Agenda Document Pack - Midlothian Integration Joint Board - Audit and Risk Committee - 05 March 2026
Midlothian Council · 5 March 2026
Back to Midlothian Integration Joint Board - Audit and Risk Committee — 5 March 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
Notice of Meeting and Agenda Midlothian Integration Joint Board - Audit and Risk Committee Venue: Virtual Meeting Date: Thursday, 05 March 2026 Time: 14:00 Morag Barrow Chief Officer Contact: Clerk Name: Democratic Services Clerk Telephone: Clerk Email: democratic.services@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Page 1 of 290
Page 2
1 Welcome, Introductions and Apologies 2 Order of Business 3 Minute of Previous Meeting 4 Audit and Risk Committee minutes 27th November 2025, Chair Action Log – Chief Finance Officer Updates 3.1 5 - 12 3.2 13 - 14 5 IJB Complaints – Chief Finance Officer Reports and Presentations 4.1 5.1 15 - 26 5.2 27 - 154 5.3 155 - 170 5.4 171 - 178 5.5 179 - 222 5.6 223 - 280 5.7 Risk Register Update 2025/26, presented by Chris King, Chief Finance Officer MLIJB and Associated Committees Handbook Update 2026, presented by Gill Main, Integration Manager External Audit: Annual Audit Plan 2025/26, presented by Audit Scotland Midlothian Integration Joint Board Internal Audit Plan 2026/27, presented by Duncan Stainbank, Chief Internal Auditor Midlothian IJB draft Performance Framework 2025-2028, presented by Gill Main, Integration Manager Audit Scotland Report: ‘Delayed discharges: A symptom of the challenges facing health and social care’ and Midlothian Performance, presented by Gill Main, Integration Manager Midlothian Council Internal Audit Reports (For noting), presented by Duncan Stainbank, Chief Internal Auditor 281 - 290 Page 2 of 290
Page 3
6 Any Other Business 7 None received. Date of Next Meeting The next meeting will be held on Thursday 4th June 2026, 14:00 - 16:00, Microsoft Teams (online). Page 3 of 290
Page 4
Page 4 of 290
Page 5
MIJB - Audit and Risk Committee MIJB – Audit and Risk Committee Thursday 5 March 2026 Item No 3.1 Meeting Date Time Venue Audit and Risk Committee Thursday, 27 November 2025 2.00pm Virtual Meeting via MS Teams Present (IJB voting members): Councillor McManus (Chair, Midlothian Council) Dr Amjad Khan (Vice Chair) Present (IJB non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Present (Officers): Hilary Way (External Audit, Audit Scotland) Duncan Stainbank (Chief Internal Auditor) In attendance: Louise Middleton (Democratic Services Officer) Apologies: Gill Main (Integration Manager) Antony Clark (Independent Member) Councillor Derek Milligan (Midlothian Council) Roxanne King (Executive Business Manager) Claire Gardiner (External Audit, Audit Scotland) Page 5 of 290
Page 6
MIJB - Audit and Risk Committee 1. Welcome and Introductions The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Audit and Risk Committee (A&R). Apologies highlighted to the group. The Chief Officer noted at this point that the Executive Business Manager was on a period of leave and would not be returning to this group for a period of 12 months. 2. Order of Business The Order of Business is as outlined in the agenda. There were no matters arising to be discussed. Declarations of Interest No declarations of interest were received. 3. Minute of Previous Meetings 3.1 The Minute of the Audit and Risk Committee meeting held on 4th September 2025 was submitted and approved. 3.2 Action Log - The Action Log was noted by the Committee. 4. Discussion Topic 4.1 IJB Complaints – Roxanne King, Executive Business Manager (verbal update) Page 6 of 290
Page 7
MIJB - Audit and Risk Committee The Chief Finance Officer provided an update in the absence of the Executive Business Manager. There have been no further complaints since the IJB session and work is ongoing to refine the process, this work should be completed at the start of 2026. 5 Public Reports Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.1 Risk Register Update 2025/26, presented by Chris King, Chief Finance Officer The Chief Finance Officer presented the Risk Register update. The report detailed all current risks. It was noted that two amendments had been made since the previous meeting. The Chief Finance Officer asked members to confirm whether these amendments appropriately reflected the prior discussion and whether any additional changes were required. The Integration Manager proposed a number of amendments: • Under Risk 1, the title should refer to “Strategic Planning and Performance” rather than “Planning, Performance and Programme.” • The reference within Risk 1 to redesign and transformation activity should reflect that this work is currently paused. • Under Risk 3, the role should be amended from “Risk Holder” to “Risk Handler.” • Consideration should be given to whether Risk 3 should sit jointly with the Chief Finance Officer and Chief Officer rather than solely with the Integration Manager. • Under Risk 5, references to Scottish Government decisions should be expanded to reflect relevant policy documentation, including the Service Renewal Framework Amendments made to all risks are brought to the next IJB Audit and Risk Committee Chief Finance Officer March 2026 Page 7 of 290
Page 8
MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments The Chair noted that Risk 3 contained both strategic and financial elements. It was agreed that the Chief Finance Officer would be Risk Owner, with the Integration Manager acting as Risk Handler. The Independent Member supported the proposed ownership change for Risk 3 and agreed that Risk 5 should be updated to reflect recent policy developments. The Chief Officer highlighted that, at the Strategic Planning Group meeting on 20 November, discussion had taken place regarding transformation capacity, the volume of work underway, financial recovery priorities and the need for potential reprioritisation. It was noted that this pressure on organisational capacity may require further reflection within the Risk Register. The Chief Officer also advised that the forthcoming departure of the Chief Finance Officer in April would require interim arrangements and engagement with Partners. Members agreed that this should be reflected within the financial risk. The Independent Member commented on the overall risk profile, noting that the most significant risks relate to financial sustainability and capacity, with direct implications for service delivery and strategic objectives. The Chief Finance Officer acknowledged that financial risk is increasing across IJBs nationally and referenced recent Development Sessions which had focused on financial sustainability and strategic delivery. In response to a query regarding national mitigation, the Chief Officer outlined engagement at national level through the Chief Officers Group, Chief Finance Officers Group and Strategic Planning Group. Collaborative work across Lothian IJBs was also noted. The Chief Finance Officer highlighted national commentary from COSLA and Audit Scotland regarding social care investment and transformation pressures. Page 8 of 290
Page 9
MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments Concern regarding the potential impact of new sub-national planning arrangements was raised with the suggestion this be reflected as a risk. It was agreed this could be incorporated within Risk 4, with clearer reference to legislative and structural change. The Chair requested that all agreed amendments be incorporated and the updated Risk Register brought back to the March meeting. 5.2 Strategic Planning Process Internal Audit Review, presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report and advised that the NHS internal audit resource, although contracted through NHS management arrangements, operates under the direction of the Chief Internal Auditor. It was noted that the Internal Audit Review received a satisfactory rating across all areas assessed. The Chief Internal Auditor commended the Integration Manager and the wider team for their work in relation to the Strategic Planning process. The audit process has now been completed and approved for publication. The Strategic Planning process was assessed as providing the highest level of assurance. The Chair and the Independent Member also recorded their congratulations to all those involved. Noted/Supported. Page 9 of 290
Page 10
MIJB - Audit and Risk Committee Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.3 Internal Audit Recommendations Follow Up, presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the bi-annual update report and confirmed that all previous audit recommendations have now been fully implemented. The only outstanding matter relates to the completion and publication of the Register of Interests for Board Members. It was noted that Board Members are required to complete a Register of Interests, and that the Chief Officer and Chief Finance Officer are also required to submit declarations. These are currently in progress and will be published on the website in due course. The Integration Manager clarified that only Board Members had been asked to complete a Register of Interests at this stage. Once the Standards Officer provides the completed registers, they will be uploaded to the website. The Integration Manager confirmed they were content to remain the Accountable Officer for the Audit Plan; however, responsibility for progressing the Registers of Interests sits with the Standards Officer. The Chief Internal Auditor agreed to liaise with the Standards Officer to ensure the completed registers are forwarded appropriately. The Chair requested that periodic reminders be issued during the year to Board Members to update their Register of Interests should their circumstances change. The Chief Internal Auditor agreed to raise this with the Standards Officer. The Independent Member asked whether Registers of Interests are formally reviewed on an annual basis. The Chief Internal Auditor indicated this was believed to be the case but will confirm with the Standards Officer. Add Register of Interest to the website. Send a reminder throughout the year to Board Members to update Register of Interest. Ensure Register of Interest in reviewed annually. Integration Manager Chief Internal Auditor/ Standards Officer Chief Internal Auditor/ Standards Officer Next meeting (March 2026) Next meeting (March 2026) Page 10 of 290
Page 11
MIJB - Audit and Risk Committee 5. Private Reports No items for discussion. Report Title/Summary Decision Action Owner Date to be Completed/ Comments 5.4 Review of Standing Orders, presented by Alan Turpie, IJB Standards Officer The Chief Finance Officer presented the report and advised that the Standards Officer had been asked to review the Standing Orders following the September IJB Audit and Risk Committee meeting. The Standards Officer concluded that no amendments were required and that the Standing Orders remain fit for purpose. The Integration Manager noted that the Terms of Reference had been updated and approved by the Board in 2024. It was also highlighted that the SPG Terms of Reference had not been included in the documentation. The Integration Manager agreed to circulate the relevant documents to the group and progress this matter. The Independent Member noted that a thorough review of the Terms of Reference had been undertaken in 2023 and emphasised the importance of ensuring that the most up-to-date version is used. The Chief Internal Auditor agreed to liaise with the Standards Officer regarding the update of the Terms of Reference. The Committee agreed to approve the document via email once the necessary amendments have been made, without the need to return it to a future meeting. Update the Terms of Reference in the review of the Standing Orders Chief Internal Auditor Next meeting (March 2026) Page 11 of 290
Page 12
MIJB - Audit and Risk Committee 6. Any Other Business No items for discussion. 8. Date of Next Meeting The meeting terminated at 2.35pm. The next meeting will be held on Thursday 5 March 2026 at 14:00-16:00 via MS Teams. Page 12 of 290
Page 13
Midlothian IJB Audit and Risk Committee – Action Log MIJB – Audit and Risk Committee Thursday 5 March 2026 Item No 3.2 Action Lead Description Notes Status Due Date Risk Register Chris King Update Risk Register following November 2025 A&R meeting Forms part of March 2026 meeting. Complete March 2026 Standing Orders Alan Turpie Update the terms of reference in the review of the Standing Orders. Papers updated and submitted to the IJB for final consideration. Complete March 2026 Complaints System Executive Business Manager Review of current complaints process following A&R support in September. Verbal update on progress forms part of March 2026 meeting. In Progress March 2026 Year End Process Chris King Define the process and protocol in relation to IJB Board formal notification to partners regarding the financial position. Discussions have been undertaken with both Partners. Each Partner will now close their respective financial positions, after which formal year-end discussions will conclude. Complete March 2026 Page 13 of 290
Page 14
Midlothian IJB Audit and Risk Committee – Action Log MIJB – Audit and Risk Committee Thursday 5 March 2026 Item No 3.2 Register of Interests Duncan Stainbank & Gill Main Upload the register of interest to the Website & develop a process to ensure members routinely update their submission. Register of interest is fully available online. Chief Internal Auditor to confirm plan for routine updates at March A&R meeting. Complete March 2026 Page 14 of 290
Page 15
Midlothian IJB Audit and Risk Committee Thursday, 5th March 2026, 14:00-16:00 Midlothian IJB Risk Register – Quarter Four Executive summary This report presents the Integration Joint Board’s (IJB) Risk Register for review at quarter four 2025/26. Midlothian IJB maintains a Strategic Risk Register in line with governance best practice, capturing key risks that may affect the development or delivery of the Strategic Plan. The register was last formally reviewed and updated in November 2025. Following the discussions at the Audit and Risk Committee meeting in November, the full risk register has been reviewed and updated. The revisions incorporate the Committee’s comments and reflect the agreement that the risks should be updated in light of recent local and national developments. A full version of the updated register, including risk descriptions, mitigations and ratings, is provided in Appendix 1. Committee Members are asked to: • Consider whether any further risks should be added, or existing entries amended. • Review, and subject to any required amendments, agree the updated Risk Register at quarter four 2025/26. Item number: 5.1 Page 15 of 290
Page 16
Midlothian Integration Joint Board Report Midlothian IJB Risk Register – Quarter Four 1 Purpose 1.1 The purpose of this paper is to present the updated Midlothian Integration Joint Board (IJB) Risk Register for review and updating at quarter four 2025/26. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Consider whether any further risks should be added, or existing entries amended. • Review, and subject to any required amendments, agree the updated Risk Register at quarter four 2025/26. 3 Background and main report 3.1 Midlothian IJB maintains a Strategic Risk Register in line with best practice for governance and assurance. This register identifies and assesses key risks that may impact the effective operation of the IJB specifically, those that could hinder the development of the Strategic Plan or the successful delivery of that plan through directions issued to its delivery partners. 3.2 The most recent formal update to the Risk Register was presented to the Audit and Risk Committee in November 2025. At that meeting, members considered a number of proposed amendments following a comprehensive review of the register, undertaken in recognition of the rapidly evolving financial, legislative and operational environment. A number of refinements were agreed, including amendments to risk ownership, clarification of risk descriptions and updates to reflect current transformation activity. 3.3 A key focus of the previous discussion was the impact of national policy and structural reform on the IJB’s ability to deliver its Strategic Plan. Members highlighted the potential implications of Scottish Government initiatives, including the Service Renewal Framework and wider reform programmes, as well as emerging sub-national planning arrangements within NHS governance structures. It was agreed that these developments should be more explicitly reflected within the Risk Register to ensure that both legislative change and structural system reform are appropriately captured and monitored. These updates have now been incorporated within risks MLIJB 4 and MLIJB 5. Page 16 of 290
Page 17
Midlothian Integration Joint Board 3.4 A complete version of the updated Risk Register, including risk descriptions, mitigating actions, and risk ratings, is provided in Appendix 1. 4 Policy Implications 4.1 This report does not have any direct impact on policy. 5 Directions 5.1 This report does not have any direct impact on existing Directions. 6 Equalities Implications 6.1 This report does not have any direct impact on equalities. 7 Resource Implications 7.1 There are no resource implications arising from this report. 8 Risk 8.1 There is a risk that not maintaining a regularly reviewed Risk Register could lead to the Midlothian IJB being unable to take the appropriate action to treat or tolerate emerging risks. 8.2 The Midlothian IJB risks are described at quarter four 2025/26 are detailed in the Midlothian IJB Risk Register (Appendix 1). 9 Involving people 9.1 This report has been written following consultation with our NHS Lothian and Midlothian Council financial Partners, officers of Midlothian IJB, and with the Midlothian HSCP executive management team. 10 Background Papers 10.1 There are no background papers 11 Governance This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. X Page 17 of 290
Page 18
Midlothian Integration Joint Board This report includes information that should be escalated to Midlothian IJB for noting only. X This report is the Audit and Risk Committee’s Business as Usual (BAU) and does not require Midlothian IJB’s review. √ Author’s Name Chris King Designation Chief Finance Officer Contact Information Chris.King@nhs.scot Date 06/02/2025 Appendices: Appendix 1: Midlothian IJB Risk Register Page 18 of 290
Page 19
Midlothian IJB Risk Register Risk Description ID MLIJB1 Title The IJB's Partners are unable to deliver the IJB's Directions. Risk Overview Description Risk Effect: There is a risk that the IJBs partners have insufficient workforce or other resources to execute the requirements and ambitions of the IJB Directions. Risk Consequence: The IJB cannot deliver on its strategic plan or financial plan. Controls In Place The controls in place are as follows: • Directions are monitored and reported on twice a year for performance updates. • Ability to review Directions annually. • Financial allocations are included within directions on an annual basis after IJB budgets have been set. • Strategic Planning and Performance continue to support with additional capacity to redesign and transform key areas of service delivery including enhanced data support for USC improvement activity • Additional capacity has been sourced to support the delivery of the HSCP Transformation and Change Programme. All activity has been reviewed and a more realistic set of Transformation workstreams are proposed through (draft) Directions for 2026/27. Adequacy of Controls Satisfactory: All controls are working and can be demonstrated through measurement. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Gill Main (Integration Manager) Consequence (Current) Moderate (3) Likelihood (Current) Unlikely (2) Rating (Current) 6 Risk Level (Current) Medium Risk Level (Target) Medium Page 19 of 290
Page 20
Midlothian IJB Risk Register Risk Description ID MLIJB2 Title The IJB cannot properly deliver its Category 1 responder status if its partners are unable to provide the necessary assurances. Risk Overview Description Risk Effect: IJBs role as Category 1 responders under the Civil Contingencies Act requires that our partners NHS Lothian and Midlothian Council maintain effective business continuity and resilience plans to ensure an appropriate response in times of emergency. There is a risk that our partners may not be able to provide these assurances. Risk Consequence: Failure to maintain up to date and effective resilience plans could result in services unable to maintain essential service delivery. Controls In Place The controls in place are as follows: • Assurance reporting to IJB routinely by Chief Nurse, Chief Social Worker and Resilience lead and an annual Category 1 Responder update provided through the Chief Officer report to the IJB. • Attendance as Midlothian IJB representative at partner resilience exercise events. • Robust operational processes within Midlothian Health and Social Care to meet requirements. • Lessons learnt from previous incident management have been incorporated within standard service delivery, ongoing work to develop a quality management approach will provide additional partnership wide assurances to IJB. • In line with IJB agreement. IJB is represented by, and authority delegated, to the Chief Officer of the IJB. Adequacy of Controls Satisfactory: All controls are working and can be demonstrated through measurement. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Sandra Bagnall (Executive Business Manager) Consequence (Current) Moderate (3) Likelihood (Current) Rare (1) Rating (Current) 3 Risk Level (Current) Low Risk Level (Target) Low Page 20 of 290
Page 21
Midlothian IJB Risk Register Risk Description ID MLIJB3 Title The IJB is not able to properly deliver its Strategic Plan due to insufficient resources. Risk Overview Description Risk Effect: The IJBs partners may not be able to allocate sufficient resource to deliver its Financial Plan and Strategic Plan. Risk Consequence: The IJB may not be able to deliver the Strategic Plan to function within the available resources. The IJB may have to amend the ambitions of Strategic in such a way that the progress towards the strategic aim of the Strategic Plan and 9 National Health and Wellbeing Outcomes is compromised. Controls In Place The controls in place are as follows: • Regular budget setting and financial planning meetings with IJB partners to ensure alignment of resource commitments with strategic priorities. • Development of the Medium Term Financial Strategy, aligned to the Strategic Plan to promote sustainability and realistic ambition. • Partnership governance structures in place to support joint decision-making and risk-sharing. • Development of transformation programmes and efficiency plans to maximise the impact of available resources. • Use of performance monitoring and impact assessment tools to ensure resource deployment is aligned with the 9 National Health and Wellbeing Outcomes. Adequacy of Controls Weak: The controls in place have not made much difference and the level of risk cannot be reduced. Risk Assessment Risk Owner Chris King (Chief Finance Officer) Risk Handler Gill Main (Integration Manager) Consequence (Current) Major (4) Likelihood (Current) Major (4) Rating (Current) 16 Risk Level (Current) Very High Risk Level (Target) Medium Page 21 of 290
Page 22
Midlothian IJB Risk Register Risk Description ID MLIJB4 Title New and/or amended national legislation may impact on the ability of the IJB to deliver its Strategic Plan. Risk Overview Description Risk Effect: There is a risk of further legislation, policy, or national improvement drivers which impact on the IJBs ability to deliver on the Strategic Plan, examples include the legislation relating to a National Care Service, the Health and Care (Staffing) (Scotland) Act 2019, and structural changes within NHS governance arrangements, including the merger or consolidation of sub national planning groups. Risk Consequence: The IJB and its partners may be distracted from the business of delivering the Strategic Plan. Legislation, policy, and national improvement drivers without fiscal support will result in additional pressure on the IJB. The merger or consolidation of sub-national planning groups, may alter decision making routes, create duplication, or dilute IJB influence within system planning structures Controls In Place The controls in place are as follows: • Respond to Scottish Government information requests on impact of future legislation, policies, and national improvement drivers. • Horizon scanning for policy developments through partners and SMT network groups. • Close working relations with Scottish Government through Chief Finance Officer, Chief Officer and COSLA. • Good working relationships with the Scottish Government Integration Governance and Evidence Unit. Adequacy of Controls Unknown: The current controls are not known, and further work is required to identify the current situation. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Chris King (Chief Finance Officer) Consequence (Current) Major (4) Likelihood (Current) Rare (1) Rating (Current) 4 Risk Level (Current) Medium Risk Level (Target) Medium Page 22 of 290
Page 23
Midlothian IJB Risk Register Risk Description ID MLIJB5 Title Impact of the Partners or the Scottish Government's decisions on the IJB and its Strategic Plan. Risk Overview Description Risk Effect: Partners may have to take decisions on functions delegated to the IJB, driven by operational or financial constraints. Similarly, the Scottish Government may issue directives to NHS Boards or Local Authorities on delegated functions which could impact the IJB. This includes national policy direction such as the Service Renewal Framework, which sets expectations on Boards in relation to service redesign and financial recovery. There is a significant financial risk that such decisions could alter the level of resource available to the IJB or require changes in service delivery that have material financial implications. This may limit the IJB’s ability to plan effectively, deliver its strategic priorities, or achieve financial sustainability. Risk Consequence: The IJB may not see sufficient or adequate progress towards its strategic aims and decisions made may reduce the IJB’s ability to deliver its strategic plan. Controls In Place The controls in place are as follows: • On-going dialogue with the Partners and through a range of national groups (CFO network, CO network) with the Scottish Government. Early engagement with Scottish Government policy leads to understand and influence national directives impacting delegated functions. • Any such decisions and the impacts thereof should be reported to the IJB along with the impact on its ability to deliver the Strategic Plan. • Clear governance arrangements and agreed scheme of integration between the IJB and its partners to reinforce roles, responsibilities, and escalation processes. • Ongoing communication and joint planning between the IJB, NHS Board, and Local Authority to support alignment of operational decisions with strategic aims. Adequacy of Controls Some weaknesses: Improvement can be demonstrated however not at optimal level. Page 23 of 290
Page 24
Midlothian IJB Risk Register Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Chris King (Chief Finance Officer) Consequence (Current) Major (4) Likelihood (Current) Possible (3) Rating (Current) 12 Risk Level (Current) High Risk Level (Target) Medium Page 24 of 290
Page 25
Midlothian IJB Risk Register Risk Description ID MLIJB6 Title Sustainability of external providers. Risk Overview Description Risk Effect There is a strategic risk and financial risk to the IJB that providers will be unable to meet their contractual obligations due to financial pressures such as the employer national insurance changes. Risk Consequence The IJB may not be able to progress its strategic aims, may experience reputational damage, or may experience financial challenge through supporting the HSCP to deliver the returned hours of statutory care to the impacted individuals. Controls In Place The controls in place are as follows: • Regular financial monitoring and sustainability reviews of commissioned providers to identify early signs of financial distress. • Engagement with providers through regular forums to understand cost pressures, including employer National Insurance increases. • Collaborative commissioning approaches with partners to reduce duplication and enhance efficiency. • Contingency planning to ensure continuity of care in the event of provider failure. • Ongoing dialogue with COSLA and Scottish Government regarding funding pressures on social care provision. Adequacy of Controls Unknown: The current controls are not known, and further work is required to identify the current situation. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Chris King (Chief Finance Officer) Consequence (Current) Major (4) Likelihood (Current) Possible (3) Rating (Current) 12 Risk Level (Current) High Risk Level (Target) Medium Page 25 of 290
Page 26
Midlothian IJB Risk Register Risk Description ID MLIJB7 Title Financial Reporting and Oversight. Risk Overview Description Risk Effect There is a risk that financial reporting for the IJB has an inbuilt inherent time lag. Risk Consequence The IJB will not be able to make timely or well considered financial decisions due to the time lag of financial information. Controls In Place The controls in place are as follows: • Use of in year financial forecasting based on available trends and prior period data to support more timely decision-making. • Regular dialogue between finance officers, budget holders, and the IJB to share emerging issues or pressures in advance of formal reporting cycles. • Development of financial monitoring dashboards to track key cost drivers and variances in near real time. • Use of scenario planning and sensitivity analysis to anticipate potential financial outcomes. Adequacy of Controls Some weaknesses: Improvement can be demonstrated however not at optimal level. Risk Assessment Risk Owner Morag Barrow (Chief Officer) Risk Handler Chris King (Chief Finance Officer) Consequence (Current) Moderate (3) Likelihood (Current) Possible (3) Rating (Current) 9 Risk Level (Current) Medium Risk Level (Target) Medium Page 26 of 290
Page 27
Midlothian IJB Audit and Risk Committee Thursday, 5th March 2026, 14:00-16:00 Midlothian Integration Joint Board and Associated Committees Handbook Update 2026 Executive summary This report outlines the improvements and updates made to the existing Midlothian Integration Joint Board (IJB) Members’ Handbook and the rationale for producing and issuing the updated version to all new members as part of their induction. The Handbook has been reviewed and refreshed to ensure it remains accurate, relevant, and aligned with current statutory guidance, with updates introduced to strengthen clarity, governance expectations, and member support. The Public Bodies (Joint Working) (Scotland) Act 2014 and associated statutory guidance on Roles and Responsibilities (Appendix 2) set out clear requirements for IJB membership. Section 2.4 specifies that appointed members must be provided with the resources and support necessary to fulfil their responsibilities, and that stakeholder members must receive appropriate training to enable them to contribute effectively. The Midlothian IJB Members’ Handbook forms a key element of this support and will be used as part of the induction process for all new members. As a result of this report, Members are asked to: • Note the content of Midlothian IJB Handbook, • Approve the Handbook’s use as the standard induction resource for all new members, and • Support resolution in relation to the appropriate process for members reasonable expenses. Item number: 5.2 Page 27 of 290
Page 28
Midlothian Integration Joint Board Report Midlothian Integration Joint Board and Associated Committees Handbook Update 2026 1 Purpose 1.1 This report outlines the improvements and updates made to the existing Midlothian Integration Joint Board (IJB) Members’ Handbook and the rationale for producing and issuing the updated version to all new members as part of their induction. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the content of Midlothian IJB Members Handbook, • Approve the Handbook’s use as the standard induction resource for all new members, and • Support resolution in relation to the appropriate process for members reasonable expenses. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Scotland) Act 2014 and associated statutory guidance on Roles and Responsibilities (Appendix 2) set out clear requirements for IJB membership. Section 2.4 specifies that appointed members must be provided with the resources and support necessary to fulfil their responsibilities, and that stakeholder members must receive appropriate training to enable them to contribute effectively. The Midlothian IJB Members’ Handbook forms a key element of this support and will be used as part of the induction process for all new members. 3.2 In addition, the Scottish Government’s On Board: A Guide for Board Members of Public Bodies in Scotland (Appendix 3) provides a standard induction resource. This will complement the tailored Midlothian IJB Handbook, ensuring new members receive both national guidance and local, partnership-specific information. 3.3 The Public Bodies (Joint Working) (Scotland) Act 2014 set out the requirement for Integration Authorities to include carer and lived experience representatives on their Integration Joint Boards (IJBs). ALLIANCE More Than Equal: Valuing and Supporting the Expert Contribution of People With Lived Experience (Appendix 4) includes recommendations that the IJB must ensure that the Board provides all Carer and Lived Page 28 of 290
Page 29
Midlothian Integration Joint Board Experience Representatives with a clear role description which outlines the scope and scale of the role, the support available to them, and training and resource opportunities. 3.4 The Handbook has been reviewed and refreshed to ensure it remains accurate, relevant, and aligned with current statutory guidance, with updates introduced to strengthen clarity, governance expectations, and member support. this has also included a comprehensive review against the current Midlothian IJB Strategic Plan 2025-2035 to ensure alignment with the IJB’s priorities and governance framework. 3.5 The Handbook also recognises the duty to ensure board members can be reasonably compensated for expenses. However, it has not been possible to establish with Partners which volunteer expense policy should be utilised, how this applies to IJB members, or whether the IJB should develop a policy of its own. Members of the Audit and Risk Committee are therefore asked to consider and direct the action required to resolve this issue. 3.6 The revised Handbook has been assessed for accessibility to ensure it meets equalities requirements and is fully usable by all members. These updates strengthen the Handbook as a key resource for supporting effective induction, promoting consistency, and ensuring members have clear, accessible guidance on their roles and responsibilities. 4 Policy Implications 4.1 Producing and maintaining the Handbook ensures compliance with the Public Bodies (Joint Working) (Scotland) Act 2014, which requires that IJB members are provided with appropriate information, support, and training to fulfil their statutory responsibilities. 5 Directions 5.1 This report does not directly impact upon service delivery ability to deliver an existing Direction. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. There is no requirement to undertake an ECRIA as a result of this report. 6.2 This report does not identify any negative impacts for people with protected characteristics. However, the updated Members’ Handbook strengthens our commitment to equality by ensuring that all new Integration Joint Board (IJB) members receive clear, accessible information that supports their ability to participate fully and Page 29 of 290
Page 30
Midlothian Integration Joint Board fairly in the work of the Board. The accessibility review undertaken as part of the update process further ensures that the Handbook meets equalities requirements and is usable by all members. 7 Resource Implications 7.1 There are no resource implications as a result of this report. 8 Risk 8.1 There is a risk that failing to produce a Members’ Handbook creates several governance and operational risks. Without a clear, consistent induction resource, new members may lack essential understanding of their statutory responsibilities, decision-making duties, and the governance framework within which the Integration Joint Board operates. This can lead to inconsistent practice, reduced effectiveness in scrutiny and decision-making, and a longer learning curve for new members. It also increases the risk of non-compliance with the Public Bodies (Joint Working) (Scotland) Act 2014, which requires that members are provided with appropriate support and training. Overall, the absence of a Handbook could undermine good governance, weaken accountability, and reduce the Board’s ability to operate transparently and effectively. 9 Involving people 9.1 This report relates to governance and does not directly involve people. 10 Background Papers 10.1 None. 11 Governance This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. X This report includes information that should be escalated to Midlothian IJB for noting only. X This report is the Audit and Risk Committee’s Business as Usual (BAU) and does not require Midlothian IJB’s review. √ Page 30 of 290
Page 31
Midlothian Integration Joint Board Author’s Name Gill Main Designation Integration Manager Contact Information Gill.Main3@nhs.scot Date 19/02/2026 Appendices: Appendix 1: Midlothian IJB Handbook 2026 Appendix 2: Public Bodies (Joint Working) (Scotland) Act 2014, Roles and Responsibilities Appendix 3: On Board – A Guide for Board Members of Public Bodies in Scotland Appendix 4: More than equal: Valuing and Supporting the Expert Contribution of People With Lived Experience Page 31 of 290
Page 32
Page 32 of 290
Page 33
1 Midlothian Integration Joint Board Handbook 2026 Page 33 of 290
Page 34
2 Contents Introduction ..................................................................................................................................................................................................... 3 Who we are .................................................................................................................................................................................................... 4 Our members .............................................................................................................................................................................................. 6 Our meetings .............................................................................................................................................................................................. 6 What we do .................................................................................................................................................................................................... 7 Strategic planning ....................................................................................................................................................................................... 7 Directions .................................................................................................................................................................................................... 8 Audit and risk .............................................................................................................................................................................................. 8 Budget setting and finance .......................................................................................................................................................................... 9 Measuring performance ........................................................................................................................................................................... 10 Equality ..................................................................................................................................................................................................... 10 Complaints ................................................................................................................................................................................................ 10 Information ................................................................................................................................................................................................ 10 Your induction .............................................................................................................................................................................................. 11 Your key contact ....................................................................................................................................................................................... 11 Your first 3 months ................................................................................................................................................................................... 11 Your development and support ..................................................................................................................................................................... 12 Accessibility .............................................................................................................................................................................................. 12 Expenses .................................................................................................................................................................................................. 12 Training, Mentoring ................................................................................................................................................................................... 12 Your role and responsibilities .................................................................................................................................................................... 13 Page 34 of 290
Page 35
3 Introduction Thank you for joining the Midlothian Integration Joint Board (IJB). As an IJB member, you will play a key role in supporting us to improve health and social care in Midlothian. Being a meaningful part of our communities and contributing to people achieving what matters to them is at the centre of all we do. Each one of our Board members plays a crucial role in shaping our work with their local knowledge and expertise that helps us plan and direct health and social care services and manage the allocation of our budget. This handbook will provide you with everything you need to know about the Board and how we work together to plan and direct integrated health and social care. In addition to the resources in this handbook, you may wish to read ‘What is Integration? A short guide to the integration of health and social care services in Scotland’ from Audit Scotland that has useful information on integration. We hope you enjoy your time with us, and look forward to working together as we learn, plan, and transform local health and social care to serve the people who live in our communities. Val de Souza Morag Barrow Councillor Connor McManus Chair, Midlothian IJB Chief Officer, Midlothian IJB Vice Chair, Midlothian IJB Page 35 of 290
Page 36
4 Who we are We are a planning and decision-making body created by Midlothian Council and NHS Lothian. We plan and direct some health and social care services. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities in our Strategic Plan 2025-2035 guide how we allocate this money. The Midlothian Health and Social Care Partnership oversees more than 60 services on our behalf. This includes two hosted services, Dietetics and Adults with Complex and Exceptional Needs, who deliver care to people across the whole Lothian region. Our responsibilities and legal duties are outlined in the Public Bodies (Joint Working) (Scotland) Act, 2014. We meet regularly and include members from NHS Lothian and Midlothian Council, the Third Sector, staff, and people who represent the interests of people and communities, people who experience our services, their families, and carers. Scottish Government asks us to take the action required by law and in national policies when deciding what our local priorities should be. Page 36 of 290
Page 37
5 Our Vision People in Midlothian lead longer and healthier lives. Our Mission We will provide the right support at the right time in the right place. Our Values Respect. Compassion. Quality. Our Strategic Aims 1. People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. 2. People are able to access the care and support they need when they need it in the community and at home. 3. People's human, social, and economic rights are protected and promoted in how we design and deliver our services. Our Approach Only by people and communities being seen, heard, and leading the change can we unlock the kind of action that will change the future of health and wellbeing in Midlothian 1. Work with our Partners (NHS Lothian & Midlothian Council), people, communities, the Third and Independent Sector, and the services who provide care and support to agree how we can best contribute to people in Midlothian living well in their community. 2. Plan and deliver services that support better health and wellbeing in our communities, using the National Health and Wellbeing Outcomes Framework. 3. Ensure each of our strategic aims support at least one of the 9 national health and wellbeing outcomes and our Directions for 2025/26 are structured this way too. 4. We also ensure services are planned and delivered in a way that follows the Principles in section 4 of the Public Bodies (Joint Working) (Scotland) Act 2014. These principles help us make sure that we take into account the particular characteristics and circumstances of people who need our services. Page 37 of 290
Page 38
6 Our members We meet regularly and are a collaborative board where every voice is heard. Everyone is treated as an equal partner, with their views taken seriously. We have voting and non-voting members, but we prefer to make decisions through consensus of the full membership rather than the use of voting. 8 voting members – 4 are non-executive board members of NHS Lothian. 4 are elected members of Midlothian Council. Non-voting members - Chief Officer, Chief Finance Officer, Professional Advisor for Social Work, Professional Advisor for Nursing, Professional Advisor for Allied Health Professionals, Representative members – there are a range of representative members on the Board including trade unions, Third Sector independent organisations, people who represent the interests of people and communities, people who experience our services, unpaid carers, and volunteers. Non-voting members must be renominated every 3 years. Information about Board members, dates of meetings and papers can be found on the Midlothian Integration Joint Board section of the Midlothian Council website. Our meetings 6 Board meetings We hold 6 Board meetings annually. These meetings are open to the public and the press. Board papers covering topics such as planning, finance, performance, and other key issues are shared one week before the meeting. 2 Special Board meetings Special Board meetings take place in March and September. These meetings focus only on the Budget and Directions (March) and the Annual Accounts and Directions (September). 5 Development Session workshops These workshops give Board members dedicated time to build skills and explore key topics. They support the IJB’s Self Development Plan and are attended solely by Board members, with support from Health and Social Care Partnership officers. 11 Reference Group sessions These sessions support our Representative Members—people with lived experience, unpaid carers, third sector representatives, and volunteers by reviewing together upcoming agenda items, discussing how this impacts people and communities, asking questions, and building confidence ahead of the next IJB meeting to ensure our Representative Members feel well informed and ready to contribute to decision making. Page 38 of 290
Page 39
7 What we do Our Midlothian Health and Social Care website is where you can find our publications and information about the work we do. Strategic planning The Public Bodies (Joint Working) (Scotland) Act 2014: Strategic Plan: Statutory Guidance requires us to develop a strategic plan for the integrated services we are responsible for, it also tells us what the plan must contain and how it must be developed, along with additional guidance about how we should prioritise and allocate resources. Our Strategic Plan describes how we will work with our partners NHS Lothian and Midlothian Council, people, communities, the Third and Independent Sector, and the services who provide care and support to agree how we can best contribute to people in Midlothian living well in their community. Our current plan is set out over 10 years from 2025-2035, and we will review and update this plan every 3 years to ensure we are meeting the aims of the 9 national health and wellbeing outcomes. We must consult our Strategic Planning Group on the first draft of our strategic plan. The Strategic Planning Group has a wide range of members supports us in developing and delivering the Strategic Plan. A range of people, including those who experience our services must be involved in the preparation and review of the plan. We work alongside people who live and work in Midlothian and our Participation and Engagement Statement 2025-2028 outlines how we do this. Every IJB in Scotland is required to have a Joint Strategic Needs Assessment (JSNA). Midlothian’s Joint Strategic Needs Assessment helps to inform our strategic plan using information coordinated from local, regional and national sources to help us understand the health and social care issues for people living in Midlothian. Page 39 of 290
Page 40
8 Directions The priorities set out in our strategic plan describe the action we will take to make our ambitions a reality. Every year, as close to the start of the new financial year as practically as possible, we issue written instructions to NHS Lothian and Midlothian Council. These instructions are called Directions and are the mechanism to deliver the ambitions of our strategic plan. Directions are legally binding and instruct NHS Lothian and Midlothian Council to do the things we think are the highest priority, describe what they need to deliver, and the budget that they have been allocated to do this with. Our Directions policy outlines the process for drafting, approving, issuing and monitoring directions from us to NHS Lothian and Midlothian Council. Our Directions are written in a way that aligns them with both the strategic aims in this plan and the 9 National Health and Wellbeing Outcomes. This allows us to be clear with what we are doing, why, and what we hope to see as a result. We review progress made towards our Directions regularly and report on this twice a year. We can issue a new Direction at any time or revise a Direction if we think we need to take corrective action e.g., if we make a decision that changes service delivery, or if we receive new funding across the year. Midlothian Health and Social Care Partnership use Directions to ensure operational planning has a clear connection between our strategy and delivery Audit and risk The Audit and Risk Committee has overall responsibility for reviewing our corporate governance arrangements and providing assurance to us. This includes reviewing risks, internal controls, audits, and financial statements to ensure services remain safe and effective. The Audit and Risk Committee meet quarterly and provides updates including any risks or concerns to our Board meetings. The Audit and Risk Committee’s work is guided by the Scottish government produced guidance on good assurance processes and the role of audit committees. Page 40 of 290
Page 41
9 Budget setting and finance We must only spend the resources that have been made available to us by our Partners, Midlothian Council and NHS Lothian. Our strategic plan helps us prioritise how we will allocate and best utilise those resources. These resources are allocated to us each year and we are then responsible for the integrated budget. The offer we receive from both our Partners changes each year and may not be enough to deliver everything we want. This makes it difficult to plan ahead in a meaningful way. Our annual budget is approximately £177.528m. This funding is split up into four parts; 1) Social Work and Social Care (from Midlothian Council) – this is for adult social care services in Midlothian. These services are managed operationally by the Midlothian Health and Social Care Partnership. 2) Health Core Services (from NHS Lothian) – these are local services which are delegated to the Health and Social Care Partnership. These include primary care services like GPs and pharmacists, and other community services like district nursing, community mental health teams, community learning disability teams, and the local community hospital. 3) Health Hosted Service (from NHS Lothian) – some services are managed on a pan-Lothian basis. We manage a share of the total budget for these services based on its population. Midlothian hosts Dietetics and Adults with 4) Complex and Exceptional Needs and provide services for people across Lothian on behalf of all four Health and Social Care Partnerships – Midlothian, East Lothian, West Lothian, and City of Edinburgh. 5) Health ‘Set Aside’ budgets (from NHS Lothian) – unscheduled care services (Accident and Emergency and unplanned admissions) are managed by NHS Lothian’s Acute Hospital system. Our budget includes a share of these services, based broadly on our population size. The budget is ‘set aside’ by NHS Lothian on our behalf. These services are delivered at the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital. Our ‘reserve’ budget All Integration authorities should have reserves as this is part of good financial management. Our medium-term financial strategy Our medium-term financial planning supports the delivery of our strategic plan for 2025-2035. Our 5-year financial plan was published in December 2025, and we will review this regularly and adapt and change to meet the challenges. Financial Risk We are currently facing a number of serious financial risks. The main risk is that our Partners may not be able to provide the necessary levels of funding to support our aims. Page 41 of 290
Page 42
10 Measuring performance There are a number of ways we work with our Partners, people, and communities to monitor and evaluate the progress we are making towards the ambitions set out in our strategic plan. 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 and the strategic aims of our strategic plan. We do this through evaluation and reporting methods that can be found on the Midlothian Health and Social Care Website. • Our Performance Framework that uses quantitative (number) and qualitative (narrative) information, • Our Annual Performance Report, • Bi-annual reports on progress against our Directions, • Our Equality Outcomes, and Mainstreaming Equality report and action plan, and • Quarterly reports from Midlothian Health and Social Care Partnership’s services. Equality We must make sure that everyone has equal opportunities to access our services and comply with the Public Sector Equality Duty. Read our Midlothian IJB Equality Outcome Report 2025- 2029 on how we aim to do this. Complaints We must comply with our legal duty to follow the Model Complaints Handling Policy and publish a report every year on the complaints we have received. 2025/26 was the first year since Midlothian IJB was formed that we received any complaints. Information We must comply with our legal duty to follow the Model Publication Scheme, Page 42 of 290
Page 43
11 Your induction Your key contact The Midlothian Health and Social Care Partnership Integration Manager is your main contact for Board member support. This post is currently held by Gill Main who can be reached at gill.main3@nhs.scot Your first 3 months You will be invited to an induction session just before or just after you are nominated to the Board. This session will be on MS Team and take you through our main responsibilities as a Board and how we work together. This session will include • Chair and Vice Chair of Midlothian IJB – a welcome and introduction to the Board. • Chief Officer - an overview of the roles and responsibilities of the IJB and HSCP. The Chief Officer is also the Director of Health and Social Care for Midlothian Council and the Joint Director of Midlothian HSCP. • Chief Finance Officer - an overview of the risks and finance responsibilities of the IJB and our Audits. • Standards Officer – an overview of the ethical standards and expectations on Members - in relation to the Register of Interests and the Code of Conduct. • Integration Manager – an overview of the Strategic Plan, how this plan is reviewed and monitored, how we plan and review Directions, and how we focus on outcomes. (You can read about these roles in the Scheme of Delegation). We will also arrange for you to visit some of our services, meet the staff that work there, and see how we deliver treatment, care and support. There is an annual programme of scheduled visits that will also include time to meet • Midlothian HSCP Executive Leadership Team • Third Sector Partners such as Midlothian Community Action & VOCAL. Page 43 of 290
Page 44
12 Your development and support Accessibility We want to ensure that everyone is supported and able to contribute fully. If you require additional support or reasonable adjustments, please let us know. Adjustments can take many forms, and we are happy to work with you to find what best meets your needs. Examples of adjustments we can provide are: • Printed documentation – if digital formats are not accessible or convenient. • Assistance with calendar invites – help setting up, managing, or tracking meetings. • Virtual attendance options – joining meetings or events remotely when needed. • Accessible formats – large print, screen-reader friendly documents, or alternative communication methods. • Quiet spaces or breaks – ensuring environments are comfortable and inclusive. • Time with an Officer of the HSCP to answer your questions. Expenses You can reclaim any costs involved in volunteering and includes all reasonable costs including things like travel. Expenses must be approved in advance. Please speak with your key contact for more information. Training, Mentoring The Scottish Government publications Guidance on Roles, Responsibilities and Membership of the Integration Joint Board and On Board – A Guide for Board Members of Public Bodies in Scotland provide helpful information on the responsibilities of an IJB Member. These can support you to identify any training and mentoring you may need. Our Development Sessions are often a good way to learn more about the work across integrated heath and social care. We also collaboratively agree a Midlothian IJB Self Development Plan each year. This is overseen by the Chief Internal Auditor. Please speak to your key contact about events, training and mentoring opportunities or any other support you may need to help you fulfil your role as an IJB Member. Page 44 of 290
Page 45
