ITEM 8 Financial Monitoring Report February 25
North Lanarkshire Council · 25 February 2025
Back to IJB Performance, Finance and Audit Committee — 25 February 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
REPORT Item No: 8 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 period 1 April 2024 to 30 November 2024. 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 contents of the report; and (2) Acknowledge the projected outturn for 2024/25 is an underspend of £1.454m 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 Chief Officer (Finance). 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 table 1, the IJB projected outturn position, prior to removal of ring- fenced funding, is an underspend of £1.454m, assuming the current trajectory of spend continues until the end of this financial year. SUBJECT: Financial Monitoring Report 2024/25 TO: IJB Performance, Finance and Audit Committee Lead Officer for Report: Chief Officer Author(s) of Report Chief Finance Officer DATE: 25 February 2025 Yes No N/A
Page 2
Table 1 6.2 Appendices 1 to 3 show a detailed revenue budget position for each care group above. 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, additional commitments relating to the Strategic Commissioning Plan and any funding gap which has been highlighted in the North Lanarkshire IJB financial plans. 7. 2024/25 FINANCIAL PERFORMANCE 7.1 The current financial forecast for 2024/25 projects a yearly underspend of £1.454m 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 – underspend of £15.920m As highlighted throughout 2024/25, 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 skill 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 within Social Care. 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) – overspend of £4.341m This overspend is primarily in relation to anticipated spend in Independent Care Homes and also within ‘Care at Home’ through self-directed support (SDS) plans. These projections are demand led and are based on full year costs for both current clients and those anticipated, therefore projections will alter as the year progresses, updates will be provided in future reports. Further details are provided below: • Independent care homes have a yearly budget to fund 1,367 care plans but at present the number of care plans is 1,468 resulting in an overspend of £2.015m. • Car at Home costs are projected to overspend by £3.364m, the budget is based on funding 2,617 care plans however the actual plans in place total 2,689. These costs are partially offset by minor underspends across other areas within payments to other bodies. £m £m £m £m £m Health Care Services 545.965 12.426 558.391 558.312 0.079 Social Care Services 263.874 0.000 263.874 262.499 1.376 TOTAL 809.839 12.426 822.265 820.811 1.454 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
Page 3
7.1.3 Transport – overspend of £0.548k The overspend is attributed to an increase in running costs associated with the home support additional pool cars that were purchased during 2024/25 along with an increase in staff mileage claims. 7.1.4 Prescribing – overspend of £6.696m This projected overspend is based on actual prescribing data available to September 2024 and estimated data for October and November 2024. The forecast will be updated as further data becomes available. Based on data received to date the cost per item has increased to £10.51, and the number of items being dispensed has increased by 1.3% based on the same period in 2023-24. Therefore, the projected overspends is attributable to both the number of medicines being prescribed and dispensed in community pharmacies remaining at high levels alongside higher prices. This is exacerbated by the fact that there hasn’t been an inflationary increase added to 2024-25 annual budget. 7.1.5 North Lanarkshire Hosted Services – projected underspend of £1.934m The main areas reporting an underspend within hosted services include speech and language therapy, children and adolescent mental health services and podiatry services. The underspends in this area are partially offset by the following areas of concern: • Continence Services – overspend of £0.792m which is related to product costs within both the care home environment and within the community. • Children Services Diabetic Nursing – overspend of £1.565m which is mainly due to additional expenditure relating to diabetic glucose monitoring machines and insulin pumps. • Prisoner Healthcare – overspend of £0.852m due to the increase in costs linked to the delivery of the new pharmacy contract and drug prices associated with prescribing. • Mental Health Eating Disorders – overspend of £0.339m relating to the day bed charges of Lanarkshire patients within the Priory. 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 table 2 shows the current funding allocation received from Scottish Government during 2024/25.
