Item 7 - Financial Monitoring
North Lanarkshire Council · 22 March 2023
Back to Health and Social Care Integration Joint Board — 22 March 2023 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: 7 1. PURPOSE OF REPORT 1.1 This paper is coming to the Integration Joint Board (IJB): For approval For endorsement For noting 1.2 This report provides a summary of the financial position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the period from 1 April 2022 to 3 February 2023. 2. ROUTE TO THE INTEGRATION JOINT BOARD 2.1 This paper has been: Prepared By: Chief Finance Officer Reviewed By: Chief Officer 3. RECOMMENDATIONS 3.1 The IJB is asked to agree the following recommendations: (1) Note the contents of the report; and (2) Note the financial position is a year-to-date underspend of £13.75m 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from the Director of Finance of NHS Lanarkshire (NHSL) and the Head of Financial Solutions of North Lanarkshire Council (NLC). 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 year to date position is an underspend of £13.75m and the projected outturn for 2022/23 is an underspend of £16.199m, assuming the current trajectory of spend continues throughout this financial year. Service Year to Date Position £m Projected Year End Outturn £m Health Care Services £6.264m £7.352m Social Care Services £7.486m £8.847m SUBJECT: Financial Monitoring Report 2022/2023 TO: Integration Joint Board Lead Officer for Report: Ross McGuffie, Chief Officer Author(s) of Report Amanda Kilburn, Chief Financial Officer DATE: 22nd March 2023 Yes No N/A
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2 Total North Lanarkshire HSCP £13.75m £16.199m 6.2 Subject to IJB approval, this estimated underspend will be allocated to manage, on a non-recurring basis, ring-fenced commitments, additional future business plans and any funding gap which may be highlighted in the North Lanarkshire IJB Medium Term Financial Plan 2023-2026. 6.3 The following provides a high-level summary of the key pressures and the main reasons why the IJB is currently projecting an underspend against its budget this year: Employee Costs net underspend of £12.205m: as previously highlighted there are ongoing challenges in terms of recruitment and retention issues 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. These are issues that are being faced by IJBs across Scotland. Home Support net overspend of £0.542m: within Home Support Services, employee costs have increased as the service continues to support delayed discharges and demand however, this additional cost is being part funded from an earmarked reserve and the current number of vacant posts throughout other parts of the partnership. Payments to Other Bodies net underspend of £2.840m: the underspend is primarily due to the staff shortages and vacancies within the Care at Home sector who provide services to individuals via the self-directed support commissioning framework. There is also an underspend in package costs due to slippage in Self-Directed Support (SDS) start dates. It is anticipated these are in-year underspends only and the full budget will be required in future years. Independent Care Homes net overspend of £0.788m: there are currently 1,503 care packages within this service however when the budget was set for this financial year, it was based on 1,461 care packages. Included within this overspend is £252k interim care bed expenditure, which will be offset by a 25% funding allocation from Scottish Government in relation to winter planning. Admin Costs net underspend of £1.884m: within the carers funding there is currently an unallocated budget of £1.8m. Work is continuing to allocate this is relevant carers package in 2022/23. At year end, any remaining underspend will be transferred to a dedicated earmark reserve to fund carers pressures in 2023/24. Prescribing net overspend of £0.300m: activity and cost per item within prescribing is 4.6% higher compared to the same period last year, which has caused this budget to move from a breakeven position when last reported to the current overspend position. Due to the uncertainty around costs and prescribing activity and the three-month time lag in receiving the data, the volatility experienced within prescribing is likely to continue for the foreseeable future.
