Midlothian Health and Social Care Partnership

1.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop an integrated Public Communication Strategy and Action Plan by March 2027.

1.4 Midlothian Council will support Midlothian HSCP as part of the redesign of the Midlothian Council website and ongoing provision of the Midlothian IJB and HSCP webpages in a way that ensures compliance with our duties in relation the Equality Act, 2010 and accessibility standards by March 2027.

1.5 NHS Lothian and Midlothian council will support Midlothian HSCP to improve the experience of people in Midlothian who are living with dementia by implementing a Dementia Framework in line with the Dementia Strategy for Scotland - Everyone’s Story (2023–2033), translating the five national outcomes into local actions, measures, and governance by July 2027.

2.3 NHS Lothian and Midlothian Council will support Midlothian HSCP to develop a set of focused ambitions for change alongside the Community Planning Partnership as it reviews the Single Midlothian Plan. This should focus on services contribution to ‘thriving communities’ through the provision of care as close to home as practicably possible through 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 July 2027. 

2.4 NHS Lothian and Midlothian Council will support Midlothian HSCP to undertake a review of Social Work and Occupational Therapy teams by December 2026.  This will include supporting existing data sharing agreements, reaching agreement on necessary data sharing requirements, and the development of data insight and visualisation tools that combine key social work data with financial information to inform effective service decision making and financial management.

2.5 NHS Lothian and Midlothian Council will support Midlothian HSCP to deliver on the duty of the Care Reform (Scotland) Act that requires all commissioned activity to be aligned with our Strategic Plan 2025-2035 by December 2027.

2.6 Midlothian Council will continue to work alongside Midlothian HSCP to deliver a shared Transitions Policy by December 2026.  This work should take a phased approach and move away from single service provision to a holistic and whole-system approach as the support people need adapts from child, to young person, into adulthood

3.4 All relevant functions delegated to Midlothian IJB will report biannually in July and December 2026 on participation and engagement activity, noting where feedback from people and communities has informed service improvements or redesign.

3.5 NHS Lothian and Midlothian Council will support Midlothian HSCP develop a framework that describes how the human, social and economic rights of people who access our services are considered as part of commissioning decisions by July 2028.

3.6 NHS Lothian Midlothian Council will support Midlothian HSCP to support the ambitions of the national Palliative Care Strategy Delivery Plan 2025 – 2028 by establishing a local delivery plan with achievable priority areas for implementation by December 2026.

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 2027.

4.5 Midlothian Council and NHS Lothian will support Midlothian HSCP to work with the NHS Lothian Primary Care Programme Board to scope and recommend viable opportunities for collaborative change.  This should focus on jointly agreed priorities with a shared commitment to change financial flows to best support the ambition to shift the balance of care and sustain and expand general practice alongside community Primary Care services at a local level by July 2027. 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.

5.1 NHS Lothian and Midlothian Council will 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 by December 2026,
• data quality assurance, by July 2027 and
• improvements in recording key data by December 2027.

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 July 2028.

5.3  NHS Lothian and Midlothian Council will support Midlothian HSCP to develop integrated data at population level by December 2027 in order to support the prediction, identification, and planning of changing demographic profile to support dynamic whole system change.

6.1 All functions delegated to Midlothian IJB that aim to move care from hospital to home will identify potential impacts of planned interventions on unpaid carers, describe service mitigations to support unpaid carers, and report biannually on impact in July and December 2026.

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 December 2026,

• 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 staff know how to support people to request and access accessible information, and all the information we provide about SDS meets accessibility standards 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.

8.3 NHS Lothian and Midlothian Council must ensure commissioned partners and providers meet the duties of the Heath and Care (Staffing) (Scotland) Act. Specifically, NHS Lothian and Midlothian Council must ensure provision in procurement and contract management support to ensure Midlothian IJB report annually on its duty to comply with the Heath and Care (Staffing) (Scotland) Act reporting on the compliance of commissioned partners who deliver services on behalf of the HSCP.

8.4 NHS Lothian and Midlothian Council will support Midlothian HSCP to provide biannual reporting in July and December 2026 on the progress towards the ambitions of the Midlothian HSCP Integrated Staff Communication, Engagement and Experience Plan 2024-27 and the impact of this on staff experience and wellbeing.

9.1 NHS Lothian will continue their work to iteratively improve their approach and methodology to better understand and evidence the use of the NHS Lothian ‘Set Aside’ budget and Unscheduled Care (USC) provision across 2026/27. As part of this work, NHS Lothian will provide quarterly ‘Set Aside’ performance and financial progress reports to the Midlothian IJB to inform local planning and enable the IJB to transparently share its overall position with Partners.

9.3 All delegated functions will continue to participate in review of service provision driven by a 5-year operational transformation programme to consider long term reform.  In 2026/27, this will build on the 2025/26 change programme and continue to support achieving a balanced financial position across 3 work-streams.

• 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 by July 2027.  This work will have clear links to wider health and social care provision and include

1. a review of services provided by Midlothian Community Hospital,
2. a review of Hospital at Home, and
3. a clearly defined operational strategy for delivery including workforce planning.

• 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 December 2026.  This should include a review of Care at Home externally contracted provision, commissioning of Care Home places, Newbyres Care Village, and the Learning Disability service.
   
• 9.3.8 Midlothian Single Point of Access (SPOA)
  Midlothian Council and NHS Lothian will support Midlothian HSCP to design and implement a multiagency solution to support all contacts across health and social care by December 2028.  In 2026 this should focus on developing an integrated and shared understanding of the relational working to drive transformation and redesign in line with the Midway. Specifically, Midlothian HSCP should report on the progress and learning by December 2026 with services, people and communities and produce a blueprint for transformation that shifts from a traditional model to a new integrated health and social care provision.

9.4 NHS Lothian and Midlothian Council should report to Midlothian IJB on a biannual basis across 2026/27 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 (appendix 1,) and with assurance of the principles of Best Value by December 2026.

• 9.5.1 NHS Lothian and Midlothian Council should support Midlothian HSCP to deliver the Midlothian IJB Medium-Term Financial Strategy and develop new ways of financial activity monitoring as services redesign and new methods of evaluation are required.  Reporting on progress, issues, and risks should be considered biannually by the Audit and Risk Committee.

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.