Agenda reports pack
Argyll and Bute Council · 19 May 2026
Back to Argyll and Bute HSCP Finance and Policy Committee — 19 May 2026 and its agenda
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12 May 2026 NOTICE OF MEETING A meeting of the ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE will be held BY MICROSOFT TEAMS on TUESDAY, 19 MAY 2026 at 10:30 AM, which you are requested to attend. BUSINESS 1. APOLOGIES FOR ABSENCE 2. DECLARATIONS OF INTEREST (IF ANY) 3. MINUTES (Pages 3 - 6) Argyll and Bute HSCP Finance and Policy Committee held on 17 March 2026 4. BUDGET MONITORING - 12 MONTHS TO 31 MARCH 2026 AND PROVISIONAL YEAR END (Pages 7 - 22) Report by Head of Finance 5. SOCIAL CARE FEES AND CHARGES - BUDGET 2026/27 (Pages 23 - 36) Report by Head of Finance 6. SOCIAL WORK / SOCIAL CARE FINANCIAL PLANNING 2027/28 (Pages 37 - 44) Report by Head of Finance 7. DATE OF NEXT MEETING Tuesday 18 August 2026 Argyll and Bute HSCP Finance and Policy Committee Councillor Dougie McFadzean (Chair) Graham Bell Karen Leach Kenny Matheson Councillor Gary Mulvaney Fiona Thomson Contact: Hazel MacInnes, Senior Committee Officer Tel:01546 604269 Public Document Pack
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MINUTES of MEETING of ARGYLL AND BUTE HSCP FINANCE AND POLICY COMMITTEE held BY MICROSOFT TEAMS on TUESDAY, 17 MARCH 2026 Present: Councillor Dougie McFadzean (Chair) Graham Bell Karen Leach Kenny Matheson Councillor Gary Mulvaney Attending: Fiona Broderick, Staffside Lead, Argyll and Bute HSCP (Health) Charlotte Craig, Business Improvement Manager, Argyll and Bute HSCP Councillor Kieron Green, Argyll and Bute Council Nikki Gillespie, Head of Complex Care and Registered Services, Argyll and Bute HSCP Kristin Gillies, Head of Strategic Planning, Performance and Technology, Argyll and Bute HSCP James Gow, Head of Finance, Argyll and Bute HSCP Rebecca Helliwell, Depute Medical Director, Argyll and Bute HSCP Julie Hodges, Scottish Care Inspectorate Fiona McCallum, Committee Services Officer, Argyll and Bute Council Alison McGrory, Associate Director of Public Health – NHS Highland, Argyll and Bute HSCP Kevin McIntosh, Staffside Lead, Argyll and Bute HSCP (Council) Councillor Ross Moreland, Argyll and Bute Council Kirstie Reid, Carers Representative, NHS Highland Takki Sulaiman, Chief Executive, Argyll and Bute Third Sector Interface Angela Tillery, Principal Accountant, Argyll and Bute Council 1. APOLOGIES FOR ABSENCE Apologies for absence were received from Fiona Thomson and Evan Beswick. 2. DECLARATIONS OF INTEREST Julie Hodges declared a non-financial interest in respect of the Integrated Impact Assessments which were discussed as part of item 4 of this Minute. 3. MINUTES The Minute of the meeting of the Argyll and Bute HSCP Finance and Policy Committee held on 24 February 2026 was approved as a correct record. 4. HSCP BUDGET 2026/27 The Committee gave consideration to the draft Budget report for the IJB which included information about public engagement and Integrated Impact Assessments. Page 3 Agenda Item 3
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Decision The Finance and Policy Committee considered and endorsed the draft IJB report which recommended the IJB - 1. approve the HSCP expenditure budget for 2026/27 totalling £430.2m, incorporating a savings plan totalling £8.0m, and allocation of £5.2m in non- recurring resourcing, 2. note the budget gap before savings and use of non-recurring resources is £13.2m, 3. note two savings proposals require further process and governance prior to final approval, 4. note that the SLA with NHS Greater Glasgow and Clyde presents a potential additional risk totalling £16.0m and that this issue is still to be resolved, 5. note the HSCP has worked with both partners to develop its budget, and 6. request further service re-design is progressed to move the HSCP to a more sustainable operating model. (Reference: Report by Head of Finance dated 17 March 2026, Reprot by Business Improvement Manager dated 17 March 2026 and Integrated Impact Assessments, submitted) 5. BUDGET MONITORING - 11 MONTHS TO 28 FEBRUARY 2026 The Committee gave consideration to a report providing a summary of financial performance for the first 11 months of the year and the financial position and year end forecast. Decision The Finance and Policy Committee noted – 1. the HSCP was now reporting a small year to date underspend and was forecasting a £0.8m underspend against budget, 2. recovery restrictions remain in place as spend was still being financed by use of reserves and the HSCP was not operating on a sustainable basis, 3. savings of £8m had been delivered, 89% of target, 4. that any actual underspend would reduce reliance on reserves which would be carried forward to support the budget in 2026/27, and 5. the risk in respect of the SLA with Greater Glasgow and Clyde. (Reference: Report by Head of Finance dated 17 March 2026, submitted) Page 4
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6. IJB FINANCIAL BULLETIN 2024/25 On behalf of the Accounts Commission, Audit Scotland has undertaken an analysis of the annual accounts for 2024/25 in respect of Scotland’s Integrated Joint Boards, and a report outlining the findings was before the Committee for information. Decision The Finance and Policy Committee noted the contents of the report. (Reference: Report by Audit Scotland dated February 2026, submitted) 7. CARE HOMES STRATEGIC DEVELOPMENT - UPDATE REPORT The Strategic Development project in respect of Care Homes has been ongoing for some time. Stages 1 and 2 have been completed and reported previously. The Committee gave consideration to a report outlining the next steps in the process and the governance arrangements. Decision The Finance and Policy Committee noted that - 1. the Care Homes Strategic Review was continuing in partnership with HUB North, 2. Public Engagement was expected to commence in June 2026, 3. a workshop to start consideration of the potential new investment had been scheduled, and 4. governance was complex and further Council engagement was required. (Reference: Report by Head of Finance and Head of Complex Care and Registered Services dated 17 March 2026, submitted) Page 5
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1 Finance & Policy Committee Date of Meeting: 19 May 2026 Title of Report: Budget Monitoring – 12 months to 31 March 2026 and provisional year end Presented by: James Gow, Head of Finance The Finance & Policy Committee is recommended to: • Note that the HSCP is reporting a £2.9m or 0.7% underspend against budget for 2025/26. • Note this represents a significant improvement in financial performance as a consequence of delivery of savings and the financial recovery plan along with favourable year end NHS inter-board charges. • Note that general reserves increased from £2.6 to £4.7m as a result of the improved financial performance. • Note savings of £8.0m have been delivered, 90% of target. 1. EXECUTIVE SUMMARY 1.1 This report provides a summary of financial performance against budget for the 2025/26 year. Financial performance is much improved as savings and the recovery plan have been delivered. Additionally, there were several areas of improvement within the NHS budget at the year end as funding allocations, drugs rebates and national and inter-board charges were confirmed. The HSCP has therefore again operated within the resources available to it and has a relatively small general reserves balance at the year end. However, £2.5m of non-recurring savings were used to fund Social Work / Social Care services and there is still a significant underlying budget gap within NHS services. 1.2 1.3 Given the context facing health and social care, it is welcomed that the HSCP has been able to operate within the budget set and its reserves position has improved. This in turn slightly reduces short term financial risk but the HSCP is still not operating on a financially sustainable basis and there are severe financial challenges ahead along with continuing service demand pressures. The un-audited annual accounts are due to be published in June and work on these is continuing, therefore the figures contained within this report are still subject to change and external audit. A further priority is to update the medium term financial outlook and accelerate the development of plans to bring NHS spend into line with available resourcing, the reserves held will hopefully create increased scope to facilitate service change. Page 7 Agenda Item 4
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2 2. Recommendations • Note that the HSCP is reporting a £2.9m or 0.7% underspend against budget for 2025/26. • Note this represents a significant improvement in financial performance as a consequence of delivery of savings and the financial recovery plan along with favourable year end NHS inter-board charges. • Note that general reserves increased from £2.6 to £4.7m as a result of the improved financial performance. • Note savings of £8.0m have been delivered, 90% of target. 3. DETAIL OF REPORT 3.1 12 Months to 31 March 2026 The table below provides the year-end figures comparing spend against budget in the usual format, there will be presentational differences between this report and the published accounts. Appendix 1 provides a further analysis of the variances: Service Actual £000 Budget £000 Variance £000 % Variance COUNCIL SERVICES TOTAL 100,483 100,540 57 0.1% HEALTH SERVICES TOTAL 295,698 298,555 2,857 1% GRAND TOTAL 396,181 399,095 2,914 0.7% Allocation to General Reserves - NHS 2,857 Allocation to General Reserves – Social Work 57 Year End Balance 399,095 399,095 0 0% 3.1.1 The year end is balanced through adjustments to general reserves. The Social Work budget assumed reliance on non-recurring pension funding totalling £2.5m to achieve balance, the outturn is that the reliance on the pension saving was used in full and there was a very small underspend of £57k that was allocated into the general reserve. The NHS underspend has resulted in an increase in the general reserves balance, this is earmarked to part fund the 2026/27 budget gap (per the March 2025 budget paper). The overall position is favourable against the budget and in comparison with performance in the prior year. There are variety of reasons for this including delivery of savings and the financial recovery plan, further detail is provided in the following sections. Social Work / Social Care Services operated within budget, the main area of concern throughout 2025/26 was in relation to Children and Families, the overspend here reduced in the latter part of the year and was offset with savings elsewhere and delivery of the recovery plan. The situation with each service is summarised below: Page 8
