Agenda Document Pack - Midlothian Integration Joint Board - 16/03/2023
Midlothian Council · 16 March 2023
Back to Midlothian Integration Joint Board — 16 March 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Notice of Special Meeting and Agenda Midlothian Integration Joint Board Venue: Virtual Meeting, Date: Thursday, 16 March 2023 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Mike Broadway Clerk Telephone: 0131 271 3160 Clerk Email: mike.broadway@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 32
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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 Public Reports 5.1 Chair’s Update – Val de Souza, Chair (2.10 - 2.20). Including the appointment of Andrew Fleming as a MIJB Voting Member and Peter Knight as a Proxy Voting Member for Nadin Akta. For Discussion 5.2 Midlothian Council Finance Update - Verbal update from David Gladwin, Acting Chief Finance Officer, Midlothian Council (2.20 - 2.40). 5.3 NHS Lothian Finance Update - Verbal update from Craig Marriot, Director of Finance, NHS Lothian (2.40 - 3.00). For Decision 5.4 Finance Update – Budget Offers from Partners for 2023/24 - Paper presented by Claire Flanagan, Chief Finance Officer (3.00 - 3.50). 3 - 18 5.5 Midlothian IJB Directions 2023/24 - Paper presented by Gill Main, Integration Manager (3.50 - 4.00) 19 - 32 ( ) - Indicative Timings 5 Private Reports No private items for discussion 6 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on: • Thursday 13 April 2023 at 14:00-16:00, MIJB Board • Thursday 11 May 2023 at 13:00–16:00, Development Workshop Page 2 of 32
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Midlothian Integration Joint Board Thursday 16th March 2023, 14:00-16:00 Finance Update – Budget Offers from Partners for 2023/24 Executive summary This report is to provide the IJB with the formal budget offer for 2023/24 from Midlothian Council and the principles and intentions set out by NHS Lothian on their indicative proposed budget offer to the IJB next financial year. The report also provides the IJB with an update on the IJBs medium term financial plan and the financial recovery plans and assumptions to support the IJB in delivering financial balance in 2023/24. Finally, the report updates the IJB on the IJBs reserves position reminding the IJB of its reserves policy and asks the IJB to agree to request options on how to mitigate the remaining financial gap be brought back to the IJB for consideration. Members are asked to: • Agree the recommendation not to accept the IJB budget offer from Midlothian Council for 2023/24 • Note the principles in the indicative NHS Lothian budget with a formal offer following in due course • Note the updated medium term financial plan projections • Note the financial recovery plans and assumptions to support the IJBs financial balance for 2023/24 • Note the IJBs provisional reserves position • Agree to request further options be brought to a future IJB meeting for the remaining financial gap for 2023/24 # Item number: 5.4 Page 3 of 32
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Midlothian Integration Joint Board Report Finance Update – Budget Offers from Partners for 2023/24 1 Purpose 1.1 This report presents the Board with confirmation on the formal budget offer to the IJB from Midlothian Council and the current indicative proposed budget offer and principles for 2023/24 from NHS Lothian. 1.2 The report also sets out the IJBs updated medium term financial plan projections and the financial recovery plans and assumptions to support the IJB balancing its budget in 2023/24. A position of the IJB reserves in included covering both general and earmarked reserves. 1.3 Finally, the reports ask the IJB to agree to request options for the remaining financial gap of £1.3m for 2023/24 be developed further and brought to Aprils IJB meeting. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Agree the recommendation not to accept the IJB budget offer from Midlothian Council for 2023/24 • Note the principles in the indicative NHS Lothian budget with a formal offer following in due course • Note the updated medium term financial plan projections • Note the financial recovery plans and assumptions to support the IJBs financial balance for 2023/24 • Note the IJBs provisional reserves position • Agree to request options for the remaining financial gap for 2023/24 be developed and assessed and brought to the IJB at its April meeting for decision. 3 Background and main report Budget Offers for 2023/24 3.1 Midlothian Council agreed their budget at Council on the 21st February 2023 following which a formal budget offer letter was issued to the IJB. Page 4 of 32
