· agenda item 2 south lanarkshire integration joint board minutes of meeting held in committee...

Agenda Item

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD Minutes of meeting held in Committee Room 1, Council Offices, Almada Street, Hamilton on 26 June 2018 Chair: Philip Campbell, Non Executive Director, NHS Lanarkshire Board Present: Health and Social Care Partnership V de Souza, Director, Health and Social Care and Chief Officer; M Moy, Chief Financial Officer NHS Lanarkshire Board Lilian Macer, Non Executive Director; Tom Steele, Non Executive Director; Iain Wallace, Medical Director South Lanarkshire Council Councillors Maureen Chalmers (substitute for Councillor Bradley), Allan Falconer, Jim McGuigan Attending: NHS Lanarkshire C Campbell, Chief Executive; L Ace, Director of Finance; C Cunningham, Head of Performance and Commissioning; M Docherty, Nurse Director; E Duguid, Lead Communication Officer; L Findlay, Medical Director; M Hayward, Head of Health and Social Care (Rutherglen/Cambuslang and East Kilbride); B McGurn, Deputy Clinical Director; C MacKintosh, Medical Director Partners G Bennie, VASLAN; H Biggins, Service User (Older People); V Johnstone, Carers’ Representative; R Ormshaw, Scottish Care; Dr K McIntyre, GP Representative; T Wilson, Health Service Trade Union Representative South Lanarkshire Council E Devlin, Service Manager; Y Douglas, Audit Manager; B Hutchinson, Head of Health and Social Care (Hamilton and Clydesdale); M Kane, Health and Social Care Programme Manager; P Manning, Executive Director (Finance and Corporate Resources); J McDonald, Administration Adviser; L Purdie, Chief Social Work Officer; J Todd, Legal Services Adviser Apologies: NHS Lanarkshire P McCrossan, Director of Allied Health Professionals Partners M Moncrieff, South Lanarkshire Health and Social Care Forum South Lanarkshire Council Councillors John Bradley (Depute) and Richard Lockhart; L Freeland, Chief Executive

Chair’s Opening Remarks The Chair advised that this would be the last meeting of the South Lanarkshire Integration Joint Board (IJB) that the following would be attending:-

Tom Steele, Non Executive Director, NHS Lanarkshire Board as he was taking up a new position as Chair of the Scottish Ambulance Service

Brenda Hutchinson, Head of Health and Social Care (Hamilton and Clydesdale), South Lanarkshire Council, Chris MacKintosh, Medical Director, NHS Lanarkshire and Iain Wallace, Medical Director, NHS Lanarkshire Board as they were retiring

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In addition, the Chair also advised that Doctor Vijay Sonthalia had attended his last meeting of the IJB. On behalf of the IJB, the Chair:-

thanked Mr Steele, Ms Hutchinson, Mr MacKintosh, Mr Wallace and Doctor Sonthalia for their hard work and contribution to the IJB and wished them every success in the future

welcomed Linda Findlay, Medical Director, Vicki Johnstone, Carers’ Representative, Brian McGurn, Deputy Clinical Director and Dr Keith McIntyre, GP Representative to their first meeting of the IJB.

In response to a Point of Order raised by Councillor Falconer regarding agenda item 16 – Investing to Modernise South Lanarkshire Care Facilities, the Chair advised that a report would be submitted to the next meeting of the South Lanarkshire Integration Joint Board (IJB), however, there would be a presentation at this meeting.

1 Declaration of Interests No interests were declared.

2 Minutes of Previous Meeting The minutes of the meeting of the South Lanarkshire Integration Joint Board held on 17 April 2018 were submitted for approval as a correct record.

The Board decided: that the minutes be approved as a correct record.

3 Minutes of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee The minutes of the meeting of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee held on 27 February 2018 were submitted for noting.

The Board decided: that the minutes be noted.

4 Financial Monitoring 2017/2018 A report dated 31 May 2018 by the Director, Health and Social Care was submitted providing:-

a summary of the financial position of the Health and Social Care Partnership (HSCP) for the period 1 April 2017 to 31 March 2018 in relation to Health Care Services and Social Work and Housing Services

details of the savings which had been identified in 2018/2019 to address part of the funding gap of £0.649 million in line with the Financial Plan for 2018/2019

An underspend of £0.647 million had been reported by NHS Lanarkshire for the South Lanarkshire HSCP for the period 1 April 2017 to 31 March 2018. An underspend of £0.701 million had been reported by South Lanarkshire Council for the South Lanarkshire HSCP for the period 1 April 2017 to 31 March 2018.

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An underspend of £0.932 million had been identified on the primary care transformation fund which was ring fenced. Details were provided on how the budget would be managed and a summary of the budget variance position was provided in Appendix 1 to the report. Details were also provided on the hosted services which were led by South Lanarkshire HSCP and North Lanarkshire HSCP and a summary of the position in respect of each was provided in appendices 2 and 3 to the report. Further details were provided on the Reserves which were subject of a separate report to this meeting of the South Lanarkshire Integration Joint Board (IJB). Details were provided on the efficiency savings of £0.649 million which were required in 2018/2019. Total savings of £0.539 million had been identified in 2018/2019 and were detailed in Appendix 4 to the report. The remaining gap in the savings plan of £0.110 million would be addressed in 2018/2019.

The Board decided:

(1) that the outturn position of a surplus of £2.280 million for 2017/2018 for the South Lanarkshire Health and Social Care Partnership be noted;

(2) that the proposed savings of £0.539 million across health care services for the financial

year 2018/2019, as detailed in Appendix 4 of the report, be approved; and

(3) that the remaining gap in efficiency savings of £0.110 million be monitored. [Reference: Minutes of 17 April 2018 (Paragraph 6)]

5 Performance Monitoring Report A report dated 30 May 2018 by the Director, Health and Social Care was submitted providing a summary of performance against the key performance measures assigned to the integration of Health and Social Care in South Lanarkshire.

The Public Bodies Joint Working (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to establish performance monitoring reports in line with the agreed suite of 23 performance measures and 6 measures which had been identified by the Ministerial Steering Group. Progress against the key performance actions and measures for the 23 national integration indicators and the 6 Ministerial Steering Group measures were provided in the appendices to the report. There were a number of areas of development which had been identified in relation to performance management and those areas would be discussed more fully at a workshop on performance to be facilitated by the Head of Commissioning and Performance.

The Board decided: that the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee of 29 May 2018 (Paragraph 8)]

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6 Reserves Strategy 2018/2019 A report dated 31 May 2018 by the Director, Health and Social Care was submitted on the Reserves Strategy 2018/2019 for the South Lanarkshire Integration Joint Board (IJB). The IJB’s Financial Regulations required that a Reserves Strategy be established to allow the IJB to hold reserves and provide security against unexpected cost pressures and to aid financial stability.

The financial position for 2017/2018 in respect of the services delegated to the IJB had been

finalised and the overall position in respect of the IJB reserves, based on the final year-end position reported by both South Lanarkshire Council and NHS Lanarkshire, was contained in the report.

The balance on reserves at 31 March 2018 was £8.278 million and the Reserves Strategy was

detailed in Appendix 2 to the report. In addition, the summary of the IJB Reserves Strategy was detailed in Appendix 3 to the report.

It was proposed that the transfer of £1.664 million to ear-marked reserves to mitigate the

financial issues detailed within the report be approved. The Board decided:

(1) that the Reserves Strategy 2018/2019 for the South Lanarkshire Integration Joint Board be noted; and

(2) that the transfer of £1.664 million to ear-marked reserves, as detailed in the report, be

approved.

7 Internal Audit Annual Report and Unaudited Annual Accounts 2017/2018 A report dated 1 June 2018 by the Director, Health and Social Care was submitted on:-

Internal Audit findings for the audit assignments carried out for the South Lanarkshire Integration Joint Board (IJB) during 2017/2018

the unaudited annual accounts for the financial year 2017/2018

As a public body responsible for the delivery of services and accountable for public resources, the IJB was required to establish effective internal audit arrangements in line with good governance principles, relevant accounting guidance and the Public Sector Internal Audit Standards. The Chief Officer had been authorised to establish effective internal audit arrangements for the financial year 2017/2018. In consultation with the Internal Audit Managers of both NHS Lanarkshire and South Lanarkshire Council, the Internal Audit Plan 2017/2018 had been prepared, taking account of the appropriate internal audit protocols to manage the key strategic priorities and risks which might impact on the achievement of the IJB’s objectives. Following approval of the Internal Audit Plan 2017/2018 by the IJB at its meeting on 5 December 2017, progress on the delivery of the 2017/2018 audit programme had been monitored and it was concluded that the delivery of audit actions by their due dates contributed to a sound control environment.

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No formal actions had been raised following the audit work undertaken during 2017/2018, however, some recommendations for improvement had been made and those were detailed within the report. Those areas identified for improvement would be included in an action plan that would be presented to future meetings of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee for monitoring. The unaudited annual accounts for the South Lanarkshire Integration Joint Board (IJB) for 2017/2018 had been prepared in line with proper accounting practice and were subject to audit by Audit Scotland. Audit Scotland would report their findings to a future meeting of the IJB in advance of completion of the audit by 30 September 2018. A copy of the unaudited Annual Accounts for 2017/2018 was attached as an appendix to the report. The accounts would be available for inspection in the offices of the Health and Social Care Partnership, Floor 8, Council Offices, Almada Street, Hamilton and on the Integration Joint Board’s website.

The Board decided:

(1) that the Internal Audit Annual Report 2017/2018 for the South Lanarkshire Integration Joint Board, as detailed in the report, be endorsed;

(2) that the findings from the audit work, which had informed the IJB’s 2017/2018 draft

governance statement, be noted;

(3) that the unaudited Annual Accounts for 2017/2018, attached as an appendix to the report, be endorsed; and

(4) that the unaudited Annual Accounts for 2017/2018 be made available for inspection.

[Reference: Minutes of 5 December 2017 (Paragraph 7)] Y Douglas left the meeting following this item of business

8 Carers (Scotland) Act 2016 - Update A report dated 30 May 2018 by the Director, Health and Social Care was submitted on the implementation of the duties of the Carers (Scotland) Act 2016.

The Carers (Scotland) Act 2016 was implemented on 1 April 2018 and placed a duty on Integration Joint Boards to support the implementation of the Act. As a result, it was proposed that the following services be commissioned:-

ongoing provision of the Care Information Strategy which had been delivered by NHS Lanarkshire at a cost of £0.212 million

ongoing provision of support which had been delivered by voluntary organisations at a cost of £0.132 million

ongoing provision of financial advice to support carers which had been delivered by South Lanarkshire Council at a cost of £0.120 million

provision of residential respite for carers by South Lanarkshire Council at a cost of £0.150 million

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The grant settlement from the Scottish Government to South Lanarkshire Council included funding of £3.931 million to support the implementation of the Carers (Scotland) Act 2016. It was proposed that £1 million be transferred from South Lanarkshire Council to the Integration Joint Board to meet the costs associated with the implementation of the Act.

The Board decided:

(1) that the transfer of £1 million from the Scottish Government grant settlement to support the implementation of the Carers (Scotland) Act 2016, subject to the approval of South Lanarkshire Council’s Social Work Resources Committee, be noted; and

(2) that the allocation of £0.727 million to support the services to be commissioned, as

detailed above, be approved.

9 Draft Annual Performance Report 2017/2018 A report dated 30 May 2018 by the Director, Health and Social Care was submitted on the draft Annual Performance Report 2017/2018 for the South Lanarkshire Integration Joint Board (IJB). The Public Bodies (Joint Working) (Scotland) Act 2014 placed a duty on Integration Joint Boards to prepare and publish Annual Performance Reports. The Annual Performance Report was to ensure that performance was open and accountable whilst providing an overall assessment of performance in relation to planning and carrying out integrated functions. Guidance issued by the Scottish Government had recommended that the following areas be included within the report:-

a summary of progress against the 9 National Health outcomes, using as a minimum the 23 core national performance indicators

financial performance and best value

reporting progress with localities

Inspection of Services, summarising any activity undertaken by Healthcare Improvement Scotland, The Care Inspectorate, Audit Scotland, Accounts Commission and Scottish Housing Regulator in the year of review

any plans to review or update the Strategic Commissioning Plan It was proposed that the Annual Performance Report for the IJB, attached as an appendix to the report, be approved and published on the South Lanarkshire Health and Social Care Partnership’s website. Discussion then took place in relation to the:-

funding process associated with the Integrated Care Fund monies for third sector growth and development

outstanding issues associated with the role of locality chairs The Chief Officer gave an undertaking to examine the funding process and advised that a report on locality chairs would be submitted to a future meeting of the IJB. The Board decided: (1) that the Annual Performance Report 2017/2018, attached as an appendix to the report, be

approved and published on the South Lanarkshire Health and Social Care Partnership’s website; and

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(2) that the Director, Health and Social Care be authorised to sign off the Annual Performance Report 2017/2018 by the deadline of 31 July 2018.

10 General Data Protection Regulations (GDPR) Requirements for Integration Joint Board A report dated 23 May 2018 by the Director, Health and Social Care was submitted on the implications for the South Lanarkshire Integration Joint Board (IJB) following the implementation of the General Data Protection Regulations (GDPR).

The GDPR, which was implemented on 25 May 2018, introduced new rules which changed the relationship between data subjects and statutory authorities that were responsible for Health and Social Care. While the IJB handled minimal personal data, it was a statutory body and data controller and therefore subject to the new Regulations.

To ensure that the IJB complied with its responsibilities in terms of the GDPR legislation, there was a requirement to undertake a number of actions as follows:-

the creation of a privacy statement detailing what personal data was processed by the IJB and why, the legal basis for processing the information, how the information was stored and retained and who it was shared with

the appointment of a Data Protection Officer (DPO) for the IJB

the creation of a Records Management Plan

the appointment of a Senior Risk Manager

It was proposed that, in order for the IJB to comply with the requirements of the GDPR, the appointment of a Data Protection Officer and Senior Risk Manager be approved.

The Board decided:

(1) that the appointment of Hazel Lawson, Legal Manager, South Lanarkshire Council as the Data Protection Officer for the IJB be approved; and

(2) that the appointment of Paul Manning, Executive Director (Finance and Corporate

Resources), South Lanarkshire Council as the Senior Risk Manager for the IJB be approved.

11 Further Integration - Direction - Joint Working Including Access to Partner IT Systems A report dated 30 May 2018 by the Director, Health and Social Care was submitted on the provision of access to core Information Technology (IT) systems within South Lanarkshire Council and NHS Lanarkshire to support the functions of the South Lanarkshire Health and Social Care Partnership.

The Public Bodies (Joint Working) (Scotland) Act 2014 placed a duty on Integration Joint Boards to ensure that service users experienced a seamless service to meet their needs when the services of the Health Board or Local Authority were required. In order to achieve this, it was essential that relevant information to meet care needs was shared in a proportionate manner.

It was proposed that an Information Sharing Agreement be established between South Lanarkshire Council, NHS Lanarkshire and the South Lanarkshire Integration Joint Board (IJB) to provide access to core IT systems to support the functions of the Health and Social Care Partnership.

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The Chair advised that approval, in principle, was being sought, subject to an assurance being provided by the South Lanarkshire Health and Social Care Partnership to NHS Lanarkshire that the systems would be the same for both North Lanarkshire Integration Joint Board and South Lanarkshire Integration Joint Board. The Board decided: that an Information Sharing Agreement be established, in

principle, between South Lanarkshire Council, NHS Lanarkshire and the IJB to provide access to core IT systems, subject to a report being submitted to a future meeting of the IJB.

12 Primary Care - Memorandum of Understanding A report dated 23 May 2018 by the Director, Health and Social Care was submitted on the Memorandum of Understanding associated with the development of a Primary Care Improvement Plan.

To support the implementation of the General Medical Services (GMS) contract 2018, a Memorandum of Understanding had been developed which detailed the responsibilities of Integration Joint Boards in relation to the GMS contract, a copy of which was attached as an appendix to the report.

The Board decided: that the Memorandum of Understanding, attached as an

appendix to the report, be noted. [Reference: Minutes of 13 February 2018 (Paragraph 10)]

13 Primary Care Improvement Plan A report dated 23 May 2018 by the Director, Health and Social Care was submitted on the governance arrangements for the implementation of the GP Contract, General Medical Services (GMS) 2018.

The General Medical Services contract had been approved in January 2018 for implementation in April 2018. As part of the implementation process, there was a requirement to develop within both North and South Lanarkshire Health and Social Care Partnerships, a Primary Care Improvement Plan (PCIP) which would detail the implementation of the new services. It was proposed that the PCIP, attached as an appendix to the report, be approved.

The development and implementation of the PCIP would be reviewed at 6 monthly intervals.

Christopher MacKintosh, Medical Director and Linda Findlay, Medical Director then gave a joint presentation on the General Medical Services 2018, GP Contract.

The Chair thanked the Medical Directors for their presentations. The Board decided: that the Primary Care Improvement Plan (PCIP), attached

as an appendix to the report, be approved and reviewed at 6 monthly intervals.

[Reference: Minutes of 13 February 2018 (Paragraph 10)]

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14 Consultation and Engagement Framework and Process A report dated 30 May 2018 by the Director, Health and Social Care was submitted on the consultation and engagement process for the South Lanarkshire Integration Joint Board (IJB).

The Public Bodies (Joint Working) (Scotland) Act 2014 placed a requirement on Integration Joint Boards to prepare a Participation and Engagement Strategy detailing how it would undertake consultation and engagement.

To support the current framework and process for consultation and engagement undertaken by both South Lanarkshire Council and NHS Lanarkshire, a Participation and Engagement Strategy for the IJB had been developed, as detailed in Appendix 1 to the report.

The Board decided: that the Participation and Engagement Strategy for the IJB,

attached as Appendix1 to the report, be approved.

15 Children's Services A report dated 23 May 2018 by the Director, Health and Social Care was submitted on the NHS Lanarkshire Children and Young People’s Health Plan 2018 to 2020.

The Children’s Services Plan 2015 to 2018 had been developed as a requirement of the Children and Young People (Scotland) Act 2014 to improve health and health services for children and young people in line with the agreed outcomes. It was proposed that the NHS Lanarkshire Children and Young People’s Health Plan 2018 to 2020 which built on the progress and achievements of the 2015 to 2018 Plan, detailed in the appendix to the report, be approved. The Board decided: that the NHS Lanarkshire Children and Young People’s

Health Plan 2018 to 2020, attached as an appendix to the report, be approved.

16 Investing to Modernise South Lanarkshire Care Facilities The Chair advised that a report in relation to Investing to Modernise South Lanarkshire Care

Facilities would be submitted to the next meeting of the South Lanarkshire Integration Joint Board (IJB). He then invited E Devlin, Service Manager and M Kane, Health and Social Care Programme Manager to give a joint presentation on Investing in Care Facilities for the Future.

One of the priorities identified within the Strategic Commissioning Plan 2016 to 2019 and a

specific Direction was to reduce the reliance on hospital and residential care, with a view to shifting the balance of care towards supporting people to remain at home independently for as long as possible.

Demographic growth predictions for South Lanarkshire had indicated that the 75+ and 85+

populations would rise year on year by 2.7% and 5.2%, respectively. The number of people diagnosed with dementia had also increased by 35% over a 3-year period.

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Based on the results of a test of change undertaken in 2016, which supported 56% of service

users involved to return home rather than be moved to a residential or nursing facility, as well as recent research, it was recognised that there was a need to transition the current model of residential care to one which was focused on intermediate care aimed at supporting individuals to return home or to a setting which best met their needs. A whole system approach was being adopted which reflected early intervention, self-management and enablement, and supported people to secure their personal outcomes. It was considered that this would be best achieved through the provision of timely re-ablement and rehabilitation intervention provided from a locally based multi-disciplinary hub.

To support the implementation of transitional care, consultation would be undertaken with key stakeholders, with the approach being phased in across all localities within South Lanarkshire.

Discussion took place on the future provision of care and care facilities and how this would be supported. The Chair advised that more details, including financial implications, would be provided in the report to be submitted to the next meeting of the IJB.

The Board decided: that the presentation be noted.

17 Partnership Performance Reporting Framework A report dated 30 May 2018 by the Director, Health and Social Care was submitted on the Performance Reporting Framework for the South Lanarkshire Health and Social Care Partnership.

The Public Bodies Joint Working (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to establish performance monitoring reports in line with the agreed suite of 23 performance measures and 6 measures which had been identified by the Ministerial Steering Group.

Following the introduction of the 6 measures, a workshop had been held to identify a suitable reporting framework. The outcome from the workshop proposed that, in view of the function of the South Lanarkshire Integration Joint Board (IJB), the performance framework should strategically direct through the Commissioning Plan and provide the IJB with assurance in relation to the direction of travel. Consequently, a draft Performance Reporting Framework had been established, as detailed in the appendix to the report, and it was proposed that it be reported to the IJB and the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee on a 6 monthly basis.

The Board decided: that the Performance Reporting Framework, as detailed in the appendix to the report, be approved and reported on a 6 monthly basis to both the IJB and the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee.

[Reference: Minutes of the South Lanarkshire Integration Joint Board (Performance and Audit)

Sub-Committee of 29 May 2018 (Paragraph 6)]

18 Risk Register A report dated 30 May 2018 by the Director, Health and Social Care was submitted on the updated Risk Register for the South Lanarkshire Integration Joint Board (IJB).

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As part of the arrangements to support the integration of Health and Social Care, a Risk Register for the IJB had been prepared to capture strategic risks relating to the delivery of services likely to affect the IJB’s delivery of the Joint Strategic Commissioning Plan.

The Risk Register, attached as an appendix to the report, had been prepared in consultation with partners and had been reviewed against the existing risk registers of NHS Lanarkshire and South Lanarkshire Council.

It was proposed that the updated Risk Register for the IJB be approved and an update report submitted to the IJB and the Performance and Audit Sub-Committee.

The Board decided:

(1) that the Risk Register for the South Lanarkshire Integration Joint Board, as detailed in the appendix to the report, be approved; and

(2) that an update report on the Risk Register be submitted to future meetings of the IJB and

the Performance and Audit Sub-Committee.

[Reference: Minutes of South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee of 29 May 2018 (Paragraph 5)]

19 Development of Strategic Commissioning Plan 2019 to 2022 A report dated 31 May 2018 by the Director, Health and Social Care was submitted on the development of the Strategic Commissioning Plan (SCP) 2019 to 2022. The Public Bodies (Joint Working) (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to develop and have in place an approved 3 year SCP detailing the strategic objectives of the South Lanarkshire Health and Social Care Partnership. The South Lanarkshire Integration Joint Board (IJB) had approved the Strategic Commissioning Plan for 2016 to 2019. However, the landscape for Health and Social Care had changed since the SCP had been approved and the SCP had subsequently been updated to reflect the changing agenda. The updated SCP would be used as the basis for the development of the SCP for 2019 to 2022 and would include:-

reviewing the current plan and most recent 2018/2019 refresh

reviewing and updating the current needs and future needs profile, including how this differed by locality

undertaking a wide range of participation, engagement and consultation activity within localities and across the Partnership, including with the wider public, through a series of locality planning events in September and December 2018

building a communications strategy around the development of the Plan

developing a market position statement for health and social care to meet future demand

working in partnership with South Lanarkshire Council and NHS Lanarkshire to ensure the SCP would achieve the national Health and Wellbeing Outcomes

The Board decided: that the report be noted. [Reference: Minutes of 26 March 2018 (Paragraph 2)]

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20 Any Other Competent Business The Chief Social Work Officer advised the Board that the Care Inspectorate would be undertaking a review of self-directed support of South Lanarkshire Health and Social Care Services in October 2018 and the South Lanarkshire Health and Social Care Partnership would be involved in preparation for the review.

The Board decided: to note the position.

Chief Officer’s Closing Remarks The Director, Health and Social Care:-

conveyed her thanks to the members of the South Lanarkshire Integration Joint Board (IJB) and the staff for their hard work and support

welcomed the new members of the IJB

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Agenda Item

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD (PERFORMANCE AND AUDIT) SUB-COMMITTEE Minutes of meeting held in Committee Room 5, Council Offices, Almada Street, Hamilton on 29 May 2018 Chair: NHS Lanarkshire Board Philip Campbell, Non Executive Director (Depute) Present: NHS Lanarkshire Board Tom Steele, Non Executive Director South Lanarkshire Council Councillor Jim McGuigan Attending: Health and Social Care Partnership V de Souza, Director, Health and Social Care; M Moy, Chief Financial Officer NHS Lanarkshire C Cunningham, Head of Performance and Commissioning; M Docherty, Nurse Director; C MacKintosh, Medical Director South Lanarkshire Council Y Douglas, Audit Manager; M Kane, Health and Social Care Programme Manager; J McDonald, Administration Adviser Also Attending: Audit Scotland S Lawton, Senior Auditor Apologies: South Lanarkshire Council Councillor John Bradley (Chair)

1 Declaration of Interests No interests were declared.

2 Minutes of Previous Meeting The minutes of the meeting of the South Lanarkshire Integration Joint Board (Performance and Audit) Sub-Committee held on 27 February 2018 were submitted for approval as a correct record.

The Sub-Committee decided: that the minutes be approved as a correct record.

3 Internal Audit Reports - Update A report dated 18 May 2018 by the Director, Health and Social Care was submitted on the delivery of the 2017/2018 Internal Audit Plan for the South Lanarkshire Integration Joint Board.

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At its meeting on 5 December 2017, the South Lanarkshire Integration Joint Board (IJB) had approved the 2017/2018 Internal Audit Plan which detailed the main areas of audit work to be undertaken through joint working arrangements within South Lanarkshire Council and NHS Lanarkshire’s audit functions. Both the Council and NHS Lanarkshire’s internal auditors would continue to be responsible for undertaking audit assignments in relation to their respective operational matters across in-scope services. Joint working arrangements would be implemented in respect of IJB only audits together with any cross cutting audits that occurred in the year. Details of the progress which had been made in relation to the main areas of audit work contained in the Internal Audit Plan 2017/2018 were provided in the appendix to the report. The Sub-Committee decided: that the content of the report be noted.

[Reference: Minutes of the South Lanarkshire Integration Joint Board of 5 December 2017 (Paragraph 5)]

4 Draft Annual Governance Statement 2017/2018 Update A report dated 9 May 2018 by the Director, Health and Social Care was submitted on the South Lanarkshire Integration Joint Board’s (IJB) Draft Annual Governance Statement for 2017/2018.

The Draft Annual Governance Statement 2017/2018, which was attached as an appendix to the report, provided an assessment of the effectiveness of the IJB’s governance arrangements in supporting the planned outcomes.

The Draft Annual Governance Statement 2017/2018 had been updated to reflect the outcome of the ongoing review of the effectiveness of the governance framework and would be included in the IJB Unaudited Annual Accounts for 2017/2018 and submitted to the IJB for formal approval. Following approval by the IJB, the Annual Governance Statement for 2017/2018 would be included in the IJB Annual Accounts for 2017/2018.

The Sub-Committee decided: that the Annual Governance Statement for 2017/2018 be

included in the IJB Unaudited Annual Accounts for 2017/2018 and submitted to the IJB for formal approval.


5 Risk Register A report dated 8 May 2018 by the Director, Health and Social Care was submitted on the

updated Risk Register for the South Lanarkshire Integration Joint Board (IJB).

As part of the arrangements to support the integration of Health and Social Care, a Risk Register for the IJB had been prepared to capture strategic risks relating to the delivery of services likely to affect the Joint Board’s delivery of the Joint Strategic Commissioning Plan.

The Risk Register had been prepared in consultation with partners and had been reviewed against the existing risk registers of NHS Lanarkshire and South Lanarkshire Council.

The IJB, at its meeting on 12 September 2017, had approved the Risk Register for the IJB and

had agreed that an update report be submitted to the IJB and the Performance and Audit Sub-Committee on an annual basis.

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It was proposed that the updated Risk Register, attached as an appendix to the report, be noted

and that progress reports be submitted to the Sub-Committee on a regular basis. Discussion then took place in relation to high risks identified by South Lanarkshire Council and

NHS Lanarkshire that impacted on the IJB and how those would be reflected in the IJB Risk Register.

The Sub-Committee decided:

(1) that the updated Risk Register for the South Lanarkshire Integration Joint Board, as detailed in the appendix to the report, be noted;

(2) that a progress report on the Risk Register be submitted to a future meeting of the Sub-

Committee; and

(3) that any high risks identified by South Lanarkshire Council and NHS Lanarkshire which impacted on the IJB be included in the IJB Risk Register.

[Reference: Minutes of South Lanarkshire Integration Joint Board of 12 September 2017

(Paragraph 8) and Minutes of 29 August 2017 (Paragraph 6)]

6 Partnership Performance Reporting Framework A report dated 30 April 2018 by the Director, Health and Social Care was submitted on the Performance Reporting Framework for the South Lanarkshire Health and Social Care Partnership.

The Public Bodies Joint Working (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to establish performance monitoring reports in line with the agreed suite of 23 performance measures and 6 measures which had been identified by the Ministerial Steering Group.

Following the introduction of the 6 measures, a workshop had been held to identify a suitable reporting framework. As a result, it was proposed that a Performance Reporting Framework be established and reported to the Integration Joint Board and Sub-Committee on a 6 monthly basis, as detailed in the report.

The Sub-Committee decided: that the Performance Reporting Framework, as detailed in the report, be progressed.

7 Draft Annual Performance Report 2017/2018 A report dated 10 May 2018 by the Director, Health and Social Care was submitted on the draft Annual Performance Report for the South Lanarkshire Integration Joint Board (IJB). The Public Bodies (Joint Working) (Scotland) Act 2014 placed a duty on Integration Joint Boards to prepare and publish Annual Performance Reports. The Annual Performance Report was to ensure that performance was open and accountable whilst providing an overall assessment of performance in relation to planning and carrying out integrated functions. Guidance issued by the Scottish Government had recommended that the following areas be included within the report:-

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a summary of progress against the 9 National Health outcomes using as a minimum the 23 core national performance indicators

financial performance and best value

reporting progress with localities

Inspection of Services, summarising any activity undertaken by Healthcare Improvement Scotland, The Care Inspectorate, Audit Scotland, Accounts Commission and Scottish Housing Regulator in the year of review

any plans to review or update the Strategic Commissioning Plan The Annual Performance Report for the IJB, attached as an appendix to the report, would be submitted to the Integration Joint Board for approval, prior to it being published. The Sub-Committee decided: that the content of the report be noted.

8 Any Other Competent Business – Performance Monitoring Report A report dated 21 May 2018 by the Director, Health and Social Care was submitted providing a summary of performance against the key performance measures assigned to the integration of Health and Social Care in South Lanarkshire.

The Public Bodies Joint Working (Scotland) Act 2014 placed a duty on Health and Social Care Partnerships to establish performance monitoring reports in line with the agreed suite of 23 performance measures and 6 measures which had been identified by the Ministerial Steering Group. Progress against the key performance actions and measures for the 23 national integration indicators and the 6 Ministerial Steering Group measures were provided in the appendices to the report. There were a number of areas of development which had been identified in relation to performance management and those areas would be discussed more fully at a workshop on performance to be facilitated by the Head of Commissioning and Performance.

The Sub-Committee decided: that the report be noted.


Chair’s Remarks The Chair advised that this would be the last meeting of the Sub-Committee that Tom Steele, Non Executive Director, NHS Lanarkshire Board would be attending as he was taking up a new position as Chair of the Scottish Ambulance Service. On behalf of the Sub-Committee, he thanked Mr Steele for his hard work and contribution to the Sub-Committee and wished him every success in the future.

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Report

Agenda Item

4

Report to: South Lanarkshire Integration Joint Board Date of Meeting: 11 September 2018 Report by: Director, Health and Social Care

Subject: Financial Monitoring 2018/2019

1. Purpose of Report 1.1. The purpose of the report is to:- [purpose]

provide a summary of the financial position of the South Lanarkshire Health and Social Care Partnership for the period from 01 April 2018 to 31 July 2018 (Health Care Services) and 01 April 2018 to 22 June 2018 (Social Work and Housing Services).

[1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs]

(1) that the contents of the report be noted; and (2) that the expected reduction to the prescribing budget, and the subsequent

transfer of this budget to the Family Health Services budget, to reflect the national agreement with Community Pharmacy Scotland, as outlined at section 5.2, be noted.

3. Background 3.1. This report is based on the Financial Monitoring reports received from the Director of

Finance of NHS Lanarkshire (NHSL) and the Executive Director of Finance and Corporate Resources of South Lanarkshire Council (SLC). The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies.

3.2. This is the first financial monitoring report presented to the South Lanarkshire

Integration Joint Board (IJB) for the financial year 2018/2019. 4. Summary and Next Steps 4.1. The financial position as at June/July 2018 is summarised as follows:

there is an overspend of £0.356m on Health Care Services

there is an underspend of £0.112m on the Primary Care Transformation Fund which is ring-fenced

there is an overspend of £0.044m on Social Care and Housing Services 4.2. The budget variance is analysed by Care Services at Appendix 1.

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5. Reasons for Major Budget Variances – Health Services 5.1. Locality and Other Services 5.1.1. There is a net underspend of £0.099m across the localities and other services.

Other services include boundary service level agreements, social care funding, management team costs, school nursing and the apprenticeship levy.

5.1.2. The net underspend on employee costs totals £0.092m and is mainly due to

vacancies across Nursing Services and Administration and Clerical Support Services within the localities. There are incremental pay increases across many services however these cost pressures are being offset in-year by the vacancies.

5.1.3. There is a net underspend of £0.007m on non pay costs which is mainly in respect of

underspends on surgical sundries and travel costs. There are overspends on equipment however these are being offset by the underspends.

5.2. Prescribing 5.2.1 An overspend of £0.306m is reported in respect of prescribing. 5.2.2 The prescribing costs reflect the position to May 2018 at this stage. Although item

numbers reduced in May in comparison to the previous year, the cost per item increased. The cost per item however is still lower than the previous year.

5.2.3 Circular PCA(P)(2018)8 Pharmaceutical Services, “Amendments to the Drug Tariff in

respect of remuneration arrangements from 1 April 2018”, advises community pharmacy contractors and NHS Boards on the outcome of the negotiations for the community pharmacy funding envelope for 2018/2019. These negotiations are between the Scottish Government, Health Boards and Community Pharmacy Scotland.

5.2.4 One area of this agreement affects the prescribing budget and relates to a £20m

reduction nationally in the drug tariff. The reduction in the drug tariff will come from 3 drugs namely £10m reduction in Pregabalin and £10m reduction in Quetiapine and Olanzapine.

5.2.5 While this reduces the drug cost, the overall effect for the IJB and the Health Board

is cost neutral as NHS Boards will require to contribute an equivalent amount of funding to increase the Global Sum paid to Community Pharmacy.

5.2.6 The impact of this will therefore be a reduction in the total prescribing budget of

£20m across Scotland but an increase of £20m to the Community Pharmacy element of the Global Sum. This is a non cash limited budget which forms part of the Family Health Service budget hosted by the South Lanarkshire IJB.

5.2.7 At this stage of the financial year, the actual value which will be deducted from the

prescribing budget and transferred to the Community Pharmacy non cash limited budget has not yet been confirmed. It is expected that a deduction will be made through the Lanarkshire allocation process. Two options are as follows: If an actual spend share is deducted, the value will be £2.899m. If an NRAC share is deducted, the value will be £2.470m.

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5.2.8 The Scottish Government will decide on the most appropriate reduction method. The allocation of the reduction to the prescribing budget between the South Lanarkshire IJB and the North Lanarkshire IJB will follow the same basis once known.

5.2.9 The Family Health Services Community Pharmacy non cash limited budget will

increase by the total amount of the decrease in the prescribing budget. This transfer reflects a movement of the budget from a directly managed prescribing budget to the hosted service which is led by the South Lanarkshire IJB. This change takes effect from 1 June 2018 however it will be backdated to 1 April 2018.

5.2.10 Prescribing costs will continue to be monitored and reliance will be placed on

Prescribing Quality and Efficiency Programme to manage prescribing activity. 5.3. Out of Area Services 5.3.1 There is an overspend of £0.214m. 5.3.2 This is mainly due to higher costs being charged by external facilities and also the

cost of services to support individuals with complex care needs. A plan has been agreed by the partners and is currently being implemented to address this overspend in 2018/2019.

5.4. Area Wide Services 5.4.1 There is an underspend of £0.089m. 5.4.2 This is mainly due to vacancies in Pharmacy Services. 5.5. Hosted Services Led by South Lanarkshire 5.5.1 The Hosted Services which are led by the South Lanarkshire Health and Social Care

Partnership (SLHSCP) are outlined at Appendix 2.

5.5.2 There is a net underspend of £0.048m as at July 2018. The significant variances are in respect of the following services:

Primary Care Transformation fund £0.112m under

Community Dental Services £0.050m under

Palliative Care Services £0.055m under

Diabetic Services £0.081m over

Out of Hours Services £0.055m over

5.5.3 The underspend on the Primary Care Transformation Fund of £0.112 is ring-fenced. There are a range of projects which are being implemented by NHSL. The funding available will be realigned to reflect the agreed implementation plan and timeline.

5.5.4 The underspend across Palliative Care Services of £0.055m is mainly due to 4.18 WTE vacancies across Medical and Nursing staff.

5.5.5 The underspend across Community Dental Services of £0.050m is mainly as a result of 14.58 WTE vacancies across Dental Nursing and Senior Medical and Dental staff.

5.5.6 Similar to last year, there are overspends within the Out of Hours Service (£0.055m) and Diabetic Services (£0.081m). Last year this was due to additional expenditure being incurred on medical cover within the Out of Hours Service and the cost of equipment within Diabetic Services. Additional funding of £0.337m has been included to cover additional spend on insulin pumps and glucose monitors. The position this year continues to be closely monitored and an update on the variance explanations will be provided in the next report to the IJB.

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5.5.7 The accounting treatment of hosted services has changed from an agency basis to a principal basis. This means that 100% of the budget and actual expenditure for the hosted

services led by the South Lanarkshire IJB are included in the financial monitoring report to the South Lanarkshire IJB. Previously, only the 49% share which was attributable to the South Lanarkshire IJB was included.

The effect of this change is to increase the hosted services budget by approx. £111.045m, being the 51% share of budget and actual expenditure managed by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB.

49% of the budget and actual expenditure of the hosted services led by the North Lanarkshire IJB on behalf of the South Lanarkshire IJB continue to be included in the financial monitoring report to the South Lanarkshire IJB.

5.5.8 In line with the Integrated Resource Advisory Group Finance Guidance, the lead partner for a Hosted Service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any underspends which may be used to offset the overspends.

5.9. Hosted Services Led By North Lanarkshire 5.9.1 The Hosted Services which are led by the North Lanarkshire Health and Social Care

Partnership (NLHSCP) are outlined at Appendix 3. In-line with the Hosted Services agreement, a break-even position is reported.

6. Vacancy Factor 6.1. The average vacancy factor is currently 6.5%. This compares to a vacancy factor of

5.9% at the end of June 2018 and an average of 9.4% during 2017/2018.

7. Additional in Year Lanarkshire Funding 7.1. Further information on additional in-year funding allocations will be included in the

next report to the IJB.

8. Set Aside Activity 8.1. The set-aside budget is a notional budget which represents the consumption of

hospital resources by South Lanarkshire residents.

8.2. Based on the 2015/2016 activity levels at the 2017/2018 prices, the notional set-aside budget has been agreed as £54.715m. Similar to the previous year, the notional budget can also be included as the estimated expenditure. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB however it has been endorsed as an acceptable approach pending further updates from the Information Services Division.

8.3. The NHSL Director of Finance, in consultation with the Chief Financial Officer, continues to improve the monitoring arrangements for the hospital acute services. The set-aside budget will be updated to reflect ongoing developments as updated information becomes available.

9. Reasons for Major Budget Variances – Social Care Services 9.1. A net overspend of £0.044m is reported as at 22 June 2018.

9.2. An overspend of £0.120m is reported in respect of an increase in the demand for adaptations within the Housing Revenue Account (HRA). In line with the agreed accounting policy, an overspend on the HRA at 31 March 2019 will be offset by an additional partner contribution from SLC. If the year-end position is an underspend, this will be retained within the HRA.

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9.3. There are underspends across social care services and non-HRA services which total £0.076m. At this stage of the financial year, expenditure and income are in line with the phased budget.

9.4. It is recognised that the requirement for social care services is difficult to predict and

the level of demand can fluctuate. The position continues to be closely monitored. 10. 2018/2019 Savings 10.1. The 2018/2019 financial plan was approved by the IJB in March 2018. Efficiency

savings of £0.230m for social care and housing services and £0.539m for health care services were approved in March 2018 and June 2018 respectively. It was also noted the remaining funding gap of £0.110m would be monitored during the year.

10.2. In respect of social care and housing services, the approved savings of £0.230m are

being implemented. Progress against savings will be reported at the end of each quarter.

10.3. In respect of health care services, the budgets totalling £0.539m have been removed

in line with the agreed savings plans. These budgets are being held separately. Once the pay and non-pay inflationary cost pressures are confirmed, this budget will be re-allocated as required to self fund the cost increases. Backpay has not yet been paid.

