Agenda Document Pack - Integration Joint Board - 06/02/2025
North Ayrshire Council · 6 February 2025
Back to Integration Joint Board — 6 February 2025 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 Meeting Thursday, 06 February 2025 at 10:00 Council Chambers, Cunninghame House, Irvine / Hybrid via Microsoft Teams Meeting Arrangements - Hybrid Meetings This meeting will be held on a predominantly physical basis but with provision, by prior notification, for remote attendance by Elected Members in accordance with the provisions of the Local Government (Scotland) Act 2003. Where possible, the meeting will be live-streamed and available to view at https://north-ayrshire.public-i.tv/core/portal/home. 1 Apologies 2 Declarations of Interest Members are requested to give notice of any declarations of interest in respect of items of business on the Agenda. 3 Minutes The accuracy of the Minutes of the meeting held on 12 December 2024 will be confirmed and the Minutes signed in accordance with Paragraph 7 (1) of Schedule 7 of the Local Government (Scotland) Act 1973 (copy enclosed). 4 Director’s Report Submit report by Caroline Cameron, Director (NAHSCP) on developments within the North Ayrshire Health and Social Care Partnership (copy enclosed). 5 Fees and Charges 2025-26 - Social Care Services Submit report by Caroline Cameron, Director (NAHSCP) on the proposed charges for provided adult social care services for 2025/26 (copy enclosed). 6 2024-25 – Month 9 Financial Performance Submit report by Eleanor Currie, Interim Chief Finance Officer (HSCP) to provide an overview of the Integration Joint Board’s financial performance as at month 9 (December) (copy enclosed) 1
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7 Financial Regulations Submit report by Eleanor Currie, Interim Section 95 Officer (HSCP) on the updated partnership financial regulations (copy enclosed) 8 Transformation Plan Q3 Progress Update Submit report by Lee Ballantyne, Senior Manager (Strategic Planning and Transformation) on the Transformation Plan Q3 Progress Update (copy enclosed). 9 Urgent Items Any other items which the Chair considers to be urgent. Webcasting Please note: this meeting may be filmed/recorded/live-streamed to the Council's internet site and available to view at https://north-ayrshire.public- i.tv/core/portal/home, where it will be capable of repeated viewing. At the start of the meeting, the Provost/Chair will confirm if all or part of the meeting is being filmed/recorded/live-streamed. You should be aware that the Council is a Data Controller under the Data Protection Act 2018. Data collected during the webcast will be retained in accordance with the Council’s published policy, including, but not limited to, for the purpose of keeping historical records and making those records available via the Council’s internet site. Generally, the press and public will not be filmed. However, by entering the Council Chambers and using the press or public seating area, you acknowledge that you may be filmed and that any information pertaining to you contained in the video and oral recording of the meeting will be used for webcasting or training purposes and for the purpose of keeping historical records and making those records available to the public. In making this use of your information the Council is processing data which is necessary for the performance of a task carried out in the public interest. If you have any queries regarding this and, in particular, if you believe that use and/or storage of any particular information would cause, or be likely to cause, substantial damage or distress to any individual, please contact dataprotectionofficer@north-ayrshire.gov.uk 2
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IJB Sederunt Voting Members Margaret Johnson (Chair) North Ayrshire Council Joyce White (Vice-Chair) NHS Ayrshire & Arran Cllr Tom Marshall North Ayrshire Council Cllr Anthea Dickson North Ayrshire Council Cllr Nairn Angus-McDonald North Ayrshire Council Sharon Morrow NHS Ayrshire & Arran Tom Hopkins NHS Ayrshire & Arran Marc Mazzucco NHS Ayrshire & Arran Professional Advisors Caroline Cameron Director Paul Doak Head of Service/Section 95 Officer Aileen Craig IJB Monitoring Officer Iain Jamieson Clinical Director Scott Hunter Chief Social Work Officer – North Ayrshire Thelma Bowers Mental Health Adviser Darren Fullarton Associate Nurse Director/ Lead Nurse Vacany Acute Services Representative Dr Louise Wilson GP Representative Sharon Hackney Lead Allied Health Professional Lynne McNiven Public Health Representative Wendy Van Riet Director of Psychological Services Stakeholder Representatives Lorna Sim Staff Rep - NHS Ayrshire and Arran Lynda MacFarlane Staff Rep Vacancy Carers Representative Clive Shephard Service User Representative Vacancy Independent Sector Representative Vicki Yuill Third SectorRepresentative 3
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North Ayrshire Health and Social Care Partnership Minute of Integration Joint Board meeting held on Thursday 12 December 2024 at 10.00 a.m. involving participation by remote electronic means and physical attendance within the Council Chambers, Irvine. Present (Physical Participation) Voting Members Joyce White, NHS Ayrshire and Arran (Vice-Chair) Councillor Nairn Angus- McDonald, North Ayrshire Council Councillor Anthea Dickson, North Ayrshire Council Councillor Tom Marshall, North Ayrshire Council Tom Hopkins, NHS Ayrshire and Arran Professional Advisers Caroline Cameron, Director of Health and Social Care Partnership Darren Fullarton, Associate Nurse Director/ Lead Nurse Sharon Hackney, Lead Allied Health Professional Paul Doak, Section 95 Officer Stakeholder Representative Linda McFarlane, Staff Representative Loretta Galloway, Unity Enterprise Vicky Yuill, Third Sector Representative Present (Remote Participation) Voting Members Marc Mazzucco, NHS Ayrshire and Arran Professional Advisers Lynne McNiven, Public Health Representative Stakeholder Representative Lorna Sim, Staff Representative NHS Ayrshire and Arran In Attendance (Physical Participation) Elizabeth Stewart, Head of Service (Children, Families and Justice) Kerry Logan, Head of Service (Health and Community Care) Eleanor Currie, Principal Manager, (Finance) Michelle Sutherland, Partnership Facilitator (Health & Community Care) Kimberley Mroz, SDS Policy Review Manager (HSCP) Michael McLennan, Lead Officer (Alcohol & Drugs Partnership) (Mental Health) Fraser Bedwell, Unity Enterprise Raymond Lynch, Senior Manager, (Legal Services) Hayley Young, Senior Committee Services Officer Claudia Cheung, Digital, Media and Marketing Analyst Agenda Item 3 5
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In Attendance (Remote Participation) Karen Andrews, Team Manager (Governance) Apologies Councillor Margaret Johnson, North Ayrshire Council (Chair) Jean Ford, NHS Ayrshire and Arran Iain Jamieson, Clinical Director Aileen Craig, IJB Monitoring Officer 1. Apologies for Absence Apologies for Absence were noted. 2. Declarations of Interest There were no declarations of interest in terms of Standing Order 7.2 and Section 5.14 of the Code of Conduct for Members of Devolved Public Bodies. 3. Minutes The accuracy of the Minutes of the meeting held on 14 November 2024 were confirmed and the Minutes signed in accordance with Paragraph 7(10 of Schedule 7 of the Local Government (Scotland) Act 1973. 4. Director’s Report Submitted report by Caroline Cameron, Director (NAHSCP) on the developments within the North Ayrshire Health and Social Care Partnership. Officers responded to members’ questions on various aspects of the report. Noted. 5. Appointment of Interim Section 95 Officer Submitted report by Caroline Cameron, Director (NAHSCP) on the appointment of an Interim Section 95 Officer to North Ayrshire Integration Joint Board Officers responded to members’ questions on various aspects of the report. The Board agreed pending the appointment of a new Head of Service - Finance and Transformation for the HSCP; that Eleanor Currie be appointed as Interim Section 95 Officer of the Integration Joint Board (IJB). 6. Unpaid Carers Service Development in North Ayrshire Submitted report by Scott Hunter, Chief Social Work Officer (NAHSCP) on the progress to expand and improve support for unpaid carers in North Ayrshire. The report demonstrated the range of activities being taken forward as a strategic partnership with Carers Gateway North Ayrshire and the progress from our joint priorities for young and adult carers. The work confirmed the continued importance of 6
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and commitment to identifying, informing, involving and supporting carers to sustain caring roles and offer opportunities alongside caring whilst embracing them as equal care partners. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) note the developments and impact for improved carer information and support services; and (b) endorse the priorities for 2025. 7. External Residential Rehabilitation (Alcohol & Drugs) Submitted report by Michael McLennan, ADP Lead Officer on the ongoing work to further develop pathways of support which enable people to access Residential Rehabilitation. A letter from the Minister for Drugs and Alcohol Policy was set out at Appendix 1 and recent communication from the Scottish Government with details of an ‘Additional Placement Fund for Residential Rehabilitation’ once local ADPs have exhausted their local funding was set out at Appendix 2 to the report. Officers responded to members’ questions on various aspects of the report. Noted. 8. 2024-25 Month 7 Financial Performance Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the Integration Joint Board’s financial performance as at month 7 (October). Appendix A to the report detailed the financial overview of the Partnership position, while Appendix B provided an overview of those service changed which did not have financial savings attached. Appendix C highlighted the movement in the budget position following the initial approved budget. Officers responded to members’ questions on various aspects of the report. The Board agreed to (a) note the overall integrated financial performance report for the financial year 2024-25 and the current overall projected year end overspend of £6.190m, reduced to £3.613m through already identified financial recovery actions; (b) the progress with delivery of agreed savings; (c) approve the actions being taken to progress financial recovery and a further recovery plan to be presented to the next meeting of the IJB; (d) notes the remaining financial risks for 2024-25; and (e) approve the budget reductions set out at section 2.10 of the report. Furthermore, request the Chief Officer writes to North Ayrshire Council and NHS Ayrshire and Arran highlighting the current projected financial outturn for 2024/2025 and to request that in line with the Integration Scheme that funding partners consider the allocation of additional in-year funding. 9. Medium Term Financial Outlook 2025-2028 Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the Medium-term financial outlook 2025-2028 and the work on the preparation of the detailed budget for 2025-26. A range of possible scenarios for the financial position in each year were considered based on the information currently available that helped to identify the financial challenges and enabling the IJB to see the impact of current and future decisions on its medium-term financial health. Officers responded to members’ questions on various aspects of the report. Noted. 7
