Month 6 Financial Performance
North Ayrshire Council · 14 November 2024
Back to Integration Joint Board — 14 November 2024 and its agenda
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Integration Joint Board 14th November 2024 Subject : 2024-25 – Month 6 Financial Performance Purpose : To provide an overview of the IJB’s financial performance as at Month 6 (September). 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 £5.611m, reduced to £2.905m 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 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 MDT 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 MDT Multi-Disciplinary Team
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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 September 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. It should also be highlighted that the NHS Ayrshire and Arran finance department have not been able to provide updated financial projections for month 6 and the position for Health delivered services reflects the month 4 position. There is a risk therefore of movement in the projections from Health for month 7, noting that with restrictions on spend in place this may be a welcomed favourable movement. 1.2 The projected outturn is a year-end overspend of £5.611m (1.7%) for 2024-25, reduced to £2.905m 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 @ mth6 £5.611m £0.812m £4.799m Less Financial Recovery Plan Projections £2.706m £0.369m £2.337m Residual Risk £2.905m £0.443m £2.462m 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 The main movements in the overall projected position and recovery plan are summarised below: Improvement: • Payroll turnover – social care £1.336m • Care at home £0.562m • LD care packages £0.126m • Integrated Island Services £0.214m Deterioration: • Children’s residential places (inflationary increases) £0.486m
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• Care Home places (inc interim places) £0.513m (including £0.156m in relation to the increase in the National Care Home Contract rate for the Agenda for Change pay award). 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 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 overspend 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. There is a requirement for the 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within allocated budget, on that basis further information will be brought forward with further detail on Lead Partnership services. 1.7 The 2024/25 financial position is being adversely impacted by several factors outwith the control of the IJB. • Formal confirmation by The Scottish Government of the 2024/25 funding for the Mental Health Outcome bundle saw a 3.5% reduction from 2023/24 which equates to £0.350m and the service are currently working through the implications of this reduction. It is expected that this can be managed within the carry forward reserves from 2023/24 so there is no impact on 2024/25 but the service is exploring the implications of bringing spend within budget in 2025/26. • Children’s residential placement contract inflation – Scotland Excel negotiate rates for several national framework contracts and the rates agreed to date are significantly higher than the 5.94% increase assumed as part of the Scottish Living Wage increase. Rates which are agreed to date are included in the projection and those still to be agreed are assumed to have an increase based on the average of rates agreed to date. Overall, the estimated impact is an increase to the projection of £0.486m. Local Government Pay Award Shortfall – the additional cost of the 2024/25 local government pay award is estimated to be £0.900m. It is unknown at this stage of this will be fully funded and the potential cost is not included in the month 6 projected outturn.
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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 6 At month 6 against the full-year budget of £321.135m there is a projected year-end overspend of £5.611m (1.7%). 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 £4.799m in social care services and a projected overspend of £0.812m 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 F provides information on the costs of bank and agency staff as requested at the August IJB. 2.3 Health and Community Care Services Against the full-year budget of £89.939m there is a projected overspend of £6.143m (6.8%) (£0.094m adverse movement) and the main variances are: a) Care home placements - the budgeted number of permanent placements was 765 and at month 6 there were 793 placements. The projected overspend is £1.072m (£0.458m adverse) on permanent placements (including £0.156m in relation to increased NCHC rates to reflect the recently agreed nursing pay award), £0.208m (£0.208m adverse) on interim placements and respite placements are projected to be online (no change). The plan to manage down the number of permanent placements to reach the target 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 £0.703m over recovered (£0.153m favourable movement). 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.
