9 2021-22 Budget Monitoring Report Mth12v1
North Ayrshire Council · 16 June 2022
Back to Integration Joint Board — 16 June 2022 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
Integration Joint Board 16 June 2022 Subject: 2021-22 – Year End Performance Purpose: To provide an overview of the IJB’s financial performance for the year ended 2021-22 and the implications for the IJB’s overall financial position including an update on the financial impact of the Covid-19 response. Recommendation: It is recommended that the IJB: (a) notes the overall integrated financial performance for the financial year 2021-22 and the overall year-end underspend of £21.148m, adjusted to £2.916m after earmarking; (b) notes the updated costs of the Covid response and the funding received; (c) notes that out-with the IJB overall position, the £1.486m debt repayment has been made to North Ayrshire Council as planned; (d) approve the budget changes outlined at section 2.11; and (e) approve the proposed earmarking of £18.232m of reserves as detailed in the report, leaving a balance of £2.916m in free general fund reserves 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 GAE Grant Aided Expenditure PAC Performance and Audit Committee 1. EXECUTIVE SUMMARY 1.1 This report provides an overview of the financial position for the partnership and outlines the unaudited year-end outturn position for 2021-22. The outturn is an overall year-end underspend of £21.148m, which when adjusted for new earmarked reserves of £18.232m is reduced to £2.916m.
Page 2
1.2 The last reported position to the IJB in March 2022 highlighted a projected underspend of £1.780m post earmarking assumptions. This favourable movement of £1.136m is mainly due to increased payroll turnover and the impact of the lead partnership recharges. The £10.247m of Covid-19 funding has been fully allocated to the appropriate service areas, reflecting the final true outturn position for each service outwith the Covid impacts. Projecting the IJB financial position continued to be challenging during 2021-22 as service levels fluctuated due to the ongoing impact of the pandemic. The additional costs associated with Covid were monitored alongside the risk that these costs may not be fully funded. These challenges will continue into 2022-23 but to a lesser extent. 1.3 The main areas of pressure continued to be within learning disability care packages, residential placements for children and Unplanned Activities (UnPACs) within the lead partnership for mental health. The delivery of an overall underspend has allowed the IJB to repay £1.486m of the debt to North Ayrshire Council as planned. 1.4 The final unaudited IJB outturn position is adjusted to reflect the impact of Lead Partnership services. In line with the current risk sharing agreement for lead partnership services, an NRAC share of the projected position has been assumed as this would be in line with the allocation in previous years. 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. 1.5 Financial balance has been achieved in 2021-22 and significant progress has been made to ensure the ongoing financial sustainability of the IJB. There is additional investment as part of the 2022-23 budget and there are earmarked funds being carried forward for use in 2022-23. 2. 2021-22 UNAUDITED BUDGET OUTTURN POSITION 2.1 The report provides an overview of the financial position for the partnership and outlines the unaudited year-end outturn position for 2021-22. The report includes the following: • Explanations of main areas of variance; • Update on progress with savings delivery; • Budget changes requiring IJB approval; • Impact of the outturn on IJB reserves position; • Lead partnerships and the impact of risk sharing; • Detail of the funding and costs of the Covid-19 response; and
Page 3
2.2 FINANCIAL OUTTURN Against the full-year budget of £294.400m there is a reported underspend of £2.916m. The Integration Scheme outlines that there is an expectation that the IJB take 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 an underspend of £1.889m in social care services and an underspend of £1.027m in health services. This position is after the earmarking of funds for use in future years. Appendix A provides the financial overview of the partnership position, this details the outturn on an HSCP managed basis, on an IJB delegated basis (following Lead Partnership recharge adjustments) and the final adjusted outturn position after accounting for new earmarked reserve balances. The sections that follow outline the significant variances in service expenditure compared to the approved budgets. 2.3 Health and Community Care Services Against the full-year budget of £81.840m there is an underspend, pre-earmarking, of £4.211m (5.1%) and the main variances are: a) Care home placements including respite placements (net position after service user contributions and charging order income) are underspent by £0.447m after applying £0.278m of Covid funding. The budgeted number of permanent placements is 790 and at month 12 there were 736 placements. The level of income recovered from charging orders was under recovered during 2021-22 by £0.236m. This is included in the overall projected underspend of £0.278m above. b) Care at home was online after applying £2.253m of funding for additional capacity for Covid and Winter Planning. Bank staff are being offered contracts and additional staff are being recruited for the in-house service. Additionally, the capacity for care at home will continue to grow to meet the increase in demand for the service; this is part of our longer-term ambition to shift the balance of care and will be funded through the recently announced Scottish Government funding for Care at Home capacity (see para 2.8 below). c) Direct Payments are online after applying £0.274m of the recently announced funding to enhance care at home capacity. d) Residential Placements are overspent by £0.279m. The overspend is due to placements transferring from adult to older people services, new packages and increases to existing packages. e) Adaptations are overspent by £0.202m. Spend was higher due to increasing demand combined with increased costs due to supply issues. The majority of the overspend relates to the purchase and installation of stairlifts.