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3 6.4 Throughout the financial 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 year to date allocations received from Scottish Government: Scottish Government Allocations 2022/23 £m Multi-Disciplinary Teams 1.743 Community Extended Care Pilot 0.933 North Family Nurse Partnership 0.070 ICU Bed Capacity Uplift 0.044 Hospitals at Home 0.250 District Nursing 0.608 Long Covid Support Funding 0.320 Learning Disability Health Checks 0.123 Alcohol and Drug Partnership – Tranche 1 2.179 Veteran 1st Point 0.126 Naloxone for Police Scotland 0.031 TOTAL 6.427 7. RESERVES 7.1 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. 7.2 The current IJB reserves position for 2022/23 is a revised balance of £69.237m and is summarised in the table below. A detailed analysis of these reserves is presented within the IJB Reserves Strategy 2022/2023. 7.3 The IJB Reserves Strategy 2022/2023 has been updated to include the revised structure of the reserves to continue to enable the IJB to meet its agreed strategic objectives, and Scottish Government policy requirements. 8. CURRENT VACANCY POSITION Opening Balance After Review Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 49.903 (24.116) (14.353) 11.434 NHSL & NLC Earmarked Reserves 31.661 17.186 (6.494) 42.353 NHSL & NLC Risk-Based Reserves 13.478 (2.130) (0.796) 10.552 NHSL Contingency Reserves 4.167 1.032 (0.301) 4.898 NHSL & NLC Closed Reserves 20.244 (15.916) (4.327) - 119.453 (23.944) (26.271) 69.237 LEAD SUMMARY Total
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4 8.1 As highlighted throughout this report, employee costs are projecting a significant underspend within all services. Recruitment continues to be progressed for vacant posts in all areas. 8.2 The table below shows the current full time equivalent (FTE) vacancy numbers within each service against the budgeted establishment: 8.3 To help cover the current vacant posts, agency staff, bankaide, overtime and excess part time hours are used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at Appendix 5. 9. DELEGATED SERVICES 9.1 The following table shows the costs of other North Lanarkshire Council services delegated to the IJB. The IJB remain accountable for these services, however, they continue to be delivered by North Lanarkshire Council. North Lanarkshire HSCP monitors the delivery of these services on behalf of the IJB. 9.2 The projected outturn position to 31 March 2023 is a breakeven position for both services. Service Annual Budget £m Projected to Year End £m Variance £m Housing 1.870 1.870 - Breakeven Establishment Actual FTE FTE FTE % North West Locality 384.98 344.68 40.30 10.5% North East Locality 323.53 298.57 24.96 7.7% Adult Services 274.01 248.56 25.45 9.3% Children Services 553.69 473.43 80.26 14.5% Mental Health 1,146.60 1,092.47 54.13 4.7% Social Care Services 834.20 660.40 173.80 20.8% Home Support 1,000.07 991.89 8.18 0.8% Other 177.02 216.79 -39.77 -22.5% TOTAL 4,694.10 4,326.79 367.31 7.8% Service Vacancies Overtime Excess Part Time Bankaide Agency £m £m £m £m North West Locality 0.118 0.033 0.437 0.040 North East Locality 0.072 0.041 0.199 - Adult Services 0.048 0.066 0.153 0.057 Children Services 0.148 0.085 0.304 0.013 Mental Health & Learning Disabilities 0.403 0.072 1.840 2.297 Social Care Services 0.879 - - 0.099 Home Support 3.529 - - - Other 0.025 0.015 0.019 - TOTAL 5.223 0.312 2.952 2.506 SERVICE Year to Date Cost