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b) Care at home is projected to be £2.672m overspent (£0.582m favourable movement). The position reflects the cost of meeting the significant demand and level of provision for care at home support. The favourable movement is due to the impact of the care at home recovery plan including the holding of vacancies and improved sickness absence rates. Earlier in the financial year it was more difficult to accurately project the cost of the in-house service due to the phased move of services in-house, more recent months provide a settled financial baseline from which more accurate projections can be estimated, providing greater confidence in the projected outturn position. c) Physical Disability Services – projected overspend of £0.790m (£0.108m adverse) split as follows: £1.116m over in residential placements, £0.050m over in direct payments and £0.376m under in community care packages. d) Integrated Island Services is projected to overspend by £0.539m (£0.214m favourable movement). The most significant variance is a projected overspend at Montrose House of £0.422m (£0.136m favourable movement) which relates to the net overspend on agency staff (i.e. net of underspend on employee costs). A new contract to procure agency nursing staff commences in November which will reduce the hourly costs moving forward and this is reflected in the projection. e) Specialist Rehab wards – projected overspend of £0.126m (no movement) (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 (no movement) due to use of supplementary staffing. 2.4 Mental Health Services Against the full-year budget of £107.398m there is a projected overspend of £0.968m (0.9%) (favourable movement of £0.101m) prior to the re-allocation of the Lead Partnership variance to East and South HSCP. The main variances are: • Learning Disabilities are projected to overspend by £0.788m (£0.126m favourable movement) across community care packages, direct payments and residential placements. This improvement reflects the positive impact of assertive reviews of care packages. • Community Mental Health services are projected to underspend by £0.380m (£0.031m favourable) across community care packages, direct payments and residential placements. The main reason for underspend is the availability and capacity of adult community providers to deliver new packages of care.
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• There is a projected underspend of £0.106m (no movement) 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 (no movement) and the main variances are as follows: • Adult Inpatients – overspent by £0.442m 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 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 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. 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 due to the use of supplementary staffing. The elderly mental health wards continue to operate at full occupancy and at times with waiting lists, with several patients who are on enhanced observations and bank costs remain high.
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• MH Pharmacy – is projected to overspend by £0.585m due to increased demand and cost of medicines. Innovation Fund – projected underspend of £0.112m due to slippage within some of the projects and not all of the funding has been allocated. • 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 Against the full-year budget of £43.839m there is a projected overspend of £1.688m (3.85%) (£0.554m adverse movement) and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £2.051m (£0.682m adverse movement). The main areas within this are noted below: • Following budget investment of £4m the children’s residential placements are overspent by £1.898m (£0.359m adverse movement) based on 31 placements at month 6. This demonstrates a reduction of 6 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.
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• Contractual inflation has increased the projected costs of residential places by £0.339m which is outwith the control of the service. 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 and an update on this programme of work is included separately on the agenda. . • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.761m underspent (£0.033m adverse movement). • Children with disabilities – there is a net projected overspend of £0.582m (£0.326m adverse movement) across residential placements, direct payments and community packages. The adverse movement is largely linked to inflation (£0.147m) and increased package costs (£0.101m) where estimated costs were used in previous periods. • Residential respite – placements are overspent by £0.135m (£0.077m adverse movement). 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 £0.172m (adverse movement of £0.044m), largely due to staffing levels in the children’s houses. b) Head of Service – is projected to underspend by £0.675m (£0.151m favourable movement). This consists of 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 amount to £0.964m (£0.145m favourable movement) and which contributes to costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to overspend by £0.246m (no movement) 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 This is projected to be on-line.
