2024-25 – Month 4 Financial Performance
North Ayrshire Council · 19 September 2024
Back to Integration Joint Board — 19 September 2024 and its agenda
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Integration Joint Board 19th September 2024 Subject : 2024-25 – Month 4 Financial Performance Purpose : To provide an overview of the IJB’s financial performance as at Month 4 (July). Recommendation : It is recommended that the IJB: (a) notes the overall integrated financial performance report for the financial year 2024-25 and the current overall projected year- end overspend of £6.697m, reduced to £2.995m through already identified financial recovery actions; (b) notes the progress with delivery of agreed savings; (c) approves the actions which are being taken to progress financial recovery and that a further recovery plan will be presented to the next IJB; (d) notes the Care at Home recovery actions detailed at Appendix F (d) notes the remaining financial risks for 2024-25; and (e) approves the budget reductions which are detailed at paragraph 2.10 Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health CAMHS Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework
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1. EXECUTIVE SUMMARY 1.1 The report provides an overview of the financial position for the Partnership and outlines the projected year-end outturn position informed by the projected expenditure and income commitments; these have been prepared in conjunction with relevant budget holders and services. It should be noted that, although this report refers to the position at the end of July, further work is undertaken following the month end to finalise projections, therefore the projected outturn position is as current and up to date as can practicably be reported. 1.2 The projected outturn is a year-end overspend of £6.697m (2.1%) for 2024-25, reduced to £2.995m through already identified financial recovery actions. There is an increasing risk to achieving financial balance during 2024-25, the projected outturn position is summarised below with the residual risk following already identified financial improvement actions: Split TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth4 £6.697m £0.857m £5.840m Less Financial Recovery Plan Projections £3.702m £0.369m £3.333m Residual Risk £2.995m £0.488m £2.507m 1.3 From the core projections, overall, the main areas of pressure are: care at home, residential placements for children, physical and learning disability care packages, supplementary staff in wards, staff costs in Montrose House and Unplanned Activities (UnPACs) within the lead partnership for mental health. 1.4 Whilst the overall projected outturn position has not significantly changed, there are material movements within services, the main movements in the overall projected position and recovery plan are summarised below: Improvement: • Children’s residential places £0.352m Deterioration: • Care Home places £0.063m • LD placements £0.320m 1.5 The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, which includes the requirement to agree a recovery plan to balance the overspending budget. Only if the recovery plan is unsuccessful will the Health Board and Council consider making available interim funds. NHS Ayrshire and Arran and North Ayrshire Council are not in a financial position to make interim funds readily available, therefore it is imperative that the IJB
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continues to support the process of development of the Financial Recovery Plan and the actions required to work towards financial balance by the year-end. 1.6 The projected IJB outturn position has been adjusted to reflect the impact of Lead Partnership services. The underspend in relation to North Lead Partnership services for Mental Health is not fully attributed to the North HSCP as a share has been allocated to East and South HSCPs, similarly the impact of the outturn on East and South led services has been shared with North, both on an NRAC basis in line with the agreed risk sharing mechanism. 1.7 The Scottish Government have recently announced the 2024/25 funding for the Mental Health Outcome bundle which estimates a 4.5% reduction from 2023/24. Formal confirmation of the funding allocation has not yet been received, but this would equate to £0.450m and the service are currently working through the implications of this reduction. 2. CURRENT POSITION 2.1 The report includes an overview of the financial position including commitments against the available resource, explanations for the main budget variances and an update on progress in terms of savings delivery. 2.2 FINANCIAL PERFORMANCE – AT MONTH 4 At month 4 against the full-year budget of £321.083m there is a projected year-end overspend of £6.697m (2.1%). The Integration Scheme outlines that there is an expectation that the IJB takes account of the totality of resources available to balance the budget in year. Following this approach, an integrated view of the financial position should be taken, however it is useful to note that this overall position consists of a projected overspend of £5.840m in social care services and a projected overspend of £0.857m in health services. Appendix A provides the financial overview of the Partnership position. The sections that follow outline the significant variances in service expenditure compared to the approved budgets. The projections for some areas will be subject to fluctuations as they depend on recruitment plans for new funding and also the capacity of providers to take on work. Appendix G provides information on the costs of bank and agency staff as requested at the August IJB.
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2.3 Health and Community Care Services Against the full-year budget of £90.116m there is a projected overspend of £6.049m (6.7%) (£0.062m adverse movement) and the main variances are: a) Care home placements - the budgeted number of permanent placements was 765 and at month 4 there were 789 placements. The projected overspend is £0.614m (£0.063m adverse) on permanent placements and respite placements are projected to be online (£0.023m adverse movement). A plan is in place to manage down the number of permanent placements to reach the target, however this is challenging due to the need to minimise delayed discharge from hospital and to continue to support those in critical and substantial need in the community. Income recovered from charging orders is projected to be £0.550m over recovered. This income is challenging to predict as it depends on the length of the legal process and time taken to sell the property that the charging order is registered to. b) Care at home (now all in house) is projected to be £3.254m overspent (no movement). The position reflects the cost of meeting the significant demand and level of provision for care at home support. These projections include the estimated cost of bringing the purchased services inhouse. The projection is complex due to services being brought in-house at different times, the number of posts and vacancies transferred, the estimated time to fill all of the posts and the costs of covering the required hours (plain time versus overtime) until the posts are filled. The projection is historically based on average costs to date but the data for month 1 – 4 is skewed because of the transfer of the purchased service at different points so this will be reviewed and refined in month 6 when there will be more representative data. c) Physical Disability Services – projected overspend of £0.682m (£0.030m adverse) split as follows: £1.007m over in residential placements, £0.027m over in direct payments and £0.352m under in community care packages. d) Integrated Island Services is projected to overspend by £0.752m. The most significant variance is a projected overspend at Montrose House of £0.561m which relates to the net overspend on agency staff (i.e. net of underspend on employee costs). e) Specialist Rehab wards – projected overspend of £0.126m (£0.009m favourable) (Redburn ward £0.152m overspend and Douglas Grant £0.026m underspend). The overspend is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. f) Wards 1 and 2 – Projected overspend of £0.762m (£0.003m favourable) due to use of supplementary staffing.
