2024-25 Budget Monitoring Report
North Ayrshire Council · 6 February 2025
Back to Integration Joint Board — 6 February 2025 and its agenda
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Integration Joint Board 6th February 2025 Subject : 2024-25 – Month 9 Financial Performance Purpose : To provide an overview of the IJB’s financial performance as at Month 9 (December). Recommendation : It is recommended that the IJB: (a) notes the overall integrated financial performance report for the financial year 2024-25 and the current overall projected year- end overspend of £5.824m, reduced to £4.415m through already identified financial recovery actions; (b) notes the progress with delivery of agreed savings; (c) approves the actions which are being taken to progress financial recovery and that a further recovery plan will be presented to the next IJB; (d) notes the remaining financial risks for 2024-25; and (e) approves the budget reductions which are detailed at paragraph 2.10 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
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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 December 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. 1.2 The projected outturn is a year-end overspend of £5.824m (1.8%) for 2024-25, reduced to £4.415m through identified financial recovery actions. There is an increasing risk to achieving financial balance during 2024-25, the projected outturn position is summarised below with the residual risk following already identified financial improvement actions: Split TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth9 £5.824m £1.539m £4.285m Less Financial Recovery Plan Projections £1.409m £0.230m £1.179m Residual Risk £4.415m £1.309m £3.106m 1.3 From the core projections, overall, the main areas of pressure are: care at home, residential placements for children, physical and learning disability care packages, supplementary staff in wards, staff costs in Montrose House and Unplanned Activities (UnPACs) within the lead partnership for mental health. 1.4 Improvement: • Care homes • Care at home • Residential Placements for Children • PD direct payments • Adult Inpatients Deterioration: • Ward 1 and 2 • UnpACS • Psychiatry • UASC grant income Overall, the financial projection has improved and reduced from a projected overspend of £6.190m to £5.824m, however the residual risk has deteriorated due to a review of the Financial Recovery Plan during Month 9 with a view to reflecting an updated and realistic outturn position at this point in the financial year. 1.5 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
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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. The Month 7 report presented to IJB on 12th December 2024 projected an overspend of £6.190m reduced to an estimated £3.613m based on the recovery plan estimates at that time. The IJB requested that the Chief Officer write formally to North Ayrshire Council and NHS Ayrshire and Arran to request additional in-year funding to support the remaining overspend, at that time being: • North Ayrshire Council £2.548m • NHS Ayrshire and Arran £1.065m Those requests have been submitted to both funding bodies, and whilst we await formal response and consideration both NAC and NHS AA have acknowledged the requests. A further update will be shared with both NAC and NHS AA based on our period 9 financial forecasts. 1.6 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, on that basis further information will be brought forward with further detail on Lead Partnership services. 1.7 The 2024/25 financial position is being adversely impacted by several factors outwith the control of the IJB, these have been noted previously by the IJB and include in- year funding allocation reductions and externally negotiated contract inflation increases. 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 9 At month 9 against the full-year budget of £327.271m there is a projected year-end overspend of £5.824m (1.8%). 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 £4.285m in social care services and a projected overspend of £1.539m in health services.
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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. The projections for some areas will be subject to fluctuations as they depend on recruitment plans for new funding and also the capacity of providers to take on work. Appendix F provides information on the costs of bank and agency staff as requested at the August IJB. 2.3 Health and Community Care Services Against the full-year budget of £92.342m there is a projected overspend of £5.741m (6.2%) (£0.494m favourable movement) and the main variances are: a) Care home placements – is overall projected to be £0.147m overspent. The budgeted number of permanent placements was 765 and at month 9 there were 769 placements which is a reduction 21 places from month 7. The projected overspend is £0.907m (£0.161m favourable) on permanent placements, £0.284m (£0.054m favourable) on interim placements and respite placements are projected to be online (no change). The plan to manage down the number of permanent placements to reach the target is challenging due to the need to minimise delayed discharge from hospital and to continue to support those in critical and substantial need in the community. The overspend is partially offset by income recovered from charging orders which is projected to be £0.760m over recovered (£0.057m favourable). 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. b) Care at home is projected to be £2.563m overspent (net £0.147m favourable movement). The position reflects the cost of meeting the significant demand and level of provision for care at home support. This projection includes an estimate for costs which will be paid in future periods in relation to cover costs during month 9 in relation to sickness and festive cover arrangements. c) Physical Disability Services – projected overspend of £0.767m (£0.131m favourable) split as follows: £1.304m over in residential placements, £0.155m under in direct payments and £0.382m under in community care packages. d) Integrated Island Services is projected to overspend by £0.522m (£0.043m favourable movement). The most significant variance is a projected overspend at Montrose House of £0.415m (£0.002m favourable movement) which relates to the net overspend on agency staff (i.e. net of underspend on employee costs) and overspends across property, supplies, admin and transport. A new contract to procure agency nursing staff commenced in November and this has
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contributed to reducing the projection along with less agency staff used and this is reflected in the projection. e) Specialist Rehab wards – projected underspend of £0.027m (£0.013m favourable movement) (Redburn ward £0.116m overspend and Douglas Grant £0.143m underspend). 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 £0.890m (£0.104m adverse movement) due to increased use of bank and supplementary staffing. g) District Nursing – projected to overspend by £0.071m (no movement) mainly due to an overspend on nursing supplies. h) Equipment and Adaptions – projected overspend of £0.330m (£0.050m favourable movement) including an overspend on the supply of stairlifts. 2.4 Mental Health Services Against the full-year budget of £109.815m there is a projected overspend of £2.487m (2.3%) (adverse movement of £0.600m) 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 £0.776m (£0.020m adverse movement) across community care packages, direct payments and residential placements. This improvement reflects the positive impact of assertive reviews of care packages. • Community Mental Health services are projected to underspend by £0.320m (£0.045m adverse) across community care packages, direct payments and residential placements. The main reason for underspend is the availability and capacity of adult community providers to deliver new packages of care. • There is a projected underspend of £0.075m (no movement) in relation to the cost of Hospital Based Complex Continuing Care (HBCCC), this reflects the impact of change in provision for these services. • The Lead Partnership for Mental Health is projected to be £2.095m overspent (£0.535m adverse movement) and the main variances are as follows: • Adult Inpatients – overspent by £0.105m (£0.156m favourable) due to overspends in supplementary staff for enhanced observations (1:1 and 2:1) and use of bank staff. There is a favourable impact from the opening of the adult mental health assessment hub which has seen the adult inpatient areas with reduced occupancy. There has also been a continuing reduction in bank costs since month 5 and this is projected to continue until the year end.
