Agenda Document Pack - Midlothian Integration Joint Board - Audit and Risk Committee - 04_06_2026
Midlothian Council · 4 June 2026
Back to Midlothian Integration Joint Board - Audit and Risk Committee — 4 June 2026 and its agenda
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Notice of Meeting and Agenda Midlothian Integration Joint Board - Audit and Risk Committee Venue: Virtual Meeting held via Teams Date: Thursday, 04 June 2026 Time: 14:00 Chair: Councillor Connor McManus, Midlothian IJB Member Vice Chair: Vacant 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 164
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1 Welcome, Introductions and Apologies 2 Order of Business 3 Including notice of new business submitted as urgent for consideration at the end of the meeting. Minute of Previous Meeting 4 Audit and Risk Committee Minutes 5th March 2025, Chair Action Log – Chief Finance Officer Updates 3.1 5 - 18 3.2 19 - 20 5 Chairs Update (Verbal) – Councillor Connor McManus, Chair IJB Complaints Update (Verbal) Reports and Presentations 4.1 4.2 5.1 21 - 34 5.2 5.3 35 - 76 5.4 77 - 152 5.5 153 - 158 5.6 159 - 164 6 Risk Register Update 2026/27 Presented by Eleonora Ho, Chief Finance Officer Annual Governance Statement Presented by Duncan Stainbank, Chief Internal Auditor - paper to follow Draft Unaudited Financial Accounts (2025/26) Presented by Eleonora Ho, Chief Finance Officer Draft Annual Performance Report (2025/26) Presented by Gill Main, Integration Manager Climate Duty Statutory Reporting Presented by Gill Main, Integration Manager Joint Strategic Needs Assessment Development Presented by Gill Main, Integration Manager Any other business Page 2 of 164
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6.1 7 Model Publication Scheme Review (verbal) Date of Next Meeting The next meeting will be held on Thursday 10th September 2026, 14.00 - 16.00, via Teams. Page 3 of 164
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MIJB - Audit and Risk Committee MIJB – Audit and Risk Committee Thursday 4th June 2026 Item No 3.1 Meeting Date Time Venue Audit and Risk Committee Thursday, 5 March 2026 2.00pm Virtual Meeting via MS Teams Present (IJB voting members): Councillor McManus (Chair, Midlothian Council) Heather Campbell (Depute Vice Chair) Present (IJB non-voting members): Morag Barrow (Chief Officer) Chris King (Chief Finance Officer) Antony Clark (Independent Member) Councillor Derek Milligan (Midlothian Council) Councillor Kelly Parry (Midlothian Council) Present (Officers): Claire Gardiner (External Audit, Audit Scotland) Duncan Stainbank (Chief Internal Auditor) Gill Main (Integration Manager) In attendance: Louise Middleton (Democratic Services Officer) Apologies: Dr Amjad Khan Wendy Metcalfe Page 5 of 164
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MIJB - Audit and Risk Committee 1. Welcome and Introductions The Chair welcomed everyone to the meeting of the Midlothian Integration Joint Board (MIJB) – Audit and Risk Committee (A&R). Apologies highlighted to the group. 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 3.1The Minute of the Audit and Risk Committee meeting held on 27 November 2025 was submitted and approved. The Chief Officer introduced Sandra Bagnall, Executive Business Manager who will be replacing Roxanne King in in the interim. 3.2 Action Log - The Action Log was noted by the Committee. The Integration Manager highlighted the last action on the action log on the Register of Interest. The Register of Interest is held by Alan Turpie, Legal and Governance Manager and Monitoring Officer and the Chief Internal Auditor has passed on the action to them to bring back a process on how the Register of Interest stays up to date. The action log will be updated to note the Legal and Governance Manager and Monitoring Officer as responsible for this. The integration Manger can be removed from this action. Page 6 of 164
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MIJB - Audit and Risk Committee 4. Discussion Topic 4.1 IJB Complaints – Roxanne King, Executive Business Manager (verbal update) The Executive Business Manager gave an update which had been provided by Lisa Cummings. The Executive Business Manager noted there had not been progress in establishing the formal system and appreciated there is a gap there and will pick this up to identify work done to date and any work that needs carried out. The Executive Business Manager noted that, as we head into some difficult financial decisions there may be a rise in the number and complexity of complaints so there is a need for a resilient process. In the meantime, complaints will be dealt with, and tracking will continue to ensure deadlines are met and an update will be given as work progresses. The Integration Manager noted that the next meeting of this group is in June, and this may be challenging as last year complaints came in in April and May. The Integration Manager had asked that Midlothian Council pick up complaints on the Council complaints system, but this has not happened. The Chief Internal Auditor will follow up on this following an offline discussion with the Integration Manager, however it was suggested this may need added to the Risk Register. The Depute Vice Chair enquired if the issue with the complaints system was impacting the performance on the standard of response and queried why complaint come in bulk. The Integration Manager noted that, last year, the complaints were managed within timeframes and only one complaint went to a stage 2, however felt there may be more complaints this year due to the financial challenges. In terms of the timing for complaints, they tend to come in when financial allocations were agreed. 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. This report presents the Integration Joint Board’s (IJB) Risk Register for review at quarter four 2025/26. Page 7 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments 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. The Chief Finance Officer noted that a long discussion took place at the last meeting of the Committee and a number of risks have been updated, specifically risk 4 and 5, and asked if the Committee were happy with the detail and had anything they wished added, or removed. Discussed at last meeting on updating the risk, largely around risk 4 and 5. The Chief Finance Officer noted that, should there be no resolution on the complaints system, this could be added as a separate risk. The Integration Manager highlighted another risk to consider. The council are upgrading their website and, as the partner that provides the Galaxy site, which holds the HSCPs and the IJBs pages, which contains all publications that are a statutory duty to publish, this should be Page 8 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments highlighted. The Integration Manager noted there had not been any discussions about the needs and requirements for the IJB so thought it something to monitor. The Independent Member asked if the departure of the Chief Finance Officer should be noted as a risk. The Chief Finance Officer noted that there was some movement on the possibility of someone taking over this role, so the risk was reduced. The Chief Officer said they were nearly in a position to confirm someone coming but that passing on knowledge and understanding would take time, and the new appointment may take time to get up to speed. The Chief Internal Auditor asked if someone was in place would this be the end of a formalised recruitment process, the Chief Officer confirmed this was the case. The Independent Member enquired about the extent to which some of the risks in the risk register aren't crystallising as there are risks that seem to have been on there for a long time, such as the impact on partners of the Scott Government's decision around strategic planning. Are they real live risks or are they on the risk register as assurance that they are at the correct risk rating. The Integration Manager noted this point adding this is part of the risk 5 partner decisions. The IJB has to resubmit its scheme of integration and partners will need to review this, specifically, what the partners wishes are, do they want to continue with the scheme as is with the statutory delegated functions plus minus. The scheme of integration must be reviewed by September to include the new change to the Public Bodies Joint Working Act on lived experience membership and their voting rights. 5.2 MLIJB and Associated Committees Handbook Update 2026, presented by Gill Main, Integration Manager The Integration Manager presented the report. Page 9 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments 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. The Integration Manager noted the typing error on Page 11. The report has a template setting out accessibility criteria and the Integration Manager will ensure that, when the report goes to IJB, reports are written to a reading age between 9-11, no screenshots, pictures have alternative text and that contrast accessibility guidelines are met. The Independent Member felt the handbook was very easy to read and appreciated the combination of summary sections and more detail as well, noting the embedded question about the expenses policy. Page 10 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments The Integration Manager said the expenses policy was difficult as there is a small budget to recompense those for travel etc. The Integration Manager added the challenge was to establish which partner's policy we should be adopting or if we should write our own one as an IJB but previously we have been encouraged to take a policy of a partner. The Chair noted they were not sighted on other policies but noted the IJB is quite unique in the way that it's represented and has individuals with disabilities and the expenses were required to take that into account. The Integration Manager felt the IJB should write their own and will bring this back to the September meeting. Produce an expenses policy for IJB. Integration Manager September 2026 meeting. 5.3 External Audit: Annual Audit Plan 2025/26, presented by Audit Scotland Audit Scotland presented the report. The report is the plan for the 4th year of Audit Scotland’s audit appointment. Audit Scotland drew attention a couple of areas, the first being materiality, highlighted in exhibit one of the plan. This is the level on which Audit Scotland base their conclusions, anything over £4 million would require a change to be made to the accounts and if no change was made, it could result in a qualified audit opinion. Anything over £0.2 million is the level at which would be reported to members, anything below this number would be discussed with management but would not necessarily be included in audit report. Exhibit 2 has highlighted the significant risks of material misstatement, there is only one which is management override of control although this is not a specific risk to IJB and is a standard risk required by auditing standards. Audit Scotland highlighted best value, noting there were no best value risks identified but there was a risk identified in relation to financial sustainability and this reflects the financial challenges Page 11 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments across the year. There is also a risk highlighted over the departure of the Chief Financial Officer role due to the loss of expertise and the cruciality of that role. Audit Scotland have set out their timetable and are working towards the audit committee in September, which reflects the national deadlines and the statutory deadline to sign before the 30th of September. The final thing noted was the audit fee which is £35,500, this is the standard increase of 4.3% and has been applied across all audited bodies. The Chief Officer noted the increase in charges versus the financial position IJB are in we're in. 5.4 Midlothian Integration Joint Board Internal Audit Plan 2026/27, presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report 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). The Chief Internal Auditor noted that the key elements include the annual assessment of internal control and governance, which includes doing the annual governance statement for the IJB. Performance management is due as an audit and that will be done in line with other audits Page 12 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments that have been done on Edinburgh and West Lothian IJBs and similar audits to be done for Midlothian and East Lothian this year so that's been covered across a pan Lothian one and will be done in conjunction with the NHS audit team as part of their provision of internal audit service to the IJB for this year. Sit for Solace have issued new guidance in 2025 in relation to the annual governance statement, which specifically states to avoid impairments of professional independence, therefore the Head of Internal Audit should not draft the annual governance statement, but where the Head of Internal Audit does draft the annual governance statement, this should be identified as a role beyond internal auditing. The Chief Internal Auditor is identifying as such and safeguards should be agreed so asked for confirmation that the committee are quite happy with this. The Independent Member confirmed they were comfortable with the Chief Internal Auditor would be able to do that piece of work whilst maintaining their independence and professional integrity. The Independent Member also enquired about the piece of work on financial recovery, noting that Audit Scotland has identified financial health and sustainability as a risk and asked if there would be an opportunity for Audit Scotland and internal audit to liaise over the issues that they be covering in their audit work and your audit work. The Chief Internal Auditor noted they were happy to work with Audit Scotland to ensure they were not crossing over on work and provide appropriate assurance in the right areas. The Chief Finance Officer highlighted that a new Chief Finance Officer may have difficulty answering questions straight away and agreed to speak with the Chief Internal Auditor offline to clarify the process. The Integration Manager noted the internal audit action around performance and the need to pick up what the scope would be as there will be some other work in other areas in NHS Lothian. The Integration Manager will pick this up with the Chief Internal Auditor. Work with Audit Scotland to liaise over issues they would be covering in their Audit work. Discuss the process if the governance statement. Discuss the scope for Chief Internal Auditor Chief Finance Officer/ Chief Internal Auditor Integration Page 13 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments the internal audit action around performance. Manager/ Chief Internal Auditor 5.5 Midlothian IJB draft Performance Framework 2025-2028, presented by Gill Main, Integration Manager The Integration Manager presented this report. 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. The Independent Member felt the report was very clear and easy to follow although felt the national indicators did not reflect what they are meant to be capturing but appreciated we had, no control of that. The Integration Manager agreed and has raised this constantly, noting that the national indicators talk about things that IJB cannot control and there may be an opportunity to discuss this in more detail at the next meeting. The Integration Manager noted they were thinking about what leading indicators are and the team are working on this now, in particular in light of the ongoing refresh of SPG and ask of IJB chair of how commissioning works in that space. There are too many lagging indicators just now and the Integration Manager hopes to have this updated by September meeting. The Vice Chair asked if, given the experience that IJB’s have had, should we be trying to produce something that is a bit more useful in terms of performance scoreboard and a Work on the leading indicators. Integration Manager September 2026 Page 14 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments dashboard. 5.6 Audit Scotland Report: ‘Delayed discharges: A symptom of the challenges facing health and social care’ and Midlothian Performance, presented by Gill Main, Integration Manager The Integration Manager presented the report. 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 Page 15 of 164
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MIJB - Audit and Risk Committee Report Title/Summary, Decision Action Owner Date to be Completed/ Comments 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. The Integration Manager noted this report would be taken to the Community Health & Social Care Board. The Chief Officer said there was huge amount of systems learning and areas working together. Counting the number of beds in usage is not a good determinate of your success. Within Midlothian there has been good improvement across all the parameters, now we are able to drill down to some of the real things that impact so a really useful exercise, benchmarking against the Audit Scotland report is really helpful and goes back to an early point about the measures not being correct and the focus not necessarily being correct. The Chief Officer noted they were proud of what the team had done, and whilst they can still improve, they are making good progress. The Independent Member felt it was good to see local stuff against the national story. The Integration Manager felt we can learn from other areas but context is critical and another area where we need national direction. Councillor Derek Milligan left the meeting at 14.56pm. 5.7 Midlothian Council Internal Audit Reports (For noting), presented by Duncan Stainbank, Chief Internal Auditor The Chief Internal Auditor presented the report. 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 Page 16 of 164
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MIJB - Audit and Risk Committee 5. Private Reports No items for discussion. 6. Any Other Business The Chair took this opportunity to thank the Chief Finance Officer for all their work and assistance and wished them well in the future. 8. Date of Next Meeting The meeting terminated at 3.05pm. The next meeting will be held on Thursday 4th June 2026, 14:00-16:00, Microsoft Teams (online). Report Title/Summary, Decision Action Owner Date to be Completed/ Comments 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. The Chief Finance Officer clarified at this point the membership for the committee and noted that, for this board to be quorate there should be two members from Midlothian Council, 2 members from NHS and 1 independent member and it may be worthwhile looking at the membership at a future meeting. Consider the membership of this committee All September meeting. Page 17 of 164
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Midlothian IJB Audit and Risk Committee – Action Log MIJB – Audit and Risk Committee Thursday 4th June 2026 Item No 3.2 Action Lead Description Notes Status Due Date Complaints System Executive Business Manager Review of current complaints process following A&R support in September 2025. Verbal update on progress forms part of June 2026 meeting. Overdue March 2026 Produce an Expenses Policy for the IJB Integration manager The committee requested the production of a separate expenses policy to be used by IJB members. In progress September 2026 Development of Leading Indicators Integration manager Review of the indicators around the performance of the MIJB to ensure they are relevant and reflecting of the work done. In Progress September 2026 A&R Membership Review All Review current Membership to ensure the committee is quorate In progress September 2026 Page 19 of 164
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Midlothian IJB Audit and Risk Committee Thursday, 4th June 2026, 14:00-16:00 Midlothian IJB Risk Register 2026/27 Executive summary This report presents the Integration Joint Board’s (IJB) Risk Register for review and updating at end Q1 2026/27. Key Change Since Previous Committee Risk MLIJB1 increased from Medium to High due to delivery performance against Directions No risks added or removed The IJB maintains an active Risk Register that is reviewed quarterly by senior management and reported to every meeting of this Committee, supporting robust governance and oversight of key strategic and operational risks. Since the previous Committee meeting, one risk (MLIJB1) has increased in rating from Medium to High due to performance against delivery of Directions. No new risks have been added. Committee Members are asked to: Review the updated Risk Register Confirm whether any further risks or amendments are required Agree the Risk Register at Q1 2026/27 Item number: 5.1 Page 21 of 164
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Midlothian Integration Joint Board Report Midlothian IJB Risk Register 2026/27 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 end Q1 2026/27. 2 Recommendations 2.1 As a result of this report, Committee Members are asked to: Review the updated Risk Register Confirm whether any further risks or amendments are required Agree the Risk Register at Q1 2026/27 3 Background and main report Background 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 At the 05th March 2026 Audit and Risk Committee meeting members did not request any updates to any of the Risks presented. 3.3 Following review with the Senior Management Team, Risk MLIJB1 has increased from Medium to High. This reflects continued challenges in partner delivery of Directions, as evidenced by performance in the previous financial year. Management actions are in place to strengthen monitoring and engagement with partners to mitigate this risk. The position will continue to be reviewed in line with performance reporting. 3.4 Overall, the Risk Register continues to be actively managed with no unmitigated or uncontrolled risks identified. 3.5 Key updates to the Risk Register include: Risk Update Risk ID MLIJB1 – The IJB's Partners are unable to deliver the IJB's Directions. Updated from Medium to High. Page 22 of 164
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Midlothian Integration Joint Board 3.6 A complete version of the updated Risk Register, including risk descriptions, mitigating actions, and risk ratings, is provided in Appendix One. 4 Policy Implications 4.1 This report does not have any direct impact on policy. 5 Directions 5.1 The content of 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 changes in risk ratings are not identified or acted upon in a timely manner, which could impact the IJB’s ability to manage emerging strategic and operational risk. 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. AUTHOR’S NAME & DESIGNATION Eleonora Ho – Chief Finance Officer CONTACT INFO Eleonora.Ho@nhs.scot DATE 22/05/2026 Appendices: Appendix 1: Midlothian IJB Risk Register Page 23 of 164
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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. 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 approved and issued Midlothian IJB 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) Likely (4) Rating (Current) 12 Risk Level (Current) High Risk Level (Target) Medium Page 25 of 164
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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 26 of 164
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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 Eleonora Ho (Chief Finance Officer) Risk Handler Gill Main (Integration Manager) Consequence (Current) Major (4) Likelihood (Current) Likely (4) Rating (Current) 16 Risk Level (Current) Very High Risk Level (Target) Medium Page 27 of 164
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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 Eleonora Ho (Chief Finance Officer) Consequence (Current) Major (4) Likelihood (Current) Rare (1) Rating (Current) 4 Risk Level (Current) Medium Risk Level (Target) Medium Page 28 of 164
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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 directions which set 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 29 of 164
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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 30 of 164
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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 31 of 164
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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 32 of 164
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Midlothian IJB Risk Register Risk Matrix Insignificant 1 Minor 2 Moderate 3 Major 4 Severe 5 5 Almost Certain Medium 5 High 10 Very High 15 Extreme 20 Extreme 25 4 Likely Medium 4 Medium 8 High 12 Very High 16 Extreme 20 3 Possible Low 3 Medium 6 Medium 9 High 12 Very High 15 2 Unlikely Very Low 2 Low 4 Medium 6 Medium 8 High 10 1 Rare Very Low 1 Very Low 2 Low 3 Medium 4 Medium 5 Page 33 of 164
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Midlothian Audit and Risk Committee Thursday, 4th June 2026 14:00-16:00 2025/26 Draft Unaudited Annual Accounts. Executive summary This report presents the Midlothian Integration Joint Board (IJB) draft unaudited accounts in line with the statutory duty to publish a set of Annual Accounts every financial year. Integration Authorities are governed by the same statutory regulations that govern local authorities. The process to prepare a set of annual accounts is done in three stages. A draft set of unaudited annual accounts must be published before the end of June. These draft accounts will then be audited by the IJB’s appointed auditors. The final audited annual accounts must be published by the end of September. The management commentary is largely shared with the Annual Performance report which is also currently in draft form. Amendments and additions to this information will be updated as they become available. Additionally, Midlothian IJB must ensure that the published document meet the requirement of Midlothian IJB Scheme of Publication. Members are asked to: Consider the attached draft annual accounts, noting that some performance detail in the management commentary is incomplete. Approve this draft and recommend the IJB gives authority to Morag Barrow in her capacity as Chief Officer to publish a set of unaudited annual accounts for 2025/26 on the Midlothian Heath and Social Care Website by 30th June 2025. Item number: 5.4 Page 35 of 164
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Midlothian Integration Joint Board Report 2024/25 Draft Unauditied Annual Accounts 1 Purpose 1.1 This report presents the Midlothian Integration Joint Board (IJB) draft unaudited accounts in line with the statutory duty to publish a set of Annual Accounts every financial year. 2 Recommendations 2.1 As a result of this report, Members are asked to: Consider the attached draft annual accounts, noting that some performance detail in the management commentary is incomplete. Approve this draft and recommend the IJB gives authority to Morag Barrow in her capacity as Chief Officer to publish a set of unaudited annual accounts for 2025/26 on the Midlothian Heath and Social Care Website by 30th June 2025. 3 Background and main report 3.1 Midlothian IJB is corporate body as defined under s106 of the local government (Scotland) act 1973. This Act requires Midlothian IJB to produce a set on Annual Accounts at the end of each financial year. 3.2 In practice there are three steps To prepare a set of unaudited accounts approved for publication by Midlothian IJB on the Midlothian Health and Social Care website before 30th June 2025. Present these accounts to Midlothian IJB’s appointed Auditors (Audit Scotland) who undertake an audit. Prepare a final set of accounts reflecting the appointed auditors’ comments and including their own formal view on the accounts. This will be presented to the IJB’s Audit and Risk Committee on 10th September 2026 prior to presentation for approval at the Midlothian IJB Special Board meeting on 24th September 2026. The audited and approved set of annual accounts will then be published on the Midlothian Health and Social Care website as soon as practicably possible. 3.3 The Draft Unaudited Annual Accounts for 2025/26 set out the financial performance and governance of the Midlothian Integration Joint Board for the year ended 31 March 2026. The accounts have been prepared in line with statutory requirements and the CIPFA/LASAAC Code of Practice and provide a true and fair view of the IJB’s financial Page 36 of 164
