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CLASSIFICATION: PUBLIC

EAST AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP

INTEGRATION JOINT BOARD: 28 SEPTEMBER 2016

FINANCIAL MANAGEMENT REPORT AS AT 31 JULY 2016

Report by Chief Finance Officer

PURPOSE OF REPORT

1. The purpose of this report is to provide details of the projected outturn position for the

East Ayrshire Health and Social Care Partnership for 2016/17, based upon the current financial position as at 31 July 2016. This includes an update on the Integrated Care Fund. The report highlights progress against approved recurring cash releasing efficiency savings and provides a brief update on the ongoing delegated budgets due diligence process. The report also provides a summary of the projected outturn on NHS hosted services managed under Lead Partnership arrangements, as well as information on Acute Services budgets in relation to the large hospitals Set Aside resource within the scope of the Strategic Plan. This report will also be presented for Members consideration at the Integration Joint Board Audit and Performance Committee on 1 November 2016.

INTRODUCTION 2. 3. 4.

This report reflects analysis of year-to-date expenditure and income and has been prepared in conjunction with relevant budget holders. The total annual budget allocation £217.724m is based upon funding allocation agreements reached on 10 March 2016 in respect of budgets delegated by East Ayrshire Council and 21 June 2016 in respect of budgets delegated by NHS Ayrshire & Arran. The budget delegated by NHS Ayrshire & Arran represents all services managed by the East Ayrshire Health and Social Care Partnership. This includes all of the Primary Care and Out of Hours functions which are managed on behalf of North and South Ayrshire under a Lead Partnership arrangement. The budget excludes East Ayrshire’s share of the budgets managed under Lead Partnership arrangements by South Ayrshire IJB (Allied Health Professionals) and North Ayrshire IJB (Specialist Mental Health Services / Children’s Services). Work is being undertaking by pan-Ayrshire Planning / Finance Leads to allocate resources to each IJB based on a ‘fair share’ principle. Paragraphs 19 to 21 of this report highlight the 2016/17 projected outturn position for services managed under Lead Partnership arrangements. The current position for the large hospitals Set Aside budget is outlined at paragraphs 24 and 25 of this report. BUDGET MOVEMENTS The initial approved budget £214.669m comprised the East Ayrshire Council delegated budget £71.114m and the NHS Ayrshire & Arran delegated budget £143.555m. The East Ayrshire Council delegated budget increases by £6.210m to £77.324m when the Scottish Government Integration Fund is included. This funding is earmarked for social care pressures and is routed to the IJB via NHS Ayrshire & Arran. The budget has increased to £217.724m at 31 July 2016. The following tables provide a summary of budget movements for the year to date for both Council and NHS managed services.


The movements include cross charging adjustments in respect of funding which transfers between the partner bodies, including Resource Transfer and the Integrated Care Fund, as well as all other transfers to and from initial approved budgets in the year-to-date: Council Managed Services

Annual Estimate 2016/17

£m

Budget Adjustments

to 31/7/16 £m

Revised Budget

£m

Budget allocation approved 10/3/16:

East Ayrshire Council delegated funding 71.114

Scottish Government Integration Fund 6.210

77.324

Additions/transfers to/(from) initial budget:

1. NHS Resource Transfer / Joint Planning / ADP 10.370

2. Integrated Care Fund - Council managed projects 1.308

3. Delayed Discharge funding transfer to NHS (0.284)

4. Delegated Functions managed outwith IJB 1.763

5. Base adjustment (0.025)

6. Grants workstream (0.028)

7. Print Review savings (0.033)

8. Disabled Amenity Grants to HSCP 0.247 13.318

Revised Budget Allocation 31/7/16: 90.642

NHS Managed Services


£m

Budget Adjustments

to 31/7/16 £m

Revised Budget

£m

Budget allocation approved 21/6/16: 143.555

Scottish Government Integration Fund (6.210)

137.345

Additions/transfers to/(from) initial budget:

1. Resource Transfer / Joint Planning / ADP - Council managed (10.370)

2. Integrated Care Fund - Council managed projects (1.308)

3. Delayed Discharge funding transfer from East Ayrshire Council 0.284

4. Urgent Care Programme 0.195

5. Hepatitis C fee increase 0.042

6. Carers' Strategy East 0.083

7. Carers' Strategy from South and East for GPs 0.027

8. Anti-Coagulation non-recurring funding 0.100

9. Primary Medical Services uplift 0.684 -10.263

Revised Budget Allocation 31/7/16: 127.082


EXECUTIVE SUMMARY 5. 6. 7.

The Period 4 Financial Management Report for the Partnership has been compiled following financial analysis and budget monitoring at East Ayrshire Council and NHS Ayrshire & Arran and the objective summary at Appendix 1 details the consolidated position for the Partnership as a whole. Appendices 2 and 3 detail the position for budgets managed within East Ayrshire Council and NHS Ayrshire & Arran respectively. The consolidated projected outturn for the Partnership is an adverse variance of £1.264m which consists of a projected adverse variance of £0.364m for services managed within East Ayrshire Council and a projected adverse variance of £0.900m for services managed within NHS Ayrshire & Arran. The Director of Health and Social Care is pursuing actions to bring expenditure into line with budget. Where these actions require changes to policy or services they will be presented to the Integration Joint Board for approval.