13 Your role and responsibilities • To participate fully in the Board’s business, providing constructive challenge and working in cooperation with others to best carry out the work of the Board. • To regularly attend meetings and provide advance notice if you will not attend. • To prepare for meetings, reading all relevant papers and supporting materials. • To focus on and give priority to your responsibilities to the Board and the residents of Midlothian. • To contribute to the development and implementation of the Board’s strategies in accordance with the Board’s vision and priorities, the national health and wellbeing outcomes, the integration delivery principles, and the Integration Scheme. • To ensure views of people, local communities, staff, and the public are heard when planning services (in line with our Engagement Statement and Planning With People). • To support the Board in providing clear, accurate financial information and helping to guide medium-term financial planning to ensure stability and informed decision making. • To ensure that resources are used sensibly and in accordance with the law and our best value duty and ensure active scrutiny of financial and service performance. • To ensure that the system of internal control is adequate and effective and that the Board’s Local Code of Corporate Governance is observed and complied with. • To maintain the highest standards of ethical conduct and comply with the Board’s Code of Conduct and Standing Orders. • To contribute to the governance of the Board in a way which encourages equal opportunities, recognises the cultural diversity within the area, and which actively promotes equal opportunity requirements. This Scottish Government guidance outlines the roles and responsibilities of IJB Members. Right First Time (2021) is a practical guide to decision-making and the law and helps assist decision makers in coming to decisions. There is advice for IJB Members from the Standards Commission for Scotland, to assist members in recognising and dealing with potential conflicts of interest. You will need to complete a non-disqualification questionnaire and register any financial or non-financial interests under the Ethical Standards in Public Life etc. (Scotland) Act 2000. Page 45 of 290
Page 46
Page 46 of 290
Page 47
Roles, Responsibilities and Membership of the Integration Joint Board Guidance and advice to supplement the Public Bodies (Joint Working) (Integration Joint Board) (Scotland) Order 2014 Public Bodies (Joint Working) (Scotland) Act 2014 Page 47 of 290
Page 48
2 Contents The Aim of this Guidance Page 3 Section 1: Role and Responsibilities of the Integration Joint Board 1.1 Role and remit of the Integration Joint Board Page 4 1.2 Duties placed on Integration Joint Boards by the Public Bodies (Joint Working) (Scotland) Act 2014 Page 5 1.3 Other key requirements of the Integration Joint Board Page 6 1.4 Liability arrangements for Integration Joint Boards and their members Page 10 1.5 The relationship between the Integration Joint Board and the strategic planning group Page 11 1.6 Appointing a Committee of an Integration Joint Board Page 12 1.7 Complaints under Integration Page 13 Section 2: Membership of the Integration Joint Board 2.1 Minimum Membership Page 15 2.2 Good Practice in the identification and appointment of members Page 17 2.3 Professional membership Page 17 2.4 Appointment of stakeholder members Page 18 2.5 Induction of members Page 19 Page 48 of 290
Page 49
3 The Aim of this Guidance This guidance is intended for use by all members of an Integration Joint Board particularly the Chair - and provides further advice to supplement the existing legislation. The document focuses on the roles, responsibilities and membership of the Integration Joint Board. Section 53 of the Public Bodies (Joint Working) (Scotland) Act 2014 (“the Act”) sets out an Integration Joint Board is required to have regard to this guidance when exercising its functions under the Act. This guidance relates to Integration Joint Boards that must be established when a Health Board and Local Authority choose a Body Corporate Model of integration (under section 1(4)(a) of the Act). Page 49 of 290
Page 50
4 Section 1: Role and Responsibilities of the Integration Joint Board 1.1 Role and remit of the Integration Joint Board The Act puts in place arrangements for integrating health and social care, in order to improve outcomes for patients, service users, carers and their families. The Act requires Health Boards and Local Authorities to work together effectively to agree a model of integration to deliver quality, sustainable care services. Where a Health Board and a Local Authority agree to put in place a Body Corporate model, an Integration Joint Board will be established. This will see Health Boards and Local Authorities delegate a significant number of functions and resource to the Integration Joint Board, who will be responsible for the planning of integrated arrangements and onward service delivery. The Health Board and Local Authority will set out within their integration scheme which of their functions they intend to delegate to the Integration Joint Board. The scope of the delegated functions will vary depending on local decision making but must adhere to the statutory minimum. The functions that must be delegated by the Health Board to the Integration Joint Board as per the Act are set out in The Public Bodies (Joint Working) (Prescribed Health Board Functions) (Scotland) Regulations 2014. The functions that must be delegated by the Local Authority to the Integration Joint Board as per the Act are set out in The Public Bodies (Joint Working) (Prescribed Local Authority Functions etc.) (Scotland) Regulations 2014. The Integration Joint Board is responsible for the strategic planning of the functions delegated to it and for ensuring the delivery of those functions through the directions issued by it under section 25 of the Act. The Integration Joint Board will also have an operational role as described in the locally agreed operational arrangements set out within their integration scheme. To fulfil its remit the Integration Joint Board will: Adhere to the content of any future regulations or guidance issued by Scottish Ministers Ensure stakeholder engagement Take into consideration national developments in policy and practice Page 50 of 290
Page 51
5 1.2 Duties placed on Integration Joint Boards by the Public Bodies (Joint Working) (Scotland) Act 2014 The Public Bodies (Joint Working) (Scotland) Act 2014, “the Act”, places a duty on Integration Joint Boards to develop a strategic plan for integrated functions and budgets. For more information, please see the guidance on Strategic Commissioning Plans. Each Integration Joint Board must establish a strategic planning group to support the strategic planning process. For more information, see section 1.5 of this guidance. An Integration Joint Board must review its strategic plan at least every three years. Sections 4 and 31 of the Act set out the integration principles which underpin delivery of integrated health and social care services. These principles describe “how” integrated care should be planned and delivered. Integration Joint Boards are under a duty to have regard to these principles when preparing a strategic plan. For more information, please see the guidance on the Integration Planning and Delivery Principles. Section 37 of the Act places Integration Joint Boards under a duty to have regard to the National Health and Wellbeing Outcomes (the Outcomes) when preparing a strategic plan. These Outcomes are high-level statements of what Integration Joint Boards are attempting to achieve through integration and ultimately through the pursuit of quality improvement across health and social care. Integration Joint Boards are required to issue directions to Health Boards and Local Authorities as to how integration functions are to be carried out. Details relating to this are set out in sections 26 and 27 of the Act. Integration Joint Boards are required to prepare an annual performance report. This must comply with the requirements of the Regulations on the Content of Performance Reports. An annual financial statement must be published setting out the total resources included in the plan for that year. For more guidance, please see the Professional Guidance, Advice and Recommendations for Integration Arrangements. A full list of guidance and advice published to support the Public Bodies (Joint Working) (Scotland) Act 2014, is available at http://www.gov.scot/HSCI. Page 51 of 290
Page 52
6 1.3 Other key requirements of the Integration Joint Board Integration Joint Boards are public bodies, and as such are subject to a range of other requirements. An Integration Joint Board must ensure that arrangements are established to comply with their duties as set out in legislation. Although the responsibility of compliance sits with an Integration Joint Board; Integration Joint Boards may choose to draw on the experience of and/or request support from their constituent Health Board and/or Local Authority to aid it in complying with the legislative requirements set out below. In such circumstances the Health Board and/or Local Authority would be expected to provide the support requested. The Public Records (Scotland) Act 2011 Integration Joint Boards are designated as “Bodies Corporate” for the purposes of the Public Records (Scotland) Act 2011. They will be obliged, therefore, to comply fully as public authorities under the legislation. The Public Records (Scotland) Act 2011 requires named public authorities to prepare and implement a records management plan which sets out proper arrangements for the management of their records. Records management plans must be agreed with the Keeper of the Records of Scotland (the Keeper) and regularly reviewed by authorities. The plan must account for all the public records for which the authority has responsibility. The plan must detail the functions of each authority and the types of records created in pursuance of these functions. It will show the policies and procedures in place for the appropriate storage, retention, disposal, archiving and security of these records. To assist public authorities to comply with their obligations, the Keeper has produced a model plan in the form of an annotated list of the elements that might be expected to be covered in a robust records management plan. In addition the Keeper has produced guidance that accompanies the model plan. A Senior Officer of the Integration Joint Board will therefore be responsible for overseeing the development and implementation of the records management plan and for approving it prior to submission for the Keeper’s agreement. Further details on the National Records of Scotland and the Public Records (Scotland) Act 2011 Assessment Team and support they provide can be found on their website. Records Management It will be necessary for an Integration Joint Board to consider how Freedom of Information (Scotland) Act 2002 / Environmental Information (Scotland) Regulations 2004 obligations impact on its records management practices, including how information is stored. The Code of Practice on Records Management sets out recommended ‘best practice’. Page 52 of 290
Page 53
7 The records management plan will need to be clearly set out if information is held by the Integration Joint Board or the information held is owned by the Integration Joint Board or held ‘on behalf of’ the relevant Local Authority or Health Board. If a request is sent to an Integration Joint Board for information it holds ‘on behalf of’ the Local Authority or Health Board, the applicant should be informed by the Integration Joint Board that it does not hold the information and they should then be directed to the relevant Local Authority or Health Board. Integration Joint Boards, Health Boards and Local Authorities may also wish to consider putting systems in place, for example, Memoranda of Understanding, to support effective handling of requests where the scope of which includes communications between the bodies, or information on topics of shared interest/joint working. Data Sharing Health Boards and Local Authorities will continue to be responsible for answering data access requests in relation to any data for which they are the Data Controller, however, for requests in relation to any data that Integration Joint Boards are responsible they will be responsible for answering any data access request. Data (Subject) Access Requests Data Access Requests (called Subject Access Requests under the Data Protection Act 1998) are requests by individuals for their personal data and work on the basis of whichever body is the Data Controller. It is possible for the same data to be held by more than one public authority as a result of agreed sharing. Integration Joint Boards must ensure that data sharing arrangements set out in the integration scheme are in place and that it is clear how subject access requests are managed by both parties when shared data is involved. Further information on Subject Access Requests can be found in the Subject Access Requests Code of Practice. The Freedom of Information (Scotland) Act 2002 and Environmental Information (Scotland) Regulations 2004 The Freedom of Information (Scotland) Act 2002 - and the related Environmental Information (Scotland) Regulations 2004 - provide any applicant with the right to request – and be provided with - any recorded information held by Scotland’s public authorities. If an authority does not wish to provide information it holds, an ‘exemption’ or (under the Environmental Information (Scotland) Regulations 2004) an ‘exception’ must be applied, for example, for legal advice or personal data. Page 53 of 290
Page 54
8 Integration Joint Boards are a “public authority” for the purpose of Freedom of Information (Scotland) Act 2002. This means they are subject to both Freedom of Information (Scotland) Act 2002 and the related Environmental Information (Scotland) Regulations 2004, as well as other requirements of Freedom of Information legislation, and will be required to respond to information requests accordingly. Integration Joint Boards should be aware of their responsibilities under this Code of Practice which sets out recommended guidance in the handling of information requests. As Health Boards and Local Authorities are already subject to information access legislation, Integration Joint Board members are likely to already have an awareness of the requirements that Freedom of Information (Scotland) Act 2002 and the related Environmental Information (Scotland) Regulations 2004 place on officials and organisations. While, in due course, Integration Joint Boards may wish to develop their own guidance and training, it is suggested that members may initially wish to familiarise themselves with existing guidance and training. For example, the Scottish Government guidance and training on information request handling. Publication Scheme Section 23 of Freedom of Information (Scotland) Act 2002 also requires that all Scottish public authorities subject to the Act maintain a publication scheme. A publication scheme sets out the types of information that a public authority routinely makes available. The Integration Joint Board will need to develop and put in place a publication scheme, along with a guide setting out what information it will make available. It is important that consideration is given to the publication scheme – and associated guides to information – as early as possible. A publication scheme must be approved by the Scottish Information Commissioner. Information on publication schemes is available on the Commissioner’s website. Office of the Scottish Information Commissioner (OSIC) The Scottish Information Commissioner promotes and enforces both the public's right to ask for information held by Scottish public authorities and good practice by authorities. The Commissioner’s staff have considerable experience in assisting authorities who are new to the Freedom of Information (Scotland) Act 2002 / Environmental Information (Scotland) Regulations 2004 responsibilities and will be pleased to help. They can be contacted on 01334 464610, or by email to enquiries@itspublicknowledge.info. Page 54 of 290
Page 55
9 Ethical Standards in Public Life - Code of Conduct Integration Joint Boards are “devolved public bodies” for the purposes of the Ethical Standards in Public Life (Scotland) Act. This means that each Integration Joint Board is required to produce a code of conduct for members. The code should be based on the model code of conduct for members of devolved public bodies. Each Integration Joint Board is required to review this model code and adopt it, with or without modifications, as its own code of conduct; applying to all members and business of the Integration Joint Board. All members are required to sign the code of conduct. Some members may have already signed similar codes of conduct i.e. Code of Conduct for Councillors; however they are still required to sign the Integration Joint Board’s code of conduct as their duties as Integration Joint Board members should be independent of the responsibilities that they may have by virtue of other posts. The Standards Commission The Standards Commission is an independent public body which encourages high ethical standards in public life through the promotion and enforcement of Codes of Conduct for those appointed to the Boards of devolved public bodies. The Commissioner for Ethical Standards in Public Life in Scotland The Commissioner is an independent office holder who works in two areas: Public appointments, regulating how people are appointed to the Boards of public bodies in Scotland; and Public standards, where the Commissioner can investigate a complaint about a Councillor or a member of a devolved public body who is alleged to have contravened the Councillors’ or the appropriate public body’s Code of Conduct. It is in this capacity that the Integration Joint Board would be under the remit of the Commissioner. Equalities Duties All public authorities in Scotland, including Integration Joint Boards, must comply with the public sector equality duty set out in the Equality Act 2010. The duty places an obligation on public authorities to take action to eradicate discrimination and to pro-actively promote equality of opportunity. The duty has a two tier structure - a general duty set out in the Equality Act 2010, and specific duties set out in Regulations made by Scottish Ministers. To better enable public authorities to locate equality data and evidence, the Scottish Government has developed an evidence finder. Page 55 of 290
Page 56
10 The Scottish Government has also produced an evidence toolkit to help authorities source supporting evidence to help with their Scottish specific reporting duties. Diversity The Scottish Government expects all public bodies to champion diversity and mainstream equal opportunities in their work. Scottish Ministers particularly welcome under-represented groups having membership on Scotland’s public bodies. The Scottish Government’s Programme for Government encourages public bodies to set a voluntary commitment for gender balance on their Boards of 50/50 by 2020, with the aim of ensuring that Boards of public bodies are broadly reflective of the wider Scottish population. The Scottish Government has already committed to achieving gender balance on its Board by 2020. Public bodies, including Integration Joint Boards, are expected to take positive action to support and enable greater diversity in the membership of and appointment to their Board. 1.4 Liability arrangements for Integration Joint Boards and their members Integration Joint Boards are eligible to join the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) which covers the following areas of liability: Clinical Negligence Employers Liability Public Liability Personal Injury, Loss, Damage to Property or other Wrongful Act Dishonest, Fraudulent, Criminal or Malicious Activities Defamation Directors and Officers Liability Consequential or Ancillary Expense Financial Loss Suffered by Member as a result Fraud/Dishonesty/Theft The National Health Service (Clinical Negligence and Other Risks Indemnity Scheme) (Scotland) Regulations 2000 (as amended) makes provision for Integration Joint Boards to apply to become a member of CNORIS. Membership is not compulsory, but represents a cost-effective alternative to arranging separate insurance. If an Integration Joint Board decides to become a member of CNORIS then they will be indemnified as above. If an Integration Joint Board decides not to become a member of CNORIS then it will be necessary to ensure alternative arrangements are put in place to cover the Integration Joint Board and its members against any claims arising in relation to liabilities listed above. Page 56 of 290
Page 57
11 1.5 The relationship between the Integration Joint Board and the strategic planning group The Public Bodies (Joint Working) (Scotland) Act 2014 places a requirement on Integration Joint Boards to create a strategic plan for the area for which it is established. As part of this process, the Integration Joint Board must establish a strategic planning group. The Integration Joint Board must also determine the processes and procedures for the strategic planning group, subject to the provisions set out in section 32 of the Act. In developing the processes and procedures for the strategic planning group, the Integration Joint Board must be mindful that the work of the strategic planning group does not end with the publication of the strategic plan. After the strategic plan is published, the strategic planning group will continue to review progress of the plan, measured against the statutory outcomes for health and wellbeing, and associated indicators. Strong lines of communication will need to be established between the strategic planning group and the Integration Joint Board. This is needed to ensure that the strategic planning group can effectively communicate its findings to the Integration Joint Board which will help to inform and facilitate revisions to the strategic plan at least every three years. A detailed explanation of the process for the development of the strategic plan can be found in the Strategic Commissioning Plan Guidance. Page 57 of 290
Page 58
12 1.6 Appointing a Committee of an Integration Joint Board Integration Joint Boards can appoint sub-committees should that be desirable. The Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 extends the options available to an Integration Joint Board in effectively planning for the provision of services by permitting an Integration Joint Board to form a committee to carry out any of its functions as it sees fit. Any decision of such a committee must be agreed by the majority of the voting members who are members of the committee. A committee of an Integration Joint Board can only exercise the functions conferred upon it by the Integration Joint Board. The purpose of the committee is to support the effective working of the Integration Joint Board on matters which have been devolved to it by the Integration Joint Board. This may be in an advisory capacity or, depending on the remit given by the Integration Joint Board, the committee may have decision making powers to carry out certain functions of the Integration Joint Board. In the interests of fairness and effective working, a committee of an Integration Joint Board must consist of equal numbers of representatives from each constituent authority, as set out in the Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014 (article 17(3)). An Integration Joint Board can appoint advisory members to sit on a committee from outside the membership of the Integration Joint Board, although, as before, any such decision must be agreed on by the voting members of the Integration Joint Board. Page 58 of 290
Page 59
13 1.7 Complaints under Integration Complaints about Integrated services Where a Health Board and Local Authority choose a body corporate model of integration, the Health Board and Local Authority will remain the responsible bodies for the delivery of health and social care services. As such any complaints about service delivery will be dealt with through the existing health procedures and social care/social work complaints procedures. To ensure complaints are joined up from the perspective of the complainants, Health Boards and Local Authorities are required to agree and set out within their integration schemes arrangements for the management of complaints relating to integrated service delivery and the process by which a service user, and those complaining on behalf of service users may make a complaint. The arrangements set out in the integration scheme cannot alter the underlying position, described above, that complaints are to be dealt with under existing health procedures and social care/social work complaints procedures. The Health Board and Local Authority must ensure that the arrangements that they have jointly agreed are: • Clearly explained • Well-publicised • Accessible • Allow for timely recourse • Complainants are signposted to independent advocacy services Complaints about Integration Joint Boards As Integration Joint Boards are newly formed public bodies complaints may be raised against them in relation to particular functions and duties that they have responsibility for, such as strategic planning. Integration Joint Boards are not currently covered under existing legislation and must put in place a robust complaints procedure in relation to the functions that have been delegated to them. The Scottish Government position is that in establishing a complaints procedure; Integration Joint Boards should implement a complaints handling procedure that follows the structure, principles and timescales set out in the Scottish Public Service Ombudsman’s (SPSO) Model Complaints Handling Procedure Guidance. The SPSO’s Model Complaints Handling Procedure Guidance recognises that each public service provider has their own way of working and has unique staffing and operational considerations, and therefore provides broad direction and support to in improving their complaints handling procedures; by setting out the high level components of an effective complaints handling procedure Page 59 of 290
Page 60
14 with a focus on simplifying and streamlining those procedures. It places an emphasis on ‘getting it right first time’ and is firmly focused on quicker, simpler and more streamlined complaints handling with local, early resolution by empowered and well trained staff. The SPSO model complaints procedure is a 3 stage complaint process: the first stage is front-line resolution – failure to resolve a complaint at this stage will result in the complaint being escalated; at the second stage, the complaint is investigated and an attempt made by a senior manager to resolve it. The third and final stage of the process is for the complaint to be referred to the SPSO for a final decision. The Scottish Government intends to amend schedule 2 of the Scottish Public Services Ombudsman Act to include Integration Joint Boards and will consult on the proposal to do so. This proposed change will have the effect of legally requiring Integration Joint Boards to put in place a complaints procedure and it will provide the Scottish Public Services Ombudsman with the powers to investigate the actions of the Integration Joint Boards in carrying out its duties, or any service failure attributable to an Integration Joint Board. It cannot, however, investigate the merits of a decision taken within the Integration Joint Board’s discretion, unless the established processes have not been followed in making that decision. Under Section 53 of the Public Bodies (Joint Working) (Scotland) Act 2014, Integration Joint Boards are required to have regard to the guidance issued by Scottish Ministers. Integration Joint Boards therefore must implement a complaints process that follows the structure, principles and timescales of the SPSO model complaints procedure outlined above. Compliance with the third and final stage of the SPSO model complaints procedure will take effect once legislative changes have come into force. Page 60 of 290
Page 61
15 Section 2: Membership of the Integration Joint Board 2.1 Minimum Membership The Public Bodies (Joint Working) (Membership and Procedures of Integration Joint Boards) (Scotland) Order 2014 (“the Order”) sets out requirements about the membership of an Integration Joint Board. This includes minimum required membership, and provision for additional members to be appointed. The Integration Joint Board is created as a new legal entity that binds the Health Board and the Local Authority together in a joint arrangement. The membership of an Integration Joint Board reflects equal participation by the Health Board and Local Authority to ensure that there is joint decision making and accountability. The Local Authority and the Health Board will set out the number of representatives that will sit on the Integration Joint Board within their integration scheme. The Order requires that the Local Authority and Health Board put forward a minimum of three nominees each. This number may be increased by local agreement, but the same number must be nominated by each party. Local Authorities can insist on nominating a maximum of 10% of their full number of Councillors. The Health Board and Local Authority may also agree that they will each nominate a larger number than this. The Local Authority will nominate Councillors to sit on the Integration Joint Board. The Health Board will nominate non-executive directors to sit on an Integration Joint Board. Where the Health Board is unable to fill all their places with non-executive directors, they can then nominate other members of the Health Board. The Integration Joint Board will make decisions about how health and social care services are planned and delivered for the communities within their areas. To do this effectively, they will require professional advice, for example, to ensure that the decisions reflect sound clinical practice. It is also essential that Integration Joint Boards include key stakeholders within the decision making processes to utilise their advice and experience. Page 61 of 290
Page 62
16 To ensure this, the Order sets out a minimum membership, but allows local flexibility to add additional nominations as Integration Joint Boards see fit. In addition to Health Board and Local Authority representatives, the Integration Joint Board membership must also include: • The Chief Social Work Officer of the constituent Local Authority • A General Practitioner representative, appointed by the Health Board • A Secondary Medical care Practitioner representative, employed by the Health Board • A Nurse representative, employed by the Health Board • A staff-side representative • A third sector representative • A carer representative • A service user representative • The Chief Officer of the Integration Joint Board • The Section 95 Officer of the Integration Joint Board The Chief Social Work Officer will be appointed by the Local Authority and the health professionals will be appointed by the Health Board because of the role they fulfil. The Chief Officer must be appointed by the Integration Joint Board and will provide a single point of accountability for integrated health and social care services. The Integration Joint Board must also appoint the Section 95 Officer who will be the responsible officer for the financial arrangements of the Integration Joint Board. The ways in which the members of the Integration Joint Board are to be identified and appointed to the Integration Joint Board will differ. The Integration Joint Board will co-opt the staff-side, third sector, carer and service user representative, and this should be done as soon as practicable once the Integration Joint Board is established. How the Integration Joint Board approaches the appointment of the staff-side, third sector, carer and service user representative members will be dependent on local circumstances, for example, through existing carers networks or the organisations operating within the area of the Integration Joint Board, therefore section 2.4 sets out principles that should be implemented in the identification of members. Whilst there is a required minimum membership for inclusion on the Integration Joint Board, there is also local flexibility for the Integration Joint Board to add additional members. The Independent Sector for example provide a significant proportion of social care services and will therefore play a key role in the successful delivery of integrated services in local areas. As part of their strategic planning responsibilities, Integration Joint Boards should consider their membership cohorts and seek appropriate additional representation as suggested by local priorities. Integration Joint Boards might also seek additional membership to reflect delegation of functions outside the minimum scope, for example additional professional advice. If an Integration Joint Board is established by more than one Local Authority, the Order makes specific provision for how the minimum membership is to be determined. Page 62 of 290
Page 63
17 2.2 Good Practice in the identification and appointment of members of Professional and Stakeholder members The Order sets out the minimum required membership. All Integration Joint Board members have equal responsibility as Board members and the reference made between professional members and stakeholder members in the following section only reflects the difference in the routes of appointment. The Order also makes provision for the Integration Joint Board to appoint additional professional and/or stakeholder members, as required. To ensure that members are able to successfully fulfil the roles they are appointed to, sections 2.3 and 2.4 set out principles that should be implemented in the identification of members. 2.3 Professional Membership The Order requires a minimum professional membership on the Integration Joint Board as follows: • Appointment of a GP • Appointment of a Nurse • Appointment of a Secondary Care representative • The Chief Officer of the Integration Joint Board • The Section 95 Officer of the Integration Joint Board • The Chief Social Work Officer of the constituent Local Authority With the exceptions of the Chief Officer, the Section 95 Officer and Chief Social Work Officer, the Order provides some flexibility in the appointment of professional members. However, due to the particular skills and experience required, and the strategic nature of the professional roles on the Integration Joint Board, the Health Board, Local Authority and the Integration Joint Board should follow the principles below to ensure they identify the appropriate members of professional staff to fill these posts: • The professional members appointed will bring professional experience and knowledge to inform the Integration Joint Board decision making in terms of planning, operational delivery and the effectiveness of major reforms. This advice will ensure the Integration Joint Board can fully take account of safety and quality of care matters. As such, the appointed person must be able to demonstrate the appropriate experience, skills and competencies to fulfil this role. The appointed member must demonstrate their ability to work at a senior level and have experience of operating at a strategic level; • Professional members should have a named, appointed deputy, able to demonstrate a similar level of skill and experience as the substantive appointment. Deputies should be expected to attend only where absolutely necessary to ensure continuity of advice from the professional. Page 63 of 290
Page 64
18 • The Health Board should ensure the appointed professional members have defined roles that are clearly set out, and held locally. The Health Board and/or Local Authority must ensure that they have time, resource and support to fulfil their responsibilities to the Integration Joint Board for the full term of their appointment. • As effective strategic planning is key, the Health Board and Local Authority must ensure that the appointed professional members are given specific training and support to contribute effectively to the Integration Joint Board, where such training is required. The above principles should also be considered when the Integration Joint Board opts to appoint additional professional members. However, in this case the application of each principle will depend on the nature and basis on which these additional members are appointed. 2.4 Appointment of Stakeholder members In addition to the professional membership, the Order also requires stakeholder members be appointed to the Integration Joint Board as follows: • A staff side member • A third sector member • A carer member • A service user member The ways in which stakeholder members will be identified and appointed to these positions on the Integration Joint Board will vary due to the local circumstances of each Integration Joint Board, such as type and number of the representative groups working within their area. Although there will not be a uniform approach in appointment of the stakeholder members, it is important that they are able to appropriately fulfil their roles. The Integration Joint Board should follow the principles set out below: • Stakeholder members will reflect the views of the groups they represent on the Integration Joint Board; naturally the individuals that comprise these stakeholder groups will be diverse. As such, the appointed person must be able to demonstrate the appropriate experience and skill to reflect the breadth and diversity of views and situations of the individuals or groups that they represent. • The Integration Joint Board should ensure the appointed member has the resources and support to fulfil their responsibilities to the Integration Joint Board for the full term of their appointment. • As effective strategic planning is key, the Integration Joint Board must ensure that the appointed stakeholder members are given specific training and support to contribute effectively to the Integration Joint Board, where such training is required. Page 64 of 290
Page 65
19 As with professional members, these principles should also be considered when the Integration Joint Board opts to appoint any additional stakeholder members. The implementation of each principle will depend on the nature and basis on which these additional members are appointed. 2.5 Induction of Members As well as their collective roles in carrying out the responsibilities of the Integration Joint Board, members will have individual roles to carry out to ensure that integrated health and social services are planned and delivered to improve outcomes for the communities they serve. In doing so, Integration Joint Board members must ensure that this is carried out effectively and in line with the integration delivery principles. Integration Joint Board members will come from a variety of backgrounds. Some members may not have had much/any experience of sitting on the board of a public body. All Integration Joint Board members will require induction training to ensure that they are able to carry out their duties to the highest standard. The training and information requirements will of course vary from member to member, and Integration Joint Boards locally decide how best to organise and operate their induction training requirements. All members should receive an induction; as a minimum this should cover the member’s specific post requirements, roles, responsibilities and policies. The Scottish Government have produced On Board: A Guide for Board Members of Public Bodies in Scotland which can be used as a standard induction pack covering generic issues such as roles and responsibilities of public bodies, and accountability and governance arrangements to supplement the tailored induction that individual Integration Joint Boards will wish to produce. The Scottish Government has also produced Leading the Journey of Integration: A Guide for Organisational Development Leaders to support the development of Integration Joint Boards. The guide highlights the important roles that are required for the integration of health and social care to be a success. It sets outs key information paired with development exercises which can be used individually or collectively by an Integration Joint Board. The guide can be found on the Adult Health Social Care Integration Implementation Website. Page 65 of 290
Page 66
w w w . s c o t l a n d . g o v . u k © Crown copyright 2015 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.scotland.gov.uk Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG ISBN: 978-1-78544-625-2 (web only) Published by The Scottish Government, September 2015 Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS56029 (09/15) Page 66 of 290
Page 67
ON BOARD A GUIDE FOR BOARD MEMBERS OF PUBLIC BODIES IN SCOTLAND Page 67 of 290
Page 68
On Board A Guide for Board Members of Public Bodies in Scotland 2 INTRODUCTION Public bodies come in a variety of forms, depending on their functions and relationship with Scottish Ministers and/or the Scottish Parliament. Public bodies are set up for specific purposes and there is no set template of what a public body should look like. Annex A provides an overview of the classification of public bodies. This classification has important implications for accountability and reporting arrangements. Information on individual bodies and contact details are available from the National Public Bodies Directory. This guidance provides the basic information that you will need to understand your role as a member of the Board of a public body in Scotland and to help make your time with the Board fulfilling and effective. It supplements the information contained in your letter of appointment which formally sets out your specific roles and responsibilities as a Board member. This guidance is for all those involved in the Boards of our Non Departmental Public Bodies (NDPBs). Due to the differing responsibilities of bodies, parts of the guidance may not be wholly appropriate for Board members of other public bodies. However Board members of other bodies may also find sections of the guidance helpful: the Chair or Chief Executive of your public body will be able to provide further advice. All public bodies should have in place supportive guidance which reflects the specific nature of their work and the extent to which separate arrangements may apply to the work of the Board. Public bodies play an essential role in performing certain functions on behalf of Government. They allow the public sector to benefit from the skills, knowledge, expertise, experience, perspectives and commitment of the members who sit on their Boards and focus in depth on clear and specific functions and purposes. Page 68 of 290
Page 69
On Board A Guide for Board Members of Public Bodies in Scotland 3 When a new Board member joins a public body, they may not have had much direct experience of that body. Effective induction serves as a valuable source of information and should provide material on specific job requirements, roles, responsibilities, policies and purposes. This guidance provides the starting point of your induction into the public body that you have joined. You should also receive further induction guidance and training from your public body on a range of topics, including: ¼ the structure, governing legislation and work of your public body and links with the sponsor Directorate in the Scottish Government ¼ the Ethical Standards Framework and Code of Conduct for Board members ¼ corporate roles and responsibilities as a Board member Annex B provides a checklist of the types of induction guidance and training that may be available from your public body. You should refer to this checklist when discussing your induction requirements with the Chair and Chief Executive. FURTHER GUIDANCE > Key reference materials and contacts are listed under each of the main sections of this guidance. The main source of further information and guidance will be the public body that you have just joined, particularly the Chair and Chief Executive. Between them, they will be able to provide you with most of the advice and information that you are likely to need during your time as a Board member of a public body in Scotland. This guidance has been produced in an interactive format to allow users to view documents referenced through the use of hyper-links. The guide will be kept under review to ensure that it continues to help promote best practice for Board members. The guide will not be produced in hard copy by the Scottish Government. Induction and Training INTRODUCTION Key to document navigation Main contents Guidance note contents Previous Page Page 69 of 290
Page 70
On Board A Guide for Board Members of Public Bodies in Scotland 4 Public Service Delivery and Reform Guidance Note 1 Principles of Corporate Governance Guidance Note 2 Roles, Responsibilities and Relationships Guidance Note 3 Effective Financial Management Guidance Note 4 Ethics and Standards of Behaviour Guidance Note 5 Annex A Classification of Public Bodies Annex B Induction and Training for Board Members The guidance is organised into five main sections: Guidance notes Page 70 of 290
Page 71
CHAPTER 1On Board A Guide for Board Members of Public Bodies in Scotland 5 Public Service Delivery and Reform Guidance Note 1 Page 71 of 290
Page 72
On Board A Guide for Board Members of Public Bodies in Scotland 6 Overview Key Messages Key References and Contacts Public Service Delivery and Reform National Performance Framework Public Service Reform The Scottish Approach to Government Government Economic Strategy Community Planning Health and Social Care Integration Scotland’s Digital Future Best Value, Efficient Government and Relocation Contents Public Service Delivery and Reform Page 72 of 290
Page 73
On Board A Guide for Board Members of Public Bodies in Scotland 7 Overview Scottish Ministers are committed to high quality, continually improving, efficient public services that are responsive to local people’s needs. To deliver on this commitment it is important that public bodies, third sector and private organisations work effectively in partnership with communities and each other. This section explains the key policy developments and strategies on the delivery and reform of public services in Scotland, the relevance of public service delivery and reform to you as a Board member of a public body, and the influential role you can play in making a real change to the lives of the people of Scotland. Key References and Contacts National Performance Framework Scottish Government Economic Strategy Christie Report Scottish Government’s Response to the Christie Report Scotland’s Digital Future – Delivery of Public Services Key Messages ¼ As a Board member, you have a responsibility to ensure the effective governance and financial management of your public body within the context of public service delivery and reform for the benefit of the people of Scotland. ¼ Public bodies are required to demonstrate their commitment to public service delivery and reform by recognising their role in the delivery of the Programme for Government and the National Performance Framework. ¼ Public service reform is built on four pillars: Prevention, Performance, People and Partnership (supported by Place) – which should be reflected in public bodies’ corporate strategic priorities and plans. ¼ The Scottish Government has developed a distinct approach to support the achievement of National Outcomes and public service reform. It is centred around empowerment and participation: enabling people to co-design, shape and deliver public services that they use; and building on the strengths of families and communities. Page 73 of 290
Page 74
On Board A Guide for Board Members of Public Bodies in Scotland 8 PUBLIC SERVICE DELIVERY AND REFORM In your role as a Board member of a public body in Scotland, you will be required to discharge specific duties in relation to the effective governance and financial stewardship of the body concerned. These duties are covered in sections three to five of this guidance, the body’s Framework Document and your letter of appointment. As a member of a public body in Scotland, you also have a general responsibility to discharge these duties within the context of public service delivery and reform to the benefit of the people of Scotland. The main policy developments and strategies which have shaped the Scottish Government’s approach to public service delivery and reform are: ¼ The outcomes-based approach of the National Performance Framework ¼ The Christie Report and the Scottish Government’s Four Pillars of Public Service Reform ¼ The strategic priorities of the Government Economic Strategy ¼ Community Planning whereby local authorities, public bodies, the Scottish Government and the third sector work together and with the local community ¼ Increased participation and delivery of public services through digital technology as described in Scotland’s Digital Future: Delivery of Public Services ¼ The Scottish Approach centred around the core concepts of Participation and Co-production, Assets-based Approaches and Improvement Methodology. The next section expands upon these policy developments and strategies, and their relevance to you as a Board member of a public body in Scotland. NATIONAL PERFORMANCE FRAMEWORK The Scottish Government’s vision for a successful Scotland is set out in the National Performance Framework. The Framework actively supports wider engagement between the Scottish Government and its delivery partners, including local government, third sector and public bodies. It consists of five main parts which support and reinforce each other: ¼ The Scottish Government’s Purpose ¼ The Purpose Targets to track progress towards the Purpose ¼ Five Strategic Objectives to focus on action ¼ 16 National Outcomes describing what the Scottish Government wants to achieve ¼ 50 National Indicators to track progress towards the Purpose and National Outcomes. Page 74 of 290
Page 75
On Board A Guide for Board Members of Public Bodies in Scotland 9 National Outcomes A shared approach to the achievement of National Outcomes encourages public service providers to direct attention towards the key long-term challenges for Scotland. As the achievement of shared outcomes is dependent on increased collaboration, effective partnership working and closer alignment of service provision, public bodies are required to ensure that their corporate strategies and plans support the National Outcomes described in the National Performance Framework. It follows that all public bodies must demonstrate the role that their corporate strategies and plans have in delivering National Outcome 16 which refers specifically to high quality, continually improving, efficient public services that are responsive to local people’s needs. Public bodies must also demonstrate their role in delivering the other National Outcomes which are relevant to the type of services they provide, working closely with partners to the benefit of the people of Scotland. This may involve crossing traditional organisational boundaries between public bodies which have separate and distinct roles but which also have a shared interest in the delivery and reform of particular areas of public service (e.g. health, justice and education). This focus on shared outcomes and partnership working can achieve outcomes which might not otherwise be possible by one body acting alone. It also opens up opportunities for sharing of limited resources to ensure more efficient, effective and sustainable public services. Scotland Performs The Scotland Performs website measures and reports on the wide range of indicators set out in the National Performance Framework. As such, it provides an open and transparent account of the progress of government in Scotland in the creation of a more successful country, with opportunities for all through increasing sustainable economic growth. PUBLIC SERVICE REFORM The Christie Commission In 2010 the Scottish Ministers invited Dr Campbell Christie to lead a Commission to identify the best ways to address the challenges of delivering public services, based on evidence of what works. The Christie Commission concluded that to achieve the outcomes that matter most to the people of Scotland, public, third sector and private organisations had to work more effectively in partnership with communities and with each other to design and deliver excellent public services that meet the needs of local people. The need for new ways of delivering public services has never been more important than it is today. The Christie Report provided an assessment of the challenges facing public services and recommended an urgent, sustained and coherent programme of public service reform. Page 75 of 290
Page 76
On Board A Guide for Board Members of Public Bodies in Scotland 10 THE SCOTTISH GOVERNMENT’S FOUR PILLARS OF PUBLIC SERVICE REFORM In its response to the Christie Report, the Scottish Government identified four pillars of reform in order to deliver better outcomes for the people of Scotland, to reduce inequalities and to ensure the delivery of sustainable services now and in the future: Prevention – reduce future demand by preventing problems arising or dealing with them early on. To promote a bias towards prevention, help people understand why this is the right thing to do, the choices it implies as well as the benefits it can bring. Performance – to demonstrate a sharp focus on continuous improvement of the National Outcomes, applying reliable improvement methods to ensure that services are consistently well designed, based on the best evidence and are delivered by the right people to the right people at the right time. People – we need to unlock the full creativity and potential of people at all levels of public service, empowering them to work together in innovative ways. We need to help create ways for people and communities to co-produce services around their skills and networks. Partnership – we need to develop local partnership and collaboration, bringing public, third and private sector partners together with communities to deliver shared outcomes that really matter to people. The Scottish Government’s approach to public service delivery and reform also focuses on the importance of “place” (locality) in the design and delivery of public services. The focus on place provides the basis for partnership and stronger community participation in the design and delivery of local services, harnessing the full spectrum of talents and capacities of public bodies, citizens, third sector organisations and local businesses. In the next sections some of the information provided may not directly impact on your role as a Board member of a public body. However, it is essential that Board members have an awareness of work being taken forward by the Scottish Government in relation to public service reform. > Page 76 of 290
Page 77
On Board A Guide for Board Members of Public Bodies in Scotland 11 THE SCOTTISH APPROACH TO GOVERNMENT The National Performance Framework and the Government’s response to Christie describe ‘what’ we are trying to achieve, the ‘Scottish Approach’ describes ‘how’ it should be delivered; centering around three core elements of Participation and Co-production, Assets and Improvement, as summarised right. The approach seeks to safeguard essential services, preserve front-line jobs and secure higher quality services through, for example: ¼ greater integration of health and social care ¼ the move to single police, and fire and rescue services ¼ the reform of post-16 education. GOVERNMENT ECONOMIC STRATEGY Scotland’s Economic Strategy reaffirms the Scottish Government’s commitment to creating a more successful country, with opportunities for all of Scotland to flourish, through increasing sustainable economic growth. It sets out an overarching framework for achieving the two mutually supportive goals of increasing competitiveness and tackling inequality in Scotland. It forms the strategic plan for existing and all future Scottish Government policy and prioritises boosting investment and innovation, supporting inclusive growth and maintaining a focus on increasing internationalisation. COMMUNITY PLANNING Community Planning is now firmly established at the heart of public service reform. It involves public services working together and with the local community to understand the different needs of communities in their area in order to resource services which make a real difference to people’s lives. ASSETS-BASED IMPROVEMENT METHODOLOGY PARTICIPATION and CO- PRODUCTION The Scottish Approach Participation and Co-production – enabling people to shape and co-design the services they use. Assets-based – valuing the strengths of people and communities to build social capital and capacity, rather than focusing solely on perceived deficits. Improvement Methodology: Creating Conditions for Change ¼ Setting out a compelling vision of the future to serve as a reference point as the change process moves forward; ¼ Backed by a story which helps people to recognise where they have been and where they are going; ¼ Identifying key actions towards realising the vision. Making the Change ¼ A clear framework for improvement; ¼ A strategy to engage, empower and motivate the workforce and develop their skills; ¼ An understanding of how the change will work locally, recognising communities and their assets are different; ¼ Building the guiding coalitions, governance and data necessary to drive and sustain the change. ¼ Page 77 of 290
Page 78
On Board A Guide for Board Members of Public Bodies in Scotland 12 Community Planning Partnerships Community Planning Partnerships (CPPs) bring public service providers (local authorities, NHS Boards, police and fire services, and other participating public bodies) together with communities and the third and private sectors to understand local needs and opportunities, agree locally shared priorities, and develop and deliver a shared plan to improve local outcomes for local people. There are 32 CPPs in Scotland, each one covering a local authority area. Single Outcome Agreements The Single Outcome Agreement is a CPP’s plan to improve local outcomes. It sets out how the CPP will work towards improving outcomes for local people in a way that reflects local circumstances and priorities, within the context of the Scottish Government’s Purpose and National Outcomes as set out in the National Performance Framework. They also take account of a number of national policy priorities, including economic recovery and growth; employment; safer and stronger communities; and addressing health inequalities. Each Single Outcome Agreement is approved by the partners in the CPP and signed off by Scottish Ministers and the local council leader. Community Empowerment (Scotland) Bill The Community Empowerment (Scotland) Bill, which is currently being considered in the Scottish Parliament with a view to becoming an Act in the summer of 2015 proposes a new legislative framework to strengthen community planning. It changes the statutory purpose of community planning, making it explicitly about how public bodies work together and with the local community to plan for, resource and provide services which improve local outcomes in the CPP area. It applies community planning duties to a number of additional public bodies, and also proposes new duties for governing the CPP on a defined set of public bodies. Bodies which are not covered by the Bill should consider pursuing opportunities for partnership working with other bodies, including local authorities, wherever this can support their respective business objectives. HEALTH AND SOCIAL CARE INTEGRATION Public Bodies (Joint Working) (Scotland) Act 2014 The shape of Scottish society is changing. People are living longer, healthier lives and as the needs of our society change, so too must the nature and form of our public services. New legislation in the form of the Public Bodies (Joint Working) (Scotland) Act 2014 requires Health Boards and local authorities to integrate their health and social care services. Local teams and professionals across health and social care will work together to deliver quality, sustainable care and services resulting in improved outcomes for the people and families who use these services. Page 78 of 290
Page 79
On Board A Guide for Board Members of Public Bodies in Scotland 13 SCOTLAND’S DIGITAL FUTURE The McClelland Review of ICT Infrastructure in the Public Sector in Scotland identified that the public sector, at all levels, could do more to transform how it procures, manages and uses digital technology to drive better public service delivery. In its response, the Scottish Government outlined priorities for action to enable public services, citizens and businesses to benefit from increased digital participation and access to digital public services. These priorities are set out in Scotland’s Digital Future: Delivery of Public Services and include a “digital first” approach to service delivery, with public bodies working collaboratively with each other and service users to develop integrated digital platforms for the delivery of effective, efficient and sustainable public services. Audit Scotland’s report, Managing ICT Projects, published in August 2012 set out recommendations for Accountable Officers. These recommendations are supported by a checklist and an overall ICT Assurance Framework to support Accountable Officers in the successful delivery of such projects and programmes. BEST VALUE, EFFICIENT GOVERNMENT AND RELOCATION Best Value, Efficient Government and Relocation are all essential elements of the public service reform agenda. These issues are covered in Guidance Note 4. FURTHER INFORMATION > Community Planning Community Empowerment (Scotland) Bill Improvement Framework Improvement Service Public bodies (Joint Working) (Scotland) Act 2014 McClelland Review Central Government ICT Assurance Framework Scottish Government’s response to the McClelland Review Page 79 of 290
