Health Boards In Scotland Face Huge Financial Pressures

30th June 2022

Audit Scotland has today published its report on the problems facing Scottish Heath boards. Highland is not included in this report as out of 32 areas only Highland adopted the different Lead Agency model. Its financial position is probably little different to the others with all the problems outlined in this report.

Funding to Integration Joint Boards increases, but significant risks and challenges ahead.

Funding of Integration Joint Boards (IJBs) in 2020/21 increased by nearly 10 per cent in real terms, bringing total funding to £10.6 billion. This was mainly due to one-off Scottish Government funding to mitigate the impacts of Covid-19.

Reserves also tripled, reflecting unspent Covid-19 funding and the late allocation of specific funding for primary care, community, mental health and alcohol and drug support.

All Scotland's IJBs, however, face significant financial sustainability issues: uncertainty of future funding, rising demand and the potential impacts of a national care service. This means:

across all 30 IJBs there remains a significant overall budget gap - this was £151 million in 2021/22, with some IJBs facing significant financial challenges

making recurring savings and delivering services differently is essential to addressing future budget gaps

81 per cent of money held in reserves is ringfenced, creating a lack of flexibility in how IJBs can use this money

Securing longer-term financial planning - only five IJBs have long-term financial plans

William Moyes, Chair, Accounts Commission said, "Scotland's 30 Integration Joint Boards face an increasingly uncertain future, with mounting financial and service pressures. All IJBs must put in place robust, detailed longer-term financial plans, helping design sustainable services.

The pressures and demands on health and social care services are significant. The long-term, adverse impacts of Covid-19 on our health is as yet unknown, alongside pre-existing rising demand, serious recruitment challenges across the social care sector, continued inflation and uncertain longer-term funding for IJBs. This comes alongside plans to develop and implement a National Care Service, which has the potential to significantly change the way IJBs operate.

Read the full report HERE

Note
Most people are not really aware of how the control and management of health and social care services have changedas mainly the facing services look the same. See the following -

About Health and Social Care Integration in Scotland
The way in which health and social care services are planned and delivered across Scotland was changed by the Public Bodies (Joint Working) (Scotland) Act 2014. Local authorities and health boards are required by law to work together to plan and deliver adult community health and social care services, including services for older people. This new way of working is referred to as ‘health and social care integration'. The Act also permitted local authorities and health boards to integrate other services, such as children’s services, homelessness and criminal justice, if they wished to do so.

At its heart, integration is about ensuring those who use health and social care services get the right care and support whatever their needs, at the right time and in the right setting at any point in their care journey, with a focus on community-based and preventative care.

In September 2018, the Scottish Government, NHS and COSLA published a joint statement reaffirming the shared commitment to integration as leaders in the public sector.

Integration model
In total, 31 health and social care partnerships have been set up across Scotland and they manage almost £9 billion of health and social care resources.

The Act required local authorities and health boards to jointly prepare an integration scheme. Each integration scheme sets out the key arrangements for how services are planned, delivered and monitored within their local area.

There is a choice of ways in which they may do this:

The health board and local authority can delegate functions between each other - the lead agency arrangement.
or

The health board and local authority can delegate to a third body called the Integration Joint Board (IJB) - the body corporate model.
LEAD AGENCY
Highland is the only area to adopt the lead agency arrangement. In this arrangement, the chief executive of the lead agency has responsibility to develop the strategic plan. NHS Highland has responsibility for adult health and social care services and Highland Council has responsibility for children’s health and social care services.

BODY CORPORATE
30 areas have adopted the body corporate model (also known as the IJB) (Clackmannanshire and Stirling formed a joint IJB) where the planning of health and social care services is led by the integration joint board. The IJB membership is broad: it includes councillors and NHS non-executive directors in all cases, plus other members (who do not have voting rights) including professional representatives and community and staff stakeholders.

Each IJB receives delegated funds from the health board and local authority (there is no separate direct funding from the Scottish Government).

The IJB is required to produce a single strategic plan to deliver the nine National Health and Wellbeing Outcomes. The IJB then commissions (or ‘directs’) the local authority and health board to deliver services in line with the strategic plan, and the IJB allocates the budget for delivery accordingly. The local authority and health board deliver these services within the budget and any other parameters directed by the IJB.

Each IJB has responsibility to appoint a chief officer to lead implementation of the strategic plan and an officer responsible for its financial administration (Section 95, Chief Finance Officer). The chief officer has a direct line of accountability to the chief executives at the health board and the local authority.

Chief officers lead the development of integrated services and actions at a local level, so that approaches are tailored to local communities and circumstances. This localism is fundamental to integration as the Act requires health and social care partnerships to divide their area into at least two localities.

A requirement of the Act is that the IJB also produces an annual performance report outlining progress towards delivery of the nine National Health and Wellbeing Outcomes within its local area.