As a result of this report, Members are asked to: • Review and provide feedback on the revised Draft Performance Framework 2025/28, • Subject to any amendment required by the Board to Directions 2026/27 at the March 26th Special Board meeting, approve this framework for publication, and • Note the requirement to review the Midlothian IJB Performance Framework annually. The Independent Member felt the report was very clear and easy to follow although felt the national indicators did not reflect what they are meant to be capturing but appreciated we had, no control of that. The Integration Manager agreed and has raised this constantly, noting that the national indicators talk about things that IJB cannot control and there may be an opportunity to discuss this in more detail at the next meeting. The Integration Manager noted they were thinking about what leading indicators are and the team are working on this now, in particular in light of the ongoing refresh of SPG and ask of IJB chair of how commissioning works in that space. There are too many lagging indicators just now and the Integration Manager hopes to have this updated by September meeting. The Vice Chair asked if, given the experience that IJB’s have had, should we be trying to produce something that is a bit more useful in terms of performance scoreboard and a Work on the leading indicators. Integration Manager September 2026 Page 52 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments dashboard. 5.6 Audit Scotland Report: ‘Delayed discharges: A symptom of the challenges facing health and social care’ and Midlothian Performance, presented by Gill Main, Integration Manager The Integration Manager presented the report. This paper sets out the main findings of the Audit Scotland performance audit ‘Delayed discharges: A symptom of the challenges facing health and social care’ (appendix 1). This also includes the Midlothian Health and Social Care Partnership (HSCP) most recent available local data to provide an update on local performance, ongoing improvement activity, and opportunities for improvement. The report published by Audit Scotland on 8th January 2026 is an assessment of the performance across Scotland relating to delayed discharges from hospital settings using data from April 2024 to October 2025. Audit Scotland explores the reasons for, and implications of, delayed discharges, the actions taken to reduce them, and the impact of delayed discharges on people. To better understand the impact of local pressures and how these challenges are being addressed, Audit Scotland focused on working with the Officers of Integration Authorities, Health Boards and Local Authority Partners in three areas; Dundee City, East Ayrshire, and Highland. Midlothian HSCP has made significant progress in reducing the number of delayed discharges for people from Midlothian and continue to play a central role in the pan Lothian Unscheduled Care improvement work. This report sets out the initiatives to identify opportunities and take action with Midlothian to improve the experience of people who are in hospital and the current performance across a range of measures including the number of delayed discharges and occupied bed days within the Royal Infirmary of Edinburgh. As a result of this report, Members are asked to: • Note the key findings and recommendations of the Audit Scotland repot ‘Delayed Page 53 of 382
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments discharges: A symptom of the challenges facing health and social care’(appendix 1). • Note the progress made within Midlothian and the areas of ongoing focus. The Integration Manager noted this report would be taken to the Community Health & Social Care Board. The Chief Officer said there was huge amount of systems learning and areas working together. Counting the number of beds in usage is not a good determinate of your success. Within Midlothian there has been good improvement across all the parameters, now we are able to drill down to some of the real things that impact so a really useful exercise, benchmarking against the Audit Scotland report is really helpful and goes back to an early point about the measures not being correct and the focus not necessarily being correct. The Chief Officer noted they were proud of what the team had done, and whilst they can still improve, they are making good progress. The Independent Member felt it was good to see local stuff against the national story. The Integration Manager felt we can learn from other areas but context is critical and another area where we need national direction. Councillor Derek Milligan left the meeting at 14.56pm. 5.7 Midlothian Council Internal Audit Reports (For noting), presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report. This report introduces the Midlothian Council Internal Audit Reports recently finalised that should be noted by the Midlothian IJB. One recent report is being brought to the attention of the Midlothian IJB Audit & Risk Committee as it provides appropriate assurance concerning relevant areas of governance. On the 23 February 2026 the Midlothian Council Audit Committee was presented with a report on Direct Payments Self Directed Support which provided a conclusion of Reasonable Assurance. Recommendations have been agreed with Council management and will be followed up to Page 54 of 382
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MIJB - Audit and Risk Committee 5. Private Reports No items for discussion. 6. Any Other Business The Chair took this opportunity to thank the Chief Finance Officer for all their work and assistance and wished them well in the future. 8. Date of Next Meeting The meeting terminated at 3.05pm. The next meeting will be held on Thursday 4th June 2026, 14:00-16:00, Microsoft Teams (online). Report Title/Summary, Decision Action Owner Date to be Completed/ Comments conclusion by the Midlothian Council Internal Audit team through the Audit Committee. One of the recommendations covers performance reporting and therefore is relevant to the IJB, however this is an operational report for Midlothian Council. As a result of this report, Members are asked to: • Note the findings of the Midlothian Council Internal Audit of Direct Payments Self Directed Support. The Chief Finance Officer clarified at this point the membership for the committee and noted that, for this board to be quorate there should be two members from Midlothian Council, 2 members from NHS and 1 independent member and it may be worthwhile looking at the membership at a future meeting. Consider the membership of this committee All September meeting. Page 55 of 382
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Midlothian Integration Joint Board Thursday, 11 June 2026, 14:00-16:00 Chief Officer Report June 2026 Item number: 5.2 Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting June 2026. Board members are asked to: Note the content of the report. # Page 57 of 382
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Midlothian Integration Joint Board Report Chief Officer Report June 2026 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting June 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 A verbal update regarding Chief Internal Auditor will be provided at the Board meeting. A meeting with NHS Lothian Chief Executive and Director of Finance took place in March, to brief again on social care budget challenges. A Partners meeting was held in May to focus on the financial challenges around the Social Care allocate budget, and financial position. Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Interim Head of Service Midlothian Local Area Coordination (Enable Scotland) working partnership with Royal National Institute for Deaf (RNID) In Midlothian our Local Area Coordination team work in partnership with a variety of different organisations. By doing this they can continue to build their knowledge of local networks, community links, agencies and services which enables them to connect individuals in their local communities and highlight the services that will be useful to them. One area of strong partnerships working has been with the RNID Coordinator. The Local Area Coordinators met with the RNID Coordinator to discuss possible ways that they could work together to offer a drop-in service for people with hearing loss. The RNID Coordinator already had some of the drop-in services within Midlothian and this was proving to be successful. As people could come along and get information on Page 58 of 382
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Midlothian Integration Joint Board hearing loss and tinnitus, have basic repairs done to their hearing aids, and to look at how to access support and services within their own area, individuals who report potential hearing difficulties may also access an on-site mini hearing assessment delivered by the RNID Coordinator. Local Area Coordinators have delivered two café drop-ins to date: Café Connect at Dalkeith Art Centre (held on the first Thursday of each month) and Linking Loanhead at the library (held fortnightly on Wednesdays). These established sessions were identified as suitable opportunities to link in with the RNID Coordinator. This approach has been effective. Individuals attending to see the RNID Coordinator are also supported by Local Area Coordinators, who provide refreshments and opportunities for informal social interaction. This has enhanced the overall offer, enabling attendees to connect with others and helping to reduce social isolation, particularly for those who may have limited contact with others. Adult Support and Protection (ASP) Financial or Material harm continues to be the most prominent type of harm referred (25%). This highlights that identifying and intervening in cases of financial harm remains a strength for the service. Self-neglect is also a prominent type of harm, accounting for 14% of all ASP Inquiries in the quarter. To ensure that the adult is protected from ongoing harm, taking a person-centred approach to safety planning and decision making is key to minimise or reduce the risk. At all times Council officers will seek to address the risk in line with the principles of the Adult Support and Protection (Scotland) Act 2007. If risks remain at the completion of the Duty to Inquire, and the three-point test has been met, an Adult Support and Protection Case Conference must be convened; this is a multi-agency forum for shared decision-making. A Protection Plan is put in place at each case conference and is reviewed at least once to ensure that it is having a positive outcome or if additional action is required. During this quarter, 2 protection plans were commenced. During the whole of 2025/2026 there were 8 adults assessed as being at risk of harm being supported through a protection plan. A range of legal measures that agencies can take to mitigate and manage identified risks and include the use of Protection Orders which are sought through an application to the Sheriff Court. Protection Orders must be in line with the principles of the Act and therefore must be the least restrictive option that will provide benefit to the adult. There were no Protection Orders required in Q4, which has been consistent for the last 3 quarters and reflects that people are being supported without the need for legal measures and that interventions taken as part of ASP are the least restrictive. A procedure has been developed to gather feedback from adults supported under the ASP process. The feedback form can be completed by the adult, or they have the option to provide feedback verbally to the Health & Social Care Practitioner within the ASP Team, who is independent from the process. Work is ongoing to embed feedback within the ASP Process to ensure that adults are enabled to inform service improvements. Page 59 of 382
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Midlothian Integration Joint Board Justice Engaging effectively with people At the end of Q4 the Justice Service team were supervising 232 people who were subject to 263 Community Payback Orders. Justice Social Work staff use a trauma- informed and person-centred approach to develop effective working relationships with people. Disengagement from community-based supervision can indicate an increased risk of reoffending as the person’s lifestyle may be more chaotic. This can be due to a number of factors for example, increased substance use, unstable housing or home situation or poor mental health. To manage this risk, it is important that Social Work staff recognise signs of dis-engagement and take early and preventative action which focuses on rebuilding trust and supporting re-engagement. It is also important that those subject to community interventions are held accountable for their engagement and robust action is taken to non-compliance; this can ultimately result in the Order being returned to Court for breach action. During the breach process staff continue to offer opportunities for the person to re-engage. Welfare Rights During Q4 the Welfare Rights Team received approximately 100 calls to the advice line increase in the volume of referrals and during Q4 with 246 new referrals, an increase of 12 % from Q3. During Q4 the Welfare Rights Officers worked with 204 clients. Referrals are received from a number of sources. The highest proportion noted as being ‘other’ and this is due to incomplete recording of referrals onto the system; steps are being taken to address this to ensure accurate reporting for 2026/27 onwards. Analysis of referral reasons indicates the increase correlates with the continuation of the roll out of devolved benefits by Social Security Scotland, in particular: launch of Pension Age Disability Benefit (replacing Attendance Allowance for people over state pension age in Scotland). The migration of people in receipt of legacy benefits to Universal Credit is now complete. Midlothian’s Dementia Implementation and Evaluation Framework 2026–2029 The Mental Health 18+, Substance Use Service (SUS), and Strategic Development Manager for Mental health 18+ and SUS, have led on the development of Midlothian’s Dementia Implementation and Evaluation Framework 2026–2029. This Framework sets out how Midlothian Health and Social Care Partnership 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, 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. Page 60 of 382
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Midlothian Integration Joint Board The Framework expects to demonstrate the achievement against each objective, including earlier diagnosis, improved post diagnostic continuity, reduced inequality of 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 work stream for Midlothian and has engaged a wide range of stakeholders across the HSCP and Third Sector. This includes those with Lived experience and their carers. 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. Fiona Kennedy, Interim Head of Service – fiona.kennedy2@midlothian.gov.uk 3.3 Head of Primary Care and Older People Diabetes service A new community diabetes service has been agreed as a 12-month test of change commencing August 2026, aimed at improving care for high-risk populations across Midlothian. The service will focus initially on patients receiving insulin via District Nursing teams, with planned expansion to care home residents and frail individuals living in the community. Delivery will include a weekly virtual consultant-led clinic to support proactive review, safe optimisation and potential reduction of insulin therapy, alongside the development of personalised and anticipatory care plans. A monthly multidisciplinary team will support management of complex cases, promote consistent clinical practice, and strengthen workforce capability across community services. The test of change will evaluate impact on patient outcomes, service demand, and safety, including reductions in avoidable admissions, medication errors, and district nurses workload, to inform future service planning and potential wider rollout. Grace Cowan, Head of Primary Care & Older People - grace.cowan@nhs.scot 3.4 Strategic Planning Midlothian IJB Annual Performance Report Strategic Planning and Performance work across the year to gather information required to deliver on the statutory reporting requirements of the Midlothian IJB Annual Performance Report 2025/26. This includes reporting on national datasets, local performance and outcomes for people and communities. A draft report was presented to Midlothian IJB Audit and Risk Committee on 4th June 2026 and will now be reviewed by Board members to ensure the Board can meet the statutory requirement to publish an APR before the end of July. Following the Public Health Scotland (PHS) release of the National Indicator data in mid-July, the data will be Page 61 of 382
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Midlothian Integration Joint Board scrutinised by the Midlothian IJB Strategic Planning Group on 24th July 2026 before a final draft is presented to Midlothian IJB on 20th August 2026. Midlothian IJB Annual Survey As part of Midlothian IJBs commitment to learning from local experience, the Midlothian Annual Survey ran from 13th April until 29th May 2026. The data is currently being analysed and will be scrutinised by the Midlothian IJB Strategic Planning Group (SPG) on 23rd July 2026 before inclusion in the final draft of the Midlothian IJB Annual Performance Report 2025/26. Midlothian IJB Joint Strategic Needs Assessment (JSNA) Strategic Planning and Performance are supporting work led by Public Health Scotland (PHS) to consider a national approach to how IIBs construct and utilise their Joint Strategic Needs Assessments (JSNAs). This comes as local planning enters a new phase of activity that has already begun exploring a more placed based approach to data. It is anticipated that this will better represent the 15 natural communities in Midlothian and more specifically support the board in its duty to plan and direct the delegated functions. A paper was presented to the Midlothian IJB Audit and Risk Committee on 4th June 2026 before work is taken forward by the Midlothian IJB Strategic Planning Group. Midlothian IJB Strategic Planning Group (SPG) Refresh Many thanks to Board members who attended the Midlothian IJB Strategic Planning Group (SPG) workshop supported by Strategic Planning and Performance on 21st May 2026. The purpose of the session was to review how the group meets the duties of Strategic Planning Groups set out in the Strategic Plans: Statutory Guidance and most effectively supports the IJB in strategic planning and commissioning activity. Feedback is being collated and will be shared with Midlothian IJB Chair, Vice Chair, Chief Officer, and SPG Chair ahead of further discussion and future planning. Gill Main, Integration Manager – gill.main3@nhs.scot 3.5 Chief Allied Health Professional Community Engagement Day (formerly referred to as Community Appointment Day) Building on the learning from the Falls Prevention Community Engagement Day in September 2025, a further event was delivered on 16 April 2026 at Lasswade High School. The aim remains to increase choice for older adults in how they access the Midlothian health and care system and to support meaningful conversations about health and lifestyle. The Falls Passport continues to provide a practical tool for capturing agreed actions, signposting, and key takeaways, supporting ongoing self-management. The event exceeded previous performance across all key measures, including attendance (219 vs 208), uptake of functional fitness testing (130 vs 103), and satisfaction levels (100% vs 92%). Notably, 40 individuals returned following the previous engagement event, indicating sustained engagement. Page 62 of 382
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Midlothian Integration Joint Board Ethical approval has now been secured to support ongoing evaluation. “What Matters to You” conversations were embedded on arrival, enabling participants to make best use of available support and providing the opportunity to consent to participate in associated research. Follow-up through focus groups and questionnaires at six months will support a deeper understanding of impact. A further engagement event is planned for 29 October at the Ladywood Centre in Penicuik. Strategically, opportunities are being explored to scale this model across the system, including consideration of key enablers and potential challenges. Obesity Pathway Improvement Programme (OPIP) and Limitless Stride (NB national comms strategy planned for 1st June) Successful grant funding has been secured via Innovate UK and the Obesity Pathway Improvement Programme (OPIP) for three years from 1st May 2025. Limitless Stride describes the two programmes we will test using this grant funding. Limitless for NHS patients, blending digital tools with community and specialist care. Stride for the Armed Forces community, combining rehabilitation, fitness assessments, and occupational health support. OPIP funding will enable the digital build of the design work previously described as the Weight Msnagement Design Accelerator completed in 2025. In collaboration with DHI and five Health Boards, this work advanced a Once for Scotland approach by designing a scalable digital triage model for weight management pathways. The project demonstrated improved consistency, efficiency, and early identification of high-risk patients, with optimised pathways through integrated clinical and psychological data. Supporting service delivery, responding to demand and creating opportunity to test additional pathways for obesity medicines (GLP-1/GIP RA), the grant funding will also enable additional virtual capacity for Weight Management services and Type 2 Prevention programmes, a Primary Care LES to enable an additional 500 patients per year to access obesity medicines and wrap around care and will enable an innovative collaboration with UK Military Defence Medical Service to support their GLP-1/GIP RA pathway with weight management wrap round services. By combining NHS and military expertise, we’re building a modern, flexible system that improves health, reduces inequalities, and supports occupational wellbeing. This approach follows national clinical guidelines and government priorities, and by testing it in both NHS and military settings, we’re proving it can scale across the UK, setting a new standard for obesity care innovation. Claire Ross, Chief AHP – claire.ross4@nhs.scot 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. Page 63 of 382
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Midlothian Integration Joint Board 5 Directions 5.1 The report reflects the ongoing work in support of the delivery of the current Directions issued by Midlothian IJB. 6 Equalities Implications 6.1 There are no specific equalities issues arising from this report. 7 Resource Implications 7.1 There are no direct resource implications arising from this report. 8 Risk 8.1 The key risks associated with the delivery of services and programmes of work are articulated and monitored by managers and, where appropriate, reflected in the risk register. 9 Involving people 9.1 There continues to be ongoing engagement and involvement with key stakeholders across the Partnership to support development and delivery of services. 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE June 2026 Page 64 of 382
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Midlothian Integration Joint Board Thursday, 11th June 2026, 14:00-16:00 Midlothian IJB Health and Care (Staffing) (Scotland) Act 2019 Update Position Report Item number: 5.5 Executive summary This report sets out an updated reporting position for compliance with the duties set out for Integration Authorities on the Health and Care (Staffing) (Scotland) Act 2019. The Act sets out a number of statutory duties relating to the assessment and provision of appropriate staffing for key staffing groups and service provision within health and social care. This legislation came into effect on the 1st of April 2024. All Integration Authorities must meet the requirements of the Act and relevant secondary legislation. These duties can be found in section 3(2) and (6) of the Act and relate to the planning or securing the provision of care services from third party providers. A significant proportion of the IJBs budget is utilised through the planning and securing of care provided by a third party. Scottish Government require all IJBs to return an Annual Report outlining how they have complied with the Duties in 2025 no later than 30 June 2026. The Scottish Government reporting template is included in Appendix 1. As a result of this report, Members are asked to: Note the contents of this Report. Agree the submission of the return to Scottish Government in Appendix A by 30 June 2026. Page 65 of 382
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Midlothian Integration Joint Board Report Midlothian IJB Health and Care (Staffing) (Scotland) Act 2019 Update Position Report 1 Purpose 1.1 This report sets out an updated reporting position for compliance with the duties set out for Integration Authorities on the Health and Care (Staffing) (Scotland) Act 2019. There is a requirement to submit a return to Scottish Government by 30 June 2026. The proposed return is in Appendix 1. 2 Recommendations 2.1 As a result of this report, Members are asked to: Note the contents of this Report. Agree the submission of the return to Scottish Government in Appendix A by 30 June 2026. 3 Background and main report 3.1 The Health and Care (Staffing) (Scotland) Act, 2019 sets out a number of statutory duties relating to the assessment and provision of appropriate staffing for key staffing groups and service provision within health and social care. This legislation came into effect on the 1st of April 2024. 3.2 The duties of the Act are different for Health Boards, Local Authorities, and Integration Authorities. Health Boards and Local Authorities must report on the staffing provision for specific staffing groups defined in the legislation, while Integration Authorities are asked to focus on the assurance relating to the provision of services planned or secured by health and social care and provided by a third party. Reporting templates have been provided by Scottish Government for Health Boards who must report quarterly and annually. 3.3 All Integration Authorities must meet the requirements of the Act and relevant secondary legislation. These duties can be found in section 3(2) and (6) of the Act and relate to the planning or securing the provision of care services from third party providers. This will require Midlothian IJB to receive assurance from Midlothian HSCP on commissioning activity for a 'care service' provided by a third party and ensure that providers are compliant with the duties of the Act. Page 66 of 382
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Midlothian Integration Joint Board 3.4 The Act defines a 'care service' as mentioned in section 41(1) of the Public Services Reform (Scotland) Act 2010. Section 3(2) of the Act describes our duty when planning or securing the provision of a care service from a third-party provider. This must include how we ensure the provision of safe and high-quality care, and the health, wellbeing and safety of staff and people who access services. 3.5 The duty applies to services provided by staff working in a care service. The definition of "working in a care service" includes working for payment or as a volunteer, and working under a contract of service or apprenticeship, a contract for services or otherwise than under a contract. 4 Policy Implications 4.1 This report is in direct response to the Health and Care (Staffing) (Scotland) Act 2019, the Statutory Guidance of which came into effect on the 1st of April 2024. 4.2 There are clear links to a range of national policies and drivers including the Scottish Government Health and Social Care: National Workforce Strategy, the guidance for Three Year Integrated Workforce Plans, Statutory Guidance for Strategic Plans, and Scottish Government guidance on Preparing to Transition Towards a National Care Service for Scotland. 5 Directions 5.1 This report directly and positively impacts upon NHS Lothian’s and Midlothian Council’s ability to deliver the following Midlothian IJBs Directions: Direction 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. 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 This report does not directly impact on groups of people with protected characteristics. Page 67 of 382
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Midlothian Integration Joint Board 7 Resource Implications 7.1 There is no resource implication as a result of this report other than the time and capacity required from the officers of Midlothian HSCP. 7.2 This report is in line with the principles of Best Value. 8 Risk 8.1 There is a risk that by not undertaking the work outlined in this report that Midlothian IJB will not be compliant with the duties of the Health and Care (Staffing) (Scotland) Act 2019 due to Midlothian HSCP being unable to provide the relevant assurance. 9 Involving people 9.1 As commissioning activity is undertaken by both NHS Lothian and Midlothian Council on behalf of Midlothian HSCP who plan and secure these services, this report will also be of interest to those service areas which plan and secure services provided by third parties. 10 Background Papers 10.1 None. Author’s Name Nick Clater Designation Head of Adult Services and CSWO Contact Information nick.clater@midlothian.gov.uk Date 26/05/26 Appendices: Appendix 1: Health and Care (Staffing) (Scotland) Act 2019: Annual Report Page 68 of 382
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Midlothian Integration Joint Board Health and Care (Staffing) (Scotland) Act Annual Report 2025/26 Page 69 of 382
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Contents Introduction............................................................................................3 Declaration.............................................................................................3 Who we are.............................................................................................4 Reporting................................................................................................5 Assurance ..............................................................................................5 Page 70 of 382
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Introduction Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). We must pay due regard to and meet the duties of legislation relating to health and social care. From the 1st of April 2024, this includes the statutory duties of the Health and Care (Staffing) (Scotland) Act, 2019. For Integration Authorities, this means we must report on how we are ensuring care services that are planned and secured through a commissioning process and delivered by a third party are meeting the duty of the Health and Care (Staffing) (Scotland) Act, 2019. We do not employ health and social care workforce directly. This means the governance and assurance relating to safe staffing within health and care services working within the Health and Social Care Partnership (HSCP) will be reported by our NHS Lothian partners, and Midlothian Council will report in relation to the registered care services. We have worked closely with all our partners to ensure we have transparent reporting across the whole system. Declaration Name of Integration Authority: Midlothian Integration Joint Board Report authorised by: Morag Barrow Chief Officer 27/05/2026 This report will be made publicly available on Midlothian Health and Social Care Partnership website under the heading – What we do Page 71 of 382
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Who we are Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian plan to plan and direct some health and social care services for the people of Midlothian. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The services we provide include commissioned services that deliver care and support on our behalf. Page 72 of 382
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Reporting This section outlines the action we have taken to provide assurance in relation to our responsibilities in relation to the Health and Care (Staffing) (Scotland) Act, 2019. Assurance The steps we have taken as an organisation to comply with section 3(2) of the Health and Care (Staffing) (Scotland) Act 2019: 3(2) In planning or securing the provision of a care service from another person under a contract, agreement or other arrangements, every local authority and every integration authority (within the meaning of section 59 of the Public Bodies (Joint Working) (Scotland) Act 2014) must have regard to — (a) the guiding principles for health and care staffing, and (b) the duties relating to staffing imposed on persons who provide care services— (i) by virtue of subsection (1) and sections 7 to 10, and (ii) by virtue of Chapters 3 and 3A of Part 5 of the Public Services Reform (Scotland) Act 2010. Work is ongoing with Midlothian Council as the Partner who provide commissioning support to Midlothian IJB to ensure that planning, procurement and contract management processes are well executed and governed. This includes the ability to report on the duties of the Health and Care (Staffing) (Scotland) Act 2019. From 1st April 2025 to 31st March 2026, no new or commissioned contracts have been issued that have been planned and secured by Midlothian Health and Social Care Partnership (HSCP) and procurement by Midlothian Council on behalf of Midlothian IJB. This has in Page 73 of 382
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part been due to Midlothian Council capacity and resourcing challenges across 2025/26, resulting in a significant backlog in contract management. As a result, there is no eligible contracting assurance information requirement for the reporting period. Midlothian Council’s standard contractual terms and conditions have been updated to reflect service providers obligations under the Health and Care (Staffing) (Scotland) Act 2019. These terms are being used for any spot purchases of services and are also in the process of being rolled out to all care providers. This ensures there is clear contractual requirement on providers to comply with legislation. Contract management arrangements are also in the process of being revised with Planning Officers taking greater responsibility for ongoing contract management. This will mean there is a more structured approach to ensuring compliance with the Health and Care (Staffing) (Scotland) Act 2019, with compliance with safe staffing requirements forming a core part of ongoing contract management activity. Assurance in relation to service quality will be a key area of focus. Ongoing risks that may affect our ability to comply with the duty set out in section 3(2) Despite having no commissioning activity in 2025/26 that would be eligible for reporting, Midlothian IJB has taken action in readiness for future procurement activity. There are a number of risks that could affect our ability to comply with the duty set out in section 3(2). It is possible that we may have difficulty assessing some services ability to comply with their duties to ensure appropriate staffing and staff training due to lack of relevant information provision, limited choices in service providers, or specific situation that make compliance difficult to monitor or record. Financial constraints are being experienced by HSCP’s means funding uplifts to care providers are constrained and there is an ongoing expectation that care providers will make ongoing efficiencies in the provision of these services. There is a risk that funding constraints could compromise quality of service provision and the expectations of high-quality service provision as set out in section 3(2). We will consider the issues and risks as they arise and seek to find solutions where it is possible to do so. Page 74 of 382
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Midlothian Integration Joint Board Thursday, 11th June 2026 14:00-16:00 2025/26 Draft Unaudited Annual Accounts Executive summary This report presents the Midlothian Integration Joint Board (IJB) draft unaudited accounts in line with the statutory duty to publish a set of Annual Accounts every financial year. Integration Authorities are governed by the same statutory regulations that govern local authorities. The process to prepare a set of annual accounts is done in three stages. A draft set of unaudited annual accounts must be published before the end of June. These draft accounts will then be audited by the IJB’s appointed auditors. The final audited annual accounts must be published by the end of September. The management commentary is largely shared with the Annual Performance report which is also currently in draft form. Amendments and additions to this information will be updated as they become available. Additionally, Midlothian IJB must ensure that the published document meets the requirement of Midlothian IJB Scheme of Publication. Members are asked to: Consider the attached draft annual accounts, noting that some performance detail in the management commentary is incomplete as well as the missing Annual Governance Statement, and Approve this draft and give delegated the authority to Morag Barrow in her capacity as Chief Officer to publish a set of unaudited annual accounts for 2025/26 on the Midlothian Heath and Social Care Website by 30th June 2026. Item number: 5.6 Page 75 of 382
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Midlothian Integration Joint Board Report 2025/26 Draft Unauditied Annual Accounts 1 Purpose 1.1 This report presents the Midlothian Integration Joint Board (IJB) draft unaudited accounts in line with the statutory duty to publish a set of Annual Accounts every financial year. 2 Recommendations 2.1 As a result of this report, Members are asked to: Consider the attached draft annual accounts, noting that some performance detail in the management commentary is incomplete as well as the missing Annual Governance Statement, and Approve this draft and give delegated the authority to Morag Barrow in her capacity as Chief Officer to publish a set of unaudited annual accounts for 2025/26 on the Midlothian Heath and Social Care Website by 30th June 2026. 3 Background and main report 3.1 Midlothian IJB is corporate body as defined under s106 of the local government (Scotland) act 1973. This Act requires Midlothian IJB to produce a set on Annual Accounts at the end of each financial year. 3.2 In practice there are three steps To prepare a set of unaudited accounts approved for publication by Midlothian IJB on the Midlothian Health and Social Care website before 30th June 2025. Present these accounts to Midlothian IJB’s appointed Auditors (Audit Scotland) who undertake an audit. Prepare a final set of accounts reflecting the appointed auditors’ comments and including their own formal view on the accounts. This will be presented to the IJB’s Audit and Risk Committee on 10th September 2026 prior to presentation for approval at the Midlothian IJB Special Board meeting on 24th September 2026. The audited and approved set of annual accounts will then be published on the Midlothian Health and Social Care website as soon as practicably possible. 3.3 The Draft Unaudited Annual Accounts for 2025/26 set out the financial performance and governance of the Midlothian Integration Joint Board for the year ended 31 March 2026. The accounts have been prepared in line with statutory requirements and the Page 76 of 382
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Midlothian Integration Joint Board CIPFA/LASAAC Code of Practice and provide a true and fair view of the IJB’s financial position. They also include narrative sections that explain the IJB’s activities, performance, and the key financial challenges faced during the year. 3.4 The Annual Accounts are structured into four main sections: Section 1 – Performance Report provides an overview of the IJB’s role, strategic priorities, operational performance, and financial performance during the year. Section 2 – Accountability Report sets out the governance arrangements, including membership, responsibilities, remuneration, and the Annual Governance Statement. Section 3 – Independent Auditor’s Report will present the findings of the external audit. Section 4 – Financial Statements includes the core financial statements (Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, and Balance Sheet) together with supporting notes that explain the figures in more detail. 3.5 The section reflecting the work of Midlothian IJB across 2025/26 remains incomplete at this time. The information required to complete this is provided by the Midlothian IJB Annual Performance Report (APR). Due to the timing of the release of Public Health Scotland (PHS) validated data, this cannot be completed until July 2026. Following Midlothian IJB approving the publication of the APR, this information will be added to the Annual Accounts. 3.6 In addition, Midlothian IJB has a statutory duty to adhere to the Model Scheme of Publication and must ensure that all content meets the accessibility requirements of this scheme. 3.7 The Midlothian IJB Audit and Risk Committee reviewed this set of draft Annual Accounts on 4th June 2026, and a verbal update will be provided on revisions and additions required ahead of the Midlothian IJB Special Board meeting on 24th September 2026. 4 Policy Implications 4.1 There are no new policy implications as a result of this report. 5 Directions 5.1 There are no direct implications for Directions as a result of this report. Page 77 of 382
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Midlothian Integration Joint Board 6 Equalities Implications An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake an ECRIA as a result of this report. 7 Resource Implications 7.1 There are no direct resource implications for the IJB arising from this report. 8 Risk 8.1 The risk of inadequate financial resources being available to the IJB is included in the IJB’s risk register. 9 Involving people 9.1 Midlothian Integration Joint Board is open to the public to attend. 9.2 Following publication, the Midlothian IJB draft Unaudited Accounts 2025/26 will be shared on the Midlothian Health and Social Care website. 10 Background Papers 10.1 There are no background papers for this report. AUTHOR’S NAME Eleonora Ho DESIGNATION Chief Finance Officer CONTACT INFO Eleonora.Ho@nhs.scot DATE 26/05/2026 Appendices: Appendix 1: Draft Unaudited Annual Accounts 2025/26 Page 78 of 382
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1 Midlothian Integration Joint Board (IJB) DRAFT Unaudited Annual Accounts 2025/26 The Annual Accounts of Midlothian Integration Joint Board for the period from 1 April 2025 to 31 March 2026, prepared pursuant to Section 105 of the Local Government (Scotland) Act 1973 and in accordance with the terms of the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2025/26. Page 79 of 382
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2 Contents Audit Arrangements...................................................................................................3 Section 1 – Performance Report..................................................................................4 Section 1.1 – Management Commentary............................................................4 Section 1.3 – Annual Performance Report - Operational Performance.................7 Section 1.4 – Future Plans – Bold and Sustained Transformation.........................8 Section 1.5 – IJB Financial Performance in 2025/26...........................................10 Section 2 – Accountability Report..............................................................................19 Section 2.1 - Membership and meetings of the IJB............................................19 Section 2.2 – Statement of Responsibilities .....................................................20 Section 2.3 - Remuneration Report..................................................................22 Section 2.4 – Annual Governance Statement 2025/26 .......................................25 Section 3 – Independent Auditor’s Report..................................................................26 Section 4 – Financial Statement................................................................................27 Section 4.1 - Comprehensive Income and Expenditure Statement ....................27 Section 4.2 - Movement in Reserves Statement................................................27 Section 4.3 - Balance Sheet.............................................................................28 Section 4.4 - Notes to the Financial Statements ...............................................29 Page 80 of 382
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3 Audit Arrangements Under arrangements approved by the Accounts Commission of Local Authority Accounts in Scotland, the auditor with responsibility for the audit of the accounts of Midlothian Integration Joint Board for the period 1 April 2025 to 31 March 2026 is Audit Scotland, 102 West Port, Edinburgh EH3 9DN. Page 81 of 382
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4 Section 1 – Performance Report Section 1.1 – Management Commentary The management commentary considers the work and financial performance of Midlothian Integration Joint Board (MLIJB) during the financial year 2025/26. It provides an overview of the role, remit, objectives, and the strategy of the Board. The role and responsibilities of the IJB The IJB is an Integration Authority set up under the Public Bodies (Joint Working) (Scotland) Act 2014. We plan for the delivery of functions that have been delegated to us by Midlothian Council and NHS Lothian. These are: Adult Social Care (Including Criminal Justice) Primary Care (GP Practices, Community Dentists, Community Pharmacies and Community Opticians) Mental Health Physical and Learning Disabilities Community Health Community Hospital Unscheduled Care (generally delivered from the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital). We assumed strategic formal responsibility for these functions in April 2016 including managing the budgets to deliver them. The third Strategic Plan for 2025-2035 was approved and published in November 2025. Page 82 of 382
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5 Our Vision and Objectives The Scottish Government measures our performance on Health and Wellbeing Outcomes. National Health & Wellbeing Outcome 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. 5 Health Inequalities Health & social care services contribute to reducing health inequalities. 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide. 9 Use of Resources Resources are used effectively and efficiently. Page 83 of 382
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6 We also measure our performance against the objectives in our Strategic Plan. The Midlothian Integration Joint Board Strategic Plan 2025–2035, published in November 2025 sets out the long-term vision and priorities for integrated health and social care across Midlothian. Developed in partnership with Midlothian Council, NHS Lothian and local communities, the Plan provides the overarching strategic framework for how the IJB will plan services, allocate resources and deliver improved health and wellbeing outcomes. Covering the period from November 2025 and subject to formal review every three years, the Strategic Plan underpins the IJB’s financial planning arrangements, including the annual budget setting process, the Medium Term Financial Strategy, and the issuing of Directions to partner organisations, which translate strategic priorities into operational and financial commitments. The Strategic Plan is centred on three core strategic aims: supporting people to stay well and prevent ill health ensuring access to care and support in the community and at home and promoting people’s rights through person-centred and equitable services These priorities directly inform decisions on the allocation of the IJB’s integrated budget and the prioritisation of investment across services. The Plan explicitly recognises that available resources are not expected to keep pace with increasing demand driven by population growth, demographic change and complexity of need. As a result, the IJB must make difficult financial choices, including service redesign and reprioritisation, to ensure resources are used to achieve best value and deliver sustainable outcomes. In this context, the Strategic Plan outlines a programme of transformation focused on prevention, early intervention and shifting the balance of care towards community- based provision. This approach is intended to improve long-term financial sustainability by reducing reliance on more costly acute services and enabling more effective use of limited resources. The Plan also highlights the constraints of annual funding settlements from partner bodies, which create challenges for longer-term financial planning and require ongoing review of priorities and resources. The Strategic Plan therefore plays also a critical role in linking financial planning, service delivery and performance management, ensuring that the IJB’s resources are aligned with its strategic objectives and national outcomes while maintaining financial balance over the medium to long term. Page 84 of 382
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7 Section 1.3 – Annual Performance Report - Operational Performance TBC – This section will be completed in line with the APR report Page 85 of 382
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8 Section 1.4 – Future Plans – Bold and Sustained Transformation Public sector finances across Scotland continue to face significant pressure. The wider economic climate, including ongoing cost of living pressures, increases demand for health and social care services while limiting the funding available. These challenges are compounded by a growing and ageing population, increasing levels of frailty and long-term conditions, and rising complexity in the care and support required. Workforce shortages and constrained resources further impact the sustainability of existing models of care. In response, the IJB recognises the need for sustained transformation to ensure services remain financially and operationally sustainable. The refreshed Strategic Plan and Medium-Term Financial Strategy provide the framework for this change, setting a clear direction towards prevention, early intervention, and more integrated, person- centred models of care. During 2025/26 and into 2026/27, this transformation was supported by a programme of financial recovery actions and savings schemes, designed to address the gap between available funding and the cost of delivering services. These actions focus on redesigning services, managing demand more effectively, and ensuring that resources are directed towards areas of greatest need and impact. While necessary, these changes require careful management to balance financial sustainability with the continued delivery of safe and effective care. The Transformation Programme Board has continued to oversee and coordinate this work. The programme is focused on: strengthening community-based services and reducing reliance on acute and specialist care increasing investment in early intervention, prevention and self-management promoting person led and strengths-based approaches to care improving access to services, including through a more streamlined “single point of access” ensuring resources are aligned to strategic priorities, which may require changes to how services are delivered Delivery of this programme is supported by a number of enabling factors, including financial planning and resource management, workforce development, improved data Page 86 of 382
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9 and insight, engagement with carers and communities, and the use of digital solutions to improve access and efficiency. This transformation agenda is essential to addressing the long-term financial challenges identified within the MTFS. However, it also carries a level of financial and operational risk, particularly where savings depend on changes to service models, workforce availability, and the timing of benefits. The IJB will continue to work closely with its partners to manage these risks and ensure that transformation supports both improved outcomes and financial sustainability. Page 87 of 382
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10 Section 1.5 – IJB Financial Performance in 2025/26 The Comprehensive Income and Expenditure Statement in Section 4 show that the IJB finished the Financial Year 2025/26 with a surplus of £0.845m. This is not, however, an indication of the financial stability of the IJB as the reported surplus is a result of an increase in the level of Earmarked Reserves held by the IJB. This means that, while the IJB ended the year in surplus, the underlying cost of delivering services continued to exceed the recurring funding available. The increase in Earmarked Reserves reflects elements of Scottish Government funding for Unscheduled Care. This is due to the timing of expenditure against planned delivery rather than an underspend in underlying funding. The funding has been set aside to support the continued delivery of agreed Unscheduled Care initiatives, where implementation is ongoing and spans financial years. The use of an earmarked reserve ensures that resources remain aligned to their intended purpose and are available to complete delivery of planned service improvements. The use of reserves remains carefully managed to support agreed priorities while recognising that reserves are not a sustainable solution to underlying financial pressures. For underlying financial position for delegated services remains challenging, with expenditure in year exceeding funding in both Health and social care leaving the Midlothian IJB with an operational over-spend of £4.379m, representing just over 2% of the overall funding received in 2025/26. Summary of the Underlying Financial Position for the year ending 31 March 2026 Financial Position Breakdown Health £000's Social Care £000's MLIJB £000's Funding for Delegated Services Income received from Midlothian Council and NHS Lothian in 2025/26 143,570 71,748 215,318 Total Expenditure Total costs incurred in the delivery of services in 2025/26 145,122 74,575 219,697 Current year Additional Payments Required One off income contribution received to ensure the IJB achieved financial balance 1,552 2,827 4,379 % Value of additional income required 1.08% 3.94% 2.03% These over-spends were supported by both Partners in line with the Integration Scheme. This reflects the continued financial pressure across delegated services and Page 88 of 382
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11 highlights the ongoing challenge of delivering financial balance on a recurring basis within the resources available. The charges (shown as expenditure above) made by Midlothian Council to the IJB reflect the net direct costs of delivering social care services in Midlothian. The charges from NHS Lothian are based on the health budget model agreed by the IJB. For services that are delivered locally by the Midlothian Health and Social Care Partnership (core services), these charges reflect the actual net costs of providing services in Midlothian. Some services used by Midlothian residents are delivered across Lothian rather than locally. These include hosted services and “set aside” services, which are managed on a pan-Lothian basis. The costs of these services are shared across the four Lothian Integration Joint Boards in line with the agreed budget model. For 2025/26, Midlothian IJB’s share of these costs is 10% for hosted services and, in general, 10% of the Lothian share of set aside services and non-cash limited budgets. How the IJB spent its funds in 2025/26 IJB Services Revised Budget £000's Actual Outturn £000's Outturn Variance £000's Joint Older People Services 33,793 34,418 624 Joint Mental health Services 7,417 7,550 133 Joint Learning Disability Service 25,259 28,992 3,733 Joint Alcohol and Drugs Service 1,144 1,136 (7) Physical Disability Service 4,669 4,922 254 Primary Care 36,256 36,861 606 Prescribing 21,166 22,295 1,128 Community Hospitals 7,455 7,542 87 Community Nursing 12,667 12,230 (436) Other Core Health Services 10,489 9,891 (598) Other Hosted Services 9,242 8,858 (384) Non-Cash Limited 14,798 14,798 0 Health Set Aside 21,656 22,611 954 Other Social Care 9,308 7,593 (1,715) NHSL/MLC Additional Contributions 4,379 0 (4,379) 219,697 219,697 0 The financial position reflects a combination of demand-led pressures, market factors, and the timing of recovery actions across both Health and Social Care services. Page 89 of 382
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12 Health: The key financial pressures within Health services are driven by rising demand, increasing complexity, and cost inflation. As in previous years, the biggest pressure on the health budget comes from the cost of medicines prescribed by GP practices. Spending on medicines is higher than the budget because prices are rising and more people need prescriptions. Some medicines are new and cost more when they are first used. At the same time, more prescriptions are being issued because Midlothian’s population is growing, and people are living longer. Many people need extra support to stay well, which increases the need for medication In addition to prescribing pressures, increasing clinical complexity and multimorbidity have contributed to higher service demand, placing additional pressure on community and primary care services. Health Set Aside services continue to be a pressure for the IJB, mainly driven by Emergency and General medicine services provided across the acute sites in NHS Lothian as well as growing pressures linked to Diabetes technology and Medicine of the Elderly care again across the hospital sites. Social Care: In Social Care services, the overspend was primarily driven by rising demand and increasing complexity of care needs. During 2025/26 work commenced to support increased governance around the allocation of spend across care packages. This work will continue in 2026/27 and will be a key action in out Medium-Term Financial Strategy. Despite these efforts, significant financial pressures remained, most notably within the Learning Disability service. In this area, the level and intensity of support required to ensure individuals’ safety and quality of life continued to grow, placing sustained pressure on resources. Financial recovery actions continue to be in place across both Health and Social Care, with a focus on service redesign, demand management and cost control. While some actions introduced during 2025/26 did not deliver full year financial benefit due to lead- in times, these remain central to the IJB’s ongoing approach to managing financial pressures in partnership with NHS Lothian and Midlothian Council. These pressures are consistent with those facing Integration Joint Boards across Scotland, reflecting rising demand for health and social care services, workforce pressures and wider cost inflation. Page 90 of 382
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13 Funding for the IJB The IJB is funded by Midlothian Council and NHS Lothian. This funding is used to provide the services the IJB is responsible for under the Integration Scheme. Many of these services are delivered day to day by the Midlothian Health and Social Care Partnership. Each year, before the start of the financial year, both partners confirm the level of funding they will provide. The IJB reviews these funding offers and decides whether to accept them. This decision is informed by guidance issued by the Scottish Government as part of the national budget process. In March 2026, the IJB accepted the funding offers from both NHS Lothian and Midlothian Council. These funding arrangements are an important part of how the IJB works in partnership with NHS Lothian and Midlothian Council to plan and deliver health and social care services locally. NHS Lothian provides funding for: Health services in Midlothian, including: o local hospitals o community health services o GP (doctor) services o other primary care services, such as dentists, opticians and pharmacies Health services used by Midlothian residents but delivered across Lothian, including: o inpatient mental health services at the Royal Edinburgh Hospital o Specialist services like Dietetics, Podiatry and Hospice and Palliative Care Unplanned hospital care for Midlothian residents, such as emergency and urgent treatment. o This care is provided at the Royal Infirmary of Edinburgh, the Western General Hospital and St John’s Hospital. The budget for this care is held by NHS Lothian on behalf of the IJB and is known as “set aside” funding. Midlothian Council provides funding: Support at Home and in the Community o Care at Home services, supporting people to live independently in their own homes o Day services and other community-based support Housing support services o Residential and Specialist Care o Residential and nursing care, including care home placements Page 91 of 382
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14 o Support for people with learning disabilities o Services for people with physical disabilities and long-term conditions Health and Wellbeing Support o Community mental health services and support o Support for unpaid carers Assessment, Care Management and Protection o Assessment and care management, including social work support and care planning o Adult protection and safeguarding services Reserves The Midlothian IJB did not hold any general reserves at the end of 2024/25. As a result, no reserves were available to manage unforeseen financial pressures in 2025/26. This limits the IJB’s financial resilience and reduces its ability to respond to emerging cost pressures or changes in demand. In response, the IJB has reviewed its Reserve Policy. The updated policy was approved by the Audit and Risk Committee during 2025/26, with final approval by the Board planned for 2026/27. The policy confirms that reserves should be built up through planned underspends against operational budgets and must be clearly linked to formal Directions issued by the Integration Joint Board, in line with the Integration Scheme. Where an underspend is not linked to a Direction, the funding will be returned to the relevant partner organisation. The policy also sets out an appropriate level of reserves, based on the scale and responsibilities of the IJB, at around 2% of net expenditure. The absence of a general reserve means the IJB remains reliant on partner funding to manage in-year pressures or unexpected costs. This presents both financial and operational risks for the IJB and its partner organisations. Page 92 of 382
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15 Financial and Risk Outlook Medium Term Financial Planning Each year, the IJB updates its financial plan to reflect the most up to date information available. The plan combines current financial data with future projections to estimate the likely financial position over the next three to five years. This allows the IJB to understand how changing demand, costs, and funding levels may impact services over time. This approach ensures we are always looking forward and clearly understand the resources we need to provide the right treatment, care, and support in Midlothian. By planning over several years, the IJB can accurately plan, see trends, and identify financial risks early. This will ensure we make informed decisions about where to invest, redesign, or disinvest by aligning our financial planning with wider strategic priorities, such as prevention, early intervention, and sustainable models of care. Budget Setting for 2026/27 At the March 2026 meeting, Midlothian IJB approved the budget offers received from both NHS Lothian and Midlothian Council and were able to set a balanced financial plan for 2026/27. This plan was underpinned by the delivery of £6.6 million in financial recovery actions covering both Health and Social Care functions. It was also agreed that there would be continued engagement with NHS Lothian to address the outstanding financial pressures within Set Aside services. This financial recovery programme represents a significant one-year plan, designed to provide a foundation of financial stability for us. Given the scale and scope of the required financial recovery actions, the programme carries a degree of financial and operational risk. This includes uncertainty around full deliverability, timing, and the potential impact on service delivery. Midlothian IJB 2026/27 Financial Plan Position Spend Type Agreed Budget £000's Expected Expenditure £000's Financial Gap £000' Health 113,660 117,564 3,904 Social Care 75,120 78,014 2,894 Total 188,780 195,578 6,798 Page 93 of 382
