2024-25 Budget Monitoring Report Mth12 with Appendix
North Ayrshire Council · 19 June 2025
Back to Integration Joint Board — 19 June 2025 and its agenda
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Integration Joint Board 19th June 2025 Subject: 2024-25 – Year End Financial Performance Purpose: To provide an overview of the IJB’s financial performance for the year ended 2024-25 and the implications for the IJB’s overall financial position Recommendation: It is recommended that the IJB: (a) Notes the overall integrated financial performance for the financial year 2024-25 and the overall year-end overspend of £1.212m pre earmarking, adjusted to £3.593m after earmarking, adjusted to on-line after additional funding contributions. (b) Notes the progress with delivery of agreed savings. (c) Approves the budget reductions which are detailed at paragraph 2.10. (d) Approve the proposed earmarking as detailed in the report, leaving a balance of £3.161m in earmarked funds. Direction Required to Council, Health Board or Both Direction to :- 1. No Direction Required X 2. North Ayrshire Council 3. NHS Ayrshire & Arran 4. North Ayrshire Council and NHS Ayrshire & Arran Glossary of Terms NHS AA NHS Ayrshire and Arran HSCP Health and Social Care Partnership MH Mental Health MDT Child & Adolescent Mental Health Services BRAG Blue, Red, Amber, Green UNPACS UNPACS, (UNPlanned Activities) – Extra Contractual Referrals NRAC NHS Resource Allocation Committee PAC Performance and Audit Committee MHOF Mental Health Outcome Framework MDT Multi-Disciplinary Team
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1. EXECUTIVE SUMMARY 1.1 The report provides an overview of the financial position for the Partnership and outlines the unaudited year-end outturn position for 2024-25. 1.2 The outturn is an overall year-end overspend of £1.212m on an IJB basis, which when adjusted for new earmarked reserves of £2.381m is increased to £3.593m (1.1%), which is a favourable movement of £1.387m from month 10. Of this favourable variance the majority relates to LD care packages due to the variance between planned care and actual care delivered. There was significant progress throughout the 2024/25 to contain costs through the financial recovery plan, which delivered a £4m improvement, the full benefits of this were not fully attributed to the bottom line as other in-year pressures impacted on the overall position. The graph below illustrates the movement in the financial outturn throughout the year: 1.3 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 an overspend of £2.036m in social care services and an overspend of £1.557m in health services. 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
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funds. At month 7 the IJB requested that the Chief Officer write formally to North Ayrshire Council and NHS Ayrshire and Arran to request additional in-year funding and at month 12 the following has been agreed: Social Care element – overspend of £2.036m. North Ayrshire Council considered this at their Cabinet meeting of 3rd June and agreed to fund this with a non-recurring funding increase and no requirement to repay the funds in future years. Health element – overspend of £1.557m. NHS Ayrshire and Arran have funded this, previous discussions with NHS AA colleagues in relation to repayment indicated the Health Board would wait to consider this following North Ayrshire Council’s consideration. The outcome of the decision by North Ayrshire Council has been communicated to NHA AA Director of Finance for consideration. Following these additional funding contributions the final position is on-line. 1.5 Projecting the IJB financial position continued to be challenging during 2024-25 as there were a number of areas of uncertainty throughout the year. Social care service provision in particular is difficult to project, with variability due to capacity and demand and can move significantly with low volume/high-cost packages of care. The ongoing financial risks were reported to the IJB during the year. These challenges will continue into 2025-26. 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 Financial balance was not been achieved in 2024-25 and the 2025-26 budget highlights several areas of significant risk. Financial modelling also anticipates a very challenging position in subsequent years. 1.8 The 2024/25 financial position was 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. The allocation for the Agenda for Change costs in relation to the reduced working week were queried with the NHS finance team to ensure we receive our ‘fair share’ of the funding but there has been no change to the allocation which adversely impacts on the IJB position.