10.4. The progress on both the budget re-allocation exercise across health care services

and also the achievement of the agreed 2018/2019 savings plans by both partners will be included in future financial monitoring reports to the IJB.

11. Reserves 11.1. The position in respect of the South Lanarkshire IJB reserves is attached at

appendix 4 for information. 11.2. In respect of health care services, the following reserves totalling £0.930m have

been called down this month and are included in the July 2018 position:

Alcohol and Drug Partnership Fund £0.473m Physio Trauma and Orthopaedics Pilot £0.093m OT Trauma and Orthopaedics Pilot £0.083m Home and Mobile Health Monitoring Pilot £0.042m Antenatal to 6 months Pathway Pilot £0.017m Transitional Fund £0.200m Diabetes Capacity Plan £0.022m

11.3. The balance on reserves has therefore reduced by £0.930m from £8.278m to £7.348m.

12. Employee Implications 12.1. There are no employee implications associated with this report. 13. Financial Implications 13.1. The financial implications are as outlined in the report. 14. Other Implications 14.1. The main risk associated with the IJB’s revenue budget is that either or both partners

may overspend.

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14.2. Prescribing cost volatility represents the most significant risk within the NHS element

of the Partnership’s budget. Demand for Care at Home Services represents the most significant risk within the Council’s element of the Partnership’s budget. These risks are managed by both NHSL and SLC through their detailed budget management and probable outturn arrangements. The Chief Officer, Chief Financial Officer and the HSCP Management Team continue to manage and review the budget across all areas of the Partnership.

14.3. There are no sustainable development issues associated with this report. 14.4. There are no other issues associated with this report. 15. Equality Impact Assessment and Consultation Arrangements 15.1. This report does not introduce a new policy, function or strategy or recommend a

change to an existing policy, function or strategy and therefore no impact assessment is required.

15.2. Consultation was undertaken with both the Director of Finance for NHSL and the

Executive Director of Finance and Corporate Resources of SLC in terms of the information contained in this report.

16. Directions 16.1. The extent to which the existing directions to each partner require to be varied is

detailed in the table below:

Direction to:

1. No Direction required

2. South Lanarkshire Council

3. NHS Lanarkshire

4. South Lanarkshire Council and NHS Lanarkshire

Val de Souza Director, Health and Social Care Date created: 31 August 2018 Link(s) to National Health and Wellbeing Outcomes

People are able to look after and improve their own health and wellbeing and live in good health for longer

People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community

People who use Health and Social Care Services have positive experiences of those services, and have their dignity respected

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Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services

Health and Social Care Services contribute to reducing health inequalities

People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

People who use Health and Social Care Services are safe from harm

People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide

Resources are used effectively and efficiently in the provision of Health and Social Care Services

Previous References

none List of Background Papers

none Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Marie Moy, Chief Financial Officer Ext: 3709 (Phone: 01698 453709) Email: [email protected]

- 23 -

- 24 -

Appendix 1

SOUTH LANARKSHIRE ANNUAL

HEALTH AND SOCIAL CARE PARTNERSHIP BUDGET BUDGET BUDGET ACTUAL GENERAL RING-FENCED TOTAL

2018/2019 Jun / Jul 2018 Jun / Jul 2018 Jun / Jul 2018 Jun / Jul 2018 Jun / Jul 2018

£m £m £m £m £m £m

Health Care Services

Locality and Other Services 25.128 18.257 18.158 0.099 0.099

Addiction Services 3.298 1.008 0.974 0.034 0.034

Medical and Nursing Directorate 2.573 0.839 0.833 0.006 0.006

Prescribing 66.549 22.183 22.489 (0.306) (0.306)

Out of Area Services 3.859 1.286 1.500 (0.214) (0.214)

Area Wide Services 5.857 1.593 1.504 0.089 0.089

Hosted Services 266.970 88.491 88.443 (0.064) 0.112 0.048

Set-Aside Budget 54.715 13.679 13.679 0.000 0.000

Expenditure - Sub Total 428.949 147.336 147.580 (0.356) 0.112 (0.244)

Social Care Services

Adult and Older People Services 164.373 31.747 31.728 0.019 0.019

Substance Misuse Services 1.470 0.348 0.319 0.029 0.029

Housing Services - General Fund 1.712 0.331 0.318 0.013 0.013

Housing Services - HRA 2.859 0.781 0.901 (0.120) (0.120)

Gross Expenditure 170.414 33.207 33.266 (0.059) (0.059)

Gross Income (6.761) (2.202) (2.217) 0.015 0.015

Net Expenditure - Sub Total 163.653 31.005 31.049 (0.044) (0.044)

TOTAL EXPENDITURE 592.602

FUNDED BY:

SLC Funding 118.005

Total - SLC 118.005

NHS Lanarkshire Funding 427.901

Social Care Funding 24.577

Resource Transfer 22.119

Total - NHSL 474.597

TOTAL 592.602

YEAR TO DATE YEAR TO DATE VARIANCE

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Hosted Services Appendix 2

Led by the South Partnership

Annual YTD YTD YTD Annual YTD YTD YTD Annual YTD YTD YTD

Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance

2018/2019 July 2018 July 2018 July 2018 2018/2019 July 2018 July 2018 July 2018 2018/2019 July 2018 July 2018 July 2018

£m £m £m £m £m £m £m £m £m £m £m £m

Community Dental Services 5.914 1.788 1.738 0.050 2.898 0.876 0.826 0.050 3.016 0.912 0.912 0.000

Out of Hours Services 5.744 1.897 1.952 (0.055) 2.815 0.930 0.985 (0.055) 2.929 0.967 0.967 0.000

Palliative Care Services 6.171 1.838 1.783 0.055 3.024 0.901 0.846 0.055 3.147 0.937 0.937 0.000

Physiotherapy Services 8.374 2.704 2.748 (0.044) 4.103 1.325 1.369 (0.044) 4.271 1.379 1.379 0.000

Primary Care Services 0.638 0.209 0.194 0.015 0.313 0.102 0.087 0.015 0.325 0.107 0.107 0.000

Occupational Therapy Services 6.883 2.240 2.244 (0.004) 3.373 1.098 1.102 (0.004) 3.510 1.142 1.142 0.000

Diabetic Services 2.980 0.979 1.060 (0.081) 1.460 0.480 0.561 (0.081) 1.520 0.499 0.499 0.000

Sub Total 36.704 11.655 11.719 (0.064) 17.985 5.711 5.775 (0.064) 18.719 5.944 5.944 0.000

Ring Fenced Funding

Family Health Services 177.954 60.027 60.027 0.000 87.197 29.413 29.413 0.000 90.757 30.614 30.614 0.000

Primary Care Transformation Fund 3.077 0.784 0.672 0.112 1.508 0.384 0.272 0.112 1.569 0.400 0.400 0.000

Sub Total 181.031 60.811 60.699 0.112 88.705 29.797 29.685 0.112 92.326 31.014 31.014 0.000

TOTAL 217.735 72.466 72.418 0.048 106.690 35.508 35.460 0.048 111.045 36.958 36.958 0.000

TOTAL North Lanarkshire IJB - 51% ShareSouth Lanarkshire IJB - 49% Share

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Hosted Services Appendix 3

Led by the North Partnership

Annual YTD YTD YTD Annual YTD YTD YTD Annual YTD YTD YTD

Budget Budget Actual Variance Budget Budget Actual Variance Budget Budget Actual Variance

2018/2019 July 2018 July 2018 July 2018 2018/2019 July 2018 July 2018 July 2018 2018/2019 July 2018 July 2018 July 2018

£m £m £m £m £m £m £m £m £m £m £m £m

Sexual health Services 2.400 0.792 0.765 0.027 1.176 0.388 0.388 0.000 1.224 0.404 0.377 0.027

Continence Services 2.052 0.682 0.705 (0.023) 1.005 0.334 0.334 0.000 1.047 0.348 0.371 (0.023)

Immunisation Services 2.102 0.330 0.384 (0.054) 1.030 0.162 0.162 0.000 1.072 0.168 0.222 (0.054)

Speech and Language Therapy Services 5.132 1.708 1.639 0.069 2.515 0.837 0.837 0.000 2.617 0.871 0.802 0.069

Children and Adolescents Mental Health Services 5.352 1.809 1.818 (0.009) 2.622 0.886 0.886 0.000 2.730 0.923 0.932 (0.009)

Childrens Services 9.994 3.301 3.228 0.073 4.897 1.617 1.617 0.000 5.097 1.684 1.611 0.073

Integrated Equipment and Adaptations Store 0.540 0.180 0.180 0.000 0.265 0.088 0.088 0.000 0.275 0.092 0.092 0.000

Dietetics Services 3.373 1.082 1.051 0.031 1.653 0.530 0.530 0.000 1.720 0.552 0.521 0.031

Podiatry Services 3.732 1.223 1.256 (0.033) 1.829 0.599 0.599 0.000 1.903 0.624 0.657 (0.033)

Prisoner Healthcare Services 1.437 0.473 0.485 (0.012) 0.704 0.232 0.232 0.000 0.733 0.241 0.253 (0.012)

Blood Borne Viruses Services 1.540 0.508 0.494 0.014 0.755 0.249 0.249 0.000 0.785 0.259 0.245 0.014

Hospital at Home 1.826 0.600 0.644 (0.044) 0.895 0.294 0.294 0.000 0.931 0.306 0.350 (0.044)

Mental Health and Learning Disability Services 61.000 20.016 19.697 0.319 29.890 9.808 9.808 0.000 31.110 10.208 9.889 0.319

TOTAL 100.480 32.704 32.346 0.358 49.235 16.025 16.025 0.000 51.245 16.679 16.321 0.358

TOTAL North Lanarkshire IJB - 51% ShareSouth Lanarkshire IJB - 49% Share

- 27 -

South Lanarkshire IJB Appendix 4

Position As At 31 July 2018

2016/2017

Balance as at

31 March 2017

Transfers

Out

Transfers

In

Balance as at

31 March 2018

Transfers

Out

Transfers

In

Balance as at

31 July 2018

Ring-Fenced Reserves £m £m £m £m £m £m £m

Primary Care and Mental Health Transformation Fund 2.749 0.000 0.932 3.681 0.000 0.000 3.681

Alcohol and Drug Partnership Fund 0.473 0.000 0.000 0.473 (0.473) 0.000 0.000

Physio Trauma and Orthopaedics Pilot 0.000 0.000 0.093 0.093 (0.093) 0.000 0.000

OT Trauma and Orthopaedics Pilot 0.000 0.000 0.083 0.083 (0.083) 0.000 0.000

Home and Mobile Health Monitoring Pilot 0.000 0.000 0.042 0.042 (0.042) 0.000 0.000

Antenatal to 6 months Pathway Pilot 0.000 0.000 0.017 0.017 (0.017) 0.000 0.000

Family Health Services 0.015 0.000 0.000 0.015 0.000 0.000 0.015

Total Ring-Fenced 3.237 0.000 1.167 4.404 (0.708) 0.000 3.696

Earmarked Reserves

Palliative Care Services 0.000 0.000 0.808 0.808 0.000 0.000 0.808

Prescribing Fund 0.636 0.000 0.100 0.736 0.000 0.000 0.736

Social Care Contingency 0.000 0.000 0.701 0.701 0.000 0.000 0.701

Transitional Fund 0.696 (0.121) 0.000 0.575 (0.200) 0.000 0.375

Training Fund - Health Visitors 0.000 0.000 0.220 0.220 0.000 0.000 0.220

Telehealth Project 0.191 0.000 0.000 0.191 0.000 0.000 0.191

IT Federated Trust Environment 0.000 0.000 0.070 0.070 0.000 0.000 0.070

Diabetes Capacity Plan 0.000 0.000 0.022 0.022 (0.022) 0.000 0.000

Total Earmarked 1.523 (0.121) 1.921 3.323 (0.222) 0.000 3.101

Contingency 1.359 (0.808) 0.000 0.551 0.000 0.000 0.551

General Fund 6.119 (0.929) 3.088 8.278 (0.930) 0.000 7.348

Useable Reserve 2017/2018 2018/2019

- 28 -

Report

Agenda Item

5


Subject: Performance Monitoring Report


update the Board on performance against the key performance measures assigned to the integration of Health and Social Care

outline future performance reporting opportunities [1purpose] 2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):- [recs]

(1) that the current performance trends be noted; and (2) that the proposed development work regarding performance management

arrangements be noted. [1recs] 3. Background 3.1. Through the Public Bodies Joint Working (Scotland) Act 2014 and the associated

regulations and guidance, an agreed suite of 23 performance measures were established for consistent application across Scotland. Consequently, Health and Social Care Partnerships (HCSP) use these measures as part of a minimum suite of performance data to report to the Integration Joint Board and its Sub-Committees.

3.2. Following this, the Scottish Government issued in December 2016, the Health and

Social Care Delivery Plan which brought about a renewed focus on six measures prioritised by the Ministerial Steering Group (MSG) in relation to:

unplanned admissions

occupied bed days for unscheduled care

A&E performance

delayed discharges

end of life care

the balance of spend across Institutional and Community Services 3.3. In addition, a number of performance measures which relate to the functions

managed by the HCSP are also reported to the NHS Lanarkshire Board, the South Lanarkshire Council Social Work Resources Committee and South Lanarkshire Community Planning Partnership. A workshop with Performance and Audit Sub-Committee members took place on 7 March 2018 and the proposals emerging from

- 29 -

this workshop were presented and approved at the June IJB meeting. Work is now progressing to build a new and more comprehensive performance framework.

3.4. This report outlines the trends in performance with regards to the six MSG

measures. 3.5. Appendix 1 shows a useful longitudinal trend analysis of the MSG indicators. 4. Delayed Discharges 4.1. There has been significant work undertaken over the last 18 months to refocus

efforts in supporting a reduction in the number of Delayed Discharges in-line with the recent Audit Scotland report on this issue as well as the internally generated Delayed Discharge action plan.

4.2. Most significant of the various pieces of work undertaken, has seen the emphasis for

both home care patients and CCA/complex assessment patients to be transferred from a hospital based approach to one which is locality led and owned. Initially, the Social Work/CCA element transferred to localities in November, whilst the Home Care transfer was undertaken in January.

4.3. By moving to a ‘locality-ownership’ approach, this has also seen the opportunity for

increased integrated approaches, with NHS staff assisting to provide early rehabilitation/discharge support as well as Support Your Independence (SYI) Home Care staff. In turn, this has enabled SYI staff to more often take over care pending optimum re-ablement and independence of service users.

4.4. ISD published data for June 2018 shows that occupied bed days performance for

South Lanarkshire delayed bed days has deteriorated. One factor which has contributed to the increase is the numbers of referrals received by localities, 390 were received, an increase of 47 when compared with June 2017.

Previous Year Current Year Increase/Reduction

March 4048 2253 -1795 (Decrease)

April 3856 2546 -1310 (Decrease)

May 3939 2822 -1117 (Decrease)

June 3453 3514 61 (Increase)

ISD: Occupied bed days All delays

4.5. From the above table, it will be noted following a period of sustained and significant

decrease in Delayed Discharge bed days, there was an increase of 61 bed days in June 2018 against June 2017.

5. Summary and Next Steps 5.1. There are a number of areas of development which are being led by the Partnership,

working alongside acute colleagues to make further improvements across the six main MSG targets. This will be supported by an Unscheduled Care workshop.

5.2. As outlined in paragraph 3.3., a more comprehensive performance reporting

framework is being developed and will be presented to a future Performance and Audit Sub-Committee.

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6. Employee Implications 6.1. There are no employee implications associated with this report. 7. Financial Implications 7.1. There are no financial implications associated with this report. 8. Other Implications 8.1. There are no additional risks associated with this report. 8.2. There are no sustainable development issues associated with this report. 8.3. There are no other implications at this stage. 9. Equality Impact Assessment and Consultation Arrangements 9.1. This report does not introduce a new policy, function or strategy or recommend a

change to an existing policy, function or strategy and therefore, no impact assessment is required.

9.2. Consultation on this work has and will continue to be part of discussions with the

Strategic Commissioning Group and Locality Planning Groups. 10. Directions 10.1. The extent to which the existing directions to each partner require to be varied is


Direction to:



3. NHS Lanarkshire







- 31 -






Previous References

report of South Lanarkshire Integration Joint Board – Annual Performance Report to Performance and Audit Sub-Committee, 29 August 2017

List of Background Papers

Appendix 1 – six MSG Measures Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Craig Cunningham, Head of Commissioning and Performance Ext: 3704 (Phone: 01698 453704) Email: [email protected]

- 32 -

Appendix 1

South Lanarkshire HCSP Health and Social Care Delivery Plan Measures

1. Context 1.1. The Health and Social Care Delivery Plan and the work of the Ministerial Steering

Group (MSG) in Health and Social Care have identified six key areas through which trends overtime will be monitored, with a view to supporting improvement and learning within partnerships and across Scotland.

1.2. A key emphasis behind this work is realising the national ambition to shift the

balance of care through strategic commissioning which shifts the focus from acute and residential settings to community based alternatives. This report gives a short overview of the South Lanarkshire position with regards to the following areas:



A&E performance

Delayed Discharges

end of life care

the balance of spend across institutional and community services 2. Summary of the ‘Big Six’ in South Lanarkshire for year 2017/18:

A&E attendances up by 4% against 2016/17

emergency admissions up by 1.39%

unscheduled bed days down by 1% year on year

Delayed Discharge bed days down year to year by 9%

people spending last six months of life in community increased by 0.3%

balance of care is broadly in-line with other similar partnerships at just under 98%

a) A&E Attendances

The following graphs show the performance against trajectory. The trajectory has been revised to reflect seasonality; this does not affect the overall target numbers. This trajectory has been calculated assuming that A&E attendances could be maintained at the previous year level. Attendances during April and May 2018 were above target levels, with 1285 attendances more than anticipated, 18,767 against a target of 17,482.

5,000

5,500

6,000

6,500

7,000

7,500

8,000

8,500

9,000

9,500

10,000

South LanarkshireA&E Attendances

Attendances Target Attendances

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b) Emergency Admissions

The graph below shows emergency admissions against the agreed trajectory. The Partnership performed well during April and May 2018 with 6295 admissions against a trajectory of 9591, 99 fewer admissions than anticipated.

1,500

2,000

2,500

3,000

3,500

4,000

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-1

6

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-1

7

Dec

-17

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

May

-18

South Lanarkshire Emergency AdmissionsApril 2015 - May 2018

Emergency Admissions Target Admisssions

c) Unscheduled Bed Days

The graph below tracks the month-on-month actual performance longitudinally against the trajectory agreed for unscheduled bed days. Acute bed days for April and May 2018 were 8,174 fewer than anticipated, however, it should be noted that there is routinely a few months lag in terms of completed episodes of care and bed day for April and May will increase.

10,000

12,000

14,000

16,000

18,000

20,000

22,000

24,000

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-15

Dec

-15

Jan

-16

Feb

-16

Mar

-16

Ap

r-1

6

May

-16

Jun

-16

Jul-

16

Au

g-1

6

Sep

-16

Oct

-16

No

v-16

Dec

-16

Jan

-17

Feb

-17

Mar

-17

Ap

r-1

7

May

-17

Jun

-17

Jul-

17

Au

g-1

7

Sep

-17

Oct

-17

No

v-17

Dec

-17

Jan

-18

Feb

-18

Mar

-18

Ap

r-1

8

May

-18

South LanarkshireUnscheduled Care Bed days

Acute Specialties

Actual Target

Both Mental Health and Geriatric Long Stay bed days have shown a significant reduction January 2015 to March 2018, and are currently performing well against target levels.

- 34 -

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

South LanarkshireUnscheduled Geriatric

Geriatric GLS Target

0

5,000

10,000

15,000

20,000

South Lanarkshire Unscheduled Mental Health

Mental Health MH Target

d) Delayed Discharge Bed Days

Delayed Discharge Bed day targets for December and January onwards were based on improvements in delays associated with Home Care, and the reclassification of offsite beds as intermediate care. Home Care improvements have resulted in a decrease in bed days for this type of delay. However the Partnership is continuing to clarify the intermediate care coding arrangements. As such, all improvements shown are directly comparable to previous information. The graph below shows revised targets which include patients in offsite beds. A comparison with April – March the previous year shows a reduction of 9% in delayed discharge bed days. Improvement in bed days during December to March has been 31%. However, bed days for April and May were beyond target by 373 and 348 respectively. Bed days performance for June deteriorated further with occupied bed days 1,531 beyond target.

- 35 -

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

South LanarkshireDelayed Discharge Bed Days (exc. Code 9s)

Non-code 9 Bed days Target incl offsite

e) Last six Months of Life by Setting

Percentage of people who spend their last six months in a community setting has steadily increased over the previous three years. With a shift of resources from acute to community it is expected that the numbers of people who spend the last six months in the community will increase. Initially the Partnership aims to achieve the average of their benchmarking group, within three years the aim is to achieve above average in-line with North Lanarkshire. The table below confirms the Partnership is increasing the proportion of South Lanarkshire residents who spend the last six months of life in the community. More recent updates from ISD show that the Partnership was ahead of the 2017/18 target.

2013/2014 2014/2015 2015/2016 2016/2017p 2017/2018 2018/2019

Community 84.2% 84.4% 84.9% 87.0% 87.3% 87.0%

Community Target 84.2% 84.4% 84.9% 87.0% 86.6%

Large Hospital 14.0% 14.3% 13.9% 12.2% 12.1% 11.7%

Large Hospital Target 14.0% 14.3% 13.9% 12.2% 12.2% f) Balance of care

The percentage of people over 75 who are not thought to be in any other setting, or receiving any home care, has increased during 2015/16. South Lanarkshire is at the average level when measuring against the Discovery peer group. Given the increase in the 75+ age group, it is suggested that the 2015/16 percentage remains the target through to 2018/19.

2013/2014 2014/2015 2015/2016 2016/2017p 2017/2018 2018/2019

Home (unsupported) 81.0% 81.8% 81.7% 82.2% Not available

Home (unsupport) Target 81.0% 81.8% 81.7% 82.0% 82.0% 82.0%

Home Supported 9.6% 9.0% 9.0% 8.8% Not available

Home Support Target 9.6% 9.0% 9.0% 9.0% 9.0% 9.0%

- 36 -

Balance of care improvements figures, shown above, were based on the over 75 population, generally those with the more complex needs. South Lanarkshire community based service provision remains just under 98%. The 98% figure presents the proportion of the overall population not in acute hospitals.

- 37 -

- 38 -

Report

Agenda Item

6


Subject: External Auditor's Annual Audit Report 2017-2018


advise members of the outcome of the audit by the South Lanarkshire Integration Joint Board’s External Auditor, Audit Scotland, within the statutory timescale of 30 September 2018

advise that the auditor has submitted an Annual Audit Report setting out their key findings for the consideration of members

advise members of the proposed response to the action plan on page 24 of the External Auditor’s Annual Audit Report


(1) that the receipt of the unqualified audit certificate in respect of the Integration Joint Board’s Annual Accounts 2017/2018 be noted;

(2) that the External Auditor’s Annual Audit Report is considered in advance of the statutory timescale of 30 September 2018 for the approval of the IJB Annual Accounts; and

(3) that the proposed response to the action plan on page 24 of the External Auditor’s Annual Audit Report, which is attached as an appendix, be approved.

[1recs] 3. Background 3.1. Following the publication of the Local Authority Accounts (Scotland) Regulations

2014, the members of the Integration Joint Board (IJB) have to meet to consider whether to approve the Audited Annual Accounts for signature no later than 30 September 2018.

3.2. The IJB’s appointed External Auditor, Audit Scotland, is required to supply an audit

certificate outlining the findings of the audit process undertaken in relation to the IJB’s Annual Accounts 2017/2018. A letter setting out their responsibilities is attached at appendix 1. The findings are detailed in the External Auditor’s Annual Audit Report for the financial year 2017/2018, which is attached at appendix 2.

3.3. The members are therefore required to have regard to any report made or advice

provided on the annual accounts by the External Auditor.

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4. External Auditor’s Annual Audit Report 2017-2018 4.1. The Audit Report on the IJB’s annual accounts extends across a number of subjects,

as follows:

2017/2018 Annual Report and Accounts

financial management and sustainability

governance, transparency and value for money 4.2. The External Auditor has concluded that the financial statements of the South

Lanarkshire IJB for 2017/2018 give a true and fair view of the state of affairs and of its net expenditure for the year and have therefore issued an unqualified independent auditor’s report.

4.3. The External Auditor’s Annual Audit Report includes the key messages at page 4

and an action plan on page 24 which has been agreed by both the Chief Officer and the Chief Financial Officer.

5. Employee Implications 5.1. There are no employee implications associated with this report. 6. Financial Implications 6.1. There are no financial implications associated with this report. 7. Other Implications 7.1. The main risk associated with the IJB Annual Accounts is a qualified audit report.

The risk has been assessed as low due to the detailed preparation in relation to the year end process and technical training undertaken by key finance staff. The finance staff across the partners co-operated to achieve key deadlines.

7.2. There are no sustainable, environmental or other implications associated with this

report. 8. Equality Impact Assessment and Consultation Arrangements 8.1. This report does not introduce a new policy, function or strategy or recommend a

change to an existing policy, function or strategy and, therefore, no impact assessment is required.

8.2. There is also no requirement to undertake any consultation in terms of the

information contained in this report. 9. Directions 9.1. This does not issue a new Direction.

Direction to:



3. NHS Lanarkshire


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Previous References

IJB report 26 June 2018 – Unaudited Annual Accounts 2017/2018 List of Background Papers

External Auditor’s annual Audit Report 2017/2018 Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Marie Moy, Chief Financial Officer Ext: 3709 (Phone: 01698 453709) Email: [email protected]

- 41 -

- 42 -

Providing services to the Auditor General for Scotland and the Accounts Commission

4th Floor 102 West Port Edinburgh EH3 9DN

4th Floor 8 Nelson Mandela Place Glasgow G2 1BT

1st Floor, Room F03 The Green House Beechwood Business Park North Inverness IV2 3BL

T: 0131 625 1500 E: [email protected] www.audit-scotland.gov.uk

South Lanarkshire Integration Joint Board 11 September 2018

South Lanarkshire Integration Joint Board

Audit of 2017/18 annual report and accounts

Independent auditor's report

1. Our audit work on the 2017/18 annual report and accounts is now substantially complete. Subject

to the receipt of a revised annual report and accounts for final review, we anticipate being able to

issue unqualified audit opinions in the independent auditor's report on 11 September 2018 (the

proposed report is attached at Appendix A).

Annual audit report

2. We also present for your consideration our proposed Annual Audit Report on the 2017/18 audit.

International Standard on Auditing (UK) 260 (Communication with those charged with

governance) requires auditors to report specific matters arising from the audit of the annual

accounts to those charged with governance in sufficient time to enable appropriate action. Within

the proposed Annual Audit Report (page 9), the section headed "Significant findings from the

audit of the financial statements" sets out the issues which we consider require to be drawn to

your attention.

3. The Annual audit report will be issued in its final form after the annual report and accounts have

been approved for issue and the independent auditor’s report has been signed.

4. In presenting this report to the Joint Board we seek confirmation that we have been informed of:

• instances of any actual, suspected or alleged fraud;

• events that have occurred since 31 March 2018 which could have a significant impact on the

annual report and accounts;

• instances of non-compliance with legislation.

Unadjusted misstatements

5. We are required to report to those charged with governance, all unadjusted misstatements, other

than those of a trivial nature, and request that they be corrected. There are no unadjusted

misstatements to be corrected

Representations from management

6. International Standard on Auditing (UK) 580 (Management representations) requires auditors to

obtain representations on certain matters from management. Accordingly, as part of the audit

- 43 -


completion process we seek written assurances from the Chief Financial Officer , as the "proper

officer" appointed by virtue of section 95 of the Local Government (Scotland) Act 1973, on

aspects of the annual report and accounts.

7. A draft letter of representation is attached at appendix B; this should be reviewed for accuracy

and any proposed amendment discussed with us. Once satisfied, the letter should be signed

and returned by the Chief Financial Officer with the signed annual report and accounts.

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APPENDIX A: Proposed Independent Auditor’s Report

Independent auditor’s report to the members of South Lanarkshire Integration Joint Board and the Accounts Commission This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 120 of the Code of Audit Practice approved by the Accounts Commission, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties.

Report on the audit of the financial statements

Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of South Lanarkshire Integration Joint Board for the year ended 31 March 2018 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the accounts, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2017/18 (the 2017/18 Code). In my opinion the accompanying financial statements:

• give a true and fair view in accordance with applicable law and the 2017/18 Code of the state of affairs of the South Lanarkshire Integration Joint Board as at 31 March 2018 and of its income and expenditure for the year then ended;

• have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2017/18 Code; and

• have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003.

Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)). My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I am independent of the South Lanarkshire Integration Joint Board in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have nothing to report in respect of the following matters in relation to which the ISAs (UK) require me to report to you where:

• the use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or

• the Chief Financial Officer has not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about South Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue.

Responsibilities of the Chief Financial Officer and South Lanarkshire Integration Joint Board for the financial statements

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As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the South Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless deemed inappropriate. The South Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to achieve reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Other information in the annual accounts The Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the information other than the financial statements, the audited part of the Remuneration Report, and my auditor’s report thereon. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on matters prescribed by the Accounts Commission to the extent explicitly stated later in this report. In connection with my audit of the financial statements, my responsibility is to read all the other information in the annual accounts and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard.

Report on other requirements

Opinions on matters prescribed by the Accounts Commission In my opinion, the audited part of the Remuneration Report has been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. In my opinion, based on the work undertaken in the course of the audit

• the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and

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https://www.frc.org.uk/Our-Work/Audit-and-Actuarial-Regulation/Audit-and-assurance/Standards-and-guidance/Standards-and-guidance-for-auditors/Auditors-responsibilities-for-audit/Description-of-auditors-responsibilities-for-audit.aspx


• the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016).

Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion:

• adequate accounting records have not been kept; or

• the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or

• I have not received all the information and explanations I require for my audit; or

• there has been a failure to achieve a prescribed financial objective. I have nothing to report in respect of these matters. Fiona Mitchell-Knight FCA Audit Director Audit Scotland 4th Floor, The Athenaeum Building 8 Nelson Mandela Place, Glasgow, G2 1BT 11 September 2018

- 47 -


APPENDIX B: Letter of Representation (ISA 580)

Fiona Mitchell-Knight, Audit Director Audit Scotland 4th Floor 8 Nelson Mandela Place Glasgow G2 1BT Dear Fiona

South Lanarkshire Integration Joint Board Annual Accounts 2017/18

1. This representation letter is provided in connection with your audit of the annual accounts of

South Lanarkshire Integration Joint Board for the year ended 31 March 2018 for the purpose of

expressing an opinion as to whether the financial statements give a true and fair view in

accordance with the financial reporting framework, and for expressing other opinions on the

remuneration report, management commentary and annual governance statement.

2. I confirm to the best of my knowledge and belief, and having made appropriate enquiries of the

Board, South Lanarkshire Council and NHS Lanarkshire, the following representations given to

you in connection with your audit of South Lanarkshire Integration Joint Board’s annual accounts

for the year ended 31 March 2018.

Financial Reporting Framework

3. The annual accounts have been prepared in accordance with the Code of Practice on Local

Authority Accounting in the United Kingdom 2017/18 (2017/18 accounting code) the

requirements of the Local Government (Scotland) Act 1973, the Local Government in Scotland

Act 2003 and The Local Authority Accounts (Scotland) Regulations 2014.

4. Disclosure has been made in the financial statements of all matters necessary for them to show a

true and fair view of the transactions and of the South Lanarkshire Integration Joint Board for the

year ended 31 March 2018.

Accounting Policies & Estimates

5. All material accounting policies adopted are as shown in the Statement of Accounting Policies

included in the financial statements. The appropriateness of these policies has been reviewed,

and takes account of the requirements set out in the Code of Practice on Local Authority

Accounting in the United Kingdom 2017/18. All accounting policies applied are appropriate to

South Lanarkshire Integration Joint Board’s circumstances and have been consistently applied.

6. The significant assumptions used in making accounting estimates are reasonable and properly

reflected in the financial statements. There are no changes in estimation techniques which

should be disclosed due to their having a material impact on the accounting disclosures.

- 48 -


Going Concern

7. I have assessed South Lanarkshire Integration Joint Board's ability to carry on as a going

concern and concluded that it is appropriate to prepare the financial statements on a going

concern basis. I am not aware of any material uncertainties that may cast significant doubt on

South Lanarkshire Integration Joint Board's ability to continue as a going concern.

Related Party Transactions

8. All transactions with related parties have been disclosed in the financial statements. I have made

available to you all the relevant information concerning such transactions, and I am not aware of

any other matters that require disclosure in order to comply with the requirements of International

Accounting Standard 24.

Remuneration Report

9. The remuneration report has been prepared in accordance with the Local Authority Accounts

(Scotland) Regulations 2014 and includes all specified remuneration for relevant officers and all

elected members.

Corporate Governance

10. I acknowledge, as the officer with responsibility for the proper administration of the Joint Board’s

financial affairs, my responsibility for the systems of internal control. I confirm that I have

disclosed to the auditor all deficiencies in internal control of which I am aware.

11. The corporate governance arrangements have been reviewed and the disclosures have been

made in the annual report and accounts in accordance with the Code of Practice on Local

Authority Accounting in the United Kingdom 2017/18. There have been no changes in the

corporate governance arrangements or issues identified, since 31 March 2018, which require

disclosure.

General

12. I acknowledge my responsibility and that of South Lanarkshire Integration Joint Board for the

annual report and accounts. All of the accounting records requested have been made available

to you for the purposes of your audit. All material agreements and transactions undertaken by

South Lanarkshire Integration Joint Board have been properly reflected in the financial

statements. All other records and information have been made available to you, including

minutes of all management and other meetings.

13. Disclosure has been made in the financial statements of all matters necessary to give a true and

fair view of the financial position of South Lanarkshire Integration Joint Board as at 31 March

2018 and the income and expenditure for the year then ended.

14. The information given in the narrative reports supporting the financial statements, including the

Management Commentary, Annual Governance Statement and Remuneration Report, presents

a balanced picture of South Lanarkshire Integration Joint Board and is consistent with the

financial statements.

15. I have considered the risk that the financial statements may be materially misstated as a result of

fraud. I confirm that there are no allegations of fraud or suspected fraud affecting the financial

- 49 -


statements. There have been no irregularities involving management or employees who have a

significant role in internal control or that could have a material effect on the financial statements.

16. I confirm that I am not aware of any uncorrected misstatements.

Balance Sheet

17. There have been no material events since the date of the balance sheet which would require the

revision of the figures in the financial statements or notes thereto.

18. Since the date of the balance sheet no events or transactions have occurred which, though

properly excluded from the accounts, are of such importance that they should be brought to your

notice.

Yours sincerely Marie Moy Chief Financial Officer 11 September 2018

- 50 -

South Lanarkshire Integration Joint Board 2017/18 Proposed Annual Audit Report

Prepared for the members of South Lanarkshire Integration Joint Board and the Controller of Audit

11 September 2018

- 51 -

Who we are

The Auditor General, the Accounts Commission and Audit Scotland work together to deliver public audit in Scotland:

• The Auditor General is an independent crown appointment, made on the recommendation of the Scottish Parliament, to audit the Scottish Government, NHS and other bodies and report to Parliament on their financial health and performance.

• The Accounts Commission is an independent public body appointed by Scottish ministers to hold local government to account. The Controller of Audit is an independent post established by statute, with powers to report directly to the Commission on the audit of local government.

• Audit Scotland is governed by a board, consisting of the Auditor General, the chair of the Accounts Commission, a non-executive board chair, and two non-executive members appointed by the Scottish Commission for Public Audit, a commission of the Scottish Parliament.

About us

Through our work for the Auditor General and the Accounts Commission, we provide independent assurance to the people of Scotland that public money is spent properly and provides value. We aim to achieve this by:

• carrying out relevant and timely audits of the way the public sector manages and spends money

• reporting our findings and conclusions in public

• identifying risks, making clear and relevant recommendations.

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South Lanarkshire Integration Joint Board: 2017/18 Proposed Annual Audit Report | 3

Contents

Key messages 4

Introduction 5

Part 1 7

Audit of 2017/18 Annual Report and Accounts

Part 2 11

Financial management and sustainability

Part 3 17

Governance, transparency and value for money

Appendix 1 24

Action plan 2017/18

Appendix 2 33

Significant audit risks identified during planning

Appendix 3 35

Summary of national performance reports 2017/18

- 53 -

4 |

Key messages

2017/18 Annual Report and Accounts

1 The financial statements of South Lanarkshire Integration Joint Board for 2017/18 give a true and fair view of the state of its affairs and of its net expenditure for the year.

2 We have issued an unqualified Independent Auditor’s Report on the South Lanarkshire Integration Joint Board Annual Report and Accounts for 2017/18.

Financial management and sustainability

3 The Joint Board reported a surplus of £2.159 million for 2017/18.

4 A medium to long term financial plan should be developed to bring together risks and opportunities affecting the Joint Board’s financial position and financial sustainability.

5 The Joint Board should ensure that a comprehensive and detailed budget is set at the start of the financial year and that any changes to the budget are clearly mapped out in budget monitoring reports.

6 Key controls within the main financial systems of both partner bodies were operating satisfactorily.

Governance, transparency and value for money

7 The Joint Board approved a refreshed Strategic Commissioning Plan for 2018-19 in March 2018. The plan sets out ten strategic priorities linked to the Scottish Government's nine health and wellbeing outcomes.

8 The Joint Board has satisfactory governance arrangements in place.

9 The Joint Board is open and transparent however, current arrangements could be further enhanced.

10 The Joint Board should develop its own mechanism to demonstrate that it is meeting its Best Value duties.

11 Oversight and scrutiny of performance is expected to be enhanced with the introduction of the partnership performance reporting framework.

- 54 -

Introduction | 5

Introduction

1. The scope of our audit was set out in our Annual Audit Plan presented to the February 2018 meeting of the Performance and Audit Committee.

2. This report sets out our findings from:

• the audit of the Annual Report and Accounts

• our consideration of the wider dimensions of public sector audit, Exhibit 1, as set out in Audit Scotland’s Code of Audit Practice.

Exhibit 1 Audit dimensions

Source: Code of Audit Practice 2016

3. The main elements of our audit work in 2017/18 were:

• an assessment of the Joint Board’s arrangements for recording financial information and its governance arrangements

• an audit of the Joint Board’s 2017/18 Annual Report and Accounts

• obtaining service auditor assurances from the auditors of NHS Lanarkshire (NHSL) and South Lanarkshire Council (SLC)

• consideration of the four audit dimensions.

4. The management of the Joint Board is responsible for, inter alia:

• preparing financial statements which give a true and fair view

• putting in place proper arrangements for the conduct of its affairs

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http://www.audit-scotland.gov.uk/report/code-of-audit-practice-2016

6 |

• ensuring that the financial position is soundly based.

5. Further details of the respective responsibilities of management and the auditor can be found in the Code of Audit Practice 2016.

6. An audit of financial statements is not designed to identify all matters that may be relevant to those charged with governance. We have included in this report only those matters that have come to our attention as a result of our normal audit procedures; consequently, our comments should not be regarded as a comprehensive record of all deficiencies that may exist or improvements that could be made. It is the auditor's responsibility to express an opinion on the financial statements prepared by management. This does not relieve management of the responsibility for the preparation of the financial statements.

7. Our aim is to add value to the Joint Board by increasing insight into, and offering foresight on financial sustainability, risk and performance and by identifying areas of improvement and recommending / encouraging good practice. In so doing, we aim to help the Council promote improved standards of governance, better management and decision making and the more effective use of resources.

8. An action plan is included at appendix 1 setting out our recommendations to address the issues and risks identified from our audit. Officers have considered the issues and agreed to take the specific steps in the column headed "Agreed management action/timing". We recognise that not all risks can be eliminated or even minimised. What is important is that the Joint Board understands its risks and has arrangements in place to manage them. The Joint Board should ensure that it is satisfied with the proposed actions and has an adequate mechanism in place to assess progress and monitor outcomes.

9. We comply with the Financial Reporting Council’s Ethical Standard. We have not undertaken any non-audit services; the audit fee of £24,000, set out in our Annual Audit Plan, remains unchanged. We are not aware of any relationships that could compromise our objectivity and independence.

10. This report is addressed to both the members of the Joint Board and the Controller of Audit and will be published on Audit Scotland's website www.audit-scotland.gov.uk in due course.

11. The cooperation and assistance afforded to the audit team during the course of the audit is gratefully acknowledged.

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Part 1 Audit of 2017/18 Annual Report and Accounts | 7

Part 1 Audit of 2017/18 Annual Report and Accounts

Audit opinions on the Annual Report and Accounts

12. The Joint Board’s Annual Report and Accounts for the year ended 31 March 2018 was approved by the Joint Board on 11 September 2018.

13. We reported, in our Independent Auditor's Report:

• an unqualified opinion on the financial statements;

• an unqualified audit opinion on the auditable part of the remuneration report, management commentary and annual governance statement.

14. We also concluded that there were no matters upon which we are required to report to the Accounts Commission by exception.

