ITEM 12 Financial Monitoring 2023 2024
North Lanarkshire Council · 22 May 2024
Back to IJB Performance, Finance and Audit Committee — 22 May 2024 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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REPORT Item No:12 SUBJECT: Financial Monitoring Report 2023/24 TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie Chief Officer NL HSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 22 May 2024 1. PURPOSE OF REPORT 1.1 This paper is coming to the Performance, Finance and Audit (PFA) Committee for: For approval For endorsement For noting 1.2 This report provides a summary of the North Lanarkshire University Health and Social Care Partnership (UHSCNL) for the financial year 2023/24 and to seek approval for the transfer of funds to reserves. 2. ROUTE TO THE PERFORMANCE, FINANCE AND AUDIT COMMITTEE 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 PFA Committee: (1) Acknowledge the year-end financial position for 2023/24; and (2) Approve the proposed transfer to General Reserves at para 9.2 and 9.3 of this report. 4. VARIATIONS TO DIRECTIONS Yes No N/A 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 The budget monitoring throughout 2023/24 has shown the IJB projecting an underspend, prior to the transfer of year-end balances to General Reserves at the financial year-end. 6.2 As detailed in the table at para 6.4, the IJB final outturn was an underspend of £18.71m.
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6.3 Once all ring-fenced balances have been transferred to the relevant reserve in line with Scottish Government guidance, the revised outturn was an underspend of £5.344m. 6.4 The table below shows the 2023/24 outturn position for North Lanarkshire IJB before and after the transfer of Scottish Government ring-fenced funding to reserves: Care Group Annual Budget 2023/24 In Year Drawdown From Reserves Revised Budget 2023/24 Year End Spend 2023/24 Year End Variance 2023/24 Less Ring- Fenced Underspend Revised Year End Variance 2023/24 £m £m £m £m £m £m £m Health Care Services 536.062 26.84 562.902 547.523 15.379 (13.365) 2.014 Social Care Services 250.917 5.027 255.944 252.614 3.331 3.331 TOTAL 786.979 31.867 818.846 800.136 18.710 (13.365) 5.344 6.5 Subject to IJB approval this underspend will be allocated to manage, on a non- recurring basis, ring-fenced commitments, additional commitments relating to the Strategic Commissioning Plan and any funding gap which has been highlighted in the North Lanarkshire IJB financial plans. 7. 2023/24 FINANCIAL PERFORMANCE 7.1 The financial outturn for 2023/24 was an underspend of £18.71m relating to various under and overspends across the whole integrated budget mainly in relation to ring-fenced Scottish Government funding. A summary of the main variances including financial challenges and key pressures are highlighted below: 7.1.1 Employee Costs – underspend of £12.008m As highlighted 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. 7.1.2 Payments to Other Bodies (PTOB) – overspend of £0.448m 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 1,457 resulting in a overspend of £0.447m. SDS is similarly overspend due to a budget to fund 2,617 care plans against 2,805 care plans for 2023/24. In line with the IJB strategy to address the demand pressures within the financial plan, a drawdown of £1.194m from the social care demand reserve was utilised to offset the 2023/24 overspend. An action plan is currently underway which focuses on overdue client reviews and ensuring outcomes and budgets are aligned. 7.1.3 Transport – overspend of £0.424k The overspend is attributed to an increase in running costs associated with the home support additional pool cars that were purchased during 2023/24 along with an increase in staff mileage claims.