Page 80
On Board A Guide for Board Members of Public Bodies in Scotland 14 Principles of Corporate Governance Guidance Note 2 On Board A Guide for Board Members of Public Bodies in Scotland 14 Page 80 of 290
Page 81
On Board A Guide for Board Members of Public Bodies in Scotland 15 Overview Key Messages Key References and Contacts Corporate Governance Translating Principles into Action Contents Principles of Corporate Governance Page 81 of 290
Page 82
On Board A Guide for Board Members of Public Bodies in Scotland 16 Overview Corporate governance concerns the strategic direction and effective stewardship of the organisation. A number of concerns have been raised about corporate governance in the private and public sectors in recent years, mainly relating to the perceived lack of control at the top of some organisations and inadequately designed systems that failed to prevent fraudulent, inefficient or inappropriate behaviour. A number of initiatives have addressed these concerns and strengthened the approach to corporate governance in both the private and public sectors. This section explains the main developments that have led to the principles of corporate governance and how these translate into the conduct and management of public business. Key Messages ¼ Corporate governance is concerned with the strategic direction and effective stewardship of the organisation. ¼ There have been a number of reviews in the private sector which together led to the development and publication of a UK Corporate Governance Code. ¼ There are similarities between the public and private sectors in terms of corporate governance principles – but Board members should recognise that it is not always possible to draw a direct parallel between the two. ¼ The Nolan Committee set new standards of conduct for Board members of public bodies in 1995 and the Ethical Standards in Public Life etc. (Scotland) Act 2000 introduced the ethical standards framework, which includes Codes of Conduct for Board members, a Chief Investigating Officer and a Standards Commission.Key References and Contacts UK Corporate Governance Code Ethical Standards in Public Life etc. (Scotland) Act 2000 Good Governance Standard for Public Services Page 82 of 290
Page 83
On Board A Guide for Board Members of Public Bodies in Scotland 17 Corporate Governance Corporate governance is the way in which organisations are directed, controlled and led. It defines relationships and the distribution of rights and responsibilities among those who work with, and in, the public body, determines the rules and procedures through which objectives are set, and provides the means of attaining those objectives and monitoring performance. Importantly, it defines where accountability lies throughout the public body. Corporate governance has been a high-profile topic in recent years, principally because of concern about ensuring control at the top of, and within, organisations. There is a perception that, in certain cases, senior managers appear to have been able to act without restraint and that inadequately designed systems have failed to prevent fraudulent, inefficient or inappropriate behaviour. The results of poor corporate governance cannot be underestimated. The international financial crisis was partially attributed to failures in governance within the Boards of major financial institutions. Key Developments in the Private Sector A number of key corporate governance reports in the private sector have contributed to the development of the UK Corporate Governance Code: Reports that shaped corporate governance in the UK Cadbury, 1992 Greenbury, 1995 Hampel, 1998 Turnbull, 1999 Myners, 2001 Smith, 2003 Higgs, 2003 Tyson, 2003 Turnbull, updated 2005 Walker, 2009 Women on Boards, 2011 Francis, 2013 Page 83 of 290
Page 84
On Board A Guide for Board Members of Public Bodies in Scotland 18 The UK Corporate Code – impact on the public sector Although there are elements of the UK Corporate Code which are relevant to Board members of public bodies, it applies primarily to companies listed on the London Stock Exchange. While there are a number of similarities between the public and private sectors in terms of corporate governance principles, Board members should be aware that it will not always be possible to draw a direct parallel between the two. Whilst public bodies face many similar challenges as private organisations, they cannot be considered to be exactly the same. Effective strategic engagement between the Scottish Government and the public body is essential in order that they work together as effectively as possible to maintain and improve public services and deliver improved outcomes. There is greater accountability, with control over public services handed in greater measure to those who use them, while Scottish Ministers take strategic policy decisions. The varying size and nature of ‘arm’s length bodies’ and the range of functions they carry out means that there is no one absolute template for how the relationship between Scottish Government Directorates and the public body operates. Further consideration on the relationship between Scottish Government Directorates and public bodies is examined in Guidance Note 3. Findings from the Financial crisis report – lack of diversity and groupthink Although the Walker Report specifically related to the collapse of banks and financial institutions its findings had significant ramifications for the Boards of all types of bodies. A key finding of the review was that ‘groupthink’, attributable in turn to a lack of diversity, had been a major contributory factor to the governance failures of the relevant Boards. Many subsequent studies have identified that companies with Boards that are apparently more diverse, such as in relation to gender, age and industry background, perform better than those companies with less diverse Boards. The different perspectives that different types of Board members bring mean that they are more likely to be able to constructively challenge proposals. If Board members are too similar to the executives, a Board’s decision-making risks being narrow and blinkered. It is important to understand that a Board made up of people who are ‘visibly diverse’ will not necessarily be immune to groupthink. Visible diversity is simply an indicator but no guarantee that the Board’s members have the diversity of skills, knowledge, experience and perspectives needed to make it effective. Having said that, a lack of diversity on the Boards of Scotland’s public bodies, which can be evidenced in relation to factors ranging from gender to BME status, employment sector and income, is an indicator that our Boards are not yet sufficiently diverse. Page 84 of 290
Page 85
On Board A Guide for Board Members of Public Bodies in Scotland 19 The impact for Scottish Public Bodies Scottish Ministers are committed to redressing this imbalance with gender parity being a particular area of focus. Boards themselves should give consideration to establishing a committee to consider matters such as planning for succession and Board performance as this should lead to more diversity at Board level. The aim should be to have 50:50 gender balance by 2020. Key Developments in the Public Sector There have been a number of high-profile reports and inquiries in Scotland highlighting inadequacies in the governance of public bodies. In one report, a Parliamentary Committee concluded that the governance arrangements in a public body did not identify or prevent a crisis which it should have done. Although not the primary factor, the Committee believed that the Board failed sufficiently to challenge the Chief Executive over a significant operational development that ultimately failed. In another report, the Scottish Parliament’s Public Audit Committee concluded that, on the evidence received, members of the Board of a public body had acted with probity throughout a very difficult period but could not escape criticism for not being aware of problems of which they should have been aware. As in the private sector, there have been a number of developments aimed at improving corporate governance in the public sector: Nolan Principles In 1995, the Committee on Standards in Public Life (the Nolan Committee) identified seven principles of conduct underpinning public life and recommended that public bodies should draw up Codes of Conduct incorporating these principles. NOLAN COMMITTEE 1995 Public bodies should draw up Codes of Conduct incorporating seven Nolan Principles of: ¼ Selflessness ¼ Integrity ¼ Objectivity ¼ Accountability ¼ Openness ¼ Honesty ¼ Leadership. > Recommendation Page 85 of 290
Page 86
On Board A Guide for Board Members of Public Bodies in Scotland 20 The then Scottish Executive took the Nolan Committee recommendations one step further with the introduction of the Ethical Standards in Public Life etc. (Scotland) Act 2000 which brought in a statutory Code of Conduct for Board Members of Devolved Public Bodies and set up a Standards Commission for Scotland to oversee the ethical standards framework. The Scottish Executive also identified nine key principles underpinning public life in Scotland, which incorporated the seven Nolan principles and introduced two further principles, Duty (Public Service) and Respect. These nine principles and their practical implications for Boards and Board members are explored in Guidance Note 5. Good Governance Standard for Public Services In 2004, the Chartered Institute of Public Finance and Accountancy and the Office for Public Management established an Independent Commission on Good Governance for Public Services. In 2005, the Independent Commission published its Good Governance Standard for Public Services which set out six core principles of good governance. GOOD GOVERNANCE STANDARD FOR PUBLIC SERVICES ¼ Statutory Code of Conduct for Board Members of Devolved Public Bodies ¼ Appointment of a Chief Investigating Officer to investigate and report to the Standards Commission for Scotland (the Standards Commission) ¼ Standards Commission to oversee ethical standards framework ¼ Seven Nolan Principles plus two further principles of Duty (Public Service) and Respect. ¼ Focus on the organisation’s purpose and on outcomes for citizens and service users ¼ Perform effectively in clearly defined functions ¼ Promote values for the whole organisation and demonstrate the values of good governance through behaviour ¼ Take informed, transparent decisions and manage risk ¼ Develop the capacity and capability of the governing body to be effective ¼ Engage stakeholders and make accountability real. > Provisions Core Principles > ETHICAL STANDARDS IN PUBLIC LIFE ETC. (SCOTLAND) ACT 2000 Page 86 of 290
Page 87
On Board A Guide for Board Members of Public Bodies in Scotland 21 Translating Principles into Action The remaining sections of this guidance provide the practical advice that is needed to enable public bodies and Board members to apply the concepts of good corporate governance to their own organisations. They pull together good practice from the private and public sectors to provide guidance to Board members across the three main dimensions of corporate governance: ¼ Roles, Responsibilities and Relationships (Guidance Note 3) ¼ Effective Financial Management (Guidance Note 4) ¼ Ethics and Standards of Behaviour (Guidance Note 5) These guidance notes explain the meaning of these dimensions of corporate governance more fully and their relevance to you as a Board member of a public body in Scotland. Page 87 of 290
Page 88
On Board A Guide for Board Members of Public Bodies in Scotland 22 Roles, Responsibilities and Relationships Guidance Note 3 On Board A Guide for Board Members of Public Bodies in Scotland 22 Page 88 of 290
Page 89
On Board A Guide for Board Members of Public Bodies in Scotland 23 Overview Key Messages Key References Fundamental Principles of Board Life Role of the Board Role of the Board as an Employer Role of the Board Committees Role and Responsibilities of the Board Member Role and Responsibilities of the Chair Role and Responsibilities of the Chief Executive Role and Responsibilities of the Accountable Officer Role and Responsibilities of the Minister Role of the Scottish Government Sponsor Directorate Managing Relationships Further information and contacts Contents Roles, Responsibilities and Relationships Page 89 of 290
Page 90
On Board A Guide for Board Members of Public Bodies in Scotland 24 Overview Every member of a Board of a public body must be clear about their specific roles and responsibilities if the Board and the public body are to operate successfully. This section outlines the roles and responsibilities of the Board, its committees, individual Board members and key internal and external stakeholders, such as the Chief Executive, Scottish Ministers and the Scottish Government sponsor Directorate. It explains the importance of managing these relationships effectively, including a clear understanding of the strategic governance and decision-making responsibilities of the Board and the operational and statutory accountability responsibilities of the Chief Executive, including as the body’s Accountable Officer. Key Messages ¼ Board members must adhere to collective corporate responsibility, confidentiality and the highest standards of conduct. ¼ Individual Board members should contribute fully to Board deliberations and exercise a healthy challenge function. The Chair will ensure that all Board members have an opportunity to contribute to Board discussions. ¼ The four main functions of the Board of a public body are: to ensure that the body delivers its functions in accordance with Ministers’ policies and priorities; to provide strategic leadership; to ensure financial stewardship; and to hold the Chief Executive and senior management team to account. ¼ Committees are established to deal with particular areas of interest outside main Board meetings and are required to submit substantive reports to summarise issues, debates and decisions. ¼ The Chair has additional responsibilities to Board members, particularly leadership, directing a diverse team and harnessing the benefits of this, and the conduct of Board business. ¼ The Chief Executive is accountable to the Board for the overall organisation, management and staffing of the public body. Where a public body manages its own budget, the Chief Executive is normally designated as its Accountable Officer with responsibilty for the proper management of public funds under the public body’s control. The Board should have regard to the issues and concerns of the Accountable Officer. ¼ The Board focuses on strategy, performance and behaviour – the Chief Executive advises the Board on all matters and is solely responsible for operational issues. Board members have no authority to instruct the Chief Executive or any member of staff on operational matters. Key References Audit Committee Handbook Audit Scotland – The Role of Boards Equality Act 2010 NDPB Model Framework Document Scottish Public Finance Manual (Accountability) Page 90 of 290
Page 91
On Board A Guide for Board Members of Public Bodies in Scotland 25 Fundamental Principles of Board Life There are three fundamental principles of Board life to which all Board members (including the Chair) must adhere: Principle 1 – Corporate Responsibility While Board members must be ready to offer constructive challenge, they must also share collective responsibility for decisions taken by the Board as a whole. If they fundamentally disagree with the decision taken by the Board, they have the option of recording their disagreement in the minutes. However, ultimately, they must either accept and support the collective decision of the Board – or resign. Board decisions should always comply with statute, Ministerial directions, Ministerial guidance and the objectives of the sponsor Directorate, as appropriate (noting of course that regulatory bodies are required to demonstrate independence in order to maintain credibility). Principle 2 – Confidentiality All Board members must respect the confidentiality of sensitive information held by the public body. This includes commercially sensitive information, personal information and information received in confidence by the organisation. It is also essential that debate of a confidential nature inside the Boardroom is not reported outside it. Principle 3 – Conduct Board members have a responsibility to set an example by demonstrating the highest standards of behaviour. It is important that nothing you do or say when acting in your capacity as a Board member tarnishes in any way the reputation of the public body or the Board. If you have specific concerns about the manner in which the public body is being run, these should be raised with the Chair in the first instance. If you fail to achieve resolution with the Chair, it is open to you to take them to the sponsor Directorate – but you should appreciate that this is a significant step. Role of the Board The four main functions of the Board are: to ensure that the body delivers its functions in accordance with Ministers’ policies and priorities; to provide strategic leadership; to ensure financial stewardship; and to hold the Chief Executive and senior management team to account. It has corporate responsibility, under the leadership of the Chair, for the following: ¼ Taking forward the strategic aims and objectives for the body agreed by the Scottish Ministers; ¼ Determining the steps needed to deal with changes which are likely to impact on the strategic aims and objectives of the body or on the attainability of its operational targets; Page 91 of 290
Page 92
On Board A Guide for Board Members of Public Bodies in Scotland 26 ¼ Promoting the efficient, economic and effective use of staff and other resources by the public body consistent with the principles of Best Value, including, where appropriate, participation in shared services arrangements; ¼ Ensuring that effective arrangements are in place to provide assurance on risk management, governance and internal control; ¼ Taking into account relevant guidance issued by Scottish Ministers; ¼ Receiving and reviewing regularly financial information concerning the management and performance of the public body and being informed in a timely manner about any concerns regarding the activities of the public body; ¼ Ensuring systems are in place to enable early notification to be provided to the Scottish Government about emerging issues which will impact on the operation or reputation of the public body; ¼ Appointing (with the approval of the Scottish Ministers) the public body Chief Executive and, in consultation with the Scottish Government, setting appropriate performance objectives and remuneration terms linked to these objectives which give due weight to the proper management and use of resources within the stewardship of the public body and the delivery of outcomes; and ¼ Demonstrating high standards of corporate governance at all times, including openness and transparency in its decision-making. Representing Ministerial Interests In the majority of cases, Boards of public bodies are appointed by Ministers to ensure delivery of Ministerial policies. Board members should be clear about Ministerial policies and expectations for their public body. If they are in any doubt on this point, they should seek clarification from the Chair or sponsor Directorate. Providing Strategic Leadership The Board usually fulfils its leadership role by developing the public body’s corporate strategy. The Board then agrees a corporate plan to turn the strategy into action over a period of about three years and promotes continuous improvements in corporate performance over this period. Both the strategy and corporate plan must align with the National Performance Framework and the National Outcomes and indicate how the public body will contribute to public service reform. The corporate plan will usually be approved by the Scottish Ministers. Ministers should write to public bodies at least annually setting out the policies and priorities which they wish them to pursue. Page 92 of 290
Page 93
On Board A Guide for Board Members of Public Bodies in Scotland 27 PROVIDING STRATEGIC LEADERSHIP ¼ Develops and agrees the organisation’s strategy; ¼ Sets cost effective plans to implement the strategy; ¼ Ensures that the strategy and plans are aligned with the National Performance Framework and the public body’s statutory duties, and the policies and priorities of the Scottish Government; ¼ Reviews the public body’s corporate and business plans and performance on a regular basis, including their own performance as a Board; ¼ Establishes a performance management framework which enables under- performance of the body to be addressed quickly; ¼ Establishes the values and standards of the organisation and ensures that the organisation adopts and complies with Codes of Conduct for Staff and the Board; ¼ Ensures that the highest standards of governance are complied with, that the organisation complies with all Ministerial guidance, its Framework Document and legislation, and that a framework of prudent and effective controls is in place to enable risks to be assessed and managed; ¼ Focuses on the positive impact that the organisation is making in the outside world, i.e. effects on customers and citizens; ¼ Ensures that the public body is a Best Value organisation and delivers Value for Money for the public sector as a whole. > The Board Ensuring Financial Stewardship The Board is collectively responsible for ensuring that the organisation adheres to strict standards of financial propriety, and complies with the financial requirements contained in the Framework Document and the Scottish Public Finance Manual. ENSURING FINANCIAL STEWARDSHIP ¼ Satisfies themselves that financial information is accurate and that financial controls and systems of risk management are robust and defensible; ¼ Considers and approves forward budget allocations and financial targets within key strategic and planning documents, such as corporate and operational business plans; ¼ Monitors the financial position against budget allocations and key financial targets and takes corrective action where required; ¼ Has regard to the issues and concerns of the Accountable Officer; ¼ Approves high value, novel or contentious expenditure proposals, for submission to the Scottish Government and Ministers for approval when it is necessary/appropriate to seek approval from the Scottish Government. > The Board Page 93 of 290
Page 94
On Board A Guide for Board Members of Public Bodies in Scotland 28 Holding the Chief Executive to account It is the Board’s duty to hold the Chief Executive (and senior management team) to account for the operational management of the organisation and the delivery of agreed plans on time and within budget. HOLDING THE CHIEF EXECUTIVE TO ACCOUNT ¼ Ensures an effective team and management arrangements are in place at the top level of the organisation; ¼ Oversees the development (and review) of the corporate strategies, plans and policies of the public body; ¼ Ensures the operation and work of the public body is closely aligned with the work of other service delivery public bodies in support of the wider aims of public service delivery and reform; ¼ Oversees the development of performance and key financial targets; ¼ Monitors performance and ensures that corrective action is taken to address any under-performance; ¼ Provides continuity of direction and effective management by making appropriate arrangements for delegation. The Board: > Page 94 of 290
Page 95
On Board A Guide for Board Members of Public Bodies in Scotland 29 ROLE OF THE BOARD AS AN EMPLOYER ¼ Has policies and procedures that comply with employment law; ¼ Avoids discrimination of any kind against current or potential employees and has policies to guarantee equal opportunities and value diversity; ¼ Has in place agreed terms and conditions of employment which should reflect the general standards set out in the Model Code for Staff; ¼ Has in place clear policies and strategies relating to staff; ¼ Complies with all health and safety requirements. This includes ensuring that the body: Role of the Board as an Employer In most cases the Board is the employer of the individuals who work for the public body, although the management of staff, apart from the Chief Executive (whose performance is appraised by the Chair), is a matter for the executive. The Board should be satisfied that the public body is meeting its moral and legal obligations to its employees and that the senior management team is fulfilling its obligations in this regard. The Board is usually responsible for the recruitment of the Chief Executive and, in some cases, other senior staff. If you take part in a recruitment exercise, you will need to be familiar with employment legislation and any codes of best practice in relation to equal opportunities issues. You should receive training in recruitment and selection before serving in that capacity. Diversity The Scottish Government expects all public bodies to champion diversity and mainstream equal opportunities in their work. The Board should give specific consideration to the impact on equality of opportunity when developing policies and making decisions. The Board should also look at how information can be presented to different groups in formats that best suit their needs and find ways of consulting effectively with people with different needs and backgrounds. Scottish Ministers particularly welcome applications for public appointments from groups that are under-represented on Scotland’s public bodies, with the aim of ensuring that Boards of public bodies are broadly reflective of the wider Scottish population with a 50:50 gender split by 2020. Public bodies are expected to take positive action to support and enable greater diversity of Ministerial appointments, through: ¼ taking an active role in succession planning, and providing advice to Ministers about the Board’s membership needs, both for new and re- appointments; ¼ ensuring that suggested criteria for the selection of new Board members meet the needs of the body, are unbiased and are not unnecessarily restrictive; ¼ taking action both during and between Board member recruitment exercises to attract the broadest range of candidates to the work of the Board; ¼ providing mentoring, shadowing and training opportunities for potential Board members; and ¼ considering the role of nominations committees. > Page 95 of 290
Page 96
On Board A Guide for Board Members of Public Bodies in Scotland 30 The Board of a public body should consider ways to attract new employees from a range of groups and perhaps set targets for increasing the number of women, disabled people and people from minority ethnic groups in the workforce to reflect the diversity of the Scottish population. The Scottish Government’s work on: increasing diversity in leadership across the public, private and third sectors; diversity in Ministerial public appointments; and diversity in the Scottish Government’s own leadership, is overseen by the Public Boards and Corporate Diversity Board. Equality Equality and fairness are at the heart of the Scottish Government’s ambition for a socially just and inclusive Scotland. They are central to its purpose, outcomes and approach to public service reform. The public sector equality duty in the Equality Act 2010 came into force in April 2011 – this is often referred to as the general duty. Scottish public authorities must have ‘due regard’ to the need to eliminate unlawful discrimination, advance equality of opportunity and foster good relations. Scottish Ministers made regulations in May 2012 placing specific duties on Scottish public authorities, as defined in the regulations, to enable the better performance of the public sector equality duty. These are also known as the Scottish Specific Duties. Public bodies should ensure that they operate in a way which promotes equality of opportunity and all policies must meet the requirements of equality legislation. Human Rights Under the Human Rights Act 1998, it is unlawful for a public body to act in a way that is incompatible with a right under the European Convention on Human Rights. The Board should seek assurances from the Chief Executive that the policies and procedures in place within the public body are compatible with Convention rights. The Board should also be committed to protecting the privacy of individuals in relation to how personal information is used as required by the Data Protection Act 1998. Page 96 of 290
Page 97
On Board A Guide for Board Members of Public Bodies in Scotland 31 Role of the Board Committees Many Boards establish committees to deal with particular areas of interest outside of main Board meetings. The extent to which Boards use committees will be dependent on the size of the organisation. Examples of Board committees include: ¼ Remuneration Committee ¼ Audit Committee ¼ Nomination Committee ¼ Area or Regional Boards where appropriate. Committees may also be set up to deal with specific aspects of the Board’s role, such as: ¼ Staff Governance ¼ Finance ¼ Policy ¼ Development ¼ Clinical Governance (in the NHS). Where appropriate, committees can allow for specialist areas relating to the Board’s role to be debated in detail by members with the appropriate knowledge or skills. The key points can then be presented to the full Board for ratification, making more effective use of scarce time. As the Board cannot be expected to understand the issues dealt with by the committee from the minutes alone, it will generally require substantive reports from the committee to summarise issues, debates and decisions. Individuals with specific skills and/or expertise may be invited to serve on committees as co-opted members. Co-opted members do not hold Board member status and must never constitute a majority of the membership of any committee. Role and Responsibilities of the Board Member Your specific role as a Board member will depend on the role of the Board to which you have been appointed and the capacity in which you have been appointed, but will normally cover a number of general duties and responsibilities. Individual Board members should act in accordance with the responsibilities of the Board as a whole and comply at all times with the Code of Conduct adopted by the public body and with the rules relating to the use of public funds and to conflicts of interest. In this context ‘public funds’ means not only any funds provided to the public body by the Scottish Ministers but also any other funds falling within the stewardship of the public body, including trading and investment income, gifts, bequests and donations. General guidance on Board members’ responsibilities will be summarised in their letter of appointment. Page 97 of 290
Page 98
On Board A Guide for Board Members of Public Bodies in Scotland 32 ROLE AND RESPONSIBILITIES OF THE BOARD MEMBER ¼ Understands the operational environment in which their public body operates within the context of the wider public service delivery landscape; ¼ Attends Board meetings on a regular basis and is well prepared by reading relevant papers in advance and, if necessary, seeks further information to ensure their understanding; ¼ Attends training events and keeps up to date with subjects relevant to the public body’s work; ¼ Contributes to the work of any committees that have been established by the Board; ¼ Represents the Board at meetings and stakeholder events when required; ¼ Contributes to strategic development and decision-making; ¼ Clarifies which decisions are reserved for the Board and delegation of those which are not; ¼ Monitors the reporting of performance and holds management to account through purposeful and constructive challenge and scrutiny; ¼ As necessary, seeks further information than that which is provided to give assurance on organisational performance; ¼ Questions and, as necessary, challenges proposals made by fellow Board members and the executive team constructively and carefully to reach and articulate a considered view on their suitability; ¼ Provides a creative contribution to the Board by providing independent oversight on issues of strategy, performance and resources; ¼ Establishes and promotes the public body’s role in the community. > The Board member Page 98 of 290
Page 99
On Board A Guide for Board Members of Public Bodies in Scotland 33 Performance Appraisal You have been appointed to the Board because your personal skills, knowledge and experience match the criteria for the post and meet the needs of the public body. Your performance as a Board member will be regularly reviewed throughout the term of your appointment, usually by the Chair of the public body. All Board members should receive a performance appraisal every year that assesses their performance in relation to certain pre-established criteria and objectives, and provides an opportunity for meaningful dialogue. The Chair is responsible for the annual appraisal of the Chief Executive and the Chair will be appraised on an annual basis by the relevant Scottish Government Director or Deputy Director (as appropriate). Succession Planning The Scottish Ministers are responsible for succession planning to ensure Boards have the skills, knowledge and experience necessary to fulfil their role economically, efficiently and effectively. They will determine the period for which an appointment, re-appointment or extension to an appointment term is to be made, based on the needs of the public body concerned. The Scottish Ministers will consider whether the needs of a Board will most effectively be met by an appointment, re-appointment or extension to an appointment term subject to any relevant provisions in the legislation which established the public body. They will balance the continuity provided by re- appointment and term extensions with the opportunity to increase the diverse range of relevant skills, knowledge and experience on a Board by making a new appointment through open competition. Re-appointment to the Board You may be re-appointed for second and subsequent terms in the same role without open competition, if you possess the skills and knowledge required on the Board at the time of re-appointment. You will only be considered for re-appointment if your performance has been assessed as effective during the initial period of appointment. The final decision as to whether or not you are re-appointed ultimately rests with the Minister, subject to the specific nature of your public body’s constitution, the needs of the Board for the foreseen period of the re-appointment and the terms upon which you are appointed. No member’s total period of appointment in the same position may exceed eight years. This eight year maximum is based on the aggregate time in post and applies regardless of whether the time in post was continuous or not. The terms and conditions of re-appointment should be outlined in a re-appointment letter. Nomination to the Board of Another Organisation Some public bodies have the right to nominate one or more Board members to the Board of another organisation. If you are nominated to be a Board member on a public body which is also a limited company, you will assume personal responsibilities as a Company Director under the Companies Acts. Any breach of your legal responsibilities as a Company Director could have serious consequences for you personally. If you are in any doubt as to your position, you should take legal advice from the Board’s legal advisers. Page 99 of 290
Page 100
On Board A Guide for Board Members of Public Bodies in Scotland 34 Civil Liability as a Board Member If you, as an individual Board member, incur a civil liability in the course of carrying out your responsibilities for the Board, you will not have to pay anything out of your own pocket provided that you have acted honestly and in good faith. However, this indemnity does not protect you if you have acted recklessly or in bad faith. Removal from Office In many cases, the founding legislation or the Board’s standing orders will set out the grounds on which you may be removed as a Board member, such as: ¼ Bankruptcy ¼ Becoming incapable of performing your duties as a Board member ¼ Being convicted of an indictable offence. Charity Trustees Some public bodies hold charitable status. This has implications for Board members who will also act as charity trustees for the purposes of the Charities and Trustee Investment (Scotland) Act 2005. A charity trustee is a person who has the general control and management of the administration of a charity. A charity may refer to its charity trustees in a number of ways including management committee members, directors and Board members. If a Board member is also the trustee of the charity, they will have the same general duties of any other charity trustee as set out at section 66 of the 2005 Act. The Office of the Scottish Charity Regulator’s guidance publication, ‘Guidance for Charity Trustees’, gives further details on the duties of charity trustees. The Role of Non-Ministerial Appointed Members The vast majority of Board members in Scotland are appointed by Scottish Ministers; however there are instances where Board composition varies to include a mix of directly elected or local authority nominated members. Provision for such arrangements will normally be set out in the public body’s enabling legislation. In circumstances where it is considered appropriate, a mix of Board membership is generally designed to deliver a balance between local and national representation in the decision-making process. However, regardless of composition, all Boards are expected to play a key role in the delivery of the Scottish Government’s Purpose through alignment with the National Performance Framework, and are required to adhere to the established principles of public sector accountability and governance set out in this guidance, including collective responsibility for decisions and actions and confidentiality. Further clarification about roles and responsibilities should be provided by the Chair and/or the Chief Executive. Role and Responsibilities of the Chair The Chair has additional responsibilities over and above those of Board members, particularly in relation to leadership and the conduct of Board business. The Chair is accountable to the Scottish Ministers and, in common with any individual with responsibility for devolved functions, may also be held to account by the Scottish Parliament. Communications between the public body Board and the Scottish Ministers should normally be through the Chair. They are responsible for ensuring that the public body’s policies and actions support the Scottish Ministers’ wider strategic policies and that its affairs are conducted with probity. The Chair is appraised by the Page 100 of 290
Page 101
On Board A Guide for Board Members of Public Bodies in Scotland 35 ROLE AND RESPONSIBILITIES OF THE CHAIR ¼ Leads representation and links with Ministers and Scottish Parliament; ¼ Leads the Board, ensures that the Board has the ability to carry out functions effectively and chairs Board meetings; ¼ Leads the Board’s approach to strategic planning; ¼ Leads the Board’s approach to the establishment of committees and ensures the Board considers substantive reports from any committees established; ¼ Ensures that the work of the Board and any committees is subject to regular self-assessment and that the Board is operating strategically and effectively; ¼ Ensures the Board has a balance of skills appropriate to directing the public body’s business, in accordance with recognised good practice in corporate governance; ¼ Ensures the Scottish Ministers are advised of the body’s needs when Board vacancies arise; ¼ Ensures the Board members are fully briefed on terms of appointment, duties, rights and responsibilities; ¼ Together with the other Board members, receives appropriate induction training, including on financial management and reporting requirements and, as appropriate, on any differences that may exist between private and public sector practice; ¼ Ensures there is a Code of Conduct for Board members in place, approved by the Scottish Ministers; ¼ Assesses the performance of individual Board members on a continuous basis and undertakes a formal appraisal at least annually; ¼ In consultation with the Board as a whole, as appropriate, is responsible for undertaking an annual appraisal of the performance of the Chief Executive. > The Chair relevant sponsor Director or Deputy Director. Mutual investment in a constructive relationship between the Chair and the Scottish Government sponsor Directorate is important to supporting the effective performance and delivery of the public body. Page 101 of 290
Page 102
On Board A Guide for Board Members of Public Bodies in Scotland 36 Role and Responsibilities of the Chief Executive The Chief Executive of the public body is employed and appointed by the Board (with the approval of Scottish Ministers). They are the Board’s principal adviser on the discharge of its functions and will be accountable to the Board. The Chief Executive’s role is to provide operational leadership to the public body, and ensure that the Board’s aims and objectives are met and the public body’s functions are delivered and targets met through effective and properly controlled executive action. The Chief Executive’s general responsibilities will include performance management and staffing of the public body. In summary, the Board focuses on strategy, performance and behaviour – the Chief Executive advises the Board on all matters and is solely responsible for operational issues. ROLE AND RESPONSIBILITIES OF THE CHIEF EXECUTIVE ¼ Advises the Board on the discharge of its responsibilities – as set out in the Framework Document, in the founding legislation and in any other relevant instructions and guidance issued by or on behalf of the Scottish Ministers – and implements the decisions of the Board; ¼ Ensures that financial considerations are taken fully into account by the Board at all stages in reaching and executing its decisions, and that appropriate financial appraisal and evaluation techniques, consistent with the Scottish Public Finance Manual, are followed; ¼ Prepares the public body’s corporate and business plans, in the light of the strategic aims and objectives agreed by the Scottish Ministers; ¼ Advises the Board on the performance of the public body compared with its aims and objectives; ¼ Ensures effective relationships with Scottish Government officials – across the wider organisation, as necessary, and with the sponsor Directorate in particular; ¼ Ensures that timely forecasts and monitoring information on performance and finance are provided to the Scottish Government; that the Scottish Government is notified promptly if overspends or underspends are likely and that corrective action is taken; and that any significant problems, whether financial or otherwise, and whether detected by internal audit or by other means, are promptly notified to the Scottish Government; ¼ Ensures robust performance and risk management arrangements, consistent with the Scottish Public Finance Manual, are in place to support the achievement of the public body’s aims and objectives and facilitate comprehensive reporting to the Board, the Scottish Government and the wider public; ¼ Ensures that the public body adheres, where appropriate, to the Scottish Government’s Programme and Project Management Principles; ¼ Ensures that adequate systems of internal control are maintained by the public body, including effective measures against fraud and theft consistent with the Scottish Public Finance Manual; ¼ Establishes appropriate documented internal delegated authority arrangements consistent with the Scottish Public Finance Manual. > Chief Executive Page 102 of 290
Page 103
On Board A Guide for Board Members of Public Bodies in Scotland 37 Role and Responsibilities of the Accountable Officer The Permanent Secretary to the Scottish Government is the Principal Accountable Officer of the Scottish Administration. The Principal Accountable Officer designates Directors-General as Portfolio Accountable Officers. The Portfolio Accountable Officer has specific responsibilities with regard to a sponsored public body with its own Accountable Officer. These are set out in a Memorandum sent by the Principal Accountable Officer on appointment. Where a public body manages its own budget, the Chief Executive will normally be designated as its Accountable Officer. Accountable Officers are personally answerable to the Scottish Parliament for the exercise of their functions, as set out in the Memorandum to Accountable Officers for Other Public Bodies issued to the Chief Executive at the time of formal designation (normally at the same time as they are appointed as Chief Executive). It is incumbent on the Chief Executive to combine their Accountable Officer responsibilities to the Scottish Parliament with their wider responsibilities to the Board. The Board and Chair should be fully aware of, and have regard to, the Accountable Officer responsibilities placed upon the Chief Executive. If the Board has serious concerns about the actions and performance of the public body’s Accountable Officer, it can recommend to the Principal Accountable Officer that Accountable Officer status should be withdrawn or suspended. The same option is open to the Principal Accountable Officer in the exercise of their own responsibilities. ROLE AND RESPONSIBILITIES OF THE ACCOUNTABLE OFFICER ¼ Signs the annual accounts and associated governance statements; ¼ Ensures the propriety and regularity of the public body’s finances and that there are sound and effective arrangements for internal control and risk management; ¼ Ensures that the resources of the public body are used economically, efficiently and effectively, and that arrangements are in place to secure Best Value for the organisation and deliver Value for Money for the public sector as a whole; ¼ Ensures compliance with relevant guidance issued by the Scottish Ministers, in particular the Scottish Public Finance Manual; ¼ Has a statutory duty to obtain written authority from the Board/Chair before taking any action which they consider would be inconsistent with the proper performance of the Accountable Officer functions. The Accountable Officer should also notify, where considered appropriate, the relevant Portfolio Accountable Officer; ¼ Represents the public body before the Public Audit Committee of the Scottish Parliament; ¼ May have their Accountable Officer status withdrawn or suspended if the Principal Accountable Officer has serious concerns about their actions and performance. The Accountable Officer > Page 103 of 290
Page 104
On Board A Guide for Board Members of Public Bodies in Scotland 38 Role and Responsibilities of the Minister Every public body sponsored by the Scottish Government is expected to be aware of, and work within, a strategic and operational framework determined by the Scottish Ministers. Most fall within the portfolio of a specific Scottish Minister who will set overall policy aims, define expected outcomes arising from implementation of that policy and review progress against outcomes. Public bodies are sometimes described as operating at ’arm’s length‘ from Ministers but this does not mean that they are outwith Ministerial control. The Minister will decide how much independence and flexibility the public body should have, depending on its size, constitution, the nature of its functions and the legislation under which it operates. Ministers may seek to increase their understanding of the public body through formal meetings with the public body’s Chair and Board and other more informal events. The founding legislation for a public body may also give Ministers the power to issue a formal direction requiring it to take particular action. However, the use of such formal powers is extremely rare. As Ministers are responsible to the Scottish Parliament, they may be asked at any time to attend Parliament or one of its Committees to answer questions from Members of the Scottish Parliament (MSPs) about the activities of public bodies within their remit. ROLE AND RESPONSIBILITIES OF THE MINISTER ¼ Considers and approves the public body’s strategic objectives and the policy and performance framework within which it operates; ¼ Secures and approves the allocation of public funds for the public body; ¼ Approves key documents such as the Framework Document and corporate plan; ¼ Makes appointments to the Board; ¼ Approves the terms, conditions and remuneration of the Chair and Board members; ¼ Approves the Chief Executive’s and staff pay remit in line with Scottish Government Pay Policy and lays accounts, together with the annual report, before Parliament; ¼ Fulfils any responsibilities specified in the founding legislation, charter or articles of association, such as approving the appointment of the Chief Executive; ¼ Issues letters of strategic guidance. The Minister > Page 104 of 290
Page 105
On Board A Guide for Board Members of Public Bodies in Scotland 39 The Role of the Scottish Government Sponsor Directorate The day-to-day link between the public body and the Minister is provided by the sponsor Directorate. Within the sponsor Directorate, a sponsor team will ensure that the public body is adequately briefed about the Scottish Government’s policies and priorities. That team will monitor the body’s activities on behalf of the Minister. However, civil servants from the sponsor Directorate will not normally attend Board meetings of the public body. On any occasion that they do, they should do so as observers, not participants, and are not party to decisions taken by the Board. The sponsor team prepares a Framework Document which sets out formally the relationship between the public body and the Minister and officials. While Framework Documents vary according to the functions, powers and finances of the public body, the Model Framework in the Scottish Public Finance Manual provides a useful template. The Framework Document will be drawn up by the Scottish Government, in consultation with the public body, and it will be reviewed at least every two to three years. The key focus for much of the sponsorship role is to support sponsored bodies in being accountable, high performing organisations, delivering Value for Money services, which meet people’s needs, as outlined in their business plan. An excellent sponsorship function is underpinned by two key elements: ¼ good governance structures and processes; and ¼ good relationships with the public body, based on openness, trust, respect and mutual support. MODEL FRAMEWORK DOCUMENT ¼ The legislative basis under which the public body was established and its statutory functions, duties and powers; ¼ Aims and objectives, how these are to be delivered and the key targets to be achieved; ¼ The roles and responsibilities of Ministers, the sponsor Directorate, the Chair, Board members, the Chief Executive and other senior officials; and the public body’s accountability to Ministers and to the Scottish Parliament; ¼ Arrangements for the planning, budgeting and control of the public body’s activities and expenditure, including funding, preparation of corporate and business plans and setting of performance targets; ¼ Arrangements for preparation and publication of the annual report and accounts and external audit procedures; ¼ Responsibilities of the public body for recruitment, pay, grading and other personnel matters. Contents: > Page 105 of 290
Page 106
On Board A Guide for Board Members of Public Bodies in Scotland 40 Managing Relationships Strategic and Operational Responsibilty It is important that the Board maintains a focus on strategy, performance and behaviour and is not diverted by detailed operational matters which are the responsibility of the Chief Executive and the Senior Executive Management Team. The Board should clearly differentiate their role in strategic governance and leadership from that of operational management. The Board should protect the Chief Executive and Senior Executive Management Team from individual Board members becoming involved in operational matters. Individual Board members have no authority to instruct the Chief Executive or any member of their staff on such matters. Decision-Making The Board should give all matters reserved to them due consideration and take ownership of the decisions taken. For instance, the Board should not simply ‘rubber stamp’ strategy proposals or a draft corporate plan put forward by the Chief Executive. It is important that both the Chief Executive and the Board understand the distinct nature of their roles. Audit Scotland’s report on The Role of Boards provides useful information about the operation of Boards in the public sector, including a series of questions at Annex 3 for Boards and individual Board members to ask themselves about how well they are working. The Chair and Board Members Individual Board members should contribute fully to Board deliberations and exercise a healthy challenge function. This expectation extends to Executive Directors (where, as is the case in many NHS bodies, they are Board members). However, it is important that no individual Board member (or Chair) dominates the debates or has an excessive influence on Board decision-making. The Chair has an important role to play in ensuring that all Board members are enabled and encouraged to contribute to Board discussions. As a Board member, you should support the Chair in their efforts to conduct Board business in an efficient and effective manner. However, you should not hesitate to challenge the Chair if you believe that a decision is wrong (even illegal) or is in contravention of the Framework Document or formal instruction from Ministers, or has been taken without a full and proper debate. Relationships with Stakeholders The Board needs to consider the concerns and needs of all stakeholders and actively manage its relationships with them. Stakeholders – and the general public – should have access to full and accurate information on the decision-making processes and activities of each public body and have the opportunity to influence decisions and actions. Scottish Ministers expect all public bodies to communicate clearly with their stakeholders, make information widely available, consult thoroughly and imaginatively and seek feedback on the public body’s performance, acting on it as appropriate. Page 106 of 290
Page 107
On Board A Guide for Board Members of Public Bodies in Scotland 41 FURTHER INFORMATION AND CONTACTS > The Data Protection Act 1998 Equality Act 2010 Freedom of Information (Scotland) Act 2002 Information Commissioner’s Office (Data Protection) Human Rights Act 1998 Principles of Strategic Engagement – December 2011 The Commissioner for Ethical Standards in Public Life Scottish Information Commissioner (FOI) Standards Commission for Scotland COMMUNICATION WITH STAKEHOLDERS ¼ Holding an Annual Open Meeting; ¼ Holding Board meetings in public, unless there is a good reason not to; ¼ Publishing summary reports and/or minutes of meetings; ¼ Inviting evidence from members of the public in relation to matters of public concern; ¼ Consulting stakeholders and users on a wide range of issues; ¼ Making corporate plans and the Annual Report and Accounts widely available. The Board should consider: > Page 107 of 290
Page 108
On Board A Guide for Board Members of Public Bodies in Scotland 42 Effective Financial Management Guidance Note 4 On Board A Guide for Board Members of Public Bodies in Scotland 42 Page 108 of 290
Page 109
On Board A Guide for Board Members of Public Bodies in Scotland 43 Overview Key Messages Key References and Contacts Scottish Public Finance Manual Budgeting in a Public Body Best Value Efficient Government Relocation Annual Reports and Accounts Performance Measurement and Reporting Risk Management and Internal Controls Internal Audit Audit Committee External Audit The Public Audit Committee of the Scottish Parliament Further Information Contents Effective Financial Management Page 109 of 290
Page 110
On Board A Guide for Board Members of Public Bodies in Scotland 44 Overview The Board, Chief Executive and senior management team must demonstrate effective financial stewardship of public funds. They must meet the requirements of the Public Finance and Accountability (Scotland) Act 2000 and the Scottish Public Finance Manual, including the need to account for the use of public money and the safe keeping of public assets. This section explains key aspects of the Scottish Public Finance Manual which aim to ensure proper stewardship of public funds. It covers the allocation of funds to public bodies by Scottish Ministers, the requirement for robust financial monitoring and reporting systems, the importance of effective risk management and internal controls, and the processes by which internal and external audit provide assurance on the proper management of public funds and resources. Key References and Contacts Scottish Public Finance Manual Scottish Public Finance Manual (Best Value) Audit Scotland Audit Scotland (Improving Public Service Efficiency) Public Finance Accountability (Scotland) Act 2000 Scottish Parliament (Public Audit Committee) Key Messages ¼ The Board satisfies itself that the public body has proper processes, systems and controls in place and receives assurances from the Chief Executive that the Scottish Public Finance Manual is being complied with. The Board also seeks assurance that systems are in place to provide accurate and timely information to the Scottish Government as part of the management of the Scottish Budget. ¼ The Board receives regular financial reports showing expenditure against planned budgets and progress towards financial targets and efficiency savings. ¼ The Board scrutinises financial and corporate plans and provides challenge on performance against these plans and any underlying assumptions. ¼ The Board satisfies itself that the public body has systems in place to secure Best Value in the performance of its functions. ¼ The Board satisfies itself that systems are in place for risk management and internal control extending from front- line services through to the Board. ¼ Where an organisation is responsible for expenditure, an Audit Committee must be established to advise the Board on internal control (including corporate governance) and audit matters. ¼ The Board is responsible for approving the annual accounts and ensuring the Minister is provided with the annual report and accounts to be laid before the Scottish Parliament. The Chief Executive as the Accountable Officer of the public body is responsible for signing the accounts and ultimately responsible to the Scottish Parliament for their actions. ¼ On completion of the external audit of the annual accounts, the appointed auditor sends a copy of the accounts and the audit opinion to the Auditor General, who may add a report of their own, before the body sends the accounts and reports to the Scottish Ministers for laying before the Parliament. ¼ The Public Audit Committee of the Scottish Parliament uses reports of the Auditor General as the basis for conducting enquiries. Page 110 of 290
Page 111