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2.4 Mental Health Services Against the full-year budget of £107.531m there is a projected overspend of £1.069m (1%) (adverse movement of £0.478m) prior to the reallocation of the Lead Partnership variance to East and South HSCP. The main variances are: • Learning Disabilities are projected to overspend by £0.916m (£0.320m adverse movement) across community care packages, direct payments and residential placements. • Community Mental Health services are projected to underspend by £0.411m (£0.011m favourable) which is mainly due to a projected underspend of £0.541m in community packages and overspends in residential placements of £0.093m and direct payments of £0.055m. The main reason for underspend is the availability and capacity of adult community providers to deliver new packages of care. • There is a projected underspend of £0.106m (£0.035m adverse) in relation to the cost of Hospital Based Complex Continuing Care (HBCCC), this reflects the impact of change in provision for these services. • The Lead Partnership for Mental Health is projected to be £0.658m overspent (£0.137m adverse movement) and the main variances are as follows: • Adult Inpatients – overspent by £0.442m (£0.058m adverse) due to overspends in supplementary staff for enhanced observations (1:1 and 2:1) and use of bank staff. • The UNPACS (Unplanned Activities) budget – projected overspend is £0.679m (£0.048m favourable movement) based on current placements and an allowance for one further placement. The actual cost of the future placements may be different from the estimated cost assumed in the projection. These placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium or long term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health who needs to be satisfied that the placement is appropriate and unavoidable prior to this being
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agreed. A new group has been established to review the UnPACS budget and placements with a wider service representation. • Learning Disability Services – projected to underspend by £0.538m (£0.011m adverse movement). This position is after recharging other areas on a cost basis for two outwith authority placements which have incurred additional costs in relation to usage of supplementary staffing due to sustained enhanced observations. There is a risk in relation to recovering this income as the two areas receiving the charges are currently refusing to pay and legal advice is being sought. • Elderly Inpatients – projected overspend of £0.415m (£0.004m adverse) due to the use of supplementary staffing. There are several patients who are on enhanced observations and bank costs remain high. • MH Pharmacy – is projected to overspend by £0.585m (£0.099m adverse) due to increased demand and cost of medicines. Innovation Fund – projected underspend of £0.112m (no change) due to slippage within some of the projects and not all of the funding has been allocated. Action 15 – projected online as any underspend will be carried forward for use in 25-26. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership as this is a Pan-Ayrshire target. There is a projected over recovery of the vacancy savings target of £0.819m in 2024-25. Further information is included in the table below: Vacancy Savings Target (£1.116m) Projected to March 2025 £1.935m Over/(Under) Achievement £0.819m 2.5 Children and Justice Services Children’s Services Against the full-year budget of £44.045m there is a projected overspend of £1.134m (2.6%) (£0.449m favourable movement) pre earmarking and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £1.369m (£0.352m favourable movement). The main areas within this are noted below:
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• Following budget investment of £4m the children’s residential placements are overspent by £1.539m based on 33 placements at month 4 and assumes a reduction to 32 places by month 6. This demonstrates a reduction of 5 places since the start of the financial year. There are a number of factors leading to this challenging position: • We have 32 places available in our internal children’s houses, due to demand these have been operating at 100% occupancy for some time, leading to increased use of external placements where residential care is required. • The requirement to support Unaccompanied Asylum-Seeking Children (UASC) under the National Transfer Scheme and to support trafficked young people who have been identified in North Ayrshire. • A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. • Where appropriate young people are placed to meet their educational needs, the cost of Residential School Placements in the most cases is shared 50/50 with Education services. Children’s Services are continuing to work with other services including Education and Housing to address the challenges through the work of the ‘Brighter Pathways’ Programme Board and associated workstreams. This forms part of the Transformation Plan which was approved at the March IJB. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.728m underspent (£0.027m favourable movement). • Children with disabilities – there is a net projected overspend of £0.256m (£0.132m adverse movement) across residential placements, direct payments and community packages. • Residential respite – placements are overspent by £0.058m. These short- term placements are used to prevent an admission to full time care or to avoid placement breakdown. • Employee costs – are projected to overspend by £0.216m, largely due to overspends in the children’s houses. b) Head of Service – is projected to underspend by £0.524m (£0.053m favourable movement). This is made up a projected overspend due to the planned saving of £0.233m in relation to the staff reconfiguration in the children’s houses which was not achieved in 23-24 and this is offset by the grant funding in relation to Unaccompanied Asylum-Seeking Children, which is projected to over-recover by £0.819m and which covers costs incurred across a number of C&F service areas.