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16 The Medium-Term Financial Strategy The Integration Joint Board operates in a financial environment that requires planning beyond a single financial year. In response to this, the IJB maintains a Medium-Term Financial Strategy (MTFS), which provides a forward-looking assessment of the key financial pressures and risks facing the organisation over the next three financial years. The MTFS reflects the anticipated impact of continued demand growth, demographic change, workforce pressures, inflation, and the cost of existing and new treatments across both Health and Social Care services. It also recognises the ongoing reliance on non-recurring measures and partner support to achieve financial balance, which presents a significant sustainability challenge. The MTFS is updated regularly to reflect the most up-to-date assumptions, funding information, and policy direction from both the Scottish Government and partner organisations. It is a key tool used by the IJB to understand the scale of its financial challenge, inform decision-making, and support the prioritisation of financial recovery and service redesign actions. While the MTFS identifies significant projected funding gaps in future years, it does not represent a fixed plan. Instead, it provides a framework for ongoing engagement with partners and stakeholders on the actions required to deliver financially sustainable health and social care services for the population of Midlothian. The table below summarises the projected funding gap identified through the current Medium Term Financial Strategy for the period 2026/27 to 2028/29. These projections are indicative and subject to change as funding assumptions, service demand, policy decisions and financial recovery plans are further developed. Spend Type Financial Year: 2026/27 - £m Financial Year: 2027/28 - £m Financial Year: 2028/29 - £m Social Care (3,904) (5,704) (7,504) Health (2,893) (3,343) (6,176) Total (6,797) (9,047) (13,680) Addressing these projected financial pressures will require sustained collaboration with NHS Lothian and Midlothian Council, difficult decisions regarding service delivery, and continued focus on prevention, demand management and transformation. The IJB will continue to use the MTFS as a core component of its financial governance and oversight arrangements. Key Financial Risks The main financial pressures facing the IJB remain consistent with those outlined in the 2024/25 Annual Accounts. These pressures are significant and ongoing, reflecting both national trends and local challenges within Midlothian. The IJB continues to face a number of financial risks. A key risk is that partner organisations may not be able to provide sufficient additional funding to support increasing demand and cost pressures. Page 94 of 382
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17 These pressures are not unique to Midlothian and are experienced across Scotland. They include rising costs associated with staff pay and conditions, increasing demand for services, the cost of existing medicines, the introduction of new treatments, and wider inflationary pressures. These factors are reflected in the IJB’s Medium Term Financial Strategy and will continue to influence future financial planning and decision-making. Demographic Pressures Midlothian has the second fastest growing population in Scotland. While national funding formulas for both Local Authorities and NHS Boards aim to reflect population change, these mechanisms face 2 key limitations: The total funding available has increased but not at a level sufficient to fully meet the scale of the pressures. Declining populations in other areas do not automatically result in proportionate reductions in service delivery costs, which limits the system's ability to redistribute resources effectively. In addition, Midlothian’s population is not only growing but also ageing. As life expectancy increases, so too does the complexity and intensity of health and social care needs. This demographic trend represents a growing and long-term challenge, both locally and nationally. Workforce Both Health and Social Care services continue to experience workforce shortages. The availability of skilled professionals remains a key constraint on the IJB’s ability to meet rising demand and deliver the Strategic Plan. A local workforce plan has been developed in collaboration with partners to mitigate this risk as much as possible. The Wider National Financial Environment The financial landscape for public services remains extremely challenging. While the Scottish Government has expressed a strong commitment to protecting Health and Social Care budgets, it has also acknowledged the broader fiscal pressures facing all public services. National taxation and policy decisions, such as increases in employer National Insurance contributions, are likely to have an impact on service providers. These pressures may increase the cost of commissioned services and threaten the financial sustainability of providers. We do not have dedicated funding to offset these pressures. However, we remain actively engaged with providers and partners to manage the implications and support continuity of service delivery wherever possible. Strengthening Financial Oversight Oversight and mitigation will be supported through established risk management frameworks within the Health and Social Care Partnership and through the governance role provided by our Audit and Risk Committee and our Board. Page 95 of 382
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18 Throughout 2026/27, we will receive routine financial reporting which will include: The overall financial position of the IJB Progress against agreed financial recovery actions Identification of emerging trends, risks, or cost pressures. This reporting will support us in adopting a forward looking and responsive approach to financial governance and management. This will enable timely decision making, ensure we operate within our available resources, and allow for additional financial recovery actions or collaborative solutions with partners if required. Maintaining financial discipline while safeguarding the quality and accessibility of care services will remain a core focus throughout the financial year. Val de Souza, IJB Chair. Morag Barrow, Chief Officer. Eleonora Ho, Interim Chief Finance Officer. Page 96 of 382
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19 Section 2 – Accountability Report Section 2.1 - Membership and meetings of the IJB The IJB met 8 times in 2025/26 for formal business meetings. We also met for 4 IJB Development sessions and 3 financial briefings. The members of the IJB as of March 2026 are as follows: Member Nominated/Appointed by Role Val de Souza Nominated by NHS Lothian Voting Member, Chair Connor McManus Nominated by Midlothian Council Voting Member, Vice Chair and Chair of the Audit and Risk Committee Pauline Winchester Nominated by Midlothian Council Voting Member Derek Milligan Nominated by Midlothian Council Voting Member Kelly Parry Nominated by Midlothian Council Voting Member Dr Amjad Khan Nominated by NHS Lothian Voting Member George Gordon Nominated by NHS Lothian Voting Member Heather Campbell Nominated by NHS Lothian Voting Member Morag Barrow Appointed by the IJB Chief Officer Chris King Appointed by the IJB Interim Chief Finance Officer Nick Clater Nominated by Midlothian Council Social Work Representative Fiona Stratton Nominated by NHS Lothian Nursing Representative Claire Ross Nominated by NHS Lothian AHP Representative Dr Paul Bailey Nominated by NHS Lothian Primary Care Representative Dr Wendy Metcalfe Nominated by NHS Lothian Medical Practitioner Representative Grace Chalmers Nominated by Midlothian Council Partnership Representative (MLC) Jordan Miller Nominated by NHS Lothian Partnership Representative (NHS) Magda Clark Appointed by the IJB Third Sector Representative Sheree Muir Appointed by the IJB Lived Experience Representative Vacant Volunteer Representative Vacant Carer Representative Notes Chris King was the IJB’s Chief Finance Officer until 26th of March 2026. Eleonora Ho has been appointed in April 2026 as interim Chief Finance Officer until a permanent appointment can be made. Page 97 of 382
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20 Section 2.2 – Statement of Responsibilities Responsibilities of the IJB We are required to: Make arrangements for the proper administration of our financial affairs and to secure that the proper officer of the board has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this authority, that officer is the Chief Finance Officer. Manage our affairs to secure economic, efficient, and effective use of resources and safeguard our assets. Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). Approve the Annual Accounts. I confirm that these Annual Accounts were approved for signature at a meeting of the Audit & Risk Committee. Signed on behalf of Midlothian Integration Joint Board. Val de Souza, IJB Chair. Page 98 of 382
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21 Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the IJB’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (the Accounting Code). In preparing the Annual Accounts, the Chief Finance Officer has: Selected suitable accounting policies and then applied them consistently. Made judgements and estimates that were reasonable and prudent. Complied with legislation. Complied with the local authority Code (in so far as it is compatible with legislation). The Chief Finance Officer has also: Kept proper accounting records which were up to date. Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that the financial statements give a true and fair view of the financial position of the Midlothian Integration Joint Board at 31 March 2026 and the transactions for the year then ended. Eleonora Ho, Interim Chief Finance Officer Page 99 of 382
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22 Section 2.3 - Remuneration Report Introduction This Remuneration Report is provided in accordance with the Local Authority Accounts (Scotland) Regulations 2014. It discloses information relating to the remuneration and pension benefits of specified IJB members and staff. The information in the tables is subject to external audit. The other sections of this report will be reviewed by Audit Scotland and any apparent material inconsistencies with the audited financial statements will be considered as part of their audit report. Remuneration: IJB Chair and Vice Chair The voting members of the IJB are appointed through nomination by Midlothian Council and NHS Lothian Board. Nomination of the IJB Chair and Vice Chair post holder alternates between a Councillor and a Health Board representative. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting board member costs borne by the partner. Neither the Chair nor the Vice Chair appointments had any taxable expenses paid by the IJB in 2025/26 (Previous Year: nil). The Chair of the IJB in 2025/26 was Val de Souza who is a non-executive member of the NHS Lothian Board, the Vice Chair was Councillor Connor McManus (who is an elected member of Midlothian Council). The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or Vice Chair. NHS Lothian no longer automatically offers another full day’s remuneration for being the Board’s Lead Voting Member on an IJB. Instead, non-executive remuneration is based on an individual’s overall estimated time commitment, which can include multiple memberships of Board committees and IJBs as well as other responsibilities, not just as committee chairs or lead voting members of the IJBs. No specific remuneration is therefore available for the Chair of the IJB in 2025/26 (Previous Year: nil). Remuneration: Officers of the IJB The IJB does not directly employ any staff; however specific post-holding officers are non-voting members of the Board. Chief Officer Under section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 a Chief Officer for the IJB must be appointed and the employing partner has to formally second Page 100 of 382
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23 the officer to the IJB. The employment contract for the Chief Officer will adhere to the legislative and regulatory framework of the employing partner organisation. The remuneration terms of the Chief Officer’s employment are approved by the IJB. The Chief Officer of the IJB is Morag Barrow, who is also the Director of Health and Social Care for Midlothian Council and the Joint Director of the Midlothian Partnership. It has been agreed that 50% of her total remuneration is to be shown in the accounts of the IJB as her remuneration as the Chief Officer of the IJB. Chief Finance Officer Although the costs of the Chief Finance Officer are not included in the charges made to the IJB by either partner, given the S95 role of the Chief Finance Officer and in the interests of transparency, the remuneration of the Chief Finance Officer is included. Chris King was Chief Finance Officer until the 26th of of March 2026, was employed by NHS Lothian and had two roles – Midlothian IJB’s Chief Finance Officer and an operational role in the NHS Lothian Finance team as Finance Business Partner. On that basis, 50% of the total remuneration for Chris King between 1st April 2025 and 26th March 2026 is shown below. Other Officers No other staff are appointed by the IJB under a similar legal regime. Other non-voting board members who meet the criteria for disclosure are included in the disclosures. Senior Employees: Salary, Fees & Allowances: Name 2024/25 £ 2025/26 £ Full Year Equivalent £ Morag Barrow 59,048 62,700 62,700 Chris King 11,832 43,163 43,763 The IJB has responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the IJB. The following table shows the IJB’s funding during the year to support officers’ pension benefits. The tables also show the total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. In year pension contributions Name For year to 2025 £ For year to 2026 £ Morag Barrow 12,241 14,108 Chris King 2,662 9,712 Page 101 of 382
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24 Total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions Name Pension (as of 31 March 2025) £000’s Lump Sum (as of 31 March 2025) £000’s Pension (as of 31 March 2026) £000’s Lump Sum (as of 31 March 2026) £000’s Morag Barrow 30 82 34 86 Chris King 9 0 12 0 Disclosure by Pay Bands As required by the regulations, the following table shows the number of persons whose remuneration for the year was £50,000 or above, in bands of £5,000. Number of Employees in Band 2024/25 Remuneration Band Number of Employees in Band 2025/26 1 £55,000 - £59,999 0 0 £60,000 - £64,999 1 0 £65,000 - £69,999 0 0 £70,000 - £74,999 0 0 £75,000 - £79,999 0 Exit Packages The IJB did not support nor did it direct to be supported by its partners, any exit packages during 2025/26 (2024/25: nil). Val de Souza, IJB Chair. Morag Barrow, Chief Officer. Page 102 of 382
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25 Section 2.4 – Annual Governance Statement 2025/26 TBC Val de Souza, Chair Morag Barrow, Chief Officer Page 103 of 382
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26 Section 3 – Independent Auditor’s Report To follow Page 104 of 382
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27 Section 4 – Financial Statement Section 4.1 - Comprehensive Income and Expenditure Statement This statement shows the cost of providing services for the year according to accepted accounting practices. IJB Comprehensive Income and Expenditure Statement 2024/25 Net Expenditure £000's Notes to the Accounts 2025/26 Net Expenditure £000's 135,018 Health Care Services - NHS Lothian 143,432 69,483 Social Care Services - Midlothian Council 74,575 204,501 Cost of Services 3 218,007 (204,650) Taxation and Non-Specific Grant Income 3 (218,852) (149) (Surplus)/Deficit on Provision of Services (845) The Integration scheme lays out that the partners will provide corporate and other support to the IJB as required and will not charge for these services. These costs are not, therefore, included. Section 4.2 - Movement in Reserves Statement This statement shows the movement in year of reserves held by the Midlothian Integration Joint Board. Movement in Reserves Notes to the Accounts 31/03/2026 £000's 31/03/2025 £000's Usable Reserves - brought forward (948) (799) Deficit/(Surplus) or provision of Services (845) (149) Closing Balance, carried forward 1 (1,793) (948) Page 105 of 382
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28 Section 4.3 - Balance Sheet The Balance Sheet shows the value of the IJB’s assets and liabilities as at the balance sheet date. The net assets (assets less liabilities) of the IJB are matched by the reserves held by the IJB. IJB Balance Sheet 31/03/2025 £000's Balance Sheet Notes to the Accounts 31/03/2026 £000's Net Current Assets 948 Debtors 6 1,793 0 Creditors: amounts falling due within one year 0 948 Total assets less current liabilities 1,793 Capital and Reserves (948) Earmarked Reserves 1 (1,793) 0 General Reserves 1 0 (948) Total Reserves (1,793) The audited accounts were authorised for issue on Chris King, Interim Chief Finance Officer. Page 106 of 382
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29 Section 4.4 - Notes to the Financial Statements 1. Significant Accounting Policies 1.1.General Principles The Financial Statements summarise the IJB’s transactions for the 2025/26 financial year and its position at the year-end of 31 March 2026. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. The Financial Statements are prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26, supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. 1.2.Basis of Preparation The IJB financial statements for 2025/26 have been prepared on a going concern basis. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. In accordance with the CIPFA Code of Local Government Accounting (2025/26), the IJB is required to prepare its financial statements on a going concern basis unless informed by the relevant national body of the intention for dissolution without transfer of services or function to another entity. The accounts are prepared on the assumption that the IJB will continue in operational existence for the foreseeable future. The IJB’s funding from and commissioning of services to partners has been confirmed for 2026/27, and a medium-term financial plan has been prepared through to 2029. Given that the IJB is wholly funded by the partners and the IJB’s Integration Scheme commits the partners to funding any overspend within the IJB I consider that there are no material uncertainties around its going concern status. 1.2.Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: Expenditure is recognised when goods or services are received, and their benefits are used by the IJB Income is recognised when the IJB has a right to the income, for instance by meeting any terms and conditions required to earn the income, and receipt of the income is probable Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet Where debts may not be received, the balance of debtors is written down Page 107 of 382
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30 1.3.Funding The IJB is wholly funded through funding contributions from the statutory funding partners, Midlothian Council and NHS Lothian. Expenditure is incurred in the form of net charges by the partners to the IJB. 1.4.Cash and Cash Equivalents The IJB does not operate a bank account or hold cash. Transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. 1.5.Debtors and Creditors The funding balance due to or from each funding partner as at 31st of March is represented as a debtor or creditor on the IJB’s Balance Sheet. Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet. 1.6.Employee Benefits The IJB does not directly employ staff. Staff are formally employed by the partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its Balance Sheet. The IJB has a legal responsibility to appoint a Chief Officer. More details on the arrangements are provided in the Remuneration Report. 1.7.Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation as at 31st of March due to a past event; settlement of the obligation is probable; and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the Comprehensive Income and Expenditure Statement and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31st of March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s Balance Sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31st of March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s Balance Sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. The IJB has none of the above. Page 108 of 382
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31 1.8.Reserves The IJB’s reserves are classified as either Usable or Unusable Reserves. The IJB’s only Usable Reserve is the General Fund. The balance of the General Fund as of 31 March shows the extent of resources which the IJB can use in later years to support service provision. As noted above, the IJB has reserves of £1,793,000 on 31 March 2026. General Fund 31/03/2025 £000's Movement £000's 31/03/2026 £000's Earmarked Reserves Embedding a gender informed effective response to domestic abuse project (7) 0 (7) Unscheduled Care (941) (845) (1,786) General Reserves 0 0 0 Total Usable Reserves (948) (845) (1,793) 1.9.Indemnity Insurance The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board member and officer responsibilities. NHS Lothian and Midlothian Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. The IJB holds separate indemnity insurance through its membership of the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) scheme, the charge for this in 2025/26 was £3,000 (PY £3,000). Unlike NHS Boards, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS. The IJB participation in the CNORIS scheme is therefore analogous to normal insurance arrangements. Known claims are assessed as to the value and probability of settlement. Where it is material the overall expected value of known claims taking probability of settlement into consideration is provided for in the IJB’s Balance Sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and, where material, presented as either a debtor or disclosed as a contingent asset. There are no outstanding claims or any indications that any claims are to be made against the IJB. 1.10. Accounting Standards that have been Issued but have not yet been Adopted The Code requires the disclosure of information relating to the impact of an accounting change that will be required by a new standard that has been issued but not yet Page 109 of 382
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32 adopted and could have a material impact on the accounts. This applies to new or amended standards within the 2025/26 Code. There are no new or amended Accounting Standards issued but not yet adopted that will have a material impact on the 2025/26 Annual Accounts. 1.11. Critical Judgements and Estimation Uncertainty The critical judgements made in the Financial Statements relating to complex transactions are: The partner organisations have considered their exposure to possible losses and made adequate provision where it is probable that an outflow of resources will be required, and the amount of the obligation can be measured reliably. Where it has not been possible to measure the obligation, or it is not probable in the partner organisations’ options that a transfer of economic benefits will be required, material contingent liabilities have been disclosed (there are none). The Annual Accounts contains estimated figures that are based on assumptions made by the IJB about the future or that are otherwise uncertain. Estimates are made taking into account historical experience, current trends and other relevant factors. However, because balances cannot be determined with certainty, actual results could be materially different from the assumptions and estimates. There are no items in the IJB’s Balance Sheet at 31 March 2026 for which there is a significant risk of material adjustment in the forthcoming financial year. 1.12. Provisions The IJB has not created any provisions in respect of compensation claims. It is not certain that all claims have been identified or that the historic level of settlement payments is a reliable guide for future settlements. 2. Subsequent Events In accordance with the requirements of International Accounting Standards 10, events after the reporting period are considered up to the date on which the accounts are authorised for issue. This is interpreted as the date that the accounts were certified by the Chief Financial Officer following approval by the Audit and Risk Committee. Events after the Balance Sheet date are those events, both favourable and unfavourable, that occur between the end of the reporting period and the date when the Annual Accounts are authorised for issue. Two types of events can be identified. • Adjusting events: Those that provide evidence of conditions that existed at the end of the reporting period. The Annual Accounts is adjusted to reflect such events. Page 110 of 382
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33 • Non-adjusting events: Those that are indicative of conditions that arose after the reporting period and the Statements are not adjusted to reflect such events. Where a category of events would have a material effect, disclosure is made in the notes of the nature of the events and their estimated financial effect. 3. Expenditure and Funding Analysis The Expenditure and Funding Analysis shows how the funding available to the IJB, in the form of partner contributions, has been used in providing services. 2024/25 Net Expenditure £000's Service Type 2025/26 Net Expenditure £000's 33,280 Joint Older People Services 34,418 7,246 Joint Mental health Services 7,550 26,080 Joint Learning Disability Service 28,992 1,000 Joint Alcohol and Drugs Service 1,136 4,235 Physical Disability Service 4,922 31,420 Primary Care 36,758 22,325 Prescribing 21,450 7,298 Community Hospitals 7,542 11,948 Community Nursing 12,230 10,568 Other Core Health Services 9,891 7,748 Other Hosted Services 8,116 13,679 Non-Cash Limited 14,798 20,728 Health Set Aside 22,611 6,947 Other Social Care 7,593 204,501 Cost of Services 218,007 (204,650) Delegated Funding (218,852) (149) (Surplus) or Deficit on Provision of Services (845) (799) Opening General Fund Balance (948) (149) (Surplus) or Deficit in Year (845) (948) Closing General Fund Balance (1,792) Page 111 of 382
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34 4. Corporate Service Included in the above costs are the following corporate services Corporate Costs 2024/25 £000's 2025/26 £000's Staff (Chief Officer) 59 63 CNORIS 3 3 Audit fee 34 35 Total 96 101 As noted above, the Chief Finance Officer is not charged to the IJB. 5. Related Party Transactions Related parties are organisations the IJB can control or influence or who can control or influence the IJB. As Partners in the Joint Venture of Midlothian IJB, both Midlothian Council and NHS Lothian are related parties and material transactions with those bodies are shown in line with the requirements of IAS 24 Related Party Disclosures. In the 2025/26 financial year the following transactions were made with NHS Lothian and Midlothian Council relating to integrated health and social care functions. Income received from the two parties: Partner 2024/25 £000's 2025/26 £000's NHS Lothian 135,578 144,277 Midlothian Council 69,072 74,575 Total 204,650 218,852 Expenditure relating to the two parties: Partner 2024/25 £000's 2025/26 £000's NHS Lothian 135,018 143,432 Midlothian Council 69,483 74,575 Total 204,501 218,007 Page 112 of 382
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35 There are elements of expenditure which are shown against NHS Lothian but where the resources are used for the Social Care services delivered by Midlothian Council, in particular these include resource transfer and social care funds. In addition, a range of support services are provided to the IJB by each partner organisation. These functions are not formally delegated under the integration scheme; however, they remain essential to maintaining the IJB’s operational infrastructure. Such services include, but are not limited to, Human Resources, Information Technology, and other corporate support functions. Page 113 of 382
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36 6. Short Term Debtors Partner 2024/25 £000's 2025/26 £000's Funding due from NHS Lothian 941 1,786 Funding due from Midlothian Council 7 7 Total 948 1,793 7. VAT The IJB is not VAT registered. The VAT treatment of expenditure in the IJB’s accounts depends on which of the Partner agencies is providing the service as these agencies are treated differently for VAT purposes. Where the Council is the provider, income and expenditure excluded any amounts related to VAT, as all VAT collected is payable to H.M. Revenue & Customs and all VAT paid is recoverable from it. The Council is not entitled to fully recover VAT paid on a very limited number of items of expenditure and for these items the cost of VAT paid is included within service expenditure to the extent that it is irrecoverable from H.M. Revenue and Customs. Where the NHS is the provider, expenditure incurred will include irrecoverable VAT as generally the NHS cannot recover VAT paid as input tax and will seek to recover its full cost as income from the Commissioning IJB. Page 114 of 382
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Midlothian Integration Joint Board Thursday, 11th June 2026, 14:00-16:00 Midlothian Integration Joint Board and Associated Committees Handbook Update 2026 Executive summary This report outlines the improvements and updates made to the existing Midlothian Integration Joint Board (IJB) Members’ Handbook and the rationale for producing and issuing the updated version to all new members as part of their induction. The Handbook has been reviewed and refreshed to ensure it remains accurate, relevant, and aligned with current statutory guidance, with updates introduced to strengthen clarity, governance expectations, and member support. The Public Bodies (Joint Working) (Scotland) Act 2014 and associated statutory guidance on Roles and Responsibilities (Appendix 2) set out clear requirements for IJB membership. Section 2.4 specifies that appointed members must be provided with the resources and support necessary to fulfil their responsibilities, and that stakeholder members must receive appropriate training to enable them to contribute effectively. The Midlothian IJB Members’ Handbook forms a key element of this support and will be used as part of the induction process for all new members. As a result of this report, Members are asked to: Note the content of Midlothian IJB Handbook (Appendix 1), Approve the Handbook’s use as the standard induction resource for all new members, and Note the recommendation of the Audit & Risk Committee on 5th March 2026 to develop a Midlothian IJB Expenses Policy. Item number: 5.7 Page 115 of 382
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Midlothian Integration Joint Board Report Midlothian Integration Joint Board and Associated Committees Handbook Update 2026 1 Purpose 1.1 This report outlines the improvements and updates made to the existing Midlothian Integration Joint Board (IJB) Members’ Handbook and the rationale for producing and issuing the updated version to all new members as part of their induction. 2 Recommendations 2.1 As a result of this report, Members are asked to: Note the content of Midlothian IJB Members Handbook (Appendix 1), Approve the Handbook’s use as the standard induction resource for all new members, and Note the recommendation of the Audit & Risk Committee on 5th March 2026 to develop a Midlothian IJB Expenses Policy. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 and associated statutory guidance on Roles and Responsibilities (Appendix 2) set out clear requirements for IJB membership. Section 2.4 specifies that appointed members must be provided with the resources and support necessary to fulfil their responsibilities, and that stakeholder members must receive appropriate training to enable them to contribute effectively. The Midlothian IJB Members’ Handbook forms a key element of this support and will be used as part of the induction process for all new members. 3.2 In addition, the Scottish Government’s On Board: A Guide for Board Members of Public Bodies in Scotland (Appendix 3) provides a standard induction resource. This will complement the tailored Midlothian IJB Handbook, ensuring new members receive both national guidance and local, partnership-specific information. 3.3 The Public Bodies (Joint Working) (Scotland) Act 2014 set out the requirement for Integration Authorities to include carer and lived experience representatives on their Integration Joint Boards (IJBs). ALLIANCE More Than Equal: Valuing and Supporting the Expert Contribution of People With Lived Experience (Appendix 4) includes recommendations that the IJB must ensure that the Board provides all Carer and Lived Page 116 of 382
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Midlothian Integration Joint Board Experience Representatives with a clear role description which outlines the scope and scale of the role, the support available to them, and training and resource opportunities. 3.4 The Handbook has been reviewed and refreshed to ensure it remains accurate, relevant, and aligned with current statutory guidance, with updates introduced to strengthen clarity, governance expectations, and member support. this has also included a comprehensive review against the current Midlothian IJB Strategic Plan 2025-2035 to ensure alignment with the IJB’s priorities and governance framework. 3.5 The Handbook also recognises the duty to ensure board members can be reasonably compensated for expenses. However, it has not been possible to establish with Partners which volunteer expense policy should be utilised, how this applies to IJB members, or whether the IJB should develop a policy of its own. Members of the Audit and Risk Committee held on 5th March 2026 were asked to consider and direct the action required to resolve this issue. 3.6 The revised Handbook was presented to Audit & Risk Committee on 5th March 2026. The Committee recommended the development of a Midlothian IJB Expenses Policy to provide clear guidance to members on the claiming of expenses. The policy is currently under development and will be presented to Midlothian IJB in due course. Once approved, a link to the policy will be incorporated into the Handbook. 3.7 The Midlothian IJB Expenses Policy will be informed by the policy of partner organisation, Midlothian Council, which is identified as the lead partner within the Midlothian IJB Scheme of Integration. 3.8 The revised Handbook has been assessed for accessibility to ensure it meets equalities requirements and is fully usable by all members. These updates strengthen the Handbook as a key resource for supporting effective induction, promoting consistency, and ensuring members have clear, accessible guidance on their roles and responsibilities. 4 Policy Implications 4.1 Producing and maintaining the Handbook ensures compliance with the Public Bodies (Joint Working) (Scotland) Act 2014, which requires that IJB members are provided with appropriate information, support, and training to fulfil their statutory responsibilities. 5 Directions 5.1 This report does not directly impact upon service delivery ability to deliver an existing Direction. Page 117 of 382
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake an ECRIA as a result of this report. 6.2 This report does not identify any negative impacts for people with protected characteristics. However, the updated Members’ Handbook strengthens our commitment to equality by ensuring that all new Integration Joint Board (IJB) members receive clear, accessible information that supports their ability to participate fully and fairly in the work of the Board. The accessibility review undertaken as part of the update process further ensures that the Handbook meets equalities requirements and is usable by all members. 7 Resource Implications 7.1 There are no resource implications as a result of this report. 8 Risk 8.1 There is a risk that failing to produce a Members’ Handbook creates several governance and operational risks. Without a clear, consistent induction resource, new members may lack essential understanding of their statutory responsibilities, decision-making duties, and the governance framework within which the Integration Joint Board operates. This can lead to inconsistent practice, reduced effectiveness in scrutiny and decision-making, and a longer learning curve for new members. It also increases the risk of non-compliance with the Public Bodies (Joint Working) (Scotland) Act 2014, which requires that members are provided with appropriate support and training. Overall, the absence of a Handbook could undermine good governance, weaken accountability, and reduce the Board’s ability to operate transparently and effectively. 9 Involving people 9.1 This report relates to governance and does not directly involve people. 10 Background Papers 10.1 None. Page 118 of 382
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Midlothian Integration Joint Board Author’s Name Lisa Cumming Designation Business Support Manager Contact Information Lisa.cumming@nhs.scot Date 09/04/2026 Appendices: Appendix 1: Midlothian IJB Handbook 2026 Appendix 2: Public Bodies (Joint Working) (Scotland) Act 2014, Roles and Responsibilities Appendix 3: On Board – A Guide for Board Members of Public Bodies in Scotland Appendix 4: More than equal: Valuing and Supporting the Expert Contribution of People With Lived Experience Page 119 of 382
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1 Midlothian Integration Joint Board Handbook 2026 Page 121 of 382
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2 Contents Introduction..........................................................................................................................................................................................................3 Who we are .........................................................................................................................................................................................................4 Our members...................................................................................................................................................................................................6 Our meetings ...................................................................................................................................................................................................6 What we do.........................................................................................................................................................................................................7 Strategic planning............................................................................................................................................................................................7 Directions.........................................................................................................................................................................................................7 Audit and risk...................................................................................................................................................................................................8 Budget setting and finance..............................................................................................................................................................................9 Measuring performance ................................................................................................................................................................................10 Equality..........................................................................................................................................................................................................10 Complaints.....................................................................................................................................................................................................10 Information.....................................................................................................................................................................................................10 Your induction ...................................................................................................................................................................................................11 Your key contact............................................................................................................................................................................................11 Your first 3 months ........................................................................................................................................................................................11 Your development and support.........................................................................................................................................................................12 Accessibility ...................................................................................................................................................................................................12 Expenses.......................................................................................................................................................................................................12 Training, Mentoring........................................................................................................................................................................................12 Your role and responsibilities.........................................................................................................................................................................13 Page 122 of 382
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3 Introduction Thank you for joining the Midlothian Integration Joint Board (IJB). As an IJB member, you will play a key role in supporting us to improve health and social care in Midlothian. Being a meaningful part of our communities and contributing to people achieving what matters to them is at the centre of all we do. Each one of our Board members plays a crucial role in shaping our work with their local knowledge and expertise that helps us plan and direct health and social care services and manage the allocation of our budget. This handbook will provide you with everything you need to know about the Board and how we work together to plan and direct integrated health and social care. In addition to the resources in this handbook, you may wish to read ‘What is Integration? A short guide to the integration of health and social care services in Scotland’ from Audit Scotland that has useful information on integration. We hope you enjoy your time with us, and look forward to working together as we learn, plan, and transform local health and social care to serve the people who live in our communities. Val de Souza Morag Barrow Councillor Connor McManus Chair, Midlothian IJB Chief Officer, Midlothian IJB Vice Chair, Midlothian IJB Page 123 of 382
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4 Who we are We are a planning and decision-making body created by Midlothian Council and NHS Lothian. We plan and direct some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities in our Strategic Plan 2025-2035 guide how we allocate this money. The Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act, 2014. We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. Scottish Government asks us to take the action required by law and in national policies when deciding what our local priorities should be. Page 124 of 382
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5 Our Vision People in Midlothian lead longer and healthier lives. Our Mission We will provide the right support at the right time in the right place. Our Values Respect. Compassion. Quality. Our Strategic Aims 1. People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. 2. People are able to access the care and support they need when they need it in the community and at home. 3. People's human, social, and economic rights are protected and promoted in how we design and deliver our services. Our Approach Only by people and communities being seen, heard, and leading the change can we unlock the kind of action that will change the future of health and wellbeing in Midlothian 1. Work with our Partners (NHS Lothian & Midlothian Council), people, communities, the Third and Independent Sector, and the services who provide care and support to agree how we can best contribute to people in Midlothian living well in their community. 2. Plan and deliver services that support better health and wellbeing in our communities, using the National Health and Wellbeing Outcomes Framework. 3. Ensure each of our strategic aims support at least one of the 9 national health and wellbeing outcomes and our Directions for 2025/26 are structured this way too. 4. We also ensure services are planned and delivered in a way that follows the Principles in section 4 of the Public Bodies (Joint Working) (Scotland) Act 2014. These principles help us make sure that we take into account the particular characteristics and circumstances of people who need our services. Page 125 of 382
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6 Our members We meet regularly and are a collaborative board where every voice is heard. Everyone is treated as an equal partner, with their views taken seriously. We have voting and non-voting members, but we prefer to make decisions through consensus of the full membership rather than the use of voting. 8 voting members – 4 are non-executive board members of NHS Lothian. 4 are elected members of Midlothian Council. Non-voting members - Chief Officer, Chief Finance Officer, Professional Advisor for Social Work, Professional Advisor for Nursing, Professional Advisor for Allied Health Professionals, Representative members – there are a range of representative members on the Board including trade unions, Third Sector independent organisations, people who represent the interests of people and communities, people who experience our services, unpaid carers, and volunteers. Non-voting members must be renominated every 3 years. Information about Board members, dates of meetings and papers can be found on the Midlothian Integration Joint Board section of the Midlothian Council website. Our meetings 6 Board meetings We hold 6 Board meetings annually. These meetings are open to the public and the press. Board papers covering topics such as planning, finance, performance, and other key issues are shared one week before the meeting. 2 Special Board meetings Special Board meetings take place in March and September. These meetings focus only on the Budget and Directions (March) and the Annual Accounts and Directions (September). 5 Development Session workshops These workshops give Board members dedicated time to build skills and explore key topics. They support the IJB’s Self Development Plan and are attended solely by Board members, with support from Health and Social Care Partnership officers. 11 Reference Group sessions These sessions support our Representative Members—people with lived experience, unpaid carers, third sector representatives, and volunteers by reviewing together upcoming agenda items, discussing how this impacts people and communities, asking questions, and building confidence ahead Page 126 of 382
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7 of the next IJB meeting to ensure our Representative Members feel well informed and ready to contribute to decision making. What we do Our Midlothian Health and Social Care website is where you can find our publications and information about the work we do. Strategic planning The Public Bodies (Joint Working) (Scotland) Act 2014: Strategic Plan: Statutory Guidance requires us to develop a strategic plan for the integrated services we are responsible for, it also tells us what the plan must contain and how it must be developed, along with additional guidance about how we should prioritise and allocate resources. Our Strategic Plan describes how we will work with our partners NHS Lothian and Midlothian Council, people, communities, the Third and Independent Sector, and the services who provide care and support to agree how we can best contribute to people in Midlothian living well in their community. Our current plan is set out over 10 years from 2025-2035, and we will review and update this plan every 3 years to ensure we are meeting the aims of the 9 national health and wellbeing outcomes. We must consult our Strategic Planning Group on the first draft of our strategic plan. The Strategic Planning Group has a wide range of members supports us in developing and delivering the Strategic Plan. A range of people, including those who experience our services must be involved in the preparation and review of the plan. We work alongside people who live and work in Midlothian and our Participation and Engagement Statement 2025-2028 outlines how we do this. Every IJB in Scotland is required to have a Joint Strategic Needs Assessment (JSNA). Midlothian’s Joint Strategic Needs Assessment helps to inform our strategic plan using information coordinated from local, regional and national sources to help us understand the health and social care issues for people living in Midlothian. Page 127 of 382
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8 Directions The priorities set out in our strategic plan describe the action we will take to make our ambitions a reality. Every year, as close to the start of the new financial year as practically as possible, we issue written instructions to NHS Lothian and Midlothian Council. These instructions are called Directions and are the mechanism to deliver the ambitions of our strategic plan. Directions are legally binding and instruct NHS Lothian and Midlothian Council to do the things we think are the highest priority, describe what they need to deliver, and the budget that they have been allocated to do this with. Our Directions policy outlines the process for drafting, approving, issuing and monitoring directions from us to NHS Lothian and Midlothian Council. Our Directions are written in a way that aligns them with both the strategic aims in this plan and the 9 National Health and Wellbeing Outcomes. This allows us to be clear with what we are doing, why, and what we hope to see as a result. We review progress made towards our Directions regularly and report on this twice a year. We can issue a new Direction at any time or revise a Direction if we think we need to take corrective action e.g., if we make a decision that changes service delivery, or if we receive new funding across the year. Midlothian Health and Social Care Partnership use Directions to ensure operational planning has a clear connection between our strategy and delivery Audit and risk The Audit and Risk Committee has overall responsibility for reviewing our corporate governance arrangements and providing assurance to us. This includes reviewing risks, internal controls, audits, and financial statements to ensure services remain safe and effective. The Audit and Risk Committee meet quarterly and provides updates including any risks or concerns to our Board meetings. The Audit and Risk Committee’s work is guided by the Scottish government produced guidance on good assurance processes and the role of audit committees. Page 128 of 382
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9 Budget setting and finance We must only spend the resources that have been made available to us by our Partners, Midlothian Council and NHS Lothian. Our strategic plan helps us prioritise how we will allocate and best utilise those resources. These resources are allocated to us each year and we are then responsible for the integrated budget. The offer we receive from both our Partners changes each year and may not be enough to deliver everything we want. This makes it difficult to plan ahead in a meaningful way. Our annual budget is approximately £177.528m. This funding is split up into four parts; 1) Social Work and Social Care (from Midlothian Council) – this is for adult social care services in Midlothian. These services are managed operationally by the Midlothian Health and Social Care Partnership. 2) Health Core Services (from NHS Lothian) – these are local services which are delegated to the Health and Social Care Partnership. These include primary care services like GPs and pharmacists, and other community services like district nursing, community mental health teams, community learning disability teams, and the local community hospital. 3) Health Hosted Service (from NHS Lothian) – some services are managed on a pan-Lothian basis. We manage a share of the total budget for these services based on its population. Midlothian hosts Dietetics and Adults with 4) Complex and Exceptional Needs and provide services for people across Lothian on behalf of all four Health and Social Care Partnerships – Midlothian, East Lothian, West Lothian, and City of Edinburgh. 5) Health ‘Set Aside’ budgets (from NHS Lothian) – unscheduled care services (Accident and Emergency and unplanned admissions) are managed by NHS Lothian’s Acute Hospital system. Our budget includes a share of these services, based broadly on our population size. The budget is ‘set aside’ by NHS Lothian on our behalf. These services are delivered at the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital. Our ‘reserve’ budget All Integration authorities should have reserves as this is part of good financial management. Our medium-term financial strategy Our medium-term financial planning supports the delivery of our strategic plan for 2025-2035. Our 5-year financial plan was published in December 2025, and we will review this regularly and adapt and change to meet the challenges. Financial Risk We are currently facing a number of serious financial risks. The main risk is that our Partners may not be able to provide the necessary levels of funding to support our aims. Page 129 of 382
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10 Measuring performance There are a number of ways we work with our Partners, people, and communities to monitor and evaluate the progress we are making towards the ambitions set out in our strategic plan. We measure our performance to see what is working well, what can be improved, and how well we are meeting the key aims of integration and the strategic aims of our strategic plan. We do this through evaluation and reporting methods that can be found on the Midlothian Health and Social Care Website. Our Performance Framework that uses quantitative (number) and qualitative (narrative) information, Our Annual Performance Report, Bi-annual reports on progress against our Directions, Our Equality Outcomes, and Mainstreaming Equality report and action plan, and Quarterly reports from Midlothian Health and Social Care Partnership’s services. Equality We must make sure that everyone has equal opportunities to access our services and comply with the Public Sector Equality Duty. Read our Midlothian IJB Equality Outcome Report 2025- 2029 on how we aim to do this. Complaints We must comply with our legal duty to follow the Model Complaints Handling Policy and publish a report every year on the complaints we have received. 2025/26 was the first year since Midlothian IJB was formed that we received any complaints. Information We must comply with our legal duty to follow the Model Publication Scheme, Page 130 of 382
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11 Your induction Your key contact The Midlothian Health and Social Care Partnership Integration Manager is your main contact for Board member support. This post is currently held by Gill Main who can be reached at gill.main3@nhs.scot Your first 3 months You will be invited to an induction session just before or just after you are nominated to the Board. This session will be on MS Team and take you through our main responsibilities as a Board and how we work together. This session will include Chair and Vice Chair of Midlothian IJB – a welcome and introduction to the Board. Chief Officer - an overview of the roles and responsibilities of the IJB and HSCP. The Chief Officer is also the Director of Health and Social Care for Midlothian Council and the Joint Director of Midlothian HSCP. Chief Finance Officer - an overview of the risks and finance responsibilities of the IJB and our Audits. Standards Officer – an overview of the ethical standards and expectations on Members - in relation to the Register of Interests and the Code of Conduct. Integration Manager – an overview of the Strategic Plan, how this plan is reviewed and monitored, how we plan and review Directions, and how we focus on outcomes. (You can read about these roles in the Scheme of Delegation). We will also arrange for you to visit some of our services, meet the staff that work there, and see how we deliver treatment, care and support. There is an annual programme of scheduled visits that will also include time to meet Midlothian HSCP Executive Leadership Team Third Sector Partners such as Midlothian Community Action & VOCAL. Page 131 of 382
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12 Your development and support Accessibility We want to ensure that everyone is supported and able to contribute fully. If you require additional support or reasonable adjustments, please let us know. Adjustments can take many forms, and we are happy to work with you to find what best meets your needs. Examples of adjustments we can provide are: Printed documentation – if digital formats are not accessible or convenient. Assistance with calendar invites – help setting up, managing, or tracking meetings. Virtual attendance options – joining meetings or events remotely when needed. Accessible formats – large print, screen-reader friendly documents, or alternative communication methods. Quiet spaces or breaks – ensuring environments are comfortable and inclusive. Time with an Officer of the HSCP to answer your questions. Expenses You can reclaim any costs involved in volunteering and includes all reasonable costs including things like travel. Expenses must be approved in advance. Please speak with your key contact for more information. Training, Mentoring The Scottish Government publications Guidance on Roles, Responsibilities and Membership of the Integration Joint Board and On Board – A Guide for Board Members of Public Bodies in Scotland provide helpful information on the responsibilities of an IJB Member. These can support you to identify any training and mentoring you may need. Our Development Sessions are often a good way to learn more about the work across integrated heath and social care. We also collaboratively agree a Midlothian IJB Self Development Plan each year. This is overseen by the Chief Internal Auditor. Please speak to your key contact about events, training and mentoring opportunities or any other support you may need to help you fulfil your role as an IJB Member. Page 132 of 382
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13 Your role and responsibilities To participate fully in the Board’s business, providing constructive challenge and working in cooperation with others to best carry out the work of the Board. To regularly attend meetings and provide advance notice if you will not attend. To prepare for meetings, reading all relevant papers and supporting materials. To focus on and give priority to your responsibilities to the Board and the residents of Midlothian. To contribute to the development and implementation of the Board’s strategies in accordance with the Board’s vision and priorities, the national health and wellbeing outcomes, the integration delivery principles, and the Integration Scheme. To ensure views of people, local communities, staff, and the public are heard when planning services (in line with our Engagement Statement and Planning With People). To support the Board in providing clear, accurate financial information and helping to guide medium-term financial planning to ensure stability and informed decision making. To ensure that resources are used sensibly and in accordance with the law and our best value duty and ensure active scrutiny of financial and service performance. To ensure that the system of internal control is adequate and effective and that the Board’s Local Code of Corporate Governance is observed and complied with. To maintain the highest standards of ethical conduct and comply with the Board’s Code of Conduct and Standing Orders. To contribute to the governance of the Board in a way which encourages equal opportunities, recognises the cultural diversity within the area, and which actively promotes equal opportunity requirements. This Scottish Government guidance outlines the roles and responsibilities of IJB Members. Right First Time (2021) is a practical guide to decision-making and the law and helps assist decision makers in coming to decisions. There is advice for IJB Members from the Standards Commission for Scotland, to assist members in recognising and dealing with potential conflicts of interest. You will need to complete a non-disqualification questionnaire and register any financial or non-financial interests under the Ethical Standards in Public Life etc. (Scotland) Act 2000. Page 133 of 382
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Roles, Responsibilities and Membership of the Integration Joint Board Guidance and advice to supplement the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014 Public Bodies (Joint Working) (Scotland) Act 2014 Page 135 of 382
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2 Contents The Aim of this Guidance Page 3 Section 1: Role and Responsibilities of the Integration Joint Board 1.1 Role and remit of the Integration Joint Board Page 4 1.2 Duties placed on Integration Joint Boards by the Public Bodies (Joint Working) (Scotland) Act 2014 Page 5 1.3 Other key requirements of the Integration Joint Board Page 6 1.4 Liability arrangements for Integration Joint Boards and their members Page 10 1.5 The relationship between the Integration Joint Board and the strategic planning group Page 11 1.6 Appointing a Committee of an Integration Joint Board Page 12 1.7 Complaints under Integration Page 13 Section 2: Membership of the Integration Joint Board 2.1 Minimum Membership Page 15 2.2 Good Practice in the identification and appointment of members Page 17 2.3 Professional membership Page 17 2.4 Appointment of stakeholder members Page 18 2.5 Induction of members Page 19 Page 136 of 382
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3 The Aim of this Guidance This guidance is intended for use by all members of an Integration Joint Board particularly the Chair - and provides further advice to supplement the existing legislation. The document focuses on the roles, responsibilities and membership of the Integration Joint Board. Section 53 of the Public Bodies (Joint Working) (Scotland) Act 2014 (“the Act”) sets out an Integration Joint Board is required to have regard to this guidance when exercising its functions under the Act. This guidance relates to Integration Joint Boards that must be established when a Health Board and Local Authority choose a Body Corporate Model of integration (under section 1(4)(a) of the Act). Page 137 of 382
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4 Section 1: Role and Responsibilities of the Integration Joint Board 1.1 Role and remit of the Integration Joint Board The Act puts in place arrangements for integrating health and social care, in order to improve outcomes for patients, service users, carers and their families. The Act requires Health Boards and Local Authorities to work together effectively to agree a model of integration to deliver quality, sustainable care services. Where a Health Board and a Local Authority agree to put in place a Body Corporate model, an Integration Joint Board will be established. This will see Health Boards and Local Authorities delegate a significant number of functions and resource to the Integration Joint Board, who will be responsible for the planning of integrated arrangements and onward service delivery. The Health Board and Local Authority will set out within their integration scheme which of their functions they intend to delegate to the Integration Joint Board. The scope of the delegated functions will vary depending on local decision making but must adhere to the statutory minimum. The functions that must be delegated by the Health Board to the Integration Joint Board as per the Act are set out in The Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014. The functions that must be delegated by the Local Authority to the Integration Joint Board as per the Act are set out in The Public Bodies (Joint Working) (Prescribed Local Authority Functions etc.) (Scotland) Regulations 2014. The Integration Joint Board is responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of those functions through the directions issued by it under section 25 of the Act. The Integration Joint Board will also have an operational role as described in the locally agreed operational arrangements set out within their integration scheme. To fulfil its remit the Integration Joint Board will: Adhere to the content of any future regulations or guidance issued by Scottish Ministers Ensure stakeholder engagement Take into consideration national developments in policy and practice Page 138 of 382
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5 1.2 Duties placed on Integration Joint Boards by the Public Bodies (Joint Working) (Scotland) Act 2014 The Public Bodies (Joint Working) (Scotland) Act 2014, “the Act”, places a duty on Integration Joint Boards to develop a strategic plan for integrated functions and budgets. For more information, please see the guidance on Strategic Commissioning Plans. Each Integration Joint Board must establish a strategic planning group to support the strategic planning process. For more information, see section 1.5 of this guidance. An Integration Joint Board must review its strategic plan at least every three years. Sections 4 and 31 of the Act set out the integration principles which underpin delivery of integrated health and social care services. These principles describe “how” integrated care should be planned and delivered. Integration Joint Boards are under a duty to have regard to these principles when preparing a strategic plan. For more information, please see the guidance on the Integration Planning and Delivery Principles. Section 37 of the Act places Integration Joint Boards under a duty to have regard to the National Health and Wellbeing Outcomes (the Outcomes) when preparing a strategic plan. These Outcomes are high-level statements of what Integration Joint Boards are attempting to achieve through integration and ultimately through the pursuit of quality improvement across health and social care. Integration Joint Boards are required to issue directions to Health Boards and Local Authorities as to how integration functions are to be carried out. Details relating to this are set out in sections 26 and 27 of the Act. Integration Joint Boards are required to prepare an annual performance report. This must comply with the requirements of the Regulations on the Content of Performance Reports. An annual financial statement must be published setting out the total resources included in the plan for that year. For more guidance, please see the Professional Guidance, Advice and Recommendations for Integration Arrangements. A full list of guidance and advice published to support the Public Bodies (Joint Working) (Scotland) Act 2014, is available at http://www.gov.scot/HSCI. Page 139 of 382