On Board A Guide for Board Members of Public Bodies in Scotland 45 The Scottish Public Finance Manual The primary document that governs all matters relating to public finance and reporting in Scottish public bodies is the Scottish Public Finance Manual (SPFM). The SPFM provides guidance to your public body and its sponsor Directorate on the proper handling of public funds. It is mainly designed to ensure compliance with statutory and parliamentary requirements (in particular, the Public Finance and Accountability (Scotland) Act 2000), to promote Value for Money and high standards of propriety, and to secure effective accountability and good systems of internal control. Essentially the Board must ensure that the public body has processes and systems in place to ensure compliance with the SPFM. Board members should look to the Chief Executive (Accountable Officer) and staff of the public body for advice and assurance that the SPFM is being complied with. The Accountable Officer has a personal responsibility for the propriety and regularity of the finances under their stewardship and for the economic, efficient and effective use of all related resources. Accountable Officers are personally answerable to the Parliament for the exercise of their functions and have a statutory duty to obtain written authority from, as the case may be, the Scottish Ministers or relevant governing body before taking any action that they consider may be inconsistent with the proper performance of their functions. The system is designed to promote good governance. It is important to recognise that the Accountable Officer’s role in relation to Value for Money is not a narrow one, restricted to considerations affecting that body, but, as defined by the SPFM, Value for Money is to be judged for the public sector as a whole. This wider consideration of Value for Money would be relevant to considerations of property and accommodation, for example, in relation to shared services. Budgeting in a Public Body The resources allocated to bodies by Scottish Ministers are determined as part of the Spending Review process. Spending Reviews take place every few years. This process dovetails with the United Kingdom Spending Review which largely sets the overall Scottish budget for each Spending Review period. After deduction has been made for the costs of the Scotland Office plus the Scottish Parliamentary Corporate Body and Audit Scotland, the Scottish Government has full discretion to decide how the Scottish budget should be divided between its various portfolios and programmes. The grant-in-aid necessary to support the agreed budgets of bodies is authorised by the Scottish Parliament in the annual Budget Act. Bodies are expected to provide supporting material to the sponsor Directorate as part of the latter’s contribution to both the Spending Review and the annual budgetary process. Wherever possible, this should be done as part of their own annual planning arrangements and they should therefore take all reasonable steps to harmonise the planning process with those of the Spending Review and annual budgetary process. Page 111 of 290
Page 112
On Board A Guide for Board Members of Public Bodies in Scotland 46 Ministers should write to public bodies at least annually setting out the policies and priorities which they wish them to pursue. Where a public body receives grant-in-aid, this is most commonly done through a Budget Allocation and Monitoring letter issued in advance of the financial year. This letter confirms the resources that Ministers have allocated to the body and sets out the priority areas of work that Ministers wish the body to pursue. Where a public body does not receive grant-in-aid, an equivalent letter should be received from the Minister covering the priority areas to be pursued. The letter should draw on material from the corporate plan and the Spending Review and any further instructions from Ministers. Typically the Board of a public body will be responsible for the approval of the corporate plan (and possibly operational plans) before submission to the sponsor Directorate. The Board should receive regular financial reports (at least quarterly) showing expenditure/use of resources against planned budgets and progress towards financial targets including projected efficiency savings. Board members should provide the ‘challenge function’, carefully scrutinising plans, performance against plans and underlying assumptions. The Board will also approve high value, novel or contentious expenditure proposals for submission to the Scottish Government and Ministers for approval when it is necessary/ appropriate to seek approval from the Scottish Government. Best Value, Efficient Government and Relocation Best Value Best Value provides a common framework for continuous improvement in public services in Scotland, and is a key foundation of the Scottish Government’s public service reform agenda. The principles of Best Value complement good governance standards and offer a sound approach to running a public service organisation. The duty of Best Value, as set out in the SPFM, is to make arrangements to secure continuous improvement in performance whilst maintaining an appropriate balance between quality and cost and in making those arrangements and securing that balance, to have regard to economy, efficiency, effectiveness, the equal opportunities requirements and to contribute to the achievement of sustainable development. Best Value ultimately is about creating an effective organisational context from which public bodies can deliver their key outcomes. Page 112 of 290
Page 113
On Board A Guide for Board Members of Public Bodies in Scotland 47 Accountable Officers appointed by the Principal Accountable Officer for the Scottish Administration have a specific responsibility to ensure that arrangements have been made to secure Best Value. The Scottish Ministers expect all Accountable Officers to comply with the duty of Best Value and for any associated matters relating to Value for Money, judged for the public sector as a whole placed upon them. In addition the Boards (or equivalents) of relevant public service organisations have corporate responsibility for promoting the efficient and effective use of staff and other resources by the organisations in accordance with the principles of Best Value. Under the terms of the Public Finance and Accountability (Scotland) Act 2000 the implementation of the duty of Best Value by relevant public service organisations is subject to scrutiny by the Auditor General for Scotland. As a Board member, you should always bear in mind the need for your public body to continually secure Best Value in the performance of its functions. In a tight financial climate, service improvements may need to be funded from internal efficiencies. Audit Scotland has adopted a generic framework for Best Value for all public bodies. This enables a consistent approach to auditing against Best Value principles across the public sector. Sustainable development and equalities are themes that run through the framework. It is a risk-based approach, recognising the increasing focus on partnership working, with the specific aim of: ¼ Reporting on overall governance and management arrangements ¼ Reporting on the delivery of outcomes ¼ Protecting taxpayers’ interests by examining the use of resources ¼ Increasing the emphasis on self- assessment by public bodies with audit support and validation. Efficient Government The Public Services Reform (Scotland) Act 2010, section 32(1)(b) provides that as soon as is reasonably practicable after the end of each financial year each listed public body must publish a statement of the steps it has taken during that financial year to improve efficiency, effectiveness and economy in the exercise of its functions. Efficiency is not about making cuts, it is about enhancing Value for Money, improving public service and raising productivity and as such efficient Government is focused on the sound management of resources and ensuring that public bodies continually review their operations to identify opportunities for efficiency improvements. Efficiency improvements are about improving the ratio of resource inputs to outputs and can be made in any area, including the administration and delivery of services and in the procurement of goods and services. By making efficiency savings, more resources are available for re-investing in the delivery of public services. Opportunities for efficiency improvements within your body should be identified as part of the corporate and business planning processes. As a Board member you should ensure that such opportunities are being identified and that arrangements are in place for measuring, monitoring, and reporting on the delivery of efficiency savings to the Board. This should include having efficiency performance indicators (such as a range of input/output ratios) that will allow you to routinely monitor the efficiency of your public body’s operations. Page 113 of 290
Page 114
On Board A Guide for Board Members of Public Bodies in Scotland 48 Audit Scotland’s report on Improving Public Service Efficiency identified that public bodies will need to improve productivity and efficiency in the delivery of public services to meet continued demands on public spending. Audit Scotland concluded that public bodies will need to take a more fundamental approach to identifying priorities, improving the productivity of public services, and improving collaboration and joint working. A Good Practice Checklist was produced to help leaders in public bodies check and challenge their approach and ultimately support better productivity and efficiency. Relocation Relocation policy is related to Best Value and Efficient Government. Location reviews are triggered by the creation or reorganisation of bodies, as well as by property events (such as lease breaks). Relocation remains an option as part of streamlining the public bodies landscape, but should only be pursued following a rigorous and transparent process that shows any move provides best possible Value for Money for the public finances and optimum service delivery. Ministers will expect Board members to have regard to this policy in decisions they make on the most efficient and effective way of delivering services. Annual Report and Accounts The accounting guidance issued to those bodies that are subject to reporting requirements set by the Scottish Ministers will set out the applicable accounting policies and principles and disclosure requirements. Where the Scottish Government makes funds available to a sponsored body the Scottish Government will account to the Parliament for the provision of those funds in the Scottish Government’s annual accounts. A sponsored body which is a separate accounting entity will account for the use of those funds (and of other funds in its stewardship) in its own annual accounts. The Board is responsible for approving the body’s annual accounts and ensuring that the Minister is provided with the annual report and accounts to be laid before the Scottish Parliament. The Chief Executive as the Accountable Officer of the public body is responsible for signing the accounts and ultimately responsible to the Scottish Parliament for their actions. The accounting requirements for a public body will normally be set out in its founding legislation and/or its Framework Document. Performance Measurement and Reporting Key targets for efficiency and effectiveness of operations and quality of service provided will be agreed as part of the planning process. The Board should ensure that robust systems are in place to monitor performance against these targets. A report on the extent to which performance targets have been achieved should be incorporated in the Annual Report, where appropriate giving a summary of trends over a five-year period. Risk Management and Internal Controls Risk concerns uncertainty of outcome. The delivery of an organisation’s objectives is surrounded by uncertainty which both poses threats to success and offers opportunities for increasing success. Risk is defined as this uncertainty of outcome, whether positive opportunity or negative threat, of actions and events. Page 114 of 290
Page 115
On Board A Guide for Board Members of Public Bodies in Scotland 49 Each public sector organisation’s internal control systems should include arrangements for identifying, assessing and managing risks. Risk management should be closely linked to the business planning process. Public bodies are required to provide a Governance Statement in order to comply with best practice as recommended by the Turnbull Committee Report. As part of that process, Directors (in the case of public bodies, the Board) are required to review, at least annually, the effectiveness of all controls, including financial, operational and compliance controls. Organisations need to show that they have established and maintained effective and on-going procedures for identifying, evaluating and managing business risks. The Board must ensure that there is a system in place for continuous risk management which extends from the front-line services through to the Board. This involves having a framework of prudent and effective controls in place to enable risks to be identified, assessed and managed. The Board itself should regularly review key business risks affecting the organisation. Audit Committee Where a body is responsible for a budget, an Audit Committee must be established to advise the Board and Accountable Officer on internal control (including corporate governance) and audit matters. All accounting entities to which the SPFM is directly applicable should establish Audit Committees. The Board (or Accountable Officer) should establish an Audit Committee of at least three members, all of whom should be either Board members or independent external members. All Audit Committees in organisations to which the SPFM is directly applicable are subject to the guidance in the Audit Committee Handbook published by the Scottish Government. A degree of flexibility will be appropriate in applying the guidance in the Handbook, particularly with regard to smaller accounting entities. The exact role of the Audit Committee will depend on the particular circumstances of the organisation. Examples of issues affecting the role of the Audit Committee include the strategic risk management arrangements that the Board and/or Accountable Officer have established, whether or not there is a separate Risk Committee and the whistleblowing arrangements which have been put in place as part of the anti-fraud and corruption arrangements. An Audit Committee should not have any executive responsibilities or be charged with making or endorsing any decisions, although it may draw attention to strengths and weaknesses in control and make suggestions for how weaknesses might be dealt with. The overarching purpose of the Audit Committee is to advise the Board and/or Accountable Officer; it is then the Board and/or Accountable Officer that makes the relevant decisions. To fulfil its role, an Audit Committee should meet at least four times per year. Additional meetings should be convened as deemed necessary. All Audit Committee members, whatever their status or background, will have training and development needs. Those who have recently joined the Audit Committee will need induction training, either to help them understand their role; or if they have audit committee experience elsewhere, to help them understand the organisation. In Page 115 of 290
Page 116
On Board A Guide for Board Members of Public Bodies in Scotland 50 particular, those joining a public sector Audit Committee for the first time will need training to help them understand public sector standards, especially those relating to governance and accountability. AUDIT COMMITTEE ¼ Have written terms of reference from the Board, which encompass all the assurance needs of the Board and Accountable Officer. Within this, the Audit Committee should have particular engagement with the work of Internal Audit, the work of the External Auditor and with financial reporting issues; ¼ Support the Board and Accountable Officer by reviewing the scope, reliability and integrity of the assurances provided to them; ¼ Highlight those aspects of risk management, governance and internal control that are functioning effectively and, just as importantly, those that need to be improved; ¼ Have at least three non-executive members, under the chairmanship of a non-executive member who should be someone other than the Chair of the public body or of any other sub- Committee of the Board; ¼ Own corporately an appropriate skills mix to allow it to carry out its overall function. At least one of the Committee members should have recent and relevant financial experience; ¼ Have a Chair whose role goes beyond chairing meetings – this is key to achieving Committee effectiveness. The additional workload should be taken into account in the appointment of the Chair; ¼ Have a Chair who is involved in the appointment of new Committee members, including providing advice on the skills and experience being sought by the Committee, and is responsible for ensuring that the work of the Audit Committee is appropriately resourced; ¼ Be independent and objective; in addition each member should have a good understanding of the objectives and priorities of the organisation and of their role as an Audit Committee member; ¼ Encourage the Accountable Officer, Head of Internal Audit and Director of Finance to attend meetings (though not as members of the Audit Committee); ¼ Should have regular and on-going liaison with External Auditors; ¼ Should ensure it has effective communication with the Board and Accountable Officer, the Head of Internal Audit, the External Auditor, and other stakeholders. In addition, the role of the Chair and provision of appropriate secretariat support are important elements in achieving Audit Committee effectiveness. The Audit Committee should: > Page 116 of 290
Page 117
On Board A Guide for Board Members of Public Bodies in Scotland 51 Internal Audit In any government related organisation there will be two significant sources of assurance that the Audit Committee can be certain will be present: Internal Audit and External Audit. The work of Internal Audit is carried out primarily for the benefit of the Board and Accountable Officer of the organisation. Although the work of External Audit is normally primarily conducted for the benefit of the Scottish Parliament, it is still of significant benefit to the organisation as well. Internal Audit is an internal appraisal service, established by the management of an organisation, to review the internal control system. It objectively examines, evaluates and reports on the adequacy of internal control as a contribution to the proper, economic, efficient and effective use of resources. The scope of the Internal Audit service should be unrestricted across the organisation’s operations. The Internal Auditors should have sufficient authority to access assets, records and personnel as necessary for the discharge of their responsibilities. The work of Internal Audit is likely to be the single most significant resource used by the Audit Committee in discharging its responsibilities. This is because the Head of Internal Audit, in accordance with the Government Internal Audit Standards, has a responsibility to offer an annual opinion on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes. There is consequently a major synergy between the purpose of the Head of Internal Audit and the role of the Audit Committee. The role of the Audit Committee in relation to Internal Audit should include advising the Board and Accountable Officer on: ¼ The Audit Strategy and periodic Audit Plans, forming a view on how well they support the Head of Internal Audit’s responsibility to provide an annual opinion on the overall adequacy and effectiveness of the organisation’s risk management, control and governance processes; ¼ The results of Internal Audit work, and management response to issues raised by that work; ¼ The resourcing of Internal Audit; and ¼ The Terms of Reference (or equivalent) for Internal Audit. Page 117 of 290
Page 118
On Board A Guide for Board Members of Public Bodies in Scotland 52 External Audit Whilst the work of the External Auditor is not primarily conducted for the benefit of the organisation or its Audit Committee, the Audit Committee should nevertheless engage with the activity of the External Auditor. As well as considering the results of External Audit work, they should enquire about and consider the External Auditor’s planned approach and the way in which the External Auditor is co-operating with Internal Audit to maximise overall audit efficiency, capture opportunities to derive a greater level of assurance and minimise unnecessary duplication of work. The Auditor General for Scotland is the External Auditor of a number of public bodies. The Auditor General may appoint a member of the staff of Audit Scotland or an appropriately qualified professional firm as the auditor of your body. Where a public body is incorporated under the Companies Act, the auditor is appointed by the members of the company (i.e. the Board members). External Audit of the Annual Accounts An External Audit of the annual accounts undertaken by the Auditor General is conducted in accordance with the Public Finance and Accountability (Scotland) Act 2000 and the Code of Audit Practice issued by Audit Scotland on behalf of the Auditor General. On completion of the External Audit, the appointed auditor sends a copy of the accounts and the audit opinion to the Auditor General. The Auditor General may then add a report (for example, on a qualification of the auditor’s opinion or other matter drawn to their attention by the auditor) before the body sends the accounts and reports to the Scottish Ministers for laying before the Parliament. EXTERNAL AUDIT OF THE ANNUAL ACCOUNTS ¼ Issue an opinion as to whether the accounts give a true and fair view of the state of affairs of the public body at the year end and of its income and expenditure for the year and whether the accounts have been prepared in accordance with any applicable legislation and accounts direction; ¼ Issue an opinion (known as the “regularity” opinion) as to whether the income and expenditure has been properly received or incurred in accordance with legislation, the Budget Act for the relevant year and any other guidance issued by the Scottish Ministers; ¼ Review the Governance Statement prepared by the body and report if it is not in accordance with the auditor’s understanding of the body; ¼ Consider the body’s governance arrangements and arrangements for prevention and detection of fraud; ¼ Provide reports to the Board, Audit Committee and/or management on matters arising during the course of the audit. The appointed auditor will: > Page 118 of 290
Page 119
On Board A Guide for Board Members of Public Bodies in Scotland 53 Performance Audit Performance audits look at the performance of a public body and include a Value for Money audit which is an examination of the economy, efficiency and effectiveness with which a body has used its resources to carry out its functions. The Auditor General has powers to conduct performance audits. These audits examine the economy, efficiency and effectiveness of aspects of the public sector. They can assess: ¼ performance across several public bodies in a particular theme – for example, managing changes in the workforce; or ¼ performance of an individual public body or a particular aspect of that body’s performance. Performance audits may be conducted by Audit Scotland staff, the appointed auditor, consultants or any combination of these. A draft report on the audit will be discussed with the public body (or bodies) to ensure factual accuracy. Once finalised, the report will be laid before the Scottish Parliament and published with an accompanying news release. In most cases, the Auditor General will present the report to the Scottish Parliament’s Public Audit Committee. Performance audit reports may contain material such as checklists to assist non- executive Board members in holding management to account. For many public bodies, the founding legislation provides that the Auditor General will appoint the auditor. In such circumstances, the Auditor General has a statutory right to carry out a Value for Money examination. Where the Auditor General is not the auditor of a public body and has not appointed the auditor, they should have rights under statute or by agreement to carry out an inspection of the use of resources by those bodies. The Public Audit Committee of the Scottish Parliament The Public Audit Committee of the Scottish Parliament is one of the committees established under the Standing Orders of the Parliament. The Public Audit Committee uses the reports of the Auditor General, which are laid before the Parliament, as the basis for conducting enquiries. It is chaired by a senior member of the Opposition and conducts its business on non-party political lines. Page 119 of 290
Page 120
On Board A Guide for Board Members of Public Bodies in Scotland 54 FURTHER INFORMATION > Audit Committee Handbook Audit Scotland (Auditing Best Value in Central Government Bodies) Audit Scotland (Code of Audit Practice) Audit Scotland (Efficient Public Services Good Practice Checklist) Public Finance Accountability (Scotland) Act 2000 Public Services Reform (Scotland) Act 2010 Scottish Public Finance Manual (Best Value) Scottish Public Finance Manual (Risk Management) Scottish Public Finance Manual (Spending Reviews) PUBLIC AUDIT COMMITTEE ¼ The Auditor General’s report is discussed with the body concerned and the facts are agreed; ¼ The report is laid before Parliament and published together with a Press Release; ¼ If an enquiry is to be conducted by the Public Audit Committee, witnesses are called to give evidence – usually the Accountable Officer of the public body and the Accountable Officer of the sponsor Directorate. It is possible that the Chair or a Board member of a public body will be required to appear as a witness, where appropriate; ¼ After the evidence session, the Committee drafts and approves a report which is published; ¼ A formal response to the Committee’s report is provided by the Scottish Government (or by the body in consultation with the Scottish Government) within two months of the Committee’s report being published. The key stages: > Typically the range of issues on which Board members should seek assurance will include: ¼ compliance with the SPFM, Framework Document and legislation (e.g. founding legislation, Equality Act 2010); ¼ financial monitoring and reporting arrangements and arrangements for delivering and reporting on efficiency savings; ¼ arrangements for securing Best Value for the organisation and Value for Money for the public sector as a whole; ¼ systems for identifying, assessing and managing risks; ¼ processes for preventing and detecting fraud, and, linked to this, whistleblowing procedures; ¼ arrangements for business continuity and disaster recovery; ¼ information management systems, including in relation to protection of personal data and compliance with Freedom of Information legislation; ¼ propriety and regularity of public finances; ¼ management systems that have clear lines of delegation and accountability; ¼ arrangements for meeting procurement requirements; ¼ arrangements for meeting the body’s moral and legal obligations to its employees; and ¼ complaints handling procedures. Boards will require to supplement these areas of assurance having regard to the purpose of the organisation and the nature of the business conducted. ISSUES ON WHICH BOARD MEMBERS SHOULD SEEK ASSURANCE > Page 120 of 290
Page 121
On Board A Guide for Board Members of Public Bodies in Scotland 55 Ethics and Standards of Behaviour Guidance Note 5 On Board A Guide for Board Members of Public Bodies in Scotland 55 Page 121 of 290
Page 122
On Board A Guide for Board Members of Public Bodies in Scotland 56 Overview Key Messages Key References and Contacts Introduction to Ethical Standards in Public Life The Commissioner for Ethical Standards in Public Life in Scotland The Standards Commission for Scotland Key Principles of the Model Code of Conduct Code of Conduct for Board Members Gifts and Hospitality Bribery Conflicts of Interest Handling Conflicts of Interest Registration of Interests Confidentiality Dispensations Lobbying Use of Social Media Whistleblowing Complaints Policy Further information Contents Ethics and Standards of Behaviour Page 122 of 290
Page 123
On Board A Guide for Board Members of Public Bodies in Scotland 57 Overview Scottish Ministers have high expectations of those who serve on the Boards of public bodies and the way in which they conduct themselves in undertaking their duties. As a Board member, it is your personal responsibility to ensure that you meet these expectations by ensuring that your conduct is above reproach. This section outlines how the Board exercises leadership in determining the values and standards of the organisation. It describes the ethical framework introduced by the Ethical Standards in Public Life etc. (Scotland) Act 2000, particularly the nine key principles of the Model Code of Conduct which all Board members are required to observe when discharging public duties. Through this framework, the Scottish Ministers aim to ensure confidence in Scottish public bodies, the Boards of those bodies and individual Board members. Key References and Contacts The Commissioner for Ethical Standards in Public Life in Scotland The Standards Commission for Scotland Model Code of Conduct for Board Members Standards Commission Guidance Note Key Messages ¼ Board members of bodies listed in Schedule 3 of the Ethical Standards Act are subject to the nine key principles outlined in the Model Code of Conduct. ¼ It is important to take care when expressing views so you do not compromise your position as a member of a public body. ¼ All public bodies have a duty to publish a Register of Board Member Interests. There are specific interests which you must register and it is your personal responsibility to ensure that your entries are current. ¼ Board members must declare financial and non-financial interests which might be perceived to influence their contribution to a discussion or decision in Board proceedings. This requirement also applies to interests held by your close family, friends and business associates. ¼ The test on making a declaration is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as so significant that it is likely to prejudice your discussion or decision-making. ¼ You must ensure that the reputation of your public body is not damaged by the receipt (or provision) of inappropriate gifts and hospitality. ¼ The Commissioner for Ethical Standards in Public Life in Scotland (the Commissioner) considers complaints about members of devolved public bodies who are alleged to have contravened the Code of Conduct. On finding a contravention of the Code, the Commissioner reports to the Standards Commission for adjudication. Where a hearing is held by the Standards Commission and a contravention of the Code is established, the Standards Commission determines the level of sanction to be applied. ¼ Part 4 of The Ethical Standards in Public Life etc. (Scotland) Act 2000 makes provision for Codes of Conduct for bodies not listed in Schedule 3 – such bodies and Board members are not subject to investigation by the Commissioner, or sanction by the Standards Commission. Page 123 of 290
Page 124
On Board A Guide for Board Members of Public Bodies in Scotland 58 Introduction to Ethical Standards in Public Life The Ethical Standards in Public Life etc. (Scotland) Act 2000 (Ethical Standards Act) introduced the power to specify the principles and rules that underpin public life in Scotland, putting ethical standards and probity at the heart of decision-making in public service. The principles set out below should be observed by all Board members of public bodies in Scotland. Key Principles Duty You have a duty to uphold the law and act in accordance with the law and the public trust placed in you. You have a duty to act in the interests of the public body of which you are a member and in accordance with the core functions and duties of that body. Selflessness You have a duty to take decisions solely in terms of public interest. You must not act in order to gain financial or other material benefit for yourself, family or friends. Integrity You must not place yourself under any financial, or other, obligation to any individual or organisation that might reasonably be thought to influence you in the performance of your duties. Objectivity You must make decisions solely on merit and in a way that is consistent with the functions of the public body when carrying out public business including making appointments, awarding contracts or recommending individuals for rewards and benefits. Accountability and Stewardship You are accountable for your decisions and actions to the public. You have a duty to consider issues on their merits, taking account of the views of others and must ensure that the public body uses its resources prudently and in accordance with the law. Openness You have a duty to be as open as possible about your decisions and actions, giving reasons for your decisions and restricting information only when the wider public interest clearly demands. Honesty You have a duty to act honestly. You must declare any private interests relating to your public duties and take steps to resolve any conflicts arising in a way that protects the public interest. Leadership You have a duty to promote and support these principles by leadership and example, and to maintain and strengthen the public’s trust and confidence in the integrity of the public body and its members in conducting public business. Page 124 of 290
Page 125
On Board A Guide for Board Members of Public Bodies in Scotland 59 Respect You must respect fellow members of your public body and employees of the body and the role they play, treating them with courtesy at all times. Similarly you must respect members of the public when performing duties as a member of your public body. Board members should apply these principles in their dealings with fellow members of their public body, its employees and other stakeholders. Similarly Board members should also observe these principles in their dealings with the public when performing duties as a member of a public body. The Ethical Standards Framework The key elements of the ethical framework introduced by the Ethical Standards in Public Life etc. (Scotland) Act 2000 are: Through this ethical framework, the Scottish Ministers aim to ensure that Scottish public bodies and all who serve on them conduct their business in a way which merits and sustains public confidence. The Commissioner for Ethical Standards in Public Life in Scotland The Public Services Reform (Commissioner for Ethical Standards in Public Life in Scotland etc.) Order 2013 came into force on 1 July 2013. The Order transferred the functions of the Public Standards Commissioner for Scotland and the Public Appointments Commissioner for Scotland to a single Commissioner for Ethical Standards in Public Life in Scotland (the Commissioner). The Commissioner is an independent office holder who works in two areas: ¼ A Standards Commission for Scotland (Standards Commission) and a Chief Investigating Officer (now the Commissioner for Ethical Standards in Public Life in Scotland) to oversee the ethical framework; ¼ A Model Code of Conduct for Members of Devolved Public Bodies on a statutory basis for those bodies listed in Schedule 3 of the Act; ¼ Codes for smaller bodies; and ¼ Publicly available Registers of Members’ Interests. ¼ Public appointments, regulating how people are appointed to the Boards of public bodies in Scotland; and ¼ Public standards, where the Commissioner can investigate a complaint about a councillor or a member of a devolved public body who is alleged to have contravened the councillors’ or the appropriate public body’s Code of Conduct. Page 125 of 290
Page 126
On Board A Guide for Board Members of Public Bodies in Scotland 60 Where the Commissioner identifies that a breach or breaches of a Code or Codes may have occurred, the Commissioner will report on the outcome of these investigations to the Standards Commission for adjudicatory action and application of sanctions, where appropriate. The Standards Commission for Scotland The Standards Commission is an independent statutory body which has responsibility for enforcing compliance with the Codes of Conduct and providing general guidance on their interpretation. It adjudicates on cases of alleged contravention of the Codes of Conduct referred to it after investigation by the Commissioner and, where a hearing is held, has the power to impose sanctions. The Standards Commission has responsibility for various aspects of the ethical framework including: On finding a contravention of a Code of Conduct for bodies listed in Schedule 3 of the Ethical Standards in Public Life etc. (Scotland) Act 2000, the Standards Commission can impose sanctions ranging from censure, or suspension from meetings of the public body for up to one year, to disqualification for up to five years. Details of the full range of sanctions available to the Commission are listed in Annex A of the Members’ Model Code of Conduct. The Standards Commission can also consider particular circumstances where it would be contrary to the spirit of the Code for it to be applied. In exceptional circumstances, it can issue dispensations to allow Members of public bodies, including councillors, to participate in discussion and vote on certain matters where, due to financial or non-financial interests, they would otherwise be prohibited from such participation. Code of Conduct for Board Members Upon appointment to the Board, you should have been provided with a copy of your public body’s Code of Conduct for Board Members, which forms part of your terms and conditions. You must not at any time advocate or encourage any action contrary to the Code of Conduct. It is your personal responsibility to make sure that your actions comply with the provisions of the Code at all times as the Code contains the standards against which your conduct will be measured. You should review regularly, and at least annually, your personal circumstances against the requirements of the Code. If you are uncertain about any aspect of the Code, you should seek advice from the Standards Officer in your public body. You ¼ adjudicating on cases of alleged contravention of the Codes of Conduct for Members of Devolved Public Bodies reported to it by the Commissioner following investigation of a complaint; ¼ promoting and enforcing Codes of Conduct and providing guidance on the operation of Registers of Interests; ¼ providing guidance to public bodies on: ¼ the promotion and observance of high standards of conduct by members of devolved public bodies and assisting them in that task; ¼ the Commission’s relationship with public bodies in carrying out its functions; and ¼ the Registers of Interests for Members of Devolved Public Bodies. Page 126 of 290
Page 127
On Board A Guide for Board Members of Public Bodies in Scotland 61 may also choose to consult your own legal and financial advisers. The Standards Commission also provides advice and guidance on the Code. The nine key principles of public life are mentioned earlier in this section. The Standards Commission guidance to devolved public bodies will provide you with more detailed information on these principles. The following paragraphs provide a brief snap- shot of information about parts of the Model Code of Conduct which Board members will require to give care and consideration to when undertaking their duties. Gifts and Hospitality As a Board member, you should ensure that the reputation of your public body is not damaged through the receipt (or provision) of inappropriate gifts and hospitality. Bribery Board members must be familiar with the provisions of the Bribery Act 2010 which came into force on 1 July 2011. The Act makes it a criminal offence for a person to take part in active bribery (making a bribe) or passive bribery (receiving a bribe). All public bodies operate a zero tolerance approach to bribery, with any allegations investigated in accordance with the relevant procedures and reported to the appropriate authorities. Conflicts of Interest Public bodies should have in place clear rules and procedures for managing conflicts of interests. Together with the rules on registration of interests, this ensures transparency of your interests which might influence, or be thought to influence, your actions. You should note that the appearance of a conflict of interest in terms of public perception can be every bit as damaging as an actual conflict – both should be avoided. GIFTS AND HOSPITALITY ¼ Do not canvass or actively seek gifts or hospitality; ¼ Your conduct should not foster the suspicion of any conflict between your official duties and your private interests; ¼ Your actions, when acting in an official capacity, should not give the impression of having been influenced by a gift or consideration to show favour or disfavour to any person or organisation; ¼ Do not accept any offer of a gift or hospitality from any individual or organisation that stands to gain from a decision that your public body may be involved in determining or that is seeking to do business with your public body; ¼ You should usually refuse offers of gifts and/or hospitality except in the following cases: gifts of an isolated and trivial character under £50; normal hospitality associated with your duties and reasonably regarded as appropriate; or gifts received on behalf of the public body; ¼ Do not accept repeated hospitality or repeated gifts from the same source; ¼ If you are in doubt about the propriety of accepting a gift or an item of hospitality you should contact the Standards Officer and/or the Chair for advice. > Page 127 of 290
Page 128
On Board A Guide for Board Members of Public Bodies in Scotland 62 Handling Conflicts of Interest Public confidence in your public body and its Board members depends on it being clearly understood that decisions are taken in the public interest and not for any other reason. In deciding whether to declare an interest, the key test is whether a member of the public, acting reasonably, might think that a particular interest could influence you. Registration of Interests All devolved public bodies have a duty to set up, maintain and make available for public inspection a register of Board member interests. The Ethical Standards in Public Life etc. (Scotland) Act 2000 (Register of Interests) Regulations 2003, as amended, describe the detail and timescale for registering. The Model Code is very specific about the interests that you, as a Board member, must register and these include: Your Code of Conduct will contain definitions of what is required under each of these categories and if you are in any doubt as to what you should or should not be registering, you should discuss this with the Standards Officer, the Chair and/or the Standards Commission. The Register should also be available for inspection by the public (electronic and paper version). Public bodies should prepare a page for this purpose on their website and ensure that it is operational. The electronic version of the Register does not need to include any personal information that would compromise personal security although the full details would be made available for public inspection in hard copy. Board members are required to keep their entries in the Register of Interests up-to-date and this involves notifying the Standards Officer of any new interest or change to an existing interest within one month of the change. Declaration of Interests In deciding whether to declare an interest, the key test is whether a member of the public, with knowledge of the relevant facts, would reasonably regard the interest as so significant that it is likely to prejudice your discussion or decision making in your role as a member of a public body. If you have a financial, or non-financial, interest you must declare your interest at Board meetings and withdraw from decision- making on the basis of such an interest when it is appropriate to do so. REGISTRATION OF INTERESTS ¼ Remuneration from employment, self-employment or directorships; ¼ Related undertakings i.e. certain unremunerated directorships; ¼ Contracts with the public body; ¼ Gifts and hospitality; ¼ Houses, land and buildings that you own or have an interest in which are of significance or relevance to, or bear upon the work and operation of, the public body; ¼ Shares and securities – holdings in a company or organisation which are of significance or relevance to, or bear upon the work and operation of, the public body; and ¼ Non-financial interests including membership or holding office in other public bodies, clubs, societies and organisations such as Trade Unions and voluntary organisations. > Page 128 of 290
Page 129
On Board A Guide for Board Members of Public Bodies in Scotland 63 Non-Declaration of Interest Where a material conflict of interest exists and a Board member does not declare their interest and withdraw, the Chair should take appropriate action to ensure that the Board (and the Board member concerned) is not compromised. In the event that a Board member refuses to leave the room when asked by the Chair to do so, the Chair should suspend the meeting and reconvene without the Board member concerned being present. Board members should bear in mind that any such action on their part may lead to an investigation by the Commissioner and the matter thereafter referred to the Standards Commission, which may apply a sanction in the event that it determines a breach of the Code of Conduct has occurred. Frequent Declarations of Interest If as a Board member you are frequently declaring interests at meetings, you should consider whether it is appropriate for you to continue in your role. In such circumstances, you may wish to discuss your continued appointment as a Board member with the Chair. Dispensations The Standards Commission does have the power to issue dispensation (where it is deemed to be in the public interest) to allow Board members to participate in a discussion and vote, despite the fact they have financial or non-financial interests which would normally prevent them from participating in discussion and voting. In addition to general dispensations, individual applications for dispensations in exceptional circumstances can be made to the Standards Commission and may be granted where it is in the public interest to do so. However, Board members must not take part in any discussion or vote on a matter (in which they are conflicted) unless and until they have actually received a dispensation. Confidentiality On occasions, Board members will be required to treat discussions, documents and other information relating to the work of the body in a confidential manner. It is imperative that Board members respect this duty of confidentiality at all times. In particular, as a Board member you should never use information to which you have privileged access for personal or financial gain or in a way that brings the public body into disrepute. Lobbying The Code of Conduct sets out clear guidance in respect of dealing with lobbyists and lobbying. If you have any concerns over the approach or methods used by anyone in their contacts with you, you should discuss the matter with your body’s Standards Officer and/or the Chair. Use of Social Media When using social media the distinction between work and private life can become blurred, and speedily made comments can be misconstrued. It is important to take special care when expressing views on social media not to compromise your position as a member of a public body. Social media offers many benefits in communicating with stakeholders and interested parties. However, you should always remember that hastily expressed views through social media can reach large (sometimes unintended) audiences instantaneously and can be difficult to retract if required to do so. Your public body should have a policy in place about the use of social media. You should familiarise yourself with the content of that policy to protect the public body’s reputation, its legal obligations, its information and its systems. You will be expected to approach any use of social media platforms responsibly and with care. Page 129 of 290
Page 130
On Board A Guide for Board Members of Public Bodies in Scotland 64 Whistleblowing Although not directly covered by the Ethical Standards Framework, Board members have a responsibility to ensure that staff have confidence in the fairness and impartiality of procedures for registering and dealing with their concerns and interests. The Public Interest Disclosure Act 1998 gives legal protection to employees who raise certain matters or concerns, known as ‘qualifying disclosures’, without fear of reprisal. As a Board member, you should ensure that your public body has a whistleblowing policy and appropriate procedures in place. This will allow staff to raise concerns on a range of issues such as fraud, health and safety etc. without having to go through the normal management structure. Audit Scotland has published guidance on employers’ and employees’ responsibilities in relation to whistleblowing. Public Bodies not covered by the Ethical Standards in Public Life etc. (Scotland) Act 2000 The Ethical Standards in Public Life etc. (Scotland) Act 2000 makes provision for Scottish Ministers to introduce a Code or Codes of Conduct under the Public Authorities Regime for bodies not listed in Schedule 3 to the Act. While such public bodies and their Board members will be expected to act in accordance with this Code of Conduct, they will not be subject to investigation by the Commissioner or to sanctions by the Standards Commission. Irrespective of the extent to which a public body is covered by the Ethical Standards Act, Board members are required to adhere to the principles that underpin the ethical standards framework and have regard to the provisions set out in the Model Code of Conduct in carrying out their public duties. Complaints Handling The Scottish Public Services Ombudsman (SPSO) is the independent body that handles complaints from members of the public about devolved public services in Scotland. Under the Public Services Reform (Scotland) Act 2010, the SPSO was given a lead role in improving the handling of complaints by public sector bodies in Scotland. In 2013 the SPSO published a model Complaints Handling Procedure (CHP) for the Scottish Government, Scottish Parliament and Associated Public Authorities, which public bodies have a statutory requirement to adopt. The CHP includes a commitment for public bodies to publish information against performance indicators, which will provide consistent complaints data across the various sectors of the public service in Scotland. Page 130 of 290
Page 131
On Board A Guide for Board Members of Public Bodies in Scotland 65 Board members should have an awareness of the importance of having an effective complaints policy in place. Promoting a ‘valuing complaints’ culture – with a pro- active approach to effective resolution, monitoring and learning from complaints – is an essential part of effective governance of public services. The Board has a collective responsibility and Board members, the Chair and the Chief Executive are also individually responsible for ensuring the public body has an effective, efficient, customer-focused approach to complaints resolution in place. COMPLAINTS HANDLING ¼ Ensure the public body and executive team are learning from service failures and customer insight provided by complaints, with systems in place to record, analyse and report on complaints outcomes, trends and actions taken; ¼ Ensure that processes are in place for the public body and executive team to identify and respond immediately to critical or systemic service failures identified from complaints handling; ¼ Take an active role in monitoring and reviewing learning from complaints and reviewing individual complaints to obtain an understanding of how any failures occurred and have been addressed; ¼ Provide the necessary challenge and hold the senior officer(s) to account for the public body’s performance in complaints handling, with Board / Board members themselves regularly monitoring and reviewing the complaints handling performance of the public body; ¼ Ensure that service improvements are agreed, actioned and reviewed, possibly on a quarterly basis. > FURTHER INFORMATION > Audit Scotland – Employer’s Guide to Whistle Blowing Bribery Act 2010 Ethical Standards in Public Life Etc. (Scotland) Act 2000 Ethical Standards Registration of Interests (Regulations) 2003 Scottish Parliamentary Commissions and Commissioners etc. Act 2010 The Scottish Public Service Ombudsman The model Complaints Handling Procedure (CHP) for the Scottish Government, Scottish Parliament and Associated Public Authorities in Scotland. Page 131 of 290
Page 132
On Board A Guide for Board Members of Public Bodies in Scotland 66 Annex A Classification of Public Bodies On Board A Guide for Board Members of Public Bodies in Scotland 66 Page 132 of 290
Page 133
On Board A Guide for Board Members of Public Bodies in Scotland 67 There are occasions where bodies carrying out public functions should operate more at ‘arm’s-length’ from Government. This may be appropriate for a variety of reasons. This can be to provide independent advice and expertise on technical, scientific or other complex issues and take this outside the political arena, e.g. on ethical issues, or funding decisions. Tribunals and other quasi- judicial bodies are set up to meet specific requirements for separation of decision- making and appeals. Public bodies carry out a wide range of functions such as independent regulation, advice, investigation, adjudication, ombudsman services, appeal, funding, partnership, commercial and health services. Such ‘arm’s-length bodies’ focus in depth on clear and specific functions and purposes. These bodies have been established to meet particular needs and situations. This flexibility and responsiveness means that the landscape of public bodies is necessarily both complex and diverse. The following provides a snapshot of the features of public bodies operating in Scotland. Executive Agencies – although an integral part of the Scottish Government, Executive Agencies generally have a strong focus on the management and direct delivery of public services which do not require day-to-day ministerial oversight; in some cases they may also have responsibility for a discrete area of government policy. They are staffed by civil servants, including the Chief Executive who is directly accountable to Ministers. They are not statutory bodies but operate in accordance with a Framework Document approved by Ministers, which may be reviewed, amended or revoked at any time. This has the advantage that they can normally be set up by administrative action without the need for legislation. Executive Non Departmental Public Bodies (NDPBs) – are not part of the Scottish Government or the Scottish Administration. They perform administrative, commercial, executive or regulatory functions on behalf of Government and operate within a framework of governance and accountability set by Ministers. They are funded by the Scottish Government through grant or grant- in-aid, but many generate additional income through provision of services. They are normally established by statute, employ staff (who are not civil servants) on their own terms and conditions subject to Scottish Public Sector Pay Policy, and manage their own budgets. They are accountable to a Board whose members are normally appointed by Ministers and publish their own annual report and accounts. Page 133 of 290
Page 134
On Board A Guide for Board Members of Public Bodies in Scotland 68 Advisory NDPBs – provide independent expert advice to Ministers and others or input into the policy-making process in relation to a particular subject. They are normally established by Ministers on a non-statutory basis, do not normally employ staff (administrative support is usually provided by the Scottish Government) and are not normally responsible for budgets or expenditure other than remuneration for Board members. They are accountable to a Board whose members are normally appointed by Ministers. Ministers are answerable to Parliament for the activities of the body and can dissolve the body at any time. Tribunals – are established by statute and have specific responsibilities for prescribed judicial functions. They are not part of the court system and are independent of the Scottish Government. They have both specialist and lay members, do not employ staff and are not responsible for budgets or expenditure other than the remuneration of Tribunal members. Non Ministerial Departments (NMDs) – are not part of the Scottish Government but are part of the Scottish Administration in their own right and staffed by civil servants. They are generally funded by Parliament and are required to publish their own annual report and accounts. They are directly accountable to the Scottish Parliament, not Ministers, for the discharge of their statutory functions. Public Corporations – are industrial or commercial enterprises under Government control which recover more than 50% of their costs through fees charged for services provided to customers. They employ their own staff, who are not civil servants, manage their own budgets and report to a Board whose members are appointed by Ministers. Health Bodies – currently comprise 14 territorial health boards, 8 special health boards and the Mental Welfare Commission for Scotland (MWCS). With the exception of MWCS, health bodies are part of NHSScotland and provide healthcare services or management, technical or advisory services. Parliamentary Commissions, Commissioners and Ombudsman – are typically responsible for safeguarding the rights of individuals, monitoring and reporting on the handling of complaints about public bodies, providing an adjudicatory role in disputes and reporting on the activities and conduct of public Boards and their members. Commission Members, Commissioners and Ombudsmen are appointed by the Parliamentary Corporation. They are accountable, and report directly, to the Scottish Parliament. Other Significant Bodies – do not fall within the recognised categories of public bodies set out above but they have a direct relationship with either the Scottish Government or the Parliament and operate within a framework set by Ministers. Page 134 of 290
Page 135
On Board A Guide for Board Members of Public Bodies in Scotland 69 Annex B Induction and Training for Board Members On Board A Guide for Board Members of Public Bodies in Scotland 69 Page 135 of 290
Page 136
On Board A Guide for Board Members of Public Bodies in Scotland 70 Induction programmes, events and material should be a standard feature with a public body providing information on a range of topics, e.g. policies, procedures, roles, responsibilities, rules and key personnel. The following list of induction guidance and training is not prescriptive but is designed to give you an idea of the type of support that may be provided by your public body. Meetings A one-to-one meeting should take place with the Chair immediately following appointment to discuss in broad terms what is expected of a Board member in the first year and any individual role he or she is expected to play. (The Chair and Board member should meet on a regular basis as part of the appraisal process.) An induction session within one month of appointment should explain: ¼ Organisational structure ¼ The collective role of the Board ¼ Arrangements, formats etc. of Board meetings ¼ Details of any subsidiary Boards and committees (e.g. Regional Boards, Audit Committee) and their responsibilities ¼ The long-term strategy of the organisation ¼ The corporate planning system ¼ The role of the Chief Executive as the Accountable Officer ¼ Current priority areas of work ¼ Budget and financial information, including the monitoring role of the Board ¼ The public body’s policies on openness – where appropriate, including the role of Board members in promoting the public body to the public and in the media ¼ Links between the public body/Board and the Scottish Government and the Scottish Parliament. This should include details of where the sponsor Directorate fits within the Scottish Government structure, details of sponsor Minister(s) etc ¼ Links to other key partner organisations ¼ Arrangements for Board members’ remuneration and expenses ¼ The organisation’s Code of Conduct for Board members and Code of Conduct issues, including policies on the registration and declaration of interests, gifts and hospitality, use of social media by Board members etc. This should include guidance on completing the Register of Interests ¼ Whistleblowing procedures – how to raise concerns and how to respond to concerns being raised ¼ Details of arrangements for monitoring and reporting on the performance of Board members ¼ The Corporate Risk Register Ideally, this session should be attended by all new Board members and by some existing Board members to allow the latter to pass on experience. Some other members of the senior management team may also attend, including the Board secretary. It may also be appropriate for a Board member to meet with other key staff in the organisation – for example the Chief Executive who will be able to advise of their role in their capacity as the Accountable Officer and, where the Board member is to sit on the Audit Committee, they may wish to meet audit and finance staff. Page 136 of 290
