Agenda Document Pack - Midlothian Integration Joint Board - 27/03/2025
Midlothian Council · 27 March 2025
Back to Midlothian Integration Joint Board — 27 March 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, 27 March 2025 Time: 15:00 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 38
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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 No items for discussion 5 Public Reports 5.1 Midlothian IJB Financial Budget Setting 2025/26 - Presented by Chris King, Midlothian IJB Chief Finance Officer 3 - 20 5.2 Midlothian IJB Directions 2025/2026 - Presented by Gill Main, Midlothian HSCP Integration Manager 21 - 38 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting of Midlothian Integration Joint Board will be held on Thursday 24 April at 2pm. Page 2 of 38
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Midlothian Integration Joint Board Thursday, 27th March 2025, 14:00-16:00 Midlothian IJB Budget Setting 2025/26 Executive summary Midlothian IJB is required to set a balanced budget before the start of each financial year. The IJB’s budget is funded by its partners, Midlothian Council and NHS Lothian. Both partners have now made budget proposals for the 2025/26 financial year. Midlothian Council’s offer is final, as it has already set its 2025/26 budget. NHS Lothian will formally set its budget at its April 2025 Board meeting but has provided the IJB with an indicative budget offer. A paper outlining the financial challenges facing the IJB was presented in February 2025. Since then, further work has been undertaken to finalise financial projections and develop a Financial Recovery Programme. While the programme carries inherent risks, it is underpinned by key principles: prioritising essential statutory duties, safeguarding those most in need, and ensuring the IJB operates effectively within available resources. The proposed programme represents the lowest-impact approach to achieving a balanced budget, ensuring short-term financial stability, and enabling a continued focus on service transformation. Members are asked to: • Accept Midlothian Council’s formal budget offer for 2025/26. • Note NHS Lothian’s indicative budget offer for 2025/26. • Note the development of the 2025/26 budget setting process. • Consider the proposals that support the development of a balanced budget for 2025/26. • Agree to set a balanced budget for 2025/26 on the presumption of the delivery of the recovery programmes including working with the other IJBs and NHS Lothian to deliver a balanced position for the Set Aside budget. • Note the requirement to review, consider, agree, and commission a bed reprovision model that will be reviewed by SPG ahead of the Boards consideration at the August 2025 meeting. Item number: 5.1 Page 3 of 38
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Midlothian Integration Joint Board Midlothian IJB Budget Setting 2025/26 1 Purpose 1.1 The purpose of this paper is to outline the budget offers received from the IJB’s partners, update members on the 2025/26 financial position, and propose financial recovery actions for 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: • Accept Midlothian Council’s formal budget offer for 2025/26. • Note NHS Lothian’s indicative budget offer for 2025/26. • Note the development of the 2025/26 budget setting process. • Consider the proposals that support the development of a balanced budget for 2025/26. • Agree to set a balanced budget for 2025/26 on the presumption of the delivery of the recovery programmes including working with the other IJBs and NHS Lothian to deliver a balanced position for the Set Aside budget. • Note the requirement to review, consider, agree, and commission a bed reprovision model that will be reviewed by SPG ahead of the Boards consideration at the August 2025 meeting. 3 Background and main report Background 3.1 This report outlines the proposed 2025/26 budget contributions delegated to the IJB by Midlothian Council and NHS Lothian. Sufficient resources are essential for the Board to deliver the three strategic aims of the Midlothian IJB (draft) Strategic Plan 2025-35: • Aim Number 1: People feel able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. • Aim Number 2: People access the care and support they need when they need it in the community and at home. • Aim Number 3: People's human, social, and economic rights are protected and promoted in how we design and deliver our services. 3.2 The report also presents the 2025/26 budget plan, highlighting the projected budget shortfall. 3.3 Midlothian faces unprecedented challenges to the financial and operational sustainability of the health and care system. These challenges stem from increasing demand due to a growing and ageing population, a rise in the complexity of care required, and resource constraints in both workforce and finances. Page 4 of 38
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Midlothian Integration Joint Board 3.4 Ultimately, resource availability can no longer keep pace with rising demand. These issues are recognised across Scotland and the wider UK. To ensure long-term sustainability, transformation and redesign of services are essential. 3.5 Given the scale of the IJB projected budget gap, a significant one-year finance recovery programme has been developed to ensure the ongoing financial sustainability of the IJB and allow for the development of a local transformation programme. Midlothian Council Budget Offer 3.6 Midlothian Council approved a balanced revenue budget for 2025/26 in February 2025. This approval included a specific recommendation that the level of resources allocated to services delegated to the IJB in 2025/26 is £71.086m, representing an increase in funding for the IJB of £7.241m (equating to an 11% increase). 