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10. Financial Inclusion Review Submitted report by Paul Doak, Head of Service (HSCP Finance and Transformation) on the current delivery model for Financial Inclusion Services with the current and proposed staffing structure set out at Appendix 1 to the report Officers responded to members’ questions on various aspects of the report. Councillor Angus-McDonald left the meeting at this point. The Board agreed to approve the proposed changes to the Financial Inclusion Service, noting the impact of (i) priority of access for the most vulnerable to the service with meaningful signposting for others; (ii) re-launch of an integrated team as Money Smart as a welfare rights and debt advice service in May 2025; (iii) workforce implications requiring formal consultation; (iv) impact on financial gains for citizens; (v) estimated full year equivalent savings of £390k; and (vi) continuing to deliver on the project work in line with funding commitments. 11. Whistleblowing Report Quarter 2, 1 July – 30 September 2024 Submitted report by Karen Callaghan, Corporate Governance Co-ordinator, in relation to whistleblowing concerns raised in Quarter 2 (1 July – 30 September 2024). Officers responded to members’ questions on various aspects of the report. The Director (NAHSCP) undertook to raise an action on HR processes as part of the Whistleblowing arrangements in place for NHS and the Council. Noted. 12. Strategic Planning Group Meeting Minutes Submitted, for information the minutes in relation to the Strategic Planning Group Meeting on 17 September 2024. Noted. The meeting ended at 12:05pm. The full meeting proceedings can be viewed at https://north-ayrshire.public-i.tv/core/portal/home 8
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Integration Joint Board 6th February 2025 Subject : Director’s Report Purpose : This report is for awareness to advise members of North Ayrshire Integration Joint Board (IJB) of developments within North Ayrshire Health and Social Care Partnership (NAHSCP) Recommendation : IJB members are asked to note progress made to date. 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 IJB Integration Joint Board HSCP Health and Social Care Partnership 1. EXECUTIVE SUMMARY 1.1 This report informs members of the Integration Joint Board (IJB) of the work undertaken within North Ayrshire Health and Social Care Partnership (NAHSCP), nationally, locally and Ayrshire wide. 2. BACKGROUND 2.1 This report provides IJB with up to date information on recent activity across the HSCP since the last IJB. The report will also provide COVID related information by exception. 3. CURRENT POSITION National Developments 3.1 Barron Review – Progress Update Report Agenda Item 4 9
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In March 2019, the Minister for Mental Health commissioned an Independent Review into the delivery of Forensic Mental Health Services (“Barron review”) chaired by Derek Barron, Director of Care at Erskine. The final report was published February 2021 and made 67 recommendations under 6 separate themes to improve the quality and delivery of Forensic Mental Health Services. The Scottish Government published their response in October 2021, committing to a collaborative and inclusive approach to inform future reforms and to working with partners to take forward recommendations. Scottish Government announced the publication of the Scottish Government Progress Update Report which was completed in December 2024. The report provides an update on the progress towards delivering the recommendations from the Barron Review thus far and associated work that has taken place across Scottish Government. The report illustrates the commitment of the Scottish Government to addressing the issues raised by the Barron Review and should be read in conjunction with the final report of the Barron Review and the Scottish Government response. The findings of the review continue to be considered nationally and locally and NAHSCP will continue to represent Ayrshire and Arran, including in recent considerations to establish a National Forensic Board and the bringing together of stakeholders to agree on a clear plan for addressing the strategic planning and governance of forensic mental health services. 3.2 New framework looks at progress of the Promise The Promise Progress Framework, created by The Promise Scotland, the Scottish Government and COSLA, brings together nearly 50 different streams of national data in one place to examine how Scotland is doing towards keeping the Promise made to care experienced children and young people. It provides the structure to be able to answer the following three questions, which together will tell the Promise Story of Progress: • How is Scotland doing in its progress towards keeping the Promise? • How are organisations doing in their work to keep the Promise? • Does the care community feel the impact of the Promise being kept? This is the first time that this data has been brought together in such a way, and will allow any individual or organisation to use it in a way that works for them - or to highlight where more work and evidence is needed. 10
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It is a way to better understand the national picture, by seeing all data in one place. This can give users a way to contextualise their own data, and can be used by organisations for their own reporting or to see where more work is needed to ensure that the Promise can be kept. 3.3 Breathing Space NHS 24’s Breathing Space is a free and confidential phone and web chat service available to anyone in Scotland aged 16 and over experiencing low mood, depression, or anxiety. Delivered by NHS 24, the service is available in the evenings (6pm to 2am weekdays) and 24 hours at the weekend (Fri 6pm to Mon 6am) on 0800 83 85 87. The web chat service can be accessed from breathingspace.scot. Celebrated annually on 1st February, Breathing Space Day aims to remind everyone to make time for activities which improve mental wellbeing as well as promoting the service. 3.4 National Care Service In a statement to Parliament on 23rd January, the Minister for Social Care announced the Scottish Government’s intention to remove Part 1 of the National Care Service Bill, which includes the proposed creation of the National Care Service structure, including national and local NCS boards. This in effect would mean the removal of proposed legislative structural reform. In place of legal structural reform, on 23rd January Scottish Government announced their intention to proceed with a non-legislative National Care Service Advisory Board to provide oversight of social care in Scotland. Scottish Government intend to proceed with revised Parts 2 and 3 of the NCS Bill, relating to key social care reforms including a Right to Breaks for Carers, Integrated Health and Care Record and care home visitation rights. Details of the non-legislative NCS Advisory Board are still to be confirmed, however Scottish Government issued a fact sheet on 23rd January which outlines the intent, they have been clear they want to focus on whole system accountability, financial transparency and the voice of lived experience. Areas for further work included in the budget correspondence from the Cabinet Secretary in December include Performance and Delivery – Rights, Equalities and Participation – Strategy, Standards and Quality – Fair Work and Ethical Commissioning – Culture, Governance and Finance – National Programmes. Scottish Ministers have indicated a desire for the NCS Advisory Board to be operational by March 2025. 11
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North Ayrshire Developments 3.5 Staff Response to Storm Eowyn As you will be aware, Storm Eowyn caused widespread damage to businesses and homes across the region, with challenging conditions continuing throughout Saturday and Sunday due to road blockages, flooding, debris, power outages and public transport issues. My thanks go to each and every staff member of NAHSCP and our providers for their efforts during Storm Eowyn and its aftermath. This proved to be the worst storm to hit North Ayrshire in almost two decades, with challenging conditions continuing throughout the weekend due to road blockages, storm debris, power outages and public transport issues. The storm caused widespread damage to businesses and homes across the region and resulted in significant disruption to our services, many of which were cancelled to ensure the safety of our staff and service users. A special thank you went to our frontline health and care staff, who went above and beyond in extremely difficult conditions to ensure the safety and wellbeing of some of our most vulnerable residents. Their commitment to ensuring that essential care services could continue was second to none, and your efforts are very much appreciated. Staff also worked tirelessly behind the scenes to provide the admin and managerial support that ensured essential services could run as smoothly as possible in the circumstances, communicating with service users about disruptions to their care, and checking in regularly with frontline staff to ensure their safety while carrying out their duties. 3.6 Young Carers Covenant North Ayrshire Council and Carers Gateway North Ayrshire have signed up to a new UK-wide commitment aimed at improving the lives of young carers and young adult carers, with NAC leading the way by being the first local authority in Scotland to sign up for this important initiative. The Young Carers Covenant was launched the by Carers Trust and the Young Carers Alliance, setting out a series of outcomes for organisations to work towards to ensure the life chances of young carers are improved. By signing up to the Covenant, we have made the commitment to work towards ten key outcomes that will improve life chances for young carers, ensuring they are identified at the earliest opportunity, receive timely support, are able to thrive in 12
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education and employment, have time for themselves, and are able to maintain good physical health and wellbeing. 3.7 Woodland View Volunteers and Staff The 2024 Compassion to Action Volunteer Awards were held recently at Fullarton ConneXions in Irvine, acknowledging and honouring the great work of volunteers across NHS Ayrshire & Arran and the staff who support them. The winners this year included staff and volunteers from Woodland View in Irvine in the following categories: Behind the Scenes – Improving the Volunteer Experience: Katie Gilmour, Administrator QI Improvement Lead Award - Improving Patient Experience: Joyce Wilson and Martyn Byers A total of 24 volunteers currently assist within Woodland View, all of whom provide a fantastic service. Previous successes at the Compassion to Action Awards for Woodland View have included: 2022: Lesley Bramwell, Business Administration Manager: Manager of the Year. 2022: Mary Hunter, Medical Records Officer: Outstanding Staff Champion 2023: Woodland View Welcomers: Team of the Year. The image shows Tracy McCrum, Senior Administration Manager, and Lesley Bramwell, Business Administration Manager, receiving the Behind the Scenes Award on behalf of Katie Gilmour. A huge thank you goes out to each and every one of our volunteers for your invaluable commitment, as well as to the administration staff for their support to the Volunteer Programme. 3.8 Dads Rock Support for dads has received a boost after the expansion of a successful venture between North Ayrshire Health and Social Care Partnership and Scottish charity Dads Rock. 13
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Originally launched in Autumn of 2023, the Dads Support Service, led by Dads Worker Ryan Warren, has been instrumental in empowering fathers and strengthening families throughout the Three Towns area. Through funding secured from the Scottish Government’s Whole Family Wellbeing Fund, the service has recently welcomed an additional Dads Worker, with support now being rolled out to dads in Irvine and Kilwinning. The service works with dads from a wide range of backgrounds who have been referred by their health visitor, family nurse, midwife or perinatal wellbeing team, providing one-to-one support that impacts on the whole family and improves outcomes for children, whether that be parenting advice, confidence building or support with general wellbeing. Peer support is available via WhatsApp, with fun days out held on a regular basis for dads and their children to come along to. Work is also under way looking at antenatal education provision for dads-to-be. In its first year, the service connected with over 60 families in the Three Towns area, with over 180 personalised support sessions, 36 group sessions and five family events taking place. And as well as working with dads who have been referred to the service, a weekly Dads Group that any dad and their baby or child can attend is held in the Ardeer Neighbourhood Centre on Wednesdays from 6.30pm, with a new group also launching on Sunday 16 February at Lanfine Community Centre in Irvine on Sundays from 10.30am. if you’d like to attend either of these groups, you can sign up online at dadsrock.beaconforms.com/form/2805e263 3.9 Peace of Mind Peace of Mind is an innovative programme aimed at reducing social exclusion and isolation as a result of a disability, impairment or long-term health condition, with a particular emphasis on people who do not receive statutory services but still need support. Run by social enterprise Peace of Mind Services, the programme has been successfully operating in Fife for the past three years and is now available in North Ayrshire thanks to funding from the National Lottery. Core to the Peace of Mind principle is the ability of individuals to exercise choice and control over how, where and when they are supported to achieve their social outcomes, recognising that engaging and taking part in community-based activities is key to health and well-being. 14