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6 1.3 Other key requirements of the Integration Joint Board Integration Joint Boards are public bodies, and as such are subject to a range of other requirements. An Integration Joint Board must ensure that arrangements are established to comply with their duties as set out in legislation. Although the responsibility of compliance sits with an Integration Joint Board; Integration Joint Boards may choose to draw on the experience of and/or request support from their constituent Health Board and/or Local Authority to aid it in complying with the legislative requirements set out below. In such circumstances the Health Board and/or Local Authority would be expected to provide the support requested. The Public Records (Scotland) Act 2011 Integration Joint Boards are designated as “Bodies Corporate” for the purposes of the Public Records (Scotland) Act 2011. They will be obliged, therefore, to comply fully as public authorities under the legislation. The Public Records (Scotland) Act 2011 requires named public authorities to prepare and implement a records management plan which sets out proper arrangements for the management of their records. Records management plans must be agreed with the Keeper of the Records of Scotland (the Keeper) and regularly reviewed by authorities. The plan must account for all the public records for which the authority has responsibility. The plan must detail the functions of each authority and the types of records created in pursuance of these functions. It will show the policies and procedures in place for the appropriate storage, retention, disposal, archiving and security of these records. To assist public authorities to comply with their obligations, the Keeper has produced a model plan in the form of an annotated list of the elements that might be expected to be covered in a robust records management plan. In addition the Keeper has produced guidance that accompanies the model plan. A Senior Officer of the Integration Joint Board will therefore be responsible for overseeing the development and implementation of the records management plan and for approving it prior to submission for the Keeper’s agreement. Further details on the National Records of Scotland and the Public Records (Scotland) Act 2011 Assessment Team and support they provide can be found on their website. Records Management It will be necessary for an Integration Joint Board to consider how Freedom of Information (Scotland) Act 2002 / Environmental Information (Scotland) Regulations 2004 obligations impact on its records management practices, including how information is stored. The Code of Practice on Records Management sets out recommended ‘best practice’. Page 140 of 382
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7 The records management plan will need to be clearly set out if information is held by the Integration Joint Board or the information held is owned by the Integration Joint Board or held ‘on behalf of’ the relevant Local Authority or Health Board. If a request is sent to an Integration Joint Board for information it holds ‘on behalf of’ the Local Authority or Health Board, the applicant should be informed by the Integration Joint Board that it does not hold the information and they should then be directed to the relevant Local Authority or Health Board. Integration Joint Boards, Health Boards and Local Authorities may also wish to consider putting systems in place, for example, Memoranda of Understanding, to support effective handling of requests where the scope of which includes communications between the bodies, or information on topics of shared interest/joint working. Data Sharing Health Boards and Local Authorities will continue to be responsible for answering data access requests in relation to any data for which they are the Data Controller, however, for requests in relation to any data that Integration Joint Boards are responsible they will be responsible for answering any data access request. Data (Subject) Access Requests Data Access Requests (called Subject Access Requests under the Data Protection Act 1998) are requests by individuals for their personal data and work on the basis of whichever body is the Data Controller. It is possible for the same data to be held by more than one public authority as a result of agreed sharing. Integration Joint Boards must ensure that data sharing arrangements set out in the integration scheme are in place and that it is clear how subject access requests are managed by both parties when shared data is involved. Further information on Subject Access Requests can be found in the Subject Access Requests Code of Practice. The Freedom of Information (Scotland) Act 2002 and Environmental Information (Scotland) Regulations 2004 The Freedom of Information (Scotland) Act 2002 - and the related Environmental Information (Scotland) Regulations 2004 - provide any applicant with the right to request – and be provided with - any recorded information held by Scotland’s public authorities. If an authority does not wish to provide information it holds, an ‘exemption’ or (under the Environmental Information (Scotland) Regulations 2004) an ‘exception’ must be applied, for example, for legal advice or personal data. Page 141 of 382
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8 Integration Joint Boards are a “public authority” for the purpose of Freedom of Information (Scotland) Act 2002. This means they are subject to both Freedom of Information (Scotland) Act 2002 and the related Environmental Information (Scotland) Regulations 2004, as well as other requirements of Freedom of Information legislation, and will be required to respond to information requests accordingly. Integration Joint Boards should be aware of their responsibilities under this Code of Practice which sets out recommended guidance in the handling of information requests. As Health Boards and Local Authorities are already subject to information access legislation, Integration Joint Board members are likely to already have an awareness of the requirements that Freedom of Information (Scotland) Act 2002 and the related Environmental Information (Scotland) Regulations 2004 place on officials and organisations. While, in due course, Integration Joint Boards may wish to develop their own guidance and training, it is suggested that members may initially wish to familiarise themselves with existing guidance and training. For example, the Scottish Government guidance and training on information request handling. Publication Scheme Section 23 of Freedom of Information (Scotland) Act 2002 also requires that all Scottish public authorities subject to the Act maintain a publication scheme. A publication scheme sets out the types of information that a public authority routinely makes available. The Integration Joint Board will need to develop and put in place a publication scheme, along with a guide setting out what information it will make available. It is important that consideration is given to the publication scheme – and associated guides to information – as early as possible. A publication scheme must be approved by the Scottish Information Commissioner. Information on publication schemes is available on the Commissioner’s website. Office of the Scottish Information Commissioner (OSIC) The Scottish Information Commissioner promotes and enforces both the public's right to ask for information held by Scottish public authorities and good practice by authorities. The Commissioner’s staff have considerable experience in assisting authorities who are new to the Freedom of Information (Scotland) Act 2002 / Environmental Information (Scotland) Regulations 2004 responsibilities and will be pleased to help. They can be contacted on 01334 464610, or by email to enquiries@itspublicknowledge.info. Page 142 of 382
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9 Ethical Standards in Public Life - Code of Conduct Integration Joint Boards are “devolved public bodies” for the purposes of the Ethical Standards in Public Life (Scotland) Act. This means that each Integration Joint Board is required to produce a code of conduct for members. The code should be based on the model code of conduct for members of devolved public bodies. Each Integration Joint Board is required to review this model code and adopt it, with or without modifications, as its own code of conduct; applying to all members and business of the Integration Joint Board. All members are required to sign the code of conduct. Some members may have already signed similar codes of conduct i.e. Code of Conduct for Councillors; however they are still required to sign the Integration Joint Board’s code of conduct as their duties as Integration Joint Board members should be independent of the responsibilities that they may have by virtue of other posts. The Standards Commission The Standards Commission is an independent public body which encourages high ethical standards in public life through the promotion and enforcement of Codes of Conduct for those appointed to the Boards of devolved public bodies. The Commissioner for Ethical Standards in Public Life in Scotland The Commissioner is an independent office holder who works in two areas: Public appointments, regulating how people are appointed to the Boards of public bodies in Scotland; and Public standards, where the Commissioner can investigate a complaint about a Councillor or a member of a devolved public body who is alleged to have contravened the Councillors’ or the appropriate public body’s Code of Conduct. It is in this capacity that the Integration Joint Board would be under the remit of the Commissioner. Equalities Duties All public authorities in Scotland, including Integration Joint Boards, must comply with the public sector equality duty set out in the Equality Act 2010. The duty places an obligation on public authorities to take action to eradicate discrimination and to pro-actively promote equality of opportunity. The duty has a two tier structure - a general duty set out in the Equality Act 2010, and specific duties set out in Regulations made by Scottish Ministers. To better enable public authorities to locate equality data and evidence, the Scottish Government has developed an evidence finder. Page 143 of 382
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10 The Scottish Government has also produced an evidence toolkit to help authorities source supporting evidence to help with their Scottish specific reporting duties. Diversity The Scottish Government expects all public bodies to champion diversity and mainstream equal opportunities in their work. Scottish Ministers particularly welcome under-represented groups having membership on Scotland’s public bodies. The Scottish Government’s Programme for Government encourages public bodies to set a voluntary commitment for gender balance on their Boards of 50/50 by 2020, with the aim of ensuring that Boards of public bodies are broadly reflective of the wider Scottish population. The Scottish Government has already committed to achieving gender balance on its Board by 2020. Public bodies, including Integration Joint Boards, are expected to take positive action to support and enable greater diversity in the membership of and appointment to their Board. 1.4 Liability arrangements for Integration Joint Boards and their members Integration Joint Boards are eligible to join the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) which covers the following areas of liability: Clinical Negligence Employers Liability Public Liability Personal Injury, Loss, Damage to Property or other Wrongful Act Dishonest, Fraudulent, Criminal or Malicious Activities Defamation Directors and Officers Liability Consequential or Ancillary Expense Financial Loss Suffered by Member as a result Fraud/Dishonesty/Theft The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000 (as amended) makes provision for Integration Joint Boards to apply to become a member of CNORIS. Membership is not compulsory, but represents a cost-effective alternative to arranging separate insurance. If an Integration Joint Board decides to become a member of CNORIS then they will be indemnified as above. If an Integration Joint Board decides not to become a member of CNORIS then it will be necessary to ensure alternative arrangements are put in place to cover the Integration Joint Board and its members against any claims arising in relation to liabilities listed above. Page 144 of 382
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11 1.5 The relationship between the Integration Joint Board and the strategic planning group The Public Bodies (Joint Working) (Scotland) Act 2014 places a requirement on Integration Joint Boards to create a strategic plan for the area for which it is established. As part of this process, the Integration Joint Board must establish a strategic planning group. The Integration Joint Board must also determine the processes and procedures for the strategic planning group, subject to the provisions set out in section 32 of the Act. In developing the processes and procedures for the strategic planning group, the Integration Joint Board must be mindful that the work of the strategic planning group does not end with the publication of the strategic plan. After the strategic plan is published, the strategic planning group will continue to review progress of the plan, measured against the statutory outcomes for health and wellbeing, and associated indicators. Strong lines of communication will need to be established between the strategic planning group and the Integration Joint Board. This is needed to ensure that the strategic planning group can effectively communicate its findings to the Integration Joint Board which will help to inform and facilitate revisions to the strategic plan at least every three years. A detailed explanation of the process for the development of the strategic plan can be found in the Strategic Commissioning Plan Guidance. Page 145 of 382
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12 1.6 Appointing a Committee of an Integration Joint Board Integration Joint Boards can appoint sub-committees should that be desirable. The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 extends the options available to an Integration Joint Board in effectively planning for the provision of services by permitting an Integration Joint Board to form a committee to carry out any of its functions as it sees fit. Any decision of such a committee must be agreed by the majority of the voting members who are members of the committee. A committee of an Integration Joint Board can only exercise the functions conferred upon it by the Integration Joint Board. The purpose of the committee is to support the effective working of the Integration Joint Board on matters which have been devolved to it by the Integration Joint Board. This may be in an advisory capacity or, depending on the remit given by the Integration Joint Board, the committee may have decision making powers to carry out certain functions of the Integration Joint Board. In the interests of fairness and effective working, a committee of an Integration Joint Board must consist of equal numbers of representatives from each constituent authority, as set out in the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (article 17(3)). An Integration Joint Board can appoint advisory members to sit on a committee from outside the membership of the Integration Joint Board, although, as before, any such decision must be agreed on by the voting members of the Integration Joint Board. Page 146 of 382
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13 1.7 Complaints under Integration Complaints about Integrated services Where a Health Board and Local Authority choose a body corporate model of integration, the Health Board and Local Authority will remain the responsible bodies for the delivery of health and social care services. As such any complaints about service delivery will be dealt with through the existing health procedures and social care/social work complaints procedures. To ensure complaints are joined up from the perspective of the complainants, Health Boards and Local Authorities are required to agree and set out within their integration schemes arrangements for the management of complaints relating to integrated service delivery and the process by which a service user, and those complaining on behalf of service users may make a complaint. The arrangements set out in the integration scheme cannot alter the underlying position, described above, that complaints are to be dealt with under existing health procedures and social care/social work complaints procedures. The Health Board and Local Authority must ensure that the arrangements that they have jointly agreed are: • Clearly explained • Well-publicised • Accessible • Allow for timely recourse • Complainants are signposted to independent advocacy services Complaints about Integration Joint Boards As Integration Joint Boards are newly formed public bodies complaints may be raised against them in relation to particular functions and duties that they have responsibility for, such as strategic planning. Integration Joint Boards are not currently covered under existing legislation and must put in place a robust complaints procedure in relation to the functions that have been delegated to them. The Scottish Government position is that in establishing a complaints procedure; Integration Joint Boards should implement a complaints handling procedure that follows the structure, principles and timescales set out in the Scottish Public Service Ombudsman’s (SPSO) Model Complaints Handling Procedure Guidance. The SPSO’s Model Complaints Handling Procedure Guidance recognises that each public service provider has their own way of working and has unique staffing and operational considerations, and therefore provides broad direction and support to in improving their complaints handling procedures; by setting out the high level components of an effective complaints handling procedure Page 147 of 382
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14 with a focus on simplifying and streamlining those procedures. It places an emphasis on ‘getting it right first time’ and is firmly focused on quicker, simpler and more streamlined complaints handling with local, early resolution by empowered and well trained staff. The SPSO model complaints procedure is a 3 stage complaint process: the first stage is front-line resolution – failure to resolve a complaint at this stage will result in the complaint being escalated; at the second stage, the complaint is investigated and an attempt made by a senior manager to resolve it. The third and final stage of the process is for the complaint to be referred to the SPSO for a final decision. The Scottish Government intends to amend schedule 2 of the Scottish Public Services Ombudsman Act to include Integration Joint Boards and will consult on the proposal to do so. This proposed change will have the effect of legally requiring Integration Joint Boards to put in place a complaints procedure and it will provide the Scottish Public Services Ombudsman with the powers to investigate the actions of the Integration Joint Boards in carrying out its duties, or any service failure attributable to an Integration Joint Board. It cannot, however, investigate the merits of a decision taken within the Integration Joint Board’s discretion, unless the established processes have not been followed in making that decision. Under Section 53 of the Public Bodies (Joint Working) (Scotland) Act 2014, Integration Joint Boards are required to have regard to the guidance issued by Scottish Ministers. Integration Joint Boards therefore must implement a complaints process that follows the structure, principles and timescales of the SPSO model complaints procedure outlined above. Compliance with the third and final stage of the SPSO model complaints procedure will take effect once legislative changes have come into force. Page 148 of 382
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15 Section 2: Membership of the Integration Joint Board 2.1 Minimum Membership The Public Bodies (Joint Working) (Membership and Procedures of Integration Joint Boards) (Scotland) Order 2014 (“the Order”) sets out requirements about the membership of an Integration Joint Board. This includes minimum required membership, and provision for additional members to be appointed. The Integration Joint Board is created as a new legal entity that binds the Health Board and the Local Authority together in a joint arrangement. The membership of an Integration Joint Board reflects equal participation by the Health Board and Local Authority to ensure that there is joint decision making and accountability. The Local Authority and the Health Board will set out the number of representatives that will sit on the Integration Joint Board within their integration scheme. The Order requires that the Local Authority and Health Board put forward a minimum of three nominees each. This number may be increased by local agreement, but the same number must be nominated by each party. Local Authorities can insist on nominating a maximum of 10% of their full number of Councillors. The Health Board and Local Authority may also agree that they will each nominate a larger number than this. The Local Authority will nominate Councillors to sit on the Integration Joint Board. The Health Board will nominate non-executive directors to sit on an Integration Joint Board. Where the Health Board is unable to fill all their places with non-executive directors, they can then nominate other members of the Health Board. The Integration Joint Board will make decisions about how health and social care services are planned and delivered for the communities within their areas. To do this effectively, they will require professional advice, for example, to ensure that the decisions reflect sound clinical practice. It is also essential that Integration Joint Boards include key stakeholders within the decision making processes to utilise their advice and experience. Page 149 of 382
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16 To ensure this, the Order sets out a minimum membership, but allows local flexibility to add additional nominations as Integration Joint Boards see fit. In addition to Health Board and Local Authority representatives, the Integration Joint Board membership must also include: • The Chief Social Work Officer of the constituent Local Authority • A General Practitioner representative, appointed by the Health Board • A Secondary Medical care Practitioner representative, employed by the Health Board • A Nurse representative, employed by the Health Board • A staff-side representative • A third sector representative • A carer representative • A service user representative • The Chief Officer of the Integration Joint Board • The Section 95 Officer of the Integration Joint Board The Chief Social Work Officer will be appointed by the Local Authority and the health professionals will be appointed by the Health Board because of the role they fulfil. The Chief Officer must be appointed by the Integration Joint Board and will provide a single point of accountability for integrated health and social care services. The Integration Joint Board must also appoint the Section 95 Officer who will be the responsible officer for the financial arrangements of the Integration Joint Board. The ways in which the members of the Integration Joint Board are to be identified and appointed to the Integration Joint Board will differ. The Integration Joint Board will co-opt the staff-side, third sector, carer and service user representative, and this should be done as soon as practicable once the Integration Joint Board is established. How the Integration Joint Board approaches the appointment of the staff-side, third sector, carer and service user representative members will be dependent on local circumstances, for example, through existing carers networks or the organisations operating within the area of the Integration Joint Board, therefore section 2.4 sets out principles that should be implemented in the identification of members. Whilst there is a required minimum membership for inclusion on the Integration Joint Board, there is also local flexibility for the Integration Joint Board to add additional members. The Independent Sector for example provide a significant proportion of social care services and will therefore play a key role in the successful delivery of integrated services in local areas. As part of their strategic planning responsibilities, Integration Joint Boards should consider their membership cohorts and seek appropriate additional representation as suggested by local priorities. Integration Joint Boards might also seek additional membership to reflect delegation of functions outside the minimum scope, for example additional professional advice. If an Integration Joint Board is established by more than one Local Authority, the Order makes specific provision for how the minimum membership is to be determined. Page 150 of 382
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17 2.2 Good Practice in the identification and appointment of members of Professional and Stakeholder members The Order sets out the minimum required membership. All Integration Joint Board members have equal responsibility as Board members and the reference made between professional members and stakeholder members in the following section only reflects the difference in the routes of appointment. The Order also makes provision for the Integration Joint Board to appoint additional professional and/or stakeholder members, as required. To ensure that members are able to successfully fulfil the roles they are appointed to, sections 2.3 and 2.4 set out principles that should be implemented in the identification of members. 2.3 Professional Membership The Order requires a minimum professional membership on the Integration Joint Board as follows: • Appointment of a GP • Appointment of a Nurse • Appointment of a Secondary Care representative • The Chief Officer of the Integration Joint Board • The Section 95 Officer of the Integration Joint Board • The Chief Social Work Officer of the constituent Local Authority With the exceptions of the Chief Officer, the Section 95 Officer and Chief Social Work Officer, the Order provides some flexibility in the appointment of professional members. However, due to the particular skills and experience required, and the strategic nature of the professional roles on the Integration Joint Board, the Health Board, Local Authority and the Integration Joint Board should follow the principles below to ensure they identify the appropriate members of professional staff to fill these posts: • The professional members appointed will bring professional experience and knowledge to inform the Integration Joint Board decision making in terms of planning, operational delivery and the effectiveness of major reforms. This advice will ensure the Integration Joint Board can fully take account of safety and quality of care matters. As such, the appointed person must be able to demonstrate the appropriate experience, skills and competencies to fulfil this role. The appointed member must demonstrate their ability to work at a senior level and have experience of operating at a strategic level; • Professional members should have a named, appointed deputy, able to demonstrate a similar level of skill and experience as the substantive appointment. Deputies should be expected to attend only where absolutely necessary to ensure continuity of advice from the professional. Page 151 of 382
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18 • The Health Board should ensure the appointed professional members have defined roles that are clearly set out, and held locally. The Health Board and/or Local Authority must ensure that they have time, resource and support to fulfil their responsibilities to the Integration Joint Board for the full term of their appointment. • As effective strategic planning is key, the Health Board and Local Authority must ensure that the appointed professional members are given specific training and support to contribute effectively to the Integration Joint Board, where such training is required. The above principles should also be considered when the Integration Joint Board opts to appoint additional professional members. However, in this case the application of each principle will depend on the nature and basis on which these additional members are appointed. 2.4 Appointment of Stakeholder members In addition to the professional membership, the Order also requires stakeholder members be appointed to the Integration Joint Board as follows: • A staff side member • A third sector member • A carer member • A service user member The ways in which stakeholder members will be identified and appointed to these positions on the Integration Joint Board will vary due to the local circumstances of each Integration Joint Board, such as type and number of the representative groups working within their area. Although there will not be a uniform approach in appointment of the stakeholder members, it is important that they are able to appropriately fulfil their roles. The Integration Joint Board should follow the principles set out below: • Stakeholder members will reflect the views of the groups they represent on the Integration Joint Board; naturally the individuals that comprise these stakeholder groups will be diverse. As such, the appointed person must be able to demonstrate the appropriate experience and skill to reflect the breadth and diversity of views and situations of the individuals or groups that they represent. • The Integration Joint Board should ensure the appointed member has the resources and support to fulfil their responsibilities to the Integration Joint Board for the full term of their appointment. • As effective strategic planning is key, the Integration Joint Board must ensure that the appointed stakeholder members are given specific training and support to contribute effectively to the Integration Joint Board, where such training is required. Page 152 of 382
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19 As with professional members, these principles should also be considered when the Integration Joint Board opts to appoint any additional stakeholder members. The implementation of each principle will depend on the nature and basis on which these additional members are appointed. 2.5 Induction of Members As well as their collective roles in carrying out the responsibilities of the Integration Joint Board, members will have individual roles to carry out to ensure that integrated health and social services are planned and delivered to improve outcomes for the communities they serve. In doing so, Integration Joint Board members must ensure that this is carried out effectively and in line with the integration delivery principles. Integration Joint Board members will come from a variety of backgrounds. Some members may not have had much/any experience of sitting on the board of a public body. All Integration Joint Board members will require induction training to ensure that they are able to carry out their duties to the highest standard. The training and information requirements will of course vary from member to member, and Integration Joint Boards locally decide how best to organise and operate their induction training requirements. All members should receive an induction; as a minimum this should cover the member’s specific post requirements, roles, responsibilities and policies. The Scottish Government have produced On Board: A Guide for Board Members of Public Bodies in Scotland which can be used as a standard induction pack covering generic issues such as roles and responsibilities of public bodies, and accountability and governance arrangements to supplement the tailored induction that individual Integration Joint Boards will wish to produce. The Scottish Government has also produced Leading the Journey of Integration: A Guide for Organisational Development Leaders to support the development of Integration Joint Boards. The guide highlights the important roles that are required for the integration of health and social care to be a success. It sets outs key information paired with development exercises which can be used individually or collectively by an Integration Joint Board. The guide can be found on the Adult Health Social Care Integration Implementation Website. Page 153 of 382
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w w w . s c o t l a n d . g o v . u k © Crown copyright 2015 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.scotland.gov.uk Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG ISBN: 978-1-78544-625-2 (web only) Published by The Scottish Government, September 2015 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS56029 (09/15) Page 154 of 382
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ON BOARD A GUIDE FOR BOARD MEMBERS OF PUBLIC BODIES IN SCOTLAND Page 155 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 2 INTRODUCTION Public bodies come in a variety of forms, depending on their functions and relationship with Scottish Ministers and/or the Scottish Parliament. Public bodies are set up for specific purposes and there is no set template of what a public body should look like. Annex A provides an overview of the classification of public bodies. This classification has important implications for accountability and reporting arrangements. Information on individual bodies and contact details are available from the National Public Bodies Directory. This guidance provides the basic information that you will need to understand your role as a member of the Board of a public body in Scotland and to help make your time with the Board fulfilling and effective. It supplements the information contained in your letter of appointment which formally sets out your specific roles and responsibilities as a Board member. This guidance is for all those involved in the Boards of our Non Departmental Public Bodies (NDPBs). Due to the differing responsibilities of bodies, parts of the guidance may not be wholly appropriate for Board members of other public bodies. However Board members of other bodies may also find sections of the guidance helpful: the Chair or Chief Executive of your public body will be able to provide further advice. All public bodies should have in place supportive guidance which reflects the specific nature of their work and the extent to which separate arrangements may apply to the work of the Board. Public bodies play an essential role in performing certain functions on behalf of Government. They allow the public sector to benefit from the skills, knowledge, expertise, experience, perspectives and commitment of the members who sit on their Boards and focus in depth on clear and specific functions and purposes. Page 156 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 3 When a new Board member joins a public body, they may not have had much direct experience of that body. Effective induction serves as a valuable source of information and should provide material on specific job requirements, roles, responsibilities, policies and purposes. This guidance provides the starting point of your induction into the public body that you have joined. You should also receive further induction guidance and training from your public body on a range of topics, including: ¼ the structure, governing legislation and work of your public body and links with the sponsor Directorate in the Scottish Government ¼ the Ethical Standards Framework and Code of Conduct for Board members ¼ corporate roles and responsibilities as a Board member Annex B provides a checklist of the types of induction guidance and training that may be available from your public body. You should refer to this checklist when discussing your induction requirements with the Chair and Chief Executive. FURTHER GUIDANCE > Key reference materials and contacts are listed under each of the main sections of this guidance. The main source of further information and guidance will be the public body that you have just joined, particularly the Chair and Chief Executive. Between them, they will be able to provide you with most of the advice and information that you are likely to need during your time as a Board member of a public body in Scotland. This guidance has been produced in an interactive format to allow users to view documents referenced through the use of hyper-links. The guide will be kept under review to ensure that it continues to help promote best practice for Board members. The guide will not be produced in hard copy by the Scottish Government. Induction and Training INTRODUCTION Key to document navigation Main contents Guidance note contents Previous Page Page 157 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 4 Public Service Delivery and Reform Guidance Note 1 Principles of Corporate Governance Guidance Note 2 Roles, Responsibilities and Relationships Guidance Note 3 Effective Financial Management Guidance Note 4 Ethics and Standards of Behaviour Guidance Note 5 Annex A Classification of Public Bodies Annex B Induction and Training for Board Members The guidance is organised into five main sections: Guidance notes Page 158 of 382
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CHAPTER 1On Board A Guide for Board Members of Public Bodies in Scotland 5 Public Service Delivery and Reform Guidance Note 1 Page 159 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 6 Overview Key Messages Key References and Contacts Public Service Delivery and Reform National Performance Framework Public Service Reform The Scottish Approach to Government Government Economic Strategy Community Planning Health and Social Care Integration Scotland’s Digital Future Best Value, Efficient Government and Relocation Contents Public Service Delivery and Reform Page 160 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 7 Overview Scottish Ministers are committed to high quality, continually improving, efficient public services that are responsive to local people’s needs. To deliver on this commitment it is important that public bodies, third sector and private organisations work effectively in partnership with communities and each other. This section explains the key policy developments and strategies on the delivery and reform of public services in Scotland, the relevance of public service delivery and reform to you as a Board member of a public body, and the influential role you can play in making a real change to the lives of the people of Scotland. Key References and Contacts National Performance Framework Scottish Government Economic Strategy Christie Report Scottish Government’s Response to the Christie Report Scotland’s Digital Future – Delivery of Public Services Key Messages ¼ As a Board member, you have a responsibility to ensure the effective governance and financial management of your public body within the context of public service delivery and reform for the benefit of the people of Scotland. ¼ Public bodies are required to demonstrate their commitment to public service delivery and reform by recognising their role in the delivery of the Programme for Government and the National Performance Framework. ¼ Public service reform is built on four pillars: Prevention, Performance, People and Partnership (supported by Place) – which should be reflected in public bodies’ corporate strategic priorities and plans. ¼ The Scottish Government has developed a distinct approach to support the achievement of National Outcomes and public service reform. It is centred around empowerment and participation: enabling people to co-design, shape and deliver public services that they use; and building on the strengths of families and communities. Page 161 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 8 PUBLIC SERVICE DELIVERY AND REFORM In your role as a Board member of a public body in Scotland, you will be required to discharge specific duties in relation to the effective governance and financial stewardship of the body concerned. These duties are covered in sections three to five of this guidance, the body’s Framework Document and your letter of appointment. As a member of a public body in Scotland, you also have a general responsibility to discharge these duties within the context of public service delivery and reform to the benefit of the people of Scotland. The main policy developments and strategies which have shaped the Scottish Government’s approach to public service delivery and reform are: ¼ The outcomes-based approach of the National Performance Framework ¼ The Christie Report and the Scottish Government’s Four Pillars of Public Service Reform ¼ The strategic priorities of the Government Economic Strategy ¼ Community Planning whereby local authorities, public bodies, the Scottish Government and the third sector work together and with the local community ¼ Increased participation and delivery of public services through digital technology as described in Scotland’s Digital Future: Delivery of Public Services ¼ The Scottish Approach centred around the core concepts of Participation and Co-production, Assets-based Approaches and Improvement Methodology. The next section expands upon these policy developments and strategies, and their relevance to you as a Board member of a public body in Scotland. NATIONAL PERFORMANCE FRAMEWORK The Scottish Government’s vision for a successful Scotland is set out in the National Performance Framework. The Framework actively supports wider engagement between the Scottish Government and its delivery partners, including local government, third sector and public bodies. It consists of five main parts which support and reinforce each other: ¼ The Scottish Government’s Purpose ¼ The Purpose Targets to track progress towards the Purpose ¼ Five Strategic Objectives to focus on action ¼ 16 National Outcomes describing what the Scottish Government wants to achieve ¼ 50 National Indicators to track progress towards the Purpose and National Outcomes. Page 162 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 9 National Outcomes A shared approach to the achievement of National Outcomes encourages public service providers to direct attention towards the key long-term challenges for Scotland. As the achievement of shared outcomes is dependent on increased collaboration, effective partnership working and closer alignment of service provision, public bodies are required to ensure that their corporate strategies and plans support the National Outcomes described in the National Performance Framework. It follows that all public bodies must demonstrate the role that their corporate strategies and plans have in delivering National Outcome 16 which refers specifically to high quality, continually improving, efficient public services that are responsive to local people’s needs. Public bodies must also demonstrate their role in delivering the other National Outcomes which are relevant to the type of services they provide, working closely with partners to the benefit of the people of Scotland. This may involve crossing traditional organisational boundaries between public bodies which have separate and distinct roles but which also have a shared interest in the delivery and reform of particular areas of public service (e.g. health, justice and education). This focus on shared outcomes and partnership working can achieve outcomes which might not otherwise be possible by one body acting alone. It also opens up opportunities for sharing of limited resources to ensure more efficient, effective and sustainable public services. Scotland Performs The Scotland Performs website measures and reports on the wide range of indicators set out in the National Performance Framework. As such, it provides an open and transparent account of the progress of government in Scotland in the creation of a more successful country, with opportunities for all through increasing sustainable economic growth. PUBLIC SERVICE REFORM The Christie Commission In 2010 the Scottish Ministers invited Dr Campbell Christie to lead a Commission to identify the best ways to address the challenges of delivering public services, based on evidence of what works. The Christie Commission concluded that to achieve the outcomes that matter most to the people of Scotland, public, third sector and private organisations had to work more effectively in partnership with communities and with each other to design and deliver excellent public services that meet the needs of local people. The need for new ways of delivering public services has never been more important than it is today. The Christie Report provided an assessment of the challenges facing public services and recommended an urgent, sustained and coherent programme of public service reform. Page 163 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 10 THE SCOTTISH GOVERNMENT’S FOUR PILLARS OF PUBLIC SERVICE REFORM In its response to the Christie Report, the Scottish Government identified four pillars of reform in order to deliver better outcomes for the people of Scotland, to reduce inequalities and to ensure the delivery of sustainable services now and in the future: Prevention – reduce future demand by preventing problems arising or dealing with them early on. To promote a bias towards prevention, help people understand why this is the right thing to do, the choices it implies as well as the benefits it can bring. Performance – to demonstrate a sharp focus on continuous improvement of the National Outcomes, applying reliable improvement methods to ensure that services are consistently well designed, based on the best evidence and are delivered by the right people to the right people at the right time. People – we need to unlock the full creativity and potential of people at all levels of public service, empowering them to work together in innovative ways. We need to help create ways for people and communities to co-produce services around their skills and networks. Partnership – we need to develop local partnership and collaboration, bringing public, third and private sector partners together with communities to deliver shared outcomes that really matter to people. The Scottish Government’s approach to public service delivery and reform also focuses on the importance of “place” (locality) in the design and delivery of public services. The focus on place provides the basis for partnership and stronger community participation in the design and delivery of local services, harnessing the full spectrum of talents and capacities of public bodies, citizens, third sector organisations and local businesses. In the next sections some of the information provided may not directly impact on your role as a Board member of a public body. However, it is essential that Board members have an awareness of work being taken forward by the Scottish Government in relation to public service reform. > Page 164 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 11 THE SCOTTISH APPROACH TO GOVERNMENT The National Performance Framework and the Government’s response to Christie describe ‘what’ we are trying to achieve, the ‘Scottish Approach’ describes ‘how’ it should be delivered; centering around three core elements of Participation and Co-production, Assets and Improvement, as summarised right. The approach seeks to safeguard essential services, preserve front-line jobs and secure higher quality services through, for example: ¼ greater integration of health and social care ¼ the move to single police, and fire and rescue services ¼ the reform of post-16 education. GOVERNMENT ECONOMIC STRATEGY Scotland’s Economic Strategy reaffirms the Scottish Government’s commitment to creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth. It sets out an overarching framework for achieving the two mutually supportive goals of increasing competitiveness and tackling inequality in Scotland. It forms the strategic plan for existing and all future Scottish Government policy and prioritises boosting investment and innovation, supporting inclusive growth and maintaining a focus on increasing internationalisation. COMMUNITY PLANNING Community Planning is now firmly established at the heart of public service reform. It involves public services working together and with the local community to understand the different needs of communities in their area in order to resource services which make a real difference to people’s lives. ASSETS-BASED IMPROVEMENT METHODOLOGY PARTICIPATION and CO- PRODUCTION The Scottish Approach Participation and Co-production – enabling people to shape and co-design the services they use. Assets-based – valuing the strengths of people and communities to build social capital and capacity, rather than focusing solely on perceived deficits. Improvement Methodology: Creating Conditions for Change ¼ Setting out a compelling vision of the future to serve as a reference point as the change process moves forward; ¼ Backed by a story which helps people to recognise where they have been and where they are going; ¼ Identifying key actions towards realising the vision. Making the Change ¼ A clear framework for improvement; ¼ A strategy to engage, empower and motivate the workforce and develop their skills; ¼ An understanding of how the change will work locally, recognising communities and their assets are different; ¼ Building the guiding coalitions, governance and data necessary to drive and sustain the change. ¼ Page 165 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 12 Community Planning Partnerships Community Planning Partnerships (CPPs) bring public service providers (local authorities, NHS Boards, police and fire services, and other participating public bodies) together with communities and the third and private sectors to understand local needs and opportunities, agree locally shared priorities, and develop and deliver a shared plan to improve local outcomes for local people. There are 32 CPPs in Scotland, each one covering a local authority area. Single Outcome Agreements The Single Outcome Agreement is a CPP’s plan to improve local outcomes. It sets out how the CPP will work towards improving outcomes for local people in a way that reflects local circumstances and priorities, within the context of the Scottish Government’s Purpose and National Outcomes as set out in the National Performance Framework. They also take account of a number of national policy priorities, including economic recovery and growth; employment; safer and stronger communities; and addressing health inequalities. Each Single Outcome Agreement is approved by the partners in the CPP and signed off by Scottish Ministers and the local council leader. Community Empowerment (Scotland) Bill The Community Empowerment (Scotland) Bill, which is currently being considered in the Scottish Parliament with a view to becoming an Act in the summer of 2015 proposes a new legislative framework to strengthen community planning. It changes the statutory purpose of community planning, making it explicitly about how public bodies work together and with the local community to plan for, resource and provide services which improve local outcomes in the CPP area. It applies community planning duties to a number of additional public bodies, and also proposes new duties for governing the CPP on a defined set of public bodies. Bodies which are not covered by the Bill should consider pursuing opportunities for partnership working with other bodies, including local authorities, wherever this can support their respective business objectives. HEALTH AND SOCIAL CARE INTEGRATION Public Bodies (Joint Working) (Scotland) Act 2014 The shape of Scottish society is changing. People are living longer, healthier lives and as the needs of our society change, so too must the nature and form of our public services. New legislation in the form of the Public Bodies (Joint Working) (Scotland) Act 2014 requires Health Boards and local authorities to integrate their health and social care services. Local teams and professionals across health and social care will work together to deliver quality, sustainable care and services resulting in improved outcomes for the people and families who use these services. Page 166 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 13 SCOTLAND’S DIGITAL FUTURE The McClelland Review of ICT Infrastructure in the Public Sector in Scotland identified that the public sector, at all levels, could do more to transform how it procures, manages and uses digital technology to drive better public service delivery. In its response, the Scottish Government outlined priorities for action to enable public services, citizens and businesses to benefit from increased digital participation and access to digital public services. These priorities are set out in Scotland’s Digital Future: Delivery of Public Services and include a “digital first” approach to service delivery, with public bodies working collaboratively with each other and service users to develop integrated digital platforms for the delivery of effective, efficient and sustainable public services. Audit Scotland’s report, Managing ICT Projects, published in August 2012 set out recommendations for Accountable Officers. These recommendations are supported by a checklist and an overall ICT Assurance Framework to support Accountable Officers in the successful delivery of such projects and programmes. BEST VALUE, EFFICIENT GOVERNMENT AND RELOCATION Best Value, Efficient Government and Relocation are all essential elements of the public service reform agenda. These issues are covered in Guidance Note 4. FURTHER INFORMATION > Community Planning Community Empowerment (Scotland) Bill Improvement Framework Improvement Service Public bodies (Joint Working) (Scotland) Act 2014 McClelland Review Central Government ICT Assurance Framework Scottish Government’s response to the McClelland Review Page 167 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 14 Principles of Corporate Governance Guidance Note 2 On Board A Guide for Board Members of Public Bodies in Scotland 14 Page 168 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 15 Overview Key Messages Key References and Contacts Corporate Governance Translating Principles into Action Contents Principles of Corporate Governance Page 169 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 16 Overview Corporate governance concerns the strategic direction and effective stewardship of the organisation. A number of concerns have been raised about corporate governance in the private and public sectors in recent years, mainly relating to the perceived lack of control at the top of some organisations and inadequately designed systems that failed to prevent fraudulent, inefficient or inappropriate behaviour. A number of initiatives have addressed these concerns and strengthened the approach to corporate governance in both the private and public sectors. This section explains the main developments that have led to the principles of corporate governance and how these translate into the conduct and management of public business. Key Messages ¼ Corporate governance is concerned with the strategic direction and effective stewardship of the organisation. ¼ There have been a number of reviews in the private sector which together led to the development and publication of a UK Corporate Governance Code. ¼ There are similarities between the public and private sectors in terms of corporate governance principles – but Board members should recognise that it is not always possible to draw a direct parallel between the two. ¼ The Nolan Committee set new standards of conduct for Board members of public bodies in 1995 and the Ethical Standards in Public Life etc. (Scotland) Act 2000 introduced the ethical standards framework, which includes Codes of Conduct for Board members, a Chief Investigating Officer and a Standards Commission.Key References and Contacts UK Corporate Governance Code Ethical Standards in Public Life etc. (Scotland) Act 2000 Good Governance Standard for Public Services Page 170 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 17 Corporate Governance Corporate governance is the way in which organisations are directed, controlled and led. It defines relationships and the distribution of rights and responsibilities among those who work with, and in, the public body, determines the rules and procedures through which objectives are set, and provides the means of attaining those objectives and monitoring performance. Importantly, it defines where accountability lies throughout the public body. Corporate governance has been a high-profile topic in recent years, principally because of concern about ensuring control at the top of, and within, organisations. There is a perception that, in certain cases, senior managers appear to have been able to act without restraint and that inadequately designed systems have failed to prevent fraudulent, inefficient or inappropriate behaviour. The results of poor corporate governance cannot be underestimated. The international financial crisis was partially attributed to failures in governance within the Boards of major financial institutions. Key Developments in the Private Sector A number of key corporate governance reports in the private sector have contributed to the development of the UK Corporate Governance Code: Reports that shaped corporate governance in the UK Cadbury, 1992 Greenbury, 1995 Hampel, 1998 Turnbull, 1999 Myners, 2001 Smith, 2003 Higgs, 2003 Tyson, 2003 Turnbull, updated 2005 Walker, 2009 Women on Boards, 2011 Francis, 2013 Page 171 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 18 The UK Corporate Code – impact on the public sector Although there are elements of the UK Corporate Code which are relevant to Board members of public bodies, it applies primarily to companies listed on the London Stock Exchange. While there are a number of similarities between the public and private sectors in terms of corporate governance principles, Board members should be aware that it will not always be possible to draw a direct parallel between the two. Whilst public bodies face many similar challenges as private organisations, they cannot be considered to be exactly the same. Effective strategic engagement between the Scottish Government and the public body is essential in order that they work together as effectively as possible to maintain and improve public services and deliver improved outcomes. There is greater accountability, with control over public services handed in greater measure to those who use them, while Scottish Ministers take strategic policy decisions. The varying size and nature of ‘arm’s length bodies’ and the range of functions they carry out means that there is no one absolute template for how the relationship between Scottish Government Directorates and the public body operates. Further consideration on the relationship between Scottish Government Directorates and public bodies is examined in Guidance Note 3. Findings from the Financial crisis report – lack of diversity and groupthink Although the Walker Report specifically related to the collapse of banks and financial institutions its findings had significant ramifications for the Boards of all types of bodies. A key finding of the review was that ‘groupthink’, attributable in turn to a lack of diversity, had been a major contributory factor to the governance failures of the relevant Boards. Many subsequent studies have identified that companies with Boards that are apparently more diverse, such as in relation to gender, age and industry background, perform better than those companies with less diverse Boards. The different perspectives that different types of Board members bring mean that they are more likely to be able to constructively challenge proposals. If Board members are too similar to the executives, a Board’s decision-making risks being narrow and blinkered. It is important to understand that a Board made up of people who are ‘visibly diverse’ will not necessarily be immune to groupthink. Visible diversity is simply an indicator but no guarantee that the Board’s members have the diversity of skills, knowledge, experience and perspectives needed to make it effective. Having said that, a lack of diversity on the Boards of Scotland’s public bodies, which can be evidenced in relation to factors ranging from gender to BME status, employment sector and income, is an indicator that our Boards are not yet sufficiently diverse. Page 172 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 19 The impact for Scottish Public Bodies Scottish Ministers are committed to redressing this imbalance with gender parity being a particular area of focus. Boards themselves should give consideration to establishing a committee to consider matters such as planning for succession and Board performance as this should lead to more diversity at Board level. The aim should be to have 50:50 gender balance by 2020. Key Developments in the Public Sector There have been a number of high-profile reports and inquiries in Scotland highlighting inadequacies in the governance of public bodies. In one report, a Parliamentary Committee concluded that the governance arrangements in a public body did not identify or prevent a crisis which it should have done. Although not the primary factor, the Committee believed that the Board failed sufficiently to challenge the Chief Executive over a significant operational development that ultimately failed. In another report, the Scottish Parliament’s Public Audit Committee concluded that, on the evidence received, members of the Board of a public body had acted with probity throughout a very difficult period but could not escape criticism for not being aware of problems of which they should have been aware. As in the private sector, there have been a number of developments aimed at improving corporate governance in the public sector: Nolan Principles In 1995, the Committee on Standards in Public Life (the Nolan Committee) identified seven principles of conduct underpinning public life and recommended that public bodies should draw up Codes of Conduct incorporating these principles. NOLAN COMMITTEE 1995 Public bodies should draw up Codes of Conduct incorporating seven Nolan Principles of: ¼ Selflessness ¼ Integrity ¼ Objectivity ¼ Accountability ¼ Openness ¼ Honesty ¼ Leadership. > Recommendation Page 173 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 20 The then Scottish Executive took the Nolan Committee recommendations one step further with the introduction of the Ethical Standards in Public Life etc. (Scotland) Act 2000 which brought in a statutory Code of Conduct for Board Members of Devolved Public Bodies and set up a Standards Commission for Scotland to oversee the ethical standards framework. The Scottish Executive also identified nine key principles underpinning public life in Scotland, which incorporated the seven Nolan principles and introduced two further principles, Duty (Public Service) and Respect. These nine principles and their practical implications for Boards and Board members are explored in Guidance Note 5. Good Governance Standard for Public Services In 2004, the Chartered Institute of Public Finance and Accountancy and the Office for Public Management established an Independent Commission on Good Governance for Public Services. In 2005, the Independent Commission published its Good Governance Standard for Public Services which set out six core principles of good governance. GOOD GOVERNANCE STANDARD FOR PUBLIC SERVICES ¼ Statutory Code of Conduct for Board Members of Devolved Public Bodies ¼ Appointment of a Chief Investigating Officer to investigate and report to the Standards Commission for Scotland (the Standards Commission) ¼ Standards Commission to oversee ethical standards framework ¼ Seven Nolan Principles plus two further principles of Duty (Public Service) and Respect. ¼ Focus on the organisation’s purpose and on outcomes for citizens and service users ¼ Perform effectively in clearly defined functions ¼ Promote values for the whole organisation and demonstrate the values of good governance through behaviour ¼ Take informed, transparent decisions and manage risk ¼ Develop the capacity and capability of the governing body to be effective ¼ Engage stakeholders and make accountability real. > Provisions Core Principles > ETHICAL STANDARDS IN PUBLIC LIFE ETC. (SCOTLAND) ACT 2000 Page 174 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 21 Translating Principles into Action The remaining sections of this guidance provide the practical advice that is needed to enable public bodies and Board members to apply the concepts of good corporate governance to their own organisations. They pull together good practice from the private and public sectors to provide guidance to Board members across the three main dimensions of corporate governance: ¼ Roles, Responsibilities and Relationships (Guidance Note 3) ¼ Effective Financial Management (Guidance Note 4) ¼ Ethics