5. Financial Monitoring Report Mth3v1 FINAL
North Ayrshire Council · 20 August 2026
Back to Integration Joint Board — 20 August 2026 and its agenda
Text extracted from the council's PDF. Layout and reading order may differ from the original.
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Integration Joint Board 20th August 2026 Subject: 2026-27 – Month 3 Financial Performance Purpose: To provide an overview of the IJB’s financial performance as at Month 3 (June). Recommendation: It is recommended that the IJB: (a) notes the overall integrated financial performance report for the financial year 2026-27 and the current overall projected year- end overspend of £5.146m; (b) notes the progress with delivery of agreed savings; (c) approves the budget reductions in para 2.10; and (d) notes the remaining financial risks for 2026-27. Direction Required to Council, Health Board or Both Direction to: - 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health MDT Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework MDT Multi-Disciplinary Team 1. EXECUTIVE SUMMARY 1.1 The report provides an overview of the financial position for the Partnership and outlines the projected year-end outturn position informed by the projected expenditure and income commitments; these have been prepared in conjunction with relevant budget holders and services. It should be noted that, although this report refers to the position at the end of June further work is undertaken following the month end to finalise projections, therefore the projected outturn position is as current and up to date as can practicably be reported.
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1.2 The projected outturn is a year-end overspend of £5.146m (1.4%). 1.3 From the core projections, overall, the main areas of pressure are: residential placements for children and supplementary staff in wards including within the lead partnership for mental health. There remains a significant risk of delivering the financial savings required from the change to social care eligibility criteria and this remains the substantive plan for further financial recovery. 1.4 The projected IJB outturn position has been adjusted to reflect the impact of Lead Partnership services. The overspend in relation to North Lead Partnership services for Mental Health is not fully attributed to the North HSCP as a share has been allocated to East and South HSCPs, similarly the impact of the outturn on East and South led services has been shared with North, both on an NRAC basis in line with the agreed risk sharing mechanism. There is a requirement for the 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within allocated budget. 2. CURRENT POSITION 2.1 The report includes an overview of the financial position including commitments against the available resource, explanations for the main budget variances and an update on progress in terms of savings delivery. 2.2 FINANCIAL PERFORMANCE – AT MONTH 3 At month 3 against the full-year budget of £360.587m there is a projected year-end overspend of £5.146m (1.4%). The Integration Scheme outlines that there is an expectation that the IJB takes account of the totality of resources available to balance the budget in year. Following this approach, an integrated view of the financial position should be taken, however it is useful to note that this overall position consists of a projected overspend of £5.042m in social care services and a projected overspend of £0.104m in health services. Appendix A provides the financial overview of the Partnership position. The sections that follow outline the significant variances in service expenditure compared to the approved budgets. Appendix E provides information on the costs of bank and agency staff. 2.3 Health and Community Care Services Against the full-year budget of £111.624m there is a projected underspend of £0.121m (0.1%) and the main variances are: Care home placements – net projected underspend of £0.459m. This includes an underspend on placements of £0.330m and an income recovery from charging
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orders and gross funded placements which is projected to be £0.130m over recovered. This income is challenging to predict as it depends on the length of the legal process and time taken to sell the property that the charging order is registered to and access to the funds or estate of service users. The budgeted number of permanent placements was 765 and at month 3 there were 760. The underspend is due to lower placement numbers and less gross funded cases than in previous years. A further 25 Placements have been funded via Whole Systems Funding monies which will be cost neutral and reflected in the month 4 projection where the funded placements will increase to 790. b) Care at home is projected to be £1.221m underspent. The underspend reflects the full year impact of the action taken to reduce the overall level of provision to reduce the 2025/26 overspend. The level of vacancies in the service has increased and whilst favourable it is coupled with continued levels of unmet need. c) Physical Disability Services – projected overspend of £0.285m split as follows: £0.818m over in residential placements, £0.215m under in direct payments due to increased clawbacks and £0.318m under in community care packages. d) Integrated Island Services is projected to overspend by £0.079m across various service areas. e) Specialist Rehab wards – projected overspend of £0.361m (Redburn ward £0.097m overspend and Douglas Grant £0.264m overspend). The overspend is due to cover costs for vacancies as well as supplementary staffing for patients who require one to one support. f) Wards 1 and 2 – Projected overspend of £0.680m. The overspend is due to increased use of supplementary staffing. All rehabilitation wards are operating at 100% occupancy supporting a high level of patient needs/complexity, which places pressure on staffing levels and the use of bank and agency staff to support additional patient observations. The number of patients is being managed in the wards in line with ward formal admission criteria to maximise opportunities to reduce the overspend in-year. 2.4 Mental Health Services Against the full-year budget of £126.517m there is a projected overspend of £0.402m (0.3%) prior to the re-allocation of the Lead Partnership variance to East and South HSCP. The main variances are: • Learning Disabilities are projected to overspend by £0.362m. This covers Children and Adults - residential placements, community packages, direct payments, property costs and an under recovery of charging income.
