Agenda Document Pack - Midlothian Integration Joint Board - 24/04/2025
Midlothian Council · 24 April 2025
Back to Midlothian Integration Joint Board — 24 April 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, 24 April 2025 Time: 13:00 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 132
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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 20th February 2025 submitted for approval 5 - 20 4.2 Minutes of Strategic Planning Group on 16th January, 2025 submitted for noting 21 - 36 4.3 Minutes of Audit and Risk Committee on 5th December, 2024 submitted for noting 37 - 42 5 Public Reports 5.1 Chair’s Update - Councillor McManus, Chair 5.2 Chief Officers Report - Morag Barrow, Chief Officer 43 - 50 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 For Decision 5.5 Midlothian IJB Equalities Outcomes 2025-2029 - Paper presented by Gill Main, Integration Manager 51 - 66 For Discussion 5.6 Midlothian IJB Finance Update - Paper presented by Chris King, Chief Finance Officer 67 - 72 5.7 Midlothian IJB Performance Update - Paper presented by Elouise Johnstone, Programme Manager 73 - 86 Page 2 of 132
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5.8 Midlothian IJB Draft Annual Performance Report - Paper presented by Gill Main, Integration Manager 87 - 90 5.9 Midlothian Unscheduled Care Workstream Update - Presentation by Grace Cowan, Head of Older Peoples & Primary Care Services 5.10 Midlothian Overview of No.11 Services (Mental Health, Substance Use & Justice) - Presentation by Nick Clater, Head of Adult Services 5.11 Midlothian IJB Integrated Assurance Report - Paper presented by Fiona Stratton, Chief Nurse & Claire Ross, Chief AHP 91 - 108 For Noting 5.12 Category 1 Responder Update: Storm Eowyn - Paper provided by Roxanne King, Executive Business Manager 109 - 114 5.13 Accounts Commission Integration Joint Boards Finance Bulletin 115 - 132 6 Private Reports 7 Date of Next Meeting The next meeting of Midlothian Integration Joint Board will be held on: Thursday 12th June 2025, 14.00 - 16:00 and will be held virtually over MS Teams. The Midlothian IJB Development Session will be held on Thursday 8th May 2025, 14:00 - 16:00 for IJB members only. Page 3 of 132
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 20 February 2025 14:00 Council Chambers, Midlothian House and Virtual Meeting held using Microsoft Teams Present (voting members): Councillor McManus (Chair) Dr Amjad Khan (NHS Lothian) (Virtual) Councillor Winchester (Virtual) Val de Souza (Vice Chair, NHS) (Virtual) Kirsty Macdonald (NHS Lothian ) (Virtual) Andrew Fleming (NHS Lothian) Present (non-voting members): Morag Barrow (Chief Officer) Fiona Stratton (Chief Nurse) Nick Clater (Head of Adult Services and Chief Social Work Officer) Grace Chalmers (Partnership Representative) Claire Ross (Chief AHP) Keith Chapman (Lived Experience member) Magda Clark (Third Sector Representative) Chris King (Chief Finance Officer) Councillor McKenzie (alternate for Councillor Parry) In attendance: Gill Main (Integration Manager) Fiona Kennedy (Group Service Manager) Roxanne King Executive Business Manager (Virtual) Elouise Johnstone (Performance Manager) Hannah Forbes (Democratic Services Officer) Midlothian Integration Joint Board Thursday 24 April 2025 Item 4.1 Page 5 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board 1. Welcome and Introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB). 2. Order of Business The order of business was confirmed as outlined in the agenda that had been previously circulated. 3. Declarations of Interest There were no declarations noted. 4. Minute of Previous Meetings 4.1 The Minute of previous Midlothian IJB Board Meeting held on 19th December 2024 was approved as an accurate record. 4.2 The Minute of the meeting of the MIJB – Strategic Planning Group held on 28th November 2024 was noted by the Board. 4.3 The Minute of the meeting of the MIJB – Audit and Risk Committee held on 12th September 2024 was noted by the Board. Nicola Thorburn (Democratic Services Officer) Apologies: Grace Cowan (Head of Older People and Primary Care Services) Claire Gardiner (Audit Scotland) Dr Rebecca Green (Clinical Director) Councillor Parry Page 6 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board 5. Public Reports Decision Action Owner Date to be Completed/ Comments 5.1 Chair’s Update – Councillor McManus, Chair The Chair opened by reminding the Board of the additional Midlothian IJB members Development Session scheduled for the 27th February 2025 to further consider i) Financial Recovery Plans and ii) Directions 2025/26 ahead of the March Special Board. The Chair noted the March Special Board has been rescheduled to the 27th March from the 13th March due ensure final or indicative offers from both Partners have been received. The Board were advised that a Midlothian IJB Members Development Session from, 14.00 – 14.50 will immediately precede the Special Board, held from 15.00 – 16.00. The Chair also noted the April Board Meeting has been rescheduled to the 24th of April 2025. The Chair passed thanks to Midlothian Health & Social Care Partnership (HSCP), for their efforts during Storm Eowyn, and particularly noted the strong collaborative working with Midlothian Council. 5.2 Chief Officers Report – Morag Barrow, Chief Officer Morag Barrow, Chief Officer presented the report and advised the paper sets out the key strategic updates for Midlothian IJB Board. This report is for noting. The Chief Officer highlighted items for the attention of the Board. • The continuation of the financial recovery work being undertaken by the HSCP, • A number of Midlothian staff recognised for exceptional work and in receipt of national awards, • St Cuthberts Supported Living in Bonnyrigg is now open, this facility supports 8 people who Page 7 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments experience learning disabilities with care or transitioned care, • The continued excellent work by the Substance Misuse Team, and their continued high performance in relation to medication assessed treatment (MAT) standards, • The innovative use of data in Midlothian through collaborative working between NHS Lothian and Midlothian Council, and • The challenges facing the nursing workforce. It was noted that NHS Lothian are undertaking staffing ‘health checks’ across all ward areas to ensure compliance with the Health and Care (Staffing) (Scotland) Act, 2019. Midlothian hospitals were noted to have appropriate and safe staffing models in place. The Chair thanked the Chief Officer for the report and opened up to any questions. The Board congratulated those that have been recognised for awards. A question regarding waiting times for children who are neurodiverse was raised and whether the HSCP are supporting people to wait well. The Head of Adult Services and Chief Social Work Officer noted that Children’s Services are not delegated to Midlothian IJB meaning Child and Adolescent Mental Health Service (CAMHS) waiting times are out with the remit of both Midlothian IJB and HSCP although collaborative working is vital to support transitions. The Board requested information relating to the data sharing agreements required to progress key pieces of work. The Integration Manager explained that local data sharing agreement are being progressed and a solution regarding secure transfer of data means there is now clear way forward for future work that will enable developing our data capabilities in new ways. The Board queried the increase to GP charges, the impact, and the Midlothian approach. The Chief Board update Clinical Director 24/04/2025 Page 8 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Officer noted the Clinical Director will provide an update The Board noted feedback in relation to limited out of hours support for people who use substances and queried capacity to increase the support. The Head of Adult Services and Chief Social Work Officer advised that this is a known issue that this is being reviewed by the Midlothian and East Lothian Drug and Alcohol Partnership (MELDAP) and will review progress with the service manager. Review progress Head of Adult Services and Chief Social Work. 24/04/2025 5.3 Strategic Planning Group Update – Report presented by Gill Main, Integration Manager Gill Main, Integration Manager, presented the main activity of the Strategic Planning Group (SPG) since December 2024 to the Board. This included ongoing development of the Strategic Plan, review and evaluation of Directions 2024/25 reporting, developing proposed Directions for 2025/26, developing a draft Directions Policy, ongoing work on the Midlothian IJB Equality Outcomes 2025-29, and the Midlothian IJB Integrated Workforce Plan 2025-28. Additionally, a requested revision to the SPG Terms of Reference (ToR) to enable any Board member to take up the position of Vice Chair of SPG will be reviewed by the Audit & Risk Committee on the 6th March 2025. The Chair thanked the Integration Manager for the report. There were no questions from the Board in relation to the report. 5.4 Audit and Risk Committee Update – Report presented by Gill Main, Integration Manager Gill Main, Integration Manager presented the main activity of the Audit & Risk Committee (A&R) on 5th December 2024 to the Board. Meeting. This included the ongoing recruitment of an Independent member, and review of the Midlothian IJB Risk Register. Page 9 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chair thanked the Integration Manager for the report. There were no questions from the Board in relation to the report. For Decision 5.4.1 Appointment to the Audit and Risk Committee of an Independent Member Paper by Duncan Stainbank, Chief Internal Auditor and Val de Souza, Audit and Risk Committee Chair Duncan Stainbank, Chief Internal Auditor, presented the report detailing the process undertaken to identify and now recommend Antony Clark as the nominee for the role of Independent Member to the Audit & Risk Committee. The Board agreed to appoint Antony Clark to the role of Independent Member. Approved For Decision 5.5 Midlothian IJB Meeting Schedule 2025 and 2026 - Paper presented by Democratic Services The Democratic Service Officer presented the report detailing the dates for Board 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). An omission of the July 2025 and 2026 SPG dates were noted, and dates of 24th July 2025 and the 23rd July 2026 were suggested. As a result of the report, Members were asked to: • Review and note the revised dates for 2025 set out in Appendix 1. Page 10 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments • 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 The Board agreed the proposed schedule for 2025 and 2026. Approved For Decision 5.6 Midlothian IJB Membership Nomination - Paper presented by Democratic Services The Democratic Service Officer presented the report noting changes to non-voting membership of Midlothian Integration Joint Board and seeking the Board’s formal endorsement of recommendation As a result of this report, Members were asked to: • Note the successful recruitment of Chris King, Chief Finance Officer. • Endorse the nomination of Chris King as a non-voting member of Midlothian IJB as the new Chief Finance Officer. The report was approved by the Board Approved For Decision 5.7 Midlothian IJB Draft Strategic Plan 2025/35 Update - Paper presented by Gill Main, Integration Manager Gill Main, Integration Manager presented the report which set out the actions and progress in the development of Midlothian Integration Joint Boards Strategic Plan for 2025-35 noting revisions and Page 11 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments amendment following public consultation and feedback from Partners, in line with the Strategic Plan Statutory Guidance. As a result of this report, Members were asked to: • Review the revised draft of the 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 the draft Strategic Plan subject to required changes, for approval to progress through the governance routes of our Partners. The Board commended the work that has been undertaken to date, noted the adoption of early feedback and revision requests and were in agreement to endorse the next steps. The Chief Officer stated that details of operational actions will be finalised and added to the plan as financial decision are taken. It was further noted that as the mechanism to deliver the strategic plan, Directions for 2025/26 are also presented under item 5.12 on the agenda. The Chair thanked the Integration Manager for the report. The Board approved the recommendations. Approved for progression Integration Manager 10/10/2025 For Decision 5.8 Midlothian IJB Finance Update and Recovery Planning - Paper presented by Chris King, Chief Finance Officer Chris King, Chief Finance officer presented this report to update Members on the 2024/25 financial position and proposed Financial Recovery Actions for 2024/25 and 2025/26 in the context of Page 12 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Midlothian Health and Social Care Partnership’s ongoing transformation plans and operational delivery. As a result of this report, Members were 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. The Chair thanked the Chief Finance Officer for the report and opened to any questions. It was noted by the Chair that Midlothian Council will meet to agree their final budget offer on Tuesday 25 February 2025. Further consideration of financial recovery will also continue at Midlothian IJB Development Session scheduled for Thursday on 27th February 2025. The Board considered the proposals and whether a 5% reduction for commissioned services should be applied be across the board. The Chief Finance officer clarified that proposals are not for a 5% reduction to all contracts, and the methodology will be reviewed in the 27th of February 2025 Development Session. The Board requested more information to gain a better understanding of likely opportunities and challenges in future years. The Chair stated that the financial position in Midlothian is consistent with the experience across the country with IJBs requiring additional funds to deliver statutory care and support. The Chair stated he Information required at Midlothian IJB Development Session Chief Finance Officer 27/02/2025 Page 13 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments continues to engage with Scottish Government and will write to Neil Gray (MP) to raise the issue of IJB sustainability. The Chief Officer stated that the IJB has reported its financial position to both Partners and with elected members in regular briefing sessions across the year. The Board further noted that difficulties in relation to budget forecasting and the 2024/25 an overspend position, noting it was keen to improve financial forecasting to avoid this in the future. The Chief Officer noted increased prescribing costs, increasing demographic pressures and new costs as people moving into the area with complex support needs. The Board recognised the work of the Officers and the significant achievement of realising £6 million in savings in 2024/25. The Board agreed to progress the discussion with providers relating to the potential outcome of the Special IJB Board Meeting on 27th March 2025 Approved For Decision 5.9 Midlothian IJB Integrated Workforce Plan 2025/28 - Paper presented by Gill Main, Integration Manager Gill Main, Integration Manager presented this report and the draft Midlothian IJB Integrated Workforce Plan 2025/28 (appendix 1) and ‘Annexe A’ (appendix 2) for approval prior to submission to Scottish Government. Page 14 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments It was noted that Scottish Government plan to review this information and provide feedback for action prior to publication. This plan has been reviewed by Midlothian HSCP Executive Leadership Team, Midlothian Integrated Workforce Governance Board and Midlothian IJB Strategic Planning Group (SPG) who recommended it to the Board for consideration at the SPG held on 16th of January 2025. As result of this report Members were asked to: • Review and approve, subject to required amendments, that the draft Integrated Workforce Plan 2025/28 and Annexe A are submitted to Scottish Government by the 17th March 2025. • Give delegated authority to the Integration Manager to submit these documents to Scottish Government. The Chair thanked the Integration manager for the report and opened it up to any questions or comments. The Board noted the hard to fill posts detailed in the Annexe A report and queried the rationale for this. The Integration Manager clarified that Scottish Government has asked for Annexe A to note pervasively difficult posts to recruit to and that this information was provided by Heads of Services. The Board noted mental health as the most common reason for sustained and long-term absence and queried the action being taken by Midlothian HSCP and employing Partners to address this. The Integration Manager referred to the section in the plan discussing wellbeing and staff engagement, and the HSCP plan to support staff in additional to the support mechanisms of both employing partners. The Board gave delegated authority to the Integration Manager to submit these documents to Scottish Government. Approved for submission Integration Manager 17/03/2025 Page 15 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments For Discussion 5.10 Midlothian IJB Performance Report - Paper presented by Gill Main, Integration Manager Gill Main, Integration Manager presented this report and provided an update on progress towards the IJB’s performance goals for 2023-25, and reviewed performance relating to Midlothian IJB Directions 2024/25. As a result of this report Members were 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. The Chair thanked the Integration Manager for the report and opened for questions from the board. The Board queried the progress of work to improve frailty pathways, as no narrative was provided. The Chief AHP apologised that this has not been provided and described the positive progress to date and plan to continue this work in 2025/26. Board noted that Frailty pathways narrative to be included in future Direction reporting. Frailty pathways to be included in Directions reporting Chief AHP 31/07/2025 For Discussion (Presentation) 5.11 Unscheduled Care Improvement Working Presentation by Morag Barrow, Chief Officer The Chief Officer provided an introduction with to this collaborative, whole system initiative. Page 16 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Councillor Mckenzie Joined the meeting at 15:03pm. The Chief Officer further highlighting the 4 phases of this plan. The phases of 1,2,3 and 4 were described to the Board and noted the close working with external providers to see the desired change. The Chief Officer highlighted targets, progress to date, and where success has been achieved. The Board welcomed the additional funding from Scottish Government to develop this work, noted improvements, and queried the mechanisms in place to support staff with the potential impact of increased workload. The Chief Officer reported additional staff are being recruitment but noted the challenging recruitment market. For Discussion 5.12 Midlothian IJB Draft Directions 2025/26 Review - Paper presented by Gill Main, Integration Manager Gill Main Integration Manager presented this paper for discussion outlining the work to date to develop Directions for 2025/26 and noted the opportunity for further discussion at the February 27th Development session ahead of the 27th March Special Board. As a result of this report, Members were asked to: • Review, discuss and provide feedback on the draft Directions 2025/2026. The Board highlighted Direction 1.4 and the importance of all information and advice should be evidence based, person-centred, and accessible in a way that was meaningful to them. It was requested the Integration Manager consider this addition to Direction 1.4. Review Direction 1.4 Integration Manager 27/03/2025 Page 17 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Integration Manager noted the production of a Midlothian IJB a writing for publication style guide for that sets out the legal requirement for accessibility and that this had been adopted for all IJB publications. For Discussion 5.13 Midlothian IJB Draft Directions Policy - Paper presented by Gill Main, Integration Manager Gill Main, Integration Manager presented the report and a draft Midlothian Integration Joint Board Directions Policy for review and approval As a result of this report, Members were asked to: • Review the proposed draft Midlothian IJB Directions Policy and, subject to any amendments, approve for publication. The Board queried whether there was an opportunity to present the work to connect the strategy, Directions and performance management of Midlothian IJB to Partners and demonstrate the connected approach of Midlothian IJB. The Integration manager advised that this work will be noted as the Strategic Plan is submitted to Partners governance meetings as part of the approval process The Board approved the publication. Approved Integration Manager 30/06/2025 For Discussion 5.14 IJB Members Self-Development Plan - Paper presented by Duncan Stainbank, Chief Internal Auditor Page 18 of 132