and Standards of Behaviour (Guidance Note 5) These guidance notes explain the meaning of these dimensions of corporate governance more fully and their relevance to you as a Board member of a public body in Scotland. Page 175 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 22 Roles, Responsibilities and Relationships Guidance Note 3 On Board A Guide for Board Members of Public Bodies in Scotland 22 Page 176 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 23 Overview Key Messages Key References Fundamental Principles of Board Life Role of the Board Role of the Board as an Employer Role of the Board Committees Role and Responsibilities of the Board Member Role and Responsibilities of the Chair Role and Responsibilities of the Chief Executive Role and Responsibilities of the Accountable Officer Role and Responsibilities of the Minister Role of the Scottish Government Sponsor Directorate Managing Relationships Further information and contacts Contents Roles, Responsibilities and Relationships Page 177 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 24 Overview Every member of a Board of a public body must be clear about their specific roles and responsibilities if the Board and the public body are to operate successfully. This section outlines the roles and responsibilities of the Board, its committees, individual Board members and key internal and external stakeholders, such as the Chief Executive, Scottish Ministers and the Scottish Government sponsor Directorate. It explains the importance of managing these relationships effectively, including a clear understanding of the strategic governance and decision-making responsibilities of the Board and the operational and statutory accountability responsibilities of the Chief Executive, including as the body’s Accountable Officer. Key Messages ¼ Board members must adhere to collective corporate responsibility, confidentiality and the highest standards of conduct. ¼ Individual Board members should contribute fully to Board deliberations and exercise a healthy challenge function. The Chair will ensure that all Board members have an opportunity to contribute to Board discussions. ¼ The four main functions of the Board of a public body are: to ensure that the body delivers its functions in accordance with Ministers’ policies and priorities; to provide strategic leadership; to ensure financial stewardship; and to hold the Chief Executive and senior management team to account. ¼ Committees are established to deal with particular areas of interest outside main Board meetings and are required to submit substantive reports to summarise issues, debates and decisions. ¼ The Chair has additional responsibilities to Board members, particularly leadership, directing a diverse team and harnessing the benefits of this, and the conduct of Board business. ¼ The Chief Executive is accountable to the Board for the overall organisation, management and staffing of the public body. Where a public body manages its own budget, the Chief Executive is normally designated as its Accountable Officer with responsibilty for the proper management of public funds under the public body’s control. The Board should have regard to the issues and concerns of the Accountable Officer. ¼ The Board focuses on strategy, performance and behaviour – the Chief Executive advises the Board on all matters and is solely responsible for operational issues. Board members have no authority to instruct the Chief Executive or any member of staff on operational matters. Key References Audit Committee Handbook Audit Scotland – The Role of Boards Equality Act 2010 NDPB Model Framework Document Scottish Public Finance Manual (Accountability) Page 178 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 25 Fundamental Principles of Board Life There are three fundamental principles of Board life to which all Board members (including the Chair) must adhere: Principle 1 – Corporate Responsibility While Board members must be ready to offer constructive challenge, they must also share collective responsibility for decisions taken by the Board as a whole. If they fundamentally disagree with the decision taken by the Board, they have the option of recording their disagreement in the minutes. However, ultimately, they must either accept and support the collective decision of the Board – or resign. Board decisions should always comply with statute, Ministerial directions, Ministerial guidance and the objectives of the sponsor Directorate, as appropriate (noting of course that regulatory bodies are required to demonstrate independence in order to maintain credibility). Principle 2 – Confidentiality All Board members must respect the confidentiality of sensitive information held by the public body. This includes commercially sensitive information, personal information and information received in confidence by the organisation. It is also essential that debate of a confidential nature inside the Boardroom is not reported outside it. Principle 3 – Conduct Board members have a responsibility to set an example by demonstrating the highest standards of behaviour. It is important that nothing you do or say when acting in your capacity as a Board member tarnishes in any way the reputation of the public body or the Board. If you have specific concerns about the manner in which the public body is being run, these should be raised with the Chair in the first instance. If you fail to achieve resolution with the Chair, it is open to you to take them to the sponsor Directorate – but you should appreciate that this is a significant step. Role of the Board The four main functions of the Board are: to ensure that the body delivers its functions in accordance with Ministers’ policies and priorities; to provide strategic leadership; to ensure financial stewardship; and to hold the Chief Executive and senior management team to account. It has corporate responsibility, under the leadership of the Chair, for the following: ¼ Taking forward the strategic aims and objectives for the body agreed by the Scottish Ministers; ¼ Determining the steps needed to deal with changes which are likely to impact on the strategic aims and objectives of the body or on the attainability of its operational targets; Page 179 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 26 ¼ Promoting the efficient, economic and effective use of staff and other resources by the public body consistent with the principles of Best Value, including, where appropriate, participation in shared services arrangements; ¼ Ensuring that effective arrangements are in place to provide assurance on risk management, governance and internal control; ¼ Taking into account relevant guidance issued by Scottish Ministers; ¼ Receiving and reviewing regularly financial information concerning the management and performance of the public body and being informed in a timely manner about any concerns regarding the activities of the public body; ¼ Ensuring systems are in place to enable early notification to be provided to the Scottish Government about emerging issues which will impact on the operation or reputation of the public body; ¼ Appointing (with the approval of the Scottish Ministers) the public body Chief Executive and, in consultation with the Scottish Government, setting appropriate performance objectives and remuneration terms linked to these objectives which give due weight to the proper management and use of resources within the stewardship of the public body and the delivery of outcomes; and ¼ Demonstrating high standards of corporate governance at all times, including openness and transparency in its decision-making. Representing Ministerial Interests In the majority of cases, Boards of public bodies are appointed by Ministers to ensure delivery of Ministerial policies. Board members should be clear about Ministerial policies and expectations for their public body. If they are in any doubt on this point, they should seek clarification from the Chair or sponsor Directorate. Providing Strategic Leadership The Board usually fulfils its leadership role by developing the public body’s corporate strategy. The Board then agrees a corporate plan to turn the strategy into action over a period of about three years and promotes continuous improvements in corporate performance over this period. Both the strategy and corporate plan must align with the National Performance Framework and the National Outcomes and indicate how the public body will contribute to public service reform. The corporate plan will usually be approved by the Scottish Ministers. Ministers should write to public bodies at least annually setting out the policies and priorities which they wish them to pursue. Page 180 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 27 PROVIDING STRATEGIC LEADERSHIP ¼ Develops and agrees the organisation’s strategy; ¼ Sets cost effective plans to implement the strategy; ¼ Ensures that the strategy and plans are aligned with the National Performance Framework and the public body’s statutory duties, and the policies and priorities of the Scottish Government; ¼ Reviews the public body’s corporate and business plans and performance on a regular basis, including their own performance as a Board; ¼ Establishes a performance management framework which enables under- performance of the body to be addressed quickly; ¼ Establishes the values and standards of the organisation and ensures that the organisation adopts and complies with Codes of Conduct for Staff and the Board; ¼ Ensures that the highest standards of governance are complied with, that the organisation complies with all Ministerial guidance, its Framework Document and legislation, and that a framework of prudent and effective controls is in place to enable risks to be assessed and managed; ¼ Focuses on the positive impact that the organisation is making in the outside world, i.e. effects on customers and citizens; ¼ Ensures that the public body is a Best Value organisation and delivers Value for Money for the public sector as a whole. > The Board Ensuring Financial Stewardship The Board is collectively responsible for ensuring that the organisation adheres to strict standards of financial propriety, and complies with the financial requirements contained in the Framework Document and the Scottish Public Finance Manual. ENSURING FINANCIAL STEWARDSHIP ¼ Satisfies themselves that financial information is accurate and that financial controls and systems of risk management are robust and defensible; ¼ Considers and approves forward budget allocations and financial targets within key strategic and planning documents, such as corporate and operational business plans; ¼ Monitors the financial position against budget allocations and key financial targets and takes corrective action where required; ¼ Has regard to the issues and concerns of the Accountable Officer; ¼ Approves high value, novel or contentious expenditure proposals, for submission to the Scottish Government and Ministers for approval when it is necessary/appropriate to seek approval from the Scottish Government. > The Board Page 181 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 28 Holding the Chief Executive to account It is the Board’s duty to hold the Chief Executive (and senior management team) to account for the operational management of the organisation and the delivery of agreed plans on time and within budget. HOLDING THE CHIEF EXECUTIVE TO ACCOUNT ¼ Ensures an effective team and management arrangements are in place at the top level of the organisation; ¼ Oversees the development (and review) of the corporate strategies, plans and policies of the public body; ¼ Ensures the operation and work of the public body is closely aligned with the work of other service delivery public bodies in support of the wider aims of public service delivery and reform; ¼ Oversees the development of performance and key financial targets; ¼ Monitors performance and ensures that corrective action is taken to address any under-performance; ¼ Provides continuity of direction and effective management by making appropriate arrangements for delegation. The Board: > Page 182 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 29 ROLE OF THE BOARD AS AN EMPLOYER ¼ Has policies and procedures that comply with employment law; ¼ Avoids discrimination of any kind against current or potential employees and has policies to guarantee equal opportunities and value diversity; ¼ Has in place agreed terms and conditions of employment which should reflect the general standards set out in the Model Code for Staff; ¼ Has in place clear policies and strategies relating to staff; ¼ Complies with all health and safety requirements. This includes ensuring that the body: Role of the Board as an Employer In most cases the Board is the employer of the individuals who work for the public body, although the management of staff, apart from the Chief Executive (whose performance is appraised by the Chair), is a matter for the executive. The Board should be satisfied that the public body is meeting its moral and legal obligations to its employees and that the senior management team is fulfilling its obligations in this regard. The Board is usually responsible for the recruitment of the Chief Executive and, in some cases, other senior staff. If you take part in a recruitment exercise, you will need to be familiar with employment legislation and any codes of best practice in relation to equal opportunities issues. You should receive training in recruitment and selection before serving in that capacity. Diversity The Scottish Government expects all public bodies to champion diversity and mainstream equal opportunities in their work. The Board should give specific consideration to the impact on equality of opportunity when developing policies and making decisions. The Board should also look at how information can be presented to different groups in formats that best suit their needs and find ways of consulting effectively with people with different needs and backgrounds. Scottish Ministers particularly welcome applications for public appointments from groups that are under-represented on Scotland’s public bodies, with the aim of ensuring that Boards of public bodies are broadly reflective of the wider Scottish population with a 50:50 gender split by 2020. Public bodies are expected to take positive action to support and enable greater diversity of Ministerial appointments, through: ¼ taking an active role in succession planning, and providing advice to Ministers about the Board’s membership needs, both for new and re- appointments; ¼ ensuring that suggested criteria for the selection of new Board members meet the needs of the body, are unbiased and are not unnecessarily restrictive; ¼ taking action both during and between Board member recruitment exercises to attract the broadest range of candidates to the work of the Board; ¼ providing mentoring, shadowing and training opportunities for potential Board members; and ¼ considering the role of nominations committees. > Page 183 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 30 The Board of a public body should consider ways to attract new employees from a range of groups and perhaps set targets for increasing the number of women, disabled people and people from minority ethnic groups in the workforce to reflect the diversity of the Scottish population. The Scottish Government’s work on: increasing diversity in leadership across the public, private and third sectors; diversity in Ministerial public appointments; and diversity in the Scottish Government’s own leadership, is overseen by the Public Boards and Corporate Diversity Board. Equality Equality and fairness are at the heart of the Scottish Government’s ambition for a socially just and inclusive Scotland. They are central to its purpose, outcomes and approach to public service reform. The public sector equality duty in the Equality Act 2010 came into force in April 2011 – this is often referred to as the general duty. Scottish public authorities must have ‘due regard’ to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations. Scottish Ministers made regulations in May 2012 placing specific duties on Scottish public authorities, as defined in the regulations, to enable the better performance of the public sector equality duty. These are also known as the Scottish Specific Duties. Public bodies should ensure that they operate in a way which promotes equality of opportunity and all policies must meet the requirements of equality legislation. Human Rights Under the Human Rights Act 1998, it is unlawful for a public body to act in a way that is incompatible with a right under the European Convention on Human Rights. The Board should seek assurances from the Chief Executive that the policies and procedures in place within the public body are compatible with Convention rights. The Board should also be committed to protecting the privacy of individuals in relation to how personal information is used as required by the Data Protection Act 1998. Page 184 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 31 Role of the Board Committees Many Boards establish committees to deal with particular areas of interest outside of main Board meetings. The extent to which Boards use committees will be dependent on the size of the organisation. Examples of Board committees include: ¼ Remuneration Committee ¼ Audit Committee ¼ Nomination Committee ¼ Area or Regional Boards where appropriate. Committees may also be set up to deal with specific aspects of the Board’s role, such as: ¼ Staff Governance ¼ Finance ¼ Policy ¼ Development ¼ Clinical Governance (in the NHS). Where appropriate, committees can allow for specialist areas relating to the Board’s role to be debated in detail by members with the appropriate knowledge or skills. The key points can then be presented to the full Board for ratification, making more effective use of scarce time. As the Board cannot be expected to understand the issues dealt with by the committee from the minutes alone, it will generally require substantive reports from the committee to summarise issues, debates and decisions. Individuals with specific skills and/or expertise may be invited to serve on committees as co-opted members. Co-opted members do not hold Board member status and must never constitute a majority of the membership of any committee. Role and Responsibilities of the Board Member Your specific role as a Board member will depend on the role of the Board to which you have been appointed and the capacity in which you have been appointed, but will normally cover a number of general duties and responsibilities. Individual Board members should act in accordance with the responsibilities of the Board as a whole and comply at all times with the Code of Conduct adopted by the public body and with the rules relating to the use of public funds and to conflicts of interest. In this context ‘public funds’ means not only any funds provided to the public body by the Scottish Ministers but also any other funds falling within the stewardship of the public body, including trading and investment income, gifts, bequests and donations. General guidance on Board members’ responsibilities will be summarised in their letter of appointment. Page 185 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 32 ROLE AND RESPONSIBILITIES OF THE BOARD MEMBER ¼ Understands the operational environment in which their public body operates within the context of the wider public service delivery landscape; ¼ Attends Board meetings on a regular basis and is well prepared by reading relevant papers in advance and, if necessary, seeks further information to ensure their understanding; ¼ Attends training events and keeps up to date with subjects relevant to the public body’s work; ¼ Contributes to the work of any committees that have been established by the Board; ¼ Represents the Board at meetings and stakeholder events when required; ¼ Contributes to strategic development and decision-making; ¼ Clarifies which decisions are reserved for the Board and delegation of those which are not; ¼ Monitors the reporting of performance and holds management to account through purposeful and constructive challenge and scrutiny; ¼ As necessary, seeks further information than that which is provided to give assurance on organisational performance; ¼ Questions and, as necessary, challenges proposals made by fellow Board members and the executive team constructively and carefully to reach and articulate a considered view on their suitability; ¼ Provides a creative contribution to the Board by providing independent oversight on issues of strategy, performance and resources; ¼ Establishes and promotes the public body’s role in the community. > The Board member Page 186 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 33 Performance Appraisal You have been appointed to the Board because your personal skills, knowledge and experience match the criteria for the post and meet the needs of the public body. Your performance as a Board member will be regularly reviewed throughout the term of your appointment, usually by the Chair of the public body. All Board members should receive a performance appraisal every year that assesses their performance in relation to certain pre-established criteria and objectives, and provides an opportunity for meaningful dialogue. The Chair is responsible for the annual appraisal of the Chief Executive and the Chair will be appraised on an annual basis by the relevant Scottish Government Director or Deputy Director (as appropriate). Succession Planning The Scottish Ministers are responsible for succession planning to ensure Boards have the skills, knowledge and experience necessary to fulfil their role economically, efficiently and effectively. They will determine the period for which an appointment, re-appointment or extension to an appointment term is to be made, based on the needs of the public body concerned. The Scottish Ministers will consider whether the needs of a Board will most effectively be met by an appointment, re-appointment or extension to an appointment term subject to any relevant provisions in the legislation which established the public body. They will balance the continuity provided by re- appointment and term extensions with the opportunity to increase the diverse range of relevant skills, knowledge and experience on a Board by making a new appointment through open competition. Re-appointment to the Board You may be re-appointed for second and subsequent terms in the same role without open competition, if you possess the skills and knowledge required on the Board at the time of re-appointment. You will only be considered for re-appointment if your performance has been assessed as effective during the initial period of appointment. The final decision as to whether or not you are re-appointed ultimately rests with the Minister, subject to the specific nature of your public body’s constitution, the needs of the Board for the foreseen period of the re-appointment and the terms upon which you are appointed. No member’s total period of appointment in the same position may exceed eight years. This eight year maximum is based on the aggregate time in post and applies regardless of whether the time in post was continuous or not. The terms and conditions of re-appointment should be outlined in a re-appointment letter. Nomination to the Board of Another Organisation Some public bodies have the right to nominate one or more Board members to the Board of another organisation. If you are nominated to be a Board member on a public body which is also a limited company, you will assume personal responsibilities as a Company Director under the Companies Acts. Any breach of your legal responsibilities as a Company Director could have serious consequences for you personally. If you are in any doubt as to your position, you should take legal advice from the Board’s legal advisers. Page 187 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 34 Civil Liability as a Board Member If you, as an individual Board member, incur a civil liability in the course of carrying out your responsibilities for the Board, you will not have to pay anything out of your own pocket provided that you have acted honestly and in good faith. However, this indemnity does not protect you if you have acted recklessly or in bad faith. Removal from Office In many cases, the founding legislation or the Board’s standing orders will set out the grounds on which you may be removed as a Board member, such as: ¼ Bankruptcy ¼ Becoming incapable of performing your duties as a Board member ¼ Being convicted of an indictable offence. Charity Trustees Some public bodies hold charitable status. This has implications for Board members who will also act as charity trustees for the purposes of the Charities and Trustee Investment (Scotland) Act 2005. A charity trustee is a person who has the general control and management of the administration of a charity. A charity may refer to its charity trustees in a number of ways including management committee members, directors and Board members. If a Board member is also the trustee of the charity, they will have the same general duties of any other charity trustee as set out at section 66 of the 2005 Act. The Office of the Scottish Charity Regulator’s guidance publication, ‘Guidance for Charity Trustees’, gives further details on the duties of charity trustees. The Role of Non-Ministerial Appointed Members The vast majority of Board members in Scotland are appointed by Scottish Ministers; however there are instances where Board composition varies to include a mix of directly elected or local authority nominated members. Provision for such arrangements will normally be set out in the public body’s enabling legislation. In circumstances where it is considered appropriate, a mix of Board membership is generally designed to deliver a balance between local and national representation in the decision-making process. However, regardless of composition, all Boards are expected to play a key role in the delivery of the Scottish Government’s Purpose through alignment with the National Performance Framework, and are required to adhere to the established principles of public sector accountability and governance set out in this guidance, including collective responsibility for decisions and actions and confidentiality. Further clarification about roles and responsibilities should be provided by the Chair and/or the Chief Executive. Role and Responsibilities of the Chair The Chair has additional responsibilities over and above those of Board members, particularly in relation to leadership and the conduct of Board business. The Chair is accountable to the Scottish Ministers and, in common with any individual with responsibility for devolved functions, may also be held to account by the Scottish Parliament. Communications between the public body Board and the Scottish Ministers should normally be through the Chair. They are responsible for ensuring that the public body’s policies and actions support the Scottish Ministers’ wider strategic policies and that its affairs are conducted with probity. The Chair is appraised by the Page 188 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 35 ROLE AND RESPONSIBILITIES OF THE CHAIR ¼ Leads representation and links with Ministers and Scottish Parliament; ¼ Leads the Board, ensures that the Board has the ability to carry out functions effectively and chairs Board meetings; ¼ Leads the Board’s approach to strategic planning; ¼ Leads the Board’s approach to the establishment of committees and ensures the Board considers substantive reports from any committees established; ¼ Ensures that the work of the Board and any committees is subject to regular self-assessment and that the Board is operating strategically and effectively; ¼ Ensures the Board has a balance of skills appropriate to directing the public body’s business, in accordance with recognised good practice in corporate governance; ¼ Ensures the Scottish Ministers are advised of the body’s needs when Board vacancies arise; ¼ Ensures the Board members are fully briefed on terms of appointment, duties, rights and responsibilities; ¼ Together with the other Board members, receives appropriate induction training, including on financial management and reporting requirements and, as appropriate, on any differences that may exist between private and public sector practice; ¼ Ensures there is a Code of Conduct for Board members in place, approved by the Scottish Ministers; ¼ Assesses the performance of individual Board members on a continuous basis and undertakes a formal appraisal at least annually; ¼ In consultation with the Board as a whole, as appropriate, is responsible for undertaking an annual appraisal of the performance of the Chief Executive. > The Chair relevant sponsor Director or Deputy Director. Mutual investment in a constructive relationship between the Chair and the Scottish Government sponsor Directorate is important to supporting the effective performance and delivery of the public body. Page 189 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 36 Role and Responsibilities of the Chief Executive The Chief Executive of the public body is employed and appointed by the Board (with the approval of Scottish Ministers). They are the Board’s principal adviser on the discharge of its functions and will be accountable to the Board. The Chief Executive’s role is to provide operational leadership to the public body, and ensure that the Board’s aims and objectives are met and the public body’s functions are delivered and targets met through effective and properly controlled executive action. The Chief Executive’s general responsibilities will include performance management and staffing of the public body. In summary, the Board focuses on strategy, performance and behaviour – the Chief Executive advises the Board on all matters and is solely responsible for operational issues. ROLE AND RESPONSIBILITIES OF THE CHIEF EXECUTIVE ¼ Advises the Board on the discharge of its responsibilities – as set out in the Framework Document, in the founding legislation and in any other relevant instructions and guidance issued by or on behalf of the Scottish Ministers – and implements the decisions of the Board; ¼ Ensures that financial considerations are taken fully into account by the Board at all stages in reaching and executing its decisions, and that appropriate financial appraisal and evaluation techniques, consistent with the Scottish Public Finance Manual, are followed; ¼ Prepares the public body’s corporate and business plans, in the light of the strategic aims and objectives agreed by the Scottish Ministers; ¼ Advises the Board on the performance of the public body compared with its aims and objectives; ¼ Ensures effective relationships with Scottish Government officials – across the wider organisation, as necessary, and with the sponsor Directorate in particular; ¼ Ensures that timely forecasts and monitoring information on performance and finance are provided to the Scottish Government; that the Scottish Government is notified promptly if overspends or underspends are likely and that corrective action is taken; and that any significant problems, whether financial or otherwise, and whether detected by internal audit or by other means, are promptly notified to the Scottish Government; ¼ Ensures robust performance and risk management arrangements, consistent with the Scottish Public Finance Manual, are in place to support the achievement of the public body’s aims and objectives and facilitate comprehensive reporting to the Board, the Scottish Government and the wider public; ¼ Ensures that the public body adheres, where appropriate, to the Scottish Government’s Programme and Project Management Principles; ¼ Ensures that adequate systems of internal control are maintained by the public body, including effective measures against fraud and theft consistent with the Scottish Public Finance Manual; ¼ Establishes appropriate documented internal delegated authority arrangements consistent with the Scottish Public Finance Manual. > Chief Executive Page 190 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 37 Role and Responsibilities of the Accountable Officer The Permanent Secretary to the Scottish Government is the Principal Accountable Officer of the Scottish Administration. The Principal Accountable Officer designates Directors-General as Portfolio Accountable Officers. The Portfolio Accountable Officer has specific responsibilities with regard to a sponsored public body with its own Accountable Officer. These are set out in a Memorandum sent by the Principal Accountable Officer on appointment. Where a public body manages its own budget, the Chief Executive will normally be designated as its Accountable Officer. Accountable Officers are personally answerable to the Scottish Parliament for the exercise of their functions, as set out in the Memorandum to Accountable Officers for Other Public Bodies issued to the Chief Executive at the time of formal designation (normally at the same time as they are appointed as Chief Executive). It is incumbent on the Chief Executive to combine their Accountable Officer responsibilities to the Scottish Parliament with their wider responsibilities to the Board. The Board and Chair should be fully aware of, and have regard to, the Accountable Officer responsibilities placed upon the Chief Executive. If the Board has serious concerns about the actions and performance of the public body’s Accountable Officer, it can recommend to the Principal Accountable Officer that Accountable Officer status should be withdrawn or suspended. The same option is open to the Principal Accountable Officer in the exercise of their own responsibilities. ROLE AND RESPONSIBILITIES OF THE ACCOUNTABLE OFFICER ¼ Signs the annual accounts and associated governance statements; ¼ Ensures the propriety and regularity of the public body’s finances and that there are sound and effective arrangements for internal control and risk management; ¼ Ensures that the resources of the public body are used economically, efficiently and effectively, and that arrangements are in place to secure Best Value for the organisation and deliver Value for Money for the public sector as a whole; ¼ Ensures compliance with relevant guidance issued by the Scottish Ministers, in particular the Scottish Public Finance Manual; ¼ Has a statutory duty to obtain written authority from the Board/Chair before taking any action which they consider would be inconsistent with the proper performance of the Accountable Officer functions. The Accountable Officer should also notify, where considered appropriate, the relevant Portfolio Accountable Officer; ¼ Represents the public body before the Public Audit Committee of the Scottish Parliament; ¼ May have their Accountable Officer status withdrawn or suspended if the Principal Accountable Officer has serious concerns about their actions and performance. The Accountable Officer > Page 191 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 38 Role and Responsibilities of the Minister Every public body sponsored by the Scottish Government is expected to be aware of, and work within, a strategic and operational framework determined by the Scottish Ministers. Most fall within the portfolio of a specific Scottish Minister who will set overall policy aims, define expected outcomes arising from implementation of that policy and review progress against outcomes. Public bodies are sometimes described as operating at ’arm’s length‘ from Ministers but this does not mean that they are outwith Ministerial control. The Minister will decide how much independence and flexibility the public body should have, depending on its size, constitution, the nature of its functions and the legislation under which it operates. Ministers may seek to increase their understanding of the public body through formal meetings with the public body’s Chair and Board and other more informal events. The founding legislation for a public body may also give Ministers the power to issue a formal direction requiring it to take particular action. However, the use of such formal powers is extremely rare. As Ministers are responsible to the Scottish Parliament, they may be asked at any time to attend Parliament or one of its Committees to answer questions from Members of the Scottish Parliament (MSPs) about the activities of public bodies within their remit. ROLE AND RESPONSIBILITIES OF THE MINISTER ¼ Considers and approves the public body’s strategic objectives and the policy and performance framework within which it operates; ¼ Secures and approves the allocation of public funds for the public body; ¼ Approves key documents such as the Framework Document and corporate plan; ¼ Makes appointments to the Board; ¼ Approves the terms, conditions and remuneration of the Chair and Board members; ¼ Approves the Chief Executive’s and staff pay remit in line with Scottish Government Pay Policy and lays accounts, together with the annual report, before Parliament; ¼ Fulfils any responsibilities specified in the founding legislation, charter or articles of association, such as approving the appointment of the Chief Executive; ¼ Issues letters of strategic guidance. The Minister > Page 192 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 39 The Role of the Scottish Government Sponsor Directorate The day-to-day link between the public body and the Minister is provided by the sponsor Directorate. Within the sponsor Directorate, a sponsor team will ensure that the public body is adequately briefed about the Scottish Government’s policies and priorities. That team will monitor the body’s activities on behalf of the Minister. However, civil servants from the sponsor Directorate will not normally attend Board meetings of the public body. On any occasion that they do, they should do so as observers, not participants, and are not party to decisions taken by the Board. The sponsor team prepares a Framework Document which sets out formally the relationship between the public body and the Minister and officials. While Framework Documents vary according to the functions, powers and finances of the public body, the Model Framework in the Scottish Public Finance Manual provides a useful template. The Framework Document will be drawn up by the Scottish Government, in consultation with the public body, and it will be reviewed at least every two to three years. The key focus for much of the sponsorship role is to support sponsored bodies in being accountable, high performing organisations, delivering Value for Money services, which meet people’s needs, as outlined in their business plan. An excellent sponsorship function is underpinned by two key elements: ¼ good governance structures and processes; and ¼ good relationships with the public body, based on openness, trust, respect and mutual support. MODEL FRAMEWORK DOCUMENT ¼ The legislative basis under which the public body was established and its statutory functions, duties and powers; ¼ Aims and objectives, how these are to be delivered and the key targets to be achieved; ¼ The roles and responsibilities of Ministers, the sponsor Directorate, the Chair, Board members, the Chief Executive and other senior officials; and the public body’s accountability to Ministers and to the Scottish Parliament; ¼ Arrangements for the planning, budgeting and control of the public body’s activities and expenditure, including funding, preparation of corporate and business plans and setting of performance targets; ¼ Arrangements for preparation and publication of the annual report and accounts and external audit procedures; ¼ Responsibilities of the public body for recruitment, pay, grading and other personnel matters. Contents: > Page 193 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 40 Managing Relationships Strategic and Operational Responsibilty It is important that the Board maintains a focus on strategy, performance and behaviour and is not diverted by detailed operational matters which are the responsibility of the Chief Executive and the Senior Executive Management Team. The Board should clearly differentiate their role in strategic governance and leadership from that of operational management. The Board should protect the Chief Executive and Senior Executive Management Team from individual Board members becoming involved in operational matters. Individual Board members have no authority to instruct the Chief Executive or any member of their staff on such matters. Decision-Making The Board should give all matters reserved to them due consideration and take ownership of the decisions taken. For instance, the Board should not simply ‘rubber stamp’ strategy proposals or a draft corporate plan put forward by the Chief Executive. It is important that both the Chief Executive and the Board understand the distinct nature of their roles. Audit Scotland’s report on The Role of Boards provides useful information about the operation of Boards in the public sector, including a series of questions at Annex 3 for Boards and individual Board members to ask themselves about how well they are working. The Chair and Board Members Individual Board members should contribute fully to Board deliberations and exercise a healthy challenge function. This expectation extends to Executive Directors (where, as is the case in many NHS bodies, they are Board members). However, it is important that no individual Board member (or Chair) dominates the debates or has an excessive influence on Board decision-making. The Chair has an important role to play in ensuring that all Board members are enabled and encouraged to contribute to Board discussions. As a Board member, you should support the Chair in their efforts to conduct Board business in an efficient and effective manner. However, you should not hesitate to challenge the Chair if you believe that a decision is wrong (even illegal) or is in contravention of the Framework Document or formal instruction from Ministers, or has been taken without a full and proper debate. Relationships with Stakeholders The Board needs to consider the concerns and needs of all stakeholders and actively manage its relationships with them. Stakeholders – and the general public – should have access to full and accurate information on the decision-making processes and activities of each public body and have the opportunity to influence decisions and actions. Scottish Ministers expect all public bodies to communicate clearly with their stakeholders, make information widely available, consult thoroughly and imaginatively and seek feedback on the public body’s performance, acting on it as appropriate. Page 194 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 41 FURTHER INFORMATION AND CONTACTS > The Data Protection Act 1998 Equality Act 2010 Freedom of Information (Scotland) Act 2002 Information Commissioner’s Office (Data Protection) Human Rights Act 1998 Principles of Strategic Engagement – December 2011 The Commissioner for Ethical Standards in Public Life Scottish Information Commissioner (FOI) Standards Commission for Scotland COMMUNICATION WITH STAKEHOLDERS ¼ Holding an Annual Open Meeting; ¼ Holding Board meetings in public, unless there is a good reason not to; ¼ Publishing summary reports and/or minutes of meetings; ¼ Inviting evidence from members of the public in relation to matters of public concern; ¼ Consulting stakeholders and users on a wide range of issues; ¼ Making corporate plans and the Annual Report and Accounts widely available. The Board should consider: > Page 195 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 42 Effective Financial Management Guidance Note 4 On Board A Guide for Board Members of Public Bodies in Scotland 42 Page 196 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 43 Overview Key Messages Key References and Contacts Scottish Public Finance Manual Budgeting in a Public Body Best Value Efficient Government Relocation Annual Reports and Accounts Performance Measurement and Reporting Risk Management and Internal Controls Internal Audit Audit Committee External Audit The Public Audit Committee of the Scottish Parliament Further Information Contents Effective Financial Management Page 197 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 44 Overview The Board, Chief Executive and senior management team must demonstrate effective financial stewardship of public funds. They must meet the requirements of the Public Finance and Accountability (Scotland) Act 2000 and the Scottish Public Finance Manual, including the need to account for the use of public money and the safe keeping of public assets. This section explains key aspects of the Scottish Public Finance Manual which aim to ensure proper stewardship of public funds. It covers the allocation of funds to public bodies by Scottish Ministers, the requirement for robust financial monitoring and reporting systems, the importance of effective risk management and internal controls, and the processes by which internal and external audit provide assurance on the proper management of public funds and resources. Key References and Contacts Scottish Public Finance Manual Scottish Public Finance Manual (Best Value) Audit Scotland Audit Scotland (Improving Public Service Efficiency) Public Finance Accountability (Scotland) Act 2000 Scottish Parliament (Public Audit Committee) Key Messages ¼ The Board satisfies itself that the public body has proper processes, systems and controls in place and receives assurances from the Chief Executive that the Scottish Public Finance Manual is being complied with. The Board also seeks assurance that systems are in place to provide accurate and timely information to the Scottish Government as part of the management of the Scottish Budget. ¼ The Board receives regular financial reports showing expenditure against planned budgets and progress towards financial targets and efficiency savings. ¼ The Board scrutinises financial and corporate plans and provides challenge on performance against these plans and any underlying assumptions. ¼ The Board satisfies itself that the public body has systems in place to secure Best Value in the performance of its functions. ¼ The Board satisfies itself that systems are in place for risk management and internal control extending from front- line services through to the Board. ¼ Where an organisation is responsible for expenditure, an Audit Committee must be established to advise the Board on internal control (including corporate governance) and audit matters. ¼ The Board is responsible for approving the annual accounts and ensuring the Minister is provided with the annual report and accounts to be laid before the Scottish Parliament. The Chief Executive as the Accountable Officer of the public body is responsible for signing the accounts and ultimately responsible to the Scottish Parliament for their actions. ¼ On completion of the external audit of the annual accounts, the appointed auditor sends a copy of the accounts and the audit opinion to the Auditor General, who may add a report of their own, before the body sends the accounts and reports to the Scottish Ministers for laying before the Parliament. ¼ The Public Audit Committee of the Scottish Parliament uses reports of the Auditor General as the basis for conducting enquiries. Page 198 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 45 The Scottish Public Finance Manual The primary document that governs all matters relating to public finance and reporting in Scottish public bodies is the Scottish Public Finance Manual (SPFM). The SPFM provides guidance to your public body and its sponsor Directorate on the proper handling of public funds. It is mainly designed to ensure compliance with statutory and parliamentary requirements (in particular, the Public Finance and Accountability (Scotland) Act 2000), to promote Value for Money and high standards of propriety, and to secure effective accountability and good systems of internal control. Essentially the Board must ensure that the public body has processes and systems in place to ensure compliance with the SPFM. Board members should look to the Chief Executive (Accountable Officer) and staff of the public body for advice and assurance that the SPFM is being complied with. The Accountable Officer has a personal responsibility for the propriety and regularity of the finances under their stewardship and for the economic, efficient and effective use of all related resources. Accountable Officers are personally answerable to the Parliament for the exercise of their functions and have a statutory duty to obtain written authority from, as the case may be, the Scottish Ministers or relevant governing body before taking any action that they consider may be inconsistent with the proper performance of their functions. The system is designed to promote good governance. It is important to recognise that the Accountable Officer’s role in relation to Value for Money is not a narrow one, restricted to considerations affecting that body, but, as defined by the SPFM, Value for Money is to be judged for the public sector as a whole. This wider consideration of Value for Money would be relevant to considerations of property and accommodation, for example, in relation to shared services. Budgeting in a Public Body The resources allocated to bodies by Scottish Ministers are determined as part of the Spending Review process. Spending Reviews take place every few years. This process dovetails with the United Kingdom Spending Review which largely sets the overall Scottish budget for each Spending Review period. After deduction has been made for the costs of the Scotland Office plus the Scottish Parliamentary Corporate Body and Audit Scotland, the Scottish Government has full discretion to decide how the Scottish budget should be divided between its various portfolios and programmes. The grant-in-aid necessary to support the agreed budgets of bodies is authorised by the Scottish Parliament in the annual Budget Act. Bodies are expected to provide supporting material to the sponsor Directorate as part of the latter’s contribution to both the Spending Review and the annual budgetary process. Wherever possible, this should be done as part of their own annual planning arrangements and they should therefore take all reasonable steps to harmonise the planning process with those of the Spending Review and annual budgetary process. Page 199 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 46 Ministers should write to public bodies at least annually setting out the policies and priorities which they wish them to pursue. Where a public body receives grant-in-aid, this is most commonly done through a Budget Allocation and Monitoring letter issued in advance of the financial year. This letter confirms the resources that Ministers have allocated to the body and sets out the priority areas of work that Ministers wish the body to pursue. Where a public body does not receive grant-in-aid, an equivalent letter should be received from the Minister covering the priority areas to be pursued. The letter should draw on material from the corporate plan and the Spending Review and any further instructions from Ministers. Typically the Board of a public body will be responsible for the approval of the corporate plan (and possibly operational plans) before submission to the sponsor Directorate. The Board should receive regular financial reports (at least quarterly) showing expenditure/use of resources against planned budgets and progress towards financial targets including projected efficiency savings. Board members should provide the ‘challenge function’, carefully scrutinising plans, performance against plans and underlying assumptions. The Board will also approve high value, novel or contentious expenditure proposals for submission to the Scottish Government and Ministers for approval when it is necessary/ appropriate to seek approval from the Scottish Government. Best Value, Efficient Government and Relocation Best Value Best Value provides a common framework for continuous improvement in public services in Scotland, and is a key foundation of the Scottish Government’s public service reform agenda. The principles of Best Value complement good governance standards and offer a sound approach to running a public service organisation. The duty of Best Value, as set out in the SPFM, is to make arrangements to secure continuous improvement in performance whilst maintaining an appropriate balance between quality and cost and in making those arrangements and securing that balance, to have regard to economy, efficiency, effectiveness, the equal opportunities requirements and to contribute to the achievement of sustainable development. Best Value ultimately is about creating an effective organisational context from which public bodies can deliver their key outcomes. Page 200 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 47 Accountable Officers appointed by the Principal Accountable Officer for the Scottish Administration have a specific responsibility to ensure that arrangements have been made to secure Best Value. The Scottish Ministers expect all Accountable Officers to comply with the duty of Best Value and for any associated matters relating to Value for Money, judged for the public sector as a whole placed upon them. In addition the Boards (or equivalents) of relevant public service organisations have corporate responsibility for promoting the efficient and effective use of staff and other resources by the organisations in accordance with the principles of Best Value. Under the terms of the Public Finance and Accountability (Scotland) Act 2000 the implementation of the duty of Best Value by relevant public service organisations is subject to scrutiny by the Auditor General for Scotland. As a Board member, you should always bear in mind the need for your public body to continually secure Best Value in the performance of its functions. In a tight financial climate, service improvements may need to be funded from internal efficiencies. Audit Scotland has adopted a generic framework for Best Value for all public bodies. This enables a consistent approach to auditing against Best Value principles across the public sector. Sustainable development and equalities are themes that run through the framework. It is a risk-based approach, recognising the increasing focus on partnership working, with the specific aim of: ¼ Reporting on overall governance and management arrangements ¼ Reporting on the delivery of outcomes ¼ Protecting taxpayers’ interests by examining the use of resources ¼ Increasing the emphasis on self- assessment by public bodies with audit support and validation. Efficient Government The Public Services Reform (Scotland) Act 2010, section 32(1)(b) provides that as soon as is reasonably practicable after the end of each financial year each listed public body must publish a statement of the steps it has taken during that financial year to improve efficiency, effectiveness and economy in the exercise of its functions. Efficiency is not about making cuts, it is about enhancing Value for Money, improving public service and raising productivity and as such efficient Government is focused on the sound management of resources and ensuring that public bodies continually review their operations to identify opportunities for efficiency improvements. Efficiency improvements are about improving the ratio of resource inputs to outputs and can be made in any area, including the administration and delivery of services and in the procurement of goods and services. By making efficiency savings, more resources are available for re-investing in the delivery of public services. Opportunities for efficiency improvements within your body should be identified as part of the corporate and business planning processes. As a Board member you should ensure that such opportunities are being identified and that arrangements are in place for measuring, monitoring, and reporting on the delivery of efficiency savings to the Board. This should include having efficiency performance indicators (such as a range of input/output ratios) that will allow you to routinely monitor the efficiency of your public body’s operations. Page 201 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 48 Audit Scotland’s report on Improving Public Service Efficiency identified that public bodies will need to improve productivity and efficiency in the delivery of public services to meet continued demands on public spending. Audit Scotland concluded that public bodies will need to take a more fundamental approach to identifying priorities, improving the productivity of public services, and improving collaboration and joint working. A Good Practice Checklist was produced to help leaders in public bodies check and challenge their approach and ultimately support better productivity and efficiency. Relocation Relocation policy is related to Best Value and Efficient Government. Location reviews are triggered by the creation or reorganisation of bodies, as well as by property events (such as lease breaks). Relocation remains an option as part of streamlining the public bodies landscape, but should only be pursued following a rigorous and transparent process that shows any move provides best possible Value for Money for the public finances and optimum service delivery. Ministers will expect Board members to have regard to this policy in decisions they make on the most efficient and effective way of delivering services. Annual Report and Accounts The accounting guidance issued to those bodies that are subject to reporting requirements set by the Scottish Ministers will set out the applicable accounting policies and principles and disclosure requirements. Where the Scottish Government makes funds available to a sponsored body the Scottish Government will account to the Parliament for the provision of those funds in the Scottish Government’s annual accounts. A sponsored body which is a separate accounting entity will account for the use of those funds (and of other funds in its stewardship) in its own annual accounts. The Board is responsible for approving the body’s annual accounts and ensuring that the Minister is provided with the annual report and accounts to be laid before the Scottish Parliament. The Chief Executive as the Accountable Officer of the public body is responsible for signing the accounts and ultimately responsible to the Scottish Parliament for their actions. The accounting requirements for a public body will normally be set out in its founding legislation and/or its Framework Document. Performance Measurement and Reporting Key targets for efficiency and effectiveness of operations and quality of service provided will be agreed as part of the planning process. The Board should ensure that robust systems are in place to monitor performance against these targets. A report on the extent to which performance targets have been achieved should be incorporated in the Annual Report, where appropriate giving a summary of trends over a five-year period. Risk Management and Internal Controls Risk concerns uncertainty of outcome. The delivery of an organisation’s objectives is surrounded by uncertainty which both poses threats to success and offers opportunities for increasing success. Risk is defined as this uncertainty of outcome, whether positive opportunity or negative threat, of actions and events. Page 202 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 49 Each public sector organisation’s internal control systems should include arrangements for identifying, assessing and managing risks. Risk management should be closely linked to the business planning process. Public bodies are required to provide a Governance Statement in order to comply with best practice as recommended by the Turnbull Committee Report. As part of that process, Directors (in the case of public bodies, the Board) are required to review, at least annually, the effectiveness of all controls, including financial, operational and compliance controls. Organisations need to show that they have established and maintained effective and on-going procedures for identifying, evaluating and managing business risks. The Board must ensure that there is a system in place for continuous risk management which extends from the front-line services through to the Board. This involves having a framework of prudent and effective controls in place to enable risks to be identified, assessed and managed. The Board itself should regularly review key business risks affecting the organisation. Audit Committee Where a body is responsible for a budget, an Audit Committee must be established to advise the Board and Accountable Officer on internal control (including corporate governance) and audit matters. All accounting entities to which the SPFM is directly applicable should establish Audit Committees. The Board (or Accountable Officer) should establish an Audit Committee of at least three members, all of whom should be either Board members or independent external members. All Audit Committees in organisations to which the SPFM is directly applicable are subject to the guidance in the Audit Committee Handbook published by the Scottish Government. A degree of flexibility will be appropriate in applying the guidance in the Handbook, particularly with regard to smaller accounting entities. The exact role of the Audit Committee will depend on the particular circumstances of the organisation. Examples of issues affecting the role of the Audit Committee include the strategic risk management arrangements that the Board and/or Accountable Officer have established, whether or not there is a separate Risk Committee and the whistleblowing arrangements which have been put in place as part of the anti-fraud and corruption arrangements. An Audit Committee should not have any executive responsibilities or be charged with making or endorsing any decisions, although it may draw attention to strengths and weaknesses in control and make suggestions for how weaknesses might be dealt with. The overarching purpose of the Audit Committee is to advise the Board and/or Accountable Officer; it is then the Board and/or Accountable Officer that makes the relevant decisions. To fulfil its role, an Audit Committee should meet at least four times per year. Additional meetings should be convened as deemed necessary. All Audit Committee members, whatever their status or background, will have training and development needs. Those who have recently joined the Audit Committee will need induction training, either to help them understand their role; or if they have audit committee experience elsewhere, to help them understand the organisation. In Page 203 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 50 particular, those joining a public sector Audit Committee for the first time will need training to help them understand public sector standards, especially those relating to governance and accountability. AUDIT COMMITTEE ¼ Have written terms of reference from the Board, which encompass all the assurance needs of the Board and Accountable Officer. Within this, the Audit Committee should have particular engagement with the work of Internal Audit, the work of the External Auditor and with financial reporting issues; ¼ Support the Board and Accountable Officer by reviewing the scope, reliability and integrity of the assurances provided to them; ¼ Highlight those aspects of risk management, governance and internal control that are functioning effectively and, just as importantly, those that need to be improved; ¼ Have at least three non-executive members, under the chairmanship of a non-executive member who should be someone other than the Chair of the public body or of any other sub- Committee of the Board; ¼ Own corporately an appropriate skills mix to allow it to carry out its overall function. At least one of the Committee members should have recent and relevant financial experience; ¼ Have a Chair whose role goes beyond chairing meetings – this is key to achieving Committee effectiveness. The additional workload should be taken into account in the appointment of the Chair; ¼ Have a Chair who is involved in the appointment of new Committee members, including providing advice on the skills and experience being sought by the Committee, and is responsible for ensuring that the work of the Audit Committee is appropriately resourced; ¼ Be independent and objective; in addition each member should have a good understanding of the objectives and priorities of the organisation and of their role as an Audit Committee member; ¼ Encourage the Accountable Officer, Head of Internal Audit and Director of Finance to attend meetings (though not as members of the Audit Committee); ¼ Should have regular and on-going liaison with External Auditors; ¼ Should ensure it has effective communication with the Board and Accountable Officer, the Head of Internal Audit, the External Auditor, and other stakeholders. In addition, the role of the Chair and provision of appropriate secretariat support are important elements in achieving Audit Committee effectiveness. The Audit Committee should: > Page 204 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 51 Internal Audit In any government related organisation there will be two significant sources of assurance that the Audit Committee can be certain will be present: Internal Audit and External Audit. The work of Internal Audit is carried out primarily for the benefit of the Board and Accountable Officer of the organisation. Although the work of External Audit is normally primarily conducted for the benefit of the Scottish Parliament, it is still of significant benefit to the organisation as well. Internal Audit is an internal appraisal service, established by the management of an organisation, to review the internal control system. It objectively examines, evaluates and reports on the adequacy of internal control as a contribution to the proper, economic, efficient and effective use of resources. The scope of the Internal Audit service should be unrestricted across the organisation’s operations. The Internal Auditors should have sufficient authority to access