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Midlothian Integration Joint Board 3.2 This position is the formal offer from Midlothian Council for 2023/24 and it should be noted is not in line with the parameters set by Scottish Government. As reported to the IJB at its February meeting these parameters were “The funding allocated to Integration Authorities should be additional and not substitutional to each Council’s 2022-23 recurring budgets for services delegated to IJBs and, therefore, Local Authority social care budgets for allocation to Integration Authorities must be at least £95 million greater than 2022-23 recurring budgets.” 3.3 Details of the budget offer are noted in the table below and a copy of the offer letter is included as Appendix 1. £m 2022/23 56.438 In year changes through distributional changes 0.155 Base 23/24 allocation 56.593 Scottish Government Funding Changes: Living wage uplift 1.436 Free personal & nursing care 0.202 End of NR interim care funding -0.305 Total 57.926 Less -1.333 2023/24 MIJB allocation 56.593 Fig 1: Midlothian Council budget offer to the IJB 3.4 Given there is no additionality in the overall budget offer from 2022/23 and the significant financial challenges facing the IJB, as reported at the December 2022 meeting when the IJBs medium term financial plan was presented, Officers are recommending the IJB do not accept this budget offer from the Council. 3.5 NHS Lothians Board does not meet until early April 2023 after which a formal budget offer to the IJB will be provided. NHS Lothian have provided, at this stage, an indicative budget offer to the IJB which lays out the principles they are applying. This letter is attached at Appendix 2 and the table below shows this position £m Full year recurring budget 92.719 Additional resources Base Uplift 1.588 Other 0.663 2.251 2023/24 Indicative allocation 94.970 Fig 2: NHS Lothian indicative budget offer to the IJB 3.6 The indicative budget offer from NHS Lothian does follow the Scottish Governments parameters and we await their formal budget offer for 2023/24 and Page 5 of 32
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Midlothian Integration Joint Board will report this back to the IJB. It should be noted the GMS budget is uplifted separately to this budget offer. 3.7 Overall, this would make the IJB total indicative budget for 2023/24 £151.6m Midlothian Integration Joint Board 2023/24 £m Midlothian Council 56.593 NHS Budget offer excluding GMS 94.970 Midlothian IJB 151.563 Fig 3: Indicative combined IJB budget Medium Term Financial Plan 3.8 The IJBs medium term financial plan was presented back in December to the Board highlighting the financial challenges facing the IJB in 2023/24 and beyond. For 2023/24 the IJB was projecting a £4.5m financial gap. The IJBs financial plan has been refined as partners refine their financial plans. 3.9 The current IJB projections based on February 2023 iteration of partners financial plans is £4.3m, this iteration was still assuming the same IJB income assumptions based on the Scottish Governments parameters of budget offers being flat cash plus the uplift or additional funding provided for IJBs. In Figure 4 below there are 2 items within the table highlighted as changes, these are a movement regarding prescribing expenditure (recent data has informed that prescribing expenditure is likely to increase above the NHS Lothians February financial plan assumptions) and to take account of the reduction of £1.3m to the IJB budget from Midlothian Council. This moves the IJBs projected gap for 2023/24 to £6m before any recovery plans. 23/24 24/25 25/26 26/27 £m £m £m £m Total Income 152.896 152.223 153.109 154.012 Total Expenditure 157.202 158.719 162.451 166.285 Gap before savings plans (4.306) (6.497) (9.343) (12.273) Gap (%) 3% 4% 6% 8% Changes increase in prescribing expenditure (0.397) MLC budget offer (1.333) Updated Gap before savings plans (6.036) (6.497) (9.343) (12.273) Updated Gap (%) 4% 4% 6% 8% Fig 4: IJBs February iteration of financial plan with amendments Financial Recovery Plans 3.10 Since the December financial plan position was reported the HSCP Officers along with other budget managers across delegated services have been building up a range of financial recovery plans to try and get back to financial balance. You’ll see for Midlothian IJB the plans and some working assumptions which assumes financial recovery plans of £4.7m as the planning of financial recovery plan was Page 6 of 32
