Agenda Document Pack - Midlothian Integration Joint Board - 12/06/2025
Midlothian Council · 12 June 2025
Back to Midlothian Integration Joint Board — 12 June 2025 and its agenda
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Council Chambers/Hybrid, Midlothian House, Dalkeith, EH22 1DN Date: Thursday, 12 June 2025 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Democratic Services Clerk Telephone: 0131 271 3160 Clerk Email: democratic.services@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 180
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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 24th April 2025 submitted for approval 5 - 22 4.2 Minutes of Strategic Planning Group on 20th March 2025 for noting only 23 - 32 4.3 Minutes of Audit and Risk Committee on 6th March 2025 for noting only 33 - 42 5 Public Reports 5.1 IJB Member Reappointment - Paper Presented by Democratic Services 43 - 48 5.2 Chair’s Update – Councillor McManus, Chair (Verbal) 5.3 Chief Officers Report – Morag Barrow, Chief Officer 49 - 60 5.4 Strategic Planning Group Update – Presented by Andrew Fleming, Strategic Planning Group Chair (Verbal) 5.5 Audit and Risk Committee Update – Presented by Val de Souza, Audit and Risk Committee Chair (Verbal) For Decision 5.6 Midlothian IJB Draft Annual Accounts 2025-2026 - Paper presented by Chris King, Chief Finance Officer 61 - 100 For Discussion 5.7 Midlothian IJB Strategic Plan 2025-2035 Update - Verbal update by Gill Main, Integration Manager Page 2 of 180
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5.8 Midlothian IJB Finance Update - Paper presented by Chris King, Chief Finance Officer 101 - 106 5.9 Midlothian IJB Performance Update - Paper presented by Elouise Johnstone, Programme Manager 107 - 156 5.10 Midlothian Unscheduled Care Workstream Update - Presentation presented by Morag Barrow, Chief Officer on behalf of Grace Cowan, Older Peoples & Primary Care Services 5.11 Prevalence and Management of Type II Diabetes in Midlothian - Paper presented by Jim Sherval, Public Health Consultant 157 - 174 5.12 Midlothian HSCP Transformation Programme - Paper presented by Morag Barrow, Chief Officer 175 - 180 For Noting No items for discussion 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting pf Midlothian Integration Joint Board will be held on Thursday 21 August 2024, 14:00-16:00. Page 3 of 180
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Midlothian Integration Joint Board Midlothian Integration Joint Board Thursday 12 June 2025 Item No 4.1 Meeting Date Time Venue Midlothian Integration Joint Board Thursday, 24 April 2025 13:00 Council Chambers, Midlothian House and Virtual Meeting held using Microsoft Teams Present (voting members): Councillor McManus (Chair) Councillor Parry Dr Amjad Khan (NHS Lothian) (Virtual) Val de Souza (Vice Chair, NHS) (Virtual) Andrew Fleming (NHS Lothian) Present (non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Nick Clater (Head of Adult Services and Chief Social Work Officer) Fiona Stratton (Chief Nurse) Claire Ross (Chief AHP) Dr Rebecca Green (Clinical Director) Grace Chalmers (Partnership Representative) Magda Clark (Third Sector Representative) Dr Wendy Metcalfe (Medical Practitioner) In attendance: Gill Main (Integration Manager) Roxanne King (Virtual) Executive Business Manager Elouise Johnstone (Performance Manager) Hannah Forbes (Democratic Services Officer) Louise Middleton (Democratic Services Officer) Page 5 of 180
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Thursday 24th April 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 of interest noted. 4. Minute of Previous Meetings 4.1 The Minute of previous Midlothian IJB Board Meeting held on 20th February 2025 was approved as an accurate record. 4.2 The Minute of the meeting of the MIJB – Strategic Planning Group held on 16th January 2025 was noted by the Board. 4.3 The Minute of the meeting of the MIJB – Audit and Risk Committee held on 5th December 2024 was noted by the Board. Apologies: Grace Cowan (Head of Older People and Primary Care Services) Keith Chapman (Lived Experience member) Councillor Milligan Councillor Winchester Page 6 of 180
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Thursday 24th April 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 the meeting by informing the Board that due to technical issues, it would not be possible to broadcast meeting live to the public. The meeting will be recorded and made publicly available on Midlothian Council’s Website. The Chair provided an update and advised that following the Special Board meeting on the 27th March 2025, Midlothian IJB have written to Partners to advise of the decisions taken by Midlothian Integration Joint Board (MIJB) in order to set a balanced budget for 2025. The Chair noted the resignation of Kirsty MacDonald who was an NHS Voting Member of the IJB. The Chair advised that the IJB are hugely grateful and thanked Kirsty for their service and wished them well for their future. The Chair highlighted to the IJB that they have received notification from the Chief Officer regarding a delay at Scottish Government in the appointment of two new NHS Lothian Non-Executive Board Members. The Chair noted that the Board will continue to work with NHS Lothian to ensure the business of Midlothian IJB can be carried out effectively during this time. It was further highlighted to the Board that the next Development Session will be held on the 8th of May 2025 between 2-4pm in the Committee Room, Midlothian House, for IJB members. The Development Session will have 2 sections, (1) discussing the work of the Third Sector in Midlothian and (2) agreeing the Midlothian IJB Board Members Self-Development Plan for 2025/2026. Page 7 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Members were asked to note that the Spring Third Sector Summit will be held on Wednesday 21st March 2025 at 13:30-16:00pm in St Johns and Kings Park Church, Dalkeith. 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 progression of the Health and Social Care Partnership (HSCP) Programme as detailed in the report. A full update will be brought to the Board in the future. • The financial recovery action with a focus on the resource panel and allocation of care packages. The Group Service Manager and the team were thanked for the work that is in place around this. • The governance route and progress of the new draft Strategic Plan. The Chair thanked the Chief Officer for the report and opened to questions from the Board. The Board noted that this report is helpful with providing updates and progress. The Board asked for an update on the current activity and engagement in relation to the National Care Service (NCS). The Head of Adult Services and Chief Social Work Officer gave an update and noted the establishment of an Advisory Board and a National Social Work Agency. The Head of Adult Services and Chief Social Work Officer noted that they welcomed the principle of establishing a National Social Work Agency, however noted some concerns with the routing of it within Scottish Government. The preference from Chief Social Work Officers and Social Work Scotland would be that it is independent from Scottish Page 8 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Government completely. It was noted that the workforce planning, particularly around education training and professional development, is welcome and this will have benefit being part of a wider government set up. The view from the Head of Adult Services and Chief Social Work Officer would be the National Social Work Agency to be an independent external body to Government. 5.3 Strategic Planning Group Update – Andrew Fleming, Strategic Planning Group Chair Andrew Fleming, Strategic Planning Group Chair, presented the main activity of the Strategic Planning Group since the last Board. This included the first draft of the Annual Performance Report, and the development of the Midlothian IJB Performance Framework which is scheduled for discussion at SPG in July 2025 and will be presented to the Board in August 2025. It was also noted that the SPG had site of the Joint Strategic Needs Assessment and an update on the rolling programme to ensure the data is up to date. Ongoing work includes supporting the progression of the Strategic Plan through the governance routes of both partner organisations and to prepare the key statutory documentation. It was also highlighted that the Vice Chair of the SPG is currently vacant. It has been suggested the Third Sector may wish to consider undertaking this position. 5.4 Audit and Risk Committee Update – Val de Souza, Audit and Risk Committee Chair Val de Souza, Audit and Risk Committee Chair presented the main activity of the Audit and Risk Committee (A&R) held on 6th March 2025 to the Board. This included noting that this was the first Page 9 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments meeting for the Chief Finance Officer (Chris King) and Independent Member (Anthony Clark), and that the Committee signed off the Internal Audit Plan and the timeline for the external audit. The Chief Finance Officer advised that the Annual Accounts will be discussed at the next Audit and Risk Committee on 6th June 2025. For Decision 5.5 Midlothian IJB Equalities Outcomes 2025-2029 - Paper presented by Gill Main, Integration Manager Gill Main, Integration Manager, presented the report of Midlothian IJB Equality Outcomes for 2025-2029, providing assurance on the development process and, subject to any amendments, seeking delegated authority to publish before the 30th April 2025. As a result of the report, Members were 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. The Integration Manager explained with an extension had previously brought to the Board in relation to the publication date due to capacity limitations. However, the Integration Manager thanked the Board for their strong commitment to equality issues threaded throughout the draft Strategic Plan, and continuing Page 10 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments to keep this visible. This had allowed officers to progress more quickly than anticipated and facilitated the presentation of this key work to Board in line with the statutory publication dates. The Integration Manager also noted the ambition to report on progress annually within the Midlothian IJB Annual Performance Report. The Chair thanked the Integration Manger for the report and opened to questions from the Board. There was a question highlighted by the Board around the risk of not developing a plan in relation to all of the 9 protected characteristics. The Integration Manager explained the consultation process that helped to understand what was most important to people in the Lothians and the process of choosing those key areas to really focus on. The Integration Manager acknowledged risk of not focusing on all of the protective characteristics, but noted the challenge of establishing meaningful actions for local people where data does not support identifying the key areas for improvement. However, there is work underway to improve the available data which will support future targeted action. The Board approved the Equality Outcomes and Action Plan for publication. Approved for publication Integration Manager Ongoing For Discussion 5.6 Midlothian IJB Finance Update - Paper presented by Chris King, Chief Finance Officer Chris King, Chief Finance Officer presented this report to provide an overview of key updates and proposed actions relating to the financial management of the Midlothian Integration Joint Board (IJB). Page 11 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 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). As a result of this report, Members were asked to: • Note the financial position, • Agree to the Midlothian IJB Audit and Risk Committee reviewing the Reserve Policy. • Note the ongoing work to develop the Medium-Term Financial Strategy (MTFS). The Chief Finance Officer noted the high-level update is due to being in between both financial years, with no further information available at this time. It was further highlighted to the Board that the Medium-Term Financial Strategy (MTFS) is under review and will provide a framework to support strategic planning and financial sustainability over 3-5 years. The Strategy will outline the key financial challenges and risks facing Health and Social Care services and set out a proactive approach to manage these pressures. The MTFS will be updated to reflect the recent financial decisions that were made in the March 27th Special Board. This is to ensure that there is a stronger alignment between financial and strategic planning. The work for the MTFS will be led by the Chief Finance Officer with support from the Integration Manager and will come back to the Board in August 2025 for review. In relation to the proposal to review the Midlothian IJB Reserves Policy, the Board asked the Chief Finance Officer what the policy options are likely to be. The Chief Finance Officer explained to the Board that maintain 2% of total budget as policy, would mean a general reserve in excess of £3 million, and that does not seem feasible in the current climate. The Chief Page 12 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Officer noted that they will work closely with other IJBs in Lothian and nationally to ensure Midlothian IJB remains in step nationally with other Board’s policy positions. The Chair noted that they attend COSLA Board for Health and Social Care and advised that they will have a discussion with the Chair to have some level of a national focus group to have a conversation regarding reserves as there are many IJBs that are in a similar position. The Board asked if there was a likely movement on the final out term position and how do we manage the financial position in that context. The Chief Finance Officer advised the Board that it is difficult to manage the financial position when we are 3 months behind and acknowledged this risk for 2024-2025. However, for 2025-2026 the Chief Finance Officer and the Integration Manager are considering more proactive reporting. The Chief Officer added that the Chief Finance Officer and the Integration Manager are scoping the development of a dashboard to improve reporting capabilities around the resource panel. 5.7 Midlothian IJB Performance Update - Paper presented by Elouise Johnstone, Programme Manager Elouise Johnstone, Programme Manager, presented this report to provide an update to the Board on the progress of the Midlothian IJB performance goals set for the period 2023-2025, proposed the timeline for Page 13 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments Midlothian IJB Performance Reporting on Directions 2025/26, and confirmed the revised process of updating the Joint Strategic Needs Assessment. 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 proposed reporting timeline for Directions 2025/26. • Note the revised process of updating the Joint Strategic Needs Assessment. The Chair thanked the Programme Manager for the report and opened for questions from the Board. There were no questions from the Board. 5.8 Midlothian IJB Draft Annual Performance Report - Paper presented by Gill Main, Integration Manager Gill Main, Integration Manager presented this repost to provide an update on the 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. As a result of this report, Members were asked to: • Review 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. Page 14 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Integration Manager advised the Board the Health and Care Experience (HACE) Survey is updated every 2 years; therefore, the indicators that are generated by the HACE Survey will not be updated for the 2024-2025 APR. The Board was asked to provide any feedback on the draft APR and note due to the late release PHS data it is not possible for us to meet the statutory deadline of 31st of July. The APR will be presented for approval to the first available Board in August 2025. The Board asked a question in relation to indicator 5 and 6 where the trend is going against the national levels for adults receiving care or support and was interested to know why that is. The Integration Manager explained that the HACE Survey is sent to a random selection of residents who live in Midlothian that are registered to a General Practice (GP) and, as only a proportion of them respond, the data can often feel different from the experience locally. Midlothian IJB’s solution to this is to undertake an annual Citizen’s Panel to help us better understand the experience of local people. As there is only 1 previous year of data to work with, officers will compare this data with the 2025 Citizens Panel data when available and consider areas for improvement and action. The Clinical Director explained the limitations to the data but noted that GP performance has improved and was pleased to see this translated through into a small improvement in the indicators. The Clinical Director noted national issues around funding and declining workforce alongside other pressures are making practice more difficult, but improvement work is delivering results. Liaise with Heads of Service for experience and Clinical Director for GP data Integration Manager/ Programme Manager 21st August 2025 Page 15 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 5.9 Midlothian Unscheduled Care Workstream Update - Presentation by Morag Barrow, Chief Office on behalf of Grace Cowan, Head of Primary Care and Older People’s Services Morag Barrow, Chief Officer spoke to the presentation on behalf of the Head of Primary Care and Older People’s Services. The presentation gave an overview of the key areas and highlighted to the Board: • there were currently 128 beds in use, with 14 considered as delayed discharge The Chair thanked the Chief Officer for the presentation and opened for questions from the Board There was a question raised in relation to care packages and where the constraints are in the system. The Chief Officer noted that it is a great piece of work however this takes up a considerable amount of management and clinical time and contributes to the workforce challenges. There are particular challenges locally and for community health and social acre to resolve alongside acute colleagues. The 4-hour target has significantly improved at Accident and Emergency (A&E), and that variation is being examined. The Clinical Director explained the cultural issues around change management can take time, with a common theme being confidence to deliver change. From an HSCP perspective, we understand the change required and that will take some time to embed. A follow up question was presented by the Board asking if we are discharging people without the support around them. Page 16 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chief Officer noted that Midlothian HSCP would not support a discharge that is not safe. The focus in Midlothian is safety and explained there is no data to suggest a pattern or trend of failed discharges. Additionally, Midlothian HSPC has invested in the Red Cross to support people on return home to ensure they are supported. The Chief AHP described the discharge risk indicator tool to the Board and the importance of a collaborative, system-wide approach to help us understand and consider both the Health and Social Cares perspective. Some gaps in the data remain for the reporting using the discharge risk indicator, but this tool is supporting us to better understand how many patients we have in the system, what the discharge risk indictor is, and the action needed to facilitate discharge. The Board queried why this approach has not been taken before now. The Chief Officer explained that leadership is key, and the national position as well as Midlothian’s view around delayed discharges has changed. There are cultural changes to ways of working that are starting to see change in Midlothian despite a small team and the injection of additional resource has helped. It was further queried by the Board if the ongoing ambition to shift the balance of care to community creating additional pressure on Primary Care, what conversations are taking place in the community and how are we going to ensure resource follows this ambition. The Clinical Director highlighted this is the first time Scottish Government has supported the use of unscheduled care funds to be utilised outside of Acute and Secondary Care. This is the first time General Practice has been provided with resource to support the hospital flow work. However, there is a situation nationally now amongst GP, where we now have more GPs that are not able to find work. Page 17 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chief Officer noted that if a sustained improvement can be demonstrated, it is possible to start discussions around the allocation to acute services as part of our set aside budget. Over the next year we hopefully be in a position to come back to the Board and discuss this in more detail. 5.10 Midlothian Overview of No.11 Services (Mental Health, Substance Use & Justice) - Presentation by Nick Clater, Head of Adult Services The Head of Adult Services and Chief Social Work Officer advised this presentation was originally delivered in 2024 and the Board has requested an update and overview of the services provided at Number 11 Recovery Hub. The Head of Adult Services and Chief Social Work Officer delivered a presentation highlighting key aspects of the work, challenges, successes, and opportunities for improvement. The Chair thanked the Head of Adult Services and Chief Social Work Officer for the presentation and opened for questions or comments from the Board. The Board commended the Head of Adult Services and Chief Social Work Officer for the report and the information that has been detailed to the Board today. The Chair noted that Number 11 is a jewel for the HSCP and expressed interest in supporting expansion into the South of Midlothian. Chair stated they would continue this conversation with relevant officers. Page 18 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments 5.11 Midlothian IJB Integrated Assurance Report - Paper presented by Fiona Stratton, Chief Nurse & Claire Ross, Chief AHP Fiona Stratton, Chief Nurse presented the Midlothian IJB Integrated Assurance Report provided by the Midlothian Health and Social Care Partnership (HSCP) to the Board. As a result of this report, Board members were asked to: • Note the contents of this report. • Consider and provide feedback on whether sufficient assurance is provided across delegated functions. • Provide feedback on any future additions or omissions requested for inclusion in the subsequent October 2025 report. The Chair thanked the Chief Nurse for the report and opened for questions from the Board. The Board raised a question relating to Serious Adverse Events and how recommendations from these reviews are brought forward and improvement sustained. The Chief Nurse advised there is a robust system in place, where outstanding actions in relation to a Serious Adverse Event and they are logged on the Datix system, and the Quality Improvement Support Team ensure they are completed. Page 19 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board Decision Action Owner Date to be Completed/ Comments The Chief Officer highlighted to the Board the Governance Assurance Framework (GAF) as a groundbreaking piece of work that Midlothian team have developed to provide assurance across all integrated health and social care. The Chief AHP highlighted the report on Q4 for this year will allow comparison with the same period in 2023/2024. During implementation, reporting using the GAF had been completed by approximately half of the system reporting low levels of assurance where now between 85-100% of the system are consistently reporting increased overall levels of assurance. The Chief AHP described that the GAF allows for the collective oversight of overall levels of assurance and that the learning generated often describes collective issues. It was further noted that there is work ongoing with the Digital Innovations Team to test the platform utilised for this reporting For Noting 5.12 Category 1 Responder Update: Storm Eowyn - Paper provided by Roxanne King, Executive Business Manager Roxanne King, Executive Business Manager presented this report that set 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 Noted Page 20 of 180
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Thursday 24th April 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 Decision Action Owner Date to be Completed/ Comments Midlothian IJB with assurance in their role as Category 1 Responders under the Civil Contingencies Act (2004). As a result of this report, Members were asked to: • Note the contents of this report. • Note the risk identified in 8.1 which recommends Partners develop a Cyber Security Plan. The Chair thanked Executive Business Manager and advised the Board accepted this report for noting. 5.13 Accounts Commission Integration Joint Boards Finance Bulletin The Chair advised the Board that this report is for noting. Page 21 of 180
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Thursday 24th April 2025 Midlothian Integration Joint Board 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 on MS Teams. A Midlothian IJB Development Session will be held on Thursday 8th May 2025, 14:00 - 16:00, for IJB members only. Page 22 of 180
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Midlothian Integration Joint Board Thursday 12 June 2025 Item 4.2 Midlothian IJB Strategic Planning Group Meeting Date Time Venue Strategic Planning Group Thursday 20 March 2025 14:00pm Committee Room/MS Teams Present (MIJB Members): Andrew Fleming (Chair) Councillor Winchester (virtual) Morag Barrow, (Chief Officer) Jordan Miller (virtual), Lead Partnership Rep Chris King, Chief Financial Officer Magda Clark, Third Sector member Present (HSCP and Partners): Gill Main, HSCP Integration Manager Elouise Johnstone, HSCP Programme Manager (Performance) Grace Cowan, HSCP Head of Primary Care and Older People Fiona Kennedy, HSCP Group Service Manager Roxanne King (virtual), Executive Business Manager Rosemary McLaughlan (virtual), VOCAL Laura Hill, VOCAL (virtual) Rebecca Miller (virtual), Strategic Development NHS Lothian Jim Sherval (virtual), Consultant in Public Health Nick Clater, HSCP Head of Adult Services & Chief Social Work Officer Claire Ross, Chief Allied Health Professional (AHP) Fiona Stratton, HSCP Chief Nurse Louise Middelton (Democratic services) Hannah Forbes (Democratic Services) Apologies: Kirsty Macdonald, NHS Lothian Keith Chapman, Lived Experience Member Rebecca Green, HSCP Clinical Director Page 23 of 180
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Strategic Planning Group 1. Welcome and introductions The Chair welcomed everyone to this meeting of the Midlothian Integration Joint Board (MIJB) Strategic Planning Group (SPG) and noted the apologies for the meeting. 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. 3.2 Action log The action log was presented by the Integration Manager and the Group reviewed the outstanding actions. The Group also noted and acknowledged the significant work undertaken in 2024/25. 3.3 Risk Register This item was discussed under item 5.8. Page 24 of 180
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Strategic Planning Group 4. Updates Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 The Chair’s Update The Chair provided a verbal update and highlighted the Vice Chair vacancy, reiterating to the group that the Terms of Reference now permit any member of the IJB to take up this role. The Chair noted scrutiny of Directions in the February Board and subsequent Development Session. The chair highlighted to the board the Special SPG meeting on the 23rd of July 2025 at 1:30pm to discuss topics around the bed base model ahead of the MIJB Board meeting due to be held on 21st August 2025 at 2pm. The Chief Officer suggested that The Third Sector may wish to consider the role of Vice Chair due to the considerable contribution of this sector and the need for close working as we implement the new strategic plan. Third Sector to Consider Magda Clark 22/05/2025 Page 25 of 180
