IJB029 Budget Scrutiny: Integration Authorities The Committee has chosen to consider the integration of health and social care as part of its consideration of the Scottish Government‟s budget. The following questions are designed to explore the budget setting process for 2016-17 and how budget allocation reflects the priorities set out in the performance framework. 1. Which integration authority are you responding on behalf of? South Ayrshire Integration Joint Board 2. Please provide details of your 2016-17 budget: £m Health board 94.6 Local authority 66.6 Set aside budget 21.6 Total 182.8 3. Please provide a broad breakdown of how your integration authority budget has been allocated across services, compared with the equivalent budgets for 2015-16. £m 2015-16 2016-17 Hospital 27.2 27.4 Community healthcare 32.7 33.2 Family health services & prescribing 37.4 38.7 Social care 83.0 83.5 Total 180.3 182.8 1 IJB029 4. The 2016-17 budget allocated £250m for social care. Please provide details of the amount allocated to your integration authority and how this money has been utilised. South Ayrshire IJB‟s share of the £250m investment for social care is £5.83m. The additional SG funding will be used to meet pay and inflationary uplifts in 2016/17; the cost of the living wage from 1st October 2016 and the shortfalls in funding base for services in place prior to 31 March 2016. Budget setting process 5. Please describe any particular challenges you faced in agreeing your budget for 2016-17 The delegated budget from NHS Ayrshire and Arran was not formally approved until 21 June 2016. 6. In respect of any challenges detailed above, can you describe the measures you have put in place to address these challenges in subsequent years? We are reviewing our experience in setting the 2016/17 budget with work being undertaken on a pan-Ayrshire basis through groups (Strategic Planning and Operational Group, Integration Finance Leads, Directors of Finance Group, Chief Executives Group) and will report to the Chief Executive Group. The timing and coordination of budget settings in the IJB is dependent on clarity of funding to the Council and NHS Board and subsequent delegation. 7. When was your budget for 2016-17 finalised? This remains under discussion in respect of certain aspects. The element of the budget that has been applied to social care services is finalised along with plans for the utilisation of additional monies. However, because of the late approval of the health budget an indicative contribution to the integrated budget was provided by NHS Ayrshire and Arran. This will require further adjustment before a full, final base budget can be confirmed. 8. When would you anticipate finalising your budget for 2017-18? March 2017. Integration outcomes 2 IJB029 9. Please provide up to three examples of how you would intend to shift resources as a result of integration over the period of your Strategic Plan: By enhancing anticipatory care there should be fewer admissions to hospital with a consequential reduction in acute in-patient stays. Increasing the multi-disciplinary rehabilitation teams should reduce the length of stay in a hospital setting and assist older people to maintain independent living. Intervention by rehabilitation teams at A&E should identify alternative solution rather than admission to hospital resulting in a reduction in admissions. Development of third sector services to assist with support to older people on discharge should allow discharges to be effected at an earlier stage. 10. What efficiency savings do you plan to deliver in 2016-17? The following efficiency savings are planned: Outstanding Service Area Requirements £ M Chalmers Road Respite Facility 0.107 Learning Disability Services 0.082 Call Monitoring System 0.105 Community Transport 0.045 Day Care contract savings 0.100 3 IJB029 Rebalancing of Nursing/Residential Care 0.100 placements Review of Management Costs 0.050 Respite - close monitoring of usage 0.250 Sleepovers 0.150 Mental Health Care Packages 0.120 LD Care Packages 0.200 PD Care Packages 0.100 Meals on Wheels 0.100 General Contract Efficiencies 0.270 AHP management post 0.080 Dietetic supplies 0.020 Addiction post 0.062 Reduction in Agency costs 0.050 Management of enhanced services 0.080 Vacancy management 1.250 4 IJB029 The following budgets were released as a result of a review of the budget provision: Outstanding Service Area Requirements £ M Self Directed Support Underspend 0.200 Day care meals income review 0.012 Resource Transfer income review 0.134 Care at Home – OP 0.315 11. Do you anticipate any further delegation of functions to the integration authority? (If so, please provide details of which services and anticipated timescales) In setting up the IJB, South Ayrshire Council and NHS Ayrshire and Arran agreed to include Children‟s Community Health Services and Social Work Services for Children and Young People and Criminal Justice within the Integration Scheme. 