Budget Update Jan 25 v2
Argyll and Bute Council · 29 January 2025
Back to Argyll and Bute HSCP Integration Joint Board (IJB) — 29 January 2025 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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1 Integration Joint Board Date of Meeting: 29 January 2025 Title of Report: Budget Update 2025/26 Presented by: James Gow, Head of Finance The Integration Joint Board is recommended to: • Note that budget planning for 2025/26 is on-going. • Note the HSCP is not currently operating on a financially sustainable basis. • Note the budget gap before savings and use of non-recurring resources is £15m. • Endorse the savings proposals to date and approve that work continues on developing these further. • Note that the HSCP may not be able to propose a balanced budget In March and the implications are being discussed with partners. 1. EXECUTIVE SUMMARY 1.1 This report provides the IJB with an estimate of the budget gap for 2025/26 and a summary of progress made in developing savings plans. The report updates the financial planning figures for the implications of the draft budget and public pay policy published in December 2024. Public finances remain under severe pressure and the Health and Social Care sector is not operating in a sustainable way. Local modelling of the national funding allocations will continue to be refined as the budget cycle progresses. 1.2 The budget gap, before the application of non-recurring funding or savings for 2025/26, is estimated at £15m. This has improved as a consequence of the budget but not to a sufficient enough extent to enable the HSCP to provide assurance that it can balance its budget in 2025/26. The cost and demand pressures are significant and take account of Social Care cost pressures experienced in the current year. The HSCP has not been able to develop savings plans which address this gap, without impacting severely on access, availability or quality of service provision. Savings proposals will be progressed on the basis that they are proportionate and seek to minimise adverse impacts on the most vulnerable. The estimated budget gap will be refined as detailed work on the budget and saving proposals continues. Based on current assumptions, additional resourcing from both partners will be required and constructive discussions are ongoing and will continue as the budgeting cycle progresses.
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2 2. Recommendations • Note that budget planning for 2025/26 is on-going • Note the HSCP is not currently operating on a financially sustainable basis. • Note the budget gap before savings and use of non-recurring resources is £15m. • Endorse the savings proposals to date and approve that work continues on developing these further. • Note that the HSCP may not be able to propose a balanced budget and the implications are being discussed with partners. 3. DETAIL OF REPORT 3.1 Budget Context The HSCP is not operating on a sustainable basis at present, this situation is common across the sector with many IJBs reliant upon reserves (where available) to achieve financial balance. Budget planning commenced early as a consequence of the scale of the problem. Multiple management team meetings have now taken place to identify potential projects to deliver savings. In addition to the challenge for next year, the HSCP is overspending in the current year which is an indicator of the on-going high levels of demand for care and dependency upon supplementary staffing to deliver it, particularly within social care. The draft Scottish Budget was published in December 2024 and this report takes this into account although there are still material uncertainties, particularly regarding funding for the Employer National Insurance increase. The budget has allocated some additional funding for the NHS and in a more limited way for Local Authorities. There is no new money at present for Social Care as all additional allocations are to fund inflationary increases. This approach fails to recognise increasing numbers of older adults requiring health and social care. Local authorities have been allocated additional funding which could be used to help support increasing Social Care costs locally. Some of the key points are: • A new Public Pay Policy has been published, 9% over 3 years. • Funding has not been confirmed to cover the NI increase for directly employed local authority staff or for commissioned service providers in the health and social care sector. • The minimum pay rate for health and social care staff is to increase from £12 to £12.60 per hour (5%) and funding allocated which is expected to cover this increase. • There is a general 3% uplift for non-pay cost pressures within the NHS budget and the NI increase is expected to be funded for NHS staff. • Health Boards in deficit are expected to work towards breaking even over a number of years and no brokerage available from 2025/26. • The NHS is expected to set out how 3% savings can be made each year to move towards financial balance.