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2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £2.787m (£1.494m favourable) and the main areas of underspend are: • There is projected slippage on the LD and MH transition funding of £0.786m (£0.186m favourable) 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 £1.836m (£1.336m favourable) for social care services and an over-recovery of payroll turnover of £0.296m (no movement) 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) Projected to be achieved by March 2025 5.137m 1.818m Over/(Under) Achievement 1.836m 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. 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. This has led to a significant increase in the level of turnover when projected to the year end. The Health element of vacancy savings will be updated in month 7. The turnover target for the North Lead Partnership for Mental Health services is detailed separately 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 Position at Month 6
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£m £m Red - 0.111 Amber 0.523 0.475 Green 9.767 - Blue - 9.704 TOTAL 10.290 10.290 b) The main area to note is that the red savings have increased since month 4 as the saving in relation to Montrose House looks unlikely to be achieved. 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 ICT Budget transfers (5) 2 Transfer to FM services re cleaning post at West Road (10) 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 6 the MH lead partnership is projected to overspend by £0.658m (£0.215m NRAC share for East and £0.188m for South). South HSCP – projected overspend of £0.581m of which £0.215m 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
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contract and equipment costs. There is also a projected overspend of £0.074m in the continence service and an underspend £0.006m in the Family Nurse Partnership East HSCP - projected underspend of £0.360m in total (of which £0.133m will be allocated to North). The main variances are: Allied Health Professions (Lead Partnership) There is a projected underspend of £0.302m (£0.431m at month 4) on AHP 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 underspend of £0.064m (£0.023m projected overspend at month 4) on the Primary Care Lead Partnership budget, with additional costs in Out of Hours services £0.321m (£0.371m at month 4), 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 £0.027m (£0.024m at month 4). These additional costs are offset by a projected underspend in Dental services totalling £0.344m (£0.219m at month 4), 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 6. In addition, there is a small saving on Primary Medical Services costs £0.058m (£0.152m at month 4). Prison and Police Healthcare (Lead Partnership) The £0.101m (£0.043m at month 4) projected underspend at month 6 is largely due reduced staffing costs. Other Services (Lead Partnership) The £0.106m (£0.243m at month 4) 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 further 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.
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The 2023/24 usage is now available as is Q1 of 2024/25 and these has been presented to Ayrshire Finance Leads for validation. The HSCPs require to agree their final share of the baseline with each other, however the aggregate will remain unchanged. 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 £435.0m. The directorate overspent by £16.8m after 6 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. 164 additional unfunded beds remained open across both main hospital sites during September. 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. 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
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future funding, including for 2024-25 pay awards, which have recently been settled for local government and NHS but the funding position is not yet clear. • 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 recurring underlying levels of overspend which 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 used 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. • 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. • Scot Excel inflationary increases for children’s service are significantly higher than assumed. These risks will continue to be monitored during 2024-25.
