ITEM 12 Financial Monitoring
North Lanarkshire Council · 25 September 2024
Back to Health and Social Care Integration Joint Board — 25 September 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 REPORT Item No: 12 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB) for: For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire University Health and Social Care Partnership (UHSCNL) for the period 1 April 2024 to 30 June 2024. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer ☒ Reviewed By: Chief Officer ☒ Endorsed By: ☐ 3. RECOMMENDATIONS 3.1 It is recommended that the IJB: (1) Acknowledge the contents of the report; and (2) Acknowledge the projected outturn for 2024/25 is an underspend of £1.429m. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from NHS Lanarkshire Director of Finance and North Lanarkshire Council Head of Financial Solutions. The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 As detailed in the following table, the IJB projected outturn position, is an underspend of £1.429m, assuming the current trajectory of spend continues until the end of this financial year. Currently there is no ring-fenced funding included in this reported position. SUBJECT: Financial Monitoring Report 2024/25 TO: Integration Joint Board Committee Lead Officer for Report: Ross McGuffie Chief Officer NL HSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 25 September 2024 Yes No N/A
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2 6.2 Appendices 1 to 3 show a detailed budget position for each care group including South led hosted services. 6.3 In line with Scottish Government guidance, unspent ring-fenced funding must be transferred to relevant reserves at the end of each financial year for use in later years. Subject to IJB approval, in-year underspends will be allocated to manage, on a non-recurring basis, ring-fenced commitments, Strategic Commissioning Plan commitments and any funding gap which has been highlighted in the North Lanarkshire IJB financial plans. 7. 2023/24 FINANCIAL PERFORMANCE 7.1 The current financial forecast for 2024/25 projects a yearly underspend of £1.429m relating to various under and overspends across the whole integrated budget. A summary of the main variances including financial challenges and key pressures are highlighted below: 7.1.1 Employee Costs – projected underspend of £14.547m As reported throughout 2023/24, there are continuing challenges in terms of recruitment and retention across all service areas. For a wide range of posts recruitment has been unsuccessful due to the availability of the skills mix required or the competition being offered by other private and public sectors. As highlighted in the financial plan, included in this underspend is £6.961m relating to a non-recurring reduction in pension contributions. This will be used to offset overspends in other areas of Adult Social Care during 2024/25 to allow time for savings plans to be realised. 7.1.2 Payments to Other Bodies (PTOB) – projected overspend of £4.824m There are two main areas of overspend within PTOB which are independent care homes and self-directed support (SDS) costs. Independent care homes have a yearly budget to fund 1,361 care plans but at present the number of care plans is 1,477 resulting in a overspend of £1.749m. SDS is similarly overspend due to a budget to fund 2,617 care plans against 2,711 care plans for 2024/25. This is an area which is currently under review and is included in the 2 year savings delivery plan. Further details are at Appendix 6. 7.1.3 Prescribing – projected overspend of £5.108m The current overspend is attributable to the continued increase in costs associated with the number of medicines being prescribed. This projection is based on actual £m £m £m £m £m Health Care Services 523.988 5.435 529.423 528.053 1.369 Social Care Services 263.395 0.000 263.395 263.336 0.059 TOTAL 787.383 5.435 792.818 791.389 1.429 Annual Budget 2024/25Care Group Projected Year End Variance 2024/25 Projected Year End Spend 2024/25 In Year Drawdown From Reserves Revised Budget 2024/25