assets, records and personnel as necessary for the discharge of their responsibilities. The work of Internal Audit is likely to be the single most significant resource used by the Audit Committee in discharging its responsibilities. This is because the Head of Internal Audit, in accordance with the Government Internal Audit Standards, has a responsibility to offer an annual opinion on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes. There is consequently a major synergy between the purpose of the Head of Internal Audit and the role of the Audit Committee. The role of the Audit Committee in relation to Internal Audit should include advising the Board and Accountable Officer on: ¼ The Audit Strategy and periodic Audit Plans, forming a view on how well they support the Head of Internal Audit’s responsibility to provide an annual opinion on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes; ¼ The results of Internal Audit work, and management response to issues raised by that work; ¼ The resourcing of Internal Audit; and ¼ The Terms of Reference (or equivalent) for Internal Audit. Page 205 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 52 External Audit Whilst the work of the External Auditor is not primarily conducted for the benefit of the organisation or its Audit Committee, the Audit Committee should nevertheless engage with the activity of the External Auditor. As well as considering the results of External Audit work, they should enquire about and consider the External Auditor’s planned approach and the way in which the External Auditor is co-operating with Internal Audit to maximise overall audit efficiency, capture opportunities to derive a greater level of assurance and minimise unnecessary duplication of work. The Auditor General for Scotland is the External Auditor of a number of public bodies. The Auditor General may appoint a member of the staff of Audit Scotland or an appropriately qualified professional firm as the auditor of your body. Where a public body is incorporated under the Companies Act, the auditor is appointed by the members of the company (i.e. the Board members). External Audit of the Annual Accounts An External Audit of the annual accounts undertaken by the Auditor General is conducted in accordance with the Public Finance and Accountability (Scotland) Act 2000 and the Code of Audit Practice issued by Audit Scotland on behalf of the Auditor General. On completion of the External Audit, the appointed auditor sends a copy of the accounts and the audit opinion to the Auditor General. The Auditor General may then add a report (for example, on a qualification of the auditor’s opinion or other matter drawn to their attention by the auditor) before the body sends the accounts and reports to the Scottish Ministers for laying before the Parliament. EXTERNAL AUDIT OF THE ANNUAL ACCOUNTS ¼ Issue an opinion as to whether the accounts give a true and fair view of the state of affairs of the public body at the year end and of its income and expenditure for the year and whether the accounts have been prepared in accordance with any applicable legislation and accounts direction; ¼ Issue an opinion (known as the “regularity” opinion) as to whether the income and expenditure has been properly received or incurred in accordance with legislation, the Budget Act for the relevant year and any other guidance issued by the Scottish Ministers; ¼ Review the Governance Statement prepared by the body and report if it is not in accordance with the auditor’s understanding of the body; ¼ Consider the body’s governance arrangements and arrangements for prevention and detection of fraud; ¼ Provide reports to the Board, Audit Committee and/or management on matters arising during the course of the audit. The appointed auditor will: > Page 206 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 53 Performance Audit Performance audits look at the performance of a public body and include a Value for Money audit which is an examination of the economy, efficiency and effectiveness with which a body has used its resources to carry out its functions. The Auditor General has powers to conduct performance audits. These audits examine the economy, efficiency and effectiveness of aspects of the public sector. They can assess: ¼ performance across several public bodies in a particular theme – for example, managing changes in the workforce; or ¼ performance of an individual public body or a particular aspect of that body’s performance. Performance audits may be conducted by Audit Scotland staff, the appointed auditor, consultants or any combination of these. A draft report on the audit will be discussed with the public body (or bodies) to ensure factual accuracy. Once finalised, the report will be laid before the Scottish Parliament and published with an accompanying news release. In most cases, the Auditor General will present the report to the Scottish Parliament’s Public Audit Committee. Performance audit reports may contain material such as checklists to assist non- executive Board members in holding management to account. For many public bodies, the founding legislation provides that the Auditor General will appoint the auditor. In such circumstances, the Auditor General has a statutory right to carry out a Value for Money examination. Where the Auditor General is not the auditor of a public body and has not appointed the auditor, they should have rights under statute or by agreement to carry out an inspection of the use of resources by those bodies. The Public Audit Committee of the Scottish Parliament The Public Audit Committee of the Scottish Parliament is one of the committees established under the Standing Orders of the Parliament. The Public Audit Committee uses the reports of the Auditor General, which are laid before the Parliament, as the basis for conducting enquiries. It is chaired by a senior member of the Opposition and conducts its business on non-party political lines. Page 207 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 54 FURTHER INFORMATION > Audit Committee Handbook Audit Scotland (Auditing Best Value in Central Government Bodies) Audit Scotland (Code of Audit Practice) Audit Scotland (Efficient Public Services Good Practice Checklist) Public Finance Accountability (Scotland) Act 2000 Public Services Reform (Scotland) Act 2010 Scottish Public Finance Manual (Best Value) Scottish Public Finance Manual (Risk Management) Scottish Public Finance Manual (Spending Reviews) PUBLIC AUDIT COMMITTEE ¼ The Auditor General’s report is discussed with the body concerned and the facts are agreed; ¼ The report is laid before Parliament and published together with a Press Release; ¼ If an enquiry is to be conducted by the Public Audit Committee, witnesses are called to give evidence – usually the Accountable Officer of the public body and the Accountable Officer of the sponsor Directorate. It is possible that the Chair or a Board member of a public body will be required to appear as a witness, where appropriate; ¼ After the evidence session, the Committee drafts and approves a report which is published; ¼ A formal response to the Committee’s report is provided by the Scottish Government (or by the body in consultation with the Scottish Government) within two months of the Committee’s report being published. The key stages: > Typically the range of issues on which Board members should seek assurance will include: ¼ compliance with the SPFM, Framework Document and legislation (e.g. founding legislation, Equality Act 2010); ¼ financial monitoring and reporting arrangements and arrangements for delivering and reporting on efficiency savings; ¼ arrangements for securing Best Value for the organisation and Value for Money for the public sector as a whole; ¼ systems for identifying, assessing and managing risks; ¼ processes for preventing and detecting fraud, and, linked to this, whistleblowing procedures; ¼ arrangements for business continuity and disaster recovery; ¼ information management systems, including in relation to protection of personal data and compliance with Freedom of Information legislation; ¼ propriety and regularity of public finances; ¼ management systems that have clear lines of delegation and accountability; ¼ arrangements for meeting procurement requirements; ¼ arrangements for meeting the body’s moral and legal obligations to its employees; and ¼ complaints handling procedures. Boards will require to supplement these areas of assurance having regard to the purpose of the organisation and the nature of the business conducted. ISSUES ON WHICH BOARD MEMBERS SHOULD SEEK ASSURANCE > Page 208 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 55 Ethics and Standards of Behaviour Guidance Note 5 On Board A Guide for Board Members of Public Bodies in Scotland 55 Page 209 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 56 Overview Key Messages Key References and Contacts Introduction to Ethical Standards in Public Life The Commissioner for Ethical Standards in Public Life in Scotland The Standards Commission for Scotland Key Principles of the Model Code of Conduct Code of Conduct for Board Members Gifts and Hospitality Bribery Conflicts of Interest Handling Conflicts of Interest Registration of Interests Confidentiality Dispensations Lobbying Use of Social Media Whistleblowing Complaints Policy Further information Contents Ethics and Standards of Behaviour Page 210 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 57 Overview Scottish Ministers have high expectations of those who serve on the Boards of public bodies and the way in which they conduct themselves in undertaking their duties. As a Board member, it is your personal responsibility to ensure that you meet these expectations by ensuring that your conduct is above reproach. This section outlines how the Board exercises leadership in determining the values and standards of the organisation. It describes the ethical framework introduced by the Ethical Standards in Public Life etc. (Scotland) Act 2000, particularly the nine key principles of the Model Code of Conduct which all Board members are required to observe when discharging public duties. Through this framework, the Scottish Ministers aim to ensure confidence in Scottish public bodies, the Boards of those bodies and individual Board members. Key References and Contacts The Commissioner for Ethical Standards in Public Life in Scotland The Standards Commission for Scotland Model Code of Conduct for Board Members Standards Commission Guidance Note Key Messages ¼ Board members of bodies listed in Schedule 3 of the Ethical Standards Act are subject to the nine key principles outlined in the Model Code of Conduct. ¼ It is important to take care when expressing views so you do not compromise your position as a member of a public body. ¼ All public bodies have a duty to publish a Register of Board Member Interests. There are specific interests which you must register and it is your personal responsibility to ensure that your entries are current. ¼ Board members must declare financial and non-financial interests which might be perceived to influence their contribution to a discussion or decision in Board proceedings. This requirement also applies to interests held by your close family, friends and business associates. ¼ The test on making a declaration is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as so significant that it is likely to prejudice your discussion or decision-making. ¼ You must ensure that the reputation of your public body is not damaged by the receipt (or provision) of inappropriate gifts and hospitality. ¼ The Commissioner for Ethical Standards in Public Life in Scotland (the Commissioner) considers complaints about members of devolved public bodies who are alleged to have contravened the Code of Conduct. On finding a contravention of the Code, the Commissioner reports to the Standards Commission for adjudication. Where a hearing is held by the Standards Commission and a contravention of the Code is established, the Standards Commission determines the level of sanction to be applied. ¼ Part 4 of The Ethical Standards in Public Life etc. (Scotland) Act 2000 makes provision for Codes of Conduct for bodies not listed in Schedule 3 – such bodies and Board members are not subject to investigation by the Commissioner, or sanction by the Standards Commission. Page 211 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 58 Introduction to Ethical Standards in Public Life The Ethical Standards in Public Life etc. (Scotland) Act 2000 (Ethical Standards Act) introduced the power to specify the principles and rules that underpin public life in Scotland, putting ethical standards and probity at the heart of decision-making in public service. The principles set out below should be observed by all Board members of public bodies in Scotland. Key Principles Duty You have a duty to uphold the law and act in accordance with the law and the public trust placed in you. You have a duty to act in the interests of the public body of which you are a member and in accordance with the core functions and duties of that body. Selflessness You have a duty to take decisions solely in terms of public interest. You must not act in order to gain financial or other material benefit for yourself, family or friends. Integrity You must not place yourself under any financial, or other, obligation to any individual or organisation that might reasonably be thought to influence you in the performance of your duties. Objectivity You must make decisions solely on merit and in a way that is consistent with the functions of the public body when carrying out public business including making appointments, awarding contracts or recommending individuals for rewards and benefits. Accountability and Stewardship You are accountable for your decisions and actions to the public. You have a duty to consider issues on their merits, taking account of the views of others and must ensure that the public body uses its resources prudently and in accordance with the law. Openness You have a duty to be as open as possible about your decisions and actions, giving reasons for your decisions and restricting information only when the wider public interest clearly demands. Honesty You have a duty to act honestly. You must declare any private interests relating to your public duties and take steps to resolve any conflicts arising in a way that protects the public interest. Leadership You have a duty to promote and support these principles by leadership and example, and to maintain and strengthen the public’s trust and confidence in the integrity of the public body and its members in conducting public business. Page 212 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 59 Respect You must respect fellow members of your public body and employees of the body and the role they play, treating them with courtesy at all times. Similarly you must respect members of the public when performing duties as a member of your public body. Board members should apply these principles in their dealings with fellow members of their public body, its employees and other stakeholders. Similarly Board members should also observe these principles in their dealings with the public when performing duties as a member of a public body. The Ethical Standards Framework The key elements of the ethical framework introduced by the Ethical Standards in Public Life etc. (Scotland) Act 2000 are: Through this ethical framework, the Scottish Ministers aim to ensure that Scottish public bodies and all who serve on them conduct their business in a way which merits and sustains public confidence. The Commissioner for Ethical Standards in Public Life in Scotland The Public Services Reform (Commissioner for Ethical Standards in Public Life in Scotland etc.) Order 2013 came into force on 1 July 2013. The Order transferred the functions of the Public Standards Commissioner for Scotland and the Public Appointments Commissioner for Scotland to a single Commissioner for Ethical Standards in Public Life in Scotland (the Commissioner). The Commissioner is an independent office holder who works in two areas: ¼ A Standards Commission for Scotland (Standards Commission) and a Chief Investigating Officer (now the Commissioner for Ethical Standards in Public Life in Scotland) to oversee the ethical framework; ¼ A Model Code of Conduct for Members of Devolved Public Bodies on a statutory basis for those bodies listed in Schedule 3 of the Act; ¼ Codes for smaller bodies; and ¼ Publicly available Registers of Members’ Interests. ¼ Public appointments, regulating how people are appointed to the Boards of public bodies in Scotland; and ¼ Public standards, where the Commissioner can investigate a complaint about a councillor or a member of a devolved public body who is alleged to have contravened the councillors’ or the appropriate public body’s Code of Conduct. Page 213 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 60 Where the Commissioner identifies that a breach or breaches of a Code or Codes may have occurred, the Commissioner will report on the outcome of these investigations to the Standards Commission for adjudicatory action and application of sanctions, where appropriate. The Standards Commission for Scotland The Standards Commission is an independent statutory body which has responsibility for enforcing compliance with the Codes of Conduct and providing general guidance on their interpretation. It adjudicates on cases of alleged contravention of the Codes of Conduct referred to it after investigation by the Commissioner and, where a hearing is held, has the power to impose sanctions. The Standards Commission has responsibility for various aspects of the ethical framework including: On finding a contravention of a Code of Conduct for bodies listed in Schedule 3 of the Ethical Standards in Public Life etc. (Scotland) Act 2000, the Standards Commission can impose sanctions ranging from censure, or suspension from meetings of the public body for up to one year, to disqualification for up to five years. Details of the full range of sanctions available to the Commission are listed in Annex A of the Members’ Model Code of Conduct. The Standards Commission can also consider particular circumstances where it would be contrary to the spirit of the Code for it to be applied. In exceptional circumstances, it can issue dispensations to allow Members of public bodies, including councillors, to participate in discussion and vote on certain matters where, due to financial or non-financial interests, they would otherwise be prohibited from such participation. Code of Conduct for Board Members Upon appointment to the Board, you should have been provided with a copy of your public body’s Code of Conduct for Board Members, which forms part of your terms and conditions. You must not at any time advocate or encourage any action contrary to the Code of Conduct. It is your personal responsibility to make sure that your actions comply with the provisions of the Code at all times as the Code contains the standards against which your conduct will be measured. You should review regularly, and at least annually, your personal circumstances against the requirements of the Code. If you are uncertain about any aspect of the Code, you should seek advice from the Standards Officer in your public body. You ¼ adjudicating on cases of alleged contravention of the Codes of Conduct for Members of Devolved Public Bodies reported to it by the Commissioner following investigation of a complaint; ¼ promoting and enforcing Codes of Conduct and providing guidance on the operation of Registers of Interests; ¼ providing guidance to public bodies on: ¼ the promotion and observance of high standards of conduct by members of devolved public bodies and assisting them in that task; ¼ the Commission’s relationship with public bodies in carrying out its functions; and ¼ the Registers of Interests for Members of Devolved Public Bodies. Page 214 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 61 may also choose to consult your own legal and financial advisers. The Standards Commission also provides advice and guidance on the Code. The nine key principles of public life are mentioned earlier in this section. The Standards Commission guidance to devolved public bodies will provide you with more detailed information on these principles. The following paragraphs provide a brief snap- shot of information about parts of the Model Code of Conduct which Board members will require to give care and consideration to when undertaking their duties. Gifts and Hospitality As a Board member, you should ensure that the reputation of your public body is not damaged through the receipt (or provision) of inappropriate gifts and hospitality. Bribery Board members must be familiar with the provisions of the Bribery Act 2010 which came into force on 1 July 2011. The Act makes it a criminal offence for a person to take part in active bribery (making a bribe) or passive bribery (receiving a bribe). All public bodies operate a zero tolerance approach to bribery, with any allegations investigated in accordance with the relevant procedures and reported to the appropriate authorities. Conflicts of Interest Public bodies should have in place clear rules and procedures for managing conflicts of interests. Together with the rules on registration of interests, this ensures transparency of your interests which might influence, or be thought to influence, your actions. You should note that the appearance of a conflict of interest in terms of public perception can be every bit as damaging as an actual conflict – both should be avoided. GIFTS AND HOSPITALITY ¼ Do not canvass or actively seek gifts or hospitality; ¼ Your conduct should not foster the suspicion of any conflict between your official duties and your private interests; ¼ Your actions, when acting in an official capacity, should not give the impression of having been influenced by a gift or consideration to show favour or disfavour to any person or organisation; ¼ Do not accept any offer of a gift or hospitality from any individual or organisation that stands to gain from a decision that your public body may be involved in determining or that is seeking to do business with your public body; ¼ You should usually refuse offers of gifts and/or hospitality except in the following cases: gifts of an isolated and trivial character under £50; normal hospitality associated with your duties and reasonably regarded as appropriate; or gifts received on behalf of the public body; ¼ Do not accept repeated hospitality or repeated gifts from the same source; ¼ If you are in doubt about the propriety of accepting a gift or an item of hospitality you should contact the Standards Officer and/or the Chair for advice. > Page 215 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 62 Handling Conflicts of Interest Public confidence in your public body and its Board members depends on it being clearly understood that decisions are taken in the public interest and not for any other reason. In deciding whether to declare an interest, the key test is whether a member of the public, acting reasonably, might think that a particular interest could influence you. Registration of Interests All devolved public bodies have a duty to set up, maintain and make available for public inspection a register of Board member interests. The Ethical Standards in Public Life etc. (Scotland) Act 2000 (Register of Interests) Regulations 2003, as amended, describe the detail and timescale for registering. The Model Code is very specific about the interests that you, as a Board member, must register and these include: Your Code of Conduct will contain definitions of what is required under each of these categories and if you are in any doubt as to what you should or should not be registering, you should discuss this with the Standards Officer, the Chair and/or the Standards Commission. The Register should also be available for inspection by the public (electronic and paper version). Public bodies should prepare a page for this purpose on their website and ensure that it is operational. The electronic version of the Register does not need to include any personal information that would compromise personal security although the full details would be made available for public inspection in hard copy. Board members are required to keep their entries in the Register of Interests up-to-date and this involves notifying the Standards Officer of any new interest or change to an existing interest within one month of the change. Declaration of Interests In deciding whether to declare an interest, the key test is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as so significant that it is likely to prejudice your discussion or decision making in your role as a member of a public body. If you have a financial, or non-financial, interest you must declare your interest at Board meetings and withdraw from decision- making on the basis of such an interest when it is appropriate to do so. REGISTRATION OF INTERESTS ¼ Remuneration from employment, self-employment or directorships; ¼ Related undertakings i.e. certain unremunerated directorships; ¼ Contracts with the public body; ¼ Gifts and hospitality; ¼ Houses, land and buildings that you own or have an interest in which are of significance or relevance to, or bear upon the work and operation of, the public body; ¼ Shares and securities – holdings in a company or organisation which are of significance or relevance to, or bear upon the work and operation of, the public body; and ¼ Non-financial interests including membership or holding office in other public bodies, clubs, societies and organisations such as Trade Unions and voluntary organisations. > Page 216 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 63 Non-Declaration of Interest Where a material conflict of interest exists and a Board member does not declare their interest and withdraw, the Chair should take appropriate action to ensure that the Board (and the Board member concerned) is not compromised. In the event that a Board member refuses to leave the room when asked by the Chair to do so, the Chair should suspend the meeting and reconvene without the Board member concerned being present. Board members should bear in mind that any such action on their part may lead to an investigation by the Commissioner and the matter thereafter referred to the Standards Commission, which may apply a sanction in the event that it determines a breach of the Code of Conduct has occurred. Frequent Declarations of Interest If as a Board member you are frequently declaring interests at meetings, you should consider whether it is appropriate for you to continue in your role. In such circumstances, you may wish to discuss your continued appointment as a Board member with the Chair. Dispensations The Standards Commission does have the power to issue dispensation (where it is deemed to be in the public interest) to allow Board members to participate in a discussion and vote, despite the fact they have financial or non-financial interests which would normally prevent them from participating in discussion and voting. In addition to general dispensations, individual applications for dispensations in exceptional circumstances can be made to the Standards Commission and may be granted where it is in the public interest to do so. However, Board members must not take part in any discussion or vote on a matter (in which they are conflicted) unless and until they have actually received a dispensation. Confidentiality On occasions, Board members will be required to treat discussions, documents and other information relating to the work of the body in a confidential manner. It is imperative that Board members respect this duty of confidentiality at all times. In particular, as a Board member you should never use information to which you have privileged access for personal or financial gain or in a way that brings the public body into disrepute. Lobbying The Code of Conduct sets out clear guidance in respect of dealing with lobbyists and lobbying. If you have any concerns over the approach or methods used by anyone in their contacts with you, you should discuss the matter with your body’s Standards Officer and/or the Chair. Use of Social Media When using social media the distinction between work and private life can become blurred, and speedily made comments can be misconstrued. It is important to take special care when expressing views on social media not to compromise your position as a member of a public body. Social media offers many benefits in communicating with stakeholders and interested parties. However, you should always remember that hastily expressed views through social media can reach large (sometimes unintended) audiences instantaneously and can be difficult to retract if required to do so. Your public body should have a policy in place about the use of social media. You should familiarise yourself with the content of that policy to protect the public body’s reputation, its legal obligations, its information and its systems. You will be expected to approach any use of social media platforms responsibly and with care. Page 217 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 64 Whistleblowing Although not directly covered by the Ethical Standards Framework, Board members have a responsibility to ensure that staff have confidence in the fairness and impartiality of procedures for registering and dealing with their concerns and interests. The Public Interest Disclosure Act 1998 gives legal protection to employees who raise certain matters or concerns, known as ‘qualifying disclosures’, without fear of reprisal. As a Board member, you should ensure that your public body has a whistleblowing policy and appropriate procedures in place. This will allow staff to raise concerns on a range of issues such as fraud, health and safety etc. without having to go through the normal management structure. Audit Scotland has published guidance on employers’ and employees’ responsibilities in relation to whistleblowing. Public Bodies not covered by the Ethical Standards in Public Life etc. (Scotland) Act 2000 The Ethical Standards in Public Life etc. (Scotland) Act 2000 makes provision for Scottish Ministers to introduce a Code or Codes of Conduct under the Public Authorities Regime for bodies not listed in Schedule 3 to the Act. While such public bodies and their Board members will be expected to act in accordance with this Code of Conduct, they will not be subject to investigation by the Commissioner or to sanctions by the Standards Commission. Irrespective of the extent to which a public body is covered by the Ethical Standards Act, Board members are required to adhere to the principles that underpin the ethical standards framework and have regard to the provisions set out in the Model Code of Conduct in carrying out their public duties. Complaints Handling The Scottish Public Services Ombudsman (SPSO) is the independent body that handles complaints from members of the public about devolved public services in Scotland. Under the Public Services Reform (Scotland) Act 2010, the SPSO was given a lead role in improving the handling of complaints by public sector bodies in Scotland. In 2013 the SPSO published a model Complaints Handling Procedure (CHP) for the Scottish Government, Scottish Parliament and Associated Public Authorities, which public bodies have a statutory requirement to adopt. The CHP includes a commitment for public bodies to publish information against performance indicators, which will provide consistent complaints data across the various sectors of the public service in Scotland. Page 218 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 65 Board members should have an awareness of the importance of having an effective complaints policy in place. Promoting a ‘valuing complaints’ culture – with a pro- active approach to effective resolution, monitoring and learning from complaints – is an essential part of effective governance of public services. The Board has a collective responsibility and Board members, the Chair and the Chief Executive are also individually responsible for ensuring the public body has an effective, efficient, customer-focused approach to complaints resolution in place. COMPLAINTS HANDLING ¼ Ensure the public body and executive team are learning from service failures and customer insight provided by complaints, with systems in place to record, analyse and report on complaints outcomes, trends and actions taken; ¼ Ensure that processes are in place for the public body and executive team to identify and respond immediately to critical or systemic service failures identified from complaints handling; ¼ Take an active role in monitoring and reviewing learning from complaints and reviewing individual complaints to obtain an understanding of how any failures occurred and have been addressed; ¼ Provide the necessary challenge and hold the senior officer(s) to account for the public body’s performance in complaints handling, with Board / Board members themselves regularly monitoring and reviewing the complaints handling performance of the public body; ¼ Ensure that service improvements are agreed, actioned and reviewed, possibly on a quarterly basis. > FURTHER INFORMATION > Audit Scotland – Employer’s Guide to Whistle Blowing Bribery Act 2010 Ethical Standards in Public Life Etc. (Scotland) Act 2000 Ethical Standards Registration of Interests (Regulations) 2003 Scottish Parliamentary Commissions and Commissioners etc. Act 2010 The Scottish Public Service Ombudsman The model Complaints Handling Procedure (CHP) for the Scottish Government, Scottish Parliament and Associated Public Authorities in Scotland. Page 219 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 66 Annex A Classification of Public Bodies On Board A Guide for Board Members of Public Bodies in Scotland 66 Page 220 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 67 There are occasions where bodies carrying out public functions should operate more at ‘arm’s-length’ from Government. This may be appropriate for a variety of reasons. This can be to provide independent advice and expertise on technical, scientific or other complex issues and take this outside the political arena, e.g. on ethical issues, or funding decisions. Tribunals and other quasi- judicial bodies are set up to meet specific requirements for separation of decision- making and appeals. Public bodies carry out a wide range of functions such as independent regulation, advice, investigation, adjudication, ombudsman services, appeal, funding, partnership, commercial and health services. Such ‘arm’s-length bodies’ focus in depth on clear and specific functions and purposes. These bodies have been established to meet particular needs and situations. This flexibility and responsiveness means that the landscape of public bodies is necessarily both complex and diverse. The following provides a snapshot of the features of public bodies operating in Scotland. Executive Agencies – although an integral part of the Scottish Government, Executive Agencies generally have a strong focus on the management and direct delivery of public services which do not require day-to-day ministerial oversight; in some cases they may also have responsibility for a discrete area of government policy. They are staffed by civil servants, including the Chief Executive who is directly accountable to Ministers. They are not statutory bodies but operate in accordance with a Framework Document approved by Ministers, which may be reviewed, amended or revoked at any time. This has the advantage that they can normally be set up by administrative action without the need for legislation. Executive Non Departmental Public Bodies (NDPBs) – are not part of the Scottish Government or the Scottish Administration. They perform administrative, commercial, executive or regulatory functions on behalf of Government and operate within a framework of governance and accountability set by Ministers. They are funded by the Scottish Government through grant or grant- in-aid, but many generate additional income through provision of services. They are normally established by statute, employ staff (who are not civil servants) on their own terms and conditions subject to Scottish Public Sector Pay Policy, and manage their own budgets. They are accountable to a Board whose members are normally appointed by Ministers and publish their own annual report and accounts. Page 221 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 68 Advisory NDPBs – provide independent expert advice to Ministers and others or input into the policy-making process in relation to a particular subject. They are normally established by Ministers on a non-statutory basis, do not normally employ staff (administrative support is usually provided by the Scottish Government) and are not normally responsible for budgets or expenditure other than remuneration for Board members. They are accountable to a Board whose members are normally appointed by Ministers. Ministers are answerable to Parliament for the activities of the body and can dissolve the body at any time. Tribunals – are established by statute and have specific responsibilities for prescribed judicial functions. They are not part of the court system and are independent of the Scottish Government. They have both specialist and lay members, do not employ staff and are not responsible for budgets or expenditure other than the remuneration of Tribunal members. Non Ministerial Departments (NMDs) – are not part of the Scottish Government but are part of the Scottish Administration in their own right and staffed by civil servants. They are generally funded by Parliament and are required to publish their own annual report and accounts. They are directly accountable to the Scottish Parliament, not Ministers, for the discharge of their statutory functions. Public Corporations – are industrial or commercial enterprises under Government control which recover more than 50% of their costs through fees charged for services provided to customers. They employ their own staff, who are not civil servants, manage their own budgets and report to a Board whose members are appointed by Ministers. Health Bodies – currently comprise 14 territorial health boards, 8 special health boards and the Mental Welfare Commission for Scotland (MWCS). With the exception of MWCS, health bodies are part of NHSScotland and provide healthcare services or management, technical or advisory services. Parliamentary Commissions, Commissioners and Ombudsman – are typically responsible for safeguarding the rights of individuals, monitoring and reporting on the handling of complaints about public bodies, providing an adjudicatory role in disputes and reporting on the activities and conduct of public Boards and their members. Commission Members, Commissioners and Ombudsmen are appointed by the Parliamentary Corporation. They are accountable, and report directly, to the Scottish Parliament. Other Significant Bodies – do not fall within the recognised categories of public bodies set out above but they have a direct relationship with either the Scottish Government or the Parliament and operate within a framework set by Ministers. Page 222 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 69 Annex B Induction and Training for Board Members On Board A Guide for Board Members of Public Bodies in Scotland 69 Page 223 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 70 Induction programmes, events and material should be a standard feature with a public body providing information on a range of topics, e.g. policies, procedures, roles, responsibilities, rules and key personnel. The following list of induction guidance and training is not prescriptive but is designed to give you an idea of the type of support that may be provided by your public body. Meetings A one-to-one meeting should take place with the Chair immediately following appointment to discuss in broad terms what is expected of a Board member in the first year and any individual role he or she is expected to play. (The Chair and Board member should meet on a regular basis as part of the appraisal process.) An induction session within one month of appointment should explain: ¼ Organisational structure ¼ The collective role of the Board ¼ Arrangements, formats etc. of Board meetings ¼ Details of any subsidiary Boards and committees (e.g. Regional Boards, Audit Committee) and their responsibilities ¼ The long-term strategy of the organisation ¼ The corporate planning system ¼ The role of the Chief Executive as the Accountable Officer ¼ Current priority areas of work ¼ Budget and financial information, including the monitoring role of the Board ¼ The public body’s policies on openness – where appropriate, including the role of Board members in promoting the public body to the public and in the media ¼ Links between the public body/Board and the Scottish Government and the Scottish Parliament. This should include details of where the sponsor Directorate fits within the Scottish Government structure, details of sponsor Minister(s) etc ¼ Links to other key partner organisations ¼ Arrangements for Board members’ remuneration and expenses ¼ The organisation’s Code of Conduct for Board members and Code of Conduct issues, including policies on the registration and declaration of interests, gifts and hospitality, use of social media by Board members etc. This should include guidance on completing the Register of Interests ¼ Whistleblowing procedures – how to raise concerns and how to respond to concerns being raised ¼ Details of arrangements for monitoring and reporting on the performance of Board members ¼ The Corporate Risk Register Ideally, this session should be attended by all new Board members and by some existing Board members to allow the latter to pass on experience. Some other members of the senior management team may also attend, including the Board secretary. It may also be appropriate for a Board member to meet with other key staff in the organisation – for example the Chief Executive who will be able to advise of their role in their capacity as the Accountable Officer and, where the Board member is to sit on the Audit Committee, they may wish to meet audit and finance staff. Page 224 of 382
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On Board A Guide for Board Members of Public Bodies in Scotland 71 Publications ¼ The latest Annual Report and Accounts ¼ The latest Corporate Plan and Operational/Business Plan ¼ The Corporate Strategy or similar strategic document ¼ Any significant recent policy or consultation documents which the public body has published ¼ The latest in-house magazine or newsletter ¼ The latest staff newsletter ¼ A list of relevant publications Written Material ¼ Guide to the legislation under which the public body was established ¼ Copy of the Budget Allocation and Monitoring letter from the sponsor Minister for the coming year ¼ National Performance Framework ¼ Strategic guidance from the Scottish Government ¼ Copy of the public body’s current Framework Document ¼ Standing Orders for the conduct of Board meetings ¼ Organisational structure, staff directory, office addresses etc ¼ Biographical and contact details of other Board members (and, where appropriate, those in subsidiary Boards and committees) ¼ Summary of key roles and responsibilities within the organisation – Board, subsidiary Boards and committees, Chief Executive/ Accountable Officer, management team, other senior staff ¼ Forward programme of Board meeting dates and any other key events (press launches, conferences etc) ¼ The organisation’s Code of Conduct for Board members ¼ The Standards Commission Guidance on the Model Code for Members of Devolved Public Bodies ¼ Copy of the organisation’s Data Protection, Freedom of Information and other relevant policies and procedures relating to corporate governance and accountability – and if they exist: ¼ Policy for Board members in dealing with the media ¼ List of acronyms relating to the public body’s area of work, partner organisations etc. ¼ The Corporate Risk Register ¼ Schedule of Matters Reserved for the Decision of the Board and Scheme of Delegation ¼ Action plan arising from most recent review of Board effectiveness ¼ The Scottish Public Services Ombudsman model Complaints Handling procedure Terms and Conditions ¼ Guidance on claiming travel and subsistence expenses ¼ Guidance on claiming other allowances where appropriate (e.g. child care) ¼ Guidance on tax issues (e.g. for home to office travel) ¼ Guidance on Register of Interests, and Gifts and Hospitality Training The public body should consider providing any further training deemed necessary to assist Board members individually or collectively, to carry out their duties, particularly covering areas such as their roles and responsibilities, the financial management and reporting requirements of public bodies, appraisal systems both for individual members and collective functionality, ethical standards and any other differences which may exist between private and public sector practice. Page 225 of 382
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w w w . g o v . s c o t © Crown copyright 2015 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG First published by The Scottish Government, APRIL 2015 ISBN: 978-1-78544-125-7 (web only) E-book in EPUB format first published by The Scottish Government, APRIL 2015 ISBN: 978-1-78544-126-4 (EPUB) E-book in MOBI format first published by The Scottish Government, APRIL 2015 ISBN: 978-1-78544-127-1 (MOBI) Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS38590 (04/15) Photo credits: Cover and content pages Architecture and Design Scotland Creative Scotland – photographer Michael Wolchover Loch Lomond & The Trossachs National Park Authority Scottish Qualifications Authority Scottish Canals Sportscotland All other images courtesy of iStockphoto and Scottish Viewpoint Page 226 of 382
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More than equal April 2024 Valuing and supporting the expert contribution of people with lived experience Page 227 of 382
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2More than equal: Valuing and supporting the expert contribution of people with lived experience Background 3 Recommendations 5 Recommendation one: Strengthen recruitment and representation 6 Recommendation two: Build capacity 8 Recommendation three: Support equity of involvement 10 Recommendation four: Evaluate impact 12 Sharing good practice 14 Final thoughts 15 Contents Page 228 of 382
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3More than equal: Valuing and supporting the expert contribution of people with lived experience The Public Bodies (Joint Working) (Scotland) Act 20141 set out the requirement for Integration Authorities to include carer and lived experience representatives on their Integration Joint Boards (IJBs). Background Since 2014, other legislative developments have extended the expectation of engagement with carers and people with lived experience within Health and Social Care (including, Carers (Scotland) Act 20162; National Care Service (Scotland) Bill3). The Coalition of Carers in Scotland (COCIS) and the Health and Social Care Alliance Scotland (the ALLIANCE) provide support to networks of Carer and Lived Experience Representatives involved in IJBs across Scotland. Since 2017, the Carer Collaborative, facilitated by COCIS, has produced Equal, Expert and Valued (EEV) reports4 which outline the experiences of Carer Rep involvement in IJBs and provide recommendations and examples of good practice. The ALLIANCE’s IJB Lived Experience Representative Network has formed more recently, but Lived Experience Network Reps report similar experiences of involvement as those highlighted in the Equal, Expert and Valued reports. 1 legislation.gov.uk/asp/2014/9/contents/enacted 2 legislation.gov.uk/asp/2016/9/contents/enacted 3 parliament.scot/bills-and-laws/bills/national-care-service-scotland-bill 4 carersnet.org/carers-collaborative Page 229 of 382
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4More than equal: Valuing and supporting the expert contribution of people with lived experience Carer and Lived Experience Reps bring a wealth of knowledge, experience and expertise to the work of IJBs. However, experiences of involvement across Scotland are mixed and there are a number of key areas where the involvement of Reps falls short of best practice. This report draws on these experiences and starts with headline recommendations for improvement, under four thematic headings: 1. Strengthen recruitment and representation 2. Build capacity 3. Support equity of involvement 4. Evaluate impact The subsequent pages give more detail on the key areas for development, actions which would support improvement, as well as links to resources that could help. The report concludes with brief good practice examples, final thoughts and thanks. Note on language used in this report: This report typically uses the word ‘Reps’ to refer to Carer and Lived Experience Representatives on IJBs (Lived Experience Reps are also sometimes known as Patient, Service User or Public Reps). Reps are usually unpaid carers (or former carers) or people who have experience of accessing health and social care services and support. It is noted that in some areas staff (e.g. from local carers centres; lived experience organisations; the local authority) fulfil the role. COCIS and the ALLIANCE are of the view that while this ensures carers and those with lived experience are represented to a degree, it is best practice to have unpaid carers and those with lived experience of services in the roles. Page 230 of 382
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5More than equal: Valuing and supporting the expert contribution of people with lived experience Recommendations Recommendation Areas for development and action 1. Strengthen recruitment and representation • Proactive and inclusive recruitment to Carer and Lived Experience Rep positions to ensure representation and representativeness. • Ensure Reps have a clear and transparent role and remit. • Ensure robust succession planning and supportive induction processes are in place. • Involve Reps in key planning groups, particularly governance and decision-making structures. 2. Build capacity • Support and resource structures for wider community involvement and ensure Carer / Lived Experience Reps have support to link with these structures. • Have a pool of carers/people with lived experience to populate strategic groups, share responsibility and enable peer support. • Provide training on the importance, value and benefits of involvement for IJB members and wider strategic partners. • Provide resources and training for Carer / Lived Experience Reps (and other IJB members) to support and enable them to undertake their role. • Ensure engagement and involvement of Carers and Lived Experience Reps in national policy discussions and structures. 3. Support equity of involvement • Ensure Reps are treated as equal partners and have voting rights. • Ensure Reps are able to place items on the agenda and there is time for discussion. • Ensure meetings are accessible e.g. papers sent on time; addressing barriers, etc. • Ensure an expenses policy is in place and full remuneration of expenses, including replacement care. • Consider a form of payment for Reps on IJBs. • ‘Carer / Lived Experience proof’ policies and plans. • Ensure ongoing support to enable Reps to undertake their role. 4. Evaluate impact • Evaluate the involvement of carers and people with lived experience. Publish findings in Annual Performance Reports to demonstrate progress and impact. • Monitor progress towards key national outcomes and indicators relating to carers and people with lived experience. • Report transparently on IJB/HSCP financial spend to support carers and people with lived experience. • Review processes and performance annually against these report recommendations. Page 231 of 382
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6More than equal: Valuing and supporting the expert contribution of people with lived experience Area for development Actions to support improvement Proactive and inclusive recruitment to Carer and Lived Experience Rep positions to ensure representation and representativeness. • Provide clear information on the role and the support which will be given to Reps to undertake the role. • Ensure unpaid carers / those with lived experience are appointed to Representative roles (rather than staff). • Ensure recruitment processes are inclusive and enable equity of access to apply for Representative roles. • Monitor representation (e.g. BAME; those with different support needs or caring roles; age groups) and proactively identify and take action to address gaps. Ensure Reps have a clear and transparent role and remit. • Provide all Carer and Lived Experience Reps with a clear role description which outlines the scope and scale of the role; support, training and resources that will be provided; skills required. Ensure robust succession planning and induction processes are in place. • Prioritise the development of succession planning and induction processes for Representative roles. This includes: » Anticipatory planning in advance of their term ending » Exit interviews with outgoing Reps. » Handover period between new / existing Reps. » Provision of key information on the processes, functions, key personnel within IJBs scope/remit. » Introductory meetings with IJB members / key HSCP personnel (e.g. Chair/Finance Lead Officer). » Provision of named contact/s for on-going support/ information. » Developing a buddying and mentoring system to provide Reps with access to on-going support (either with other Reps or key HSCP personnel). Recommendation one: Strengthen recruitment and representation What needs to happen The context IJBs appear to face challenges with the recruitment of IJB Carer and Lived Experience Reps. At the time of writing (Apr 2024), this includes: Carer and Lived Experience Rep vacancies on up to seven IJBs; Rep roles are being undertaken by staff (on at least two IJBs); carers or people with lived experience being unable or unwilling to get involved due to the scope and scale of the role; lack of succession planning processes resulting in some Reps being in their roles for two or three terms (up to nine years); more needing to be done to ensure diversity of experience and representation from all sections of the community. Page 232 of 382
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7More than equal: Valuing and supporting the expert contribution of people with lived experience Resources that can help: The Carer Collaborative’s role description template carersnet.org/wp-content/uploads/2021/10/Carer-Rep-Role-Description.pdf The ALLIANCE’s Engaging People with Lived Experience: best practice, challenges and opportunities report. alliance-scotland.org.uk/blog/news/new-report-engaging-people-with-lived-experience Scottish Government’s Participation Framework gov.scot/publications/participation-framework Area for development Actions to support improvement Involve Reps in key planning groups, particularly governance and decision-making structures. • Ensure Reps have information about the IJBs wider planning and strategy groups and opportunities to be involved in these, particularly those related to governance and decision-making (e.g. budget setting; commissioning). • Provide support for Reps to be involved in wider planning groups to ensure carer / lived experience perspectives are considered in discussions and decisions. Page 233 of 382
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8More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Support and resource structures for involvement and ensure Reps have support to link with these structures. • Provide Reps with information and support to link with wider involvement structures* so they can fully represent carer / lived experience views. Be cognisant that Reps need time to engage with others (e.g. when issuing IJB papers). * Structures for involvement can include Carers Voice groups; voluntary sector orgs/networks that support people who access services; involvement teams within HSCP. Have a pool of carers / people with lived experience to populate strategic groups, share responsibility and enable peer support. • Provide support to a wider pool of carers / people with lived experience who can be involved in the range of IJB strategic groups to ensure sustainable representation including: » Sharing responsibility for different areas of strategic work so Reps don’t become overburdened. » Offering opportunities for peer support to share experiences, knowledge and learning. Provide training on the importance, value and benefits of involvement for IJB members and wider strategic partners. • Provide regular training for all IJB members and wider strategic partners who support the work of the IJB to build: » A shared understanding of the importance and value of involvement. » An understanding of the range of expertise and experience Reps bring to the IJB. » A willingness to listen and desire to seek out the experiences of carers and people with lived experience. » An understanding of different approaches to involvement and barriers some may face. » Knowledge on safeguarding measures to ensure engagement is purposeful and people are able to contribute their lived experience in a safe and appropriate way Recommendation two: Build capacity What needs to happen The context IJBs need to develop a wider pool of carers and people with lived eperience to ensure representation does not depend on a few people. To ensure sustainable representation of the views of carers/people with lived experience it is vital that: Reps have opportunities and support to engage with wider involvement networks; IJBs support a wider pool of carers/people with lived experience to ensure Reps don’t become overburdened with involvement in numerous IJB strategic groups. Alongside this, capacity building training is key to ensure: Reps have the information and knowledge they need to undertake their role; IJB members and wider stakeholders have an understanding of the importance, value and benefits of involvement. Page 234 of 382
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9More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Provide resources and training for Reps (and other IJB members) to support and enable them to undertake their role. • Provide ‘baseline’ training on the topics / key areas of focus that are discussed within the IJB remit (e.g. policy landscape). • Regularly discuss other training and support needs with Reps – these will differ for each person. • Have a dedicated training budget to provide on-going capacity building support for Reps. Ensure engagement and involvement of Reps in national policy discussions and structures. • Provide information for Reps about national involvement networks (e.g. COCIS’ Carers Collaborative; the ALLIANCE’s IJB Lived Experience Representative Network). • Provide information on key areas of national policy development (e.g. National Care Service) and other national structures that Reps could link with (e.g. COSLA board). Resources that can help: COCIS’ Carer Collaborative carersnet.org/carers-collaborative The ALLIANCE’s IJB Lived Experience Representative Network alliance-scotland.org.uk/lived-experience/networks/ijb-lived-experience-representative- network/ Mind’s Influence and Participation Toolkit mind.org.uk/workplace/influence-and-participation-toolkit Page 235 of 382
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10More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Ensure Reps are treated as equal partners and have voting rights. • Ensure Reps are able to effectively and regularly engage with other carers / people with lived experience to ensure their views are represented and considered in decision-making. This includes ensuring there is time to consult and engage with others on decisions. Ensure Reps are able to place items on the agenda and there is time for discussion. • Ensure there is a clear and accessible process for Reps to submit items for the IJB (and strategic groups) agendas. • Allow time in meetings for discussions and questions. Ensure meetings are accessible e.g. papers sent on time; addressing barriers to involvement. • Ensure meeting papers are issued sufficiently in advance, to allow Reps to read, consult with wider carer / lived experience networks and prepare for meetings. • Discuss any barriers to involvement (including format of IJB papers; participation support needs; meeting timings e.g. for carers/people with lived experience who work) and take action to address these. Ensure an expenses policy is in place and full remuneration of expenses, including replacement care. • Provide Reps with the IJB expenses policy at induction (or during their tenure if already in post). • Publish expenses policy on the IJB/HSCP website. • Provide expenses forms and a clear, straightforward claim process. • Ensure replacement care expenses are available to Reps who need these (without requiring them to use their own network of support or existing care packages). Recommendation three: Support equity of involvement What needs to happen The context Across Scotland Reps report mixed experiences of being involved as equal partners on IJBs. It should be noted that within this recommendation there was a divergence of views about Reps having voting rights (as recommended in the Independent Review of Adult Social Care5). Whilst both Carer and Lived Experience Reps were keen for equity in the form of voting rights, some Lived Experience Reps noted that they would only be comfortable having voting rights if they were able to effectively engage with others with lived experience. Alongside this, there was a divergence of views around establishing a form of payment for Reps. Payment can be a complex issue and should be fully assessed to mitigate any adverse implications (e.g. tax, benefits, employment law). 5 gov.scot/publications/independent-review-adult-social-care-scotland Page 236 of 382
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11More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Consider a form of payment for Reps on IJBs. • Consider a range of options for payment (e.g. financial recompense; vouchers), take legal/financial advice (e.g. tax/benefits/employment law) and discuss with Reps to ensure payments would not have adverse implications. ‘Carer / Lived Experience proof’ plans and policies. • Ensure plans and policies produced by the IJB (and its strategic groups) are impact assessed for carers / people with lived experience and that their needs and aspirations are considered. For example, the needs of carers / people with lived experience being included in Equality Impact Assessments/Statements. Ensure ongoing support to enable Reps to undertake their role. • Examples of on-going support which Reps report can help include: » Pre-meetings with support staff / other IJB members to discuss papers and ask questions. » Support with admin e.g. IJB papers; claiming expenses. » Key contact person for IJB-related business and processes who acts as a ‘go to’ for any questions. » Links with organisations that support people with lived experience and carers (e.g. Carers Centres; lived experience orgs/networks). Resources that can help: The Carer Collaborative’s expenses policy template carersnet.org/wp-content/uploads/2021/10/Carer-Expenses-Policy.pdf The Carer Collaborative’s briefing paper on Carers and Equality Impact Assessments carersnet.org/wp-content/uploads/2021/10/Carers-and-EQIA.pdf The ALLIANCE’s Engagement Insights Report alliance-scotland.org.uk/wp-content/uploads/2021/05/Engagement-Insights-Report.pdf Scottish Human Rights Commission’s Paying People with Lived Experience for their Participation: a review of legislation, literature and practice research report scottishhumanrights.com/media/2251/paid-participation-report-vfinal.pdf Scottish Government’s Guidance: Paying participant expenses and compensating for time gov.scot/publications/guidance-paying-participant-expenses-compensating-time/pages/1/ Page 237 of 382
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12More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Evaluate the involvement of carers and people with lived experience. Publish findings in Annual Performance Reports to demonstrate progress and impact. • Have regular and robust evaluation processes that enable the impact of Reps’ involvement to be assessed. • Involve Reps in the design of evaluation processes and identification of the outcomes which are important to assess. • Share evaluation feedback with Reps and identify any changes needed to improve involvement processes. • Share details of involvement processes (e.g. how Reps are involved in IJB) and plans for improvements within IJB/HSCP Strategic Plans. Provide details of progress towards actions for improvement and the impact of involvement within HSCP Annual Performance Reports. Monitor progress towards key national outcomes and indicators relating to carers and people with lived experience. • Identify key national outcomes and indicators relating to people with lived experience and carers (e.g. National Health & Wellbeing Outcome 6; National Performance Framework, National Outcomes relating to Human Rights and Health). • Ask for Reps’ views on the key national indicators which would be important to monitor locally. • Report on progress in HSCP Annual Performance Reports. Report transparently on IJB/HSCP financial spend to support carers and people with lived experience. • Provide details of funding awarded and financial spend that is related to supporting people with lived experience and carers (e.g. Carers Act funding) in IJB Annual Accounts and HSCP Annual Performance Reports. Review processes and performance annually against these report recommendations. • Use these recommendations, areas for development and action to develop a framework to monitor progress of involvement locally, and to compare nationally. Recommendation four: Evaluate impact The context The development and implementation of robust, co-designed evaluation processes is essential to understand the impact of involvement. Alongside this, it is important to provide consistent and transparent feedback on progress made, what improvements are needed, and links to wider outcomes frameworks. Clear information about financial spend against support for carers and people with lived experience should also be provided to ensure transparency and enable Reps to fully undertake their roles. What needs to happen Page 238 of 382
