Agenda and draft minutes

1.1      Apologies had been received from Mrs K Hamilton and Miss I Bishop.

1.2     The Chair welcomed a range of attendees to the meeting including Mr I Ritchie, Non Executive, NHS Greater Glasgow & Clyde and Mr S Pow, Principal Internal Auditor, SBC, Mr S Burt, General Manager MH&LD.

1.3     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 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.

19.06.2023 (Copy attached.)

3.1     The minutes of the meeting of the Integration Joint Board Audit Committee held on 19 June 2023 were approved.

(a)  Action Tracker (Copy attached.)

(b)  Annual Accounts Update

4.1     Action 2023-3: Best Value: Mr Chris Myers advised that the RAG status should be revised to Red given Mrs Hazel Robertson was absent on long term sick leave. The appointment of an interim Chief Financial Officer was being explored.

4.2     Action 2023-5: PCIP: Mr Myers advised that progress had been made and the RAG status should be updated to Green. A demonstrator programme bid had been submitted and agreed by the Scottish Government and the finer detail of the funding to be allocated was awaited.

4.3     Action 2023-1: IJB Audit Committee: Mrs Jill Stacey reported that the 3 Chairs of the partner organisations had met on 21.08.23 to gain an understanding of how their respective Committees operated. A repeat meeting was not concluded as necessary.

The SCOTTISH BORDERS HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD AUDIT COMMITTEE agreed to close Action 2023-1.

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

4.4     Annual Accounts Update: Mr Chris Myers advised that the process had been delayed and he had been working through the Annual Accounts with Mr Andrew Bone, Director of Finance, NHS Borders. The Annual Accounts would be submitted to Audit Scotland for review and depending on the resulting response from Audit Scotland there may be a requirement to hold an Extraordinary IJB Audit Committee to review the annual accounts prior to submission to the IJB for formal approval.

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

5.1     Mrs Jill Stacey provided an overview of the content of the report to the Committee and highlighted: best value work; refresh of the communications strategy; and workforce planning.

5.2     Mr Chris Myers drew the attention of the Committee to the MSG self evaluation action, tackling health care inequalities framework and locality working groups.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) 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 AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted that Internal Audit would continue to monitor the improvements arising from the Internal Audit recommendations, to ensure they were sustained, and would provide update reports to the Committee.

6.1     Mrs Jill Stacey provided an overview of the content of the report to the Committee and highlighted: internal audit work that was carried out; local code of corporate governance; financial regulations and assurance processes; internal audit work overseen by partners audit committees and look at the relevant content.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the progress made in the first six months of the year to deliver the approved Internal Audit Annual Plan 2023/24 for the Scottish Borders Health and Social Care Integration Joint Board (Appendix 1).

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE considered the list of Internal Audit reports by Partners’ Internal Auditors presented to their respective Audit Committees that are relevant to the IJB for assurance purposes (Appendix 2), and considered the assurances contained therein

7.1     Mr Chris Myers provided an overview of the content of the report and highlighted several elements including: section 6.3 and the health and social care Strategic Framework; using risk management in a live way; changes to the risk management policy; and section 7.3 and updates to the risk management strategy.

7.2     Mrs Jill Stacey commented that as the IJB was a separate legal entity it needed its own strategic framework and risk register as a commissioning body and had formed an integrated risk forum with SBC and NHS Borders.

7.3     The Chair enquired how the Committee could influence better attendance at engagement events in the communities. Mrs Stacey noted the good engagement with communities on the Strategic Framework and noted it was a challenge to engage with communities that might feel overloaded with consultations and engagement.

7.4     Mr Chris Myers suggested he discuss with Wendy Henderson how engagement with communities might be more appropriate and meaningful.

7.5     Further discussion focused on: integrated risk forum; of the 6 strategic objectives, not all of those could be achieved and should the Committee have a view on the 2 most important, so that a prioritisation of those could be fed into directions and procedures; decisions could be challenged if not in the normal procedures and policies for decisions on risk; and potential to hold a workshop for IJB members on the practical application of risk management.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE endorsed the refreshed IJB Risk Management Policy Statement (Appendix 1) and the updated Risk Management Strategy 2023-2026 (Appendix 2) and recommend them to the full IJB for approval taking into account the suggestions made.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE acknowledged the role and responsibilities of the IJB Audit Committee within the IJB Risk Management Policy.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the reporting for assurance purposes on the efficacy of risk management arrangements within the IJB Risk Management Policy.

8.1     Mr Chris Myers provided an overview of the content of the directions policy and highlighted the amendments made since the last iteration. He drew the attention of the Committee to a presentation on key considerations.