Page 4
f) Carers Act funding underspent by £1.114m. Charges for respite were waived per the IJB 2021-22 budget paper recommendation and a contribution was made to the increased capacity for children’s respite at Roslin House. g) Day Care for Older People underspent by £0.363m as vacancies have been held whilst the service has been closed due to Covid and the unachieved saving of £0.050m is assumed to be Covid funded. h) Anam Cara is online after applying £0.181m of the Scottish Government funding for interim care. i) District Nursing is overspent by £0.124m due to an overspend on supplies. j) Rehabilitation wards are overspent by £0.067m (Redburn ward £0.224m overspent and Douglas Grant £0.157m underspent). The overspend at Redburn is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. k) Scottish Government Funding has underspent by £2.238m (Care at Home Capacity £1.192m and Interim care £1.046m) and this will be earmarked for use in 2022-23. 2.4 Mental Health Services Against the full-year budget of £88.742m there is an underspend of £7.251m (8.2%). The main variances are: a) Learning Disabilities are overspent by £0.214m. The main variances are: • Care Packages (including residential and direct payments) - overspends of £0.314m in community care packages, £0.243m in direct payments and £0.468m for residential placements. Community Learning Disability Care packages have been one of the most challenging areas to address overspends and to project spend. This is partly due to the impact of services still remobilising in the earlier part of the year and also the impact of the roll out of the CM2000 call monitoring system. The data from CM2000 will be reported back to the service to allow them to see where care has deviated from the planned level and focus reviews to those areas. • Purchased day care has underspent by £0.153m as day care services have not fully remobilised. • In house day care underspent by £0.473m as a result of reduced service provision due to Covid restrictions and the ongoing service redesign and staffing model changes. • Trindlemoss – non-employee costs were £0.289m underspent due to lower maintenance costs and utility costs than budgeted. This was partly due to the swimming pool being non-operational during this period. These budgets will be
Page 5
reviewed during 2022-23 to establish what the normal running costs would be when the facility is fully operational. b) Community Mental Health services underspent by £0.650m; included within this is an underspend of £0.591m in community packages (including direct payments) and an overspend of £0.072m for residential placements. c) Addiction services underspent by £0.577m but £0.543m of this relates to the Alcohol and Drugs Partnership (ADP) underspend which will be earmarked for use in 2022-23. d) The Lead Partnership for Mental Health was £6.238m underspent (pre- earmarking) and the main variances are as follows: • An overspend in Adult Inpatients of £0.111m mainly due to staff in redeployment following the closure of the Lochranza ward. There was also reduced bed sale income of £0.130m but this was covered by Covid-19 funding. • UNPACS overspend by £0.864m which includes a backdated charge for a patient in the state hospital. 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. This can necessitate an UNPlanned ACtivities (UNPACs) placement with a specialist provider which can be out-of-area. 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. • An underspend in MH Pharmacy of £0.086m due reduced pharmacy spend in the wards. • Learning Disability Services overspent by £0.562m. This is mainly due to high usage of supplementary staffing, cross-charging against this budget for a LD patient whose discharge has been delayed and redeployment staffing costs. Supplementary staffing costs relate to backfill for sickness, increased and sustained enhanced observations and vacancies. The enhanced observations are reviewed on a daily basis however, due to the individuals being acutely unwell at present, this level of enhanced observations has been maintained for a lengthy period of time. • Daldorch charging income under recovered by £0.156m. Previously income was received from other Health Boards for out of area Children/Young Persons attending Daldorch but the service has been redesigned and is no longer chargeable as it is not an education provider. This was approved as a pan Ayrshire pressure as part of the 2022-23 budget which means it will not be a recurring overspend in 2022-23. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership as this is a Pan-Ayrshire target. There was an over-recovery of the vacancy savings target of £1.875m in 2021-22, further information is included in the table below: Vacancy Savings Target (£0.400m) Turnover Achieved to March 2022 £2.275m Over/(Under) Achievement £1.875m
Page 6
The main areas contributing to this vacancy savings position are noted below: • Adult Community Health services £0.167m • Elderly Inpatients £0.257m • CAMHS £0.598m • Mental Health Admin £0.304m • Psychiatry £0.332m • Psychology £0.565m • Associate Nurse Director £0.052m 2.5 Children and Justice Services Children’s Services Against the full-year budget of £36.579m there is an overspend of £1.239m (3.4%). The main variances are: a) Care Experienced Children and Young People overspent by £1.476m. The main areas within this are noted below: • Children’s residential placements overspent by £2.202m prior to Covid funding and overspent by £1.261m after £0.941m of Covid funding. We started 21/22 with 17 placements (which included 1 in Secure) but this had increased to 20 by the end of the year. • Fostering placements underspent by £0.214m based on the budget for 131 places and 117 actual placements (of which 6 are Covid related and are funded through the Covid-19 mobilisation plan) since the start of the year. Recruitment of foster carers is an active priority for the team, both to limit the requirement for external foster placements and reduce pressures elsewhere on the service. This is promoted through regular targeted recruitment campaigns, community awareness raising and daily presence on various social media platforms. Our active recruitment strategy is gaining some interest and we are actively pursuing a number of enquiries as a result. • Fostering Xtra placements underspent by £0.156m after £0.086m of Covid funding. There was budget for 33 placements and there were 26 actual placements since the start of the year. • Private Fostering placements overspent by £0.131m based on the budget for 10 placements and 16 actual placements since the start of the year. • Kinship placements overspent by £0.099m based on the budget for 353 places and 355 actual placements since the start of the year. The number of placements was higher during the first six months of the year hence the level of overspend. • Adoption placements overspent by £0.099m based on the budget for 57 places and 68 actual placements since the start of the year. b) Children with disabilities – residential placements underspent by £0.059m based on 7 placements at the year end. c) Residential respite – placements overspent by £0.598m due to short-term placements continuing longer than previously projected. These short-term placements are used to prevent an admission to full residential care. d) Transport costs – underspent of £0.061m due to less mileage being incurred.
