Month 10 Financial Performance
North Ayrshire Council · 20 March 2025
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Integration Joint Board 20th March 2025 Subject : 2024-25 – Month 10 Financial Performance Purpose : To provide an overview of the IJB’s financial performance as at Month 10 (January). 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 £4.980m which includes the recovery plan reductions anticipated until the year-end; (b) notes the progress with delivery of agreed savings; (c) notes the actions which are being taken to progress financial recovery and note the benefit of £4.002m achieved in-year; and (d) notes the remaining financial risks for 2024-25. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health MDT Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework MDT Multi-Disciplinary Team 1. EXECUTIVE SUMMARY 1.1 The report provides an overview of the financial position for the Partnership and outlines the projected year-end outturn position informed by the projected expenditure and income commitments; these have been prepared in conjunction with relevant budget holders and services. It should be noted that, although this report
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refers to the position at the end of January 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 £4.980m (1.5%). 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. The main areas of movement in the reporting period are: Improvement: • Ward 1 and 2 • Elderly Inpatients Deterioration: • Montrose House agency costs • Social Care payroll • Adult Inpatients • Psychiatry The 2024/25 financial position has also been 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. 1.4 The Integration Scheme describes the required approach where there is a projected overspend on the IJB integrated budget, which includes the requirement to agree a recovery plan to balance the overspending budget. Only if the recovery plan is unsuccessful will the Health Board and Council consider making available interim funds. 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. Those requests have been submitted to both funding bodies and acknowledged, NHS Ayrshire and Arran has confirmed they will factor the overspend into the NHS Board financial outturn position and North Ayrshire Council have acknowledged and confirmed they will take a report to Cabinet as part of their final 2024/25 revenue budget monitoring in June 2025. The residual overspend has changed since Month 7 and monthly updates have been provided to both NHS AA and NAC, the movement is noted below:
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Month NAC NHS AA 7 £2.548m £1.065m 9 £3.106m £1.309m 10 £3.180m £1.800m 1.5 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. 1.6 The current allocation from NHS AA for the Agenda for Change costs in relation to the reduced working week are currently being queried with the NHS finance team to ensure we receive our ‘fair share’ of the funding. The cost of covering all of the reduced hours is £1.344m versus the current funding calculation of £0.658m which would cover 49% of the costs if all of the hours were replaced, however NHS finance proposals for in-year funding for 2024/25 are at a lower level. It is important the IJB receives a fair share of funding and this is rectified before budgets are rolled forward into 2025/26. This funding is not yet included within the forecast outturn for services, and the final allocation basis will potentially positively impact on the outturn for NHS AA delivered services. Previous concerns were also raised in relation to the provision of financial information and projections from NHS AA, these have been formally raised with the NHS AA Chief Executive and work is ongoing with the HSCP and NHS AA finance teams to improve the provision of timely access to accurate information. 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 10 At month 10 against the full-year budget of £327.384m there is a projected year-end overspend of £4.980m (1.5%). 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
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of a projected overspend of £3.180m in social care services and a projected overspend of £1.800m in health services. Appendix A provides the financial overview of the Partnership position. The sections that follow outline the significant variances in service expenditure compared to the approved budgets. 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 £92.290m there is a projected overspend of £5.678m (6.2%) (£0.063m favourable movement) and the main variances are: a) Care home placements – net projected overspend of £0.268m (£0.121m adverse movement). The budgeted number of permanent placements was 765 and at month 10 there were 779 placements which is an increase of 10 places from month 9. The projected overspend is £1.084m (£0.177m adverse) on placements including additional support costs. Within this projection there is a projected overspend on interim placements (£0.084m favourable). Respite placements are projected to be £0.048 under spent (£0.048m favourable). 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 £0.816m over recovered (£0.056m 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 £2.635m overspent (net £0.072m adverse movement). The position reflects the cost of meeting the significant demand and level of provision for care at home support. This projection assumes all of the cover costs during month 9 in relation to sickness and festive cover arrangements were paid in month 10. The adverse movement relates to purchased care at home.
