Agenda Document Pack - Midlothian Integration Joint Board - 09/02/2023
Midlothian Council · 9 February 2023
Back to Midlothian Integration Joint Board — 9 February 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 Meeting and Agenda Midlothian Integration Joint Board Venue: Virtual Meeting, Date: Thursday, 09 February 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 206
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1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting 4.1 Minutes of the MIJB held on 15 December 2022 - For Approval 5 - 14 4.2 Minutes of the Strategic Planning Group held on 24 November 2022 - For Noting (2.05 - 2.10) 15 - 20 5 Public Reports 5.1 Chair’s Update – Val de Souza, Chair (2.10 - 2.20) 5.2 Chief Officer Report - Morag Barrow, Chief Officer (2.20 – 2.30) 21 - 28 For Decision 5.3 Midlothian IJB Performance Framework - Paper presented by Elouise Johnstone, Performance Manager (2.30 - 2.40) 29 - 52 For Discussion 5.4 Primary Care GP activity data - Paper presented by Rebecca Green, Clinical Director (2.40 - 2.55) 53 - 60 5.5 Midlothian IJB Directions End of Year Update 2022-23, and Proposed Directions 2023-24 - Paper presented by Gill Main, Integration Manager and Elouise Johnstone, Performance Manager (2.55 - 3.05) 61 - 80 5.6 Midlothian IJB Mainstreaming Equalities Report and Action Plan - Paper presented by Gill Main, Integration Manager (3.05 - 3.15) 81 - 100 5.7 Midlothian Integration Joint Board Standing Orders - Paper presented by Alan Turpie, Standards Officer (3.15 - 3.30) 101 - 122 5.8 Finance Update – Quarter 3 2022/23 - Paper presented by Claire Flannagan, Chief Finance Officer (3.30 - 3.45) 123 - 140 Page 2 of 206
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5.9 Midlothian IJB Performance Report - Paper presented by Elouise Johnstone, Performance Manager (3.45 - 3.50) 141 - 156 For Noting (3.50 - 4.00) 5.10 Midlothian IJB Internal Audit Arrangements & Plan 2022/23 - Paper by Duncan Stainbank, Chief Internal Auditor 157 - 164 5.11 Midlothian Community Justice Annual Report 2020 -Paper by Nick Clater, Head of Adult Services 165 - 206 ( ) Indicative timings. 6 Private Reports No private reports to be discussed at this meeting. 7 Date of Next Meeting The next meeting of the Midlothian Integration Joint Board will be held on: • Thursday March 16th 2023 at 14.00-15.00 Special Midlothian Integration Board Meeting Please note that this meeting will be followed immediately by a development session from 15.00 – 16.00 for Board members only • Thursday April 13th 2023 at 14.00-16.00 Midlothian Integration Joint Board Page 3 of 206
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Midlothian Integration Joint Board Meeting Date Time Venue Midlothian Integration Joint Board Thursday 15 December 2022 2.00pm Virtual Meeting held using Microsoft Teams. Present (voting members): Val de Souza (Chair) Cllr Colin Cassidy (Vice Chair) Nadin Akita Jock Encombe Angus McCann Cllr Pauline Winchester Cllr Stuart McKenzie (substitute for Cllr Kelly Parry) Present (non-voting members): Morag Barrow (Chief Officer) Joan Tranent (Chief Social Work Officer) Fiona Stratton (Chief Nurse) Johanne Simpson (Medical Practitioner) Rebecca Green (Clinical Director) Grace Chalmers (Staff side representative) Wanda Fairgrieve (Staff side representative) Hannah Cairns (Allied Health Professional) Keith Chapman (User/Carer) Miriam Leighton (Third Sector) Chris King (NHS Lothian) (substitute for Chief Finance Officer, Claire Flanagan) In attendance: Nick Clater (Head of Adult & Social Care) Grace Cowan (Head of Primary Care and Older Peoples Services) Gill Main (Integration Manager) Roxanne King (Executive Business Manager) Alan Turpie (Standards Officer) Elouise Johnstone (Programme Manager for Performance) Sandra Bagnall (Macmillan Programme Manager (Improving the Cancer Journey)) Sandra McKenzie and Dawn Craig (The Thistle Foundation) Mike Broadway (Clerk) Apologies: Cllr Derek Milligan Cllr Kelly Parry Claire Flanagan (Chief Finance Officer) Midlothian Integration Joint Board Thursday 9 February 2023 Item No 4.1 Page 5 of 206
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2 Midlothian Integration Joint Board Thursday 15 December 2022 1. Welcome and Introductions The Chair, Val de Souza, welcomed everyone to this virtual Meeting of the Midlothian Integration Joint Board. 2. Order of Business The order of business was confirmed as outlined in the agenda that had been previously circulated. 3. Declarations of interest No declarations of interest were received. 4. Minute of previous Meetings 4.1 The Minutes of Meeting of the Midlothian Integration Joint Board held on 13 October 2022 were submitted and approved as a correct record. 4.2 The Minutes of Meeting of the MIJB Audit and Risk Committee held on 1 September 2022 were submitted and noted. 4.3 The Minutes of Meeting of the MIJB Strategic Planning Group held on 14 September 2022 were submitted and noted. 5. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.1 Chair’s Update - Presented by Val de Souza Val de Souza reminding everyone about the upcoming online event open to all IJB members (voting and non-voting) being hosted by Health and Social Care Scotland and the Improvement Service, to consider the Scottish Government and COSLA’s ambition to develop trauma-informed services, systems and workforces across Scotland and how this can support health and social care priorities, on Noted the Chairs update All To Note Page 6 of 206
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3 Midlothian Integration Joint Board Thursday 15 December 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments Tuesday 17 January 2023, 2.30-4.00 pm; details of which had been circulated to all Board Members. Val then went on to update Board Members on a recent in person event hosted by the IJB Chairs and Vice-Chairs Network which had included very helpful input from Audit Scotland and discussion around the proposed National Care Service. On the subject of which it would be helpful at some stage to get Members’ thoughts/feedback on Integration and more specifically what had worked and would be worth keeping. 5.2 Chief Officers Report This report provided a summary of the key service pressures and service developments which had occurred during the previous months across health and social care as well as looking ahead at future developments. Having heard from Chief Officer, Morag Barrow in amplification of her report, the Board discussed the challenges posed by system pressures heading into the busy winter period; workforce related issues in particular staff recruitment and retention and the need for innovation in addressing what was an acknowledged issue across H&SC and the wider public sector; and progress in updating the Primary Care Improvement Plan and the Integration Scheme. The Board congratulated Kenny Barber, Community Mental Health Nurse in the Midlothian Substance Use Service and Lynsey Buchan, Team Manager in Noted the issues and updates arising from the Chief Officers Report. Page 7 of 206
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4 Midlothian Integration Joint Board Thursday 15 December 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments Health Visiting and pre-school Immunisations on their prestigious Queen’s Nursing Awards. They also noted the impending departure of Jock Encombe who had announced his resignation from NHS Lothian Board as a Non-Executive Director, and subsequently as a Midlothian IJB Board Member, expressing thanks to him for all his hard work and wishing him every future success. 5.5 Chief Social Work Officers Report - Paper presented by Joan Tranent, Chief Social Work Officer The purpose of this report was to present the annual report of the Chief Social Work Officer (CSWO). The report provided a high level summary of social work and social care activity, including key developments and information on statutory decisions made by the Chief Social Work Officer on behalf of the Council and Council services. The report was not intended to be exhaustive but gave an indication of trends, priorities, challenges and opportunities over the past year, and in recognition of the arrival and impact of the COVID 19 pandemic, the report also included a summary of how services had responded and adapted during this period. Having heard from Chief Social Work Officer, Joan Tranent, who responded to Members’ question and comments, the Board discussed the challenging nature and breadth of the work undertaken by Social Work staff, thanking Joan and her colleagues. Noted the contents of, and the issues raised in, the report. Page 8 of 206
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5 Midlothian Integration Joint Board Thursday 15 December 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.3 Midlothian IJB Medium Term Financial Plan 2022/23 – 2026/27; and 5.7 Finance Update – Quarter 2 2022/23 - Papers presented by Chris King on behalf of Claire Flannagan, Chief Finance Officer The purpose of this report was to present the Board with a 5-year financial plan (2022/23 to 2026/27). The plan had been prepared following acceptance of the formal budget offers for 2022/23 utilising the in-year financial information and the financial plans and assumption of Partner’s (Midlothian Council and NHS Lothian) for future years; a copy of the full financial plan summary was appended to the report. Also submitted was a report setting out the results of the Partner’s quarter two financial reviews, which considered how these impact on the projected financial position of the IJB for 2022/23. The Board, having heard from Chris King, who having taken Members through the reports, responded to Members’ question and comments, discussed the budgetary pressures being faced by both Partners, leading into some debate over their continuing ability to fund the IJB in the same manner to which it had become accustomed. Of more immediate concern was the fact that confirmation was still awaited from Midlothian Council on the inclusion of its share of the £140m national funding to support the Local Authority pay settlement being passed on to the IJB. (a) Noted the medium-term financial plan (2022/23 to 2026/27); (b) Noted the future work required to refine this financial plan and the requirement for significant recovery actions to bring the plan back into balance; (c) Noted the quarter two financial reviews undertaken by partners; and (d) Agreed that the Chief Officer write in the first instance to the Council Leader and the Chief Executive seeking clarity regarding funding to support the Local Authority pay settlement being passed on. In the event that none was forthcoming to then take up matters as appropriate with Scottish Government. Chief Officer Page 9 of 206
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6 Midlothian Integration Joint Board Thursday 15 December 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.4 Midlothian Integrated Joint Board Governance Documents - Paper presented by Alan Turpie, Standards Officer. The purpose of this report was to update Members on the key actions currently being undertaken to ensure statutory governance requirements were fulfilled. The pandemic and associated pressures resulted in some statutory requirements being granted an extension to completion. Integration Joint Boards must now review all governance arrangements and ensure updates were made where required. The report explained that having successfully reviewed both the Code of Conduct and the Integration Scheme, it was now intended to commence a review of Standing Orders and Scheme of Delegation; copies of which were appended to the report. The Board, having heard from Alan Turpie, Standards Officer, who having taken Members through the recommended changes and future actions, responded to Members’ question and comments, acknowledged the importance of having up-to-date Standing Orders and Scheme of Delegation. (a) Noted the action taken to update the Code of Conduct and Integration Scheme; (b) Noted the action plan and timelines to review the Standing Orders and Scheme of Delegation; and (c) Agreed that any comments be fed back to the Standards Officer, Alan Turpie. All/Standards Officer 5.5 Improving the Cancer Journey & the Wellbeing Service - Presentation led by Sandra Bagnall, Macmillan Programme Manager (Improving the Cancer Journey). The purpose of this presentation was to provide an update on the progress made so far by the Improving (a) Noted the progress made to date by the Improving the Cancer Journey Service; (b) Noted how this work aligns with the existing Wellbeing Service; and Page 10 of 206
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7 Midlothian Integration Joint Board Thursday 15 December 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments the Cancer Journey Service since going live in March 2021 and to outline the future plans to strengthen alignment with the existing Wellbeing Service in Midlothian. The presentation highlighted: • Activity Data • Outcomes and Case Studies • How ICJ & Wellbeing were working collaboratively, evidencing where there was common ground and where there were differences The Wellbeing Service was an integral backdrop to the Improving the Cancer Journey (ICJ) work. The Wellbeing/MIDWAY approach, which Midlothian ICJ workers apply in their work, and its existing position in primary care has enabled the ICJ project to embed in Midlothian and was influencing ICJ practice in other areas, both across the Lothians (as part of the Pan- Lothian ICJ Programme) and ICJ services across Scotland. Current funding arrangements: • Thistle Foundation concludes 31 October 2023 • Improving the Cancer Journey (Macmillan) concludes November 2024. Sandra Bagnall, Macmillan Programme Manager (Improving the Cancer Journey) provided the Board with a broad overview of the progress which had (c) Noted the direction of travel in terms of ICJ & Wellbeing and how this should inform options for the exit strategy. Page 11 of 206
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8 Midlothian Integration Joint Board Thursday 15 December 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments been made, details of some of the impacts, and an outline of future plans. Sandra McKenzie and Dawn Craig, The Thistle Foundation, then highlighted some of these points by making reference to two case studies. Thereafter, they collectively responded to Members’ questions and comments. The Board, in considering the presentation, welcomed the progress which had been made and commented favourably on the services being provided, expressing support for the future plans. 5.8 IJB Improvement Goals - Report from Elouise Johnstone, Programme Manager for Performance; 5.9 Alcohol and Drug Partnership (MELDAP) Annual Report 2021/22 - Report from Nick Clater, Head of Adult Services; 5.10 Community Payback Order Annual Report 2021/22 - Report from Nick Clater, Head of Adult Services; 5.11 East Lothian and Midlothian Public Protection Committee Annual Report 2021/22 - Report from Nick Clater, Head of Adult Services; and 5.12 Multi-Agency Public Protection Arrangements (MAPPA) Report for Edinburgh, the Lothians, and Scottish Borders - Report from Nick Clater, Head of Adult Services Manager. Noted the contents of the various reports. All to Note. Page 12 of 206
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9 Midlothian Integration Joint Board Thursday 15 December 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments The above mentioned reports were all submitted for noting. Members were encouraged to review the reports and should they have any questions or queries on their content, to raise them directly with Integration Manager, Gill Main. 6. Private Reports No private business to be discussed at this meeting. 7. Any other business Board Members joined Val de Souza in expressing their thanks to Jock Encombe for all his hard work as a Member of the Midlothian IJB Board and wishing him every future success. 8. Date of next meeting The next meetings of the Midlothian Integration Joint Board would be held on: • Thursday 12 January 2023 2.00pm Development Workshop. • Thursday 9 February 2023 2.00pm Midlothian Integration Joint Board (Action: All Members to Note) The meeting terminated at 16:02. Page 13 of 206
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Midlothian Integration Joint Board Meeting Date Time Venue Strategic Planning Group Thursday 24 November 2022 14.00 Virtual Meeting held using MS Teams. Present (MIJB members): Morag Barrow (Chair) Present (HSCP): Gill Main (Integration Manager) Shelagh Swithenbank (Planning Officer) Elouise Johnstone (programme Manager, Performance) Hannah Cairns (Chief AHP) Debbie Marklow Fiona Stratton (Chief Nurse) Rebecca Green (Clinical Director) Debbie Crerar Roxanne Watson (Executive Business Manager) Matthew Curl (programme Manager, Digital) Chris King Nick Clater (Head of Adult Services) In attendance: Nicola McTaggart Laura Hutchison (NHSL Equality Lead) Laura Hill (VOCAL) Midlothian Integration Joint Board Thursday 9 February 2023 Item No 4.2 Page 15 of 206
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2 Strategic Planning Group Wednesday 14 September 2022 Apologies: Grace Cowan Claire Flanagan Wanda Fairgrieve Karen Darroch 1. Welcome and introductions Morag Barrow (Chair) welcomed everyone to the meeting. 2. Order of Business The order of business was as set out in the Agenda. 3. Minutes of Meeting The Minutes of Meeting of the Strategic Planning Group held on 14 September were reviewed and approved. 4. Public Reports Report Title/Summary Decision Action Owner Date to be Completed/Comments 4.1 Chairs Update Morag Barrow acknowledged system pressures thanked teams for continuing to provide high quality services despite challenges. Morag highlighted the good work of the Planning, Performance and Programme team leading on the HSCP Outnav Outcome Map and good progress with Directions in initial workshops with the senior team Page 16 of 206
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3 Strategic Planning Group Wednesday 14 September 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments before the IJB development session in January. The Planning, Performance and Programme team have also been leading on work with the Equality and Human Rights Commission (EHRC) to ensure compliance with the Public Sector Equality Duty (PSED) by January 2023 compliance and review of our Mainstreaming Equality action plan for 2023-25 The HSCP workforce Plan has been completed and Morag confirmed a Programme Manager for Workforce and Strategic Planning post is out for advert to lead on the delivery of this plan. Morag confirmed there is currently no Chief Internal Auditor, however, Midlothian and East Lothian plan to progress a joint arrangement. Morag thanked all teams for their continued hard work and dedication. 4.2 PAGG update – Elouise Johnstone (Programme Manager for Performance) Elouise Johnstone provided an update on plan to review the IJB local improvement goals and set new goals and targets for 2023-24. Morag recognised good progress has been made. 5.1 Items for discussion Supporting the Delivery of Digital Transformation (presentation) – Hannah Cairns (Chief AHP) & Matthew Curl (Programme Manager, Digital) Page 17 of 206
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4 Strategic Planning Group Wednesday 14 September 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments Hannah Cairns provided an overview presentation and an update on the Digital Transformation programme. Morag Barrow commented on the impressive progress to date and on positive feedback received from Grace Vickers and links with Midlothian Council strategy. Hannah confirmed the Exec Management Team have a planned digital development session with Steve Handy from the Scottish Digital Academy 5.2 Directions 2023-24 update – Gill Main (Integration Manager) Gill Main provided an overview of the proposed governance timeline and actions to develop the IJB Directions for 2023/24. 5.3 Carers Strategy (presentation) – Shelagh Swithenbank (Planning Officer) and Laura Hill (VOCAL) Shelagh Swithenbank and Laura Hill provided an overview presentation, highlighted ways in which services can embed support for unpaid carers and discussed plans to use additional resource to support unpaid carers. Page 18 of 206
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5 Strategic Planning Group Wednesday 14 September 2022 Report Title/Summary Decision Action Owner Date to be Completed/Comments 5.4 NHS Lothian Equality and Human Rights Priorities (presentation) – Laura Hutchison, NHSL Equalities Lead Laura Hutchison provided an overview presentation and discussed the 6 strategic priorities for the next 5 years, the difference we want to make and the use of an action plan to make the change happen. Laura confirmed the strategy will be published in April with outcome equalities. Laura will continue to link with the Planning, Performance and Programme team and bring future developments back to the group. 5.5 Spotlight Quarterly updates Primary Care, MCH & Frailty Not discussed. Learning Disability – Nick Clater Nick Clater reported increased joint working resulting in good progress being made. Workforce – Gill Main Gill Main confirmed that final revisions were completed, and that the report has now been published and submitted to Scottish Government. Page 19 of 206
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6 Strategic Planning Group Wednesday 14 September 2022 6. Any other business Report Title/Summary Decision Action Owner Date to be Completed/Comments none 7. Date of next meeting The next meeting of the Strategic Planning Group will be held on 26 January 2023 at 2.00pm. Actions: All Members please note and progress the actions detailed in this document The meeting terminated at 4.00pm Page 20 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Chief Officer Report Executive summary The paper sets out the key strategic updates for Midlothian IJB Board meeting February 2023. Board members are asked to: • Note the content of the report # Item number: 5.2 Page 21 of 206
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Midlothian Integration Joint Board Report Chief Officer Report 1 Purpose 1.1 The paper sets out the key strategic updates for Midlothian IJB Board meeting February 2023. 2 Recommendations 2.1 As a result of this report Members are asked to: • Note the content of the report 3 Background and main report 3.1 Chief Officer Systems Pressure The Health and Social care system continues to be under pressure. Despite demand and workforce challenges, the HSCP have continued to maintain patient flow throughout the winter period to date, supporting community referrals for urgent assessment, palliative care support for people within their own homes and supporting discharge from hospital. Review work is underway for those receiving care packages to ensure that the care delivered is meeting their assessed need, with a focus on reablement for those supported out of hospital or experiencing crisis in the community. Medical colleagues across HSCP services continue to collaborate to reduce avoidable admissions where possible and treat patients back in the community at the earliest opportunity. Hospital at Home have continued to work at a higher capacity and local GPs are supporting the care of patients in interim facilities. Investment into the HSCP Hospital at Home team has resulted in Capacity move from 13 beds to 21 beds. Admissions to the virtual ward has increased from 35 patients in September 2022 to 68 patients in October 2022. This has been sustained at this level over the following months. The increased capacity means that more people are now receiving safe Acute health care provision within their home. Morag Barrow, Chief Officer - morag.barrow@nhslothian.scot.nhs.uk 3.2 Head of Adult Services Work is continuing around the preparation for an anticipated joint adult inspection this year. In December 2022. the partnership gave a renewed system-wide commitment (after 3 test pilots sites - Midlothian Community Hospital, Social Work Duty Team and MSK Physio) to using ‘OutNav’ (designed by Matter of Focus); a digital outcome mapping tool that allows teams and services to collate and review outcomes. The OutNav tool supports teams and Page 22 of 206
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Midlothian Integration Joint Board services to measure progress against the nine National Health and Wellbeing Outcomes as well as personal outcomes for people and communities. Going forward, OutNav will be pivotal to the IJB performance framework. In recognition of streamlining self-evaluation and recording outcomes, a significant amount of work has gone into ensuring that the Care Inspectorate and Health Improvement Scotland’s inspection criteria can be mapped into the OutNav tool. This will allow teams and services to analyse and review outcomes against a range of key measures, thus demonstrating the impact their service area has on people, staff and communities. Learning Disabilities and Mental Health will be supported over the coming months to work alongside Matter of Focus to begin to collate evidence to review, analyse and evaluate their own performance. Medicated Assisted Treatment (MAT): Implementation of the 10 MAT standards Individuals in Midlothian have the right to access, through Midlothian Substance Use Services (SUS), high quality treatment/intervention and recovery support that meet their individual needs. This will be achieved through the successful implementation of the national MAT standards that are designed to: • improve access by making getting the help you need easier and quicker by reducing barriers to treatment and making treatment immediately accessible by providing medication on the day that people ask for help and ensure there is outreach to people who are not in treatment. • provide choice to people in treatment – reducing stigma, providing choice on treatment decisions. • offer people support – ensuring people can stay in treatment for as long as they want and offer them the support, they need including the right to have family involved in a person’s treatment. In 2022-23, Midlothian HSCP have successfully developed and approved the implementation plan of all MAT standards 1 to 10. Within the year 2022-2023 Midlothian SUS services were to work towards embedding all 10 standards but for this reporting year there was to be a focus on full implementation of MAT 1-5 and have these 5 standards implemented by March 2023. Each quarter Midlothian HSCP presents their updates to the Scottish Government (SG). A final review and sign off meeting with the SG will take place mid-February 23 where Midlothian HSCP will present and provide evidence to demonstrate the full implementation on MAT 1-5. Midlothian SUS services held an initial meeting in January 2023 with representative of the SG where the services presented our progress and evidence. Midlothian SUS services are pleased to report the outcome from this meeting was very positive and the predicted outcome for the February 2023 meeting is Midlothian SUS will have implemented MAT Standards 1-5 ahead of March 2023. Justice During the last month of Q3 the Unpaid Work team supported those in need across Midlothian. They have worked in partnership with Gorebridge Food Bank and Social Bite to put together 389 family Christmas hampers for the Food Bank and delivered 100 gift bags and Christmas dinners for vulnerable residents. Page 23 of 206
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Midlothian Integration Joint Board Social Work Investments The Scottish Government has allocated an additional £335,000 to Midlothian HSCP for additional Social Workers. It is explicit that the money is to be spent on Social Work staff with a particular focus on Mental Health, Mental Health Officers and Adult Protection (ie. statutory, legislative, work). The Mental Health aspects are to cover mental illness, learning disabilities and dementia (ie. all of the categories defined in legislation as “Mental Disorder”). This money is recurring. Nick Clater, Head of Adult Services - Nick.clater@midlothian.gov.uk 3.3 Head of Primary Care and Older People Vaccinations The Midlothian Vaccination Team have responsibility for all vaccinations. This includes Seasonal Flu, all covid vaccines, shingles, pneumococcal, and all unscheduled vaccines that were part of the Vaccination Transformation Programme from General Practice to the HSCP. In accordance with JCVI guidance, the Autumn/Winter vaccination programme for Flu and covid booster continues until 31st March 2023. All eligible cohorts have received and been invited for their vaccinations across 4 venues – Midlothian Community Hospital, Rosewell Steading, Gorebridge Leisure Centre and Penicuik YMCA-YWCA. From December, clinics were opened to drop-in clinics to increase and promote uptake. As per the plan, Penicuik YMCA-YWCA closed on 22 December 2022 with the other venues remaining open. As of 8 January 2023, the uptake of flu vaccines for adults administered in Midlothian HSCP is 67%, and 68% for Covid booster vaccines. The Community Vaccination Team continues to deliver the school flu programme, and the 0-5 immunisation team deliver the 2-5 year flu programme with a 59% uptake. The housebound, inpatient and Care home vaccination programmes are successfully complete with ongoing mop-ups arranged. As part of the inclusivity plan and to promote further uptake in line with the Scottish Government target of 80% uptake, pop up clinics took place at IKEA Edinburgh and Mayfield Community Big Dig event. Specific sessions were also held inviting individuals in homeless accommodation, and individuals with Learning Disabilities, to attend for vaccination. There is further work planned for Q4 in line with the inclusivity plan. Grace Cowan, Head of Primary Care & Older People grace.cowan@nhslothian.scot.nhs.uk 3.4 Planning, Performance and Programme Equalities Officers of the HSCP have undertaken a significant piece of work with the Equalities and Human Rights Commission to improve the HSCP and IJBs application of the duties set out in The Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012. This work has also helped to improve the EHRCs understanding of the sector, the role of the IJB as a strategic commissioning body, the range and scope of the IJBs activities, and the mechanisms available to it to improve equality outcomes. Page 24 of 206
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Midlothian Integration Joint Board Outcomes As previously noted, work continues to develop our understanding and application of contribution analysis and the use of OutNav to record and measure the HSCP contribution to improvements in personal outcomes. The architecture is based on one Outcome Map for statutory services and one for our commissioned services that have standardised core requirements evidence each outcome ambition. Outcome mapping has been aligned with the Inspection Indicators for Health Improvement Scotland and the Care Inspectorate resulting in services recording inspection evidence systematically and consistently while ensuring the principles of personal outcomes remain the centre of our governance. As more services are 'onboarded' the HSCP will have facility to evaluate not only our progress towards improved outcomes by team, service, group service and whole, but also the IJBs six strategic aims. IJB Directions HSCP Planning and Performance have supported the IJB to develop the first draft of Directions 2023-24. This has seen our planning team lead on the further development of strategic model and simultaneously develop the HSCP governance framework to allow service planning to absorb previously issued operational Directions. The first draft sees a reduction from 157 Directions in 2022-23 to approximately 20 that align with the 9 National Health and Wellbeing Outcomes. This sits alongside a new IJB performance framework anticipated for Board approval following the issue of Midlothian IJB Directions 2023-24 on 1st April 2023. Gill Main, Integration Manager - gill.main3@nhslothian.scot.nhs.uk 3.5 Chief Allied Health Professional Midlothian Health & Social Care Partnership are working in partnership with Chest Heart and Stroke Scotland (CHSS) to develop and implement the Long Covid Pathway which provides a combination of digitally enabled support, and 1:1 support from an advice line practitioner, to help patients manage symptoms, such as fatigue, breathlessness, pacing and anxiety, caused by Long Covid. The pathway is a patient information and support service for those diagnosed with long covid and does not provide clinical treatment for long covid. The implementation of this service within Midlothian is part of an NHS Lothian wide project to offer this existing service to all residents within Lothian who have been diagnosed with Long Covid. Midlothian Health & Social Care Partnership is the first partnership within Lothian to rollout this service following a pilot programme (phase 1) across Lothian involving 26 GP Practices, including Penicuik Health Centre. The support is being provided through an App or web-based digital platform called Tailored Talks, where patients will receive personalised health information before being offered 1-12 weeks support from a CHSS advice line practitioner. The CHSS advice line aims to deliver an enhanced person-centred pathway through a series of telephone calls for up to 12 weeks. This part of the service aims to: • Improve the quality of life for people in the community experiencing long COVID • Provide increased knowledge of the condition • Provide advice on how to manage common symptoms such as fatigue and breathlessness Page 25 of 206
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Midlothian Integration Joint Board • Provide advice and confidence on self-management • Refer on to community-based support if appropriate Hannah Cairns, Chief AHP - hannah.cairns@nhslothian.scot.nhs.uk 3.6 Primary Care in Midlothian All GP practices continue to demonstrate high levels of clinical activity, with exceptional unscheduled demand in the 2 weeks before Christmas due to circulating viral illness and parental concern due to Strep A, causing significant strain on most practice teams. However, despite the current challenges, a 6-month bridging contract has now been secured from another Midlothian practice to provide GMS services at Danderhall Medical Practice, pending public formal tender for the long-term contract. This is a positive result for patients and staff alike, and the patient list will re-open for new registrations from 1 February. Frailty programme Work continues to successfully engage and train care staff in 10 of the Nursing and Residential care facilities across Midlothian about anticipatory care planning, using a human rights-based approach. The next step is to develop an ACP pathway with local GPs, with the aim of further reducing avoidable admissions. Rebecca Green, Clinical Director – rebecca.green@nhslothian.scot.nhs.uk 4 Policy Implications 4.1 The issues outlined in this report relate to the integration of health and social care services and the delivery of policy objectives within the IJBs Strategic Plan. 5 Directions 5.1 The report reflects the ongoing work in support of the delivery of the current Directions issued by Midlothian IJB. 6 Equalities Implications 6.1 There are no specific equalities issues arising from this update report. 7 Resource Implications 7.1 There are no direct resource implications arising from this report. 8 Risk 8.1 The key risks associated with the delivery of services and programmes of work are articulated and monitored by managers and, where appropriate, reflected in the risk register. 9 Involving people 9.1 There continues to be ongoing engagement and involvement with key stakeholders across the Partnership to support development and delivery of services. Page 26 of 206
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Midlothian Integration Joint Board 10 Background Papers AUTHOR’S NAME Morag Barrow DESIGNATION Chief Officer CONTACT INFO 0131 271 3402 DATE February 2023 // Appendices: Page 27 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Midlothian IJB Performance Framework Executive summary The purpose of this report is to provide the Board with a draft of the Performance Framework for 2023-2024. Board members are asked to: • Note the draft Performance Framework for 2023-2024. • Note the process and schedule for completion, approval, and publication of the full Performance Framework for 2023-2024. A performance framework is a summary of all the measures used to determine how well an organisation is meeting its aims. There are five key steps: • Agree measures • Collect data • Analyse information • Present results • Make decisions. We measure our performance to see what is working well, what can be improved and how well we are meeting the key aims of integration, our strategic aims and progressing our strategic plan. The Performance Framework will also play a role in assurance and governance around sources and use of data for reporting on outputs and outcomes. Item number: 5.3 Page 29 of 206