Page 4
Table 2 7.3 Directors should note the Mental Health funding original allocation for 2024/25 did not cover all the partnerships current Mental Health commitments. However, following numerous discussions with the Scottish Government an additional allocation has been awarded on a one-off basis bringing the total allocated for the year up to £17.329m. As shown in table 3 the projected spend against this is currently £16,231m and the reason for this underspend is the result of vacancies being held during the year when the funding commitment was uncertain. 7.4 The 2025/26 allocation from Scottish Government has been budgeted at £14.8m however the NHSL draft financial plan includes an additional allocation to the partnership of £2.5m to address the shortfall. It is anticipated that the full £17.329m will be utilised during 2025/26 as Managers will be permitted to recruit to this value. Table 3 Scottish Government Allocations as at 30 November 2024 £m Alcohol and Drug Partnership Funding 1.684 Band 7 OPAT Post 0.069 Digital Mental Health Licences 0.120 Distress Brief Intervention 2.780 Family Nurse Partnership 1.074 Hospital at Home 0.276 Long Covid Support Fund 0.224 Meningitis C 0.106 Mental Health Outcomes 0.166 Specialty and Specialist Doctors Contract 0.194 V1P & ICU Funding 0.170 Dementia Post 0.431 Enhanced Mental Health Outcomes Framework 14.829 TOTAL 22.122 Funding Forecast £m £m Scottish Government Allocation 14,829 Top Up 2,500 Action 15 3,965 Perinatal 590 Infant 433 Neonates 190 Child and Adolescent Mental Health Services 5,642 Psychologists 1,643 Historical Mental Health 2,378 Learning Disability Health checks 23 School Nursing North 729 School Nursing South 638 TOTAL 17,329 16,231
Page 5
8. GENERAL RESERVES 8.1 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 statute and is part of a range of measures in place to ensure that s106 public bodies do not over- commit themselves financially. 8.2 The current IJB reserves position for 2024/25 after adjustments for the drawdown of in-year reserves, is a revised balance of £63.098m and is summarised in table 4. Table 4 8.3 A detailed list of all reserve movement during 2024/25 is at appendix 5 including a key guidance table showing how the reserves are aligned to our five ambition statements detailed in the Strategic Commissioning Plan 2023-26. 8.4 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. 9. SAVINGS 9.1 The saving delivery plan commenced in April 2024 with a target of £29.093m over financial years 2024/25 and 2025/26. 9.2 CORE management team alongside 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. 9.3 The current IJB savings position at the end of September 2024, show total savings achieved of £9.664m and is summarised in chart 1. Opening Balance As At 1 April 2024 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 £m £m £m £m NHSL Ring-Fenced Reserves 19.281 0.000 (5.630) 13.651 NLC/NHSL Earmarked Reserves 20.955 0.000 (1.693) 19.261 NLC/NHSL Risk-Based Reserves 17.045 0.000 0.000 17.045 NHSL Contingency Reserves 13.390 0.000 (0.250) 13.140 NLC/NHSL Closed Reserves 4.853 0.000 (4.852) 0.001 75.524 0.000 (12.426) 63.098Total LEAD SUMMARY
Page 6
Chart 1 9.4 Appendix 6 shows a detailed list, including target value, of all IJB approved saving plans. 10. VACANCY POSITION 2024/25 10.1 Table 5 shows the full time equivalent (FTE) vacancy numbers at 30 November 2024 within each service compared against their budgeted establishment. Table 5 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 and summarised in Table 6. Establishment Actual Vacancies FTE FTE FTE North West Locality 393.60 366.58 27.02 North East Locality 332.01 310.68 21.33 Adult Services 294.97 282.61 12.37 Children Services 495.19 542.22 -47.03 Mental Health 1,168.67 1,177.33 -8.66 Social Care Services 987.70 838.69 149.01 Home Support 996.57 952.75 43.82 Other 219.08 235.04 -15.96 TOTAL 4,887.79 4,705.90 181.89 Position as at 30 November 2024 Service
Page 7
Table 6 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: Overtime Excess Part Time Bankaide Agency TOTAL £m £m £m £m £m North West Locality 0.058 0.022 0.454 0.011 0.545 North East Locality 0.034 0.013 0.271 -0.002 0.316 Adult Services 0.037 0.048 0.210 0.008 0.303 Children Services 0.107 0.027 0.443 0.172 0.749 Mental Health 0.215 0.054 2.815 2.744 5.828 Social Care Services 0.516 - - 0.011 0.526 Home Support 3.016 - - - 3.016 Other 0.010 0.009 0.037 - 0.056 TOTAL 3.993 0.173 4.228 2.944 11.338 SERVICE Costs As At 30 November 2024 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
Page 8
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 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 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)
Page 9
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 Very High Nicola Scott Prevention and Detection of Fraud, Bribery and/or Corruption Low Claire Rae National Set-Aside Budget High Claire Rae Hosted Services Medium Claire Rae Prescribing Activity and Costs Very High Claire Rae Pharmacy Pressures within Prison Service High Claire Rae Third and Voluntary Sector Low Claire Rae Ineffective Governance Arrangements Low Claire Rae 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 Chief Officer (Finance) within 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 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.