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3 3.2 • Funding for Agenda for Change banding uplifts and reduced working week is expected to be made available to cover costs. There are no new medium term planning figures available and therefore this report focusses only on the single year budget for 2025/26. Service Demand An increasing concern for financial planning relates to demographic change. It is clear that both health and social care spend are directly correlated to age and that the number of older adults is increasing and projected to do so for many years. A second strategic challenge is the continuing inability to recruit permanent staff (HSCP and commissioned services), not wholly unrelated to the demographic issue. Long term population modelling is complex and subject to variation with the actual future population. Analytical work is continuing to better understand this and the implications for future service demand and models of care in our communities. The modelling below summarises Argyll & Bute population projections: Age Group 2023 2028 2033 2038 2043 2048 65 to 74 12,779 13,565 14,469 13,773 11,382 10,028 75 to 84 8,332 9,098 9,222 9,833 10,444 9,855 85+ 2,814 3,089 3,711 3,899 4,024 4,323 The conclusion is that we can expect demand to increase incrementally each year well into the 2040’s. For example, the 75+ age group is expected to increase by 16% over the next 10 years (1.6% per year) with the 85+ group increasing by more. The Scottish Government appear to be making little allowance for this, as has been highlighted by Audit Scotland and Alzheimer Scotland (Commission on the future of long-term care in Scotland) in recent months. While funding models do allocate resources to areas based on demographics, the total budget is not being uplifted in a way that makes specific allowance. Recent uplifts do not take account of cost inflation fully, never-mind increasing service demand. This approach is likely to result in continuing annual overspending as budgets are not increased in correlation with a well understood pressure for the sector. Alternatively, budget setting will require a significant element of service reduction year on year as the pressure cannot be managed through efficiencies and management controls alone. 3.3 Social Work / Social Care Budget – 2025/26 Detailed work on the Social Work budget is underway. The gap is such that the HSCP is in on-going discussions with the Council to establish the most appropriate response to the pressures in Social Care. Local Authorities have been allocated additional funding in the budget and some of this could be passed to the HSCP, there is no additional funding for social care other than for increases in costs, mainly to fund the living wage increase.
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4 A fundamental risk to the delivery of social care services next year is the increase in employer National Insurance, the threshold change in particular has an adverse impact on the sector due to the number of part time employees. An estimate from one key partner is that the cost is circa 3% on total contract values and funding for this is a threat to viability. While the HSCP is not in a position to accurately assess the cost, it is likely in the £1-1.4m range with no funding confirmed either from the UK or Scottish Government at the time of writing. The table below provides an outline of the expected position for 2025/26: Social Work Budget 2025/26 £m £m Underlying budget deficit 1.3 Direct Pay Costs 3% Pay increase 1.0 Pay increments 0.2 National Insurance Increase 1.0 Less assumed additional funding via Council: 1% of pay 3% increase funded (0.3) TBC Staff NI Increase – 50% funded by SG / 50% from Council (1.0) TBC Net additional pay costs 0.9 Cost & Demand Pressures Anticipated unfunded inflation on contracts, supplies and services 0.9 Estimated Living Wage increase (5%) 2.9 Children & Families Cost pressures 0.7 Older Adult Residential – fund current level of overspend 1.2 Care @ Home – fund current level of overspend 0.8 Allowance for 1% demand growth Older Adults – Demographic Change 0.5 Cost & Demand Pressures 7.0 Additional Resourcing: Real Living Wage Funding 2.9 Inflation on NHS Resource Transfer 0.4 Community Mental Health 0.1 Total Additional Resourcing (3.4) Budget gap before savings 2025/26 5.8m The budget gap does not include an allowance for the impact of the National Insurance increase for contractors. It is unlikely that the HSCP will be able to address this gap in full next year. Intended proposals for addressing the situation are:
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5 3.4 Quantified Savings Service Risk Review of Care at Home Services – target saving 0.9 Medium Use of non-recurring pension fund saving 2.5 - Inflation increases on Fees and Charges TBC 0.3 Medium Non-recurring reserves resourcing – potential cancellation of projects 0.5 Medium Flat cash settlements on some contracts / other adjustments 0.3 Medium Savings Target 4.5 Residual Gap £1.3m Potential NI pressure for contracted services £1.3m Priorities are for improvement and spend to save intended to move towards addressing the challenge in the medium term. The HSCP is seeking to look at these in as integrated a way as possible. Some of these could start to deliver savings during 2025/26. • Care @ Home Service – scheduling, digital & systems development and analysis of resourcing models and assessment processes. • Agency staffing and accommodation. • Care Homes Strategic Assessment. • High-Cost Care Packages and direct payments. • Kintyre and Mid Argyll Service Sustainability. The HSCP is working with the Council to establish how the remaining budget gap can be managed in 2025/26. The use of £3m in non-recurring