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Midlothian Integration Joint Board Measures will be organised within the following key areas: • IJB Strategic Aims • MSG Indicators • IJB Local Improvement Goals • IJB Directions (National Health and Wellbeing Outcomes). The Performance Framework will be completed following confirmation of Directions for 2023-24 and will be subject to parallel internal governance processes. This approach will ensure approval of the Framework to permit its publication in support of the timeline for publication of Directions 2023-24. Page 30 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian IJB Performance Framework 1 Purpose 1.1 The purpose of this report is to provide the Board with a draft of the Performance Framework for 2023-2024. 2 Recommendations 2.1 As a result of this report Members are asked to: • Note the draft Performance Framework for 2023-2024. • Note the process and schedule for completion, approval, and publication of the full Performance Framework for 2023-2024. 3 Background and main report 3.1 A performance framework is a summary of all the measures used to determine how well an organisation is meeting its aims. There are five key steps set out below: 3.2 Agree measures A performance framework needs to contain clearly defined measures and data sources. They should link as closely as possible to the aim, whilst taking a pragmatic approach to the use of proxy measures. The measures must be monitored regularly and consistently, with the insights being shared with team, service and organisational leads, along with Board members where appropriate. The measures should be designed in a way that supports their use for other functions, for example audits and reports to partners, people and communities. Clarity of definitions is critical to the success of measurement and may take several iterations to achieve. 3.3 Collect data Once the measures have been agreed, then the data to evidence them can be collected. This is likely to involve accessing data from multiple systems, including operational, financial and HR, as well as feedback surveys (e.g. Care Opinion, Health and Care Experience Survey) or external benchmarking data (e.g. Core Suite of Integration Indicators). Page 31 of 206
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Midlothian Integration Joint Board Under current data sharing arrangements, one of the most significant challenges faced by Midlothian Health and Social Care Partnership is the lack of access to a safe, structured data warehouse. Collecting and connecting this data is a complex set of tasks and whilst many tools exist (e.g. Tableau, PowerBI), they are not yet used consistently across our partner organisations. 3.4 Analyse information When the data has been collected, it must be carefully analysed to ensure that no details have been overlooked. The time it takes to thoroughly interrogate data is often underestimated. Working with teams to understand their data needs provides an opportunity to ask useful questions: • What do others need to know about our performance? • How do we know what good looks like? • How do we know if our performance is meeting any required standards? • If our performance is good, could it be even better? • How are we doing in relation to similar teams / services / organisations? • Is there variation in our data and do we understand it? • Are there any significant shifts / trends? • What is the impact of any changes in performance? 3.5 Present Results Data presentation, done well, looks simple. It is a complex task requiring a combination of skills: analysis, design, and communication. Successful presentation of data requires the following: • Understand the audience, to provide the data they need, in a format they can understand, acknowledging the variation in requirements of detail and granularity; • Simplify the message to reduce confusion and distraction, by designing simple, clear and accurate visuals. Additional information may be required to provide wider context for the data – this should be kept to the minimum; • Communicate the message using the visual that is most effective: this will often be graphs and tables. Simplify these as far as possible. 3.6 Make decisions The presentation of performance data needs to be accessible to the relevant audience and provide the information they need to make good decisions. This could include Red/Amber/Green status, measured over time to understand any trends, with additional information to provide wider context (e.g. how are other parts of the system performing). The context should inform, and therefore support, better decision-making regarding prioritisation, service delivery and design, allocation of resources and the ongoing measurement required to monitor progress / impact of any change. Page 32 of 206
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Midlothian Integration Joint Board The measures within the Performance Framework should be reviewed regularly to ensure they continue to meet requirements across the whole system. 3.7 At its most fundamental level, a Performance Framework should support the following activities: • measure • monitor • inform / report • decide. We measure our performance to see what is working well, what can be improved and how well we are meeting the key aims of integration, our strategic aims and progressing our strategic plan. We plan and direct health and social care services and manage the allocation of the budget. We aim to: • Improve the quality of health and social care services and achieve the 9 national health and wellbeing outcomes; • Change how health and social care is delivered to better understand and meet the needs of the increasing number of people with long term health conditions, with complex needs and those who need support, working with people as partners in their health and social care. • Provide more support, treatment, and care for people in their homes, communities, or a homely setting rather than in hospitals. 3.8 A Performance Framework can also play a role in assurance and governance around sources and use of data for reporting on outputs and outcomes. The Integration Joint Board is the governing body for what is commonly referred to as the Midlothian Health & Social Care Partnership. These Standing Orders are made under the Public Bodies (Joint Working) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (No 285) (“the Order”). 3.9 There are a number of performance-related matters reserved for the Integration Joint Board: Strategic Planning 12.5 The Integration Joint Board shall establish a Strategic Planning Group (Section 32 of Public Bodies (Joint Working) Scotland Act 2014), and appoint its membership (except for the members nominated by each constituent party). 12.6 The Integration Joint Board shall approve its Strategic Plan (Section 33) and any other strategies that it may need to develop for all the functions which have been delegated to it. The Integration Joint Board will also review the effectiveness of its Strategic Plan (Section 37). Page 33 of 206
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Midlothian Integration Joint Board 12.7 The Integration Joint Board shall review and approve its contribution to the Community Planning Partnership for the local authority area. The Integration Joint Board shall also appoint its representative(s) at Community Planning Partnership meetings. Performance Management 12.15 The Integration Joint Board shall approve the content, format, and frequency of performance reporting. 12.16 The Integration Joint Board shall approve its performance report for the reporting year. 3.10 There is a statutory duty on the IJB to report on performance: Integration authority: performance report (1)Each integration authority must prepare a performance report for the reporting year. (2)A performance report is a report setting out an assessment of performance during the reporting year to which it relates in planning and carrying out the integration functions for the area of the local authority. (3)The Scottish Ministers may by regulations prescribe the form and content of performance reports. (4)An integration authority must— (a)publish each performance report before the expiry of the period of 4 months beginning with the end of the reporting year, and (b)provide a copy of it to the persons mentioned in subsection (5). (5)Those persons are— (a)where the integration authority is an integration joint board, each constituent authority, (b)where the integration authority is a local authority and a Health Board acting jointly, the integration joint monitoring committee, (c)where the integration authority is a Health Board or a local authority— (i)the integration joint monitoring committee, and (ii)the other authority. (6)A constituent authority must provide an integration authority which is an integration joint board with such information as the authority may reasonably require for the purpose of preparing a performance report. (7)The other authority must provide an integration authority which is a Health Board or a local authority with such information as the integration authority may reasonably require for the purpose of preparing a performance report. Page 34 of 206
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Midlothian Integration Joint Board (8)In this section— • “other authority” means the local authority or the Health Board with which the integration authority prepared the integration scheme in pursuance of which the integration authority acquired its delegated functions, • “reporting year”, in relation to an integration authority, means— (a) the period beginning with the date prescribed under section 9(3) or, as the case may be, 15(2) and ending on the first anniversary of that date, and (b) each subsequent period of a year. 3.11 The Performance Framework will describe the measures, data sources and frequency for: • IJB Strategic Aims • IJB Improvement Goals (MSG) • National Health and Wellbeing Outcomes • IJB Directions. 3.12 The Performance Framework will be completed following confirmation of Directions for 2023-24 and will be subject to parallel internal governance processes. This approach will ensure approval of the Framework to permit its publication in support of the timeline for publication of Directions 2023-24. 4 Directions 4.1 There are no implications on the Directions. 5 Equalities Implications 5.1 There are no equality implications from focussing on these goals but there may be implications in the actions that result from work to achieve them. 6 Resource Implications 6.1 There may be resource implications resulting from additional capacity and capability requirements to develop data collection, analysis and visualisation systems and processes. 7 Risk 7.1 The main risk is that the capacity and capability of the workforce does not match the requirements and demands placed upon it by the scale, complexity and profile of the workload. Page 35 of 206
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Midlothian Integration Joint Board 7.2 Given the dependency on limited resources of partners within Midlothian Council and NHS Lothian in relation to data access, storage and governance, there is a risk that this work may not progress at an adequate pace and scale. 8 Involving people 8.1 The Performance Assurance & Governance Group (PAGG) meet monthly to review and discuss these measures as part of wider data assurance. 9 Background Papers AUTHOR’S NAME Elouise Johnstone DESIGNATION Performance Manager CONTACT INFO elouise.johnstone@nhslothian.scot.nhs.uk DATE 17/01/2022 Appendix 1: Draft Performance Framework 2023-24 Page 36 of 206
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Midlothian Integration Joint Board Performance Framework 2023/24 Page 37 of 206
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Contents Measures IJB Strategic Aims MSG Indicators IJB Local Improvement Goals IJB Directions (National Health and Wellbeing Outcomes) Page 38 of 206
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Midlothian IJB Strategic Aims 2023-24 Aim Data Source Frequency 1 Increase people’s support and opportunities to stay well, prevent ill or worsening health, and plan ahead. OutNav* Service outcome data Annually & end of Strategic Plan period 2 Enable more people to get support, treatment and care in community and home-based settings. OutNav* Service outcome data Annually & end of Strategic Plan period 3 Increase people’s choice and control over their support and services. OutNav* Service outcome data Annually & end of Strategic Plan period 4 Support more people with rehabilitation and recovery OutNav* Service outcome data Annually & end of Strategic Plan period 5 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. OutNav* Service outcome data Annually & end of Strategic Plan period 6 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. OutNav* Service outcome data Annually & end of Strategic Plan period * Not all services are currently using OutNav so local service outcome data will be used Page 39 of 206
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Midlothian IJB Local Improvement Goals 2023-24 Improvement Goal 2023/24 Aim Data Source Frequency 1 2 3 4 5 6 Page 40 of 206
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National Health and Wellbeing Outcomes 2023-24 Outcome Data Source Frequency Health & Wellbeing: People are able to look after and improve their health and wellbeing and live in good health for longer Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual 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 Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Positive Experiences & Dignity: People who use health & social care services have positive experiences of those services, and have their dignity respected Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Quality of Life: Health & social care services help to maintain or improve the quality of life of people who use those. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Health Inequalities: Health & social care services contribute to reducing health inequalities. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Support for Carers: People who provide unpaid care are supported to look after their health and wellbeing. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Safe from Harm: People using health & social care services are safe from harm. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Page 41 of 206
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Workforce: Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Use of Resources: Resources are used effectively and efficiently Health and Care Experience Survey Core Suite of Integration Indicators Bi-Annual Annual Page 42 of 206
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7 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Midlothian IJB Directions 2023-24 Page 43 of 206
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8 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. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 44 of 206
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9 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 45 of 206
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10 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 46 of 206
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11 5 Health Inequalities Health & social care services contribute to reducing health inequalities. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 47 of 206
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12 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 48 of 206
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13 7 Safe from Harm People using health & social care services are safe from harm. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 49 of 206
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14 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 50 of 206
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15 9 Use of Resources Resources are used effectively and efficiently. No Area Direction Performance Measures What is the measure you are using to demonstrate progress? How will you know that a change is an improvement? What is the data/information source being used? Page 51 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Primary Care GP activity data Executive summary 62% of people say they have had a positive experience of the care provided by their GP practice, but this is lower than in previous years, and lower than the average in Scotland. Primary Care and GP appointments represent excellent value for money in providing healthcare for patients close to home. Access to an appropriate primary care professional or service (‘right person right time right place’) is therefore a priority for local residents, the wider health & social care system, and for the Scottish Government. Access can be better understood by considering evidence of Demand, Capacity, Activity, Queue (DCAQ). This paper intends to provide an objective update and provide assurance that appropriate measures and being taken to maintain and improve access for patients in Midlothian to Primary Care general medical services, including unscheduled care. Board members are asked to: • Note the data provided on local demand, capacity, and activity in primary care in Midlothian, including the higher clinical activity than across the rest of Lothian. • Recognise the disparity between the objective evidence presented and the often- unhelpful narrative portrayed in the lay media and some anecdotal reports/opinion. • Note the significant pressure on local GP practices which is impacting on resilience and risks the future provision of sustainable general medical services. • Consider the potential need to ‘invest to save’ to support resilience of local practices to be able to continue to provide the high-value care for patients in the community and close to home. Item number: 5.4 Page 53 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board Primary Care GP activity data 1 Purpose 1.1 Update IJB on current Primary Care GP activity data and provide assurance that appropriate actions are being taken to maintain and improve access for patients to general medical services, including unscheduled care. 2 Recommendations 2.1 As a result of this report what are Members being asked to: • Note the data provided on local demand, capacity, and activity in primary care in Midlothian, including the higher clinical activity than across the rest of Lothian. • Recognise the disparity between the objective evidence presented and the often- unhelpful narrative portrayed in the lay media and some anecdotal reports/opinion. • Note the significant pressure on local GP practices which is impacting on resilience and risks the future provision of sustainable general medical services. • Consider the potential need to ‘invest to save’ to support resilience of local practices to be able to continue to provide the high-value care for patients in the community and close to home. 3 Background and main report 3.1 NHS Lothian subcontracts the provision of General Medical Services (GMS) to General Practitioners. All 12 practices in Midlothian are run this way. GPs are contracted to provide essential services during core hours which are “appropriate to meet the reasonable needs of patients and with arrangements in place for patients to access such services throughout the core hours in case of emergency.” 3.2 The IJB have previously shown interest and exercised scrutiny of access to primary care and GP services. In November 2021 the GP management team gave a presentation to the IJB to explain local models of access and show data to demonstrate that access to GP advice and appointments had increased again after the COVID-19 pandemic. 3.3 Midlothian HSCP’s 2022 Annual Performance Report (using results from the 2022 Scottish Health & Care Experience Survey) described how over a third of patients were concerned about the arrangements for accessing advice and support from local health centres. 62% of people said they had a positive experience of the care provided by their GP practice but this is lower than in 2020/21 (67%) and is lower than the average in Scotland (67%, also reduced from 79% in 2020/21). Page 54 of 206
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Midlothian Integration Joint Board 3.4 However, 88% of people said they had a positive experience when needing to see a GP urgently. This is a small increase from 2020/21 and is higher than the average for Scotland (85%). We think these positive results are due to changes to access models that have increased opportunities to quickly assess urgent problems. Initial Primary Care medical assessment is now available by telephone, video, and email in some practices. 3.5 Access to an appropriate primary care professional or service (‘right person right time right place’) can be better understood using a Demand, Capacity, Activity, Queue (DCAQ) approach. 3.6 Demand (perceived or actual need for clinical assessment and treatment) – 3.6.1 The population of Midlothian is projected to have increased by 13.8% in 10 years up to 2028. This compares to a projected increase of 1.8% for the rest of Scotland. This growth has affected local GP practices disproportionately, depending on where local housing developments are sited, with five practices experiencing patient list growth of more than a third in the last 10 years. 3.6.2 In addition to a growing population, mean 18.35% of residents are now over 65 years old. Two local GP practices have populations of over 65-years of more than 23%. This proportion is expected to continue to increase and as people live for longer many more people will be living at home with frailty and/or dementia and/or multiple health conditions. This patient group frequently requires a disproportionate time for each consultation and access GP services with greater frequency than younger patients. 3.6.3 Midlothian also has some significant pockets of deprivation with patients in SIMD-1 in some areas. This patient group has lower life expectancy and higher rates of GP consultations, particularly for mental health issues. 3.6.4 Each winter demand increases due to illness caused by seasonal viruses, including Influenza. Prevalence of such viruses has been higher this winter now that all COVID- 19 infection control precautions have been lifted. In addition to this, a spike in the prevalence of Group A Strep throat infections and reported cases of IGAS in England caused significant levels of parental concern during December 2022. All practices report exceptional levels of unscheduled demand, with some practices reporting increases in same-day unscheduled demand of up to 80%. 3.7 Capacity (total time/resource available to undertake clinical work) – 3.7.1 The BMA has recently recommended a safe level of working for all GPs of 25 patient contacts per day3 with longer appointments. Currently most GPs work well-above this capacity to treat and meet the uncapped demand. 3.7.2 Funding for general medical services (see 3.1) is complicated but is predominantly capitation based and therefore essentially resources a fixed capacity of clinical workforce. Demand for and provision of care that exceeds capacity does not attract additional income. 3.7.3 The current Primary Care workforce is shrinking due to recruitment and retention challenges. GP colleagues are exhausted and demoralised by the unrelenting demand which consistently and significantly exceeds capacity, as well as unrealistic Page 55 of 206
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Midlothian Integration Joint Board expectations fuelled by unhelpful narrative in the media which does not accurately describe the actual activity delivered despite the limited capacity. WTE numbers of GPs are reducing despite the promise of more doctors in training, and in addition senior doctors are being forced out by punitive pension taxes and burnout. We undertook a local workforce survey in January 2022 which recorded that 91 GPs were providing GMS services to 1,811 registered patients per WTE, compared to mean 1,315 across the rest of Scotland. 4% of our Midlothian GPs are planning to retire in the next 2 years, and a further 7% are planning to retire between 2-5 years. 8 practice nurses (26%) are planning to retire in the next 2 years. 3.7.4 Rising demand due to local population growth in Danderhall has significantly outstripped capacity due to recruitment failure of new GPs. This unfortunately forced the remaining single-handed GP to close the patient list to new registrations, and ultimately to resign from their GMS contract as the workload had become untenable. 3.7.5 In 2018 the New GMS GP General Medical Services (GMS) Contract2 proposed Primary Care Improvement Plans to provide a multidisciplinary team to support GPs and reduce workload by releasing some of their time to concentrate on medical complex cases. Locally the team includes pharmacists, physiotherapists, treatment (CTAC) nurses and phlebotomists, mental health nurses, and wellbeing practitioners. Locally these colleagues provide about 10-15% of all appointment capacity, but there are also recruitment challenges with several vacancies across the teams as demand for this workforce outstrips supply and leaches vital workforce away from secondary care or specialist services. 3.8 Activity (actual clinical contacts undertaken) – 3.8.1 Over 60% of all healthcare activity takes place in primary care. A recent King’s Fund report describes how GP workload has grown hugely, both in volume and complexity. The research sample shows a 15 per cent overall increase in contacts in the last 5 years2. 3.8.2 Lothian Medical Committee GP subcommittee have been facilitating the collection of self-reported clinical activity data each Monday since September 2022. Local participation has been good, and median clinical activity in Midlothian has been recorded as 32 clinical contacts per 1,000 patients, compared to a lower median 27/1,000 across the rest of Lothian. 20 25 30 35 40 45 Clinical activity per 1,000 patients Source: SITREP data via LMC Midlothian Lothian Page 56 of 206
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Midlothian Integration Joint Board 3.8.3 Based on these figures, we estimate that 10,500 – 16,300 clinical patient contacts now take place each week in Midlothian, depending on seasonal variation. 3.8.4 Face-to-face (F2F) consultation rates remain difficult to accurately quantify as this intelligence is held on GP practices’ own IT systems. However, more practices are now signing up to share their data with NHS Lothian’s DataLoch and there is early evidence and good examples to demonstrate that F2F activity has been increasing continuously and has now returned to pre-COVID-19 levels. 3.9 Queue (demand exceeds capacity or when activity and capacity are mismatched) – 3.9.1 Waiting times for routine appointments with a GP in Midlothian are difficult to quantify. They are likely to vary considerably across and within practices, due to local capacity pressures and continuity (demand to see a particular GP). Overall, only 36 % of respondents in the 2022 Scottish Health & Care Experience Survey reported satisfaction with booking an appointment 3 or more days in advance. 3.9.2 However, 88% of respondents in Midlothian said they had a positive experience when needing to see a GP urgently. This is a small increase from 2020/21 and is higher than the average for Scotland (85%). These positive results are likely to be due to changes to access models that have increased opportunities for timely access to medical advice to assess urgent problems by telephone, video, and email in some practices. 3.9.3 Out-of-hours consultations at Midlothian Community Hospital are lower than pre- COVID-19. 3.9.4 Despite higher levels of primary care clinical activity in Midlothian than across the rest of Lothian, attendance at Accident & Emergency (A&E) has been consistently higher than for the rest of Lothian. These higher levels of attendance are seen in all age groups, except the very elderly >75 years. 3.10 Improving Access 3.10.1 To increase capacity (and therefore activity) we need to increase workforce. Provision has been made in the Midlothian 2023-24 Primary Care Improvement Plan for further pharmacy support staff and Community Treatment (CTAC) Band 5 nurses. We are also evaluating the best-value use of other staff groups to ensure that optimal access for patients can be achieved, and GP workload is controlled or reduced as intended in the new GMS Contract 2018 and Memorandum of Understanding (MOU2). 3.10.2 Independent Contractor GPs should not be expected to personally fund an increase in clinical workforce capacity to improve access. But practices will be encouraged to engage in a range of access initiatives and process improvements. These will include a range of initiatives, including: • Midlothian-wide patient comms re current pressures • Improved signposting to health resources and supported self-management via practice website • Improved Care Navigation protocols to direct patients to right person right place first time Page 57 of 206
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Midlothian Integration Joint Board • Funding for digital access platform to test blended additional access approaches • Protected ‘same day’ appointments for MSK-APP (physiotherapists) to create provision for assessment of minor injuries and acute musculoskeletal pain • Mental Health triage appointments • 7-day CTAC service • Pharmacotherapy medicines reconciliation hub • Acute prescribing improvement work & move to serial prescribing • Polypharmacy reviews for complex/frail patients • Anticipatory care planning. 3.10.3 As well as access and patient experience assurance measures, it will be important to also be important to monitor other measures of system pressure and access sustainability including sickness, recruitment & retention rates of primary care staff, the number of practices who maintain an open list for patient registration, and continuity of care. Good continuity reduces mortality and risk of unscheduled admissions but prioritising better urgent/unscheduled access can reduce continuity with a patient’s usual care provider. 4 Policy Implications 4.1 The Scottish Government has made improving access for patients their priority and have pledged to invest in multi-disciplinary teams to increase capacity in primary care. This will allow patients to be seen at the right time by the right person, and also help reduce General Practitioner (GP) workload. 5 Directions 5.1 Scottish Government PCIF funding and available workforce are currently inadequate to fully deliver the expectations of the New GMS Contract 20182 including full implementation of CTAC to effectively manage and support patients with long-term conditions (MIJB-5.3) and full pharmacotherapy services (MIJB-5.5 & 5.6). 5.2 Capital funding has not yet been allocated by the Scottish Government to allow progression of plans for new health centres in Shawfair and South Bonnyrigg/Rosewell (MIJB-5.8 & 5.13). 5.3 Data sharing capability between GPs and HSCP still limited (MIJB-5.10) to fully understand current activity until new NHS Lothian IT provisioning is completed and DataLoch/Tableau dashboards are fully interactive. GPs as independent contractors retain the right not to share their data. 5.4 Options for older people will be limited if there is not ongoing recurring funding for a continued local Frailty programme (MIJB-5.14). 6 Equalities Implications 6.1 Population/list growth is disproportionate between practices so ease of access may be dependent on where a patient lives and which practice they are registered with. Page 58 of 206
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Midlothian Integration Joint Board 6.2 There is known variation in model/service provision between practices, ranging from digital access platforms and total telephone triage to manage demand, to more traditional access routes and direct patient appointment booking. 6.3 It is important that we consider the impact on all patient groups for any changes planned so that we do not cause or increase in inequalities in access. Digital innovation will be an important part of this work but will need appropriate mitigations. 7 Resource Implications 7.1 A GP consultation costs around £39 which compares to the average cost of £77 for someone who attends an urgent care centre and receives the lowest level of investigation and treatment or at least £359 for an individual at a major A&E department who receives more complex investigation and treatment3. Primary care assessment and treatment is therefore real value for money and allows patients to be treated closer to home. 7.2 However, Primary Care in Scotland has been chronically underfunded with recent funding streams also being withdrawn, e.g. PCIF underspend, PC wellbeing funding. Local enhanced service payments have not been uplifted for 7 years. 7.3 Sustaining current levels of access for patients in Midlothian will need local investment to help practices stay resilient. An ‘invest to save’ approach may be required to fund initiatives such as LEGUP grants to support practices to keep their practice list open, service level agreements (SLAs) to provide backfill payment for clinical time to look after patients in interim care facilities and extra-care housing facilities, etc 8 Background Papers 8.1 GMS contract: 2018 - gov.scot (www.gov.scot) 8.2 Understanding pressures in general practice | The King's Fund (kingsfund.org.uk) May 2016 8.3 Key facts and figures about the NHS | The King's Fund (kingsfund.org.uk) January 2022 8.4 IJB GP Access presentations November 2021 AUTHOR’S NAME Dr Rebecca Green DESIGNATION GP and HSCP Clinical Director CONTACT INFO rebecca.green@nhslothian.scot.nhs.uk DATE 26th January 2023 Page 59 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Midlothian IJB Directions End of Year Update 2022-23, and Proposed 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. The end of year report on progress towards each Direction is provided in appendix 1. This provides an overall status rating for each Direction area. A rigorous audit process has been undertaken to ensure that each previously issued Direction is clearly auditable. A more detailed account of the specific action for each Direction was reviewed by the Strategic Planning Group on 26th January 2023. In line with the IJB’s ambition to reduce the number of Directions issued by the Board and ensure a more strategic focus is taken for 2023-24, Proposed Directions for 2023-24 are also presented for consideration (appendix 2) following a series of workshops and development sessions with the HSCP executive team and IJB Board members. SPG scrutinised the first draft of the Midlothian IJB Directions 2023-24 on, 26th January 2023 and recommended this draft for IJB consideration. SPG will review amendments and revisions on 23rd February 2023 to provide assurance and make further recommendation to the Board. Midlothian IJB Directions 2023-24 will be presented to the Board on 16th March 2023 to seek approval before publication on 1st April 2023. Board members are asked to: • Note the end of year performance updates for the 2022-23 Directions • Note the recommendations from SPG to progress Directions as Complete, Revised, or Revoked • Review and provide feedback on the first draft Directions for 2023-24 Item number: 5.5 Page 61 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian IJB Directions End of Year Update 2022-23, and Proposed Directions 2023-24 1 Purpose 1.1 This report discusses the end of report on progress towards Directions issued in 2022-23 and presents the first draft of MIJB Directions 2023-24. 2 Recommendations 2.1 As a result of this report what are Members being asked to:- • Note the end of year performance updates for the 2022-23 Directions • Note the recommendations from SPG to progress Directions as Complete, Revised, or Revoked • Review and provide feedback on the first draft Directions for 2023-24 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 The end of year report on progress towards each Direction is provided in appendix 1. This provides an overall status rating for each Direction area. A rigorous audit process has been undertaken to ensure that each previously issued Direction is clearly auditable. A more detailed account of the specific action for each Direction was reviewed by the Strategic Planning Group on 26th January 2023. 3.4 In line with the IJB’s ambition to reduce the number of Directions issued by the Board and ensure a more strategic focus is taken for 2023-24, Proposed Directions for 2023-24 are also presented for consideration (appendix 2) following a series of workshops and development sessions with the HSCP executive team and IJB Board members. Page 62 of 206