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3 prescribing data available to April 2024. The forecast will be updated as further data becomes available. 7.1.4 North Lanarkshire Hosted Services – projected overspend of £2.924m The main variances within North Lanarkshire hosted services relate to: Continence Services – overspend of £0.664m which is related to increases in product and delivery costs. Children Services – overspend of £1.597m which is mainly due to additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. Prisoner Healthcare – overspend of £0.663m due to the increase in costs linked to the delivery of the new pharmacy contract and drug prices associated with prescribing. 7.2 Throughout the year, adjustments are made to the original budget due to additional budget allocations and budget transfers. Appendix 4 provides a reconciliation of the main budget adjustments applied this financial year and the table below shows the current funding allocation received from Scottish Government: Scottish Government Allocations 2024/25 £m Alcohol and Drug Partnership Funding 2.146 Digital Mental Health Licences 0.120 Distress Brief Intervention 2.780 Enhanced Mental Health Outcomes Framework* 6.286 Family Nurse Partnership 1.074 Long Covid Support Fund 0.224 Meningitis C Funding 0.106 Specialty and Specialist Doctors Contract 0.194 TOTAL 12.930 *Further discussion is underway with Scottish Government regarding this funding stream as the allocation received in July does not cover all the partnerships current Mental Health commitments. 8. SAVINGS 8.1 The saving delivery plan commenced in April 2024 with a target of £29.093m over financial years 2024/25 and 2025/26. 8.2 CORE management team and various sustainability and value groups have been meeting on a regular basis to discuss and monitor the management actions reported in the financial plans to progress savings and redesign of services to help support future years budget planning. This includes the following areas of work: Review of financial planning assumptions for 2024/25. Review of all current vacancies including length of time left vacant. Review of discretionary spend and supplementary staffing. Updates on saving planning in significant areas of budget pressures.
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4 Various service reviews across the partnership. Collaboration with South UHSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. 8.3 The current IJB savings position at the end of June 2024, show total savings achieved of £6.331m and is summarised in the table below: 8.4 Appendix 6 shows a detailed list, including target value, of all IJB approved saving plans. 9. GENERAL RESERVES 9.1 It is important for the long-term financial stability and the sustainability of the IJB that sufficient funds are held in reserve to manage unanticipated pressures from year to year. The requirement for financial reserves is acknowledged in statue and is part of a range of measures in place to ensure that s106 public bodies do not over-commit themselves financially. 9.2 The current IJB reserves position for 2024/25 after adjustments for the drawdown of in-year reserves, is a revised balance of £70.089m and is summarised in the table below: 9.3 Appendix 5 shows a detailed list of all reserve movement during this financial year. 29.093 6.331 4.910 1.421 Delivery Plan Target Total Savings Achieved Health Achieved to Date Social Care Achieved to Date 0.000 5.000 10.000 15.000 20.000 25.000 30.000 £m North Lanarkshire IJB 2 Year Savings Delivery Plan (£m) Opening Balance As At 1 April 2023 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 June 2024 £m £m £m £m NHSL Ring-Fenced Reserves 23.773 0.000 (4.474) 19.298 NLC/NHSL Earmarked Reserves 20.975 0.000 (0.619) 20.356 NLC/NHSL Risk-Based Reserves 17.045 0.000 0.000 17.045 NHSL Contingency Reserves 13.390 0.000 0.000 13.390 NLC/NHSL Closed Reserves 0.341 0.000 (0.341) (0.000) 75.524 0.000 (5.435) 70.089Total LEAD SUMMARY
