Agenda Document Pack - Midlothian Integration Joint Board - Audit and Risk Committee - 07/09/2023
Midlothian Council · 7 September 2023
Back to Midlothian Integration Joint Board - Audit and Risk Committee — 7 September 2023 and its agenda
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Notice of Meeting and Agenda Midlothian Integration Joint Board - Audit and Risk Committee Venue: Virtual Meeting, Date: Thursday, 07 September 2023 Time: 14:00 Executive Director : Place Contact: Clerk Name: Mike Broadway Clerk Telephone: 0131 271 3160 Clerk Email: mike.broadway@midlothian.gov.uk Further Information: This is a meeting which is open to members of the public. Privacy notice: Please note that this meeting may be recorded. The recording may be publicly available following the meeting. If you would like to know how Midlothian Council collects, uses and shares your personal information, please visit our website: www.midlothian.gov.uk Page 1 of 28
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1 Welcome, Introductions and Apologies 2 Order of Business Including notice of new business submitted as urgent for consideration at the end of the meeting. 3 Declaration of Interest Members should declare any financial and non-financial interests they have in the items of business for consideration, identifying the relevant agenda item and the nature of their interest. 4 Minute of Previous Meeting 4.1 Minute MIJB Audit and Risk 28 June 2023 submitted for approval 3 - 10 5 Public Reports 5.1 Update on audited annual accounts 2022/23 & external audit report 2022/23 process – CFO verbal update 5.2 Risk Register - Chief Officer Place – Derek Oliver (To Follow) 5.3 Recommissioning in Matter of Focus and Outnav – Integration Manager – Gill Main 11 - 28 5.4 Additional Meeting required Oct/Nov 2023 – CFO verbal update 6 Private Reports No items for discussion 7 Date of Next Meeting The next meeting will be held on Thursday 7th December 2023. Page 2 of 28
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Midlothian Integration Joint Board Meeting Date Time Venue Audit and Risk Committee Wednesday 28 June 2023 2.00pm Virtual Meeting held using MS Teams. Present (voting members): Cllr Connor McManus (Chair) Angus McCann Andrew Fleming Present (non-voting members): Morag Barrow (Chief Officer) Claire Flanagan (Chief Finance Officer) Derek Oliver (Chief Officer Place) Duncan Stainbank (Chief Internal Auditor) In attendance: Patricia Fraser (Audit Scotland, External Auditor) Claire Gardiner (Audit Scotland, External Auditor) Janet Ritchie (Democratic Services Officer) Apologies: MIJB Audit and Risk Committee Thursday 7 September 2023 Item No 4.1 Page 3 of 28
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2 Audit and Risk Committee Wednesday 28 June 2023 1. Welcome and Introductions The Chair welcomed everyone to the meeting Order of Business was as detailed in the agenda. 2. Order of Business The Order of Business was as detailed in the agenda. 3. Declarations of interest No declarations of interest were received. 4. Minutes of Meeting 4.1 The Minutes of Meeting of the Audit and Risk Committee held on 01 December 2022 was submitted and approved as a correct record. 4.2 Matters Arising: None 5. Public Reports 5.1 Midlothian Integration Joint Board Annual Audit Plan 2022/23 Claire Gardiner advised that she has recently taken over the audit from Gillian Woolman following her retirement and introduced the Annual Audit Plan 2022/23 advising this was the first plan following appointment and provided the Board with an outline of the sections contained within the Plan. The Chair, Cllr McManus commented positively on the report and opened it up for questions. Mr McCann raised a question with regards to the timetable and at the start it was noted that we are a bit behind and asked for an update on meeting the timetable. Page 4 of 28
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3 Audit and Risk Committee Wednesday 28 June 2023 Ms Flanagan responded advising that they were hoping to stick to the timetable and will work closely with the Audit Team to ensure they meet those time scales. Ms Flanagan further advised that even although over the last few years during the pandemic the deadlines were extended the still met the September deadline so they were positive they would continue to meet the deadlines. Action: The Midlothian integration Joint Board, Audit and Risk noted the Report. 5.2 Midlothian Integration Joint Board Internal Audit Annual Assurance Report 2022/23 The purpose of this report is to present the Internal Audit Annual Assurance Report 2022/23 for the Midlothian Health and Social Care Integration Joint Board (MIJB) which includes the Chief Internal Auditor’s independent assurance opinion on the adequacy of MIJB's overall control environment for the year ended 31 March 2023 Duncan Stainbank, Chief Internal Auditor introduced this report and advised that the Internal Audit Annual Assurance Report 2022/23 was Appendix 1 to the report and the Partners’ Internal Audit Assurance 2022/23 Appendix 2 to the report. Mr Stainbank further highlighted some of the main sections contained within these reports. The Chair thanked Mr Stainbank for the report and opened it up for questions. Mr McCann commented on ‘P30, 2.6 - Further improvements in governance, risk management and internal control’ and asked for some further feedback on this and the implementation of the previous internal audit recommendations. Mr Stainbank in responding confirmed that a report would be brought back to the next committee on the details of those. Mr McCann asked a further question in relation to Recommendation 2 (The Medium-term Financial Plan should be developed to include a more explicit link to the Midlothian IJB Strategic plan and its priorities for the years ahead) and while he does agree with this, he asked how we propose to develop this. Mr Stainbank advised that further work is required going forward linking into the Strategic plan and advised that Ms Flanagan could perhaps give more details on how that will happen in terms of the strategic plan linkage. Ms Flanagan advised that in the last report the audit recommendation was to make more of a link between the MIJB financial plan and its Strategic plan and highlighted this was a substantial piece of work and outlined some of the challenges and that the risk was that the finances may potentially hinder the implementation of the MIJB Strategic plan. Page 5 of 28