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Midlothian Integration Joint Board position. They also include narrative sections that explain the IJB’s activities, performance, and the key financial challenges faced during the year. 3.4 The Annual Accounts are structured into four main sections: Section 1 – Performance Report provides an overview of the IJB’s role, strategic priorities, operational performance, and financial performance during the year. Section 2 – Accountability Report sets out the governance arrangements, including membership, responsibilities, remuneration, and the Annual Governance Statement. Section 3 – Independent Auditor’s Report will present the findings of the external audit. Section 4 – Financial Statements includes the core financial statements (Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, and Balance Sheet) together with supporting notes that explain the figures in more detail. 3.5 The section reflecting the work Midlothian IJB across 2024/25 remains incomplete at this time. The information required to complete this is provided by the Midlothian IJB Annual Performance Report (APR). Due to the timing of the release of Public Health Scotland (PHS) validated data, this cannot be completed until July 2025. Following Midlothian IJB approving the publication of the APR, this information will be added to the Annual Accounts. 3.6 In addition, Midlothian IJB has a statutory duty to adhere to the Model Scheme of Publication and must ensure that all content meets the accessibility requirements of this scheme. 4 Policy Implications 4.1 There are no new policy implication as a result of this report. 5 Directions 5.1 There are no direct implications for Directions as a result of this report 6 Equalities Implications 6.1 There are no equalities implication arising from this paper 7 Resource Implications 7.1 There are no direct resource implications for the IJB arising from this report. 8 Risk Page 37 of 164
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Midlothian Integration Joint Board 8.1 The risk of inadequate financial resources being available to the IJB is included in the IJB’s risk register. 9 Involving people 9.1 The IJB holds its meetings in public and makes its papers publicly available. 10 Background Papers 10.1 There are no background papers for this report. AUTHOR’S NAME Eleonora Ho DESIGNATION Chief Finance Officer CONTACT INFO Eleonora.Ho@nhs.scot DATE 27/05/2026 Appendices: Appendix 1: Draft Unaudited Annual Accounts 2025/26 Page 38 of 164
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1 Midlothian Integration Joint Board (IJB) DRAFT Unaudited Annual Accounts 2025/26 The Annual Accounts of Midlothian Integration Joint Board for the period from 1 April 2025 to 31 March 2026, prepared pursuant to Section 105 of the Local Government (Scotland) Act 1973 and in accordance with the terms of the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2025/26. Page 39 of 164
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2 Contents Audit Arrangements..............................................................................................3 Section 1 – Performance Report .............................................................................4 Section 1.1 – Management Commentary..............................................................4 Section 1.3 – Annual Performance Report - Operational Performance ............8 Section 1.4 – Future Plans – Bold and Sustained Transformation....................9 Section 1.5 – IJB Financial Performance in 2025/26.........................................11 Section 2 – Accountability Report..........................................................................20 Section 2.1 - Membership and meetings of the IJB...........................................20 Section 2.2 – Statement of Responsibilities......................................................21 Section 2.3 - Remuneration Report.....................................................................23 Section 2.4 – Annual Governance Statement 2025/26......................................26 Section 3 – Independent Auditor’s Report ..............................................................27 Section 4 – Financial Statement............................................................................28 Section 4.1 - Comprehensive Income and Expenditure Statement.................28 Section 4.2 - Movement in Reserves Statement................................................28 Section 4.3 - Balance Sheet.................................................................................29 Section 4.4 - Notes to the Financial Statements................................................30 Page 40 of 164
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3 Audit Arrangements Under arrangements approved by the Accounts Commission of Local Authority Accounts in Scotland, the auditor with responsibility for the audit of the accounts of Midlothian Integration Joint Board for the period 1 April 2025 to 31 March 2026 is Audit Scotland, 102 West Port, Edinburgh EH3 9DN. Page 41 of 164
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4 Section 1 – Performance Report Section 1.1 – Management Commentary The management commentary considers the work and financial performance of Midlothian Integration Joint Board (IJB) during the financial year 2025/26. It provides an overview of the role, remit, objectives, and the strategy of the Board. The role and responsibilities of the IJB The IJB is an Integration Authority set up under the Public Bodies (Joint Working) (Scotland) Act 2014. Midlothian IJB plan for the delivery of functions that have been delegated to us by Midlothian Council and NHS Lothian. These are: Adult Social Care (Including Criminal Justice) Primary Care (GP Practices, Community Dentists, Community Pharmacies and Community Opticians) Mental Health Physical and Learning Disabilities Community Health Community Hospital Unscheduled Care (generally delivered from the Royal Infirmary of Edinburgh, the Western General Hospital and St. John’s Hospital). We assumed strategic formal responsibility for these functions in April 2016 including managing the budgets to deliver them. The third Strategic Plan for 2025-2035 was approved and published in November 2025. Page 42 of 164
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5 IJB Vision and Objectives Our vision and objectives in the IJB’s Integration Scheme reflect the 9 national health and wellbeing outcomes which apply to integrated health and social care. National Health & Wellbeing Outcome 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. 5 Health Inequalities Health & social care services contribute to reducing health inequalities. 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide. 9 Use of Resources Resources are used effectively and efficiently. Page 43 of 164
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6 We also contribute to the achievement of the national criminal justice outcomes. This is because the NHS Lothian and Midlothian Council agreed to delegate criminal justice social work to Midlothian IJB in the Midlothian Scheme of Integration. Page 44 of 164
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7 IJB Activities for 2025/26 Strategic Plan The Midlothian Integration Joint Board Strategic Plan 2025–2035, published in November 2025 sets out the long-term vision and priorities for integrated health and social care across Midlothian. Developed in partnership with Midlothian Council, NHS Lothian and local communities, the Plan provides the overarching strategic framework for how the IJB will plan services, allocate resources and deliver improved health and wellbeing outcomes. Covering the period from November 2025 and subject to formal review every three years, the Strategic Plan underpins the IJB’s financial planning arrangements, including the annual budget setting process, the Medium Term Financial Strategy, and the issuing of Directions to partner organisations, which translate strategic priorities into operational and financial commitments. The Strategic Plan is centred on three core strategic aims: supporting people to stay well and prevent ill health ensuring access to care and support in the community and at home and promoting people’s rights through person-centred and equitable services These priorities directly inform decisions on the allocation of the IJB’s integrated budget and the prioritisation of investment across services. The Plan explicitly recognises that available resources are not expected to keep pace with increasing demand driven by population growth, demographic change and complexity of need. As a result, the IJB must make difficult financial choices, including service redesign and reprioritisation, to ensure resources are used to achieve best value and deliver sustainable outcomes. In this context, the Strategic Plan outlines a programme of transformation focused on prevention, early intervention and shifting the balance of care towards community- based provision. This approach is intended to improve long-term financial sustainability by reducing reliance on more costly acute services and enabling more effective use of limited resources. The Plan also highlights the constraints of annual funding settlements from partner bodies, which create challenges for longer-term financial planning and require ongoing review of priorities and resources. The Strategic Plan therefore plays also a critical role in linking financial planning, service delivery and performance management, ensuring that the IJB’s resources are aligned with its strategic objectives and national outcomes while maintaining financial balance over the medium to long term. Page 45 of 164
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8 Section 1.3 – Annual Performance Report - Operational Performance TBC Page 46 of 164
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9 Section 1.4 – Future Plans – Bold and Sustained Transformation Public sector finances across Scotland continue to face significant pressure. The wider economic climate, including ongoing cost of living pressures, increases demand for health and social care services while limiting the funding available. These challenges are compounded by a growing and ageing population, increasing levels of frailty and long-term conditions, and rising complexity in the care and support required. Workforce shortages and constrained resources further impact the sustainability of existing models of care. In response, the IJB recognises the need for sustained transformation to ensure services remain financially and operationally sustainable. The refreshed Strategic Plan and Medium-Term Financial Strategy (MTFS) provide the framework for this change, setting a clear direction towards prevention, early intervention, and more integrated, person-centred models of care. During 2025/26 and into 2026/27, this transformation was supported by a programme of financial recovery actions and savings schemes, designed to address the gap between available funding and the cost of delivering services. These actions focus on redesigning services, managing demand more effectively, and ensuring that resources are directed towards areas of greatest need and impact. While necessary, these changes require careful management to balance financial sustainability with the continued delivery of safe and effective care. The Transformation Programme Board has continued to oversee and coordinate this work. The programme is focused on: strengthening community-based services and reducing reliance on acute and specialist care increasing investment in early intervention, prevention and self-management promoting person led and strengths-based approaches to care improving access to services, including through a more streamlined “single point of access” ensuring resources are aligned to strategic priorities, which may require changes to how services are delivered Delivery of this programme is supported by a number of enabling factors, including financial planning and resource management, workforce development, improved data Page 47 of 164
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10 and insight, engagement with carers and communities, and the use of digital solutions to improve access and efficiency. This transformation agenda is essential to addressing the long-term financial challenges identified within the MTFS. However, it also carries a level of financial and operational risk, particularly where savings depend on changes to service models, workforce availability, and the timing of benefits. The IJB will continue to work closely with its partners to manage these risks and ensure that transformation supports both improved outcomes and financial sustainability. Page 48 of 164
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11 Section 1.5 – IJB Financial Performance in 2025/26 The Comprehensive Income and Expenditure Statement in Section 4 show that the IJB finished the Financial Year 2025/26 with a surplus of £0.845m. This is not, however, an indication of the financial stability of the IJB as the reported surplus is a result of an increase in the level of Earmarked Reserves held by the IJB. This means that, while the IJB ended the year in surplus, the underlying cost of delivering services continued to exceed the recurring funding available. The increase in Earmarked Reserves reflects elements of Scottish Government funding for Unscheduled Care. This is due to the timing of expenditure against planned delivery rather than an underspend in underlying funding. The funding has been set aside to support the continued delivery of agreed Unscheduled Care initiatives, where implementation is ongoing and spans financial years. The use of an earmarked reserve ensures that resources remain aligned to their intended purpose and are available to complete delivery of planned service improvements. The use of reserves remains carefully managed to support agreed priorities while recognising that reserves are not a sustainable solution to underlying financial pressures. For underlying financial position for delegated services remains challenging, with expenditure in year exceeding funding in both Health and social care leaving the Midlothian IJB with an operational over-spend of £4.379m, representing just over 2% of the overall funding received in 2025/26. Summary of the Underlying Financial Position for the year ending 31 March 2026 Health £000's Social Care £000's MLIJB £000's Funding for Delegated Services Income received from Midlothian Council and NHS Lothian in 2025/26 143,570 71,748 215,318 Total Expenditure Total costs incurred in the delivery of services in 2025/26 145,122 74,575 219,697 Current year Additional Payments Required One off income contribution received to ensure the IJB achieved financial balance 1,552 2,827 4,379 % Value of additional income required 1.08% 3.94% 2.03% These over-spends were supported by both Partners in line with the Integration Scheme. This reflects the continued financial pressure across delegated services and Page 49 of 164
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12 highlights the ongoing challenge of delivering financial balance on a recurring basis within the resources available. The charges (shown as expenditure above) made by Midlothian Council to the IJB reflect the net direct costs of delivering social care services in Midlothian. The charges from NHS Lothian are based on the health budget model agreed by the IJB. For services that are delivered locally by the Midlothian Health and Social Care Partnership (core services), these charges reflect the actual net costs of providing services in Midlothian. Some services used by Midlothian residents are delivered across Lothian rather than locally. These include hosted services and “set aside” services, which are managed on a pan-Lothian basis. The costs of these services are shared across the four Lothian Integration Joint Boards in line with the agreed budget model. For 2025/26, Midlothian IJB’s share of these costs is 10% for hosted services and, in general, 10% of the Lothian share of set aside services and non-cash limited budgets. How the IJB spent its funds in 2025/26 Revised Budget £000's Actual Outturn £000's Outturn Variance £000's Joint Older People Services 33,793 34,418 624 Joint Mental health Services 7,417 7,550 133 Joint Learning Disability Service 25,259 28,992 3,733 Joint Alcohol and Drugs Service 1,144 1,136 (7) Physical Disability Service 4,669 4,922 254 Primary Care 36,256 36,861 606 Prescribing 21,166 22,295 1,128 Community Hospitals 7,455 7,542 87 Community Nursing 12,667 12,230 (436) Other Core Health Services 10,489 9,891 (598) Other Hosted Services 9,242 8,858 (384) Non-Cash Limited 14,798 14,798 0 Health Set Aside 21,656 22,611 954 Other Social Care 9,308 7,593 (1,715) NHSL/MLC Additional Contributions 4,379 0 (4,379) 219,697 219,697 0 The financial position reflects a combination of demand-led pressures, market factors, and the timing of recovery actions across both Health and Social Care services. Page 50 of 164
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13 Health: The key financial pressures within Health services are driven by rising demand, increasing complexity, and cost inflation. As in previous years, the biggest pressure on the health budget comes from the cost of medicines prescribed by GP practices. Spending on medicines is higher than the budget because prices are rising and more people need prescriptions. Some medicines are new and cost more when they are first used. At the same time, more prescriptions are being issued because Midlothian’s population is growing, and people are living longer. Many people need extra support to stay well, which increases the need for medication In addition to prescribing pressures, increasing clinical complexity and multimorbidity have contributed to higher service demand, placing additional pressure on community and primary care services. Health Set Aside services continue to be a pressure for the IJB, mainly driven by Emergency and General medicine services provided across the acute sites in NHS Lothian as well as growing pressures linked to Diabetes technology and Medicine of the Elderly care again across the hospital sites. Social Care: In Social Care services, the overspend was primarily driven by rising demand and increasing complexity of care needs. During 2025/26 work commenced to support increased governance around the allocation of spend across care packages. This work will continue in 2026/27 and will be a key action in out Medium-Term Financial Strategy. Despite these efforts, significant financial pressures remained, most notably within the Learning Disability service. In this area, the level and intensity of support required to ensure individuals’ safety and quality of life continued to grow, placing sustained pressure on resources. Financial recovery actions continue to be in place across both Health and Social Care, with a focus on service redesign, demand management and cost control. While some actions introduced during 2025/26 did not deliver full year financial benefit due to lead- in times, these remain central to the IJB’s ongoing approach to managing financial pressures in partnership with NHS Lothian and Midlothian Council. These pressures are consistent with those facing Integration Joint Boards across Scotland, reflecting rising demand for health and social care services, workforce pressures and wider cost inflation. Page 51 of 164
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14 Funding for the IJB The IJB is funded by its partners, Midlothian Council and NHS Lothian. This funding is used to deliver the services that are the IJB’s responsibility under the Midlothian Integration Scheme. Many of these services are delivered day to day by the Midlothian Health and Social Care Partnership. Each year, before the start of the financial year, both partners confirm the level of funding they will provide. The IJB reviews these funding offers and decides whether to accept them. This decision is informed by guidance issued by the Scottish Government as part of the national budget process. In March 2026, the IJB accepted the funding offers from both NHS Lothian and Midlothian Council. These funding arrangements are an important part of how the IJB works in partnership with NHS Lothian and Midlothian Council to plan and deliver health and social care services locally. NHS Lothian provides funding for: Health services in Midlothian, including: o local hospitals o community health services o GP (doctor) services o other primary care services, such as dentists, opticians and pharmacies Health services used by Midlothian residents but delivered across Lothian, including: o inpatient mental health services at the Royal Edinburgh Hospital o Specialist services like Dietetics, Podiatry and Hospice and Palliative Care Unplanned hospital care for Midlothian residents, such as emergency and urgent treatment. o This care is provided at the Royal Infirmary of Edinburgh, the Western General Hospital and St John’s Hospital. The budget for this care is held by NHS Lothian on behalf of the IJB and is known as “set aside” funding. Midlothian Council provides funding: Support at Home and in the Community o Care at Home services, supporting people to live independently in their own homes o Day services and other community-based support o Housing support services Page 52 of 164
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15 Residential and Specialist Care o Residential and nursing care, including care home placements o Support for people with learning disabilities o Services for people with physical disabilities and long-term conditions Health and Wellbeing Support o Community mental health services and support o Support for unpaid carers Assessment, Care Management and Protection o Assessment and care management, including social work support and care planning o Adult protection and safeguarding services Reserves The Midlothian IJB did not hold any general reserves at the end of 2024/25. As a result, no reserves were available to manage unforeseen financial pressures in 2025/26. This limits the IJB’s financial resilience and reduces its ability to respond to emerging cost pressures or changes in demand. In response, the IJB has reviewed its Reserve Policy. The updated policy was approved by the Audit and Risk Committee during 2025/26, with final approval by the Board planned for 2026/27. The policy confirms that reserves should be built up through planned underspends against operational budgets and must be clearly linked to formal Directions issued by the Integration Joint Board, in line with the Integration Scheme. Where an underspend is not linked to a Direction, the funding will be returned to the relevant partner organisation. The policy also sets out an appropriate level of reserves, based on the scale and responsibilities of the IJB, at around 2% of net expenditure. The absence of a general reserve means the IJB remains reliant on partner funding to manage in-year pressures or unexpected costs. This presents both financial and operational risks for the IJB and its partner organisations. Page 53 of 164
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16 Financial and Risk Outlook Medium Term Financial Planning Each year, the IJB updates its financial plan to reflect the most up to date information available. The plan combines current financial data with future projections to estimate the likely financial position over the next three to five years. This allows the IJB to understand how changing demand, costs, and funding levels may impact services over time. This approach ensures we are always looking forward and clearly understand the resources we need to provide the right treatment, care, and support in Midlothian. By planning over several years, the IJB can accurately plan, see trends, and identify financial risks early. This will ensure we make informed decisions about where to invest, redesign, or disinvest by aligning our financial planning with wider strategic priorities, such as prevention, early intervention, and sustainable models of care. Budget Setting for 2026/27 At the March 2026 meeting, Midlothian IJB approved the budget offers received from both NHS Lothian and Midlothian Council and were able to set a balanced financial plan for 2026/27. This plan was underpinned by the delivery of £6.6 million in financial recovery actions covering both Health and Social Care functions. It was also agreed that there would be continued engagement with NHS Lothian to address the outstanding financial pressures within Set Aside services. This financial recovery programme represents a significant one-year plan, designed to provide a foundation of financial stability for us. Given the scale and scope of the required financial recovery actions, the programme carries a degree of financial and operational risk. This includes uncertainty around full deliverability, timing, and the potential impact on service delivery. Midlothian IJB 2026/27 Financial Plan Position Agreed Budget £000's Expected Expenditure £000's Financial Gap £000' Health 113,660 117,564 3,904 Social Care 75,120 78,014 2,894 Total 188,780 195,578 6,798 Page 54 of 164
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17 The Medium-Term Financial Strategy The Integration Joint Board operates in a financial environment that requires planning beyond a single financial year. In response to this, the IJB maintains a Medium-Term Financial Strategy (MTFS), which provides a forward-looking assessment of the key financial pressures and risks facing the organisation over the next three financial years. The MTFS reflects the anticipated impact of continued demand growth, demographic change, workforce pressures, inflation, and the cost of existing and new treatments across both Health and Social Care services. It also recognises the ongoing reliance on non-recurring measures and partner support to achieve financial balance, which presents a significant sustainability challenge. The MTFS is updated regularly to reflect the most up-to-date assumptions, funding information, and policy direction from both the Scottish Government and partner organisations. It is a key tool used by the IJB to understand the scale of its financial challenge, inform decision-making, and support the prioritisation of financial recovery and service redesign actions. While the MTFS identifies significant projected funding gaps in future years, it does not represent a fixed plan. Instead, it provides a framework for ongoing engagement with partners and stakeholders on the actions required to deliver financially sustainable health and social care services for the population of Midlothian. The table below summarises the projected funding gap identified through the current Medium Term Financial Strategy for the period 2026/27 to 2028/29. These projections are indicative and subject to change as funding assumptions, service demand, policy decisions and financial recovery plans are further developed. Financial Year: 2026/27 - £m Financial Year: 2027/28 - £m Financial Year: 2028/29 - £m Social Care (3,904) (5,704) (7,504) Health (2,893) (3,343) (6,176) Total (6,797) (9,047) (13,680) Addressing these projected financial pressures will require sustained collaboration with NHS Lothian and Midlothian Council, difficult decisions regarding service delivery, and continued focus on prevention, demand management and transformation. The IJB will continue to use the MTFS as a core component of its financial governance and oversight arrangements. Key Financial Risks The main financial pressures facing the IJB remain consistent with those outlined in the 2024/25 Annual Accounts. These pressures are significant and ongoing, reflecting both national trends and local challenges within Midlothian. The IJB continues to face a number of financial risks. A key risk is that partner organisations may not be able to provide sufficient additional funding to support increasing demand and cost pressures. Page 55 of 164
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18 These pressures are not unique to Midlothian and are experienced across Scotland. They include rising costs associated with staff pay and conditions, increasing demand for services, the cost of existing medicines, the introduction of new treatments, and wider inflationary pressures. These factors are reflected in the IJB’s Medium Term Financial Strategy and will continue to influence future financial planning and decision-making. Demographic Pressures Midlothian has the second fastest growing population in Scotland. While national funding formulas for both Local Authorities and NHS Boards aim to reflect population change, these mechanisms face 2 key limitations: The total funding available has increased but not at a level sufficient to fully meet the scale of the pressures. Declining populations in other areas do not automatically result in proportionate reductions in service delivery costs, which limits the system's ability to redistribute resources effectively. In addition, Midlothian’s population is not only growing but also ageing. As life expectancy increases, so too does the complexity and intensity of health and social care needs. This demographic trend represents a growing and long-term challenge, both locally and nationally. Workforce Both Health and Social Care services continue to experience workforce shortages. The availability of skilled professionals remains a key constraint on the IJB’s ability to meet rising demand and deliver the Strategic Plan. A local workforce plan has been developed in collaboration with partners to mitigate this risk as much as possible. The Wider National Financial Environment The financial landscape for public services remains extremely challenging. While the Scottish Government has expressed a strong commitment to protecting Health and Social Care budgets, it has also acknowledged the broader fiscal pressures facing all public services. National taxation and policy decisions, such as increases in employer National Insurance contributions, are likely to have an impact on service providers. These pressures may increase the cost of commissioned services and threaten the financial sustainability of providers. We do not have dedicated funding to offset these pressures. However, we remain actively engaged with providers and partners to manage the implications and support continuity of service delivery wherever possible. Strengthening Financial Oversight Oversight and mitigation will be supported through established risk management frameworks within the Health and Social Care Partnership and through the governance role provided by our Audit and Risk Committee and our Board. Page 56 of 164