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As such, the organisation offers tailored experiences for individuals and groups based on their interests and aspirations. This can include independent living skills such as managing money, preparing healthy meals, attending the gym, or a wide range of activities such as going to art galleries and museums. Referrals are currently being accepted to the program, and you can register your interest or the details of someone you support via the website. Visit the Peace of Mind website to find out more about the programme, or contact Jim Withers by emailing jim@peaceofmind.scot or calling 07824 727 694. 3.10 Child Poverty – Ministerial Visit Shirley-Anne Somerville, Cabinet Secretary for Social Justice, visited Irvine Royal Academy on 22 January to speak to staff from Council services that work hard to help make life better for families and highlight the work being done in North Ayrshire to tackle poverty. She met with Headteacher Linzie Sloan and members of her leadership team to hear about the impactful work that is being carried out at the school to ensure financial constraints are not a barrier to children thriving. The cost of the school day is made affordable for families through projects including the Royal Resources Shop - a community shop offering free uniforms and food - and the free badge service, which sees school badges being pressed onto pre-loved uniforms. Welfare Rights Officers, who work within the North Ayrshire Health and Social Care Partnership’s Money Matters team, also explained how they ensure parents are accessing welfare benefits they are entitled to. 3.11 Grant funding applications open for projects that reduce drug and alcohol-related harms North Ayrshire Alcohol and Drug Partnership is inviting applications for grants of up to £15k for projects that can reduce alcohol and drug-related harms in North Ayrshire. The grants will be awarded this year to projects in North Ayrshire that have a particular focus on: • recovery-based activities in the evenings and at weekends. • developing opportunities for people to take part in activities that could help to develop their skills, try something new, volunteer, or make connections with other people in the community. • proposals that focus on engaging with young people about alcohol and drugs, and challenging stigma in an innovative way. • the provision of community-based activities for children who may be impacted by substance use. 15
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Application criteria can be found on the NAHSCP website. For a copy of the application form and guidance notes, please contact adp@north-ayrshire.gov.uk. 3.12 Joint Inspection of Adult Support and Protection – Self Evaluation North Ayrshire Adult Protection Committee have formally been offered a place to participate in Workstream 4 of the Adult Support and Protection Self Evaluation which will focus on support, early intervention, prevention and trauma informed practice. The work will be undertaken in conjunction with Care Inspectorate, Health Improvement Scotland (HIS) and HMICS and will the aimed at jointly undertaking self- evaluation and will focus on escalation of risk management, early intention and prevention, early multi-agency discussions, and trauma informed approaches. Introductory meetings have taken place on how to progress a joint approach to this exercise. IJB members will be updated on progress as the self-evaluation progresses. 3.13 Collaborating to Reduce Health Inequalities (CHES) North Ayrshire is embarking on a new and innovative collaboration to improve health equity in partnership with Public Health Scotland and the Institute for Health Equity, led by Professor Sir Michael Marmot, at University College London. North Ayrshire has some of the lowest healthy life expectancies across Scotland, with significant health inequalities across our communities. North Ayrshire Council are partnering with the Integration Joint Board to be one of the 3 local authority areas in Scotland to take this work forward. The Collaboration for Heath Equity in Scotland (CHES) programme focuses on using the eight ‘Marmot principles’ to deliver better health outcomes through improving the conditions in which people are born, grow, live, work and age. The North Ayrshire CHES programme will officially launch on 25th February and the IJB will be included and kept informed of progress. 4. IMPLICATIONS 4.1 Financial None. 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk None. 16
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4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION 5.1 No specific consultation was required for this report. User and public involvement is key for the partnership and all significant proposals will be subject to an appropriate level of Consultation. Caroline Cameron, Director [Carolinecameron@north-ayrshire.gov.uk/01294 317723] Appendices Nil 17
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Integration Joint Board 6th February 2025 Subject : Fees and Charges 2025-26 - Social Care Services Purpose : To outline the proposed charges for provided adult social care services for 2025/26 which will form part of the annual review of the Charging Policy and will inform the IJB budget setting process for 2025/26. Recommendation : To approve the proposed charges and remit this to a meeting of North Ayrshire Council for formal ratification. Direction Required to Council, Health Board or Both (where Directions are required please complete Directions Template) Direction to :- 1. No Direction Required 2. North Ayrshire Council X 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 1. EXECUTIVE SUMMARY 1.1 Charging and contributing for social care services in North Ayrshire is aligned with the annual update of COSLA National Strategy and Guidance for Charging Applying to Non-Residential Care Services and the Charging for Residential Accommodation Guidance (CRAG). The National Guidance is intended to assist Local Authorities and Integration Authorities to determine whether to charge a person for social care support, and in calculating how much - which is usually done through a financial assessment process. 1.2 This report details proposed charges for social care services for 2025/26, which will be reflected in the Integration Joint Board’s Revenue Budget and seeks IJB approval to submit these proposals to North Ayrshire Council to approve these charges as part of their 2025/26 budget setting. The schedule in Appendix 1 sets out the current charges, proposed 2025/26 charges and indicative charges for the following two years. The revised charges are estimated to increase income by £547k in 2025/26, this will partly offset increased costs, a shortfall in current income collection and support the overall revenue budget position. Agenda Item 5 19
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1.3 The proposed charges for 2025/26 are informed by a review of current charges, benchmarking with other areas and with consideration of the costs of delivering services. The outcome of this being an individual charge uplift basis rather than a general inflationary increase to charges across social care services, this also includes the introduction of new charges for services. The proposals have been shared and discussed at the IJB Finance Working Group. 1.4 The approved charges will be included in the annual review of the Charging Policy which will be published on the NAHSCP website, service users directly impacted will also be communicated with in advance of the new financial year. 2. BACKGROUND 2.1 North Ayrshire Health and Social Care Partnership (NAHSCP) support adults to ensure they are able to live as well and independently as possible. To help the Partnership provide services which meet people’s identified outcomes, we may charge a contribution to the cost of the care. 2.2 The charging policy is reviewed annually and any revisions to charges and financial assessment rules are approved by North Ayrshire Council as part of the annual budget setting process. The legal basis for setting charges remains with the Local Authority, however Integration Authorities can agree charges as part of financial planning and budget setting processes. 2.3 What services do we charge for? • Administration of Blue Badge scheme • Community support (non-personal care only) • Day care • Meals at home • Telecare (includes community alarm, which is a chargeable service) • Respite care (when required for your care needs rather than to give your carer a break from caring duties) • Residential Care – including Montrose House What services do we not charge for? • Care management. • Children’s care and support. • Criminal justice social work. • Information and advice. • Needs assessment. • Respite care (when part of a carer’s assessment) • Personal care for all adults and children 20
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2.4 Contribution to services is determined on an individual basis by completion of a financial assessment form. This will take account of income, savings and other capital to work out how much each service user can afford to pay toward the cost of the services provided. Part of this assessment process will ensure that income is maximised and all appropriate benefits are being received. In North Ayrshire services users are supported by Money Matters to ensure benefits are maximised alongside their financial assessment for charges. Charges apply whether services delivered by the Health and Social Care Partnership directly, a provider or via a Direct Payment. 2.5 The Charging Policy is based on the following principles: • You will only be charged for the hours of care and support that you receive. • You will not be charged more than it costs to provide the service for which your charge has been assessed. • Where the charge is subject to a financial assessment, this will be based on your ability to pay, following an income maximisation assessment. • You will know how and why you are being charged. You will be treated in a fair, transparent and equitable manner. 2.6 The current charges have been benchmarked and compared to the cost of providing the service and with charges in place in other areas across Scotland. A standard increase across all charges is not being recommended for 2025/26 and instead increases will be informed by the benchmarking exercise and cost of service review, this has been shared through the Finance Working Group. 21
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2.7 The below from Public Health Scotland illustrates the current framework for social care charging in Scotland: 22
