Agenda and minutes

1.1      Apologies had been received from Cllr Jane Cox, Elected Representative, Scottish Borders Council and Mrs Sue Holmes, Principal Auditor, SBC.

1.2       The Chair to welcomed Mr Kai Harrod, Lay Member to the Committee.

1.3      The Chair advised that Cllr Jane Cox would be standing down from the Integration Joint Board (IJB) and the IJB Audit Committee and a new elected representative from Scottish Borders Council (SBC) would be nominated as a replacement in the new year.

1.4       The Chair confirmed the meeting was quorate.

1.5      Mrs Hazel Robertson advised that a new external audit team from Audit Scotland had been appointed to the IJB, however their details were not yet known.

Members should declare any financial and non financial interests they have in the items of business for consideration, identifying the relevat agenda item and the nature of their interest.

2.1       The Chair sought any verbal declarations of interest pertaining to items on the Agenda.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted there were none.

28.11.22

3.1       The minutes of the meeting of the Integration Joint Board Audit Committee held on 28 November 2022 were approved.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted there were none.

5.1       Mrs Karen Hamilton introduced the report.  Mrs Jill Stacey highlighted the key messages including: improvements to be implemented using the skills and knowledge toolkit for Audit Committees: changes to the Chairs of the Audit Committees across all partners; and the intention for all partner Audit Committee chairs to meet to share information and good practice.

5.2       The Chair recorded his thanks to Mrs Stacey for her support to him in his role as Chair of the Audit Committee.  Mrs Hamilton echoed the Chairs’ comments.

5.3       Mr Kai Harrod enquired how the Committee would increase its maturity and synchronise with the partners Audit Committees.  Mrs Stacey commented that the Committee needed to seek assurance from the partner organisations that they were fulfilling their roles and it did gain some assurance in that respect through the current mechanisms of sharing minutes.  However if there were any particular elements that the Integration Joint Board Audit Committee had an interest in it could raise those very specific points and the starting point for that dialogue would be through the partners Audit Committee Chairs.

5.4       Mrs Stacey advised that in terms of development the focus would have been on areas of improvement as identified in the 2022 self evaluation.  The 2023 self evaluation would take place in March 2023 and should lead to a fuller discussion on particular areas of interest that the Committee would wish to focus on.

5.5       Mrs Hazel Robertson commented that there were 8 action points outstanding from external audit and in order to progress those she needed to liaise with colleagues in the partner organisations.  She suggested agreeing the sequencing with Scottish Borders Council and NHS Borders to get a tripartite discussion would be very helpful.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE approved the IJB Audit Committee Annual Report 2021/22 (Appendix 1) which incorporates its self-assessments (Appendices 2 and 3) using the CIPFA Audit Committees Guidance.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE agreed that the IJB Audit Committee Annual Report 2021/22 (Appendix 1) should be presented to the IJB.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE agreed a joint session with the Audit Committee Chairs of the partner bodies should be expedited as soon as possible.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE agreed to hold development sessions ahead of each formal IJB Audit Committee meeting.

6.1       Mrs Hazel Robertson provided an overview of the content of the report.  She advised that the IJB was holding over £10m in reserves which related to NHS funding ring fenced for specific purposes.  Mrs Robertson commented that the revised reserves policy met all of the requirements of the 3 partner bodies for those shared resources attached to the IJB and would enable more flexibility in its use as a mechanism to carry funds forward.

6.2       Mr Kai Harrod enquired about the 4% and Mrs Robertson explained that it would be a general reserve that could be used to build up funds to address an anticipated issue in the future, such as a high cost out of area Learning Disability placement.

6.3       Mrs Karen Hamilton enquired if there was anything specific that Mrs Robertson would need to advise the IJB of in regard to the document.  Mrs Robertson commented that all IJBs were required to have a reserves policy and the revised policy was a more usable document than the previous version and would be beneficial to all 3 partner bodies.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE approved the recommendation of the revised Reserves Policy to the IJB for formal approval.

7.1            Mrs Jill Stacey provided an overview of the content of the report. 

7.2            Mrs Lucy O’Leary commented that there appeared to be substantive assurance from SBC and partial assurance from NHS Borders and she enquired if that was as a consequence of a different culture in terms of the Audit Committee nature of reporting or evidence collecting or risk appetite.

7.3            Specifically Mrs O’Leary enquired about the audit plan for strategic commissioning and the addition of the integrated workforce plan.  She recalled that the integrated workforce plan had been approved by the IJB with some caveats in regard to granularity and enquired if the line in the report in regard to the integrated workforce plan related to that discussion.  Mrs Stacey confirmed that even in light of the comments made at the IJB in regard to the integrated workforce plan she was comfortable that there was sufficient work done to complete the internal audit recommendation.

7.4            In terms of the assurance levels, Mrs Stacey advised that the consequences of different terminology, different language and different internal auditors did lead to slight differences in assurance level ratings.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted the progress made in the first six months of the year to deliver the approved Scottish Borders Health and Social Care Integration Joint Board Internal Audit Annual Plan 2022/23 (Appendix 1).

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE considered the list of Internal Audit reports by partners’ Internal Auditors presented to their respective Audit Committees that are relevant to SBIJB for assurance purposes (Appendix 2), consider the assurances contained therein, and provide any commentary thereon.