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• Community Mental Health services are projected to underspend by £0.004m. The main reason for underspend in community packages is the availability and capacity of adult community providers to deliver new packages of care. • There is a projected underspend of £0.353m in relation to the unused funds arising from the Hospital Based Complex Continuing Care (HBCCC) service, this reflects the impact of change in provision for these services. • The Lead Partnership for Mental Health is projected to be £0.393m overspent and the main variances are as follows: • Adult Inpatients – projected overspend by £1.454m due to very high levels of occupancy, patient mix and complexity and levels of continuous intervention which require additional supplementary staff and enhanced observations (1:1, 2:1 and 3:1) and use of bank staff. Absence levels are also impacting this area. • The UNPACS (Unplanned Activities) budget – projected overspend of £0.375m) based on current placements. UnPACS placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium- or long-term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health who needs to be satisfied that the placement is appropriate and unavoidable prior to this being agreed. • Learning Disability Services – projected to underspend by £0.161m. The underspend relates to saving made until the new service to replace Ward 7A commences offset by legacy costs of the Ward 7A staff who have still to be redeployed. • Elderly Inpatients – projected overspend of £0.332m due to the use of supplementary staffing. The elderly mental health wards continue to operate at full occupancy with waiting lists, with several patients who are on enhanced observations and bank costs remain high. • Eating Disorders – projected to be £0.100m overspent. This service is currently being reviewed and options considered.
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• Enhanced Mental Health Outcome Framework (EMHOF within CAMHS) – projected underspend of £0.253m. This is the balance of the remaining funding from the 25/26 review. • Psychiatry – is projected to overspend by £0.318m across all specialities including some agency locum costs. A wholescale workforce review has been commissioned to determine longer term solutions for sustainability. • MH Pharmacy/Substitute Prescribing – is projected to underspend by £0.368m. This is partly due to a rebate and expected drug price increases are not evident at month 3. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership as this is a Pan-Ayrshire target. There is a projected over recovery of the vacancy savings target of £0.452m in 2026-27. Further information is included in the table below: Vacancy Savings Target (£1.250m) Projected to March 2027 £1.802m Over/(Under) Achievement £0.452m 2.5 Children and Justice Services Against the full-year budget of £46.913m there is a projected overspend of £2.893m (6.2%) and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £2.891m. Some of these costs are offset by the contribution from the Home Office for Unaccompanied Asylum-Seeking Children which is detailed below. The main areas within this are noted below: • The children’s residential placements are projected to overspend by £2.794m based 37 placements in month 3. There are several factors leading to this challenging position: o We have 32 places available in our internal children’s houses, due to demand these have been operating at 100% occupancy or over for some time, leading to increased use of external placements where residential care is required. o There remains an acute shortage of foster carers leading to residential care being necessary in emergency placement situations. o The requirement to support Unaccompanied Asylum-Seeking Children (UASC) under the National Transfer Scheme and to support trafficked young people who have been identified in North Ayrshire.
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o A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. o Where appropriate young people are placed to meet their educational needs, the cost of Residential School Placements in the most cases is shared 50/50 with Education services. o Contractual inflation has still to be agreed for 1 provider. If this is higher than the assumed contractual inflation and it is likely that this will increase the projected costs of residential places which is outwith the control of the service. o Delays with the opening of Boyle Street supported accommodation development which has in turn delayed planned moves from placements for young people. A full report on the ‘Brighter Pathways’ Programme will be presented to the October 2026 IJB, this will include more detailed information on the operational and financial impact and progress with plans. Note that the costs associated with mobilising Boyle Street are being finalised and will be funded by the Service Redesign Funds in the earmarked reserves. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.238m underspent. • Employee costs – are projected to overspend by £0.267m largely due to staffing levels in the children’s houses. • Care Leavers – projected underspend of £0.022m in rent costs. • Section 29 Payments (all Teams) are projected to overspend by £0.075m. b) Head of Service – is projected to overspend by £0.006m. This consists of a projected overspend of £0.144m in relation to the previous staff reconfiguration saving in the children’s houses which was not achieved and this is offset by the grant funding in relation to Unaccompanied Asylum-Seeking Children (UASC), which is projected to amount to £0.143m and which contributes to costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to underspend by £0.057m mainly due a seconded post that has not yet been backfilled. d) Lead Partnership – Children’s Services – projected overspend of £0.017m within the immunisation budget. 2.6 ALLIED HEALTH PROFESSIONALS (AHP)
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The non-employee costs element of the AHP services are projected to be on-line. All underspends in employee costs have contributed to payroll turnover. 2.7 CHIEF SOCIAL WORK OFFICER This is projected to underspend by £0.018m. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to overspend by £2.172m and the main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.315m due to delays in children transitioning into adult services and updated costing of care packages. This involves complex planning by services with service users and families and can change over time based on assessed need when moving into adult services. • There is also a balance of overachieved savings of £0.052m. • The 2026/27 budget included additional approved savings to contribute towards the 2025/26 overspends that would continue into 2026/27. These savings were £1.4m for social care and £0.245m for non-lead health services. This shows as a total underspend of £1.645m. • As outlined in para 2.9 there remains £4.628m of social care eligibility criteria savings to be achieved and these are reported as a projected overspend under management and support. This figure will be updated and reduced each month to reflect the outcome of re-assessments. • An over-recovery of payroll turnover of £0.165m for social care services and an over-recovery of £0.207m for health services as outlined in the table below. The turnover targets and achievement for the financial year for Health and Social Care services outwith the Lead Partnership is noted below: Social Care Health Vacancy Savings Target (£3.507m) (£1.628m) Projected to be achieved by March 2027 £3.672m £1.835m Over/(Under) Achievement £0.165m £0.207m The areas contributing to the health and social care vacancy savings are spread across a wide range of services with vacancy savings being achieved in most areas. As part of the recovery plan, the vacancy scrutiny group has been enhanced with the Heads of Service and professional leads attending. Each post is scrutinised and filled only where deemed necessary with a recruitment freeze now implemented for all non-essential posts. The turnover target for the North Lead Partnership for Mental Health services is detailed separately within the Lead Partnership information at section 2.4.