8.

FINANCIAL MANAGEMENT Council Managed Services For services managed within East Ayrshire Council, the £0.364m projected overspend includes the following budget variances:

(i) Children’s Health Care and Community Justice Services

The projected overspend on secure accommodation / outwith placements costs £0.274m was reported to the Outwith Placement Screening Group meeting on 2 August 2016 and is due to increased demand for placements. The approved annual budget for the year £3.734m is net of an approved saving £0.800m. A further £0.500m saving has been approved for 2017/18 and will be extremely challenging. The Alternative Education and Care Programme Board are undertaking work to redesign the service to reduce costs by £1.300m in total by 1 April 2017. The budget for secure accommodation placements £0.307m is fully committed for the current financial year. The budget provides for one full time equivalent placement over the course of the financial year. As at 31 July 2016, one young person has been accommodated and it is considered prudent to project on line with budget at this early stage of the financial year. Demand for secure accommodation and outwith placements is unpredictable and both budgets will be closely monitored over the course of the year.

The projected additional expenditure on secure accommodation and outwith placements is largely offset by savings in other budgets totalling £0.270m. A projected saving of £0.287m in Locality Services is largely due to savings from vacant posts, a significant number of which are due to maternity leave and reflects the difficulty in replacing Social Workers on a temporary basis. Within Authority Wide Services, the marginal projected overspend £0.017m largely relates to additional spend within both internal and external foster care budgets, partially offset by savings on vacant posts.

There are no significant variances to report within Community Justice Services.


9.

(ii) Community Health and Care Services

The projected adverse variance within Learning Disabilities services £0.274m primarily relates to additional care package costs. This projected outturn position takes account of the reinstatement of the 2016/17 reablement and review savings target £0.983m in the budget delegated to the IJB. Reviews of care packages are ongoing and savings are being achieved. These savings are however being consumed by additional demand and increased costs on existing care packages. This budget continues to present considerable challenges and will be closely monitored over the course of the financial year. These additional care packages costs are partially offset by savings from vacant posts within the adult day care service.

The cost of care packages is also the primary overspend within Mental Health services and is projected to outturn by £0.123m over budget. These additional costs are partially offset by higher than anticipated income from charges for care at home services.

The £0.188m projected overspend in Older People’s services largely relates to increasing demand for externally commissioned care at home purchased via Self Directed Services Option 1 (supported person is allocated a sum of money to purchase their own services to meet their needs) as well as increased staffing demand within the Review Team. The budget for elderly residential and nursing care placements is currently projected to outturn on line. Both internally provided and externally commissioned care at home services budgets (outwith SDS option 1) are projected to outturn on line.

The month 4 projection for National Living Wage costs in the externally commissioned care at home sector is predicated on a 25% contribution from service providers. Discussions involving the Scottish Government, COSLA and care providers’ groups are ongoing and any financial implications will be reflected in future Financial Management Reports to the IJB.

(iii) Service Strategy

The projected underspend for the year £0.189m largely relates to staff turnover across the service. This includes service development funding set-aside for posts which are currently vacant but which will be recruited to during the financial year.

The following table provides a subjective analysis of the projected outturn position for Partnership services managed within East Ayrshire Council:

Detail


£m

Projected Actual to 31/3/17

£m

Projected Variance

(Favourable) / Adverse

£m

EMPLOYEE COSTS 39.614 39.076 (0.538)

TRANSPORT COSTS 1.511 1.514 0.003

SUPPLIES & SERVICES 3.844 3.857 0.013

THIRD PARTY PAYMENTS 44.796 45.607 0.811

TRANSFER PAYMENTS 8.389 8.465 0.076

TOTAL EXPENDITURE 98.154 98.519 0.365

INCOME (7.512) (7.513) (0.001)

NET EXPENDITURE 90.642 91.006 0.364


10.

NHS Managed Services For services managed within NHS Ayrshire & Arran, the £0.900m projected overspend includes the following budget variances:

(i) Community Health and Care Services

The £0.604m projected overspend reported within community nursing is primarily due to unachieved Community Health and Care Services efficiency savings totalling £0.696m including £0.168m brought-forward from 2015/16. An element of the savings from the previous financial year £0.162m has recently been identified however the balance remains unallocated resulting in an overspend. Underspends within district nursing are helping to partially offset the shortfall.

Kirklandside is projected to have a small underspend of £0.011m for this financial year. For the year to date, the staffing budget for the ward has overspent due to high use of supplementary staffing (bank and agency) but it is expected that with the recent changes at Kirklandside there will no longer be a requirement for this additional staffing. The supplementary staffing issues highlighted was also the main factor underlying the £0.193m overspend at Kirklandside in 2015/16.

(ii) Primary Care and Out of Hours Services

The overall Lead Partnership Primary Care projected overspend £0.417m includes currently unallocated efficiency savings £0.606m (£0.729m less £0.123m non-recurring dental savings).