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3 Children and Families The Looked After Children budget was highlighted as an area of overspend throughout the year. This was due to a higher number of children in external placements and the final overspend was £1.1m on a £7.8m budget. The overspend reduced from a higher forecast early in the year as alternative arrangements were made for some children in out of area, high cost placements. Savings were made on other parts of the service budget and the net overspend was £520k against the £16.9m budget. The recovery plan saving of £100k relating to income recovery was not achieved. The service secured capital funding for the Bairns Hoose in Helensburgh and this is now operational. Towards the end of the year funding was also secured for the development of a similar facility in Lochgilphead during 2026/27. Older Adults The Older Adult Service underspent by £0.6m, a significant improvement in comparison with the situation last year. The implementation of the ceiling of care and the management down of agency costs contributed to more effective management of the budget. The underspend is however non-recurring as it is largely due to the recovery of £533k of unspent direct payments, these related to balances held by clients to cover assessed care costs which had not been spent nor recovered for some time. This financial recovery plan action delivered a bigger financial benefit that was expected. This will not be recurring but teams are now working to ensure funds are monitored more effectively so they do not build up to such an extent in future. Adult Services Budget Actual Spend Variance External Residential Placements – demand led @ national contract rate £13.4m £13.2m £0.2m Care @ Home Service £17.9m £17.8m £0.1m Internal Care Home Placements £7.8m £ 8.2m (£0.4m) Older Adults - Other £13.4m £ 12.7m £0.7m Total £52.5m £51.9m £0.6m The outturn improved at the year-end in comparison to the forecast due to additional income from client contributions and the effect of the ceiling of care. External care home placements include those placed with the independent sector within Argyll & Bute and outside the area. In addition to recovery of direct payments, another recovery plan action was to reduce spend on agency staffing, the table below summarises progress: Agency Staffing Cost Analysis 2024/25 £’000 2025/26 £’000 Care Homes Kintyre Care Centre 613 692 Gortonvogie 441 145 Tigh a Rudha 158 62 Care Homes – other internal 34 0 Care Homes Total 1,246 899 Page 9
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4 Care @ Home Islay & Jura 528 469 Mull & Iona 373 310 Tiree & Coll 257 109 Kintyre 344 424 Lorn 1,249 1,037 Mid Argyll 161 93 Progressive Care Centres 67 204 Care @ Home Total 2,979 2,646 Children & Families 270 291 Social Work - Adults 208 218 Social Work – MH / LD 271 205 Total 4,974 4,259 A £715k or 14% reduction in agency staff costs was achieved in comparison with 2024/25. Staffing pressures remain in the Kintyre and Oban areas in particular. Whilst this demonstrates measurable progress, spend remains high. There is some prospect of improvement in Kintyre but the situation within the care at home service in Oban remains difficult and there is risk of increased reliance on agency staff as providers continue to hand back activity. The saving on agency has contributed to the delivery of the savings and the recovery plan but some has avoided cost pressures rather than delivered a recurring saving against budget. For comparison, spend in the 2023/24 was £3.2m and £1m the year before that. It is difficult to accurately assess how much these hours would have cost if the HSCP had been able to: • recruit and retain its own staff better. • experienced reduced absence. • had been able to commission contractors to deliver more care @ home within the contract. There are smaller levels of external agency costs borne by the independent sector which are not included in these figures, the shortage of workers is a key challenge for the future of care provision. Actions taken to achieve improved financial performance include the introduction of the ceiling of care and managing care at home hours within budget, particularly in the latter part of the year. The service impacts include increasing waits for service and an increase to delayed discharges from hospital. This is consistent with what has been observed elsewhere in the country when care at home restrictions are put in place to manage spend. However, services were being provided significantly beyond sustainable staffing levels and available budget, to meet increasing demand. That situation could not continue. Learning Disability / Physical Disability / Mental Health These services operated above budget with increased spend becoming apparent in the later part of the year as care package and external placement costs increased. The budget was £25.3m and spend was £378k higher. Page 10
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5 Social Work / Social Care Funding / Budget The Social Work / Social Care funding allocations were: Social Work £m A & B Council Allocation 82.7 Bon-recurring Pension Fund Saving 2.5 Funds flow from NHS Budget 15.3 Total Budget 100.5 The remaining £0.5m of the pension fund saving has been held for transformation by Argyll & Bute Council. Spend from this has been approved but not drawn down during the year. Spend in total was therefore still higher than the resources that would normally have been available to the HSCP. the net £57k underspend was added to the general reserve held by Argyll and Bute Council on behalf of the IJB. 3.1.2 NHS Budget The HSCP reported an underspend of £2.8m in respect of its NHS services. The position improved markedly in the final months of the year. The main factors which resulted in the improvement were: - Reduced costs of national services confirmed in February and March. - Increased national drug rebates confirmed at year end. - Reduced cost per case activity with other Scottish Boards than anticipated. - Reduced prescribing costs due to national price reductions (£1m saving). The underspend has been transferred to the IJB General Reserves giving a final year end position of breakeven. Whilst the outturn is favourable, the IJB approved a health budget for 2026/27 which requires the use of the reserves. The HSCP plans to rely on the reserves to fund the impact of existing cost pressures and the likely impact of the ongoing geo-political crisis. It is necessary that this underspend is carried forward to fund the 2026/27 budget deficit as outlined in the budget paper. Analysis has been undertaken to ensure that favourable variances, where they are likely to be recurring, are used to reduce the underlying budget gap. However, many of them are considered fortuitous and would have been hard to predict earlier in the year. The year end position along with the on-going issue with the Greater Glasgow and Clyde SLA does indicate the importance of increasing capacity to better manage the patient flows to other Boards. The reduction in prescribing costs, £1m of the underspend, is one area where consideration will be given to increasing the operational savings target with a view to reducing the underlying recurring cost pressures and deficit. Page 11
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6 In-Year Cost Pressures There are overspends which have had to be managed during 2025/26. The top 10 are listed below: Service Budget £ Actual £ Variance £ Comment LIH General Medical Staff 2,773,100 3,856,546 1,083,446 Agency cover for vacancies HSCP Underlying Deficit 968,000 0 968,000 Budget Gap savings not delivered External MH Placements 0 716,068 716,068 Long term care costs 2C Practice - Kilcreggan 471,221 818,145 346,924 Agency cover for GP vacancies Other Board Patient Treatments 4,931,200 5,209,860 278,660 Increased charges from Forth Valley and the Golden Jubilee LIH Surgical Staffing 1,360,700 1,639,263 278,563 Agency cover for vacancies Campbeltown Hospital staffing 2,421,900 2,679,131 257,231 Agency cover for dialysis unit and ward vacancies External NHS Board Mental Health Treatment 103,400 354,175 250,775 increased costs for secure unit and dementia patients External Women's & Children treatment 25,800 259,367 233,567 Elective maternity referrals to Forth Valley Patient Travel - Islay 463,600 682,118 218,518 Increase in patient flights to Glasgow Total 11,582,921 16,214,673 4,631,752 There are three key drivers from the table above which will continue to impact the HSCP’s financial position in 26/27: • Workforce pressures – workforce planning & recruitment strategies require to be reviewed for services which are consistently overspending due to a lack of a stable staffing model. LIH General Medical and General Surgery Medical Staffing have been reliant on locum / agency staffing every year since the pandemic ended. • External Patient Treatments – activity assumptions and pathways need to be considered for those services which the HSCP has no formal pathway to allow robust forecasting and financial planning at a patient level to minimise the time spent in high cost complex care settings. • Structural deficit/unachieved savings. Greater Glasgow and Clyde (GG&C) SLA No account has been made in the year position for the additional costs of the NHS GG&C rebased SLA. This has not impacted on the figures for 2025/26 but remains an area of contention and cost pressure for 2026/27 and beyond. There is going to be a requirement to make some additional payment to NHS GGC in 26/27. The longer term approach to funding this also needs to be clarified. Appendix 1 provides further analysis of variances against the budget. 3.2 Unaudited Accounts The unaudited accounts are due to be completed in June, these will be considered by the Audit and Risk Committee prior to publication. It is still Page 12
