Agenda and minutes

1.1 Apologies had been received from Mrs Sue Holmes, Principal Auditor, SBC.

1.2 The Chair welcomed Cllr Neil Richards to his first meeting of the IJB Audit Committee.

1.3 The Chair welcomed Ms Jennifer Law, Mr John Boyd and Ms Stephanie Harold to the meeting who were the new external auditors for the IJB from Audit Scotland. 1.4 The Chair welcomed Rachel Mollart GP to the meeting who spoke to item 6.2 PCIP on the agenda.

1.5 The Chair confirmed the meeting was quorate.

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

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

19.12.22

3.1 The minutes of the meeting of the Integration Joint Board Audit Committee held on 19 December 2022 were approved.

Action Tracker

4.1 Action 2023-1: Meeting date still to be arranged

4.2 Action 2023-5: Mr Chris Myers advised that he had not drafted a letter for the Chair of the Audit Committee to send to the Chair of the IJB in regard to PCIP funding, as he was awaiting further clarification of funding from the Scottish Government. He anticipated that a letter was to be released to organisations later in the week.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE note the Action Tracker.

5.1 Mrs Hazel Robertson provided an overview of the content of the report and highlighted: the background to the regulations; agreement with the Directors of Finance in NHS Borders and Scottish Borders Council; and that there were a small number of areas to be clarified with the partners before a final version would be reached.

5.2 The Chair recorded the thanks of the Committee to Mrs Robertson for the work undertaken to produce such a valuable document which was a vast improvement on previous documentation.

 5.3 Mr Chris Myers echoed the Chairs comments and advised that in line with best value and the new financial regulations, he anticipated better decision making across the partnership and improvements in managing the financial risk better.

 5.4 Mrs Jill Stacey commented that the Directors of Finance in the partner organisations would need to clarify that the arrangements aligned with their respective financial regulations. Mrs Robertson confirmed that in terms of her gaining overall assurance the adoption of the financial regulations sat with her and her 2 peers who had been fully consulted. She would receive financial information from the partners and formulate the IJB report and then share the report with her peers to show what the financial situation looked like across the patch and ensure everyone was following the same standards to drive up compliance. She advised that the regulations would be for all budget holders not just finance colleagues. She intended writing to all budget holders within the partnership to offer guidance on the adoption and compliance with the financial regulations.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted that the Regulations had been substantially reviewed by the IJB CFO and confirmed by SBC and NHSB. A small number of provisions were still to be discussed and agreed across the partnership.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted that the Audit Committees of partner bodies would also require to consider and accept that the changes conformed with their own governance arrangements.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE considered the draft Regulations and identified any further improvements required.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE requested a final draft of the Financial Regulations to the next meeting for approval.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the creation of a Financial Framework with further development activity to improve the financial control environment, which would be brought to future meetings for consideration.

6.1 Mrs Hazel Robertson provided a high level overview of the external audit points that had been active when she took up post. She highlighted several key elements including: appointment of Chief Financial Officer; set aside budget guidance; virtual team; financial sustainability; decision making on longer term plans; and ledger and governance arrangements.

6.2 Mr Chris Myers commented in regard to item 7, that the self assessment results would be discussed at the IJB development session to be held on 19 April. He suggested the new strategic framework would provide an oversight of all the delegated services and encourage the further movement of the integration of services and assist the IJB to fulfil its role as the Board for delegated services.

 6.3 Mrs Jill Stacey commented that in regard to the internal audit recommendations those were captured within the system and would be updated following the monitoring information received by the Committee.

6.4 Mrs Stacey enquired if the “ledger” was a requirement for IJBs to have. Mrs Robertson advised that it was not, some of the larger partnerships had them as they could easily resource them, however she did not see any value in having one locally given the small size of the partnership.

6.5 Mr John Boyd commented that in terms of narrative the use of the word “ledger” suggested a system or application to meet the requirement for books and records of transactions to be logged. Audit Scotland saw across a number of IJBs that it was a simple spreadsheet of a central record of transactions relating to the IJB rather than it being a year end account and obviously it depended on the information received from the other partners. He suggested he would normally recommend that a central record was held.

6.6 Mrs Stacey enquired if Mr Boyd would expect it to be contained within the financial regulations. Mr Boyd clarified that he would.

6.7 Mrs Robertson advised that the regulations did mention it and said that the IJB would not have a separate ledger. She suggested she follow up the matter outwith the meeting with external audit colleagues.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE considered the update and sought clarification of any aspects.

7.1 Mr John Boyd provided an overview of the 2022/23 report. He commented that the plan was the draft external audit plan for the year and as in previous years it covered responsibilities under the code of audit practice. He highlighted several elements including: materiality; risk management; clawback of COVID-19 funding; use of resources; financial sustainability; timetable; management fee; and first year of the audit appointment.

7.2 Mrs Jill Stacey enquired to what extent the assurance on climate change and cyber security would be associated with the partners given the IJB was a commissioning body.