8.2     Discussion focused on: supporting governance around directions and engagement; creating exceptions for urgent matters; members briefings; role of joint executive team; by-exception cases for partner organisations; target operating models for delivery; and engagement.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE discussed and reviewed the Directions Policy.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted that all directions are now worked up via the Joint Executive Team (JET).

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted that due to risk or urgency some directions are submitted directly to the IJB without review by SPG.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the suggestion that the review of directions is including in the new HSCP Delivery Report for reporting by exception rather than to the IJB Audit Committee.

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

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the governance routes to the IJB need to be streamlined.

9.1     Mr Chris Myers introduced the report and commented that it was a new report which had been formulated following feedback from members of the IJB. It encompassed the delivery of directions issued and the operational reality of what was being delivered across the partnership. The intention was to also incorporate the performance report within the delivery report to provide assurance on delivery and performance. Mr Myers highlighted 2 areas of concern to the Committee, being the financial position overall and primary care improvement plan delivery.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the contents of the Health and Social Care Partnership Delivery Report.

10.1 Mr Paul McMenamin provided an overview of the financial position and highlighted that there was a £7.4m overspend to the end of October with an adverse variance of £4.6m forecast. Both partner organisations were working to try and deal with the issues both in year and over the medium term; delegated health care functions showed a £6.5m adverse pressure forecast; requirement to deliver savings;

10.2 Mr John Yallop provided an overview in regard to the financial position of social care functions and highlighted learning disability client cost pressures, adult social care and agency and overtime costs.

10.3 Mrs Janice Cockburn provided an overview of the hospital set aside budget and highlighted the current year end forecast of £4.7m made up of £3.8m in operational terms and £900k in unmet savings.

10.4 Mr Chris Myers assured the Committee that savings plans were being worked up across the partnership and he highlighted elements including; positive risk taking approach; working on coming home programme; discussions on risk sharing arrangements between the partners; surge plan impacts; and the payment offer process.

10.5 Further discussion focused on: the IJB reserves position and a large proportion of that being ring fenced for specific purposes and the deduction of reserves by the Scottish Government; sustainable way of restoring affordability to the financial plan over the medium term; impacts on the prescribing budget; primary care improvement plan funding; partner annual delivery plans; expectations of the public and our staff; and workforce reviews with the Scottish Government expected head count reductions in social care and health.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE requested an update on the IJB Reserves position be presented to the next IJB and IJB Audit Committee meeting.

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

11.1 Mr Chris Myers provided an update on progress with the full business case for the proposed Tweedbank care village and highlighted that significant progress had been made and in September Scottish Borders Council had agreed to progress to procurement and full planning. Engagement had taken place with the public through various community events and a service integrated model of care was being worked up.

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

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

12.1 Mr Chris Myers provided an overview of the reformatted performance report and highlighted various elements including: workforce information; demography; and setting up a remote and rural task and finish group across Scotland to look at collective challenges and innovations taking place.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE discussed the content of the report and reflect any views back to the IJB.

Adult Mental Health Services (Accounts Commission and Auditor General)

13.1 Mr Simon Burt provided an overview of the contents of the adult mental health services report and how the integrated services benchmarked against the report findings. He further highlighted: the 10-year mental health strategy; funding for mental health services; distress brief interventions; referral rates to the Renew service; costed delivery plan in relation to primary care, mental health and wellbeing services; people with neurodevelopment disorders; primary care improvement plan funding withdrawn in relation to community link workers; HEAT targets; skills mix; service dashboards; suicide safer communities; some measurement of quality; and health inequalities strategies.

13.2 Discussion focused on: funding for mental health services; allocation of funding to mental health services; how many of the recommendations do we have plans for and how many are affordable; and focus on the bits of the specification that are deliverable.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD (IJB) AUDIT COMMITTEE noted the Adult Mental Health Services report.

14.1 Accounts Commission Blog: Mrs Jill Stacey drew the attention of the Committee to a recently released blog by the Accounts Commission which focused on scrutiny by the Accounts Commission.

14.2 Mr Chris Myers commented that provider failure was a key risk that was a feature of the IJB Risk Register and work continued to mitigate against provider failure.

14.3 Mr Kai Harrod enquired about the cancellation of the September 2023 meeting and noted that the meeting had been cancelled as the Annual Accounts and Audit Report were not available. He was keen for the minute to reflect that the Audit Committee members were available for the meeting but the business of the meeting was not available.

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

Monday 18 March 2024, 2.00pm to 4pm, via Microsoft Teams

15.1 The Chair confirmed that the next meeting of the IJB Audit Committee would be held on Monday 18 March 2024 at 2.00pm via Microsoft Teams.