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Strategic Planning Group 5. Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1 Design and Development Strategic Plan 2025/2035 Update – Gill Main, Integration Manager The integration Manager gave a short verbal update on the progress of the Strategic Plan through the governance route of Partners. The Chair opened to the Group for any comments and questions. Chair requested an update on the feedback from Partners The Integration Manager noted that NHS Lothian Strategic CMT NHS Lothian will review the plan on 25the March 2025 and Midlothian Council CMT on 9th April 2025 before continuing through other committees and boards. The Integration Manager will provide an update on progress at the next meeting. The Integration Manager to provide an update to the SPG on the outcome of the Strategic CMT. The Integration Manager 22/05/2025 5.2 Citizen’s Panel Survey Design – Elouise Johnstone, Performance Manager The Performance Manager outlined the detailed review of the citizens panel and rationale. This includes mix of previously included questions to build the data and some expansion on the questions following feedback from SPG last year. The Performance Manager noted that this panel is a key part of the Boards community Engagement and provides supplementary and complementary questions to Health and Care Experience Survey. As a result of this report, Members are asked to; • Discuss and approve the draft questions. Page 26 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Performance Manager asked the Group to review the proposed set of questions, consider content, and note any required additions or amendments. The Group discussed the dissemination of the data and noted the 3rd sector summit as a useful mechanism. The Performance Manager noted the survey won’t be complete and been subject to the appropriate governance and publication until the autumn. The Chief Officer requested the Group review the proposed question relating to funding streams. The Group agreed to remove this question. The language within the unpaid carers section was reviewed and VOCAL agreed to support the Performance Manager with some revisions and additions. The Chair noted some of the questions are binary, and queried whether there could be provision made to capture more detail. The Performance Manager clarified that the items in question are HACE questions and were not altered for data set comparison but suggested in future years it may be helpful to add a sliding scale. Chair requested that the Officers of the HSCP consider asking Scottish Government to consider change to the HACE survey. The Performance Manager further noted that because the HACE survey is required for IJBs Performance Report in legislation it is difficult to influence change due to the impact it will then have on subsequent reporting years. The Chair asked the Integration Manager to discuss with the Scottish Government Integration office. Remove funding stream question Review of unpaid carers section Discuss HACE with Scottish Government Performance Manager Performance Manager and VOCAL Integration Manager 31/03/2025 31/03/2025 22/05/2025 Page 27 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.3 Implementation Public Engagement Statement Discussion – Gill Main, Integration Manager The Integration Manager introduced the report setting out the proposed actions and timeline to ensure the delivery of a revised Midlothian IJB Public Engagement Statement in 2025. As a result of this report, Members are asked to; • Note and agree the action required, the governance route, and the proposed publication date. The Integration Manager noted that IJB consultation and engagement must clearly demonstrate that the views of people in communities have been taken into account and central to the Boards decision making. The timeline set out for this work included 28th April 2025: Midlothian HSCP Executive Leadership Team review 19th May 2025: Midlothian HSCP the Senior Management Team review 22nd May 2025: Strategic Planning Group review It was further highlighted the current Public Engagement Statement is available for review on the website. 5.4 Reporting and Evaluation Draft Annual Performance Report - Elouise Johnstone, Performance Manager The Performance Manager introduced this report presenting a first draft of the 2024/25 Midlothian Integration Joint Board (IJB) Annual Performance Report (APR) proposed content as far as it has been available to include. Page 28 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments As a result of this report, Members are asked to: • Consider the first draft of the Midlothian IJB APR and provide feedback on areas for review or additional inclusion. • Note that Public Health Scotland (PHS) will release management data in May 2025 meaning the next draft of the Midlothian IJB APR will not be presented to this Group until 22nd May 2025. • Note that Public Health Scotland (PHS) will release validated data in July 2025 and this will not support meeting the Scottish Government deadline for publication of the APR by 31st July 2025. The Performance Manager asked the Group for any feedback. The Group requested if that the indicators could support identifying the difference from data from previous years. The Performance Manager noted that there is a paragraph at each indicator detailing this information. The Integration Manager noted the officers have introduced new way of working to ensure that and narrative can be utilised more easily directly from the Operational NHS and Midlothian Council quarterly reports. The Group highlighted on page 35, working with local communities, the other thematic group that we lead on is ‘Midlothian will be safer’, and that should be included alongside the reference that the HSCP is also thematic lead for ‘Midlothian will be healthier’. To include ‘Midlothian will be safer’ along with Midlothian will be healthier in narrative Performance Manager 22/05/2025 5.5 IJB Revised Performance Framework Discussion - Gill Main, Integration Manager Page 29 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Integration Manager provided an overview of the work that had led to a review of the Performance Framework including the Strategic Plan and Directions and highlighted the need to ensure that Group Service operational performance is captured alongside Group Service financial performance, and with population experience data. The Performance Manager noted the aggregation of reporting and the timeline for submission to SPG in September for Directions half year reporting. Review at next SPG Performance Manager 22/05/2025 5.6 Midlothian JSNA Data Review Programme of Work Update – Elouise Johnstone, Performance Manager The Performance Manager presented the report that set out the Q4 update to the Midlothian IJB Joint Strategic Needs Assessment. As a result of this report, Members are asked to review, consider and discuss: • The revised timeline for presentation in May • The move to a twice-yearly update process. The Performance Manager advised that delays in the provision of external data had resulted in the update not being complete in time for this quarter. As a result, the Integration Manager has suggested a timeline of biannual reporting in May and November going forward. The Group agreed to this new proposed timeline Biannual reporting May and September Performance Manager 22/05/2025 5.7 Corrective Actions Impact of JSNA Q3 update on Directions – Andrew Fleming, Chair Page 30 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chair asked the Heads of Service and Professional Leads for their update on how the data is changing and the impact on the operational areas following the JSNA data presented in January 2025. The chair opened to the Group for a discussion. A change in demographics profile was noted with queries as to the scope to increase equalities data into the JSNA. The Chief Officer noted the HSCP team do not have capacity to do this as there is no longer an HSCP Equality lead. The Performance Manager noted the potential to re design the JSNA and include broader data sets but this requires an understanding of where the gaps are for operational services. It was highlighted in the discussion that some joint work on the data could support 2 Directions; 2.4 and 9.3.7. The Chair and the Group agreed that this should be taken this forward as an action. To review discrete data opportunities Performance Manager & Group Service Manager 20/11/2025 5.8 Risk Register: Consideration to new & existing risks – Andrew Fleming, Chair The Chief Finance Officer informed the Group that the Audit and Risk Committee agreed to undertake a comprehensive review of the Midlothian IJB Risk Register in light of the new financial landscape. Chair requested that SPG be able to provide input on the risk register ahead of Audit and Risk review SPG to review IJB Risk Register in May SPG Chief Finance Officer 22/05/2025 5.9 Reflections & Key Messages for Midlothian IJB Sharing – Andrew Fleming, Chair Page 31 of 180
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Strategic Planning Group Report Title/Summary Decision Action Owner Date to be Completed/Comments The Chair noted that there is a good note of productivity of the work and reporting structures for operational teams. 6. Date of next meeting The next meeting of the MIJB SPG will be held on 22nd May 2025 at 14:00pm. The meeting terminated at 15:51pm. Page 32 of 180
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MIJB - Audit and Risk Committee Midlothian Integration Joint Board Thursday 12 June 2025 Item No 4.3 Meeting Date Time Venue Audit and Risk Committee Thursday, 6 March 2025 2.00pm Virtual Meeting held using MS Teams Present (IJB voting members): Val De Souza (Vice Chair) (NHS) Kirsty Macdonald (NHS Lothian) Councillor Milligan (Midlothian Council) Present (IJB non-voting members): Morag Barrow (Chief Officer) Chris King (Interim Chief Finance Officer) Present (Officers): Gill Main (Integration Manager) Duncan Stainbank (Chief Internal Auditor) Patricia Fraser (External Auditor) Roxanne King (Executive Business Manager) Antony Clark (Independent Member) In attendance: Hannah Forbes (Democratic Services Officer) Apologies: Claire Gardiner (External Auditor) Page 33 of 180
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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. The Chair formally welcomed Antony Clark as the Independent Member and introduced the new Interim Chief Finance Officer Chris King to the meeting. The Chair also thanked Councillor Milligan for Chairing the last meeting. Apologies were noted from Claire Gardiner, Audit Scotland. 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. Minute of Previous Meetings 4.1 The Minute of the Audit and Risk Committee meeting held on 5 December 2024 was submitted and approved, subject to the following amendment - Kirsty Macdonald’s membership status to be corrected from non-voting member to voting member. 4.2 The Chair noted the absence of a designated "Matters Arising" section on the Audit and Risk Committee agenda and used this opportunity to raise several points from the previous meeting Page 34 of 180
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MIJB - Audit and Risk Committee • Vice Chair Appointment: There was a discussion at the last meeting regarding the potential appointment of a Vice Chair, with Councillor Parry suggested for the role. Councillor Milligan confirmed they would follow up with Councillor Parry prior to the next meeting. • Datix Presentation: The Chair recalled an aspiration for a Datix presentation to be included on the March agenda, which had not been actioned. The Interim Chief Finance Officer agreed to schedule this for the June meeting. • Internal Audit Actions: The Chair requested an updated report on outstanding actions from Internal Audit be brought to the June meeting. 5. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.1 Chairs Update (Verbal) – Val de Souza, Chair The Chair provided an update to the Audit and Risk Committee and noted that the Committee is currently undergoing a period of transition. The Chair welcomed the new Interim Chief Finance Officer, Chris King, and the newly appointed Independent Member, Antony Clark, emphasising the value that an Independent Member brings in offering objective challenge and support. Appreciation was expressed for the dedication and engagement shown by staff across the Health and Social Care Partnership in progressing financial recovery efforts. The Chair noted that at the recent IJB meeting, there was a positive update on the proposed budget offer from Midlothian Council. The chair acknowledged while the proposed allocation Page 35 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments does not fully resolve the financial pressures facing the IJB, it demonstrates a strong commitment from Midlothian Council to supporting the IJB The Chair highlighted the recent publication from the Accounts Commission regarding the financial position of IJBs across Scotland. The report stresses the need for transformation and improved collaboration between partners and IJBs to ensure future sustainability. The Chief Officer advised that the formal report had been published earlier that day and would be circulated to Committee Members. The Committee requested that the Accounts Commission report be brought back for a more detailed discussion at the next Audit and Risk Committee meeting, with a focus on its implications in the Midlothian context. Agreed – Request Audit Scotland present at the next meeting. Chief Finance Officer June 2025 5.2 Risk Register – Interim Chief Finance Officer The Interim Chief Finance Officer provided an overview of the extract from the Risk Register paper originally presented by David King, former Chief Finance Officer, in December 2024. It was noted that the Risk Register is presented for noting at this meeting, with an acknowledgment that a full review is required following the budget setting meeting held on the 27th of March 2025. Page 36 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Interim Chief Finance Officer proposed that an updated Risk Register and revised Risk Policy be brought forward as a combined package to the June 2025 Audit and Risk Committee meeting. The Chair thanked the Interim Chief Finance Officer for the report and confirmed agreement with the recommendation to return with the updated documents in June 2025. Agreed Chief Finance Officer June 2025 5.3 Internal Audit Plan 2025/26 - Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the proposed 2025/26 Internal Audit Annual Plan for Midlothian IJB. As a result of this report, Members are asked to: • Approve the Internal Audit Annual Plan 2025/26 for the Midlothian Integration Joint Board. The Chair thanked the Chief Internal Auditor for the report and opened for questions. The Integration Manager sought clarification on item 3, Performance Management, in the appendix, asking whether this referred to performance reporting rather than governance. The Chief Internal Auditor confirmed that it pertains to performance reporting The Chair asked the Chief Officer if they were content with the plan and if there was sufficient capacity to support its delivery. The Chief Officer confirmed they were satisfied with the plan and had been involved in its initial development. They acknowledged that capacity can be a challenge due to the size of the Health Page 37 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments and Social Care Partnership (HSCP) management team and audit provision but assured that any issues would be flagged to the Audit and Risk Committee if they arise. The plan was agreed and for noting at the Midlothian IJB on 24th April 2025. Agreed – submitted to IJB for noting. Chief Internal Auditor April 2025 5.4 External Audit Plan - Audit Scotland Audit Scotland presented the 2024/25 Annual Audit Plan, outlining the planned scope and timing of the audit for Midlothian IJB’s annual accounts. The plan includes details of the audit work to be undertaken in accordance with auditing standards, the Code of Audit Practice, and associated supplementary guidance. The Chair thanked Patricia Fraser for the report and opened to any comments or questions. The Interim Chief Finance Officer confirmed agreement with the materiality levels set out in the plan. While acknowledging the tight timetable for submission of the first draft accounts, it was stated this is manageable and consistent with previous years’ timelines. The Chief Officer noted the proposed 2% increase in audit fees and requested further detail on the fee setting process. Audit Scotland responded that they are mindful of the financial pressures facing organisations and reassured Members that efforts are being made to reduce their internal costs. Recent cost reductions have contributed to the comparatively lower increase in fees this year. Agreed – Draft Annual Accounts to be submitted to the next meeting. Chief Finance Officer June 2025 Page 38 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments In response to a question from the Committee, Audit Scotland confirmed they formally request assurance from the auditors of both the Health Board and the Council annually, in line with standard accounting practices. The Integration Manager emphasised the importance of early planning and alignment between the Chief Finance Officer and Audit Scotland to ensure timelines are met. It was reiterated that meeting statutory duties, including those outlined in the Scheme of Publication as well as financial responsibilities, is essential for maintaining the Board’s integrity and compliance. 5.5 Amendment to Strategic Planning Group Terms of Reference - Gill Main, Integration Manager The Integration Manager stated that this report is presented for consideration and proposes an amended Terms of Reference for the Midlothian IJB Strategic Planning Group (SPG). As a result of this report, Members are asked to: • Review the revised Midlothian IJB Strategic Planning Group (SPG) Terms of Reference (ToR). • Note the proposed change and implications for membership and Standing Orders. • Consider approval of these Terms of Reference (ToRs) and instruct the Standards Officer to review the Standing Orders accordingly. A question was raised by the Committee asking for more information as to why it has been so difficult to recruit a voting member. Agreed Page 39 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Integration Manager explained that a range of complex factors are likely contributing to this challenge. The Chief Officer agreed with this assessment and suggested there may be potential in approaching the current Third Sector Representative to take on the role of Vice Chair. The Chair proposed a discussion on what enhanced Third Sector involvement might look like, including the possibility of arranging a development session later in the year. The Integration Manager noted that the Third Sector were scheduled to lead and IJB Development Session on 8th May 2025. 5.6 Internal Audit Report: Financial Recovery Action Reporting - Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report. The purpose of this report to detail the findings and recommendations from the recently completed Internal Audit review of Midlothian IJB Recovery Plan Reporting, completed under supervision from the Midlothian Council Chief Internal Auditor by the NHS Lothian Internal Audit team. As a result of this report, Members are asked to: • To consider the findings and recommendations from the recently completed Internal Audit review of Midlothian IJB Recovery Plan Reporting. The Chair thanked the Chief Internal Auditor for the report and opened for questioning. The Interim Chief Finance Officer emphasised the importance of accurate and timely reporting on financial recovery actions. It was noted that these actions are included within the Quarter 3 Agreed Page 40 of 180
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MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments financial paper, and this approach will continue as a core element of finance reporting going forward. The Audit and Risk Committee agreed to the findings and recommendations from the recently completed Internal Audit Review of Midlothian IJB Recovery Plan Reporting. 5.7 NHS Lothian Audit and Risk Committee Management - Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report. The purpose of this report is to Inform the Midlothian IJB Audit and Risk Committee of the NHS Lothian Internal Audit Report on Risk Management providing Moderate Assurance. As a result of this report, Members are asked to: • Note the findings of the NHS Lothian Internal Audit on Risk Management. The Chair thanked the Chief Internal Auditor for the report and opened for questions and comments. The Chair queried whether such reports are reviewed by Non Executive Directors before being submitted to the Audit and Risk Committee. The Chief Internal Auditor confirmed that the report had been presented to the NHS Lothian Audit and Risk Committee in November, and following discussion at that Committee, the reports are made publicly available via the NHS Lothian website. The Chair acknowledged the report’s insightful and impactful content and noted the importance of considering such reports carefully in the future. Page 41 of 180
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MIJB - Audit and Risk Committee 6. Private Reports No items for discussion. 7. Any Other Business The Chair invited Members to raise any additional items for noting or discussion. The Interim Chief Finance Officer acknowledged their recent appointment and shared aspirations for the Audit and Risk Committee meetings to evolve into a more impactful and meaningful forum, with a stronger focus on addressing the key risks facing the IJB. The Chief Officer reflected on the Committee’s future direction, noting that the recent additions of the Interim Chief Finance Officer and Independent Member present an opportunity to review how the Committee operates. It was proposed that a dedicated 1 hour session be scheduled during 2025 to consider potential improvements to the Committee’s structure and function. The Chair supported this proposal, highlighting it as a valuable opportunity for collective reflection and discussion. The Chair extended thanks to Kirsty Macdonald for her significant contributions over the past year and acknowledged that this meeting would be her last attendance as a Committee Member. The Chief Internal Auditor also requested permission from Kirsty Macdonald to distribute questionnaires in advance of her departure to support the review. The Chair noted that the Chief Officer and Councillor McManus meet regularly and confirmed that the key points raised at today’s meeting will be included in their discussions. Other officers may be invited to attend as appropriate. . 8. Date of Next Meeting The meeting terminated at 15:08pm. The next meeting will be held on Thursday 5th June 2025 at 14:00-16:00 via MS Teams Page 42 of 180
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Midlothian Integration Joint Board Thursday, 12th June 2025, 14:00-16:00 Reappointment of NHS Lothian Board Member to the Midlothian Integration Joint Board Executive summary The purpose of this report is to note and approve the reappointment of Val de Souza, as the Lead Voting Member of the Midlothian Integration Joint Board. Board members are asked to: • Note and approve the extension of term from 1 August 2022 to 31 March 2025 (retrospectively) of Val de Souza, as Lead Voting Member of NHS Lothian on Midlothian IJB until 31 July 2025. • to reappoint Val de Souza as the Lead Voting Member of NHS Lothian on Midlothian IJB, from 1 August 2025 (for a further 3-year term). # Item number: 5.1 Page 43 of 180
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Midlothian Integration Joint Board Report Reappointment of NHS Lothian Board Member to the Midlothian Integration Joint Board 1 Purpose 1.1 The purpose of this report is to outline that NHS Lothian Board have provided confirmation to Midlothian Integration Joint Board of the reappointment of Val de Souza as the Lead Voting Member of the Midlothian Integration Joint Board. 2 Recommendations 2.1 As a result of this report, Board members are asked to: • Note and approve the extension of term from 1 August 2022 to 31 March 2025 (retrospectively) of Val de Souza, as Lead Voting Member of NHS Lothian on Midlothian IJB until 31 July 2025. • to reappoint Val de Souza as the Lead Voting Member of NHS Lothian on Midlothian IJB, from 1 August 2025 (for a further 3-year term). 3 Background and main report 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (as amended) determines the membership of Integration Joint Boards. 3.2 Under the Act and associated Regulations, Local Authorities and Health Boards are required to jointly submit Integration Schemes for Ministerial approval. Midlothian IJB’s Integration Scheme was first formally approved by Scottish Government 2015, reviewed in 2022 and approved by Scottish Government in July 2023 . 3.3 The Integration Scheme outlines the arrangements for membership and chairing of the Midlothian IJB. 3.4 The Order provides that the term of office for members of Integration Joint Boards is not to exceed 3 years (this does not apply to the Chief Officer, Chief Finance Officer, and the Chief Social Work Officer). At the end of a term of office, the member may be reappointed for a further term of office. 3.5 At the NHS Lothian Board meeting on 16th April 2025, it was agreed that Val de Souza be re-nominated by the Board for a second three-year term, from 31 July 2025 to 1 August 2028. Page 44 of 180
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Midlothian Integration Joint Board 4 Policy Implications 4.1 The creation of Integration Joint Boards is intended to rebalance care towards community-based health and social care services. In keeping with the Christie Report on the Future Delivery of Public Services, the IJB membership will be expected to continue to develop approaches which are more effective in promoting good health, wellbeing, and recovery wherever possible. 5 Directions 5.1 There are no direct implication for Directions as a result of this report. 6 Equalities Implications 6.1 There is no direct impact on inequalities arising from this report although it is important to note that a primary objective of Midlothian IJB is to addressing health inequalities. 7 Resource Implications 7.1 There are no resource implications as a result of this report. 8 Risk 8.1 There is a risk that without a clear and robust process for appointing voting and non- voting members to the IJB, that new arrangements may not be compliant with regulations. 9 Involving people 9.1 The regulations accompanying the Public Bodies Act (2014) are clear about the importance of working with people and communities in a meaningful way. In line with these regulations, Midlothian IJB has established a Strategic Planning Group, and all board members are incited to join this Committee of the Board. 10 Background Papers 10.1 N/a AUTHOR’S NAME Democratic Service Officer DESIGNATION Democratic Services CONTACT INFO Democratic.services@midlothain.gov.uk DATE 21 May 2025 Page 45 of 180
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Midlothian Integration Joint Board Appendices: Appendix 1 Confirmation of reappointment from NHS Lothian Board Page 46 of 180
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Lothian NHS Board Corporate Governance www.nhslothian.scot Sent by Email Lisa Cumming Business Support Manager Fairfield House 8 Lothian Road Dalkeith EH22 3AA Date 29 May 2025 Our Ref IJBs/Appointments Enquiries to Chris Graham Email chris.graham@nhs.scot Dear Lisa, NON-VOTING MEMBER APPOINTMENT TO MIDLOTHIAN INTEGRATION JOINT BOARD At the Lothian NHS Board meeting held on 16 April 2025. The following re-appointment was agreed: • To extend (retrospectively) Val De Souza until 31 July 2025 and to reappoint Val De Souza as the Lead Voting Member of the Midlothian IJB, from 1 August 2025 (for a further 3-year term). Yours sincerely Chris Graham Manager – Corporate Governance Team Page 47 of 180
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Midlothian Integration Joint Board Thursday, 12th June 2025, 14:00-16:00 Chief Officer Report June 2025 Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting June 2025. Board members are asked to: • Note the content of the report. Item number: 5.3 Page 49 of 180
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Midlothian Integration Joint Board Report Chief Officer Report June 2025 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting June 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 NHS Lothian have established a Gold and Silver meeting infrastructure to address challenges with Mental Health Beds and hospital flow for the Royal Edinburgh Hospital. Overarching leadership for Mental health will be under Alison White (Director of Health and Social Care for West Lothian), with a newly appointed Site Director joining the Royal Edinburgh Hospital team in the summer. Weekly Gold meetings are in place, led by Caroline Hiscox (NHS Lothian CEO), with an initial focus on Acute mental health beds. Health and Social Care Scotland have written to the Cabinet secretary on behalf of IJB Chief Officers in relation to the financial position IJBs are facing. This letter has been sent to Board members for information. Morag Barrow, Chief Officer – morag.barrow@nhs.scot 3.2 Head of Adult Services Mental Health and Substance Use Midlothian Substance Use Services continue to maintain Medication Assisted Treatment (MAT) standards 1-5 which the service fully implemented in March 2023. Over the last year the service has been focussing on the criteria for MAT 6-10, with the final submission for 24/25 being submitted in April 2025. The HSCP are pleased to say Midlothian is in a positive position and has exceeded the set Scottish Government criteria for March 2025 (MAT 1-5 Green and MAT 6-10 Provisional Green), both through the submission of relevant evidence of process measures, and numerical measures. Midlothian has had confirmation feedback that we have been rag rated green for all Page 50 of 180