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c) C&F Health Team – is projected to overspend by £0.246m (£0.015m favourable) mainly in relation to the Band 6 to 7 regrade for Health Visitors and the progression of posts up the Band 7 scale. 2.6 ALLIED HEALTH PROFESSIONALS (AHP) The non-employee costs element of the AHP services are projected to be on-line. All underspends in employee costs have contributed to payroll turnover. 2.7 CHIEF SOCIAL WORK OFFICER There is a projected underspend of £0.012m mainly due to a delay in spend in the Carers Strategy funding. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £1.293m (£0.068m adverse) and the main areas of underspend are: • There is projected slippage on the LD and MH transition funding of £0.661m due to delays in children transitioning into adult services and actual costs being less than estimated. This involves complex planning by services with service users and families and can change over time based on assessed need when moving into adult services. • The 2024-25 budget included a budgeted deficit on the social care side of £0.437m which is offset by a budgeted surplus of £0.437m on the health side of the budget. The net impact is neutral, but Appendix A shows this position for each element. • An over-recovery of payroll turnover of £0.500m for social care services and an over-recovery of payroll turnover of £0.296m for health services as outlined in the table below. The turnover targets and achievement for the financial year for Health and Social Care services outwith the Lead Partnership is noted below: Social Care Health Vacancy Savings Target (3.301m) (1.522m) Achieved to March 2025 3.801m 1.818m Over/(Under) Achievement 0.500m 0.296m The areas contributing to the health and social care vacancy savings are spread across a wide range of services with vacancy savings being achieved in most areas. The partnership significantly over-achieved on turnover targets last financial year which helped greatly to support the overall financial position. The early projections for 2024-25 indicate a reduction in the turnover being projected, which reflects a more
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optimistic position for recruitment and reduced vacancies but clearly has an impact on the ability to use this to offset overspends in other budget areas. As part of the recovery plan, the vacancy scrutiny group has been enhanced with the Heads of Service and professional leads attending. Each post is scrutinised and filled only where deemed necessary with a recruitment freeze now implemented for all non-essential posts. The turnover target for the North Lead Partnership for Mental Health services is detailed within the Lead Partnership information at section 2.4. 2.9 Savings Progress a) The approved 2024-25 budget included £10.290m of savings. BRAG Status Position at Budget Approval £m Position at Month 4 £m Red - - Amber 0.523 0.675 Green 9.767 0.600 Blue - 9.015 TOTAL 10.290 10.290 b) The main area to note is that the amber savings have increased as the care home budget is currently projecting an overspend but this will be managed into an online position. Appendix B provides an overview of those service changes which do have financial savings attached to them and the BRAG status around the deliverability of each saving. 2.10 Budget Changes The Integration Scheme states that “either party may increase it’s in year payment to the Integration Joint Board. Neither party may reduce the payment in-year to the Integration Joint Board nor Services managed on a Lead Partnership basis…. without the express consent of the Integration Joint Board.” Appendix C highlights the movement in the budget position following the initial approved budget. Reductions Requiring Approval: Ref Description Amount (£000) 1 Post to medical records (37)
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2.11 Pan Ayrshire Lead Partnership services and Large Hospital Set Aside Lead Partnerships: - The IJB position is adjusted to reflect the impact of Lead Partnership services. The outturn for all Lead Partnership services is shared across the 3 Partnerships on an NRAC basis. The outturn in relation to North Lead Partnership services is not fully attributed to the North IJB as a share is allocated to East and South Partnerships; similarly, the impact of the outturn on East and South led services is shared with North. At Month 4 the MH lead partnership is projected to overspend by £0.658m (£0.215m NRAC share for East and £0.188m for South). South HSCP (month 3 info) – projected overspend of £0.551m of which £0.204m will be allocated to North. The variance is mainly due to an overspend of £0.512m in the community store. This includes the costs of replacing mattresses, repairs and maintenance contract and equipment costs. There is also a projected overspend of £0.069m in the continence service and an underspend £0.030m in the Family Nurse Partnership. East HSCP - projected underspend of £0.208m (£0.176m favourable movement) in total (of which £0.077m will be allocated to North). The main variances are: Allied Health Professions (Lead Partnership) There is a projected underspend of £0.431m on AHPs services hosted by East Ayrshire for the current year, which mainly relates to staffing savings in Physiotherapy / MSK and Podiatry services and is partially offset by increased Orthotics costs. Primary Care and Out of Hours Services (Lead Partnership) There is a small projected overspend of £0.023m on the Primary Care Lead Partnership budget and additional costs in Out of Hours services £0.371m, with work ongoing to mitigate increased costs as far as possible over the course of the 2024/25 financial year and going forward, as well as additional Primary Care contracting and support costs £0.024m. These additional costs are largely offset by a projected underspend in Dental services totalling £0.219m, where staffing numbers are running at less than establishment. Recruitment over the remainder of the financial year has the potential to impact further on the projected outturn position at month 4. In addition, there is a small saving on Primary Medical Services costs £0.152m. Prison and Police Healthcare (Lead Partnership) The £0.043m projected underspend at month 4 is largely due reduced staffing costs.
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Other Services (Lead Partnership) The £0.243m projected overspend is due to increased Area Wide Evening Services costs, mainly due to additional staffing costs including high use of bank staff, which will require to be addressed going forward. Set Aside: - Work has been undertaken with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes arrangements in relation to the use of Directions, Joint Commissioning Plans and overall progression towards fair share allocations of resources. Further work has been undertaken through the Ayrshire Finance Leads group to establish baseline resources for each partnership and how this compares to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the four full years prior to the pandemic, 2016/17 – 2019/20 inclusive. The 2023/24 usage is now available as is Q1 of 2024/25 and these will be presented to Ayrshire Finance Leads for validation. IJB Baseline at 2022/23 prices (£) East 26,215,888 North 35,007,962 South 28,371,789 Total 89,595,639 The annual budget for Acute Services is £432.3m. The directorate overspent by £11.2 million after 4 months. This was caused by overspends on agency medical and nursing staff, together with drug expenditure including the New Medicines Fund, equipment and supplies. These have been required due to the level of operational pressure being experienced, in common with many other areas in Scotland. 156 additional unfunded beds remained open across both main hospital sites during July. There is a material underlying deficit caused by: • Unachieved efficiency savings • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are above the Scottish average. • High expenditure on medical and nursing agency staff, high rates of absence and vacancies causing service pressure. • Delayed transfers of care and high acuity of patients.
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The IJBs and the Health Board work closely in partnership to maintain service and improve performance. Initial work has commenced to develop a joint strategic commissioning plan for the provision of unscheduled care services, which will outline these services will be delivered over the medium-term using the set aside resources available. This will support a shift in the balance of care into the community and support a reduction in the number of acute beds. 2.12 FINANCIAL RISKS There are a number of financial risk areas that impact or may impact on the financial position. • The recent announcements by Scottish Government in relation to public sector finances and in-year spending reductions will impact on current and future funding, including for 2024-25 pay awards, which have not yet been settled for local government or NHS. • Continued growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The provider market and the ongoing ability to source packages of care for service users. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges, for example the joint mission for delayed discharge improvement. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • The ongoing review of the Integration Scheme. • Progress with the work to develop set aside arrangements and the risk sharing arrangements agreed as part of this. • The wider system financial challenges, especially the financial position of NHS Ayrshire and Arran Health Board, their financial deficit and the risks around further escalation in the national framework for financial escalation. North Ayrshire IJB have already discussed our position in relation to the request for payment for delayed discharges last financial year. • The underlying levels of overspend which are recurring into 2024-25 and may impact on the Partnership’s ability to continue to sustain service levels in the future. • The IJB free general fund reserves are estimated to be fully utilised during this financial year, leading to an increased risk of requiring additional in-year financial contributions from NHS Ayrshire and Arran and North Ayrshire Council to break even. • High risk areas of low volume / high-cost services areas e.g. Children’s residential placements, Learning Disability care packages and complex care packages; • Lead / hosted service arrangements, including managing pressures and reporting this across the 3 IJBs.