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3. PROPOSALS Maximum Weekly Charge 3.1 The 2024/25 maximum charge is £106.26 and it is proposed to increase this to £120. This will bring the maximum weekly charge in line with the other Ayrshire authorities. There are only 6 people being charged the maximum weekly charge in 2024/25. 3.2 Community Alarms- Charges for community alarms are based on a flat rate weekly charge rather than being means tested per the charging policy. 3.2.1 Revised charge for the digital community alarm service – the community alarm service is in the process of transitioning from an analogue to digital service. The digital service has additional recurring costs and this charge is being updated to fund this. Any additional income will be reinvested in the community alarm service to cover the additional costs of the digital community alarm service. 3.2.2 Introduction of a charge for a second community alarm in a household – at present we only charge for one community alarm irrespective of how many people in the house have an alarm. It is proposed to charge any second alarm in a household at 50% of the weekly charge for an alarm. 3.2.3 HRA Recharge – the 2024/25 budget included income from the HRA for the community alarms within sheltered housing. This recharge will be increased to reflect the introduction of the charge for the digital community alarm service. Any additional income will be reinvested in the community alarm service to cover the additional costs of the digital community alarm service. 3.2.4 Community Alarm – frequency of billing – It is proposed to change the frequency of billing from four weekly to quarterly in arrears to reduce the administrative burden of issuing accounts and dealing with queries. The proposed Community Alarm revised charges are set out in Appendix 1, for example the Community Alarm Service on the mainland for a 1st alarm connection will increase from £5.85 this year to £6.85 for 2025/26. 3.3 Day Care Charges for day care are means tested per the charging policy. 3.3.1 Day Care for Older People – it is proposed to increase the current day care charge of £16.49 by 20% each year from 2025/26 to 2027/28. The average cost of providing older people day care is £58.04 per day per person and it proposed to increase the contribution that day care attendees pay towards the cost of the service to reduce the gap between the cost of delivering the service and the contribution made to the service. 3.3.2 Day Care for People with Learning Disabilities – it is proposed to increase the current day care charge of £16.49 by 25% each year from 2025/26 to 2027/28. The 23
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average cost of providing learning disability day care is £100.49 per day per person and it proposed to increase the contribution that day care attendees pay towards the cost of the service to reduce the gap between the cost of delivering the service and the contribution made to the service. 3.3.3 Dirrans Centre – introduction of a new charge – at present services at the Dirrans Centre don’t incur a charge and it is proposed to introduce a charge equivalent to the rate paid for older people day care. The current cost of providing this service is £144.70 per day. 3.4 Financial Intervention Services – Introduction of a new charge. The Adults with Incapacity (Scotland) Act 2000 (AWI) was introduced to protect individuals with incapacity and provide support for their families and carers in managing and safeguarding the individuals’ welfare and finances. The financial intervention team has grown in recent years from one Financial Intervention Officer (FIO) to 3 FIOs, an assistant FIO and admin support due to the increased demand for the service. They cover all aspects of financial management including budget management, payment of utilities, rent, council tax, insurance as well as day to living expenses. It is proposed to charge £3.50 per week for care home-based services users and £5.50 per week for community-based service users. This will be a flat rate charge. For new cases, no charge will be made for the first 12 weeks from commencement of Appointeeship. This will allow a sufficient period of time to identify and budget income and expenditure on behalf of the individual. A waiver of charges (on an individual basis) will be applicable for those with limited funds where their annual budget does not cover the charge. This is particularly in relation to care home residents with no capital whose income is subject to an assessed charge and personal allowance. 3.5 Housing Support / Non-personal care – this is currently charged at £18.47 per hour and it is proposed to increase this to £23.08 (25%/£4.61 per hour increase), this rate is to align with the rate we pay to providers for the services. This charge is means tested per the Charging Policy and only applies to non-personal care aspects of an individual’s assessment. 3.6 Meals at home – a 5% increase is proposed for this service. This is a flat rate charge per the charging policy. Any additional income will be reinvested in the meals at home budget to reduce the current deficit that the service operates under. 3.7 Montrose House and Trindlemoss House – it is proposed to increase the weekly charge by the same percentage increase applied to the National Care Home Contract (NCHC). This is estimated as 6.3% pending confirmation of the 2025/26 NCHC rate. This charge is determined by an individual assessment and in line with separate guidance for Charging for Residential Accommodation Guidance (CRAG). 3.8 The HSCP publish annually a Social Care Charging Policy, 2024/25 version of this - Social Care Charging Policy - Non-residential and residential care services. The policy for 2025/26 will be updated in line with the approved charges and will reflect any updates from the COSLA guidance. The charging process can be complex for 24
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families and individuals, particularly when accessing different services and types of support, therefore there is a requirement to clearly set out our policy, this includes sharing worked examples of how financial assessments are calculated. 3.9 Anticipated Outcomes The charges proposed represent a fair and equitable approach which aligns with national policy and recognises the significant financial pressures for social care services and for some services will reduce the gap between the cost of providing the service and the contribution made by the service user. 3.10 Measuring Impact Charging income will be monitored as part of the 2025/26 budget monitoring reports presented to the IJB. 4. IMPLICATIONS 4.1 Financial The estimated financial impact is per below. The projected additional income of £186k will be incorporated into the financial plans for the IJB for 2025/26. Projected Additional Income (gross) £547,000 Less amounts to be reinvested to meet the additional cost of delivering the Community Alarm digital service (£161,000) Less the current under recovery of income (£200,000) Projected Additional Income (net) £186,000 4.2 Human Resources None 4.3 Legal None 4.4 Equality/Socio-Economic An EQUIA has been completed, this recognises that charges will continue to be applied on an individual basis by the completion of a financial assessment form, that the policy is applied equally to all adult service users and will not impact on the level of care provided. Although increased charges may impact on the ability to pay, the policy maintains mitigations around the ability to pay, ensuring continuing to ensure income is maximised including benefits. The introduction of a charge for financial intervention services could not be consulted on as the service users can lack capacity. The proposal was instead referred to the Chief Social Work Officer for consideration on their behalf and there is support for the proposal to introduce a charge. 25
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4.5 Risk 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. 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 2025/26. This report will contribute to reducing this risk by identifying additional income which will contribute overall to service sustainability. 5. CONSULTATION 5.1 The IJB Finance Working Group have considered the policy and approach for charging next year at two workshops. The proposals have been shared with North Ayrshire Council finance colleagues to ensure these are considered as part of the budget setting process for North Ayrshire Council. Following formal approval individual communications outlining the changes to charges will be sent to the following groups of service users: • Digital community alarm services – increased charge • Second community alarms in a household – new charge • Dirrans Centre – new charge • Older People Day Care – increased charge • LD Day Care – increased charge This communication will outline the approved charges for 2025/26. The actual contribution to services that each person will make is determined on an individual basis by completion of a financial assessment form. This will take account of income, savings and other capital to work out how much each service user can afford to pay toward the cost of the services provided. These assessments will take place from March 2025 onwards and service users will be provided with information on how to contact services if there are any concerns. Caroline Cameron, Director Author - Eleanor Currie, Principal Manager Finance eleanorcurrie@north-ayrshire.gov.uk Appendix 1 – NAHSCP Proposed Fees & Charges 26
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The figures highlighted in yellow are estimated pending the issuance of the Charging for Residential Accommodation Guidance (CRAG). This is usually issued by the Scottish Government in mid-February. North Ayrshire Health and Social Care Partnership Proposed Fees & Charges for 2025-26 to 2027-28 Ref Charge Description Current Approved Charge excluding VAT (2024/25) £ Proposed Charge (2025/26) Indicative Charge (2026/27) Indicative Charge (2027/28) 1 Maximum Weekly Non-Residential Charge £106.26 £120.00 £126.00 £132.30 2 Care at Home Adults £18.47 £23.08 £24.23 £25.44 3 Day Care - Older People (purchased and provided) £16.49 £19.79 £23.75 £28.50 4 Day Care - Learning Disability (purchased and provided) £16.49 £20.61 £25.76 £32.20 5 Day Care and Dirrans Centre (charges to Other Local Authorities) £267.42 £280.79 £294.83 £309.57 6 Community Alarms service - mainland (1st alarm in the household) £5.85 £6.85 £7.19 £7.55 7 Community Alarms service - mainland - weekly charge to HRA for sheltered housing properties £5.85 £6.85 £7.19 £7.55 8 Community Alarms service - Arran (1st alarm in the household) £2.86 £3.43 £3.60 £3.78 9 Community Alarms service - mainland (2nd alarm in the household) £0.00 £3.43 £3.60 £3.78 10 Community Alarms service - Arran (2nd alarm in the household) £0.00 £1.74 £1.83 £1.92 11 Meals on Wheels £3.70 £3.89 £4.08 £4.28 12 Care at Home Older People per hour £18.47 £23.08 £24.23 £25.44 13 Financial Intervention - Management of Service User Finances - residential service users £0.00 £3.50 £3.68 £3.86 14 Financial Intervention - Management of Service User Finances - community based service users £0.00 £5.50 £5.78 £6.07 15 Dirrans Centre £0.00 £19.79 £23.75 £28.50 16 Respite (for an individual's care need rather than to give the carer a break) Age 16-24 £76.52 £81.34 £85.41 £89.68 17 Respite (for an individual's care need rather than to give the carer a break) Age 25 - 64 £95.29 £101.29 £106.35 £111.67 18 Respite (for an individual's care need rather than to give the carer a break) Age 65+ £175.10 £186.13 £195.44 £205.21 19 Sleepover £14.50 £15.45 £16.22 £17.03 20 Trindlemoss House - permanent placement £1,190.70 £1,265.71 £1,329.00 £1,395.45 21 Montrose House - permanent residential placement (capital below £34,999)* £825.94 £877.97 £921.87 £967.96 22 Montrose House - permanent residential placement (capital above £35,000) £1,190.70 £1,265.71 £1,329.00 £1,395.45 23 Montrose House - permanent nursing placement (capital below £34,999)* £948.59 £1,008.35 £1,058.77 £1,111.71 24 Montrose House - permanent nursing placement (capital above £35,000) £1,378.13 £1,464.95 £1,538.20 £1,615.11 25 Sleepover £14.50 £15.45 £16.22 £17.03 26 Direct Payments - Personal Assistants £15.42 £16.94 £17.79 £18.68 27 Direct Payments - Agency Rates £18.47 £23.08 £24.23 £25.44 28 Direct Payments - Sleepovers £14.39 £15.83 £16.62 £17.45 29 Blue Badge (charge for a three year period) £20.00 £20.00 £20.00 £20.00 27
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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 Agenda Item 6 29
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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 30
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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. 31
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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 32
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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. 33
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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. 34
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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. 35
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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 36