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Midlothian Integration Joint Board MAT standards 1-10. Below graph demonstrates the progress for the Alcohol and Drug Partnership area (Midlothian and East Lothian) from 2022-2025. MAT Standards Benchmarking by reporting year Year 1 2 3 4 5 6 6+10 7 8 9 10 2022 1 2 2 2 2 2023 3 3 3 3 3 2 2 2 2 2024 4 4 4 4 4 3 3 3 3 2025 4 4 4 4 4 4 4 4 4 1 = not yet met 2 = not fully met but progress being made 3 = provisionally fully met 4 = fully met As part of MAT 6 and 10 standards, Midlothian had successfully implemented a training programme to support trauma informed practice, and the expected target set by the Scottish Government of 50% of staff trained in tier 1 training by March 2025, the HSCP can confirm that Midlothian has exceeded this target with 77 % of staff trained. MAT 1 incorporates the treatment service A11 waiting time, where each individual referred for either substance use, or alcohol use is triaged and commenced on treatment if appropriate within 21 days of referral. The service continues to meet the waiting time A11 heat target. Overall, the services continue to provide direct access to timely and appropriate treatment that best meets an individual’s needs, psycho-social support and peer led support for those affected by their or other drugs and/or alcohol use. Percentage of individuals who waited less than 21 days for treatment Performance TARGET Q1 Q2 Q3 Q4 Percentage of all individuals who did not wait longer that 3 weeks (21 days) from point of referral to drug and /or alcohol triage. 90% 100% 98.11% 100% 100% Mental Health Social Work/Mental Health Officer (MHO) The Adult mental Health social work team/Mental health officer team consists of 8 Mental Health officers (MHO). Over the last year 2024/25 the HSCP continue to support further development and training in partnership with Learning and development team, where specific training was developed for the wider HSCP in Adult with Incapacity Training (AWI), thus enhancing the knowledge and understanding of the AWI process for the wider workforce. In addition, as part of our improvement work in 2024, a performance indicator target was implemented to improve the MHO uptake of Adults with Incapacity (AWI) reports in a timely manner. The service target is to ensure 80% of AWI reports were allocated to Mental Health Officers within 12 weeks Page 51 of 180
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Midlothian Integration Joint Board of receipt of the referral. On review of our data performance the service has continued to perform consecutively at 100%. Percentage of Adults with Incapacity reports allocated to MHO within 12 weeks PIs TARGET Q1 Q2 Q3 Q4 Percentage of all Adults with Incapacity reports (AWI) allocated to MHO within 12 weeks. 80% 100% 100% 100% 100% Mental Health Bed Base The Royal Edinburgh Hospital manages the acute Mental Health bed base for Midlothian HSCP. We currently commission 8 acute beds, 1 IPCU bed and 6 rehabilitation beds. Whilst Midlothian HSCP generally operates either at, or under our bed base, there are significant pressures on beds elsewhere in the system. Work is currently underway to identify where the greatest pressures lie, the reasons for these and what action needs to be put in place to improve flow, patient experience and patient safety. Gold and Siler level meetings have been established involving appropriate managers and Chief Officers. As part of this work, Midlothian HSCP are being asked to set out whether the current commissioned bed base will be sufficient for the future. Work is being undertaken internally to ensure the community model is optimal and whether the bed base needs to increase. This will involve discussions at a pan-Lothian level but particularly with East Lothian HSCP. A further area for development is the rehabilitation model currently in operation. Midlothian HSCP has a small number of patients delayed in hospital who could move to specialist mental health housing should the provision be available. Work is being undertaken to scope out the scale of this and what could be done jointly with other HSCPs. It is proposed that a full paper will be brought to the IJB to set out options and recommendations later in 2025. Learning and Development The Learning and Development team are working in partnership with Education colleagues in Midlothian Council and are finalising the placement availability for the next cohort of Foundations apprenticeships across Adult Social Care and Children and Young people. There are over 90 nominations from S5 and S6 pupils. These are encouraging figures as it demonstrates the increased number of young people who are interested in developing a career in Health and Social Care. The HSCP SVQ assessment centre will provide the input, assessments and coordinate all the placements over the academic year. Care at Home Care at home continues to be challenged by the increase in demand for care. However, there is an increased number of hours delivered per week across the HSCP internal service, the 3 commissioned providers, and the SDS option 2 providers which currently is around 9,000 hours per week. Successful recruitment to posts will enable more efficient carer caseloads, creating less pressure on the system. Page 52 of 180
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Midlothian Integration Joint Board Welfare Rights The HSCP Welfare Rights team have had MacMillan funding extended for a further 1 year which enables increased capacity in the team to manage increasing demand in referrals. Justice Service The work of the No 11 Allocation Service has now been evaluated and there is evidence of progress in meeting the following outcomes for those leaving custody after serving a short custodial sentence or a period on remand. The data analysed was gathered during 1st September 2023 and 30th June 2024. • Impact on re-offending (Recidivism) 85% did not return to custody within the reporting period. 8% did commit an offence that resulted in them being returned to custody. • Housing and accommodation 100% of individuals had accommodation on release. 39% were provided with accommodation as a result of being discussed at the allocation service; 17% were provided with temporary accommodation. • 86% (no =48) of people had a Substance Use issue. Those who required continuity of treatment leaving custody and this was supported by the Substance Use Service, who are one of the key partners within the Allocation Service. In respect of work with women involved with the justice system, the HSCP Spring Team Leader, has been instrumental in developing and maintaining the National Women in Justice Network. The goals of the network are: • to share and disseminate best practice. • to learn and connect with colleagues. • to advocate for women’s issues nationally The next meeting is due to take place on 28th May 2025, will feature Professor Jane Monkton Smith who will discuss and review her theoretical framework, the Homicide Timeline. The Homicide Timeline is based on research analysing hundreds of intimate partner homicide cases and identifying a common pattern of coercive control and stalking behaviours and is used to support professionals assess risk and predict potential threats. This research is key developing robust safety plans and, where necessary, effective risk management plans. Adult Support and Protection (ASP) Over the last quarter of 2024/2025 the ASP team deal with 216 referrals in relation to an adult suspected, or known, to be at risk of harm. Of these referrals 131 progressed to an inquiry. In 16 incidences there were concerns of immediate risk and progressed to an Initial Referral Discussion (e-IRD) with partners in Police Scotland and NHS Lothian. In 23% of cases the outcome of the ASP Inquiry was that the person was assessed as meeting the 3-point test (1. unable to safeguard their own wellbeing, property rights or other interests; 2. are at risk of harm and 3. because they are affected by disability, mental disorder, illness or physical and mental infirmity, is more vulnerable to being harmed then those not so affected). During the quarter an application was successfully made to the Sheriff Court for a Banning Order under the Page 53 of 180
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Midlothian Integration Joint Board Adult Support and Protection (Scotland) Act 2007 and ongoing monitoring and review through ASP Case Conferences provided assurance that this is effective. Adult Duty Social Work Staff within the HSCP duty team are committed to listening to service users to support service delivery. A short feedback survey was developed and came into use in early 2024. It was not possible until this month to analyse the information within the completed survey. The findings are interesting and, together with significantly low numbers of complaints, reflect that the support and intervention provided by the Duty team is positively received. Chart: Did our support maintain or improve the quality of your life? Chart: Do you feel listened to? There is an option to provide comments and 58% of people provided written feedback all of which was positive. Feedback included: • [Worker] was so nice and extremely helpful and so fast at providing the help my husband needed. Thank you so much. • I wrote not sure on the last answer, but I hope things will improve and thing will get better for the care I need. The duty person was very nice to me, and she helped very much on things that would be better for me then worst for what I was going to do. • A lovely woman who understood our needs. You could clone her! An asset to the team, thank you :) • The lady that assessed me was unable to promise me a package of care. This is why I put unsure in last question. She was very helpful, friendly and explained clearly what the next steps would be. • Service has been excellent. Worker A and Worker B went above and beyond to help me. The support I have been given has dramatically improved my quality of life. Thank you! Nick Clater, Head of Adult Services - nick.clater@midlothian.gov.uk Yes, 91% No, 9% Yes, 100% Page 54 of 180
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Midlothian Integration Joint Board 3.3 Head of Primary Care and Older People Unscheduled Care (USC) To support the USC agenda a funded programme of work is being delivered to shift the balance of care to the community by: • ensuring systems for early identification of Midlothian residents in hospital are in place • maximising capacity for supported discharge • enhancing our admission prevention agenda • ensuring systems to support downstream flow are optimised This is enabling Midlothian HSCP to support delivery of the Scottish Government targets to reduce bed occupancy and reduce delayed discharges by ensuring our residents are seen in the right place, at the right time, by the right person. Home First review A Home First review is currently underway to review the current model of care, streamline pathways, identify areas for improvement, and future-proof the Home First service within available budget. The team are working with NHS Lothian Sustainability and Value team and will produce a first Blueprint outlining areas for improvement and recommended service model in June 2025. Grace Cowan, Head of Primary Care & Older People – grace.cowan@nhs.scot 3.4 Strategic Planning, Business Support, and Intelligence Midlothian IJB Strategic Plan The draft Midlothian IJB Strategic Plan continues to progress through the governance route of both out NHS Lothian and Midlothian Council partners. The draft plan has most recently been discussed at Midlothian Council CMT, the NHS Lothian Strategic Planning and Performance Committee, and at a Midlothian Council Elected Members briefing. Planned revisions prior to Strategic Planning Group (SPG) and Midlothian IJB review include a description of the ambition for an Ageless Model of Care (particularly in relation to Justice, Disabilities and Mental Health), clearer commentary on the IJB’s statutory duty to deliver services within the available budget, and a clearer description of the annual budget setting process. The Midlothian IJB Strategic Plan is scheduled for final approval by Midlothian IJB in October 2025. Community Engagement Work continues to improve Midlothian IJB’s programme of community engagement. This includes the Officers of the HSCP supporting the Strategic Planning Group (SPG) undertake the HIS Quality Framework for Community Engagement Self-Assessment and develop an action plan. The Midlothian IJB Public Engagement Statement is also currently under review and will be presented for approval to the Board in August 2025. Page 55 of 180
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Midlothian Integration Joint Board Midlothian Citizen's Panel The 2025/26 Midlothian IJB Citizens Panel is now underway, and the information returned will be scrutinised by the Strategic Planning Group in July 2025. Some of this information generated by the Citizens Panel will be included in the Midlothian IJB Annual Performance Report (APR) for 2024/25. This local feedback will also be disseminated widely within the HSCP, utilised as part of our Joint Strategic Needs Assessment (JSNA), considered by planning officers and planning groups, and shared with our Third Sector colleagues. Improving the Quality of National Data Following a request from the Strategic Planning Group (SPG) to consider how Midlothian might be able to influence the questions within the Health and Care Experience (HACE) Survey and available data, work is underway in collaboration with Scottish Government. Officers of the HSCP have reached out to Scottish Government colleagues to investigate how the HACE survey and data analysis could be improved and support Midlothian IJB to identify more specific opportunities for improvement. This request has been well received and a plan has been agreed to collaboratively review analytics and survey questions across Autumn 2025 to consider where changes or additional data analysis could be explored. Updates will be reported to the Board as this work progresses. Gill Main, Integration Manager – gill.main3@nhs.scot 3.5 Clinical Director General Practice All practices remain open for core general medical services and are accepting new patient registrations. A wide range of Enhanced Services are also being provided by all practices, except for Minor Injuries which is only being provided by the 3 most southern practices in the county which are furthest away from an Emergency Department. The HSCP has submitted its latest Primary Care Improvement Plan (PCIP) tracker to the Scottish Government. This demonstrates full use of the resource over 2024-25 and stable workforce planning for 2025-26. However, the increasing challenge of maintaining the same level of service provision as previous years was noted, due to the NRAC share of funding not being uplifted in line with population growth and the reduced working week for Agenda for Change staff. The GP Quality Cluster continues to collaborate across 3 main projects, seeing improvements over the last year in the monitoring of Type 2 diabetes (to allow earlier intervention to prevent long-term complications), continuity of care (to deliver a wide range of evidence-based benefits including better satisfaction with care and reduced morbidity and mortality), and the assessment of frailty with subsequent Future Care Planning and polypharmacy review (to reduce the risk of avoidable hospital admission and medicines-related harm). Page 56 of 180
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Midlothian Integration Joint Board Pharmacy The Pharmacy team have returned 140% against their year-end efficiencies target for 2024-25, demonstrating their ongoing commitment and persistence at delivering best value medicines across the Partnership. In a challenging world of rising medication cost prices, stock shortages, and increasing demand for new treatments, this is once again a remarkable feat. Rebecca Green, Clinical Director – rebecca.green@nhs.scot 3.6 Chief Allied Health Professional Falls The new NHS Lothian Falls Prevention and Management Framework has launched. This framework outlines the commitments to support our population, workforce and stakeholders to reduce the risk of falls and harm from falls across the health and care system. The framework is based on the pillars of prevention, collaboration, person centred, education and knowledge and data informed to describe what this means for both the workforce and population for the next three years (2025-2028.) An implementation group will support system-wide delivery and local ownership of key priorities. Digital National funding will support a new digital Type 2 Diabetes Remission Programme is expected to support 3000 patients across Scotland from January 2026. The Accelerated National Innovation Adoption (ANIA) programme is informed by collaborative research led by Glasgow and Newcastle Universities, consisting of a 12- month digital programme, providing support from dietitians and health coaches alongside initial meal replacement and weight maintenance. Our weight management team are engaged in this work to support system readiness for January's go live. This is expected to augment the current Type 2 remission programme. Claire Ross, Chief AHP – claire.ross4@nhs.scot 3.7 Chief Nurse Health Visiting Working in partnership with Speech and Language Therapists, the Midlothian Health Visiting Service is delivering an additional ante natal session for all expectant families which will take place in the last 3 months of pregnancy. This is a follow on from the existing 3 classes delivered by midwives. This is an approach that has been developed in Midlothian as a response to the evidence that many parents need help to understand how to communicate and play with their babies. The sessions aim to support parents to communicate effectively with their newborns; this promotes cognitive and social development, the acquisition of language skills and supports the development of relationships and attachment between parents and their babies. Since the Covid 19 pandemic, the numbers of children with additional support needs have increased significantly, and this approach is an example of local innovation to contribute to the prevention and self-management agenda. The sessions are delivered Page 57 of 180
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Midlothian Integration Joint Board by Nursery Nurses who are part of the existing Health Visiting Service, and Speech and Language Therapists. Feedback and evaluation is underway. Initial responses from parents have been positive. Fiona Stratton, Chief Nurse – fiona.stratton@nhs.scot 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. 5 Directions 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 Page 58 of 180
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Midlothian Integration Joint Board AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE June 2025 Page 59 of 180
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Midlothian Audit and Risk Committee Thursday, 5th June 2025 14:00-16:00 2024/25 Draft Unaudited Annual Accounts Executive summary This report presents the Midlothian Integration Joint Board (IJB) draft unaudited accounts in line with the statutory duty to publish a set of Annual Accounts every financial year. Integration Authorities are governed by the same statutory regulations that govern local authorities. The process to prepare a set of annual accounts is done in three stages. • A draft set of unaudited annual accounts must be published before the end of June. • These draft accounts will then be audited by the IJB’s appointed auditors. • The final audited annual accounts must be published by the end of September. The management commentary is largely shared with the Annual Performance report which is also currently in draft form. Amendments and additions to this information will be updated as they become available. Additionally, Midlothian IJB must ensure that the published document meet the requirement of Midlothian IJB Scheme of Publication. Members are asked to: • Consider the attached draft annual accounts, noting that some performance detail in the management commentary is incomplete, and • Approve this draft and give delegated the authority to Morag Barrow in her capacity as Chief Officer to publish a set of unaudited annual accounts for 2024/25 on the Midlothian Heath and Social Care Website by 30th June 2025. Item number: 5.6 Page 61 of 180
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Midlothian Integration Joint Board Report 2024/25 Draft Unauditied Annual Accounts 1 Purpose 1.1 This report presents the Midlothian Integration Joint Board (IJB) draft unaudited accounts in line with the statutory duty to publish a set of Annual Accounts every financial year. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Consider the attached draft annual accounts, noting that some performance detail in the management commentary is incomplete, and • Approve this draft and give delegated the authority to Morag Barrow in her capacity as Chief Officer to publish a set of unaudited annual accounts for 2024/25 on the Midlothian Heath and Social Care Website by 30th June 2025. 3 Background and main report 3.1 Midlothian IJB is corporate body as defined under s106 of the local government (Scotland) act 1973. This Act requires Midlothian IJB to produce a set on Annual Accounts at the end of each financial year. 3.2 In practice there are three steps • To prepare a set of unaudited accounts approved for publication by Midlothian IJB on the Midlothian Health and Social Care website before 30th June 2025. • Present these accounts to Midlothian IJB’s appointed Auditors (Audit Scotland) who undertake an audit. • Prepare a final set of accounts reflecting the appointed auditors’ comments and including their own formal view on the accounts. This will be presented to the IJB’s Audit and Risk Committee on 4th September 2025 prior to presentation for approval at the Midlothian IJB Special Board meeting on 18th September 2025. The audited and approved set of annual accounts will then be published on the Midlothian Health and Social Care website as soon as practicably possible. 3.3 There are five sections to the annual accounts: 1 A description of what the IJB is and how it operates. 2 A management commentary in two sections a) A reflection of the financial performance of the IJB and a consideration of the financial challenges in the next financial year Page 62 of 180
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Midlothian Integration Joint Board b) A reflection of the work the IJB has undertaken during the year to deliver the ambitions of the strategic plan. 3 A section to provide assurance on governance including the Annual Governance Statement (AGS) prepared by the IJB’s Chief Internal Auditor. This AGS will be brought to Midlothian IJB’s Audit and Risk committee on 5th June 2025. 4 A report from the appointed auditors. This will not be available until after the appointed auditors have completed their audit. 5 The annual account details. 3.4 The section reflecting the work Midlothian IJB across 2024/25 remains incomplete at this time. The information required to complete this is provided by the Midlothian IJB Annual Performance Report (APR). Due to the timing of the release of Public Health Scotland (PHS) validated data, this cannot be completed until July 2025. Following Midlothian IJB approving the publication of the APR, this information will be added to the Annual Accounts. 3.5 In addition, Midlothian IJB has a statutory duty to adhere to the Model Scheme of Publication and must ensure that all content meets the accessibility requirements of this scheme. 3.6 The Midlothian IJB Audit and Risk Committee reviewed this set of draft Annual Accounts on 5th June and a verbal update will be provided on revisions and additions required ahead of the Midlothian IJB Special Board meeting on 18th September 2025. 4 Policy Implications 4.1 There are no new policy implications as a result of this report. 5 Directions 5.1 There are no direct implications for Directions as a result of this report. 6 Equalities Implications 6.1 There are no equalities implications arising from this paper. 7 Resource Implications 7.1 There are no direct resource implications for the IJB arising from this report. 8 Risk 8.1 The risk of inadequate financial resources being available to the IJB is included in the IJB’s risk register. Page 63 of 180
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Midlothian Integration Joint Board 9 Involving people 9.1 The IJB holds its meetings in public and makes its papers publicly available. 10 Background Papers 10.1 There are no background papers for this report. AUTHOR’S NAME Chris King DESIGNATION Chief Finance Officer CONTACT INFO Chris.King@nhs.scot DATE 26/05/2025 Appendices: Appendix 1: Draft Unaudited Annual Accounts 2024/25 Page 64 of 180
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1 Midlothian Integration Joint Board (IJB) Unaudited Annual Accounts 2024/25 The Annual Accounts of Midlothian Integration Joint Board for the period from 1 April 2024 to 31 March 2025, prepared pursuant to Section 105 of the Local Government (Scotland) Act 1973 and in accordance with the terms of the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2024/25. Page 65 of 180
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2 Contents Audit Arrangements ................................................................................. 3 Management Commentary....................................................................... 4 IJB Financial Performance in 2024/25 ..................................................... 11 Statement of Responsibilities ................................................................. 19 Remuneration Report ............................................................................. 21 Annual Governance Statement 2024/25 ................................................. 24 Independent Auditor’s Report ................................................................ 25 Comprehensive Income and Expenditure Statement ............................... 26 Movement in Reserves Statement .......................................................... 27 Balance Sheet ....................................................................................... 28 Notes to the Financial Statements .......................................................... 29 Page 66 of 180
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3 Audit Arrangements Under arrangements approved by the Accounts Commission of Local Authority Accounts in Scotland, the auditor with responsibility for the audit of the accounts of Midlothian Integration Joint Board for the period 1 April 2024 to 31 March 2025 is Audit Scotland, 102 West Port, Edinburgh EH3 9DN. Page 67 of 180
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4 Management Commentary The role and responsibilities of the IJB The IJB is an Integration Authority set up under the Public Bodies (Joint Working) (Scotland) Act (2014). The IJB plans for the delivery of functions that have been delegated to it by Midlothian Council and NHS Lothian. These are: • Adult Social Care • Primary Care (GP Practices, Community Dentists, Community Pharmacies and Community Opticians) • Mental Health • Physical and Learning Disabilities • Community Health • Community Hospital • Unscheduled Care (generally delivered from the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital). The IJB assumed formal responsibility for these functions in April 2016 including the budgets to deliver them. Midlothian IJB approved its third Strategic Plan for 2022-2025 in April 2022. In August 2023, work began to develop the draft Strategic Plan for 2025-2035. This new Strategic Plan is currently being reviewed by the relevant Committees and Boards of both our NHS Lothian and Midlothian Council Partners. The scheduled publication date of the Midlothian IJB Strategic Plan 2025-2035 is October 2025. Page 68 of 180
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5 Membership of IJB The IJB met 8 times in 2024/25 for formal business meetings. There were also 5 IJB Development sessions and 2 additional financial briefings. The members of the IJB as of March 2025 Member Nominated/Appointed by Role Conor McManus Nominated by Midlothian Council Voting Member, Chair Val de Souza Nominated by NHS Lothian Voting Member, Vice Chair and Chair of the Audit and Risk Committee Pauline Winchester Nominated by Midlothian Council Voting Member Derek Milligan Nominated by Midlothian Council Voting Member Kelly Parry Nominated by Midlothian Council Voting Member Dr Amjad Khan Nominated by NHS Lothian Voting Member Andrew Fleming Nominated by NHS Lothian Voting Member Vacant Nominated by NHS Lothian Voting Member Morag Barrow Appointed by the IJB Chief Officer Chris King Appointed by the IJB Interim Chief Finance Officer Nick Clater Nominated by Midlothian Council Social Work Representative Fiona Stratton Nominated by NHS Lothian Nursing Representative Claire Ross Nominated by NHS Lothian AHP Representative Dr Rebecca Green Nominated by NHS Lothian Primary Care Representative Dr Wendy Metcalfe Nominated by NHS Lothian Medical Practitioner Representative Grace Chalmers Nominated by Midlothian Council Partnership Representative (MLC) Jordan Miller Nominated by NHS Lothian Partnership Representative (NHS) Magda Clark Appointed by the IJB Third Sector Representative Keith Chapman Appointed by the IJB Lived Experience Representative Vacant Volunteer Representative Vacant Carer Representative Notes David King was the IJB’s Chief Finance Officer until 5th of December 2024 when he retired. Chris King has been appointed as interim Chief Finance Officer until a permanent appointment can be made. Page 69 of 180
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6 IJB Vision and Objectives The IJB’s vision and objectives are laid out in the IJB’s Integration Scheme, and these reflect 9 national health and wellbeing outcomes which apply to integrated health and social care. These are: The IJB also contributes to the achievement of the national criminal justice outcomes. This is because the NHS Lothian and Midlothian Council agreed to delegate criminal justice social work to Midlothian IJB in the Midlothian Scheme of Integration. Page 70 of 180
