Paper 6 East Ayrshire Health & Social Care Partnership Shadow Integration Board - 19 August 2014 Financial Management Report as at 31 July 2014 Report by Executive Director of Finance and Corporate Support East Ayrshire Council and Executive Director of Finance NHS Ayrshire and Arran 1. PURPOSE 2 The purpose of this report is to provide details of the current financial position of the East Ayrshire Health and Social Care Partnership, as well as the projected outturn for 2014/15 as at 31 July 2014. 3. INTRODUCTION 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 £191.891m is based upon funding allocation agreements reached in March 2014. 5. EXECUTIVE SUMMARY 6 The Period 4 financial report for the Partnership has been compiled following financial analysis and budget monitoring at East Ayrshire Council and NHS Ayrshire and Arran and the summary at Appendix 1 details the consolidated position for the partnership as a whole. Appendices 2 and 3 details the position for budgets managed within East Ayrshire Council and NHS Ayrshire and Arran. 7 The consolidated projected outturn for the Partnership is an adverse variance of £0.656m which is made up of an adverse variance of £0.576m for the East Ayrshire Council and an £0.080m adverse variance for the NHS Ayrshire and Arran. 8 Financial Management 9 In respect of East Ayrshire Council the variance predominantly relates to additional costs in respect of adult care packages, slippage in respect of adult day care services, increasing demand for self directing services, additional foster care and adoption costs and potential costs relating to the partnership management structure. These have been offset by savings due to the timing of the filling of vacant posts and delayed implementation in the new Ross Court facility. 23 10 The NHS Ayrshire and Arran adverse variance mainly relates to additional costs in general medical services due to increasing demand for anti-coagulation monitoring as well as additional staff costs at the Kirklandside Community Hospital. These are partially offset by vacant posts within Mental Health community services. It should be noted that although the prescribing budget within Primary Care Services is projected to outturn in line with budget, the setting of this budget is based upon a number of assumptions and it is very early to determine whether all of the assumptions are valid. The needs led / demand driven nature of Health and Social Care services will 11 undoubtedly be reflected in changes to projections in future reports to the Shadow Integration Board over the course of the financial year. Work will be undertaken by the Director of Health and Social Care to manage budget variances and pressures to ensure that the Partnership outturns within the 2014/15 annual budget. Where this involves changes to service levels or policies such decisions will be presented to the Shadow Implementation Board. 12 Expenditure Reduction Measures 13 In setting the budget, actions to generate recurring efficiency savings of £2.474m have been agreed by East Ayrshire Council for 2014/15 and an analysis of the efficiencies which present considerable challenge at this time are attached is provided in the following table. Efficiency 2014/15 2014/15 Update Approved Revised Saving Saving £ £ Efficiencies from investment in 826,000 826,000 Will represent a significant challenge reablement and review. based on 13/14 actual costs. Possible savings from combination of re- negotiation of contracts and further adult reviews (Witchhill / Ross Court developments etc). Work ongoing to reduce costs however additional RAG Group demand continues to impact. Increased efficiency through 15,000 15,000 Children and Families overtime budgets reduction of overtime budget overspent in 13/14. Mainly Children's Houses - under review. 13 The approved efficiencies for 2014/15 include an increased focus on reablement and promotion of independent living saving of £0.686m. Expenditure is currently within budget after taking account of additional recurring 2014/15 Older People’s Change Fund and additional demography pressures funding, as well as a non-recurring 2013/14 Older People’s Change Fund balance. The increasing elderly population, as well as the impact of hospital delayed discharge targets reducing from four to two weeks places continued pressure upon these budgets. 