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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 has implications for all current and any future Directions. 6 Equalities Implications 6.1 There are no specific Equalities Implications from this report. Health and Social Care Partnership programmes that relate to Directions and the Strategic Plan are subject to individual Integrated Impact Assessments (IIAs). 7 Resource Implications 7.1 All approved Directions 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. 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. 9 Involving people 9.1 Community, staff and stakeholder engagement on the planning and review of services related to Directions will continue. Page 63 of 206
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Midlothian Integration Joint Board 9.2 SPG will again review Midlothian IJB Directions 2023-24 on 23rd February 2023 to provide assurance and make a recommendation regarding these Directions to the Board. Midlothian IJB Directions 2023-24 will be presented to the Board on 16th March 2023 to seek approval before publication on 1st April 2023. 10 Background Papers AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO gill.main3@nhslothian.scot.nhs.uk DATE 27 January 2023 Appendices: Appendix 1: Directions 2022-23 End of Year Report Appendix 2: First Draft MIJB Directions 2023-24 Page 64 of 206
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Midlothian Integration Joint Board Year End Summary Directions 2022/23 Page 65 of 206
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Direction Direction to Issued & Continuing Revised into new Direction 2023/24 Completed Revoked 1 Unscheduled Care - Acute Hospitals NHS Lothian & Midlothian Council 1.3 1.6 1.14 1.17 1.18 1.19 1.13 MIJB agreed to close 15/09/2022 1.15 Group Service Specification Action 1.16 MIJB agreed to close 15/09/2022 2 Accident and Emergency (A&E) NHS Lothian & Midlothian Council 2.6 2.8 2.12 2.3 Service / Programme Plan Action 2.11 Service / Programme Plan Action 2.13 Service / Programme Plan Action 3 MCH NHS Lothian & Midlothian Council 3.6 3.8 3.5 3.4 Service / Programme Plan Action 3.7 Service / Programme Plan Action 3.9 Service / Programme Plan Action 3.10 MIJB agreed to close 15/09/2022 4 Palliative Care NHS Lothian & Midlothian Council 4.2 4.4 4.5 (Service / Programme Plan Action) 4.6 (Group Service Specification Action) 4.7 5 Primary Medical Services NHS Lothian 5.16 5.3 5.5 5.6 5.7 5.8 (Workforce Plan) 5.9 MIJB agreed to close 15/09/2022 5.10 (Group Service Specification Action) 5.11 (Group Service Specification Action) 5.12 (Service / Programme Plan Action) 5.13 MIJB agreed to close 15/09/2022 5.14 (Service / Programme Plan Action) 5.15 MIJB agreed to close 15/09/2022 6 Community Health Services NHS Lothian 6.14 6.17 6.6 6.7 6.13 6.16 6.4 MIJB agreed to close 15/09/2022 6.5 Service / Programme Plan Action 6.8 Service / Programme Plan Action 6.9 Service / Programme Plan Action 6.10 MIJB agreed to close 15/09/2022 6.11 MIJB agreed to close 15/09/2022 6.12 MIJB agreed to close 15/09/2022 6.15 MIJB agreed to close 15/09/2022 6.18 Service / Programme Plan Action Page 66 of 206
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Direction Direction to Issued & Continuing Revised into new Direction 2023/24 Completed Revoked 7 Dental, Ophthalmic & Audiology NHS Lothian 7.2 7.4 7.8 7.5 Group Service Specification Action 7.6 Group Service Specification Action 7.7 Group Service Specification Action 8 Older People NHS Lothian & Midlothian Council 8.11 8.12 8.13 8.14 8.1 MIJB agreed to close 15/09/2022 8.2 MIJB agreed to close 15/09/2022 8.3 MIJB agreed to close 15/09/2022 8.4 Service / Programme Plan Action 9 Physical Disability, Sensory Impairment & Long-Term Conditions NHS Lothian & Midlothian Council 9.1 9.8 9.9 9.12 9.2 9.6 9.7 9.10 9.11 9.13 9.3 Not a delegated service 9.4 Service / Programme Plan Action 10 Learning Disability NHS Lothian & Midlothian Council 10.6 10.9 10.12 10.1 Service / Programme Plan Action 10.3 Service / Programme Plan Action 10.4 Service / Programme Plan Action 10.7 Service / Programme Plan Action 10.8 Service / Programme Plan Action 10.10 Service / Programme Plan Action 10.11 Service / Programme Plan Action 11 Mental Health NHS Lothian & Midlothian Council 11.1 11.2 11.4 11.9 11.11 11.14 11.15 11.16 11.18 11.19 11.20 11.21 11.13 Service / Programme Plan Action 11.17 Service / Programme Plan Action Page 67 of 206
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Direction Direction to Issued & Continuing Revised into new Direction 2023/24 Completed Revoked 12 Substance Use NHS Lothian & Midlothian Council 12.1 12.2 12.4 12.5 12.6 12.7 12.8 12.9 12.3 MIJB agreed to close 15/09/2022 13 Community Justice Midlothian Council 13.4 13.6 13.5 Service / Programme Plan Action 14 Unpaid Carers NHS Lothian & Midlothian Council 14.3 14.4 14.6 14.5 Service / Programme Plan Action 14.7 Service / Programme Plan Action 14.8 Service / Programme Plan Action 15 Care At Home Midlothian Council 15.6 15.4 15.2 MIJB agreed to close 15/09/2022 15.5 MIJB agreed to close 15/09/2022 15.7 Service / Programme Plan Action 18 Adult Protection & Domestic Abuse NHS Lothian & Midlothian Council 18.1 18.4 18.7 18.10 18.11 18.15 18.8 Service / Programme Plan Action 18.9 Service / Programme Plan Action 18.12 Service / Programme Plan Action 18.13 Service / Programme Plan Action 18.14 Service / Programme Plan Action 18.16 Service / Programme Plan Action 19 Public Health NHS Lothian 19.2 19.11 19.6 Service / Programme Plan Action 19.7 MIJB agreed to close 15/09/2022 19.12 Service / Programme Plan Action 19.13 Service / Programme Plan Action 19.15 Service / Programme Plan Action 20 Services to People under 18years (H/V) NHS Lothian 20.10 20.3 Group Service Specification Action 20.9 Group Service Specification Action 20.11 Group Service Specification Action 20.12 Group Service Specification Action Page 68 of 206
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Direction Direction to Issued & Continuing Revised into new Direction 2023/24 Completed Revoked 25 Financial NHS Lothian & Midlothian Council 25.4 25.1 Group Service Specification Action 25.2 Group Service Specification Action 25.3 Group Service Specification Action 26 Other Core and Hosted Services NHS Lothian 26.1 Page 69 of 206
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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. 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. Page 71 of 206
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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. All services delegated to Midlothian IJB must ensure service planning describes a clear process to ensure fair access, by January 2024. Page 72 of 206
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Outcomes not activities All services delegated to Midlothian IJB will contribute to the IJBs ability to describe activity, experience and outcomes. Services use and develop outcome mapping, by January 2024. 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. 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. Page 73 of 206
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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. 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. 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. Page 74 of 206
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We have designed and delivered a transformed system that delivers complex and palliative care in a person-centred, integrated and emotionally competent way (that begins to address inequalities in access 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. 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. Page 75 of 206
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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. 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. Page 76 of 206
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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 a traditional referral pathways, by January 2024. 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. 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. Page 77 of 206
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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. 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. Page 78 of 206
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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. 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. Page 79 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Midlothian IJB Mainstreaming Equalities Report and Action Plan Executive summary Midlothian IJB is subject the Public Sector Equality Duty (PSED) and must report on the progress towards mainstreaming equality. This report provides key updates on progress against the 2021-23 action plan and proposes a new set of actions for 2023-25. Although Midlothian Health and Social Care Partnership (HSCP) is responsible for the operational delivery of its’ services, the Public Sector Equality Duty lie with the IJB. The Midlothian Health and Social Care Equalities Outcomes and Mainstreaming Report included an action plan for 2021-2023 in relation to equality mainstreaming. The IJB must now publish a report of the progress made to date and set out plan for 2023- 25. The Strategic Planning Group scrutinised the draft report and proposed action plan on 26th January 2023 and recommended to progress for Board review. Board members are asked to: • Note the status of actions outlined in the Equalities Outcomes and Mainstreaming Report for 2021-2023 • Review the proposed actions for 2023-2025 • Note the resource and capacity implications • Note specifically the requirement for the IJB to develop, implement, monitor and review a system for completing Integrated Impact Assessments for all its all new and revised strategies, policies and plans, provisions, practices, and activities, and the resource implications of this • Provide feedback for review. A final draft of the 2023-25 action plan will come before the Board on 13th April 2023. Item number: 5.6 Page 81 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian IJB Mainstreaming Equalities Report and Action Plan 1 Purpose 1.1 This report provides key updates on progress against the 2021-23 action plan and proposes a new set of actions for 2023-25. 2 Recommendations 2.1 As result of this report Members are asked to: • Note the status of actions outlined in the Equalities Outcomes and Mainstreaming Report for 2021-2023 • Review the proposed actions for 2023-2025 • Note the resource and capacity implications • Note specifically the requirement for the IJB to develop, implement, monitor and review a system for completing Integrated Impact Assessments for all its all new and revised strategies, policies and plans, provisions, practices, and activities, and the resource implications of this • Provide feedback for review. A final draft of the 2023-25 action plan will come before the Board on 13th April 2023. 3 Background and main report 3.1 The IJB is legally subject to the Public Sector Equality Duty and must report on the progress towards mainstreaming equality. These duties support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. 3.2 The proposed Equality Outcomes and Mainstreaming Report: Action Update Report (appendix 1) fulfils the statutory requirement for an interim progress report on equality mainstreaming actions and provides an update on each action from the 2021-23 action plan. The report also contains proposed actions for 2023-25 for review and feedback prior to further review and Board approval. The actions proposed for 2023-25 as follows: • Provide ‘Equality and Diversity’ training for Board members • Agree and implement a process for Midlothian IJB to identify, complete, publish, monitor, and review Integrated Impact Assessments (IIAs) Page 82 of 206
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Midlothian Integration Joint Board • Complete Integrated Impact Assessments (IIAs) for to all new and revised strategies, policies and plans, provisions, practices, and activities which fall under the Midlothian IJB remit • Assess the impact of Midlothian HSCP services through the HSCP governance and assurance • Review the information Midlothian IJB publishes and ensure it meets Scottish Government accessibility standards • Ensure the Midlothian IJB and Midlothian HSCP webpages hosted on the Midlothian Council website are distinct and hold the relevant information 4 Policy Implications 4.1 The Equality and Human Rights Commission (EHRC) is the regulator for the Public Sector Equality Duty. Midlothian IJB is recognised by the EHRC as compliant with this duty, having published a Mainstreaming Equality Report, a set of Equality Outcomes and Equality Outcomes Progress Report, and published an IIA on the Strategic Commissioning Plan 2022-25. 4.2 However, the EHRC has requested that all Integration Authorities agree and implement a system for the identification, completion, publication, monitoring, and review of equality impact assessments (EIAs) by the end of March 2023. This process must be applied to all new and revised strategies, policies and plans, provisions, practices, and activities which fall under the Midlothian IJB remit. 5 Directions 5.1 This report does not relate to any specific directions. 6 Equalities Implications 6.1 This report is specifically about work that improves Midlothian IJBs ability to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs and encourage participation 6.2 Adhering to the statutory equality duties on both the IJB and MHSC, these reports have been written with accessibility in consideration and outline proposed actions to further equality mainstreaming. 7 Resource Implications 7.1 The resource implications arising from this report are limited to the time required for the Board and officers of the HSCP to undertake specific actions. Recruitment to an Equalities Planning Officer is currently on hold in order to meet savings targets. 7.2 Resources required to address the Boards statutory requirements will be an ongoing requirement. In particular, the requirements in relation to IIAs and statutory Page 83 of 206
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Midlothian Integration Joint Board accessibility standards in relation to online material are not insignificant. Resource and capacity from both Midlothian IJB, the officers of the HSCP, and our Midlothian Council partners will be required to implement, monitor, maintain and evaluate these statutory requirements. 8 Risk 8.1 The following risks should be considered: • Lack of progress and evidence demonstrating the impact on people with protected characteristics in the community could result in non-compliance with the Public Sector Equality Duty (PSED) and EHRC referral for legal action. • Accessibility requirements are a key component of compliance with the Public Sector Equality Duty (PSED). The resource implications to address our published materials, and ensure future information is accessible, should be noted. 9 Involving people 9.1 The Strategic Planning Group scrutinised the draft report and proposed action plan on 26th January 2023 and recommended to progress for Board review. 9.2 Mainstreaming Equalities highlights the importance of ongoing engagement with people, communities and the health and social care workforce to effectively progress equality mainstreaming. Training delivered by our NHS and Local Authority partners have been limited due to limitations of the pandemic and it is proposed to continue the action to monitoring the provision and impact of training in 2023-25. 9.3 There is recognition that engagement with those in the community with protected characteristics, and the ability to demonstrate the impact equality work has on these people required improvement. 10 Background Papers None AUTHOR’S NAME & DESIGNATION Gill Main, Integration Manager Emma-Jane Gunda, Assistant, Strategic Programme Manager CONTACT INFO gill.main3@nhslothian.scot.nhs.uk DATE 27 January 2023 Appendix 1: Midlothian IJB Draft Mainstreaming Equalities Report and Action Plan Page 84 of 206
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Midlothian Integration Joint Board Equalities Outcomes & Mainstreaming Update & Future Plans 2023 Page 85 of 206
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Contents Introduction .......................................................................... 3 Who we are .......................................................................... 4 Integration Joint Board Actions ............................................ 5 Board Membership, Induction & Training .......................... 5 Integrated Impact Assessments (IIAs) ................................ 6 Data, Evidence & Directions ............................................... 7 Communication with the public ......................................... 8 Our Partner’s Actions ......................................................... 10 Staff Training, Awareness & Understanding .................... 10 Engagement with the Public ............................................ 11 Integrated Impact Assessments (IIAs) .............................. 12 Page 86 of 206
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Introduction This report shows our progress on our actions to improve equality and our plans for the future. It looks at the progress we made over 2021/22 to deliver the key priorities from our Equalities Outcomes and Mainstreaming 2021-2025 Report. Everyone should be treated equally: no-one should have worse opportunities because of where they were born, how they identify, what they believe or whether they have a disability. Under the law there are 9 characteristics which protect people from being treated differently, unfairly or excluded. These are: • Age • Disability • Gender reassignment • Marriage or civil partnership • Pregnancy and maternity • Race • Religion or belief • Gender • Sexual orientation. This report shows how we are progressing with our mainstreaming equality work. This includes the way we make decisions; the way people who work for and on behalf of us behave; how we decide how we spend money and how we improve our services. Midlothian Health and Social Care Partnership is the organisation delivering services to the community, and working to further equality in its work, but the IJB must publish the report on its actions. We have shown how we are progressing against the actions from last year using a simple code: - We have achieved the target set. - We have partially achieved the target set. - We have not achieved the target set. Page 87 of 206
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Who we are The Midlothian Integration Joint Board (IJB) plan and direct health and social care services for the people of Midlothian. We are a planning and decision-making body created by Midlothian Council and NHS Lothian. We are responsible for the integrated budget (received from Midlothian Council and NHS Lothian) and allocate this in line with our objectives in the Strategic Commissioning Plan. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act (2014). The Midlothian Integration Joint Board (IJB) is subject to the Public Sector Equality Duty –we must work towards eliminating discrimination and harassment and advancing equality opportunities between people who share a protected characteristic and those who do not. Page 88 of 206
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Integration Joint Board Actions Board Membership, Induction & Training Our Board is made up of four male and four female voting members and a range of non-voting members. The Board membership includes • elected councillors who are then appointed to the IJB as voting members • Non-Executive Directors appointed to the NHS Board who are then appointed to the IJB as voting members • health and social care professionals who are appointed as members of staff to NHS Lothian or Midlothian Council and appointed to the IJB as non-voting members due to their professional leadership roles • a range of other representatives for people who experience services, carers and the voluntary sector Update to Actions 2021-2023 We have produced an induction handbook book for Board members. An induction programme has also been developed that includes a series of information sharing sessions. These sessions include information about how the IJB operates, introductory sessions with the officers of the Health and Social Care Partnership, and information about the service offers and supports in Midlothian. As the IJB is unable to influence the membership of the Board, we have been unable to progress a diversity plan. Action Performance Indicator Our Progress Improve induction for Board Members - Induction Handbook produced Develop Training Plan for Board Members - Diversity succession plan and training programme Page 89 of 206
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Future Plans 2023-2025 Midlothian IJB is committed to ensuring our work helps to remove or minimise disadvantage, meets different needs, encourage participation, and helps to tackle prejudice and promote understanding. To do this we will review the training and development opportunities for our Board members. Integrated Impact Assessments (IIAs) Equality Impact Assessments (EIAs) help us assess the impact of a new policy, practice or service change. We use these assessments to make sure we’re not discriminating and against any groups of people, and to try and remove or minimise disadvantage where possible. These assessments help us to meet different needs and encourage participation. In Lothian, a regional working group ensures our NHS and Local Authority partners work together and have agreed these assessments should be carried across health and social care in the same way. Because we work together in an integrated way, we call this assessment an Integrated Impact Assessments (IIAs). Update to Actions 2021-2023 Future Plans 2023-2025 Midlothian IJB will agree and implement a system for the identification, completion, publication, monitoring, and review of Integrated Impact Assessments (IIAs). This process will include all new and revised strategies, policies and plans, provisions, practices, and activities which fall under the Midlothian IJB remit Action Performance Indicator Our Progress Improve Board members understanding of their role in relation to equalities issues by: - Provide training in the role of Board Members in relation to equalities - Board members report a greater understanding of equalities issues Action Performance Indicator Our Progress Assess the impact of new policies, practices, or service change. - 1 IIA completed: Our Strategic Commissioning plan Page 90 of 206
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Data, Evidence & Directions Our Joint Strategic Needs Assessment contains information on our communities and their needs. This includes information on differences in health, wellbeing and the length of life for different population groups, alongside data on the wider social determinants of health. Update to Actions 2021-2023 Future Plans 2023-2025 We must ensure there is a process to gather and review relevant to our communities in Midlothian. This data will help to shape how we tackle equality and how people with protected characteristics are being treated. We will ensure that the Midlothian IJB Directions are used as a mechanism to identify equality issues and make specific reference to areas for improvement. Action Performance Indicator Our Progress Agree and implement a system for the identification, completion, publication, monitoring, and review of Integrated Impact Assessments (IIAs) - Process in place by April 2023 - Quarterly Audits Assess the impact of new IJB policies and practices, in particular: - Public Engagement Plan for 2024, and - Scheme of Publication - IIAs completed Assess the impact of Midlothian HSCP services - Request assurance via HSPC Governance that new and revised HSCP service strategies, policies and plans have completed an IIA where appropriate. - HSPC Assurance received Action Performance Indicator Our Progress Improve Equalities Data in the Joint Strategic Needs Assessment Quartlerly updates to data Page 91 of 206
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Communication with the public We must consider accessibility of all our published information in line with the duties of the Accessibility Regulations. This includes meeting papers for the Board, our policies, and strategies. Information must be clear and written so that someone with a reading age of upper primary school could easily understand it. It must be available in the alternative formats and languages as required. Accessibility includes how people access information and, therefore, the visibility and searchability of equality information. We will ensure that published Midlothian IJB and Midlothian HSCP information meets accessibility standards. We will continue working with our partners to ensure all health and social care information in Midlothian follows accessibility guidance. Future Plans 2023-2025 Action Performance Indicator Our Progress Improve the infrastructure required to collect equality data for Midlothian HSCP by: - Ensuring services have data by HSCP area - Ensure services have relevant equality data to improve service design and delivery - Data by HSPC area is available - Relevant equality data is available Action Performance Indicator Our Progress Review the information Midlothian IJB publishes online - Published information meets Scottish Government accessibility standards - IJB Board Papers are available online in an accessible and searchable format Page 92 of 206
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Action Performance Indicator Our Progress Ensure the Midlothian IJB and Midlothian HSCP webpages hosted on the Midlothian Council website are distinct and hold the relevant information - Review the content of all Midlothian Council hosted webpages with our Midlothian Council Partners. - Midlothian IJB webpages hold IJB information and activity - Midlothian HSCP webpages hold HSCP information and activity - The activity of delivery partners is appropriately signposted with links where appropriate Page 93 of 206
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Our Partner’s Actions Midlothian IJB doesn’t directly employ staff or run any services. Midlothian Health and Social Care Partnership (HSCP) oversees the delivery of the IJBs Strategic Commissioning Plan in collaboration with our partners, NHS Lothian and Midlothian Council. It is NHS Lothian and Midlothian Council who employ the local workforce. As such, the actions below are not undertaken by the IJB, but in collaboration with Midlothian HSCP. Staff Training, Awareness & Understanding It is important for staff to have the understanding and awareness of equality and available resources and support. Update to Actions 2021-2023 Action Performance Indicator Our Progress Improve understanding, knowledge and skills of equalities issues by: - Training courses - Staff attend Midlothian Equalities Forum - Staff attend community events organised by People’s Equality Group - 93 staff attended Equality, Diversity and Rights Module - 1 staff attended Transgender Equality and Inclusion Module - Forum paused Train staff on IIA process Our partners cannot currently provide disaggregated data for Midlothian Page 94 of 206
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Future Plans 2023-2025 We will continue to monitor, the training, development and equality awareness opportunities provided by our partners Engagement with the Public We want to work with the people who live in Midlothian who use our services, their families and the community to make sure our services work well for them. Engagement means that services involve people and communities in decision-making processes to better understand their needs. Midlothian HSCP published its Public Engagement strategy in 2021. Work continues to embed these principles across services in Midlothian. Update to Actions 2021-2023 Action Performance Indicator Our Progress Improve understanding, knowledge and skills of equalities issues by: - Highlighting training - No of staff attending Equality, Diversity and Rights module - No of staff attending Transgender Equality and Inclusion Module - No of Midlothian Equality Forum meetings and events - No of staff attending IIA training Action Performance Indicator Our Progress The HSCP will develop, implement and support services to adopt an engagement strategy - HSCP Public Engagement Strategy published - % of services with evidence of co- production and design Page 95 of 206
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Future Plans 2023-2025 We will continue to ask Midlothian HSCP for assurance on how services are implementing the Public Engagement Strategy and increasing the opportunities for people and communities to be part of our decision making Integrated Impact Assessments (IIAs) Update to Actions 2021-2023 Future Plans 2023-2025 We will continue to work with Midlothian HSCP to ensure IIAs completed in relation all new and revised strategies, policies and plans, provisions, practices, and activities delivered by Midlothian HSCP. Action Performance Indicator Our Progress Improve the quality of all health and social care related public information in Midlothian - Midlothian HSCP will creating a Standard Operating Procedure for publishing information on the Midlothian HSCP webpages hosted on the Midlothian Council website - Midlothian HSCP will create guidance for Third and Independent Sector providers when providing information about a service we have commissioned - Standard Operating Procedure completed - Guidance created Action Performance Indicator Our Progress IIAs completed 8 IIAs have been completed across the HSCP during 2021/22 Action Performance Indicator Our Progress IIAs completed No of IIAs across the HSCP completed each year between 2023-25 Page 96 of 206
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Summary of Actions 2023-25 Midlothian IJB Actions Area Action Board Membership, Induction and Training Improve Board members understanding of their role in relation to equalities issues by: - Provide training in the role of Board Members in relation to equalities Integrated Impact Assessment (IIA) Agree and implement a system for the identification, completion, publication, monitoring, and review of Integrated Impact Assessments (IIAs) Integrated Impact Assessment (IIA) Assess the impact of new IJB policies and practices, in particular: - Public Engagement Plan for 2024, and - Scheme of Publication Integrated Impact Assessment (IIA) Assess the impact of Midlothian HSCP services - Request assurance via HSPC Governance that new and revised HSCP service strategies, policies and plans have completed an IIA where appropriate. Data, Evidence, & Directions Improve the infrastructure required to collect equality data for Midlothian HSCP by: - Ensuring services have data by HSCP area - Ensure services have relevant equality data to improve service design and delivery Communication with the Public Review the information Midlothian IJB publishes online Communication with the Public Ensure the Midlothian IJB and Midlothian HSCP webpages hosted on the Midlothian Council website are distinct and hold the relevant information - Review the content of all Midlothian Council hosted webpages with our Midlothian Council Partners. Page 97 of 206
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Actions in Collaboration with our HSCP, NHS Lothian and Local Authority Partners Area Action Staff Training, Awareness and Understanding Improve understanding, knowledge, and skills of equalities issues by - Staff Training Engagement with the Public Improve the quality of all health and social care related public information in Midlothian - Midlothian HSCP will creating a Standard Operating Procedure for publishing information on the Midlothian HSCP webpages hosted on the Midlothian Council website - Midlothian HSCP will create guidance for Third and Independent Sector providers when providing information about a service we have commissioned Integrated Impact Assessment (IIA) Ensure IIA completion where appropriate Page 98 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Midlothian Integration Joint Board Standing Orders Executive summary This report sets out proposed amendments to the Board’s Standing Orders in order to ensure that the Standing Orders remain fit for purpose. Board members are asked to: • Note the review of the Standing Orders • Consider the proposed amendments to the Standing Orders • Note the requirement for the completion of an Integrated Impact Assessment (IIA), and • Highlight any areas of concern and propose any other amendments. # Item number: 5.7 Page 101 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian Integration Joint Board Standing Orders 1 Purpose 1.1 This report sets out the proposed amendments to the Board’s Standing Orders following the review exercise carried out by the Standards Officer. The Board is entitled to amend its Standing Orders and this review was considered appropriate to ensure the Standing Orders remained relevant and fit for purpose. 1.2 The proposed amendments to the Standing Orders are set out in appendix 1. 2 Recommendations 2.1 As a result of this report Members being asked to:- • Note the review of the Standing Orders • Consider the proposed amendments to the Standing Orders • Note the requirement for the completion of an Integrated Impact Assessment (IIA), and • Highlight any areas of concern and propose any other amendments. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 sets out the provisions which apply to the membership, proceedings and operation of all Integration Joint Boards. Paragraph 18 of the Order requires that Boards must make and may amend Standing Orders to regulate meetings of the Board and its Committees. On 1st March 2018, the Board approved its Standing Orders to regulate the conduct and proceedings of meetings of the Board in terms of the above Order. Given the passage of time and change to working practices since that date, the Board tasked the Standards Officer to review the Standing Orders to ensure the Orders still reflect good governance. 3.2 That review has taken place. Whilst the Standing Orders were found to be robust and still fit for purpose, a number of possible amendments were identified to provide greater clarity and to reflect the ability to hold of remote meetings. 3.3 These proposed amendments are track changed in the attached Standing Orders. The amendments can be summarised as follows: Page 102 of 206
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Midlothian Integration Joint Board • Standing Order 2.2 – to allow flexibility to amend or suspend Standing Orders during the course of a meeting • Standing Order 5.4 – to allow remote meetings to continue at the discretion of the Chair • Standing Order 6.1 – to ensure one voting member from both Midlothian Council and the Lothian Health Board are present at all quorate meetings • Standing Order 9.3 – to distinguish between pre-submitted written motions and motions and amendments made during the course of a meeting • Standing Order 9.5 – to clarify when a motion may be withdrawn • Standing Order 10.1 – to clarify when decisions may be re-visited within 6 months of the original decision being made. • Standing Order 13.5 – to provide a link to the terms of the Code of Conduct. 3.4 It must be stressed that these amendments are only presented to the Board as proposals and it is entirely for the Board which if, any, they wish to accept. Equally it is open to the Board, if they wish, to propose alternative amendments or to ask the Standards Officer to provide a review of specific parts of the Standing Orders. 4 Policy Implications 4.1 The Standing Orders are a statutory requirement. 5 Directions 5.1 There are no implications regarding Directions. 6 Equalities Implications 6.1 To ensure Midlothian IJB is complaint with the requirements of The Equality Act 2010 (Specific Duties) (Scotland) Regulations 2012, Midlothian IJB must complete an Integrated Impact Assessment (IIA) on all strategies, policies, and plans. The Equalities and Human Rights Commission (EHRC) have recognised that some policies, in particular model schemes, have limited scope for change but have communicated their expectation is that the local application of a policy is considered against the Public Sector Equality Duty (PSED). 6.2 An IIA must therefore be completed on the draft Standing Orders proposal before approval by the Board. The impact of the local application of this policy must be considered against the Public Sector Equality Duty (PSED) acknowledging and limitation in scope for revision or action being reflected in the assessment. 7 Resource Implications 7.1 There are no resource implications. Page 103 of 206