3.7 As part of the budget offer to the IJB, Midlothian Council agreed to pass through funding received from the Scottish Government for the following policy commitments: • Increase in the real living wage to adult social care workers in the third and private sectors to £12.60 per hour - £1.863m. • Free personal nursing care uplift - £0.137m. 3.8 In addition, recognising the significant financial challenges faced by the IJB and reaffirming its commitment to integration, Midlothian Council agreed to provide additional funding for: • A 3% pay increase - £0.772m • The full direct impact of employer National Insurance changes - £0.355m • Recurring support for demographic pressures - £3.000m • Non-recurring support to enable transformation - £1.100m 3.9 The Midlothian Council budget contribution to the IJB complies with the Scottish Government’s conditions regarding budget contributions to IJBs. The Scottish Government funding outlined above has been fully allocated to the IJB and is in addition to the recurring 2024/25 budget. 3.10 A copy of the budget offer letter can be seen in Appendix 1. NHS Lothian Budget Offer 3.11 The NHS Lothian financial plan is scheduled to be presented to the NHS Lothian Board for approval on the 16th of April 2025. Until the plan is approved, the budget contribution to the IJB remains indicative. The proposed contribution is based on the latest NHS Lothian budget assumptions. 3.12 The indicative budget offer from NHS Lothian for services delegated to the IJB in 2025/26 is £105.234m, representing an increase in funding for the IJB of £10.311m (equating to an 11% increase). Page 5 of 38
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Midlothian Integration Joint Board 3.13 The total recurring funding for delegated services, £105.234m, excludes non- recurring funding allocated to the IJB annually. Additionally, the £105.234m does not account for the pay award uplift or the pass-through of the non-pay uplift from NHS Lothian (3%). Both elements have been included in the current working assumptions at the following values: • Pay award - £1.424m • Non-Pay - £1.155m 3.14 The uplift for General Medical Services (GMS) is excluded from the budget offer, as it has not yet been confirmed by the Scottish Government for 2025/26. However, it is expected to be uplifted, and the associated funding to be passed through to the IJB. 3.15 Funding and costs related to employer National Insurance increases are included in the NHS Lothian financial plan. It is anticipated that 60% of the increase in employer National Insurance costs will be funded by Scottish Government with NHS Lothian funding the other 40%. Therefore, the costs for delegated health services will be fully funded. 3.16 NHS Lothian has also been advised to assume a share of £250m non-recurring national “sustainability” funding in their financial plan for 2025/26. NHS Lothian has confirmed their commitment to working collaboratively with its IJB partners and that they will look to target this funding at financial pressure across both delegated and non-delegated health budgets. 3.17 A copy of the indicative budget offer letter can be seen in Appendix 2. Financial Plan Projections 2025/26 3.18 The finance update presented to Midlothian IJB on the 20th of February 2025 included a draft outline of the 2025/26 financial plan, projecting an initial budget gap of £13.180m. At that time, the position remained fluid, as partners were still finalising their respective plans, and the IJB had not yet received budget offers from partners. This projection has now been finalised, incorporating revised key assumptions. The opening financial plan position, before accounting for financial recovery actions, is detailed in the table below: Table 1 - 2025/26 Financial Plan Position £m Adult Social Care Services (2.616) Core Health Services (2.385) Share of Pan Lothian Hosted Services (0.225) Share of Acute Set Aside Services (1.609) Total (6.835) 3.19 Financial planning for Health and Social Care services is inherently subject to risk, as assumptions made in the financial modelling can change due to a range of unpredictable factors. Some of the key financial risks are detailed below: • Health & Social Care Pay Awards – Negotiations on pay settlements for 2025/26 are ongoing, and there is a risk that the final pay award costs may exceed the allocated funding resulting in a cost pressure. Page 6 of 38
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Midlothian Integration Joint Board • Prescribing Costs – Medication costs remain volatile due to global market conditions and demographic pressures in Midlothian. As seen previously, the introduction of new medications also creates significant financial pressures. • Demographic Growth – As outlined, Midlothian’s population is both growing and ageing, increasing the risk that demand, and associated costs will surpass projected levels. This was a key driver of the Adult Social Care position in 2024/25. • National Policies – The introduction of new national policies that increase IJB expenditure without corresponding funding, such as national care home rate adjustments, pose financial risk. • Impact of New External Care Homes in Midlothian – The opening of new care homes in Midlothian may increase the IJB’s cost base due to the statutory requirement to fund free personal and nursing care. 3.20 Should any of these financial risks materialise, they will be actively managed through ongoing engagement with key partners, including Midlothian Council, NHS Lothian, and the Scottish Government. In addition, the IJB will receive regular financial reports, enabling timely identification of emerging pressures and the development of appropriate mitigation actions. Financial Recovery Programme 3.21 Midlothian IJB is required to set a balanced budget for 2025/26. To achieve this there is a requirement to identity and agree financial recovery actions equating to £6.835m to bridge the projected financial gap. 3.22 Over the past year, extensive work has been carried out to develop financial recovery actions. Engagement sessions have taken place with key stakeholders, including Midlothian Council, NHS Lothian, elected members, the Third Sector, and external providers. 3.23 The financial recovery process has focused on identifying solutions that balance the need to close the budget gap while prioritising essential statutory duties, safeguarding those most in need of support, and ensuring the IJB can operate effectively within the available resources. 3.24 Given the scale of the financial challenge, some recovery actions will impact services, performance, people of Midlothian, and staff. While these impacts are acknowledged, the recovery programme represents the lowest risk and lowest impact approach to achieving financial balance. 3.25 The current level of expenditure is unsustainable, as evidenced by the 2024/25 IJB financial outturn projection, and failure to address this issue risks compromising the future provision of critical services and support. Page 7 of 38