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7.1.4 Prescribing – overspend of £1.781m The 2023/24 overspend is attributable to the continued increase in costs associated with the number of medicines being prescribed. Similar to the increase in SDS demand, the prescribing increase was in part forecast and reported in the financial plan and therefore a drawdown of £3.835m from the prescribing reserve was utilised in-year. 7.1.5 North Lanarkshire Hosted Services – underspend of £5.063m The main variances within North Lanarkshire hosted services relate to: Mental Health – underspend of £6.662m which includes £4.389m Scottish Government ring-fenced funding for use in 2025/26. The remaining underspend is in relation to vacant posts across the service. Children and Adolescents Mental Health Services (CAMHS) – underspend of £0.883m is in relation to a high level of vacant posts across the service. Continence Services – overspend of £0.991m which is related to increases in product and delivery costs. Childrens Services – overspend of £1.128m which is mainly due to additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. Prisoner Healthcare – overspend of £1.002m due to the increase in costs linked to the delivery of the new pharmacy contract and drug prices associated with prescribing. 7.1.6 Addiction Services – underspend of £3.597m The total underspend is in relation to Scottish Government ring-fended funding which will be carried forward for use in 2025/26. 7.2 The table below shows the 2023/24 year-end financial position for each client group including the revised year end variance after Scottish Government ring- fenced funding has been removed: Care Group Revised Budget 2023/24 Year End Spend 2023/24 Year End Variance 2023/24 Less Ring- Fenced Underspend Revised Year End Variance 2023/24 £m £m £m £m £m Locality and Other Services 67.471 59.671 7.800 (4.277) 3.523 Addiction Services 7.551 3.954 3.597 (3.597) 0.000 Medical and Nursing Directorate 4.639 4.105 0.534 (0.692) -0.159 Prescribing 76.661 78.442 -1.781 -1.781 Out of Area Services 4.318 4.585 -0.267 -0.267 Area Wide Services 8.054 7.621 0.433 (0.341) 0.092 Hosted Services 195.779 190.715 5.063 (4.457) 0.606 Family Health Services 123.854 123.854 0.000 0.000 Set-Aside Budget 74.575 74.575 0.000 0.000 Social Care Services 255.945 252.614 3.331 3.331 TOTAL 818.846 800.136 18.710 (13.365) 5.344
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7.3 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 during 2023/24: Scottish Government Allocations 2023/24 £m Additional Staffing Band 2-4 1.093 Alcohol and Drug Partnership 3.173 Childcare Flu Vaccines 1.264 Child Death Review 0.024 Dementia Post Diagnostic Support 0.430 Digital Therapy Posts 0.111 Distress Brief Intervention 3.019 District Nursing 0.682 Family Nurse Practitioner Funding 1.196 Hospital at Home 0.527 Learning Disabilities Health Checks 0.246 Long Covid Support Fund 0.260 Meningitis C 0.106 Mental Health Action 15 1.478 Mental Health Community Perinatal 0.456 Mental Health Infant and Maternity 0.476 Mental Health Outcomes Framework 6.965 Mental Health Support Veterans 0.126 Multi-Disciplinary Teams 2.661 Neonatal Psychological Interventions 0.138 North Lanarkshire Council Provider Sustainability Payment 0.220 Outcomes Framework 2.770 PCR Prison Care Nursing Roles 0.013 School Nursing Posts 0.840 Shingles Vaccines 2.446 Specialist Doctor Contracts 0.194 TOTAL 30.914 8. SAVINGS 8.1 Within 2023/24 prescribing budget, the UHSCNL had an action plan that included our contribution to the health board-wide efficiency measures, including drug switches and prescribing improvement projects resulting in a savings target of £2.7m. 8.2 A wide range of work commenced in March 2023, ranging from reducing waste and inefficiencies to changing prescribing practices and culture. The impact of this work has recorded savings during 2023/24 totalling £2.138m. This savings measure will continue into 2025/26 and will be incorporated into the North Lanarkshire IJB two year saving delivery plan.
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8.3 In addition, CORE management team and various sustainability and value workshops 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. Various service reviews across the partnership. Collaboration with South UHSCP Management Team primarily to review hosted services and joint working arrangements across Lanarkshire. 8.4 The two year saving delivery plan will commence from April 2024. Regular updates on progress against each agreed savings will be reported to the IJB within the quarterly financial monitoring reports during 2024/25 and 2025/26. 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 In closing the annual accounts and in line with the IJB Reserves Policy, the PFA is asked to approve the transfer of an additional £18.71m to IJB reserves as detailed in appendix 5. The increase to reserves will continue to enable the IJB meets its strategic objectives, and Scottish Government policy requirements. Summary Year End Transfer to Reserves (Pending PFA Approval) £m Scottish Government Ring-Fenced Reserves 13.365 Earmarked Reserves 0.524 Contingency Reserves 4.821 Total Year End Transfer to Reserves 18.710 9.3 The table below shows the final summary position for 2023/24 adjusted for the drawdown of reserves in year and pending approval of year end transfer of reserves detailed in appendix 5: 2023/24 Prescribing Savings (£m) SAVINGS ACHIEVED 2.138 SAVINGS TARGET 2.700 0.000 0.500 1.000 1.500 2.000 2.500 3.000