7.3 Mr Boyd commented that the external audit team work in relation to the IJB would build upon the work undertaken in the key partners and would report on how applicable those arrangements were to the IJB itself.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE approved the External Audit Plan.

8.1 Mrs Jill Stacey provided an overview of the content of the plan.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE approved the proposed Internal Audit Annual Plan 2023/24 for the Scottish Borders Health and Social Care Integration Joint Board (Appendix 1).

9.1 Mrs Jill Stacey provided an overview of the content of the update. She suggested changing the cycle of the IJB Strategic Risk Register being received by the IJB to enable better alignment to some of the content within the report.

9.2 Mr Chris Myers comments that it was a live risk register and there was an increased focus on risk management given the framework was based on the 6 biggest risks and there was further work to do on it. He recorded his thanks to Mrs Stacey and her team for their support. He suggested that a more integrated risk approach would be undertaken given there were the same risks on the IJB and partner organisations risk registers that were mitigated differently.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted that a refresh of the IJB Strategic Risk Register had been undertaken to better reflect the role and remit of the IJB, support and underpin the objectives of integration and reflect significant and strategic local and national developments.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE acknowledged the improvements in the application of risk management within the IJB, in accordance with the IJB Risk Management Policy and Strategy.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the benefits for the IJB that accrued from more systematic and assured risk management.

10.1 Mr Hazel Robertson provided an overview of the tracker.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the contents of the Directions Tracker and the follow up to be undertaken before the end of March 2023.

11.1 Mrs Hazel Robertson introduced the PCIP update and commented that it was challenging in terms of the provision of funding from the Scottish Government. The issue of a shortfall in funding in the region of £1.2m to develop all the workstreams and implement the GMS contract had been consistently raised by the PCIP Executive.

11.2 Dr Rachel Mollart commented that the PCIP Executive had been very robust in its analysis of spending and budgeting to deliver what it could within the financial envelope available. The majority of spending had been on staffing, however the budget was some £2.1m to £2.5m short to be able to deliver all of the elements of the contract that the Scottish Government wished to be delivered. It had been agreed that CTAC was the right way forward and that was being progressed.

11.3 Mr Chris Myers commented that at a meeting with the Scottish Government the previous week they had made it clear that the MoU 2 remained in place and the 3 priority areas remained as Vaccinations, Pharmacotherapy and the Community Treatment and Care (CTAC) service. For those areas that did not provide those 3 elements there were transitionary payments made from Health Board and those payments were made by the Scottish Government to the Health Board. Those payments were no longer funded by the Scottish Government. He emphasised that the 2 main areas of financial risk were the CTAC service and vaccinations.

11.4 Mrs Lucy O’Leary enquired of the position of other Chief Officers on the matter and also if there was a national network of IJB Audit Committees.

11.5 Mrs Jill Stacey advised that she was not aware of an IJB Audit Committee forum nationally.

11.6 Mr Chris Myers commented that he would raise the topic with other Chief Officers.

11.7 Mrs Karen Hamilton enquired about the next step given it was a contractual arrangement between GPs and the Health Board with the IJB as the commissioner.

11.8 Mr Robertson suggested reviewing the reserves available within the IJB to see the extent to which some of those could be diverted and used. She suggested she and Mr Myers review them and provide some proposals to the next meeting.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted no growth in funding provided by Scottish Government despite all efforts at escalation. Confirmation received that pay awards would be funded.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted that whilst some funding may be able to be directed from earmarked reserves, that would be insufficient to fund the full programme.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the programme of consultation, engagement and communications that was required.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted risks to Primary Care service delivery and sustainability due to the full programme not being implemented.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION  ...  view the full minutes text for item 11.

12.1 Mr Chris Myers provided an overview of the content of the paper.

12.2 Dr Rachel Mollart commented that 80-90% of palliative care took place in the community with people dying at home. She welcomed the involvement of social care colleagues and suggested GP colleagues had not been fully engaged in the process.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted progress.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the timescales for the review.

13.1 Mr Chris Myers provided an update on the oral services direction and advised that:- • The NHSB Dental Services and Oral Health Strategy Group has been re-established with a refreshed membership to take forward development of the Strategic Plan for Oral Health. It had been agreed that it would be a long term plan over 12 years, split into 4 x 3 year action plans to take a phased approach and allow for flexibility to respond to changing circumstances over time whist working towards the aims of the overall strategic plan. • The recommendations of the Oral Health Needs Assessment completed in 2020 had been reviewed and agreed as current. • Work was ongoing to draft an outline Strategic Plan with a view to engaging with the dental workforce, the public and wider stakeholders in the autumn. Feedback from that engagement would support further development of the Strategic Plan with the aim of implementing it from April 2024.

13.2 The Chair commented that things had greatly improved in Kelso for Kelso residents.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the update.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the NHS in Scotland 2022 Audit Scotland Report.

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

Monday 19 June 2023, 2.00pm to 4.00pm, Committee Froom 2, SBC and Microsoft Teams.

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 19 June 2023 at 2.00pm in Committee Room 2, Scottish Borders Council and via Microsoft Teams.