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7 IJB Activities for the Year 2024/25 Strategic Plan The Public Bodies (Joint Working) (Scotland) Act 2014 places a statutory duty on the IJB to develop a Strategic Plan that directs how delegated health and social care functions will be planned and delivered. This includes how resources will be used to meet agreed priorities. Officers from Midlothian Health and Social Care Partnership (HSCP) established a dedicated project team in August 2023 to develop a Strategic Plan for 2025-2035. The approach has been guided by Scottish Government statutory guidance and has followed the required consultation and governance procedures led by the Strategic Planning Group (SPG), and involving NHS Lothian, Midlothian Council, third and independent sector partners, and the wider public. Between September and November 2023, an initial consultation gathered feedback on the 2022–2025 Strategic Plan and identified emerging priorities. This informed the development of strategic proposals, which were reviewed by the IJB during a development session in January 2024 and subsequently approved by the IJB in February 2024. A first draft of the new Strategic Plan was developed during February and March 2024 with a revised second draft produced following further IJB and Strategic Planning Group (SPG) sessions, leading to its approval in August 2024 for a statutory three- month public consultation period. During the consultation period (August–November 2024), the Strategic Planning Group conducted an Equality and Children’s Rights Impact Assessment, which informed final revisions. Feedback from consultation, the Impact Assessment, and the audit were incorporated into the draft, with final adjustments made in close consultation with both NHS Lothian and Midlothian Council. In December 2024, the IJB agreed to delay the publication of the final plan to ensure alignment with 2025/26 budget decisions and a reflection of operational transformation planning. Throughout the process, engagement with Partner organisations has been sustained through direct discussions with senior leaders, strategic leads, and representation on the Strategic Planning Group. The voices of more than 1,500 individuals, services, and organisations have contributed to the development of this plan. The Strategic Plan remains a dynamic and evolving document and is planned for publication in October 2025. Page 71 of 180
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8 Operational Performance The Annual Performance Report for 2024/25 will be published in August 2025. This will detail Midlothian’s progress and achievements in delivering against the IJB’s strategic priorities, as well as performance in relation to the Scottish Government’s national health and wellbeing outcomes and associated indicators. **Given the reporting timescales and the timing of national data releases, the current draft of the annual accounts does not yet include the updated performance information. This will be incorporated once the final performance data becomes available** Page 72 of 180
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9 Future Plans – Bold and Sustained Transformation Public sector finances are under significant pressure across Scotland. The wider economic climate and the ongoing cost of living crisis continue to create uncertainty. These financial challenges are intensified by a growing and ageing population, rising levels of frailty and long-term conditions, and increasing complexity in the care and support that people require. Workforce challenges and limited financial resources impact the ability to sustain current models of care. In response, the IJB recognises the urgent need for bold and sustained transformation. Our Strategic Plan and Medium-Term Financial Strategy will form the foundations for a new sustainable model for health and social care focusing on prevention, early intervention, and integrated, person led care. To achieve transformation on scale strong leadership, cross sector collaboration, and meaningful engagement with communities will be essential to ensure that services remain sustainable, equitable, and responsive to local needs. A Transformation Programme Board will develop and oversee these changes. They will: • Shift the focus away from specialist services toward a broader range of community-based services across health, social care, and primary care. • Invest more in early intervention, self-management, education, and primary and community care services. • Promote and embed a person-led, strengths-based approach to improve the outcomes that matter most to people and communities. • Build on the principles of the Public Bodies (Joint Working) (Scotland) Act 2014, to develop more personalised and flexible services, planned together. • Continue to support the implementation of the Social Care (Self-Directed Support) (Scotland) Act 2013, recognising individuals as experts in their own lives, with a range of assets and skills. • Develop a single point of access to help people navigate services more easily and get the right support at the right time. • Redirect resources to areas of high priority. This may mean disinvestment in some services. Workstreams that will support this transformation • Palliative Care • Bed based provision – Care Home and Community Hospitals • Home First Model of Care • Primary, Community and Social Care Page 73 of 180
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10 • Commissioning and Third sector • Community Assets • Mental Health/Dementia • Midlothian Community Front Door (Single Point of Access) Page 74 of 180
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11 IJB Financial Performance in 2024/25 For the year ending 31 March 2025 the IJB recorded a surplus of £0.149 million. The IJB incurred operational overspends in both Health and Social Care services during the 2024/25 financial year which amounted to £2.949 million and £4.883 million respectively. In line with the Integration Scheme, both Partners, NHS Lothian and Midlothian Council, provided additional year end funding allocations to fully cover these overspends. The reported surplus is a result of an increase in the level of Earmarked Reserves held by the IJB. These reserves are set aside to fund specific future commitments and priorities. Summary of the IJB’s financial position for the year ending 31 March 2025 Year-end Position Health £000’s Social Care £000’s Total £000’s Income 135,578 69,072 204,650 Income received from the partners Midlothian Council and NHS Lothian in 2024/25 Expenditure 135,018 69,483 204,501 Expenditure incurred by the partners in the delivery of the IJB’s delegated functions for 2024/25. Surplus/ (Deficit) 560 (411) 149 Analysis of Financial Position As in previous years, the main financial pressure contributing to the overspend within health services continues to be the cost of medications prescribed through GP services. These costs are exceeding the available budget due to a combination of increasing prices and growing demand. Price increases are influenced by the introduction of new medications, which are often expensive when first released. In parallel, the volume of prescriptions continues to rise, reflecting Midlothian’s growing and ageing population, and the associated need for increased medical intervention to support people’s health and wellbeing. Another contributing factor to the overspend in health services was the timing of financial recovery actions linked to service redesigns. While a number of planned financial recovery actions were implemented during the year, the full financial benefits Page 75 of 180
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12 were not realised in 2024/25 due to lead in times. The financial benefits associated with these plans are expected to materialise in full during the 2025/26 financial year. In Social Care services, the overspend was primarily driven by rising demand and increasing complexity of care needs. During 2024/25, a comprehensive review was undertaken of all commissioned care packages to ensure that individuals' needs were being met in the most appropriate and cost effective way. This review covered 585 care packages across a range of services. Despite these efforts, significant financial pressures remained, most notably within the Learning Disability service. In this area, the level and intensity of support required to ensure individuals’ safety and quality of life continued to grow, placing sustained pressure on available resources. Page 76 of 180
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13 Funding for the IJB The IJB is funded exclusively by its partners (Midlothian Council and NHS Lothian) to deliver the functions that are delegated to the IJB in the Midlothian Scheme of Integration. A significant proportion of the services that deliver this care and support are operationally managed by Midlothian HSCP. Budget offers (representing the funding) are made to the IJB by the partners before the start of each financial year. The IJB assesses these offers and bases its acceptance of these offers on the guidance from the Scottish Government which it issues as part of its own budget setting process. The IJB accepted the indicative budget offer from NHS Lothian and the formal budget offer from Midlothian Council in March 2024. NHS Lothian’s funding is for: • Health services in Midlothian (Core funding) This includes the running costs of the local hospitals, the community health services, the running costs of the Medical General Practitioners services (the local GPs) and a share of other primary care services (General Ophthalmic Services, General Dental Services and General Pharmaceutical services). • Health services for Midlothian residents, delivered and managed on a pan- Lothian basis by NHS Lothian (Hosted funding). This includes Mental Health inpatients beds at the Royal Edinburgh Hospital. • Unscheduled health services for Midlothian residents, delivered and managed by NHS Lothian’s Acute Services (Set Aside funding) This is delivered at the Royal Infirmary of Edinburgh, the West General Hospital and St. John’s Hospital at Howden. This is budget ‘set aside’ by NHS Lothian on behalf of the IJB. Midlothian Council’s funding is for: • Adult Social Care services in Midlothian Reserves During the 2023/24 financial year, the IJB fully utilised all of its general reserve. As a result, there were no reserves available to mitigate unforeseen financial pressures in 2024/25. This is a financial risk to both the IJB and its partners, as it significantly reduces the IJB’s financial resilience and ability to respond to emerging cost pressures or volatility. In response to this risk, the IJB has requested a comprehensive review of its current reserves policy. The existing policy sets out an aspiration to maintain a general reserve equivalent to 2% of annual expenditure. The Chief Finance Officer will lead this review across 2025/26, assess whether the current target remains appropriate, and consider how financial resilience can be reestablished over time. The outcomes of the review will Page 77 of 180
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14 be presented to the IJB’s Audit and Risk Committee prior to making a recommendation to the IJB. IJB spend in 2024/25. The Financial Statements are all presented on a net basis. Performance of the functions that are delegated to the IJB for 2024/25 Health Social Care Health Social Care Variance Note Budget Budget Expenditure Expenditure £000’s £000’s £000’s £000’s £000’s Direct Midlothian Services Community AHPS 3,828 0 3,772 0 56 Community Hospitals 7,146 0 7,142 0 4 District Nursing 9,002 0 9,228 0 (225) General Medical Services 19,549 0 19,726 0 (176) Health Visiting 2,784 0 2,720 0 64 Mental Health 3,215 0 3,045 0 170 Other 8,895 0 9,578 0 (683) 1 Prescribing 20,472 0 22,285 0 (1,814) Resource Transfer 6,973 0 6,941 0 31 2 Older People 0 29,412 0 31,908 (2,495) Learning Disabilities 0 21,298 0 24,456 (3,158) Mental Health 0 1,314 0 1,132 182 Physical Disabilities 0 4,232 0 4,235 (3) Assessment & Care Management 0 4,113 0 3,608 505 Social Care Other 0 3,819 0 3,734 85 3 Midlothian Share of Pan Lothian Set Aside 20,192 0 20,728 0 (535) 4 Mental Health 2,899 0 3,070 0 (170) Learning Disabilities 1,322 0 1,333 0 (11) GP Out of Hours 1,553 0 1,513 0 40 Rehabilitation 990 0 884 0 106 Sexual Health 993 0 965 0 28 Psychology 1,757 0 1,782 0 (26) Substance Misuse 573 0 531 0 42 Allied Health Professions 1,739 0 1,664 0 75 Oral Health 1,034 0 838 0 197 Hosted Other 4,033 0 4,154 0 (121) Page 78 of 180
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15 Dental 7,231 0 7,231 0 0 5 Ophthalmology 2,117 0 2,117 0 0 5 Pharmacy 4,332 0 4,332 0 0 5 Sub Totals 132,628 64,188 135,578 69,072 (7,833) Partner Additional Contributions 2,949 4,883 0 0 7,833 6 Movement in Earmarked Reserves 0 0 (560) 411 149 7 Per Annual Accounts 135,578 69,072 135,018 69,483 149 Notes 1. Other includes £4.816m for the Social Care Fund which is held in the Health Budget but expended in the Social Care services. It also includes the impact of the addition to the Earmarked reserve – see point 7. 2. Resource Transfer are funds for specific purposes which are transferred from Health to Social Care. However, these remain part of the health budget and are reported there. 3. Social Care Other includes care for non-specific groups, substance misuse services and other management and performance costs. 4. Set Aside are the budgets for those functions delegated to the IJB which are managed by the Acute Services management teams within NHS Lothian. These services are delivered at the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital and cover the following: • Accident and Emergency • Cardiology • Diabetes • Endocrinology • Gastroenterology • General Medicine • Geriatric Medicine • Rehabilitation Medicine • Respiratory Medicine • Various ancillary support services for the above 5. Dental, Ophthalmology, Pharmacy - in the health system, expenditure to support the delivery of community dentistry, community opticians and community pharmacists is termed as ‘non-cash limited’ (NCL) but is clearly part of the delivery of primary care services and these functions are delegated to the IJB. However, being NCL there is no budget as such, but any expenditure incurred is supported in its entirety by the Scottish Government. The NCL values are not part of the budget setting process, there being no budget, but NHS Lothian has matched the NCL expenditure with income to cover this expenditure. 6. Additional contributions from Partners - In line with the Integration Scheme, as the IJB does not hold general reserves, any funding shortfalls incurred during the year are met by the respective partner. In 2024/25, the IJB experienced operational pressures in both Health and Social Care services. As a result, both NHS Lothian and Midlothian Page 79 of 180
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16 Council provided additional year-end funding to address the overspends within their respective areas of responsibility. 7. Movement in Earmarked Reserves - The net movement in Earmarked Reserves during the year resulted in a £0.149 million increase in reserves for the IJB. • Within Health, reserves held by NHS Lothian increased by £0.560 million, primarily due to the receipt of Unscheduled Care funding. Although this was processed through as expenditure, it is not considered in year spend and has therefore been excluded when calculating the IJB’s net position. • Within Social Care, Earmarked Reserve balances were used as planned, resulting in a drawdown of £0.411 million, which is reflected as expenditure. The charges (shown as expenditure above) made by Midlothian Council to the IJB are the net direct costs incurred in the delivery of social care in Midlothian. The charges from NHS Lothian are based on the health budget setting model as agreed by the IJB. That is, charges for the core services (specifically for and delivered by the Midlothian partnership) are based on the net direct actual costs incurred in Midlothian. However, charges for hosted and set aside services (not managed by the Midlothian Health and Social Care Partnership and are delivered on a pan-Lothian basis) are based on the total actual costs for these services shared across four IJBs per the budget setting model. The IJB share of the total actual costs incurred in 2023/24 for hosted services is 10% and, generally, 10% of the Lothian element of the set aside budgets and the non- cash limited budgets. How the IJB spent its funds in 2024/25 Spend 2024/25 £000’s Percentage Share % Adult Social Care Services £82,408 40% Primary Care Services £55,690 28% Other Community Health Services £45,675 22% Acute Services £20,728 10% Total £204,501 100% • Adult Social Care includes funds from NHS Lothian which are used to support social care (see note 6 at the end of this report) • Primary Care includes GPs, GP prescribing, community opticians, community pharmacists and community dental services • Other Community includes local community hospitals, community nursing services, community allied health professionals and Midlothian’s share of pan- Lothian hosted services • Acute includes Midlothian Share of Acute services that have been delegated to the IJB Page 80 of 180
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17 Consideration of the 2024/25 financial position At its March 2025 meeting, the IJB approved the budget offers received from both NHS Lothian and Midlothian Council and were able to set a balanced financial plan for 2025/26. This plan is underpinned by the delivery of £5.8 million in financial recovery actions covering both Health and Social Care functions. It was also agreed that there would be continued engagement with NHS Lothian to address the outstanding financial pressures within Set Aside services. This financial recovery programme represents a significant one year plan, designed to provide a foundation of financial stability for the IJB. Given the scale and scope of the required financial recovery actions, the programme carries a degree of financial and operational risk. This includes uncertainty around full deliverability, timing, and the potential impact on service delivery. The IJB has acknowledged these risks and is committed to managing them proactively. Oversight and mitigation will be supported through established risk management frameworks within the Health and Social Care Partnership (HSCP) and through the governance role provided by the IJB’s Audit and Risk Committee & the IJB Board. Throughout 2025/26, the IJB will receive routine financial reporting which will include: • The overall financial position of the IJB, • Progress against agreed financial recovery actions, • Identification of emerging trends, risks, or cost pressures. This reporting will support the IJB in adopting a forward looking and responsive approach to financial governance and management. The objective is to enable timely decision making, ensure the IJB operates within its available resources, and allow for additional financial recovery actions or collaborative solutions with partners if required. Maintaining financial discipline while safeguarding the quality and accessibility of care services will remain a core focus throughout the financial year. Key Risks, challenges and uncertainties The main financial pressures facing the IJB remain consistent with those outlined in the 2023/24 Annual Accounts. These pressures are significant and continuing, and they reflect both national trends and specific local challenges within Midlothian: 1. Demographic Change: A Growing and Ageing Population Midlothian has the fastest growing population in Scotland. While national funding formulas for both Local Authorities and NHS Boards aim to reflect population change, these mechanisms face two key limitations: • The total funding available has increased but not at a level sufficient to fully meet the scale of the pressures identified. Page 81 of 180
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18 • Declining populations in other areas do not automatically result in proportionate reductions in service delivery costs, which limits the system's ability to redistribute resources effectively. In addition, Midlothian’s population is not only growing but also ageing. As life expectancy increases, so too does the complexity and intensity of health and social care needs. This demographic trend represents a growing and long term challenge, both locally and nationally. 2. Workforce Availability Both Health and Social Care services continue to experience workforce shortages. The availability of skilled professionals remains a key constraint on the IJB’s ability to meet rising demand and deliver its Strategic Plan. A local workforce plan has been developed in collaboration with partners to mitigate this risk as much as possible. 3. The Wider National Financial Environment The financial landscape for public services remains extremely challenging. While the Scottish Government has expressed a strong commitment to protecting Health and Social Care budgets, it has also acknowledged the broader fiscal pressures facing all public services. National taxation and policy decisions, such as increases in employer National Insurance contributions, are likely to have an impact on service providers. These pressures may: • increase the cost of commissioned services, • threaten the financial sustainability of providers. The IJB does not have dedicated funding to offset these pressures. However, it remains actively engaged with providers and partners to manage the implications and support continuity of service delivery wherever possible. Conor McManus IJB Chair. Morag Barrow, Chief Officer. Chris King, Interim Chief Finance Officer. Page 82 of 180
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19 Statement of Responsibilities Responsibilities of the IJB The IJB is required to: • Make arrangements for the proper administration of its financial affairs and to secure that the proper officer of the board has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this authority, that officer is the chief finance officer. • Manage its affairs to secure economic, efficient, and effective use of resources and safeguard its assets. • Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). • Approve the Annual Accounts. I confirm that these Annual Accounts were approved for signature at a meeting of the Audit & Risk Committee. Signed on behalf of Midlothian Integration Joint Board. Conor McManus, IJB Chair. Page 83 of 180
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20 Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the IJB’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (the Accounting Code). In preparing the Annual Accounts, the Chief Finance Officer has: • Selected suitable accounting policies and then applied them consistently. • Made judgements and estimates that were reasonable and prudent. • Complied with legislation. • Complied with the local authority Code (in so far as it is compatible with legislation). The chief finance officer has also: • Kept proper accounting records which were up to date. • Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that the financial statements give a true and fair view of the financial position of the Midlothian Integration Joint Board as at 31 March 2025 and the transactions for the year then ended. Chris King, Interim Chief Finance Officer Page 84 of 180
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21 Remuneration Report Introduction This Remuneration Report is provided in accordance with the Local Authority Accounts (Scotland) Regulations 2014. It discloses information relating to the remuneration and pension benefits of specified IJB members and staff. The information in the tables is subject to external audit. The other sections of this report will be reviewed by Audit Scotland and any apparent material inconsistencies with the audited financial statements will be considered as part of their audit report. Remuneration: IJB Chair and Vice Chair The voting members of the IJB are appointed through nomination by Midlothian Council and NHS Lothian Board. Nomination of the IJB Chair and Vice Chair post holders alternates between a Councillor and a Health Board representative. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting board member costs borne by the partner. Neither the Chair nor the Vice Chair appointments had any taxable expenses paid by the IJB in 2024/25 (Previous Year: nil). The Chair of the IJB in 2024/25 was Councillor Connor McManus (who is an elected member of Midlothian Council), the Vice Chair was Val de Souza who is a non-executive member of the NHS Lothian Board. The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or Vice Chair. NHS Lothian no longer automatically offers another full day’s remuneration for being the Board’s Lead Voting Member on an IJB. Instead, non-executive remuneration is based on an individual’s overall estimated time commitment, which can include multiple memberships of Board committees and IJBs as well as other responsibilities, not just as committee chairs or lead voting members of the IJBs. No specific remuneration is therefore available for the vice chair of the IJB in 2024/25 (Previous Year: nil). Page 85 of 180
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22 Remuneration: Officers of the IJB The IJB does not directly employ any staff; however specific post-holding officers are non-voting members of the Board. Chief Officer Under section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 a Chief Officer for the IJB has to be appointed and the employing partner has to formally second the officer to the IJB. The employment contract for the Chief Officer will adhere to the legislative and regulatory framework of the employing partner organisation. The remuneration terms of the Chief Officer’s employment are approved by the IJB. The Chief Officer of the IJB is Morag Barrow, who is also the Director of Health and Social Care for Midlothian Council and the Joint Director of the Midlothian Partnership. It has been agreed that 50% of her total remuneration is to be shown in the accounts of the IJB as her remuneration as the Chief Officer of the IJB. Chief Finance Officer Although the costs of the Chief Finance Officer are not included in the charges made to the IJB by either partner, given the S95 role of the Chief Finance Officer and in the interests of transparency, the remuneration of the Chief Finance Officer is included. David King was Chief Finance Officer until the 5th December 2024 and was employed by NHS Lothian and had two roles – Midlothian IJB’s Chief Finance Officer, the Chief Finance Officer of East Lothian IJB. On that basis, 50% of the total remuneration for David King between 1st April 2024 and 6th December 2024 is shown below. From the 19th of December 2024 until 31st March 2025, Chris King was appointed as Chief Finance Officer on an interim basis. He is employed by NHS Lothian. His role is that of Chief Finance Officer with Midlothian IJB and an operational role in the NHS Lothian finance team as a Finance Business Partner. Therefore, 50% of the total remuneration during this period is shown below. Other Officers No other staff are appointed by the IJB under a similar legal regime. Other non-voting board members who meet the criteria for disclosure are included in the disclosures. Senior Employees: Salary, Fees & Allowances: Name 2023/24 £ 2024/25 £ Morag Barrow (Note 1) £55,822 £59,048 Claire Flanagan £15,038 - David King (Note 2) £10,272 £23,522 Chris King - £11,832 Page 86 of 180
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23 Note 1: Morag Barrow became an active member of the SPPA in 2024/25. Note 2: David King is no longer an active member of the SPPA. The IJB has responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the IJB. The IJB’s funding during to support officers’ pension benefits. Name For year to 2024 £ For Year to 2025 £ Claire Flanagan £3,077 - Morag Barrow £0 £12,241 Chris King - £1,456 Total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions Name Pension (as at 31 March 2024) £000’s Lump Sum (as at 31 March 2024) £000’s Pension (as at 31 March 2025) £000’s Lump Sum (as at 31 March 2025) £000’s Morag Barrow £0 £0 £30 £82 Claire Flanagan £22 £55 - - Chris King - - £9 £0 Disclosure by Pay Bands Pay band information is not separately provided as all staff pay information has been disclosed in the information above. Exit Packages The IJB did not support nor did it direct to be supported by its partners, any exit packages during 2024/25 (2023/24: nil). Conor McManus, IJB Chair. Morag Barrow, Chief Officer. Page 87 of 180
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24 Annual Governance Statement 2024/25 ***The annual governance statement will be included in the accounts following the review by the Audit & Risk Committee in June 2025*** Conor McManus, Chair Morag Barrow, Chief Officer Page 88 of 180
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25 Independent Auditor’s Report Independent auditor’s report to the members of Midlothian Integration Joint Board and the Accounts Commission ***This will be provided after the independent auditors have completed their audit.*** Page 89 of 180
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26 Comprehensive Income and Expenditure Statement This statement shows the cost of providing services for the year according to accepted accounting practices. Where the impact on the General Fund is amended by statutory adjustments, this is shown in both the Expenditure and Funding Analysis and the Movement in Reserves Statement. IJB Comprehensive Income and Expenditure Statement Income/Expenditure 2023/24 2024/25 Net Expenditure Net Expenditure £000’s £000’s Health Care Services - NHS Lothian £132,906 £135,018 Social Care Services - Midlothian Council £66,036 £69,483 Cost of Services £198,942 £204,501 Taxation and Non-Specific Grant Income (£186,584) (£204,650) Surplus/(deficit) on Provision of Services (£12,358) £149 The Integration scheme lays out that the partners will provide corporate and other support to the IJB as required and will not charge for these services. These costs are not, therefore, included. Page 90 of 180