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2. 2024-25 UNAUDITED BUDGET OUTTURN POSITION 2.1 The report includes an overview of the financial position, explanations for the main budget variances and an update on progress in terms of savings delivery. 2.2 FINANCIAL OUTTURN 2024-25 Against the full-year budget of £326.629m there is a reported overspend of £1.212m pre-earmarking. After earmarking the overspend of £3.593m consists of an overspend of £2.036m in social care services and an overspend of £1.557m in health services. Following additional funding contributions this position was brought on-line. Appendix A provides the financial overview of the partnership position, this details the outturn on an HSCP managed basis, on an IJB delegated basis (following Lead Partnership recharge adjustments) and the final adjusted outturn position after accounting for new earmarked reserve balances. The sections that follow outline the most significant variances in service expenditure compared to the approved budgets. 2.3 Health and Community Care Services Against the full-year budget of £92.549m there is an overspend of £5.632m (6.1%) and the main variances are: a) Care home placements – net overspend of £0.176m (£0.092m favourable movement). The budgeted number of permanent placements was 765 and at month 12 there were 771 placements which is a reduction of 8 places from month 10. The overspend is £1.010m (£0.074m favourable) on placements including additional support costs. Respite placements are £0.037m under spent (£0.001m favourable). The plan to manage down the number of permanent placements to reach the target was 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 £0.834m over recovered (£0.018m 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 £2.712m overspent (net £0.077m adverse). The position reflects the cost of meeting the significant demand and level of provision for care at home support.
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c) Physical Disability Services overspend of £0.714m (£0.016m favourable) split as follows: £1.295m over in residential placements, £0.298m under in direct payments and £0.283m under in community care packages. d) Integrated Island Services are £0.682m (£0.207m adverse movement). The most significant variance is an overspend at Montrose House of £0.464m (£0.049m 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. The full benefit of the lower rates will be seen in 25-26. There is also an overspend on supplies of £0.297m (continence and medical supplies) but this is partially offset by an underspend in employee costs of £0.156m. e) Specialist Rehab wards – overspend of £0.076m (£0.070m adverse movement) (Redburn ward £0.133m overspend and Douglas Grant £0.057m 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 – overspend of £0.735m (£0.058m adverse movement). The overspend is due to increased use of bank and supplementary staffing. g) District Nursing – overspent by £0.088m (£0.017m adverse) mainly due to an overspend on nursing supplies. h) Equipment and Adaptions – overspend of £0.235m (£0.095m favourable movement) mainly due to an overspend on the supply of stairlifts. 2.4 Mental Health Services Against the full-year budget of £108.721m there is an underspend of £0.898m (0.8%) (favourable movement of £3.593m) prior to the re-allocation of the Lead Partnership variance to East and South HSCP. This favourable swing is mainly due to: 1) The inclusion of £2.237m of underspends that will be earmarked and carried forward for use in 2025-26. These are £1.884m of Lead Partnership underspends and £0.353m for the ADP; and 2) A favourable movement of £1.308m in Learning Disabilities mainly due to the variance between planned care and actual care delivered.
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The areas of main variance are: • Learning Disabilities care packages are underspent by £0.322m (£1.018m 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. The year end reconciliation also highlighted a higher than anticipated invoice variation which is the difference between planned care and delivered care which is the main cause of the favourable swing. There was also an underspend of £0.197m in supported accommodation property costs. These budgets will be reviewed and reconfigures in 2025/26. • Community Mental Health services are underspent by £0.632m (£0.343m favourable movement) 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 and the variation between planned and actual care. There was also an underspend of £0.136m in relation to supported accommodation at Nethermains as full year budget was provided for a service that incurred part year costs. • There is an underspend of £0.102m (£0.027m favourable) 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 £0.716m overspent prior to earmarking of £1.884m resulting in an overspend of £2.600m (£0.243m adverse movement) and the main variances are as follows: • Adult Inpatients – overspent by £0.150m (£0.029m 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. There has also been a continuing reduction in bank costs. • The UNPACS (Unplanned Activities) budget – overspent by £1.143m (£0.083m adverse movement) based on current placements. UnPACS placements are for individuals with very specific needs that require a higher level of security and/or care from a staff group with a particular skill set/competence. There are no local NHS secure facilities for women, people with a learning disability or people with neurodevelopmental disorder. This can necessitate an UNPACs placement with a specialist provider which can be out-of-area. The nature of mental health UNPACs spend is that it is almost exclusively
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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 – underspent by £0.212m (£0.080m favourable). 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 –overspend of £0.447m (£0.004m 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. • Enhanced Mental Health Outcome framework is underspent by £0.624m all of which will be earmarked and carried forward for use in 2025-26 to cover legacy costs for projects and posts that are discontinuing and continued pressures within the Lead Partnership. • Eating Disorders – overspent by £0.107m (£0.003m adverse 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 overspent by £0.495m (£0.045m adverse movement) due to the use of agency staff and junior doctors. A mitigation plan has been developed by the Associate Medical Director to reduce this overspend in 2025-26. • MH Pharmacy – overspent by £0.675m (£0.017m adverse 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. There is pan Ayrshire investment in this area for 2025-26.
