Agenda Document Pack - Midlothian Integration Joint Board - 20/02/2025
Midlothian Council · 20 February 2025
Back to Midlothian Integration Joint Board — 20 February 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Council Chambers/Hybrid, Midlothian House, Dalkeith, EH22 1DN Date: Thursday, 20 February 2025 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Democratic Services Clerk Telephone: 0131 271 3160 Clerk Email: democratic.services@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 316
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1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting 4.1 Minutes of previous Midlothian IJB Board Meeting held on 19th December 2024 - submitted for approval 5 - 20 4.2 Minutes of Strategic Planning Group on 28th November 2024 - submitted for noting 21 - 28 4.3 Minutes of Audit and Risk Committee on 12th September 2024 - submitted for noting 29 - 36 5 Public Reports 5.1 Chair’s Update – Councillor McManus, Chair 5.2 Chief Officers Report – Morag Barrow, Chief Officer 37 - 48 5.3 Strategic Planning Group Update – Andrew Fleming, Strategic Planning Group Chair 5.4 Audit and Risk Committee Update – Val de Souza, Audit and Risk Committee Chair 49 - 52 5.4.1 Appointment to the Audit and Risk Committee of an Independent Member Paper by Duncan Stainbank, Chief Internal Auditor and presented by Val de Souza, Audit and Risk Committee Chair For Decision 5.5 Midlothian IJB Meeting Schedule 2025 and 2026 - Paper presented by Democratic Services 53 - 60 5.6 Midlothian IJB Membership Nomination - Paper presented by Democratic Services 61 - 64 Page 2 of 316
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5.7 Midlothian IJB Draft Strategic Plan 2025/35 Update - Paper presented by Gill Main, Integration Manager 65 - 164 5.8 Midlothian IJB Finance Update and Recovery Planning - Paper presented by Chris King, Chief Finance Officer 165 - 172 5.9 Midlothian IJB Integrated Workforce Plan 2025/28 - Paper presented by Gill Main, Integration Manager 173 - 214 For Discussion 5.10 Midlothian IJB Performance Report - Paper presented by Gill Main, Integration Manager 215 - 272 5.11 Unscheduled Care Improvement Working Presentation by Grace Cowan, Head of Older People and Primary Care Services 5.12 Midlothian IJB Draft Directions 2025/26 Review - Paper presented by Gill Main, Integration Manager 273 - 296 5.13 Midlothian IJB Draft Directions Policy - Paper presented by Gill Main, Integration Manager 297 - 306 5.14 IJB Members Self-Development Plan - Paper presented by Duncan Stainbank, Chief Internal Auditor 307 - 314 For Noting 5.15 Future Plan for the National Care Service Letter from Minister for Social Care, Mental Wellbeing and Sport 315 - 316 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on: Thursday 27 March 2025. Please note that this session will include a Development Session for Board Members only from 14:00-14:50pm which will be immediately followed by the Midlothian Integration Joint Board Special Board Meeting. Page 3 of 316
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 19 December 2024 14:00 Council Chambers, Midlothian House and Virtual Meeting held using Microsoft Teams Present (voting members): Val de Souza (Vice Chair, NHS) Dr Amjad Khan (NHS Lothian) Councillor Winchester Councillor Parry Present (non-voting members): Morag Barrow (Chief Officer) Dr Rebecca Green (Clinical Director) Nick Clater (Head of Adult Services and Chief Social Work Officer) Grace Chalmers (Partnership Representative) Claire Ross (Chief AHP) Keith Chapman (Lived Experience member) In attendance: Councillor McKenzie Gill Main (Integration Manager) Fiona Kennedy (Group Service Manager) Grace Cowan (Head of Primary Care and Andrew McCreadie (NHS Lothian, Deputy Jim Sherval (Consultant in Public Health) Midlothian Integration Joint Board Thursday 20 February 2025 Item No 4.1 Page 5 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board 1. Welcome and Introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB). It was noted that Val De Souza will be acting as Chair instead of Councillor McManus for this meeting. The Chair noted the appointment of Dr Wendy Metcalfe to the MIJB and welcomed others joining for the first time. It was highlighted to the Board, in the absence of a current MIJB Chief Financial Officer (CFO) post holder, that Andrew McCreadie, the NHS Lothian Deputy Director of Finance and Ruth Nichols, Midlothian Council Senior Finance Business Partner (HSCP), would be presenting the Finance papers today. 2. Order of Business The order of business was confirmed as outlined in the agenda that had been previously circulated. The Chair highlighted to the Board that the additional late paper by the Chief Officer will be heard after item 5.5 MIJB Membership Recommendations. 3. Declarations of Interest Older Peoples Services) Director of Finance) (virtual) (virtual) Elouise Johnstone (Performance Manager) Ruth Nichols (Midlothian Council Senior Finance Business Partner (HSCP) Tracy Anne Miller (Employee Director, NHS Lothian) (virtual) Roxanne Watson (Executive Business Manager) Hannah Forbes (Democratic Services Officer) Louise Middleton (Democratic Services Officer) Apologies: Magda Clark (Third Sector member) Dr Wendy Metcalfe (Medical Practitioner) Councillor McManus Kirsty MacDonald (NHS Lothian) Tracy Baird David King (Interim Chief Finance Officer) Councillor Milligan Page 6 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Keith Chapman noted a declaration of interest as the Co-Chair for Alzheimer Scotland. 4. Minute of Previous Meetings 4.1 The Minute of previous Midlothian IJB Board Meeting held on 19 September 2024 was approved as an accurate record. 4.2 The Minute of previous Midlothian IJB Board Meeting held on 24 October 2024 was approved as an accurate record. 4.3 The Minute of the meeting of the MIJB – Strategic Planning Group held on 29 August 2024 was approved as an accurate record. 4.4 The Minute of the meeting of the MIJB – Strategic Planning Group held on 26 September 2024 was approved as an accurate record. 5. Public Reports Decision Action Owner Date to be Completed/Co mments 5.1 Chair’s Update, presented by Val De Souza The Chair opened by reflecting on the year, noting a number of changes to Board membership and thanking Board members past and present, Officers of the Health and Social Care Partnership (HSCP), and operational services for their commitment and work in challenging times. The Chair highlighted the Scottish Government budget announcement on the 4th of December and its significance for Health and Social Care. The Chair noted the next Board meeting is to be held on the 20th of February 2025 following a Development Session on the 30th of January 2025 to review the financial position and transformation plans. 5.2 Chief Officer’s Report – Presented by Morag Barrow, Chief Officer Page 7 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments The Chief Officer introduced the report setting out key updates for noting and comment. The Chief Officer noted the Scottish Government announcement to pause the progression of legislation relating to the National Care Service (NCS) to allow more time to address outstanding issues, a continued strong performance in reducing delayed discharges, and the publication of the Annual Progress Report. The Chief Officer also noted the formal public consultation on the MIJB Strategic Plan 2025-2035 has now closed. The Chair commented positively on the Speech and Language leaflets in the Adult Support and Protection Team update. 5.3 Strategic Planning Group Update – Report presented by Gill Main, Integration Manager The Integration Manager provided an update on the work of the Strategic Planning Group (SPG). Key activity included the development of draft MIJB Directions for 2025/2026 and the MIJB Strategic Plan 2025-2035. The Integration Manager noted 2 issues raised by SPG for the Board’s attention • The timely publication of MIJB Strategic Plan 2025-2035 and the MIJB Equality Outcomes for 2025-2029 for discussion in item 5.7. • Consideration to publishing the Strategic Governance Outcome Framework Report annually for their consideration in item 5.8. The Chair thanked the Integration Manager for the update. Page 8 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments 5.4 Audit and Risk Committee Update – Report presented by Councillor Milligan The Chair noted that due to Councillor Milligan’s apologies submitted for today this update will be moved to the February 2025 Board meeting. Moved to the next Board meeting in Feb 2025 Councillor Milligan 20 February 2025 For Decision 5.5 MIJB Membership Recommendations - Paper presented by Democratic Services, Louise Middleton Louise Middleton, Democratic Services Officer, presented the report. Members of the Board are asked to: • Review and endorse the nomination of Dr Wendy Metcalfe, Renal Clinical Director, as the Medical Practitioner Representative (non-voting member) of the MIJB. • Welcome Dr Metcalf to the MIJB. The Chair thanked Democratic Services for the report. The Board agreed to endorse the nomination of Dr Wendy Metcalfe. For Decision 5.6 Whole System Improvement Initiative: Improving Unscheduled Care Performance in Lothian - Paper presented by Grace Cowan, Head of Older People and Primary Care Services The Head of Older People and Primary Care Services presented the paper. This report sets out the actions taking place system-wide across NHS Lothian in partnership with the Integration Joint Boards The Chair requested inclusion of an USC performance Integration Manager 30/01/2025 Page 9 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments (IJBs). It sets out the funding received from the Scottish Government, specifically related to Midlothian HSCP and the expected outcomes for receipt of this funding linked into the system-wide focus on unscheduled care performance across NHS Lothian. For Midlothian the funding received is £1.65 million for Care at Home and £734k for enhanced Social Care Partnership services. The Head of Older People and Primary Care Services asked the Board to note the work underway and the timeline of delivery noted in section 7 of the report. Members are asked to note the contents of this report and specifically both appendices which relate to: • The original proposal (12th November 2024) submitted jointly by NHS Lothian and Lothian Health & Care System (LHCS) that comprises NHS Lothian, the Health & Social care Partnerships (HSCPs) and Local Authorities. • Scottish Government response (4th December 2024) which sets out confirmation of funding. The Chief Officer highlighted a proposal had been submitted to Scottish Government, approved and mobilised at pace, with Chief Officers and Chief Executives having met to consider finance and delivery implications including continuing Social Care pressures on 16th December. Concerns were noted regarding the increasing capacity and demand pressures, in the content of delayed discharges and waiting lists continuing to increase. The Chief Officer noted the concerns and noted Midlothian is moving towards a target bed occupancy of 85%. The Chair asked the Head of Primary Care and Older Peoples Services to discuss and mitigate for any workforce risks at the Short Life Working Group leading this work. update in a Development Session with the MIJB in the new year. Page 10 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments The Clinical Director noted a share of the wider allocation from Scottish Government being directed to General Practice and Primary Care. The successful bid for this additional resource is partly in recognition of MIJB historic performance keeping people safe and well at home, and out of hospital. The Chair requested an update at a Development Session with the Board Members in the new year. The Board welcomed the additional resource to improve performance in Unscheduled Care and queried if GPs and Primary Care staff have the capacity to support this work given the rising numbers due to population increase. The Chief Officer advised that the Clinical Director is part of the Emergency Department Group to ensure Community Health and Social Care remains part of planning consideration. Following an invitation to meet with the Cabinet Secretary in the new year, Chair noted the intention to accept, and they will discuss with other MIJB members and the Chief Officer. The Chair thanked the Head of Older People and Primary Care Services for all the information in the report and the associated work. The recommendations were noted by the Board. For Discussion 5.7 IJB Finance Update and Medium-Term Financial Strategy - Paper prepared by Andrew McCreadie, NHS Lothian Deputy Director of Finance, David Gladwin, Midlothian Council Chief Financial Officer/Section 95 Officer and Ruth Nichols, Midlothian Council Senior Finance Business Partner (HSCP) The NHS Lothian Deputy Director of Finance presented the report which sets out – • An update on the IJB’s 2024/25 projected out-turn. Page 11 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments • An update on the Scottish Government’s 2025/26 draft budget. • An outline of the 2025/26 financial projection • Proposals for both short and medium terms recovery actions • Proposals for the development the transformation programme The NHS Lothian Deputy Director of Finance highlighted the financial challenge of 2024/2025 and the key issues, such as prescribing, and advised that the MIJB is working closely with colleagues within Health and Social Care integration authorities and pharmacies across the NHS Lothian to manage this. The NHS Lothian Deputy Director of Finance noted a National Allocation Formula (NRAC) parity funding adjustment is made each year to ensure no Board is more than 0.6% away from their target share. No further NRAC parity will be allocated for NHS Lothian as the Board is under 0.6% parity. The Deputy Director of Finance advised the Board that it is reasonable to assume that the NHS Lothian projected position will not significantly change for 2025/2026. The Chair thanked the NHS Lothian Deputy Director of Finance for the report and opened it for questions. The Board discussed section 3.4 regarding the impact of the National Insurance increase and noted that the impact is currently unclear. The Chief Officer noted concerns raised at Council and the impact on MIJB partner providers. There were further questions around Primary Care prescribing and the accuracy of the prescribing cost pressure predictions as this is higher than expected each quarter. The NHS Lothian Deputy Director of Finance advised that the MIJB has a 10% value across all of Lothian over Acute Medicine and Primary Care Medicine. Overall price and volume growth has impacted the overall numbers and that has made the Board recalibrate the numbers for this year. Page 12 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments The Midlothian Council Senior Finance Business Partner (HSCP) noted that the Scottish Government’s budget proposals include the uplifts for the real living wage and increase of free Personal and Nursing Care rates. The Council’s Chief Financial Officer/Section 95 Officer is currently working through the detail of the draft budget including the implications of the increase in the employers’ National Insurance and the funding that will be available. An updated end of year position for Adult Social Care will be available mid-January 2025. The Chief Officer thanked both the NHS Lothian Deputy Director of Finance and the Midlothian Council Senior Finance Business Partner (HSCP) for the report and highlighted that the second part of the paper details the current gap for this financial year. The HSCP has a projected delivery of £6 million in saving this year and the Chief Officer acknowledged the team for their hard work. Two proposals were detailed to the Board for consideration, which highlighted that safety remains a priority. Key messages were detailed to the Board, including a greater focus on prevention, working closely with its 3rd sector partners, and investing in Primary Care and Community Care. The Chair thanked all for the report and the discussion and asked that these plans were reflected in the draft Strategic Plan, highlighting that a revised draft would be taken to the SPG in January 2025, then the Board in February 2025. It would then be shared with the Strategic Corporate Management Team NHS Lothian in March 2025 with the ambition that this will come back to the MIJB meeting in October 2025. It was further noted that previous recommendations in relation to Care Homes would not be taken forward at this time, noting that this was agreed by the Board. For Discussion 5.8 IJB Performance Report - Paper presented by Elouise Johnstone, Performance Manager The Chief Internal Auditor to Chief Internal Auditor 20/02/2025 Page 13 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments The Performance Manager introduced the report updating the Board on progress towards the IJB performance goals. Due to the processes required to validate this data, the full reporting year is almost complete for all indicators. As a result of this report, Members are asked to: • Note the performance against the IJB Improvement Goals for 2023/2024 (Appendix 1). • Note the inclusion of the OutNav Strategic Governance Map (Appendix 2). The Chief Officer thanked the HSCP Team for their work on improving performance reporting using outcomes mapping. The Chair noted it was their preference to see a comprehensive view. The MIJB Members self-improvement plan was highlighted as not having been reviewed or evaluated. The Chief Officer noted the challenge given the financial focus of the MIJB. It was noted to ask Duncan Stainbank, the Chief Internal Auditor, to provide an update on some revised time scales for evaluation of this plan and future planning. It was further highlighted that this has been a huge piece of work, and the Board thanked the team for all their hard work. provide an update on some revised time scales. For Discussion 5.9 Midlothian HSCP Public Health Practitioner Update - Paper by Ruth Flynn, Public Health Practitioner The Chair requested an update in relation to the early intervention. The Public Health Practitioner Page 14 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments The Public Health Practitioner presented the report briefing the IJB on Drug Use and Alcohol Specific Deaths in Midlothian covering the period of 2020 to 2023. Actions were highlighted in the report and detailed to the board. IJB Members are being asked to note the content of this report. The Chair thanked the Public Health Practitioner for the report and opened for questions or comments. The Chief Officer noted that this report is aligned to the planned transformation model and provides a very helpful update. The Chair welcomed this report and highlighted the importance of early intervention. The Chair requested a future update in relation to the early intervention. For Discussion 5.10 Integrated Assurance Report - Paper presented by Fiona Stratton, Chief Nurse and Claire Ross, Chief Allied Health Professional The Chief Nurse spoke to the report which details the Integrated Assurance report provided by the Midlothian HSCP to the Midlothian IJB. The report provides the IJB assurance around the processes in place to deliver Clinical and Care governance and risk and resilience management, describing the systems and processes in place including the governance and assurance framework. The report also highlights the joint undertaken by the Care Inspection and Health Improvement Scotland, and His Majesty’s Inspectorate of Constabulary into Adult Support and Protection arrangements. Board members are asked to discuss and approve the content of this report. Page 15 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments The Chair thanked the Chief Nurse for this report and asked the Chief Officer if they were confident the report covered all the areas, with all risks being considered brought to the IJB. The Chief Officer confirmed that the report in comprehensive across all areas and noted opportunities to include key information in the Performance Framework. The Board noted the report. For Noting 5.11 Darzi Report - Paper prepared by Gill Main, Integration Manager The Integration Manager presented the report considering the recent Independent Investigation of the NHS in England and presenting key themes for discussion. Members are asked to; • Review the Independent Investigation of the NHS in England (appendices 1 and 2). • Consider some of the key themes as they relate to Midlothian IJB. • Discuss and consider if the Board wishes to take any action in response. The Chair thanked the Integration Manager for the report and asked if there was any cross reference from Darzis recommendations relevant to the work planned, particularly in relation to the Unscheduled Care workstream. The Chief Officer advised that as part of the transformation model the HSCP will investigate options to develop trend analysis that can underpin predictive planning. The Integration Manager highlighted 3 aspects from the Darzi Report; culture and implementation, finding new and increasingly innovative way to use data to identify meaningful action that measure outcomes, not just outputs, and the role of prevention and early intervention. Page 16 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments For Noting 5.12 East Lothian and Midlothian Public Protection Team Annual Report - Paper prepared by Nick Clater, Head of Adult Services and Chief Social Work Officer The Head of Adult Services and Chief Social Work Officer presented the report which introduced the Public Protection Committee Annual Report, explaining the function of the Public Protection Committee for those less familiar with it, and highlighting its priorities detailed in section 3.3. Members are asked to note the contents of the report. The Chair thanked the Head of Adult Services and Chief Social Work Officer for the excellent report noting the values and the voice of children and adults, providing a range of learning opportunities. The Chair highlighted some key information throughout the report, noting the 25% increase in Adult Support and Protection referrals. The Head of Adult Services and Chief Social Work Officer advised that it has been raised at the Chief Officer’s forum and noted the method of recording does not fault describe the challenge of increasing complexity in the high numbers, but work is ongoing to address this. The Group Service Manager added there is some discrepancy with the numbers from Midlothian to East Lothian, however the ongoing audits on the Midlothian cases are showing this is entirely appropriate with any exceptions being appropriately identified. Page 17 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/Co mments For Noting 5.13 Chief Social Work Officer Annual Report - Paper prepared by Nick Clater, Head of Adult Services and Chief Social Work Officer The Head of Adult Services and Chief Social Work Officer presented the report which provides Council and IJB with the annual report of the Chief Social Work Officer (CSWO) and offers a high-level overview of activity in each service area and identifies the great work, along with the challenges and changes that have occurred over the past year. The Head of Adult Services and Chief Social Work Officer added that this report was drafted and presented by Joan Tranent, the previous CSWO, to Midlothian Council in October 2024. Members are asked to: 1.1 Note the report. 1.2 Note the positive work undertaken by Social Work and Social Care staff across the many different sectors over the past year. The Chair thanked the Head and Adult Services and Chief Social Work Officer for the informative report. The Chair welcomed the learning and development piece on trauma and having a Development Worker and the significant group of trained staff. The Board noted the report. 5.14 Chief Officer – Additional Item The Chief Officer announced that followed recent interviews Chris King had been successful in appointment to the Interim Chief Finance Officer role, starting in post on 20th December 2024. A paper recommending Chris King to the Board as Interim Chief Finance Officer will be presented at the February Board. Page 18 of 316
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Thursday 19 December 2024 Midlothian Integration Joint Board 5 Private Reports No items for discussion. 6 Any Other Business No items for discussion. 7 Date of Next Meeting The date of the next MIJB meeting will be the 20 February 2025. The Development Session will now be held on 30 January 2025. The meeting terminated at 16:00. Decision Action Owner Date to be Completed/Co mments Sincere thanks were noted to David King for their hard work and dedication to the IJB. Page 19 of 316
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Midlothian Integration Joint Board Meeting Date Time Venue Strategic Planning Group 28 November 2024 14:00 Council Chambers/MS Teams Present (MIJB members): Andrew Fleming (Chair) Dr Amjad Khan (virtual) Keith Chapman, Lived Experience Member Present (HSCP and Partners): Morag Barrow, (Chief Officer) Gill Main, Integration Manager Lisa Cumming (virtual), Business Support Manager Roxanne King (virtual), Executive Business Manager Laura Hill (virtual), VOCAL Emma-Jane Gunda (virtual), Assistant Strategic Programme Manager Elouise Johnstone, HSCP Programme Manager (Performance) Nick Clater, Head of Adult Services Fiona Kennedy (virtual), Group Service Manager Rebecca Miller, Strategic Development NHS Lothian Apologies: Rebecca Green, Clinical Director Jim Sherval, Consultant in Public Health Claire Ross, Chief AHP Fiona Stratton, Chief Nurse David King, Interim Chief Financial Officer Annette Lang, Group Service Manager Midlothian Integration Joint Board Thursday 20 February 2025 Item No 4.2 Page 21 of 316
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Strategic Planning Group Councillor Winchester Magda Clark, Third Sector Member Grace Cowan, Head of Primary Care and Older People 1. Welcome and introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (IJB) Strategic Planning Group (SGP). The apologies submitted were noted. 2. Order of Business The Chair advised that the order of business was as set out in the agenda, but item 3.3 would be discussed later in the meeting. 3. Minutes of Meeting 3.1 The minutes of the Strategic Planning Group 26th September 2024 were approved as an accurate record. 3.2 Action log An update for action 11 was recorded with the NHS Lothian Head of Strategy Development advising liaison with HSCP Programme Manager was still to take place due to changes to funding and timelines. A new due date will be proposed at the next meeting. An update for action 17 was noted with the SLWG membership being developed. Chair noted the SLWG must link with the Integration Manager ahead of any proposals coming back to this group. 3.3 Risk Register Due to the ongoing financial uncertainly impacting on risk description and consequence risks will be reviewed following the indicative budget offers, noted in SPG, and held by the MIJB Audit and Risk Committee. . 4. Updates Page 22 of 316
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 The Chair’s Update The Chair advised that the Midlothian Integration Joint Board (IJB) held a recent development session on the MIJB’s financial situation. The Chief Officer highlighted an upcoming Partners meeting in early December to consider a new operational transformation model. A formal proposal will be brought to the February IJB meeting. The Chair highlighted the Scottish Government budget proposal and noted the ongoing intention for development of the National Care Service, noting a pause in progressing the legislation. The Chair also highlighted two townhall meetings on IJB draft Strategic Plan. It was also noted that the SPG Vice Chair position is still vacant. The Chair raised and opened for discussion the on the format of SPG meetings. Chair concluded that face to face with a hybrid option would continue and ask for all members to consider face to face attendance where possible. Members to contact Chair if further points to be raised. The update was noted. SGP members to contact Chair if required All All n/a 30/12/2024 5. Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1 Reporting and Evaluation Effective Evaluation, presented by HSCP Programme Manager (Performance). The HSCP Programme Manager (Performance) presented the Midlothian progress on national indicators detailed in Annual Performance report noting examples of where work was strong and where there was opportunity for taking Page 23 of 316
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments action to see improvement. The group were invited to discuss where targeted action for improvement could be undertaken. The Chair noted the need to share good practices and successes, to inform improvement work elsewhere. Chair requested that the Cluster Leader provide an overview of what they have done this year. The group discussed the importance of understanding the predictable clusters of need. The Integration Manager advised that current data does not provide this level of detail, although a tracking model could be adopted. The Chair noted the need for more service level data and the Head of Adult Services was invited to comment. The inability to ascertain information from the HACE survey, and indicators 1-9, on which services were involved with the people that described their poor experiences was noted by the group. The integration Manager suggested the Citizens Panel could be used to ask more questions about improvement opportunities. Discussions turned to what can be done to better understand the action we can take and our performance. The Head of Adult Services advised of capacity challenges but will discuss with Service Manager cohorts. The Chief Officer noted that this will be central to the new transformation model and the Integration Manager highlighted the focus on improving quarterly reporting and developing ways to describe our contribution more fully. Clinical Director to liaise with GP Cluster Lead to consider presentation EJG to liaise with CD To action review of Citizen Panel questions. Clinical Director Integration Manager Performance Manager 30/12/2024 April 2025 5.2 Design and Development Directions 2025/26 Development (Gill Main, Integration Manager) Page 24 of 316
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Integration Manager presented an overview of the development process for IJB Directions for 2025/2026, highlighting the mechanism, approach, monitoring and evaluation methodology used. A logic model was introduced to help generate discussion and identify the key areas of action for IJB directions SPG participated in an exercise using the model. The Integration Manager thanked everyone for their contributions which would inform the next stage of development. Any interest to collaborate on Directions further would be welcomed. SPG members to contact the Assistant Strategic Programme Manager. All 5.3 Implementation Strategic Plan 2025-2035 Accompanying Documents Review, presented by the Assistant Strategic Programme Manager and the Business Support Manager. This item includes 3 draft documents that must be published alongside the IJB’s Strategic Plan 2025-35for SPG to review; the Market Facilitation Plan, the Housing Contribution Statement, and the Consultation and Engagement Statement Members of SPG were asked to: • Note and review the content of the draft Market Facilitation Plan, Housing Contribution Statement, and Consultation and Engagement Statement; • Offer feedback, input, and collaborative working offers for the development of these draft documents The Chief Officer noted the highlighted gaps in the Market Facilitation Plan with this being the first iteration and noted the work to be undertaken requiring input for commissioning and procurement colleagues. The Lived Experience Member noted the relationship between ethical procurement and inequalities, and the Integration Manager replied work suggested will be proportionate on to ensure Page 25 of 316
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments what the IJB does is legal and feasible. The Integration Manager added on going liaison with the Policy Unit Head on Procurement Policy and Market Facilitation from the Scottish Government is informing this work. It was queried if there were any current provision draft Housing Contribution Statement as to the possibility of co-location of carers and the person, they care for in housing allocation assessments. An action was agreed to speak with Councillor McKenzie, the Housing portfolio holder, to inquire about opportunities to review housing prioritisation. The Chair thanked the Assistant Strategic Programme Manager and the Business Support Manager for the report and presentation. Explore inclusion of ethical procurement topic in Market Facilitation Plan Inquire as to Midlothian Council provisions / future provisions as to Housing Allocation Assessments for inclusion in Housing Business Support Manager Assistant Strategic Programme Manager. 30/03/2025 09/01/2025 5.4 Review of Midlothian IJB Strategic Governance Map: Column Three (How they feel) Presented by the Integration Manager. The Integration Manager noted the Strategic Governance Framework and reiterated the functionality of this to describe the boards strategic governance. This is new and will be supported through ongoing discussion, items for review, and board papers. Each column in the framework has key action stepping stones which in turn have a set of success criteria. The column for Governance review every November relates to column three; how they (the board) feel in relation to the being supported, informed, and confident in their role. The information provided set out the activities undertaken to achieve this and it was noted that • The progress has been rated as some progress with a high level of confidence in the evidence Page 26 of 316
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments • The IJB had not reviewed its self-development plan in 2024/25 and this may be an area for the board to consider ensuring any development needs are met. The Chief Officer noted that the report captures the topic well, and asked regarding how other IJBs are doing in this area. The Integration Manager advised that this model is unique to Midlothian. The Chief Officer asked if this information is shared with public, and noted the MIJB will need to consider how information is shared to the public in an easy and accessible way. The Integration Manager suggested that this framework is utilised in several statutory publications and could be used more explicitly but that the board may wish to consider if the framework in its entirety be published The Chair thanked the Integration Manager for the report. To include details of this work in APR, Strategic Plan and Annual Accounts. For board to consider publication of the report annually Performance Manager Integration Manager CFO Chief Officer Ongoing 30/03/2025 5.5 For noting only Midlothian IJB Strategic Plan 2025/35 ECRIA The Chair noted that this item was for noting only following the draft circulated for comment and additional actions noted in this final version. No further comment received from the group. To progress signatures To publish alongside the Strategic Plan Assistant Strategic Programme Manager Integration Manager 30/12/2024 01/04/2025 5.6 Reflections and Key Messages for Sharing with Midlothian IJB Presented by the Chair The Chair asked SPG members to reflect on key messages from this meeting toto be shared with the Board next month. Concerns were raised about how Page 27 of 316
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments individual elements of strategic planning will come together due to financial uncertainty, and the risk around the associated timelines. The Chair thanked everyone for their contributions during this meeting. Members noted a preference to continue to utilise meeting space at Midlothian House with a desire to meet in-person. Any Other Business • Equality Outcomes The Integration Manager highlighted that all public bodies need to report on their equality duties and data, advising that the IJB is expected to finalise their report by the 1st of April. Advising it will not be possible for the IJB to meet this timeline, and proposed the IJB request an extension. The Chair stated they are confident the Board will be supportive of this and agreed to present to the IJB. Proposal of PSED extension request supported for presentation at December IJB. Integration Manager 19/12/2024 6. Date of next meeting The next meeting of the Midlothian Integration Joint Board Audit and Risk Committee would be held on 16th of January 2pm. The meeting terminated at 15:49. Page 28 of 316
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Midlothian Integration Joint Board Meeting Date Time Venue Audit and Risk Committee Thursday, 12 September 2024 9:00am Virtual Meeting held using MS Teams Present (voting members): Val De Souza (Chair) Councillor McManus Councillor Milligan Councillor Parry Present (non-voting members): Morag Barrow (Chief Officer) David King (Chief Finance Officer (Interim)) Duncan Stainbank (Chief Internal Auditor) Kirsty Macdonald Patricia Fraser (External Auditor) Roxanne King (Executive Business Manager) Claire Gardiner In attendance: Hannah Forbes (Democratic Services Officer) Apologies: Gill Main (Integration Manager) Midlothian Integration Joint Board Thursday 20 February 2025 Item No 4.3 Page 29 of 316
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2 MIJB - Audit and Risk Committee Thursday 7 March 2024 1. Welcome and Introductions The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Audit and Risk Committee. 2. Order of Business The Order of Business was as detailed in the agenda. 3. Declarations of interest No declarations of interest were received. 4. Minutes of Meeting 4.1 The Minute of Meeting of the Audit and Risk Committee held on 6 June 2024 was submitted and approved as a correct record. 5. Public Reports 5.1 Matter Arising - David King The interim Chief Financial Officer provided a verbal update on a number of subjects. • It was noted that it would be necessary to arrange a Datix development session, this could be done as an additional 30–45-minute session following a committee meeting. Members were asked to consider whether this would be a good arrangement and either contact the Chief Financial Officer or discuss at the next committee meeting. • The role of the independent member for the committee has been approved. Members agreed it would be very beneficial to have an independent member on the committee as this would ensure further transparency. A further discussion ensued on how to recruit an independent member, such as advertising through the website. Page 30 of 316
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3 MIJB - Audit and Risk Committee Thursday 7 March 2024 • It was noted that a vice chair has yet to be appointed to this committee. This is to be added to the agenda for the next Audit and Risk Committee meeting. • Quorum arrangements for the committee were discussed. If the minimum quorum is three members, and if membership of the committee consists of 2 members from NHS, 2 members from Midlothian Council and one independent member, it may be preferable to recruit an additional independent member or organise a deputy system as otherwise the onus may rest on the independent member to always be available for meetings. After some discussion it was agreed 3 out of 5 members of the committee in attendance was a reasonable arrangement. The matters of the Vice Chair and recruitment of independent member were to be added to the next meeting agenda. 5.2 Risk Register The interim Chief Financial Officer presented the report, The report presents the IJB’s Q2 risk register for discussion by the committee. The Audit and Risk Committee members are requested to: • Note the Q2 risk register. • Consider if any further additions or changes should be made to the risk register. • Agree to the proposal that, at a workshop, a presentation on the use of Datix is provided to the committee along with a further, more detailed consideration of the management of the risk register. The Committee discussed the new risk relating to the National Care Service and if we can be explicit on decisions and the potential impact they may have on Midlothian and the IJB. The chair thanked the Interim Chief Financial Officer for the report and noted the recommendations. 5.3 Annual Accounts 23/24 - report of the appointed auditors - External auditors Page 31 of 316
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4 MIJB - Audit and Risk Committee Thursday 7 March 2024 The IJB’s appointed auditor (from Audit Scotland) presented the Report of the External Auditor on the Annual Accounts and apologised for a slight delay with the report but expressed satisfaction with the progress made. It was noted the external auditor’s view provides a clean audit opinion and that there have been no significant adjustments. Appendix B in the report contains a letter of representation for the Interim Chief Financial Officer to sign on behalf of the Committee having recommended the Annual Accounts to the IJB and the IJB having approved them. The Audit report is in its draft format and will be finalised after today’s meeting. A number of points were highlighted for the Members consideration: • Exhibit 1 – materiality levels – It was noted there has been increased expenditure this year, and that there has been no change in benchmark levels. • An issue was identified where significant insurances did not reflect the numbers, a partner body presented this paper and appropriate action was taken. • The main risk for misstatement were noted, but no adjustments were needed • Management commentary has been improved to tell the story of the IJB better. It was noted that IJB broke even in 2023/24 but had used all its reserves. Audit Scotland is reassured financial sustainability is appropriate, and actions will be taken as appropriate. The report also suggests there is appropriate governance in place. Finally, it was noted that there is evidence of good management, and it was recommended good practice guidelines continue to be observed going forward. The Appointed Auditor thanked the Interim Chief Financial Officer for his cooperation in the process. Page 32 of 316
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5 MIJB - Audit and Risk Committee Thursday 7 March 2024 After discussion Members confirmed they approve the findings of the cover and main audit report, and agreed to recommend approval of the annual accounts to the IJB. 5.4 Annual Accounts 23/24 The interim Chief Financial Officer presented the report, The IJB has prepared annual accounts for the financial year 2023/24; these have now been audited by the IJB’s Independent Auditors. Their report has been presented to committee at item 5.3. As a result of this report Members are being asked to: • Note the report of the independent auditor • Consider the 2023/24 annual accounts of the IJB. • Recommend approval of the accounts by the IJB. The chair thanked the Interim Chief Financial Officer for the report and the committee are happy to note the recommendations. 5.5 Audit Scotland - Audit report on IJB's The Interim Chief Finance Officer presented the report and detailed this paper presents the Accounts Commission’s July 2024 report on Integration. The Committee members are asked to: • Note this report. • Note the report of the accounts commission. • Consider the IJB’s position against the recommendations in the Accounts Commission report. • Request that a further report be made to a Board meeting of the IJB. It was noted by the Committee that this is a very helpful report, and the timing is very helpful. What we have been trying to do leading up to the budget allocations is to be open and honest and transparent about where we are and what we are trying to do to recover. I think this report Page 33 of 316
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6 MIJB - Audit and Risk Committee Thursday 7 March 2024 would be helpful to take this to the Board to give context and position Midlothian and give us an opportunity to reinforce the work that has been going on behind the scenes. 5.6 Audit Report - MIJB directions The Chief Internal Auditor presented the report, The purpose of this report is to present the findings and recommendations. from the recently completed Internal Audit review of Midlothian IJB Directions, completed by the Midlothian Council Internal Audit team. It is recommended the Audit and Risk Committee note the findings and recommendations from the report. The Chair thanked the Internal Auditor for the report. In relation to the recommendations on ensuring that there is a clear link between the Directions issued and the budget allocation the IJB has taken a different route with directions which cut across multiple service areas. As Services are budgeted for it is not possible to provide this direct link, however for 2024/25 each direction has clear links to recovery actions with savings against each one. The chair acknowledged the work completed and noted recommendations of the report. 5.7 Audit Report - NHS Lothian Directions from IJBs The Chief Internal Auditor presented the report and advised that the report reviews the audit work that has been completed across the two partner organisations. The purpose of this report is to: • Inform the MIJB Audit and Risk Committee of the NHS Lothian Internal Audit Report on IJB Directions providing Limited Assurance; and • Inform the MIJB Audit and Risk Committee of the NHS Lothian Internal Audit Report on Financial Sustainability providing Significant Assurance. The MIJB Audit and Risk Committee is asked to: Page 34 of 316
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7 MIJB - Audit and Risk Committee Thursday 7 March 2024 • Note the findings of the NHS Lothian Internal Audit on IJB Directions. • Note the findings of the NHS Lothian Internal Audit on Financial Sustainability. The Chair thanked the Internal Auditor for the report. It was noted that all apart from one of the recommendations on the IJB Directions Report should now be completed and that work had been undertaken in NHS Lothian to implement these recommendations. The Chair noted that the report is welcomed. The Audit and Risk committee noted the actions in the report. 6. Private Reports No private business discussed at this meeting. 7. Date of next meeting The next meeting will be held on Thursday, 5 December 2024 at 2.00pm. The meeting terminated at 10:24am. Page 35 of 316
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Midlothian Integration Joint Board Thursday, 20 February 2025, 14:00-16:00 Chief Officer Report Item number: 5.2 Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting February 2025. Board members are asked to: • Note the content of the report. # Page 37 of 316
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Midlothian Integration Joint Board Report Chief Officer Report 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting February 2025. 2 Recommendations 2.1 As a result of this report Members are asked to: • Note the content of the report. 3 Background and main report 3.1 Chief Officer The HSCP team continue to work on financial recovery programme, looking into options for 2025/26 for the Board to consider at March 2025 Board meeting. Two Partners meetings have been held, as well as two Elected member Briefing sessions. Financial position is reported at both NHS Lothian and Midlothian performance review meetings, as well as routine Finance meetings. Continued recognition of staff excellence remains a focus within the HSCP team. Vivian Wallace (Ageing Well coordinator) was awarded an MBE for services to Older People, Ryan Ball (Nurse manager for Older Adults Mental Health Team), and Louise Healey (Nurse manager for Community Mental Health Team) were awarded the Queens Nursing Award, and the NHS Lothian Dietetics Weight Management team were awarded Team of the Year at the Celebrating Desmond awards. Congratulations, and thanks to those above, but also for the wider staff group who continue to provide high quality care to the residents of Midlothian. Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Head of Adult Services Learning Disability Services The “St. Cuthberts Supported Living” project is nearing completion. This core and cluster service consists of 8 one-bedroom flats with 24/7 on site support. The first tenants have moved in and the remaining flats will be the occupied over the next two months. Four flats have been allocated to individuals who are able to live relatively independently but will require ongoing access to 24/7 support. The other 4 flats will be allocated to individuals who in the longer term will be able to live independently in their own tenancy, but in the short term will require access to 24/7 support while they develop their independence skills. This service will assist these individuals, typically young adults with a Learning Disability leaving home, acquire the necessary skills and transition to a regular tenancy. Page 38 of 316
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Midlothian Integration Joint Board Older Peoples’ Services In November there was an event for older people arranged by the Older People’s Assembly, attended by older people representative of the diversity in our community, including some invited service users. A significant number of voluntary, third sector and statutory services from both health and social care provided stalls and information to the attendees. There was an opportunity to discuss supports and community resources that provided social, educational, recreational and health improvement supports. Feedback was positive and allowed for networking and information sharing. The annual Older People’s newsletter was completed and distributed throughout Midlothian from GP surgeries, libraries, health centres, care homes etc. It contains information on services, community groups and services and aimed to support older people to reduce isolation and access support and assistance to live well as they age. Justice Services The work undertaken by the Justice Service supports work ongoing to achieve progress in: • Single Midlothian Plan Priorities: Individuals and communities have improved health and skills for learning, life and work. • Single Midlothian Plan Themes: Midlothian Will be Safer • National Health & Wellbeing Outcomes: Living in the Community, Positive Experiences and Dignity, Quality of life, Health inequalities, Safe from harm Individuals become formally involved with Justice Social Work at the point of conviction when a Court makes a request for a Justice Social Work Report; requests for assessment and risk management planning are received from the Scottish Prison Service and the Parole Board. Table 1 shows the number of reports requested over each of the 3 months. The main type of report is the Justice Social Work Report (JSWR) and these are requested by a Sheriff or Judge to inform sentencing. The Justice Service also compete reports for Scottish prison Service and the Parole Board for those who are progressing through their custodial sentence. Staff in the Justice Service work with men and women subject to Community Payback Orders who present with a wide range of presenting risk and needs. This includes individuals with mental health, substance use, adverse childhood experiences, trauma and negative experiences of education and or employment. Staff working within Justice Services require the appropriate level of support and training to enable them to effectively engage with people in order to progress interventions towards positive changes in behaviour. An important part of ensuring that men and women in the justice system have ease of access to services and resources is the provision of robust community-based alternatives to custodial sentences as Page 39 of 316
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Midlothian Integration Joint Board it enables individuals to remain in their community, maintain relationships and ensures continuity of care. The main community-based sentence is a Community Payback Order (CPO), which can have several requirements attached to it. The most frequently imposed requirements are Supervision and Unpaid Work. During Q3 the Courts imposed 42 Community Payback Orders, Table 2 shows how many of these included the main two requirements. Alongside managing individuals on Community Payback Orders, the Justice Service provides a throughcare service to people who are in prison and to their families/named support, from the point of sentence, during the period in custody and following release. It comprises of two elements that are fundamentally connected, services provided during the custodial sentence and services provided on release back into the community. Justice Social Work have a statutory duty to provide a service to persons who will be subject to statutory supervision on release. This includes a life sentence, Order for Lifelong Restriction (OLR), long-term determinate sentence (4 years and over), short term sex offender sentence, extended sentence or a Supervised Release Order (SRO). It is essential to establishing and maintaining confidence in community-based sentences that there is assurance that robust action is taken on non-compliance. To be able to comply with the requirements of the order the individual has understand the expectations and consequences of non-compliance it is important that staff are skilled in being able to engage with people effectively. Justice Social Work staff use a trauma informed and person-centred approach to develop effective working relationships with clients. In the interests of justice, and to maintain the public confidence in community sentences, all missed appointments, or failure to comply, are responded to robustly using disciplinary procedures which can result in the order being returned to court in breach. During the breach process we continue to seek to engage individuals to re-engage with interventions to reduce and manage the risk of re-offending. Table 3 illustrates the percentage of individuals who have been breached and those with whom we have been able to maintain effective engagement with during the breach process. The number of open orders is greater than the number of individuals supervised as a person can be subject to more than one CPO at any given time. Page 40 of 316
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Midlothian Integration Joint Board Suicide Prevention In Quarter 3 the Public Health team hosted a Suicide critical response workshop. The purpose of the workshop was to stress test Midlothian’s response to a suicide. The workshop was facilitated by Public Health Scotland and used a fictional scenario to work through varies aspects including data sharing, support for those affected and communications. Sixteen people attended the workshop from a variety of sectors including HSCP, 3rd Sector, Education, Children’s services, Public Health, and Housing. As part of the evaluation of the event people fed back that they enjoyed the interactive nature of the session and found the discussion useful, describing the value of the interactive format, the informal discussions, and the networking conversations. The attendees reported that they learned and gained a better understanding of the gaps in our response and the processes we currently have in place when a suicide happens in Midlothian, and recognised the importance of people, perspectives and information. We also asked what people would do differently as a result of attending. The main response was addressing actions to ensure our response is effective. This workshop has helped to establish a baseline for our response to suicide in Midlothian and will help develop the 3-year strategy going forward. Substance Use Services Midlothian SUS treatment service Q3 performance predicted 100%, for all individuals referred to the service both for Substance use and Alcohol dependency were seen and assessed/treatment started within 21 days. (Due to reporting schedule final report not confirmed). The service continues to progress with implementation of the MAT standards and are on target for the Scottish Government target expectations for March 2025, evidence of sustained Mat 1-5 and provisional Green 6-10. Midlothian has submitted recent progress report for Q3 and is on target for expected deliverables. The service confirms MAT progress report has been submitted and accepted by Scottish Government for Q3. The service received 44 new referrals over Q3, off which 23 referrals were for alcohol and 21 for Drugs. As reported all individuals for both alcohol and drugs have been seen within the 21 days. Page 41 of 316
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Midlothian Integration Joint Board Midlothian Substance Use Treatment Service Q3 A11 – all individuals seen within 21 days of referral. Predicted 100% Caseload 334 New Referrals (excludes re titration) 44 NFO assertive outreach (treatment service required only) 18 Midlothian SUS service recognises the importance of Patient/Client feedback, it enables the service to improve the quality of services and ensures that care meets the needs of patients and clients, which in turn provides better outcomes for Patients/Clients. Feedback is important in identifying areas for improvement, evidencing the strengths and gaps of a service, through the voice of those with lived experience. The service continues to strive to obtain feedback both through 1:1 but also for the group actives held. Throughout Quarter 3 the service’s focus has been on the following 4 questions: • ‘What part of the service are you happy with and why’? • ‘Is there anything about the service you feel needs improving’? • ‘Are there services that are not available that you feel we should provide’? • ‘Do you have any other comments on the service we provide’? Below is a ‘Mindmap’ of the feedback received from Patients/Clients highlighting what parts of the service they are happy with and why. Throughout the feedback Patients/Clients highlighted an area for improvement, individuals reported not fully knowing what was available to them. On receiving this feedback, the services came together and developed a resource board, which is situated within main reception area outlining all that’s available to support individuals with their personal recovery. Further, services all agreed to demonstrate that they were positively making changes based on the feedback from Patients/Clients. The service developed ‘You Said, We Did’ section, this has been a positive and welcomed addition to NO 11. Our priority is engaging with Patients/Clients to ensure they feel engaged in-service design as well as demonstrating that services are listening and hearing the voice of a person with lived experience. Page 42 of 316
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Midlothian Integration Joint Board Mental Health – Neurodiversity Neurodiversity presents as a national challenge for waiting time performance, both Autistic Spectrum Disorder (ASD) and Attention deficit hyperactive disorder (ADHD). Midlothian’s waiting time performance for both conditions continue to be the shortest across Lothian, where individuals from point of referral acceptance for ADHD longest wait is 65 weeks and ASD is 61 weeks. There is ongoing development work Pan Lothian to look at how we can robustly address the current and increasing demand. Midlothian Adult Mental Health (Medical, Nursing and AHP) Q3 Waiting times Community Mental Health Team (CMHT) 2-3 weeks dependent on urgency. Waiting time target 100% of individuals seen within 18 weeks ADHD – 293 individuals on waiting list- longest wait 65 weeks ASD - 61 individuals on waiting list- longest wait 61 weeks. Reduction of 40 individuals waiting since last quarter. New Referrals 371 Neurodiversity assessments provided by Midlothian Adult Mental Health service incorporate ADHD assessment and ASD assessments, they are built into routine outpatient appointments. Midlothian do not have neurodiverse service or dedicated staff to meet the needs of the ND waiting list. Prior to 2024 assessments were collated manually and this was resource intensive (we only have a small sample since 2022 of manual collation), since 2024 Midlothian has onboarded to the electronic health system Trak with dedicated waiting lists for both ADHD and ASD, which will make it easier to monitor and pull accurate data, this must be considered when review the following data. Neurodiversity Referrals received: Page 43 of 316
