Reform urgently needed to tackle precarious health and social care finances

27th March 2025

Community health and social care finances are increasingly precarious. Integration Joint Boards (IJBs) must urgently work with their partners in the NHS and councils to reform how they deliver services to achieve financial sustainability.

Scotland's IJBs plan and commission many vital community-based health and social care services. A new report from the Accounts Commission warns that IJBs cannot manage future financial pressures in isolation - collaboration across IJBs and between council and NHS partners is vital. The continuing high turnover of chief executive and chief financial officers is worrying at a time when strong and stable collaborative leadership is crucial.

IJB funding has increased in the past year, but there is ongoing overspending, running down of reserves and reliance on one-off savings. During 2023/24, reserves were depleted by 40 per cent, with the projected funding gap for services increasing from £357 million in 2023/24 to £457 million in 2024/25. This will hinder IJBs' ability to address future budget gaps and make them less able to meet unexpected costs.

IJBs, alongside their NHS and council partners, need to be transparent with communities about what this means for services, and collaborate to plan for the major reforms required.

Malcolm Bell, Member of the Accounts Commission said:

For too long, Integration Joint Boards have been fire-fighting immediate financial challenges. Now they must shift from making one-off savings and relying on reserves to transform how services are delivered if they are to tackle their precarious finances.

A stronger focus on prevention is needed, with candid conversations with communities, councils and NHS partners vital around the difficult choices that need to be made.

Read the full report HERE