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19 Throughout 2026/27, we will receive routine financial reporting which will include: The overall financial position of the IJB Progress against agreed financial recovery actions Identification of emerging trends, risks, or cost pressures. This reporting will support us in adopting a forward looking and responsive approach to financial governance and management. This will enable timely decision making, ensure we operate within our available resources, and allow for additional financial recovery actions or collaborative solutions with partners if required. Maintaining financial discipline while safeguarding the quality and accessibility of care services will remain a core focus throughout the financial year. Val de Souza, IJB Chair. Morag Barrow, Chief Officer. Eleonora Ho, Interim Chief Finance Officer. Page 57 of 164
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20 Section 2 – Accountability Report Section 2.1 - Membership and meetings of the IJB The IJB met 8 times in 2025/26 for formal business meetings. We also met for 4 IJB Development sessions and 3 financial briefings. The members of the IJB as of March 2026 are as follows: Member Nominated/Appointed by Role Val de Souza Nominated by NHS Lothian Voting Member, Chair Connor McManus Nominated by Midlothian Council Voting Member, Vice Chair and Chair of the Audit and Risk Committee Pauline Winchester Nominated by Midlothian Council Voting Member Derek Milligan Nominated by Midlothian Council Voting Member Kelly Parry Nominated by Midlothian Council Voting Member Dr Amjad Khan Nominated by NHS Lothian Voting Member George Gordon Nominated by NHS Lothian Voting Member Heather Campbell Nominated by NHS Lothian Voting Member Morag Barrow Appointed by the IJB Chief Officer Chris King Appointed by the IJB Interim Chief Finance Officer Nick Clater Nominated by Midlothian Council Social Work Representative Fiona Stratton Nominated by NHS Lothian Nursing Representative Claire Ross Nominated by NHS Lothian AHP Representative Dr Paul Bailey Nominated by NHS Lothian Primary Care Representative Dr Wendy Metcalfe Nominated by NHS Lothian Medical Practitioner Representative Grace Chalmers Nominated by Midlothian Council Partnership Representative (MLC) Jordan Miller Nominated by NHS Lothian Partnership Representative (NHS) Magda Clark Appointed by the IJB Third Sector Representative Sheree Muir Appointed by the IJB Lived Experience Representative Vacant Volunteer Representative Vacant Carer Representative Notes Chris King was the IJB’s Chief Finance Officer until 26th of March 2026. Eleonora Ho has been appointed in April 2026 as interim Chief Finance Officer until a permanent appointment can be made. Page 58 of 164
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21 Section 2.2 – Statement of Responsibilities Responsibilities of the IJB We are required to: Make arrangements for the proper administration of our financial affairs and to secure that the proper officer of the board has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this authority, that officer is the Chief Finance Officer. Manage our affairs to secure economic, efficient, and effective use of resources and safeguard our assets. Ensure the Annual Accounts are prepared in accordance with legislation (The Local Authority Accounts (Scotland) Regulations 2014), and so far, as is compatible with that legislation, in accordance with proper accounting practices (section 12 of the Local Government in Scotland Act 2003). Approve the Annual Accounts. I confirm that these Annual Accounts were approved for signature at a meeting of the Audit & Risk Committee. Signed on behalf of Midlothian Integration Joint Board. Val de Souza, IJB Chair. Page 59 of 164
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22 Responsibilities of the Chief Finance Officer The Chief Finance Officer is responsible for the preparation of the IJB’s Annual Accounts in accordance with proper practices as required by legislation and as set out in the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom (the Accounting Code). In preparing the Annual Accounts, the Chief Finance Officer has: Selected suitable accounting policies and then applied them consistently. Made judgements and estimates that were reasonable and prudent. Complied with legislation. Complied with the local authority Code (in so far as it is compatible with legislation). The Chief Finance Officer has also: Kept proper accounting records which were up to date. Taken reasonable steps for the prevention and detection of fraud and other irregularities. I certify that the financial statements give a true and fair view of the financial position of the Midlothian Integration Joint Board at 31 March 2026 and the transactions for the year then ended. Eleonora Ho, Interim Chief Finance Officer Page 60 of 164
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23 Section 2.3 - Remuneration Report Introduction This Remuneration Report is provided in accordance with the Local Authority Accounts (Scotland) Regulations 2014. It discloses information relating to the remuneration and pension benefits of specified IJB members and staff. The information in the tables is subject to external audit. The other sections of this report will be reviewed by Audit Scotland and any apparent material inconsistencies with the audited financial statements will be considered as part of their audit report. Remuneration: IJB Chair and Vice Chair The voting members of the IJB are appointed through nomination by Midlothian Council and NHS Lothian Board. Nomination of the IJB Chair and Vice Chair post holder alternates between a Councillor and a Health Board representative. The IJB does not provide any additional remuneration to the Chair, Vice Chair or any other board members relating to their role on the IJB. The IJB does not reimburse the relevant partner organisations for any voting board member costs borne by the partner. Neither the Chair nor the Vice Chair appointments had any taxable expenses paid by the IJB in 2025/26 (Previous Year: nil). The Chair of the IJB in 2025/26 was Val de Souza who is a non-executive member of the NHS Lothian Board, the Vice Chair was Councillor Connor McManus (who is an elected member of Midlothian Council). The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of voting IJB members. Therefore, no pension rights disclosures are provided for the Chair or Vice Chair. NHS Lothian no longer automatically offers another full day’s remuneration for being the Board’s Lead Voting Member on an IJB. Instead, non-executive remuneration is based on an individual’s overall estimated time commitment, which can include multiple memberships of Board committees and IJBs as well as other responsibilities, not just as committee chairs or lead voting members of the IJBs. No specific remuneration is therefore available for the Chair of the IJB in 2025/26 (Previous Year: nil). Remuneration: Officers of the IJB The IJB does not directly employ any staff; however specific post-holding officers are non-voting members of the Board. Chief Officer Under section 10 of the Public Bodies (Joint Working) (Scotland) Act 2014 a Chief Officer for the IJB must be appointed and the employing partner has to formally second Page 61 of 164
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24 the officer to the IJB. The employment contract for the Chief Officer will adhere to the legislative and regulatory framework of the employing partner organisation. The remuneration terms of the Chief Officer’s employment are approved by the IJB. The Chief Officer of the IJB is Morag Barrow, who is also the Director of Health and Social Care for Midlothian Council and the Joint Director of the Midlothian Partnership. It has been agreed that 50% of her total remuneration is to be shown in the accounts of the IJB as her remuneration as the Chief Officer of the IJB. Chief Finance Officer Although the costs of the Chief Finance Officer are not included in the charges made to the IJB by either partner, given the S95 role of the Chief Finance Officer and in the interests of transparency, the remuneration of the Chief Finance Officer is included. Chris King was Chief Finance Officer until the 26th of of March 2026, was employed by NHS Lothian and had two roles – Midlothian IJB’s Chief Finance Officer and an operational role in the NHS Lothian Finance team as Finance Business Partner. On that basis, 50% of the total remuneration for Chris King between 1st April 2025 and 26th March 2026 is shown below. Other Officers No other staff are appointed by the IJB under a similar legal regime. Other non-voting board members who meet the criteria for disclosure are included in the disclosures. Senior Employees: Salary, Fees & Allowances: Name 2024/25 £ 2025/26 £ Full Year Equivalent £ Morag Barrow 59,048 62,700 62,700 Chris King 11,832 43,163 43,763 The IJB has responsibility for funding the employer contributions for the current year in respect of the officer time spent on fulfilling the responsibilities of their role on the IJB. The following table shows the IJB’s funding during the year to support officers’ pension benefits. The tables also show the total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions. In year pension contributions Name For year to 2025 £ For year to 2026 £ Morag Barrow 12,241 14,108 Chris King 2,662 9,712 Page 62 of 164
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25 Total value of accrued pension benefits which may include benefits earned in other employment positions and from each officer’s own contributions Name Pension (as of 31 March 2025) £000’s Lump Sum (as of 31 March 2025) £000’s Pension (as of 31 March 2026) £000’s Lump Sum (as of 31 March 2026) £000’s Morag Barrow 30 82 34 86 Chris King 9 0 12 0 Disclosure by Pay Bands As required by the regulations, the following table shows the number of persons whose remuneration for the year was £50,000 or above, in bands of £5,000. Number of Employees in Band 2024/25 Remuneration Band Number of Employees in Band 2025/26 1 £55,000 - £59,999 0 0 £60,000 - £64,999 1 0 £65,000 - £69,999 0 0 £70,000 - £74,999 0 0 £75,000 - £79,999 0 Exit Packages The IJB did not support nor did it direct to be supported by its partners, any exit packages during 2025/26 (2024/25: nil). Val de Souza, IJB Chair. Morag Barrow, Chief Officer. Page 63 of 164
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26 Section 2.4 – Annual Governance Statement 2025/26 TBC Val de Souza, Chair Morag Barrow, Chief Officer Page 64 of 164
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27 Section 3 – Independent Auditor’s Report To follow Page 65 of 164
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28 Section 4 – Financial Statement Section 4.1 - Comprehensive Income and Expenditure Statement This statement shows the cost of providing services for the year according to accepted accounting practices. IJB Comprehensive Income and Expenditure Statement 2024/25 Net Expenditure £000's Notes 2025/26 Net Expenditure £000's 135,018 Health Care Services - NHS Lothian 143,432 69,483 Social Care Services - Midlothian Council 74,575 204,501 Cost of Services 3 218,007 (204,650) Taxation and Non-Specific Grant Income 3 (218,852) (149) (Surplus)/Deficit on Provision of Services (845) The Integration scheme lays out that the partners will provide corporate and other support to the IJB as required and will not charge for these services. These costs are not, therefore, included. Section 4.2 - Movement in Reserves Statement This statement shows the movement in year of reserves held by the Midlothian Integration Joint Board. Notes 31/03/2026 £000's 31/03/2025 £000's Usable Reserves - brought forward (948) (799) Deficit/(Surplus) or provision of Services (845) (149) Closing Balance, carried forward 1 (1,793) (948) Page 66 of 164
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29 Section 4.3 - Balance Sheet The Balance Sheet shows the value of the IJB’s assets and liabilities as at the balance sheet date. The net assets (assets less liabilities) of the IJB are matched by the reserves held by the IJB. IJB Balance Sheet 31/03/2025 £000's Notes 31/03/2026 £000's Net Current Assets 948 Debtors 6 1,793 0 Creditors: amounts falling due within one year 0 948 Total assets less current liabilities 1,793 Capital and Reserves (948) Earmarked Reserves 1 (1,793) 0 General Reserves 1 0 (948) Total Reserves (1,793) The audited accounts were authorised for issue on Chris King, Interim Chief Finance Officer. Page 67 of 164
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30 Section 4.4 - Notes to the Financial Statements 1. Significant Accounting Policies 1.1.General Principles The Financial Statements summarise the IJB’s transactions for the 2025/26 financial year and its position at the year-end of 31 March 2026. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. The Financial Statements are prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2025/26, supported by International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment. The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future. The historical cost convention has been adopted. 1.2.Basis of Preparation The IJB financial statements for 2025/26 have been prepared on a going concern basis. The IJB was established under the requirements of the Public Bodies (Joint Working) (Scotland) Act 2014 and is a Section 106 body as defined in the Local Government (Scotland) Act 1973. In accordance with the CIPFA Code of Local Government Accounting (2025/26), the IJB is required to prepare its financial statements on a going concern basis unless informed by the relevant national body of the intention for dissolution without transfer of services or function to another entity. The accounts are prepared on the assumption that the IJB will continue in operational existence for the foreseeable future. The IJB’s funding from and commissioning of services to partners has been confirmed for 2026/27, and a medium-term financial plan has been prepared through to 2029. Given that the IJB is wholly funded by the partners and the IJB’s Integration Scheme commits the partners to funding any overspend within the IJB I consider that there are no material uncertainties around its going concern status. 1.2.Accruals of Income and Expenditure Activity is accounted for in the year that it takes place, not simply when settlement in cash occurs. In particular: Expenditure is recognised when goods or services are received, and their benefits are used by the IJB Income is recognised when the IJB has a right to the income, for instance by meeting any terms and conditions required to earn the income, and receipt of the income is probable Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet Where debts may not be received, the balance of debtors is written down Page 68 of 164
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31 1.3.Funding The IJB is wholly funded through funding contributions from the statutory funding partners, Midlothian Council and NHS Lothian. Expenditure is incurred in the form of net charges by the partners to the IJB. 1.4.Cash and Cash Equivalents The IJB does not operate a bank account or hold cash. Transactions are settled on behalf of the IJB by the funding partners. Consequently, the IJB does not present a ‘Cash and Cash Equivalent’ figure on the balance sheet. 1.5.Debtors and Creditors The funding balance due to or from each funding partner as at 31st of March is represented as a debtor or creditor on the IJB’s Balance Sheet. Where income and expenditure have been recognised but settlement in cash has not taken place, a debtor or creditor is recorded in the Balance Sheet. 1.6.Employee Benefits The IJB does not directly employ staff. Staff are formally employed by the partners who retain the liability for pension benefits payable in the future. The IJB therefore does not present a Pensions Liability on its Balance Sheet. The IJB has a legal responsibility to appoint a Chief Officer. More details on the arrangements are provided in the Remuneration Report. 1.7.Provisions, Contingent Liabilities and Contingent Assets Provisions are liabilities of uncertain timing or amount. A provision is recognised as a liability on the balance sheet when there is an obligation as at 31st of March due to a past event; settlement of the obligation is probable; and a reliable estimate of the amount can be made. Recognition of a provision will result in expenditure being charged to the Comprehensive Income and Expenditure Statement and will normally be a charge to the General Fund. A contingent liability is a possible liability arising from events on or before 31st of March, whose existence will only be confirmed by later events. A provision that cannot be reasonably estimated, or where settlement is not probable, is treated as a contingent liability. A contingent liability is not recognised in the IJB’s Balance Sheet but is disclosed in a note where it is material. A contingent asset is a possible asset arising from events on or before 31st of March, whose existence will only be confirmed by later events. A contingent asset is not recognised in the IJB’s Balance Sheet but is disclosed in a note only if it is probable to arise and can be reliably measured. The IJB has none of the above. Page 69 of 164
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32 1.8.Reserves The IJB’s reserves are classified as either Usable or Unusable Reserves. The IJB’s only Usable Reserve is the General Fund. The balance of the General Fund as of 31 March shows the extent of resources which the IJB can use in later years to support service provision. As noted above, the IJB has reserves of £1,793,000 on 31 March 2026. 31/03/2025 £000's Movement £000's 31/03/2026 £000's Earmarked Reserves Embedding a gender informed effective response to domestic abuse project (7) 0 (7) Unscheduled Care (941) (845) (1,786) General Reserves 0 0 0 Total Usable Reserves (948) (845) (1,793) 1.9.Indemnity Insurance The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding Board member and officer responsibilities. NHS Lothian and Midlothian Council have responsibility for claims in respect of the services that they are statutorily responsible for and that they provide. The IJB holds separate indemnity insurance through its membership of the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS) scheme, the charge for this in 2025/26 was £3,000 (PY £3,000). Unlike NHS Boards, the IJB does not have any ‘shared risk’ exposure from participation in CNORIS. The IJB participation in the CNORIS scheme is therefore analogous to normal insurance arrangements. Known claims are assessed as to the value and probability of settlement. Where it is material the overall expected value of known claims taking probability of settlement into consideration is provided for in the IJB’s Balance Sheet. The likelihood of receipt of an insurance settlement to cover any claims is separately assessed and, where material, presented as either a debtor or disclosed as a contingent asset. There are no outstanding claims or any indications that any claims are to be made against the IJB. 1.10. Accounting Standards that have been Issued but have not yet been Adopted The Code requires the disclosure of information relating to the impact of an accounting change that will be required by a new standard that has been issued but not yet Page 70 of 164
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33 adopted and could have a material impact on the accounts. This applies to new or amended standards within the 2025/26 Code. There are no new or amended Accounting Standards issued but not yet adopted that will have a material impact on the 2025/26 Annual Accounts. 1.11. Critical Judgements and Estimation Uncertainty The critical judgements made in the Financial Statements relating to complex transactions are: The partner organisations have considered their exposure to possible losses and made adequate provision where it is probable that an outflow of resources will be required, and the amount of the obligation can be measured reliably. Where it has not been possible to measure the obligation, or it is not probable in the partner organisations’ options that a transfer of economic benefits will be required, material contingent liabilities have been disclosed (there are none). The Annual Accounts contains estimated figures that are based on assumptions made by the IJB about the future or that are otherwise uncertain. Estimates are made taking into account historical experience, current trends and other relevant factors. However, because balances cannot be determined with certainty, actual results could be materially different from the assumptions and estimates. There are no items in the IJB’s Balance Sheet at 31 March 2026 for which there is a significant risk of material adjustment in the forthcoming financial year. 1.12. Provisions The IJB has not created any provisions in respect of compensation claims. It is not certain that all claims have been identified or that the historic level of settlement payments is a reliable guide for future settlements. 2. Subsequent Events In accordance with the requirements of International Accounting Standards 10, events after the reporting period are considered up to the date on which the accounts are authorised for issue. This is interpreted as the date that the accounts were certified by the Chief Financial Officer following approval by the Audit and Risk Committee. Events after the Balance Sheet date are those events, both favourable and unfavourable, that occur between the end of the reporting period and the date when the Annual Accounts are authorised for issue. Two types of events can be identified. • Adjusting events: Those that provide evidence of conditions that existed at the end of the reporting period. The Annual Accounts is adjusted to reflect such events. Page 71 of 164
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34 • Non-adjusting events: Those that are indicative of conditions that arose after the reporting period and the Statements are not adjusted to reflect such events. Where a category of events would have a material effect, disclosure is made in the notes of the nature of the events and their estimated financial effect. 3. Expenditure and Funding Analysis The Expenditure and Funding Analysis shows how the funding available to the IJB, in the form of partner contributions, has been used in providing services. 2024/25 Net Expenditure £000's 2025/26 Net Expenditure £000's 33,280 Joint Older People Services 34,418 7,246 Joint Mental health Services 7,550 26,080 Joint Learning Disability Service 28,992 1,000 Joint Alcohol and Drugs Service 1,136 4,235 Physical Disability Service 4,922 31,420 Primary Care 36,758 22,325 Prescribing 21,450 7,298 Community Hospitals 7,542 11,948 Community Nursing 12,230 10,568 Other Core Health Services 9,891 7,748 Other Hosted Services 8,116 13,679 Non-Cash Limited 14,798 20,728 Health Set Aside 22,611 6,947 Other Social Care 7,593 204,501 Cost of Services 218,007 (204,650) Delegated Funding (218,852) (149) (Surplus) or Deficit on Provision of Services (845) (799) Opening General Fund Balance (948) (149) (Surplus) or Deficit in Year (845) (948) Closing General Fund Balance (1,792) Page 72 of 164
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35 4. Corporate Service Included in the above costs are the following corporate services 2024/25 £000's 2025/26 £000's Staff (Chief Officer) 59 63 CNORIS 3 3 Audit fee 34 35 Total 96 101 As noted above, the Chief Finance Officer is not charged to the IJB. 5. Related Party Transactions Related parties are organisations the IJB can control or influence or who can control or influence the IJB. As Partners in the Joint Venture of Midlothian IJB, both Midlothian Council and NHS Lothian are related parties and material transactions with those bodies are shown in line with the requirements of IAS 24 Related Party Disclosures. In the 2025/26 financial year the following transactions were made with NHS Lothian and Midlothian Council relating to integrated health and social care functions. Income received from the two parties: 2024/25 £000's 2025/26 £000's NHS Lothian 135,578 144,277 Midlothian Council 69,072 74,575 Total 204,650 218,852 Expenditure relating to the two parties: 2024/25 £000's 2025/26 £000's NHS Lothian 135,018 143,432 Midlothian Council 69,483 74,575 Total 204,501 218,007 Page 73 of 164
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36 There are elements of expenditure which are shown against NHS Lothian but where the resources are used for the Social Care services delivered by Midlothian Council, in particular these include resource transfer and social care funds. In addition, a range of support services are provided to the IJB by each partner organisation. These functions are not formally delegated under the integration scheme; however, they remain essential to maintaining the IJB’s operational infrastructure. Such services include, but are not limited to, Human Resources, Information Technology, and other corporate support functions. Page 74 of 164
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37 6. Short Term Debtors 2024/25 £000's 2025/26 £000's Funding due from NHS Lothian 941 1,786 Funding due from Midlothian Council 7 7 Total 948 1,793 7. VAT The IJB is not VAT registered. The VAT treatment of expenditure in the IJB’s accounts depends on which of the Partner agencies is providing the service as these agencies are treated differently for VAT purposes. Where the Council is the provider, income and expenditure excluded any amounts related to VAT, as all VAT collected is payable to H.M. Revenue & Customs and all VAT paid is recoverable from it. The Council is not entitled to fully recover VAT paid on a very limited number of items of expenditure and for these items the cost of VAT paid is included within service expenditure to the extent that it is irrecoverable from H.M. Revenue and Customs. Where the NHS is the provider, expenditure incurred will include irrecoverable VAT as generally the NHS cannot recover VAT paid as input tax and will seek to recover its full cost as income from the Commissioning IJB. Page 75 of 164
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Midlothian IJB Audit and Risk Committee Thursday, 4th June 2026, 14:00-16:00 Midlothian IJB draft Annual Performance Report 2025/26 Executive summary This report presents a draft of the Midlothian Integration Joint Board (IJB) draft Annual Performance Report (APR) 2025/26 (appendix 1). In order to ensure Midlothian IJB can meet the statutory duty of Integration Authorities to publish an APR before 31st July annually, the Midlothian IJB Audit and Risk Committee is requested to review this draft report and subject to any amendments, recommended to Midlothian IJB that a draft Annual Performance Report (APR) 2025/26 is published without the Public Health Scotland (PHS) validated National Indicator data. Following the template and process developed over the past 4 years, narrative content and best practice examples have been themed within the 9 National Health and Wellbeing Outcomes and align with the themes of Early Intervention and Prevention, Support and Treatment, and Crisis and Emergency. This is complemented by local narrative derived from a combination of sources including operational quarterly reporting, the Midlothian IJB Annual Survey, and nationally curated local performance data. The validated National Indicator data is provided by Public Health Scotland is expected in mid-July and will therefore be included in the final draft of the APR which will be scrutinised by Midlothian IJB Strategic Planning Group on 23rd July and recommended to the Board for final approval in the Midlothian IJB meeting of 20th August 2026. As a result of this report, Members are asked to: Review this draft of the Midlothian IJB Annual Performance Report (APR) 2025/26, and Subject to any amendments, recommend this draft Annual Performance Report (APR) 2025/26 for publication to Midlothian IJB. Item number: 5.4 Page 77 of 164