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4 Audit and Risk Committee Wednesday 28 June 2023 Further comments were made on the challenges in linking these two 3-year plans and would have been ideal if this had happened at the start of the new Strategic plan and they would look at getting a work around position to get the MJIB Financial plan more aligned to the currently approved Strategic plan. Chief Officer, Morag Barrow highlighted on P37 under each Recommendation in the column ‘Responsibility and timescale’ can we add in the title who is responsible - CFO. Ms Barrow commented on the recommendation which was scored down as there is no certainty on the budget and they can develop that longer term plan, but it is on the assumption that the full allocations are passed over and this year for example the planning was based on that and at the last minute we didn’t get it all so there can be certain things that are out with our control. The Chair commented everyone would agree that this year was an example when things didn’t go particularly right and it’s about building that resilience into the plans in the future to ensure we have future financial sustainability. Mr Fleming raised a question with regards to 4.2.4 where it notes an incremental approach to service change continues to be taken and it flags up the risk of potential disintegration and how we are going to address this with the challenges we must face. In responding Ms Flanagan advised that open and transparent dialogue around some of the challenges in financial settlements need to take place at an early stage and highlighted the struggle this year in balancing the budget following the decision made in June. Mr Stainbank also provided an explanation on the timing of the audit and that ordinarily there would have been recommendations 1 and 2 and recommendations 3 and 4 probably would not have been there if the audit had been done earlier in the year. The requirement for the recovery plans had come in at a later date during and when the audit work was completed. The Chair commented on the importance of thinking about next budget now and it was a priority that Morag was very much involved in conversations and that we are clear on where we are and that there are no surprises. Further discussion took place with regards both parties working to together to manage the uncertainties that each are facing, the Strategic plan and the projects planned and the importance of early discussion in going forward. Action: The Midlothian integration Joint Board, Audit and Risk noted the Report 5.3 Midlothian Integration Joint Board Draft Unaudited Annual Accounts 2022/23 The Chief Finance Officer presented the draft Unaudited Annual Accounts 2022/23 for the Board to agree to be published and presented to Audit Scotland. The Chief Finance Officer then provided an overview of the main points contained within the report highlighting The Management Commentary, The Annual Governance Statement and the Financial Position. Page 6 of 28
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5 Audit and Risk Committee Wednesday 28 June 2023 Thereafter Mr McCann, thanked the Chief Finance Officer for the report and agreed to the publication. He further commented on P52 of the pack, under ‘IJBs Visions and Objectives’ - The IJB’s vision and objections are laid out in the IJB’s Integration Scheme, advising he didn’t think this was in the integration scheme but thought in the Strategic plan. Ms Flanagan advised that perhaps vision objectives was not the right word and commented that there is a component of the vision of integration laid out within the Integration Scheme and then more specifically to Midlothian it is within the Strategic Plan. Action: It was agreed subject to the change discussed with regards to the Vision and Objectives the draft Unaudited Annual Accounts 20233/23 were approved. 5.4 Midlothian Integration Joint Board Risk Register Q3 and Q4 The Integrated Joint Board (IJB) Audit and Risk Committee maintains a strategic risk profile which is regularly scrutinised. However, it is important that Midlothian IJB is kept informed of its key risks and the actions undertaken to manage these risks. This report contains the strategic risk profile covering Quarter 3 2022/23, 1st October 2022 – 31st December 2022 and Quarter 4 2022/23, 1st January 2023 – 31st March 2023. Chief Officer, Place Derek Oliver presented the Strategic Risk profiles for Quarter 3 and Quarter 4 advising that Quarter 3 was presented at the last meeting but as this was not quorate is presented today along with Quarter 4 to complete the quarterly updates for the last financial year. There followed a brief discussion on these two reports and in response to a questions raised with regards to IJB’s role as Category 1 responder status and the risk control measures it was highlighted by the Chief Officer, Morag Barrow that 18 months ago the IJB were made Category 1 responders, although they don’t have a building or staff therefore it is about ensuring that the IJB is linking in with partner organisations around their category one status and operationally being part of their planning, it is again around the wording of this item. Mr McCann stated it would be helpful if the wording could be looked at regarding this point and asked a further question with regards to only one quarter report being presented to the committee at one time and following further discussion it was agreed that having updates in the table to allow comparison back through the quarters would be helpful. Further discussion followed with regards to controls in place and where the risks sit – should they be on the IJB risk register or is it more operational, it was agreed that this required further discussion to explore how this could be presented clearer to the board. Page 7 of 28
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6 Audit and Risk Committee Wednesday 28 June 2023 Action: • It was agreed moving forward into 2023/24, after Quarter 1 reporting, Quarter 2 will retain Quarter 1 and what was approved and then carry on like this each quarter. • Further discussion to take place with regards to exploring how these risks are presented • To otherwise approve Quarter 3 and Quarter 4 Risk Profiles. 