Audit Scotland today details the ‘considerable’ financial challenges and ‘immense’ workforce pressures mounting for Scotland’s Integrated Joint Boards (IJBs) – despite most IJBs underspending the money allocated to them in 2021/22.

Scotland’s Auditor General and the Accounts Commission, the watchdogs holding local and national governments to account, say Scotland’s IJBs, the bodies overseeing the nation’s 31 health and social care partnerships, face considerable funding and operational challenges – with “significant transformation needed” for long-term sustainability.

Across Scotland, IJBs have a combined projected funding gap of £124m for 2022/23 to cover anticipated spending.

Edinburgh IJB recently met to discuss how to make unprecedented cuts of £47m in 2023/24, with members struggling to agree on proposals.

In the financial analysis of IJBs for 2021/22, the Auditor General outlines that social care “cannot wait” for the promised National Care Service to deal with the workforce and service demands, stating that “action is needed now” to improve outcomes for people reliant on health and social services.

This echoes previous calls for work to advance change in the social care sector to continue while the NCS Bill is paused to improve co-design and financial planning.

The Chair of the Accounts Commission William Moyes says:   

“Change is needed now - it cannot wait for a National Care Service. Action is needed to tackle funding pressures, which are under increasing stress from rising demand and cost pressures. The workforce challenges are considerable, with mounting unmet need.”

Difficulties recruiting staff in health and care for 2021/22 led to unplanned vacancies which, alongside pandemic reductions in service provision, has meant that most IJBs underspent on providing services in 2021/22.

In turn, reductions in service provision are likely to have contributed to an increase in unmet health and social care needs – which impacts both the health of Scotland’s population and demands on staff.

To ensure not just the long-term capacity, but also the quality of services people receive and fiscal sustainability, the watchdogs say widespread changes are needed.

With an ageing population and increasing demand, 2021/22 saw the number of care hours for those aged over 65 reach almost £25m. Yet, the ongoing workforce crisis in health and social care meant the proportion of care services reporting vacancies increased by 11% to 47% for the same year.

Scotland is seeing a 30% turnover of staff each year in its care services while most IJBs, which plan and commission community-based health and care services, are seeing demand increasing.

COSLA Health & Social Care spokesperson, Councillor Paul Kelly, said the report is “concerning” and highlights the “enormous pressure” on health and social care services, adding:

“People across Scotland rely on vital health & social care services every day, and it is critical that there is meaningful investment in the system which ensures their long-term capacity.

“We must ensure focus remains on frontline service improvement and sustainability, rather than the bureaucratic structural change presented through the National Care Service Bill.”

While IJBs returned significant surpluses in 2021/22, with reserves doubling to over £1.3bn, this was mainly a result of a boost to funding late in the year. The additional funding received was earmarked for specific government policy commitments, including COVID-19, which meant it could not simply be used to balance budgets.

The Scottish government are currently exploring options to recover around two-thirds of the unspent COVID-19 money held in reserves.

Audit Scotland’s report states that, for longer-term financial sustainability, IJBs must reduce their reliance on reserves and implement detailed plans clearly outlining continuous savings.

Currently, the use of non-recurring reserves accounts for around 14% of IJBs plans to bridge their funding gaps – which still leaves an average of 28% of the budget gap where no savings have been identified.

In February, the Auditor General called for the Scottish government to be more transparent about the difficult choices facing the NHS and how long it will take for NHS recovery and reform.

Audit Scotland is now urging IJBs to show how they will achieve the ongoing savings needed on a recurring basis and support urgently needed service transformation.  

Moreover, Audit Scotland is calling for a focus on prevention while transforming services. William Moyes, Chair of the Accounts Commission added:   

“We need to see services focus on prevention, with appropriate funding in place to transform the way services are delivered and to improve lives.”  

Read more: RCN: Staff need to see light at the end of the tunnel; Mr Yousaf: “Scotland is a great place to work”; Auditor General: Difficult choices for Scotland’s NHS; Emails show haste to publish recovery plan

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