8.1            Mrs Jill Stacey provided an overview of the content of the report and highlighted the 4 recommendations.

8.2            Discussion took place on the timelines for the recommendations and it was suggested that the due date for recommendation 4 be extended to February 2023 to allow the Strategic Planning Group to focus on equalities and human rights; and the due date for recommendation 2 be extended to July 2023.

8.3            Mr Kai Harrod enquired of the timeline for concluding recommendations that were rated as High or Medium or if there was an escalation process if they were not concluded in a timely fashion.  Mrs Stacey commented that the expectation was that all medium recommendations would be concluded within 6 months.  The 2 recommendations in regard to the 2020/21 period had been inherited by the new Chief Officer and discussions had taken place with him in regard to looking at a different way to achieve the same outcomes.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted the current status of progress made by Management in implementing Internal Audit recommendations to improve internal controls and governance, and mitigate risks.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE agreed to the revised due dates of three of the Internal Audit recommendations requested by the IJB Chief Officer.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted that Internal Audit will continue to monitor for completion the open Internal Audit recommendations and will provide update reports to this Committee.

9.1            Mrs Hazel Robertson provided an overview of the content to the letter.

9.2            Mr Kai Harrod enquired if analysis was required in regard to the National Care Service (NCS) and the IJB strategic goals.  Mr Chris Myers confirmed that a swot analysis had been undertaken and the NCS was seen as both an opportunity and a threat.  A joint letter from the partners had be written to the Minister to offer the Scottish Borders as a pathfinder given the Scottish Borders was in a co-terminous situation which was not reflected through the majority of Scotland.

9.3            Mrs Jill Stacey commented that it had been challenging in the past to evidence best value within the IJB given its strategic commissioning role.

9.4            Mrs Robertson commented that she had had a helpful conversation with Audit Scotland who were looking at best value of the NCS in terms of the additional money spent on the NCS providing best value for the local population.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted the letter.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE recommended that it informally engaged with the process with Audit Scotland to map out activities and determine value and impact.

10.1        Mrs Hazel Robertson provided background to and an overview of the IJB Directions Tracker.  She explained that it captured all of the directions that had been issued and remained live.  She intended for the tracker to be presented to each meeting of the Committee for monitoring purposes.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted the status of outstanding Directions.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE sought assurance regarding timescales, costs and outcomes.

Health Board Oral Services – Development of Plan

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE agreed to defer the item to the next meeting.

Integrated Home Based Reablement Service – Business case for integrated SB Cares and Home First Service

12.1        Mr Paul Williams provided an update on the progress being made in regard to integrating the Home Based Reablement service with the Home First Service.  He highlighted that one of the significant difficulties with the integration of the services was the differences in pay and terms and conditions of the staff affected.

12.2        The Chair commented that he had raised the issue of pay differentials several times in the past and did now see how that could be avoided.  Mr Williams commented that the intention was to have different defined roles but he accepted pay differentials would be the most complicated piece of the process.

12.3        Further discussion focused on: consensus of workforce challenges; capturing the benefits of reablement against on-going costs of packages of care; impact on whole system flow; prevention of admissions and enablement of discharges; correlation with the integrated workforce plan; development of an internal business case template; and alignment of the workforce, commissioning and financial plans of the IJB.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted the update.

PCIP – Manage PCIP within existing funding

13.1        Mrs Hazel Robertson drew the attention of the Committee to several key points within the report including: the PCIP was funded to help Board to implement the new GMS contract; the IJB were concerned that there was not enough clarity on how the funding was being used; the IJB recognised the funding provided was not enough to implement the full GMS contract; engagement took place with the Scottish Government in regard to funding; funding gap of £2.1m; the GPs had identified the phlebotomy service as their key priority and that was being progressed; and the phlebotomy service was part of the CTAC package of services.

13.2        Mr Kai Harrod enquired about the financials and the significant uplift in staffing.  Mrs Robertson commented that the programme was fully staffed and the projects identified by the PCIP Executive and been agreed in conjunction with the Scottish Government and were those that provided the best benefit to the GPs to manage their workload.  In terms of the CTAC programme, it would not be fully implemented however the local decision had been made to implement the phlebotomy service.

13.3        Further discussion focused on: risk; consequences of non delivery; consideration at the unscheduled care programme board; and potential for escalation to the IJB and then NHS Borders.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted the feedback on actions taken by the PCIP Executive Group.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE considered and agreed that the direction had been implemented appropriately.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE agreed that the Chair of the IJB Audit Committee should write to the Chair of the IJB to advise that although matters appeared to be progressing, no solution was emerging in regard to the funding issue and the impact that would have on delivery.

14.1    Mr Kai Harrod enquired how much the Scottish Borders was aligned to the Audit Scotland recommendations and the Miller House direction answered any of those initiatives.

14.2        Mrs Jill Stacey commented that it was essential good practice to look at any learning from a national context.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE noted the report.

15.1        The Chair advised that no further business had been identified.

Monday 20 March 2023, 2.00pm to 4.00pm, in Committee Room 2, Scottish Borders Council.

Monday 19 June 2023

Monday 18 September 2023

Monday 18 December 2023

16.1        The Chair confirmed that the next meeting of the IJB Audit Committee would be held on Monday 20 March 2023 at 2.00pm in Committee Room 2, Scottish Borders Council and via Microsoft Teams.