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Thursday 20 February 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Duncan Stainbank, Chief Internal Auditor presented this report which provided an update on the progress of the Midlothian IJB Board Members Self Development Plan for 2023/24. The proposed methodology for updating the plan was also outlined to ensure Board members continued to meet best practice standards. As a result of this report, Members were asked to: • Agree to participate in an annual assessment of the Board and creation of a Board Improvement Plan. • Agree to attend a Development Session on an annual basis to undertake a review process. • Provide views on areas for self-improvement via a questionnaire. The Chair noted the Board agreed to continue with a self-development programme and for development at the planned Development Session on 8th May 2025. Approved Chief Internal Auditor 08/05/2025 For Noting 5.15 Future Plan for the National Care Service Letter from Minister for Social Care, Mental Wellbeing and Sport The Chair noted that letter of response from the Minster of Social Care, Mental Wellbeing and Sport regarding the future plans for the National Care Service had been circulated to members by the Chief Officer. The chair opened to any questions or comments from the board. The Board queried the plans for ongoing engagement and requested regular updates. The Chair noted continued discussion between Scottish Government and stakeholders regarding the progress of the Bill. Future updates to be noted IJB Chair Ongoing Page 19 of 132
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Thursday 20 February 2025 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 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. The meeting terminated at 15:54pm. Decision Action Owner Date to be Completed/ Comments The Head of Adult Services and Chief Social Work Officer noted the proposal to embed the National Social Work Agency within Scottish Government, and the professional view that this should be developed as an independent agency. The Chair closed the conversation advising that updates on progress will be brough to the board as they are received. Page 20 of 132
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Midlothian Integration Joint Board Meeting Date Time Venue Strategic Planning Group 16 January 2025 14:00 Committee Room/MS Teams Present (MIJB Members): Councillor McManus (virtual) Councillor Winchester (virtual) Present (HSCP and Partners): Andrew Fleming (Chair) Morag Barrow, (Chief Officer) Chris King, Interim Chief Financial Officer Gill Main, Integration Manager Nick Clater, Head of Adult Services & Chief Social Work Officer Grace Cowan, Head of Primary Care and Older People Elouise Johnstone, HSCP Programme Manager (Performance) Roxanne Watson (virtual), Executive Business Manager Rosemary McLaughlan (virtual), VOCAL Jordan Miller (virtual), Lead Partnership Rep Rebecca Miller (virtual), Strategic Development NHS Lothian Claire Ross, Chief Allied Health Professional (AHP) Jim Sherval (virtual), Consultant in Public Health Fiona Stratton, Chief Nurse Apologies: Sarah Archibald, Clinical Service Manager Keith Chapman, Lived Experience Member Magda Clark, Third Sector Member Midlothian Integration Joint Board Thursday 24 April 2025 Item 4.2 Page 21 of 132
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Strategic Planning Group D. Collins, Non-Commercial Provider of Social Housing Representative Lesley Crozier, Equality, Diversity & Human Rights Officer Rebecca Green, Clinical Director James Hill, Midlothian Council Representative Laura Hill, VOCAL Rachael Honeyman, Head of Volunteering NHS Laura Hutchison, Equality, Diversity & Human Rights Lead Saty Kaur, Chief Officer Corporate Solutions Fiona Kennedy, Group Service Manager Dr Amjad Khan, NHS Lothian Annette Lang, Group Service Manager Fiona Robertson, Executive Director, Children, Young People & Partnerships 1. Welcome and introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB) Strategic Planning Group (SPG), and introduced Chris King, the new Interim Chief Financial Officer. The apologies submitted were noted. 2. Order of Business The Chair advised that the order of business was as set out in the agenda. 3. Minutes of Meeting 3.1 The minutes of the Strategic Planning Group 28th November 2024 were approved as an accurate record in principle, however there were two typing corrections to be made, and shared with Democratic Services to action. 3.2 Action log The Integration Manager noted that over the last year 43 actions have been closed, 67% of identified actions are completed, with significant progress made since this group last met. Action 11, in relation to the Scottish Government's Women's Health Plan. The Integration Manager advised this has been delayed due to challenges with funding and resourcing and the expected timeline will be added when available. Page 22 of 132
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Strategic Planning Group Action 17, Primary Care Sustainability Direction. The Integration Manager noted that this item is now complete from an MIJB SPG perspective, and the Short Life Working Group has been set up. Action 18, to identify an MIJB voting member as the Strategic Planning Group Vice Chair. The Integration Manager noted that this is currently open and overdue. The Chair added that this will be addressed within their update later in this meeting. Actions 20 – 20.9, in relation to Equalities & Children’s Rights. The Integration Manager advised that while some of these actions have been completed others will continue between now and publication, and the team are progressing these. Action 22, The Clinical Director will liaise directly with the General Practitioner (GP) Cluster Lead. Action 22.1, The Health & Social Care Partnership (HSCP) Programme Manager (Performance) is tabled on the next MIJB SPG to update on the development of the Citizen Panel questions. Action 23, Directions 2025/26 Development. The Integration Manager advised that an update on Directions is included in the meeting papers for today. No notes of interests to collaborate from SPG members were received. Action 24, Strategic Plan 2025/35 Accompanying Documents. The Integration Manager noted that these were reviewed at the last MIJB SPG meeting, and the group will continue to review these. The documents must be published at the same time as the Strategic Plan, which is on target for publication in October 2025. Action 24.1, Strategic Plan 2025/35 Accompanying Documents. The Integration Manager advised that this item is complete following confirmation from colleagues in Housing that the Housing Allocation Policy currently considers supporting evidence for collocating carers and the cared for person where possible. Action 25, MIJB Strategic Governance Map Review. The Integration Manager advised that this is a rolling action, remains on target, and will be reviewed by SPG ahead of each MIJB IJB meeting. Action 25.1, MIJB Strategic Governance Map Review. SPG have asked the MIJB whether they wish to consider the publication of the report and this is under consideration. Page 23 of 132
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Strategic Planning Group Action 26, Any Other Business (AOB): Equality Outcomes. This item has been completed. An extension request went to the MIJB in December 2024 and the Chair gave the Integration Manager delegated responsibility to discuss with the Scottish Government. 3.3 Risk Register This item was not discussed. 4. Updates Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 The Chair’s Update The Chair advised that a Vice Chair has not been identified, and it is unlikely that any of the non-executives or Members will take on this role. The Integration Manager suggested that a member of the MIJB may be willing to be Vice Chair of this group, and if so the Terms of Reference would be updated accordingly after approval by the MIJB Audit & Risk and the MIJB. Chair asked the Integration Manager to action. The Chair requested views on hybrid meetings whether this was conducive for engagement, and for comments from those attending virtually. Sound quality was raised with Council Chamber raised as an alternative. The Chief Officer stated the Committee Room was her preference as more conducive to a group discussion. The Chief Officer added that ideally everyone should attend these meetings in person due to the collaborative nature of items, but recognised attending virtually is an important option to support attendance. The update was noted. Review of ToR All GM n/a 30/04/2025 Page 24 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chair highlighted the contribution of Emma-Jane Gunda over the last 2 years, noted thanks for their service and wished them well in their new role. 5. Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1 Design and Development Strategic Plan 2025/2035 (Gill Main, Integration Manager) The Integration Manager presented the report, highlighting actions and progress to date in relation to the development of MIJB’s new Strategic Plan for 2025-2035 now in third draft plan following public consultation and feedback from partners, in line with the Strategic Plan Statutory Guidance. The plan will continue to develop as it goes through the governance process with both partners before seeking approval from the IJB on 9th October 2025. Ongoing financial uncertainty until the March budget setting Board, is limiting the detail that can be added at this time. SPG Members are asked to: • Review the revised third draft Strategic Plan 2025/2035, provide feedback and comments, and provide offers of support for any recommended amendments or identified gaps. Approved to progress through the governance routes of our partners and Midlothian MIJB’s February Board. Integration Manager TBC Page 25 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments • Approve this draft Strategic Plan subject to required changes, for recommendation to Midlothian IJB’s February meeting seeking approval to progress through the governance routes of our Partners. The Chair recognised the work that has gone into developing the plan and opened for questions. The Chair asked the NHS Lothian and Midlothian Council representatives if they foresee any barriers or challenges in the plan. The NHS Lothian Head of Strategy Development advised that they have worked closely with the Integration Manager and their team on the content. They agreed that operational details were required, acknowledged the current limitations, but agreed that the plan is going in the right direction. The Chief Officer thanked the NHS Lothian Head of Strategy Development for their continued support and feedback. The Chief Officer added that they are meeting with the Midlothian Council Chief Executive in early February to discuss the plan. Any actions coming from this meeting will be taken forward by the Chief Officer and the Integration Manager. The Chair noted the Early Intervention & Prevention objective within the plan and asked if more detail could be added here. Chair requested services consider ideas for inclusion and liaise with Integration Manager. The Chief Officer advised that this is part of MIJB’s financial recovery planning and will be presented to the MIJB at the end of the month so more detail can be added in the coming months. The Chief Officer suggested that the Consultant in Public Health might have ideas on what they will want to focus on in the next 2-3 years. Services to identify contributions to the plan on Early intervention and Prevention. PHC to identify contributions to the plan on Early intervention and Prevention. Heads of Service and Professional Leads Consultant in Public Health 30/05/2025 30/05/2025 Page 26 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Consultant in Public Health added that they were pleased to see the endorsement of Public Health Practitioners in this plan, and it was positive to see preventative activity. The Chair noted the Market Facilitation Plan, and suggested the position around the ageing population and the consequences on the statutory services must be clearly articulated to highlight this future pressures. The Chair also raised a point on Green, or Social Prescribing and whether more should be included on this in the plan. These topics were not discussed any further, but the Chair left this with the group to consider. The Chair also noted the need for consideration to resources for digital support and queried the Partners’ position and opportunities. The Chief Officer agreed that it was vital to maximise the benefit from Partners resources in this area. The Chief AHP (and HSCP Digital Lead) added a draft plan for e-Health is in development, but this and a timeline for delivery are both unclear. The Midlothian Council Digital Plan has good visibility and there are opportunities for operational efficiencies that could be progressed. Chair asked the Chief AHP to link with the integration Manager to articulate what the digital opportunities and actions in the draft plan Market Facilitation Plan addition Liaise with integration Manager to ensure more detail on Digital is included within the Strategic Plan. Integration Manager Chief AHP 30/09/2025 30/05/2025 5.2 Implementation Directions 2025/2026 (Gill Main, Integration Manager) The Integration Manager presented the report which details the performance of Midlothian Integration Joint Board on Directions for 2024/2025, draft Directions for 2025/26, and presents a proposed Directions Policy for review and comment. SPG Members are asked to: Page 27 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments • Review performance in relation to Directions 2024/2025 noting the Directions that are proposed to be either completed or revoked, revised, or continued. • Review, discuss, and further develop the presented Directions for 2025/2026 for recommendation to MIJB, and • Review and make comments on the proposed Directions Policy The Integration Manager reminded SPG members that Directions are the mechanism to execute the Strategic Plan, and for 2025/26 are looking forward to the new plan. Directions 2024/25 Reporting The Integration Manager highlighted that the report describes progress detailed in service plan updates. An excel version of the qualitative and quantitative data has been created which provides evidence for auditable purposes. The integration Manager noted that despite improved processes, there are still areas where data is incomplete. This highlighted the importance of the strategic planning of Heads of Service and Professional Lead level at the start of the year. The Chair thanked the Integration Manager for the report and opened it for comments by querying the undelivered Directions and if it is possible to show what the scale of those undelivered items is. The Integration Manager noted that they were only able to report on the information reported. The Chief Officer added that areas with limited progress were largely due to the operational focus in 2024/25 being on financial recovery. The HSCP Programme Manager (Performance) noted the challenge of some Directions applying to everyone with progress updates only provided when items are completed and limited updates noting progress to date or a nil return. The Approved to go to MIJB’s February Board. Integration Manager 20/02/2025 Page 28 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments Integration Manager added that this information will be included in the paper for the February MIJB meeting. The Chief AHP asked how Directions can be mapped to specific services as this information will help going forward. The Integration Manger added that following the February Board the new strategic aims, the sub-aims, and Directions will be sufficiently progressed for the purposes of planning. The Integration Manager will provide templates and meet with Heads of Service and Professional Leads where this can be reviewed with each Head of Service and Professional Leads to consider the Group Service Strategic Planning Process. The VOCAL Representative raised a query on Support for Carers and why there was no narrative included on the update in 6.2. The Head of Adult Services (Chief Social Work Officer) advised that he will provide an update for the report and additionally meet with VOCAL to discuss next steps. The Chief Officer noted that item 9.4 does not have a narrative and asked that this was updated. The Group agreed to recommend the draft Directions 2024/25 Report to the IJB subject to the noted amendments. Proposed Directions for 2025/2026 The Chair asked if Hosted Services required a Direction. The Integration Manager advised that all delegated services are covered in these Directions, but additional, specific instruction could be issued via a Directions as this is the mechanism to execute the Strategic Plan. Chair requested the Professional Leads liaise with the Integration Manager to consider the visibility of hosted services in the Strategic Plan and consider any requirement for a Direction. The Chief Officer added that there had been a lot of debate, driven by Update required for 6.2 Update required for 9.4 Head of Adult Services Performance Manager 30/01/2025 30/01/2025 Page 29 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments Edinburgh Council, around performance reporting on Hosted Services which should already be happening, however this is an operational task and does not need to be noted as a Direction. The representative for NHS Lothian Head of Strategy Development, added that it can be difficult not to conflate the role of the IJB and the operational delivery. The IJB oversee the functions, and the HSCP and other parts of NHS Lothian deliver the operational services. Where there are Hosted Services, these can be included in the Strategic Plan as NHS Lothian has oversight of the delivery of services and the performance of the HSCP. The Chair asked if expected delivery targets will be described for the new Directions and the Integration Manager advised that this will be included in the new performance framework that will be developed over the coming months following board approval of Directions 2025/26. The Chair mentioned item 9.1.2 Unscheduled Care, and how MIJB is responding to this. The Chair highlighted that the MIJB is the commissioning body for Unscheduled Care and asked for clarity in this Direction on intended outcome. The Chair queried Young Persons and Mental Health. The Head of Adult Services & Chief Social Work Officer advised that this is not a delegated service. The Chief Officer noted that commentary should be added to item 9.33 Home First Model. The Integration Manager added that information is required from the Interim Chief Financial Officer before some of the “To Be Confirmed” items can be fully populated. The Interim Chief Financial Officer advised that the timeline is tight but achievable. The Integration Manager advised that if needed indicative figures could be used. Review hosted service content in Strategic Plan and liaise with Integration Manager for inclusion. Review and rephrase the wording in relation to 9.1.2 Unscheduled Care to make this clearer. Professional Leads Chief Officer and Integration Manager 30/05/2025 30/01/2025 Page 30 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chair asked if further discussion in relation to the proposed Directions for MIJB Members was required. The Integration Manager confirmed that this draft is already tabled for discussion in February MIJB meeting, and an additional Development Session can be arranged after this and before the March Special Board. The Group agreed to recommend the draft Directions 2025/26 to the IJB subject to the noted amendments. Directions Policy The Chair opened the item for comments. No comments received. The Group agreed to recommend the draft Directions Policy to the IJB. Additional development session to be arranged Integration Manager 20/01/2025 5.3 Midlothian JSNA Q3 Update and Insights The HSCP Programme Manager (Performance) presented the report setting out the Quarter 3 update of the MIJB Joint Strategic Needs Assessment (JSNA). SPG Members are asked to review, consider and discuss the clarity and accessibility of the content, the completeness of the data, and the potential applications of the information and insights. The HSCP Programme Manager (Performance) advised that the information presented today has been collated, analysed and discussed by the JSNA team prior to presentation to SPG, highlighting the high level of expertise involved The MIJB Strategic Planning Group approved the Q3 update for publication. All n/a Page 31 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments across Public Health Scotland, the LIST Team, the HSCP Public Health team, the HSPC Performance and Improvement service. All data is validated by national colleagues and a rolling programme of updates adopted to ensure accurate and up-to-date data provision. This has been recognised nationally as an exemplar model. The HSCP Programme Manager (Performance) drew attention to the following three points within the report. “3.19 Details that the enablers of health and wellbeing do not all sit within the HSCP or the MIJB, and therefore it is important to recognise the work of our partners. 