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LEAD SUMMARY Opening Balance As At 1 April 2023 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 Movement in Reserves 2023/24 £m £m £m £m £m NHSL Ring-Fenced Reserves 25.593 12.818 (14.297) 24.114 (1.479) NLC/NHSL Earmarked Reserves 32.767 0.936 (12.727) 20.976 (11.791) NLC/NHSL Risk-Based Reserves 12.952 10.973 (6.880) 17.045 4.093 NHSL Contingency Reserves 8.060 5.330 0.000 13.390 5.330 NLC/NHSL Closed Reserves 18.574 (11.347) (7.227) (0.000) (18.574) Total 97.946 18.710 (41.132) 75.525 (22.421) 9.4 A detailed list of all reserve movement during 2023/24 is at appendix 6 including a key guidance table showing how the reserves are aligned to our five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 9.5 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 2023/24 10.1 The table below shows the full time equivalent (FTE) vacancy numbers at 31 March 2024 within each service compared against their budgeted establishment: Service Establishment FTE Actual FTE Vacancies FTE North West Locality 395.19 350.09 45.10 North East Locality 332.09 301.47 30.62 Adult Services 291.14 284.81 6.33 Children Services 594.07 557.65 36.42 Mental Health 1,195.44 1,152.75 42.69 Social Care Services 986.90 795.06 191.84 Home Support 1,000.17 968.32 31.85 Other 207.82 209.63 -1.81 TOTAL 5,002.82 4,619.78 383.04 10.2 To help cover the vacant posts throughout 2023/24, agency staff, bankaide, overtime and excess part time hours were used, the cost of which is included within the financial position reported. A detailed analysis of these costs is at appendix 7. SERVICE Costs As At 31 March 2024 Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.147 0.041 0.769 0.239 1.196 North East Locality 0.072 0.024 0.495 0.068 0.658 Adult Services 0.073 0.097 0.350 0.190 0.710 Children Services 0.216 0.082 0.638 0.085 1.021 Mental Health 0.498 0.076 3.348 4.623 8.545 Social Care Services 1.201 - - 0.376 1.578 Home Support 4.702 - - - 4.702 Other 0.030 0.020 0.085 - 0.135 TOTAL 6.939 0.339 5.685 5.581 18.544
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11. IMPLICATIONS 11.1 NATIONAL OUTCOMES 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 ☒ 11.2 ASSOCIATED MEASURE(S) Each partner is required to remain within their approved budgetary provision. 11.3 FINANCIAL This paper has been reviewed by Finance: Yes No N/A 11.4 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 11.5 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
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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 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. 11.6 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 12. BACKGROUND PAPERS None. 13. APPENDICES Appendix 1 - North Lanarkshire IJB 2023/24 Budget Appendix 2 - Hosted Services Led by North Lanarkshire Appendix 3 - Hosted Services Led by South Lanarkshire Appendix 4 - North Lanarkshire IJB Budget Reconciliation 2023/24 Appendix 5 – Final Outturn 2023/24 – Transferred to Reserves Appendix 6 – North Lanarkshire IJB General Reserves 2023/24 Appendix 7 - Analysis of Additional Employee Costs 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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North Lanarkshire IJB Revenue Budget Position 2023/24 Expenditure Budget 2023/24 £m Actual 2023/24 £m Variance 2023/24 £m Health Care Services Locality and Other Services Addiction Services Medical and Nursing Directorate Prescribing Out of Area Services Area Wide Services Hosted Services Family Health Services Set-Aside Budget Total Expenditure - NHSL 67.471 7.551 4.639 76.661 4.318 8.054 195.779 123.854 74.575 562.901 59.671 3.954 4.105 78.442 4.585 7.621 190.715 123.854 74.575 547.522 7.800 3.597 0.534 (1.781) (0.267) 0.433 5.063 0.000 0.000 15.379 Social Care Services 256.442 253.463 2.979 Social Care Services Gross Expenditure Social