Agenda Document Pack - Midlothian Integration Joint Board - 21/03/2024
Midlothian Council · 21 March 2024
Back to Midlothian Integration Joint Board — 21 March 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Notice of Meeting and Agenda Midlothian Integration Joint Board Venue: Council Chambers/Hybrid, Midlothian House, Dalkeith, EH22 1DN Date: Thursday, 21 March 2024 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 58
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1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting No items for discussion 5 Public Reports 4.1 Chair’s Update by Councillor McManus 4.2 Midlothian IJB Outturn Projection 2023-24, report by Chief Finance Officer (Interim) 3 - 8 4.3 2024/25 Budget Offers from Midlothian IJB’s Funding Partners, report by Chief Finance Officer (Interim) 9 - 20 4.4 Midlothian IJB Budget Setting 2024/25, report by Chief Finance Officer (Interim) 21 - 58 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting will be held on Thursday 18 April 2024 at 2pm. Page 2 of 58
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Midlothian Integration Joint Board Thursday, 21St March 2024, 14:00-15:00 Midlothian IJB 2023/24 Out-turn Projection Executive summary This paper considers the IJB’s projected out-turn position for 2023/24. The final financial position for the IJB will be supplied by the IJB’s partners by the end of May 2024. This projected out-turn is therefore remains an estimate, but Midlothian IJB must note this position for two key reasons 1. The significant recurrent overspend in the IJB’s social care budget in 2023/24 means that a recovery programme is necessary. A financial recovery programme alongside the requirement to find additional efficiencies to support further financial pressures in 2024/25 will result in a very challenging savings target for 2024/25. 2. The IJB has reserves. These reserves are required to be used in 2023/24 to allow the IJB to break-even. The result is that the IJB will not have any uncommitted reserves in 2024/25 with which to support the savings programmes in that year. Members are asked to: • Note the projected financial out-turn for 2023/24. • Note that the IJB’s available reserves will all be used in 23/24 (based on the current forecast). # Item number:4.2 Agenda number Page 3 of 58
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Midlothian Integration Joint Board Report Midlothian IJB 2023/24 Out-turn Projection 1 Purpose 1.1 This report sets out the projected out-turn for the IJB for the financial year ending 31st March 2024. The report notes that supporting the overspend year-end position will utilise all of the IJB’s available reserves. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the projected financial out-turn for 2023/24. • Note that the IJB’s available reserves will all be used in 23/24 (based on the current forecast). 3 Background and main report 3.1 Midlothian IJB’s partners (Midlothian Council and NHS Lothian) provide regular updates which provide estimated financial out-turns for the current financial year (2023/24). The quarter 1 position was reported to the IJB on 24th August 2023. This projected an out-turn position of an overspend of c. £7.9m consisting of an overspend of £3.4m within the IJB’s health budgets, and £4.5m within the IJB’s social care budget. 3.2 The quarter 2 reported to Midlothian IJB on 21st December 2023. This showed a projected overspend of c. £8.7m consisting of c. £3.2m in the IJB’s health budgets, and £5.5m within the IJB’s social care budgets. 3.3 Quarter 3 information is now available. This shows an overspend of £6.6m, consisting of £2.6m in the IJB’s health budgets, and £4.0m in the IJB’s social care budgets. The variances in each budget line are shown below (brackets are overspends) £000's Health Core (1,267) Hosted 376 Set Aside (1,686) Social Care (4,012) Total (6,590) Page 4 of 58
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Midlothian Integration Joint Board 3.4 The Midlothian HSCP management team and partners who deliver the IJB’s services have been working on improving this financial position. It is possible that this position may see some improvement when finally reported in May 2024. 3.5 The main drivers of the overspend within the IJB’s health budgets are within the Set Aside Budgets. These are the budgets for those functions delegated to the IJB which are managed by the Acute Management Teams at the Royal Infirmary of Edinburgh and the Western General Hospital. The major overspends being within Diabetes & Endocrinology, ED & minor injuries, Gastroenterology and General Medicine. 3.6 It should be noted that the Set Aside budget model has been revised and a new budget model has been applied to the 2024/25 budgets. This is discussed further as part of the IJB’s 2024/25 budget offers. 3.7 The main financial pressures with Midlothian IJB’s health community services are the IJB’s prescribing budget, driven by increased demand and demographic pressures. 3.8 Previous finance papers presented to Midlothian IJB have discussed the difficulty in forecasting the social care costs however, it is clear that there is a very significant overspend in the current financial year. There are three main drivers behind this position. a. Unfunded inflationary pressures: These are unfunded pay awards and unfunded inflationary costs which are incurred by the third party service providers who provide the majority of adult social care. Midlothian IJB members will recall the budget settlement for 2023/24 which generated a significant financial pressure. b. Unfunded demographic pressures: Midlothian has the fastest growing population in Scotland. This will be exacerbated in coming years with the planning housing developments required by the National Planning Framework. Additionally, Midlothian’s ageing population will create an additional pressure through the increased demand on health and social care support alongside rising absolute population numbers and increasing overall pressures on health and social care services c. Covid-19: The increased delivery costs of managing Covid in the general population and associated service changes remain considerable. However, the funding to manage these costs has since been withdrawn. Work continues to quantify the costs above to ensure that further financial planning takes these pressures into consideration. 3.10 Midlothian IJB had £13.2m of reserves at the start of the financial year. These were split into the two elements of earmarked reserves (funds held for specific purposes), and general reserves (funds available to be utilised by the IJB). The earmarked reserves are being utilised during the current financial year and it is estimated that by 31/3/24 only c. £1.0m will remain. This residual value will be carried forward into 2024/25 but can only be used for the purpose for which the funds were allocated initially. This was detailed in the finance paper presented to Midlothian IJB on 8th February 2024. Page 5 of 58
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Midlothian Integration Joint Board 3.11 The IJB has agreed that it will fund some of the Planning, Performance, and Programme service from its general reserves. The costs to Midlothian of its contribution to this team in 2023/24 are estimated at £413,000 and therefore by 31/3/24 the balance in the IJB’s general reserve will be c. £5.8. 3.12 Midlothian IJB is governed by its Integration Scheme. This scheme described the agreements between Midlothian Council and NHS Lothian as to how the IJB should manage any year-end overspends. Section 9.14.1 lays out that ‘where an overspend occurs at the end of the financial year end, and there are insufficient available reserves to meet the overspend then the Parties may make additional payment to the Board [IJB]’. Given that the projected overspend is currently in excess of the available reserves then it is now presumed that all reserves will be utilised to underpin the year end position. 3.13 Both partners have been approached laying out this position. The partners are currently discussing the disbursement of the IJBs reserves and any further allocations that they may need to make to support the 23/24 position. Once this work has been completed, the position will be reported to the IJB. 3.14 Midlothian IJB has, as a matter of good practice, a reserves policy. This states that the IJB should endeavour to hold a general reserve of 2% of its turnover (c. £3.5m). Although this is the ambition of Midlothian IJB, there is no statutory requirement to hold such reserves. These reserves are part of the financial risk management of the IJB and, given that the reserves are no longer available, this additional financial risk is now part of the IJB’s future financial planning. 4 Policy Implications 4.1 There are no new policy implications in this report. 5 Directions 5.1 This report does not impact on any of the IJB’s current Directions nor require an additional Direction 6 Equalities Implications 6.1 This report has no implications on equalities. However, the any reduction in funding to the Planning, Performance and Programme service funding may result in a reduced ability for Midlothian IJB to meet statutory duties in relation to Mainstreaming Equalities, the Equality Duty, and Community Engagement activity that may include people with protected characteristics. Page 6 of 58
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Midlothian Integration Joint Board 7 Resource Implications 7.1 Resource implications are set out above in relation to the IJB’s projected in-year financial position. 8 Risk 8.1 Financial risks are already recorded on the IJB’s risk register. 9 Involving people 9.1 This report has been written following a range of consultations with Midlothian IJB members, the Boards partners, and the HSCP management team. 10 Background Papers 10.1 IJB Financial Reports, December 2023 and February 2024. IJB financial workshop 29/2/24. AUTHOR’S NAME David King DESIGNATION Interim Chief Finance officer CONTACT INFO David.king4@nhslothian.scot.nhs.uk DATE March 2024 Appendices: None. Page 7 of 58