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7 possible, but unlikely, that there will be changes to the figures in this report as the accounts are finalised. 3.3 Savings Delivery 3.4 3.4.1 3.4.2 Savings declared totalled £8.0m (90%) of the £8.9m target, although £2.7m of the health savings still have to be converted into recurring rather than in-year savings. Savings performance against the approved plan has therefore been very positive and has been supplemented by favourable variances and strong performance in delivering the financial recovery plan. Governance of the savings plan has continued to be managed through the Savings Review Group, chaired by the Chief Finance Officer and attended by Heads of Service on a rotational basis. 2025/26 Savings Year to 31 March Target Achievement Balance % £' 000 £' 000 £' 000 Fully Achieved 7,980 7,980 0 Carried Forward 944 45 899 Total 8,924 8,025 899 90% Appendix 2 lists the savings, the fully complete ones will not be reported upon further, the non-recurring ones and those that were not achieved will be carried forward into 2026/27. The Children & Families £100k recovery plan saving will be offset against the service growth budget as it cannot be delivered. Reserves Earmarked reserves of £20.7m were carried into 2025/26. Of this, £5.6m was spent during the year. This included spend on a number of key projects listed in appendix 4. Some of the main areas of reserves spend included: • Children’s Acute Mental Health Services £244k • Delivery of E Health projects £245k • Hospital at Home £414k • The Prevention Programme £258k • Campbeltown Hospital / X Ray £352k • Final phase of the Tiree Care Home remodelling £209k £2.9m of the funding carried forward for the agenda for change costs were also spent during the year. This largely related to re-grading of nursing staff and funding the financial impact of the reduced working week. Spend of reserves carried forward was less than expected as the Sustainability and Value funding (£4.7m) has been carried forward for another year and reserves were not required to the extent planned to support the revenue budget. A number of new funding allocations were also received in 2025/26 and not spent prior to the year end. Therefore reserves have increased overall. The total of the new allocations to reserves is £15.5m. Some of the main ones are: • Agenda for Change liabilities and costs £8.5m Page 13
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8 4 4.1 5 5.1 6 6.1 • Hospital @ Home expansion £1.3m • Long Covid project £0.3m • System Flow and Improvement £1.1m • Primary Care & GP Walk In Service £0.6m • NHS revenue underspend £2.8m Appendix 3 provides a full analysis of opening reserves, spend and new reserves received and carried forward. Better than planned financial performance during 2025/26 has again provided some degree of resilience, however there remains significant structural problems with the financial sustainability of NHS services within Argyll & Bute in particular and the issue regarding the SLA has still not been adequately resolved. General Reserves Opening £000 Spend £000 New Reserves £000 Closing Balance £000 A & B Council 1,585 209 57 1,433 NHSH 992 534 2,857 3,315 Total General Reserve 2,577 743 2,914 4,748 Total Reserves – Council 2,247 209 202 2,239 Total Reserves - NHS 18,500 5,434 15,321 28,387 General reserves (those reserves that are not earmarked for a specific purpose) are £4.7m. The IJB reserves policy is that it should aim to hold a minimum contingency reserve of 1% of annual spend (£4m) and should hold 2% (£8m) as an aspirational target. At the year end, general reserves were slightly above the 1% level. Given the scale of the underlying budget deficit it is not intended that significant spend from the general reserve is progressed at present. The earmarked reserves are not held entirely at the discretion of the IJB, these are held for specific purposes and mostly relate to NHS funding streams and are generally required to cover the costs of commitments already made, particularly in relation to staffing costs. RELEVANT DATA AND INDICATORS Information is derived from the financial systems of both partners. CONTRIBUTION TO STRATEGIC PRIORITIES The Integration Joint Board has a responsibility to balance its budget and ensure spend and investment is aligned to the Strategic Plan. GOVERNANCE IMPLICATIONS Financial Impact – the outturn position is favourable in comparison to budget and the HSCP therefore has been able to increase its general Page 14
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9 6.2 6.3 reserves slightly and has not had to rely on unplanned financial support. The improved performance indicates that financial governance was effective during 2025/26. Staff Governance – None directly from this report, there is a strong link between HR management and delivering a balanced financial position. Clinical Governance – None directly. 7. 7.1 8. PROFESSIONAL ADVISORY Professional Leads have been consulted with on the implications of the budget and savings programme. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 None. 9. 9.1 10. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. RISK ASSESSMENT 10.1 There are financial risks included in the Strategic Risk Register, the year end position does not change these or the risk ratings. The increase in general reserve will be of assistance in ensuring that the HSCP is perceived as a going concern and has a route to fund its budget deficit (NHS) in 2026/27. 11. PUBLIC AND USER INVOLVEMENT AND ENGAGEMENT 11.1 None directly from this report, engagement on activities relating to savings and transformation forms part of the project plans where appropriate. The HSCP is transparent in respect of its finances and it conducted an extensive budget engagement exercise in the December 2025 to March 2026 period. 12. CONCLUSIONS 12.1 12.2 This report provides a summary of the financial position as at the end of the 2025/26 financial year and confirms that the HSCP has taken effective steps to manage within budget for the year. This means that it again has a small level of financial resilience and has reserve funding in place to fund its budget gap for 2026/27 (NHS services). The delivery of savings and the social work financial recovery plan has been effective and has contributed to the improved position. The outturn was better than had been forecast during the year. This is in part due to the financial impacts of the recovery plan actions becoming evident in the later part of the year. There were also late funding allocations and savings confirmed relating to the NHS service underspend. The future challenge is however significant and the need for service re-design and transformation is increasingly important. Page 15
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10 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) Finance & Polic Committee Budget Monitoring – 12 months to 31 March 2026 19/5/2026 TBC SLT Budget Monitoring – 12 months to 31 March 2026 25/5/2026 TBC APPENDICES: Appendix 1 – M12 Outturn Appendix 2a and 2b – Savings Programme Appendix 3 – Reserves AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk Page 16
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Classification: OFFICIAL# ARGYLL AND BUTE HEALTH AND SOCIAL CARE PARTNERSHIP APPENDIX 1 REVENUE BUDGET MONITORING SUMMARY - YEAR TO DATE POSITION AS AT 31 MARCH 2026 Reporting Criteria: +/- £50k or +/- 10% For information: The Council don't do monthly based accrual accounting, whereas Health do. On the Council side, there may be a mismatch between year to date actual and budgets, due to timing differences as to when invoices are paid. Health do monthly based accrual accounting, therefore, you should see a correlation in the year to date position and the year end outturn position. Service Actual £000 Budget £000 Variance £000 % Variance Explanation COUNCIL SERVICES: Chief Officer 1,697 2,016 319 15.8% The underspend is due to uncommitted centrally held funds offsetting overspends at service level. Service Development 473 486 13 2.7% Outwith reporting criteria. Looked After Children 8,894 7,776 (1,118) (14.4%) The overspend is due to the increased costs and demand for childrens residential placements. Child Protection 3,419 3,855 436 11.3% The saving is due to vacancies across the teams and offset some of the overspend above. Children with a Disability 831 929 98 10.5% The saving is due to lower than budgeted property costs at the Ardlui Facility along with a reduction in the need for some third sector grants. Criminal Justice 116 280 164 58.6% The saving is due to one vacant post (council funded) and grant claim that includes recovery of support services costs which are non-controllable. Children and Families Central Management Costs 4,163 4,063 (100) (2.5%) The overspend is due to unbudgeted spend on overtime, sick pay, payments in leiu and legal fees. Older People 51,898 52,490 592 1.1% The underspend is mainly due to an over recovery from direct payments overpayments and vacant posts in assessment and care management teams partially offset by agency cover. Physical Disability 3,272 3,312 40 1.2% Outwith reporting criteria. Learning Disability 20,595 20,219 (376) (1.9%) The overspend is due to increaed demand for supported living packages and respite care. Mental Health 4,397 4,276 (121) (2.8%) The overspend is due to increased demand for residential placements. Adult Services Central Management Costs 728 838 110 13.1% The underspend is due to lower than anticipated spend on third party payments. COUNCIL SERVICES TOTAL 100,483 100,540 57 0.1% HEALTH SERVICES: Explanation Hospital & Community Care Services 75,309 74,179 (1,130) (1.5%) The overspend is due to continuing agency staff usage, predominently to cover medical staff vacancies in Lorn & Isles Hospital. Complex Care & Registered Services 21,513 21,350 (163) (0.8%) The overspend is due to high cost out of area patient placements Children & Families Services 13,416 13,517 100 0.7% The saving is due to staff vacancies. Commissioned Services 86,804 87,916 1,112 1.3% The underspend is due to reduced cost per case charges for patient treatments & increased drug rebates. Commissioned Services - Other 5,416 5,206 (210) (4.0%) The overspend is due to high cost individual cost per case patient treatment Primary Care Services inc Dental 33,885 33,499 (387) (1.2%) The overspend is due to the cost agency medical staff to run 2c practices. Other Primary Care Services 12,150 12,150 0 0.0% Outwith reporting criteria. Prescribing 24,991 25,931 941 3.6% The underspend is due to staff vacancies and drug price reductions. Public Health 2,550 2,532 (18) (0.7%) Outwith reporting criteria. Lead Nurse 1,935 2,081 147 7.0% The favourable variance is due to vacancies/secondments. Management Service 2,762 2,937 175 5.9% The underspend is due senior management vacancies & reduced services from external providers Planning & Performance 3,091 3,089 (2) (0.1%) Outwith reporting criteria. Budget Reserves 0 3,483 3,483 100.0% The underspend is due to slippage on reserves due to delays in implementation, generally due to recruitment delays. Budget Reserves - Committed 0 0 0 0.0% Outwith reporting criteria. Income (2,121) (2,081) 39 (1.9%) Outwith reporting criteria. Estates 13,997 13,735 (262) (1.9%) The overspend is due to unplanned but essential Estates works, mainly in Campbeltown. Centrally Held Savings 0 (968) (968) 100.0% Adverse variance due to unachieved savings HEALTH SERVICES TOTAL 295,698 298,555 2,857 1.0% GRAND TOTAL 396,181 399,095 2,914 0.7% Page 17