Submission of Annual Report and Accounts for audit

15. We received the unaudited financial statements on 15 June, in line with our agreed audit timetable. The working papers provided with the unaudited Annual Report and Accounts were of a good standard and finance staff provided good support to the audit team which helped ensure the audit process ran smoothly.

16. Information was provided to NHS Lanarkshire and South Lanarkshire Council in relation to the year-end figures in accordance with the pre-agreed timetable. The information provided was considered adequate for consolidation purposes. Assurances from NHS Lanarkshire and South Lanarkshire Council were received by the Joint Board in a timely manner.

Risks of material misstatement

17. The concept of audit risk is of central importance to our audit approach. During the planning stage of our audit we identified a number of key audit risks which involved the highest level of judgement and potential impact on the financial statements. We set out in our Annual Audit Plan, the audit work we proposed to undertake to secure appropriate levels of assurance. Appendix 2 sets out the significant audit risks identified and how we addressed each risk in arriving at our opinions on the Annual Report and Accounts.

Main judgements

The financial statements of South Lanarkshire Integration Joint Board for 2017/18 give a true and fair view of the state of its affairs and of its net expenditure for the year.

We have issued an unqualified Independent Auditor’s Report on the South Lanarkshire Integration Joint Board Annual Report and Accounts for 2017/18.

The Annual Report and Accounts is the principal means of accounting for the stewardship of the Joint Board’s resources and its performance in the use of those resources.

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Materiality

18. Materiality can be defined as the maximum amount by which auditors believe the financial statements could be misstated and still not be expected to affect the perceptions and decisions of users of the financial statements. The assessment of what is material is a matter of professional judgement. It involves considering both the amount and nature of the misstatement. A misstatement or omission, which would not normally be regarded as material by value, may be important for other reasons (for example, an item contrary to law).

19. Our initial assessment of materiality for the financial statements was undertaken during the planning phase of the audit. We assessed the materiality of uncorrected misstatements, both individually and collectively, in forming our opinions on the financial statements.

20. On receipt of the Annual Report and Accounts and following completion of audit testing materiality levels were recalculated: summarised at exhibit 2. There was no significant change between the levels of materiality calculated at the planning stage and our final calculation.

Exhibit 2 Materiality levels

Materiality level Amount

Overall materiality £4.762 million

Performance materiality £2.857 million

Reporting threshold £0.100 million

Source: Audit Scotland, 2017/18 Annual Audit Plan

Evaluation of misstatements

21. One material adjustment was identified in the unaudited accounts. This relates to a change in the prescribed accounting treatment of expenditure incurred on services hosted by South Lanarkshire Integration Joint Board on behalf of North Lanarkshire Integration Joint Board, further details of which are included at exhibit 3, point 2. The appropriate adjustment was made and this resulted in an increase of £20.410 million to both income and expenditure in the Comprehensive Income and Expenditure Statement. There were no other adjusted or unadjusted errors.

Significant findings

22. International Standard on Auditing (UK) 260 requires us to communicate significant findings from the audit “to those charged with governance”. Our significant findings are summarised at exhibit 3. Where a finding has resulted in a recommendation to management, a cross reference to the Action Plan at appendix 1 is included.

23. The findings include our views about significant qualitative aspects of accounting practices including: significant financial statements disclosures, the impact of any uncertainties, misstatements in the Annual Report and Accounts, accounting estimates and judgements, and the effect of any unusual transactions on the financial statements.

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Part 1 Audit of 2017/18 Annual Report and Accounts | 9

Exhibit 3 Significant findings

Issue Resolution

1. Hospital acute services (set aside)

The “set aside” budget is the Joint Board’s share of the budget for delegated acute services provided by large hospitals, on behalf of the Joint Board. Included within the total Joint Board expenditure of £496.655 million is £54.715 million “set aside” costs.

The budget and actual expenditure reported for the “set aside” are equal. The figure is based on 2015/16 activity levels for hospital inpatient and day case activity, as provided by NHS National Services Scotland’s Information Services Division, adjusted to reflect 2017/18 costs.

The Comprehensive Income and Expenditure Account correctly incorporates the set aside costs.

This is a transitional arrangement which was agreed by the Scottish Government for 2016/17 and 2017/18. NHS Lanarkshire and the Joint Board have made good progress in establishing processes for identifying and managing services delivered within the acute setting.

Recommendation 1 (refer appendix 1, action plan)

2. Accounting for hosted services

The Integration Scheme sets out healthcare services which are provided by South Lanarkshire Joint Board on behalf of North Lanarkshire Joint Board.

In 2017/18 joint boards were required to revise the accounting arrangements for hosted services. Essentially, where one body is delivering services on behalf of another the full cost and income in respect of that service should be included in the host body’s Comprehensive Income and Expenditure Statement. Guidance in this area was not clear and this led to the understatement of income and expenditure in respect of hosted services by £20.410 million.

The necessary adjustments were made to the accounts. This resulted in an increase in hosted services expenditure and corresponding income of £20.410 million. There is no net impact on the accounts.

The Joint Board should ensure that there is a formal minute of agreement with North Lanarkshire Integration Joint Board and NHS Lanarkshire around how under and overspends on hosted services will be managed.


Good practice in financial reporting

24. In the main, the Annual Report and Accounts reflect good practice as set out in the Audit Scotland good practice note on ‘Improving the quality of local authority accounts – integration joint boards’ (April 2018). In accordance with normal audit practice, some minor presentational amendments were agreed with management.

Follow up of prior year recommendations

25. We followed up actions reported in 2016/17 and assessed progress on implementation, appendix 1. Revised responses and timescales have been agreed with management.

26. Overall the Joint Board has made steady progress in implementing the agreed actions. There were ten agreed actions in 2016/17. Of these:

• five have been fully implemented

• five are not actioned or have only partly been actioned

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27. The outstanding actions are either in progress or there are implementation plans in place.

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Part 2 Financial management and sustainability | 11

Part 2 Financial management and sustainability

Financial management

28. Financial management is about financial capacity, sound budgetary processes and the control environment in operation over financial systems. It is the Joint Board's responsibility to ensure that its financial affairs are conducted in a proper manner.

29. The Joint Board is required by statute to make arrangements for the proper administration of its financial affairs and to appoint a “proper officer” to have “responsibility for the administration of those affairs” (section 95 of the Local Government (Scotland) Act 1973). For the South Lanarkshire Integration Joint Board, that officer is the Chief Financial Officer. Financial regulations and standing orders are comprehensive and mirror those of the partner bodies.

30. A statement providing guidance on the role of the Chief Financial Officer in local government was issued by CIPFA in 2016. The guidance is intended to support CFOs in the fulfilment of their duties. The statement sets out principles that define the core activities of the role of the CFO in local government, including:

• Being a key member of the leadership team.

• Promoting and delivering good financial management.

• Influencing business decisions and ensuring alignment with financial strategy.

• Leading and directing the finance function.

31. The integration scheme between NHS Lanarkshire and South Lanarkshire Council regulates the relationship between the partners. The Joint Board commissions delegated health and social care services from the partners using budget contributions allocated by the partners.

32. The Joint Board does not have any assets, nor does it directly incur expenditure or employ staff. All expenditure relating to services delegated to the

Main judgements

The Joint Board reported a surplus of £2.159 million for 2017/18.

A medium to long term financial plan should be developed to bring together risks and opportunities affecting the Joint Board’s financial position and financial sustainability.

The Joint Board should ensure that a comprehensive and detailed budget is set at the start of the financial year and that any changes to the budget are clearly mapped out in budget monitoring reports.

Key controls within the main financial systems of both partner bodies were operating satisfactorily.

Financial management is about financial capacity, sound budgetary processes and whether the control environment and internal controls are operating effectively.

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Joint Board is incurred by NHS Lanarkshire or South Lanarkshire Council and processed through the respective financial systems.

33. The Joint Board is responsible for financial and operational performance and for taking action to address variances from budget. In order to discharge this duty, it is essential that timeous and comprehensive budget monitoring information is submitted to the Joint Board. Budget monitoring reports featured on the agenda for all Joint Board meetings during 2017/18, with the exception of the special meetings, and follow a prescribed format which includes explanations for significant variances and a forecast for the year end outturn. This represents an improvement in the quality of budget monitoring information presented to the Joint Board in 2016/17.

34. Differing committee cycles mean that there can be time lags in excess of two months from the end of the financial reporting period and the date of the Joint Board meeting where the report is considered. The table at exhibit 4 shows the reporting dates for the partner bodies for each of the Joint Board meetings. The Joint Board should work with partners to align budget monitoring processes to minimise the delay between the end of the reporting period and the information being considered by the Joint Board. Management are considering how committee cycles could be aligned to ensure the timeliness of reporting.


Exhibit 4 Periods covered in budget monitoring reports

Joint Board meeting Health care reporting date

Social care reporting date

17 April 2018 28 February 2018 2 February 2018

13 February 2018 31 December 2017 9 December 2017

5 December 2017 30 September 2017 15 September 2017

12 September 2017 31 July 2017 21 July 2017

Source: Audit Scotland

Financial performance in 2017/18

35. In 2017/18 the Joint Board reported a surplus of income over expenditure of £2.159 million against a budget of £498.814 million.

36. During 2017/18 financial monitoring reports, which included a forecast year end outturn, were submitted to the Joint Board. These reports forecast an overspend position, mainly due to overspends in prescribing and social care. During the year NHS Lanarkshire contributed a further £1 million funding to off-set the prescribing overspend. This has the effect of reducing the overall underspend against original budget by £1 million.

37. The most significant variances from budget are within the health side of the Joint Board’s activities. Management advised in the final outturn report of a range of contributory factors including unfilled staff vacancies and equipment costs, however, the main reason was the delay in progressing the “Primary Care

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Transformation Fund” projects (£0.932 million). No specific reasons for the delay were provided.

38. The final outturn report indicated that the main contributory factor in the social care side was a £0.790 million underspend attributable to care home discharges being higher than expected; and higher than anticipated levels of contributions to care costs from service users.

Budget monitoring and scrutiny

39. Good financial management is fundamental to achieving strategic aims, demonstrating that public money is used well and establishing confidence in the public services. Fundamental to sound financial management is the preparation of a detailed budget to:

• demonstrate how much planned services will cost and how they will be financed

• demonstrate budget holder accountability

• trigger remedial action where needed

• facilitate scrutiny by members

40. It is the Chief Financial Officer’s responsibility to establish a strong framework for implementing and maintaining good financial management across the Joint Board. This includes provision of budgetary control information, at an appropriate level of detail, to both members and budget holders as required. To facilitate this the Chief Financial Officer should be provided with the appropriate level of financial information from the partner bodies.

41. The Joint Board’s budget for 2017/18 was set at the highest level. The Integrated Financial Plan considered by members in March 2017 set out budget assumptions and savings proposals. No detail was presented to, or approved by, members. This meant that the Joint Board was pursuing its strategic plan activities without a formally agreed detailed budget and continues to operate without an approved detailed budget for 2018/19.

42. The first high level line by line budget was presented to the Joint Board on 12 September 2017. In the absence of an approved detailed budget members had no way of knowing what variances were present in the interim figures. Effective scrutiny under these circumstances is not possible. The Joint Board should ensure that a comprehensive and detailed budget is set at the start of the financial year and that any changes to the budget are clearly mapped out in budget monitoring reports.


43. Notwithstanding, the absence of detailed budgets, the format and structure of the budget monitoring reports submitted to the Joint Board are of a good standard. However, a greater level of explanation for movements in under/overspends between periods would improve the ability of members to scrutinise and challenge service delivery and progress against goals.

44. At present performance monitoring reports are considered by both the Joint Board and the Performance and Audit Committee and there is evidence of good challenge around these reports. Instances have also been observed of members making their own links between financial monitoring information and performance reporting; this enhances the scope and quality of scrutiny. Having now embedded financial and performance reporting, the Joint Board should consider combining these to ensure that members have clear sight of the impact of variances against budget in terms of service performance. The opportunity for comprehensive

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scrutiny could be further enhanced by combining performance reporting with financial reporting.

45. Overall, the Joint Board’s budget monitoring arrangements need to be further enhanced to ensure that members are properly sighted on financial progress against plan throughout the year.

Efficiency savings

46. The Joint Board needs to make efficiency savings to maintain financial balance. In 2017/18 the Joint Board was expected to make efficiency savings of £2.625 million, (£2.127 million from health and £0.498 million from social care).

47. The 2018/19 financial plan was approved by the Joint Board in March 2018. This set out required savings of £0.649 million and £0.230 million from health and social care respectively. Proposals for achieving savings in social care services were agreed at the meeting. In June 2018 the Chief Financial Officer presented a report to the Joint Board which set out proposals for savings amounting to £0.539 million in health services. These were approved by the Joint Board leaving a budget deficit of £0.110 million to be addressed during the year.

48. It is important that efficiency savings are delivered in a planned way, to ensure that agreed levels of service provision are not compromised. In terms of the overall budget of the Joint Board the required savings are modest and achievable. There is, however, currently no reporting to the Joint Board on whether savings targets are being met, how these are being achieved and whether there are any unpredicted consequences.


Financial planning

49. In 2016/17 we reported the importance of a medium to long term financial plan to support longer term planning for the Joint Board. This was included as an action point and the Joint Board agreed to develop a medium to long term plan by December 2017. Management have advised that work is still ongoing to develop a medium term financial plan. One of the challenges for the Joint Board is the shortterm financial planning cycle of the Scottish Government and the resulting uncertainty over future NHS budgets. We understand that the Scottish Government intends to issue a five year financial plan for the NHS shortly, which the Chief Financial Officer will use to inform the longer term financial plan of the Joint Board. The action point from 2016/17 has been carried forward for action in 2018/19.

Reserves strategy

50. The Joint Board is empowered to hold reserves. The Reserves Policy was approved by the Joint Board in February 2017 and the Reserves Strategy for 2018/19 was approved by the Joint Board in June 2018.

51. The Strategy sets out the level of reserves held at 31 March 2018 and the planned use of the reserves. At 31 March 2018 the Joint Board held £8.278 million in the General Fund, £5.447 million of which was earmarked for specific purposes in 2017/18 and a further £1.113 million was earmarked for use in 2018/19. Ring-fenced funding of £1.167 million was also held, mainly relating to the Primary Care and Mental Health Transformation Fund (£0.932 million). The remaining balance of £0.551 million has not been allocated for a specific purpose.

52. Of the £5.447 million earmarked for use in 2017/18, only £0.121 million was spent in year. The remaining balance has been carried forward to 2018/19 to be spent on the same intended purpose.

Financial sustainability looks forward to the medium and longer term to consider whether the body is planning effectively to continue to deliver its services or the way in which they should be delivered.

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Exhibit 6 Summary of Reserves

Reserve 2016/17

£m

2017/18

£m

Earmarked Reserves 2017/18

Primary Care and Mental Health Transformation Fund 2.749 2.749

Alcohol and Drug Partnership Fund 0.473 0.473

Family Health Services 0.015 0.015

Prescribing Fund 0.636 0.636

Transitional Fund 0.696 0.575

Telehealth Project 0.191 0.191

Palliative Care Services - 0.808

Earmarked Reserves for 2018/19

Social Care Contingency - 0.701

Training Fund – Health Visitors - 0.220

Increase to Prescribing Fund - 0.100

IT Federated Trust Environment - 0.070

Diabetes Capacity Plan - 0.022

Ring-fenced Reserves for 2018/19

Primary Care and Mental Health Transformation Fund - 0.932

TEC British Heart Foundation Funds - 0.042

TEC Antenatal Pilot - 0.017

Physio Trauma and Orthopaedics Pilot - 0.093

OT Trauma and Orthopaedics Pilot - 0.083

Unallocated

Contingency 1.359 0.551

Total Reserves 6.119 8.278

Source: South Lanarkshire Joint Board 2018/19 Reserves Strategy

53. The CIPFA Local Authority Accounting Panel (LAAP) bulletin 99 provides guidance on the establishment and maintenance of reserves. It does not prescribe the level of reserves, but places the responsibility on the Chief Financial Officer to

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advise the Joint Board on the creation and levels of reserves appropriate to the Joint Board’s circumstances. The bulletin recognises that “earmarked” reserves are a valid way to meet known or predicted requirements.

54. As part of the annual budget setting process, a review of reserves, including earmarked balances, should be undertaken and reported to the Joint Board. The Joint Board should ensure that where funds are earmarked for a specific purpose to support service transformation and delivery, that these are used as planned to deliver the intended service benefits. If not, they should not be classified as earmarked balances.


Systems of internal control

55. All financial transactions of the Joint Board are processed through the financial systems of NHS Lanarkshire and South Lanarkshire Council. As part of our audit approach we sought assurances from the external auditors of NHS Lanarkshire and South Lanarkshire Council. We concluded that the key controls within the main financial systems of the partner bodies were operating satisfactorily and that no significant risks were identified.

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Part 3 Governance, transparency and value for money | 17

Part 3 Governance, transparency and value for money

Governance arrangements

56. The integration scheme between South Lanarkshire Council and NHS Lanarkshire sets out governance arrangements. The Joint Board is responsible for establishing arrangements for ensuring proper conduct of its affairs and for monitoring the adequacy of these arrangements. The Joint Board’s governance arrangements and procedures are regulated by a set of procedural documents including a Scheme of Delegation; Standing Orders; Terms of Reference: and Financial Regulations.

57. The Joint Board is responsible for the strategic commissioning of health and social care services in South Lanarkshire and is supported by a number of groups, exhibit 7. It is responsible for setting priorities and policies in the context of legislative requirements and has an obligation to report, explain and be answerable for decisions. It comprises a wide range of service users and partners including four elected councillors nominated by South Lanarkshire Council and four directors nominated by NHS Lanarkshire.

58. The Joint Board is supported by a Chief Officer who provides overall strategic and operational advice to the Joint Board and is directly accountable for the delivery of services. The Chief Officer is also accountable to both the Chief Executive of South Lanarkshire Council and the Chief Executive of NHS Lanarkshire and provides regular reports to both the Council and the Board of NHS Lanarkshire.

59. The Joint Board and Performance and Audit Committee meet on a regular basis throughout the year. We attend meetings of the Joint Board, mainly as observers and we attend and contribute to the Performance and Audit Committee throughout the year.

60. In April 2018 officers ran a development session for Joint Board members which aimed to develop a shared understanding of the role and function of the Joint Board and how this links with the partner organisations, South Lanarkshire Council and NHS Lanarkshire. A programme of quarterly development sessions is planned, with members consulted on proposed topics at the meeting of the Joint Board in September 2018. These development sessions will support members in ensuring that they have the necessary knowledge and understanding to discharge their responsibilities as members of the Joint Board.

Main judgements

The Joint Board has satisfactory governance arrangements in place.

The Joint Board is open and transparent however, current arrangements could be further enhanced.

The Joint Board should develop its own mechanism to demonstrate that it is meeting its Best Value duties.

Oversight and scrutiny of performance is expected to be enhanced with the introduction of the partnership performance reporting framework.

Governance and transparency is concerned with the effectiveness of scrutiny and governance arrangements, leadership and decision-making and transparent reporting of financial and performance information.

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Exhibit 7 Committees and groups at South Lanarkshire Integration Joint Board

Source: Audit Scotland

61. Last year we suggested that the Joint Board should review how it is organised to conduct its work and whether it could work more effectively through greater use of committees. In response to our recommendation, a paper was presented to the Joint Board in September 2018 recommending that the role of the Performance and Audit Committee be extended to include responsibility for scrutinising financial information and any other items which would benefit from further scrutiny. In our view, this change will help to ensure more effective scrutiny while managing the workload of the Joint Board.

62. We concluded that, overall, the Joint Board has satisfactory governance arrangements in place. The Joint Board should monitor the impact of the changes to the governance arrangements set out above to ensure they are delivering the intended outcome.

Refreshed strategic plan

63. The Joint Board approved the 2016-19 Strategic Commissioning Plan in March 2016. In recognition of the plan entering its third and final year, a refreshed plan for 2018-19 was approved by the Joint Board in March 2018. The plan identifies ten strategic priorities linked to the Scottish Government's nine health and wellbeing outcomes. These are:

• Statutory / core work

• Early intervention, prevention and health improvement

• Carers support

• Models of self-care and self-management

• Seven-day services

• Intermediate care to reduce reliance on hospital and residential care

Joint Board

Clydesdale Locality Planning Group

East Kilbride Locality Planning Group

Hamilton/Blantyre Locality Planning Group

Rutherglen/Cambuslang Locality Planning Group

Performance and Audit Committee

Strategic Planning Advisory Group

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• Suitable and sustainable housing

• Single points of contact

• Mental health and wellbeing

• Enablers to support better integrated working

64. The refreshed strategic plan aims to build on the experiences of the first two years of integration and reflects changes in national and local policies. Key areas for development are included in the plan which provide a focus for the year ahead and are useful stepping stones for the development and approval of the 2019-2022 Strategic Commissioning Plan. Key areas identified for continuing development include: changing cultures; strengthening the locality model; and, shifting the balance of care.

Value for money and performance management

65. The Local Government in Scotland Act 2003 places local authorities, including joint boards, under a duty to make arrangements that secure Best Value and defines Best Value as "continuous improvement in the performance of the authority's functions". The audit findings included throughout this report, comment on arrangements that have been put in place by the Joint Board to secure Best Value in areas such as the financial position, financial management, governance and performance management arrangements.

66. While there is evidence of elements of Best Value being demonstrated by the Joint Board, there is no overall mechanism for formal review. Reliance is placed on the arrangements adopted by the partners to demonstrate that services are delivering Best Value. Mechanisms and reporting arrangements should be implemented to provide assurance, to the Chief Officer and the Joint Board that Best Value is being secured for the Joint Board. This was raised as an action point in 2016/17 and is included at appendix 1 as an outstanding action. Management has agreed to undertake a formal review in 2018/19 to demonstrate how the duty of Best Value is being met.

67. The Public Bodies (Joint Working) (Scotland) Act 2014 requires that an annual performance report is published by 31 July each year. The Joint Board’s annual performance report was published on the website ahead of the statutory deadline of 31 July 2018. In the main, the annual performance report covers the key areas set out in statutory guidance. However, there are some areas where content and presentation could be further developed to provide a more informative and user friendly publication.


68. During 2017/18 performance management was delivered through a combination of arrangements within the partnership bodies and the Joint Board.

69. The Joint Board receives bi-monthly performance reports which track progress against the six priority measures as determined by the Scottish Government ministerial group. The reports show actual performance compared to target and provides a useful graphic of performance trends since April 2015. The indicators currently reported are:

• unplanned admissions

• delayed discharges

• occupied bed days for unscheduled care

• end of life care

Value for money is concerned with using resources effectively and continually improving services.

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• accident and emergency performance

• the balance of spend across institutional and community services

70. In May 2018 the Performance and Audit Committee approved a refreshed performance reporting framework with the objective of having greater oversight of performance. The new reporting framework measures a suite of indicators at organisation, senior management and locality levels based on:

• strategic indicators relating to the Commissioning Plan which will be monitored on a 6-monthly basis

• a mix of strategic and operational measures by partnership area and the 4 localities which will be monitored on a quarterly basis.

71. Performance monitoring information reported to the Joint Board in June 2018 highlighted the following:

• A&E attendances are up year to year by 4%. The latest reported information is for October 2017 which indicated A&E attendances at 8,866 against a target of 8,015

• Unscheduled bed days decreased by 6% year on year and are continuing to reduce

• Delayed discharge bed days have reduced significantly. As at March 2018 the Joint Board saw a reduction of 1,795 bed days lost compared to the same period in 2017. This represents a 44% reduction in bed days lost and reflects the ongoing trend since December 2017

• The number of people spending the last six months of life in the community is increasing

• South Lanarkshire community based service provision remains just under 98% which is broadly in line with other large partnerships.

72. At an operational level, a quarterly Chief Executive Performance Review is compiled for a suite of 71 indicators which indicates performance against the 9 strategic outcomes. The 2017/18 year end report, exhibit 8, indicates:

• 42 (59%) showing improved performance

• 7 (10%) showing “minor” slippage

• 10 (14%) showing major slippage

• the remaining 12 (17%) are contextual or not currently available.

73. In 2016/17 we commented on the high level of delayed discharges within South Lanarkshire and noted the steps taken by the Joint Board to reduce these delays. The reduction in delayed discharges suggest that the Joint Board’s actions are having a positive impact. Overall, the Joint Board’s reported performance against some key indicators is encouraging although it continues to face challenges in reducing A&E attendance and hospital admissions.

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Exhibit 8 Performance: Q4 in 2017/18 compared to Q4 in 2016/17

Source: Quarterly CE Dashboard Report Q4 2017/18

Transparency

74. Transparency means that the general public has access to understandable, relevant and timely information about how the Joint Board is taking decisions and how it is using resources.

75. In 2016/17 we recommended that the Joint Board should develop its own website to ensure that interested citizens had better access to information relating to the Joint Board. The Joint Board launched its own website in December 2017 and the Chief Officer has advised that the feedback on the website has been very positive. Agendas and minutes for all Joint Board and Performance and Audit Committee meetings are available to the public through the website.

76. The launching of the website and the availability of agendas and minutes is good progress. Management are considering what further enhancements could be made to the website to ensure that it continues to contain useful and informative content for citizens and other stakeholders moving forward.


77. Overall, we concluded that the Joint Board conducts its business in an open and transparent manner. We expect openness and transparency to be further developed as the organisation matures and a wider public understanding of its functions develops.

Internal audit

78. Internal audit provides the Joint Board, the Chief Officer and the Chief Financial Officer with independent assurance on the organisation’s overall risk management, internal control and corporate governance processes. The internal audit function is carried out on a joint basis by the Chief Auditors of South Lanarkshire Council and NHS Lanarkshire. A formal review of the adequacy of internal audit was completed for the Integration Joint Board in January 2018. In addition, the external auditors of the partners have completed assessments of their respective bodies. All assessments found that internal audit services operate in accordance with Public

Major slippage Minor slippage

Performance improved Contextual / unavailable

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Sector Internal Audit Standards (PSIAS) and have sound documentation standards and reporting procedures in place.

79. To avoid duplication of effort we place reliance on the work of internal audit wherever possible. In 2017/18 we placed formal reliance on internal audit’s work on Strategic Planning and Commissioning and Financial Planning. We also considered internal audit report findings as part of our wider dimension work.

Standards of conduct and arrangements for the prevention and detection of bribery and corruption

80. As auditors of the Joint Board, we obtain assurances from the auditors of the partner bodies in respect of internal controls and aspects of governance arrangements. Each partner body has a code of conduct for members and staff which sets out the standards expected in undertaking their duties.

Cyber security

81. The Scottish Government issued a Public Sector Action Plan on Cyber Resilience in November 2017. This requires all public sector bodies to carry out a review to ensure their cyber security arrangements are appropriate. As set out above, the Joint Board does not have any of its own systems so relies on the ICT arrangements in the partner organisations. The interim audit reports of NHS Lanarkshire and South Lanarkshire Council noted that they are on target to secure the Cyber Essentials and Cyber Essentials Plus accreditations respectively, by October 2018 in accordance with the Scottish Government target.

General Data Protection Regulation

82. The EU General Data Protection Regulation (GDPR) came into force across all member states on 25 May 2018. GDPR contains provisions and requirements pertaining to the processing of personally identifiable information and has introduced new and significantly changed data protection concepts.

83. The Director of Health and Social Care took a report to the Joint Board in June 2018 on the implications of GDPR for the Joint Board. The Joint Board approved the appointment of a Data Protection Officer and a Senior Risk Officer for the Joint Board in line with recommendations of the Information Commissioner’s Office. The Joint Board is clearly sighted on its obligations in respect of GDPR and is taking the necessary steps to remain compliant.

National performance audit reports

84. Audit Scotland carries out a national performance audit programme on behalf of the Accounts Commission and the Auditor General for Scotland. In 2017/18 we published some reports which are of direct interest to the Joint Board, appendix 3.

85. Review of agendas for the Joint Board and the Performance and Audit Committee meetings in 2017/18 established that relevant national reports such as the Overview of NHS in Scotland (November 2017) had not been considered by the members. The Joint Board should develop protocols to ensure that all national reports which are relevant to the Joint Board are considered by members and any necessary action taken to address the recommendations of the report.


Health and Social Care Integration performance audit

86. Audit Scotland, as part of a series of reports, has undertaken a national study to examine the impact of the integration of health and social care services. South Lanarkshire Integration Joint Board was visited as part of the fieldwork

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https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0ahUKEwihp7eo5IrbAhWmI8AKHZ1YDioQFggyMAI&url=https%3A%2F%2Fbeta.gov.scot%2Fpublications%2Fcyber-resilience-strategy-scotland-public-sector-action-plan-2017-18%2F&usg=AOvVaw0It_qu0mHDaKmcJfxbJ9S-

https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=3&cad=rja&uact=8&ved=0ahUKEwihp7eo5IrbAhWmI8AKHZ1YDioQFggyMAI&url=https%3A%2F%2Fbeta.gov.scot%2Fpublications%2Fcyber-resilience-strategy-scotland-public-sector-action-plan-2017-18%2F&usg=AOvVaw0It_qu0mHDaKmcJfxbJ9S-


for the study. The report is due to be published in November 2018 and will reflect on leadership and collaboration, integrated finances and strategic planning.

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24 |

Appendix 1 Action plan 2017/18

2017/18 recommendations for improvement

No.

Issue/risk

Recommendation

Agreed management action/timing

1 Hospital acute services (set aside)

The total Joint Board expenditure includes “set aside” costs for hospital acute services. The figure is an estimate, based on 2015/16 activity levels.

Risk

In future years the sum set aside recorded in the annual accounts will not reflect actual activity levels.

NHS Lanarkshire and the Joint Board should continue to build on the progress made in developing a methodology for identifying relevant activity, in accordance with Scottish Government guidance.

Opportunities will continue to be progressed in order to capture activity levels and costs as accurately as possible and to comply with emerging guidance on the “set aside” budget. Progress in this regard still continues to rely on the information from ISD on activity levels.

Chief Financial Officer in consultation with the NHS Lanarkshire Director of Finance

March 2019

2 Accounting for hosted services

The South Lanarkshire Integration Scheme is not explicit on the arrangements for over or underspends in respect of hosted services.

Risk

Over/underspends on hosted services become an area of dispute.

The Joint Board should ensure that there is a formal minute of agreement with North Lanarkshire Integration Joint Board and NHS Lanarkshire around how under and overspends on hosted services will be managed.

A formal minute of agreement with North Lanarkshire Integration Joint Board and NHS Lanarkshire will be developed.

Chief Financial Officer

February 2019

3 Budget monitoring reporting periods

Timeous budget monitoring is essential to ensure that action can be taken promptly to address concerns around variances from budget.

Risk

Variances against budget are not identified in sufficient time

The Joint Board should work with partners to align budget monitoring processes to minimise the delay between the end of the reporting period and the information being considered by the Joint Board.

A review of the reporting schedules for the Joint Board and the partners will be undertaken to minimise potential delays. The remit of the Performance and Audit Sub-Committee will also be considered as part of this review.


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Appendix 1 Action plan 2017/18 | 25

No.

Issue/risk

Recommendation


to allow corrective action or re-allocation of resources.

February 2019

4 Budget setting and scrutiny

The Joint Board’s budget for 2017/18 was set at the highest level. No detail was presented to, or approved by, members.

Risk

Members are unable to effectively scrutinise and challenge officers on performance.

The Joint Board should ensure that a comprehensive and detailed budget is set at the start of the financial year and that any changes to the budget are clearly mapped out in budget monitoring reports.

A review will be undertaken to further develop the financial monitoring arrangements for the Joint Board.


March 2019

5 Efficiency savings

There is no reporting to the Joint Board on whether savings targets are being met, how these are being achieved and whether there are any unpredicted consequences.

Risk

Savings are not being delivered in accordance with decisions taken by the Joint Board.

The Joint Board should develop reporting arrangements to demonstrate how planned efficiency savings are being met.

The progress in respect of the achievement of planned efficiency savings will be included in the financial monitoring reports to the Joint Board.


December 2018

6 Reserves

The Joint Board held reserves amounting to £8.278 million at 31 March 2018, £5.998 million of which was brought forward from 2016/17 for “earmarked” purposes.

Risk

Reserves are not being used for the purpose originally intended and anticipated service benefits are not realised.

As part of the annual budget setting process, a review of reserves, including earmarked balances, should be undertaken and reported to the Joint Board. The Joint Board should ensure that where funds are earmarked these are used as planned to deliver the intended service benefits.

A review of earmarked reserves will be undertaken and reported to the Joint Board as part of the annual budget setting process.


December 2018

7 Public performance reporting

The Joint Board’s annual performance report was published on the website ahead of the statutory deadline of 31 July 2018. There are some areas where content and presentation could be further developed to provide a more

The Joint Board should review the structure and content of its public performance report and consider whether it could be improved to better inform stakeholders.

A review will be undertaken to further develop the public performance report.

Chief Officer

March 2019

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26 |

No.

Issue/risk

Recommendation


informative and user friendly publication.

Risk

Public performance reporting does not meet best practice and citizens are poorly informed.

8 Transparency

Further information, could usefully be included on the website.

Risk

The organisation is perceived as not being open and transparent.

Management should consider what enhancements to publicly accessible information could be made.

Opportunities will be considered to continue to enhance the website.

Chief Officer

March 2019

9 Consideration of national reports

National reports are not currently being considered by members of the Joint Board.

Risk

Findings and recommendations of national studies which are relevant to the Joint Board are not considered and taken forward.

The Joint Board should develop protocols to ensure that all national reports which are relevant to it are considered by members and any necessary action taken to address the recommendations of the report.

Arrangements will be established to ensure national reports are formally presented to the members of the Joint Board as appropriate. The remit of the Performance and Audit Sub-Committee will also be considered as part of this development.

Chief Officer

March 2019

Follow up of prior year recommendations

b/f Hospital acute services (set aside)

Included within the total Joint Board expenditure of £467.469 million is £55.154 million ‘set aside’ costs for hospital acute services.

The figure is, essentially an estimate, based on 2014/2015 activity levels for hospital inpatient and day case activity and provided by NHS National Services Scotland’s Information Services Division.

Risk

In future years the sum set aside recorded in the annual

NHS Lanarkshire and the Joint Board should prioritise establishing revised processes for planning and performance management of delegated hospital functions and associated resources in 2017/18.

Agreed

Work is ongoing to develop a more robust measurement of the use of hospital acute services.

This development relies on the information from ISD on activity levels.

Responsible Officer

Chief Financial Officer in consultation with the NHS Lanarkshire Director of Finance

Timing

December 2017

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No.

Issue/risk

Recommendation


accounts will not reflect actual hospital use.

Audit Comments 2017/18: The Joint Board has been working with NHS Lanarkshire during the year to develop a robust measurement of the use of hospital acute services. Work has progressed but is not yet complete. The Scottish Government consented to transitional arrangements being extended to 2017/18 so the accounting treatment applied within 2017/18 is in accordance with the guidance.

b/f Budget monitoring

During the year incomplete budget monitoring information was reported in respect of Health Care Services and it was not possible to reconcile budget/expenditure to the delegated budget for the Joint Board.

Risk

The Chief Financial Officer is not able to provide members with information sufficient to enable them to scrutinise and challenge performance effectively or consider in-year re-allocation resources to other service areas.

Financial information reporting processes from partners should be improved to ensure that the Chief Financial Officer is being provided with complete, relevant and timely financial information.

Agreed

The financial monitoring arrangements continue to be refined to ensure the in-year financial reporting is accurate and complete and financial risks continue to be effectively managed.

NHS Lanarkshire also recognise the value of providing a financial projection to 31 March and are progressing this.

The Chief Financial Officer is developing a new financial reporting template for the Joint Board.

Responsible Officer

Chief Financial Officer in consultation with the NHS Lanarkshire Director of Finance and the South Lanarkshire Council Executive Director (Finance and Corporate Resources)

Timing

September 2017 to December 2017

Audit Comments 2017/18: Management has been refining budget monitoring arrangements throughout the year, in collaboration with its partner bodies.

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28 |

No.

Issue/risk

Recommendation


Action complete

b/f Members training

It is important that members understand the financial information presented in budget monitoring reports and are equipped with the knowledge and skills to enable them to effectively scrutinise and challenge.

Risk

Members do not have a sufficient understanding of information being presented to them to enable them to properly challenge and/or make decisions.

Members should be provided with specific financial training to help them discharge their financial responsibilities.

Agreed

A programme is being developed to ensure the Joint Board members receive appropriate support to fulfil their responsibilities.

Responsible Officer


Timing

September 2017 to March 2018

Audit Comments 2017/18: Management has introduced a programme of development sessions to support members in their role. Action complete

b/f Medium to long term financial planning

The Joint Board has no financial plans in place beyond 2017/18.

Risk

In the absence of medium to long term financial planning the future financial risks facing Joint Board may not be clearly understood.

Management should prepare a 3-5 year rolling budget using what information is available and incorporating sensitivity analysis and scenario planning.

Agreed

A medium to long term financial plan is being developed. This relies on the financial planning assumptions of each partner.

Responsible Officer


Timing

December 2017

Audit Comments 2017/18: The medium to long term plan is not yet in place but is in the process of being developed.

Agreed action and timescale:

The medium financial plan will be developed and reported to the Joint Board in advance of the 2019/2020 annual budget setting process. This will continue to rely on the financial planning assumptions of each partner.

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No.

Issue/risk

Recommendation



March 2019

b/f Meetings

Joint Board meetings are attended by in excess of thirty people. Extensive agendas include varied, and sometimes complex papers for discussion and decisions.

Risk

Loss of focus on strategic issues at Joint Board level.

The Joint Board should review how it is organised to conduct its work and whether it could work more effectively through greater use of committees.

Agreed

Following the first year of operation, a review of the Joint Board arrangements will be undertaken to ensure business is conducted effectively.

Responsible Officer

Chief Officer

Timing

December 2017

Audit Comments 2017/18: There are now name plates for each of the Joint Board members at the meetings. This ensures clarity over who sits on the Joint Board. At present key stakeholders attend Joint Board meetings and sit round the table however there is ongoing discussion on how meetings should be managed.


An agreed programme of development sessions for the members of the Joint Board will be held throughout 2018/2019.

Chief Officer

March 2019

b/f Internal Audit

Protocols have not yet been developed to provide a framework within which the internal audit service is provided.

Risk

Lack of clarity over responsibilities, planning and

The Joint Board should review internal audit arrangements and ensure that the internal audit work is deliverable within the required timescales.

Agreed

Internal audit protocols will be finalised and presented to the Audit and Performance Committee.

Responsible Officer

South Lanarkshire Council Audit Manager and NHS

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30 |

No.

Issue/risk

Recommendation


conducting work and the reporting of results.

Lanarkshire Chief Internal Auditor

Timing

December 2017

Audit Comments 2017/18: Protocols now in place for how the Internal Audit service will be delivered. Internal Audit Charter taken to the Performance and Audit Committee Feb 2018.

Action complete

b/f Website

The Joint Board does not have its own website.

Risk

Service users, members and staff have difficulty in accessing information.

The Joint Board’s status is as leader in health and social care is diluted.

The Joint Board should consider whether a dedicated website would afford interested citizens and stakeholders better access to information.

Agreed

The Joint Board website is already being developed.

Responsible Officer

Communications Officer

Timing

December 2017

Audit Comments 2017/18: The website was launched December 2018. Action complete

b/f Public accessibility

A number of public sector organisations broadcast meetings live on the web and/or make recordings of meetings available via their websites.

Risk

The Joint Board is seen as remote from its stakeholders.

As part of the commitment to openness and transparency the Joint Board should consider whether greater public engagement could be achieved through promotion of public attendance at meetings and/or the use of technology to reach a wider audience.

Agreed

Consideration will be given to further developing effective engagement with the public.

Responsible Officer

Chief Officer

Timing

March 2018

Audit Comments 2017/18: With the exception of the introduction of the website, which includes the agenda notice for Joint Board meetings, there has been no change to the public accessibility arrangements for meetings.

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No.

Issue/risk

Recommendation



Opportunities to further enhance the public accessibility arrangements for meetings will be considered.

Chief Officer

March 2019

b/f Best Value

The Joint Board should have systems and processes to ensure that it can demonstrate that it is delivering Best Value by assessing and reporting on the economy, efficiency, effectiveness and equality in service provision.

Risk

Opportunities for improvement through Best Value review are missed.

Mechanisms and reporting arrangements should be implemented to provide assurance, to the Chief Officer and the Joint Board, that partners have arrangements in place to demonstrate that they are delivering Best Value.

Agreed

A Best Value Framework will be developed which demonstrates that each partner is securing economy, efficiency, effectiveness and equality in service provision.

Responsible Officer

Chief Officer

Timing

March 2018

Audit Comments 2017/18: There is currently no formal best value framework in place to demonstrate that the Joint Board is meeting its statutory duty to deliver best value. The Chief Financial Officer plans to undertake an exercise to document the arrangements in place to demonstrate that best value is being achieved.


A mechanism to demonstrate that the Joint Board is meeting its Best Value duties will be established.


March 2019

b/f Annual Performance Report

The statutory publication deadline for the Annual Performance Report was missed for 2016/17.

Arrangements should be put in place to ensure that the Joint Board meets its statutory reporting responsibilities in future years.