Page 137
On Board A Guide for Board Members of Public Bodies in Scotland 71 Publications ¼ The latest Annual Report and Accounts ¼ The latest Corporate Plan and Operational/Business Plan ¼ The Corporate Strategy or similar strategic document ¼ Any significant recent policy or consultation documents which the public body has published ¼ The latest in-house magazine or newsletter ¼ The latest staff newsletter ¼ A list of relevant publications Written Material ¼ Guide to the legislation under which the public body was established ¼ Copy of the Budget Allocation and Monitoring letter from the sponsor Minister for the coming year ¼ National Performance Framework ¼ Strategic guidance from the Scottish Government ¼ Copy of the public body’s current Framework Document ¼ Standing Orders for the conduct of Board meetings ¼ Organisational structure, staff directory, office addresses etc ¼ Biographical and contact details of other Board members (and, where appropriate, those in subsidiary Boards and committees) ¼ Summary of key roles and responsibilities within the organisation – Board, subsidiary Boards and committees, Chief Executive/ Accountable Officer, management team, other senior staff ¼ Forward programme of Board meeting dates and any other key events (press launches, conferences etc) ¼ The organisation’s Code of Conduct for Board members ¼ The Standards Commission Guidance on the Model Code for Members of Devolved Public Bodies ¼ Copy of the organisation’s Data Protection, Freedom of Information and other relevant policies and procedures relating to corporate governance and accountability – and if they exist: ¼ Policy for Board members in dealing with the media ¼ List of acronyms relating to the public body’s area of work, partner organisations etc. ¼ The Corporate Risk Register ¼ Schedule of Matters Reserved for the Decision of the Board and Scheme of Delegation ¼ Action plan arising from most recent review of Board effectiveness ¼ The Scottish Public Services Ombudsman model Complaints Handling procedure Terms and Conditions ¼ Guidance on claiming travel and subsistence expenses ¼ Guidance on claiming other allowances where appropriate (e.g. child care) ¼ Guidance on tax issues (e.g. for home to office travel) ¼ Guidance on Register of Interests, and Gifts and Hospitality Training The public body should consider providing any further training deemed necessary to assist Board members individually or collectively, to carry out their duties, particularly covering areas such as their roles and responsibilities, the financial management and reporting requirements of public bodies, appraisal systems both for individual members and collective functionality, ethical standards and any other differences which may exist between private and public sector practice. Page 137 of 290
Page 138
w w w . g o v . s c o t © Crown copyright 2015 This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open- government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: psi@nationalarchives.gsi.gov.uk. Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned. This publication is available at www.gov.scot Any enquiries regarding this publication should be sent to us at The Scottish Government St Andrew’s House Edinburgh EH1 3DG First published by The Scottish Government, APRIL 2015 ISBN: 978-1-78544-125-7 (web only) E-book in EPUB format first published by The Scottish Government, APRIL 2015 ISBN: 978-1-78544-126-4 (EPUB) E-book in MOBI format first published by The Scottish Government, APRIL 2015 ISBN: 978-1-78544-127-1 (MOBI) Produced for The Scottish Government by APS Group Scotland, 21 Tennant Street, Edinburgh EH6 5NA PPDAS38590 (04/15) Photo credits: Cover and content pages Architecture and Design Scotland Creative Scotland – photographer Michael Wolchover Loch Lomond & The Trossachs National Park Authority Scottish Qualifications Authority Scottish Canals Sportscotland All other images courtesy of iStockphoto and Scottish Viewpoint Page 138 of 290
Page 139
More than equal April 2024 Valuing and supporting the expert contribution of people with lived experience Page 139 of 290
Page 140
2More than equal: Valuing and supporting the expert contribution of people with lived experience Background 3 Recommendations 5 Recommendation one: Strengthen recruitment and representation 6 Recommendation two: Build capacity 8 Recommendation three: Support equity of involvement 10 Recommendation four: Evaluate impact 12 Sharing good practice 14 Final thoughts 15 Contents Page 140 of 290
Page 141
3More than equal: Valuing and supporting the expert contribution of people with lived experience The Public Bodies (Joint Working) (Scotland) Act 20141 set out the requirement for Integration Authorities to include carer and lived experience representatives on their Integration Joint Boards (IJBs). Background Since 2014, other legislative developments have extended the expectation of engagement with carers and people with lived experience within Health and Social Care (including, Carers (Scotland) Act 20162; National Care Service (Scotland) Bill3). The Coalition of Carers in Scotland (COCIS) and the Health and Social Care Alliance Scotland (the ALLIANCE) provide support to networks of Carer and Lived Experience Representatives involved in IJBs across Scotland. Since 2017, the Carer Collaborative, facilitated by COCIS, has produced Equal, Expert and Valued (EEV) reports4 which outline the experiences of Carer Rep involvement in IJBs and provide recommendations and examples of good practice. The ALLIANCE’s IJB Lived Experience Representative Network has formed more recently, but Lived Experience Network Reps report similar experiences of involvement as those highlighted in the Equal, Expert and Valued reports. 1 legislation.gov.uk/asp/2014/9/contents/enacted 2 legislation.gov.uk/asp/2016/9/contents/enacted 3 parliament.scot/bills-and-laws/bills/national-care-service-scotland-bill 4 carersnet.org/carers-collaborative Page 141 of 290
Page 142
4More than equal: Valuing and supporting the expert contribution of people with lived experience Carer and Lived Experience Reps bring a wealth of knowledge, experience and expertise to the work of IJBs. However, experiences of involvement across Scotland are mixed and there are a number of key areas where the involvement of Reps falls short of best practice. This report draws on these experiences and starts with headline recommendations for improvement, under four thematic headings: 1. Strengthen recruitment and representation 2. Build capacity 3. Support equity of involvement 4. Evaluate impact The subsequent pages give more detail on the key areas for development, actions which would support improvement, as well as links to resources that could help. The report concludes with brief good practice examples, final thoughts and thanks. Note on language used in this report: This report typically uses the word ‘Reps’ to refer to Carer and Lived Experience Representatives on IJBs (Lived Experience Reps are also sometimes known as Patient, Service User or Public Reps). Reps are usually unpaid carers (or former carers) or people who have experience of accessing health and social care services and support. It is noted that in some areas staff (e.g. from local carers centres; lived experience organisations; the local authority) fulfil the role. COCIS and the ALLIANCE are of the view that while this ensures carers and those with lived experience are represented to a degree, it is best practice to have unpaid carers and those with lived experience of services in the roles. Page 142 of 290
Page 143
5More than equal: Valuing and supporting the expert contribution of people with lived experience Recommendations Recommendation Areas for development and action 1. Strengthen recruitment and representation • Proactive and inclusive recruitment to Carer and Lived Experience Rep positions to ensure representation and representativeness. • Ensure Reps have a clear and transparent role and remit. • Ensure robust succession planning and supportive induction processes are in place. • Involve Reps in key planning groups, particularly governance and decision-making structures. 2. Build capacity • Support and resource structures for wider community involvement and ensure Carer / Lived Experience Reps have support to link with these structures. • Have a pool of carers/people with lived experience to populate strategic groups, share responsibility and enable peer support. • Provide training on the importance, value and benefits of involvement for IJB members and wider strategic partners. • Provide resources and training for Carer / Lived Experience Reps (and other IJB members) to support and enable them to undertake their role. • Ensure engagement and involvement of Carers and Lived Experience Reps in national policy discussions and structures. 3. Support equity of involvement • Ensure Reps are treated as equal partners and have voting rights. • Ensure Reps are able to place items on the agenda and there is time for discussion. • Ensure meetings are accessible e.g. papers sent on time; addressing barriers, etc. • Ensure an expenses policy is in place and full remuneration of expenses, including replacement care. • Consider a form of payment for Reps on IJBs. • ‘Carer / Lived Experience proof’ policies and plans. • Ensure ongoing support to enable Reps to undertake their role. 4. Evaluate impact • Evaluate the involvement of carers and people with lived experience. Publish findings in Annual Performance Reports to demonstrate progress and impact. • Monitor progress towards key national outcomes and indicators relating to carers and people with lived experience. • Report transparently on IJB/HSCP financial spend to support carers and people with lived experience. • Review processes and performance annually against these report recommendations. Page 143 of 290
Page 144
6More than equal: Valuing and supporting the expert contribution of people with lived experience Area for development Actions to support improvement Proactive and inclusive recruitment to Carer and Lived Experience Rep positions to ensure representation and representativeness. • Provide clear information on the role and the support which will be given to Reps to undertake the role. • Ensure unpaid carers / those with lived experience are appointed to Representative roles (rather than staff). • Ensure recruitment processes are inclusive and enable equity of access to apply for Representative roles. • Monitor representation (e.g. BAME; those with different support needs or caring roles; age groups) and proactively identify and take action to address gaps. Ensure Reps have a clear and transparent role and remit. • Provide all Carer and Lived Experience Reps with a clear role description which outlines the scope and scale of the role; support, training and resources that will be provided; skills required. Ensure robust succession planning and induction processes are in place. • Prioritise the development of succession planning and induction processes for Representative roles. This includes: » Anticipatory planning in advance of their term ending » Exit interviews with outgoing Reps. » Handover period between new / existing Reps. » Provision of key information on the processes, functions, key personnel within IJBs scope/remit. » Introductory meetings with IJB members / key HSCP personnel (e.g. Chair/Finance Lead Officer). » Provision of named contact/s for on-going support/ information. » Developing a buddying and mentoring system to provide Reps with access to on-going support (either with other Reps or key HSCP personnel). Recommendation one: Strengthen recruitment and representation What needs to happen The context IJBs appear to face challenges with the recruitment of IJB Carer and Lived Experience Reps. At the time of writing (Apr 2024), this includes: Carer and Lived Experience Rep vacancies on up to seven IJBs; Rep roles are being undertaken by staff (on at least two IJBs); carers or people with lived experience being unable or unwilling to get involved due to the scope and scale of the role; lack of succession planning processes resulting in some Reps being in their roles for two or three terms (up to nine years); more needing to be done to ensure diversity of experience and representation from all sections of the community. Page 144 of 290
Page 145
7More than equal: Valuing and supporting the expert contribution of people with lived experience Resources that can help: The Carer Collaborative’s role description template carersnet.org/wp-content/uploads/2021/10/Carer-Rep-Role-Description.pdf The ALLIANCE’s Engaging People with Lived Experience: best practice, challenges and opportunities report. alliance-scotland.org.uk/blog/news/new-report-engaging-people-with-lived-experience Scottish Government’s Participation Framework gov.scot/publications/participation-framework Area for development Actions to support improvement Involve Reps in key planning groups, particularly governance and decision-making structures. • Ensure Reps have information about the IJBs wider planning and strategy groups and opportunities to be involved in these, particularly those related to governance and decision-making (e.g. budget setting; commissioning). • Provide support for Reps to be involved in wider planning groups to ensure carer / lived experience perspectives are considered in discussions and decisions. Page 145 of 290
Page 146
8More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Support and resource structures for involvement and ensure Reps have support to link with these structures. • Provide Reps with information and support to link with wider involvement structures* so they can fully represent carer / lived experience views. Be cognisant that Reps need time to engage with others (e.g. when issuing IJB papers). * Structures for involvement can include Carers Voice groups; voluntary sector orgs/networks that support people who access services; involvement teams within HSCP. Have a pool of carers / people with lived experience to populate strategic groups, share responsibility and enable peer support. • Provide support to a wider pool of carers / people with lived experience who can be involved in the range of IJB strategic groups to ensure sustainable representation including: » Sharing responsibility for different areas of strategic work so Reps don’t become overburdened. » Offering opportunities for peer support to share experiences, knowledge and learning. Provide training on the importance, value and benefits of involvement for IJB members and wider strategic partners. • Provide regular training for all IJB members and wider strategic partners who support the work of the IJB to build: » A shared understanding of the importance and value of involvement. » An understanding of the range of expertise and experience Reps bring to the IJB. » A willingness to listen and desire to seek out the experiences of carers and people with lived experience. » An understanding of different approaches to involvement and barriers some may face. » Knowledge on safeguarding measures to ensure engagement is purposeful and people are able to contribute their lived experience in a safe and appropriate way Recommendation two: Build capacity What needs to happen The context IJBs need to develop a wider pool of carers and people with lived eperience to ensure representation does not depend on a few people. To ensure sustainable representation of the views of carers/people with lived experience it is vital that: Reps have opportunities and support to engage with wider involvement networks; IJBs support a wider pool of carers/people with lived experience to ensure Reps don’t become overburdened with involvement in numerous IJB strategic groups. Alongside this, capacity building training is key to ensure: Reps have the information and knowledge they need to undertake their role; IJB members and wider stakeholders have an understanding of the importance, value and benefits of involvement. Page 146 of 290
Page 147
9More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Provide resources and training for Reps (and other IJB members) to support and enable them to undertake their role. • Provide ‘baseline’ training on the topics / key areas of focus that are discussed within the IJB remit (e.g. policy landscape). • Regularly discuss other training and support needs with Reps – these will differ for each person. • Have a dedicated training budget to provide on-going capacity building support for Reps. Ensure engagement and involvement of Reps in national policy discussions and structures. • Provide information for Reps about national involvement networks (e.g. COCIS’ Carers Collaborative; the ALLIANCE’s IJB Lived Experience Representative Network). • Provide information on key areas of national policy development (e.g. National Care Service) and other national structures that Reps could link with (e.g. COSLA board). Resources that can help: COCIS’ Carer Collaborative carersnet.org/carers-collaborative The ALLIANCE’s IJB Lived Experience Representative Network alliance-scotland.org.uk/lived-experience/networks/ijb-lived-experience-representative- network/ Mind’s Influence and Participation Toolkit mind.org.uk/workplace/influence-and-participation-toolkit Page 147 of 290
Page 148
10More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Ensure Reps are treated as equal partners and have voting rights. • Ensure Reps are able to effectively and regularly engage with other carers / people with lived experience to ensure their views are represented and considered in decision-making. This includes ensuring there is time to consult and engage with others on decisions. Ensure Reps are able to place items on the agenda and there is time for discussion. • Ensure there is a clear and accessible process for Reps to submit items for the IJB (and strategic groups) agendas. • Allow time in meetings for discussions and questions. Ensure meetings are accessible e.g. papers sent on time; addressing barriers to involvement. • Ensure meeting papers are issued sufficiently in advance, to allow Reps to read, consult with wider carer / lived experience networks and prepare for meetings. • Discuss any barriers to involvement (including format of IJB papers; participation support needs; meeting timings e.g. for carers/people with lived experience who work) and take action to address these. Ensure an expenses policy is in place and full remuneration of expenses, including replacement care. • Provide Reps with the IJB expenses policy at induction (or during their tenure if already in post). • Publish expenses policy on the IJB/HSCP website. • Provide expenses forms and a clear, straightforward claim process. • Ensure replacement care expenses are available to Reps who need these (without requiring them to use their own network of support or existing care packages). Recommendation three: Support equity of involvement What needs to happen The context Across Scotland Reps report mixed experiences of being involved as equal partners on IJBs. It should be noted that within this recommendation there was a divergence of views about Reps having voting rights (as recommended in the Independent Review of Adult Social Care5). Whilst both Carer and Lived Experience Reps were keen for equity in the form of voting rights, some Lived Experience Reps noted that they would only be comfortable having voting rights if they were able to effectively engage with others with lived experience. Alongside this, there was a divergence of views around establishing a form of payment for Reps. Payment can be a complex issue and should be fully assessed to mitigate any adverse implications (e.g. tax, benefits, employment law). 5 gov.scot/publications/independent-review-adult-social-care-scotland Page 148 of 290
Page 149
11More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Consider a form of payment for Reps on IJBs. • Consider a range of options for payment (e.g. financial recompense; vouchers), take legal/financial advice (e.g. tax/benefits/employment law) and discuss with Reps to ensure payments would not have adverse implications. ‘Carer / Lived Experience proof’ plans and policies. • Ensure plans and policies produced by the IJB (and its strategic groups) are impact assessed for carers / people with lived experience and that their needs and aspirations are considered. For example, the needs of carers / people with lived experience being included in Equality Impact Assessments/Statements. Ensure ongoing support to enable Reps to undertake their role. • Examples of on-going support which Reps report can help include: » Pre-meetings with support staff / other IJB members to discuss papers and ask questions. » Support with admin e.g. IJB papers; claiming expenses. » Key contact person for IJB-related business and processes who acts as a ‘go to’ for any questions. » Links with organisations that support people with lived experience and carers (e.g. Carers Centres; lived experience orgs/networks). Resources that can help: The Carer Collaborative’s expenses policy template carersnet.org/wp-content/uploads/2021/10/Carer-Expenses-Policy.pdf The Carer Collaborative’s briefing paper on Carers and Equality Impact Assessments carersnet.org/wp-content/uploads/2021/10/Carers-and-EQIA.pdf The ALLIANCE’s Engagement Insights Report alliance-scotland.org.uk/wp-content/uploads/2021/05/Engagement-Insights-Report.pdf Scottish Human Rights Commission’s Paying People with Lived Experience for their Participation: a review of legislation, literature and practice research report scottishhumanrights.com/media/2251/paid-participation-report-vfinal.pdf Scottish Government’s Guidance: Paying participant expenses and compensating for time gov.scot/publications/guidance-paying-participant-expenses-compensating-time/pages/1/ Page 149 of 290
Page 150
12More than equal: Valuing and supporting the expert contribution of people with lived experience Areas for development Actions to support improvement Evaluate the involvement of carers and people with lived experience. Publish findings in Annual Performance Reports to demonstrate progress and impact. • Have regular and robust evaluation processes that enable the impact of Reps’ involvement to be assessed. • Involve Reps in the design of evaluation processes and identification of the outcomes which are important to assess. • Share evaluation feedback with Reps and identify any changes needed to improve involvement processes. • Share details of involvement processes (e.g. how Reps are involved in IJB) and plans for improvements within IJB/HSCP Strategic Plans. Provide details of progress towards actions for improvement and the impact of involvement within HSCP Annual Performance Reports. Monitor progress towards key national outcomes and indicators relating to carers and people with lived experience. • Identify key national outcomes and indicators relating to people with lived experience and carers (e.g. National Health & Wellbeing Outcome 6; National Performance Framework, National Outcomes relating to Human Rights and Health). • Ask for Reps’ views on the key national indicators which would be important to monitor locally. • Report on progress in HSCP Annual Performance Reports. Report transparently on IJB/HSCP financial spend to support carers and people with lived experience. • Provide details of funding awarded and financial spend that is related to supporting people with lived experience and carers (e.g. Carers Act funding) in IJB Annual Accounts and HSCP Annual Performance Reports. Review processes and performance annually against these report recommendations. • Use these recommendations, areas for development and action to develop a framework to monitor progress of involvement locally, and to compare nationally. Recommendation four: Evaluate impact The context The development and implementation of robust, co-designed evaluation processes is essential to understand the impact of involvement. Alongside this, it is important to provide consistent and transparent feedback on progress made, what improvements are needed, and links to wider outcomes frameworks. Clear information about financial spend against support for carers and people with lived experience should also be provided to ensure transparency and enable Reps to fully undertake their roles. What needs to happen Page 150 of 290
Page 151
13More than equal: Valuing and supporting the expert contribution of people with lived experience Resources that can help: Scottish Government’s National Performance Framework nationalperformance.gov.scot Scottish Government’s National Health and Wellbeing Outcomes Framework gov.scot/publications/national-health-wellbeing-outcomes-framework Evaluation Support Scotland’s range of resources and tools to support impact measurement evaluationsupportscotland.org.uk Page 151 of 290
Page 152
14More than equal: Valuing and supporting the expert contribution of people with lived experience To support progress towards the recommendations made in this report, a small selection of good practice examples from across Scotland are provided below. Sharing good practice As noted at the beginning of this report, the Carer Collaborative has been operating for a number of years and the IJB Lived Experience Network has formed more recently, therefore most of these examples are more focused on Carer Rep feedback on involvement practices in their local area. However, as can be seen below, many of the improvements mentioned can equally apply to involvement of Lived Experience Reps. COCIS and the ALLIANCE believe that increased national opportunities for IJB members/key HSCP personnel to come together with Reps from the Carers Collaborative and the IJB Lived Experience Representative Network, would support the sharing of good practice and the development of more consistent, high-quality involvement in IJBs across Scotland. In East Dunbartonshire members of the Public Service User and Carers (PSUC) group receive a full induction to prepare them for their role. An induction meeting takes place with the HSCP Development Officer and a Service User/ Carer Rep who gives them a service user/carer’s viewpoint of the role. A full description of the role and remit is given as well as an induction pack with all the paperwork needed for the role including induction policy; full expenses policy and claim forms; terms of reference; mentoring policy; communications strategy; confidentiality agreement; aide memoire and glossary of terms; code of conduct; training record; meeting preparation and notes forms. Reps also have regular awareness sessions and can request specific topics when they feel they need more information to help them contribute to meeting discussions. Three HSCPs, Falkirk, North Ayrshire and South Ayrshire, publish their expenses policy on their websites (Falkirk HSCP also publish their claim form). In Fife Carer Support Workers (funded by the HSCP) were appointed by the local Carers Centre in early 2020 to engage directly with carers in each of the localities and gather their views and experiences. Carers Strategy funding has also been used to create a new team within the HSCP dedicated to supporting the involvement, participation and engagement of unpaid carers. The Carer Rep noted that the engagement conversations so far have been exceptionally good, with a range of different views and experiences being shared, and excellent collation, analysis and reporting after the meetings. The Carer Rep is now keen to see more carers involved in these engagement meetings, and that the evidence gathered through these engagement activities is listened to more widely and influences policy development and decision-making. Page 152 of 290
Page 153
15More than equal: Valuing and supporting the expert contribution of people with lived experience Final thoughts… Whilst there has been undoubtable and welcome progress in the involvement of carers and people with lived experience on IJBs, this report has highlighted areas where focused attention and action are still needed. Carer and Lived Experience Reps bring huge value to IJBs, sharing their experiences, expertise and knowledge willingly and generously. This requires a significant investment of Reps’ time, which they balance with their other life commitments and responsibilities. The benefits of Carer and Lived Experience Rep involvement in IJBs is significant, supporting the voices and perspectives of carers and those with lived experience to be central to local policy and service development. But as this report highlights, there remain key areas for improvement and development to ensure Reps are seen as equal partners on IJBs with valuable expertise and perspectives to share. The proposed plans, within the National Care Service (Scotland) Bill, to reform and enhance IJBs gives opportunities to formalise the role of Reps and achieve more consistency in relation to support across Scotland. And thanks… This report ends with a huge thanks to all Carer and Lived Experience Reps, who have given, and continue to give, their time, experience and expertise so generously to IJBs to improve health and social care policy, services and support in local areas. A further thanks goes to the Reps who are part of the Carer Collaborative and the IJB Lived Experience Representative Network, whose experience, knowledge and expertise contributes to key national health and social care policy developments, and to the recommendations in this report. In Perth & Kinross representation of carers’ (and lived experience) views has greatly improved since publication of the first COCIS Equal, Expert and Valued report in 2017. The IJB Carer Rep noted that when they started their role seven years ago, they were the only representative member on the IJB which felt very difficult and isolating. The key things which have been improved and made a difference are: there are now four Representatives on the IJB (two carer and two lived experience); there is an established Carers Voice Group which Carer Reps can link with to obtain views; the IJB understands that Carer (and lived experience) Reps have a representative role which is based on the views of a network of carers / people with lived experience. These positive changes mean the role feels less tokenistic and more representative of the wide range of views. In South Lanarkshire, the IJB Lived Experience Rep is also the Chair of the South Lanarkshire Health and Social Care Forum. The Forum has four localities who deal with local issues and feed into the Forum, and, through the Chair, to the IJB. The Forum has 65 members, 15 of whom represent local organisations, thus covering almost 100,000 people in the community. The Forum also has a training and mentoring programme for members to ensure they understand their roles and responsibilities. Members also have representation on a variety of IJB and other subgroups and regularly receive presentations from the Chief Officer and Head of Commissioning and Performance enabling members to actively influence health and social care services. The IJB Lived Experience Rep is also Chair of an Independent Advisor Panel with membership from the Forum, third sector organisations, Chair of the Adult Protection Committee and a senior Union Representative, to ensure any service changes have appropriate consultation. Page 153 of 290
Page 154
The ALLIANCE is the national third sector intermediary for health and social care, bringing together a diverse range of people and organisations who share our vision. We work with our members and partners to ensure lived experience and third sector expertise is listened to and acted upon by informing national policy and campaigns, and putting people at the centre of designing support and services. Since our formation in 2006, the ALLIANCE has built a strong and diverse membership of over 3,600 organisations and individuals. Our vision is a Scotland where everyone has a strong voice and enjoys their right to live well with dignity and respect. Our broad range of programmes and activities deliver support, research and policy development, digital innovation and knowledge sharing. We manage funding and spotlight innovative projects working directly with people, using their experience to find ways to improve wellbeing and support rights-based self-management approaches. E integration@alliance-scotland.org.uk www.alliance-scotland.org.uk The Coalition of Carers exists to advance the voice of carers by facilitating carer engagement and bringing carers and local carer organisations together with decision makers at a national and local level. It is our vision that carers in Scotland will achieve full recognition as equal partners in care. Carers will have the right to quality services and access to personalised support at every stage in their caring role to ensure they enjoy good health and a life outside of caring. E coalition@carersnet.org www.carersnet.org The work of the Carer Collaborative and the IJB Lived Experience Representative Network is funded and supported by the Scottish Government. Page 154 of 290
Page 155
Midlothian Integration Joint Board Annual Audit Plan 2025/26 Prepared for Midlothian Integration Joint Board March 2026 Page 155 of 290
Page 156
Midlothian Integration Joint Board Annual Audit Plan | 2 Contents Introduction 3 Audit scope and responsibilities 4 Audit of the annual accounts 6 Wider scope and Best Value 9 Reporting arrangements, timetable and audit fee 11 Other matters 14 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Page 156 of 290
Page 157
Introduction | 3 Introduction Purpose of the Annual Audit Plan 1. The purpose of this Annual Audit Plan is to provide an overview of the planned scope and timing of the 2025/26 audit of Midlothian Integration Joint Board’s annual accounts. It outlines the audit work planned to meet the audit requirements set out in auditing standards and the Code of Audit Practice, including supplementary guidance. Appointed auditor and independence 2. Claire Gardiner, of Audit Scotland, has been appointed by the Accounts Commission as external auditor of Midlothian Integration Joint Board for the period from 2022/23 until 2026/27. The 2025/26 financial year is therefore the fourth of the five-year audit appointment. 3. The appointed auditor and the audit team are independent of Midlothian Integration Joint Board in accordance with relevant ethical requirements, including the Financial Reporting Council’s Ethical Standard. This standard imposes stringent rules to ensure the independence and objectivity of auditors. Audit Scotland has robust arrangements in place to ensure compliance with ethical standards. The arrangements are overseen by the Executive Director of Innovation and Quality, who serves as Audit Scotland’s Ethics Partner. 4. The Ethical Standard requires auditors to communicate any relationships that may affect the independence and objectivity of the audit team. There are no such relationships pertaining to the audit of Midlothian Integration Joint Board to communicate. Page 157 of 290
Page 158
Audit scope and responsibilities | 4 Audit scope and responsibilities Scope of the audit 5. The audit is performed in accordance with the Code of Audit Practice, including supplementary guidance, International Standards on Auditing (UK), and relevant legislation. These set out the requirements for the scope of the audit which includes: • An audit of the financial statements and an opinion on whether they give a true and fair view and are free from material misstatement. • An opinion on statutory other information published with the financial statements in the annual accounts, the Management Commentary and the Annual Governance Statement and an opinion on the audited part of the Remuneration Report. • Conclusions on Midlothian Integration Joint Board’s arrangements in relation to the wider scope areas: Financial Management, Financial Sustainability, Vision, Leadership, and Governance, and Use of Resources to Improve Outcomes. • Reporting on Midlothian Integration Joint Board’s arrangements for securing Best Value. • Provision of an Annual Audit Report setting out significant matters identified from the audit of the annual accounts and the wider scope areas specified in the Code of Audit Practice. Responsibilities 6. The Code of Audit Practice sets out the respective responsibilities of Midlothian Integration Joint Board and the auditor. A summary of the key responsibilities is outlined below. Auditor’s responsibilities 7. The responsibilities of auditors in the public sector are established in the Local Government (Scotland) Act 1973. These include providing an independent opinion on the financial statements and other information reported within the annual accounts, and concluding on Midlothian Integration Joint Board’s arrangements in place for the wider scope areas. Midlothian Integration Joint Board’s responsibilities 8. Midlothian Integration Joint Board has primary responsibility for ensuring proper financial stewardship of public funds, compliance with Page 158 of 290
Page 159
Audit scope and responsibilities | 5 relevant legislation and establishing effective arrangements for governance, propriety and regularity that enables it to successfully deliver its objectives. The features of proper financial stewardship include: • Establishing arrangements to ensure the proper conduct of its affairs. • Preparation of annual accounts, comprising financial statements that give a true and fair view and other information. • Establishing arrangements for the prevention and detection of fraud, error and irregularities, and bribery and corruption. • Implementing arrangements to ensure its financial position is soundly based. • Making arrangements to secure Best Value. • Establishing an internal audit function. Page 159 of 290
Page 160
Audit of the annual accounts | 6 Audit of the annual accounts Introduction 9. The audit of the annual accounts is driven by materiality and the risks of material misstatement in the financial statements, with greater attention being given to the significant risks of material misstatement. This chapter outlines materiality, the significant risks of material misstatement that have been identified, and the impact these have on the planned audit procedures. Materiality 10. The concept of materiality is applied by auditors in planning and performing an audit, and in evaluating the effect of any uncorrected misstatements on the financial statements or other information reported in the annual accounts. 11. Materiality is used to determine whether matters identified during the audit could reasonably be expected to influence the decisions of users of the financial statements. Auditors set a monetary threshold when determining materiality, although some issues may be considered material by their nature. Therefore, materiality is ultimately a matter of the auditor’s professional judgement. 12. The materiality levels determined for the audit of Midlothian Integration Joint Board are outlined in Exhibit 1. Exhibit 1 2025/26 Materiality levels for Midlothian Integration Joint Board Materiality Midlothian Integration Joint Board Materiality – based on an assessment of the needs of users of the financial statements and the nature of Midlothian Integration Joint Board’s operations, the benchmark used to determine materiality is gross expenditure based on the audited 2024/25 financial statements. Materiality has been set at 2% of the benchmark. £4.0 million Performance materiality – this acts as a trigger point. If the aggregate of misstatements identified during the audit exceeds performance materiality, this could indicate that further audit procedures are required. £3.0 million Page 160 of 290
Page 161
Audit of the annual accounts | 7 Materiality Midlothian Integration Joint Board Using professional judgement, performance materiality has been set at 75% of planning materiality. Reporting threshold – all misstatements greater than the reporting threshold will be reported. £0.2 million Source: Audit Scotland Significant risks of material misstatement to the financial statements 13. The risk assessment process draws on the audit team’s cumulative knowledge of Midlothian Integration Joint Board, including: • the nature of its operations and its significant transaction streams • the system of internal control • governance arrangements and processes; and • developments that could impact on its financial reporting. 14. Based on the risk assessment process, significant risks of material misstatement to the financial statements have been identified and these are summarised in Exhibit 2. These are the risks which have the greatest impact on the planned audit approach, and the planned audit procedures in response to the risks are outlined in Exhibit 2. 15. The risk assessment process is an iterative and dynamic process. The assessment of risks set out in this Annual Audit Plan and Exhibit 2 may change as more information and evidence is obtained over the course of the audit. Where such changes occur, these will be reported to Midlothian Integration Joint Board and those charged with governance, where relevant. Exhibit 2 Significant risks of material misstatement to the financial statements Risk of material misstatement Planned audit response Fraud caused by management override of controls Management is in a unique position to perpetrate fraud because of management’s ability to override • Agreement of balances and transactions to Midlothian Council and NHS Lothian financial reports, the General Ledger and relevant correspondence. Page 161 of 290
Page 162
Audit of the annual accounts | 8 Risk of material misstatement Planned audit response controls that otherwise appear to be operating effectively. • Constituent body auditor assurances will be obtained over the completeness, accuracy and allocation of income and expenditure to Midlothian Integration Joint Board activities included in the annual accounts. • Significant adjustments at the year-end will be reviewed where we consider there to be the greatest risk of material misstatement through management override of controls. • We will evaluate any significant unusual transactions outside the normal course of business. • Assess the adequacy of controls in place for identifying and disclosing related party relationships and transactions in the financial statements. Source: Audit Scotland Key audit matters 16. The Code of Audit Practice requires public sector auditors to communicate key audit matters. Key audit matters are those matters, that in the auditor’s professional judgement, are of most significance to the audit of the financial statements and require most attention when performing the audit. 17. In determining key audit matters, auditors consider: • Areas of higher or significant risk of material misstatement. • Areas where significant judgement is required, including accounting estimates that are subject to a high degree of estimation uncertainty. • Significant events or transactions that occurred during the year. 18. The matters determined to be key audit matters will be communicated in the Annual Audit Report. Page 162 of 290
Page 163
Wider scope and Best Value | 9 Wider scope and Best Value Introduction 19. Reflecting the fact that public money is involved, the Code of Audit Practice requires that public audit is planned and undertaken from a wider perspective than in the private sector. The wider scope audit set out by the Code of Audit Practice broadens the audit of the annual accounts to include consideration of additional aspects or risks in four wider scope areas, which are summarised below: • Financial Management – this means having sound budgetary processes. Factors that can impact on Midlothian Integration Joint Board being able to secure sound financial management include the strength of the financial management culture, accountability, and arrangements to prevent and detect fraud, error and other irregularities, bribery and corruption. • Financial Sustainability – this means looking forward over the medium and longer term in planning the services to be delivered and how they will be delivered effectively. This is assessed by considering Midlothian Integration Joint Board’s medium to longer- term planning for service delivery. • Vision, Leadership and Governance – this means having a clear vision and strategy, with set priorities within the vision and strategy. This is assessed by considering the clarity of plans in place to deliver the vision and strategy and the effectiveness of the governance arrangements to support delivery. The Interim Chief Finance Officer is due to resign from Midlothian Integration Joint Board and arrangements are ongoing to appoint a successor to the role. We will continue to review the arrangements and monitor the processes in place to ensure continued financial management arrangements and compliance with the Public Bodies (Joint Working Integration Joint Boards) (Scotland) Order 2014. • Use of Resources to Improve Outcomes – this means using resources to meet stated outcomes and improvement objectives through effective planning and working with partners and communities. This is assessed by considering Midlothian Integration Joint Board’s arrangements for ensuing resources are deployed to improve strategic outcomes, meet the needs of service users, and deliver continuous improvement. Page 163 of 290
Page 164
Wider scope and Best Value | 10 20. A conclusion on the effectiveness and appropriateness of the arrangements Midlothian Integration Joint Board has in place for each of the wider scope areas will be reported in the Annual Audit Report. Best Value 21. Under the Code of Audit Practice, the duty on auditors to consider the arrangements an audited body has in place to secure Best Value applies to audited bodies that fall within section 106 of the Local Government (Scotland) Act 1973, which the Midlothian Integration Joint Board does. 22. Consideration of the arrangements Midlothian Integration Joint Board has in place to secure Best Value will be carried out alongside the wider scope audit, and a conclusion on the arrangements Midlothian Integration Joint Board has in place will be reported in the Annual Audit Report. Significant wider scope and Best Value risks 23. The risk assessment process has identified a significant risk in the wider scope areas and Best Value as outlined in Exhibit 3, and this includes the planned audit procedures in response to the risk. Exhibit 3 Significant wider scope and Best Value risks Description of risk Planned audit response Financial sustainability In recent years, Midlothian Integration Joint Board has achieved short-term financial balance through a variety of measures including the use of reserve balances, which have now been depleted. The latest financial monitoring reports highlight that the IJB is continuing to face significant challenges in delivering financial balance in 2025/26 and over the medium term. A recovery plan needs to be agreed with partners to address the budget gap for 2025/26. The audit team will: • Review progress against the 2025/26 financial recovery actions • Review any medium-term financial plans developed and assess the appropriateness of the financial plans and any assumptions made. • Discuss with management the progress made in obtaining any additional funding. Source: Audit Scotland Page 164 of 290
Page 165
Reporting arrangements, timetable and audit fee | 11 Reporting arrangements, timetable and audit fee Audit outputs 24. The outputs from the 2025/26 audit include: • This Annual Audit Plan. • An Independent Auditor’s Report to Midlothian Integration Joint Board and the Accounts Commission setting out opinions on the annual accounts. • An Annual Audit Report to Midlothian Integration Joint Board and the Accounts Commission setting out significant matters identified from the audit of the annual accounts, conclusions from the wider scope and Best Value audit, recommendations, and any good practice identified. 25. The matters to be reported in the outputs will be discussed with Midlothian Integration Joint Board for factual accuracy before they are issued. All outputs from the audit will be published on Audit Scotland’s website, apart from the Independent Auditor’s Report, which is included in the audited annual accounts. 26. Target dates for the audit outputs are set by the Accounts Commission. In setting the target dates for the audit outputs, consideration is given to the target date for approving the annual, which is 30 September 2026 for local government bodies. 27. The Independent Auditor’s Report and Annual Audit Report are planned to be issued by the target date of 30 September 2026. Audit timetable 28. Achieving the timetable for production of the annual accounts, supported by complete and accurate working papers, is critical to delivery of the audit to agreed target dates. Exhibit 4 includes a timetable for the audit, which has been agreed with management. Agreed target dates will be kept under review as the audit progresses, and any changes required, and their potential impact, will be discussed with Midlothian Integration Joint Board and reported to those charged with governance, where required. Page 165 of 290
Page 166
Reporting arrangements, timetable and audit fee | 12 Exhibit 4 2025/26 audit timetable Audit activity Midlothian IJB target date Audit team target date Relevant committee date Issue of Annual Audit Plan N/A 31 March 2026 5 March 2026 Annual Accounts • Consideration of unaudited annual accounts by those charged with governance 30 June 2026 N/A 4 June 2026 • Submission of unaudited annual accounts and all working papers to audit team 30 June 2026 N/A N/A • Latest date for audit clearance meeting 20 August 2026 20 August 2026 N/A • Issue of draft Letter of Representation, proposed Independent Auditor’s Report, and proposed Annual Audit Report N/A 3 September 2026 10 September 2026 • Agreement of audited and unsigned annual accounts 30 September 2026 30 September 2026 24 September 2026 • Approval by those charged with governance and signing of audited annual accounts 30 September 2026 30 September 2026 24 September 2026 • Signing of Independent Auditor’s Report and issue of Annual Audit Report 30 September 2026 30 September 2026 24 September 2026 Source: Audit Scotland Audit fee 29. Midlothian Integration Joint Board’s audit fee is determined in line with Audit Scotland’s fee setting arrangements. The proposed audit fee for the 2025/26 audit is £35,480 (2024/25: £34,000). 30. In setting the audit fee, it is assumed that Midlothian Integration Joint Board has effective governance arrangements in place and the complete annual accounts will be provided for audit in line with the agreed timetable. The audit fee assumes there will be no significant changes to the planned scope of the audit. Where the audit cannot proceed as planned, for Page 166 of 290
Page 167
Reporting arrangements, timetable and audit fee | 13 example, due to incomplete or inadequate working papers, the audit fee may need to be increased. Page 167 of 290
Page 168
Other matters | 14 Other matters Internal audit 31. Midlothian Integration Joint Board is responsible for establishing an internal audit function as part of an effective system of internal control. As part of the audit, the audit team will obtain an understanding of internal audit, including its nature, responsibilities, and activities. 32. While internal audit and external audit have differing roles and responsibilities, external auditors may seek to rely on the work of internal audit where it is considered appropriate. A review of internal audit’s 2025/26 audit plan was carried out to identify if there were any areas where the audit team could rely on its work. The audit team concluded it will not rely on internal audit’s work. However, the audit team will review internal audit’s reports and assess if there is any impact on the audit. Audit quality 33. Audit Scotland is committed to the consistent delivery of high-quality audit. Audit quality requires ongoing attention and improvement to keep pace with external and internal changes. Details of the arrangements in place for the delivery of high-quality audits is available from the Audit Scotland website. 34. The International Standards on Quality Management (ISQM) applicable to Audit Scotland for 2025/26 audits are: • ISQM (UK) 1, which deals with an audit organisation’s responsibilities to design, implement, and operate a system of quality management (SoQM) for audits. Audit Scotland’s SoQM consists of a variety of components, such as governance arrangements and culture to support audit quality, compliance with ethical requirements, ensuring Audit Scotland is dedicated to high- quality audit through engagement performance and resourcing arrangements, and ensuring there are robust quality monitoring arrangements in place. Audit Scotland carries out an annual evaluation of its SoQM and has concluded it complies with this standard. • ISQM (UK) 2, which sets out arrangements for conducting engagement quality reviews, which are performed by senior management not involved in an audit, to review significant judgements and conclusions reached by the audit team, and the appropriateness of proposed audit opinions on high-risk audits. Page 168 of 290
Page 169
Other matters | 15 35. To monitor quality at an individual audit level, Audit Scotland carries out internal quality reviews on a sample of audits. Additionally, the Institute of Chartered Accountants of England and Wales (ICAEW) carries out independent quality reviews on a sample of audits. 36. Actions to address deficiencies identified by internal and external quality reviews are included in a rolling Quality Improvement Action Plan, which is used to support continuous improvement. Progress with implementing planned actions is monitored on a regular basis by Audit Scotland’s Quality and Ethics Committee. 37. Audit Scotland may periodically seek the views of Midlothian Integration Joint Board on the quality of audit services provided. The audit team would also welcome feedback at any time. Page 169 of 290
Page 170
Midlothian Integration Joint Board Annual Audit Plan 2025/26 Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 www.audit.scot AS.5.0 Page 170 of 290
Page 171
Midlothian IJB Audit and Risk Committee Thursday, 5th March 2026, 14:00-16:00 Midlothian Integration Joint Board Internal Audit Plan 2026/27 Executive summary The purpose of this report is to gain approval to the proposed Internal Audit Annual Plan 2026/27 for the Midlothian Integration Joint Board (MIJB) to enable the MIJB Chief Internal Auditor to prepare the annual opinion on the adequacy of the overall control environment of the Midlothian Integration Joint Board. As a result of this report, Members are asked to: • Note the content of Midlothian IJB Internal Audit Annual Plan 2026/27 • Approve the Midlothian IJB Internal Audit Annual Plan 2026/27 (Appendix 1). Item number: 5.4 Page 171 of 290
Page 172
Midlothian Integration Joint Board Report Midlothian Integration Joint Board Internal Audit Plan 2026/27 1 Purpose 1.1 The purpose of the Report is to present the proposed Internal Audit Annual Plan 2026/27 for the Midlothian Integration Joint Board for discussion and approval by the MIJB Audit and Risk Committee. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the content of Midlothian IJB Internal Audit Annual Plan 2026/27 • Approve the Midlothian IJB Internal Audit Annual Plan 2026/27 (Appendix 1). 3 Background and main report 3.1 Internal Audit activity adds value to the organisation (and its stakeholders) when it considers strategies, objectives, and risks; strives to offer ways to enhance governance, risk management and control processes; and objectively provides relevant assurance. The Internal Audit programme of work is designed to add value to and improve the Midlothian Integration Joint Board’s operations in order to meet the objectives set out in the Strategic Plan. 3.2 Global Internal Audit Standard 9.4 on the preparation of the Internal Audit Plan states the following: The chief audit executive must create an internal audit plan that supports the achievement of the organisation’s objectives. 3.3 The chief audit executive must base the internal audit plan on a documented assessment of the organisation’s strategies, objectives, and risks. This assessment must be informed by input from the board and senior management as well as the chief audit executive’s understanding of the organisation’s governance, risk management, and control processes. The assessment must be performed at least annually. The internal audit plan must: • Consider the internal audit mandate and the full range of agreed-to internal audit services. Page 172 of 290
Page 173
Midlothian Integration Joint Board • Specify internal audit services that support the evaluation and improvement of the organisation’s governance, risk management, and control processes. • Consider coverage of information technology governance, fraud risk, the effectiveness of the organisation’s compliance and ethics programs, and other high-risk areas. • Identify the necessary human, financial, and technological resources necessary to complete the plan. • Be dynamic and updated timely in response to changes in the organisation’s business, risks operations, programs, systems, controls, and organisational culture. 3.4 The chief audit executive must discuss the internal audit plan, including significant interim changes, with the board and senior management. The plan and significant changes to the plan must be approved by the board. The Audit & Risk Committee in approving the plan is acting within the delegated authority to do so by the MIJB Board. 3.5 The Internal Audit Annual Plan 2026/27 for the MIJB (Appendix 1) includes 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. 3.6 At the end of the year the Internal Audit Annual Assurance Report 2026/27 for the MIJB which will be reported to Management and to the MIJB Audit and Risk Committee, for governance and scrutiny purposes, will include the audit opinion based on the audit work during the year, and will state the results from each audit engagement outlining the risks, controls and conclusions. It will also state any Internal Audit recommendations that have been made to improve internal controls and governance in the form of an improvement action plan that will include the responsible owner and timescale for implementation. The outcomes of any monitoring of implementation of agreed actions or acceptance of risk will also be stated. 3.7 The Internal Audit findings and annual opinion will be used to inform the MIJB’s Annual Governance Statement for inclusion in the MIJB’s Annual Report and Accounts. 4 Policy Implications 4.1 This report does not directly impact upon any policies. 5 Directions 5.1 This report does not directly impact upon service delivery ability to deliver an existing Direction. Page 173 of 290
Page 174
Midlothian Integration Joint Board 6 Equalities Implications 6.1 There are no equalities implications. 7 Resource Implications 7.1 There is a commitment by Midlothian Council to provide Internal Audit resource to the MIJB. The Midlothian Council Internal Audit Annual Plan 2026/27, was presented to its Audit Committee on 23 February 2026 for approval, allocates a total of 30 days to support the MIJB Internal Audit Annual Plan 2026/27, 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 Global Internal Audit Standards and the approach to the planning, delivery and reporting of Internal Audit activity associated with the MIJB. 7.2 There is a commitment by NHS Lothian to provide Internal Audit resource to the MIJB, it is understood that this will continue with the appointment of a new Internal Audit contract. The NHS Lothian Internal Audit team resource allocated to the MIJB which will be reflected in the NHS Lothian Internal Audit Annual Plan 2026/27 that is scheduled for presentation to its Audit and Risk Committee for approval in accordance with its Internal Audit governance. 8 Risk 8.1 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 have been 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 2026/27 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. 8.2 The MIJB Internal Audit Annual Plan 2026/27 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. Page 174 of 290
Page 175
Midlothian Integration Joint Board 9 Involving people 9.1 Consultation on this Plan has been undertaken with the MIJB Chief Officer, Chief Finance Officer and the HSCP Integration Manager, and Executive Business Manager prior to submission to the MIJB Audit and Risk Committee. 10 Background Papers 10.1 None. 11 Governance This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. X This report includes information that should be escalated to Midlothian IJB for noting only. √ This report is the Audit and Risk Committee’s Business as Usual (BAU) and does not require Midlothian IJB’s review. X Author’s Name Duncan Stainbank Designation MIJB Chief Internal Auditor Contact Information Duncan.Stainbank@midlothian.gov.uk Date 25/02/2026 Appendices: Appendix 1: Midlothian IJB Internal Audit Annual Plan 2026/27 Page 175 of 290