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c) Physical Disability Services – projected overspend of £0.730m (£0.037m favourable) split as follows: £1.240m over in residential placements, £0.158m under in direct payments and £0.352m under in community care packages. d) Integrated Island Services is projected to overspend by £0.584m (£0.062m adverse The most significant variance is a projected overspend at Montrose House of £0.415m (£0.085m adverse 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. Payments due under the NHS contract have been made in Period 10 & 11 and the full benefit of the lower rates will be seen in 2025-26. e) Specialist Rehab wards – projected overspend of £0.006m (£0.033m adverse movement) (Redburn ward £0.133m overspend and Douglas Grant £0.127m 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 £0.677m (£0.213m favourable movement). The overspend is 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 (no movement) including an overspend on the supply of stairlifts. 2.4 Mental Health Services Against the full-year budget of £109.794m there is a projected overspend of £2.695m (2.5%) (adverse movement of £0.208m) 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 £0.696m (£0.080m favourable movement) across community care packages, direct payments and residential placements. This improvement reflects the positive impact of assertive reviews of care packages and increased clawbacks from direct payments. • Community Mental Health services are projected to underspend by £0.289m (£0.031m 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.
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• 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 £2.357m overspent (£0.262m adverse movement) and the main variances are as follows: • Adult Inpatients – overspent by £0.121m (£0.016m adverse) 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. • The UNPACS (Unplanned Activities) budget – projected overspend is £1.060m (£0.160m adverse movement) based on current placements. The adverse movement is partly due to a new case in England who will require repatriation to North Ayrshire. UnPACS placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively on medium- or long-term complex secure residential placements which are very expensive so a small change in placements can have a high budgetary impact. Due to the complexity and risk involved, transitions between units or levels of security can take many months. Applications to approve a placement are made to the Associate Medical Director for Mental Health who needs to be satisfied that the placement is appropriate and unavoidable prior to this being agreed and furthermore remitted to the High Cost Care Package Group. 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 £0.132m (£0.061m 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. This risk has also been highlighted to NHS AA.
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• Elderly Inpatients – projected overspend of £0.451m (£0.075m 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 in future years. • Psychiatry – is projected to overspend by £0.450m (£0.100m adverse movement) due to the use of agency staff and junior doctors. A mitigation plan has been developed which will see this overspend significantly reduce moving into 2025/26. • MH Pharmacy – is projected to overspend by £0.658m (no 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. This has also been shared with East and South Ayrshire IJBs following the FWG for consideration of how to manage this moving into next financial year. Innovation Fund – projected underspend of £0.108m (no movement) 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 (no movement). 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 £44.421m there is a projected overspend of £1.558m (3.5%) (£0.072m favourable movement) and the main variances are: a) Care Experienced Children and Young People is projected to overspend by £1.896m (£0.144m 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:
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• Following budget investment of £4m the children’s residential placements are overspent by £1.748m (£0.037m favourable) based 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. • 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.. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is projected to be £0.723m underspent (£0.007m adverse). • Children with disabilities – there is a net projected overspend of £0.537m (£0.043m favourable movement) across residential placements, direct payments and community packages. The favourable movement is due a reduced projection in community packages. • Residential respite – placements are overspent by £0.143m (no 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 £0.114m (£0.046m 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 £0.719m (£0.071m adverse movement). This consists of a projected overspend due to the planned saving of £0.223m 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
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to £0.922m (£0.025m 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 (no movement) mainly in relation to the Band 6 to 7 regrade for Health Visitors and the progression of posts up the Band 7 scale. Some provision for this 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 £0.037m. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £3.678m (£0.777m favourable) and the main areas of variance are: • There is projected slippage on the LD and MH transition funding of £0.961m (£0.019m 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. • There were favourable movements across various budget lines which resulted in a £0.050m favourable movement (£0.050m favourable movement). • The recovery plan actions in relation to the reserves and service redesign funds totalling £0.873m are now reflected in the projection. • An over-recovery of payroll turnover of £1.300m (£0.286m adverse) for social care services and an over-recovery of payroll turnover of £0.417m 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:
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Social Care Health Vacancy Savings Target (£3.301m) (£1.522m) Projected to be achieved by March 2025 £4.601m £1.939m Over/(Under) Achievement £1.300m £0.417m The areas contributing to the health and social care vacancy savings are spread across a wide range of services with vacancy savings being achieved in most areas. As part of the recovery plan, the vacancy scrutiny group has been enhanced with the Heads of Service and professional leads attending. Each post is scrutinised and filled only where deemed necessary with a recruitment freeze now implemented for all non-essential posts. This has led to an 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 10 £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 in relation to care homes and recovery and rehab will not be achieved in 2024-25. 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. There are no reductions requiring approval in month 10.