3.20 This is a high-level view of Midlothian’s population compared to that of Scotland and can hide some economic inequalities. 3.21 Covers the predictive shift in our economic profile which may lead to economic deprivation being disguised which may affect funding which would further disadvantage deprived communities.” The Chair asked the Heads of Service if there is anything in the emerging data that changes the view on their current activities. The Head of Primary Care and Older People advised that this had been discussed and compared to last year, recognising the importance of noting any changes in this information next year, particularly in relation to the flow and mortality rates. The Chief AHP added that this information is very helpful and provides a good translation of need in Midlothian for Heads of Service and Professional Leads. Page 32 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chief Nurse added that this information informs the strategic and operational planning in relation to workforce and employment. The Head of Adult Services highlighted the information around the high prevalence of Attention Deficit Hyperactivity Disorder (ADHD) reflected in the significant number of enquiries and complaints relating to access to care. The Consultant in Public Health added that this information will dovetail with committee profiles and committee planning. They also recognised the engagement from those at today’s meeting. It was acknowledged that the JSNA is a large document, and while it is difficult to discuss everything, the document will be kept “live” with ongoing updates. The Chief Officer and the Head of Adult Services & Chief Social Work Officer left the meeting at 15:41. 5.4 Equalities Outcome Setting (Gill Main, Integration Manager) The Integration Manager noted that during the previous SPG meeting the group had highlighted the challenges of meeting the 30 April 2025 deadline set by the Scottish Government to publish the MIJB’s Equality Outcomes for 2025-2029, the Mainstreaming Equality Report and Action Plan. The reasons being delays relating to the pan-Lothian consultation on draft outcomes and a lack of capacity. The IJB gave delegated authority for the Integration Manager to engage with Scottish Government and the Equality and Human Rights Commission (EHRC) regarding a delay in Publication. It is likely that a set of draft Equality Outcomes will be ready for publication at the end of April 2025 with a delay to publishing the mainstreaming Equality Report and Action Plan until June 2025. The MIJB Strategic Planning Group noted the update. All n/a Page 33 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.5 Reporting and Evaluation Integrated Workforce Plan 2025-28 Draft Review (Gill Main, Integration Manager) The Integration Manager presented the report which sets out the progress made to date in relation to the MIJB Integrated Workforce Plan 2025/2028 noting the revised Scottish Government timeline of June 2025 now required by 17th March 2025. The Integration Manager noted areas for further work ahead of the MIJB in February 2025 for approval and then onto the Scottish Government. The Head of Primary Care and Older People and the Chief Nurse agreed that current Hospital at Home and District Nursing sections are superseded by the recent update from the Chief Nurse. The HSCP executive team noted interest is final review ahead of the February Board. SPG Members are asked to: • Note the progress made in MIJB Integrated Workforce Plan 2025/2028 to date. • Note the work still to be undertaken regarding data, Executive Leadership Team (ELT), and operational updates, and make comments, suggestions and offers of support to ensure the timely completion of this plan. • Note the governance route and timelines for completion. • Agree, subject to required amendments, the draft Integrated Workforce Plan and Annex A are recommended to MIJB at the February Board for approval requesting delegated authority to submit to Scottish Government by 7th March. Integration Manager to circulate the latest version of the Integrated Workforce Plan 2025-28 for review and track changes. Approved to go to MIJB’s February Board. Heads of Service and Professional Leads Integration Manager 26/01/2025 20/02/2025 Page 34 of 132
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Group agreed to recommend the draft Integrated Workforce Plan 2025/28 to the IJB. 5.6 Reflections and Key Messages for Sharing with Midlothian IJB The Chair asked SPG Members to reflect on key messages from this meeting. The Chief Nurse reflected on the Nursing workforce and advised that they are heading into a crisis where the sector’s ambitions rest on having a strong workforce. The Head of Primary Care and Older People agreed and noted that there is expected to be a 50% drop in Adult Nursing by 2027. The Chief Nurse added that a paper from NHS Lothian will be submitted to the NHS Lothian Corporate Management Team for Chief Officers to develop a plan and mitigate the risk. Provide any relevant updates to the Integration Manager for inclusion in the Integrated Workforce Plan. Chief Nurse 26/01/2025 5.7 Risk Register: Consideration to new & existing risks The Chair noted that the financial risks should be considered. The Integration Manager added that there is work to be done with the Chief Financial Officer and more clarity will be provided in the coming weeks via the Audit and Risk Committee. The Chair requested the Integration Manager, and the Interim Chief Financial Officer consider how the Medium-Term Financial Plan is added to the Strategic Plan. Any Other Business No items were discussed. Page 35 of 132
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Strategic Planning Group 6. Date of next meeting The next meeting of the MIJB SPG will be held on 20th March at 2pm. The meeting terminated at 15:59. Page 36 of 132
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Midlothian Integration Joint Board Meeting Date Time Venue Audit and Risk Committee Thursday, 5 December 2024 2:00pm Virtual Meeting held using MS Teams Present (voting members): Councillor Milligan (Chair) Present (non-voting members): Morag Barrow (Chief Officer) David King (Interim Chief Finance Officer) Duncan Stainbank (Chief Internal Auditor) Kirsty Macdonald (NHS Lothian) Patricia Fraser (External Auditor) Gill Main (Integration Manager) In attendance: Hannah Forbes (Democratic Services Officer) Apologies: Val De Souza (Vice Chair) (NHS) Roxanne King (Executive Business Manager) Councillor Parry Midlothian Integration Joint Board Thursday 24 April 2025 Item 4.3 Page 37 of 132
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MIJB - Audit and Risk Committee 1. Welcome and Introductions The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Audit and Risk Committee. Councillor Milligan advised that they would be acting as Chair instead of Val de Souza. Apologises were submitted from Roxanne King and Councillor Parry. 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 the Audit and Risk Committee Meeting held on 12 September 2024 was submitted and approved as the correct record. 5. Public Reports 5.1 Matter Arising – Verbal Update by David King The Interim Chief Financial Officer provided a verbal update on several subjects. The Interim Chief Financial Officer noted what was previously discussed relating to the Independent Member and the ongoing recruitment. They mentioned the advert for the vacant role on the website which closed on the 30 November, and unfortunately there was no interest to the post. A recommendation has been made for someone who has worked for Scottish Audit previously, and the Interim Chief Financial Officer explained that they have sent the person of interest a note. If the candidate fits the correct criteria, they will go through an interview process and if successful, the Chair and Vice Chair will need to agree they are the correct fit for an Independent Member and report it back to the IJB. Page 38 of 132
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MIJB - Audit and Risk Committee The Committee highlighted the need for a Vice Chair and Councillor Parry was noted as a recommendation for the role. The Chair advised that they would discuss this with Councillor Parry. The Interim Chief Financial Officer further discussed the Datix and the currently held position on that. It was noted that two meetings prior to this there was agreement that this would be discussed at the meeting held today, however the colleague due to give the presentation was unavailable for today’s session. The Interim Chief Financial Officer discussed this with the Datix Team, who were also unavailable to attend today’s session. The Datix Team will be organised to attend the next meeting of Audit & Risk Committee in March 2025. The Integration Manager highlighted the Interim Chief Financial Officer’s upcoming retirement and asked who will be picking up the role and the current actions. The Interim Chief Financial Officer advised that the Deputy Director of Finance at National Health Service (NHS) Lothian will be copied into emails and has an insight on the current situation. They will ensure the actions discussed today will not be misplaced and will be followed up. There is currently an advertisement for a secondment of 6 months for the Interim Chief Financial Officer post, which would fill the position for the March and June meetings if a candidate is found. 5.2 Risk Register – Report by David King The Interim Chief Financial Officer presented the report which outlines the IJB’s Risk Register for Quarter 3 of 2024/2025. The IJB maintains a Risk Register which is presented to every meeting of this Committee and reviewed by management quarterly prior to the next meeting. Changes agreed at the September 2024 meeting have now been actioned and updated into Datix – the Risk Management software used by the IJB. Committee members are asked to - • Note the Quarter 3 Risk Register. • Consider if any further additions or changes should be made to the Risk Register. The Interim Chief Financial Officer spoke to the Risk Register highlighting key factors, first being the National Care Service (NCS) and the importance of this remaining on the Risk Register, as this is something that the IJB A&R will need to be aware of. It was mentioned that the IJB must have a Chief Financial Officer (CFO) and this needs to be tackled urgently. The Committee hoped that there will be a candidate name next week and it was suggested that this should be put on the Risk Register. The Chief Officer stated that this has been discussed on numerous occasions and advertised with East Lothian Council. The Committee expressed keenness for testing this initially for the 6 months secondment to decide if the individual is suitable and to consider the financial implications. There is a need for a CFO role as the Chief Officer cannot fill this. Interviews will take place on the 18 December 2024. For the Page 39 of 132
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MIJB - Audit and Risk Committee December IJB the Interim Chief Financial Officer will not be present, and the Committee is waiting to hear back from the partners on who will be taking this place to present the Finance report. The Chair thanked the Interim Chief Financial Officer for the report and noted the recommendations. 5.3 Recommendations Internal Audit Follow- up Review – Completed Actions & In Progress Actions, Report by Duncan Stainbank The Chief Internal Auditor presented the report and advised that the purpose of this report is to: • Inform the MIJB Audit and Risk Committee of the number of recommendations raised by Internal Audit for the MIJB that are in progress. • Note the MIJB’s reported performance in addressing the associated internal control and governance issues by the agreed implementation; and • Highlight the main governance and financial risks where recommendations are found to be outstanding. The MIJB Audit and Risk Committee is asked to: • Acknowledge the progress made by management in implementing Internal Audit recommendations to improve internal controls and governance, and mitigate risks; • Consider whether it is satisfied with the progress made by management and any other actions required; and • Note that Internal Audit will continue to monitor the completion of the outstanding recommendations and will provide update reports to the MIJB Audit and Risk Committee. The Chief Internal Auditor spoke to the report highlighting an update to the recommendations, including 9 completed recommendations with only 4 remaining open. They advised that all ongoing open recommendations should be completed by the end of March 2025. The 4 remaining recommendations listed were the Medium-Term Financial Plan to be developed to have a more explicit link to the Strategic Plan, the Public Engagement Statement to be reviewed and made available to the IJB website, the Obligation Scheme - a direction of policy should be established for the MIJB as there needs to be a clearer audit link between the direction, and the Health and Social Care Service plans. All ongoing recommendations should be completed by the 31 March 2025. The Integration Manager noted the Register of Interest and noted that is now on the website, but it is not complete as some documentation from the Standard Officer is still pending. The Public Engagement Statement will not be completed by the 31 March 2025, more likely to be October 2025. The directions are under control. The Chief Officer noted that the request regarding the Standards Office has been pending for several months now. It was suggested to be linked to the Risk Register, as due to the financial position and the Board’s decision to reduce the size of the team that supports some of this workload, there is now a risk that the workload will slow down. The MIJB is very dependent on partner support, and as a small IJB, there is Page 40 of 132
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MIJB - Audit and Risk Committee not a very big support structure. MIJB will work hard to ensure the work is completed, however the pace of MIJB is not the same as some of the larger IJBs that have a more significant infrastructure below them. The Chair thanked the Chief Internal Auditor for the report and noted the recommendations. 5.4 Return – Report by David King The Interim Chief Financial Officer advised that as IJB is a public body it must complete a Climate Change Duties compliance reporting template that needs to be reported to the Audit and Risk Committee. This report should have been submitted to the Committee, however this was forgotten. It was requested to have it minuted that this return was completed on behalf of the IJB and will be supplemented and circulated on behalf of the Committee. The Interim Chief Financial Officer apologised for the report not being submitted on time and advised that the report has been completed and will be circulated. The Integration Manager noted matters which will come to the IJB, one being that all IJB members will need to be Disclosure checked and option 1 SDS reporting. The Committee will be updated. The Chair thanked the Interim Chief Financial Officer on behalf of the Committee for all their hard work for the Committee and highlighted that it has been a pleasure to work with them and hoped they enjoy their retirement. 6. Private Reports No private business discussed at this meeting. 7. Date of next meeting The next meeting will be held on Thursday, 6 March 2024 at 2.00pm. The meeting terminated at 2:30pm. Page 41 of 132
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Midlothian Integration Joint Board Thursday, 24th April 2025, 13:00-15:00 Chief Officer Report April 2025 Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting April 2025. Board members are asked to: • Note the content of the report. # Item number: 5.2 Page 43 of 132
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Midlothian Integration Joint Board Report Chief Officer Report April 2025 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting April 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 transformation programme continues to progress, with the initial focus on Home First, bed modelling and Contracts and Commissioning. Marianne Hayward has agreed to support the programme, as a critical friend/external scrutiny from this month on a sessional basis. Marianne has a wealth of experience across the national spectrum, and her knowledge and skills will support local planning development. The team continue to focus on Scottish Government funded unscheduled care programme of work. Midlothian remain in a recruitment process to develop and augment our service models, but initial investment has delivered a significant improvement to patients experiencing delays for local rehabilitation, package of care, and care home beds. A separate bid has been submitted to a national fund to establish a multi-agency In-reach team to identify Midlothian residents in the Royal Infirmary who could be supported locally, and safely discharged earlier. The HSCP Planning and Performance team will also shortly commence work to triangulate national data with local GP practice data to provide early identification of the next high users of unscheduled care, to allow a wraparound case management model to be put in place to support their needs, and safely reduce unnecessary admissions. Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Head of Adult Services Newbyres Care Village Improvement planning and implementation continues after the recent, positive, Care Inspectorate inspection. The unit will be implementing new care planning documentation, in a planned way to ensure that residents and carers have a high Page 44 of 132
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Midlothian Integration Joint Board standard of care and support. Recruitment has been successful and the care home are now at full staffing establishment. This will mean a further reduction in agency staffing going forward. Women’s Justice Network This is a forum established in 2023. Despite the title this is a network that will be of interest to all social work staff working with women who have a history of trauma and complex needs. The purpose of the forum is to share best practice, knowledge of local resources and advocate for women’s issues. The next forum meeting is on 28th May. The speaker is Professor Jane Monkton Smith who will be speaking about the Homicidal TimeLine (a framework for tracking homicide risk in cases of coercive control and stalking). This eight-stage sequence is based on research which looked at over 400 cases of intimate partner homicide to identify a common behavioural pattern that can be used in a practical way by professionals to assess threat and risk). Staff in Justice and Children and Families have undertaken this training. National Social Work Agency Plans are going ahead to create a National Social Work Agency (NSWA) as part of the Care Reform (Scotland) Bill, despite the National Care Service being dropped. The intention is the NSWA will provide leadership, support, and oversight to the social work profession. It will be responsible for: education (pre and post qualifying), training and development; workforce planning, improvement and scaling up of good practice. The NSWA will be established as an Executive Agency, i.e. part of the Scottish Government. Education Scotland, Social Security Scotland, and the Scottish Prison Service are all examples of Executive Agencies. The NSWA will be staffed by civil servants and headed by the National Chief Social Work Adviser, a civil servant who is required to be a registered social worker. The National Chief Social Work Adviser advises Ministers on policy in relation to social work and the protection of individuals at particular risk of harm. As head of the NSWA they will be required to prepare an annual report for Scottish Ministers on the state of social work services and the social work workforce. The intention is that the responsibilities of the NSWA will be carried out through a formal Social Work Partnership between the NSWA/Scottish Govt, COSLA and Social Work Scotland (the national body for Chief Social Work Officers and other social work managers). There will be a Partnership Board and the Partnership will be underpinned by a Memorandum of Understanding between the three parties. A shadow Board will be in place by summer 2025, with the full Partnership complete by April 2026. The Partnership will represent the social work profession and be a voice for all qualified social workers and paraprofessionals, and individuals training to become social workers. Each party will lead on a specific area of responsibility: • NSWA/Scottish Government: education, training, professional development. • COSLA: workforce planning. • Social Work Scotland: professional leadership and governance. Page 45 of 132