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Innovation Fund – underspend of £0.104m (£0.004m adverse movement) due to slippage within some of the projects and not all of the funding has been allocated. • Action 15 has underspent by £0.487m all of which will be earmarked and carried forward for use in 2025-26 to cover legacy costs for projects and posts that are discontinuing. • There is also an underspend in MH Infrastructure of £0.322m which will be earmarked and carried forward for use in 2025-26. • 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 an over recovery of the vacancy savings target of £0.479m (£0.279m favourable) in 2024-25. Further information is included in the table below: Vacancy Savings Target (£1.116m) Projected to March 2025 £1.445m Over/(Under) Achievement £0.329m 2.5 Children and Justice Services Against the full-year budget of £43.717m there is an overspend of £0.577m (1.3%) (£0.981m favourable movement of which £0.934m relates to an underspend for the Whole Family Wellbeing Fund which will be earmarked and carried forward for use in 2025-26) and the main variances are: a) Care Experienced Children and Young People is overspent by £1.903m (£0.005m 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 £1.837m (£0.089m adverse) based 28 placements. 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.
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• 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. The Brighter Pathways progress and recommendations are being finalised and will be presented to the IJB after the summer recess. • Looked After and Accommodated Children (fostering, adoption, kinship etc) is £0.859m underspent (£0.136m favourable). • Children with disabilities – there is a net overspend of £0.496m (£0.041m 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. • Residential respite – placements are overspent by £0.138m (£0.005m favourable). These short-term placements are used to prevent an admission to full time care or to avoid placement breakdown. • Employee costs – are overspent by £0.130m (£0.016m adverse movement), largely due to staffing levels in the children’s houses and regrading of posts. b) Head of Service – is underspent by £0.787m (£0.068m favourable 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 to £0.922m (no change) and which contributes to costs incurred across a number of C&F service areas. c) C&F Health Team – is projected to overspend by £0.351m (£0.067m adverse) mainly in relation to the Band 6 to 7 regrade for Health Visitors and the progression of posts up the Band 7 scale. Part of this recurring cost (£0.246m) has been approved as a budget pressure for 2025/26.
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2.6 ALLIED HEALTH PROFESSIONALS (AHP) The non-employee costs element of the AHP services are on-line as all underspends in employee costs have contributed to payroll turnover. 2.7 CHIEF SOCIAL WORK OFFICER This is overspent by £0.090m (£0.053m adverse) which relates to an overspend in Learning and Development costs. 2.8 MANAGEMENT AND SUPPORT Management and Support Services are projected to underspend by £3.721m (£0.035m favourable) and the main areas of variance are: • There is slippage on the LD and MH transition funding of £0.974m (£0.013m 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 was not achieved in 2024-25 but will be achieved in 2025-26. • The recovery plan actions in relation to the reserves and service redesign funds totalling £0.686m are now reflected in the outturn. • An over-recovery of payroll turnover of £1.163m for social care services and an over-recovery of payroll turnover of £0.483m 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) Achieved at March 2025 £4.464m £2.005m Over/(Under) Achievement £1.163m £0.483m 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
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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 12 £m Red - - Amber 0.523 0.475 Green 9.767 - Blue - 9.815 TOTAL 10.290 10.290 b) The main area to note is that the amber savings in relation to care homes and recovery and rehab will not be fully achieved in 2024-25 but there is a plan to fully deliver in 2025/26. 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 0.004 2 Reduction in SG Allocation for Global sum within prescribing budget 0.002 3 Return Anticipated Specialist Com Perinatal MH, Infant & Neonatal 24/25 as this was reclaimed as part of the EMHOF bundle. 0.750