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2.11 Pan Ayrshire Lead Partnership services and Large Hospital Set Aside 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 £2.357m (£0.772m NRAC share for East and £0.674m 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.
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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). 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 £29 million after 10 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:
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• Unachieved efficiency savings • Length of Stay (LoS) and emergency admission rates in NHS Ayrshire and Arran acute hospitals are above the Scottish average. • High expenditure on medical and nursing agency staff, high rates of absence and vacancies causing service pressure. • Delayed transfers of care and high acuity of patients. The IJBs and the Health Board work closely in partnership to maintain service and improve performance. 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 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 been settled for local government and NHS but the 25-26 position is unclear. • 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 and to respond to ongoing concerns re financial sustainability from providers. • 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 – with in-year funding allocations for example the Mental Health Outcomes Framework • 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.
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• 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. • 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 and 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 and the use of high-cost agency staff to support frontline service delivery in areas where there are recruitment challenges. • Agenda for Change Pay Reform programme – including Nursing Band 5-6 re- grade, protected learning time and reduction to the working week. Non- recurring funding has been provided to NHS AA to meet costs associated with this but as noted the HSCP are challenging the proposed allocation methodology for pass through funding. • External contract uplifts and frameworks, for example Scotland 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 and moving into 2025-26. 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 across 2024/25 and 2025/26. A further review will be undertaken of the 2025/26 balance alongside consideration of the budget. Further detail on the reserves is given in Appendix D.
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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. Following the finalisation of the 2023/24 outturn position, the IJB agreed some initial recovery actions at the meeting in June 2024. 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 recovery plan savings achieved are outlined in full at Appendix E. This appendix also outlines the draft 2025-26 opening position, as some of the areas of recovery will have a recurring impact on the budget position, with the impact on the 2025-26 opening position estimated to be £1.595m. This will require to be addressed as part of the 2025-26 budget planning. Since the initial recovery plan was agreed in June 2024 there has been a £4.002m reduction in costs, whilst the full benefit of this has not been realised in-year in the bottom line outturn, it has supported the delivery of mitigating a further deterioration to the position introduced through other in-year unexpected financial pressures. Services will continue to work towards implementing the recovery plan to deliver cost reduction targets while carefully managing the level of risk. 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.
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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 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 six 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 • Budget Planning for 2025/26 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
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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. 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. Those requests have been submitted to both funding bodies and acknowledged, NHS Ayrshire and Arran has confirmed they will factor the overspend into the NHS Board financial outturn position and North Ayrshire Council have acknowledged and confirmed they will take a report to Cabinet as part of their final 2024/25 revenue budget monitoring in June 2025. The residual overspend has changed since Month 7 and monthly updates have been provided to both NHS AA and NAC, the movement is noted below: Month NAC NHS AA 7 £2.548m £1.065m 9 £3.106m £1.309m 10 £3.180m £1.800m 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 mitigating the impact on the financial position, 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. 3.3 Measuring Impact Ongoing updates to the financial position have been reported to the IJB throughout 2024-25, the final outturn position for 2024-25 will be reported to the IJB in June 2025. 4. IMPLICATIONS 4.1 Financial The outturn is a projected overall year-end overspend of £4.980m (1.5%). 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. 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.