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Midlothian Integration Joint Board working to ensure the £4.3m projected gap and the £0.4m prescribing change could be manged next year. 23/24 24/25 25/26 26/27 £m £m £m £m Financial Recovery Plans core 1.846 hosted 0.221 set aside* 1.678 social care 0.953 Total 4.698 0 0 0 Fig 5: IJBs financial recovery plans 2023/24 3.11 Within the financial recovery assumptions above, even after the identification of financial recovery plans there was still a financial gap within set aside services. The Chief Finance Officer has discussed this with NHS Lothian’s Director of Finance. Both have agreed a shared ambition to work collaboratively to deliver a balanced outturn. On that basis the working assumption built into the financial plan is that set aside services will break even. A fuller table of financial recovery plans and assumptions is attached at Appendix 3. Reserves position 3.12 The IJB does hold both general and earmarked reserves and has a reserves policy with a minimum level of general reserves to be held being 2%. This equates to circa £3.2m. Given the financial sustainability challenges reported above it is vital we hold the general or contingency reserves at this minimum level. 3.13 A summary of the reserves position is shared at Appendix 4 and worth noting that through our earmarked reserves all COIVD funding has been utilised or reclaimed, moving into 2023/24 the IJB does not hold any COVID funding. 3.14 Planned utilisation of the earmarked reserve in year is currently projected to be £14.7m and similarly there is planned utilisation of the general reserve of £0.5m to support decisions made by the IJB previously. For the general reserve there is also a longer-term projection included within the appendix and this should be noted and considered in line with the medium term financial plan projections above. Final Financial Recovery Actions to mitigate remaining gap 3.15 With a £6m projected overspend next year and only £4.7m of financial recovery plans there remains a £1.3m financial gap that the IJB requires to decide how this is mitigated. The options are included below: 3.16 It is recommended the IJB request that Officers come back to the IJB in April with further financial recovery actions to aim to mitigate the additional financial gap. These actions should be developed further, and an assessment of the actions undertaken. Page 7 of 32
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Midlothian Integration Joint Board 3.17 This would mean at this stage the IJB does not have a balanced budget and the CFO will ensure both Partners are aware of this. The IJB at its April meeting will consider the formal budget offer from NHS Lothian and the financial recovery actions to balance the IJBs budget. Any delay to decisions on the actions will impact of the financial impact they will deliver in year. 4 Policy Implications 4.1 There are no policy implications from this report. 5 Directions 5.1 There is no implication for Direction at this stage. 6 Equalities Implications 6.1 There are no equalities implication from this report at this stage. 7 Resource Implications 7.1 The resource implication are laid out above. 8 Risk 8.1 The risks raised by this report are included within the IJB risk register 9 Involving people 9.1 The IJB papers are publicly available. 10 Background Papers 10.1 None AUTHOR’S NAME Claire Flanagan DESIGNATION Chief Finance Officer CONTACT INFO claire.flanagan@nhslothian.scot.nhs.uk DATE March 2023 Appendices: Appendix 1 – Midlothian IJB Letter 2023/24 from Midlothian Council Appendix 2 – Midlothian IJB Indicative Budget Letter 2023/24 from NHS Lothian Appendix 3 – Financial Recovery Plans Summary Appendix 4 – Draft IJB Reserves Position Page 8 of 32
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Place Financial Services Midlothian Council Midlothian House Buccleuch Street Dalkeith Executive Director EH22 1DN Kevin Anderson Tel 0131-271-3132 Fax 0131-271-3251 Your Ref: Our Ref: www.midlothian.gov.uk Midlothian 22 February 2023 Morag Barrow Chief Officer Midlothian Integration Joint Board Fairfield House 8 Lothian Road DALKEITH EH22 3AA Dear Morag ALLOCATION TO MIDLOTHIAN INTEGRATION JOINT BOARD 2023-24 Following the Council meeting on Tuesday 21st February I am writing to confirm that Council agreed an allocation to the Integration Joint Board of £56.593 million. This offer is made up as follows and includes an expectation that the Integration Joint Board will be able to transform service provision to contain costs at 2022/23 funding levels. The makeup of the allocation is as follows:- Approved Requisition 2022/23 £56.438 million In-year changes through distributional changes £0.155 million Base 2023/24 allocation £56.593 million Scottish Government Funding Changes: Living Wage Uplift net of Housing element £1.436 million Free Personal & Nursing Care Uplift £0.202 million Ending of non-recurring Interim Care funding (£0.305) million Total £57.926 million Less (£1.333) million 2023/24 MIJB Requisition £56.593 million I hope that you will understand that the offer reflects the overall financial position of the Council and the overall available Scottish Government funding for 2023-24. I would be grateful if you could confirm in due course Midlothian Integration Joint Board’s acceptance of the 2023-24 allocation. Yours sincerely Page 9 of 32
