Jeane Freeman has signalled that reform of NHS boards’ funding and changes to IJB decision-making could be on the agenda after the covid-19 pandemic.

The Scottish health secretary admitted the formula used to divide cash between the country’s 14 regional health boards did not reflect the additional needs of rural areas.

Speaking to the Scottish Parliament’s Health Committee yesterday, Ms Freeman also said bureaucracy in the integration joint boards (IJBs) that oversee community health and care spending was “overdone” and could be cut back.

An additional £1.1bn for health and social care services was announced yesterday by the Scottish government.

Scottish government health finance lead Richard McCallum told the committee this figure covered costs incurred by IJBs since April and included “about £150m that’s been allocated for social care”.

A breakdown of the funding by health board reveals that NHS National Services Scotland – which has been responsible for sourcing PPE – will receive nearly £400m.

During the evidence session, it emerged that tweaking the NRAC funding formula – the calculation used to allocate funds to NHS boards – had been on the agenda before covid-19 hit.

Labour MSP David Stewart asked what could be done to support rural NHS boards, which he said faced “chronic structural financial problems”.

“I do think we need to find a way to have equity of distribution of funds but with a degree of flex that allows us to recognise the particular challenges that they [rural boards] face,” Ms Freeman replied.

The committee heard this work had been set back by the pandemic but the Health Secretary said “it is an area that we would want to be able to return to”.

Another set of potential changes relates to the structure of IJBs

During the pandemic IJBs have suspended normal procedures and given chief officers more decision-making powers.

Normally the officers are overseen by a board made up of councillors, NHS representatives and other figures from the community.

MSPs were told discussions about the “degree of committee structures that IJBs have in place” were underway.

Ms Freeman said: “It feels to me that perhaps our IJBs have overdone the replication of committees that already exist in boards, for their governance purposes, and in local government for their governance purposes. I’m not sure we need a third tier of all of that.”

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