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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 and will require to remain in place moving into 2025-26. 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 accordingly. 5. CONSULTATION 5.1 This report has been produced in consultation with relevant budget holders and the Partnership Senior Management Team. 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]
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PUBLIC INFORMATION 2024-25 Budget Monitoring Report–Objective Summary as at 31st January 2025 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 72,661 77,348 4,687 19,629 20,620 991 92,290 97,968 5,678 5,741 (63) : Locality Services 30,419 31,529 1,110 5,624 5,696 72 36,043 37,225 1,182 1,139 43 : Community Care Service Delivery 38,180 40,871 2,691 0 0 38,180 40,871 2,691 2,681 10 : Rehabilitation and Reablement 2,062 2,432 370 0 0 2,062 2,432 370 359 11 : Long Term Conditions 913 954 41 9,812 10,622 810 10,725 11,576 851 1,041 (190) : Community Link Workers 331 331 0 0 0 0 331 331 0 (1) 1 : Integrated Island Services 756 1,231 475 4,193 4,302 109 4,949 5,533 584 522 62 MENTAL HEALTH SERVICES 34,295 34,708 413 75,499 77,781 2,282 109,794 112,489 2,695 2,487 208 : Learning Disabilities 25,788 26,484 696 564 564 0 26,352 27,048 696 776 (80) : Community Mental Health 6,467 6,178 (289) 1,793 1,793 0 8,260 7,971 (289) (320) 31 : Addictions 2,040 2,046 6 1,943 1,943 0 3,983 3,989 6 11 (5) : HBCCC 0 0 0 353 278 (75) 353 278 (75) (75) 0 : Lead Partnership Mental Health NHS Area Wide 0 0 0 70,846 73,203 2,357 70,846 73,203 2,357 2,095 262 CHILDREN & JUSTICE SERVICES 39,243 40,477 1,234 5,178 5,502 324 44,421 45,979 1,558 1,630 (72) : Irvine, Kilwinning and Three Towns 3,040 3,072 32 0 0 0 3,040 3,072 32 37 (5) : Garnock Valley, North Coast and Arran 3,138 3,189 51 0 0 0 3,138 3,189 51 48 3 :Intervention Services 1,689 1,685 (4) 0 0 0 1,689 1,685 (4) (6) 2 : Care Experienced Children & Young people 27,397 29,293 1,896 0 0 0 27,397 29,293 1,896 2,040 (144) : Head of Service - Children & Families 1,091 372 (719) 0 0 0 1,091 372 (719) (790) 71 : Justice Services 2,472 2,472 0 0 0 0 2,472 2,472 0 0 0 : C&F Health Team 416 394 (22) 4,447 4,754 307 4,863 5,148 285 284 1 : Lead Partnership NHS Children's Services 0 0 0 731 748 17 731 748 17 17 0 CHIEF SOCIAL WORK OFFICER 1,598 1,635 37 0 0 0 1,598 1,635 37 16 21 PRIMARY CARE 0 0 0 53,830 53,821 (9) 53,830 53,821 (9) (9) 0 ALLIED HEALTH PROFESSIONALS 0 0 10,914 10,914 0 10,914 10,914 0 0 0 MANAGEMENT AND SUPPORT COSTS 9,821 6,630 (3,191) 4,716 4,229 (487) 14,537 10,859 (3,678) (2,901) (777) OUTTURN ON A MANAGED BASIS 157,618 160,798 3,180 169,766 172,867 3,101 327,384 333,665 6,281 6,964 (683) Over/ (Under) Spend Variance at Period 9 Movement in variance from Period 9 TOTAL Partnership Budget - Objective Summary Council Health 2024/25 Budget
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PUBLIC INFORMATION TOTAL Budget Budget Budget Revised Outturn Over/ (Under) Spend Variance Budget Revised 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 (772) (772) 0 (772) (772) (686) (86) Return Hosted Over/Underspends South 0 0 0 0 (674) (674) 0 (674) (674) (599) (75) Receive Hosted Over/Underspends South 0 0 0 0 228 228 0 228 228 228 0 Receive Hosted Over/Underspends East 0 0 0 0 (83) (83) 0 (83) (83) (83) 0 OUTTURN ON AN IJB BASIS 157,618 160,798 3,180 169,766 171,566 1,800 327,384 332,364 4,980 5,824 (844) Over/ (Under) Spend Variance at Period 9 Movement in variance from Period 9 Partnership Budget - Objective Summary 2024/25 Budget Council Health