General medical services within East Ayrshire are projected to underspend by £0.098m due to a benefit from an over-estimate last year of QOF and Global Sum payments being lower than budgeted. This currently assumes no overspend on the current flu budget.

ADOC is projected to overspend by £0.235m due to GPs having to cover gaps in the nursing rota caused by the shortage and higher turnover of ANPs. An element of the outstanding cumulative efficiency savings £0.280m has been applied against ADOC budgets which increases the projected overspend to £0.515m. Overspends are being offset by reduced expenditure within Primary Medical Services (primarily recruitment and retention payments).

(iii) Service Strategy (Partnership Management)

The overall £0.144m projected variance is largely due to a projected overspend of £0.123m within the partnership management posts which includes non-reclaimable VAT £0.064m and a currently unfunded post for which a solution is being sought. Discussions are still ongoing between the Scottish Government and HMRC to resolve Integration VAT leakage issues with a final VAT opinion expected in October this year.


11.

12.

13. 14.

(iv) Children’s Services

There are ongoing discussions between the East and North HSCPs about a possible realignment of budgets for health visitors, with the potential for some budget to transfer to from East to North. It has been assumed for the purposes of this report that once discussions have been concluded the health visiting budget will be in a balanced position. The £0.082m projected variance takes account of the £0.161m unallocated efficiency saving which is being partially offset against vacant posts in the current year.

The following table provides a subjective analysis of the projected outturn position for Partnership services managed within NHS Ayrshire & Arran:

Detail Annual Estimate

2016/17 £m


£m

Projected Variance


£m

EMPLOYEE COSTS 26.724 27.826 1.102

SUPPLIES & SERVICES 16.420 16.459 0.039

PRESCRIBING COSTS 25.837 25.837 0.000

PRIMARY MEDICAL SERVICES 15.244 15.146 (0.098)

FAMILY HEALTH SERVICES 46.785 46.785 0.000

ADMINISTRATION COSTS 1.095 0.952 (0.143)

TOTAL EXPENDITURE 132.105 133.005 0.900

INCOME (5.023) (5.023) 0.000

NET EXPENDITURE 127.082 127.982 0.900

Paragraphs 8 and 10 highlight that there are a number of additional and continuing pressures within the budget including;

Core services that are unfunded or depend on non-recurring funding

Historic overspends in services that require to be funded or services reduced in line with budget

Unavoidable demand that has not been fully funded. The Partnership Management Team will throughout the year seek to manage and monitor the budget and service implications through tight financial governance. Financial management reports are received and reviewed on a four weekly/monthly basis by budget managers who are fully aware of the requirement to balance budgets and achieve approved cash releasing efficiency targets. Budget pressures and the non-achievement of approved savings represent a key financial risk to the Partnership and progress will continue to be closely monitored with the position outlined in future Financial Management reports to the Integration Joint Board in 2016/17. INTEGRATED CARE FUND The projected outturn figures include anticipated full spend against the Partnership’s share of the £100m Scottish Government Integrated Care Fund £2.470m. This funding has been allocated to Partnerships initially via NHS Boards however responsibility for the funding is delegated to the IJB to support the delivery of health and wellbeing outcomes for adult health and social care and contribute to wider work designed to tackle health inequalities within Community Planning Partnerships. The ICF outcomes are being delivered through a total of 42 dedicated projects.


15. 16.

There were originally 47 projects however 5 have been discontinued with 6 subject to redesign. Appendix 4 to this report provides a summary of projected spend v budget across continuing projects. The annual budget allocation against the continuing projects was highlighted in the Integrated Care Fund 2016/17 report which was approved by the IJB on 24 March 2016 in terms of continued investment in community capacity and preventative interventions. Projected expenditure of £1.798m against continuing projects is projected for the year. It was agreed at the IJB Development Day on 18 February this year that opportunities for further innovation / transformational change could be funded from the ICF and the summary highlights additional planned expenditure in the current year £0.672m. This includes a currently unallocated balance of funding £0.121m which will be utilised by 31 March 2017. The ICF will continue to be closely monitored over the course of the financial year to ensure that outcomes are delivered. CASH RELEASING EFFICIENCY TARGETS In total, additional recurring cash releasing efficiency savings of £2.971m have been approved for the East Ayrshire Health and Social Care Partnership for 2016/17. This overall savings target comprises £1.717m approved for services managed within East Ayrshire Council and £1.254m approved for services managed within NHS Ayrshire & Arran. Council Managed Services The savings tracker at Appendix 5 highlights progress in relation to achievement of 2016/17 Council approved savings on a recurring and sustainable basis. This is presented in a ‘traffic lights’ format and the following paragraphs provide information on savings highlighted at red and amber:


The approved £0.402m efficiency from reablement and promotion of independent Living within East Ayrshire Council Older People’s services coupled with additional demand for services represents a considerable challenge at this time. The third bullet point at paragraph 8 (ii) highlights a £0.188m projected overspend in Older People’s services which largely relates to increasing demand for externally commissioned care at home purchased via Self Directed Services Option 1. A review team is in place with the ultimate aim of matching resources to budget. Savings are being achieved however these savings are being consumed by demand for additional care packages.