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Classification: OFFICIAL# Appendix 2a - 2025/26 Fully Complete Savings Target Ref. Savings Description £' 000 Social Work 2324-07 Care at Home Commissioning 400 2425-03 Structured and monitored review of high cost care packages 150 2324-04 Contract & Demand Officer Post - revised and saving taken on catering shared service post instead 49 2526-1 Review of Responder Service / mobile teams 742 2425-01 Revert to National Minimum Pay Rate - uplift for some contracts - remaining balance 31 2526-2 Increased Fees and Charges 200 2526-3 Flat cash settlements on contracts 100 2425-08 Sleepovers Review 34 2526-4 Care @ Home Efficicencies 250 2526-7 Telecare Charges Increase 40 2425-07 Review of expensive care packages 98 2526-6 Just Checking 15 1819-33 Catering, Cleaning and other Ancillary Services 71 2526-5 High Cost Care Packages (LD/MH/PD) 200 2526-11 KCC estates support post 31 2526-17 Care @ Home Efficicencies - Accomodation (Recovery Plan) 44 2526-15 Threshold of Care (Recovery Plan) 80 2526-12 LCC Removal of Voids (Recovery Plan) 5 2526-9 Direct payment Recovery (Recovery Plan) 50 2526-10 SLT Vacant Posts (Recovery Plan) 25 Health AB1920-35 Bed reduction CCH 2019 150 AB1920-4 Review of Service Contracts 19 AB20-21 16 Dunoon Medical Services 120 AB2021-19 Hotel Services redesign to reflect reduction in inpatient numbers 79 AB2526-01 Depreciation - end of life assets 70 AB2526-02 Energy price reductions 100 AB2526-03 Prescribing - Primary Care 250 AB2526-04 Performance Analyst 0.5FTE 22 AB2526-05 Health Intelligence Support Worker 0.5FTE 20 AB2526-06 Public Health Addictions Contract saving 21 AB2526-07 Cessation of Living Well Grants 12 AB2526-08 Redesign of Living Well Network 25 AB2526-09 Prevention Outcomes Framework 12 AB2526-11 Dental Services efficency 100 AB2526-13 Housekeeping savings 50 AB2526-14 Establishment Reviews 65 AB2526-16 Review of telecoms contract 35 AB2526-15 Reduction in minor allocations budget 45 AB2526-10 Drug Purchasing Efficiencies 400 AB2526-17 Patient Treatment Income 30 AB2526-18 Review of staff bandings 25 AB2526-16 Reserves Review 400 AB2526-22 Reduction in fleet vehicle numbers (NHS Recovery Plan) 50 AB2526-24 Patients Travel Savings (NHS Recovery Plan) 75 AB2526-27 Slippage on budget reserves (NHS Recovery Plan) 100 AB2526-28 Contract Efficiencies (NHS Recovery plan) 140 AB2526-29 Review of MH Care Packages (NHS Recovery Plan) 100 AB2526-12 Secondary Care Drugs 100 AB2526-26 Medical Agency Costs - 2C (NHS Recovery Plan) 300 non recurring AB2526-21 Out of Area Patient - non recurring (NHS Recovery Plan) 250 non recurring AB2526-27 Slippage on Reserves (NHS Recovery Plan - £300k addnl) 500 non recurring AB2526-30 Slippage on care packages (NHS Recovery Plan) 50 non recurring AB2526-17 Patient Treatment Income 100 non recurring AB2526-20 Suplementary Staffing Reduction 200 non recurring AB2526-25 Reduce Agency Medical - LIH Model (NHS Recovery Plan) 1000 non recurring AB2324-26 Childrens & Families Staffing and service re-modelling 250 non recurring AB2526-14 Establishment Reviews 100 non recurring Total Fully Complete 7,980 Page 19
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Classification: OFFICIAL# Appendix 2b - LIVE SAVINGS PROGRAMME Target Declared Remaining RISK NOTES Ref. Savings Description £' 000 £' 000 £' 000 Social Work 2324-14 Reduce external placement budget by one (C&F) 160 160 No expectation this will be achieved at present - carried into 26/27 2526-8 Additional Income from Adoptions (Recovery Plan) 100 100 Not deliverable due to court ruling - offset against growth budget as no prospect of achieving this 2526-13 Day Services Review (Recovery Plan) 50 50 Review to report and make recommendations - carried into 2026/27 2526-14 Community Transport (Recovery Plan) 25 25 Achieved in 2026/27 - carried forward 2526-16 Agency Workers - (Recovery Plan) 90 45 45 Saving partially achieved to date, balance carried forward. Health AB2021-64 FME (Dunoon) 50 50 Project group now established as staffing in place to deliver this in 2026/27. AB2223-9 Forensic Service Contracts 20 20 Project group now established as staffing in place to deliver this in 2026/27. AB2021-4a/b Admin & Clerical 120 120 1 Post now held at vacancy monitoring group. AB2021-20 Centralised booking of medical records - reduction in admin costs 97 97 as above AB2122-33 Lab ordering / consumables LIH 40 40 Managed service contract now in place, saving should be deliverable in 2026/27 AB2122-66 Savings from building rationalisation 63 63 Was dependent upon cancelled Dunoon project, now delivered through a number of small savings, £8k delivered 24/25 AB2223-5 Estates Staffing Structure 129 129 NHSH now seeking to progress, carried into 26/27 944 45 899 95 0 95 322 45 277 527 0 527 Page 20
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# Appendix 3 - Reserves Opening Reserves £ Spend during 2025/26 £ Additional Reserves 2025/26 £ Closing Reserves Balance £ Provisional use of reserves for NHS Budget Gap 26/27 £ Technology Enabled Care (Near Me) 17,802 17,802 17,802 ADP Funding 407,201 242,000 200,386 365,587 5,200 Best Start - Maternity Services 105,773 8,353 114,126 105,773 Supporting Improvements to GP Premises 178,441 113,000 65,441 Scotgem Funding 30,188 30,188 Childrens Mental Health Services (CAHMS) 621,670 244,300 377,370 Primary Care Funding 490,162 124,736 602,178 967,604 Trauma Network Tranche 1 / Tranche 2 36,825 36,825 36,825 PFG School Nursing 166,783 9 166,774 99,360 District Nurse Posts 89,515 89,515 49,515 E-health Strategy Funding 429,310 245,000 145,144 329,454 274,310 Perinatal MH Funding 13,887 13,887 0 Mental Health Officer Training / Recovery 28,221 28,221 Type 2 Diabetes Framework / Healthy Weight 37,379 37,379 0 Trauma Training Programme 79,297 18,472 97,769 Oban Accommodation 145,000 145,000 Primary Care Education Fund 250,000 250,000 Fleet Decarbonisation 20 20 Additional Band 2-4 Staffing 467,913 38,784 429,129 Nursing Support for Care Homes 166,957 17,200 149,757 Mental Health Facilities 165,284 165,284 165,284 Diabetic Technologies 34 34 Waiting Times, Cancer Waiting Times & Improving Flow 189,786 189,786 1,146,983 1,146,983 Medical Assisted Treatment Standards 55,052 55,052 Psychological Therapies 55,923 55,923 0 Dementia Post Diagnostic Support 158,710 10,700 148,010 148,010 Eating Disorders 85 85 SARCS Programme 50,000 50,000 Mental Health Recovery Services 18,831 18,831 0 Whole Family Wellbeing Fund 495,060 126,416 621,476 Multi Disciplinary Teams 44,000 150,353 194,353 General Reserves - Service Transformation & Estates 1,584,696 209,000 57,015 1,432,711 Social Work Workforce 38,990 38,990 Criminal Justice Fund 20,667 20,667 Nurse Director Support for Care Homes 62,386 62,386 Digital Therapies 39,547 15,224 24,323 Community Glaucoma Service 38,744 38,744 GDS element of the Public Dental Service 191,589 191,589 191,589 Hospital at Home 413,945 413,945 1,262,854 1,262,854 Learning Disability Health Checks 75,244 75,244 75,244 Recovery Children's Oral Hlth & Dent(Childsmile) 10,827 10,827 10,827 Long Covid Project / ME 297,594 297,594 Sustainability & Value 4,697,000 100,000 4,797,000 Prevention Programme 444,000 257,700 186,300 General Reserves - Revenue Funding 41,168 41,168 General Reserves - Estates & Transformation Projects 950,537 533,900 2,856,562 3,273,199 Agenda for Change and nurse regrading Reserve 7,181,385 2,861,700 8,512,461 12,832,146 Total 20,747,090 5,643,004 15,523,515 30,627,601 1,179,739 Held by NHS 18,500,159 5,434,004 15,321,612 28,387,767 Held by Argyll & Bute Council 2,246,931 209,000 201,903 2,239,834 Total 20,747,090 5,643,004 15,523,515 30,627,601 Page 21
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1 Finance & Policy Committee Date of Meeting: 19 May 2026 Title of Report: Social Care Fees and Charges – Budget 2026/27 Presented by: James Gow, Head of Finance The Finance & Policy Committee is asked to: • Note that the Responder Service is to be maintained as a 24 hour, 7 day per week service. • Note the responder service is non-statutory and will cost £2.0m in 2026/27; • Endorse the introduction of a £5 per week charge for the responder service and note the IIA; • Note that the HSCP expects to implement the charge from September 2026 so there is sufficient time to implement and communicate the change and fee waiver process; • Endorse the increase in the social care weekly charging cap from £145 to £167 from 6 July 2026; and • Note that Argyll & Bute Council approved the above changes to fees and charges at Council on 29 April 2026. • Note that there remains some degree of risk in respect of this responder service charge. 1. EXECUTIVE SUMMARY 1.1 The IJB approved its budget and savings plan for 2026/27 at its meeting held on the 25th March 2026. In response to the public engagement exercise, it was decided that the Responder Service should be maintained as a 24 hour service as communities indicated its value and the proposed saving was removed from the plan. However to support ongoing sustainability of a non statutory service it was agreed by the Integration Joint Board that the service in future would be part funded by the introduction of a new fee set at £5 per week. The purpose of this report is to seek formal approval from the IJB for the implementation of the charge, to be implemented in September 2026. 1.2 This report also seeks approval for an increase in the weekly fee cap and highlights that the IJB does not have delegated authority to set fees although it has included this new fee within its budget as approved by Argyll & Bute Council. The weekly fee cap has not consistently risen with the annual inflationary uplift and the proposed uplift falls below the rate had this been the case. 2. Recommendations 2.1 The Finance & Policy Committee is recommended to: • Note that the Responder Service is to be maintained as a 24 hour, 7 day per week service. • Note the responder service is non-statutory and will cost £2.0m in 2026/27; • Endorse the introduction of a £5 per week charge for the responder service and note the IIA; Page 23 Agenda Item 5