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27 Movement in Reserves Statement The movement in reserves statement shows the value of the IJBs reserve and how this has reduced during 2024/25. Movements in Reserves during 2024/25 IJB Reserves Earmarked Reserves £000's General Reserves £000's Total Reserves £000's Opening Balance - 31/3/2024 £799 £0 £799 Drawdown of Reserve in year (£792) £0 (£792) Additions to Reserve in year £941 £0 £941 Closing Balance - 31/3/2025 £948 £0 £948 Movements in Reserves during 2023/24 IJB Reserves Earmarked Reserves £000's General Reserves £000's Total Reserves £000's Opening Balance - 31/3/2023 £6,975 £6,182 £13,157 Drawdown of Reserve in year (£6,176) (£6,182) (£12,358) Additions to Reserve in year £0 £0 £0 Closing Balance - 31/3/2024 £799 £0 £799 Page 91 of 180
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28 Balance Sheet The Balance Sheet shows the value of the IJB’s assets and liabilities as at the balance sheet date. The net assets (assets less liabilities) of the IJB are matched by the reserves held by the IJB. IJB Balance Sheet – Current Assets Net Current Assets 31 March 2024 £000’s 31 March 2025 £000’s Notes Debtors £799 £948 7 Creditors: amounts falling due within one year £0 £0 Total assets less current liabilities £799 £948 IJB Balance Sheet – Capital and Reserves Net Liabilities 31 March 2024 £000’s 31 March 2025 £000’s Notes Earmarked Reserve £799 £948 1 General Reserve £0 £0 1 Total Reserves £799 £948 See note 7 at end of report See note 1 at end of report - IJB usable reserves Chris King, Interim Chief Finance Officer. Page 92 of 180
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29 Notes to the Financial Statements 1 Significant Accounting Policies General Principles The Financial Statements summarise the IJB’s transactions for the 2024/25 financial year and its position at the year-end of 31 March 2025. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. The Financial Statements are prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2024/25, supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. Basis of Preparation The IJB financial statements for 2024/25 have been prepared on a going concern basis. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. In accordance with the CIPFA Code of Local Government Accounting (2024/25), the IJB is required to prepare its financial statements on a going concern basis unless informed by the relevant national body of the intention for dissolution without transfer of services or function to another entity. The accounts are prepared on the assumption that the IJB will continue in operational existence for the foreseeable future. The IJB’s funding from and commissioning of services to partners has been confirmed for 2024/25, and a medium-term financial plan has been prepared through to 2028. Given that the IJB is wholly funded by the partners and the IJB’s Integration Scheme commits the partners to funding any overspend within the IJB I consider that there are no material uncertainties around its going concern status. Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: • Expenditure is recognised when goods or services are received, and their benefits are used by the IJB • Income is recognised when the IJB has a right to the income, for instance by meeting any terms and conditions required to earn the income, and receipt of the income is probable Page 93 of 180
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30 • Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet • Where debts may not be received, the balance of debtors is written down Funding The IJB is wholly funded through funding contributions from the statutory funding partners, Midlothian Council and NHS Lothian. Expenditure is incurred in the form of net charges by the partners to the IJB. Cash and Cash Equivalents The IJB does not operate a bank account or hold cash. Transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. Debtors and Creditors The funding balance due to or from each funding partner as at 31st of March is represented as a debtor or creditor on the IJB’s Balance Sheet. Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet. Employee Benefits The IJB does not directly employ staff. Staff are formally employed by the partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its Balance Sheet. The IJB has a legal responsibility to appoint a Chief Officer. More details on the arrangements are provided in the Remuneration Report. Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation as at 31st of March due to a past event; settlement of the obligation is probable; and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the Comprehensive Income and Expenditure Statement and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31st of March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s Balance Sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31st of March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s Balance Sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. The IJB has none of the above. Page 94 of 180
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31 Reserves The IJB’s reserves are classified as either Usable or Unusable Reserves. The IJB’s only Usable Reserve is the General Fund. The balance of the General Fund as at 31 March shows the extent of resources which the IJB can use in later years to support service provision. As noted above, the IJB has reserves of £948,000 on 31 March 2025. IJB useable reserve Reserves 2024/25 Closing Balance £000’s Embedding a gender informed effective response to domestic abuse Project £7 Unscheduled Care £941 General Reserves £0 Total £948 Indemnity Insurance The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board member and officer responsibilities. NHS Lothian and Midlothian Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. The IJB holds separate indemnity insurance through its membership of the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) scheme, the charge for this in 2024/25 was £3,000 (PY £3,000). Unlike NHS Boards, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS. The IJB participation in the CNORIS scheme is therefore analogous to normal insurance arrangements. Known claims are assessed as to the value and probability of settlement. Where it is material the overall expected value of known claims taking probability of settlement into consideration is provided for in the IJB’s Balance Sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and, where material, presented as either a debtor or disclosed as a contingent asset. There are no outstanding claims or any indications that any claims are to be made against the IJB. Page 95 of 180
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32 2 Critical Judgements and Estimation Uncertainty The critical judgements made in the Financial Statements relating to complex transactions are: • The partner organisations have considered their exposure to possible losses and made adequate provision where it is probable that an outflow of resources will be required, and the amount of the obligation can be measured reliably. Where it has not been possible to measure the obligation, or it is not probable in the partner organisations’ options that a transfer of economic benefits will be required, material contingent liabilities have been disclosed (there are none). • The Annual Accounts contains estimated figures that are based on assumptions made by the IJB about the future or that are otherwise uncertain. Estimates are made taking into account historical experience, current trends and other relevant factors. However, because balances cannot be determined with certainty, actual results could be materially different from the assumptions and estimates. • There are no items in the IJB’s Balance Sheet at 31 March 2025 for which there is a significant risk of material adjustment in the forthcoming financial year. Provisions The IJB has not created any provisions in respect of compensation claims. It is not certain that all claims have been identified or that the historic level of settlement payments is a reliable guide for future settlements. 3 Subsequent Events In accordance with the requirements of International Accounting Standards 10, events after the reporting period are considered up to the date on which the accounts are authorised for issue. This is interpreted as the date that the accounts were certified by the Chief Financial Officer following approval by the Audit and Risk Committee. Events after the Balance Sheet date are those events, both favourable and unfavourable, that occur between the end of the reporting period and the date when the Annual Accounts are authorised for issue. Two types of events can be identified. • Adjusting events: Those that provide evidence of conditions that existed at the end of the reporting period. The Annual Accounts is adjusted to reflect such events. • Non-adjusting events: Those that are indicative of conditions that arose after the reporting period and the Statements are not adjusted to reflect such events. Where a category of events would have a material effect, disclosure is made in the notes of the nature of the events and their estimated financial effect. Page 96 of 180
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33 4 Expenditure and Funding Analysis Income and Expenditure 2024/25 Services specifically for Midlothian 2023/24 2024/25 £000’s £000’s Health £79,694 £83,878 Social Care £66,036 £69,483 Midlothian’s share of Lothian Health Services (Hosted) £28,884 £30,412 Midlothian’s share of Lothian Health Services (Set Aside) £24,328 £20,728 Total £198,942 £204,501 Funded by: Midlothian Council £57,416 £69,072 Funded by: NHS Lothian £129,168 £135,578 Total Funding £186,584 £204,650 Surplus/(Deficit) (£12,358) £149 Expenditure above has been split into three main areas: • Services delivered specifically for the population of Midlothian. These services are managed locally by the Midlothian Partnership – shown under Health and Social Care. • Hosted Services – these are health services managed either by the Edinburgh, East Lothian and West Lothian Partnerships or managed by NHS Lothian on a pan-Lothian basis. These services included Mental Health Services, Learning Disability Services, Substance Misuse Services, Rehabilitation services, General Dental Services, General Pharmaceutical Services and General Ophthalmic Services. This is the IJB’s agreed share of these services. • Set Aside Services – these are services delivered in the main acute hospitals (Royal Infirmary of Edinburgh, Western General Hospital and St. John’s Hospital) and managed by NHS Lothian. This is the IJB’s agreed share of these services. 5 Corporate Service Included in the above costs are the following corporate services IJB Corporate Costs 2023/24 £000’s 2024/25 £000’s Staff (Chief Officer) £56 £59 CNORIS £3 £3 Audit Fee £33 £34 Total £92 £96 As noted above, the Chief Finance Officer is not charged to the IJB. Page 97 of 180
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34 6 Related Party Transactions As partners with the IJB, both Midlothian Council and NHS Lothian are related parties and the material transactions with these bodies are disclosed in these accounts. There are elements of expenditure which are shown against the NHS Lothian above but where the resources are used by the Social Care services delivered by Midlothian Council. Transfers of resources between Health and Social Care services Funding Partner/ Resources transferred 2023/24 2024/25 £000’s £000’s NHS Lothian £132,906 £135,018 Resource Transfer (£6,928) (£6,941) Social Care Fund (£4,816) (£4,816) Other Resources transferred (£389) (£1,168) Net NHS Lothian Expenditure £120,773 £122,093 Midlothian Council £66,036 £69,483 Resource Transfer £6,928 £6,941 Social Care Fund £4,816 £4,816 Other Resources Transferred £389 £1,168 Gross Social Care Expenditure £78,169 £82,408 Both Resource Transfer and the Social Care Fund are resources which are part of the NHS Lothian budget, but these funds are used to deliver Social Care service supplied by Midlothian Council. As is noted above, the IJB is not charged for the costs of its Chief Finance Officer, nor any fees paid to its Vice Chair. The costs of the IJB’s Chief Officer are disclosed in the remuneration report and included in the charges to the IJB in section 4 above. Section 4 above shows the contributions received from each of the IJB’s funding partners and the commissioning expenditure provided to each partner. Section 5 above shows the corporate costs incurred by the IJB, these are funded by the partners and included in the expenditure analysis above. Page 98 of 180
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35 7 Short Term Debtors Owed to the IJB at 31 March 2025 2023/24 £000’s 2024/25 £000’s Funding due from NHS Lothian £381 £941 Funding due from Midlothian Council £418 £7 Total £799 £948 8 VAT The IJB is not VAT registered. The VAT treatment of expenditure in the IJB’s accounts depends on which of the Partner agencies is providing the service as these agencies are treated differently for VAT purposes. Where the Council is the provider, income and expenditure excluded any amounts related to VAT, as all VAT collected is payable to H.M. Revenue & Customs and all VAT paid is recoverable from it. The Council is not entitled to fully recover VAT paid on a very limited number of items of expenditure and for these items the cost of VAT paid is included within service expenditure to the extent that it is irrecoverable from H.M. Revenue and Customs. Where the NHS is the provider, expenditure incurred will include irrecoverable VAT as generally the NHS cannot recover VAT paid as input tax and will seek to recover its full cost as income from the Commissioning IJB. Page 99 of 180
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Midlothian Integration Joint Board Thursday, 12th June 2025, 14:00-16:00 Midlothian IJB Finance Update Executive summary This report outlines the approach to the development of the Medium-Term Financial Strategy (MTFS) for the Midlothian Integration Joint Board (IJB). The Medium-Term Financial Strategy (MTFS) provides the 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-led care. The MTFS is aligned with Midlothian IJB’s strategic priorities and underpins the delivery of the Strategic Plan via Directions. Following the 2025/26 budget setting process, the MTFS must now be 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 to deliver Midlothian IJB’s Strategic Plan 2025-2035 currently scheduled for publication in October 2025. The MTFS is now under development and will be reviewed by the Midlothian IJB Strategic Planning Group (SPG) on 24th July 2025. Subject to any revisions, it is anticipated that the SPG will recommend the MTFS to the Board for review in the 21st August 2025 Midlothian IJB meeting. Members are asked to: • Note the requirement to review the Midlothian IJB Medium Term Financial Strategy (MTFS), • Note the areas of financial resilience, budget setting, strategic alignment, and Directions as the key mechanisms for executing good financial governance, and • Review the planned activity outlined in the report, provide feedback, and agree to progressing this work. Item number: 5.8 Page 101 of 180
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Midlothian Integration Joint Board Report Midlothian IJB Finance Update 1 Purpose 1.1 This report outlines the approach to the development of the Medium-Term Financial Strategy (MTFS) for the Midlothian Integration Joint Board (IJB). 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the requirement to review the Midlothian IJB Medium Term Financial Strategy (MTFS), • Note the areas of financial resilience, budget setting, strategic alignment, and Directions as the key mechanisms for executing good financial governance, and • Review the planned activity outlined in the report, provide feedback, and agree to progressing this work. 3 Background and main report 3.1 Background The Medium-Term Financial Strategy (MTFS) provides the 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-led care. The MTFS is aligned with Midlothian IJB’s strategic priorities and underpins the delivery of the Strategic Plan via Directions. 3.2 It is essential that the MTFS reflects the complex and evolving financial landscape, including demographic change, rising demand for services, inflationary pressures, and workforce constraints. It should emphasise the importance of early planning, transformation, and collaborative working across partners to support innovation and deliver sustainable services. 3.3 Following the 2025/26 budget setting process, the MTFS must now be 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 to deliver Midlothian IJB’s Strategic Plan 2025-2035 currently scheduled for publication in October 2025. Page 102 of 180
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Midlothian Integration Joint Board 3.4 Additionally, this review will also enhance transparency and enable more meaningful engagement with stakeholders around the financial realities and strategic choices facing Midlothian IJB. 3.5 Financial Resilience A key element of the MTFS will be Midlothian IJB’s approach to financial resilience. This encompasses the ability to manage and respond to unforeseen financial pressures, cost volatility, and emerging service demands. 3.6 The MTFS will include Midlothian IJB’s approach to the development and management of reserves. A draft policy has been reviewed by the Audit and Risk Committee and is scheduled for recommendation to the Board at the 21st August 2025 meeting. Reserves will not be viewed solely as a contingency measure but as a strategic enabler to support service transformation, manage demand, and where possible invest in preventative approaches that contribute to long term sustainability. 3.7 Strategic Planning The MTFS will be embedded in the delivery of Midlothian IJB’s draft Strategic Plan 2025–2035. This plan sets out the vision, principles, and long-term priorities for integrated care in Midlothian. The MTFS will act as the financial roadmap to support implementation of the strategy, aligning investment with desired outcomes. 3.8 Key areas of alignment between the MTFS and Strategic Plan include: • Strategic shifts towards prevention and early intervention. • Investment in community based and digitally enabled care. • Redesign of unscheduled care pathways. • Supporting and sustaining the health and care workforce. 3.9 Like the strategic plan, the MTFS will also be closely informed by operational service plans developed by health and social care teams. These plans set out the delivery priorities and resource requirements at a service level and will provide the operational foundation for medium term financial planning. Operational leads will be asked to identify: • Current and projected service pressures • Opportunities for efficiency and redesign • Workforce and infrastructure implications • Key risks and enablers 3.10 This approach will ensure that the MTFS is aligned to operational realities while promoting consistency and coordination across planning processes. 3.11 Governance It is proposed this work will be led by the Chief Finance Officer and the Integration Manager for the Boards review in the 21st August 2025 Board meeting. 3.12 Input to the development of the strategy will be sought from: • IJB members • Partners (NHS Lothian and Midlothian Council) • Heads of Service across operational Health and Social Care teams Page 103 of 180
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Midlothian Integration Joint Board 3.13 Governance of the MTFS development process is the role of Midlothian IJB. Progress updates will be provided to the Strategic Planning Group and any other relevant sub committees as required. 3.14 The MTFS is now under development and will be reviewed by the Midlothian IJB Strategic Planning Group (SPG) on 24th July 2025. Subject to any revisions, it is anticipated that the SPG will recommend the MTFS to the Board for review in the 21st August 2025 Midlothian IJB meeting. 4 Policy Implications 4.1 There are no direct policy implications as a result of this paper. 4.2 However, Midlothian IJB can only allocate the resources made available to it by NHS Lothian and Midlothian Council. This has the potential to limit both Midlothian IJB and Midlothian HSCP’s ability to deliver on national policy that is not funded through either ringfenced or additional resource. 5 Directions 5.1 The content of this report does not have any direct impact on existing Directions at this time. 5.2 However, as Directions are the mechanism for delivering the Midlothian IJB draft Strategic Plan 2025-2035, there are significant opportunities to deliver the ambitions of the MTFS through Directions. 5.3 It is likely that the revision of the MTFS will result in the Board amending or revising Directions in the future to take corrective action or to accelerate progress towards the Board’s strategic aims. 6 Equalities Implications 6.1 An Equalities and Children’s Rights Impact Assessment (ECRIA) Screening Tool has been submitted with this paper. 6.2 This report does not have any direct impact on equalities, but highlights that decisions required as a consequence of this paper may require the completion of an ECRIA as part of early operational planning. 7 Resource Implications 7.1 There are no financial implications as a result of this report. Page 104 of 180
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Midlothian Integration Joint Board 8 Risk 8.1 There is a risk that, without developing a meaningful Medium-Term Financial Strategy, Midlothian IJB is vulnerable to additional financial challenge. 8.2 There is also a risk that, without agreeing a Medium-Term Financial Strategy aligned to strategic ambitions, Midlothian IJB Directions for 2025/26 will be unrealistic and significantly underestimate the resources required for safe and effective delivery. 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 Gill Main, Integration Manager CONTACT INFO Chris.King@nhs.scot Gill.Main@nhs.scot DATE 26/05/2025 Page 105 of 180
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Midlothian Integration Joint Board Thursday 12th June 2025, 14:00-16:00 Midlothian IJB Performance Report Executive summary The purpose of this report is to • Update the Midlothian IJB on progress towards the IJB performance goals set for the period 2023-25. • Provide Midlothian IJB with assurance in relation to Column 1 ‘What we do’ of the OutNav Strategic Governance Map. Due to an inbuilt reporting delay in the processes required to validate statutory IJB performance goal data, the full reporting year is almost complete for all indicators. A report describing progress against each improvement goal is attached in appendix 1. 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 provided 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 OutNav Strategic Governance Map has now been incorporated into this IJB Performance Report. This is provided at appendix 2. Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1) • Note the inclusion of the Midlothian IJB Strategic Governance Map (appendix 2). • Consider the assessment of progress described in Column 1 of the Midlothian IJB Strategic Governance Map, and • Provide feedback in relation to improvements in evaluation and planning. Item number: 5.9 Page 107 of 180
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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. • Provide Midlothian IJB with assurance in relation to Column 1 ‘What we do’ of the OutNav Strategic Governance Map. 2 Recommendations 2.1 Members are asked to: • Note performance against the Midlothian IJB Improvement Goals for 2023-25 (appendix 1) • Note the inclusion of the Midlothian IJB Strategic Governance Map (appendix 2). • Consider the assessment of progress described in Column 1 of the Midlothian IJB Strategic Governance Map, and • Provide feedback in relation to improvements in evaluation and planning. 3 Background and main report 3.1 The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. They are based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care). 3.2 At the IJB meeting in June 2023 the Performance Assurance and Governance Group recommended that the improvement goals for 2023-25 were set to prioritise an increase in system stability, focussing on workforce recovery and wellbeing. 3.3 An updated report describing progress against each improvement goal is attached in appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. Members are asked to specifically note data completeness. Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. This means that we are not yet able to calculate the full year performance for some measures. 3.4 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. Page 108 of 180
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Midlothian Integration Joint Board 3.5 A&E Attendances 2022/23 Target Rate per 100,000 people 2,629 / month 2024/25 Running Average 2,725 / month The validated data are available up to December 2024. Based on this information, the target is not currently being met. The most recent non-validated management information data (accessed May 2025) indicate the target is currently being met. 3.6 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2024/25 Running Average 749 / month The validated data are only available up to September 2024. Based on this information, the target is currently being met. The most recent non-validated management information data (accessed May 2025) indicate the target is not currently being met. 3.7 Unplanned Bed Days (Acute) 2022/23 Target Rate per 100,000 5,074 / month 2024/25 Running Average 5,150 / month The validated data are only 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 May 2025) indicate the target is currently being met. 3.8 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2024/25 Running Average 1166 / month The validated data are only available up to December 2024. Based on this information, the target is currently not being met. The most recent non-validated management information data (accessed May 2025) indicate that the target is not currently being met. 3.9 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. 3.10 Balance of Care 2022/23 Target Rate >96.4% This indicator was not updated in the latest release of published data from Public Health Scotland. It is not possible to refer to management information as these data are not held locally. 3.11 The Midlothian IJB Strategic Governance Map has now been incorporated into this IJB Performance Report. Page 109 of 180
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Midlothian Integration Joint Board 3.12 For this report, the focus was on the annual review and update of Column 1: “What We Do?” This column of the Midlothian IJB Strategic Governance Map is designed to provide assurance to the Board on the activity undertaken in relation to 1 the development, agreement and oversight of implementation of a three- year strategic plan, 2 the agreement and provision of clear Directions and associated resource allocation to our Midlothian Council and NHS Lothian Partners that are operationally overseen by Midlothian HSCP, and 3 the establishment and maintenance of robust governance arrangements. 3.1 In all three areas, Midlothian IJB can take a high level of assurance that the core functions of the Board are undertaken in line with statutory duties. 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 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 or 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. 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. Page 110 of 180
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Midlothian Integration Joint Board 8 Risk 8.1 The risk of not finding solutions to address complex performance measurement challenges is that we are underinformed in relation to increases in complexity, acuity and the resulting additional pressures these create for our workforce; and what this may mean for wellbeing, retention and recruitment. 9 Involving people 9.1 Following the decision to step down the Performance and Assurance Group, the role of data assurance is performed by Strategic Planning Group which has a wider membership including representation of Board members, Officers of the HSCP, the Third and Independent sector, and Public Health. 10 Background Papers 10.1 No background papers. AUTHOR’S NAME Elouise Johnstone DESIGNATION Programme Manager for Performance & Improvement CONTACT INFO elouise.johnstone@nhslothian.scot.nhs.uk DATE 20th May 2025 Appendices: Appendix 1: Local Intelligence Support Team (LIST) Report Appendix 2: Midlothian IJB Strategic Governance Outcomes Map: Column 1 ‘What we do’ Page 111 of 180
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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), April 2025 Page 113 of 180
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Contents 2 1. 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 114 of 180
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Data completeness Source: MSG data release Mar-25, PHS 3Page 115 of 180