(ii) Children’s Health Care and Community Justice

The approved £0.350m efficiency from rebalancing foster care provision from external to internal comprises an agreed savings target of 7 external places. It is anticipated that this will be achieved by the end of the financial year however the timing of placement end dates results in a marginal projected overspend of £0.024m. Due to the uncertain nature of demand for additional foster care placements it is considered prudent to highlight progress at amber at this early stage of the financial year.


17.

As previously outlined at the first bullet point at paragraph 8 (i) the projected overspend on outwith placements costs £0.274m is due to increased demand for placements. The approved annual budget for the year £3.734m is net of the £0.800m approved saving. A further £0.500m saving has been approved for 2017/18 and will be extremely challenging. The Alternative Education and Care Programme Board comprising staff from the Health and Social Care Partnership and East Ayrshire Council’s Education service is undertaking work to redesign the service to reduce costs by £1.300m in total by 1 April 2017. A report entitled Development of Residential Childcare and Intensive Foster Care Services was presented to East Ayrshire Council Cabinet on 22 June 2016. This report highlighted that Cabinet had previously approved a report on a new approach to seeking better outcomes for looked after and accommodated children in East Ayrshire on 5 March 2014. The financial model approved in the March 2014 report was a gross saving of £3.045m on outwith placement costs, offset by additional investments totalling £1.688m, resulting in a net saving of £1.357m (rounded down to £1.300m) by the close of financial year 2016/17. The additional investments comprised recruitment of additional 12 Intensive Foster Carers and the construction of an additional children’s house. On 22 June 2016, Cabinet approved the recruitment of a reduced number of Intensive Foster Carers alongside the development of a revised two/four bedded children’s house model which will result in the purchase of a two bedded house and either the purchase of a four bedded house or the scoping of appropriate sites. The revised children’s houses model results in a recurring annual commitment of £1.139m incorporating staffing costs £0.954m, running costs £0.099m and capital debt charges £0.086m. The current projected overspend on outwith placements is £0.274m and this approved additional investment in the two children’s houses alongside the requirement to deliver a further saving on outwith placements of £0.500m from 2017/18 represents a significant financial risk for the IJB at this stage.

NHS Managed Services The savings tracker at Appendix 6 highlights progress in relation to achievement of 2016/17 NHS approved savings on a recurring and sustainable basis. This is also presented in a ‘traffic lights’ format and the following paragraphs provide information on savings highlighted as red and amber:


The approved 3% efficiency savings target for core NHS services from 2015-16 totalling £0.330m was partially achieved with £0.168m still to be finalised at this stage of the current financial year. The 5% additional efficiencies target for 2016/17 £0.528m has still to be finalised in the current financial year. The total unallocated saving is £0.696m and is allocated at this stage against Community Nursing within Appendices 1 and 3 of this report. Discussions are ongoing to identify recurring solutions and once finalised the savings will be allocated to services as appropriate.


18.

19. 20.

(ii) Children’s Health Care and Community Justice

The approved 3% efficiency target for NHS Children’s Services in 2015/16 £0.062m was offset against savings from vacant Health Visitor posts. The 5% additional efficiencies target for 2016/17 £0.099m is partially offset by savings from vacant Health Visitor posts in the current year. The total unallocated saving is £0.161m. Discussions are ongoing to determine how this saving is to be achieved on a recurring basis however the budget largely comprises direct staffing costs which presents difficulty in respect of Scottish Government aspirations to increase Health Visitor numbers.

(iii) Primary Care and Out of Hours Services

The approved 3% efficiency target for Primary Care in 2015/16 £0.283m was partially achieved with £0.123m being realised in-year through non-recurring underspends within dental. The 5% additional efficiencies target for 2016/17 £0.606m has still to be finalised in the current financial year. The total unallocated saving is £0.729m. Discussions are ongoing to identify recurring solutions and once finalised the savings will be allocated to services as appropriate.

DUE DILIGENCE PROCESS The Approved Budget 2016/17 report to the IJB on 18 August 2016 outlined that work is being undertaken to finalise a consolidated due diligence report for the three Ayrshire Health and Social Care Partnerships. On completion, this paper will initially be considered by the pan Ayrshire Strategic Planning and Operations Group and the Chief Executives Group. Following these initial discussions individual budget due diligence reports will be submitted for approval by each of the IJBs. These reports will consider if all base line budget issues have been addressed to ensure that unresolved issues can be discussed with parent organisations. These reports will ultimately provide an assessment of the IJBs ability to proceed with service planning to align to the wider Strategic Plan in line with budgets delegated by the parent organisations. It is anticipated that the East Ayrshire due diligence report will be submitted to the next meeting of the IJB on 24 November 2016. LEAD PARTNERSHIP SERVICES

The Integration Scheme creates various Lead Partnership roles across the three Ayrshire Integration Joint Boards. Within the Integration Scheme, as with all delegated budgets, the intention is that services should be delivered within budget. Should that not be possible, a recovery plan requires to be developed and approved by all three Integration Joint Boards. Failure to reach agreement will require interim additional contributions in proportion of service usage pending final agreement of the recovery plan. In 2015/16 there was an agreement that the financial position would be viewed as a further year of due diligence and each parent organisation would take responsibility for any shortfall in funding. As highlighted previously at paragraph 18 of this report, a due diligence exercise is being carried out for 2016/17. Should recovery plans fail for Lead Partnership managed services, then all IJBs are required to address any shortfalls which are not related to base line budget issues. Shortfalls will be distributed to each partner based on a ‘fair share’ principle which is currently being developed across the three Ayrshire partnerships.