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Midlothian Integration Joint Board Current waiting list size and longest wait: Condition Current waiting list size Longest wait ADHD 241 68 ASD 115 61 In 2024 number of Assessments offered: Condition Assessments Offered ADHD 228 ASD 145 Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Integration manager Scottish Government Adult Social Care Ethical Commissioning Working Group Officers of the HSCP are working closely with Scottish Government colleagues who are undertaking a review of current procurement practices. A working group has been convened with a range of representation to ensure work remains cognisant of the complex policy landscape across health and social care. The objective of the group is to develop guidance and tools to support the implementation of ethical commissioning. Key actions of the working group include: • identifying good procurement practice and understand the impact of procurement practice on the service provided to individuals • reviewing the current guidance and tools available against the proposed ethical commissioning principles and approach • review the use of current guidance and tools and identify new ways to support an ethical procurement approach • support the development of updated tools and guidance • consider alignment of procurement with other health and social care policies and statute e.g. Getting It Right for Everyone and Self-Directed Support This work will help inform the IJB Market Facilitation Plan and ongoing work on Commissioning. Data Sharing Agreement In December 2024, the HSCP was successful in securing agreement for the first Data Sharing Agreement (DSA) between NHS Lothian and Midlothian council to allow the Midcare service have essential oversight of work to keep people safe and well at home. Although this was a very small data set, the agreement of safe data transfer is a significant achievement and the result of three years of negotiation and development. This achievement sees Midlothian leading the way in in the use of integrated data and work will now progress to develop priority DSAs to support services deliver high quality, effective, efficient, and safe care. Page 44 of 316
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Midlothian Integration Joint Board IJB Publications Work continues on a range of statutory IJB Publications which are progression through various stages of governance. Work underway includes the Midlothian IJB Strategic Plan 2025/35 (including the Housing Statement, Market Facilitation Plan and Consultation and Engagement Statement) , Midlothian IJB Workforce Plan 2025/28, Midlothian IJB Equality Outcomes and Mainstreaming Equality Report, Midlothian IJB Community Engagement Self- Assessment and Action Plan, and the Midlothian IJB Public Engagement Statement. Gill Main, Integration Manager – gill.main3@nhs.scot 3.3 Clinical Director General Practice All 11 practices continue to have open lists for registration and patient access to core general medical services (GMS). However, financial pressures from increased facilities charges, increased employers increased national insurance contributions, and some reductions in enhanced service payments, mean that many practices have had to reduce their capacity to deliver safe care within their resources. Medicines Waste After a cessation in clinical and medicines waste services at local community pharmacies due to a contract dispute with NHS Lothian, the HSCP has successfully set up interim provision of the service for all patients via the Vaccination Centre at Midlothian Community Hospital. Work continues by NHS Lothian to re-establish wider provision again in future. HSCP Pharmacy The Midlothian Primary Care Pharmacy Team continue to manage an annual prescribing efficiencies plan which has delivered well against their year-end target. A invest-to save proposal has been supported for recruitment of additional pharmacy staff to undertake a range of planned efficiency work against our top 20 medicines spend in 2025-26. Medical Staff As part of discussions between the Scottish Government and BMA Scotland it has been agreed that doctors formerly known as ‘Junior’ Doctors will now be referred to as ‘Resident’ Doctors. This applies to all doctors formerly referred to as ‘Junior’ Doctors, not only doctors who are in training, and therefore recognises the skills and extended experience that many of these medical colleagues have. Rebecca Green, Clinical Director – rebecca.green@nhs.scot 3.4 Chief Nurse National Update The Scottish Executive Nurse Director’s Group (SEND) submitted a letter to the First Minister highlighting the key enablers for NHS renewal ahead of the discussions on Wednesday 22 January. These addressed the need to address the significant workforce gaps anticipated, for governance and resources to keep pace with practice and policy, for ongoing digital transformation and the need to focus on and address other key risks. Page 45 of 316
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Midlothian Integration Joint Board Specific areas highlighted included: • Funding to support international nursing graduates • Creating alternative routes to Registered Nursing (widening access/earn while you learn) • Development of strategic objectives for the social care workforce (particularly nursing in social care settings) • Clarification on the permanency (including funding and role clarification) of care home assurance arrangements introduced as an emergency during the Covid 19 pandemic • Highlighting the importance of collaboration with NHS Education for Scotland in designing and delivering the health and social care workforce, education and training, data and digital • The need for review of medicines in the home care setting, including moving away from reliance on paper-based systems • Recognition of the challenges and the need to address consistent application of health and social care policy across all sectors to reduce inequalities • Continued work to accelerate the implementation of digital innovation and to address waiting times for planned care and diagnostics Pan Lothian Community Nursing Review The pan Lothian Community Nursing Review continues, and significant progress has been made across the four main workstreams of Workforce, Education, IT and Digital and Communication and Engagement. A further workforce planning workshop took place as this update was being written on 30th January. Testing of electronic referrals from different hospital sites is at an advanced stage and GP practices have been engaged in developing a consistent electronic referral process that reduce risk of missed communication and reduces duplication. Considerable work has been undertaken to support effective signposting and triaging of referrals to enable patients to receive the right care from the most appropriate professional at the right time. NHS Lothian Clinical Education has developed and delivered a new range of learning opportunities specifically targeted at the District Nursing workforce. A comprehensive Options Appraisal has been undertaken with the support of NHS Lothian eHealth to enable progress to be made towards delivering a more digitally enabled DN service in order to improve patient safety, communication and efficiency. This work supports the implementation of the local review of District Nursing in Midlothian that has identified action required to deliver a safe and effective DN service within the HSCP to meet increasing demand and complexity requiring nursing in the home within our local communities. Further information about the Community Nurse Review can be accessed on the NHS Lothian intranet Health and Care (Safe) Staffing Duties Work is ongoing to meet the requirements of the Health and Care Staffing legislation within nursing in the HSCP. This included a recent establishment ‘health check’ exercise within Midlothian Community Hospital and the use of workload and professional judgement tools to inform the local component of the District Nursing Review. The tools have enabled an objective appraisal of staffing against demand, risk and complexity and an opportunity to check that establishment and budgets are aligned. All areas now run the recognised workforce and workload tools on at least an annual basis, an exercise which provides assurance to the NHS Lothian Board and the IJB and enables clinical staff to be involved in decisions that affect them and their patients on a day-to-day basis and meeting the duty to seek professional advice in relation to staffing. Page 46 of 316
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Midlothian Integration Joint Board Recruitment Workforce remains a significant risk for all professions in the partnership, and nursing has worked hard to reduce the establishment gap and address challenges around recruitment and retention. As we are midway through the academic year, plans are at an advanced stage to attract newly qualified nurses to our teams in Midlothian, and we are working with the Corporate Nursing Recruitment team to plan an event that will highlight the opportunities available to new graduates in the HSCP in early March. 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. 5 Directions 5.1 The report reflects the ongoing work in support of the delivery of the current Directions issued by Midlothian IJB. 6 Equalities Implications 6.1 There are no specific equalities issues arising from this update 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 February 2025 Page 47 of 316
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Midlothian Integration Joint Board Thursday, 20 February 2025, 14:00-16:00 Appointment to the Midlothian IJB Audit & Risk Committee of an Independent Member Executive summary A report to the June 2024 Audit & Risk Committee Meeting presented by the Interim Chief Finance Officer gained the support of the Audit & Risk Committee to recruit an Independent Member. The role of Independent Member is included in the Audit & Risk Committee Terms of Reference. The Interim Chief Finance Officer advertised for this role, which is not renumerated, and one applicant was put forward for the position. An Interview with the applicant took place in January 2025 and the Chair of the Audit & Risk Committee along with the Chief Finance Officer and the Chief Internal Auditor agreed to appoint Antony Clark, to the position subject to the approval of the Midlothian IJB. Prior to retirement, Antony Clark held the position of the Executive Director of Performance and Best Value at Audit Scotland Members are asked to: • Members are asked to approve the appointment of Antony Clark as the Independent Member of the Audit & Risk Committee. # Item number: 5.4.1 Page 49 of 316
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Midlothian Integration Joint Board Report Appointment to the Midlothian IJB Audit & Risk Committee of an Independent Member 1 Purpose 1.1 This report sets out the process that has been undertaken to appoint an Independent Member of the Audit & Risk Committee and asks the Midlothian IJB to approve the appointment. 2 Recommendations 2.1 As a result of this report, Members are asked to approve the appointment of Antony Clark as the Independent Member of the Audit & Risk Committee. 3 Background and main report 3.1 CIPFA’s Position Statement 2022: Audit committees in local authorities and police, which provides the appropriate best practice guidance for the IJB Audit & Risk Committee states: “Where there is no legislative direction to include co-opted independent members, CIPFA recommends that each authority audit committee should include at least two co-opted independent members to provide appropriate technical expertise.” 3.2 A report to the June 2024 Audit & Risk Committee Meeting, by the Interim Chief Finance Officer identified support of the Audit & Risk Committee for the recruitment of an independent member which was already included in the Audit & Risk Committee terms of reference. 3.3 The Interim Chief Finance Officer advertised for this role, which is not renumerated, and one applicant was put forward for the position. An interview with the applicant took place in January 2025 and the Chair of the Audit & Risk Committee along with the Chief Finance Officer and the Chief Internal Auditor agreed to appoint Antony Clark to the position subject to the approval of the Midlothian IJB Board. 3.4 Antony Clark was considered an excellent candidate having had a substantial public sector audit career, culminating in his most recent position as the Executive Director of Performance and Best Value at Audit Scotland. Mr Clark clearly has an excellent understanding of the Scottish Public Sector environment at a high level, including IJB, NHS and Local Authority sectors. This experience would allow for an appropriate level of scrutiny from an experienced and enthusiastic professional with perspectives from across Scotland and locally in Midlothian. Page 50 of 316
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Midlothian Integration Joint Board 4 Policy Implications 4.1 None 5 Directions 6.1 There are no further policy implications arising from this report. 6 Equalities Implications 7.1 This report has no Equalities implications 7 Resource Implications 8.1 This report provides a further valuable scrutiny resource to the IJB without requiring any further expenditure. 8 Risk 9.1 This report provides a further valuable scrutiny resource that should enhance the scrutiny provided to the IJB risk management processes. 9 Involving people 9.1 The Chair of the Audit & Risk Committee and the Chief Finance Officer have been fully involved in the decision to appoint. 10 Background Papers 10.1 None. AUTHOR’S NAME AND DESIGNATION Duncan Stainbank, Chief Internal Auditor CONTACT INFO Duncan.stainbank@midlothian.gov.uk DATE 03/02/2025 Page 51 of 316
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Midlothian Integration Joint Board Thursday, 20 February 2025, 14:00-16:00 Midlothian Integration Joint Board Proposed Meeting Schedule and Development Session Dates for 2025/26 Executive summary The purpose of this report is to set out revised dates for Midlothian Integration Joint Board meetings, development sessions, and committees and propose dates for 2025 and propose dates for 2026. Dates for Midlothian Integration Joint Board (IJB) meetings, development sessions and committees, have been agreed up to the end of December 2025, having been previously presented to the Board on April 18th, 2024. These are detailed in Appendix 1 with amendments for noting. New dates for Midlothian Integration Joint Board (IJB) meetings, development sessions, and committees, are proposed in Appendix 2. Members are asked to: • Review and note the revised dates for 2025 set out in Appendix 1. • Approve the meeting schedule, development session, and committee dates for 2026 as set out in Appendix 2. • Note that service visits will be scheduled as required or at the request of members of the Midlothian Integration Joint Board # Item number: 5.5 Page 53 of 316
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Midlothian Integration Joint Board Report Proposed Meeting Schedule and Development Session Dates for 2026 1 Purpose 1.1. To set the dates for meetings, development sessions, and committees of Midlothian Integration Joint Board for 2025/26, as prescribed by the Midlothian Integration Joint Board Standing Orders (5.2). 2 Recommendations 2.1 As a result of the report, members are asked to: • Review and note the revised dates for 2025 set out in Appendix 1. • Approve the meeting schedule, development session and committee dates for 2026 as set out in Appendix 2. • Note that service visits will be scheduled as required or at the request of members of the Midlothian Integration Joint Board 3 Background and main report 3.1 The proposed schedule follows the current existing pattern where Midlothian Integration Joint Board meetings and development sessions are held on alternative months, with Special Integration Joint Board meetings in April and September to consider the budget, annual accounts, and Directions respectively. 3.2 As the committees of Midlothian IJB, the proposed schedule also continues to note quarterly Audit & Risk meetings and the six Strategic Planning Group meetings. 3.3 Dates for the Midlothian Integration Joint Board meetings, development sessions, and committees, have been agreed up to December 2025 having been previously presented to the Board on April 18th, 2024. These are detailed in Appendix 1 with amendments for noting. 3.4 New dates for Midlothian Integration Joint Board (IJB) meetings, development sessions and committees, are proposed in Appendix 2. 3.3 Members are reminded that the facility exists under Standing Orders for special meetings to be called if and when required. 3.4 Appropriate arrangements are made where applicable to allow for the access of the public and press to attend. 3.5 Any service visits will continue to be scheduled as required, or at the request of Members of the Midlothian Integration Joint Board. Page 54 of 316
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Midlothian Integration Joint Board 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 There are no implications on Directions arising from this report. 6 Equalities Implications 6.1 There are no equalities issues arising from this report. 7 Resource Implications 7.1 There are no implications on Directions arising from this report. 8 Risk 8.1 The availability of the schedule of meeting dates contributes to mitigating risks by: • facilitating forward planning for meetings, • contributing to the governance framework which allows Midlothian IJB to conduct its business; and • providing a timetable to which Officers can work to ensure that reports are submitted timeously. 9 Involving people 9.1 There are no implications for involving people as a result of this report. 10 Background Papers None. AUTHOR’S NAME AND DESIGNATION Iina Jaara, Democratic Services Team Leader CONTACT INFO Democratic.Services@Midlothian.gov.uk DATE 3 February 2025 Appendices: Appendix 1: Proposed Midlothian IJB schedule of meetings and development session dates for 2025 Appendix 2: Proposed Midlothian IJB schedule of meetings and development session dates for 2026 Page 55 of 316
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Midlothian Integration Joint Board Page 1 Midlothian Integration Joint Board Appendix 1: Proposed Meeting Schedule and Development Session Dates 2025 2025 Day/Date Time Meeting January Thursday 16th January 2025 Thursday 30th January 2025 2pm 2pm Midlothian IJB Strategic Planning Group Midlothian IJB Development Session February Thursday 20th February 2025 Thursday 27th February 2025 2pm 2pm Midlothian IJB Board Meeting Midlothian IJB Strategic Planning Group March Thursday 6th March 2025 Thursday 27th March 2025 2pm 2pm Midlothian IJB Audit and Risk Committee Midlothian IJB Development Session and Special Board Meeting April Thursday 24th April 2025 2pm Midlothian IJB Board Meeting May Thursday 8th May 2025 Thursday 22nd May 2025 2pm 2pm Midlothian IJB Development Session Midlothian IJB Strategic Planning Group June Thursday 5th June 2025 Thursday 12th June 2025 2pm 2pm Midlothian IJB Audit and Risk Committee Midlothian IJB Board Meeting Summer Recess August Thursday 21st August 2025 2pm Midlothian IJB Board Meeting September Thursday 4th September 2025 Thursday 18th September 2025 Thursday 25th September 2025 2pm 2pm 2pm Midlothian IJB Audit and Risk Committee Midlothian IJB Special Board Meeting and Development Session Midlothian IJB Strategic Planning Group Page 57 of 316
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Midlothian Integration Joint Board Page 2 October Thursday 9th October 2025 2pm Midlothian IJB Board Meeting November Thursday 13th November 2025 Thursday 20th November 2025 Thursday 27th November 2025 2pm 2pm 2pm Midlothian IJB Development Session Midlothian IJB Strategic Planning Group Midlothian IJB Audit and Risk Committee December Thursday 11th December 2025 2pm Midlothian IJB Board Meeting Service Visits Further service visits will be scheduled as required or at the request of members of the Midlothian Integration Joint Board. Page 58 of 316
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Midlothian Integration Joint Board Midlothian Integration Joint Board Appendix 2: Proposed Meeting Schedule and Development Session Dates 2026 2026 Day/Date Time Meeting January Thursday 15th January 2026 Thursday 29th January 2026 2pm 2pm Midlothian IJB Development Session Midlothian IJB Strategic Planning Group February Thursday 19th February 2026 2pm Midlothian IJB Board Meeting March Thursday 5th March 2026 Thursday 12th March 2026 Thursday 26th March 2026 2pm 2pm 2pm Midlothian IJB Audit and Risk Committee Midlothian IJB Strategic Planning Group Midlothian IJB Development Session and Special Board Meeting April Thursday 2nd April 2026 2pm Midlothian IJB Board Meeting May Thursday 7th May 2026 Thursday 21st May 2026 2pm 2pm Midlothian IJB Development Session Midlothian IJB Strategic Planning Group June Thursday 4th June 2026 Thursday 11th June 2026 2pm 2pm Midlothian IJB Audit and Risk Committee Midlothian IJB Board Meeting Summer Recess August Thursday 20th August 2026 2pm Midlothian IJB Board Meeting September Thursday 3rd September 2026 Thursday 10th September 2026 Thursday 24th September 2026 2pm 2pm 2pm Midlothian IJB Strategic Planning Group Midlothian IJB Audit and Risk Committee Midlothian IJB Special Board Meeting and Development Session Page 59 of 316
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Midlothian Integration Joint Board October Thursday 8th October 2026 2pm Midlothian IJB Board Meeting November Thursday 12th November 2026 Thursday 19th November 2026 Thursday 27th November 2026 2pm 2pm 2pm Midlothian IJB Development Session MIJB Midlothian IJB Strategic Planning Group Midlothian IJB Audit and Risk Committee December Thursday 10th December 2026 2pm Midlothian IJB Board Meeting Service Visits Further service visits will be scheduled as required or at the request of members of the Midlothian Integration Joint Board. Page 60 of 316
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Midlothian Integration Joint Board Thursday, 20th of February 2025, 14:00-16:00 Midlothian IJB Membership Recommendations Executive summary This report provides information about changes to non-voting membership of Midlothian Integration Joint Board (IJB) and seeks the Board’s formal endorsement of the membership nomination detailed in the report. Members are asked to: • Note the successful recruitment of a Chief Financial Officer. • Endorse the nomination of Chris King as a non-voting member of Midlothian IJB as the new Chief Finance Officer. # Item number: 5.6 Page 61 of 316
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Midlothian Integration Joint Board Report Midlothian IJB Membership Recommendations 1 Purpose 1.1 This report notes and seeks the Board’s endorsement of nomination for a non- voting member to Midlothian Integration Joint Board, for membership, following the appointment of Chris King to the role of the Interim Chief Finance Officer. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the successful recruitment of a Chief Financial Officer. • Endorse the nomination of Chris King as a non-voting member of Midlothian IJB as the new Chief Finance Officer. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 determines the membership of Integration Joint Boards. This details the requirement to ensure members are representative of service users in the local authority, staff engaged in the provision of services, and third sector bodies carrying out activities related to health and social care in the local authority. 3.2 The Midlothian IJB was informed of the retirement of the previous Interim Chief Finance Officer, David King, at the Midlothian IJB meeting of 24th October 2024. Following this announcement, a recruitment process began to fill this role. 3.3 Midlothian IJB was advised on the 19th of December 2024 that Chris King had been successful in recruiting to the Chief Finance Officer role, and a paper would follow to the February 2025 Board meeting to endorse his Board membership nomination. 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 There are no implications for Directions arising from this report. Page 62 of 316
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 There is no direct impact on inequalities arising from this report. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 Failure to appoint Integration Joint Board members would result in the Integration Joint Board being unable to meet the requirements of the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014. 9 Involving people 9.1 The regulations and guidance accompanying the Public Bodies (Joint Working) Act (2014) requires the IJB membership to be reflective of those working in the delivery of health and social care in the community and should include representation from all key stakeholders. This includes staff, service users, voluntary bodies and independent organisations related to health and social care in the local authority. 10 Background Papers 10.1 N/A AUTHOR’S NAME AND DELEGATION Iina Jaara, Democratic Services Team Leader, Democratic Services AUTHOR’S CONTACT DETAILS democratic.services@midlothian.gov.uk DATE 5th of February 2025 Page 63 of 316
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Midlothian Integration Joint Board Thursday, 20th February 2025, 14:00-16:00 Midlothian Integration Joint Board (IJB) Draft Strategic Plan 2025/35 Executive summary This report sets out the actions and progress to date in relation to the development of Midlothian Integration Joint Boards new Strategic Plan for 2025-35 and presents a revised third draft plan (appendix 1) following public consultation and feedback from Partners, in line with the Strategic Plan Statutory Guidance. Midlothian IJB developed is strategic proposals in January 2024 following a stakeholder and public consultation between September and December 2023. These proposals were developed into a first draft of the Strategic Plan and reviewed by the Strategic Planning Group, and Midlothian IJB before undertaking an assessment of Place and Wellbeing by Public Health Scotland and the Improvement service. Following incorporation of feedback and recommendations, a second draft of this plan was approved by Midlothian IJB on 22nd August 2024 for statutory public consultation between 30th August and 30th November 2024. The views in response to this consultation have supported a third revision of the Strategic Plan reviewed by the Strategic Planning Group on 16th January 2025. The Strategic Plan continues to be an evolving document in collaboration with Partners and all stakeholders. Changes, amendments and additions are recorded in a change log (appendix 2). Some critical detail remains outstanding and will be included following the budget setting for 2025/26 and subsequent agreement relating to operational transformation planning. This third draft has been completed in preparation for commencing a formal governance process with both our Midlothian Council and NHS Lothian Partners after which final Midlothian IJB approval planned for 8th October 2025. Members are asked to: • Review the revised third draft Strategic Plan 2025/35, noting the plan will continually evolve as it is presented to various committees and governance groups and Midlothian IJB budget decisions are taken. • Approve this draft Strategic Plan subject to required changes, for approval to progress through the governance routes of our Partners. Item number: 5.7 Page 65 of 316
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Midlothian Integration Joint Board Report Midlothian Integration Joint Board (IJB) Draft Strategic Plan 2025/35. 1 Purpose 1.1 This report sets out the actions and progress to date in relation to the development of Midlothian Integration Joint Boards new Strategic Plan for 2025-35 and presents a revised third draft plan (appendix 1) following public consultation and feedback from Partners, in line with the Strategic Plan Statutory Guidance. 2 Recommendations 2.1 As a result of this report, Members are asked to; • Review the revised third draft Strategic Plan 2025/35, noting the plan will continually evolve as it is presented to various committees and governance groups and Midlothian IJB budget decisions are taken. • Approve this draft Strategic Plan subject to required changes, for approval to progress through the governance routes of our Partners. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Scotland) Act, 2014 places a duty on Integration Authorities to plan and direct delegated health and social services through the development of a Strategic Plan. Stakeholders must be fully engaged in the preparation, publication, and review of the plan, in order to establish a meaningful co-productive approach. 3.2 The key stages of the process are; • Integration Authorities must develop strategic proposals and ask the Strategic Planning Group to consult and develop these in the development of a first draft of the Strategic Plan. • Integration Authorities must then seek the views of the Strategic Planning Group on the draft, taking into consideration the views in response to the consultation on the first draft. • Integration Authorities are then required to prepare a second draft of the strategic plan and send a copy of it for comment to the local authority and the health board, as well as representatives of groups prescribed by Scottish Government and any other persons as the integration authority considers appropriate. Page 66 of 316
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Midlothian Integration Joint Board 3.3 Following receiving the support of the Board, officers of Midlothian HSCP established a project team in August 2023 to oversee the process of developing a new Midlothian IJB Strategic Commissioning Plan. 3.4 Between September and November 2023, a first stage consultation was undertaken to review and feedback on the current Strategic Commissioning Plan 2022-2025 and explore the hopes and ambitions of people and communities, delegated services, partner organisations and Third and Independent Sector partners. Over 150 individuals, services, and organisations took part, and a thematic analysis was completed to highlight key recurring themes. On 18th January 2024, the Midlothian HSPC Planning and Performance Teams led a Midlothian IJB Development Session to establish the strategic proposals for 2025-35 approved by Midlothian IJB on 8th February 2024. 3.5 A first draft was developed over February and March 2024 with an Assessment of Place and Wellbeing conducted by Public Health Scotland and The Improvement Service. The first draft was reviewed by SPG on 26th April 2024 and revised in response to feedback. Following a Midlothian IJB Development Session on 16th May 2024, significant revision was undertaken to produce a second draft of the plan. This was reviewed in July 2024 by the Vice Chair if Midlothian IJB and officers of the HSCP resulting in further edit and amendment made in response to feedback. 3.6 On 22nd August 2024 the Board approved the draft Strategic Plan 2025/35 for public consultation between 30th August and 30th November 2024. A high-level summary of the feedback received can be found in appendix 3. 3.7 In November 2024 an audit of the draft Strategic Plan was undertaken against the Scottish Government Strategic Plan Statutory Guidance (appendix 4) highlighting a high level of compliance. 3.8 On the 26th September 2024 the Strategic Planning Group undertook an Equality and Children’s Right Impact Assessment (ECRIA) which was noted without amendment on 28th November 2024 (appendix 5). The ECRIA recommends a number of considerations, amendments, and revisions to the Plan which have been actioned by the Strategic Planning Group. 3.9 The views in response to consultation and areas for action resulting from the audit and ECRIA have been reviewed and incorporated into this third draft of the Strategic Plan. Some actions can only be completed as key milestones in the governance calendar are undertaken i.e. budget setting and have been highlighted in the audit document. 3.10 On 19th December 2024, Midlothian IJB considered and agreed a request to delay the publication of the Strategic Plan by approximately 6 months to October 2025. This was to ensure that any impact from the upcoming budget negotiations were considered and reflected in the new plan with opportunity for Heads of Service to consider the action required to deliver on these ambitions. 3.11 Partner engagement has continued through this process through the Midlothian IJB Strategic Planning Group and discussion with the strategic leads and senior officers Page 67 of 316
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Midlothian Integration Joint Board of both Partners. A change log (appendix 2) has been utilised to record edits and amendments to the strategic plan. 3.12 The Strategic Plan continues to be an evolving document in collaboration with Partners and all stakeholders. Changes, amendments and additions are recorded in a change log (appendix 2). Some critical detail remains outstanding and will be included following the budget setting for 2025/26 and subsequent agreement relating to operational transformation planning. 3.13 This third draft has been completed in preparation for comment from local authority and the health board Partners. The Strategic Planning Group reviewed this third draft of the Plan on 16th January 2025 and agreed to recommend the plan to the board for approval to progress through the governance routes of our Partners. 3.14 The proposed governance route is set out below • 25/03/2025 NHS Lothian Strategic CMT • 09/04/2025 Midlothian Council CMT • 21/05/2025 NHS Lothian Strategic Planning and Performance Committee • May 2025 Elected Members Briefing and Development Session • 09/09/2025 Midlothian Council • 11/09/2025 NHS Lothian Strategic Planning and Performance Committee • 08/10/2025 NHS Lothian Board • 09/10/2025 Midlothian IJB Final Approval 3.15 Members of the Board are now asked to review this draft, provide feedback, and approve the draft Midlothian IJB Strategic Plan 2025/35, subject to required changes, for approval to progress through Midlothian Council and NHS Lothian governance. 4 Policy Implications 4.1 There are no implications for policy as a direct result of this report. However, the new Strategic Plan 2025/35 will influence all future service delivery, redesign, and commissioning. 5 Directions 5.1 There are no direct implications for Directions as a direct result of this report. 5.2 However, the development of a new Strategic Plan will involve the alignment of strategic financial and workforce plan, and inevitably impact on the Directions issued by Midlothian IJB to both NHS Lothian and Midlothian Council in the future. 5.3 Draft Directions for 2025/26 have been prepared by Strategic Planning Group (SPG) for Midlothian IJBs review. These Directions align with the ambitions of the Strategic Plan 2025/35 and Map to the 9 National health and Wellbeing Outcomes. Page 68 of 316
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 There are no implications for people with protected characteristics as a direct result of this report. 6.2 Undertaking an ECRIA is a statutory duty and a vital component in Midlothian IJBs work to ensure that equality can be advanced through the identification of any unintended consequences for people with protected characteristics. 6.3 An Equality and Children’s Rights Impact Assessment (ECRIA) on the consultation draft of the Strategic Plan was undertaken by the Strategic Planning Group (SPG) and informed amendments and revisions to the plan. The impact assessment is presented to the Board in appendix 5. 7 Resource Implications 7.1 There are no implications for Best Value as a direct result of this report. 7.2 The Integration Manager and Chief Finance Officer worked together in 2024 to develop a Best Value Framework in line with the proposed Strategic Plan, Statutory Guidance, the Local Government in Scotland Act 2003 and the Public Finance and Accountability (Scotland) Act 2000. 8 Risk 8.1 Not approving the Strategic Plan 2025/35 to progress through the governance routes of our Partners risks the inability to meet the required legislative duties to develop this plan within the required the required time period. With limited opportunities for Board review, and a complex timetable of Midlothian IJB, Council and NHS Board and Committee meetings set over a year in advance, any delay is likely to cause significant additional delay to the overall process. 9 Involving people 9.1 Board members, officers of the HSCP, services, partner organisations, and people and communities have been involved in the process to establish this draft Strategic Plan 2025-35. Ongoing engagement and consultation will continue and inform the development of the final version of this plan before publication anticipated in October 2025. 10 Background Papers 10.1 None Page 69 of 316
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Midlothian Integration Joint Board AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO Via email or MS Teams DATE 03/02/2025 Appendices: Appendix 1: MIJB Strategic Plan 2025/35 Appendix 2: MIJB Draft Strategic Plan 2025/35 Change Log Appendix 3: MIJB Strategic Plan 2025/35 consultation feedback Appendix 4: SP vs SP Guidance v0.5 Response and Actions Undertaken Appendix 5: MIJB Strategic Plan Equality and Children’s Right Impact Assessment Page 70 of 316
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1 Midlothian Integration Joint Board Strategic Plan 2025/2035 Page 71 of 316
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2 Contents Contents................................................................................................................................................ 2 Foreword ............................................................................................................................................... 3 Introduction ........................................................................................................................................... 4 Who we are ...................................................................................................................................... 4 National ambitions for local action ................................................................................................ 5 What people told us ........................................................................................................................ 5 What we will do ................................................................................................................................ 6 Our strategy on a page ....................................................................................................................... 8 Information, evidence, and insight .................................................................................................... 9 Working with our partners ................................................................................................................ 20 Strategic Aim No.1 ........................................................................................................................ 22 Strategic Aim No.2 ........................................................................................................................ 29 Strategic Aim No.3 ........................................................................................................................ 34 Making this a reality .......................................................................................................................... 40 Other key documents and information ....................................................................................... 40 Our workforce ................................................................................................................................ 40 Operational planning ..................................................................................................................... 40 How services plan ......................................................................................................................... 41 Budget and financial plan ............................................................................................................. 41 Monitoring and evaluation ................................................................................................................ 45 How we measure performance ................................................................................................... 45 Appendices ......................................................................................................................................... 46 Appendix 1: Our responsibilities ................................................................................................. 46 Appendix 2: Locality planning ..................................................................................................... 47 Appendix 3: Engagement with people ....................................................................................... 48 Appendix 4: Market facilitation .................................................................................................... 49 Appendix 5: Policy and drivers .................................................................................................... 50 Page 72 of 316
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3 Foreword TBC TBC Councillor Connor McManus Val de Souza Morag Barrow Chair, Midlothian IJB Vice Chair, Midlothian IJB Chief Officer, Midlothian IJB Page 73 of 316
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4 Introduction This Strategic Plan has been developed by Midlothian Integration Joint Board (IJB). The purpose of this plan is to describe how we will work with people, communities, the Third and Independent Sector, and the services who provide care and support and agree how we can best contribute to people in Midlothian living well in their community. This plan is effective from 30th October 2025 until 31st April 2035, but we will review and update this work every three years. Who we are Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in this Strategic Plan will guide how we allocate the money we receive. Scottish Government asks us to take action required by law and in national policies when deciding what our local priorities should be. Some of these policies and national drivers are in appendix 5. Page 74 of 316
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5 National ambitions for local action Like all Integration Authorities in Scotland, our role is to plan and deliver the services that support better health and wellbeing in our communities. We are asked by the Scottish Government to work with our partners to plan across the whole system using the National Health and Wellbeing Outcomes Framework. Evaluating and reporting on what we contribute to the 9 National Health and Wellbeing Outcomes becoming a reality for more people in Midlothian is how Scottish Government measure our performance. This plan has also been written in line with the Principles for Planning and Delivering Integrated Health and Social Care which are the driving force behind our planned activity to successfully and improve outcomes. These national ambitions are the same for every Integration Authority in Scotland and they will be our ultimate aim for as long as we are asked to work in this way. The action we choose to take, and the pace at which we are able to make progress, is unique to Midlothian. What people told us As we prepared this plan, we spoke to over XX people who experience our services, their families, and carers. Between September 2023 and December 2024, we undertook a range of consultation and asked what mattered to people, how they wanted things to change, and asked for feedback on a draft of our plan. We also listened to our third-party services, providers, and partner organisations to better understand what is already working well and where they are opportunities to improve, so we can focus our contribution to see progress towards people in Midlothian living good lives, and achieving the things that matter most to them. The two main things people told us were • People want to be reassured we are prepared for the future During our consultation, there was a clear message that our ambitions and aims still felt like the right ones, but that strategies and plans can feel like words that don’t mean anything. The consultation challenged us to look at plans over the years and be clear about what had really changed. Some people were concerned with the rate of expansion in Midlothian and were unsure if the system will cope unless we do things differently in the future. • People want us to simply tell them what we are going to do The challenges for health and social care are understood by our communities and they don’t want a well-rehearsed list of reasons and explanations for why things are difficult like increased demand, demographic changes, funding issues, or the pandemic. They told us they don't want to read about our future ambitions if those ambitions are out of reach in the coming years. People asked us to be clear, and realistic. You can read more about how we listened and consulted people and partners over the past 18 months to develop this plan in our Consultation Statement. Page 75 of 316
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6 What we will do Strategy isn’t always new or exciting. Strategies find solutions to the challenges we face. Because we still have to find sustainable ways of working to meet all of our challenges, you might have heard some of this before. That doesn’t mean we will stop trying to find ambitious solutions to these issues. Our job is to write a strategic plan that sets out our ambitions and the approach we will take, allocate available funding to the services that we are responsible for, and issue Directions to our partners NHS Lothian and Midlothian Council about how we want them to support achieving the ambitions of this plan. Funding and resources Our partners have supported us with the best funding offer they can, but it is not enough to keep pace with increases in our population or the changing health and social care needs of people and communities. We can only spend the resources that are made available to us from our Partners. This may mean our progress slows down or that some services will stop. Hard choices lie ahead, but we will always make decisions that aim to ensure the services you need most are available when you need them. Sometimes we will not be able to deliver everything we want to provide with the resources we have, but that doesn't mean we won't keep working hard to support you with what you need or keep improving what we can offer. Redesign and Transformation We continue to believe that our services are best placed to work with people and communities to design the services people need. We know this can’t happen as quickly as we would like, and that we won't always get it right. However, we will always do our best to support positive change, and always put our communities at the centre of our decisions. We have set out an ambitious programme for redesign for 2025/35 and will work with people and communities to achieve this. Our capabilities Planning is important, but we know it is the action we choose to in order to change and adapt that matters. Our strategy will continue to evolve, and we will adapt as we learn. To do this, we must continue to support the Health and Social Care Partnership to have the skills and capabilities to redesign and respond to financial challenges, population growth, and increasing demand. The future of health and social care The future of integrated health and social care and our role in a National Care Service is unclear. Plans and are progressing for a National Care Service, but in a new way. Scottish Government have advised us that there will revisions to the National Care Service Bill and that some previously proposed policies will have to be delivered in different ways to originally planned. Until the Scottish Government provide further details, we do not know how we will be asked to plan and direct care in the future. Page 76 of 316
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7 Our commitment is therefore to • Keep it simple and avoid strategies and plans that add nothing new or add no value to people and communities. • Do things differently. Just because something is ‘statutory’ it doesn’t mean we shouldn't think about planning and delivering that service in new and radical ways. • Focus on impact by understanding what our collective contribution is to personal outcomes and positive change. • Have better conversations with our communities, be visible, and be part of the work. • Be ambitious, ready to change, and adapt. The rest of this plan sets out the areas of focus and ambitions that we believe will allow services to continue to provide high quality care and support while also taking significant steps forward to reform local health and social care. Page 77 of 316
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8 Our strategy on a page Our Vision People in Midlothian are enabled to lead longer and healthier lives. Our Mission We will provide the right support at the right time in the right place. Our Values Respect. Compassion. Quality. Our Strategic Aims 1. People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health 2. People are able to access the care and support they need when they need it in the community and at home 3. People's human, social, and economic rights are protected and promoted in how we design and deliver our services. Page 78 of 316
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9 Information, evidence, and insight This section sets out the information, evidence and insight that has helped us develop our strategic aims and why we have prioritised these actions. We have identified three strategic aims which we think we can make the biggest impact in the shortest time possible. These strategic aims all focus on the national ambition to provide the right care, at the right time, and in the right place. Each of the strategic aims support at least one of the 9 National Health and Wellbeing outcomes and our Directions for 2025/26 are structured this way too. We have intentionally designed our planning this way to help people see how our ambitions for change are linked to the way we make decisions about funding and the action we ask our partners to take. Health and social care services collect and report on a huge amount of information. The way we are asked to do this means the data we collect is often about one part of the system or a single issue. We are working hard to improve the data and evidence we use so we can be more confident about the decisions we make and how the whole system fits together. We have reviewed all our data and information to make sure it is accurate and available to us at the right time to make good decisions. An important part of the data and evidence we have used to inform this plan is the Midlothian Joint Strategic Needs Assessment (JSNA). This brings together a range of available information from local, regional, and national sources to help us understand the main health and social care issues for people living in Midlothian. We have developed new ways to review and present information in the JSNA so we can understand what people in Midlothian need now, and in the future. Although the JSNA is a key piece of evidence in our planning, we have also looked at a wide range of other information and evidence. This is so we can be as sure as we can that the priorities in this plan will help us make the fastest progress towards achieving the 9 National Health and Wellbeing Outcomes for everyone who lives in Midlothian. Our communities are more than just numbers and statistics to us, and we have combined number data with descriptive data, people’s stories, and experiences to ensure this plan helps everyone in Midlothian achieve what matters most to them. When a new source of data has become available, we have connected it with existing information in new ways. Seeing the links between existing and new information across the whole system has given us better insight into where real change can be achieved. We have examined the information, evidence, and insight from all of these sources to help us make decisions about our plan. As more data becomes available across time, we will review this alongside information from Midlothian Health and Social Care Partnership services to help identify emerging risks and inform our decisions when we need to change our approach. Page 79 of 316
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10 Strategic Aim No.1 People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health What we are trying to achieve 1.1 People can easily find the information they need to make good decisions. 1.2 People achieve the things that matters most to them, and our services are confident of what our contribution is to their success. 1.3 People access services and support designed around how they live their lives. It should be easy for people to find information when they need support. In our recent Citizens’ Panel survey, we asked residents of Midlothian to tell us how they find information about services in their community. They told us that the top two sources of information they use are word of mouth (56%) and social media (56%). This means that we need to ensure all our information is easily available and accessible to everyone. This includes leaflets, letters, posters, websites, and social media. Digital skill and access Digital skills and confidence, along with access to devices and data, are becoming essential to life in the UK. People should be able to use digital technologies in ways that enhance their lives and contribute to helping them overcome other disadvantages which they might face. Digital exclusion (limited or no access to internet connection, devices, skills) creates digital inequalities, which are strongly linked to wider social and economic disadvantage. In Scotland, areas of higher economic deprivation have lower levels of internet uptake. 97% of people in Midlothian report having access to the internet at home. The average internet speed in Midlothian is 97 Mbps (15% lower than the UK average). 31% of Midlothian’s population experience slow or very slow internet connections. Older people are less likely to own smartphones or connect to the internet. People with lower income are less likely to have access to smartphones in their household and be on pay monthly contracts and data plans. Page 80 of 316
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11 Employment Workers in Midlothian (by place of residence) consistently earn less than the Scottish median earnings per week. Midlothian full-time employed residents in 2022 earned on average £622.90 per week compared to the Scottish equivalent of £640.30. In 2022/23: 11,200 people were classed as economically inactive. 29.2% were inactive due to long-term sickness (this has been relatively consistent over the past ten years). 25.6% of people are retired, an increase from 17.6% in the past ten years. In December 2022, there were 5,200 people claiming out-of-work benefits, a 5% increase since 2021. In October 2023, 2.2% of the Midlothian residents aged 16-64 were claiming Universal Credit, with more male (2.6%) claimants than female (1.8%). In 2022/23, the economically active population in Midlothian was 80.3% of the total working age population, and the largest local employer is Midlothian Council. Over 50% of the working age population work in Edinburgh. Because people generally access health and care close to home, rather than where they work, services need to support people who need to commute, those who work locally, those who are unable to work, and those who have caring responsibilities. Good conversations Along with services being easy to find, and designed around how people live their lives, we need to ensure that people are supported to achieve the things that matter most to them. This means taking the time to have good conversations with people, to understand what is working well, what could be better, and who might be able to help. We call this The MidWay, and all staff are supported with training. Respondents to our Citizens’ Panel survey told us that the three most important things for health and care professionals to do are: Start with asking about what matters to me 68% Ask me what I think would make a difference 63% Ask about other areas of my life where I might need some help 55% Page 81 of 316
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12 We know these good conversations are vital in understanding how to support someone to achieve their personal outcomes. This can be difficult to measure as it is often a combination of factors that people describe as making a positive difference. To ensure that services can describe their contribution, we use an approach called Outcome Mapping, which is a way to understand how our services contribute to people achieving the outcomes that matter to them and can help services make more targeted, locally informed decisions about how to design, deliver or commission 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 in their lives. Outcome mapping is a process of continual improvement and supports services to develop meaningful action plans for change and is central to the approach to measurement developed by Midlothian HSPC, based on the triangulation of three types of data: service data (activity), system data (population experience), and what matters to people (outcome mapping). Page 82 of 316
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13 Strategic Aim No.2 People access the care and support they need when they need it in the community and at home What we are trying to achieve 2.1 People easily access the services that help them stay well, independent, and active. 2.2 People have access to services in their own community. 2.3 People are living in the place of their choosing for longer. We want people to stay well independent and active, and one of the ways to measure overall health is by looking at information about life expectancy. Life expectancy Healthy life expectancy is the average number of years that a new-born can expect to live in “full health”. Since the last review of local data in 2019, the gap between life expectancy and healthy life expectancy has increased by 0.9 years for both men and women in Midlothian. Life expectancy at birth in Midlothian is slightly better than the Scottish average (2019/21) for both males and females. Women’s overall life expectancy is higher than men’s in Midlothian. Life expectancy varies by up to 10 years across different parts of Midlothian, because of poverty and social disadvantage. Less than half of adults in Midlothian meet the physical activity recommendation of more than 2.5 hours of activity per week. Adults in the most deprived areas are less likely to meet the physical activity guidelines compared to those in the least deprived. Maintaining a healthy weight is important. People who are overweight may be at higher risk from illness and diseases which can lead to premature death or reduced quality of life. 2 out of 3 adults in Midlothian are overweight or obese, which is similar to national levels. This means people are living less of their lives in good health, so we need to make it easier for people to access the services they need to help them stay well, independent, and active. In our Page 83 of 316