Page 10
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 2024/25 Budget 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 Nicola Scott on telephone number 07816 126362.
Page 11
North Lanarkshire IJB Revenue Budget Position 1 April 2024 to 30 November 2024 Appendix 1 Annual Year To Date Variance Projected Year End Outturn Budget Budget Actual Total Total 2024/25 November 2024 November 2024 November 2024 2024/25 £m £m £m £m £m Health Care Services Locality and Other Services 67.305 43.401 41.600 1.801 2.702 Addiction Services 4.765 2.898 2.893 0.004 0.007 Medical and Nursing Directorate 4.734 3.232 2.949 0.283 0.424 Prescribing 74.360 50.013 54.477 (4.464) (6.696) Out of Area Services 4.318 2.879 2.606 0.273 0.409 Area Wide Services 8.468 4.923 4.702 0.220 0.331 Hosted Services 188.745 132.844 130.910 1.934 2.902 Family Health Services 131.159 91.298 91.298 0.000 0.000 Set-Aside Budget 74.537 49.691 49.691 0.000 0.000 Total Expenditure - NHSL 558.391 381.178 381.126 0.051 0.079 Social Care Services Social Care Services Gross Expenditure 269.367 186.485 185.586 0.899 1.123 Social Care Services Gross Income (7.722) (5.346) (5.400) 0.054 0.078 Social Care Services Net Expenditure 261.645 181.139 180.187 0.952 1.201 Housing Revenue Account 2.229 (1.543) (1.664) (0.121) 0.175 Social Care, Housing and Transport Services Net Expenditure 263.874 179.596 178.522 0.831 1.376 Total Expenditure - NHSL and NLC 822.265 560.774 559.649 0.883 1.454 Annual Budget 2024/25 £m NHS Lanarkshire Funding (545.965) Social Care Funding (23.417) Resource Transfer (23.975) Commissioned Services (6.965) Transfer from Reserves (Approved) (12.426) Total Funding - NHSL (612.748) NLC Funding - Social Care Services (207.288) NLC Funding - Housing Services (2.229) Transfer from Reserves (Approved) 0.000 Total Funding - NLC (209.517) Total Funding - NHSL and NLC (822.265) Care Group Year To Date Funded By:
Page 12
Hosted Services Appendix 2 November 2024 November 2024 November 2024 November 2024 November 2024 November 2024 November 2024 November 2024 November 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 3.607 2.497 2.480 0.017 1.876 1.298 1.281 0.017 1.732 1.198 1.198 0.000 Continence Services 2.527 1.692 2.148 (0.456) 1.314 0.880 1.336 (0.456) 1.213 0.812 0.812 0.000 Immunisation Services 2.218 2.998 2.891 0.108 1.153 1.559 1.451 0.108 1.065 1.439 1.439 0.000 Speech and Language Therapy Services 7.495 5.009 4.366 0.643 3.897 2.605 1.962 0.643 3.598 2.405 2.405 0.000 Children and Adolescents Mental Health Services 9.910 9.331 9.040 0.290 5.153 4.852 4.562 0.290 4.757 4.479 4.479 0.000 Childrens Services 13.113 9.037 10.412 (1.375) 6.819 4.699 6.075 (1.375) 6.294 4.338 4.338 0.000 Integrated Equipment and Adaptations Store 0.817 0.628 0.619 0.009 0.425 0.327 0.317 0.009 0.392 0.302 0.302 0.000 Dietetics Services 4.566 3.107 2.909 0.198 2.375 1.616 1.418 0.198 2.192 1.492 1.492 0.000 Podiatry Services 5.151 3.444 3.105 0.338 2.678 1.791 1.452 0.338 2.472 1.653 1.653 0.000 Prisoner Healthcare Services 2.101 1.412 1.556 (0.144) 1.093 0.734 0.878 (0.144) 1.009 0.678 0.678 0.000 Blood