Item 8 - Financial Monitoring
North Lanarkshire Council · 21 June 2023
Back to IJB Performance, Finance and Audit Committee — 21 June 2023 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
Page 1
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 year-end position of the North Lanarkshire Health and Social Care Partnership (HSCP) for the financial year 2022/2023 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 2022/23; and (2) Approve the proposed transfers to General Reserves at para 7.2 and 7.3 of this report. 4. VARIATIONS TO DIRECTIONS 5. BACKGROUND/SUMMARY OF KEY ISSUES 5.1 This report is based on the financial monitoring reports received from NHS Lanarkshire Director of Finance and North Lanarkshire Council Head of Financial Solutions. The position detailed in these reports is therefore based on the information contained in each partner’s respective financial systems and includes accruals and adjustments in-line with their financial policies. 6. CONCLUSIONS 6.1 Budget monitoring throughout 2022/23 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 £35.495m. SUBJECT: Financial Monitoring Report 2022/2023 TO: Performance, Finance and Audit Committee Lead Officer for Report: Ross McGuffie, Chief Officer NHSCP Author(s) of Report Amanda Kilburn, Chief Finance Officer DATE: 21 June 2023 Yes No N/A
Page 2
2 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 £14.084m. 6.4 The table below shows the 2022/23 outturn position for North Lanarkshire IJB before and after the transfer of Scottish Government and NHS Lanarkshire ring- fenced funding to reserves: Service 2022/23 £m Health Care Services £25.617m Social Care Services £9.878m Total North Lanarkshire HSCP (prior to transfer of ring-fenced reserves) £35.495m Ring-Fenced Funding (£21.411m) Revised Outturn Total 2022/2023 £14.084m 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 is highlighted in the North Lanarkshire IJB Medium Term Financial Plan 2023-2026. 6.6 There are a number of reasons for the operational underspend of £14.084m (excluding ring-fenced funding), and these include: Employee Costs net underspend of £9.107m: 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. Payments to Other Bodies net underspend of £1.511m: 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. Admin Costs net underspend of £1.431m: 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. This has been transferred to a dedicated earmark reserve to fund carers pressures in 2023/24. Income over recovery of £6.031m: for social care is due to the drawdown of earmark reserves to offset expenditure relating to winter planning, adaptations, digital and IT and staffing costs associated with services within Muirpark.
Page 3
3 Supplies and Services net overspend of £2.531m: the overspend is due to additional purchases of PPE and staff uniform due to the increase in home support staff and costs associated with winter planning. There has also been additional expenditure in relation to aids and adaptations to meet current demand. £1.550m additional income was drawn down from earmarked reserves to offset some of this overspend and is showing in the over recovery of income. Prescribing net overspend of £1.750m: activity and cost per item within prescribing is 3.19% higher compared to 2021/2022. 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. 6.7 The table below shows the year-end financial position for 2022/23 for each client group separated into pay costs and non-pay costs and excluding ring-fenced reserves: 6.8 Throughout financial year 2022/2023, adjustments are made to the original budget due to additional budget allocations and budget transfers. The table below shows the funding allocations received from Scottish Government during 2022/2023: Scottish Government Allocations 2022/23 £m Multi-Disciplinary Teams 1.743 Community Extended Care Pilot 0.933 Distress Brief Intervention 0.869 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 0.246 Alcohol and Drug Partnership – Tranche 1 2.179 Alcohol and Drug Partnership National Mission 0.618 Veteran 1st Point 0.126 Child Death Review 0.024 Young Patient Family Fund 0.002 Outcomes Framework 2.773 Family Nurse Practitioner Funding 1.215 Pay Budget Pay Costs Less Ring- Fenced Reserves Pay Variance Non-Pay Budget Non-Pays Costs Less Ring- Fenced Reserves Non-Pay Variance Total Under/(Over) Spend £m £m £m £m £m £m £m £m £m Adult Social Care 87.970 85.969 2.001 153.788 145.911 7.877 9.878 North West Localities 18.374 16.424 (0.404) 1.546 2.014 2.174 (0.160) 1.386 North East Localities 15.475 14.066 1.408 1.511 1.736 (0.226) 1.182 Adult Services 14.553 13.568 (0.283) 0.702 5.670 5.840 (0.170) 0.532 Childrens Services 33.203 28.302 (3.202) 1.699 3.895 4.644 (0.749) 0.950 Mental Health & Learning Disabilities 70.635 68.319 (1.216) 1.100 14.038 6.500 (7.482) 0.057 1.157 Area Wide Services 9.989 9.323 0.665 1.777 1.866 (0.088) 0.577 Other Areas 18.197 15.048 (3.165) (0.016) 78.190 72.344 (5.659) 0.187 0.171 Perscribing - - - 69.582 71.332 (1.750) (1.750) TOTAL 268.396 251.020 (8.270) 9.106 330.466 312.347 (13.141) 4.978 14.084 Client Group Year End Outturn 2022/2023