Page 7
Justice Services Against the full-year budget of £2.385m there was an underspend of £0.005m (0.002%) within the MAPPA service. This underspend is not included in the overall projection as it will need to be paid back to the Scottish Government as a ring-fenced grant. 2.6 ALLIED HEALTH PROFESSIONALS (AHP) AHP services are underspent by £0.082m due to underspends in non-employee costs. 2.7 MANAGEMENT AND SUPPORT Management and Support Services are underspent by £11.454m pre-earmarking. The main areas of underspend are: • Covid funding of £8.597m which will be earmarked and carried forward for use against 22/23 costs. • £0.353m relates to funding set aside for unscheduled care. £0.277m of this funding is uncommitted and £0.076m relates to the enhanced hospital social work team only incurring part year costs. • There is also an over-recovery of payroll turnover of £1.259m (£0.729m for health services and £0.530m for social care) as outlined in para 2.9 below. • Slippage of £0.717m in funding set aside for transition packages and the balance of funding from the living wage allocation. • Underspends on Scottish govt funding of £0.934m which will be earmarked and carried forward for use in 22/23. 2.8 ADDITIONAL SCOTTISH GOVERNMENT FUNDING The Scottish Government confirmed on 5 October 2021 a range of measures and new investment that is being put in place to help protect health and social care services over the winter period, and to provide longer term improvement in service capacity across health and social care systems. This funding is predicated on four key principles: • Maximising Capacity. • Ensuring Staff Wellbeing. • Ensuring System Flow and • Improving Outcomes. On 4th November, the Scottish Government announced additional funding to support this. It is expected that NHS Boards, Integration Authorities and Local Authorities will work collaboratively to ensure a whole system response. Specifically it covers the areas below but the Scottish Government have confirmed that there will be flexibility across the funding streams:
Page 8
NAHSCP Share 21/22 (£m) 21/22 underspend earmarked for use in 22/23 (£m) Interim care arrangements* 1.109 1.046 Enhanced care at home capacity 1.719 1.060 Increase hourly rate to £10.02 for adult social care staff employed by commissioned providers 0.866 - Enhancing Multi-Disciplinary Teams (MDTs) 0.644 0.644 TOTAL 4.338 2.750 *non-recurring beyond 2022/23. The underspend on these additional Scottish Government funds at the year-end has been earmarked and held in reserve for use in 2022/23. Detailed spending plans are currently being developed to utilise these non-recurring funds. 2.9 Turnover/Vacancy Savings The turnover targets and actual achievement for the financial year for Health and Social Care services out with the Lead Partnership is noted below: 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, however, the most significant areas are: • Locality Services £0.480m • Care experience young people £0.386m • Community Care service delivery £0.300m • Irvine, Kilwinning & 3 Towns £0.156m There have been no intentional plans during the pandemic to pause or delay recruitment and services have actively continued to recruit, in some areas this has proven difficult to fill posts. The turnover target for the North Lead Partnership for Mental Health services is detailed within the Lead Partnership information at section 2.4. Social Care Health Services Vacancy Savings Target (2.014m) (0.655m) Achieved to March 2022 2.544m 1.384m Over/(Under) Achievement 0.530m 0.729m
Page 9
2.10 Savings Progress a) The approved 2021-22 budget included £2.528m of savings. BRAG Status Position at Budget Approval £m Position at Month 12 £m Red - 0.552 Amber 0.204 0.050 Green 2.324 - Blue - 1.926 TOTAL 2.528 2.528 b) The main areas to note are: i) Red savings of £0.450m relating to reducing children’s residential placements, £0.066m adoption allowances and £0.036m external fostering placements, all of which overspent. ii) Whilst all savings remain on the plan to be delivered in 22-23 there are delays with some savings with delays in implementation due to Covid- 19, for example the savings in relation to day care for adults and older people. These savings of £0.138m are noted as blue as they were achieved through vacancies rather than service design funded by Covid funding. iii) The confidence with some savings reduced since the budget was set due to the ongoing impact of Covid-19, for example Care at Home related savings. These savings been superseded by the additional Scottish Government Funding. Appendix C provides the final BRAG status around the deliverability of each saving. The unachieved savings due to Covid-19 have been reflected in the final outturn position as the savings delays were compensated with additional Covid funding. The delays were included in the mobilisation plan return to the Scottish Government. 2.11 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 D highlights the movement in the overall budget position for the Partnership following the initial approved budget. Reductions Requiring Approval: : Training grade adjustment £0.014m : Dundonald GP admin to Primary Care £0.004m : North ABI to East HSCP £0.009m : NSAIS Overclaimed Funding £0.634m : Douglas Grant Admin to Acute £0.010m
Page 10
2.12 NHS – Further Developments/Pan Ayrshire Services Lead Partnerships: The IJB outturn 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; this position is currently the default pending further work to develop a framework to report the financial position and risk sharing across the 3 Partnerships in relation to hosted or lead service arrangements, which has been delayed by the requirement to focus efforts on the Covid response. The final 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 will require to be shared with North. At Month 12 the MH lead partnership was underspent by £6.238m pre- earmarking (£1.939m NRAC share for East and £1.751m for South). East HSCP – Underspend of £8.708m (£2.948m NRAC share for NA IJB). The main areas of variance are: Primary Care and Out of Hours Services (Lead Partnership) On a managed services basis, there is an underspend of £8.350m on the Primary Care Lead Partnership budget. This includes an underspend of £5.749m on the Primary Care Improvement Fund which has been earmarked for carry-forward on an actual spend basis at individual IJB level. The £1.690m underspend in Dental services includes savings due to reduced service provision with an anticipated increase in staffing costs going forward. This underspend includes additional funding allocations for Practice Improvements (£0.715m) and Winter Preparedness (£0.347m), both of which have been earmarked for carry-forward on an individual IJB basis. There are reduced costs of £0.395m in Ayrshire Urgent Care Services (AUCS) due to vacancies within the service, as well as a reduction in the number of sites used for part of the year, resulting in a reduction in GP costs. The level of GP activity will continue to be closely monitored going forward. Prison and Police Healthcare (Lead Partnership) The £0.351m underspend is largely due to net staffing savings. In addition, the medical contracts at both Prison and Police have reduced and is contributing to the underspend. The underspend includes RMP4 funding £0.105m which has been earmarked for carry-forward within the IJB Reserve. South HSCP – overspend of £0.061m (£0.022m NRAC share for NAHSCP). The overspend is mainly due to an overspend in the community store of £0.143m and continence service of £0.043m offset by vacancies in the Family Nurse Partnership of £0.113m.
