Edinburgh Integration Joint Board (IJB) grapples with how to make an unprecedented £47m of cuts in 2023/24, as councillors and lay members raise concerns of being forced into agreeing proposals with “one hand tied behind their backs”.

Proposals for a first phase of savings, which will see £11.45m in cuts in 2023/24, were agreed by members of Edinburgh’s IJB after more than three hours of intense discussion.

The paper presented to the board last week says Edinburgh IJB has ‘exhausted all opportunities’ to deliver further savings in 2023/24 without a significant detrimental impact on service delivery.

Still faced with a £35m shortfall, Edinburgh IJB’s finance officers have suggested a new approach to financial sustainability which would see a five-year medium term financial strategy (MTFS) put in place to avoid “relentless savings programmes”.

An MTFS is currently in development, according to the Chief Finance Officer’s paper, and will focus on a number of themes including reducing agency spend, ‘making the most’ of personal assistants and direct payments and optimising homecare.

After a heated and lengthy discussion last week, members have decided to delay approving the new approach as many raised concerns about a lack of clarity around the risks.

Councillors reported feeling “unsettled” by the way the proposals have been developed and called for a much deeper process of engagement with board members to understand the impacts on stakeholders and users of services.

Allister McKillop, service user representative, told board members that he felt they were “being rushed into decisions with one hand tied behind our backs” and that no one had a “realistic idea” of the risks.

Meanwhile, Councillor Max Mitchell told the meeting that he and other new board members felt uneasy about being asked to approve a set of proposals with such little detail publicly available:

“What worries me is the financial setting we’re in is quite intimating and I think it’d be much more appropriate if we deferred the final sign off until the next meeting where we can have a good look at everything in detail.

“For the service users, the carers, taxpayers, and the people delivering care in this city – that would be better. It’s important to look at all the various impact assessment and get a bit more detail on those.

“I don’t see why this entire process can’t be made a lot more informed.”

Since its inception, the Edinburgh IJB has routinely faced an underlying budget gap which it has been unable to bridge on a sustainable basis.

The financial plan, presented by Chief Financial Officer Moira Pringle, says the proposed new approach will leave the IJB with an unbalanced budget going into 2023/24, as it focuses on longer-term changes.

It recognises that this is a risky approach, though the alternative – making millions of pounds of cuts to frontline services and operations – is also far from ideal.

Confusion over whether the IJB is able to set an unbalanced budget dominated the discussion, with councillors citing its Glasgow counterpart’s “radically different approach” that saw it recently approve £20m of cuts.

Councillor Claire Miller said she was concerned members of the board had different understandings of what their duties are – and whether setting an unbalanced budget for 2023/24 was possible without bringing forward a financial recovery plan.

In the event of an in-year overspend, Edinburgh’s Integration Scheme requires IJBs to approve and implement a financial recovery plan to address the gap.

Judith Proctor, Chief Officer of the IJB, warned members that a financial recovery plan would see more severe cuts enacted in 2023/24, especially as the clock ticks closer to the beginning of the next financial year:

“I’m very keen to pursue a very careful approach cross a timeline to achieve balance.

“What we’ve tried to do with that paper is set out a carefully staged approach and as far as possible try to mitigate the level of savings by setting that out in wider strategic change over a medium term.

“A recovery plan will, instead, focus on delivering the net of £47m of savings over a year. By definition, that will not be careful or staged or necessarily mitigate the worst impacts of the extent of that funding gap. That will focus on doing that quickly by the end of the financial year. We would have 10 months essentially to achieve that level of saving.”

Edinburgh IJB is facing cuts of £47m – around 5% of its total budget.

Chair Tim Pogson told the meeting that this is “at a different scale” than the board has had to consider previously.

Board members agreed to push forward with £11.45m in cuts in 2023/24, including a £1m reduction of the community investment fund and a £1.6m reduction in commissioned interim beds.

The October 2022 closure of older peoples’ mental health Pentland Ward – estimated to save the board £1.1m – will now not be invested as previously planned and instead taken as a saving.

The board has also agreed to take forward national contract uplifts – including raising wages in line with the national living wage which is due to rise to £10.90 from the start of April.

Members agreed on a one-month pause before a decision is made on the rest of the recommendations in the 2023/24 Financial Plan.

 

Read more: NHS boards’ ‘unprecedented’ budget challenges; Planned primary care improvements on pause; NHS faces ‘extraordinarily difficult’ budget decisions; NHS Highland: ‘worst funding gap seen’

 

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