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Place Financial Services Midlothian Council Midlothian House Buccleuch Street Dalkeith Executive Director EH22 1DN Kevin Anderson Tel 0131-271-3132 Fax 0131-271-3251 Your Ref: Our Ref: www.midlothian.gov.uk Midlothian David Gladwin Acting Chief Financial Officer david.gladwin@midlothian.gov.uk cc Claire Flanagan, Chief Financial Officer Midlothian IJB Ruth Nichols, Senior Finance Business Partner Page 10 of 32
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Lothian NHS Board Finance Director’s Office Waverley Gate 2-4 Waterloo Place Edinburgh EH1 3EG Telephone 0131 536 9000 www.nhslothian.scot.nhs.uk By Email Only Letter to Chief Officer & Chief Finance Officer of Midlothian IJB Date 10 March 2023 Your Ref Our Ref Enquiries to Craig Marriott Extension 35543 Direct Line 0131 465 5543 Email Craig.Marriott@nhslothian.scot.nhs.uk Dear Colleagues, MIDLOTHIAN IJB – INDICATIVE UPLIFT FOR 2023/24 Further to NHS Lothian’s Finance and Resources (F&R) Committee on February 7th, I write to update you on the position relating to uplift to be allocated to Midlothian IJB by NHS Lothian in 2023/24. We have yet to conclude our financial planning process, and we will look to take a final iteration of the Plan through our F&R Committee on the 20th of March, with final sign off at our Board meeting on the 5thApril. The figures shared with you at this stage are therefore indicative until the final Plan has been agreed, and also the final SG uplift settlement has been confirmed after the pay uplift for 22/23 is resolved. In total, and based on the indicative 2% uplift communicated to Boards from the Scottish Government in its letter of December 15th, NHS Lothian’s uplift allocation against baseline for 2023/24 equates to £32.8m. As agreed and per previous years, we will pass through the full share of this settlement to each IJB, based on budget shares. The Plan shared at the February Committee recognised a budget of £92,719k for Midlothian IJB. Net of GMS (which will receive a separate uplift allocation) the total recurring budget equates to £79,764k, although this still includes elements of budget beyond the baseline. The total proportionate share of the indicative uplift to be passed through to Midlothian IJB has been calculated at £1,588k. We have assumed that each IJB will continue to prioritise funding of pay awards. At this stage, the Plan for Midlothian IJB shows the following share of resource requirements (see Appendix for further detail): Page 11 of 32
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Pay Uplift (@2%) £ 851k Balance of Uplift £ 737k Total Uplift £1,588k The final review of the NHS Lothian Financial Plan will conclude shortly, and further updates will be incorporated in the final iteration in terms of any agreed changes to the IJB mapping table for 2023/24 (where these are agreed with CFOs), additional savings and efficiencies identified and any further additional resourses allocated. A further update on 2023/24 budgets will be provided to you at this time. We will also update you on any changes to your budget offer, relating to additional funding expected into your base as a result of the 2022/23 pay agreement. Given that our financial planning indicates that the level of uplift is insufficient to meet all cost pressures in the system, I am keen to understand from Midlothian IJB as early as possible how its Directions will shape the delivery of efficiency savings in 2023/24 and the application of resources in support of financial balance. I would be happy to have further discussion with your IJB in advance of the final confirmation on the application of health resources in 2023/24. Yours sincerely CRAIG MARRIOTT Director of Finance Page 12 of 32
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APPENDIX 1 - 2023/24 DRAFT FINANCIAL PLAN SUMMARY BY INTEGRATED JOINT BOARDS Mid Lothian IJB £k Full Year Recurring Expenditure Budget 92,719 Baseline Pressures (1,996) Projected Expenditure Uplifts & Commitments (1,590) Growth and Other Commitments (1,539) Policy Decisions Strategic Investments 160 Essential Service Development Projected Expenditure Uplifts & Commitments (2,969) Percentage of Recurring Budget (3.2%) Projected Costs (4,965) Recurring Resources 23/24 Base Uplift @ 2% 1,588 Recurrency of 22/23 Uplift 613 Recurrency of 22/23 FP Investment 50 Non Recurring Resources 0 Additional Resources 2,251 Financial Outlook Gap before FRP's (2,713) Financial Recovery Plans 668 Financial Outlook Gap after FRP's (2,045) Percentage of Recurring Budget (2.2%) Final estimated outturn - 23/24 (2,045) Page 13 of 32