Page 4
4 Mental Health Action 15 3.929 Mental Health Outcomes Framework 2.346 Mental Health Innovation Fund 0.487 Mental Health Perinatal, Infant, Maternity and Neonatal 0.107 Neurodevelopmental Pathway Pilot 0.100 CAMHS Capacity Building for Psychological Therapies 0.845 Dementia Post Diagnostic Support 0.322 Rapid Cancer GI 0.033 Funding for Naloxone 0.031 TOTAL 20.150 7. GENERAL 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 In closing the annual accounts and in line with the IJB Reserves Policy, the PFA is asked to approve the transfer of an additional £35.495m to IJB reserves as detailed in appendix 4. Summary New Reserves 2022/23 (Pending PFA Approval) £m Scottish Government Ring-Fenced Reserves 18.621 Health Ring-Fenced Reserves 2.790 Total Ring-Fenced Reserves 21.411 Earmarked Reserves 6.199 Contingency Reserves 7.885 Total 35.495 7.3 The increase to reserves will continue to enable the IJB to meet its strategic objectives, and Scottish Government policy requirements. In particular, it is proposed that two new earmarked reserves are created for the following purposes: £0.650m window replacement on Mental Health wards following a contravention of health and safety law notified by the Health and Safety Executive to NHS Lanarkshire Health Board on 30th November 2022. This reserve may need to be increased as detailed costs becomes available. £3.169m social worker regrading of posts, following a range of challenges impacting on the sustainability of the social worker workforce and the consequent vulnerabilities with respect to service delivery. This reserve will cover a three-year period to allow a recurring funding solution to be identified. Additional details regarding this regrading can be found at appendix 5. 7.4 Within the ring-fenced reserves total of £21.411m, there is funding of £2.790m provided by NHS Lanarkshire for unscheduled care pressures in 2023/24. This is to assist the IJB to meet its delegated responsibilities relating to unscheduled care and is in addition to any specific Scottish Government funding such as multidisciplinary teams and Health Care Social Workers funding which the IJB is already deploying.
Page 5
5 7.5 The table below shows the final summary position for 2022/23 adjusted for the drawdown of reserves in 2022/2023 and pending approval of the new reserves detailed in appendix 4: 7.6 The IJB contingency reserves currently equate to 3% of the financial envelope. Appendix 6 shows a detailed list of all reserve movement during 2022/23. 7.7 Regular updates will be provided to the IJB throughout 2023/24 as analysis and reviews of all reserves are monitored to ensure they continue to meet on-going pressures and remain fit for purpose. 7.8 Appendix 7 shows all new reserves created in 2022/2023 including a key guidance table showing how these new reserves are aligned to our five ambition statements detailed in the Strategic Commissioning Plan 2023-2026. 8. COVID-19 RESERVES 8.1 Throughout 2022/2023 Covid-19 costs has been reported to the Scottish Government through the Lanarkshire Finance Performance Return (FPR). The Covid-19 costs incurred for the partnership in 2022/2023 totalled £7.072m. 8.2 As previously advised to the PFA Committee, £24.051m of uncommitted Covid-19 reserves were returned to the Scottish Government in January 2023. The remaining Covid-19 balance of £1.865m was also returned in April 2023, bringing the total funding reclaimed by Scottish Government to £25.916m. A small balance of £7k has been retained to provide unpaid carers with PPE. 8.3 The table below shows the movement for the financial year 2022/2023: Summary of Covid-19 Funding and Costs 2022/2023 £m NHS Lanarkshire Funding North Lanarkshire Council Funding Uncommitted Funding Returned to Scottish Government Adjustment to Covid-19 Reserve NHS Lanarkshire Costs North Lanarkshire Council Costs (31.686) (1.342) 25.916 0.033 5.730 1.342 Balance as at 31/03/2023 (0.007) Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 48.998 (5.562) (15.859) 27.577 NHSL & NLC Earmarked Reserves 30.772 24.521 (7.885) 47.408 NHSL & NLC Risk-Based Reserves 13.478 2.490 (1.067) 14.901 NHSL Contingency Reserves 4.167 4.267 (0.374) 8.060 NHSL & NLC Closed Reserves 22.037 (16.029) (6.008) 0.000 119.452 9.687 (31.193) 97.946Total SUMMARYLEAD
Page 6
