The Argyll & Bute Health and Social Care Partnership (HSCP) Changes to Limit Care To 25 hours - Highland may be next

4th August 2025

NHS Highland has been struggling with recruitment and retention of home-care staff, leading to missed or shortened visits, delays in discharge from hospital, and excessive unmet need—particularly in rural areas like Caithness, Sutherland, Skye, Easter Ross and Lochaber.

At one point there were 274 patients in hospital stuck due to lack of care at home, and over 2,700 hours of unmet weekly care need across the north.

Regulators and unions have repeatedly raised serious concerns about safety and staffing levels, especially after they found the Sutherland Care at Home service to be "seriously and significantly" underperforming, risking closure unless improvements are made.

This consultation is NHS Highland's attempt to manage resources fairly, prioritize care where it's most needed, and ensure sustainable delivery of services across Argyll & Bute.

The current consultation only applies to Argyll & Bute, not the wider Highland region. It's being led by the Argyll & Bute Health and Social Care Partnership—one of two HSCPs under NHS Highland (the other covering the rest of Highland)

There is currently no plan to extend a 25‑hour limit across the entire NHS Highland region.

If there are future changes - such as expanding a threshold policy or adapting integration models across the Highlands. These would likely be announced via separate regional consultations or updates involving both HSCPs.

The proposed 25-hour weekly care threshold in Argyll & Bute is explicitly a budget-saving measure, though it's also framed as a response to staff shortages and service sustainability.

Financial Context:
The Argyll & Bute Health and Social Care Partnership (HSCP) faces severe financial pressures, with a £5.8 million overspend in its adult social care budget last year.

They have stated that continuing current care levels is unaffordable, and that rebalancing is necessary to stay within budget.

"The cost of packages of care has increased significantly, and this is not sustainable." — HSCP spokesperson.

Why 25 Hours?
25 hours of home care per week is roughly equivalent in cost to a residential care place.

The idea is to cap spending on individual home care packages, so those above 25 hours would trigger a review, with residential care potentially recommended if it's more sustainable.

While the proposal includes clinical and compassionate exemptions, it's clear the primary goal is financial control alongside staff resource balancing.

What They Hope to Achieve:
Reduce the number of high-hour care packages that cost significantly more than available alternatives.

Encourage more cost-effective models of care, like shared or residential support where feasible.

Limit growth in budget pressures as demand increases with the aging population.

Highland Partnership Issues
Key Points on Budget Shortfall in Highland HSCP:
Rising Demand for Services:

Increasing elderly population: The Highland region has one of the highest proportions of elderly people in Scotland, with a high demand for home care, residential care, and long-term support services.

The region's vast geographical area adds additional complexity, as services must be delivered across rural and remote areas, which often results in higher costs.

Recruitment and Retention Issues:

Staff shortages are a major challenge. It's tough to recruit and retain care workers in remote and rural areas, contributing to a higher reliance on agency workers and thus increased costs.

Wages for care staff have not kept pace with the rising cost of living, leading to high turnover and insufficient staffing levels. This affects the ability to meet demand for services without paying a premium for temporary solutions.

Budget Deficit:

For the 2024-2025 fiscal year, the Highland HSCP faced a £10.5 million budget gap in adult social care services alone, which includes home care and residential placements. This is due to a combination of overspending and an increase in demand for services. (This figure has fluctuated in previous years but remains significant.)

To cope, the HSCP has been forced to make cuts in certain areas, including non-essential services, and limit the expansion of home care packages.

Budget Pressures and Cost-Cutting Measures:

To address these shortfalls, the Highland HSCP has proposed more stringent measures such as:

Introducing care thresholds (similar to what is being considered in Argyll & Bute).

Tightening eligibility criteria for services.

Increased reliance on volunteer-run services and other community-based care options.

Restructuring some services to focus on cost-effectiveness rather than expanding them.

Emphasizing prevention and early intervention, such as supporting individuals in their own homes rather than in long-term care.

Impact on Care Recipients:

Home care services have already seen significant reductions and delays, which has created a backlog and left many individuals without the support they need.

The increased demand for residential care and the limited availability of beds have created a situation where some individuals have delayed discharge from hospitals, adding to pressure on hospital beds and emergency services.

Community and Political Reactions:

Local councils and community organizations have expressed concern about the effects of these cuts on vulnerable populations. There are concerns that reducing home care or moving more people into residential care could be less beneficial for people's quality of life.

There has been public pushback over the potential impact on the quality of care and the availability of services, with some questioning whether the savings are worth the human cost.

Financial Breakdown:
Adult social care (home care, long-term care) accounts for the largest share of the HSCP's budget and has seen year-on-year overspending.

The total budget for Highland HSCP is around £1.1 billion, with £100 million or more allocated for adult social care. However, rising demand, inflation, and increased staffing costs have made it increasingly difficult to balance.

What is Being Done?
The Highland HSCP has been exploring various cost-saving measures to plug this gap, such as:

Reviewing all service users to ensure they receive only the services they absolutely need.

Exploring alternative models of care such as telecare or digital solutions for less intensive needs.

Collaborating with local community services to provide more community-based care options and volunteer-run services.

Additionally, there's ongoing advocacy for more central government funding, but the financial situation remains a strain.

