This meeting will focus on the approval of the Scottish Borders Integration Joint Board (IJB) final audited accounts for 2023/24. The IJB's performance in delivering its strategic objectives, particularly in the realm of unscheduled care and delayed discharges, will also be discussed. Finally, there will be a review of the progress made on implementing internal audit recommendations.

The IJB Annual Accounts 2023/24

The committee will review the final audited IJB Annual Accounts for 2023/24. These accounts highlight the financial outturn for the period ending 31st March 2024. A similar financial position is reported to that of the previous year. The accounts show a year-end deficit of income over expenditure of £2.997m. This is significantly better than the previous year's deficit of £16.753m, but the report clarifies that the improvement is not by itself an indicator of the financial health of the IJB as the figure accounts for the use of reserves carried forward from the previous year. An overspend of £4.544m (2.21%) was reported against a revised delegated budget of £206.066m, primarily attributable to overspending on delegated health services. The accounts show that this overspend was met by an “additional payment”¹ of £5.714m from NHS Borders, whilst a delegated social work services underspend of £1.170m was returned to the council.
Significantly, the report notes an overspend of £3.602m in Set-Aside healthcare functions² relating to demand and capacity for services, a figure that has almost doubled in the last financial year. This overspend is the responsibility of NHS Borders and will be incorporated into their overall financial outturn.

Health and Social Care Partnership Performance and Delivery Report

The committee will discuss a report on the Health and Social Care Partnership (HSCP) performance and delivery in the six months since the last meeting. It assesses the HSCP’s progress on implementing its Strategic Framework 2023-26 and Annual Delivery Plan, and how these have impacted on a range of services. The report also includes an assessment of the HSCP’s performance on the implementation of directions from the IJB. Overall, the report notes good progress on implementing the directions, highlighting only one significant challenge in the integration of Home First with Adult Social Care. This has been delayed due to concerns about governance and pay parity between workers, and will be reviewed and updated further at this meeting. The report suggests that this model will be trialled for 4 weeks from November 2024 in Kelso. Further concerns are noted in the report about the financial position of the HSCP, and the ongoing pressures associated with delayed discharge. The report notes that, as of 13th November 2024, there are 81 people waiting for care as “delayed discharges” against a target of 77. The report proposes various actions to address the high numbers of delayed discharges, including converting underused bed based respite at Saltgreens and St Ronans into enhanced dementia and residential beds. The performance on the implementation of directions, and the financial position of the HSCP, will be discussed further during this meeting.

Internal Audit Annual Plan 2024/25 for the IJB

The committee will receive a progress update on the Internal Audit Annual Plan 2024/25 for the IJB, including a list of internal audit reports from partner organisations. The committee will be asked to note the progress made, consider the reports, and comment on the assurances provided. The internal audit plan is designed to cover a range of key areas of risk for the IJB. It includes:

• An evaluation of the IJB’s risk management arrangements, corporate governance and internal control of its delegated resources
• An assessment of the IJB’s financial governance, including an examination of its key internal financial controls and its processes for commissioning health and social care services
• An evaluation of the IJB’s governance arrangements, and its progress in implementing the Integrated Workforce Plan

Progress on Implementation of Internal Audit Recommendations

The Committee will review the progress that management has made in implementing the recommendations included in the Internal Audit Annual Assurance Report 2023/24 for the IJB. This review focuses on the recommendations made by Mrs Jill Stacey, IJB Chief Internal Auditor, to improve internal control and governance. The report summarises the IJB Chief Internal Auditor’s view, after monthly meetings with the IJB Chief Officer and Chief Financial Officer, that all three outstanding recommendations are in progress. It suggests that this is supported by “satisfactory evidence”.