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• The impact on Lead Partnership and acute services from decisions taken by other Ayrshire areas. • The use of supplementary staffing for enhanced observations across a number of service areas. • The use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for Change Pay Reform programme – including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. Non- recurring funding has been provided to meet costs associated with this but it is unclear whether this will be sufficient. These risks will continue to be monitored during 2024-25. 2.13 RESERVES The IJB reserves position is summarised in the table below. General Fund Reserve Earmarked Reserves Total Unearmarked External Funding HSCP £m £m £m £m Balance – 1 April 2024 0.357 3.379 1.774 5.510 Anticipated Drawdown (0.357) (3.379) (1.202) (4.938) Balance – 31 March 2025 - - 0.572 0.572 The £1.774m HSCP earmarked reserve relates to the Service Redesign and Change Fund; of this total only £0.096m currently remains uncommitted with the balance being committed to investment in an early intervention approach within Children and Families social work and supporting the delivery of the transformation programme across 2024-25 and 2025-26. Further detail on the reserves is given in Appendix D. 2.14 Financial Recovery Plan The IJB set a balanced budget for 2024/25 on 14th March 2024. This did not require any draw on reserves but did include the approval of £10.290m of savings to achieve financial balance. Following the finalisation of the 2023/24 outturn position, the IJB agreed some initial recovery actions at the meeting in June. In line with the requirements of the integration scheme, work has continued to develop the financial recovery plan and identify further targets for financial improvements. The current plan is outlined in full at Appendix E.
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There has been progress towards some of the targets, and these are already reflected in the current projected outturn of £6.697m overspend. Further work is required to deliver on the balance of these targets as well as the additional targets which have now been identified. Services will work towards implementing the recovery plan to deliver on these cost reduction targets while carefully managing the level of risk. This will include the preparation of equality impact assessments. It is recognised that there needs to be further savings identified to move towards a breakeven position. Any decisions to implement changes which have significant impact on service delivery and the wider system will be discussed at the Finance Working Group before being brought back to the IJB for further approval as part of the financial recovery plan. A summary of the Care at Home plan is included at Appendix F. MANAGEMENT ACTIONS/CONTROLS: Other management actions which have been implemented include: • Review of expenditure authorisation levels across the Partnership and escalation of specific decisions to senior officers. In particular, a new governance group has been introduced, involving the Director and Heads of Service, to oversee the agreement of higher value packages of care (above £40,000 per annum). • Staff communication in relation to discretionary/non-essential spend. • Review of temporary posts and robust vacancy management/approval. The vacancy scrutiny group now has representation from all of the Heads of Service and a recruitment freeze will be implemented for all but essential frontline posts. • Restrictions on all but essential overtime working. • Ongoing review of future year savings or transformation programmes to identify scope for acceleration. • Maximise opportunities from the recently reopened Independent Living Fund (ILF) Scotland. GOVERNANCE: • In order to facilitate greater scrutiny of the financial position and the delivery of the financial recovery plan during 2024/25, the IJB agreed at the June meeting to establish a ‘Finance Working Group’, chaired by the IJB Vice Chair. The Director and Heads of Service will be members of the group. This will meet monthly to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. Meetings have now been scheduled to the end of the year and the first meeting took place on 9th September.
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• Strengthened support from Finance Team to front line services and increased engagement with Heads of Service and Senior Management Teams, including line by line reviews of all budget areas. Review and enhancement of frequency and level of financial information provided to support oversight and decision making in line with financial constraints, with an added focus on areas of underspend to maximise opportunities to delay or stop spend and contribute to the overall financial challenge. INTEGRATION SCHEME The Integration Scheme describes the required approach where there is a projected overspend: The Chief Officer will deliver the Outcomes within the total delegated resources (paid and Set Aside) and where there is a forecast overspend against an element of the operational budget, the Chief Officer, the Chief Finance Officer of the Integration Joint Board and the appropriate finance officers of the Parties must agree a recovery plan to balance the overspending budget, which recovery plan shall be subject to the approval of the Integration Joint Board. If the recovery plan is not successful the Parties will consider making interim funds available based on the agreed percentage contribution for joint responsibilities, as outlined above, with repayment in future years on the basis of a revised recovery plan agreed by the Parties and Integration Joint Board. There is an increasing risk to achieving financial balance during 2024-25, the projected outturn position is summarised below with the residual risk following already identified financial improvement actions and illustrates the current estimated risk exposure to the IJBs funding partners: Split TOTAL Health/NHS AA Social Care/NAC Projected Overspend @ mth4 £6.697m £0.857m £5.840m Less Financial Recovery Plan Projections £3.702m £0.369m £3.333m Residual Risk £2.995m £0.488m £2.507m 3. PROPOSALS 3.1 Anticipated Outcomes Continuing to closely monitor the financial position will allow the IJB to take corrective action where required to deliver services in 2024-25 from within the available resource, thereby limiting the financial risk to the funding partners. The transformational change programme will have the greatest impact on the financial sustainability of the partnership, the IJB require to have a clear understanding of progress with the delivery of the transformation plan.
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3.3 Measuring Impact Ongoing updates to the financial position will be reported to the IJB throughout 2024- 25. 4. IMPLICATIONS 4.1 Financial The outturn is an overall year-end overspend of £6.697m (2.1%). The report outlines the main variances for individual services. There IJBs unearmarked reserve balance is projected to be zero by the end of the financial year and there is an ongoing risk in relation to the £2.995m of the overspend where financial recovery improvement actions require to be identified. This current position poses a financial risk to North Ayrshire Council and NHS Ayrshire and Arran. 4.2 Human Resources The report highlights vacancy or turnover savings achieved during the year. Services will review any staffing establishment plans and recruitment in line with normal practice when implementing service change and reviews as per agreement with the IJB. Tight vacancy scrutiny management arrangements are in place for the HSCP. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk Para 2.12 highlights the financial risks. The report falls in line with the agreed risk appetite statement which is a low-risk appetite in respect to adherence to standing financial instructions, financial controls and financial statutory duties and a high-risk appetite in relation to finance and value for money. The ‘financial viability of the HSCP’ risk on our strategic risk register has increased the risk score to reflect the 23/24 outturn and current projected 24/25 overspend. 4.6 Community Wealth Building None. 4.7 Key Priorities The ability to deliver on our strategic priorities may be compromised due to the greater financial risk faced in 2024-25 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2024-25. If we are unable to successfully develop a financial recovery plan to achieve financial balance, consideration may be given to revising the strategic commissioning plan.