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5 9.4 Regular updates will be provided to the IJB throughout the year as analysis and reviews of all reserves are monitored to ensure they continue to meet on-going pressures and remain fit for purpose. 10. VACANCY POSITION 2024/25 10.1 The table below shows the full time equivalent (FTE) vacancy numbers at 30 June 2024 within each service compared against their budgeted establishment: * Over establishment is in relation to Mental Health commitments highlighted in para 7.2 above. 10.2 To help cover the vacant posts throughout the year, agency staff, bankaide, overtime and excess part time hours is used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 7. 11. DIGITAL FINANCE POSITION 2024/25 11.1 Below is a summary of the current North Lanarkshire IJB digital programmes of work and the agreed funding associated with each: Establishment Actual Vacancies FTE FTE FTE North West Locality 394.82 368.21 26.61 North East Locality 332.09 314.56 17.53 Adult Services 294.58 287.60 6.98 Children Services* 492.38 548.16 -55.78 Mental Health* 1,165.83 1,172.48 -6.65 Social Care Services 986.90 820.85 166.05 Home Support 1,000.17 861.23 138.94 Other 228.76 228.76 0.00 TOTAL 4,895.53 4,601.85 293.68 Position as at 30 June 2024 Service Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.027 0.009 0.143 0.008 0.186 North East Locality 0.022 0.007 0.112 -0.002 0.139 Adult Services 0.015 0.016 0.067 0.002 0.100 Children Services 0.042 0.013 0.155 0.000 0.210 Mental Health 0.083 0.023 0.937 1.193 2.236 Social Care Services 0.194 - - 0.000 0.194 Home Support 1.023 - - - 1.023 Other 0.004 0.004 0.015 - 0.023 TOTAL 1.409 0.071 1.428 1.201 4.110 SERVICE Costs As At 30 June 2024
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6 11.2 Currently two of the three programmes are progressing within their allocated funding however, Community Alarms envisage a gap in recurring funding from 2026/27 onwards. To ensure future financial transparency, the Medium Term Financial Plan will be updated to reflect this additional pressure. 12. IMPLICATIONS 12.1 NATIONAL OUTCOMES Social Work Case Management System (MOSAIC) COST £m FUNDING £m Year 1 (23/24) 0.213 Year 2 (24/25) 0.174 Year 3 (25/26) 0.114 Year 4 (26/27) 0.114 Year 5 (27/28) 0.114 Year 6 (28/29) 0.114 Year 7 (29/30) 0.114 TOTAL COST OF PROGRAMME 0.957 Capital Budget (0.157) Non-Recurring Funding (0.100) Earmarked Reserve (0.700) TOTAL FUNDING AVAILABLE (0.957) Home Support Scheduling System (ACCESS) COST £m FUNDING £m Year 1 (23/24) 0.521 Year 2 (24/25) 0.610 Year 3 (25/26) 0.547 Year 4 (26/27) 0.312 Year 5 (27/28) 0.326 Year 6 (28/29) 0.340 TOTAL COST OF PROGRAMME 2.656 Recurring Revenue Budget (0.224) Earmarked Reserve (2.432) TOTAL FUNDING AVAILABLE (2.656) Community Alarms Analogue to Digital COST £m FUNDING £m Year 1 (24/25) 0.399 Year 2 (25/26) 0.229 Year 3 (26/27) 0.279 TOTAL COST OF PROGRAMME 0.907 Capital Budget (0.087) Recurring Revenue Budget (0.135) Earmarked Reserve (0.465) TOTAL FUNDING AVAILABLE (0.687) Recurring Funding Gap From Year 3 (26/27) 0.220
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7 People are able to look after and improve their own health and wellbeing and live in good health for longer ☐ People, including those with disabilities or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community ☐ People who use Health and Social Care Services have positive experiences of those services, and have dignity respected ☐ Health and Social Care Services are centred on helping to maintain or improve the quality of life of people who use those services ☐ Health and Social Care Services contribute to reducing health inequalities ☐ People who use Health and Social Care Services are safe from harm ☐ People who work in Health and Social Care Services feel engaged with the work they do and are supported to continuously improve the information, support, care, and treatment they provide ☐ Resources are used effectively and efficiently in the provision of Health and Social Care Services ☒ 12.