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Midlothian Integration Joint Board The workforce in scope for the NSWA has changed and now includes Residential Child Care staff. It continues to exclude Occupational Therapists and Social Care workers. The SSSC is currently consulting on whether social work assistants and all other social work paraprofessionals should in future be registered. This proposal is related to the NSWA plans. A paraprofessional job role, qualification and CPL requirements are out for consultation until 9 April. In scope for the NSWA are: • All Registered Social Workers • All Social Work Paraprofessionals - social work assistants, family support workers, unpaid work supervisors in Justice Services and all those undertaking duties in support of statutory social work functions by working within social work teams and carrying a caseload of non-statutory tasks under the stewardship of a registered social worker. • Residential Child Care Staff – those working in residential childcare who must have certain qualifications to meet SSSC registration requirements. The rationale for including these staff is that they fulfil a specific social work function providing care to children and young people who are the responsibility of a local authority. A distinction is being made between the employed, paid workforce that requires a qualification and those who fulfil care giving roles in their own home. Kinship carers, foster carers and prospective adopters are therefore not in scope. The Workforce Not in Scope: • Occupational Therapists – are core members of social work teams but despite representations from UNISON and the RCOT, they remain outside the scope of the NSWA. The argument made by government is that professional leadership for OTs is provided through the Chief Allied Health Professions Officer (not the Chief Social Work Adviser) and OTs have their own separate arrangements for professional registration, qualifications and development. • Social Care workers – the government says that ‘given the scale and variety of social care, the broad expertise and provision, and the extensive variety of providers, the focus of the Partnership will need to be explicitly narrow to the social work profession to remain effective’. The NSWA will be established as soon as the Care Reform (Scotland) Bill has passed (it is in the final stage of the parliamentary process). A shadow Partnership Board will be in place by Summer 2025, comprising the Office of the Chief Social Work Adviser, Social Work Scotland and COSLA. HSCP Social Work and Occupational Therapy Review As part of the HSCP Transformational Change programme, the team have commenced the Review of Social Work and Occupational Therapy services. This is a large-scale programme that will look at workforce, purpose and roles, and links into the aforementioned national work regarding the establishment of a National Social Work Agency. Resource Panel Review A paper was presented to the Midlothian Council Business Transformation Board in March outlining the conclusions from the Resource Panel Review project led by Page 46 of 132
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Midlothian Integration Joint Board Fiona Kennedy (Group Service Manager) in 2024. This project involved establishing a Review Team from existing resources and then reviewing approximately 600 care packages to ensure that everyone in receipt of a care package was receiving a level of care appropriate to their assessed needs. The next stage of reporting will involve Elected Members having site of this work at the Council’s Business Transformation Steering Group which is chaired by the Leader of the Council. Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk 3.3 Strategic Planning, Business Support, and Intelligence Midlothian IJB Strategic Plan The draft Midlothian IJB Strategic Plan has recently been reviewed by both NHS Lothian Strategic Corporate Management Team (CMT) and Midlothian Council CMT. The draft plan was well received and both Partners have agreed for the plan to progress without amendment at this stage. The draft plan will be reviewed by the NHS Lothian Strategic Planning and Performance Committee and Midlothian Council Elected Members in May before further review in September ahead of the October IJB. Midlothian IJB Directions Midlothian IJB Directions were issued to both Partners on Friday 28th March 2025 along with the final status position for 2024/25 in the Directions Log. Work has begun to operationalise Directions for 2025/26, and board members will be regularly updated on progress. The officers of the HSCP will present plans across the Group Service areas to the Strategic Planning Group in May. Equality in Midlothian Since 2022, the Equality and Hunan Rights Commission (EHRC) has been undertaking a programme of Public Sector Equality Duty (PSED) improvement work with all Integration Authorities. This involved regular compliance monitoring and seeking assurance on the provision of key information required by The Equality Act 2019 (Specific Duties) (Scotland) Regulations 2012. Following a recent compliance exercise, the EHRC have reported that they are satisfied that Midlothian IJB are now compliant with the PSED and were reassured by the improvement work undertaken by the Board. To ensure Midlothian IJB remain complaint, the Midlothian IJB Equality Outcomes and Mainstreaming Equalities action plan will be reviewed by the Board for approval in the April 2025 Board with the annual update on progress reported in the Midlothian IJB Annual Performance Report (APR) scheduled for publication in August 2025. Midlothian Citizen's Panel Work is underway to ensure that a Midlothian IJB Citizens Panel can be undertaken in May 2025. The Strategic Planning Group scrutinised the proposed questionnaire on 20th March 2025 and recommended this for progression. Liaison with our Third Sector colleagues in ongoing to refine and improve the questions and ensure the information returned is meaningful to a range of audiences. Gill Main, Integration Manager – gill.main3@nhs.scot Page 47 of 132
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Midlothian Integration Joint Board 3.4 Clinical Director General Practice All practices remain open and accepting new patient registrations. A recent uplift in both core General Medical Services (GMS) and Enhanced Services (ES) has been welcomed colleagues, but this unfortunately has been offset by the significant impact of the increase in National Insurance employer contributions and increases in NHS Lothian facilities management charges, leaving many practices with financial challenges with some consequent restriction in patient access and service. However, the Primary Care Improvement Plan (PCIP) now enters a new year of multidisciplinary team support for general practice, with a focus on a more efficient use of resource to maximise activity and productivity. Update on Frailty The HSCP are now one year into a large-scale integrated community stakeholder engagement programme to understand how we can better meet the needs of our growing elderly population. Midlothian’s vision is to design and develop a transformational holistic whole-life approach to living and ageing well in our communities where prevention and early intervention enables everyone to recognise people at risk of frailty and access a system-wide pathway to facilitate actions which achieve better personal outcomes. The widespread use of a Frailty Score, adapted for use by community partners in an integrated setting, is now facilitating a common language which can be understood and applied by all professionals and services and is key to unlocking access to a sliding spectrum of integrated resources, allowing more seamless movement across traditional service boundaries and interfaces without repeated referrals and re-assessments. This is being supported by the development of a digital resource directory for staff so that they can target the most appropriate intervention(s) depending on a person’s stage of frailty. Over time, a programme of community engagement and the development of digital solutions (ultimately including a frailty passport) will underpin and support this approach. In addition, the programme has run recent sessions for all services, staff and community partners to raise awareness and introduce resources to support good conversations with people about supported self-management, Future Care Planning and Power of Attorney. It is widely recognised that having a multidisciplinary culture and approach to these conversations will ensure that they are started earlier meaning people are better prepared as their frailty advances. The outputs (what people do differently) and impacts (what difference it makes) of this programme of work will be monitored over time to ensure that it continues to evolve and adapt to best deliver a safe, effective, and person-centred pathway for our frail citizens. Rebecca Green, Clinical Director – rebecca.green@nhs.scot Page 48 of 132
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Midlothian Integration Joint Board 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 report. 7 Resource Implications 7.1 There are no direct resource implications arising from this report. 8 Risk 8.1 The key risks associated with the delivery of services and programmes of work are articulated and monitored by managers and, where appropriate, reflected in the risk register. 9 Involving people 9.1 There continues to be ongoing engagement and involvement with key stakeholders across the Partnership to support development and delivery of services. 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE April 2025 Page 49 of 132
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Midlothian Integration Joint Board Thursday 24th April 2025, 13:00-15:00 Midlothian IJB Equalities Outcomes 2025-2029 Executive summary This report presents draft Midlothian IJB Equality Outcomes for 2025-2029, provides assurance on the development process and, subject to any amendments, seeks delegated authority to publish before the 30th April 2025. Midlothian IJB is required to publish both Equality Outcomes every 4 years and a Mainstreaming Equality progress report at least every 2 years that describes the action taken to deliver the Public Sector Equality Duty (PSED). Midlothian IJB last published Equality Outcomes 2021-25 in 2021 and Mainstreaming Equality Report and Action Plan in 2023 so must publish both Equality Outcomes and a Mainstreaming Equality Report and Action Plan in 2025. Officers of Midlothian Health and Social Care Partnership (HSCP) have worked with equality leads in NHS Lothian, Lothian local authorities and Health and Social Care Partnerships to identify the most important equality issues across the region. Midlothian IJB’s strong commitment to advancing equality has ensured that the draft Equality Outcomes set out in Appendix 1 are closely aligned to both the IJB’s strategic aims and Directions 2025/26. It is proposed that Midlothian IJB will include the 2023-25 Mainstreaming Equality progress report within the Midlothian IJB Annual Performance Report and adopt annual reporting thereafter. This will ensure advancing equality remains a central component of Midlothian IJB’s performance evaluation and strategic planning. Members are asked to: • Note the legislative requirement to develop and publish Equality Outcomes, • Review and, subject to any required amendments, approve the draft Equality Outcomes 2025-2029 for publication, and • Note that Mainstreaming Equality progress is proposed to be included annually in the Midlothian IJB Annual Performance Report. Item number: 5.5 Page 51 of 132
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Midlothian Integration Joint Board Report Midlothian IJB Equalities Outcomes 2025-2029 1 Purpose 1.1 This report presents draft Midlothian IJB Equality Outcomes for 2025-2029, provides assurance on the development process and, subject to any amendments, seeks delegated authority to publish before the 30th April 2025. 2 Recommendations 2.1 Members are asked to: • Note the legislative requirement to develop and publish Equality Outcomes, • Review and, subject to any required amendments, approve the draft Equality Outcomes 2025-2029 for publication, and • Note that Mainstreaming Equality progress is proposed to be included annually in the Midlothian IJB Annual Performance Report. 3 Background and main report 3.1 The Equality Act, 2010 provides specific protection for people with protected characteristics. Midlothian IJBs must not unlawfully discriminate against any of these characteristics and must advance equality of opportunity and foster good relations between groups of people who share these characteristics as well as with those who do not. 3.2 The Equality Act 2010 provides protection for people based on specific characteristics. It applies to us all as we all have at least one of them: • Age • Disability • Gender reassignment • Pregnancy and maternity • Marriage or civil partnership • Race • Religion and Belief • Sexual Orientation • Sex 3.3 The equality duty requires Midlothian IJB have due regard to: • Eliminating unlawful discrimination, harassment and victimisation and other conduct that is prohibited by the Equality Act 2010. • Advancing equality of opportunity between people who share a relevant protected characteristic and those who do not. Page 52 of 132
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Midlothian Integration Joint Board • Fostering good relations between people who share a protected characteristic and those who do not. 3.4 Midlothian IJB must publish a set of equality outcomes every 4 years to support targeted change and advance equality. This is a statutory duty of the Equality Act, 2010 to ensure equality is a cornerstone of the activity of Public Bodies. As a result, Midlothian IJB is required to anticipate the needs of people who experience integrated health and social care services and, as far as is reasonably practicable, make sure people with protected characteristics can access treatment and support in an equitable way. 3.5 As a strategic planning body, Midlothian IJB is limited in the action it can take itself to deliver change. However, the PSED cannot be delegated and Midlothian Health and Social Care Partnership (HSCP) must work collaboratively to ensure Midlothian IJB is meeting this statutory duty. 3.6 Officers of Midlothian HSCP worked with equality leads in NHS Lothian, Lothian local authorities and Health and Social Care Partnerships to identify the most important equality issues across the region. The review process included considering previous outcomes, current data, and the views of staff and people who experience integrated health and social care services, and community organisations. 3.7 As a result, the draft Midlothian IJB Equality Outcomes do not cover every protected characteristic and instead represent the equality issues raised as most important to people and communities during consultation. Midlothian IJB’s strong commitment to advancing equality has also ensured that the draft Equality Outcomes set out in Appendix 1 are closely aligned to both the IJB’s strategic aims and Directions 2025/26. 3.8 It is proposed that ongoing progress on these outcomes will be noted annually in the Midlothian IJB Annual Performance Report. This will ensure advancing equality remains a central component of Midlothian IJB’s performance evaluation and strategic planning 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 annual reporting on progress towards these draft Equality Outcomes may result in amending existing Directions or to develop a new Direction. Page 53 of 132
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 There are no equality implications from focussing on these goals but there may be implications for work undertaken to achieve them. 7 Resource Implications 7.1 There re no direct resource implications as a result of this report. 8 Risk 8.1 There is a risk that not publishing Equality Outcomes will constitute a breach of the legislative duty to do so, and investigation or further action taken by the Equality and Human Rights Commission (EHRC). 8.2 Whilst there are no specific penalties or fines outlined in the legislation, there is a risk that failing to publish Equality Outcomes could lead to reputational damage or legal challenge. 9 Involving people 9.1 Officers of Midlothian HSCP engaged widely in the development of the draft Equality Outcomes for 2025-2029. This included discussion with equality leads in NHS Lothian, Lothian local authorities and Health and Social Care Partnerships, staff and people who experience integrated health and social care services, and community organisations. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO gill.main3@nhs.scot DATE 08/04/2025 Appendices: Appendix 1: Draft Equality Outcomes 2025-29 Page 54 of 132
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IJB Equalities Outcomes 2025 – 2029 (Draft 1st April 2025) Page 55 of 132
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Contents Introduction ................................................................................................ 3 Who we are ................................................................................................. 4 How we chose our equality outcomes ........................................................ 5 People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. ................................................ 6 Links to our strategic aim that people can access the care and support they need when they need it in the community and at home ............................ 8 People's human, social, and economic rights are protected and promoted in how we design and deliver our services ................................................ 10 To ask for this in anther format or language email: loth.midhscp@nhs.scot Page 56 of 132
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Introduction The Equality Act 2010 provides protection for people based on specific characteristics. It applies to us all as we all have at least one of them: • Age • Disability • Gender reassignment • Pregnancy and maternity • Marriage or civil partnership • Race • Religion and Belief • Sexual Orientation • Sex Our work must not unlawfully discriminate against someone because of any of these characteristics and it must advance equality of opportunity and foster good relations between groups of people who share these characteristics and those who do not. Every 2 years we must publish a report to show how we are making equality integral to our day to day work. In addition we must publish a set of more specific outcomes every 4 years that will help us achieve more targeted change. We have a duty to make reasonable adjustments for people with protected characteristics. This requires us to take positive steps to ensure that they can access our services. It is a cornerstone of the Equality Act 2010 and goes beyond avoiding discrimination. We are required to anticipate the needs of people using our services and so far as is reasonably practicable, to make sure the access they enjoy is as near as possible to that enjoyed by the rest of the public. Page 57 of 132
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Who we are Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian that plans and directs some health and social care services. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). 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. Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. The decisions our partners make influence people’s choices and ultimately how well we are able to achieve our ambitions. We will always share our plans, successes, and challenges so we can support people to live well and thrive 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. Page 58 of 132
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How we chose our equality outcomes We worked with equality leads in NHS Lothian, Lothian local authorities and Health and Social Care Partnerships to identify the most important equality issues. We looked at our previous outcomes, current data and spoke to staff, people who use our services and community organisations. We are working towards making equality part of our day-to-day work and our mainstreaming outcomes support everyone with each of the protected characteristics. Our 4 specific equality outcomes in this report do not cover every protected characteristic but are chosen as they link closely to the aims in our Strategic Plan 2025-2035, and they people told us they were important to them in our consultation. It is important that we work together with all our partners to improve outcomes for everyone in Midlothian. We have given consideration to how our Equality Outcomes link to those of NHS Lothian and Midlothian Council. We will report our progress on these outcomes in our Annual Performance Report. Evidence used: - Joint Strategic Needs Assessment - 2022 Census - Equality and Human Rights Commission (EHRC) Is Scotland Fairer? - NHS L & MLC Workforce data Consultations used: - Midlothian Integration Joint Board Strategic Plan - Midlothian Council British Sign Language (BSL) Plan - Midlothian Integration Joint Board Citizen’s Panel - Midlothian Integration Joint Board ECRIAs - Pan Lothian Consultation on outcomes with responses from staff, people in the community and organisations - Discussion and input by the Midlothian Integration Joint Board Strategic Planning Group (including representation of geography, interest and experience) - VOCAL carer’s survey 2021 Page 59 of 132