6 9. VACANCY POSITION 2022/2023 9.1 As highlighted throughout this report, employee costs final outturn created a significant underspend within all services. 9.2 The table below shows the full time equivalent (FTE) vacancy numbers at 31 March 2023 within each service compared against their budgeted establishment: 9.3 To help cover the vacant posts throughout 2022/2023, agency staff, bankaide, overtime and excess part time hours were used. A detailed analysis of these costs is at Appendix 8. SERVICE 2022/2023 Overtime Excess Part Time Bankaide Agency £m £m £m £m North West Locality 0.157 0.048 0.605 0.163 North East Locality 0.097 0.052 0.262 - Adult Services 0.077 0.087 0.224 0.109 Children Services 0.223 0.109 0.427 0.021 Mental Health & Learning Disabilities 0.524 0.101 2.459 3.294 Social Care Services 1.142 - - 0.179 Home Support 4.382 - - - Other 0.037 0.022 0.028 - TOTAL 6.638 0.420 4.005 3.765 10. DELEGATED SERVICES 2022/2023 10.1 The following table shows the costs of other North Lanarkshire Council services delegated to the IJB during 2022/2023. The outturn position at 31 March 2023 is breakeven for both services. Service Expenditure £m Income £m Housing 1.886 (1.886) Breakeven Transport 0.551 (0.551) Breakeven Total 2.437 (2.437) Breakeven Establishment Actual Vacancies FTE FTE FTE North West Locality 384.80 344.36 40.44 North East Locality 322.58 296.00 26.58 Adult Services 277.68 289.71 -12.03 Children Services 571.96 483.62 88.34 Mental Health 1,174.71 1,098.93 75.78 Social Care Services 834.20 653.80 180.40 Home Support 1,000.07 995.99 4.08 Other 130.28 260.79 -130.51 TOTAL 4,696.28 4,423.20 273.08 Service
Page 7
7 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 Prescribing Activity and Costs Very High 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 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
Page 8
8 place to suit different needs ☐ Measure how well we involve community stakeholders in the planning, design, and delivery of our services ☒ Provide regular feedback on how stakeholder engagement and participation is shaping and influencing service development and delivery Financial information is shared with stakeholders on a regular basis and is provided to the PFA and IJB on a quarterly basis. ☒ Provide support to enable stakeholder representatives to participate meaningfully and confidently at meetings ☐ Develop participation guidelines to ensure a common understanding and set of expectations for both stakeholders and partnership staff ☒ Support engagement planning and participation in localities, taking account of other engagement activity and local plans across the Community Planning Partnership IJB Financial Plan and Reserves Strategy aligns and supports the IJB Strategic Commissioning Plan to ensure robust financial monitoring and scrutiny. 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 Health and Social Care Partnership Budget Appendix 2 - Hosted Services Led by North Lanarkshire Appendix 3 - Hosted Services Led by South Lanarkshire Appendix 4 – HSCP Final Outturn 2022/23 – Transferred to Reserves Appendix 5 - Social Work Regrading of Posts Appendix 6 - North Lanarkshire IJB General Reserves 2022/2023 Appendix 7 - New Reserves Created in 2022/2023 Appendix 8 - 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.
Page 9
9 North Lanarkshire Health and Social Care Partnership Budget Appendix 1 Budget Actual Variance Expenditure 2022/2023 March 2023 March 2023 £m £m £m Health Care Services Locality and Other Services 59.075 49.424 9.651 Addiction Services 6.792 4.219 2.572 Medical and Nursing Directorate 5.644 4.805 0.839 Prescribing 69.582 71.332 (1.750) Out of Area Services 4.571 5.115 (0.544) Area Wide Services 11.766 11.189 0.577 Hosted Services 175.077 160.805 14.272 Family Health Services 115.625 115.625 0.000 Set-Aside Budget 69.120 69.120 0.000 Covid-19 5.730 5.731 (0.000) Total Expenditure - NHSL 522.982 497.365 25.617 Social Care Services Social Care Services Gross Expenditure 241.758 239.996 1.762 Social Care Services Gross Income (2.893) (11.009) 8.116 Social Care Services Net Expenditure 238.865 228.987 9.878 Housing Revenue Account Expenditure 1.870 1.870 0.000 Transport Services Expenditure 0.551 0.551 0.000 Social Care, Housing and Transport Services Net Expenditure 241.286 231.408 9.878 Total Expenditure - NHSL and NLC 764.268 728.773 35.495 Funded By: Annual Budget 2022/2023 £m NHS Lanarkshire Funding (497.820) Social Care Funding (22.964) Resource Transfer (23.421) Commissioned Services (6.721) Scottish Government Funding - Covid-19 and Remobilisation (5.730) Transfer from Reserves (Approved) (19.432) Total Funding - NHSL (576.088) 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 (764.268)
Page 10