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 12.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 12.4 RISK ASSESSMENT/RISK MANAGEMENT The strategic financial risks detailed in the IJB Risk Register has been updated where necessary and are included in a separate report to the IJB. Relevant Risk Register Details Current Risk Level Risk Owner Financial Challenges High Amanda Kilburn Prevention and Detection of Fraud, Bribery and/or Corruption Low Ross McGuffie National Set-Aside Budget High Ross McGuffie Hosted Services Medium Ross McGuffie Prescribing Activity and Costs Very High Ross McGuffie Third and Voluntary Sector Low Ross McGuffie Ineffective Governance Arrangements Medium Ross McGuffie 12.5 ENGAGEMENT & PARTICIPATION Please tick the engagement and participation objectives that link(s) with this piece of work and provide further details on the engagement and participation that was undertaken. Objectives Further details ☒ Involve stakeholders in the development work aimed at achieving the national outcomes The Director of Finance of NHSL and the Head of Financial Solutions of NLC both continue to be consulted on the financial position of the NL IJB. ☐ Provide stakeholders with information on how to get involved ☐ Ensure a diverse range of engagement and participation and opportunities are in
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8 place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 12.6 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed and EQIA added to website: Yes No N/A 13. BACKGROUND PAPERS None. 14. APPENDICES Appendix 1 - North Lanarkshire IJB Budget Position Appendix 2 - Hosted Services Led by North Lanarkshire Appendix 3 - Hosted Services Led by South Lanarkshire Appendix 4 - North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 5 – North Lanarkshire IJB Movement on Reserves Appendix 6 – North Lanarkshire IJB 2 Year Savings Delivery Plan Appendix 7 – Analysis of Additional Employee Costs 2024/25 Chief Finance Officer Members seeking further information about any aspect of this report, please contact Amanda Kilburn on telephone number 07816 126362.
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9 North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 30 June 2024 Appendix 1 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2024/25 June 2024 June 2024 June 2024 2024/25 £m £m £m £m £m Health Care Services Locality and Other Services 62.321 15.873 14.995 0.878 3.513 Addiction Services 4.625 1.446 1.443 0.002 0.010 Medical and Nursing Directorate 4.034 1.144 1.048 0.096 0.383 Prescribing 72.295 18.074 19.351 (1.277) (5.108) Out of Area Services 4.318 1.079 0.858 0.221 0.885 Area Wide Services 7.702 1.751 1.583 0.168 0.672 Hosted Services 174.188 46.752 46.498 0.254 1.015 Family Health Services 125.402 31.127 31.127 0.000 0.000 Set-Aside Budget 74.537 18.634 18.634 0.000 0.000 Total Expenditure - NHSL 529.423 135.881 135.538 0.342 1.369 Social Care Services Social Care Services Gross Expenditure 265.652 81.739 81.731 0.009 0.028 Social Care Services Gross Income (4.487) (1.381) (1.390) 0.010 0.031 Social Care Services Net Expenditure 261.165 80.359 80.340 0.018 0.059 Housing Revenue Account 2.229 0.686 0.686 0.000 0.000 Social Care, Housing and Transport Services Net Expenditure 263.394 81.044 81.026 0.018 0.059 Total Expenditure - NHSL and NLC 792.818 216.925 216.564 0.361 1.429 Annual Budget 2024/25 £m NHS Lanarkshire Funding (523.988) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.962) Transfer from Reserves (Approved) (5.435) Total Funding - NHSL (583.778) NLC Funding - Social Care Services (206.811) NLC Funding - Housing Services (2.229) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (209.040) Total Funding - NHSL and NLC (792.818) Year To Date Care Group Funded By:
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10 Hosted Services Appendix 2 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 3.321 0.885 0.903 (0.017) 1.727 0.460 0.478 (0.017) 1.594 0.425 0.425 0.000 Continence Services 2.475 0.625 0.790 (0.166) 1.287 0.325 0.491 (0.166) 1.188 0.300 0.300 0.000 Immunisation Services 2.072 0.518 0.710 (0.192) 1.078 0.269 0.462 (0.192) 0.995 0.249 0.249 0.000 Speech and Language Therapy Services 7.066 1.767 1.594 0.173 3.674 0.919 0.746 0.173 3.392 0.848 0.848 0.000 Children and Adolescents Mental Health Services 9.309 3.373 3.148 0.224 4.841 1.754 1.529 0.224 4.469 1.619 1.619 0.000 Childrens Services 12.272 3.173 3.572 (0.399) 6.382 1.650 2.049 (0.399) 5.891 1.523 1.523 0.000 Integrated Equipment and Adaptations Store 0.567 0.142 0.138 0.004 0.295 0.074 0.070 0.004 0.272 0.068 0.068 0.000 Dietetics Services 4.239 1.111 1.013 0.098 2.204 0.578 0.480 0.098 2.035 0.533 0.533 0.000 Podiatry Services 4.890 1.230 1.125 0.104 2.543 0.639 0.535 0.104 2.347 0.590 0.590 0.000 Prisoner Healthcare Services 2.008 0.517 0.682 (0.166) 1.044 0.269 0.434 (0.166) 0.964 0.248 0.248 0.000 Blood Borne Viruses Services 1.854 0.463 0.411 0.052 0.964 0.241 0.189 0.052 0.890 0.222 0.222 0.000 Hospital at Home 2.616 0.737 0.731 0.006 1.360 0.383 0.377 0.006 1.256 0.354 0.354 0.000 Mental Health and Learning Disability Services 81.877 22.285 21.753 0.532 42.576 11.588 11.056 0.532 39.301 10.697 10.697 0.000 TOTAL 134.568 36.825 36.571 0.254 69.975 19.149 18.895 0.254 64.593 17.676 17.676 0.000 Led by the North Partnership South Lanarkshire IJB - 48% Share Year to DateAnnual Budget 2024/25 Annual Budget 2024/25 Year to Date North Lanarkshire IJB - 52% ShareYear to DateAnnual Budget 2024/25 Hosted Services Appendix 3 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 June 2024 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 7.944 1.975 1.811 0.165 4.131 1.027 1.027 0.000 3.813 0.948 0.783 0.165 Brain Injury Unit 2.216 0.565 0.575 (0.009) 1.153 0.294 0.294 0.000 1.064 0.271 0.281 (0.009) Out of Hours Services 9.978 2.494 2.257 0.237 5.188 1.297 1.297 0.000 4.789 1.197 0.960 0.237 Palliative Care Services 7.104 1.800 1.773 0.027 3.694 0.936 0.936 0.000 3.410 0.864 0.837 0.027 Physiotherapy Services 11.709 2.927 2.665 0.262 6.089 1.522 1.522 0.000 5.620 1.405 1.143 0.262 Primary Care Services 0.857 0.214 0.176 0.038 0.446 0.111 0.111 0.000 0.412 0.103 0.065 0.038 Occupational Therapy Services 8.919 2.248 2.034 0.214 4.638 1.169 1.169 0.000 4.281 1.079 0.865 0.214 Diabetic Services 4.244 1.061 1.267 (0.206) 2.207 0.552 0.552 0.000 2.037 0.509 0.715 (0.206) Primary Care Improvement Fund 23.221 5.805 5.606 0.200 12.075 3.019 3.019 0.000 11.146 2.787 2.587 0.200 TOTAL 76.193 19.091 18.163 0.928 39.620 9.928 9.928 0.000 36.573 9.164 8.236 0.928 Annual Budget 2024/25 Year to Date South Lanarkshire IJB - 48% Share Led by the South Partnership Annual Budget 2024/25 Year to Date Annual Budget 2024/25 Year to Date North Lanarkshire IJB - 52% Share
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11 North Lanarkshire IJB Budget Reconciliation 2024/25 Appendix 4 2024/25 NHSL Financial Allocation to North Lanarkshire HSCP £m 2024/25 NLC Financial Allocation to North Lanarkshire HSCP £m 2024/25 North Lanarkshire HSCP Financial Allocation 338.816 2024/25 North Lanarkshire HSCP Financial Allocation 206.812 Set-Aside Budget 74.537 NLC Funding - Housing Services 2.229 South Hosted @ 52% 39.188 NLC Financial Allocation at 21 June 2024 209.041 Family Health Service South @ 52% 124.475 NHSL Financial Allocation at 31 May 2024 577.016 Budget Adjustments Posted in Month 3 Draw Down From Reserves 1.747 Increase in ERS Usage 1.943 Long Covid, ADP, Men C Funding 0.387 Budget Realignment 0.981 Increase in Hosted Services Led by South 1.358 Increase in Area Wide Services 0.072 Other Budget Adjustments 0.273 NHSL Financial Allocation at 30 June 2024 583.777