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Midlothian Integration Joint Board 3.26 The financial recovery programme has two components: • Operational Recovery Actions – These are smaller scale recovery actions designed to identify efficiencies, facilitate redesign, and strengthen financial management. This component also includes recovery actions approved and implemented in 2024/25. While some financial benefits were realised in 2024/25, the full benefits are expected to be realised in 2025/26. These actions do not require IJB approval as do not impact the ability to deliver the strategic objectives of the Board. • Strategic Redesign Recovery Actions – These are larger scale recovery actions that have been developed and require approval from the IJB. 3.27 The impact of the financial recovery programme on the financial plan is shown below: Table 2 – Recovery Actions Health Social Care IJB Total £m £m £m Opening Gap (4.219) (2.616) (6.835) Recovery Actions: Operational Recovery Actions 3.016 1.973 4.989 Strategic Redesign Recovery Actions 0.000 0.812 0.812 Total (1.203) 0.169 (1.034) 3.28 Pending the finalisation of the NHS Lothian financial plan, the 2025/26 budget is £1.034m out of balance. This financial pressure remaining in Health services relates to Set Aside services which are currently projected to be £1.269m overspent. 3.29 As previously noted, NHS Lothian are expected to receive "sustainability” funding. While further details are still awaited from the Scottish Government, NHS Lothian has confirmed its intention to allocate its share of this funding across both delegated and non-delegated services. The specific impact on the budget delegated to the IJB will be clarified in the coming weeks. Given NHS Lothian’s commitment to supporting the IJB, it is anticipated that this funding will be sufficient to balance the budget. 3.30 A breakdown of the Financial Recovery Programme is provided in Appendices 3 and 4. To further support informed decision-making, Equalities and Children’s Rights Impact Assessments (ECRIAs) have also been shared with IJB Board members. 3.31 If approved, the outlined financial recovery programme and the transfer of sustainability funding will allow for the IJB to set a balance budget for 2025/26. This approach will allow for financial stability in the short term and enable a shift to a more strategic focus on transformation for future years. Transformation 3.32 As referenced in the Audit Scotland IJB finance bulletin, IJBs across Scotland are experiencing significant financial challenges and IJBs need to work collaboratively Page 8 of 38
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Midlothian Integration Joint Board with each other and with their NHS and Council partners to find ways to transform services to ensure sustainability. The bulletin also highlighted that investment in prevention and early intervention is needed to help slow the ever-increasing demand for services, the cost of more complex care and, improve the experience and outcomes for people. 3.33 Midlothian IJB has made a significant commitment to both collaborative cross system working and early intervention and prevention activity in its draft Strategic Plan and carefully considered how this can best be set into motion in a set of draft Directions for 2025/26. Ongoing review of the strategic progress towards these ambitions will be monitored via a revised Midlothian IJB Performance Framework, Midlothian IJB Directions Reporting, and evaluation of nationally validated data in the Midlothian IJB Annual Performance Report. 3.34 Operationally, as part of the financial recovery programme development, clear themes of transformation emerged. In response, an Operational Transformation and Change Programme Board, chaired by the Midlothian IJB Chief Officer/HSCP Joint Director, was established. 3.35 The objective of the Operational Transformation and Change Programme Board is to achieve the strategic priorities of the Board within the available resources allocated by NHS Lothian and Midlothian Council. To this end, the group have established several key workstreams, one of which involves the review and reprovisioning of the current bed model. This proposal will be developed in collaboration with key stakeholders, scrutinised by the Midlothian IJB Strategic Planning Group in July 2025 for review and amendment, prior to recommendation to the Board for approval in August 2025. 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. 5.2 However, any decisions taken by the board in relation to Financial Recovery Planning must be set out in a Direction to the relevant Partner(s). Midlothian IJB reviewed both the draft Strategic Plan and draft Directions 2025/26 in a Board members development session on 27th February 2025. The board reviewed the connection between the draft Strategic Plan and the actions proposed and provided a high level of assurance that these were complete and sufficient to deliver the change required. 5.3 This report is closely aligned with the draft Directions for 2025/26 that clearly set out the financial recovery and transformation ambitions of Midlothian IJB in Section 9 ‘Our Resources’. 5.4 A second draft of Directions for 2025/26 is also presented to the Board in this Special Board Meeting by the Integration Manager. Page 9 of 38