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14 recent Citizens’ Panel survey, people told us that even when it is easy to find information, only 37% agreed that “it is easy to get the support I need when I need it”. There are areas where Midlothian is making sustained improvements in improving outcomes for people, in prevention, early intervention, treatment and support, and crisis and emergency. Early deaths of people aged under 75 years from cancer and chronic heart disease have both been reducing over time. Hospitalisations for asthma and COPD are both at their lowest in Midlothian since 2002. Emergency admissions for people aged 65 and over are reducing overall. Deaths from suicide are also reducing and currently below the national average. The number of babies reported by their parent as being exposed to second-hand smoke at the 6-8 week review has fallen significantly from 38.46% in 2002, to 6.82% in 2023. However, despite the overall decline in rates of early deaths in Midlothian, some areas of Midlothian with higher deprivation are experiencing increasing rates. Early death from chronic heart disease varies across areas. Dalkeith had the highest rate of early deaths with the next highest rate in Easthouses, whilst Pentland had the lowest rate. Accessing services When we asked a sample of Midlothian residents to tell us about the health and care services they had accessed recently, the most frequent responses were all community-based: • GP team (64%) • Pharmacy (61%) • Dentist (30%) • Optician (21%) When we asked about journey time from home to health and care appointments; 58% of respondents stated that they travel by car to appointments at a GP practice, hospital, or vaccination clinics, with 23% walking and only 11% using public transport. just under two thirds (64%) travelled less than 15 minutes, a further 29% travelling 15 to 30 minutes. Only 8% of said that their journey times were more than 30 minutes. Page 84 of 316
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15 We know that the current geographic location of GP practices does not meet the requirements of 20-minute neighbourhood zones. It is likely that the large housing developments underway at Rosewell, Newtongrange and Mayfield will not support the development of 20-minute neighborhoods in Midlothian. Increasing and changing population Midlothian’s population has grown every year since 2006 and at the 2022 Census there were 96,600 people living in Midlothian. It is the fastest growing Council area in Scotland. The local birth rate and the number of people either moving to, or leaving, Midlothian each year combined with plans for new houses means the population of Midlothian could increase by 27% by 2036. The challenge facing health and social care providers is not only that the population is increasing. The profile of who lives in Midlothian is also changing, and the impact of this is difficult to predict with certainty. We know we have more babies being born, more people moving into the area, and more people living into older age. Midlothian has the highest standardised birth rate of all council areas in Scotland. The proportion of people aged 75 and over is predicted to grow by over 40%. Data on ethnicity at a Midlothian level from the 2022 census has not been published yet, so the 2011 census provides the most recent view of the ethnic make-up of the population. 1.8% of the population belonged to a Minority Ethnic Community this figure is double that of the 2001 census for Midlothian. Midlothian data is often very similar to the national average across Scotland. However, we know that health inequality still has a more significant impact in some of our communities and highlights the difference in outcomes across the area. What is less clear is how the economic profile of Midlothian may change in future years, and what the impact on access to community services might be. We anticipate a population increase in Midlothian of approximately 40% over the next 10 years. This is largely due to large, planned housing developments. It is likely that the health and care needs of these new families will be different to those of the people already living in the area or close by in neighboring housing developments. If more affluent families, who often have higher levels of health literacy, move into Midlothian, there is a risk that residents in areas of existing economic deprivation may find it harder to access Page 85 of 316
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16 the support they need. This is sometimes called the inverse care law, where those who need care the most are least able to access it. This will mean that new types of health and care services will be required, in different numbers, and in new locations to avoid existing health inequalities widening, particularly for the most vulnerable people. We must work together to ensure that everyone in Midlothian can access services in their own community. Page 86 of 316
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17 Strategic Aim No.3 People's human, social, and economic rights are protected and promoted in how we design and deliver our services What we are trying to achieve 3.1 People are recognised as experts in their own lives, are involved in planning services, and feel valued. 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want. 3.3 People benefit from organisations working together and sharing information safely. The MidWay supports people to achieve what matters most to them, and because people are the experts in their own experiences, it is vital that people feel valued and are involved in planning services. Less than half of the Citizens’ Panel respondents agreed that they “feel confident about getting involved in decision-making in my community” when thinking about health and social care. One of the reasons for this is that it relies on people having enough free time to be able to get involved. Free time can be limited by several factors, but one of the most significant is having caring responsibilities. Unpaid carers tell us that it can be difficult to arrange cover, or respite care, for the person they look after. Impact of caring 12.5% of the Midlothian population are carers. 79% of carers report that being a carer affects their mental health, and 64% report it affects their physical health. Many carers do not identify what they do as “caring”. Some groups are more affected than others with more women identifying as carers, and 28% of carers live in the 20% most deprived data zones. The national Health and Care Experience Survey 2023/24 asked people about the impact of having caring responsibilities: (Midlothian) 37% agreed that “I have a say in services provided for the person I look after” 35% agreed that “I feel supported to continue caring” 64% agreed that “I have a good balance between caring and other things in my life” 33% agreed that “Local services are well coordinated for the person I look after” Page 87 of 316
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18 Joined up working Health and social care services are provided by a number of organisations with different structures: for example, hospitals, GP practices, care at home and social work all have their own specialised multidisciplinary teams. These teams often need to work together to support people, especially when their needs change. This might be a single event, like an admission and discharge from hospital, or it might be support provided over a period of time that increases as the person’s needs change. 73% of the Citizens’ Panel respondents agreed that they “feel safe when using the services I need”. 56% of respondents asked us to “contact other support or services that might help me on my behalf”. To do this well, we need to improve how we share information safely. The information held about people can sit in the systems of our Partners, but they aren’t connected to each other. In Midlothian, a person could have their health and care data saved in at least ten separate electronic systems. We must continue to influence our Partners so that they put agreements in place that allow us to connect their systems in ways that mean health and care professional can see them more easily, to save people having to tell their story many times. Workforce We also need to make sure we have a workforce that is developing the right people, with the right skills, to meet the future changes in need. Given that the population of Midlothian is changing the need for social care services is likely to increase, but there may be a lack of people to recruit. In 2021 there were 1,100 staff employed by the Public Sector in Social Care Services and 45 registered care services in Midlothian. This is an increase of 32.5% more staff working in the public sector for Social Care Services from 2012. In 2021 employees were mostly between the ages of 35 and 64. The rate of 16-19 years olds in employment is higher in Midlothian than in Scotland. Across Scotland the majority of 16-19 year olds are in education, with a slightly lower rate for Midlothian. Page 88 of 316
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19 Most of the workforce were full-time employees and Midlothian has seen a slight decrease in full- time workforce from 2012-2019. Over the same period there has been an increase in the number of self-employed, part-time, and retired individuals, which could increase the scale of the challenge as social care services tend to employ full-time workers. Volunteering There is a thriving local Third Sector in Midlothian, supported by the Midlothian Third Sector Interface (TSI): There are at least 500 formal groups or voluntary associations and other Community Planning Partners. Approximately 56% of the population volunteer informally. 92% of respondents to our Citizens Panel survey who provide support as a formal volunteer stated that it makes a positive difference to their health/wellbeing. 90% of respondents to our Citizens Panel survey who receive support from an informal group stated that it makes a positive difference to their health/wellbeing. To move closer towards our ambition of shifting the balance of care closer to home, we need to continue to work in ever more connected ways, building on the strengths of voluntary organisations, whilst doing our best to ensure that unpaid carers are not under additional pressure as a result. Page 89 of 316
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20 Working with our partners The aim of integrated health and social care is to ensure that everyone in Midlothian has joined up care and support. We know the decisions we make influence how people live and make choices about what they do and where they go within our communities. We also know that we can’t design services that rely on communities to take action without contributing to community resilience. The decisions our partners make will also influence people’s choices and ultimately how well we are able to achieve the ambitions in this plan. We must work with all our partners to avoid this plan unintentionally making it harder for people to live well in their community. We will always share our plans and be open about our challenges so we can better support each other to see people live well and thrive. When people need services, it is important to get support quickly. We want to have different conversations and create new relationships with our partners so that together, all our offers collectively support more people. We will work with our partners where it is possible to develop joint frameworks for planning across the whole system and use mechanisms like our Market Facilitation to drive change. We have started this work in key areas, e.g., workforce planning, and will continue to find opportunities to work and find solutions together. Where it makes sense to do so, we will explore ways to create more opportunities to have shared goals and outcomes, jointly fund services, and share our data. For example, services like mental health, substance use, primary care, housing, employability, and welfare support can all contribute to preventing some of the causes of poor or deteriorating mental health. We must avoid limiting what we can do with unnecessary ‘red tape’ while also meeting our duties to keep people safe. Where people live can have a significant impact on health and health inequalities. An emerging threat to heath and health inequalities is climate change. The IJB has a duty to report on how it is working with partners in this regard, and we must find the shared opportunities within all our strategies to underpin the principles of equality, net zero emissions, and sustainability. We will continue to support ‘Green Health Prescribing’ and work with local partners to ensure the health and social care needs of people are considered as part of proposed local development plans. Public transport provides opportunities for active travel which has a direct positive impact on health. If we want to provide more community-based treatment, care, and support, Midlothian needs to have good transport links that help people travel locally and sustainably. We will prioritise working with our partners to help reduce poverty because we know there is a strong relationship between money, income and wealth, and health and wellbeing. We will ask services to make sure that every contact counts and we actively connect people to the support they need, rather than expecting them to navigate complex systems alone. Where we can help, we will work with our partners so people can access specialist welfare and debt advice. This might be Page 90 of 316
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21 through our local services in venues that are easy to access, for example, day services, community venues, and our Community Hospital. We want to see more fair work for local people. In addition to generating income, good employment also provides social connections and can support people to improve their mental and physical health and wellbeing. We don’t employ anyone, but we will continue to build on the work with our partners and do all we can to support local opportunities in health and social care. Secure, quality, and affordable housing is another foundation of good health and wellbeing and has a significant positive impact on people’s lives. We want to ensure we can coordinate available health and social care support with people’s housing options. We don’t have any direct responsibility for housing matters other than aids and adaptations but can support the work of others to improve housing stability and security and prevent homelessness. Our Housing Contribution Statement sets out how we will continue to work with all our partners but particularly Midlothian Council to ensure people live in safe and quality housing within their community. Midlothian Community Planning Partnership Prioritising our work with the Midlothian Community Planning Partnership is one of the best ways to ensure all the strategies and plans for services across Midlothian are joined up. We lead 'Midlothian will be Healthier' thematic area of the Midlothian Community Planning Partnership Single Midlothian Plan 2023/27 and work together to achieve more together than health and social care can do alone. The Third Sector The Third Sector is a vital part of health and social care in Midlothian. There are at least 700 voluntary sector group and organisations in Midlothian, and 228 registered charities (voluntary organisations or community groups) who identify their main operating area to be Midlothian. Approximately 40 organisations are commissioned by Midlothian Health and Social Care Partnership to provide services and support for people and communities. The Midlothian Third Sector Interfaces (TSIs) plays a key role and is a single point of access for support and advice. Midlothian Council The Midlothian Council Plan 2020/25 sets the ambition to grow and transform by harnessing opportunities. The strategic objectives and key priorities align with the Scottish Government’s Economic Strategy and links to the Community Planning Partnership’s Single Midlothian Plan vision. NHS Lothian The NHS Lothian Strategic Development Framework sets out what needs to happen across Lothian’s Health and Care system over the next 5 years. It is a joint plan between the all the Health and Social Care Partnerships in the Lothians. The vision is that; • Citizens live longer, healthier lives, with better outcomes from the care and treatment we provide • We connect health and social care services seamlessly, wrapping around the citizen in their home. • We improve performance across our system, with better experiences for citizens Page 91 of 316
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22 Strategic Aim No.1 People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health What we are trying to achieve 1.1 People can easily find the information they need to make good decisions. 1.2 People achieve the things that matters most to them, and our services are confident of what our contribution is to their success. 1.3 People access services and support designed around how they live their lives. We know that our service offers and supports are only one part of what helps people and communities stay well and feel connected. The only way we can be sure that what we are doing are the things that support people to stay well is to plan alongside people and communities. In 2024 we reviewed our Community Engagement Plan. As part of that work, people told us we should spend more time having conversations with people and communities to understand what matters to them then help them take action to see the things become a reality. People also told us they wanted to be part of how we redesign our service offers and supports. Most people wanted us to stop talking about models and pathways because these words don’t mean anything to them. People said it would be helpful to have information that was easy to find and services that were easy to access. We know when communities are involved in designing services, they have a better understanding of their own health and wellbeing and plan ahead using the resources that already exist in their community. We know we need to ensure that the people in our communities who are the most disadvantaged have a voice in how we work towards a more equal future. By working together and being clear, we think everyone will have a better understanding of what we can offer, and what people can do for themselves. Page 92 of 316
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23 Short term aims 1.1 People can easily find the information they need to make good decisions • Information is easy to find and accessible When strategies, plans, and service information are not designed to be accessible, people get left behind without alternatives. In 2024/25 we undertook a review of the information we provided and found there was work to do to improve our published documents and information about the services Midlothian Health and Social Care Partnership provides. Work is underway to improve how we share printed materials and our website. We will work closely with both our Partners to help people find the information they need, and ensure information is up to date on all our webpages. Our information needs to be equally available to everyone, which means everything is easy to read, in plain English, and compatible with text to speech technology. We aim to have this completed by early 2026. We know we have work to do to better understand the preferred formats and methods of communication for people living in Midlothian. This includes both how and when we present information, as well as how useful the information is. Our Community Engagement Plan sets out how we plan to have better conversations with people and communities then act of the things that are most important to them. Our work with the Community Planning Partnership is an important part of how we stay connected with local partners. We have also asked Midlothian Health and Social Care Partnership to develop a Public Communication Strategy and Action Plan to help as many people as possible access the information they need. • Early intervention and prevention We must not let the challenges in some areas take our attention away from the need to develop our early intervention and prevention offer. We know that the best way to prevent people needing our service is the future is to improve our population health. As part of our programme of transformation and change, the Midlothian Health and Social Care Partnership Public Health Practitioners coordinate several early intervention and prevention initiatives across Midlothian. This includes information and support to people as early as possible and working with our Partners to ensure people have good quality housing, education, and employment. Page 93 of 316
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24 To add: Justice innovation To add: Early Intervention and Prevention (following agreement of Financial Recovery Actions) • Justice Services We must meet the challenges of the rising prison population. An important part of the Justice service will. Ensuring that people can access appropriate information and resources at each stage of their Justice journey is vital. We will ensure we continually improve the ways we do this by continue to work collaboratively with key stakeholders including people impacted by, or involved in, the Justice system. 1.2 People achieve the things that matters most to them, and our services are confident of what our contribution is to their success • Self-Management Self-management is a way of living that helps people living with long term conditions feel more in control of their own health and wellbeing. This can be through access to information or developing the skills and confidence people need to be able to manage their own health and wellbeing, on their own terms. ‘Green prescribing’ is one way in which professionals can support people to improve their wellbeing e.g., Health Visitors encourage mums to go for ‘pram walks’ a part of maintain good mental health. People told us they can find it difficult to understand what self-management means for them and wanted clarity before deciding if this was the right approach to support their health and wellbeing. We will support Midlothian Health and Social Care Partnership to develop a self- management strategy that defines self-management and sets out how we will support people to manage their own conditions as well as possible. This will support people to decide if this approach is right for them, be more informed about their condition(s), be better prepared for when they feel less well, and know how to access support when it is needed. Page 94 of 316
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25 • Personal outcomes As we continue to work towards people achieving what matters most to them, it is important that we understand what our contribution is that process is. To do this, we have not simply taken old processes and made them electronic, we have adopted a new way to describe how we are making an impact in Midlothian. This is called Outcome Mapping. We began developing our approach in 2021/22 with a framework that describes how we work with people and communities to improve outcomes. Based on this learning, we have continually improved the process over the last three years with a common approach for services to tell their story and describe the contribution we make to changing outcomes. We have chosen to further develop our whole-system approach using a Strategic Governance Outcome Map. This map describes how the IJB operates and can give assurance on the progress we are making towards our three strategic aims and the 9 National Health and Wellbeing Outcomes. Storytelling and the stories of the people who experience our services are an important part of showing and evidencing how people feel and the difference we have helped make in their lives. This information is also very useful to help us learn and continually improve and share this with our Partners. We have asked Midlothian Health and Social Care Partnership to ensure that every service area is reporting their contribution to outcomes for people, and our strategic aims. This approach also supports Midlothian Health and Social Care Partnership’s services describe how the work they do continually improves to support people achieve what matters most to them. Medium term aims 1.3 People access services that are designed around how they live their lives • Whole system Transformation System transformation is more than service redesign. We are already developing our ability to understand the relationship and connections between services to help us make good decisions. This includes continually developing intelligence and decision making based on objective data that helps us make the right changes to transform health and social care. We have worked with the Health and Social Care Partnership to start planning a whole system model of transformation. This work will see us deliver care and support in ways that will completely redesign how we think about health and social care. It’s important that we keep early intervention and prevention at the centre of our planning and decisions. Our Third and Independent Sector Partners and community group will also continue to play a vital role in this model. Page 95 of 316
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26 • Primary care and connected community services As we develop our Primary Care services and the care they provide in the community or as close to home as possible, this might change the number of hospital beds we require. We will monitor this closely as we transform and continually review where we are spending our money. We are hopeful that by investing in these community services and working with our GP colleagues so fewer people need to go to hospital. One of the ways we think we can improve how people access the care and support they need quickly, is to develop a multiagency Single Point of Access to reach any of our services across Midlothian. This will take time, and require all of our Partners across the system to work together. • Unscheduled care We must ensure that people are only directed to A&E when they need this type of care. Our work to better understand the system tells us that this is most likely if we strategically investing in social care. There is an opportunity for a transformed approach to unscheduled care access and the contribution of social care assessment as well as right across the care spectrum. We believe there is still considerable scope to improve outcomes from social care early intervention and prevention activity in addition to existing work to avoid people being in hospital when they could be at home. We are continuing to work in a ‘whole system’ way with the Scottish Government, NHS Lothian, Midlothian Council and Third sector partners on an innovative, new model to improve the experience of people who need to go to hospital when the care they need cannot be provided at home. This includes working in different ways to make sure people are not in hospital for any longer than they need to be. Midlothian Health and Social Care Partnership are reviewing their ‘Home First’ model. This includes a redesign of support available at Highbank Intermediate Care service. Our ambitions to deliver Hospital at home where it is possible to provide this support at home will also contribute to this redesign. • Digital Using digital tools is an important part of how we deliver care and helps people to live the lives they choose. This means considering where digital tools and options play a meaningful part of our service offers. We understand that digital has to be a choice, and needs to be an appropriate part of safe and effective care. We are already working to move from an analogue to digital model for our telecare support. This is an important part of keeping people safe and well at home by providing services that alert professional when they they help. We will also continue to increase the Page 96 of 316
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27 number of ways that people can access our services e.g., digital consultations, telephone review, text message reminders, and Artificial Intelligence (AI). To add: Digital plans (following agreement of Financial Recovery Actions) Longer terms aims • Living well with multiple conditions One of the ways we think we can make a big difference is how we support people with more than one health condition (known as multimorbidity). In the UK, one in four people are now living with at least two health conditions. We know that people often have several long- term conditions, and focusing on people who we can predict are most likely to have multiple long-term conditions and frailty is the obvious thing to do. In Midlothian we are working more effectively to improve care for people with multiple health and social conditions where the right mix of services working together has made a real difference to people and communities. This has been particularly successful with the Health and Social Care Partnership’s use of ‘No.11’ which houses a range of integrated Mental Health, Substance Use, Justice Services, and Third Sector partners That doesn’t mean we can simply recreate this success by asking services to work in the same building. To be well connected, services and supports need more than a shared working location or to be reorganised in a single management structure. Without creating the time and resources for Midlothian Health and Social Care Partnership to think through the practicalities of how to join up their work around people and communities, plans will not be successful. We know improving coordination is about relationships between people, not just the buildings they work in. There is an opportunity to build new relationships and work much more closely with our natural partners. As we collect local evidence about how and where we could better coordinate and link service and supports for people with complex needs, we will be able to connect services and multidisciplinary teams (MDTs) in new ways. • Falls and frailty Falls, and illnesses associated with frailty remain common reasons for people in Midlothian being admitted to hospital. Reducing falls and reducing how many people need to go to hospital will help people stay well, improve wellbeing, and reduce pressure on the wider system. For older people, we know that falls can be associated with being unwell. However, falls are not an inevitable consequence of getting older. Page 97 of 316
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28 We are taking a multi-agency approach to make sure people are able to take action and bring to life the outcomes and ambitions of the Health Improvement Scotland’s Ageing and Frailty Standards, the new National Falls Strategy, and the NHS Lothian Falls Strategy (expected August 2024). Building new relationships and working much more closely with a range of partners will better coordinate and link redesigned services for people with multiple conditions, including frailty. Page 98 of 316
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29 Strategic Aim No.2 People access the care and support they need when they need it in the community and at home What we are trying to achieve 2.1 People easily access the services that help them stay well, independent, and active. 2.2 People have access to services in their own community. 2.3 People are living in the place of their choosing for longer. People told us that they know there is not enough people or money in the health and social care system to do everything for everyone. One of the things we can do to help people continue to live in the place of their choosing for longer is ensure we are providing care, support and rehabilitation that supports people to make good choices and prevent difficulties in the future. Activities, interventions, or information resources that supports people to recover, adapt, and achieve their full potential are all types of ‘rehabilitation’. If we have the right service offers and supports in place, people will recover faster and fewer people will need support from health and social care services. This includes supported self- management, and information that helps people take action to stay well. Working with our partners to ensure it is possible to provide what people need in our communities is a priority. Of course, this means making sure the right health and social care is available but is also requires availability of transport and other services that help people able to access the support they need in their community. Short term aims. 2.1 People have access to services that help them stay well, independent, and active for longer. • The right support is offered We want to provide the right support at the right time then continue to support people to thrive while stepping back. Having the right service offers and support to supplement what Page 99 of 316
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30 people can do for themselves is crucial and we know our Third sector colleagues and other partner providers are the key to success. We want everyone in Midlothian to have equal opportunities to improve their health and wellbeing and this will mean the services we commission over time might change. In order to make the fastest progress possible towards our strategic aims, we have already started work to review the services we commission and are using the learning from this process to ensure the most effective range of services are provided by our partners. Our Market Facilitation Plan sets out how we want to work collaboratively with our partners that provide services. We don’t have any more funds, but we can make sure we are using the resources we do have in the most effective way. We have asked NHS Lothian and Midlothian Council to work alongside us and all our delivery partners to ensure the right services, in the right numbers, from the right range of providers are available in Midlothian so we can work towards a future where everyone in Midlothian has good health and wellbeing outcomes. This will mean developing a new relationship with all our partners and providers to ensure everything we commission is strategically chosen to see the most progress for people and communities in the shortest possible time. • Support is easy to access Ensuring people can easily access the right help when they need it is vital to improve health and wellbeing. However, we know that some of our services are not as easy to access as we would like. People have to wait longer than we would like for some services, and others don’t have enough staff to offer the flexibility and adaptability that we would like to offer. Midlothian Health and Social Care Partnership’s Social Work and Occupational Therapy teams are reviewing the way they plan and deliver support. This review will consider the current legislative requirements for Social Work alongside a range of key information and help us support people more effectively and efficiently while still retaining specialist knowledge and skills within the service. To add: waiting time initiative(s) / delivery redesign (following agreement of Financial Recovery Actions) • Staying active Wellness is influenced by so many things, but we know staying active and making good choices is one of the best ways to contribute to good health and wellbeing. Our work with Midlothian Active Choices and our Allied Health Professional teams are good examples of when this works well and has helped us support more people in the community, create opportunities for people to design the support they need, and develop more links with services. Page 100 of 316
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31 We will learn from the successes and challenges of working in this way and develop more opportunities for people to improve their health and wellbeing e.g., the Weight Management Physical Activity programme. A review of weight management services is already underway by Midlothian Health and Social Care Partnership. We know that people are often impacted by weight stigma. The Health Inclusion Team, Public Health and Dietetics are working together to develop new ways to support both professionals and families. This includes reviewing the options and types of support available, and improving the effectiveness of weight management programmes as part of a whole systems approach. Medium term aims 2.2 People have access to services in their own community. • Better choices, better care We know that providing care in the community is preferable to people being in hospital whenever it is possible to do so, and this requires support and resources for community services. We know that hospital admissions that could have been avoided often have poor outcomes and that this is an expensive way to provide care. What we also know is that moving care from hospital-based to community-based settings is better for people, but very rarely less expensive. We must link what we know about care and outcomes for people, with what we know about the resources available. This means working with all our partners to better understand the whole system. • Bed based care Bed based care is a term we use to describe care received by someone in a hospital or care facility. NHS Lothian is leading key work in developing a system of ‘bed-based modelling’ that will help health and social care understand the resources across the system. We are working with NHS Lothian to make sure this will help us understand the factors unique to Midlothian. This strategic planning digital tool will help us predict the availability of bed based care across the whole system bed and record and forecast how capacity is affected under a variety of conditions. This will help us plan across winter, for outbreaks of disease, and understand what the impact in Midlothian might be when changes are proposed in other areas. • Planning for the future If we adapt and change how we deliver services in the community, we hope that fewer people will need hospital-based acute services in the future. Page 101 of 316
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32 We want to capitalise on what we already know about the quality of care and support provided by services, build a better understanding of the relationship between these care and support options, and look for opportunities that could support people to live in their community for longer. We hope that more people will be able to benefit from care in their own home and that when people do need to go to hospital, it will be for shorter periods of time How we use Midlothian Community Hospital, Highbank Intermediate Care Facility, Newbyres Care Village, and our Care at Home service is vital to this ambition. We will undertake a review of all our bed based care as part of our a transformation Programme across Midlothian Community Hospital, Highbank Intermediate Care Facility, Newbyres Care Village, Extra Care Housing, and our Care at Home service. This will include the development of a new strategy and workforce plan to ensure people can access bed based care when they need it as part of our service offer to support independence and maximise what people can do for themselves. • Continually improving To make positive changes to health and social care in Midlothian as safely, equitably, and as quickly as possible, we need to work in new ways and be confident that we are continually improving. Better understanding the relationship between our services and improving links between them is one way we can support people to take action to prevent, ill or worsening health and stay well. We know that we must support Midlothian Health and Social Care Partnership to continually evolve and adapt using the available resources. We are supporting services and our Partners to develop a culture of continuous improvement so the range of services are changing to support people achieve what matters most to them. All of these programmes of work will be in line with national ambitions, including realistic care and support. Longer terms aims 2.3 People are living in the place of their choosing for longer • Thriving communities We want our communities to thrive and for people to need less help and support from formal health and social care services to live as independently as possible for longer in the place of their choosing. We know how important it is to strike the right balance between health and social care supporting population approaches to improve health and wellbeing, the care and support Page 102 of 316
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33 delivered locally by our services, and the action individual people take to stay well. We want to get this right because we know how important it is to improve health equality across our communities. The progress we make in the next 10 years towards the 9 National Health and Wellbeing outcomes, will contribute to our ambition to see strong and resilience communities taking action to prevent ill or worsening health. We will continue to work with Midlothian Community Planning Partnership to ensure we are supporting community planning effectively and working with our wider partners to achieve more than we can through health and social care alone. To add: ‘Midlothian is healthier’ contribution Page 103 of 316
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34 Midlothian Health and Social Care Partnership is reviewing and refreshing the Midway. This includes a focus on the trauma informed and inequalities informed elements of this work. It is anticipated that this work will be completed in 2025. Strategic Aim No.3 People's human, social, and economic rights are protected and promoted in how we design and deliver our services. What we are trying to achieve 3.1 People are recognised as experts in their own lives, are involved in planning services, and feel valued. 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want. 3.3 People benefit from organisations working together and sharing information safely. We believe that everyone should have equal opportunities. No one should have less life chances because of their sex or gender, what they believe, or whether they have a disability. Short term aims 3.1 People and their carers are recognised as experts in their own lives, are involved in planning services, and feel valued. Midlothian has built a long-term commitment to strength based, and community led health and social care and have taken a "good conversations" approach, for over a decade. More recently this has grown in a system wide approach in Midlothian – The Midway. This is not just about how we welcome people into our services and work alongside them, but also how we lead and plan, talk about health and social care, and work with each other. Page 104 of 316
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35 • Equality Equality does not mean that everybody should be treated in the same way. Equality means services should be provided in different ways to meet the different needs of people. We are committed to working to advance equality in Midlothian. Our Equality Outcomes for 2025/29 set out our priorities for the next 4 years and describe how we will take action and work together for a fairer and more equal Midlothian. • Shared decision making, representation, participation, inclusion, and action People told us they want to see be included in decisions, treated with dignity and as individuals, and that they value meaningful face-to-face interactions and feedback. We want to plan for the future alongside people and have person-led service officers and supports. We want to hear what matters most to people and then work with them to make what they care about the most become a reality. Th Our Community Engagement Plan (in development) sets out the agreement we have made with people and communities about how we will work together. It also sets out how we will ensure people who experience our services, their carers, and families are represented and included in service design and planning. Our revised Public Engagement Statement (in development) describes how we will practically support people and communities to be part of service design and planning. To add: codesign initiative (following agreement of Financial Recovery Actions) • Carers We will continue to invest supporting carers, raising awareness of the important role of carers, support people to identify when they are providing a caring role, and then ensure they can easily access the services that will best meet their needs. As we work to deliver more care as close to home as possible, we understand this could impact on our unpaid carers Our Carers Strategy 2022/25 sets out how we are working with carers, the people they care for, and all our partners to improve the accessibility of services and support the ambition for carers to receive appropriate remuneration and experience fairer working conditions. The Carers Strategy will be refreshed in 2025. Work is continually underway to better understand how we can support carers in Midlothian. This includes working with our Partners, VOCAL, to consider how the information, advice and support that matters most to carers could be improved. To add: (following agreement of Financial Recovery Actions) Page 105 of 316
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36 • Doing more of what people value More than half of the population of Midlothian volunteer informally in their community by doing things like supporting others or participating in local projects and groups. People told us that they benefit from volunteering, they value receiving support from volunteers, and that this support makes a positive difference to their health and wellbeing. Where possible, we want volunteers to be part of our plans and continue to build on our good relationships with volunteers, volunteering groups, and Third Sector organisations. As care and support services improve and evolve, services are considering how volunteers can work alongside service delivery models. This includes considering where there could be opportunities for Voluntary Service Managers to help coordinate this work in a way that is sustainable, safe, and meaningful for both volunteers and people who access this type of support. To add: Volunteering (following agreement of Financial Recovery Actions) Medium term aims 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want We want to make sure that when people’s needs, choices, or decisions change, we can respond quickly and help people take as much control of their care as they would like to. We will continue to work with all our partners to ensure this happens consistently and as easily as possible when needs or choices change. • Self-Directed Support We know the importance of choice, independence, and good conversations to support people managing their own care if they would like to. Self-Directed Support (SDS) is a Scottish Government policy that supports people to access the care that they want to help them live the life they choose. We want to make is as easy as possible for people to make the choices that matter most to them, but we know that people are uncertain about what is available to them through social care are SDS options. We will continue to support Midlothian Health and Social Care Partnership’s services to explain SDS to people and ensure they know how to access the right amount of support. Page 106 of 316
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37 We have asked Midlothian Health and Social Care Partnership to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms, this includes • ensuring all the teams who work with people, including the teams of our Partners, understand what SDS is and how to signpost this information at the right time, • providing training for staff in sensory awareness, • understanding how to support people to request and access accessible information, • ensuring the information we provide about SDS is accessible so those who may benefit from different options are able to make informed choices • Choice and opportunity We want people in Midlothian to live independently as possible, with choices and opportunities, and in a safe environment. We are already working with our partners to provide more opportunities and choices to support this. We are learning from where we have had success in supporting other groups of people to live well in the community, e.g., Primrose Lodge. What we know already works well, and what we would need to do differently is helping us plan for new developments. For example, we are already planning a new development to support older people have more choices and opportunities to stay at home for longer and receive the care and support they need. Primrose Lodge in Loanhead is a development of four tenancies with a ‘short breaks’ service for two people next door. The development will become available in 2025 and be is part of the strategic redesign of Learning Disability services in Midlothian. Primrose Lodge will be home to an inspiring group of young people with unique personalities, great potential, skills to offer, and vibrant lives to lead. The building has been designed to be accessible and barrier free with provided 24 hours a day, seven days a week, by highly trained staff that are supported by specialist disciplines such as nursing, physiotherapy, speech and language therapy, dietetics, and occupational therapy. • Changing needs People’s needs can change for a number of reasons and at any time. When this happens, we want to be able to respond as quickly as possible and provide the right care. This is important for everyone but can significantly improve the experience of care for people at the end of their life. As part of the transformation programme, we have asked Midlothian Health and Social Care Partnership to ensure people can access well co-ordinated, timely and high-quality palliative care, care around death, and bereavement support based on their needs and preferences. This must include support for both families and carers as they deal with loss and grief, and for staff to manage the emotional impact of caring for people at the end of life. Page 107 of 316
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38 We will review how we provide support for people with complex needs. The Adults with Complex and Exceptional Needs (ACENS) service will continue to provide person-led care as we work with both of our Partners to develop a whole system model that can cope with the increasing demand and provide the right support to those who need this specialist service. Longer terms aims 3.3 People benefit from organisations working together and sharing information safely • People have access to their own health and social care information We know that people and health care systems want information about care to be shared more easily between services. People also want to be able to also share information easily themselves and on their terms. This would require care records to be linked in ways are currently not possible. Integrated care records could help avoid people having to repeat their story, help people better manage their care, and support discussion and shared decision-making. Effective digital systems and linked technologies could also lead to better and more consistent care. In Scotland, we are some way off from the data sharing agreements that would need to be in place between a number of organisations to have linked records. However, this remans a key objective for Scottish Government, and we will continue to work with all our partners to make sure we are able to adopt new ways of working as soon as it is possible. • Bringing data together in new ways Our experience tells us that there are some services that people are more likely to need at the same time. As we determine what these predictable clusters are in Midlothian, we will be able to reorganise our health and social care around what people most frequently need, rather than individual diseases. This will help us understand the local patterns of health and wellbeing to help us redesign our services around how people live their lives. Currently, due to the way national information is collected, there is currently no data that can tell us the most commonly occurring clusters of health and social care need in Midlothian. We must develop how we use the data we already have and make sure we can access all the data that we need to better understand how people access our services in Midlothian. Creating the conditions for safe sharing of information between Page 108 of 316
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39 organisations will connect systems and help us improve how we support people who need health and social care services. We are confident using information this way will help us plan and design more person-centred approaches , service offers, and support. We are working with local and national partners and data specialist to bring together health and social care data that has never been reviewed in this way before. This will help us understand how to create new ways of safely storing, sharing, and connecting information so that people only need to tell their story once. By doing this we will save time for people and staff and create new opportunities to do things differently. Page 109 of 316
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40 Making this a reality Other key documents and information In developing this Strategic Plan, Scottish Government require us to produce a number of other documents. You will have noticed we have referred to some of these throughout the plan. • Midlothian Joint Strategic Needs Assessments • Consultation and Engagement Statement • Housing Contribution Statement • Market Facilitation Plan • Equality and Children’s Rights Impact Assessment on the Strategic Plan Our workforce We do not directly employ any staff. The health and social care workforce are employed through Midlothian Council, NHS Lothian, and organisations in the Independent and Third sector alongside our unpaid carers and volunteers. However, we know that this combined workforce is the single biggest asset available to us in progressing the ambitions of this plan and improving outcomes for people and communities. We know the needs of our workforce are changing and dependent on many new factors. In 2022 Midlothian Health and Social Care Partnership published its first Integrated Workforce Plan for 2022/25 alongside a staff Communication, Engagement and Experience Delivery Plan. Our Integrated Workforce Plan focuses on the 5 pillars of workforce planning set by Scottish Government to support recovery, growth and transformation of health and social care. We have continued to develop our skills in this area and worked with Midlothian Health and Social Care Partnership to develop an Integrated Workforce Plan for 2025/28. This plan describes how we will plan, attract, train, and support the development of the workforce required to deliver the ambitions of this plan. Operational planning To put our plan into action we send written instructions to NHS Lothian and Midlothian Council. These instructions are called ‘Directions’. Directions are legally binding and instruct NHS Lothian and Midlothian Council on what they need to deliver and the budget that they have been allocated to do this with. Directions are issued to NHS Lothian and Midlothian Council at the beginning of each financial year, and we can add, revoke, or review a Direction at any time e.g., if we make a decision that changes a service delivery plan, or if we receive new funding across the year. We review progress towards these Directions twice a year. Page 110 of 316
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41 How services plan Midlothian Health and Social Care Partnership plans and delivers services on our behalf. People told us they believed our ambitions were the right ones, but they wanted to know what we were going to do about it. We have asked Midlothian Health and Social Care Partnership to ensure they have annual Service Plans that detail how this Strategic Plan will be brought to life in our communities. Services plans, care, and support are based on this Strategic Plan, our Directions, national priorities and drivers, and what we know about people and communities. Frameworks including the Framework for Community Health and Social Care Integrated Services and the proposed multi- agency Getting Right for Everyone approach are both central to how Midlothian Health and Social Care Partnership plans its services. The Midlothian Heath and Social Care Partnership Service Plans will be published on our website as soon as they are available. Budget and financial plan This Strategic Plan helps us prioritise how we will allocate our resources. We have agreed that achieving the ambitions of this plan will bring the change we want to see in our communities. How we allocate funding to the services that Midlothian Health and Social Care Partnership manage will be based on this plan. However, we know we don’t have enough resources to meet all the needs of the growing population in Midlothian. As we monitor our progress towards the 9 National Health and Wellbeing Outcomes, we will consider if the things we thought would make the biggest difference are working in the way we hoped. We might not have resources available to us to make as much progress as quickly as we’d like, but our strategy will continue to aim to make these outcomes a reality for everyone in Midlothian. Midlothian Health and Social Care Partnership operationalises this plan and uses the money allocated to its services to plan, deliver, monitor, and evaluate the services it provides and commissions. The actions services take, and how they use the resources allocated to them will determine how much progress we make, and how quickly. We monitor these plans and will ask Midlothian Health and Social Care Partnership to do things differently when we think there is a need to do so. Best Value Best Value is about ensuring that we effectively manage the resources available to us and focus on improvement to deliver the best possible outcomes for people and communities. We know that achieving Best Value will only be possible if we work alongside our partners. To help us do this the best way we can, we monitor our actions using a Best Value Framework and record our progress in Page 111 of 316