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2.9 Savings Progress The 2026-27 savings are detailed within Appendix C. The savings are RAG rated informed by an overall assessment of the ease of delivery and the impact on services, indicating an overall risk of deliverability. The savings are split into: • Previously agreed savings • Adjustments (payroll turnover and recharges) • Operational savings • Policy – Models of care or efficiency • Policy – Service reduction or cessation The approved 2026-27 budget included £2.816m of savings that were not related to the eligibility criteria saving. BRAG Status Position at Budget Approval £m Position at Month 3 £m Red - 0.043 Amber 0.141 0.564 Green 2.675 0.640 Blue - 1.569 TOTAL 2.816 2.816 Any shortfall in relation to the red and amber rated savings are already reflected in the projected outturn. In relation to the Eligibility Criteria Review savings the progress achieved at month 3 is: Full Year £m Part Year £m Target (5.828) (5.828) Achieved at month 3 1.481 1.200 Still to be Delivered (4.347) (4.628) The part year saving to be achieved of £4.628m is reflected as an overspend in the month 3 projections. There remains a significant risk of delivering the financial savings required from the change to social care eligibility criteria and this remains the substantive plan for further financial recovery. Progress is being monitored through the programme board, with a more detailed progress update planned for the IJB in October 2026. 2.10 Budget Changes
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The Integration Scheme states that “either party may increase its in-year payment to the Integration Joint Board. Neither party may reduce the payment in-year to the Integration Joint Board nor Services managed on a Lead Partnership basis…. without the express consent of the Integration Joint Board.” Appendix C highlights the movement in the budget position following the initial approved budget. Reductions Requiring Approval: Ref Description Amount (£’m) 1 Primary Care prescribing CRES 1.464 2 Primary Care 26/27 Savings 0.507 3 Training Grade adjustment 0.008 4 Reduced Working Week – transfer to pan Ayrshire posts 0.018 5 Transfer to East and South re pan Ayrshire pressures 0.028 2.11 Pan Ayrshire Lead Partnership services and Large Hospital Set Aside Lead Partnerships: - There is a requirement for the 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within allocated budget. Full detail on the Lead Partnerships is given in the report in appendix F. Set Aside: - Work has been undertaken with partnerships to progress and develop set aside arrangements to fully implement the legislative requirement. This includes arrangements in relation to the use of Directions, Joint Commissioning Plans and overall progression towards fair share allocations of resources. Further work has been undertaken through the Ayrshire Finance Leads group to establish baseline resources for each partnership and how these compare to the NRAC “fair share” of resources. Ayrshire Finance Leads have now agreed a baseline methodology for set aside budgets which involves using the four full years prior to the pandemic, 2016/17 – 2019/20 inclusive. The HSCPs require to agree their final share of the baseline with each other, however the aggregate will remain unchanged. The table below shows the cost of the historic baseline at 2024/25 prices. The 2025/26 actual usage information is not known until later in the year. IJB 2024-25 Activity at 2025-26 prices inflated by 2% for 2026-27 East 34,003 North 42,670 South 34,844
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Total 111,517 The annual budget for Acute Services is £520.5m. The directorate is overspent by £3.3m after 3 months. There is a material underlying deficit caused by: • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are above the Scottish average. • High expenditure on medical and nursing agency staff, high rates of absence and vacancies causing service pressure. • Delayed transfers of care and high acuity of patients. The IJBs and the Health Board work closely in partnership to maintain service and improve performance. 2.12 FINANCIAL RISKS There are a number of ongoing financial risk areas that may impact on the 2026-27 budget during the year, these include: • Growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • Unearmarked reserves are minimal, there is limited scope to absorb in-year variances, with any overspends requiring additional funding from partners. • The ongoing review of the Integration Schemes, where there is a focus on financial arrangements and risk share. • The wider system financial challenges and impact across the whole system, for example the financial position of NHS AA and the decisions taken to reduce the Board’s deficit may have impacts on other parts of the health and care system. • The overall sustainability of commissioned care providers • The recurring underlying levels of overspend which may impact on the Partnership’s ability to continue to sustain service levels in the future. • The use of supplementary staffing for enhanced observations across a number of service areas and the use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for Change Pay Reform programme – including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. • Risk related to NHS Reform investment being allocated by Scottish Government on a payment by results basis and in arrears.