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5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team. 5.2 The IJB financial monitoring report is shared with the NHS Ayrshire and Arran Director of Finance and North Ayrshire Council’s Head of Finance after the report has been finalised for the IJB. Caroline Cameron, Director Author – Paul Doak, Head of Finance and Transformation Eleanor Currie, Principal Manager Finance [pdoak@north-ayrshire.gov.uk/eleanorcurrie@north-ayrshire.gov.uk]-
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PUBLIC INFORMATION 2024-25 Budget Monitoring Report–Objective Summary as at 31st July 2024 Appendix A Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 COMMUNITY CARE AND HEALTH 71,300 76,257 4,957 18,816 19,908 1,092 90,116 96,165 6,049 5,987 62 : Locality Services 30,392 31,227 835 5,366 5,410 44 35,758 36,637 879 795 84 : Community Care Service Delivery 36,732 40,208 3,476 0 36,732 40,208 3,476 3,447 29 : Rehabilitation and Reablement 2,099 2,116 17 0 2,099 2,116 17 35 (18) : Long Term Conditions 987 997 10 9,459 10,373 914 10,446 11,370 924 927 (3) : Community Link Workers 358 358 0 0 0 0 358 358 0 1 (1) : Integrated Island Services 732 1,351 619 3,991 4,125 134 4,723 5,476 753 782 (29) MENTAL HEALTH SERVICES 34,339 34,858 519 73,192 73,742 550 107,531 108,600 1,069 591 478 : Learning Disabilities 25,723 26,640 917 556 555 (1) 26,279 27,195 916 596 320 : Community Mental Health 6,575 6,165 (410) 1,739 1,738 (1) 8,314 7,903 (411) (400) (11) : Addictions 2,041 2,053 12 1,899 1,899 0 3,940 3,952 12 15 (3) : HBCCC 0 0 0 353 247 (106) 353 247 (106) (141) 35 : Lead Partnership Mental Health NHS Area Wide 0 0 0 68,645 69,303 658 68,645 69,303 658 521 137 CHILDREN & JUSTICE SERVICES 39,130 40,018 888 4,915 5,161 246 44,045 45,179 1,134 1,583 (449) : Irvine, Kilwinning and Three Towns 3,054 3,086 32 0 0 0 3,054 3,086 32 25 7 : Garnock Valley, North Coast and Arran 3,206 3,249 43 0 0 0 3,206 3,249 43 40 3 :Intervention Services 1,716 1,715 (1) 0 0 0 1,716 1,715 (1) 7 (8) : Care Experienced Children & Young people 27,185 28,554 1,369 0 0 0 27,185 28,554 1,369 1,721 (352) : Head of Service - Children & Families 1,082 558 (524) 0 0 0 1,082 558 (524) (471) (53) : Justice Services 2,472 2,472 0 0 0 0 2,472 2,472 0 0 0 : C&F Health Team 415 384 (31) 4,203 4,449 246 4,618 4,833 215 261 (46) : Lead Partnership NHS Children's Services 0 0 0 712 712 0 712 712 0 0 0 CHIEF SOCIAL WORK OFFICER 1,561 1,573 12 0 0 0 1,561 1,573 12 (62) 74 PRIMARY CARE 0 0 0 53,109 53,109 0 53,109 53,109 0 (42) 42 ALLIED HEALTH PROFESSIONALS 0 10,306 10,306 0 10,306 10,306 0 0 0 MANAGEMENT AND SUPPORT COSTS 9,038 8,500 (538) 4,407 3,652 (755) 13,445 12,152 (1,293) (1,361) 68 FINANCIAL INCLUSION 970 972 2 0 0 0 970 972 2 (13) 15 OUTTURN ON A MANAGED BASIS 156,338 162,178 5,840 164,745 165,878 1,133 321,083 328,056 6,973 6,683 290 Over/ (Under) Spend Variance at Period 3 Movement in variance from Period 3 TOTAL Partnership Budget - Objective Summary Council Health 2024/25 Budget
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PUBLIC INFORMATION Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Return Hosted Over/Underspends East 0 0 0 0 (215) (215) 0 (215) (215) (171) (44) Return Hosted Over/Underspends South 0 0 0 0 (188) (188) 0 (188) (188) (149) (39) Receive Hosted Over/Underspends South 0 0 0 0 204 204 0 204 204 204 0 Receive Hosted Over/Underspends East 0 0 0 0 (77) (77) 0 (77) (77) (12) (65) OUTTURN ON AN IJB BASIS 156,338 162,178 5,840 164,745 165,602 857 321,083 327,780 6,697 6,555 142 Over/ (Under) Spend Variance at Period 3 Movement in variance from Period 3 Partnership Budget - Objective Summary 2024/25 Budget Council Health TOTAL
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PUBLIC INFORMATION 2024-25 Savings Tracker Appendix B Social Care: Description Deliverability Status at budget setting Deliverability Status at Month 4 2024/25 Saving Description of the Saving Children, Families & Criminal Justice Service redesign Amber Blue 0.123 Restructure areas of specialist service provision including substance use and corporate parenting, embedding the roles and functions of those teams within our locality-based early intervention approaches and strategic planning including engagement. Community Care & Health Review of Day Care provision Amber Blue 0.100 Carry out a review and streamline day care provision. Sensory Impairment Team Green Blue 0.062 Remove the dedicated management post and realign the team into core social work teams. Care Home places Green Amber 0.375 Reduce the number of funded care home places by 15, leaving budgetary provision for 765 places at average cost. Charging for community alarm provision to sheltered housing tenants Amber Amber 0.200 Introduce a charge for community alarm provision in council sheltered housing units to ensure an equitable approach across all housing tenures. Montrose House capacity Green Blue 0.111 Restrict the capacity at Montrose House care home to the current level of residency. Voluntary Early Release Green Blue 0.174 Recurring savings achieved by the release of back-office staff through the council's voluntary early release scheme. Carers Strategy funding Green Blue 0.384 Utilise the remaining Carer's Strategy funding to invest in respite provision and short breaks for carers and to support existing investments in services which support unpaid carers. Increase to charging Green Blue 0.131 Increase charges for non-residential care by 10% and charges for residential care by 5% Remove vacant posts Green Blue 0.280 Remove a number of vacant posts across support services. Employers' superannuation contributions Green Blue 7.238 Align the budget to the new employer superannuation contribution rates from 1st April 2024. Payroll Turnover Green Blue 0.077 Increase targets for payroll turnover through the recruitment process. TOTAL SOCIAL CARE SAVINGS 9.255 North Ayrshire Health and Social Care Partnership 2024/25 Savings Support Services and Partnership-wide savings