Care Services Gross Income (3.647) (3.998) 0.351 Social Care Services Net Expenditure 252.796 249.465 3.331 Housing Revenue Account 2.599 2.599 0.000 Transport Services Account 0.551 0.551 0.000 Social Care, Housing and Transport Services Net Expenditure 255.945 252.614 3.331 Total Expenditure - NHSL and NLC 818.846 800.136 18.710 Funded By: Annual Budget 2023/24 £m NHS Lanarkshire Funding (536.061) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.961) Transfer from Reserves (Approved) (26.840) Total Funding - NHSL (617.255) NLC Funding - Social Care Services (193.415) NLC Funding - Housing Services (2.599) NLC Funding - Transport Services (0.551) Transfer from Reserves (Approved) (5.027) Total Funding - NLC (201.591) Total Funding - NHSL and NLC (818.846) Appendix 1
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Hosted Services Hosted Services South Lanarkshire IJB - 48% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 3.958 3.134 0.824 1.363 1.297 0.067 4.825 4.765 0.060 3.638 3.565 0.073 5.634 5.478 0.155 0.431 0.322 0.109 4.310 4.070 0.240 2.211 2.238 (0.027) 11.145 11.146 (0.001) 37.515 36.015 1.500 North Lanarkshire IJB - 52% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 4.288 4.288 0.000 1.477 1.477 0.000 5.227 5.227 0.000 3.941 3.941 0.000 6.103 6.103 0.000 0.467 0.467 0.000 4.669 4.669 0.000 2.395 2.395 0.000 12.074 12.074 0.000 40.641 40.641 0.000 Led by the South Partnership South Hosted Services 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m Community Dental Services 8.246 7.422 0.824 Brain Injury Unit 2.840 2.773 0.067 Out of Hours Services 10.052 9.991 0.060 Palliative Care Services 7.580 7.507 0.073 Physiotherapy Services 11.737 11.581 0.155 Primary Care Services 0.899 0.790 0.109 Occupational Therapy Services 8.978 8.739 0.240 Diabetic Services 4.606 4.633 (0.027) Primary Care Improvement Fund 23.219 23.220 (0.001) TOTAL 78.156 76.656 1.500 South Lanarkshire IJB - 48% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 1.661 1.661 0.000 1.187 1.187 0.000 2.721 2.721 0.000 3.426 3.426 0.000 6.975 6.975 0.000 6.410 6.410 0.000 0.272 0.272 0.000 2.115 2.115 0.000 2.405 2.405 0.000 0.982 0.982 0.000 0.833 0.833 0.000 1.773 1.773 0.000 43.706 43.706 0.000 74.466 74.466 0.000 North Lanarkshire IJB - 52% Share 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m 1.800 1.908 (0.108) 1.286 2.278 (0.991) 2.948 3.093 (0.145) 3.712 3.369 0.342 7.556 6.673 0.883 6.944 8.072 (1.128) 0.295 0.529 (0.234) 2.291 2.038 0.254 2.605 2.468 0.137 1.063 2.065 (1.002) 0.902 0.834 0.068 1.920 1.595 0.326 47.348 40.686 6.662 80.671 75.608 5.063 Led by the North Partnership North Hosted Services 2023/24 Budget £m 2023/24 Actual £m 2023/24 Variance £m Sexual Health Services 3.461 3.569 (0.108) Continence Services 2.473 3.465 (0.991) Immunisation Services 5.670 5.815 (0.145) Speech and Language Therapy Services 7.138 6.796 0.342 Children and Adolescents Mental Health Services 14.531 13.648 0.883 Childrens Services 13.354 14.482 (1.128) Integrated Equipment and Adaptations Store 0.567 0.801 (0.234) Dietetics Services 4.406 4.152 0.254 Podiatry Services 5.010 4.873 0.137 Prisoner Healthcare Services 2.045 3.047 (1.002) Blood Borne Viruses Services 1.735 1.667 0.068 Hospital at Home 3.693 3.367 0.326 Mental Health and Learning Disability Services 91.054 84.393 6.662 TOTAL 155.137 150.074 5.063 Appendix 2 Appendix 3
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North Lanarkshire IJB Budget Reconciliation 2023/24 2023/24 NLC Financial Allocation to North Lanarkshire HSCP £m 2023/24 North Lanarkshire HSCP Financial Allocation 190.677 NLC Funding - Housing Services 2.095 NLC Funding - Transport Services 0.551 Pay Award Drawdown from Reserves 3.176 NLC Financial Allocation at 02 February 2024 196.499 Budget Adjustments Posted in Month 12 1.851 Pay Award Drawdown from Reserves Pay Award Recurring Budget Uplift 2.738 NLC Funding - Housing Services 0.504 NHSL Financial Allocation at 01 March 2024 201.592 2023/24 NHSL Financial Allocation to North Lanarkshire HSCP £m 2023/24 North Lanarkshire HSCP Financial Allocation 333.065 Set-Aside Budget 70.502 South Hosted @ 52% 37.901 Family Health Service South @ 52% 116.616 NHSL Financial Allocation at 30 June 2023 558.084 Budget Adjustments Posted in Month 4 1.845 Draw Down From Reserves Pay Award Uplift Including One-Off Payments 14.592 Scottish Government 2% Uplift to Resource Transfer and