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42 the Strategic Governance Outcomes Map. This helps us continually improve, and describe our work across 7 key areas. • Vision and leadership • Governance and accountability • Effective use of resources • Partnerships and collaborative working • Working with communities • Sustainability • Fairness and equality Our resources We can only use the resources that are made available to us. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. We receive a budget offer from both of these partners each year and this may not be enough to deliver everything we want to. We work closely with both partners but 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. Future funding decisions that impact on our Partners are likely to also impact on the resources we have. This could mean that progress towards our strategic aims slows down, or that we need to revise this plan to ensure we are prioritising the right actions. Our annual budget Our budget for 2025/26 is £xxxm* This is split up into four parts: Social work and Social Care (from Midlothian Council). £xxm* This is for the adult social care services in Midlothian. These services are managed operational by the Midlothian Health and Social Care Partnership. Health Core Services (From NHS Lothian). £xxm* These are local health services which are delegated to the Health and Social Care Partnership. These include primary care services (GPs, pharmacists etc), district nursing, community mental health teams, community learning disability teams, and the local community hospital. Health Hosted Services (from NHS Lothian) £xxm* Some services are managed on a pan-Lothian basis. We manage a share of the total budget for these services based on its population. Midlothian hosts Dietetics and Adults with Complex and Exceptional Needs and provide services for people across Lothian on behalf of all four Health and Social Care Partnerships - Midlothian, East Lothian, West Lothian, and City of Edinburgh. Health ‘Set Aside’ budgets (from NHS Lothian). £xxm* Unscheduled care services (Accident and Emergency and unplanned admissions) are managed by NHS Lothian’s Acute Hospital system. The IJB’s budget includes a share of these services, based broadly on our population size. The budget is ‘set aside’ by NHS Lothian on the IJB’s behalf. These services are Accident and Emergency, Cardiology, Diabetes, Endocrinology, Gastroenterology, General Medicine, Geriatric Medicine, Rehabilitation Medicine, Respiratory Medicine, and various ancillary support services for the above. They are delivered at the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital. Page 112 of 316
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43 *budgets TBC Opportunities for transformation and change The financial resources available to us are agreed when we set our annual budget. This is usually in March every year. Sometimes further resources are made available by the Scottish Government. Working this way makes thinking about our strategy difficult. By law, we have to review our Strategic Plan every three years but also know that change doesn’t happen quickly. We will review and refresh this plan in three years, but we only have the budget confirmed for one year at a time year. We also know that our population is changing, and we need to plan for this by thinking much further ahead. This Strategic Plan asks the services in Midlothian Health and Social Care Partnership to redesign in specific ways over the next 15 years. New legislation, national policies, or other national changes may also require services to do things differently. When this happens, it often needs additional investment, but we don’t always receive more money. How we fund ‘Transformation’ We have spent several years improving and making our services as efficient as they can be. This meane we are no longer able to redesign with an intention of doing more with less to achieve saving targets. We can still consider total system transformation, but successful whole system transformation processes require additional resource and capacity in the early planning and implementation stages of this work. This is because work at that scale requires a huge amount of planning, testing, learning, and retesting on top of our day-to-day business of supporting people and communities. We only have three options available to us to fund additional work. This means we will not be able to do additional work without one of these options being made available to us. New resources from Scottish Government. These are generally agreed as part of the budget setting process each year. A transfer of resources from elsewhere in the system. For example, as we provide more care in communities and avoid people going to hospital unnecessarily, more resources should be released from hospitals to support community services. However, in practice this is difficult to achieve and impacts on our ability to do more of the work we would make the biggest difference in our communities. A reorganisation of our how we allocate our own budgets. We can choose to fund areas differently but giving more to one area means giving less to another. Sometimes this means we have to stop providing some services and will always discuss these options with all our partners, people, and communities before making any permanent decisions. Our ‘Reserve’ budget All Integration Authorities should have reserves as this is part of good financial management. There are two types of reserves: general reserves, and earmarked reserves. • General reserves are funds which have been built up from surpluses in previous financial years. The main purposes of general reserves are to help with cash flow and avoid Page 113 of 316
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44 unnecessary temporary borrowing and support unexpected financial pressures through the year. In 2023/24 we had to spend all of our general reserve (c. £6.2m) to pay for services. Although this was planned, it has meant we no longer have any reserves to support recovery plans or to investment in service transformation. • Earmarked reserves are funds that we may have carried forward one year to the next for specific and allocated services or projects. We continue to have earmarked reserves for this purpose. Our medium-term financial strategy Although our financial position is more unpredictable now than it has ever been, we do have a five- year financial plan that runs from 2024/25 to 2028/29. We review this regularly and adapt and change to meet the challenges. We have worked hard to make sure our medium-term financial planning supports the delivery of this strategic plan for 2025/35 and closely links with our workforce plan currently being developed for 2025/28. You can find our medium-term financial plan on our website. Financial risks We are currently facing a number of serious financial risks. The main risk is that our partners may not be able to provide the appropriate levels of funding to support our aims. The financial pressures we face are the same all across Scotland: the costs of changes relating to staff pay, terms and conditions, the changing cost of existing drugs and the cost of new drugs, and rising costs due to inflation. NHS Lothian and Midlothian Council have supported us with the best funding offer they can in the circumstances. However, in the future, they may have to prioritise funding their own services first. This would mean less money was available for community health and social care. There is also a risk that future Scottish Government policy decisions could impact on the way we have to use the money we have available to us. For example, is it not clear how the National Care Service will impact of the funding we receive of the services we will be asked to plan for. Page 114 of 316
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45 Monitoring and evaluation There are a number of ways we work with our partners, people, and communities to monitor and evaluate the progress we are making toward the ambitions of this plan. Our Strategic Governance Outcome Map is the performance framework for this plan and how we monitor and evaluate progress towards our strategic aims. We are using this unique approach to provide a real time picture of the progress we are making towards our strategic aims and the nine National Health and Wellbeing Outcomes across the whole system. We do this by linking to service outcome maps and other national and local data. Our Strategic Planning Group reviews the data and evidence we collect at every meeting. This group oversees the quality of the data we use and scrutinises the interpretation of our analysis. Where there are data that need further examination, the group asked the senior leaders in the HSCP to help us understand where we can learn from areas of success as well find opportunities for change. Alongside our Performance Framework, this helps us better understand the contribution we are making to personal outcomes for people. Outcome maps are a way to understand how services contribute to people achieving the outcomes that matter to them. Working this way means Midlothian Health and Social Care Partnership services can quickly learn from what has worked well and what needs to improve and use this information to make more targeted, locally informed decisions about how to design, deliver or commission services. This approach allows services to describe what they do, who with, what people learn and gain as a result, how this makes them feel and the difference this makes in their lives. How we measure performance We measure our performance to see what is working well, what can be improved and how well we are meeting the key aims of integration, our strategic aims and progressing our strategic plan. We do this through a number of key evaluation and reporting methods that can be found on the Midlothian Health and Social Care website : • Our Annual Performance Report • Bi-annual reports on our Strategic Governance Outcome Map. • Our Equality Outcomes, and Mainstreaming Equality report and action plan • A performance framework with quantitative (number) and qualitative (narrative) information • Bi-annual reports on progress against our Directions • Quarterly reports from Midlothian Health and Social Care Partnership’s services Page 115 of 316
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46 Appendices 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 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. We have listed some of the services below 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 Social Work support for adults including adults with dementia, learning disabilities, older people Care at Home services Day services for older adults 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 116 of 316
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47 Appendix 2: Locality planning The Public Bodies Act requires that each Integration Authority area is split into at least two localities. However, the numbers in the available validated data that would support this are often too small to be reported. There is no natural split into two or more areas across Midlothian and the population isn’t large enough to make a locality approach viable for commissioning services. As the smallest mainland authority in Scotland, we do not consider this is a meaningful approach. Instead, we work with the local Community Planning Partnership and Neighbourhood Plans to work with our 15 natural communities to identify what is working well and plan areas for development. The voluntary sector has strong roots in local areas and supports a system wide understanding of community intelligence that is invaluable. Our ongoing partnership with the third sector is at the core of our work in communities. This approach has been particularly effective during civil emergencies such as extreme weather conditions and more recently, the pandemic. More information on the health and social care needs of the Midlothian adult population can be found in our Joint Strategic Needs Assessment. Page 117 of 316
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48 Appendix 3: Engagement with people We work closely with people and partner organisations through representatives from the third sector, carers and people with lived experience joining our formal planning groups including the IJB, and the Strategic Planning Group. However, the best way to evaluate how well we are doing is by talking to more people who live in Midlothian. In 2024 we completed the Heath Care Improvement Scotland Quality Framework for Community Engagement and created an action plan to improve how we listen to all the voices in our community. This helped us plan how we worked alongside people and communities to write this plan. Our Consultation and Engagement Statement sets out how we planned, carried out and evaluated feedback alongside people who experience our services, their families, and carers. Page 118 of 316
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49 Appendix 4: Market facilitation The Public Bodies (Joint Working) (Scotland) Act 2014 is accompanied by statutory guidance that we must follow when developing our plans for health and social care in Midlothian. The statutory guidance says we must prepare a Market Facilitation Plan alongside our strategic plan and involve a range of service providers, people who use services, carers, representative bodies, and professionals in the processes. Market facilitation is both the planning and securing of services across a range of providers and types of support for people to choose from and supports a flourishing community. There are three elements of market facilitation: market intelligence, market interventions, and market structure. • Market Intelligence is the common and shared understanding of local supply and demand that helps us describe and evidence the market position in Midlothian. • Market Interventions are the things we do to deliver the care and support that is required and support our communities to flourish. • Market Structure is the shape of the market as a result of the actions we have taken collectively based on shared values and the outcomes we hope to achieve. A Market Facilitation Plan should describe how the strategic plan will be delivered and how we will work together with the services, agencies, providers, and people and communities in Midlothian to put the right services and supports in place. This is ‘the market’ and includes what currently exists as well as what might exist in the future so that people stay well and take action to prevent ill or worsening health. To do this, we need a shared understanding of what services and supports are required, and how much of them we need to ensure we can support people can achieve what matters most to them. This also includes ensuring we have ethical commissioning and procurement principles, appropriate choice from range of different types of support, and a range of providers. Our Market Facilitation Plan describes how we will work with service providers, people who experience our services, their families, and carers to shape the future of the local health and social care market. This plan aims to identify the demand for care and support, design and respond to the changing needs of people living in Midlothian and shape the future market in readiness for population changes. Market Intelligence Market Intervention Market Structure Page 119 of 316
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50 Appendix 5: Policy and drivers Some of the most important national policies that have contributed to this plan are • Health and Social Care Standards (2017) • National Health and Wellbeing Outcomes Framework • National Performance Framework • Principles for Planning and Delivering Integrated Health and Social Care • Best Value in Public Services • Delivering Value Based Health and Care: a Vision for Scotland (2022) • Framework for Community Health and Social Care Integrated Services • Fair Work Action Plan (2021) • Housing to 2040 (2021) • National Workforce Strategy for Health and Social Care (2022) • My Health, My Care, My Home - Healthcare Framework for Adults living in Care Homes (2022) • National Clinical Strategy for Scotland (2016) • NHS Recovery Plan 2021-2026 • Getting it Right for Everyone • Getting it Right for Every Child Policy Statement 2022 • National Carers Strategy (2022) • Self-Directed Support: framework of standards (2021) • Rehabilitation and Recovery: a person-centred approach (2022) • National Mental Health Strategy 2017-2027 • National Drug Mission Plan 2022-2026 • Creating Hope Together – Suicide Prevention Strategy 2022-2032 • General Medical Services Contract in Scotland (2018) • Primary Care Improvement Programme • Diabetes Improvement Plan (2014) • Palliative and End of Life Care Strategic Framework for Action (2015) • Palliative and End of Life Care by Integration Authorities: advice note (2018) • Learning / intellectual disability and autism transformation plan (2021) • See Hear – A strategic framework for meeting the needs of people with a sensory impairment in Scotland (2014) • Enabling, Connecting and Empowering: Care in the Digital Age – Scotland’s Digital Health and Care Strategy (2021) • Greater access, better insight, improved outcomes: a strategy for data-driven care in the digital age (2023) Page 120 of 316
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Midlothian IJB Strategic Plan 2025/35 Phase three consultation summary • Phase three of consultation was live between August and November 2024. • Consultation survey prompted 34 responses. • Majority of respondents identified as female (62%), with the age range 31-60 providing the most responses (65%) • Respondents largely read the draft plan online (67%) as opposed to reading a paper copy. • 27 respondents stated the plan was easy to understand. • All respondents, bar one who opted not to answer, agreed with the use of ‘people’ being employed in the plan to describe the community. • 38% of respondents identified as unpaid carers, 47% did not with 12% preferring not to say. Did the plan explain who the Integration Joint Board is and what we do? - Explain IJB Number of responses % Yes 31 91.2% No 3 8.8% Not Sure 0 0.0% TOTAL 34 100.0% Does our plan support our vision to enable people to lead longer and healthier lives? - Number of responses % Yes 19 55.9% No 1 2.9% Not Sure 13 38.2% N/A 1 2.9% TOTAL 34 100.0% Does our plan support our mission to provide the right support at the right time in the right place? Number of responses % Yes 16 47.1% No 1 2.9% Not Sure 17 50.0% N/A 0 0.0% TOTAL 34 100.0% Page 121 of 316
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Strategic Aim 1 Do you think our plan is clear about how we will achieve our first Strategic Aim? That aim is that people feel able to make good decisions that help them stay well, plan ahead and prevent ill or worsening health. Number of responses % Yes 14 41.2% No 5 14.7% Not Sure 14 41.2% N/A 1 2.9% TOTAL 34 100.0% Do you feel we will be able to achieve this aim? - Achieve aim 1 Number of responses % Yes 5 14.7% No 8 23.5% Not Sure 21 61.8% N/A 0 0.0% TOTAL 34 100.0% Strategic Aim 2 Do you think our plan is clear about how we will achieve our second Strategic Aim? That aim is that people are able to access the care and support they need when they need it in the community and at home. Number of responses % Yes 13 38.2% No 6 17.6% Not Sure 15 44.1% N/A 0 0.0% TOTAL 34 100.0% Do you feel we will be able to achieve this aim? Number of responses % Yes 2 5.9% No 8 23.5% Not Sure 23 67.6% N/A 1 2.9% TOTAL 34 100.0% Strategic Aim 3 Page 122 of 316
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Do you think our plan is clear about how we will achieve our third Strategic Aim? That aim is that people's human, social and economic rights are protected and promoted in how we design and deliver our services. Number of responses % Yes 13 38.2% No 6 17.6% Not Sure 15 44.1% N/A 0 0.0% TOTAL 34 100.0% Do you feel we will be able to achieve this aim? - Achieve aim 3? Number of responses % Yes 3 8.8% No 6 17.6% Not Sure 24 70.6% N/A 1 2.9% TOTAL 34 100.0% Positive & Negative Themes Several comments referred to liking the ‘Plan on a Page’ section of the draft Strategic Plan, & it’s structure. 0 1 2 3 4 5 6 7 8 Easy to read Plain language, visuals People at centre Honest ambitous Number of Responses Selected Element What is good about our plan? Page 123 of 316
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Comments were noted around the level of detail in the draft Strategic Plan, with emphasis on how the ambitions and aims will be realised. Diminishing resources, the ‘people’ factor and a contingency plan were also highlighted in responses. 0 1 2 3 4 5 6 7 8 9 Detail Budget implications NCS Resource challenges Number of Responses Category of concern What is missing from our plan? Page 124 of 316
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Strategic Plan Strategic Plan vs Statutory Guidance for Strategic Planning Assessment Report Introduction The Scottish government has provided statutory guidance on the production of health and social care strategic plans (strategic plans: statutory guidance - gov.scot (www.gov.scot)). This report details the findings of an assessment of Midlothian IJB’s Draft Strategic Plan compared to the statutory guidance, highlighting any gaps. Method The statutory guidance provides a list of wider planning duties (Annex A) and the checklist in preparing a strategic plan (Annex C). Using the guidance as a basis for the assessment, each item of Annex A and Annex C was used to search the Draft Strategic Plan. Items of Annex A and C were identified within the plan and ranked from ‘Not Referenced’ to ‘Clearly Referenced’. (Table 1: Scale Description) Scale Description Not referenced No mention of the guidance item in the Draft Plan Briefly referenced Guidance item referred to less than 3 times and without further explanation or links to guidance/policy or other plans Frequently referenced Guidance item referred to frequently (more than 5 time) throughout the plan but without further details or links to guidance/policy or other plans Clearly referenced Guidance item is referred to frequently and is supported by further explanation, links to guidance/policy or other plans Page 125 of 316
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Findings The findings from the assessment of the Draft Strategic Plan have been collated into Table 2. The table outlines the guidance item, a description of where the item is referenced in the draft plan, a Rag status indicating its scale ranking and the rational for the gap and/or action to rectify the gap. Table 2: Findings Key Not referenced Red Briefly referenced Orange Frequently referenced Yellow Clearly referenced Green Guidance Item Description RAG Rational/Action Annex A: Wider planning duties - Health and social care - strategic plans: statutory guidance - gov.scot (www.gov.scot) Drug and Alcohol Partnership National Drug Mission Plan mentioned in Appendix 5. No other mention of Drug or Alcohol Partnership Orange Appropriate The Midlothian and East Lothian Drug and Alcohol partnership is not under the IJB governance Carers Carers are a key theme throughout the draft plan. However, there is currently no clear reference/link to the local carer strategy Yellow For action The Midlothian Carers Strategy 2022-25 is available on the website and a link should be added to the strategic plan. The Carers Strategy should also refreshed in line with this new strategic plan and would be anticipated for publication in 2025. Reference to this will be added to the plan. Page 126 of 316
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Children’s Service Planning Reference to family support throughout the plan. however, there is no clear link to children's service plans, how services positively impact children's wellbeing, or the transitions from children to adult services. Red Appropriate Children’s services is not a delegated function. Include a link to Getting it right for every child in Appendix 5 Climate Change Paragraph included that acknowledges the impact of climate change on health inequalities (P. 17, Working with our partners). No comment on the IJB duty to report (annually). Orange For Action: A sentence has been added to note the IJBs duties in this regard. Community Justice Justice is mentioned as part of a summary of the services housed at No.11 (P. 22). No other reference to community justice Red For Action: Include further information about community justice A ‘placeholder’ has been added until the budget allows for more detailed planning assumptions Hosted Services Not discussed Red For Action: Include further information about Dietetics and ACENS. ‘Placeholders’ have been added until the budget allows for more detailed planning assumptions. Community Planning Community Planning Partnership and single Midlothian plan is clearly referenced in Appendix 2: Locality Planning Green n/a Equality Equality Outcomes are clearly referenced in section 3.1 (P. 28). Green n/a Health Annual Delivery Plans: Service plans referenced in section ‘making this a reality’ sub section how services plan (P. 33) Workforce Plan: clearly referenced Medium Term Operational Plans: less clear Green Revised ‘Operational planning’ and ‘How services plan’ sections with ‘Making this a reality’ to distinguish the strategic plan for operational planning cycles Page 127 of 316
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Housing Clearly links to the housing statement that will be published alongside the plan Green n/a Annex C: Checklist in preparing a strategic plan - Health and social care - strategic plans: statutory guidance - gov.scot (www.gov.scot) Engagement with SPG Clearly referenced Green n/a ECRIA Clearly referenced Green n/a Joint Strategic needs assessment Clearly referenced Green n/a Market Facilitation Plan To be published alongside the SP Green n/a Framework for Community Health and Social Care Integrated Services Clearly referenced and linked Green n/a Financial Plan Budget and financial plan section included Green n/a Local Plans Appendix 2: Locality planning Green n/a Wider engagement, beyond the Strategic Planning Group, including linking into existing local forums and across policy boundaries Detailed in the Public Engagement and Consultation Statement Green n/a Implementation plan(s) outlining how the strategic plan will be delivered Annual Delivery Plans: Service plans referenced in section ‘making this a reality’ sub section how services plan (P. 33) Green n/a Annual financial statement, ready to publish alongside the strategic plan The audited Annual Accounts are anticipated to be published ahead of the Strategic Plan Green For Action: For publication in line with financial governance. Awaiting indicative offers and the budget setting. Consultation statement Referenced with link Green n/a Easy Read Version NYS For Action: For development. Page 128 of 316
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Additional adjustments will be made on request to meet needs of individuals. Publication Approach NYS For Action: For development in collaboration with Comms to ensure accessibility and reach. Monitoring the impact of the plan via annual performance reports etc. Reference is made to annual performance reports Green n/a Page 129 of 316
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1 Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report Midlothian Integration Joint Board Strategic Plan 2025-35 Page 131 of 316
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2 Contents Description Evidence Summary of ECRIA Making a difference Sharing with decision-makers Monitoring the impact Tables Impact on equality & socio-economic disadvantage Impact on UNCRC rights Report written by: Midlothian HSCP Programme Manager for Performance & Improvement Report authorised by: Midlothian IJB Chief Officer: Date: 30 December 2024 Once your proposal has been agreed and signed off, send the completed Impact Assessment Report to loth.midhscp@nhs.scot for website publication. Page 132 of 316
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3 Description Guidance pages 4-7 Title of proposed work Midlothian Integration Joint Board’s Strategic Plan 2025-35 Purpose/objective of proposed work The purpose of the Strategic Plan is to describe how we have come together alongside 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. Who will be affected by this proposed work All people living within the boundary of the Midlothian Health and Social Care Partnership’s geographical footprint. All people may need to make use of health and social care services, and this could be at any time across their lifetime. However, we assume that the most vulnerable in our community are more likely to potentially experience disproportionate impacts, both positive and negative, of the Strategic Plan’s contents. These groups may include but are not limited to people belonging to Protected Characteristic Groups noted in the Equality Act 2020: those experiencing socio-economic deprivation, people from a care experienced background, veterans, carers, the elderly, people with experience of the justice system and people with substance and alcohol use challenges. Page 133 of 316
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4 Evidence Evidence used: This Midlothian Demographic Profile is based on the 2011 and 2022 census data, Midlothian Council Internal Data, the Joint Needs Assessment and other relevant data reports. • On 30 June 2022, the population of Midlothian was 97,030. This is an increase of 1.4% from 95,690 in 2021. Over the same period, the population of Scotland increased by 0.5%. • Compared with 2001, the number of dwellings in Midlothian has increased by 32.3%. This is the highest percentage change out of the 32 council areas in Scotland and a more rapid change than for Scotland as a whole (+17.3%). Age In terms of overall size, the 45 to 64 age group was the largest in 2021, with a population of 25,243. In contrast, the 75 and over age group was the smallest, with a population of 7,740. Sex In 2022, there were more females (51.7%) than males (48.3%) living in Midlothian. There were also more females (51.4%) than males (48.6%) living in Scotland overall. Reference: National Records of Scotland Midlothian Council Area Profile (nrscotland.gov.uk) Page 134 of 316
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5 Disability In the 2022 census, the National Records of Scotland report that in Midlothian 8.8 people identified themselves as living with a physical disability that had lasted or was expected to last at least 12 months. This was close to the Scottish average of 6.7%. In Midlothian in 2023, records show that: • 3,179 adults (18 and over) known to the Adults and Social Care team have physical disability recorded as their primary care group, • 1,200 people are recorded as wheelchair users, and • 5,681 people have a blue badge. Reference: Midlothian Council Internal Data: Mosaic, accessed Feb 2023 In 2021/22, Scotland and Wales had the highest proportion of disabled people (both 26%), compared with the UK average of 24% [UK Parliament Research Briefing]. Analysis based on the Scottish Household Survey 2015 showed that there were around 87,340 households with a wheelchair user in Scotland (3.6% of all households). In 2021, Scottish Government reported that there were 235,779 live Blue Badges in Scotland. 785 adults with a Learning Disability are known to Social Care services in Midlothian. Reference: Midlothian Council Internal Data: Mosaic, accessed Feb 2023. Based on the Learning Disability Statistics Scotland (LDSS) 2019 report, there were 23,584 adults with a Learning Disability known to local authorities across Scotland. This national dataset is collected by Public Health Scotland but has not been published since 2019, so a more recent comparison is not possible. Midlothian has a higher prevalence rate of adults with a Learning Disability known to Social Care (6.3 per 1,000) in comparison to the Scottish average (5.2 per 1,000). In Midlothian, 66.4% of adults with learning disabilities lived in mainstream accommodation without support. This is slightly greater than in the whole of Scotland where it was 61.8% in 2019. [Reference: Scottish Commission for Learning Disability, 2019]. Page 135 of 316
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6 Gender reassignment The 2022 census included a question on trans status or history for the first time. This was a voluntary question for people aged 16 and over. For Scotland as a whole, the census found that 19,990 people were trans or had a trans history. This equates to 0.44% of people aged 16 and over. Almost half (46.1%) of trans people were aged 16 to 24 with around a quarter (26.0%) aged 25 to 34. In Midlothian, the majority (n= 74,094) of people aged 16 and over, stated that they are not trans and do not have a trans history. The number of people who stated that they either are trans or have a trans history was 230. [Reference: Scotland Census 2022 – National Records of Scotland scotlandscensus.gov.uk] Marriage & civil partnership Marriages have declined in Midlothian, from 701 in 2005 to 319 in 2021. Civil Partnerships have also declined since being introduced in 2005, averaging 5 per year from 2006-2014 and recording 5 in total from 2015-2021. [Reference: Marriages and Civil Partnership - Time Series Data | National Records of Scotland (nrscotland.gov.uk)] Pregnancy & maternity In 2021, there were 1,071 births in Midlothian. This is an increase of 9.4% from 979 births in 2020. In Midlothian, the standardised birth rate increased from 10.8 per 1,000 population in 2020 to 11.7 in 2021. In comparison, the rate in Scotland overall increased from 8.6 to 8.7. In 2021, Midlothian was the council area with the highest standardised birth rate. Reference: National Records Scotland Midlothian Council Area Profile (nrscotland.gov.uk) Race The 2022 census shows that the majority of people in Midlothian are White (including White Scottish, Other White British, White Irish, White Gypsy/Traveler, White Polish and Other White): • White Total: 92,527 • Asian, Asian Scottish, Asian British Total: 2219 • African Total: 474 • Caribbean or Black Total: 95 • Other ethnic groups total: 562 Reference: Scotland Census 2022 – National Records of Scotland (scotlandscensus.gov.uk) Page 136 of 316
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7 Religion and Belief In 2011 in Midlothian the most common religion was Church of Scotland (33.7%), followed by Roman Catholic (9.8%), other Christian (4%), Muslim (0.6%), other religion (0.5%). 45.2% of people reported no religion and 6.2% didn’t state their religion. Reference: 2011 Census National Records of Scotland Sexual orientation Census data relating to sexual orientation was also included as a voluntary question for the first time in 2022. It found that there were 183,860 LGB+ people in Scotland, 4.0% of people aged 16 and over. In 2019, 90% of people aged 16 and over in Midlothian identified as Straight/Heterosexual. 1205 people identified as Gay or Lesbian, 990 identified as Bisexual, and 238 identified as ‘Other sexual orientation’ Reference: Scotland Census 2022 – National Records of Scotland Council Area 2029 by Sexual orientation by Age (scotlandscensus.gov.uk) Socio-economic Deprivation In 2020, Midlothian had 8.7% share of 20% most deprived data zones. This means that there are 20 Local Authorities with a higher share of the 20% most deprived data zones. Reference: Scottish Government, 2023 Whilst all areas in the most deprived 20% were around Dalkeith, Mayfield, Easthouses and Gorebridge, areas in the most deprived 20-30% were spread more widely including Thornybank, Penicuik and Newtongrange. Reference: Midlothian HSCP, Joint Needs Assessment, Inequalities - Midlothian Health and Social Care Partnership, May 2024 Page 137 of 316
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8 Summary of the ECRIA: The Integrated Impact Assessment was held as an agenda item at the Midlothian Strategic Planning Group, 26 September 2024. Details will be recorded under benefits, major concerns, and minor concerns. The composition of the group consisted of Strategic Planning Group members, Integration Joint Board Members (including representatives of the Third and Independent sector, people and communities), and service leads. An equality professional facilitated the activity. Benefits • Should all ambitions of the plan be delivered, it was considered to be likely that the plan would have a positive impact on people with protected characterises. • The significant emphasis on outcomes for people was noted as a likely to have a positive impact on people with protected characterises. Major concerns • It was noted that legacy changes following the pandemic and the current financial uncertainty continue to impact on strategic planning and operational delivery. • The rapid expansion of the Midlothian population, in combination with an expectation of reduced financial resources in future, were raised as a concern. • The projected increase in eldest age category was noted in relation to how to maintain equality standards for this group. The same challenge was noted in relation to Midlothian’s high birth rate. • The impact on carers was noted as people who take on carer roles often face reduced life chances – employability options, poor health and poverty were noted. This was reinforced by the results of the recent Carers’ Survey. Minor concerns • The vital relationship between all the IJBs partners and sectors across Scotland raises the issue of external dependencies which may limit the progress of strategic aims and potential impact on groups of people with protected characteristics. • The negative impact of the cost of travel for care and support was noted, in particular for those on lower incomes. • The context of what ‘home’ and ‘living in the community’ mean for people who experience homelessness. Page 138 of 316
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9 Recommendations This ECRIA is reviewed by SPG and following agreement, be submitted to Midlothian IJB. The specific recommendations in relation to the three Strategic Aims follow in the next section. Making a difference What changes will you make to your proposal based on the results of this impact assessment? Changes What difference this will make Strategic Aim No.1 Recognise the role of our partners relating to information sharing to support people making informed decisions in relation to health and wellbeing. Reinforce commitment to provision of clear, accessible information to support for services in terms of operational planning. Acknowledge in the plan that we have more work to do to understand what the preferred formats and methods of communication are for people living in Midlothian. Ensure the review of the MidWay is linked to the ambitions of the plan. This would reduce the potential negative impact on equality in relation to literacy and health literacy. This would increase the potential for services to be designed in ways that reduce health inequalities. This would reduce the potential of experiencing inequalities for older people who traditionally prefer face-to-face engagement; for people with different levels of literacy; for speakers of English as a second language; and for people with sensory impairments. This would help to embed the principles of ‘Good Conversation’ in the way in which the staff who are managed by the Health and Social Care Partnership work with people and communities, and with each other. The inclusion of and focus on the trauma-informed and inequalities- Page 139 of 316
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10 Changes What difference this will make informed elements of the Midway would support a positive impact on people with protected characteristics. Page 140 of 316
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11 Changes What difference this will make Strategic Aim No.2 Consideration to be given to the importance of language, as ‘at home, care at home/closer to home’ and what this means to groups with protected characteristics. This will be addressed within the scope of the IJB Housing Contribution Statement, and the ‘Working with others’ section of the Strategic Plan. Strengthen contribution of storytelling as one of the elements of evidence of improved outcomes, including the use of OutNav, the framework to facilitate contribution analysis approach to outcome evaluation. Highlight the importance of transport as a potential enabler of this strategic aim. This will be addressed within the ‘Working with others’ section of the Strategic Plan. This will support partners to understand any changes required to practice in their areas of responsibility / expertise. (Homelessness and the duty to prevent are covered in Housing Contribution Statement). Evidence from services can be aggregated up to demonstrate the combined improvements, while also supporting equality in planning, as any areas of concern can be investigated at a more granular level. Potential for Partners to work to reduce impact of inequality relating to costs of transport for those living on low incomes in particular. Strategic Aim No.3 Reinforce the potential negative impact on unpaid carers as more care moves closer to home. The majority of unpaid carers are women, and sex is a protected characteristic. Signpost to Carers Strategy Emphasise impact of current limitations to the safe sharing of organisational information. Better recognition of the challenges, and increased support for carers could reduce the impact often experienced by women when they take on carer roles – limited employability options, poor health and increased risk of poverty. Creating the conditions for safe sharing of organisational information will effectively connect separate systems. This will increase our ability to describe the prevalence and impact of living with multiple barriers to health and care services. In turn, this could inform more holistic and Page 141 of 316
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12 Changes What difference this will make person-centred approaches to design and delivery of health and care services. Additional Recommendations Review the Carers Strategy in line with the new Strategic Plan Ensure that the current needs of carers are reflected in the Carers Strategy and the action plan is supported by the ambitions of the IJB. This is anticipated to improve the experience for Carers and ensure the board is more aware of where there remains work to do. Sharing with decision-makers Guidance page 26 This ECRIA, proposed changes and mitigations will be shared with all members of SPG for final review and agreement. When satisfied that all actions have been undertaken of planned for delivery, the Chair of SPG will recommend this ECRIA to Midlothian IJB. Page 142 of 316
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13 Monitoring the impact Guidance page 27 What information will you start or continue to collect and report on? What impact are you measuring It was recognised in the discussion that the responsibility for evaluating plans and data scrutiny sit with SPG, and that should include a focus on equality impacts. It was noted that this should be highlighted as part of the monitoring section. The Core Suite of Integration Indicators are published annually and provide evidence of progress towards the 9 National Health and Wellbeing Outcomes. Health Inequalities Health & social care services contribute to reducing health inequalities. Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Where possible, activity data will be disaggregated by age, sex and postcode. The data we hold in relation to ethnicity is not sufficiently consistent to be reliable, due to challenges around disclosure and recording in the electronic systems. To demonstrate equitable service provision in relation to people with protected characteristics, and those experiencing the impact of economic deprivation where they live. Page 143 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 14 Impact on equality & socio-economic disadvantage Guidance pages 16-22 Negative impacts Using the evidence you have collected, explain if your proposal could be discriminatory and/ or put a group of people sharing one of these characteristics at a disadvantage for a reason connected to that characteristic. Note – answer yes/ no and if yes provide brief reasons. Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? People in different age groups No Yes – Midlothian has the highest birth rate in Scotland, and a significant projected increase in 75+ population. This creates the potential for the need for support to exceed service ability to provide for these age groups. Disabled people No Yes - Midlothian has a higher prevalence rate of adults with a Learning Disability known to Social Care (6.3 per 1,000) in comparison to the Scottish average (5.2 per 1,000). This creates the potential for the need for support to exceed service ability to provide. The methods we use to provide information need to take into consideration the different needs of people with learning/intellectual disabilities. Practical barriers to accessing information online include lack of internet access, restrictive support hours, and lack of privacy, Page 144 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 15 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? which can be compounded by overprotective and discriminatory attitudes Trans and non-binary people No None specific People who are pregnant or on maternity leave No None specific People from different ethnic backgrounds No Yes - the 2022 census shows that the majority of people in Midlothian identify as “White Scottish”, 82.4%. or “White Other British”, 7.8%. Whilst those identifying as a from “minority ethnic background” represent 9.8%. This creates the potential for the needs of people from different ethnic backgrounds to be overlooked in planning and designing services. People with religious or protected beliefs No None specific Page 145 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 16 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? Men and women [This may include carers, because many are women.] No Yes - in 2022, there were more females (51.7%) than males (48.3%) living in Midlothian. The ambition to move care ‘closer to home’ has the potential to increase the reliance on unpaid carers, the majority of whom are women. People who are heterosexual, lesbian, gay or bisexual No None specific People who are married or in a civil partnership [only in employment situations] No None specific Care experienced people NOTE - there is no legal protection from discrimination on basis of care experience. None specific People experiencing health inequalities caused by socio- economic disadvantage [This may include people living in different or difficult circumstances such as people experiencing homelessness, who are in prison or NOTE - there is no legal protection from discrimination on basis of socio-economic disadvantage. Yes – health inequalities caused by socio-economic disadvantage have the potential to be increased by a lack of accessible information in relation to health and wellbeing. Midlothian’s rapidly expanding population is likely to drive a shift in the overall demographic and SIMD Page 146 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 17 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? are ex-offenders, people with addictions and people involved with prostitution. Note – travel costs have a particular impact on people experiencing poverty.] profile, potentially masking any increase in health inequalities. People experiencing employment inequalities caused by socio-economic disadvantage [This may include people living in different or difficult circumstances, such as people experiencing homelessness, who are in prison or ex-offenders, people with addictions, ex-service personnel/veterans and people involved with prostitution. Note – travel costs have a particular impact on people experiencing poverty.] NOTE - there is no legal protection from discrimination in employment on basis of socio-economic disadvantage. None specific. Carers NOTE - there is no legal protection from discrimination on basis of caring responsibilities. Women continue to have the majority of caring responsibilities and can be put at a particular disadvantage in connection Yes - in 2022, there were more females (51.7%) than males (48.3%) living in Midlothian. The ambition to move care ‘closer to home’ has the potential to increase the reliance on unpaid carers, the majority of whom are women. Page 147 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 18 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? with this. This may be unlawful indirect sex discrimination. Whilst there is no legal protection from discrimination on basis of caring responsibilities, or economic deprivation, there is a need to be mindful of the potential for indirect discrimination in relation to women. Across Scotland the largest proportion of households with a carer (28%) are in the 20% most deprived data zones in the Scottish Index of Multiple Deprivation. In the 2021 VOCAL Carers survey, 79% of respondents in Midlothian agreed that being a carer has affected their mental health, with 38% strongly agreeing. This is an increase on the 2017 survey where 55% agreed with the statement “being a carer has made my health worse” (VOCAL, Midlothian Carer Survey 2021) Intensive caring can result in carers being more likely to experience ill-health than non-carers: 64% agreed that being a carer affected their physical health. The survey demonstrated that respondents have experienced barriers accessing care for themselves due to caring responsibilities, 49% of respondents Page 148 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 19 Relevant group Could your work result in unlawful discrimination? Could your work put people at a disadvantage/ make their lives worse? have experiences at least one barrier to accessing care for themselves. In the 2021 survey, 51% of carers agreed they felt isolated from family and friends, which is an increase from 42% in 2017, the pandemic could have impacted on this response. Page 149 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 20 Positive impact Using the evidence you have collected, explain if and how your proposal could have a positive impact on reducing inequalities experienced by groups of people sharing these characteristics. Note – answer yes/ no and if yes provide brief reasons. Relevant group Can your work advance equality of opportunity? [reduce disadvantage, meet needs, increase participation] Can your work foster good relations? [reduce prejudice + increase tolerance] People in different age groups Yes Yes – the ambition to create integrated datasets could create the insight required to inform pathway redesign for older people. Disabled people Yes Yes - the ambition to create integrated datasets could inform more accurate modelling and projections of future need in relation to children transferring to adult services when they turn 18. Trans and non-binary people None specific None specific People who are pregnant or on maternity leave None specific None specific Page 150 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 21 Relevant group Can your work advance equality of opportunity? [reduce disadvantage, meet needs, increase participation] Can your work foster good relations? [reduce prejudice + increase tolerance] People from different ethnic backgrounds Yes Yes – the aim is to provide differing formats of information, as well as giving consideration to different cultural / religious practices to minimise any negative impact. People with religious or protected beliefs None specific None specific Men or women [This may include carers, because many are women] Yes Yes People who are heterosexual, lesbian, gay or bisexual None specific None specific Care experienced people None specific None specific People who experience health inequalities caused by socio-economic disadvantage Yes Yes – providing care and support closer to home reduces the need to travel, the cost of which creates additional barriers for those already experiencing health inequalities caused by socio-economic disadvantage. Page 151 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 22 Relevant group Can your work advance equality of opportunity? [reduce disadvantage, meet needs, increase participation] Can your work foster good relations? [reduce prejudice + increase tolerance] [This may include people in different or difficult circumstances, such as people experiencing homelessness, who are in prison or ex-offenders, people with addictions and people involved with prostitution. Note – travel costs have a particular impact on people experiencing poverty.] People who experience employment inequalities caused by socio-economic disadvantage. [This may include people in different or difficult circumstances, such as people experiencing homelessness, who are in prison or ex-offenders, people with addictions, ex- service personnel/veterans and people involved with prostitution. Note – travel costs have a particular impact on people experiencing poverty.] None specific None specific Page 152 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 23 Relevant group Can your work advance equality of opportunity? [reduce disadvantage, meet needs, increase participation] Can your work foster good relations? [reduce prejudice + increase tolerance] Carers Yes Yes – the majority of unpaid carers are women who, as a result of their carer responsibilities, face reduced life chances, including employability. Working with our commissioned services for carers, the third and voluntary sectors to increase the profile of, and support for, unpaid carers will ensure that they have a voice in planning and making decisions relating to the support provided to the cared-for person. Page 153 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 24 Impact on UNCRC rights Guidance pages 23-25 If your proposal does not affect children and young people do not complete this section. If your proposal affects children and young people up to age 18, use the evidence you have collected to explain how your proposal could impact Children’s Rights. Not all UNCRC rights may apply to your proposal. If this is the case, simply say ‘Neutral.’ UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted 1 – we must make sure everyone under 18 years old can enjoy all UNCRC rights Neutral 2 – we must make sure all UNCRC rights apply to every child without discrimination. Neutral 3 – we must make sure the best interests of the child are a top priority in all decisions and actions that affect the child. Yes Health Visiting and Preschool immunisations are delegated. These services provide support to families with very young children, and promote prevention and early intervention. Vaccination activity data indicate high levels of equity. Children aged 0-2. Preschool children. Page 154 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 25 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted 4 - we must create systems that promote and protect UNCRC rights. Neutral 5 – we must respect the rights and responsibilities of parents and carers to provide guidance and direction to their child as they grow up, recognising the child’s capacity to make their own choices. Neutral 6 – we must do everything we can to ensure that children survive and develop to their full potential. Yes Health Visiting and Preschool immunisations are delegated. These services provide support to families with very young children, and promote prevention and early intervention. Children aged 0-2. Preschool children. 7 – we must respect the right to be registered at birth, to have a name and nationality and as far as possible for children to know and be cared for by their parents. Neutral 8 – we must respect and protect children’s right to an identity and prevent a child’s name, nationality or family relationships from being changed unlawfully. Neutral Page 155 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 26 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted 9 – we must not separate children from their parents against their will unless it is in their best interests and uphold the right to stay in contact with both parents, unless this could cause them harm. Neutral 10 – we must respond quickly and sympathetically if a child or their parents apply to live together in the same country. The right to visit and keep in contact with both parents if they live in different countries. Neutral 11 – we must do everything we can to stop children being taken out of their own country illegally by their parents or other relatives, or being prevented from returning home. Neutral 12 – we must respect the right for children to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. Neutral 13 – we must make sure every child is free to express their thoughts and opinions and to access all kinds of Neutral Page 156 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 27 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted information, as long as it is within the law. 14 – we must respect children’s right to think and believe what they choose and also to practise their religion as long as they are not stopping other people from their rights. We must respect the rights and responsibilities of parents to guide their child as they grow up. Neutral 15 – we must respect the right to meet with other children and join groups and organisations as long as this does not stop other people from enjoying their rights. Neutral 16 – we must respect the right to privacy and protecting the child’s private, family and home life, including protecting children from unlawful attacks that harm their reputation. Neutral 17 – we must ensure children have access to reliable information from a variety of sources, and help to protect children from materials that could harm them. Neutral Page 157 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 28 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted 18 – we must support parents by creating support services for children and giving parents the help they need to raise their children. Yes Health Visiting and Preschool immunisations are delegated. These services provide support to families with very young children, and promote prevention and early intervention. Children aged 0-2. Preschool children. 19 – we must do everything we can to protect children from all forms of violence, abuse, neglect and bad treatment by their parents or anyone else who looks after them. Neutral 20 – we must give children who cannot be looked after by their immediate family special protection and assistance, that is continuous and respects their culture, language and religion. Neutral 21 – the process of adoption must be safe, lawful and prioritises children’s best interests. Neutral 22 – if a child is seeking refuge or has refugee status, we must provide them with appropriate protection and assistance (within our remit/ functions) to help them enjoy UNCRC rights. Neutral Page 158 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 29 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted 23 – we must do all we can to support disabled children and their families to enjoy their right to live a full and decent life with dignity and as far as possible independence and to play an active part in the community. Neutral 24 – we must provide good quality health care and education on health and well-being so that children can stay healthy. Yes Health Visiting and Preschool immunisations are delegated. These services provide support to families with very young children, and promote prevention and early intervention. Children aged 0-2. Preschool children. 25 – we must make sure children who have been placed away from home for the purpose of care or protection (e.g. in hospital) can have a regular review of their treatment, the way they are cared for and their wider circumstances. Neutral 26 – Governments must provide social security, including financial support and other benefits to families in need of assistance. Neutral 27 – we must help families (within our remit, functions) who cannot afford to, to provide their child with a standard of living that is good enough to meet their Neutral Page 159 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 30 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted physical and social needs and support their development. 28 – every child has the right to an education and discipline in schools must respect children’s dignity and their rights. Neutral 29 – education must develop every child’s personality, talents and abilities to the full and encourage child’s respect for human rights, as well as respect for their parents, their own and other cultures and the environment. Neutral 30 – we must respect that every child has the right to learn and use their language, customs and religion of their family, whether or not these are shared by the majority of the people in the country where they live. Neutral 31 – we must respect the right of every child to relax, play and take part in a wide range of cultural and artistic activities. Neutral Page 160 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 31 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted 32 – we must protect children from economic exploitation and work that is dangerous or might harm their health, development or education. Neutral 33 – we must protect children from the illegal use of drugs and from being involved in the production or distribution of drugs. Neutral 34 – we must protect children from all forms of sexual abuse and exploitation. Neutral 35 – we must protect children from being abducted, sold or moved illegally to a different place in or outside their country for the purpose of exploitation. Neutral 36 – we must protect children from all other forms of exploitation (e.g. by the media, or for medical research) Neutral 37 – we must not torture or cause suffering or other cruel or degrading treatment or punishment. Children should be detained only as a last resort and for the shortest time possible. They Neutral Page 161 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 32 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted must be treated with respect and care and be able to keep in contact with their family. 38 – we must do everything we can to protect and care for children affected by war and armed conflicts. Neutral 39 – we must provide special support to help children who have experienced neglect, abuse, exploitation, torture or who are victims of war to recover their health, dignity, self-respect and social life. Neutral 40 – we must treat a child accused or guilty of breaking the law with dignity and respect. Neutral 41 – we must comply with national laws and standards that go further than UNCRC rights. Neutral Page 162 of 316