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Midlothian Integration Joint Board Thursday, 21st March 2024, 14:00-15:00 2024/25 Budget Offers from Midlothian IJB’s Funding Partners Executive summary Midlothian IJB receives its funding from its statutory partners - Midlothian Council and NHS Lothian. The partners have made offers to the IJB for 2024/25 and Midlothian IJB must now consider these offers prior to setting its own 2024/25 budget. The offer from Midlothian Council is final in that Midlothian Council has now set its own 2024/25 budget. NHS Lothian will set a budget for 2024/25 at its April Board meeting but it has provided the IJB with an indicative offer. The IJB applies two tests to the partners offers, these being that the offer complies with the Scottish Government’s guidance, and that the partner is offering the IJB what it has available. It should be noted that Midlothian Council’s offer considerably exceeds the first test. Members are asked to: • Note the budget offers and the details behind them. • Accept Midlothian Council’s formal budget offer for 2024/25 • Accept NHS Lothian’s Budget indicative budget offer for 2024/25. # Item number: 4.3 Agenda number Page 9 of 58
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Midlothian Integration Joint Board Report 2024/25 Budget Offers from Midlothian IJB’s funding Partners 1 Purpose 1.1 This report sets out the 2024/25 budget offers from Midlothian IJB’s funding partners - Midlothian Council and NHS Lothian. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the detail behind the partner’s budget offers for 2024/25 • Accept Midlothian Council’s 2024/25 formal budget offer • Accept NHS Lothian’s indicative 2024/25 budget offer 3 Background and main report 3.1 Midlothian IJB has been delegated a range of health and social care functions from its partners NHS Lothian and Midlothian Council. In order to plan for the delivery of these functions the IJB receives funding from both of these bodies. Midlothian Council have now made a formal budget offer to the IJB having set their own budget for 2024/25. NHS Lothian have provided an indicative offer for 2024/25. NHS Lothian will set a budget for 2024/25 at their April Board meeting. 3.2 The IJB applies two tests to the partners’ budget offers, these being compliance with the Scottish Government’s own budget settlement letters to the NHS, and a more subjective test of ‘fairness’. The latter test is a mechanism to reflect that the funding partner can only pass on what they themselves have been given through the Scottish Government’s budget settlement. 3.3 NHS Lothian has now revised its budget setting model for the Set Aside budget, following a request to do so by the 4 Lothian IJB Chief Officers. The original model set up in 2014 reflected on the theoretical delegation of ‘acute’ functions and tried to match these to the appropriate budgets. This has been a work-in-progress and NHS Lothian has now finished a detailed review. Although this reduced the Set Aside budget, it more accurately reflects the budgets for the delegated functions, will reduce the charges against these budgets, and reduce the overall impact of the financial pressure on the 4 Lothian IJBs. 3.4 Given this adjustment above, the NHS Lothian offer is effectively flat, recognising that this is the budget settlement that they themselves have available. That said, the Scottish Government have committed to funding pay awards made in 2024/25 Page 10 of 58
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Midlothian Integration Joint Board to NHS staff and NHS Lothian are clear in their budget offer that any such pay award funding will be appropriately passed onto the IJB. 3.5 The Scottish Government settlement to the Local Authorities was also effectively flat. However, the Scottish Government also made funds available to allow the providers of social work to pay their staff the Real Living Wage (RLW) of a minimum of £12-00 per hour, and an additional uplift to the allowance for free personal and nursing care. These funds were to be passed on to the IJB. 3.6 Midlothian Council’s offer is as follows :- £000's Notes Baseline 56,593 Minor in year adjustment -24 Pay Uplift 23/24 794 1 Revised baseline 57,363 Adjustment for Employers Pension contributions -669 2 Pay Uplift (3%) 664 3 RLW Funding 3,344 4 FPNC 164 4 Transitions 500 5 Elderly Demographic 1,000 5 Contractual & Other Inflation 1,168 5 Budget offer 63,534 Notes – Note 1: In 23/24, the Scottish Government has made funds available to Local Authorities to reflect that the pay awards are greater than the original assumptions. As part of the 23/24 budget setting the Scottish Government did not make any pay award funding available and considered that an indicative 3% award had to be found within the Councils own resources. Funds made available in year are for the additionality (that is the amount over 3%) in the pay award settlement in 2023/24. The funds above being the social care element. Note 2: The cost of employing a member of staff is the total of the costs of their pay plus the employer’s contribution towards the employee’s pension and a contribution towards the employee’s National Insurance payments. A review of the Local Authority pension fund has indicated that these funds are now over- provided for their future pension commitments. As a result, the employer’s contribution has now been reduced and this reduces the total cost of employing a member of staff. Therefore, although the budget is reduced, the staffing costs are also reduced, and this adjustment has no impact on the IJB’s overall financial position. Note 3: These are additional funds to support the 24/25 pay awards. These funds have come from within the Council’s own resources, and this has a positive impact on the IJB’s financial position. Page 11 of 58
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Midlothian Integration Joint Board Note 4: The Council has passed through, in full, the Scottish Government funds for RLW and FNPC. These funds will then be passed onto the providers of social care. Although the net impact is zero, it is very helpful to have these funds which otherwise would have created additional pressures. Note 5: These are additional funds, not in the IJB’s original 2024/25 forecasts and will be used to resolve a significant range of pressures. 3.7 Midlothian Council’s budget offer contains an additional £3.3m of ‘new’ monies which had not been in the IJB’s opening 2024/25 plans. These funds are very welcome. Given the above, it is clear that both parties have passed the budget offer ‘tests’ and the IJB should now accept these offers. 3.9 In summary the opening IJB budget for 2024/25 is as follows – Summary Proposed Budgets 2024/25 £000's Core 66,180 Hosted 12,292 Set Aside 16,434 Total Health 94,906 Social Care 63,534 Total Opening Budget 158,440 This includes an indicative allocation for GMS (General Medical Services, the running costs of the GP Practices in Midlothian), the allocation from the Scottish Government for GMS for 2024/25 will not be received until the new financial year. 3.10 The budget offers from both parties are attached. 4 Policy Implications 4.1 There are no direct policy implications in relation to this report. 5 Directions 5.1 This report does not impact on any current Direction or require any further Direction to be issued. 6 Equalities Implications 6.1 This report does not have direct impact on people with protected characteristics. 7 Resource Implications 7.1 The resource implications are described above. Page 12 of 58
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Midlothian Integration Joint Board 8 Risk 8.1 Financial risks are included in the IJB’s risk register. 9 Involving people 9.1 This report has been written following a range of consultations with Midlothian IJB members, the Boards partners, and the HSCP management team. 10 Background Papers None AUTHOR’S NAME David King DESIGNATION Interim Chief Finance Officer CONTACT INFO David.king4@nhslothian.scot.nhs.uk DATE March 2024 Appendices: Appendix 1: Letter from David Gladwin (CFO, Midlothian Council) – Budget Offer for 2024/25 from Midlothian Council. Appendix 2: Letter from Craig Marriott (Director of Finance, NHS Lothian) – Indicative Budget offer for 2024/25 from NHS Lothian. Page 13 of 58
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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 29 February 2024 Morag Barrow Chief Officer Midlothian Integration Joint Board Fairfield House 8 Lothian Road DALKEITH EH22 3AA Dear Morag ALLOCATION TO MIDLOTHIAN INTEGRATION JOINT BOARD 2024-25 Following the Council meeting on Tuesday 27th February I am writing to confirm that Council agreed an allocation to the Integration Joint Board of £63.546 million. This offer is made up as follows and includes an expectation that the Integration Joint Board will be able to transform service provision to contain costs within this financial envelope. The makeup of the allocation is as follows: £m Approved Requisition 2023/24 56.593 Minor in-year changes (0.024) Additional pay funding 0.794 Base 2023/24 allocation 57.363 Employers Pension Contribution change (0.669) Pay uplift (3%) 0.664 Scottish Government funding for £12 per hour for commissioned services 3.344 Pree Personal Nursing Care uplifts 0.164 Children to Adulthood transitions for clients with complex additional support needs 0.500 Elderly Demographic pressures 1.000 Contractual and other inflation costs 1.168 2024/25 MIJB Requisition 63.534 The offer exceeds Scottish Government minimum funding expectations for IJB’s, as outlined in the Deputy First Ministers, letter by £3.3 million. I would be grateful if you could confirm Midlothian Integration Joint Board’s acceptance of the 2024-25 allocation. Page 15 of 58
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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 Yours sincerely David Gladwin Chief Financial Officer and Section 95 Officer david.gladwin@midlothian.gov.uk cc David King, Interim Chief Finance Officer, Midlothian Integration Joint Board Ruth Nichols, Senior Finance Business Partner Page 16 of 58