Borne Viruses Services 1.893 1.275 1.109 0.165 0.984 0.663 0.497 0.165 0.908 0.612 0.612 0.000 Hospital at Home 3.212 2.064 2.064 0.001 1.670 1.073 1.073 0.001 1.542 0.991 0.991 0.000 Mental Health and Learning Disability Services 90.089 62.409 60.270 2.139 46.846 32.453 30.314 2.139 43.243 29.957 29.957 0.000 TOTAL 146.699 104.904 102.970 1.934 76.284 54.550 52.616 1.934 70.416 50.354 50.354 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 November 24 November 24 November 24 November 24 November 24 November 24 November 24 November 24 November 24 Budget Actual Variance Budget Actual Variance Budget Actual Variance £m £m £m £m £m £m £m £m £m £m £m £m Community Dental Services 8.524 5.713 5.061 0.652 4.433 2.971 2.971 0.000 4.092 2.742 2.090 0.652 Brain Injury Unit 2.502 1.668 1.584 0.084 1.301 0.868 0.868 0.000 1.201 0.801 0.717 0.084 Out of Hours Services 10.327 6.885 6.248 0.637 5.370 3.580 3.580 0.000 4.957 3.305 2.668 0.637 Palliative Care Services 7.323 4.912 4.870 0.042 3.808 2.554 2.554 0.000 3.515 2.358 2.316 0.042 Physiotherapy Services 12.310 8.207 7.307 0.900 6.401 4.267 4.267 0.000 5.909 3.939 3.039 0.900 Primary Care Services 0.880 0.587 0.506 0.081 0.458 0.305 0.305 0.000 0.423 0.282 0.201 0.081 South Improving Cancer Journey 0.300 0.300 0.300 0.000 0.156 0.156 0.156 0.000 0.144 0.144 0.144 0.000 Occupational Therapy Services 9.039 6.050 5.699 0.351 4.700 3.146 3.146 0.000 4.339 2.904 2.553 0.351 Diabetic Services 5.096 3.037 3.840 (0.803) 2.650 1.579 1.579 0.000 2.446 1.458 2.261 (0.803) Primary Care Improvement Fund 24.556 16.371 16.366 0.005 12.769 8.513 8.513 0.000 11.787 7.858 7.853 0.005 TOTAL 80.858 53.730 51.781 1.949 42.046 27.940 27.940 0.000 38.812 25.791 23.842 1.949 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
Page 13
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 206.811 Set-Aside Budget 74.537 NLC Funding - Housing Services 2.229 South Hosted @ 52% 39.188 NLC Financial Allocation at 11 October 2024 209.040 Family Health Service South @ 52% 124.475 Budget Adjustments Posted in Month 5 NHSL Financial Allocation at 31 May 2024 577.016 Transfer Scottish Living Wage budget to Housing -0.023 NHSL Financial Allocation at 23 August 2024 209.017 Budget Adjustments Posted in Month 3 Budget Adjustments Posted in Month 6 Draw Down From Reserves 1.747 Scottish Living Wage for Childrens Services 0.500 Increase in ERS Usage 1.943 NHSL Financial Allocation at 11 October 2024 209.517 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 Budget Adjustments Posted in Month 4 Draw Down From Reserves 1.626 Non Recurring Funding Hospital at Home 0.442 Other Budget Adjustments 0.084 NHSL Financial Allocation at 31 July 2024 585.929 Budget Adjustments Posted in Month 5 Draw Down From Reserves 2.935 Increase in Hosted Services Led by South 0.087 Veterans 1st Point Funding 0.126 Other Budget Adjustments 0.886 NHSL Financial Allocation at 31 August 2024 589.963 Budget Adjustments Posted in Month 6 Draw Down From Reserves 0.846 Increased income 0.099 Increase in Hosted Services Led by South 5.734 Prescribing adjustments 1.144 Other budget