10 Hosted Services Appendix 2 North Hosted Services March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 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 Sexual Health Services 3.146 2.974 0.171 1.604 1.433 0.171 1.541 1.541 0.000 Continence Services 2.402 2.452 (0.050) 1.225 1.275 (0.050) 1.177 1.177 0.000 Immunisation Services 1.918 2.473 (0.556) 0.978 1.534 (0.556) 0.940 0.940 0.000 Speech and Language Therapy Services 6.520 5.994 0.525 3.325 2.800 0.525 3.195 3.195 0.000 Children and Adolescents Mental Health Services 14.679 11.127 3.552 7.486 3.934 3.552 7.193 7.193 0.000 Childrens Services 12.316 12.220 0.096 6.281 6.185 0.096 6.035 6.035 0.000 Integrated Equipment and Adaptations Store 0.567 0.710 (0.142) 0.289 0.432 (0.142) 0.278 0.278 0.000 Dietetics Services 4.074 3.753 0.321 2.078 1.757 0.321 1.996 1.996 0.000 Podiatry Services 4.592 4.434 0.158 2.342 2.184 0.158 2.250 2.250 0.000 Prisoner Healthcare Services 1.784 1.908 (0.124) 0.910 1.034 (0.124) 0.874 0.874 0.000 Blood Borne Viruses Services 1.560 1.535 0.025 0.795 0.771 0.025 0.764 0.764 0.000 Hospital at Home 2.606 2.166 0.440 1.329 0.889 0.440 1.277 1.277 0.000 Mental Health and Learning Disability Services 84.674 74.819 9.855 43.184 33.329 9.855 41.490 41.490 0.000 TOTAL 140.837 126.565 14.272 71.827 57.555 14.272 69.010 69.010 0.000 South Lanarkshire IJB - 49% ShareNorth Lanarkshire IJB - 51% Share Hosted Services Appendix 3 March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 March 2023 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 Community Dental Services 7.856 7.081 0.775 4.007 4.007 0.000 3.850 3.074 0.775 Brain Injury Unit 2.737 1.856 0.881 1.396 1.396 0.000 1.341 0.460 0.881 Out of Hours Services 9.424 9.003 0.420 4.806 4.806 0.000 4.618 4.197 0.420 Palliative Care Services 7.329 7.412 (0.084) 3.738 3.738 0.000 3.591 3.675 (0.084) Physiotherapy Services 10.855 10.427 0.428 5.536 5.536 0.000 5.319 4.891 0.428 Primary Care Services 0.886 0.810 0.076 0.452 0.452 0.000 0.434 0.358 0.076 South Improving Cancer Journey 0.046 0.047 (0.001) 0.024 0.024 0.000 0.023 0.023 (0.001) Occupational Therapy Services 8.530 7.909 0.621 4.350 4.350 0.000 4.180 3.559 0.621 Diabetic Services 5.194 5.113 0.080 2.649 2.649 0.000 2.545 2.464 0.080 Telehealth 0.711 0.319 0.392 0.362 0.362 0.000 0.348 (0.044) 0.392 Sub Total 53.569 49.979 3.590 27.320 27.320 0.000 26.249 22.659 3.590 Ring Fenced Funding Primary Care Improvement Fund 13.569 10.973 2.595 6.920 6.920 0.000 6.649 4.053 2.595 Primary Care Transformation Fund 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 0.000 Sub Total 13.569 10.973 2.595 6.920 6.920 0.000 6.649 4.053 2.595 TOTAL 67.137 60.952 6.185 34.240 34.240 0.000 32.897 26.712 6.185 South Lanarkshire IJB - 49% ShareLed by South Partnership North Lanarkshire IJB - 51% Share
Page 11
11 Appendix 4 Scottish Government Ring- Fenced Reserve NHS Lanarkshire Ring-Fenced Reserve New Earmarked Reserves Realignment to Existing Earmarked Reserves Increase to Existing Contingency Reserves Total Underspend 2022/2023 £m £m £m £m £m £m Alcohol and Drug Partnership Funding 2.572 2.572 Area Wide Services - Refugees and Displaced Persons 0.056 0.056 Blood-Borne Viruses Services 0.025 0.025 Children and Adolescent Mental Health Services 3.201 3.201 District Nursing - Scottish Government Funded 0.376 0.376 Hospital at Home Services - Support Development 0.250 0.250 Learning Disabilities Health Checks 0.246 0.246 Long Covid Pathways 0.320 0.320 Medical Director - Child Death Review Funding 0.012 0.012 Mental Health and Learning Disability Services - Action 15 3.930 3.930 Mental Health and Learning Disability Services - Distress Brief Intervention 3.155 3.155 Mental Health Covid Clinicians (Cossette) 0.200 0.200 Mental Health - Diagnostic Support Service Dementia Post 0.322 0.322 Mental Health Eating Disorders 0.070 0.070 Mental Health Neurodevelopmental Pathways 0.100 0.100 Mental Health Perinatal, Infant, Maternity and Neonatal 0.005 0.005 Mental Health Psychology Posts 0.670 0.670 Mental Health Pharmacy Recovery Plan 0.175 0.175 NES SLA Pharmacy Training 0.173 0.173 North Planning Band 2-4 Posts 0.933 0.933 Upper GI Dietetics Band 4 0.033 0.033 Business Case - Health Care Support Workers, Multi-Disciplinary Teams 1.797 1.797 Unscheduled Care Funding 2.790 0.330 3.120 Scottish Clinical Leadership Fellowship 0.074 0.074 Adaptations Fund 0.289 0.289 Carers Act 2018 - Support 1.800 1.800 Area Wide Services - Pre School Vision Screening (0.075) (0.075) Shielding - Social Care Support Fund (0.038) (0.038) Contingency Balance Held By NHSL 3.265 3.265 Contingency Balance Held By NLC 4.620 4.620 Social Workers Regrading of Posts 3.169 3.169 Mental Health Wards Window Replacement 0.650 0.650 New Reserves 18.621 2.790 3.819 2.380 7.885 35.495 HSCP Final Outturn 2022/2023 - Transferred to Reserves
Page 12
12 Social Work Regrading of Posts - Additional Information from Chief Social Work Officer and Head of Adult Social Work Services Appendix 5 Over the past year increasing concerns around the sustainability of the frontline social work force have emerged and been further analysed and considered by the social workforce group, which provides a vehicle to consider cross-cutting professional and workforce issues for all social work care groups. In the context of growing demand and new national investment (some temporary) in posts to address both policy priorities and post Covid backlogs there has been a national shortage of social workers. Detailed local analysis of recruitment and turnover supplemented by intelligence from staff engagement identified challenges with respect both to recruitment and retention in particular of both experienced staff and