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5 Transport 0.551 0.551 - Breakeven Total 2.421 2.421 - Breakeven 10. IMPLICATIONS 10.1 NATIONAL OUTCOMES The effective management of financial resources contributes to the achievement of the national outcomes. 10.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. The IJB Medium Term Financial Plan 2023-2026 is currently being completed. 10.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 10.4 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. 10.5 PEOPLE None 10.6 STAKEHOLDER ENGAGEMENT 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 North Lanarkshire IJB. 10.7 INEQUALITIES & FAIRER SCOTLAND DUTY Equality and Diversity Impact Assessment Completed & Fairer Scotland Impact Assessment Form Completed: Yes No N/A 10.8 CARBON MANAGEMENT IMPLICATIONS Yes No N/A 11. BACKGROUND PAPERS None. 12. APPENDICES North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Hosted Services Led by North Lanarkshire Appendix 2 Hosted Services Led by South Lanarkshire Appendix 3 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 Analysis of Additional Employee Costs Appendix 5
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6 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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7 North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Expenditure Annual Year To Date Variance Budget Budget Actual Total 2022/2023 January 2023 January 2023 January 2023 £m £m £m £m Health Care Services Locality and Other Services 51.907 32.325 29.999 2.326 Addiction Services 5.827 2.885 2.605 0.279 Medical and Nursing Directorate 5.296 3.940 3.447 0.492 Prescribing 69.582 52.187 52.487 (0.300) Out of Area Services 4.571 3.428 3.620 (0.192) Area Wide Services 11.099 7.482 7.220 0.262 Hosted Services 158.901 116.858 113.462 3.396 Family Health Services 113.512 85.714 85.714 0.000 Set-Aside Budget 66.858 55.715 55.715 0.000 Covid-19 2.766 2.766 2.766 (0.000) Total Expenditure - NHSL 490.319 363.299 357.035 6.264 Social Care Services Social Care Services Gross Expenditure 241.758 187.698 180.617 7.081 Social Care Services Gross Income (Including Covid-19 Income) (2.896) (0.620) (1.025) 0.406 Social Care Services Net Expenditure 238.861 187.078 179.592 7.486 Housing Revenue Account Expenditure 1.870 1.667 1.667 0.000 Transport Services Expenditure 0.551 0.169 0.169 0.000 Social Care, Housing and Transport Services Net Expenditure 241.282 188.915 181.428 7.486 Total Expenditure - NHSL and NLC 731.601 552.214 538.463 13.750 Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (471.076) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.718) Scottish Government Funding - Covid-19 and Remobilisation (2.766) Transfer from Reserves (Approved) (16.477) Total Funding - NHSL (543.421) NLC Funding - Social Care Services (185.759) NLC Funding - Housing Services (1.870) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (188.180) Total Funding - NHSL and NLC (731.601) 2022/2023 Year To Date
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8 Hosted Services Appendix 2 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 Budget Actual Variance Budget Actual Variance Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Sexual Health Services 2.986 2.243 2.118 0.125 1.523 1.144 1.019 0.125 1.463 1.099 1.099 0.000 Continence Services 2.361 1.771 1.776 (0.005) 1.204 0.903 0.908 (0.005) 1.157 0.868 0.868 0.000 Immunisation Services 1.898 1.423 1.852 (0.429) 0.968 0.726 1.155 (0.429) 0.930 0.698 0.698 0.000 Speech and Language Therapy Services 6.114 4.589 3.959 0.630 3.118 2.340 1.710 0.630 2.996 2.249 2.249 0.000 Children and Adolescents Mental Health Services 12.448 8.591 7.581 1.010 6.349 4.381 3.371 1.010 6.100 4.209 4.209 0.000 Childrens Services 12.444 9.030 8.755 0.275 6.346 4.605 4.330 0.275 6.097 4.425 4.425 0.000 Integrated Equipment and Adaptations Store 0.567 0.426 0.508 (0.082) 0.289 0.217 0.299 (0.082) 0.278 0.208 0.208 0.000 Dietetics Services 3.856 2.897 2.663 0.234 1.967 1.477 1.243 0.234 1.890 1.419 1.419 0.000 Podiatry Services 4.357 3.266 3.160 0.106 2.222 1.666 1.560 0.106 2.135 1.600 1.600 0.000 Prisoner