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Midlothian Integration Joint Board Report Midlothian IJB draft Annual Performance Report 2025/26 1 Purpose 1.1 This report presents a draft of the Midlothian Integration Joint Board (IJB) draft Annual Performance Report (APR) 2025/26 (appendix 1). In order to ensure Midlothian IJB can meet the statutory duty of Integration Authorities to publish an APR before 31st July annually, the Midlothian IJB Audit and Risk Committee is requested to review this draft report and subject to any amendments, recommended to Midlothian IJB that a draft Annual Performance Report (APR) 2025/26 is published without the Public Health Scotland (PHS) validated National Indicator data. 2 Recommendations 2.1 As a result of this report, Members are asked to: Review this draft of the Midlothian IJB Annual Performance Report (APR) 2025/26, and Subject to any amendments, recommend this draft Annual Performance Report (APR) 2025/26 for publication to Midlothian IJB. 3 Background and main report 3.1 The Public Bodies (Joint Working) (Scotland) Act, 2014 places a duty on Integration Authorities to publish an Annual Performance Report (APR) that provides an assessment of progress towards achieving the 9 National Health and Wellbeing Outcomes as indicated by a core suite of national performance indicators. 3.2 The Midlothian IJB draft APR 2024/25 (appendix 1) presents data from the national performance indicators alongside local performance narrative within the 9 National Health and Wellbeing Outcomes. Following the template and process developed over the past 4 years, narrative content and best practice examples have been themed and align with the themes of Early Intervention and Prevention, Support and Treatment, and Crisis and Emergency. 3.3 This local narrative is derived from a combination of sources including operational quarterly reporting, the Midlothian IJB Annual Survey, and nationally curated local performance data. Page 78 of 164
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Midlothian Integration Joint Board 3.4 National Indicator Updates 2025/26 is a reporting year for the Health and Care Experience Survey (HACE). As a result, the National Indicators populated by this survey will be made available to Midlothian IJB from mid-July 2026. As this is too late to meet the statutory reporting deadline of 31st July, it is proposed that a draft APR is published as an interim measure and updated following the validated National Indicator data being scrutinised by the Midlothian IJB Strategic Planning Group on 23rd July 2026 and presented to Midlothian IJB at its meeting on 20th August 2026. 4 Policy Implications 4.1 There are no direct policy implications as a result of this report. 5 Directions 5.1 This report does not directly impact Midlothian IJB Directions. 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 This report does not have implications for groups of people with protected characteristics. However, Midlothian IJB may wish to revise or develop a new strategy, policy, plan, provision, practice, or activity to respond to identified improvement goals in response to this performance information. 6.3 Any new or revised strategy, policy, plan, provision, practice, or activity produced in response to the performance data and analysis presented in this Midlothian IJB draft APR 2025/26 will require the completion of an Equality and Children’s Rights Impact Assessment (ECRIA) to inform development. 7 Resource Implications 7.1 There are no direct resource implications as a result of this report. 8 Risk 8.1 The statutory publication date for Integration Authorities to publish an Annual Performance Report is 31st July annually. Due to the timing of the Public Health Scotland (PHS) release of validated data, it is proposed that a draft APR is presented to Midlothian IJB for publication without the Public Health Scotland (PHS) validated National Indicator data. Page 79 of 164
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Midlothian Integration Joint Board 8.2 There is a risk that any significant revision required following the receipt of the PHS data may result in additional delay to the approval and publication of the final Midlothian IJB APR 2025/26. 9 Involving people 9.1 Following publication, the Midlothian IJB draft APR 2025/26 will be shared widely, in print, electronically via email, via social media, and on the Midlothian Health and Social Care website. 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. √ 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. X Author’s Name Gill Main Designation Integration Manager Contact Information gill.main3@nhs.scot Date 21/04/2025 Appendices: Appendix 1: Midlothian IJB draft Annual Performance Report (APR) 2025/26 Page 80 of 164
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DRAFT Midlothian Integration Joint Board Annual Performance Report 2025/26 Page 81 of 164
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DRAFT 2 Contents Executive Summary...................................................................................................3 Foreword..................................................................................................................3 Introduction..............................................................................................................5 Who we are............................................................................................................5 What we are trying to achieve..................................................................................6 How we measure our performance .........................................................................8 How did we do?.......................................................................................................10 The National Indicators.........................................................................................10 Communication and Engagement............................................................................50 Equality ..................................................................................................................54 Looking forward ......................................................................................................58 Inspections.............................................................................................................59 Business and governance........................................................................................66 Data Appendix ........................................................................................................70 Ministerial Steering Group Targets ...........................................................................71 Page 82 of 164
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DRAFT 3 Executive Summary The Midlothian Integration Joint Board (IJB) plans and directs health and social care services for the people of Midlothian. We are a planning and decision-making body responsible for the integrated budget from Midlothian Council and NHS Lothian. This section will be updated prior to publication in August 2026. Page 83 of 164
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DRAFT 4 Foreword Welcome to our 11th Annual Performance Report which reflects on our progress and performance from 1st April 2025 to 31st March 2026. This section will be updated prior to publication in August 2026. Morag Barrow Chief Officer, Midlothian IJB Page 84 of 164
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DRAFT 5 Introduction Who we are The Midlothian Integration Joint Board (IJB) plan and direct health and social care services for the people of Midlothian. We are a planning and decision-making body created by Midlothian Council and NHS Lothian. We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in our Strategic Plan guide how we allocate the money we receive. 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. 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 for the four Health and Social Care Partnerships - Midlothian, East Lothian, West Lothian, and City of Edinburgh. 99,880 Page 85 of 164
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DRAFT 6 What we are trying to achieve The Scottish Government measure our performance on Health and Wellbeing Outcomes. National Health & Wellbeing Outcome 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. 2 Living in the Community People are able to live, as much as possible, independently and at home or in a homely setting in their community. 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. 5 Health Inequalities Health & social care services contribute to reducing health inequalities. 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. 7 Safe from Harm People using health & social care services are safe from harm. 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide. 9 Use of Resources Resources are used effectively and efficiently. We also measure our performance against the objectives in our Strategic Plan. Page 86 of 164
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DRAFT 7 Our Strategic Plan 2025-2035 has three main aims and six sub-aims: 1. People are able to make good decisions that help them stay well, plan ahead, and prevent ill or worsening health 1.1 People can easily find the information they need to make good decisions. 1.2 People achieve the things that matter most to them, and our services are confident of what our contribution is to their success. 1.3 People access services and support designed around how they live their lives. 2. People access the care and support they need when they need it in the community and at home 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. 3. People’s human, social, and economic rights are protected and promoted in how we design our services 3.1 People are recognised as experts in their own lives, 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. We recognise people are the experts in manging their own health and wellbeing and want to provide the right support, treatment, and care for people to live well in their homes and communities. We want services to be available when people need them and at every stage of their care and treatment: Preventing ill health and providing support early, Ongoing support and treatment, In times of crisis and emergency. We think about how we work, and how we can improve, in three ways: Integration is about how we work with all our partners to ensure everyone gets the right care, at the right time, and in the right setting. Quality is about 6 key areas of services – are they safe, effective, efficient, timely, person- centred, equitable. Best Value is about ensuring resources are well managed improving services that deliver the best possible outcomes for people and communities. Page 87 of 164
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DRAFT 8 How we measure our performance Our contribution to people’s outcomes The services we plan and direct must, by law, aim to improve outcomes for people who use our services, their carers, and families. Many factors influence peoples’ lives, and it can be hard to know the impact of each service or support we offer. To ensure that we understand the impact of our work, we use an approach called Outcome Mapping. This is a way to understand how our services contribute to people achieving the outcomes that matter to them. It can also help us make more targeted, locally informed decisions about how to plan and direct services. This approach allows us to describe what we do, who with, what people learn and gain as a result, how this makes them feel and the difference this makes to their lives. The data we use Scottish Government’s Ministerial Strategic Group targets Scottish Government’s National Performance Indicators The National Indicators 1-9 are taken from the Health and Care Experience Survey, conducted every 2 years. 2025/26 is a reporting year for the Survey and changes are included in this Annual Performance Report. In November 2025 the survey was posted to a random sample of people living in Midlothian and registered with a GP in Scotland. People were asked about their experiences during the previous 12 months - accessing and using their GP practice and Out of Hours services; aspects of care and support provided by local authorities and other organisations; and caring responsibilities and related support. The Scottish Government updated the survey in 2023, (the changes are in the Scottish Government Technical Report). This means it is difficult to compare our performance with previous years, and in some cases, we only have data from 2020. This section will be updated in August following the publication of the HACE survey responses. Feedback from people who use our services, their families, and carers In early 2026, we carried out the Midlothian IJB Annual Survey by inviting people living in Midlothian to complete a questionnaire to share their views about health and social care. This section will be updated in August following the analysis of the Midlothian IJB Annual Survey. Page 88 of 164
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DRAFT 9 iMatter survey for employees This section will be updated in August following the release of the 2025/26 iMatter results. Staff are asked about their work and their wellbeing. The Employee Engagement Index (EEI) is the overall score for the organisation. The survey explores how staff feel they are: - Informed, trained & developed, - Involved in decisions, - Treated fairly and consistently, with dignity and respect, in an environment where diversity is valued, - Provided with a continuously improving and safe working environment, promoting the health and wellbeing of staff, patients, and the wider community. Other Data We use a range of other data sources in this report. Some of the data we use in this report covers elements of services that are delivered by GP independent contractors. We also use information from national organisations and professional bodies, e.g. National Records of Scotland, Public Health Scotland, and the Care Inspectorate. How we are reporting our data Full data is provided in the Appendix. This includes our progress over time and our position in comparison to the rest of Scotland. We look at each of the Health and Wellbeing Outcomes alongside the National Performance Indicators used to measure each one and summarised our progress: - Our performance has improved compared to last year. - There hasn’t been a significant change in performance compared to last year. - Our performance has worsened compared to last year. For each Health and Wellbeing Outcome we have described the impact of what we do. We have used icons to show if the impact was for Early Intervention and Prevention, Support and Treatment or Crisis and Emergency. This report brings together information about our activity, experience, and outcomes across all the functions that are delegate to us to plan for and direct. This includes the two pan-Lothian hosted services that are managed by Midlothian Health and Social Care Partnership. Page 89 of 164
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DRAFT 10 How did we do? The National Indicators National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. 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*. 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. Adults supported at home agreed services and support had an impact on improving or maintaining their quality of life*. Carers feel supported to continue in their caring role. Adults supported at home agreed they felt safe*. National Indicator Our result Our Progress Premature Mortality Rate. (People under 75) Page 90 of 164
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DRAFT 11 . National Indicator Our result Our Progress 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 who were admitted to hospital). Care services graded Good or better in Care Inspectorate Inspections. 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. Health and Care resource spent on hospital stays where the person was admitted as an emergency. Page 91 of 164
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DRAFT 12 1 Health & Wellbeing People are able to look after and improve their health and wellbeing and live in good health for longer. Scottish Government descriptors for this outcome 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 National Indicators used to measure this outcome This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Indicator 1 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, this indicator has been updated from the 2023/24 data. One of the ways we help people to access the information they need is to ensure it is visible and easy to understand. Throughout 2025/26 we have ensured our services design accessible and straightforward information on webpages, posters and leaflets to let people know about available services and supports. These included: a leaflet about support in the first year after someone leaves prison and returns to their local community, a leaflet with ‘Diversion from Prosecution’ information for those who may be able to undertake community treatment and avoid prosecution, a leaflet on how men in the Justice system can access emotional support, a new Community Justice section on the Midlothian Council website to help people navigate support and assistance, posters in GP surgeries that provide information on how to use asthma and COPD medicines, posters in GP surgeries to raise awareness of dementia and available support, and a Home Safety Guide for people with dementia, their family and carers. National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. Premature Mortality Rate (People under 75) Emergency Admission Rate Page 92 of 164
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DRAFT 13 The support we offer to people living with physical disabilities and long-term conditions can have a positive impact on their ability to look after their own health, but we know the barriers and challenges people experience are different for every person. It is important for people to have their circumstances assessed as quickly as possible and receive the right support to live in better health for longer. Throughout 2025/26, 93% of physical disability referral screenings were completed within the standard of 3 days, and 89% of interventions achieved the planned outcome. Partnering with other organisations can offer even more support for those with physical disabilities. Midlothian’s partnership with the Royal National Institute for Deaf (RNID) Midlothian’s Local Area Coordination Team work in partnership with a variety of organisations to build knowledge of local networks, strengthen community links and connect individuals to services that can offer support. In 2025 the Local Area Coordinators met with the RNID Coordinator to discuss a new drop-in service to provide information on hearing loss and tinnitus, and support and services within their own area. They also provide mini hearing tests on-site, and basic hearing repairs. The RNID Coordinator was connected to existing drop-in services at Café Connect at Dalkeith Art Centre and Linking Loanhead at Loanhead Library to meet local people experiencing hearing loss and learn more on what support people in Midlothian need. Plans are underway to further develop these drop-in services and offer more locations to better support people in different areas of Midlothian. Page 93 of 164
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DRAFT 14 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. Scottish Government descriptors for this outcome 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 Indicators used to measure this outcome National Indicator Our result Our Progress 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. Page 94 of 164
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DRAFT 15 This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Indicators 2 and 3 are taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, these indicators have been updated from the 2023/24 data. We know that circumstances can change, and people may find that they need additional support. The Care at Home teams delivered an average of 9000 hours of care and support in people’s homes every week throughout 2025/26. During 2025 our external providers worked to improve consistency of care and focused on increasing staff retention. This means people were more likely to be supported by the same carers and develop a long-term relationship. When people need more support, the Highbank Intermediate Care Unit provides bed-based care. As part of our plan to review and redesign our bed-based care, residents at our Highbank Intermediate Care Facility will move to a new unit at Polton Street. This facility has been designed to provide placements to progress assessments for rehabilitation, packages of care, or care home placement, to ensure people do not have to stay in hospital longer than they need to. Social Workers have a key role in supporting people receive the right support and reduce hospital delays by supporting admissions and discharge planning. For people with dementia, delivering support in a coordinated way can help people live in their community for as long as possible. Social Workers in the Dementia Team continue to focus on the outcomes that matter most to people, support people to stay at home for longer, and provide assessment for long-term care if this is required. Throughout 2025/26, Social Workers attended dementia café groups to ensure we keep listening to people and better understand how we can continually improve the quality of the care we provide. When people’s needs become more complex, residential care may be required to provide the right care. However, there continues to be a shortage of available care home places in Midlothian. To address this, quality assessments are undertaken to help us improve how we communicate with people, their families and carers, and increase the availability of additional clinical support when moving from an acute hospital to intermediate or longer-term care placement. 95% of initial Care Home reviews were completed within the 12-week standard throughout 2025/26. National Indicator Our result Our Progress 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 95 of 164
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DRAFT 16 Art therapy at Newbyres We know that how people feel about their environment is important to their sense of wellbeing and belonging. In March 2026 Newbyres Care Village worked with a local artist and former member of staff to decorate a linking corridor with a garden-inspired mural. The ‘garden corridor’ has been brought to life with 3D foliage, butterflies, and a working lantern with plans for chairs and background nature sounds. Residents can now enjoy the outdoors no matter the weather and visiting friends and relatives have described the initiative as “wonderful”. Cycling to success Cycling UK is a registered charity that works with local councils and services through their Connecting Communities programme to help residents own their own bikes, discover local cycling routes, build confidence while riding, and find practical alternatives to car journeys. In Midlothian, Cycling UK has been working with our commissioned partner, VOCAL, and since July 2025 planning new walking, cycling and wheeling routes around Shawfair and Auchendinny to better connect new housing developments with surrounding towns and villages. People in Midlothian who engaged with Cycling UK reported they get more exercise, use their car less, and feel safer when cycling. “We will now use the bike for trips to the shop and nursery instead of the car. We are looking forward to further cycle infrastructure to make even more journeys by bike.” Providing information and delivering care in community settings can help people live independently by increasing access to services in their local area. We know that when services are provided in local areas, people find it easier to attend because travel time and costs can be reduced. Page 96 of 164
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DRAFT 17 Care closer to home The Orthopaedic Rehabilitation Clinic supports people with musculoskeletal and orthopaedic conditions through a range of physiotherapy sessions and group classes. In 2025, 89 rehabilitation appointments were offered at Midlothian Community Hospital instead of the Royal Infirmary of Edinburgh. This gave people the option to attend appointments closer to home and saved 145.67 miles in travel. Holding these appointments locally made best use of local rehabilitation facilities and provided opportunities for training and knowledge sharing within our Musculoskeletal Physiotherapy Team. This success has led to the Pulmonary Rehabilitation service in Midlothian planning two new classes at Midlothian Community Hospital. This will help manage growing demand and local waiting times and improve outcomes after surgery. One stop shop for falls prevention 220 people attended a Community Engagement Day on Falls Prevention on September 25th at the Lasswade Centre. Throughout the day, 103 people completed an MOT during the session, which assessed people’s ‘sit to stand’ ability and their core strength. All attendees received signposting to further support and advice. This included information on falls prevention and recovery, frailty, and overall bone health. This community-based multidisciplinary event aimed to prevent or reduce falls and injury, hospital admission, loss of physical activity, reduced confidence, and social isolation. “Good variety of stalls with helpful info. I was able to have questions answered and advice given to take away.” “The personal fitness MOT was an excellent activity to see where I am compared to average for my age.” Feedback from the day was very positive and another Community Engagement Day was held in April 2026. Page 97 of 164
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DRAFT 18 We are committed to transforming the delivery of palliative and end of life care by June 2026. This work is linked to the Pan Lothian commissioning of Specialist Palliative Care services and the updated national Palliative Care Strategy Delivery Plan 2025. As part of this work, we have asked Midlothian Health and Social Care Partnership to ensure people can access co-ordinated, timely and high-quality palliative care, care around death, and bereavement support based on their needs and preferences. We want to ensure there is support for families and carers as they deal with loss and grief, and for staff to manage the emotional impact of caring for someone at the end of life. Page 98 of 164
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DRAFT 19 3 Positive Experiences & Dignity People who use health & social care services have positive experiences of those services, and have their dignity respected Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome National Indicator Our result Our Progress 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 99 of 164
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DRAFT 20 Indicators 3, 4, 5 and 6 are taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, these indicators have been updated from the 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey GP Practices are often the first place people go to get support with their health and wellbeing. Practices located near each other belong to a ‘GP cluster’ which contributes to the oversight and development of local healthcare and takes part in quality improvement activity. Midlothian GP cluster quality improvement initiatives have focused on improving access to timely, effective care and supporting patient safety. Electronic reviews for Hormone Replacement Therapy (HRT) Dalkeith and Pathhead GP practices in Midlothian upgraded their websites to allow annual HRT review forms to be completed and submitted electronically without patients needing to see a doctor or nurse. This resulted in between 80-90% less appointments being needed at both practices. Similar electronic reviews are planned for contraceptive, ADHD, and depression medications. Community services aim to provide treatment, care, and support as close to home as possible. However, some treatment can only be provided in a hospital setting. People told us that when they needed emergency care, they were having to wait longer in A&E, staying longer in hospital, and sometimes being delayed when leaving hospital for home. NHS Lothian developed their Unscheduled Care Improvement Plan to improve people’s experience within a hospital setting. In Midlothian, this has focused on supporting people to come home more quickly by supporting more care in community settings. Page 100 of 164