5.5 Midlothian Integration Joint Board Internal Audit Annual Plan 2022/23 The purpose of this report is to gain approval to the proposed Internal Audit Annual Plan 2023/24 for the Midlothian Health and Social Care 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 Health and Social Care Integration Joint Board. Chief Internal Auditor, Duncan Stainbank presented this report advising that this report was brough forward from the last committee and Appendix 1 to the report outlines the Internal Audit Plan 2023/24. Mr Stainbank advised that this audit work was managed and completed by Midlothian Council internal audit team in conjunction with some resources provided from the NHS internal audit team. Mr Stainbank in responding to a question raised by Mr McCann provided clarity on the IJB’s publication scheme advising that this identifies all public documents and the way in which the IJB communicates with the public over such items as the Strategic plan. Following a brief discussion on this audit and the resources and number of days to complete the audit, Mr Stainbank agreed that once all the resources were secured, he would consider the balance and probably put more resource time on the direction setting. Ms Flanagan also provided a further explanation on the challenges previously in obtaining the full resource from the NHS audit team and the reasons why this is put against a planned audit. Mr Fleming raised a question with regards to the biggest risks and the process and order in which the audits are undertaken and what gives most value and Mr Stainbank provided some clarity on how they determine which audits to consider by reviewing the risk register and also work that has been completed in previous years. He further advised that he is open to keep this flexible and if over the course of the year there is a need to reconsider the plan and it can be brought back to the Audit committee with revised elements. Further discussion took place regarding the plan and Mr Stainbank advised that considerable discussion regarding performance framework had taken place and the decision was that that would sit better in the 2024/25 audit plan when it has been developed and implemented a bit further on to give the best value. Following the discussion Mr Stainbank agreed that for future plans they will demonstrate some of the items they have looked at and also items for consideration for future years, so assurances are given when presenting the plan that they have all been considered. Page 8 of 28
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7 Audit and Risk Committee Wednesday 28 June 2023 Action: In going forward to reflect in future plans items which have been looked at and also items for consideration for future years, so assurances are given when presenting the plan that they have all been considered. To otherwise approve the report. 5.6 Midlothian Integration Joint Board Medium Term Financial Planning Report The purpose of this report is to present the findings and recommendations from the recently completed Internal Audit review of Medium- Term Financial Planning, completed in partnership between the Midlothian Council and NHS Lothian Internal Audit teams. As part of the Internal Audit Plan for 2022/23, approved by the audit and risk committee on 3 March 2022, an Internal Audit of Medium-Term Financial Planning. The report presents the findings of the review with the internal audit work undertaken by the NHS Lothian Internal Audit team and managed through the Midlothian Council Internal Audit team. The report provides 3 medium and 1 low rated recommendation that have all been agreed by the Chief Financial Officer Chief Internal Auditor, Duncan Stainbank presented this report highlighting the main sections as contained within the report. The Chair thanked Mr Stainbank for the report advising that a lot of what was detailed in the report has already been covered. Action: To note the report. 6. Private Reports No private business to be discussed at this meeting. 7. Date of next meeting The next meeting will be held on Thursday 7 September 2023 at 2 pm. (Action: All Members to Note) The Chair advised that Ms Flanagan will be leaving her role as Chief Financial Officer and has been successful in getting a promoted post within NHS Lothian and expressed his congratulations and thanks to Ms Flanagan. The meeting terminated at 3.11 pm. Page 9 of 28
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Midlothian Integration Joint Board Midlothian IJB Audit and Risk Committee Thursday 7th September 2023, 14.00- 16.00 Midlothian IJB and HSCP Performance Framework and Measurement of Outcome Data Executive summary This paper describes the work to establish an integrated performance framework across health and social care and details the proposal and identified funding for continuing this work. A high level overview (appendix 1) is provided of work jointly undertaken by Midlothian Health and Social Care Partnership (HSCP) and Matter of Focus to deliver the commission from Midlothian Integration Joint Board (IJB) of developing a performance measurement tool that provides strategic assurance, assurance on the organisational progress toward the 6 strategic aims of the Strategic Commissioning Plan 2022/25, and meets national ambitions in relation to understanding of our contribution to improving outcomes for people and communities. A more detailed evaluation of phase 1 and 2 of this work and current progress (appendix 2 and 3) is also provided along with the proposal for phase 3 across 2023/25 to correspond with the evaluation of the Strategic Commissioning Plan 2022/25. This work has been designed to fundamentally connect the Midlothian IJB and HSCP Performance Frameworks and provide a mechanism to articulate in a consistent way across our integrated services the meaningful progress they are making towards improving personal outcomes. Additionally, the direct measurement designed to complement the HSCP Integrated Governance and Assurance Framework provides the ability for Midlothian IJB to ensure strategic governance and take greater assurance on the work of the HSCP in relation to both outcomes and governance through a triangulated approach of population health (experience), service outputs (activity), and personal outcomes (outcomes). This work has been ongoing since 2021 and the proposed new contract for 2023/25 continues to support services to deliver on Midlothian IJB Directions 3.1 and 3.3 and provide the qualitative data essential to deliver the triangulated data approach of both the Midlothian Integration Joint Board (IJB) and Midlothian Health and Social Care Partnership (HSCP) Performance Frameworks. Item number: 5.3 Page 11 of 28