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Appendix 3 - Financial Recovery Plans 2023/24 Financial Recovery Plans Midlothian IJB Value (£m) Core Workforce 0.273 GP Prescribing 1.297 Procurement and Contracts 0.060 Capacity/Service Redesign 0.198 NHS Lothian Thematic Programmes 0.018 Core Sub total 1.846 Hosted Workforce 0.074 GP Prescribing 0.000 Procurement and Contracts 0.001 Capacity/Service Redesign 0.141 NHS Lothian Thematic Programmes 0.005 Hosted Sub total 0.221 Set Aside Workforce 0.238 Acute Medicines 0.056 Procurement and Contracts 0.007 Capacity/Service Redesign 0.000 NHS Lothian Thematic Programmes 0.006 Other * 1.372 Set Aside Sub total 1.678 Social Care Workforce 0.192 Procurement and Contracts 0.161 Capacity/Service Redesign 0.600 Social Care Sub total 0.953 Grand Total 4.697 Page 15 of 32
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Appendix 4 - Draft Reserves Position 23/24 Earmarked Reserves £m Opening balance 2022/23 17.641 Drawn down or planned to utilise in year 14.709 DRAFT closing balance 2.932 Earmarked Funding in Reserves TEC project 0.208 GP & GP premises 0.180 Mental Health recovery & renewal 0.242 Carers act 0.679 Integrated care fund 0.399 Wellbeing service funding 0.242 Interim care 0.450 Big lottery funding 0.049 Community living support fund 0.307 Other 0.177 Commitments in place for future years 2.932 Balance 0.000 23/24 24/25 25/26 26/27 General Reserves £m £m £m £m £m Opening balance 2022/23 5.870 5.376 3.852 3.297 2.709 Drawn down or planned to utilise in year 0.494 0.524 0.555 0.588 0.624 DRAFT closing balance 5.376 4.852 3.297 2.709 2.085 Reserve Policy @ 2% 3.200 3.200 3.300 3.300 Position against Policy 1.652 0.097 (0.591) (1.215) Analogue to Digital alarms Est 1.000 Care at Home block contracts OutNav Balance 3.852 3.297 2.709 2.085 * actual reserve balances will be finalised at year end Page 17 of 32
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Midlothian Integration Joint Board Thursday 16th March 2023, 14:00 – 16:00 Midlothian IJB Directions 2023-24 Executive summary IJBs, Health Boards and Local Authorities have a legal obligation to both issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. Midlothian IJB Directions for 2022-23 were issued to the Chief Executives of Midlothian Council and NHS Lothian. Proposed Directions for 2023-24 are presented for approval (appendix 1) following a collaborative development and governance process. A series of workshops and development sessions with the HSCP executive team and IJB Board members took place between September 2022 and January 2023. The Strategic Planning Group (SPG) scrutinised the first draft of the Midlothian IJB Directions 2023-24 on 26th January 2023 and recommended this draft for IJB consideration. SPG reviewed amendments and revisions on 23rd February 2023 who recommended Direction be returned to the Board for approval. to provide assurance and the Board approve to seek approval before publication on 1st April 2023. Board members are asked to: • Consider and approve the presented Directions for 2023-24 • Give delegated authority to issue these Directions for 2023-24 to the Chief Executives of NHS Lothian and Midlothian Council on 31st March 2023 Item number: 5.5 Page 19 of 32
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian IJB Directions 2023-24 1 Purpose 1.1 This report presents the proposed Midlothian Integration Joint Board Directions 2023-24. 2 Recommendations 2.1 As a result of this report what are Members being asked to:- • Consider and approve the presented Directions for 2023-24 • Give delegated authority to issue these Directions for 2023-24 to the Chief Executives of NHS Lothian and Midlothian Council on 31st March 2023 3 Background and main report 3.1 IJBs have a legal duty to both issue Directions and monitor their effectiveness, as described in the Public Bodies (Joint Working) (Scotland) Act 2014. 3.2 Directions are how the IJB action their strategic plan to achieve their aims. Directions are also an important part of governance and accountability between the IJB, the Health Board and the Local Authority. They are the legal basis on which the Health Board and the Local Authority deliver services that are under the control of the IJB. They are also a legal record of the Health Board and the Local Authority responsibility in relation to audit, finance and decision-making. 3.3 In line with the IJB’s ambition to reduce the number of Directions issued by the Board, a more strategic focus is taken for 2023-2. Proposed Directions for 2023-24 are presented for approval (appendix 1) following a collaborative development and governance process. A series of workshops and development sessions with the HSCP executive team and IJB Board members took place between September 2022 and January 2023. 3.4 The Strategic Planning Group (SPG) scrutinised the first draft of the Midlothian IJB Directions 2023-24 on 26th January 2023 and recommended this draft for IJB consideration. SPG reviewed amendments and revisions on 23rd February 2023 who recommended Direction be returned to the Board for approval. to provide assurance and the Board approve to seek approval before publication on 1st April 2023 Page 20 of 32