adjustments 0.187 NHSL Financial Allocation at 31 September 2024 597.973 Budget Adjustments Posted in Month 7 Draw Down From Reserves 0.691 Increased income 0.554 Increase in Hosted Services Led by South 1.727 Prescribing adjustments 0.400 AW 0.354 Other budget adjustments 8.019 NHSL Financial Allocation at 31 October 2024 609.718 Budget Adjustments Posted in Month 8 Draw Down From Reserves 0.886 Increased income 0.654 Increase in Hosted Services Led by South 0.465 AW 0.163 Prescribing adjustments 0.520 Other budget adjustments 0.342 NHSL Financial Allocation at 30 November 2024 612.748
Page 14
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 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.597 (1.021) 2.576 (1.021) 1, 2, 4, 5 NHSL Area Wide Services - Refugees and Dis 0.106 (0.025) 0.081 (0.025) 1, 2, 4, 5 NHSL Blood-Borne Viruses Services 0.194 (0.039) 0.155 (0.039) 1, 2, 4, 5 NHSL Children and Adolescent Mental Health 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 Family Nurse Practitioner Funding 0.072 0.072 0.000 1, 2, 3, 4, 5 NHSL Frailty Nursing 0.401 (0.400) 0.001 (0.400) 1, 2, 3, 4, 5 NHSL Hospital at Home Services 0.962 (0.283) 0.679 (0.283) 1, 2, 4, 5 NHSL Learning Disabilities Health Checks 0.491 0.491 0.000 2, 3 NHSL Long Covid Pathways 0.234 (0.257) (0.024) (0.257) 2, 3, 4, 5 NHSL Mental Health Covid Clinicians 0.052 0.052 0.000 1, 2, 4, 5 NHSL Mental Health Diagnostic Support Service Dementia Post 0.972 (0.250) 0.722 (0.250) 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 Eating Disorders 0.036 0.036 0.000 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 0.148 0.148 0.000 1, 2, 4, 5 NHSL North Planning Band 2-4 Posts & Multi-D 2.719 (2.871) (0.152) (2.871) 1, 2, 3, 4, 5 NHSL PCR Prison Care Network Transforming 0.013 (0.012) 0.001 (0.012) 1, 2, 3, 4, 5 NHSL School Nursing 0.622 (0.288) 0.334 (0.288) 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 0.247 (0.172) 0.075 (0.172) 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 (0.013) 0.014 (0.013) 3 19.281 0.000 (5.630) 13.651 (5.630) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Adult Social Care Winter Preparedness F 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 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 (0.196) 0.509 (0.196) 1, 2, 5 NLC Business Case - Non-Recurring NLC 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 0.268 0.268 0.000 4 NHSL Childrens Services - Paediatric Band 7, 0.107 (0.175) (0.068) (0.175) 3 NHSL Development of Chryston Community 0.212 0.212 0.000 1, 5 NHSL Dietetics Services - Double Running 0.064 (0.009) 0.055 (0.009) NLC Digital and IT Strategy Technology 0.465 0.465 0.000 2, 3 NLC Digital and IT Strategy Technology 3.699 3.699 0.000 2, 3 NLC Digital and IT Strategy Technology 0.389 0.389 0.000 NLC Digital and IT Strategy Technology 0.700 0.700 0.000 2, 3 NLC Financial Strategy - Changes to LA 0.027 0.027 0.000 NHSL Health Inequalities - Screening 0.044 (0.019) 0.025 (0.019) 2 NHSL Health Visiting Students/Trainees 0.311 (0.223) 0.088 (0.223) 3 NLC Home Support Resilience (2 year 0.656 0.656 0.000 3, 4 