21. 22.

Given the potential financial impact on the East Ayrshire IJB, it is therefore important to understand the 2016/17 projected financial position of budgets being managed in Lead Partnership arrangements:

In East Ayrshire Integration Joint Board the Primary Care budgets are projected to marginally overspend by £0.417m at this early stage of the financial year. The main pressure is on the out of hours medical service where there is a shortage of ANPs, as well as efficiency targets to achieve. This is being partially offset by underspends within dental and primary medical services.

In North Ayrshire Integration Joint Board, Specialist Mental Health Services and Children’s Services (Health Visiting) are both projecting overspends of £1.146m and £0.280m respectively in the current financial year. The main budget pressures are as follows:

Specialist Mental Health Services: Adult inpatient wards £0.688m. Supplementary staffing within Woodland View

to cover sickness absence and constant observations. This includes increased use of agency staff due to shortage of bank staff willing to travel to Irvine.

Elderly inpatient wards £0.210m. Staffing over-establishment in some wards with use of supplementary staffing to cover sickness absence.

Adult community services. £0.081m. This relates to the requirement to provide out of hours liaison cover at University Hospital Crosshouse to replace the Advanced Nurse Practitioner service which transferred to Woodland View.

Addiction service ward £0.085m. This relates to the new detox model of care delivered from Woodland View which was part of the business case and forward planning for the new service including the design of the new addiction service ward, but which did not receive funding in the NHS budget.

Children’s Services: Projected overspend £0.280m in relation to trainee Health Visitors. The

Scottish Government has awarded additional funding in the 2016/17 budget to allow planned growth in Health Visitor posts. Funding received has been insufficient to fully fund the numbers targeted by the Scottish Government and negotiations are continuing with NHS Ayrshire & Arran to resolve.

In South Ayrshire Integration Joint Board, the Allied Health Professionals Services are projected to be in a balanced position at this early stage of the financial year.

MITIGATING ACTION Integration Joint Boards as Lead Partners have responsibility for developing recovery plans for services which are over-spending. These recovery plans require to be agreed by the host IJB and presented to the other two IJBs for approval. Recovery plans will require to consider gaps in funding commitments to deliver on service outcomes under due diligence. The actions being taken by North Ayrshire HSCP in respect of Specialist Mental Health Services and Health Visiting is presented in Appendix 7. It is important to note that this recovery plan is reliant on additional funding being secured from NHS Ayrshire & Arran for gaps in funding commitments. If this funding is not provided, further mitigating action will be required.


23. 24. 25.

A recovery plan will be developed for Ayrshire Doctors on Call. This plan will require to consider gaps in funding commitments under due diligence and identify operational risks associated with potential reduced service provision to achieve financial balance in the current financial year. SET ASIDE BUDGET The Integration Scheme establishes that pressures in respect of large hospitals Set Aside budgets will be managed in-year by NHS Ayrshire & Arran with any over or under spend being considered as part of the annual budget setting process. Acute Services within NHS Ayrshire & Arran continue to face particular budget pressures around the costs of covering a high level of medical vacancies and the increasing needs of patients requiring nursing support above funded levels. These pressures are being scrutinised and options developed to minimise costs. It is difficult to estimate the total Set Aside budget for 2016/17 as there are a high number of unfunded beds in use to meet demands. This will be managed in-year by NHS Ayrshire & Arran and the budget implications for 2017/18 which are not linked to base line budget issues will be discussed across the three Ayrshire Partnerships. Guidance published by the Integrated Resources Advisory Group (IRAG) highlights that for each Integration Joint Board, the resources within the scope of the Strategic Plan will comprise the integrated budget (i.e. the sum of the payments to the IJB from the NHS Board and Council) and the amount set-aside by the NHS Board for large hospital services for use by the IJB population. The ability to plan with the overall resource for defined populations and user groups and to use budgets flexibly is one of the hallmarks of integrated care. The initial Set Aside budget for each Ayrshire Integration Joint Board will be based upon their historic use of Acute Services. The Integration Scheme outlines that any redesign of service will require to be agreed across the three IJBs and reflected in the Strategic Plans.