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DRAFT 21 Getting home sooner 30% of all unplanned hospital admissions for Midlothian residents to the Royal Infirmary of Edinburgh are people aged 75 and over. The work in Midlothian to reduce the length of time people spent in hospital saw the length of stay in hospital reduce by almost a week for this age group. This is the equivalent of approximately 20, 000 bed days that were saved across Midlothian in 2025. When people are discharged from hospital, they sometimes need to be readmitted for further care. Readmission rates to hospital are often used to evaluate how well we plan and support discharge. Our local data show that readmission rates for 2025/26 for people living in Midlothian improved when compared with 2024/25. The readmission rate after 6 months reduced from 23% to 19%, and after 28 days reduced from 11% to 10%. The readmission rate after 7 days remained stable at 4% throughout 2025/26. Digital solutions FLOK Health is an AI platform that offers advice and exercises for treating lower back pain. It has been tested by health care professionals across Lothian and signposting and advertising has been exhibited in GP practices across Midlothian. FLOK assesses a person’s symptoms and develops an individual 12-week program with exercises and advice on how to manage pain. Data returned between August and November 2025 showed that after six months of using FLOK, 80% of people did not need to return to primary care, their GP or the MSK service for further treatment. This shows the effectiveness of FLOK in helping people to better manage their health without needing face to face appointments. Other services in Midlothian are now considering digital platforms to support people to self-manage their symptoms and conditions. We continued to work with our commissioned partners to ensure adults with learning disabilities in Midlothian have the opportunity to build practical skills, gain confidence in their abilities, and feel proud of their achievements. 92% of care package reviews for people with a learning disability had been completed within the 2-year standard throughout 2025/26. Garvald Edinburgh provides day services to adults with learning disabilities in Midlothian. The service offers opportunities to build skills, pride, and confidence through experiences with cooking, gardening, pottery, textiles, Page 101 of 164
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DRAFT 22 jewellery, art, and printmaking. Activities to improve physical and mental health and wellbeing are also offered, including walking and swimming groups, music and dance, and meditation. We know that working with people and developing relationships is the best way to support people to achieve what matters to them. In 2025/26 we worked alongside the charity Access to Industry to support people in Midlothian to return to work. Access to Industry is a registered Charity with specialist skills to support unemployed people across Scotland who face barriers to employment. In 2025/26, Access to Industry supported 57 people across four different projects at local libraries, community centres, and recovery cafes across Midlothian as well as the Learning Hub in Hardengreen. Classes and groups promoted the benefits of connection and routine with Personal Learning and Development Action Plans created for each person to help them achieve their goals. Throughout 2025/26 the cohort achieved 34 new qualifications and resulted in 5 participants moving into employment, 15 entering further education at Edinburgh and Newbattle Abbey Colleges, 6 taking up volunteer roles, 1 entering the SDF Addiction Workers Programme, and 13 undertaking residential rehabilitation and aftercare support. Support to achieve what matters to you Access to Industry supported a local young adult who was experiencing anxiety and low confidence to get back into work. Through weekly sessions, Access to Industry provided tailored support to help the person develop strong working relationships with staff that supported them to become more confident and motivated. As a result, they studied for and passed their driving theory and soon took up a college place in Edinburgh. In summer 2025 Access to Industry recognised the young adult’s achievement with a local award, noting they are thriving and looking forward to continuing their college education. Page 102 of 164
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DRAFT 23 4 Quality of Life Health & social care services help to maintain or improve the quality of life of people who use those. Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome National Indicator Our result Our Progress 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 103 of 164
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DRAFT 24 Indicators 5 and 7 are taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, these indicators have been updated from the 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. We have continued to support people in Midlothian to make positive changes, improve their quality of life, and achieve the outcomes that matter to them. One example of this is unpaid work. Organised through the Justice service, unpaid work aims to provide opportunities that also benefit the community e.g. gardening, house clearing, and maintenance. 44% of residents who were helped by those undertaking unpaid work throughout 2025/26 told us about their positive experience. Midlothian Health and Social Care Partnership’s services are trauma-informed because we know that exposure to trauma can impact on neurological, biological, psychological and social development. Trauma-informed practice is an approach to health and care interventions that ensures a person-centred approach by focusing on safety, trust and choice. Services and supports should help people to do the things that matter most to them. People who were subject to a Community Payback Order in 2025/26 told us it is important to them to improve their mental health, build a routine, avoid boredom, improve finances, and change their alcohol and drug use. The Community Justice service team asked the people they worked with about the improvements they saw in their lives: mental health (67%) build a routine and avoid boredom (50%) financial position (50%) positive change to alcohol and drug use (33%). Everyone supported by the Justice Social Work service is asked to complete a questionnaire at the beginning and end of their support. When the exit questionnaires were completed, 100% of people reported that they felt listened to, and the majority thought the service had helped them to maintain or improve their quality of life. Most people rated the service they received as good or excellent based on their experience of relationship and trust with our teams, as well as the care and support provided. Midlothian Substance Use Service brings together nurses, doctors, social workers and psychologists to provide assessment, care and treatment of people who use alcohol and/or drugs. The service supports people both at home and in the community to make positive changes to their “This has saved me fines when I leave the property that I wouldn’t be able to pay on my pension.” “Without this help I wouldn’t be able to get out of hospital.” Page 104 of 164
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DRAFT 25 lives. When people have the support they need, we know this leads to better outcomes. Throughout 2025/26, the service continued to achieve the 90% target to meet the 21-day standard from referral to treatment. In additional to one-to-one appointments, the Midlothian Substance Use Service provides information on mental health, coping skills, and advice on benefits and financial support available. Further assistance is offered through the Horizons recovery café, where people who are in recovery can speak to the Citizen’s Advice Bureau on matters such as Universal Credit, debt relief, housing and council tax. Horizons is open every Monday and Friday and between 30 – 60 people attended each day throughout 2025/26. Page 105 of 164
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DRAFT 26 5 Health Inequalities Health & social care services contribute to reducing health inequalities Scottish Government descriptors for this outcome My local community gets the support and information it needs to be a safe and healthy place Support and services are available to me My individual circumstances are taken into account National Indicators used to measure this outcome Health inequalities among older people in Scotland are influenced by a complex mix of social, economic, and health related factors. The Scottish Index of Multiple Deprivation (SIMD) is how the Scottish Government identifies deprivation in Scotland. SIMD data is organised into 10 data zones, from the most to the least deprived. In Midlothian, 8.5% of the population live in a zone that is considered to be the most deprived, and 13.6% live in a zone that is considered to be the least deprived. According to the Scottish Burden of Disease study, by 2044, Scotland is projected to see: 63% increase in chronic obstructive pulmonary disease (COPD) 56% increase in atrial fibrillation 36% increase in both diabetes and stroke. Our local data over the last three years also tell us that people aged 75 and over are only a small number of attendances at A&E but often spend much longer there than younger age groups. 64% of people living in Midlothian who are aged 65 – 74 have a long-term condition. This rises to 84% for those aged 85 and over, which means older people often need more time for the right assessment, treatment, and care. The three most common long-term conditions in people aged 65 and over living in Midlothian are arthritis, cancer, and coronary heart disease. National Indicator Our result Our Progress Premature Mortality Rate (People under 75) Emergency Admission Rate Page 106 of 164
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DRAFT 27 The number of older people in Scotland living with long-term health conditions is increasing and this impacts on health inequalities over a lifetime. Older adults in more deprived areas of Scotland tend to experience shorter life expectancy, more years lived in poor health, and higher rates of hospital admissions and chronic conditions. Our experiences in early life including poverty, poor housing, limited access to education, and unhealthy working conditions have a significant impact on our future. We want everyone to live good lives, for longer. To reduce health inequalities that can be experienced by older people, we are working across the system to continually improve the care and support we provide. Our local data told us that older adults are more likely to be admitted to hospital than other age groups, and people aged 75 and over were more likely to experience a delay to their discharge. We took a targeted approach in 2025/26 to implement new ways of working designed to reduce the time people spend in hospital, especially when they are medically ready to return home. Our local data for attendances at the Royal Infirmary of Edinburgh’s Emergency Department (ED) show some age-related variation. People from Midlothian aged 75+ accounted for 18% attendances. This change in age profile will continue to be monitored as part of the work to support the NHS Lothian Unscheduled Care Improvement Programme. The contributions from teams across health and social care have improved the experience of hospital admission and discharge throughout 2025/26 for all age groups, with the most significant reduction in delayed discharges being achieved for the 75 and over age group. We will continue to monitor this data, to ensure the positive impact in reduction of health inequalities is sustained in the longer term. The Older People’s Social Work Team provide social work assessment, care management and a review of services for people over 65 years old and their carers. In order to ensure residents are receiving the best possible care, we are working collaboratively with care homes on a range of topics including resident experience, care planning, medicine management, falls management, recruitment and retention and staff wellbeing. A Care Inspectorate report in January 2026 found that staff at Newbyres Care Village were knowledgeable about people’s care needs, showed genuine care and respect when supporting people, and that the people who lived at Newbyres and their families were happy with the care provided. The In Reach Social Work Team are a key service that ensure people are given the right support to return home as quickly as possible. The team provide assessment and discharge planning for people who live in Midlothian and have been admitted to one of five hospital sites or the Highbank Intermediate Care Unit. Throughout 2025/26 the team received approximately 750 referrals. The average number of people experiencing a delay to their discharge from hospital for a social reason reduced from 8.4 to 5.7. People living with obesity can experience weight stigma and face a combination of physical and social barriers to accessing healthcare. The Public Health Practitioner team spoke to people living Page 107 of 164
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DRAFT 28 with obesity in Midlothian and 80% reported that the felt stigmatised in a healthcare setting. In response to these discussions, the team developed and delivered training to increase the awareness of Weight Bias, and to give staff and volunteers the knowledge, skills and confidence to have positive, constructive conversations with people about their weight. This work has challenged attitudes, behaviour and environments, and reduced barriers for people who are overweight or obese to talk openly about their weight without feeling stigmatised. 19 sessions were offered throughout 2025/26 with over 193 participants. 63 evaluations of the training were returned and feedback showed that staff would recommend the training to others. We know that good sexual health is important for overall health and well-being and can impact couples, families, and the social and economic development of communities. Inequalities in care can lead to higher risks of Sexually Transmitted Infections (STIs) and unintended pregnancies. Support with sexual health, and access to services that provide information and advice, can help people make good decisions for their treatment options. ‘No.11’ in Dalkeith houses a range of integrated services including Mental Health, Substance Use, Justice Services, and the Third Sector. The team at No. 11 are working in partnership with Chalmers Sexual Health Centre and Midlothian Health and Social Care Partnership’s Health Inclusion Team to support people with their sexual health and wellbeing. Sexual health advice and support appointments, including STI testing and treatment, are offered each month to vulnerable adults affected by homelessness, criminal justice, mental health and/or substance use issues. Sexual health training is offered to all staff based at No. 11 as part of the Homeless Outreach Support Service run by the Health Inclusion Team. Educational materials on long-acting contraception, and stocks of pregnancy tests and condoms are available in the building and are free to all. “It made me challenge my thoughts more on why I was hesitant when addressing the subject, when I wouldn’t hesitate to address a heart condition for example. Made me rethink my tone, body language and generally language used whilst approaching patients.” “I think this has raised my awareness in terms of language to use when discussing weight. It highlighted the importance of checking with patients first whether this is an area they want to discuss or not.” Page 108 of 164
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DRAFT 29 6 Support for Carers People who provide unpaid care are supported to look after their health and wellbeing. Scottish Government descriptors for this outcome 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 National Indicators used to measure this outcome Indicator 8 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, this indicator has been updated from the 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Understanding the experience of carers in Midlothian is vital to ensure we design and deliver services and support that carers need. All carers are entitled to a personalised plan or statement that outlines their needs as a carer and the support they will receive. Adult Carer Support Plans are developed alongside carers to ensure their voice is heard and their views are reflected. Throughout 2025/26, 98 Adult Carer Support Plans were completed by the Midlothian Health and Social Care Partnership with an additional 1281 offered and 921 completed by our commissioned partner, VOCAL. VOCAL supports unpaid carers in Midlothian through a range of services for adult carers who are caring for family members or friends with physical disabilities, mental health conditions, alcohol and drug use. Our Unpaid Carer Strategy 2025-2028 sets out the action we will take over the next three years to improve the experience of carers in Midlothian. We approved Our Unpaid Carer Strategy in February 2026. Due to the joint approach with Midlothian Council Children’s Services we published this plan in May 2026 following Midlothian Council approval of the element relating to Young Carers. National Indicator Our result Our Progress Carers feel supported to continue in their caring role. Page 109 of 164
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DRAFT 30 This strategy was developed in collaboration with the Health and Social Care Partnership’s Carers Planning Group and Third Sector partners, and in consultation with unpaid carers across Midlothian. Our Unpaid Carer Strategy is a central part of how we will make progress towards our strategic aims and identifies the priority themes and actions we will take to support local carers such as: Carer Rights and Identification; Providing Information, Advice and Support; Providing Carer Economic Wellbeing; Supporting Health and Wellbeing (including breaks from caring); Supporting Carer Involvement in Care Planning. Caring for another person can have a significant impact on a carer’s health and wellbeing. People will not always identify themselves as a carer, so VOCAL hold monthly ‘Think Carer’ sessions that provide training for professionals to help them support unpaid carers they come into contact with. Training focuses on how carers are identified, the impact caring can have on health and wellbeing, and support available in the Lothians. 98 sessions were offered throughout 2025/26 and 518 people attended. To reach as many people as possible in Midlothian and reduce barriers to carer support, VOCAL established a small team of carer support practitioners who provide face-to-face ‘drop-in’ support. Throughout 2025/26, 136 drop-in sessions were held in GP practices, hospitals, libraries and community hubs as well as locations in rural areas to improve people’s access to support. We want to support carers by providing opportunities to learn new skills, spend time doing the things that matter to them, and bring carers together for peer support. In 2025/26 a series of small grants enabled ten groups to be set up throughout Midlothian specifically aimed at supporting carers to meet new people, learn new skills, and spend time outdoors. These groups also offer peer support opportunities like the Carer Pause group for parents who care for children, and a branch of the Men’s Shed in Dalkeith for male carers. Carers who have attended told us that having support close by has made a real difference. It can be difficult for carers to prioritise their own health and wellbeing. VOCAL run a Carer Health Surgery each month where people can book a 45-minute appointment with a nurse practitioner. Since June 2025, over 70% of available appointments were attended by 24 local carers to support them to look after their own health and wellbeing. Throughout 2025/26, VOCAL have also supported 76 carers in over 867 counselling appointments with a trained counsellor, focusing on positive ways for carers to manage their own mental health while caring. Carers told us they appreciate time to focus on their own wellbeing. “Accessing support in my local village has made it possible for me to receive support. Being able to talk to a carer support worker has been life changing, it’s the first time I’ve been able to share how difficult I’ve been finding things.” Page 110 of 164
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DRAFT 31 Working with our commissioned partners, VOCAL, we have ensured that carers are offered short break grants and funded opportunities to enable carers to take time away from their caring duties. In 2025/26, 344 carers accessed a funded break and a further 402 carers received vouchers or tickets for activities such as day tours, meals out and visits to attractions like wildlife parks, historical sites and gardens. Opportunities for respite from caring reopened at Highbank Intermediate Care in 2023. These facilities are planned to move to the Midlothian Life Care Facility currently under development at Polton Street. This will include 40 beds with 10 rehabilitation flats, 27 interim care beds, and 3 beds to support respite stays that can be made available to those supported by unpaid carers. A new addition to the facility is the Midlothian Life Health and Social Hub, a staff and service facility hub with other health and social care organisations, information and signposting. “I had been worried about my own health for a while … I attended a health surgery at VOCAL and it was so reassuring to be able to meet with a nurse and have the time to talk through what was going on. Having time to be able to focus on my own health was so helpful.” Page 111 of 164
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DRAFT 32 7 Safe from Harm People using health & social care services are safe from harm. Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome Indicator 9 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. As 2025/26 is a reporting year, this indicator has been updated from the 2023/24 data. National Indicator Our result Our Progress 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 112 of 164
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DRAFT 33 This section will be updated in August following the publication of the core suite of integration indicators and the analysis of the Midlothian IJB Annual Survey. Indicator 9 focuses on the perspective of people receiving support at home, and whether they feel safe within that context. The results are used to assess the quality of care and identify areas where improvements can be made to ensure person-centred care and support. Some people are more vulnerable and need additional protection from abuse and harm. The Adult Support and Protection (Scotland) Act 2007 provides duties, powers and measures for the support and protection of adults who may be at risk of harm. A range of guidance and services have been developed for vulnerable adults in Midlothian to empower them to suggest improvements to the service. A new advocacy service was launched in early 2026 for those with experience of adult support and protection to share their views on what went well and what could be improved. This includes asking for adaptation when services could be delivered in a different way, providing feedback on whether they felt listened to and their views were respected, and if they felt safer. Our social work services are a lifeline to people in our communities and ensure people are given the support they need to be safe at home for as long as possible. This includes undertaking the statutory obligation to make inquiries about an adult at risk's well-being, property or financial affairs. This is called the Duty to Inquire. Support when you need it A Midlothian resident was referred to Social Work following concerns that their living environment was no longer safe. The case was allocated to a Council Officer to undertake a Duty to Inquire. The Officer took time to understand what mattered most and the support they needed to make decisions about how ensure their wellbeing at home. Teams worked together to ensure that the right support was available including Council Services, Social Work, Health, Justice Services, Scottish Fire and Rescue and the Third Sector. As a result, the house was cleared, deep cleaned, new furniture was purchased, a smoke alarm fitted, and garden paths and walkways were cleared to reduce the risk of falls, and ensure it was safe to come and go. The resident told us they were happy with the help received and that their wish to be independent was respected. In January 2026 the Care Inspectorate visited Newbyres Care Village and reported improvements to medication safety and oversight. Staff have worked to improve processes and safe handling of medicines, including daily checks and recording of medications. The long-term use of medicines to Page 113 of 164
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DRAFT 34 manage pain can create safety risks, especially in older people. Midlothian Community Hospital has had specialist input from pharmacy colleagues to support people in safely reducing their use of high-risk medicines. In Scotland, an ‘Appropriate Adult’ provides vulnerable people aged 16 and over with crucial communication support during police investigations. Appropriate Adults support people over 16 who have a mental disorder as defined by The Mental Health (Care and Treatment) (Scotland) Act 2003 e.g., mental health problems, learning disabilities, Autism, ADHD, dementia, acquired brain injury. Section 42 of The Criminal Justice (Scotland) Act 2016 requires that the police and agencies ensure the provision of communication support for vulnerable adults in police custody. Appropriate Adults are provided mainly at the request of Police Scotland for people who are being interviewed and who are believed to have a mental disorder. An Appropriate Adult’s main roles are to ensures that the persons’ rights are upheld, and to provide communication support so that they can understand and be understood. In Midlothian Health and Social Care Partnership, there are 9 trained Appropriate Adults who fulfil this role for those who live in the area. They have worked with 13 people throughout 2025/26 to ensure they are supported and treated fairly throughout the custody process. We also received feedback on our services in 20 Care Inspectorate Reports across 2025/26. There were a number of areas where the Care Inspectorate told us we were doing well, including wellbeing support, leadership, staff teams and the planning of care and support. Full details of these reports, including the assessment ratings and improvement plans, can be found on page 58. Page 114 of 164
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DRAFT 35 8 Workforce Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome These are no National Indicators to measure our progress towards this outcome. We use staff surveys and other local information to evaluate our performance. Staff experience - iMatter In the 2025/26 iMatter survey, the Midlothian Health and Social Care Partnership Employee Engagement Index was 78/100. This is the same score as 2024/25. 62% of staff took part in the iMatter survey, which is also the same as the rate in 2024/25 (62%). The 2025 iMatter Survey highlighted several areas where staff had a positive experience. I feel my direct line manager cares about my health and wellbeing I am clear about my duties and responsibilities I am treated with dignity and respect as an individual My work gives me a sense of achievement My direct line manager is sufficiently approachable Our workforce The workforce is our greatest asset, but we do not directly employ any staff. The health and social care workforce are employed through Midlothian Council, NHS Lothian, and organisations in the Independent and Third sector alongside our unpaid carers and volunteers. Scottish Government asked us to develop an Integrated Workforce Plan for 2025-28. We consulted with our Partners, staff, Trade Unions, HR, and Finance. The themes that emerged were leadership and management, a nurtured and empowered workforce, training and development, and recruitment and retention. A draft Integrated Workforce Plan was submitted to Scottish Government on 17th March 2025. We must wait for feedback on this before a publication date can be set. Because Midlothian Health and Social Care Partnership is a Directorate of both NHS Lothian and Midlothian Council there will be overlap between this plan and both the NHS Lothian Workforce Plan and the Midlothian Council Workforce Strategy 2024-34. Our Integrated Workforce Plan 2022-25 can be found on our website. Page 115 of 164