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12 North Lanarkshire IJB Movement on Reserves Audit Trail NHSL & NCL Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 June 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.597 (0.420) 3.177 (0.420) 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Displaced Persons 0.106 0.106 0.000 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.194 0.194 0.000 1, 2, 4, 5 NHSL Children and Adolescent Mental Health Services 2.849 2.849 0.000 1, 2, 4, 5 NHSL Community Living Change Fund 1.164 1.164 0.000 1, 4, 5 NHSL District Nursing 0.292 (0.191) 0.101 (0.191) 1, 2, 3, 4, 5 NHSL Family Nurse Practitioner Funding 0.072 0.072 0.000 1, 2, 3, 4, 5 NHSL Frailty Nursing 0.401 (0.118) 0.283 (0.118) 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.962 (0.098) 0.864 (0.098) 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.234 (0.153) 0.081 (0.153) 2, 3, 4, 5 NHSL Mental Health Action 15 0.729 (0.675) 0.054 (0.675) 1, 2, 4, 5 NHSL Mental Health Covid Clinicians (Cossette) 0.052 0.052 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 0.972 (0.090) 0.882 (0.090) 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.111 0.111 0.000 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 3.396 (1.399) 1.998 (1.399) 1, 2, 4, 5 NHSL Mental Health Eating Disorders 0.036 0.036 0.000 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.074 (0.063) 0.011 (0.063) 1, 2, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.029 1.029 0.000 1, 2, 4, 5 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.148 0.000 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 (1.148) 1.570 (1.148) 1, 2, 3, 4, 5 NHSL PCR Prison Care Network Transforming Nursing Rolls 0.013 0.013 0.000 1, 2, 3, 4, 5 NHSL School Nursing 0.622 (0.023) 0.599 (0.023) 1, 2, 3, 4, 5 NHSL Specialist Doctor Contracts 0.194 0.194 0.000 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 3 NHSL Third Sector Initiatives To Improve Health 0.247 (0.091) 0.156 (0.091) 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 2.790 2.790 0.000 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.027 (0.006) 0.022 (0.006) 3 23.773 0.000 (4.474) 19.298 (4.474) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 June 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Adult Social Care Winter Preparedness Fund 1.000 1.000 0.000 1, 2, 3, 4, 5 NLC Adaptations Fund 0.308 0.308 0.000 2, 4 NLC Adult Protection (share with C&F and NHSL) 0.050 0.050 0.000 1, 2, 4, 5 NLC Advocacy Services 0.065 0.065 0.000 1, 2, 4, 5 NHSL Breast Feeding Team (2 year funding) 0.705 (0.057) 0.648 (0.057) 1, 2, 5 NLC Business Case - Non-Recurring NLC Costs 1.319 1.319 0.000 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.596 2.596 0.000 1, 2, 4, 5 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.268 0.268 0.000 4 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.107 (0.058) 0.049 (0.058) 3 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 1, 5 NHSL Dietetics Services - Double Running Costs 0.064 (0.009) 0.055 (0.009) NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.465 0.465 0.000 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.699 3.699 0.000 2, 3 NLC Digital and IT Strategy Technology Improvements - Other 0.389 0.389 0.000 NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.700 0.000 2, 3 NLC Financial Strategy - Changes to LA Services Muirpark 0.027 0.027 0.000 NHSL Health Inequalities - Screening 0.044 (0.007) 0.037 (0.007) 2 NHSL Health Visiting Students/Trainees 0.311 (0.081) 0.230 (0.081) 3 NLC Home Support Resilience (2 year funding) 0.656 0.000 0.656 0.000 3, 4 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.087 0.087 0.000 3 NLC IJB Helpline (2 years funding) 0.360 0.360 0.000 1, 4, 5 NHSL Kylepark Works 0.134 0.134 0.000 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.162 0.162 0.000 3, 4 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 