Contracts 1.135 Scottish Government Non Recurring Ring Fenced Monies 7.073 Increase in Hosted Services Led by South 1.843 Increase in Area Wide Services 0.571 Other Budget Adjustments 0.185 NHSL Financial Allocation at 31 July 2023 585.328 Budget Adjustments Posted in Month 5 4.985 Draw Down From Reserves NHS Lanarkshire Unscheduled Care Reserve -2.790 North Lanarkshire Council Provider Sustainability Payment 0.220 Scottish Government Non Recurring Ring Fenced Monies 0.125 Increase in Hosted Services Led by South 1.058 Other Budget Adjustments 0.200 NHSL Financial Allocation at 31 August 2023 589.126 Budget Adjustments Posted in Month 6 3.276 Draw Down From Reserves Increase in Family Health Services 3.944 Medical Pay Award 1.705 Funding from NES and Digitial Therapy Posts 0.366 Decrease in Hosted Services Led by South -0.142 Other Budget Adjustments 0.027 NHSL Financial Allocation at 30 September 2023 598.302 Budget Adjustments Posted in Month 7 1.653 Draw Down From Reserves Funding from NES & Glasgow 0.419 Increase in Hosted Services Led by South 0.059 Other Budget Adjustments 0.127 NHSL Financial Allocation at 31 October 2023 600.560 Budget Adjustments Posted in Month 8 0.999 Draw Down From Reserves Non-Recurring Pay Award -2.329 Service Level Agreements Uplifts 0.728 Funding for Dementia Post 0.430 Increase in Hosted Services Led by South 3.060 NHSL Financial Allocation at 30 November 2023 603.448 Budget Adjustments Posted in Month 9 1.788 Draw Down From Reserves Non-Recurring Taskforce Funding 0.258 Non-Recurring Hospital @ Home 0.188 Non-Recurring Pharmacy Tariff Increase 1.598 Funding from NES 0.162 Other Budget Adjustments 0.117 NHSL Financial Allocation at 31 December 2023 607.559 Budget Adjustments Posted in Month 10 0.625 Draw Down From Reserves Increase to Notional Set-Aside Budget 4.035 Other Budget Adjustments 0.112 NHSL Financial Allocation at 31 January 2024 612.331 Budget Adjustments Posted in Month 11 0.695 Draw Down From Reserves Non-Recurring Income Various 0.464 Increase in Hosted Services Led by South 0.024 Other Budget Adjustments 0.034 NHSL Financial Allocation at 29 February 2024 613.548 Budget Adjustments Posted in Month 12 0.625 Draw Down From Reserves Childcare Flu & Shingles Vaccines Funding 2.288 Hospital at Home Funding 0.801 Other Budget Adjustments -0.008 NHSL Financial Allocation at 31 March 2024 617.254 Appendix 4
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APPENDIX 5 IJB FINAL OUTTURN 2023/24 - Transferred to Reserves Scottish Government Ring-Fenced Reserves £m Realignment to Existing Reserves £m Increase to Existing Contingency Reserves £m Total Underspend 2023/24 £m Alcohol and Drug Partnership Funding 3.597 3.597 Blood-Borne Viruses Services 0.068 0.068 District Nursing 0.292 0.292 Family Nurse Practitioner Funding 0.072 0.072 Fraility Nursing 0.401 0.401 Hospital at Home Services 0.424 0.424 Learning Disabilities Health Checks 0.245 0.245 Long Covid Pathways 0.233 0.233 Mental Health Action 15 0.154 0.154 Mental Health Covid Clinicians (Cossette) 0.052 0.052 Mental Health Diagnostic Support Dementia Post 0.430 0.430 Mental Health Digital Therapy Post 0.111 0.111 Mental Health Distress Brief Intervention 3.397 3.397 North Planning Band 2-4 Posts & Multi-Disciplinary Teams 2.719 2.719 PCR Prison Care Network Transforming Nursing Posts 0.013 0.013 Pharmacy Mental Health & NES Training 0.341 0.341 School Nursing 0.622 0.622 Specialist Doctor Contracts 0.194 0.194 Adaptations Fund 0.309 0.309 Adult Protection Post (shared between Children & Families and NHSL) 0.034 0.034 Advocacy Services 0.013 0.013 Planned Date of Discharge – Locality Social Worker Post (0.015) (0.015) Staff Training Academy 0.183 0.183 Contingency Balance Held by NHSL 2.014 2.014 Contingency Balance Held by NLC 2.807 2.807 Total Transferred to Reserves 13.365 0.524 4.821 18.710