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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 Date 29 February 2024 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 BUDGET FOR 2024/25 Further to NHS Lothian’s Finance and Resources (F&R) Committee on February 14th, I write to update you on the position relating to Midlothian IJB in 2024/25. 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 27th of March, with final sign off at our Board meeting on the 24th April. The figures shared with you at this stage are therefore indicative until the final plan has been agreed. Further to the Scottish Government Budget announcement on 19th December 2023, 4.3% uplift for Health Boards in 2024/25 was set out. However, this is not new resource rather a reinstatement of resource received in 2023/24. The Scottish Government have also set out that further funding support will be made available to Boards for any pay awards made for 2024/25. As in previous years, we will pass through the share of this settlement to each IJB, based on budget shares. The IJB mapping table used to collate the delegated IJB budget, and the consequential share of costs has been through a routine review and update following external audit recommendations in 2023 and at the request of Chief Finance Officers (CFOs). This updated mapping table has been used to review the latest financial plan position by IJB. The Plan shared at the February Committee recognised a budget of £94,342k for Midlothian IJB. This budget figure includes GMS elements which are non recurring in nature and other additional non recurring budget adjustments with Table 1 showing the breakdown. Page 17 of 58
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The final review of the NHS Lothian Financial Plan will conclude shortly, a further update on 2024/25 budgets will be provided to you at this time. We will also update you on any changes to your budget offer as a result of the 2024/25 pay agreement. I am keen to understand from Midlothian IJB as early as possible how its Directions will shape the delivery of financial recovery savings in 2024/25 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 2024/25. Yours sincerely CRAIG MARRIOTT Director of Finance Table 1: Budget for Midlothian IJB 24/25 Status Allocation Midlothian IJB £'000 Baseline Budget Delegated Core 52,576 Hosted 12,292 Set Aside 16,434 81,302 GMS 13,040 Total 94,342 Additional other budget adjustments 564 Total Budget 94,906 Page 18 of 58
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APPENDIX 1 - 2024/25 DRAFT FINANCIAL PLAN SUMMARY BY INTEGRATED JOINT BOARDS Midlothian IJB £k Full Year Recurring Expenditure Budget 94,342 Baseline Pressures (3,829) Projected Expenditure Uplifts & Commitments (212) Growth and Other Commitments (1,156) Policy Decisions (91) Strategic Investments 0 Essential Service Development 0 Unscheduled Care 0 Projected Expenditure Uplifts & Commitments (1,460) Percentage of Recurring Budget (1.5%) Projected Costs (5,288) Recurring Resources Recurrency of 23/24 FP Invesment 10 Additional Resources 10 Financial Outlook Gap before FRP's (5,278) Financial Recovery Plans 1,746 Financial Outlook Gap after FRP's (3,532) Percentage of Recurring Budget (3.7%) Final estimated outturn - 24/25 (3,532) Page 19 of 58
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Midlothian Integration Joint Board Thursday, 21st March 2024, 14:00-15:00 Midlothian IJB Budget Setting 2024/25 Executive summary Midlothian IJB is required to set a balanced budget before the start of the financial year. The IJB’s budget is funded by its partners, Midlothian Council and NHS Lothian. The partners have now made budget offers to the IJB for the 2024/25 financial year. The offer from Midlothian Council is final in that Midlothian Council has now set its own 2024/25 budget. NHS Lothian will set a budget for 2024/25 at its April Board meeting but it has provided the IJB with an indicative offer. A paper laying out the indicative financial pressures for the years 2024/25 to 2028/29 was presented to the IJB on 21st December 2023. This showed a very significant projected financial pressure in 2024/25 of £12.5m. This position was prior to the Scottish Government’s own budget setting process, the impact of which was to increase the IJB’s gap to a forecast position of £14.3m. Since then, the forecasts have been revised and additional funding has been made available by Midlothian Council. However there remains a financial pressure for Midlothian IJB in 24/25 of c. £10.0m. A series of proposals have been brought forward by the operational management teams which would, if agreed, allow the IJB to set a balanced budget for 2024/25. It is worth also noting that the Set Aside budget is not balanced at this time. Members are asked to: • Note the development of the 2024/25 budget setting process. • Consider the proposals that support the development of a balanced budget for 2024/25. • Agree to set a balanced budget for 2024/25 on the presumption of the delivery of the savings programmes include working with the other IJBs and NHS Lothian to deliver a balanced position for the Set Aside budget. Item number:4.4 Agenda number Page 21 of 58
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Midlothian Integration Joint Board Report Midlothian IJB Budget Setting 2024/25 1 Purpose 1.1 This report sets out the 2024/25 budget setting process and the work undertaken to date. It then lays out a proposed balanced budget for the IJB based on a range of savings proposals. 1.2 The IJB must set a balanced budget before the start of the new financial year. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the development of the 2024/25 budget setting process. • Consider the proposals that support the development of a balanced budget for 2024/25. • Agree to set a balanced budget for 2024/25 on the presumption of the delivery of the savings programmes including working with the other IJBs and NHS Lothian to deliver a balanced position for the Set Aside budget. 3 Background and main report 3.1 The IJB continues to develop its five-year financial plan. Midlothian IJB were presented with a paper on 21st December 2023 indicating the financial challenges over the next five years. This projection was drawn up before the Scottish Government presented its 2024/25 budget proposals. The December paper indicated a financial gap in 2024/25 of £12.5m. Given that the IJB has to set a balanced budget prior to the start of the financial year it was clear that a significant range of savings proposals would be required to bring the 2024/25 back into balance. 3.2 The Scottish Government’s budget proposition for 2024/25 impacted the health position significantly. This was described in detail in the finance paper presented to Midlothian IJB on 8th February 2024 when a further projected position for 2024/25 (as part of the Workshop of 29/2/24) then indicated a financial gap of c. £14.3m. 3.3 Midlothian Council’s budget offer to the IJB for 2024/25 provided the IJB with a significant element of additional funding (c. £3.3m). This additional resource and an additional revision to the Set Aside forecast arising from NHS Lothian’s revision to Page 22 of 58
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Midlothian Integration Joint Board the Set Aside budget model (which reduced the financial pressures to the IJB) resulted in the current projected financial gap for 2024/25 of £10.0m. 3.4 The projected financial pressure for 2024/25 is made up as follows: Budget Projected Gap £000's NHS (Core) (3,213) Social Care (4,504) Total (7,717) Hosted (155) Set Aside (1,717) Total (9,589) IJB (448) Grand Total (10,037) 3.5 Within the health budgets the main financial pressures are due to staffing issues in relation to both the increased costs and demand for drugs both in the community services (GP Prescribing), and within the Set Aside services (Acute budgets) and to the continued high levels of demand. 3.6 The social care budget pressure is made up as follows :- Budget £000's 23/24 out-turn - 'systemic' overspend (4,012) N/R Support from Earmarked Reserves in 23/24 (1,583) MLC - MTFS October '23 - Inflationary & Other pressures (1,241) Proxy for Demography (1,000) Opening Pressures Forecast (7,836) Impact of Council Budget Settlement Elderly Demographic Pressures 1,000 Transitions 500 Pay Award Uplift 664 Provision for inflationary and other pressures 1,168 (4,504) 3.7 The opening pressures (values in brackets) are more fully described in papers 4.2 and 4.3. In brief, these are a) 23/24 out-turn and 'systemic' overspend: This is a reflection of the 23/24 financial pressures which now require a recovery programme. The recovery programme being part of the 24/25 financial plan. Page 23 of 58
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Midlothian Integration Joint Board b) Non-recurring support from Earmarked Reserves in 23/24: Elements of Midlothian IJB’s earmarked reserves have been used to underpin the financial position in 23/24. These funds will not be available in 24/25. This is also part of the recovery programme. c) Midlothian Council Medium Term Financial Strategy October '23: As part of Midlothian Council’s Medium Term Financial Strategy (MTFS) an estimate was made of financial pressures in 2024/25 arising from unfunded pay awards and service delivery inflation. d) Proxy for Demography: The demographic pressures in Midlothian were discussed briefly in the previous paper regarding the 23/24 out-turn. This is an estimate of the financial impact. Work continues to develop a more rigorous quantification of the financial pressures arising from demography. 3.7 In this context, the positive impact of Midlothian Council’s budget offer is clearly seen. Despite this, Midlothian IJB continues to have an overall financial gap in its 2024/25 budget of £10m. To address this the management teams have developed a range of savings programmes which would allow the IJB to close this gap. 3.8 There are three categories of savings programmes that have been developed – a) Grip and Control: This is the review of all financial management and more rigorous examination of operational management of expenditure. The most significant saving being c£778,000 of savings in the projected 2024/25 prescribing position. b) Efficiency & Redesign: This is a review of the method of service delivery with a view to reducing the costs. Frequently this is a reduction in the use of bank staff and a recasting of the operational workforce. Both (a) and (b) above should, in principle, not impact on the IJB’s Strategic Plan. c) Choice: This is the significant change in service delivery and likely to involve redesign which will have an impact on the IJB’s Strategic Goals and its plan. For each of these a template describing the actions and their impact has been prepared. 5 Financial Recovery Action templates are attached to this report. 3.9 The proposed savings schemes are as follows – Health Core Social Care IJB Hosted Set Aside Total £000's £000's £000's £000's £000's Grip & Control 2,052 945 2,997 Efficiency& Redesign 1,235 720 328 310 2,593 Choices 3,511 448 3,959 Total 3,287 5,176 448 328 310 9,549 3.10 At the time of writing, Midlothian IJB has the details behind the Grip and Control and Efficiency schemes that have been delivered by the HSCP. Midlothian IJB is Page 24 of 58