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• A risk of delivering an online position at the year-end set against continued increased demand for services, inflationary impacts on the cost of care and the more difficult decisions which are required to reduce spend. • Scarcity of residential placements for children which is being raised on a national level. These risks will continue to be monitored. 2.13 RESERVES The IJB opening reserves position are summarised in the table below. General Fund Reserve Earmarked Reserves Total Unearmarked External Funding HSCP £m £m £m £m Balance – 1 April 2025 0 2.381 0.780 3.161 Drawdowns 0 (2.381) (0.459) (2.840) Transfer in – underspend 0.696 0 0 0.696 New earmarking 0 1.805 0 1.805 Balance – 31 March 2026 0.696 1.805 0.321 2.822 If the IJB ends the financial year with an overspend the Unearmarked Reserves will be drawn down first to offset any overspend position. 2.14 Financial Recovery Plan The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, which includes the requirement to agree a recovery plan to balance the overspending budget. Only if the recovery plan is unsuccessful will the Health Board and Council consider making available interim funds. Despite being in a projected overspend position additional financial recovery action is not recommended at this stage as the focus remains on achieving the remaining savings relating to the eligibility criteria, if this is successfully delivered year-end financial balance would be delivered, as illustrated below: TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth 3 5.146 0.104 5.042 Assumed eligibility savings still to be achieved (4.628) 0 (4.628) Residual Projected Overspend 0.518 0.104 0.414
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Unearmarked GF Reserves (0.696) Net Projected Overspend (0.178) It is anticipated that the management and recovery actions developed in previous years will continue into 2026-27. This includes: • Review of temporary posts and robust vacancy management/approval. The vacancy scrutiny group now has representation from all of the Heads of Service, and a recruitment freeze will be implemented for all but essential frontline posts. • Restrictions on all but essential overtime working. • Ongoing review of future year savings or transformation programmes to identify scope for acceleration. • Continued focus through the ‘Finance Working Group’, chaired by the IJB Chair or Vice Chair. The Director and Heads of Service are members of the group. It meets monthly to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. • Recruitment delay – there will be a recruitment drag with vacancy scrutiny approved vacancies being held for four weeks before they are advertised to create more payroll turnover. This will be for all vacancies except clinical or registered services vacancies or those which will incur cover costs. • High-cost care package group – the remit of this group expanded to include care packages for children with a disability and all UNPACs placement requests. • Oversight group for looked after and accommodated children in residential care – this group meets fortnightly to actively review all placements. • All care packages (outwith in house care at home and older people placements agreed via CARG) will be considered for approval by the high- cost care package group. 3. PROPOSALS 3.1 Anticipated Outcomes Continuing to closely monitor the financial position will allow the IJB to take corrective action where required to deliver services in 2026-27 from within the available resource, thereby limiting the financial risk to the funding partners. The transformational change programme, along with the revised eligibility criteria, will have the greatest impact on the financial sustainability of the partnership, the IJB require to have a clear understanding of progress with the delivery of the transformation plan. 3.3 Measuring Impact The final outturn will be reported to the IJB.
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4. IMPLICATIONS 4.1 Financial There is a projected overspend of £5.146m (1.4%). The report outlines the main variances for individual services. 4.2 Human Resources The report highlights vacancy or turnover savings achieved during the year. Services will review any staffing establishment plans and recruitment in line with normal practice when implementing service change and reviews as per agreement with the IJB. Tight vacancy scrutiny management arrangements are in place for the HSCP. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk Para 2.12 highlights the financial risks. The report falls in line with the agreed risk appetite statement which is a low-risk appetite in respect to adherence to standing financial instructions, financial controls and financial statutory duties and a high-risk appetite in relation to finance and value for money. The ‘financial viability of the HSCP’ risk is on our strategic risk register. 4.6 Community Wealth Building None. 4.7 Key Priorities The ability to deliver on our strategic priorities may be compromised due to the greater financial risk faced in 2026-27 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2026-27. If we are unable to successfully develop a financial recovery plan to achieve financial balance, consideration may be given to revising the strategic commissioning plan. 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team.