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Inclusive Information People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health Consultation findings “People are feeling left out as everything is on the internet these days” “The system should be made easier for people to seek and receive help” “It needs to be easier to access services” “Digital by design doesn’t suit everyone” Page 60 of 132
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Inequality issue Outputs Equality Outcomes • 1 in 6 Scottish adults lack the digital skills needed for everyday life – this includes disabled or older people who feel excluded with a move to digital services. • Digital exclusion (limited or no access to internet connection, devices, skills) creates digital inequalities, which are linked to social and economic disadvantage. • Older people are less likely to own smartphones or be connected 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. • Barriers to accessing information online for people with Learning Disabilities include lack of internet, restrictive support hours, and lack of privacy. Review all publicly available information to ensure it is compliant with our duties relating to accessibility and is accessible both on and offline. Collect feedback that we can use to continuously improve the information we provide Highlight Contact Scotland BSL, the national British Sign Language (BSL) video interpreting relay service, as a method of contacting the Council. Outcome 1: People have a choice about how they access information and support from integrated services. Page 61 of 132
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Equitable Access People can access the care and support they need when they need it in the community and at home Consultation findings “We have a generation of older people who are feeling left out” “Deal with dementia as you would a cancer diagnosis with support throughout for families” “The older community is becoming more and more isolated. Lack of services …prevent elderly accessing services they require.” Page 62 of 132
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Inequality issue Outputs Equality Outcome • Older people are at greater risk of a poor experience of emergency hospital care than other adults. • People aged 75 and over from Midlothian wait longer in Emergency Departments. • People aged 75 and over from Midlothian are more likely to be admitted to hospital in an emergency. • People aged 75 and over from Midlothian are more likely to have their discharge from hospital delayed. Improve the data on risk of admission and readmission to hospital, to support clinicians and practitioners to identify and provide appropriate preventative care and early interventions. Build new relationships and work closely with a range of partners to better coordinate and link redesigned services for people with multiple conditions, including frailty. Outcome 2: Older people have a reduced risk of admission and readmission to hospital. Page 63 of 132
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Putting People First People's human, social, and economic rights are protected and promoted in how we design and deliver our services Consultation findings “Making people aware of what help is available without stigma attached to seeking help.” “More prominent and accessible translation and interpretation services are required. Improved access to BSL across all services” “I need opportunities to be on my own outside of work and caring. If I’m not at work, I am caring and it can be draining.” “I have no room or time for appointments of my own right now as my role as a carer takes up almost all my time.” Page 64 of 132
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Inequality issue Outputs Equality Outcomes • We don’t always know what people’s additional needs are in advance and it isn’t always easy for people to find information in Easy Read, Large Print, British Sign Language (BSL) and plain English. (NHS Lothian and Disabled People’s Organisations). • Midlothian has a higher prevalence rate of adults with a Learning Disability known to Social Care in comparison to the Scottish average. • Over 200 people in Midlothian use BSL and many face difficulties accessing interpreters (BSL plan consultation). • Nearly 10% of Midlothian’s population is from a minority ethnic group and may require information in a language other than English. Staff use the Midlothian IJB ‘Writing for Publication Style Guide’ to ensure all service information is person-centred and meaningful from the perspective of those it is intended to support. Develop consistently presented online and paper service information, and link with both partner’s website and information. Ensure staff can support people to request and access accessible information Outcome 3: People who want to choose Self Directed Support have better information about which option is right for them. • The ambition to move care ‘closer to home’ has the potential to increase the reliance on unpaid carers, who are often female, older and live in areas of economic deprivation. They also often report that being a carer has a negative impact on their own health. • Only 35% of carers in Midlothian feel supported to continue caring. • Any reduction in bed-based services may require further to travel which will impact carers. • The impact of higher energy costs may increase fuel poverty for unpaid carers. Consider the impact of moving care from hospital to home on unpaid carers, and evidence supportive actions. Ensure that unpaid carers have access to Welfare Benefits advice. Ensure that unpaid carers have a Carer Support Plan in place. Outcome 4: Unpaid carers feel supported to continue in their caring role. Page 65 of 132
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Midlothian Integration Joint Board Thursday, 24th April 2025, 13:00-15:00 Midlothian IJB Finance Update Executive summary This report provides an overview of key updates and proposed actions relating to the financial management of the Midlothian Integration Joint Board (IJB). This includes the 2024/25 financial forecast, a review of the Midlothian IJB Reserve Policy. and ongoing work to develop the Midlothian IJB Medium-Term Financial Strategy (MTFS). The 2024/25 quarter three financial forecast projected a year end overspend of £8.357 million, with pressures spread across both delegated Health and Social Care services. A revised Month 11 update from NHS Lothian indicates a slight improvement on the Health side, reducing the overall projected overspend for Midlothian IJB. In February 2025, Midlothian IJB approved the use of earmarked reserves to offset the projected Social Care overspend; however, uncertainty remains until final figures are available in May. Discussions with Partners in relation to the year end position are ongoing and remain constructive. The final outturn will be presented in June as part of the unaudited annual accounts. Midlothian IJB approved a Reserve Policy in 2017. This now requires updating to reflect the current financial climate and acknowledge the increasing difficulty in maintaining the 2% target. It is proposed the Midlothian IJB Audit and Risk Committee take forward this work prior to recommendation to the Board for review and approval. The Midlothian IJB Medium-Term Financial Strategy (MTFS) is also being refreshed following the 2025/26 budget setting process to ensure this plan underpins and connects strategic and financial planning. This review aims to strengthen the alignment between financial decisions and strategic priorities, ensuring that resources are deployed effectively to meet the needs of the population and support long term sustainability. It is proposed this work will be led by the Chief Finance Officer and the Integration Manager for the boards review in the August 2025 board meeting. Members are asked to: • Note the financial position, • Agree to the Midlothian IJB Audit and Risk Committee reviewing the Reserve Policy, and • Note the ongoing work to develop the Medium-Term Financial Strategy (MTFS). Item number: 5.6 Page 67 of 132
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Midlothian Integration Joint Board Report Midlothian IJB Finance Update 1 Purpose This report provides an overview of key updates and proposed actions relating to the financial management of the Midlothian Integration Joint Board (IJB). This includes the 2024/25 financial forecast, a review of the Midlothian IJB Reserve Policy. and ongoing work to develop the Midlothian IJB Medium-Term Financial Strategy (MTFS). 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the financial position, • Agree to the Midlothian IJB Audit and Risk Committee reviewing the Reserve Policy, and • Note the ongoing work to develop the Medium-Term Financial Strategy (MTFS). 3 Background and main report 3.1 Background This report outlines a number of key updates and proposed actions relating to the financial management of the Midlothian Integration Joint Board (IJB). 3.2 2024/25 Forecast Outturn The quarter three budget forecast position was reported to Midlothian IJB on the 20th February 2025, projecting a year end overspend of £8.357 million. This forecast was split between delegated Health functions (£2.657 million) and delegated Social Care functions (£5.700 million). 3.3 NHS Lothian has since provided a revised Month 11 forecast for delegated Health functions, which indicates a slight improvement. The updated projection shows a reduced overspend of £2.226 million. This is an improvement of £0.431 million from the previous forecast. 3.4 In line with the reporting schedule, there has been no formal update to the Social Care financial forecast. However, in February 2025, Midlothian IJB approved the use of historic earmarked reserves to mitigate the projected overspend in Social Care. While this action is expected to improve the position, a degree of uncertainty remains due to ongoing volatility in expenditure, which will persist until final figures are confirmed. 3.5 It has been reported to, and discussed by, Midlothian IJB that the Board will not achieve financial balance in 2024/25. In accordance with the Integration Scheme, Page 68 of 132
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Midlothian Integration Joint Board any residual shortfall will be met by the appropriate Partner. Discussions with both Partners have been constructive, with a shared understanding of the financial pressures facing Midlothian IJB. These discussions remain ongoing and will inform the final approach to year end financial management, with final figures anticipated in early May 2025. 3.6 The final year end outturn position will be presented to Midlothian IJB on 12th June 2025 as part of the unaudited Annual Accounts. 3.7 Annual Accounts Audit Scotland’s Annual Audit Plan was presented to the Audit and Risk Committee on 6th March 2025. The audit of the Midlothian IJB Annual Accounts will be carried out in line with the statutory deadline of September 2025 for approval of the final audited accounts. The draft unaudited accounts will be presented to the Board in June 2025 for consideration. 3.8 Reserve Policy The Midlothian IJB approved a Reserve Policy in 2017 to support sound financial management and sustainability. The policy outlines the purpose, use, and governance of reserves and sets a target level of 2% of Midlothian IJB’s annual revenue budget as a prudent contingency to mitigate risk and promote financial resilience. 3.9 Since the policy was last reviewed, there have been significant changes in the financial landscape. It is proposed that it is now appropriate to revisit and update the Reserve Policy. Rising demand, workforce challenges, and inflationary pressures have created an increasingly difficult financial environment. In this context, the assumptions and thresholds in the existing policy may no longer reflect Midlothian IJB’s current operational and financial realities. 3.10 It is also important to acknowledge the increasing difficulty in achieving and maintaining the 2% reserve target. Year on year budget balancing has required a sustained focus on financial recovery, and opportunities to generate surplus balances have become more limited. While maintaining a reserve remains essential, revising this policy would offer a more realistic and practical framework that continues to support financial stability and good governance. 3.11 It is proposed the Midlothian IJB Audit and Risk Committee take forward this work prior to recommendation to the Board for review and approval. 3.12 Medium-Term Financial Strategy The Medium-Term Financial Strategy (MTFS) provides a framework to support strategic planning and financial sustainability over a three-to-five-year horizon. It outlines the key financial challenges and risks facing integrated Health and Social Care services in Midlothian and sets out a proactive approach to managing those pressures while continuing to deliver high-quality, person-centred care. The MTFS is aligned with the IJB’s strategic priorities and underpins the delivery of the Strategic Plan. 3.13 It is important that the MTFS recognises the complex and evolving financial landscape, including demographic change, increased demand for services, inflationary pressures, and workforce constraints. It should emphasise the Page 69 of 132
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Midlothian Integration Joint Board importance of early planning, transformation, and collaborative working across partners to drive innovation and deliver sustainable services. 3.14 Following the 2025/26 budget setting process, the MTFS is now being reviewed and updated to reflect the decisions taken and to ensure a stronger alignment between financial planning and strategic planning. This review presents an opportunity to clearly connect financial decisions with desired outcomes and to ensure that available resources are targeted effectively. It will also enhance transparency and enable more meaningful engagement with stakeholders around the financial realities and strategic choices facing the IJB. 3.15 It is proposed this work will be led by the Chief Finance Officer and the Integration Manager for the boards review in the August 2025 board meeting. 4 Policy Implications 4.1 This report suggests a review of the Midlothian IJB Reserve Policy. 5 Directions 5.1 The content of this report does not have any direct impact on existing Directions at this time. 5.2 However, the review of both the Midlothian IJB Reserve Policy and the MTFS could result in amendments or revision to Directions in the future. 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 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. 7 Resource Implications 7.1 The financial implications of this report are laid out above. 8 Risk 8.1 There are a number of risks for Midlothian IJB Board members to note as result of this report. 8.2 There is a risk that 2024/25 Social Care position is not finalised and may have deteriorated. Page 70 of 132
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Midlothian Integration Joint Board 8.3 There is a risk that the time and capacity required to implement the 2025/26 Financial Recovery Programme while also progressing a programme of transformation may result in slippage. 8.4 There is a risk that any slippage in relation to the agreed 2025/26 Financial Recovery Programme will impact on the IJB’s ability to deliver a balanced budget. 8.5 There is a risk that Midlothian IJB may experience a slowing in progress towards its strategic aims, or be required to revise Directions, or agree further Financial Recovery Actions to ensure a balanced budget can be achieved. 9 Involving people 9.1 This report has been written following consultation with our NHS Lothian and Midlothian Council financial Partners, officers of Midlothian IJB, and with the Midlothian HSCP Executive Leadership Team. 10 Background Papers 10.1 There are no background papers. AUTHOR’S NAME & DESIGNATION Chris King, Chief Finance Officer CONTACT INFO Chris.King@nhs.scot DATE 04/04/2025 Page 71 of 132
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Midlothian Integration Joint Board Thursday 24th April 2025, 13:00-15:00 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 period 2023-25. • Propose the timeline for Midlothian IJB Performance Reporting on Directions 2025/26. • Confirm the revised process of updating the Joint Strategic Needs Assessment. Due to the processes required to validate statutory IJB performance goal data, the full reporting year is almost complete but subject to an inbuilt reporting delay for all indicators. A report describing progress against each improvement goal is attached in appendix 1. It should be noted at the tie of 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. The Board is required to publish a report on progress towards Directions twice each year. The proposed timeline is set out in the paper for review. The Joint Strategic Needs Assessment update process has been revised to biannual rather than quarterly. Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1) • Note the proposed reporting timeline for Directions 2025/26. • Note the revised process of updating the Joint Strategic Needs Assessment. Item number: 5.7 Page 73 of 132
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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 period 2023-25. • Propose the timeline for Midlothian IJB Performance Reporting on Directions 2025/26. • Confirm the revised process of updating the Joint Strategic Needs Assessment. 2 Recommendations 2.1 Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1) • Note the proposed reporting timeline for Directions 2025/26. • Note the revised process of updating the Joint Strategic Needs Assessment. 3 Background and main report 3.1 Midlothian 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 In June 2023, the Performance Assurance & Governance Group recommended that the Midlothian IJB 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 Health and Social Care Partnership (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 74 of 132
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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 April 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 April 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 April 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 75 of 132
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Midlothian Integration Joint Board 3.12 The Board is required to publish a report on progress towards Directions twice each year. The measures will be developed and incorporated into the Midlothian IJB Performance Framework for 2025/26. The report will be populated using an aggregation of Group Service contributions to each Direction. 3.13 To support the aggregation process and the overall calculation of progress towards Directions, the Performance and Improvement Team will create and manage an auditable log to record Group Service contributions. 3.14 The proposed timeline for the Directions Half Year report is set out below: • Scrutiny and interrogation of data by SPG on 25th September 2025. • Review and approval to publish by the Board on 9th October 2025. 3.15 The proposed timeline for the Directions Year End report is set out below: • Scrutiny and interrogation of data by SPG on 29th January 2026. • Review and approval to publish by the Board on 19th February 2026. 3.16 In response to capacity challenges across the system, including the analytical expertise provided by the LIST team, the Joint Strategic Needs Assessment update process has been revised to biannual rather than quarterly. This approach ensures the JSNA remains comfortably within the legislative requirement of being updated every three years. 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. 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. Page 76 of 132
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Midlothian Integration Joint Board 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 The role of data assurance is performed by Strategic Planning Group which has a wide membership including representation from 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 4th April 2025 Appendices: Appendix 1: Local Intelligence Support Team (LIST) Report Page 77 of 132
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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), March 2025 Page 79 of 132
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Contents 2 1. Data completeness 2. Data sources 3. A&E attendances a) monthly 5. Emergency admissions 6. Unplanned bed days: a) Acute b) Mental Health 7. Delayed discharges occupied bed days 8. End of life Page 80 of 132
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Data completeness Source: MSG data release Dec-24, PHS 3Page 81 of 132
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Data Sources 4 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 82 of 132