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2 • Note that the HSCP expects to implement the charge from September 2026 so there is sufficient time to implement and communicate the change and fee waiver process; • Endorse the increase in the social care weekly charging cap from £145 to £167 from 6 July 2026; and • Note that Argyll & Bute Council approved the above changes to fees and charges at Council on 29 April 2026. • Note that there remains some degree of risk in respect of this responder service charge. 3. DETAIL OF REPORT 3.1 The budget for 2026/27 was approved by the IJB on 25th March 2026. As outlined in the budget paper, further governance processes are required in order to effect an increase in fees and charges for the responder service. Fees and Charges are not delegated to the IJB and therefore Council approval was required. 3.2 Responder Service Charge There is a day time and night time responder service operating in all 5 Argyll & Bute mainland operational areas (Kintyre, Mid Argyll, Oban & Lorn, Cowal and Helensburgh & Lomond), plus Bute. The Responder Service does not cover the other islands. It is not a statutory service and does not typically provide planned care, it is an emergency response for cases that fall short of requiring a blue light response. The cost of the service is approximately £2.0m in 2026/27. The process for accessing the service is via the telecare service in the first instance with calls being passed to the responder service where appropriate and / or where there is no named person / key holder available to provide help. As stated in the budget report, the intention is to implement a charge for access to the responder service at £5 per week. This is in addition to (but separate from) the charge for telecare. It will not normally be possible to access the responder service (currently provided by Carr Gomm under contract) unless clients have the telecare service in place. The charge for the telecare service from 1 April 2026 will be £7.25 per week. The charges are being kept separate as some clients may wish to access telecare only (eg if family members can respond) and telecare clients who live on the islands (apart from Bute) have no access to a responder service. Based on a charge of £5 per week and 2280 clients the maximum income available would be around £590k in a full year. This is not a realistic estimate of the income the HSCP will receive: 1. Some clients are likely to opt out as they have nominated key holders who can respond rather than using the responder service. 2. Some clients will be covered by a fee waiver. There are generally a small number of these clients, most of which have a terminal illness. 3. Some telecare clients are already in debt and increased charges are likely to add to debt. 4. There will be some requirement to increase administrative staffing to manage the increased workload associated with billing (1.5 FTE approx. @ £40-60k gross). A more realistic estimate is that the net financial benefit will be £300k in a full year. The budgeted saving for 2026/27 is £160k in 2026/27. The rationale for implementing a fee for the service includes: Page 24
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3 • Feedback from the budget engagement process strongly supported the maintenance of a 24 hour, 7 day per week responder service. • There was some support for increased charging in preference to service reduction. • The service is not statutory and therefore the HSCP can charge for it. • The suggested fee will cover no more than 25% of the full cost of the service, therefore any free personal care included in the service will be met from the publicly funded element of the contract. • The public feedback also highlighted the psychological importance of the availability of the service for both clients and their families, even if they do not use it often or at all. There is a separate exercise underway to re-define the contract and expectations associated with it as there is variation across the area. 3.3 Fee/Charge Waiver A significant number of people are currently living in poverty and are having to manage on-going cost of living pressures. This is currently recorded as a very high / red rated risk on the strategic risk register. Therefore, it is important that the new charge is supported by a waiver system. This is already currently applied to telecare clients and there are currently around 20 active approved waivers. These cases would automatically receive a waiver for this new charge. Reasons for approving a waiver are as follows: • Terminally ill • Financial hardship • Disability related costs • Risk of harm • Service redesign Upon the introduction of the new charge all users will be provided with details of the waiver process and will be encouraged to discuss this with their social work support should they feel that they are unable to pay or entitled to a waiver. Where individuals choose not to pay for the responder service but at a later date require help from the service in response to a call, charging will commence. It would not be desirable for more costly interventions to be deployed in cases where someone requires support from the responder service. An IIA for the charge is included as appendix 1. This has been considered and endorsed by the IJB as part of its budget approval process. 3.4 Weekly Social Care Cap There is also a cap on the weekly contributions individuals can be asked to make towards the cost of their full package of social care. The cap has historically been based upon 7 hours of homecare provision per week. There is a complex means testing process to establish the amount individuals can be asked to pay but, at present, this won’t exceed the cap, currently £145 per week. The cap was increased for 2026/27 as fees and charges were under review at the time the standard annual fee increase was approved. It has also been frozen several times in recent years and is no longer aligned to the 7 hours per week homecare rate. The cap was frozen during a period where the Scottish Page 25
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4 Government had a policy intention to end social care charging altogether, this didn’t progress. The table below outlines the recent history: It is proposed that for 2026/27 the weekly cap should be increased from £145 to £167. The rationale for this increase is that it covers the increase in the homecare rate plus £10 to reduce the gap that has been created in recent years between the cap and the cost of 7 hours of homecare (at our cheapest 2025/26 rate). It should be noted that the cap will apply to all social care clients in receipt of chargeable services, including those with lifelong conditions (LD, PD and MH Clients). The suggested cap is still going to be circa £35 per week below the 7 hours of homecare rate for 2026/27. A full 28 hour per week homecare package will typically cost between £840 and £1100 per week. At present there are around 17 clients who would move from the current cap to the new one (their care package is over £167 per week). There are a further 40 or so people who will pay more than they currently do but less than £167 as a result of this change. This change is not considered to be a policy change as it is just narrowing the gap between current rates and those set by the policy of setting a cap at the equivalent of 7 hours of care. The number of people impact is expected to increase slightly as financial assessments are reviewed and will take account of increasing costs and changes to client incomes including increases in pensions and benefits. Personal care is free and there are no proposed changes to processes. 3.5 Governance Argyll & Bute Council have not delegated responsibility for setting fees to the IJB. This creates an issue as the IJB have approved a savings programme which requires an increase in the fee for the responder service. If not approved alternative savings measures will require to be identified. Council legal have confirmed that it is not possible for the setting of fees and charges to be delegated to the HSCP per the Council’s constitution. The Council’s Scheme of Administration and Delegations reserve to the full Council the power to fix the levels of charges for any services. Changing this would require a change to the Council’s constitution. Council approved the changes outlined in this report on 29 April 2026. 4. RELEVANT DATA AND INDICATORS 4.1 The data provided in this report is largely drawn from the social work finance and management systems operated by the HSCP / Argyll & Bute Council. It also relies Year Home Care Rate £ Means Testing Cap £ Cap at 7 hours per week £ 2019/20 17.96 125 125.72 2020/21 18.48 125 129.36 2021/22 19.04 125 133.28 2022/23 21.48 125 150.36 2023/24 23.40 125 163.80 2024/25 25.62 125 179.34 2025/26 27.16 145 190.12 2026/27 28.93 TBC 167 202.51 Page 26
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5 upon the budget engagement exercise as reported at the March 2026 IJB meeting along with the Integrated Impact Assessment (presented to the IJB in March). 5 CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 The increase in fees and charges is necessary for the HSCP to deliver upon its savings programme and to operate within the approved budget. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – the increase will enable the HSCP to recover additional fees as a contribution to the cost of providing social care services. 6.2 Staff Governance – there is additional resourcing required to establish the new charge and administer it in the longer term. 6.3 Clinical Governance – some individuals who require the service may not wish to pay for it or apply for a waiver. 7. Professional Advisory 7.1 Professional advice has been provided throughout the development of the budget and the IIAs. 8. EQUALITY & DIVERSITY IMPLICATIONS 8.1 The proposal to implement a new charge will impact on people with protected characteristics, most clients in receipt of the responder service are older adults, they will be asked to contribute towards the cost of the service. The increase in the weekly cap will have implications for a small number of service users in receipt of chargeable services but is not a policy change. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 None. 10. RISK ASSESSMENT 10.1 The proposed fees outlined in this report aim to address the financial risk facing the IJB including delivery of its budget and savings programme in 2026/27. Other risks include: • A higher number of people than expected refuse to pay for the responder service or cannot afford to. • Use of the responder service is reduced as a consequence of fewer clients. This could result in harm or more expensive interventions being required. • A higher number of clients access the service but build up significant debts. • There is a small risk of challenge as the responder service, on occasion, is used for the provision of social care out of hours which could be described as personal care which is free to service users. This risk is mitigated as personal care is not the main reason for the service provision and the new charge will fund less than 25% of the service cost. The service is primarily to provide out of hours, unplanned assistance. Page 27