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• The UNPACS (Unplanned Activities) budget – projected overspend is £0.900m (£0.161m adverse movement) based on current placements. The adverse movement is due to increased costs for existing placements and one transfer not taking place when expected. The actual cost of the future placements may be different from the estimated cost assumed in the projection. These 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. A new group has been established to review the UnPACS budget and placements with a wider service representation. • Learning Disability Services – projected to underspend by £0.193m (£0.091m adverse movement). The adverse movement is due to an increased use of bank and agency staff in Ward 7A. This position is after recharging other areas on a cost basis for two outwith authority placements which have incurred additional costs in relation to usage of supplementary staffing due to sustained enhanced observations. There is a risk in relation to recovering this income as the two areas receiving the charges are currently refusing to pay and legal advice is being sought. The projected income due from prior and the current year is £2.308m. • Elderly Inpatients – projected overspend of £0.526m (£0.002m favourable movement) due to the use of supplementary staffing. The elderly mental health wards continue to operate at full occupancy and at times with waiting lists, with several patients who are on enhanced observations and bank costs remain high. • Eating Disorders – projected to overspend by £0.104m (no movement) due to the staffing level being higher than the funding allocation. This will be considered alongside the overall resource allocation for future years.
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• Psychiatry – is projected to overspend by £0.350m (£0.150m adverse movement) due to the use of agency staff and junior doctors. A mitigation plan is being developed. • MH Pharmacy – is projected to overspend by £0.658m (£0.003m favourable movement) due to increased demand and cost of medicines and in particular the cost of Buvidal, further detail on this area of pressure has been shared at the Finance Working Group. Innovation Fund – projected underspend of £0.108m (£0.004m adverse) due to slippage within some of the projects and not all of the funding has been allocated. • 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 £0.200m (£0.300m adverse movement) in 2024-25. Further information is included in the table below: Vacancy Savings Target (£1.116m) Projected to March 2025 £1.316m Over/(Under) Achievement £0.200m 2.5 Children and Justice Services Against the full-year budget of £44.507m there is a projected overspend of £1.630m (3.7%) (£0.128m favourable movement) and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £2.040m (£0.273m favourable). 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: • Following budget investment of £4m the children’s residential placements are overspent by £1.785m (£0.203m favourable movement) based on 30 placements at month 9 and reducing to 28 placements in month 10. This demonstrates a reduction of 9 places since the start of the financial year. There are a number of factors leading to this challenging position: • 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.
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• 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. • A number of young people in residential care have requested Continuing Care, whereby a young person can remain in their placement until age 21. • 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. • Contractual inflation has increased the projected costs of residential places which is outwith the control of the service. Children’s Services are continuing to work with other services including Education and Housing to address the challenges through the work of the ‘Brighter Pathways’ Programme Board and associated workstreams. This forms part of the Transformation Plan which was approved at the March IJB. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.730m underspent (£0.009m favourable movement). • Children with disabilities – there is a net projected overspend of £0.580m (£0.061m favourable movement) across residential placements, direct payments and community packages. The adverse movement is due to the confirmed costs of a recent placement being higher than previously estimated. The favourable movement is due to increased clawback of Direct Payment underspends. • Residential respite – placements are overspent by £0.143m (£0.008m adverse movement). These short-term placements are used to prevent an admission to full time care or to avoid placement breakdown. • Employee costs – are projected to overspend by £0.160m (£0.040m favourable movement), largely due to staffing levels in the children’s houses and regrading of posts. b) Head of Service – is projected to underspend by £0.790m (£0.052m adverse movement). This consists of a projected overspend due to the planned saving of £0.233m in relation to the staff reconfiguration in the children’s houses which was not achieved in 23-24 and this is offset by the grant funding in relation to Unaccompanied Asylum-Seeking Children (UASC), which is projected to amount to £0.947m (£0.113m adverse movement) and which contributes to costs incurred across a number of C&F service areas. The adverse movement in the grant income is due to a backlog with the UASC claims and the actual income was less than assumed. c) C&F Health Team – is projected to overspend by £0.284m (£0.073m adverse movement) mainly in relation to the Band 6 to 7 regrade for Health Visitors and
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the progression of posts up the Band 7 scale. This recurring cost has been incorporated into budget pressures for 2025/26. 2.6 ALLIED HEALTH PROFESSIONALS (AHP) 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 overspend by £0.016m. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £2.901m (£0.057m adverse) and the main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.942m (£0.046m favourable) due to delays in children transitioning into adult services and actual costs being less than estimated. 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. • The 2024-25 budget included a budgeted deficit on the social care side of £0.437m which is offset by a budgeted surplus of £0.437m on the health side of the budget. The net impact is neutral, but Appendix A shows this position for each element. • The £0.100m saving in relation to recovery and rehab will not be achieved and is now reflected as an overspend in the projection. • An over-recovery of payroll turnover of £1.586m for social care services and an over-recovery of payroll turnover of £0.435m 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 (£3.301m) (£1.522m) Projected to be achieved by March 2025 £4.887m £1.957m Over/(Under) Achievement £1.586m £0.435m 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