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2020/21 targets and actuals Source: MSG objectives 2020-21 template - Midlothian IJB; MSG data release Mar-25, PHS 4 Indicator 2020/21 target Annual Monthly Annual Monthly 1. A&E attendances Maintain 32,614 2,718 26,391 2,199 ✓ 2. Emergency admissions 5% decrease 9,520 793 9,211 768 ✓ 3a. Unplanned bed days (acute) 10% decrease 62,963 5,247 57,462 4,789 ✓ 3c. Unplanned bed days (MH) Decrease 15,712 1,309 12,544 1,045 ✓ 4. Delayed discharges occupied bed days 20% decrease 13,886 1,157 9,779 815 ✓ 5. Last 6 months of life (% in large hospital) Decrease <8.7% - 7.5% - ✓ 2020/21 target (rate per 100,000) 2020/21 (rate per 100,000) Target met Page 116 of 180
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Data Sources 5 2020/21 MSG Targets • Source: MSG data release v1.70, Mar-25; 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 117 of 180
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A&E Attendances Source: MSG data release Mar-25; data published up to Dec-24 6Page 118 of 180
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Emergency Admissions Source: MSG data release Mar-25; data published up to Sep-24 7 Page 119 of 180
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Unplanned Bed Days - Acute Source: MSG data release Mar-25; data published up to Sep-24 8Page 120 of 180
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Delayed Discharges Occupied Bed Days (18+) Source: MSG data release Mar-25; data published up to Dec-24 9Page 121 of 180
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End of Life - Percentage of Last Six Months Spent in Large Hospitals Source: MSG data release Mar-25; data published up to 2022/23 10Page 122 of 180
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27th May 2025 This report has been created using OutNav developed by Matter of Focus. Midlothian IJB Strategic Governance Outcomes Map Page 123 of 180
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Page 2 of 33 Contents 1. IJB Strategic Governance Outcomes Map Progress 2. IJB Strategic Governance Outcomes Map Detailed Findings • Column One: What we do 3. IJB Strategic Governance Outcomes Map Sources and Success Criteria 4. Our Evidence Standards Page 124 of 180
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Page 3 of 33 IJB Strategic Governance Outcome Progress Page 125 of 180
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Page 5 of 33 IJB Strategic Governance Outcome Map Column One: What we do Develop, agree and oversee implementation of a three year strategic commissioning plan Progress: Great Confidence: High National Health and Wellbeing Outcomes Like all Integration Authorities in Scotland, our role is to plan and deliver the services that support better health and wellbeing in our communities. We are asked by the Scottish Government to work with our partners to plan across the whole system using the National Health and Wellbeing Outcomes Framework. Evaluating and reporting on what we contribute to the 9 National Health and Wellbeing Outcomes becoming a reality for more people in Midlothian is how Scottish Government measure our performance. The Scottish Government measures our progress towards the 9 National Health and Wellbeing Outcomes every year through the publication of our Annual Performance Report. The National Health and Wellbeing Outcomes Framework makes particular reference to moving away from the delivery of services being an endpoint of activity, and towards seeing personal outcomes as the purpose of engagement and activity with people and communities. It is essential we do this with meaningful supporting planning, commissioning, evaluation, and improvement. Page 127 of 180
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Page 6 of 33 We are using OutNav to help us measure our performance against our objectives in our Strategic Commissioning Plan 2022-2025 and better understand the impact of what we do for the people who live in Midlothian. Strategic Commissioning Plan 2022-25 Our Strategic Commissioning Plan for 2022-2025 was approved by Midlothian IJB on 14th April 2022. The plan aims to • Improve the quality of health and social care services and achieve the 9 national health and wellbeing outcomes; • Change how health and social care is delivered to better understand and meet the needs of the increasing number of people with long term health conditions, with complex needs and those who need support, working with people as partners in their health and social care. • Provide more support, treatment, and care for people in their homes, communities, or a homely setting rather than in hospitals We want to work with people as partners in their own health and social care and we want to provide more support, treatment, and care for people in their homes and communities. To do this, we have asked the Midlothian Health and Social Care Partnership to ensure they offer services in a timely way at every stage of someone’s care and treatment: • Preventing ill health and providing support early, • Ongoing support and treatment, • In times of crisis and emergency. Page 128 of 180
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Page 7 of 33 This plan is coming to the end of its strategic life and work has been underway on developing our next strategic plan since August 2023. We have recognised that health and social care needs radical transformation, and this doesn’t happen over a 3-year planning cycle. To ensure we are planning for a future with sustainable health and social care, the draft Midlothian IJB Strategic Plan 2025-2035 includes our ambitions for reform looks forward in a 10-year strategy. Strategic Commissioning Plan 2025-2035 We are currently developing our next Strategic Commissioning Plan. This plan will set out our ten-year vision for integrated health and social care services and how we will use our resources to improve the health and wellbeing of people and communities in Midlothian. This plan has been written in line with the Principles for Planning and Delivering Integrated Health and Social Care which are the driving force behind our planned activity to successfully and improve outcomes. These national ambitions are the same for every Integration Authority in Scotland and they will be our aim for as long as we are asked to work in this way. The action we choose to take, and the pace at which we are able to make progress, is unique to Midlothian. On 24th August 2023, Midlothian IJB approved the timeline for this work and initially anticipated publication date before the end of April 2025. The Public Bodies (Joint Working) (Scotland) Act, 2014 places a duty on Integration Authorities to plan and direct delegated health and social services through the development of a Strategic Plan. Stakeholders must be fully engaged in the preparation, publication, and review of the plan, in order to establish a meaningful co-productive approach. The key stages of the process are; • We must develop strategic proposals and ask the Strategic Planning Group to consult and develop these in the development of a first draft of the Strategic Plan. Page 129 of 180
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Page 8 of 33 • We must then seek the views of the Strategic Planning Group on the draft, taking into consideration the views in response to the consultation on the first draft. • We are then required to prepare a second draft of the strategic plan and send a copy of it for comment to the local authority and the health board, as well as representatives of groups prescribed by Scottish Government and any other persons as the integration authority considers appropriate. Following receiving the support of the Board, officers of Midlothian HSCP established a project team in August 2023 to oversee the process of developing a new Midlothian IJB Strategic Commissioning Plan. Between September and November 2023, a first stage consultation was undertaken to review and feedback on the current Strategic Commissioning Plan 2022-2025 and explore the hopes and ambitions of people and communities, delegated services, partner organisations and Third and Independent Sector partners. Over 150 individuals, services, and organisations took part, and a thematic analysis was completed to highlight key recurring themes. On 18th January 2024, the Midlothian HSPC Planning and Performance Teams led a Midlothian IJB Development Session to establish the strategic proposals for 2025-35 approved by Midlothian IJB on 8th February 2024. A first draft was developed over February and March 2024 with an Assessment of Place and Wellbeing conducted by Public Health Scotland and The Improvement Service. The first draft was reviewed by SPG on 26th April 2024 and revised in response to feedback. Following a Midlothian IJB Development Session on 16th May 2024, significant revision was undertaken to produce a second draft of the plan. This was reviewed in July 2024 by the Vice Chair if Midlothian IJB and officers of the HSCP resulting in further edit and amendment made in response to feedback. On 22nd August 2024 the Board approved the draft Strategic Plan 2025-2035 for public consultation between 30th August and 30th November 2024. We undertook a range of activities and events including surveys, online question and answer sessions and group discussions. We spoke to internal and external stakeholders including staff, third sector organisations and local people to help us draft our vision, values and aims for the next 10 years. The Midlothian Citizens panel undertaken in 2024 and 2025 has also significantly continued to the development of the draft Page 130 of 180
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Page 9 of 33 Strategic Plan. We believe that our services will be more effective if we focus on how we help people take steps to stay healthy and prevent illness or worsening health. Feedback from our consultation has included oner 1500 voices. In November 2024 an audit of the draft Strategic Plan was undertaken against the Scottish Government Strategic Plan Statutory Guidance highlighting a high level of compliance. On the 26th September 2024 the Strategic Planning Group undertook an Equality and Children’s Right Impact Assessment (ECRIA) which was noted without amendment on 28th November 2024. The ECRIA recommended a number of considerations, amendments, and revisions to the Plan which have been actioned by the Strategic Planning Group. On 19th December 2024, Midlothian IJB considered and agreed a request to delay the publication of the Strategic Plan by approximately 6 months to October 2025. This was to ensure that any impact from the upcoming budget negotiations were considered and reflected in the new plan with opportunity for Heads of Service to consider the action required to deliver on these ambitions. Partner engagement has continued through this process through the Midlothian IJB Strategic Planning Group and discussion with the strategic leads and senior officers of both Partners. A change log has been utilised to record edits and amendments to the strategic plan. The Strategic Plan for 2025-2035 continues to be an evolving document in collaboration with Partners and all stakeholders. Changes, amendments and additions are recorded in a change log. Some critical detail remains outstanding and will be included following the budget setting for 2025/26 this is being developed alongside operational transformation planning. This third draft has been completed in preparation for comment from local authority and the health board Partners. The Strategic Planning Group reviewed this third draft of the Plan on 16th January 2025 and agreed to recommend the plan to the board for approval to progress through the governance routes of our Partners. The 20th February 2025, Midlothian IJB agreed for the draft Midlothian IJB draft Strategic Plan 2025-2035 to progress through the governance routes of its partners. This began on the 25th March 2025 at NHS Lothian’s Strategic CMT, and Midlothian Council’s CMT on 7th May 2025. Feedback included an ask to include further clarity on the budget setting process, reiterate that Midlothian IJB can only allocate resources made available to it by Partners, and to develop additional detail on the ambition to provide an ‘ageless’ model of care particularly in relation to justice, disabilities, and mental health services. Page 131 of 180
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Page 10 of 33 On the 15th May 2025, the Chief Officer and Integration Manager hosted an elected members briefing on the draft plan and on 21st May 2025 NHS Lothians Strategic Planning and Performance Committee approved the plan for recommendation to the NHS Lothian Board for review. The remaining processes in relation to the draft plan are • 16/07/2025 Midlothian Council CMT • 09/09/2025 Midlothian Council • 11/09/2025 NHS Lothian Strategic Planning and Performance Committee • 08/10/2025 NHS Lothian Board • 09/10/2025 Midlothian IJB Final Approval On 26th May 2025, internal audit commenced an audit on the strategic planning process. The outcome of this audit is expected in mid-June 2025. Alongside our Strategic Plan for 2025-2035 we must also publish a suite of documents to support this plan. These include a • Joint Strategic Needs Assessment: It is a statutory requirement to oversee the production of a Joint Strategic Needs Assessment (JSNA) to support the commissioning of health and social care services locally based on a detailed analysis and understanding of population need. In Midlothian this is completed in a rolling programme of review that ensure all data included in the JSNA is reviewed at least annually to support services make the best decisions they can. This rolling programme ensures the JSNA is refreshed more frequently than the 3-year statutory requirement. • Public Consultation and Engagement Statement: This statement describes the full range of consultation and engagement activity from September 2023 until October 2025 that have informed the development of the strategic plan 2025-2035. This is currently under development and will be reviewed by the Strategic Planning Group in July 2025 prior to recommendation to the Board. Page 132 of 180
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Page 11 of 33 • Market Facilitation Plan: Our Market Facilitation Plan 2025-2028, describes our commitment to influencing and encouraging an ethical approach to the planning and securing of health and social care services provided by a third party. This document forms the basis of a Partner Provider Statement that will describe how we work alongside our provider partners. This is currently under development and will be reviewed by the Strategic Planning Group in July 2025 prior to recommendation to the Board. • Housing Contribution Statement: In Midlothian, Housing is not a delegated function and is delivered by Midlothian Council. However, we do have responsibility for aids and adaptation and our Housing Contribution Statement sets out how we will provide this service and continue to work with all our partners ensure people live in safe and quality housing within their community. This is currently under development and will be reviewed by the Strategic Planning Group in July 2025 prior to recommendation to the Board. Agree and provide clear Directions and associated resource allocation to our LA and NHS partners that are operationally overseen by Midlothian HSCP Progress: Great Confidence: High Directions In line with the provisions of sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014, Directions are the key mechanism by which Midlothian IJB’s strategic plan is actioned. Directions are issued by Midlothian IJB to Midlothian Council and NHS Lothian Health Board, setting out how all functions delegated to the IJB and operationally managed predominantly by Midlothian Health and Social Care Partnership (HSCP) are to be delivered and funded via the integrated budget. Directions are legally binding and provide a formal record and audit trail of Midlothian IJB’s decisions and responsibilities between Partners. Page 133 of 180
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Page 12 of 33 Directions also provide the detail of how Midlothian IJB is aligning its resources. The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to allocate these resources in line with its objectives and strategic aims. The Development of Directions Practice in Midlothian In 2022, Midlothian IJB completed a rigorous review of all issued Directions to ensure grip and control around strategic planning, performance monitoring and ongoing review of priority actions. Due to Midlothian IJBs previously issuing highly operational Directions, these Directions replaced operational planning. Operational services felt constrained by Midlothian IJB Directions as the level of operational instruction in the Directions imposed solutions and didn’t allow the freedom for services to explore, identify challenges, and find new solutions alongside people and communities. Services told us there were too many in number to complete well and were too limited in their instruction. The main objective for Midlothian IJB in 2022-23 was to find a more sustainable solution to setting and measuring the effectiveness of Directions. 1. Phase One was to create an auditable log of Directions. A log of Directions from 2020-2023 was created for comprehensive scrutiny and review. 2. Phase Two ensured meaningful evaluation of each of the Directions already set and introduced a reporting template that asked for a clear measure, how a change would be an improvement, a baseline, and reporting at two points across the year. 3. Phase Three saw officers of the HSCP work with the Board to develop a more strategic framework that aligned to the 6 strategic aims of the IJBs Strategic Commissioning Plan 2022-2025 and the Health and Wellbeing Outcomes. 4. Phase Four developed a means to demonstrate the impact the IJB was making in the lives of people and communities in the ways that mattered most to them using a contribution analysis approach and triangulating outcomes, experience, and activity. 5. Phase Five saw the development our 2023-24 Directions. This resulted in 21 Directions, 36 measures and 19 data sources framed within the 9 National Health and Wellbeing Outcomes 6. Phase Six saw the development of the IJB Outcomes Focused Performance Framework Page 134 of 180
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Page 13 of 33 7. Phase Seven was for the HSCP to design and develop an operational strategic planning tool to support services to deliver on Directions, and report progress via service governance and the governance groups of the HSCP 8. Phase Eight is to ensure the development of an HSCP Performance Framework provides the required operational governance and assurance to Midlothian IJB alongside outcome measurement. This work allowed the Board to reappraise the value of issuing high numbers of operational Directions and has resulted in a decision to move towards a more strategic approach for 2023/24. Midlothian IJB issued Directions to NHS Lothian and Midlothian Council on 1st April 2023 following approval from Midlothian IJB at the16th March 2023 Board meeting. Directions 2024/25 In 2024/5 Midlothian IJB decided not to significantly change Directions to allow partners the time to understand the full impact of funding changes. The financial position has become more challenging across this time and many services are operating differently within new financial models through a combination of Grip and Control, Transformation, and Choices. Midlothian IJB issued Directions to NHS Lothian and Midlothian Council on 24th June 2024 following approval form Midlothian IJB at the 20th June 2024 board meeting. Internal Audit completed a review of Midlothian IJB Directions as part of the Audit Annual Plan 2024/25 and assurance work. The purpose of the audit is to review the processes in place to agree Midlothian Integration Joint Board (IJB) Directions and the governance to monitor and review Directions on an ongoing basis. The audit focused on key controls to ensure that: • the Direction setting process within the Midlothian IJB (MIJB) is in accordance with the Public Bodies (Joint Working) (Scotland) Act 2014 and the Scottish Government statutory guidance published in 2020; • there is a clear linkage between the directions and the IJB Strategic Plan; • Directions, when set, have been clearly communicated to the organisations, people and structures required to deliver these; and • there is a clear process in place to monitor and review the progress of Directions during the year. The audit was completed in August 2024 and returned a final audit outcome of 'Reasonable Assurance'. Page 135 of 180
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Page 14 of 33 Directions 2025/26 Despite continuing financial uncertainty and challenge, Midlothian IJB also must evolve and commission services in new and increasingly innovative ways while continuing to provide safe, high-quality care and support in line with its Strategic Plan. To ensure Midlothian IJB is able to appropriately direct Partners in a way that aligns with our strategy and future ambitions, it has become increasingly important to provide clear instruction on key actions for delivery in 2025/26, particularly in relation to Financial Recovery Planning. Midlothian IJB worked closely with both Partners in developing Directions for 2025/26 and will continue to monitor progress closely. Midlothian IJB will consider when Directions need to be revised or new Directions are required to be issued issue to partners across 2025/26. The proposed Directions for 2025/26 were presented to the Midlothian IJB Strategic Planning Group Board (SPG) for scrutiny and development on 16th January 2025. This session followed a series of exploration workshops and liaison with Midlothian Health and Social Care Partnership colleagues, representatives of both Partners, and the Strategic Planning Group. Midlothian IJB reviewed the draft Directions for 2025/26 on 20th February 2025 and further development was undertaken in an IJB members session on 27th February 2025. Directions for 2025/26 were approved on 13th March 2025 before issuing to Partners on 31st March 2025. Midlothian IJB Directions remained aligned to the nine National Health and Wellbeing Outcomes, the new Midlothian IJB strategic Plan (in development) for 2025/35, and shares the overarching strategic vision of the Lothian Strategic Development Framework, the Single Midlothian Plan, and the ambitions of the Midlothian Community Planning Partnership. This integrated approach is designed achieve the greatest change in the shortest time possible to improve the outcomes that matter most to people and communities. To effectively monitor and evaluate progress towards the new strategic aims of the draft Midlothian IJB Strategic Plan (2025-2035, and Directions 2025/26, the Midlothian IJB Performance Framework 2023/24 is under revision to bring together the strategic ambitions of the organisation with operational activity captured in the Midlothian HSCP Governance and Assurance Framework and Group Service Specification and Plans. The financial values (‘budgets’) attached to these Directions are based on • Midlothian Council’s budget proposition of £71.086m for 2025/26 was accepted by Midlothian IJB at the IJB meeting on 27th March 2025. Page 136 of 180
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Page 15 of 33 • The indicative 2025/26 NHS Lothian recurring budget from the February Finance and Resources committee saw £105.234m. NHS Lothian approved their 2025/26 budget at the NHS Lothian Board on for 16th of April 2025. At the time of our special IJB Board meeting on 27th March 2025, the NHS Lothian offer was indicative. Following the Special IJB Board meeting on the 27th March 2025, we issued Directions to the Chief Executives of both NHS Lothian and Midlothian Council on 28th March 2025. Both Partners have formally acknowledged receipt of these Directions and work continues to collaboratively deliver these ambitions. The Directions Log for 2025/26 has been updated and Group Service planning documentation has been produced for completion by Head of Service and Professional Leads to support operational strategic planning with clear links from the Midlothian IJB Strategic Plan aims and objectives. Each Group Service area has ensured that services have also developed plans which link to Directions and our strategic aims. This resulted in 35 Directions and performance measures framed within the 9 National Health and Wellbeing Outcomes that clearly articulate the priority actions we will undertake to see the fastest possible progress towards our Strategic Plan. This has allowed us to be clear on the how our Directions are driving the key priorities of our draft Strategic Plan as we improve our reporting an evaluation capabilities. We anticipate this will help us be much clearer on the actions that help us deliver the outcomes that matter most to our communities and support us to take corrective action based on the evidence of what help people take action to stay well, prevent ill or worsening health, and plan ahead. Page 137 of 180
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Page 17 of 33 Establish and maintain robust governance arrangements Progress: Great Confidence: High Midlothian IJB is required to ensure all statutory governance requirements are fulfilled. The additional pressures experience across health and social care from March 2020 resulted in some statutory governance requirements being paused or extension for completion. Integration Joint Boards are public bodies and must ensure that arrangements are established to comply with their public body duties. The Public Bodies (Joint Working) (Scotland) Act 2014 includes duties to develop a Strategic Plan for integrated functions and budgets, prepare an Annual Performance Report and publish an annual Financial Statement. There are also duties placed on Integration Joint Boards by specific legislation as follows; Committees of Midlothian IJB Midlothian IJB has two committees; The Audit and Risk Committee (A&R) and the Strategic Planning Group (SPG). The Committees may set up working groups to support specific pieces of work and membership of working groups will be open to anyone whom the Committee considers will assist in the task assigned. The working groups will make recommendations to the Strategic Planning Group or the Audit and Risk Committee but are not decision-making groups or formal committees themselves. Audit and Risk Committee The Financial Regulations for the IJB were approved Integration Board on 29th October 2015. Section 3.11 of the Financial Regulations state that Midlothian IJB will have an Audit and Risk Committee. As such the Audit and Risk Committee is a statutory committee of governance set up according to best practice in the governance of public bodies. Page 139 of 180
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Page 18 of 33 The IJB set up an Audit and Risk committee in early 2016. The role of the Audit and Risk committee is laid out in the IJB's Standing Orders. The Audit and risk committee meets 4 times per financial year and • Approves the IJB's Chief Internal Auditor's Internal Plan • Receives the CIA's reports • Reviews the IJB's Risk Register • Approves the appointed (external) auditors plan • Reviews the report of the appointed auditors on the IJB's Annual Accounts • Considers governance issue The Audit and Risk Committee Terms of Reference were reviewed in Q1 of 2024 by the Chief Finance Officer and the Integration Manager. The proposed Terms of Reference were then reviewed by the Audit and Risk Committee on 6th June 2024 and recommended to the Midlothian IJB for approval. Midlothian IJB approved the Terms of Reference on 22nd August 2024. Strategic Planning Group Section 32 of The Public Bodies (Joint Working) (Scotland) Act 2014 make provision for Integration Authorities to establish a Strategic Planning Group (SPG) for the development and delivery of the Strategic Plan. The role of the Strategic Planning Group is to • Receive direction and feedback from the IJB in respect of development of the strategic plan and delivery of the objectives therein over the period of the plan. • Prepare proposals for the Strategic Plan in regard to the integration delivery principles as described in section 31 of the Act. • set out the arrangements for the carrying out of the integration functions for the area of the IJB over the period of the plan. • setting out how those arrangements are intended to achieve, or contribute to achieving, the national health and wellbeing outcomes, and including such other material as the integration authority thinks fit. Page 140 of 180
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Page 19 of 33 The remit of the Strategic Planning Group is directed by the Integrated Joint Board to develop and review the Strategic Commissioning Plan ensuring the alignment of Midlothian HSCP service strategies. The Strategic Planning Group Terms of Reference were reviewed in Q1 of 2024 by the Chief Finance Officer and Integration Manager. The proposed Terms of Reference were then reviewed by the Audit and Risk Committee on 6th June 2024 and recommended to Midlothian IJB for approval. Midlothian IJB will review the proposed Terms of Reference on 22nd August 2024. The Terms of Reference were updated on 6th March 2025 to allow any Board member to be nominated as Chair or Vice Chair. Annual Audited Accounts Midlothian IJB is corporate body as defined under s106 of the local government (Scotland) act 1973. This Act requires Midlothian IJB to produce a set on Annual Accounts at the end of each financial year. In practice there are three steps • To prepare a set of unaudited accounts approved for publication by Midlothian IJB on the Midlothian Health and Social Care website before 30th June 2025. • Present these accounts to Midlothian IJB’s appointed Auditors (Audit Scotland) who undertake an audit. • Prepare a final set of accounts reflecting the appointed auditors comments and including their own formal view on the accounts. This will be presented to the IJB’s Audit and Risk Committee on 4th September 2025 prior to presentation for approval at the Midlothian IJB Special Board meeting on 18th September 2025. The audit and approved set of annual accounts will then be published on the Midlothian Health and Social Care website as soon as practicably possible. Page 141 of 180