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Midlothian Integration Joint Board 8 Risk 8.1 These Standing Orders are required to support the proper governance of the Board. 9 Involving people 9.1 This report relates to governance and does not directly involve people. 10 Background Papers AUTHOR’S NAME Alan Turpie DESIGNATION Standards Manager CONTACT INFO Alan.turpie@midlothian.gov.uk DATE 27/01/2023 Appendices: Appendix 1: MIJB Standing Orders Page 104 of 206
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Midlothian Health & Social Care Partnership MIDLOTHIAN INTEGRATION JOINT BOARD STANDING ORDERS March 2018 Page 105 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 2 STANDING ORDERS FOR THE PROCEEDINGS AND BUSINESS OF AN INTEGRATION JOINT BOARD 1 General 1.1 These Standing Orders regulate the conduct and proceedings of the Midlothian Integration Joint Board. The Midlothian Integration Joint Board is the governing body for what is commonly referred to as the Midlothian Health & Social Care Partnership. These Standing Orders are made under the Public Bodies (Joint Working) (Scotland) Act 2014 and the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (No 285) (“the Order”). The Integration Joint Board approved these Standing Orders on XXXXX. Membership of the Integration Joint Board 1.2 The Integration Joint Board shall have two categories of members: (i) Voting Members; and (ii) Non-Voting Members 1.3 Midlothian Council and Lothian NHS Board have elected to nominate 4 members each to the Integration Joint Board, who shall be the voting members. 1.4 The Order prescribes a list of non-voting members who are to be included in the membership, and these members shall be appointed as described by the Order. The Integration Joint Board may appoint additional non-voting members as it sees fit. 1.5 Midlothian Council and the Lothian NHS Board shall also attend to any issues relating to the resignation, removal and disqualification of members in line with the Order. 1.6 If a voting member is unable to attend a meeting of the Integration Joint Board, the relevant constituent authority is to use its best endeavours to arrange for a suitably experienced substitute , who is either a councillor, or as the case may be, a member of the health board. The substitute voting member may vote on decisions put to that meeting, but may not preside over the meeting. If a non-voting member is unable to attend a meeting of the Integration Joint Board, that member may arrange for a suitably experienced substitute to attend the meeting subject to prior agreement with the Chair. 2 Varying, Revoking or Suspending Standing Orders 2.1 Any statutory provision, regulation or direction by Scottish Ministers shall have precedence if they are in conflict with these Standing Orders. Page 106 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 3 2.2 Any one or more of these Standing Orders may be varied, suspended or revoked at a meeting of the Integration Joint Board following a motion moved and seconded and with the consent of the majority of voting members present and voting, provided the proposal itself does not result in the Integration Joint Board not complying with any statutory provision or regulation. 3 Chair 3.1 The Chair of the Integration Joint Board will be appointed in line with the terms agreed within the Integration Scheme and the Order. The Chair will preside at every meeting of the Integration Joint Board that he or she attends. 3.2 If both the Chair and Vice Chair are absent, the voting members present at the meeting shall choose a voting Integration Joint Board member to preside. 4 Vice-Chair 4.1 The Vice-Chair of the Integration Joint Board will be appointed in line with the terms agreed within the Integration Scheme and the Order. 4.2 In the absence of the Chair the Vice-Chair shall preside at the meeting of the Integration Joint Board. 5 Calling and Notice of Integration Joint Board Meetings 5.1 The first meeting of an Integration Joint Board is to be convened at a time and place determined by the Chair. 5.2 The Chair may call a meeting of the Integration Joint Board at any time. The Integration Joint Board shall meet at least six times in the year and will annually approve a forward schedule of meeting dates. 5.3 A request for an Integration Joint Board meeting to be called may be made in the form of a requisition specifying the business to be transacted, and signed by at least two thirds of the number of voting members, and presented to the Chair. If the Chair refuses to call a meeting, or does not do so within 7 days of receiving the requisition, the members who signed the requisition may call a meeting. They must also sign the notice calling the meeting. However no business shall be transacted at the meeting other than that specified in the requisition. 5.4 Before each meeting of the Integration Joint Board, a notice of the meeting (in the form of an agenda), specifying the date, time, place and business to be transacted and approved by the Chair, or by a member authorised by the Chair to approve on that person’s behalf, shall be delivered electronically to every member (e.g. sent by email) or sent by post to the members’ usual place of residence so as to be available to them at least five clear days before the Page 107 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 4 meeting. The notice shall be distributed along with any papers for the meeting that are available at that point. Any meeting of the Integration Joint Board may be held remotely at the discretion of the Chair. 5.5 With regard to calculating clear days for the purpose of notice: Delivery of the Notice Days excluded from the calculation of clear days: ✓ The day the notice is sent ✓ The day of the meeting ✓ Weekends ✓ Public holidays Example: If a meeting is to be held on a Tuesday, the notice must be sent on the preceding Monday. The clear days will be Tuesday, Wednesday, Thursday, Friday, and Monday. If the notice is sent by post it must be sent out a day earlier. 5.6 Lack of service of the notice on any member shall not affect the validity of a meeting. 5.7 Integration Joint Board meetings shall be held in public. The Chief Officer shall place a public notice of the time and place of the meeting at the designated office of the Integration Joint Board at least five clear days before the meeting is held. The designated office of the Midlothian Integration Joint Board is Midlothian House, Buccleuch Street, Dalkeith. 5.8 While the meeting is in public the Integration Joint Board may not exclude members of the public and the press (for the purpose of reporting the proceedings) from attending the meeting. 5.9 The Integration Joint Board may pass a resolution to meet in private in order to consider certain items of business, and may decide to do so for the following reasons: 5.9.1 The Integration Joint Board is still in the process of developing proposals or its position on certain matters, and needs time for private deliberation. 5.9.2 The business relates to the commercial interests of any person and confidentiality is required, e.g. when there is an ongoing tendering process or contract negotiation. Page 108 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 5 5.9.3 The business necessarily involves reference to personal information, and requires to be discussed in private in order to uphold the Data Protection Principles. 5.9.4 The business necessarily involves reference to exempt information, as determined by Schedule 7A of the Local Government (Scotland) Act 1973. 5.9.5 The Integration Joint Board is otherwise legally obliged to respect the confidentiality of the information being discussed. 5.10 The minutes of the meeting will reflect the reason(s) why the Integration Joint Board resolved to meet in private. 5.11 A member may be regarded as being present at a meeting of the Integration Joint Board if he or she is able to participate from a remote location by a video link or other communication link. A member participating in a meeting in this way will be counted for the purposes of deciding if a quorum is present. 6 Quorum 6.1 No business shall be transacted at a meeting of the Integration Joint Board unless there are present at least one half of the voting members of the Integration Joint Board, including at least one member nominated by Midlothian Council and one member nominated by Lothian NHS Board. 6.2 If a quorum is not present, the meeting will stand adjourned to such date and time as may be fixed by the Chair. 7 Authority of the Chair at meetings of the IJB and its Committees 7.1 The duty of the person presiding is to ensure that the Standing Orders or the Committee’s terms of reference are observed, to preserve order, to ensure fairness between members, and to determine all questions of order and competence. The ruling of the person presiding shall be final and shall not be open to question or discussion. 7.2 Any member who disregards the authority of the Chair, obstructs the meeting, or conducts himself/herself offensively shall be suspended for the remainder of the meeting, if a motion (which shall be determined without discussion) for his/her suspension is carried. Any person so suspended shall leave the meeting immediately and shall not return without the consent of the meeting. 7.3 The Chair has the right to adjourn a meeting in the event of disorderly conduct or other misbehaviour at the meeting. Page 109 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 6 7.4 No business shall be transacted at any meeting of the Integration Joint Board other than that specified in the notice of the meeting except on grounds of urgency. Any request for the consideration of an additional item of business must be made to the Chair at the start of the meeting and the majority of voting members present must agree to the item being included on the agenda. 8 Adjournment 8.1 If it is necessary or expedient to do so for any reason, a meeting may be adjourned to another day, time and place. A meeting of the Integration Joint Board, or of a committee of the Integration Joint Board, may be adjourned by a motion, which shall be moved and seconded and be put to the meeting without discussion. If such a motion is carried, the meeting shall be adjourned to such day, time and place as may be specified in the motion. 9 Voting and Debate 9.1 The Board may reach consensus on an item of business without taking a formal vote and the formal voting process outlined in paragraphs 9.2-9.10 would not need to be used. 9.2 Where a vote is taken, every question at a meeting shall be determined by a majority of votes of the members present and voting on the question. A vote may be taken by members by a show of hands, or by ballot, or any other method determined by the Chair. In the case of an equality of votes, the person presiding at the meeting does not have a second or casting vote. 9.3 Any voting member may move a motion in advance of a meeting. Every such notice of motion must be in writing, signed by the Member giving the notice and countersigned by at least one other voting Member. The terms of the motion must be clearly stated and the notice delivered to the Chief Officer five working days in advance of the meeting. Any voting member may move a motion or an amendment to a motion during the course of a meeting of the IJB. Every such motion or amendment must be seconded by another voting member otherwise it will not be considered. . 9.4 Any voting member may second the motion and may reserve his/her speech for a later period of the debate. 9.5 Once a motion has been seconded it shall not be withdrawn or amended other than by the mover with the consent of their seconder. 9.6 Where a vote is being taken, except for the mover of the original motion, no other speaker may speak more than once in the same discussion. Page 110 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 7 9.7 After debate, the mover of any original motion shall have the right to reply. In replying he/she shall not introduce any new matter, but shall confine himself/herself strictly to answering previous observations and, immediately after his/her reply, the question shall be put by the Chair without further debate. 9.8 A motion to adjourn any debate on any question or for the closure of a debate shall be moved and seconded and put to the meeting without discussion. Unless otherwise specified in the motion, an adjournment of any debate shall be to the next meeting. 9.9 Where there has been an equality of votes, the Chair of the Integration Joint Board on reflection of the discussion will give direction to the Chief Officer on how the matter should be taken forward. The Chief Officer will then be obliged to review the matter, with the aim of addressing any concerns, and developing a proposal which the integration joint board can reach a decision upon in line with Standing Order 9. 9.10 Where the matter remains unresolved, and the Chair concludes that the equality of votes is effectively a representation of a dispute between the two constituent parties, then the dispute resolution process which is set out in the integration scheme shall take effect. If the unresolved equality of votes is not a representation of a dispute between the two constituent parties, then the Chair and the Chief Officer must work together to arrive at an acceptable position for the integration joint board. 10 Changing a Decision 10.1 A decision of the Integration Joint Board cannot be changed by the Integration Joint Board within six months unless notice has been given in the notice of meeting and: 10.1.1 The Chair rules there has been a material change of circumstance: or 10.1.2 The Integration Joint Board agrees by a majority of the voting members that the decision was based on incorrect or incomplete information. 11 Minutes 11.1 The names of members present at a meeting of the Integration Joint Board, or of a committee of the Integration Joint Board, shall be recorded. The names of any officers in attendance shall also be recorded. 11.2 The Chief Officer (or his/her authorised nominee) shall prepare the minutes of meetings of the Integration Joint Board and its committees. The Integration Joint Board or the committee shall receive and review its minutes for agreement at its following ordinary meeting. Page 111 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 8 11.3 Once agreed, the minutes of meetings of the Integration Joint Board will be submitted to Midlothian Council and Lothian NHS Board, whilst the minutes of Committee meetings will be submitted to the Integration Joint Board, for noting and consideration of any recommendations. 12 Matters Reserved for the Integration Joint Board Standing Orders 12.1 The Integration Joint Board shall approve its Standing Orders. Committees 12.2 The Integration Joint Board shall approve the establishment of, and terms of reference of all of its committees. 12.3 The Integration Joint Board shall appoint all committee members, as well as the chair of any committees. Values 12.4 The Integration Joint Board shall approve organisational values, should it elect to formally define these. Strategic Planning 12.5 The Integration Joint Board shall establish a Strategic Planning Group (Section 32 of Public Bodies (Joint Working) Scotland Act 2014), and appoint its membership (except for the members nominated by each constituent party). 12.6 The Integration Joint Board shall approve its Strategic Plan (Section 33) and any other strategies that it may need to develop for all the functions which have been delegated to it. The Integration Joint Board will also review the effectiveness of its Strategic Plan (Section 37). 12.7 The Integration Joint Board shall review and approve its contribution to the Community Planning Partnership for the local authority area. The Integration Joint Board shall also appoint its representative(s) at Community Planning Partnership meetings. Risk Management 12.8 The Integration Joint Board shall approve its Risk Management Policy. 12.9 The Integration Joint Board shall define its risk appetite and associated risk tolerance levels. Page 112 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 9 Health & Safety 12.10 In the event that the Integration Joint Board employs five or more people, it shall approve its Health & Safety Policy. Finance 12.11 The Integration Joint Board shall approve its annual financial statement (Section 39 ). 12.12 The Integration Joint Board shall approve Standing Financial Instructions and a Scheme of Delegation. 12.13 The Integration Joint Board shall approve its annual accounts. 12.14 The Integration Joint Board shall approve the total payments to the constituent bodies on an annual basis, to implement its agreed Strategic Plan. Performance Management 12.15 The Integration Joint Board shall approve the content, format, and frequency of performance reporting. 12.16 The Integration Joint Board shall approve its performance report (Section 43) for the reporting year. 13 Integration Joint Board Members – Ethical Conduct 13.1 Voting and non-voting members of the Integration Joint Board are required to subscribe to and comply with the Code of Conduct which is made under the Ethical Standards in Public Life etc (Scotland) Act 2000. The Commissioner for Public Standards can investigate complaints about members who are alleged to have breached their Code of Conduct. The Chief Officer (or his/her authorised nominee) shall maintain the Integration Joint Board’s Register of Interests. When a member needs to update or amend his or her entry in the Register, he or she must notify the Chief Officer (or his/her authorised nominee) of the need to change the entry within one month after the date the matter required to be registered. 13.2 Substitutes, of both voting and non-voting members, should be aware of the Integration Joint Board’s Code of Conduct and should ensure that they comply with its requirements and the duties it places on members. Page 113 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 10 13.3 The Chief Officer (or his/her authorised nominee) shall ensure the Register is available for public inspection at the principal offices of the Integration Joint Board at all reasonable times. 13.4 Members and substitutes must always consider the relevance of any interests they may have to any business presented to the Integration Joint Board or one of its committees and disclose any direct or indirect pecuniary and non-pecuniary interests in relation to such business, before determining whether to take part in any discussion or decision on the matter. 13.5 Members shall make a declaration of any gifts or hospitality received in their capacity as an Integration Joint Board member in terms of paragraph 3.20 of the Code of Conduct. Such declarations shall be made to the Chief Officer (or his/her authorised nominee) who shall make them available for public inspection at all reasonable times at the principal offices of the Integration Joint Board. 14 Committees and Working Groups 14.1 The Integration Joint Board shall appoint such committees, and working groups as it thinks fit. The Integration Joint Board shall appoint the chairs of these committees. The Board shall approve the terms of reference and membership of the committees and shall review these as and when required. The terms of reference of these committees and working groups, where appropriate, will be incorporated into a Scheme of Administration (Appendix 1 to these Standing Orders). This Standing Order should be read in conjunction with the Scheme of Adminstration. 14.2 The committee must include voting members, and must include an equal number of voting members appointed by the Health Board and local authority. 14.3 The Integration Joint Board shall appoint committee members to fill any vacancy in the membership as and when required. 14.4 Any Integration Joint Board member may substitute for a committee member who is also an Integration Joint Board member. 14.5 The Standing Orders relating to the calling and notice of Integration Joint Board meetings, conduct of meetings, minutes and conduct of Integration Joint Board members shall also be applied to committee meetings but not working groups. 14.6 The Integration Joint Board shall approve a calendar of meeting dates for its committees. The committee chair may call a meeting any time, and shall call a meeting when requested to do so by the Integration Joint Board. Page 114 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 11 14.7 The Integration Joint Board may authorise committees to co-opt members for a period up to one year. A committee may decide this is necessary to enhance the knowledge, skills and experience within its membership to address a particular element of the committee’s business. A co-opted member is one who is not a member of the Integration Joint Board, cannot vote and is not to be counted when determining the committee’s quorum. 14.8 A member may be regarded as being present at a meeting of a committee if he or she is able to participate from a remote location by a video link or other communication link. A member participating in a meeting in this way will be counted for the purposes of deciding if a quorum is present. 15 Urgent Decisions 15.1 If a decision which would normally be made by the Integration Joint Board or one of its committees, requires to be made urgently between meetings of the Integration Joint Board or committee, the Chief Officer, in consultation with the Chair and Vice-Chair, may take action, subject to the matter being reported to the next meeting of the Integration Joint Board or committee. Page 115 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 13 Appendix 1 Midlothian Health & Social Care Partnership MIDLOTHIAN INTEGRATION JOINT BOARD SCHEME OF ADMINISTRATION (Relative to Standing Order 14.1) Approved by Midlothian Integration Joint Board on: 1st March 2018 Page 117 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 14 MIDLOTHIAN HEALTH AND SOCIAL CARE PARTNERSHIP AUDIT AND RISK COMMITTEE TERMS OF REFERENCE INTRODUCTION 1. The Audit and Performance Committee is identified as a Committee of the Integration Joint Board (IJB). The approved Terms of Reference and information on the composition and frequency of the Committee will be considered as an integral part of the Standing Orders. The Committee will be a Standing Committee of the IJB. 2. The Financial Regulations for the IJB were approved Integration Board on 29th October 2015. Section 3.11 of the Financial Regulations state that the IJB will have an Audit and Risk Committee CONSTITUTION 3. The IJB shall appoint the Committee. The Committee will consist of (at least) four members of the IJB, excluding professional advisors. At least four Committee members must be IJB voting members, 2 from the Health Board and 2 from the Council 4. The Committee may at its discretion set up working groups for review work. Membership of working groups will be open to anyone whom the Committee considers will assist in the task assigned. The working groups will not be decision making bodies or formal committees but will make recommendations to the Audit and Risk Committee. CHAIR 5. The Chair of the Committee will be a voting Member nominated by the IJB, noting that the Chair of the IJB cannot also chair the Audit and Risk Committee. QUORUM 6. Three Members of the Committee will constitute a quorum. ATTENDANCE AT MEETINGS 7. The Chief Officer, Chief Finance Officer, Chief Internal Auditor and other professional advisors or their nominated representatives will normally attend meetings. Other persons shall attend meetings at the invitation of the Committee. 8. The external auditor will be invited to all meetings. MEETING FREQUENCY Page 118 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 15 9. The Committee will meet at least three times each financial year. MINUTES 10. The Committee shall receive and review its minutes for agreement at its following ordinary meeting. The minutes, once agreed, will then be submitted to the IJB for noting and consideration of any recommendations. AUTHORITY 11. The Committee is authorised to request reports and make recommendations to the IJB for further investigation on any matters which fall within its Terms of Reference. DUTIES 12. The Committee will review the overall internal control arrangements of the IJB and make recommendations to the Board regarding signing of the Governance Statement. 13. Specifically it will be responsible for the following duties: GOVERNANCE, RISK AND CONTROL 1. To review the IJB’s corporate governance arrangements against the good governance framework and consider annual governance reports and assurances. 2. To review the Annual Governance Statement prior to approval and consider whether it properly reflects the risk environment and supporting assurances, taking into account internal audit’s opinion on the overall adequacy and effectiveness of the IJB framework of governance, risk management and control. 3. To consider the IJB arrangements to secure value for money and review assurances and assessments on the effectiveness of these arrangements. 4. To consider the IJB framework of assurance and ensure that it adequately addresses the risk and priorities of the IJB. 5. To monitor the effective development and operation of risk management in the IJB. 6. To monitor progress in addressing risk-related issues reported to the committee. 7. To consider reports on the effectiveness of internal controls and monitor the implementation of agreed actions. Page 119 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 16 INTERNAL AUDIT 8. To approve the internal audit charter. 9. To review proposals made in relation to the appointment of external providers of internal audit services and to make recommendations. 10. To approve the risk-based internal audit plan, including internal audit’s resources requirements, the approach to using other sources of assurance and any work required to place reliance upon those other sources. 11. To approve significant interim changes to the risk-based internal audit plan and resource requirements. 12. To make appropriate enquiries of both management and the head of internal audit to determine if there are any inappropriate scope or resource limitation. 13. To consider reports from the head of internal audit on internal audit’s performance during the year, including the performance of external providers of internal audit services. These will include: a) Updates on the work of internal audit including key findings, issues of concern and action in hand as a result of internal audit work. b) Regular reports on the results of the Quality Assurance and Improvement Programme. c) Reports on instances where the internal audit function does not conform to the Public Sector Internal Audit Standards and Local Government Application Note, considering whether the non-conformance is significant enough that it must be included in the Annual Governance Statement. 14. To consider the head of internal audit’s annual report: a) The statement of the level of conformance with the Public Sector Internal Audit Standards and Local Government Application Note and the results of Assurance and Improvement Programme that supports the statement – these will indicate the reliability of the conclusions of internal audit. b) The opinion on the overall adequacy and effectiveness of the IJBl’s framework of governance, risk management and control together with the summary of the work supporting the opinion - these will assist the committee in reviewing the Annual Governance Statement. 15. To consider summaries of specific internal audit reports as requested. Page 120 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 17 16. To receive reports outlining the action taken where the head of internal audit has concluded that management has accepted a level of risk that may be unacceptable to the authority or there are concerns about progress with the implementation of agreed actions. 17. To contribute to the Quality Assurance and Improvement Programme and in particular, to the external quality assessment of internal audit that takes place at least once every five years. 18. To consider a report on the effectiveness of internal audit to support the Annual Governance Statement. 19. To support the development of effective communication with the head of internal audit. EXTERNAL AUDIT 20. To consider the external auditor’s annual letter, relevant reports, and the report to those charged with governance. 21. To consider specific reports as agreed with the external auditor. 22. To comment on the scope and depth of external audit work and to ensure it gives value for money. 23. To commission work from internal and external audit. 24. To advise and recommend on the effectiveness of relationships between external and internal audit and other inspection agencies or relevant bodies. FINANCIAL REPORTING 25. To review the annual statement of accounts. Specifically, to consider whether appropriate accounting policies have been followed and whether there are concerns arising from the financial statements or from the audit that need to be brought to the attention of the IJBl. 26. To consider the external auditor’s report to those charged with governance on issues arising from the audit of the accounts. ACCOUNTABILITY ARRANGEMENTS 27. To report to those charged with governance on the committee’s findings, conclusions and recommendations concerning the adequacy and effectiveness of their governance, risk management and internal control frameworks; financial reporting arrangements, and internal and external audit functions. Page 121 of 206
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Midlothian Integration Joint Board – Standing Orders – March 2018 18 28. To report to the IJB on a regular basis on the committee’s performance in relation to the terms of reference and the effectiveness of the committee in meeting its purpose. Page 122 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Finance Update – Quarter 3 2022/23 Executive summary Both the IJB’s partners (Midlothian Council and NHS Lothian) have undertaken quarter three financial reviews. This process requires the available financial information to be analysed and subsequently used to project a forecast outturn position. Board members are asked to: • Note the quarter three financial reviews undertaken by partners. # Item number: 5.8 Page 123 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board Finance Update – Quarter 3 2022/23 1 Purpose 1.1 This report lays out the results of the partner’s (Midlothian Council and NHS Lothian) quarter three financial reviews and considers how these impact on the projected financial position of the IJB for 2022/23. 2 Recommendations 2.1 As a result of this report Members are being asked to:- • Note the quarter three financial reviews undertaken by partners. 3 Background and main report 3.1 At the IJB meeting during December 2022, we reported on the quarter two financial review which provides a forecast financial outturn for 2022/23. The Midlothian Council and NHS Lothian quarter two financial reviews were based on information to the end of September 2022. 3.2 The quarter two financial review position for the IJB was a projected overspend of £1.6m this position has deteriorated and the quarter three (Q3) financial review position for the IJB is reporting a projected overspend of £2.0m and a breakdown is shown below Annual Budget as at end of December 2022 Forecast Expenditure Q3 Forecast Under/(Over) Spend £k £k £k Core 68,057 68,369 (312) Hosted 14,672 14,514 158 Set Aside 19,622 20,514 (892) Health 102,352 103,398 (1,046) Social Care 56,489 57,491 (1,002) Total 158,841 160,889 (2,048) (Fig 1 : IJB Quarter 3 review forecast) Page 124 of 206
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Midlothian Integration Joint Board 3.3 The budget movements from the partners budgets offers at the start of the financial year to the budget position at Q3 are a combination of additional funding allocations from Scottish Government and some COVID funding being drawn down from the reserve to support the remaining COVID costs in 2022/23. Further draw downs of COVID funding continue throughout this year. 3.4 The forecast position reflects the projections for both partners. NHS Lothian are due to present their Q3 financial projections to their Finance & Resources Committee on the 7th February 2023. Midlothian Council are due to present their Q3 financial projections to their Council meeting on the 21st February 2023. 3.5 The forecast highlights projected overspends on the health side of the budget within core (£0.3m) and set aside (£0.9m). Within the core budget a deterioration from Q2 projection has been within the prescribing budget, this budget has seen an increase in cost per item plus short supply issues. Within the set aside budget there continues to be a financial pressure driven by Gastroenterology drugs, the drugs pressure across acute is significant and has been growing due mainly to new medicines. There is also financial pressure from within the RIE nursing budgets due to vacancy and sickness levels and the need to support this with high-cost agency cover. 3.6 The social care forecast is still projecting a £1.0m overspend, there was some improved financial performance within the HSCP to drive down costs however the Q3 forecast hasn’t improved. This is due to the decision taken by the Council not to allocate the IJB a share of the revenue funding the Council received from Scottish Government to support the cost of the Local Authority pay settlement. 3.7 There was £140m of national revenue funding to support all Council staffing budgets with the costs of the pay deal, this included staff within budgets delegated to the IJB. The IJB are facing cost increases of £0.8m because of this and we were anticipating a share of this funding to offset these costs increases. We have been informed during December and early January 2023 this funding will not be allocated to the IJB but retained by the Council. This decision has meant the social care position within Midlothian Council delegated to the IJB has an overspend with no mitigation actions for recovering this position. This position also has an impact on future years. 3.8 As reported to the IJB previously Scottish Government are looking to reclaim surplus IJB COVID reserves. We have through the routine reporting to Scottish Government submitted our December 2022 COVID cost projections for Midlothian HSCP this is summarised in the table below. 2021/22 Q1 2022/23 Return via NHS Lothian Q2 2022/23 Return via NHS Lothian December 2022 Return via NHS Lothian £k £k £k £k COVID Reserve as at March 2022 9,703 9,703 9,703 COVID cost projections 5,488 2,857 3,564 3,864 Balance 6,846 6,139 5,839 (Fig 2: COVID Cost Projections) 3.9 We will continue to update the IJB at future meetings on this reclaim of funding. Page 125 of 206
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Midlothian Integration Joint Board 3.10 Moving to 2023/24 we have the received the recent correspondence from Scottish Government regarding the IJB budget offers from partners and the parameters clearly set out in the letters are in line with previous year. The letters state 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. 3.11 Both letters are attached at appendices 1 and 2. 4 Policy Implications 4.1 There are no policy implications from this report. 5 Directions 5.1 The utilising of our COVID funding is in line with our direction to Partners, Direction 25 Financial Instruction. 6 Equalities Implications 6.1 There are no equalities implications from this report. 7 Resource Implications 7.1 The resource implications are laid out above. 8 Risk 8.1 The risk regarding the pay awards settlement is raised above in report 8.2 The “business as usual” risks raised by this report are already 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 February 2023 Page 126 of 206
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Midlothian Integration Joint Board Appendices: Appendix 1 - Budget Letter 2023/24 to NHS Chief Executives Appendix 2 - Letter from Deputy First Minister on 2023/24 budget Page 127 of 206