24 14 Work is ongoing to review care packages and to consider alternative supported accommodation models, including the new Ross Court facility, which will become operational towards the end of 2014. Slippage on the re-design of adult day care services is anticipated in the current financial year and work is being undertaken in conjunction with budget managers to track progress and finalise the position for 2014/15. Any resultant change will be included in future reports to the Board. 15. RECOMMENDATION 16 It is recommended that the Shadow Integration Board note content of this report, including specific key actions on significant variances. Person to Contact Alex McPhee, Executive Director of Finance and Corporate Support, East Ayrshire Council, East Ayrshire Council Headquarters, London Road, KILMARNOCK, KA3 7BU: Tel – 01563 576279: e-mail: [email protected] Derek Lindsay, Executive Director of Finance, NHS Ayrshire and Arran, Greenan House, Ailsa Hospital, Dalmellington Road, AYR, KA6 6AB: Tel – 01292 – 513326: e- mail: [email protected] 25 APPENDIX 1 East Ayrshire Health and Social Care Partnership - Revenue Budget Monitoring 2014/15 Consolidated Monitoring Report Period 4 : 1st April 2014 - to 31st July 2014 Annual Projected Variance Estimate Actual to (Favourable) Service Division 2014/15 31/3/15 / Adverse £m £m £m Core Services LEARNING DISABILITIES 15.171 15.729 0.558 MENTAL HEALTH 4.978 4.946 (0.032) ADDICTION 2.054 2.054 0.000 ADULT SUPPORT & PROTECTION 0.453 0.454 0.001 OLDER PEOPLE 35.008 34.874 (0.134) PHYSICAL DISABILITIES 0.781 0.827 0.046 SENSORY 0.230 0.194 (0.036) SERVICE STRATEGY 4.327 4.611 0.284 TRANSPORT 0.431 0.431 0.000 COMMUNITY NURSING 6.037 6.037 0.000 PRESCRIBING 23.099 23.099 0.000 GENERAL MEDICAL SERVICES 14.926 15.006 0.080 107.495 108.262 0.767 Non District General Hospitals EAST AYRSHIRE COMMUNITY HOSPITAL 2.775 2.775 0.000 KIRKLANDSIDE HOSPITAL 1.130 1.280 0.150 3.905 4.055 0.150 Lead Partnership Services STANDBY SERVICES 0.237 0.237 0.000 PRIMARY CARE (INCLUDING DENTAL) 60.859 60.859 0.000 61.096 61.096 0.000 Children's Services CHILDREN & FAMILIES / WOMEN'S SERVICES 17.481 17.234 (0.247) JUSTICE SERVICES 1.616 1.602 (0.014) HEALTH VISITING 2.144 2.144 0.000 21.241 20.980 (0.261) Funded Elements JUSTICE SERVICES GRANT (1.846) (1.846) 0.000 (1.846) (1.846) 0.000 TOTAL 191.891 192.547 0.656 26 APPENDIX 2 East Ayrshire Health and Social Care Partnership - Revenue Budget Monitoring 2014/15 Council Monitoring Report Period 4 : 1st April 2014 - to 31st July 2014 Annual Projected Variance Estimate Actual to (Favourable) Service Division 2014/15 31/3/15 / Adverse £m £m £m Core Services LEARNING DISABILITIES 14.694 15.252 0.558 MENTAL HEALTH 3.119 3.237 0.118 ADDICTION 0.399 0.399 0.000 ADULT SUPPORT & PROTECTION 0.453 0.454 0.001 OLDER PEOPLE 35.008 34.874 (0.134) PHYSICAL DISABILITIES 0.781 0.827 0.046 SENSORY 0.230 0.194 (0.036) SERVICE STRATEGY 4.327 4.611 0.284 TRANSPORT 0.431 0.431 0.000 59.442 60.279 0.837 Lead Partnership Services STANDBY SERVICES 0.237 0.237 0.000 0.237 0.237 0.000 Children's Services CHILDREN & FAMILIES / WOMEN'S SERVICES 17.481 17.234 (0.247) JUSTICE SERVICES 1.616 1.602 (0.014) 19.097 18.836 (0.261) Funded Elements RESOURCE TRANSFER / JOINT PLANNING (8.850) (8.850) 0.000 JUSTICE SERVICES GRANT (1.846) (1.846) 0.000 (10.696) (10.696) 0.000 TOTAL 68.080 68.656 0.576 27 APPENDIX 3 East Ayrshire Health and Social Care Partnership - Revenue Budget Monitoring 2014/15 NHS Monitoring Report Period 4 : 1st April 2014 - to 31st July 2014 Annual Projected Variance Estimate Actual to (Favourable) Service Division 2014/15 31/3/15 / Adverse £m £m £m Core Services LEARNING DISABILITIES 0.477 0.477 0.000 MENTAL HEALTH 1.859 1.709 (0.150) ADDICTION 1.655 1.655 0.000 COMMUNITY NURSING 6.037 6.037 0.000 PRESCRIBING 23.099 23.099 0.000 GENERAL MEDICAL SERVICES 14.926 15.006 0.080 RESOURCE TRANSFER / JOINT PLANNING 8.850 8.850 0.000 56.903 56.833 (0.070) Non District General Hospitals EAST AYRSHIRE COMMUNITY HOSPITAL 2.775 2.775 0.000 KIRKLANDSIDE HOSPITAL 1.130 1.280 0.150 3.905 4.055 0.150 Lead Partnership Services PRIMARY CARE (INCLUDING DENTAL) 60.859 60.859 0.000 60.859 60.859 0.000 Children's Services HEALTH VISITING 2.144 2.144 0.000 2.144 2.144 0.000 TOTAL 123.811 123.891 0.080 28 .