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13More than equal: Valuing and supporting the expert contribution of people with lived experience Resources that can help: Scottish Government’s National Performance Framework nationalperformance.gov.scot Scottish Government’s National Health and Wellbeing Outcomes Framework gov.scot/publications/national-health-wellbeing-outcomes-framework Evaluation Support Scotland’s range of resources and tools to support impact measurement evaluationsupportscotland.org.uk Page 239 of 382
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14More than equal: Valuing and supporting the expert contribution of people with lived experience To support progress towards the recommendations made in this report, a small selection of good practice examples from across Scotland are provided below. Sharing good practice As noted at the beginning of this report, the Carer Collaborative has been operating for a number of years and the IJB Lived Experience Network has formed more recently, therefore most of these examples are more focused on Carer Rep feedback on involvement practices in their local area. However, as can be seen below, many of the improvements mentioned can equally apply to involvement of Lived Experience Reps. COCIS and the ALLIANCE believe that increased national opportunities for IJB members/key HSCP personnel to come together with Reps from the Carers Collaborative and the IJB Lived Experience Representative Network, would support the sharing of good practice and the development of more consistent, high-quality involvement in IJBs across Scotland. In East Dunbartonshire members of the Public Service User and Carers (PSUC) group receive a full induction to prepare them for their role. An induction meeting takes place with the HSCP Development Officer and a Service User/ Carer Rep who gives them a service user/carer’s viewpoint of the role. A full description of the role and remit is given as well as an induction pack with all the paperwork needed for the role including induction policy; full expenses policy and claim forms; terms of reference; mentoring policy; communications strategy; confidentiality agreement; aide memoire and glossary of terms; code of conduct; training record; meeting preparation and notes forms. Reps also have regular awareness sessions and can request specific topics when they feel they need more information to help them contribute to meeting discussions. Three HSCPs, Falkirk, North Ayrshire and South Ayrshire, publish their expenses policy on their websites (Falkirk HSCP also publish their claim form). In Fife Carer Support Workers (funded by the HSCP) were appointed by the local Carers Centre in early 2020 to engage directly with carers in each of the localities and gather their views and experiences. Carers Strategy funding has also been used to create a new team within the HSCP dedicated to supporting the involvement, participation and engagement of unpaid carers. The Carer Rep noted that the engagement conversations so far have been exceptionally good, with a range of different views and experiences being shared, and excellent collation, analysis and reporting after the meetings. The Carer Rep is now keen to see more carers involved in these engagement meetings, and that the evidence gathered through these engagement activities is listened to more widely and influences policy development and decision-making. Page 240 of 382
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15More than equal: Valuing and supporting the expert contribution of people with lived experience Final thoughts… Whilst there has been undoubtable and welcome progress in the involvement of carers and people with lived experience on IJBs, this report has highlighted areas where focused attention and action are still needed. Carer and Lived Experience Reps bring huge value to IJBs, sharing their experiences, expertise and knowledge willingly and generously. This requires a significant investment of Reps’ time, which they balance with their other life commitments and responsibilities. The benefits of Carer and Lived Experience Rep involvement in IJBs is significant, supporting the voices and perspectives of carers and those with lived experience to be central to local policy and service development. But as this report highlights, there remain key areas for improvement and development to ensure Reps are seen as equal partners on IJBs with valuable expertise and perspectives to share. The proposed plans, within the National Care Service (Scotland) Bill, to reform and enhance IJBs gives opportunities to formalise the role of Reps and achieve more consistency in relation to support across Scotland. And thanks… This report ends with a huge thanks to all Carer and Lived Experience Reps, who have given, and continue to give, their time, experience and expertise so generously to IJBs to improve health and social care policy, services and support in local areas. A further thanks goes to the Reps who are part of the Carer Collaborative and the IJB Lived Experience Representative Network, whose experience, knowledge and expertise contributes to key national health and social care policy developments, and to the recommendations in this report. In Perth & Kinross representation of carers’ (and lived experience) views has greatly improved since publication of the first COCIS Equal, Expert and Valued report in 2017. The IJB Carer Rep noted that when they started their role seven years ago, they were the only representative member on the IJB which felt very difficult and isolating. The key things which have been improved and made a difference are: there are now four Representatives on the IJB (two carer and two lived experience); there is an established Carers Voice Group which Carer Reps can link with to obtain views; the IJB understands that Carer (and lived experience) Reps have a representative role which is based on the views of a network of carers / people with lived experience. These positive changes mean the role feels less tokenistic and more representative of the wide range of views. In South Lanarkshire, the IJB Lived Experience Rep is also the Chair of the South Lanarkshire Health and Social Care Forum. The Forum has four localities who deal with local issues and feed into the Forum, and, through the Chair, to the IJB. The Forum has 65 members, 15 of whom represent local organisations, thus covering almost 100,000 people in the community. The Forum also has a training and mentoring programme for members to ensure they understand their roles and responsibilities. Members also have representation on a variety of IJB and other subgroups and regularly receive presentations from the Chief Officer and Head of Commissioning and Performance enabling members to actively influence health and social care services. The IJB Lived Experience Rep is also Chair of an Independent Advisor Panel with membership from the Forum, third sector organisations, Chair of the Adult Protection Committee and a senior Union Representative, to ensure any service changes have appropriate consultation. Page 241 of 382
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The ALLIANCE is the national third sector intermediary for health and social care, bringing together a diverse range of people and organisations who share our vision. We work with our members and partners to ensure lived experience and third sector expertise is listened to and acted upon by informing national policy and campaigns, and putting people at the centre of designing support and services. Since our formation in 2006, the ALLIANCE has built a strong and diverse membership of over 3,600 organisations and individuals. Our vision is a Scotland where everyone has a strong voice and enjoys their right to live well with dignity and respect. Our broad range of programmes and activities deliver support, research and policy development, digital innovation and knowledge sharing. We manage funding and spotlight innovative projects working directly with people, using their experience to find ways to improve wellbeing and support rights-based self-management approaches. E integration@alliance-scotland.org.uk www.alliance-scotland.org.uk The Coalition of Carers exists to advance the voice of carers by facilitating carer engagement and bringing carers and local carer organisations together with decision makers at a national and local level. It is our vision that carers in Scotland will achieve full recognition as equal partners in care. Carers will have the right to quality services and access to personalised support at every stage in their caring role to ensure they enjoy good health and a life outside of caring. E coalition@carersnet.org www.carersnet.org The work of the Carer Collaborative and the IJB Lived Experience Representative Network is funded and supported by the Scottish Government. Page 242 of 382
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Midlothian Integration Joint Board Thursday, 11th June 2026, 14:00-16:00 Midlothian IJB draft Annual Performance Report 2025/26 Executive summary This report presents a draft of the Midlothian Integration Joint Board (IJB) draft Annual Performance Report (APR) 2025/26 (appendix 1). In order to ensure Midlothian IJB can meet the statutory duty of Integration Authorities to publish an APR before 31st July annually, the Midlothian IJB Audit and Risk Committee was requested to review this draft report and subject to any amendments, has recommended Midlothian IJB publish a draft Annual Performance Report (APR) 2025/26 without the Public Health Scotland (PHS) validated National Indicator data. Following the template and process developed over the past 4 years, narrative content and best practice examples have been themed within the 9 National Health and Wellbeing Outcomes and align with the themes of Early Intervention and Prevention, Support and Treatment, and Crisis and Emergency. This is complemented by local narrative derived from a combination of sources including operational quarterly reporting, the Midlothian IJB Annual Survey, and nationally curated local performance data. The validated National Indicator data is provided by Public Health Scotland is expected in mid-July and will therefore be included in the final draft of the APR which will be scrutinised by Midlothian IJB Strategic Planning Group on 23rd July and recommended to the Board for final approval in the Midlothian IJB meeting of 20th August 2026. The Board is therefore requested to approve the publication of this draft APR in order to meet the statutory duty of integration Authorities to publish an APR before 31st July annually noting the section to be updated. As a result of this report, Members are asked to: Review this draft of the Midlothian IJB Annual Performance Report (APR) 2025/26, Subject to any amendments, give delegated authority to Morag Barrow in her capacity as Chief Officer of Midlothian IJB to publish the Midlothian IJB Annual Performance Report (APR) 2024/25 by Friday 31st July 2026. Item number: 5.8 Page 243 of 382
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Midlothian Integration Joint Board Report Midlothian IJB draft Annual Performance Report 2025/26 1 Purpose 1.1 This report presents a draft of the Midlothian Integration Joint Board (IJB) draft Annual Performance Report (APR) 2025/26 (appendix 1). In order to ensure Midlothian IJB can meet the statutory duty of Integration Authorities to publish an APR before 31st July annually, the Midlothian IJB Audit and Risk Committee was requested to review this draft report and subject to any amendments, and recommended Midlothian IJB publish a draft Annual Performance Report (APR) 2025/26 without the Public Health Scotland (PHS) validated National Indicator data. 2 Recommendations 2.1 As a result of this report, Members are asked to: Review this draft of the Midlothian IJB Annual Performance Report (APR) 2025/26, Subject to any amendments, give delegated authority to Morag Barrow in her capacity as Chief Officer of Midlothian IJB to publish the Midlothian IJB Annual Performance Report (APR) 2024/25 by Friday 31st July 2026. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Scotland) Act, 2014 places a duty on Integration Authorities to publish an Annual Performance Report (APR) that provides an assessment of progress towards achieving the 9 National Health and Wellbeing Outcomes as indicated by a core suite of national performance indicators. 3.2 The Midlothian IJB draft APR 2024/25 (appendix 1) presents data from the national performance indicators alongside local performance narrative within the 9 National Health and Wellbeing Outcomes. Following the template and process developed over the past 4 years, narrative content and best practice examples have been themed and align with the themes of Early Intervention and Prevention, Support and Treatment, and Crisis and Emergency. 3.3 This local narrative is derived from a combination of sources including operational quarterly reporting, the Midlothian IJB Annual Survey, and nationally curated local performance data. Page 244 of 382
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Midlothian Integration Joint Board 3.4 National Indicator Updates 2025/26 is a reporting year for the Health and Care Experience Survey (HACE). As a result, the National Indicators populated by this survey will be made available to Midlothian IJB from mid-July 2026. As this is too late to meet the statutory reporting deadline of 31st July, it is proposed that a draft APR is published as an interim measure and updated following the validated National Indicator data being scrutinised by the Midlothian IJB Strategic Planning Group on 23rd July 2026 and presented to Midlothian IJB at its meeting on 29th August 2026. 4 Policy Implications 4.1 There are no direct policy implications as a result of this report. 5 Directions 5.1 This report does not directly impact upon service ability to deliver an existing Direction. 5.2 However, as a result of the Midlothian IJB draft APR 2025/26, the Midlothian IJB may wish to consider any operational implications for an existing Direction and suggest corrective action that involve revision to one or more Direction, or the development of a new Direction(s). 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 This report does not have implications for groups of people with protected characteristics. However, Midlothian IJB may wish to revise or develop a new strategy, policy, plan, provision, practice, or activity to respond to identified improvement goals in response to this performance information. 6.3 Any new or revised strategy, policy, plan, provision, practice, or activity produced in response to the performance data and analysis presented in this Midlothian IJB draft APR 2025/26 will require the completion of an Equality and Children’s Rights Impact Assessment (ECRIA) to inform development. 7 Resource Implications 7.1 There are no direct resource implications as a result of this report. Page 245 of 382
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Midlothian Integration Joint Board 8 Risk 8.1 The statutory publication date for Integration Authorities to publish their Annual Performance Report is 31st July annually. Due to the timing of the Public Health Scotland (PHS) release of validated data, it is proposed that a draft APR published without the Public Health Scotland (PHS) validated National Indicator data. 8.2 There is a risk that any significant revision required following the receipt of the PHS data may result in additional delay to the approval and publication of the final Midlothian IJB APR 2025/26. 9 Involving people 9.1 Following publication, the Midlothian IJB draft APR 2025/26 will be shared widely, in print, electronically via email, via social media, and on the Midlothian Health and Social Care website. 10 Background Papers 10.1 None Author’s Name Gill Main Designation Integration Manager Contact Information gill.main3@nhs.scot Date 25/05/2025 Appendices: Appendix 1: Midlothian IJB draft Annual Performance Report (APR) 2025/26 Page 246 of 382
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DRAFT Midlothian Integration Joint Board Annual Performance Report 2025/26 Page 247 of 382
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DRAFT 2 Contents Executive Summary...................................................................................................3 Foreword..................................................................................................................3 Introduction..............................................................................................................5 Who we are............................................................................................................5 What we are trying to achieve..................................................................................6 How we measure our performance .........................................................................8 How did we do?.......................................................................................................10 The National Indicators.........................................................................................10 Communication and Engagement............................................................................50 Equality ..................................................................................................................54 Looking forward ......................................................................................................58 Inspections.............................................................................................................59 Business and governance........................................................................................66 Data Appendix ........................................................................................................70 Ministerial Steering Group Targets ...........................................................................71 Page 248 of 382
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DRAFT 3 Executive Summary The Midlothian Integration Joint Board (IJB) plans and directs health and social care services for the people of Midlothian. We are a planning and decision-making body responsible for the integrated budget from Midlothian Council and NHS Lothian. This section will be updated prior to publication in August 2026. Page 249 of 382
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DRAFT 4 Foreword Welcome to our 11th Annual Performance Report which reflects on our progress and performance from 1st April 2025 to 31st March 2026. This section will be updated prior to publication in August 2026. Morag Barrow Chief Officer, Midlothian IJB Page 250 of 382
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DRAFT 5 Introduction Who we are The Midlothian Integration Joint Board (IJB) plan and direct health and social care services for the people of Midlothian. We are a planning and decision-making body created by Midlothian Council and NHS Lothian. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in our Strategic Plan guide how we allocate the money we receive. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships - Midlothian, East Lothian, West Lothian, and City of Edinburgh. 99,880 Page 251 of 382
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DRAFT 6 What we are trying to achieve The Scottish Government measure our performance on Health and Wellbeing Outcomes. National Health & Wellbeing Outcome 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. 5 Health Inequalities Health & social care services contribute to reducing health inequalities. 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide. 9 Use of Resources Resources are used effectively and efficiently. We also measure our performance against the objectives in our Strategic Plan. Page 252 of 382
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DRAFT 7 Our Strategic Plan 2025-2035 has three main aims and six sub-aims: 1. People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health 1.1 People can easily find the information they need to make good decisions. 1.2 People achieve the things that matter most to them, and our services are confident of what our contribution is to their success. 1.3 People access services and support designed around how they live their lives. 2. People access the care and support they need when they need it in the community and at home 2.1 People easily access the services that help them stay well, independent, and active. 2.2 People have access to services in their own community. 2.3 People are living in the place of their choosing for longer. 3. People’s human, social, and economic rights are protected and promoted in how we design our services 3.1 People are recognised as experts in their own lives, are involved in planning services, and feel valued. 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want. 3.3 People benefit from organisations working together and sharing information safely. We recognise people are the experts in manging their own health and wellbeing and want to provide the right support, treatment, and care for people to live well in their homes and communities. We want services to be available when people need them and at every stage of their care and treatment: Preventing ill health and providing support early, Ongoing support and treatment, In times of crisis and emergency. We think about how we work, and how we can improve, in three ways: Integration is about how we work with all our partners to ensure everyone gets the right care, at the right time, and in the right setting. Quality is about 6 key areas of services – are they safe, effective, efficient, timely, person- centred, equitable. Best Value is about ensuring resources are well managed improving services that deliver the best possible outcomes for people and communities. Page 253 of 382
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DRAFT 8 How we measure our performance Our contribution to people’s outcomes The services we plan and direct must, by law, aim to improve outcomes for people who use our services, their carers, and families. Many factors influence peoples’ lives, and it can be hard to know the impact of each service or support we offer. To ensure that we understand the impact of our work, we use an approach called Outcome Mapping. This is a way to understand how our services contribute to people achieving the outcomes that matter to them. It can also help us make more targeted, locally informed decisions about how to plan and direct services. This approach allows us to describe what we do, who with, what people learn and gain as a result, how this makes them feel and the difference this makes to their lives. The data we use Scottish Government’s Ministerial Strategic Group targets Scottish Government’s National Performance Indicators The National Indicators 1-9 are taken from the Health and Care Experience Survey, conducted every 2 years. 2025/26 is a reporting year for the Survey and changes are included in this Annual Performance Report. In November 2025 the survey was posted to a random sample of people living in Midlothian and registered with a GP in Scotland. People were asked about their experiences during the previous 12 months - accessing and using their GP practice and Out of Hours services; aspects of care and support provided by local authorities and other organisations; and caring responsibilities and related support. The Scottish Government updated the survey in 2023, (the changes are in the Scottish Government Technical Report). This means it is difficult to compare our performance with previous years, and in some cases, we only have data from 2020. This section will be updated in August following the publication of the HACE survey responses. Feedback from people who use our services, their families, and carers In early 2026, we carried out the Midlothian IJB Annual Survey by inviting people living in Midlothian to complete a questionnaire to share their views about health and social care. This section will be updated in August following the analysis of the Midlothian IJB Annual Survey. Page 254 of 382
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DRAFT 9 iMatter survey for employees This section will be updated in August following the release of the 2025/26 iMatter results. Staff are asked about their work and their wellbeing. The Employee Engagement Index (EEI) is the overall score for the organisation. The survey explores how staff feel they are: - Informed, trained & developed, - Involved in decisions, - Treated fairly and consistently, with dignity and respect, in an environment where diversity is valued, - Provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients, and the wider community. Other Data We use a range of other data sources in this report. Some of the data we use in this report covers elements of services that are delivered by GP independent contractors. We also use information from national organisations and professional bodies, e.g. National Records of Scotland, Public Health Scotland, and the Care Inspectorate. How we are reporting our data Full data is provided in the Appendix. This includes our progress over time and our position in comparison to the rest of Scotland. We look at each of the Health and Wellbeing Outcomes alongside the National Performance Indicators used to measure each one and summarised our progress: - Our performance has improved compared to last year. - There hasn’t been a significant change in performance compared to last year. - Our performance has worsened compared to last year. For each Health and Wellbeing Outcome we have described the impact of what we do. We have used icons to show if the impact was for Early Intervention and Prevention, Support and Treatment or Crisis and Emergency. This report brings together information about our activity, experience, and outcomes across all the functions that are delegate to us to plan for and direct. This includes the two pan-Lothian hosted services that are managed by Midlothian Health and Social Care Partnership. Page 255 of 382
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DRAFT 10 How did we do? The National Indicators National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. 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*. 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. Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life*. Carers feel supported to continue in their caring role. Adults supported at home agreed they felt safe*. National Indicator Our result Our Progress Premature Mortality Rate. (People under 75) Page 256 of 382
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DRAFT 11 . National Indicator Our result Our Progress 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 who were admitted to hospital). Care services graded Good or better in Care Inspectorate Inspections. 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. Page 257 of 382
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DRAFT 12 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. Scottish Government descriptors for this outcome 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 National Indicators used to measure this outcome This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Indicator 1 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, this indicator has been updated from the 2023/24 data. One of the ways we help people to access the information they need is to ensure it is visible and easy to understand. Throughout 2025/26 we have ensured our services design accessible and straightforward information on webpages, posters and leaflets to let people know about available services and supports. These included: a leaflet about support in the first year after someone leaves prison and returns to their local community, a leaflet with ‘Diversion from Prosecution’ information for those who may be able to undertake community treatment and avoid prosecution, a leaflet on how men in the Justice system can access emotional support, a new Community Justice section on the Midlothian Council website to help people navigate support and assistance, posters in GP surgeries that provide information on how to use asthma and COPD medicines, posters in GP surgeries to raise awareness of dementia and available support, and a Home Safety Guide for people with dementia, their family and carers. National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. Premature Mortality Rate (People under 75) Emergency Admission Rate Page 258 of 382
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DRAFT 13 The support we offer to people living with physical disabilities and long-term conditions can have a positive impact on their ability to look after their own health, but we know the barriers and challenges people experience are different for every person. It is important for people to have their circumstances assessed as quickly as possible and receive the right support to live in better health for longer. Throughout 2025/26, 93% of physical disability referral screenings were completed within the standard of 3 days, and 89% of interventions achieved the planned outcome. Partnering with other organisations can offer even more support for those with physical disabilities. Midlothian’s partnership with the Royal National Institute for Deaf (RNID) Midlothian’s Local Area Coordination Team work in partnership with a variety of organisations to build knowledge of local networks, strengthen community links and connect individuals to services that can offer support. In 2025 the Local Area Coordinators met with the RNID Coordinator to discuss a new drop-in service to provide information on hearing loss and tinnitus, and support and services within their own area. They also provide mini hearing tests on-site, and basic hearing repairs. The RNID Coordinator was connected to existing drop-in services at Café Connect at Dalkeith Art Centre and Linking Loanhead at Loanhead Library to meet local people experiencing hearing loss and learn more on what support people in Midlothian need. Plans are underway to further develop these drop-in services and offer more locations to better support people in different areas of Midlothian. Page 259 of 382
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DRAFT 14 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. Scottish Government descriptors for this outcome 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 National Indicators used to measure this outcome National Indicator Our result Our Progress 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). Adults with intensive care needs are receiving care at home. Page 260 of 382
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DRAFT 15 This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Indicators 2 and 3 are taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, these indicators have been updated from the 2023/24 data. We know that circumstances can change, and people may find that they need additional support. The Care at Home teams delivered an average of 9000 hours of care and support in people’s homes every week throughout 2025/26. During 2025 our external providers worked to improve consistency of care and focused on increasing staff retention. This means people were more likely to be supported by the same carers and develop a long-term relationship. When people need more support, the Highbank Intermediate Care Unit provides bed-based care. As part of our plan to review and redesign our bed-based care, residents at our Highbank Intermediate Care Facility will move to a new unit at Polton Street. This facility has been designed to provide placements to progress assessments for rehabilitation, packages of care, or care home placement, to ensure people do not have to stay in hospital longer than they need to. Social Workers have a key role in supporting people receive the right support and reduce hospital delays by supporting admissions and discharge planning. For people with dementia, delivering support in a coordinated way can help people live in their community for as long as possible. Social Workers in the Dementia Team continue to focus on the outcomes that matter most to people, support people to stay at home for longer, and provide assessment for long-term care if this is required. Throughout 2025/26, Social Workers attended dementia café groups to ensure we keep listening to people and better understand how we can continually improve the quality of the care we provide. When people’s needs become more complex, residential care may be required to provide the right care. However, there continues to be a shortage of available care home places in Midlothian. To address this, quality assessments are undertaken to help us improve how we communicate with people, their families and carers, and increase the availability of additional clinical support when moving from an acute hospital to intermediate or longer-term care placement. 95% of initial Care Home reviews were completed within the 12-week standard throughout 2025/26. National Indicator Our result Our Progress 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. Page 261 of 382
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DRAFT 16 Art therapy at Newbyres We know that how people feel about their environment is important to their sense of wellbeing and belonging. In March 2026 Newbyres Care Village worked with a local artist and former member of staff to decorate a linking corridor with a garden-inspired mural. The ‘garden corridor’ has been brought to life with 3D foliage, butterflies, and a working lantern with plans for chairs and background nature sounds. Residents can now enjoy the outdoors no matter the weather and visiting friends and relatives have described the initiative as “wonderful”. Cycling to success Cycling UK is a registered charity that works with local councils and services through their Connecting Communities programme to help residents own their own bikes, discover local cycling routes, build confidence while riding, and find practical alternatives to car journeys. In Midlothian, Cycling UK has been working with our commissioned partner, VOCAL, and since July 2025 planning new walking, cycling and wheeling routes around Shawfair and Auchendinny to better connect new housing developments with surrounding towns and villages. People in Midlothian who engaged with Cycling UK reported they get more exercise, use their car less, and feel safer when cycling. “We will now use the bike for trips to the shop and nursery instead of the car. We are looking forward to further cycle infrastructure to make even more journeys by bike.” Providing information and delivering care in community settings can help people live independently by increasing access to services in their local area. We know that when services are provided in local areas, people find it easier to attend because travel time and costs can be reduced. Page 262 of 382
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DRAFT 17 Care closer to home The Orthopaedic Rehabilitation Clinic supports people with musculoskeletal and orthopaedic conditions through a range of physiotherapy sessions and group classes. In 2025, 89 rehabilitation appointments were offered at Midlothian Community Hospital instead of the Royal Infirmary of Edinburgh. This gave people the option to attend appointments closer to home and saved 145.67 miles in travel. Holding these appointments locally made best use of local rehabilitation facilities and provided opportunities for training and knowledge sharing within our Musculoskeletal Physiotherapy Team. This success has led to the Pulmonary Rehabilitation service in Midlothian planning two new classes at Midlothian Community Hospital. This will help manage growing demand and local waiting times and improve outcomes after surgery. One stop shop for falls prevention 220 people attended a Community Engagement Day on Falls Prevention on September 25th at the Lasswade Centre. Throughout the day, 103 people completed an MOT during the session, which assessed people’s ‘sit to stand’ ability and their core strength. All attendees received signposting to further support and advice. This included information on falls prevention and recovery, frailty, and overall bone health. This community-based multidisciplinary event aimed to prevent or reduce falls and injury, hospital admission, loss of physical activity, reduced confidence, and social isolation. “Good variety of stalls with helpful info. I was able to have questions answered and advice given to take away.” “The personal fitness MOT was an excellent activity to see where I am compared to average for my age.” Feedback from the day was very positive and another Community Engagement Day was held in April 2026. Page 263 of 382
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DRAFT 18 We are committed to transforming the delivery of palliative and end of life care by June 2026. This work is linked to the Pan Lothian commissioning of Specialist Palliative Care services and the updated national Palliative Care Strategy Delivery Plan 2025. As part of this work, we have asked Midlothian Health and Social Care Partnership to ensure people can access co-ordinated, timely and high-quality palliative care, care around death, and bereavement support based on their needs and preferences. We want to ensure there is support for families and carers as they deal with loss and grief, and for staff to manage the emotional impact of caring for someone at the end of life. Page 264 of 382
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DRAFT 19 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome National Indicator Our result Our Progress 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. Page 265 of 382
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DRAFT 20 Indicators 3, 4, 5 and 6 are taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, these indicators have been updated from the 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey GP Practices are often the first place people go to get support with their health and wellbeing. Practices located near each other belong to a ‘GP cluster’ which contributes to the oversight and development of local healthcare and takes part in quality improvement activity. Midlothian GP cluster quality improvement initiatives have focused on improving access to timely, effective care and supporting patient safety. Electronic reviews for Hormone Replacement Therapy (HRT) Dalkeith and Pathhead GP practices in Midlothian upgraded their websites to allow annual HRT review forms to be completed and submitted electronically without patients needing to see a doctor or nurse. This resulted in between 80-90% less appointments being needed at both practices. Similar electronic reviews are planned for contraceptive, ADHD, and depression medications. Community services aim to provide treatment, care, and support as close to home as possible. However, some treatment can only be provided in a hospital setting. People told us that when they needed emergency care, they were having to wait longer in A&E, staying longer in hospital, and sometimes being delayed when leaving hospital for home. NHS Lothian developed their Unscheduled Care Improvement Plan to improve people’s experience within a hospital setting. In Midlothian, this has focused on supporting people to come home more quickly by supporting more care in community settings. Page 266 of 382
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DRAFT 21 Getting home sooner 30% of all unplanned hospital admissions for Midlothian residents to the Royal Infirmary of Edinburgh are people aged 75 and over. The work in Midlothian to reduce the length of time people spent in hospital saw the length of stay in hospital reduce by almost a week for this age group. This is the equivalent of approximately 20, 000 bed days that were saved across Midlothian in 2025. When people are discharged from hospital, they sometimes need to be readmitted for further care. Readmission rates to hospital are often used to evaluate how well we plan and support discharge. Our local data show that readmission rates for 2025/26 for people living in Midlothian improved when compared with 2024/25. The readmission rate after 6 months reduced from 23% to 19%, and after 28 days reduced from 11% to 10%. The readmission rate after 7 days remained stable at 4% throughout 2025/26. Digital solutions FLOK Health is an AI platform that offers advice and exercises for treating lower back pain. It has been tested by health care professionals across Lothian and signposting and advertising has been exhibited in GP practices across Midlothian. FLOK assesses a person’s symptoms and develops an individual 12-week program with exercises and advice on how to manage pain. Data returned between August and November 2025 showed that after six months of using FLOK, 80% of people did not need to return to primary care, their GP or the MSK service for further treatment. This shows the effectiveness of FLOK in helping people to better manage their health without needing face to face appointments. Other services in Midlothian are now considering digital platforms to support people to self-manage their symptoms and conditions. We continued to work with our commissioned partners to ensure adults with learning disabilities in Midlothian have the opportunity to build practical skills, gain confidence in their abilities, and feel proud of their achievements. 92% of care package reviews for people with a learning disability had been completed within the 2-year standard throughout 2025/26. Garvald Edinburgh provides day services to adults with learning disabilities in Midlothian. The service offers opportunities to build skills, pride, and confidence through experiences with cooking, gardening, pottery, textiles, Page 267 of 382
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DRAFT 22 jewellery, art, and printmaking. Activities to improve physical and mental health and wellbeing are also offered, including walking and swimming groups, music and dance, and meditation. We know that working with people and developing relationships is the best way to support people to achieve what matters to them. In 2025/26 we worked alongside the charity Access to Industry to support people in Midlothian to return to work. Access to Industry is a registered Charity with specialist skills to support unemployed people across Scotland who face barriers to employment. In 2025/26, Access to Industry supported 57 people across four different projects at local libraries, community centres, and recovery cafes across Midlothian as well as the Learning Hub in Hardengreen. Classes and groups promoted the benefits of connection and routine with Personal Learning and Development Action Plans created for each person to help them achieve their goals. Throughout 2025/26 the cohort achieved 34 new qualifications and resulted in 5 participants moving into employment, 15 entering further education at Edinburgh and Newbattle Abbey Colleges, 6 taking up volunteer roles, 1 entering the SDF Addiction Workers Programme, and 13 undertaking residential rehabilitation and aftercare support. Support to achieve what matters to you Access to Industry supported a local young adult who was experiencing anxiety and low confidence to get back into work. Through weekly sessions, Access to Industry provided tailored support to help the person develop strong working relationships with staff that supported them to become more confident and motivated. As a result, they studied for and passed their driving theory and soon took up a college place in Edinburgh. In summer 2025 Access to Industry recognised the young adult’s achievement with a local award, noting they are thriving and looking forward to continuing their college education. Page 268 of 382
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DRAFT 23 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome National Indicator Our result Our Progress 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. Page 269 of 382
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DRAFT 24 Indicators 5 and 7 are taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, these indicators have been updated from the 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. We have continued to support people in Midlothian to make positive changes, improve their quality of life, and achieve the outcomes that matter to them. One example of this is unpaid work. Organised through the Justice service, unpaid work aims to provide opportunities that also benefit the community e.g. gardening, house clearing, and maintenance. 44% of residents who were helped by those undertaking unpaid work throughout 2025/26 told us about their positive experience. Midlothian Health and Social Care Partnership’s services are trauma-informed because we know that exposure to trauma can impact on neurological, biological, psychological and social development. Trauma-informed practice is an approach to health and care interventions that ensures a person-centred approach by focusing on safety, trust and choice. Services and supports should help people to do the things that matter most to them. People who were subject to a Community Payback Order in 2025/26 told us it is important to them to improve their mental health, build a routine, avoid boredom, improve finances, and change their alcohol and drug use. The Community Justice service team asked the people they worked with about the improvements they saw in their lives: mental health (67%) build a routine and avoid boredom (50%) financial position (50%) positive change to alcohol and drug use (33%). Everyone supported by the Justice Social Work service is asked to complete a questionnaire at the beginning and end of their support. When the exit questionnaires were completed, 100% of people reported that they felt listened to, and the majority thought the service had helped them to maintain or improve their quality of life. Most people rated the service they received as good or excellent based on their experience of relationship and trust with our teams, as well as the care and support provided. Midlothian Substance Use Service brings together nurses, doctors, social workers and psychologists to provide assessment, care and treatment of people who use alcohol and/or drugs. The service supports people both at home and in the community to make positive changes to their “This has saved me fines when I leave the property that I wouldn’t be able to pay on my pension.” “Without this help I wouldn’t be able to get out of hospital.” Page 270 of 382
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DRAFT 25 lives. When people have the support they need, we know this leads to better outcomes. Throughout 2025/26, the service continued to achieve the 90% target to meet the 21-day standard from referral to treatment. In additional to one-to-one appointments, the Midlothian Substance Use Service provides information on mental health, coping skills, and advice on benefits and financial support available. Further assistance is offered through the Horizons recovery café, where people who are in recovery can speak to the Citizen’s Advice Bureau on matters such as Universal Credit, debt relief, housing and council tax. Horizons is open every Monday and Friday and between 30 – 60 people attended each day throughout 2025/26. Page 271 of 382
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DRAFT 26 5 Health Inequalities Health & social care services contribute to reducing health inequalities Scottish Government descriptors for this outcome My local community gets the support and information it needs to be a safe and healthy place Support and services are available to me My individual circumstances are taken into account National Indicators used to measure this outcome Health inequalities among older people in Scotland are influenced by a complex mix of social, economic, and health related factors. The Scottish Index of Multiple Deprivation (SIMD) is how the Scottish Government identifies deprivation in Scotland. SIMD data is organised into 10 data zones, from the most to the least deprived. In Midlothian, 8.5% of the population live in a zone that is considered to be the most deprived, and 13.6% live in a zone that is considered to be the least deprived. According to the Scottish Burden of Disease study, by 2044, Scotland is projected to see: 63% increase in chronic obstructive pulmonary disease (COPD) 56% increase in atrial fibrillation 36% increase in both diabetes and stroke. Our local data over the last three years also tell us that people aged 75 and over are only a small number of attendances at A&E but often spend much longer there than younger age groups. 64% of people living in Midlothian who are aged 65 – 74 have a long-term condition. This rises to 84% for those aged 85 and over, which means older people often need more time for the right assessment, treatment, and care. The three most common long-term conditions in people aged 65 and over living in Midlothian are arthritis, cancer, and coronary heart disease. National Indicator Our result Our Progress Premature Mortality Rate (People under 75) Emergency Admission Rate Page 272 of 382
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DRAFT 27 The number of older people in Scotland living with long-term health conditions is increasing and this impacts on health inequalities over a lifetime. Older adults in more deprived areas of Scotland tend to experience shorter life expectancy, more years lived in poor health, and higher rates of hospital admissions and chronic conditions. Our experiences in early life including poverty, poor housing, limited access to education, and unhealthy working conditions have a significant impact on our future. We want everyone to live good lives, for longer. To reduce health inequalities that can be experienced by older people, we are working across the system to continually improve the care and support we provide. Our local data told us that older adults are more likely to be admitted to hospital than other age groups, and people aged 75 and over were more likely to experience a delay to their discharge. We took a targeted approach in 2025/26 to implement new ways of working designed to reduce the time people spend in hospital, especially when they are medically ready to return home. Our local data for attendances at the Royal Infirmary of Edinburgh’s Emergency Department (ED) show some age-related variation. People from Midlothian aged 75+ accounted for 18% attendances. This change in age profile will continue to be monitored as part of the work to support the NHS Lothian Unscheduled Care Improvement Programme. The contributions from teams across health and social care have improved the experience of hospital admission and discharge throughout 2025/26 for all age groups, with the most significant reduction in delayed discharges being achieved for the 75 and over age group. We will continue to monitor this data, to ensure the positive impact in reduction of health inequalities is sustained in the longer term. The Older People’s Social Work Team provide social work assessment, care management and a review of services for people over 65 years old and their carers. In order to ensure residents are receiving the best possible care, we are working collaboratively with care homes on a range of topics including resident experience, care planning, medicine management, falls management, recruitment and retention and staff wellbeing. A Care Inspectorate report in January 2026 found that staff at Newbyres Care Village were knowledgeable about people’s care needs, showed genuine care and respect when supporting people, and that the people who lived at Newbyres and their families were happy with the care provided. The In Reach Social Work Team are a key service that ensure people are given the right support to return home as quickly as possible. The team provide assessment and discharge planning for people who live in Midlothian and have been admitted to one of five hospital sites or the Highbank Intermediate Care Unit. Throughout 2025/26 the team received approximately 750 referrals. The average number of people experiencing a delay to their discharge from hospital for a social reason reduced from 8.4 to 5.7. People living with obesity can experience weight stigma and face a combination of physical and social barriers to accessing healthcare. The Public Health Practitioner team spoke to people living Page 273 of 382
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DRAFT 28 with obesity in Midlothian and 80% reported that the felt stigmatised in a healthcare setting. In response to these discussions, the team developed and delivered training to increase the awareness of Weight Bias, and to give staff and volunteers the knowledge, skills and confidence to have positive, constructive conversations with people about their weight. This work has challenged attitudes, behaviour and environments, and reduced barriers for people who are overweight or obese to talk openly about their weight without feeling stigmatised. 19 sessions were offered throughout 2025/26 with over 193 participants. 63 evaluations of the training were returned and feedback showed that staff would recommend the training to others. We know that good sexual health is important for overall health and well-being and can impact couples, families, and the social and economic development of communities. Inequalities in care can lead to higher risks of Sexually Transmitted Infections (STIs) and unintended pregnancies. Support with sexual health, and access to services that provide information and advice, can help people make good decisions for their treatment options. ‘No.11’ in Dalkeith houses a range of integrated services including Mental Health, Substance Use, Justice Services, and the Third Sector. The team at No. 11 are working in partnership with Chalmers Sexual Health Centre and Midlothian Health and Social Care Partnership’s Health Inclusion Team to support people with their sexual health and wellbeing. Sexual health advice and support appointments, including STI testing and treatment, are offered each month to vulnerable adults affected by homelessness, criminal justice, mental health and/or substance use issues. Sexual health training is offered to all staff based at No. 11 as part of the Homeless Outreach Support Service run by the Health Inclusion Team. Educational materials on long-acting contraception, and stocks of pregnancy tests and condoms are available in the building and are free to all. “It made me challenge my thoughts more on why I was hesitant when addressing the subject, when I wouldn’t hesitate to address a heart condition for example. Made me rethink my tone, body language and generally language used whilst approaching patients.” “I think this has raised my awareness in terms of language to use when discussing weight. It highlighted the importance of checking with patients first whether this is an area they want to discuss or not.” Page 274 of 382
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DRAFT 29 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Scottish Government descriptors for this outcome 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 National Indicators used to measure this outcome Indicator 8 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, this indicator has been updated from the 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Understanding the experience of carers in Midlothian is vital to ensure we design and deliver services and support that carers need. All carers are entitled to a personalised plan or statement that outlines their needs as a carer and the support they will receive. Adult Carer Support Plans are developed alongside carers to ensure their voice is heard and their views are reflected. Throughout 2025/26, 98 Adult Carer Support Plans were completed by the Midlothian Health and Social Care Partnership with an additional 1281 offered and 921 completed by our commissioned partner, VOCAL. VOCAL supports unpaid carers in Midlothian through a range of services for adult carers who are caring for family members or friends with physical disabilities, mental health conditions, alcohol and drug use. Our Unpaid Carer Strategy 2025-2028 sets out the action we will take over the next three years to improve the experience of carers in Midlothian. We approved Our Unpaid Carer Strategy in February 2026. Due to the joint approach with Midlothian Council Children’s Services we published this plan in May 2026 following Midlothian Council approval of the element relating to Young Carers. National Indicator Our result Our Progress Carers feel supported to continue in their caring role. Page 275 of 382
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DRAFT 30 This strategy was developed in collaboration with the Health and Social Care Partnership’s Carers Planning Group and Third Sector partners, and in consultation with unpaid carers across Midlothian. Our Unpaid Carer Strategy is a central part of how we will make progress towards our strategic aims and identifies the priority themes and actions we will take to support local carers such as: Carer Rights and Identification; Providing Information, Advice and Support; Providing Carer Economic Wellbeing; Supporting Health and Wellbeing (including breaks from caring); Supporting Carer Involvement in Care Planning. Caring for another person can have a significant impact on a carer’s health and wellbeing. People will not always identify themselves as a carer, so VOCAL hold monthly ‘Think Carer’ sessions that provide training for professionals to help them support unpaid carers they come into contact with. Training focuses on how carers are identified, the impact caring can have on health and wellbeing, and support available in the Lothians. 98 sessions were offered throughout 2025/26 and 518 people attended. To reach as many people as possible in Midlothian and reduce barriers to carer support, VOCAL established a small team of carer support practitioners who provide face-to-face ‘drop-in’ support. Throughout 2025/26, 136 drop-in sessions were held in GP practices, hospitals, libraries and community hubs as well as locations in rural areas to improve people’s access to support. We want to support carers by providing opportunities to learn new skills, spend time doing the things that matter to them, and bring carers together for peer support. In 2025/26 a series of small grants enabled ten groups to be set up throughout Midlothian specifically aimed at supporting carers to meet new people, learn new skills, and spend time outdoors. These groups also offer peer support opportunities like the Carer Pause group for parents who care for children, and a branch of the Men’s Shed in Dalkeith for male carers. Carers who have attended told us that having support close by has made a real difference. It can be difficult for carers to prioritise their own health and wellbeing. VOCAL run a Carer Health Surgery each month where people can book a 45-minute appointment with a nurse practitioner. Since June 2025, over 70% of available appointments were attended by 24 local carers to support them to look after their own health and wellbeing. Throughout 2025/26, VOCAL have also supported 76 carers in over 867 counselling appointments with a trained counsellor, focusing on positive ways for carers to manage their own mental health while caring. Carers told us they appreciate time to focus on their own wellbeing. “Accessing support in my local village has made it possible for me to receive support. Being able to talk to a carer support worker has been life changing, it’s the first time I’ve been able to share how difficult I’ve been finding things.” Page 276 of 382
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DRAFT 31 Working with our commissioned partners, VOCAL, we have ensured that carers are offered short break grants and funded opportunities to enable carers to take time away from their caring duties. In 2025/26, 344 carers accessed a funded break and a further 402 carers received vouchers or tickets for activities such as day tours, meals out and visits to attractions like wildlife parks, historical sites and gardens. Opportunities for respite from caring reopened at Highbank Intermediate Care in 2023. These facilities are planned to move to the Midlothian Life Care Facility currently under development at Polton Street. This will include 40 beds with 10 rehabilitation flats, 27 interim care beds, and 3 beds to support respite stays that can be made available to those supported by unpaid carers. A new addition to the facility is the Midlothian Life Health and Social Hub, a staff and service facility hub with other health and social care organisations, information and signposting. “I had been worried about my own health for a while … I attended a health surgery at VOCAL and it was so reassuring to be able to meet with a nurse and have the time to talk through what was going on. Having time to be able to focus on my own health was so helpful.” Page 277 of 382
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DRAFT 32 7 Safe from Harm People using health & social care services are safe from harm. Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome Indicator 9 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, this indicator has been updated from the 2023/24 data. National Indicator Our result Our Progress 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. Page 278 of 382
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DRAFT 33 This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Indicator 9 focuses on the perspective of people receiving support at home, and whether they feel safe within that context. The results are used to assess the quality of care and identify areas where improvements can be made to ensure person-centred care and support. Some people are more vulnerable and need additional protection from abuse and harm. The Adult Support and Protection (Scotland) Act 2007 provides duties, powers and measures for the support and protection of adults who may be at risk of harm. A range of guidance and services have been developed for vulnerable adults in Midlothian to empower them to suggest improvements to the service. A new advocacy service was launched in early 2026 for those with experience of adult support and protection to share their views on what went well and what could be improved. This includes asking for adaptation when services could be delivered in a different way, providing feedback on whether they felt listened to and their views were respected, and if they felt safer. Our social work services are a lifeline to people in our communities and ensure people are given the support they need to be safe at home for as long as possible. This includes undertaking the statutory obligation to make inquiries about an adult at risk's well-being, property or financial affairs. This is called the Duty to Inquire. Support when you need it A Midlothian resident was referred to Social Work following concerns that their living environment was no longer safe. The case was allocated to a Council Officer to undertake a Duty to Inquire. The Officer took time to understand what mattered most and the support they needed to make decisions about how ensure their wellbeing at home. Teams worked together to ensure that the right support was available including Council Services, Social Work, Health, Justice Services, Scottish Fire and Rescue and the Third Sector. As a result, the house was cleared, deep cleaned, new furniture was purchased, a smoke alarm fitted, and garden paths and walkways were cleared to reduce the risk of falls, and ensure it was safe to come and go. The resident told us they were happy with the help received and that their wish to be independent was respected. In January 2026 the Care Inspectorate visited Newbyres Care Village and reported improvements to medication safety and oversight. Staff have worked to improve processes and safe handling of medicines, including daily checks and recording of medications. The long-term use of medicines to Page 279 of 382
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DRAFT 34 manage pain can create safety risks, especially in older people. Midlothian Community Hospital has had specialist input from pharmacy colleagues to support people in safely reducing their use of high-risk medicines. In Scotland, an ‘Appropriate Adult’ provides vulnerable people aged 16 and over with crucial communication support during police investigations. Appropriate Adults support people over 16 who have a mental disorder as defined by The Mental Health (Care and Treatment) (Scotland) Act 2003 e.g., mental health problems, learning disabilities, Autism, ADHD, dementia, acquired brain injury. Section 42 of The Criminal Justice (Scotland) Act 2016 requires that the police and agencies ensure the provision of communication support for vulnerable adults in police custody. Appropriate Adults are provided mainly at the request of Police Scotland for people who are being interviewed and who are believed to have a mental disorder. An Appropriate Adult’s main roles are to ensures that the persons’ rights are upheld, and to provide communication support so that they can understand and be understood. In Midlothian Health and Social Care Partnership, there are 9 trained Appropriate Adults who fulfil this role for those who live in the area. They have worked with 13 people throughout 2025/26 to ensure they are supported and treated fairly throughout the custody process. We also received feedback on our services in 20 Care Inspectorate Reports across 2025/26. There were a number of areas where the Care Inspectorate told us we were doing well, including wellbeing support, leadership, staff teams and the planning of care and support. Full details of these reports, including the assessment ratings and improvement plans, can be found on page 58. Page 280 of 382
