Midlothian Integration Joint Board (IJB) is a planning and decision-making body created by Midlothian Council and NHS Lothian in 2015. The IJB plans and directs health and social care services for the people of Midlothian using the integrated budget received from Midlothian Council and NHS Lothian.
The Public Bodies (Joint Working) (Scotland) Act 2014 requires the IJB to allocate these resources in line with its objectives and strategic aims.
Directions are the mechanism by which Integrated Authorities execute their strategic plans and communicate their priority actions to both NHS and Local Authority partners. Midlothian IJB Directions are designed to promote integrated practice and collaborative working that will bring positive change as quickly as possible and improve outcomes for people and communities. Current financial challenges mean that services must evolve in new and increasingly innovative ways while continuing to provide safe, high-quality care and support.
To ensure we are appropriately directing our NHS Lothian and Midlothian Council Partners to take action that aligns with our strategy, we have provided clear instructions on priority actions for delivery in our Directions for 2025/26.
1.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by December 2025.
1.4 Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review to inform the redesign and/or refresh of all publicly available information to support self-management, early intervention and prevention in a way that is compliant with our duties relating to accessibility by December 2025. This should include the alignment with the Model Publication Scheme and specifically include
consistent use and application of the Midlothian IJB ‘Writing for Publication Style Guide’,
assurance all service information is person-centred and meaningful from the perspective of those it is intended to support,
a review of the Midlothian Health and Social Care website pages to ensure compliance the Equality Act 2010 and accessibility standards,
the development of consistently presented online and paper service information resources, and
links with both partners website, information, and signposting provisions.
2.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop or redesign services to consider and evidence services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible by December 2026.
2.4 NHS Lothian and Midlothian Council will support Midlothian HSCP to undertake a review of Social Work and Occupational Therapy teams by December 2025.
3.2 NHS Lothian and Midlothian Council will support operational services for all relevant functions delegated to Midlothian IJB to develop and demonstrate an increase in the effective and proactive outreach to people living with frailty, by December 2025.
3.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to revise and update ‘The Midway’ by October 2025.
3.4 NHS Lothian and Midlothian Council will support operational services for all functions delegated to Midlothian IJB to embed and evidence community engagement and feedback from people who experience services as part of continuous improvement and service design by December 2025.
4.1 NHS Lothian and Midlothian Council will support the HSCP integrated services to demonstrate how feedback informs service continual improvement redesign by December 2025.
4.2 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated self-management framework that sets out an expectation of how services will work with people to be more informed about their condition(s), be better prepared for when they feel less well, and describes how to access the right support when it is needed by December 2025.
4.4 NHS Lothian and Midlothian Council will support operational services for all functions delegated to Midlothian IJB to record the impact of their contribution to health and wellbeing outcomes, and evidence how they have used this information to inform service design by December 2025.
5.1 NHS Lothian and Midlothian Council must ensure that data can be disaggregated by HSCP area in order to support the equitable provision of service offers and support across our communities, minimise disadvantage where possible, meet different needs, and encourage participation. This should include ensuring
systems and data have the capabilities to collect and filter data appropriately by HSCP area and by protected characteristics
health and social care workforce are suitably trained and skilled to gather and input this data, and
data quality assurance, by December 2025
5.2 NHS Lothian and Midlothian Council will explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by December 2025.
5.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop integrated data at population level to support the prediction, identification, and planning of changing demographic profile and need to support dynamic whole system change across time and report on progress by December 2025.
6.1 All functions delegated to Midlothian IJB that aim to move care from hospital to home will ensure consideration of the potential impact of planned interventions on unpaid carers, and evidence appropriate supportive actions, by December 2025.
6.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop a Carers strategy for 2025-28 by December 2025. This must specifically outline the action to be taken in collaboration with our Partners, VOCAL, to consider how the information, advice and support improve to see improved outcomes for carers.
7.1 All relevant functions delegated to Midlothian IJB will explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to traditional referral pathways, by December 2025.
7.2 Where there is a statutory responsibility to manage harmful behaviours, all functions must communicate the impact of action taken to maximise people's safety in our communities, by December 2025.
7.4 Midlothian Health and Social Care Partnership will support services to adopt new approaches to ensure people who experience services or supports are given the right information, advice and help to them make the decisions that are right for their life. In practical terms, this includes establishing (and taking action where necessary) by June 2025,
that all the teams who work with people, including the teams of our Partners, understand what SDS is and how to signpost this information at the right time,
that all relevant staff have received training in sensory awareness and understanding how to support people to request and access accessible information,
that all the information we provide about SDS is accessible so those who may benefit most are able to make informed choices.
that comprehensive system evidence is gathered on all changes in uptake between one option and another, any increase in budget, and any HSCP financial impact.
8.1 NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2025-26 by June 2025.
8.2 NHS Lothian and Midlothian Council will collaboratively work with Midlothian HSCP to support the delivery of the Midlothian IJB Integrated Workforce Plan 2025-28 by June 2025.
8.3 NHS Lothian and Midlothian Council must ensure provision in procurement and contract management support to ensure Midlothian IJB is able to report on its duties to comply with the Heath and Care (Staffing) (Scotland) Act in relation to assurance reporting on the workforce provision for services planned and secured by HSCP managed services and delivered by third parties through commissioning by December 2025.