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5.2 The IJB financial monitoring report is shared with the NHS Ayrshire and Arran Director of Finance and North Ayrshire Council’s Head of Finance after the report has been finalised for the IJB. Caroline Cameron, Director Author – Eleanor Currie, Chief Finance Officer [eleanorcurrie@north-ayrshire.gov.uk]
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2026-27 Budget Monitoring Report–Objective Summary as at 30th June 2026 Appendix A Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 COMMUNITY CARE AND HEALTH 89,140 87,997 (1,143) 22,484 23,506 1,022 111,624 111,503 (121) : Locality Services 34,685 34,469 (216) 6,191 6,190 (1) 40,876 40,659 (217) : Community Care Service Delivery 48,761 47,656 (1,105) 0 0 0 48,761 47,656 (1,105) : Rehabilitation and Reablement 2,316 2,365 49 0 0 0 2,316 2,365 49 : Long Term Conditions 978 1,037 59 11,458 12,499 1,041 12,436 13,536 1,100 : Community Link Workers 426 417 (9) 0 0 0 426 417 (9) : Integrated Island Services 1,974 2,053 79 4,835 4,817 (18) 6,809 6,870 61 MENTAL HEALTH SERVICES 44,760 45,122 362 81,757 81,797 40 126,517 126,919 402 : Learning Disabilities 34,760 35,122 362 864 864 0 35,624 35,986 362 : Community Mental Health 7,469 7,465 (4) 1,912 1,912 0 9,381 9,377 (4) : Addictions 2,531 2,535 4 2,138 2,138 0 4,669 4,673 4 : HBCCC 0 0 0 353 0 (353) 353 0 (353) : Lead Partnership Mental Health NHS Area Wide 0 0 0 76,490 76,883 393 76,490 76,883 393 CHILDREN & JUSTICE SERVICES 40,331 43,265 2,934 6,582 6,541 (41) 46,913 49,806 2,893 : Irvine, Kilwinning and Three Towns 3,690 3,706 16 0 0 0 3,690 3,706 16 : Garnock Valley, North Coast and Arran 3,833 3,852 19 0 0 0 3,833 3,852 19 :Intervention Services 2,186 2,188 2 0 0 0 2,186 2,188 2 : Care Experienced Children & Young people 25,178 28,069 2,891 0 0 0 25,178 28,069 2,891 : Head of Service - Children & Families 1,510 1,516 6 0 0 0 1,510 1,516 6 : Justice Services 3,493 3,492 (1) 0 0 0 3,493 3,492 (1) : C&F Health Team 441 442 1 5,700 5,642 (58) 6,141 6,084 (57) : Lead Partnership NHS Children's Services 0 0 0 882 899 17 882 899 17 CHIEF SOCIAL WORK OFFICER 2,140 2,122 (18) 0 0 0 2,140 2,122 (18) PRIMARY CARE 0 0 0 53,830 53,819 (11) 53,830 53,819 (11) ALLIED HEALTH PROFESSIONALS 0 12,379 12,379 0 12,379 12,379 0 MANAGEMENT AND SUPPORT COSTS 2,410 5,317 2,907 4,774 4,039 (735) 7,184 9,356 2,172 OUTTURN ON A MANAGED BASIS 178,781 183,823 5,042 181,806 182,081 275 360,587 365,904 5,317 TOTAL Partnership Budget - Objective Summary Council Health 2026/27 Budget
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Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Return Hosted Over/Underspends to East 0 0 0 0 (132) (132) 0 (132) (132) Return Hosted Over/Underspends to South 0 0 0 0 (122) (122) 0 (122) (122) Receive Hosted Over/Underspends South 0 0 0 0 0 0 0 0 0 Receive Hosted Over/Underspends East 0 0 0 0 83 83 0 83 83 OUTTURN ON AN IJB BASIS 178,781 183,823 5,042 181,806 181,910 104 360,587 365,733 5,146 Partnership Budget - Objective Summary 2026/27 Budget Council Health TOTAL
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2026-27 Savings Tracker Appendix B Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description Adjustments and Previously Agreed Savings: Inflate Payroll Turnover 107,348 60,150 90,225 257,723 Green Green Increased target to reflect the pay award Recharge to East for Ward 2 beds - 25,000 - 25,000 Green Blue Increased charge to reflect the pay award Financial Inclusion Review 32,500 - - 32,500 Green Blue Full year impact of the 2024/25 saving Social Care Model at Trindlemoss House - 175,000 - 175,000 Green Green Moving from a nursing led model to a social care led model 139,848 260,150 90,225 490,223 Operational Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description Social Care Fees and Charges 5% increase 100% included 120,000 - - 120,000 Green Green Increased income to reflect the 2026/27 charges LES Payment - Buckreddan Care Home 43,000 - - 43,000 Green Red Service will be ither cease or be funded by the care home LES Payment - Toddhill 22,000 - - 22,000 Green Blue Service will cease Third Sector Capacity Building 34,000 - - 34,000 Green Blue Reduction of a post Business Admin - Phase 1 - Quick wins 251,979 - - 251,979 Green Blue Reduction in 6.8 WTE posts Moving and Handling post 55,000 - - 55,000 Green Blue Reduction of a post Business Admin Team - senior structure - 40,000 - 40,000 Green Blue Saving following