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4 Training grade adjustment 0.036 5 Mh: Foxgrove - North Share to Reserves 24/25 0.074 6 Mh: Foxgrove - East Share 0.103 7 Mh: Foxgrove - South Share 0.107 8 Balance prescribing to zero 0.364 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. South HSCP: Overspend of £0.598m of which £0.221m will be allocated to North. The variance is mainly due to an overspend of £0.454m in the community store due to overspends on beds and mattresses and moving and handling equipment. There is also a projected overspend of £0.145m in the continence service. East HSCP: Prior to earmarking against specific commitments, there is an underspend of £2.119m on services managed by East Ayrshire IJB under pan- Ayrshire Lead Partnership arrangements. After taking account of earmarking £2.001m, the underspend reduces to £0.118m. The main variances are: Primary Care and Out of Hours Services (Lead Partnership) On a managed services basis, there is an overall underspend of £1.857m on the Primary Care Lead Partnership budget (prior to pan-Ayrshire earmarking £2.001m), resulting in a small overspend of £0.144m. Earmarking includes a net overall underspend of £1.091m on the Primary Care Improvement Fund (PCIF) which has been earmarked for carry-forward on an actual spend basis at individual IJB level, as well as specific PCIF Phased Investment funding £0.819m, which has also been carried-forward to offset expenditure commitments on a pan-Ayrshire NRAC basis. In addition, pan-Ayrshire earmarking of sums to offset future costs in GP premises improvements £0.007m, and Appropriate Adult funding £0.005m have been accounted for on a NRAC basis. Primary Medical Services have overspent £0.556m, due to additional staffing costs, including increased pension, maternity, paternity and sickness cover costs. There are additional costs in Ayrshire Urgent Care Services of £0.064m, with work ongoing to re-design the service to mitigate pressures going forward. Funding has been allocated to fully offset Urgent Care Pathway costs £0.977m, as well as Covid-19 Therapeutics costs £0.202m.
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There is a £0.654m underspend in Dental services that reflects that staffing numbers are running at less than establishment. A sum of £0.079m has been earmarked on a pan-Ayrshire NRAC basis to offset future expenditure on Dental Practices improvements. Prison and Police Healthcare (Lead Partnership) The £0.024m overspend at month 12 is largely due increased staffing costs due to recruitment to vacant posts, as well as increased prescribing costs. Allied Health Professions (Lead Partnership) There is an underspend of £0.391m on AHPs services hosted by East Ayrshire for the current year. This mainly relates to staffing savings in Physiotherapy / MSK and Podiatry services and is partially offset by increased Orthotics costs. Other Services (Lead Partnership) The £0.105m 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 2023/24 prices. IJB Baseline at 2024/25 prices East 31,869,955 North 39,965,941 South 34,488,109 Total 106,324,005 The annual budget for Acute Services is £462.6million. The directorate overspent by £36.9 million in the 12 months to 31 March 2025. This was caused by overspends on agency medical and nursing staff, together with medicines expenditure,
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equipment and supplies. These have been required due to the level of operational pressure being experienced, in common with many other areas in Scotland. November saw a successful reduction in unfunded beds. Operational challenges in December carried on into the final quarter. Ayr had 24 additional beds open between Station 8 and Station 12 every day and an average of 13 on Station 11. Crosshouse continued with 78 unfunded beds open in March, and in addition 24 full capacity beds were open each day on average. The SAFER programme in Crosshouse is progressing well and early indications show a reduction in Length of Stay (LoS) across two wards by 2.5 days each. The cohorting of patients in the active wards is also demonstrating a reduction in LoS in other areas. 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. • 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 were a number of financial risk areas during the year that impacted on the financial position. Some of these will continue into 2025-26 and there are increased risks as a result of the 2024-25 outturn. • The announcements by Scottish Government in relation to public sector finances and in-year spending reductions. • 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.