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 An Equalities and Children’s Rights Impact Assessment (ECRIA) Screening Tool has been submitted with this paper. This report does not have any direct impact on equalities but highlights that the decisions 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 an 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. ECRIAs are only required to be published when a decision to progress has been taken. As a result, two Equalities and Children’s Rights Impact Assessments (ECRIAs) have been provided for Board members that consider the impact of proposed Financial Recovery Planning across the two main areas of ‘Commissioned Services’ and ‘Bed Based Provision’ 6.3 A range of ECRIAs will be required to inform and enable the development of system wide Financial Recovery Planning and the associated operational transformation and change. 7 Resource Implications 7.1 The financial implications of this report are laid out above. 8 Risk 8.1 Achieving a balanced financial position is contingent upon the full implementation of the Financial Recovery Programme. Any significant deviation from the programme will result in financial pressures emerging in the 2025/26 financial year. 8.2 Beyond financial challenges, the scale of the Financial Recovery Programme presents substantial risks to Midlothian IJB’s ability to fulfil the ambitions outlined in its Strategic Plan. 8.3 The requirement to deliver the Financial Recovery Programme may hinder or delay progress towards achieving the nine National Health and Wellbeing Outcomes for individuals and communities. 8.4 The financial impact of the UK Government’s increase in National Insurance contributions for providers and the third sector must be thoroughly assessed. However, complete information will not be available until after the start of the next financial year. 8.5 All risks associated with the Financial Recovery Programme will be closely monitored and managed in a timely and appropriate manner. The Health and Social Care Partnership management team will oversee emerging risks through established Page 10 of 38
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Midlothian Integration Joint Board governance frameworks, ensuring that mitigation strategies are effectively implemented. Any significant issues requiring escalation will be directed through the IJB’s governance structures, including the Audit and Risk Committee and, where necessary, the Board, to ensure appropriate scrutiny and decision-making. This approach will support financial sustainability while safeguarding the delivery of essential health and social care services. 8.6 A comprehensive review of Midlothian IJB’s risk register will be conducted as part of the June 2025 Audit and Risk Committee meeting before being presented to the Board for further consideration. 9 Involving people 9.1 This report has been written following consultation with our NHS Lothian and Midlothian Council financial Partners, officers of Midlothian IJB, and with the Midlothian HSCP executive management team. 10 Background Papers 10.1 There are no background papers. AUTHOR’S NAME & DESIGNATION Chris King, Chief Finance Officer CONTACT INFO Chris.King@nhs.scot DATE 10/03/2025 Appendices: Appendix 1: Midlothian Council Budget Offer Appendix 2: NHS Lothian Indicative Budget Offer Appendix 3: Overview of Financial Recovery Programme Appendix 4: Commissioned Services Recovery Action Page 11 of 38
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Midlothian Council Midlothian House Buccleuch Street Dalkeith EH22 1DN David Gladwin – Chief Financial Officer & Section 95 Officer Your Ref: Our Ref: www.midlothian.gov.uk Midlothian 26 February 2025 Morag Barrow Chief Officer Midlothian Integration Joint Board Fairfield House 8 Lothian Road DALKEITH EH22 3AA Dear Morag ALLOCATION TO MIDLOTHIAN INTEGRATION JOINT BOARD 2025-26 Following the Council meeting on Tuesday 25th February I am writing to confirm that Council agreed an allocation to the Integration Joint Board of £71.086 million. This offer is made up as follows and includes an expectation that the Integration Joint Board will be able to transform service provision to contain costs within this financial envelope. £m Approved Requisition 2024/25 63.534 Additional 2024/25 funding for pay costs 0.311 Revised 2024/25 funding 63.845 Funding for 3% pay increase in 25/26 0.772 Funding for full direct impact of eNIC changes 0.355 Other minor changes 0.014 Scottish Government funding for £12.60 per hour living wage rate for commissioned services 1.863 Scottish Government funding for uplift to Free Personal & Nursing Care rates 0.137 Total 66.986 Additional recurring funding to support demographic pressures 3.000 Additional non-recurring funding to allow delivery of transformational change by 2026/27 1.100 2025/26 MIJB Requisition 71.086 The non-recurring funding of £1.1 million is provided in expectation that delivery of ongoing and new transformation work will be completed to the extent that savings or cost reductions to the value of the non-recurring funding will delivered by the start of financial year 2026/27. I would be grateful if you could confirm Midlothian Integration Joint Board’s acceptance of the 2025-26 allocation. Page 13 of 38
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2 Yours sincerely David Gladwin Chief Financial Officer & Section 95 Officer David.Gladwin@midlothian.gov.uk cc Chris King, Chief Finance Officer, Midlothian Integration Joint Board Ruth Nichols, Senior Finance Business Partner Page 14 of 38
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Lothian NHS Board Finance Director’s Office NHS Lothian Mainpoint 102 West Port Edinburgh EH3 9DN Date 10 March 2025 Enquiries to Craig Marriott Email craig.marriott@nhs.scot Dear Chris, MIDLOTHIAN IJB – INDICATIVE BUDGET FOR 2025/26 Further to NHS Lothian’s Finance and Resources (F&R) Committee on February 12th, I write to update you on the position relating to Midlothian IJB budget position for 2025/26. We continue to update our financial plan, and will look to take a final iteration of the Plan through our F&R Committee on the 26th of March, with final sign off at our Board meeting on the 23rd April. The figures shared with you at this stage are therefore indicative until the final plan has been agreed. Further to the Scottish Government Budget announcement on 4th December 2023, 3% uplift for Health Boards in 2025/26 was set out. We will look to pass through to each IJB, based on budget shares, the baseline uplift settlement we receive. Currently the budget resource for Midlothian IJB is £105m before the 3% 2025/26 uplift is applied. This budget figure does include GMS budgets which although are non recurring in nature are assumed at this stage as part of the budget offer to be consistent with previous years. This figure does not include GMS uplift or Vaccination Allocations, nor does it include other allocations received non-recurrently from the Scottish Government. Table 1 shows the breakdown. Table 1 - Midlothian IJB Delegated Budget Status Allocation Midlothian IJB £'000 Delegated Core 57,586 Hosted 14,918 Set Aside 18,358 Recurring Budget 90,862 GMS 14,372 Total 105,234 (based on recurrent budgets as at Feb’25, with budgets subject to change as SG Allocations are received) Page 15 of 38