2, 4 NHSL Minor Capital Works 1.027 1.027 0.000 3 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.450 (0.042) 0.408 (0.042) 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 3 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.569 (0.015) 0.554 (0.015) 1, 2, 3 NLC Planned Date of Discharge - Discharge To Assess 0.109 0.109 0.000 1, 5 NHSL Podiatry Services - Foot Screening 0.350 0.350 0.000 1, 2 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.020 (0.019) 0.001 (0.019) 3 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 3 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.023) 0.037 (0.023) 3 NHSL Sexual Health Services - Forensic Medical 0.152 (0.050) 0.102 (0.050) 1, 2 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.404 0.404 0.000 1, 2 NLC Social Care Contracting Staff within Quality Assurance Services 0.087 0.087 0.000 3 NLC/NHSL Staff Training Academy 2.042 (0.175) 1.868 (0.175) 3 NHSL Vulnerable and Complex Cases - Test of Change 0.816 (0.084) 0.732 (0.084) 5 20.975 0.000 (0.619) 20.356 (0.619) To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 LEAD RING-FENCED RESERVES Ongoing TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES Ambition Statement & Performance APPENDIX 5 Ambition Statement & Performance To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing
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13 Appendix 5 Continued Opening Balance As At 1 April 2024 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 30 June 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Prescribing Fund 4.361 4.361 0.000 2, 4 NLC Social Care Demand 12.684 12.684 0.000 2, 4 17.045 0.000 0.000 17.045 0.000 Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 June 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 13.390 13.390 0.000 13.390 0.000 0.000 13.390 0.000 Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 June 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL PCR Prison Care Network Transforming Nursing Rolls 0.341 (0.341) (0.000) (0.341) 1, 2, 3, 4, 5 0.000 0.000 0.341 0.000 (0.341) (0.000) (0.341) 75.524 0.000 (5.435) 70.089 (5.435) KEY (5.435) 1 2 3 4 5 LEAD CONTINGENCY FUND RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ambition Statement & Performance CLOSED RESERVES TOTAL CLOSED RESERVES TOTAL RESERVES LEAD RISK-BASED RESERVES TOTAL RISK-BASED RESERVES Develop and support a workforce for the future. Improve mental health and wellbeing. Supporting people through a whole family approach. Ambition Statement & Performance Ambition Statement & Performance Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. Ambition Statement & Performance Do the right thing first time. To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing TOTAL CONTINGENCY FUND RESERVES LEAD To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing
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14 APPENDIX 6 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 1 Ongoing Prescribing Savings 2.280 0.549 0.549 1.731 2 Financial Management - North Consequential Funding 3.446 3.446 3.446 0.000 3 Service Redesign: Mental Health Hospital Based Complex Care Contracted Beds 2.600 0.000 2.600 4 Review of Discretionary Spend 2.188 0.000 2.188 5 Review of Supplementary Staffing 0.982 0.296 0.296 0.686 6 Workforce Management and Service Redesign 4.699 0.311 0.311 4.388 7 Financial Management - Support Costs and Vacancy Review 1.486 0.309 0.309 1.177 17.681 4.910 0.000 4.910 12.771 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 8 Financial Management - Overspends 4.827 0.000 4.827 9 Service Redesign: Review of Provision of Registered Social Landlords 0.600 0.266 0.266 0.334 10 Review of Supplementary Staffing 0.750 0.750 0.750 0.000 11 Service Redesign and Contract Review 0.400 0.405 0.405 (0.005) 12 Review of Operating Model Supporting Back to Basics 3.825 0.000 3.825 13 Financial Management - Vacancy Review 1.000 0.000 1.000 11.402 1.421 0.000 1.421 9.981 