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Midlothian Integration Joint Board Midlothian IJB Audit and Risk Committee This proposal for 2023/25 outlines the expected outcomes and describes the actions required to ensure that Midlothian Health and Social Care Partnership (HSCP) can continue to transition from a model of consultant-led support to self-managed pathway provision from 2025 onwards. Members are asked to: • Review the performance of the Matter of Focus Outcomes Measurement Project Commissioned in 2020 noting: - that performance against this contract has met and exceeded expectation with significant positive impacts, - where performance could be improved with integrated working, and the benefits of developing this practice, - the integral role outcome measurement has in the Midlothian IJB and both Midlothian HSCP Performance Framework and Integrated Governance Framework. • Approve the use of £49,986 of identified funding to be enable the ongoing - provision of service described in the proposal for 2023/25 - provision of the strategic governance required for Midlothian IJB - provision of the assurance Midlothian IJB requires of Midlothian HSCP in relation to performance measurements and operational governance through this triangulated approach - provision of support for services to deliver on Midlothian IJB Directions 3.1 and 3.3, and • Note the requirement to develop the organisation’s understanding of - service outputs vs personal outcomes - the impact of qualitative data in environments where quantitative data is more frequently requested or valued. Page 12 of 28
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1 Purpose 1.1 This paper describes the work to establish an integrated performance framework across health and social care and details the proposal and identified funding for continuing this work. 1.2 A high level overview (appendix 1) is provided of work jointly undertaken by Midlothian Health and Social Care Partnership (HSCP) and Matter of Focus to deliver the commission from Midlothian Integration Joint Board (IJB) of developing a performance measurement tool that provides strategic assurance, assurance on the organisational progress toward the 6 strategic aims of the Strategic Commissioning Plan 2022/25, and meets national ambitions in relation to understanding of our contribution to improving outcomes for people and communities. 1.3 A more detailed evaluation of phase 1 and 2 of this work and current progress (appendix 2 and 3) is also provided along with the proposal for phase 3 across 2023/25 to correspond with the evaluation of the Strategic Commissioning Plan 2022/25. 1.4 The proposal allows for the continued development of this framework and the tools to support services deliver on Midlothian IJB Directions 3.1 and 3.3 and provide the qualitative data essential to deliver the triangulated data approach of the Midlothian IJB Performance Frameworks and both the Midlothian Performance Framework and Integrated Governance and Assurance Framework. 1.5 This proposal also outlines the expected outcomes and describes the actions required to ensure that Midlothian Health and Social Care Partnership (HSCP) can continue to transition from a model of consultant-led support to a self-managed pathway provision approach from 2025 onwards. 1.6 This paper also notes the requirement and intention to support and to develop the organisations understanding of service outputs vs personal outcomes and to better maximise the impact of qualitative data in environments where quantitative data is more frequently requested or valued. 2 Recommendations 2.1 As result of this report what are Members being asked to:- • Review the performance of the Matter of Focus Outcomes Measurement Project Commissioned in 2020 noting: - that performance against this contract has met and exceeded expectation with significant positive impacts, - where performance could be improved with integrated working, and the benefits of developing this practice, - the integral role outcome measurement has in the Midlothian IJB and both Midlothian HSCP Performance Framework and Integrated Governance Framework. • Approve the use of £49,986 of identified funding to be enable the ongoing - provision of service described in the proposal for 2023/25 - provision of the strategic governance required for Midlothian IJB Page 13 of 28
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Midlothian Integration Joint Board - provision of the assurance Midlothian IJB requires of Midlothian HSCP in relation to performance measurements and operational governance through this triangulated approach - provision of support for services to deliver on Midlothian IJB Directions 3.1 and 3.3, and • Note the requirement to develop the organisation’s understanding of - service outputs vs personal outcomes - the impact of qualitative data in environments where quantitative data is more frequently requested or valued. 3 Background and main report 3.1 Matter of Focus have been working with Midlothian Health and Social Care Partnership (HSCP) since 2021 to develop and implement an integrated outcome- based performance framework that provides strategic assurance, assurance on the organisational progress toward the 6 strategic aims of the Strategic Commissioning Plan 2022/25 and meets national ambitions in relation to understanding of our contribution to improving outcomes for people and communities 3.2 The ambition of this work was additionally to support local learning and improvement, further embed the personal outcome focused within the HSCP, create meaningful outcome focused performance reporting, and align strategic aims, national outcomes, operational planning, and governance and assurance. 3.3 Phase 1 of this work involved co-designing a comprehensive outcome-based performance framework individualised for each service using the Matter of Focus software, OutNav, These frameworks considered how services contributed to improved outcomes for people. This was piloted in three services areas: Frailty, Number 11, and Unpaid Carers in 2021. Evaluation and learning from this phase of the work was that the process was lengthy, difficult for services to identify the key elements to best support evaluation, and unable to deliver whole system learning. 3.4 Learning from Phase 1 shaped the development of Phase 2 where a single streamlined organisational outcome map with clearly defined success criteria and required evidence sources was developed. In August 2022 the Midlothian HSCP Senior Management Team (SMT) agreed to complete a test of change to evaluate the change in ‘onboarding’ for services. 3.5 The revised outcome map was piloted with one of the original services, unpaid carers and with three new service areas: Midlothian Community Hospital, Duty Social Work, and the Integrated Mental Health Team. The evaluation found a significantly faster process to onboard service areas and demonstrated clear connectivity to the strategic aims for the organisation, governance, and assurance requirements. In addition, the new framework considered the anticipated requirements for Self-Evaluation within Care Inspectorate and Health Improvement Scotland (HIS) inspection framework. 3.6 In December 2022 and following these successful trials, the Midlothian HSCP SMT agreed that OutNav was a key component in the organisations commitment to quality management and additional work was undertaken to support the Learning Disability and Autism Team, the Health Improvement Team, and the Page 14 of 28