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Directorate for Health Finance and Governance Richard McCallum, Director T: 0131-244 3464 E: richard.mccallum@gov.scot Chief Executives, NHS Scotland Copy to: NHS Chairs NHS Directors of Finance Integration Authority Chief Officers Integration Authority Chief Finance Officers Issued via email 15th December, 2022 Dear Chief Executives Scottish Government Budget 2023-24 Following the announcement of the Scottish Government’s Budget for 2023-24 by the Deputy First Minister in Parliament today, I am writing to provide details of the indicative funding settlement for Health Boards. A breakdown of this is provided in Annex A to this letter. The Deputy First Minister has set out this budget in the context of the current cost of living crisis and funding parameters set by the Chancellor of the Exchequer in November 2022. This budget sets out the next steps to deliver the Health and Social Care commitments outlined in the Programme for Government, taking into account the current economic environment and recent Emergency Budget Review. As in previous years, the position will be subject to any amendments agreed through the Scottish Parliament’s Budget Bill process, as well as recognising the further work that we will undertake with you specifically in relation to Covid-19 and pay funding arrangements. I will keep you up to date with any changes to our planning assumptions. Budget Uplift Compared to 2022-23 budgets, Boards will receive a total increase of 5.9% for 2023-24. This includes recurring funding for pay in 2022-23 and a baseline uplift of 2% for 2023-24. Within this total, those Boards furthest from NRAC parity will receive a share of £23.2 million, which will continue to maintain all Boards within 0.8% of parity. In terms of pay, given the challenging and uncertain outlook for inflation, the need to conclude some pay deals for the current year and the associated implications for spending baselines, the Government has not set out a public sector pay policy alongside the 2023-24 Budget and we will say more on 2023-24 pay (covering Agenda for Change and other staff groups) at an appropriate point in the new year. As part of Boards recurring adjustments for 2022-23, amounts have been included based on pay offers for Agenda for Change and Medical and Dental staffing in 2022-23. The Agenda for Change pay deal remains subject to agreement, and we will work with Directors of Finance to finalise this position once the outcome is known. I will write to Boards in 2023 to confirm finalised baseline budgets following the conclusion of this work. Page 129 of 206
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Health & Social Care Levy Funding I can confirm that the £69.1 million allocated in 2022-23 to support Boards with the costs of the additional National Insurance levy in 2022-23 will remain with Boards. Following the change in policy by UK Government, this funding is not ringfenced and it is to be determined locally how this resource is utilised. Covid-19 Funding Whilst the scale of Covid-19 costs has reduced significantly in 2022-23 and projected to reduce further in 2023-24, we recognise that there are specific legacy costs that will require additional funding support in the new financial year. This includes funding for: - Vaccinations staffing and delivery; - Test & Protect activities including Regional Testing facilities; - Additional PPE requirements; and - Some specific Public Health measures. Following today’s budget we will seek to provide early clarity as to the total funding to be provided to support these costs. However, beyond the above, NHS Boards and Integration Authorities should expect to meet remaining costs from baseline funding and should continue to drive these costs down as far as possible. Policy Funding In addition to the baseline uplift outlined, funding aligned to policy commitments and recovery of health and social care services will be allocated to Boards and Integration Authorities in 2023-24. It is our intention to provide early indication of allocations, where possible, and to align this to the planning guidance that will be issued in relation to Annual Delivery Plans, setting out the priorities for health and social care in the coming year. Recognising the level of funding that is provided through in-year non-recurring allocations, and to maximise flexibility in delivery, we intend to review funding arrangements ahead of 2023-24. As part of this work, we will seek to bundle and baseline funding where this is appropriate. We will work closely with both Territorial and National Boards to establish a suitable approach. Health and Social Care Integration In line with previous years, 2023-24 NHS payments to Integration Authorities for delegated health functions must deliver an uplift of 2% over 2022-23 agreed recurring budgets and make appropriate provision for 2022-23 pay. The Health and Social Care Portfolio will transfer net additional funding of £95 million to Local Government to support social care and integration, which recognises the recurring commitments on adult social care pay in commissioned services (£100 million) and inflationary uplift on Free Personal Nursing Care rates (£15 million). This is offset by non-recurring Interim Care money ending (£20 million). The overall transfer to Local Government includes additional funding of £100 million to deliver a £10.90 minimum pay settlement for adult social care workers in commissioned services, in line with Real Living Wage Foundation rate. Page 130 of 206
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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. Capital Funding The Health Capital settlement for 2023-24 is in line with the expectations of the Capital Spending Review. Therefore I can confirm that Boards’ Capital Resource Limit will be in line with that for 2022-23, plus additional funding will be provided for legally committed projects. The capital programme and commitments is subject to ongoing review by the National Infrastructure Board and the Capital Investment Group, and Boards will be advised at the earliest opportunity on any further allocations for projects in development during 2023-24. 2023-24 Financial Planning As previously confirmed, where Boards are indicating that financial support is required in 2022-23, we have asked Boards to submit financial recovery plans in the new year, setting out a return to financial balance in the next three years. I expect that Boards are taking proactive steps to develop these plans. We will be requesting that financial plans for 2023-24 are submitted in the new year and will be issuing guidance to this effect shortly. As noted in my letter on 12 September, all Boards are expected to be engaging with the Sustainability and Value (S&V) programme, reflecting this work at a local level to support delivery of a cost reduction target of 3% per annum and productivity and related improvements in line with the four aims. The S&V board is now meeting regularly as are the working groups taking forward specific ideas. Value propositions have been set out to bring various elements of this work together which will be shared in due course. Longer term work is required as we move out of recovery, towards transformation and renewal of our health services to deliver world-class, safe, person-centred, and sustainable healthcare for the people of Scotland. This will build on and prioritise specific areas of work in a joined-up way, whilst working in parallel to develop longer term transformation and renewal of our health services. It is clear that there is significant financial challenge in 2023-24 and we will continue to work closely with Chief Executives to address this. I thank you again for your support to date and your continued engagement moving into the next financial year. Yours sincerely Richard McCallum Director of Health Finance and Governance Page 131 of 206
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St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot Annex A – Board Funding Uplifts 2022-23 Allocation Recurring Allocations* 22-23 Pay** Total 2022-23 Allocation Uplift*** 2023-24 Total Allocation Uplift from 2022-23 NRAC Funding Distance from NRAC Parity HSC Levy Funding (retained by Boards) **** Uplift from 2022-23 (inclusive of HSC Levy) NHS Territorial Boards £m £m £m £m £m £m % £m % Ayrshire and Arran 806.8 (0.6) 27.4 833.5 16.7 850.2 5.4% 0.0 -0.4% 4.4 6.0% Borders 234.8 (0.1) 8.0 242.6 6.0 248.6 5.9% 1.1 -0.8% 1.3 6.5% Dumfries and Galloway 334.1 (0.2) 11.3 345.3 6.9 352.2 5.4% 0.0 1.9% 1.8 6.0% Fife 749.4 (0.5) 25.5 774.3 16.5 790.8 5.5% 1.0 -0.8% 4.0 6.1% Forth Valley 598.1 (0.3) 20.3 618.1 13.0 631.1 5.5% 0.6 -0.8% 3.2 6.1% Grampian 1,072.2 (0.9) 36.4 1,107.7 22.2 1,129.9 5.4% 0.0 -0.4% 5.8 6.0% Greater Glasgow and Clyde 2,504.0 (1.4) 85.0 2,587.6 51.8 2,639.4 5.4% 0.0 1.7% 13.6 6.0% Highland 725.6 (0.5) 27.8 752.9 15.3 768.2 5.9% 0.2 -0.8% 3.9 6.4% Lanarkshire 1,346.8 (0.8) 45.7 1,391.8 32.3 1,424.1 5.7% 4.5 -0.8% 7.3 6.3% Lothian 1,639.3 (1.3) 55.7 1,693.7 49.6 1,743.3 6.3% 15.7 -0.8% 8.9 6.9% Orkney 57.1 (0.1) 1.9 59.0 1.2 60.2 5.5% 0.1 -0.8% 0.3 6.0% Shetland 57.0 0.0 1.9 59.0 1.2 60.1 5.5% 0.0 2.3% 0.3 6.1% Tayside 856.5 8.7 29.1 894.3 17.9 912.2 6.5% 0.0 -0.7% 4.7 7.1% Western Isles 84.5 (0.0) 2.9 87.3 1.7 89.0 5.4% 0.0 11.5% 0.5 6.0% Territorials Total 11,066.1 2.0 379.0 11,447.1 252.2 11,699.2 5.7% 23.2 60.0 6.3% NHS National Boards National Waiting Times Centre 68.1 0.0 6.2 74.3 1.5 75.8 11.3% 0.9 12.8% Scottish Ambulance Service 305.9 5.6 16.2 327.7 6.6 334.2 9.3% 2.0 10.0% The State Hospital 40.0 0.0 1.7 41.7 0.8 42.5 6.3% 0.3 7.0% NHS 24 78.4 5.5 5.0 88.9 1.8 90.7 15.7% 0.7 16.7% NHS Education for Scotland 492.3 1.4 13.8 507.5 10.1 517.6 5.1% 2.8 5.7% NHS National Services Scotland 355.3 5.6 10.4 371.2 7.4 378.6 6.6% 1.5 7.0% Healthcare Improvement Scotland 30.4 1.1 1.4 32.9 0.7 33.6 10.4% 0.2 11.0% Public Health Scotland 52.1 0.2 3.5 55.8 1.1 56.9 9.3% 0.7 10.8% Nationals Total 1,422.6 19.5 58.0 1,500.1 30.0 1,530.1 7.6% 9.1 8.3% Total NHS Boards 12,488.7 21.5 437.0 12,947.2 282.2 13,229.3 5.9% 69.1 6.5% * Includes recurring allocations from 2021-22 ** Includes estimated funding for Agenda for Change and Medical & Dental pay uplift in 2022-23. *** Includes NRAC parity adjustments. **** Included in Boards 2022-23 Baseline Budgets Page 132 of 206
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot An Leas-phrìomh Mhinistear agus Ath-shlànachadh Cobhid Deputy First Minister and Cabinet Secretary for Covid Recovery John Swinney MSP T: 0300 244 4000 E: DFMCSCR@gov.scot Councillor Morrison COSLA President Verity House 19 Haymarket Yards Edinburgh EH12 5BH Copy to: Councillor Steven Heddle The Leaders of all Scottish local authorities ___ 15 December 2022 Dear Shona, Today I formally set out the Scottish Government’s proposed Budget for 2023-24 in a statement to the Scottish Parliament. I write now to confirm the details of the local government finance settlement for 2023-24. As discussed when I met with you, the Resources Spokesperson, and Group Leaders on 1 December, we are facing the most challenging budget circumstances since devolution. This is primarily due to over a decade of austerity eroding financial settlements from Westminster, compounded by the impact of Brexit and the disastrous mini-budget. Scottish and local government are experiencing unprecedented challenges as a result of the UK Government’s economic mismanagement, resulting in rising prices and soaring energy bills, with inflation estimated to be running at a 41 year high of 11.1% at the time of the Chancellor’s Autumn Statement. My Cabinet colleagues and I have engaged extensively with COSLA Leaders and spokespersons over the course of the year and there is collective understanding that this economic context is also having a significant impact upon local authorities. Councils, like the Scottish Government and rest of the public sector, are working hard to support people through the cost crisis. In this regard we are hugely grateful to councils for their hard work and we fully appreciate that no part of public life has been immune from taking deeply difficult decisions to live within the current fiscal reality. I have already taken the unprecedented step of making a statement to Parliament to reprioritise over £1.2 billion of funding as part of my Emergency Budget Statement. Despite the scale of that challenge the Scottish Government actively chose to protect Councils during Page 133 of 206
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot that exercise and increased the funding available to councils whilst most other portfolios were required to make significant savings. The Scottish Government’s revenue raising powers offer limited flexibility to deal with challenges of this magnitude. I wrote to the Chancellor on 19 October to highlight the impact of inflation on the Scottish Government’s budget and to call for additional funding to help us deal with these inflationary pressures and to support public services. As we face these challenges, and in the absence of meaningful change in direction by the UK Government, we need to work together to ensure that we deliver for people within the financial constraints we have. I very much welcomed the open discussion on 1 December about how we focus our efforts on our shared priorities, and to that end we are offering to jointly develop an approach to working within this budget which delivers our ambitions. The Local Government Settlement Before turning to that offer, I will first set out how I have sought to support local government through the budget itself. The Resource Spending Review guaranteed the combination of General Revenue Grant and Non-Domestic Rates Income at existing levels between 2023-24 and 2025-26 including the baselining of the £120 million that was added in Budget Bill 2022-23. The Budget delivers those commitments in full, despite the fact that the UK Government’s Autumn Statement reversed their previous position on employer National Insurance Contributions resulting in negative consequentials. This decision has conferred around £70 million of additional spending power for local government. The difficult decisions in the Emergency Budget Statement provided one-off additional funding to support enhanced pay deals for local government staff. We recognise the role that increasing pay for local authority employees, especially those on lower incomes, plays in helping more people cope with the cost crisis, but the fact remains that every additional pound we spend on recurring pay deals, must be funded from elsewhere within the Scottish Government budget. I therefore hope that councils will welcome the fact that the budget baselines the additional £260.6 million allocated in 2022-23 to support the local government pay deal and also delivers additional funding to ensure that payment of SSSC fees for the Local Government workforce will continue to be made on a recurring basis. Despite the challenging budget settlement I have sought to increase funding as much as I can. I have been able to increase General Revenue Grant by a further £72.5 million, taking the total increase to over £550 million. I have also ensured that we have maintained key transfers worth over £1 billion and added a further £102 million of resource to protect key shared priorities particularly around education and social care. The Resource Spending Review also confirmed the outcome of the 2021 Capital Spending Review and this has been supplemented by £120.6 million mentioned as part of the support to the local government pay deal plus a further £50 million to help with the expansion of the Free School Meals policy. With regards to that wider settlement, we are providing £145 million to be used by councils to support the school workforce. The Cabinet Secretary for Education and Skills has written separately to COSLA on this matter. Page 134 of 206
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot I am also very grateful for the work undertaken through the Early Learning and Childcare Finance Working Group to develop and scrutinise detailed analysis of the delivery costs for the 1140-hour commitment. This is crucial to ensuring we meet our shared commitment to providing transparency and value for money in a significant programme of public sector investment. The Early Learning and Childcare settlement for 2023-24 takes account of significant declines in the eligible population in recent years and makes provision for important policy and delivery priorities based on feedback from COSLA and local government colleagues. As set out in separate detailed communications, the Health and Social Care Portfolio will transfer net additional funding of £95 million to Local Government to support social care and integration, which recognises the recurring commitments on adult social care pay in commissioned services (£100 million) and inflationary uplift on Free Personal Nursing Care rates (£15 million). This is offset by the non-recurring interim care money ending (£20 million). The overall transfer to Local Government includes additional funding of £100 million to deliver a £10.90 minimum pay settlement for adult social care workers in commissioned services, in line with Real Living Wage Foundation rate. 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. The consolidation of funding into the new £30.5 million homelessness prevention fund not only reflects the importance local and national government jointly place on homelessness prevention and earlier intervention, but also simplifies the homelessness funding landscape. This provides more flexibility for council and greater clarity for citizens who want to understand how national and local government are working jointly to improve outcomes. In total, including the funding to support the devolution of Empty Property Relief, the budget increases the local government settlement by over £550 million relative to the Resource Spending Review position. I am conscious of the position you set out to me, and the challenges which councils will still face, like all parts of the public sector, in meeting current and emerging demands from within this budget. Therefore, I am offering to continue to work with you with real urgency in the coming weeks to determine how we might jointly approach these challenges and ensure sustainable public services to support our shared priorities now and in the future. Delivering for People and Communities by Working Together Flexibly Through the Covid Recovery Strategy, Scottish Government and Local Government, committed to work together to address the systemic inequalities made worse by Covid, to make progress towards a wellbeing economy, and accelerate inclusive person-centred public services. We must sustain this focus on the outcomes we care most deeply about, in particular: i) tackling child poverty, Page 135 of 206
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot ii) transforming the economy to deliver net zero, and iii) sustaining our public services. No single part of the public service landscape can deliver these outcomes alone. We need to work in partnership to deliver outcomes for people and places across Scottish and local government as our two spheres of government, recognising our joint accountability for change. Local service providers have the critical relationships with people and communities and must be empowered and enabled to organise services around their needs, rather than the funding stream, policy area or body delivering. By doing so, we will collectively reduce complexity and barriers for people, deliver improved outcomes and reduce inequalities among communities in Scotland, and enable the fiscal sustainability of key public services. Strong local leadership will make this approach work in practice, supported by a national vision and learning from good practice. Community Planning Partnerships are the mechanism in which we need to see a collective and intensive effort to align available resources into prevention and early intervention focused on delivering shared outcomes for people and place. Local authorities have the leading, critical role in CPPs, but CPPs also involve a range of public bodies which must play their part, alongside local third sector and community bodies. The Scottish Government is committed to building trust and maximising benefits for our citizens and communities. We will act to: - align budgets to maximise impact on outcomes; - remove barriers which hinder flexibility in funding, and in the design and delivery of services around people, helping to embed the service changes flowing from this; - require our partner public bodies and agencies to work collaboratively within CPPs to deliver shared outcomes, take action to address local priorities and align local funding, this will be supported by our Place Director network; - enable third sector partners to participate and contribute in local plans, including through flexible funding. Local authorities are key partners in this endeavour. Through COSLA, we will invite local authorities to work with us to: - prioritise spending to agreed key outcomes for which we are jointly accountable, with clarity as to the way in which we will work together to secure and measure success; - ensure that joint plans of activity across Community Planning Partnerships can deliver those outcomes in a way which reflects the needs of a local communities, and to robustly account for delivery of these plans; - share resources across CPPs to deliver these activities in whatever way is most effective; - continue to share and learn from best practice nationally and locally to embed person centred approaches that work for individuals and communities, and reduce barriers and duplication in our joint systems. We will seek to agree jointly how to put this commitment into operation practically over the coming months and to develop robust assurance that demonstrates delivery of critical priorities and reform. We need to be data driven and transparent, reflecting the accountability which comes with responsibility. Scottish and Local Government need to agree metrics and mechanisms for monitoring impact and outcomes, so that intervention and resource can be Page 136 of 206
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot targeted where it is most needed to secure improvement. This will include seeking to reduce unnecessary reporting. This approach is aimed at building trust and relationships and as well as adopting it through this budget, it will be reflected in the partnership agreement that will underpin the New Deal for Local Government set out in the Resources Spending Review. In order to offer flexibility across funding and work towards removal of ring fencing, the Scottish Government will need clear commitment from local government about delivery of agreed joint outcomes. The Cabinet Secretary for Social Justice, Housing and Local Government would welcome an initial discussion on this when you meet next week at the Strategic Review Group, in order to pave the way for work at pace among our officials. Non-Domestic Rates and Other Local Taxation Measures As Leaders will be aware, the 1 April 2023 marks the date of the next Non-Domestic Rates revaluation, and the first to reflect the reforms introduced by the independent Barclay Review of Non-Domestic Rates. These reforms, including the move to three‑yearly revaluations and a one‑year tone date, will ensure that property values more closely align with prevailing property market conditions in Scotland. The Budget freezes the poundage and acknowledges the impact of the revaluation by introducing a number of transitional reliefs to ensure that any properties which see significant increases in their rates liabilities following the revaluation do so in a phased manner. The Barclay Review also recommended a number of reforms to the Non-Domestic Rates appeals process which are critical to ensuring the deliverability of the three-yearly revaluation. The new two-stage appeals process will commence on 1 April 2023 alongside the transfer of functions of Valuations Appeals Committees to the Scottish Courts and Tribunals Service. The Non-Domestic Rates (Scotland) Act 2020 and subsequent regulations have, amongst other things, provided Assessors and Councils with greater information-gathering powers and have also increased the transparency of the process for ratepayers including, for the first time, the provision of draft values on 30 November 2022. These reforms are intended to reduce the reliance on the formal appeals process to deliver accurate rateable values and the Act also provided a legal basis for the pre-agreement of values. Many of the reforms of the Barclay Review seek to incentivise behaviour changes to deliver a more effective and efficient system. Reflecting the ability to pre-agree values and the importance of building resilience in the new appeals system to support the transition to more frequent revaluations, Ministers plan to make administrative changes to the funding treatment of appeals associated with public sector bodies, including councils. The current system essentially sees the public sector challenge other parts of the public sector with private sector advisor fees effectively extracting resources from public services. The conclusion of the process determines funding allocations outside the remit of the annual budget framework with successful public bodies benefiting financially to the detriment of other ratepayers and public services. The volume of public sector appeals also serves to delay access to justice for other appellants. Ministers do not believe that this offers value for money for the public. Whilst the right to propose and appeal will remain, to incentivise the use of the pre-agreement powers and Page 137 of 206
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot discourage the continued reliance on the formal appeals process, from 1 April 2023, all bodies, including councils, who receive their funding through the Scottish Government budget process, will see the financial incentive for proposing and appealing removed. Where a property occupied by a public body is subject to a successful proposal or appeal, the financial benefit from the reduction in rateable value will result in a downward re- determination of revenue allocations at a subsequent fiscal event. On this basis, Ministers will be encouraging all public bodies to begin the process of pre-agreement with their local assessors ahead of 1 April 2023 to ensure that values are accurate prior to the start of the revaluation and that this approach be adopted by default for future revaluations. The Non-Domestic Rates (Scotland) Act also had the effect of abolishing Empty Property Relief as agreed with the Scottish Green Party a part of the 2019-20 Budget process. Unoccupied properties will therefore be liable for full rates from 1 April 2023 if relief is not available under a local scheme. To effectively devolve responsibility for the relief and provide greater fiscal empowerment for council, as agreed by the Settlement and Distribution Group, the budget provides an additional £105 million of General Revenue Grant, significantly more than the cost of maintaining the national relief in light of the subsequent decision to freeze the poundage. In addition, following consultation with members of the Institute of Revenues, Rating and Valuation, we will bring forward regulations intended to empower councils to tackle rates avoidance more effectively. In combination, the funding transfer and the proposed new powers will provide significant additional fiscal flexibility to councils to administer support for unoccupied properties in a way that is tailored to local needs. Furthermore, I can confirm that the Scottish Government will not seek to agree any freeze or cap in locally determined increases to Council Tax, meaning each council will have full flexibility to set the Council Tax rate that is appropriate for their local authority area. I do hope that councils will reflect carefully on the cost pressures facing the public when setting council tax rates. We are also committed to expanding councils’ ability to raise additional revenues and discussions among our respective officials have commenced to identify a structured approach to future potential local taxes. At the same time, councils now have the power to establish local workplace parking levy schemes and our work to introduce a local visitor levy bill in this parliamentary session is on track. Finally, I am conscious that, while it is not directly applicable to Local Government pay negotiations, many stakeholders have used Public Sector Pay Policy as a reference point in previous years. For this reason, I feel it is important to highlight to you that we have taken the decision not to announce pay uplifts or publish a Public Sector Pay Policy for 2023-24. There are a number of reasons for this, not least among them the desire to approach pay negotiations differently for 2023-24, the imperative for reform and the need to ensure the sustainability of public sector pay and workforce arrangements. This does not change our view that our job in the midst of a cost crisis is not to press down on pay, particularly the most vulnerable. We will be sharing further guidance in relation to 2023-24 pay at an appropriate point in the new year which is likely to be considered by Trade Union colleagues relevant in Local Government pay negotiations, if you agree I will ask my officials to engage Page 138 of 206
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Scottish Ministers, special advisers and the Permanent Secretary are covered by the terms of the Lobbying (Scotland) Act 2016. See www.lobbying.scot St Andrew’s House, Regent Road, Edinburgh EH1 3DG www.gov.scot with COSLA officers as this develops to determine if you might wish to formally endorse or adopt it. I am under no illusions about the challenging fiscal environment we face across all of our public services over the next few years but I have sought to protect the local government settlement as far as possible as far as possible with an overall settlement of over £13.2 billion. The budget goes significantly beyond the commitments made in the Resource Spending Review. It provides substantive additional funding and it does not pass on the negative consequentials for employer national insurance contributions resulting from of the Autumn Statement. Importantly, it provides a number of fiscal and policy flexibilities. Alongside the settlement, I hope my offer to build on the Covid Recovery Strategy will be warmly and urgently received, to enable us to make urgent progress on the New Deal. I want us to work in partnership, to build on the Covid Recovery Strategy and agree an approach which improves delivery of sustainable public services, designed around the needs and interests of the people and communities of Scotland, at its heart. I would welcome confirmation that you are supportive of the proposed joint work outlined above and I look forward to working with COSLA and Leaders in the months ahead to deliver on our shared priorities. JOHN SWINNEY Page 139 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 IJB Performance Report Executive summary The purpose of this report is to update the IJB on progress towards achieving the current IJB performance goals for the financial year 2022/23. The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. An updated report describing progress against each improvement goal is attached in Appendix 1. Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided. Board members are asked to: • Note the performance against the IJB Improvement Goals for 2022/23. # Item number: 5.9 Page 141 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board IJB Performance Report 1 Purpose The purpose of this report is to update the IJB on progress towards achieving the current IJB performance goals (2022/23). 2 Recommendations 2.1 As a result of this report Members are asked to: • Note the performance against the IJB Improvement Goals for 2022/23 (Appendix 1). 3 Background and main report 3.1 The IJB has previously identified improvement goals to monitor progress on reducing unscheduled hospital activity and use of institutional care. They are based on goals recommended by the Scottish Government Ministerial Strategic Group for Health and Community Care (find out more here). 3.2 At the IJB meeting in June 2022 the Performance Assurance & Governance Group recommended that the improvement goals for 2022/23 were set to prioritise an increase in system stability, focussing on workforce recovery and wellbeing. 3.3 The Members approved the following goals: MSG Indicator 2021/22 Target Rate per 100,000 2021/22 Running Average per 100,000 2022/23 Target Rate per 100,000 A&E Attendances 2,629 / month 2,789 (at Feb 2022) 2,629 / month Emergency Admissions 767 / month 820 (at Feb 2022) 767 / month Unplanned Bed Days 5,074 / month 4,714 (at Feb 2022) 5,074 / month Delayed Discharge Occupied Bed Days 820 / month 680 (at Feb 2022) 820 / month End of Life - Percentage of Last Six Months Spent in Large Hospitals <8.7% 7.4% (provisional) <8.7% Balance of Care >96.4% 96.7% (provisional) >96.4% Page 142 of 206
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Midlothian Integration Joint Board 3.4 An updated report describing progress against each improvement goal is attached in Appendix 1. This report is produced by the Local Intelligence Support Team (LIST) on behalf of the Midlothian HSCP. Members are asked to note the information in Appendix 1, specifically regarding data completeness (slide 4). Due to the processes required to validate these data for publication, there is an inbuilt reporting delay, and this information is not taken from a “live” system. This means that we are not yet able to calculate the full year performance for some measures. 3.5 More recent management data are available for a number of the improvement goals but as they have not been validated, they cannot be published. In order to support the Board’s understanding of the current position regarding progress towards the improvement goals, a brief summary is provided below. 3.6 A&E Attendances 2022/23 Target Rate per 100,000 people 2,629 / month 2022/23 Running Average 2,816 / month The validated data are only available up to September 2022. Based on this information, the target is not currently being met. Non-validated management information, up to and including November 2022, indicates that system activity levels continue to present a significant challenge to achieving the target set. 3.7 Emergency Admissions 2022/23 Target Rate per 100,000 767 / month 2021/22 Rate 799 / month The validated data are only available up to March 2022. Based on this information, the target is not currently being met. Non-validated management information, up to and including November 2022, indicates that system activity levels continue to present a significant challenge to achieving the target set. 3.8 Unplanned Bed Days 2022/23 Target Rate per 100,000 5,074 / month 2021/22 Rate 4,779 / month The validated data are only available up to March 2022. Based on this information, the target is currently being met. Non-validated management information, up to and including November 2022, indicates that system activity levels have increased to the extent that a significant challenge to achieving the target set now exists. 3.9 Delayed Discharge Occupied Bed Days 2022/23 Target Rate per 100,000 820 / month 2022/23 Running Average 1,121 Page 143 of 206
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Midlothian Integration Joint Board The validated data are only available up to September 2022. Based on this information, the target is not currently being met. Non-validated management information, up to and including November 2022, indicates that system activity levels continue to present a significant challenge to achieving the target set. 3.10 End of Life – Percentage of Last Six Months Spent in Large Hospitals 2022/23 Target Rate <8.7% 2020/21 Rate 7.5% The validated data are only available for 2020/21. Based on this information, the target is currently being met. It is not possible to refer to management information as these data are not held locally. 3.11 Balance of Care 2022/23 Target Rate >96.4% 2020/21 Rate 97% (provisional data) The validated data are only available on a provisional basis for 2020/21. Based on this information, the target is currently being met. It is not possible to refer to management information as these data are not held locally. 4 Directions 4.1 There are no implications on the Directions. 5 Equalities Implications 5.1 There are no equality implications from focussing on these goals but there may be implications in the actions that result from work to achieve them. The focus of most of the goals is on reducing hospital activity and hospitals are not used equally by the population. There are groups of people that make more use of hospitals than others – for example older people, people living in areas of deprivation or people who live alone. 6 Resource Implications 6.1 There will be resource implications resulting from further action to achieve these improvement goals. Page 144 of 206
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Midlothian Integration Joint Board 7 Risk 7.1 The main risk is that the IJB fails to set improvement goals that take cognisance of the continued instability of health and care systems, the significant operational system pressures, and the ongoing challenges of supporting workforce wellbeing. 8 Involving people 8.1 The Performance Assurance & Governance Group (PAGG) meet monthly to review and discuss these measures as part of wider data assurance. Membership of the group will be expanded to ensure increased representation of elected officials, the third sector and public health. 9 Background Papers N/A. AUTHOR’S NAME Elouise Johnstone DESIGNATION Performance Manager CONTACT INFO elouise.johnstone@nhslothian.scot.nhs.uk DATE 17/01/2022 Appendix 1: LIST Report describing progress against the IJB improvement goals 2022/23. Page 145 of 206