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Midlothian Integration Joint Board awaiting the detail behind those efficiency schemes that are proposed by the management teams that support the Set Aside and Hosted Budgets. 3.11 For the purpose of setting a balanced budget for 2024/25, it is assumed that the Grip & Control and Efficiency Schemes will not impact on Midlothian IJB’s Strategic Plan and therefore are available to support the financial pressures in 2024/25. Appendix 1 details the Grip & Control and Efficiency and Redesign Schemes which have been proposed by the HSCP. The IJB will request information behind the schemes proposed by the management teams who support the hosted and Set Aside budgets. 3.11 Prior to including the ‘choices’ schemes the financial position is as follows – 3.12 Recognising that no one of the 4 Lothian IJB can resolve the Set Aside financial issues alone, Midlothian IJB will commit to work with the other 3 IJBs and NHS Lothian to support this position this leaves this position. £000's Gap as above (4,447) Remove hosted/Set Aside (1,234) Gap to be closed (3,213) 3.13 The following savings proposals have been categorised as ‘choices’ and were discussed at the IJB’s financial workshop on 29th February 2024. £000's Transport Review - External Taxis 240 Newbyres - recovery plan 1,200 Commissioning Reduction proposal 1,350 Change Service Delivery source- Internal/External (80/20) 721 Review of Planning, Performance, and Performance service 448 3,959 3.14 The value against each of the proposed Financial Recovery Actions is the estimated total financial benefit if each proposal is delivered in full. It is clear that a great deal of additional work will be required to fully deliver these projects and it is unlikely that Budget Projected Gap Grip& Control Efficiencies & Redesign Remaining Gap £000's £000's £000's £000's NHS (Core) (3,213) 2,052 1,235 74 Social Care (4,504) 1,445 220 (2,839) Hosted (155) 328 173 Set Aside (1,717) 310 (1,407) IJB (448) (448) Grand Total (10,037) 3,497 2,093 (4,447) Page 25 of 58
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Midlothian Integration Joint Board all of this financial benefit can be realised in 2024/25. That said, if these projects are progressed then in principle, excluding the Set Aside budget, Midlothian IJB should be able to break-even in 2024/15. 3.15 Appendix 2 summarises this position and lays out a balanced financial position for the IJB for 2024/25 excluding the Set Aside position. 3.16 There are a range of further factors which will need to be considered a) NHS Lothian are developing a policy of delivering an element of their efficiencies in year ‘locally’. This would include an element of local management by their business units, e.g., Midlothian HSCP, and an element ‘corporately’. It will be important to recognise the role of all 4 Lothian IJBs in this process and further discussions with NHS Lothian colleagues are underway to clarity this. b) The General Medical Services (GMS) budget for the GP practices has not yet been distributed by the Scottish Government. It is likely that further financial pressures will arise in this budget. It is important to note this is not built into the current forecast. c) The partners have set up appropriate processes to ensure the delivery of the savings programmes. Midlothian IJB needs to consider how it can monitor its budget 2024/25. d) Midlothian IJB needs to continue to develop its five-year financial plan. Indications from the December 2023 paper are that there are additional pressures over and above the pressures managed in 2024/25 that will reach into 2025/26 and beyond. Midlothian IJB will be required to develop further savings schemes to manage these pressures. 4 Policy Implications 4.1 There may be policy implication in this paper. These will be examined in further detail and any changes to policy will be brought back to Midlothian IJB for review. 5 Directions 5.1 This budget may require changes to the current Directions and/or require additional Direction(s) to be issued. This will be reviewed and further information brough back to the IJB in June 2024. 6 Equalities Implications 6.1 This budget may have equalities implications. Full impact assessments will be carried out following the Boards decision in relation to the options presented in this Page 26 of 58
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Midlothian Integration Joint Board paper. Equality Impact Assessment screening has been carried out for each of the 5 Financial Recovery Actions and can be found in the appendix 7 Resource Implications 7.1 The resources implications are considered above. 8 Risk 8.1 A list of risks is attached as appendix 2 9 Involving people 9.1 The IJB meets in public and publishes all of its papers. 10 Background Papers 10.1 The Finance reports at the IJB’s December 2023 and February 2024 meetings AUTHOR’S NAME David King DESIGNATION Interim Chief Finance Officer CONTACT INFO David.king4@nhslothian.scot.nhs.uk DATE March 2024 Appendices: Appendix 1: Summary of Grip & Control and Efficiency & Redesign Schemes Appendix 2: Summary of 2024/25 budget position Appendix 3: High level summary of Risks Appendix 4: The 5 Financial Recovery Action ‘Choices’ schemes overview templates Appendix 5: Equality Impact Assessment Screening templates Page 27 of 58
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Midlothian Integration Joint Board Appendix 1 - Summary of Grip & Control and Efficiency & Redesign Schemes Grip & Control Budget Type Value £000's Health Medicine 778 Non Pay 380 Workforce 894 Social Care Workforce 945 2,997 Efficiency/Redesign (HSCP Only) Health Workforce 1,235 Social Care Non Pay 30 Service Delivery 500 Workforce 190 1,955 Page 28 of 58
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Midlothian Integration Joint Board Appendix 2 - Summary of 2024/25 budget position 2024/25 Budgets per budget Offers from the Partners £000's Core 66,180 Hosted 12,292 Set Aside 16,434 Total Health 94,906 Social Care 63,534 Total Opening Budget 158,440 Estimated Expenditure 168,477 Forecast Gap (10,037) Savings Schemes Grip & Control 2,997 Efficiencies & Redesign 2,593 Set Aside (net of Hosted) 1,234 Choices delivered in 24/25 3,213 10,037 Page 29 of 58
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Midlothian Integration Joint Board Appendix 3 - . High level summary of Risks The IJB has its own risk policy and risk management process. It maintains a risk register and risk is a standing agenda item at the IJB’s Audit and Risk Committee. However, there are a further range of risks that could arise from this budget setting process and this are laid out below. High Level Risks 1. Further operational pressures may arise during the 2024/25 financial year – for example within the GMS budget as above and demand driven by demographic pressures 2. The Partners may themselves take decisions which impact on the delivery of the IJB’s strategic plan, these decisions being driven by the financial pressures 3. The IJB may have to further revise its Strategic Plan to reflect the financial position. New Directions may have to be developed. 4. The savings programmes may impact on the population mor significantly than is currently foreseen. 5. It may prove more challenging to deliver the savings programmes than currently estimated. 6. Delivery the savings programmes whilst concurrently undertaking the appropriate Impact Assessments and consultation requirements is a considerable risk in terms of both delivery and governance. Page 30 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Midlothian Health and Social Care Financial Recovery Actions 2024/25 Finance Recovery Action: Care at Home Exec Lead(s): Nick Clater, Head of Adult Services Description: A realigning of care at home provision to a 20/80 split (internal = 20%, external = 80%). Lead Service Area(s): Adult Services Financial Recovery Value £721k Risk Level (of not delivering the financial saving) High Plan Date 21/03/2024 Version v1 Strategic Aims Actions Dependencies Risk Mitigation Delivery Timeframe Which Strategic Aims are impacted by this recovery action? What are the high-level actions that you are going to take? What are the factors that influence this work that are out with your control? What are the main risks? How are you mitigating these risks? No.1 No.2 No.3 No.4 No.5 No.6 Complete staffing algorithm for move to new configuration for a new split of care at home hours. Complete review of all packages. Work with Midlothian Council’s Procurement Department and as part of the Transformational Blueprint work on contracts and commissioning. Work with providers to identify how capacity can be created. Develop a communication strategy for both providers and services users and their families. Recruitment and retention across the care sector remain precarious. Sickness absence in care services generally remain challenging. That providers do not create enough capacity to enable the shift safely. That providers working across Lothian and beyond decide that it is not sustainable or cost-effective for them to operate in Midlothian resulting in contracts not being fulfilled or handed back. Work would need to be undertaken with providers to identify where efficiencies could be made and whether there is greater scope for a sharing of packages or for delivering support in different ways. 31st March 2025. Page 31 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Triangulation Evidence and Data Sources Tolerance Reporting Frequency The areas of our triangulated approach