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Midlothian Integration Joint Board 4 Policy Implications 4.1 This paper supports the strategic Direction of the IJB and relates to the Public Bodies (Joint Working) (Scotland) Act 2014. (section 26 and 26) and the requirement for Directions from Integration Authorities to Health Boards and Local Authorities. 4.2 Statutory Guidance (2020) on Directions from integration authorities to health boards and local authorities how to improve practice in the issuing and implementation of Directions issued under the Public Bodies (Joint Working) (Scotland) Act 2014. 5 Directions 5.1 This report proposed the IJB Directions for 2023-24. 6 Equalities Implications 6.1 There are no specific equalities implications from this report. All Directions are designed to progress the ambitions of the 6 strategic aims of the Midlothian Integration Joint Board Strategic Commissioning Plan 2022-25. An IIA has been published in relation to this plan. 6.2 Health and Social Care Partnership service strategy, policy, plans, provisions, practices, and activities that relate to these Directions and the Strategic Plan should be subject to a screening process to determine if an Integrated Impact Assessment (IIA) is required. 7 Resource Implications 7.1 Directions should include the financial resources available for carrying out the functions that are the subject of the Directions, including the allocated budget and how that budget is to be used, whether this is a payment, or a sum set aside and made available. Indicative funding by service area is provided in Appendix 1. 8 Risk 8.1 IJBs, Health Boards and Local Authorities have a legal obligation to issue and monitor the effectiveness of Directions as described in the Public Bodies (Joint Working) (Scotland) Act 2014. Not complying will pose legislative risks and it will be more difficult for the IJB to undertake its duties related to accountability and good governance. Page 21 of 32
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Midlothian Integration Joint Board 9 Involving people 9.1 Community, staff and stakeholder engagement on the planning and review of services related to Directions will continue. 9.2 The Strategic Planning Group will review the progress towards these Directions and continually monitor the requirement to make recommendation to the Board in regards and necessary revision or addition to the IJBs Directions. 10 Background Papers AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO gill.main3@nhslothian.scot.nhs.uk DATE 06/03/2023 Appendix 1: Midlothian Integration Joint Board Directions 2023-24 Page 22 of 32
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Midlothian Integration Joint Board Directions 2023-24 Page 23 of 32
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MIJB_Directions2023-24_v1 Introduction Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian in 2015. The IJB plans and directs health and social care services for the people of Midlothian using the integrated budget received from Midlothian Council and NHS Lothian. The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to allocate these resources in line with its objectives and strategic aims. The Midlothian IJB Strategic Commissioning Plan 2022-25 focus on prevention, early intervention, recovery, and self-management. Increase people’s support and opportunities to stay well, prevent ill or worsening health, and plan ahead. Enable more people to get support, treatment and care in community and home-based settings. Increase people’s choice and control over their support and services. Support more people with rehabilitation and recovery. Improve our ability to promote and protect people's human rights, including social and economic rights and meet our duties under human rights law through our services and support. Expand our joint working, integration of services, and partnership work with primary care, third sector organisations, providers, unpaid carers, and communities to better meet people’s needs. Directions are the mechanism by which Integrated Authorities communicate their priority actions to both Midlothian Council and NHS Lothian. Midlothian IJB Directions for 2023-24 ask services to accelerate existing integrated practice and collaborative working to deliver positive change and improve outcomes for people and communities as quickly as possible. Current financial challenges mean that services must evolve in new and increasingly innovative ways while continuing to provide safe, high-quality care and support. The financial values (‘budgets’) attached to these Directions are based on the a) Midlothian Council’s budget proposition of £56,593,000 was/was not formally accepted agreed by the IJB at its meeting on 16th March 2023. b) The indicative 2023-24 NHS Lothian budgets from the February Finance and Resources committee is £94,970,000. NHS Lothian will approve their 2023-24 budget at the 5th of April 2023 meeting of their Board. These values are therefore indicative. Indicative funding allocations can be found in Appendix 1 1 4 3 2 5 6 Page 24 of 32