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PUBLIC INFORMATION 2024-25 Savings Tracker Appendix B Social Care: Description Deliverability Status at budget setting Deliverability Status at Month 10 2024/25 Saving Description of the Saving Children, Families & Criminal Justice Service redesign Amber Blue 0.123 Restructure areas of specialist service provision including substance use and corporate parenting, embedding the roles and functions of those teams within our locality-based early intervention approaches and strategic planning including engagement. Community Care & Health Review of Day Care provision Amber Blue 0.100 Carry out a review and streamline day care provision. Sensory Impairment Team Green Blue 0.062 Remove the dedicated management post and realign the team into core social work teams. Care Home places Green Red 0.375 Reduce the number of funded care home places by 15, leaving budgetary provision for 765 places at average cost. Charging for community alarm provision to sheltered housing tenants Amber Blue 0.200 Introduce a charge for community alarm provision in council sheltered housing units to ensure an equitable approach across all housing tenures. Montrose House capacity Green Red 0.111 Restrict the capacity at Montrose House care home to the current level of residency. Voluntary Early Release Green Blue 0.174 Recurring savings achieved by the release of back-office staff through the council's voluntary early release scheme. Carers Strategy funding Green Blue 0.384 Utilise the remaining Carer's Strategy funding to invest in respite provision and short breaks for carers and to support existing investments in services which support unpaid carers. Increase to charging Green Blue 0.131 Increase charges for non-residential care by 10% and charges for residential care by 5% Remove vacant posts Green Blue 0.280 Remove a number of vacant posts across support services. Employers' superannuation contributions Green Blue 7.238 Align the budget to the new employer superannuation contribution rates from 1st April 2024. Payroll Turnover Green Blue 0.077 Increase targets for payroll turnover through the recruitment process. TOTAL SOCIAL CARE SAVINGS 9.255 North Ayrshire Health and Social Care Partnership 2024/25 Savings Support Services and Partnership-wide savings
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PUBLIC INFORMATION Health: Description Deliverability Status at budget setting Deliverability Status at Month 10 2024/25 Saving Description of the Saving Hospital Based Complex Continuing Care (HBCCC) provision Green Blue 0.500 Align the budget to the level of ongoing need for HBCCC provision. Increase recharge to East Ayrshire for beds at Woodland View Green Blue 0.021 Apply an inflationary increase to the recharge to East Ayrshire HSCP. Community Recovery and Rehab provision Amber Red 0.100 Review and streamline a range of current provisions to remove duplication. Enhanced ICT Green Blue 0.100 Carry out a review of the service delivery model and release recurring staffing savings. Payroll Turnover Green Blue 0.314 Increase targets for payroll turnover through the recruitment process. TOTAL HEALTH SAVINGS 1.035 TOTAL NORTH HSCP SAVINGS 10.290