5 IJB029 Performance framework 12. (a) Please provide details of the indicators that you will use to monitor performance and show how these link to the nine national outcomes The HSCP is finalising the performance framework for inclusion in the first Annual Report to be considered by the IJB in September 2016. This work is still in development. Performance reports have been submitted to the IJB Performance and Audit Committee. A copy of a recent report from June 2016 is attached below. (b) If possible, also show how your budget links to these outcomes National Outcome Indicators 2016-17 budget People are able to look after and We are will be using the Core Suite of Integration N/A improve their own health and wellbeing Indicators published by the Scottish Government. See: and live in good health for longer. http://www.gov.scot/Resource/0047/00473516.pdf People, including those with disabilities N/A or long-term conditions, or who are frail, are able to live, as far as reasonably practicable, independently and at home or in a homely setting in their community. People who use health and social care N/A services have positive experiences of those services, and have their dignity respected. Health and social care services are N/A centred on helping to maintain or improve the quality of life of people who use those services. 6 IJB029 National Outcome Indicators 2016-17 budget Health and social care services N/A contribute to reducing health inequalities. People who provide unpaid care are N/A supported to look after their own health and wellbeing, including to reduce any negative impact of their caring role on their own health and wellbeing. People who use health and social care N/A services are safe from harm. People who work in health and social N/A care services feel engaged with the work they do and are supported to continuously improve the information, support, care and treatment they provide. Resources are used effectively and N/A efficiently in the provision of health and social care services. 7 IJB029 SOUTH AYRSHIRE HEALTH AND SOCIAL CARE PARTNERSHIP PERFORMANCE AND AUDIT COMMITTEE 17th June, 2016 Report by Director of Health & Social Care 1. PURPOSE OF REPORT 1.1 The purpose of this report is to submit for consideration the second Partnership Performance Report for aspects of service for Adults and Older people and the initial report for Children‟s Health Care and Criminal Justice, comprising both baseline information and in some cases information for the period to 31st March 2016. 2. RECOMMENDATION 2.1 That the Performance & Audit Committee considers and notes the performance data detailed in Appendix 1 and Appendix 2. 3. BACKGROUND INFORMATION 3.1 At the December 2015 meeting of the Performance and Audit Committee the initial Partnership Performance Report for Adult and Older People‟s Services for the period to 30th September 2015 was submitted for consideration.. It was agreed that updates would be submitted to the Committee on a six monthly basis for its consideration and that the next reporting cycle would include the Children‟s Health and Criminal Justice Performance Report. Information is provided up to the 31st March 2016, where available, or alternatively the most recently published data is provided. It should be noted that some data for Children‟s Health and Care is not available for 2015/16, or the latest quarters, due to the reporting schedule being aligned to the Educational year i.e. from August to July each year rather than the financial year of April to March. 8 IJB029 3.2 The range of the performance data being presented is still fairly limited in that it does not cover all of the functions delegated to the Partnership, particularly in relation to the areas noted below at 3.3. The construction of the performance framework will continue to develop and evolve within this strategic planning period as services are reviewed and change in accordance with the programme of activity that has begun. 3.3 At the last meeting of the Committee it was acknowledged that there are areas where further development is required in terms of measures to reflect all of the activity within the Partnership, including those noted below: District Nursing Learning Disabilities Mental Health Corporate Performance measures Work has been undertaken since the last report to incorporate a range of Health Promotion indicators and these are now included in both performance reports. Discussions have also taken place with Allied Health Professional Leads who are currently in the process of mapping available data to the Strategic Objectives to allow for future reporting of performance in this service area. Further work is planned as part of the reviews around Mental Health and Learning Disabilities to establish key performance indicators which will incorporated into future reports.