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1.1 All services delegated to Midlothian IJB must demonstrate through service planning and reporting how they have increased collaborative and integrated working that improves population health and wellbeing, by January 2024 1.2 To support proactive population approaches to health, wellbeing and wellness, services should ensure service planning demonstrates reduced medicalisation of non-medical issues, by January 2024. 2.1 All services delegated to Midlothian IJB must evidence the connection with communities, partners, and use of technology to improve self-management and self-monitoring, by January 2024. 2.2 All services delegated to Midlothian IJB must ensure service planning describes a clear process to ensure fair access, by January 2024. 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. Page 25 of 32
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3.1 All services delegated to Midlothian IJB will contribute to the IJBs ability to describe activity, experience, and outcomes. Services must use and develop outcome mapping, by January 2024. 3.2 All relevant services delegated to Midlothian IJB must develop and demonstrate an increase in the effective and proactive outreach to people living with frailty, by January 2024. 3.3 All services delegated to Midlothian IJB should review practices and further develop person-centred approaches to support recovery including The Midway and Good Conversations approach, by January 2024. 4.1 NHS Lothian and Midlothian Council must ensure accessible feedback mechanisms for all people and communities by January 2024 in order to develop innovative, integrated service offers and supports. 4.2 In order to maximise opportunities to improve personal outcomes, all services delegated to Midlothian IJB should ensure that the principles of self-management are embedded in service delivery design, by January 2024. 4.3 All relevant services delegated to Midlothian IJB should evidence how they are sharing information about Self Directed Support (SDS) options, and recording changes in uptake, by January 2024. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. Page 26 of 32
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5.1 NHS Lothian and Midlothian Council must ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring • systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics • health and social care workforce are suitably trained and skilled to gather and input this data, and • data quality assurance, by January 2025. 5.2 NHS Lothian and Midlothian Council must explore opportunities for integrated system- wide digital solutions and create an action plan of jointly agreed priorities by January 2024. 6.1 All services delegated to Midlothian IJB that aim to move care from hospital to home should ensure service planning considers the impact of this on unpaid carers, and evidence appropriate supportive actions, by January 2024. 6.2 Explore and define the demand for and the benefit of a Midlothian Care and Support Co- operative in order to provide a platform that facilitates brokerage of personalised support for carers, identifies local assets, and enhances local economic value by January 2024. 5 Health Inequalities Health & social care services contribute to reducing health inequalities 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Page 27 of 32
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7.1 All relevant services delegated to Midlothian IJB must explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to traditional referral pathways, by January 2024. 7.2 Where there is a statutory responsibility to manage harmful behaviours, all services must communicate the impact of action taken to maximise people's safety in our communities, by January 2024. 7.3 Services should improve the people who use substances’ understanding of their rights and responsibilities in relation to supported self-assessment and risk management, by January 2024. Services should evaluate the relationship between this work and any reduction in harm or improvements in personal outcomes 8.1 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the integrated Midlothian HSCP Staff Engagement Plan 2023-24. 8.2 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Workforce Plan 2022-25. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Page 28 of 32