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North Lanarkshire IJB Appendix 6 Movement on Reserves Audit Trail NHSL & NCL LEAD RING-FENCED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 2.926 3.597 (2.926) 3.597 0.671 ✓ ✓ 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Displaced Persons 0.250 (0.144) 0.106 (0.144) ✓ ✓ 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.171 0.068 (0.046) 0.194 0.023 ✓ ✓ 1, 2, 4, 5 NHSL Children and Adolescent Mental Health Services 4.101 (1.252) 2.849 (1.252) ✓ ✓ 1, 2, 4, 5 NHSL Community Living Change Fund 1.298 (0.134) 1.164 (0.134) ✓ ✓ 1, 4, 5 NHSL District Nursing 0.376 0.292 (0.376) 0.292 (0.084) ✓ ✓ 1, 2, 3, 4, 5 NHSL Family Nurse Practitioner Funding 0.072 0.072 0.072 ✓ 1, 2, 3, 4, 5 NHSL Frailty Nursing 0.401 0.401 0.401 ✓ 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.621 0.425 (0.084) 0.962 0.341 ✓ ✓ 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.246 0.245 0.491 0.245 ✓ ✓ 2, 3 NHSL Long Covid Pathways 0.764 0.016 (0.547) 0.234 (0.530) ✓ ✓ 2, 3, 4, 5 NHSL Mental Health Action 15 3.930 0.155 (3.356) 0.729 (3.201) ✓ ✓ 1, 2, 4, 5 NHSL Mental Health Covid Clinicians (Cossette) 0.200 0.052 (0.200) 0.052 (0.148) ✓ ✓ 1, 2, 4, 5 NHSL Mental Health - Diagnostic Support Service Dementia Post 0.751 0.430 (0.209) 0.972 0.221 ✓ ✓ 1, 2, 3, 4, 5 NHSL Mental Health Digital Therapy Post 0.111 0.111 0.111 ✓ 1, 2, 3, 4, 5 NHSL Mental Health Distress Brief Intervention 3.155 3.397 (3.155) 3.396 0.241 ✓ ✓ 1, 2, 4, 5 NHSL Mental Health Eating Disorders 0.070 (0.034) 0.036 (0.034) ✓ ✓ 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.100 (0.026) 0.074 (0.026) ✓ ✓ 1, 2, 4, 5 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 (0.811) 1.029 (0.811) ✓ ✓ 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 0.933 2.719 (0.933) 2.719 1.786 ✓ ✓ 1, 2, 3, 4, 5 NHSL PCR Prison Care Network Transforming Nursing Rolls 0.013 0.013 0.013 ✓ 1, 2, 3, 4, 5 NHSL Pharmacy Mental Health Recovery & NES Training 0.341 0.341 0.341 ✓ 1, 2, 3, 4, 5 NHSL School Nursing 0.622 0.622 0.622 ✓ 1, 2, 3, 4, 5 NHSL Specialist Doctor Contracts 0.194 0.194 0.194 ✓ 1, 2, 3, 4, 5 NHSL Staff Wellbeing 0.254 0.254 0.000 ✓ 3 NHSL Third Sector Initiatives To Improve Health 0.306 (0.059) 0.247 (0.059) ✓ ✓ ✓ 1, 2, 3, 4, 5 NHSL Unscheduled Care Funding 3.120 (0.330) 2.790 (0.330) ✓ 1, 2, 3, 4, 5 NHSL Upper GI Dietetics Band 4 0.033 (0.006) 0.027 (0.006) ✓ ✓ 3 TOTAL RING-FENCED RESERVES 25.593 12.818 (14.297) 24.114 (1.479) LEAD EARMARKED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Adult Social Care Winter Preparedness Fund 1.941 (0.941) 1.000 (0.941) ✓ ✓ 1, 2, 3, 4, 5 NLC Adaptations Fund 0.289 0.408 (0.388) 0.308 0.019 ✓ ✓ 2, 4 NLC Adult Protection (share with C&F and NHSL) 0.050 0.034 (0.034) 0.050 0.000 ✓ ✓ 1, 2, 4, 5 NLC Advocacy Services 0.118 0.013 (0.066) 0.065 (0.053) ✓ ✓ 1, 2, 4, 5 NHSL Breast Feeding Team (2 year funding) 0.828 (0.123) 0.705 (0.123) ✓ ✓ 1, 2, 5 NLC Business Case - Non-Recurring NLC Costs 3.811 0.001 (2.493) 1.319 (2.492) ✓ ✓ 1, 2, 3, 4, 5 NLC Carers Act 2018 - Support 2.643 0.058 (0.105) 2.596 (0.047) ✓ ✓ ✓ 1, 2, 4, 5 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 (0.078) 0.268 (0.078) ✓ ✓ 4 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.414 (0.307) 0.107 (0.307) ✓ ✓ 3 NHSL Development of Chryston Community Health Clinic 0.212 0.212 0.000 ✓ 1, 5 NHSL Dietetics Services - Double Running Costs 0.110 (0.046) 0.064 (0.046) ✓ ✓ NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.588 (0.123) 0.465 (0.123) ✓ ✓ 2, 3 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 3.776 (0.077) 3.699 (0.077) ✓ ✓ ✓ 2, 3 NLC Digital and IT Strategy Technology Improvements - Other 0.566 (0.177) 0.389 (0.177) ✓ ✓ NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.700 0.000 ✓ 2, 3 NLC Financial Strategy - Changes to LA Services Muirpark 1.099 (0.311) (0.761) 0.027 (1.072) ✓ ✓ NHSL Health Inequalities - Screening 0.071 (0.027) 0.044 (0.027) ✓ ✓ 2 NHSL Health Visiting Students/Trainees 0.484 0.090 (0.263) 0.311 (0.173) ✓ ✓ 3 NLC Home Support Resilience (2 year funding) 3.498 0.148 (2.990) 0.656 (2.842) ✓ ✓ 3, 4 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.187 (0.101) 0.087 (0.101) ✓ ✓ 3 NLC IJB Helpline (2 years funding) 0.575 (0.215) 0.360 (0.215) ✓ ✓ 1, 4, 5 NHSL Kylepark Works 1.578 (1.444) 0.134 (1.444) ✓ ✓ 4, 5 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.069 0.120 (0.027) 0.162 0.093 ✓ ✓ 3, 4 NHSL Mental Health Wards Window Replacement 0.650 0.650 0.000 ✓ 2, 4 NHSL Minor Capital Works 1.162 (0.135) 1.027 (0.135) ✓ ✓ 3 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.550 (0.100) 0.450 (0.100) ✓ ✓ ✓ 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 ✓ 3 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.881 (0.312) 0.569 (0.312) ✓ ✓ 1, 2, 3 NLC Planned Date of Discharge - Discharge To Assess 0.304 (0.195) 0.109 (0.195) ✓ ✓ 1, 5 NHSL Podiatry Services - Foot Screening 0.426 (0.076) 0.350 (0.076) ✓ ✓ 1, 2 