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filled only where deemed necessary with a recruitment freeze now implemented for all non-essential posts. This has led to a significant increase in the level of turnover when projected to the year end. The turnover target for the North Lead Partnership for Mental Health services is detailed separately within the Lead Partnership information at section 2.4. 2.9 Savings Progress a) The approved 2024-25 budget included £10.290m of savings. BRAG Status Position at Budget Approval £m Position at Month 9 £m Red - 0.586 Amber 0.523 - Green 9.767 - Blue - 9.704 TOTAL 10.290 10.290 b) The main area to note is that the red savings have increased since month 7 as the saving in relation to care homes and recovery and rehab look unlikely to be achieved. Appendix B provides an overview of those service changes which do have financial savings attached to them and the BRAG status around the deliverability of each saving. 2.10 Budget Changes The Integration Scheme states that “either party may increase it’s 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 (£000) 1 ICT budget transfer (0.002) 2 MDT adjustments (0.058) 3 Mat Standards post to pharmacy acute (0.041) 4 ADP 24/25 - ABI to East (0.010) 2.11 Pan Ayrshire Lead Partnership services and Large Hospital Set Aside
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Lead Partnerships: - The IJB position is adjusted to reflect the impact of Lead Partnership services. The outturn for all Lead Partnership services is shared across the 3 Partnerships on an NRAC basis. The outturn in relation to North Lead Partnership services is not fully attributed to the North IJB as a share is allocated to East and South Partnerships; similarly, the impact of the outturn on East and South led services is shared with North. At Month 9 the MH lead partnership is projected to overspend by £2.095m (£0.686m NRAC share for East and £0.599m for South). South HSCP (month 9 info) – projected overspend of £0.617m of which £0.228m will be allocated to North. The variance is mainly due to an overspend of £0.431m in the community store. This includes the costs of replacing mattresses, repairs and maintenance contract and equipment costs. There is also a projected overspend of £0.181m in the continence service and an overspend £0.004m in the Family Nurse Partnership. East HSCP (month 9 info) - projected underspend of £0.225m (£0.025m favourable) in total (of which £0.083m will be allocated to North). The main variances are: Allied Health Professions There is a projected underspend of £0.338m (£0.302m at month 6) on AHPs services hosted by East Ayrshire for the current year, which mainly relates to staffing savings in Physiotherapy / MSK and Podiatry services and is partially offset by increased Orthotics costs. Primary Care and Out of Hours Services There is a small projected underspend of £0.010m (£0.064m projected underspend at month 6) on the Primary Care Lead Partnership budget, with additional costs in Out of Hours services £0.347m (£0.321m at month 6), with work ongoing to mitigate increased costs as far as possible over the course of the 2024/25 financial year and going forward, as well as additional Primary Care contracting and support costs £0.037m (£0.027m projected underspend at month 6). These additional costs are offset by a projected underspend in Dental services totalling £0.439m (£0.344m month 6), where staffing numbers are running at less than establishment. Recruitment over the remainder of the financial year has the potential to impact further on the projected outturn position at month 9. In addition, there are projected additional Primary Medical Services costs £0.092m (£0.058m projected underspend at month 6). This mainly relates to updated information on staffing costs, including maternity, paternity and sick leave costs. Prison and Police Healthcare The £0.021m projected overspend at month 9 is largely due increased staffing costs due to recruitment to vacant posts, as well as increased prescribing costs (£0.101m overall projected underspend at month 6).
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Other Services The £0.102m (£0.106m at month 6) projected overspend is due to increased Area Wide Evening Services costs, mainly due to additional staffing costs including high use of bank staff, which will require to be further addressed going forward. 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 2022/23 prices. IJB Baseline at 2022/23 prices (£) East 26,215,888 North 35,007,962 South 28,371,789 Total 89,595,639 The annual budget for Acute Services is £461.5 million. The directorate overspent by £25.6 million after 9 months. This was caused by overspends on agency medical and nursing staff, together with drug expenditure including the New Medicines Fund, equipment and supplies. These have been required due to the level of operational pressure being experienced, in common with many other areas in Scotland. Whilst unfunded beds remained open across both main hospital sites during October, progress is now being made in reducing these with commensurate financial improvement expected to follow. There is a material underlying deficit caused by: • Unachieved efficiency savings • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are above the Scottish average.
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• 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. Initial work has commenced to develop a joint strategic commissioning plan for the provision of unscheduled care services, which will outline these services will be delivered over the medium-term using the set aside resources available. This will support a shift in the balance of care into the community and support a reduction in the number of acute beds. 2.12 FINANCIAL RISKS There are a number of financial risk areas that impact or may impact on the financial position. • The recent announcements by Scottish Government in relation to public sector finances and in-year spending reductions will impact on current and future funding, including for 2024-25 pay awards, which have recently been settled for local government and NHS but the funding position is not yet clear. • Continued growing demand for services. • Staff recruitment and retention challenges across a number of service areas. • The provider market and the ongoing ability to source packages of care for service users. • The expectation that performance will continue to be maintained or improved despite the significant resource challenges, for example the joint mission for delayed discharge improvement. • Ongoing delivery costs of Scottish Government policy directives, particularly where these are not fully funded or inflation proofed. • The ongoing review of the Integration Scheme. • Progress with the work to develop set aside arrangements and the risk sharing arrangements agreed as part of this. • The wider system financial challenges, especially the financial position of NHS Ayrshire and Arran Health Board, their financial deficit and the risks around further escalation in the national framework for financial escalation. North Ayrshire IJB have already discussed our position in relation to the request for payment for delayed discharges last financial year. • The recurring underlying levels of overspend which may impact on the Partnership’s ability to continue to sustain service levels in the future. • The IJB free general fund reserves are estimated to be fully used during this financial year, leading to an increased risk of requiring additional in-year financial contributions from NHS Ayrshire and Arran and North Ayrshire Council to break even.