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A&E Attendances Source: MSG data release Dec-24; data published up to Sep-24 5Page 83 of 132
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Emergency Admissions Source: MSG data release Dec-24; data published up to Jun-24 6 Page 84 of 132
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Delayed Discharges Occupied Bed Days (18+) Source: MSG data release Dec-24; data published up to Sep-24 7Page 85 of 132
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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 86 of 132
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Midlothian Integration Joint Board Thursday, 24th April 2025, 13:00-15:00 Annual Performance Report 2024/25 Executive summary This report presents a first draft of the 2024/25 Midlothian Integration Joint Board (IJB) Annual Performance Report (APR) and includes the proposed content as far as it is available to include. Following the template and process developed over the past 3 years, narrative content and best practice examples have been themed within the 9 National Health and Wellbeing Outcomes, to align with the themes of Midlothian IJB’s Strategic Plan 2022/25: • Early Intervention and Prevention, • Support and Treatment, and • Crisis and Emergency There are some sections that require further oversight and a number of sections that cannot be completed without the National Indicator data that is provided by Public Health Scotland. Publication of management data is expected to be made available during May 2025 and validated data expected in July 2025. The Midlothian IJB Strategic Planning Group (SPG) reviewed this draft on 20th March 2025 and will continue to oversee revisions and scrutinise data as it becomes available. A final draft will be presented to the Board on 21st August 2025 for publication by Friday 29th August 2025. Members are asked to: • Review this first draft of the Midlothian IJB Annual Performance Report (APR) and provide feedback on areas for review or additional inclusion. • Note that Public Health Scotland (PHS) will release validated data in July 2025. This does not allow sufficient time to meet the Scottish Government deadline for publication of 31st July 2025. Item number: 5.8 Page 87 of 132
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Midlothian Integration Joint Board Report Annual Performance Report 2024/25 1 Purpose 1.1 This report presents a first draft of the 2024/25 Midlothian Integration Joint Board (IJB) Annual Performance Report (APR) and includes the proposed content as far as it has been available to include. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Review this first draft of the Midlothian IJB Annual Performance Report (APR) and provide feedback on areas for review or additional inclusion. • Note that Public Health Scotland (PHS) will release validated data in July 2025. This does not allow sufficient time to meet the Scottish Government deadline for publication of 31st July 2025. 3 Background and main report 3.1 Midlothian Integration Joint Board (IJB) is required by Scottish Government and the Public Bodies Joint Working (Scotland) Act, 2014, to publish an Annual Performance Report (APR) that provides an assessment of progress towards achieving the 9 National Health and Wellbeing Outcomes as indicated by a core suite of national performance indicators. 3.2 The 2024/25 APR will organise narrative content and best practice examples to align with the key themes of the Midlothian Strategic Plan 2022/25. This includes reporting within the 9 National Health and Wellbeing Outcomes under • Early Intervention and Prevention, • Support and Treatment, and • Crisis and Emergency. 3.3 There are some sections that require further oversight and a number of sections that cannot be completed without the National Indicator data that is provided by Public Health Scotland. The themes of Integration, Best Value and Quality first identified in Midlothian IJBs APR 2021/22 remain in the opening section as fundamental core principles of how the IJB operates. 3.4 The first set of data released by Public Health Scotland will form the basis of analysis of performance of Midlothian HSCP in 2024/25. A more detailed narrative will be presented to the Midlothian IJB Strategic Planning Group (SPG) for review and discussion once these data are received. Page 88 of 132
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Midlothian Integration Joint Board 3.5 The Midlothian IJB Strategic Planning Group (SPG) reviewed this a first draft of the 2024/25 Midlothian Integration Joint Board APR on 20th March 2025 and will continue to oversee revisions and scrutinise data as it becomes available. 4 Policy Implications 4.1 There are no direct policy implications as a result of this report. 5 Directions 5.1 This report does not directly impact upon service ability to deliver an existing Direction 5.2 However, as a result of this, or future drafts of the 2024/25 APR, Midlothian IJB may • identify operational implications for an existing Direction and ask the Health and Social Care Partnership to consider solutions that involve revision to one or more Direction, • recommend the development of a new Direction(s). 6 Equalities Implications 6.1 This report does not have implications for groups of people with protected characteristics. However, future drafts of the APR may identify the requirement to revise or develop a new strategy, policy, plan, provision, practice, or activity to respond to identified improvement goals. 6.2 Any new or revised strategy, policy, plan, provision, practice, or activity produced in response to the performance data and analysis presented in this or future drafts of the 2024/25 APR will require the completion of an Equality and Children’s Rights Impact Assessment (ECRIA) to inform development. 7 Resource Implications 7.1 There are no direct resource implications as a result of this report. 8 Risk 8.1 Public Health Scotland (PHS) will release management data in May 2025, and validated data in July 2025. To allow officers of the HSCP time to review data, complete necessary works, and meet distribution deadlines for both the SPG and Midlothian IJB, the next draft of the APR will be presented to the on 22nd May 2025, and to the Board on 21st August. This will not meet the Scottish Government deadline for publication of 31st July 2025. Page 89 of 132
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Midlothian Integration Joint Board 8.2 There is a risk that any delays to data publication, or significant changes between management data and published results, may result in a revised timeline for publication. 9 Involving people 9.1 Following publication, the Midlothian IJB APR will be shared widely, in print, electronically via email, via social media, and on the Midlothian Health and Social Care website. 10 Background Papers n/a AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO gill.main3@nhs.scot DATE 08/04/2025 Appendices: Appendix 1: Draft Midlothian IJB Annual Performance Report 2024/25 Page 90 of 132
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Midlothian Integration Joint Board Thursday, 24th April 2025, 13.00-15.00 Integrated Assurance Report Executive summary This report is presented to provide the Midlothian Integration Joint Board (IJB) with assurance around the processes in place to deliver clinical and care governance and risk and resilience management by the Midlothian Health and Social Care Partnership (HSCP). The Board is asked to take moderate assurance that relevant clinical and care governance policies are implemented appropriately in Midlothian, and that robust mechanisms are in place to assess and manage risk and ensure service resilience. The structure for oversight of safe, effective, and person-centred care and professional governance consists of the Clinical and Care Governance Group and service level Quality Management Groups (QMGs). Specialist groups and subgroups ensure focus on professional and subject-specific oversight including attention to identified risks and most common harms. A culture of shared learning and improvement is promoted. The Governance and Assurance Framework (GAF) has been in use for nearly 2 years and work to refine this approach is ongoing. Six Governance Groups report to the Senior Management Team (SMT) and work continues to ensure that areas highlighted as medium or low assurance by services in GAF quarterly submissions and scrutinised by the relevant Governance Group (Appendix 1). The Social Work Assurance Group (SWAG) provides a locus for the delivery of assurance for all Midlothian HSCP Social Work Services. No further strategic inspection activity has taken place since the last report. Aligned to Directions and the Strategic Plan, Group Service, Service, and Team Plans are in place across Midlothian HSCP, and plans remain in place for the delivery of progress reports to address identified risks. This provides a framework for assurance being reported and supports the continuing ambition to implement a total Quality Management System (QMS) linking clinical and care governance with the management of performance and resources. The Partnership’s structures and processes for risk management, resilience and major incident planning address the requirements of Midlothian Council and the Lothian NHS Board. This includes the maintenance of Midlothian HSCP’s Risk Register and processes which support the appropriate escalation of identified risks. Item number: 5.11 Page 91 of 132
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2 Board members are asked to • Note the contents of this report, • Consider and provide feedback on whether sufficient assurance is provided across delegated functions, and • Provide feedback on any future additions or omissions requested for inclusion in the subsequent October 2025 report. Page 92 of 132
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3 Midlothian Integration Joint Board Integrated Assurance Report 1 Purpose 1.1 This is the Integrated Assurance report provided by the Midlothian Health and Social Care Partnership (HSCP) to the Midlothian Integration Joint Board (IJB). 2 Recommendations 2.1 As a result of this report, Board members are asked to • Note the contents of this report, • Consider and provide feedback on whether sufficient assurance is provided across delegated functions, and • Provide feedback on any future additions or omissions requested for inclusion in the subsequent October 2025 report. 3 Background and main report 3.1 This report updates Midlothian IJB on the activity undertaken to provide assurance around the delivery of safe, effective, and person-centred care in Midlothian and the processes in place to cover risk and resilience. 3.2 Six Governance Groups report to the Senior Management Team (SMT) and Executive Leadership Team (ELT): Clinical and Care Governance, Integrated Workforce Governance Board, Finance and Performance, Business Governance, Digital Programme Board, and the Partnership Forum. Work continues to ensure that areas highlighted as medium or low assurance by services in the Governance and Assurance Framework (GAF) are additionally reviewed by the relevant Governance Group (Appendix 1). Risk is a standing item within the Terms of Reference of all six groups. 3.3 Clinical and Care Governance and Assurance Structure and Processes The Clinical and Care Governance Group (CCGG) meets quarterly to maintain oversight of the safety, effectiveness, and person centredness of Midlothian Health and Social Care Partnership (MHSCP) services. Group Service, Service and Team Plans have been in place across Midlothian HSCP since April 2023. The associated implementation of the GAF, and a review of meeting structures provide the CCGG with a complete picture of the assurance being provided and any identified risks to the delivery of clinical services and social care being reported across all services at every meeting. Page 93 of 132
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4 Service level Quality Management Groups (QMGs) report to the CCGG on the systems, processes, and evidence of clinical and care governance, risk management, and quality management activity. The QMGs are expected to meet at least four times per year and submit a quarterly GAF submission and completed CCGG template. The quarterly reporting template collates evidence for assurance and provides information about actions in place relating to the learning arising from investigation of adverse events and complaints, implementation of actions around safety alerts, specific standards and guidance, improvement work, action plans arising from audit and inspection activity and any other service-specific issues which could have impact on the quality and safety of care the service provides. QMGs are required to deliver an annual summary report in the form of a short presentation to the CCGG. The GAF continues to evolve, reflecting learning across our system, changes in our structures and modifications to the digital application. This approach supports a culture of learning and oversight of assurance levels across the system. Completion rates for the GAF continue to be monitored. Simple digital reminders ensure teams collate system data and use the framework to facilitate discussions across the safe, effective, person centred and regulatory domains. The digital application is used to input the consensus reached in terms of impact, assurance and overall governance across the measures within the domain areas. Tableau interfaces with the GAF application to provide a digital dashboard for oversight across the HSCP (Appendix 2.) Quarterly reporting to the Midlothian HSCP ELT provides oversight of the assurance levels across all areas of responsibility. Service Managers have responsibility to follow up the progress of their action plans through line management processes and within the CCGG for good practice and learning to be shared. The role of Chief Social Work Officer, which carries statutory functions sits within the HSCP with the Head of Adult Services as Chief Social Work Officer for Midlothian Council. The CSWO is a member of Midlothian IJB. QMG processes are integrated, and managers report on all Midlothian HSCP business to provide assurance regarding social work services. The oversight of the Social Work Assurance Group (SWAG) combines with the GAF and QMG/CCGG processes to provide assurance for all Social Work services in Midlothian HSCP. The SWAG meets fortnightly and is chaired by the CSWO with attendance from the Deputy CSWO and the Group Service Manager for Midlothian HSCP. It provides leadership and assurance regarding statutory/regulatory improvement activity (i.e. Mental Welfare Commission and Care Inspectorate inspections of internally provided services). All new Policies and Procedures for Social Work services are approved at SWAG and it has a role in overseeing audit and quality assurance work. SWAG covers all social work services in Midlothian including those services which are out with the delegated functions of the Midlothian IJB. 3.3 The Clinical and Care Governance Group The Clinical and Care Governance Group meets on a quarterly basis. Since the last report to the IJB, two meetings have taken place. Page 94 of 132
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5 Midlothian HSCP will provide its Annual Assurance Report to the NHS Lothian Healthcare Governance Committee in September 2025. In 2024, the Committee accepted moderate assurance that Midlothian HSCP has comprehensive systems in place to deliver safe, effective and person-centred care. 3.4 Investigating and Learning from Adverse Events and Complaints Three groups provide oversight of all significant adverse events reported within NHS Lothian services delivered by Midlothian HSCP. Specific groups address in- patient falls at Midlothian Community Hospital, and pressure ulcers which are two of the most common reported harms. A Morbidity and Mortality Review group is established at Midlothian Community Hospital to undertake multidisciplinary review of unexpected in-patient deaths as a further measure to develop learning to improve the delivery of safe care. The Midlothian Safety and Experience Action Group (MSEAG) has oversight of all significant adverse events (adverse events which result in harm assessed as moderate or above), including the death or suicide of patients engaged with mental health and substance use services or unexpected medical deaths. This group commissions external reviews of major harm or death significant events in line with NHS Lothian protocols. The MSEAG minutes are submitted to the Midlothian HSCP SMT, and all Serious Adverse Events approved as complete in Midlothian require the approval of the NHS Lothian Medical Director and Executive Nurse Director before final closure. The Midlothian HSCP SMT receives a monthly report of performance in the management of complaints and the reporting and management of adverse events on the Datix system. Datix is a web-based tool which can be accessed by all NHS Lothian staff to report and learn from safety concerns, adverse events with harm and near misses. It helps in the collection and analysis of information to inform action plans which support safety and quality improvement. The system also provides modules to support the administration of Complaints, Claims and Service and Team level Risk Registers, to provide an integrated information system. MSEAG undertakes quarterly review of themes and learning arising from complaints and adverse events, which are also addressed at quarterly NHS Lothian performance meetings. At the time of writing 9 Significant Adverse Event (SAEs) are open in Midlothian HSCP; 3 have been approved locally and are being managed towards final sign off by NHS Lothian Quality Improvement Support Team (QIST), and 6 are under local investigation. Chart 1 shows Midlothian’s closures keeping pace with reported events, with no backlog being built up. Chart 2 identifies a stable position regarding Midlothian HSCP’s overdue SAEs. One level 1 SAE has been open for over 6 months at the time of writing, and one other non-level 1 review which had breached the 70-day target for its completion has now been approved locally for closure. Work continues to support actions that will enable local teams to address all adverse events within the Healthcare Improvement Scotland performance indicators and assure the quality of the reviews and the implementation of learning gained. Ongoing review of learning needs is undertaken and the SMT works with the NHS Lothian QIST to discuss actions required and to enable appropriate learning opportunities to be identified and delivered. Page 95 of 132
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6 Outstanding actions from previously investigated Significant Adverse Events are recorded on Datix and continue to be monitored by the MSEAG to ensure that they are completed. Chart 1: Midlothian Serious Adverse Events reported and closed at 1st March 2025 Chart 2: Midlothian Overdue Adverse Events Reported with Major Harm and Death Outcomes at 1st March 2025 Page 96 of 132
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7 Work to develop an adverse events management process for Social Work and Social Care services was paused due to inspectorial activity which commenced in May of last year and will be progressed as resources to undertake this work are released from other priority activity. As a result, processes for adverse event management and oversight for Midlothian Council services within Midlothian HSCP currently remain less mature than for Health. A paper was agreed at Midlothian Council Corporate Management Team (CMT) in March 2025. This paper contains recommendations for the progress of a short life working group (from the three Council Directorates) to take forward the development of a Council Policy and Procedure relating to Adverse Events. Within Midlothian HSCP governance for this will be provided by Social Work Assurance Group (SWAG). The SWAG provides a route for the governance of all Council Social Work and Social Care services and, has proven to be key in providing assurance that services are operating well and safely. The Chief Social Work Officer chairs this group and standing agenda items include strategic inspections, registered services inspections, Mental Welfare Commission Reports, learning review outcomes and shared policy and procedure developments. Complaints are generally managed through the respective organisations’ complaints handling processes, although efforts are made to respond in an integrated way where required and appropriate. Elected Member, MP and MSP enquiries tend to be channelled through a Council route and are usually managed by respective Heads of Service. Performance against KPIs and an analysis of themes and learning from complaints received in relation to NHS Lothian services delivered within Midlothian HSCP is monitored by MSEAG and reported to quarterly NHS Lothian performance review meetings. Data up to January 2025 from the report received from the NHS Lothian Patient Experience team on 18th March 2025 are presented here. Charts 3 and 4 illustrate the numbers of complaints received via the NHS complaints processes which relate to services delivered within the Midlothian HSCP. Chart 3: Number of Stage 1 complaints received. Page 97 of 132