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Equality. Fairer Scotland. Children’s Rights. Impact Assessment Report 33 UNCRC right Is your work compatible with this right? How will your work progress this right? Are any groups of children particularly impacted 42 – we must actively work to make sure children and adults know about UNCRC. Neutral Page 163 of 316
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Midlothian Integration Joint Board Thursday, 20th February 2024, 14:00-16:00 Finance Update: 2024/25 and 2025/26 Executive summary The purpose of this paper is to update members on the 2024/25 financial position and propose Financial Recovery Actions for 2024/25 and 2025/26 in the context of Midlothian Health and Social Care Partnership’s ongoing transformation plans and operational delivery. Despite approving a balanced budget with cost-reduction measures, and subsequently delivering over £6 million in savings, the forecasted IJB year-end position for 2024/25 remains an £8.4 million overspend (5% of budget). This is primarily driven by pressures in Adult Social Care and prescribing costs within Core Health Services, exacerbated by rising demand, complexity, inflation, and constrained funding. With no general reserves available, discussions with Midlothian Council and NHS Lothian are ongoing to determine year-end financial management strategies. The updated 2025/26 financial plan projects an opening funding gap of £13.2 million, reflecting revised assumptions, the absence of financial recovery actions, pending budget offers from partners, and the unaccounted impact of National Insurance changes. Given the scale of the challenge, and the requirement for the IJB to live within the resources available, a significant recovery programme will be required. To mitigate financial pressures, two key recovery actions have been identified: a review of Carers funding and reductions in Commissioned Services. The proposal is that Carers funding will be redesigned within the existing £1.44 million recurring allocation, with £0.2 million in programme slippage used to help offset financial pressures in 2024/25. For Commissioned Services, a 5% reduction (£1.4 million in potential savings) is proposed for 2025/26, following a delayed implementation of the planned 3% reduction in 2024/25 due to further risk assessment and collaboration. However, contractual lead times may limit the ability to achieve full-year savings. Work is underway to develop both short-term cost-saving measures and long-term transformation initiatives, with detailed options to be presented at the March IJB Special Board meeting. Members are asked to: • Note the delivery of financial recovery actions in 2024/25. • Note the projected out-turn position for 2024/25. • Note the indicative 2025/26 financial position. Item number: 5.8 Page 165 of 316
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Midlothian Integration Joint Board • Consider the risks laid out in Section 8 • Support the short- and medium-term actions described to manage the financial challenges. • Approve the progression of discussion with providers to achieve a 5% reduction in volume or rates. Page 166 of 316
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Midlothian Integration Joint Board Report Finance Update: 2024/25 and 2025/26 1 Purpose 1.1 The purpose of this paper is to update members on the 2024/25 financial position and propose Financial Recovery Actions for 2024/25 and 2025/26 in the context of Midlothian Health and Social Care Partnership’s ongoing transformation plans and operational delivery. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the delivery of financial recovery actions in 2024/25. • Note the projected out-turn position for 2024/25. • Note the indicative 2025/26 financial position. • Consider the risks laid out in Section 8 • Support the short- and medium-term actions described to manage the financial challenges. • Approve the progression of discussion with providers to achieve a 5% reduction in volume or rates. 3 Background and main report 3.1 2024/25 IJB Financial Position This report outlines the financial performance including the forecast outturn for the IJB in 2024/25. This has been informed by nine months of financial data up to the end of December 2024. Reporting on the performance of delegated resources aligns with the IJB’s financial regulations and Midlothian Integration Scheme. 3.2 On 21st March 2024, Midlothian IJB approved a balanced budget for 2024/25, based on a suite of cost reduction actions. Significant progress has been made against the identified actions – a summary of the progress is shown in the table below. Table 1 - 2024/25 Recovery Progress Target Forecast Delivery Progress £’000 £'000 % Grip & Control 3,009 2,600 86% Efficiency & Redesign 2,109 1,472 70% Choices 3,875 2,374 61% Total 8,993 6,446 72% Page 167 of 316
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Midlothian Integration Joint Board 3.3 The forecast projected presented to Midlothian IJB on 19th December 2024 was an £8.4 million overspend by year-end. Despite ongoing efforts to improve the financial position, quarter 3 financial forecast modelling by Midlothian Council and NHS Lothian indicates the forecast position has remained static at an overspend of £8.4 million. This is equivalent to 5% of Midlothian IJB’s budget. 3.4 The financial environment remains highly challenging, with high inflation, constrained funding, and increasing demand placing significant pressure on the delivery of health and social care services within the available budget. 3.5 The table below reflects the 2024/25 year-end forecast outturn against budget: Table 2 - 2024/25 Forecast Outturn Budget Forecast Variance £’000 £'000 £'000 Adult Social Care Services 63,843 69,543 (5,700) Core Health Services 80,136 82,615 (2,479) Share of Pan Lothian Hosted Services 15,882 15,730 151 Share of Acute Set Aside Services 19,241 19,570 (329) Total 179,102 187,458 (8,357) 3.6 The key cost drivers of the financial position are: • Adult Social Care: The Resource Panel, which oversees both care at home and residential placements, is now projected to be £5.27 million overspent. This represents a deterioration of £0.92 million since the last forecast. This movement is primarily due to the approval of additional necessary care requests which are thoroughly assessed against the eligibility criteria. The Resource Panel remains the largest area of overspend, driven by increasing demand, rising costs, and the growing complexity of care provision within commissioned adult services. • Core Health Services: The prescribing budget is now forecast to be overspent by £2.32m at the end of the year. Prescribing volumes are now anticipated to be growing at 5.1% whereas it was previously assumed that growth would be 3.1%, and average prices are falling by only 0.4% rather than the predicted 3.8% fall. 3.7 It remains evident from these projections that delivering Health and Social Care services within the available budget continues to be extremely challenging due to persistent financial pressures and rising demand. 3.8 In the current financial year 2024/25, it is unlikely that the IJB will achieve a break- even position. With no general reserves available to offset the projected overspend, the Midlothian Integration Scheme set out that any residual shortfall will revert to the appropriate Partner. Discussions with Partners are ongoing to determine the approach to year-end financial management. 3.9 2025/26 IJB Financial Position The finance update presented to Midlothian IJB on 24th October 2024 included a draft of the Medium-Term Financial Plan which projected an opening gap of £11.3 million in 2025/26 before any recovery plans. This projection has now been updated, with key assumptions revised. Most notably, the Social Care baseline pressure has increased from £4 million to £5.2 million. This movement is driven by the deterioration in the 2024/25 projections. The revised financial plan shows a gap of £13.2m. Detail is shown in the table below: Page 168 of 316
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Midlothian Integration Joint Board Table 3 - 2025/26 Financial Plan Position £’000 Adult Social Care Services (7,216) Core Health Services (4,150) Share of Pan Lothian Hosted Services (337) Share of Acute Set Aside Services (1,477) Total (13,180) 3.10 The initial financial plan is based on several key assumptions: • Current projections do not include any financial recovery actions. • Formal budget offers have not yet been received from Partners. • The potential impact of National Insurance changes is not factored into the projections. 3.11 Both partners are still refining their local assumptions for financial planning. This, combined with external uncertainties such as Scottish Government budget offers and National Insurance changes, means the financial projections remain fluid and subject to change. However, initial modelling makes it clear that a significant recovery programme will be required to achieve financial balance in 2025/26 and beyond. 3.12 On this basis, work is underway to develop a range of options for consideration. These will include both short-term measures and longer-term transformation initiatives to ensure Midlothian IJB remains both financially and operationally sustainable. A detailed presentation of these options will be provided at the March IJB Special Board meeting. 3.13 Recovery Action and Response to Financial Challenge Given the scale of the financial challenge facing the IJB, two immediate plans have been identified to help mitigate the financial position: • Review of Carers Funding • Review of Commissioned Services 3.14 Carers Funding: In the 2023/24 financial year, the IJB utilised earmarked reserves for carers to achieve a break-even position. This funding was originally planned for future years to supplement the recurring carers allocation, which stands at £1.44 million. However, given the current financial challenges, this approach is no longer viable. Midlothian IJB does not have the capacity to reinstate the non-recurring funding previously used. 3.15 Therefore, the proposal is to redesign spending plans to align with the recurring resource available. This funding will remain ring-fenced and will not be subject to future reductions. Additionally, due to the impact of the projected overspend on Partners, in this case primarily Midlothian Council, it is proposed that any in-year programme slippage be used to help offset the financial position. Current estimates suggest this could amount to approximately £0.2 million. 3.16 Commissioned Services: As part of the 2024/25 budget-setting process, the IJB approved a financial recovery action to implement a 3% reduction across all commissioned services. Following approval, additional work was undertaken to assess the feasibility and impact of this reduction on providers, ensuring that risks were identified and Page 169 of 316
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Midlothian Integration Joint Board mitigated where possible. However, due to the further testing and collaboration required, no funding reductions were implemented in 2024/25. 3.17 For 2025/26, the revised proposal is to reduce commissioned spend by 5% in either volume or rate. Approximately £28 million in contracts are within scope, equating to a maximum potential reduction of £1.4 million. However, it is acknowledged that achieving the full-year effect of these cost reductions may not be possible due to contractual lead times. 3.18 As previously presented to the IJB, this approach carries inherent risks, particularly given the volume and complexity of contracts. However, given the scale and urgency of the financial challenge, it is deemed necessary. If supported by the IJB, officers will proceed with planning and provider engagement, ensuring clear communication throughout. A full options appraisal, outlining the preferred approach, will be presented at the development session on the 27th of February. 4 Policy Implications 4.1 This report does not have any direct impact on policy. However, decisions taken by the Board will impact on the viable content of IJB Strategic Plan 2025/35 and this is likely to impact on a number of operational policies. 5 Directions 5.1 The content of this report does not have any direct impact on existing Directions. However, decisions taken by the board in relation to Financial Recovery Planning must be set out in a Direction to Partners. 5.2 It is proposed that any implications for Directions 2025/26 are considered by the Integration Manager and brought for review to a development session for Board members on 27th February 2025. Following any amendments, a second draft of Directions for 2025/26 will be presented to the Board at the Special Board Meeting on 13th March 2025. 6 Equalities Implications 6.1 An Equalities and Childrens Rights Impact Assessment (ECRIA) Screening Tool has been submitted with this paper. This report does not have any direct impact on equalities, but highlights the decision required as a consequence of this paper will require further investigation and the completion of an ECRIA a part of early operational planning. 6.2 All new or revised strategies, plans, provisions, or activities that include significant change require a full ECRIA to be completed as early as possible in the development stage to assess the impact of propositions on people, or groups of people, with protected characteristics. A range of ECRIAs will be required to inform and enable the development of system wide Financial Recovery Planning, transformation, and change. Page 170 of 316
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Midlothian Integration Joint Board 7 Resource Implications 7.1 The financial implications of this report are laid out above. 8 Risk 8.1 Full budget offers from partners are currently unknown. 8.2 The impact of the UK Government’s increase in the National Insurance contributions for employees needs to be fully evaluated. This information will not be complete until after the start of the next financial year. 8.3 The impact of demography and increased dependency especially on the Social Care budget is significant and expressed through the overspend in both 2023/24 and 2024/25. Whether the level of resources to support social care is adequate should be considered. 8.4 In addition to the financial challenges, the scale of Financial Recovery Planning poses significant risks for Midlothian IJB in relation to its ability to achieve the ambitions of its Strategic Plan and deliver statutory care and support. 8.5 This will not only slow or stop progress towards the nine National Health and Wellbeing Outcomes for people and communities, but also risks a devastating impact on Third and Independent Sector partners and providers, and risks reversing the population health gains made in recent years. It is likely that the impact of the financial gap and actions required to achieve a balanced budget will result in a multigenerational deterioration in population health and result in avoidable harm. 8.6 A review of Midlothian IJB’s risk register will be undertaken as part of the 6th March 2025 Audit and Risk Committee before review in the 24th April 2025 IJB meeting. 9 Involving people 9.1 This report has been written following consultation our NHS Lothian and Midlothian Council financial Partners, officers of Midlothian IJB, and with the Midlothian HSCP executive management team. 10 Background Papers 10.1 There are no background papers AUTHOR’S NAME & DESIGNATION Chris King, Chief Finance Officer CONTACT INFO Via email or MS Teams DATE 10/02/2025 Appendices: none Page 171 of 316
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Midlothian Integration Joint Board Midlothian Integration Joint Board Thursday, 20th February 2025, 14.00 – 16.00 Midlothian IJB Integrated Workforce Plan 2025/28 and ‘Annexe A’ Item number: 5.9 Executive summary This report presents the draft Midlothian IJB Integrated Workforce Plan 2025/28 (appendix 1) and ‘Annexe A’ (appendix 2) for submission to Scottish Government. Scottish Government previously provided guidance on the completion of Three-Year Workforce Plans, for submission by 01 June 2025, and for publication on organisations’ public websites by 31 October 2025. On 24th September 2024, the Midlothian Integrated Workforce Governance Board agreed that, in light of no specialist resource to support this work, the Integration Manager would lead a refresh of the 2022/25 Workforce Plan with Midlothian HSCP Executive Leadership Team support. On 17th December 2024, Scottish Government issued a letter to Chief Officers with a reduced ask for submission by 17th March 2025. Scottish Government have indicated they require the submission of an ‘Annexe A’ document to assist with the rapid assessment and review of workforce planning issues. However, to complete the original Scottish Government ask the plan was largely updated, and to complete ‘Annexe A’ the majority of the plan content is required. On the 17th December 2024, and in receipt of this information, the Midlothian HSCP Integrated Workforce Board agreed to proceed with the plan and signpost to information using the ‘Annexe A’ template. The Strategic Planning Group reviewed the draft Midlothian IJB Integrated Workforce Plan 2025/28 and ‘Annexe A’ on 16th January 2025 and agreed to recommend both the plan and ‘Annexe A’ to the IJB for approval prior to submission to Scottish Government. The Workforce Plan will not be published at his time, awaiting feedback from Scottish Government. Members are asked to: • Review and approve, subject to required amendments, the draft Integrated Workforce Plan 2025/28 and ‘Annexe A’ are submitted to Scottish Government by the 17th March 2025 deadline. • Give delegated authority to the Integration Manager to submit these documents to Scottish Government . Page 173 of 316
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Midlothian Integration Joint Board Report Midlothian IJB Integrated Workforce Plan 2025/28 and ‘Annexe A’ 1 Purpose 1.1 This report presents the draft Midlothian IJB Integrated Workforce Plan 2025/28 (appendix 1) and ‘Annexe A’ (appendix 2) for submission to Scottish Government. 2 Recommendations 2.1 As result of this report Members are asked to: • Review and approve, subject to required amendments, the draft Integrated Workforce Plan 2025/28 and Annexe A are submitted to Scottish Government by the 17th March deadline. • Give delegated authority to the Integration Manager to submit these documents to Scottish 3 Background and main report 3.1 Scottish Government previously provided guidance on the completion of Three- Year Workforce Plans, for submission by 01 June 2025, and for publication on organisations’ public websites by 31 October 2025. 3.2 This guidance follows the previous Three-Year Workforce Planning Guidance issued in the Directors Letter of April 2022 and the National Workforce Strategy for Health and Care, also published in 2022. 3.3 On 24th September 2024, the Midlothian Integrated Workforce Governance Board agreed that, in light of no specialist resource to support this work, the Integration Manager would lead a refresh of the 2022/25 Workforce Plan with Midlothian HSCP Executive Leadership Team support. 3.4 On 17th December 2024, Scottish Government issued a letter to Chief Officers with a reduced ask for submission by 17th March 2025. Scottish Government have indicated they require the submission of an ‘Annexe A’ document to assist with the rapid assessment and review of workforce planning issues. However, to complete the original Scottish Government ask the plan was largely updated, and to complete ‘Annexe A’ the majority of the plan content is required 3.5 Also on the 17th December 2024, and in receipt of this information, the Midlothian HSCP Integrated Workforce Board agreed to proceed with the plan and signpost to information using the ‘Annexe A’ template. Page 174 of 316
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Midlothian Integration Joint Board 3.6 The Strategic Planning Group reviewed the draft Midlothian IJB Integrated Workforce Plan 2025/28 and ‘Annexe A’ on 16th January 2025 and agreed to recommend both the plan and ‘Annexe A’ to the IJB for approval prior to submission to Scottish Government. The Workforce Plan will not be published at his time, awaiting feedback from Scottish Government 3.7 Midlothian IJB is now requested to review and approve, subject to any required amendments, the draft Midlothian IJB Integrated Workforce Plan 2025/28 and ‘Annexe A’ for submission to Scottish Government by the 17th March 2025deadline. 4 Policy Implications 4.1 This report does not have a direct impact on policy although the workforce planning limitations of Midlothian HSCP may impact of the delivery of key policy ambitions and priorities in the future. 5 Directions 5.1 This report directly related and impacts upon NHS Lothians and Midlothian Councils ability to deliver the following Midlothian IJBs Directions • Direction 8.1 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the integrated Midlothian HSCP Staff Engagement Plan 2023-24. • Direction 8.2 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Workforce Plan 2022-25. 6 Equalities Implications 6.1 This report does not directly adversely impact on groups of people with protected characteristics. 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 Midlothian HSCP staff to support this oversight group. Page 175 of 316
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Midlothian Integration Joint Board 8 Risk 8.1 There is a risk that limited time and resources may result in the Midlothian IJB Integrated Workforce Plan and ‘Annexe A’ not meeting the requirements set out by Scottish Government. This may result in Scottish Government colleagues requesting amendments and additions following submission in March 2025. 9 Involving people 9.1 This Integrated Workforce Plan has been written in collaboration with Midlothian HSCP Executive Leadership Team, strategic planning and Performance and Improvement. Further consultation will be undertaken with Midlothian HSCP Senior Management Team and Midlothian IJB Strategic Planning Group. 10 Background Papers None AUTHOR’S NAME & DESIGNATION Gill Main, Midlothian HSCP Integration Manager CONTACT INFO Via email or MS Teams DATE 03/01/2025 Appendices: Appendix 1: Draft Midlothian IJB Integrated Workforce Plan Appendix 2: Draft Midlothian IJB ‘Annexe A’ Workforce Document Page 176 of 316
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1 Midlothian Integration Joint Board Workforce Plan 2025/28 Page 177 of 316
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2 Contents Contents ....................................................................................................................................................................... 2 Introduction .................................................................................................................................................................. 3 Who we are .................................................................................................................................................................. 4 National Context ........................................................................................................................................................... 5 National Health and Wellbeing Outcomes ............................................................................................................... 5 National Workforce Strategy .................................................................................................................................... 5 The Health and Care (Staffing) (Scotland) Act .......................................................................................................... 6 The National Care Service ......................................................................................................................................... 6 Local Context ................................................................................................................................................................ 7 Integrated Workforce Plan for 2022/25 ................................................................................................................... 7 Challenges ................................................................................................................................................................. 8 Midlothian data ............................................................................................................................................................ 9 Local data and demographics ................................................................................................................................... 9 The Workforce in Midlothian ................................................................................................................................. 10 The Health and Social Care Workforce ................................................................................................................... 11 NHS Lothian Employed Workforce ......................................................................................................................... 15 Medics ................................................................................................................................................................ 18 Nursing ................................................................................................................................................................ 18 Allied Health Professionals ................................................................................................................................. 20 Primary Care ....................................................................................................................................................... 21 Midlothian Council Employed Workforce .............................................................................................................. 23 Mental Health Officer Training ........................................................................................................................... 25 Practice Education .............................................................................................................................................. 25 Social Care .......................................................................................................................................................... 25 Carers ...................................................................................................................................................................... 26 Staff experience ...................................................................................................................................................... 26 Supporting staff wellbeing ...................................................................................................................................... 27 The Midway ............................................................................................................................................................ 27 A Digitally Enabled Workforce ................................................................................................................................ 28 Sustainability, and the Environment ...................................................................................................................... 30 Action Plan .............................................................................................................................................................. 31 Page 178 of 316
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3 Introduction The Scottish Government has requested that all Health and Social Care Partnerships to develop 3-year workforce plans aligned with the key policy commitments set out in the NHS Recovery Plan (2021) together with the projected recovery needs in social care services, in anticipation of the development of the National Care Service. Integration Authorities and Health and Social Care Partnerships do not directly employ any staff. The health and social care workforce in Midlothian are employed through Midlothian Council, NHS Lothian, and organisations in the Independent and Third sector alongside our unpaid carers and volunteers. However, we know that this combined workforce is the single biggest asset available to us in progressing the ambitions of our Strategic Plan and improving outcomes for people and communities. We have been asked to support Midlothian Health and Social Care Partnership to assess upcoming workforce demand and need in a 3-year Integrated Workforce Plan including • the current workforce including a gap analysis to understand workforce demand in relation to service demand, • an assessment of the workforce required to fill any gaps , and • an action plan to progress the ambitions of the Five Pillars of the National Workforce Strategy. Midlothian Health and Social Care Partnership the operation arm of the IJB that manages many of the services delivering our strategic plan. 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. In the development of this plan, we consulted with key stakeholders in a variety of ways surveys e.g., focus groups, and informal feedback. This included discussions with the workforce, Trade Unions, HR Strategy, and Financial leads, Third and Independent Sector representatives, and people who experience our services, their families, and carers. The themes that emerged from our consultation were leadership and management, a nurtured and empowered workforce, training and development, and recruitment and retention. This plan is aligned to our medium-term financial strategy and supports the delivery of our Strategic Plan 2025-2035 to improve outcomes for people and communities. How we work with our partners is outlined in both our Strategic Plan and our Market Facilitation Plan. This plan is also accompanied by an appendix requested by Scottish Government (appendix A). Page 179 of 316
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4 Who we are Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in our Strategic Plan guide how we allocate the money we receive. Page 180 of 316
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5 National Context Like all Integration Authorities in Scotland, our role is to plan and deliver the services that support better health and wellbeing in our communities. National Health and Wellbeing Outcomes We are asked by the Scottish Government to work with our partners to plan across the whole system using the National Health and Wellbeing Outcomes Framework. Evaluating and reporting on what we contribute to the 9 National Health and Wellbeing Outcomes becoming a reality for more people in Midlothian is how Scottish Government measure our performance. National Health and Wellbeing Outcome No.8 relates specifically to the workforce, and No.9 askes us to ensure we are using our resources effectively and efficiently. This of course includes how we are deploying the workforce of our partners. National Workforce Strategy The National Workforce Strategy outlines the vision for the health and social care workforce to be “a sustainable, skilled workforce with attractive career choices and fair work where all are respected and valued for the work they do”. The strategy sets out Five Pillars of the workforce journey to guide development of national and local workforce plans. Support evidence based workforce planning Attract the best staff into health and care employment Support staff through education and training to equip them with the skills to deliver the best quality of care Make health and social care organisations "employers of choice" by ensuring staff are, and feel, valued and rewarded Create a workforce and leadership culture focusing on the health and well-being of staff Page 181 of 316
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6 The Health and Care (Staffing) (Scotland) Act 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. Section 1 of the Act lists the guiding principles for the purposes of staffing for health care and care services are to provide safe and high-quality services, and to ensure the best health care or care outcomes for people using these services. Services overseen by Midlothian HSCP are working with NHS Lothian and Midlothian Council to ensure the duties of the employing partner are being met. The Act also states that where a care service is being planned or secured from another person by a local authority or integration authority, the local authority or integration have a statutory duty to ensure providers also have met the requirements of this legislation. How that is achieved and implemented will be through a range of activities including the procurement processes, contracting, Service Level Agreements (SLAs), or similar arrangements and must also include how arrangements for these services are monitored, reviewed, and terminated. How we do this is set out in our Market Facilitation Plan 2025/28. The National Care Service The introduction of a National Care Service (NCS) will result in specific duties in relation to workforce planning for social care providers. The future of integrated health and social care and our role in a National Care Service is unclear. Plans and are progressing for a National Care Service, but in a new way. Scottish Government have advised us that there will revisions to the National Care Service Bill and that some previously proposed policies will have to be delivered in different ways to originally planned. We do not know how we will be asked to plan and direct care in the future. Scottish Government have advised that this workforce plans should continue to include actions to support a sustainable social care workforce, and that further guidance will be provided as plans for the National Care Service progress. Page 182 of 316
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7 Local Context Integrated Workforce Plan for 2022/25 In 2022 Midlothian Health and Social Care Partnership published its first Integrated Workforce Plan for 2022/25 alongside a staff Communication, Engagement and Experience Delivery Plan. Over the past three years, we have continued to develop our skills in this area and worked with Midlothian Health and Social Care Partnership to develop this Integrated Workforce Plan for 2025/28. This refreshed Integrated Workforce Plan continues to focus on the 5 pillars of workforce planning set by Scottish Government to support recovery, growth and transformation of health and social care and describes how we will plan, attract, train, and support the development of our workforce. As part of our Integrated Workforce Plan 2022/25 and action plan to support workforce planning, we asked Midlothian Health and Social Care Partnership to put in place a workforce governance and assurance structure. This was designed to help plan, develop, and constantly improve how we support our workforce. This included supporting new Workforce Lead post within the Health and Social Care Partnership. A new Integrated Workforce Governance Board was established to support quality planning between our services, NHS Lothian, Midlothian Council, Midlothian Community Planning Partnership, the Third Sector, and other partners. The Board oversees and directs the work of two SubGroups: Workforce Planning and Workforce Engagement. A Workforce Planning SubGroup was tasked with the development, delivery, monitoring and reporting of the Integrated Workforce Plan 2022-25 and supported the Health and Social Care Partnership to increase its skills and capacity in relation to workforce planning. The Workforce Planning Subgroup also supported our understanding of the duties of the Health and Care (Staffing) (Scotland) Act. A Workforce Engagement Subgroup was tasked with the development, delivery, monitoring and reporting of workforce engagement activity, and staff governance and development. This SubGroup was also responsible for the development and delivery of Midlothian Health and Social Care Partnership’s Staff Communication Engagement and Experience Plan, and the measurement and evaluation of the 12 months action plan. Unfortunately, due to the financial challenges we face, we have been unable to continue to afford a Workforce Lead and work in this area has slowed down as a result. The Integrated Workforce Governance Board continues to oversee workforce planning and support activity, but the two SubGroup have paused. Page 183 of 316
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8 Challenges As we look forward in this new Integrated Workforce Plan, there continue to be both challenges and opportunities for change. • Specialist Skills and Resource: We will continue to review our financial position and the potential to identify dedicated resource for a Workforce Planning Lead • A Changing Workforce: There continued to be a reduced availability of staff with appropriate qualifications or skills, including General Practitioners, Social Care Workers, and Registered Nurses. System pressures and the legacy of Covid-19 continues to impact on staff absence and deployment. The workforce of both our Partners is also aging and they are considering ways to attract a new generation of younger employees. • Financial Pressures: Our financial outlook remains uncertain. This has an impact on what we can deliver and limits how we can plan for the future. Annual budget offers from our partners, ring- fenced budgets and continued pressure to make savings all directly impact on workforce capacity. • A Growing and Ageing Population: Midlothian will experience high population growth in the coming years. With approximately 12,000 new houses being built, our communities are changing, and this will increase pressure on all services. • Social Isolation and Loneliness: Recent surveys indicate that loneliness affects a substantial number of people, but it is not evenly distributed across the population. People who are more likely to experience loneliness include those with long-term disabilities or health conditions, people living in deprived areas, LGBTQ+ individuals, and ethnic minorities. Nesta’s 2024 research Investigating the impact of loneliness and social isolation on health | Nesta found strong evidence that loneliness causes depression, comparable to the effects of bereavement and unemployment. Their results provide evidence that loneliness causes an increased risk of multimorbidity, and that loneliness may cause an increased risk of early death. • Living Alone: Those who live alone can experience greater social isolation and the 2022 census showed the number of people living alone in Scotland increased by over 100,000 since 2011. In Midlothian, we know there are 5289 people aged 66 and over who live alone. Older people living alone are 50% more likely to access emergency care services, and 40% more likely to have more than 12 general practice appointments over a 12-month period when compared to older people not living alone. People living alone and over 70 years of age are most likely to need health and social care services. • Local Workforce: Midlothian has relatively low unemployment but, due to our proximity to Edinburgh as well as other local authorities and health boards, the health and social care workforce who live in Midlothian often work in neighbouring areas. • Transformation: We know that the ways we have traditionally delivered health and care services is no longer sustainable and need to see resources move from hospital to community-based services to focus on prevention. Despite this being the ambition in Scotland for nearly 10 years, this has been difficult to achieve and will continue to be challenging in the current financial climate. Page 184 of 316
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9 Midlothian data Local data and demographics Midlothian is one of the smallest local authorities in Scotland yet has one of the highest projected population growth, due to a combination of its extensive house building programme, migration and comparatively high birth rate. The 2023 midyear population estimate was 98,260, an increase of 1.3% from 2022. Over the same period, the population of Scotland increased by 0.8%. Between 2018 and 2028, the population of Midlothian is projected to increase from 91,340 to 103,945. This is an increase of 13.8%, which compares to a projected increase of 1.8% for Scotland as a whole. This is the highest projected percentage increase out of the 32 council areas in Scotland. The increase is made up of a 1.4% increase due to natural change (more births than deaths) and a 12.4% increase in net migration. The total fertility rate in Midlothian decreased from 1.64 in 2022 to 1.52 in 2023. Out of the 32 council areas in Scotland, Midlothian had the joint 4th highest rate in 2023 and this is higher than the rate of 1.3 for Scotland as a whole. The National Records of Scotland demographic profile forecasts: • 11.2% increase in children, • 16.1% increase in those of working age, and • 8.9% increase in those of pension age. The 75 years+ age group is projected to see the largest percentage increase of 40.9% whilst the 25-44 age groups are projected to be the largest overall. The population growth, demographic change, and potential for shift in the economic profile of Midlothian mean we must plan to both expand and redesign our services, ensuring we recruit and retain the corresponding workforce to meet the needs of people and communities. Page 185 of 316
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10 The Workforce in Midlothian In 2023 12.1% of the estimated 30,000 jobs in Midlothian were in the health and social care sector, which was lower than the national average of 16.2%. Midlothian has large education, manufacturing, construction, and retail sectors with high levels of employment. Gross weekly pay for people living in Midlothian has historically been below the Scotland average. In 2023 this gap narrowed significantly, and the data for 2024 show that gross weekly pay for people living in Midlothian now slightly exceeds the Scotland average (Midlothian: £741.3, Scotland: £740). Source: Labour Market Profile - Nomis - Official Census and Labour Market Statistics (nomisweb.co.uk) The most recent data show that 62.3% of the Midlothian population are of working age (n=59,600). Of these 85.5% are economically active, which is well above the Scottish average of 77.3%. It is estimated that 2.5% of the economically active population are unemployed (Circa 1,200) which is below the national average of 3.5%. 2.4 2.1 12.1 12.1 6.8 5.3 9.1 1.2 0.9 1.5 6.8 2.4 18.2 9.1 0.9 7.6 1.7 2.8 16.2 16.2 6.5 7 7.3 1.4 3.3 3.2 8.8 4.6 13.3 5.1 0.8 7 0 2 4 6 8 10 12 14 16 18 20 %of people employed in sector Employment Sector Percentage of people employed by sector Proportion of Employee Jobs by Sector 2023 Midlothian Proportion of Employee Jobs by Sector 2023 Scotland Page 186 of 316
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11 14.5% (Circa 8,200) of the population aged 16-64 are categorised as economically inactive (e.g., students, people looking after family/home, those with long term illness, people who have retired etc.). Of these it is estimated that 84.5% do not want a job, however the sample size is too small to accurately estimate how many would like to return to work. The Midlothian Local Development Plan outlines the ambitious house building programme which will result in an estimated increase in population of 31,000. This will require an expansion of health and social care provision, and may create a shift in the economic profile of the area, in relation to the classification of areas of economic deprivation. Capital funding for the proposed health and social care centre of excellence at Shawfair has been put on hold. Attracting and retaining a skilled health and care workforce to Midlothian also means ensuring housing availability. Midlothian is now the 5th most expensive local authority in Scotland by property value, and since the 2011 census, had the biggest percentage increase in households living in detached houses, up 44.9% (n=3,100). The average price as of August 2024 in Midlothian for a detached property was £458,000. Based on analysis of current vacancies, the average salary for a healthcare support worker in Scotland is approx. £17,148, and for social care it is approx. £22,493. Affordability of local housing may present a barrier to recruitment. The Health and Social Care Workforce As the partners who employ the workforce, Midlothian Council and NHS Lothian each have Workforce Plans. Our partners have taken very different approaches to workforce planning, and we have been mindful of this in preparing this integrated plan. Providing an integrated analysis of the workforce in the partnership is challenging as there is limited information on terms and conditions and different systems are used to collect data. We have used data from NHS Tableau, Midlothian Council and the SSSC workforce data (December 2023). Because we cannot provide insights based on integrated data, the information provided in this section describes only the integrated data we can reliably combine. More detailed workforce data relating to both the NHS Lothian and Midlothian Council employed workforce can be found in the ‘Health’ and ‘Social Care’ sections below The HSCP has approximately 1,360 staff (headcount) with 62% employed through NHS Lothian and 38% employed through Midlothian Council. Since the publication of our last Workforce Plan, the percentage of staff employed through NHS Lothian has increased by 7 percentage points. In addition, the HSCP commission independent and voluntary sector organisations to provide care at home and in care homes with a combined workforce of around 1,460 (headcount). The independent and voluntary sectors account for 52% of the overall health and social care workforce within Midlothian. The number of people employed by NHS Lothian and Midlothian Council in services delegated to the HSCP has grown overall by 2.2% (which is equivalent to an increase of approximately 30 members of staff), while the number of people employed in the independent and voluntary sectors has reduced by 4.6% (which is equivalent to a reduction of approximately 70 staff). This means that since the publication of our last Workforce Plan, there are now approximately 40 fewer staff employed in the overall health and social care workforce within Midlothian. Page 187 of 316
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12 The age profile of the combined workforce indicates that only 6% are under 25 with the majority of these employed within the private sector. 45% of the workforce are over age 45 and 25% are over age 55. Succession planning for those approaching retirement, as well as those who may ‘retire and return’ is vital, and we must attract young people leaving school and those changing career into health and social care roles. 34 18 17 30 0 5 10 15 20 25 30 35 40 Private NHS Lothian Midlothian Council Voluntary % Employer Midlothian Health and Social Care Workforce by Employer Page 188 of 316
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13 15% of the combined workforce is male and 85% is female. This proportion has varied by less than one percentage point since the publication of our last workforce plan. The National Workforce Strategy sets out in a commitment to increase the NHS Workforce by 1% 2022- 2026 to support the NHS Recovery Plan. The Scottish Government’s Medium Term Financial Framework (MTFF) previously estimated that to address increasing demand, the workforce would need to grow by 1.3% per annum more NHS employees and 1.7% per annum more social care employees in the period to 2024. Up to October 2024 the data show that the percentage of staff employed through NHS Lothian has increased by 7 percentage points, which means that the percentage of staff employed through Midlothian Council has reduced by the same number. Overall, the combined HSCP workforce has grown by 2.2% (which is equivalent to an increase of approximately 30 members of staff). We will undertake work over the coming months to establish the annual growth assumptions in Midlothian to inform the medium-term workforce ambitions of this plan. However, determining this for integrated services is difficult as Midlothian Council do not routinely report on Establishment and Establishment Gap. 5 76 98 135 169 29 90 190 180 160 150 50 30 20 40 20 10 18 209 233 187 186 12 0 100 200 300 400 500 600 <25 years 25-34 years 35-44 years 45-54 years 55-64 years 65+ years NUMBER OF STAFF AGE GROUP AGE PROFILE OF HEALTH AND SOCIAL CARE WORKFORCE Council Private Voluntary NHS Page 189 of 316
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14 Absence management is an increasing area of focus and further details can be found in the sections below for each of our employing Partners. As a Directorate of both NHS Lothian and Midlothian Council, the Health and Social Care Partnership is supporting both Partners ambitions to better understand and reduce absences. A focus on areas with particularly high absences has revealed that as the overall combined establishment within the Health and Social Care Partnership has reduced, the combined absence rate has increased. Staff chose to leave employment for a range of reasons and our Partners have different mechanism for evaluating this. This information is not routinely provided from our Partners. However, we know that exit interviews are a vital tool to help us to understand the underlying reasons why a member of our team chooses to leave. There is no integrated mechanism to capture this data, but we know identify trends related to workload, leadership, career progression and culture would be useful to help us develop targeted plans for improvement, improve staff wellbeing and enhance our culture. The financial challenges across the public sector mean we our financial recovery plans are likely to impact on the Establishment of staff working within Midlothian Health and Social Care Partnership. Of course, any reduction in posts is challenging, particularly in the context of growing demand. To help manage any change staffing numbers and avoid a disinvestment in the wrong parts of the system, in 2024 we introduced a vacancy panel to review all vacancies and ensure we were considering the risk of recruitment alongside the risks of not recruiting. The Midlothian Health and Social Care Partnership recruitment panel is led by the Joint Director and supported by finance leads, Partnership, and Trade Union representation from health and social care. The vacancy panel was formed to provide assurance on all workforce-related decisions and support financial recovery and redesign where required. It has since become a key platform for reviewing local service proposals, ensuring the strategic alignment of workforce decisions, and fostering continuous improvement and innovation in workforce profiles, roles, and required skillsets. However, the requirement to make efficiency savings across the system does not take in consideration the increasing service demand. As part of our work to better understand our changing population size, a changing needs profile, and to improve workforce planning and forecasting, we have started testing real-time workforce tools that consider service capacity, service demand, and variation across time. We will continue to develop this work in the absence of nationally validated tools for all professionals or areas of practice subject to the duties of the Health and Care (Staffing) (Scotland) Act. We know the needs of the workforce are changing and dependent on many new factors. As we transform our services, our focus is increasingly on collaboration with partners from all sectors to ensure we have a workforce fit for the future and with people at the heart of everything we do. The redesign of health and social care in Midlothian through our transformation programme presents opportunities to review skill mix and maximise our ambition to integrate health and social care data. We will design an approach to develop workforce modelling data as we develop our skills and capabilities in this area We have established a leadership programme to support the development of leadership behaviours across the organisation and to support staff to develop and grow. This has also included some practical support like information sessions about the organisation’s ambitions, and support and guidance for everyone to be an effective leader regardless of their role. Page 190 of 316
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15 Part of our workforce planning involves supporting more opportunities for practice placements and exploring apprenticeship roles with guaranteed employment. We regularly utilise social media platforms to advertise vacancies and have worked alongside our Local Employability Partnership to develop an action plan to support ore people into meaningful work. This is now a central part of our work to improve recruitment and retention. We also recognise that a sustainable workforce plan requires us to engage with a range of programmes that encourage people to follow a career in health and social care. These include: • Foundation apprenticeships for those aged 16-18 still in education • Modern apprenticeships for health & social care staff to gain recognised qualifications • Introduction to Health & Social Care Adult Learning Courses • Young Person's Guarantee Programme • No One Left Behind Offer for people of all ages to gain skills & confidence for employment, training & education • Developing the Young Workforce through promoting Health and Social Care Careers in schools • Working with DWP to promote work & volunteer opportunities through supported work placements & flexible working arrangements • Working with Barnardo's Drive to Work Programme offering young people training placements in Health and Social Care • Delivering accredited courses at Midlothian Campus of Edinburgh College with offer of interview for Access Course NHS Lothian Employed Workforce The data at October 2024 showed the NHS Lothian workforce consisted of 704.4 WTE, with a total headcount of 845. Over the previous 12-month period 96 employees left and 102 new employees joined. This is a turnover rate of 11%. The age profile of the NHS Lothian workforce is set out below. 18 77 132 119 114 90 97 114 72 12 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Number of staff Age Group NHS Lothian Staff (Headcount) Page 191 of 316
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16 The overall establishment gap in October 2024 was 2.98%. This varies across job families as set out in the following table. Job Family Sum of Funded Establishment WTE Establishment Gap % Administrative Services 68.9 73.4 -6.5% Allied Health Professionals (all grades) 217.1 233.0 -7.34% Medical / Dental 16.81 7.53 55.19% Nursing & Midwifery (all grades) 389.6 357.6 8.20 Other Therapeutic 27.28 27.11 0.62 Support Services 5.44 4.77 12.32% 17.5 71.8 113.5 97 95.3 73.1 84.4 94 49.2 8.6 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Whole Time Equivalent Age Group NHS Lothian Staff (Whole Time Equivalent) Page 192 of 316
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17 The absence data at October 2024 for all job families combined showed an overall absence rate of 25.25%. The Long-Term Absence Rate had been below the financial year average rate of 2.14% over the summer months, but increased by 60% between August and September, and remained high in October. The age groups currently experiencing the highest rates of long-term absence are • 40-44, • 50-54, and • 55-59. The rates for these age groups can be up to four times higher than other age groups. The age groups currently experiencing the lowest rates of long-term absence are • 25-29, • 35-39, and • 45-49. Due to the need to protect confidentiality, the reasons for long term absence are only reported when there are 5 or more episodes recorded for the 12 months prior to the time period selected. The category with the highest number of hours lost is ‘Anxiety / Stress / Depression / Other Psychiatric Illnesses’. A relatively small number of episodes (9 in total) accounts for a significant number of hours lost (951). 12.29% 3.21% 6.30% 0.74% 2.68% Staff Leave by Type Annual Leave Maternity Leave Sick Leave Study Leave Other Leave Page 193 of 316