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• High risk areas of low volume / high-cost services areas e.g. Children’s residential placements, Learning Disability care packages and complex care packages; • Lead / hosted service arrangements, including managing pressures and reporting this across the 3 IJBs. • The impact on Lead Partnership and acute services from decisions taken by other Ayrshire areas. • The use of supplementary staffing for enhanced observations across a number of service areas. • 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. Non- recurring funding has been provided to meet costs associated with this but it is unclear whether this will be sufficient. • Scot Excel inflationary increases for children’s service are significantly higher than assumed. • There is a risk in relation to recovering recharge income in relation to the LD Assessment and Treatment patients from outwith Ayrshire. These risks will continue to be monitored during 2024-25. 2.13 RESERVES The IJB reserves position is summarised in the table below. General Fund Reserve Earmarked Reserves Total Unearmarked External Funding HSCP £m £m £m £m Balance – 1 April 2024 0.357 3.379 1.774 5.510 Anticipated Drawdown (0.357) (3.379) (1.202) (4.938) Balance – 31 March 2025 - - 0.572 0.572 The £1.774m HSCP earmarked reserve relates to the Service Redesign and Change Fund which is fully committed. Further detail on the reserves is given in Appendix D. 2.14 Financial Recovery Plan The IJB set a balanced budget for 2024/25 on 14th March 2024. This did not require any draw on reserves but did include the approval of £10.290m of savings to achieve financial balance.
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Following the finalisation of the 2023/24 outturn position, the IJB agreed some initial recovery actions at the meeting in June. In line with the requirements of the integration scheme, work has continued to develop the financial recovery plan and identify further targets for financial improvements. The current plan is outlined in full at Appendix E. There has been progress towards some of the targets, and these are already reflected in the current projected outturn of £5.824m overspend. Further work is required to deliver on the balance of these targets and targets have been revised at period 9 with a reassessment of the realistic further progress and financial impact of actions in the last 3 months of the financial year. Services will work towards implementing the recovery plan to deliver on these cost reduction targets while carefully managing the level of risk. This will include the preparation of equality impact assessments. It is recognised that there needs to be further savings identified to move towards a breakeven position. Any decisions to implement changes which have significant impact on service delivery and the wider system will be discussed at the Finance Working Group before being brought back to the IJB for further approval as part of the financial recovery plan. MANAGEMENT ACTIONS/CONTROLS: Other management actions which have been implemented include: • Review of expenditure authorisation levels across the Partnership and escalation of specific decisions to senior officers. In particular, a new governance group has been introduced, involving the Director and Heads of Service, to oversee the agreement of higher value packages of care (above £40,000 per annum). • Staff communication in relation to discretionary/non-essential spend. • 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. • Maximise opportunities from the recently reopened Independent Living Fund (ILF) Scotland. GOVERNANCE: • In order to facilitate greater scrutiny of the financial position and the delivery of the financial recovery plan during 2024/25, the IJB agreed at the June
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meeting to establish a ‘Finance Working Group’, chaired by the IJB Vice Chair. The Director and Heads of Service will be members of the group. This will meet monthly to facilitate increased oversight and scrutiny of the financial position and transformation programme as well as detailed budget planning for future financial years. Meetings have now been scheduled to the end of the year. To date the Finance Working Group has met five times and covered: • Care at home • Care homes • Charging income • Financial inclusion • An overview of the 24/25 budget • Brighter Pathways project • Addictions Prescribing • Medium-Term Financial Outlook • 2025/26 Budget Outlook • Delayed discharge performance and improvement actions • Community OT – Aids and Adaptations The Finance Working Group acknowledged the efforts being made by the senior management team and services and notes the progress being made to work towards a sustainable financial position for the partnership. • Strengthened support from Finance Team to front line services and increased engagement with Heads of Service and Senior Management Teams, including line by line reviews of all budget areas. Review and enhancement of frequency and level of financial information provided to support oversight and decision making in line with financial constraints, with an added focus on areas of underspend to maximise opportunities to delay or stop spend and contribute to the overall financial challenge. INTEGRATION SCHEME The Integration Scheme describes the required approach where there is a projected overspend: The Chief Officer will deliver the Outcomes within the total delegated resources (paid and Set Aside) and where there is a forecast overspend against an element of the operational budget, the Chief Officer, the Chief Finance Officer of the Integration Joint Board and the appropriate finance officers of the Parties must agree a recovery plan to balance the overspending budget, which recovery plan shall be subject to the approval of the Integration Joint Board. If the recovery plan is not successful the Parties will consider making interim funds available based on the agreed percentage contribution for joint responsibilities, as outlined above, with repayment in future years on the basis of a revised recovery plan agreed by the Parties and Integration Joint Board.