frontline managers. For experienced staff both salary comparisons with neighbouring authorities and the areas relating to wide working context were identified as problematic, against which previous measures, principally the implementation of a senior practitioner scheme, were insufficiently effective. Resulting vacancy levels and the impact of turnover on experience levels and workforce balance were identified as key risks to service delivery which could not await the outcome of national discussions to address issues. It was also identified that job profiles/descriptions for frontline social workers/senior social workers were outdated and no longer reflected day to day demands, and workforce qualities required to deliver on key priorities specifically the need for empowered and trauma informed practitioners able to operate in an integrated and increasingly complex legislative environment. In response to this a number of actions were proposed and approved by the council’s corporate management team in February 2023 subject to further work on related costs and funding: Continuation of the successful Supported Year in Practice Pilot for Newly Qualified Social Workers – confirmation has since been received that this will receive grant funding from Scottish Government for a further year prior to arrangements being rolled out nationally from 2024. Further work with the council’s Training and Organisational Development Team to bring post qualifying support and training opportunities together into a coherent framework to enhance practice and professional support, CPC, career pathways and succession planning to enhance skills and ensure a clearer and more attractive offer to staff. This will be cost neutral. The re-establishment of a small scale ‘grow your own scheme’ for social workers recruiting from support and para-professional roles within the service. This will be funded for 4 years from an earmarked reserve and government funding targeted at enhancing the social work workforce. There is the potential that this may be supplemented in future by national initiatives in this area. In the interim a minimum of 6 trainees will be supported through these funds. Management initiated re-evaluation of relevant job roles though the council’s job-evaluation scheme to ensure these are reflective of current requirements and demands. This has led to the re- valuation of social worker and NLC occupational therapist roles from NLC10 to NLC11 and senior social worker and relevant team leader roles from NLC12 to NLC13 subsequently agreed in line with NLC processes through the North Lanarkshire Council Workforce Steering Group on 28 April 2023. It is anticipated that this will support the retention as well as recruitment of staff in the current market and importantly ensuring that job roles are fit for the purpose and ambition of the council/partnership. The re-evaluation for Children and Families Social Work will be funded through funding allocated to the Education and Families Service to address a range of cost pressures, whilst funding for the change within Justice will be covered from Section 27 grant. The additional cost for Adult Services will be funded from an earmarked reserve pending approval.
Page 13
13 North Lanarkshire IJB APPENDIX 6 Movement on Reserves Audit Trail NHSL & NCL Opening Balance As At 1 April 2022 Proposed Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Ring-Fenced Reserves 48.998 (5.562) (15.859) 27.577 NHSL & NLC Earmarked Reserves 30.772 24.521 (7.885) 47.408 NHSL & NLC Risk-Based Reserves 13.478 2.490 (1.067) 14.901 NHSL Contingency Reserves 4.167 4.267 (0.374) 8.060 NHSL & NLC Closed Reserves 22.037 (16.029) (6.008) 0.000 119.452 9.687 (31.193) 97.946 Opening Balance As At 1 April 2022 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Alcohol and Drug Partnership Funding 3.154 2.572 (2.800) 2.926 NHSL Alcohol and Drug Partnership - Local Implementation Plan 0.167 0.167 NHSL Alcohol and Drug Partnership - Long Acting Buprenorphine 0.255 0.255 NHSL Area Wide Services - Refugees and Displaced Persons 0.400 0.056 (0.206) 0.250 NHSL Blood-Borne Viruses Services 0.146 0.025 0.171 NHSL Children and Adolescent Mental Health Services 5.333 3.201 (4.433) 4.101 NHSL Community Living Change Fund 1.298 1.298 NHSL Covid-19 Funding 29.742 (25.950) (3.785) 0.007 NHSL District Nursing - Scottish Government Funded 0.376 0.376 NHSL Hospital at Home Services - Support Development 0.414 0.250 (0.043) 0.621 NHSL Learning Disabilities Health Checks 0.246 0.246 NHSL Long Covid Pathways 0.764 0.764 NHSL Medical Director - Child Death Review Funding 0.021 0.012 (0.021) 0.012 NHSL Mental Health and Learning Disability Services - Action 15 3.019 3.930 (3.019) 3.930 NHSL Mental Health and Learning Disability Services - Distress Brief Intervention 1.552 3.155 (1.552) 3.155 NHSL Mental Health Covid Clinicians (Cossette) 0.200 0.200 NHSL Mental Health - Diagnostic Support Service Dementia Post 0.429 0.322 