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DRAFT 36 Staff wellbeing Working within community settings can be challenging with regular exposure to complex and distressing situations. Psychological issues, including stress, continue to be the primary cause of sickness absence. We want to prioritise ensuring that all staff that work within Midlothian Health and Social Care Partnership are safe and well at work and have continued to fund a Staff Wellbeing Lead post to work alongside staff groups, listen to what matters to them, and provide tailored support. In 2025/26 Midlothian Health and Social Care Partnership refreshed its Staff Wellbeing, Experience and Engagement Delivery Plan for 2025-2028. This plan focused on the four key drivers designed to improve and maintain staff wellbeing. Work has meaning and a positive impact on staff Work is a healthy place to be We are all able to show leadership We listen to staff, and they feel heard. Managers from within the Midlothian Health and Social Care Partnership have committed to sharing information with staff and being transparent over how decisions are made. We do this by demonstrating visible leadership through developing a schedule of engagement opportunities for senior managers of NHS Lothian, Midlothian Council and Midlothian IJB, and ensuring staff feel involved in decision making with regular feedback opportunities. One example of this is the Midlothian Health and Social Care Partnership Question Time which is a new initiative in 2025/26. This regular ‘Question and Answer’ session is with Midlothian health and social care leaders and is an opportunity for staff to explore the issues that matter to them and hear updates on key issues. Questions are collected in advance so the meeting can address popular themes and build connections between staff. Staff in Midlothian continue to enjoy a monthly lunchtime Soup Stop hosted in the café at Midlothian Community Hospital. These events give staff an opportunity to spent time together, share support, and meet the Executive Leadership Team. Conversations focus on working together and staff wellbeing. In 2025/26 over 250 meals were provided with 25-35 people attending each session. Our Welbeing support includes education and information sessions and opportunities to learn something new. Midlothian Health and Social Care Partnership encourages all staff to take part in the Staff Network ‘Lunch and Learn’. Sessions are held regularly throughout the year and cover a range of subjects from carers rights, menopause and menstrual health, pelvic floor health, disability pride, and neurodiversity. In 2025/26 we supported the NHS workplace campaign ‘Better Informed, Better Choices’ to improve staff access to clear, accurate, and timely health information. The project supported staff Page 116 of 164
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DRAFT 37 to access digital tools and screening information covering topics such as breast and prostate cancer, diabetes, and hypertension. Reflective Practice sessions are offered to staff to provide an opportunity for continued learning by considering situations they have experienced in their work, exploring outcomes, and improving the quality of their service. In 2025/26, 25 sessions were held and between 10 – 14 people attended each one. In recognition of the challenging day to day emotional and physical demands experienced by staff working within the Learning Disabilities team, four bespoke support sessions were delivered at the Cherry Road Centre to encourage teamwork, camaraderie, wellness, and resilience. Quarterly reflective practice sessions are now in place and staff noted the success. One to one Wellbeing Support and Coaching provided by the staff Wellbeing Lead can help staff take a step back and think about how to care for their own health and wellbeing. During 2025/26 over 25 individual and group sessions were offered to staff in Midlothian. National Workforce Wellbeing Week took place in the first week of September and Midlothian Health and Social Care Partnership hosted 5 sessions with over 200 members of staff coming together to have meaningful conversations about wellbeing within the workplace. Topics focused on how to use cognitive behavioural approaches to manage stress, recognising and managing menopause, and mindful movement and meditation. To mark the end of National Workforce Wellbeing Week, an event was held at Midlothian Community Hospital supported by Midlothian Council, NHS Lothian, and the Third Sector. The event was attended by over 60 staff. who joined in team building exercises, e-bike rides, a silent disco, and hand massages. Feedback was overwhelmingly positive and when staff were asked if they would attend a future National Workforce Wellbeing event, 98% said yes. “It was good to have time to listen to each other and find out what is going on for each other.” “I think it helped having someone out with the team facilitating the conversation. It allowed me to participate as an equal.” “My coach offered me a different way to look at things and made me think about giving consideration to my own needs. I left the meetings with next steps in place, which I wouldn’t have achieved by myself.” “The coach was a great listener and calming to talk to.” Page 117 of 164
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DRAFT 38 On November 6th 2025, Occupational Therapy colleagues, Therapy Support Workers and Community Care Assistants from across Midlothian Health and Social Care Partnership met to mark National Occupational Therapy Week. This was an opportunity for staff to meet face to face and connect with professionals they often only speak to virtually. The day was spent sharing experiences, learning from one another, and celebrating the vital role occupational therapy plays in helping people live meaningful lives. 32 people attended the event, and the impact as described by the attendees was “transformative, meaningful, person-centred and empowering”. Everyone working across health and social care has an important contribution to positive and healthy working environments. Midlothian Community Hospital were offered a programme of support for staff to learn about each other, share thoughts and ideas, and appreciate differences. Four consecutive weekly sessions were provided and a range of staff attended, with positive feedback reported. We continue to prioritise working closely with our NHS Lothian and Midlothian Council Partners to develop skills and knowledge of all staff working within Midlothian Health and Social Care Partnership. In the last year, the Learning and Development team delivered and coordinated more than 1000 learning opportunities, from SVQ programmes (Levels 2, 3 and 4) to Adult Support and Protection, Foundation and Modern Apprenticeships, Child Protection, Team Teach, Trauma Informed Practice, Motivational Interviewing, Dementia Awareness and Medication training. Staff have also accessed post-graduate courses through Edinburgh and Stirling Universities, The Open University, and Napier University. In line with the experience across health and social care nationally, recruitment and retention continued to be a challenge for Midlothian Health and Social Care Partnership. Areas where this has been particularly challenging is recruiting to Social Worker posts, and ongoing staff vacancies within Highbank Intermediate Care Unit, Care at Home, and Newbyres Care Village. The Third Sector plays a significant role in Midlothian by working alongside health and social care services to help vulnerable people, support services and encourage a sense of community. In Midlothian there are approximately 30 000 volunteers working with over 500 formal groups or voluntary associations, including sports clubs, uniformed youth groups (e.g. Brownies and Scouts) and small special interest groups such as art clubs and history societies. In addition, there are 270 registered charities and 73 social enterprises. We work also work closely with the Midlothian Third Sector Interface through the Board and committee meetings, and support the Third Sector Summits held in May and October 2025. “The sessions were very relaxing and very eye opening how we handle situations mentally and physically, also making us realise how much we overthink things we cannot control, it brought us all together and gave us a reason to listen to one another." Page 118 of 164
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DRAFT 39 On 25th May 2025 volunteers from across Midlothian arrived at Newbattle Abbey College for the annual Midlothian Volunteer Awards Ceremony. This celebration is part of the national initiative, Volunteer’s Week, and Midlothian Health and Social Care Partnership sponsors the Health and Wellbeing and Active Volunteer Award at the ceremony each year. Page 119 of 164
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DRAFT 40 9 Use of Resources Resources are used effectively and efficiently. Scottish Government descriptors for this outcome 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. National Indicators used to measure this outcome Indicator 4 is taken from the national Health and Care Excellence Survey (HACE), which is published every two years. 2025/26 is a reporting year and so this indicator has been updated from 2023/24 data. This section will be updated in August following the publication of the core suite of integration indicators. National Indicator Our result Our Progress 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 120 of 164
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DRAFT 41 We are responsible for an integrated budget that we receive from Midlothian Council and NHS Lothian. The priorities set out in our Strategic Plan guide how we allocate the money we receive. The Midlothian IJB Medium-Term Financial Strategy supports the monitoring of financial activity and planning. Midlothian Health and Social Care Partnership use the money allocated to services to plan, deliver, monitor, and evaluate the services it provides and commissions. In 2025/26, Midlothian Council and NHS Lothian supported us with the best funding offer they could, but it was not enough to keep pace with the health and social care needs of our people and community. We worked with Midlothian Health and Social Care Partnership to transform services in Midlothian and address local financial challenges. Our transformation priorities for 2025/26 were set out in our Directions 9.3.1 to 9.3.8. Over the course of 2025/26 we learned that we had asked Midlothian Health and Social Care Partnership to undertake too many changes at the same time. The ambitious programme of work in combination with ‘Business as Usual’ service provision and delivering on Financial Recovery Plans meant that we made good progress in some areas and found it more challenging to see change in others. 1. Direction 9.3.1: Midlothian Council and NHS Lothian will support Midlothian HSCP to ensure people can access well-coordinated, timely and high-quality palliative care, care around death, and bereavement support based on their needs and preferences. Services that provide palliative care continue to deliver quality care and support and this workstream focused on delivering the ambitions of the national Palliative Care Strategy Delivery Plan 2025 – 2028. 2. Direction 9.3.2: Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign and ensure the most efficient and effective operational model of bed-based provision. A Midlothian Community Hospital review redesigned bed-based and community pathways to reduce length of stays and support the Home First principles. Planned Date of Discharge was introduced with a 90% compliance rate and overall lengths of stays reduced. Work also included the progression of the Midlothian Life Care Facility with 40 beds and rehabilitation flats and the completion of the design of the Midlothian Life Health and Social Care Hub. Wider transformational planning and progress have been limited due to operational pressures and the complexity and interrelated components of this workstream. This remans a priority for 2026/27. 3. Direction 9.3.3: Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign the Home First model of care. Great progress was made, and a full update was provided to the Transformation and Change Programme Board in November 2025. Staff engagement sessions highlighted improvements that could be made in data collection and process improvement to deliver care more efficiently. Several opportunities for redesign were identified, including triage, screening processes and travel efficiencies. 4. Direction 9.3.4: Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review to scope viable opportunities to change financial flow from acute hospital services to the community designed to sustain and expand general practice, mental health & community services at a local level. The Midlothian Health and Social Care Partnership Primary Care Strategic Working Group has made progress in this area and identified a number of priority areas for continued improvement. Page 121 of 164
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DRAFT 42 5. Direction 9.3.5: 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. A review of commissioned contracts was undertaken and a revised model of Contracts and Commissioning is planned. This remains a priority for 2026/27. 6. Direction 9.3.6: Midlothian Council and NHS Lothian will ensure that the Midlothian Community Planning Partnership makes best use of the opportunity to bring local public bodies together with local communities and local community partner organisations to effectively strategically plan, design, and deliver service offers that make a real difference in people’s lives. The Community Planning Partnership “Midlothian Will Be Healthier” group was reconvened, and work undertaken with a range of stakeholders to agree priorities for 2026. Planning has also commenced to prepare for the new Single Midlothian Plan. 7. Direction 9.3.7: NHS Lothian and Midlothian Council will support Midlothian HSCP to improve the experience of people in Midlothian with Dementia by ensuring everyone with a diagnosis of dementia can be offered Post-Diagnostic Support for the first year of their diagnosis and has access to 8 Pillars Model of Community Support. Great progress was made in 2025/26 with plans for 2026/27 to implementing the Midlothian Health and Social Care Partnership Dementia Framework. Work includes reviewing accommodation options for long-term patients, access to services, and ensuring a consistent service approach. 8. Direction 9.3.8: Midlothian Council and NHS Lothian will support Midlothian HSCP to review and improve both the system flow, and the experience of people seeking information and seeking support from integrated services by telephone, electronic communication, or written communication. Transformational planning and progress have been limited due to operational pressures. This work is at an early stage, but the ambition is to provide clear, simple and consistent access to care. This remains a priority for 2026/27. We listened to the services undertaking the design and delivery of this work and recognised that delivering services day to day, executing financial recovery plans, and leading on transformation was a big ask. Our Directions for 2026/27 have taken this into account and we have aligned this work without financial recovery actions in a more focused approach. Page 122 of 164
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DRAFT 43 Next steps for Transformation In our Directions for 2026/27, we have asked Midlothian Council and NHS to support Midlothian Health and Social Care Partnership to focus on three areas of transformation. Direction 9.3.2 Bed based provision, to enable people to access appropriate levels of care when their needs change. Direction 9.3.5 Commissioning and Third Sector, to undertake a review of commissioning spend and establish a new partner provider model. Direction 9.3.8 Midlothian Single Point of Access, to design and implement a method to support people’s contact across different health and social care services. Page 123 of 164
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DRAFT 44 Our hosted services We plan for and direct two pan-Lothian hosted services that are managed by Midlothian Health and Social Care Partnership. These are Dietetics and the Adults with Complex and Exceptional Needs Service (ACENS) who deliver care to people across the whole Lothian region for the four Health and Social Care Partnerships; Midlothian, East Lothian, West Lothian, and City of Edinburgh. Dietetics Service Adult Acute Adult Acute Dietetic team support people who are in hospital and are at risk of malnutrition and provide advice and support to people with complex nutritional care needs before being admitted to hospital. Nutrition plays a crucial role in acute care and cancer care as nutrition is an important part of recovering from operations and can help people leave hospital and return home more quickly. In 2025/26, the team introduced a nutritional screening pilot to help lower the impact of surgical stress, reduce lengths of stay in hospital, and contribute to positive outcomes of treatment and support. This work has led to improvements in a number of acute hospital and cancer services: Following dietetic assessment, 48% of people who needed a liver transplant were started on Oral Nutritional Supplements (ONS) or had their ONS increased. Dietetics support to people with lung cancer led to a 95% confidence level that their length of hospital stay would be reduced compared to those without dietetic input. Nutritional support for people with endometriosis and pelvic pain led to significant reductions in ward admissions from a total of 62 over a five-year period to just 3 in 2025/26. Nutritional support for people in critical care recovery made significant reductions to length of stay in hospital. At the Royal Infirmary of Edinburgh, length of stay decreased from 16 days to 11.5 days and at the Western General Hospital from 22 days to 18 days. Paediatric The Paediatric Dietetic service supports children and young people, as well as their families and carers, in community-based clinics across Lothian. Throughout 2025/26, the service received around 480 new referrals with 80% of those seen in appointments. The dietetic-led coeliac pathway manages 5 – 7 referrals a month and delivers timely support in diagnosing coeliac disease. In 2025/26, the service saved approximately £400 000 by optimising both diagnosis and treatment of cow’s milk protein allergies. Community Enteral Nutrition The Enteral Feeding Dietetic team supports around 300 adults receiving tube feeding across Lothian. People receive care either in their own homes or in an outpatient clinic, supporting care closer to home and reducing reliance on acute services. The team works closely with Nutricia Homeward service nurses in a collaborative approach that supports patients to remain safely at home, manage tube-related complications in the community, and prevent avoidable hospital Page 124 of 164
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DRAFT 45 admissions. Recent recruitment initiatives have enabled the team to provide support to the Head and Neck Oncology clinic, with a dedicated dietitian attending appointments once a week. Intellectual Disability The Intellectual Disability Dietetic team supports a range of complex health, social and communication needs, including 100 people who receive tube feeding. The team work closely with community nurses, learning disability teams, GPs and social care staff to ensure safe, coordinated and effective nutritional care. The team provides inclusive, accessible education and actively contributes to research activity in the Lothians, including a multi-centre trial evaluating the use of DESMOND education groups adapted for people with an intellectual disability. Community Gastrointestinal (GI) The Community GI Dietetic team provide care across the Lothians with a strong emphasis on digital innovation, timely access and patient choice. Face to face clinics are offered at a range of locations, enabling people to be seen close to home, 89% of people who had support from the team in 2025/26 said they were happy with venue of their appointment. As part of the Irritable Bowel Syndrome (IBS) care pathway, 60% of patients access their first appointment via a video link which reduces travel and supports self-management. At the end of 2025, follow up session that could be requested by patients were introduced and found this helped reduced the number of unnecessary appointments and supported continuity of care. Community Locality The Community Locality Dietetic team works alongside patients, their relatives, and carers to manage nutritional needs within the community and helps those with long-term conditions make dietary changes to support rehabilitation and quality of life. The team receives an average of 5154 referrals annually across Lothian, with between 30-50 of these referrals are supported at Midlothian Community Hospital. Prescribing and Care Home The Care Homes and Prescribing Dietetic team provides specialist advice and support to all care homes across NHS Lothian. They provide early intervention, safe prescribing, and nutritional care for residents with complex needs. The team are working collaboratively with two GP practices in Midlothian to manage oral nutritional supplement (ONS) and enteral tube feed prescribing and plan to extend this service to more GP practices. Midlothian Community Respiratory Team The Midlothian Community Respiratory Dietetic team deliver care for people with chronic obstructive pulmonary disease (COPD) and bronchiectasis and focus on self-management, rehabilitation and prevention of admission to hospital. The team includes physiotherapists, a psychologist and a dietitian who can support early identification of malnutrition and offer prompt treatment. This work has significantly contributed to admission rates to hospital for people from Midlothian with COPD being lower than the national average. Page 125 of 164
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DRAFT 46 Dietetics and digital Digital delivery is a critical part of how Dietetics deliver their services and expanding digital and hybrid delivery of care continues to be a focus. Currently, 56% of appointments are delivered via virtual groups and individual assessments, with both Gestational Diabetes and Diabetes Remission offering a fully remote service. Further work is planned to help streamline access to services and triage, increase capacity so more people can receive treatment, and improve pathways so people can easily move between services to get the right support at the right time. Adults with Complex and Exceptional Needs The Adult Complex & Exceptional Needs Service (ACENS) provides care across the four Lothian regions for people with exceptional health care needs. The service supports care in a variety of community environments including home and respite settings. ACENS provides consistent and continuous high-quality care, up to 24 hours a day, 7 days a week, working in partnership with the person and their family, carers and other care giving agencies including the Education and Social Work departments and respite facilities. Many of the people receiving care from ACENS depend on technology to support them live well in their community with a life limiting condition. The service provides highly specialist care for people in challenging circumstances and also support the families of those being cared for by offering dignified and respectful care that centres on the person and their loved ones. In 2025/26, the ACENS team were nominated for the Scottish Health Awards in the Integrated Care category. This was in recognition of their compassionate and skilled intervention to support a young person and their family through the transition from paediatric services to adult services during challenging period of health and wellbeing. Page 126 of 164
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DRAFT 47 How we spent our money (2025/26) We are funded by our partners, Midlothian Council and NHS Lothian, and are responsible for the integrated budget we receive. This funding is to deliver health and social care in Midlothian. We work closely with our Partners and receive a budget offer from them both every year. However, we often don’t know exactly what this will be until February or March each year. This is because of how our Partners receive funding from Scottish Government. Financial challenges during 2025/26 We continue to experience financial pressures that reflect both national trends and specific local challenges within Midlothian. This section will be updated in August following the publication of our draft annual accounts. How we spent our money in 2025/26 Health Budget £000’s Social Care Budget £000’s Health Expenditure £000’s Social Care Expenditure £000’s Variance £000’s Note Direct Midlothian Services Community AHPS Community Hospitals District Nursing General Medical Services Health Visiting Mental Health Other Prescribing Resource Transfer Older People Learning Disabilities Mental Health Physical Disabilities Assessment & Care Management Social Care Other Midlothian Share of Pan Lothian Set Aside Page 127 of 164
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DRAFT 48 Health Budget £000’s Social Care Budget £000’s Health Expenditure £000’s Social Care Expenditure £000’s Variance £000’s Note Mental Health Learning Disabilities GP Out of Hours Rehabilitation Sexual Health Psychology Substance Use Allied Health Professions Oral Health Hosted Other Dental Ophthalmology Pharmacy Sub Totals Partner Additional Contributions Movement in Earmarked Reserves Per Annual Accounts Page 128 of 164
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DRAFT 49 Main Areas of Spend (2018/19-2025/26) The graph below compares our spend trends for the past 8 years. We are unable to report on spend by locality as we do not hold data in this form. £ 000's 112,900 32,273 22,285 19,726 17,317 Community Hospital Prescribing GMS Other 120,000 100,000 80,000 60,000 40,000 20,000 0 Main Areas of Spend 2018/19 - 2025/26 2018/19 2019/20 2020/21 2021/22 2022/23 2023/24 2024/25 Page 129 of 164
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DRAFT 50 Communication and Engagement We have worked with local people throughout the year to help us understand what is working well, where we can improve and how we can do better. Some examples across 2025/26 include: This section will be updated in August following the analysis of the Midlothian IJB Annual Survey. Self-Evaluation of our community engagement We used the Healthcare Improvement Scotland Quality Framework for Community Engagement and Participation and Self Evaluation Tool to consider how well we were working alongside people and communities, and the impact of this on strategy development and service improvement. We used the quality indicators within the Framework to recognise what was already working well and identify opportunities for improvement. We concluded we had areas of strength in ‘Involvement of people in service planning, strategy and design’, and that we were improving in areas of ‘Governance and leadership’. We also identified ‘Ongoing engagement and involvement of people’ as an area for improvement. In October 2025 we published our Midlothian IJB Participation and Engagement Statement 2025-2028 which outlines the action we will take across 2025- 2028 to improve how we work alongside people and communities in Midlothian. Living Well In Midlothian annual survey In spring 2026 we launched our second annual survey and invited people living in Midlothian to complete a questionnaire to share their views about health and social care. We asked people about their health and wellbeing, getting the help and support they need, providing help and support to others, help with everyday living, health conditions and illnesses, and community and services. We took a similar approach to the national Health and Care Experience Survey, using validated questions, to help us better understand local people’s experience, focus on opportunities for learning, and identify areas for action. Unpaid Carers Strategy 2025-2028 As we developed our Unpaid Carer Strategy, we listened to local unpaid carers about the roles they undertake and their experience as carers. This helped us to understand what they can contribute, the impact of caring on them, the support they need to continue, and how we can help support them to have a life of their own alongside their caring role. We also listened to the workforce and our commissioned partners. We researched and listened to carer experiences, including how people were identified as a carer, how they accessed support and felt supported, the impact on their finances and employment, carer wellbeing and having a break from caring, and being involved in decisions about their own care and plans for the person they care for. Page 130 of 164