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DRAFT 35 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome These are no National Indicators to measure our progress towards this outcome. We use staff surveys and other local information to evaluate our performance. Staff experience - iMatter In the 2025/26 iMatter survey, the Midlothian Health and Social Care Partnership Employee Engagement Index was 78/100. This is the same score as 2024/25. 62% of staff took part in the iMatter survey, which is also the same as the rate in 2024/25 (62%). The 2025 iMatter Survey highlighted several areas where staff had a positive experience. I feel my direct line manager cares about my health and wellbeing I am clear about my duties and responsibilities I am treated with dignity and respect as an individual My work gives me a sense of achievement My direct line manager is sufficiently approachable Our workforce The workforce is our greatest asset, but we do not directly employ any staff. The health and social care workforce are employed through Midlothian Council, NHS Lothian, and organisations in the Independent and Third sector alongside our unpaid carers and volunteers. Scottish Government asked us to develop an Integrated Workforce Plan for 2025-28. We consulted with our Partners, staff, Trade Unions, HR, and Finance. The themes that emerged were leadership and management, a nurtured and empowered workforce, training and development, and recruitment and retention. A draft Integrated Workforce Plan was submitted to Scottish Government on 17th March 2025. We must wait for feedback on this before a publication date can be set. Because Midlothian Health and Social Care Partnership is a Directorate of both NHS Lothian and Midlothian Council there will be overlap between this plan and both the NHS Lothian Workforce Plan and the Midlothian Council Workforce Strategy 2024-34. Our Integrated Workforce Plan 2022-25 can be found on our website. Page 281 of 382
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DRAFT 36 Staff wellbeing Working within community settings can be challenging with regular exposure to complex and distressing situations. Psychological issues, including stress, continue to be the primary cause of sickness absence. We want to prioritise ensuring that all staff that work within Midlothian Health and Social Care Partnership are safe and well at work and have continued to fund a Staff Wellbeing Lead post to work alongside staff groups, listen to what matters to them, and provide tailored support. In 2025/26 Midlothian Health and Social Care Partnership refreshed its Staff Wellbeing, Experience and Engagement Delivery Plan for 2025-2028. This plan focused on the four key drivers designed to improve and maintain staff wellbeing. Work has meaning and a positive impact on staff Work is a healthy place to be We are all able to show leadership We listen to staff, and they feel heard. Managers from within the Midlothian Health and Social Care Partnership have committed to sharing information with staff and being transparent over how decisions are made. We do this by demonstrating visible leadership through developing a schedule of engagement opportunities for senior managers of NHS Lothian, Midlothian Council and Midlothian IJB, and ensuring staff feel involved in decision making with regular feedback opportunities. One example of this is the Midlothian Health and Social Care Partnership Question Time which is a new initiative in 2025/26. This regular ‘Question and Answer’ session is with Midlothian health and social care leaders and is an opportunity for staff to explore the issues that matter to them and hear updates on key issues. Questions are collected in advance so the meeting can address popular themes and build connections between staff. Staff in Midlothian continue to enjoy a monthly lunchtime Soup Stop hosted in the café at Midlothian Community Hospital. These events give staff an opportunity to spent time together, share support, and meet the Executive Leadership Team. Conversations focus on working together and staff wellbeing. In 2025/26 over 250 meals were provided with 25-35 people attending each session. Our Welbeing support includes education and information sessions and opportunities to learn something new. Midlothian Health and Social Care Partnership encourages all staff to take part in the Staff Network ‘Lunch and Learn’. Sessions are held regularly throughout the year and cover a range of subjects from carers rights, menopause and menstrual health, pelvic floor health, disability pride, and neurodiversity. In 2025/26 we supported the NHS workplace campaign ‘Better Informed, Better Choices’ to improve staff access to clear, accurate, and timely health information. The project supported staff Page 282 of 382
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DRAFT 37 to access digital tools and screening information covering topics such as breast and prostate cancer, diabetes, and hypertension. Reflective Practice sessions are offered to staff to provide an opportunity for continued learning by considering situations they have experienced in their work, exploring outcomes, and improving the quality of their service. In 2025/26, 25 sessions were held and between 10 – 14 people attended each one. In recognition of the challenging day to day emotional and physical demands experienced by staff working within the Learning Disabilities team, four bespoke support sessions were delivered at the Cherry Road Centre to encourage teamwork, camaraderie, wellness, and resilience. Quarterly reflective practice sessions are now in place and staff noted the success. One to one Wellbeing Support and Coaching provided by the staff Wellbeing Lead can help staff take a step back and think about how to care for their own health and wellbeing. During 2025/26 over 25 individual and group sessions were offered to staff in Midlothian. National Workforce Wellbeing Week took place in the first week of September and Midlothian Health and Social Care Partnership hosted 5 sessions with over 200 members of staff coming together to have meaningful conversations about wellbeing within the workplace. Topics focused on how to use cognitive behavioural approaches to manage stress, recognising and managing menopause, and mindful movement and meditation. To mark the end of National Workforce Wellbeing Week, an event was held at Midlothian Community Hospital supported by Midlothian Council, NHS Lothian, and the Third Sector. The event was attended by over 60 staff. who joined in team building exercises, e-bike rides, a silent disco, and hand massages. Feedback was overwhelmingly positive and when staff were asked if they would attend a future National Workforce Wellbeing event, 98% said yes. “It was good to have time to listen to each other and find out what is going on for each other.” “I think it helped having someone out with the team facilitating the conversation. It allowed me to participate as an equal.” “My coach offered me a different way to look at things and made me think about giving consideration to my own needs. I left the meetings with next steps in place, which I wouldn’t have achieved by myself.” “The coach was a great listener and calming to talk to.” Page 283 of 382
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DRAFT 38 On November 6th 2025, Occupational Therapy colleagues, Therapy Support Workers and Community Care Assistants from across Midlothian Health and Social Care Partnership met to mark National Occupational Therapy Week. This was an opportunity for staff to meet face to face and connect with professionals they often only speak to virtually. The day was spent sharing experiences, learning from one another, and celebrating the vital role occupational therapy plays in helping people live meaningful lives. 32 people attended the event, and the impact as described by the attendees was “transformative, meaningful, person-centred and empowering”. Everyone working across health and social care has an important contribution to positive and healthy working environments. Midlothian Community Hospital were offered a programme of support for staff to learn about each other, share thoughts and ideas, and appreciate differences. Four consecutive weekly sessions were provided and a range of staff attended, with positive feedback reported. We continue to prioritise working closely with our NHS Lothian and Midlothian Council Partners to develop skills and knowledge of all staff working within Midlothian Health and Social Care Partnership. In the last year, the Learning and Development team delivered and coordinated more than 1000 learning opportunities, from SVQ programmes (Levels 2, 3 and 4) to Adult Support and Protection, Foundation and Modern Apprenticeships, Child Protection, Team Teach, Trauma Informed Practice, Motivational Interviewing, Dementia Awareness and Medication training. Staff have also accessed post-graduate courses through Edinburgh and Stirling Universities, The Open University, and Napier University. In line with the experience across health and social care nationally, recruitment and retention continued to be a challenge for Midlothian Health and Social Care Partnership. Areas where this has been particularly challenging is recruiting to Social Worker posts, and ongoing staff vacancies within Highbank Intermediate Care Unit, Care at Home, and Newbyres Care Village. The Third Sector plays a significant role in Midlothian by working alongside health and social care services to help vulnerable people, support services and encourage a sense of community. In Midlothian there are approximately 30 000 volunteers working with over 500 formal groups or voluntary associations, including sports clubs, uniformed youth groups (e.g. Brownies and Scouts) and small special interest groups such as art clubs and history societies. In addition, there are 270 registered charities and 73 social enterprises. We work also work closely with the Midlothian Third Sector Interface through the Board and committee meetings, and support the Third Sector Summits held in May and October 2025. “The sessions were very relaxing and very eye opening how we handle situations mentally and physically, also making us realise how much we overthink things we cannot control, it brought us all together and gave us a reason to listen to one another." Page 284 of 382
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DRAFT 39 On 25th May 2025 volunteers from across Midlothian arrived at Newbattle Abbey College for the annual Midlothian Volunteer Awards Ceremony. This celebration is part of the national initiative, Volunteer’s Week, and Midlothian Health and Social Care Partnership sponsors the Health and Wellbeing and Active Volunteer Award at the ceremony each year. Page 285 of 382
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DRAFT 40 9 Use of Resources Resources are used effectively and efficiently. Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome Indicator 4 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. 2025/26 is a reporting year and so this indicator has been updated from 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators. National Indicator Our result Our Progress 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. Page 286 of 382
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DRAFT 41 We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in our Strategic Plan guide how we allocate the money we receive. The Midlothian IJB Medium-Term Financial Strategy supports the monitoring of financial activity and planning. Midlothian Health and Social Care Partnership use the money allocated to services to plan, deliver, monitor, and evaluate the services it provides and commissions. In 2025/26, Midlothian Council and NHS Lothian supported us with the best funding offer they could, but it was not enough to keep pace with the health and social care needs of our people and community. We worked with Midlothian Health and Social Care Partnership to transform services in Midlothian and address local financial challenges. Our transformation priorities for 2025/26 were set out in our Directions 9.3.1 to 9.3.8. Over the course of 2025/26 we learned that we had asked Midlothian Health and Social Care Partnership to undertake too many changes at the same time. The ambitious programme of work in combination with ‘Business as Usual’ service provision and delivering on Financial Recovery Plans meant that we made good progress in some areas and found it more challenging to see change in others. 1. Direction 9.3.1: Midlothian Council and NHS Lothian will support Midlothian HSCP to ensure people can access well-coordinated, timely and high-quality palliative care, care around death, and bereavement support based on their needs and preferences. Services that provide palliative care continue to deliver quality care and support and this workstream focused on delivering the ambitions of the national Palliative Care Strategy Delivery Plan 2025 – 2028. 2. Direction 9.3.2: Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign and ensure the most efficient and effective operational model of bed-based provision. A Midlothian Community Hospital review redesigned bed-based and community pathways to reduce length of stays and support the Home First principles. Planned Date of Discharge was introduced with a 90% compliance rate and overall lengths of stays reduced. Work also included the progression of the Midlothian Life Care Facility with 40 beds and rehabilitation flats and the completion of the design of the Midlothian Life Health and Social Care Hub. Wider transformational planning and progress have been limited due to operational pressures and the complexity and interrelated components of this workstream. This remans a priority for 2026/27. 3. Direction 9.3.3: Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign the Home First model of care. Great progress was made, and a full update was provided to the Transformation and Change Programme Board in November 2025. Staff engagement sessions highlighted improvements that could be made in data collection and process improvement to deliver care more efficiently. Several opportunities for redesign were identified, including triage, screening processes and travel efficiencies. 4. Direction 9.3.4: Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review to scope viable opportunities to change financial flow from acute hospital services to the community designed to sustain and expand general practice, mental health & community services at a local level. The Midlothian Health and Social Care Partnership Primary Care Strategic Working Group has made progress in this area and identified a number of priority areas for continued improvement. Page 287 of 382
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DRAFT 42 5. Direction 9.3.5: 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. A review of commissioned contracts was undertaken and a revised model of Contracts and Commissioning is planned. This remains a priority for 2026/27. 6. Direction 9.3.6: Midlothian Council and NHS Lothian will ensure that the Midlothian Community Planning Partnership makes best use of the opportunity to bring local public bodies together with local communities and local community partner organisations to effectively strategically plan, design, and deliver service offers that make a real difference in people’s lives. The Community Planning Partnership “Midlothian Will Be Healthier” group was reconvened, and work undertaken with a range of stakeholders to agree priorities for 2026. Planning has also commenced to prepare for the new Single Midlothian Plan. 7. Direction 9.3.7: NHS Lothian and Midlothian Council will support Midlothian HSCP to improve the experience of people in Midlothian with Dementia by ensuring everyone with a diagnosis of dementia can be offered Post-Diagnostic Support for the first year of their diagnosis and has access to 8 Pillars Model of Community Support. Great progress was made in 2025/26 with plans for 2026/27 to implementing the Midlothian Health and Social Care Partnership Dementia Framework. Work includes reviewing accommodation options for long-term patients, access to services, and ensuring a consistent service approach. 8. Direction 9.3.8: Midlothian Council and NHS Lothian will support Midlothian HSCP to review and improve both the system flow, and the experience of people seeking information and seeking support from integrated services by telephone, electronic communication, or written communication. Transformational planning and progress have been limited due to operational pressures. This work is at an early stage, but the ambition is to provide clear, simple and consistent access to care. This remains a priority for 2026/27. We listened to the services undertaking the design and delivery of this work and recognised that delivering services day to day, executing financial recovery plans, and leading on transformation was a big ask. Our Directions for 2026/27 have taken this into account and we have aligned this work without financial recovery actions in a more focused approach. Page 288 of 382
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DRAFT 43 Next steps for Transformation In our Directions for 2026/27, we have asked Midlothian Council and NHS to support Midlothian Health and Social Care Partnership to focus on three areas of transformation. Direction 9.3.2 Bed based provision, to enable people to access appropriate levels of care when their needs change. Direction 9.3.5 Commissioning and Third Sector, to undertake a review of commissioning spend and establish a new partner provider model. Direction 9.3.8 Midlothian Single Point of Access, to design and implement a method to support people’s contact across different health and social care services. Page 289 of 382
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DRAFT 44 Our hosted services We plan for and direct two pan-Lothian hosted services that are managed by Midlothian Health and Social Care Partnership. These are Dietetics and the Adults with Complex and Exceptional Needs Service (ACENS) who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships; Midlothian, East Lothian, West Lothian, and City of Edinburgh. Dietetics Service Adult Acute Adult Acute Dietetic team support people who are in hospital and are at risk of malnutrition and provide advice and support to people with complex nutritional care needs before being admitted to hospital. Nutrition plays a crucial role in acute care and cancer care as nutrition is an important part of recovering from operations and can help people leave hospital and return home more quickly. In 2025/26, the team introduced a nutritional screening pilot to help lower the impact of surgical stress, reduce lengths of stay in hospital, and contribute to positive outcomes of treatment and support. This work has led to improvements in a number of acute hospital and cancer services: Following dietetic assessment, 48% of people who needed a liver transplant were started on Oral Nutritional Supplements (ONS) or had their ONS increased. Dietetics support to people with lung cancer led to a 95% confidence level that their length of hospital stay would be reduced compared to those without dietetic input. Nutritional support for people with endometriosis and pelvic pain led to significant reductions in ward admissions from a total of 62 over a five-year period to just 3 in 2025/26. Nutritional support for people in critical care recovery made significant reductions to length of stay in hospital. At the Royal Infirmary of Edinburgh, length of stay decreased from 16 days to 11.5 days and at the Western General Hospital from 22 days to 18 days. Paediatric The Paediatric Dietetic service supports children and young people, as well as their families and carers, in community-based clinics across Lothian. Throughout 2025/26, the service received around 480 new referrals with 80% of those seen in appointments. The dietetic-led coeliac pathway manages 5 – 7 referrals a month and delivers timely support in diagnosing coeliac disease. In 2025/26, the service saved approximately £400 000 by optimising both diagnosis and treatment of cow’s milk protein allergies. Community Enteral Nutrition The Enteral Feeding Dietetic team supports around 300 adults receiving tube feeding across Lothian. People receive care either in their own homes or in an outpatient clinic, supporting care closer to home and reducing reliance on acute services. The team works closely with Nutricia Homeward service nurses in a collaborative approach that supports patients to remain safely at home, manage tube-related complications in the community, and prevent avoidable hospital Page 290 of 382
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DRAFT 45 admissions. Recent recruitment initiatives have enabled the team to provide support to the Head and Neck Oncology clinic, with a dedicated dietitian attending appointments once a week. Intellectual Disability The Intellectual Disability Dietetic team supports a range of complex health, social and communication needs, including 100 people who receive tube feeding. The team work closely with community nurses, learning disability teams, GPs and social care staff to ensure safe, coordinated and effective nutritional care. The team provides inclusive, accessible education and actively contributes to research activity in the Lothians, including a multi-centre trial evaluating the use of DESMOND education groups adapted for people with an intellectual disability. Community Gastrointestinal (GI) The Community GI Dietetic team provide care across the Lothians with a strong emphasis on digital innovation, timely access and patient choice. Face to face clinics are offered at a range of locations, enabling people to be seen close to home, 89% of people who had support from the team in 2025/26 said they were happy with venue of their appointment. As part of the Irritable Bowel Syndrome (IBS) care pathway, 60% of patients access their first appointment via a video link which reduces travel and supports self-management. At the end of 2025, follow up session that could be requested by patients were introduced and found this helped reduced the number of unnecessary appointments and supported continuity of care. Community Locality The Community Locality Dietetic team works alongside patients, their relatives, and carers to manage nutritional needs within the community and helps those with long-term conditions make dietary changes to support rehabilitation and quality of life. The team receives an average of 5154 referrals annually across Lothian, with between 30-50 of these referrals are supported at Midlothian Community Hospital. Prescribing and Care Home The Care Homes and Prescribing Dietetic team provides specialist advice and support to all care homes across NHS Lothian. They provide early intervention, safe prescribing, and nutritional care for residents with complex needs. The team are working collaboratively with two GP practices in Midlothian to manage oral nutritional supplement (ONS) and enteral tube feed prescribing and plan to extend this service to more GP practices. Midlothian Community Respiratory Team The Midlothian Community Respiratory Dietetic team deliver care for people with chronic obstructive pulmonary disease (COPD) and bronchiectasis and focus on self-management, rehabilitation and prevention of admission to hospital. The team includes physiotherapists, a psychologist and a dietitian who can support early identification of malnutrition and offer prompt treatment. This work has significantly contributed to admission rates to hospital for people from Midlothian with COPD being lower than the national average. Page 291 of 382
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DRAFT 46 Dietetics and digital Digital delivery is a critical part of how Dietetics deliver their services and expanding digital and hybrid delivery of care continues to be a focus. Currently, 56% of appointments are delivered via virtual groups and individual assessments, with both Gestational Diabetes and Diabetes Remission offering a fully remote service. Further work is planned to help streamline access to services and triage, increase capacity so more people can receive treatment, and improve pathways so people can easily move between services to get the right support at the right time. Adults with Complex and Exceptional Needs The Adult Complex & Exceptional Needs Service (ACENS) provides care across the four Lothian regions for people with exceptional health care needs. The service supports care in a variety of community environments including home and respite settings. ACENS provides consistent and continuous high-quality care, up to 24 hours a day, 7 days a week, working in partnership with the person and their family, carers and other care giving agencies including the Education and Social Work departments and respite facilities. Many of the people receiving care from ACENS depend on technology to support them live well in their community with a life limiting condition. The service provides highly specialist care for people in challenging circumstances and also support the families of those being cared for by offering dignified and respectful care that centres on the person and their loved ones. In 2025/26, the ACENS team were nominated for the Scottish Health Awards in the Integrated Care category. This was in recognition of their compassionate and skilled intervention to support a young person and their family through the transition from paediatric services to adult services during challenging period of health and wellbeing. Page 292 of 382
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DRAFT 47 How we spent our money (2025/26) We are funded by our partners, Midlothian Council and NHS Lothian, and are responsible for the integrated budget we receive. This funding is to deliver health and social care in Midlothian. We work closely with our Partners and receive a budget offer from them both every year. However, we often don’t know exactly what this will be until February or March each year. This is because of how our Partners receive funding from Scottish Government. Financial challenges during 2025/26 We continue to experience financial pressures that reflect both national trends and specific local challenges within Midlothian. This section will be updated in August following the publication of our draft annual accounts. How we spent our money in 2025/26 Health Budget £000’s Social Care Budget £000’s Health Expenditure £000’s Social Care Expenditure £000’s Variance £000’s Note Direct Midlothian Services Community AHPS Community Hospitals District Nursing General Medical Services Health Visiting Mental Health Other Prescribing Resource Transfer Older People Learning Disabilities Mental Health Physical Disabilities Assessment & Care Management Social Care Other Midlothian Share of Pan Lothian Set Aside Page 293 of 382
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DRAFT 48 Health Budget £000’s Social Care Budget £000’s Health Expenditure £000’s Social Care Expenditure £000’s Variance £000’s Note Mental Health Learning Disabilities GP Out of Hours Rehabilitation Sexual Health Psychology Substance Use Allied Health Professions Oral Health Hosted Other Dental Ophthalmology Pharmacy Sub Totals Partner Additional Contributions Movement in Earmarked Reserves Per Annual Accounts Page 294 of 382
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DRAFT 49 Main Areas of Spend (2018/19-2025/26) The graph below compares our spend trends for the past 8 years. We are unable to report on spend by locality as we do not hold data in this form. £ 000's 112,900 32,273 22,285 19,726 17,317 Community Hospital Prescribing GMS Other 120,000 100,000 80,000 60,000 40,000 20,000 0 Main Areas of Spend 2018/19 - 2025/26 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 2024/25 Page 295 of 382
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DRAFT 50 Communication and Engagement We have worked with local people throughout the year to help us understand what is working well, where we can improve and how we can do better. Some examples across 2025/26 include: This section will be updated in August following the analysis of the Midlothian IJB Annual Survey. Self-Evaluation of our community engagement We used the Healthcare Improvement Scotland Quality Framework for Community Engagement and Participation and Self Evaluation Tool to consider how well we were working alongside people and communities, and the impact of this on strategy development and service improvement. We used the quality indicators within the Framework to recognise what was already working well and identify opportunities for improvement. We concluded we had areas of strength in ‘Involvement of people in service planning, strategy and design’, and that we were improving in areas of ‘Governance and leadership’. We also identified ‘Ongoing engagement and involvement of people’ as an area for improvement. In October 2025 we published our Midlothian IJB Participation and Engagement Statement 2025-2028 which outlines the action we will take across 2025- 2028 to improve how we work alongside people and communities in Midlothian. Living Well In Midlothian annual survey In spring 2026 we launched our second annual survey and invited people living in Midlothian to complete a questionnaire to share their views about health and social care. We asked people about their health and wellbeing, getting the help and support they need, providing help and support to others, help with everyday living, health conditions and illnesses, and community and services. We took a similar approach to the national Health and Care Experience Survey, using validated questions, to help us better understand local people’s experience, focus on opportunities for learning, and identify areas for action. Unpaid Carers Strategy 2025-2028 As we developed our Unpaid Carer Strategy, we listened to local unpaid carers about the roles they undertake and their experience as carers. This helped us to understand what they can contribute, the impact of caring on them, the support they need to continue, and how we can help support them to have a life of their own alongside their caring role. We also listened to the workforce and our commissioned partners. We researched and listened to carer experiences, including how people were identified as a carer, how they accessed support and felt supported, the impact on their finances and employment, carer wellbeing and having a break from caring, and being involved in decisions about their own care and plans for the person they care for. Page 296 of 382
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DRAFT 51 There were three main pieces of consultation that informed the Strategy: 1. In-person staff workshop in May 2025. This workshop included 26 members of staff from the Third Sector, Midlothian Council and Midlothian Health and Social Care Partnership 2. In-person Carers Action Midlothian meeting in October 2025. We spoke to 5 carers and 2 members of staff from our commissioned partner, VOCAL. 3. Online public survey in across November and December 2025. 34 people gave feedback on our draft strategic priorities. In all the conversation we had with carers and staff, there was strong support for the draft priorities and a shared desire for change in how services connect, communicate, and respond. The most urgent needs were identified as the need for a single point of contact, better navigation support, early and proactive identification, accessible and consistent information, financial support and employment flexibility, replacement care to make breaks possible, and meaningful involvement at all transition points. Midlothian Health and Social Care Partnership Engagement Advocacy Strategy Midlothian Health and Social Care Partnership ran a lived experience engagement process to inform the development of the Midlothian Health and Social Care Partnership Independent Advocacy Strategy 2026–2029. The focus was on gathering views from individuals with a statutory right to independent advocacy under the Mental Health (Care and Treatment) (Scotland) Act 2003. A variety of approaches were used to reach adults with mental ill health, adults with learning disabilities, older adults with mental ill health, and young people with disabilities. These included a digital survey, three focus groups, and one to one conversations. Third Sector and independent advocacy providers played a key role in supporting participation and building safe, accessible opportunities for people to contribute. Four key areas were explored: awareness, accessibility, effectiveness, and priorities for the future of independent advocacy. A digital survey in 2025 gathered 25 responses which told us people value independent advocacy, but it is not always easy to understand or access. Collective independent advocacy also matters as it helps people work together, shape services and support one another. People said it gave them confidence, connection and a real voice in decisions that affect them. Midlothian Health and Social Care Partnership have made a commitment to ensure more people in Midlothian have access to advocacy and can get advice and support to stay well. Adult Support and Protection (ASP) Adult Support and Protection Case Conferences (ASPCC) are multi-agency meetings where services from social work, police, and health discuss plans to offer support to an adult who is at risk of harm under the Adult Support and Protection (Scotland) Act 2007. The adult at risk is invited to attend the Page 297 of 382
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DRAFT 52 ASPCC and is offered advocacy and support. Midlothian Social Work is currently developing a process where adults who have been to an ASPCC are offered an opportunity to provide feedback on their experiences with first contact, assistance during a case conference, and the difference the support made to their care. A form has been reviewed and is now in use for people to give feedback via a paper or electronic copy, or on the phone with the Health and Social Care Practitioner within the ASP Team. Work is ongoing to embed feedback in our planning and ensure that the feedback gathered is meaningful. Community Justice Midlothian’s Community Justice Partnership coordinated a consultation survey from 7th July to 17th August 2025 to inform service design and delivery. There were 9 main survey questions, and 285 responses were received. When people were asked what Midlothian’s Community Justice Partnership could do better, respondents most commonly said they wanted awareness of the service to improve, and that services are kept relevant to reflect the specific needs of Midlothian. People also wanted to be kept up to date with community justice updates digitally through social media and website updates. People were also positive about the role services play in Midlothian communities. Trauma Awareness Week Between the 15th and 19th of September, Midlothian Health and Social Care Partnership organised a week of face to face and online events and webinars to share feedback and lived experience on how to support people with trauma. 58 people attended the in-person launch on Monday September 15th and the event focused on collaboration, with presentations from East and Midlothian Women’s Aid, Midlothian House Project, Play Therapy Base, and Midlothian’s Trauma Informed Practice Steering Group. A further 91 people joined webinars throughout the rest of the week and discussions focused on subjects like trust, safety, empowerment and choice. Feedback was overwhelmingly positive and participants shared that they felt confident to put their learning into practice. Consultation on supporting and promoting Gaelic in Midlothian 2026-2031 In the 2022 Scottish census, 0.6% of the Midlothian population identified themselves as Gaelic speakers with 365 individuals speaking, reading and writing Gaelic. Midlothian Council conducted a public consultation on supporting and promoting Gaelic in the local area between November 2025 “The events have all been excellent and certainly have people talking and thinking about the impact of trauma, which we all know is important.” “Women’s Aid and Children’s First I feel are one of the best services in Midlothian. I feel they communicate well together, have a great understanding that not everything is black and white, and have other knowledge of access to help within the community.” Page 298 of 382
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DRAFT 53 and January 2026. The consultation was designed to help Midlothian Council deliver their Gaelic Language Plan 2026-2031 which aims to increase opportunities for the community to engage with Gaelic, support the sustainability of Gaelic education (GME) and progress Gaelic Learner Education (GLE), and increase the visibility of Gaelic resources and materials. The results of the consultation were not available at the time of this report. Page 299 of 382
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DRAFT 54 Equality We ensure equality is at the heart of what we do. This includes how we make decisions and spend money, the way we work alongside people and communities, and how we improve our services. Protected characteristics are aspects of a person’s identity that are protected by law under the Equality Act 2010. These include age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. We must work towards ensuring everyone receives fair and equal health and social care. Midlothian has a unique population with its own specific health and social care needs. We use data from the National Census to understand the profile of the people who live in Midlothian and how their access to health and social care may be affected. In Midlothian, Equality and Children’s Rights Impact Assessments (ECRIAs) are completed to consider how our decisions might impact on people with protected characteristics and advance equality where possible. We completed 9 Equality and Children’s Rights Impact Assessments for the following new or revised strategies, policies and plans, provisions, practices, and activities: 1. Midlothian Integration Joint Board Participation and Engagement Statement 2025-2028 2. Midlothian Integration Joint Board Strategic Plan 2025-2035 3. Midlothian Integration Joint Board Unpaid Carer Strategy 2025-2028 4. Midlothian Integration Joint Board Financial Recovery Plan Commissioning 2025-2026 5. Midlothian Integration Joint Board Financial Recovery Plan Bed Base 2025-2026 6. Midlothian Integration Joint Board Financial Recovery Plan Commissioning 2025-2026 7. Midlothian Integration Joint Board Financial Recovery Plan MCH Bed Base Review 2026-2027 8. Midlothian Integration Joint Board Financial Recovery Plan Care at Home 2026-2027 9. Midlothian Integration Joint Board Financial Recovery Plan Learning Disability 2-1 and Sleepovers 2026-2027. Page 300 of 382
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DRAFT 55 Protected characteristics in Midlothian Page 301 of 382
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DRAFT 56 Update on our Equality Outcomes 2025-2029 Mainstreaming Equality Update Our Equality Outcomes 2025-2029 set out the actions we would take to advance equality in Midlothian. To comply with our Public Sector Equality Duty, we must provide an update every two years on what we have done to address equality issues in Midlothian. As part of our ambition for equality to be central to our planning, delivery, reporting and evaluation, we have provided an update on our activity for 2025-2026 in this report and will continue to report on progress every year. We are working towards making equality part of our day-to-day work and our mainstreaming outcomes support everyone with each of the protected characteristics. Our 4 specific equality outcomes in this report do not cover every protected characteristic but are chosen as they link closely to the aims in our Strategic Plan 2025-2035, and people told us they were important to them in our consultation: Outcome 1: People have a choice about how they access information and support from integrated services. Actions: We have reviewed our publicly available information to ensure it is compliant with our duties relating to accessibility and is accessible both on and offline. Everything published by the IJB during 2025/26 has been checked and is compliant with accessibility policies. We collected feedback that we can use to continuously improve the information we provide. Several services have used feedback to improve how they share information: 1. Midlothian Community Hospital designed an information board to be installed at reception to assist families of those in care to navigate the hospital, 2. A number of staff were offered weight stigma training that was designed based on individual feedback on how people felt they were treated due to their weight, and 3. STRIDE, a program designed to help men who had contact with the Justice service manage their emotions, coproduced a leaflet with people with lived experience to raise awareness of the service. Outcome 2: People who want to choose Self Directed Support have better information about which option is right for them. Actions: We have asked Midlothian HSCP to adopt our ‘Writing for Publication Style Guide’ to ensure all service information is person-centred and meaningful from the perspective of those it is intended to support. A revised version of the guide was published in January 2026 and is accessible for all staff. Page 302 of 382
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DRAFT 57 We have developed consistently presented online and paper service information, and link with both Partner’s websites and information. There is an ongoing program to review and improve these links. We have ensured that staff can support people to request and access accessible information. We did not receive any requests for information in an alternative format in 2025/26. Outcome 3: Older people have a reduced risk of admission and readmission to hospital. Actions: We have improved the data on risk of admission and readmission to hospital to better support clinicians and practitioners to identify and provide appropriate preventative care and early interventions. We have taken the time to build new relationships and work closely with a range of partners to better coordinate and link redesigned services for people with multiple conditions, including frailty. Outcome 4: Unpaid carers feel supported to continue in their caring role. Actions: We have considered the impact of moving care from hospital to home on unpaid carers, and evidence supportive actions. We have published ECRIAs on our transformation plans and this includes consideration for the impact on unpaid carers. Our Unpaid Carers Strategy sets out the actions we will take to support carers welfare and their ability to provide care for as long as they wish to. We have ensured that unpaid carers have access to Welfare Benefits advice and that unpaid carers have been offered a Carer Support Plan. We will continue to make sure that carers have access to information on other benefits, grants and financial support that is available to them. We have asked our Midlothian Council and NHS Lothian Partners to improve the standard of workforce equality data. NHS Lothian delivers an annual Equality and Inclusion Staff Survey to invite staff to share their experiences and opinions. 1670 members of staff across NHS Lothian completed the 2025/26 survey, and responses are being used to support the priorities identified in the Equality and Human Rights Strategy 2023-2028. Midlothian Council are developing a system to record equality information on their workforce system ‘iTrent’ and are working to raise awareness of why this information is important. Page 303 of 382
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DRAFT 58 Looking forward We continue to look to the future. In October 2025 we published our Strategic Plan with a 10-year vision setting out an ambitious but realistic programme of transformation. We have asked Midlothian Health and Social Care Partnership to redesign health and social care as part of a new, sustainable financial model. Integrated health and social care is changing. This is because of the way our communities are growing, the types of support that people need, and other influencing factors like legislation, national policy, and Scottish Government priorities. We must balance our decisions with safety, efficiency, and effectiveness, and use opportunities to redesign to deliver a new and sustainable future for health and social care. We know we need to do things differently. The scale of transformation required means we must deliver care and support in new ways. The Midlothian Health and Social Care Partnership Operational Transformation and Change Programme Board is redesigning a range of health, social and primary care community-based services that are personalised, flexible, and person-led. This work aims to invest in early intervention and prevention, self-management, and education so people make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. In our Directions for 2026/27, we have asked Midlothian Council and NHS to support Midlothian Health and Social Care Partnership to focus on three areas of transformation. 1. Bed based provision, to enable people to access appropriate levels of care when their needs change. 2. Commissioning and Third Sector, to undertake a review of commissioning spend and establish a new partner provider model. 3. Midlothian Single Point of Access, to design and implement a method to support people’s contact across different health and social care services. We have also agreed two strategic financial priorities for effective financial planning and reporting. 1. We use a new financial evaluation framework to monitor our financial performance in a dynamic and changing system. We use System Thinking to design new feedback loops that help us make good decisions as health and social care transforms, use financial forecasting to plan ahead and anticipate change, and take corrective action when our funding decisions are no longer helping us achieve our priorities. 2. As the system changes and transforms, we are confident we are investing in the right places to deliver change in the shortest time possible. We have effective feedback loops that describe the financial position as the system transforms, identified where investment will make the biggest impact, and evidence how we are delivering care and support more efficiently and effectively. Page 304 of 382
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DRAFT 59 Inspections The Care Inspectorate inspect care homes and care at home services to check the quality of care. The majority of care homes in Midlothian are not managed by the Health and Social Care Partnership. Read the full reports at the Care Inspectorate website. 6 Excellent 5 Very Good 4 Good 3 Adequate 2 Weak 1 Poor Care at Home – Support Services Name Date People's wellbeing Leadership Staff team Setting Care & support planning CC Homecare Ltd Support Service September 2025 Not assessed Call-In Home Care West Lothian Support Service October 2025 Not assessed Not assessed Tanshe Care Services October 2025 Not assessed Not assessed J R Care Community Services February 2026 Not assessed Page 305 of 382
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DRAFT 60 Recommendations and Areas for Improvement (if any) Name Recommended Improvement Call-In Home Care West Lothian Support Service To ensure people's health and the wellbeing of staff and people, the provider should ensure that quality assurance and leadership tasks are prioritised by managers. This should include, but not be limited to, ensuring that managers are not regularly delivering direct care and support, to enable staffing and quality assurance processes to be completed. Tanshe Care Services The service should ensure that they develop contingency planning in order to anticipate and respond proactively to adverse circumstances which might impact on care delivery. The service should ensure that staff working with people with complex stress and distressed presentation have undertaken training which supports safe and effective care delivery. Service reviews should be convened at a minimum of six-monthly intervals, or as and when people's needs change. Review should place a greater evaluative focus on the outcomes arising from care delivery. Personal plans should be maintained and accurately reflect people's circumstances. The author of the personal plan should be clearly indicated. Where risk is identified, there should be a clear risk management response, in order to guide staff and promote effective care outcomes. J R Care Community Services By 14 April 2026 the provider must ensure people have confidence that the service they use is led well and managed effectively. To do this, the provider must at a minimum: a) The management have effective oversight of the day-to-day delivery of care to service users to ensure their care needs are fully met. b) The management have a visible presence within the service and engage with service users, relatives and staff to support the development of management oversight required. c) The management engage in a meaningful way with service users and staff about the quality of the service and take action to address improvements identified, to ensure improved outcomes. By 10 March 2026, the provider must ensure all staff employed within the registered service in roles that fall within SSSC regulated categories are registered with the Scottish Social Services Council (SSSC). To do this, the provider must at a minimum: a) Verify that all staff who require SSSC registration hold an active registration or have submitted an application within the required timeframe. b) Maintain accurate and up to date records of each employee’s registration status, renewal dates, and conditions of practice. Page 306 of 382
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DRAFT 61 Name Recommended Improvement c) Monitor ongoing compliance, including ensuring staff complete required post registration training and learning. d) Notify the SSSC of any concerns. By 14 April 2026, to ensure people experience high quality care and support delivered by a competency, confident and well supported workforce, the provider must ensure that all staff receive regular, planned and recorded supervision, appropriate training which is assessed for learning outcomes with ongoing observations of practice. To do this, the provider must at a minimum: a) Implement a structured supervision system that ensures all staff receive supervision at the frequency stated in the service’s own policy. b) Ensure supervision records are completed, stored appropriately, and demonstrate reflective discussion, identification of learning needs, and follow up actions. c) Develop and maintain an Up To Date training matrix, that clearly shows mandatory, refresher and role specific training, including due dates and completion status. d) Ensure all staff complete mandatory training within expected timescales, and that training is evaluated for effectiveness. e) Introduce a planned programme of direct observations of practice, carried out by suitably skilled senior staff, with written records that identify strengths, areas for development, and agreed actions. f) Use information from supervision, training and observations to inform ongoing workforce development and to ensure staff practice meets expected standards. Care Homes for Older People Name Date People's wellbeing Leadership Staff team Setting Care & support planning Nazareth House July 2025 Pittendreich Care Home September 2025 Springfield Bank Nursing Home September 2025 Nazareth House November 2025 Not assessed Not assessed Not assessed Newbyres Care Village January 2026 Aaron House Care Home February 2026 Not assessed Not assessed Page 307 of 382
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DRAFT 62 Name Date People's wellbeing Leadership Staff team Setting Care & support planning Archview Lodge Care Home February 2026 Not assessed Not assessed Recommendations and Areas for Improvement Name Recommended Improvement Nazareth House Hand hygiene practices among people receiving care are consistent, particularly for those with cognitive or physical challenges. Establish scheduled hand hygiene support led by staff, prioritising mealtimes, and toileting routines. Place clear, user-friendly signage near hygiene stations to encourage good technique and independence. Increase availability of hand sanitiser in communal areas and ensure residents are encouraged and assisted in using it appropriately. Reviewing and updating cleaning protocols to reflect the latest standards, with targeted attention to high-touch surfaces and communal areas. Establishing and maintaining a robust cleaning schedule with clear roles and responsibilities, regular monitoring, and documented evidence of completion. Delivering continuous training and supervision for domestic and care staff on effective cleaning practices, including correct usage of cleaning products and equipment. Conducting regular environmental audits to assess standards of cleanliness, with prompt and responsive action taken when improvements are identified. Oversight must be in place from the management team. Pittendreich Care Home To ensure people experience high quality care, the provider should enable opportunities for staff to reflect on their practice through discussions at team meetings and through regular supervision with their manager. Skin and wound care was being monitored through clinical overviews however, evidencing and recording of checks and treatment plans needed to be improved upon. There must be a system in place that is able to demonstrate that the skin care needs of those residing in the home are regularly assessed and adequately met. A refurbishment plan was now in place. Refurbishment work had commenced however, this was still in the Page 308 of 382
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DRAFT 63 Name Recommended Improvement early stages, with significant work remaining. The manager needed to ensure the onsite maintenance team clearly understood their roles and responsibilities in relation to ongoing maintenance and repairs of the building. Personal plans did not consistently give detailed information regarding people’s health and wellbeing. This included personal care, oral care, food and fluids. Whilst staff appeared attentive to people's needs and knew them well, records should accurately reflect the care given as described in the personal plan. Springfield Bank Nursing Home The provider should ensure that there is a structured support and supervision system in place for staff which incorporates observations of practice in a variety of areas including but not limited to moving and handling, medication, infection control, and stress and distress. This is to support the ongoing development of staff, ensuring they are competent, skilled and able to reflect on their practice to continue to meet people’s needs. Aaron House Care Home In order to promote activity and independence for people living in the service, the provider should have appropriate signage around the home. The use of the King's Fund Environmental Assessment Tool and involving people/their representative in designing the environment is recommended to help ensure that best practice and people's needs and wishes are taken into account. Care Homes for Adults with Learning Disabilities Name Date People's wellbeing Leadership Staff team Setting Care & support planning Dougall Court Care Home Service September 2025 Not assessed Not assessed Not assessed Drummond Grange Nursing Home October 2025 Not assessed Parkside Court February 2026 Not assessed Not assessed Recommendations and Areas for Improvement Page 309 of 382
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DRAFT 64 Name Recommended Improvement Dougall Court Care Home Service The manager should prioritise advancing plans to explore refurbishment of the home, or alternative options as previously outlined, and ensure that individuals using the service, along with their relatives or guardians, are actively and meaningfully involved in shaping decisions about the future of the environment. Clear and realistic timeframes should be established for the completion of all proposed actions. Parkside Court The manager should continue to adapt premises for changing support needs, whilst looking at alternative options as previously outlined, and ensure individuals using the service, along with their relatives or guardians, are actively and meaningfully involved in shaping decisions about the future of the environment. Clear and realistic timeframes should be established for the completion of all proposed actions. Housing Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning St Joseph’s Services – Circle of Best Practise 1 June 2025 Not Assessed Not Assessed Not Assessed St Joseph’s Services – Circle of Best Practise 2 June 2025 Not Assessed Not Assessed St Joseph’s Services – Circle of Best Practise 3 June 2025 Not Assessed Not Assessed Not Assessed Midlothian Park Cottage June 2025 Not Assessed Not Assessed Page 310 of 382
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DRAFT 65 Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning Broomhill Day Centre Penicuik July 2025 The Community Access Team September 2025 Not Assessed Not Assessed Recommendations and Areas for Improvement Name Recommended Improvement Broomhill Day Centre Penicuik To ensure people experience high quality care, the provider should enable opportunities for staff to reflect on their practice and identify further learning and development needs through regular supervision with their manager. To ensure people’s outcomes and aspirations are fully achieved, the provider should utilise the sources of evidence from quality audits, discussions with people, staff, and supportive documents to develop a service improvement and development plan. The Community Access Team The service should consult with and determine key stakeholders’ views on engagement with quality assurance processes in the service. Consideration should be given to developing a forum or forums which allow people to share their views and contribute to service development and improvement plans. The service should develop a training matrix which allows management overview of learning undertaken and insight into when refresher training updates are needed. The Provider should develop a training matrix which allows management overview of learning undertaken and insight into when refresher training updates are needed The service should develop competency-based observations of staff practice, clarifying they have the requisite skills and that they put them into practice during support. Observations should include feedback from people who experienced care and inform discussion, supervision and professional development for the staff concerned. Page 311 of 382
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DRAFT 66 Business and governance IJB Membership Date Change in membership June 2025 Val De Souza was nominated and reappointed as the Lead Voting Member of NHS Lothian with effect from 1st August 2025. Dr Rebecca Green was reappointed as a Non-Voting Member of Midlothian IJB with effect from 18th July 2025. August 2025 Councillor Connor McManus was nominated and accepted as Vice Chair of the Midlothian IJB with effect from 1st July 2025. Val De Souza was nominated and accepted as Chair of the Midlothian IJB with effect from 1st August 2025. July 2025 Colin Small was nominated and accepted to Midlothian IJB’s Strategic Planning Group as a Volunteer Representative with effect from 1st July 2025. September 2025 Keith Chapman resigned from Midlothian IJB as a Lived Experience Member with effect from 30th September 2025. October 2025 Jay Johnson was nominated and accepted as a Lived Experience Member of the Midlothian IJB with effect from 1st September 2025. Following her appointment to the post of NHS Lothian Non-Executive Director, Heather Campbell was nominated and accepted as a voting member of the Midlothian IJB with effect from 13th August 2025. December 2025 Andrew Fleming resigned from Midlothian IJB and as Chair from SPG with effect from 31st December 2025. George Gordon was nominated and accepted as a Non-Executive Board Member of the Midlothian IJB with effect from 1st January 2026. January 2026 Sheree Muir was nominated and accepted as a Lived Experience Member of the Midlothian IJB with effect from 29th January 2026. Dr Anna Beaglehole was nominated as the named deputy for GP representative with effect from 29th January 2026. Page 312 of 382
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DRAFT 67 Date Change in membership February 2026 Dr Anna Beaglehole’s resigned the named deputy for GP representative with effect from 4th February 2026. Dr Paul Bailey was nominated and accepted as a Non-Voting member of Midlothian IJB and specifically as the “registered medical practitioner whose name is on the list of primary medical services performers” with effect from 4th February 2026. Dr Rebecca Green resigned as a Non-Voting Member of Midlothian IJB with effect from 19th February 2026. March 2026 Jay Johnson resigned from Midlothian IJB as a Lived Experience Member with effect from 1st March 2026. Page 313 of 382
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DRAFT 68 Key Decisions Finance Sep 2025 The Midlothian IJB reviewed and updated the Reserve Policy. Jun 2025 The Midlothian IJB draft Annual Accounts 2024/25 were approved for publication. Sep 2025 The Midlothian IJB Annual Accounts 2024/25 were approved for publication. Mar 2026 The Midlothian IJB approved a balanced budget for 2026/27. Strategy, Planning, and Performance Apr 2025 The Midlothian IJB Equality Outcomes for 2025-2029 were approved for publication. Aug 2025 The Midlothian IJB Annual Performance Report 2024/25 was approved for publication. Oct 2025 The Midlothian IJB Strategic Plan 2025-2035 and the suite of accompanying documents were approved for publication. Oct 2025 The Midlothian IJB Participation and Engagement Statement was approved for publication. Feb 2026 The Midlothian IJB Unpaid Carers Strategy 2025-2028 was approved for publication subject to Midlothian Council approving the section on Young Carers (awaiting). Mar 2026 The Midlothian IJB Directions for 2026/27 were approved for publication. Mar 2026 The Midlothian IJB Directions for 2026/27 were issued to the Chief Executives of Midlothian Council and NHS Lothian. Governance and Audit Nov 2025 Midlothian IJB received a conclusion of Significant Assurance from Internal Audit in relation to its strategic planning process. Feb 2026 The Midlothian IJB Meeting Schedule for 2026/27 was approved. Feb 2026 The Midlothian IJB Standing Orders, Scheme of Administration and Scheme of Delegation were approved for publication. Other Activity Mar 2026 IJB Member site visit to Polton Street. Copies of the relevant reports can be found in the committee reports on the Midlothian Integration Joint Board pages of the Midlothian Council website. Page 314 of 382
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DRAFT 69 Our Strategic Governance Outcome Map – this will be updated after the publication of the core suite of indicators. 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 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 People living in Midlothian and who use our services and their unpaid carers Page 315 of 382
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DRAFT 70 Data Appendix National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. Page 316 of 382
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DRAFT 71 Ministerial Steering Group Targets MEASURE 2021-22 2022-23 2023-24 2024-25 2025-26 STATUS Maintain emergency admissions into hospital from Midlothian at or below 767 / month. 9,606 8,458 8,263 9,087 Maintain number of unscheduled hospital bed days: acute specialties at or below 5,074 / month 57,394 60,452 58,123 69,029 Maintain the use of unscheduled: geriatric long-stay beds (all ages) mental health beds (all ages) at or below 2021/22 levels 16,638 11,934 16,747 12,345 14,099P 8,997P 14,604P 7,836P Maintain Emergency Department Attendance (all ages) at or below (2,629 / month) 33,155 33,233 32,453 26,805 Maintain Delayed Discharge Occupied Bed Days at or below 820 / month. 6,135 12,608 9,627 12,501 Reduce the percentage of time people spend in a large hospital in their last six months of life. 8% 8.1% 8.2% No data Maintain the proportion of people over the age of 65 who are living in the community at 97% or higher. 96.9% 96.9% 93% No data SOURCE: Public Health Scotland Integration Performance Indicators 2026 Page 317 of 382
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DRAFT 72 *Where noted the calendar year 2025 is used as a proxy for 2025/26 due to the national data for 2025/26 being incomplete. We have done this following guidance from Public Health Scotland. Where noted this data is provisional. Page 318 of 382