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PUBLIC INFORMATION Health: Description Deliverability Status at budget setting Deliverability Status at Month 4 2024/25 Saving Description of the Saving Hospital Based Complex Continuing Care (HBCCC) provision Green Green 0.500 Align the budget to the level of ongoing need for HBCCC provision. Increase recharge to East Ayrshire for beds at Woodland View Green Blue 0.021 Apply an inflationary increase to the recharge to East Ayrshire HSCP. Community Recovery and Rehab provision Amber Amber 0.100 Review and streamline a range of current provisions to remove duplication. Enhanced ICT Green Green 0.100 Carry out a review of the service delivery model and release recurring staffing savings. Payroll Turnover Green Blue 0.314 Increase targets for payroll turnover through the recruitment process. TOTAL HEALTH SAVINGS 1.035 TOTAL NORTH HSCP SAVINGS 10.290
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PUBLIC INFORMATION 2024-25 Budget Reconciliation Appendix C COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 156.190 Adjustments to baseline (0.574) Less Resource Transfer 23/24 (24.640) Revised Budget 130.976 Resource Transfer 24/25 1-3 P 24.861 Realign Girfec Team To Connected Communities 1-3 P (0.073) ICT Budget Transfers 1-3 P (0.006) CJSW Funding 2425 1-3 T 0.053 Children’s Living Wage Allocation 1-3 T 0.525 Roundings 1-3 0.002 Social Care Budget Reported at Month 3 156.338 HEALTH Period Permanent or Temporary £'m Initial Budget exc set aside 157.894 Add Resource Transfer 23/24 24.640 Month 10-12 Adjustments and adjusting for the full year impact of part years amounts and temporary funding. (0.033) Revised Budget P 182.501 Add resource Transfer 24/25 (24.861) North Superannuation 24/25 uplift 1 1.134 MH: Anticipate Hollybush Combat Stress 24/25 1 1.424 MH: Anticipate Delivery of Veteran Funding 24/25 1 0.105 MH: Anticipate Perinatal MH, Infant MH (inc MNPI) 24/25 1 0.750 Training grade ADJ - April 1 0.063 Pecos Nurse Post 1 (0.018) Script Switch To Pharmacy 1 (0.002) Breastfeeding Pay Award - South 2 0.005 Nest - South 2 0.066 24-25 Foxgrove North 2 0.033 24-25 Breast Feeding - North 2 0.005 24-25 Huntingtons North 2 0.005 24-25 NEST North 2 0.066 Phlebotomy Admin Returned 2 0.005
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PUBLIC INFORMATION 23-24 - 50% North Share to East - Tier 3 Weight Management 2 (0.077) 24-25 North Share to East - Tier 3 Weight Management 2 (0.022) Anticipate ADP Afc Pay Uplift 3 0.091 Anticipate ADP Drug Prevalence 3 0.084 Anticipate ADP Lived & Living Exp 3 0.013 Anticipate ADP Mat 3 0.250 Anticipate ADP National Mission 3 0.296 Anticipate ADP Residential Rehab 3 0.134 Anticipate ADP Whole Family Approach 3 0.094 Training Grade Adj - Jun 3 (0.054) Prescribing (Ambush) North Rx 3 1.573 Prescribing (Ambush) North Rx Cres 3 (1.477) 24-25 North Budget Paper - Office 365 (to East) 3 (0.073) 24-25 North Budget Paper - Prison Pharm Contract (to East) 3 (0.093) South Mat Funding - Psychiatrist 3 0.029 Hd198: Early Intervention In Psychosis/ Body Image And Social Media Resource 3 0.242 Hd203: Digital Mental Health Programme Licence & Support 3 0.005 Reduction to the Working Week (mth 2 - 4) 4 0.105 Post to medical records 4 (0.037) HD107: breast Feeding project funds 4 0.056 BBV 4 0.280 Anticipated budgets assumed in the report but not yet allocated 4 2.045 Health Budget Reported at Month 4 164.745 TOTAL COMBINED BUDGET 321.083
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PUBLIC INFORMATION 24-25 IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2024 2024-25 Anticipated Draw Downs Projected Balance at 31 March 2025 : Alcohol & Drug Partnership 641 (641) 0 : Mental Health Action 15 57 (57) 0 : Service Redesign / Challenge Fund 1,774 (1,202) 572 : Community Living Change Fund 377 (377) 0 : Family Wellbeing Fund 1,313 (1,313) 0 : Wellbeing Fund 50 (50) 0 : Breast Feeding Network 26 (26) 0 : MH Recovery and Renewal 546 (546) 0 : Buvidal 23 (23) 0 : Brooksby 5 (5) 0 : Cossette Funding 4 (4) 0 : Expansion of Primary Care Estates 55 (55) 0 : GP Premises Improvements - tranches 1 and 2 63 (63) 0 : Mental Health Wellbeing in Primary Care 81 (81) 0 : Dental Practice Improvement 29 (29) 0 :Appropriate Adult Scheme 2 (2) 0 :Adult Tier 3 Weight Management Service 19 (19) 0 : Phlebotomy 22 (22) 0 : LD Health Checks 66 (66) 0 Total Earmarked 5,153 (4,581) 572 Unallocated General Fund 357 (357) 0 General Fund 5,510 (4,938) 572 Earmarked Funds
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PUBLIC INFORMATION Financial Recovery Action Plan Appendix E FINANCIAL RECOVERY PLAN £m £m £m Projected Overspend at Month 4 6.697 SERVICE AREA Cost reduction target Achieved in projected outturn Still to be achieved Target set? Health and Community Care Reduce care home placements in line with budget saving (0.700) (0.086) (0.614) June IJB Reduce CAH capacity/delay recruitment/in- house efficiencies (0.850) 0.000 (0.850) June IJB Community Wards - reduce supplementary staffing and review bed capacity (0.500) (0.247) (0.253) June IJB MH and LD (North Ayrshire) Freeze adult community support approvals outwith transitions 0.000 0.000 0.000 June IJB Respite provision - ensure use of in-house capacity is maximised 0.000 0.000 0.000 June IJB HBCCC mitigation plan (0.106) (0.106) 0.000 August IJB MH and LD (Lead Partnership) Ward staffing (adults/elderly inpatients) (0.300) 0.000 (0.300) August IJB Psychiatry (use of agency) (0.312) (0.312) 0.000 August IJB CEDS/CAMHS (0.202) (0.202) 0.000 August IJB North Ayrshire share (38.6%) (0.314) (0.198) (0.116) Children and Families Reduce children's external placements - early reduction from Brighter Pathways work (0.500) (0.500) 0.000 June IJB Additional target re-residential placements (0.500) (0.229) (0.271) August IJB Additional target re-residential placements (0.225) 0.000 (0.225) September IJB Reduce investment in C&F social work via service redesign fund (0.300) 0.000 (0.300) September IJB Cross Partnership Vacancy management and temporary posts (0.500) 0.000 (0.500) June IJB Use of remaining reserve balance (0.357) 0.000 (0.357) August IJB Review of earmarked reserves (0.216) 0.000 (0.216) September IJB Target Achieved Outstanding (5.068) (1.366) (3.702) Remaining projected overspend 2.995