a retiral and resultant revised structure Carers UK Annual Subscription 3,500 - - 3,500 Green Blue Cease the subscription NADARS NHS non staffing budget - 26,771 - 26,771 Green Blue Saving in non staffing costs Pan Ayrshire Alcohol & Drug Services Management Team - 16,478 16,478 32,956 Green Blue Saving in staffing costs Removal of SW Trainee Post 54,000 - - 54,000 Green Blue Removal of a SW trainee post Child Health Assessment - Charge for Out of Authority cases - 6,000 - 6,000 Green Amber New charge for Out of Authority health assessments Children and Families Throughcare Review 87,000 - - 87,000 Green Green Reduction in staffing Support Services outwith business support 100,000 - - 100,000 Amber Amber Reduction in staffing (WTE TBC as it is a target) 770,479 89,249 16,478 876,206
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Policy - Model of Care or Efficiency Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description Roslin House - shared respite/residential model 300,000 - - 300,000 Green Amber Moved to respite and residential model. Assumes 4 external placements will move to Roslin House Trindlemoss - review of care delivery model 116,989 - - 116,989 Green Amber Review of care delivery model. Budget reduction regarding the Pan Ayrshire Prevention & Service Support Team - - 40,817 40,817 Green Blue Saving in non staffing costs Phase 1 - Children and Families -quick wins re: retirements, WLB and vacant posts 250,000 - - 250,000 Green Blue Reduction in staffing (7 WTE) Phase 1 - Psychology - - 231,138 231,138 Green Blue Reduction in staffing (2.5 WTE and a reduction in grade for 1 post) 666,989 271,955 938,944 Policy - Service Reduction/Cessation (all agreed with East and South HSCP) Council NHS (non lead) NHS (lead) TOTAL BRAG Deliverability Status BRAG Deliverability Month 3 Description DBI - Distress Brief Intervention service - - 157,500 157,500 Green Blue Cessation of the Distress Brief Intervention service (7mths assumed) MH Innovation Fund (reduction of posts) - - 41,331 41,331 Amber Amber Reduction of Innovation Funded posts. 3mths of savings assumed as the posts will be redeployed. (2.7 WTE) RISE Team - Resilience in Stressful Events - - 192,131 192,131 Green Blue Reduction in the RISE service Mental Health Practitioners (MHPs) in GP practices - - 120,000 120,000 Green Blue Reduction in the MHPs ( est 3 WTE posts) - - 510,962 510,962 TOTAL SAVINGS 1,577,316 349,399 889,620 2,816,335
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2026-27 Budget Reconciliation Appendix C COUNCIL Period £'m Initial Approved Budget 151.506 Adjustments to baseline (0.012) Revised Budget 151.494 Resource Transfer 25/26 1-3 25.949 Change Fund - Bank Project 3 0.007 Section 27 Justice Service Grant 3 1.331 Social Care Budget Reported at Month 3 178.781 HEALTH Period £'m Initial recurring base budget exc set aside 149.214 Month 10-12 Adjustments and adjusting for the full year impact of part years amounts and temporary funding. 51.766 Revised Budget 200.980 Resource Transfer 25/26 (25.949) 2% pass through 2026/27 2.891 Pay Awards 2026/27 top up 1.682 Reduced Working Week (1 hour) 2026/27 2.362 PC Prescribing uplift (£1,466,000) 0.537 PC Prescribing cres (£4,000,000) (1.464) PC Prescribing Tariff Adjustment North 0.549 Veterans First Point 0.105 Training Grade Adjustment (Dean Funding) (0.008) Junior Doctors Pay Award - additional 1.75% 0.019 Transfer MAT Standards Psychiatrist 0.2 WTE from South 0.029 ADP Pay Uplifts from South 0.014 School Nursing 6.12 WTE from South 0.377 North Budget Paper - Office 365 to East (0.009) North Budget Paper - Palliative Care to East (0.018) BBV Transfer Band 8B Pharmacist to Addictions (from PH) 0.013 Early Years funding 0.45 WTE Band 4 - MIN Allocation (from PH) 0.019 North Budget Paper - Office 365 to East Adjustment (0.001) RWW Action 15 backfill cover arrangements allocated to South HSCP (0.006) RWW Action 15 backfill cover arrangements allocated to East HSCP (0.012) Training Grade Adjustment (Dean Funding) - Vacancy 0.032 GP Prescribing 2026/27 savings (0.507) Anticipated budgets 0.171 Health Budget Reported at Month 3 181.806 TOTAL COMBINED BUDGET 360.587
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26-27 IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2026 Earmarked Funds Alcohol and Drug Partnership 147 Primary Care Improvement Fund 183 Service Redesign / Challenge Fund 321 Family Wellbeing Fund 906 Telecare / community alarms 180 Magic Notes 88 Adult Social Work Restructure resource 38 LD – Coming Home 212 Early Intervention in Psychosis 51 Total Earmarked 2,126 Unallocated General Fund 696 General Fund 2,822