Agreed

A timeline will be agreed to ensure the Annual Performance Report is

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32 |

No.

Issue/risk

Recommendation


Risk

Failure to achieve statutory deadlines.

published by 31 July each year.

Responsible Officer

Head of Commissioning and Performance

Timing

December 2017

Audit Comments 2017/18: The Board has made significant progress in drafting and agreeing the annual performance report for 2017/18 and is well sighted and on-target to ensure that it is published by 31 July 2018.

Action complete

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Appendix 2 Significant audit risks identified during planning | 33

Appendix 2 Significant audit risks identified during planning

The table below sets out the audit risks we identified during our planning of the audit and how we addressed each risk in arriving at our conclusion. The risks are categorised between those where there is a risk of material misstatement in the annual accounts and those relating our wider responsibility under the Code of Audit Practice 2016.

Audit risk Assurance procedure Results and conclusions

Financial statement issues and risks

1 Risk of management override of controls

ISA 240 requires that audit work is planned to consider the risk of fraud, which is presumed to be a significant risk in any audit. This includes consideration of the risk of management override of controls.

Detailed testing of journal entries.

Service auditor assurances will be obtained from the auditors of NHS Lanarkshire and South Lanarkshire Council over the completeness, accuracy and allocation of the income and expenditure.

Assurances obtained from service auditors over the adequacy of controls in place within the partner bodies. No issues identified which would impact on the integrity of the Joint Board financial statements identified.

2 Risk of fraud over expenditure Code of Audit Practice expands the ISA assumption on fraud over income to aspects of expenditure.

The expenditure of the JOINT BOARD is processed through the financial systems of NHS Lanarkshire and South Lanarkshire Council. There is a risk that non-Joint Board related expenditure is incorrectly charged to the Joint Board account codes.

Obtain assurances from the auditors of NHS Lanarkshire and South Lanarkshire Council over the accuracy, completeness and appropriate allocation of the Joint Board ledger entries.

Assurances obtained from service auditors over the adequacy of controls in place within the partner bodies. No issues identified which would impact on the integrity of the Joint Board financial statements identified.

3 Reporting timetable There are a number of reporting deadlines which must be met to enable the annual accounts to be prepared, agreed with partner organisations and submitted for audit. In addition, the Joint Board is required to publish its Annual Performance Report by 31 July.

There is a risk that reporting deadlines are not met.

Engage with officers prior to the accounts being prepared to ensure that arrangements are in place to meet all agreed timescales.

Engaged with Chief Financial Officer during the year to ensure there was a clearly understood reporting timetable. Accounts delivered to audit in accordance with the timetable.

During the course of the year the Joint Board has been considering drafts of the 2017/18 Annual Performance Report to ensure the deadline of the 31st July was met.

4 Hospital acute services (set aside) The “set aside” budget is the Integration Joint Board’s share of the budget for delegated

Engage with officers to ensure that a robust mechanism has been developed to quantify South Lanarkshire Integration

The Joint Board has been working with NHS Lanarkshire to determine an approach to quantifying activity and cost for

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34 |

Audit risk Assurance procedure Results and conclusions

acute services provided by large hospitals on behalf of the Joint Board. The budget and actual expenditure reported for the “set aside” were equal in 2016/17: the amount set aside, was based on 2014/15 activity levels and provided by NHS National Services Scotland’s Information Services Division. There is a risk that the income and expenditure of the Joint Board is misstated due to the lack of current activity information.

Joint Board’s set aside income and expenditure.

Monitor Scottish Government guidance on the treatment of set aside in the 2017/18 financial statements to establish whether the financial statements are compliant.

the set-aside activity. The Scottish Government issued guidance in late 2017/18 which permitted joint board s and health boards to continue with transitional arrangements which was to take 2015/16 activity data compiled by ISD and uprate this for 2017/18 costs. This is the approach that has been taken in 2017/18.

Risks identified from the auditor's wider responsibility under the Code of Audit Practice

5 Demonstrating the delivery of Best Value

The statutory duty of Best Value applies to all public bodies in Scotland. There is a risk that, the Joint Board is unable to demonstrate that it is meeting its statutory duty to deliver Best Value.

Monitor guidance on the Integration Joint Board’s statutory duty on best value. Engage with officers to ensure that the Board has appropriate arrangements in place to demonstrate that it is meeting its statutory duty on delivering Best Value.

A position statement will be reported in the Annual Audit Report.

There is currently no formal approach in place to demonstrate the delivery of best value.

.

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Appendix 3 Summary of national performance reports 2017/18 | 35

Appendix 3 Summary of national performance reports 2017/18

Reports relevant to Integration Joint Boards

Self-directed support: 2017 progress report – August 2017

NHS in Scotland 2017 – October 2017

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http://www.audit-scotland.gov.uk/report/self-directed-support-2017-progress-report

http://www.audit-scotland.gov.uk/report/nhs-in-scotland-2017

36 |

South Lanarkshire Integration Joint Board 2017/18 Proposed Annual Audit Report

If you require this publication in an alternative format and/or language, please contact us to discuss your needs: 0131 625 1500 or [email protected]

For the latest news, reports and updates, follow us on:

Audit Scotland, 4th Floor, 102 West Port, Edinburgh EH3 9DN T: 0131 625 1500 E: [email protected] www.audit-scotland.gov.uk

AS.1.4

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mailto:info%40audit-scotland.gov.uk?subject=


https://auditscotland.wordpress.com/

https://twitter.com/AuditScotland

https://www.facebook.com/Audit-Scotland-1649085352037675/timeline/

https://uk.pinterest.com/AuditScotland/

https://www.linkedin.com/company/audit-scotland

https://public.govdelivery.com/accounts/UKAS/subscriber/new?pop=t

Report

Agenda Item

7


Subject: Audited Annual Accounts 2017/2018


advise members of the requirement to approve the Annual Accounts 2017/2018 for signature


(1) that the Audited Annual Accounts 2017/2018 be approved for signature; and (2) that it be noted that the Signed Audited Annual Accounts 2017/2018 will be

advertised as being available to the general public in Health and Social Care Partnership, Floor 8, Council Offices, Almada Street, Hamilton, and also on the Integration Joint Board website.

[1recs] 3. Background 3.1. Following the publication of the Local Authority Accounts (Scotland) Regulations

2014, the members of the Integrated Joint Board (IJB) have to meet to consider whether to approve the Audited Annual Accounts for signature no later than 30 September 2018.

4. Annual Accounts 2017/2018 4.1. The Annual Accounts 2017/2018 were prepared in accordance with the requirements

of the Local Government (Scotland) Act 1973 and the Local Government in Scotland Act 2003. This means that suitable accounting policies were selected and applied consistently, reasonable and prudent judgements were made and proper accounting records were maintained. The preparation of the Annual Accounts also met the statutory deadlines of 30 June 2018 and 30 September 2018.

4.2. The unsigned Audited Annual Accounts 2017/2018 are attached as an appendix. 4.3. The External Auditor has concluded that the financial statements of the South

Lanarkshire IJB for 2017/2018 give a true and fair view of the state of affairs and of its net expenditure for the year and have therefore issued an unqualified independent auditor’s report. The findings of the audit process have also been reported to the IJB and an action plan approved as set out in the External Auditor’s Annual Audit Report.

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5. Summary and Next Steps 5.1. Once signed, the Audited Annual Accounts 2017/2018 will be advertised as being

available to the general public in the Health and Social Care Partnership, Floor 8, Council Offices, Almada Street, Hamilton. The signed Audited Annual Accounts 2017/2018 will also be available on the IJB’s website.

6. Employee Implications 6.1. There are no employee implications associated with this report. 7. Financial Implications 7.1. There are no financial implications associated with this report. 8. Other Implications 8.1. The main risk associated with the IJB Annual Accounts is a qualified audit report.

The risk has been assessed as low due to the detailed preparation in relation to the year end process and technical training undertaken by key finance staff. The finance staff across the partners co-operated to achieve key deadlines.

8.2. There are no sustainable, environmental or other implications associated with this


change to an existing policy, function or strategy and, therefore, no impact assessment is required.

9.2. There is also no requirement to undertake any consultation in terms of the

information contained in this report. 10. Directions 10.1. This report does not issue a new Direction.

Direction to:



3. NHS Lanarkshire


Val de Souza Director, Health and Social Care Date created: 08 August 2018

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Link(s) to National Health and Wellbeing Outcomes










Previous References

IJB report 26 June 2018 – Unaudited Annual Accounts 2017/2018 List of Background Papers

Unsigned Audited Annual Accounts 2017/2018 Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Marie Moy, Chief Financial Officer Ext: 3709 (Phone: 01698 453709) Email: [email protected]

- 89 -

- 90 -

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD

ANNUAL ACCOUNTS AUDITED

2017/2018

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SOUTH LANARKSHIRE INTEGRATION JOINT BOARD ANNUAL ACCOUNTS 2017/2018

Page | 2

SOUTH LANARKSHIRE INTEGRATION JOINT BOARD

ANNUAL ACCOUNTS 2017/2018

Page

Management Commentary

3

Statement of Responsibilities

12

Remuneration Report

13

Annual Governance Statement

17

Comprehensive Income and Expenditure Statement 25

Movement in Reserves Statement 26

Balance Sheet 27

Notes to the Accounts

28

Independent Auditor’s Report 40

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Page | 3

MANAGEMENT COMMENTARY Introduction The South Lanarkshire Integration Joint Board (IJB) was established as a body corporate by order of Scottish Ministers in October 2015 with integrated delivery of health and social care services commencing in April 2016. 2017/2018 is the second year of operation for the IJB. The functions delegated by South Lanarkshire Council (SLC) and NHS Lanarkshire (NHSL) to the IJB are detailed in the Integration Scheme which is available at South Lanarkshire Integration Scheme 1. The South Lanarkshire Health and Social Care partnership refers to the joint working arrangements between the partners SLC and NHSL. The IJB is a separate legal entity which is responsible for the strategic planning and commissioning of the wide range of health and social care services across South Lanarkshire. The partnership is responsible for the operational delivery of the IJB’s strategic directions.

The purpose of the IJB is to improve the wellbeing of people who use health and social care services and their carers’ and to deliver on the Scottish Government’s nine national health and wellbeing outcomes. In addition to these, extensive participation and engagement activity was undertaken as part of developing the South Lanarkshire Strategic Commissioning Plan 2016-2019. From this, the public told us that there were 10 priorities which were important to them in developing integrated health and social care services as detailed in the table below:

1 Statutory and Core Work 6 Suitable and sustainable housing

2 Early intervention, prevention and health improvement

7 Intermediate care to reduce reliance on hospital and residential care

3 Carers support 8 Single points of contact

4 Seven day services 9 Mental health and wellbeing

5 Models of self-care and self-management including telehealth and telecare

10 Enablers to support better integrated working

Taken together, the nine outcomes and 10 priorities form the commitment of the IJB to progress the integration of health and social care services. There are multi faceted factors which impact on the demand for health and social care services across South Lanarkshire, particularly for those whose needs are complex. The population is 317,100: 22% are under 18 years of age, 59% are aged between 18 and

64 years and 19% are over 65 years. The population projections between 2014 and 2039 indicate a net reduction of 12% in the age group under 65 but an increase of 37% in those aged 65 to 74 years and 87% in the 75+ age group.

In comparison to the Scottish average, life expectancy in South Lanarkshire is lower. Many older people and a growing number of younger people are living with two or more long term conditions such as diabetes and respiratory disease.

South Lanarkshire has 431 data zones, 6.1% of the total across Scotland. Data zones have no standard geographical size and can vary from a small urban area to a large rural spread. In 2016, there were 6,976 data zones in Scotland. 1,046 data zones (15%) were assessed as the most deprived areas. 62 of the 431 data zones (14.4%) in South Lanarkshire ranked within the worst 15% in Scotland. This represents the highest number recorded since 2004.

Over the last 20 years, prevalence of people smoking in Lanarkshire has dropped from 35% to 22%. In the most deprived communities, although it has also dropped from 40% to 32% over the last three years, the number of people who smoke still remains too high.

This management commentary provides an overview of the key outcomes relating to the objectives and strategy of the IJB. It considers our financial performance for the year ended 31st March 2018 and provides an indication of the issues and risks which may impact upon our finances in the future.

1( Link: http://www.southlanarkshire.gov.uk/slhscp/downloads/file/59/south_lanarkshire_health_and_social_care_integration_scheme)

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http://www.southlanarkshire.gov.uk/slhscp/downloads/file/59/south_lanarkshire_health_and_social_care_integration_scheme

http://www.southlanarkshire.gov.uk/slhscp/downloads/file/59/south_lanarkshire_health_and_social_care_integration_scheme


Page | 4

MANAGEMENT COMMENTARY (Cont.) The Role and Remit of the IJB The IJB has responsibility for the strategic planning and commissioning of a wide range of health and social care services within the South Lanarkshire area including: accident and emergency (A&E) services provided in a hospital; inpatient services related to general medicine, geriatric medicine, rehabilitation medicine,

respiratory medicine and palliative care services in a hospital; community health services including Lanarkshire-wide or hosted services; and social care services (excluding children’s services and justice services). The IJB is made up of eight voting members: four elected members appointed by South Lanarkshire Council and four non-executive directors appointed by NHS Lanarkshire. Non voting members of the Board include the Chief Officer, the Chief Social Work Officer, the Nurse Advisor, the Medical Advisor, the Chief Financial Officer, the Registered Medical Practitioner and representatives for staff, the third sector, service users and carers. Our Strategic Commissioning Plan was reviewed during 2017/2018 in order to focus our efforts on the achievement of our priorities over the remaining term of the current plan and to build upon the successes achieved to date. The next comprehensive review of the Strategic Commissioning Plan is planned for 2019. Our vision remains clear: “Working together to improve health and wellbeing in the community – with the community.” The IJB’s Business Model and Strategy The business model for the IJB is managed by the partnership through core leadership groups, which ensure cross-care and cross-locality working. The IJB’s Strategic Commissioning Plan, the SLC Plan, Connect 2017-2022 and the NHS Lanarkshire Healthcare Strategy, Achieving Excellence are aligned. The plan is available at South Lanarkshire Strategic Commissioning Plan

2016 to 2019 2.

Front-line service delivery continues to be carried out by SLC and NHSL across four localities in line with the directions from the IJB. The directions from the IJB to NHSL and SLC outline what the IJB requires both bodies to do, the funding allocated to these functions and the mechanisms through which the performance in delivering the directions will be monitored. The IJB’s Outcomes for the Year Strong financial planning and management, the achievement of best value and the allocation of resources to support sustainable models of service delivery from a whole system perspective underpin everything that the IJB and the partners do to ensure our limited resources are targeted to achieve our outcomes to best effect.

The performance framework continues to be extended which monitors our achievement of the 9 national health and well being outcomes and the 10 priority areas we agreed to focus on as a result of the extensive participation and engagement activity previously undertaken. In addition to these commitments, in order to ensure more integrated working across the wider health and social care pathways, the following six indicators put in place by the Ministerial Steering Group are also being monitored: unplanned admissions occupied bed days for unscheduled care A&E department performance delayed discharges end of life care the balance of spend across health and social care

2 (Link: http://www.nhslanarkshire.org.uk/About/HSCP/Documents/Strategic%20Commissioning%20Plans/SLHSCP-Commission-Plan-16-19.pdf)

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http://www.nhslanarkshire.org.uk/About/HSCP/Documents/Strategic%20Commissioning%20Plans/SLHSCP-Commission-Plan-16-19.pdf





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MANAGEMENT COMMENTARY (Cont.) The IJB’s Outcomes for the Year (Cont.) The 2017/2018 Annual Performance Report 3, which sets out our key highlights over the last year, has been published. Although A&E attendances and emergency admissions are both up year on year by 4%, delayed discharge bed days are down year on year by 4%. As at March 2018, the total number of bed days associated with delayed discharges decreased by 1,795 when compared to March 2017. Unscheduled bed days are also down by 6% year on year and this positive trajectory is continuing. The number of people spending the last six months of their life in a community setting is also increasing. In order to further support people at the end of their life, the IJB agreed to open 12 hospice beds within South Lanarkshire providing palliative care services. This service, which commenced in August 2018, will be fully operational by October 2018. As part of the strategy to shift the balance of care, the IJB agreed to disinvest in 30 beds within the Douglas Ward of Udston Hospital, which closed in March 2018, and reinvest funding of £0.700m to create the necessary capacity to support more people at home. This includes homecare, district nursing and other community based supports. The partnership continues to aim to reduce reliance on residential and nursing care services through enhancing the support provided in the community. South Lanarkshire has one of the highest numbers of people in long-term residential/nursing care. There are currently over 2,358 people whose needs are being met in Care Homes at any point in time. SLC are also currently considering an investment of £18m to modernise existing care facilities. The opportunity to redesign and enhance the existing model of care, particularly in light of population demands which have significantly changed over the last twenty years, is currently being explored in consultation with key stakeholders. There is evidence that increasing and developing capacity within intermediate care, for example transitional and crisis intervention beds, could allow many service users to have their care managed earlier and be supported to return to their own home. The development of Integrated Care and Support Teams, combined with integrated service triaging, has resulted in a significant reduction in the need for home care services across all localities. The integrated team includes community nursing, physiotherapy services, occupational therapy services and homecare services across the localities. This approach has re-energised the ‘supporting your independence’ and rehabilitative dimension of health and social care intervention. Since October 2017, the East Kilbride Integrated Care and Support Teams and homecare teams have been providing timeous response to hospital discharge. 98% of all hospital discharges requiring home care to be sourced are effected within 3 days of referral, with 92% of all hospital discharges sourcing home care on the day of referral. This approach has now been rolled out across all the localities with similar outcomes being achieved. In partnership with both Macmillan Cancer Support and the North Lanarkshire Health and Social Care Partnership, the national Transforming Care After Treatment project established a person-centred approach that supported people to think about what would make a positive difference to their life after treatment for cancer, enabling them to take control of their own care post treatment.

3 (Link: http://www.slhscp.org.uk/downloads/download/39/south_lanarkshire_integration_joint_board)

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http://www.slhscp.org.uk/downloads/download/39/south_lanarkshire_integration_joint_board



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MANAGEMENT COMMENTARY (Cont.) The IJB’s Outcomes for the Year (Cont.) Community Capacity Building across all four localities has been developed. A range of projects have been set up, some examples of which include: the establishment of physical activity programme clinics to inform and support the public and colleagues by promoting life choices which will enhance their health and wellbeing; through the “Weigh to Go” programme, the provision of support to adults to help them manage their weight; and access to advice and support through the “Active Health” Programme to help people manage long term conditions. The continence care pilot project to reduce the impact of incontinence has markedly improved the lives of people in some Lanarkshire care homes including reducing the incidences of infections and falls. The project was praised by Professor Jason Leitch, the National Clinical Director of Healthcare Quality and Strategy for The Scottish Government, who met the project team during a visit to the residential care home, David Walker Gardens, in Rutherglen. The pharmacy plus homecare initiative across all the localities has created an opportunity to amend prescribing practices both from consultants and General Practitioners (GPs). Early indicators have shown there are cost reductions to be made.

42% of our carers feel supported to continue in their caring role. This is above the national average of 41%. Recognising that carers and their input are critical to the overall vision of supporting people to remain at home, we are committed to implementing the requirements of the Carers’ (Scotland) Act 2016 and we are developing a Carers Strategy 2018/2021, the Adult Carer Support Plan and Young Carer statement.

Primary health care is at the heart of the vision for health and social care to enable everyone to live longer, healthier lives at home or in a homely setting by 2021. Stronger GP services and community health services are essential to managing future demand and ensuring the success of integrated working. The South Lanarkshire IJB is the lead partner for the hosted service, Primary Care Services. Primary care transformation is one of our most significant strategic imperatives and will continue to be so in the years ahead. The size, breadth and complexity of the transformational change programme is challenging. 7 workstreams have been established, one of which includes the implementation of the new General Medical Services Contract between the NHS Board and General Medical Practitioners. This particular area of work proposes new contractual arrangements with GPs and is right at the centre of ensuring that primary care transformation is successful. The Primary Care Improvement Plan was approved by the IJB on 26 June 2018. During 2017/18 good progress was made with the development of a digital strategy for Health and Social Care Services, including the development of digital tools that help people to manage their own health and wellbeing at home and in the community. Telehealth and telecare technology continue to be an important strategic development for the IJB, supporting a growing number of people in Lanarkshire with a variety of conditions to feel safe, connected and in control whilst increasing independence. Some examples include home and mobile health monitoring to support a variety of health conditions.

One of the systems, Florence Simple Telehealth text messaging, allows people with conditions including high blood pressure, to monitor and text their readings from home. This ensures safety and reduces the need to attend the Doctor’s surgery for routine checks.

The latest video conferencing technology is also being introduced to improve connections with people and clinical support. At several local authority and independent sector care homes across Lanarkshire, for example, the technological infrastructure is now in place so residents have the opportunity to link into GPs and other health staff for consultations. Some care homes are also using the system for online video conference get-togethers, ranging from sing-alongs to group exercise. Among the overall benefits are improved levels of long-term condition self-management, staff and service users reducing time travelling to clinics and meetings and residents in care homes connecting with their local communities.

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MANAGEMENT COMMENTARY (Cont.) The IJB’s Outcomes for the Year (Cont.) There is a continued upward trajectory in people benefiting from telehealth and telecare technology, supported by this award-winning team. In respect of the South Lanarkshire residents who participated in the health and social care experience survey, positive feedback was received as follows: 77% of adults receiving any care or support rated it as excellent or good 86% of people had a positive experience of the care provided by their GP practice 81% of adults supported at home agreed that their services and support had an impact on

improving or maintaining their quality of life and they felt safe 74% of adults supported at home agreed that they had a say in how their help, care or support

was provided and agreed their health and social care services seemed to be well coordinated 80% of adults supported at home agreed that they were supported to live as independently as

possible. 94% of adults felt able to look after their health very well or quite well. 20 inspections were carried out in 2017/2018 by the Care Inspectorate over 18 services. 16 are evaluated in the grade range ‘excellent’, ‘very good’ and ‘good’ with the remaining 4 in the grade range ‘adequate’ or ‘weak’. Improvement plans are developed and agreed to ensure that the recommendations that have been identified through these inspections are being met within timescale. The IJB’s Financial Position at 31 March 2018 The delegated funds for the IJB come from SLC and NHSL. The level of funding available to the IJB is therefore heavily influenced by these organisations’ grant settlements from the Scottish Government. Consistent with the majority of public sector organisations, both SLC and NHSL have, over many years, faced challenges balancing their respective budgets due to cost pressures exceeding the provisional level of funding available. Notwithstanding these pressures, within the financial envelope available to each partner and following a process of consultation, the IJB agreed a financial plan for 2017/2018 in order to achieve a balanced budget by 31 March 2018. The overall net increase in the funding received from the partners in 2017/2018 is summarised in the following table.

Total Partner Contributions As At 31 March 2017 £491.480m

Plus Additional Partner Contributions 2017/2018

Social Care Fund £6.450m

Scottish Government in-year funding –recurring £0.839m

Scottish Government in-year funding - non-recurring £9.199m NHSL Health Board funding - non-recurring for prescribing £1.000m

SLC Funding- net increase £4.854m Sub Total

£22.342m

Less Adjustments to Partner Contributions

Removal of 2016/2017 Non-recurring Funding (£14.071m)

Savings 2017/2018 (£0.498m)

Set-Aside Notional Budget Adjustment – reduction (£0.439m)

Sub Total

(£15.008m)

Total Partner Contributions As At 31 March 2018 £498.814m

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MANAGEMENT COMMENTARY (Cont.) The IJB’s Financial Position at 31 March 2018 (Cont.) The total funding for the IJB in 2017/2018 was £498.814m (NHSL- £382.021m; SLC - £116.793m). This is included in the comprehensive income and expenditure statement at page 25. A financial strategy to address the cost pressures in 2017/2018 was agreed with both partners. SLC provided additional recurring funding of £7.301m and NHSL provided additional funding of £6.450m. Additional funding for NHSL was also issued during the year. Approximately 87% of the in-year NHSL funding was ring fenced for areas covered by the North and South Lanarkshire IJBs. Although SLC would have been allowed by the Scottish Government to reduce the contribution to the IJB by £4.830 million, they approved a decision not to do so and instead maintained the 2016/2017 baseline funding. The profile of expenditure which is detailed on page 25 is summarised as follows: 32% of the budget is allocated to front line social care services (£156.703m) 17% of the budget is allocated to family health services (£85.223m) 14% of the budget is spent on prescribing (£67.571m) 18% is incurred on a range of hosted services including the 49% share of those hosted

services led by the South Lanarkshire IJB (£87.102m) 11% represents the large hospital services notional set-aside budget (£54.715m) 8% is incurred on a range of health care services (£40.169m) 1% relates to housing services (£5.020m) 0.03% is incurred in IJB corporate services (£0.152) The comparison between 2016/2017 and 2017/2018 of the actual expenditure on services stated gross is graphically illustrated in the chart below. The expenditure aligned to services has remained broadly consistent between the years. The increase in expenditure in 2017/2018 is mainly attributable to inflationary cost increases and demographic growth.

Key Risks and Uncertainties The IJB Risk Management Strategy complements the existing risk management processes within each partner. All three risk registers are reviewed regularly by the management team. The two key risks facing the IJB are the non-availability of finance and staffing shortages, both of which could impact on the ability to continue to provide sufficient services within required timescales. The availability of the workforce, and the impact of withdrawing from the European Union (EU), is a national issue.

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MANAGEMENT COMMENTARY (Cont.) Key Risks and Uncertainties (Cont.) Spending on drugs continues to increase and is a key financial risk. Before the start of the financial year, an overspend against the prescribing budget appeared highly unlikely however the price of a range of drugs increased considerably during the year as, across the UK, shortages in supply emerged. The intensity of the Pan-Lanarkshire Prescribing Quality and Efficiency Programme was maintained during the year and, while both the South Lanarkshire and the North Lanarkshire IJBs benefited, their activity could not in itself compensate for the short supply factors, leaving a forecast year-end overspend across Lanarkshire due to price increases. The short supply issues have not yet washed out of the market, leading to predictions that 2018/2019 will also be a difficult year. In order to mitigate against this risk, the existing prescribing reserve of £0.636m has therefore been increased by £0.100m to £0.736m, which represents 1% of the prescribing budget of £67.571m (note 10 on page 37). The Director of Finance of NHS Lanarkshire continues to progress the exercise to update the notional set-aside budget. This notional budget represents the consumption of hospital resources by South Lanarkshire residents, is based on the 2015/2016 activity levels at the 2017/2018 prices and is estimated to be £54.715m. Similar to the previous year, the notional budget can also be included as the estimated expenditure for the 2017/2018 annual accounts. It is recognised that this will not necessarily reflect the actual usage of these hospital services by the IJB in 2017/2018 however it has been endorsed as an acceptable approach pending further updates from the Information Services Division. This critical judgement in respect of the complex accounting treatment of the hospital acute services (set-aside) therefore follows the advice issued by the Scottish Government on how the sum set-aside should be recorded in the annual accounts and is explained in more detail at note 2 on page 29. A whole system approach is being adopted by the partners to support the use of, and where possible, the transfer of set-aside resources. The closure of the Douglas ward in Udston Hospital is an example of a shift in resources of £0.700m from the set-aside budget to the directly managed community budgets to further develop the integrated care pathways. During the year, the Chief Financial Officer, in consultation with both partners, reviewed and further developed the financial monitoring arrangements for the IJB. Throughout the year, the financial monitoring reports set out the key financial risks including in particular variance explanations in respect of prescribing costs and also the impact of the agreed budget recovery plan on reducing the original anticipated overspend across social care services. Further work will be undertaken in 2018/2019 to more specifically align the financial allocations to the strategic commissioning plan intentions and the directions to each partner. Matters of Strategic Importance Projected growth in elderly demographics and the increasing complexity of need, together with inflationary rises, continue to drive the cost pressures across home support, care home placements and adaptations. The financial plan for 2018/2019 was approved by the IJB in March 2018. Cost pressures and current and future policy commitments are projected to total in excess of £14m. Additional funding of £13.2m was received from both partners. The balance of the cost pressures of £0.8m is being addressed by the savings strategy which was recommended to the IJB. This strategy was considered to be the best fit with the strategic commissioning intentions and the best value requirement to use resources more effectively.

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MANAGEMENT COMMENTARY (Cont.)

Matters of Strategic Importance (Cont.) In November 2017, the Scottish Government published “The 2018 GMS Contract in Scotland” following agreement with the BMA. It also published “The National Code of Practice for GP Premises” which sets out the Scottish Government’s plan to facilitate the shift to a model which does not entail GPs providing their practice premises. The new contract came into effect on 1st April 2018. Primary care services are a hosted service within the South Lanarkshire IJB. As the lead partner for this hosted service, the South Lanarkshire IJB is responsible for the implementation of the new contract across Lanarkshire. The governance arrangements for the implementation of the new GMS 2018 GP contract have been set out in reports to the IJB. The future role of GPs is critical to reshaping service delivery and managing future demand. The number of GPs retiring is however increasing and sustainability plans therefore require to be developed.

The Carers (Scotland) Act 2016 came into effect on 1 April 2018 and significant work has been undertaken in preparing for the implementation of the legislation. The IJB’s share of the 2018/2019 Scottish Government allocation of £66m is £3.931m. This includes funding of £1.140m for the implementation of the Carer’s (Scotland) Act 2016 for all age groups including children, adults and older people.

Legislative changes continue to influence the landscape, including the Carers (Scotland) Act 2016, the extension of free personal care to under 65s (e.g. Frank’s Law) and the proposed Safe Staffing Bill. The introduction of the Children & Young Persons (Scotland) (Act) 2014, in particular the requirements for a named person service and corporate parenting provisions and the new Universal Pathway in Health Visiting will add additional demands on the service. Complex and complicated governance arrangements require to be complied with across SLC, NHSL and the IJB. These include data sharing protocols, staff management and decision-making responsibilities.

There is some reliance on the recruitment of EU nationals to deliver services, including across the independent providers and the voluntary sector. There is uncertainty about what the post-Brexit rules will be with the EU and the impact on staff recruitment and retention. It is intended that work will be undertaken by each partner during 2018/2019 to assess the preparedness for the changes.

The Fairer Scotland Duty came into force in Scotland in April 2018. When making strategic decisions, the IJB and its partners have a legal responsibility to actively consider how they can reduce inequalities of outcomes caused by socio-economic disadvantages. Whilst still having due regard to best value and equality, tackling inequality needs to be at the heart of our decision-making.

Although we are taking steps to avoid future cost pressures and manage demand by redesigning services, the financial outcome of this is difficult to quantify. The financial planning assumptions for 2019/2020 are being updated. It is difficult to predict future cost pressures as there are a number of uncertainties. Future pay increases, including the living wage, the national care home contract negotiations and the prescribing cost volatility will impact on cost pressures, the extent to which is not yet known.

Annual Accounts 2017/2018 As the South Lanarkshire IJB was established under the Public Bodies (Joint Working) (Scotland) Act 2014, it falls within section 106 of the Local Government (Scotland) Act 1973 and is required to prepare annual accounts in accordance with the Local Authority Accounts (Scotland) Regulations 2014.

A surplus of £2.159m is reported at 31 March 2018 which represents 0.5% of the total funding available of £478.404m. It is critical to note that part of this underspend will be non-recurring. This position also reflects a break-even position in respect of prescribing costs which was secured as a result of the additional one-off funding of £1m provided by the Health Board to address an in-year overspend of £1m.

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MANAGEMENT COMMENTARY (Cont.)

Annual Accounts 2017/2018 (Cont.) The balance on the IJB reserves at 1 April 2017 was £6.119m. This provided a contingency against demographic demand and service volatility in 2017/2018 and facilitated the implementation of the strategic transformational change programme. A total of £0.121m was transferred from the IJB reserves during 2017/2018. The total amount which is being transferred to reserves at 31 March 2018 is £2.280m. The net movement on reserves in 2017/2018 is therefore £2.159m as detailed in the movement in reserves statement on page 26.

The main factors contributing to the surplus across the partnership include vacancies and a decrease in the net cost of care home placements.

Hosted services are those services which are delivered on a pan-Lanarkshire basis by one IJB on behalf of the other IJB. In line with the Integrated Resource Advisory Group Finance Guidance, the lead partner for a hosted service is responsible for managing any overspends incurred. With the exception of ring-fenced funding, the lead partner can also retain any underspends which may be used to offset other overspends. There was an underspend of £1.204m in respect of the hosted services led by the South Lanarkshire IJB, £0.932m of which is ring fenced to take forward the future commitments associated with the Primary Care transformation Fund. Of this total, £0.457m (49%) is attributable to the South Lanarkshire IJB.

In preparing the 2017/2018 annual accounts, the treatment of hosted services has changed. The full cost of services which are hosted by the South Lanarkshire IJB are now reflected in our accounts and are no longer adjusted to reflect the activity on behalf of the North Lanarkshire IJB. The change in the treatment of this critical judgement is explained fully at note 2 on page 29 and reflects our responsibility in relation to service delivery and the risk and reward associated with it.

The services which are hosted by North Lanarkshire IJB on behalf of the South Lanarkshire IJB and the hosted services which are led by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB are detailed in note 9 on pages 35 and 36. A break-even position is reported across both of these areas.

Internal Audit completed a specific programme of audit work in 2017/2018 undertaking a high level review of strategic planning and commissioning and financial planning arrangements of the IJB. Actions recommended from 2016/2017 audit work were also followed up near the end of 2017/2018. Internal Audit work established that, at a strategic level, expected controls are in place in relation to both the commissioning and financial plans for the IJB. Nevertheless, there continues to be an inherent risk that demand for services exceeds projections, resulting in overspends of the budgets available. On this basis, Internal Audit advised that closer links to financial plans could be made in future strategic plans.

The financial position for public services continues to be challenging. The IJB have committed, within the 2017/2018 IJB Governance Statement, to continue to align financial and commissioning strategies in the future. In consultation with our partners, we will continue to review the way we currently deliver health and social care services to ensure we achieve our priorities and they offer best value. Philip Campbell Val de Souza Marie Moy Chair Chief Officer Chief Financial Officer Date 11 September 2018 Date 11 September 2018 Date 11 September 2018

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STATEMENT OF RESPONSIBILITIES

Responsibilities of the South Lanarkshire Integration Joint Board

The South Lanarkshire Integration Joint Board (IJB) is required to: make arrangements for the proper administration of its financial affairs and to secure that the

proper officer of the IJB has responsibility for the administration of those affairs (section 95 of the Local Government (Scotland) Act 1973). In this IJB, that officer is the Chief Financial Officer.

manage its affairs to secure economic, efficient and effective use of resources and safeguard its 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 for signature.

I confirm that these Annual Accounts were approved for signature at a meeting of the South Lanarkshire Integration Joint Board on 11 September 2018. Signed on behalf of the South Lanarkshire Integration Joint Board Chair: Philip Campbell Date: 11 September 2018

Responsibilities of the Chief Financial Officer

As Chief Financial Officer I am responsible for the preparation of the IJB’s Annual Accounts in accordance with proper practices as required by legislation which, in terms of the CIPFA/LASAAC Code of Practice on Local Authority Accounting in the United Kingdom 2016/2017 (the Accounting Code), as supported by the International Financial Reporting Standard (IFRS), is required to give a true and fair view of the financial position of the South Lanarkshire Integration Joint Board at the financial year end and its income and expenditure for the year then ended.

In preparing the Annual Accounts, I am responsible for: selecting suitable accounting policies and applying them consistently; making judgements and estimates that are reasonable and prudent; complying with legislation; and complying with the Accounting Code in so far as it is compatible with legislation.

I am also required to: keep proper accounting records which are up to date; and take reasonable steps to ensure the propriety and regularity of the finances of the IJB.

I certify that these Annual Accounts present a true and fair view of the financial position of the South Lanarkshire Integration Joint Board as at 31st March 2018 and the transactions for the year then ended.

Chief Financial Officer Marie Moy Date 11 September 2018

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REMUNERATION REPORT Introduction The Remuneration Report has been prepared in accordance with the Local Authority Accounts (Scotland) Regulations 2014 which requires, at least, disclosure about the remuneration and the pension benefits of any person whose remuneration is £150,000 or more. Integration Joint Board The Standing Orders of the IJB, as prescribed by the Public Bodies (Joint Working) (Integration Joint Board) Order 2014, sets out the detail regarding IJB membership, voting and the calling of meetings. The IJB comprises eight voting members, four of whom are elected members appointed by South Lanarkshire Council and four of whom are non-executive directors appointed by the NHS Lanarkshire Health Board. The term of office of members is for a period of three years. The appointments of Chair and Depute Chair are for a period of 2 years with the current appointments being effective from 1 April 2017. There are also non-voting representatives on the IJB drawn from health and social care professionals, employees, the third sector, service users and carers. Remuneration: IJB Chair and Depute Chair The board members do not currently receive remuneration or expenses directly from the IJB however voting board members will be remunerated by their relevant IJB partner organisation. The IJB does not provide any additional remuneration to the Chair, Depute 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 member costs borne by the partner. Until May 2017, Councillor Jackie Burns was the Chair of the IJB and Mr Philip Campbell was the Depute Chair. Following the local government elections, Mr Philip Campbell was appointed as the Chair of the IJB. Councillor Stephanie Callaghan was the Depute Chair between May 2017 and December 2017. Councillor John Bradley was the Depute Chair between December 2017 and March 2018. The details of the Chair and Depute Chair appointments held during 2017/2018 are outlined in the table below. No taxable expenses were paid by the IJB in 2016/2017 or 2017/2018.

Period Post Held Name Nominated by

April 2017 to May 2017

Chair Cllr. Jackie Burns South Lanarkshire Council

May 2017 to March 2018

Chair Mr Philip Campbell NHS Lanarkshire

April 2017 to May 2017

Depute Chair Mr Philip Campbell NHS Lanarkshire

May 2017 to December 2017

Depute Chair Cllr. Stephanie Callaghan South Lanarkshire Council

December 2017 to March 2018

Depute Chair Cllr. John Bradley South Lanarkshire Council

The IJB does not have responsibilities, either in the current year or in future years, for funding any pension entitlements of the voting IJB members. The pension rights disclosures for the Chair and the Depute Chair are set out in the remuneration reports of each partner organisation as appropriate.

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REMUNERATION REPORT (Cont.)

Senior officers The Chief Officer is appointed by the IJB in consultation with NHS Lanarkshire Health Board and South Lanarkshire Council. The Chief Officer is employed by South Lanarkshire Council. Although their contract of employment is with South Lanarkshire Council, the Chief Officer is regarded as an employee of the IJB for 50% of their time.

The Chief Financial Officer is appointed by the South Lanarkshire IJB and is employed by South Lanarkshire Council. The Chief Financial Officer, whose services have been secured under the requirements of section 95 of the Local Government (Scotland) Act 1973, is seconded to the IJB in line with the local arrangements.

The IJB is responsible for the strategic planning and commissioning of health and social care services. Each partner is responsible for the operational delivery of the IJB’s strategic directions. The IJB does not directly employ any Health or Social Care staff. They are employed by either NHS Lanarkshire or South Lanarkshire Council and remuneration for staff is reported in the annual accounts of the relevant employing organisation.

Remuneration: Officers of the IJB The remuneration of the senior officers is set with reference to national arrangements as well as local decisions on management structures and their associated remuneration levels. The Scottish Joint National Committee for Local Authority Services sets out the spinal column salary points for Chief Officers which can be utilised in setting salary levels for such posts. The senior officers received the following remuneration in the year:

Name Salary, fees, allowances

2017/2018 Total Remuneration

2016/2017 Total Remuneration

Val de Souza Chief Officer (April 2017 to March 2018)

£64,129

£64,129

£32,277 (FYE - £62,626)

Harry Stevenson Chief Officer (April 2016 to September 2016)

-

-

£29,937 (FYE - £64,377)

Marie Moy Chief Financial Officer (April 2017 to March 2018)

£32,889

£32,889

£32,563

The remuneration disclosed in the table above is the proportion of remuneration received in relation to the activity of the South Lanarkshire IJB during 2017/2018.

The Chief Officer is appointed to the South Lanarkshire IJB however South Lanarkshire Council continues to meet 50% of the costs of this post directly. This reflects the Chief Officer’s responsibilities for Children and Justice Services, Performance and Support Services and Money Matters Advice Services which are not delegated functions to the IJB. The Chief Officer, as the Director of Health and Social Care, also contributes to the strategic direction of South Lanarkshire Council as part of the Corporate Management Team.

The Chief Financial Officer is also appointed to the North Lanarkshire IJB. The remuneration in respect of this post is therefore shown separately in the North Lanarkshire IJB Annual Accounts.

There were no exit packages awarded during the financial year.

There were no taxable expenses paid to the Chief Officers or the Chief Financial Officer in 2016/2017 or 2017/2018.

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REMUNERATION REPORT (Cont.)

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.