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DRAFT 51 There were three main pieces of consultation that informed the Strategy: 1. In-person staff workshop in May 2025. This workshop included 26 members of staff from the Third Sector, Midlothian Council and Midlothian Health and Social Care Partnership 2. In-person Carers Action Midlothian meeting in October 2025. We spoke to 5 carers and 2 members of staff from our commissioned partner, VOCAL. 3. Online public survey in across November and December 2025. 34 people gave feedback on our draft strategic priorities. In all the conversation we had with carers and staff, there was strong support for the draft priorities and a shared desire for change in how services connect, communicate, and respond. The most urgent needs were identified as the need for a single point of contact, better navigation support, early and proactive identification, accessible and consistent information, financial support and employment flexibility, replacement care to make breaks possible, and meaningful involvement at all transition points. Midlothian Health and Social Care Partnership Engagement Advocacy Strategy Midlothian Health and Social Care Partnership ran a lived experience engagement process to inform the development of the Midlothian Health and Social Care Partnership Independent Advocacy Strategy 2026–2029. The focus was on gathering views from individuals with a statutory right to independent advocacy under the Mental Health (Care and Treatment) (Scotland) Act 2003. A variety of approaches were used to reach adults with mental ill health, adults with learning disabilities, older adults with mental ill health, and young people with disabilities. These included a digital survey, three focus groups, and one to one conversations. Third Sector and independent advocacy providers played a key role in supporting participation and building safe, accessible opportunities for people to contribute. Four key areas were explored: awareness, accessibility, effectiveness, and priorities for the future of independent advocacy. A digital survey in 2025 gathered 25 responses which told us people value independent advocacy, but it is not always easy to understand or access. Collective independent advocacy also matters as it helps people work together, shape services and support one another. People said it gave them confidence, connection and a real voice in decisions that affect them. Midlothian Health and Social Care Partnership have made a commitment to ensure more people in Midlothian have access to advocacy and can get advice and support to stay well. Adult Support and Protection (ASP) Adult Support and Protection Case Conferences (ASPCC) are multi-agency meetings where services from social work, police, and health discuss plans to offer support to an adult who is at risk of harm under the Adult Support and Protection (Scotland) Act 2007. The adult at risk is invited to attend the Page 131 of 164
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DRAFT 52 ASPCC and is offered advocacy and support. Midlothian Social Work is currently developing a process where adults who have been to an ASPCC are offered an opportunity to provide feedback on their experiences with first contact, assistance during a case conference, and the difference the support made to their care. A form has been reviewed and is now in use for people to give feedback via a paper or electronic copy, or on the phone with the Health and Social Care Practitioner within the ASP Team. Work is ongoing to embed feedback in our planning and ensure that the feedback gathered is meaningful. Community Justice Midlothian’s Community Justice Partnership coordinated a consultation survey from 7th July to 17th August 2025 to inform service design and delivery. There were 9 main survey questions, and 285 responses were received. When people were asked what Midlothian’s Community Justice Partnership could do better, respondents most commonly said they wanted awareness of the service to improve, and that services are kept relevant to reflect the specific needs of Midlothian. People also wanted to be kept up to date with community justice updates digitally through social media and website updates. People were also positive about the role services play in Midlothian communities. Trauma Awareness Week Between the 15th and 19th of September, Midlothian Health and Social Care Partnership organised a week of face to face and online events and webinars to share feedback and lived experience on how to support people with trauma. 58 people attended the in-person launch on Monday September 15th and the event focused on collaboration, with presentations from East and Midlothian Women’s Aid, Midlothian House Project, Play Therapy Base, and Midlothian’s Trauma Informed Practice Steering Group. A further 91 people joined webinars throughout the rest of the week and discussions focused on subjects like trust, safety, empowerment and choice. Feedback was overwhelmingly positive and participants shared that they felt confident to put their learning into practice. Consultation on supporting and promoting Gaelic in Midlothian 2026-2031 In the 2022 Scottish census, 0.6% of the Midlothian population identified themselves as Gaelic speakers with 365 individuals speaking, reading and writing Gaelic. Midlothian Council conducted a public consultation on supporting and promoting Gaelic in the local area between November 2025 “The events have all been excellent and certainly have people talking and thinking about the impact of trauma, which we all know is important.” “Women’s Aid and Children’s First I feel are one of the best services in Midlothian. I feel they communicate well together, have a great understanding that not everything is black and white, and have other knowledge of access to help within the community.” Page 132 of 164
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DRAFT 53 and January 2026. The consultation was designed to help Midlothian Council deliver their Gaelic Language Plan 2026-2031 which aims to increase opportunities for the community to engage with Gaelic, support the sustainability of Gaelic education (GME) and progress Gaelic Learner Education (GLE), and increase the visibility of Gaelic resources and materials. The results of the consultation were not available at the time of this report. Page 133 of 164
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DRAFT 54 Equality We ensure equality is at the heart of what we do. This includes how we make decisions and spend money, the way we work alongside people and communities, and how we improve our services. Protected characteristics are aspects of a person’s identity that are protected by law under the Equality Act 2010. These include age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. We must work towards ensuring everyone receives fair and equal health and social care. Midlothian has a unique population with its own specific health and social care needs. We use data from the National Census to understand the profile of the people who live in Midlothian and how their access to health and social care may be affected. In Midlothian, Equality and Children’s Rights Impact Assessments (ECRIAs) are completed to consider how our decisions might impact on people with protected characteristics and advance equality where possible. We completed 9 Equality and Children’s Rights Impact Assessments for the following new or revised strategies, policies and plans, provisions, practices, and activities: 1. Midlothian Integration Joint Board Participation and Engagement Statement 2025-2028 2. Midlothian Integration Joint Board Strategic Plan 2025-2035 3. Midlothian Integration Joint Board Unpaid Carer Strategy 2025-2028 4. Midlothian Integration Joint Board Financial Recovery Plan Commissioning 2025-2026 5. Midlothian Integration Joint Board Financial Recovery Plan Bed Base 2025-2026 6. Midlothian Integration Joint Board Financial Recovery Plan Commissioning 2025-2026 7. Midlothian Integration Joint Board Financial Recovery Plan MCH Bed Base Review 2026-2027 8. Midlothian Integration Joint Board Financial Recovery Plan Care at Home 2026-2027 9. Midlothian Integration Joint Board Financial Recovery Plan Learning Disability 2-1 and Sleepovers 2026-2027. Page 134 of 164
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DRAFT 55 Protected characteristics in Midlothian Page 135 of 164
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DRAFT 56 Update on our Equality Outcomes 2025-2029 Mainstreaming Equality Update Our Equality Outcomes 2025-2029 set out the actions we would take to advance equality in Midlothian. To comply with our Public Sector Equality Duty, we must provide an update every two years on what we have done to address equality issues in Midlothian. As part of our ambition for equality to be central to our planning, delivery, reporting and evaluation, we have provided an update on our activity for 2025-2026 in this report and will continue to report on progress every year. We are working towards making equality part of our day-to-day work and our mainstreaming outcomes support everyone with each of the protected characteristics. Our 4 specific equality outcomes in this report do not cover every protected characteristic but are chosen as they link closely to the aims in our Strategic Plan 2025-2035, and people told us they were important to them in our consultation: Outcome 1: People have a choice about how they access information and support from integrated services. Actions: We have reviewed our publicly available information to ensure it is compliant with our duties relating to accessibility and is accessible both on and offline. Everything published by the IJB during 2025/26 has been checked and is compliant with accessibility policies. We collected feedback that we can use to continuously improve the information we provide. Several services have used feedback to improve how they share information: 1. Midlothian Community Hospital designed an information board to be installed at reception to assist families of those in care to navigate the hospital, 2. A number of staff were offered weight stigma training that was designed based on individual feedback on how people felt they were treated due to their weight, and 3. STRIDE, a program designed to help men who had contact with the Justice service manage their emotions, coproduced a leaflet with people with lived experience to raise awareness of the service. Outcome 2: People who want to choose Self Directed Support have better information about which option is right for them. Actions: We have asked Midlothian HSCP to adopt our ‘Writing for Publication Style Guide’ to ensure all service information is person-centred and meaningful from the perspective of those it is intended to support. A revised version of the guide was published in January 2026 and is accessible for all staff. Page 136 of 164
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DRAFT 57 We have developed consistently presented online and paper service information, and link with both Partner’s websites and information. There is an ongoing program to review and improve these links. We have ensured that staff can support people to request and access accessible information. We did not receive any requests for information in an alternative format in 2025/26. Outcome 3: Older people have a reduced risk of admission and readmission to hospital. Actions: We have improved the data on risk of admission and readmission to hospital to better support clinicians and practitioners to identify and provide appropriate preventative care and early interventions. We have taken the time to build new relationships and work closely with a range of partners to better coordinate and link redesigned services for people with multiple conditions, including frailty. Outcome 4: Unpaid carers feel supported to continue in their caring role. Actions: We have considered the impact of moving care from hospital to home on unpaid carers, and evidence supportive actions. We have published ECRIAs on our transformation plans and this includes consideration for the impact on unpaid carers. Our Unpaid Carers Strategy sets out the actions we will take to support carers welfare and their ability to provide care for as long as they wish to. We have ensured that unpaid carers have access to Welfare Benefits advice and that unpaid carers have been offered a Carer Support Plan. We will continue to make sure that carers have access to information on other benefits, grants and financial support that is available to them. We have asked our Midlothian Council and NHS Lothian Partners to improve the standard of workforce equality data. NHS Lothian delivers an annual Equality and Inclusion Staff Survey to invite staff to share their experiences and opinions. 1670 members of staff across NHS Lothian completed the 2025/26 survey, and responses are being used to support the priorities identified in the Equality and Human Rights Strategy 2023-2028. Midlothian Council are developing a system to record equality information on their workforce system ‘iTrent’ and are working to raise awareness of why this information is important. Page 137 of 164
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DRAFT 58 Looking forward We continue to look to the future. In October 2025 we published our Strategic Plan with a 10-year vision setting out an ambitious but realistic programme of transformation. We have asked Midlothian Health and Social Care Partnership to redesign health and social care as part of a new, sustainable financial model. Integrated health and social care is changing. This is because of the way our communities are growing, the types of support that people need, and other influencing factors like legislation, national policy, and Scottish Government priorities. We must balance our decisions with safety, efficiency, and effectiveness, and use opportunities to redesign to deliver a new and sustainable future for health and social care. We know we need to do things differently. The scale of transformation required means we must deliver care and support in new ways. The Midlothian Health and Social Care Partnership Operational Transformation and Change Programme Board is redesigning a range of health, social and primary care community-based services that are personalised, flexible, and person-led. This work aims to invest in early intervention and prevention, self-management, and education so people make good decisions that help them stay well, plan ahead, and prevent ill or worsening health. In our Directions for 2026/27, we have asked Midlothian Council and NHS to support Midlothian Health and Social Care Partnership to focus on three areas of transformation. 1. Bed based provision, to enable people to access appropriate levels of care when their needs change. 2. Commissioning and Third Sector, to undertake a review of commissioning spend and establish a new partner provider model. 3. Midlothian Single Point of Access, to design and implement a method to support people’s contact across different health and social care services. We have also agreed two strategic financial priorities for effective financial planning and reporting. 1. We use a new financial evaluation framework to monitor our financial performance in a dynamic and changing system. We use System Thinking to design new feedback loops that help us make good decisions as health and social care transforms, use financial forecasting to plan ahead and anticipate change, and take corrective action when our funding decisions are no longer helping us achieve our priorities. 2. As the system changes and transforms, we are confident we are investing in the right places to deliver change in the shortest time possible. We have effective feedback loops that describe the financial position as the system transforms, identified where investment will make the biggest impact, and evidence how we are delivering care and support more efficiently and effectively. Page 138 of 164
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DRAFT 59 Inspections The Care Inspectorate inspect care homes and care at home services to check the quality of care. The majority of care homes in Midlothian are not managed by the Health and Social Care Partnership. Read the full reports at the Care Inspectorate website. 6 Excellent 5 Very Good 4 Good 3 Adequate 2 Weak 1 Poor Care at Home – Support Services Name Date People's wellbeing Leadership Staff team Setting Care & support planning CC Homecare Ltd Support Service September 2025 Not assessed Call-In Home Care West Lothian Support Service October 2025 Not assessed Not assessed Tanshe Care Services October 2025 Not assessed Not assessed J R Care Community Services February 2026 Not assessed Page 139 of 164
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DRAFT 60 Recommendations and Areas for Improvement (if any) Name Recommended Improvement Call-In Home Care West Lothian Support Service To ensure people's health and the wellbeing of staff and people, the provider should ensure that quality assurance and leadership tasks are prioritised by managers. This should include, but not be limited to, ensuring that managers are not regularly delivering direct care and support, to enable staffing and quality assurance processes to be completed. Tanshe Care Services The service should ensure that they develop contingency planning in order to anticipate and respond proactively to adverse circumstances which might impact on care delivery. The service should ensure that staff working with people with complex stress and distressed presentation have undertaken training which supports safe and effective care delivery. Service reviews should be convened at a minimum of six-monthly intervals, or as and when people's needs change. Review should place a greater evaluative focus on the outcomes arising from care delivery. Personal plans should be maintained and accurately reflect people's circumstances. The author of the personal plan should be clearly indicated. Where risk is identified, there should be a clear risk management response, in order to guide staff and promote effective care outcomes. J R Care Community Services By 14 April 2026 the provider must ensure people have confidence that the service they use is led well and managed effectively. To do this, the provider must at a minimum: a) The management have effective oversight of the day-to-day delivery of care to service users to ensure their care needs are fully met. b) The management have a visible presence within the service and engage with service users, relatives and staff to support the development of management oversight required. c) The management engage in a meaningful way with service users and staff about the quality of the service and take action to address improvements identified, to ensure improved outcomes. By 10 March 2026, the provider must ensure all staff employed within the registered service in roles that fall within SSSC regulated categories are registered with the Scottish Social Services Council (SSSC). To do this, the provider must at a minimum: a) Verify that all staff who require SSSC registration hold an active registration or have submitted an application within the required timeframe. b) Maintain accurate and up to date records of each employee’s registration status, renewal dates, and conditions of practice. Page 140 of 164
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DRAFT 61 Name Recommended Improvement c) Monitor ongoing compliance, including ensuring staff complete required post registration training and learning. d) Notify the SSSC of any concerns. By 14 April 2026, to ensure people experience high quality care and support delivered by a competency, confident and well supported workforce, the provider must ensure that all staff receive regular, planned and recorded supervision, appropriate training which is assessed for learning outcomes with ongoing observations of practice. To do this, the provider must at a minimum: a) Implement a structured supervision system that ensures all staff receive supervision at the frequency stated in the service’s own policy. b) Ensure supervision records are completed, stored appropriately, and demonstrate reflective discussion, identification of learning needs, and follow up actions. c) Develop and maintain an Up To Date training matrix, that clearly shows mandatory, refresher and role specific training, including due dates and completion status. d) Ensure all staff complete mandatory training within expected timescales, and that training is evaluated for effectiveness. e) Introduce a planned programme of direct observations of practice, carried out by suitably skilled senior staff, with written records that identify strengths, areas for development, and agreed actions. f) Use information from supervision, training and observations to inform ongoing workforce development and to ensure staff practice meets expected standards. Care Homes for Older People Name Date People's wellbeing Leadership Staff team Setting Care & support planning Nazareth House July 2025 Pittendreich Care Home September 2025 Springfield Bank Nursing Home September 2025 Nazareth House November 2025 Not assessed Not assessed Not assessed Newbyres Care Village January 2026 Aaron House Care Home February 2026 Not assessed Not assessed Page 141 of 164
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DRAFT 62 Name Date People's wellbeing Leadership Staff team Setting Care & support planning Archview Lodge Care Home February 2026 Not assessed Not assessed Recommendations and Areas for Improvement Name Recommended Improvement Nazareth House Hand hygiene practices among people receiving care are consistent, particularly for those with cognitive or physical challenges. Establish scheduled hand hygiene support led by staff, prioritising mealtimes, and toileting routines. Place clear, user-friendly signage near hygiene stations to encourage good technique and independence. Increase availability of hand sanitiser in communal areas and ensure residents are encouraged and assisted in using it appropriately. Reviewing and updating cleaning protocols to reflect the latest standards, with targeted attention to high-touch surfaces and communal areas. Establishing and maintaining a robust cleaning schedule with clear roles and responsibilities, regular monitoring, and documented evidence of completion. Delivering continuous training and supervision for domestic and care staff on effective cleaning practices, including correct usage of cleaning products and equipment. Conducting regular environmental audits to assess standards of cleanliness, with prompt and responsive action taken when improvements are identified. Oversight must be in place from the management team. Pittendreich Care Home To ensure people experience high quality care, the provider should enable opportunities for staff to reflect on their practice through discussions at team meetings and through regular supervision with their manager. Skin and wound care was being monitored through clinical overviews however, evidencing and recording of checks and treatment plans needed to be improved upon. There must be a system in place that is able to demonstrate that the skin care needs of those residing in the home are regularly assessed and adequately met. A refurbishment plan was now in place. Refurbishment work had commenced however, this was still in the Page 142 of 164
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DRAFT 63 Name Recommended Improvement early stages, with significant work remaining. The manager needed to ensure the onsite maintenance team clearly understood their roles and responsibilities in relation to ongoing maintenance and repairs of the building. Personal plans did not consistently give detailed information regarding people’s health and wellbeing. This included personal care, oral care, food and fluids. Whilst staff appeared attentive to people's needs and knew them well, records should accurately reflect the care given as described in the personal plan. Springfield Bank Nursing Home The provider should ensure that there is a structured support and supervision system in place for staff which incorporates observations of practice in a variety of areas including but not limited to moving and handling, medication, infection control, and stress and distress. This is to support the ongoing development of staff, ensuring they are competent, skilled and able to reflect on their practice to continue to meet people’s needs. Aaron House Care Home In order to promote activity and independence for people living in the service, the provider should have appropriate signage around the home. The use of the King's Fund Environmental Assessment Tool and involving people/their representative in designing the environment is recommended to help ensure that best practice and people's needs and wishes are taken into account. Care Homes for Adults with Learning Disabilities Name Date People's wellbeing Leadership Staff team Setting Care & support planning Dougall Court Care Home Service September 2025 Not assessed Not assessed Not assessed Drummond Grange Nursing Home October 2025 Not assessed Parkside Court February 2026 Not assessed Not assessed Recommendations and Areas for Improvement Page 143 of 164
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DRAFT 64 Name Recommended Improvement Dougall Court Care Home Service The manager should prioritise advancing plans to explore refurbishment of the home, or alternative options as previously outlined, and ensure that individuals using the service, along with their relatives or guardians, are actively and meaningfully involved in shaping decisions about the future of the environment. Clear and realistic timeframes should be established for the completion of all proposed actions. Parkside Court The manager should continue to adapt premises for changing support needs, whilst looking at alternative options as previously outlined, and ensure individuals using the service, along with their relatives or guardians, are actively and meaningfully involved in shaping decisions about the future of the environment. Clear and realistic timeframes should be established for the completion of all proposed actions. Housing Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning St Joseph’s Services – Circle of Best Practise 1 June 2025 Not Assessed Not Assessed Not Assessed St Joseph’s Services – Circle of Best Practise 2 June 2025 Not Assessed Not Assessed St Joseph’s Services – Circle of Best Practise 3 June 2025 Not Assessed Not Assessed Not Assessed Midlothian Park Cottage June 2025 Not Assessed Not Assessed Page 144 of 164
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DRAFT 65 Support Service Name Date People's wellbeing Leadership Staff team Setting Care & support planning Broomhill Day Centre Penicuik July 2025 The Community Access Team September 2025 Not Assessed Not Assessed Recommendations and Areas for Improvement Name Recommended Improvement Broomhill Day Centre Penicuik To ensure people experience high quality care, the provider should enable opportunities for staff to reflect on their practice and identify further learning and development needs through regular supervision with their manager. To ensure people’s outcomes and aspirations are fully achieved, the provider should utilise the sources of evidence from quality audits, discussions with people, staff, and supportive documents to develop a service improvement and development plan. The Community Access Team The service should consult with and determine key stakeholders’ views on engagement with quality assurance processes in the service. Consideration should be given to developing a forum or forums which allow people to share their views and contribute to service development and improvement plans. The service should develop a training matrix which allows management overview of learning undertaken and insight into when refresher training updates are needed. The Provider should develop a training matrix which allows management overview of learning undertaken and insight into when refresher training updates are needed The service should develop competency-based observations of staff practice, clarifying they have the requisite skills and that they put them into practice during support. Observations should include feedback from people who experienced care and inform discussion, supervision and professional development for the staff concerned. Page 145 of 164