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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. There has been progress towards some of the targets, and these are already reflected in the current projected outturn of £5.611m 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
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Working Group before being brought back to the IJB for further approval as part of the financial recovery plan. 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. To date the Finance Working Group has met three times and covered care at home, care homes, charging income, financial inclusion, an overview of the budget and the Brighter Pathways project. The next meeting will review Complex Care, Addictions Prescribing and an update to the Medium-Term Financial Outlook. • 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
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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 @ mth6 £5.611m £0.812m £4.799m Less Financial Recovery Plan Projections £2.706m £0.369m £2.337m Residual Risk £2.905m £0.443m £2.462m 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. 3.3 Measuring Impact Ongoing updates to the financial position will be reported to the IJB throughout 2024- 25.
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4. IMPLICATIONS 4.1 Financial The outturn is an overall year-end overspend of £5.611m (1.7%). 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 £2.905m 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. 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team.
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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 30th September 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 71,123 76,174 5,051 18,816 19,908 1,092 89,939 96,082 6,143 6,049 94 : Locality Services 30,440 31,937 1,497 5,366 5,410 44 35,806 37,347 1,541 879 662 : Community Care Service Delivery 36,664 39,469 2,805 0 36,664 39,469 2,805 3,476 (671) : Rehabilitation and Reablement 2,063 2,390 327 0 2,063 2,390 327 17 310 : Long Term Conditions 917 934 17 9,459 10,373 914 10,376 11,307 931 924 7 : Community Link Workers 338 338 0 0 0 0 338 338 0 0 0 : Integrated Island Services 701 1,106 405 3,991 4,125 134 4,692 5,231 539 753 (214) MENTAL HEALTH SERVICES 34,206 34,624 418 73,192 73,742 550 107,398 108,366 968 1,069 (101) : Learning Disabilities 25,694 26,482 788 556 555 (1) 26,250 27,037 787 916 (129) : Community Mental Health 6,485 6,105 (380) 1,739 1,738 (1) 8,224 7,843 (381) (411) 30 : Addictions 2,027 2,037 10 1,899 1,899 0 3,926 3,936 10 12 (2) : HBCCC 0 0 0 353 247 (106) 353 247 (106) (106) 0 : Lead Partnership Mental Health NHS Area Wide 0 0 0 68,645 69,303 658 68,645 69,303 658 658 0 CHILDREN & JUSTICE SERVICES 38,924 40,366 1,442 4,915 5,161 246 43,839 45,527 1,688 1,134 554 : Irvine, Kilwinning and Three Towns 3,021 3,075 54 0 0 0 3,021 3,075 54 32 22 : Garnock Valley, North Coast and Arran 3,123 3,154 31 0 0 0 3,123 3,154 31 43 (12) :Intervention Services 1,700 1,704 4 0 0 0 1,700 1,704 4 (1) 5 : Care Experienced Children & Young people 27,131 29,182 2,051 0 0 0 27,131 29,182 2,051 1,369 682 : Head of Service - Children & Families 1,064 389 (675) 0 0 0 1,064 389 (675) (524) (151) : Justice Services 2,472 2,472 0 0 0 0 2,472 2,472 0 0 0 : C&F Health Team 413 390 (23) 4,203 4,449 246 4,616 4,839 223 215 8 : Lead Partnership NHS Children's Services 0 0 0 712 712 0 712 712 0 0 0 CHIEF SOCIAL WORK OFFICER 1,559 1,558 (1) 0 0 0 1,559 1,558 (1) 12 (13) PRIMARY CARE 0 0 0 53,109 53,109 0 53,109 53,109 0 0 0 ALLIED HEALTH PROFESSIONALS 0 10,306 10,306 0 10,306 10,306 0 0 0 MANAGEMENT AND SUPPORT COSTS 9,608 7,576 (2,032) 4,407 3,652 (755) 14,015 11,228 (2,787) (1,293) (1,494) FINANCIAL INCLUSION 970 891 (79) 0 0 0 970 891 (79) 2 (81) OUTTURN ON A MANAGED BASIS 156,390 161,189 4,799 164,745 165,878 1,133 321,135 327,067 5,932 6,973 (1,041) Over/ (Under) Spend Variance at Period 4 Movement in variance from Period 4 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) (215) 0 Return Hosted Over/Underspends South 0 0 0 0 (188) (188) 0 (188) (188) (188) 0 Receive Hosted Over/Underspends South 0 0 0 0 215 215 0 215 215 204 11 Receive Hosted Over/Underspends East 0 0 0 0 (133) (133) 0 (133) (133) (77) (56) OUTTURN ON AN IJB BASIS 156,390 