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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 37
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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 38
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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). 39
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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. 40
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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. 41
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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. 42
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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 43
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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. 44
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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 45
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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. 46
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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 47
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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 48
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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 49
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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 50
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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 51
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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 52
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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 53
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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 54
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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 55
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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 56
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Integration Joint Board 6th February 2025 Subject : Financial Regulations Purpose : • To seek approval for the updated partnership financial regulations Recommendation : The IJB are asked to approve the financial regulations detailed in Appendix 1. Direction Required to Council, Health Board or Both (where Directions are required please complete Directions Template) 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 NAHSCP North Ayrshire Health and Social Care Partnership IJB Integration Joint Board 1. EXECUTIVE SUMMARY 1.1 This report sets out the outcome of a review of the Financial Regulations which detail the responsibilities of the IJB for its own financial affairs, and which also set out the respective responsibilities of the Chief Officer and the Chief Finance Officer of the IJB. 2. BACKGROUND 2.1 Both the Council and the Health Board operate under Financial Regulations/Standing Financial Instructions in the operational delivery of services. As this service delivery will continue to be carried out within the Council and the Health Board, all operational and transactional finance matters for delivery of partnership services will comply with Council Financial Regulations and Health Board Standing Financial Instructions as appropriate. 2.2 Under Scottish Government Regulations, for all IJBs in Scotland, the Chief Officer, supported by the Chief Finance Officer, must ensure that there are adequate systems and controls in place for the proper management of its financial affairs. 2.3 As these Financial Regulations relate specifically to the affairs of the IJB itself, they are therefore more limited and focussed in scope. Agenda Item 7 57
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3. PROPOSALS 3.1 This report recommends moving forward that the Financial Regulations are reviewed at least every three years and if changes are required that these are reported to the IJB for approval with PAC undertaking a scrutiny role if required. 3.2 Anticipated Outcomes The IJB’s Financial Regulations are an essential part of the corporate governance of the IJB. These require to be kept under review to ensure that there are adequate systems and controls in place for the proper management of the IJB’s affairs. 3.3 Measuring Impact Performance and Audit Committee will undertake a scrutiny role in relation to the Financial Regulations. 4. IMPLICATIONS 4.1 Financial None. 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk 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. 4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION 5.1 There was no consultation undertaken. 58
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Eleanor Currie, Interim Section 95 Officer eleanorcurrie@north-ayrshire.gov.uk Appendices • Appendix 1, North Ayrshire Integration Joint Board Financial Regulations 59
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Appendix 1 1 North Ayrshire Integration Joint Board Financial Regulations Version Date of Approval Review Date 1 February 2021 February 2024 2 February 2025 February 2028 60
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Appendix 1 2 PART A) SCOPE AND OBSERVANCE 1.1 Both the Health Board and the Council operate under Financial Regulations/Standing Financial Instructions in the operational delivery of services. As this service delivery will continue to be carried out within the Health Board and the Council, these Financial Regulations relate specifically to the affairs of the Integration Joint Board (IJB) itself and therefore are more limited and focussed in scope. All operational and transactional finance matters for delivery of North Ayrshire Health and Social Care Partnership (NAHSCP) will comply with North Ayrshire Council (NAC) Financial Regulations and NHS Ayrshire & Arran (NHSA&A) Standing Financial Instructions. 1.2 North Ayrshire Integration Joint Board is a legal entity in its own right created by Parliamentary Order, following Ministerial approval of the Integration Scheme. It is accountable for the stewardship of public funds and is expected to operate under public sector best practice governance arrangements, proportionate to its transactions and responsibilities. The IJB will direct the Council and the Health Board on how resources will be spent in line with the approved Strategic plan and allocate resources back to the Council and Health Board in accordance with this direction per the Statutory Guidance on Directions published in January 2020. The IJB retains responsibility for oversight and management of expenditure within the allocated budgets. 1.3 Stewardship is a function of management and, therefore, a responsibility placed upon the appointed members and officers of the Integration Joint Board, in particular: • Section 95 of the Local Government (Scotland) Act 1973 requires that every local authority shall make arrangements for the proper administration of their financial affairs and shall secure that the proper officer of the authority has responsibility for the administration of those affairs, including: o Approve the financial systems o Approve the duties of officers operating these systems o Maintain a written description of such approved financial systems including a list of specific duties 1.4 These financial regulations should be read in conjunction with the standing financial instructions of NHS Ayrshire and Arran Health Board and the Financial Regulations and Codes of Financial Practice of North Ayrshire Council. 1.5 The Regulations also set out the respective responsibilities of the Chief Officer and the Chief Finance Officer of the IJB. The Chief Officer and the Chief Finance Officer will follow these Regulations at all times in relation to the conduct of the IJB’s own financial affairs. All actions that affect the Integration Joint Board’s finances should only be carried out by properly authorised employees. The Chief Officer will establish a clear and effective framework of authorisation for the IJB. 61
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Appendix 1 3 2 The Integration Joint Board will appoint an officer responsible for its financial administration. 2.1 The Chief Officer may be appointed to this role if the Integration Joint Board deems it to be appropriate. If in such circumstances the Chief Officer does not hold a recognised professional accounting qualification arrangement must be put in place to provide the post holder and the Integration Joint Board with financial advice from a qualified person. 2.2 In appointing the Chief Financial Officer the Integration Joint Board has regard to CIPFA guidance on the ‘Role of the Chief Financial Officer in Local Government’. 2.3 The Integration Joint Board Chief Financial Officer and Chief Officer will discharge their duties in respect of the delegated resources by: • Establishing financial governance systems for the proper use of the delegated resources; and • Ensuring that the Strategic Plan meets the requirement for best value in the use of the Integration Joint Board’s resources. 2.4 The Chief Finance Officer (in consultation with the Chief Officer) will advise the IJB on the financial implications of the IJB’s activities. The Chief Finance Officer will ensure that budget holders receive impartial advice, guidance and support and appropriate information to enable them to effect control over expenditure and income 3 Responsibility of Health Board Accountable Officer; NHS Board Director of Finance & Council Section 95 Officer (Chief Financial Officer) - The Health Board Accountable officer and the Council’s Section 95 Officer discharge their responsibility - as it relates to the resources that are delegated to the Integration Joint Board - by setting out in the Integration Scheme the purpose for which resources are used and the systems and monitoring arrangements for financial performance management. It is their responsibility to ensure that the provisions of the Integration Scheme enable them to discharge their responsibilities in this respect. 3.1 The Health Board Director of Finance and the Chief Financial Officer (Section 95 Officer) of North Ayrshire Council will provide specific advice and professional support to the Chief Officer and Chief Financial Officer to support the production of the Strategic Plan and also to ensure that adequate systems of internal control are established by the Integration Joint Board. 62
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Appendix 1 4 4 Responsibility of Chief Officer 4.1 The Chief Officer is the accountable officer of the Integration Joint Board. The Chief Officer will discharge their duties in respect of the delegated resources by: • ensuring that the strategic plan meets the requirement for economy, efficiency and effectiveness in the use of the Integration Joint Board resources; and • giving directions to the NHS Ayrshire & Arran Health Board and North Ayrshire Council that are designed to ensure resources are spent in accordance with the plan; it is the responsibility of the Chief Officer to ensure that the provisions of the directions enable them to discharge their responsibilities in this respect within available resources. 5 Directions 5.1 The IJB will give directions to NAC and NHSA&A that are designed to ensure resources are spent in accordance with the Strategic Plan and Integration Scheme. Directions are the mechanism to action the strategic commissioning plans (Strategic Plan) as laid out in sections 26 to 28 of the Public Bodies (Joint Working) (Scotland) Act 2014. 6 Responsibility of Chief Officer and the Integration Joint Board Chief Financial Officer 6.1 It will be the duty of the Chief Officer assisted by the Integration Joint Board Chief Financial Officer to ensure that these Regulations are made known to the appropriate persons within the Integration Joint Board and to ensure that they are adhered to. 7 Breach of Regulations 7.1 Any breach of these regulations should be reported immediately to the Chief Financial Officer, who may then discuss the matter with the Chief Officer, NHS Board Chief Executive, Local Authority Chief Executive or another nominated or authorised person as appropriate to decide what action to take. 8 Review of Financial Regulations 8.1 These Regulations will be the subject of regular review (at least every three years) by the Integration Joint Board Chief Financial Officer in consultation with the NHS Board Director of Finance and the Council’s Section 95 Officer, and where necessary, subsequent adjustments will be submitted to the Integration Joint Board for approval. 63