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Midlothian Integration Joint Board Physical Disability and Long-Term Conditions Service to create outcome maps for their service areas. 3.7 The new process ensures success criteria and evidence sources are structured in a way that provides a single streamlined approach to reporting, that is fully aligned with strategic requirements and priorities. This new outcome map has now been rolled out in 40% of service areas and is contributing to a data triangulation approach as an integral part of the Midlothian IJB Performance Frameworks and both the Midlothian Performance Framework and Integrated Governance and Assurance Framework 3.8 Two further template outcome maps have been developed: one for commissioned services and one for hosted service reporting. The outcome map for commissioned services has been successfully trialled with Thistle Wellbeing Service and Midlothian Voluntary Service who have used this to report on their contract performance. The template outcome map for hosted services is now being used by the five dietetics service leads and the Dietetics Head of Service as part of a Lothian-wide initiative to improve the hosting service area’s ability to disaggregate local data metrics and deliver a new level of transparency for NHS Lothian and the 4 Health and Social Care Partnerships. 3.9 This work is fundamentally linked to the Midlothian IJB and HSCP Performance Frameworks and provides a mechanism to articulate in a consistent way across our integrated services the meaningful progress they are making towards improving personal outcomes. 3.10 Additionally, the direct measurement designed to complement the HSCP Integrated Governance and Assurance Framework provides the ability for Midlothian IJB to ensure strategic governance and take greater assurance on the work of the HSCP in relation to both outcomes and governance through a triangulated approach of population health (experience), service outputs (activity), and personal outcomes (outcomes). In June 2023, the Midlothian HSCP SMT agreed that OutNav remained a fundamental component of the HSCP Integrated Governance. 3.11 This work has been recognised by the Scottish Government, The Government Outcomes Lab at University of Oxford, Healthcare Improvement Scotland, and Audit Scotland as sector-leading and pioneering. A detailed breakdown of achievements against the 2021/23 contract and current progress can be found in appendix 2 and 3. 3.12 This proposal for Phase 3 details a further two years of OutNav and a tailored programme of support to embed the approach, including how this work moves towards a more self-managed approach and reduces consultant input as more services become familiar with telling their story of contributing to personal outcomes. 4 Policy Implications 4.1 The delivery of this work directly influences the ability for the HSPC and IJB to meet key elements of national regional and local policy. The 9 National Health and Page 15 of 28
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Midlothian Integration Joint Board Wellbeing Outcomes are central to how Scottish Government evaluates the performance of Midlothian IJB and HSCP. It is Scottish Government’s expectation that all these ambitions are actively progressed equally across health and social care services in Scotland under the Public Bodies (Joint Working) (Scotland) Act, 2014. 4.2 The National Health and Wellbeing Outcomes Framework makes reference to moving away from the delivery of services being an endpoint of activity, and towards seeing personal outcomes as the purpose of engagement and activity with people and communities. This crucially supporting planning, commissioning, evaluation, and improvement. 4.3 It is also worth noting the strong links between the IJB Strategic Commissioning Plan and the ability of operational services to evidence progress towards Midlothian IJB’s 6 strategic aims, the ambitions of The Midlothian Community Planning Partnership’s Single Midlothian Plan, the NHS Lothian Strategic Development Framework, and the Midlothian Council 5-year plan. These include being able to evidence how services are supporting people to look after and improve their own health and wellbeing, supporting independent living, reducing health inequalities, and achieving what matters most to people and communities. 5 Directions 5.1 The content of this report directly impacts on the ability of all services to contribute to the legally binding Directions for 2023/24 (3.1 and 3.3) issued by Midlothian IJB on 30th March 2023. 6 Equalities Implications 6.1 This report does not have direct implication for groups of people with protected characteristics. 7 Resource Implications 7.1 This proposal for 2023/25 includes over a 50% reduction in cost using identified one- off underspend in the Planning, Performance and Programme budget managed by the Integration Manager. This proposal includes a plan for a further cost reduction by approximately 70% in 2025. 8 Risk 8.1 Not continuing with the support outlined in the proposal for 2023/25 will limit to ability of Midlothian IJBs to demonstrate strategic governance or receive integrated assurance from the HSCP’s in relation to outcome measurement. This will additionally significantly limit the HSCPs ability to progress Directions 3.1 and 3.3 issued by Midlothian IJB. Page 16 of 28
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Midlothian Integration Joint Board 8.2 The framework delivered through the Matter of Focus software, OutNav is also the only way to provide the essential outcome data to maintain a triangulated approach to population health and wellbeing performance reporting, as detailed in the Midlothian Integration Joint Board (IJB) and Midlothian Health and Social Care Partnership (HSCP) Performance Frameworks. 9 Involving people 9.1 The Outcomes approach was fully considered by the Strategic Planning Group on 29th January 2021 and approved by Midlothian IJB on 11th February 2021. Members endorsed the approach as one which will enhance the capacity of the Partnership to continuously monitor and evaluate its effectiveness across all its services. 9.2 The approach has been periodically reviewed by the Senior Management Team (SMT) and approved for ongoing development work on 17th August 202 and 19th December 2022 and acknowledged by the group as a vital element of HSCP governance on 5th June 2023. 9.3 The development of outcome maps for each service area requires the inclusion of the views of people who experience our services and their feedback. 10 Background Papers n/a AUTHOR’S NAME Gill Main DESIGNATION Integration Manager CONTACT INFO gill.main3@nhslothian.nhs.scot.uk DATE 28 August 2023 Appendices: Appendix 1: Main, G., Cook, A., Johnstone, E., and Boyd, J. 2023. Developing an outcome focused approach to strategic governance within a local Health and Social Care Partnership. [Poster]. Social Outcomes 2023, 13-15 September, Government Outcomes Lab, Oxford University. Appendix 2: Matter of Focus Evaluation 2020/23 and Proposal 2023/25 Appendix 3: Matter of Focus Outcome Map and Report https://www.outnav.net/view-live-report/g/cPawJxGBFVmVPd6jD4G7QRZ9ZxuNGm4z Page 17 of 28