Page 11
Set Aside: The budget for set aside resources for 2021/22 is in line with the amount for 2020/21 (£33.054m) inflated by the 2.8% baseline uplift. The 2020/21 value was based on 2019/20 activity as 2020/21 was not considered representative. At the time of setting the IJB budget it was noted that this may require to be updated following the further work being undertaken by the Ayrshire Finance Leads to establish the baseline resources for each Partnership and how this compares to the Fair Share of resources. It was anticipated that 2020-21 would be used as a shadow year for these arrangements, however, and 2021/22 activity was not representative either due to the ongoing pandemic. Notwithstanding this a method of capturing up to date local activity and pricing it for set aside calculations is now in place, subject to IJB review and refinement. Quarterly updates were issued throughout the year. The annual budget for Acute Services is £383.9m. The directorate is overspent by £3.4m, caused by increasing overspends on agency medical and nursing staff, as well as overtime and bank usage. These have been required due to the level of operational pressure being experienced, in common with many other areas in Scotland at present. There is a material underlying deficit caused by: • Unachieved efficiency savings • High expenditure on medical and nursing agency staff, high rates of absence and vacancy causing service pressure • High numbers of delayed discharges COVID-19 – FINANCE MOBILISATION PLAN IMPACT 2.13 Summary of position From the outset of the pandemic the HSCP acted very swiftly to respond and developed a mobilisation plan detailing the additional activities to support our response, alongside the estimated financial impact. Financial returns were submitted to the Scottish Government on a regular basis during 2020-21, on the premise that any additional costs aligned to mobilisation plans would be fully funded and this process continued during 2021-22. There was a risk that if the full cost of the Covid- 19 response was not funded that the IJB may require to recover any overspend in- year however, the final Scottish Government funding covered all 2021-22 costs and allowed for a further £8.579m of funding to be carried forward to 2022-23 for future Covid-19 costs. 2.14 Mobilisation Plan The initial 2021-22 mobilisation plan cost submission was submitted in February 2021 and estimated the costs to be £5.481m to March 2022. By quarter 4 these costs had increased to £10.247m. The local finance mobilisation plan submission is included as Appendix E. The main areas of cost together with the movement over the period are summarised below:
Page 12
Service Area Initial 2021-22 Return £m Quarter 1 Update £m Quarter 2 Update £m Quarter 3 Update £m Quarter 4 Update £m Payments to Providers 0.750 2.421 2.119 2.854 3.002 PPE 2.000 2.000 0.581 0.472 0.453 Additional Staff 1.459 1.901 3.704 3.309 4.448 Mental Health 1.172 1.172 0.000 0.000 0.000 Loss of Income 0.100 0.430 0.480 0.569 0.700 Unachieved Savings - 0.138 0.138 0.138 0.138 Children & Families - - 0.949 0.914 1.157 Other Areas - 0.217 0.396 0.594 0.349 TOTAL 5.481 8.279 8.367 8.850 10.247 The main reason for the increase in costs at quarter 4 was increased staff costs which reflects the higher level of absence due to the Omicron covid outbreak. 2.15 Covid-19 Funding Position At the outset of the pandemic there was an assurance that subject to any additional expenditure being fully aligned to local mobilisation plans, including the IJB responses, reasonable funding requirements will be supported. This was on the basis that a process would be developed for these to be accurately and immediately recorded and shared with the Scottish Government. The basis of this reporting was drawn up and agreed with COSLA and Health and Social Care Partnerships. The Scottish Government provided a funding allocation in February 2022 which brought the funding up to 100% of costs. On this basis the overall financial risk to the IJB for 21-22 was fully mitigated. 2.16 Provider Sustainability Payments and Care Home Occupancy Payments COSLA Leaders and Scottish Government have agreed an approach to supporting the social care sector to ensure that reasonable additional costs will be met. We have been making payments to commissioned social care providers in line with the agreed national principles for sustainability and remobilisation payments to social care providers during COVID 19. Care Home Occupancy Payments - we have engaged with older people’s care homes in relation to care home occupancy payments and make regular monthly payments to care home providers with emergency faster payments being made if required. The Scottish Government ceased these payments at the end of October 2021, although additional financial support can still be provided where a Care Home is in a Covid outbreak situation for more than 28 days. Sustainability payments - providers are responsible for submitting a claim for additional support to the Partnership for sustainability payments and this is assessed as to what support is required on a case-by-case basis based on the supporting evidence provided. Each case is assessed by the same group to ensure equity and consistency across providers.