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Midlothian Integration Joint Board Thursday, 11th June 2026, 14:00-16:00 Statutory Climate Reporting Duties for Integration Authorities Executive summary This report sets out the statutory reporting requirements of Integration Authorities (IAs) following a revision of the Scottish Government Public Bodies Climate Change Duties: Statutory Guidance. Midlothian IJB has a statutory duty to report on climate duties and action taken in November each year. The revised statutory guidance notes in Annexe K that the IJB’s reporting duty falls under scope 3 (indirect emissions) and in their wider influence within the health and social care sector. Scottish Government describes IJBs as ‘major players’ and note their important role in responding to the climate crisis and biodiversity loss. This is despite not having assets, employees, or a supply chain of their own and on the basis of the significant influence IJBs have in relation to the local health and social care agenda and the scale of their annual budgets. In order to ensure the IJB can meet is statutory reporting duties, the Audit and Risk Committee considered the action described in section 3.3 and proposed Direction in 5.2 and recommended this to Midlothian IJB for their consideration and approval. As a result of this report, Members are asked to: Note the revised Public Bodies Climate Change Duties: Statutory Guidance, Consider the recommended action described in section 3.3 and proposed Direction in 5.2, and Approve this action and issue of a new Direction 9.6. Item number: 5.9 Page 319 of 382
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Midlothian Integration Joint Board Report Statutory Climate Reporting Duties for Integration Authorities 1 Purpose 1.1 This report sets out the statutory reporting requirements of Integration Authorities (IAs) following a revision of the Scottish Government Public Bodies Climate Change Duties: Statutory Guidance 2 Recommendations 2.1 As a result of this report, Members are asked to: Note the revised Public Bodies Climate Change Duties: Statutory Guidance, Consider the recommended action described in section 3.3 and proposed Direction in 5.2, and Approve this action and issue of a new Direction 9.6. 3 Background and main report 3.1 Midlothian IJB has a statutory duty to report on climate duties and action taken in November each year. The revised statutory guidance notes in Annexe K that the IJB’s reporting duty falls under scope 3 (indirect emissions) and in their wider influence within the health and social care sector. Scottish Government describes IJBs as ‘major players’ and note their important role in responding to the climate crisis and biodiversity loss. This is despite not having assets, employees, or a supply chain of their own, and on the basis of the significant influence IJBs have in relation to the local health and social care agenda and the scale of their annual budgets. 3.2 The Climate Ready South East Scotland (CRSES) Climate Risk and Opportunity Assessment (CROA) combines scientific evidence with local knowledge and lived experiences. Members may also be interested to note the Climate Ready South East Scotland (CRSES) report on key messages for Midlothian in their Phase One (2023- 2025) results report which notes health and social care is predicted to be one of the most impacted sectors. 3.3 The Public Bodies Climate Change Duties: Statutory Guidance notes that IJBs must consider the indirect emissions generated through purchased goods and services that they are responsible for, or can influence, Page 320 of 382
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Midlothian Integration Joint Board IJBs should embed adaptation in their strategic plans, account for this in their work with partners, and ensure adaptation is considered through the impact assessment process, IJBs should ensure that assessment of strategic risks and opportunities includes those posed by the changing climate, with a broad risk included in the IJB Risk Register, how they can best use their influence on the health and social care sector, and on the communities they serve, to support wider mitigation efforts, how the design and delivery of health and social care services can help deliver emissions reductions by describing » critical impacts the changing climate may have on key services or the goods they need to deliver health and social care services; this should include consideration of stacked or cascading risks, » climate impacts on staff and care users, including in relation to the protected characteristics, and » how the design and delivery of health and social care services can be made more resilient to the changing climate. 3.4 In order to ensure the IJB can meet is statutory reporting duties, it is recommended that the following actions are presented to Midlothian IJB for their consideration at the June Board. 3.4.1 Midlothian IJB should include more detail relating to climate considerations at a strategic level in the IJB Strategic Plan 2028-31 refresh. Strategic Planning will continue to note the work alongside the two Partners in relation to climate change awareness and actions noting where delegated functions could contribute to Partners’ ambitions. Discussion and dialogue led by Strategic Planning is ongoing between the relevant NHS and Local Authority lead officers. This work is specifically to » provide high level assurance of the IJBs collaborative working with Partners, and » include the key links to partners policies and plans, as far as they are actionable for the delegated functions of the IJB, in the refresh of the Strategic Plan 2028-2031. 3.4.2 The IJB should update its Risk Register to include a risk regarding its ability to progress climate action. The IJB may also wish to consider cross reference to the climate risks of its NHS and local authority Partners. 3.4.3 The IJB should review the content of its Joint Strategic Needs Assessment (JSNA) and include content related to climate issues and impact. This will be supported by a new place-based approach to the Midlothian IJB JSNA that is currently under development. 3.4.4 The IJB should refresh its ECRIA Tracker, ECRIA Template, and Screening Tool to include prompts regarding climate change and in particular any impact on protected characteristics. 3.4.5 Led jointly by the IJB and HSCP Commissioning, the IJB Market Facilitation Plan should be refreshed to include detail on the ways in which this plan can positively influence the health and social care sector through commissioning, and how it will work with all our partners and providers. 3.4.6 In addition, Midlothian IJB should ensure there are key discussions in relevant fora: Page 321 of 382
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Midlothian Integration Joint Board » The IJB Strategic Planning Group Chair will work with members to ensure i. climate action is considered in each new proposal for service design or delivery. » The HSCP Contracts and Commissioning Group Chair will ensure i. consideration is given to climate action and mitigations within the Midlothian HSCP Partner Provider Statement, ii. ECRIAs are completed for each new commissioning activity iii. appropriate checks and balances are in the Terms and Conditions of contracts e.g., ‘whole life cycle of product’ considered as part of product selection and ensuring procurement practices reflect circular economy principles to minimise any carbon footprint, and iv. an annual report is provided in April each year on how it has influenced change in the previous financial year. 3.4.7 The IJB Workforce Plan should be refreshed in line with Scottish Government timelines and include consideration of climate issue and appropriate action. 3.4.8 As a Category 1 Responder, the IJB should strengthen its emergency response planning for communities in the wake of an extreme weather event requiring multifaceted or multiagency response e.g., storms (frequency and magnitude) that may impact transport, powerlines, flooded or blocked roads and the knock on of these cascading impacts for health and social care. 3.4.9 The IJB is also recommended to issue a Direction to all delegated functions that biannual Directions reporting must include: » critical impacts the changing climate may have on key services or the goods they need to deliver health and social care services; this should include consideration of stacked or cascading risks, » climate impacts on staff and care users, including in relation to the protected characteristics, and » how the design and delivery of health and social care services can be made more resilient to the changing climate. 3.5 A template for completion will be issued to Midlothian IJB from the Sustainable Scotland Network (SSN) in the summer of 2026 with a reporting deadline of 30th November 2026. 4 Policy Implications 4.1 This report is in direct response to the Public Bodies Climate Change Duties: Statutory Guidance issued by the Scottish Ministers to Scottish public bodies under the Climate Change (Scotland) Act 2009. 4.2 Midlothian IJB should continue to work closely with both NHS Lothian and Midlothian Council to ensure it supports the delivery of Partners policies relating to climate action as far as they are actionable for the delegated functions of Midlothian IJB. 5 Directions Page 322 of 382
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Midlothian Integration Joint Board 5.1 This report raises the requirement for a new Direction for Board consideration. 5.2 To enable Midlothian IJB to collate and submit a statutory response to the Sustainable Scotland Network, it is recommended that Midlothian IJB consider the following Direction for issue to both Partners Section 9: Use of Resources Direction 9.6: All delegated functions should take action to be able to provide biannual Directions including details of the » critical impacts the changing climate may have on key services or the goods they need to deliver health and social care services; this should include consideration of stacked or cascading risks, » climate impacts on staff and care users, including in relation to the protected characteristics, and » how the design and delivery of health and social care services can be made more resilient to the changing climate. 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 may be required as part of the implementation of this work. 7 Resource Implications 7.1 There are no direct financial implications as a result of this report. 8 Risk 8.1 There is a risk that Midlothian IJB will not be complaint with the duties of the Climate Change (Scotland) Act 2009 without action as set out in the Public Bodies Climate Change Duties: Statutory Guidance, and Annexe K. 9 Involving people 9.1 This report has been written in consultation with officers of Midlothian IJB, and the lead climate officers of both NHS Lothian and Midlothian Council. 10 Background Papers Page 323 of 382
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Midlothian Integration Joint Board 10.1 n/a Author’s Name Gill Main Designation Integration Manager Contact Information Via email or MS Teams Date 14/05/2026 Appendices: Public Bodies Climate Change Duties: Statutory Guidance Public Bodies Climate Change Duties: Statutory Guidance Annexes Page 324 of 382
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Midlothian Integration Joint Board Thursday, 11th June 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: 5.10 Page 325 of 382
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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 326 of 382
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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 1,780 / month The validated data are available up to December 2025. Based on this information, the target is currently being met. Please note the potential impact of seasonal variation in December datasets. The most recent non-validated management information data (accessed May 2026) indicate the target is currently being met. 3.7 Emergency Admissions Target per 100,000 767 / month Position at December 2025 625 / month The validated data are only available up to December 2025. Based on this information, the target is currently being met. Please note the potential impact of seasonal variation in December datasets. The most recent non-validated management information data (accessed May 2026) indicate the target is not currently not being met. 3.8 Unplanned Bed Days (Acute) Target per 100,000 5,074 / month Position at December 2025 3,532 / month The validated data are only available up to December 2025. Based on this information, the target is currently being met. Please note the potential impact of seasonal variation in December datasets. The most recent non-validated management information data (accessed May 2026) also indicate the target is currently being met. 3.9 Delayed Discharge Occupied Bed Days Target per 100,000 820 / month Position at December 2025 866 / month The validated data are only available up to December 2025. Based on this information, the target is currently not being met. Please note the potential impact of seasonal variation in December datasets. The most recent non-validated management information data (accessed May 2026) indicate that the target is currently 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. Page 327 of 382
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Midlothian Integration Joint Board 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% 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: 3 indicator targets are being met 1 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. It is recommended that the Board take note of the potential impact of seasonal variation in relation to patterns of unscheduled care activity in December. 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 Page 328 of 382
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Midlothian Integration Joint Board 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. 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 26/05/2026 Page 329 of 382
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Midlothian HSCP MSG Indicators Local Intelligence Support Team (LIST), Data Workbook accessed May 2026 Page 331 of 382
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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 332 of 382
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3 A&E Attendances 18+ 1,866 1,885 1,136 1,404 1,946 1,608 1,950 1,531 1,939 1,710 1,606 2,020 1,780 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 2,500 2,000 1,500 1,000 500 0 Page 333 of 382
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Emergency Admissions 18+ 4 591 709 438 680 589 717 441 445 687 497 639 503 440 626 685 625 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-25 800 700 600 500 400 300 200 100 0 Page 334 of 382
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Unplanned Bed Days – Acute 18+ 5 5,305 4,245 5,131 3,229 5,003 3,942 4,936 5,614 4,030 4,928 5,461 4,400 5,239 3,842 3,338 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 6,000 5,000 4,000 3,000 2,000 1,000 0 Page 335 of 382
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Delayed Discharges Occupied Bed Days (18+) 6 1,086 704 964 199 849 395 979 355 780 552 1,042 859 592 624 866 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 1,200 1,000 800 600 400 200 0 Page 336 of 382
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Midlothian Integration Joint Board Thursday, 11th June 2026, Time 14:00-16:00 Midlothian IJB Risk Register Update 2026/2027 Item number: 5.12 Executive summary This report presents the Midlothian Integration Joint Board (IJB) Risk Register for members’ review and update, reflecting the position at the end of Quarter 1, 2026/27. Key Changes Since Previous Committee Risk MLIJB1 has increased from Medium to High, reflecting delivery performance against Directions. No risks have been added to or removed from the register since the previous Committee. Midlothian IJB maintains an active Risk Register that is reviewed quarterly by senior management and reported to every meeting of this Committee, supporting robust governance and oversight of key strategic and operational risks. Since the previous Committee meeting, one risk (MLIJB1) has increased in rating from Medium to High due to performance against delivery of Directions. No new risks have been added. As a result of this report, Members are asked to: Review the updated Risk Register Confirm whether any further risks or amendments are required Agree the Risk Register at Q1 2026/27 Page 337 of 382
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Midlothian Integration Joint Board Report Midlothian IJB Risk Register Update 2026/2027 1 Purpose 1.1 This report presents the Midlothian Integration Joint Board (IJB) Risk Register for members’ review and update, reflecting the position at the end of Quarter 1, 2026/27. 2 Recommendations 2.1 As a result of this report, Members are asked to: Review the updated Risk Register Confirm whether any further risks or amendments are required Agree the Risk Register at Q1 2026/27 3 Background and main report 3.1 Midlothian IJB maintains a Strategic Risk Register in line with best practice for governance and assurance. This register identifies and assesses key risks that may impact the effective operation of the IJB specifically, those that could hinder the development of the Strategic Plan or the successful delivery of that plan through directions issued to its delivery partners. 3.2 Following review with the Senior Management Team, Risk MLIJB1 has increased from Medium to High. This reflects continued challenges in partner delivery of Directions, as evidenced by performance in the previous financial year. Management actions are in place to strengthen monitoring and engagement with partners to mitigate this risk. The position will continue to be reviewed in line with performance reporting. 3.3 Overall, the Risk Register continues to be actively managed with no unmitigated or uncontrolled risks identified. 3.4 Key updates to the Risk Register include: Risk Update Risk ID MLIJB1 – The IJB's Partners are unable to deliver the IJB's Directions. Updated from Medium to High. 3.5 A complete version of the updated Risk Register, including risk descriptions, mitigating actions, and risk ratings, is provided in Appendix 1. Page 338 of 382
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Midlothian Integration Joint Board 4 Policy Implications 4.1 This report does not have any direct impact on policy. 5 Directions 5.1 The content of this report does not have any direct impact on existing Directions. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake and ECRIA as a result of this report. 7 Resource Implications 7.1 There are no resource implications arising from this report 8 Risk 8.1 There is a risk that changes in risk ratings are not identified or acted upon in a timely manner, which could impact Midlothian IJB’s ability to manage emerging strategic and operational risk. 9 Involving people 9.1 This report has been written following consultation with our NHS Lothian and Midlothian Council financial Partners, Officers of Midlothian IJB, and with the Midlothian Health and Social Care Partnership’s Executive Management Team. 9.2 This report was presented to the Audit and Risk Committee of Midlothian IJB on the 4th June 2026. 10 Background Papers 10.1 There are no background papers Page 339 of 382
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Midlothian Integration Joint Board 11 Governance Please select yes or no: This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. X Author’s Name Eleonora Ho Designation Chief Finance Officer Contact Information Eleonora.ho@nhs.scot Date 26/05/2026 Appendices: Appendix 1: Midlothian IJB Risk Register Page 340 of 382
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Midlothian IJB Risk Register Risk Description ID MLIJB1 Title Midlothian IJB's Partners are unable to deliver the IJB's Directions. Risk Overview Description Risk Effect: There is a risk that Midlothian IJBs partners have insufficient workforce or other resources to execute the requirements and ambitions of the IJB Directions. Risk Consequence: Midlothian IJB cannot deliver on its strategic plan or financial plan. Controls In Place The controls in place are as follows: Directions are monitored and reported on twice a year for performance updates. Ability to review Directions annually. Financial allocations are included within directions on an annual basis after IJB budgets have been set. Strategic Planning and Performance continue to support with additional capacity to redesign and transform key areas of service delivery including enhanced data support. Additional capacity has been sourced to support the delivery of the HSCP Transformation and Change Programme. All activity has been reviewed and a more realistic set of Transformation workstreams are proposed through approved and issued Midlothian IJB Directions for 2026/27. Adequacy of Controls Satisfactory: All controls are working and can be demonstrated through measurement. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Gill Main (Integration Manager) Consequence (Current) Moderate (3) Likelihood (Current) Likely (4) Rating (Current) 12 Risk Level (Current) High Risk Level (Target) Medium Page 341 of 382
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Midlothian IJB Risk Register Risk Description ID MLIJB2 Title Midlothian IJB cannot properly deliver its Category 1 responder status if its partners are unable to provide the necessary assurances. Risk Overview Description Risk Effect: IJBs role as Category 1 responders under the Civil Contingencies Act requires that our partners NHS Lothian and Midlothian Council maintain effective business continuity and resilience plans to ensure an appropriate response in times of emergency. There is a risk that our partners may not be able to provide these assurances. Risk Consequence: Failure to maintain up to date and effective resilience plans could result in services unable to maintain essential service delivery. Controls In Place The controls in place are as follows: Assurance reporting to IJB routinely by Chief Nurse, Chief Social Worker and Resilience lead and an annual Category 1 Responder update provided through the Chief Officer report to the IJB. Attendance as Midlothian IJB representative at partner resilience exercise events. Robust operational processes within Midlothian Health and Social Care to meet requirements. Lessons learnt from previous incident management have been incorporated within standard service delivery, ongoing work to develop a quality management approach will provide additional partnership wide assurances to IJB. In line with IJB agreement. IJB is represented by, and authority delegated, to the Chief Officer of the IJB. Adequacy of Controls Satisfactory: All controls are working and can be demonstrated through measurement. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Sandra Bagnall (Executive Business Manager) Consequence (Current) Moderate (3) Likelihood (Current) Rare (1) Rating (Current) 3 Risk Level (Current) Low Risk Level (Target) Low Page 342 of 382
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Midlothian IJB Risk Register Risk Description ID MLIJB3 Title Midlothian IJB is not able to properly deliver its Strategic Plan due to insufficient resources. Risk Overview Description Risk Effect: The IJBs partners may not be able to allocate sufficient resource to deliver its Financial Plan and Strategic Plan. Risk Consequence: The IJB may not be able to deliver the Strategic Plan to function within the available resources. The IJB may have to amend the ambitions of Strategic in such a way that the progress towards the strategic aim of the Strategic Plan and 9 National Health and Wellbeing Outcomes is compromised. Controls In Place The controls in place are as follows: Regular budget setting and financial planning meetings with IJB partners to ensure alignment of resource commitments with strategic priorities. Development of the Medium-Term Financial Strategy, aligned to the Strategic Plan to promote sustainability and realistic ambition. Partnership governance structures in place to support joint decision-making and risk-sharing. Development of transformation programmes and efficiency plans to maximise the impact of available resources. Use of performance monitoring and impact assessment tools to ensure resource deployment is aligned with the 9 National Health and Wellbeing Outcomes. Adequacy of Controls Weak: The controls in place have not made much difference and the level of risk cannot be reduced. Risk Assessment Risk Owner Eleonora Ho (Chief Finance Officer) Risk Handler Gill Main (Integration Manager) Consequence (Current) Major (4) Likelihood (Current) Likely (4) Rating (Current) 16 Risk Level (Current) Very High Risk Level (Target) Medium Page 343 of 382
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Midlothian IJB Risk Register Risk Description ID MLIJB4 Title New and/or amended national legislation may impact on the ability of the IJB to deliver its Strategic Plan. Risk Overview Description Risk Effect: There is a risk of further legislation, policy, or national improvement drivers which impact on the IJBs ability to deliver on the Strategic Plan, examples include the legislation relating to a National Care Service, the Health and Care (Staffing) (Scotland) Act 2019, and structural changes within NHS governance arrangements, including the merger or consolidation of sub national planning groups. Risk Consequence: Midlothian IJB and its partners may be distracted from the business of delivering the Strategic Plan. Legislation, policy, and national improvement drivers without fiscal support will result in additional pressure on the IJB. The merger or consolidation of sub-national planning groups, may alter decision making routes, create duplication, or dilute IJB influence within system planning structures Controls In Place The controls in place are as follows: Respond to Scottish Government information requests on impact of future legislation, policies, and national improvement drivers. Horizon scanning for policy developments through partners and SMT network groups. Close working relations with Scottish Government through Chief Finance Officer, Chief Officer and COSLA. Good working relationships with the Scottish Government Integration Governance and Evidence Unit. Adequacy of Controls Unknown: The current controls are not known, and further work is required to identify the current situation. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Eleonora Ho (Chief Finance Officer) Consequence (Current) Major (4) Likelihood (Current) Rare (1) Rating (Current) 4 Risk Level (Current) Medium Risk Level (Target) Medium Page 344 of 382
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Midlothian IJB Risk Register Risk Description ID MLIJB5 Title Impact of the Partners or the Scottish Government's decisions on the IJB and its Strategic Plan. Risk Overview Description Risk Effect: Partners may have to take decisions on functions delegated to the IJB, driven by operational or financial constraints. Similarly, the Scottish Government may issue directives to NHS Boards or Local Authorities on delegated functions which could impact the IJB. This includes national policy directions which set expectations on Boards in relation to service redesign and financial recovery. There is a significant financial risk that such decisions could alter the level of resource available to the IJB or require changes in service delivery that have material financial implications. This may limit the IJB’s ability to plan effectively, deliver its strategic priorities, or achieve financial sustainability. Risk Consequence: The IJB may not see sufficient or adequate progress towards its strategic aims and decisions made may reduce the IJB’s ability to deliver its strategic plan. Controls In Place The controls in place are as follows: On-going dialogue with the Partners and through a range of national groups (CFO network, CO network) with the Scottish Government. Early engagement with Scottish Government policy leads to understand and influence national directives impacting delegated functions. Any such decisions and the impacts thereof should be reported to the IJB along with the impact on its ability to deliver the Strategic Plan. Clear governance arrangements and agreed scheme of integration between the IJB and its partners to reinforce roles, responsibilities, and escalation processes. Ongoing communication and joint planning between the IJB, NHS Board, and Local Authority to support alignment of operational decisions with strategic aims. Adequacy of Controls Some weaknesses: Improvement can be demonstrated however not at optimal level. Page 345 of 382
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Midlothian IJB Risk Register Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Chris King (Chief Finance Officer) Consequence (Current) Major (4) Likelihood (Current) Possible (3) Rating (Current) 12 Risk Level (Current) High Risk Level (Target) Medium Page 346 of 382
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Midlothian IJB Risk Register Risk Description ID MLIJB6 Title Sustainability of external providers. Risk Overview Description Risk Effect There is a strategic risk and financial risk to the IJB that providers will be unable to meet their contractual obligations due to financial pressures such as the employer national insurance changes. Risk Consequence The IJB may not be able to progress its strategic aims, may experience reputational damage, or may experience financial challenge through supporting the HSCP to deliver the returned hours of statutory care to the impacted individuals. Controls In Place The controls in place are as follows: Regular financial monitoring and sustainability reviews of commissioned providers to identify early signs of financial distress. Engagement with providers through regular forums to understand cost pressures, including employer National Insurance increases. Collaborative commissioning approaches with partners to reduce duplication and enhance efficiency. Contingency planning to ensure continuity of care in the event of provider failure. Ongoing dialogue with COSLA and Scottish Government regarding funding pressures on social care provision. Adequacy of Controls Unknown: The current controls are not known, and further work is required to identify the current situation. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Chris King (Chief Finance Officer) Consequence (Current) Major (4) Likelihood (Current) Possible (3) Rating (Current) 12 Risk Level (Current) High Risk Level (Target) Medium Page 347 of 382
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Midlothian IJB Risk Register Risk Description ID MLIJB7 Title Financial Reporting and Oversight. Risk Overview Description Risk Effect There is a risk that financial reporting for the IJB has an inbuilt inherent time lag. Risk Consequence The IJB will not be able to make timely or well considered financial decisions due to the time lag of financial information. Controls In Place The controls in place are as follows: Use of in year financial forecasting based on available trends and prior period data to support more timely decision-making. Regular dialogue between finance officers, budget holders, and the IJB to share emerging issues or pressures in advance of formal reporting cycles. Development of financial monitoring dashboards to track key cost drivers and variances in near real time. Use of scenario planning and sensitivity analysis to anticipate potential financial outcomes. Adequacy of Controls Some weaknesses: Improvement can be demonstrated however not at optimal level. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Chris King (Chief Finance Officer) Consequence (Current) Moderate (3) Likelihood (Current) Possible (3) Rating (Current) 9 Risk Level (Current) Medium Risk Level (Target) Medium Page 348 of 382
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Midlothian IJB Risk Register Risk Matrix Insignificant 1 Minor 2 Moderate 3 Major 4 Severe 5 5 Almost Certain Medium 5 High 10 Very High 15 Extreme 20 Extreme 25 4 Likely Medium 4 Medium 8 High 12 Very High 16 Extreme 20 3 Possible Low 3 Medium 6 Medium 9 High 12 Very High 15 2 Unlikely Very Low 2 Low 4 Medium 6 Medium 8 High 10 1 Rare Very Low 1 Very Low 2 Low 3 Medium 4 Medium 5 Page 349 of 382
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Midlothian Integration Joint Board Thursday, 11th June 2026, 14:00-16:00 Medium Term Financial Strategy Update Item number: 5.13 Executive summary This report presents the Medium Term Financial Strategy for Midlothian Integration Joint Board. The strategy sets out the financial outlook for the period 2025/26 to 2028/29 and explains the action needed to support a sustainable financial position over the medium term. The strategy shows a growing financial gap over the next three years if no corrective action is taken. The forecast gap is £6.797 million in 2026/27, £9.047 million in 2027/28 and £13.680 million in 2028/29. This reflects rising pay, inflation, prescribing costs, demographic change, increasing demand for services, and continued uncertainty in relation to future funding. The Medium Term Financial Strategy supports delivery of the Midlothian IJB Strategic Plan 2025-2035. It provides a financial framework to help the IJB plan ahead, make informed decisions, and direct resources to the areas that will make the greatest difference for people and communities in Midlothian. The strategy confirms that the current model of care will not be affordable in the medium term without further change. It therefore sets out the need for a continued focus on financial recovery, service redesign, transformation, and stronger links between finance, activity, performance and outcomes. As a result of this report, Members are asked to: note amendments made to the Medium Term Financial Strategy, following review by newly appointed Chief Finance Officer; note the forecast financial gap over the period 2026/27 to 2028/29; note that further recovery actions, transformation activity and financial planning work will be required to support a sustainable financial position; and note that the Medium Term Financial Strategy will be used to inform future financial planning, service change and decision making. Page 351 of 382
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Midlothian Integration Joint Board Report Medium Term Financial Strategy Update 1 Purpose 1.1 This report presents the Medium Term Financial Strategy for Midlothian Integration Joint Board. The strategy sets out the financial outlook for the period 2025/26 to 2028/29 and explains the action needed to support a sustainable financial position over the medium term. 2 Recommendations 2.1 As a result of this report, Members are asked to: note amendments made to the Medium Term Financial Strategy, following review by newly appointed Chief Finance Officer; note the forecast financial gap over the period 2026/27 to 2028/29; note that further recovery actions, transformation activity and financial planning work will be required to support a sustainable financial position; and note that the Medium Term Financial Strategy will be used to inform future financial planning, service change and decision making. 3 Background and main report 3.1 Midlothian Integration Joint Board is required to plan its finances over the medium term to support delivery of its strategic priorities and to ensure that available resources are used effectively, efficiently and sustainably. 3.2 The Medium Term Financial Strategy provides a financial planning framework for the period 2025/26 to 2028/29. It supports the Midlothian IJB Strategic Plan 2025-2035 and sets out the main financial pressures, assumptions, risks and priorities that will shape decision making over the next 3 years. 3.3 The strategy identifies a significant and increasing financial gap over the planning period. The forecast gap is £6.797 million in 2026/27, £9.047 million in 2027/28 and £13.680 million in 2028/29, before any recovery actions or savings measures are applied. 3.4 The forecast reflects a range of known and emerging pressures, including pay awards, inflation, prescribing costs, demographic growth, increasing complexity of need, and growing demand across health and social care services. Page 352 of 382
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Midlothian Integration Joint Board 3.5 The strategy also reflects a number of planning assumptions. These include assumptions that national pay awards, Real Living Wage commitments and Free Personal and Nursing Care uplifts will continue to be funded. However, there remains uncertainty in relation to future partner contributions, inflationary pressures, demand growth and the impact of national policy reform. 3.6 The Medium Term Financial Strategy makes clear that the current model of care will not be affordable over the medium term without significant action. This means the IJB must continue to develop and implement recovery actions, strengthen financial control, and redesign services where this is needed to improve sustainability and outcomes. 3.7 The strategy is closely linked to the Midlothian IJB Strategic Plan and reflects the need to direct resources towards prevention, early intervention, community-based support and models of care that make the best use of available public resources. 3.8 It also highlights the need for stronger links between finance, service activity, performance and outcomes. This will support better decision making and help the IJB understand where investment, disinvestment or redesign is required. 3.9 The strategy identifies key areas where transformation and service change will be important, including Care at Home, Midlothian Community Hospital, Learning Disabilities services and wider work to improve the use of resources across the system. 3.10 The Medium Term Financial Strategy does not remove the need for annual budget setting or in-year financial recovery planning. Instead, it provides the medium-term context within which these decisions can be made more clearly and consistently. 3.11 Approval of the strategy will support future financial planning and provide a framework for ongoing discussion with Midlothian Council, NHS Lothian and other partners about affordability, service sustainability and priorities for change. 4 Policy Implications 4.1 The Medium Term Financial Strategy supports delivery of the Midlothian IJB Strategic Plan 2025-2035 and reflects the IJB’s responsibilities under the Public Bodies (Joint Working) (Scotland) Act 2014. 5 Directions 5.1 This report does not in itself require a new Direction. 6 Equalities Implications Page 353 of 382
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Midlothian Integration Joint Board 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake and ECRIA as a result of this report. 7 Resource Implications 7.1 This report does not have resource implications. 8 Risk 8.1 There is a risk that without timely action, the IJB will not be able to deliver a sustainable financial position over the medium term. 8.2 There is also a risk that future funding levels from partner bodies and national government will not keep pace with inflation, pay pressures, prescribing growth, demographic change and service demand. 9 Involving people 9.1 The Medium Term Financial Strategy has been developed using local financial intelligence, service knowledge and planning discussions with partner organisations. It is informed by the strategic planning context already shaped through engagement with stakeholders, partners and communities as part of the wider Strategic Plan. 9.2 Further engagement and consultation will be required where specific service changes or redesign proposals are developed in response to the financial position set out in the strategy. 10 Background Papers 10.1 There are no Background papers 11 Governance Please select yes or no: This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. √ Page 354 of 382
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Midlothian Integration Joint Board Author’s Name Eleonora Ho Designation Chief Finance Officer Contact Information Eleonora.ho@nhs.scot Date 26/05/2026 Appendices: Appendix 1 - Medium Term Financial Strategy 2025/26 to 2028/29 Page 355 of 382
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1 Midlothian Integration Joint Board Medium Term Financial Strategy 2025-2028 Page 357 of 382
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2 Contents Introduction .....................................................................................3 Legal duties......................................................................................5 Risks and challenges ........................................................................8 Our yearly budget............................................................................11 Our future plans..............................................................................13 Appendices....................................................................................23 Page 358 of 382
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3 Introduction This Medium-Term Financial Strategy sets out how we, the Midlothian Integration Joint Board (IJB), will allocate our budget between June 2026 and November 2028 to support our Strategic Plan for 2025 to 2035. We have identified a growing financial gap between the funding we receive and the cost of running services. This increases from £6.8 million in 2026/27 to £9.1 million in 2027/28, and £13.7 million in 2028/29, before any recovery actions are in place. The current way of working will not be affordable and change is needed. The main pressures are linked to demographic growth, medicines and growing demand. This strategy assumes funding will cover the Real Living Wage, Free Personal and Nursing Care uplifts, and staff pay awards, but not population growth or wider increases in demand. We will focus on change in Care at Home, Midlothian Community Hospital, and Learning Disabilities services with two financial priorities to strengthen the link between spending, service activity, and outcomes, and to direct resources to where they will make the biggest difference. Page 359 of 382
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4 Who we are We are a decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in our Strategic Plan will guide how we allocate the money we receive. Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships; Midlothian, East Lothian, West Lothian, and City of Edinburgh. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act, 2014. We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. Page 360 of 382
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5 Legal duties Page 361 of 382
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6 What the law says we must do The Public Bodies (Joint Working) (Scotland) Act 2014 requires us to write a Strategic Plan to plan and direct some health and care services. Our Strategic Plan must incorporate a medium-term financial plan for the resources within the scope of the Strategic Plan. We must also publish an Annual Financial Statement setting out the total resources included in each year of the plan. Our resources are allocated to us by Midlothian Council and NHS Lothian each year and we are then responsible for the integrated budget. The budget offer we receive from both our Partners changes from each year and may not be enough to deliver everything we want to. We can only use the resources that are made available to us. We work closely with both Partners but often don’t know exactly what our budget offers will be until February or March each year. This is because of how our Partners receive funding from Scottish Government. Future funding decisions by our partners will affect how much we have to spend. This makes it hard to plan ahead because we do not know the full amount from both partners until after the financial year starts. The decisions made by our partners also affect how well we can respond to changing needs in our communities. Setting a balanced budget The law requires us to set a balanced budget - we must only spend the money we have. Even though our partners support us, there is not enough public money to keep up with rising costs, more people needing help, and changes in the population. This means we have to make hard choices about how we use our money. We must give priority to the services that help people in Midlothian the most, while still making sure we meet our legal duties to provide care and support. Each year, the IJB follows a budget setting process, and we make a plan to help balance the budget. We look carefully at what each change could mean for money, services, and people. We try to choose changes that have the least impact, help us work better, and improve services instead of simply reducing services. In this way, we aim to balance the budget while keeping health and social care services safe, good quality, and able to last into the future Page 362 of 382
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7 How we fund ‘Transformation’ We agree our budget each year, usually in March. Sometimes the Scottish Government gives us extra money too. This extra money is often for specific jobs or plans. Annual Budgets can make planning hard. By law, we must review our Strategic Plan every 3 years, but we also know that big changes take time. Our Strategic Plan asks services in Midlothian Health and Social Care Partnership to change how they work over the next 10 years. New laws or national rules may also mean services have to work in different ways. When this happens, it often costs more money, but we do not always get extra funding. For several years, we have worked hard to make our services better and use money wisely. This means there is not much left to save by doing more with less. Now we need bigger changes across the whole system. Work on changes this big takes a lot of planning, testing, learning, and trying again, as well as our everyday work to support people and communities. Our ‘reserve’ budget The Scottish Government recommends that we have a reserves policy and reserves strategy, which include the level of reserves required and their purpose. This should be agreed as part of annual budget setting. We have two kinds of reserves: General reserves are money left over from earlier years. They help us deal with unexpected costs during the year. In 2023/24, we used all this funding to help pay for services. This means we now do not have any general reserve left to help with recovery plans or to invest in changing services. Earmarked reserves are funding we carry over from one year to the next for a special reason. This money is set aside for certain services or projects, and we have earmarked reserves for this purpose. Page 363 of 382
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8 Risks and challenges Page 364 of 382
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9 Growing demand The demand for health and social care services in Midlothian continues to grow every year. This increasing demand puts real pressure on both budgets and the workforce, making it harder to meet everyone’s needs within the money available. More children with complex needs are moving into adult services The level of care required for existing individuals is becoming more complex. People are not living as long in good health as before. This means many people may need care and support earlier in their lives. More people are needing care and support Between 2001 and 2023, the number of people living in Midlothian went up by 21.4%. This was the biggest rise of all 32 council areas in Scotland. The number of people living here is expected to keep growing over the next 10 to 15 years. National Records of Scotland predicts that the population of Midlothian will grow to 113,683 by 2038. This is based on births, deaths, and people moving in or out. In Midlothian, births are going down, deaths are fairly steady, and the number of people moving here is changing a lot. Midlothian Council’s Land Development Plan predicts the population will increase even more to 123,225 by 2038. Figure 1: Midlothian population growth 2018 - 2037 NRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS PopulationNRS Population NRS PopulationNRS PopulationNRS Population NRS Population NRS Population, 113,683 Housebuilding ProjectionHousebuilding ProjectionHousebuilding ProjectionHousebuilding ProjectionHousebuilding ProjectionHousebuilding ProjectionHousebuilding Projection Housebuilding ProjectionHousebuilding ProjectionHousebuilding Projection Housebuilding ProjectionHousebuilding ProjectionHousebuilding Projection Housebuilding Projection Housebuilding Projection Housebuilding Projection Housebuilding Projection Housebuilding Projection, 123,225 2018 2023 2028 2033 2038 125,000 120,000 115,000 110,000 105,000 100,000 95,000 90,000 Page 365 of 382
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10 Funding risks We face several serious funding risks. The biggest risk is that our partners may not be able to give us all the funding we need to reach our aims. The funding pressures we face include: Staff pay is rising. The cost of medicines, including new medicines, is going up. Prices of both good and services are also rising because of inflation. The total amount of money we receive from the Scottish Government, even though it has increased as our population has increased, it is not enough to cover the pressures we face. The total amount of money we receive from NHS Lothian and Midlothian Council may not be enough to cover the pressures we face - this could mean less money is available for community health and social care. Future decisions by the Scottish Government could change how we must use our money. For example, we do not yet know how the National Care Service might affect the money we get or the services we may need to plan. Page 366 of 382
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11 Our yearly budget Page 367 of 382
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12 Our yearly budget Our yearly budget for 2026/27 is £185.908m. Figure 2: Midlothian IJB Budget 2026/27 £m The Remaining of our budget is within Hosted and Set Aside services from NHS Lothian – these are either specialist services or parts of the Acute System. £13.999m - Health Hosted Services (from NHS Lothian) Midlothian hosts Dietetics and Adults with Complex and Exceptional Needs and provide services for people across Lothian on behalf of all four Health and Social Care Partnerships - Midlothian, East Lothian, West Lothian, and City of Edinburgh. £19.922m - Health ‘Set Aside’ budgets (from NHS Lothian). Unscheduled care services (Accident and Emergency and unplanned admissions) are managed by NHS Lothian’s Acute Hospital system. The IJB’s budget includes a share of these services, based broadly on our population size. Over 82% of our budget is managed within the Midlothian Health and Social Care Partnership for Social Work and Social Care or Health Core Services: £75.122m - Social work and Social Care (from Midlothian Council). This is for the adult social care services in Midlothian. £76.865m - Health Core Services (from NHS Lothian). These are local health services which delegated to the Health and Social Care Partnership. These include primary care services like GPs and Pharmacists, and other community services like district nursing, community mental health teams, community learning disability teams, and the local community hospital. Social Work and Social Care, 75.122 Health Core Services, 76.865 Health Hosted Services, 13.999 Health Set Aside Budgets, 19.922 Page 368 of 382
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13 Our future plans Each year, we update our financial plan. The plan looks at what is happening now and what may happen in the next 3 to 5 years to understand how changing needs, rising costs, and funding levels may affect services over time. By planning over several years, we can spot patterns and risks and make better decisions Page 369 of 382
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14 Medium Term Financial Plan: 2026 - 2029 The Medium-Term Financial Plan is based on a predicted gap in the amount of money we will receive and the cost of delivering services. This cost includes rising prescribing costs, funding changes, and increasing demand in Older People and Learning Disabilities services. Table 1 – Gap between funding and cost of delivering services 2026/27 (£m) 2027/28 (£m) 2028/29 (£m) Social Care 3,904 5,704 7,504 Health 2,893 3,343 6,176 Total 6,797 9,047 13,680 These figures are before any recovery actions have been identified or delivered. This means we need to change services to close the gap over the short and medium term. Figure 3 – Factors driving the gap between funding and costs -126 207 314 314 1100 1102 3886 Offsets Hosted and set asideGrowth in Learning disabilitie sGrowth in Older people Change in Funding Growth in Prescribin g Baseline pressures -500 0 500 1000 1500 2000 2500 3000 3500 4000 4500 Page 370 of 382
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15 What shapes our financial planning We work with NHS Lothian and Midlothian Council to understand the local issues, pressures, and opportunities. The Scottish Government’s Medium-Term Financial Strategy sets the national financial context for public services. It highlights ongoing pressures on funding. Future funding is expected to focus on maintaining frontline services, meeting national pay commitments, and supporting reform. However, without significant additional investment, smaller systems like Midlothian may find it difficult to deliver the level of change required. To support us to plan, we use two factors: Factors we are certain will happen Pay awards – national increases are assumed to be fully funded. Real Living Wage – additional funding is assumed to cover this cost. Free Personal and Nursing Care – national uplifts are assumed to be fully funded. Factors that may happen Funding from NHS Lothian and Midlothian Council may change. Inflation – rising prices may increase costs further. Demand growth – more people may require support than currently forecast. Housing and population growth – faster growth may increase pressure on services sooner National Care Service– national reform may affect funding and service delivery. Planning Principles Financial decisions will be based on the most accurate and up-to-date information available, taking account of the changing health and social care landscape. Clear reporting, consistent data, and open communication will help ensure plans remain fit for purpose. Financial decisions will support sustainable service delivery over the medium to long term. This includes prioritising actions that maintain financial balance, deliver value for money, and reduce demand through prevention, early intervention, and efficient use of resources. Financial decisions will be developed in partnership with NHS Lothian, Midlothian Council, and wider partners to ensure shared priorities. Joint planning and open communication will help maximise the impact of resources across the whole system. Page 371 of 382
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16 Our financial plan We need to work in different ways. The changes we need are big, so we must provide care and support in new ways. When we change how we deliver services, we also need new ways to check, review, and report how well they are working. We have agreed two main financial priorities to help us plan better and report more clearly. Financial priority No.1 We will use a new way to check how well we are using our funding in a system that is changing. Financial priority No. 2 As services change, we want to make sure we are putting money into the right places so change can happen as quickly as possible. Our focus We have decided to concentrate on the areas that will see more growth over the next few years and where we want change to happen at a faster pace. Care at Home We will improve short-term support to help people stay independent and work with providers to deliver high- quality, reliable services that make best use of resources. Midlothian Community Hospital We will review bed capacity to match patient need and support more care closer to home. Learning Disabilities We will review care plans and explore different ways of delivering services, including greater use of technology to support independence. Page 372 of 382
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17 Financial priority No.1 We use a new way to check how well we are using our funding in a system that is changing. What we are trying to achieve: 1.1 We will better connect our funding plans, what services do, and outcomes, so our financial plan can change when services change. 1.2 We use budget tagging and forecasting to get ready for change and support good-value health and care. 1.3 If our spending decisions are no longer helping us reach the goals in our Strategic Plan, we will make changes. Page 373 of 382
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18 1.1 We will better connect our funding plans, what services do, and outcomes, so our financial plan can change when services change. Financial strategy is not just about staying within budget. We must learn from what has happened before, plan, and deal with problems that may come up later. If health and social care services are changing how they give treatment, care, and support, we also need new ways to check how well they are working. Getting our financial strategy right is very important. It helps us do our best for people and communities and focus on what matters most to them. This means we need new ways to understand whether we are using our money well and whether it is helping us reach our goals. We have asked the Strategic Planning and Performance team to work closely with the Chief Finance Officer so we have the right information to make the best decisions we can. Phase 1 – Social Care Expenditure Review Examine current activity to provide context to dynamically changing financial data Identify historic patterns, trends, and variation for further examination Phase 2 – Identify leading indicators to support change and improvement across Social Care We will develop performance and financial indicators that help us make better decisions Page 374 of 382
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19 1.2 We use budget tagging and forecasting to get ready for change and support good- value health and care. We know it is important to understand our budget better and link it to the outcomes we want to achieve. This will help us carry out our strategy. We want to better link how we use our money to the outcomes for people in Midlothian. This will help us move towards value-based health and care. We also know that making reliable forecasts about future spending is not easy. As we improve our understanding of the budget, we want to use this information to build better tools that help us plan ahead. 1.3 If our spending decisions are no longer helping us reach the aims of our Strategic Plan, we will make changes. Our Strategic Planning Group checks how well we are moving towards the goals in our Strategic Plan 2025 to 2035. Our Audit and Risk Committee checks how well we are managing money. These groups need to work closely together so the information they use helps guide our Directions. We will keep improving how we explain the funding linked to our Directions and will share this information on the Midlothian Health and Social Care website. We usually issue Directions in March and September each year, but we can issue them at any time. As we learn more about the changes we are making, we may issue Directions more often. Phase 1 - Develop the evaluation framework Establish what the right measures for evaluation are and embed them across our governance structure. Phase 1 – Budget Tagging Identify population outcomes and carry out budget tagging to support planning and transformation. Phase 2 – Forecasting Improve our systems and processes to use forecasting as a tool to track change and improvement as well as financial sustainability. Page 375 of 382
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20 Financial priority No. 2 As services change, we want to make sure we are putting money into the right places so change can happen as quickly as possible. What we are trying to achieve 2.1 We will use our improved knowledge of the system and financial position to describe changes as services transforms 2.2 We know where spending money will make the biggest difference. 2.3 We can show that how we use our money helps us support more people in a better and more efficient way. Page 376 of 382
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21 2.4 2.1 We will use our improved knowledge of the system and financial position to describe changes as services transforms Information, intelligence and insight As we change and redesign services, we need better ways to check whether our choices about spending money are working well. This will help us make good decisions in the future so people get the right treatment, care, and support. This work may help shape longer-term money decisions across the whole system so we can reach our strategic goals and support the aims of the Transformation and Change Programme Board. 2.2 We know where spending will make the biggest difference. System Thinking To make good decisions, we need to understand how different parts of the whole system connect and affect each other. This is complicated, and we know we can do it better. We want to use what we learn to connect people with the services they need in better ways. We also need to learn from our early work on change so we know what to do next. Over the next two years we will set out more clearly how we want Midlothian Health and Social Care Partnership to adopt a more person- led approach to service design. This will support us to develop a system that ‘pulls in’ the right professionals to support individuals rather than ‘pushing out’ referrals to multiple services across the system. We must develop a more granular understanding of allocation of resource as part of • the Midlothian Health and Social Care spend, • Map the process, barriers, and opportunities for change • Identify variation and variability across the system to support further change Page 377 of 382
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22 2.3 We can show that how we use our funding helps us support more people in a better and more efficient way Driving Transformation and Change Making these changes is very important if we want health and social care to stay strong in the future. The changes we need are too big to happen with short-term fixes alone. We need a clear plan, people working together, and investment in new ways of giving care and support. Over the next five years, we will focus on changing services around people and communities, helping earlier to stop problems getting worse, and cutting out services that do the same job twice. We will keep learning from our work to make change happen. We will use facts and evidence to help us decide what to do, check progress, and change our approach if needed. By working closely with our partners, staff, and communities, we will make sure these changes are useful and possible to carry out. Develop clear metrics that link financial input, activity levels, and service outcomes, allowing us to assess value for money across all major service areas. Introduce benchmarking against other IJBs to assess productivity, efficiency, and outcome performance. Use data from the new social care reporting framework to better understand patterns of demand and service utilisation. Review and align our performance reporting and financial monitoring cycles to ensure decision making is based on timely, accurate information. Publish annual summary reports to demonstrate how investment decisions are improving outcomes for people and communities in Midlothian. Page 378 of 382
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23 Appendices Page 379 of 382
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24 Appendix 1: Our responsibilities Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). We meet regularly and include members from NHS Lothian and Midlothian Council, the Third and Independent Sector, staff, and people who represent their community, people who experience our services, their families, and carers. Midlothian Health and Social Care Partnership oversees more than 60 services on behalf of Midlothian IJB. All people who work in Midlothian Health and Social Care Partnership are employed by either Midlothian Council or NHS Lothian. You can find the full list of services the IJB is responsible for in the Midlothian Scheme of Integration. This includes 2 hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region for the 4 Health and Social Care Partnerships. Some of the services include: NHS Lothian • Care in Hospitals which isn’t planned (unscheduled care) including Accident and Emergency, Minor Injuries, Acute wards • Midlothian Community Hospital • Community based health care (Primary care) including GPs, District Nurses, Dentists, Pharmacists, Mental Health services, Substance Use Services, Community Respiratory Team • The following Health services for children and young people under 18: Health Visiting, School Nurses, Vaccinations of children • Allied Health Professionals – including physiotherapists, dietitians, podiatrists • Palliative and End of Life Care Midlothian Council • Social Work support for adults including adults with dementia, learning disabilities and older people • Care at Home services • Day services for older people and people with learning disabilities • Services to support unpaid carers and breaks from caring • Health services for people who are homeless • Extra Care Housing for people who need housing with extra support • Care Homes • Services to address health and care needs of people in the Justice system Page 380 of 382
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25 Appendix 2: Policy and drivers Some of the most important national policies that have contributed to this strategy are National Performance Framework National Health and Wellbeing Outcomes Framework Principles for Planning and Delivering Integrated Health and Social Care Health and social care integration: finance guidance Best Value in Public Services Delivering Value Based Health and Care: a Vision for Scotland (2022) NHS Scotland Operational Improvement Plan Health and Social Care Service Renewal Framework Scotland’s Population Health Framework Framework for Community Health and Social Care Integrated Services Page 381 of 382
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