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Matter of Focus and Midlothian HSCP OutNav Implementation: Phase 3 Background Matter of Focus have been working with Midlothian HSCP since 2020, supporting you to develop and implement a single outcome-based performance framework to: • Support local learning and improvement • Deepen the personal outcome focused across the partnership, including the Midway • Allow for meaningful outcome focused performance reporting at a strategic level, linking service and team outcomes to strategic performance • Be aligned with strategic aims, national outcomes, operational planning, and operational governance and assurance. The first phase of work involved co-designing a comprehensive outcome-based performance framework that showed how all aspects of your work as a partnership contributed to improved outcomes for people and piloting this with three services and programmes; Frailty, Number 11 and Unpaid carers. In the second phase of work we took forward learning from Phase 1 and significantly streamlined the outcome map to ensure it aligned with the strategic aims for the organisation and governance and assurance requirements. Throughout this process we considered how the use of OutNav would support self-evaluation and strategic inspection. OutNav was a standing agenda at the Self Evaluation Board which met until June 2022 , which provided valuable opportunity to get feedback from the Midlothian Care Inspectorate Link Inspector. Following the disbanding of this Board, we have worked closely with the Midlothian HSCP Integration Manager, the Strategi Programme Manager for Performance, alongside the Chief AHP and the Group Service Manager leading on Inspection . We piloted the revised outcome map with one of the original services, unpaid carers and with three new service areas: Midlothian Community Hospital, Duty Social Work, and the Integrated Mental Health Team. Following these successful trails, additional work was undertaken to support the Learning Disability and Autism Team, the Health Improvement Team, and the Physical Disability and Long Term Conditions Service create outcome maps for their service areas. We also explored the use of OutNav for Self Directed Support. This process led to further learning, and we worked closely with the Integration Manager and the Planning and Performance Team to codesign and finalise the current outcome map, success criteria and evidence sources within a single streamlined approach to reporting that is fully aligned with strategic requirements and priorities. This new outcome map has been rolled out in 40% of service areas. This has included additional developmental work to establish meaningful organisational reporting that links with the Performance Framework of the Midlothian Integrated Joint Board (IJB) and The Health and Social Care Partnership (HSCP). We have developed two further template outcome maps; for commissioned services and hosted services. We have trialled the outcome map for commissioned services with two providers to use it to report as part of their contract: Thistle Wellbeing Service and Midlothian Voluntary Service. The template outcome map for hosted services is now being used by the five dietetics service leads and the Dietetics Head of Service as part of a Lothian wide initiative to improve the hosting service area’s ability to disaggregate local data metrics and deliver a new level of transparency for NHS Lothian and the 4 Health and Social Care Partnership . Page 21 of 28
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2 www.matter-of-focus.com We are delighted that this work has been recognised by the Scottish Government, The Government Outcomes Lab at University of Oxford, and Audit Scotland as internationally sector-leading and pioneering. A more detailed breakdown of achievements against the 2021/23 contract can be found in the Appendix. This proposal for Phase 3 details a further two years of OutNav and a tailored programme of support to embed the approach including how this work moves towards a more self-managed approach and reduces consultant input as more services become familiar with telling their story of contributing to personal outcomes. Our understanding of your requirements for phase 3. Midlothian IJB has asked Midlothian HSCP ensure that all service use and develop outcome mapping by January 2024, and are contributing to the IJBs ability to describe activity, experience, and outcomes. Our learning from phase one and two tells us that services often need support to think about data differently, to see the value in qualitative data, link this to quantitative data in a way that tells a richer story and link the work to what they know matters to people. Services have needed support to do this and have required time for sense-making and coming together the collaboratively review and assess progress beyond service output data. Once all service areas have reported once, teams will need support to improve and mainstream their systems and processes around reporting in OutNav in order to report well and embed this new approach. In addition, the Group Service Leads, the Executive Leadership Team and the Planning and Performance Teams will require support with planning for the analysis and reporting on the aggregated data from OutNav. As this is pioneering work, we will continue to work closely with the Integration Manager, and the Strategic Programme Manager for Performance, and other senior leaders as required to ensure that the work continues to align closely to strategic prioritises and reporting requirements. The organisations ambitions to move from a more traditional ‘performance management’ approach to more ‘relational performance measurement’ necessarily requires teams and services to meaningfully identify, record and articulate qualitative data and move beyond evaluation of service outputs. Phase 3 of this work is vital to ensure the foundations of outcomes focused contribution analysis are embedded within the organisation to support a greater level of self-management in future years. The Proposal By December 2023 we anticipate that the HSCP will be in a strong position in relation to the implementation of OutNav. More than two thirds of service areas will have been onboarded to the tool and supported to complete a first draft of their analysis. We propose that the tasks will be broken down between year 1 and 2 of this phase of work as follows: Year Task Deliverable 1 Onboard remaining services to OutNav Full and half day workshops and review meetings 1 Support HSCP to prepare aggregate report for IJB meetings in September 2023 and January 2024 Workshops, meetings, desktop analysis and writing 1 Ongoing support and mentoring for services Meetings with project teams and free access to our OutNav clinics 1 Work with the Integration Manager to capture learning from the process and make any improvements Agreed way forward post January 2024 Page 22 of 28