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PUBLIC INFORMATION 2024-25 Budget Reconciliation Appendix C COUNCIL Period Permanent or Temporary £'m Initial Approved Budget 156.190 Adjustments to baseline (0.574) Less Resource Transfer 23/24 (24.640) Revised Budget 130.976 Resource Transfer 24/25 1-3 P 25.169 Realign Girfec Team To Connected Comm 1-3 P (0.073) ICT Budget Transfers 1-3 P (0.006) CJSW Funding 2425 1-3 T 0.053 Childrens Living Wage Allocation 1-3 T 0.525 ICT Budget Transfers 6 P -0.002 ICT Budget Transfers 6 P -0.003 Post Realigned from the Policy, Performance & Elections Team 6 P 0.059 Transfer to FM Services re Cleaning Services at West Road 6 P -0.01 Transfer to Capital re West Road 7 T -0.281 Transfer from NAC Commercial Waste 7 T 0.007 ICT Budget Transfers 9 P -0.002 Summer Activities EMF Q2 & Q3 Draw- Down 9 T 0.002 Pay Award 24/25 9 P 1.057 Scottish Disability Allowance 9 P 0.134 Transfer from Housing re Domestic Abuse Alarns 10 P 0.017 Roundings 10 T -0.004 157.618 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 10
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PUBLIC INFORMATION HEALTH Period Permanent or Temporary £'m Initial Budget exc set aside 157.894 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 1.724 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 0.001 169.766 TOTAL COMBINED BUDGET 327.384 Health Budget Reported at Month 10
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PUBLIC INFORMATION 24-25 IJB Reserves Position Appendix D Area of Reserves Balance at 31 March 2024 2024-25 Anticipated Draw Downs Projected Balance at 31 March 2025 : Alcohol & Drug Partnership 641 (641) 0 : Mental Health Action 15 57 (57) 0 : Service Redesign / Challenge Fund 1,774 (1,202) 572 : Community Living Change Fund 377 (377) 0 : Family Wellbeing Fund 1,313 (1,313) 0 : Wellbeing Fund 50 (50) 0 : Breast Feeding Network 26 (26) 0 : MH Recovery and Renewal 546 (546) 0 : Buvidal 23 (23) 0 : Brooksby 5 (5) 0 : Cossette Funding 4 (4) 0 : Expansion of Primary Care Estates 55 (55) 0 : GP Premises Improvements - tranches 1 and 2 63 (63) 0 : Mental Health Wellbeing in Primary Care 81 (81) 0 : Dental Practice Improvement 29 (29) 0 :Appropriate Adult Scheme 2 (2) 0 :Adult Tier 3 Weight Management Service 19 (19) 0 : Phlebotomy 22 (22) 0 : LD Health Checks 66 (66) 0 Total Earmarked 5,153 (4,581) 572 Unallocated General Fund 357 (357) 0 General Fund 5,510 (4,938) 572 Earmarked Funds
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PUBLIC INFORMATION Financial Recovery Action Plan Appendix E SERVICE AREA TOTAL ACHIEVED Health and Community Care Reduce care home placements in line with budget saving (0.200) Reduce CAH capacity/delay recruitment/in-house efficiencies (0.850) Community Wards - reduce supplementary staffing and review bed capacity (0.450) MH and LD (North Ayrshire) HBCCC mitigation plan (0.075) MH and LD (Lead Partnership) Ward staffing (adults/elderly inpatients) (0.300) CEDS/CAMHS (0.098) North Ayrshire share (38.6%) (0.154) Children and Families Reduce children's external placements - early reduction from Brighter Pathways work (0.900) Reduce investment in C&F