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DRAFT 66 Business and governance IJB Membership Date Change in membership June 2025 Val De Souza was nominated and reappointed as the Lead Voting Member of NHS Lothian with effect from 1st August 2025. Dr Rebecca Green was reappointed as a Non-Voting Member of Midlothian IJB with effect from 18th July 2025. August 2025 Councillor Connor McManus was nominated and accepted as Vice Chair of the Midlothian IJB with effect from 1st July 2025. Val De Souza was nominated and accepted as Chair of the Midlothian IJB with effect from 1st August 2025. July 2025 Colin Small was nominated and accepted to Midlothian IJB’s Strategic Planning Group as a Volunteer Representative with effect from 1st July 2025. September 2025 Keith Chapman resigned from Midlothian IJB as a Lived Experience Member with effect from 30th September 2025. October 2025 Jay Johnson was nominated and accepted as a Lived Experience Member of the Midlothian IJB with effect from 1st September 2025. Following her appointment to the post of NHS Lothian Non-Executive Director, Heather Campbell was nominated and accepted as a voting member of the Midlothian IJB with effect from 13th August 2025. December 2025 Andrew Fleming resigned from Midlothian IJB and as Chair from SPG with effect from 31st December 2025. George Gordon was nominated and accepted as a Non-Executive Board Member of the Midlothian IJB with effect from 1st January 2026. January 2026 Sheree Muir was nominated and accepted as a Lived Experience Member of the Midlothian IJB with effect from 29th January 2026. Dr Anna Beaglehole was nominated as the named deputy for GP representative with effect from 29th January 2026. Page 146 of 164
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DRAFT 67 Date Change in membership February 2026 Dr Anna Beaglehole’s resigned the named deputy for GP representative with effect from 4th February 2026. Dr Paul Bailey was nominated and accepted as a Non-Voting member of Midlothian IJB and specifically as the “registered medical practitioner whose name is on the list of primary medical services performers” with effect from 4th February 2026. Dr Rebecca Green resigned as a Non-Voting Member of Midlothian IJB with effect from 19th February 2026. March 2026 Jay Johnson resigned from Midlothian IJB as a Lived Experience Member with effect from 1st March 2026. Page 147 of 164
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DRAFT 68 Key Decisions Finance Sep 2025 The Midlothian IJB reviewed and updated the Reserve Policy. Jun 2025 The Midlothian IJB draft Annual Accounts 2024/25 were approved for publication. Sep 2025 The Midlothian IJB Annual Accounts 2024/25 were approved for publication. Mar 2026 The Midlothian IJB approved a balanced budget for 2026/27. Strategy, Planning, and Performance Apr 2025 The Midlothian IJB Equality Outcomes for 2025-2029 were approved for publication. Aug 2025 The Midlothian IJB Annual Performance Report 2024/25 was approved for publication. Oct 2025 The Midlothian IJB Strategic Plan 2025-2035 and the suite of accompanying documents were approved for publication. Oct 2025 The Midlothian IJB Participation and Engagement Statement was approved for publication. Feb 2026 The Midlothian IJB Unpaid Carers Strategy 2025-2028 was approved for publication subject to Midlothian Council approving the section on Young Carers (awaiting). Mar 2026 The Midlothian IJB Directions for 2026/27 were approved for publication. Mar 2026 The Midlothian IJB Directions for 2026/27 were issued to the Chief Executives of Midlothian Council and NHS Lothian. Governance and Audit Nov 2025 Midlothian IJB received a conclusion of Significant Assurance from Internal Audit in relation to its strategic planning process. Feb 2026 The Midlothian IJB Meeting Schedule for 2026/27 was approved. Feb 2026 The Midlothian IJB Standing Orders, Scheme of Administration and Scheme of Delegation were approved for publication. Other Activity Mar 2026 IJB Member site visit to Polton Street. Copies of the relevant reports can be found in the committee reports on the Midlothian Integration Joint Board pages of the Midlothian Council website. Page 148 of 164
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DRAFT 69 Our Strategic Governance Outcome Map – this will be updated after the publication of the core suite of indicators. What we do Who with How they feel What they learn and gain What they do differently What difference this makes Develop, agree and oversee implementation of a three-year strategic plan Agree and provide clear Directions and associated resource allocation to our LA and NHS partners that are operationally overseen by Midlothian HSCP HSCP officers, partners and providers Establish and maintain robust governance arrangements IJB members People are able to make good decisions that help them stay well, plan ahead and prevent ill or worsening health People access the care and support they need when they need it in the community and at home We transform services to make effective use of resources People's human, social, and economic rights are protected and promoted in how we design and deliver our services Health and Wellbeing: People are able to look after and improve their health and wellbeing and live in good health for longer 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 Positive Experiences and Dignity: People who use health & social care services have positive experiences of services, and have their dignity respected Quality of Life: Health &social care services help to maintain or improve the quality of life of people who use them Health Inequalities: Health & social care services contribute to reducing health inequalities Safe from Harm: People using health & social care services are safe from harm Workforce: Staff are engaged with their work and are supported to continuously improve the information, support, care, and treatment they provide Resources are used effectively and efficiently Support for Carers: People who provide unpaid care are supported to look after their health and wellbeing IJB members feel supported, informed and confident in their role Assurance and oversight on the progress towards achieving our Directions Assurance that our services are safe, effective, aligned to our strategic priorities and continually improving People living in Midlothian and who use our services and their unpaid carers Page 149 of 164
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DRAFT 70 Data Appendix National Indicator Our result Our Progress Adults are able to look after their health very well or quite well. Page 150 of 164
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DRAFT 71 Ministerial Steering Group Targets MEASURE 2021-22 2022-23 2023-24 2024-25 2025-26 STATUS Maintain emergency admissions into hospital from Midlothian at or below 767 / month. 9,606 8,458 8,263 9,087 Maintain number of unscheduled hospital bed days: acute specialties at or below 5,074 / month 57,394 60,452 58,123 69,029 Maintain the use of unscheduled: geriatric long-stay beds (all ages) mental health beds (all ages) at or below 2021/22 levels 16,638 11,934 16,747 12,345 14,099P 8,997P 14,604P 7,836P Maintain Emergency Department Attendance (all ages) at or below (2,629 / month) 33,155 33,233 32,453 26,805 Maintain Delayed Discharge Occupied Bed Days at or below 820 / month. 6,135 12,608 9,627 12,501 Reduce the percentage of time people spend in a large hospital in their last six months of life. 8% 8.1% 8.2% No data Maintain the proportion of people over the age of 65 who are living in the community at 97% or higher. 96.9% 96.9% 93% No data SOURCE: Public Health Scotland Integration Performance Indicators 2026 Page 151 of 164
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DRAFT 72 *Where noted the calendar year 2025 is used as a proxy for 2025/26 due to the national data for 2025/26 being incomplete. We have done this following guidance from Public Health Scotland. Where noted this data is provisional. Page 152 of 164
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Midlothian IJB Audit and Risk Committee Thursday, 4th June 2026, 14:00-16:00 Statutory Climate Reporting Duties for Integration Authorities Executive summary This report sets out the statutory reporting requirements of Integration Authorities (IAs) following a revision of the Scottish Government Public Bodies Climate Change Duties: Statutory Guidance. Midlothian IJB has a statutory duty to report on climate duties and action taken in November each year. The revised statutory guidance notes in Annexe K that the IJB’s reporting duty falls under scope 3 (indirect emissions) and in their wider influence within the health and social care sector. Scottish Government describes IJBs as ‘major players’ and note their important role in responding to the climate crisis and biodiversity loss. This is despite not having assets, employees or a supply chain of their own, and on the basis of the significant influence IJBs have in relation to the local health and social care agenda and the scale of their annual budgets. In order to ensure the IJB can meet is statutory reporting duties, it is requested that the Audit and Risk Committee consider and recommend to Midlothian IJB the action described in section 3.3 and proposed Direction in 5.2. As a result of this report, Members are asked to: Note the revised Public Bodies Climate Change Duties: Statutory Guidance, Consider the recommended action described in section 3.3 and proposed Direction in 5.2, and Recommend this action to Midlothian IJB for their consideration at the June Board. Item number: 5.5 Page 153 of 164
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Midlothian Integration Joint Board Report Statutory Climate Reporting Duties for Integration Authorities 1 Purpose 1.1 This report sets out the statutory reporting requirements of Integration Authorities (IAs) following a revision of the Scottish Government Public Bodies Climate Change Duties: Statutory Guidance 2 Recommendations 2.1 As a result of this report, Members are asked to: Note the revised Public Bodies Climate Change Duties: Statutory Guidance, Considers the recommended action described in section 3.3 and proposed Direction in 5.2, and Recommend this action to Midlothian IJB for their consideration at the June Board. 3 Background and main report 3.1 Midlothian IJB has a statutory duty to report on climate duties and action taken in November each year. The revised statutory guidance notes in Annexe K that the IJB’s reporting duty falls under scope 3 (indirect emissions) and in their wider influence within the health and social care sector. Scottish Government describes IJBs as ‘major players’ and note their important role in responding to the climate crisis and biodiversity loss. This is despite not having assets, employees, or a supply chain of their own, and on the basis of the significant influence IJBs have in relation to the local health and social care agenda and the scale of their annual budgets. 3.2 The Climate Ready South East Scotland (CRSES) Climate Risk and Opportunity Assessment (CROA) combines scientific evidence with local knowledge and lived experiences. Members may also be interested to note the Climate Ready South East Scotland (CRSES) report on key messages for Midlothian in their Phase One (2023- 2025) results report which notes health and social care is predicted to be one of the most impacted sectors. 3.3 The Public Bodies Climate Change Duties: Statutory Guidance notes that IJBs must consider the indirect emissions generated through purchased goods and services that they are responsible for, or can influence, Page 154 of 164
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Midlothian Integration Joint Board IJBs should embed adaptation in their strategic plans, account for this in their work with partners, and ensure adaptation is considered through the impact assessment process, IJBs should ensure that assessment of strategic risks and opportunities includes those posed by the changing climate, with a broad risk included in the IJB Risk Register, how they can best use their influence on the health and social care sector, and on the communities they serve, to support wider mitigation efforts, how the design and delivery of health and social care services can help deliver emissions reductions by describing » critical impacts the changing climate may have on key services or the goods they need to deliver health and social care services; this should include consideration of stacked or cascading risks, » climate impacts on staff and care users, including in relation to the protected characteristics, and » how the design and delivery of health and social care services can be made more resilient to the changing climate. 3.4 In order to ensure the IJB can meet is statutory reporting duties, it is recommended that the following actions are presented to Midlothian IJB for their consideration at the June Board. 3.4.1 Midlothian IJB should include more detail relating to climate considerations at a strategic level in the IJB Strategic Plan 2028-31 refresh. Strategic Planning will continue to note the work alongside the two Partners in relation to climate change awareness and actions noting where delegated functions could contribute to Partners’ ambitions. Discussion and dialogue led by Strategic Planning is ongoing between the relevant NHS and Local Authority lead officers. This work is specifically to » provide high level assurance of the IJBs collaborative working with Partners, and » include the key links to partners policies and plans, as far as they are actionable for the delegated functions of the IJB, in the refresh of the Strategic Plan 2028-2031. 3.4.2 The IJB should update its Risk Register to include a risk regarding its ability to progress climate action. The IJB may also wish to consider cross reference to the climate risks of its NHS and local authority Partners. 3.4.3 The IJB should review the content of its Joint Strategic Needs Assessment (JSNA) and include content related to climate issues and impact. This will be supported by a new place-based approach to the Midlothian IJB JSNA that is currently under development. 3.4.4 The IJB should refresh its ECRIA Tracker, ECRIA Template, and Screening Tool to include prompts regarding climate change and in particular any impact on protected characteristics. 3.4.5 Led jointly by the IJB and HSCP Commissioning, the IJB Market Facilitation Plan should be refreshed to include detail on the ways in which this plan can positively influence the health and social care sector through commissioning, and how it will work with all our partners and providers. 3.4.6 In addition, Midlothian IJB should ensure there are key discussions in relevant fora: Page 155 of 164
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Midlothian Integration Joint Board » The IJB Strategic Planning Group Chair will work with members to ensure i. climate action is considered in each new proposal for service design or delivery. » The HSCP Contracts and Commissioning Group Chair will ensure i. consideration is given to climate action and mitigations within the Midlothian HSCP Partner Provider Statement, ii. ECRIAs are completed for each new commissioning activity iii. appropriate checks and balances are in the Terms and Conditions of contracts e.g., ‘whole life cycle of product’ considered as part of product selection and ensuring procurement practices reflect circular economy principles to minimise any carbon footprint, and iv. an annual report is provided in April each year on how it has influenced change in the previous financial year. 3.4.7 The IJB Workforce Plan should be refreshed in line with Scottish Government timelines and include consideration of climate issue and appropriate action. 3.4.8 As a Category 1 Responder, the IJB should strengthen its emergency planning and response for communities in the wake of an extreme weather event requiring multifaceted or multiagency response e.g., storms (frequency and magnitude) that may impact transport, powerlines, flooded or blocked roads and the knock on of these cascading impacts for health and social care. 3.4.9 The IJB is also recommended to issue a Direction to all delegated functions that biannual Directions reporting must include: » critical impacts the changing climate may have on key services or the goods they need to deliver health and social care services; this should include consideration of stacked or cascading risks, » climate impacts on staff and care users, including in relation to the protected characteristics, and » how the design and delivery of health and social care services can be made more resilient to the changing climate. 3.5 A template for completion will be issued to Midlothian IJB from the Sustainable Scotland Network (SSN) in the summer of 2026 with a reporting deadline of 30th November 2026. 4 Policy Implications 4.1 This report is in direct response to the Public Bodies Climate Change Duties: Statutory Guidance issued by the Scottish Ministers to Scottish public bodies under the Climate Change (Scotland) Act 2009. 4.2 Midlothian IJB should continue to work closely with both NHS Lothian and Midlothian Council to ensure it supports the delivery of Partners policies relating to climate action as far as they are actionable for the delegated functions of Midlothian IJB. 5 Directions Page 156 of 164
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Midlothian Integration Joint Board 5.1 This report raises the requirement for a new Direction for Board consideration. 5.2 To enable Midlothian IJB to collate and submit a statutory response to the Sustainable Scotland Network, it is recommended that Midlothian IJB consider the following Direction for issue to both Partners Section 9: Use of Resources Direction 9.6: All delegated functions should take action to be able to provide biannual Directions including details of the » critical impacts the changing climate may have on key services or the goods they need to deliver health and social care services; this should include consideration of stacked or cascading risks, » climate impacts on staff and care users, including in relation to the protected characteristics, and » how the design and delivery of health and social care services can be made more resilient to the changing climate. 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. However, further consideration to the completion of additional ECRIAs may be required as part of the implementation of this work. 7 Resource Implications 7.1 There are no direct financial implications as a result of this report. 8 Risk 8.1 There is a risk that Midlothian IJB will not be complaint with the duties of the Climate Change (Scotland) Act 2009 without action as set out in the Public Bodies Climate Change Duties: Statutory Guidance, and Annexe K. 9 Involving people 9.1 This report has been written in consultation with officers of Midlothian IJB, and the lead climate officers of both NHS Lothian and Midlothian Council. 10 Background Papers Page 157 of 164
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Midlothian Integration Joint Board 10.1 n/a 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. √ 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. X Author’s Name Gill Main Designation Integration Manager Contact Information Via email or MS Teams Date 17/04/2026 Appendices: Public Bodies Climate Change Duties: Statutory Guidance Public Bodies Climate Change Duties: Statutory Guidance Annexes Page 158 of 164
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Midlothian IJB Audit and Risk Committee Thursday, 4th June 2026, 14:00-16:00 Midlothian IJB JSNA Development Item Number: 5.6 Executive summary This report sets out the work underway to develop the Midlothian IJB Joint Strategic Needs Assessment (JSNA) and highlights the link to key work of the Midlothian IJB Strategic Planning Group (SPG). Scottish Government guidance states that Integration Authorities should oversee the production of Joint Strategic Needs Assessments (JSNAs) to analyse the needs of local populations and to inform and guide the strategic planning of health, wellbeing and social care services within their area. Midlothian JSNA updates are coordinated and completed on a rolling quarterly basis by a multidisciplinary working group. This work has received recognition at a national level as an exemplar, and the model has been adopted by other IJBs. However, there are opportunities to develop this key piece of statutory planning and a jointly produced blueprint for change containing the most comprehensive locally owned account of what local communities actually need through closer work with our 15 natural communities and focused local engagement. The statutory planning guidance for Integration Authorities asks that local objectives are informed by the JSNA to address the health inequalities it identifies. These are not advisory suggestions and are design requirements of a JSNA. Midlothian IJB has an opportunity to improve how its JSNA identifies the biggest levers for improving the health and wellbeing of local people and communities by taking a Place-based approach and moving beyond a mapping of health inequalities at a geographic level. As a result of this report, Members are asked to: Consider the work underway to develop Midlothian IJB Joint Strategic Needs Assessment (JSNA), Note the connection to the strategy refresh 2028-2031 as the ‘medium term’ component of the Midlothian IJB Strategic Plan 2025-2035, and Note the opportunities this new approach would provide for the Midlothian IJB Strategic Planning Group (SPG) to identify strategic priorities, transformation, and Quality Improvement Initiatives. Page 159 of 164
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Midlothian Integration Joint Board Report Midlothian IJB Joint Strategic Needs Assessment Development 1 Purpose 1.1 This report sets out the work underway to develop the Midlothian IJB Joint Strategic Needs Assessment (JSNA) and highlights the link to key work of the Midlothian IJB Strategic Planning Group (SPG). 2 Recommendations 2.1 As a result of this report, Members are asked to: Consider the work underway to develop Midlothian IJB Joint Strategic Needs Assessment (JSNA), Note the connection to the strategy refresh 2028-2031 as the ‘medium term’ component of the Midlothian IJB Strategic Plan 2025-2035, and Note the opportunities this new approach would provide for the Midlothian IJB Strategic Planning Group (SPG) to identify strategic priorities, transformation, and Quality Improvement Initiatives. 3 Background and main report 3.1 Scottish Government guidance states that Integration Authorities should oversee the production of Joint Strategic Needs Assessments (JSNAs) to analyse the needs of local populations and to inform and guide the commissioning of health, wellbeing and social care services within their area. The main goal of a JSNA is defined as accurately assessing the care needs of a local population in order to improve the physical and mental health and wellbeing of individuals and communities. Integration Authorities should complete and/or use joint strategic needs assessment output in the formation of their strategic plans. 3.2 Midlothian JSNA updates are coordinated and completed on a rolling quarterly basis by a multidisciplinary working group. In accordance with guidance, this is a collaboration between the Public Health Scotland Local Intelligence Support Team (LIST), NHS Lothian Public Health, Midlothian HSCP Public Health Practitioners, Midlothian HSCP Planning, Performance and Improvement Team and Midlothian Council. 3.3 This work has received recognition at a national level as an exemplar, and the model has been adopted by other IJBs. However, there are opportunities to develop this key Page 160 of 164
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Midlothian Integration Joint Board piece of statutory planning and a jointly produced blueprint for change containing the most comprehensive locally owned account of what local communities actually need through closer work with our 15 natural communities and focused local engagement. 3.4 The statutory planning guidance for Integration Authorities asks that local objectives are informed by the JSNA to address the health inequalities it identifies. However, 10 years into integration there still remains a risk that the JSNA is treated as a compliance exercise rather than the strategic foundation it should be. These are not advisory suggestions and are design requirements of a JSNA. 3.5 Midlothian IJB has an opportunity to improve how its JSNA identifies the biggest levers for improving the health and wellbeing of local people and communities by talking a Place-based approach and moving beyond a mapping of health inequalities at a geographic level. A good JSNA should provide something more than any national data set can replicate. It tells you which communities carry the highest burden of unmet need, not just which populations present most often to services. It surfaces the wider determinants of health and wellbeing that clinical teams can't address alone e.g., poor housing, insecure employment, social isolation. It gives communities a voice in how their needs are described before plans are written, and it provides the baseline against which local health outcomes can actually be measured over time. 3.6 By adopting a new framework for the JSNA based on the 15 natural communities in Midlothian, work is focusing on creating a place-based evaluation of Midlothian using the 7 components of Place, Profile, People, Priorities, Plans, Projects, and Performance (see appendix 1). 3.7 This approach will also be a vital component of the work of the Strategic Planning Group (SPG) as it moves forward with a greater focus on strategically commissioning the right services, evidence the choices made, and evaluate of the impact of all the services planned and directed by Midlothian IJB. The health and social care model is not intended to meet every demand, need, or wish, and a joint commissioning approach with shared decision making, and shared accountability for outcomes supports setting the strategic vision and the priority areas for commissioned activity. 3.8 The focus on communities being a part of how this community data is presented allows the Midlothian IJB Strategic Planning Group to benefit from the JSNA not relying on geographic data alone. Decision making for place-based services, in service of population outcomes and informed by Place-based data and experience, will allow the IJB to meaningfully consider what could be commissioned differently. 3.9 Finally, following a revision of the Scottish Government Public Bodies Climate Change Duties: Statutory Guidance Annexe K, Integration Authorities are required to ensure that assessment of strategic risks and opportunities includes those posed by the changing climate. The inclusion of key information relating to Place-based climate action in the JSNA supports the IJB to meet its statutory duties, by considering how it Page 161 of 164
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Midlothian Integration Joint Board can use its influence across the health and social care sector and within local communities. 4 Policy Implications 4.1 This report related specifically to the requirements of the Health and Social Care Strategic Plans: Statutory Guidance. 4.2 This report is also in direct response to the Public Bodies Climate Change Duties: Statutory Guidance issued by the Scottish Ministers to Scottish public bodies under the Climate Change (Scotland) Act 2009. 5 Directions 5.1 This report does not directly impact upon service ability to deliver an existing Direction, raise the need to bring suggested revisions or discuss operational implications for an existing Direction, or highlight the requirement for a new Direction for Board consideration. 6 Equalities Implications 6.1 One of the purposes of the JSNA is to identify health inequalities and implication for groups of people with protected characteristics. 6.2 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 and ECRIA as a result of this report. However, further consideration to the completion of additional ECRIAs will be consider as part of the implementation of this work. 7 Resource Implications 7.1 There are no direct financial implications as a result of this report. However, the JSNA should inform the effective strategic commissioning of Midlothian IJB and therefore may influence future financial decisions. 8 Risk 8.1 There is a risk that without highly relevant, co-produced data, Midlothian IJB may not be able to make the most effective decisions in how it plans and directs delegated health and social care functions in Midlothian. Page 162 of 164
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Midlothian Integration Joint Board 9 Involving people 9.1 Midlothian JSNA updates are coordinated and completed on a rolling quarterly basis by a multidisciplinary working group. In accordance with guidance, this is a collaboration between the Public Health Scotland Local Intelligence Support Team (LIST), NHS Lothian Public Health, Midlothian HSCP Public Health Practitioners, Midlothian Council, and Midlothian HSCP Strategic Planning and Performance. 9.2 In 2026/27, the JSNA team will also include representation from the Third Sector and seek active involvement from local communities. 10 Background Papers 10.1 None. 11 Governance Please select yes or no: 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 21/04/2026 Appendices: Page 163 of 164
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