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The final review of the NHS Lothian Financial Plan will conclude shortly, and a further update on 2025/26 delegated budgets will be provided to you at this time. In preparing the final Financial Plan NHS Lothian has been advised to assume a share of £250m non recurring national sustainability funding in 2025/26. NHS Lothian is committed to working collaboratively with its IJB partners and therefore we would look to target this funding at financial pressure which sit across both delegated and non delegated health budgets. As previously highlighted, I am keen to understand from Midlothian IJB how its Directions will shape the delivery of financial recovery savings in 2025/26 and the application of resources in support of financial balance. I would be happy to have further discussion with your IJB in advance of the final confirmation on the application of health resources in 2025/26, and we are keen to work together to ensure ongoing support to achieve an overall balanced health position. Yours sincerely CRAIG MARRIOTT Director of Finance Page 16 of 38
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Appendix 3 – Overview of Financial Recovery Programme Grouping No Title/Theme Value £m Financial Risk Rating Operational Risk Rating Operational 1 Prior Year Recovery Actions 1.500 Low Low 2 Workforce Redesign 0.959 Low Medium 3 Prescribing Efficiency 0.966 Medium Low 4 Income Maximisation 0.353 Low Low 5 Equipment Rationalisation 0.100 Low Medium 6 Vaccination Service Redesign 0.100 Low Low 7 High-Cost Package Review 0.300 Medium Medium 8 Realistic Based Care 0.200 Medium Low 9 Hosted Services Actions 0.171 Low Low 10 Set Aside Actions 0.340 Low Low Sub Total 4.989 Strategic 11 Commissioned Services 0.812 Medium Medium Grand Total 5.801 Page 17 of 38
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Midlothian IJB Financial Recovery Planning Appendix 4 – Details of Strategic Redesign Recovery Proposal: No. 1 Savings Proposal: Commissioned Services Lead: Nick Clater Proposal Summary (Scope & Analysis) Context: » Following the IJB decision in March 2024 for a 3% reduction in commissioned spend, work has been undertaken in collaboration with providers and the third sector to identify opportunities to reduce spend. » No reductions in contracts were actioned in the 2024/25 financial year. The following areas will not be in scope: » Residential Placements funded via the National Care Home Contract. » External Residential Placements (they have been reviewed as part of the Reviews Project). » Advocacy contracts (a separate review is underway). » Carers funding (in recognition of the role unpaid carers play at a time of financial challenge). Principles: » Adherence to eligibility criteria (critical and substantial). » Protect core care (i.e. reviewed and agreed by the Resource Panel). » No blanket reductions or ‘salami slicing’ (provider session feedback). » Review contract delivery and utilisation first. » Consider alternative delivery where possible/appropriate. Methodology » Scoping exercise and assessment. » Identification of service contracts in and out of scope. » Contract manager liaison, SCOT analysis, and risk assessment. » Individual contract review. Financial Impact Forecast Recovery Value for 25/26 (£m) £0.812m Page 19 of 38
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Midlothian IJB Financial Recovery Planning Phase 1: » Care reviewed and agreed by the Resource Panel will be protected as Core Provision of high quality, safe and effective care. » The efficiency and effectiveness of all commissioned interventions will be reviewed. » The total Financial Recovery Deliverable will be identified through a combination of a transport review, a targeted reduction of contracts and a review of day service options » Ongoing assessment of any impact on the Resource Panel from the bed-based transformation programme. » A large-scale consultation will be undertaken to inform a larger proposal of coordinated and supported transformation in Phase 2. Phase 2 » Work to collaboratively develop the IJB Market Facilitation plan into a Partner Provider Statement that sets out a framework for all commissioned activity » Develop clearly defined areas of commissioning with agreed budgets lines for each agreed area of com- missioning. » Revise and update governance routes and processes for planning, procurement, monitoring, evaluation, and re/decommissioning. Phase 3 » Using monitoring, evaluation, to consider futures strategic investment through sustainable commissioning and ensure alignment to the IJB Strategic Aims. Risks and impacts Unintended consequences of this workstream An Equality and Children’s Rights Impact Assessment (ECRIA) has been undertaken to inform decision making. Additionally, there is a risk that some providers may no longer find it viable to operate in Midlothian due to a range of financial pressures. Unintended consequences of other workstreams Work undertaken as part of the bed-based transformation programme has the potential to significantly impact on this workstream. This is because any changes to the bed model could increase the demand and required capacity for community services. An increase in the statutory provision of community services has potential to result in increased spend for the resource panel and will be closely monitored. Page 20 of 38