0.751 NHSL Mental Health Eating Disorders 0.070 0.070 NHSL Mental Health Neurodevelopmental Pathways 0.100 0.100 NHSL Mental Health Perinatal, Infant, Maternity and Neonatal 0.005 0.005 NHSL Mental Health Psychology Posts 0.670 0.670 NHSL Mental Health Recovery Renewal - Facilities Projects 1.840 1.840 NHSL Mental Health Wellbeing in Primary Care Services 0.148 0.148 NHSL Mental Health Pharmacy Recovery Plan 0.175 0.175 NHSL NES SLA Pharmacy Training 0.173 0.173 NHSL North Planning Band 2-4 Posts 0.933 0.933 NHSL Staff Wellbeing 0.254 0.254 NHSL Test and Protect Funding 0.520 0.520 NHSL Third Sector Initiatives To Improve Health 0.306 0.306 NHSL Unscheduled Care Funding 3.120 3.120 NHSL Upper GI Dietetics Band 4 0.033 0.033 48.998 (5.562) (15.859) 27.577TOTAL RING-FENCED RESERVES LEAD SUMMARY Total LEAD RING-FENCED RESERVES Opening Balance As At 1 April 2022 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NLC Long Covid Contingency 3.000 (1.051) 1.949 NHSL Prescribing Fund 4.361 4.361 NLC Social Care Demand 6.117 2.490 (0.016) 8.591 13.478 2.490 (1.067) 14.901 Opening Balance As At 1 April 2022 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Contingency Balance Held By NHSL 4.167 4.267 (0.374) 8.060 4.167 4.267 (0.374) 8.060 LEAD CONTINGENCY FUND RESERVES TOTAL RISK-BASED RESERVES LEAD RISK-BASED RESERVES TOTAL CONTINGENCY FUND RESERVES
Page 14
14 Opening Balance As At 1 April 2022 Transfers To / From Reserves Drawdown from Reserves Revised Balance As At 31 March 2023 £m £m £m £m NHSL Adult Social Care Winter Preparedness Fund 1.941 1.941 NLC Adaptations Fund 0.289 0.289 (0.289) 0.289 NLC Adult Protection (share with C&F and NHSL) 0.050 0.050 NLC Advocacy Services 0.123 0.061 (0.066) 0.118 NHSL Area Wide Services - Health Promotion - North Lanarkshire Leisure agreement 0.123 0.123 NHSL Area Wide Services - NES Training 0.132 0.132 NHSL Area Wide Services - Primary Care Corporate (iHUB Project - NES funding) 0.034 0.034 NLC Assistive Technology Contract x 12 months (ATC) 0.090 (0.082) 0.008 NHSL Breast Feeding Team (2 year funding) 0.828 0.828 NHSL Business Case - Health Care Support Workers, Multi-Disciplinary Teams 1.794 1.797 (1.794) 1.797 NLC Business Case - Non-Recurring NLC Costs 5.380 0.537 (2.106) 3.811 NHSL Care Homes Allocation 0.318 0.318 NLC Carers Act 2018 - Support 0.852 1.800 (0.009) 2.643 NHSL Champions Board Funding 0.172 0.172 NHSL Children and Adolescent Mental Health Services - Udston Top Up Funding 0.346 0.346 NHSL Childrens Services - Paediatric Band 7, Band 6 x 4.12 WTE, Band 2 x 9.59 WTE 0.645 (0.231) 0.414 NHSL Development of Chryston Community Health Clinic 0.212 0.212 NHSL Dietetics Services - Double Running Costs 0.110 0.110 NLC Digital and IT Strategy Technology Improvements - Community Alarms 0.694 (0.106) 0.588 NLC Digital and IT Strategy Technology Improvements - Home Support Scheduling System 1.000 2.776 3.776 NLC Digital and IT Strategy Technology Improvements - Other 0.566 0.566 NLC Digital and IT Strategy Technology Improvements - SWIS 0.700 0.700 NHSL Discharge Support Workers Band 4 x 2 WTE 0.107 0.107 NHSL Distinction Awards 0.036 0.036 NLC Financial Strategy - Changes to LA Services Muirpark 2.973 (1.874) 1.099 NHSL Forensic Band 3 x 5 WTE 0.147 0.147 NHSL GPIT Reprovisioning Gap 0.181 0.181 NHSL Health Inequalities - Screening 0.098 (0.027) 0.071 NHSL Health Visiting Students/Trainees 0.840 (0.356) 0.484 NLC Home Support Resilience (2 year funding) 3.498 3.498 NHSL HR Employability Team (2 year funding, 50:50 split between North and South) 0.187 0.187 NLC IJB Helpline (2 years funding) 0.600 (0.025) 0.575 NHSL Integrated Authority Support 6.076 (1.150) 4.926 NHSL Kylepark Works 1.000 0.608 (0.030) 1.578 NHSL Learning Disabilities Band 3 x 4 FTE 0.118 0.118 NLC Local Government Pay Award 23/24 2.653 2.653 NLC Mental Health Social Workers 2 x NL10 x 24 months 0.107 (0.038) 0.069 NHSL Mental Health Wards Window Replacement 0.500 0.500 NHSL Minor Capital Works 1.387 (0.225) 1.162 NHSL Neonatal & Paediatrics Dieteics Intervention (3 year funding) 0.550 0.550 NHSL Organisational Development Fund 0.260 0.260 NHSL Paediatric Diabetes Insulin Pumps and Additional Staff 0.908 (0.027) 0.881 NLC Planned Date of Discharge - Discharge To Assess 0.200 0.241 (0.137) 0.304 NLC Planned Date of Discharge - Locality Social Work Manager Post 0.055 0.096 (0.074) 0.077 NHSL Podiatry Services - Foot Screening 0.459 (0.033) 0.426 NHSL Prisioner Healthcare - Transitional Project Band 8A 0.070 0.070 NHSL Psychology Posts 2 x Band 6 0.098 0.098 NHSL Regrading of Posts Including Backpay 0.125 0.125 0.250 NHSL Scottish Clinical Leadership Fellowship 0.045 0.074 (0.019) 0.100 NHSL Sexual Health Services - Forensic Medical 0.222 (0.047) 0.175 NHSL Sexual Health Services - Long-Acting Reversible Contraception (LARC) 0.109 0.386 (0.004) 0.491 NLC Social Care Contracting Staff within Quality Assurance Services 0.047 0.028 (0.072) 0.003 NLC Social Care Regrading of Staff (SSW, SP, SW, OT, TL and TM) 3.169 3.169 NLC/NHSL Staff Training Academy 2.400 2.400 NHSL Stigma Free Lanarkshire (3 year funding) 0.450 0.450 NHSL Supervisor Training 0.077 (0.012) 0.065 NLC Unmet Saving 21/22 - IDS/LSS (merging building Coatbridge & Cumbernauld) 0.086 (0.086) 0.000 NLC Violence Against Women (Joint Initiative with SLC and C&F) 0.030 0.030 NHSL Vulnerable and Complex Cases - Test of Change 1.208 (0.116) 1.092 30.772 24.371 (7.885) 47.258 LEAD EARMARKED RESERVES TOTAL EARMARKED RESERVES 22.037 (16.029) (6.008) 0.000 119.452 9.687 (31.193) 97.946 TOTAL CLOSED RESERVES TOTAL RESERVES