RECOMMENDATIONS

26. It is recommended that the Integration Joint Board:

i) Note the projected outturn position for East Ayrshire Health and Social Care Partnership at July 2016, including specific key actions on significant variances;

ii) Note the projected outturn in respect of services funded from the Integrated Care Fund and approve the additional innovation projects £0.672m funded from slippage in 2016/17;

iii) Note progress towards achievement of approved cash releasing efficiency

savings;

iv) Note the ongoing Due Diligence process in respect of 2016/17 baseline budgets;

v) Note the projected outturn position in respect of services managed under Lead

Partnership arrangement;

vi) Note the mitigating actions being taken and approve the recovery plan put forward by North Ayrshire Health and Social Care Partnership in respect of Specialist Mental Health Services and Children’s Services;


vii) Direct the Director of Health and Social Care to produce an overall recovery

plan and associated analysis of risks to achieve financial balance in the current financial year;

viii) Direct the Director of Health and Social Care to produce a recovery plan and

associated analysis of risks for the Lead Partnership Ayrshire Doctors on Call for consideration and approval by all three Ayrshire Integration Joint Boards;

ix) Note the current position in respect of large hospital set aside budgets; and

x) Otherwise note the content of the report.

Craig McArthur Chief Finance Officer 21 September 2016 For further information please contact: Alex McPhee, Senior Manager – Finance, East Ayrshire Health and Social Care Partnership, East Ayrshire Council Headquarters, London Road, KILMARNOCK, KA3 7BU: Tel – 01563 576213: e-mail: [email protected]

mailto:[email protected]


Appendix 1

APPENDIX 1

East Ayrshire Health and Social Care Partnership - Revenue Budget Monitoring 2016/17

Consolidated Monitoring Report Period 4 : 1st April 2016 - to 31st July 2016

Service Division


£m


£m

Projected Variance


£m

Core Services

LEARNING DISABILITIES 16.522 16.802 0.280

MENTAL HEALTH 5.587 5.663 0.076

ADDICTION 1.954 1.953 (0.001)

ADULT SUPPORT & PROTECTION 0.374 0.374 0.000

OLDER PEOPLE 37.732 37.920 0.188

PHYSICAL DISABILITIES 2.393 2.377 (0.016)

SENSORY 0.172 0.166 (0.006)

SERVICE STRATEGY 6.110 6.065 (0.045)

TRANSPORT 0.456 0.456 0.000

HEALTH IMPROVEMENT 0.197 0.197 0.000

COMMUNITY NURSING 3.660 4.264 0.604

PRESCRIBING 25.837 25.837 0.000

GENERAL MEDICAL SERVICES 15.244 15.146 (0.098)

INTEGRATED CARE FUND 2.470 2.470 0.000

118.708 119.690 0.982

Non District General Hospitals

EAST AYRSHIRE COMMUNITY HOSPITAL 2.939 2.916 (0.023)

KIRKLANDSIDE HOSPITAL 1.195 1.184 (0.011)

4.134 4.100 (0.034)

Lead Partnership Services

STANDBY SERVICES 0.242 0.242 0.000

PRIMARY CARE (INCLUDING DENTAL) 66.031 66.448 0.417

PRISON AND POLICE HEALTHCARE 2.975 2.876 (0.099)

WAR PENSIONER 1.224 1.225 0.001

OTHER LEAD SERVICES 0.147 0.072 (0.075)

70.619 70.863 0.244

Children's Services

CHILDREN & FAMILIES / WOMEN'S SERVICES 18.203 17.933 (0.270)

SECURE ACCOMMODATION / OUTWITH PLACEMENTS 4.041 4.315 0.274

JUSTICE SERVICES 1.785 1.771 (0.014)

HEALTH VISITING 2.289 2.371 0.082

26.318 26.390 0.072

Funded Elements

JUSTICE SERVICES GRANT (2.055) (2.055) 0.000

(2.055) (2.055) 0.000

TOTAL 217.724 218.988 1.264

APPENDIX 2


Appendix 2


Council Monitoring Report Period 4 : 1st April 2016 - to 31st July 2016

Service Division


£m


£m

Projected Variance


£m

Core Services


MENTAL HEALTH 3.477 3.600 0.123

ADDICTION 0.868 0.868 0.000

ADULT SUPPORT & PROTECTION 0.374 0.374 0.000

OLDER PEOPLE 37.448 37.636 0.188

PHYSICAL DISABILITIES 2.393 2.377 (0.016)

SENSORY 0.172 0.166 (0.006)

SERVICE STRATEGY 5.713 5.524 (0.189)

TRANSPORT 0.456 0.456 0.000

HEALTH IMPROVEMENT 0.197 0.197 0.000

INTEGRATED CARE FUND - COUNCIL LED 1.308 1.308 0.000

68.426 68.800 0.374


STANDBY SERVICES 0.242 0.242 0.000

0.242 0.242 0.000

Children's Services

CHILDREN & FAMILIES / WOMEN'S SERVICES 18.203 17.933 (0.270)

SECURE ACCOMMODATION / OUTWITH PLACEMENTS 4.041 4.315 0.274

JUSTICE SERVICES 1.785 1.771 (0.014)

24.029 24.019 (0.010)

Funded Elements

JUSTICE SERVICES GRANT (2.055) (2.055) 0.000

(2.055) (2.055) 0.000

TOTAL 90.642 91.006 0.364


Appendix 3


NHS Monitoring Report Period 4 : 1st April 2016 - to 31st July 2016

Service Division


£m


£m

Projected Variance


£m

Core Services


MENTAL HEALTH 2.110 2.063 (0.047)

ADDICTION 1.086 1.085 (0.001)