to monitoring impact What data/information source(s) are you using to monitor change over time? What would indicate the recovery action is being successfully managed? What would indicate corrective or additional support is required to deliver this recovery action? How frequently will you report on progress? Population Need Unmet Need lists would need to be monitored. Waiting lists would need to be monitored. That the balance of care is shifted across to external providers. That there has been no evidence of reduction in spend. Waiting lists for care have increased. Unmet need increases and/or there is an increase in Adult Protection Quarterly Finance Monthly Service Finance Reports. The total financial recovery value has been achieved. Agreed targets towards the total financial recovery value are met at key milestones. No progress has been made towards achieving the total financial recovery value. Limited progress has been made towards achieving the total financial recovery value and key milestones have not been met. Quarterly Outcomes OutNav: Commissioned Services are not included in OutNav. However, the IJB has a statutory duty to report on safe staffing in relation to all commissioned services. This will be included in the IJB Strategic Commissioning Map and in the Annual Midlothian IJB Health and Care (Staffing) (Scotland) Act published reports. The OutNav Heatmap will shows a maintained or improved position in both our progress and our confidence in the strength of our evidence. The OutNav Heatmap clearly demonstrates the contribution of effective commissioning and safe staffing, and the 6 strategic aims continue to indicate progress and a high confidence in the strength of the evidence. The IJB is not satisfied personal outcomes are being met appropriately or in a timely manner. The IJB is not satisfied on the evidence that commissioned services are giving due regard to the duties of the Health and Care (Staffing) (Scotland) Act, or that improvement is progressed appropriately or in a timely manner. Quarterly Page 32 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Midlothian Health and Social Care Financial Recovery Actions 2024/25 Finance Recovery Action: Commissioning of Services Exec Lead(s): Nick Clater, Head of Adult Services Description: A 3% reduction in overall costs of commissioned arrangements to be achieved through a programme of transformational change in partnership with Midlothian Council and NHS Lothian. Lead Service Area(s): Adult Services Financial Recovery Value £1,350k Risk Level (of not delivering the financial saving) High Plan Date 21/03/2024 Version v1 Strategic Aims Actions Dependencies Risk Mitigation Delivery Timeframe Which Strategic Aims are impacted by this recovery action? What are the high-level actions that you are going to take? What are the factors that influence this work that are out with your control? What are the main risks? How are you mitigating these risks? No.1 No.2 No.3 No.4 No.5 No.6 Delete as applicable Complete updating of register of all contracts held by HSCP. Commence review of all external contracts held within the HSCP. Initial focus to be on all non-front facing contracts (ie. those contracts not directly providing services to people). Work with Midlothian Council’s Procurement Department and as part of the Transformational Blueprint work on Requires work specifically with Midlothian Council – there is a Council-wide Transformational Blueprint programme which includes commissioning across all Council Directorates. We continue to see need increasing, particularly in key areas such as Learning Disabilities and Older People and have statutory responsibilities that cannot be abdicated. The time required to complete this will be dependent on the pace of the work being undertaken on this within Midlothian Council as part of Transformational Blueprint work, it cannot be done in isolation of this. The bulk of external contracts within a Midlothian Council procurement framework. There is a clear risk that people in need will see a reduction in their support and therefore not receive a service in line with their assessed needs. This could, in theory, lead to an increase in hospital admissions and increased vulnerability in the community. The HSCP does not meet statutory responsibilities. Work would need to be undertaken with providers to identify where efficiencies could be made and whether there is greater scope for a sharing of packages or for delivering support in different ways. Close working with Midlothian Council and NHS Lothian Procurement staff to ensure that progress is made. Unknown at this stage due to the need for greater scoping. Page 33 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 contracts and commissioning. Work with providers to identify where efficiencies could be made in the first instance and what scope there would be to change the way support may be delivered. Ensure reviews of care packages are being undertaken. Develop a communication strategy for both providers and services users. That providers working across Lothian and beyond decide that it is not sustainable or cost- effective for them to operate in Midlothian resulting in contracts not being fulfilled or handed back. Page 34 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Triangulation Evidence and Data Sources Tolerance Reporting Frequency The areas of our triangulated approach to monitoring impact What data/information source(s) are you using to monitor change over time? What would indicate the recovery action is being successfully managed? What would indicate corrective or additional support is required to deliver this recovery action? How frequently will you report on progress? Population Need Unmet Need lists would need to be monitored. Waiting lists would need to be monitored. A reduction in spend is achieved. Contract management arrangements are uniform and monitored by the Planning Officers in a robust way. That there has been no evidence of reduction in spend. Waiting lists for care have increased. Unmet need increases and/or there is an increase in Adult Protection Quarterly Finance Monthly Service Finance Reports. The total financial recovery value has been achieved. Agreed targets towards the total financial recovery value are met at key milestones. No progress has been made towards achieving the total financial recovery value. Limited progress has been made towards achieving the total financial recovery value and key milestones have not been met. Quarterly Outcomes OutNav: Commissioned Services are not included in OutNav. However, the IJB has a statutory duty to report on safe staffing in relation to all commissioned services. This will be included in the IJB Strategic Commissioning Map and in the Annual Midlothian IJB Health and Care (Staffing) (Scotland) Act published reports. The OutNav Heatmap will shows a maintained or improved position in both our progress and our confidence in the strength of our evidence. The OutNav Heatmap clearly demonstrates the contribution of effective commissioning and safe staffing, and the 6 strategic aims continue to indicate progress and a high confidence in the strength of the evidence. The IJB is not satisfied personal outcomes are being met appropriately or in a timely manner. The IJB is not satisfied on the evidence that commissioned services are giving due regard to the duties of the Health and Care (Staffing) (Scotland) Act, or that improvement is progressed appropriately or in a timely manner. Quarterly Page 35 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Midlothian Health and Social Care Financial Recovery Actions 2024/25 Finance Recovery Action: Newbyres Exec Lead(s): Nick Clater, Head of Adult Services Description: A reduction in agency usage in Newbyres Care Village and a sustained operation within an established financial footprint. Lead Service Area(s): Adult Services Financial Recovery Value £1.,200k Risk Level (of not delivering the financial saving) Moderate Plan Date 21/03/2024 Version v1 Strategic Aims Actions Dependencies Risk Mitigation Delivery Timeframe Which Strategic Aims are impacted by this recovery action? What are the high-level actions that you are going to take? What are the factors that influence this work that are out with your control? What are the main risks? How are you mitigating these risks? No.1 No.2 No.3 No.4 No.5 No.6 Undertake a complete remodelling of Newbyres bed base including revising admission criteria and purpose. Develop clear workforce strategy including safe staffing numbers and training requirements. Continue to implement “break glass” process for agency escalation so there is Senior Management oversight. Develop a communication strategy for residents, their families, staff, elected members, IJB members and the wider community in Gorebridge. Requires the wider bed-based review for Midlothian to be completed. Sickness absence rates continue to be high in Newbyres but are, to a large extent, out with the control of management. That sickness absence and vacancy rates remain at a high level and therefore require increased use of agency. That the lack of care home beds in Midlothian results in increased pressure to re-open beds in Newbyres thus creating safety issues. Recruitment is ongoing to vacancy posts and a robust approach is being taken to managing sickness absence. Work continues with Care Home providers to increase capacity in care home beds in Midlothian. 