Page 176
Page 176 of 290
Page 177
Midlothian Health and Social Care Integration Joint Board Internal Audit Annual Plan 2026/27 Appendix 1 Ref Category Audit Days Commentary 1. Assurance Annual Assessment of Internal Control and Governance 5 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 Performance Management To be Confirmed NHS Lothian Internal Audit team will deliver this Audit. Provide assurance that a strategic governance processes is in place that has reported performance information in line with best practice and regulatory requirement to the MIJB Board. 3. Assurance Financial Recovery Plan Governance, Reporting and Management. 10 Provide assurance that a strategic governance processes is in place to ensure that financial recovery plans are being developed, managed and monitored in conjunction with partner operational governance processes to deliver appropriate financial assurance in conjunction with partner operational planning. Page 177 of 290
Page 178
Ref Category Audit Days Commentary 4. Other Recommendations Follow Up Review 6 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 3 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 4 Prepare for and attend MIJB Board / Audit and Risk Committee meetings. 8. Other Audit Planning for 2026/27 1 Renew risk assessment, develop and consult on proposed coverage within the MIJB Internal Audit Annual Plan 2027/28. Total 30 plus NHS support Midlothian Council’s Internal Audit function will provide 30 days and NHS Lothian Internal Audit team will provide resources to support the delivery of the Plan in conjunction with plans to be completed. Page 178 of 290
Page 179
Midlothian IJB Auditand Risk Committee Thursday, 5th March 2026, 14.00-16:00 Midlothian IJB draft Performance Framework 2025-2028 (revised) Executive summary This report presents a revised Draft Performance Framework 2025/28 (appendix 1), realigned with draft Directions for 2026/27. As a result of this report, Members are asked to: • Review and provide feedback on the revised Draft Performance Framework 2025/28, • Subject to any amendment required by the Board to Directions 2026/27 at the March 26th Special Board meeting, approve this framework for publication, and • Note the requirement to review the Midlothian IJB Performance Framework annually. Item number: 5.5 Page 179 of 290
Page 180
Midlothian Integration Joint Board Report Midlothian IJB draft Performance Framework 2025-2028 (revised) 1 Purpose 1.1 This report presents a revised Draft Performance Framework 2025/28 (appendix 1), realigned with draft Directions for 2026/27. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Review and provide feedback on the revised Draft Performance Framework 2025/28, • Subject to any amendment required by the Board to Directions 2026/27 at the March 26th Special Board meeting, approve this framework for publication, and • Note the requirement to review the Midlothian IJB Performance Framework annually. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Content of Performance Reports) (Scotland) Regulations 2014 state that performance reports must include: • an assessment of performance in relation to the integration authority’s strategic plan • an assessment of performance in relation to the national health and wellbeing outcomes, including; - a description of the extent to which arrangements set out in the strategic plan and the expenditure allocated in the financial statement have achieved, or contributed to achieving, the national health and wellbeing outcomes - information on the integration authority’s performance against the national indicators (including a comparison between the reporting year and the five preceding reporting years) • information about the number of significant decisions that have been made outside of strategic planning and reasons for such decisions. 3.2 The regulations state that performance must be measured in the context of the arrangements set out in strategic plans. The national health and wellbeing outcomes and core integration indicators are the tools made available to integration authorities to achieve this. Page 180 of 290
Page 181
Midlothian Integration Joint Board 3.3 The national health and wellbeing outcomes are set out in the Public Bodies (Joint Working) (National Health and Wellbeing Outcomes) (Scotland) Regulations 2014, and focus on the experiences and quality of services for people using those services, carers and their families. 3.4 The suite of core integration indicators were developed and agreed by the Ministerial Strategic Group for Health and Community Care. Public Health Scotland (PHS) publishes the data for these indicators online. Integration authorities are required to use these indicators as evidence of local progress towards the national health and wellbeing outcomes. 3.5 Scottish Government guidance states that integration joint boards should utilise performance reports as part of the process to assess the effectiveness of directions issued to health boards and local authorities, in the delivery of the aims as defined in their strategic plan. This should include learning from experience, recognising successes and considering interventions where insight and information indicates that ambitions are not being met, or where performance is falling short of expectations. 3.6 The first Performance Framework to support the delivery of this plan was published alongside the strategic plan in October 2025. The Framework consists of five sections, each designed to meet the specific legislative duties of integration authorities to report their performance as set out above. 3.7 Following the process of development and approval of Directions for 2026/27, the Performance Framework requires to be revised and published. Section 4 of the sets out the Midlothian IJB Directions for 2026/27, and provides detailed information relating to individual measures and data sources. The format of the previous Performance Framework has been retained for continuity of presentation. 3.8 Sections 1-3 and 5 of the Performance Framework (see below) do not require to be updated at this stage, and the format of the previous Performance Framework has been retained for continuity of presentation: • National Health and Wellbeing Outcomes, • Midlothian IJB Strategic Aims 2025-2035, • Midlothian IJB Strategic Governance Map, • Ministerial Steering Group Indicators 2026/27. 3.9 Midlothian IJB are now asked to review and provide feedback on the Draft Performance Framework, and subject to any amendment, approve this framework for publication. 4 Policy Implications 4.1 There are no direct policy implications as a result of this report. Page 181 of 290
Page 182
Midlothian Integration Joint Board 5 Directions 5.1 This report does not have a direct impact on Directions at this time. 5.2 The Performance Framework to support the delivery of this plan will be published alongside the strategic plan in October. The draft Midlothian IJB Performance Framework 2025-2028 includes a rigorous system of reporting on Directions. The part year reporting on Directions will be scrutinised by the Strategic Planning Group on 3rd September 2026 and brought to the Midlothian IJB Board meeting on 8th October 2026. 5.3 Performance reporting will include and insight report and gap analysis. The result of this reporting may require corrective action and planning to revise Directions for 2026/27 and 2027/28. 5.4 As such, the Audit and Risk Committee should note that while there is a requirement for IJBs to have a Performance Framework in place that aligns with their 3 year strategic plan, the Midlothian IJB Performance Framework will be reviewed on at last an annual basis to remain current. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. 7 Resource Implications 7.1 There are no new direct financial implications as a result of this report. 8 Risk 8.1 With limited opportunities for review, any delay at this stage is likely to cause delay to the final publication date. 9 Involving people 9.1 Board members, officers of the HSCP, services, partner organisations, and people and communities have been involved in the process to establish the Strategic Plan 2025- 35 and the suite of documents that accompany it, including this Performance Framework. Page 182 of 290
Page 183
Midlothian Integration Joint Board 10 Background Papers 10.1 None 11 Governance This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. X This report includes information that should be escalated to Midlothian IJB for noting only. X This report is the Audit and Risk Committee’s Business as Usual (BAU) and does not require Midlothian IJB’s review. √ Author’s Name Gill Main Designation Integration Manager Contact Information Via email or MS Teams Date 24/02/2026 Appendices: Appendix 1: Midlothian IJB draft Performance Framework 2025-2028 (revised) Page 183 of 290
Page 184
Page 184 of 290
Page 185
Midlothian Integration Joint Board Performance Framework 2025-2028 (Year 2) Page 185 of 290
Page 186
Contents National Health and Wellbeing Outcomes ................................................................. 3 Midlothian IJB Strategic Aims 2025-2035 .................................................................. 13 Midlothian IJB Strategic Governance Map ................................................................ 14 Midlothian IJB Directions 2025/26 ............................................................................. 15 Ministerial Steering Group Indicators 2025/26 ................................................. 37 Page 186 of 290
Page 187
National Health and Wellbeing Outcomes 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. Expectations: • I am supported to look after my own health and wellbeing • I am able to live a healthy life for as long as possible • I am able to access information. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual National Indicators Adults are able to look after their health very well or quite well. Premature Mortality Rate (People under 75) Emergency Admission Rate Page 187 of 290
Page 188
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. Expectations: • I am able to live as independently as possible for as long as I wish • Community based services are available to me • I can engage and participate in my community. National Indicator Adults supported at home agreed that they are supported to live as independently as possible. Adults supported at home agreed they had a say in how their help, care or support was provided. Emergency Admission Rate. Emergency Bed Day Rate. Readmission to hospital within 28 days. Proportion of the last 6 months of life spent at home or a community setting. Falls Rate (People over 65 admitted to hospital as an emergency). Adults with intensive care needs are receiving care at home. The number of days people aged over 75 spend in hospital when they are ready to be discharged. Page 188 of 290
Page 189
Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual National Indicator Health and Care resource spent on hospital stays where the person was admitted as an emergency. Page 189 of 290
Page 190
3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected Expectations: • I have my privacy respected • I have positive experiences of services • I feel that my views are listened to • I feel that I am treated as a person by the people doing the work - we develop a relationship that helps us to work well together • Services and support are reliable and respond to what I say. Data source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual National Indicator Adults supported at home agreed they had a say in how their help, care or support was provided. Adults supported at home agreed that their health and social care services seemed to be well coordinated. Adults receiving care or support rated it as excellent or good. Adults had a positive experience of the care provided by their GP practice. Readmission to hospital within 28 days. Proportion of the last 6 months of life spent at home or a community setting. The number of days people aged over 75 spend in hospital when they are ready to be discharged. Page 190 of 290
Page 191
Expectations: • I'm supported to do the things that matter most to me • Services and support help me to reduce the symptoms that I am concerned about • I feel that the services I am using are continuously improving • The services I use improve my quality of life. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. National Indicator Adults receiving care or support rated it as excellent or good. Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life. Emergency Bed Day Rate Readmission to hospital within 28 days Falls Rate (People over 65) The number of days people aged over 75 spend in hospital when they are ready to be discharged. Health and Care resource spent on hospital stays where the person was admitted as an emergency. Page 191 of 290
Page 192
Expectations: • My local community gets the support and information it needs to be a safe and healthy place to be • Support and services are available to me • My individual circumstances are taken into account Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual 5 Health Inequalities Health & social care services contribute to reducing health inequalities. National Indicator Premature Mortality Rate (People under 75) Emergency Admission Rate Page 192 of 290
Page 193
6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Expectations: • I feel I get the support I need to keep on with my caring role for as long as I want to do that • I am happy with the quality of my life and the life of the person I care for • I can look after my own health and wellbeing. Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual National Indicator Carers feel supported to continue in their caring role. Page 193 of 290
Page 194
7 Safe from Harm People using health & social care services are safe from harm. Expectations: • I feel safe and am protected from abuse and harm • Support and services I use protect me from harm • My choices are respected in making decisions about keeping me safe from harm. Indicators: Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual National Indicator Adults supported at home agreed they felt safe. Emergency Admission Rate Emergency Bed Day Rate Readmission to hospital within 28 days. Falls Rate (People over 65) Care services graded Good or better in Care Inspectorate Inspections. Health and Care resource spent on hospital stays where the person was admitted as an emergency. Page 194 of 290
Page 195
Expectations: • I feel that the outcomes that matter to me are taken account of in my work • I feel that I get the support and resources I need to do my job well • I feel my views are taken into account in decisions. There are no National Indicators to measure our progress towards this outcome, so we use staff surveys and other local information to evaluate our performance. Data Source Frequency iMatter Annual 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. Page 195 of 290
Page 196
9 Use of Resources Resources are used effectively and efficiently. Expectations: • I feel resources are used appropriately • Services and support are available to me when I need them • The right care for me is delivered at the right time. Indicators: Data Source Frequency Health and Care Experience Survey Bi-Annual Core Suite of Integration Indicators Annual Midlothian Health and Wellbeing Survey Annual National Indicator Adults supported at home agreed that their health and social care services seemed to be well coordinated. Emergency Admission Rate Proportion of the last 6 months of life spent at home or a community setting. Falls Rate (People over 65) The number of days people aged over 75 spend in hospital when they are ready to be discharged. Health and Care resource spent on hospital stays where the person was admitted as an emergency. Page 196 of 290
Page 197
Midlothian IJB Strategic Aims 2025-2035 Aim Data Source Frequency Direction 1 People feel able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. What we are trying to achieve People can easily find the information they need to make good decisions. People achieve the things that matters most to them, and our services are confident of what our contribution is to their success. People access services that are designed around how they live their lives. MIJB Strategic Governance Outcomes Map Service outcome data Annual End of Strategic Plan period 1 4 5 2 People access the care and support they need when they need it in the community and at home. What we are trying to achieve 2.1 People easily access the services that help them stay well, independent, and active. 2.2 People have access to services in their own community. 2.3 People are living in the place of their choosing for longer. MIJB Strategic Governance Outcomes Map Service outcome data Annual End of Strategic Plan period 2 2 2 3 People's human, social, and economic rights are protected and promoted in how we design and deliver our services What we are trying to achieve 3.1 People are recognised as an expert in their own experiences, and are involved in planning services, and feel valued. 3.2 People’s care and support adapts when their needs, choices and decisions change and can control their own care and support if this is what they want. 3.3 People benefit from organisations working together and sharing information safely. MIJB Strategic Governance Outcomes Map Service outcome data Annual End of Strategic Plan period 3 and 6 7 8 and 9 * Not all services are currently using outcome mapping so local service outcome data will also be used. Page 197 of 290
Page 198
Midlothian IJB Strategic Governance Map Page 198 of 290
Page 199
15 Midlothian IJB Directions 2026/27 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. No Direction 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? 1.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by March 2027. Completion of integrated Public Communication Strategy and Action Plan. By March 2027, Midlothian HSCP will publish an integrated Public Communication Strategy and Action Plan. HSCP Governance Documentation HSCP website 1.4 Midlothian Council will support Midlothian HSCP as part of the redesign of the Midlothian Council website and ongoing provision of the Midlothian IJB and HSCP webpages in a way that ensures compliance with our duties in relation to the Equality Act, 2010 and accessibility standards by March 2027. Completion of review Completion of the redesign and / or refresh of all publicly available information Number of web pages reviewed Number of web pages redesigned Number of webpages refreshed By March 2027, 100% of Midlothian HSCP’s webpages will meet the following standards: • Compliance with Midlothian IJB ‘Writing for Publication Style Guide’ • Compliance with the Equality Act 2010 and accessibility standards HSCP Website Action Tracker HSCP Website Change Log Page 199 of 290
Page 200
16 No Direction 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? 1.5 NHS Lothian and Midlothian council will support Midlothian HSCP to improve the experience of people in Midlothian who are living with dementia by implementing a Dementia Framework in line with the Dementia Strategy for Scotland - Everyone’s Story (2023–2033), translating the five national outcomes into local actions, measures, and governance by July 2027. Development, approval and implementation of a Midlothian HSCP Dementia Framework. By July 2027, Midlothian HSCP will provide assurance of a delivery plan that has translated the five national outcomes into local actions, measures, and governance. HSCP Governance Documentation Page 200 of 290
Page 201
17 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 Direction 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? 2.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop a set of focused ambitions for change alongside the Community Planning Partnership as it reviews the Single Midlothian Plan. This should focus on services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible through co- design and partner agreement to co- deliver the ‘Midlothian will be healthier’ component of the Single Midlothian Plan alongside people, communities and community partners, by July 2027. The development of a set of focused ambitions for change within the ‘Midlothian will be healthier’ component of the Single Midlothian Plan. By July 2027, Midlothian HSCP will provide assurance of: • a focus on services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible, • co-design and partner agreement to co-deliver the ‘Midlothian will be healthier’ component of the Single Midlothian Plan alongside HSCP Governance Documentation Single Midlothian Plan Page 201 of 290
Page 202
18 No Direction 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? people, communities and community partners. 2.4 NHS Lothian and Midlothian Council will support Midlothian HSCP to undertake a review of Social Work and Occupational Therapy teams by December 2026. This will include supporting existing data sharing agreements, reaching agreement on necessary data sharing requirements, and the development of data insight and visualisation tools that combine key social work data with financial information to inform effective service decision making and financial management. Completion of review. By December 2026, Midlothian HSCP will provide assurance that they have undertaken a review of Social Work and Occupational Therapy teams. HSCP Service records HSCP Governance Documentation 2.5 NHS Lothian and Midlothian Council will support Midlothian HSCP to deliver on the duty of the Care Reform (Scotland) Act that requires all commissioned activity to be Midlothian HSCP delivery on the duty of the Care Reform (Scotland) Act to ensure that all commissioned activity has been By December 2027, Midlothian HSCP will provide assurance that all commissioned activity has HSCP Commissioning and Procurement records Page 202 of 290
Page 203
19 No Direction 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? aligned with our Strategic Plan 2025- 2035 by December 2027. aligned with our Strategic Plan 2025-2035. been aligned with our Strategic Plan 2025-2035. HSCP Governance Documentation 2.6 Midlothian Council will continue to work alongside Midlothian HSCP to deliver a shared Transitions Policy by December 2026. This work should take a phased approach and move away from single service provision to a holistic and whole-system approach as the support people need adapts from child, to young person, into adulthood. Development, approval and implementation of a Midlothian HSCP shared Transitions Policy. By December 2026, Midlothian HSCP will provide assurance that they have: • Taken a phased approach • Moved to a holistic and whole-system approach • Delivered a shared Transitions Policy. HSCP operational service data HSCP Governance Documentation Page 203 of 290
Page 204
20 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected No Direction 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? 3.4 All relevant functions delegated to Midlothian IJB will report biannually in July and December 2026 on participation and engagement activity, noting where feedback from people and communities has informed service improvements or redesign. Percentage of operational services who are able to demonstrate evidence of community engagement. Percentage of operational services who are able to demonstrate use of feedback from people who experience services as part of continuous improvement and service design. By July 2026, and December 2026, all operational services will provide assurance that they are able to demonstrate evidence of community engagement and their use of feedback as part of continuous improvement and service design. HSCP operational service data 3.5 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop a framework that describes how the human, social and economic rights of people who access our services are considered as part of commissioning decisions by July 2028. Development, approval and implementation of a Midlothian HSCP Commissioning Framework. By July 2028, Midlothian HSCP will provide assurance that all commissioning decisions are made with consideration given to the human, social and economic rights of people who access our services. HSCP operational service data HSCP Governance Documentation HSCP commissioning and procurement records Page 204 of 290
Page 205
21 No Direction 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? 3.6 NHS Lothian Midlothian Council will support Midlothian HSCP to support the ambitions of the national Palliative Care Strategy Delivery Plan 2025 – 2028 by establishing a local delivery plan with achievable priority areas for implementation by December 2026. Development and approval of a Midlothian HSCP Palliative Care Delivery Plan. By December 2026, Midlothian HSCP will provide assurance that they have established a local delivery plan that: • supports the ambitions of the national Palliative Care Strategy Delivery Plan 2025 – 2028 • identifies achievable priority areas for implementation. HSCP operational service data HSCP Governance Documentation Page 205 of 290
Page 206
22 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. No Direction 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? 4.2 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated self- management framework that sets out an expectation of how services will work with people to be more informed about their condition(s), be better prepared for when they feel less well, and describes how to access the right support when it is needed by December 2027. Number and percentage of services contributing to the development of an integrated self-management framework. By December 2027, people will be more informed about their condition(s), be better prepared for when they feel less well, and know how to access the right support when it is needed. Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers HSCP website 4.5 Midlothian Council and NHS Lothian will support Midlothian HSCP to work with the NHS Lothian Primary Care Programme Board to scope and recommend viable opportunities for collaborative change. This should focus on jointly agreed priorities with a shared Agreement of action plan to increase the focus on preventative care and early intervention strategies which will be required to improve long- term health outcomes and improve patient access and safe, efficient, and person- By July 2027, Midlothian HSCP will provide assurance of NHS Lothian Primary Care Programme Board activities to develop jointly agreed priorities with a shared commitment to change financial flows to NHS Lothian Primary Care Programme Board minutes and action plans. Page 206 of 290
Page 207
23 No Direction 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? commitment to change financial flows to best support the ambition to shift the balance of care and sustain and expand general practice alongside community Primary Care services at a local level by July 2027. The aim should be to increase the focus on preventative care and early intervention strategies which will be required to improve long- term health outcomes and improve patient access and safe, efficient, and person-centred quality of care close to home. centred quality of care close to home. best support the ambition to shift the balance of care and sustain and expand general practice alongside community Primary Care services. Page 207 of 290
Page 208
24 5 Health Inequalities Health & social care services contribute to reducing health inequalities. No Direction 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? 5.1 NHS Lothian and Midlothian Council will 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 by December 2026, • data quality assurance, by July 2027 and • improvements in recording key data by December 2027. Percentage of electronic systems that have capacity to record HSCP area and protected characteristics. Percentage of electronic systems that support extraction and disaggregation when reporting data. Percentage of services with data quality assurance processes and structures in place. Increase in completion of key data fields. By December 2026, HSCPs have timely, credible, disaggregated data to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. By July 2027, Midlothian HSCP will provide assurance that 100% of services have data quality assurance processes and structures in place. By December 2027, Midlothian HSCP will provide assurance of activities to support an This is new and will need to be designed with NHS Lothian and Midlothian Council. Page 208 of 290
Page 209
25 No Direction 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? increase in completion of key data fields (e.g. protected characteristics). 5.2 NHS Lothian and Midlothian Council will explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by July 2028. Monitor activities of appropriate existing forum and / or establish short-life working group to explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities. The Digital Oversight Programme Board will provide assurance on progress towards its aims and objectives. By July 2028, a Joint Plan will be in place that describes the priority actions agreed between NHS Lothian and Midlothian Council. This should include, but not be limited to: Timeline Allocation of tasks Integrated Impact Assessment Stakeholder Engagement Governance structures (HSCP, NHS Lothian eHealth, Midlothian Digital Services). Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers Digital Oversight Programme Board Documentation 5.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop integrated data at population level by December 2027 in order to support the prediction, Development and agreement of data sets for inclusion. Creation and approval of all required DPIAs and DSAs to initiate data gathering / transfer. Design and test of prototype. By December 2027, Midlothian HSCP will provide assurance relating to the development of a minimum viable product, HSCP Information Management records HSCP Performance & Improvement Action Tracker Page 209 of 290
Page 210
26 No Direction 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? identification, and planning of changing demographic profile to support dynamic whole system change. Approval of final design. Development and agreement of a measurement and evaluation plan. Explore opportunities to validate data. Test and evaluate the usefulness and relevance of the data in multiple contexts. that combines existing risk prediction data with agreed key health and social care data sets. SPG papers and minutes IJB papers and minutes Page 210 of 290
Page 211
27 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. No Direction 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? 6.1 All functions delegated to Midlothian IJB that aim to move care from hospital to home will identify potential impacts of planned interventions on unpaid carers, describe service mitigations to support unpaid carers, and report biannually on impact in July and December 2026.. Midlothian HSCP will provide assurance on the content of relevant Service Plans to support consideration of the impact on unpaid carers of the movement of care from hospital to home. Midlothian HSCP will provide assurance on the content of relevant Service Reports to demonstrate evidence of appropriate supportive actions. By July and December 2026, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans support consideration of the impact on unpaid carers of the movement of care from hospital to home. By July and December 2026, Midlothian HSCP will provide assurance that the content of 100% of relevant Service Plans includes evidence of planned appropriate supportive actions. HSCP Governance Documentation Health and Care Experience Survey** Page 211 of 290
Page 212
28 7 Safe from Harm People using health & social care services are safe from harm. No Direction 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? 7.4 Midlothian Health and Social Care Partnership will support services to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms, this includes establishing (and taking action where necessary) by December 2026, • that all the teams who work with people, including the teams of our Partners, understand what SDS is and how to signpost this information at the right time, • that staff know how to support people to request and access accessible information, and all the information we provide Midlothian HSCP will provide assurance of: • the percentage of teams who work with people who understand what SDS is and how to signpost this information at the right time, • the percentage of relevant staff who have received training in sensory awareness and understanding how to support people to request and access accessible information, • the percentage of the information we provide about SDS that is accessible, By December 2026, Midlothian HSCP will provide assurance that all staff are appropriately trained, that all information is accessible, and that any financial impact of changes in options is clearly evidenced and reported. HSCP Staff Training Records HSCP Service Records HSCP Service Budget Updates Page 212 of 290
Page 213
29 No Direction 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? about SDS meets accessibility standards so those who may benefit most are able to make informed choices. • that comprehensive system evidence is gathered on all changes in uptake between one option and another, any increase in budget, and any HSCP financial impact. • any changes in uptake between one option and another, • any increase in budget, • any HSCP financial impact. Page 213 of 290
Page 214
30 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care and treatment they provide. No Direction 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? 8.3 NHS Lothian and Midlothian Council must ensure commissioned partners and providers meet the duties of the Heath and Care (Staffing) (Scotland) Act. Specifically, NHS Lothian and Midlothian Council must ensure provision in procurement and contract management support to ensure Midlothian IJB report annually on its duty to comply with the Heath and Care (Staffing) (Scotland) Act reporting on the compliance of commissioned partners who deliver services on behalf of the HSCP. Midlothian HSCP will provide assurance on the progress towards the IJB’s ability to comply with the Heath and Care (Staffing) (Scotland) Act in relation to assurance reporting on the workforce provision for services planned and secured by HSCP managed services and delivered by third parties through commissioning. By March 2027, Midlothian IJB will be able to comply with the Heath and Care (Staffing) (Scotland) Act in relation to assurance reporting on the workforce provision for services planned and secured by HSCP managed services and delivered by third parties through commissioning. Procurement and contract management documentation Heath and Care (Staffing) (Scotland) Act submissions 8.4 NHS Lothian and Midlothian Council will support Midlothian HSCP to provide biannual Biannual reports in place (July and December2026). By July and December 2026, Midlothian HSCP will provide assurance of progress towards HSCP Governance Documentation Page 214 of 290
Page 215
31 No Direction 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? reporting in July and December 2026 on the progress towards the ambitions of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2024-27 and the impact of this on staff experience and wellbeing. the ambitions of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2024-27, and provide evidence of the impact of this on staff experience and wellbeing. Page 215 of 290
Page 216
32 9 Use of Resources Resources are used effectively and efficiently. No Direction 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? 9.1 NHS Lothian will continue their work to iteratively improve their approach and methodology to better understand and evidence the use of the NHS Lothian ‘Set Aside’ budget and Unscheduled Care (USC) provision across 2026/27. As part of this work, NHS Lothian will provide quarterly ‘Set Aside’ performance and financial progress reports to the Midlothian IJB to inform local planning and enable the IJB to transparently share its overall position with Partners. NHS Finance colleagues attending *agreed key meetings, including but not limited to: Midlothian Integration Joint Board Strategic Planning Group Planning and Transformation HSCP Performance Leads Steering Group Relevant Service Working Groups. By March 2027, HSCPs are provided with consistent, clear information relating to the use of the set aside budget and associated services. By March 2027, HSCPs can provide consistent, clear information to demonstrate the impact of community prevention and early intervention activity across the whole system. Audit of *agreed key meeting documentation, including but not limited to: Minutes Papers Action Plans Action Trackers 9.3 All delegated functions will continue to participate in review of service provision driven by a 5-year operational transformation programme to consider long term reform. In 2026/27, this will build on the 2025/26 change programme and continue to support achieving a balanced financial position across 3 work-streams. 9.3.2 Bed based provision Completion of a review of services provided by Midlothian By July 2027, Midlothian HSCP will provide assurance that HSCP operational service data Page 216 of 290
Page 217
33 No Direction 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 Council and NHS Lothian will support Midlothian HSCP to redesign and ensure the most efficient and effective operational model of bed-based provision. This should be designed to enable people to access appropriate levels of care when their needs change within this model and enable the safe and timely return to living well in the community by July 2027. This work will have clear links to wider health and social care provision and include i) a review of services provided by Midlothian Community Hospital, ii) a review of Hospital at Home, and iii) a clearly defined operational strategy for delivery including workforce planning. Community Hospital, a review of Hospital at Home, and a clearly defined operational strategy for delivery including workforce planning. people are enabled to access appropriate levels of care when their needs change and return to living well in the community in a safe and timely manner. HSCP Governance Documentation 9.3.5 Commissioning and Third Sector Completion of a review of commissioning spend that Midlothian HSCP will provide assurance that the partner HSCP operational service data Page 217 of 290
Page 218
34 No Direction 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 Council and NHS Lothian will support Midlothian HSCP to undertake a review of commissioning spend and establish a new partner provider model that is closely aligned with the strategic aims of the IJB, supports the delivery of key ambitions and increases opportunities for health equality across Midlothian by December 2026. This should include a review of Care at Home externally contracted provision, commissioning of Care Home places, Newbyres Care Village, and the Learning Disability service. includes Care at Home externally contracted provision, commissioning of Care Home places, Newbyres Care Village, and the Learning Disability service. Establishment of a new partner provider model. provider model is closely aligned with the strategic aims of the IJB, supports the delivery of key ambitions and increases opportunities for health equality across Midlothian in relation to commissioned spend. HSCP Governance Documentation HSCP commissioning and procurement records 9.3.8 Midlothian Single Point of Access (SPOA) Midlothian Council and NHS Lothian will support Midlothian HSCP to design and implement a multiagency solution to support all contacts across health and social Production of a blueprint for transformation. Design and implementation pf Midlothian Single Point of Access (SPOA). By December 2026, Midlothian HSCP will provide a report on the progress and learning with services, people and communities. By December 2028, Midlothian HSCP will provide assurance HSCP operational service data HSCP Governance Documentation Page 218 of 290
Page 219
35 No Direction 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? care by December 2028. In 2026 this should focus on developing an integrated and shared understanding of the relational working to drive transformation and redesign in line with the Midway. Specifically, Midlothian HSCP should report on the progress and learning by December 2026 with services, people and communities and produce a blueprint for transformation that shifts from a traditional model to a new integrated health and social care provision. that a Midlothian SPOA is in place that has shifted from a traditional model to a new integrated health and social care provision. 9.4 NHS Lothian and Midlothian Council should report to Midlothian IJB on a biannual basis across 2026/27 on issues and risks relating to non-delegated functions that will impact on delegated functions. Number of reports submitted by NHS Lothian and Midlothian Council to Midlothian IJB. Midlothian IJB are well- informed in relation to NHS Lothian and Midlothian Council issues and risks relating to non-delegated functions that will impact on delegated functions. Midlothian IJB minutes. Page 219 of 290
Page 220
36 No Direction 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? 9.5 NHS Lothian and Midlothian Council must ensure that all operational services delivering functions delegated to Midlothian IJB continue to provide assurance of high quality, safe, and effective service delivery within the allocated budget (appendix 1,) and with assurance of the principles of Best Value by December 2026. Percentage of operational services delivering within allocated budgets. Midlothian HSCP will provide assurance that operational services are delivered safely and effectively within allocated budgets, aligned to the principles of Best Value. Annual Accounts. 9.5.1 NHS Lothian and Midlothian Council should support Midlothian HSCP to deliver the Midlothian IJB Medium-Term Financial Strategy and develop new ways of financial activity monitoring as services redesign and new methods of evaluation are required. Reporting on progress, issues, and risks should be considered biannually by the Audit and Risk Committee. Reporting on progress, issues, and risks should be considered biannually by the Audit and Risk Committee. Reporting on progress, issues, and risks should be considered biannually by the Audit and Risk Committee. Audit and Risk minutes. Page 220 of 290
Page 221
37 Ministerial Steering Group Indicators 2026/27 Indicator Data Source Frequency Accident and Emergency Attendance Local Intelligence Support Team Release Quarterly Annual Emergency admissions into hospital Local Intelligence Support Team Release Quarterly Annual Number of unplanned hospital bed days: acute specialties (all ages) Local Intelligence Support Team Release Quarterly Annual Number of unplanned geriatric long-stay beds (all ages) Local Intelligence Support Team Release Quarterly Annual Number of unplanned mental health beds (all ages) Local Intelligence Support Team Release Quarterly Annual Delayed Discharges Occupied Bed Days Local Intelligence Support Team Release Quarterly Annual End of Life - Percentage of Last Six Months Spent in Large Hospitals Local Intelligence Support Team Release Annual Balance of Care - Percentage of 65+ Population Living at Home (supported and unsupported) Local Intelligence Support Team Release Annual Page 221 of 290
Page 222
Page 222 of 290
Page 223
Midlothian IJB Audit and Risk Committee Thursday, 5th March 2025, 14:00-16:00 Audit Scotland Report: ‘Delayed discharges: A symptom of the challenges facing health and social care’ and Midlothian Performance Item number: 5.6 Executive summary This paper sets out the main findings of the Audit Scotland performance audit ‘Delayed discharges: A symptom of the challenges facing health and social care’ (appendix 1). This also includes the Midlothian Health and Social Care Partnership (HSCP) most recent available local data to provide an update on local performance, ongoing improvement activity, and opportunities for improvement. The report published by Audit Scotland on 8th January 2026 is an assessment of the performance across Scotland relating to delayed discharges from hospital settings using data from April 2024 to October 2025. Audit Scotland explores the reasons for, and implications of, delayed discharges, the actions taken to reduce them, and the impact of delayed discharges on people. To better understand the impact of local pressures and how these challenges are being addressed, Audit Scotland focused on working with the Officers of Integration Authorities, Health Boards and Local Authority Partners in three areas; Dundee City, East Ayrshire, and Highland. Midlothian HSCP has made significant progress in reducing the number of delayed discharges for people from Midlothian and continue to play a central role in the pan Lothian Unscheduled Care improvement work. This report sets out the initiatives to identify opportunities and take action with Midlothian to improve the experience of people who are in hospital and the current performance across a range of measures including the number of delayed discharges and occupied bed days within the Royal Infirmary of Edinburgh. As a result of this report, Members are asked to: • Note the key findings and recommendations of the Audit Scotland repot ‘Delayed discharges: A symptom of the challenges facing health and social care’(appendix 1). • Note the progress made within Midlothian and the areas of ongoing focus. Page 223 of 290
Page 224
Midlothian Integration Joint Board Report Audit Scotland Report: ‘Delayed discharges: A symptom of the challenges facing health and social care’ and Midlothian Performance 1 Purpose 1.1 This paper sets out the main findings of the Audit Scotland performance audit ‘Delayed discharges: A symptom of the challenges facing health and social care’(appendix 1). This also includes the Midlothian Health and Social Care Partnership (HSCP) most recent available local data to provide an update on local performance, ongoing improvement activity, and opportunities for improvement. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the key findings and recommendations of the Audit Scotland repot ‘Delayed discharges: A symptom of the challenges facing health and social care’ (appendix 1). • Note the progress made within Midlothian and the areas of ongoing focus. 3 Background and main report 3.1 The report published by Audit Scotland on 8th January 2026 is an assessment of the performance across Scotland relating to delayed discharges from hospital settings using data from April 2024 to October 2025. Audit Scotland explores the reasons for, and implications of, delayed discharges, the actions taken to reduce them, and the impact of delayed discharges on people. To better understand the impact of local pressures and how these challenges are being addressed, Audit Scotland focused on working with the Officers of Integration Authorities, Health Boards and Local Authority Partners in three areas; Dundee City, East Ayrshire, and Highland. 3.2 A number of key facts are presented as part of Audit Scotland’s assessment of delayed discharged in Scotland. These data are shown in Table 1 below with comparative data for Midlothian in 2024/25, and additionally the Midlothian position to date for 2025/26. Page 224 of 290
Page 225
Midlothian Integration Joint Board 3.3 Table 1: Key facts Audit Scotland Delayed Discharge Indicators Scotland 2024/25 Midlothian 2024/25 Midlothian 2025/26 Year To Date Number of times people experienced a delayed discharge 17,915 734 406 Number of hospital bed days lost due to delayed discharges 720,119 6,075 3,397 Proportion of beds occupied due to delayed discharges 1 in 9 No comparable data available Delayed discharges as a proportion of adult inpatient discharges 3.2% 6.5% 9.5% Percentage of all delayed discharge bed days occupied in 2024/25 by people aged: 75 years and above 18 to 74 years 66% 34% 82% 18% 70% 30% 3.4 Audit Scotland have used the Public Health Scotland (PHS) census data. When disaggregated to Midlothian data, there are discrepancies between the Public Health Scotland data, the Scottish Government Whole System Pressures Dashboard, the NHS Lothian Analytics Dashboard, and local data. This can be in part accounted for by a change in how delays were reported from July 2023 but there continues to be variation. It appears to be the case that although the pattern of activity is the same, dashboards are using differing inclusion and exclusion criteria. The variation in absolute numbers reported in different products means that comparison should be made with caution. 3.5 In October 2024, the number of people across Scotland who were in hospital and delayed in being discharged was reported by Public Health Scotland (PHS) to have peaked at 2,030. Audit Scotland recognised the current improvement in the national position report but noted that the number is rising and remains higher than pre- pandemic levels. 3.6 The NHS Lothian Analytics Services Dashboard uses an automated process to calculate delayed discharges as an average rather than an actual count, so the data cannot be directly compared. The Health and Social Care Whole System Pressures Dashboard does not hold data before 2020 so we cannot show whether performance in Midlothian has followed the same pattern over time. Page 225 of 290
Page 226
Midlothian Integration Joint Board 3.7 The Health and Social Care Whole System Pressures Dashboard holds data relating to people from Midlothian who experience a delay to their discharge from the Royal Infirmary of Edinburgh, St John’s Hospital, the Western General Hospital, and Midlothian Community Hospital (Mental Health). In September 2020, the total number of people from Midlothian delayed in these four hospitals was 29. This dropped to a low of 3 in March 2021 and gradually increased to a peak of 41 in June 2022. In July 2023 there was a change to the method used to count delays. The peak of 37 in June 2024 reduced steadily to a low of 14 by October 2025. The most recent data for January 2026 show a slight increase to 24 delays. 3.8 Audit Scotland note that the proportion of beds occupied due to delayed discharge is 1 in 9 across Scotland. There are no comparable data as the bed allocation for Midlothian changes, sometimes on a daily basis. Midlothian HSCP continues to seek clarity on the NHS Lothian bed allocation calculation methodology and is keen to ensure a fixed baseline that will support more accurate evaluation of performance over time. 3.9 Audit Scotland note that the pressure on hospital bed capacity is likely to grow, with unplanned hospital admissions projected to increase in Scotland by 11.8 per cent from 2024 to 2034. Audit Scotland did not include the methodology they used to calculate a projected increase of 11.8% to 2034. 3.10 Midlothian admissions to the RIE have increased by 43% over the period 2003 – 2024 as shown in Chart 1. Based on the Midlothian rate of growth between 2003 and 2024, the estimated total annual admissions forecast to 2037 could see an increase of 28%, to 8,941. However, modelling is complex, and this figure does not take account of any changes to population size, population health, the significant improvement already implemented across the system, or any future changes to system design and delivery. 3.11 Chart 1: Midlothian Admissions 4,885 6,987 8,941 0 1,000 2,000 3,000 4,000 5,000 6,000 7,000 8,000 9,000 10,000 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025 2027 2029 2031 2033 2035 2037 Midlothian Admissions to RIE 2003 -2024 (actual) 2025 -3037 (estimate) Actual Estimate Page 226 of 290
Page 227
Midlothian Integration Joint Board 3.12 Audit Scotland calculated a daily cost of £618 for a hospital bed and estimated the cost of the 720,119 bed days occupied by delayed discharges across Scotland in 2024/25 to be over £440 million. Using the same approach, the estimated cost of the 5,635 bed days occupied by delayed discharges from Midlothian in the RIE in 2024/25 was £3,482,430. However, work in Midlothian to reduce occupied bed days has resulted in an average reduction of 163 bed days occupied by delayed discharges per month in 2025/26 to date. 3.13 Using the Audit Scotland calculation, this would indicate a comparable saving of £1,588,878 to the system. It is important to note that this is not a saving that can be utilised for community health and social care or counted as a reduction in costs as other people who needed care were admitted to hospital and occupied the beds. 3.14 The reasons for delayed discharges are varied and often related to local challenges. Audit Scotland presented the percentage of delayed discharges in 2024/25 across 5 categories. For accurate comparison with national reporting, Midlothian data has been extracted by utilising the same categories as Audit Scotland, as provided by Public Health Scotland (PHS). In line with Public Health Scotland reporting, any delays that are recorded and coded as “Health Delays” have been excluded. For clarity, the Midlothian data reported below utilised the following codes • Place availability (codes 24, 26, 27, 46) • Complex delays (code 9) • Care arrangements (code 25) • Care assessment (codes 11A and 11B) • Other (e.g. Funding, Transport, Patient/Carer/Family) 3.15 The national data show that ‘awaiting place availability’ (28%), ‘complex delays’ (27%) and ‘awaiting completion of care arrangements’ (27%) were the most frequent reasons for a discharge to be delayed. The Midlothian data show that ‘awaiting completion of care arrangements’ (52%) and ‘awaiting community care assessment’ (26%) were the most frequent reasons for a discharge to be delayed. 3.16 The Midlothian IJB Strategic Plan 2025-2035 recognises the opportunities to improve outcomes for people and communities and create a new and sustainable future for health and social care that organises services around people’s needs, rather than traditional service models. The Audit Scotland Report recognised the demand for health and social care services and the capacity challenges exacerbated by the complicated governance, planning, and delivery arrangements created by the priorities, strategies, cultures and systems of local organisations. 3.17 In Midlothian, a priority of improvement work has been to focus on delayed discharge with a whole system solution and less about the individuals who are delayed. Although the increase in complexity and people living with multiple conditions has a significant influence in many situations, the overarching narrative that complexity is driving system challenges is not causing delays to discharge for everyone, and certainly not for every admission. Work in Midlothian has found that prefacing every conversation with 'complexity' may limit thinking differently. Page 227 of 290
Page 228
Midlothian Integration Joint Board 3.18 Chart 2 shows that in Midlothian, age is a contributing factor to predicting the likelihood of someone experiencing a delay to discharge from the RIE. The most recent management data for the period 22nd December – 20th January 2026 show that 74% of people from Midlothian being delayed in the RIE were aged 75 and over. 3.19 Chart 2: Average Midlothian bed days in delay in RIE, per person, by age group 3.20 The Midlothian data shows that 13% of delayed discharges in the financial year 2024/25 were people within the last 3 months of life. What is not clear, is the percentage of those people who may have benefitted from treatment and care in the community or the wishes of this cohort regarding the location of their end-of-life care. 3.21 Midlothian HSCP has focused on understanding local challenges and identifying actions that will drive change and make the most meaningful impact. Compassionate and intentional leadership and a joint commitment to shared ambitions have resulted in a sustained change in both performance and culture. Clear communication, intentional system planning, and shared decision making have improved multi- professional working with rapid and actionable learning from the successes and challenges of the teams undertaking the work. Operational leadership has identified the strengths and benefits of local improvement work to include daily scrutiny supported by high-quality data analysis. 3.22 Future opportunities for positive change include • working alongside people and their families to improve the readiness and use of mechanisms that support decision making i.e., Power of Attorney , Key Information Summaries (KISS),and Anticipatory Planning, • taking early action should particular delay codes show an increasing trend, and • learning during the implementation of ‘Planned Date of Discharge’ (PDD) across acute settings to inform new opportunities to improve. 26.1427.44 9.76 16.6217.45 22.14 18.3 21.6424.49 16.33 34.5 0 5 10 15 20 25 30 35 40 Average bed days per person Page 228 of 290
Page 229
Midlothian Integration Joint Board 3.23 Audit Scotland Recommendations The Audit Scotland report notes it is too early to evaluate national and local initiatives to reduce delayed discharges and instead proposes 7 recommendations for national change. These include ambitions to develop a consistent approach to evaluating and reporting, collaboration and sharing best practice, update current discharge planning guidance, provide clear delivery guidance on national frameworks, priorities, and key activities, ensure key enabling processes are in place like power of attorney or a Guardianship order, establish a shared plan for digital solutions, and ensure support for unpaid carers that includes joint discharge planning from the point of admission. 3.24 Evaluation and Reporting Audit Scotland recommend that the Scottish Government review current measures for monitoring performance in reducing delays and establish a suite of key indicators. However, there are a number of reasons why variation between local areas could be legitimate and it is important to ensure clarity on which indicators add value to be examined nationally and those that should be considered locally, selected for their evidence-based merit, and relevant to local circumstances. 3.25 There is an opportunity to realise the ambition for a consistent approach to measurement and evaluation, to inform outcomes that matter to people and communities, and demonstrate Best Value to solve the continued challenge of the Scottish Government and Public Health Scotland requirement to report on cost and savings. However, there is limited value in broad comparison of geographic areas, and this type of benchmarking risks creating the conditions for competition, rather than collaboration. The co-design of a collaboratively developed and jointly agreed set of indicators could reduce duplication of effort and outputs, simplify access to validated data, and clarify the roles of wider stakeholder agencies, such as the Improvement Service. 3.26 Appropriate expertise must be engaged to ensure that proxy indicators are recognised as such and to be clear that length of time in ED, reduced length of stay, and fewer people being delayed are only part of the solution. For example, readmission data can be a helpful indicator of a safe, effective and well-planned discharge, but this data can also be subject to variation in recording and analysis so should always be considered as one of a set of balancing measures, along with other relevant indicators of unintended consequences. 3.27 A comprehensive suite of indicators that include outcome, process, and balancing measures could create the connections between what we think, what we know, and what can be evidenced about the performance of a system. 3.28 Of course, any ambition to establish a new national approach to evaluation means acknowledging what hasn't worked in the past. Some parts of the public sector continue to adopt a factory logic approach to efficiency and as a result have seen solutions become more process driven rather than outcomes focused. Improvement plans that are process-focused can make the error of good measures being used as targets. This approach risks treating public services as a series of discrete, standardised transactions and people becoming a unit of demand to be processed. Page 229 of 290
