Midlothian Health and Social Care Partnership

1.1 All functions delegated to Midlothian IJB must demonstrate through service planning and reporting how they have increased collaborative and integrated working that improves population health and wellbeing, by January 2025. 

1.2 To support proactive population approaches to health, wellbeing and wellness, all delegated functions should ensure service planning demonstrates reduced medicalisation of non-medical issues, by January 2025.

2.1 All functions delegated to Midlothian IJB must evidence the connection with communities, partners, and use of technology to improve self-management and self-monitoring, by January 2025.

2.2 All functions delegated to Midlothian IJB must ensure service planning describes a clear process to ensure fair access, by January 2025.

3.1 All functions delegated to Midlothian IJB will contribute to the IJB's ability to describe activity, experience, and outcomes. This includes developing outcome mapping, by January 2025.

3.2 All relevant functions delegated to Midlothian IJB must develop and demonstrate an increase in the effective and proactive outreach to people living with frailty, by January 2025.

3.3 All functions delegated to Midlothian IJB should review practices and further develop person-centred approaches to support recovery including The Midway and Good Conversations approach, by January 2025.

4.1 NHS Lothian and Midlothian Council must ensure accessible feedback mechanisms for all people and communities by January 2025 in order to develop innovative, integrated service offers and supports.

4.2 In order to maximise opportunities to improve personal outcomes, all functions delegated to Midlothian IJB should ensure that the principles of self-management are embedded in service delivery design, by January 2025.

4.3 All relevant functions delegated to Midlothian IJB should evidence how they are sharing information about Self Directed Support (SDS) options, and recording changes in uptake, by January 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 January 2025

5.2 NHS Lothian and Midlothian Council must explore opportunities for integrated system-wide digital solutions and create an action plan of jointly agreed priorities by January 2025.

6.1  All functions delegated to Midlothian IJB that aim to move care from hospital to home should ensure service planning considers the impact of this on unpaid carers, and evidence appropriate supportive actions, by January 2025.

6.2  Explore and define the demand for and the benefit of a Midlothian Care and Support Co-operative in order to provide a platform that facilitates brokerage of personalised support for carers, identifies local assets, and enhances local economic value by January 2025.

7.1 All relevant functions delegated to Midlothian IJB must explore and evaluate the benefits and risks of adopting a ‘request for assistance’ approach as an alternative to traditional referral pathways, by January 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 January 2025.

7.3 All relevant functions should improve the people who use substances’ understanding of their rights and responsibilities in relation to supported self-assessment and risk management, by January 2025. Services should evaluate the relationship between this work and any reduction in harm or improvements in personal outcomes.

8.1 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the integrated Midlothian HSCP Staff Engagement Plan 2023-24.

8.2 NHS Lothian and Midlothian Council should work in collaboration with Midlothian HSCP to support the delivery of the Midlothian HSCP Integrated Workforce Plan 2022-25.

9.1 NHS Lothian should maximise opportunities to work collaboratively across Lothian to design an approach and methodology to better understand and evidence the use of the set aside budget and associated services by HSPC area.   This should include mechanism to better understand the impact of community prevention and early intervention activity across the whole system.

• 9.1.1 Following the 2023/24 review of the set aside budget, NHS Lothian should report to Midlothian IJB on a quarterly `basis with performance and financial progress information.

9.2  All functions delegated to Midlothian IJB must be able to demonstrate Best Value with evidence-based data based on the operational ‘grip and control’ schemes developed for 2024/25. Midlothian IJB has agreed a series of recovery actions as part of its 2024/25 budget setting and expects these to be actioned.  These are specifically

• 9.2.1 Care at home provision should be realigned to a 20/80 split (internal 20%, external 80%) by October 2024.
• 9.2.2 A 3% reduction in overall costs of commissioned arrangements should be achieved through a programme of transformational change in partnership with Midlothian Council and NHS Lothian by January 2025.
• 9.2.3 Newbyres Care Village must reduce agency usage and sustain operation within an established financial footprint October 2024.
• 9.2.4 Transport for service users must reduce in spend by £240,000 by October 2024.
• 9.2.5 Recurring staff-pay costs will reduce by £364.5k in Planning, Performance, and Programme service.

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.