NHSL HR Employability Team (2 year funding 50:50 split between North and 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 0.162 0.162 0.000 3, 4 NHSL Mental Health Wards Window 0.650 0.650 0.000 2, 4 NHSL Minor Capital Works 1.027 1.027 0.000 3 NHSL Neonatal & Paediatrics Dieteics 0.450 (0.129) 0.321 (0.129) 1, 2, 5 NHSL Organisational Development Fund 0.260 0.260 0.000 3 NHSL Paediatric Diabetes Insulin Pumps and 0.569 (0.031) 0.538 (0.031) 1, 2, 3 NLC Planned Date of Discharge - Discharge 0.109 0.109 0.000 1, 5 NHSL Podiatry Services - Foot Screening 0.350 (0.004) 0.346 (0.004) 1, 2 NHSL Regrading of Posts Including Backpay 0.250 0.250 0.000 3 NHSL Scottish Clinical Leadership Fellowship 0.060 (0.025) 0.035 (0.025) 3 NHSL Sexual Health Services - Forensic 0.152 (0.127) 0.025 (0.127) 1, 2 NHSL Sexual Health Services - Long-Acting 0.404 (0.077) 0.327 (0.077) 1, 2 NLC Social Care Contracting Staff within 0.087 0.087 0.000 3 NLC/NHSL Staff Training Academy 2.042 (0.443) 1.599 (0.443) 3 NHSL Vulnerable and Complex Cases - Test 0.816 (0.236) 0.580 (0.236) 5 20.955 0.000 (1.693) 19.261 (1.693) Ambition Statement & Performance APPENDIX 5 Ambition Statement & Performance To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing Ongoing TOTAL RING-FENCED RESERVES LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 LEAD RING-FENCED RESERVES
Page 15
Opening Balance As At 1 April 2024 Transfers To / From Reserves Pending Drawdown from Reserves Revised Balance As At 30 November 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 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL Contingency Balance Held By NHSL 13.390 (0.250) 13.140 (0.250) 13.390 0.000 (0.250) 13.140 (0.250) Opening Balance As At 1 April 2024 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 30 November 2024 Movement in Reserves 2024/25 £m £m £m £m £m NHSL District Nursing 0.292 (0.292) 0.000 (0.292) 1, 2, 3, 4, 5 NHSL Mental Health Action 15 0.729 (0.730) (0.000) (0.730) 1, 2, 4, 5 NHSL Mental Health Distress Brief Intervention 3.396 (3.396) 0.000 (3.396) 1, 2, 4, 5 NHSL Mental Health Neurodevelopmental Pathways 0.074 (0.074) 0.000 (0.074) 1, 2, 4, 5 NHSL Pharmacy Mental Health Recovery & NE 0.341 (0.341) (0.000) (0.341) 1, 2, 3, 4, 5 NHSL Prisioner Healthcare - Transitional 0.020 (0.019) 0.001 (0.019) 3 4.853 0.000 (4.852) 0.001 (4.852) 75.524 0.000 (12.426) 63.098 (12.426) KEY 1 2 3 4 5 LEAD CONTINGENCY FUND RESERVES To Be Drawn Down 2024/25 To Be Drawn Down 2025/26 Ongoing APPENDIX 5 (CONTD) 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
Page 16
APPENDIX 6 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 1 Ongoing Prescribing Savings 2.280 1.309 1.309 0.971 GREEN 2 Financial Management - North Consequential Funding 3.446 3.446 3.446 0.000 GREEN 3 Service Redesign: Mental Health Hospital Based Complex Care Contracted Beds 2.600 0.263 0.263 2.337 RED 4 Review of Discretionary Spend 2.188 0 0.000 2.188 RED 5 Review of Supplementary Staffing 0.982 0.959 0.959 0.023 GREEN 6 Workforce Management and Service Redesign 4.699 0.927 0.927 3.772 RED 7 Financial Management - Support