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Bank and Agency Costs to Month 3 Appendix E 2) SOCIAL CARE Month 3 Spend Montrose House Brodick 35,257 Mental Health 58,229 98,486 1) NHS 4863 (Registered) 4864 (Unregistered) 4865 (Agency Locum Consultant) TOTAL WARD 1 WOODLANDS VIEW 13,222 81,309 94,531 WARD 2 WOODLANDS VIEW 15,515 78,431 93,945 ACH REDBURN REHAB WARD NRS 3,013 45,010 48,024 ACH DOUGLAS GRANT REHAB WD NRS 7,378 19,375 26,754 WARD 3 WOODLANDS VIEW NURSING 13,783 135,870 149,653 WARD 4 WOODLANDS VIEW NURSING 37,211 37,211 NEW CLONBEITH NURSING(JURA) 15,866 96,880 112,746 WVIEW THE GLEN ECT 2,423 9,210 11,633 WVIEW WARD 10 ACUTE MH NRS 1,041 91,689 92,730 WVIEW WARD 8 ACUTE MH NRS 15,403 295,229 310,633 WARD 5 WOODLANDS VIEW 5,779 18,476 24,255 WVIEW WARD 7B REHAB MH NRS 2,122 2,122 NEW DUNURE NURSING(CLONBEITH) 24,899 95,354 120,253 MH BED MANAGEMENT 2,358 2,358 TRINDLEMOSS 2,291 78,491 80,782 ARRAN HOSPITAL NURSING 17,323 20,292 37,616 CAMHS UNSCHEDULED CARE 1,377 1,377 EARLY YRS-C/F TEAM 3 1,595 1,595 IMMUNISATION NURSING BANK 525 129 654 PACKAGE OF CARE (P) - AMG 30,284 30,284 PACKAGE OF CARE (P) - LMO 325 325 NC POC TEAM 2 692 692 ARRAN DN 1,525 1,525 THREE TOWNS DN 269 269 IRVINE DN 278 278 NORTH WEST COAST DN 661 661 GARNOCK VALLEY DN 467 467 LADY MARGARET NURSING 4,687 1,915 6,603 NORTH CLDT 263 263 LDS MANAGEMENT 2,122 2,122 MHS ASSOC NURSE DIRECTOR 644 644 MHANPS MH UNSCHEDULED CARE 6,235 6,235 MHS INPATIENT MGT 7,045 7,045 CMHT NURSING-NORTH AYRSHIRE 207 207 WVIEW WARD 7C FORENSIC REHAB N 6,523 62,919 69,442 INTENSIVE COMMUNITY NURSING TEAM 9,974 3,695 13,669 ADULT MENTAL HEALTH LIASION TEAM 4,190 4,190 PCMHT NORTH 3,053 3,053 WVIEW WARD 6 LOW SECURE NRS 27,940 39,677 67,617 WARRIX AVE 26,402 19,148 45,549 FORENSIC PSYCHOLOGY 583- 583- ICFN - COMMUNITY PHLEBOTOMY 2,616 2,616 OLD AGE 69,442 69,442 WVIEW WARD 9 ACUTE MH NRS 5,251 117,530 122,781 WVIEW WARD 11 ACUTE MH NRS 12,342 152,460 164,802 265,202 1,534,425 69,442 1,869,068 Bank Agency
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Appendix F Lead Partnership Report Background: The Integration Scheme creates various Lead Partnership roles across the three Ayrshire Integration Joint Boards. Each IJB, acting as lead partner, commissions services on behalf of the three Ayrshire IJBs and reclaims the costs involved. This arrangement is treated as an agency arrangement. The projected outturn position for each IJB is adjusted to reflect the impact of Lead Partnership services. The over or underspend in relation to each Lead Partnership services is not fully attributed to that partnership, and a share will be allocated to the other Ayrshire IJBs on an NRAC* basis in line with the agreed risk sharing mechanism. Within the Integration Scheme, as with all delegated budgets, the intention is that services managed under Lead Partnership arrangements should be delivered within budget. Should that not be possible, a financial recovery plan requires to be developed and approved by all three Integration Joint Boards. Should financial recovery plans for Lead Partnership services fail, then all IJBs are required to address any shortfalls which are not related to base line budget issues. There is a requirement for the 3 IJBs to be aware of the position for Lead Partnership services and plans to deliver services from within allocated budget. *NRAC and the percentage information is explained later in the report
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1. SUMMARY 1.1 The summary of the financial position month 3 is given in the table below: Further detail by IJB is given below. Allocation of Variance IJB Area of Service Period Covered Budget £’000’s Outturn £’000’s Variance £’000’s North £’000’s South £’000’s East £’000’s North Mental Health Month 3 76,490 76,883 (393) (149) (117) (127) North Children Lead Partnership Month 3 882 899 (17) (6) (5) (6) South Community Store Month 3 1,599 1,457 142 53 43 46 South Family Nurse Partnership Month 3 2,125 2,125 0 0 0 0 South Continence Team Month 3 580 722 (142) (53) (43) (46) East Standby Services Month 3 414 414 0 0 0 0 East Primary Care (including Dental) Month 3 141,702 142,393 (691) (256) (215) (220) East Prison and Police Healthcare Month 3 4,301 4,186 115 43 36 37 East Allied Health Professionals (Lead) Month 3 5,717 5,385 332 123 103 106 East Other Lead Services Month 3 2,463 2,444 19 7 6 6 2. North Ayrshire: Month 3 2.1 Services managed under Lead Partnership arrangements by North Ayrshire Integration Joint Board are projected to overspend by £0.410m in total. 2.2 Allocation of Variance IJB Area of Service Budget £000’s Outturn £000’s Variance £000’s North £000’s South £000’s East £000’s North Mental Health Lead Partnership 76,490 76,883 (393) (149) (117) (127) North Children Lead Partnership 882 899 (17) (6) (5) (6) North TOTAL 77,372 77,782 (410) (156) (122) (132) 2.3 The Lead Partnership for Mental Health is projected to be £0.393m overspent and the main variances are as follows: • Adult Inpatients – projected overspend by £1.454m due to very high levels of occupancy, patient mix and complexity and levels of continuous intervention which require additional supplementary staff and enhanced observations (1:1 and 2:1) and use of bank staff.