161,189 4,799 164,745 165,557 812 321,135 326,746 5,611 6,697 (1,086) Over/ (Under) Spend Variance at Period 4 Movement in variance from Period 4 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 6 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 Blue 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 Red 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 6 2024/25 Saving Description of the Saving Hospital Based Complex Continuing Care (HBCCC) provision Green Blue 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 Blue 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 ICT Budget Transfers 6 P (0.002) ICT Budget Transfers 6 P (0.003) Post Realigned from the Policy, Performance & Elections Team 6 P 0.059 Transfer to FM Services re Cleaning Services at West Road 6 P (0.010) Roundings 1-3 0.010 Social Care Budget Reported at Month 6 156.390 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
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PUBLIC INFORMATION 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 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 6 164.745 TOTAL COMBINED BUDGET 321.135
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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 6 5.611 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) 0.000 (0.700) June IJB Reduce CAH capacity/delay recruitment/in- house efficiencies (0.850) (0.582) (0.268) 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) (0.500) 0.000 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) (2.362) (2.706) Remaining projected overspend 2.905
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PUBLIC INFORMATION Bank and Agency Costs to Month 6 Appendix F Bank and Agency Costs 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) TOTAL AAC074 NORTH CORE SLT ADULT 8,393 8,393 AAC403 WARD 1 WOODLANDS VIEW 34,920 225,803 260,722 AAC406 WARD 2 WOODLANDS VIEW 26,513 155,470 181,983 AAC410 ACH REDBURN REHAB WARD NRS 4,978 61,525 66,503 AAC412 ACH DOUGLAS GRANT REHAB WD NRS 8,280 36,613 44,893 AAD401 WARD 3 WOODLANDS VIEW NURSING 24,023 183,094 1,589 709 209,415 AAD402 WARD 4 WOODLANDS VIEW NURSING 27,339 154,288 185 181,812 AAH047 NEW CLONBEITH NURSING(JURA) 70,510 52,118 122,628 AAH415 WVIEW THE GLEN ECT 1,797 1,797 AAH417 WVIEW WARD 10 ACUTE MH NRS 30,213 42,330 72,543 AAH423 WVIEW WARD 8 ACUTE MH NRS 18,861 431,987 251 451,100 AAH460 WARD 5 WOODLANDS VIEW 13,856 17,339 31,195 AAH466 WVIEW WARD 7B REHAB MH NRS 2,103 2,103 AAH492 NEW DUNURE NURSING(CLONBEITH) 29,391 83,451 112,842 AAT001 TRINDLEMOSS 38,661 87,076 125,737 AAW047 ARRAN HOSPITAL NURSING 16,496 21,877 13,091 51,465 ACA405 CAMHS MANAGEMENT 1,943 1,943 ACN004 PACKAGE OF CARE (P) - CY 15,313 15,313 ACN012 PACKAGE OF CARE (P) - AMG 36,067 36,067 ACN013 PACKAGE OF CARE (P) - LMO 4,884 4,884 ACP002 NC POC TEAM 2 259 259 ACP003 NC POC TEAM 3 1,199 1,199 ACA412 CAMHS UNSCHEDULED CARE 3,287 3,287 ACF002 EARLY YRS-C/F TEAM 2 290 290 ACF051 IMMUNISATION NURSING 11,321 7,237 18,558 ACN000 ARRAN HV 316 316 ACN047 ARRAN DN 235 235 ADN000 THREE TOWNS DN 7,927 161 8,088 ADN033 IRVINE DN 13,138 13,138 ADN042 NORTH WEST COAST DN 4,037 99 4,136 ADN075 GARNOCK VALLEY DN 58,839 58,839 ADN080 NORTH DN TEAM LEADERS 4,286 4,286 ALA047 LADY MARGARET NURSING 9,159 4,116 13,275 AMA408 PREVENTION + SERVICES SPT TEAM 1,481 1,481 AML146 LD HEALTH CHECKS 73,240 73,240 AML392 NORTH CLDT 429 429 AML402 LDS MANAGEMENT 4,190 4,190 AML442 NORTH PARTNERSHIP ADMIN MH 13 13 AML500 MHS INPATIENT MGT 16,335 16,335 AMN412 CMHT NURSING-NORTH AYRSHIRE 8,054 8,054 AMN415 WVIEW WARD 7C FORENSIC REHAB N 5,340 72,642 77,982 AMN419 DAY ACTIVITIES TEAM 227 227 AMN425 INTENSIVE COMMUNITY NURSING TEAM 21,003 21,003 AMN431 ADULT MENTAL HEALTH LIASION TEAM 2,295 2,295 AMN433 PCMHT NORTH 1,663 1,663 AMN446 WVIEW WARD 6 LOW SECURE NRS 37,984 117,628 155,611 AMN454 WARRIX AVE 12,933 19,271 32,204 ANP074 NORTH CORE SLT PAEDS 1,483 1,483 AMN468 ACTION 15 - ADULT LIAISON 5,410 5,410 ANU632 ICFN - COMMUNITY PHLEBOTOMY 6,877 6,877 AWV438 WVIEW WARD 7A LD A+T NRS 11,497 382,852 1,588 5,379 401,316 AXC407 WVIEW WARD 9 ACUTE MH NRS 22,091 101,402 123,494 AXC418 WVIEW WARD 11 ACUTE MH NRS 46,675 155,589 257 202,521 TOTAL 723,286 2,498,562 16,442 6,782 3,245,072 2) SOCIAL CARE Month 6 Agency Cost Montrose House 498,029 Acm - Irvine 1,188 Mh Acm 54,708 Ld Acm 15,852 TOTAL 569,777 Bank Agency