Healthcare Services 1.707 1.281 1.248 0.032 0.870 0.653 0.621 0.032 0.836 0.627 0.627 0.000 Blood Borne Viruses Services 1.529 1.147 1.103 0.044 0.780 0.585 0.541 0.044 0.749 0.562 0.562 0.000 Hospital at Home 2.502 1.749 1.518 0.232 1.276 0.892 0.661 0.232 1.226 0.857 0.857 0.000 Mental Health and Learning Disability Services 73.762 55.827 54.602 1.224 37.619 28.472 27.247 1.224 36.143 27.355 27.355 0.000 TOTAL 126.530 94.238 90.842 3.396 64.530 48.061 44.665 3.396 62.000 46.177 46.177 0.000 Led by the North Partnership South Lanarkshire IJB - 49% Share Year to Date Annual Budget 2022/2023 Annual Budget 2022/2023 Year to Date North Lanarkshire IJB - 51% ShareYear to DateAnnual Budget 2022/2023 Hosted Services Appendix 3 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 December 2022 Budget Actual Variance Budget Actual Variance Budget Actual Variance 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 2022/2023 £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 7.488 5.545 5.053 0.492 3.819 2.828 2.828 0.000 3.669 2.717 2.225 0.492 Brain Injury Unit 2.365 1.414 1.322 0.092 1.206 0.721 0.721 0.000 1.159 0.693 0.601 0.092 Out of Hours Services 8.919 6.629 6.600 0.028 4.548 3.381 3.381 0.000 4.370 3.248 3.220 0.028 Palliative Care Services 7.215 5.437 5.312 0.124 3.680 2.773 2.773 0.000 3.535 2.664 2.540 0.124 Physiotherapy Services 10.209 7.666 7.279 0.387 5.207 3.910 3.910 0.000 5.003 3.756 3.369 0.387 Primary Care Services 0.806 0.600 0.556 0.044 0.411 0.306 0.306 0.000 0.395 0.294 0.250 0.044 Occupational Therapy Services 7.988 6.017 5.541 0.476 4.074 3.069 3.069 0.000 3.914 2.948 2.473 0.476 Diabetic Services 4.948 4.007 3.947 0.059 2.524 2.043 2.043 0.000 2.425 1.963 1.904 0.059 Telehealth 0.660 0.421 0.228 0.192 0.336 0.215 0.215 0.000 0.323 0.206 0.014 0.192 Sub Total 50.598 37.735 35.839 1.896 25.805 19.245 19.245 0.000 24.793 18.490 16.594 1.896 Ring Fenced Funding Primary Care Improvement Fund 12.874 6.617 6.617 0.000 6.566 3.375 3.375 0.000 6.308 3.243 3.242 0.000 Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Sub Total 12.874 6.617 6.617 0.000 6.566 3.375 3.375 0.000 6.308 3.243 3.242 0.000 TOTAL 63.471 44.352 42.456 1.896 32.370 22.620 22.620 0.000 31.101 21.733 19.836 1.896 Annual Budget 2022/2023 Year to Date South Lanarkshire IJB - 49% Share Led by the South Partnership Annual Budget 2022/2023 Year to Date Annual Budget 2022/2023 Year to Date North Lanarkshire IJB - 51% Share
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9 North Lanarkshire IJB Budget Reconciliation 2022/2023 Appendix 4 2022/23 NHSL Financial Allocation to North Lanarkshire HSCP £m 2022/23 NLC Financial Allocation to North Lanarkshire HSCP £m 2022/22 North Lanarkshire HSCP Financial Allocation 506.931 2022/22 North Lanarkshire HSCP Financial Allocation 132.575 Add: Set-Aside Budget 66.858 NLC Funding - Housing Services 1.870 Less: Budget Adjustments NLC Funding - Transport Services 0.551 Social Care Fund -22.964 Add: Budget Adjustments Resource Transfer -23.421 Social Care Fund 22.964 Commissioned Services -6.799 Resource Transfer 23.421 NHSL Financial Allocation at 31 May 2022 520.605 Commissioned Services 6.799 NLC Financial Allocation at 16 September 2022 188.180 Draw Down from Reserves 1.949 Increase to Employers NI 1.262 NES Trainee 1.021 Other Budget Adjustments 0.425 NHSL Financial Allocation at 30 June 2022 525.262 Draw Down from Reserves 0.460 Junior Medical Income -0.040 Other Budget Adjustments 0.023 NHSL Financial Allocation at 31 July 2022 525.705 Draw Down from Reserves 0.453 Child Death Review Funding 22-23 0.024 Increase to Hosted Services Led by South 1.146 Other Budget Adjustments 0.220 NHSL Financial Allocation at 31 August 2022 527.548 Draw Down from Reserves 1.740 Junior Doctor Income 2.274 Adustment to Commissioned Services 