Financial woes continue to plague Borders IJB

by EWAN LAMB

The joint organisation which integrates health and social care services in the Scottish Borders failed to meet seven of the eight national performance benchmarks during the last financial year as the pressures on the local health authority and the council continued to grow, resulting in a £4.7 million over-spend.

A delayed annual report from the Scottish Borders Integrated Joint Board [IJB] for 2021/2022 shows the scale of the issues facing health and social work professionals in the region as the proportion of elderly residents requiring care continues to grow.

The document shows the Borders IJB performed better than the national benchmarking system in a single area - "more people reported that they were able to look after their health very well or quite well".

But the report goes on to state: "We performed worse than the national benchmarks in the remaining eight National Health and Wellbeing outcome areas: Fewer adults who were supported at home agreed that they are supported to live as independently as possible. Fewer adults receiving care than the national average would rate the care they receive as excellent or good 

"Fewer people had a positive experience of care at their GP practice than the national average. Fewer adults supported at home agreed that their services and support had an impact on improving or maintaining their quality of life. Fewer adults supported at home agreed that they had a say in how their help, care or support was provided. Fewer adults supported at home agreed that their health and social care services seemed to be well co-ordinated. Fewer carers felt supported to continue in their caring role. Fewer adults supported at home agreed they felt safe."

Under a heading Performance Analysis, the annual report concedes: "It is important to note that due to the pressures that we have faced over the last year, we have seen a significant deterioration in local Health and Wellbeing Outcomes in 2021/22. This is very much reflective of the feedback that we have received from our service users, staff, unpaid carers and partners about the significant pressures that they are under, about the challenges of being able to provide or access key services in a timely manner, and in the higher levels of risk being experienced across the whole health and social care system."

In 2016 Ministerial approval was given under the Joint Working Public Bodies (Scotland) Act 2014 to establish the Scottish Borders Integration Joint Board (IJB) between NHS Borders and Scottish Borders Council. The IJB is a separate legal entity set up to integrate the planning and commissioning of health and social care services in the Scottish Borders. The IJB is responsible for the strategic planning of hospital services most commonly associated with emergency / unscheduled care.

The IJB has struggled financially from the outset. And it appears those financial issues will continue to confront the Board in future.

According to the annual report: "Financial outlook - The IJB continues to face significant financial challenges and both of its partners are facing challenges in meeting the demand for health and social care services within the financial quantum available. The Scottish Government budget outlined resource commitments for a single year pending the medium term spending review in May 2022. 

"The IJB budget is therefore presented on a one year basis in line with SG planning assumptions. Within the IJB, the key barriers to managing the financial position arises from demographic pressures of demand, together with capacity to plan and deliver required levels of transformation and efficiency savings. The significant growth anticipated in the number of older people and their need for suitable services, requires innovative solutions to allow services to be provided within funding levels available and, the ability of the partnership to transform services to help meet this demand."

 In his management commentary, Chris Myers, recently appointed chief officer of the IJB, says in his first five months in post he had heard from many people who use the services, from unpaid carers, and from people delivering health, social care and adult social work services that the pressures they are experiencing are unlike anything that they have ever faced before. 

"This certainly also rings true from my perspective. The prolonged impacts of Covid-19 have been felt by everyone in the Scottish Borders, and this is reflected in our health and wellbeing outcomes. It has also led to pressures in the health, social care and adult social work services commissioned by the Integration Joint Board. In addition to Covid-19, we are faced with meeting increased levels of need and dependency, in the context of significant financial challenges and workforce challenges. 

"The Integration Joint Board will continue to renew its focus on partnerships, on engagement, and on working with our communities to enhance how we strategically commission to best improve the outcomes for people living in the Scottish Borders, in these challenging times. By taking this approach, the Integration Joint Board will support improved outcomes while supporting a more sustainable future health, social care and adult social work landscape, with the people of the Scottish Borders at the front and centre of everything we do."

The accounts will now be examined by public spending watchdog Audit Scotland. In its audit plan for the Borders IJB Audit Scotland states: "There remains uncertainty around financial sustainability as the wider impact of Covid-19 is not yet known. In addition, there is a projected shortfall of £6.3 million against the required efficiency savings of £9.2 million agreed as part of the 2021/22 budget for the IJB. There is a risk of added financial pressure in subsequent years as budgets become increasingly constrained."