29.083 6.331 0.000 6.331 22.752 Reference 1 2 3 4 5 6 7 8 Reference 8 9 10 11 12 13 Review of all unfunded posts (£4.324m). Redesign of Continence Service delivery schedule and products (£0.375m). Review of all vacant posts and realignment of support costs to all funding streams to show true cost of each service. Review of non traditional respite, advocacy and community services. Review of whole system approach to ensure that when people contact our services the response is quick and effective, with a focus on helping people to help themselves first. Review of all vacant posts. Reducing current overspends to align with allocated budgets. (IEAS, Independent Care Homes, SDS, Private Sector Housing Grants) Review of all Registered Social Landlords services in North Lanarkshire keeping with the approach taken by other local authorities by opting to reconfigure some existing sheltered/very sheltered housing to retirement models. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review. North Lanarkshire IJB 2024/25 & 2025/26 - 2 Year Savings Delivery Plan Total Health Care Services Reference Reference Total Adult Social Care Services TOTAL Total Achieved Health Care Services RAG Rating Adult Social Care Services RAG Rating Health Care Services Savings Delivery Plan Review all areas of discretionary spend including postage, stationery and printing, staff travel and subsistence, domestic supplies, subscriptions and licenses and hospitality. Review of all overtime and agency costs including premium rate staffing review, professional and skill mix review and sickness absence review. Adult Social Care Services Savings Delivery Plan Outstanding Target to Date The prescribing efficiency programme will continue. This will include additional efficiencies around medicines of low clinical value, drug patent expiry list, product switches, complex rebates and prescribing waste. Reducing current overspends to align with allocated budgets. For 2024/25, this is being off set by non-recurring consequential funding from Scottish Government. Additional non-recurring funding received in year from Scottish Government. This will be used in 2024/25. Outstanding Target to Date 2 Year Savings Delivery Plan (Target = £17.681m) Plan Total Achieved 2 Year Savings Delivery Plan (Target = £11.402m) Plan The current model of HBCCC is being reviewed with a view of moving patients into a more suitable and homely environment, such as a mainstream care home which would be a less intensive setting whilst also improving the quality of life of the individual.
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15 Analysis of Additional Employee Costs 2024/25 Appendix 7 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 50,169 38,615 22,052 56,191 305,642 4,702 477,371 2 41,325 32,875 23,320 46,102 264,497 7,042 415,161 3 51,328 40,468 21,249 52,407 367,143 3,350 535,945 4 0 5 0 6 0 7 0 8 0 9 0 10 0 11 0 12 0 TOTAL 142,822 111,958 66,621 154,700 937,282 15,094 1,428,477 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 6,112 -1,743 - - 286,364 - 290,733 2 - - 589 -80 569,840 - 570,349 3 1,526 - 1,229 - 337,115 - 339,870 4 0 5 0 6 0 7 0 8 0 9 0 10 0 11 0 12 0 13 0 TOTAL 7,638 -1,743 1,818 -80 1,193,319 0 1,200,952 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 7,896 6,109 4,121 14,860 30,578 -5,031 -36,239 737 23,031 2 11,173 8,470 4,855 17,042 30,317 84,416 341,911 2,508 500,692 3 7,738 7,429 5,896 10,311 21,831 65,331 331,451 1,247 451,234 4 48,786 385,446 434,232 5 0 6 0 7 0 8 0 9 0 10 0 11 0 12 0 13 0 TOTAL 26,807 22,008 14,872 42,213 82,726 193,502 1,022,569 4,492 1,409,189 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 4,408 2,005 7,033 9,061 9,873 1,559 33,939 2 2,745 3,160 4,339 3,462 5,718 1,250 20,674 3 1,508 1,689 4,890 850 6,956 776 16,669 4 0 5 0 6 0 7 0 8 0 9 0 10 0 11 0 12 0 TOTAL 8,661 6,854 16,262 13,373 22,547 3,585 71,282 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period AGENCY COSTS YEAR TO DATE