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Midlothian Integration Joint Board Thursday 27th March 2024, 15:00 – 16:00 Midlothian IJB Directions for 2025/26 Executive summary This report presents the proposed Midlothian Integration Joint Board (IJB) Directions for 2025/26. Integration Authorities, Health Boards and Local Authorities have a legal obligation to both issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. Midlothian IJB Directions are issued to the Chief Executives of Midlothian Council and NHS Lothian. The proposed Directions for 2025/26 are structured within the framework of the 9 National Health and Wellbeing Outcomes and linked to the 3 strategic aims and 9 sub aims of the draft Strategic Plan 2025/35. Directions for 2025/26 have been developed with input from Board Members and the Strategic Planning Group based on themes generated by Midlothian HSCP Executive Leadership Team and with engagement from both Partners. These Directions also focus on the specific action required to achieve operational transformation and financial balance across the system. This approach allows Midlothian IJB to review activity and progress then take any decisions necessary to facilitate the whole system change required to deliver transformation. Draft Directions for 2025/26 were reviewed at the 20th February Midlothian IJB meeting and further scrutinised by Board members in the Midlothian IJB Board Development session on 27th February 2025 before final consideration at this Special Midlothian IJB Board. Board members are asked to: • Consider and approve the presented Directions for 2025/26. • Give delegated authority to the Chief Officer to issue these Directions to the Chief Executives of NHS Lothian and Midlothian Council on 31st March 2025. Item number: 5.2 Page 21 of 38
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Midlothian Integration Joint Board Report Midlothian IJB Directions for 2025/26 1 Purpose 1.1 This report presents the proposed Midlothian Integration Joint Board (IJB) Directions for 2025/26. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Consider and approve the presented Directions for 2025/26. • Give delegated authority to the Chief Officer to issue these Directions to the Chief Executives of NHS Lothian and Midlothian Council on 31st March 2025. 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 all functions delegated to the IJB are to be delivered and funded via the integrated budget made available to by NHS Lothian and Midlothian Council Partners. 3.3 Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. 3.4 In 2024/25, Midlothian IJB decided not to significantly change Directions from 2023/24 to allow partners the time to understand the full impact of funding changes. The financial position has become increasingly challenging across this time with many services operating differently within new financial models as a result of grip and control measures, transformation, and choices. 3.5 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 the Strategic Plan. To ensure Midlothian IJB is able to appropriately direct Partners in a way that aligns with the draft Strategic Plan 2025/35, clear instructions are required for key delivery priorities in 2025/26 to continue to embed the integrated practice and collaborative working that improves outcomes for people and communities. Page 22 of 38
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Midlothian Integration Joint Board 3.6 The proposed Directions for 2025/26 are structured within the framework of the 9 National Health and Wellbeing Outcomes and link to the 3 strategic aims and 9 sub aims of the draft Strategic Plan 2025/35. These Directions also focus on the specific action required to achieve operational transformation and financial balance across the system. This approach allows Midlothian IJB to review activity and progress then take any decisions necessary to facilitate the whole system change required to deliver transformation. 3.7 Directions for 2025/26 have been developed with input from Board Members and the Strategic Planning Group based on themes generated by Midlothian HSCP Executive Leadership Team and with engagement from both Partners. 3.8 Draft Directions were reviewed at the 20th February Midlothian IJB meeting. Further review was undertaken by Board members in the Midlothian IJB Board Development session on 27th February 2025 before final consideration at this Special Midlothian IJB 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. 5 Directions 5.1 This report proposes the Midlothian IJB Directions for 2025/26. 6 Equalities Implications 6.1 There are no specific equalities implications as a result of this report. 6.2 All Directions are designed to progress the ambitions of the strategic aims of the Midlothian Integration Joint Board. An Equality and Children’s Right Impact Assessment (ECRIA) has been published in relation to the Strategic Plan 2022/25, and, on 26th September 2024, the Strategic Planning Group undertook an ECRIA on the draft Strategic Plan 2025/35. The recommendations of this ECRIA were noted without amendment on 28th November 2024, have been actioned and incorporated into the draft Strategic Plan 2025/35. 6.3 Health and Social Care Partnership service strategy, policy, plans, provisions, practices, and activities that relate to these Directions and the Strategic Plan are subject to a screening process to determine if an Equality and Children’s Right Impact Assessment (ECRIA) is required. Page 23 of 38