Page 13
In general, all payment terms have been reduced and once any payment is agreed it is being paid quicker to assist the cash flow position of providers. The assessment of some claims has been difficult due to delays with additional information and supporting evidence being submitted to support claims, hence there are a number of claims that are in process. The sustainability payments are a significant cost in our mobilisation plan and the timely submission and assessment of claims is key to ensuring we can accurately estimate the financial cost and ensure the costs are reclaimed from the Scottish Government. Providers in North Ayrshire are not all strictly adhering to these timescales, and we have received some backdated claims; the commissioning team are working with providers to support them to submit claims. The tables below show the support provided to date and the outstanding claims as at the end of March. The current financial sustainability principles (excluding care home occupancy payments), guidance and criteria have now been extended until 30th June 2022. PROVIDER SUMMARY NCHC Care Homes Other Total Total Number of Providers 17 49 66 Number contacting NAC 17 30 47 Providers Supported to date 17 17 34 OUTSTANDING CLAIMS NCHC Care Homes Other Total Total Number of Claims 3 5 8 Value of Claims 49,635 175,485 225,120 SUPPORT PROVIDED NCHC Care Homes Other Services TOTAL £ £ £ Occupancy Payments* 1,143,507 0 1,143,507 Staffing 891,320 136,691 1,028,011 PPE, Infection Control 519,722 94,053 613,774 Other 163,090 54,016 217,105 TOTAL 2,717,639 284,760 3,002,397 Arrangements for support have been agreed alongside guidance which sets out the criteria that need to be met for financial support, the approach for payment for care that cannot be delivered, the categories of additional costs which may be met, the approach to evidencing additional costs and key principles for requesting and making payments. The key principles of this ongoing support include:
Page 14
• Understanding the reasons why care cannot be delivered, only Covid related impacts can be funded through sustainability payments; • The ‘planned care’ approach of continuing to pay for undelivered care has been removed and providers and HSCPs will be required to explore opportunities for creatively delivering services in a different way, temporarily re-deploy staff into other HSCP services (voluntarily), where this is not possible providers will be required to access national supports in the first place, including the potential to furlough staff; • Where payment for undelivered care is agreed as the only option this will be at a reduced level depending on the type of service, for example for care homes subject to the NCHC occupancy payments will be made at 80% of the rate for all vacancies, this is dependent on care homes continuing to admit new residents where it is clinically safe to do so; • The Social Care Staff Support Fund will remain in place to ensure all staff receive their full pay during a Covid related absence; and • Additional reasonable costs that are incurred as a result of Covid which cannot be covered from other funding sources will be reimbursed, including for example PPE, infection prevention control and additional staffing costs. 2.17 RESERVES The IJB reserves position is outlined in the table below. General Fund Reserves Earmarked Reserves Total Debt to NAC Free GF SG Funding HSCP £m £m £m £m £m Opening Balance - 1 April 2021 (3.807) 4.151 5.487 0.681 6.512 Prior Year Adjustment - - 1.245 - 1.245 Revised Opening Balance (3.807) 4.151 6.732 0.681 7.757 Movement in-year: Debt Repayment 1.486 1.486 2021-22 Outturn 3.097 (0.181) 2.916 Use of SG Funding (1.159) (1.159) SG Funding – Earmarking per Appendix B 17.447 17.447 Non-SG Funding – Earmarking per Appendix B 0.785 0.785 Balance at 31 March 2022 (2.321) 7.248 23.020 1.285 29.232 The ‘free’ general fund balance of £7.248m is held as a contingency balance, this equates to around 2.5% of the IJB budget for 2021-22 which falls within the good practice level of between 2% and 4%. The £1.486m will continue to be set aside in future years to support the repayment of the debt.
Page 15
3. PROPOSALS 3.1 Anticipated Outcomes The final outturn position for 2021-22 and the work services have undertaken to ensure financial balance during the pandemic are the building blocks for financial sustainability moving into 2022-23. The focus during the year was to ensure the final outturn position was at online for core service delivery whilst closely monitoring the additional Covid costs. This was achieved and the overall debt owed to the Council has reduced. 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 plans and any actions that can be taken to bring the change programme into line, including the impact of the Covid response financially and on the delivery of the transformation plan. 3.2 Measuring Impact The position reported is the unaudited year-end outturn position for 2021-22, further information will also be contained within the unaudited IJB annual accounts. Ongoing updates to the financial position including the reserves position will be reported to the IJB throughout 2022-23. 