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PUBLIC INFORMATION Appendix F - Care at Home Recovery Plan 1. Situation The overspend on Care at Home is reflective of an increase in the overall capacity and complexity of need within the service, alongside a rise in service costs, as we strive to meet the growing level of demand in our communities and to support hospital discharge(s). The Care at Home Service in North Ayrshire has seen a 50% increase in the number of annual care visits in the last 4 years. Below summarises the budget and spend position for Care at Home Services since 2019. The Care at Home budget has increased significantly since 2019-20 with an overall increase of £9.8m over that period, however most of this increase is directly related to pay inflation with the only additional funding for additional capacity being £3.4m to support with winter pressures. The Care at Home budget has been relatively static in real terms against a backdrop of a significant increase in demand. The Care at Home service has a budget of £30.061m for 24/25. This is inclusive of Care at Home services delivered via SDS Option 2 and 3. Currently this is projecting an overspend of £3.255m for 2024/25 financial year. As part of the overall Financial Recovery Plan for the IJB there is a requirement for a reduction in current spend in-year, with a move to working towards delivering services within budget thereafter. A £1m savings target was identified for the Care at Home service to deliver in 2024-25.
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PUBLIC INFORMATION 2. Background Self-Directed Support is the way that care and support is delivered in Scotland, providing people with options, choice and control. From 2019 to 2023, the landscape for Care at Home delivery in North Ayrshire has been very fragile with 5 Care at Home providers exiting the market for the provision of care in an unplanned basis. In July 2024 the delivery of Care at Home supports in North Ayrshire, via Self Directed Support Option 3, moved to a fully inhouse model. This change in the way care is delivered was reflective of a number of factors including quality and the safe delivery of care and support. Currently there are over 2,000 people in receipt of care and support via Care at Home, with 92% receiving services through the Partnership’s inhouse Care at Home service. The Partnership utilises eligibility criteria to deploy its available resources, with priority given to those adults with the greatest need. Care at Home supports are provided across the 4 mainland localities in North Ayrshire, and on the islands of Arran and Cumbrae. Since 2020, to date, there has been a 40% increase in the planned hours of care delivered by the inhouse Care at Home service, with a 50% increase in the individual number of care visits provided over this same period. Staffing levels for the Partnership’s inhouse Care at Home service have also increased over this same period by 50% from 653 contracted staff in 2020 to 981 in August 2024. Whilst the growth in the Partnership’s Care at Home service is evident, demand for Care at Home supports has risen by around 30% from pre pandemic levels. Whilst there is robust application of criteria to access services, and use of initiatives such as reablement designed to only provide shorter term supports and to reduce levels of dependency, social work and service delivery teams report significant changes in the complexity of need required in supporting people in the community. This is demonstrated by the Job Evaluation and regrading of the Partnership’s Care at Home Assistant role in 2023, which reflected the change in the role and the skills required to provide more complex and intensive community Care at Home supports. Unfortunately, Health and Community Care teams continue to manage a significant waiting list for community and hospital referrals which is a result of aforementioned increase in referral activity and complexity of need. Given the waiting list for supports, and levels of unmet need, a priority of need is applied to those who are waiting supports – this prioritises people with care needs associated with end-of-life care, public protection and hospital discharges. Levels of unmet need can fluctuate and are influenced by peaks in demand. Below illustrates the priority of need framework used by Care at Home services to prioritise demand, unmet need and waiting lists from the Community and Hospital:
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PUBLIC INFORMATION Positively, community unmet need has reduced since December 2023 when 193 people in the community were awaiting a new package of care, with 166 waiting as at August 2024. Levels of delayed discharge associated with Care at Home had shown signs of improvement earlier in 2024, however this improvement wasn’t sustained and as at reporting in August 2024, 24 people were a delayed discharge awaiting a package of care. Overall, 76% of unmet need for care at home is for people waiting in the community for care. The Partnership also provides a Community Alarm and Telecare service to over 4,000 people across Ayrshire. The alarm service generates around 450k activations on an annual basis with requests for support directed to identified contacts and, where appropriate, to the Partnership’s responder service who provide approximately 6,000 physical responses to North Ayrshire service users on a monthly basis. The Community Alarm and Telecare service is in the process of transitioning from analogue to digital technology. 3. Plan As part of the financial recovery plan, targeted savings for the remainder of the financial year 2004-25, have been identified from the Care at Home service. The vast majority of the service cost is workforce and any reduction in workforce will inevitably result in reduced service capacity. The required service changes include a reduction in the inhouse workforce (circa 1,062 weekly hours), reduction in Self Directed Support (Option 2) spend and actions related to the management of spend and approval of additional staffing costs linked to vacancies and sickness absence. It is proposed that workforce changes will be achieved by natural turnover and a targeted recruitment freeze, alongside careful future targeted recruitment activity to maintain safe care delivery.