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18 Medics In Midlothian, there are a small number of medical staff who work within the Health and Social Care Partnership including Consultants, specialty (SaS) doctors, clinical fellows and GPs with extended roles (GPwER). A survey undertaken by the British Medical Association (BMA) Scotland in November 2024 revealed that doctors working in Scotland are regularly concerned about the unsafe levels of medical staffing in their workplace. Of the 610 responders, only 1% said they felt their department was well-staffed beyond safe levels, with 80% saying they believe staffing of both doctors and their wider multi-disciplinary support team is either sometimes (49%), or regularly (31%), unsafe. Additionally, the survey results noted that • 72% of those who responded think that medical staffing has decreased relative to patient demand over the last two years. • 62% are worried or very worried there won’t be enough doctors in Scotland’s NHS to meet patient demand over winter. • 76% are worried there aren’t enough doctors to meet patient demand in the longer-term and ahead of next winter. • 83% do not believe there is an adequate medical workforce plan in place to improve the recruitment and retention of doctors in Scotland in the long-term. Midlothian has received new investment to host medical student placements from 2024 which will support the supply of doctors to take up an increased number of trainee doctor posts available. Significant investment has resulted in an additional 153 trainee doctor posts created for 2025. This will be the largest annual expansion on record and represents a 2.3% increase above the current whole time equivalent workforce of 6570 trainees. The additional posts are being funded by the Scottish Government to help meet growing demand in a number of key specialties. This will cost approximately £42m over the next four years. NHS Education for Scotland recommended uplifts in 24 different specialties overall, including anaesthetics, emergency medicine, general practice, intensive care medicine, paediatrics, psychiatry and surgery. Successful applicants will take up their posts in August 2024. Nursing Nursing teams nationally continue to address the challenges of increasing and changing demand, retention, and recruitment. There is concern that the number of student nurses qualifying over the next 3 years may not be enough to fill posts as current nurses leave and retire. The number of nurses projected to graduate in 2027 will be around half of those due to graduate in 2025. This will likely change the role of the Registered Nurse as NHS Lothian develops a range of approaches to address the predicted shortfall. Additionally, challenges are different across the system e.g., the vacancy rate of nurses working within the Lothian Page 194 of 316
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19 Health and Social Care Partnerships is higher than the agreed targets and the level maintained in acute settings NHS Lothian is responsible for workforce planning for Nursing - delivered through the Corporate Nursing Directorate under the leadership of the Director of Corporate Nursing on behalf of the Executive Nurse Director. The workforce pressures within nursing are changing the role of Registered Nursing. This changes means a focused development and investment in professional and leadership capacity is required to support Registered Nurses to lead teams, delegate, supervise and oversee caseloads and care appropriately. Initiatives to improve recruitment processes retention include ‘retire and return’ and flexible working. Work is underway to develop different approaches to skill mix within our staff teams. The NHS Lothian Nursing and Midwifery Workforce Programme Board oversees: • recruitment, planning and future vacancies • education of staff • compliance with Health and Care Staffing legislation including financial recovery planning and reducing use of agency staffing to deliver on quality and safety drivers • the use of workforce and workload tools including ‘Safecare’. This provides real time staffing levels and provides an auditable, transparent trail around staffing decisions. NHS Lothian has an escalation and response framework to gather information and support decision making about staffing levels and inform workforce planning. Other tools are being developed to improve workforce date and help plan for safe staffing levels. This includes using ‘establishment healthchecks’ currently used in all bed based areas in community and out patient settings. The Clinical Education Team oversees: • A project where student nurses can apply for paid employment as Assistant Practitioners (Band 4) for 1 shift a week during their final year. This increases numbers of nursing staff and supports their transition from student to Registered Nurse. • Training for Health Care Support Workers to become Assistant Practitioners and as a route to higher education and qualification as a Registered Nurse. • Working with Further Education providers to support routes into NHS Careers, including Skills Boost for new entrants and HNC programmes for existing staff to become Registered Nurses. • Ensuring training and development opportunities for advanced practice, and the education and training of Advanced Nurse Practitioners. Band 5 Registered Nursing Posts As part of the review of the Agenda for Change system, Band 5 nurses can request to have the banding of their role reviewed. Staff can submit a request through a portal, and it will be reviewed by a Panel. Work is underway to estimate the cost implications, the full financial impact is unknown. It is not clear what impact this will have on staff in Band 6 roles and above. There is a risk that they may question their level of pay, leading to tensions between staff, difficulty in recruiting, and a lack of clarity in role descriptors. The loss of salary progression may disincentivise staff from further education or taking on roles with a management/leadership component and destabilise future service delivery. Page 195 of 316
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20 District Nursing There is a mismatch between demand and capacity with District Nurses in the context of financial constraint. A review addressed immediate concerns and established a model of service delivery to enable future development. This included work on eligibility criteria, referral pathways, and training and education. A wider NHS Lothian review will lead longer term transformational change, including digital approaches and modernised IT systems. Health Visiting Health Visiting establishment is driven by the nationally agreed caseload weighting tool. This informs planning for future training places and considers the age profile of Health visitors and factors driving turnover and staffing gaps. Health Visiting remains a popular career and, although not currently a workforce pressure in Midlothian, there is potential for wider nursing shortfalls to impact on the staff group. Allied Health Professionals AHP workforce priorities are influenced by several national drivers including the Health and Care (Staffing) (Scotland) Act, the National Rehabilitation Framework, Primary Care Improvement Planning, Waiting Times Improvement Plans, and Transforming Roles. The Allied Health Professional (AHP) groups that work within Midlothian Health and Social Care Partnership include physiotherapists that are part of the MSK and GP Advanced Practice Physiotherapists (APPs) service, occupational therapists across health and social care, and a hosted Dietetics service. We have supported Midlothian Health and Social Care Partnership to establish professional and strategic governance for both NHS and Midlothian Council employees through the leadership and direction of the Chief Allied Health Professional. Current Workforce Initiatives for AHPs within Midlothian Health and Social Care Partnership are embedding an AHP Governance and Assurance Framework, developing new ways of working as we learn from the Health and Care (Staffing) (Scotland) legislation and statutory reporting, and implementing the NHS Lothian AHP Learning and Development Strategy. This work includes defining ‘Protected Learning Time’ across the professions and revising Job Plans to reflect this, using a Development Needs Analysis tool to identify development needs, and creating learning and development opportunities. Learning from our work to comply with the Health and Care (Staffing) (Scotland) legislation and statutory reporting we continue to work on reporting real time staffing and escalation. Workload analysis and professional judgement tools continue to be refined as part of the wider NHS Lothian AHP workforce plan. Data informed workforce planning is supported by the NHS Lothian AHP workforce plan. In Midlothian, the use of service specifications has supported AHPs to maximise the use of data in service planning and ensure job plans are used meaningfully in all service areas. Page 196 of 316
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21 We are working with our colleagues in General Practice to sustaining the number of AHPs in GP practices and improve access to rehabilitation and outcomes through our Advanced Practice Physiotherapist roles. National work is also progressing to support Dietitians develop into Advanced Practice roles in primary care. This has created opportunities to think differently about future workforce projections including workforce establishment, skill mix, staffing support and development, succession planning, and recruitment. The prescribing agenda remains a focus for workforce development, particularly within Dietetics and supplementary prescribing to support both the diabetes and weight management pathways. National discussions continue around Independent Prescribing for this profession. Locally, we are working on the Transforming Roles agenda with a focus on our Advanced Practice workforce. We want to ensure we are setting consist expectations across role and have clearly defined competency frameworks e.g., developments in our dietetics service include testing supplementary prescribing roles in our diabetes and weight management pathways. We will continue to explore how to support Band 3 and Band 4 Assistant Practitioner roles through Modern Apprenticeship opportunities and explore alternative routes into healthcare roles that allow people to ‘earn while they learn’. Non-traditional routes to registered practice are an important part of planning for the future e.g., volunteering and work-experience opportunities, highlighting AHP careers as first choice for school leavers, and developing and expanding pathways of entry to practice. Additionally, retire and return options support the current workforce to remain working for as long as they are able and willing to do so with more flexible employment later in their career journey. We continue to focus on supplementary staffing through our AHP bank development. Primary Care Primary care provides a wide range of services; general practice, community pharmacy, general dental services and general ophthalmic services which are largely delivered by independent contractors, as well as HSCP services district nursing, vaccination programmes, community treatment and care centres (CTAC), mental health, and physiotherapy and pharmacotherapy. General practice out-of-hours services, dental out-of-hours services are delivered by NHS Lothian. The General Medical Services (GMS) contract agreed in 2018 outlined the joint commitment to implementing the new GMS contract, focusing on redesigning the balance and flow of work between GPs as the Expert Medical Generalist and other professional staff working within a multi- disciplinary team. This aimed mitigate rising workload for GPs by increasing other members of the practice team for the benefit of patients and to release GP time to be an expert medical generalist for complex conditions. The Scottish Government provided Primary Care Improvement Fund (PCIF) monies to support the development of Primary Care Improvement Plans (PCIP) to implement models of delivery including the HSCP services specified above. In 2022 there was 91 GPs (56 WTE) in Midlothian providing GMS services to 1,811 registered patients per WTE, compared to mean 1,315 across the rest of Scotland. Several practices are currently facing significant GP workforce shortages due to retiral and recruitment failure. 4% of Midlothian GPs are Page 197 of 316
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22 planning to retire in the next 2 years, and a further 7% are planning to retire between 2-5 years. 8 practice nurses (26%) are planning to retire in the next 2 years. Burnout & stress-related illness are an increasing risk for the GP workforce, as the rate of clinical encounters per patient in Midlothian remains consistently higher than in the other Lothian HSCPs and may be related to Midlothian’s higher prevalence of long-term conditions, cancer, and co-morbidity. The Midlothian Primary Care Improvement Plan (PCIP) sets out a number of actions to mitigate some of the challenges and associated risks including provision of a range of other primary care roles and services designed to enhance the capacity of the multidisciplinary team. There are several limitations affecting full implementation of the PCIP, including • Recruitment and retention of suitable workforce has been challenging due to shortfalls in the labour market, and competition with other HSCPs to fulfil similar roles (with increased risk in the last year with two adjacent HSCP areas as demonstrator sites with increased PCIP investment). • The newly recruited PCIP multi-disciplinary workforce has variable levels of competence and confidence, which requires additional GP time for training and supervision. • There are several practices in Midlothian with premises which limit the physical capacity to accommodate additional services and staff. • Population growth and rapid house building programme are placing an additional burden on GP practice list sizes. Practice list growth in some areas is as high as 5% per year. It is estimated that the equivalent of two new practices would be required to meet the needs of the growing population in Midlothian. Workforce Initiatives in Primary Care: • Further development and recruitment to the general practice multidisciplinary team to enable increased capacity to meet growing population demand and allow GPs to focus on their role as Expert Medical Generalist. • Development of the pharmacotherapy service in line with Scottish Government guidance including development of attractive roles to support recruitment and retention. Design of roles and working models which make best use of skill mix and enable pharmacotherapy tasks to be coordinated from one ‘hub’ location. • CTAC service review and role descriptions to ensure staff are supported and able to work at the top of their professional licence and provide best value care. • Embedding the Midlothian Integrated governance and Assurance Framework. • Ring-fenced funding of backfill time for GPs to provide medical supervision of training requirements for extended or enhanced roles. • Funding Practice Learning Time (PLT). • List Extension Growth Uplift (LEGUP) grants to pump-prime recruitment of clinical staff for practices with rapid list size growth. • Review of practice premises to determine physical capacity and options for development and augmentation. Many GP practices in Midlothian also host National Education Scotland (NES) GP trainees for supervised training before full qualification. Giving these trainees a good experience and protected learning time increases the success of retaining them in Midlothian for substantive jobs once they qualify. Undertaking these actions will be challenging given a wide range of factors such as current and future workforce availability, funding, and the challenges of an increasing and ageing population. Page 198 of 316
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23 Midlothian Council Employed Workforce The data at October 2024 showed the Midlothian Council workforce consisted of 439.3 WTE, with a total headcount of 514. Over the previous 12-month period 86 employees left. It is not possible to calculate a turnover rate for council employed staff as Midlothian Council were unable to provide the date required to carry out this calculation. The age profile of the Midlothian Council workforce is set out below. 5 33 23 56 42 50 85 91 78 29 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Number of Staff Age Group Midlothian Council Health and Social Care Headcount 4.67 28.75 36.23 48.32 38.04 43.83 76.76 77.82 62.21 20.17 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Whole Time Equivalent Age Group Midlothian Council Health and Care Staff Whole Time Equivalent Page 199 of 316
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24 The age groups currently experiencing the highest rates of sickness absence are • 50-54, • 55-59, and • 60-64. The rates for these age groups can be up to four times higher than other age groups. The age groups currently experiencing the lowest rates of long-term absence are • 20-24, and • 65+. Due to the need to protect confidentiality, the reasons for long term absence are only reported when there are 5 or more episodes recorded for the 12 months prior to the time period selected. The category with the highest number of hours lost is ‘Anxiety / Stress / Depression’ accounting for 1432 days lost.Midlothian Adult Social Work services consist of number of highly skilled and experienced Social Work teams that including Justice Services, Older People, Learning Disability, Complex Care and Long- Term Conditions, Social Work Duty, Hospital In-Reach team, Joint Mental Health Team, Joint Dementia Team, and the Substance Use Service. At the time of writing, we intend to support a review of the structure of our Social Work services. This review is expected to conclude in 2025. Social Work Scotland had published the Setting the Bar report, which looks at the capacity of Scotland's Social Work workforce and asks, 'what will it take to deliver what we need?' Over the coming year we will continue to benchmark our Social Work services against the findings in this report to inform the future capacity and workforce requirements. 61.40% 2.20% 2.20% 34.20% Staff Leave by Type (October 2024) Annual Leave Special Leave Maternity Leave Sickness Page 200 of 316
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25 Mental Health Officer Training Recruiting and retaining qualified Mental Health Officers is a local national challenge and we have taken steps to minimise the local impact and risks. Appropriate remuneration is reported to be a key contributing factor to recruitment and retention challenges. We are working closely with colleagues in Social Work Scotland, the Social Work Education Partnership (SWEP) and the Office of the Chief Social Work Officer (OCSWO) to consider how a remuneration framework could maximise opportunities and incentives for undertaking post qualification training to meet the needs of service demands. Practice Education We are developing ways to support more Social Workers take on practice educator roles for Social Work student placements. Midlothian has a long history of working with universities including Edinburgh, Stirling, Napier, and the Open University to provide high quality practice placements for up to 15 Social Work students every year. Offering quality Social Work placements creates an opportunity to attract final year students to apply for vacant posts on qualification. The Practice Learning and Development team supports both staff who work within the Health and Social Care Partnership and Midlothian Council Children’s Services. The team are developing a work plan to ensure there are appropriate numbers of qualified practice educators and link workers to support Social Work student placements across all Social Work services. This includes influencing the development of varied career pathways into Social Work, developing future Social Work leaders, and contributing to effective succession planning. Social Care The 2021 Independent Review of Adult Social Care in Scotland highlighted the differences and inequalities between health and social care support workers. Recommendations were that a holistic approach to workforce planning across health and social care must be prioritised, and that regulation as well as training, development were areas with scope for significant improvements. It was also recommended that revised commissioning and procurement arrangements include a commitment from employers to workforce development. The education routes and pathways for health and social care are different. Health Care Support Workers (HCSWs) undertake (non- recordable) Professional Development Awards and National Progression Awards (NPAs). NPAs are delivered in partnership between schools, colleges, and employers that would be equivalent of between SCQF Levels 2-6. Social Care Support Workers (SCSWs) SCSWs do recordable SVQs. There is no comparability or ability to transfer learning credits between the two approaches. We have a well-established approach to support employability, that contributes to workforce supply and development. The development of The Lothian Care Academy has supported a consistent approach across Lothian and an agreed plan that focuses on common training, career pathways, accreditation and recognition, and development of social care Support Worker capacity with expected outcomes: - • Staff will be trained and educated to the same standards. • Consistent standards of care for people requiring support will exist. • Reduced risk of injury for staff and people requiring support e.g., same de-escalation techniques used where there is a risk of violence and aggression. Page 201 of 316
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26 • Clear expectations of staff competence where care is delegated. • Clear governance arrangements. • Equitable access to training opportunities across Lothian. • More flexible pool of staff able to work in different care environments. • Increased number of learning environments for learners. Carers It is estimated 1 in 7 employees across the UK have carer responsibilities. It is important we recognise the unpaid carers both in our communities and who work within the Health and Social Care Partnership and provide a supportive and flexible working environment in line with the principles of fair work. According to the 2022 census, 12.5% of the Midlothian population are carers compared to 11.86% of the Scottish population. In Midlothian 59.4% of carers are female and 2,839 people reporting providing 50 or more hours of unpaid care per week. We continue to work alongside our partners and commissioned services to support carers in line with Scottish Government aspirations. Staff experience iMatter is an annual survey sent to all employees across health and social care in the Lothians. In 2023/24, 65% of the workforce in Midlothian Health and Social Care Partnership completed the survey. This is a significant increase compared with 2022/23 (48% completion rate). Staff are asked about their work and their wellbeing including ‘effective team working’, ‘health and wellbeing’, and ‘being involved in decisions’. The Employee Engagement Index is the overall score given to the organisation. The five key areas of this measure how well staff feel they are: • Informed, • Appropriately trained & developed, • Involved in decisions, • Treated fairly and consistently, with dignity and respect, in an environment where diversity is valued, and • Provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients, and the wider community. In 2023/24 Midlothian Health and Social Care Partnership Employee Engagement Index was 78 (the maximum score is 100). The Index score did not change between 2022/23 and 2023/24, but significant more people took part in the imatter survey. This means that we can have much greater confidence in what the survey tells us. We will continue to use the iMatter survey to help us understand the experience of staff who work within Midlothian Health and Social Care Partnership. Page 202 of 316
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27 Supporting staff wellbeing Midlothian Health and Social Care Partnership has responded to the Scottish Government’s request to strengthen existing local arrangements for staff wellbeing and to provide support and practical advice. Staff who work within Midlothian Health and Social Care Partnership tell us that delivering quality, person centred care is both rewarding and demanding. We know in recent years the challenges of delivering high quality , safe and effective health and social care have changed. We have recognised that everyone who works for the partnership, regardless of their role, needs the right support they need to thrive. It has been important to reflect on the longer-term physical and psychological impact of the pandemic as well as the continuing influence this has had on how we redesign services and manage financial uncertainty. We have had to think very differently about how we support the workforce to carry out their role to the best of their ability and effectively contribute to people achieving the outcomes that matter most to them. We have invested in a Wellbeing Lead and worked with our partners to establish a working group to provide the rights support for different staff groups across the whole system. Members of this group include NHS Lothian, Midlothian Council, Trade Unions, Human Resources, Third and Independent Sectors, and Chaplaincy Services. A delivery plan supports the work of this group to identify and implement innovative solutions framed around six key dimensions. • Communication: Providing clear communications that provide information and drive engagement including strong links with NHS Lothian “Work Well” strategy, and regularly updating the Midlothian Wellbeing Directory, and • Programme of Support: Sustaining a programme of support to strengthen and where possible extend existing local arrangements for staff wellbeing including opportunities to explore the emotional demands of working in the community, coping strategies, managing emotional risk, and trauma informed training as part of our ambition for Midlothian to be a trauma informed community • Leadership: Offering a range of training opportunities to help leaders across the system support staff wellbeing alongside a refreshed Staff Communication, Engagement and Experience Delivery Plan for 2025/28. • Mental Wellbeing: Increasing access to mental health support and interventions to promote psychological wellbeing including peer support groups and 1:1 support, ‘Mindful Mondays’, ‘Energise You’ ‘Changing Gear’, and newly developed Mental Health workshops • Environment: Improving local facilities that enhance the working environment and Wellbeing Hubs to ‘Rest, Refresh and Refuel’ throughout Midlothian • Engagement: Creating the conditions for engaged, informed, and empowered staff including a refresh of “The Midway” The Midway Midlothian has built a long-term commitment to strength based, and community led health and social care and have taken a "good conversations" approach, for over a decade. More recently this has grown in a system wide approach in Midlothian. We call this The MidWay. This is not just about how we Page 203 of 316
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28 welcome people into our services and work alongside them, but also how we lead and plan, talk about health and social care, and work with each other. Along with services being easy to find, and designed around how people live their lives, we need to ensure that people are supported to achieve the things that matter most to them. This means taking the time to have good conversations with people, to understand what is working well, what could be better, and who might be able to help. The Midway recognises people as the experts in their own care and experiences. When working with people, it is vital that people feel valued and are involved in planning services that support them to achieve the things that matter most. By focusing on what is already strong, what is working well, and building towards better outcomes, staff work in partnership with people, understand the impact of trauma, and meet people where they are. As part of our commitment to effectively address health inequalities, we are working hard to ensure all staff are supported with Good Conversations training to ensure everyone has the knowledge, skills, and confidence to effectively contribute to positive change. A Digitally Enabled Workforce The Scottish Government published a national strategy, a changing nation: how Scotland will thrive in a digital world in 2021 and outlined the critical factors for organisations to progress digitally. In addition, Scotland’s Digital Health & Care Strategy was revised in 2021. We know digital is an enabler to quality service design and delivery and helps us to ensure ‘Best Value’ in new ways. We will continue to identify opportunities where digital can support how we create new models of care, and better experiences for people who access our services and the workforce. It is important we help everyone develop the knowledge, skills, and confidence to make the most of digital offers if this is their preference. We also know that digital can enable us to improve our business planning and processes. In response to these national and local ambitions, we developed a Digital Implementation and Delivery Plan with eight priorities connected to the development of our workforce and how we are planning for the future. To achieve these ambitions, we are working alongside our NHS Lothian and Midlothian Council partners. Our Digital Plan outlines the key drivers, aims and outcomes to ensure that we are all more digitally enabled. The aims are ambitious and support people working with us to codesign the shape of future of the health and social care to achieve the things that matter most to them, with greater control of their own data. Below is a summary of progress to date. Page 204 of 316
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29 Priority Area Key Deliverables Progress Future focus Develop Leadership & Management To have increased digital management and leadership capacity, with service-led Digital and TEC solutions across all areas. Established a Digital Programme and Oversight Board Annual system assessment of Digital Maturity Digital leadership role development to support digital transformation Ensure Appropriate Resources Ensure there are appropriate levels of investment and resource in equipment, infrastructure, and workforce to prove a baseline of digital capability with service-led Digital and TEC solutions across all areas Pan Lothian Digital Board providing opportunities for sharing learning and developments. Asset register maintained Growing digital and Trak champions networks Digital capability assessed via Digital Maturity annually Business case development Consistent digital offerings across community-based services Testing Turas Digital and Data Capability Framework Build a Digital Culture for Service Planning & Development To have increased digital capacity across all areas. Maintain focus on digital as an enabler in all redesign and new models of care Data based decision making Adopt new service design approaches Digital and Data Strategy development Promote Prevention, Early Intervention & Self- Management To have increased digital offerings that relate to early intervention and prevention, across all areas. Enhanced falls self-management resources on HSCP webpages Digital solutions to support early intervention and self-management Mitigate Digital Inequality To have increased digital awareness, access, and capability across all areas 97% of Midlothian residents have access to the internet at home (Scottish Household Survey 2021) text reminders are now available to community based services to help maximise attendance and meet a 5% DNA target Digital choices provided alongside traditional options Adopt Co- design & Co- production in Service Development To have increased participation in service design and development from people who experience services and providers across all areas Increased co-design Measurement and evaluation from active participation of people and providers in developments Work in Partnership To have established an active Pan-Lothian forum, to influence eHealth policy Forum established January 2023 Dynamic response to change Page 205 of 316
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30 Priority Area Key Deliverables Progress Future focus Existing committed and known projects To have evidence of progress in our committed projects and assurance in the governance of our decisions MHSCP Digital Programme Board providing oversight of the projects initiated. Consistent methodology in project governance Dynamic response to change Sustainability, and the Environment The elected members of Scottish Parliament have declared a Climate Emergency exists and that we must take collective and community-based action to reduce carbon and other greenhouse gas emissions. We recognise the importance of working together towards net zero. We have supported achieving equal mileage payment arrangements for staff in employed by NHS Lothian and Midlothian Council and considering how to maximise the use of electric vehicles and public transport. We will continue to work in line with the principles of the NHS Lothian and Midlothian Council environmental strategies and policies to support climate change goals. Page 206 of 316
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31 Action Plan Deliver a MHSCP Integrated Workforce Plan. Continue to review our Senior Team workforce planning capacity. Progress our workforce data ambitions. Maintain our Integrated Workforce Planning governance structure. Promote MHSCP as an attractive place to work. Work with partners to develop targeted recruitment. Develop our workforce. Support effective leadership. Ensure Learning & Development plan in place. Develop a career development toolkit. Support local people into meaningful employment. Support staff to stay in work. Focus on staff wellbeing. Develop relationships with independent and third sector partners, unpaid carers, trade union & staff partnerships. Page 207 of 316
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32 Summary Plan Deliver and deliver our Integrated Workforce Plan for 2025/28 • Develop a Workforce Plan every 3 years that aligns with our Strategic Plan and the strategies of our NHS and Local Authority partners • Design a Measurement Framework and review it annually to support the delivery of this Workforce Plan Maintain our Integrated Workforce Planning governance structure • Review and update our Governance Model • Review and update reporting processes • Embed escalation routes from local service Governance and Assurance Framework to the integrated Workforce Governance Board • Support MHSCP to establish Group Service, Service and Team Workforce plans Continue to review our Senior Team workforce planning capacity • Continue to review the financial position and potential to identify dedicated resource for a Workforce Planning Lead • Identify gaps and strengths to create a Workforce Planning Skills and Competencies Development Plan Progress our workforce data ambitions • Develop integrated workforce data dashboards to support service workforce planning • Identify data strength and opportunities to further develop our Workforce Planning insights • Test and improve real-time workforce tools to improve workforce planning Promote MHSCP as an attractive place to work • Continue to build our relationships with Schools, local employers, the Third Sector, and the Employability Partnership • Attract and develop a more sustainable workforce demographic Work with partners to develop targeted recruitment • Ensure a joined-up approach to developing diverse workforce through workforce supply, recruitment, and retention Page 208 of 316
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33 Develop our workforce • Continue to develop a trauma-informed workforce • Review and refresh the Midway and associated action plan Ensure Learning & Development plans in place • Work with MLC and NHSL on L&D Plans • Work with the Lothian Care Academy Support effective leadership • Continue to our programme of work to support leadership development • Embed our Quality Management approach Develop a career development toolkit • Support opportunities to develop new roles • Support all staff to achieve learning objectives • Support succession planning Support local people into meaningful employment • Develop our understanding and use of Employability Programmes, Modern Apprenticeship & Kick Start programmes • Develop workforce supply pipelines including volunteering and the Third Sector Support staff to stay in work: • Provide a platform for collaborative working between MLC and NHSL Focus on staff wellbeing • Review the Staff Communication Engagement and Experience Plan. • Support the Staff Wellbeing Plan • Support Good Conversation training Develop collaborative relationships • Continue Third Sector Summits Page 209 of 316
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Midlothian Integration Joint Board Workforce Plan 2025/28 ANNEX A In answering the questions below, respondents should set out as far as possible how they plan to achieve what is being asked, when they plan to achieve it and what are the expected results of the action(s) taken. 1. Hard to fill posts Please use the table below to outline posts that have been, or continue to be, difficult to recruit for. Please also provide detail on what action you have taken to attract staff to this post. The roles detailed should be as specific as possible, breaking it down by sub-job family where appropriate. Hard to fill role Is the difficulty in filling this location specific? How long has this issue persisted? How many roles within this job family are affected? What service is at risk as a result of this (if applicable)? What have you done and what are you doing to address this issue? Registered Nurses No. This is a national challenge This is a pervasive issue that has worsened over the last 5 years. All nursing roles /adult branches are impacted by the recruitment challenge. In Midlothian HSCP, this is a funded establishment of 389.6 of which 357.6 WTE are in post (please see NHS Lothian Workforce Plan) Immediate concerns around School Nursing (SCPHN qualified), Registered Mental Health Nursing in Community, including inpatient Older People’s Mental Health Services /Dementia, and Registered Nurse (Adults branch) roles in Community Hospitals. Projections around shortfalls in Registered Nurses for people with Learning Disabilities from recent university Please see the nursing section of this plan and NHS Lothian Workforce Plan Page 211 of 316
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intakes raise concerns about the risk of developing a vacancy gap in learning disabilities also over the next 2 - 3 years Mental Health Officer MHOs are Social Workers with enhanced training in Mental Health. There is a national shortage of MHOs and it is an ageing workforce. 10+ years. Midlothian has no limit placed on the numbers of MHOs trained and practicing. Without suitably qualified MHOs, we would be at risk of not meeting statutory responsibilities. In Midlothian, we “grow our own” MHOs by sending two Social Workers on the MHO training every year. 2. Please outline how you are managing your vacancies and plans on how to fill them? In the context of reducing supplementary staffing spend, for example high-cost agency usage, please advise how you plan to reduce the number of vacancies you have and ensure that you maintain adequate staffing levels to meet service demand? See ‘The Health and Social Care Workforce’ section of our plan 3. Please provide detail on your sickness absence rate. What is your sickness absence rate currently? Are you taking any steps to reduce this or are you taking steps to sustain this rate? Please detail how you are doing this. Are their any specific areas of concern for you with regard to sickness absence? This could be an absence reason or a service at risk as a result of absence. In addition, what are your main reasons for long-term sickness absence? Finally, please provide detail on how you support staff wellbeing as a preventative measure to sickness absence. See ‘Health and Social Care Workforce’ section and ‘NHS Employed Workforce’, and ‘Midlothian Employed Workforce’ sections of our plan. Page 212 of 316
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4. What are you doing in terms of role diversification and reform to meet supply issues? Given the challenges facing the workforce with regard to hard to fill roles, it may not be possible to recruit for every role and therefore the skill might need to be filled by another means. Are there any local initiatives you are taking with regard to role diversification to address skills gaps? In addition, could you provide feedback on any national initiatives of role diversification where this is applicable? See ‘Health and Social Care Workforce’ section of our plan 5. How are you using technology/IT to improve performance? How are you using technology to improve performance within the services that you plan for? What examples of innovation are you exploring for implementation to help reduce pressures on workforce and improve outcomes? See ‘A Digitally Enabled Workforce’ section of our plan 6. What are you doing to retain current workforce and attract staff? This could be, but is not limited to, opportunities for career progression, training, or support offered to staff. Please advise of any local initiatives you are taking to attract staff such as working with partners to establish supply routes. In addition, please give analysis of turnover in your services, with a turnover rate and the actions you are taking to understand the reasons that staff are leaving the workforce as well as the reasons for leaving where available. See ‘NHS Employed Workforce’, and ‘Midlothian Employed Workforce’ sections of our plan 7. Are there any location specific challenges that are affecting your workforce? This could be, but is not limited to, challenges due to the unique nature of your demographic, infrastructure issues, transport issues etc. Could you also detail any issues here that may be specific to your local area? For example, perhaps there is a specialist service offered in your area that is challenging to deliver or sustain? In addition, and where applicable, please advise of actions you are taking to attract, recruit and retain staff in your rural and island areas. This could be, but is not limited to, role diversification, reform, bespoke contracts, pastoral care, training and career progression opportunities, wellbeing initiatives etc. See ‘The workforce in Midlothian’ section Page 213 of 316
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8. Is there anything else that you wish to make the Scottish Government aware of? Asking Integration Authorities and Health and Social Care Partnership to produce workforce plans raises a number of challenges. As a strategic planning body who do not employ any staff directly, many of the lever and mechanisms required to drive an effective workforce plan are not ultimately decided or controlled by us. We can issue Directions to the employing partners, but Midlothian Council and NHS Lothian may take decisions that impact on the ability of Midlothian Health and Social Care Partnership to achieve the ambitions of this Integrated Workforce Plan. For example, a Direction to the employing partners to employ additional workers cannot be actioned if the employing partner has implemented a recruitment freeze. As Midlothian Health and Social Care Partnership is a directorate of both NHS Lothian and Midlothian Council, we would have assumed that the workforce plan of both our partners would be sufficient as this covers all the staff that they employ and therefore, all the staff that work within the Health and Social Care Partnership. Delivering a meaningful Integrated Workforce Plan is a complex ask where there is more than one local authority or Health and Social Care Partnership within the geographical footprint of the Health Board, This is the case for Midlothian Health and Social Care Partnership, and we continue to work closely with all our partners to deliver the best workforce planning we can with the resource available. However, a lack of data sharing agreements that would allow us to consider the workforce of integrated teams as an integrated workforce continues to present challenges. Although there is a national ambition to establish an integrated social care and health record although, there is currently no detail of how this will be achieved, and no mention of workforce data sets. Cultural differences and perceptions of professional identity between the two partner organisations can mean the staff delivering services managed by the Health and Social Care Partnership may associate themselves with their employing partner over the Health and Social Care Partnership. Terms and conditions of employment are different for staff employed by NHS Lothian to staff employed by Midlothian Council. This includes, pay scales, working hours, health and safety training, mandatory training, and HR policies like absence management and protection from redundancy. This impacts not only wellbeing but also the appetite for some teams to work in an integrated way. We have seen this reflected in the annual (integrated) iMatter survey and the employee engagement index score. Of course, there are some places where there are outstanding examples of integrated working and practice. Local leadership is often the difference as there are many fully integrated and high functioning teams in Midlothian. The ‘No 11’ flagship building in Dalkeith is a great example of integrated team across the integrated system and houses mental health, substance use, and justice services amongst others. Page 214 of 316
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Midlothian Integration Joint Board Thursday 20th February 2025, 14:00-16:00 Midlothian IJB Performance Report Executive summary The purpose of this report is to • Update the Midlothian IJB on progress towards the IJB performance goals set for the financial year 2023/25. • review the Midlothian IJB Performance on Directions 2024/25. Due to the processes required to validate statutory IJB performance goal data, the full reporting year is almost complete for all indicators due to an inbuilt reporting delay. A report describing progress against each improvement goal is attached in appendix 1. It should be noted that due to the timescales for publication, and the deadline for paper submission, there has been no update to the published indicators for this report. More recent management data are available for a number of the improvement goals but cannot be published in this report as these data are not validated and for management purposes only. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided. An element of the Midlothian IJB Strategic Governance Map is now incorporated into each Midlothian IJB Performance Report. For this February Board, the focus is on Column 4 which assesses and assures the progress made towards delivering on Directions (appendix 2). The Directions Year End report has been incorporated into this IJB Performance Report (appendix 3). Midlothian IJB Improvement Goals will be reviewed by the Strategic Planning Group and agreed by Midlothian IJB following budget setting for 2025/26. Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023/25 (appendix 1) • Note the Midlothian IJB Strategic Governance Map (appendix 2). • Consider the ‘progress’ and ‘confidence’ ratings in Column 4 (appendix 2). • Note the inclusion of the Midlothian IJB Directions Year End Report (appendix 3). • Note the improvements to the processes of Directions reporting. Item number: 5.10 Page 215 of 316
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Midlothian Integration Joint Board Report Midlothian IJB Performance Report 1 Purpose 1.1 The purpose of this report is to • Update the Midlothian IJB on progress towards the IJB performance goals set for the financial year 2023/25. • review the Midlothian IJB Performance on Directions 2024/25. 2 Recommendations 2.1 Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023/25 (appendix 1) • Note the Midlothian IJB Strategic Governance Map (appendix 2). • Consider the ‘progress’ and ‘confidence’ ratings in Column 4 (appendix 2). • Note the inclusion of the Midlothian IJB Directions Year End Report (appendix 3). • Note the improvements to the processes of Directions reporting. 3 Background and main report 3.1 The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. They are based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care). 3.2 At the IJB meeting in June 2023 the Performance Assurance & Governance Group recommended that the improvement goals for 2023/25 were set to prioritise an increase in system stability, focussing on workforce recovery and wellbeing. 3.3 An updated report describing progress against each improvement goal is attached in appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. Members are asked to specifically note data completeness. Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. This means that we are not yet able to calculate the full year performance for some measures. 3.4 Members are also asked to note that Public Health Scotland (PHS) has moved to a schedule of quarterly, rather than monthly, updates. Please note that due to the timescales for publication, and the deadline for paper submission, there has been no update to the published indicators for this report. Page 216 of 316
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Midlothian Integration Joint Board 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 2022/23 Target Rate per 100,000 people 2,629 / month 2024/25 Running Average 2,724 / month The validated data are available up to September 2024. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed February 2025) indicate an improved position, currently meeting the target. 3.7 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2024/25 Running Average 775 / month The validated data are only available up to June 2024. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed February 2025) indicate an improved position, currently meeting the target. 3.8 Unplanned Bed Days (Acute) 2022/23 Target Rate per 100,000 5,074 / month 2024/25 Running Average 5,007 / month The validated data are only available up to June 2024. Based on this information, the target is currently being met. The most recent non-validated management information data (accessed February 2025) indicate the target is currently being met. 3.9 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2024/25 Running Average 1189 / month The validated data are only available up to September 2024. Based on this information, the target is currently not being met. The most recent non-validated management information data (accessed February 2025) indicate that the target is not 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% The validated data are only available on a provisional basis for 2022/23. Based on this information, the target is currently being met. 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. Page 217 of 316
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Midlothian Integration Joint Board 3.12 The Midlothian IJB Strategic Governance Map has been incorporated into this IJB Performance Report, which is included at appendix 2. 3.13 Future updates describing progress toward the IJB’s strategic aims will be provided in a scheduled programme, to align with Board meeting dates, key reporting timelines, and with scrutiny provided in advance by SPG. 3.14 For the February report each year, the focus will be on the content reported in the fourth column: “What they [MIJB] learn and gain”. This column is designed to show progress in two distinct but related areas: • Assurance that all services are safe, effective, aligned to strategic priorities and continually improving; and • Assurance and oversight on the progress towards achieving Directions. 3.15 The evidence used to assess progress against these outcomes is set out in full in the data sources described in the Midlothian IJB Strategic Governance Report at appendix 2. This includes the Midlothian IJB full year Directions update, the Midlothian IJB Part Year Directions update, Strategic Planning Group Agendas and Minutes, the Governance and Assurance Framework, OutNav reports and OutNav Onboarding and Update information. 3.16 In relation to assurance that services are safe, effective, aligned to our strategic priorities and continually improving, the progress rating is ‘Some’ with a ‘High’ confidence rating in the information. While there are high levels of assurance on service delivery from HSPC integrated governance reporting, the alignment to strategic priorities and evidence of continual improvement. This will, in part, be resolved by the final part of the planning redesign of IJB and HSCP reporting on Directions 2025/26 that are linked to the draft Strategic Plan for 2025/35. 3.17 Midlothian HSCP has made some progress towards a Total Quality Management approach. This has included expanding and iteratively improving a robust, integrated Governance and Assurance Framework (GAF) through the Governance and Assurance Framework (Activity), understanding population data through the IJB and HSCP performance frameworks (Experience), and evaluating our progress towards improving personal outcomes through outcome mapping (Outcomes). 3.18 In comparison with the first reporting quarter using the GAF, the proportion of High compliance submitted has increased by 15 percentage points. 3.19 Currently 16 service areas are actively using OutNav and 17 Heatmaps are underway or completed, including updates of the Strategic Governance Map for Columns 3, 4 and 6. Regular (quarterly) updates will continue in alignment with agreed SPG and Midlothian IJB reporting timelines. 3.20 This work has also contributed to the digital transformation agenda: rather than digitising an existing process, the use of the OutNav digital platform has enabled Planning and Performance to work in entirely new and innovative ways. OutNav acts as an integrated electronic ‘library’, where information and evidence from both employing partners and the third sector can be held. The aggregation of data provides an elegant solution to the challenge of elevating service reporting at system and strategic levels and has enabled us to generate and connect new types of information and insight. Page 218 of 316
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Midlothian Integration Joint Board 3.21 In relation to the Board having assurance and oversight on the progress towards achieving Directions, the progress rating is ‘Some’ with a ‘High’ confidence rating in the information. 3.22 Midlothian HSCP has made significant developments in 2024/25 that provide the Midlothian IJB with high-quality assurance and oversight of progress towards achieving our Directions. The process of gathering, reviewing and synthesising this information is now more robust. The Directions Report 2024/25 is a synthesis of the information provided by, Service Managers, Heads of Service, and Professional Leads on service plan progress updates mapped to the appropriate Directions. 3.23 Where evidence has been provided, we have high confidence in this. However, despite an improved integrated planning and reporting process, there are places where data is incomplete due to operational capacity pressures. In line with the criteria for assessing confidence in evidence, the HSCP Performance Team have accessed multiple sources of evidence for progress with a balance of types of evidence including quantitative measures and qualitative data and our approach to the analysis has been clear and replicable. 3.24 Detailed progress for Directions 2024/25 is set out in the Directions Report at appendix 3. In summary: • 8 Directions for 2024/25 are proposed to be complete • 21 Directions for 204/25 are proposed to be revised and continue in 2025/26 • 1 Direction is recommended to be revoked. 3.25 Proposed revisions and new Directions are presented in the Draft Directions 2025/26 Report. 4 Policy Implications 4.1 There are no policy implications arising from this report. 5 Directions 5.1 This report does not directly impact upon service ability to deliver existing Directions or require a new Directions to be considered. 5.2 It is acknowledged that there will be a requirement for ongoing review and revision to the Performance Report, in alignment with any revisions to existing Directions / issue of new Directions at any stage in the reporting period. 6 Equalities Implications 6.1 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. Page 219 of 316
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Midlothian Integration Joint Board 6.2 The focus of most of the goals is on reducing hospital activity and hospitals are not used equally by the population. There are groups of people that make more use of hospitals than others – for example older people, people living in areas of deprivation or people who live alone. 7 Resource Implications 7.1 There is no direct resource implication as a result of this report. 7.2 However, there will be resource implications resulting from further action to achieve these improvement goals. 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 Following the decision to step down the Performance and Assurance Group, 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, and Public Health. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME Elouise Johnstone DESIGNATION Programme Manager for Performance & Improvement CONTACT INFO elouise.johnstone@nhslothian.scot.nhs.uk DATE 3rd February 2025 Appendices: Appendix 1: Local Intelligence Support Team (LIST) Report Appendix 2: Midlothian IJB Strategic Governance Map Appendix 3: Midlothian IJB Directions Year End Report Page 220 of 316
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Midlothian HSCP MSG Indicators Performance from April 2019 to September 2024, with 2020/21 MSG targets and trends Local Intelligence Support Team (LIST), January 2024 Page 221 of 316
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Data completeness Source: MSG data release Dec-24, PHS 2Page 222 of 316
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Data Sources 3 2020/21 MSG Targets • Source: MSG data release v1.69, Dec-24; Public Health Scotland • These are official monthly figures released by PHS and will be nationally published (some data is provisional and not yet published) • Next data release: TBC Page 223 of 316
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A&E Attendances Source: MSG data release Dec-24; data published up to Sep-24 4Page 224 of 316
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Emergency Admissions Source: MSG data release Dec-24; data published up to Jun-24 5 Page 225 of 316
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Unplanned Bed Days - Acute Source: MSG data release Dec-24; data published up to Jun-24 6Page 226 of 316
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Delayed Discharges Occupied Bed Days (18+) Source: MSG data release Dec-24; data published up to Sep-24 7Page 227 of 316
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End of Life - Percentage of Last Six Months Spent in Large Hospitals Source: MSG data release Dec-24; data published up to 2022/23 8Page 228 of 316
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3rd February 2025 This report has been created using OutNav developed by Matter of Focus. IJB Strategic Governance Map Midlothian Health and Social Care Partnership Page 229 of 316
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Page 2 of 19 Contents 1. IJB Strategic Commissioning – pathway progress 2. IJB Strategic Commissioning - detailed findings 3. IJB Strategic Commissioning - sources and success criteria 4. Our evidence standards Page 230 of 316
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Page 3 of 19 IJB Strategic Commissioning - pathway progress Page 231 of 316