resourcing is not sustainable and must be addressed during 2025/26. COSLA are also in the process of raising the issues outlined in this paper with SG. NHS Budget The expectation from Scottish Government is that all Boards should improve their financial position (where they are in deficit) each year with a view to achieving a balanced budget in the medium term. Efficiency savings of 3% are to be delivered each year. The implication for the HSCP is that the savings target is therefore 3% of circa £280m or £8.5m. If it is accepted that it is not possible for the HSCP to cut its SLA payments, mainly to GG&C, (£81m) or Primary Care related costs (£30m) a more reasonable interpretation of this target for the HSCP might be £5m. There are several other budgets which cannot be reduced easily including the PFI contract and the provision of small-scale services in remote communities. Additionally, current operating frameworks within the NHS are being maintained and these restrict the ability of Boards to change the way in which they operate in the short term. Significant service change needs to comply with the Planning with People Guidance and there are currently no mechanisms
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6 which would enable boards to reduce permanent staffing other than through natural turnover. Current budget planning for the HSCP NHS services: NHS Budget 2025/26 £m £m Opening Underlying Deficit 5.2 Baseline Uplift - NRAC improvement and Funding (13.8) Inflation & Cost Pressures Pay Inflation 3% 3.0 SLA Inflation 3% 3.1 Non-Pay elements Agenda for Change 2.8 Prescribing Inflation 8% 2.5 LIH Medical Staffing 1.8 Out of Area & Complex Care Packages - MH 1.0 Resource Transfer Uplift 0.4 National Services Increased Top Slice 0.7 Regional Heart & Lung SLA uplift 0.5 Glasgow - service increases 0.4 Safe Staffing Act 0.3 Fleet 0.2 Estates & PFI Charges 0.6 Others 0.5 Total Cost Pressures 17.8 2025/26 Recurring Deficit 9.2 To date the following costed savings proposals have been identified and governance is in place for monitoring these within the fortnightly leadership team meetings: Saving Opportunity Risk Rating/Potential for Saving £'000 £'000 £'000 Team Depreciation - end of life assets 70 Estates Energy price reduction 50 Estates Performance Analyst 0.5wte Band 5 22 Planning Public Health - Contract Cost Reduction - Addictions 47 Public Health Band 4 health intelligence support worker 0.5 wte 20 Public Health Living Well Grants 12 Public Health Living Well Network Funding 25 Public Health Effective prevention outcomes framework 12 Public Health Flow Navigation & Unscheduled Care Management - NHSH 277 Management Total 277 22 236 £535,000 There are number of other opportunities to deliver cash releasing savings in 2025/26 that are still to be costed. Specifically work on prescribing is expected to result in a saving, specific areas under consideration include:
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7 3.5 • Medicines of Low Clinical Value – SG Initiative • Prescribing Costs – Drugs switches etc • Medical staffing, locum and agency staffing • Contract reviews • Telecoms rationalisation A material risk to the NHS budget which could impact in 2025/26 is the outcome of the new SLA model being developed by Greater Glasgow and Clyde Health Board. While we have no firm information on the impact, it is clear GG&C are looking to pass on cost increases to other Boards to the extent that they have not be funded. It is acknowledged that the model has not been updated to reflect current activity patterns for some years and cost and activity patterns may not align with the contract value. Additionally, there are circa £1.1m of current savings which will be carried forward into 2025/26. The HSCP does not expect to be able to put in place a plan for deliverable savings which align with the target outlined above. It will continue to work to narrow its budget gap for 2025/26 and will progress the longer term projects summarised in the following sections. These, as with the Social Care priorities, are not necessarily expected to deliver significant savings in 2025/26. The position has been discussed with NHSH on this basis and they are aware of both the expected budget position and the plans that are being progressed to deliver longer term change. HSCP Summary Financial Planning Estimate 2025/26 NHS £m Social Care £m IJB Total £m Opening Underlying Gap 5.2 1.3 6.5 Additional Resourcing (13.8) (3.4) (17.2) Estimated Pay, Cost & Demand Pressures 17.8 7.9 25.7 2025/26 Gap 9.2 5.8 15.0 Mitigations Non-recurring Resources (3.0) (3.0) Quantified Savings Proposals (0.3) (1.5) (1.8) Remaining Gap / Additional Funding Requirement 8.9 1.3 10.2 Detailed work is on-going within both finance teams and will identify other opportunities for reducing the gap. This will include ensuring that the cost pressures are unavoidable and estimating slippage where they may not apply for the whole year. Prescribing, an analysis of reserves and modelling of the agenda for change costs are expected to improve the NHS position. It is not expected that deliverable savings can be identified to the extent required to enable the HSCP to propose a balanced budget in March. Both