Page 15
15 Reserve Title Reserve Description Pending Approval 21 June 2023 Approved by IJB 22 March 2023 Ambition Statement Key Window Replacement on Mental Health Wards To comply with the Notification of Contravention to secure patient accessible windows within Wards 19 and 20 in a closed position pending replacement of a 'Polar' ligature reduction design window. Anticipated timeline is September 2023. 2, 4 Social Worker Regrading To address the immediate and medium-term recruitment and retention challenges with a view to ensuring an empowered and effective social work workforce. This includes a revised and strengthened recruitment model, alongside further work to enhance whole career support and development allied to the wider ambitions of Workforce for the Future. 3 Breast Feeding Team To introduce a peer support model to improve breastfeeding initiation and reduce attrition and to introduce a seven-day support provision to deliver person centred care through the mother's postnatal journey from hospital discharge to one year post birth. 1, 2, 5 Development of Chryston Community Health ClinicTo fund the repatriation of services under 'The Plan for North Lanarkshire' which sets out an estates strategy to develop community hubs and campuses. 1, 5 HR Employability Team To fund a dedicated HR team within health with the cost split 50:50 between North and South Lanarkshire partnerships. 3 Long Covid Pathways To support people with long term effects of Covid-19 where their physical and mental wellbeing has suffered. This earmarked reserve will allow continued investment in recruitment to deliver improved care and support for people living with long Covid and will ensure it remains a priority. 2, 3, 4, 5 Neonatal and Paediatrics Dietetics Support To provide premature babies with dietetic intervention aimed at reducing morbidity and mortality rates, reducing length of hospital stays, improving short and long-term neurodevelopment and growth outcomes and providing support to parents/carers. 1, 2, 5 Organisational Development Fund To support the 2023/24 organisational development plan focussing heavily on sector and unit management team development. 3 Psychology Posts 2 x Band 6 To fund additional posts within Psychology to help with the substantial waiting lists by extending trainee contracts until March 2024. 3, 4 Staff Training Academy To assist the development of staff by offering apprenticeships and support to implement a HSCP 'Grow our Own' initiative in recognition of the ongoing challenges in recruitment and retention and a national shortage of key skills. 3 Stigma Free Lanarkshire To continue investment in addressing challenging mental health stigma and discrimination in line with the outcomes in the Lanarkshire Mental Health Strategy. 2, 4 Vulnerable and Complex Cases To provide co-ordinated, person-centred, care managed approach with individuals who have often become disengaged and need assistance to be re-directed and reconnected to appropriate services within the Health and Social Care settings or the community. 5 Assistive Technology 12 Month Contract To fund a 12-month contract that provides a service to the council in assessing, recommending, and procuring assistive technologies to enable our employees with a disability or impairment to maximise their ability to work effectively. 3, 4 Home Support Resilience To support the effective recruitment and retention of home support staff by maintaining and increasing the number of pool cars available to the service and offering home support worker incentives. 3, 4 IJB Cost-of-Living Helpline To maintain and enhance the existing single point of contact for advice on a range of impacts from the cost-of-living crisis. This would provide one gateway for residents to receive direct advice and where required a direct route to follow up appointments for support. 1, 4, 5 Local Government Pay Award 23/24 To assist with the on-going staffing pay pressure. This will cover 2023/24 financial year only and will be replaced by a recurring budget in 2024/25. 