31st March 2025. Page 37 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Triangulation Evidence and Data Sources Tolerance Reporting Frequency The areas of our triangulated approach to monitoring impact What data/information source(s) are you using to monitor change over time? What would indicate the recovery action is being successfully managed? What would indicate corrective or additional support is required to deliver this recovery action? How frequently will you report on progress? Population Need Agency Escalation data. Waiting lists for care homes data (i.e., demand). Financial reports. A reduction in spend is achieved. Reduction in vacancy rates and sickness absence. That there has been no evidence of reduction in spend. Waiting lists for care homes have increased or delays have increased. Quarterly Finance Monthly Service Finance Reports. The total financial recovery value has been achieved. Agreed targets towards the total financial recovery value are met at key milestones. No progress has been made towards achieving the total financial recovery value. Limited progress has been made towards achieving the total financial recovery value and key milestones have not been met. Quarterly Outcomes OutNav: Newbyres Map The OutNav Heatmap will shows a maintained or improved position in both our progress and our confidence in the strength of our evidence. The OutNav Heatmap clearly demonstrates the contribution of effective commissioning and safe staffing, and the 6 strategic aims continue to indicate progress and a high confidence in the strength of the evidence. The IJB is not satisfied personal outcomes are being met appropriately or in a timely manner. The IJB is not satisfied on the evidence that commissioned services are giving due regard to the duties of the Health and Care (Staffing) (Scotland) Act, or that improvement is progressed appropriately or in a timely manner. Quarterly Page 38 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Midlothian Health and Social Care Financial Recovery Actions 2024/25 Finance Recovery Action: Planning, Performance, and Programme Funding Exec Lead(s): Gill Main, Integration Manager Description: A reduction in funding to the Planning Performance and Programme team will initiate Organisational Change in partnership with NHS Lothian, Midlothian Council and Trade Union partners to reduce recurring staff-pay costs by £448K. Lead Service Area(s): Planning, Performance, and Programme Financial Recovery Value £448K Risk Level (of not delivering the financial saving) High Plan Date 21/03/2024 Version v1 Strategic Aims Actions Dependencies Risk Mitigation Delivery Timeframe Which Strategic Aims are impacted by this recovery action? What are the high-level actions that you are going to take? What are the factors that influence this work that are out with your control? What are the main risks? How are you mitigating these risks? No.1 No.2 No.3 No.4 No.5 No.6 Commence Organisational Change with NHS Lothian, Midlothian Council and Trade Union partners. Determine the most effective use of the available resources to meet the needs of Midlothian IJB and HSCP. Progress and then conclude Organisational Change to realise the total financial recovery value. Collaborative working across organisations and staff groups. Any ongoing HR processes. NHS Lothian and Midlothian Council terms and conditions of employment. The time between commencing and concluding organisational change will result in a limited return on the savings target in 24/25. The full recovery value will not be realised until organisational change concludes in full. Organisational change will be required across NHS Lothian and Midlothian Council employed staff groups and impact widely on a range of roles and job descriptions. Key IJB and HSCP duties are likely to be incomplete or delayed. Suspend recruitment to posts which become vacant prior to organisational change commencing. Close working with the HSPC management team, Partnership colleagues, all staff groups impacted, Employee Relations, and HR. Request NHS Lothian and Midlothian Council support the HSCP Management Team to create the conditions for Organisational Change to commence. Reduce the scope and depth of support to the IJB and HSCP. Reallocate tasks that require skills and competencies that are not unique to strategic planning, analysis, or project management professionals. Unknown Page 39 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Triangulation Evidence and Data Sources Tolerance Reporting Frequency The areas of our triangulated approach to monitoring impact What data/information source(s) are you using to monitor change over time? What would indicate the recovery action is being successfully managed? What would indicate corrective or additional support is required to deliver this recovery action? How frequently will you report on progress? Population Need Progress towards an agreed timeline and achievement of key milestones. iMatter reports and Staff Stress Risk Assessments. Organisational Change documentation. Organisational Change is underway and being progressed appropriately and in a timely manner. Staff remain well, at work and productive throughout the Organisational Change process. There is strong evidence of collaborative working, shared decision making and shared responsibility for outcomes across the HSCP Management Team. Organisational Change has not commenced. iMatter engagement index or PDr/MPM completion decreases, and/or staff absence, stress at work or attrition increase. Progress cannot be made in advancing Organisational Change. Quarterly Finance Monthly Service Finance Reports. The total financial recovery value has been achieved through Organisational Change Agreed targets towards the total financial recovery value are met at key milestones. No progress has been made towards achieving the total financial recovery value. Limited progress has been made towards achieving the total financial recovery value and key milestones have not been met. Quarterly Outcomes OutNav: IJB Strategic Commissioning Map. The OutNav Heatmap will shows a maintained or improved position in both our progress and our confidence in the strength of our evidence. The OutNav Heatmap clearly demonstrates the contribution the service make to the 6 strategic aims continues to indicate progress and a high confidence in the strength of the evidence. The IJB is not satisfied the statutory governance of the IJB is being conducted appropriately or in a timely manner. The IJB is not satisfied the business of the IJB is being conducted appropriately or in a timely manner. The IJB is not satisfied that strategic planning activity and reporting is being conducted appropriately or in a timely manner. Quarterly Page 40 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Midlothian Health and Social Care Financial Recovery Actions 2024/25 Finance Recovery Action: Transport Spend Exec Lead(s): Nick Clater, Head of Adult Services Description: A reduction in spend on transport for service users by £240,000. Lead Service Area(s): Adult Services Financial Recovery Value £240k Risk Level (of not delivering the financial saving) High Plan Date 21/03/2024 Version v1 Strategic Aims Actions Dependencies Risk Mitigation Delivery Timeframe Which Strategic Aims are impacted by this recovery action? What are the high-level actions that you are going to take? What are the factors that influence this work that are out with your control? What are the main risks? How are you mitigating these risks? No.1 No.2 No.3 No.4 No.5 No.6 Undertake a review of all transport provision for Social Work within Midlothian. Develop a strategy to reduce spend and consolidate journey where feasible. Form part of Midlothian Council’s Transformational Blueprint work on transport. Develop a communication strategy for service users, their families, staff, elected members, IJB members and the wider community in Midlothian. The Transformational Blueprint work involves Adult Social Care, Childrens’ Services and Education Services so progress is dependent on progress in all three elements. External taxi spend can be dependent on the vagaries of the market. That demand increases for placements for people with disabilities resulting in an increase in need for transport. That external transport costs rise due to capacity/demand and inflationary uplifts. Work continues to apply eligibility criteria robustly to packages of care. Work is being undertaken – through the Transformation Blueprint work – for there to be a clear procurement framework in relation to taxi spend. 31st March 2025. Page 41 of 58
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Midlothian HSCP_Financial Recovery Actions_Overview_v1 Triangulation Evidence and Data Sources Tolerance Reporting Frequency The areas of our triangulated approach to monitoring impact What data/information source(s) are you using to monitor change over time? What would indicate the recovery action is being successfully managed? What would indicate corrective or additional support is required to deliver this recovery action? How frequently will you report on progress? Population Need Financial reports. Lists of transitions, college and day placements. A reduction in spend is achieved. That there has been no evidence of reduction in spend. That there is unmet need due to lack of availability of transport. Quarterly Finance Monthly Service Finance Reports. The total financial recovery value has been achieved. Agreed targets towards the total financial recovery value are met at key milestones. No progress has been made towards achieving the total financial recovery value. Limited progress has been made towards achieving the total financial recovery value and key milestones have not been met. Quarterly Outcomes OutNav: As transport could impact personal outcomes for a range of people accessing services across the system, it is not possible to predict which maps will directly reflect this change. The IJB Strategic Commissioning Map will continue to show overall progress towards achieving what matters most to people and the 6 strategic aims of the IJB. The OutNav Heatmap will shows a maintained or improved position in both our progress and our confidence in the strength of our evidence. The OutNav Heatmap clearly demonstrates the contribution of effective commissioning and safe staffing, and the 6 strategic aims continue to indicate progress and a high confidence in the strength of the evidence. The IJB is not satisfied personal outcomes are being met appropriately or in a timely manner. The IJB is not satisfied on the evidence that commissioned services are giving due regard to the duties of the Health and Care (Staffing) (Scotland) Act, or that improvement is progressed appropriately or in a timely manner. Quarterly Page 42 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Midlothian Integration Joint Board Integrated Impact Assessment (IIA) Screening Tool This Screening Tool should accompany all Midlothian IJB reports and papers. Decisions on whether an impact assessment should be completed must happen as early as possible in the planning of a new, or revision of an existing, initiative. This tool will help you record any decisions made and provide evidence. Title of Midlothian IJB Report: Move of Internal/External Care at Home to a 20/80 Split Presenting Officer: Nick Clater, Head of Adult Services Does an IIA Accompany this Report? Yes No √ If yes, please attach the IIA to the report If no, please complete the screening tool below Type of Initiative: New √ Revised Aim / purpose of new or revised initiative: This Financial Recovery Action is in relation to moving the internal/external split of care at home to 20% (Internal) and 80% (external). Financial Recovery Action Plan Implications Identification & Screening: Information on potential impact: Positive / Negative / Requires further investigation Does the content of this report affect service users, employees of the wider community, & therefore potentially have an effect in terms of equality? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Requires Further Investigation In theory, a different way of procuring and managing care at home should not disadvantage service users of their families. The internal service would remain the provider of last resort. Is it a major policy, significantly affecting how functions are delivered? Yes Requires Further Investigation In theory, a different way of procuring and managing care at home should not disadvantage service users of their families. Page 43 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Will it have a significant effect on how other organisations operate? (For example, criteria for funding) Yes Requires Further Investigation If there is a different procurement model put in place for external care at home, this may affect those providers. Does it have an impact on health inequalities, socio-economic inequalities, needs assessments for care experienced people, human rights, or the environment? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Requires Further Investigation In theory, a different way of procuring and managing external care at home should not disadvantage service users of their families. Does it relate to functions that have previously been identified as being important to particular protected groups? Yes Requires Further Investigation See above. Does it relate to an area where Midlothian IJB has set equality outcomes? Yes Requires Further Investigation See above. Does it relate to an area where there are known inequalities? (For example, disabled people’s access to services offers and supports; the gender pay gap; racist or homophobic behaviour, etc.) Yes Requires Further Investigation See above. Does it relate to a policy where there is significant potential for reducing inequalities or improving outcomes? (For example, improving access to health services for transsexual people, or increasing take-up of apprenticeships by female students) No Requires Further Investigation See above. If you answered “yes” to any of the questions above, a full Integrated Impact Assessment (IIA) must be considered. If an IIA is not required, please state the reasons why here. An IIA is required and will be completed should the Board wish to progress this Financial Recovery Action. Screening Completed by: Nick Clater Screening Reviewed & Signed by Integration Manager: Date: 07/03/24 Date: 07/03/2024 Page 44 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Midlothian Integration Joint Board Integrated Impact Assessment (IIA) Screening Tool This Screening Tool should accompany all Midlothian IJB reports and papers. Decisions on whether an impact assessment should be completed must happen as early as possible in the planning of a new, or revision of an existing, initiative. This tool will help you record any decisions made and provide evidence. Title of Midlothian IJB Report: Commissioning of Services Presenting Officer: Nick Clater, Head of Adult Services Does an IIA Accompany this Report? Yes No √ If yes, please attach the IIA to the report If no, please complete the screening tool below Type of Initiative: New √ Revised Aim / purpose of new or revised initiative: This Financial Recovery Action is in relation to reducing commissioned services spend. Financial Recovery Action Plan Implications Identification & Screening: Information on potential impact: Positive / Negative / Requires further investigation Does the content of this report affect service users, employees of the wider community, & therefore potentially have an effect in terms of equality? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Negative Impact This recovery action will impact on service users and their carers as it may result in a reduction in services. It will also have an indirect impact on staff who are managing risk. Whilst transformational change can bring positive change, the extent of the change required will determine who is affected and the impact of this. Is it a major policy, significantly affecting how functions are delivered? Yes Negative Impact This recovery action will likely result in a reduction in service provision to service users. Page 45 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Will it have a significant effect on how other organisations operate? (For example, criteria for funding) Yes Negative Impact Any reduction in funding to commissioned services will impact adversely on them and restrict their ability to deliver and maintain current service provision. It will also impact adversely on any ability to create capacity for increasing demand. Does it have an impact on health inequalities, socio-economic inequalities, needs assessments for care experienced people, human rights, or the environment? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Negative Impact Any reduction in commissioned services funding will disproportionately affect those from protected groups. Does it relate to functions that have previously been identified as being important to particular protected groups? Yes Negative Impact See above. Does it relate to an area where Midlothian IJB has set equality outcomes? Yes Negative Impact The following MIJB Equality Outcomes will be affected: 1. Improve access to health and social care services and information If people cannot access care due to restrictions in funding, they will be adversely affected by this. 3. Improve safety and inclusivity of communities A reduction in care will potentially impact on individuals’ ability to maintain safety and be connected to their communities. Does it relate to an area where there are known inequalities? (For example, disabled people’s access to services offers and supports; the gender pay gap; racist or homophobic behaviour, etc.) Yes Negative Impact By implication, a reduction in care provision will impact adversely those with disabilities, mental health issues or frailty as it is broadly these groups who meet HSCP Eligibility Criteria for services (i.e.. are assessed as being in critical or substantial need). Page 46 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Does it relate to a policy where there is significant potential for reducing inequalities or improving outcomes? (For example, improving access to health services for transsexual people, or increasing take-up of apprenticeships by female students) No Requires further investigation If you answered “yes” to any of the questions above, a full Integrated Impact Assessment (IIA) must be considered. If an IIA is not required, please state the reasons why here. An IIA is required and will be completed should the Board wish to progress this Financial Recovery Action. Screening Completed by: Nick Clater Screening Reviewed & Signed by Integration Manager: Date: 07/03/24 Date: 07/03/2024 Page 47 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Midlothian Integration Joint Board Integrated Impact Assessment (IIA) Screening Tool This Screening Tool should accompany all Midlothian IJB reports and papers. Decisions on whether an impact assessment should be completed must happen as early as possible in the planning of a new, or revision of an existing, initiative. This tool will help you record any decisions made and provide evidence. Title of Midlothian IJB Report: Newbyres Presenting Officer: Nick Clater, Head of Adult Services Does an IIA Accompany this Report? Yes No √ If yes, please attach the IIA to the report If no, please complete the screening tool below Type of Initiative: New √ Revised Aim / purpose of new or revised initiative: This Financial Recovery Action is in relation to reducing agency spend in Newbyres and operating within a sustained established financial footprint. Financial Recovery Action Plan Implications Identification & Screening: Information on potential impact: Positive / Negative / Requires further investigation Does the content of this report affect service users, employees of the wider community, & therefore potentially have an effect in terms of equality? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Requires Further Investigation In theory, the removal of beds from Newbyres could affect the wider community but this needs to be offset by there being a need to provide a safe and quality service. More beds are problematic to staff safely currently. Is it a major policy, significantly affecting how functions are delivered? Yes Negative Impact This recovery action will likely result in a reduction in service provision to service users although, as above, there is merit in the argument that a smaller number of beds would provide for a safer service. Page 49 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Will it have a significant effect on how other organisations operate? (For example, criteria for funding) Yes Requires Further Investigation If there are fewer beds in Newbyres going forward, it may place further pressure on external provision in Midlothian. Does it have an impact on health inequalities, socio-economic inequalities, needs assessments for care experienced people, human rights, or the environment? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Negative Impact A reduction in beds may disproportionately affect those who do not have the ability to self-fund their care as choice of care homes will be fewer. Does it relate to functions that have previously been identified as being important to particular protected groups? Yes Negative Impact See above. Does it relate to an area where Midlothian IJB has set equality outcomes? Yes Negative Impact The following MIJB Equality Outcomes will be affected: 1. Improve access to health and social care services and information If people cannot access care due to restrictions in funding, they will be adversely affected by this. 3. Improve safety and inclusivity of communities A reduction in care home beds in Newbyres will potentially impact on individuals’ ability to maintain safety and be connected to their communities. Families may have further to travel to visit relatives in care homes out with Midlothian. Does it relate to an area where there are known inequalities? (For example, disabled people’s access to services offers and supports; the gender pay gap; racist or homophobic behaviour, etc.) Yes Negative Impact A reduction in care home provision will impact adversely those who do not have the ability to self-fund their care. Page 50 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Does it relate to a policy where there is significant potential for reducing inequalities or improving outcomes? (For example, improving access to health services for transsexual people, or increasing take-up of apprenticeships by female students) No Requires Further Investigation If you answered “yes” to any of the questions above, a full Integrated Impact Assessment (IIA) must be considered. If an IIA is not required, please state the reasons why here. An IIA is required and will be completed should the Board wish to progress this Financial Recovery Action. Screening Completed by: Nick Clater Screening Reviewed & Signed by Integration Manager: Date: 07/03/24 Date: 07/03/2024 Page 51 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Midlothian Integration Joint Board Integrated Impact Assessment (IIA) Screening Tool This Screening Tool should accompany all Midlothian IJB reports and papers. Decisions on whether an impact assessment should be completed must happen as early as possible in the planning of a new, or revision of an existing, initiative. This tool will help you record any decisions made and provide evidence. Title of Midlothian IJB Report: Planning, Performance and Programme Service Funding Presenting Officer: Gill Main, Integration Manager Does an IIA Accompany this Report? Yes No √ If yes, please attach the IIA to the report If no, please complete the screening tool below Type of Initiative: New √ Revised Aim / purpose of new or revised initiative: This Financial Recovery Action is in relation to the use of reserves that are currently utilised in staff-pay costs Financial Recovery Action Plan Implications Identification & Screening: Information on potential impact: Positive / Negative / Requires further investigation Does the content of this report affect service users, employees of the wider community, & therefore potentially have an effect in terms of equality? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Requires further investigation This recovery action will impact on staff members within Administrative Services. Organisational Change can bring positive change, but extent of the organisation change required will determine the number of people who are likely to be affected and the significance of the effect on them Is it a major policy, significantly affecting how functions are delivered? Yes Negative Impact This recovery action will require a reduction in service and a review of how statutory functions pertaining to the business Page 53 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 and governance of Midlothian IJB and HSCP are delivered and sustained. Will it have a significant effect on how other organisations operate? (For example, criteria for funding) No n/a Does it have an impact on health inequalities, socio-economic inequalities, needs assessments for care experienced people, human rights, or the environment? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. No n/a Does it relate to functions that have previously been identified as being important to particular protected groups? Yes Requires further investigation The statutory functions pertaining to the business and governance of Midlothian IJB and HSCP include key activities that are important for particular protected group. The most significant of these are community engagement, public involvement and consultation, equalities and human rights, and leading the thematic area of ‘Midlothian will be Healthier’ for the Community Planning Partnership. Does it relate to an area where Midlothian IJB has set equality outcomes? Yes Negative Impact The Planning, Performance and Programme Service directly contributes to the following MIJB Equality outcomes 1.Improve access to health and social care services and information through the work of the service to provide governance and support to Midlothian IJB and HSCP to deliver on the requirements of the Model Scheme of Publication including the production and review of all statutory IJB publications, managing the website and ensuring all public facing documents meet the legal duty for accessibility. Page 54 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 3.Improve safety and inclusivity of communities through the work of the service as the thematic area for health and Social Care in the Midlothian Community Planning Partnership and the cross sector liaison and partnership working in the development, monitoring and reporting on the Strategic Commissioning Plan 5. The Midlothian Integration Joint Board will support the participation of, and more accurately reflect, the community it serves. through the work of the service to support the business of Midlothian IJB and work to undertake public consultation and engagement on behalf of the Board. Does it relate to an area where there are known inequalities? (For example, disabled people’s access to services offers and supports; the gender pay gap; racist or homophobic behaviour, etc.) No n/a Does it relate to a policy where there is significant potential for reducing inequalities or improving outcomes? (For example, improving access to health services for transsexual people, or increasing take-up of apprenticeships by female students) No n/a If you answered “yes” to any of the questions above, a full Integrated Impact Assessment (IIA) must be considered. If an IIA is not required, please state the reasons why here. An IIA is required and will be completed should the Board wish to progress this Financial Recovery Action. Screening Completed by: Gill Main Screening Reviewed & Signed by Integration Manager: Date: 02/03/2024 Date: 02/03/2024 Page 55 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Midlothian Integration Joint Board Integrated Impact Assessment (IIA) Screening Tool This Screening Tool should accompany all Midlothian IJB reports and papers. Decisions on whether an impact assessment should be completed must happen as early as possible in the planning of a new, or revision of an existing, initiative. This tool will help you record any decisions made and provide evidence. Title of Midlothian IJB Report: Reduction in Transport Costs for Adult Social Care Presenting Officer: Nick Clater, Head of Adult Services Does an IIA Accompany this Report? Yes No √ If yes, please attach the IIA to the report If no, please complete the screening tool below Type of Initiative: New √ Revised Aim / purpose of new or revised initiative: This Financial Recovery Action is in relation to reducing transport costs for Adult Social Care. Financial Recovery Action Plan Implications Identification & Screening: Information on potential impact: Positive / Negative / Requires further investigation Does the content of this report affect service users, employees of the wider community, & therefore potentially have an effect in terms of equality? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Requires Further Investigation In theory, a different way of procuring and managing transport should not disadvantage service users of their families. Is it a major policy, significantly affecting how functions are delivered? Yes Requires Further Investigation In theory, a different way of procuring and managing transport should not disadvantage service users of their families. Will it have a significant effect on how other organisations operate? (For example, criteria for funding) Yes Requires Further Investigation If there is a different procurement model put in place for external transport, this may affect those providers. Page 57 of 58
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MIJB_Governance_Equality Duty_IIA Screening _v2 Does it have an impact on health inequalities, socio-economic inequalities, needs assessments for care experienced people, human rights, or the environment? Please note the relevance of a policy will depend not only on the number of people affected, but also the significance of the effect on them. Yes Requires Further Investigation In theory, a different way of procuring and managing transport should not disadvantage service users of their families. Does it relate to functions that have previously been identified as being important to particular protected groups? Yes Requires Further Investigation See above. Does it relate to an area where Midlothian IJB has set equality outcomes? Yes Requires Further Investigation See above. Does it relate to an area where there are known inequalities? (For example, disabled people’s access to services offers and supports; the gender pay gap; racist or homophobic behaviour, etc.) Yes Requires Further Investigation See above. Does it relate to a policy where there is significant potential for reducing inequalities or improving outcomes? (For example, improving access to health services for transsexual people, or increasing take-up of apprenticeships by female students) No Requires Further Investigation See above. If you answered “yes” to any of the questions above, a full Integrated Impact Assessment (IIA) must be considered. If an IIA is not required, please state the reasons why here. An IIA is required and will be completed should the Board wish to progress this Financial Recovery Action. Screening Completed by: Nick Clater Screening Reviewed & Signed by Integration Manager: Date: 07/03/24 Date: 07/03/2024 Page 58 of 58