9.1 NHS Lothian and Midlothian Council will maximise opportunities to work collaboratively across Lothian to design an approach and methodology to better understand and evidence the use of the NHS Lothian ‘Set Aside’ budget and Unscheduled Care (USC) provision by HSCP area by October 2025. This should include the design of effective mechanisms to better describe and understand the impact of improvement activity in USC performance.
- 9.1.1 Following the review of the NHS Lothian ‘Set Aside’ budget, NHS Lothian will report to Midlothian IJB on a quarterly basis with performance and financial progress information in order to inform Midlothian IJB planning and allow the IJB to transparently share our overall position with Partners.
- 9.1.2 NHS Lothian and Midlothian Council will support Midlothian HSCP to effectively execute a Scottish Government funded programme to improve Unscheduled Care (USC) performance, with particular focus on the Royal Infirmary of Edinburgh. This will reduce USC beds used by Midlothian IJB to 27 beds by June 2025.
9.3 All delegated functions will participate in a review of service provision driven by a 5-year operational transformation programme to consider long-term reform. This includes a change programme for 2025/26 to support achieving a balanced financial position across eight work-streams.
- 9.3.1 Palliative Care - Midlothian Council and NHS Lothian will support Midlothian HSCP to ensure people can access well-coordinated, timely and high-quality palliative care, care around death, and bereavement support based on their needs and preferences by December 2025. This will include support for both families and carers as they deal with loss and grief, and for staff to manage the emotional impact of caring for people at the end of life.
- 9.3.2 Bed based provision - Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign and ensure the most efficient and effective operational model of bed-based provision. This should be designed to enable people to access appropriate levels of care when their needs change within this model and enable the safe and timely return to living well in the community. A key output of this work should be the development of an integrated strategy by June 2026. This strategy will have clear links to wider health and social care provision and i) a detailed delivery plan with objectives for 3, 5 and 10 years and ii) an accompanying workforce plan to deliver this strategy.
- 9.3.3 Home First Model of Care - Midlothian Council and NHS Lothian will support Midlothian HSCP to redesign the Home First model of care. This should result in a transformed model and use of resources that can demonstrate improved efficiency and effectiveness, delivering the right care in the right place at the right time, facilitating discharge without delay, and avoidance of unnecessary hospital admission. The review and redesign of services will be completed by June 2025.
- 9.3.4 Primary, Community, and Social Care - Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review to scope viable opportunities to change financial flow from acute hospital services to the community designed to sustain and expand general practice, mental health & community services at a local level by June 2026. The aim should be to increase the focus on preventative care and early intervention strategies which will be required to improve long-term health outcomes and improve patient access and safe, efficient, and person-centred quality of care close to home.
- 9.3.5 Commissioning and Third Sector - Midlothian Council and NHS Lothian will support Midlothian HSCP to undertake a review of commissioning spend and establish a new partner provider model that is closely aligned with the strategic aims of the IJB, supports the delivery of key ambitions and increases opportunities for health equality across Midlothian by June 2026.
- 9.3.6 Community Assets - Midlothian Council and NHS Lothian will support Midlothian HSCP to make best use of the opportunity to bring local public bodies together with local communities and local community partner organisations to effectively strategically plan, design, and deliver service offers that make a real difference in people’s lives through the Midlothian Community Planning Partnership. This should include supporting the HSCP to lead the revision, co-design, and partner agreement to co-deliver the ‘Midlothian will be healthier’ component of the Single Midlothian Plan alongside people, communities and community partners, by December 2025.
- 9.3.7 Mental Health and Dementia - NHS Lothian and Midlothian Council will support Midlothian HSCP to improve the experience of people in Midlothian with Dementia by ensuring everyone with a diagnosis of dementia can be offered Post-Diagnostic Support for the first year of their diagnosis and has access to the 8 Pillars Model of Community Support by December 2026.
- 9.3.8 Midlothian Single Point of Access (SPOA) - Midlothian Council and NHS Lothian will support Midlothian HSCP to review and improve both the system flow, and the experience of people seeking information and seeking support from integrated services by telephone, electronic communication, or written communication by December 2026. Specifically, this should include planning that results in an eventual multiagency hub to support all contacts across health and social care. In 2025/26 this should focus on further exploration and development of single point of access/contact, development, implementing, and evaluating experience feedback, and reporting on impact and recommendations for future improvements.
9.4 NHS Lothian and Midlothian Council should report to Midlothian IJB on a biannual basis across 2025/26 on issues and risks relating to non-delegated functions that will impact on delegated functions.
9.5 NHS Lothian and Midlothian Council must ensure that all operational services delivering functions delegated to Midlothian IJB continue to provide assurance of high-quality, safe, and effective service delivery within the allocated budget and with assurance of the principles of Best Value by December 2025.
This Direction describes the action required in relation to the other core and hosted functions delegated to Midlothian IJB. A number of these Directions 1 to 9 will require service redesign and transformation.
Functions delegated to Midlothian IJB are detailed in the Midlothian Integration Scheme. All functions, including hosted functions, should be provided in accordance with legislation, policies, and procedures. Unless specified in the accompanying Directions, services should continue to be provided to high standards within the available budgets. All services should provide information on both activity and outcomes for service offers and supports delivered to improve the health, wellbeing and wellness of the people and communities of Midlothian.