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• 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. • 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 fully used during this financial year. • 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. Some 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 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 Drawdowns (0.357) (3.379) (0.994) (4.730) New Earmarking - 2.381 - 2.381 Balance – 31 March 2025 - 2.381 0.780 3.161
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The £0.780m HSCP earmarked reserve relates to the Service Redesign and Change Fund which is fully committed across 2024/25 and 2025/26. 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. 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. Since the initial recovery plan was agreed in June 2024, where there was a forecast overspend position of £6.555m, there has been a £4.002m impact on costs, the full benefits of this were not fully attributed to the bottom line as other in-year pressures impacted on the overall position. It is assumed that all mitigations and controls established in 2024-25 continue throughout 2025-26 as it is recognised that the same uncertainty and risks remain into 2025-26 and there needs to be tight grip and control over expenditure overall. 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. At month 7 the IJB requested that the Chief Officer write formally to North Ayrshire Council and NHS Ayrshire and Arran to request additional in-year funding and at month 12 the following has been agreed:
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Social Care element – overspend of £2.036m. North Ayrshire Council considered this at their Cabinet meeting of 3rd June and agreed to fund this with a non-recurring funding increase and no requirement to repay the funds in future years. Health element – overspend of £1.557m. NHS Ayrshire and Arran have funded this, previous discussions with NHS AA colleagues in relation to repayment indicated the Health Board would wait to consider this following North Ayrshire Council’s consideration. The outcome of the decision by North Ayrshire Council has been communicated to NHA AA Director of Finance for consideration. Following these additional funding contributions the final position is on-line. 3. PROPOSALS 3.1 Anticipated Outcomes Continuing to closely monitor the financial position will allow the IJB to take corrective action where required to ensure the Partnership can deliver services in 2025-26 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. 3.3 Measuring Impact The financial position reported is the unaudited year-end outturn position for 2024- 25, further information will also be contained within the unaudited IJB annual accounts. Ongoing updates to the financial position including the reserves position will be reported to the IJB throughout 2025-26. 4. IMPLICATIONS 4.1 Financial The outturn is an overall year-end overspend of £1.212m, which when adjusted for new earmarked reserves of £2.381m is increased to £3.593m. This overspend was brought on-line by additional funding contributions from North Ayrshire Council and NHS Ayrshire and Arran. The report outlines the main variances for individual services. 4.2 Human Resources The report highlights vacancy or turnover savings achieved during the year. Services will review any staffing establishment plans and recruitment in line with normal practice when implementing service change and reviews as per agreement with the IJB. Tight vacancy scrutiny management arrangements are in place for the HSCP. 4.3 Legal