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PUBLIC INFORMATION The planned reduction is estimated to deliver an in-year 2024-25 reduction of £0.850m against an original target of £1m, this is deemed to be the maximum reduction which can safely be delivered in-year. The reduction in Care at Home workforce will result in an overall reduction in Care at Home capacity within the service. Whilst efforts will be made to minimise the impact of this and to manage any resultant risks and challenges. A summary of these is provided below: Risks/Impacts • Reduction in capacity will reduce the volume of Care at Home supports which the Partnership can provide and may result in longer waiting times to receive care • A disproportionate impact on people awaiting services in the community as we continue to prioritise urgent referrals and hospital discharge • Reduction in capacity may result in increased delays in people being able to access Care at Home supports, both from the community and to support hospital discharge - approximate increase to the waiting list(s) combined of 56 people (3%) however this may vary dependent on hours/care requirements • Impact on other people and services – for example length of stay in hospital, access to community rehab beds, requirement for access to long term care settings • Increased reliance on informal supports and carers • The service may be less flexible/responsive to critical care requests • Seasonal/Winter responsiveness • Greater risk of workforce pressures • There will not be the same level of capacity to absorb and respond to any potential future unplanned care provider market issues Whilst the above outlines the potential impact of this change and reduction in care capacity, the below are a range of management mitigations either in place or proposed to reduce this and to manage risk. Mitigations • Continue to follow the existing priority of need framework which ensures those most in need of the service will be prioritised • Weekly unmet need oversight and assurance group, which includes arrangements for how service users are contacted whilst they wait • Recruitment to 6-month reablement lead to re-establish and promote reablement service provision • Reablement Service Access pilot expansion • Consider wider ‘access to service’ opportunities for demand management • Care Monitoring System review to maximise efficiency in existing service delivery • Programme of Care at Home reviews for existing users
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PUBLIC INFORMATION • Scaling up use of technology and Community Alarm/Telecare • Closely monitor absence and vacancy levels on a weekly basis • Continue to recruit to casual workforce to promote and develop contingency options • Refresh service wellbeing at work strategy to minimise staff absence levels through sickness • Protect and promote the Community Alarm and Telecare Service, particularly to those service users awaiting a service
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PUBLIC INFORMATION Bank and Agency Costs to Month 4 Appendix G 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) TOTAL AAC074 NORTH CORE SLT ADULT 5,412 5,412 AAC403 WARD 1 WOODLANDS VIEW 25,510 137,942 163,452 AAC406 WARD 2 WOODLANDS VIEW 15,759 93,103 108,861 AAC410 ACH REDBURN REHAB WARD NRS 1,587 39,712 41,299 AAC412 ACH DOUGLAS GRANT REHAB WD NRS 6,446 33,955 40,400 AAD401 WARD 3 WOODLANDS VIEW NURSING 17,386 117,487 447 135,320 AAD402 WARD 4 WOODLANDS VIEW NURSING 21,871 101,551 185 123,607 AAH047 NEW CLONBEITH NURSING(JURA) 51,193 34,734 85,927 AAH415 WVIEW THE GLEN ECT 1,611 1,611 AAH417 WVIEW WARD 10 ACUTE MH NRS 22,585 31,444 54,029 AAH423 WVIEW WARD 8 ACUTE MH NRS 10,300 303,301 251 313,852 AAH460 WARD 5 WOODLANDS VIEW 5,940 9,978 15,919 AAH466 WVIEW WARD 7B REHAB MH NRS 2,103 2,103 AAH492 NEW DUNURE NURSING(CLONBEITH) 17,669 56,237 73,905 AAT001 TRINDLEMOSS 26,773 46,783 73,556 AAW047 ARRAN HOSPITAL NURSING 11,398 16,007 5,717 33,122 ACN004 PACKAGE OF CARE (P) - CY 10,198 10,198 ACN012 PACKAGE OF CARE (P) - AMG 18,187 18,187 ACN013 PACKAGE OF CARE (P) - LMO 3,368 3,368 ACP003 NC POC TEAM 3 966 966 ACA412 CAMHS UNSCHEDULED CARE 1,703 1,703 ACF002 EARLY YRS-C/F TEAM 2 290 290 ACN047 ARRAN DN 235 235 ADN000 THREE TOWNS DN 4,284 161 4,446 ADN033 IRVINE DN 9,597 9,597 ADN042 NORTH WEST COAST DN 235 99 334 ADN075 GARNOCK VALLEY DN 38,464 38,464 ADN080 NORTH DN TEAM LEADERS 3,360 3,360 ALA047 LADY MARGARET NURSING 5,935 2,012 7,947 AMA408 PREVENTION + SERVICES SPT TEAM 1,481 1,481 AML102 MH UNPACS (PRIVATE) 0 0 AML146 LD HEALTH CHECKS 51,594 51,594 AML392 NORTH CLDT 157 157 AML402 LDS MANAGEMENT 2,129 2,129 AML500 MHS INPATIENT MGT 13,137 13,137 AMN412 CMHT NURSING-NORTH AYRSHIRE 6,609 6,609 AMN415 WVIEW WARD 7C FORENSIC REHAB N 1,950 45,193 47,143 AMN419 DAY ACTIVITIES TEAM 227 227 AMN425 INTENSIVE COMMUNITY NURSING TEAM 8,845 8,845 AMN431 ADULT MENTAL HEALTH LIASION TEAM 2,295 2,295 AMN433 PCMHT NORTH 1,663 1,663 AMN446 WVIEW WARD 6 LOW SECURE NRS 27,425 79,182 106,607 AMN454 WARRIX AVE 6,071 7,342 13,413 AMN468 ACTION 15 - ADULT LIAISON 2,951 2,951 ANU632 ICFN - COMMUNITY PHLEBOTOMY 5,860 5,860 AWV438 WVIEW WARD 7A LD A+T NRS 5,532 211,353 250 217,136 AXC407 WVIEW WARD 9 ACUTE MH NRS 16,258 54,635 70,894 AXC418 WVIEW WARD 11 ACUTE MH NRS 35,370 129,107 257 164,734 TOTAL 477,553 1,603,525 5,878 1,391 2,088,346 2) SOCIAL CARE Agency Cost Montrose House 252,121 Acm - Irvine 1,188 Mh Acm 15,895 Ld Acm 7,826 TOTAL 277,030 Bank Agency