3 Ambition Statement Key Do The Right Thing First Time When people contact our services, we need to respond quickly and effectively, with a focus on helping people to help themselves first. We will continue to develop ‘First Point of Contact’ by incorporating good conversations across the HSCP and prioritising and embedding the whole system approach to get it right first time. 1 Increased Focus on Prevention, Early Intervention and Tackling Inequalities by Working with Communities and People The population and needs analysis highlighted the need to do things differently, to understand the demographic challenges facing North Lanarkshire and to harness the opportunities of people living healthier lives for longer. We need to keep changing the way we deliver services and support people, focusing more on prevention, early intervention, and empowering people to live fulfilling lives. By providing ‘upstream’ support at an early stage, we can reduce the demand on intensive health and care services and re-invest in more community focused support services. By working with our partners in the Third Sector, we can identify, support, and develop local community-based programmes, run by voluntary and independent organisations that focus on the health and care needs of local communities. We will continue to support and empower people to continue to live healthy, meaningful, and more personally satisfying lives as active members of their community for as long as possible by showing ambition and innovation to develop and try new ways of providing services. We value and recognise the vital role local people and communities play by continuing to ensure we listen and provide a voice to their needs and aspirations. We will continue to engage and participate with local people as we extend into the delivery of our partnership priorities. 2 Develop And Support a Workforce for The Future The increase in ageing population of North Lanarkshire is broadly mirrored within the workforce of the Health and Social Care sector, therefore it is important for us to be cognisant of this and ensure mechanisms are put in place to allow flexibility and support to our workforce to ensure their physical and mental health is nurtured. There are also continuing challenges with regards to resourcing, attracting, recruiting, and retaining staff. Whole system planning requires further development to better understand the needs and demands of communities including the public health challenges, the types of roles needed to support different care needs, and the availability of different types of workers over time and geographically. 3 Mental health concerns are continuing to increase in the population which could lead to a greater demand for mental health services and community supports. There is a need for a refreshed and reinvigorated approach to mental health improvement with the focus on the four core areas within the Lanarkshire Mental Health and Wellbeing Strategy: · Good mental health for all · Improving access to mental health supports and services · Children and young people’s mental health and wellbeing · Specialist mental health services Supporting People Through a Whole Family Approach Our aspiration is to support adults and children of all ages with the tools to set, plan and achieve their goals together. This puts wellbeing at the heart of our approach by considering the situation that adults and children live in, who they live with and their family relationships. In practice, this means understanding each person as an individual, as well as recognising the part they play in their family and community. This approach builds on people’s strengths and resilience. 5 STRATEGIC COMMISSIONING PLAN 2023-2026 AMBITION STATEMENT 4Improve Mental Health and Wellbeing Appendix 7NORTH LANARKSHIRE IJB NEW RESERVES CREATED IN 2022/2023:
Page 16
16 Analysis of Additional Employee Costs Appendix 8 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 10 56,000 21,500 25,000 39,500 202,500 3,500 348,000 11 56,000 21,500 25,000 39,500 202,500 3,500 348,000 12 56,000 20,000 21,000 44,000 214,000 2,000 357,000 TOTAL 605,000 262,000 224,000 427,000 2,459,000 28,000 4,005,000 North West Locality £ Adult Services £ Children Services £ Learning Disabiliti es £ 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 11,285 16,710 4,141 57,024 221,263 20,796 331,219 11 23,686 14,913 24,634 180,893 57,701 301,827 12 87,839 20,190 3,936 222,091 290,700 47,831 672,587 13 32,022 32,022 TOTAL 162,899 108,566 20,779 749,619 2,544,242 178,890 3,764,995 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 10,665 8,985 6,280 27,683 38,918 86,099 254,737 4,842 438,209 11 15,115 7,879 9,800 21,887 39,758 79,279 377,024 2,751 553,493 12 12,745 8,193 13,229 25,238 42,028 96,920 358,412 4,497 561,262 13 165,891 493,738 659,629 TOTAL 156,821 97,207 77,194 223,222 523,645 1,141,941 4,381,567 36,781 6,638,378 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 10 4,663 2,832 7,814 10,241 10,094 1,667 37,311 11 5,211 3,749 5,611 6,717 8,715 2,397 32,400 12 5,098 5,127 8,044 6,407 9,843 3,625 38,144 TOTAL 47,982 52,351 87,313 108,608 101,058 22,466 419,778 BANKAIDE COSTS 2022/2023 OVERTIME COSTS 2022/2023 AGENCY COSTS 2022/2023 EXCESS PART TIME COSTS 2022/2023 Period Period Period Period