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3 www.matter-of-focus.com 2 Provide ongoing support to the IJB, HSCP and Group Heads of Service to analyse and aggregate data from OutNav 6 x Half day workshops with these teams to review aggregated analysis and capture learning for their work areas 2 Provide ongoing support to specific services One to one and collective meetings. Updating handbook, and providing free access to the OutNav drop in help sessions. 1 and 2 Ongoing project management and coordination Regular review meetings. Timescale We will work with you to ensure that activities are carried out within a realistic timescale and the project is kept on track. Our work to date has been most successful where there has been strong senior leadership and services have been supported to create the time for learning and reflection. We anticipate the core work to be completed between September 2023 and August 2024 but recognise that some areas continue to experience significant challenges limiting their ability to progress at pace. We know that this process can take time therefore any unused support may be carried over and used over the next three months. Costs* Activities Cost VAT Total including VAT Year 1 tailored support £15,000 £3,000 £18,000 Year 2 Tailored support £11,188 £2,798 £13,986 OutNav subscription for up to 50 outcome maps for 2 years from 6.1.24 – 5.1.26 (including 50% discount) £15,000 £3000 £18,000 Total £49,986 Invoice quarterly in advance, unless negotiated otherwise. OutNav is offered at a discounted rate in exchange for support from Midlothian HSCP with agreed dissemination activities, such as a webinar, case study and presentations at relevant conferences and events. This proposal for 2023/25 describes the actions required to ensure that Midlothian Health and Social Care Partnership (HSCP) can continue to transition from a model of consultant-led support to self-managed pathway provision from 2025 onwards. *All costs are valid for 90 days from the date of this proposal. The team you will be working with Our team is overseen by Directors and Co-founders, Ailsa Cook and Sarah Morton who both have internationally recognised expertise in data and information, evaluation methods, action research, outcomes, and evidence to action along with five decades of experience of working with organisations delivering complex change. Our project will be led by: Director, Dr Ailsa Cook, who has internationally recognised expertise in data and information, evaluation methods, action research, outcomes and evidence to action along with two decades of experience of working with organisations Page 23 of 28
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4 www.matter-of-focus.com delivering complex change. Ailsa has led pioneering improvement programmes focused on bringing organisations together to develop and improve practice in focusing on outcomes at programme, personal and population levels. She has also worked extensively with policy makers to ensure a focus on outcomes is supported by policy. Evaluation Consultant Dr Audrey Buelo, previously of Public Health Scotland, who brings her experience in public health intervention development and evaluation. Audrey’s background is multi-faceted and has worked on projects around physical activity promotion in individuals at high risk of chronic conditions; economic policy and income inequalities; and novel co-production approaches to engage hard-to-reach audiences. As required further expert support will be provided by: Principal Evaluation Consultant Simon Bradstreet who is experienced in the voluntary, health and academic sectors. Specifically, in the commissioning, design, delivery, and management of social and health research, Simon is also recognised internationally as an expert in mental health recovery and peer support. Page 24 of 28
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5 www.matter-of-focus.com Appendix 1. Report on phase 2 contract Contract requirement Achievements Main contract Provide tailored support to Midlothian HSCP to embed more meaningful , outcome focused evaluation and performance Over the past 2 years we have provided a series of face to face and online workshops and meetings. These include full day workshops with individual service teams, online collective support sessions and planning meetings. We have brought an experienced team to this work, led by Dr Ailsa Cook. Enable the partnership to adopt the approach at a strategic level Have worked closely with the Integration Managers throughout the period and a wider team to plan the work and ensure strategic alignment. This work has taken an Agile approach to development and included significant redesign to support a clear connection from operational activity to evidence the progress of the HSCP and IJB towards strategic ambitionsOur approach has been mindful of the approach of the Care Inspectorate and a refresh of the framework to fit with new strategic aims and agreed processes around service planning and governance and assurance. Support the development of 20 outcome maps A total of 24 teams have been involved in the work in phase 2 which has led to the creation of 20 unique outcome maps. Many of the teams have made significant progress with analysis and reporting across the tool, For example https://www.outnav.net/view-live- report/u/Q00juyD4MC17jlxCGZaTnnSOUbkdvv5G and https://www.outnav.net/view-live- report/g/arQi2EocdbIugRrmvDAkKHEdEle2ufC7 Support the partnership to build capacity and skills to sustain the approach A total of 68 members of staff have been introduced to OutNav through workshops, training and support offered including: participation in full day OutNav onboarding days, OutNav orientations, one to one meetings, presentations. Everyone has had access to an extensive knowledge base and the opportunity to attend bi-weekly OutNav help sessions. In the final stage of phase 2 we will produce a handbook for all staff to use to support their work in OutNav. Work with the partnership to capture the learning from this work with a view to rolling the approach out more widely across the partnership We have worked closely with a core steering group throughout phase 2 of this work, regularly capturing learning and use this to inform next steps. Some of this learning was shared at a recent Complexity and Outcomes conference at the University of Northumbria. Provide access to OutNav through an annual subscription The current phase of work includes a subscription for up to 30 outcome maps from 6 Jan 2022- 5th January 2024. Participate as a Scottish Government pathfinder site in evaluating the approach from a national perspective The work was completed March 2023. Link to the final summary evaluation here https://tec.scot/programme- Page 25 of 28