social work via service redesign fund (0.300) Cross Partnership Vacancy management and temporary posts (0.500) Use of remaining reserve balance (0.357) Review of earmarked reserves (0.216) TOTAL RECOVERY PLAN SAVINGS ACHIEVED (NA Share) (4.002) Non-Recurring (reserves and vacancy management) (1.373) Recurring Savings (2.629) Projected Overspend 24/25 - M10 4.980 Full Year Impact: Brighter Pathways 0.850 Care at Home 0.850 Montrose House Agency Staff 0.300 Care Homes - into line with placements 0.268 Care Packages - LD & MH - full year impact 24-25 reductions 0.407 Equip and Adapt 0.330 Share of Lead Partnership 0.380 Other areas 0.056 Residual 25-26 opening position 1.595
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PUBLIC INFORMATION Bank and Agency Costs to Month 10 Appendix F Bank and Agency Costs M1-10 2024-25 1) NHS 4863 (Registered) 4864 (Unregistered) 4853 (Registered) 4854 (Unregistered) 4865 (Agency Locum Consultant) 4867 (Agency Locum Spec Registrar) TOTAL NORTH CORE SLT ADULT - WARD 1 WOODLANDS VIEW 56,737 333,629 390,366 WARD 2 WOODLANDS VIEW 36,934 349,321 386,254 ACH REDBURN REHAB WARD NRS 9,501 96,421 105,922 ACH DOUGLAS GRANT REHAB WD NRS 17,631 47,499 530 65,660 WARD 3 WOODLANDS VIEW NURSING 37,015 289,730 1,589 709 329,043 WARD 4 WOODLANDS VIEW NURSING 34,683 210,514 185 245,382 NEW CLONBEITH NURSING(JURA) 110,373 112,343 222,717 WVIEW THE GLEN ECT 1,989 1,989 WVIEW WARD 10 ACUTE MH NRS 36,700 62,843 99,544 WVIEW WARD 8 ACUTE MH NRS 34,381 673,589 251 708,220 WARD 5 WOODLANDS VIEW 19,694 21,856 41,549 WVIEW WARD 7B REHAB MH NRS 4,901 4,901 NEW DUNURE NURSING(CLONBEITH) 35,345 152,405 187,750 MH BED MANAGEMENT 3,708 3,708 TRINDLEMOSS 64,034 184,672 582 379 249,667 ARRAN HOSPITAL NURSING 23,337 24,372 13,091 60,800 CAMHS MANAGEMENT 1,943 1,943 CAMHS UNSCHEDULED CARE 8,591 8,591 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 71,022 71,022 PACKAGE OF CARE (P) - LMO 6,752 6,752 ARRAN DN 1,401 1,401 NC POC TEAM 2 2,875 2,875 NC POC TEAM 3 3,080 3,080 THREE TOWNS DN 16,206 16,206 IRVINE DN 23,114 23,114 NORTH WEST COAST DN 6,942 99 7,042 GARNOCK VALLEY DN 91,532 91,532 NORTH DN TEAM LEADERS 4,286 4,286 NORTH AHP MANAGEMENT TEAM 9,876 9,876 LADY MARGARET NURSING 13,465 6,999 20,464 PREVENTION + SERVICES SPT TEAM 1,481 1,481 MH UNPACS (PRIVATE) - LD HEALTH CHECKS 114,150 114,150 NORTH CLDT 429 429 LDS MANAGEMENT 6,153 6,153 NORTH PARTNERSHIP ADMIN MH 13 13 MHS INPATIENT MGT 27,551 27,551 CMHT NURSING-NORTH AYRSHIRE 8,689 8,689 WVIEW WARD 7C FORENSIC REHAB N 11,781 98,298 110,079 DAY ACTIVITIES TEAM 227 227 INTENSIVE COMMUNITY NURSING TEAM 38,656 38,656 ADULT MENTAL HEALTH LIASION TEAM 2,554 2,554 PCMHT NORTH 3,802 3,802 WVIEW WARD 6 LOW SECURE NRS 65,744 199,697 265,441 WARRIX AVE 18,203 32,155 50,358 ACTION 15 - ADULT LIAISON 26,064 26,064 NORTH CORE SLT PAEDS - FORENSIC PSYCHOLOGY 2,062 2,062 ICFN - COMMUNITY PHLEBOTOMY 8,986 8,986 WVIEW WARD 7A LD A+T NRS 21,097 751,908 4,525 20,316 797,846 WVIEW WARD 9 ACUTE MH NRS 34,318 172,839 379 207,536 WVIEW WARD 11 ACUTE MH NRS 57,842 213,211 257 271,310 ADULT EAST 62,786 62,786 ADULT SOUTH 77,070 111,301 188,370 1,186,789 4,214,745 20,492 22,476 139,856 111,301 5,695,659 2) SOCIAL CARE Month 10 Agency Cost Montrose House 505,485 Children Acm - Irvine 1,188 Mh Acm 129,421 Ld Acm 35,404 TOTAL 671,498 Bank Agency