4. IMPLICATIONS Financial: The outturn is a year-end underspend of £2.916m after earmarking £18.232m of funds for future use and this is also after £1.486m of debt repayment budget back to the Council. The main areas of overspends and underspends are highlighted in the report. Human Resources: The report highlights vacancy or turnover savings achieved to date. 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, there is no intention to sustain this level of staffing capacity reduction on a recurring or planned basis. Legal: None Equality: None Children and Young People None Environmental & Sustainability: None Key Priorities: None Risk Implications: Within the projected outturn there are various over and underspends including the non-achievement of savings. There is a review of aged debt being undertaken and this could have an adverse impact on the final outturn position. Community Benefits: None
Page 16
Direction Required to Council, Health Board or Both Direction to: - 1. No Direction Required 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran √ 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team. 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. 6. CONCLUSION 6.1 It is recommended that the IJB: (a) notes the overall integrated financial performance for the financial year 2021-22 and the overall year-end underspend of £21.148m, adjusted to £2.916m after earmarking; (b) notes the updated costs of the Covid response and the funding received; (c) notes that out-with the IJB overall position, the £1.486m debt repayment has been made to North Ayrshire Council as planned; (d) approve the budget changes outlined at section 2.11; and (e) approve the proposed earmarking of £18.232m of reserves as detailed in the report, leaving a balance of £2.916m in free general fund reserves. For more information please contact: Paul Doak, Head of Finance and Transformation at pdoak@north-ayrshire.gov.uk or Eleanor Currie, Principal Manager – Finance at eleanorcurrie@north-ayrshire.gov.uk
Page 17
2021-22 Budget Monitoring Report–Objective Summary as at 31st March 2022 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 64,253 59,935 (4,318) 17,587 17,694 107 81,840 77,629 (4,211) (1,413) (2,798) : Locality Services 26,225 24,813 (1,412) 5,348 5,493 145 31,573 30,306 (1,267) 47 (1,314) : Community Care Service Delivery 31,677 29,848 (1,829) 0 0 0 31,677 29,848 (1,829) (555) (1,274) : Rehabilitation and Reablement 1,768 1,866 98 1,745 1,726 (19) 3,513 3,592 79 148 (69) : Long Term Conditions 2,561 1,458 (1,103) 8,269 8,502 233 10,830 9,960 (870) (834) (36) : Integrated Island Services 2,022 1,950 (72) 2,225 1,973 (252) 4,247 3,923 (324) (219) (105) MENTAL HEALTH SERVICES 27,054 26,147 (907) 61,688 55,344 (6,344) 88,742 81,491 (7,251) 31 (7,282) : Learning Disabilities 19,608 19,829 221 479 472 (7) 20,087 20,301 214 1,069 (855) : Community Mental Health 5,125 4,543 (582) 1,700 1,632 (68) 6,825 6,175 (650) (365) (285) : Addictions 2,321 1,775 (546) 1,416 1,385 (31) 3,737 3,160 (577) (23) (554) : Lead Partnership Mental Health NHS Area Wide 0 0 0 58,093 51,855 (6,238) 58,093 51,855 (6,238) (650) (5,588) CHILDREN & JUSTICE SERVICES 32,488 33,741 1,253 4,091 4,077 (14) 36,579 37,818 1,239 1,319 (80) : Irvine, Kilwinning and Three Towns 3,597 3,554 (43) 0 0 0 3,597 3,554 (43) (53) 10 : Garnock Valley, North Coast and Arran 1,991 1,954 (37) 0 0 0 1,991 1,954 (37) (49) 12 : Intervention Services 1,686 1,657 (29) 332 332 0 2,018 1,989 (29) (5) (24) : Care Experienced Children & Young people 21,370 22,846 1,476 0 0 0 21,370 22,846 1,476 1,570 (94) : Quality Improvement 1,170 1,145 (25) 0 0 0 1,170 1,145 (25) (148) 123 : Public Protection 0 0 0 0 0 0 0 0 0 0 0 : Justice Services 2,384 2,385 1 0 0 0 2,384 2,385 1 0 1 : Universal Early Years 290 200 (90) 3,311 3,275 (36) 3,601 3,475 (126) 4 (130) : Lead Partnership NHS Children's Services 0 0 0 448 470 22 448 470 22 0 22 PRIMARY CARE 0 0 0 50,073 50,047 (26) 50,073 50,047 (26) 0 (26) ALLIED HEALTH PROFESSIONALS 0 6,853 6,771 (82) 6,853 6,771 (82) (95) 13 COVID NHS 0 0 0 2,132 2,005 (127) 2,132 2,005 (127) 0 (127) MANAGEMENT AND SUPPORT COSTS 23,654 13,843 (9,811) 4,527 2,884 (1,643) 28,181 16,727 (11,454) (1,437) (10,017) OUTTURN ON A MANAGED BASIS 147,449 133,666 (13,783) 146,951 138,822 (8,129) 294,400 272,488 (21,912) (1,595) (20,317) Return Hosted Over/Underspends East 0 0 0 0 1,735 1,735 0 1,735 1,735 211 1,524 Return Hosted Over/Underspends South 0 0 0 0 1,569 1,569 0 1,569 1,569 200 1,369 Receive Hosted Over/Underspends South 0 0 0 0 22 22 0 22 22 8 14 Receive Hosted Over/Underspends East 0 0 0 0 (1,092) (1,092) 0 (1,092) (1,092) (604) (488) Allocation of PCIF from East 0 0 0 0 (1,856) (1,856) 0 (1,856) (1,856) 0 (1,856) Allocate the Action 15 underspend to East 0 0 0 0 204 204 0 204 204 0 204 Allocate the Action 15 underspend to South 0 0 0 0 182 182 0 182 182 0 182 OUTTURN ON AN IJB BASIS 147,449 133,666 (13,783) 146,951 139,586 (7,365) 294,400 273,252 (21,148) (1,780) (19,368) Less Earmarking (detailed separately on Appendix A (i) 11,894 11,894 6,338 6,338 18,232 18,232 FINAL OUTTURN POSITION 147,449 145,560 (1,889) 146,951 145,924 (1,027) 294,400 291,484 (2,916) (1,780) (1,136) Over/ (Under) Spend Variance at Period 10 Movement in projected variance from Period 10 Partnership Budget - Objective Summary 2021/22 Budget Council Health TOTAL