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Appendix 1 5 8.2 NAC and NHS A&A will provide legal advice regarding these Financial Regulations as required in relation to the functions delegated to the IJB. PART B) FINANCIAL PLANNING AND REPORTING 9 Responsibility of Integration Joint Board 9.1 The IJB will continuously work to secure best value for money, and economy, efficiency and effectiveness in how the organisation directs its resources. 9.2 The Integration Scheme sets out the detail of the integration arrangement agreed between NHS Ayrshire and Arran and North Ayrshire Council. In relation to financial management it specifies: • The financial management arrangements including treatment of budget variances; • Reporting arrangements between the Integration Joint Board, NHS Ayrshire and Arran, and North Ayrshire Council • The method for determining the resources to be made available by NHS Ayrshire and Arran and North Ayrshire Council to the Integration Joint Board; and • The functions which are delegated to the Integration Joint Board by NHS Ayrshire and Arran and North Ayrshire Council. 10 Strategic Plan and Integrated Budget 10.1 The IJB will approve a Strategic Plan which sets out arrangements for planning and directing the functions delegated to it by NAC and NHSA&A. The Strategic Plan will normally cover a three-year period recognising that these may need to be indicative for years two and three. The IJB will publish its Strategic Plan by the March prior to each three-year period. 10.1.1 The Chief Officer and the Chief Finance Officer will develop the integrated budget based on the Strategic Plan and present it to the IJB for consideration and agreement as part of the annual budget setting process. 11 Budget Management 11.1 Budget holders within the Council and the Health Board will be accountable for all budgets within their control as directed by the IJB in line with its Strategic Plan. The IJB will ensure appropriate arrangements are in in place to support good financial management and planning. The Chief Finance Officer and relevant finance staff will use finance IT systems within both organisations to produce financial reports and forecasts in order to monitor the overall financial performance in relation to the approved Revenue Budgets. 64
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Appendix 1 6 11.2 The Chief Finance Officer will provide regular budget monitoring updates to the IJB along with explanations for any significant variations from budget and the action planned to deal with them. Budget monitoring reports will also be provided to the Council and the Health Board from an operational perspective, as required and/or requested. 12 Financial Planning 12.1 The IJB will develop an integrated budget which takes accounts of: • Activity Changes. The impact on resources in respect of increased demand (e.g. demographic pressures and increased prevalence of long-term conditions) and for other planned activity changes; • Cost inflation. Pay and supplies cost increases; • Efficiencies. All savings (including increased income opportunities and service rationalisations/cessations) should be agreed between the Integration Joint Board, North Ayrshire Council and NHS Ayrshire and Arran as part of the annual rolling financial planning process to ensure transparency; • Performance on outcomes. The potential impact of efficiencies on agreed outcomes must be clearly stated and open to challenge by the North Ayrshire Council and NHS Ayrshire and Arran • Legal requirements. Legislation may entail expenditure commitments that should be considered in adjusting the payment; • Transfers to/from the notional budget for hospital services set out in the Strategic Plan. • Adjustments to address equity. North Ayrshire Council and NHS Ayrshire and Arran may choose to adjust contributions to smooth the variation in weighted capita resource allocations across partnerships; information to support this will be provided by ISD and ASD. 12.2 The IJB will liaise and consult with the Council and Health Board as part of the budget setting process. It should be noted that Councils and Health Boards may be required to comply with IJB funding conditions as indicated by the Scottish Government. 13 Limits on Expenditure 13.1 No expenditure will be incurred by the Integration Joint Board unless it has been included within the approved Integration Budget and Strategic Plan, except: (i) Where additional funding has been approved by NHS Ayrshire and Arran Board and/or North Ayrshire Council and the integrated budget/strategic plan updated appropriately; (ii) Where a supplementary budget has been approved by the Integration Joint Board; (iii) In emergency situations in terms of any scheme of delegation; 65
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Appendix 1 7 (iv) Where a virement has been approved. 14 Preparing Procedures, Records and Accounts 14.1 All accounting procedures and records of the Integration Joint Board/Health and Social Care Partnership will be determined by the Integration Joint Board Chief Financial Officer. These will also be subject to discussion with the Chief Financial Officer of the NHS Board/Council. 14.2 Legislation provides that the Integration Joint Board is subject to the audit and accounts provision of a body under section 106 of the Local Government (Scotland) Act 1973. This requires audited annual accounts to be prepared with the reporting requirements specified in the relevant legislation and regulations - Section 12 of the Local Government in Scotland Act 2003 and regulations under section 105 of the Local Government (Scotland) Act 1973. These will be proportionate to the limited number of transactions of the Integration Joint Board whilst complying with the requirement for transparency and true and fair reporting in the public sector. 14.3 North Ayrshire Council and NHS Ayrshire and Arran will include additional disclosures in their statutory accounts which reflect their formal relationship with the Integration Joint Board. The Integration Joint Board Chief Financial Officer will liaise with nominated contacts within each organisation to ensure that appropriate information is exchanged within agreed timescales. 15 Presenting External Audit Reports 15.1 The Chief Finance Officer will ensure the presentation of all External Audit reports including reports on the audited Annual Accounts to the IJB or Performance and Audit Committee. These reports will be made available to the Health Board and Local Authority. 15.2 The Chief Finance Officer will make appropriate arrangements for the public inspection of the IJB’s Accounts. 16 Virement 16.1 Virement is defined by CIPFA as “the transfer of an underspend on one budget head to finance additional spending on another budget head, in accordance with the Financial Regulations”. In effect virement is the transfer of budget from one main budget heading (employee costs, supplies and services etc), to another, or a transfer of budget from one service to another. 16.2 Virements require approval and they will be permitted subject to any Scheme of Delegation of the Integration Joint Board as follows: 66
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Appendix 1 8 (i) Virement must not create additional overall budget liability. One off savings or additional income should not be used to support recurring expenditure or to create future commitments including full year effects of decisions made part way through a year. Where the virement involves the transfer of up to £100,000 between operational budget headings and will not affect the execution of existing Integration Joint Board policy, the transfer will be approved jointly by the Chief Financial Officer and Chief Officer. (ii) Where the amount is over £100,000 or where the transfer of any amount would affect the execution of existing Integration Joint Board policy, the prior approval of the Integration Joint Board will be required. (iii) The Chief Officer will not be permitted to vire between the Integrated Budget and those budgets managed by the Chief Officer, but which are outside of the scope of the strategic plan, unless agreed by those bodies. 17 Budgetary Control 17.1 It is the responsibility of the Chief Officer and Chief Financial Officer to report regularly and timeously on all budgetary control matters, comparing projected outturn with the approved financial plan to the Integration Joint Board and other bodies as designated by NHS Ayrshire and Arran Board and North Ayrshire Council. 17.2 The Director of Finance (NHS Ayrshire and Arran) and the Chief Financial Officer (section 95) of North Ayrshire Council will, along with the Integration Joint Board Chief Financial Officer put in place a system of budgetary control which will provide the Chief Officer with management accounting information for both arms of the operational budget and for the Integration Joint Board in aggregate. 17.3 It is the responsibility of the Integration Joint Board Chief Financial Officer, in consultation with the Director of Finance (NHS Ayrshire and Arran) and the Chief Financial Officer (section 95) of North Ayrshire Council, to agree a consistent basis and timetable for the preparation and reporting of management accounting information. 18 Variances 18.1 The Integration Scheme specifies how in year over/under spends will be treated. Where it appears that any heading of income or expenditure may vary significantly from that appearing in the Financial Plan, it will be the duty of the Chief Officer and Integration Joint Board Chief Financial Officer, in conjunction with the NHS Board Director of Finance and Section 95 Officer of the Council, to report in accordance with the appropriate method established for that purpose by the Integration Joint 67
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Appendix 1 9 Board, NHS Board and Council, the details of the variance and any remedial action required. 19 Reports to Integration Joint Board 19.1 All reports to the Integration Joint Board and sub-committees thereof must specifically identify the extent of any financial implications. These must have been discussed and agreed with the Integration Joint Board Chief Financial Officer prior to lodging of reports. 20. Legality of Expenditure 20.1 It will be the duty of the Chief Officer to ensure that no expenditure is incurred or included within the Strategic Financial Plan unless it is within the power of the Integration Joint Board. In cases of doubt the Chief Officer should consult the respective legal advisors of the NHS Board and Council before incurring expenditure. Expenditure on new service developments, initial contributions to other organisations and responses to new emergency situations which require expenditure, must be clarified as to legality prior to being incurred. PART C – INTERNAL AUDIT INTERNAL AUDIT 21 Responsibility for Internal Audit 21.1 The Integration Joint Board will establish adequate and proportionate internal audit arrangements for review of the adequacy of the arrangements for risk management, governance and control of the delegated resources. This will include determining who will provide the internal audit service for the Integration Joint Board and nominating a Chief Internal Auditor. 21.2 Internal Audit services will be provided by North Ayrshire Council. Such provision will be subject to agreement. 21.3 The operational delivery of internal audit services within NHS Ayrshire and Arran and North Ayrshire Council will be contained within their respective and established arrangements. 21.4 A Chief Internal Auditor will be appointed to act as Integration Joint Board Chief Internal Auditor in addition to their substantive post. 21.5 The Internal Audit Service will undertake its work in compliance with the Public Sector Internal Audit Standards. 68