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There is an increasing risk to achieving financial balance during 2024-25, the projected outturn position is summarised below with the residual risk following already identified financial improvement actions and illustrates the current estimated risk exposure to the IJBs funding partners: Split TOTAL Health/ NHS AA Social Care/NAC Projected Overspend @ mth9 £5.824m £1.539m £4.285m Less Financial Recovery Plan Projections £1.409m £0.230m £1.179m Residual Risk £4.415m £1.309m £3.106m The Month 7 report presented to IJB on 12th December 2024 projected an overspend of £6.190m reduced to an estimated £3.613m based on the recovery plan estimates at that time. The IJB requested that the Chief Officer write formally to North Ayrshire Council and NHS Ayrshire and Arran to request additional in-year funding to support the remaining overspend, at that time being: • North Ayrshire Council £2.548m • NHS Ayrshire and Arran £1.065m Those requests have been submitted to both funding bodies, and whilst we await formal response and consideration both NAC and NHS AA have acknowledged the requests. A further update will be shared with both NAC and NHS AA based on our period 9 financial forecasts. 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 2024-25 from within the available resource, thereby limiting the financial risk to the funding partners. The transformational change programme 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. 3.2 Measuring Impact Ongoing updates to the financial position will be reported to the IJB throughout 2024- 25. 4. IMPLICATIONS 4.1 Financial
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The outturn is an overall year-end overspend of £5.824m (1.8%). The report outlines the main variances for individual services. The IJB unearmarked reserve balance is projected to be zero by the end of the financial year and there is an ongoing risk in relation to the £4.415m of the overspend where financial recovery improvement actions require to be identified. This current position poses a financial risk to North Ayrshire Council and NHS Ayrshire and Arran and also for the IJBs financial position moving into 2025-26. 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 on our strategic risk register has increased the risk score to reflect the 23/24 outturn and current projected 24/25 overspend. 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 2024-25 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2024-25. 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, Interim Chief Finance Officer eleanorcurrie@north-ayrshire.gov.uk Appendices Appendix A - 2024-25 Budget Monitoring Report–Objective Summary as at 31.12.24 Appendix B - 2024-25 Savings Tracker
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PUBLIC INFORMATION 2024-25 Budget Monitoring Report–Objective Summary as at 31st December 2024 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 £'000 £'000 COMMUNITY CARE AND HEALTH 72,730 77,283 4,553 19,612 20,800 1,188 92,342 98,083 5,741 6,235 (494) : Locality Services 30,396 31,463 1,067 5,624 5,696 72 36,020 37,159 1,139 1,596 (457) : Community Care Service Delivery 38,209 40,890 2,681 0 38,209 40,890 2,681 2,787 (106) : Rehabilitation and Reablement 2,062 2,421 359 0 2,062 2,421 359 384 (25) : Long Term Conditions 956 990 34 9,795 10,802 1,007 10,751 11,792 1,041 909 132 : Community Link Workers 338 337 (1) 0 0 0 338 337 (1) (6) 5 : Integrated Island Services 769 1,182 413 4,193 4,302 109 4,962 5,484 522 565 (43) MENTAL HEALTH SERVICES 34,316 34,783 467 75,499 77,519 2,020 109,815 112,302 2,487 1,887 600 : Learning Disabilities 25,796 26,572 776 564 564 0 26,360 27,136 776 756 20 : Community Mental Health 6,470 6,150 (320) 1,793 1,793 0 8,263 7,943 (320) (365) 45 : Addictions 2,050 2,061 11 1,943 1,943 0 3,993 4,004 11 11 0 : HBCCC 0 0 0 353 278 (75) 353 278 (75) (75) 0 : Lead Partnership Mental Health NHS Area Wide 0 0 0 70,846 72,941 2,095 70,846 72,941 2,095 1,560 535 CHILDREN & JUSTICE SERVICES 39,329 40,635 1,306 5,178 5,502 324 44,507 46,137 1,630 1,758 (128) : Irvine, Kilwinning and Three Towns 3,070 3,107 37 0 0 0 3,070 3,107 37 39 (2) : Garnock Valley, North Coast and Arran 3,157 3,205 48 0 0 0 3,157 3,205 48 37 11 :Intervention Services 1,695 1,689 (6) 0 0 0 1,695 1,689 (6) 0 (6) : Care Experienced Children & Young people 27,425 29,465 2,040 0 0 0 27,425 29,465 2,040 2,313 (273) : Head of Service - Children & Families 1,094 304 (790) 0 0 0 1,094 304 (790) (842) 52 : Justice Services 2,472 2,472 0 0 0 0 2,472 2,472 0 0 0 : C&F Health Team 416 393 (23) 4,447 4,754 307 4,863 5,147 284 211 73 : Lead Partnership NHS Children's Services 0 0 0 731 748 17 731 748 17 0 17 CHIEF SOCIAL WORK OFFICER 1,559 1,575 16 0 0 0 1,559 1,575 16 6 10 PRIMARY CARE 0 0 0 53,830 53,821 (9) 53,830 53,821 (9) 77 (86) ALLIED HEALTH PROFESSIONALS 0 10,914 10,914 0 10,914 10,914 0 1 (1) MANAGEMENT AND SUPPORT COSTS 9,667 7,610 (2,057) 4,637 3,793 (844) 14,304 11,403 (2,901) (2,958) 57 OUTTURN ON A MANAGED BASIS 157,601 161,886 4,285 169,670 172,349 2,679 327,271 334,235 6,964 7,006 (42) Over/ (Under) Spend Variance at Period 7 Movement in variance from Period 7 TOTAL Partnership Budget - Objective Summary Council Health 2024/25 Budget
