The public bodies meant to create a seamless health and social care service face “increasingly unsustainable” finances, while councils are also “straining to keep pace” with demand, spending watchdogs warn today.

In a double alarm call, the Accounts Commission said both Integrated Joint Boards (IJBs) and local authorities were struggling to balance their books.

It said it was particularly concerned that the 30 IJBs, which oversee £8.6 billion of health and social care, had lost one-third of their most senior staff last year.
Commission chair Graham Sharp said: “This instability inevitably impacts on leadership capacity and the pace of progress.”

The warning coincided with the Scottish Government launching its first staffing plan for health and social care services – more than three years after their integration began. Opposition parties said it was “long overdue” but welcome.

In its annual financial overview the Accounts Commission again highlighted councils being forced to raid reserves to pay for services after a 7.6 per cent real terms funding drop since 2013/14.

The Scottish Government has cut the rest of public spending by just 0.4% over the same period, leaving councils to bear the brunt of Treasury austerity.

The Commission said that in the last three years, 23 of Scotland’s 32 councils had turned to their £2.5bn in reserves, with a net reduction in the amount held by councils of £45 million at the end of 2018/19, the second drop in a row.

If Moray continues at its current pace, it will exhaust its main reserves within five years, the Commission said.

Councils also face a “funding gap” of £500m, or 3% of their total budgets, in 2019/20 despite a real terms increase in Scottish Government funding of 0.9%.
Pressures on authorities include pay rises and a growing elderly population. 

A court ruling also saw councils’ share of the liability in the local government pension scheme increase by 41%, from £6.6bn to £9.3bbn in March this year.
“There may be a funding pressure, with councils having to make additional future employer contributions to cover the increased liabilities,” the report said.

The financial overview also raised warnings about the state of the country’s IJBs, an often overlooked part of the public sector which are jointly funded around 2:1 by the NHS and councils. 

Since 2016 the boards have been meant to ensure more people are cared for in the community or at home, rather than in hospital, freeing up beds and other NHS resources.

The Commission said it was worried about the slow progress on this and high turnover of senior staff, with a third of IJBs losing their chief officer, chief financial officer or both last year.

At Argyll & Bute, where the chief officer changed and two chief financial officers left in an eight-month period, it meant six months of temporary cover and “weakness in financial reporting and a reduced focus on the delivery of approved savings,” it said. 

The overview said 19 of the 30 IJBs needed extra cash or ran deficits last year as they struggled with their finances.

Without the financial support, the boards would have lost £58m last year.

Mr Sharp said the pace of integration was “too slow” and there was still no evidence of a “significant shift” in spending and services from hospitals to community and social care –  the whole point of the SNP Government’s reforms. 

He added: “I continue to be concerned about the significant turnover in senior staff in IJBs. This instability inevitably impacts on leadership capacity and the pace of progress.”

He went on: “We urgently need much faster progress in the reform of our health and social care services. The current position is increasingly unsustainable.

“There’s a need for councils to continue rethinking how they deliver services, as well as look at ways to increase their income.

“For some councils in Scotland, finding ways to do this is getting more and more difficult as their current income doesn’t match demand.”

Ahead of the damning report, Health Secretary Jeane Freeman announced a workforce plan for health and social care services, the first of its kind in the UK.
Developed with councils, it aims to recruit the  375 full-time district nurses by 2024 in order to increase the number of people receiving care at home.

There will also be an 8% increase in mental health officers and 60 more training places for clinical psychologists.

In addition a new thrombectomy services will be created, using £600,000 to train medics in mechanical thrombectomy, which removes blood clots to treat stroke victims. 

Ms Freeman said: “This is the UK’s first integrated health and social care workforce plan and it will be invaluable in helping us to anticipate and respond to the changing and growing demand faced by our health and social care services. 

“One key example of this is our commitment to create a national thrombectomy service to treat stroke victims - a vital step in the planning and delivery of a comprehensive stroke service for Scotland.

“We have record numbers working across our health and social care services – with NHS staffing levels up 11.3% since 2006 and the social care workforce at its highest level since reports began. As this plan outlines, the threat of a ‘no deal’ Brexit remains, and as a responsible government we will continue to do all we can to protect our health and social care services.”

Tory MSP Miles Briggs said it was a “mystery” why the workforce plan had taken so long. 

He said: “It’s been well-established for some time that, with an ageing and increasing population, our social care services are under immense pressure.

“Perhaps if the nationalists had acted sooner, we wouldn’t be facing this crisis.”

Labour MSP Monica Lennon said: “This plan is long overdue and whilst we welcome some of these announcements, not least the establishment of a thrombectomy service, what we now need to see is action from SNP ministers to actually deliver the workforce and resources that our NHS needs. 

“NHS staff are under pressure and overworked, and Scottish Labour has repeatedly raised concerns about staff wellbeing.

“Predictions that Scotland needs an additional 20,000 staff in the next four years are concerning, particularly given the SNP government’s track record of failing to get a grip on the significant vacancies that currently persist across our health and social care services.”

Scottish Tory local government spokesman Alexander Stewart accused the Scottish Government of “cutting local authority funding to the bone”.

“Under the SNP, councils are increasingly raiding their rainy-day fund just to keep things going,” he said.

“That’s unsustainable and before long these reserves built up over decades will be gone.

“That’s what happens when you have an SNP Government which has cut local authority funding to the bone.”

Gail Macgregor, for the council umbrella group Cosla, said: “This report clearly states how Scottish councils have borne the brunt of Scottish Government cuts.   

“This cannot continue. For the benefit of communities across Scotland, the Scottish Government must make the choice to invest in Local Government. We need fair funding for Councils and a return to local democratic decision-making as quickly as possible.”