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 (0.050) 0.020 (0.050) ✓ ✓ 3 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 ✓ ✓ 3 NHSL Scottish Clinical Leadership Fellowship 0.100 (0.040) 0.060 (0.040) ✓ ✓ 3 NHSL Sexual Health Services - Forensic Medical 0.175 0.035 (0.058) 0.152 (0.023) ✓ ✓ 1, 2 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.491 (0.087) 0.404 (0.087) ✓ ✓ 1, 2 NLC Social Care Contracting Staff within Quality Assurance Services 0.003 0.157 (0.073) 0.087 0.084 ✓ ✓ 3 NLC/NHSL Staff Training Academy 2.400 0.183 (0.541) 2.042 (0.358) ✓ ✓ ✓ 3 NHSL Vulnerable and Complex Cases - Test of Change 1.092 (0.276) 0.816 (0.276) ✓ ✓ 5 TOTAL EARMARKED RESERVES 32.767 0.936 (12.727) 20.976 (11.791)
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(22.421) Appendix 6 Continued LEAD RISK-BASED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 31 March 2024 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Prescribing Fund 4.361 3.835 (3.835) 4.361 0.000 ✓ ✓ ✓ 2, 4 NLC Social Care Demand 8.591 7.138 (3.045) 12.684 4.093 ✓ ✓ ✓ 2, 4 TOTAL RISK-BASED RESERVES 12.952 10.973 (6.880) 17.045 4.093 LEAD CONTINGENCY FUND RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Contingency Balance Held By NHSL 8.060 5.330 13.390 5.330 ✓ ✓ TOTAL CONTINGENCY FUND RESERVES 8.060 5.330 0.000 13.390 5.330 LEAD CLOSED RESERVES Opening Balance As At 1 April 2023 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2024 Movement in Reserves 2023/24 To Be Drawn Down 2023/24 To Be Drawn Down 2024/25 Ongoing Ambition Statement & Performance £m £m £m £m £m NHSL Alcohol and Drug Partnership - Local Implementation Plan 0.167 (0.167) 0.000 (0.167) ✓ 1, 2, 4, 5 NHSL Alcohol and Drug Partnership - Long Acting Buprenorphine 0.255 (0.255) 0.000 (0.255) ✓ 1, 2, 4, 5 NHSL Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 (0.123) 0.000 (0.123) 1, 2, 4, 5 NHSL Area Wide Services - NES Training 0.132 0.006 (0.138) 0.000 (0.132) ✓ 3 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 (0.034) 0.000 (0.034) 1, 2, 4, 5 NHSL Assistive Technology Contract x 12 months (ATC) 0.008 (0.008) 0.000 (0.008) 3, 4 NHSL Business Case - Health Care Support Workers, Multi-Disciplinary Teams 1.797 (1.797) 0.000 (1.797) ✓ 1, 2, 3, 4, 5 NHSL Care Homes Allocation 0.318 (0.318) 0.000 (0.318) 2, 5 NHSL Champions Board, Promise & Public Potection Joint Resourcing Funding 0.172 (0.172) 0.000 (0.172) 1, 2, 4, 5 NHSL Covid-19 Funding 0.007 (0.007) 0.000 (0.007) ✓ 2, 3, 4, 5 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 (0.107) 0.000 (0.107) 3 NHSL Distinction Awards 0.036 (0.036) 0.000 (0.036) 3 NHSL Forensic Band 3 x 5 WTE 0.147 (0.147) 0.000 (0.147) 3 NHSL GPIT Reprovisioning Gap 0.181 (0.181) 0.000 (0.181) 1, 2, 4, 5 NHSL Integrated Authority Support 4.926 (4.926) 0.000 (4.926) 1, 2, 3, 4, 5 NHSL Learning Disabilities Band 3 x 4 FTE 0.118 (0.118) (0.000) (0.118) ✓ 3 NLC Local Government Pay Award 23/24 2.653 0.177 (2.830) 0.000 (2.653) ✓ 3 NLC Long Covid Contingency 1.949 (1.949) 0.000 (1.949) 2, 3, 4, 5 NHSL Medical Director - Child Death Review Funding 0.012 (0.012) 0.000 (0.012) ✓ 2 NHSL Mental Health Pharmacy Recovery Plan 0.175 (0.175) 0.000 (0.175) ✓ 1, 2, 4, 5 NHSL Mental Health Perinatal, Infant, Maternity and Neonatal 0.005 (0.005) 0.000 (0.005) ✓ 1, 2, 4, 5 NHSL Mental Health Psychology Posts 0.670 (0.528) (0.142) 0.000 (0.670) ✓ 1, 2, 3, 4, 5 NHSL NES SLA Pharmacy Training 0.173 (0.173) 0.000 (0.173) ✓ 3, 4 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.077 (0.015) (0.062) 0.000 (0.077) ✓ 3 NHSL Psychology Posts 2 x Band 6 0.098 (0.098) 0.000 (0.098) 3 NLC Social Care Regrading of Staff (SSW, SP, SW, OT, TL and TM) 3.169 (2.823) (0.346) 0.000 (3.169) ✓ 3 NHSL Stigma Free Lanarkshire (3 year funding) 0.450 (0.450) 0.000 (0.450) ✓ 2, 4 NHSL Supervisor Training 0.065 (0.065) 0.000 (0.065) 3 NHSL Test and Protect Funding 0.520 (0.520) 0.000 (0.520) ✓ 1, 2 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 (0.030) 0.000 (0.030) ✓ 1, 2, 4, 5 TOTAL CLOSED RESERVES 18.574 (11.347) (7.227) (0.000) (18.574) TOTAL RESERVES 97.946 18.710 (41.132) 75.525 (22.421) KEY Ambition Statement & Performance 1 Do the right thing first time. 2 Increased focus on prevention, early intervention and tackling inequalities by working with communities and people. 3 Develop and support a workforce for the future. 4 Improve mental health and wellbeing. 5 Supporting people through a whole family approach.