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Page 4 of 19 IJB Strategic Commissioning - detailed findings What they learn and gain Assurance that our services are safe, effective, aligned to our strategic priorities and continually improving Progress: Some Confidence: High Midlothian IJB has asked Midlothian HSCP to invest in the infrastructure to provide assurance that services are safe, effective, aligned to strategic priorities, and continually improving. Change management is complex and challenging. The implementation of this work has continued in a planned, measured, and proportionate way alongside the ongoing challenges created by whole system operational pressures. Midlothian HSCP and Quality Management Midlothian HSCP has made some progress towards a Total Quality Management approach. This has included expanding and iteratively improving a robust, integrated Governance and Assurance framework through the Governance and Assurance Framework (Activity), understanding population data through the IJB and HSCP performance frameworks (Experience), and evaluating our progress towards improving personal outcomes through outcome mapping (Outcomes). The relationship between the Governance and Assurance Framework (GAF) and the improvements in the Clinical and Care Governance (CCG) structure and assurance process continue to provide a strong basis for assurance in operational activity as part of the organisational Quality Management System. The IJBs ambition is to ensure we can take as much assurance as possible from data, knowing that data sets may not be complete during the phased approach to implementation. This resulted in Planning and Performance working to develop and adopt a triangulation approach that has not yet been implemented across all services. Page 232 of 316
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Page 5 of 19 Triangulating outcomes, activity, and experience Performance measurement of health and care services is frequently asked to report based on siloed examination of single sources of output data: number of referrals, waiting times, budget. Connecting system-wide qualitative and quantitative data has helped us better identify organisational themes and dependencies. The Midlothian HSCP Planning, Performance and Improvement Team recognised the limitations of both local, internal, subjective measures, and the inappropriate reliance on hospital-based metrics to demonstrate the impact of primary, community and social care. In order to reduce any disproportionate focus created by reliance on a single source, we are working to routinely consider our data across outcome, activity, and experience. Midlothian IJB Approach to Triangulation Page 233 of 316
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Page 6 of 19 OutNav (outcomes) Using OutNav to help services tell their story of how they are making a difference is one part of our approach to provide robust assurance across all our activities both strategically and operationally. Some of the challenges have been due to the fundamental differences between being outcome led and outcome focused, as well as the predictable variation across services undertaking redesign or transformation planning. During the first phase, we took an iterative learning approach starting with a test of change in 3 areas and then building the number of areas using OutNav. This work has continued with more services now onboarded to OutNav, and a number of areas are using this information to better inform service redesign that is person-led. This includes one of the services that MIJB hosts on behalf of all four NHS Lothian HSCPs. This work has been recognised nationally as innovative and sector-leading, and the officers of Midlothian HSCP were invited to present the learning at the Oxford University Social Outcomes Conference in 2023. The further development of this approach continues to be of interest, and Audit Scotland featured this work as a case study, published in Summer 2024. However, it has not been possible to progress as anticipated, in part due to service capacity limitations. This will be taken forward as part of the Performance and Improvement Team’s 2025 action plan to further improve HSCP and IJB reporting. Currently 16 service areas are actively using OutNav and 17 Heatmaps are underway or completed, including updates of the Strategic Commissioning Map for Columns 3, 4 and 6. Regular (quarterly) updates will continue in alignment with agreed SPG and IJB reporting timelines. A system that continually improves is able to demonstrate this with evidence that is collected, analysed and synthesized using a consistent approach. This allows greater confidence both in what we know, and what we don’t know. The work undertaken by the Planning, Performance and Improvement Team to apply this approach during 2024/25 has created a much better understanding of where improvement has occurred, and where there are opportunities to do more. This more detailed knowledge will support the services to target their improvement activities in the areas where they can create the greatest return. The Performance and Improvement Team's 2025 action plan to provide enhanced support to services and increase and improve the utilisation of OutNav would improve service activity reporting, progress and achievements including outcome tracking, support quarterly service reporting to Partners, and provide a mechanism to consistently describe the service's approach to continual Improvement This work has also contributed to the digital transformation agenda: rather than digitising an existing process, the use of the OutNav digital platform has enabled us to work in entirely new and innovative ways. OutNav acts as an integrated electronic ‘library’, where information and evidence from both employing partners and the third sector can be held. The aggregation of data provides an elegant solution to the challenge of elevating service reporting at system and strategic levels, and has enabled us to generate and connect new types of information and insight. Page 234 of 316
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Page 7 of 19 The Midlothian HSCP Integrated Governance and Assurance Framework (Activity) The Midlothian HSCP Governance and Assurance Framework (GAF) is aligned with the now established local model for Clinical and Care Governance (CCG). Midlothian IJB has asked the HSCP to provide assurance on its governance in four distinct governance areas: Safe, Effective, Person-Centred, and Regulatory. The HSCP developed the GAF to allow those responsible to clearly and consistently articulate assurance levels for their service areas by providing evidence of actions taken to address any outstanding issues. The NHS Lothian Digital Innovations Team have continued to iteratively develop the GAF App, based on user experience feedback from across HSCP services. Changes have been made to improve functionality, as well as more accurately reflecting the service area and group service structures within the HSCP. At Q2 of 2024/25, the GAF status was summarised in the dashboard visualisation below: In comparison with the first reporting quarter using the GAF, the proportion of High compliance submitted has increased by 15 percentage points. Our confidence in the strength of the evidence has increased as the number of services that are completing GAF quarterly returns and also updating OutNav on a quarterly basis increases. This is also an important element of how we can better understand the relationship between strategy, operational strategic planning, and operational activity. This is central to the commission Midlothian IJB has given the HSCP, and the driver for developing these new mechanisms to better understand the health and social care contribution to the wider system. Page 235 of 316
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Page 8 of 19 The work to map the GAF to the correlating sections of OutNav has not yet progressed to the extent of the original ambition. The Planning, Performance and Improvement Team will be taking this forward as a key activity in 2025/26, to better understand how this information can be used to support services in the measurement, evaluation and future planning of both the governance of activity, and the evidence they can use to describe their contribution to improving outcomes. Population Data (experience) To complete a credible mechanism for the reporting of experience using population data, we have selected a number of key national, externally validated indicators focusing on those that relate to the services we provide. This includes indicators for life expectancy & mortality, behaviours, mental health, ill health and injury. We have selected Healthy Life Expectancy as the primary indicator as it aligns with the strategic vision of people in Midlothian living longer, healthier lives. The additional indicators are: • alcohol-related hospital admissions • alcohol-specific deaths • drug-related hospital admissions • drug-related deaths • hospital admissions attributed to smoking • deaths attributed to smoking • hospitalisation for people with COPD • deaths from COPD • cancer registrations • lung cancer deaths • deaths from suicide Page 236 of 316
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Page 9 of 19 • percentage of the population who are prescribed drugs for anxiety / depression / psychosis • emergency hospital admissions. These indicators can be disaggregated by Scottish Index of Multiple Deprivation (SIMD) data zones to demonstrate variation in the impact of health inequalities. It can take several years, sometimes decades, to achieve improvements to population health and this triangulation will allow us to understand the contribution our services make towards people being able to live longer, healthier lives over time. We continue to monitor these indicators each year, to build our understanding of how outcome-focused service activities contribute to change at population level. We understand there are a number of other factors to be considered (income, housing, education) so we are targeting our analysis in the areas where our community teams can have the greatest impact. Triangulation report and gap analysis of outcome, activity and experience Work has begun to build a dashboard visualisation of where this triangulation process can highlight areas where we can see strong correlation or agreement between related data, and areas where we might be more curious to why the data is not telling the story we would expect. This may be in relation to quality assurance but is more likely to be areas of learning that may be applicable across the system and support change at scale pace. This is currently a work in progress and can only be done for service areas where they are submitting data and evidence for both OutNav and the GAF. Internal Audit Review of Directions and the links to Operational Plans As part of the 2024 Internal Audit of Directions, the operational plans of Midlothian HSCP were reviewed to provide assurance on the strategic alignment of these plan to the Midlothian IJB Directions. A recommendation of the audit was for Midlothian HSCP to improve how services articulate the links between Directions and service planning and redesign. This is anticipated to will be significantly easier to demonstrate in 2025/26 as the governance of the IJB has matured and coincides with the development of a new strategic plan, aims, and sub aims that support the connection to Group Service planning. The evolution of the performance reporting hierarchy requires a solid parallel hierarchy of planning. The IJB’s Strategic Plan clearly sets out the Strategic Aims, under which sit a number of Sub Aims. These Aims are collectively used to inform the creation and agreement of Directions, which the IJB issue to NHS Lothian and Midlothian Council and form a key part of operational planning. The Directions are used to set Group Service Objectives, from which Service Objectives are agreed. These objectives are set out in annual Service Plans, using a consistent HSCP-wide integrated template that includes workforce, Page 237 of 316
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Page 10 of 19 finance, service activities, measures and data sources. The Service level actions provide the foundation for Team Plans, which are then used as the basis for the annual setting of individual staff Objectives. These are captured, monitored and evaluated annually in TURAS or MPM, depending on which partner the staff member is employed by. Implementing this multi-level, integrated, consistent approach to planning across the HSCP in 2025/26 is anticipated to reduced unwarranted variation that has limited reporting in the past. We hope that this will provide greater confidence and connection between individual staff activities and the Strategic Aims of the IJB, and support the approach of measuring and aggregating contributions at all levels. The governance process and links from strategic plan to Group Service planning are set out in the schematic below One outstanding internal audit recommendation remains and this is to evidence the connection between IJB Directions and operational planning. This will be reviewed by the Executive Business Manager in May 2025 Page 238 of 316
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Page 11 of 19 Whole System Learning Midlothian IJB knows that having well governed strategy and performance is not the same as understanding the relationship and impact of connection and relationship between all the parts of the system. The Board has asked the HSCP Planning team to visualise how the considerable work around strategy, planning, performance, and governance links to the primary goal of creating a clear connect between strategy, operational strategic planning and operational delivery. The figure below shows how the individual pieces of strategic planning, performance and governance are linked in a multi-triangulation approach. As operational services continue to report, learn and improve using the Midlothian HSCP Integrated Governance and Assurance Framework and recording the service contribution to personal outcomes, the data will mature and support insightful and impactful whole system analysis and review. Page 239 of 316
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Page 12 of 19 Assurance and oversight on the progress towards achieving our Directions Progress: Some Confidence: High Midlothian HSCP has made significant developments in 2024-25 that provide the IJB with high-quality assurance and oversight of progress towards achieving our Directions. The process of gathering, reviewing and synthesising this information is now more robust, which is reflected in the 'High Confidence' in the available evidence rating. The Directions Report 2024/25 is a synthesis of the information provided by, Service Managers, Heads of Service, and Professional Leads on service plan progress updates mapped to the appropriate Directions. To create this synthesised insight report, the Performance and Improvement Team created an Excel record of submissions, and examples of best practice were extracted from the service plan progress updates and assessment of collective progress towards achieving each Direction was completed collaboratively by the Performance Manager and Integration Manager, noting progress and highlighting examples of best practice. Where evidence has been provided, we have high confidence in what it is telling us. However, despite an improved integrated planning and reporting process, there are places where data is incomplete. In many cases, this is likely to be due to capacity pressures. In line with our criteria for assessing confidence in our evidence, we have accessed multiple sources of evidence for progress with a balance of types of evidence including quantitative measures and qualitative data and our approach to the analysis has been clear and replicable. IN combination with the new strategic plan aims and sub aims linking to the 9 National Health and Wellbeing Outcomes and Draft Directions 2025/26, both the planning support mechanisms, the process for drawing together assurance and oversight information will support increasingly robust assurance as the processes mature. The priority going forward will be to build in reliability by ensuring that the reporting is undertaken consistently and comprehensively across all services, so that we can reach a point of greater confidence in the collective analysis. Summary of progress towards the Directions Detailed progress towards achieving our Directions is broken down in the Directions Report and the Directions Log. In summary: • 8 Directions for 2024-2025 are considered complete • 19 Directions for 2024-25 have been revised and will continue to 2025-2026 • 1 Direction is recommended to be revoked. Page 240 of 316
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Page 13 of 19 Completed Directions Overall, 8 Directions were assessed as complete in 2024/25. Evidence was provided from across integrated health and social care, forming the basis of these assessments. As an example, Direction 7.2 was issued to ensure that where there is a statutory responsibility to manage harmful behaviours, all functions must communicate the impact of action taken to maximise people's safety in our communities. Services were asked to submit evidence of how they were working towards National Health and Wellbeing Outcome 7: Safe from Harm. The Community Justice Team provided an update relating to the delivery of their Community Justice Outcome Improvement Plan, which includes: • Protecting the public through effective interventions and scrutiny via Multi-Agency Public Protection Arrangements • Ensuring all staff are trained on relevant risk assessment materials • Updating Risk Assessment & Management Guidance for approval by the Social Work Assurance Group. Though the implementation of this plan, justice services are supporting early and effective intervention and in accordance with National Outcomes and Standards, working collaboratively to ensure that people are protected from harm in accordance with Adult Support and Protection procedures. This includes ongoing review of effective practice and what works in reducing offending. There will be additional learning that can be drawn from the examples of good practice highlighted in the table and discussed in more detail in the Directions report, which could support the ongoing processes of continuous improvement for other services. Directions to be continued/revised 19 Directions were assessed as requiring to be continued. These include Directions where there are changes to completion dates, or where two or more Directions have been combined as appropriate. Directions may be continued because a longer period of time and / or additional capacity is required to make sufficient progress, or because they are considered to be supporting an ongoing strategic priority. As an example, some progress has been made towards Direction 8.2, to support the delivery of the Midlothian HSCP Integrated Workforce Plan 2022-25. Midlothian HSCP has engaged with Scottish Government to review the national guidance and develop a workforce plan and template for submission in March 2025. However, the work required to develop a suite of tools to support service level workforce planning by providing specialist input and data has not been able to be taken forward due to the loss of the Workforce Lead post as a result of a Financial Recovery Plan and service review. Page 241 of 316
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Page 14 of 19 Directions recommended to be revoked Direction 1.2 was issued with the aim of reducing the medicalisation of non-medical issues. Whilst this is still a valid ambition in its broadest sense, the ability to make significant progress in 2024/25 has been limited by the extreme pressures facing the whole health and care system. This is in part due to the increased degree of complexity and acuity that people are experiencing when they are unwell and requiring support, usually requiring some medical care alongside other types of support. Since these pressures are predicted to continue, it is unlikely that 2025/26 will provide the additional capacity required to make improvements in this area. Whole System Learning As part of the Directions reporting process, opportunities to consider where the IJB could take corrective action have been reviewed by the HSCP Executive Leadership team and the Strategic Planning Group before being presented to the Board. Key areas identified for 2025/26 were 1. Self Management support and the provision of quality information 2. Digital innovation 3. Integrated Population Data 4. A revised bed base model 5. Whole System Transformation Planning Page 242 of 316
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Page 15 of 19 IJB Strategic Commissioning - sources and success criteria This table lists the sources of evidence and success criteria that we have referred to whilst developing the analysis presented in this report. What they learn and gain Stepping Stone Source Assurance that our services are safe, effective, aligned to our strategic priorities and continually improving Governance and Assurance Framework Outcome, activity and experience gap analysis OutNav Onboarding and Update Report OutNav reports Triangulation report (population data, OutNav and GAF) Success Criteria All services have assessed progress towards outcomes relating to our Strategic Aims in OutNav The HSCP Service Plans are clearly aligned to our strategic aims Page 243 of 316
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Page 16 of 19 We have complete data on the HSCP Governance and Assurance Framework We have completed a Gap Analysis and produced an Annual Triangulation Report We have data and evidence from the biannual Integrated Assurance Report Assurance and oversight on the progress towards achieving our Directions MIJB full year Directions update MIJB Part year Directions update Performance Assurance and Governance Group Agendas Strategic Planning Group Agendas and Minutes Success Criteria We have identified our opportunities for action (do more, do less, do differently) We have Part Year, and Full Year Update Reports on the progress made towards our Directions Page 244 of 316
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Page 17 of 19 Our evidence standards PROGRESS STATEMENT CRITERIA Great progress • Enough people and groups experience this in the timescale you have defined • Risks have been mitigated and assumptions achieved Some progress • Some people and groups experience this in the timescale you have defined • Some risks have been mitigated and some assumptions achieved Low progress • Not enough people and groups experience this in the timescale you have defined • Risks have not been mitigated and assumptions found to be unrealistic CONFIDENCE ASSESSMENT CRITERIA High confidence Most of these criteria apply • more than one source of evidence with appropriate balance of types • evidence collected purposefully and for this purpose • reasonable number of responses • no disagreement between evidence sources • backed up by other research • analysis is clear and purposeful (someone else could replicate and get broadly the same results) Page 245 of 316
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Page 18 of 19 Some confidence Some of these criteria apply • more than one source of evidence with appropriate balance of types of evidence • evidence is collected purposefully and for this purpose • reasonable number of responses • no disagreement between evidence sources • backed up by other research • analysis is clear and purposeful (someone else could replicate and get broadly the same results) And / or • there is some disagreement or lack of clarity of the findings • the data is mostly gathered opportunistically Low confidence Few of the above criteria apply AND / OR • there is disagreement within the data • assessments are based solely on an individual's perspectives Page 246 of 316
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Page 19 of 19 This report has been created using Developed by Matter of Focus. OutNav supports initiatives with a vision for social change to understand and track how their work makes a difference. The cloud-based tool enables teams to apply a practical and meaningful approach to outcomes-focused monitoring and evaluation, developed by Matter of Focus. https://www.matter-of-focus.com Page 247 of 316
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Midlothian Integration Joint Board Directions 2024/25 Year End Report Page 249 of 316
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2 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. No Direction Performance Measures Measure Update Source 1.1 All functions delegated to Midlothian IJB must demonstrate through service planning and reporting how they have increased collaborative and integrated working that improves population health and wellbeing, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% Service Reports includes evidence of collaborative and integrated working to improve population health. Community Nursing Continual review of Community Treatment and Care Centre model (CTAC) to effectively manage and support patients with long term/chronic conditions in the community. Reduction in timed phlebotomy appointments creating greater capacity. Standardised appointment times across all CTAC practices creating greater capacity. GP APP / MSK Physio Liaison with Thistle foundation for Pathway for chronic pain patients within lifestyle management classes +/- physio input: Discussion and training for facilitators regarding chronic pain, and joint working with pharmacy. Planning, Performance & Improvement Develop the ability to explore potential data sets that provide evidence of the impact of prevention and early intervention activities at HSCP population level: This has not progressed due to reduced capacity following organisational change restructure. HSCP Service Reports Midlothian IJB Directions 2024-25 Page 250 of 316
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3 Business Support and Administration Create and publish alongside the next Strategic Plan, the IJB Market Facilitation Plan, that meets statutory guidance of The Public Bodies (Joint Working) (Scotland) Act 2014: Framework was completed and presented at Strategic Planning Group on 28th November 2024. This plan will continue to develop in 2025 alongside work on local commissioning. 1.2 To support proactive population approaches to health, wellbeing and wellness, all delegated functions should ensure service planning demonstrates reduced medicalisation of non- medical issues, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of Service Plans supports reduced medicalisation of non-medical issues. Health Visiting Universal Health Visitor Pathway delivered in full with correct allocation of Health Plan Indicators: Consistent number of meetings taking place Good engagement from Partner agencies 114 GIRFEC meetings with Child Plans in 2023 Discuss and promote vaccine uptake with parents when indicated in the Universal Health Visiting Pathway and during immunisation appointments: Midlothian regularly meets the PHS target of 95% for routine childhood vaccination programme. Planning, Performance & Improvement Develop analytical function to provide data to support a transformed health and social care model designed around how people live their lives, including linking new data sets to create new data intersections, and identifying the most frequently occurring clusters of need in Midlothian: This has not progressed due to reduced capacity following organisational change restructure. HSCP Service Reports Page 251 of 316
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4 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. No Direction Performance Measures Measure Update Source 2.1 All functions delegated to Midlothian IJB must evidence the connection with communities, partners, and use of technology to improve self- management and self-monitoring, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% Service Reports includes evidence of connection with communities, partners, and use of technology to improve self- management and self-monitoring. Mental Health Easily accessible information and self-help information on mental health: delivery of Midspace. All commissioned services have completed end of year reviews. In-depth service review requests sent to all commissioned services. Tenders of all commissioned services end June 25, which will await evaluation of requested service reviews and stakeholder feedback. Planning re-tendering of service options in partnership with contracts and commissioning. Learning Disability CAT and Cherry Road service reviews complete – implementation plans to be developed. Transitions Policy Development and Implementation in progress. Progress transformational actions identified by care providers not started. Progress has been delayed due to wider work on budget management. Newbyres Care Village Develop and implement a framework for maximising occupancy rates: Full occupancy still to be reached. 5 vacancies at time of reporting. Assessments being completed to maximise occupancy and waiting lists updated weekly. Support staff to ensure that initial care home reviews are completed within 6 weeks of admission to care: Initial reviews are being completed promptly within the timescales. Currently a large proportion of care home reviews are completed by community care assistants. HSCP Service Reports Page 252 of 316
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5 2.2 All functions delegated to Midlothian IJB must ensure service planning describes a clear process to ensure fair access, by January 2025. By January 2025, Midlothian HSCP will provide assurance of progress towards actions as detailed in the Midlothian IJB Mainstreaming Equalities Report & Action Plan 2023- 25. Health Visiting Improve the breastfeeding rate in Mayfield and Easthouses by providing co-ordinated Breast-feeding support including peer support: Raised awareness and increased the number of BF friendly spaces (Mayfield, Easthouses, Pathhead) Mental Health Increase access to individuals aged 65 + who require support for mental health and wellbeing including DBI: Soft launch of 65+. Physical Disability & Long Term Conditions Clear and accessible information is available about the Service role, remit, and access: Introduction of letters / communication sent to people when they are referred in to explain processes. Discussions have taken place with Project Lead but unclear if financial commitment is available. Guidelines continue to be sent out to people, including elected members, to support their understanding. Meeting has taken place with local MSP Team. Care At Home Reduce the number of people waiting on the community waiting list for a package of care by regular review: Community list coming down gradually. Increase the number of clients having a completed future care plan in place: The template for the plan is completed and signed off. Page 253 of 316
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6 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected No Direction Performance Measures Measure Update Source 3.1 All functions delegated to Midlothian IJB will contribute to the IJBs ability to describe activity, experience, and outcomes. This includes developing outcome mapping, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% Service Reports includes evidence of the development and use of outcome mapping. Physical Disability & Long Term Conditions The Service is onboarded into OutNav and Service OutNav information updated. Greater information been recorded on ‘Outcomes achieved’ with patterns emerging. Planning, Performance & Improvement Support the onboarding of services to OutNav: Some progress has been made relating to onboarding, but this has been restricted by service capacity limitations. This will be taken forward as part of the Performance and Improvement Team’s action plan to further improve HSCP and IJB reporting. Complete regular (quarterly) updates of Strategic Commissioning Map: Complete for Columns 3 & 6 @ Q2 24/25. Regular updates will continue in alignment with agreed SPG & IJB reporting timelines. This work has also contributed to the digital transformation agenda: rather than digitising an existing process, the use of the OutNav digital platform has enabled us to work in entirely new and innovative ways. OutNav acts as an integrated electronic ‘library’, where information and evidence from both partners and the third sector can be held. The HSCP Service Reports Page 254 of 316
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7 aggregation of data provides an elegant solution to the challenge of elevating service reporting to system / strategic level, and has enabled us to generate and connect new types of information and insight. 3.2 All relevant functions delegated to Midlothian IJB must develop and demonstrate an increase in the effective and proactive outreach to people living with frailty, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports includes evidence of proactive outreach to people living with frailty. No narrative provided. HSCP Service Reports 3.3 All functions delegated to Midlothian IJB should review practices and further develop person- centred approaches to support recovery including The Midway and Good Conversations approach, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of Service Reports includes evidence of review of practices and further developments in person- centred approaches to support recovery including The Midway and Good Conversations Approach. Physical Disability & Long term Conditions Midway and Good Conversations are embedded into the language and ethos of the Service. Some staff still waiting for Good Conversations training. Good Conversations and Midway discussed in Team Meetings and Supervision. More work requires to be undertaken around Outcomes and Outputs. HSCP Service Reports Page 255 of 316
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8 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. No Direction Performance Measures Measure and metric Update Source 4.1 NHS Lothian and Midlothian Council must ensure accessible feedback mechanisms for all people and communities by January 2025 in order to develop innovative, integrated service offers and supports. By January 2025, all NHS Lothian and Midlothian Council feedback mechanisms meet accessibility legislative requirements. Justice Reduce the use of remand and short-term sentences by maintaining provision of quality interventions for the benefit of service users and the local community. Monitor the number of Community Payback Orders imposed and the number successfully completed. Gather feedback from Service users / consultations. Monitor the number of people achieving a positive destination: On target – based on information for 23-24. Business Support and Administration Implement the recommendations and improvements identified in the 2023/24 Internal Audit review of the Scheme of Publication including: • The Registers of Interests for Board members should be uploaded to the IJB website and linked through the documented Model Publication Scheme (MPS): Not completed – the Standards Officer has not gathered Register of Interest forms from all Midlothian IJB members. • Public Engagement Statement should be reviewed and made available on the Midlothian IJB website and linked through the documented MPS: Not completed – the Public Engagement Statement will be reviewed in 2025. HSCP Service Reports Page 256 of 316
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9 • Financial information needs to be appropriate and accessible both online and through the documented MPS: Complete. • Guidance needs to be included within the documented MPS and online advising the public on how to submit freedom of information requests: Complete. • Information available online needs to be linked to the relevant class within the documented MPS: Complete. • The Scottish Information Commissioners self-assessment checklist needs to be used to assess against current activity and practice: • Improved service information provision: Not complete. • An IJB / HSPC style guide and robust development, review, approval, monitoring and updating process for all published information (printed and electronic): Complete. Planning, Performance and Improvement The Healthcare Improvement Scotland Community Engagement Self Evaluation was completed in collaboration with a range of stakeholders, and the Action Plan will be presented to SPG on 27th February 2024. Performance and Improvement Explore opportunities for data linkage with third party providers, the voluntary sector, and academic institutions, including comprehensive review of data sharing agreements and opportunities: Early discussions have taken place with the University of Edinburgh, to begin to scope a potential collaboration in relation to population level data prediction and modelling. Page 257 of 316
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10 4.2 In order to maximise opportunities to improve personal outcomes, all functions delegated to Midlothian IJB should ensure that the principles of self- management are embedded in service delivery design, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of Service Reports includes evidence of the principles of self- management being embedded in service delivery design. Physical Disability and Long term Conditions The Service has appropriate and accessible feedback mechanisms in place using online and paper feedback forms, the completion of Mosaic ‘End Involvement’ pages and feedback form evidenced via Service Quarterly reporting. Data from feedback surveys and End Involvement continue to grow with themes emerging around Eligibility Criteria when we have not supported people to achieve outcomes. HSCP Service Reports 4.3 All relevant functions delegated to Midlothian IJB should evidence how they are sharing information about Self Directed Support (SDS) options, and recording changes in uptake, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of sharing information about, and evidence of changes in uptake of, Self Directed Support (SDS) options. Learning Disability Implementation of SDS Standards: Plan being rebaselined due to impact of transitions workstream. HSCP Service Reports Page 258 of 316
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11 5 Health Inequalities Health & social care services contribute to reducing health inequalities. No Direction Performance Measures Measure Update Source 5.1 NHS Lothian and Midlothian Council must ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring • systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics • health and social care workforce are suitably trained and skilled to gather and input this data, and • data quality assurance, by January 2025. By January 2025, HSCPs have timely, credible, disaggregated data to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. By January 2025, Midlothian HSCP will provide assurance that 100% of the appropriate health and social care workforce are suitably trained and skilled to gather and input this data. Health Visiting Ensure specific service provision and signposting for families who have children with Additional Support Needs Specialist immunisation clinic in place for children with ASN. Performance and Improvement To support new system-wide approaches, by reducing the reliance on legacy silo data and generating new data intersections that are collected, connected, and visualised: Created information governance infrastructure across partner organisations; Tested linkage of data from multiple systems (internal and external); Designed visualisation. Significant progress has been made and approval has been secured for the DPIA & DSA for the MidCare dashboard as prototype / proof of concept. Next steps: integrated workforce data and discrete priority dataset development. HSCP Service Reports Page 259 of 316
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12 By January 2025, Midlothian HSCP will provide assurance that 100% of services have data quality assurance processes and structures in place. Planning, Performance and Improvement Begin work on developing a refreshed set of equality outcomes and the development of a new mainstreaming equality report and action plan 2025-29: Work is underway and draft outcomes are currently out for public consultation. 5.2 NHS Lothian and Midlothian Council must explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by January 2025. By January 2025, a Joint Plan will be in place that describes the priority actions agreed between NHS Lothian and Midlothian Council. Progress towards this Direction continues to be significantly restricted by the vacant post of Digital Programme Lead. HSCP Service Reports Page 260 of 316
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13 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. No Direction Performance Measures Measure Update Source 6.1 All functions delegated to Midlothian IJB that aim to move care from hospital to home should ensure service planning considers the impact of this on unpaid carers, and evidence appropriate supportive actions, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support consideration of the impact on unpaid carers of the movement of care from hospital to home; and include evidence of planned appropriate supportive actions. Learning Disability Carers Strategy – update: revised 2025/28 plan in progress. Assurance carers’ services meet needs of unpaid carers: Report received, but further work required to define RAG scales for report. Physical Disability & Long Term Conditions Adult Carer Support Plans should be offered to all appropriate carers for people transferring out of hospital. Changes have been made to Mosaic which will enable information to be gathered relating to the number of support plans offered. Work is being done by the Carers Planning Officer to improve uptake. The Carers Planning Officer has met with the Team to discuss Mosaic changes. HSCP Service Reports 6.2 Explore and define the demand for and the benefit of a Midlothian Care and Support Co-operative in order to provide a platform that facilitates brokerage of personalised support for carers, identifies local assets, and enhances local economic value by January 2025. By January 2025, a Midlothian Care and Support Co-operative will be established. Discussions have taken place regarding the development of a Carers Co- operative. In the context of ongoing budgetary challenges, further discussions are required regarding the prioritisation of carers funding. Page 261 of 316
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14 7 Safe from Harm People using health & social care services are safe from harm. No Direction Performance Measures Measure Update Source 7.1 All relevant functions delegated to Midlothian IJB must explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to traditional referral pathways, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support exploration and evaluation of the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to a traditional referral pathways. Physical Disability & Long Term Conditions No work has been undertaken in relation to R4A model as it is felt this needs to be system wide rather than by only one service. Work has started to review how people refer into the Service. Work is also being undertaken to review the information provided to people on our web page, to make this process more straightforward and clear for them. HSCP Service Reports 7.2 Where there is a statutory responsibility to manage harmful behaviours, all functions must communicate the impact of action taken to maximise people's safety in our communities, by January 2025. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of the impact of action taken to maximise people's safety in our communities. Justice Deliver a model of partnership working through Community Justice Outcome Improvement Plan: On target. Report submitted for 23-24. Protect the public through effective interventions and scrutiny via Multi-Agency Public Protection Arrangements: All staff trained on relevant risk assessment materials. Risk Assessment & Management Guidance updated and presented to Social Work Assurance Group for sign off. Justice services provide services that support early and effective intervention and in accordance with National Outcomes and Standards. HSCP Service Reports Page 262 of 316
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15 Services work collaboratively to ensure that people are protected from harm in accordance with ASP procedures. Ongoing review of effective practice and what works in reducing offending. Implementation of new initiatives: On target 7.3 All relevant functions should improve the people who use substances’ understanding of their rights and responsibilities in relation to supported self-assessment and risk management, by January 2025. Services should evaluate the relationship between this work and any reduction in harm or improvements in personal outcomes. By January 2025, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence improvements to the people who use substances’ understanding of their rights and responsibilities in relation to supported self- assessment and risk management, and support evaluation of the relationship between this work and any reduction in harm or improvements in personal outcomes. MELDAP Ensure the provision of Medication Assisted Treatment is safe, effective and of high quality All people accessing services have the option to start appropriate treatment Medication Assisted Treatment (MAT) from the same day of presentation. Number of people seen within 21 days target. Q1 – 98.44% Q2 -98.11% HSCP Service Reports Page 263 of 316
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16 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. No Direction Performance Measures Measure Update Source 8.1 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the integrated Midlothian HSCP Staff Engagement Plan 2023-24. By January 2025, Midlothian HSCP will provide assurance that the HSCP Staff report: increased levels of engagement with their work, and increased confidence in their abilities to continuously improve the information, support, care and treatment they provide. Learning Disability All LD staff on track to complete mandatory training. LD iMatter reports completed. GP APP / MSK Physio TURAS completion > 80% by end of Dec 24. I-Matters feedback :green for supervision section. LearnPro stats: > 80% complete achieved. All staff LearnPro updated with role essential as per MSK subgroup work: All sitting at > 90% Newbyres Care Village Support employees to access relevant training appropriate to their role i.e. Supervision, Management and Leadership, ASP, Mental Health Officer, Practice Education and Social Work Traineeship. Record number of staff undertaking post qualifying training in this academic year. HSCP Service Reports 8.2 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Workforce Plan 2022-25. Midlothian HSCP will provide assurance on the progress towards the objectives of the Midlothian HSCP Integrated Workforce Plan 2022-25 actions delivered. Mental Health Engaged in work force planning meeting both local and pan Lothian. Engaged with the development of the reduction in working week. Commenced safe staffing huddle Completed professional safe staffing. Band 5 nursing review commenced. HSCP Service Reports Page 264 of 316
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17 Newbyres Care Village Undertake a staffing review across Social Work and Occupational Therapy to establish a model for good practice (hospital in reach service team). Project group established. Commence consultation with staff members affected by the review. Policy and procedure review commenced Learning and Development Practitioners working closely with Team leaders and service managers to regularly review and monitor the learning and development frameworks to ensure all relevant training is captured in the frameworks in line with updated legislation and social policy: All frameworks have been updated for 2025. Planning Lead the development of an HSCP Integrated Workforce Plan: Engaged with Scottish Government to review guidance and develop workforce plan and template. SPG 16th Jan 2025 and IJB 20th Feb for March 17th submission to SG. Additionally a benchmarking position report was presented to Midlothian IJB on 22nd Aug 2024 to set out the current position in relation to the IJB’s duty to comply with the Health and Care (Staffing) (Scotland) Act and the planning and securing of care delivered by a third party. Performance and Improvement Support the development of an HSCP Integrated Workforce Plan by providing specialist input and data: Page 265 of 316
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18 As the DSA is not yet in place, a manual extraction of the required data from employing partner single systems (itrent and Tableau) has been completed, to populate separate visuals. Support the development of a suite of tools to support service level workforce planning by providing specialist input and data: No progress due to loss of Workforce Lead post in organisational change service review. Page 266 of 316
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19 9 Use of Resources Resources are used effectively and efficiently. No Direction Performance Measures Measure Update Source 9.1 NHS Lothian should maximise opportunities to work collaboratively across Lothian to design an approach and methodology to better understand and evidence the use of the set aside budget and associated services by HSCP area. This should include mechanism to better understand the impact of community prevention and early intervention activity across the whole system. HSCPs are provided with consistent, clear information relating to the use of the set aside budget and associated services. HSCPs can provide consistent, clear information to demonstrate the impact of community prevention and early intervention activity across the whole system. By January 2024, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of Best Value. By year-end 2023-24, 2024-25, and 2025-26, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Reports include evidence of meeting annual cost efficiency targets. GP APP / MSK Physio Reviewed devices licenses and stopped all those out of use. Justice Staff are confident in assessing needs and resources are provided in line with assessment against the eligibility criteria and statutory obligations: Discussion with Head of Service and Finance regarding grip and control measures. Eligibility Criteria has been revised and updated to provide clarity. Ongoing discussion with Team Leaders re assessments and requests for packages of care. Grip and control measures implemented: Resource Panel decisions agreed by Service Manager. Exceptional costs require approval from Head of Service. HSCP Service Reports Page 267 of 316
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20 9.1.1 Following the 2023/24 review of the set aside budget, NHS Lothian should report to Midlothian IJB on a quarterly basis with performance and financial progress information 9.2 All functions delegated to Midlothian IJB must be able to demonstrate Best Value with evidence based data based on the operational ‘grip and control’ schemes developed for 2024/25. Midlothian IJB has agreed a series of recovery actions as part of its 2024/25 budget setting and expects these to be actioned. These are specifically: Planning Develop a joint approach between planning, performance, business, and finance to evaluate and articulate Best Value that supports the description of system resource and identify potential opportunities to invest differently: Matrix agreed by CFO and Integration Manager. Best Value Framework mapped in OutNav. HSCP Service Reports 9.2.1 Care at home provision should be realigned to a 20/80 split (internal 20%, external 80%) by October 2024. Completed. HSCP Service Reports 9.2.2 A 3% reduction in overall costs of commissioned arrangements should be achieved through a programme of transformational change in partnership with Midlothian Council and NHS Lothian by January 2025. Learning Disability Updated Contract Register (Compliant Contracts, Management of spot contracts): Register complete but definition of compliant contracts still under development. Migration to Scotland Excel Framework paused - migration on hold due to risk of increased cost. Decision to be taken on whether to proceed with this work. HSCP Service Reports 9.2.3 Newbyres Care Village must reduce agency usage and sustain operation within an established financial footprint by October 2024. Progress has been made to reduce agency staffing in 2024-25 with an average spend of £6,500 per week in comparison to £23,000 per week in 2023-24. Work is ongoing to further reduce this. HSCP Service Reports Page 268 of 316
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21 through recruitment measures and the rigorous application of sickness absence policies and procedures. Planning, Performance and Improvement To support a wider strategic review of Newbyres Care Village, a deep dive review into health and social are datasets was completed by Planning, Performance and Improvement. The Tableau dashboard has been created and is being held ‘in development’, pending the progression of DPIA and DSA. 9.2.4 Transport for service users must reduce in spend by £240,000 by October 2024. A Council-wide Transport Board has been established under the Business Transformation Blueprint work within Midlothian Council. As an interim measure, work was undertaken to review the current transport cost allocation methodology. This review resulted in the IJB spend reducing by £240,000. 9.2.5 Recurring staff-pay costs will reduce by £364.5k in Planning, Performance, and Programme service. Savings target achieved in full. Action complete. 9.3 All delegated functions will participate in review of service provision driven by a 5- year operational transformation programme to consider long term reform. This includes a change programme for 2024/25 to support achieving a balanced financial position. HSCP Transformation Programme The HSCP Transformation Programme Board was set up in in 2024 to review bed-based provision in Midlothian and a range of cost and productivity projects (grip and control) developed in addition to five specific Financial Recovery Action plans agreed by Midlothian IJB for 2024/25. Four of these specific areas agreed by Midlothian IJB in April 2024 formed part of Midlothian Council’s Transformation Blueprint programme; Commissioning, Newbyres Care Village, Care at Home services and Transport. The fifth Financial Recovery Action area specified was a service review of Planning, Performance and Programme. The work has been in two phases. Phase 1 : 2024/25 this work has supported the range of grip and control measures across the IJB. Some actions are complete and some continue in 2025/26. There are 23 current projects and project briefs as of December 2024. This programme links directly to the IJB Strategic Plan, the NHS HSCP Service Reports Page 269 of 316
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22 Lothian Strategic Development Framework (LSDF), Midlothian Council Single Plan, Midlothian (Joint Strategic Needs Assessment (JSNA). Phase 2: 2025/26 is now looking at longer term transformation projects. Further work has been undertaken on the development of the draft Transformation model which helps drive the direction of the work and to explain and underpin the changes proposed to take place across Midlothian. Performance and Improvement Contribute to a programme of work to create the conditions for whole system transformation, identifies priority actions in the 1-5, 5-10 and 10-15 years, and evaluate progress and effectiveness, by working with the Integration Manager to support whole system transformation through specialist performance and data management support: Data provided in relation to demographics (age), impact of housebuilding, potential shift in household profile, impact on NRAC / SIMD, and granular interrogation of Care At Home and Residential Care hours / cost trends over time. Contribute to an HSCP Strategic Enabler plan for 2024/25 that describes the role of the services that enable system change, the contribution of these essential system connectors, and how strategic, financial, and workforce planning aligns through a series of objectives and measures aligned to 4 strategic pillars; • Finance and Resource • Workforce • Business, Intelligence and Insight • Digital and Environmental Sustainability: This work was paused due to financial uncertainty and requirement for organisational change. The IJB may wish to consider how to ensure there is appropriate resource to meet the requirements of planned transformation, as these enablers are significant factors for success. Page 270 of 316
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23 9.4 NHS Lothian and Midlothian Council should report to Midlothian IJB on a quarterly basis on their decisions in relation to non- delegated functions that will impact on delegated functions. Discussions are underway with both NHS Lothian and Midlothian council can present meaningful updates on a biannual basis to Midlothian IJB. It is anticipated that this will form part of the Development Session programme overseen by the Integration Manager. Page 271 of 316
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Midlothian Integration Joint Board Thursday 20th February 2025, 14:00 – 16:00 Midlothian IJB Draft Directions for 2025/26 Executive summary This report acknowledges the Midlothian IJB Performance on Directions 2024/25 and proposes draft Directions for 2025/26 (appendix 1). Integration Authorities, have a legal obligation to both issue and monitor the effectiveness of Directions issued to Health Boards and Local Authorities as described in the Public Bodies (Joint Working) (Scotland) Act, 2014. Midlothian IJB Directions must be issued to the Chief Executives of Midlothian Council and NHS Lothian by 31st March 2025. The draft Directions 2025/26 are structed within the framework of the 9 National Health and Wellbeing Outcomes and linked to the 3 Strategic aims and 9 sub aims of the draft Strategic Plan 2025/35. These draft Directions have been developed utilising input from the Strategic Planning Group on themes generated by Midlothian HSCP Executive Leadership Team and engagement from both Partners. It is recommended that Directions for 2025/26 focus on the specific action required to achieve operational transformation and financial balance across the system. This approach allows Midlothian IJB to commission services and activity in new and innovative ways by reviewing mid-year progress and taking any decisions necessary to facilitate the whole system change required to deliver transformation. These Direction will be further reviewed by Board members in the upcoming 27th February 2025 Midlothian IJB Board Development session before final consideration at the Special Midlothian IJB Board on 27th March 2025. An internal Audit of Midlothian IJB Directions in 2024 returned with ‘Reasonable Assurance’ and noted high levels of compliance with Scottish Government Statutory Guidance (2020) on Directions. Members are asked to: • Review, discuss, and further develop the presented Directions for 2025/26 for recommendation to Midlothian IJB (appendix 1). Item number: 5.12 Page 273 of 316