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8 Chart 4: Number of Stage 2 complaints received. Chart 5 illustrates performance regarding Stage 2 complaints responses and shows that over the period July - September 2024 the 20-day target for the provision of a response was not met for 5 complaints. Key contributing factors to delayed responses included service pressures (including non-availability of staff due to annual leave), and the co-ordination of complex complaints within and across different Midlothian HSCP services or Directorates of Midlothian Council and NHS Lothian. Chart 6 illustrates the percentage achievement of stage 2 complaints within the 20- day SPSO KPI. To provide assurance to the IJB about the management of complaints by Midlothian HSCP, data were requested from the Patient Experience Team. Analysis for the period 1 February 2024 to 31 January 2025, identified that 30 complaints were received by Midlothian HSCP; the mean response time was 16.1 days with a median of 15 days (range of 7-42 days). Over the year reviewed, 6 complaints in total fell out with the 20-day response standard set by the SPSO. At the time of writing Midlothian HSCP is involved in responding to 5 open complaints, which are within the KPI for response. Chart 5: Number of Stage 2 responses exceeding 20-day KPI. Chart 6: % achievement of Stage 2 responses within 20-day KPI. Work continues to share learning from the investigation of adverse events and complaints and to improve local services in line with findings and recommendations. 3.5 Clinical and Professional Oversight of Care Homes Page 98 of 132
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9 The Scottish Government published My Health, My Care, My Home - Healthcare Framework for Adults Living in Care Homes in June 2022. An Advice Note on Enhanced Collaborative Clinical and Care Support for Care Homes issued on 14 December 2022 provides guiding principles and a framework to continue cross sector work to continue to improve the health and wellbeing of people living in care homes. Work is continuing in Midlothian and on a pan-Lothian basis to ensure these recommendations are met and that partners involved in the delivery of care home services are engaged in shaping the model going forward. The approach recognises that the role of the HSCP is different to that of the inspection and regulation responsibilities exercised by the Care Inspectorate. 3.6 Inspections The CCGG and the SWAG maintain oversight of the inspections undertaken by regulatory bodies, including the monitoring of action plans for improvements. Managers log service inspection reports with their QMG submissions. Midlothian HSCP services are subject to external inspections from statutory bodies. This includes Healthcare Improvement Scotland, the Mental Welfare Commission, and the Care Inspectorate. These reports are lodged at SMT, and actions plans monitored operationally and reported through the QMGs, CCGG, The East and Midlothian Public Protection Committee, and the SWAG. Immediate action is taken when internal concerns or external inspections identify improvements which are required to address standards of care. Operational and professional leads have shared oversight of action plans. Implementation is led by Service Managers and progress monitored and supported through operational and care and clinical governance routes, ensuring the implementation of actions deliver sustainable improvement. On the 15th of July 2024 the Care Inspectorate notified all Local Authorities and HSCPs of their intention to undertake a review of social work governance and assurance arrangements. The review is being carried out under Section 53 of the Public Services Reform (Scotland) Act 2010. Through the review the Care Inspectorate will answer these questions - How well do social work governance and assurance arrangements support leaders to: • Ensure statutory duties are carried out safely and effectively? • Enable social work staff to be supported, accountable and effective in their practice? • Assist social work staff to uphold core social work values? They will span all areas of statutory social work including adults, children and justice social work services and will cover all local authority areas in Scotland. The review will include a review of documents, a national staff survey, interviews with key leaders from across Scotland and a range of focus groups with middle and senior managers. A final report is expected by June 2025. The Social Work and Occupational Therapy review commenced at the end of 2024. Four workstreams have been identified including ‘communication and engagement’, ‘data, performance and practice’, ‘learning and development’ and ‘organisational structure’. A working group has been convened with good representation from all professional areas impacted by the review and this group is instrumental in progressing the identified workstreams. To date, key progress has been made in Page 99 of 132
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10 reviewing the underpinning policies and procedures, Mosaic data has been scrutinised and roles and remits consulted on. This workstream sits as a Direction for 2025/26 to deliver on the draft Strategic Plan 2025-35 and as a project within the Midlothian HSCP Transformation programme agenda. Through the QMGs, a more systematic approach to managing recommendations from Mental Welfare Commission themed reports has been developed. Generally, such reports have a range of actions for Scottish Government, NHS Boards and HSCPs. These are worked into an Action Plan for later submission back to the Mental Welfare Commission. Governance is provided by reports coming to the Midlothian HSCP SMT and the SWAG (where appropriate). 3.7 Risk Management Midlothian HSCP is compliant with the NHS Lothian Risk Management Policy and Midlothian Council Risk Management Policy and Strategy. The Risk Management process within Midlothian was audited in 2021 and the finalised report confirmed that the Risk Management processes within Midlothian provided high assurance and demonstrated best practice in several areas: • Midlothian HSCP SMT meets monthly, and risk is a standing agenda item. • Service level risks registers are locally managed, and oversight is held by Heads of Service for review and escalation to the SMT (if required). • Risks are routinely monitored through these escalating levels with additional risk oversight held by Midlothian Council and Midlothian IJB both strategically and operationally. • Each risk recorded either operationally or strategically have actions associated to mitigate the risk, these are routinely monitored through the appropriate level of monitoring as mentioned above. • Each risk has a risk owner identified who is the accountable person for managing the related actions and providing routine updates on the status of the risk. 3.8 Resilience and Major Incident Planning Midlothian HSCP supports its partner organisations, NHS Lothian and Midlothian Council, to deliver their obligations to respond to incidents as Category 1 Responders under the Civil Contingencies Act (2004). Midlothian HSCP acts on behalf of Midlothian IJB to fulfil the Board’s role as a Category 1 Responder and works in cooperation with our partners Midlothian Council and NHS Lothian to meet this legal duty. The Civil Contingencies Act (2004) places 7 legal duties upon Category 1 Responders: • Duty of assess risk • Duty to maintain emergency plans • Duty to maintain business continuity plans • Duty to promote business continuity • Duty to communicate with the public • Duty to share information • Duty to co-operate Midlothian HSCP maintains major incident plans in line with NHS Lothian’s Resilience Policy and provides assurance through NHS Lothian’s reporting cycle on Page 100 of 132
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11 resilience, major incident planning and business continuity. A virtual control room is in place for incident management along with physical control rooms in both Midlothian Community Hospital and Fairfield House. Service Managers are required to review and update their service-specific resilience and business continuity plans annually and these feed into the overarching Midlothian HSCP Resilience Plan. Training and staff awareness sessions are planned for 2025/26 and lessons learned from resilience incidents are incorporated into future resilience preparedness and demonstrate Midlothian HSCP’s focus on continuous improvement. 3.9 Risk Register Operational risks are captured in the Partnership Risk Register, which is held on Datix. The risk register is reviewed and updated quarterly at SMT meetings, and risks are escalated when required to the NHS Lothian Corporate Risk Register and Midlothian Council Strategic Risk Profile. The Midlothian HSCP Risk Management Process is illustrated in Appendix 3. Midlothian HSCP mitigation plans contribute to the overarching corporate risk registers held by NHS Lothian and Midlothian Council. The following risks on the NHS Lothian Corporate Risk Register are relevant to the Midlothian HSCP: • 4 Hours Emergency Access Target • Hospital Bed Occupancy 4.0 Policy Implications 4.1 The Board is asked to take moderate assurance that relevant clinical and care governance policies are implemented appropriately in Midlothian, and that robust mechanisms are in place to assess and manage risk and ensure service resilience. 5.0 Directions 5.1 Clinical and care governance, risk management and resilience planning are implicit in various Directions 2025/26 that relate to the delivery of care. 6.0 Equalities Implications 6.1 In supports of the HSCP’s compliance with the Public Sector Equality Duty (PSED), the GAF requires services to provide assurance of compliance with Equalities duties, including the completion of an Equality and Children’s Rights Impact Assessment (ECRIA) where necessary. Page 101 of 132
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12 7.0 Resource Implications 7.1 Resource implications are identified by managers as part of service development. and additional resource may at times be required to ensure required standards of clinical and care governance, risk management and resilience planning are met. The expectation is that these activities are embedded in service areas and teams and that staff have time built in to attend the relevant oversight groups and undertake the associated responsibilities. 8.0 Risk 8.1 This report is intended to keep Midlothian IJB informed of governance arrangements and any related risks and to provide assurance to members around improvement and monitoring activity. 8.2 All risks associated with the delivery of services are monitored by managers and where appropriate they are reflected in the risk register. 9.0 Involving people 9.1 Staff working within Midlothian HSCP are involved in the development and ongoing monitoring of processes related to clinical and care governance and risk identification, assessment and management. Midlothian IJB members are encouraged to provide feedback and raise any questions in relation to this report. 10.0 Background Papers N/A AUTHOR’S NAME AND DELEGATION Fiona Stratton, Chief Nurse Claire Ross, Chief AHP Nick Clater, Head of Adult Services/Chief Social Work Officer Dr Rebecca Green, Clinical Director Roxanne King, Executive Business Manager CONTACT INFO fiona.stratton@nhslothian.scot.nhs.uk claire.l.ross@nhslothian.scot.nhs.uk nick.clater@midlothian.gov.uk rebecca.green@nhslothian.scot.nhs.uk roxanne.king@nhslothian.scot.nhs.uk DATE 7th April 2025 Appendices: Appendix 1: Midlothian HSCP Governance Structure Appendix 2: Midlothian Integrated Governance and Assurance Framework Q3 January 2025 Appendix 3: Midlothian HSCP Risk Management Process Page 102 of 132
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Appendix 1 Page 103 of 132
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Appendix 2 – MHSCP GAF Dashboard Q3 2024/5 Page 105 of 132
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Appendix 3: Midlothian HSCP Risk Management Process Page 107 of 132
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Midlothian Integration Joint Board Thursday, 24th April, 13:00-15:00 Category 1 Responder: Adverse Weather Report Executive summary On 24th January 2025, Storm Eowyn caused significant disruption across Scotland, with Midlothian experiencing high winds, heavy rainfall and widespread travel disruption. The storm led to local power outages, damage to infrastructure and hazardous conditions on roads, impacting public transport and emergency services response times. All Schools in Midlothian were closed, and Midlothian Health and Social Care Partnership (HSCP) moved to providing critical services only in line with resilience plans. On receiving notification of the red weather warning, Midlothian HSCP swiftly activated emergency response plans in line with the delegated role to act on behalf of Midlothian IJB as Category 1 Responders under the Civil Contingencies Act (2004). Midlothian HSCP cooperated with partner Category 1 Responders (Midlothian Council, NHS Lothian, Scottish Ambulance Service, Police Scotland, Scottish Power Energy Network) to prioritise maintaining critical service delivery, ensuring the safety of staff and members of the public, monitoring power outages and maintaining communication with staff, patients and the general public. The response demonstrated effective coordination, and the storm passed with limited impact on Midlothian. Lessons learnt from this incident have been incorporated into future contingency planning to enhance preparedness for future adverse weather events. Members are asked to: • Note the contents of this paper, and • Note the risk identified in 8.1 recommending Partners develop a Cyber Security Plan to ensure service continuity during future incidents. # Item number: 5.12 Page 109 of 132
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Midlothian Integration Joint Board Report Category 1 Responder: Adverse Weather Report 1 Purpose 1.1 This report sets out the actions taken by Midlothian Health and Social Care Partnership (HSCP), together with partners Midlothian Council and NHS Lothian in response to the red weather warning issued by the Met Office for Storm Eowyn to provide Midlothian IJB with assurance in their role as Category 1 Responders under the Civil Contingencies Act (2004). 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the contents of this report, and • Note the risk identified in 8.1 recommending Partners develop a Cyber Security Plan to ensure service continuity during future incidents. 3 Background and main report 3.1 Storm Eowyn was a large cyclone storm system that was identified by the Met Office on 21st January and resulted in an initial amber weather warning being issued for Scotland. This escalated to a red weather warning on 23rd January covering the period of 10am – 5pm on 24th January 2025. 3.2 A red weather warning is categorised as danger to life and is the highest level for the Met Office. Due to the nature and expected impacts of this storm, this initiated a national resilience response. 3.3 Midlothian HSCP acts on behalf of Midlothian IJB to fulfil its role as a Category 1 Responder, this report outlines the response provided to ensure the requirements under the Civil Contingencies Act (2004) were met. 3.4 Midlothian HSCP cooperated with partner Category 1 Responders (Midlothian Council, NHS Lothian, Scottish Ambulance Service, Police Scotland, Scottish Power Energy Network) to prioritise maintaining critical service delivery, ensuring the safety of staff and members of the public, monitoring power outages and maintaining communication with staff, patients and the general public. 3.5 The Civil Contingencies Act (2004) places 7 legal duties upon Category 1 Responders. These are: • Duty of assess risk Page 110 of 132
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Midlothian Integration Joint Board • Duty to maintain emergency plans • Duty to maintain business continuity plans • Duty to promote business continuity • Duty to communicate with the public • Duty to share information • Duty to co-operate 3.5.1 Duty to assess risk On receiving notification of the red weather warning, Midlothian HSCP initiated emergency response and called an Incident Management Team (IMT). This is attended by all members of the Senior Leadership Team. The purpose of this meeting is to assess, communicate and take action (ACT), agree roles and responsibilities of the IMT members in response to the incident, decisions are made on incident management and a communication plan is agreed and put in place. In response to this incident the agreed actions were: - Midlothian HSCP emergency virtual control room activated. - IMT assessed the likelihood of Midlothian impacts provided by the Met Office predicted trajectory of the storm, Midlothian expected to see winds exceeding 80mph between 10am – 5pm. - Due to the high risk to staff and patients and the early warning from Police Scotland on a ‘do not travel’ instruction, it was agreed to move to critical services only. - IMT agreed attendance at key Category 1 Responder meetings including, NHS Lothian GOLD, Midlothian Council Incident Management Team (CIMT), Met office briefings and Lothian and Borders Local Resilience Partnership (L&BLRP). 3.5.2 Duty to maintain emergency plans, Duty to maintain business continuity plans, and Duty to promote business continuity Midlothian HSCP promotes and maintains an active engagement with resilience planning and business continuity planning throughout the year. Plans are routinely updated with a formal annual review process. Business continuity and resilience plans were activated by impacted teams across the partnership and by partners. 3.5.3 Duty to communicate with the public, Duty to share information Midlothian HSCP communicated with all staff and members of the public to share the official guidance on the red weather warning, shared the ‘do not travel’ instruction from Police Scotland, and moved to critical services only. Additional support services were put in place to support vulnerable members of the public who may experience impacts of the storm. Key resilience meetings were attended: • NHSL Gold – Midlothian IJB Chief Officer • CIMT – Midlothian IJB Chief Officer, Head of Primary Care and Older People, Head of Adult Services, Executive Business Manager. • L&BLRP – Executive Business Manager Page 111 of 132
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Midlothian Integration Joint Board • Met Office Briefings – Executive Business Manager • Scottish Government Resilience Briefing – Executive Business Manager • Midlothian HSCP IMT met regularity to share information. • Midlothian HSCP SIT REP was used to share information with staff and to maintain contact throughout the 24th January. 3.5.4 Duty to co-operate Due to the advance warning of this storm, IMT were able to initiate and plan the response well. This additional time allowed for business continuity and resilience plans to be activated, measured decision making to be achieved and an excellent framework of incident management meetings to be set up which ensured that a focused and structured approach to managing this incident, all Category 1 Responders cooperated well. 3.6 Impacts The most significant impacts of Storm Eowyn were • GP Practices moved to triage and digital appointments to ensure ongoing service provision. • The significant road disruption caused by fallen trees and debris was cleared and managed effectively and efficiently by Midlothian Council. • Storm damage impacted two bases within Midlothian: Bonnyrigg Health Centre and Penicuik Health Centre. Actions were taken swifty and buildings made safe by NHS Lothian Estates. • Several areas of Midlothian were hit by power outages. 3.7 Debrief Local debriefs were held following the storm to review the response, what worked well and what could be improved. 3.8 Lessons Learnt IMT identified the need to • develop local cyber security plans in case of a complete loss of network access. Work is ongoing in this area, with the initial focus on ensuring that critical services can be maintained with no access to networks. This has to be done in conjunction with Partners. • develop a more robust system to record, maintain and access the details of vulnerable Midlothian residents who may need additional support during major incidents. • ensure a back-up solution in times of power outages to ensure that staff and premises can assess emergency power. • provide ongoing resilience training. Sessions are currently being organised. 4 Policy Implications 4.1 There are no implications for the policies of Midlothian IJB as a result of this report. 5 Directions 5.1 There is no impact on Midlothian IJB Directions 2025/26 as a result of this report. Page 112 of 132