COMMUNITY NURSING 3.944 4.548 0.604

PRESCRIBING 25.837 25.837 0.000

GENERAL MEDICAL SERVICES 15.244 15.146 (0.098)

SERVICE STRATEGY (PARTNERSHIP MANAGEMENT) 0.397 0.541 0.144

INTEGRATED CARE FUND - NHS LED 1.162 1.162 0.000

50.282 50.890 0.608

Non District General Hospitals

EAST AYRSHIRE COMMUNITY HOSPITAL 2.939 2.916 (0.023)

KIRKLANDSIDE HOSPITAL 1.195 1.184 (0.011)

4.134 4.100 (0.034)


PRIMARY CARE (INCLUDING DENTAL) 66.031 66.448 0.417

PRISON AND POLICE HEALTHCARE 2.975 2.876 (0.099)

WAR PENSIONER 1.224 1.225 0.001

OTHER LEAD SERVICES 0.147 0.072 (0.075)

70.377 70.621 0.244

Children's Services

HEALTH VISITING 2.289 2.371 0.082

2.289 2.371 0.082

TOTAL 127.082 127.982 0.900

APPENDIX 4East Ayrshire Health and Social Care Partnership

Integrated Care Fund (ICF) 2016/17 - All Projects

Project

Number Project Name NHS/LA 2016/17

Annual

Budget

2016/17

£

Projected

Cost

2016/17

£

Projected

Variance

2016/17

£

1 East Ayrshire Carers Centre NHS CONTINUE 30,000 30,000 0

2 Volunteer Centre: Befriending Project NHS CONTINUE 30,000 30,000 0

3 East Ayrshire Advocacy Project NHS CONTINUE 20,000 20,000 0

4 The Zone: Homebuddies NHS CONTINUE 70,000 70,000 0

5 Garden Maintenance Scheme NHS CONTINUE 15,000 15,000 0

6 Training, Asset Mapping & Network Development NHS CONTINUE 20,000 20,000 0

7 Connect Call Service NHS CONTINUE 20,000 20,000 0

8 3rd Sector Service delivery NHS CONTINUE 40,000 40,000 0

9 Management & administration fee NHS CONTINUE 5,000 5,000 0

10 Data Analyst Post NHS DISCONTINUE 0 0 0

11 Dieticians - Band 6 (1.2 wte) NHS CONTINUE 44,689 57,397 12,708

12 Telehealthcare Support LA CONTINUE 120,000 59,318 -60,682

13 Falls Screening NHS CONTINUE 24,000 11,459 -12,541

14 Falls Lead NHS CONTINUE 15,000 14,472 -528

15 Dementia Strategy Officer LA DISCONTINUE 0 0 0

16 New Models of Care in Care Homes LA REDESIGN 90,000 30,000 -60,000

17 Development Officer (Pan Ayrshire) LA CONTINUE 20,200 22,200 2,000

18 Community Ward Service NHS CONTINUE 190,000 175,407 -14,593

19 Supported Accommodation and Community Health Development LA CONTINUE 75,000 75,000 0

20 Supported Accommodation and Community Health Development LA CONTINUE 55,000 55,000 0

21 Falls - Invigor8 LA CONTINUE 18,241 18,241 0

22 Red Cross - recurring (gross - NAC & SAC share) LA CONTINUE 93,145 93,145 0

23 My Home Life LA CONTINUE 42,185 31,355 -10,830

24 Nurse training commitment - G5 to G6 implications NHS CONTINUE 20,847 10,000 -10,847

25 Developing Enhanced Dental Services in Primary Care NHS CONTINUE 67,000 44,538 -22,462

26 Joint Equipment Store NHS DISCONTINUE 0 0 0

27 Care & Repair LA CONTINUE 40,000 40,000 0

28 Improvement Support Team LA CONTINUE 145,348 145,348 0

29 Supporting Adoption of House of Care NHS REDESIGN 21,000 0 -21,000

30 A new model for integrated. Person-centred, Community based Health & SC NHS REDESIGN 66,000 0 -66,000

31 Self Management Support Network NHS CONTINUE 2,600 2,600 0

32 Talking About Diabetes - For Carers & Home Care Staff NHS REDESIGN 3,223 3,223 0

33 Improving collaboration across Health & SC for people living with diabetes in A&A NHS REDESIGN 48,033 49,099 1,066

34 Delivering Talking Mats Training NHS CONTINUE 13,089 13,089 0

35 Food, fluid and nutrition NHS REDESIGN 40,000 37,200 -2,800

36 Weigh to Go - Leisure provision NHS CONTINUE - 16/17 ONLY 16,725 16,725 0

37 Post Diagnostic Support LA CONTINUE 65,553 65,553 0

38 GP Cover EACH (non-recurring 15/16 only) NHS DISCONTINUE 0 0 0

39 Rehabilitation, Health & Wellbeing Programme for individuals with Multi-Morbidity NHS REDESIGN 98,351 98,351 0

40 Weight Management NHS CONTINUE 30,000 30,000 0

41 Partners for Change LA DISCONTINUE 0 0 0

42 Pharmacy Input to MDTs, Care Homes & Care at Home NHS CONTINUE 52,000 50,734 -1,266

43 Community Connectors LA CONTINUE 200,000 200,000 0

44 Local Practitioner Networks NHS CONTINUE 10,000 10,000 0

45 Community Access to information in range of media LA CONTINUE 20,000 20,000 0

46 Community Equipment Service - equipment NHS CONTINUE 93,300 20,000 -73,300

47 MHO - Grade 12 Team Manager LA CONTINUE 48,260 48,260 0

Total Projects Expenditure 2,138,788 1,797,714 -341,074

Other Expenditure 2016/17 NHS/LA

Projected

Cost

2016/17

£

Innovation / Transformational Change:

ICES/Comm Alarms LA 125,000

Action for Hearing Loss LA 8,433

Participatory Budgeting LA 10,000

Participatory Budgeting LA 30,000

Discharge to Assess LA 160,000

Phlebotomy NHS 63,340

District Nursing NHS 30,000

Occupational Therapy NHS 35,562

Project Management - CM2000 LA 46,000

Project Management - Supported Tenancy / Shared Lives LA 25,555

Workforce Planning Lead NHS 17,872

Innovation Fund / Transformational - balance (budgeted in NHS pending allocation) NHS 120,524

Total Other Expenditure 672,286

Total ICF Expenditure 2,470,000


APPENDIX 5

Council managed services: efficiences tracker

Division of Service Options

2016/17

Approved

Saving

£m

Progress

Community Health and

Care Services

Review of adults day care in

line with self directed support,

and a reduced emphasis on a

buildings based model of care.

0.075 Green


Care Services

Review of charges and

charging policy

0.083 Green


Care Services

Increase focus on reablement

and promotion of independent

living

0.402 Amber

Children's Health Care

and Community Justice

Services

Expand the Council's internal

foster service and reduce the

use of externally funded foster

care placements for short term

/ emergency placements.

0.350 Amber



Services

Continue to implement

strategies to maintain reduced

level of secure accommodation

presentations

0.007 Green



Services / Education

Services (East Ayrshire

Council)

Development of an integrated

educational and care provision

for children / young people

with complex / additional

needs.

0.800 Red

Total 1.717


APPENDIX 6

NHS managed services: efficiences tracker

Division of Service Options

2015/16

Approved

Saving £m

2015/16

Saving

Achieved

£m

2016/17

Unachieved

Saving £m

2016/17

Approved

Saving £m

2016/17

Saving

Achieved

£m

2016/17

Unachieved

Saving £m

Total

Unallocated

Saving £m

Progress

Community Health

and Care Services

2015/16: 3% CRES

2016/17: 5% CRES

0.330 0.162 0.168 0.528 0.000 0.528 0.696 Red

Primary Care 2015/16: 3% CRES

2016/17: 5% CRES

0.283 0.160 0.123 0.606 0.000 0.606 0.729 Red

Children's Health

Care and

Community Justice

Services

2015/16: 3% CRES

2016/17: 5% CRES

0.062 0.000 0.062 0.099 0.000 0.099 0.161 Red

Service Strategy 2015/16: 3% CRES

2016/17: 5% CRES

0.013 0.013 0.000 0.021 0.021 0.000 0.000 Green

Total 0.688 0.335 0.353 1.254 0.021 1.233 1.586


Objective Heading Service Area Action

Lead

Partnership

target

saving

£'000

· 1% reduction in total sickness absence levels across

unit

· 20 % reduction in staff hours associated with

enhanced observations

· Review of IPCU model to include function of crisis

admission for those from acute required significantly

enhanced care for a short period

· Introduce Mental Health specific bank nursing system

to support short notice needs in Mental health inpatient

services reducing spend on expensive agency nursing

· Reducing requirement for whole shift cover to meet

short notice & term needs through allocation/movement

of staff across Woodland View site and as per

discussion at Daily Huddle

· Review of the nursing workforce tool

· 1% reduction in total sickness absence levels across

unit

· Introduce Mental Health specific bank nursing system

to support short notice needs in Mental health inpatient

services reducing spend on expensive agency nursing

· Reducing requirement for whole shift cover to meet

short notice & term needs through allocation/movement

of staff across Ailsa site and as per discussion at Daily

Huddle

· Continuing reduction in Band 2/3 posts as per agreed

adjustment to skill mix/numbers as existing surplus staff

leave

· Review of the nursing workforce tool

: Lead Partnership – adult community Continue to pursue additional funding from the NHS for

out of hours liaison cover at Crosshouse

81

: Lead Partnership – addictions ward Continue to pursue additional funding from the NHS for

this detox ward

85

809

Children's Services and

Criminal Justice

: Health Visitors Continue to pursue the NHS for adequate funding to

support this initiative. This is the amount being requested

in the report being considered by the NHS (£0.349m).

349

349

1,158

Mitigating action required:

REVISED TOTAL

APPENDIX 7

North Ayrshire Health and Social Care Partnership

TOTAL – Children’s Services and Criminal Justice

TOTAL – Mental Health

: Lead Partnership - elderly inpatients 210

Mental Health : Lead partnership - adult Inpatients 433

Lead Partnership managed services 2016/17


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