Remuneration Band Number of Employees in Band 2017/2018

Number of Employees in Band 2016/2017

£60,000 - £64,999 1 -

Pension Benefits In respect of officers’ pension benefits, the statutory liability for any future contributions to be made rests with the relevant employing partner organisation. On this basis, there is no pensions liability reflected on the IJB balance sheet for the Chief Officer or any other officers. The IJB however, 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 senior officers are members of the Strathclyde Pension Fund which is a Local Government Pension Scheme (LGPS). The LGPS is a defined benefit statutory scheme, administered in accordance with the Local Government Scheme Regulations 2014.

The costs of the pension scheme contributions for the year to 31 March 2018 are shown in the table below:

Name To 31 March 2018 To 31 March 2017

Val de Souza Chief Officer (April 2017 to March 2018)

In-year pension contributions Accrued pension benefits Movement in accrued pension benefits Lump Sum

£24,754

£39,577

£38,246

£60,404

£12,459

£1,331

£1,331

£0

Harry Stevenson Chief Officer (April 2016 to September 2016)


-

-

-

-

£11,556

£68,615

£131

£166,155

Marie Moy Chief Financial Officer (April 2017 to March 2018)


£12,695

£23,936

£1,659

£39,676

£12,569

£22,277

£1,547

£39,283

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REMUNERATION REPORT (Cont.) Pension Benefits (Cont.) The pension benefits detailed in the table above relate to the total amount attributable to each post on a full-time basis. A pro-rata approach has not been adopted. During 2017/2018, Ms De Souza transferred in pension benefits accrued with another pension fund from her previous service with another local authority. The information contained within the Remuneration and Pension Benefits sections above is subject to audit. Philip Campbell Val de Souza

Chair Chief Officer

Date 11 September 2018 Date 11 September 2018

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ANNUAL GOVERNANCE STATEMENT 2017/2018

Introduction The Annual Governance Statement explains the governance arrangements and the system of internal control for the IJB and reports on their effectiveness. Scope of Responsibility The IJB is responsible for the commissioning of health and social care supports and services to improve the outcomes for the people of South Lanarkshire. It is responsible for ensuring its business is conducted in accordance with legislation and proper standards and that public money is safeguarded and properly accounted for. It also has a statutory duty of best value and is required to make arrangements to secure continuous improvement and performance, while maintaining an appropriate balance between quality and cost, having regard to economy, efficiency and effectiveness. To meet these responsibilities, the IJB has established arrangements for governance which includes a system of internal control to ensure its functions are exercised in a timely, inclusive, open, honest and accountable manner. This includes: setting the strategic direction, vision, culture and values of the IJB; engaging with and, where appropriate, leading communities; monitoring whether strategic partnership objectives have been achieved; ensuring services are delivered cost effectively; and ensuring appropriate arrangements are in place for the management of risk. The system of internal control is proportionate to the IJB’s strategic responsibility and reliance is placed on the NHS Lanarkshire and South Lanarkshire Council systems of internal control. The effective operation of each partner’s financial and corporate systems, processes and internal controls are key to the achievement of the IJB’s outcomes. The internal control system can only provide reasonable and not absolute assurance of effectiveness. The Purpose of the Governance Framework The overall aim of the governance framework is to ensure that resources are directed in accordance with agreed policy and according to priorities, that there is sound and inclusive decision making and there is clear accountability for the use of those resources in order to achieve desired outcomes for service users and communities. The governance framework enables the IJB to monitor the attainment of the partnership outcomes, including the identification and management of key risks. This included evaluating the likelihood of those risks being realised and the impact of those risks if they are realised. The system also aims to help manage the risks efficiently, effectively and economically. Internal controls cannot eliminate all risks of failing to achieve policies, aims and objectives. Internal controls however are a significant part of the governance framework and are designed to manage risk at a reasonable level. The governance framework within the IJB is set out in the South Lanarkshire IJB Code of Corporate Governance 4 which comprises of the systems, processes, culture and values by which the IJB is directed and controlled. The Code of Corporate Governance is consistent with the seven core principles of the Delivering Good Governance in Local Government Framework (CIPFA 2016) and also the International Framework, Good Governance in the Public Sector.

4 (Link: http://www.southlanarkshire.gov.uk/slhscp/downloads/file/73/south_lanarkshire_ijb_code_of_corporate_governance)

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ANNUAL GOVERNANCE STATEMENT 2017/2018 (Cont.) Review of Adequacy and Effectiveness The Local Authority Accounts (Scotland) Regulations 2014 require a review at least once in each financial year of the effectiveness of the system of internal control. The IJB is required to report publicly on compliance with its own Code of Corporate Governance on an annual basis including how it has monitored the effectiveness of its governance arrangements during the year under review and planned future changes. The review undertaken for 2017/2018 was informed by: an annual self-assessment against the IJB’s Local Code of Corporate Governance consistent

with the principles and recommendations of the new CIPFA/SOLACE Framework (2016); IJB internal audit reports; IJB external audit reports; relevant reports by other external scrutiny bodies and inspection agencies; a review of the principal risks and uncertainties and how these are being managed; an assessment of impact of the 2017/2018 continuous improvement actions undertaken; and an assessment of the IJB’s ability to achieve future service priorities including consideration

of ongoing service sustainability. The review was also informed by cross-assurances from each partner, NHS Lanarkshire and South Lanarkshire Council, including consideration of their internal audit and external audit reports.

The Governance Framework and Internal Control System In line with the seven core principles of good governance, the main features of the South Lanarkshire IJB governance framework and internal control system include the following: Behaving with integrity, demonstrating strong commitment to ethical values and respecting the rule of law The members and officers of the IJB work within a decision-making framework which incorporates “The Seven Principles of Public Life” identified by the Nolan Committee. Professional advice on the discharge of duties is provided to the IJB by the Chief Officer supported by the Chief Financial Officer, the Standards Officer, the Chief Internal Auditors, the Medical Advisor, the Nurse Advisor and the Chief Social Work Officer as appropriate.

The roles and responsibilities of IJB members and statutory officers are set out across a range of key documents including the Integration Scheme, Standing Orders, Financial Regulations and Codes of Conduct. The Chief Officer is responsible for ensuring that agreed procedures are followed and that all applicable statutes and regulations are complied with. The conduct of the IJB’s business is governed by these processes which ensure that public business is conducted with fairness and integrity.

Governance structures are in place and operate effectively. These include the following: Senior Management Team; Support, Care and Clinical Governance Committee; Learning Improvement and Review Group; Learning and Workforce Development Board; Social Work Governance Committee; Quality Improvement Committee; Health Governance Committee; Mental Health and Learning Disabilities Governance Group; Substance Misuse Governance Group; and Locality Governance Groups.

Reliance is placed upon the arrangements across the partnership to ensure the right conditions are created in order for the IJB to fulfil its responsibilities in accordance with legislative and regulatory requirements and ethical values. This includes processes for handling complaints, whistleblowing policies and procedures, recruitment and staff appraisal processes, identifying, mitigating and recording conflicts of interest, hospitality and gifts and the sustainable procurement of goods which represent best value.

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ANNUAL GOVERNANCE STATEMENT 2017/2018 (Cont.) Ensuring openness and comprehensive stakeholder engagement The IJB meet in public and decisions are documented in the public domain. The only exception to this would be if there were good reasons for not doing so on the grounds of confidentiality. Changes to the Integration Scheme require that key stakeholder and prescribed consultees are either informed or consulted. The implementation of the Carers Act has implications for the IJB, NHS Lanarkshire and South Lanarkshire Council and the Integration Scheme was amended to reflect the Carers (Scotland) Act 2016, which came into effect on 1 April 2018. The amendment required the new duties cited within this Act to be delegated specifically to the IJB and the partners were notified of this in December 2017. Defining outcomes in terms of sustainable economic, social, and environmental benefits The South Lanarkshire Strategic Commissioning Plan 2016-2019 sets out the vision, strategic objectives and outcomes for the health and social care partnership. A well developed performance framework has been established across the partnership to monitor the progress of the nine national health and well being outcomes, the agreed suite of 23 national performance measures and the 6 priority measures set by the Ministerial Steering Group. Equalities as well as environmental and rural implications are considered during the decision making process. The combined economic, social and environmental impact of policies and plans is considered when decisions are taken about service provision, ensuring fair access. A long term view is taken with regard to decision making, with a focus on sustainability and the link between governance and public financial management. Decisions in respect of capital investment remain the responsibility of each partner. Determining the interventions necessary to optimise the achievement of the intended outcomes The South Lanarkshire Strategic Commissioning Plan 2016-2019 is based on consultation. The plan will be updated before the end of its life and any update will be based upon further consultation. The Strategic Commissioning Group has a key role in influencing and supporting the overall future strategy. Each partner has established effective relationships, collaborative working and contractual arrangements with other public, private and voluntary organisations in delivering services. Effective financial controls were in place across the partnership in 2017/2018. The Financial Plan for 2018/2019 sets out the parameters to achieve a balanced budget. The medium to long term financial strategy, which will cover a 3 to 5 year period, is being finalised and will provide a balanced and objective analysis of service priorities, financial affordability and other resource constraints, including the workforce. The strategy will set the context for ongoing decisions on significant delivery issues and responses to the changes in the external environment. These include the impact of the end of the public sector pay cap, the national care home contract, the Carers (Scotland) Act 2016 and the EU withdrawal. Developing the entity’s capacity, including the capability of its leadership and the individuals within it The objectives of the Health and Social Care partnership link to the NHS Lanarkshire’s Healthcare Strategy, South Lanarkshire Council’s Plan and the South Lanarkshire Health and Social Care Partnership’s Strategic Commissioning Plan. The partnership also supports the agreed outcomes for Children’s Services and Justice Services.

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ANNUAL GOVERNANCE STATEMENT 2017/2018 (Cont.) The roles of the Chief Officer and the Chief Financial Officer are defined in agreed job profiles. The Chief Officer is responsible and accountable to the Board for all aspects of management including promoting sound governance and providing quality information and support to inform decision-making and scrutiny. Regular meetings are held between the Chief Officer and the Chair and Vice Chair of the IJB. The Chief Officer also meets regularly with the Chief Executives of the partner organisations. The Chief Financial Officer is responsible for the proper administration of all aspects of the IJB’s financial affairs including ensuring appropriate advice is given to the IJB on all financial matters. Thematic groups have been established across the partnership to progress key developments. These included: maximising efficiency within the care at home sector, including the introduction of mobile

working and a new contractual framework with providers; progressing the “bed modelling” exercise and developing community facilities to support the

delivery of improved outcomes; exploring options to use bed-based resources in a different way; progressing the arrangements for hosted services in consultation with the North Lanarkshire

Health and Social Care Partnership and NHS Lanarkshire. progressing Primary Care Transformation; and progressing Self Directed Support. The Locality Planning Groups have a key role in implementing the strategy and ensuring assessed needs within the locality are addressed. Staff performance is reviewed in accordance with each partner’s performance development review process. A development session was arranged for IJB members in April 2018. The aim of the session included developing a shared understanding of the role and function of the IJB and how this relates to the Health Board and the Council. A programme of development for the IJB for the coming year was agreed and a report is being presented to the IJB in September 2018 outlining the proposed topics. Quarterly development sessions will begin following the appointment of two new IJB members. Managing risks and performance through robust internal control and strong public financial management The IJB is the decision-making body and is governed by its key constitutional documents. Effective and constructive challenge and debate on policies and objectives is encouraged at the IJB and the Performance and Audit Sub-Committee. The Financial Plan for 2017/2018 was agreed in March 2017. In accordance with the requirements set out in the Public Bodies (Joint Working) (Scotland) Act 2014, the IJB issued directions effective from 1 April 2017 to NHS Lanarkshire Health Board and South Lanarkshire Council in respect of the delivery of integrated functions and how resources were to be allocated for resultant services. The budget was further refined during the course of the year by both partners and also updated to reflect additional in-year funding. Each of the partners, South Lanarkshire Council and NHS Lanarkshire have a proven track record of sound financial management and robust monitoring arrangements to manage their finances in year. The IJB places reliance on these existing financial monitoring arrangements. Financial monitoring reports are presented to the IJB at each meeting. The financial reports have been developed to include an annual outturn by each partner. A risk management strategy has been approved by the IJB which complements the existing risk management processes within each partner. A risk management strategy is in place to mitigate and monitor those risks which threaten the IJB’s ability to meet its objectives to deliver services to the public. The IJB strategic risks are monitored regularly. The operational risks in respect of the delegated health and social care functions are also regularly monitored by both partners. The IJB has oversight of service delivery and the associated risks.

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ANNUAL GOVERNANCE STATEMENT 2017/2018 (Cont.)

As at June 2018, there are 13 risks on the IJB Risk Register (Agenda Item No 18 Pages 225 to 234) 5. After taking into consideration the adequacy of the controls, two risks are assessed as high risk, ten are medium risk and one is low. The action being taken to address the two high risks is as follows:

Shifting the balance of care from residential and acute settings to community based alternatives In order to continue to shift the balance of care from residential and acute settings to community based alternatives, the strategic commissioning intentions and directions will be further developed. Services will also continue to be redesigned to ensure locality pathways support maintaining people at home. This will include establishing transitional care models. The investment of £18m by South Lanarkshire Council to modernise existing care facilities will significantly enhance the existing model.

Efficient and effective use of resources (IT / premises / governance) In order to ensure the efficient and effective use of resources, it is intended to complete the proposed federated trust approach for IT. An earmarked reserve for £0.070m has been established as part of the overall funding package of £0.400m to take this initiative forward (Note 10 on page 37). A joint protocol for the co-location of staff will also be developed and agreed with the partners.

Further information on the medium and low risks is detailed in the IJB’s risk register which can be located on the South Lanarkshire Health and Social Care partnership website 6.

A quarterly performance report is prepared. At the September 2017 IJB meeting, the Annual Performance Report for 2016/2017 was approved. This provided an overview of performance against the strategic objectives in the first year. The 2017/2018 Annual Performance Report 7, which was considered by the IJB on 26 June 2018, has been published.

The IJB is committed to high standards of governance including information governance. An Information Sharing Protocol has been implemented. A publication scheme has been agreed and a process is also in place for responding to Freedom of Information requests and for handling complaints. The IJB relies upon each partner to manage data in accordance with relevant legislation and to minimise the risk of fraud, theft, corruption and crime. This is integral to delivering services effectively and sustainably, protecting public finances and safeguarding assets.

Implementing good practices in transparency, reporting and audit to deliver effective accountability The internal audit service plays an essential role in the control environment by providing assurance that internal controls are being applied. The IJB approved the joint appointment of the Audit Manager for South Lanarkshire Council and the Chief Internal Auditor for NHS Lanarkshire. The IJB complies with “The Role of the Head of Internal Audit in Public Organisations” (CIPFA) and operates in accordance with “Public Sector Internal Audit Standards” (CIPFA). Both Heads of Internal Audit report directly to the Performance and Audit Sub-Committee with the right of access to the Chief Financial Officer, Chief Officer and Chair of the IJB Performance and Audit Sub-Committee on any matter. Effective working arrangements are in place between the partner’s respective internal auditors on matters relevant to the IJB. The annual programme of internal audit work is based on a strategic risk assessment. The 2017/2018 internal audit plan was agreed on 5 December 2017 and included a review of the strategic planning and commissioning arrangements and a review of the financial planning process. Internal audit also followed up the actions arising from audits undertaken in 2016/2017.

5(Link: http://www.southlanarkshire.gov.uk/slhscp/downloads/file/137/sl_ijb_agenda_pack_-_26_june_2018pdf)

6 (Link: http://www.southlanarkshire.gov.uk/slhscp/) 7 (Link: http://www.slhscp.org.uk/downloads/download/39/south_lanarkshire_integration_joint_board)

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http://www.southlanarkshire.gov.uk/slhscp/



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ANNUAL GOVERNANCE STATEMENT 2017/2018 (Cont.)

The findings and recommendations of internal audit, external audit and inspection bodies are reported to the IJB. The Performance and Audit Sub-Committee is integral to ensuring that recommendations are acted upon and improvements in internal control and governance are monitored. No control weaknesses or governance issues were reported by internal audit in 2017/2018. An external audit plan has been approved for 2017/2018. Overview of Control and Governance Improvements during 2017/2018 As a result of the improvement areas identified in the 2017/2018 Annual Governance Statement, the IJB’s governance arrangements were further developed as outlined in the table below.

Area for improvement identified in 2017/2018 Action Undertaken 2017/2018

Ensure a balanced budget is achieved for 2017/2018.

A balanced budget was set for 2017/2018 and identified savings were implemented.

In respect of the medium to longer term financial outlook, ensure a financial strategy is developed to maintain a balanced budget.

A medium to long term financial strategy for the IJB is being developed. The strategy will be consistent with the financial planning principles adopted by each partner.

The role of the IJB members will continue to be developed.

The recommendations of the external audit review on the role of Board members have been considered and the role of the IJB members continues to develop.

Further develop the governance arrangements for the IJB and the partnership to ensure effective controls are in place, best value is secured and outcomes are achieved.

A group is in place to review governance arrangements and implement best practice.

Health Boards and Integration Authorities will be encouraged to prioritise establishing revised processes for the planning and performance management of delegated hospital functions (set-aside) and associated resources in 2017/18.

Extensive work has been progressed by NHS Lanarkshire to review the framework for the planning and performance management of delegated hospital functions and associated resources (the set-aside). The ‘bed modelling’ exercise has been progressed and options to use bed-based resources in a different way have been explored.

Ongoing effectiveness of business continuity plans.

Business continuity and resilience plans are regularly reviewed.

Further development of the Performance Management Framework.

A well established performance monitoring framework is in place and quarterly performance reports are presented to the IJB. The framework will continue to be developed.

Further develop stakeholder engagement. A consultation and engagement framework has been established through which proposed strategic decisions are considered. On 26 June 2018, the IJB approved a wider Participation and Engagement Strategy as the recognised way forward for all IJB participation and engagement activity.

Further develop the strategic commissioning plan.

On 26 March 2018, the IJB approved the refreshed Strategic Commissioning Plan for 2018/2019 which identified a range of refreshed proposals to support the 9 National Health and Wellbeing Outcomes and the 10 priorities identified from our extensive participation and engagement activity in 2015/2016, all of which remain relevant to the direction. The 2018/2019 IJB Financial Plan and the IJB Directions for each partner were also approved on 26 March 2018.

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ANNUAL GOVERNANCE STATEMENT 2017/2018 (Cont.) Overview of Control and Governance Improvements for 2018/2019 Following consideration of the internal review of the adequacy and effectiveness of the IJB governance arrangements, continuous improvement actions will be progressed in 2018/2019 to further develop good governance controls. These actions, including the timeline, are detailed in the table below.

Ref. Area for Improvement and Outcome To Be Achieved

Improvement Action Agreed Lead Officer and Timeline

1

Ensure the financial and commissioning strategies of the IJB and each partner continue to be aligned in order to progress the health and social care integration agenda and respond to the national and local policy initiatives within the context of on-going significant financial challenges.

Review Financial Framework Review Financial Regulations Finalise the medium to long term

financial strategy Further develop transparency and

financial management reporting Specify the resources to be

attached to the directions in line with strategic commissioning plan intentions.

Consider the options to review the alignment of financial resources to reflect the population and locality needs

Chief Financial Officer April 2018 to March 2020

2

Further develop the performance management framework to secure improvement activity and evidence the shift in the balance of care.

Review Performance Framework Review performance targets and

outcomes Review shifting the balance of care Review the ongoing sustainability

of services

Head of Commissioning and Performance April 2018 to March 2020

3

Continue to embed governance structures across the partnership and promote a culture that fully endorses and accepts challenge among partners.

Review Governance Arrangements Embed governance framework and

link to the directions pathway Review terms of reference of

Performance and Audit Sub-Committee

Provide ongoing support and personalised development opportunities for IJB members

Progress learning and review opportunities which actively encourage meaningful and constructive feedback from key stakeholders.

Chief Officer April 2018 to March 2020

4

Implementation of national agreements and new legislative duties

GMS 2018 contract Carers (Scotland) Act 2016 Contribute to consultations (e.g.

Safe Staffing Bill and Free Personal Care to under 65s)

Heads of Health and Social Care April 2018 to March 2020

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ANNUAL GOVERNANCE STATEMENT 2017/2018 (Cont.) Internal Audit Opinion Based solely on the programme of internal audit work undertaken in 2017/2018, it is Internal Audit’s opinion that reasonable assurance can be placed on the adequacy and effectiveness of the South Lanarkshire Integrated Joint Board’s framework of governance, risk management and control arrangements for the year ending 31 March 2018. Following on from the audit work undertaken in 2017/2018, the work planned for 2018/2019 will continue to focus on key strategic and operational areas of risk for the IJB. Conclusion and Opinion on Assurance During 2017/2018, the IJB has adhered to the stated principles of good governance, acted in the public interest and been committed to continuous improvement. The IJB continued to demonstrate that the governance arrangements and framework within which it operates are sound and effective and are consistent with the principles and recommendations of the CIPFA/SOLACE Framework (2016). Although areas for further improvement have been identified, it is our opinion that there is sufficient evidence that the IJB’s Local Code of Corporate Governance is operating effectively and that the IJB complies with that Local Code in all significant respects. In South Lanarkshire, the Health and Social Care Partnership’s vision is to work together to improve health and wellbeing in the community - with the community. The IJB recognises the need to focus on the long term and take account of the impact of current decisions and actions on future generations. Systems are in place to regularly review and improve the governance framework and this process will be supported by action plans going forward. This assurance is limited, however, to the work undertaken during the year, the assurances provided by each partner and the evidence available at the time of preparing this statement. Philip Campbell Val de Souza Chair Chief Officer Date 11 September 2018 Date 11 September 2018

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COMPREHENSIVE INCOME AND EXPENDITURE STATEMENT FOR THE YEAR ENDED 31 MARCH 2018

This statement shows the actual cost of providing services in accordance with generally accepted accounting practices, the total funding contributions from the partners and the surplus on activities during the year.

2016/2017 (Restated) 2017/2018

Gross Expenditure

Gross Income

Net

Gross Expenditure

Gross Income

Net

£m £m £m £m £m £m

150.729 0.000 150.729 Social Care Services 156.703 (0.221) 156.482

84.231 0.000 84.231 Family Health Services 85.223 0.000 85.223

67.013 0.000 67.013 Prescribing Costs 67.571 0.000 67.571

80.484 0.000 80.484 Hosted Services 87.102 0.000 87.102

55.154 0.000 55.154 Hospital Acute Services (Notional Set Aside Budget)

54.715 0.000 54.715

42.401 0.000 42.401 Health Care Services 40.169 0.000 40.169

5.202 (2.924) 2.278 Housing Services 5.020 (3.008) 2.012

0.147 0.000 0.147 Corporate Services

(Note 6) 0.152 0.000 0.152

485.361 (2.924) 482.437 Cost of Services

496.655 (3.229) 493.426

0.000 (488.556) (488.556)

Taxation and Non-Specific Grant Income (Note 5)

0.000 (495.585) (495.585)

485.361 (491.480) (6.119)

(Surplus) on provision of services and total comprehensive (income) and expenditure (Note 10)

496.655 (498.814) (2.159)

The IJB was established on 6 October 2015. Integrated delivery of health social care services commenced on 1 April 2016. 2017/2018 is the second year of operation for the IJB. There are no statutory or presentation adjustments which affect the IJB’s application of the funding received by partners. The movement in the General Fund balance is therefore solely due to the transactions shown in the Comprehensive Income and Expenditure Statement. Consequently, an Expenditure and Funding Analysis is not provided in these annual accounts. The income and expenditure statement has been restated in 2016/2017 to reflect the revised position in relation to hosted services. Further details are provided at Note 2 and Note 9.

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MOVEMENT IN RESERVES STATEMENT This statement shows the movement in the year on the IJB’s reserves. The movements which arise due to statutory adjustments which affect the General Fund balance are separately identified from the movements due to accounting practices.

Movements in Reserves during 2017/2018

General Fund

Balance £m

Total

Reserves £m

Opening balance at 1 April 2017

6.119

6.119

Total Comprehensive Income and Expenditure

2.159 2.159

Increase or decrease in 2017/2018

2.159 2.159

Closing balance at 31 March 2018

8.278 8.278

Movements in Reserves during 2016/2017

General Fund

Balance £m

Total

Reserves £m

Opening balance at 1 April 2016

0.000

0.000

Total Comprehensive Income and Expenditure

6.119

6.119

Increase or decrease in 2016/2017

6.119

6.119

Closing balance at 31 March 2017

6.119

6.119

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BALANCE SHEET AS AT 31 MARCH 2018 The balance sheet shows the value as at 31 March 2018 of the IJB’s assets and liabilities at the balance sheet date. The net assets of the IJB are matched by the reserves held by the IJB.

Notes

31 March 2018

£m

31 March 2017

£m

Current assets Short term debtors

7 8.278 6.119

Net assets / (liabilities)

8.278 6.119

Usable reserves

10 8.278 6.119

Total reserves

8.278 6.119

The Statement of Accounts present a true and fair view of the financial position of the South Lanarkshire Integration Joint Board as at 31 March 2018 and its income and expenditure for the year then ended. The unaudited accounts were authorised for issue on 26 June 2018 and the audited accounts were authorised for issue on 11 September 2018. Marie Moy Chief Financial Officer Date: 11 September 2018

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NOTES TO THE ACCOUNTS 1. Accounting policies 1.1 General principles

The Annual Accounts summarise the transactions of the IJB for the financial year 2017/2018 and its position at the year end of 31 March 2018. 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. It is a joint venture between South Lanarkshire Council and NHS Lanarkshire. The financial statements are therefore prepared in compliance with the Code of Practice on Local Authority Accounting in the United Kingdom 2017/2018, supported by the International Financial Reporting Standards (IFRS), unless legislation or statutory guidance requires different treatment.

1.2 Going concern

The accounts are prepared on a going concern basis, which assumes that the IJB will continue in operational existence for the foreseeable future.

1.3 Accounting convention

The accounts are prepared under the historical cost convention.

1.4 Accruals of income and expenditure Activity is accounted for in the year that it relates to and not simply when financial transactions are undertaken. 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. 1.5 Funding

The IJB is primarily funded through funding contributions from the statutory funding partners, South Lanarkshire Council and NHS Lanarkshire, to fund its services. Expenditure is incurred as the IJB commissions specified health and social care services from the funding partners for the benefit of service recipients in South Lanarkshire.

1.6 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. There is therefore no requirement for the IJB to prepare a cash flow statement. The funding balance due to or from each funding partner as at 31 March 2018 is represented as a debtor or creditor on the IJB’s balance sheet.

1.7 Employee benefits

The IJB does not directly employ staff. Staff are formally employed by the funding 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.

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NOTES TO THE ACCOUNTS (Cont.) 1.8 Corporate services

The IJB has a legal responsibility to appoint a Chief Officer. A Chief Financial Officer has also been appointed to the IJB. The details in respect of these arrangements are outlined in the Remuneration Report. The charges from the employing partner are treated as employee costs within Corporate Services. The absence entitlement of both the Chief Officer and the Chief Financial Officer as at 31 March 2018 is not material and has therefore not been accrued.

1.9 Indemnity Insurance

The IJB has indemnity insurance for costs relating primarily to potential claim liabilities regarding board member and officer responsibilities. NHS Lanarkshire and South Lanarkshire Council have responsibility for claims in respect of the services that they are statutory responsible for and that they provide. Unlike NHS Boards, the IJB does not have any “shared risk” exposure from participation in the Clinical Negligence and Other Risks Indemnity Scheme (CNORIS). The IJB participation in CNORIS is therefore analogous to normal insurance arrangements.

1.10 Debtors and creditors

Where income and expenditure have been recognised but cash has not been received or paid, a debtor or creditor for the relevant amount is recorded in the balance sheet.

1.11 Reserves A reserve is the accumulation of surpluses, deficits and appropriation over a number of years. Reserves of a revenue nature are available and can be spent or earmarked at the discretion of the IJB. Reserves should be split between usable and unusable on the balance sheet. As at 31 March 2018, the useable reserve balance totals £8.278 million. There are no unusable reserves.

2. Critical judgements and estimation uncertainty

The critical judgements made in the financial statements relating to complex transactions are in relation to the accounting treatment of hosted services and the hospital acute services (set-aside). The aforementioned areas of expenditure are therefore included in the financial statements on the basis of estimated figures. Estimates are made taking into account the best available information, however, actual results could be materially different from the assumptions and estimates used.

2.1 Hosted services

In applying the accounting policies set out above, the IJB has had to make a critical judgement relating to complex transactions in respect of values included for services hosted within South Lanarkshire IJB for North Lanarkshire IJB. In previous financial years, the annual accounts have been prepared on the basis that the costs associated with activity for services related to non-South Lanarkshire residents were removed and transferred to the North Lanarkshire IJB to reflect the location of the service recipients. Costs were also added to reflect activity for services delivered by other IJB’s related to South Lanarkshire residents. The costs removed or added were based upon budgeted spend such that any overspend or underspend remained with the hosting IJB. In preparing the 2017/2018 annual accounts, this adjustment will no longer be made.

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NOTES TO THE ACCOUNTS (Cont.)

2. Critical judgements and estimation uncertainty (Cont.)

2.1 Hosted services (Cont.)

Within Lanarkshire, each IJB has operational responsibility for the services which it hosts on behalf of the other IJB. In delivering these services the IJB has primary responsibility for the provision of the services and bears the risk and reward associated with this service delivery in terms of demand and the financial resources required. As such, the full costs are now reflected within the annual accounts for the services which the IJB hosts. This is the basis upon which the 2017/2018 annual accounts have been prepared. The 2016/2017 figures have also been restated to ensure expenditure and partner funding contributions are comparable. The effect of this restatement is outlined in the table below.

2016/2017 Annual Accounts – Restatement

2016/2017 Original

£m

Adjustment

£m

2016/2017 Restated

£m

Comprehensive Income and Expenditure Statement and Note 4

Hosted Services – Total

62.592 17.892 80.484


Cost of Services and Total Comprehensive (Gross) Expenditure 467.469 17.892 485.361


Total Taxation and Non-Specific Grant Income

(470.664) (17.892) (488.556)

Note 4

Hosted Services - Led by the South IJB including the Primary Care Transformation Fund

15.043 17.892 32.935

Note 4

Funding Contribution - NHS Lanarkshire

(356.024) (17.892) (373.916)

Note 4

Total Comprehensive (Income)

(473.588) (17.892) (491.480)

Note 5 and Note 11

Funding Contribution from NHS Lanarkshire

(356.813) (17.892) (374.705)

Note 11

Expenditure on Services Provided by NHS Lanarkshire

311.391 17.892 329.283

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NOTES TO THE ACCOUNTS (Cont.) 2. Critical judgements and estimation uncertainty (Cont.) 2.1 Hosted services (Cont.)

The relevant share of the pan Lanarkshire and area wide service expenditure is therefore included in the South Lanarkshire IJB on the basis of 49% of the total expenditure. 51% of the services relating to the North Lanarkshire IJB are also included as the South Lanarkshire IJB is acting as the principal for the delivery of these services. In line with the Integrated Resource Advisory Group Guidance, the IJB responsible for the management of the hosted service is also responsible for managing overspends. As a result, these are accounted for within the annual accounts of the lead IJB. The same accounting treatment was adopted where an underspend arose in respect of a hosted service.

2.2 Hospital Acute Services (Set Aside)

The legislation sets out that Integration Authorities are responsible for the strategic planning of hospital services most commonly associated with the emergency care pathway along with primary and community health care and social care services. In respect of the current financial year 2017/2018, a notional figure for the sum set aside has been agreed with NHS Lanarkshire and will be included in both the Health Board and IJB 2017/2018 annual accounts. This is based on 2015/2016 activity levels uprated to reflect the 2017/2018 price basis and adjusted for the transfer of agreed activity out to the community during 2017/2018. It should be noted therefore that the sum set aside recorded in the annual accounts will not therefore reflect actual hospital use in 2017/2018. This is a transitional arrangement for 2017/2018. Advice is expected to be issued in 2018/2019 to Health Boards and Integration Authorities to help establish arrangements that meet the legislative requirements and statutory guidance.

3. Events after the reporting period

The Chief Financial Officer authorised the audited accounts for issue on 11 September 2018. There have been no other material events since the date of the balance sheet which requires revision to the figures in the Accounts.

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NOTES TO THE ACCOUNTS (Cont.) 4. Expenditure and Income Analysis by Nature

2016/2017 (Restated)

£m

Expenditure and Income 2017/2018 £m

2017/2018 £m

150.729 Social Care Services 156.703

84.231 Family Health Services 85.223

67.013 Prescribing Costs 67.571

32.935 Hosted Services - Led by the South IJB (Note 9) 38.816

47.549 Hosted Services - Led by the North IJB 48.286

80.484 Hosted Services – Total 87.102

55.154 Hospital Acute Services (Notional Set Aside Budget) 54.715

27.476 Health Care Services - Localities 29.056

6.055 Health Care Services - Area Wide 6.618

8.870 Health Care Services - Out-of Area 4.495

42.401 Health Care Services - Total 40.169

2.924 Housing Services - Housing Revenue Account 3.008

2.278 Housing Services - General Fund 2.012

5.202 Housing Services – Total 5.020

0.147 Corporate Services 0.152

485.361 Total Gross Expenditure 496.655

(104.587) Funding Contribution - South Lanarkshire Council (106.350)

(373.916) Funding Contribution - NHS Lanarkshire (382.021)

(0.789) North Lanarkshire IJB Hosted Service Funding 0.000

(2.924) Specific Service Income (3.229)

(9.264) Other Service Income (7.214)

(491.480) Total Income (498.814)

(6.119) Surplus on the provision of services (2.159)

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NOTES TO THE ACCOUNTS (Cont.) 5. Taxation and Non-Specific Grant Income


£m

2017/2018 £m

(374.705) Funding Contribution from NHS Lanarkshire (382.021)

(113.851) Funding Contribution from South Lanarkshire Council (113.564)

(488.556) Total (495.585)

The funding contribution from the NHS Board shown above includes £54.715 million in respect of the “set aside” resources relating to acute hospital and other resources. These are provided by NHS Lanarkshire which retains responsibility for managing the costs of providing these services. The IJB however, has responsibility for the consumption of, and level of demand placed on, these resources. There are no other non-ring fenced grants or contributions. The funding contributions from the partners shown above exclude any funding which is ring-fenced for the provision of specific services. Such ring-fenced funding is presented as income in the Cost of Services in the Comprehensive Income and Expenditure Statement. The only ring fenced contribution is in relation to the Housing Revenue Account and totals £3.008m. Income and expenditure in relation to a local authority's own direct provision of housing must be recorded separately within a Housing Revenue Account as laid out in Section 203 of the Housing (Scotland) Act 1987.

6. Corporate Services

31 March 2017 £m

31 March 2018 £m

0.125 Staff Costs 0.125

0.017 External Audit Fee 0.024

0.005 Administration Costs 0.003

0.147 Total 0.152

7. Short Term Debtors

31 March 2017 £m

31 March 2018 £m

6.119 NHS Lanarkshire Health Board 7.577

0.000 South Lanarkshire Council 0.701

6.119 Total 8.278

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NOTES TO THE ACCOUNTS (Cont.) 8. VAT

The IJB is not VAT registered and as such the VAT is settled or recovered by the partner agencies. The VAT treatment of expenditure in the IJB’s accounts depends on which of the partner agencies is providing the service as these are treated differently for VAT purposes. VAT payable therefore is included as an expense only to the extent that it is not recoverable from Her Majesty’s Revenue and Customs. VAT receivable is excluded from income. The services provided by the Chief Officer to the IJB are outside the scope of VAT as they are undertaken under a specific legal regime.

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9. Hosted Services - Income and Expenditure On behalf of the North Lanarkshire IJB within the NHS Lanarkshire area, the South Lanarkshire IJB acts as the lead for a number of delegated hosted services. It therefore commissions services on behalf of the North Lanarkshire IJB and reclaims the costs involved. The payments that are made on behalf of the North Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement. The net amount of expenditure and income relating to these hosted services arrangements is shown below:

2016/2017

Delegated Services - Hosted Services

2017/2018

Expenditure on hosted services

Income from

hosted services

Net

Expenditure


Income from

hosted services

Net

Expenditure

£m £m £m £m £m £m

1.251 (1.251) 0.000 Primary Care Transformation 1.844 (1.844) 0.000

3.259 (3.259) 0.000 Community Dental Services 3.075 (3.075) 0.000

3.040 (3.040) 0.000 Out of Hours Services 2.949 (2.949) 0.000

1.389 (1.389) 0.000 Diabetic Services 1.475 (1.475) 0.000

3.500 (3.500) 0.000 Occupational Therapy Services 3.446 (3.446) 0.000

0.865 (0.865) 0.000 Palliative Care Services 3.133 (3.133) 0.000

0.318 (0.318) 0.000 Primary Care Services 0.318 (0.318) 0.000

4.270 (4.270) 0.000 Physiotherapy Services 4.170 (4.170) 0.000

17.892 (17.892) 0.000 Services hosted by the South Lanarkshire IJB on behalf of the North Lanarkshire IJB

20.410 (20.410) 0.000

15.043 Services hosted by the South Lanarkshire IJB on behalf of the South Lanarkshire IJB

18.406

32.935 Services hosted by the South Lanarkshire IJB Total (Note 4)

38.816

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9. Hosted Services - Income and Expenditure (Cont.) Similarly, the North Lanarkshire IJB within the NHS Lanarkshire area acts as the lead for a number of delegated hosted services on behalf of the South Lanarkshire IJB. The payments that are made by the North Lanarkshire IJB on behalf of the South Lanarkshire IJB, and the consequential reimbursement, are included in the Comprehensive Income and Expenditure Statement, since this expenditure is incurred for the residents of South Lanarkshire.

The net amount of expenditure and income relating to those arrangements hosted by the North Lanarkshire IJB is shown below:

2016/2017

Delegated Services - Hosted Services

2017/2018


Income from

hosted services

Net

Expenditure


Income from

hosted services

Net

Expenditure

£m £m £m £m £m £m

1.127 (1.127) 0.000 Sexual Health Services 1.135 (1.135) 0.000

1.091 (1.091) 0.000 Continence Services 1.059 (1.059) 0.000

1.200 (1.200) 0.000 Immunisation Services 1.082 (1.082) 0.000

2.397 (2.397) 0.000 Speech and Language Therapy Services 2.588 (2.588) 0.000

2.520 (2.520) 0.000 Child & Adolescent Mental Health Services 2.691 (2.691) 0.000

4.803 (4.803) 0.000 Children’s Services 4.886 (4.886) 0.000

0.495 (0.495) 0.000 Integrated Equipment and Adaptations Services 0.265 (0.265) 0.000

1.589 (1.589) 0.000 Dietetics Services 1.589 (1.589) 0.000

1.798 (1.798) 0.000 Podiatry Services 1.800 (1.800) 0.000

0.718 (0.718) 0.000 Prisoner Healthcare Services 0.693 (0.693) 0.000

0.777 (0.777) 0.000 Blood Borne Viruses 0.777 (0.777) 0.000

29.034 (29.034) 0.000 Mental Health Services 29.721 (29.721) 0.000

47.549 (47.549) 0.000

Services hosted by the North Lanarkshire IJB on behalf of the South Lanarkshire IJB

48.286 (48.286) 0.000

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10. Usable Reserve: General Fund The IJB holds a balance on the General Fund for two main purposes:

To earmark, or build up, funds which are to be used for specific purposes in the future, such as known or predicted future expenditure needs. This supports strategic financial management.

To provide a contingency fund to cushion the impact of unexpected events or emergencies. This is regarded as a key part of the IJB’s risk management framework.

The table below shows the movements on the General Fund balance, analysed between those elements earmarked for specific planned future expenditure, and the amount held as a general contingency.

2016/2017

Useable Reserve 2017/2018

Balance as at 1 April 2016

Transfers Out

Transfers In

Balance as at 31 March 2017

Transfers Out

Transfers In

Balance as at 31 March 2018

£m £m £m £m Ring-Fenced Reserves £m £m £m

0.000 0.000 2.749 2.749 Primary Care and Mental Health Transformation Fund 0.000 0.932 3.681

0.000 0.000 0.473 0.473 Alcohol and Drug Partnership Fund 0.000 0.000 0.473

0.000 0.000 0.000 0.000 Physio Trauma and Orthopaedics Pilot 0.000 0.093 0.093

0.000 0.000 0.000 0.000 OT Trauma and Orthopaedics Pilot 0.000 0.083 0.083

0.000 0.000 0.000 0.000 Home and Mobile Health Monitoring Pilot 0.000 0.042 0.042

0.000 0.000 0.000 0.000 Antenatal to 6 months Pathway Pilot 0.000 0.017 0.017

0.000 0.000 0.015 0.015 Family Health Services 0.000 0.000 0.015

0.000 0.000 3.237 3.237 Total Ring-Fenced 0.000 1.167 4.404

Earmarked Reserves

0.000 0.000 0.000 0.000 Palliative Care Services 0.000 0.808 0.808

0.000 0.000 0.636 0.636 Prescribing Fund 0.000 0.100 0.736

0.000 0.000 0.000 0.000 Social Care Contingency 0.000 0.701 0.701

0.000 0.000 0.696 0.696 Transitional Fund 0.121 0.000 0.575

0.000 0.000 0.000 0.000 Training Fund - Health Visitors 0.000 0.220 0.220

0.000 0.000 0.191 0.191 Telehealth Project 0.000 0.000 0.191

0.000 0.000 0.000 0.000 IT Federated Trust Environment 0.000 0.070 0.070

0.000 0.000 0.000 0.000 Diabetes Capacity Plan 0.000 0.022 0.022

0.000 0.000 1.523 1.523 Total Earmarked 0.121 1.921 3.323

0.000 0.000 1.359 1.359 Contingency 0.808 0.000 0.551

0.000 0.000 6.119 6.119 General Fund 0.929 3.088 8.278

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NOTES TO THE ACCOUNTS (Cont.) 11. Related Party Transactions

The IJB has related party transactions with NHS Lanarkshire and South Lanarkshire Council. In particular, the nature of the partnership means that the IJB may influence, and be influenced by, its partners. The following transactions and balances included in the IJB’s accounts are presented to provide additional information on the relationships.