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Page 20 of 33 There are five sections to the annual accounts 1. A description of what the IJB is and how it operates. 2. A management commentary in two sections a. A reflection of the financial performance of the IJB and a consideration of the financial challenges in the next financial year b. A reflection of the work the IJB has undertaken during the year to deliver the ambitions of the strategic plan. 3. A section to provide assurance on governance including the Annual Governance Statement (AGS) prepared by the IJB’s Chief Internal Auditor. The AGS was reviewed by Midlothian IJB’s Audit and Risk committee on 5th June 2025. 4. A report from the appointed auditors. This will not be available until after the appointed auditors have completed their audit. 5. The annual account details. The section reflecting the work Midlothian IJB across 2024/25 remains incomplete at this time. The information required to complete this is provided by the Midlothian IJB Annual Performance Report (APR). Due to the timing of the release of Public Health Scotland (PHS) validated data, this cannot be completed until July 2025. Following Midlothian IJB approving the publication of the APR, this information will be added to the Annual Accounts. The Midlothian IJB Audit and Risk Committee reviewed this set of draft Annual Accounts on 5th June 2025 and a verbal update will be provided on revisions and additions required ahead of the Midlothian IJB Special Board meeting on 18th September 2025. Annual Budget Setting and the Medium Term Financial Strategy The IJB’s funding partners make a formal budgetary offer to the IJB in February each year. Once a budget offer is received, the IJB must consider if this offer meets the Scottish Government’s guidance, and if it a ‘fair share’ of the partner’s resources. On 27th March 2025 March Midlothian IJB considered and accepted these budget offers and agreed its budget for the 2025/26 financial year. The Medium-Term Financial Strategy (MTFS) provides the framework to support strategic planning and financial sustainability over a three to five year horizon. The MTFS was presented to the IJB on 20th December 2023 as part of the financial planning process for the 2024/25 Page 142 of 180
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Page 21 of 33 financial year. This plan 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-led care. The MTFS is aligned with Midlothian IJB’s strategic priorities and underpins the delivery of the Strategic Plan via Directions. Following the 2025/26 budget setting process, the MTFS must now be 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 to deliver Midlothian IJB’s Strategic Plan 2025- 2035 currently scheduled for publication in October 2025. The MTFS is now under development and will be reviewed by the Midlothian IJB Strategic Planning Group (SPG) on 24th July 2025. Subject to any revisions, it is anticipated that the SPG will recommend the MTFS to the Board for review in the 21st August 2025 Midlothian IJB meeting. Internal Audit Midlothian IJB has adopted the CIPFA Financial Management Code. Compliance is considered by the IJB's Chief Internal Auditor who makes a formal report annually to the IJB's Audit and Risk Committee. Midlothian IJB has appointed a Chief Internal Auditor who develops and presents an annual audit plan which was approved by the Audit and Risk Committee on 5th June 2025. Internal audit reports are presented to the committee during the financial year for consideration. The Annual Governance Statement has been included in the IJB's Annual Accounts and will be audited by Audit Scotland as the IJB's appointed external auditors. External Audit The IJB is a statutory body constituted unto s106 of the Local Government (Scotland) Act 1973 and is required to produce a set of annual accounts which must be submitted audit. Midlothian IJBs Annual Accounts are audited by the IJB’s appointed (external) auditor. The auditor submits their report on the IJB’s annual accounts to the IJB’s Audit and Risk committee for discussion and to the IJB who then approve the IJB’s accounts. Page 143 of 180
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Page 22 of 33 Governance of the IJB The Governance arrangements for Midlothian IJB are jointly overseen by the Audit and Risk Committee, the Strategic Planning Group and supported by both the Integration Manager, and the Standards Officer. Scheme of Integration The Public Bodies (Joint Working) (Scotland) Act 2014 sets out the statutory duty for health boards and local authorities to work together to provide integrated health and care and the requirement for both parties to jointly establish a Scheme of Integration. This NHS Lothian and Midlothian Council scheme outlines the establishment, governance, scope, and operation of the Midlothian IJB. A new Midlothian Scheme of Integration was approved by Scottish Government on 15th May 2023. This will next be reviewed in 2027. Code of Corporate Governance The Board is responsible for ensuring that its business is conducted in accordance with the law and proper standards. This is to allow the public funds and the assets at its disposal to be safeguarded and used efficiently and effectively in pursuit of best value. Furthermore, Board Members are responsible for the governance of the business affairs of the Board. This includes setting the strategic direction, vision, culture, and values of the Board and establishing appropriate and cost-effective systems, processes, and internal controls to allow the strategic objectives to be delivered. In April 2021, the Board approved the Midlothian Integration Joint Board Local Code of Corporate Governance based on the Delivering Good Governance in Local Government Framework 2016 published by the Chartered Institute of Public Finance and Accountancy (CIPFA) and the Society of Local Authority Chief Executives’ (SOLACE). There has been no change to the CIPFA guidance which underwrites the Code since the Midlothian Integration Joint Board Code was approved in 2021. While there is no immediate need to review this Code, it is good practice to undertake regular review and ensure relevant in practice. The Chief internal Auditor reviewed the Local Code of Corporate Governance in 2024. Page 144 of 180
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Page 23 of 33 Standing Orders The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 sets out the provisions which apply to the membership, proceedings, and operation of all Integration Joint Boards. Midlothian IJB agreed Standing Orders to regulate the conduct and proceedings of meetings of the Board in terms of the above Order on 9th February 2023. The Terms of Reference for both the Audit and Risk Committee and the Strategic Planning Group were reviewed by the Audit and Risk Committee on the 6th June 2024 and recommended to Midlothian IJB for approval. Any approved changes to either the Audit and Risk Committee or the Strategic Planning Group Terms of Reference may require Midlothian IJBs Standing Orders to be reviewed. Directions Policy Scottish Government published statutory guidance for Directions in January 2020 which describes the best practice for the issue and implementation of Directions. In order to comply with statutory guidance, Midlothian IJB is required to have a formal Directions policy in place. Following a significant review of Directions and the ongoing development of a new Strategic Plan, a review of the MIJB Directions Policy was been delayed to allow for any proposed changes to be fully considered in line with both statutory guidance and local process, and be informed by an Internal Audit currently underway. In 2024/25 a Midlothian IJB Directions Policy was developed and approved by on 20th February 2025. This policy outlines the process for drafting, approving, issuing, and monitoring Directions from Midlothian Integration Joint Board (IJB) to partner organisations Midlothian Council and NHS Lothian Health Board. The policy has been developed with reference to relevant legislation and statutory guidance and will be reviewed on an annual basis. Midlothian IJB Performance Framework The Midlothian IJB Performance Framework was first presented to the Board for approval in March 2023. Page 145 of 180
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Page 24 of 33 To ensure that performance is transparent and accountable, section 42 of the The Public Bodies (Joint Working) (Scotland) Act 2014 outlines the requirement for integration authorities to prepare and publish an annual performance report as described in the Scottish Government Annual Performance Reports: Statutory Guidance. This includes reporting on the national Core Suite of Integration Indicators provided by Public Health Scotland, to support reporting on how well Midlothian IJB is leading change for people and communities in regard to the 9 National Health and Wellbeing Outcomes. In order to provide assurance to the Board on both Midlothian IJBs performance and transparency in regard the data governance mechanisms and processes, Midlothian IJB first approved a Performance Framework in March 2023 following an internal audit action stating “Performance measures in the MIJB’s Performance Management Framework should be more appropriately aligned to key priorities and outcomes of its Strategic Plan”. In August 2023 the Midlothian IJB Performance Framework was updated and approved following discussion of the new local Improvement Goal 2023/24. Midlothian IJB’s draft Strategic Plan for 2025-2035 is currently progressing through the governance routes of its Partners with a planned publication date of October 2025. In line with statutory requirements and best practice, revisions to the proposed Performance Framework will primarily be in relation to the reporting and assurance process for monitoring and valuation progress towards this plan and the 9 National Health and Wellbeing Outcomes. As the mechanism for delivering the strategic plan, Directions and Direction reporting play a central role in the Midlothian IJB Performance Framework to demonstrate clear alignment to the strategic aims in the draft Midlothian IJB draft Strategic Plan 2025-2035. The proposed Performance Framework for 2025-2035 will describe the measures, data sources and frequency for: • IJB Strategic Aims • Ministerial Steering Group Indicators • National Health and Wellbeing Outcomes • Midlothian IJB Directions Reporting The Strategic Planning Group will review a revised draft Midlothian IJB Performance Framework in July 2025 prior to recommending this to the Board for approval. Page 146 of 180
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Page 25 of 33 Risk Register Policy and Risk Register Midlothian IJB Risk Register Policy was first approved in 2016. This has been reviewed by the Chief Finance Officer and was presented to the Midlothian Audit and Risk Committee in December 2024. This was further reviewed in 2025 for presentation to the Audit and Risk Committee. The risk register is regularly reviewed by both Committees of the Board. On 22nd May 2025, the Strategic Planning Group reviewed the Risk Register and recommendations will be considered at the Audit and Risk Committee on 5th June 2025. Equality Outcomes and Mainstreaming Equality in Midlothian On 24th April 2025, our Equality Outcomes for 2025-2029 and Action Plan were approved and published on our website. We will ensure we report annually on our progress towards mainstreaming equality and will include this in our Annual Performance Report (APR). We must also consider equalities issues for all new or revised strategies, policies, plans, provisions or activities. This includes undertaking an Equalities and Children’s Rights Impact Assessment (ECRIA). To ensure that we are complying with the Public Sector Equality Duty, we ask that all reports that come to the IJB are accompanied by a Equalities Screening Tool and ensure ECRIAs are developed, considered and recommendations actioned where equality issues are identified when we do not know the impact of our decisions. Climate Reporting Midlothian IJB acknowledges its role in relation to tackling climate change in Midlothian and submits annual returns to Scottish Government in line with the Climate Change (Scotland) Act 2019. Page 147 of 180
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Page 26 of 33 Midlothian IJB also has a statutory duty to comply with Model Governance Schemes Model Scheme of Publication Section 23 of the Freedom of Information (Scotland) Act 2002 requires Integration Joint Boards to develop and put in place a publication scheme, along with a guide setting out what information it will make available. It is important that consideration is given to the publication scheme and associated guides to information to make clear how the Board intends to communicate with people and communities. The Board adopted the Scottish Information Commissioner’s Model Publication Scheme on 31 May 2017. The Model publication scheme was updated in 2018 and 2021 by the Scottish Information Commissioner should now be to be reviewed and updated. This should also include changes in the location of information on the Midlothian Council Website and the Boards ambitions to review and improve Community Engagement. The Integration Manager led a review of this Scheme in 2024 and revisions submitted to and approved by the Scottish Information Commissioner. Internal Audit have subsequently undertaken an audit of this process and a conclusion of 'Reasonable Assurance' was received in April 2024. This was reviewed by the Midlothian Audit and Risk Committee on the 6th June 2024 and all actions were agreed as closed by internal Audit in October 2024. Records Management Plan The Public Records (Scotland) Act 2011 details the requirements of all public authorities in relation to records management. Under Section 1 Integration Joint Boards must prepare and implement a records management plan which sets out proper arrangements for the management of their records. The records management plan must be submitted for agreement by the Keeper of the Records of Scotland. The plan must account for all the public records for which the authority has responsibility. The plan must detail the functions of each authority and the types of records created in pursuance of these functions. It will show the policies and procedures in place for the appropriate storage, retention, disposal, archiving and security of these records. Page 148 of 180
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Page 27 of 33 A senior officer of the Integration Joint Board will therefore be the Records Manager and responsible for overseeing the development and implementation of the records management plan and for approving it prior to submission for the Keeper's agreement. In Midlothian, this is the Executive Business Manager. This plan was last reviewed in 2017 and must be urgently reviewed by the Executive Business Manager and the Midlothian Audit and Risk Committee prior to Board review and submission to the Keeper of the Records of Scotland for consideration and approval. Page 149 of 180
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Page 28 of 33 IJB Strategic Commissioning - sources and success criteria This table lists the sources of evidence and success criteria that we have referred to whilst developing the analysis presented in this report. What we do Stepping Stone Source Develop, agree and oversee implementation of a three year strategic commissioning plan Development process and plan SCP 2022-25 SCP 2025-35 Success Criteria The plan meets the legislative requirements for publication Agree and provide clear Directions and associated resource allocation to our LA and NHS partners that are operationally overseen by Midlothian HSCP Directions log Evidence of Directions published on our website Midlothian IJB Directions Policy Page 150 of 180
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Page 29 of 33 Success Criteria Directions are issued annually by the 31st March We maintain a log of issued Directions Establish and maintain robust governance arrangements Board meeting papers Midlothian IJB Code of Corporate Governance Midlothian IJB Committees Terms of Reference (ToR) Midlothian IJB Performance Framework Midlothian IJB Records Management Plan Midlothian IJB Risk Management Policy Midlothian IJB Scheme of Publication Midlothian IJB Standing Orders Midlothian Scheme of Integration Success Criteria All governance is reviewed and refreshed in a Page 151 of 180
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Page 30 of 33 timely way (usually every three years) The Board has the required statutory committees (Audit and Risk, Strategic Planning Group) The Board is compliant with the CIPFA Financial Management Code There is a performance framework for the IJB that provides appropriate insight There is a year on year improvement in IJB performance Page 152 of 180
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Page 31 of 33 Our evidence standards PROGRESS STATEMENT CRITERIA Great progress • Enough people and groups experience this in the timescale you have defined • Risks have been mitigated and assumptions achieved Some progress • Some people and groups experience this in the timescale you have defined • Some risks have been mitigated and some assumptions achieved Low progress • Not enough people and groups experience this in the timescale you have defined • Risks have not been mitigated and assumptions found to be unrealistic CONFIDENCE ASSESSMENT CRITERIA High confidence Most of these criteria apply • more than one source of evidence with appropriate balance of types • evidence collected purposefully and for this purpose • reasonable number of responses • no disagreement between evidence sources • backed up by other research • analysis is clear and purposeful (someone else could replicate and get broadly the same results) Page 153 of 180
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Page 32 of 33 Some confidence Some of these criteria apply • more than one source of evidence with appropriate balance of types of evidence • evidence is collected purposefully and for this purpose • reasonable number of responses • no disagreement between evidence sources • backed up by other research • analysis is clear and purposeful (someone else could replicate and get broadly the same results) And / or • there is some disagreement or lack of clarity of the findings • the data is mostly gathered opportunistically Low confidence Few of the above criteria apply AND / OR • there is disagreement within the data • assessments are based solely on an individual's perspectives Page 154 of 180
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Page 33 of 33 This report has been created using Developed by Matter of Focus. OutNav supports initiatives with a vision for social change to understand and track how their work makes a difference. The cloud-based tool enables teams to apply a practical and meaningful approach to outcomes-focused monitoring and evaluation, developed by Matter of Focus. https://www.matter-of-focus.com Page 155 of 180
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Midlothian Integration Joint Board Midlothian Integration Joint Board Thursday, 12th June 2025, 14:00-16:00 Type II Diabetes: Prevalence and Management in Midlothian Item number: 5.11 Executive summary There are currently 5.87% of Midlothian population living with Type II diabetes and 5.7% of the population with Prediabetes. This represents a substantial portion of our population that then requires intervention, support and resources. The number of cases of Type II diabetes is increasing rapidly in the UK and worldwide, associated with increasing levels of obesity and ageing populations (ScotPHO, 2025). Type II diabetes can be preventable and can be managed or reversed (in some cases) with medication, dietary and activity changes (ScotPHO, 2025). Midlothian IJB should ensure that efforts continue to concentrate on prevention and early intervention to tackle this increasing prevalence and improve quality of life. Members are asked to: • Note the report, • Endorse a continued commitment to this ongoing work, and • Discuss the potential early intervention opportunities for those in the population of ‘pre-diabetes’. Page 157 of 180
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Midlothian Integration Joint Board Report Type II Diabetes: Prevalence and Management in Midlothian 1 Purpose 1.1 The purpose of this report is to provide an overview of the prevalence of Type II diabetes in Midlothian and the current work managing Type II diabetes. 2 Recommendations 2.1 Members are asked to: • Note the report, • Endorse a continued commitment to this ongoing work, and • Discuss the potential early intervention opportunities for those in the population of ‘pre-diabetes’ 3 Background and main report 3.1 The NHS Lothian Public Health Intelligence Team has provided all of the relevant data for this report in regard to population data. 3.2 Type II Diabetes Prevalence Please note that prevalence is presented as a percentage (%) in this report. All prevalence rates are crude rates and could be impacted by the age profile of an area. This data is complete until June 2024. 3.3 Overall, there are 5,769 individuals living with Type II Diabetes in Midlothian. This equates to 5.87% of the total population. Under 18s have been removed within this dataset due to small numbers. Figure 1 shows an increase year on year suggesting the problem of Type II diabetes is worsening within Midlothian. 3.4 There is a slight difference in the prevalence by sex with Males having a slightly higher percentage rate than females. There is also a correlation with deprivation, illustrated in figure 2 by the increased percentage of cases within the lower SIMD deciles. Page 158 of 180
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Midlothian Integration Joint Board Figure 1: Prevalence of Type II diabetes in Midlothian from 2012 to 2013 Figure 2: Prevalence of Type II diabetes in Midlothian across SIMD decile 3.5 This demonstrates the need to ensure an inequalities approach is taken to our workstreams and ensure increased access for those in the most deprived areas. Page 159 of 180
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Midlothian Integration Joint Board 3.6 The prevalence by intermediate zone demonstrates the top areas with the highest percentage of their population living with Type II diabetes, the top 5 of these zones are: • Newtongrange • Straiton • Dalkeith • Loanhead • Bonnyrigg North 3.7 There is a correlation with age and Type II diabetes. As people get older, they are more likely to have Type II diabetes. 3.8 Overall, it can be seen from the data that Type II diabetes prevalence continues to increase especially in our aging populations and areas of deprivation (figure 3). Figure 3: Prevalence of Type II diabetes in Midlothian across age group 3.9 Prediabetes Prevalence in Midlothian Please note that prevalence is presented as a percentage (%) in this report. All prevalence rates are crude rates and could be impacted by the age profile of an area. The data in figures 4 and 5 is complete to May 2025. 3.10 To be defined within this data set as pre-diabetic the following conditions need to be met: • No diabetes code (Type I and Type II) in SCI-diabetes • HbA1c measure 42-47 mmol/mol OR fasting glucose within range 5.5- 6.9mmol/l • Aged over 18 Page 160 of 180
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Midlothian Integration Joint Board 3.11 Overall, there are 5,623 individuals over 18 years old with Prediabetes in Midlothian. This equates to 5.7% of the total population. 3.12 Similar to Type II diabetes, the likelihood of prediabetes also increases with age. Although it should be noted that in Prediabetes females are slightly higher than males. 3.13 In comparison to Type II diabetes group, the Prediabetes group is higher in the earlier age ranges. Those with Type II diabetes under the age of 40 account for 1% of the cases however, those who are Pre-diabetic under 40 account for 2.2% of cases, which indicates intervention is needed much earlier with those in the Prediabetes group. There is also a correlation with deprivation however, it is not as stark as with those living with Type II diabetes. Figure 4: Prevalence of Prediabetes in Midlothian across age group 3.14 The prevalence by intermediate zones demonstrates the top areas with the highest percentage of those with Prediabetes, some of these zones also have the highest prevalence of Type II diabetes as well as those also Prediabetic: • Straiton • Loanhead • Penicuik East • Penicuik Southeast • Newtongrange 3.15 Overall, the data shows that the Prediabetes prevalence is almost as high as the prevalence of Type II diabetes. Without intervention there is a high possibility that people who are pre-diabetic will go on to develop Type II diabetes. This will require Page 161 of 180
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Midlothian Integration Joint Board resources, support, and cost to Midlothian Health and Social Care Partnership (HSCP). Figure 5: Prevalence of Prediabetes in Midlothian across SIMD decile 3.16 There is significant work underway to combat the prevalence of both Type II diabetes and Prediabetes. Illustrated below are actions that focus on three areas: Prevention, Early Intervention and Mitigation. 3.17 Prevention There are key pieces of prevention work happening in Midlothian, including the Whole Systems Approach to Type II diabetes, Weight bias and conversations about weight, and the Let’s Prevent Diabetes service. 3.18 Whole Systems Approach The Better ME project is a Whole Systems Approach pilot in the Mayfield and Easthouses area, the purpose of which is to help prevent Type II Diabetes. This work was first established in 2019 as part of the implementation of the East Region Partnership National Type II Diabetes Framework. Midlothian was one of five early adopters to pilot a Whole System Approach (WSA) to diet and healthy weight. The work was paused due to COVID19 and re-commenced in January 2022. The pilot work ended in March 2025 and next steps are underway to ensure this work continues and includes all of Midlothian. 3.19 There are 3 key priority areas for this work: • Increasing access to healthy food options • Increasing opportunities to be physically active • Increasing opportunities to access money and benefits Page 162 of 180
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Midlothian Integration Joint Board 3.20 For the Whole Systems work, a contribution analysis model has been used. Contribution analysis provides a systematic way of understanding the contribution an intervention has made to observed results. It involves developing or drawing on a reasoned, plausible causal theory of how change comes about. We know that if people have opportunities for healthy food options, physical activity options, and money to keep them well, they will have a reduced risk of developing Type II diabetes or their diabetes worsening. While individual projects cannot claim to be the only contributing factor, we know that they will have contributed to that outcome. Appendices 1, 2, and 3 detail some key achievements from the work in each priority area: 3.21 Weight bias and conversations about weight In February 2025, non-reoccurring funding was secured to recruit to a 1-year post. This post allows a focus on developing and delivering training focusing on weight bias and addressing how to have positive conversations about weight. By addressing weight bias, more support can be offered for people to access services should they need them, as well as addressing the stigma that many people feel when communicating with weight services. The target areas for this work include Primary Care, Education and Children’s services. As this work develops, senior management will remain actively involved. 3.22 Let’s Prevent Diabetes Let’s Prevent Diabetes is an education programme run by the weight management service. The team identifies and supports individuals diagnosed with pre-diabetes. It is a 6-hour course delivered face to face or virtually and patients can opt for the online self-led programme (MyDesmond) as an adjunct to the Let’s Prevent group education or as a stand-alone option. Patients can enter the programme via GP referral, self- referral and other healthcare professionals. 3.23 The above details the current prevention work within Midlothian related to preventing Type II diabetes. Support and endorsement of these pieces of work are essential. Figure 6: Let’s Prevent Diabetes referral numbers Workstream No. of referrals in 24/25 Numbers enrolled Waiting time LPD 197 (12.8% of 24/25 Referrals were Mid) 38 45 weeks 3.24 Considering the Prediabetes population, and given the number of people and the length of wait time for Let’s Prevent programme, it is important for Midlothian HSCP to consider how this population is supported to prevent those whom are Pre-diabetic developing Type II diabetes. 3.25 Early Intervention Early intervention is defined as providing support for those at risk and/or living with Type II diabetes. Early intervention is hugely important in this work as it offers an opportunity to reverse Type II diabetes or prevent it worsening. Page 163 of 180