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PUBLIC INFORMATION TOTAL Budget Budget 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 £'000 £'000 Return Hosted Over/Underspends East 0 0 0 0 (686) (686) 0 (686) (686) (511) (175) Return Hosted Over/Underspends South 0 0 0 0 (599) (599) 0 (599) (599) (446) (153) Receive Hosted Over/Underspends South 0 0 0 0 228 228 0 228 228 215 13 Receive Hosted Over/Underspends East 0 0 0 0 (83) (83) 0 (83) (83) (74) (9) OUTTURN ON AN IJB BASIS 157,601 161,886 4,285 169,670 171,209 1,539 327,271 333,095 5,824 6,190 (366) Over/ (Under) Spend Variance at Period 7 Movement in variance from Period 7 Partnership Budget - Objective Summary 2024/25 Budget Council Health
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PUBLIC INFORMATION 2024-25 Savings Tracker Appendix B Social Care: Description Deliverability Status at budget setting Deliverability Status at Month 9 2024/25 Saving Description of the Saving Children, Families & Criminal Justice Service redesign Amber Blue 0.123 Restructure areas of specialist service provision including substance use and corporate parenting, embedding the roles and functions of those teams within our locality-based early intervention approaches and strategic planning including engagement. Community Care & Health Review of Day Care provision Amber Blue 0.100 Carry out a review and streamline day care provision. Sensory Impairment Team Green Blue 0.062 Remove the dedicated management post and realign the team into core social work teams. Care Home places Green Red 0.375 Reduce the number of funded care home places by 15, leaving budgetary provision for 765 places at average cost. Charging for community alarm provision to sheltered housing tenants Amber Blue 0.200 Introduce a charge for community alarm provision in council sheltered housing units to ensure an equitable approach across all housing tenures. Montrose House capacity Green Red 0.111 Restrict the capacity at Montrose House care home to the current level of residency. Voluntary Early Release Green Blue 0.174 Recurring savings achieved by the release of back-office staff through the council's voluntary early release scheme. Carers Strategy funding Green Blue 0.384 Utilise the remaining Carer's Strategy funding to invest in respite provision and short breaks for carers and to support existing investments in services which support unpaid carers. Increase to charging Green Blue 0.131 Increase charges for non-residential care by 10% and charges for residential care by 5% Remove vacant posts Green Blue 0.280 Remove a number of vacant posts across support services. Employers' superannuation contributions Green Blue 7.238 Align the budget to the new employer superannuation contribution rates from 1st April 2024. Payroll Turnover Green Blue 0.077 Increase targets for payroll turnover through the recruitment process. TOTAL SOCIAL CARE SAVINGS 9.255 North Ayrshire Health and Social Care Partnership 2024/25 Savings Support Services and Partnership-wide savings
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PUBLIC INFORMATION Health: Description Deliverability Status at budget setting Deliverability Status at Month 9 2024/25 Saving Description of the Saving Hospital Based Complex Continuing Care (HBCCC) provision Green Blue 0.500 Align the budget to the level of ongoing need for HBCCC provision. Increase recharge to East Ayrshire for beds at Woodland View Green Blue 0.021 Apply an inflationary increase to the recharge to East Ayrshire HSCP. Community Recovery and Rehab provision Amber Red 0.100 Review and streamline a range of current provisions to remove duplication. Enhanced ICT Green Blue 0.100 Carry out a review of the service delivery model and release recurring staffing savings. Payroll Turnover Green Blue 0.314 Increase targets for payroll turnover through the recruitment process. TOTAL HEALTH SAVINGS 1.035 TOTAL NORTH HSCP SAVINGS 10.290