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Midlothian HSCP MSG Indicators Performance from April 2019 to September 2022, with 2020/21 MSG targets and trends Local Intelligence Support Team (LIST), January 2023 Page 147 of 206
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Contents 1. Methodology 2. Data completeness 3. A&E attendances 4. Emergency admissions 5. Unplanned bed days 6. Delayed discharges occupied bed days 7. End of life 2Page 148 of 206
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2020/21 MSG Targets - Methodology • The MSG Objectives Performa was submitted in February 2020 which specified the 2020/21 targets and an action plan on how those targets were to be achieved • 2017/18 MSG data was used as the baseline to calculate the 2020/21 targets 3Page 149 of 206
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Data completeness Source: MSG data release Nov-22, PHS 4 Indicator Published until Provisional until Data completeness issues 1. A&E attendances Sep-22 n/a - 2. Emergency admissions Mar-22 Sep-22 (SMR01) Nov-20 = 93%, Nov-21 = 95% 3a. Unplanned bed days (acute) Mar-22 Sep-22 (SMR01) Nov-20 = 93%, Nov-21 = 95% 3b. Unplanned bed days (GLS) n/a Sep-22 (SMR01E) Quarters ending: Dec-21 = 97%; Mar-22 = 98%; Jun-22 = 91%; Sep- 22 = 95% 3c. Unplanned bed days (MH) Mar-21 Sep-22 (SMR04) Quarters ending: Jun-22 = 91% 4. Delayed discharges occupied bed days Sep-22 n/a - 5. Last 6 months of life (% in community setting) 2020/21 2021/22 - 6. Balance of care (% at home) n/a 2020/21 - Page 150 of 206
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Data Sources 2020/21 MSG Targets • Source: MSG data release v1.60, Nov-22; Public Health Scotland • These are official monthly figures released by PHS and will be nationally published (some data is provisional and not yet published) • Next data release: Mar-23 5Page 151 of 206
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A&E Attendances Source: MSG data release Nov-22; data published up to Sep-22 • The rate of attendances in 2020/21 was 21% lower than 2019/20, and 17% lower than the 2017/18 baseline year. Much of this may be due to covid-19. • The rate of attendances had increased back to typical levels by Aug-20, but steadily decreased again until Mar-21 when it started increasing. • From May-21 – Nov-21 it exceeded the 2020/21 target level. Between Dec- 21 and Feb-22 it dipped below the target again. • The 2020/21 target was met 6 Target = maintain Annual Monthly 2020/21 Target Rate (per 100,000) 31,543 2,629 2019/20 Rate (per 100,000) 33,319 2,777 2020/21 Rate (per 100,000) 26,391 2,199 2021/22 Rate (per 100,000) 33,153 2,763 2022/23 Running average (Sep) 2,816 Page 152 of 206
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Emergency Admissions Source: MSG data release Nov-22; data published up to Mar-22 • The rate of emergency admissions dropped in Apr- 20 due to Covid-19, but quickly returned to more typical levels – although remained lower than 2019/20 until March-21 • In the first quarter of 2021/22 the admissions rate increased above the 2020/21 target level and above 2020/21 levels; this discrepancy has reduced since • The 2020/21 target was met 7 Target = 5% decrease Annual Monthly 2020/21 Target Rate (per 100,000) 9,207 767 2019/20 Rate (per 100,000) 10,969 914 2020/21 Rate (per 100,000) 9,208 767 2021/22 Rate (per 100,000) 9,586 799 Page 153 of 206
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Unplanned Bed Days - Acute Source: MSG data release Nov-22; data published up to Mar-22 • The rate dropped drastically in Apr-20 due to Covid-19, but was back to a more typical level by Jul-20. • The rate has remained stable since then • The 2020/21 target was met 8 Target = 10% decrease Annual Monthly 2020/21 Target Rate (per 100,000) 60,888 5,074 2019/20 Rate (per 100,000) 64,683 5,390 2020/21 Rate (per 100,000) 57,459 4,788 2021/22 Rate (per 100,000) 57,351 4,779 Page 154 of 206
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Delayed Discharges Occupied Bed Days Source: MSG data release Nov-22; data published up to Sep-22 • The rate of delayed discharge occupied bed days in Apr-20 was about 80% lower than the previous April’s rate due to Covid-19 • The rate has remained mostly lower than the previous year ever since; during much of 2021/22 it was lower than the 2020/21 target level, although it has now exceeded it since Feb- 22 and has risen substantially over the last few months • The 2020/21 target was met 9 Target = 20% decrease Annual Monthly 2020/21 Target Rate (per 100,000) 9,836 820 2019/20 Rate (per 100,000) 14,336 1,195 2020/21 Rate (per 100,000) 9,779 815 2021/22 Rate (per 100,000) 8,249 687 2022/23 Running average (Sep) 1,121 Page 155 of 206
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End of Life - Percentage of Last Six Months Spent in Large Hospitals Source: MSG data release Nov-22; data published up to 2020/21 10 • The 2020/21 target was met • The provisional percentage for 2021/22 is below the target but is higher than the 2020/21 level Target = decrease Annual 2020/21 Target <8.7% 2019/20 9.1% 2020/21 7.5% Page 156 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Midlothian IJB Internal Audit Arrangements and Plan 2022/23 Executive summary The purpose of this report is to update the Midlothian Health and Social Care Integration Joint Board (MIJB) on the Internal Audit arrangements that have been agreed by Midlothian Council for the continued provision of a MIJB Chief Internal Auditor, and provide an update on the progress with the Internal Audit Plan for 2022/23 for the MIJB. The MIJB is therefore asked to note the arrangements in place for the Provision of a MIJB Chief Internal Auditor, and the progress with the Internal Audit Plan for 2022/23 for the MIJB. Item number: 5.10 Page 157 of 206
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Midlothian Integration Joint Board Page 2 Midlothian Integration Joint Board Midlothian IJB Internal Audit Arrangements and Annual Plan 2022/23 1. Purpose 1.1 The purpose of the Report is to present the new arrangements in place for the provision of a Chief Internal Auditor for MIJB and provide an update on the progress with the MIJB Internal Audit Plan for 2022/23 for noting by the MIJB. 2. Recommendations 2.1 To approve to note the arrangements in place for the Provision of a MIJB Chief Internal Auditor, and the progress with the Internal Audit Plan for 2022/23 for the MIJB. 3. Background and main report 3.1 At the Midlothian Council Audit Committee Meeting on the 27th September 2022 it was agreed to enter into an agreement with East Lothian Council to share a Chief Internal Auditor who would act as Chief Internal Auditor for Midlothian Council, East Lothian Council, Midlothian IJB and East Lothian IJB. A Service Level Agreement (SLA) has subsequently been entered into between Midlothian and East Lothian Council to formalise this agreement. 3.2 The agreement provides a Chief Internal Auditor that will cover all 4 organisations for an initial 18 month trial period covering the 1 January 2023 to the 30 June 2024, in order to operate over a full internal audit plan cycle. Officers in both Councils have identified the opportunities for efficiencies identified by this arrangement and potential future benefits of combining skills and capabilities of a joint working arrangement. 3.3 The Internal Audit Annual Plan 2022/23 for the MIJB (Appendix 1) included sufficient work to enable the MIJB’s appointed Chief Internal Auditor to prepare an annual independent and objective audit opinion on the adequacy of the arrangements for risk management, governance and control of the delegated resources within the MIJB. Progress has been made against this plan with follow up work being completed and co-ordination with the NHS audit team to arrange for completion of a review of the Medium Term Financial Planning Process. Page 158 of 206
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Midlothian Integration Joint Board Page 3 Chief Internal Auditor Arrangements 3.4 As a result of the Service Level Agreement entered into between Midlothian Council and East Lothian Council the Chief Internal Auditor for Midlothian IJB will be provided for the period 1 January 2023 to 30 June 2024 by the Service Manager Internal Audit of East Lothian Council. Internal Audit and Counter Fraud Services will continue to be provided by the Midlothian Council Internal Audit Team in partnership with the NHS Lothian Internal Audit Team. 3.5 The Midlothian IJB and Midlothian Council had previously shared a Chief Internal Auditor with Scottish Borders Council from 2017 until June 2022 and the current arrangements will provide continuity with this arrangement. 3.6 The Midlothian Council Internal audit team currently has 2 Internal Auditors and 2 Fraud & Audit Officers who are managed by a Principal Auditor. Additional budget is also available to support the joint arrangements. Audit Plan 2022/23 and 2023/24 Planning Arrangements 3.7 The Internal Audit Plan 2022/23 is being reviewed as part of the arrangements for the change in Chief Internal Auditor. It is anticipated that all audit work on the 2022/23 Internal Audit Plan will be complete in order to provide an Annual Governance Statement to the June MIJB Audit & Risk Committee with the exception of the planned audit of Financial Reporting. The requirement and scope for this audit will be discussed with the External Audit team to ensure that there is no duplication of audit assurance in this area. 3.8 Planning for the 2023/24 Internal Audit Plan is underway consideration should be given by all stakeholders on areas of MIJB activity that would require assurance activity. Contact can be made with the Chief Internal Auditor or the Chair of the MIJB Audit & Risk Committee. The plan will also be discussed with the MIJB Chief Officer and Chief Financial Officer. 4. Directions 4.1 There are no Directions implications arising from this report. 5. Equalities Implications 5.1 There are no equalities implications. 6. Resource Implications 6.1 There is a commitment by Midlothian Council to provide Internal Audit resource to the MIJB. The Midlothian Council Internal Audit Annual Plan 2022/23, allocated a total of 40 days to support the MIJB Internal Audit Page 159 of 206
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Midlothian Integration Joint Board Page 4 Annual Plan 2022/23, including providing the MIJB Chief Internal Auditor. The Internal Audit Charter and Internal Audit Strategy, presented for approval at the same meeting of Midlothian Council Audit Committee, are applicable for the provision of Internal Audit services to MIJB. Those documents set out respectively the conformance of the Internal Audit team to the PSIAS standards and the approach to the planning, delivery and reporting of Internal Audit activity associated with the MIJB. 6.2 There is a commitment by NHS Lothian to provide Internal Audit resource to the MIJB. This is reflected in the NHS Lothian Internal Audit Annual Plan 2022/23 and a review has been agreed for completion as part of this plan. 7. Risks 7.1 Key components of the audit planning process include a clear understanding of the MIJB’s functions, associated risks, and potential range and breadth of audit areas for inclusion within the plan. As in previous years, to capture potential areas of risk and uncertainty more fully, key stakeholders will be consulted. This exercise is informed by key developments at both a national and local level and other relevant background information, for example the Strategic Plan. Discussions with the MIJB’s Chief Officer and Chief Finance Officer will continue on a regular basis to ensure Internal Audit assurance meet the needs of the MIJB and Management and other key stakeholders. The MIJB Internal Audit Annual Plan 2022/23 has been informed by the risks, controls and mitigation actions as set out within the MIJB’s Strategic Risk Register to ensure that Internal Audit plans are risk-based and provide relevant assurance. 7.2 The PSIAS require Internal Audit to evaluate the effectiveness of the MIJB’s Risk Management arrangements and contribute to improvements in the process. Each Internal Audit assignment will be risk-based and will test the MIJB’s management of risk. 7.3 The MIJB Internal Audit Annual Plans should be considered to be flexible and will be periodically reviewed, and amended as required, to reflect any new arrangement or changing risks and priorities. Any amendments relating to the MIJB will be brought to the MIJB Audit and Risk Committee for approval. 8. Involving People 8.1 Consultation on Internal Audit planning will be undertaken with all key stakeholders. Page 160 of 206
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Midlothian Integration Joint Board Page 5 9. Background Papers AUTHOR’S NAME Duncan Stainbank DESIGNATION MIJB Chief Internal Auditor CONTACT INFO Duncan.stainbank@midlothian.gov.uk DATE 23/01/2023 Appendix 1: MIJB Approved Internal Audit Plan 2022/23 Appendix 1. Page 161 of 206
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Midlothian Health and Social Care Integration Joint Board Internal Audit Annual Plan 2022/23 Appendix 1 Ref Category Audit Days Commentary 1. Assurance Annual Assessment of Internal Control and Governance 12 Prepare an annual assurance report for MIJB Management and MIJB Audit and Risk Committee summarising the work undertaken by Internal Audit during the year and forming an opinion on the adequacy of the MIJB’s arrangements for risk management, governance and internal control for delegated resources. Conduct a high level review of risk management arrangements in operation. Test a sample of the key elements in the MIJB Code of Corporate Governance to determine whether these are operating effectively. This will be used to inform the MIJB’s Annual Governance Statement. 2. Assurance tbc 30 NHS Lothian Internal Audit team will deliver this Audit. The scope of the Audit is yet to be determined. Options for discussion: focus on a specific MIJB Direction or commissioned service; the implementation of the ministerial task force recommendations; set aside and financial planning; or other area of risk. 3. Assurance Financial Reporting 15 Review to ensure that financial statements have been prepared in accordance with the CIPFA Code of Practice on Local Authority Accounting in the United Kingdom and the CIPFA Financial Management Code. Page 163 of 206
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Ref Category Audit Days Commentary 4. Other Recommendations Follow Up Review 8 Undertake two reviews: The first will assess performance against closing Audit Actions by the agreed due date; and the second will include a sample check on the adequacy of new internal controls for Audit Actions flagged as closed. 5. Other Administration of Audit Scotland Reports 1 Monitor publication of Audit Scotland reports and co-ordinate submission by Management of relevant Audit Scotland Reports to the MIJB Audit and Risk Committee / Board. 6. Other Audit Committee Self- Assessment 1 Provide assistance to Chair in undertaking a self-assessment of the MIJB Audit and Risk Committee against the CIPFA best practice guidance. 7. Other Attendance at Boards / Committees 2 Prepare for and attend MIJB Board / Audit and Risk Committee meetings. 8. Other Audit Planning for 2023/24 1 Renew risk assessment, develop and consult on proposed coverage within the MIJB Internal Audit Annual Plan 2023/24. Total 70 Midlothian Council’s Internal Audit function will provide 40 days and NHS Lothian Internal Audit team will provide 30 days to support the delivery of the Plan. Page 164 of 206
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Midlothian Integration Joint Board Thursday 9th February 2023, 14:00 – 16:00 Midlothian Community Justice Annual Report 2020 Executive summary The Community Justice (Scotland) Act 2016 places a duty on local community justice statutory partners to produce a Community Justice Outcome Improvement Plan (CJOIP) which outlines key local needs and priorities and the plans and actions to address these. Beyond this, partners are also tasked with reporting on an annual basis to Community Justice Scotland. The introduction of the Community Justice (Scotland) Act 2016 triggered the formal implementation of the new model of Community Justice in Scotland. The Act places a duty on local community justice statutory partners to produce a Community Justice Outcome Improvement Plan (CJOIP) which outlines key local needs and priorities and the plans and actions to address these. This report is a summary of the April 2021/2022 Annual Report prepared for Community Justice Scotland by the Midlothian Community Justice Partnership. The report highlights key aspects of community justice activities, outcomes and improvements during the financial. Board members are asked to: Note the content of this report. # Item number: 5.11 Page 165 of 206
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Midlothian Integration Joint Board Midlothian Integration Joint Board Midlothian Community Justice Annual Report 2020 1 Purpose 1.1 The purpose of this report is to update the IJB on activity carried out by the Community Justice Partnership in Midlothian during 2021/2022. 2 Recommendations 2.1 Members asked to note the content of this report. 3 Background and main report 3.1 The introduction of the Community Justice (Scotland) Act 2016 placed a duty on local community justice statutory partners to produce a Community Justice Outcome Improvement Plan (CJOIP) outlining key local needs and priorities and the actions to address these. The current CJOIP was a three year plan from 2020 – 2023. Beyond this, Communality Justice Partners are tasked with reporting on an annual basis the community justice outcomes and improvements in their Local Authority area. The April 2021 - 2022 Annual Report is attached as an appendix. 3.2 Several key aspects of the Annual Report are highlighted below: Victim focused: The Community Safety and Justice Partnership (‘The Partnership’) has continued ensure that we deliver trauma informed and survivor focused services and interventions. This includes working alongside partners working to prevent Violence Against Women and Girls, including providing a focus on Priority four “Men desist from all forms of Violence against Women and Girls and perpetrators of such violence receive a robust and effective response” within the Community Safety and Justice Partnership Board and Working Group meetings and actions. In line with the Scottish Government’s ‘Vision for Justice’ and the Community Justice Scotland’s ‘National Priorities’ the partnership have been active in promoting a justice system that meets the needs of those that cause harm and survivors. Midlothian was selected to be part of a pilot for the local Sheriffdom for provision of generic Restorative Justice but developed this further in collaboration with third sector partners, Thriving Survivors, to promote a survivor led justice and develop a national hub for restorative justice in cases of sexual harm. Raising awareness of Justice and Community Justice: A Midlothian Community Justice Toolkit was developed on Learnpro as a learning module for Midlothian Page 166 of 206
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Midlothian Integration Joint Board Council Staff. It is intended that this e-learning model will be used to engage with community groups also. Midlothian Community Justice developed a strong relationship with Edinburgh College (Midlothian Campus). We supported the media students in their final 2nd year assessment that focused on ‘Community Justice’. The support included providing a series of mini lectures focusing on wider areas of justice including the promotion of a survivor led justice system. The students produced short films, animations and documentaries based on research and the learning from the lecture series. It is planned that the final edits of films will be available on social media in February/March 2023. A ‘Directory of Community Justice’ was co-produced in consultation with clients and staff in the Justice Unpaid Work Team. The purpose is to provide a source of information on key support services for individuals and their families at any stage in the Justice System. The booklet is made up of chapters focusing on an issue linked to reducing (re)offending including substance use, Adverse Childhood Experiences (ACEs), employment, housing, victims, and positive relationships. This has been published and marketed online. To ensure partners and relevant agencies are kept up to date with the ever-changing justice system, the partnership produces a bi-monthly summary report named ‘Justice Update’. This report provides the reader with an executive summary of the key themes from all relevant justice articles, and published papers, including health, employment and third sector. Working with women involved in the Justice system: Spring is a multi-agency service specifically for women with complex needs. The service has continued to ensure that it reflects research developments and the Justice Service recruited a full time Social Worker for the service in November 2021. Research from the Female Offender Strategy recognised that 60% of female offenders have experienced domestic abuse and the complexity of female criminality is often embedded in family disputes, trauma and mental health. The Spring social worker preparing the court report and then supervising the community based disposal is beneficial as it provides continuity of service, avoiding repetition of information that is often traumatic. Early and/or timely intervention: In September 2021 The Justice Service made a Structured Deferred Sentence (SDS) available as an interim sentencing option available to Courts for all those aged 18 and over and who reside in Midlothian. SDS is primarily available for those convicted of an offence and assessed as posing a low to moderate risk of re-offending; as a means of preventing them from being further drawn into the formal Justice system. The aim of this disposal is to provide access to positive pathways to support desistance from further offending without being ‘up- tariffed’ through imposition of sentences such as a Community Payback Order. Since its introduction in September 2021, up to the end of the financial year, six such disposals were imposed. Services supporting the Justice Service in providing support and interventions include the Substance Use Service, Spring Service, Venture Trust and Change Grow Live. The Number 11 Allocation Meeting continues to ensure that every individual from Midlothian, liberated from the Scottish Prison Service, is: provided with accommodation, offered voluntary throughcare support by Change Grow Live, and if necessary, substance support from services within the No 11 Recovery Hub. This Page 167 of 206
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Midlothian Integration Joint Board ensures that basic needs are addressed particularly for those clients who are returning to the community with limited or no family support. This model of the No 11 Allocations Service has been shared with two other local authorities to date as an example of good practice. 4 Policy Implications 4.1 None. 5 Directions 5.1 MIJB 13.4 Community Justice relates to the delivery of groupwork interventions: Continue to develop the Spring service. Specifically develop ‘Stepping Stones’ and the ‘Next Steps’ phase of Spring. 5.2 MIJB 13.5 relates to the delivery of CPOs: Prevent the risk of further offending by improving interventions with people who are on/ have completed a Community Payback Order. 5.3 Priority areas identified within the SNSA are the focus of the Community Justice Outcome Improvement Plan 2020-23 which contains forty actions that the partnership will strive to achieve over the next three years. A new Community Justice Outcome Improvement Plan (CJOIP) is currently being developed, this will be a five-year plan and it is anticipated that it will shape the Directions related to Community Justice over the next reporting period. 6 Equalities Implications 6.1 The Strategic Needs and Strengths Assessment (SNSA) was published in early 2020. It identified a number of inequalities in health, housing, finance, and employment within the Midlothian area which enables us to ensure that the work undertaken by the Justice Service meets the needs of those from the area and those who have been affected by crime. 7 Resource Implications 7.1 N/A 8 Risk 8.1 The main risk associated with the Community Safety and Justice Partnership Annual Report and CJOIP is not poor performance against objectives and outcomes. A full risk register has been produced by the partnership and available upon request. Page 168 of 206
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Midlothian Integration Joint Board 9 Involving people 9.1 A key pillar of the Community Justice (Scotland) Act 2016 and the Community Justice Scotland Strategy is empowering communities. Effective community justice relies on its partnerships working collaboratively to support the delivery of the shared objective to reduce offending and re-offending. Consultation remains key to partnership working over the reporting year and a variety of methods have been used to ensure that community voices are captured to support development and delivery of service provision. This has included a range of consultations including: Citizens Panel; with individuals in care at HMP Edinburgh; individuals supervised by Justice Social Work including those subject to supervision and unpaid work as part of Community Payback Orders. Actions within the 2020-2023 CJOIP, and future plans, relate directly to communication and engagement. This is to achieve increased awareness, understanding of, and participation with, Community Justice among the public and partners from all sectors within Midlothian. The audience for this communication and engagement plan is all inclusive: strategic and non-strategic partners, third sector organisations, elected members, local neighbourhoods and communities, people affected by offending, families of people that have offended and victims of crime. We are supported in developing the CJOIP by these partners and Community Justice Scotland. 10 Background Papers AUTHOR’S NAME Julie Jessup DESIGNATION Interim Service Manager – Community Justice, Justice Adult Support and Protection and Adult Duty Social Work. CONTACT INFO julie.jessup@midlothian.gov.uk DATE 17th January 2023 Appendix 1: Community Justice Annual Report, April 2021/2022 Appendices available upon request: Community Justice Outcome Improvement Plan and Framework 2020-2023 Communication and Engagement Strategy 2020-23 National Strategy Community Justice June 2022 2019 SNSA Page 169 of 206
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Page 1 of 36 April 2021/22 Community Justice Scotland Ceartas Coimhearsnachd Alba Community Justice Outcome Activity Across Scotland Local Area Annual Return Template Guidance 2021-22 Page 171 of 206
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Page 2 of 36 1) Community Justice Partnership / Group Details Name of local authority area/s Midlothian Community Safety & Justice Partnership, Midlothian Council Name and contact detail of the partnership Chair Name: Jim Sherval Email: Jim.Sherval@nhslothian.scot.nhs.uk Telephone: Contact for queries about this report Name: David Russell Email: David.Russell2@Midlothian.gov.uk Telephone: 07825 864 888 2) Template Sign-off from Community Justice Partnership / Group Chair Date: 28/09/2022 Name: Jim Sherval Page 172 of 206
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Page 3 of 36 3) Governance Arrangements Describe your current governance structure for community justice arrangements and include links to wider community planning. The Midlothian Community Safety & Justice Partnership Board was established to coordinate and oversee community justice in Midlothian. The Board has responsibility for the implementation of the improvement actions contained within the CJOIP and content of the national strategy. Members of the Board report annually on the indicators contained within the National Outcomes, Performance and Improvement Framework. A multi-agency Midlothian Community Justice Working Group – consisting of statutory and non-statutory partners - was established alongside the Board to develop the CJOIP and drive forward the improvement actions agreed within. The progress of the working group is overseen by the Midlothian Community Safety and Justice Partnership Board. The statutory partners are required to review the Midlothian Community Justice Outcome Improvement Plan throughout the three year period, and in the following circumstances, to determine when a new plan is required: When a revised National Performance Framework for Community Justice is published When a revised National Strategy for Community Justice is published When a revised (Community Planning Partnership) Local Outcomes Improvement Plan (LOIP) for the local authority area is published. Indicators within the CJOIP are included in the LOIP (Single Midlothian Plan) and reported on by the Community Planning Partnership. The Midlothian Community Safety and Justice Partnership is one of five strategic groups within the Community Planning Partnership, and is made up of the following statutory partners: Police Scotland Midlothian Council (Communities and Lifelong Learning, Housing, Education, Children and Families, and Justice Social Work). Scottish Fire and Rescue Service NHS Lothian Integrated Joint Board for Health and Social Care Skills Development Scotland Scottish Courts and Tribunal Service Scottish Prison Service Crown Office and Procurator Fiscal Service In addition to a number of non-standard partners agreed by the partnership: Victim Support Midlothian Midlothian and East Lothian Drugs and Alcohol Partnership (MELDAP) Mid and East Lothian Women’s Aid Change Grow Live Health in Mind Midlothian Third Sector Interface MYPAS - Young People's Drug and Alcohol Service Families Outside Thriving Survivors The Community Empowerment (Scotland) Act 2015 creates the legislative framework for community planning in Scotland. It places a duty on specific statutory partners to contribute towards improving outcomes through community planning. One of the strategic priorities within community planning is reducing inequalities; this includes all of the services that support the reduction of offending and reoffending. Page 173 of 206
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Page 4 of 36 4) Progress From 2020-21 Recommendations These recommendations were published at the end of the reporting year and concern 3rd sector engagement, futures planning, and compliance with the Community Justice (Scotland) Act 2016. Please detail what work partners have undertaken, or intend to undertake, in response to the following 2020-21 recommendations: Recommendation 1: Partnerships should build on work undertaken within the reporting period relating to third sector identification and engagement, and apply lessons learned to ensure they have established mechanisms to identify and engage with victim organisations as well. a) What local strengths or recent progress relates to recommendation 1? The 2020-21 annual report concluded with the action to ensure the partnership enhanced survivor/victim accessibility to the justice system within a local context. It was noted that there was a fundamental need to enhance survivor experience within the justice system and ensure service delivery was both survivor focused and trauma-informed. In achieving this action the partnership have increased local and national engagement with third sector organisations in particular those that support survivors and that actively work to reduce recidivism with individuals that have caused harm such as Thriving Survivors and Community Justice Scotland. The partnership continue to develop relationships and holistic approaches with the East and Midlothian Public Protection Office (PPO). This has been particularly prevalent with the partnerships focus on the prevention of violence against woman and girls (VAWGs). The partnership have included a standalone agenda item at each working group and board that solely focuses on ‘Priority 4 – “Men desist from all forms of Violence against Women and Girls and perpetrators of such violence receive a robust and effective response” and promotion of active campaigns within this field. Woman’s Aid, VAWG co-ordinator and the PPO Manager are active partners within both the working group and board and the partnership continues to advocate in this area. A victim-centred approach has also been utilised in the consideration and planning of a restorative justice (RJ) delivery within Midlothian. Findings from the ‘National Consultation – Survivors voices’ (Scotland et al, 2021) have been central to our development specifically in the consideration of survivor’s voices within this process that highlights the importance of choice and survivor empowerment. In line with the Scottish Government’s Vision for Justice and the Community Justice Scotland’s National Strategy, Midlothian Community Justice Partnership (MCJ) have been active in promoting a justice system that meets the needs of those that cause harm and survivors. Whilst Midlothian was selected as part of the Sheriffdom pilot area for generic RJ, we took the initiative to exceed statutory expectations and ensure suitable and innovative services are available specifically to meet the needs of survivors/victims of crime. Midlothian identified the need for collaborative working with third sector organisation, Thriving Survivors in supporting the development of the national hub for RJ in cases of sexual harm. Our partnership has actively promoted a survivor led justice system in line with national guidance and has facilitated innovative research in determining motivation and suitability of those who have caused harm to participate in the restorative process. We predict this will be a core area of focus for our partnership within the next 12 – 24 month period. The third sector Interface Manager continues to represent at both working group and board level alongside Community Planning. Links have been enhanced between Community Planning and the partnership, including the development of a well-being economy group that brings all partners together on an eight weekly basis to focus on social economy and bridging the gap on poverty within Midlothian. Page 174 of 206