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• The UNPACS (Unplanned Activities) budget – projected overspend of £0.375m based on current placements. UnPACS placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium- or long-term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. • Learning Disability Services – projected to underspend by £0.161m. The underspend relates to saving made until the new service to replace Ward 7A commences offset by legacy costs as the staff are still being redeployed. • Elderly Inpatients – projected overspend of £0.332m due to the use of supplementary staffing. The elderly mental health wards continue to operate at full occupancy with waiting lists, with several patients who are on enhanced observations and bank costs remain high. • Eating Disorders – projected to be £0.100m overspent. This service is currently being reviewed and options considered. • Enhanced Mental Health Outcome Framework (EMHOF within CAMHS) – projected underspend of £0.253m. This is the balance of the spare funding from the 25/26 review. • Psychiatry – is projected to overspend by £0.318m across all specialities including some agency locum costs. A wholescale workforce review has been commissioned to determine longer term solutions for sustainability. • MH Pharmacy/Substitute Prescribing – is projected to underspend by £0.368m. The is partly due a rebate and expected drug price increases are not evident at month 3. • The turnover target for vacancy savings for the Lead Partnership is held within the Lead Partnership as this is a Pan-Ayrshire target. There is a projected over recovery of the vacancy savings target of £0.452m in 2026-27. Further information is included in the table below: Vacancy Savings Target (£1.250m) Projected to March 2027 £1.802m Over/(Under) Achievement £0.452m 2.4 Recovery Plan Action Despite being in a projected overspend position a formal recovery plan is not being recommended at this stage. The projections will continue to be refined and updated to
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reflect additional ward costs in month 4. A decision on recovery action will be made in month 4. 2.5 Performance Information To be further developed 3. South Ayrshire: Month 3 3.1 Services managed under Lead Partnership arrangements by South Ayrshire Integration Joint Board are projected to be in line with budget. 3.2 Allocation of Variance IJB Area of Service Budget £000’s Projected Outturn £000’s Variance £000’s North £000’s South £000’s East £000’s South Community Store 1,599 1,457 142 53 43 46 South Family Nurse Partnership 2,125 2,125 0 0 0 0 South Continence Team 580 722 (142) (53) (43) (46) South TOTAL 4,304 4,304 (0) (0) (0) (0) The main variances are as follows: Community Equipment Store – projected underspend of £0.142m. At period 3 there is an underspend of £0.112m. This underspend is to be maintained to offset against overspend in Continence Team. Operational Improvement Plan non-recurring funding of £0.500m to be used in 2026-27 to support whole system improvement outcomes, reducing Delayed Transfer of Care and acute beds. Family Nurse Partnership - projected to come in line with budget. Scottish Government funding allocation of £0.250m has been allocated on a non-recurring basis this financial year to support delivery of outcomes in the Tackling Child Poverty Delivery plan. Confirmation of recurring funding is expected later in the year. The additional funding will support capacity to deliver on offer FNP services to age 20 to 25 with previous care experience. An additional 1.8WTE posts were advertised with 0.8WTE recruited due to start in September. The further post will not be recruited until March 27, to fit in with scheduled training programme. Any underspend of the additional funding will be earmarked for use in 2027-28. Continence Team – projected overspend of £0.142m. Continence Supplies projected overspend of £0.142m based on prior year outturn and current spend to date. The continence team are working with the community nursing teams to reduce spend, and focussed work will commence on review of care home spend. Following this work any recurring financial pressure will be identified for review in the budget setting process for 2027-28.
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3.3 Recovery Plan Action No recovery action required, financial pressures within the continence team will be managed through an underspend in the community equipment store budget. Budget setting process for 2027-28 will consider the recurring financial pressure within the continence team for inclusion in the budget. 3.4 Performance Information To be further developed 4. East Ayrshire: Month 3 4.1 Services managed under Lead Partnership arrangements by East Ayrshire Integration Joint Board are projected to overspend by £0.225m in total. This equates to 0.15% of delegated Lead Partnership budget. 4.2 Allocation of Variance IJB Area of Service Budget £000’s Outturn £000’s Variance £000’s North £000’s South £000’s East £000’s East Standby Services 414 414 0 0 0 0 East Primary Care (including dental) 141,702 142,393 (691) (256) (215) (220) East Prison and Police Healthcare 4,301 4,186 115 43 36 37 East Allied Health Professionals (Lead) 5,717 5,385 332 123 103 106 East Other Lead Service (Lead) 2,463 2,444 19 7 6 6 East Total 154,597 154,822 (225) (83) (69) (73) The main variances are as follows: • Allied Health Professions (Lead Partnership) - There is a projected underspend of £0.332m on AHPs services hosted by East Ayrshire for the current year, which mainly relates to staffing savings. Wigs is projected to be in line. • Primary Care and Out of Hours Services (Lead Partnership) - The Primary Care and Out of Hours Services £141.702m budget has a projected overspend by £0.691m at this early stage of the year due to Primary Medical Services projected overspend of £1.005m, largely due to high spend in General medical services and increased pension and sickness cover costs. Primary Medical Services payments also show high spend against premises and additional IT costs. These additional costs were partially offset by a projected underspend of £0.099m against Ayrshire Urgent Care Services and projected underspends within Primary Care Contracting and Support £0.025m. Funding had been allocated to partially offset Urgent Care Pathway costs £0.800m with projected full spend of allocation. Funding had also been allocated to Covid-19 Therapeutics of £0.067m, with projected full spend.
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• The projected underspend of £0.189m in Dental services that reflects that staffing numbers are running at less than establishment, alongside reduced equipment costs. • Prison and Police Healthcare (Lead Partnership) – projected underspend of £0.115m is due to reduced staffing costs. • Other Services (Lead Partnership) - The £0.019m projected underspend is due to reduced Palliative Care Services costs. 4.3 Recovery Plan Action No additional Financial Recovery Plan proposals for East Ayrshire hosted services are included within this report. Details and actions to reduce the overspend projections will be included within the next report. 4.4 Performance Information To be further developed 5. NRAC 5.1 NRAC is the NHS Scotland Resource Allocation Committee Formula, a method to allocate funding to NHS Scotland Health Boards. Its primary objective is to promote equitable access to healthcare by assessing each board's relative need based on factors like population size, characteristics influencing healthcare needs, and service delivery costs. The formula sets "target shares" for funding distribution, although final allocations may differ to ensure funding stability. 6. Reporting Cycle North: Month 3,4,6,7,9,10 and 12 South: Month 3,6,9,10 and 12 East: Month 2, 4, 6, 9 and 12