£m

Transactions with NHS Lanarkshire

2017/2018 £m

(374.705) Funding Contributions received from NHS Lanarkshire (382.021)

0.000 Service Income received from NHS Lanarkshire 0.000

329.283 Expenditure on Services Provided by NHS Lanarkshire 334.780

0.063 Key Management Personnel: Non-Voting Board Members

0.000

0.021 Support Services 0.027

(45.338) Net Transactions with NHS Lanarkshire (47.214)

Key Management Personnel: The non-voting Board members are not directly employed by NHS Lanarkshire however a contribution of 50% of the cost of the Chief Officer and the Chief Financial Officer is made by NHS Lanarkshire. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. Details of the remuneration of these post holders is included in the Remuneration Report. NHS Lanarkshire provide a range of support services for the IJB including finance services, personnel services, planning services, audit services, payroll services and creditor services. There is no charge from NHS Lanarkshire to the IJB for these support services.

31 March 2017 £m

Balances with NHS Lanarkshire

31 March 2018 £m

6.119 Debtor balances: Amounts due from NHS Lanarkshire 7.577

0.000 Creditor balances: Amounts due to NHS Lanarkshire 0.000

6.119 Net Balance with NHS Lanarkshire 7.577

2016/2017 £m

Transactions with South Lanarkshire Council

2017/2018 £m

(113.851) Funding Contributions received from South Lanarkshire Council (113.564)

(2.924) Service Income received from South Lanarkshire Council (3.229)

155.931 Expenditure on Services Provided by South Lanarkshire Council 161.723

0.063 Key Management Personnel: Non-Voting Board Members 0.125

0.000 Support Services 0.000

39.219 Net Transactions with South Lanarkshire Council 45.055

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NOTES TO THE ACCOUNTS (Cont.) 11. Related Party Transactions (Cont.)

Key Management Personnel: The Chief Officer and the Chief Financial Officer are non-voting Board members and are directly employed by South Lanarkshire Council. Only 50% of the cost of the Chief Officer is allocated by South Lanarkshire Council to the IJB. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. The cost is shared equally between South Lanarkshire Council and NHS Lanarkshire. Only 50% of the cost of the Chief Financial Officer is allocated by South Lanarkshire Council to the IJB. This payment is included in the Corporate Services cost in the Comprehensive Income and Expenditure Statement. The cost is shared equally between South Lanarkshire Council and NHS Lanarkshire. Details of the remuneration of these post holders is included in the Remuneration Report. South Lanarkshire Council also provide a range of support services for the IJB including finance services, personnel services, planning services, legal services, audit services, payroll services and creditor services. There is no charge from South Lanarkshire Council to the IJB for these support services.

31 March 2017 £m

Balances with South Lanarkshire Council

31 March 2018 £m

0.000 Debtor balances: Amounts due from South Lanarkshire Council 0.701

0.000 Creditor balances: Amounts due to South Lanarkshire Council 0.000

0.000 Net Balance with South Lanarkshire Council 0.701

The financial information contained in the IJB Annual Accounts excludes any values associated with transactions between each of the partners. This has been removed to prevent double counting.

12. New standards issued but not yet 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 adopted. The IJB considers that there are no such standards which would have significant impact on its annual accounts.

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Independent auditor’s report to the members of South Lanarkshire Integration Joint Board and the Accounts Commission This report is made solely to the parties to whom it is addressed in accordance with Part VII of the Local Government (Scotland) Act 1973 and for no other purpose. In accordance with paragraph 120 of the Code of Audit Practice approved by the Accounts Commission, I do not undertake to have responsibilities to members or officers, in their individual capacities, or to third parties.

Report on the audit of the financial statements

Opinion on financial statements I certify that I have audited the financial statements in the annual accounts of South Lanarkshire Integration Joint Board for the year ended 31 March 2018 under Part VII of the Local Government (Scotland) Act 1973. The financial statements comprise the Comprehensive Income and Expenditure Statement, Movement in Reserves Statement, Balance Sheet and notes to the accounts, including a summary of significant accounting policies. The financial reporting framework that has been applied in their preparation is applicable law and International Financial Reporting Standards (IFRSs) as adopted by the European Union, and as interpreted and adapted by the Code of Practice on Local Authority Accounting in the United Kingdom 2017/18 (the 2017/18 Code). In my opinion the accompanying financial statements:

give a true and fair view in accordance with applicable law and the 2017/18 Code of the state of affairs of the South Lanarkshire Integration Joint Board as at 31 March 2018 and of its income and expenditure for the year then ended;

have been properly prepared in accordance with IFRSs as adopted by the European Union, as interpreted and adapted by the 2017/18 Code; and

have been prepared in accordance with the requirements of the Local Government (Scotland) Act 1973, The Local Authority Accounts (Scotland) Regulations 2014, and the Local Government in Scotland Act 2003.

Basis for opinion I conducted my audit in accordance with applicable law and International Standards on Auditing (UK) (ISAs (UK)). My responsibilities under those standards are further described in the auditor’s responsibilities for the audit of the financial statements section of my report. I am independent of the South Lanarkshire Integration Joint Board in accordance with the ethical requirements that are relevant to my audit of the financial statements in the UK including the Financial Reporting Council’s Ethical Standard, and I have fulfilled my other ethical responsibilities in accordance with these requirements. I believe that the audit evidence I have obtained is sufficient and appropriate to provide a basis for my opinion. Conclusions relating to going concern basis of accounting I have nothing to report in respect of the following matters in relation to which the ISAs (UK) require me to report to you where:

the use of the going concern basis of accounting in the preparation of the financial statements is not appropriate; or

the Chief Financial Officer has not disclosed in the financial statements any identified material uncertainties that may cast significant doubt about South Lanarkshire Integration Joint Board’s ability to continue to adopt the going concern basis of accounting for a period of at least twelve months from the date when the financial statements are authorised for issue.

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Responsibilities of the Chief Financial Officer and South Lanarkshire Integration Joint Board for the financial statements As explained more fully in the Statement of Responsibilities, the Chief Financial Officer is responsible for the preparation of financial statements that give a true and fair view in accordance with the financial reporting framework, and for such internal control as the Chief Financial Officer determines is necessary to enable the preparation of financial statements that are free from material misstatement, whether due to fraud or error. In preparing the financial statements, the Chief Financial Officer is responsible for assessing the South Lanarkshire Integration Joint Board’s ability to continue as a going concern, disclosing, as applicable, matters related to going concern and using the going concern basis of accounting unless deemed inappropriate. The South Lanarkshire Integration Joint Board is responsible for overseeing the financial reporting process. Auditor’s responsibilities for the audit of the financial statements My objectives are to achieve reasonable assurance about whether the financial statements as a whole are free from material misstatement, whether due to fraud or error, and to issue an auditor’s report that includes my opinion. Reasonable assurance is a high level of assurance, but is not a guarantee that an audit conducted in accordance with ISAs (UK) will always detect a material misstatement when it exists. Misstatements can arise from fraud or error and are considered material if, individually or in the aggregate, they could reasonably be expected to influence the economic decisions of users taken on the basis of these financial statements. A further description of the auditor’s responsibilities for the audit of the financial statements is located on the Financial Reporting Council's website www.frc.org.uk/auditorsresponsibilities. This description forms part of my auditor’s report. Other information in the annual accounts The Chief Financial Officer is responsible for the other information in the annual accounts. The other information comprises the information other than the financial statements, the audited part of the Remuneration Report, and my auditor’s report thereon. My opinion on the financial statements does not cover the other information and I do not express any form of assurance conclusion thereon except on matters prescribed by the Accounts Commission to the extent explicitly stated later in this report. In connection with my audit of the financial statements, my responsibility is to read all the other information in the annual accounts and, in doing so, consider whether the other information is materially inconsistent with the financial statements or my knowledge obtained in the audit or otherwise appears to be materially misstated. If I identify such material inconsistencies or apparent material misstatements, I am required to determine whether there is a material misstatement in the financial statements or a material misstatement of the other information. If, based on the work I have performed, I conclude that there is a material misstatement of this other information, I am required to report that fact. I have nothing to report in this regard.

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https://www.frc.org.uk/Our-Work/Audit-and-Actuarial-Regulation/Audit-and-assurance/Standards-and-guidance/Standards-and-guidance-for-auditors/Auditors-responsibilities-for-audit/Description-of-auditors-responsibilities-for-audit.aspx


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Report on other requirements

Opinions on matters prescribed by the Accounts Commission In my opinion, the audited part of the Remuneration Report has been properly prepared in accordance with The Local Authority Accounts (Scotland) Regulations 2014. In my opinion, based on the work undertaken in the course of the audit

the information given in the Management Commentary for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with statutory guidance issued under the Local Government in Scotland Act 2003; and

the information given in the Annual Governance Statement for the financial year for which the financial statements are prepared is consistent with the financial statements and that report has been prepared in accordance with the Delivering Good Governance in Local Government: Framework (2016).

Matters on which I am required to report by exception I am required by the Accounts Commission to report to you if, in my opinion:

adequate accounting records have not been kept; or

the financial statements and the audited part of the Remuneration Report are not in agreement with the accounting records; or

I have not received all the information and explanations I require for my audit; or

there has been a failure to achieve a prescribed financial objective. I have nothing to report in respect of these matters. Fiona Mitchell-Knight FCA Audit Director Audit Scotland 4th Floor, The Athenaeum Building 8 Nelson Mandela Place, Glasgow, G2 1BT 11 September 2018

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Report

Agenda Item

8


Subject: Internal Audit Plan 2018/2019


present the proposed Internal Audit Plan for 2018/2019 that has been prepared by the Chief Internal Auditors of South Lanarkshire Council and NHS Lanarkshire Health Board


(1) that the proposed Internal Audit Plan for 2018/2019, detailed in Appendix 3 of the report, be approved; and

(2) that the previous approach to deliver this as a joint service by South Lanarkshire Council and NHS Lanarkshire Health Board be approved for 2018/2019.

[1recs] 3. Background 3.1. The Public Bodies (Joint Working) (Scotland) Act 2014, requires the Integration Joint

Board (IJB) to comply with the accounts and audit regulations and legislation under section 106 of the Local Government (Scotland) Act 1973.

3.2. The Integrated Resources Advisory Group guidance set out the South Lanarkshire

IJB’s responsibility to establish adequate and proportionate internal audit arrangements, including arrangements to review risk management, governance and control of delegated resources.

3.3. The Chief Officer was mandated, at a meeting of the IJB on 13 September 2016, to

establish effective internal audit arrangements, including a framework to review the key strategic risks that could impact on the achievement of the IJB’s objectives. This included the agreement of appropriate protocols to provide a framework within which Internal Audit Services would be provided and to manage the key strategic priorities and risks that could impact on the achievement of the IJB’s objectives.

3.4. A professional and objective joint Internal Audit Service has been established in

accordance with recognised internal audit standards and practices as laid out in the Public Sector Internal Audit Standards (PSIAS), in order to comply with article 7 of the Local Authority Accounts (Scotland) Regulations 2014. The joint approach by

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the internal audit functions of South Lanarkshire Council (SLC) and National Health Service Lanarkshire (NHSL) to deliver the annual Internal Audit Plan of work for previous years was approved by the Board at its meetings on 13 September 2016 for 2016/2017 and 5 December 2017 for 2017/2018.

3.5. The Chief Internal Auditors have drafted an Internal Audit Charter in line with the

requirements of PSIAS and this was approved by the Board at its meeting on 17 April 2018, a copy of which is attached at Appendix 1. The Charter sets out the purpose and scope of the internal audit function and lays out the requirements of the Chief Internal Auditors. A reporting protocol, approved by the Performance and Audit Sub-Committee at its meeting on 3 November 2017, sets out the arrangements by which internal audit reports will be cleared for publication and clarifies the responsibilities of all relevant parties, as detailed in Appendix 2 to the report.

3.6. A formal review of the adequacy of internal audit arrangements was completed for

the IJB in January 2018 by Audit Scotland, the IJB’s external auditor. In addition, the external auditors of the partners have completed assessments of their respective bodies. All assessments found that Internal Audit Services operate in accordance with PSIAS and have sound documentation standards and reporting procedures in place

4. 2018/2019 Audit Plan 4.1. The proposed Internal Audit Plan, detailed at Appendix 3, totals 75 days and

presents a plan of work covering key aspects of the IJB’s assurances arrangements and risk management and performance management processes together with a follow-up of the implementation of actions arising from previous audit findings and the production of an Internal Audit Annual Report for 2018/2019. This programme of work will be delivered by 31 March 2019 and will ensure compliance with the Local Authority Accounts (Scotland) Regulations 2014 and also the guidance issued by the Integrated Resource Advisory Group in respect of internal audit arrangements.

4.2. The Plan also takes account of assurance which can be provided to the IJB based

on work performed under the Internal Audit Plans of both SLC and NHSL for 2018/2019. The relevant extracts from both plans are attached at Appendices 4 (SLC) and 5 (NHSL) for information.

4.3. It is proposed that the joint working arrangements, as first established between SLC

and NHSL in 2016/2017 to deliver the plan of internal audit work, should continue for 2018/2019. The Board is asked to approve this approach.

4.4. NHSL Internal Auditors would continue to be responsible for undertaking audit

assignments in relation to operational matters across in-scope NHS Services. SLC Internal Auditors would continue to be responsible for undertaking audit assignments in relation to operational matters across social work and in-scope housing services. Joint working arrangements would be implemented in respect of ‘IJB only’ audits and any cross-cutting audits.

5. Summary and Next Steps 5.1. Following approval of the 2018/2019 Internal Audit Plan, arrangements will be made

to progress the audit assignments. 6. Employee Implications 6.1. The Internal Audit Plan for 2018/2019 will be delivered jointly by the internal audit

functions within SLC and NHSL.

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7. Financial Implications 7.1. There will be no charge for the provision of this support service as joint working

arrangements have been established to deliver this service. 8. Other Implications 8.1. This report relates to all national outcomes as effective governance arrangements

will ensure that the IJB can fulfil its statutory duties. 8.2. To mitigate against the risk of the non-delivery of the Plan, the progress of every

assignment will be monitored using South Lanarkshire Council’s risk management software, Figtree. Audit performance will require co-operation from the IJB and delivery of the Plan is dependent on assignments being finalised within four weeks of the completion of fieldwork. To assist in meeting this target, it would be helpful if:

designated contacts could attend opening and closing meetings

a senior officer could be nominated to liaise with auditors during the field work.

draft reports could be reviewed for factual accuracy and agreed within four weeks of the issue of this report.

8.3. There are no sustainable or environmental implications arising directly from this


change to existing policy, function or strategy and, therefore, no impact assessment is required.

9.2. There is also no requirement to undertake any further consultation in terms of the

information contained in this report. 10. Directions 10.1.

Direction to:



3. NHS Lanarkshire



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Previous References


none Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Yvonne Douglas, Audit and Compliance Manager Ext: 2618 (Phone: 01698 452618) Email: [email protected] Tony Gaskin, Chief Internal Auditor NHS Fife, Tayside and Lanarkshire Phone: 01344 696028

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South Lanarkshire IJB Internal Audit Charter Appendix 1 Introduction 1. This charter, which accords with the current Public Sector Internal Audit Standards

(PSIAS), supplements the Integration Joint Board (IJB) Financial Regulations and sets out the responsibility and authority for and approach to South Lanarkshire IJB’s internal audit activity.

2. The charter was endorsed by the Performance and Audit Sub-Committee on 27

February 2018 and has effect from that date and until such time as it is replaced or revoked. The Charter will be updated concurrently with any amendments to relevant sections of the South Lanarkshire IJB’s Financial Regulations and subject to a full review at least biennially.

3. The Charter also acknowledges the Chartered Institute of Internal Auditors (CIIA) Code

of Ethics for Internal Auditors. Internal Audit Standards 4. Overall responsibility for arranging internal audit provision rests with the Chief

Accountable Officer but is delivered by the South Lanarkshire Council and NHS Lanarkshire internal audit teams, under the direction of their respective Chief Internal Auditors.

5. The Chief Internal Auditors must ensure that internal audit activity is delivered in accordance with PSIAS and CIIA Code of Ethics for Internal Auditors.

Vision and Mission 6. The vision of Internal Audit is to provide continuously improving, high quality assurance

and advice. The mission of Internal Audit is: a) to provide the Chief Accountable Officer, in an economical and timely manner, with

an objective evaluation of, and opinion on, the overall adequacy and effectiveness of the organisation’s framework of governance, risk management and internal control. The Chief Internal Auditor opinion is a key part of the framework of assurance that the Chief Accountable Officer needs to inform the completion of the Annual Governance Statement (AGS);

b) to provide independent assurance and advice to the IJB, Performance and Audit Sub-Committee and the senior management team on all aspects of governance and risk across South Lanarkshire IJB; and

c) to provide advice and assistance to directors and senior managers in carrying out their internal control responsibilities including matters of risk, fraud, business improvement, policy, procedure and compliance.

7. The mission is supported by the PSIAS and the Chartered Institute of Internal Auditors’

(CIIA) definition of Internal Auditing: “Internal Audit is an independent, objective assurance and consulting activity designed to add value and improve an organisation’s operations. It helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluate and improve the effectiveness of risk management, control and governance processes”.

Responsibility 8. Within the organisation, responsibility for internal control rests fully with management to

ensure that appropriate and adequate arrangements are established. Internal Audit will be responsible for conducting an independent appraisal and giving assurance to the Audit Committee on internal control arrangements.

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9. Internal Audit will be responsible for obtaining relevant, reliable and sufficient audit evidence in order to provide an opinion to the IJB on the adequacy and effectiveness of internal controls. Internal Audit will also assist management by evaluating and reporting to them on the effectiveness of the controls for which they are responsible.

10. Internal Audit will consider the adequacy of controls necessary to secure propriety,

economy, efficiency and effectiveness and will seek to confirm that management have taken the necessary steps to achieve these objectives.

11. Internal Audit work must be sufficient to meet the requirements of PSIAS which requires

Internal Audit to evaluate and contribute to the improvement of governance, risk management and control processes using a systematic and disciplined approach.

12. In fulfilling this responsibility Internal Audit will:

evaluate the design, implementation and effectiveness of the organisation’s ethics-related objectives, programmes and activities

evaluate risk exposures relating to the organisation’s governance, operations and information systems regarding the: o reliability and integrity of financial and operational information o effectiveness and efficiency of operations and programmes o safeguarding of assets o compliance with laws, regulations, policies, procedures and contracts

evaluate the potential for the occurrence of fraud and how the organisation manages fraud risk

refrain from assuming any management responsibility for managing risks when assisting management in establishing or improving risk management processes in addition, Internal Audit scope must be sufficient to provide the Chief Accountable Officer with the opinion on the adequacy and effectiveness of internal control required to support the Board’s Governance Statement

Authority 13. The IJB shall ensure that, for all information and areas under the direction of the IJB,

that its Internal Auditors are entitled to require and receive, without necessarily giving prior notice: a) access to all records, documents and correspondence relating to any transactions,

including documents of a confidential nature; b) access at all reasonable times to any land, premises or employee of the

organisation; c) the production of any cash, stores or other property of each organisation under an

employee’s control; and d) explanations concerning any matter under investigation.

Independence 14. PSIAS requires the Internal Audit function to be independent and objective, to interact

directly with the Board and to have unfettered access to the Chief Accountable Officer. The Chief Internal Auditor and the External Auditor have a right of attendance at all Committees. The Chief Internal Auditor and External Auditor shall have the right to direct access to the Chairs of the Board and all Committees.

Appointment of Chief Internal Auditor and Internal Audit Staff, Professionalism, Skills & Experience 15. Both the Health Board and Local Authority shall each provide a Chief Internal Auditor

who is a member of a CCAB Institute or CMIIA with experience equivalent to at least five years post-qualification experience and at least three years of audit.

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Reporting arrangements including Key Performance Indicators 16. Arrangements for reporting and following up individual assignments are contained within

the reporting and follow-up protocols to be approved by the Performance and Audit Sub-Committee.

17. The principal report to be produced by Internal Audit will be the Annual Audit Report for each audit year. This will be prepared in time for submission to the Performance and Audit Sub-Committee not later than the agreed target date, in order to provide the assurance required in considering the IJB’s Annual Accounts and in line with the assurance arrangements agreed with the parties.

18. Internal Audit will identify key performance indicators and report these in full within the

Annual Internal Audit Report. Assurances provided to parties outside the organisation: 19. Internal Audit will not provide assurance on activities undertaken by South Lanarkshire

IJB to outside parties without specific instruction from South Lanarkshire IJB with the exception of the sharing of reports and working papers with the statutory External Auditors and the application of the Freedom of Information (Scotland) Act 2002. Sharing of Internal Audit reports with the parties will be a matter for the IJB and its local authority and health board partners under the terms of an agreed output sharing protocol.

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South Lanarkshire IJB Internal Audit Reporting Protocol Appendix 2 1. Introduction 1.1 This paper details the protocol by which Internal Audit reports will be cleared for

publication. It clarifies the roles and responsibilities of all relevant parties, including the officer designated by the Executive Director, Health and Social Care as being responsible for liaising with Internal Audit regarding each individual audit assignment (hereafter referred to as the Responding Officer).

2. Process 2.1 The Annual Internal Audit Plan, presented in Spring to the South Lanarkshire

Integration Joint Board (IJB) for approval each year, details the audit reviews to be carried out for the financial year ahead. Prior to the start of each review, the audit will be assigned to either the South Lanarkshire Council (SLC) or National Health Service Lanarkshire (NHSL) Internal Audit team, by agreement between both Chief Internal Auditors, or, occasionally, where appropriate and agreed by both Chief Internal Auditors, conducted jointly by both Internal Audit teams.

2.2 The draft Assignment Remit for each audit will be agreed between both Chief Internal Auditors and issued to the Executive Director, Health and Social Care and Chief Financial Officer for comment and nomination of the Responding Officer (as per 1.1 above). The Assignment Remit will be agreed with the Responding Officer prior to the commencement of the audit. The finalised Assignment Remit will be issued to all relevant parties, including the Chief Accountable Officer, the Chief Financial Officer and the Responding Officer. The Assignment Remit will be issued in advance of the assignment and include the indicative timing of the audit.

2.3 Assignments allocated to either or both Internal Audit teams (as per 2.1 above) will be conducted in accordance with the documented audit approach adopted by that team, including appropriate quality assurance processes, and a draft report produced by the relevant Internal Audit team or in the case of jointly conducted audits, relevant staff from both Internal Audit teams will liaise to compile a joint draft report.

2.4 An exit meeting will be arranged prior to preparation of the draft report at the

discretion of the relevant Chief Internal Auditor. 2.5 Both Chief Internal Auditors will agree all draft reports, whether the audit was

conducted separately or jointly, prior to formal issue. 2.6 Draft reports will be issued by the SLC or NHSL Chief Internal Auditor, according to

whichever Internal Audit team undertook the work. Issue of joint reports will be agreed between both Chief Internal Auditors.

2.7 All draft reports will be issued to the relevant Responding Officer for agreement

regarding the accuracy of the findings and consideration of the audit opinion and the recommendations detailed in the Action Plan appended to the draft report.

2.8 The target deadline for issue of the draft report will be in line with deadlines

governing the target Performance and Audit Sub-Committee meeting as detailed in the Assignment Remit.

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2.9 Opportunity will be given to the Responding Officer to discuss any issues with staff from the relevant Internal Audit team prior to submission of the written management response for inclusion in the final report.

2.10 The Responding Officer should submit their written response detailing agreement or otherwise regarding all recommendations included in the Action Plan, together with any related comments, details of the responsible officer and a timescale for implementation of the proposed action.

2.11 It is the responsibility of the Responding Officer to ensure that the response

accurately reflects the official position of the IJB and the proposed action and timescale for completion is appropriate to the risk. The target deadline for this stage will be intimated on issuing the draft report.

2.12 The finalisation process for audit reports will be undertaken by whichever Internal

Audit team (SLC or NHSL) issued the draft report and include follow up of any late replies and discussion with the Responding Officer regarding any ‘disagreed’ recommendations including the underlying reasons, clarification of any management comments which do not appear to fully address the recommendation made and clarification of any timescales which appear overly extended. A further formal management response will be sought, where required, to confirm management’s final position following discussion regarding the above for inclusion in the final report.

2.13 In the event of a failure to receive a suitable response from the Responding Officer

within the required timescale, or to reach agreement on a fundamental recommendation, the matter will be referred to the Chief Financial Officer.

2.14 Where assignments are conducted jointly by both Internal Audit teams, the

finalisation process will include appropriate liaison between both teams. Both Chief Internal Auditors will agree all final reports, whether the audit was conducted separately or jointly, prior to formal issue.

2.15 The finalisation process will commence promptly on receipt of the Responding

Officer’s response. 2.16 On completion of the finalisation process as per 2.12 above, the final report will be

issued by either the SLC or NHSL Chief Internal Auditor, according to whichever Internal Audit team undertook the work or, where audit work was undertaken jointly by both Internal Audit teams, by either Chief Internal Auditor as agreed between them.

2.17 Final reports will be issued to the Executive Director, Health and Social Care seeking

confirmation of management’s final position prior to formal issue. Final reports will then be issued to the Executive Director, Health and Social Care for distribution to all relevant parties, according to the coverage of the report.

2.18 Where any issues are not resolved via the finalisation process, the final report will reflect the final management response provided. Any ‘disagreed’ issues will be highlighted to the Performance and Audit Sub-Committee in the subsequent Internal Audit progress report (see 2.21) to enable the Performance and Audit Sub-Committee to take the issue(s) concerned forward as appropriate.

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2.19 The target deadline for issue of the final report will be in line with deadlines governing the target Performance and Audit Sub-Committee meeting as detailed in the Assignment Remit.

2.20 Performance and Audit Sub-Committee members and the Integration Joint Board’s

appointed External Auditors will receive a summary of all Internal Audit final reports issued via the agenda papers circulated by the Chief Financial Officer in advance of each Performance and Audit Sub-Committee meeting.

2.21 A progress report will be presented at each Performance and Audit Sub-Committee

by either Chief Internal Auditor as agreed between them, summarising each Internal Audit final report issued since the last progress report and highlighting particularly any Internal Audit final reports issued offering ‘limited’ assurance.

2.22 Progress on reporting timescales will be monitored via regular meetings, in advance

of Performance and Audit Sub-Committee meetings, held between the Chief Financial Officer and both Chief Internal Auditors, with additional meetings between both Chief Internal Auditors as required.

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Proposed 2018/2019 Audit Plan Appendix 3

Audit assignment Outline Scope Expected days

Risk Management Review of systems of risk management, assessment of risk maturity and consideration of assurances mechanism for key controls required to implement risk based audit approach.

15

Performance Management

Review of the IJB’s performance management arrangements in order to ensure that they effectively:

reflect the IJB’s priorities and strategic objectives and are integrated into business planning arrangements

produce data which is analysed and monitored at an appropriate level

provide a basis for accountability

enable poor performance to be identified and challenged

provide a focus for action and improvement, with improvement actions which are specific and measurable and where progress is monitored

20

Assurance Mapping Lead a structured process of identifying and mapping the main sources and types of assurance available to the IJB via the preparation of an assurance map to provide independent, timely and reliable information on the effectiveness of the management of major strategic and operational risks and significant control issues. Such an exercise:

provides an opportunity to identify gaps in assurance needs that are vital to the organisation and to address them in a timely, efficient and effective manner

can be used to raise understanding of the risk profile and strengthen accountability and clarity of ownership of controls and assurance thereon, avoiding duplication or overlap

can clarify, rationalise and consolidate multiple assurance inputs, providing greater oversight of assurance activities; and

enables evidence based on corporate reporting and statements about the effectiveness of internal controls to be properly supported in a structured manner

Assignment will also review progress of any audit actions falling due during 2018/2019 and progress with action plans developed by CFO in

30

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response to audit findings and general governance issues.

Internal Audit Annual Report

Annual report containing annual internal audit opinion on assurance and review of the IJB’s self-assessment of governance and systems for preparing the 2017/2018 Annual Governance Statement.

5

Audit Management Preparation of 2019/2020 audit plan. Liaison with senior management and the external auditor (as appropriate). Attendance at Committees (as appropriate).

5

Total 75

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Relevant assignments SLC Internal Audit Plan 2018/2019 Appendix 4

Lead Resource


Social Work

Mobile Working (Homecare)

Provide assurance that risks in relation to mobile working are managed and benefits are being realised.

20

Social Work

Kinship Care Provide assurance that processes are robust and deliver good governance.

20

Social Work

Self Directed Support

Provide assurance of compliance with Act and review procedures around service options and adequacy of controls to mitigate against potential risks.

5

All Contract Scrutiny Groups

Participate in Contract Scrutiny Groups as required.

10

All General contingency

Conclude all 2017/2018 audits. Respond to requests for unplanned work during 2018/2019, including advice and guidance to Resources.

50

All Fraud Contingency

Deliver of a programme of anti-fraud reviews to provide assurance that robust and effective controls are in place that both prevent and detect fraud. Undertake investigations as required.

170

All National Fraud Initiative (NFI)

Facilitate the investigation of 2017/2018 matches and provision of NFI data in 2018/2019.

40

All Fraud Alerts

React to fraud alerts through internal and external sources and disseminate information as appropriate.

1

All Follow Up

For all Council Resources, identify audit recommendations due in the period April 2017 to March 2018. Risk assess and follow-up to ensure implementation of all high risk actions.

75

All CCM

Continue to download data in current CCM areas. Use data for analysis and to inform internal and external audit testing. Prepare formal reports to allow exceptions and unusual trends

75

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Lead Resource


in financial controls to be reported to Resources for further investigation

All Informal Follow Up

Prompt Resources on a quarterly and monthly basis of actions due within that period. Collate responses for reporting.

15

Finance and Corporate

Budgetary Control Review budgetary control processes to ensure effective and controls robust.

30

Finance and Corporate

General Ledger Data

Provide 2017/2018 general ledger entry data to External Audit for the audit of the financial accounts for the year ended 31 March 2018.

20

Total number of days 531

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Relevant assignments NHSL Internal Audit Plan 2018/2019 Appendix 5

Description Scope Audit Days

Strategic Planning Overall management of delivery of ‘Achieving Excellence’

25

Workforce strategy, operational planning and information

Review of strategic workforce planning to support corporate strategies including identification and resolution of strategic workforce risks

25

Review of operational activity to mitigate identified workforce Corporate Risks

20

Capable and Effective Workforce

Recruitment, appraisal, training, management and development of staff and mitigation of risks

25

Total number of days 95

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Report

Agenda Item

9


Subject: Integration Joint Board Development and Locality Planning


provide the Integration Joint Board with a number of recommendations for approval with regards to IJB member development, the future role of the Performance and Audit Sub Committee and governance arrangement in regards to Locality Planning


(1) that the content of the report be noted; (2) that the recommendations with regards to IJB member development, the role

of the Performance and Audit Sub Committee and Locality Planning Groups, as detailed at sections 4 and 5 of the report, be approved.

[1recs] 3. Background 3.1. The Public Bodies (Joint Working) (Scotland) Act 2014 (thereafter the Act) and its

regulations and guidance place a strong emphasis the role of the Integration Joint Board, Strategic Planning Group and Locality Planning Group in a strategic leadership context.

3.2 This was further emphasised in the 2016/17 South Lanarkshire Integration Joint

Board Annual Audit Report, whereby two distinct recommendations were made as follows:

IJB Board Members development which specifically referred to the importance of IJB members understanding the financial information presented in budget monitoring reports and that they are equipped with the knowledge and skills to enable them to effectively scrutinise and challenge. For this to be actioned, it was recommended that IJB Members should be provided with financial training to help them to discharge this role

Attendance at IJB meetings and the size and complexity of the agendas for discussion and decisions were highlighted with the recommendation that the IJB should review how it is organised, particularly with regards to the use of committees to help manage the business.

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3.3. Over and above this, a development session was facilitated with IJB voting members

on 19th April, 2018 and this highlighted a number of supplementary areas for action including the connection between the IJB and Locality Planning Groups. Further information on the content and write – up of this session is detailed in appendix 1.

3.4 This paper seeks to address some of these issues highlighted and proposes a

number of recommendations regarding how these issues can be progressed.

4. Current Position and Recommendations 4.1. In taking each of the above areas in turn, the following represents the current

position and proposed next steps:

Issue Current Position Recommendations

IJB Member Development

Whilst IJB member development has been undertaken since the inception of the IJB, there have been membership changes over recent years. This programme of development will continue and from the most recent session held in April, 2018 a number of areas of action have been agreed

Progress work from the April, 2018 Development Session to take account of agreed actions in relation to: A programme of meetings for

2019 to be facilitated on a more frequent basis (quarterly) to consider areas such as finance, decision – making, increasing understanding of the social care and health elements of the business, the independent and third sector contribution, carers and any other themes deemed relevant. It is proposed that these take place on the morning of the IJB to allow stakeholders to attend both within the same day

Continuing to increase understanding of roles and responsibilities

Increased use of the Sub Committee Structure

There is currently one Sub Committee supporting IJB business (Performance and Audit Sub Committee). At present, the Sub Committee has no decision – making authority and focuses primarily on scrutinising performance, risk and audit reports.

It is proposed the role of the Sub Committee be extended to consider financial information and also items which would benefit from further scrutiny and consideration in advance of these going to the IJB for approval, for example workforce development/planning.

Locality Planning Groups

At present, IJB Voting Members chair the four Locality Planning Groups (LPGs), thus providing a tangible link back to the IJB. This is not a statutory requirement of the Public Bodies Act, but the South Lanarkshire IJB took this decision at its meeting in February, 2016. However, due to recent changes in IJB Voting Members, only two of the four LPGs have a nominated IJB Voting member as chair (Clydesdale and Rutherglen/Cambuslang).

A specific meeting was facilitated to look at locality planning and governance arrangements with IJB members. Although a number of options were considered with regards to how the Partnership builds on strengthening the links between the IJB, there was a broad consensus that the current arrangements were most fit for purpose at this stage.

In view of this, it is proposed that the two LPGs who currently do not have a nominated Chair (East Kilbride and Hamilton) are offered to those voting members who currently do not Chair an LPG.

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5. Summary and Next Steps 5.1. On the basis of the IJB ratifying the above recommendations, a number of next steps

are proposed as follows:

Arrange a programme of IJB development for 2019 to take place on the morning of the IJB to allow stakeholders to attend both within the same day.

Review and extend the Terms of Reference of the Performance and Audit Sub Committee in order to assist the IJB with the management of the increasing volume of business. A revised Terms of Reference will be brought back to the IJB for sign off.

Secure nominations from IJB voting members to chair the Hamilton and East Kilbride localities. Any nominations should be directed to the IJB Chair and Chief Officer to formalise the IJB representative for each of the two vacant localities.

6. Employee Implications 6.1. There are no employee implications associated with this report. 7. Financial Implications 7.1. There are no financial implications associated with this report. 8. Other Implications 8.1. There are no additional risk implications associated with this report. 8.2. There are no sustainable development issues associated with this report. 8.3. There are no other issues associated with this report. 9. Equality Impact Assessment and Consultation Arrangements 9.1. There is no requirement to carry out an impact assessment in terms of the proposals

contained within this report. 9.2. The above proposals have been worked up by IJB members through recent

development sessions 10. Directions 10.1. This report does not issue a new Direction.

Direction to:



3. NHS Lanarkshire



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Previous References

Integration Joint Board of 13 February 2018, Paragraph 7 List of Background Papers

Development Session Output (Appendix 1)

IJB Membership Update to February IJB Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Yvonne Cannon, Organisational Development Manager Ext: 4249 (Phone: 01698 454249) Email: [email protected]

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South Lanarkshire Health and Social Care Partnership

Integration Joint Board Development Session

11th of April 2018

1. Purpose:

Develop a shared understanding of the role and function of the IJB and how it relates to the

Health Board and the Council.

To provide clarity on the role of individual members inclusive of how they provide advice to

the IJB on matters relating to services they represent and how they obtain those views from

the services more broadly

Explore the cultural differences across organisations represented within the IJB and develop

new ways of working that bring the best from existing cultures and allows for open

discussion and debate

Develop a programme of development for the Board for the coming year

2. Participants:

Gordon Bennie, VasLan

Helen Biggins, Seniors Together

Maureen Chalmers, Councillor

Maria Docherty, Nurse Director

Val de Souza, Director

Allan Falconer, Councillor

Linda Findlay, Associate Medical Director

Martin Kane, Planning and Performance Officer

Marianne Hayward, Head of Health and Social Care

Brenda Hutchinson, Head of Health and Social Care

Richard Lockhart, Councillor

Margaret Moncrieff, Health and Social Care Partnership Forum

Marie Moy, Chief Financial Officer

Jim McGuigan, Councillor

Vijay Sonthalia, General Practitioner

Tom Steele, Non Executive Director

Tom Wilson, Staff Side Representative, NHS

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3. Methodology

The group were divided into two groups, each group facilitated by an officer from the

partnership.

Participants introduced themselves by describing their role on the board, their

understanding of the role of the board, their IJB experience so far and what their

expectations of the day were.

This set the context for development session reaffirming the need for regular development

sessions to:

Gain a greater understanding of the role the board,

Highlighting the range of experience that individuals can bring to the board

The changing membership of the board

The need for a link officer for board members

4. Vision and Values

As part of the group work discussions took place on the development needs going forward

and these have been captured and are included in section 6 of this report.

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5. Role and Function of the IJB and Individual Members

The role of the board The role of board members

To provide the strategic direction for integrating and improving services across health, social care, the independent sector and the voluntary sector To ensure arrangements are in place for all aspects of Governance inclusive of Support, Care and Clinical Governance, Financial Governance and Staff Governance To scrutinise and evaluate all service delivery within the partnership against the 9 National outcomes To develop and review the partnerships Strategic Plan To issue directions to the health board and the local authority as to how Integration functions are to be carried out To deliver against the 9 National Outcomes in pursuit of quality improvement

Bring a range and depth of experience to enrich discussions “nosy neighbours” To provide oversight and input to development of services from various areas across the partnership Creating the conditions to be a strong board Developing integrated services that meet the needs of the population of South Lanarkshire To provide the links back to the people we represent on the Board To support senior officers within the partnership in delivering integration To acknowledge the tensions in representing both the IJB and the wider organisations providing care To gain the confidence of the public

The role of senior officers Individual and joint accountabilities

Provide information and advice Briefing board members and ensuring inclusion of a wide range of other senior officers in presenting to the board Provide and seek assurance and governance Ensuring effective utilisation of resources

Supporting each other Balance the needs of our respective organisations against the needs of the IJB Knowing what ‘hat’ we are wearing Managing expectations of the public Education/shared learning

6. How we will deliver

To explore how the IJB will deliver a few prompt questions were asked looking at:

How we would be at our best, how we will prepare and deal with difficult decisions, who we

will avoid becoming stuck and what will help us reach good outcomes.

Discussions identified that change is difficult, however, redesign of services is critical. We

need to change the terminology we use moving from PARENT to PARTNER organisations.

We need the information to assess and make the right decisions, this requires no surprises

with open and honest discussions and the time to do this.

From this a range of development opportunities were identified inclusive of:

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Clarity on the responsibility and authority of the board

An overview of Social Care, Health, Independent Sector, Voluntary Sector and Carers to broaden understanding of each other’s

Discussions and involvement of key issues and developments, examples included East Kilbride Day Centre and Palliative Care

Improved understanding of localities.

7. Next steps

7.1 A paper will be taken to the IJB in September with the recommendations for future

development of the IJB.

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Report

Agenda Item

10


Subject: Investing to Modernise South Lanarkshire Council Care Facilities


advise the members of the planned investment by South Lanarkshire Council to modernise care facilities in keeping with the Strategic Commissioning Plan and the IJB direction

2. Recommendation(s) 2.1. The Integration Joint Board is asked to approve the following recommendation(s):-

(1) that the approach approved by South Lanarkshire Council in response to the direction to reduce reliance on nursing and residential care be noted;

(2) that the progress to date in respect of phase one of the transformational plan for care facilities as outlined at sections 4 to 7 be noted;

(3) that the requirement for the delegated funding to continue to be available to operate phase one of the new care facilities be noted; and

(4) that the capital investment by South Lanarkshire Council of £17.6 million to modernise care facilities be noted.