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Appendix 1 10 21.6 On or before the start of each financial year the Integration Joint Board Chief Internal Auditor will prepare and submit a strategic risk-based audit plan to the Performance and Audit Committee for approval. It is recommended this is shared with the relevant committee of both NHS Ayrshire and Arran and North Ayrshire Council. 21.7 The Integration Joint Board Chief Internal Auditor will submit an annual audit report of the Internal Audit function to the Chief Officer and the Performance and Audit Committee indicating the extent of audit cover achieved and providing a summary of audit activity during the year. As a minimum the annual audit report and Chief Internal Auditor’s opinion will also be reported to the Audit Committees of the NHS Ayrshire & Arran Board and North Ayrshire Council. 22 Authority of Internal Audit 22.1 In relation to Internal Audit work being carried out the person appointed by the Integration Joint Board to carry out the Internal Audit or their authorised representatives will have authority, on production of identification, to: (i) Enter at all reasonable times and without notice any premises or land used or operated by the Integration Joint Board; (ii) Have access to, and remove, all records (both paper and electronic), documents and correspondence within the possession or control of any officer, relating to any financial or other transaction of the Integration Joint Board; (iii) Be provided with a separate log-in to any computer system used by the partners of the Integration Joint Board and have full access to any system, network, personal computer or other device including hardware owned by third party service providers; (iv) Require and receive such explanations as are necessary concerning any matter under examination; (v) Require any employee to produce cash, stores or any other assets under their control. PART D) OTHER AREAS 23 Capital Planning 23.1 The Chief Finance Officer annually, in consultation with the Council and NHS A&A, will prepare a Capital Plan to make best use of existing resources and identify the asset requirements to support the Strategic Plan and deliver on the IJB’s Property Strategy. 69
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Appendix 1 11 23.2 Business Cases will be prepared and submitted to Council’s Capital Planning Group or NHS A&A’s Capital Planning Group for approval. 23.3 The Chief Officer or nominated delegate will be a member of both partners’ Capital Planning Groups. 23.4 Where new capital investment is required to deliver the Strategic Plan both partners should consider the Capital Plan. 24 Control of Capital Expenditure 24.1 The IJB does not receive a capital funding allocation. Capital projects are funded by either NAC or NHS A&A and expenditure will be controlled in accordance with their financial regulations. 25 Reserves 25.1 Legislation, under Section 106 of the Local Government (Scotland) Act 1973 empowers the Integration Joint Board to hold reserves, which should be accounted for in the financial accounts and records of the Integration Joint Board. 25.2 As any underspend will be held by the Council on behalf of the Integration Joint Board on the balance sheet as creditor balances to be drawn down by the Integration Joint Board as planned. 25.3 The IJB will approve a Reserves Policy which outlines the statutory and regulatory framework for reserves and the operation of reserves. The purpose of a reserves policy is to: • outline the legislative and regulatory framework underpinning the creation, use or assessment of the adequacy of reserves; • identify the principles to be employed by the IJB in assessing the adequacy of the IJB’s reserves; • indicate how frequently the adequacy of the IJB’s balances and reserves will be reviewed; and • set out arrangements relating to the creation, amendment and use of reserves and balances. 25.4 The Reserves Policy will normally cover a three-year period. The level of reserves will be considered as part of the budget setting process each year and be formally approved by the IJB. 26 VAT 26.1 HM Revenues and Customs have confirmed that there is no requirement for a separate VAT registration for the Integration Joint Board as it will not be delivering any services within the scope of VAT. This position will require to be kept under 70
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Appendix 1 12 review by the Integration Joint Board Chief Financial Officer should the operational activities of the Board change and a need to register be established. HMRC guidance will apply to Scotland which will allow a VAT neutral outcome. 27 Board Members’ Expenses 27.1 Payment of voting Board Members’ allowances will be the responsibility of the Members' individual Council or Health Board and will be made in accordance with their own Schemes. 27.2 Members are entitled to payment of travel and subsistence expenses relating to approved duties. Members are required to submit claims on the IJB's agreed expenses claim form and as far as practicable to provide receipts in support of any expenses claimed. 27.3 Non-voting members of the IJB will be entitled to payment of travel and other expenses, such as the cost of replacement care where they have caring responsibilities. Non-voting members are required to submit claims on the IJB's agreed expenses claim form and as far as practicable to provide receipts in support of any expenses claimed. The costs relating to expenses incurred by the non- voting members of the IJB will be shared equally by the Health Board and the Council. 28 Procurement / Commissioning of Services 28.1 Public Bodies (Joint Working) (Integration Joint Boards) (Scotland) Order 2014/285 provides that the Integration Joint Board may enter into a contract with any other person in relation to the provision to the integration joint board of goods and services for the purpose of carrying out the functions conferred on it by the Act. 28.2 As a result of specific VAT and accounting issues associated with the Integration Joint Board contracting directly for the provision of goods and services the Chief Officer is required to consult with the NHS Board Director of Finance, the Chief Financial Officer (section 95 officer) of the Council and the IJB Chief Financial Officer prior to any direct procurement exercise being undertaken, RISK MANAGEMENT AND INSURANCE 29 Responsibility for Insurance and Risk 29.1 The Integration Joint Board will make appropriate insurance arrangements for all activities of the Integration Joint Board in accordance with the risk management strategy. 71
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Appendix 1 13 29.2 The Chief Officer will arrange, taking such specialist advice as may be necessary, that adequate insurance cover is obtained for all normal insurable risks arising from the activities of the Integration Joint Board and for which it is the general custom to insure. This will include the provision of appropriate insurance in respect of Members of the Integration Joint Board acting in a decision-making capacity. 29.3 The NHS Board Director of Finance and the Chief Financial Officer (Section 95) of the Council will ensure that the Chief Officer has access to professional support and advice in respect of risk management. 30 Risk Strategy and Risk Register 30.1 The Chief Officer will be responsible for the Integration Joint Board’s risk strategy and profile and developing the risk reporting arrangements; this will include arrangements for a risk register. The Risk Management Strategy will be approved by the Integration Joint Board. 30.2 The NHS Ayrshire & Arran Board and North Ayrshire Council will continue to identify and manage within their own risk management arrangements risks they have retained under the integration arrangements. The Health Board and Council will continue to report risk management to the existing committees, including the impact of the integration arrangements. 31 Notification of Insurance Claims 31.1 The Chief Officer and the Integration Joint Board Chief Financial Officer will put in place appropriate procedures for the notification and handling of any insurance claims made against the Integration Joint Board. 32 ECONOMY, EFFICIENCY AND EFFECTIVENESS (BEST VALUE) 32.1 The Chief Officer will ensure that arrangements are in place to maintain control and clear public accountability over the public funds delegated to the Integration Joint Board. This will apply in respect of: • the resources delegated to the Integration Joint Board by the partner Local Authority and Health Board; and • the resources paid to the partner Local Authority and Health Board by the Integration Joint Board for use as directed and set out in the Strategic Plan. 32.2 The Integration Joint Board has a duty to put in place proper arrangements for securing Best Value in the use of resources and delivery of services. There will be a process of strategic planning which will have full Member involvement, in order to establish the systematic identification of priorities and realisation of Best Value in the delivery of services. It will be the responsibility of the Chief Officer to deliver the arrangements put in place to secure Best Value and to co-ordinate policy in regard to ensuring that the Joint Board provides Best Value. 72
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Appendix 1 14 32.3 The Chief Officer will be responsible for ensuring implementation of the strategic planning process. Best Value should cover the areas of human resource and physical resource management, commissioning of services, financial management and policy, performance and service delivery process reviews. 33 PARTNERSHIPS 33.1 The IJB will put in place appropriate governance arrangements to record all joint working arrangements entered into by the IJB. Date of Review: 21.01.25 73
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Integration Joint Board 6th February 2025 Subject : Transformation Plan Q3 Progress Update Purpose : This update is for awareness and to assure IJB of progress. Recommendation : The IJB should note the progress to date. 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 IJB Integrated Joint Board PID Project Initiation Document SDS Self Directed Support 1. EXECUTIVE SUMMARY 1.1 The North Ayrshire HSCP Transformation Plan 2024-27 is an ambitious programme of change consisting of a range of improvement and reform projects across all service areas, each aiming to improve the quality of our services and contribute to the long- term sustainability of health and care in North Ayrshire. This report highlights key activity and general updates on progress made in the six months since approval. Work is ongoing alongside budget planning for 2025-26 to align financial impacts to the transformation plan. T 2. BACKGROUND 2.1 The Transformation Plan was approved by IJB in March 2024. There are 77 change projects and programmes on the plan, from across every area of the partnership. 2.2 A six-month progress update was provided to IJB in September 2024, after which the Board requested ongoing reports, in a similar format, every quarter. 2.3 Through 2024-25 the financial outlook has deteriorated, and the need for transformation and the redesign of services has become more urgent and more important to the long-term sustainability of the services for which we are responsible. At the same time our capacity for change is diminishing due to increasing demands on people’s capacity including the short-term actions required to deliver the financial recovery plan. Agenda Item 8 75