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8 3.6 3.6.1 3.6.2 partners are aware and dialogue is on-going to ensure that the HSCP has a workable expenditure budget at the start of 2025/26. • The NI issue for Health and Social Care providers is a significant risk for 2025/26. • Reliance on non-recurring funding is a risk for 2026/27. The main issues to be addressed in the remainder of the planning and budgeting cycle for 2025/26 include: • Confirming approach to the expected budget shortfall with partners. • Finalising work on savings proposals and EQIAs to enable IJB approval in March. • Establishing plans to address the structural deficit. Savings 2025/26 The IJB will be asked to approve specific savings proposals in March. Failure to have the savings proposals endorsed will clearly have implications for both partners. The management team expect to present a list of non-contentious budget savings, some of which are included above. These will continue to develop as the detailed budget work between finance teams and budget holders progresses. They will be supported by equality impact assessments where appropriate (EQIAs). There will additional be proposals that will have material impacts upon the provision of health and social care services or upon local communities. These will also be supported by EQIAs where appropriate. Summaries are provided below of the ones under development: Care at Home Services - £0.9m Progress on this saving is being withheld at this stage due to commercial sensitivity. Inflation on Contracts £0.3m estimate Minimising the impact of inflation is a further mitigation. Analytical work is continuing to establish where there are opportunities to offer flat cash only and request providers and grant recipients to scale service to available resource where possible. This has to be considered alongside the high- grade strategic risk relating to the sustainability of commissioned service providers and recognise that many contracts and uplifts are negotiated nationally (national care home contract) or linked to external measures such as inflation or the living wage. Efforts to minimise this will apply to both Social Care and NHS services.
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9 6.6.3 3.7 The review of contracts may also identify opportunities to review the value for money associated with them. This will be considered in more detail by the Finance & Policy Committee in February. Fees and Charges £0.3m estimate Social Care Fees and Charges are typically increased in line with the rate of increase in cost. The proposed increased is therefore above current measures of inflation as staff (and other) cost increases exceed this level. Actual income generation depends upon numbers of self-funders in care homes and assessments of contributions towards care costs. Normal governance processes are being followed whereby Fees and Charges are formally approved by the Council. Transformation and Service Reviews The Transformation Programme is in place, available resource is being allocated to priorities which will address the financial and staff resource challenge in the short and longer term. Investment in change is challenging as resources that could have been targeted here are now being used to fund revenue cost pressures. There is also a continuing shortage of the capital resource required to enable estates and digital transformation as for example as resources that are available are used to address backlog maintenance. The Transformation Board and a series of other short life working groups are responsible for governance oversight. 3.7.1 3.7.2 Children’s & Families – Maternity Services Review A full review of maternity services is underway. It is intended that the process will pilot a model for reviewing all services within Children, Families and Justice. The process includes staff engagement from the outset and will take into account: • Configuration of services within Argyll & Bute. • Demographics, birth rates and complexity of need; and • Best practice and national service developments. The scope of the directly delivered service budget under review is £2.7m with a further £3m included within the SLA with Greater Glasgow and Clyde for births which take place within their maternity units. The review is anticipated to complete in February 2025, organisational change processes will follow, if the review recommends changes to service provision. The outcome will be reported through existing governance structures. If immediate savings derive from this work it will be reported in the March budget paper but delivery of savings is likely to fall into 2026 and beyond. Adult Services – Care @ Home Services The care at home service is a priority for transformation as it is not operating on a sustainable basis in some areas and different models are now operating. Some areas are largely or wholly covered by the new contract,
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10 3.7.3 others delivered by HSCP employed staff and others highly dependent upon agency staff as part of a mixed approach. Challenges include: • Continuing high demand and unmet need. • Increasing use of agency staff. • Lack of housing options for workers (Islands & Oban). • Pressure to minimise hospital delays. The service impacts on a wide range of other services such as those offered by community nurses, AHP teams and demand for residential care. The budget sits at circa £20m. Specific consideration is being given to: • The linkages between telecare, care @ home services and contracts. • How the service can achieve a reduction in the use of agency staff and operate with sustainable staffing models. • Access and equity for Self-Directed Support payments. • Reviewing of assessment processes and governance of care package implementation. • A requirement for an improved scheduling system and digital systems • A value for money review of the different models currently operating and re-consideration of the best strategic approach. The draft expenditure budget has made some allowance for the impact of demographic change. Longer-term planning for the financial and staffing implications of the increasing number of older adults is not adequately resolved nationally or locally. In order to reduce cost, it will be