Future Outlook
The Highland region's budget shortfall isn't expected to improve drastically unless there is a significant influx of funding or radical changes in how services are delivered. Budget cuts and limiting service hours may continue unless there are policy shifts at a national level.

What is Scottish Government doing about funding issues in health boards budget shortfalls?

The Scottish Government has been actively trying to address the financial challenges faced by NHS health boards and the health and social care sector in Scotland, including the budget shortfalls that have led to difficult decisions like cuts to services or limiting care hours.

Overview of the actions the Scottish Government has taken and is considering in response to these ongoing budget pressures:

Increased Funding Allocations (but Not Enough)
The Scottish Government has allocated additional funding for NHS and social care services in recent budgets, but it has not been enough to fully cover the growing financial pressures. For example:

In 2023-2024, the Scottish Government allocated an extra £600 million to support NHS services across Scotland. However, even with these allocations, health boards have continued to face budget shortfalls due to rising demand, inflation, and staffing costs.

In the 2024-2025 budget, a further £1.1 billion was earmarked for health and social care, but health boards have still expressed that it is insufficient to meet the exponential increase in demand.

Despite these increases in funding, many health boards have still faced deficits in the range of millions of pounds, mainly because funding doesn't keep pace with inflation and increased service demand.

Investment in Social Care Reform
The Scottish Government has pledged to make significant reforms to social care in Scotland, though these are long-term goals rather than immediate financial fixes.

National Care Service (NCS): The Scottish Government has committed to creating a National Care Service that will standardize and improve the delivery of social care across Scotland. The NCS aims to ensure equitable and sustainable access to care, but its implementation could take several years and is likely to require significant additional investment.

The Fair Work in Social Care initiative was introduced to improve care workers' pay, working conditions, and training. This was partly aimed at tackling staff retention issues, which are a major source of rising costs for health boards.

However, while the NCS aims to provide long-term stability for the care sector, it does not immediately solve the funding gap.

Funding for Specific Health Boards
The Scottish Government has been making targeted investments in health boards that are facing particularly severe financial difficulties, such as NHS Highland, which has been struggling with both its budget deficit and staffing shortages.

In 2023, the Scottish Government offered £100 million of extra funding specifically to support the rural and remote health boards, including NHS Highland and NHS Western Isles. These funds are aimed at helping with staffing recruitment, covering backlog care, and reducing delayed discharge.

The Scottish Government is also encouraging NHS boards to collaborate with local authorities and the third sector (e.g., charities) to deliver services more efficiently and share costs.

Bailout or Financial Assistance for Overrun
In some cases, the Scottish Government has intervened to bail out health boards facing deficits, providing emergency financial support to prevent service cuts or staff layoffs. However, this has been criticized by some as being a temporary fix rather than addressing the root causes of the shortfalls.

NHS Tayside, for example, faced a massive deficit a few years ago and received £54 million in emergency funding from the Scottish Government to keep operations running.

Efficiency and Cost-Cutting Measures
Alongside these funding increases, the Scottish Government has been pushing NHS boards to focus on efficiency savings and cost-cutting measures, which include:

Reducing administrative costs and streamlining management.

Cutting back on non-essential spending, such as capital projects or optional treatments.

Using data and technology to improve service delivery efficiency, e.g., through electronic patient records, telemedicine, and AI in clinical settings.

These measures are meant to reduce pressure on the system, but they have limited impact on the overall funding gap and can sometimes compromise service quality.

Increased Focus on Prevention and Community Care
The Scottish Government has been placing increasing emphasis on preventative health care and community-based care models in an attempt to reduce long-term costs.

The goal is to prevent illness early (e.g., through better mental health services, chronic condition management, and health promotion programs) and decrease demand for emergency services and hospital admissions.

The National Health and Social Care Integration agenda, which brings together NHS and local government services, aims to shift care away from hospitals and into the community, where it is thought to be both more cost-effective and beneficial for patients.

Lobbying for More UK Government Funding
Health boards in Scotland are also lobbying the Scottish Government to push the UK Government for more funding, particularly as the cost of living crisis and brexit continue to put pressure on health and social care services. The NHS in Scotland operates with a fixed block grant from the UK government, and any increase in healthcare funding depends on UK-wide spending decisions.

Scottish First Minister Humza Yousaf and other politicians have repeatedly called for increased devolved powers to manage health finances independently, citing the growing budget pressures and healthcare demands.

Challenges with Funding
While the Scottish Government is doing its best to support the NHS and social care services, the root causes of funding issues—including an aging population, rising staffing costs, and inefficiencies in service delivery—are difficult to address within a single budget cycle.

A Few Key Figures
The total Scottish NHS budget for 2023-2024 was around £18 billion, with £1.5 billion allocated for social care.

NHS boards in Scotland, such as NHS Highland and NHS Grampian, have experienced overruns of several million pounds per year.

Despite an increase in funding in recent years, many NHS boards are still struggling with deficits that range between £5 million to £30 million, depending on the region.

Looking Ahead
The Scottish Government is expected to continue making incremental changes in an attempt to manage these financial challenges. However, the structural issues—such as increasing demand for services, rising inflation, and workforce shortages—are unlikely to be resolved without long-term reform and greater investment in public health and social care.