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Midlothian Integration Joint Board 7 Resource Implications 7.1 Directions should include the financial resources available for carrying out delegated functions, including the allocated budget and how that budget is to be used, whether this is a payment, or a sum set aside and made available. This information can be found in the appendix of the draft Midlothian IJB Directions 2025/26 (Appendix 1). 7.2 Directions relating to Financial Recovery Planning must be clearly stated as such. Relevant Directions in the Midlothian IJB Draft Directions 2025/26 are closely aligned to the proposed transformation programme and included under Health and Wellbeing Outcome No.9: Use of Resources. 8 Risk 8.1 IJBs, Health Boards, and Local Authorities have a legal obligation to issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. Not complying will pose legislative risks and it will be more difficult for the IJB to undertake its duties related to accountability and good governance. 8.2 Board members should routinely consider when Directions need to be revised, or new Directions are required to be issued issue to partners. 9 Involving people 9.1 Board members, officers of the HSCP, services, partner organisations, and people and communities have been involved in the process to develop the Midlothian IJB Directions for 2025/26. 9.2 The Strategic Planning Group 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. 10 Background Papers AUTHOR’S NAME & DESIGNATION Gill Main, Integration Manager CONTACT INFO gill.main3@nhs.scot DATE 15/03/2025 Appendices: Appendix 1: Midlothian Integration Joint Board Directions 2025/26 Page 24 of 38
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1 Midlothian Integration Joint Board Directions 2025/26 Page 25 of 38
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2 Introduction Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian in 2015. The IJB plans and directs health and social care services for the people of Midlothian using the integrated budget received from Midlothian Council and NHS Lothian. Directions are the mechanism by which Integration Authorities communicate their priority actions to both Midlothian Council and NHS Lothian. The Midlothian IJB Strategic Commissioning Plan 2022-25 focuses on prevention, early intervention, recovery, and self-management and this remains woven through the strategic aims of the Midlothian IJB draft Strategic Plan for 2025/35. Our Directions for 2025/26 look forward to the ambitions of our draft Strategic Plan 2025/35 and set out the action we think will help us best progress towards the 9 National Health and Wellbeing Outcomes within the financial resources made available to us by our Partners. The Strategic aims for 2025/35 are People feel able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health People access the care and support they need when they need it in the community and at home. People's human, social, and economic rights are protected and promoted in how we design and deliver our services. 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 increasingly challenging across this time with many services operating differently within new financial models as a result of Grip and Control measures, Transformation, and Choices. However, Midlothian IJB must evolve and commission services in new and increasingly innovative ways while continuing to provide safe, high-quality care and support in line with its Strategic Plan. To ensure we are able to appropriately direct Partners in a way that aligns with our strategy and future ambitions, we recognise we must provide clear instruction on key actions for delivery in 2025/26 that require services to continue to embed the integrated practice and collaborative working that improves outcomes for people and communities. We have worked closely with both 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 £71.086m for 2025/26 was accepted by Midlothian IJB at the Board meeting on 27th March 2025. b) The indicative 2025/26 NHS Lothian recurring budget from the February Finance and Resources committee is £105.234m. NHS Lothian will approve their 2025/26 budget at the NHS Lothian Board scheduled for 16th of April 2025. These values are therefore indicative. Funding allocations can be found in Appendix 1 1 3 2 Page 26 of 38
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3 1.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by December 2025. 1.4 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 include » consistent use and application of the Midlothian IJB ‘Writing for Publication Style Guide’, » assurance all service information is person-centred and meaningful from the perspective of those it is intended to support, » a review of the Midlothian Health and Social Care website pages to ensure compliance the Equality Act 2010 and accessibility standards, » the development of consistently presented online and paper service information resources, and » links with both partners website, information, and signposting provisions. 2.3 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 NHS Lothian and Midlothian Council will support Midlothian HSCP to undertake a review of Social Work and Occupational Therapy teams by December 2025. 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. Page 27 of 38
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4 3.2 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 NHS Lothian and Midlothian Council will support Midlothian HSCP to revise and update ‘The Midway’ by October 2025. 3.4 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. 4.1 NHS Lothian and Midlothian Council will support the HSCP integrated services to demonstrate how feedback informs service continual improvement redesign by December 2025. 4.2 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated self-management framework that sets out an expectation of how services will work with people to be more informed about their condition(s), be better prepared for when they feel less well, and describes how to access the right support when it is needed by December 2025. 4.4 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. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. Page 28 of 38
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5 5.1 NHS Lothian and Midlothian Council will ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring » systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics » 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 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. 5.3 NHS Lothian and Midlothian Council will 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. 6.1 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. 6.3 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. 5 Health Inequalities Health & social care services contribute to reducing health inequalities 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Page 29 of 38