Page 18
EARMARKED FUNDS – CARRIED FORWARD FOR USE IN 2022-23 Appendix B Earmarked Funds - SG Funding £ 000's Earmarked Funds - Other £ 000's : Alcohol & Drug Partnership 554 : Neighbourhood Networks 145 : Action 15 511 : NAC Recovery and Renewal – Mental Health Element 71 : PCIF 1,856 : Joint Equipment 5 : Covid-19 Funding 8,597 : Nethermains Adaptations 40 : MHO Development Grant 41 : Supported Accommodation 50 : Care at Home Capacity 1,192 : Trauma Trainer 48 : Interim Care 1,046 : Perinatal MH Nurse 65 : Trauma Training 50 : Medical photography 4 : Family Wellbeing Fund 106 : Data Sims 28 : Unaccompanied Asylum-Seeking Children 11 : School Nursing 56 : MDTs 644 : Buvidal 109 : Health Care Support Workers 144 : Perinatal and Infant Mental Health 86 : MH Recovery and Renewal 2,057 : Replacement Mattress Programme 78 : AHP Winter Funding 51 Total Earmarked Funds - SG Funding 785 : Cossette Funding 18 : Expansion of Primary Care Estates 55 TOTAL EARMARKING 18,232 : GP Premises Improvements - tranches 1 and 2 81 : Mental Health Wellbeing in Primary Care 40 : Dental Practice Improvement 265 : Dental Winter Preparedness 128 Total Earmarked Funds - SG Funding 17,447
Page 19
2021-22 Savings Tracker Appendix C Savings ref number Description Deliverability Status at budget setting Approved Saving 2021/22 £m Deliverability Status Month 12 Saving Delivered @ Month 12 £m Delivered during Year £m Shortfall £m 1 Children and Young People - External Residential Placements Green 0.450 Red - - 0.450 2 Adoption Allowances Green 0.066 Red - - 0.066 3 Fostering - Reduce external placements Green 0.036 Red - - 0.036 4 Community Support - Children's Care Packages Green 0.008 Blue 0.008 - - 5 Integration of LD/ MH Teams Green 0.050 Blue 0.050 - - 6 Learning Disability Day Services Green 0.088 Blue 0.088 - - 7 Mental Health - Flexible Intervention Service Green 0.008 Blue 0.008 - - 8 Care Homes Green 0.500 Blue 0.500 - - 9 TEC Solutions Green 0.150 Blue 0.150 - - 10 Care at Home - Reablement Investment Green 0.300 Blue 0.300 - - 11 Care at Home - Review Green 0.135 Blue 0.135 - - 12 Day Centres - Older People Green 0.050 Blue 0.050 - - 13 Charging Policy - Montrose House Green 0.050 Blue 0.050 - - 14 Payroll Turnover Inflation Green 0.057 Blue 0.057 - - 15 Business Support Review Green 0.150 Amber 0.100 - 0.050 16 Suppprted Accomodation Amber 0.204 Blue 0.204 - - 17 Transport Green 0.050 Blue 0.050 - - 18 Charging Policy - Inflationary Increase Green 0.050 Blue 0.050 - - TOTAL SOCIAL CARE SAVINGS 2.402 1.800 0.000 0.602 Whole System Children, Families & Criminal Justice Mental Health and LD Services Health and Community Care
Page 20
Savings ref number Description Deliverability Status at budget setting Approved Saving 2021/22 £m Deliverability Status Month 12 Saving Delivered @ Month 12 £m Delivered during Year £m Shortfall £m 19 Payroll Turnover Inflation Green 0.010 Blue 0.010 0 0 20 Elderly Mental Health inpatients (lead partnership) Green 0.116 Blue 0.116 0 0 TOTAL HEALTH SAVINGS 0.126 0.126 0.000 0.000 TOTAL NORTH HSCP SAVINGS 2.528 1.926 0.000 0.602
Page 21
2021-22 Budget Reconciliation Appendix D COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 100.065 Base budget adjustments 1 (0.053) Resource Transfer 1 P 21.086 BSL Budget Correction 2 P (0.005) 941 x CAH O365 Licences (6 months) 2 P (0.017) Summer Play Funding 4 T 0.042 Education Contribution - Roslin House 5 T 0.311 MH INVESTMENT - EM FUNDS 5 T 0.445 Computer Lines Budget Transfer WAN 6 P (0.002) £500 Payment reimburse other departments 6 T (0.054) Commercial Waste - Corporate Adjustment 7 T 0.020 Occupational Health Recharges 7 P (0.121) Commercial Waste - Corporate Adjustment 8 T 0.007 Wages Uplift Funding - £10.02 9 T 0.866 Fin Circ 9/2021 Living Wage £9.50 9 T 0.861 Fin Circ 9/2021 MH Recovery and Renewal 9 T 0.068 Fin Circ 9/2021 Care at Home Winter Plan 9 T 1.719 Fin Circ 9/2021 Interim Care 9 T 1.109 National Trauma Training 9 T 0.050 Scottish Disability Assistance 9 T 0.028 Telephones - Corporate 9 P (0.053) Recovery & Renewal Funding - Eglinton Gardens transfer to Community Gardens 9 T (0.040) Internal Commerical Waste - Corporate 10 P 0.010 Recovery Development Worker DDTF 12 T 0.026 Whole Family Wellbeing 12 T 0.106 Telecare Fire Safety 12 T 0.028 Computer Equipment - Education funding bulk Laptop spend in Childrens service 12 T 0.027 21/22 Insurance Allocation 12 T 0.061 HSCP Funding 12 T 1.486 National Transfer Scheme - UASC 12 T 0.011 £500 pyt Income adj to Corporate 12 T 0.054 Resource Transfer Increase 12 P 19.304 Roundings 12 T 0.004 147.449 HEALTH Period Permanent or Temporary £'m Initial Approved Budget 154.659 Resource Transfer (21.086) Month 10-12 Adjustments 18.437 Adjust for Non recurring funding (20.435) Full Year effect of Part Year Reductions (0.057) RX Return to reserves 1.027 Additional 1.3% Uplift 1.324 RX Cres (0.828) REVISED 21-21 BUDGET 133.041 Budget Reported at Month 12
Page 22