necessary to change the way care needs are assessed and the level of care that can be provided within the available budget. A principled and values-based approach is being taken which will seek to deliver on the priorities (as outlined in the strategic plan) in a fair, safe and equitable way. There is a short term opportunity to derive savings from reductions in agency staff utilisation. A strategic development process is also underway in respect of HSCP operated care homes, this piece of work is complex and will take some time to complete, it is not expected that financial savings will be derived from this budget in 2025/26 other than through inflation increases on charges. Adult Services – Time to Care The Time to Care project is approximately half-way through, it is externally facilitated by Meridian and funded by NHS Highland. It is intended to model how staff time is used within community teams with the objective of increasing the time staff have available to spend with patients and clients. The process will also focus on the training and development of systems and people at team leader and management levels. There are some opportunities for efficiencies, however this does not necessarily mean it will be easy to realise savings. It is intended that the project will report in February in a way that will enable savings to be attributed to it. These are not likely to be immediate cash releasing savings
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11 3.7.4 3.7.5 3.7.6 but could help identify opportunities to reduce supplementary staffing in some areas. Acute & Complex Care – Rural General Hospital A review of the services offered within LIH is in its early stages. It is intended that the HSCP will work with NHS Highland to look for opportunities to better co-ordinate activity in Oban and Fort William in particular. It is anticipated that there may be some options to reduce duplication across the sites and create more joined up and sustainable staffing structures. There are expensive out of hours arrangements in place and excess theatre capacity. An approach to making better use of theatre capacity would also feature in this transformation work with potential for income generation or reduction in activity within SLA contracts. Mid Argyll & Kintyre Service Model This project is intended to review all services delivered across the area to: • Address consistent and continuing staffing shortages. • Review demographic data and care needs. • Review the impact of recent investment in Kintyre (purchase of KCC and transition to an internal care at home service) • Identify areas of unnecessary duplication. It is expected that this work will identify savings, some of these could be available during the course of 2025/26 but some should be considered as a longer-term change to sustain services although there may be specific services where shorter term change is required due to staffing challenges. No specific changes are being incorporated in the savings plans at present. Care Package Reviews A decision has been made to invest in the review of care packages. The programme is being scoped out but will include: • Care @ Home packages • LD/PD and Mental Health packages • Direct payments (Self Directed Support) The process will look to improve governance over care package decision making and the process will set specific targets for the number of packages to be revied starting with most expensive ones. Care packages at present have a total cost of around £30m with 55 packages costing over £100k or £8.5m of the total. The reviews will be designed to ensure that care provision appropriately meets the needs of the vulnerable people being supported. It is not possible to set a target financial saving at this stage.
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12 3.8 Next Steps The development of the budget will include progressing the projects described above as well as seeking to identify other opportunities for savings through, for example vacancy and expenditure control processes: • Chief Officer approval of all locum and agency contracts and extensions. • Further scrutiny of vacant posts. • Changes to PECOS approval processes to stop unnecessary spend. • Tightening of care package approval processes. The situation is challenging, particularly in the operational context facing the management team. On-going communication and consultation are critical as is engagement with partners as they will be required to provide support for the change required. In particular, support with the HR aspects of change is a gap within the management structure. It is accepted that some mechanisms that organisations normally apply to reducing costs are not available in the context of HSCPs as a result of policy commitments and approaches to HR management. Engagement with staff and the IJB and Finance and Policy Committee will continue throughout the process. The financial challenge should be viewed as continuing rather than annual one at this stage. January / February -Firm up savings plans and agree target savings -Develop engagement plans for staff and communities where appropriate. January 2025 Detailed discussions with both partners at exec level January 2025 Update F&P and IJB on progress, anticipated position and key savings proposals January – February 2025 Conduct engagement and detailed planning in respect of proposals March 2025 Approval of Expenditure budget and savings by IJB On-going Establishment and monitoring of service change plans to address structural deficit 4 4.1 5 5.1 RELEVANT DATA AND INDICATORS Information is derived from publicly available public planning documents, professional networks and 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 and the priorities therein.
