'Radical change' warning for health and social care integration join boards

The finances of the bodies responsible for planning local health and social care services have hit “critical” levels, it is warned.

Integration joint boards (IJBs) see councils partner with health boards to organise provision.

But increasing costs and dwindling reserves mean that even though real-terms funding is up, the sum is not enough to protect their finances  and they could now become unsustainable within 12-24 months, a report has found.

Reserve levels have fallen across the country and almost half of the country’s 30 IJBs now hold no contingency pots, the Accounts Commission has said. It says the situation is “increasingly concerning” and there is now not enough in reserves to cover the £449m projected budget gap for this year.

“Difficult decisions” about what to cut and where are now ahead, the watchdog stated.

This includes how services are delivered, the appropriate level of services, and possible redesign, reduction or discontinuation of services.

The report said: “They must be transparent with service users and the public about the potential impact of these changes on service performance and outcomes.”

Accounts Commission member Malcolm Bell said: “The cost of delivering services is rising faster than available funding. Tackling this could include difficult decisions about redesigning or reducing services, and whether new or additional charges need to be made. Whatever decisions are made, service users, their families and wider communities must be consulted.

“But without radical change the services delivered by IJBs can’t be sustained. The gap between funding available and the cost of meeting demand is widening, and the gap of nearly £450m cannot be bridged with savings alone.”

Part of the pressure comes from the increase in people with long-term complex needs, as well as higher operating costs and growing demand.

Funding to the IJBs went up by more than two per cent in 2024-25 to more than £12bn. But most reported operational overspends in-year.

As well as making savings and using reserves, the bodies have been reliant on extra monies from NHS and council partners. But the Accounts Commission says they must now plan their finances “more realistically”, with “significant financial pressures” weighing on those partner organisations.

Scottish Labour’s Jackie Baillie said her party has “long warned that the black hole in integrated joint board budgets would lead to a total meltdown in the social care sector”. She said further cuts would have a “devastating impact on vulnerable people and those requiring care”.

Baillie said: “This is a damning indictment of the incompetence and complacency of successive SNP ministers who have failed to heed the alarm bells that have been sounding for years. 

“We need strong and effective leadership on health and social care more than ever, but the prospect of further cuts will only increase the pressure on frontline providers and staff who deliver these services.”

Social care minister Tom Arthur said: “While this report acknowledges a real-terms increase in IJB funding between 2023-24 and 2024-25, we recognise the financial pressures facing the health and social care sector, and remain committed to meaningful reform.

“We have provided a record settlement for local government and will deliver funding of almost £22.5bn to health and social care in 2026-27.

“The integration of health and social care planning is essential in ensuring services are well-co-ordinated and responsive to the population’s evolving needs. This report recognises the need for local collaboration in setting budgets.

“Through the national care service programme, and the delivery of the service renewal framework, we are taking practical steps towards our vision of a Scotland where people live longer, healthier and more fulfilling lives.”