HEALTH Period Permanent or Temporary £'m Anticipate Trauma Funding 3 P 0.375 Anticipate Vet 1st Point - North Hscp 3 T 0.105 Anticipate Nsais Funding 3 P 0.634 Podiatry Re-align 3 P 0.678 RX Uplift 21.22 3 P 0.756 RX Uplift 21.22 NR 3 P 0.396 DOAC REVERSAL DRUG-NORTH 3 P 0.100 Funding transfer to Acute (Medical Records) 3 P (0.034) Specialist Pharmacist in Substance Misuse 3 P 0.012 Public Health Outcomes Bundle 3 P 0.242 Training Grade Funding 3 P (0.044) District Nursing Funding 3 P 0.119 Respiratory Rapid Response 3 P (0.078) Hd56 Action 15 Tranche 1 3 P 1.180 Hd69 Mat & Neo Psychol Interv 3 P 0.123 Hd70 Perinatal & Infant Mh 3 P 0.303 Hd7 Mh Recovery And Renewal 3 T 2.393 Hd8 Mh Support For Hosp Covid 3 T 0.103 North Hscp Covid Rmp3 M1-3 3 T 0.158 North Hscp Covid M1-3 3 T 0.034 Diabetes Prevention 4 T 0.040 Iona/Lewis Patient 4 T (0.046) North TEC contribution 4 T (0.053) ANP Allocation - MIN 4 T 0.020 Long Covid Funding 4 T 0.400 Covid-19 Service Funding North 4 T 0.283 Veterans 1st Point 4 T 0.028 Training Grade Funding 5 P 0.029 PCRS CRES 5 P (0.044) ADP Funding -Recurring 5 P 0.366 ADP Funding -Non-Recurring 5 T 0.744 Covid-19 Service Funding North 5 T 0.147 Training Grade Funding 6 P 0.001 Hd301-camhs Improve-ipcu 6 P 0.122 Hd302-camhs Improve-ihtt 6 P 0.148 Hd303-camhs Improve-ld, F & S 6 P 0.052 Hd304-camhs Improve-ooh U/care 6 P 0.086 Hd305-camhs Improve-liaison 6 P 0.129 Hd306-camhs Improve-neuro 6 P 0.226 Non Fatal O'dose Fr East 6 T 0.053 Hd264-emerg Covid-eat Disorders 6 T 0.328 Community Store Funding To Sth 6 P (0.017) Covid-19 Service Funding North 6 T 0.082 Training Grade Funding 7 P (0.021) GMS Premises to East 7 P (0.140) Community Store Funding To Sth-corr 7 P (0.001) Covid-19 Service Funding North 7 T 0.108 Winter Funding Excl Covid-19 7 T 0.112 Pay Award - Band 8A+ 7 P 0.080
Page 23
HEALTH Period Permanent or Temporary £'m MSK Physio and physio materials tfr to East 8 P (0.008) Covid-19 Service Funding North 8 T 0.136 Hd466 Psycholigical Therapies Funding 8 T 0.286 Hd369 Buvidal Funding 8 T 0.295 Covid-19 Service Funding North 8 T 0.016 Trauma 20/21 Underspent To Capital 8 T (0.307) Training Grade adjuastment 8 P 0.037 Training Grade adjuastment 9 P 0.032 Covid-19 Service Funding North 9 T 0.167 Training Grade adjuastment 10 P (0.013) Early Years Health Promotion supplies funding from East 10 T 0.003 GMS LDS Transfer to East 10 T (0.007) Dist Nrs Bladder Scanners To Capital 10 T (0.023) Hd305 Camhs Tfr To Cap For Ward 1b 10 T (0.082) Hd595 Trauma Funding Uplift 10 P 0.023 Covid-19 Service Funding North 10 T 0.187 Min - North Infant Feeding 11 T 0.001 Hd Ref 484 Dementia Pds 11 T 0.095 Training Grade Adj - February 11 P (0.014) Hd Ref 663 Band 2-4 Staffing 11 P 0.175 CAHMS Admin from South HSCP 11 P 0.011 Hd305 Camhs Tfr To Cap For Ward 1b 11 T 0.082 Hd537 Med & Dent Pay Uplift - North 11 P 0.130 Hd778 Action 15 Tranche 2 11 P 1.430 Covid-19 Service Funding North 11 T 0.166 Covid-19 Service Funding North 11 T 0.271 Further Covid Funding - Social Care 11 T 14.237 Covid-19 Service Funding North 11 T 2.511 Hd Ref 275 Workforce Wellbeing Primary & Social Care 12 T 0.054 Hd Ref 375 Workforce Wellbeing Primary & Social Care 12 T 0.054 Dundonald GP Admin to Primary Care 12 P (0.004) Hd Ref 634 Acceleration Of Mdt Recruitment 12 T 0.089 Hd Ref 662 Multi-disciplinary Teams 12 T 0.555 Hd Ref 818 (mat)drug Death Taskforce 12 T 0.163 North Abi to East HSCP 12 T (0.009) Medical Discretionary Points 12 P 0.045 NSAIS Funding overclaimed 12 T (0.634) Douglas Grant Admin to Acute 12 P (0.010) Camhs Accommodation 12 T 0.300 Lead Rx Offset Sch 5 Overspend 12 T 0.563 Hd954 Camhs Accomodation 12 T 1.106 Apprenticeship Levy 12 T 0.294 Resource Transfer Increase 12 P (19.304) Roundings 12 T (0.006) 146.951 TOTAL BUDGET AT MONTH 12 294.400 Budget Reported at Month 12
Page 24
Appendix E Mobilisation Submission – Quarter 4 £000s April May June July August September October November December January February March 2021-22 Revenue Total Additional PPE 167 167 167 0 0 0 (13) (3) (3) (10) (10) (10) 451 Additional Capacity in Community 81 81 139 182 149 149 144 141 140 311 311 310 2,138 Additional Equipment and Maintenance 0 0 0 0 0 19 1 17 4 6 6 7 60 Additional Staff Costs 40 42 155 171 131 145 168 168 167 340 340 341 2,208 Additional FHS Contractor Costs 6 9 8 7 7 11 0 8 12 11 11 12 102 Social Care Provider Sustainability Payments 422 422 422 163 143 157 165 192 192 241 241 242 3,002 Children and Family Services 18 18 18 18 18 18 445 72 72 153 153 153 1,157 Loss of Income 50 50 50 33 33 33 91 48 47 87 88 89 700 Other 0 0 0 25 7 50 (37) 6 6 6 6 6 75 Total Covid-19 Costs 788 790 962 598 479 582 965 649 637 1,145 1,146 1,150 9,893 Unachievable Savings 23 23 23 23 23 23 0 0 0 0 0 0 138 Total Covid-19 Costs - HSCP - NHS 811 813 985 621 502 605 965 649 637 1,145 1,146 1,150 10,031 £000s April May June July August September October November December January February March 2021-22 Revenue Total Reducing Delayed Discharge 0 0 0 19 19 19 19 19 19 34 34 35 216 Total Remobilisation Costs 0 0 0 19 19 19 19 19 19 34 34 35 216 Total HSCP Costs 811 813 985 640 521 624 984 668 656 1,179 1,180 1,185 10,247 Total Covid-19 Costs Total Remobilisation Costs