Page 230
Midlothian Integration Joint Board 3.29 The work in Midlothian has begun the process of changing this and had noted that many service design principles that improve transactional efficiency are less effective when applied to complex human challenges. However, with no agreed methodology or mechanism to truly measure and evaluate our contribution to personal outcomes, targets and metrics often drive decisions with limited experience data relying on short-term boosts of funding into the same system to drive numbers down. 3.30 The focus on implementing the use of Planned Date of Discharge has led to some improvement in earlier planning for discharge, as evidenced by the reduction in time taken to set the first Estimated Date of Discharge (EDD). From 2024 to 2025, for people admitted to the RIE from Midlothian, there has been a 27.6% decrease in the average number of days to set the first EDD. The proportion of patients who have their EDD set within 48 hours has increased from 57.3% in 2024, to 69.6% in 2025. This suggests that, if setting a Planned Date of Discharge within 48 hours is indicative of a well-planned discharge, there is a significant improvement in this practice for people who are in hospital and live in Midlothian. 3.31 Significant reductions to the average Length of Stay (days) in hospital have been achieved for people being admitted to the RIE from Midlothian, as shown in Table 3. This is evidence of sustained success, although the older age groups still spend longer in hospital when they need to be admitted. It is vital to continue to monitor this, as the most recent month’s data (NHS Lothian Tableau, accessed 20th January 2026), showed that 30% of all unplanned admissions from Midlothian to RIE were people aged 75 and over. 3.32 Table 2: Reduction in Length of Stay (Midlothian to RIE) by Age Age Range 2024 2025 % Decrease 18-24 2.3 2.2 4.3% 25-44 3.0 2.4 20.0% 45-64 6.1 5.0 18.0% 65-74 10.2 7.6 25.5% 75+ 19.4 12.9 33.5% 3.33 Audit Scotland report recognises that continuing to focus on hospital targets and short-term funding creates challenges in shifting the balance of care from hospital to community driven care. This is because people are less frequently experiencing temporary setbacks with clear solutions and instead living with chronic health conditions. Families are often in long-term crisis, and mental health is impacted by debt, unstable housing, and unemployment. These issues are complex, interconnected, and ongoing. 3.34 The answer must be sustainable, community-based change to how health and social care ensure responsive and flexible community responses that enable people to move in and out of health care settings. The Midlothian IJB Strategic Plan 2025-2035 is clear that service offers must be person-led, foster agency, and uphold dignity to realise meaningful change. Page 230 of 290
Page 231
Midlothian Integration Joint Board 3.35 Sharing Best Practice The Audit Scotland report notes large variation in how health boards perform and learning from best practice must of course be a vital component of national learning. However, it is important to note that there are very few improvement initiatives that can simply be lifted from one area and successfully overlayed in another without a commitment consideration to local factors, the interrogation of local data, and a commitment to the process of change. 3.36 The Audit Scotland report noted the Lothian Partnership as an example of where shared learning can support change. However, differences in local context between neighbouring Integration Authorities can be a significant confounding factor. This can be seen in the variation of population demographics across the Lothians. 3.37 The NHS Lothian Unscheduled Care Improvement Programme set an emergency Bed Occupancy Target for Midlothian of 115 beds. Local data from 20th January 2026 showed • the total emergency beds occupied by people from Midlothian was 114. • there were 14 standard delays and 2 delays to Adults With Incapacity, and • the percentage of beds used by delays for Midlothian was 16.3%. The Lothian HSCP range on the same date was 9.3% - 19.5%. 3.38 Data examples of local variation The most recent management data for the period 22nd December – 20th January 2026 for attendances at RIE Emergency Department (ED) show some age-related variation, with people aged 75+ accounting for between 18% and 23% of attendances across City of Edinburgh, East Lothian, and Midlothian (18%). Attendances at ED by people aged 45-64 are consistent across all three areas at 26%. 3.39 For the same time period, unplanned admissions to the RIE show similar levels of variation with people aged 75+ accounting for approximately 30% of admissions from all three HSCPs, with Midlothian at 28%. Midlothian currently has the highest rate of unplanned admissions for the 45-64 age group at 25%. 3.40 Delayed discharges for the same time period show that for Edinburgh and East Lothian, 80% of delays occur to people aged 75+. However, in Midlothian the percentage is notably lower, currently at 70. A significant improvement has been seen in Midlothian as a result of the NHS Lothian Unscheduled Care Improvement Plan with an average reduction of 7 days to the number of occupied bed days per admission for people over 75. 3.41 Between January 2025 and January 2026, NHS Lothian management data indicates a 30% reduction in delayed discharges across all delays. 3.42 Power of Attorney and Guardianship Orders The Audit Scotland report that Adults with Incapacity (AWI) often experience a longer length of delay in hospital. Data review. What is the difference in experience of all adults marked and AWI vs others – all ages/by age cohort in Mid Page 231 of 290
Page 232
Midlothian Integration Joint Board 3.43 Across Scotland, Adults with Incapacity were on average delayed in hospital for 10 days. It has not possible to provide comparable Midlothian due to the limitations of the search functionality within the Business Objects reporting tool. However the following information provides some insight into the performance of Midlothian HSCP in this regard. • In 2024/25, 6.5% of all occupied bed days that were marked as a delay related to an Adults with Incapacity (AWI) • In 2025/26 to date, 9.8% of all occupied bed days that were marked as a delay related to an Adults with Incapacity (AWI) 3.44 Digital Solutions The Digital Maturity Assessment in Scotland is designed to assess the digital capabilities of NHS Boards, Health and Social Care Partnerships, and Local Authorities across Scotland. This assessment helps organisations identify their strengths and areas for improvement in using digital technologies to enhance service delivery and outcomes for people. In 2025, Midlothian HSCP contributed 74 staff responses as part of the pan-Lothian submission. NHS Lothian scored above the Scotland average on 18 of the 19 indicators in the assessment. 3.45 Digital and digital interventions are widely recognised as a vital component of a new and sustainable future for both health and social care. However, access to the expertise and support to plan, implement, and evaluate digital solutions. Midlothian HSCP does not have a dedicated Digital Lead and there are no programme or project support staff meaning that any new innovations must be led and resourced from existing service capacity to deliver treatment, care and support, the transformation agenda, and financial recovery plans. 3.46 Support for Unpaid Carers Midlothian IJB recognises that unpaid carers are a vital part achieving improved outcomes for people. In 2024/25, how well carers feel that they are supported to continue in their caring role had improved from the Health and Care Experience survey 2 years ago, but it is still very low. The national picture is equally challenging, with all Health and Social Care Partnerships in Scotland having a rating below 50%. In 2025/26, the Midlothian Annual Survey results showed that only 8% of respondents agreed they had received an assessment of their needs as a carer, or a written plan about their caring role and support. 3.47 For this reason, Midlothian IJB issued Direction 6.1 to NHS Lothian and Midlothian Council in March 2025 that asked all services that are involved in shifting the balance of care form hospital to home to include consideration to unpaid carers. Draft Directions for 2026/27 are currently being prepared and Direction 6.1 has been revised to encourage more intentional action to improve the experience of carers in Midlothian. 3.48 Improving Outcomes for People and Communities In Midlothian, integrated health and social care has been built on 'good conversations' with people and communities for over 10 years, focusing on what matters to people and the outcomes that are important to them. This asset-based approach is 'called The Midway' and incudes how services focus on understanding what is important to people and how to make that a reality. Page 232 of 290
Page 233
Midlothian Integration Joint Board 3.49 While supporting people to remain at home for as long as they want to be there is the aim, this doesn’t prevent hospital admissions. Investment in social care must be given the same priority and understanding as is given to unscheduled care priorities. The work in Midlothian has taken a whole-system approach and benefitted from enhanced local data support and a multi-professional oversight to view the challenges through more than just a health lens. 3.50 As a result, the NHS Lothian Unscheduled Care Improvement Plan enabled Midlothian HSCP to make a significant investment into social work and social care to keep communities, prevention, and social care at the heart of the solution. This included investment in Care at Home to increase both number of care packages available and the speed of allocation. Investment in Allied Health Professionals (AHPs) working within social care has also recognised the contribution of this staff group who focus on rehabilitation, maintaining and regaining function, and facilitating discharge. 3.51 Other areas of investment as a result of the NHS Lothian Unscheduled Care Improvement Plan in Midlothian included Hospital and Home and The Third Sector. Work with partner organisations is a vital part of health and social care in Midlothian and collaborative working with the British Red Cross has led to significant improvements in support people return home without delay. 3.52 The impact of the NHS Lothian Unscheduled Care Improvement Plan activities across integrated health and social care can be demonstrated in the improved Midlothian readmission rate over the past 2 years as shown in Table 3. 3.53 Table 3: Midlothian HSCP Readmission data at 7 days, 28 days, and 6 months. Readmission Rate Midlothian to RIE 2024/25 Midlothian to RIE 2025/26 year to date 7 day 4% 4% 28 day 11% 10% 6 month 23% 19% 3.54 The readmission rates for Midlothian are slightly higher than the overall RIE figures but there is no statistical significance when compared to other Lothian HSCPs. Readmission rates are often included as a proxy indicator for safety of care, but it is important to note that there can be inconsistencies in how these data are recorded in TRAK, with variation in application of operational definitions. 3.55 Avoiding admission is of course the key to reducing the use of unscheduled care and preventing admissions becoming delays. This means ensuring preventative and supportive measures support people to live in the place of their choosing, including the right mechanisms being in place when someone needs to go hospital, and when they return home. Without sustainable fund and investment in social care it is likely that we will continue to see predominantly our most vulnerable citizens experiencing delays in hospital. Page 233 of 290
Page 234
Midlothian Integration Joint Board 4 Policy Implications 4.1 In January 2025 the Government announced 3 publications that will shape the future of health and social care in Scotland; the NHS Scotland Operational Improvement Plan, the Health and Social Care Service Renewal Framework and Scotland’s Population Health Framework. The 5 principles of the Service Renewal Framework focus on prevention, people, community, population planning and digital innovation. Midlothian IJB have always understood that people, not services, are at the centre of our decisions and the Health and Social Care Service Renewal Framework is in alignment with the Boards vision. 4.2 Audit Scotland note that guidance from Scottish Government is required to clarify the role of Integration Joint Boards (IJBs) and Health and Social Care Partnerships (HSCPs) and how they will be asked to contribute to the delivery of the Health and Social Care Service Renewal Framework. Policy implication will be addressed as the asks, impact and implication for IJBs arise. 4.3 Additionally, the Scottish Government DL(2025)25 issued in November 2025 to all NHS Boards, set out instructions for Health Boards to self-organise into two subnational structures; the East and West of Scotland and superseding previously issued guidance on Regional Planning. The directive to develop an improved model of flow navigation will also influence how work to improve delayed discharges by community health and social care is prioritised and undertaken. 5 Directions 5.1 There are no direct implication for Directions as a result of this report. 6 Equalities Implications 6.1 An Equality and Children’s Rights Impact Assessment (ECRIA) screening tool has been completed and submitted with this report. 6.2 As this report is a response to the Audit Scotland performance audit that assesses the national performance in relation to delayed discharges from hospital, there is no requirement to undertake an ECRIA as a result of this report. 7 Resource Implications 7.1 There are no resource implications as a direct result of this report. Page 234 of 290
Page 235
Midlothian Integration Joint Board 8 Risk 8.1 There is a risk that a growing population in Midlothian, an aging population, and continuing and increasing operational resource and capacity challenges could result in a deteriorating performance in relation to delayed discharges. 9 Involving people 9.1 This report has been written in consultation with officers of Midlothian IJB, and with the Midlothian HSCP Executive Leadership Team. 10 Background Papers None 11 Governance This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. X This report includes information that should be escalated to Midlothian IJB for noting only. √ This report is the Audit and Risk Committee’s Business as Usual (BAU) and does not require Midlothian IJB’s review. X Author’s Name Gill Main Designation Integration Manager Contact Information Via email or MS Teams Date 27/01/2026 Appendices: Appendix 1: Delayed discharges: A symptom of the challenges facing health and social care Page 235 of 290
Page 236
Page 236 of 290
Page 237
Prepared by Audit Scotland January 2026 Delayed discharges A symptom of the challenges facing health and social care Page 237 of 290
Page 238
2Delayed discharges Contents Key facts 3 Key messages 4 Recommendations 6 Introduction 8 1. Delayed discharges – what’s the problem 10 2. Delayed discharges – what’s happening 18 3. Delayed discharges – what needs to happen 34 Endnotes 39 Appendix 41 Accessibility You can find out more and read this report using assistive technology on our website www.audit.scot/accessibility. Audit team The core audit team consisted of: Kathrine Sibbald, Adam Bullough, Naomi Ness, Nathalie Cornish and Lindsay Stother, under the direction of Carol Calder. Page 238 of 290
Page 239
3Key facts Key facts 17,915 Number of times people experienced a delayed discharge in 2024/25 720,119 days The number of hospital bed days lost due to delayed discharges in 2024/25 1 in 9 Proportion of beds occupied due to delayed discharges in 2024/25 3.2% Delayed discharges as a proportion of adult inpatient discharges in 2024/25 The percentage of all delayed discharge bed days occupied in 2024/25 by people aged: 66% 34% 75 years and above 18 to 74 years Page 239 of 290
Page 240
4Key messages Key messages 1 A delayed discharge is when someone remains in hospital despite being medically ready to leave. During the month of October 2024, Public Health Scotland reported the highest number (2,030) of people experiencing a delayed discharge at the monthly census point. The number of delayed patients has decreased slightly since the peak levels in October 2024, but numbers remain well above pre-pandemic levels and are rising again. In 2024/25, people delayed from being discharged spent 720,119 clinically unnecessary days in hospital. While the full costs to the health and social care system are likely to be much higher, we estimate the cost of hospital days alone to be over £440 million a year. 2 Despite only around three per cent of all people discharged from hospital experiencing a delay, each delay has a detrimental effect on the individual’s physical and mental wellbeing. This includes increased risk of infections, reduced mobility and independence and can result in higher social care needs upon discharge. Delays also impact the flow of patients through hospitals, reducing staffing availability and capacity for other patients, and in 2024/25 resulted in 11.7 per cent of hospital beds being unnecessarily occupied. This means that the system cannot function as intended, and it will be challenging to meet the projected increase in demand if delayed discharges are not reduced. 3 While the reasons behind delayed discharges are complex and vary significantly by area, hospital and each patient, it is a symptom of much wider challenges across the health and social care system. NHS Scotland, councils, integration authorities, Page 240 of 290
Page 241
Key messages 5 as well as the third sector and independent providers, all face significant financial challenges. Demand for health and social care services continues to rise. Capacity across the system is constrained by workforce recruitment and retention problems, which are particularly acute for rural and remote areas. The priorities, strategies, cultures and systems of the many national and local bodies involved vary, creating complicated governance, planning and delivery arrangements, which can affect how efficiently patients can be discharged once they are well enough. 4 The Scottish Government, integration authorities and their partners, the NHS boards and councils, have actively targeted delayed discharges as an issue. This has led to some improvements, but this varies across the country. The lack of a consistent approach to evaluating initiatives makes it very difficult to understand their impact. Better analysis and transparency are needed to understand both the costs and impacts of delayed discharges, what is providing better quality of outcomes for individuals and value for money for public spending. 5 Limited progress with addressing the wider challenges in the health and social care sector restricts further progress with reducing delays. Scotland’s population health framework, the health and social care service renewal framework and the NHS operational improvement plan, offer an opportunity to make progress, with a common focus on prevention. But it’s not clear how shared accountability and joint decision-making will be achieved, particularly given there is limited reflection of the critical role of social care, and of integration joint boards and health and social care partnerships in the arrangements. Page 241 of 290
Page 242
Recommendations 6 Jointly, the Scottish Government, NHS Scotland, the Convention of Scottish Local Authorities (COSLA), Healthcare Improvement Scotland, integration authorities and their partner NHS boards and councils, should: • Over the next 12 months, develop a consistent approach to evaluating and reporting on initiatives to improve delayed discharges, such as discharge without delay and the Lothian Partnership, and sharing best practice and areas for improvement. Evaluation should be reported annually and include assessing effectiveness, value for money, and whether the initiatives are improving the balance of care. This evaluation should be used to update current discharge planning guidance (paragraph 109). • In the next six months, publish guidance to clarify and strengthen the role of integration joint boards and health and social care partnerships in the governance and delivery of the health and social care service renewal framework (paragraph 106). • Over the next 12 months, provide guidance on, and better promote public awareness of the benefits of, establishing a power of attorney or a guardianship order (paragraph 84). • Over the next 12 months, work together to develop and action an implementation plan to share learning and practice from digital solutions used for tackling delayed discharges, early intervention and prevention (paragraph 95). Jointly, the Scottish Government and Public Health Scotland should: • Produce a clear estimate of the total costs of delayed discharges and the savings being made through initiatives to reduce delayed discharges. This should be completed within the next 12 months, updated regularly and reported in the annual analysis of delayed discharge performance (paragraph 111). Recommendations Page 242 of 290
Page 243
Recommendations 7 The Scottish Government should: • Assess the current measures for monitoring performance in reducing delays and establish a suite of key indicators. These should be agreed by working in consultation with NHS boards and integration authorities to ensure indicators are both evidence-based and relevant to local circumstances, while focused on improving hospital flow and clearly linked to improving outcomes. This should be completed within the next 12 months, regularly reviewed and reported in the annual analysis of delayed discharge performance (paragraph 114). Jointly, integration authorities and their partner NHS boards and councils should: • In the next six months, ensure they fully implement the Carers (Scotland) Act 2016 by understanding the point of the discharge planning process where this is failing to happen, intervening with support for local areas to improve their processes for carers to be involved in discharge planning from the point of admission (paragraph 71). Page 243 of 290
Page 244
8Introduction Introduction Background 1. Most patients in Scotland’s hospitals are discharged promptly. In December 2025, Public Health Scotland (PHS) reported that in 2024/25, 97 per cent of adult inpatients were discharged without delay. In three per cent of adult inpatient stays, or 17,915 inpatient stays, the patient experienced a delayed discharge, meaning they remained in hospital beyond the point they were medically ready to leave.1 This could be, for example, due to a lack of available home care services, delays in securing a care home place, or waiting for adaptations to be made to their home. 2. Delayed discharge has significant implications for an individual’s wellbeing. Staying in a hospital longer than necessary can lead to deconditioning (deterioration of a person’s physical/mental health), loss of independence, and a higher risk of infections. 3. Delayed discharges pose significant challenges in the health and social care systems. Prolonged hospital stays add to the cost of providing health and social care services, they contribute to bed shortages and make it harder for new people to be admitted, including those needing emergency care. Staff resources are stretched as hospitals must care for patients who no longer require acute medical care. It can also mean an increased need for social care support on discharge due to the detrimental impact on the person’s wellbeing. Health and social care were integrated to improve care and support for people and address issues such as delayed discharges 4. The health and social care sector involves a wide array of national and local bodies from the public, third and the independent sectors. Priorities, strategies and cultures vary making coordinating and leading change across the sector complex. 5. In 2016, the Scottish Government legislated under the Public Bodies (Joint Working) (Scotland) Act 2014 to bring together health and social care into an integrated system to improve care and support for people who use services, their carers, and their families. This included addressing whole-system issues such as delayed discharges. This led to 31 integration authorities (IAs) being created in Scotland that are responsible for strategic planning of designing, delivering, and coordinating health and social care services and have a key role in reducing delays in discharge. Page 244 of 290
Page 245
Introduction 9 6. The size of IAs varies depending on council boundaries. Most NHS boards have two or more IAs within their boundary, but the number ranges from one to six IAs in others. 7. IAs are currently structured in two ways, either through an integration joint board (IJB) or using a lead agency model. You can find more information about integration arrangements in our short guide. All areas except Highland elected to adopt the IJB model. Clackmannanshire and Stirling decided to form a single IA to service the needs of both areas. In December 2024, members of the Highland Council and NHS Highland Joint Monitoring Committee agreed to move from the lead agency model of integration to the IJB model. About this audit 8. This performance audit aims to assess how well the challenge of reducing hospital delayed discharges is being addressed in Scotland. The audit provides oversight of the factors that contribute to delays and analyses the impact of initiatives put in place to address them. 9. Our findings and recommendations in this report are based on evidence gathered through document review, data analysis and interviews. To better understand how local pressures and challenges are being addressed, our work focused on three IAs – Dundee City, East Ayrshire and Highland, engaging with IA officers and those within the NHS board and council partner bodies. In the report, we include examples from these sample areas. These are not necessarily examples of best practice or the only approaches being taken across the country. We also engaged with Scottish Government policy leads, chief officers of integration authorities, chairs of IJBs and a range of national organisations across the public and third sector. 10. The scope of our audit focused on the reasons for, and implications of, delayed discharges and the actions taken to reduce them. The audit has looked at the impact of delayed discharges on people through secondary evidence and engagement with external stakeholders. 11. This report is accompanied by an online interactive delayed discharges tool that allows users to explore the national and local performance of IAs. The tool also includes local and national contextual data from the 2022 census that illustrates the increasing population pressures nationally and the significant variation across Scotland. Page 245 of 290
Page 246
101. Delayed discharges – what’s the problem 1. Delayed discharges – what’s the problem Delayed discharges have a detrimental impact on the people affected and on the wider health system. They are a symptom of the many demographic, population health, workforce, governance and financial challenges faced by the health and social care sector. The number of people delayed in hospital has decreased slightly from the peak levels in October 2024, but numbers remain well above pre-pandemic levels and are rising again 12. Public Health Scotland (PHS) collects, analyses and publishes data on delayed discharges. In the financial year ending 31 March 2025, PHS reported that people who were delayed from being discharged spent 720,119 days in hospital, marking the highest annual figure reported since current recording guidelines were introduced in July 2016.2 This was an increase of almost 33 per cent from the financial year prior to the Covid-19 pandemic, where the total days delayed patients spent in hospital was 542,204. The number of people delayed from being discharged at the monthly census point peaked in October 2024 at 2,030 (Exhibit 1, page 11). 13. Of the 720,119 bed days occupied by people delayed in their discharge in 2024/25, 66 per cent were occupied by people aged 75 and over. 14. Following this peak in October 2024, the number of people experiencing delays each month started to slowly decrease, to 1,840 in May 2025. However, delays at the monthly census point have risen again. The most recent data, to October 2025, shows a 3.3 per cent reduction from October 2024, with 1,962 people delayed from being discharged.3 Page 246 of 290
Page 247
1. Delayed discharges – what’s the problem 11 0 500 1,000 1,500 2,000 2,500 Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay Jan Sep M ay JanJan Jan Jan Jan Jan Jan Jan Oct 2019 20212020 2022 2023 2024 2025 Exhibit 1. Total number of delayed discharges in Scotland at the monthly census point, between January 2019 and October 2025 The total number of delayed discharges in Scotland at the monthly census point have risen substantially since 2020 and short-term reductions in the numbers have not been sustained. Note: The large drop in early 2020 reflects the impact of special measures undertaken due to Covid-19. Source: Delayed discharges in NHS Scotland monthly, figures for October 2025, Public Health Scotland, December 2025 Number of delayed discharges Scotland 15. At a local level, there is significant variation in the trends of the numbers of delayed discharges between IAs. This reflects the varying contexts, needs and challenges of different areas. Between October 2024 and October 2025, delays at the monthly census point have ranged between 3.9 per 100,000 population in Renfrewshire (September 2025) and 152.5 per 100,000 population in Eilean Siar (March 2025).4 Between October 2024 and October 2025, 17 IAs have reduced their level of delayed discharges, while in 14 IAs, delayed discharges have increased. The Appendix contains a table of all IAs’ performance (number and rate of delays at the monthly census point) between October 2024 and October 2025. Page 247 of 290
Page 248
1. Delayed discharges – what’s the problem 12 Delayed discharges have a detrimental impact on the people affected Staying in a hospital longer than necessary can lead to deconditioning, loss of independence and a higher risk of infections 16. Delays in discharge negatively impact patients, leading to deconditioning, higher infection risks, and reduced mobility, especially in older or frail individuals. Frailty is common among those over 65 and affects over half of adults in hospitals or care homes.5 People with dementia and/or frailty often have longer hospital stays, worsening their symptoms and physical health. Just 24 hours in bed can reduce muscle power by two to five per cent, and up to 20 per cent in seven days, increasing fall risks and care needs.6 Lack of physical activity can lead to dependency and demotivation, while bright, noisy wards may cause stress and confusion. Longer delays, typically faced by adults with incapacity, have profound impacts on the individuals and their families 17. Adults with incapacity are people aged 16 or over who lack capacity to make some or all decisions due to mental illness, learning disability, dementia or a related condition, or an inability to communicate. Adults with incapacity face risks of their human rights not being met. Their right to independent living can be affected by long stays, leading to a disconnection from family, friends and community, institutionalisation and a deterioration of mental as well as physical health. 18. Adults with incapacity generally have a longer length of delay in hospital. Patients delayed in their discharge for standard, non-complex reasons in 2024/25 experienced an average delay of ten days.7 In 2024/25, there have been between 146 and 180 patients at each monthly census point who have experienced a delay of over 12 weeks because of incapacity.8 Of these, between 35 and 65 people each month have been delayed more than six months. Delays in securing legal mechanisms like power of attorney and guardianship orders are a significant barrier to timely discharge. 19. Addressing these delays requires close collaboration between health, legal, and social care systems to ensure timely and appropriate discharge planning. Patients with a long length of stay in hospital (considered three weeks or more) tend to be in poorer health and may require more support upon discharge. They also face a higher risk of re-admission. 20. Complex and lengthy legal processes can conflict with a person- centred, human rights-based approach to care that seeks to support adults with incapacity and their carers with shared decision-making. Waiting for guardianship orders to be processed and approved by the court before more suitable accommodation and/or care arrangements are found can lead to lengthy delays. According to a 2024 Mental Welfare Commission report, the number of existing guardianship orders has more than doubled in the last ten years.9 Deconditioning is the gradual decline in physical, psychological, and functional capacity due to reduced activity or prolonged immobility. Power of attorney is a written document giving someone else authority to take actions or make decisions on your behalf. The power of attorney details the names of the people, known as attorneys, who you want to help you and lists the individual powers that you want them to have. Guardianship order is a court appointment which authorises a person to act and make decisions on behalf of an adult with incapacity. Anyone with an interest can make an application for a guardianship order. Page 248 of 290
Page 249
1. Delayed discharges – what’s the problem 13 21. In February 2025, NHS Greater Glasgow and Clyde reported that they had over 100 people delayed due to a lack of a power of attorney, roughly equivalent to four acute inpatient wards.10 It highlighted that around a third of patients were delayed from being discharged from hospital because they did not have a power of attorney in place. Delayed discharges increase pressures on the wider health system 22. People who are delayed in their discharge occupied approximately one in nine hospital beds in Scotland in 2024/25, considerably reducing the beds available for incoming emergency and planned patients.11 This adds to existing pressures in the health system, making it more difficult to admit patients, contributing to overcrowding in emergency and assessment units and increasing planned care waiting lists. 23. A lack of available beds also exacerbates pressure across ambulance services and increases stress on the workforce. These impacts have been highlighted in our NHS in Scotland 2023 report and again more recently in our NHS in Scotland 2024 report. 24. It will be challenging for health boards to increase acute hospital capacity to meet the projected increase in demand if IAs and their partners are not able to reduce delayed discharges. This will place even more pressure on limited hospital beds and may pose risks to patient safety if there is not the capacity to meet patient needs. The cost of delayed discharges is unknown, but in 2024/25, the total estimated cost of the 720,119 bed days occupied by delayed discharges alone was over £440 million 25. There has been no published information on the costs of delayed discharges since 2019/20. PHS advises this is due to challenges in receiving patient level costs from NHS boards since the Covid-19 pandemic. In the absence of up-to-date costs relating to delayed discharges, we have used the NHS cost book to calculate the approximate cost of providing the type of hospital care a person experiencing delayed discharge may receive. 26. Based on 2023/24 costs, the average daily net cost of a hospital bed in Scotland where a patient receives nursing, allied health professional (AHP) and other direct patient care (excluding medical, pharmacy, laboratory and operating theatre-related care) is estimated at £618.12 This compares with £144.72 per day for a publicly funded care home placement with nursing, and £126 per day for a publicly funded residential care home placement.13 27. Assuming a daily cost of £618 for a hospital bed, in 2024/25 the total estimated cost of the 720,119 bed days occupied by delayed discharges alone was over £440 million. This is a minimum estimated cost as it does not include wider costs across the health and social care system resulting Page 249 of 290
Page 250
1. Delayed discharges – what’s the problem 14 from delayed discharges. For example, opportunity costs associated with the reduced capacity for planned care, and the potential costs of additional care required post-discharge due to deconditioning experienced during an extended hospital stay. 28. Reducing delayed discharges would not directly generate a cash saving as it would transfer the costs to other parts of health and social care, and the hospital beds would be occupied by others in need of care. However, ensuring that a person is cared for in the most appropriate place for them may be more cost effective. The Scottish Government needs to be able to understand the true costs of patients’ delayed discharge from hospital and the savings and individual benefits being made through initiatives to reduce delayed discharges (paragraph 111). Delayed discharges occur for many different reasons Most delayed discharges happen as a result of trying to ensure that appropriate care arrangements are in place 29. Once someone is medically ready to be discharged from hospital, there are a range of reasons why their discharge might be delayed and they are kept in hospital. 30. Exhibit 2 (page 15) shows the proportion of delayed discharges by reason for delay in 2024/25, of the average 1,967 people delayed in their discharge recorded at each monthly census in 2024/25. Page 250 of 290
Page 251
1. Delayed discharges – what’s the problem 15 Exhibit 2. Percentage of delayed discharge reasons, average number across monthly censuses between April 2024 and March 2025 Source: Delayed Discharges in NHS Scotland, Annual summary of occupied bed days and census figures: Data to March 2025, Public Health Scotland, June 2025 28% Awaiting place availability: for example, waiting for a care home place. 27% Complex delays: people delayed due to awaiting place availability in a high-level needs specialist facility, and where an interim option is not appropriate or where an adult may lack capacity. 27% Awaiting completion of care arrangements: for example, people waiting on a care package (eg, home care, equipment support services). 14% Awaiting community care assessment: for example, people waiting for a formal evaluation of their care needs by community-based professionals (eg, social workers, occupational therapists, or other adult social care staff). 4% Other reasons: includes patient and family-related delays, awaiting funding and transport. 28% 27% 27% 14% 4% Delayed discharges are a symptom of the many challenges faced by the health and social care sector 31. NHS Scotland, councils, integration authorities, as well as the third sector and independent providers, all face significant challenges (Exhibit 3, page 16). Page 251 of 290
Page 252
1. Delayed discharges – what’s the problem 16 Exhibit 3. Delayed discharges are a symptom of the many challenges faced by the health and social care sector Challenge area Key issues The financial challenges facing health and social care services are critical The NHS in Scotland is experiencing immediate financial pressures, as noted in the NHS in Scotland 2025: Finance and performance report. Scotland's councils continue to face severe financial pressures, as highlighted in the Local government in Scotland: Financial bulletin 2023/24. In our Integration Joint Boards: Finance bulletin 2023/24, we reported that 24 Integration Joint Boards (IJBs) reported a financial deficit in 2023/24, with the projected funding gap for IJBs worsening to £457 million for 2024/25. IJBs are making difficult decisions about funding and providing services, often relying on dwindling financial reserves and non- recurring savings, which is not sustainable long-term. Health and social care governance is complicated, and arrangements vary making partnership working and delivery complex Different priorities, strategies, and cultures among the national and local bodies involved in community health and social care, create a web of shared responsibility, complicating decision-making, governance, planning, and operational activities as we highlighted in the Integration Joint Boards: Finance and performance 2024 report. The NHS in Scotland: Spotlight on governance highlighted some NHS boards have created strong relationships to support better planning and decision-making, but others struggle with limited control or influence over IJB decisions. The demand for health and social care services continue to grow with the needs of an ageing population Rising demand and budget pressures mean Integration Authorities face challenges in providing services that fully meet the care needs of their populations. Health inequalities are widening, with a focus on crisis medical treatment rather than preventative measures to maintain good health and wellbeing in the community. Pressure on hospital bed capacity is likely to grow, with unplanned acute inpatient hospital admissions in Scotland projected to increase by 11.8 per cent from 2024 to 2034. Cont. Page 252 of 290
Page 253
1. Delayed discharges – what’s the problem 17 Challenge area Key issues Significant workforce recruitment and retention challenges impact on the capacity to deliver services Workforce shortages, high vacancy rates and challenges with staff retention have resulted in gaps in social work, social care services, allied health professionals, nursing, and general practice. Recruitment and retention are particularly problematic in rural and remote areas. These challenges have been worsened by the impacts of Covid-19, EU withdrawal, increases in national insurance contributions and changes to UK-wide immigration policy. A lack of suitable housing makes it harder to provide care, particularly in more remote and rural areas There is a lack of planning for the future housing needs of an ageing population. Most housing stock is not built with people's longer-term care needs in mind. A shortage of suitable, affordable homes impacts key worker recruitment and retention. Delays in housing adaptations for people with learning disabilities and complex needs result in a lack of access to independent living options and prolonged stays in unsuitable accommodation or hospital. Limited housing options for staff make increasing or maintaining service capacity difficult in some areas. Source: Audit Scotland Page 253 of 290
Page 254
182. Delayed discharges – what’s happening 2. Delayed discharges – what’s happening There is significant activity to reduce delayed discharge, with examples of good practice, but a lack of evaluation means it is difficult to understand the overall impact. The Scottish Government, integration authorities and their partners have actively targeted delayed discharges, but more needs to be done to effectively measure the impact and value of approaches 32. Many of the national and local initiatives to reduce delayed discharges are still at an early stage and are too recent to assess impact and effectiveness. Some initiatives lack outcome measures or published outcomes, making it difficult to make judgements of the overall impact in reducing delays and whether they are delivering value for money. Reducing delayed discharges is a priority for the Scottish Government, with a focus on preventative actions 33. The Scottish Government’s 2024/25 Programme for Government14 reiterated its commitment to reducing delayed discharges and the variation in practice across Scotland. It outlined activities such as ensuring that partners work together to support effective discharge and reducing hospital admissions by providing the right care in the right setting. 34. The most recent Programme for Government, published in May 2025, and the NHS Scotland operational improvement plan,15 published in March 2025, emphasise a focus on prevention, through ensuring more people can be cared for at home and reducing pressures in hospitals. This will be achieved by expanding the number of Hospital at Home (H@H) beds to at least 2,000 by December 2026. It also commits to ensuring frail patients with complex needs receive the wrap-around care they need to return home or into a care setting as soon as possible, improving hospital discharges.16 The Scottish Government and COSLA have a structured approach to tackling delayed discharges through regular monitoring, collaboration and targeted support, but this lacks transparency 35. The Scottish Government and COSLA place a significant emphasis on performance management and monitor the numbers of delayed discharges nationally and in each IA, engaging with local health systems to understand performance fluctuations. Hospital at Home (H@H) provides urgent short-term hospital level care at home. This may range from one day to several weeks which would otherwise be spent in hospital. Page 254 of 290
Page 255
2. Delayed discharges – what’s happening 19 36. The Scottish Government and COSLA gain assurance over the performance of IAs through review of weekly management information on the number of delays, alongside discussions with HSCP leaders to understand the reasons behind performance, challenges and mitigations being put in place. This intelligence is shared with other leaders within the health and social care system, and performance is monitored by the First Minister and the cabinet. 37. The Collaborative Response and Assurance Group (CRAG) is a key part of the approach. It is co-chaired by the Cabinet Secretary for health and social care and COSLA health and social care spokesperson. It brings together leaders from across health and social care to coordinate responses and ensure the delivery of effective services. It focuses on areas of concern, such as delayed discharges from hospitals, by holding regular meetings to monitor performance and implement improvement strategies. 38. The Scottish Government and COSLA intended CRAG meetings to provide local oversight and consider the reasons behind high levels of delayed discharges and why the number of delays were not improving. This was difficult for some local areas for often multiple and complex reasons. Three working groups were established: • Working Group 1: A targeted performance and support work group – Rapid Peer Review and Support Team (RPRST) has engaged directly with the local systems and worked locally to improve performance (paragraph 48). • Working Group 2: Focuses on delays related to learning disabilities and mental health, including adults with incapacity. The group allows for more intensive work in these areas. • Working Group 3: Designed to look at national issues. Chaired by COSLA. It identified local case studies to highlight good practice. 39. There have been tensions with CRAG’s directional approach and how data is presented. The approach to meetings has developed over time, and general feedback is that meetings have evolved into a more collaborative space that offers a forum for sharing best practices. But there is a lack of transparency outside of the group. The Scottish Government and COSLA intend to review the remit and focus of CRAG to ensure it aligns with NHS board operational planning processes and the remit of the National Care Service (NCS) Interim Advisory Board. 40. While CRAG has established a structured approach to tackling delayed discharges through regular collaboration and targeted support, the persistence of high delayed discharge figures and significant variation in certain regions indicates that further efforts, with better analysis and evaluation of what is providing better quality outcomes for individuals, are necessary to achieve significant and consistent reductions across Scotland. Page 255 of 290
Page 256
2. Delayed discharges – what’s happening 20 In June 2025, the Scottish Government allocated additional funding of £92 million to NHS boards to improve unscheduled care services and to support the delivery of the NHS Scotland operational improvement plan 41. Reducing delayed discharges is a national priority for the Scottish Government, COSLA and IAs. In February 2025, the Scottish Government invited all NHS boards to bid for additional funding to improve unscheduled care services, supporting the delivery of the NHS Scotland operational improvement plan.17 The Scottish Government was unable to approve the entirety of each NHS board’s plans because these exceeded the total additional funding available. Ultimately, the additional urgent and unscheduled care funding for 2025/26 were made up of: • Hospital at Home funding – £21.3 million • improving flow, discharge without delay, and frailty services – £39.7 million • core unscheduled care funding – £29.8 million • mental health/adults with incapacity/learning disabilities – £824,000. 42. The Scottish Government has set out that it expects NHS boards to consider how they use the additional funding to redesign services and realign existing budgets to fully deliver on their proposals. The allocation of this additional funding is conditional on the delivery of these outcomes. The Scottish Government has set out that it will monitor progress and identify any slippages. It is the intention for the funding for future years to be made recurrent based on activity, actual spend, and evidence of delivery of outcomes required. As not all plans or initiatives have been fully funded, NHS boards will need to consider how existing budgets can be used to support their proposals. 43. The Scottish Government has a long-standing commitment to shift the balance of care from secondary, acute health services to primary and community services. Our 2016 report on Changing models of health and social care noted that the continued focus on challenging secondary care targets and short-term funding was making shifting the balance of care difficult. These issues remain, and the Scottish Government has recognised the continued need to make a long-term shift in the balance of care in its health and social care service renewal framework.18 It aims to do this by focusing new resources on building capacity and service improvement in primary and community care, leading to community services receiving an increasing share of investment over time. 44. Within IAs, there are opportunities to maximise the impact of financial resources by organising services around people’s needs, rather than traditional service/professional boundaries. However, current financial challenges make this difficult and it requires collaborative leadership. Page 256 of 290
Page 257
2. Delayed discharges – what’s happening 21 The National Care Service (NCS) Advisory Board has a remit to provide advice and suggest where improvements can be made to social care, social work and community health services. Hence it has a key role in supporting the sector to reduce delayed discharges 45. The NCS interim advisory board was set up in May 2025 to provide advice and suggest where improvements can be made to social care, social work and community health services. The aim of the interim board is to help ensure services are consistent, fair and high-quality across Scotland hence it has a key role in supporting the sector to reduce delayed discharges. The board includes people with personal experience of accessing and delivering social care, social work and community health services. It is important that the NCS advisory board is aligned with the existing groups and adds value by advising on embedding lived experience into system design, strengthening collaborative governance, developing approaches for wider participation and providing agile, evidence informed advice, rather than adding a further layer of governance, which could result in further complexity, lack of transparency, and unclear accountabilities. The Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan has encouraged local areas to focus on adopting best practice, with 11 boards embedding discharge without delay 46. The Scottish Government’s Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan (the Plan) was introduced in March 2023. It builds on the principles of its best practice discussion paper, transforming urgent and unscheduled care – optimising flow – discharge without delay, published in August 2021, and aimed to promote known good practice in terms of discharge planning and whole-system working (Exhibit 4, page 22). 47. IAs are required to complete annual self-assessments against the Plan and submit these to the Scottish Government. IAs are now on their third iteration of self-assessment. Some IAs have reported action plans against these self-assessments, but the Scottish Government has not finalised an overall summary of these self-assessments or detailed how IAs are progressing against the Plan, which makes it difficult to evidence whether the self-assessments are driving improvement. Page 257 of 290
Page 258
2. Delayed discharges – what’s happening 22 Exhibit 4. Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan delivery actions Source: Audit Scotland The Plan focuses on three delivery actions: 1. Good practice Has focused on ‘getting the basics right’ by using the Discharge without Delay (DwD) programme, see Case study 3 (page 31). The DwD collaborative has developed guiding principles for boards to follow, and there are now 11 boards signed up that are at varying stages of embedding the DwD programme. 2. Data Management A Whole System Pressures Dashboard has been developed through a collaboration between NHS National Services Scotland, Public Health Scotland and the Scottish Government. It provides a weekly summary of current pressures across the health and care system, with the aim of supporting strategic decision making. The data includes weekly discharge data, summary counts of people delayed by Health and Social Care Partnership, split by delay reasons. It also includes other data related to planned care, unscheduled care, the Scottish Ambulance Service (SAS), and other parts of the system. The usage of the dashboard can be tracked, and over 800 users have access to the dashboard. What is not clear is how individual IAs are using this data, and it is difficult to assess, as they all have different processes for analysing performance. 3. Workforce Has looked at addressing labour shortages in social care through recruitment campaigns such as ‘There’s More to Care than Caring’ and ‘You Can Make a Difference’. But challenges remain with the workforce, and many IAs and independent care providers still face recruitment challenges across the health and social care sector in Scotland, see Exhibit 3. The Rapid Peer Response and Support Team has provided targeted support to IAs struggling with persistent delayed discharge pressures, and has been positively received, but lacks evaluation to understand the overall impact 48. The Rapid Peer Response and Support Team (RPRST), initiated by the Scottish Government, has provided tailored support to NHS boards and IAs that have faced challenges in reducing delayed discharges. They collaborate with IAs to identify issues and share best practices to improve performance in reducing delayed discharges. Page 258 of 290
Page 259
2. Delayed discharges – what’s happening 23 49. The RPRST has worked closely with a variety of HSCPs to scope out bespoke packages of support. It focuses on problem identification and solving, encouraging peer support, and avoiding duplication and unnecessary bureaucracy. Some examples include: • The Aberdeenshire HSCP worked with the RPRST to map patient pathways following discharge from hospital. Following the mapping exercise, the RPRST has worked with the Aberdeenshire HSCP to develop a Standard Operating Procedure (SOP) for facilitating the discharge of patients from Aberdeen Royal Infirmary to home or via community hospitals in Aberdeenshire to home or a homely setting. The Aberdeenshire HSCP is currently working with the RPRST on implementation of the SOP. • With South Ayrshire HSCP, the RPRST helped scope Local Support Intelligence Team support from Public Health Scotland, which has enabled South Ayrshire to access data on the most frequent A&E attenders and updated trend analysis on single- and double- handed care. 50. The RPRST shares local intelligence and learning with CRAG and escalates any barriers or issues that cannot be resolved by the local area and RPRST. It maintains a network of peers to provide peer support. There has been positive feedback from boards that have been involved with the team, but there has not been any evaluation to assess the success of these initiatives and the direct impact they have had on improving performance in reducing delayed discharges. Hospital at home is a nationally supported model that can prevent hospital admissions, but there is no analysis of its cost- effectiveness in relation to other models of community or home- based care 51. The Hospital at Home (H@H) programme has been implemented as a strategic response to alleviate delayed discharges by providing acute-level care in patients’ homes. This initiative aims to reduce hospital stays, free up bed capacity, and enhance patient outcomes. 52. H@H has prevented an estimated 15,811 hospital admissions from April 2024 to March 2025, representing a ten per cent increase in the number of patients managed by H@H between April 2023 and March 2024.19 53. The 2025/26 Scottish Budget included a £100 million fund to support various reform and improvement measures, including reducing delayed discharges and expanding the capacity of H@H.20 Some of this £100 million has already been earmarked for other purposes, such as a new cardiovascular service in general practice. In June 2025, the Scottish Government informed NHS boards of the funding arrangements for H@H, allocating £21.3 million for 2025/26, and confirmed the funding for future years will be made recurrent based on activity and actual spend incurred and evidence of delivery of outcomes required. Page 259 of 290
Page 260
2. Delayed discharges – what’s happening 24 54. Health boards have highlighted that the requirement for H@H to be a secondary care consultant-led service can make it unaffordable. There is also a risk that finite resources are taken away from other areas, putting an additional burden on carers. While there is some evidence that H@H can be more cost-effective than hospital-based care, the Scottish Government or HIS have not completed a full assessment to analyse the cost-effectiveness of H@H in relation to other models of community or home-based care. 55. The Scottish Government has commissioned PHS to develop consistent national data on H@H activity. PHS plan to publish statistics quarterly from spring 2026 alongside updates by HIS on H@H improvement work. HIS and PHS should consider including metrics on the costs of H@H services, to allow assessments on the cost- effectiveness, relative to other models of care. Flow Navigations Centres, Integrated Clinical Hubs and Pathways Hubs are virtual assessment hubs that help direct patients more efficiently and effectively Flow Navigation Centres (FNCs) 56. FNCs are part of the Scottish Government’s national initiative to improve access to urgent and unscheduled care by ensuring patients receive the right care, in the right place. They offer an opportunity for professional-to-professional advice with direct referrals from primary care, NHS24 and SAS with an aim to improve coordination of patient flow. This can contribute to reducing the number of people requiring hospital care by identifying alternatives to hospital admission, such as community- based care, specialist outpatient services, home treatment options and hospital at home services. Examples of the use of FNCs: • NHS Lothian – With funding from the Scottish Government, NHS Lothian enhanced its flow navigation service by directing provision to consultant-led flow centres. The service has 11 consultants from acute medical and emergency medicine, offering a Monday to Friday 9am-6pm referral service. The new model aims to minimise the need for transfers to hospital, identify unmet need within the system and protect any one part of the system from becoming overburdened. Funding constraints means they are not currently able to operate a 24-hours-a-day, seven-day-a-week service. • NHS Greater Glasgow and Clyde – Operate an enhanced FNC+ model, bringing together a multidisciplinary team to provide assessments and navigate patients to access alternatives to hospital admission when appropriate. Central to this development is the creation of a virtual hospital, which will provide 1,000 ‘virtual beds’ across NHSGGC. Patients suitable for this model of care will be supported at home using remote monitoring technology and clinician-led interventions, allowing hospital-level care to be delivered without the need for a hospital stay. Page 260 of 290