Costs and Vacancy Review 1.486 0.777 0.777 0.709 GREEN 17.681 7.681 0.000 7.681 10.000 2024/25 2025/26 Achieved to Date Achieved to Date £m £m £m £m £m 8 Financial Management - Overspends 4.827 0 0.000 4.827 RED 9 Service Redesign: Review of Provision of Registered Social Landlords 0.600 0.293 0.293 0.307 GREEN 10 Review of Supplementary Staffing 0.750 0.75 0.750 0.000 GREEN 11 Service Redesign and Contract Review 0.400 0.485 0.485 (0.085) GREEN 12 Review of Operating Model Supporting Back to Basics 3.825 0.135 0.135 3.690 RED 13 Financial Management - Vacancy Review 1.000 0.32 0.320 0.680 RED 11.402 1.983 0.000 1.983 9.419 29.083 9.664 0.000 9.664 19.419 Reference 1 2 3 4 5 6 7 8 Reference 8 9 10 11 12 13 Adult Social Care Services Savings Delivery Plan 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. Health Care Services RAG Rating Adult Social Care Services RAG Rating North Lanarkshire IJB 2024/25 & 2025/26 - 2 Year Savings Delivery Plan Total Health Care Services Reference Reference Outstanding Target to Date 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. Total Adult Social Care Services TOTAL Total Achieved 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. 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. 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.
Page 17
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 58,802 28,506 17,872 45,313 315,928 4,243 470,664 5 61,261 31,359 29,225 52,339 399,493 4,356 578,033 6 49,005 24,134 22,906 47,399 332,879 3,695 480,018 7 60,542 27,518 26,314 48,610 346,546 4,197 513,726 8 81,265 47,032 47,065 94,164 482,507 5,357 757,389 9 0 10 0 11 0 12 0 TOTAL 453,697 270,507 210,003 442,525 2,814,634 36,941 4,228,307 North West Locality £ North East Locality £ Adult Services £ Children Services £ Mental Health £ Social Care Services £ TOTAL £ 1 6,112 -1,743 -17 - 286,364 - 290,716 2 - - 606 -80 569,840 - 570,366 3 1,526 - 1,229 - 337,115 - 339,870 4 1,280 - 51,839 - 335,537 - 388,656 5 528 - -33,399 - 351,443 2,311 320,883 6 1,352 0 606 0 290,147 0 292,105 7 0 -428 -11,959 4,286 282,409 0 274,308 8 569 0 -1,096 167,781 291,259 5,732 464,245 9 2,626 2,626 10 0 11 0 12 0 13 0 TOTAL 11,367 -2,171 7,809 171,987 2,744,114 10,669 2,943,775 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 7,253 5,666 3,373 17,206 29,554 48,786 385,446 1,407 498,691 5 6,018 1,257 7,614 10,756 19,232 40,111 412,126 253 497,367 6 7,059 714 5,354 12,415 30,811 60,954 400,282 490 518,079 7 4,767 2,620 3,308 13,841 24,698 63,268 360,760 2,293 475,555 8 6,319 1,819 2,563 10,898 27,613 80,104 408,207 1,451 538,974 9 77,587 412,013 489,600 10 0 11 0 12 0 13 0 TOTAL 58,223 34,084 37,084 107,329 214,634 515,526 3,015,957 10,386 3,993,223 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 2,606 991 5,042 3,474 5,352 1,315 18,780 5 1,732 2,785 5,716 1,863 6,623 966 19,685 6 2,353 632 7,455 1,266 7,388 554 19,648 7 3,283 307 8,342 4,200 6,327 1,087 23,546 8 3,199 1,606 5,031 2,974 6,134 1,246 20,190 9 0 10 0 11 0 12 0 TOTAL 21,834 13,175 47,848 27,150 54,371 8,753 173,131 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