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Page 5 of 36 4) Progress From 2020-21 Recommendations Recommendation 3: Partnerships should undertake (or evidence the work already undertaken) to understand the future need and demand on their services: in particular, but not constrained to, recovery from the pandemic. b) What gaps or emerging changes in need and demand for services have been identified? In line with the Scottish Government’s Vision publication consideration must be carefully given to the alternatives to remand. The partnership support the view that short term remand has little impact on individuals that have caused harm or survivors of crime and demonstrates detrimental effects on recidivism and wider networks such as family members effected by imprisonment, a well evidenced adverse childhood experience. Alternative disposals, including diversion from prosecution and Community Payback Orders (CPOs), still appear to be used inconsistently and are often dictated by crime index. A wider analysis of risk, vulnerability and need is required to identify suitability that ensures JSW assessments are considered key in decision making and risk management. The partnership continues to advocate for the prevention of VAWG and holds responsibility for Priority 4 – ‘Men desist from all forms of Violence against Women and Girls and perpetrators of such violence receive a robust and effective response’. Both Woman’s Aid and the Public Protection Office (PPO) continue to be valued partners in achieving the aim to eradicate VAWG. Currently Woman’s Aid and other organisations within this field continue to see an increase in demand for services to support woman and girls with average waiting lists exceeding a four month period. Although the partnership is actively supporting this work it is apparent that additional resources are required to ensure efficient and timely intervention. The partnership have also identified gaps with involving men and boys within a preventative approach to VAWG. The group have initiated discussions and planning for the future CJOIP to explore ways in which prevention can be a key driver to the eradication of VAWG. Woman’s Aid East & Midlothian (WAEML) waiting list was generated in late 2020 due to a significant demand that followed the easing of lockdown restrictions. This is the first time the organisation has ever operated a waiting list for its outreach support. WAEML observed that restrictions impacted on demand, specifically lockdowns and school closures, saw a dip in demand but immediately restrictions were lifted the demand increased and all at once. This unfortunately created a bottleneck as demand fluctuated over the entire period of the pandemic. This was exacerbated by staff absence (at times noted due to vicarious trauma), as well as some of the core funding ending and the usual staff turnover for anyone on fixed term contracts. There was a period of 6 months where WAEML were carrying vacant posts, alongside supporting staff induction, and this impacted on capacity and staff resilience. Since late 2021 WAEML has had a full staff compliment and was seeing an impact of having staff in post however, a member of the DASW staff left post and the majority of the local pathway work was re-allocated via WAEML which saw the waiting list increase again. Concerns are shared in relation to the ongoing cost of living crisis. Although data is not yet available, significant concern has been raised to the likelihood of an increase in commercial sexual exploitation. This area is predominantly dominated via social media and online communications making identification a complex area. The online world offers individuals access to “quick cash” with the upload of sexual imagery and also the communication in facilitating sex for pay. Given the current financial strain many are under these predications appear to be an accurate observation that may require consideration in the very near future. Development of services and staff has been hindered due to the pandemic and as we slowly phase into the “new normal” services are still managing the back log of work that was created during lockdown. This has put significant strain on service delivery and limited service development. The courts are still significantly behind in sitting cases and we cannot underestimate the impact this has had on both people that have instigated harm and survivors of crime. Although a trauma informed approach is at the heart of practice, these long waiting periods appear to be having significant impact on survivors awaiting their day in court. This echoes the importance of collaborative working more than ever and the need for statutory organisations to utilise existing and new relationships with the third sector. Page 175 of 206
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Page 6 of 36 4) Progress From 2020-21 Recommendations Within this reporting period Midlothian saw an increase in drug misuse death (DMD) from the last reporting period. A high proportion of the DMDs recorded were due to non-accidental overdose. A common theme within this data was individuals appearing to have long-term substance use and not engaged with health professionals, highlighting the need for future planning within our service delivery to ensure services are accessible. Over the last five years there have been an average of 12.6 probable suicides a year. This is above Scotland and Lothian average. The Scottish average rate was 13.5 per 100,000 while Lothian was 13.8 and Midlothian was rate 14.9. Compared to ten years ago there has been a 7% decrease in the rate. This is similar to Lothian but not as impressive as the decrease for Scotland as a whole (18%). However this hides substantial change between the rates for men and women. Men – Midlothian has seen a 4% increase. This is higher than Scotland and Lothian rates - Scotland has decreased by 19%, and Lothian decreased by 4%. The ScotSID report found that the bulk of deaths are men in their middle years with a strong emphasis on social isolation and economic inequality. Most people were in employment. A large minority had mental health and other needs but were not in contact with healthcare services. Women - Midlothian has seen a 35% decrease. This is below Scotland and Lothian rates. In terms of deprivation the more deprived intermediate zones in Midlothian tended to have a higher rate of suicide This is similar to national figures For additional information and a statistical overview please see link: Mental Health - Data - Midlothian Health and Social Care Partnership Uncertainty for Justice Services has become more apparent in relation to the National Care Service (NCS) strategy. The partnership provided a response to the national consultation and shared a collective response that included areas of strength but predominantly highlighted concerns surrounding the revised approach and the shared the view that further clarity was required. Although the partnership shared the view not to support the incorporation of Justice Services within NCS we appreciated the need for a further presence of Public Health to promote desistance at the root of the cause. Detail appeared to lack in the delivery of the NCS approach and did not give a clear pathway of how Justice Services will be included within this process. The partnership shared the view that further clarity was also required in the role of third sector agencies, an area that the NCS overview did not provide an adequate summary. The question of third sector was specifically apparent in relation to fund streams and how these would be assigned nationally. c) How has this been identified? a) SNSA published in early 2020. b) CJOIP 2020-2023 published on 30 March 2020 complete with participation statement. c) Annual report is published each year including 2019/20 and 2020/21 and submitted to Community Justice Scotland. d) Consultation with communities e) Bi-monthly Justice Update Publication Our SNSA was published early in 2020 to establish the community justice landscape. Community Justice Scotland reviewed our SNSA and gave feedback in November 2020. This review highlighted that our SNSA excels in the cohort specific data that is included in respect of need. That our evidence Page 176 of 206
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Page 7 of 36 4) Progress From 2020-21 Recommendations of national and local data was clearly used in the process of identifying local priorities. In Midlothian our Community Safety and Justice Partnership Board is one of five thematic themes. The overarching Single Midlothian Plan incorporates those priorities identified in our strategic planning. Updates from the CJ Working Group action log and where appropriate progress against the local outcomes within the CJOIP. Analytical products relevant to the management and monitoring against the CJOIP Our Community Justice Partnership links in with other relevant Partnership outcome reporting frameworks locally e.g. Community Planning Partnerships (CPP), Alcohol and Drug Partnerships, Gender Based Violence Partnerships. We have outcomes and indicators adopted from MELDAP’s plan embedded within our CJOIP. All of our one year CJOIP outcomes sit within the CPP Single Midlothian Plan and the Health & Social Care Partnership. When our CJOIP 2020-2023 was published on 30 March 2020 we had no overlap with VAWG actions/indicators however our Community Safety action plan does include VAWG actions/indicators, as well as actions and indicators from the local policing plan. However in December 2020 it was requested that CSJP take responsibility for delivering priority 4 locally as part of the Equally Safe National Strategy. This was ratified at the Midlothian Community Justice Partnership Board in March 2021. Whilst our current CJOIP does not have explicit actions against Priority 4 it will remain a standing agenda item on all working group meetings to support progress with its implementation. Our Annual report is published each year including 2019/20 and 2020/21 and submitted to Community Justice Scotland. The partnership are currently reviewing and updating the existing SNSA to support the publication of the next CJOIP that will commence March 2023 to March 2025. The partnership are recruiting a data analyst from Police Scotland to support the development and ongoing evaluation of Community Justice within Midlothian. Consultation has been key to partnership working over the past year in which a variety of methods have been used to ensure that community voices are captured throughout our development and delivery of service provision. This has included a range of consultations including: Citizens Panel; individuals in care at HMP Edinburgh; individuals allocated to Justice Social Work or engaging in allocated groups including Unpaid work as part of Community Payback Orders. To ensure partners and relevant agencies are kept up to date with the ever changing justice system, the partnership initiated production of a bi-monthly summary report named ‘Justice Update’. This report provides the reader an executive summary and key themes from all relevant justice articles and any papers in circulation relevant to this field including health, employment and third sector including links to full reports/articles. d) How will partners respond? Midlothian Community Safety & Justice Partnership places particular importance on partnership working, adopting a holistic and inclusive approach in the development of strategy. Positive partnerships are in place with a range of statutory and third sector organisations. The partnership has introduced a process which reflects a multi-agency and collaborative approach to the development and monitoring of CJOIP outcomes. The partnership will give particular consideration to the identified gaps and work collaboratively to ensure these areas are central to the future CJOIP and progressed accordingly within the next 12 to 24 month period. Page 177 of 206
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Page 8 of 36 4) Progress From 2020-21 Recommendations e) What has restricted progress in this recommendation? As we have gradually staged out of the pandemic we continue to highlight areas that have been affected such as face to face interventions and other areas that are highlighted throughout this report. Recommendation 4: Partners should note their collective statutory responsibilities under the Act to ensure that: all partners are aware of the statutory obligations, and that clarity and agreement is sought over partner expectations and contribution to ensuring these are met all national partners understand and comply with their individual responsibilities to supporting partnerships achieve their aims (section 35) f) What work has been undertaken or planned to make improvements against recommendation 4? All areas of planning, development and delivery instigated by the Community Justice team are actively supported by partners. We continue to grow and form relationships with existing and new partners and utilise partners’ areas of specialism or expertise to ensure the best possible outcomes are achieved within Midlothian. The Community Justice Manager actively supports other areas of business including representing Community and Justice services in a range of thematic groups including; VAWG Delivery Group; Community Planning Working Group & Board; Youth Justice Management Group. Each partner provides an organisation or service update at each working group that encourages a holistic approach in achieving outcomes from the partnership and demonstrates the awareness of expectations and statutory responsibilities. All partners supported the completion of an Integrated Impact Assessment (IIA) to ensure that partnership delivery is inclusive and eliminates discrimination. The IIA assessed impact and predicted impact based on the planning and delivery of the partnership. A key pillar of the Community Justice (Scotland) Act 2016 and the Community Justice Scotland Strategy is empowering communities. Sitting parallel to this is the Community Empowerment (Scotland) Act 2015 and the Public Bodies (Joint Working) (Scotland) Act 2014 where community engagement is also key to meeting local outcomes. We recognised the importance of a collaborative communication and engagement strategy that highlights the collective statutory responsibility the partnership holds. Therefore the purpose of this strategy is to outline Midlothian Community Justice Partnership’s (MCJP) approach to communications and engagement on reducing offending and re-offending and achieving the best outcomes for individuals, families and communities. The two key purposes of this strategy ensures: MCJP will engage effectively with all relevant stakeholder groups and communities to increase awareness and understanding on what can cause offending behaviour. MCJP will communicate key messages in an open, transparent way, promoting understanding and supporting the partnership and collaborative approach which is at the heart of local delivery. Page 178 of 206
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Page 9 of 36 4) Progress From 2020-21 Recommendations The principles employed in both communication and consultation are those outlined in the Midlothian Community Engagement Strategy which mirrors the National Standards for Community Engagement. These include: Involvement: we will identify and involve the people and organisations who have an interest in the focus of the engagement. Support: we will identify and overcome any barriers to involvement. Planning: we will gather evidence of the needs and available resources and use this evidence to agree the purpose, scope and timescale of the engagement and the actions to be taken. Methods: we will agree and use methods of engagement that are fit for purpose. Working Together: We will agree and use clear procedures that enable the participants to work with one another effectively and efficiently. Sharing Information: we will ensure that necessary information is communicated between the participants. Working with Others: we will work effectively with others with an interest in the engagement. Improvement: we will develop actively the skills, knowledge and confidence of all the participants. Feedback: we will feed back the results of the engagement to the wider community and agencies affected. Monitoring and Evaluation: we will monitor and evaluate whether the engagement achieves its purpose and meets the national standards for community engagement. The partnership sets actions that collaborate with the CJOIP and MCJP which range from reviewing and redesigning client service evaluations to ensure they are accessible to all including those with additional support needs to co-working with education professionals in raising awareness of Community Justice. Actions completed within this reporting period are the following: - Annual input into Citizen’s Panel Questionnaire - Bi-monthly justice update report for HSCP & partnership members - The publication of Community Justice E-Learning module - The redesign and develop measurable outcomes for beneficiaries of Unpaid Work Projects, and market online application form for unpaid work. - Bi-annual Community Justice Consultation g) What did this achieve? The ongoing development and communication with current and new partners has increased the focus on the importance of a survivor led justice system. Engagement with clients and wider communities has been enhanced, specifically after pandemic, and face to face contact and communication has almost returned to normal and in some instances increased. The partnership’s involvement with Community Planning has allowed non-justice partners to understand the wider factors that may impact and influence criminality and offending, which has given the partnership the opportunity to raise awareness on areas such as adversity and links to prevention. Page 179 of 206
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Page 10 of 36 4) Progress From 2020-21 Recommendations h) In what ways did local partnership compliance to the Community Justice (Scotland) Act 2016 change during 2020/21? As we continued to re-emerge from the pandemic the partnership maintained learning gained from the previous year. This mainly consisted of moving all aspects of business to an online platform including our working group and board. During the pandemic learning and development initially lost momentum, it was clear throughout the year that the importance of training was ever more essential. The partnership designed and facilitated various training inputs throughout this year that included topics such as VAWG, Autism and Minor Attracted People. Although the partnership appreciated the limitations in online learning we adapted an approach that provided professionals with a selection of short and informative inputs. Although online communication has provided the partnership with flexibility and the opportunity to maximise attendance at various meetings and events, we are keen to return to a hybrid model that will meet the needs of all members. Page 180 of 206
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Page 11 of 36 5) Covid-19 Pandemic Impact The pandemic continued in 2021-22. This section should be used to reflect some of the a) challenges/negative implications and b) opportunities/positive implications from the Covid-19 pandemic on the community justice partnership. This can include impact on the improvement activity, partner collaboration, delivery of services. Challenges / Negatives Positives / Opportunities The Covid-19 pandemic brought some challenges for community justice partnerships in 2021-22. In this section we are looking for you to describe some of the negative impact(s) and/or challenge(s) your community justice partnership faced as a result of the Covid-19 pandemic. You may include how the partners responded to these in your response. Please keep this to no more than 300 words. For example, redeployment of community justice partners to pandemic response, challenges with hosting virtual meetings, furloughed partners. Adapting service delivery was a demanding and ever changing task. The limited face to face contact impacted on both service users and staff. WAEML waiting list was generated in late 2020 due to a significant demand that followed the easing of lockdown restrictions. This is the first time the organisation has ever operated a waiting list for its outreach support. WAEML observed that restrictions impact on demand, specifically lockdowns and school closures saw a dip in demand but immediately restrictions were lifted the demand increased and all at once. This unfortunately created a bottleneck as demand fluctuated over the entire period of the pandemic. This was also against the backdrop of staff absence (at times noted due to vicarious trauma), as well as some of the core funding ending and the usual staff turnover for anyone on fixed term contracts. There was a period of 6 months where WAEML were carrying vacant posts, supporting staff induction and this impacted on capacity. Since late 2021 WAEML has had a full staff compliment and was seeing an impact of having staff in post however a As we start to return to normal business the partnership has utilised learning from the pandemic such as online meetings and learning opportunities. The online platform has ensured better accessibility for professionals to meet on a more frequent basis and increased attendance at both board and working group level. Last year’s reporting highlighted the need to communicate with the broader public, those involved in the justice system and victims of crime. To relay this message the development of Midlothian’s Community Justice Toolkit has been completed for use of Learnpro. This has, and will continue to be used to engage with community groups and is now a compulsory learning module for Midlothian Council Staff. It will be available for partnership agencies via the community section of Learnpro. This E-learning module was initially only available for justice or client facing services, however to raise awareness and highlight the broad work that Community Justice covers this was made available to the all employees within Midlothian Council. Within the first year of the E-Learning going live, 532 Midlothian staff have completed the module. Page 181 of 206
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Page 12 of 36 5) Covid-19 Pandemic Impact The pandemic continued in 2021-22. This section should be used to reflect some of the a) challenges/negative implications and b) opportunities/positive implications from the Covid-19 pandemic on the community justice partnership. This can include impact on the improvement activity, partner collaboration, delivery of services. Challenges / Negatives Positives / Opportunities member of the DASW staff left post and the majority of the local pathway work was re-allocated via WAEML which saw the waiting lists increase again. The third sector have highlighted a range of growing challenges that include the long term impact of COVID-19 but also the complexities of Brexit. Resource and staffing is a shared area of significant concern throughout the partnership and in particular the short term fund streams that third sector are finding increasingly unhelpful to deliver essential services with such uncertainty around longer term funding. Due to ongoing impact of Covid this reporting year proved to be a challenging time for the Unpaid Work Team. Following feedback the max. group size remains 3; smaller groups allows for more meaningful relationships to be established. Through collaboration and partnership working with DWP, Newbattle Abbey College, Cyrenians and the council’s Communities and Lifelong Learning team we ensured that payback was meaningful and have: - Supported communities through referrals made from across Health and Social Care partnership. This supported frontline workers to tailor care packages as we were able to assist vulnerable people with: gardening tasks; removals and general house and garden clear ups. The work enabled those on unpaid work to have a positive impact on the wellbeing of beneficiaries by supporting them to remain in their own homes. 208 referrals completed in the reporting year - Supported Foodbanks across Midlothian with Food Drives. This included a Foodbank Christmas Hamper project, where clients helped package and deliver 276 Christmas Hampers for 459 Adults and 551 Children Page 182 of 206
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Page 13 of 36 5) Covid-19 Pandemic Impact The pandemic continued in 2021-22. This section should be used to reflect some of the a) challenges/negative implications and b) opportunities/positive implications from the Covid-19 pandemic on the community justice partnership. This can include impact on the improvement activity, partner collaboration, delivery of services. Challenges / Negatives Positives / Opportunities - Supported the Weekly Waste Amnesty Project targeting Midlothian’s 3 highest areas of unregulated fire incidents; completing 107 uplifts which accounted for 395 combustible items being removed and recycled. Page 183 of 206
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Page 14 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. NATIONAL OUTCOME ONE Communities improve their understanding and participation in community justice With regard to the following indicators: Activities carried out to engage with ‘communities’ as well as other relevant constituencies Consultation with communities as part of community justice planning and service provision Participation in community justice, such as co-production and joint delivery Level of community awareness of / satisfaction with work undertaken as part of a CPO Evidence from questions to be used in local surveys / citizens’ panels and so on Perceptions of the local crime data New activities: What new activities in 2021-22 were driven / undertaken collectively by the community justice partners/hip in relation to outcome one? What was the impact of these activities? Activity - Community awareness events & training Impact – The Community Justice Manager has provided various community awareness and training to both professionals and the general public. These inputs have varied in topics but all with an underlying focus of community justice, recidivism and desistance. The following national and local events have been facilitated or planned for the coming year: - The SCVO ‘Gathering’ event at Glasgow Sec Hydro – Restorative Justice in cases of sexual harm - CJS Network event – Understanding Autism and sexual harm - JSW Midlothian – Minor attracted persons training - JSW Midlothian – Involuntary Celibates training - Edinburgh College – students mini-series lectures on community justice Page 184 of 206
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Page 15 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Activity – Engaging education Activity - A Citizen’s Panel survey was carried out in winter 2021. Respondents were asked to indicate what work they felt was required to address each of the five identified priorities (e.g. resources required, tactics, education, and community participation). Activity - Set up a standalone input on community justice in the quarterly Midlothian Health and Social Care Partnership Newsletter - StopItNow! National event – LGBTQI & technology assisted harmful sexual behaviour - Community Justice Board Midlothian – VAWG focus awareness session - Community Justice Board Midlothian – Restorative Justice - Community Justice briefing to Community Council- Service Manager Impact - Midlothian community justice have developed a strong relationship with Edinburgh College Midlothian Campus. This has been evident specifically in supporting the Media students and their final 2nd year assessment that focused on ‘Community Justice’. This was supported by providing a series of mini lectures facilitated by our Community Justice Manager focusing on the wider areas of justice including the promotion of a survivor led justice system. The students produced short films, animations and documentaries based on their own research and the learning from lecture series. It is planned that the final edits of films will be used to support the delivery of the seven-day campaign. Impact - Clearer understanding of community priorities for community justice as well as education and awareness raising on the issues linked to (re)offending. It is hoped that following a decrease in crimes and offences during 2020/21 this will have an impact of reducing the fear of crime within local communities. A strong evidence base gleaned from service users self- identified needs will ensure the service is fit for purpose and user-led. (Follow link for breakdown of the participants feedback: Citizens' Panel | Community Planning in Midlothian | Midlothian Council) Impact - Given the amount of reports, consultations and legislative documents circulated within justice nationally, the partnership amended their approach on developing this action. A bi-monthly ‘Justice Update Report’ is now produced that summarises a range of material that is distributed throughout key partners both internally and externally. Page 185 of 206
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Page 16 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. What ongoing activities took place in relation to outcome one? What was the impact of these activities? Activity - Social Media continuing to be used as a platform for sharing relevant local and national consultations, strategies and partnership movements. Activity – Stride men’s service Impact – continued use of social media promotes key messages from the Community Justice working group. This underpins the community justice planning and service provision. During COVID it has been particularly useful to reach communities so they have updated information in line with ever changing COVID restrictions. The Midlothian Community Justice Partnership Twitter account is frequently used to promote work and awareness raising from the partnership. To date we have 497 followers on this platform. Impact - Stride, a group focused on supporting men to desist from offending is a psychoeducational group programme that focuses on strength based approach. The delivery is underpinned by the ‘Decider Skills’ framework that promotes resilience and for clients to either gain new skills or share healthier coping strategies. Group delivery commenced September 2021 with the majority of referrals being made via Justice Social Work. The group environment promotes equality and allows individuals to reflect on areas of their life including past or existing relationships. The skills and strategies that are central to the programme support participants to consider how their behaviour impacts others including intimate partners allowing the group dynamic to break down barriers of masculinity and challenges in an appropriate manner. From initial intake to April 2022 Stride has supported 28 individuals. This support has ranged from group work to bespoke 1:1 support dependent on the individuals needs and learning style. Client feedback post Stride group programme: “I was really nervous coming to Stride the first time, well actually I didn’t event go! I thought then I would have a mark against my name but the team were great. They meet me on my own and made me feel comfortable to come along to group. I’m really glad I done it cause it was great meeting new Page 186 of 206
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Page 17 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. people and sharing some stuff that could help us all get a better life. I wouldn’t have got that if I hadn’t went to Stride” NATIONAL OUTCOME TWO Partners plan and deliver services in a more strategic and collaborative way Where applicable have regard to the following indicators. Services are planned for and delivered in a strategic and collaborative way Partners have leveraged resources for community justice Development of community justice workforce to work effectively across organisational/professional /geographical boundaries Partners illustrate effective engagement and collaborative partnership working with the authorities responsible for the delivery of MAPPA What new activities in 2021-22 were driven / undertaken collectively by the community justice partners/hip in relation to outcome two? What was the impact of these activities? Activity - In November 2021 introduction of a full time social worker at Spring who supervises court orders was initiated. This provides a new part to the Spring service for women involved with the Justice system. Research from the Female Offender Strategy recognised that 60% of female offenders have experienced domestic abuse and the complexity of female criminality is often embedded in family disputes, trauma and mental health. Providing continuity with the Spring social worker preparing the court report and then supervising the community based disposal is beneficial for women in the justice system avoiding a repetition of information that is often traumatic. Impact - Weekly allocations meeting are now held to review those referrals into the service, this allocation discussion then matches the women to the most appropriate 1:1 support from our partner agencies which includes Women’s Aid, Shine, Health in Mind, Occupational Therapy and Health Inequalities Team. This 1:1 support allows preparation work prior to women attending group and or if appropriate attending the shared lunch as an alternative introduction to support. Currently all referrals recorded have been screened and 1:1 support offered. Staff have worked hard to clear the waiting list that had previously gathered. This has been assisted by a change in the format of Spring assessment used for women coming into service. All partner agencies have now been trained in Outcome Star which is an assessment and planning tool. When looking at the last 32 referrals, which accounts for this reporting period, the breakdown of agencies is as follows; 28% from Justice; 12.5% from JMHT; Page 187 of 206
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Page 18 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. 9.5% CMHT and 9.5% CGL. The remaining referrals have come from Shine, Psychological Therapy Service, HiT nurse, MELD, Health Visitor and Substance Use Service. It is positive that we have both voluntary and statutory agencies referring into Spring. Work continues to engage teams who are located in the No 11 Health & Social Care Hub to help promote the multi- agency support that Spring offers. To date the experience of recording stories has been very positive. Spring clients shared the following: “I feel comfortable with the Spring. If I convince myself to go it is really beneficial for me. If I can’t come in its nice to know I won’t be pulled up for not attending. I feel people are working with me.” “Working with you must be making a difference as although I’m impulsive I don’t react in such a negative way. In the past when I was depressed I would overspend or gamble. In most cases now I will stop and think about things before I do it.” “I now recognise that I am more independent than I previously gave myself credit for. I have enjoyed creating an outdoor space and have even been able to build up a swing chair on my own. I have taken on board what I have learned with my psychology appointments and Spring and I now put myself first rather than other people, and it has helped me to cope better. I feel that Spring has made me feel stronger and I now have my voice back and feel more confident” “My life has turned around and I am loving my new flat despite being really nervous about moving away from supported accommodation. Spring has been so helpful with it all and also put me forward to get support from Housing First which has been great. I am beginning to notice the changes in myself and accept the reality. Spring is helping me to get things into alignment and sort things out in my head”. Page 188 of 206
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Page 19 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Activity - The continued impact of Covid-19 and periods of national and localised restrictions continued to present challenges for staff assessing and managing those assessed as posing a significant risk of harm to others alongside. However agencies within MAPPA continued to work effectively using a number of means to share and assess information including e-mail, telephone, Microsoft teams, and when deemed appropriate and safe to do in, face to face. Within MAPPA there are three risk management levels: Level 1 - routine risk management by the Responsible authority Level 2 - Multi agency risk management Level 3 - Multi-agency Public Protection Panels. Activity - In September 2021 a Structured Deferred Sentence (SDS) was made available as an interim sentencing option available to Courts for all those aged 18 and over and who reside in Midlothian. Impact - Throughout 2021/2022 the Level 2 panel members continued to meet, when required, using Microsoft Teams, to review and ratify all relevant information and the Risk Management Plans for the individuals requiring multi agency risk management. Justice Services continued to work effectively with other agencies to ensure that relevant information is shared and timely actions/decisions taken to reduce or manage risk. The forum for this type of multi-agency working is the Risk Management Case Conference and representatives include Housing, Children Services, Health and Police Scotland. Third sector partners are also involved when they are actively working with the individual and have key information relevant to risk assessment and risk management. The oversight and governance of the effectiveness of multi-agency working arrangements within Midlothian continues to be reviewed on a quarterly basis through random selection of cases managed by Police and Justice Social Work. The findings of these audits continues to highlight positive examples of both good practice and information sharing as means to manage the risk to, and from individuals. Staff involved in MAPPA processes have continued to review and update skills and knowledge and this has included workshops to share the learning from Initial and Significant Case Reviews. The MAPPA Guidance was updated in March 2022 and significant work was undertaken by the MAPPA Co-Ordinator to ensure that all staff were kept informed of the proposed changes and impact on practice. The forthcoming year will be used to embed these changes in practice. Impact - A SDS is primarily available for those individuals assessed as posing a low to moderate risk of re-offending as a means of preventing them from being further drawn into the formal Justice system. The overall aim of this disposal is to provide access to positive pathways to support desistance from further offending without being ‘up-tariffed’ through imposition of sentences Page 189 of 206