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Key Activity 2.4 In September a new online Tracker was launched to provide ongoing real time monitoring of projects (Screenshot in Appendix I). The Tracker is linked to a dashboard to provide a visual representation (screenshot in Appendix II). 2.5 In October the Transformation Board was updated on the progress of the new Digital and Data Plan which consists of a Landscape Review and a Phase 1 Delivery Plan. The Landscape Review includes: an outward look across the sector, including national digital and data strategies; and inward look incorporating the staff digital experience survey, case studies, and local plans and strategies. The Delivery Plan, informed by the Landscape Review, aims to address immediate priorities and establish a solid foundation for longer term transformative improvements. Priorities for this plan include improving access and supporting the workforce to develop essential digital and data skills. An overview will be presented to the Strategic Planning Group in March. 2.6 Also, in October the Senior Manager (Strategic Planning and Transformation) was successful in securing a funded place on MSc in Leading Digital Transformation in Health and Social Care in Scotland delivered by the Usher Institute at University of Edinburgh, and aims to “enhance the ability of current and future leaders to drive, deliver and embed digital transformation across Scotland’s health and social care services”. 2.7 In December the Transformation Board focused on some key partnership-wide programmes including an update on the Carers Strategy and an update on the Self- Directed Support Learning Review Implementation, as well as an overview of the initial findings from the Accessing Health and Care Service Review. 2.8 Also in December, the Service Lead for the Tech First Programme in Health and Community Care was successful in achieving a fully funded place the Professional Development Award Technology Enabled Care starting in January 2025. The qualification is designed to “empower individuals to evaluate and adopt technologies that support health and care delivery while reflecting on how these could be used to assist people to self-manage and live independently”. 2.9 The third Ayrshire-wide Innovation Event took place on the 3rd December and included: an overview of the new Digital Capability Framework and supporting resources from the Digitally Enabled Workforce Team at NHS Education Scotland; a demo of the Seer 2 platform which provides national technology and infrastructure capabilities for data management and analytics for health and social care across Scotland; and an overview of how NearMe is used in South Ayrshire. Service Updates 2.10 Health and Community Care 76
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• The Blue Badge Review to streamline processes has concluded with successful outcomes. • The Analogue to Digital work continues to roll out • The Tech First project has produced an Options Appraisal with proposed next steps. • The Packages of Care Project has convened with subgroup leads to establish their action plans. • The Palliative and End of Life Care Group has proposed with East and South the "implementation of the Pan Ayrshire End of Life and Palliative Care Programme to deliver improvements in patient care; through the identification of evidence based sustainable models of care, effective staff training and efficient delivery of equipment and support". The North subgroup "Education & Training" has been established and a work plan will be taken forward by a dedicated lead, reporting back to the programme board. • The Day Service Review has produced and Options Appraisal with proposed next steps. • The multi-agency Delayed Discharge and Winter Preparedness Project continues and includes support to 'MADE & Safer", investigating and improving referral pathways from acute to HSCP, and a service wide action plan which is updated weekly to ensure momentum and progress. A performance monitoring framework is in place. • The Home First Strategy is being explored. • The Arran Single Point of Contact is also delayed, this is due to funding delays and IT infrastructure issues. • The Enhanced Intermediate Care Team review is advancing with four subgroups established. • The Community Rehab work has been focussing on good practice and mapping services. This will culminate in a workshop with all relevant services. A visioning group has been convened who will oversee preparation of the recommended model for service delivery. 2.11 Children, Families and Justice • Brighter Pathways Board and workstreams are meeting regularly. Housing and Throughcare are developing a Housing Protocol and have developed a Tracker for prioritised applications, in this case care-experienced young people. Engagement has been undertaken with foster carers and the new digital site is live, and new Foster Schemes are being develop. Meetings continue with Education to develop pathway to residential school placements and a position paper is being developed. A position paper is also being developed to provide strategic direction on next steps in terms of reconfiguring the model of care in Children’s Houses. It is hoped that Psychological Services can work alongside staff and young people within the Residential Houses to improve supports/outcomes. 77
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• Neuro Developmental Supports (this is a lifespan focus not just Children’s) is progressing: • The Multi-Agency Panel test of change is almost complete, the workstream will assess the findings with a view to informing the Business Case being developed. • Parents & Carers Engagement Report will be presented to the North Implementation Group next week, there are twenty-three actions to be considered by the Group. • Family Supports - List has been published on NEST website, further communication is being developed by way of a Video that will go on the site, to assist service users/parents in accessing supports. • A review of the North Ayrshire Justice Court team has been carried out and now service user testimonies are being sought. It is anticipated that the preferred option will be signed off early 2025. • The Transport Provision PID has been approved and the workstream is being set up aiming to reduce costs by reconfiguring how service is provided and moving away from single journey taxi provision. 2.12 Mental Health and Learning Disabilities • Continuing to monitor and make improvements on the delivery of all MAT Standards. Regular Support to Report meetings with the national support team (MIST) have taken place who continue to be reassured at local progress. A formal update report to the Scottish Government being collated. • Since establishment the Learning Disabilities Intensive Support Team have had 20 referrals and currently have 13 active cases, 2 of which are delayed discharge in hospital. Review of out of area placements is being carried out. • A review of the Adult Community Mental Health Service is underway. Data and research has been gathered and staff and service user engagement is complete. The project is on track to deliver recommendations by early 2025. Workshop of solutions pushed back to Q4 to bring into alignment with Wellbeing project timelines. • The Community Wellbeing services are being looked at through a cross-functional project bringing together Mental Health and Learning Disabilities and Health and Community Care. A workshop was held with project team to agree the future model of Wellbeing Services. Options are being developed and presentations were given on all existing Wellbeing Services to inform decision making. • Work continues for the Digital Programme with a review of the entire digital landscape for Mental Health services across Ayrshire and Arran. Outline findings were reported to the Mental Health Digital Transformation Group. TrakCare Implementation continues with progression of solutions for Learning Disabilities 78
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Service and improvements to Care Partner forms for Psychological Services teams. • The Extreme Team implementation plan and recommendations to improve support for people with disabilities throughout their life course work are now being operationalised across services. The Children with Disabilities team and Adult Learning Disabilities team has now integrated into a single leadership structure within adult services and will continue to progress and implement recommendations with details of future pieces of work will follow. • As part of the models of care work at Woodland View, an Ayrshire Central Hospital Inpatient Site review has commenced to reduce overspends, and a bimonthly group is meeting to review all persons subject to high-cost placements. • A Programme Board has been established to review the LD Acute Assessment model based at Woodland View alongside community models and in alignment with IST service. Feeding into that are three main areas workstreams. 1) Workforce 2) Environment 3) Delayed Discharges. In addition to that, work is ongoing to build a communication plan for all pieces of work to appraise all stakeholders of progress. A weekly risk meeting is in place to address and mitigate more immediate operational challenges and bring pace to discharge planning. 2.13 Partnership-wide • The Carer Partnership focus continues to reach more people, in more places, in more ways with activity on a range of areas including: o North Ayrshire Short Breaks Services Statement has been drafted. o Communication and marketing materials - Carer Pack aligned with the self- help resource o Wider carer engagement including development of a Carer Champions Board. First meeting before Christmas. o Continued networking, mapping and partnership building. o Continued work on Bridgit (digital self-help portal for carers) and use of digital/ social media. Development of a young carer section. o Improved strategies to identify and support hidden or minority carer groups. o Improved process and pathways for identification, registration and completion of Adult Carer Support Plans and Young Carer Support options from Gateway Service. o Development of Section 28 – Identifying & Involving Carers in Hospital Discharge. o Clarity on the Gateway role and offer to be embedded across schools. • The implementation of the recommendations from the SDS learning review continued through Q3 with: o A policy review o Design sessions: to identify areas to progress. 79
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o Staff Interviews: Interviewed senior staff to understand the future direction of SDS, barriers and current organisational cultures. o Service User Interviews: Captured user experiences to use as case studies for training. o Team Manager Sessions: Discussed SDS progress and improvements. o Brand Kit: Created a design kit for clarity. o Graphic Design: Supported related work in other areas such as unpaid carers and learning disability. o SDS Microsite: Designed a site for SDS information and resources. o Value-based Leadership Programme: Developed a programme to consider the culture and behaviours required to bring about system level changes. o Ethical Framework: Started a new overarching ethical framework for SDS. • The Front Door Review had a joint meeting of the Board and Reference Group on Monday 25th November, where workstream representatives presented their recommendations. These were deliberated by the Board and amended to reflect their comments. • The Year 2 report for the Workforce Plan 2022-25 has been completed and presented to the Transformation Board and PSMT. The report will be published and also taken to the Performance and Audit Committee. Work to replace the Workforce Plan has not yet commenced, and the HSCP has been informally advised that the Scottish Government will be looking for interim updates for 2025 instead. • The implementation of our new case management system for social care, Eclipse, is progressing with go-live later in 2025. 3. PROPOSALS 3.1 It is proposed that IJB note the progress to date. 3.2 Anticipated Outcomes Informing IJB and the people of North Ayrshire on the progress of the Transformation Plan, and also providing assurance of the governance arrangements and that the Transformation Board has appropriate oversight. 3.3 Measuring Impact Stakeholders are assured of progress. 4. IMPLICATIONS 4.1 Financial 80
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A number of the transformation projects will deliver financial savings; some financial targets have been identified as part of the budget development for 2025/26 (and will be reflected in the Medium-Term Financial Outlook). Identified savings and overspend reductions are tracked in the online trackers. 4.2 Human Resources None. 4.3 Legal None. 4.4 Equality/Socio-Economic None. 4.5 Risk None. 4.6 Community Wealth Building None. 4.7 Key Priorities None. 5. CONSULTATION 5.1 Consultation has taken place with Planning Managers in the Transformation Team, and with the Transformation Board which includes representation from across services. Lee Ballantyne, Senior Manager (Strategic Planning and Transformation) LeeBallantyne@north-ayrshire.gov.uk Appendices • Online Tracker [screenshot] • Online Dashboard [screenshot] 81
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Appendix I: Online Tracker [Screenshot] 82
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Appendix II: Online Dashboard [Screenshot] 83
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