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6 The increase is the weekly social care charging cap will also result in additional costs and will add, to some extent, to the risk associated with the cost of living situation and poverty. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 11.1 The introduction of a new charge to help maintain the responder service is supported by the budget engagement which took place in February and March 2026. 12. CONCLUSIONS 12.1 This report seeks formal approval for the new charge for the responder service at £5 per week. It also requests Argyll & Bute Council increase the weekly cap on Social Work / Social Care fees to accommodate this and the inflationary increase on the cost of providing care. The report also notes that the IJB is responsible for approving its own budget but does not have delegated authority for setting fees. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) Argyll & Bute Council Social Care Fees and Charges 29 April 2026 Approved Finance & Policy Committee Social Care Fees and Charges 19 May 2026 TBC AUTHOR NAME: James Gow, Head of Finance / John Dreghorn, project Manager EMAIL: james.gow@argyll-bute.gov.uk / john.dreghorn@nhs.scot Appendix 1 - Integrated Impact Assessment Page 28
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Sustainability and new charge to the Carr Gomm Responder Service About the Proposal Title of Proposal: Sustainability and charging for the Carr Gomm Responder Service Intended outcome of the proposal: To generate income from this service to partially offset the cost of the contract to support budget constraint and long term sustainability How does your proposal align with strategy? This proposal is aligned to the HSCPs requirement to provide sustainable and affordable services and to deliver a balanced budget. There are a number of services which the HSCP applies a charge to, particularly those services which it does not have a statutory requirement to provide Description of proposal. It is proposed that the HSCP introduces a £5 per week charge for access to the responder service which is provided by Carr Gomm 24/7. This is a non-statutory service which was originally designed to provide an urgent response to clients activating their telecare alarm, and who had no named key holder who could respond to their needs. There are currently around 2500 telecare clients of whom around 800 have no identified key holder, but in the vast majority of cases it is the responder service who are tasked with responding to client’s requests for assistance. Clients will be given the option of opting out of the responder service if they have a nominated key holder and in addition there will be fee waivers for those who meet the standard waiver criteria. Fees and charges are not delegated to the IJB and would ultimately be decided by the council. A nominal charge alongside telecare which is also a chargeable service would support the ongoing sustainability of a service which has been identified through engagement as a key service for rural communities. Lead and Appropriate Officers Lead officer: James Gow Lead Officer Title: Chief Finance Officer Lead officer service: Finance Appropriate officer: Nicola Gillespie Appropriate officer Job title: Head of Complex Care & Registered Services Who will deliver proposal: Simon Deveney Signed off by. James Gow Date.17/03/2026 Evidence Data - What data have you used to inform the IIA We compared the provision of this service with the type of services being provided in other areas of Scotland, and specifically with the service being provided in Highland. In most areas responses to telecare are provided by individuals named by the client as key holders. This is how the service in Page 29
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Highland operates. In those areas clients who cannot provide a named individual do not have access to telecare. In Argyll & Bute there are around 2500 telecare clients, of which around 800 have not provided a named key holder and would, if living in Highland, not receive this service. We have looked at the estimated income generated through various weekly charge options from £1/week to £5/week. We have also considered the number of current telecare clients who have payment wavers. This is generally between 15 - 25 out of 2500 clients. Other information - This may include reference to reports by other people / organisations relevant to the impacts you identified. No other relevant information used/identified Gaps in evidence: At this time we do not know how many clients (with named key holders) will choose not to have access to the Carr Gomm responder service if a payment is required. It is also not known how many of the 800 clients without a named key holder will opt out or be unable to afford the charge. Both of these gaps in evidence will be ascertained prior to implementation. Knock on affect: Some clients may choose to opt out of the responder service There may be an impact on other means tested services income streams if this pushes the clients over the means test threshold. Knock on affect details. There will be an increase in the charge to telecare clients by £5 per week (£260 per year). This will be in addition to the £6.85/week currently changed for telecare equipment, giving a total weekly charge of £11.85 Monitoring - How will you monitor the impacts of your proposal. All current telecare clients will be written to advising of this new charge and giving them the option to opt out if they do not wish to make this payment. The Telecare HQ team will monitor the opt out rate, and also the number of waiver requests and approvals and any risk. This will be disaggregated by equality characteristics, and will be reviewed and reported monthly. This will be reported through SLT, and the Finance and Policy Committee, and the IJB as required Fairer Scotland Impact on service users Service users Impact Mainland rural population Negative Island population No Impact Low income Negative Low wealth Negative Material deprivation Negative Area deprivation No Impact Socio-economic Negative Communities of place No Impact Communities of interest No Impact Impacts details. Page 30
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The impact would be financial for clients. The cost is being set as low as possible to ensure minimal impact. It is estimated that each visit by the Responder service costs the HSCP between £15-£30, based on the hourly rate for this service, so a weekly charge of £5 is well below the actual cost of a single visit. All clients will have the option to opt out and some will be covered by waivers. The majority of waivers at present are for DS1500 (terminal and end of life). Those clients would automatically have a waiver for this new charge. There will be no charge for most island clients as the responder service is only available on the mainland (and Bute) Impact on service deliverers Service deliverers Impact Mainland rural population No impact Island population No Impact Low income No Impact Low wealth No Impact Material deprivation No Impact Area deprivation No Impact Socio-economic No impact Communities of place No Impact Communities of interest No Impact Impacts details. None Don't knows Not applicable Due regard The HSCP has kept the proposed charge as low as possible to cover the additional administrative costs, and allowing for opt outs and waivers. The majority of current telecare charge waivers are for DS1500/Terminal illness, and very few for financial or other reasons. Income maximisation will still be undertaken with all clients who are concerned about this additional payment and they will be supported to apply for a waiver if necessary. Clients and their families will receive written notification and sufficient time to consider whether to opt out or apply for a waiver. They will be also supported by telecare staff during this part of the process. Consumer Duty Does your proposal affect individuals, businesses or both? This proposal affects individuals On the basis of your assessment, what are the likely impacts of your proposal? Consumer Impact Rating Choice Positive Fairness No Impact Redress No Impact Safety No Impact Page 31
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Information No Impact Access No impact Representation No Impact Positive impacts you have identified: This proposal for the first time gives clients the choice of how their unplanned care needs are met. Currently the default outcome of a telecare call activation is for Carr Gomm to be contacted and requested to visit. Clients will now have the option of only having their named key holder(s) visit when unplanned care is required. For the 800 clients without a key holder, they will be asked/ encouraged to provide one. Negative impacts you have identified: Additional cost to clients of £5 per week (£260 per year) which is in addition to the £6.85 per week payment for telecare (£357 per year). Total annual cost of £617. There is therefore a risk that some low income clients will opt out despite not having an alternative key holder who can respond What alternatives have you considered which can improve outcome for customers and/or reduce harm? We had considered reducing the operating hours of the responder service. Prior to 2022 the service was provided over 20 hour per day with a 4 hours gap from 8pm to midnight. We have looked a various options to spread that gap over the day rather than as a block. This would have had a similar financial benefit to the HSCP but would have increased risk for clients. A small weekly payment should have the least impact on clients. We considered various lower weekly rates but concluded that to meet the administrative costs and to ensure a reasonable income allowing for opt out that £5 we the lowest level we could set the payment at. We ruled out means testing as this charge is directly aligned to the telecare charge which is not means tested. How have you reduced harm to consumers through the development of your proposal? As mentioned above we had considered reducing the operational hours of the Responder service. This would have increased the risk of harm If you have not been able to reduce harm to your consumers, why not? Children Rights and Wellbeing Are there any aspects to your proposal which directly impact on children? We have screened this proposal for relevance and concluded that a Children's Rights and Wellbeing Impact Assessment is not required because this proposal will not obviously impact, directly nor indirectly, children under the age of 18. Direct impact on children details. None Are the any aspects to your proposal which indirectly impact on children? No Indirect impact on children details. None Page 32