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Page 20 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. such as a community payback order. Since its introduction in September 2021, up to the end of the financial year, six such disposals were imposed. Services supporting the Justice Service in providing support and interventions include the Substance Use Service, Spring Service, Venture Trust and Change Grow Live. Staff within the Justice Service have also been working closely with colleagues in the Court, Bail and Diversion Team at Edinburgh Sheriff Court to review the delivery of supervised bail for residents of Midlothian. Previously this was a service that was provided on our behalf by City of Edinburgh. To ensure that those living in Midlothian have access to locally based resources, the decision was made to bring this service in house from 1st Aril 2022. The work that is being completed as part of this review has ensured that we are able to meet the Scottish Government commitment of increasing the use of Supervised Bail and reducing the number of people placed on remand. NATIONAL OUTCOME THREE People have better access to the services that they require, including welfare, health and wellbeing, housing and employability Where applicable have regard to the following indicators. Partners have identified and are overcoming structural barriers for people accessing services Existence of joint-working arrangements such as processes / protocols to ensure access to services to address underlying needs Initiatives to facilitate access to services Speed of access to mental health services % of people released from a custodial sentence: a) registered with a GP b) have suitable accommodation c) have had a benefits eligibility check Page 190 of 206
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Page 21 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Targeted interventions have been tailored for and with an individual and had a successful impact on their risk of further offending What new activities in 2021-22 were driven collectively by the community justice partnership in relation to outcome three? What was the impact of these activities? Activity - In July 2019, the Scottish Prison Service announced plans to temporarily suspend its Throughcare service due to staffing pressures linked to the rising prison population. This left a fundamental service gap in terms of supporting individuals leaving custody and in their desistance from further offending. In an attempt to plug this service gap the Midlothian Community Justice Team coordinated the No. 11 Allocations’ forum which met for the first time in December 2019. This visionary forum brings together colleagues from Health, Substance use, Social Work, Housing, DWP and third sector agencies to develop bespoke packages of care/support/treatment to clients having served a custodial sentence. The forum has some excellent examples of holistic support being offered to services users. In-reach work in the prisons and then transitioning support to the community is now coordinated, person- centred and solution focused; involving Midlothian specific services, resources and agencies. The forum has also been invaluable on planning for early release prisoners coming out of custody during the Covid-19 crisis. This model has remained in place throughout 2021-22 and continues to demonstrate effective multi-agency working to achieve the best possible outcomes for our clients. Activity - ‘Directory of Community Justice’ co-produced in consultation with clients and staff in the Justice Unpaid Work Team. The purpose is to provide a source of information on key support services for individuals and their families at any stage in the Justice System. The booklet is made up of chapters each focusing on an issue linked to reducing (re)offending including substance use, Adverse Childhood Experiences (ACEs), employment, housing, victims, Impact - Currently every individual liberated from the Scottish Prison Service to Midlothian is provided with accommodation, offered voluntary throughcare support by Change Grow Live, and if necessary substance support from services within the No 11 Recovery Hub. This ensures that basic needs are addressed particularly for those clients who are returning to the community with limited or no family support. A client being released on a Friday often presents with challenges in terms of accessing services which are at times closed over the weekend. The Allocation Service ensured that the client was seen at the No 11 Hub by housing, SUS and CGL. This reduces the waiting time for the client who might be anxious that they would experience a delay in receiving necessary support. Partner’s discussions ensure that support is not duplicated and the most pressing needs are delivered on the day of release. This model of the No 11 Allocations Service has been shared with two other local authorities to date as an example of good practice. Impact – This consultation with clients in the unpaid work team helped shape the content of the directory and ensured it was relevant to the clients and family. Production of the publication ensures that client’s views are heard in how information is shared in Midlothian. This step will in the longer term increase awareness of the range of elements that constitute community justice and the impact on the likelihood of (re)offending. The completed booklet has initially been distributed to all partners in the Community Justice working group. Page 191 of 206
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Page 22 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. and positive relationships. Now published and marketed online as opposed to paper copies. Activity - Build stronger links with Department of Work and Pensions, Welfare Rights and Skills Development Scotland to ensure better access to their services by creating drop-in clinics at Number 11. In addition 40 copies have gone to HMP Edinburgh and the Family Visitor Centre. The publication will continue to be rolled out over Midlothian in both electronic and paper copies. Impact - DWP have representatives at both the Community Justice Working Group and Board. Given the ongoing and growing concerns of poverty and the links to crime it was felt DWP could provide additional support to individuals involved with justice services. DWP and Midlothian Community Justice created a bespoke monthly drop in within No11 to give individuals the opportunity to seek advice and discuss a number of factors including benefits and alternative supports. The DWP drop in has been live for 6 months within the reporting period, in this time 17 people have been supported while attending appointments at No11. These supports have ranged from referrals to bespoke DWP services through to supporting on debt management. NATIONAL OUTCOME FOUR Effective interventions are delivered to prevent and reduce the risk of further offending Where applicable have regard to the following indicators. Use of ‘other activities requirements’ in CPOs Effective risk management for public protection Quality of CPOs and DTTOs Reduced use of custodial sentences and remand: a) Balance between community sentences relative to short custodial sentences under one year b) Proportion of people appearing from custody who are remanded The delivery of interventions targeted at problem drug and alcohol use [NHS Local Delivery Plan (LDP) Standard] Page 192 of 206
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Page 23 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Number of Police Recorded Warnings, police diversion, fiscal measures, fiscal diversion, supervised bail, community sentences (including CPOs , DTTOs and RLOs ) Number of short-term sentences under one year What new activities in 2021-22 were driven collectively by the community justice partnership in relation to outcome four? What was the impact of these activities? Activity – Midlothian Community Justice Partnership is responsible for the delivery and implementation of ‘Priority 4’ working collaboratively with justice services and third sector to ensure men desist from VAWG. Impact - Addressing domestic abuse in Midlothian remains a priority of the local authority and partner agencies. The Justice Team delivers the Caledonian Programme which is a two year accredited programme mandated through court proceedings and is delivered throughout Scotland. Over the last 18 months Midlothian Families First (MFF) has been developed to offer a Caledonian Programme on a voluntary basis. Development of MFF has been in consultation with colleagues in Children and Families Social Work and clients who are already in the Justice system. These consultations highlighted the need for the right support at the right time to create sustainable change in behaviours to develop respectful and healthy relationships. Both the Caledonian and MFF programmes seek to deliver effective intervention with men who are perpetrators of domestic abuse. This work is offered through a combination of 1:1 work, group work sessions and maintenance sessions. The respective programmes take a systemic approach offering support to the partner and or ex-partner and also support to children who have experienced domestic abuse. The overall aim is to increase safety and support recovery for families. A referral to MFF can be on a self-refer basis or by a professional working with the family. In the first instance you can call the Justice team asking for a Justice Team Leader to speak to you regarding MFF. Social Worker will then contact the family to explain about the MFF programme beginning the discussion about those behaviours that the perpetrator of the domestic abuse would want to change. Offering support on a voluntary basis to compliment the statutory work from the courts will aim to support an overall reduction of domestic abuse in Midlothian. Page 193 of 206
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Page 24 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Activity - In early 2021 the Community Justice Partnership agreed to take responsibility for Priority 4 from the Equally Safe strategy which is “Men desist from all forms of Violence against Women and Girls and perpetrators of such violence receive a robust and effective response”. Priority 4 will be a standing agenda item at the MCSJP working group. This will help facilitate availability of early interventions both statutory and non-statutory that will support perpetrators to desist all forms of violence against women and girls. This work will make best use of the multi-agency platforms within Midlothian – MARAC, PPU etc. Those interventions will provide sufficient support to desist perpetrators for repeat offending giving a robust and effective response. This facilitation of the described interventions will be measured against outcomes embedded in the Caledonian Programme and MFF, S&T, Spring, VAWG performance outcomes. The measurements will evidence change across all service provisions in Midlothian to then be measured on a national basis against Scottish Government’s Equally Safe Strategy. Action - Unpaid Work Team developed and implemented a training pathway for clients. Impact - A standing agenda item at the Community Justice working group will allow dedicated time for partnership coordination and decision making. This will offer oversight of the implementation of Priority 4 within Midlothian to evidence work that is being achieved will underpin a reduction in all forms of violence against women and girls. The Partnership will facilitate short term focus sessions to enable the direction of the implementation with the expertise of those services directly supporting women and girls who are victims of such perpetrator violence. Impact - This new pathway starts with all clients undertaking a Scottish Credit and Qualifications Framework (SCQF) award at Level 4 in Health and Safety. This not only promotes safe working practices whilst clients are on their Unpaid Work Placements but is a qualification that can be used to assist with gaining employment or accessing further training opportunities. The pathway then allows clients to undertake further SCQF qualifications including various first aid, advanced level health and safety training and manual handling. Working with the Community Lifelong Learning Team (CLL) a further pathway has been developed to allow clients to undertake a variety of training courses including: an adult achievement award, CSCS card (needed to work on building sites), digital skills, an introduction to wellbeing or to work to improve their literacy and numeracy skills. In the 2020/21 financial year, despite the national lockdowns, 35 clients gained SCQF recognised qualifications delivered by our team. A Page 194 of 206
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Page 25 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. further 15 clients completed an award through a referral to CLL. An example of the success of this approach, integrating training into a client’s Unpaid Work, is demonstrated by PW (anonymised initials). PW as part of his Order was placed at a local foodbank helping to sort donations and make up food parcels. PW also undertook training as part of his Order completing his SCQF level 4 health and safety and SCQF level 5 First Aid qualifications. He was then referred to CLL where he completed his CSCS card training. Towards the end of his Order PW had 6 job offers and accepted one position working as a labourer on a building site. He also continued to volunteer at the foodbank over the festive period despite his Order coming to an end. NATIONAL OUTCOME FIVE Life chances are improved through needs, including health, financial inclusion, housing and safety, being addressed. Have regard to the following indicator. Individuals have made progress against the outcome How do partners measure outcome five for individuals? If this information has been collated, what does it show? Activity - ‘Housing First’ approach now adopted in Midlothian. This is a national project which adopts a method of helping people who are repeatedly homeless, impacted by complex needs which leaves them without secure accommodation. Housing First Principles Impact – This is a significant change in terms of housing provision and challenges structural barriers to accessing a tenancy. Housing First will provide 20 secure tenancies to the most vulnerable households who have experienced repeat homelessness in Midlothian. Support is not time limited, security of tenure is given for people with multiple and enduring needs. This route to housing first replaces the more traditional temporary accommodation route for those who are assessed as having complex needs and need support Page 195 of 206
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Page 26 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. People have the right to a home. Flexible support for a long as needed. Housing and support are separated. Individuals have choice and control. An active engagement approach is taken. The service is based on people’s strengths, goals and aspirations. A Harm Reduction approach is taken. Housing First approach is using housing as a starting point rather than an end goal. Referrals come from all sectors of health and social care which are then reviewed by a multi-disciplinary panel for selection. Activity - Midlothian Council Housing Service to sustain a tenancy. Midlothian Housing department is working with third sector agency “With You” who deliver the support element of the tenancy. See below some key themes: The average time from acceptance to tenancy start date is 200 days across Scotland, in Midlothian we are currently at 27 days. There is a broader spread of routes into housing first for Midlothian (42% Homeless, 26% Addition/substance use, 21% justice, all other services are 2.5% each), across Scotland 53% come from homeless and 6% each from justice and addiction services. 16% of referrals come from Area Housing Office across Scotland, this is not new referrals into housing first as such but how management transfers are recorded as no one has been evicted from a Housing First tenancy to our knowledge. In Midlothian this is 5% as we have had two management transfers. Impact - Midlothian Council Housing Service continues to work proactively with the Scottish Prison Service and Justice Social Work Services to share information about individuals on admission to, and liberation from custody. This process in now firmly imbedded and is assisting to provide positive forward planning in terms of Housing and Housing Advice for service users. And is considered a model of good practice in the delivery of SHORE standards. Housing Services have two dedicated specialist Housing Staff who are the key contacts for this process which has resulted in more efficient ways of working and no offender leaving Prison without an identified housing destination. Housing Services Homeless Officers frequently link with Change Grow Live and Substance use Services to ensure there is joint working across the service to best meet the needs of the service user. Page 196 of 206
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Page 27 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Activity – No11 Department of work and pension drop in Impact - DWP and Midlothian Community Justice created a bespoke monthly drop in within No11 to give individuals the opportunity to seek advice and discuss a number of factors including benefits and alternative supports. The drop in is made accessible within No11 reception area offering a safe environment for people to access support if and when required. This enhanced relationship with DWP has also supported staff in No11 in providing consultancy for their clients. NATIONAL OUTCOME SIX People develop positive relationships and more opportunities to participate and contribute through education, employment and leisure activities Have regard to the following indicator. Individuals have made progress against the outcome Providing evidence on person centric outcomes has been challenging for most areas. How do partners measure outcome six for individuals? If this information has been collated, what does it show? The following activities are measured by utilising frequent client and partner engagement via consultation and focus sessions: Activity - Redesign exit questionnaires for all individuals on Community Payback Orders to gain feedback on the service delivery of the justice team. Impact - It is essential that we capture meaningful evaluation to support the ongoing development of services. However, to ensure the data collected give an accurate account of a client’s perspective the partnership facilitated service user engagement sessions to improve how we collect information from clients. Key findings from these focus groups were: individuals preferred visual forms opposed to heavy narrative; existing forms were not appropriate for individuals Page 197 of 206
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Page 28 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Activity - Develop the role of peer workers, volunteers and other MELDAP services within Number 11 Activity - The 2021/22 reporting year proved to be a challenging time for the Unpaid Work Team due to the impact of the Covid 19 pandemic and the previous associated lockdowns. The Unpaid Work Team were able to get group work back up and running as soon as Lockdown restrictions eased in April 2021. Group sizes remained at a maximum of 3. Another full time supervisor was recruited to maximise placements to work through our backlog of hours and going forward keep group sizes smaller where possible. It was found through client feedback that anxiety was reduced when group sizes were with a learning disability or difficulty; existing form was too long. The feedback provided supported the partnership to develop a visual and inclusive document which was positively received by the service user groups. A core theme that clients fed back to the working group was that they felt the current evaluation template had too much narrative and they felt the use of visual aids would be more user friendly. This has been a key amendment to the format of JSW evaluation templates within Midlothian Justice Services. Impact - Health and mind provide a range of training programmes to both paid and volunteered peer workers to support clients within justice services. The peer support is person centred, promotes resilience and aims to have a positive impact on recidivism. The Recovery & Justice Support Service Peer Support Co-ordinator (PSC) started in this new role in mid-September 2021. The role was developed by a Midlothian cross-sector group, who identified an opportunity to bring together the peer support work delivered by staff and volunteers involved in substance use, mental health and justice services. To date 170 people have been supported by Recovery & Justice Support between the 1st July 2021 to 31st March 2022. These referrals have come from a wide range of partner agencies including, No.11 Justice Team/Unpaid Work Team/Substance Use, Change Grow Live, Thistle, Penumbra, Red-Cross, MELD, GP’s, Self-Referrals and the No.11 Allocation Group. Support received by the individuals included 1:1 in-person/online/phone peer support, Group support - Monday Drop-in Group. Impact - Pre-Covid we could provide 42 supervised client spaces Monday to Friday and 20 Supervised Spaces Saturday and Sunday. This reduced to 33 Spaces Monday to Friday and 14 Spaces Saturday and Sunday. This is inclusive of recruiting a new Full Time Supervisor. To further address our backlog of hours we procured services from the Cyrenians Charity to supervise a further 12 Spaces per week with placements at the Community Garden at the Bonnyrigg Community Hospital. Page 198 of 206
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Page 29 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. smaller and this has allowed for more meaningful relationships to be built between client and worker. The Team were successful in a funding bid in partnership with the DWP, Newbattle Abbey College and our Council’s Communities and Lifelong Learning team to run an 8 Week course 3 days per week for a max of 10 clients to work in Newbattle Abbey’s grounds. This ran from May through June 2021. 6 Clients attended and achieved the FOLA (Forest and Outdoor Learning award), First Aid at Work, CPR and Defibrillator Award, Health and Safety in the workplace Award at Level 5 and The Adult Achievement Award. The Unpaid Work Team started back supporting communities with referral work from other Health and Social care services, assisting their most vulnerable users with gardening tasks, removals and general house and garden clear ups. All of which helped frontline workers deliver care packages, assist with the beneficiary’s wellbeing and support victims of crime. We completed 208 referrals for the 2021/22 reporting year. We have continued to give ongoing support to Foodbanks across Midlothian assisting them with Food Drives throughout the year. This includes Gorebridge and Mayfield’s Foodbanks Christmas Hamper project, where clients helped put together and deliver 276 Christmas Hampers for 459 Adults and 551 Children. We started to re-engage with placement providers although impacted through closures from Covid-19. We continued to work with the Salvation Army, Barnardo’s and developed new placements with Nivensknowe Boarding Kennels & Cattery, Mayfield and Easthouses Development Trusts (MAEDT) Community Café, Food Pantry and Garden. We delivered our Weekly Waste Amnesty Project targeting Midlothian’s 3 highest areas of unregulated fire incidents for the 6th Year running in October 21; completing 107 uplifts which accounted for 395 combustible items being removed and recycled. We also continued to implement our Learning pathway for clients, delivering Scottish Credit and Qualifications Framework (SCQF) award at Level 4 in Health and Safety in the workplace during client’s inductions and promoting other courses that would be of value to the client. 83 Accredited Awards were Page 199 of 206
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Page 30 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. achieved by 55 clients; 63 of the Certificates were delivered by the Unpaid Work Team In-House. We continue to work in partnership with Communities Life Long Learning (CLL) Team to ready clients for the CSCS Card. An example of a client’s journey (anonymised): Iain advised that he has enjoyed being on unpaid work and has been out in the van “doing a bit of everything from pickups for the bonfires to collecting food for foodbanks”. He stated that “what I am doing is helping other people”. He reflected that the biggest benefit to him as “I have not worked in 10 years and his is helping me to get back into a work routine by getting me up and out early”. He stated that through unpaid work he achieved an H&S certificate and also enabled to apply for his CSCS card. “What we are doing, the people we are helping can’t do it themselves and being a small part of something bigger is really rewarding”. If available, provide a supporting case study or other information to demonstrate activity and impact relating to outcome six. One client received a short CPO from Court. They completed their Health and Safety in the workplace and Emergency First Aid Certificate within 4 weeks of receiving the Order. They then went onto community Group work and linked into Health in Minds Peer Support Training. When the Order was completed they went on to volunteer for the Peer Service. Page 200 of 206
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Page 31 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Another Client joined our service, at the time they were in homeless accommodation and unemployed. Unpaid Work supported him by signposting to relevant housing services to address his current needs. As he was enthusiastic about gaining employment he was encouraged for the remainder of his hours to attend a placement at the community café to utilise previous kitchen skills. Following completion of his Order he was successful in gaining employment with MAEDT as a part time Community Café worker. From the skills and confidence he gained through this he went on to achieve a long term goal of starting his own catering business. NATIONAL OUTCOME SEVEN Individuals’ resilience and capacity for change and self- management are enhanced Have regard to the following indicator. Individuals have made progress against the outcome Providing evidence on person centric outcomes has been challenging for most areas. How do partners measure outcome six for individuals? If this information has been collated, what does it show? Activity – Scoping the impact and effectiveness of Restorative Justice to support recidivism and a survivor led justice system. Impact - In line with the Scottish Government’s Vision for Justice and the Community Justice Scotland’s National Strategy, Midlothian Community Page 201 of 206
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Page 32 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. Activity - All women on a CPO are considered for the Spring Service. The Spring offers one to one support and programmed group work. Spring offers opportunities to learn new skills to cope with difficult and stressful situations and manage complex emotions, build self-esteem and reduce isolation, improve health, wellbeing and safety and access a range of supports. Justice Partnership (MCJ) have been active in promoting a justice system that meets the needs of both those that cause harm but also survivors and victims of crime. Whilst Midlothian were selected as part of the Sheriffdom pilot area for generic RJ, we took the initiative to exceeded statutory expectations and ensure suitable and innovative services are available specifically to meet the needs of survivors or victims of crime. Midlothian identified the need for collaborative working with third sector organisation, Thriving Survivors, to develop the national hub for RJ in cases of sexual harm. Our partnership has actively promoted a survivor led justice system in line with national guidance and has facilitated innovative research in determining motivation and suitability of those who have caused harm participating in the restorative process. These findings including the benefits RJ can have on recidivism have been delivered at a range of national events and will be presented as a key note at the NOTA Scotland annual conference in August. Midlothian are one of the first local authorities in Scotland to take forward this ground-breaking, innovative and partnership-led work. Consultation, engagement, research and training and development have all contributed to the design of an effective, person centred and trauma informed RJ delivery pilot that will be available for those that request it. As such, we have actively promoted and prioritised the voice of survivors to ensure they are facilitated in their journey to recovery. Impact – referrals to Spring and work completed whilst attending is to help promote the necessity for increased resilience, ability to make positive decisions and promote belief in self to achieve personal goals. As stated earlier COVID restrictions limited group work however the Spring Service Occupational Therapist did individual visits to help sustain engagement. In addition online sessions were developed which again supported continued engagement. In 2020/21 50% of women indicating improvement in managing their mental health, by an average of over 2 points on the scale. Further, in terms of work and living skills, 67% of women indicated improvements in both areas and in relation to ‘work’, the average increase was over 3 points on the Page 202 of 206
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Page 33 of 36 6) Performance Reporting – National Outcomes This section is designed to capture the evidence and data that has been used by your partnership over the reporting period to assess progress against the national outcomes. scale. The change in measure for the updated star is ‘use of time’, which is more relevant to our group of women. There are low numbers who would hope to seek work following involvement in Spring, but a significant focus of the service is for women to leave being more connected to the community and better able to engage in meaningful activity. 7) If you have identified other local community justice activities and outcomes which go beyond the national outcomes, then record them here. Local outcomes Please describe the activity Then describe the impact Activity - All staff working within No11 given the opportunity to become Naloxone trained. Impact – To ensure the safety of clients and staff attending No11 the substance use team provided various Naloxone training inputs that allowed staff to become comfortable in administering in emergencies. This training was well attended by a range of professionals within the building. Staff members response to training: Page 203 of 206
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Page 34 of 36 Activity - As learning opportunities were initially hindered due to the pandemic, the partnership, alongside JSW, developed and facilitated a range of training inputs for JSW. Activity – Review of supervised bail for Midlothian residents Activity – ‘The Huddle’ “I feel more able and prepared to support people at No11. Before I completed this training I was so nervous about how I would help in this situation, the training demystified a lot of myths and misconceptions and gave me the opportunity to learn for the best possible reason”. Impact – The training opportunities provided included specialist inputs on supporting individuals with autism, MAPs and sexual harm. These inputs provided participants the opportunity to reflect on practice within these groups and gained insight into said areas. As we gradually emerged from the restrictions of the pandemic, we gradually brought teams back to face to face development days facilitated by Bridgett Rothwell. These days allowed staff to explore team dynamics and explore ways of returning back to “normal” practice. Impact - Staff within the Justice Service have also been working closely with colleagues in the Court, Bail and Diversion Team at Edinburgh Sheriff Court to review the delivery of supervised bail for residents of Midlothian. Previously this was a service that was provided on our behalf by City of Edinburgh. To ensure that those living in Midlothian have access to locally based resources, the decision was made to bring this service in house from 1st Aril 2022. The work that is being completed as part of this review has ensured that we are able to meet the Scottish Government commitment of increasing the use of Supervised Bail and reducing the number of people placed on remand. Impact - The links between justice service and substance use service are well interlinked. A lot of our clients are shared and it makes sense for our services to share information to ensure that our patients/clients do not fall through the justice or health gaps - by taking this approach we are reducing the risk of relapse into criminal behaviour or lapse in substance use. Midlothian Health & Social Care Partnership have developed a robust meeting which is attended by staff who work within the prison, housing, justice staff and nurse team manager to ensure that patients who are having their liberation from prison planned therefore ensuring that their care is seamless. From the MAT standards a key component 'Standard 8: Independent Advocacy and Social Support' - All people have access to independent advocacy and support for housing, welfare and income needs. People have the right to ask for a worker who will support them with any help they need with housing, welfare or income. This worker will support people when using services, make sure they get what Page 204 of 206
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Page 35 of 36 8) What other achievements and challenges happened? Achievements Challenges Activity - Internally, we have focused on learning and development opportunities. A management audit of Justice Social Work Reports led to sourcing training around Trauma-Informed Court Report Writing Training, working with people with Autism and Sexual Harm and Minor Attracted Persons training. Two staff development days continued our theme of staff wellbeing, service design and development. Challenge - Covid-19 has continued to have an impact on staff development has there have been limited numbers able to attend mandatory training and the frequency of the delivery of these course has also been reduced. A consequence of this has been fewer staff in the team with the skills and knowledge to assess and manage individuals convicted of a sexual or domestic violence offence. This is an issue which continues to be discussed with Community Justice Scotland. best suits them and that they are treated fairly. The work carried out between Midlothian H&SCP meets this need and will continue to develop to ensure the ongoing needs of our client group are met. Page 205 of 206
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Page 36 of 36 9) Additional Information including, next steps for the partnership As we come to the end of our current three year Community Justice Outcome and Improvement Plan (CJOIP) planning is currently focused on our future two year plan (2023-2025) that will be instrumental in our delivery within the partnership. As noted within the above narrative and in line with the Scottish Government vision, Restorative Justice will be an area of particular focus, shaping the delivery of a survivor led justice system within Midlothian. Careful planning and delivery with key and specialist partners will be essential in ensuring a safe and inclusive provision of Restorative Justice for those that seek it. Midlothian have progressed with a range of alternative and trauma-informed services including Stride and Spring that values the importance of peer learning and developments continue within both services to consider approaches that will have an impact on future rates of recidivism. The work undertaken by unpaid work continues to promote a range of learning and employment opportunities, an area the partnership will continue to develop alongside relevant partners including DWP to support clients in achieving positive destinations and goals. As we move out of the pandemic, uncertainty remains in regards to funding streams and the political landscape. We continue to advocate for those living within the systems that we manage and we hold their views as central to development. This will be key in the planning of our future CJOIP and the role that lived/living experience will play will be significant both within development and delivery of services. As noted throughout the report the partnership intend to continue to develop relationships with survivor organisations to ensure survivors are held central within the recovery aspect of the justice system. Third Sector partners continue to provide invaluable support to the partnership and it is apparent more than ever the importance of their role within justice and recovery services. The partnership will ensure continued growth in the involvement of Third Sector partners and support the innovative services the sector continues to provide. Page 206 of 206