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PUBLIC INFORMATION 2024-25 Budget Reconciliation Appendix C COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 156.190 Adjustments to baseline (0.574) Less Resource Transfer 23/24 (24.640) Revised Budget 130.976 Resource Transfer 24/25 1-3 P 25.169 Realign Girfec Team To Connected Comm 1-3 P (0.073) ICT Budget Transfers 1-3 P (0.006) CJSW Funding 2425 1-3 T 0.053 Childrens Living Wage Allocation 1-3 T 0.525 ICT Budget Transfers 6 P -0.002 ICT Budget Transfers 6 P -0.003 Post Realigned from the Policy, Performance & Elections Team 6 P 0.059 Transfer to FM Services re Cleaning Services at West Road 6 P -0.01 Transfer to Capital re West Road 7 T -0.281 Transfer from NAC Commercial Waste 7 T 0.007 ICT Budget Transfers 9 P -0.002 Summer Activities EMF Q2 & Q3 Draw- Down 9 T 0.002 Pay Award 24/25 9 P 1.057 Scottish Disability Allowance 9 P 0.134 Roundings 9 T -0.004 157.601 HEALTH Period Permanent or Temporary £'m Initial Budget exc set aside 157.894 Add Resource Transfer 23/24 24.640 Month 10-12 Adjustments and adjusting for the full year impact of part years amounts and temporary funding. (0.033) Revised Budget P 182.501 Add resource Transfer 24/25 (25.169) North Superannuation 24/25 uplift 1 1.134 MH: ANTICIPATE HOLLYBUSH COMBAT STRESS 24/25 1 1.424 MH: ANTICIPATE DELIVERY OF VETERAN SPECIFIC 24/25 1 0.105 MH: ANTICIPATE PERINATAL MH, INFANT MH (INCL MNPI) 24/25 1 0.750 Training grade ADJ - April 1 0.063 Pecos Nurse Post 1 (0.018) Script Switch To Pharmacy 1 (0.002) Breastfeeding Pay Award - South 2 0.005 Nest - South 2 0.066 24-25 Bwg Foxgrove North 2 0.033 24-25 E Bwp Breast Feeding - North 2 0.005 24-25 E Bwp Huntingtons North 2 0.005 24-25 E Bwp Nest North 2 0.066 Phlebotomy Admin Returned 2 0.005 23-24 - 50% North Share to East - Tier 3 Weight Management 2 (0.077) 24-25 North Share to East - Tier 3 Weight Management 2 (0.022) Anticipate Adp Afc Pay Uplift 3 0.091 Anticipate Adp Drug Prevalence 3 0.084 Anticipate Adp Lived & Living Exp 3 0.013 Anticipate Adp Mat 3 0.250 Social Care Budget Reported at Month 9
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PUBLIC INFORMATION HEALTH Period Permanent or Temporary £'m Anticipate Adp National Mission 3 0.296 Anticipate Adp Residential Rehab 3 0.134 Anticipate Adp Whole Family Approach 3 0.094 Training Grade Adj - Jun 3 (0.054) Ambush North Rx 3 1.573 Ambush North Rx Cres 3 (1.477) 24-25 North Budget Paper - Office 365 (to East) 3 (0.073) 24-25 North Budget Paper - Prison Pharm Contract (to East) 3 (0.093) South Mat Funding - Psychiatrist 3 0.029 Hd198: Early Intervention In Psychosis/ Body Image And Social Media Resource 3 0.242 Hd203: Digital Mental Health Programme Licence & Support 3 0.005 Reduction to the Working Week (mth 2 - 4) 4 0.105 Post to medical records 4 (0.037) HD107: breast Feeding project funds 4 0.056 BBV 4 0.280 Rww 1/2 Hour Overtime M5 5 0.006 Min Anp Allocation 5 0.020 Ml: Nr Prog - Mappa 5 0.004 Training Grade Adj - August 5 0.051 Training Grade Vac Adj - August 5 (0.025) MH: Return Hollybudh anticipated budget back to reserves 24/25 5 (1.424) HD271: Combat Stress Clinical services for Veterans 5 0.583 Reduction to the Working Week 1/2 Hour Overtime M6 6 0.002 Hd283 24-25 Pharmacy Tariff Red 6 (0.031) Reduction to the Working Week 1/2 Hour Overtime M7 7 0.003 Afc Partnership Pay Award 7 4.710 Training Grade Adj - October 7 (0.026) 24-25 E Bwp Huntington's North - Return To East 7 (0.005) Mh - Afc Reform Reduced Working Week 7 0.037 Pharmacy Tarrif reduction reinstated 7 0.031 Return Anticipated MDT 7 (0.316) MDT reduction by SG 7 0.179 Anticipated budgets assumed in the report but not yet allocated 7 1.628 Rww 1/2 Hour Overtime M8 8 0.002 Ret Antic Mdt 24-25 Alloc Correct 8 (0.017) Virement No. 14: North Mdt Funds To Arran Medical Group 8 (0.041) HD231: PDS Dementia 8 0.094 Mh: Return Afc Partnership Pay Award 8 0.146 Fund RX Overspend at M8 8 0.396 Rww Worked November Paid December 9 0.001 MH: ALLOCATE MAT STANDARDS - MAT 7 PRIMARY CARE (PAN AYRSHIRE) PHARMACIST 9 (0.042) MH: ADP 24/25 - ABI to East 9 (0.010) HD413: Veterans Specific Services - Combat Stress 9 0.010 Medical Pay Award Part 1 9 0.804 Med Pay Award - December 9 0.182 Fund Rx Overspent At M9 9 0.325 Roundings 9 0.001 169.670 TOTAL COMBINED BUDGET 327.271 Health Budget Reported at Month 9
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PUBLIC INFORMATION 24-25 IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2024 2024-25 Anticipated Draw Downs Projected Balance at 31 March 2025 : Alcohol & Drug Partnership 641 (641) 0 : Mental Health Action 15 57 (57) 0 : Service Redesign / Challenge Fund 1,774 (1,202) 572 : Community Living Change Fund 377 (377) 0 : Family Wellbeing Fund 1,313 (1,313) 0 : Wellbeing Fund 50 (50) 0 : Breast Feeding Network 26 (26) 0 : MH Recovery and Renewal 546 (546) 0 : Buvidal 23 (23) 0 : Brooksby 5 (5) 0 : Cossette Funding 4 (4) 0 : Expansion of Primary Care Estates 55 (55) 0 : GP Premises Improvements - tranches 1 and 2 63 (63) 0 : Mental Health Wellbeing in Primary Care 81 (81) 0 : Dental Practice Improvement 29 (29) 0 :Appropriate Adult Scheme 2 (2) 0 :Adult Tier 3 Weight Management Service 19 (19) 0 : Phlebotomy 22 (22) 0 : LD Health Checks 66 (66) 0 Total Earmarked 5,153 (4,581) 572 Unallocated General Fund 357 (357) 0 General Fund 5,510 (4,938) 572 Earmarked Funds