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9.1 Maximise opportunities to work collaboratively across Lothian to design an approach and methodology to better understand and evidence the use of the set aside budget and associated services by HSPC area. This should include mechanism to better understand the impact of community prevention and early intervention activity across the whole system. 9.2 All services delegated to Midlothian IJB must be able to demonstrate Best Value with evidence-based data and meet cost efficiency targets in 2023-24, 2024-25, and 2025-26. This Direction describes the action required in relation to the other core and hosted services delegated to Midlothian IJB. A number of these services are included in Directions 1 to 9 and describe the required service redesign and transformation. Services delegated to Midlothian IJB are detailed in the Midlothian Integration Scheme. All services, including hosted services, should be provided in accordance with legislation, policies, and procedures. Unless specified in the accompanying Directions, services should continue to be provided to high standards within the available budgets. All services should provide information on both activity and outcomes for service offers and supports delivered to improve the health, wellbeing and wellness of the people and communities of Midlothian. Services delegated to the IJB from NHS Lothian within the Integration Scheme are detailed below Provision for people over the age of 18 1. Accident and Emergency services provided in a hospital. 2. Inpatient hospital services relating to the following branches of medicine a. general medicine b. geriatric medicine c. rehabilitation medicine d. respiratory medicine; and 9 Use of Resources Resources are used effectively and efficiently. 10 Delegated Functions Core and hosted services within the NHSL Lothian and Midlothian Council Integration Scheme are detailed below Page 29 of 32
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e. Psychiatry of learning disability 3. Palliative care services provided in a hospital 4. Inpatient hospital services provided by General Medical Practitioners. 5. Services provided in a hospital in relation to an addiction or dependence on any substance. 6. Mental health services provided in a hospital, except secure forensic mental health services. 7. District nursing services 8. Services provided out with a hospital in relation to an addiction or dependence on any substance. 9. Services provided by allied health professionals in an outpatient department, clinic, or out with a hospital. 10. The public dental service. 11. Primary medical services provided under a general medical services contract, and arrangements for the provision of services made under section 17C of the National Health Service (Scotland) Act 1978, or an arrangement made in pursuance of section 2C(2) of the National Health Service (Scotland) Act 1978 12. General dental services provided under arrangements made in pursuance of section 25 of the National Health (Scotland) Act 1978(27). 13. Ophthalmic services provided under arrangements made in pursuance of section 17AA or section 26 of the National Health Service (Scotland) Act 1978(28). 14. Pharmaceutical services and additional pharmaceutical services provided under arrangements made in pursuance of sections 27 and 27A of the National Health Service (Scotland) Act 1978 15. Services providing primary medical services to patients during the out-of-hours period. 16. Services provided outwith a hospital in relation to geriatric medicine. 17. Palliative care services provided outwith a hospital. 18. Community learning disability services. 19. Mental health services provided outwith a hospital. 20. Continence services provided outwith a hospital. 21. Kidney dialysis services provided outwith a hospital. 22. Services provided by health professionals that aim to promote public health Provision for people under the age of 18 1. Primary medical services and general medical services (including generally practitioner pharmaceutical services) 2. General dental services, public dental services, and the services provided by the Edinburgh Dental Institute 3. General ophthalmic services 4. General pharmaceutical services 5. Out of hours primary medical services 6. Learning disabilities 7. Health visiting 8. School nursing Page 30 of 32
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Services delegated to the IJB from Midlothian Council within the Integration Scheme are detailed below 1. Social work services for adults and older people 2. Services and support for adults with physical disabilities and learning disabilities 3. Mental health services 4. Drug and alcohol services 5. Adult protection and domestic abuse 6. Carers support services 7. Community care assessment teams 8. Support services 9. Care home services 10. Adult placement services 11. Health improvement services 12. Aspects of housing support, including aids and adaptations 13. Day services 14. Local area co-ordination 15. Respite provision 16. Occupational therapy services 17. Reablement services, equipment, and telecare 18. Justice social work services Page 31 of 32
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MIJB_Directions2023-24_v1 Appendix 1: Funding Allocation TBC Page 32 of 32