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Midlothian Integration Joint Board 3.26 DESMOND Delivered as part of weight management services work, DESMOND is a structured education programme for those with ongoing or newly diagnosed Type II diabetes. A full day educational course is offered, either face to face or online along with access to the MyDesmond app. 3.27 Remission Programme The Type II Diabetes Remission Programme is an evidenced based dietetic intervention offering structured low-calorie and low-carbohydrate dietary programme aimed at achieving remission in individuals recently diagnosed with Type II diabetes through weight loss. Patients can enter the programme via GP referral, self-referral and via other healthcare professionals. Delivery is digital with virtual (NearMe), 1:1, group and telephone appointments. Patients are closely monitored for improvements in HbA1c, weight loss, and medication changes, with many able to reduce or stop their diabetes medication. Collaboration with primary care and diabetes teams is required to adjust relevant medications and de-prescribe medicines as needed. This ensures patients receive holistic and safe care throughout the intervention and reduces the burden of polypharmacy. Psychological and behavioural support is integrated to promote long-term change and sustainability of remission outcomes. 3.28 Gestational Diabetes Pathway The Gestational Diabetes Pathway is well established with referrals received from Midwives on antenatal diagnosis of Gestational Diabetes Mellitus (GDM) who refer patients into the Diabetic Specialist Nurse (DSN) clinic and to the dietetic GDM team. Patients are contacted to book an appointment within 7 days of referral to the service. Service delivery is digital and includes an initial GDM peer group and 1:1 follow up interventions. Groups are offered throughout the week and review appointments daily including some later afternoon, early evening appointments. Patients are followed up post-partum and all patients are offered a postnatal wellbeing review. Figure 7: Desmond, remission and gestational diabetes referral numbers Workstream No. of referrals in 24/25 Numbers enrolled Waiting time DESMOND 226 (13% of 24/25 referrals were Mid) 49 Patients attended a Midlothian Group 48 weeks Remission 27 (10.2% of 24/25 Referrals were Mid) 17 23 weeks Gestational diabetes 62 (11% of 24/25 referrals were Mid) 59 Zero (nature of GDM requires treatment within 7 days of referral) 3.29 Weight management services do important work to ensure that early intervention pathways and access to services are established while working to address Page 164 of 180
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Midlothian Integration Joint Board inequalities within this population. 3.30 Mitigation Mitigation within this population is defined as support for individuals living with Type II diabetes to ensure that their condition is well managed, and they are supported to self-manage. 3.31 Weight Management Tier 2 Second Nature is a fully digital app providing initial intervention for 12 weeks with peer support and a health coach (nutritionist/dietitian) to support and lead the digital group. Patients have access to online content through the app such as recipes, exercise routines, journalling, meal planners and articles of useful information, which are released daily. After 12 weeks, the support provided by a health coach within that same digital peer support group finishes but patients have lifelong access to wider community groups, which may have a focus on different topics of support. Physical activity support is offered to patients free through a Service Level Agreement (SLA) with Midlothian leisure at all leisure centres in Midlothian. Patients have access to this Midlothian Active Choices (MAC) service via a direct referral route from weight management. 3.32 Weight Management Tier 3 Patients undergo a 1:1 60-minute initial assessment appointment with a dietitian face to face or virtually (NearMe). The core programme consists of 6 x 90-minute fortnightly group sessions over 12 weeks. Maintenance is 12 monthly group sessions. Group sessions are available virtually and F2F, group numbers average 12 - 15 per group. Patients who are identified at assessment appointments to have potential disordered eating will be referred to Weight Management Psychology for further assessment and possible completion of the 'Eat, Think, Change' group programme. The psychologists also provide regular supervision and consultation to the team to offer further indirect support. Eligible patients are offered to opt into the exercise specialist programme of an initial 1:1 assessment followed by completion of a 12-week exercise group. 3.33 Anti-obesity medicines These are now on the East Region Formulary and a short life working group is underway to develop pathways for roll-out of these medicines in line with SG phase 1 recommendations. 3.34 Learning Disability Weight Management Service This service involves carers training quarterly plus a specialist LD WM monthly clinic. Nurse led clinics continue but are locality dependent. Work is being done with the wider LD team to increase access and equitability to weight management services for individuals with a learning disability. 3.35 Fertility Non-recurring funding from the Edinburgh Fertility Centre to support specialist fertility dietitian support. Patients are offered a weight management virtual group or can be referred onto Second Nature with enhanced support from the specialist dietitian. Figure 8: Weight management tier 2 and tier 3 referral numbers Page 165 of 180
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Midlothian Integration Joint Board Workstream No. of referrals in 24/25 Numbers enrolled Waiting time TIER 2 314 Referrals to T2 Triage (11.7% of 24/25 referrals to T2 were Mid) 111 Referrals for Mid SN after Patient Focused Booking (PFB) , of which 55 also opted in to the additional physical activity programme 100 Patients in total 20 Engaged with both PA & SN 80 Engaged with SN only 59 weeks from Referral to Patient Focused Booking (PFB). No wait from option in to Assessment or registration provided we have sufficient digital places. TIER 3 T3 – 289 (13.3% of 24/25 referrals were Mid) Fertility – 13 (10.5% of 24/25 referrals were Mid) PHYSICAL ACTIVITY – 19 (8.4% of 24/25 referrals were Mid) T3 – 116 Fertility – 10 Physical Activity – 29 T3 – 93 weeks Fertility – 35 weeks Physical Activity – 23 weeks 3.36 From the above it should be noted that there is a substantial demand for weight and diabetes management, especially within mitigation. In addition, the wait time is significant for most of the services which could contribute to worsening t=Type II diabetes. 3.37 Podiatry Diabetes Service Those seen within the service are managed predominantly in the community podiatry clinics. New referrals, and complex cases, of active ulceration are managed by the Advanced Diabetes Team at acute hospital sites at the Royal Infirmary of Edinburgh, Western General Hospital and St John’s Hospital. The Diabetic Foot Clinics (DFC) aim to see all new referrals within two working days. 3.38 The podiatry service’s focus is to see anyone newly diagnosed as moderate risk and those who are high risk, in remission or have active ulceration: • Moderate Risk: has at least one risk factor, for example, loss of sensation, signs of peripheral arterial disease, is unable to or has no help to self-care or an eGFR <30. Referral to podiatry occurs when a patient is first identified as moderate risk for an agreed treatment and management plan to be put in place. • High Risk: has more than one risk factor present. The patient will be reviewed annually as a minimum according to the patients’ needs Page 166 of 180
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Midlothian Integration Joint Board 3.39 Midlothian patients with foot ulceration will predominantly attend the RIE Diabetic Foot Clinic. 3.40 Recent Service Developments These include • Dedicated inpatient capacity B7 inpatient capacity has been developed at the RIE and SJH to ensure continuity of care for patients who are admitted to hospital with a diabetic foot ulcer. Capacity for the WGH is planned to start imminently with recent recruitment to a new B7 post. • WGH/SJH Virtual MDT A new MDT has been set up to include diabetes, orthopaedic, OPAT and vascular consultants alongside podiatry to help manage the most complex cases. • High risk planned repeat list A new planned repeat list has been created to ensure requirements are met to have an annual review for high risk/in remission patients who don’t have an ongoing podiatry need. These patients all have open access to the service and will be sent an annual appointment to ensure they are not lost to follow up. • Infection pathway It has been recently agreed with OPAT to have direct referrals from Specialist and Advanced Practice Podiatrists and work is being done on a clear infection pathway to ensure patients with mild, moderate and severe infection are treated appropriately and quickly. • Charcot neuroarthropathy pathway Work is underway to have a clear pathway in place for patients who present with Charcot symptoms. This is often misdiagnosed in the early stages of the condition and can lead to significant structural deformity and higher risk of developing ulcers. • AHP Fellowship supporting developing vascular pathways A B7 Advanced Practitioner was successful in gaining a place on the AHP Fellowship where they will be working with the vascular team to develop referral pathways for the Podiatry service and extend the scope of practice for the AP’s to be able to request duplex scanning. 3.41 Referrals to the Podiatry community and diabetes services for patients with a Midlothian postcode is 177 per month, 11 per month of which are referrals to the Diabetic Foot Clinics. There are 120 appointments per month at the DFC attended by Midlothian patients. There are 210 dressing appointments per month in Midlothian community clinics, on average 30% of these will be for diabetic foot ulcers. 3.42 Summary There are currently 5.87% of Midlothian population living with Type II diabetes and 5.7% of the population with Prediabetes. This represents a substantial portion of the Midlothian population who require intervention, support and resources. Midlothian IJB and HSCP should ensure efforts are concentrated on prevention and early intervention to tackle this increasing prevalence. 4 Policy Implications Page 167 of 180
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Midlothian Integration Joint Board 4.1 Workstreams and services are delivered based on guideline recommendations including the national T2DM Framework A Healthier Future – Framework for the Prevention, Early Detection and Early Intervention of type 2 diabetes and the recently published SIGN guidelines Prevention and remission of type 2 diabetes. 5 Directions 5.1 This work relates to the following directions: • Direction 4.2 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated self-management framework that sets out an expectation of how services will work with people to be more informed about their condition(s), be better prepared for when they feel less well, and describes how to access the right support when it is needed by December 2025. • Direction 4.4 NHS Lothian and Midlothian Council will support operational services for all functions delegated to Midlothian IJB to record the impact of their contribution to health and wellbeing outcomes, and evidence how they have used this information to inform service design by December 2025. 6 Equalities Implications 6.1 All services have completed relevant Equality and Children’s Rights Impact Assessments (ECRIAs). 7 Resource Implications 7.1 There are no direct resource implications as a direct result of this report. 7.2 However, continued investment in services and investment in prevention and early intervention is required to deliver change. 8 Risk 8.1 There is a risk of continued prevalence of Type II diabetes if prevention and early intervention not prioritised. 8.2 There is a risk of increased challenge for services to meet demand if prevalence continues to rise. 8.3 There is a risk of extended wait times for people, potentially leading to poorer patient experience and outcomes. Page 168 of 180
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Midlothian Integration Joint Board 9 Involving people 9.1 Services routinely collect feedback from people who experience Midlothian HSCP services. AUTHOR’S NAME Jacqueline Kirkland DESIGNATION Public Health Practitioner CONTACT INFO Jacqueline.kirkland@nhs.scot DATE 13.5.25 Appendices: Appendix 1: Increasing opportunities for healthy eating Appendix 2: Increasing opportunities to be physically active Appendix 3: Increasing opportunities to access money and benefits Page 169 of 180
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Midlothian Integration Joint Board Appendix 1: Increasing opportunities for healthy eating Project Name Quantitative data How they Feel What they learn and gain Qualitative data Y2K – YP cooking 116 YP have taken part in cookery class 19 of those have also taken part in healthy eating workshops 65% report more confidence 85% report improved skills using equipment and ingredients ‘Participants have learned how to use spices and herbs to change flavours of leftover food to help with variety in meals while reducing food waste.’ MAEDT – Pantry 327 were people offered a pantry shop in addition to their foodbank parcel and 98% have redeemed this offer. Anecdotally report feeling less food insecurity Anecdotally report increase in food choice ‘This funding has enabled us to give a food parcel, look through it with the client to help them identify potential meals for the next few days and then offer a pantry shop to compliment the parcel. Clients have found this incredibly valuable and, when they return the next week for their second pantry shop, will often comment on how well they have eaten in the past week.’ MAEDT – Community events 20 Events 16 people on average attending each event 100% reported feeling more connected to their community 30% tried new foods ‘A chef from Poland and one from Pakistan helped our cooks to prepare the food and advised on authentic methods of preparation... These meals went down really well, with more, new customers, from the regions visiting for the meal. We were also able to talk about how the food was made and Page 170 of 180
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Midlothian Integration Joint Board Project Name Quantitative data How they Feel What they learn and gain Qualitative data (largest number 45 people and lowest number 7 people) where to source specific ingredients during the meal.’ Page 171 of 180
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Midlothian Integration Joint Board Appendix 2: Increasing opportunities to be physically active Project Name Quantitative data How they Feel What they learn and gain Qualitative data Play Midlothian – Outdoor play 97 children have taken part 91 Out2Play sessions delivered Average 8 per session 85% of recorded staff observation shows an increase in children’s’ confidence 91% of children ‘felt better about themselves’ due to attending sessions 94% of recorded staff observation shows an increase in physical activity ‘Play Midlothian staff observed a number of children talking about the Paris Olympics... Staff used this interest to encourage the children to use the resources available to create their own Olympic themed play (obstacle courses, hurdles over deck boards, target games etc). These sessions are highly accessible given they are drop-in sessions in local green spaces and incur no charge.’ P7 Transitions Programme 650 YP took part 60% reported increase extra- curricular activities at high school (an increase of 780 attendees in 2024 academic year) Anecdotally report YP enjoyed the sessions Anecdotally reported an increase social connection Anecdotally report YP feel more connected ‘The P7 transition has helped all the young people moving on from primary to secondary get to know their PE department. This has helped them boost their confidence, got to know their future peers and built up that relationship before they attend the school.’ Page 172 of 180
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Midlothian Integration Joint Board Appendix 3: Increasing opportunities to access money and benefits Project Name Quantitative data How they Feel What they learn and gain Qualitative data CAB Dalkeith – Pension Credit 22 clients and a Client Financial Gain of £85,000 >10% increase in the number of people assisted RE pension credit 25% increase in access to information 15% increase in successful claims for pension credit ‘We have provided leaflets and awareness sessions to make clients aware of PC. By our service providing holistic advice we have identified more claims.’ Page 173 of 180
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Midlothian Integration Joint Board Thursday, 12 June 2025, 14:00-16:00 Midlothian HSCP Transformation Programme Executive summary This report provides an update on the Midlothian Health and Social Care Partnership’s (HSCP’s) Transformation Programme and the work overseen by the Operational Transformation and Change Programme Board (the Programme Board). The Transformation Programme consists of 3 phases. • Phase 1: 2024/25 to deliver a range of grip and control measures across Midlothian HSCP. Some actions have been completed and some continue across 2025/26, • Phase 2: 2025-28, and • Phase 3: 2028 and beyond. The work being undertaken will deliver transformation, redesign, or change to ensure a sustainable future for integrated health and social care. New capital investment is currently unlikely, and this creates additional financial limitations. The work of the Transformation Board is in direct response to the Midlothian IJB Directions for 2025/26, specifically Direction 9.3. This includes projects that require services to develop plans for transformation, redesign, or adaptation to current service provision while continuing to deliver high-quality, person-led services. Members are asked to: • note the significant financial recovery achieved in 2024/25, the ongoing impact of financial challenges on services, and the actions being undertaken by the HSCP within the transformation projects noted, • note the continuing development of transformation plans across all three phases of the Transformation Programme, • note the growing demand and complexity of care provision and its impact on budgetary pressures, and • note the capacity challenges within the HSCP Executive Leadership Team created by simultaneously taking forward the Financial Recovery Programme and the Transformation and Change work streams. Item number: 5.12 Page 175 of 180
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Midlothian Integration Joint Board Report Midlothian HSCP Transformation Programme 1 Purpose 1.1 This report provides an update on the Midlothian Health and Social Care Partnership’s (HSCP’s) Transformation Programme and the work overseen by the Operational and Change Programme Board (the Programme Board). 2 Recommendations 2.1 As a result of this report, Members are asked to: • note the significant financial recovery achieved in 2024/25, the ongoing impact of financial challenges on services, and the actions being undertaken by the HSCP within the transformation projects noted, • note the continuing development of transformation plans across all three phases of the Transformation Programme, • note the growing demand and complexity of care provision and its impact on budgetary pressures, and • note the capacity challenges within the HSCP Executive Leadership Team created by simultaneously taking forward the Financial Recovery Programme and the Transformation and Change work streams. 3 Background and main report 3.1 Midlothian Health and Social Care Partnership (HSCP) is undertaking a significant Programme of work to deliver transformation, redesign, and change to ensure a sustainable future for integrated health and social care. 3.2 Phase 1: 0-2 years The Programme Board continues to progress work that commenced in 24/25 and oversee the development of additional plans for redesign and transformation changes. 3.3 Financial Recovery Plans agreed at the start of the 2024/25 financial year have delivered a substantial in-year saving of over £6 million. This is an unprecedented level of local financial recovery and a key achievement of the Midlothian HSCP Executive Leadership Team in 2024/25. 3.4 However, the overall financial position remains challenging. Rising demand and the increasing complexity of care has significantly increased service costs. This has Page 176 of 180
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Midlothian Integration Joint Board created delays to achieving some recovery programmes, driven by the long lead times associated with workforce redesign and organisational change processes. 3.5 The 2024/25 Quarter 3 position projected an overspend in Social Care of £5.7 million. This was primarily due to increasing demand and pressure on the Resource Panel. The final outturn position for 2024/25 within Social Care was £4.88m. 3.6 Financial Recovery Plans for 2025/26 continue to be influenced by a range of factors including • underlying pressures that were not addressed in 2024/25 now carry forward into 2025/26, • the impact of pay awards and general inflation, • the impact of demography (reflected in the observed 30% increase in demand in care hours), • the impact of Scottish Government policy and national direction where ambitions are accompanied by additional funding to deliver, and • the cost of providing care for children with Additional Support Needs as they transition to adult services. 3.7 Phase 2 and Phase 3 Work in 2025/26 will establish the longer term Transformation Workstreams that are anticipated to deliver sustainble change. Midlothian HSCP has also developed a Transformation model to identify the priorities of the Transformation Programme and help describe the necessary work to underpin changes across integrated health and social care in Midlothian. 3.8 The Midlothian HSCP Executive Leadership Team has identified a number of Workstreams to take forward in 2025-26 and beyond (Table 1). It is anticipated that these Workstreams will change and adapt over time as the work is informed by learning from continuous improvement activity. Senior Responsible Officers have been identified to lead on each Workstream and will report on progress to the Midlothian Transformation and Change Programme Board thoughout 2025-2028 Table 1: Transformation Workstreams and Senior Responsible Officers Transformation Workstream Senior Responsible Officer (SRO) Palliative Care Fiona Stratton Bed Based Provision Bruce Dickie Home First Model of Care Claire Ross Primary, Community and Social Care Rebecca Green and Fiona Kennedy Commissioning and Third Sector Gill Main and Nick Clater Community Assets Claire Ross Midlothian Community Front Door Fiona Kennedy Mental Health/Dementia Nick Clater Page 177 of 180
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Midlothian Integration Joint Board 3.9 The Midlothian Transformation and Change Programme Board has also identified several enabling factors that are essential to the delivery of the transformation. These enablers are key pillars of success, and the Transformation Programme Board will consider how to ensure the necessary resources and skills are made available to deliver the ambitions of the workstreams. This will be a challenge given the existing pressures and capacity challenges across the system. Table 2: Transformation Enablers and Senior Responsible Officers Transformation Workstream Senior Responsible Officer (SRO) Finance and Resource Chris King Business, Intelligence, and Insight Gill Main Workforce Roxanne King Carers Nick Clater Sustainability (including Digital) Claire Ross 3.10 The principles of transformation for Phase 2 are • Shift the focus away from more specialist services to a wider range of community-based services across health, social and primary care. This will take an asset-based approach to person-led care with a focus on prevention and self- management. • Shift the focus towards investing more in early intervention, self-management, education, primary care, and community services, that are based on effective models, for example the LifeCurve. • Refocus on taking an asset-based approach, to support the health wellbeing of people and communities to achieve the outcomes that matter most to them. An asset-based approach looks at the all the resources a person has available to them at an individual level (skills, capacity, knowledge, interests), an organisational level (networks and local connections), and a community level (economic resources available from organisations, public, private third sector, local places to enhance wellbeing). • Moving towards more personalised and flexible services planned around the person to provide care and support as close to home as possible. • Recognise Individuals as the experts in their own lives and support them to choose the care that is right for them. This includes supporting people to access information on Self Directed Support (SDS). • Develop a Community Front Door, often called a ‘single point of access’, to support people reach the right support first time and ensure our services offers and support are joined up and focus on early support. 3.11 In delivering the ambitions of this transformation model, Midlothian IJB can only allocate the resources made available by Midlothian Council and NHS Lothian. This will require Midlothian IJB and HSCP to consider how to strategically disinvest in some areas to allow for resources to be diverted to deliver transformation on this scale e.g., reviewing the use of the institutional bed base for both health and social care to provide this differently in future through a revised model of hospital at home (virtual Page 178 of 180
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Midlothian Integration Joint Board beds) and supporting people to stay at home or in a more homely environment for as long as possible. 3.12 Financial Sustainability and Transformation Given the size and scale of the Financial Recovery Programme in 2025/26 and to simultaneously progress the work of the Transformation Programme Board, there are both challenges and reduced capacity to take forward this work. These include • limited management capacity and operational resource, • recognition and realism of likely outputs and timeframes, • the need for balance between short term, medium term, and long-term planning. 3.13 Creating the conditions for success include ensuring wholescale commitment and support for the Transformation Programme and an appetite to consider and identify possible income streams. 3.14 As the HSCP executive Leadership Team have changed focus from achieving financial recovery plans in Quarter 4 of 2024/25 (of £6m achieved) to the transformation planning in Quarter 1 of 2025/26 there remains the requirement to deliver on financial recovery actions alongside the Workstreams within the Transformation and Change programme. 4 Policy Implications 4.1 There are no policy implications at this stage of development. 5 Directions 5.1 The work of the Midlothian HSCP Transformation Programme is in direct response to the Midlothian IJB Directions for 025/26, specifically Direction 9.3. 6 Equalities Implications 6.1 This report provides an update and narrative on work of the Operational Transformation and Change Programme Board. 6.2 However, there are elements of this report which may require new and/or revised planning, policies, procedures and provisions. Equality and Children’s Rights Impact Assessments (ECRIAs) will be undertaken for these items as they are developed. 7 Resource Implications 7.1 There are no direct resource implications as a result of this report. Page 179 of 180
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Midlothian Integration Joint Board 7.2 However, as the Midlothian HSCP Transformation Programme develops there may be a requirement to support its progress through additional programme resource or review funding allocations as part of strategic investment to achieve the ambitions of the Midlothian IJB strategic aims. 8 Risk 8.1 There is a risk that not delivering the Midlothian HSCP Transformation Programme in a timely manner will have implications for both the financial and operational sustainability of services. 9 Involving people 9.1 The senior leadership officers and their teams have been involved in developing the Midlothian HSCP Transformation Programme. 9.2 Wider public consultation and engagement on the Midlothian IJB Strategic Plan has informed the development of the Midlothian HSCP Transformation Programme. 9.3 A programme of service consultation will be developed to ensure Midlothian IJB and HSCP meets its duties in relation to community engagement, consultation and codesign. 10 Background Papers 10.1 n/a AUTHOR’S NAME Morag Barrow DESIGNATION Director of Health & Social Care CONTACT INFO Morag.Barrow@nhs.scot DATE 26/05/2025 Appendices: Page 180 of 180