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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 and 24/25 outturn and the known challenges in 25/26. 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 and 2026-27 and the increased focus required on financial rather than service improvement. This will be kept under close scrutiny throughout 2025-26. If we are unable to successfully develop a financial recovery plan to achieve financial balance, and consideration will be given as part of our current review of the strategic plan. 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 March 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 COMMUNITY CARE AND HEALTH 72,796 77,311 4,515 19,753 20,870 1,117 92,549 98,181 5,632 : Locality Services 30,287 31,269 982 5,633 5,722 89 35,920 36,991 1,071 : Community Care Service Delivery 38,598 41,337 2,739 0 38,598 41,337 2,739 : Rehabilitation and Reablement 2,045 2,283 238 0 2,045 2,283 238 : Long Term Conditions 905 951 46 9,921 10,789 868 10,826 11,740 914 : Community Link Workers 331 319 (12) 0 0 0 331 319 (12) : Integrated Island Services 630 1,152 522 4,199 4,359 160 4,829 5,511 682 MENTAL HEALTH SERVICES 34,187 32,714 (1,473) 74,534 75,109 575 108,721 107,823 (898) : Learning Disabilities 25,451 24,956 (495) 568 568 0 26,019 25,524 (495) : Community Mental Health 6,835 6,202 (633) 1,748 1,749 1 8,583 7,951 (632) : Addictions 1,901 1,556 (345) 1,949 1,909 (40) 3,850 3,465 (385) : HBCCC 0 0 0 353 251 (102) 353 251 (102) : Lead Partnership Mental Health NHS Area Wide 0 0 0 69,916 70,632 716 69,916 70,632 716 CHILDREN & JUSTICE SERVICES 38,495 38,721 226 5,222 5,573 351 43,717 44,294 577 : Irvine, Kilwinning and Three Towns 2,946 2,974 28 0 0 0 2,946 2,974 28 : Garnock Valley, North Coast and Arran 3,076 2,196 (880) 0 0 0 3,076 2,196 (880) :Intervention Services 1,173 1,162 (11) 0 0 0 1,173 1,162 (11) : Care Experienced Children & Young people 27,358 29,261 1,903 0 0 0 27,358 29,261 1,903 : Head of Service - Children & Families 1,039 252 (787) 0 0 0 1,039 252 (787) : Justice Services 2,477 2,476 (1) 0 0 0 2,477 2,476 (1) : C&F Health Team 426 400 (26) 4,447 4,798 351 4,873 5,198 325 : Lead Partnership NHS Children's Services 0 0 0 775 775 0 775 775 0 CHIEF SOCIAL WORK OFFICER 1,635 1,725 90 0 0 0 1,635 1,725 90 PRIMARY CARE 0 0 0 53,575 53,662 87 53,575 53,662 87 ALLIED HEALTH PROFESSIONALS 0 10,748 10,749 1 10,748 10,749 1 MANAGEMENT AND SUPPORT COSTS 12,311 9,702 (2,609) 3,373 2,261 (1,112) 15,684 11,963 (3,721) OUTTURN ON A MANAGED BASIS 159,424 160,173 749 167,205 168,224 1,019 326,629 328,397 1,768 TOTAL Partnership Budget - Objective Summary Council Health 2024/25 Budget
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PUBLIC INFORMATION TOTAL Budget Budget Budget Outturn Over/ (Under) Spend Variance Budget Revised Outturn Over/ (Under) Spend Variance Budget Outturn Over/ (Under) Spend Variance £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 £'000 Return Hosted Over/Underspends to East 0 0 0 0 (122) (122) 0 (122) (122) Return Hosted Over/Underspends North 0 0 0 0 0 0 0 0 Return Hosted Over/Underspends to South 0 0 0 0 (229) (229) 0 (229) (229) Receive Hosted Over/Underspends South 0 0 0 0 221 221 0 221 221 Receive Hosted Over/Underspends East 0 0 0 0 (426) (426) 0 (426) (426) OUTTURN ON AN IJB BASIS 159,424 160,173 749 167,205 167,668 463 326,629 327,841 1,212 Adjusted for Earmarking ADP 0 353 353 0 0 0 0 353 353 Whole Family Wellbeing Fund 0 934 934 0 0 0 0 934 934 Action 15 0 0 0 0 135 135 0 135 135 Breastfeeding Network 0 0 0 0 36 36 0 36 36 Enhanced MH Outcome Framework 0 0 0 0 241 241 0 241 241 Early Intervention in Psychosis 0 0 0 0 92 92 0 92 92 Police Scotland 0 0 0 0 1 1 0 1 1 MH Infrastructure 0 0 0 0 124 124 0 124 124 LD SG Funding 0 0 0 0 82 82 0 82 82 Earmarking for East LP services 0 0 0 0 383 383 0 383 383 OUTTURN POSITION PRIOR TO ADDITIONAL FUNDING CONTRIBUTIONS 159,424 161,460 2,036 167,205 168,762 1,557 326,629 330,222 3,593 CONTRIBUTION FROM NORTH AYRSHIRE COUNCIL 2,036 0 (2,036) 0 0 0 2,036 0 (2,036) CONTRIBUTION FROM NHS AYRSHIRE & ARRAN 0 0 0 1,557 0 (1,557) 1,557 0 (1,557) FINAL OUTTURN POSITION 161,460 161,460 0 168,762 168,762 0 330,222 330,222 0 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 12 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 Amber 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 Amber 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 Support Services and Partnership-wide savings