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Children rights Children rights Impact Article 2: (non-discrimination) The Convention applies to every child without discrimination, whatever their ethnicity, sex, religion, language, abilities or any other status, whatever they think or say, whatever their family background. No impact Article 3: (best interests of the child) The best interests of the child must be a top priority in all decisions and actions that affect children. No impact Article 6: (life, survival and development) Every child has the right to life. The council must do all it can to ensure that children survive and develop to their full potential. No impact Article 12 (respect for the views of the child) Every child has the right to express their views, feelings and wishes in all matters affecting them, and to have their views considered and taken seriously. No impact Have you identified any other article as being relevant to your proposal? No Children's wellbeing Children wellbeing Impact Safe No Impact Healthy No Impact Achieving No Impact Nurtured No Impact Active No Impact Respected No Impact Responsible No Impact Included No Impact Island Community How many islands does your proposal affect? One Which islands are affected by your proposal? Bute. None of the other island are covered by the responder service and therefore no charge would be applied to those telecare clients. During engagement Bute has noted this service as a key part of the infrastructure of safe care on island. Page 33
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Does your proposal impact on Island communities? Island community Impact Demography No Impact Economy No Impact Society No Impact Equality Impact Equality impact on service users Service users Impact Disability Negative Race No Impact Marriage and civil partnership No Impact Religion or belief No Impact Sex Negative Pregnancy and maternity No Impact Age Negative Sexual orientation No Impact Gender reassignment No Impact Impact on service users: The main impact on any service user will be an additional weekly payment of £5. Older people and people with a disability are more likely to be users of this service than other groups in the community. Additionally as females make up a higher proportion of the older age group they are also more likely to be affected Don't knows identified. We do not know: how many service users will chose to opt out of having access to this service; how many will apply for a waiver; and how many will exceed the means test threshold for other paid for services Equality impact on service deliverers Service deliverers Impact Disability No Impact Race No Impact Marriage and civil partnership No Impact Religion or belief No Impact Sex No Impact Pregnancy and maternity No Impact Age No Impact Sexual orientation No Impact Page 34
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Gender reassignment No Impact Impact on service deliverers. None Don't knows identified. None Due regard. The majority of current telecare charge waivers are for DS1500/Terminal illness, and very few for financial or other reasons. Income maximisation will be undertaken with all clients who are concerned about this additional payment and they will be supported to apply for a waiver if necessary. Clients and their families will receive written notification and sufficient time to consider whether to opt out or apply for a waiver. They will be also supported by telecare staff during this part of the process Page 35
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1 Finance & Policy Committee Date of Meeting: 19 May 2026 Title of Report: Social Work / Social Care Financial Planning 2027/28 Presented by: James Gow, Head of Finance The Finance & Policy Committee is asked to: • Note that the Council is commencing financial planning for 2027/28. • Note that the HSCP is engaged in this process and is forecasting a budget gap of circa £3.2m which will require to be addressed through the development of further savings plans and / or additional resourcing. • Note there is a high degree of uncertainty and risk regarding funding and costs for 2027/28. • Note the HSCP intends to report its full 3 year outlook to the next meeting. 1. EXECUTIVE SUMMARY 1.1 Argyll & Bute Council are currently in the process of developing budget plans for 2027/28 and beyond. This work is now considered as a continual rather than an annual process due to the scale of the projected budget gaps and perception of the future financial challenges. The HSCP position forms an important element of the overall Council budget. The purpose of this report is to provide members with the summary information provided to support the Council’s budget working group. It outlines the potential Social Work / Social Care budget gap for next year and provides an update regarding the savings programme for the current year. There is a high degree of uncertainty in respect of financial modelling at the time of writing. 1.2 The HSCP is working on its medium-term financial plans and will provide its full financial modelling to the next meeting of the Finance & Policy Committee. 2. Recommendations 2.1 The Finance & Policy Committee is recommended to: • Note that the Council is commencing financial planning for 2027/28. • Note that the HSCP is engaged in this process and is forecasting a budget gap of circa £3.2m which will require to be addressed through the development of further savings plans and / or additional resourcing. • Note there is a high degree of uncertainty and risk regarding funding and costs for 2027/28. • Note the HSCP intends to report its full 3 year outlook to the next meeting. 3. DETAIL OF REPORT 3.1 The budget for 2026/27 was approved by the IJB on 25th March 2026, this outlined a challenging savings programme and, along with other internal and Audit Scotland reports, indicated that the public funding outlook for future years is difficult also. It is therefore extremely important that the HSCP and IJB begin Page 37 Agenda Item 6
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2 consideration of actions to balance the budget in 2027/28 as early as possible, and in partnership with NSH Highland and Argyll & Bute Council. This report provides members of the Finance & Policy Committee with information used to support the Council’s budget planning. It does not provide any information in respect of the NHS element of the HSCP budget. 3.2 HSCP Financial Planning 2027/28 – Social Work / Social Care Only The HSCP financial plan for 2026/27 requires £2.3m of savings to achieve financial balance. Delivery of the savings programme is an immediate priority. In respect of 2027/28, early modelling of Social Work / Social Care cost and demand pressures indicates an expected budget gap totalling £3.4m with the added pressure of £1m of the 2026/27 funding settlement from Argyll & Bute Council being non-recurring, if that funding is removed the 2027/28 budget gap is estimated at £4.4m. The table below summarises the mid-range financial modelling: £’000 Pay inflation and increments (3%) 1,545 Non-pay inflation 731 Older People Demand Growth – demographic change 465 Looked After Children demand growth 251 Contingency for unknown cost and demand pressures (additional inflation) 400 Total Cost and Demand Pressures 3,392 Removal of non-recurring funding 1,000 Total Budget Pressure for HSCP 4,392 The first priority is therefore to request that the non-recurring allocation is made on a recurring basis as it is clear that demand for social care services will continue to increase for many years to come. The Key assumptions built into the mid- range model are: • Real living wage increases will be fully funded by Government. • The 2026/27 savings programme is delivered in full. • Demand pressures don’t exceed the allowance made for them. • No new legislative / policy changes increase costs further without associated funding. Additionally, at the time of writing, there is significant concern and uncertainty regarding the war in the middle east. Forecasts suggest that inflation will increase again, initially relating to energy and vehicle fuels but then feeding into inflation more broadly. This could place substantial extra pressures on the budget including upward pressure on pay settlements. Economic recession is also being predicted, this could be of further detriment to an already challenging public funding outlook. Clearly this is not within local control but is a substantial strategic risk for 2026/27 and following years. Modelling will continue to be updated as the scale of the adverse implications become clearer. Management are considering the situation on a regular basis. There are some mitigations which offset the cost and demand pressures: Page 38