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Midlothian Integration Joint Board 6 Equalities Implications 6.1 There are no direct implications for equality issues as a result of this report. 6.2 However, people with some protected characteristics may be more vulnerable to the impact of future adverse weather events. Midlothian HSCP will continue to work with all its partners to ensure the impact of future events can be minimised. 7 Resource Implications 7.1 There are no direct resource implications as a result of this report. 8 Risk 8.1 Risk 5773 is recorded on the IJB Risk Register –The IJB cannot properly deliver its Category 1 Responder status if its partners are unable to provide the necessary assurances. There is a risk that critical services cannot be maintained without investment from partners in a Cyber Security Plan with additional mitigations provided to support services in case of complete system/power outages. 9 Involving people 9.1 Not applicable 10 Background Papers 10.1 None AUTHOR’S NAME Roxanne King DESIGNATION Executive Business Manager CONTACT INFO Roxanne.king@nhslothian.scot.nhs.uk DATE 1st April 2025 Appendices: None Page 113 of 132
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Integration Joint Boards Finance bulletin 2023/24 Prepared by Audit Scotland March 2025 Midlothian Integration Joint Board Thursday 24 April 2025 Item 5.13 Page 115 of 132
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Integration Joint Boards | 2 Contents Key messages 3 Introduction 5 Context 6 Financial performance 7 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility Page 116 of 132
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Key messages | 3 Key messages 1 Integration Joint Boards’ (IJBs) finances continue to be precarious. IJBs 2023/24 funding has increased in real terms compared to 2022/23 but there is a concerning picture of continued overspending, depletion of reserves and required savings being met through one-off rather than recurring savings. 2 The majority of IJBs reported a deficit on the cost of providing services requiring unplanned use of reserves and additional contributions from partner bodies: • Total reserves held by IJBs have reduced by 40 per cent in 2023/24. Contingency reserves have almost halved, limiting IJBs ability to address future deficits. Nine IJBs now do not hold any contingency reserves reducing their financial flexibility and increasing the risk to their financial sustainability. • NHS boards and councils face significant financial challenges themselves and IJBs cannot continue to rely on their partners being able to find additional money to support them during the year. IJBs need to agree budgets that are realistic and transparent and to have strategies in place to manage in-year risks. 3 The majority of the total planned savings were achieved, but a substantial proportion were achieved on a one-off basis meaning these non-recurring savings need to be carried forward and covered each year to balance future budgets. 4 The financial position is set to worsen with a projected funding gap of £457 million in 2024/25. The budget process needs collaboration with partners and candid conversations with communities about the impact of the savings needed to set a balanced budget. The budgets and proposed savings need to be realistic and achievable. 5 A continued high turnover of chief officers and chief finance officers adds to the risks around effective strategic planning and decision-making. Page 117 of 132
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Key messages | 4 6 IJBs need to be working collaboratively with each other and with their NHS and council partners to find ways to transform services so that they are affordable. 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. Page 118 of 132
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Introduction | 5 Introduction 1. Integration Joint Boards (IJBs) are responsible for the governance, planning and resourcing of social care, primary and community healthcare and unscheduled hospital care for adults in their local area. The Public Bodies (Joint Working) (Scotland) Act 2014 (the Act) requires the 32 Scottish councils and 14 territorial NHS boards to work together in partnerships to integrate how social care and community healthcare services are provided. IJBs were created as part of the Act. More information about the role of IJBs is set out in a short video available on our website What are Integration Joint Boards? 2. On behalf of the Accounts Commission, Audit Scotland has undertaken an analysis of the IJB annual accounts for 2023/24 and the annual audit reports produced by local auditors. The data and analysis is published on the Audit Scotland website as an interactive online tool – The IJB Finance bulletin 2023/24. 3. The interactive online tool allows users to explore the financial performance of their local IJB, as well as compare individual IJBs. We anticipate this will be a useful resource for IJBs, their stakeholders and members of the public. It includes data on the funding and income and reserves position, outturn budget position, savings performance and financial outlook. The tool also includes local and national contextual data from the 2022 census that illustrates the increasing population pressures nationally and the significant variation across Scotland. Accompanying guidance on how to use the online tool is also available on the Audit Scotland website. 4. This document provides a summary of the national level messages from the online Finance bulletin. 5. Our findings are based on the 2023/24 annual accounts for 29 IJBs (27 audited and two unaudited), 2023/24 annual audit reports, as well as IJB budget documentation. The accounts for East Dunbartonshire IJB were unavailable at the time of publication. 6. We have published the Finance bulletin as early as possible to help inform budget-setting discussions. Further information will be added to the data tool as it becomes available. By Autumn 2025, it will also include performance and outcome data. Page 119 of 132
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Context | 6 Context Demographic shifts are driving an increase in the demand and complexity of health and care needs 7. The pressures on Scotland's social care and healthcare services are escalating, with higher demand, workforce difficulties, and financial strains, further aggravated by inflationary cost pressures. 8. Scotland’s wide-ranging population density also presents different logistical and workforce challenges, along with associated cost pressures, to providing services. 9. The 2022 Census sets out how the underlying factors impacting on the demand for social care and healthcare services have changed since 2011. 2022 Census data Movement since 2011 census/range Population 5.4 million 2.7% increase Proportion of population aged over 65 20% Increasing from 17% Population density (residents per km2) 70 Varying from 9 (Eilean Siar) to 3,555 (Glasgow) Percentage of people who reported having bad or very bad health 7% 27% increase Percentage of people with a long-term illness, disease or condition 21% Increasing from 19% Percentage of population that provide unpaid care 12% 28% increase Source: Scotland’s Census 2022 10. These societal changes result in an increased resource demand for social care and healthcare services and impact on the financial sustainability of these services as we set out later in this report. Page 120 of 132
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Financial performance | 7 Financial performance The financial health of IJBs continues to weaken and there are indications of more challenging times ahead IJB funding has increased in real terms compared to 2022/23 11. IJBs receive their funding as annually agreed contributions from their council and NHS board partners. Funding is largely received to cover in- year expenditure on providing services but can also be received for specific services and national initiatives to be funded in future years. The funding split between NHS and council partners remains around 70 per cent from NHS boards and 30 per cent from councils. 12. There has been a four per cent real-terms increase in IJB funding between 2022/23 to 2023/24 (Exhibit 1). Exhibit 1 IJB Funding and income 2020/21 – 2023/24 Funding increased by four per cent in real terms in the past year Note: * Position/movement excluding East Dunbartonshire IJB as accounts are unavailable. Source: Audited accounts £10,577 £10,792 £9,996 £11,841 £507 £960 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 11,000 12,000 2020/21 2021/22 2022/23 2023/24* £ million Partner contributions Covid-19 funding Page 121 of 132
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Financial performance | 8 The majority of IJBs reported a deficit on the cost of providing services requiring additional contributions from partner bodies and the unplanned use of reserves 13. Twenty-four IJBs reported a deficit on the cost of providing services with the majority (18) reporting a deficit between zero and three per cent (Exhibit 2, page 9). 14. Of the 24 IJBs reporting an operating deficit, 11 received additional contributions from partner bodies to cover the year end overspend and 16 made an unplanned drawdown from reserves. A number of IJBs will have received additional partner contributions during the year that will not be captured by this analysis. These additional in-year contributions can arise for a variety of reasons, including specific one-off cost pressures not anticipated during budget-setting. 15. Five IJBs reported an operational surplus, down from 19 in 2022/23. Reasons reported for surplus’ included delays in the launch of some transformation and improvement projects and challenges in health and social care recruitment. 16. Recruitment and retention issues facing the sector persist, but the related savings from holding vacancies, that contributed to the majority of operational surpluses in 2022/23, are being outstripped by inflationary cost pressures and, reflecting the workforce pressures, a higher spend on agency/locum/bank staff. Other financial pressures driving the increase in the costs of providing services include increasing demand for services, prescribing costs and pay inflation. Page 122 of 132
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Financial performance | 9 Exhibit 2 Operational surplus/deficit as a proportion of the 2023/24 net cost of service The majority of IJBs reported a deficit on the cost of providing services in 2023/24 requiring additional contributions from partner bodies and the unplanned use of reserves. Note: * Comparable data for 2022/23 was not available for these IJBs. ** East Dunbartonshire IJB accounts unavailable. Source: Audited accounts, auditor returns The majority of the total planned savings were achieved, but a substantial proportion was achieved only on a one-off basis 17. There was a 154 per cent increase in the savings target between 2022/23 and 2023/24, increasing to £214 million. Overall, IJBs achieved 79 per cent of their planned savings targets in 2023/24. This was down -10% -5% 0% 5% 10% Shetland Orkney* Dumfries & Galloway* Falkirk Eilean Siar Midlothian Aberdeen East Renfrewshire Fife Aberdeenshire Scottish Borders East Ayrshire Perth and Kinross North Ayrshire Moray East Lothian Glasgow Dundee Clackmannanshire & Stirling Edinburgh* West Dunbartonshire Inverclyde West Lothian Renfrewshire East Dunbartonshire** Argyll & Bute South Lanarkshire Angus North Lanarkshire South Ayrshire 2022/23 2023/24 Page 123 of 132
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Financial performance | 10 from 84 per cent in 2022/23. Only seven IJBs achieved all of their savings target with three IJBs achieving less than half their target (Exhibit 3, page 11). 18. Fifty-seven per cent of savings were achieved on a recurring basis with the remaining 43 per cent being achieved on a non-recurring basis. The non-recurring savings will be carried forward to be found again in future years. Page 124 of 132
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Financial performance | 11 Exhibit 3 2023/24 Savings performance 79 per cent of total planned savings were achieved in 2023/24, compared to 84 per cent in 2022/23. Note: * In the absence of the 2023/24 East Dunbartonshire IJB accounts, the 2022/23 Net Cost of Service was used. Source: 2023/24 Audited accounts, auditor returns 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% North Lanarkshire Angus Inverclyde Perth and Kinross Renfrewshire Clackmannanshire & Stirling South Ayrshire Orkney Scottish Borders East Ayrshire East Dunbartonshire* Glasgow North Ayrshire Moray East Renfrewshire Fife Dundee Shetland Aberdeen West Lothian Argyll & Bute Edinburgh West Dunbartonshire Eilean Siar Falkirk Dumfries & Galloway Savings target as a proportion of the net cost of service Savings achieved Savings target + target amount £23.2m £1.4m £13.5m £7.9m £20.7m £8.9m £6.6m £9.4m £2.0m £5.1m £21.4m £7.1m £4.1m £5.0m £21.5m £3.9m £5.2m £2.5m £2.4m £2.4m £2.5m £3.3m £4.4m £1.3m £0.9m £2.7m 85% 59% 146% 71% 106% 83% 97% 79% 57% 100% 53% 39% 66% 94% 100% 64% 61% 100% 85% 31% 95% 85% 75% 100% 100% 57% 100% Page 125 of 132
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Financial performance | 12 19. IJBs achieved 79 per cent of their planned savings target in 2023/24. Over two-fifths of this were achieved on a non-recurring basis. This means that these savings will be carried forward to be found again in future years. Identifying and achieving savings every year on a recurring basis, and moving away from relying on one-off savings, is essential for IJBs to maintain financial sustainability. Total reserves held by IJBs have reduced by 40 per cent in 2023/24. 20. By the end of 2023/24, IJBs reported a reduction in their total level of reserves, decreasing by 36 per cent between 2022/23 and 2023/24 (40 per cent real-terms reduction). Part of the reduction relates to the use of ringfenced reserves to support Scottish Government national policy objectives (Exhibit 4). Exhibit 4 Total reserves by year Total reserves held by IJBs have reduced by 40 per cent in real terms in 2023/24. Note: * 2023/24 position/movement excludes the East Dunbartonshire IJB position. Source: Audited accounts £- £200.00 £400.00 £600.00 £800.00 £1,000.00 £1,200.00 £1,400.00 2020/21 2021/22 2022/23 2023/24 Millions Ringfenced/Earmarked reserves Contingency reserves Covid reserves Page 126 of 132
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Financial performance | 13 Contingency reserves have almost halved, limiting IJBs ability to address future deficits 21. Contingency reserves have almost halved (49 per cent real-terms reduction) and now represent 0.8 per cent of the total Net Cost of Services (down from 1.6 per cent). These are reserves that are held but have not been earmarked for a specific purpose and are often used to mitigate the financial impact of unforeseen circumstances (Exhibit 5). Exhibit 5 2023/24 year end IJB reserves as a proportion of the net cost of services Over half of all IJBs had contingency reserve levels of less than one per cent of net cost of services. Source: Audited and unaudited accounts 0.0% 2.0% 4.0% 6.0% 8.0% 10.0% 12.0% Aberdeenshire Midlothian Fife East Lothian Shetland Edinburgh East Renfrewshire Moray Perth and Kinross North Ayrshire Dumfries & Galloway Aberdeen West Lothian East Ayrshire Clackmannanshire & Stirling Scottish Borders Argyll & Bute Dundee Glasgow Orkney South Lanarkshire South Ayrshire Renfrewshire Falkirk West Dunbartonshire North Lanarkshire Angus Inverclyde Eilean Siar Ringfenced/Earmarked reserves Contingency reserves Page 127 of 132
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Financial performance | 14 22. One IJB (Aberdeenshire) utilised all their reserves in year, meaning that any future overspend position would require additional funding from partner bodies. 23. Four IJBs utilised all their contingency reserve in year, bringing the total number of IJBs without any contingency reserves, at the end of 2023/24, to nine. Financial sustainability risks have been identified by auditors in the vast majority of IJBs 24. The majority of auditors raised financial sustainability risks as part of their annual audits of IJBs. The risks identified included the reliance on non-recurring sources of income, such as reserves and one-off savings, to meet overspends. 2023/24 Audit Financial management risks identified* 22% Financial sustainability risks identified* 96% Medium-term financial plan in place** 90% Accounts presented within agreed timetable** 83% Unmodified opinion* 100% IJBs reporting turnover in senior officer roles (CO/CFO)** 57% IJBs who agreed their 2024/25 budget prior to the start of the financial year** 87% Note: * Based on 27 IJBs, where Annual Audit Reports were available. ** Based on all IJBs. Turnover figures include IJBs with interim Chief Officers (CO)/Chief Finance Officers (CFO) in place. Source: Annual Audit Reports, IJB budget papers, Medium-term financial plans 25. Other financial sustainability risks highlighted by auditors included: • Reserves level falling below minimum required as per their individual reserves policies. In one case, the general reserve has been depleted in full. • Undeveloped/underdeveloped plans for the achievement of recurring savings to allow IJBs to reach a balanced financial position. Page 128 of 132
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Financial performance | 15 • Additional contributions being required from IJB partners to meet cost pressure. • Inability to reduce reliance on agency and locum staff due to ongoing recruitment challenges. 26. Financial management risks identified included: • Inaccurate information provided or not presented in line with regulations. • Insufficient detail provided to allow the reader to fully assess the board’s overall performance. • Financial forecasting requiring more accuracy. • Requirement to enhance the reporting to provide greater clarity regarding the underlying IJB budget and performance against the budget during the year. Instability of leadership continues to be a challenge for IJBs 27. Over half of IJBs reported a change of Chief Officer or Chief Finance Officer in 2023/24. We previously reported that half of IJBs reported a change in senior leadership across 2021/22 and 2022/23. 28. The leadership and strategic vision of senior officers is crucial in the strategic planning and decision making required to drive much needed transformation change. Instability in leadership teams has the potential to disrupt strategic planning and the leadership capacity to bring about the fundamental change required to address the growing scale of challenges facing IJBs. The projected financial position is set to worsen 29. 2024/25 budget-setting revealed that the projected funding gap for IJBs has increased again to £457 million (£357 million for 2023/24) (Exhibit 6, page 16). 30. For 2024/25, 16 of the 30 IJBs agreed a balanced budget before the start of the financial year. Delays in the agreement of savings plans and NHS partner funding were the most common reasons for balanced budgets not being agreed at the start of the financial year. Page 129 of 132
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Financial performance | 16 Exhibit 6 IJB funding gaps as a proportion of 2023/24 net cost of services IJB annual accounts and budget papers identify a 28 per cent increase in the overall projected funding gap between 2023/24 and 2024/25. Note: * In the absence of the 2023/24 East Dunbartonshire IJB accounts, the 2022/23 Net Cost of Service was used. Source: IJB budget papers, auditor returns Reliance on non-recurring sources of income is not sustainable 31. At the time of the 2024/25 budget-setting, nine per cent of the projected funding gap was planned to be bridged using non-recurring reserves (Exhibit 7, page 17). 0% 2% 4% 6% 8% 10% 12% Scottish Borders South Ayrshire Angus West Lothian North Ayrshire Perth and Kinross Argyll & Bute East Dunbartonshire* West Dunbartonshire Orkney East Lothian Fife Falkirk Moray Eilean Siar 2024/25 gap as proportion of Net Cost of Service 2023/24 gap as proportion of Net Cost of Service Page 130 of 132
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Financial performance | 17 32. A proportion of the funding gap did not have planned savings agreed against it at the time of budget-setting. These unidentified savings made up 13 per cent of the total projected funding gap and were the result of 12 IJBs starting the 2023/24 financial year with an unbalanced budget. Exhibit 7 2024/25 IJB funding gap planed action The use of non-recurring reserves makes up nine per cent of plans to bridge the funding gap. Source: IJB budget papers, auditor returns 33. The proposed savings contain both recurring and non-recurring savings. The reliance on non-recurring sources of income to fund recurring budget pressures is unsustainable in the medium to long term. The identification and delivery of recurring savings and a reduced reliance on drawing from reserves to fund revenue expenditure will be key to ensuring long-term financial sustainability. Agreed savings 76% Use of reserves 9% Other 2% Remaining gap 13% Agreed savings Use of reserves Other Remaining gap Page 131 of 132
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Integration Joint Boards Finance bulletin 2023/24 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 Email: info@audit.scot www.audit.scot ISBN 978 1 915839 65 7 AS.5.0 Page 132 of 132