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PUBLIC INFORMATION Health: Description Deliverability Status at budget setting Deliverability Status at Month 12 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 Amber 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 P 26.217 Realign Girfec Team To Connected Commu 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 (0.010) 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 0.008 Drugs Taskforce post 12 T 0.009 ICT Budget Transfers 12 P (0.004) Summer Activities Q4 Draw-Down 12 T 0.001 Apprenticeship Levy 12 P 0.010 EM Funds Victim Witness Support 12 T 0.009 Insurance Excess 12 T 0.026 Change fund - equipment and adaptations 12 T 0.024 Storm Costs 12 T 0.019 CFCR 47 West Road 12 T 0.090 24/25 Insurance Allocation 12 T 0.088 HSCP trf from EM Funds& Invest fund 12 T 0.260 Financial Inclusion VER costs 12 T 0.234 Additional contribution re overspend 12 T 2.036 Roundings 12 T (0.003) 161.460Social Care Budget Reported at Month 12
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PUBLIC INFORMATION 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 (26.217) 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 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)
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PUBLIC INFORMATION HEALTH Period Permanent or Temporary £'m 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 0.282 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 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)
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PUBLIC INFORMATION HEALTH Period Permanent or Temporary £'m 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 (0.041) 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 Specialist/specialty Docs Pay Award 11 0.038 Training Grade Adj - February 11 0.017 Virement 23 Fr Aml443 - part year costs of a Bsnd 3 post transferring from South to North 11 0.001 Hd490 Reduction in SG Allocation for Global sum within prescribing budget 11 (0.002) Rx To Fund Overspend 11 0.110 Reduced Working Week - Mth 9 -12 11 0.220 Mh: Return Anticipated Specialist Com Perinatal Mh, Infant & Neonatal 24/25 - reclaimed via EMHOF 12 (0.750) Enhanced Mental Health Outcome Framework 12 0.968 Medcial Discretioanry Point funding 24/25 12 0.024 Training Grade Adj - March 12 (0.006) Mh: 23/24 Foxgrove Frm Reserves - North Share 23/24 12 0.045 Mh: Foxgrove - North Share To Reserves 24/25 12 (0.074) Training Grade Adj - March 12 (0.030) Mh: Foxgrove - East Share 23/24 12 (0.103) Mh: Foxgrove - South Share 23/24 12 (0.107) Balance Prescribing To Zero 12 (0.364) Learning Disabilities Physical Adaptations 12 0.212 Alzheimer Scotl Dementia Consultants Programme 12 0.010 Additional contribution re overspend 12 1.557 168.762 TOTAL COMBINED BUDGET 330.222 Health Budget Reported at Month 12
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PUBLIC INFORMATION 24-25 IJB Reserves Position Appendix D Balance at 31 March 2024 Area of Reserves Transfers Out 2024-25 Transfers In 2024-25 Balance at 31 March 2025 Earmarked Funds 641 : Alcohol & Drug Partnership (641) 353 353 57 : Mental Health Action 15 (57) 135 135 0 : Primary Care Improvement Fund 0 46 46 1,774 : Service Redesign / Challenge Fund (994) 780 377 : Community Living Change Fund (377) 0 1,313 : Family Wellbeing Fund (1,313) 934 934 50 : Wellbeing Funding (50) 0 0 26 : Breastfeeding Network (26) 36 36 546 : MH Recovery and Renewal /Enhanced MH Outcome Framework (546) 365 365 0 : Early Intervention in Psychosis 0 92 92 23 : Buvidal (23) 0 : LD funding 0 82 82 5 : Brooksby (5) 0 4 : Cossette Funding (4) 0 0 : Donation (Police Scotland) 0 1 1 0 : Primary Care Improvement Fund IP 0 303 303 55 : Expansion of Primary Care Estates (55) 0 63 : GP Premises Improvements - tranches 1 an (63) 3 3 81 : Mental Health Wellbeing in Primary Care (81) 0 0 29 : Dental Practice Improvement (29) 29 29 2 : Appropriate Adult (2) 2 2 19 :Adult Tier 3 Weight Management Service (19) 0 0 22 : Phlebotomy Service (22) 0 0 20 : LD Health Checks (20) 0 46 : LD Health Checks - NHS (46) 0 5,153 Total Earmarked (4,373) 2,381 3,161 357 Unallocated General Fund - NAC (357) 0 0 5,510 General Fund (4,730) 2,381 3,161