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Analysis of Additional Employee Costs 2023/24 Period BANKAIDE COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 74,898 36,739 35,561 69,550 331,019 10,506 558,273 2 67,549 30,009 34,077 52,510 234,588 8,215 426,948 3 71,996 33,984 29,543 55,338 233,159 7,164 431,184 4 77,147 49,890 31,916 62,994 337,320 8,162 567,429 5 73,672 36,828 42,883 48,749 315,567 8,740 526,439 6 73,701 50,064 34,181 47,520 320,258 7,555 533,279 7 64,435 42,627 29,527 43,917 240,358 6,547 427,411 8 55,201 42,019 24,288 45,014 240,941 6,029 413,492 9 62,864 44,132 26,592 59,452 291,603 7,046 491,689 10 48,587 33,879 22,401 41,949 234,626 5,411 386,853 11 48,967 43,102 18,134 50,434 256,743 5,637 423,017 12 50,014 51,512 21,266 60,547 311,718 3,877 498,934 TOTAL 769,031 494,785 350,369 637,974 3,347,900 84,889 5,684,948 Period AGENCY COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 42,416 - 2,717 1,571 406,062 -13,522 439,244 2 62,289 2,876 25,213 6,576 389,942 32,744 519,640 3 27,805 2,262 9,143 - 405,161 36,290 480,661 4 5,197 16,099 14,458 25,834 377,191 53,866 492,645 5 6,542 734 11,784 28,422 415,155 44,091 506,728 6 9,846 10,346 19,352 21,284 438,512 5,887 505,227 7 6,662 3,251 17,960 1,081 355,250 40,989 425,193 8 17,479 - 21,870 - 367,171 47,998 454,518 9 31,763 10,274 14,935 - 337,877 41,651 436,500 10 12,763 12,594 15,304 - 379,646 24,639 444,946 11 9,208 5,205 23,130 - 327,419 11,714 376,676 12 7,268 3,949 13,745 652 423,528 8,319 457,461 13 41,576 41,576 TOTAL 239,238 67,590 189,611 85,420 4,622,914 376,242 5,581,015 Period OVERTIME COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ Home Support £ Other £ TOTAL £ 1 15,591 5,617 9,055 25,740 47,690 4,691 87,355 5,664 201,403 2 13,874 6,412 7,221 23,070 40,800 86,847 309,302 4,051 491,577 3 13,617 5,469 5,833 24,261 40,838 105,859 304,161 2,651 502,689 4 11,666 3,537 6,890 19,867 38,083 85,974 314,146 2,718 482,881 5 18,101 4,007 4,757 20,670 53,362 87,461 355,153 3,486 546,997 6 10,892 7,970 4,565 22,477 44,961 92,742 358,190 3,201 544,998 7 14,033 5,262 4,075 12,600 46,278 86,480 350,687 1,162 520,577 8 10,831 6,048 8,322 13,901 45,513 88,577 364,293 589 538,074 9 12,467 7,133 4,360 15,899 39,353 105,900 514,029 699 699,840 10 11,273 6,246 5,950 12,955 32,012 99,595 319,748 737 488,516 11 7,700 6,736 4,926 11,511 31,410 55,090 359,500 1,452 478,325 12 7,317 7,074 7,098 12,878 37,634 102,611 373,566 3,929 552,107 13 199,562 691,512 891,074 TOTAL 147,362 71,511 73,052 215,829 497,934 1,201,389 4,701,642 30,339 6,939,058 Period EXCESS PART TIME COSTS YEAR TO DATE North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Other £ TOTAL £ 1 6,273 4,839 7,436 7,174 11,599 2,093 39,414 2 3,055 1,717 5,869 5,494 6,373 2,626 25,134 3 4,200 2,878 7,399 5,563 6,369 972 27,381 4 3,944 2,268 6,222 5,946 5,735 2,039 26,154 5 3,958 2,798 8,666 7,518 5,736 2,723 31,399 6 3,725 1,451 9,861 3,175 4,302 2,020 24,534 7 4,084 2,024 12,318 7,358 5,005 1,370 32,159 8 2,121 910 9,672 8,200 5,730 1,289 27,922 9 2,468 289 9,507 8,144 6,745 1,135 28,288 10 2,066 2,110 6,562 6,723 7,858 876 26,195 11 2,205 1,086 6,650 7,554 4,940 1,083 23,518 12 2,600 1,751 6,808 8,712 6,013 1,323 27,207 TOTAL 40,699 24,121 96,970 81,561 76,405 19,549 339,305 Appendix 7