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3 Opening Budget Gap 4,392 Removal of mitigation funding for 3rd sector savings (180) Full Year Impact of Responder service fee increase (140) Potential for pension fund saving 17.5%-15% (TBC) (900) Net budget pressure / saving target / additional income 3,172 It is hoped there will be some additional funding to help offset the cost pressure associated with pay increases and/or the £1m of non-recurring funding. The HSCP is not able to allocate reserves at the present time as these currently fall well short of the reserves policy approved by the Finance & Policy Committee. The savings plan for 2026/27 focussed mainly upon reductions in: • Support for 3rd sector organisations • Services for Older Adults – Care @ Home and Contracts The priorities for 2027/28 are expected to be directed to other areas of budget as older adult and 3rd sector provided services (mainly to carers and older adults) have experienced detriment in the current savings plan. Future savings are expected to focus upon: • Children’s Social Work Services including expensive external placements (cost avoidance). • Services to support LD / PD / MH Clients. • Efficiency improvements across Care & Home and Care Homes which do not impact on service delivery capacity (eg staffing models, systems and accommodation). 3.3 Key Risks Financial modelling for 2027/28 is uncertain and there are many risks facing the development of the budget: • Impact of inflation increasing relating to middle east conflict – additional pay / non pay and contract costs. • Financial performance and delivery of savings in 2026/27. • Public Sector funding and policy environment post election and the impact of public sector reform. • The pension fund valuation as at 31 March 2026 may not enable a reduction in the employer rate, worsening the position further. • The NHS funding environment is a further risk as Boards continue to be financially unsustainable, this could result in further pressure to reduce services and costs. 3.4 Strategic Development Priorities The transformation and strategic development priorities are outlined in the new Joint Strategic Plan. The implementation of these remains a priority and in respect of Social Care include: Page 39
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4 • Digital and utilisation of AI. • Care Homes Strategic Review – Engagement to commence in summer 2026. • Care @ Home digitisation and service re-design. 3.3 2026/27 Savings – as at 30/4/26 The table below provides an early summary of progress regarding the 2026/27 savings plan: Service Savings £’000 Update Increase in fees and charges Inflation increases already approved by Council and considered at IJB in January 2026 180 Complete – no further action required. Budget monitoring will confirm achievement as year progresses Threshold of Care Full year impact of policy change and restrictions on commissioning. The value of this target has been reduced due to increased delayed discharges and unmet need. 500 Complete – no further action required. This saving should be achieved as long as care at home hours are managed at current levels. Budget monitoring will confirm progress as year progresses. Children and Families Social Work Posts – 2 FTE to be held. These posts are not being removed from staffing structures at present. Child protection risk identified – saving reduced and further work on risk assessment underway and subject to review. 113 Posts identified and held but not confirmed as a saving as posts not removed from the structure. Approach to this to be agreed. S Williams / A Tillery / J Gow / J Mc Dill to confirm approach. Adult Social Work – 2 FTE Posts. As above, these posts are not being removed from the structure but will be held vacant. Risks identified and mitigations being developed. 113 As above C Robertson / A Tillery / J Gow / J McDill to confirm. LD/PD/MH support posts – 1.5 FTE Posts vacant 90 Complete – posts removed from structure and saving achieved. Extra Care Services – Lorne Campbell Court Consultation on-going to deliver saving through implementation of new service model in Kintyre. 200 Engagement with key stakeholders is on-going, this includes staff side representatives. Firm dates for delivery of the saving is still to be confirmed. Additional ADP funding to support services Funding allocated to mitigate proposed saving – no service impact. 32 M Moir / A McGrory / A Tillery to organise transfer of resource to cover saving. NB – this will be a new cost pressure in 2027/28 unless the recurring cost is reduced or the funding is confirmed on a recurring basis. Contract Savings – for Approval Mobile Teams Contract Saving reduced to protect 24 Hour, 7-day Responder 450 Whole system funding has been agreed to cover the saving for the Page 40
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5 Service. The Mobile Teams in Kintyre and Cowal will be managed out over 3 months and replaced by mainstream care provision. first 3 months. Anticipated that saving will be achieved by May June. Plan in place – J Dreghorn, S Torrie, N Gillespie, J Gow to confirm when new contract / saving is fully agreed with Carr Gomm. Assumption of flat cash on all contracts – inflation removed Contracts that are not being reduced will be held at flat cash. 41 Complete – saving removed from budget no further action required. Helensburgh Community Transport – funding reduced Provides for some mitigation as options to develop a sustainable model are progressed. 51 In place – some assurance still required from Interloch re impact and future of service. No further action to achieve saving at the moment. Scottish Care – funding withdrawn Mitigation required in respect of engagement with independent sector. 44 Complete – meeting being arranged to address relationship with independent sector to put in place new communication channels. S Devaney to progress. Carers Centres – 6 Contracts / Providers with proposed maximum 15% saving Impact assessments provided, some resourcing is being held centrally to develop an area wide digital platform to modernise the service in partnership with the carer’s centres. The funding for mitigation will help manage the transition. 165 On-going but no immediate action required and low risk Carers centres aware and now in the process of considering access to flexibility fund. Agreed to continue at current rate for first quarter and reduction thereafter. Funded from £180k below. Care & Repair Negotiations underway to deliver modification to service 25 Complete Alzheimer’s Scotland – Outreach service Negotiations underway to deliver reduction to service. The main post diagnostic support contract with Alzheimer’s Scotland which provides an area wide service is being protected from savings. 118 Complete – agreed and Alzheimer’s Scotland will access the transition funding and are looking to part fund some service in Helensburgh funded from elsewhere. Mitigation / Flexibility – total saving to be achieved in a full year on contracts is £470k Funding for mitigation / transition. This funding will enable the HSCP to support transitional costs. (180) £45k allocated to date. Low risk and will continue to be managed by S Torrie / J Gow / HoS Full year saving for 2027/28 is £180k Saving requiring further Approval / governance New charges for Responder Service Requires A&B Council to approve implementation of £5 per week. Assume implemented from 1 July. Preference to protect the service even if charging is required to do so. 160 Report to Council and IJB in May. If approved this can be delivered. Full Year Additional Saving for 2027/28 is £140k Day Services Engagement on-going, Option appraisal to be presented in May 2026. 150 High risk at present – approach to delivery of this saving is to be confirmed. Page 41
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6 Use of General Reserve 67 This is being used to fund Interloch mitigation for 26/27 only Savings & Reserves 2,319 Considered Complete as at 17/4/2027 1,039 45% The impact of the savings programme is being monitored and will be reported to the IJB and its Clinical Governance Committee as evidence is gathered. A priority for the HSCP is to increase care at home capacity as there are demonstrable impacts and care bottlenecks being caused by the reduction in hours within care at home services. 3rd sector partners who are experiencing a reduction in funding are accessing the transitional resource set aside and, so far, the changes appear to be being managed and mitigated as well as can be expected. 3.5 Governance The HSCP will continue to be considered as one of the Council’s financial risks going forward and therefore it is expected that financial planning and the development of further savings plans will continue throughout the current year. Decisions already taken and the learning from the consultation process undertaken in December to March will assist the process, however identifying more savings will likely be increasingly difficult and impactful. 4. RELEVANT DATA AND INDICATORS 4.1 The data provided in this report is largely drawn from the social work finance and management systems operated by the HSCP / Argyll & Bute Council. 5 CONTRIBUTION TO STRATEGIC PRIORITIES 5.1 Financial planning is a key element of ensuring that the HSCP remains sustainable and can deliver on the Joint Strategic Plan. 6. GOVERNANCE IMPLICATIONS 6.1 Financial Impact – the outlook for the Social Work / Social Care budget in 2027/28 is challenging. It is positive that work on this is progressing early. 6.2 Staff Governance – none directly. 6.3 Clinical Governance – non directly. 7. Professional Advisory 7.1 Professional input has been provided throughout the development of the budget and the IIAs. 8. EQUALITY & DIVERSITY IMPLICATIONS 8.1 Integrated Impact Assessments will be required for all savings proposals required to balance the budget in 2027/28. 9. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE 9.1 None. Page 42
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7 10. RISK ASSESSMENT 10.1 Specific risks relating to financial planning for 2027/28 are outlined in this report. Financial Sustainability remains a very high grade strategic risk. Any requirement to progress with substantial new savings schemes will increase existing risks and / or create new ones. 11. PUBLIC & USER INVOLVEMENT & ENGAGEMENT 11.1 Public engagement on the budget has been extensive. The HSCP is transparent in respect of its finances and normally makes its financial reports publicly available. 12. CONCLUSIONS 12.1 This report seeks to provide an early overview of the budget outlook for social work and social care services for 2027/28. Whilst there is a high degree of uncertainty the development of a balanced budget is likely to be very challenging again. The Council are beginning work on this early, the HSCP is in the process of modelling the totality of its budget and will report full three year outlook figures to the next meeting of the Finance & Policy Committee. 13. DIRECTIONS Directions required to Council, NHS Board or both. Directions to: tick No Directions required √ Argyll & Bute Council NHS Highland Health Board Argyll & Bute Council and NHS Highland Health Board 14. PREVIOUS REVIEW OF THE REPORT Meeting Title of report Date Output (if relevant) N/A AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk Page 43
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