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Midlothian Integration Joint Board Report Midlothian IJB Draft Directions 2025/26 1 Purpose 1.1 This report acknowledges the Midlothian IJB Performance on Directions 2024/25 and proposes draft Directions for 2025/26 (appendix 1). 1.2 A recommendation on whether a Direction from 2024/25 is complete, revised, or revoked is provided alongside where a new Directions for 2025/26 is proposed and illustrates the progression and evolution of the Midlothian IJB Directions 2024/25 into the draft Directions for 2025/26. 2 Recommendations 2.1 As a result of this report what are Members being asked to:- • Review, discuss, and further develop the presented Directions for 2025/26 for recommendation to Midlothian IJB (appendix 1). 3 Background and main report 3.1 Directions are how Integration Authorities action their strategic plan. In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act, 2014, Directions are the key mechanism by which Midlothian IJB’s strategic plan is actioned. 3.2 Directions are issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how functions delegated to the IJB and operationally managed predominantly by Midlothian Health and Social Care Partnership (HSCP) are to be delivered and funded via the integrated budget. Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. 3.3 Integration Authorities, have a legal obligation to both issue and monitor the effectiveness of Directions issued to Health Boards and Local Authorities. Midlothian IJB Directions must be issued to the Chief Executives of Midlothian Council and NHS Lothian by 31st March 2025. 3.4 In light of ongoing financial uncertainty financial outlook experienced across health and social care in 2024/25, it is recommended to ensure that Directions for 2025/26 focus on the specific action required to achieve operational transformation and financial balance. This approach additionally allows Midlothian IJB to commission Page 274 of 316
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Midlothian Integration Joint Board services and activity in new and increasingly innovative ways by reviewing mid-year progress and taking any decisions necessary to facilitate the whole system change required to deliver transformation. 3.5 The Midlothian IJB Draft Directions 2025/26 are structed within the framework of the 9 National Health and Wellbeing Outcomes and linked to the 3 Strategic aims and 9 sub aims of the draft Strategic Plan 2025/35. These draft Directions have been developed utilising input from the Strategic Planning Group on themes generated by Midlothian HSCP Executive Leadership Team and engagement from both Partners. 3.6 The origin of each Direction should be Midlothian IJB’s Strategic Plan. For the purposes of Directions 2025/26, and to facilitate the rapid transformation of health and social care, the ambitions of the draft Strategic Plan 2025/35 have been drawn on. This allows Directions to be mapped directly to the draft Strategic Plan and the opportunity in September 2025 to revisit Directions to ensure the Strategic Plan can be executed in totality. 3.7 The Midlothian IJB Draft Directions 2025/26 describe the main strategic activity that is anticipated to see positive change as quickly as possible and improve outcomes for people and communities. As a result, many of the proposed Directions for 2025/26 are new. 3.8 Scottish Government published Statutory Guidance (2020) for Directions that describes the best practice for the issue and implementation of Directions. An internal Audit of Midlothian IJB Directions in 2024 returned a ‘Reasonable Assurance’ outcome with high levels of compliance with this Statutory Guidance. 4 Policy Implications 4.1 This paper supports the strategic Directions of the Midlothian IJB and relates to the • Public Bodies (Joint Working) (Scotland) Act 2014. (section 26 and 26) and the requirement for Directions from Integration Authorities to Health Boards and Local Authorities. • Statutory Guidance (2020) on Directions from Integration Authorities to health boards and local authorities on how to improve practice in the issuing and implementation of Directions issued under the Public Bodies (Joint Working) (Scotland) Act 2014. 4.2 In order to comply with Scottish Government Statutory Guidance (2020) on Directions, Midlothian IJB is required to have a formal Directions Policy and this in under development. 5 Directions 5.1 This report proposes the Midlothian IJB Directions for 2025/26. Page 275 of 316
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 There are no specific equalities implications from this report. All Directions are designed to progress the ambitions of the strategic aims of the Midlothian Integration Joint Board Strategic Plan 2022/25. An Equality and Children’s Rights Impact Assessment (ECRIA) has been undertaken and published in relation to both the current Strategic Plan 2022/25 and the draft plan for 2025/35. 6.2 Health and Social Care Partnership service strategy, policy, plans, provisions, practices, and activities that relate to Directions are subject to a screening process to determine an ECRIA is required. 7 Resource Implications 7.1 Directions should include the financial resources available for carrying out delegated functions, including the allocated budget and how that budget is to be used, whether this is a payment, or a sum set aside and made available. 7.2 Directions relating to Financial Recovery Planning must be clearly stated as such. Relevant Directions in the Midlothian IJB Draft Directions 2025/26 are closely aligned to the proposed transformation programme and included under Health and Wellbeing Outcome No.9: Use of Resources. 7.3 The information relating to finance is not included in the draft Directions 2025/26 and will be updated following indicative offers from Partners ahead of the Midlothian IJB Special Board for budget setting. 8 Risk 8.1 IJBs, Health Boards and Local Authorities have a legal obligation to issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act, 2014. Not complying with this legislation carries risks that Midlothian IJB will be unable to undertake its duties related to accountability and good governance. 9 Involving people 9.1 Engagement on the planning and review of services related to Directions will continue. 9.2 Midlothian IJB and its Strategic Planning Group and will review the progress towards these Directions and continually monitor the requirement to make recommendation to the Board in regards and necessary revision or addition to the IJBs Directions. Page 276 of 316
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Midlothian Integration Joint Board 10 Background Papers n/a AUTHOR’S NAME & DESIGNATION Gill Main, Integration Manager CONTACT INFO Via MS Teams or email DATE 03/02/2025 Appendices: Appendix 1: Midlothian Integration Joint Board Draft Directions 2025/26 Page 277 of 316
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Midlothian Integration Joint Board Directions 2025/26 Page 279 of 316
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Introduction Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian in 2015. The IJB plans and directs health and social care services for the people of Midlothian using the integrated budget received from Midlothian Council and NHS Lothian. The Midlothian IJB Strategic Commissioning Plan 2022-25 focuses on prevention, early intervention, recovery, and self-management. The ambitions of Midlothian IJB are to see progress towards the 9 National Health and Wellbeing Outcomes by delivering safe and high-quality care and support within the financial resources made available to us by our Partners. The Strategic aims for 2022-25 are Increase people’s support and opportunities to stay well, prevent ill or worsening health, and plan ahead. Enable more people to get support, treatment and care in community and home-based settings. Increase people’s choice and control over their support and services. Support more people with rehabilitation and recovery. Improve our ability to promote and protect people's human rights, including social and economic rights and meet our duties under human rights law through our services and support. Expand our joint working, integration of services, and partnership work with primary care, third sector organisations, providers, unpaid carers, and communities to better meet people’s needs. Directions are the mechanism by which Integration Authorities communicate their priority actions to both Midlothian Council and NHS Lothian. Midlothian IJB Directions for 2025/6 require services to continue embedding the integrated practice and collaborative working to see positive change as quickly as possible and improve outcomes for people and communities. In 2024/5 Midlothian IJB decided not to significantly change Directions to allow partners the time to understand the full impact of funding changes. The financial position has become more challenging across this time and many services are operating differently within new financial models through a combination of Grip and Control, Transformation, and Choices. However, Midlothian IJB must evolve and commission services in new and increasingly innovative ways while continuing to provide safe, high-quality care and support in line with its Strategic Plan. To ensure we are able to appropriately direct Partners in a way that aligns with our strategy and future ambitions, we recognise we must provide clear instruction on key actions for delivery in 2025/26. We have worked closely with both Partners in developing these Directions and will continue to monitor progress closely. We will also continue to consider when Directions need to be revised or new Directions are required to be issued issue to partners across 2025/26. The financial values (‘budgets’) attached to these Directions are based on a) Midlothian Council’s budget proposition of £XXm was accepted by Midlothian IJB at the Board meeting on 13th March 2025. b) NHS Lothian indicative budget proposal of £XXm was accepted by the IJB at the Board meeting on 13th March 2025. NHS Lothian continue to update the IJB’s health budget as additional allocations are received in year from the Scottish Government. The current opening budget is £XXm Funding allocations can be found in Appendix 1 1 4 3 2 5 6 Page 280 of 316
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1.1 COMPLETED All functions delegated to Midlothian IJB must demonstrate through service planning and reporting how they have increased collaborative and integrated working that improves population health and wellbeing, by January 2025. 1.2 COMPLETED To support proactive population approaches to health, wellbeing and wellness, all delegated functions should ensure service planning demonstrates reduced medicalisation of non- medical issues, by January 2025. 1.3 NEW NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by December 2025. 1.4 NEW Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review to inform the redesign and/or refresh of all publicly available information to support self- management, early intervention and prevention in a way that is compliant with our duties relating to accessibility by December 2025. This should include the alignment with the Model Publication Scheme and specifically • consistent use and application of the Midlothian IJB ‘Writing for Publication Style Guide’, • review of the Midlothian Health and Social Care website pages to ensure compliance the Equality Act 2010 and accessibility standards • development of consistently presented online and paper service information resources, and • links with both partners website, information, and signposting provisions 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. Page 281 of 316
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2.1 COMPLETED All functions delegated to Midlothian IJB must evidence the connection with communities, partners, and use of technology to improve self-management and self-monitoring, by January 2025. 2.2 COMPLETED All functions delegated to Midlothian IJB must ensure service planning describes a clear process to ensure fair access, by January 2025. 2.3 NEW NHS Lothian and Midlothian Council will support Midlothian HSCP to develop or redesign services to consider and evidence services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible by December 2026. 2.4 NEW NHS Lothian and Midlothian Council will support Midlothian HSCP to undertake a review of Social Work and Occupational Therapy teams by December 2025. 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. Page 282 of 316
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3.1 REVISED / COMBINED Previously Now below in 4.4 All functions delegated to Midlothian IJB will contribute to the IJBs ability to describe activity, experience, and outcomes. This includes developing outcome mapping, by January 2025. 3.2 REVISED (TECHNICAL WORDING AND DATE ONLY) NHS Lothian and Midlothian Council will support operational services for all relevant functions delegated to Midlothian IJB to develop and demonstrate an increase in the effective and proactive outreach to people living with frailty, by December 2025. 3.3 REVISED Previously NHS Lothian and Midlothian Council will support Midlothian HSCP to revise and update ‘The Midway’, by October 2025. All functions delegated to Midlothian IJB should review practices and further develop person- centred approaches to support recovery including The Midway and Good Conversations approach, by January 2025. 3.4 NEW NHS Lothian and Midlothian Council will support operational services for all functions delegated to Midlothian IJB to embed and evidence community engagement and feedback from people who experience services as part of continuous improvement and service design by December 2025. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected Page 283 of 316
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4.1 REVISED Previously NHS Lothian and Midlothian Council will support the HSCP integrated services to demonstrate how feedback informs service continual improvement redesign by December 2025. NHS Lothian and Midlothian Council must ensure accessible feedback mechanisms for all people and communities by January 2025 in order to develop innovative, integrated service offers and supports. 4.2 REVISED Previously NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated self-management framework that sets out an expectation of how services will work with people to be more informed about their condition(s), be better prepared for when they feel less well, and describes how to access the right support when it is needed by December 2025. In order to maximise opportunities to improve personal outcomes, all functions delegated to Midlothian IJB should ensure that the principles of self-management are embedded in service delivery design, by January 2025. 4.3 REVISED Previously Now moved to 7.4 All relevant functions delegated to Midlothian IJB should evidence how they are sharing information about Self Directed Support (SDS) options, and recording changes in uptake, by January 2025. Now in 7.4 4.4 REVISED / COMBINED Previously 3.1 NHS Lothian and Midlothian Council will support operational services for all functions delegated to Midlothian IJB to record the impact of their contribution to health and wellbeing outcomes, and evidence how they have used this information to inform service design by December 2025. 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. Page 284 of 316
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5.1 REVISED (DATE ONLY) NHS Lothian and Midlothian Council will ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring • systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics • health and social care workforce are suitably trained and skilled to gather and input this data, and • data quality assurance, by December 2025. 5.2 REVISED (DATE ONLY) NHS Lothian and Midlothian Council will explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by December 2025. 5.5 NEW NHS Lothian and Midlothian Council must support Midlothian HSCP to develop integrated data at population level to support the prediction, identification, and planning of changing demographic profile and need to support dynamic whole system change across time and report on progress by December 2025. 5 Health Inequalities Health & social care services contribute to reducing health inequalities Page 285 of 316
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6.1 REVISED (TECHNICAL WORDING AND DATE ONLY) All functions delegated to Midlothian IJB that aim to move care from hospital to home will ensure consideration of the potential impact of planned interventions on unpaid carers, and evidence appropriate supportive actions, by December 2025. 6.2 REVOKED Previously Explore and define the demand for and the benefit of a Midlothian Care and Support Co- operative in order to provide a platform that facilitates brokerage of personalised support for carers, identifies local assets, and enhances local economic value by January 2025. REVOKED 6.3 NEW NHS Lothian and Midlothian Council will support Midlothian HSPC to develop a Carers strategy for 2025-28 by December 2025. This must specifically outline the action to be taken in collaboration with our Partners, VOCAL, to consider how the information, advice and support improve to see improved outcomes for carers. 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Page 286 of 316
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7.1 REVISED (DATE ONLY) All relevant functions delegated to Midlothian IJB will explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to traditional referral pathways, by December 2025. 7.2 REVISED (DATE ONLY) Where there is a statutory responsibility to manage harmful behaviours, all functions must demonstrate the impact of action taken to maximise people's safety in our communities, by December 2025. 7.3 COMPLETED All relevant functions should improve the people who use substances’ understanding of their rights and responsibilities in relation to supported self-assessment and risk management, by January 2025. Services should evaluate the relationship between this work and any reduction in harm or improvements in personal outcomes. COMPLETED 7.4 REVISED / COMBINED Previously in 4.3 Midlothian Health and Social Care Partnership will support services to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms, this includes establishing (and taking action where necessary) by June 2025. • that all the teams who work with people, including the teams of our Partners, understand what SDS is and how to signpost this information at the right time, • that all relevant staff have received training in sensory awareness and understanding how to support people to request and access accessible information, • that all the information we provide about SDS is accessible so those who may benefit most are able to make informed choices. • that comprehensive system evidence is gathered on all changes in uptake between one option and another, any increase in budget, and any HSCP financial impact. 7 Safe from Harm People using health & social care services are safe from harm. Page 287 of 316
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8.1 REVISED (TECHNICAL WORDING AND DATE ONLY) NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the integrated Midlothian HSCP Staff Engagement Plan 2025-26 by June 2025. 8.2 REVISED (TECHNICAL WORDING AND DATE ONLY) NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Workforce Plan 2025-28 by June 2025. 8.3 NEW NHS Lothian and Midlothian Council must ensure provision in procurement and contract management support to ensure Midlothian IJB is able to report on its duties to comply with the Heath and Care (Staffing) (Scotland) Act in relation to assurance reporting on the workforce provision for services planned and secured by HSPC managed services and delivered by third parties through commissioning by December 2025. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Page 288 of 316
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9.1 REVISED (TECHNICAL WORDING AND DATE ONLY) NHS Lothian and Midlothian Council will maximise opportunities to work collaboratively across Lothian to design an approach and methodology to better understand and evidence the use of the NHS Lothian ‘Set Aside’ budget and Unscheduled Care (USC) provision by HSCP area by October 2025. This should include the design of effective mechanisms to better describe and understand the impact of improvement activity in USC performance. 9.1.1 REVISED (TECHNICAL WORDING ONLY) Following the review of the NHS Lothian ‘Set Aside’ budget, NHS Lothian will report to Midlothian IJB on a quarterly basis with performance and financial progress information in order to inform Midlothian IJB planning and allow the IJB to transparently share our overall position with Partners. 9.1.2 NEW NHS Lothian and Midlothian Council will support Midlothian HSCP to effectively execute a Scottish Government funded programme to improve Unscheduled Care (USC) performance, with particular the Royal Infirmary of Edinburgh. This reduce USC beds used by Midlothian IJB to 27 beds by June 2025. 9.2 COMPLETE Midlothian IJB agreed a series of Financial Recovery as part of its 2024/25 budget setting. COMPLETE 9.2.1 Care at Home provision should be realigned to a 20/80 split (internal 20%, external 80%) by October 2024. COMPLETE 9.2.2 REVISED / COMBINED Now below in 9.3.5 A 3% reduction in overall costs of commissioned arrangements should be achieved through a programme of transformational change in partnership with Midlothian Council and NHS Lothian by January 2025. 9.2.3 COMPLETE Newbyres Care Village must reduce agency usage and sustain operation within an established financial footprint by October 2024. COMPLETE 9.2.4 COMPLETE Transport for service users must reduce in spend by £240,000 by October 2024. COMPLETE 9.2.5 COMPLETE Recurring staff-pay costs will reduce by £364.5k in Planning, Performance, and Programme service. COMPLETE 9 Use of Resources Resources are used effectively and efficiently. Page 289 of 316
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9.3 REVISED All delegated functions will participate in review of service provision driven by a 5-year operational transformation programme to consider long term reform. This includes a change programme for 2025/26 to support achieving a balanced financial position across eight work- streams. 9.3.1 NEW Palliative Care 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. This will include support for both families and carers as they deal with loss and grief, and for staff to manage the emotional impact of caring for people at the end of life. Total operating budget £Xm 9.3.2 NEW Bed based provision Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign and ensure the most efficient and effective operational model of bed-based provision. This should be designed to enable people to access appropriate levels of care when their needs change within this model and enable the safe and timely return to living well in the community. A key output of this work should be the development of an integrated strategy by June 2026. This strategy with have clear links to wider health and social care provision and i) a detailed delivery plan with objectives for 3, 5 and 10 years and ii) an accompanying workforce plan to deliver this strategy. Total operating budget £Xm 9.3.3 NEW Home First Model of Care TBC Total operating budget £Xm 9.3.4 NEW Primary, Community , and Social Care 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 by June 2026. The aim should be to increase the focus on preventative care and early intervention strategies which will be required to improve long-term health outcomes and improve patient access and safe, efficient, and person-centred quality of care close to home. Total operating budget £Xm 9.3.5 REVISED / COMBINED Previously 9.2.2 Commissioning and Third Sector Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review of commissioning spend and establish a new partner provider model that is closely aligned with the strategic aims of the IJB, supports the delivery of key ambitions and increases opportunities for health equality across Midlothian. Total operating budget £Xm Page 290 of 316
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9.3.6 NEW Community Assets TBC including work to reform the HSCP contribution to the Midlothian Community Planning Partnership Total operating budget £Xm 9.3.7 NEW Mental Health and Dementia NHS Lothian and Midlothian Council will support Midlothian HSCP to improve the experience of people in Midlothian with Mental Health conditions and Dementia by December 2026. Total operating budget £Xm 9.3.8 NEW Midlothian Single Point of Access (SPOA) 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 by December 2026. Specifically, this should include planning that results in an eventual multiagency hub to support all contacts across health and social care. In 2025/26 this should focus on • Further exploration and development of single point of access/contact • development, implementing, and evaluating experience feedback • reporting on impact and recommendations for future improvements Total operating budget £Xm 9.4 REVISED (TECHNICAL WORDING AND DATE ONLY) NHS Lothian and Midlothian Council should report to Midlothian IJB on a biannual basis across 2025/26 on issues and risks relating to non-delegated functions that will impact on delegated functions. 9.5 NEW NHS Lothian and Midlothian Council must ensure that all operational services delivering functions delegated to Midlothian IJB continue to provide assurance of high quality, safe, and effective service delivery within the allocated budget (appendix 1,) and with assurance of the principles of Best Value by December 2025. Page 291 of 316
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This Direction describes the action required in relation to the other core and hosted functions delegated to Midlothian IJB. A number of these Directions 1 to 9 will require service redesign and transformation. Functions delegated to Midlothian IJB are detailed in the Midlothian Integration Scheme. All functions, including hosted functions, should be provided in accordance with legislation, policies, and procedures. Unless specified in the accompanying Directions, services should continue to be provided to high standards within the available budgets. All services should provide information on both activity and outcomes for service offers and supports delivered to improve the health, wellbeing and wellness of the people and communities of Midlothian. Functions delegated to the IJB from NHS Lothian within the Integration Scheme are detailed below Provision for people over the age of 18 1. Accident and Emergency services provided in a hospital. 2. Inpatient hospital services relating to the following branches of medicine a. general medicine b. geriatric medicine c. rehabilitation medicine d. respiratory medicine; and e. Psychiatry of learning disability 3. Palliative care services provided in a hospital 4. Inpatient hospital services provided by General Medical Practitioners. 5. Services provided in a hospital in relation to an addiction or dependence on any substance. 6. Mental health services provided in a hospital, except secure forensic mental health services. 7. District nursing services 8. Services provided out with a hospital in relation to an addiction or dependence on any substance. 9. Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 10. The public dental service. 11. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C(2) of the National Health Service (Scotland) Act 1978 12. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978(27). 13. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978(28). 14. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978 15. Services providing primary medical services to patients during the out-of-hours period. 16. Services provided outwith a hospital in relation to geriatric medicine. 17. Palliative care services provided outwith a hospital. 18. Community learning disability services. 19. Mental health services provided outwith a hospital. 20. Continence services provided outwith a hospital. 21. Kidney dialysis services provided outwith a hospital. 22. Services provided by health professionals that aim to promote public health 10 Delegated Functions Core and hosted services within the NHSL Lothian and Midlothian Council Integration Scheme are detailed below Page 292 of 316
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Provision for people under the age of 18 1. Primary medical services and general medical services (including generally practitioner pharmaceutical services) 2. General dental services, public dental services, and the services provided by the Edinburgh Dental Institute 3. General ophthalmic services 4. General pharmaceutical services 5. Out of hours primary medical services 6. Learning disabilities 7. Health visiting 8. School nursing Functions delegated to the IJB from Midlothian Council within the Integration Scheme are detailed below 1. Social work services for adults and older people 2. Services and support for adults with physical disabilities and learning disabilities 3. Mental health services 4. Drug and alcohol services 5. Adult protection and domestic abuse 6. Carers support services 7. Community care assessment teams 8. Support services 9. Care home services 10. Adult placement services 11. Health improvement services 12. Aspects of housing support, including aids and adaptations 13. Day services 14. Local area co-ordination 15. Respite provision 16. Occupational therapy services 17. Reablement services, equipment, and telecare 18. Justice social work services Page 293 of 316
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Appendix 1: Midlothian IJB Indicative Budgets for 2025/26 for Directions (TBC Following indicative budget offers) Health Service ML IJB 25/26 Budget £000’s Core Community Equipment Community Hospitals Community Nursing Diabetes & Endocrinology District Nursing Geriatric Medicine GMS Health Visiting Learning Disabilities Mental Health ML Partnership Management PC Management PC Services Pharmacy Prescribing Reserves Resource Transfer Substance Misuse Therapy Services Core Total Hosted Complex Care Diabetes & Endocrinology GMS Hospices & Palliative Care Learning Disabilities LUCS Mental Health Oral Health Services PC Services Prescribing Psychology Services Public Health Rehabilitation Medicine Sexual Health Substance Misuse Therapy Services UNPAC Hosted Total Acute (Set Aside) Acute Management Cardiology Page 294 of 316
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Children Therapies Diabetes & Endocrinology ED & Minor Injuries General Medicine Geriatric Medicine Outpatients Rehabilitation Medicine Respiratory Medicine Therapy Services Acute Total Total Health Social Care Service ML IJB 25/26 Budget £000’s Core Addictions Assessment and Care Management Criminal Justice Learning Disability Services Management and Administration MELDAP/Recovery Hub Mental Health Services Non-Specific Groups Older People People with AIDS/HIV Performance and Planning Physical Disability Services Public Protection Service Management Strategic Commissioning Total Social Care Total IJB Page 295 of 316
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Midlothian Integration Joint Board Thursday 20th February 2025, 14:00 – 16:00 Midlothian IJB Draft Directions Policy Executive summary This report presents a proposed Midlothian Integration Joint Board Directions Policy for review and comment (appendix 1). In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014, Directions are the key mechanism by which Midlothian IJB’s strategic plan is actioned. Directions are issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how all functions delegated to the IJB and operationally managed predominantly by Midlothian Health and Social Care Partnership (HSCP) are to be delivered and funded via the integrated budget. The draft policy outlines the process for drafting, approving, issuing, and monitoring Directions from Midlothian Integration Joint Board (IJB) to partner organisations Midlothian Council and NHS Lothian Health Board. The policy has been developed in line with Scottish Government published Statutory Guidance (2020) on Directions and was reviewed by the Strategic Planning Group on the 16th January 2025 where the policy was agreed for recommendation to the Board for approval. It is recommended that this policy is reviewed every three years. Members are asked to: • Review the proposed draft Midlothian IJB Directions Policy (appendix 1) and, subject to any amendments, approve for publication. Item number: 5.13 Page 297 of 316
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Midlothian Integration Joint Board Report Midlothian IJB Draft Directions Policy 1. Purpose 1.1 This report presents a proposed Midlothian Integration Joint Board Directions Policy for review and comment (appendix 1). 2. Recommendations 2.1 As a result of this report what are Members being asked to:- • Review the proposed draft Midlothian IJB Directions Policy (appendix 1) and, subject to any amendments, approve for publication. 3. Background and main report 3.1 Directions are how Integration Authorities action their strategic plan. In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014, Directions are the key mechanism by which Midlothian IJB’s strategic plan is actioned. Directions are issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how all functions delegated to the IJB and operationally managed predominantly by Midlothian Health and Social Care Partnership (HSCP) are to be delivered and funded via the integrated budget. 3.2 Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. 3.3 The draft policy outlines the process for drafting, approving, issuing, and monitoring Directions from Midlothian Integration Joint Board (IJB) to partner organisations Midlothian Council and NHS Lothian Health Board. 3.4 Scottish Government published Statutory Guidance (2020) on Directions in January 2020 that describes the best practice for the issue and implementation of Directions. In order to comply with statutory guidance, Midlothian IJB is required to have a formal Directions policy in place. 3.5 The policy has been developed with reference to relevant legislation and statutory guidance and was reviewed by the Strategic Planning Group on the 16th January 2025 where the policy was agreed for recommendation to the Board for approval. It is recommended that this policy is reviewed every three years. Page 298 of 316
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Midlothian Integration Joint Board 4. Policy Implications 4.1 This paper supports the strategic Direction of the IJB and relates to the • Public Bodies (Joint Working) (Scotland) Act 2014. (section 26 and 26) and the requirement for Directions from Integration Authorities to Health Boards and Local Authorities. • Statutory Guidance (2020) on Directions from Integration Authorities to health boards and local authorities on how to improve practice in the issuing and implementation of Directions issued under the Public Bodies (Joint Working) (Scotland) Act 2014. 4.2 In order to comply with Scottish Government Statutory Guidance (2020) on Directions, Midlothian IJB is required to have a formal Directions Policy. 5. Directions 5.1 This proposed Midlothian IJB Draft Directions Policy will impact on the development, issue, monitoring and evaluation of all Midlothian IJB Directions. 6. Equalities Implications 6.1 There are no specific equalities implications from this report. All Directions are designed to progress the ambitions of the strategic aims of the Midlothian Integration Joint Board Strategic Plan 2022/25. An Equality and Children’s Rights Impact Assessment (ECRIA) has been undertaken and published in relation to both the current Strategic Plan 2022/25 and the draft plan for 2025/35. 6.2 Health and Social Care Partnership service strategy, policy, plans, provisions, practices, and activities that relate to Directions are subject to a screening process to determine an ECRIA is required. 7. Resource Implications 7.1 There are no direct financial implications as a result of this report. 8. Risk 8.1 IJBs, Health Boards and Local Authorities have a legal obligation to issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act, 2014. Not complying with this legislation carries risks that Midlothian IJB will be unable to undertake its duties related to accountability and good governance. Page 299 of 316
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Midlothian Integration Joint Board 9. Involving people 9.1 This policy has been drafted alongside the protocols of our Partners and reviewed by the Strategic Planning Group. 10 Background Papers n/a AUTHOR’S NAME & DESIGNATION Gill Main, Integration Manager CONTACT INFO Via MS Teams or email DATE 03/02/2025 Appendices: Appendix 1: Midlothian Integration Joint Board Draft Directions Policy Page 300 of 316
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MIJB_Governance_Directions Policy v0.1 Contents 1. Introduction and policy context ...................................................................................................... 3 2. Form and content of Directions ...................................................................................................... 3 3. Process for approval and issue of Directions .................................................................................. 4 4. Implementation of Directions ......................................................................................................... 5 5. Monitoring and evaluation of Directions ........................................................................................ 6 6. Policy review ................................................................................................................................... 6 Page 302 of 316
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MIJB_Governance_Directions Policy v0.1 1. Introduction and policy context 1.1 This policy document outlines the process for drafting, approving, issuing, and monitoring Directions from Midlothian Integration Joint Board (IJB) to partner organisations Midlothian Council and NHS Lothian Health Board. The policy has been developed with reference to relevant legislation and statutory guidance and will be reviewed on an annual basis. 1.2 In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014, Directions are the key mechanism by which Midlothian IJB’s strategic plan is actioned. Directions are issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how all functions delegated to the IJB and operationally managed predominantly by Midlothian Health and Social Care Partnership (HSCP) are to be delivered and funded via the integrated budget. Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. 1.3 Scottish Government published statutory guidance for Directions in January 2020 that describes the best practice for the issue and implementation of Directions. In order to comply with statutory guidance, Midlothian IJB is required to have a formal Directions policy in place. 2. Form and content of Directions 2.1 Directions are a necessary and important element of Midlothian IJB’s governance structure designed to communicate IJB decisions and clarify responsibilities between Partners within a clear framework for delivery of delegated functions. Directions must be in writing and drafted in sufficient detail to ensure Midlothian IJB’s decision making is accurately and effectively communicated to both Midlothian Council and NHS Lothian Health Board. 2.2 Directions must be in line with Midlothian IJB’s strategic plan priorities. Directions must also be in line with clinical and care governance standards to ensure high quality, safe and effective care that considers staff welfare and financial governance arrangements. 2.3 As a minimum, Directions must provide the following information: • A reference number to maintain version control and support audit. • Detail the function(s) in scope and the scale of the intervention required. Page 303 of 316
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MIJB_Governance_Directions Policy v0.1 • Details of overall budget. • Details of the actions or outputs required in line with the IJB’s strategic priorities. • Timescales for delivery and performance. 2.4 Midlothian IJB has developed a template for the issue of Directions to Midlothian Council and NHS Lothian Health Board (appendix 1), and published Directions on its website. 3. Process for approval and issue of Directions 3.1 This process aims to ensure that a Direction represents the formal end point of a shared decision-making process, has been considered as part of a collaborate and collegiate approach, and has been initiated by a decision made by Midlothian IJB. 3.2 Midlothian IJB must approve all Directions. Directions will be prepared and issued in respect of all delegated functions referred to an annex 1 (part 2) and annex 2 (part 2) of the Integration Scheme at the start of each financial year. Where Midlothian IJB is the lead for a pan-Lothian healthcare services i.e. hosted services, Directions must be developed in consultation with relevant stakeholders. 3.3 In order to determine when a new or amended Direction is required, the standard report format for Midlothian IJB and its committees include a section on Directions. This will act as a prompt for the report author to consider whether a new or amended Direction requires to be issued to Midlothian Council and/or NHS Lothian Health Board and to seek approval from Midlothian IJB as appropriate. Where a new or amended Direction is considered to be required, a draft Direction should be included with the report following consultation with the Integration Manager and review by Midlothian IJB’s Strategic Planning Group. 3.4 The Special Board meetings held in March and September are the two formal points in the year where Directions are reviewed and proposed for adoption. Directions will be issued to partners by the Chief Officer. 3.5 Following Midlothian IJB approval of proposed Directions, the board may give delegated authority to the Midlothian IJB Chief Officer to issue Directions on behalf of Midlothian IJB. This should be as soon as practicable following approval by Midlothian IJB and no later than 31st March annually, and 30th September should additions or amendments be made at the mid-year review. Page 304 of 316
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MIJB_Governance_Directions Policy v0.1 3.6 Although Midlothian IJB will issue Directions to Midlothian Council and NHS Lothian Health Board at the point of agreeing the budget for the following financial year, it may not be possible for Midlothian IJB to make all the decisions required in relation to delivery or transformation at this time. Midlothian IJBs may make decisions about service change, service redesign, and investment and disinvestment at any time and Directions will be issued following a decision made by Midlothian IJB. 3.7 Directions should be issued to Chief Executives in the Local Authority and Health Board and should copy the Midlothian IJB Chair, the Midlothian Council Leader, and the NHS Chair into this correspondence. 3.8 Once issued, Directions continue to be legal and binding until they are agreed by Midlothian IJB to be completed, revised, or revoked as a consequence of a board decision or in response to changes in strategic and financial priorities during the course of the year. A clear audit trail will be maintained through the creation of a chronological Directions log. A standard Directions Log template is used to record the ‘Status of Directions’ year on year (appendix 2). 4. Implementation of Directions 4.1 Midlothian Council and NHS Lothian Health Board are responsible for complying with and implementing Midlothian IJB Directions. 4.2 The Chief Executives of both organisations are expected to formally acknowledge receipt of all Directions issued by the IJB. As Directions are legally binding, Partners may not amend, disregard, appeal or veto any Direction. Similarly, neither partner may use the resources allocated via the IJB for any other purpose than that intended in the Directions. 4.3 The statutory guidance for Directions refers to consideration of those impacted by the change a Directions may result in e.g., patients, people who experience services, carers, local communities, and staff. Midlothian IJB would expect Partners to undertake an Equality and Childrens Rights impact Assessment (ECRIA) as part of the Quality Planning process for any activity that was either a new or revised strategy, policy, plan, provision, practice, or activities. Completed ECRIAs should be provided as part of the reporting required for the monitoring and evaluation of Directions. Page 305 of 316
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MIJB_Governance_Directions Policy v0.1 4.4 Should either Partner experience difficultly in implementing a Direction, this should be initially discussed with the Chief Officer who will seek to resolve the matter on an informal basis in conjunction with the IJB Chair and Vice Chair as appropriate. In the unlikely event that formal dispute resolution is required, the dispute resolution mechanism outlined in section 15 of the Midlothian Integration Scheme will apply. 5. Monitoring and evaluation of Directions 5.1 Directions are subject to Internal and External Audit. 5.2 Midlothian IJB will seek information from both Midlothian Council and NHS Lothian Health Board for performance monitoring and reporting purposes. The required performance outputs will be clearly articulated in the Direction. 5.3 As part of Midlothian IJB’s performance management framework, the Strategic Planning Group will oversee the progress on Directions by conducting mid-year and full year reviews of the Directions log. This will require progress reports from Partners and issues will be escalated to Midlothian IJB as appropriate by the Strategic Planning Group who will present an assurance report to Midlothian IJB in relation to mid-year and full year Directions Reporting. 5.4 Progress made towards Directions will also be recorded on the Midlothian IJB Strategic Governance Outcome Map, where evaluation of progress made and confidence in quality of evidence provided will be considered. This will include a synthesis report within the Outcome Map describing considering the three elements of combined activity, experience, and outcomes to support Midlothian IJB’s ability to take corrective action where necessary. 6. Policy review 6.1 This Directions policy will be reviewed every 3 years. Page 306 of 316
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Midlothian Integration Joint Board Thursday, 20 February 2025, 14:00-16:00 Midlothian IJB Board Member’s Improvement Plan Executive summary On the 8th February 2024 the Midlothian IJB Board approved the Midlothian IJB Improvement Plan. The Improvement Plan had been created following survey questionnaires issued by the Improvement Service in April 2023, a subsequent IJB Development Workshop facilitated by the Improvement Service in May 2023, and then a further IJB Development Workshop facilitated by the Chief Internal Auditor in November 2023. In preparation for the refresh of the Improvement Plan, questionnaires were issued to all Midlothian IJB Board members in November 2024 in advance of a proposed Development Session. Only 1 Board member returned the questionnaire, and the Development Session was diverted for other more urgent and important discussion. If members approve continuing to take forward best practice in completion of an annual assessment and improvement plan, a further development session is required with Midlothian IJB Board members to establish if the focus of improvement actions on appropriate areas. This is proposed to take place in May 2025. Members are asked to: 1.1 Members are asked to approve: • Continuation of an annual assessment of the Board and creation of a Board Improvement Plan; • Scheduling of a Development Session on an annual basis to complete the assessment; and • Confirmation that members wish to provide views on improvement areas in the format of a questionnaire to provide a structure for the Development Session. Item number: 5.14 Page 307 of 316
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Midlothian Integration Joint Board Report Midlothian IJB Board Member’s Improvement Plan 1 Purpose 1.1 This report provides an update on the progress of the Midlothian IJB Board Improvement Plan 2024, which was approved by the Board in January 2024 and provides a proposed methodology for updating the plan, which could be enacted if the Board approves continuation of this annual governance best practice. 2 Recommendations 2.1 As a result of this report, Members are asked to approve: • Continuation of an annual assessment of the Board and creation of a Board Improvement Plan; • Scheduling of a Development Session on an annual basis to complete the assessment; and • Confirmation that members wish to provide views on improvement areas in the format of a questionnaire to provide a structure for the Development Session. 3 Background and main report 3.1 On the 8th February 2024 The Midlothian IJB Board approved the Midlothian IJB Improvement Plan. The Improvement Plan had been created following survey questionnaires issued by the Improvement Service in April 2023, a subsequent IJB Development Workshop facilitated by the Improvement Service in May 2023 and then a further IJB Development Workshop facilitated by the Chief Internal Auditor in November 2023. 3.2 In preparation for the refresh of the Improvement Plan, questionnaires were issued to all Midlothian IJB Board members in November 2024 in advance of a proposed Development Session. Only 1 Board member returned the questionnaire, and the Development Session was diverted for other more urgent and important discussion. 3.3 Discussions with the Midlothian IJB chair and HSCP management have indicated that all actions identified in relation to improvement theme 1 have been completed, being “Look for ways to ensure the agenda for Board meetings allows more time for strategic planning and debate”. 3.4 The actions for the other 2 key themes identified have been progressed however further work may be required to fully ensure desired outcomes have been reached these themes are: • Review the IJB’s current mechanisms for engaging with key stakeholders, service users and the wider public to more effectively seek their views. • Consider how the IJB can further align resources to facilitate the desired shift to early intervention and prevention. Page 308 of 316
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Midlothian Integration Joint Board 3.5 A further development session is required with Midlothian IJB Board members to establish if the improvement themes previously identified require to be altered to focus improvement actions on appropriate areas. This is proposed to take place in May 2025. 4 Policy Implications 5.1 None 5 Directions 6.1 There are no impacts on directions arising directly from this report 6 Equalities Implications 7.1 This report has no Equalities implications 7 Resource Implications 8.1 Midlothian IJB Board members time is the only resource 8 Risk 9.1 There are no specific risks highlighted in this report. 9 Involving people 10.1 There has been no requirement to consult directly with the public or partners in preparing this report. 10 Background Papers n/a AUTHOR’S NAME & DESIGNATION Duncan Stainbank, Chief Internal Auditor CONTACT INFO Duncan.stainbank@midlothian.gov.uk DATE 04/02/2025 Appendices: Appendix 1: Midlothian IJB Board Improvement Plan - January 2024 Page 309 of 316
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Appendix 1 Midlothian IJB Board Improvement Plan – January 2024 Improvement actions Board Action Owner Implications [Risk, Cost, Resource] Target Date Measure Outcomes 1. Look at ways to ensure the agenda for Board meetings allows for more strategic planning and debate. 1. Determine what existing agenda items can be shortened, removed, or marked for information only. Including consideration of providing reflection sections. Agree to have at least 2 Board Development session a Year in person. Cllr Connor McManus Risks • Reducing time to debate current issues. • Duplicating discussions elsewhere. Costs • Board Member time. • Opportunity cost. 1 April 2024 New format for agendas established. In person meetings designated on schedule for 2024/25 Board Development Sessions. Board debates and discussions become more strategic with greater awareness of work completed elsewhere, leading to more effective focus on the delivery of change. 2. Have at least one member of the Board formally attend the Strategic Planning Group meetings and feedback to the Board on the work and discussions undertaken. Consideration should be given to the Board Member being Chair of the Strategic Planning Group. Andrew Fleming 1 August 2024 Board Member identified and regularly attending Strategic Planning Group. The Board to have considered making the Board Member chair of the Strategic Planning Group. Page 311 of 316
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2. Review the IJB’s current mechanisms for engaging with key stakeholders, service users and the wider public to more effectively seek their views. 1. Support the ‘Community Engagement’ self-assessment with Board involvement being undertaken through the completion of the Health Care Improvement Scotland Quality Framework for Community Engagement led by the Strategic Planning Group. This self-assessment process will result in an action plan and revision of the Midlothian Health and Social Care Public Engagement Statement Nadin Akta Risks • We don’t achieve the outcomes that matter most to people and communities. • Ineffective engagement – we don’t reach all stakeholders. • Managing capacity to undertake this work – sacrifice other work for this. • Time constraints for Board members to engage – need to ensure Board members engage. • Managing expectations on what can be achieved – need to be clear. Risks if improvement action not implemented • Out of touch, not doing what communities want. • Won’t see transformation of Health and Social Care services. • Lose trust of community. Costs • Costs associated with different engagement mechanisms. • Staff capacity to undertake this work. 1st September 2024. Strategic planning Group Self- assessment exercise has taken place with the Board involvement. Actions resulting reported back to the Board. Midlothian IJB can evidence that it delivers outcomes, including our Strategic Aims, that matter for the people of Midlothian. 2. Invite Board members to Third Sector summits to increase board engagement and visibility. Magda Clark 1st April 2024 Board member attendance at Third Sector Summits. Page 312 of 316
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3. Consider how the IJB can further align resources to facilitate the desired shift to early intervention and prevention. 1. Identify and map areas where HSCP currently working in prevention and early intervention. Look to highlight existing good work and consider what resources are currently allocated here. Morag Barrow . Risks • Raising expectations with the public. • Affordability and sustainability. • De-commissioning services can be very difficult with local interests in services. • If invest more money in this area, means less money for somewhere else. Need to acknowledge this is an intended choice and to map out any unintended impact. • Limited capacity. • Need budgeting over longer timescales to better plan. Need to lobby Scottish Government for a more sustainable budget stream to IJBs. Costs • The cost is time for services. • 1st April 2024. Consideration of Early Intervention and Prevention as part of a review of the Annual Performance Report. Progress made in prevention and early intervention approaches that support work on inequalities. 2. The Board will increase knowledge of how to support the delivery of a Strategic Commissioning Plan for 2024/25 achieved through engaging with the Strategic Commissioning Plan process and attending development sessions across 2024/25. 1st April 2024. Attendance at Development sessions and interaction with the Strategic Commissioning Plan 3. Develop a clear Board understanding of equality and human rights issues, by completing equalities training with the Board. 1st April 2024. Completion of Equalities training by Board Members. Page 313 of 316
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Tha Ministearan na h-Alba, an luchd-comhairleachaidh sònraichte agus an Rùnaire Maireannach fo chumhachan Achd Coiteachaidh (Alba) 2016. Faicibh www.lobbying.scot Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot Taigh Naomh Anndrais, Rathad Regent, Dùn Èideann EH1 3DG St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Minister for Social Care, Mental Wellbeing and Sport Maree Todd MSP Ministear airson Cùram Sòisealta, Sunnd Inntinn is Spòrs Maree Todd BPA T: 0300 244 4000 E: MinisterforSCMWS@gov.scot ___ 23 January 2025 I am writing to update you on our plans for the National Care Service going forward. I delivered a statement to Parliament today (Thursday, 23 January) on some proposed changes to the Bill, as well as plans to improve the social care system. Following feedback and lots of discussions with people who access or deliver social care, social work and community health, as well as other stakeholders, I have worked to find a way to deliver on our commitment for a National Care Service that delivers much-needed change. We are absolutely committed to bringing forward a Bill that will ensure reforms to information records and standards, procurement, and a right to breaks for unpaid carers. The introduction of Anne’s Law, which upholds the rights of residents in care homes to be visited by families or friends, will be included in the legislation to reform social care, alongside a right to breaks for unpaid carers. This fulfils a commitment this Government made to the many families who have campaigned for this. Despite considerable efforts to gain agreement, there are some parts of the Bill we have had to change, meaning some of our proposed policies will now be delivered in other ways. For example, we will introduce an Advisory Board rather than a National Board enshrined in law. This non-statutory advisory board – comprising of people with lived experience of accessing care, social care workers, care providers, trade unions, the NHS and local government – will be established to provide guidance and drive improvement within the sector. It is expected to meet for the first time in the spring. I know some of you might feel disheartened by this, but please take comfort in the fact that developing this Board without the need for formal legislation means we can pick up the pace of reform and introduce changes faster than if we had to wait for the Bill to pass. Midlothian Integration Joint Board Thursday 20 February 2025 Item No 5.15 Page 315 of 316
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Tha Ministearan na h-Alba, an luchd-comhairleachaidh sònraichte agus an Rùnaire Maireannach fo chumhachan Achd Coiteachaidh (Alba) 2016. Faicibh www.lobbying.scot Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot Taigh Naomh Anndrais, Rathad Regent, Dùn Èideann EH1 3DG St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Our plans for the National Care Service have always focused on improving the services that people need, in partnership with people with first-hand experience of delivering or accessing social care, social work and community health. We will not hesitate in our commitment to reform the landscape in Scotland and ensure everyone in Scotland gets the care and support they deserve. You can find my full statement on Ministerial Statement: Future of the National Care Service - gov.scot. There is also a factsheet available to read online which provides further detail on each area of the Bill and our future National Care Service plans. I want to thank you for your ongoing support and commitment to creating a National Care Service. I have been privileged to meet with many of you to hear your thoughts and experiences of social care, and I understand how crucial it is that we get this right. I look forward to continuing to work with you all as we deliver strong, meaningful social care reform for the people of Scotland. With best wishes, MAREE TODD MSP Minister for Social Care, Mental Wellbeing and Sport Scottish Government Page 316 of 316