3. Background 3.1. The IJB is responsible for the strategic planning and commissioning of health and

social care services in order to achieve the nine National Health and Wellbeing Outcomes (appendix 1). South Lanarkshire Council (SLC) and NHS Lanarkshire (NHSL) are both committed to contributing to these outcomes.

3.2. Demographic growth projections for South Lanarkshire indicate that the 75+

population and 85+ population will rise year on year by 2.7% and 5.2% respectively. People are living longer but not necessarily healthier lives. Recent figures identify an increase of 35% in the number of people diagnosed with dementia over a three year period. The population projections for South Lanarkshire and each of the four localities is provided graphically in appendix 2.

3.3. Since 1996, whilst significant funding was invested to upgrade and refurbish the

South Lanarkshire Council residential care home estate, the current model of service delivery has remained relatively static whilst factors such as demographic demand, complexity of care needs and government policy to shift the balance of care have all changed significantly in this timeframe.

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3.4. In terms of this estate, four of the existing eight care homes are ageing in building

infrastructure and design layout. The four care homes identified are Kirkton House (Blantyre), Canderavon House (Stonehouse), McWhirters House (Larkhall) and McClymont House (Lanark). The total number of registered care places is 134.

3.5. The remaining four residential care homes, Dewar House (Hamilton), Meldrum

Gardens and McKillop Gardens (East Kilbride) and David Walker Gardens (Rutherglen) are of a sufficiently high standard to continue to meet regulatory requirements, thus providing the opportunity to continue to provide care provision within these locations. The total number of registered care places is 138.

3.6. The National Health and Wellbeing Outcome 2 specifically refers to supporting

people to live independently at home. It is also important that the IJB and its partners deliver against the six national measures prioritised by the Ministerial Steering Group and reported on a monthly basis to the Scottish Government in relation to:-



A&E performance

delayed discharges

end of life care (% of people supported to remain at home at this stage of their life)

balance of spend across Institutional and Community Services (shifting the balance of care)

3.7. The Scottish Government’s Strategy “Age, Home and Community” (2012-2021) also

sets out a 10-year vision to develop appropriate housing for older people, aimed at shifting the balance of care towards supporting people to remain at home independently for as long as possible, rather than in care homes or hospitals. In line with this, the Local Housing Strategy 2017-2022, “Affordable Homes, Sustainable Places”, sets out a specific outcome for supporting people with particular needs and their carers to live independently within the community in a suitable and sustainable home.

3.8 The Council Plan ‘Connect 2017-22’ has a specific objective to improve later life and

through this commitment the Council aims to support older people will live more independently and choose what matters most to them about their care and support.

3.9. The IJB Strategic Commissioning Plan 2016-2019 (SCP) sets out the proposed

direction of travel. Through its strategic commissioning relationship with the IJB, SLC and NHSL operationally deliver elements of the SCP. The SCP articulates how this Partnership arrangement will deliver against the 9 Health and Wellbeing Outcomes and 10 priorities identified through consultation with local communities. Specifically, one of the national outcomes reflects that people, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. To deliver against this, one of the SCP priorities agreed was intermediate care to reduce reliance on hospital and residential care, with the aim of providing appropriate and timely support to people at risk of admission to hospital, those requiring support at discharge and also to reduce the risk of premature admission to long term residential care.

3.10. Social Work Services for Adults and Older People, Care Home Services and respite

provision were functions, amongst others, which were delegated to the South

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Lanarkshire IJB on 1 April 2016. This delegation was required by the Public Bodies (Joint Working) Scotland Act 2014 and is set out at clause 5.2 in the South Lanarkshire Health and Social Care Integration Scheme. The ownership of the properties from which Health and Social Care Services are delivered however was retained by local authorities and health boards in line with the legislation.

3.11. There is a mixed market of registered care home provision for both nursing and

residential care services across South Lanarkshire. 3.12. SLC is registered to provide 272 places which represents approximately 11% of the

total market. The remaining 89% of long term nursing and residential care is delivered by the private and independent sector. SLC provides residential care only. The total revenue budget to operate the eight South Lanarkshire Council residential care home services is currently £13.049m.

3.13. There is a difference between residential care homes and nursing care homes with

nursing. Both provide accommodation, supervision from staff 24 hours a day, meals and help with personal care needs. Nursing homes however have registered nurses on duty at all times and this is required for people who have an illness or medical condition that requires frequent nursing care.

3.14. Within the local authority residential care homes, there are no nursing staff and, as

such, people with any level of nursing need are not admitted to these homes. If a resident requires temporary nursing interventions, these can be provided by the community nurses who will visit the resident in the care homes. Where a resident deteriorates or requires ongoing nursing care, they will often have to be re-located to a nursing home with nursing staff availability 24/7. Where people are assessed as having significant and complex care or nursing care needs and/or medical conditions, they will be admitted to nursing care homes. Nursing staff are able to observe and monitor changing health care needs and ensure appropriate medical interventions are provided as required. As the Health and Social Care Partnership has developed and delivered an increased range of community based services to meet the majority of people’s social and nursing care needs in people’s own homes, the demand for residential care is decreasing.

3.15. The Council commissions nursing and residential care home services for

approximately 2,100 people through contractual arrangements with external providers, the majority of which is for nursing care (98%). The revenue budget to commission care home services from external providers is £48.401 million.

3.16. In March 2018, the IJB agreed to issue a specific Direction to the partner SLC to

“reduce reliance on nursing and residential Care through the development of proposals to remodel a proportion of residential care beds to focus on transitional support and the ‘home for life’ principle”.

3.17. This report provides oversight to the IJB of the response to the direction to reduce

reliance on nursing and residential care which was approved by the partner SLC on 20 June 2018. The report also advises the IJB of phase one of the transformational plan for care facilities as outlined at sections 4 to 7 and of the capital investment by SLC of £17.6 million to modernise care facilities.

4. Progress to date 4.1. In 2016, a pilot/test of change was undertaken within the care facilities of

Canderavon House, Meldrum Gardens and McKillop Gardens through the provision of 22 intermediate/transitional beds. Evaluation of the pilot confirms that service

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users who would have otherwise moved to nursing or residential care have been supported to regain skills and confidence. Of the people supported through this service, 56% successfully returned home supporting the view that, through an enabling approach, more people can be supported to return to their community.

4.2. New models of care and developing practice were also considered by officers across

the Health and Social Care Partnership. Research was undertaken and a number of observational visits took place to explore opportunities and to consider the application of these findings within South Lanarkshire.

4.3. The findings were also consistent with national evidence and reinforces the priority

set out in the IJB Strategic Commissioning Plan and subsequent direction. Based on the test of change and the research, SLC and its partners recognised the need to transition the current model of residential care to one which is focused on intermediate care aimed at supporting the person to return home or to a setting which best meets their needs.

4.4. SLC’s approach to the future model of care incorporates the following principles:-

the flexible use of beds to support people through a transitional period, particularly those who are at risk of premature admission to long term care; require crisis intervention; have palliative care needs; or have been subject to acute hospital admission and require a period of recovery

the provision of an environment to undertake further multi-disciplinary assessment, monitoring, rehabilitation and enablement

the provision of a recovery and recuperation period to enable the person to return home safely

be centred around a Hub which will be resourced by a multi-disciplinary team, with multi-function rooms to undertake the necessary rehabilitation and re-ablement of service users in the designated transitional beds

connect with wider community supports, with both staff in the Hub and in the community providing in-reach and out-reach support.

the availability of multi-purpose rooms will allow community staff to deliver inputs such as Podiatry, Occupational Therapy and Physiotherapy Services

a carers and third sector Hub to support carers and community engagement 4.5. A whole system approach is therefore being adopted which reflects early

intervention, self-management and enablement and supports people to secure their personal outcomes.

4.6. Timely re-ablement and rehabilitation interventions will be provided from a locality

based multi–disciplinary Hub. The Hub will provide accommodation for multi-disciplinary staff including social care workers, allied health professionals and nursing staff. The new General Medical Services (GMS) Contract 2018 may also bring opportunities for accessible multi – disciplinary working. Together, the staff will provide integrated services within the model set out.

4.7. This innovative model of care will support more people to return home who may

otherwise have been prematurely admitted to a care home setting or resided longer than necessary in a hospital bed. The service will be responsive, flexible and available at times of crisis to ensure the person recovers and maximises their independence. Within the proposed model, the bed flow of the 20 transitional beds alone will have the capacity to support a threefold increase in the number of individuals who can benefit from these services.

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4.8. The model will have a stronger connection to existing community based resources including the Home Care Re-ablement Teams, the Integrated Community Support Teams and Hospital at Home Service. The model will also support a fuller assessment period prior to any decision regarding permanent admission to a nursing or residential care home. This will ensure the option of institutional care is only utilised at the most appropriate point in the person’s life journey.

4.9. The key beneficial outcomes of the new service model can be summarised as

follows:

a service can be delivered to over 3 times the number of people who are currently receiving a service

this threefold increase in capacity as a result of phase 1 will address the increase in the demographic care demands and the increasing care needs which arise from an ageing population

The new model responds to the feedback from consultation and engagement activity that people’s expressed wish is to remain at home and in their community

Housing options for adults and older people with complex care needs will become available on completion of phase 1

There will be no job losses

Integrated, multi-disciplinary community care services will support people to remain at home, reduce admissions to hospital, reduce the length of stay in hospital and facilitate discharge from hospital when medically fit

The new model contributes to the achievement of the six national measures prioritised by the Ministerial Steering Group as set out at section 3.6

The issues associated with the ageing care homes in phase 1 will be addressed 4.10. South Lanarkshire Council has previous experience of managing this level of change

and care and clinical governance requirements have been complied with. 5. Communication and Engagement 5.1. On 18 April 2018 and 16 May 2018, sessions were facilitated to communicate

progress with all Council Elected Members. The format and scope of these sessions covered the following elements:-

the changing strategic context of Adult and Older People Services

demographic and future demand challenges, including increasing complexity of care

the proposed model to meet this changing demand

the starting point for the model

the proposed implementation plan and roll-out

discussion and opportunity for questions and to seek clarification 5.2. Overall, the sessions were well attended with a number of important issues

discussed and highlighted by Elected Members with regards to:-

the impact on long term care capacity as a result of re-modelling a proportion of existing residential care beds to transitional care beds

how successful the model will be

the impact of the new model on other resources such as potential increased demand on other community resources including home care through supporting more people to remain at home

how the model will be financed

the impact on Council staff

the contribution of other partners to the model

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5.3. Subsequent to this, a Question and Answer briefing, together with a one page summary briefing was prepared and circulated to all Elected Members following the initial briefing sessions.

5.4. Following the main briefing sessions, the Director, Health and Social Care, together

with members of the Senior Management Team also held a number of meetings with Senior Elected Members in order to have continued dialogue regarding the proposals.

5.5. From 19 April 2018, all SLC residential care home managers have been briefed on

the proposed model and the potential implications.

A core brief was prepared and disseminated to individual staff members by the care home managers.

The staff employed within care homes within phase 1 have received individual correspondence and attended meeting with the Chief Social Work Officer and the Service Manager (Transitions).

Further meetings are arranged as part of the ongoing consultation and engagement process.

Communication with all staff continues to be encouraged and dynamic. 5.6. Similarly, in addition to written correspondence, all residents, families and carers

were personally contacted by the Care Home Managers about the service modernisation programme. Since then, following agreement at the Social Work Committee on 20 June 2018, there has been four meetings held with relatives and the Chief Social Work Officer and the Service Manager (Transitions). Regular follow up meetings are planned.

5.7. The direction of travel has been discussed and agreed with the IJB.

The Strategic Commissioning Plan for 2018/2019 was refreshed and agreed by the IJB on 26 March 2018 and the directions to the partners were varied as appropriate.

A presentation on Investing to Modernise South Lanarkshire Council Care Facilities was delivered to the IJB on 26 June 2018.

A presentation and discussion session was held on 23 August 2018 to advise the members of the IJB about the redesign of care facilities in South Lanarkshire. Frequently Asked Questions and Answers were circulated and a further follow up meeting was offered to the participants to clarify any points of detail.

A Briefing Note on Investing to Modernise South Lanarkshire Council Care Facilities was circulated on 28 August 2018 to Elected Members, MSPs, MPs and the IJB Members.

5.8. Full involvement and engagement with service users, families and staff will continue

to be a key aspect of the project plan and all key stakeholders will be kept informed of progress as appropriate going forward.

6. Phasing the Investment – Care Facilities 6.1. It is proposed that the new care model will be implemented South Lanarkshire wide

across the four localities. The Hamilton locality has been identified as the starting point for the implementation of phase one as follows:

Locality Implementation

Hamilton Kirkton House and McWhirters House will be replaced by a new care facility. SLC residential care beds will continue to be available in Dewar House.

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6.2. There are a number of factors supporting the proposals to start in Hamilton including

ageing care homes within this locality and the identified need in relation demographic growth. The Hamilton locality has the largest population of 107,000 and the most significant growth in the 85+ population. 29.4% of the population comprises people aged 65+. Frailty amongst the Hamilton population is higher and the locality has the highest prevalence of mental health needs, including dementia. It also has the highest rates of emergency admissions and people living with multiple long term conditions.

6.3. A preferred site has been identified – the former St Joseph’s Primary School in

Blantyre. This site provides the opportunity to co-locate and integrate the following services and amenities:-

20 transitional ensuite rooms providing care for adults and older people with multi – purpose rooms for re-ablement and rehabilitation interventions. There will be staff accommodation to enable the delivery of in reach and outreach support

20 technology enabled homes which support adults with complex needs and older people to live independently. Where support is required, this would be provided by community based Health and Social Care teams

a Centre of Excellence which would host Telehealth/Telecare demonstration space, facilities to train and develop our own care staff, accommodation for students, a community cafe and a community I.T Hub

community regeneration and intergenerational space to promote social enterprises such as community gardens, sensory garden and children’s play area which is autism and disability friendly

employment opportunities created through community cafe and social enterprise

new supply of mainstream social rented housing built to Housing for Varying Needs Standards, which includes barrier free internal spaces and other accessibility features

6.4. This concept is set out diagrammatically at appendix 3. 7. Next Steps and Future Phases 7.1. It is anticipated that phase one will be followed in sequential order by Clydesdale,

East Kilbride then Rutherglen/Cambuslang. 7.2. It is intended that the model will be tailored to each locality’s requirements beyond

the core elements, recognising that the asset base and current service configuration in each locality will be different, thus providing their own unique opportunities. This will be further developed by SLC following consultation and engagement with key stakeholders.

7.3. In terms of the Integration Scheme, the IJB is responsible for setting out the strategic

plan for service provision across the range of designated services. Thereafter, the operational delivery of the integrated functions falls to the respective partners through the Health and Social Care Partnership. Given the significance of the capital investment and the transformational change programme, the IJB is being asked to note the approach approved by SLC. At this stage, only Phase 1 has been signed off by SLC Social Work Committee. All further phases require to be signed off by the Social Work Resources Committee.

7.4. The IJB is also asked to note the requirement for the delegated funding to continue

to be available to operate the new care facilities. The transition to the new model of service delivery relies on the ongoing availability of the revenue budget allocation

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delegated by the IJB to SLC. The financial implications of phase 1 are outlined at section 9.

7.5. The existing communication strategy has been extended to include a wider group of

stakeholders. This includes working with relevant stakeholders in each of the localities to tailor the specifics of the model in line with the unique characteristics of each locality.

7.6. With regards to the delivery of the build programme, work is already underway to

develop specific project briefs and specifications for the Hamilton/Blantyre site and it is currently anticipated that phase one of the works will commence on site later in 2018, subject to planning consent. A joint Social Work/Housing and Technical Resources Programme Board has been established to oversee the physical and financial progress made in the delivery of this programme.

7.7. Six monthly progress reports will be presented to the IJB Performance and Audit

Sub-Committee and the IJB in order to monitor the implementation of phase 1 during the next two years. The progress and developments of each phase will also be the subject of further reports to future Social Work Committees.

8. Employee Implications 8.1. The employee implications associated with the transition to the new model of care

facilities will be managed by SLC in partnership with Trade Union colleagues. 8.2. There are a total of 87 whole time equivalent posts (Kirkton House - 44 posts;

McWhiters House - 43 posts). The new model of care will be delivered by SLC and a significant number of the post holders will have the opportunity to benefit from the enhanced training and career opportunities that the new staffing model will provide or alternatively be redeployed into vacant posts. It is therefore envisaged that there will be the opportunity for staff will be able to develop their skills and knowledge across a wider range of activities.

8.3 SLC is well placed to support staff to undertake the necessary personal development

to equip them to discharge their professional roles in line with regulatory requirements. A meeting was held with Trade Union colleagues, the Head of Adult and Older People Services and Human Resources colleagues. Fortnightly meetings have now been planned as we move into implementation phase.

8.4. Workstreams have already been established to ensure that there continues to be

effective consultation and communication over the next 2 years. These include Workforce Planning, Transitions Meetings, Decommissioning Group and Trade Union Consultation Forums.

8.5. As the model develops, future workforce planning and staff profiling will be

undertaken by the SLC and NHSL Human Resources teams, in consultation with Trade Union colleagues. This will ensure the future workforce will meet the requirements to support people to remain in their communities through the new model of care. Staff governance arrangements have and will continue to be complied with during the transition process.

9. Financial Implications 9.1. The financial implications of the Hamilton proposal (phase one) are summarised as

follows:

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9.1.1 The IJB currently allocates total gross funding of £2.828m to SLC for the provision of Kirkton House (£1.279m), McWhirters House (£1.292m) and nursing care home placements (£0.257m). This funding is comprised as follows:

IJB / SLC funding £2.286m

Financial contributions from care home residents £0.542m 9.1.2 Phase one of the new model of care will cost a total of £2.286m as follows:

20 transitional ensuite rooms £1.244m

20 technology enabled homes £0.345m

10 additional home care placements £0.230m

10 additional nursing care home placements £0.224m

Centre of Excellence £0.083m

Outdoor space £0.007m

Telecare equipment £0.100m

Management costs £0.053m Total £2.286m 9.1.3 In order to support phase one, the IJB is therefore asked to note that the current

allocation of recurring funding of £2.286m will require to continue to be allocated to SLC, who will deliver the new model of care. The new model does not impact on the current allocation of funding between in-house and externally commissioned services.

9.2 As highlighted above, in respect of phase 1, the total cost of the new care model of

£2.286m is £0.542m (19%) less than the total cost of the currently commissioned services of £2.828m. The configuration of costs within the new model is different, particularly in respect of property and accommodation related costs. This will correspond to the reduced financial contribution made by care home residents towards their care costs within the existing service model.

9.3. A detailed decommissioning plan for phase one is being developed by SLC which

will be person centred and will seek to minimise service disruption to existing residents.

9.3.1 The actual non-recurring cost will depend on the transition arrangements required for

the residents at the point when each home is decommissioned. It is anticipated that non-recurring costs of circa £0.700m may be incurred.

9.3.2 On 26 June 2018, the IJB approved the allocation of £0.701m to an earmarked

reserve in order to mitigate, in the short term, the financial impact of demographic change and also any other costs associated with social care services including the impact of transformational changes.

9.3.3 The IJB is therefore asked to note the potential use of part or all of this earmarked

reserve, the Social Care Contingency Fund, for this purpose and that further updates will be provided to the IJB once costs are confirmed.

9.4. There will be additionality from community health resources that will be attached to

the multi-disciplinary Hub with the co-location of additional social care and health resources including the promotion of new technology and telecare. This will ensure a best value approach both financially and in terms of outcomes for service users.

9.5. SLC approved the investment of £17.6m for the replacement of Social Work care

facilities. The capital cost of the care facilities development across South

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Lanarkshire will therefore be met from within SLC’s agreed capital investment programme. The development of the Hamilton/Blantyre site will be met in a phased way from the current capital investment.

9.6. The cost of building the Technology Enabled Homes in phase 1 will be partially met

by funding from the Housing Revenue Account (HRA), Scottish Government Affordable Housing Grant and the Care Home Replacement budget. These homes will be owned by SLC through the HRA with an allocation process being agreed with Social Work Resources subject to the approval of the Housing and Technical Resources Committee.

9.7. As the proposals for other phases progress, the financial implications will be reported

to the Social Work Resources Committee and the IJB. 9.8. The financial governance requirements have been complied with and will continue to

be monitored. 10. Other Implications 10.1. The approved capital investment programme will mitigate future operational risks

which would otherwise emanate from the deterioration of four of the existing residential care homes.

10.2. There is no sustainable development issues associated with this report. 10.3. There are no other issues associated with this report. 11. Equality Impact Assessment and Consultation Arrangements 11.1. A full equality impact assessment will be undertaken of the strategy for care facilities

in the future, including the Fairer Scotland duties. 11.2. SLC has undertaken consultation with Trade Union colleagues in respect of the

impact and opportunities for employees of the new model of care. 11.3. As outlined in the report, ongoing consultation and engagement will be a key

component of the implementation approach. 12. Directions 12.1. The extent to which the existing directions to each partner require to be varied is


Direction Required to Council, Health Board or Both

Direction to:

1. No Direction Required √


3. NHS Lanarkshire


13. National Health and Wellbeing Outcomes 13.1 The strategy set out in this report will contribute to the following national health and

wellbeing outcomes:

1 People are able to look after and improve their own health and wellbeing and live in good health for longer

√

2 People, including those with disabilities or long term conditions, or who are frail, are able to live, as far as reasonable practicable, independently and at home or in a homely setting in their community

√

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3 People who use health and social care services have positive experiences of those services, and have their dignity respected

√

4 Health and social care services are centred on helping to maintain or improve the quality of life of people who use those services

√

5 Health and social care services contribute to reducing health inequalities √

6 People who provide unpaid care are supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing

7 People who use health and social care services are safe from harm √

8 People who work in health and social care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide

9 Resources are used effectively and efficiently in the provision of health and social care services

√

Val de Souza Director, Health and Social Care 7 August 2018 Previous References

Integration Joint Board 26 March 2018 – Directions from the South Lanarkshire Integration Joint Board to NHS Lanarkshire and South Lanarkshire Council


none Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Evelyn Devlin, Service Manager, Transitions Ext: 3938 (Phone: 01698 453938) Email: [email protected]

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National Health and Wellbeing Outcomes Appendix 1 The National Health and Wellbeing Outcomes are high-level statements of what health and social care partners are attempting to achieve through integration and ultimately through the pursuit of quality improvement across health and social care. By working with individuals and local communities, Integration Authorities will support people to achieve the following outcomes: Outcome 1: People are able to look after and improve their own health and wellbeing

and live in good health for longer. Outcome 2: People, including those with disabilities or long term conditions, or who are

frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community.

Outcome 3: People who use health and social care services have positive experiences

of those services, and have their dignity respected. Outcome 4: Health and social care services are centred on helping to maintain or

improve the quality of life of people who use those services. Outcome 5: Health and social care services contribute to reducing health inequalities. Outcome 6: People who provide unpaid care are supported to look after their own

health and wellbeing, including to reduce any negative impact of their caring role on their own health and well-being.

Outcome 7: People using health and social care services are safe from harm. Outcome 8: People who work in health and social care services feel engaged with the

work they do and are supported to continuously improve the information, support, care and treatment they provide.

Outcome 9: Resources are used effectively and efficiently in the provision of health and

social care services.

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Demographic Growth projections South Lanarkshire and Localities Appendix 2

1. South Lanarkshire 50+ Demographic Growth Compared with Scotland

The chart below gives a breakdown of the 50+ demographic growth for South Lanarkshire compared with the national (Scotland) growth

2. South Lanarkshire Locality Demographic Growth 2018 – 2027

The following chart shows the 75+ demographic growth across each of the 4 localities of South Lanarkshire between 2018 and 2027

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Intergenerational model of care Appendix 3

Person Centred

Support within the Hamilton/Blantyre

Community

Transitional Support HUB

20 transitional ensuite rooms

for short stay across two

wings for hospital step down

and community step up care

Multi – purpose rooms for re-

ablement and rehabilitation

for in-reach and out-reach

support

Staff accommodation

Technology Enabled

Properties x20

20 adaptable/ technology enabled

homes providing

personalised/independent living

Will accommodate both adults and

older people and be supported by

the HUB and wider community

resources

Additional general housing around

the site through RSL provision etc

2x student flat on-site

accommodation

Centre for Excellence, Skills

and Learning

Growing our own care workers

Functional multi – purpose lecture

room with cinema type technology

for students and community

Training suite for staff for dementia,

mental health, learning disability

and Telehealth/Telecare

Carers and voluntary sector support

HUB

Community Cafe

Community I.T HUB/Telehealth &

Telecare Demonstration

Community Regeneration and Social

Enterprise & Intergenerational Space

Seating areas, linked to Cafe

Children’s play activity area

which is autism and learning

disability friendly

Sensory Gardens

Community enterprise initiatives

including vegetable and flower

gardens

Supported employment

opportunities e.g. cafe

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Report

Agenda Item

11


Subject: Infection Prevention and Control Annual Report 2017/2018


provide members of the Board with an overview of Infection Prevention and Control activities during 01 April 2017 - 31 March 2018 in the form of our Annual Report. The report was ratified by the Lanarkshire Infection Control Committee at its meeting on 11 July 2018 and the Healthcare Quality Assurance and Improvement Committee on 12 July 2018


(1) that the content of the report be noted. [1recs] 3. Background 3.1. There is a national requirement for Infection Prevention and Control Teams (IPCT)

across NHS Scotland to produce an annual report as stated in the NHS Health Department Letter 2001-53 released 27 June 2001.

3.2 A similar report to this was taken to the most recent Performance and Audit Sub

Committee on 28th August for consideration, discussion and scrutiny. 4. Key achievements from the Infection Prevention and Control (IPC) Annual

Report 2017-2018 4.1. The IPCT made a number of achievements throughout their activity year in 2017-

2018 as noted below for ease of reference to Board members:

the 2017/2018 Local Delivery Plan Standard for Clostridium Difficile Infection (CDI) was achieved for the second consecutive year with a rate of 0.24 (118 cases) against a national target rate of no more than 0.32 per 100,000 Acute Occupied Bed Days. The national year-end position across NHS Scotland was 0.27

in addition, NHS Lanarkshire (NHSL) improved CDI performance by reducing the number of cases by 26 (18%) against the 2016/2017 year end position

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the 2017/2018 Local Delivery Plan Standard for Staphylococcus Aureus Bacteraemias (SABs) was not achieved however, NHSL improved SAB performance by reducing the overall number of cases by 11% against 2016/2017 position and also 11% reduction in the number of Healthcare Associated Infection SABs

the IPCT have successfully led a number of initiatives in relation to recognition and prompt management of outbreaks of infection. In 2017/2018 there was a significant decrease in the number of healthcare associated outbreaks of infection with a total of 27 outbreaks managed by the IPCT and frontline staff in comparison to 73 outbreaks in 2016/2017. This equates to a 64% reduction across Acute Services and a 50% reduction in the Health and Social Care Partnerships

the organisation achieved the highest compliance scores since national monitoring of Meticillin Resistant Staphylococcus Aureus (MRSA) inpatient screening began in 2012/2013

IPCT won the best poster award at the Infection Prevention Society at Manchester in September 2017. The poster titled ‘Vascular access device system assessment – a vital step before attempting system improvement’ details the significant work completed by the IPCT in relation to driving improvement in the management of intravenous devices

there were a number of successful quality improvement initiatives led by the IPCT including:

‘Stay Safe – Stay Connected’ campaign in relation to the management of intravenous therapies

Manual for Best Practice with Invasive Devices is currently being progressed for local implementation in 2018/2019 to support staff in the safe preparation, insertion and maintenance of devices

there was an announced inspection by the Healthcare Environment Inspectorate at Udston Hospital on 20-21 September 2017. The final report was published 29 November 2017 with one requirement and no recommendations and demonstrated significant improvement in the findings of external scrutiny reports in NHSL. This is the best report NHSL has received to date from a Healthcare Environment Inspection

a clinical skills laboratory was designed the IPCT in Ward 18 at University Hospital Hairmyres and used to highlight, to a range of staff, the importance of robust methodologies and equipment for cleaning of the environment and patient equipment. A total of seven sessions were completed during August – September 2017. The sessions were well received by those in attendance which included Executive Directors and Non-Executive Directors

the Decontamination Clinical Nurse Specialist took up post in November 2017

an A-Z Template for Decontamination successfully implemented across wards and departments to demonstrate compliance with national standards in relation to decontamination of reusable medical devices

95% of the NHSL Infection Control Committee annual work plan was achieved 5. Summary and Next Steps 5.1 Infection Prevention and Control will be reported (in the future) through the

Performance and Audit Sub Committee, thus providing the IJB with the necessary assurance and governance around this particular agenda.

6. Employee Implications 6.1 There are no employee implications associated with this report.

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7. Financial Implications 7.1 This paper does not describe any new financial implications 8. Other Implications 8.1 There are no risk implications associated with this report. 8.2 There are no sustainable development implications associated with this report. 8.3 There are no other issues associated with this report. 9. Equality Impact Assessment and Consultation Arrangements 9.1 This report does not introduce a new policy, function or strategy or recommend a


9.2 This report has been worked up and presented to a number of forums prior to being

presented to Performance and Audit Sub-Committee. 10. Directions 10.1 The extent to which the existing directions to each partner require to be varied is


Direction to:



3. NHS Lanarkshire








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Previous References


none Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Emer Shepherd, Head of Infection Prevention and Control, NHS Lanarkshire Phone: 01698 366039 Email: [email protected]

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mailto:[email protected]

1

DRAFT

INFECTION PREVENTION & CONTROL

ANNUAL REPORT

1 April 2017 – 31 March 2018

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2

Contents

The Team ....................................................................................................................................... 3

Introduction .................................................................................................................................... 4

Executive Summary ....................................................................................................................... 5

Key Achievements 2017-2018 ....................................................................................................... 6

Financial Cost of Healthcare Associated Infection ......................................................................... 7

Monitoring Programme................................................................................................................... 8

Infection Related Intelligence Service ............................................................................................ 9

Staphylococcus aureus bacteraemia ........................................................................................... 10

Carbapenemase producing enterobacteriaceae .......................................................................... 13

Clostridium difficile Infection ......................................................................................................... 14

Surgical Site Infection .................................................................................................................. 15

Escherichia coli Bacteraemia ....................................................................................................... 18

Hand Hygiene .............................................................................................................................. 19

Outbreak Management ................................................................................................................ 20

Training and Education ................................................................................................................ 21

LICC and Sub-Groups.................................................................................................................. 22

Glossary of Terms ........................................................................................................................ 27

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3

The Team

Management Team Irene Barkby, Executive Director Nursing Midwifery and Allied Health Professionals (NMAHPs) Emer Shepherd, Head of Infection Prevention and Control (IPC) Babs Gemmell, Scrutiny and Assurance Manager Clare Mitchell, Senior Nurse Sarah Whitehead, IPC Doctor

IPC Nursing Team Linda Thomas, Clinical Nurse Specialist Carol Whitefield, Clinical Nurse Specialist Lee Macready, Clinical Nurse Specialist Sandra Burke, Clinical Nurse Specialist Lyndsay Quarrell, IPC Nurse Nicola Miller, IPC Nurse Julie Burns, IPC Nurse Kaileigh Begley, IPC Nurse

Surveillance Team Liz Young, Lead Surveillance Nurse Alison Gold, Surveillance Nurse

Administration Team Pauline Ferula, Administrative Lead Letitia McCafferty, Team Secretary Clare Penrice, Data Co-ordinator

Decontamination Lorna Barbour, Clinical Nurse Specialist

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4

Introduction Healthcare associated infections (HCAIs) can develop either as a direct result of healthcare interventions such as medical or surgical treatment, or from being in contact with a healthcare setting and pose a significant threat to patient safety. The mandatory surveillance programme in place across NHS Scotland currently includes:

Staphylococcus aureus bacteraemias (SABs)

Meticillin resistant staphylococcus aureus (MRSA)

Meticillin sensitive staphylococcus aureus (MSSA)

Clostridium difficile infection (CDI)

Escherichia coli (EColi) HCAIs cover any infection contracted:

As a direct result of treatment in, or contact with, a health or social care setting

As a result of healthcare delivered in the community

Outside a healthcare setting (for example, in the community) and brought in by patients, staff or visitors and transmitted to others (for example, norovirus)

The purpose of this annual report is to provide an overview of Infection Prevention and Control (IPC) activities in the past 12 months and to highlight service achievements.

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5

Executive Summary

Clostridium difficile infection (CDI) Local Delivery Plan (LDP) Standard: To

achieve 32 CDI cases or less per 100,000 acute occupied bed days (AOBD) in the aged 15 and over age group by 31 March 2018. NHS Lanarkshire (NHSL) performance in 2017/2018:

Incidence rate in patients aged 65 and above was 0.23 per 100,000 AOBDs (82

cases)

Incidence rate in patients aged 15 years and above was 0.24 per 100,000 AOBDs

(118 Cases) equates to 18% reduction on last year.

LDP STANDARD ACHIEVED for the second consecutive year.

Hand Hygiene NHSL performance in 2017/2018: Achieved 86%

against a national requirement of 95%.

Surgical Site Infections (SSIs) NHSL performance in 2017/2018

1.91% C-Section SSIs (1466 cases/28 SSIs)

0.95% Hip Arthroplasty SSIs (421 cases/5 SSI)

7.53% Colorectal Surgery SSIs (332 cases/25 SSIs)

3.12% Vascular Surgery SSIs (256 cases/8 SSIs)

Gram Negative Bacteraemia and Carbapenemase Producing Enterobacteriaceae (CPE)

According to Health Protection Scotland (HPS) multidrug resistance amongst Gram Negative bacteria has increased significantly since 2008 and poses a major risk to public health and patient safety.

108 cases of CPE were reported to HPS in 2017/2018 in comparison to 73 reported in 2016/2017.

3 cases of CPE were identified in NHSL in 2017/2018.

Outbreak Incidence

27 separate outbreak situations; 7 in University Hospital Monklands (UHM); 10 in University Hospital Wishaw (UHW); 7 in University Hospital Hairmyres (UHH); 3 in the Health &Social Care Partnerships (H&SCPs)

7 ward closures; 20 room restrictions – 5 room closures led to a full ward closure

120 bed days lost

95 patients; 43 staff affected

Staphylococcus aureus Bacteraemia (SAB) LDP Standard: To achieve 24 SAB cases or less

per 100,000 AOBDs by 31 March 2018. NHSL performance in 2017/2018:

Incidence rate of SABs was 0.37 per 100,000

AOBDs (160 cases).

Incidence rate of MRSA was 0.009 per

100,000 AOBDs (4 cases)

Incidence rate of MSSA was 0.36 per 100,000

AOBDs (156 cases)

LDP Standard not achieved however there

was an 11% decrease in the number of SAB cases compared to 2016/2017.

Escherichia coli (EColi) Bacteraemia (ECBs)

597 cases of ECBs reported during 2017/2018.

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6

Key Achievements 2017-2018

* The 2017/2018 LDP Standard for CDIs was achieved for the second consecutive year with a rate of 0.24 (118 cases) against a national target rate of no more than 0.32 per 100,000 AOCB. The national year-end position across NHS Scotland was 0.27.

* In addition NHSL improved CDI performance by reducing the number of cases by 26 (18%) against the 2016/2017 year end position.

* The 2017/2018 LDP Standard for SABs was not achieved however NHSL improved SAB performance by reducing the overall number of cases by 11% against 2016/2017 position and also 11% reduction in the number of HCAI SABs.

* The Infection Prevention and Control Team (IPCT) have successfully led a number of initiatives in relation to recognition and prompt management of outbreaks of infection. In 2017/2018 there was a significant decrease in the number of healthcare associated outbreaks of infection with a total of 27 outbreaks managed by the IPCT and frontline staff in comparison to 73 outbreaks in 2016/2017. This equates to a 64% reduction across acute services and a 50% reduction in the H&SCPs.

* The organisation achieved the highest compliance scores since national monitoring of MRSA inpatient screening began in 2012/2013.

* IPCT won the best poster award at the Infection Prevention Society (IPS) at Manchester in September 2017. The poster titled ‘Vascular access device system assessment – a vital step before attempting system improvement’ details the significant work completed by the IPCT in relation to driving improvement in the management of intravenous devices.

* There were a number of successful quality improvement initiatives led by the IPCT including: ‘Stay Safe – Stay Connected’ campaign in relation to the management of intravenous therapies.

Manual for Best Practice with Invasive Devices is currently being progressed for local implementation in 2018/2019 to support staff in the safe preparation, insertion and maintenance of devices.

* There was an announced inspection by the Healthcare Environment Inspectorate (HEI) at Udston Hospital on 20-21 September 2017. The final report was published 29 November 2017 with 1 requirement and no recommendations and demonstrated significant improvement in the findings of external scrutiny reports in NHSL. This is the best report NHSL has received to date from an HEI inspection.

* A clinical skills laboratory was designed the IPCT in Ward 18 at UHH and used to highlight, to a range of staff, the importance of robust methodologies and equipment for cleaning of the environment and patient equipment. A total of 7 sessions were completed during August – September 2017. The sessions were well received by those in attendance which included Executive Directors and Non-Executive Directors.

* The Decontamination Clinical Nurse Specialist (DCNS) took up post in November 2017. * An A-Z Template for Decontamination successfully implemented across wards and departments to

demonstrate compliance with national standards in relation to decontamination of reusable medical devices.

* 95% of the NHS Lanarkshire Infection Control Committee (LICC) annual work plan was achieved.

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Financial Cost of Healthcare Associated Infection The outcomes of an HCAI include extended length of patient stay and extended length of treatment. There is currently a lack of robust information in relation to the actual financial cost of HCAIs across NHS Scotland. In a bid to establish a cost specific to NHSL, the IPCT, in collaboration with colleagues from finance, have calculated the financial cost for cases of HCAI specifically SABs and CDIs to NHSL. It should be noted that the length of the patient stay may or may not be extended due to infection and may vary due to other contributing factors e.g. some patients with CDI may require more than one course of treatment. Also the actual cost of antibiotic treatment has not been factored into the data as there is a variance in cost depending on types of antibiotics used. The financial costs noted should be considered with caution as these are purely based on the average of an inpatient stay and number of days required to treat a patient with a SAB or CDI. Using data from finance to cost an average inpatient stay for 24 hours (£567.00) against the average number of days required to treat a SAB (14 days of antibiotic treatment) and CDI (approximately 10 days of treatment) the IPCT have produced a table demonstrating costs for 2016/2017 versus costs from 2017/2018.

Average Cost for 24 Hour Patient Stay

Expected Course of Treatment

(=days)

Number of HCAI Cases

Total cost for HCAI Cases

SAB Cases 2017/2018 £567 14 days 113 £896,994 CDI Cases 2017/2018 £567 10 days 54 £306,180 TOTAL COSTS 2017/2018

£1,203,174

SAB Cases 2016/2017 £567 14 days 127 £1,008,126 CDI Cases 2016/2017 £567 10 days 64 £362,880 TOTAL COSTS 2016/2017

£1,371,006

(Calculation=average cost for 24 hour patient stay x expected course of treatment x number of HCAI cases)

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Monitoring Programme The role of an IPCT in healthcare is to prepare for, prevent, detect and manage outbreaks of infection. In order to achieve this, a key focus on prevention of infection is paramount – the greater the emphasis on prevention, the less time spent controlling.

July 2017 National Education for Scotland (NES) Standard Infection Prevention and Control Education Pathway (SIPCEP) IPCT Firstport

August 2017 Appropriate patient placement and cleanliness of commodes

September 2017 Norovirus awareness

October 2017 Hand hygiene

November 2017 – March 2018 Invasive device awareness

January – March 2018 Training and education was provided as required in the management of outbreaks as well as other alert organisms during periods of data exceedance.

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Infection Related Intelligence Service

Every NHS Board in Scotland is mandated by the Standards for HAI (2015) to have robust and effective surveillance systems of alert organisms and conditions in place. The IPCT in NHSL designed a bespoke surveillance system in 2016/2017 and at various points in 2017/2018 successfully tested the system to assure our internal processes were robust and in line with national guidance. The Winter of 2016/2017 was a particularly challenging period for the IPCT. The IPCT experienced a significant increase in the number of patients referred to the service with confirmed or suspected Influenza. The IPCT dealt with 316 positive influenza cases in comparison to 60 positive cases for the same time period in 2016/2017. In addition, the service also received over 100 referrals for suspected influenza cases in January 2018 alone. The IPCT extended working hours to provide a seven day service to the organisation and worked in close collaboration with colleagues to provide up to date status reports on the numbers of suspected and confirmed influenza cases. Successful and timely management of these cases using the IRIS allowed safe and effective management of all influenza and norovirus cases over the winter period despite significant challenges with patient placement at times. The IPC Pink Star alert across NHSL and H&SCPs is now fully embedded with good awareness amongst front line staff in relation to the meaning of the alert and the requirement for effective patient placement. This is evidenced by the significant reduction in the number of outbreaks of HCAIs in 2017/2018. Throughout 2017/2018, there were a total of 2,360 alert organisms referred via the laboratory to the IPCT to monitor and manage within an acute setting and 829 via General Practitioner (GP) samples received. The following chart provides an overview of the alert organisms:

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Staphylococcus aureus bacteraemia When Staphylococcus aureus (S. aureus) breaches the body’s defence mechanisms, it can cause a wide range of illness from minor skin infections to serious infections such as bacteraemia or bloodstream infection.