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6 www.matter-of-focus.com areas/transforming-local-systems/resources/tls-final- evaluation-midlothian-may-2023 Contract variation – Transforming Local Systems Pathfinder Carry out and write up a final evaluation report for the Transforming Local Systems Pathfinder programme that captures the high-level impacts of the work. This report has been completed, approved by the Scottish Government Digital Citizenship Board and is available here https://tec.scot/programme- areas/transforming-local-systems/resources/tls-final- evaluation-full-report Pull out key learning from the programme for the implementation of the Scottish Approach to Service Design for transforming health and social care. This learning is captured in the main report, conclusions and learning section Inform these reports both by reflective learning session involving Pathfinder teams, the work of Pathfinder teams and National teams in OutNav and interviews and a survey with key stakeholders. The report includes a full methodology section detailing the evidence gathered, which includes all of these processes. Outstanding tasks to be completed within phase 2. Task Discussion Timescale Produce handbook This work has been delayed due to the quality improvement and learning associated with understanding the needs of services in different parts of the system. Learning from this process is now informing the production of this support tool November 2023 Set up all service areas and teams in OutNav as per the Midlothian HSCP Service Onboarding Plan V4 This work has been informed by creating links with the HSCP Governance and Assurance Framework (GAF) September 2023 Support to Digital Team Onboarding November 2023 Support to Performance and Planning team / Community Planning Partnership Following work to align operational outcome mapping to both the HSPC and IJB strategic and performance frameworks, this work can now commence November 2023 Support to Midlothian Community Hospital to onboard new wards To create pathways for each of the ward areas with this service areas September 2023 Support to Learning disability and autism service to refine their reporting Ongoing support and learning November 2023 Support Mental Health team to refine their reporting and onboard new service areas Ongoing support and learning November 2023 Ongoing planning Liaising with Integration Manager as Executive Sponsor ongoing Page 26 of 28
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7 www.matter-of-focus.com Appendix 2. About Matter of Focus Matter of Focus is a mission led company that supports organisations to make better use of data and information to learn, improve and tell the story of the difference they make. We specialise in working with organisations that make a difference by inspiring, educating, empowering, caring for, leading or connecting with people. Over the past year we worked with more than 150 teams and projects from organisations as diverse as the Scottish Government, Healthcare Improvement Scotland, East Renfrewshire Health and Social Care Partnership, UNICEF, NHS Lothian and others. We do this through consultancy support and our unique cloud base software tool OutNav. OutNav is the only software on the market that supports organisations to plan, manage and report on outcomes using a theory-based approach to evaluation. It significantly enhances the capability of organisations to embed learning from data and evaluation into their practice. To maximise the benefit that OutNav will bring your organisation, the OutNav subscription is combined with a bespoke package of tailored support. This proposal outlines your package and the associated costs. You can read more about our approach to supporting organisations here. What is unique about our approach? Matter of Focus have developed a reputation for insightful effective evaluation of complex programmes and projects when other evaluation approaches or evaluators have failed. This is why organisations such as the London School of Economics; The Global Partnership to end Violence against Children, the University of Edinburgh and Health Technology Wales work with us. There are several features of our offer that set us apart: • Our expertise. Our experienced client support team is led by Co-Directors Dr Ailsa Cook and Dr Sarah Morton who have internationally recognised expertise in data and information, evaluation methods, action research, outcomes and evidence to action along with five decades of experience of working with organisations delivering complex change • Our approach to theory based evaluation, which was developed from the Co-Directors programmes of academic research. This approach is informed by contribution analysis, evidence to action and action research. Our award winning software, OutNav which supports organisations to embed evaluation into their change process, ensuring the insights are timely and can be used for continual improvement. Membership of our OutNav community All OutNav account holders become members of the OutNav Community, which adds another layer of help and support. OutNav Community members have access to twice weekly drop-in sessions, hosted by a member of our team. These sessions are spaces for individuals or small groups to get help with any aspect of working in OutNav. This could be a practical walk-through of the tool for new users, or help with refining stepping-stones or pathways through an initiative’s outcome map, for example. We invite the OutNav Community to come together online every quarter for shared learning around our approach, and an opportunity to meet other people working in OutNav. Page 27 of 28
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