The financial health of the bodies responsible community health and social care in Scotland continues to weaken, as the national finance watchdog warns of tougher times ahead.

An analysis of the 2023/24 accounts of Scotland’s integration joint boards (IJBs), published today by the Accounts Commission, reveals widespread overspending.

Despite receiving more money from funding partners than the year before, most IJBs needed to dip into their reserves or request top-up funds from their local NHS board or council to make ends meet.

The watchdog says these solutions are not sustainable, putting extra pressure on already stretched NHS and council budgets.

The Accounts Commission warns that IJBs’ financial situation will worsen even further in 2024/25, with IJBs set to face a total funding gap of £457m.

This means IJBs will need to find an additional £100m this year to plug the gap between what they receive from the NHS and councils and how much they spend on delivering services.

While IJBs achieved 79% of their savings targets in 2023/24, a substantial proportion were non-recurring, meaning similar sums will need to be found again in future years.

Nine of Scotland’s 31 IJBs now do not have any money set aside to cover future unexpected costs, which the Accounts Commission says both limits their financial flexibility and risks sustainability of their services.

A Scottish government spokesperson says £2.2bn was invested in social care and integration in 2024/5, and next year will see record investment in councils.

They also acknowledge "significant concerns" around additional pressures caused by the UK government’s proposed increase in Employer National Insurance Contributions.

Urgent need for service transformation

IJB leaders must now work with each other and their NHS and council partners to set “realistic” budgets and to sustainably transform services, according to the Accounts Commission.  

Councillor Paul Kelly, Health and Social Care Spokesperson for local authority organisation COSLA, says councils are committed to working with partners across the sector to understand the impact the current and projected financial position is having on the system:

“Given the present challenges facing the system, there needs to be constructive collaboration between local government, Scottish government, IJBs, and NHS partners around the scale of the challenge – and what this means for what people and stakeholders can expect from the system.

“Social care is and will remain a sector delivered by people for people, and I am encouraged by the work already taking place between IJBs, councils and other partners in the face of current pressures.”

Today’s report echoes concerns raised by the Commission last summer of an “unprecedented” crisis in community health and social care.

Uncertainty around the government’s National Care Service plans had contributed to difficulties in IJBs’ ability to plan and deliver services, the Commission said, while failure to invest in prevention and early intervention meant demand for services continued to rise.

Now, with plans to reform IJBs shelved indefinitely, Accounts Commission member Malcolm Bell says it is time for “candid conversations” with communities about the difficult choices that must be made.

Don’t forget the third sector

Responding to the report, Sara Redmond, Chief Officer at the ALLIANCE, highlights the “critical” role of the third sector in tackling health inequalities and shifting the balance of care into communities.

She is urging IJBs to include third sector organisations – many of whom deliver community health

services on behalf of councils – more effectively into planning and budgetary decisions:

“IJBs and their partners must dedicate funding, resource and energy toward preventative approaches that have the potential to generate long term savings and support the sustainability of Scotland’s health and social care services.

“At the same time, the Scottish government must increase the pace and level of investment in preventative, community-based services, and there must be investment and a commitment to shift the balance of care into communities and closer to people’s homes.”

“The challenging financial climate IJBs, and indeed all public services are operating in, requires us to do things differently – to take bold, courageous leadership, to work more closely with the third sector and the people in their communities to reimagine how we design, deliver and invest in services for the wellbeing of all people across Scotland.”

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