S.aureus bacteraemia 160 SAB cases

0.37 annual incidence rate of SAB per 100,000 AOBDs.

MRSA bacteraemia 4 MRSA cases

0.009 annual incidence rate of SAB per 100,000 AOBDs

MSSA bacteraemia 156 MSSA cases

0.36 annual incidence rate of SAB per 100,000 AOBDs

LDP Standard: All Scottish NHS Boards are required to achieve the SAB LDP Standard of 24 cases or less per

100,000 AOBD by 31 March 2018. The target did not change from the previous year. NHSL did not achieve the SAB LDP Standard for 2017/2018.

NHSL achieved a rate of 0.37 against a national requirement of 0.24. NHS Scotland year-end rate position in 2017/2018 was 0.33.

Despite not achieving the standard, NHSL had an 11% reduction on the number of SAB cases against last years performance.

63 HAI Cases

50 HCAI Cases

47 CAI Cases

Quality Improvement and interventions to reduce S.aureus infections:

A ‘Stay Safe – Stay Connected’ campaign was completed in relation to the management of intravenous therapies. Training and education was provided to all relevant clinical areas across NHSL by members of the IPCT.

SAB multi-disciplinary reviews for patients with a SAB noted on the death certificate is completed. Clinical teams are involved and the outcomes/lessons learned/actions from each review and taken forward via the respective hospital hygiene meetings and risk.

Providing additional data relating to source of SAB at each hospital hygiene group to enable sites to initiate improvement work & days between information available.

Introduction of a SAB sticker to the medical notes when initiating investigation and completion of SAB review to assist with patient management.

IPCT Focus for 2018/2019

A Manual for Best Practice with Invasive Devices is currently being progressed for local implementation in 2018/2019 to support staff in the safe preparation, insertion and maintenance of devices.

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MRSA Acute Inpatient Admission Screening

A national MRSA acute inpatient admission screening policy has been in place in Scotland since March 2012. An MRSA clinical risk assessment (CRA) is completed for all acute inpatient admissions and against the screening policy identifies a subset of patients at high risk of MRSA colonisation or infection on admission to hospital. These patients are then screened in line with national guidelines for MRSA screening. This method of screening reduces the number of patients that require to be laboratory tested for MRSA and allows high risk patients to be pre-emptively isolated in a single room whilst the results of the test are awaited.

LDP Standard:

Overall compliance was 91% against a national requirement of 90% or above. The highest level achieved against the national compliance level of 90% since reporting nationally began in 2012/2013.

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Carbapenemase producing enterobacteriaceae Enterobacteriaceae are a family of Gram negative bacteria (sometimes called coliforms) which are part of the normal bacterial gut flora. They include common pathogens such as E. coli, Klebsiella sp, Proteus sp and Enterobacter sp. When the bacteria live harmlessly in the gut without causing any problems, this is called colonisation. These organisms are some of the most common causes of many infections such as urinary tract infections, intra-abdominal infections and bloodstream infections. Carbapenems are a class of very broad spectrum intravenous antibiotics which are reserved for serious infections or when other therapeutic options have failed. Carbapenemase producing enterobacteriaceae (CPE) is a type of extremely antibiotic resistant bacteria. These bacteria carry a gene for a carbapenemase enzyme that breaks down carbapenem antibiotics. The emergence of CPE in the UK is of concern following extensive spread occurring within a number of European countries, with some countries moving to an endemic situation. The key principles in combating this threat are through:

Early detection (through clinical alertness, good diagnostic practice and surveillance),

Containment (through infection control measures together with patient and contact screening as required), and

Prudent prescribing of antibiotics.

A national CPE Screening Programme similar to the MRSA Screening Programme was launched in 2017 requesting that all NHS Boards complete risk assessments on acute inpatient admissions similar. UHM implemented CPE screening in late in 2017 followed by UHH and UHW in early 2018. National reporting using the same monitoring system as MRSA commenced in April 2018. Local compliance levels are not available for this annual report however, the NHSL position will be provided for local reports from June 2018.

CPE Confirmed Cases 2017/2018 In advance of the completion of the local implementation of CPE Screening, the IPCT received 3 confirmed CPE results in UHH between 16-24 November 2017. This number of CPE referrals was classified as data exceedance and triggered further investigation including establishment of an Incident Management Team (IMT). Debrief from the IMT provided useful learning for the organisation in relation to the repatriation of Lanarkshire residents from other UK hospitals and abroad. This has ensured a safe and robust process is now in place for timely isolation and screening of all potential admission at the earliest opportunity in line with national guidance.

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Clostridium difficile Infection CDI is a significant HCAI, which usually causes diarrhoea and contributes to a significant burden of morbidity and mortality. Prevention of CDI is therefore essential and an important patient safety issue.

LDP Standard: All Scottish NHS Boards are required to achieve the CDI LDP Standard of 32 cases or less per

100,000 AOBD in the aged 15 and over age group by 31 March 2018.

NHSL achieved the CDI LDP Standard in 2017/2018 for the second consecutive year with a rate of 0.27 against a national rate requirement of 0.32. NHS Scotland year-end rate position in 2017/2018 was 0.27. There was also an 18% reduction in CDI cases by comparison to the previous year.

Patients 15 years and above

118 CDI cases

0.24 annual incidence rate of CDI per 100,000 AOBDs

Patients aged 15 to 64

37 CDI cases


Patients aged 65 years and above

81 CDI cases


54 HCAI Cases

56 CAI Cases

8 Unknown Source

Quality Improvement and interventions to reduce CDIs:

Implementation of CDI Severity Marker Guidance and casenote sticker.

Multi-disciplinary severe CDI case review to support improvement in assessment / detection for early intervention and patient management.

Promotion of the Antimicrobial Stewardship Workbook to raise awareness and promote best practice.

Prompt patient placement.

Improved information by Microbiology when electronic laboratory report sent out to clinical staff.

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Surgical Site Infection SSI is one of the most common HCAI and can cause increased morbidity and mortality. It is estimated on average to double the cost of treatment, mainly due to the resultant increase in length of stay. SSI can have a serious consequence for patients affected as they can result in increased pain, suffering and in some cases require additional surgical intervention.

Caesarean Section 1466 Procedures carried out 28 SSIs following procedure 1.91% Infection Rate NHSL is unable to provide a comparison to the previous activity year as the national methodology for collecting SSI data has been changed from 10 days to 30 day surveillance review.

Hip Arthroplasty 421 Procedures carried out 5 SSIs following procedure 0.95% Infection Rate NHSL is unable to provide a comparison to the previous activity year as the national methodology for collecting SSI data has been changed from 10 days to 30 day surveillance review.

Colorectal (large bowel) Surgery 332 Procedures carried out 25 SSIs following procedure 7.53% Infection Rate No local or national baseline data available for SSIs relating to colorectal (large bowel) surgery. The national mandatory standard surveillance for elective Colorectal (large bowel) commenced from April 2017.

Vascular Surgery 256 Procedures carried out 8 SSIs following procedure 3.12% Infection Rate No local or national baseline data available for SSIs relating to vascular surgery. The national mandatory standard surveillance for elective vascular surgery commenced from April 2017.

Quality Improvement and interventions to reduce SSIs:

The IPC Surveillance Nurses (IPCSN) attend the Hairmyres Theatre Patient Safety Meeting and Maternity Clinical Effectiveness Group to present SSI data to establish any areas of improvement with clinicians and nursing staff.

IPCSNs collaborated with the Enhanced Recovery After Surgery (ERAS) Midwives and Nurses to provide key points in relation to preventing SSI to be included in their surgery school presentations.

NHSL has access to SSI surveillance reports within NSS Discovery at board level, this method of reporting allows comparison of patients’ outcome with Scotland overall and other NHS boards.

The IPCSN liaises with the relevant clinician responsible for the patient following detection of an SSI to discuss the findings of the review, an electronic copy is also sent to the clinician.

Quarterly SSI surveillance reports comprising Statistical Process Charts (SPC) are used to provide feedback to clinicians.

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* Currently there are still too few data points to assess against the statistical control methodology and therefore a run chart has been used to display the data to date for vascular and colorectal SSIs.

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Escherichia coli Bacteraemia Gram-negative bacteria continue to be an emerging threat in healthcare and in 2017/18 the number of cases of bacteraemia reported increased in Scotland. These infections predominantly originate from community sources with a rate of 47.5 cases per 100,000 population. In NHSL, the majority of cases of HCAI in 2017/2018 were lower urinary tract infections, a trend replicated across NHS Scotland with over half of the total cases of bacteraemia reported as lower urinary tract infections originating in the community. A system wide targeted improvement approach is required to drive improvement by focusing on preventative strategies such as Hydration Campaigns and the Catheter Passport. In NHSL, the IPCT have been working on a number of initiatives as part of the Invasive Devices Manual of excellence including defining criteria for insertion and removal of urinary catheters. Progress with these initiatives will be reported across the organisation throughout 2018/2019.

Total 597 Cases of EColi Bacteraemia during 2017/2018

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Hand Hygiene Hand Hygiene is recognised as being the most effective cornerstone of IPC in healthcare and quality of care in healthcare settings.

NHSL has reached an overall compliance level of 86% during 2017/2018 for the second consecutive year against the national compliance level of 95% or above. The organisation reached its highest overall levels of 90% and above in December 2017 which is to be commended given the difficulties the organisation faced during winter pressures.

Hand Hygiene is a term used to describe the decontamination of hands by various methods including routine hand washing and/or hand disinfection which includes the use of alcohol gels and rubs. The 5 Moments for Hand Hygiene (as shown in the diagram) approach defines the key opportunities when health-care workers should perform hand hygiene.

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Outbreak Management

7 UHM

10 UHW

7 UHH

3 H&SCPs

27 Separate Outbreak Situations in 2017-2018

In 2017/2018 there was a significant decrease in the number of healthcare associated outbreaks of infection with a total of 27 outbreaks managed by the IPCT and frontline staff in comparison to 73 outbreaks in 2016/2017 (reduction of 63%).

64% reduction across acute services (67 outbreaks in 2016/2017 compared to 24 in 2017/2018)

50% reduction in the H&SCPs (6 outbreaks in 2016/2017 compared to 3 in 2017/2018).

120 Bed days lost

95 Patients affected

43 staff affected

7 Full Ward Closures

20 Room restrictions

Next Steps

Completion of winter preparedness events across acute and H&SCPs

IPCT Attendance at Winter Planning forums to raise awareness

Engaging with staff to work proactively in managing patients / isolation / cohort to minimise effect

Apply learning from IMT and / or Outbreak Management Debriefs

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Training and Education

IPCT Training & Education Sessions The organisation has 12,300 staff members (clinical and non-clinical roles). Throughout 2017, 142 training and educational sessions were completed by the IPCT. The training topics consisted of:

Topic specific Golden Hour / Golden Nugget (ward based training)

Hand hygiene

LanQIP

Corporate Induction

Medical Induction

Newly Qualified Nurse Induction

Healthcare Support Worker (HCSW) Induction

Ward 18, UHH – Environmental Training for executive directors/senior management teams

Stop the Spread of Flu campaign

CAAS Follow-Up Half Day Event Launch (All Acute and Site Specific)

Winter Preparedness Roadshows

SSI Surveillance ‘Buzz Sessions’

University Hospital Wishaw – Attention to Detail Week

The IPCT in NHSL provided support to National Education for Scotland (NES) in launching the foundation pathway for the national SIPCEP.

NHSL Staff Learnpro Modules Completed

8,312

Modules Complete

5,542

Hand Hygiene

1,283

Norovirus

657

MRSA Screening &

Patient Management

425

Clostridium difficile

10

HAI CLinical Induction

270

Principles of Aseptic

Technique

125

Safe Management of

linen

There are 7 key learnPro modules that new and existing staff members have access to complete. Hand Hygiene is mandatory for completion by staff and on a yearly basis. The other modules noted below are for completion as part of individuals personal development plans (PDP).

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LICC and Sub-Groups Lanarkshire Infection Control Committee (LICC)

There have been 6 meetings held during the activity year.

The annual work plan for the LICC was 95% complete at year end with the remaining actions carried forward the 2018/2019 work plan.

Excellent progress been made over the last year in progressing the HCAI agenda for NHSL.

The quality and presentation of documentation to the LICC has continued to be of a high standard.

Policy Review Group (PRG)

NHSL has a responsibility to ensure arrangements are in place to warrant the continual health and safety of the population of Lanarkshire from the effects of infection or microbiological environmental hazards. The LICC and the Health Protection Committee (HPC) are the lead forums to oversee this area.

The PRG is a sub-group of the LICC and the HPC is the strategic group responsible for ensuring the policies, guidelines and Standard Operating Procedures (SOPs) relating to IPC are updated and reviewed on a 2 yearly basis in line with the Standards for HCAI (2015).

The PRG is a collaborative group which includes the Health Protection Team (HPT) and co-opts others on to the group as required e.g. antimicrobial pharmacist. Over the past year 13 policies have been reviewed and ratified.

Decontamination Expert Advisory Group (DEMG)

Between April 2017 and March 2018 there were 5 meetings held, one of which was given over to the production of an A-Z of equipment and cleaning responsibilities, in line with the HPS report (2015) “Roles and Responsibilities for reusable patient care equipment and environmental decontamination”

A DCNS was appointed in October 2017 and a situational assessment of decontamination across NHSL completed. The findings of the assessment have been used to inform the Work Plan for the DEMG in 2018/19.

The A-Z of decontamination of reusable patient equipment has been completed and is in use across NHSL.

A suite of guidance in relation to decontamination including guidance on the management of decontamination failures has now been approved by the LICC and uploaded to the Decontamination portal on the IPC pages within FirstPort.

Enhanced collaboration with external service providers is now in place to oversee the quality of service delivered for decontamination of reusable devices used in Theatres.

Water Safety Group (WSG)

Following a number of temperature excursions and positive Legionella counts, mitigation measures were put in place and a series of extraordinary meetings of the WSG (sub-group) was convened. Both the short, medium and long term management of the issues were discussed at length with the HubCo providers of Kilsyth, Hunter and Houldsworth Health Centres and a technical solution found. Mitigation measures and enhanced sampling were put into place and an agreed solution has now led to several months of 0 Legionella counts found through monthly sampling. The extra ordinary meeting was dissolved and the issue is being regularly managed in the normal way through the regular WSG.

Annual audit was undertaken by the Authorising Engineer for water and the results and actions for improvement are being managed through the WSG. Actions for improvement are few and relatively minor in nature, and the

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formed action plan was managed to conclusion through the WSG.

A number of positive Legionella counts were found through regular sampling at UHM (in Ward 24 only). Again, mitigation measures were immediately put into place and the issues managed through WSG leads until repeat sampling showed no positive counts of Legionella in these locations.

UHH Ward 18A (Room 5), low positive Legionella count on WHB blended hot water was found. Tap cleaned and re-samples taken. Re-sample results returned clear. No further actions were required in this regard.

Humidifiers removed from UHH, and the plant at UHW disconnected with planned preventative maintenance in place to cover residual fittings which cannot be removed. This was an energy savings initiative, reducing electrical costs and maintenance costs and contributing to savings 2017/18.

Antimicrobial Management Committee (AMC)

New guideline developments, e.g. revised Acute and Primary Care Empirical policies and a new vancomycin dosage calculator made available to clinical staff for the first time as an I-phone/smart phone app. Antifungal policy review generated approximately £186,000 annual saving when generic caspofungin substitution was agreed amongst NHSL clinical stakeholders

Safety initiatives included two Allergy Awareness Weeks delivered at UHM and UHH and a national Allergy Point Prevalence Survey conducted at UHW site. Feedback of improvement in practice with unprecedented staff engagement presented at local site stakeholder meetings and national SAPG events; work also accepted as poster presentation at Federation of Infection Societies Conference, 30 November 2017, Birmingham.

Antimicrobial Stewardship Training delivered at acute site and prescribing management team staff inductions as well as other relevant clinical forums e.g. Regional FY2 Medical Education Event, CAAS Nurse Educational workshops. More targeted ‘buzz sessions’ at ward level also included e.g. a nurse led stewardship mentorship programme within Ward 2, UHM & ICPT Surveillance Nurse Team completion of NES/SAPG validated workbook. Additional Gentamicin and vancomycin training delivered at UHM site as part of a wider Medicines Awareness week at the specific request of UHM consultant leads.

Staff and Public Engagement was sought at Antimicrobial Guardian live sign up events (www.antibioticguardian.com) as part of the annual Winter Preparedness Road Show Events throughout October 2017 across various Lanarkshire Locality locations using validated national materials to promote public understanding and involvement in relation to antibiotic stewardship.

AMC audit and assurance activity included antimicrobial input to all severe case reviews for CDI and SAB conducted by the IPCT. “Management of high risk medicines – learning from Gentamicin” presentation delivered to NHSL Medicines Safety Sub Group focused on sharing themes of successful local improvement interventions and participation in a national SAPG sponsored Point Prevalence Survey assessed current performance and clinical management of patients prescribed Gentamicin and Vancomycin across all 3 acute NHSL hospital sites.

National hospital antimicrobial key performance indicator audit processes embedded across acute sites with collaborative input from medical, nursing and ward pharmacists drove improvement in local standards of antibiotic care. Data from NHSL local initiatives actively shared at national SAPG meetings to inform future national strategy.

NHSL met the Scottish Government ‘reducing total antibiotic use’ national level 3 quality indicator for 2017/2018 and a sustained reduction of 14% in primary care antibiotic use since 2012 has been delivered with further new initiatives planned in 2018/2019:

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* Pharmacy First’ Antimicrobial Patient Group Directions for Urinary Tract

Infection (UTI) and Impetigo launched across NHSL community pharmacies allowing patients greater access to appropriate antibiotic care and alleviating some service pressure on local GP practices.

* Antimicrobial updates to Primary Care prescribers regularly cascaded via monthly Prescribing Bulletin and for the first time NHSL Healthcare Improvement Library at Law House promoted a suite of SAPG endorsed antimicrobial prescribing support materials directly to GP practices.

* NHSL GP practices received antimicrobial prescribing data analysis from local prescribing management pharmacy projects and from the National Services Scotland co-ordinated FAPPC (Feedback of Antibiotic Prescribing to Primary Care) initiative with the purpose of stimulating local reflection and improvement.

* NHSL collaboration with Health Improvement Scotland (HIS) delivered the first ‘One Health’ Antimicrobial Stewardship Stakeholder meeting with local NHSL Veterinary Practitioners with further related initiatives to improve antibiotic use in animals to follow.

UHH Hygiene Group Following on from last year’s work with Beckton Dickinson® UHH had 471 days with no Peripheral Venous Cannula (PVC) related SABs. Two of our Senior Nurses will be presenting the work at an international conference.

A Band 5 Registered Nurse from within Ward 12 (respiratory) has been identified to work with the antimicrobial team on data collection and to be a ‘champion’ for this. This is an opportunity for forging stronger links between the antimicrobial team and the clinical areas, and is an excellent development opportunity for the Registered Nurse selected.

UHH have had our best staff uptake for the flu jab ever at UHH this year, with 50.04% of staff vaccinated across the hospital and 53.9% within the priority clinical areas, at the end of December 2017.

There was an unannounced HIS inspection in May 2017. The outcome of this inspection showed improvement from the previous one; however challenges were identified in the Medical Receiving Ward. The main changes implemented following this inspection were that there has been increased domestic hours put into this area, the Hospital Hygiene Agenda has been reviewed to reflect a more robust escalation process and our service providers now take full responsibility for cleaning of patient chairs.

New Hospital Cover HEI tool introduced identifying any issues found are highlighted both locally and to the Senior Nurse responsible for the area. The tests of change to embed the tool and processes continue and results are fed through the Hospital Hygiene Group meetings.

UHM Hygiene Group There has been representation at the monthly hygiene meetings however this is going to be further reviewed to ensure there is more senior charge nurse representation to further enhance the delivery of the hygiene work plan.

The number of PVC related SABs has been a key action for the hygiene group from information provided by the IPCT which led to the PVC awareness week being arranged in May 2018 to raise awareness of PVC insertion and maintenance bundles, IV to oral switch, the stay safe stay connected campaign and for staff to pledge what actions they were taking forward. This was well received by all disciplines of staff and action plan devised and being taken forward to ensure sustainability. There was also work undertaken by Beckton Dickinson to undertake observational audits of the practice regarding safe use of PVC and devices. An action plan was developed and is being taken forward by the Senior charge nurses. Findings were shared with staff

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via a newsletter. This work was undertaken by the IP&C Team within the site with drop in sessions and ward/department on site educational sessions. The uptake from staff was very good.

Hand hygiene compliance has been variable throughout the activity year. The IP&C Team arranged a series of drop-in and ward/department on site educational sessions. The uptake from staff was very good and work continues to improve the compliance levels on site.

UHW Hygiene Group

HEI Group session in 24/01/18. Positive feedback and assurance was given to HEI by the level of detail and evidenced provided.

The completion of three mock inspections in June 2017, August 2017 and October 2017 which inspected a total of 18 wards. There were 18 wards reviewed were overall good inspection, staff welcoming with good leadership. This was extremely worthwhile, well received in terms of the approach together with the key learning and improvements identified from the findings. The inspection process will continue into 2018/2019.

There has been improvement in LanQIP access which now allows the clinical areas / departments to upload their monitoring programme results to support local improvement programmes.

Directorate Safety huddles discuss compliance of cleaning schedules and provide support as required.

Audited Cleaning schedules in July 2017 and revised cleaning schedules across UHW.

There has been significant work undertaken in conjunction with Beckton Dickinson (BD) in identifying key areas for improvement with regard to PVC insertion and maintenance bundle compliance which is being taken forward locally and reported to the Hygiene Groups and LICC.

North H&SCP Hygiene Group

Continuing to build on the sharing of good practice within the group through the use of presentations and group discussions. A recent presentation on implementation of Daily Walkrounds to support sustaining high standards of hygiene in the ward and raising awareness of the risks posed to laundry staff following a recent Bagging & Tagging audit. There was also group discussion of local protocols used in learning disabilities and how they could be used elsewhere.

Hand Hygiene remains a key area of focus and IPCT ran a series of awareness sessions for the partnership. With the exception of the integrated services that have a mixture of NHS and North Lanarkshire Council staff, there has been a sustained improvement in Hand Hygiene this quarter, with local audits ranging between 80-100%. The integrated team have however, made considerable progress thanks to the leadership of the service manager and the service are showing improvement month on month. There are some environmental issues which will take longer but are being progressed.

There have been a number of unannounced inspections carried out by the IPCT, the reports have been good on the whole with a number of minor issues raised in each. The IPCT have commented on how welcoming the staff have been and praised not only their engagement the inspections but their timeous response to addressing any actions identified.

The hygiene group continues to develop and can see a greater degree of awareness and engagement from the attendees, reporting has improved however this remains variable and are focusing on sustaining the required standard, this is a key area of focus for this year.

South H&SCP Hygiene Group

The Hygiene Group continues to meet monthly.

The Group membership has increased during 2017/2018, to include additional

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clinical teams, further enhancing assurance around infection prevention and control across South H&SCP.

Auditing and reporting processes have improved, whilst logging data onto LanQIP, from all clinical areas, continues to be refined.

Remedial and Improvement Action Plans are reported via the Governance Structure provided of the South Hygiene Group and reflective learning is shared broadly by means of this membership.

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Glossary of Terms ABHR Alcohol Based Hand Rub AMC Antimicrobial Management Committee AMR Antimicrobial Resistant AOBDs Acute Occupied Bed Days BD Beckton Dickinson BSI Blood Stream Infection CAAS Care Assurance Accredited Scheme CAI Community Associated Infection CDI Clostridium difficile Infection CMT Corporate Management Team CPE Carbapenemase Producing Enterobacteriaceae CRA Clinical Risk Assessment CVC Central Venous Cannula DCNS Decontamination Clinical Nurse Specialist DEMG Decontamination Environmental Monitoring Group ECB Escherichia coli Bacteraemia ECDC European Centre for Disease Control Ecoli Escherichia coli ERAS Enhanced Recovery After Surgery FAPPC Feedback of Antibiotic Prescribing to Primary Care GP General Practitioner H&SCPs Health and Social Care Partnerships HAI Healthcare Associated Infection HCAI Healthcare Associated Infection HCSW Healthcare Support Worker HIS Health Improvement Scotland HPC Health Protection Committee HPS Health Protection Scotland IDEAG Invasive Device Expert Advisory Group IMT Incident Management Team IPC Infection Prevention and Control IPCSN Infection Prevention and Control Surveillance Nurses IPCT Infection Prevention and Control Team IPS Infection Prevention Society IRIS Infection related intelligence service LDP Local Delivery Plan LICC Lanarkshire Infection Control Committee MRSA Meticillin resistant staphylococcus aureus MSSA Meticillin sensitive staphylococcus aureus NES National Education for Scotland NHS National Health Service NHSL NHS Lanarkshire NMAHPS Nursing, Midwifery and Allied Health Professionals NPPS National Point Prevalence Survey NSS National Services Scotland PDP Personal Development Plan PMS Patient Management System PRG Policy Review Group PVC Peripheral Venous Cannula PVL Panton-Valentine Leukocidin SAB Staphylococcus aureus bacteraemia SAPG Scottish Antimicrobial Pharmacy Group SEED Surveillance, Education, Engagement, Devices SICPs Standard Infection Control Precautions

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SIPCEP Standard Infection Prevention and Control Education Pathway SOP Standard Operating Procedure SPC Statistical Process Chart SPSP Scottish Patient Safety Programme SPUD Surveillance Prevalence Update Daily SSIs Surgical Site Infections TBPs Transmission Based Precautions UHH University Hospital Hairmyres UHM University Hospital Monklands UHW University Hospital Wishaw UTI Urinary Tract Infection VRE Vancomycin resistant enterococci WHO World Health Organisation WSG Water Safety Group

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Report

Agenda Item

12


Subject: Mental Health Strategy in Lanarkshire


provide an update to the Integration Joint Board on the development of the Mental Health Strategy for Lanarkshire


(1) that the content of the report and progress to date be noted. [1recs] 3. Background 3.1. The Scottish Government’s previous Mental Health Strategy 2012-15 set out a range

of key commitments across the full spectrum of mental health improvement, services and recovery to ensure delivery of effective, quality care and treatment for people with a mental illness, their carers and families.

3.2 The 2012-15 Strategy brought together health improvement activity and mental

health services for the first time into in a single strategy. It set out commitments to work together with partners to respond to the ongoing challenge of improving mental health and wellbeing and ensuring improved services and outcomes for individuals and communities over the period to 2015.

3.3 This particular strategy has now been superseded by the Mental Health Strategy

2017-2027, which in turn sets out ambitions to continue the transformation in Mental Health Services that has already taken place. The strategy includes several themes which can be grouped under the following headings:

prevention and early intervention

access to treatment and joined up accessible services

the physical wellbeing of people with mental health problems

rights, information use and planning 3.4 The overall aim is stated as “we must prevent and treat mental health problems with

the same commitment, passion and drive as we do with physical health problems”.

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3.5 To support this, the Strategy document sets out 40 actions intended to join up and focus services on how we might attain these goals.

4. Local Context 4.1. The Mental Health and Learning Disabilities Service is a hosted service, based within

North Lanarkshire. The Executive Lead for the Mental Health Strategy is Janice Hewitt, Chief Accountable Officer, North Lanarkshire Health and Social Care. The Mental Health and Learning Disability Strategy and Planning Group meets quarterly and agrees the direction of travel for the service, including the implementation of the commitments made in Achieving Excellence. This Group is jointly chaired by Janice Hewitt and Anne Armstrong, as the Lead for the Area Wide Services grouping that includes Mental Health, Learning Disabilities, addictions and Justice. This group has wide representation from both South Lanarkshire and North Lanarkshire. From a South Lanarkshire perspective, Maria Docherty, Nurse Director is lead officer linking into this.

5. A Mental Health Strategy for Lanarkshire 5.1. The Mental Health and Learning Disability Strategy and Planning Group has tasked

the Mental Health and Learning Disabilities Management Team with writing a Mental Health Strategy for Lanarkshire that takes account of both the national ambitions and our local aims, including those in Achieving Excellence.

5.2. It has been agreed that the Mental Health Strategy for Lanarkshire will incorporate

six main chapters:

1. Public Mental Health Improvement Prevention and early intervention are vital to promote better Mental Health. As a result of public events last year, we have high level plans for “Good Mental Health for All” in North Lanarkshire and South Lanarkshire. In the next stage of this work, these Action Plans are to be taken down to a Locality level with further development events planned.

2. Children and Young People’s mental health and well being A further focus on the service will expand on the 14 actions pertaining to children and young people from the national strategy. These actions cover a wide range of aspects of services, ranging from Education to Justice. The strategy will outline local Collaborative arrangements.

3. A “whole systems” approach The Strategy acknowledges that in order to provide better mental health care, we must look at our entire system. We need to ensure that we are providing good access and appropriate interventions at the right time, and that everyone in our organisations understand the impact of mental wellbeing and stigma. This involves changing the way existing services interact, and creating new opportunities for people to access help across a wide range of areas including Primary Care and acute hospitals. There are multiple projects across health, social care and third sector partners taking this agenda forward. Tests of change as part of the Primary Care Mental Health Transformation Fund have already started to explore different ways of working together. These tests of change have informed the work needing to be undertaken to implement the new GMS contract and changes within Out-of-Hours GMS Services, to improve sustainability, as well as informing the work which will be taken forward under Action 15 of the Mental Health Strategy. There is no health without mental health and aligning these strategy areas provides a unique opportunity to improving the mental wellbeing of those with physical illness. Further,

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Lanarkshire’s plan for the implementation of Action 15 of the Mental Health Strategy, has been submitted to the Scottish Government for consideration. This plan details a collaborative programme board approach to implementation with steering group and workstreams and wide management and professional representation. The work will link with other programmes, ensuring prompt implementation and evaluation of outcomes.

4. Rights Based Approach An overarching aim of the strategy is to embed a Rights based approach into every aspect of care delivery. This has been an area of interest within Lanarkshire already and initial work in the form of a Patient Rights Pathway has already taken place as part of the “Rights in Mind” project in conjunction with the Mental Welfare Commission. This chapter will also include legislative changes such as the new proposals regarding Adults with Incapacity (AWI) legislation and the Mental Health Act.

5. Dementia Although not part of the Mental Health Strategy directly, Scotland’s Third Dementia Strategy is in the process of being delivered locally. There are strong synergies within the delivery and planning of services across the same wide range of areas. Including this within the Mental Health Strategy will bring benefits to people with dementia and their families. Lanarkshire will include the Dementia Strategy within the wider Mental Health Strategy.

6. National Suicide plan and work around Suicide Prevention The Scottish Government has recently published its Suicide Prevention Plan, “Every Life Matters”, setting an ambitious target to reduce suicides. Existing work is already well established, but it makes sense to tie these efforts more closely into the wider Mental Health Strategy.

5.3. The Integration Joint Board (IJB) is asked to support the development of the Lanarkshire Mental Health Strategy.

6. Summary and Next Steps 6.1. A final Mental Health Strategy will be present to the IJB at a future date. In terms of

finalising this work, this will be done in conjunction with North Lanarkshire Health and Social Care Partnership the host organisation for Mental Health and Learning Disability.

7. Employee Implications 7.1. There are no employee implications associated with this report. 8. Financial Implications 8.1. There are no financial implications associated with this report. 9. Other Implications 9.1. There are no risk implications associated with this report. 9.2. There are no sustainable development issues associated with this report. 9.3. There are no other issues associated with this report. 10. Equality Impact Assessment and Consultation Arrangements 10.1. An Equality Impact Assessment will be undertaken as the Strategy is being

developed.

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10.2. Consultation and engagement activity will be intrinsic to the development of this

strategy. 11. Directions 11.1. This report does not issue a new Direction.

Direction to:



3. NHS Lanarkshire












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Previous References

None


The Mental Health Strategy 2012-15 https://www.gov.scot/Resource/0039/00398762.pdf

The Mental Health Strategy 2017-2027 https://www.gov.scot/Publications/2017/03/1750

Scotland’s Suicide Prevention Plan https://www.gov.scot/Resource/0053/00539045.pdf

Transforming Mental Health in Lanarkshire – Action 15 Implementation Plan

Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Maria Docherty, Nurse Director, South Lanarkshire Health and Social Care Partnership Phone: 01698 453735 [email protected] Adam Daly, Interim Associate Medical Director Phone: 01698 723216 Email: [email protected] Anne Armstrong, Director of Nursing, North Lanarkshire Health and Social Care Partnership Phone: 01698 858116 Email: [email protected] Alistair Cook, Medical Director, North Lanarkshire Health and Social Care Partnership Phone: 01698 858183 Email: [email protected]

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https://www.gov.scot/Resource/0039/00398762.pdf

https://www.gov.scot/Publications/2017/03/1750

https://www.gov.scot/Resource/0053/00539045.pdf





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Report

Agenda Item

13


Subject: Community Planning Partnership - Health and Social Care Contribution Report 2017/2018


present to the Board an update on the Health and Social Care contribution to the delivery of the South Lanarkshire’s Community Plan – Stronger Together


(1) that the progress and contribution of Health and Social Care to the Community Plan be noted; and

(2) that the contribution of Health and Social Care Services to the delivery of the Community Plan outcomes be noted.

3. Background 3.1. The South Lanarkshire Community Plan was approved in October 2017 and sets out

the priorities and outcomes for the Partnership over 10 years from 2017-2027. 3.2. The Community Plan is underpinned by Partnership Improvement Plans (PIPs)

which contain detailed action plans and performance measures for each of the Partnership’s key thematic areas.

3.3. The Community Plan and the PIPs are accompanied by a comprehensive reporting

framework which sets out performance indicators, targets and specific actions for the Partnership over the life of the Community Plan.

3.4. The overarching theme of the Community Plan is focused on tackling poverty,

deprivation and inequality. There are four Partnership Boards, who each make a contribution to the delivery of the Community Plan and this is outlined within their Partnership Improvement Plans or PIPs. For information, the four Partnership Boards are:

Community Safety

Health and Care

Sustainable Economic Growth

Getting it Right for South Lanarkshire’s Children

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3.5. This report outlines the progress made by the by the Health and Social Care Partnership in relation to the contribution being made to the delivery of the Community Plan.

4. Reporting Requirements 4.1. The Health and Care PIP is closely aligned to the commitments set out in the South

Lanarkshire Strategic Commissioning Plan 2016-2019. The PIP itself is made up of three overarching priority outcomes as follows:

individuals, families and communities are empowered to take preventative action to support positive health and wellbeing with a focus on communities and groups whose health outcomes are the poorest

shifting the balance of care from hospital and residential settings to community based alternatives

carers and in particular those on low incomes are fully supported to access financial advice, information and practical wellbeing support

4.2. Aligned to the three priority outcomes is a suite of 58 quantitative and project based

interventions which provides assurance to the Community Planning Partnership (CPP) Board that the health and care elements of the Plan are being progressed and delivered.

4.3. The report uses a “traffic light” system to indicate if there are any concerns about

whether a target will be reached or whether an action will be completed as intended. In general, a green status indicates that there are no concerns about meeting a target or achieving an action. Amber and red are used to flag up where there might be slippage or deviation from plans. The following definitions are used:

Status Definition

Green We are on course to achieve the target or complete the action as planned/the timescale or target has been met as per expectations

Amber There has been minor slippage against timescale or minor shortfall against target

Red There has been major slippage against timescale or major shortfall against target

To be reported later

For some measures, the statistics are not yet available to allow us to say whether the target has been reached or not. These will be reported when available

Contextual A small number of measures are included for “information only”, to set performance information in context

4.4. From a frequency perspective, progress against the PIP is reported annually, with

key elements of each of the 4 thematic PIPs (referred to in section 3.4) forming an overall report to the CPP Board.

5. Progress with the Health and Care PIP 5.1. As highlighted in section 4.2, there are 58 measures within the Health and Care PIP.

The reporting period covers the most up to date annual data and by way of summary, the traffic light status is detailed in the table below:

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Priority

Status by year

Total Green Amber Red

Report Later/Not Available

Priority Outcome 1: Individuals, families and communities are empowered to take preventative action to support positive health and wellbeing with a focus on communities and groups whose health outcomes are the poorest

23 1 0 0 24

Priority Outcome 2: Shifting the balance of care from hospital and residential settings to community based alternatives

23 1 0 0 24

Priority Outcome 3: Carers and in particular those on low incomes are fully supported to access financial advice, information and practical wellbeing support

7 0 0 3 10

Total 53 2 0 3 58

5.2. A detailed overview of each of the 58 measures is available on request or can be

accessed via the following HSCP Appendix. The measures which relate to amber performance are as follows:

Outcome Measure Position


Maintain the percentage of clients waiting no longer than three weeks from referral received to appropriate drug or alcohol treatment that supports their recovery

There were 638 referrals for drug/alcohol treatment in 2017-18 across South Lanarkshire. Only 94.2% of these referrals started treatment within three weeks of the referral. There has been recent changes in the structure of substance misuse teams and new systems working which may have impacted on performance. This will be monitored by the management team


Reduce conversion of Accident and Emergency attendances to admissions

Most recent data shows that the median for A&E attendances to admissions conversions rate has increased from 28% to 29%. The Partnership is working with Acute colleagues to reduce admissions with actions progressed through the Unscheduled Care and Delayed Discharge Programme Board

5.3. From a highlights perspective, the following provides a useful summary of some of

the key achievements from a health and care perspective:

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Life expectancy among males living in the most deprived 15% areas of South Lanarkshire has increased

94% of the adult population report that they are able to look after their own health very well or quite well

The Building and Celebrating Communities strategy has been approved by the IJB and is now being rolled out across the four localities

14 of the 18 projects funded through Integrated Care Fund resources to grow capacity in the 3rd Sector evaluated positively, with robust evidence presented to demonstrate where the impact was being made

Get Walking Lanarkshire now offers 31 community walks and 14 closed walks for specific target groups. In the past year the project has attracted 319 new walkers and trained a further 32 walk leaders

The Keep Well project has facilitated 91 clinics throughout South Lanarkshire, with 374 people having benefited from a health check

The latest evaluation of Physical Activity Prescription (PAP) has shown a total of 1,060 referrals received with 43 out of 49 GP practices now having sent referrals. 58% of referrals were from SIMD 1 and 2

The use of Telehealth and Telecare continues to increase, particularly

around blood pressure monitoring and video conferencing. Over 2,300 people in South Lanarkshire have remotely texted their monitoring results and this reduced the need for appointments and travel for patients


The Locality First Tiered intervention model has been developed and rolled out across the four localities

Delayed discharge bed days have reduced 6% year on year and average weekly delays have been reduced from an average of 90 to 60 per week

87% of people in South Lanarkshire are spending the last six months of life in the community and this is now consistently in line with the Scottish average from a previous position of being below average

Through bed modelling, £700,000 has been re-invested into community services through the de-commissioning of beds within Udston Hospital

A successful evaluation of intermediate care was undertake, whereby 56% of service users supported through the model have successfully returned home, when they would otherwise have had their care provided through nursing or residential care

A target of 30% reduction in home care hours continues to be achieved for people being supported through re-ablement – thus highlighting the success in supporting people to be more independent

Priority Outcome 3: Carers and in particular those on low incomes are fully supported to access financial advice, information and practical wellbeing support

In 2017/18, a total of 3,460 new carers have been identified and supported in their caring role. This is mainly attributed to increased outreach work and awareness raising of supports available across localities

£1,205,733 in additional annual benefits support was secured for carers in 2017/18 through Welfare Rights Officers supporting carers directly

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The latest figures suggest that 42% of carers in South Lanarkshire feel they were supported to continue their caring role, this is slightly above the Scottish average of 41%

A new Carers Strategy is being developed in conjunction with the full implementation of the Carers Act (2016) requirements including eligibility criteria, adult support plans, young carer support plans and a short break statement

6. Summary and Next Steps 6.1. A report similar to this will be brought annually to the IJB as part of demonstrating the

wider contribution of Health and Social Care Services to Community Planning. 6.2. As part of developing the next 2019-2022 Strategic Commissioning Plan, work will

continue to bring about closer alignment of the Health and Social Care priorities with that of the wider Community Planning Partnership priorities.

7. Employee Implications 7.1. There are no employee implications associated with this report. 8. Financial Implications 8.1. There are no financial implications associated with this report. 9. Other Implications 9.1. There are no additional risks associated with this report. 9.2. There are no sustainable development issues associated with this report. 9.3. There are no other implications at this stage. 10. Equality Impact Assessment and Consultation Arrangements 10.1. This report does not introduce a new policy, function or strategy or recommend a


10.2. This proposal has been worked up in conjunction with all key stakeholders. 11. Directions 11.1. This report does not introduce a new direction.

Direction to:



3. NHS Lanarkshire


Val de Souza Director, Health and Social Care

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Date created: 15 August 2018 Link(s) to National Health and Wellbeing Outcomes










Previous References


none Contact for Further Information If you would like to inspect the background papers or want further information, please contact:- Martin Kane, Programme Manager Ext: 3704 (Phone: 01698 453704) Email: [email protected]

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