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PUBLIC INFORMATION Financial Recovery Action Plan Appendix E FINANCIAL RECOVERY PLAN £m £m £m Projected Overspend at Month 9 5.824 SERVICE AREA Cost reduction target Revised Target (Jan 2025) Achieved in projected outturn Still to be achieved Health and Community Care Reduce care home placements in line with budget saving (0.700) (0.300) (0.200) (0.100) Reduce CAH capacity/delay recruitment/in- house efficiencies (0.850) (0.850) (0.802) (0.048) Community Wards - reduce supplementary staffing and review bed capacity (0.500) (0.400) (0.270) (0.130) MH and LD (North Ayrshire) Freeze adult community support approvals outwith transitions 0.000 0.000 0.000 0.000 Respite provision - ensure use of in-house capacity is maximised 0.000 0.000 0.000 0.000 HBCCC mitigation plan (0.075) (0.075) (0.075) 0.000 MH and LD (Lead Partnership) Ward staffing (adults/elderly inpatients) (0.300) (0.400) (0.241) (0.159) Psychiatry (use of agency) (0.312) (0.100) 0.000 (0.100) CEDS/CAMHS (0.202) (0.098) (0.098) 0.000 North Ayrshire share (38.6%) (0.314) (0.231) (0.131) (0.100) Children and Families Reduce children's external placements - early reduction from Brighter Pathways work (0.500) (0.500) (0.500) 0.000 Additional target re-residential placements (0.500) (0.500) (0.342) (0.158) Additional target re-residential placements (0.225) 0.000 0.000 0.000 Reduce investment in C&F social work via service redesign fund (0.300) (0.300) 0.000 (0.300) Cross Partnership Vacancy management and temporary posts (0.500) (0.500) (0.500) 0.000 Use of remaining reserve balance (0.357) (0.357) 0.000 (0.357) Review of earmarked reserves (0.216) (0.216) 0.000 (0.216) Target Target Achieved Outstanding (5.037) (4.229) (2.820) (1.409) Remaining projected overspend 4.415
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PUBLIC INFORMATION Bank and Agency Costs to Month 9 Appendix F 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) 4865 (Agency Locum Consultant) 4867 (Agency Locum Spec Registrar) TOTAL NORTH CORE SLT ADULT 8,393 8,393 WARD 1 WOODLANDS VIEW 53,739 315,258 368,996 WARD 2 WOODLANDS VIEW 32,403 294,962 327,365 ACH REDBURN REHAB WARD NRS 9,501 88,038 97,539 ACH DOUGLAS GRANT REHAB WD NRS 15,072 46,022 530 61,624 WARD 3 WOODLANDS VIEW NURSING 36,120 277,477 1,589 709 315,895 WARD 4 WOODLANDS VIEW NURSING 33,985 206,538 185 240,708 NEW CLONBEITH NURSING(JURA) 101,794 102,319 204,113 WVIEW THE GLEN ECT - 1,989 1,989 WVIEW WARD 10 ACUTE MH NRS 36,351 50,134 86,485 WVIEW WARD 8 ACUTE MH NRS 30,170 597,190 251 627,611 WARD 5 WOODLANDS VIEW 19,514 21,305 40,820 WVIEW WARD 7B REHAB MH NRS 4,901 4,901 NEW DUNURE NURSING(CLONBEITH) 33,599 135,886 169,485 MH BED MANAGEMENT 3,708 - 3,708 TRINDLEMOSS 56,989 165,120 222,109 ARRAN HOSPITAL NURSING 23,288 22,467 13,091 58,847 CAMHS MANAGEMENT 1,943 - 1,943 CAMHS UNSCHEDULED CARE 7,054 - 7,054 EARLY YRS-C/F TEAM 2 290 - 290 IMMUNISATION NURSING 61,852 44,371 106,223 ARRAN HV 506 161 667 PACKAGE OF CARE (P) - CY - 22,276 22,276 PACKAGE OF CARE (P) - AMG - 65,850 65,850 PACKAGE OF CARE (P) - LMO - 6,496 6,496 ARRAN DN 1,401 1,401 NC POC TEAM 2 - 1,810 1,810 NC POC TEAM 3 - 2,811 2,811 THREE TOWNS DN 15,228 15,228 IRVINE DN 21,370 21,370 NORTH WEST COAST DN 6,682 99 6,781 GARNOCK VALLEY DN 85,503 85,503 NORTH DN TEAM LEADERS 4,286 4,286 LADY MARGARET NURSING 12,088 6,232 18,320 PREVENTION + SERVICES SPT TEAM 1,481 1,481 MH UNPACS (PRIVATE) - - LD HEALTH CHECKS 106,000 106,000 NORTH CLDT - 429 429 LDS MANAGEMENT 4,110 4,110 NORTH PARTNERSHIP ADMIN MH - 13 13 MHS INPATIENT MGT 22,360 22,360 WVIEW WARD 7C FORENSIC REHAB N 11,082 92,846 103,928 DAY ACTIVITIES TEAM 227 227 INTENSIVE COMMUNITY NURSING TEAM 29,942 29,942 ADULT MENTAL HEALTH LIASION TEAM 2,554 2,554 PCMHT NORTH 3,802 3,802 WVIEW WARD 6 LOW SECURE NRS 62,364 185,855 248,219 WARRIX AVE 16,806 28,035 44,841 ACTION 15 - ADULT LIAISON 18,978 18,978 NORTH CORE SLT PAEDS 1,483 1,483 FORENSIC PSYCHOLOGY 2,062 2,062 ICFN - COMMUNITY PHLEBOTOMY - 8,091 8,091 WVIEW WARD 7A LD A+T NRS 18,171 655,201 3,914 11,233 688,518 WVIEW WARD 9 ACUTE MH NRS 32,823 156,772 189,595 WVIEW WARD 11 ACUTE MH NRS 56,054 197,322 257 253,633 ADULT EAST 65,142 65,142 ADULT SOUTH 77,102 110,907 188,009 1,098,156 3,809,077 19,299 12,635 142,244 110,907 5,192,318 2) SOCIAL CARE Month 9 Agency Cost Montrose House 475,849 Children Acm - Irvine 1,188 Mh Acm 111,256 Ld Acm 32,103 TOTAL 620,396 Bank Agency