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13 6 6.1 6.2 6.3 GOVERNANCE IMPLICATIONS Financial Impact – the budget gap is significant and plans to reduce spend are required. The HSCP will continue to work with both partners with a view to being able to propose a workable expenditure budget in March 2025. As things stand it is unlikely that this will be within the totality of the resources that would normally be available to the HSCP in 2025/26. Staff Governance – None directly from this report but there is a strong link between HR management and delivering a balanced financial position. Staff have been asked for ideas to contribute to savings and these have been reported to the IJB previously. Clinical Governance – There are clinical governance implications associated with the reductions in service required to reduce spend, these will be risk assessed and mitigated as far as possible. 7. 7.1 8. PROFESSIONAL ADVISORY The budget planning process for 2025/26 ensures that Professional Leads are fully engaged. They are playing a key role in the on-going work to deliver financial savings from a key social care contract. EQUALITY AND DIVERSITY IMPLICATIONS 8.1 Service changes will require impact assessments to be completed, the reductions in service being planned at present will have impacts on service users, typically individuals and groups that are covered by equality legislation. 9. 9.1 10. GENERAL DATA PROTECTION PRINCIPLES COMPLIANCE None. RISK ASSESSMENT 10.1 Financial sustainability is a Very High risk on the strategic risk register. Specific risks relating to this report include: • The HSCP is not able to identify savings opportunities to a great enough extent to enable it to propose a balanced budget. This could result in interventions from partners or Government. • Social Care funding for the Employer NI increase is not forthcoming putting the sector at risk or further inflating HSCP cost pressures. • The IJB may not support the proposals due to increased risk. • Some of the planning assumptions turn out to be optimistic. • Scottish Government or partners do not pass on funding as assumed or make available resources. • Adverse impact upon workforce and lack of HR and support service support to effect change. • The HSCP is not able to deliver the approved savings and operate on a financially sustainable basis in 2025/26 and beyond. This could have significance consequences for the IJB.
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14 The HSCP is not currently in a sustainable financial position as spend and service demand exceed available funding, this is included in the Strategic Risk Register. 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 generally makes all reports publicly available. A public consultation on the budget was conducted in February 2024 using an interactive tool. The outcome of this was reported to the IJB in March. Whilst there were some specific issues raised, the overall tone of the responses indicated disappointment at the need to make reductions. To the extent that savings are necessary, the consensus indicated they should be evenly spread across services. A desire for management costs to be reduced was communicated by the public. The HSCP is not intending to re-run the exercise as there is both an opportunity cost and real cost of extending the license for the software (circa £4k). It will however continue to communicate and engage with all partners in respect of the financial challenge it faces. 12. CONCLUSIONS 12.1 12.2 12.3 This report provides an update on the likely financial position of the HSCP following publication of the draft Scottish Budget. The report outlines some key savings plans which will require formal approval. It also confirms that on-going work on budgets is expected to improve the position outlined this report which is that there is a remaining gap of £10m in total. The HSCP does not anticipate that it can close this gap fully and expects to be reliant on both partners for additional support in 2025/26. This is a structural and national problem facing Health and Social Care. The consequences the National Insurance increase will have upon commissioned service providers is highlighted as a key risk that has not yet been resolved. Dialogue with both partners in respect of the situation is required and the sector is seeking to ensure government are aware of the scale of the challenge facing the sector, as have Audit Scotland. It is not realistic to assume that the HSCP can deliver a balanced budget for 2025/26 based on current planning assumptions. The constraints on the pace of service change do not enable such a level of change in the timescale available.
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15 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) SLT Budget Update 18/09/24 Amendments made IJB Budget Update 25/9/24 Recommendations noted Finance & Policy Committee Budget Update 28/9/24 As above SLT Budget Update 20/11/24 Noted Finance & Policy Committee Budget Update 22/11/24 Noted Finance & Policy Committee Budget Update 21/01/25 Noted Appendix 1 – Commercially Sensitive - Not in Public Domain AUTHOR NAME: James Gow, Head of Finance EMAIL: james.gow@argyll-bute.gov.uk