Page 261
2. Delayed discharges – what’s happening 25 57. FNC models and levels of expertise vary across Scotland, and it can be difficult to replicate for smaller boards who may have less resource to staff FNCs as well as access and capacity in the community. There is also no unified data set collected by PHS, which makes it difficult to compare activities and outcomes. Integrated Clinical Hubs and Pathways Hubs 58. Scottish Ambulance Service (SAS) Integrated Clinical Hubs allow SAS to remotely assess and consult with patients avoiding unnecessary ambulance dispatch and hospital admissions and readmissions. The Pathways Hub is a single point of contact for SAS clinicians to access a range of proactive and preventative pathways. 59. The Integrated Clinical Hub has a remote multidisciplinary team of clinical advisers, advanced practitioners and GPs who engage with patients that would benefit from clinical assessment and review. The Pathways Hub provides pathways for those not requiring urgent or emergency care into preventative services such as falls prevention, alcohol and drug services, Distress Brief Intervention or social services, or refers patients to third sector providers that can best suit their specific needs. 60. Through the introduction of Integrated Clinical Hubs and Pathways Hubs, SAS manages around 50 per cent of emergency calls outwith acute emergency hospital settings. Patients can be supported at the point of call or by SAS clinicians on scene, reducing the need for hospital conveyance and potential admission. In June 2025, SAS highlighted that over 175,000 patients have been supported through the Hub, with more than 55,000 ambulance journeys being avoided.21 There is a focus on early identification, assessment, and management of frailty 61. Early identification and management of frailty through the provision of community frailty services is important to allow people to live as independently as possible, avoid unnecessary hospital admissions, readmissions, and reduce length of stay, if hospital admission is required. 62. Having a clinical focus on frailty at the ‘front door’ (the part of the hospital where patients initially present when unwell, such as an emergency department) and early comprehensive geriatric assessments can ensure that patients are supported by the most appropriate services. 63. The Scottish Government has set a target for every emergency department in Scotland to have direct access to specialised frailty teams by summer 2025, to support early identification, assessment and management of frailty at the hospital front door.22 HIS has developed ageing and frailty standards and set foundations for front door frailty, which sits alongside its foundations for community frailty services and key steps to setting up a front door frailty service to help organisations implement the ageing frailty standards. Page 261 of 290
Page 262
2. Delayed discharges – what’s happening 26 Getting it Right for Everyone principles have been developed to promote effective discharge planning and help prevent delayed discharges 64. Getting it right for everyone, or GIRFE, launched in May 2025, is a Scottish Government multi-agency approach to care that focuses on working together around the person. It responds to frustrations people have with the current system, such as repeating their story multiple times, navigating complex information and attending multiple appointments with different professionals. The Scottish Government worked with nine pathfinder health and social care partnerships, professionals and individuals receiving and providing care between 2022 and 2024 to develop the GIRFE approach. 65. A GIRFE toolkit has been developed to help practitioners apply a more personalised and preventative approach to care. The core principles focus on person-centred discharge planning, multi-agency coordination and, taking a consistent and ‘whole-life’ approach to ensuring an individual’s needs are considered and necessary support is in place before discharge. Discharge planning and processes vary across the country with many improvement programmes and initiatives evident 66. When a person attends a hospital for clinical care, an initial assessment should be completed to determine if their care needs can be properly met in any setting other than a hospital. The assessment should establish the best place for the person to have their clinical healthcare needs met. Where appropriate, they should be discharged to a suitable community setting, home with no ongoing support, home with support, a care home or supported accommodation. 67. If a person is admitted to a hospital, the discharge planning process should start immediately, to ensure the right care is available in the community at the time of discharge. This discharge planning process should be carried out by the responsible consultant, informed by the multi-disciplinary team (MDT), in partnership with the patient, family or carer, with their views and wishes being considered. 68. The approach to discharge planning varies across the 31 IAs. Some areas have embedded good practice involving collaboration of MDT, while others face challenges due to workforce shortages, limited resources and varying levels of cooperation and joint working Unpaid carers are often involved too late in the discharge process 69. With an ageing population, people living longer with multiple complex health conditions, and care being brought closer to home, caring is likely to be a feature of most people’s lives in the future.23 Page 262 of 290
Page 263
2. Delayed discharges – what’s happening 27 70. The Carers (Scotland) Act 2016 was introduced to provide carers in Scotland with additional rights. Part 4, section 28 of the Act provides unpaid carers the right to be involved in planning for discharge when the cared for person is admitted to hospital. In 2019, Health and Social Care Scotland published a practical guide for health and social care practitioners involved in discharge planning from hospitals.24 71. Involving carers early in the discharge planning process leads to smoother discharge and reduced delays. Readmissions are less likely as carers are better equipped to provide ongoing support, and their involvement leads to better informed care assessments. Despite this, there is still a lack of communication with carers, leading to assumptions around what support is or is not needed, and carers being often involved too late during the discharge process. 72. IAs are having to make difficult decisions on how to allocate limited budgets, and as a result some services are increasingly having to tighten eligibility criteria, such as for packages of home care. This means that people may have to rely more on family support and unpaid care. 73. An example of effectively involving carers as part of the discharge planning process is the collaboration between East Ayrshire HSCP and East Ayrshire Carers Centre. 74. East Ayrshire Carers Centre supports carers of all ages and recognises the need to involve families and carers from admission. They currently have two hospital discharge carer link workers based in University Hospital Crosshouse and University Hospital Ayr, as well as linking in with East Ayrshire Community Hospital and Biggart Hospital, working closely with the discharge without delay teams. They advise and support unpaid carers through the hospital discharge process and help identify what support they may require to continue to provide care and support for their loved ones after discharge, giving a more accurate picture of the patient’s needs and available support. Care packages are commonly cancelled on admission; changing this can reduce delays to discharge but is challenging to do 75. When someone is admitted to hospital, any existing care at home package will likely be cancelled as not being required, during the period of inpatient stay and restarted, if required, on discharge. This can save on costs and resources but impacts the continuity of care. 76. Keeping care packages open can speed up discharge. For example, in East Ayrshire IA, they try to keep care packages open for up to four weeks; this allows the continuity of care to be maintained, and it is less likely that this becomes a reason for a delayed discharge, but because of financial constraints and increasing demand, this is becoming more difficult. However, when care packages are kept open while an individual is in hospital, if demand for care packages exceeds capacity, this could mean that someone could be awaiting services in the community, so there is a delicate balance that needs to be managed.Page 263 of 290
Page 264
2. Delayed discharges – what’s happening 28 Some IAs have used financial reserves to address delayed discharges in the short term, but this is not a sustainable option 77. Using reserves to address challenges such as delayed discharges, for example, to pay for interim care placements or boosting social care capacity during peak times, can have a positive impact on performance, but this is not sustainable. 78. In our Financial bulletin on IJB finances 2023/24, we reported that IJB reserves decreased by 36 per cent in real terms (adjusting for inflation) between 2022/23 and 2023/24. Contingency reserves, which are not earmarked for a specific purpose, decreased by 49 per cent in real terms. Some IJBs have used reserves to improve performance in reducing delays (Case study 1). Case study 1. Focusing on finances and reserves for reducing delays Falkirk IA has experienced an increasing number of delayed discharges and struggled to maintain short-term improvements in performance. In 2023, Falkirk sought to understand the reasons behind increases in delays. The findings highlighted a lot of care at home waits, so the Health and Social Care Partnership focused on targeting specific blockages within the care at home service, using reserves to invest in care services to bring down delays. This resulted in an improvement from 87 delays at the April 2024 census point to 65 delays at the October 2024 census point, but the increased focus and spending resulted in a budget overspend. Falkirk quickly introduced control measures to reduce spending, and the number of delays increased. Part of the control measures were to have two people come out of a care home bed before one person could go in, and a limit on care at home hours. Analysis of care at home demand showed that the investment resulted in the lowest level of unmet demand in the community in Scotland, essentially meeting all care needs. However, as reserves were utilised and with control measures in place, delays again increased. Source: Falkirk Integration Authority Page 264 of 290
Page 265
2. Delayed discharges – what’s happening 29 Local whole-system and multidisciplinary approaches reflect the complexity of delayed discharges 79. Individual approaches may improve specific aspects of the discharge process locally and have a positive impact on the levels of delayed discharge. However, as set out in Part 1, delayed discharges are a symptom of wider challenges within the health and care system, involving many different factors, services and professions. To have a significant lasting impact on the level of delayed discharges requires shared accountability and a collaborative approach from all stakeholders, at all levels, which is built on evaluation and uses data to support decision-making. 80. There are some examples of whole-system and multidisciplinary team initiatives which have had a positive impact on delayed discharges. For example, the Lothian Partnership unscheduled care improvement programme is a local application of a whole-system approach. This aimed to enable transformation of models of care to ensure long-term sustainability and has resulted in reducing delays (Case study 2). Case study 2. Lothian Partnership – unscheduled care improvement programme In autumn 2024, there was a wider concern about the level of pressure across the whole system in NHS Lothian, with high hospital occupancy levels, especially in acute hospitals, and accident and emergency delays were very high. This was caused by several factors, including delayed discharges. The Scottish Government approached NHS Lothian to explore options to improve unscheduled care (USC) performance. The programme initially focused on the Royal Infirmary of Edinburgh and aimed to create a whole-system approach to enable the transformation of care models, ensuring long-term sustainability. The programme looked to move towards better partnership working, home-first approaches and a seven-day USC staffing model. This included discharging patients every day of the week and shifting care from acute to community services. The programme goals included reducing attendances, admissions, bed occupancy and length of stay in hospital, with data being used to support accountability and decision-making. It provided several benefits in respect of patient flow through the hospital, and although there was no focus or specific targets on delayed discharges, at the end of the 2024/25 financial year, NHS Lothian reported a reduction in delayed discharges at the Royal Infirmary of Edinburgh by 17 per cent and Western General Hospital by 32 per cent. Staff morale has improved, along with collaborative leadership and a belief in a whole-system approach. Source: NHS Lothian A whole-system approach looks at all aspects of how a system operates, the role of each part within the system, and how they are connected. This can help understand how things can be done differently to improve systems. Page 265 of 290
Page 266
2. Delayed discharges – what’s happening 30 Case study 3. Discharge without Delay (DwD) programme The DwD programme was built on principles developed in Tayside and is a whole-system initiative designed for frail older people currently accessing hospitals in Scotland. It integrates best practices, individual services, and care pathways into a model that prioritises delivering a comprehensive geriatric assessment of the patient promptly, ensuring that patients experience no negative consequences from their hospital stay, while facilitating a smoother transition from hospital to home. The DwD programme has four key integrated workstreams: • Planned Date of Discharge (PDD) and Integrated Discharge Hubs Workstream – A single point of referral for complex discharges, setting a realistic planned date of discharge, supported by a MDT approach. • Discharge to Assess (D2A)/Home First Workstream – The completion of social care assessment post discharge. Enabling people to return home without delay, through services that offer responsive community-based home care support. • Community Hospital and Step-Down Rehabilitation Units Workstream – Enhanced use of these facilities to care for frail individuals requiring rehabilitation and extended assessments. • Acute Frailty Unit Workstream – Frailty units early in the admission process in acute hospitals provide early comprehensive geriatric assessments for frail older people. The DwD collaborative meets fortnightly and now has over 50 members across 11 boards in Scotland. All boards in the DwD group have undertaken a needs assessment aligned to the guiding principles set out by the DwD collaborative that will support the development of a comprehensive action plan to guide service, workforce, and budget planning for the year ahead and inform the respective annual delivery plan 2025/26. 81. Multidisciplinary team (MDT) collaboration brings together health services, social care, housing, and community providers to coordinate care, share information, and streamline patient transitions. When these partners work closely, they can identify and resolve barriers more quickly, ensure appropriate support is in place post-discharge, and improve outcomes for patients. Strong, sustained collaboration fosters a more integrated system, reducing delays and improving overall efficiency. The Discharge without Delay (DwD) programme is another example of a collaborative, multidisciplinary, whole-system approach (Case study 3). Page 266 of 290
Page 267
2. Delayed discharges – what’s happening 31 Power of attorney and guardianship orders can be a lengthy, complicated process with long waits for legal aid 82. In December 2024, Health and Social Care Scotland funded the development of a power of attorney stakeholder toolkit and associated media campaign around a national power of attorney day to raise awareness of the importance of having a power of attorney in place. 25 As for many, especially those on lower incomes, having a power of attorney in place is not considered a priority. In more rural areas, this can be challenging, for example, in Highland, there are very few solicitors who accept legal aid due to capacity. According to the Scottish Legal Aid Board (SLAB), in 2024–25, adults with incapacity cases accounted for 47 per cent of all grants, up from just two per cent in 2005–06.26 83. There may be opportunities for IAs to target proactive support for patients who are most likely to require a power of attorney. For example, East Ayrshire HSCP has been supporting dementia patients to set up a power of attorney. Working with Alzheimer’s Scotland, they are supporting individuals and their families to put in place a power of attorney during dementia post-diagnostic support, while they still have capacity. A range of teams across the HSCP are engaged in supporting power of attorney discussions at the earliest opportunity across the wider population. Work is under way to ensure there is a shared approach to identification, promotion, and provision of power of attorney, including market testing to explore improved access to quality assured legal partners. 84. Our stakeholder engagement has highlighted that better public awareness of power of attorney and guardianship orders is needed, and support for those on lower incomes may be useful to ensure families have them in place before they are admitted to hospital. 85. The Scottish Government is considering changes to the Adults with Incapacity (Scotland) Act 2000 to better protect people’s rights and dignity, and the 2024/25 Programme for Government, published in September 2024, committed to bringing forward a Bill amending the Adults with Incapacity legislation. Between July and October 2024, the Scottish Government carried out a consultation on its proposals, publishing analysis from these consultations in January 2025.27 The responses to the consultation will inform the development of that legislation and the accompanying guidance and revised codes of practice. The DwD collaborative has agreed on four key targets to reduce delayed discharges and their impact (detailed in paragraph 115). There are early signs that the DwD programme is now having an impact in reducing delays across some boards that have implemented the new principles, but boards are at varying stages of implementing service changes, and the principles will take time to fully embed. Source: Discharge without delay collaborative Page 267 of 290
Page 268
2. Delayed discharges – what’s happening 32 The third sector is a key partner in tackling delayed discharges, especially in community-based interventions and carer support 86. Many IAs rely on third sector organisations to deliver social care services, including care home and care at home services. They also rely on the third sector to deliver services that enable timely discharge, such as housing support, befriending, and palliative care. 87. For example, the British Red Cross (BRC) supports health and social care across the UK, providing services in hospitals, primary care, social care and in the community. Their services include home from hospital support, assisted discharge, reablement, patient transport and discharge to assess, enabling faster, safer discharges and reducing the likelihood of readmission: • In East Ayrshire, the BRC is a key delivery partner offering assisted discharge, transports such as oxygen and stretcher transport, and non-regulated support services such as practical and emotional support to people for up to 12 weeks after discharge. • In partnership with Ninewells Hospital and Dundee HSCP, the BRC has co-developed a D2A model. Assessments are done in the person’s own home, and the Red Cross can provide wrap-around care and support during the assessment process for up to 21 days. 88. The Health and Social Care Alliance Scotland (the ALLIANCE) reported in April 2025,28 that overall, there had been local examples of good practice with health and social care integration across IAs, but these are yet to be adapted and implemented at scale. The ALLIANCE further reported that effective partnership working and collaboration between the third and public sector are undermined by financial challenges, negative attitudes toward the third sector, and complex organisational processes. 89. As significant contributors in the delivery of community health and social care services, the third sector and, where appropriate, the independent sector, should be involved in developing approaches to whole-system change. Digital solutions are playing an increasingly vital role in tackling delayed discharges 90. The use of artificial intelligence (AI) and digital technology is a powerful tool that can transform access to healthcare, improve efficiency and support long-term savings and better integration: • Remote and virtual care with enhanced online accessibility reduces the need to travel and virtual assistants can provide health advice, triage symptoms, and guide patients to appropriate care 24/7. Page 268 of 290
Page 269
2. Delayed discharges – what’s happening 33 • AI can help hospitals and health professionals allocate resources more efficiently and streamline administrative tasks. Our Tackling digital exclusion report gives examples of how digital options can improve access to services and help save money, such as the Near Me video consulting service. 91. An example of where digital technology has improved efficiency and supported better discharge planning by improving the interface between acute and community teams has been the launch by NHS Highland of a dynamic discharge app. 92. It follows the planned date of discharge principle of discharge without delay. The app links together multidisciplinary decision-making teams in both acute and community settings, improving communication to help ensure patients are put on the correct pathway as early in the process as possible. Upgrades to the app have included a clinical frailty scale, and a chat function to improve real-time communication to support the flow of patients through the hospital. 93. There is potential for AI and technology-enabled care (TEC) to support people to live more independently at home, including supporting the elderly and those living with dementia. Digital connections form part of East Ayrshire HSCP’s longer-term strategic plan to align the Home First model of care to a Digital First principle promoting the use of TEC for independent living.29 Recent innovations include the East Ayrshire smart hub which showcases different smart home technologies and is part of the Smart Supports initiative, using technology to provide services which can help people live independently within their homes and communities. 94. In our Community health and social care performance report, published in January 2026, we note that the Scottish Government has encouraged, through a number of workstreams, the growth of TEC. Although preventative initiatives to keep individuals in the community, such as the use of community alarms and telecare, have been used across IAs, the estimated number of people receiving community alarms and/or telecare is relatively static. 95. With the growing challenge of an ageing population, workforce shortages and rising costs, IAs should work together to share learning and best practice from these digital initiatives, as digital technology and digital innovations will be an important consideration in early intervention and prevention strategies. Page 269 of 290
Page 270
343. Delayed discharges – what needs to happen 3. Delayed discharges – what needs to happen Scotland’s Population Health Framework and the Health and Social Care Service Renewal Framework offer an opportunity for a common focus on prevention across health and social care. But it is not clear how the shared accountability and joint decision-making needed across all stakeholders will be achieved and how the underlying challenges in the social care sector will be addressed. The lack of a consistent approach to evaluating initiatives makes it very difficult to understand their impact. More needs to be done to understand the true costs of delays, what actions and initiatives are providing better quality of outcomes for individuals, and which approaches represent value for money for public spending. There is a long-term recognition of the need for extensive change in the health and social care sector to improve outcomes, including a focus on prevention, shifting the balance of funding and better collaborative working across sectors and organisations 96. In 2005, we published Moving on? An overview of delayed discharges in Scotland. In this report, we highlighted that solving the problem of delayed discharges needs action across all parts of the health and care system. In our Health and social care integration: Update on progress report, published in November 2018, we reported that significant changes are required in the way that health and care services are delivered, and highlighted: • appropriate leadership capacity must be in place • all partners need to be signed up to and engaged with the reforms Page 270 of 290
Page 271
3. Delayed discharges – what needs to happen 35 • partners also need to improve how they share learning • change cannot happen without meaningful engagement with staff, communities and politicians. 97. At both a national and local level, all partners need to work together to be more honest and open about the changes that are needed to sustain health and care services in Scotland. 98. These messages were reiterated in our Integration Joint Boards: Finance and performance report, published in July 2024. It highlighted that we still have not seen significant evidence of the shift in the balance of care from hospitals to the community intended by the creation of IJBs. It also noted there is a lack of collaboration and systematic shared learning. Scotland’s population health framework and the health and social care service renewal framework provide high-level guidance for change, but more clarity is needed on how these ambitions will be achieved 99. In June 2025, the Scottish Government and COSLA launched Scotland’s Population Health Framework 2025–2035 (PHF) and the Health and Social Care Service Renewal Framework (SRF). Both frameworks are a welcome development, recognising the need for a cross- sector approach to address the challenges of health and social care, with a focus on prevention at the core. Scotland’s population health framework provides a common vision, but it is not clear how shared accountability and joint decision- making will be achieved and there is limited reflection of the role of social care 100. The PHF sets out at a high level ‘a ten-year approach to improving health and wellbeing in Scotland’. It focuses on population-level prevention by improving health outcomes and reducing inequalities across Scotland. It clearly recognises the need to engage across public, private and third sector bodies to have a meaningful impact on public health and wellbeing and address these inequalities. 101. Although delayed discharges are not a central theme, the scope of the framework, which includes a cross-sector approach focusing on prevention drivers of health and wellbeing, supports actions to indirectly address delayed discharges. Importantly, the role of social care, as a critical element in the infrastructure for public health, is not fully recognised. The framework largely reflects the issues from an NHS perspective. This imbalance risks the achievement of the aims of this framework, including improving outcomes such as reducing delayed discharges. 102. The framework is a positive step towards having common aims to achieve long-term improvement of outcomes, although it is not clear how the shared accountability and joint decision-making needed across all stakeholders will be achieved, and it remains to be seen whether the required cross-sector buy-in can be achieved. Page 271 of 290
Page 272
3. Delayed discharges – what needs to happen 36 The Health and Social Care Service Renewal Framework is an opportunity for progress to be made with health and social care reform but IJBs and social care need to be more central to the arrangements, and it is not clear how the framework approach will address the leadership, cultural, financial and governance barriers that integration has not managed to overcome over the past ten years 103. The SRF provides a high-level guide for change, to ensure the sustainability, efficiency, quality and accessibility of health and social care services in Scotland. It sets out a shift towards a community-orientated approach to health and social care which, in turn, will contribute to better integration of services to meet individuals’ and families’ needs. 104. The SRF aims to ‘progress reform to ensure long-term financial sustainability, reduce health and care inequalities, further harness the benefits of digital technology, and improve health outcomes for people in Scotland’. The framework has the potential to reduce delayed discharges, improve workforce sustainability, and enhance patient outcomes, but only if it is implemented effectively and underpinned by genuine collaboration. 105. The SRF offers an opportunity to make the progress needed in the integration of health and social care. However, as with the PHF, there is limited reflection of social care or the role of IJBs. The Public Bodies (Joint Working) (Scotland) Act, 2014 (the Act) was intended to ensure that health and social care services were well integrated, that people receive the care they need at the right time and in the right setting, with a focus on community-based, preventative care. However, Scotland is yet to achieve this shift in the balance of care. The underlying challenges in the social care sector remain. It is not clear how the SRF approach will address the leadership, cultural, financial and governance barriers that integration has not managed to overcome over the past ten years. 106. Without IJBs and HSCPs being at the centre of the planning and decision-making about service renewal it is unlikely this framework will achieve the engagement and affect the change intended. In developing the plans to support this framework, more consideration is required of what this will mean for social care and social work services. The NHS Scotland operational improvement plan looks to address delayed discharges through reducing the pressure in hospitals and by shifting the balance of care 107. The NHS Scotland operational improvement plan (2025–2026),30 published in March 2025, is the Scottish Government’s short-term plan that sets out actions that are intended to progress reform and enhance NHS delivery. The plan is a useful summary of current key initiatives and commitments but does not set out specific actions in any detail. It looks to address delayed discharges and the pressures on hospitals through Page 272 of 290
Page 273
3. Delayed discharges – what needs to happen 37 programmes such as H@H, approaches to manage frailty, including specialist frailty services and managing frailty at A&Es and access to GPs and primary health care. 108. As highlighted in relation to the PHF and SRF, these approaches cannot be achieved in isolation and need to be planned and progressed in partnership with the social care sector, primarily through the IAs and HSCPs. In isolation, the NHS is limited in how effectively it can achieve the aims set out in this plan. The lack of a consistent approach to evaluating initiatives makes it very difficult to understand their impact and assess value for money 109. There has been significant work by the Scottish Government, integration authorities and their partners to reduce delays. Some regional areas are showing improved performance, but there has not been an overall assessment of the impact of these initiatives. Having a consistent approach to evaluating national initiatives for reducing delayed discharges and preventing hospital admissions would improve transparency of their effectiveness, if they are delivering value for money and if they are improving the balance of care which would help inform future resource allocation decisions. The Scottish Government does not measure the total costs associated with delayed discharges 110. As of October 2021, PHS stopped reporting the underlying costs of beds associated with delayed discharges, which was due to metrics being out of date and likely an underestimate of the true cost. 111. At present, the Scottish Government does not measure the total costs associated with delayed discharges. The Scottish Government recognises this as a gap in its data, but given the priority and investment in reducing delays, the Scottish Government needs to be able to understand the true costs of delays and the savings made through initiatives to reduce delayed discharges. In a system under extreme financial pressure, it is essential that the Scottish Government can identify the cost of delayed discharges and take targeted action to reduce them, enabling more effective and productive use of resources. The Scottish Government and COSLA do not have targets to monitor performance in reducing delays 112. The national mission to reduce delayed discharges was jointly agreed by the Scottish Government and COSLA, and between July 2024 and October 2024, the Scottish Government and COSLA assessed IAs performance against a national target of 34.6 delays per 100,000 population, based on a pre-pandemic rate, with each IA having to bring Page 273 of 290
Page 274
3. Delayed discharges – what needs to happen 38 down delays to a specific level to contribute to this national target. This was a time-bound target up to October 2024. By October 2024, the target was not met, with national performance at 44.8 delays per 100,000 population. A new target was not introduced. 113. The Scottish Government and COSLA now monitor IA performance based on the trajectories of the numbers of people delayed, outliers, and comparison with the Scottish average. At a national level, the delayed discharge rate has remained above 40 delays per 100,000 population, peaking at 44.8 in October 2024. 114. The Scottish Government, along with feedback from delivery partners and COSLA, advises that setting a single national target for delays may narrow focus and divert resources from community-based activities. While national targets can highlight key areas for improvement, they may not address the complexity of local issues. Measures should be set in consultation with partners to ensure they are evidence-based, sensitive to local circumstances, and linked to improved outcomes. Many local service providers prefer the indicators developed by the DwD collaborative, which considers the number of delays as one of several performance indicators. 115. Locally driven targets can help focus efforts to reduce delays where they will make the most impact. Analysis of local data on the processes and barriers faced in their local context has allowed some IAs to target investment and implement service changes that have resulted in reductions in delayed discharges. IAs involved in the DwD programme (Case study 3) have agreed four key targets to improve system flow, reduce delayed discharges and ensure actions put in place are achieving the intended impact: • Reduce acute geriatric length of stay by more than 20 per cent compared to March 2024 levels, by the end of March 2026. • Reduce community hospital and step-down care length of stay by more than 20 per cent compared to March 2024 levels, by the end of March 2026. • Reduce respective HSCP delayed discharges by more than 20 per cent compared to March 2024 levels, by end of March 2026, because of improved flow. • Less than 25 per cent of total delayed discharges in acute hospitals by December 2025. 116. The Scottish Government is working with the DwD group to ensure that all data reporting requirements and measures for monitoring are aligned. Page 274 of 290
Page 275
39EndnotesEndnotes Endnotes 1 Delayed discharges in NHS Scotland, annual summary of occupied bed days and census figures, data to March 2025 (planned revision), Public Health Scotland, December 2025. 2 Delayed discharges in NHS Scotland, annual summary of occupied bed days and census figures, data to March 2025, Public Health Scotland, June 2025. 3 Delayed discharges in NHS Scotland monthly, All delay reasons summary tables to October 2025, Public Health Scotland, December 2025. 4 Delayed discharges in NHS Scotland monthly, All delay reasons summary tables to October 2025, Public Health Scotland, December 2025; Mid-year population estimates for Scotland time series data, National Records of Scotland, August 2025. 5 Frailty Briefing, British Geriatrics Society, February 2025. 6 Health and Social Care Delayed Discharge and Hospital Occupancy Action Plan, Scottish Government, March 2023. 7 Median length of delays at point of discharge, Standard delays tables to June 2025, Delayed Discharges in NHS Scotland monthly, Public Health Scotland, August 2025. 8 Code 9 delays tables to June 2025, Delayed Discharges in NHS Scotland monthly, Public Health Scotland, August 2025. 9 Adults with Incapacity Act Monitoring Report 2023-24, Mental Welfare Commission, September 2024. 10 Your future in your hands with Power of Attorney, NHS Greater Glasgow and Clyde, February 2025. 11 Delayed discharges in NHS Scotland, annual summary of occupied bed days and census figures, data to March 2025 (planned revision), Public Health Scotland, December 2025. 12 Hospital cost breakdown, specialty cost and activity – inpatients in all specialties (excluding long stay) (R040), Scottish Health Service Costs 2023/24, Public Health Scotland, February 2025. 13 National Care Home Contract (NCHC) Fee Negotiation 2025/25 Offer Letter to Scottish Care, Scotland Excel, March 2025. 14 Programme for Government 2024-25, Serving Scotland, the Scottish Government, September 2024. 15 NHS Scotland operational improvement plan, the Scottish Government, March 2025. 16 Programme for Government 2025-26, Building the Best Future for Scotland, the Scottish Government, May 2025. 17 NHS Scotland operational improvement plan, the Scottish Government, March 2025. 18 Health and Social Care Service Renewal Framework 2025-2035, Scottish Government and COSLA, June 2025. 19 Hospital at Home Programme progress update, Healthcare Improvement Scotland, May 2025. 20 Scottish Budget 2025 to 2026, the Scottish Government, December 2024. 21 Integrated Clinical Hub – the Scottish Ambulance Service Evolution, the Scottish Ambulance Service, June 2025. Page 275 of 290
Page 276
Endnotes 40 22 NHS Scotland Operational Improvement Plan, Scottish Government, March 2025. 23 Scotland Briefing Caring About Equality, Carers Week 2025. 24 Involving Carers in Discharge Planning, Health and Social Care Scotland, March 2019. 25 Power of Attorney – stakeholder toolkit, Health and Social Care Scotland, December 2024. 26 Legal Aid Enquiry, Scottish Legal Aid Board, April 2025. 27 Adults With Incapacity Amendment Act Summary and Analysis of Response to Consultation, the Scottish Government, January 2025. 28 The Integration Journey: Celebrating a decade of health and social care, the ALLIANCE, April 2025. 29 Strategic Plan 2021-2023, 2024-2027 update, East Ayrshire Health and Social Care Partnership, June 2025. 30 NHS Scotland operational improvement plan, the Scottish Government, March 2025. Page 276 of 290
Page 277
41Appendix Appendix Integration authorities’ performance (number and rate of delays at the monthly census point) between October 2024 and October 2025 October 2024 October 2025 Percentage change Delays at monthly census point Delays at monthly census point per 100,000 population Delays at monthly census point Delays at monthly census point per 100,000 population Aberdeen City 64 33.8 49 25.9 -23.4% Aberdeenshire 84 39.8 80 37.9 -4.8% Angus 30 31.8 17 18.0 -43.3% Argyll and Bute 33 44.8 53 71.9 60.6% Clackmannanshire and Stirling 54 45.2 45 37.7 -16.7% Dumfries and Galloway 79 65.3 101 83.5 27.8% Dundee City 25 20.4 23 18.8 -8.0% East Ayrshire 28 28.4 34 34.5 21.4% East Dunbartonshire 27 30.7 24 27.3 -11.1% East Lothian 38 41.2 31 33.6 -18.4% East Renfrewshire 12 15.6 17 22.0 41.7% Edinburgh 192 43.2 121 27.2 -37.0% Eilean Siar 16 73.9 25 115.5 56.3% Falkirk 65 50.2 68 52.5 4.6% Fife 128 41.9 113 37.0 -11.7% Glasgow City 231 42.8 252 46.7 9.1% Cont. Page 277 of 290
Page 278
Appendix 42 Integration authorities’ performance (number and rate of delays at the monthly census point) between October 2024 and October 2025 October 2024 October 2025 Percentage change Delays at monthly census point Delays at monthly census point per 100,000 population Delays at monthly census point Delays at monthly census point per 100,000 population Highland 223 114.2 215 110.1 -3.6% Inverclyde 7 10.8 13 20.0 85.7% Midlothian 32 40.5 20 25.3 -37.5% Moray 33 42.7 38 49.2 15.2% North Ayrshire 74 67.2 104 94.5 40.5% North Lanarkshire 106 38.4 103 37.3 -2.8% Orkney 7 38.7 15 82.9 114.3% Perth and Kinross 47 37.1 46 36.3 -2.1% Renfrewshire 20 13.0 9 5.8 -55.0% Scottish Borders 84 86.9 43 44.5 -44.8% Shetland 11 59.1 12 64.5 9.1% South Ayrshire 79 84.8 88 94.5 11.4% South Lanarkshire 124 45.9 107 39.6 -13.7% West Dunbartonshire 24 33.3 53 73.5 120.8% West Lothian 51 34.6 40 27.2 -21.6% Scotland 2030 44.8 1962 43.3 -3.3% Sources: Delayed discharges in NHS Scotland monthly, All delay reasons summary tables to October 2025, Public Health Scotland, December 2025. Mid-year population estimates for Scotland time series data, National Records of Scotland, August 2025 Page 278 of 290
Page 279
Delayed discharges A symptom of the challenges facing health and social care Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN Phone: 0131 625 1500 www.audit.scot ISBN 978 1 915839 95 4 AGS: AGS/2026/1 Page 279 of 290
Page 280
Page 280 of 290
Page 281
Midlothian IJB Audit and Risk Committee Thursday, 5th March 2026, 14:00-16:00 Midlothian Council Internal Audit Reports (For Noting) Executive summary This report introduces the Midlothian Council Internal Audit Reports recently finalised that should be noted by the Midlothian IJB. One recent report is being brought to the attention of the Midlothian IJB Audit & Risk Committee as it provides appropriate assurance concerning relevant areas of governance. On the 23 February 2026 the Midlothian Council Audit Committee was presented with a report on Direct Payments Self Directed Support which provided a conclusion of Reasonable Assurance. Recommendations have been agreed with Council management and will be followed up to conclusion by the Midlothian Council Internal Audit team through the Audit Committee. One of the recommendations covers performance reporting and therefore is relevant to the IJB, however this is an operational report for Midlothian Council. As a result of this report, Members are asked to: • Note the findings of the Midlothian Council Internal Audit of Direct Payments Self Directed Support. Item number: 5.7 Page 281 of 290
Page 282
Midlothian Integration Joint Board Report Midlothian Council Internal Audit Reports (For Noting) 1 Purpose 1.1 The purpose of the Report is to inform the MIJB Audit and Risk Committee of the Midlothian Council Internal Audit Report on Direct Payments Self Directed Support providing Reasonable Assurance. 2 Recommendations 2.1 As a result of this report, Members are asked to: • Note the findings of the Midlothian Council Internal Audit of Direct Payments Self Directed Support. 3 Background and main report 3.1 The Chief Internal Auditor continues to review audit papers for both NHS Lothian and Midlothian Council on an ongoing basis. Where Internal Audit reports may be relevant to the IJB details of these reports are brought forward to the MIJB Audit & Risk Committee to note. 3.2 On the 23 February 2026 the Midlothian Council Audit Committee was presented with a report on Direct Payments Self Directed Support which provided a conclusion of Reasonable Assurance. Recommendations have been agreed with Council management and will be followed up to conclusion by the Midlothian Council Internal Audit team through the Audit Committee. One of the recommendations covers performance reporting and therefore is relevant to the IJB, however this is an operational report for Midlothian Council. 3.3 Members should note that this report is an operational report in relation to Midlothian Council and the agreed actions are being resolved and monitored by Midlothian Council Audit Committee. 4 Policy Implications 4.1 This report does not directly impact upon any policies. Page 282 of 290
Page 283
Midlothian Integration Joint Board 5 Directions 5.1 This report does not directly impact upon service delivery ability to deliver an existing Direction. 6 Equalities Implications 6.1 There are no equalities implications. 7 Resource Implications 7.1 There are no direct resource implications for the IJB arising from this report. 8 Risk 8.1 There are no direct risk impacts as a result of this report. 9 Involving people 9.1 These reports have been through appropriate management review within NHS Lothian prior to finalisation and are presented here for noting 10 Background Papers 10.1 Appendix 1 is the Executive Summary of the Midlothian Council Internal Audit Report on Direct Payments Self Directed Support. 11 Governance This report is in relation to a Midlothian IJB strategy, plan, policy, Direction, or financial decision that should be escalated to Midlothian IJB for final approval. X This report includes information that should be escalated to Midlothian IJB for noting only. X This report is the Audit and Risk Committee’s Business as Usual (BAU) and does not require Midlothian IJB’s review. √ Author’s Name Duncan Stainbank Designation MIJB Chief Internal Auditor Contact Information Duncan.Stainbank@midlothian.gov.uk Date 25/02/2026 Page 283 of 290
Page 284
Midlothian Integration Joint Board Appendices: Appendix 1: Executive Summary of the Midlothian Council Internal Audit Report on Direct Payments Self Directed Support Page 284 of 290
Page 285
Appendix 1: Executive Summary: Direct Payments – Self Directed Support (SDS) Conclusion: Reasonable Assurance Policies and procedures are in place for Direct Payments Self Directed Support (SDS) and guidance is being updated within Adult Health and Social Care. Strength-based assessments have been undertaken and authorisation processes are in place to ensure that Direct Payments are only made for assessed needs and in accordance with an appropriately completed financial assessment. Testing highlighted that Direct Payment Agreements and Local Authority Agreements to Employ a Family Member forms were not on file and Direct Payment care packages were not reviewed on a timely basis. Financial reassessments were not undertaken on a timely basis and financial outcome letters were not sent to service users whose contributions had changed following reassessment. A number of cases were identified where the service user had not received a Direct Payment for a period of time which may be due to the service user not adequately managing their personal budget. Background Under the Social Care (Self-Directed Support) Scotland Act 2013, Self-Directed Support (SDS) options must be offered to all social work service users which include four options: Direct Payment of funds to service users to purchase their own care, service user direction over the use of funds held by a third party, Council selection of and payment for services, or a mix of all three. Direct Payments are local health and social care payments for people with an assessed need who would prefer to arrange and pay for their own care and support. Information is recorded on the case management system, Mosaic and Direct Payments are made through a BACS transfer paid into the service user’s bank account. The Council is currently considering introducing pre-paid cards for service users. Summary of findings & recommendations • Direct Payment agreements formally detailing how the funding will be used and the Local Authority Agreement to Employ a Family Member form were not on file for any of the cases tested. Management will ensure the agreements and forms are completed and held on file by 30 September 2026. • Financial reassessment reviews were not undertaken on a timely basis and financial outcome letters were not issued to service users whose contributions had changed following a financial re-assessment for the cases tested. Management will ensure financial reviews are completed and letters issued by 31 March 2026. • A number of cases were identified where a Direct Payment had not been issued for a period of time. Management have agreed to investigate these cases and establish if any further action is required by 30 September 2026. • Testing highlighted that Direct Payment care package reviews had not always been undertaken when required. There is no regular specific reporting of Direct Payment cases that are due for review. A report on Direct Payment cases due for review will be regularly produced by 30 September 2026 and the completion of reviews managed in accordance with the resources and pressures of the whole service. Recommendation Summary Recommendations Grade High Medium Low Total Current Report - 6 7 13 Prior Report N/A N/A N/A N/A Materiality 314 people were in receipt of Direct Payments (as at August 2025) and the total value of Direct Payments was £1,262,940 (from April to September 2025). The total value of Direct Payments during 2024/25 was £2,610,325. Page 285 of 290
Page 286
2 Headlines Objectives Conclusion Comments 1. Policies and procedures for Self-Directed Support and Direct Payments are in place which comply with legislation and includes local eligibility criteria Reasonable Assurance Policies and procedures are in place for SDS which includes Direct Payments and these are in line with best practice, relevant regulations and legislation. The Council offers all SDS options which are discussed as part of the strength-based assessment. Adult Health and Social Care are in the process of updating the Direct Payments guidance and the update will incorporate the recommendations made within this audit report. There is a lack of Direct Payment operating procedures detailing responsibilities for tasks within each service area which has led to processes not being completed due to a misunderstanding over who is responsible for what. The SDS policy states that reviews should be undertaken in line with the Council’s review policy but the review policy hasn’t been updated since 2011 and there is no review policy on the Internet. The Council’s 2025/26 charging policy was applicable from 1 April 2025 but was not published on the website and intranet until December 2025. 2. Strength-based assessments have been undertaken, and authorisation processes are in place to ensure that Direct Payments are only made for assessed needs and in accordance with an appropriately completed financial assessment. Reasonable Assurance Strength-based assessments are undertaken (for Adult Services and Children’s Services) and proposed support packages are submitted to the Resource Panel for authorisation. It was noted that Adult Health and Social Care used different assessment forms which did not always detail service users outcomes. Direct Payment guidance is currently being updated to ensure there is a consistent practice within Adult Health and Social Care. If a client chooses Direct Payment Option 1, part of the assessment involves the practitioner or the social worker discussing the practicalities of the Direct Payment process such as who is managing the Direct Payment and service users are made aware of the support available however this is not formally recorded on the Mosaic form as part of the assessment. Within the SDS Act 2014, there are provisions for support to be provided by family members under Direct Payments provided the conditions are appropriate. If a user requests for a family member to provide the services of a Personal Assistant (PA), this must be documented on the Direct Payment Agreement and a Local Authority Agreement to Employ a Family Member form should be completed. This is then assessed to determine if the arrangement is suitable From the 15 cases reviewed, 2 cases had a family member employed as a PA but no form had been completed. Financial assessments are completed in accordance with the relevant legislation and guidance. Page 286 of 290
Page 287
3 3. Adequate financial controls and monitoring procedures are in place and regular reviews are undertaken to ensure Direct Payments are used appropriately and only for eligible support. Limited Assurance Direct Payment audit monitoring returns must be completed by service users every quarter to demonstrate that funds provided have been spent appropriately. Checks are undertaken within the Operational Support team and cases are referred to the service manager if inappropriate spend is identified. If sufficient evidence is not received the next payment is withheld. Reminders are sent out every quarter, but this is not always followed up if no evidence is received. It was noted that there are a number of Direct Payment client accounts which have not been paid for a period of time which may be due to the service user not adequately managing their personal budget. Financial reassessments should be undertaken annually to establish whether the service user is required to make a financial contribution. These are not being completed on a timely basis and Financial Assessment Outcome Letters had not been issued for the cases tested following reassessment which required a change to their contribution. There were 475 cases due for reassessment (Nov25) and only 205 had been undertaken (this includes non Direct Payment cases). Audit testing identified 2 cases where small overpayments were paid by the service users due to them not being informed of their updated contributions after reassessment. The Care and Support (Direct Payments) Regulations 2014 set out that the local authority must review Direct Payments initially within 6 months, and thereafter every 12 months This process is managed in accordance with the reviews of all other social work client groups It was noted from the sample testing of 15 cases that 11 reviews scheduled on Mosaic had gone past their review date. A report was requested to identify how many care package reviews in relation to Direct Payments have gone past their review date but this information could not be provided at the time of testing. 4. Service users are receiving appropriate information, support and guidance in managing their Direct Payments and appropriate action is taken to recover any funds that have not been utilised or not utilised for appropriate purposes. Limited Assurance A Direct Payment Agreement formally detailing the terms and conditions, the agreed budget and, how it will be used to meet the identified outcomes and needs of the supported person was not on file for any of the 15 cases sampled. This can result in confusion and disputes over what the funding can be used for. The Council commissions LCIL to support service users who receive a Direct Payment. The support offered from LCIL includes payroll services, helping with money management and maintaining accurate records. A Statement of Rates letter is in place for 2025-26 which details the cost of the service for approximately 95 individuals (circa £20k pa) and that periodic service reviews shall be carried out by the Council and the provider to ensure effective delivery of the service. Testing highlighted a case where LCIL were not sending paperwork to the Operational Support team on a timely basis to enable the quarterly audit checks to be undertaken. Page 287 of 290
Page 288
4 Areas where expected controls are met/good practice No. Areas of Positive Assurance 1. Policies and procedures are in place for Self-Directed Support (SDS) which includes Direct Payments as one of the options and includes the eligibility criteria. These are in line with best practice, relevant regulations and legislation. Information is available on the Council’s website about Self Directed Support including Direct Payments as one of the options which includes information on managing funds. 2. The Council has a ‘charging policy’ for residential and non-residential services which complies with COSLA’s National Strategy and Guidance for Charges Applying to Non-Residential Social Care Services, the National Assistance Act 1948 and the National Assistance (Assessment of Resources) Regulations 1992. 3. Strength based assessments are carried out for all service users (adults services and children services) considering the self-directed support route which involves the client and establishes desired outcomes. All care packages are agreed at the resource panel (separate resource panels for adults and children) and confirms that as part of the assessment undertaken, the eligible person has been offered each of the 4 options. An outcome assessment forum was established within Children’s Services in March 2025 to review the assessments before they go to the resource panel. This also provides a training opportunity for social workers. Children Services use a consistent assessment form and a budget calculator which is currently being reviewed. 4. Service users in receipt of a Direct Payment are required to provide audit monitoring returns every quarter to demonstrate that funds provided have been spent appropriately. No further payments are made if evidence is not submitted and payments are not topped up if the service user has sufficient funds. The service reviews the evidence to determine whether support has been purchased in accordance with the agreed care package. If it is identified that payments have not been used in accordance with the relevant care package, arrangements are made to reclaim the monies. 5 A disability team was established in September 2024 in Children’s Services. The service is improving practice and consistency to ensure families are receiving a fair and equitable response to assessed social work needs. The development of this team supports the Business Transformation Project focused on improving transitions across Education, Children’s Services and Adult Services. The introduction of the team will support better tracking of young people who need support as they move into adulthood. 6 A process is in place to terminate Direct Payments for service users who have passed away and to raise an invoice for any outstanding monies. Page 288 of 290
Page 289
5 Recommendation Grading/Overall Opinion Definitions Recommendation Definition High Recommendations relating to factors fundamental to the success of the control objectives of the system. The weaknesses may give rise to significant financial loss/misstatement or failure of business processes. Medium Recommendations which will improve the efficiency and effectiveness of the existing controls. Low Recommendations concerning minor issues that are not critical, but which may prevent attainment of best practice and/or operational efficiency. Levels of Assurance Definition Substantial Assurance A sound system of governance, risk management and control exists, with internal controls operating effectively and being consistently applied to support the achievement of objectives in the area audited. Reasonable Assurance There is a generally sound system of governance, risk management and control in place. Some issues, noncompliance or scope for improvement were identified which may put at risk the achievement of objectives in the area audited. Limited Assurance Significant gaps, weaknesses or non-compliance were identified. Improvement is required to the system of governance, risk management and control to effectively manage risks to the achievement of objectives in the area audited. No Assurance Immediate action is required to address fundamental gaps, weaknesses or non-compliance identified. The system of governance, risk management and control is inadequate to effectively manage risks to the achievement of objectives in the area audited. Page 289 of 290
Page 290
Page 290 of 290