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6 7.1 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 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. 7.4 Midlothian Health and Social Care Partnership will support services to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms, this includes establishing (and taking action where necessary) by 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. 8.1 NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2025-26 by June 2025. 8.2 NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the Midlothian IJB Integrated Workforce Plan 2025-28 by June 2025. 8.3 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 HSCP managed services and delivered by third parties through commissioning by December 2025. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Page 30 of 38
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7 9.1 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 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 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. 9.3 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 2025/26 to support achieving a balanced financial position across eight work- streams. 9.3.1 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 by December 2025. 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. 9.3.2 Bed based provision Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign and ensure the most efficient and effective operational model of bed-based provision. This should be designed to enable people to access appropriate levels of care when their needs change within this model and enable the safe and timely return to living well in the community. 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. 9 Use of Resources Resources are used effectively and efficiently. Page 31 of 38
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8 9.3.3 Home First Model of Care Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign the Home First model of care. This should result a transformed model and use of resources that can demonstrate improved efficiency and effectiveness, delivering the right care in the right place at the right time, facilitating discharge without delay, and avoidance of unnecessary hospital admission. The review and redesign of services will be completed by June 2025. 9.3.4 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. 9.3.5 Commissioning and Third Sector Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review of commissioning spend and establish a new partner provider model that is closely aligned with the strategic aims of the IJB, supports the delivery of key ambitions and increases opportunities for health equality across Midlothian by June 2026. 9.3.6 Community Assets Midlothian Council and NHS Lothian will support Midlothian HSCP to make best use of the opportunity to bring local public bodies together with local communities and local community partner organisations to effectively strategically plan, design, and deliver service offers that make a real difference in people’s lives through the Midlothian Community Planning Partnership. This should include supporting the HSCP to lead of the revision, co-design, and partner agreement to co-deliver the ‘Midlothian will be healthier’ component of the Single Midlothian Plan alongside people, communities and community partners, by December 2025. 9.3.7 Mental Health and Dementia NHS Lothian and Midlothian Council will support Midlothian HSCP to improve the experience of people in Midlothian with Dementia by ensuring everyone with a diagnosis of dementia can be offered Post-Diagnostic Support for the first year of their diagnosis and has access to 8 Pillars Model of Community Support by December 2026. Page 32 of 38
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9 9.3.8 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 9.4 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 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 33 of 38
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10 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 34 of 38
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11 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 35 of 38
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12 Appendix 1: Midlothian IJB Indicative Budgets for 2025/26 for Directions (noting health funding is indicative until the NHS Lothian April Board) Health Service ML IJB 25/26 Budget £000’s Core Community Equipment 607 Community Hospitals 6,694 Community Nursing 1,778 Diabetes & Endocrinology 21 District Nursing 3,751 Geriatric Medicine 518 GMS 15,701 Health Visiting 2,784 Learning Disabilities 397 Mental Health 2,222 ML Partnership Management 463 PC Management 8,712 PC Services 513 Pharmacy 3 Prescribing 19,376 Resource Transfer 6,973 Substance Misuse 197 Therapy Services 2,578 Core Total 73,288 Hosted Community Hospitals 9 Complex Care 185 Diabetes & Endocrinology 5 GMS (589) Hospices & Palliative Care 522 Learning Disabilities 1,324 LUCS 1,482 Mental Health 2,308 Oral Health Services 1,104 PC Services 676 Prescribing 73 Psychology Services 1,731 Public Health 388 Rehabilitation Medicine 949 Sexual Health 865 Substance Misuse 344 Therapy Services 1,555 UNPAC 657 Hosted Total 13,589 Page 36 of 38
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13 Acute (Set Aside) Acute Management 703 Cardiology 12 Children Therapies 24 Diabetes & Endocrinology 547 ED & Minor Injuries 3,130 General Medicine 6,827 Geriatric Medicine 3,422 Outpatients 136 Rehabilitation Medicine 377 Respiratory Medicine 1,323 Therapy Services 1,858 Acute Total 18,358 Total Health 105,234 Social Care Service ML IJB 25/26 Budget £000’s Core Addictions 41 Assessment and Care Management 4,207 Criminal Justice 39 Learning Disability Services 21,479 Management and Administration 122 MELDAP/Recovery Hub 253 Mental Health Services 1,314 Non-Specific Groups 1,162 Older People 36,010 People with AIDS/HIV (33) Performance and Planning 705 Physical Disability Services 4,232 Public Protection 829 Service Management 519 Strategic Commissioning 207 Total Social Care 71,086 Total IJB 176,230 Page 37 of 38
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