0.082 Increase to Hosted Services Led by South 0.433 Other Budget Adjustments 0.002 NHSL Financial Allocation at 30 September 2022 532.079 Draw Down from Reserves 1.039 Scottish Government Funding Health Care Support Workers 1.743 Scottish Government Funding for Band 2-4 (North Allocation) 0.933 Increase to Hosted Services Led by South 0.634 Other Budget Adjustments 0.160 NHSL Financial Allocation at 30 October 2022 536.588 Draw Down from Reserves 1.275 Medical Pay Award 4.5% 0.979 Junior Medical 0.132 Increase to Hosted Services Led by South 2.450 Other Budget Adjustments 0.022 NHSL Financial Allocation at 30 November 2022 541.446 Adjustment to Reserves -2.321 Junior Medical & Trainee Income 0.073 Learning Disabilities Health Checks 0.123 Increase to Hosted Services Led by South 4.085 Other Budget Adjustments 0.015 NHSL Financial Allocation at 31 December 2022 543.421 Budget Adjustments Posted in Month 9 Budget Adjustments Posted in Month 8 Budget Adjustments Posted in Month 6 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 4 Budget Adjustments Posted in Month 5 Budget Adjustments Posted in Month 7
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10 Analysis of Additional Employee Costs Appendix 5 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 44,000 32,000 17,500 35,500 209,500 2,000 340,500 2 44,000 32,000 17,500 35,500 209,500 2,000 340,500 3 53,000 34,000 22,000 30,000 205,000 3,000 347,000 4 54,000 30,000 17,000 38,000 216,000 5,000 360,000 5 49,000 33,000 17,000 41,000 212,000 4,000 356,000 6 43,000 31,000 12,000 34,000 196,000 4,000 320,000 7 53,000 32,000 17,000 43,000 221,000 6,000 372,000 8 46,000 33,000 24,000 40,000 186,000 7,000 336,000 9 51,000 -58,000 9,000 7,000 185,000 -14,000 180,000 TOTAL 437,000 199,000 153,000 304,000 1,840,000 19,000 2,952,000 North West Locality £ Adult Services £ Children Services £ Learning Disabilities £ Mental Health £ Social Care Services £ TOTAL £ 1 1,396 6,804 9,018 19,329 72,766 109,313 2 406 6,804 1,303 37,927 338,077 384,517 3 2,527 6,804 42,413 184,579 236,323 4 4,348 4,796 37,915 199,682 246,741 5 5,698 4,988 38,211 212,758 261,655 6 759 4,797 1,627 49,939 193,626 250,748 7 2,817 4,796 59,821 234,119 301,553 8 10,554 4,796 97,273 182,799 7,204 302,626 9 11,584 12,168 754 63,042 232,980 13,336 333,864 10 20,796 20,796 11 57,701 57,701 TOTAL 40,089 56,753 12,702 445,870 1,851,386 99,037 2,505,837 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 13,187 8,071 10,569 12,294 49,952 8,427 109,798 4,808 217,106 2 12,032 8,789 3,582 9,091 42,880 73,558 285,090 1,096 436,118 3 21,425 6,426 4,508 7,572 29,605 76,713 277,793 2,558 426,600 4 12,482 4,153 2,223 16,873 30,022 74,719 290,873 2,923 434,268 5 17,069 10,685 3,218 9,750 53,447 87,187 321,181 1,541 504,078 6 10,687 7,575 4,373 14,542 48,147 76,800 326,698 2,629 491,451 7 13,149 4,503 6,412 21,905 55,807 84,165 362,809 4,290 553,040 8 9,351 9,011 7,230 27,429 58,631 113,755 503,326 2,800 731,533 9 8,914 12,937 5,770 28,958 34,450 118,428 420,088 2,046 631,591 10 86,099 254,737 340,836 11 79,279 377,024 456,303 TOTAL 118,296 72,150 47,885 148,414 402,941 879,130 3,529,417 24,691 5,222,924 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 6,869 5,164 12,800 6,579 10,496 889 42,797 2 3,401 4,223 7,228 5,775 8,002 796 29,425 3 4,231 6,891 8,791 6,755 9,229 656 36,553 4 3,007 4,827 5,230 8,288 7,947 2,269 31,568 5 3,801 3,348 5,450 7,051 9,240 4,532 33,422 6 3,660 3,937 5,002 11,180 7,207 649 31,635 7 2,077 1,879 6,954 12,542 8,465 1,605 33,522 8 2,447 3,914 6,168 12,599 6,428 1,591 33,147 9 3,517 6,460 8,221 14,474 5,392 1,790 39,854 TOTAL 33,010 40,643 65,844 85,243 72,406 14,777 311,923 BANKAIDE COSTS YEAR TO DATE OVERTIME COSTS YEAR TO DATE AGENCY COSTS YEAR TO DATE EXCESS PART TIME COSTS YEAR TO DATE Period Period Period Period