Integration Joint Boards (Funding)

– in the Scottish Parliament on 2nd April 2019.

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Photo of Kezia Dugdale Kezia Dugdale Labour

2. To ask the Scottish Government how it plans to support integration joint boards with funding shortfalls. (S5T-01593)

Photo of Jeane Freeman Jeane Freeman Scottish National Party

Our budget this year provides investment of £711 million in social care and integration, which represents a 29 per cent increase on last year. Additionally, the “Review of Progress with Integration of Health and Social Care”, which was published on 4 February this year, identifies a range of actions, including on integrated finances and financial planning, all of which are to be delivered by March 2020.

Photo of Kezia Dugdale Kezia Dugdale Labour

The leaders of the Edinburgh board have refused to accept its funding deal, which was due to start yesterday. It has made £11.6 million worth of cuts already, but it still faces a further funding black hole of £12.6 million. Board member Mike Ash said:

“We can’t go on pretending we can deliver the services people expect with the money we have.”

If he is being so honest, why can the cabinet secretary not be? Edinburgh does not have enough money to care for its vulnerable, does it, cabinet secretary?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I will repeat the answer that I gave to the previous question. I am being completely honest—there has been a 29 per cent increase in the budget this year. I remind Ms Dugdale that that increase is against a 6.8 per cent cut in real terms to this Government’s budget from the United Kingdom Government b etween 2010-11 and 2019-20. I do not accept that this Government has done anything other than absolutely prioritise the health budget, including for health and social care. However, I require integration authorities to look at how they can reform the delivery of their services to get the best value and deliver what patient care needs, and that applies to both the health board and the local authority.

As I am sure Ms Dugdale is well aware, the point of integration is to devolve such decisions to integration joint boards, which should be best placed to determine what their local populations need, with significant additional funding from the Government. I do not accept the premise of Ms Dugdale’s question. The Government, along with the Convention of Scottish Local Authorities, will continue to engage with the integration joint boards to help them to do the work that we need them to do in the areas in which they face difficulties.

Photo of Kezia Dugdale Kezia Dugdale Labour

The cabinet secretary needs to lift her head from a spreadsheet and look at exactly what is happening in the real world. In order to balance its books, the Edinburgh board is considering cutting mental health services and slashing its drug and alcohol partnership funding. On top of that, a freedom of information request from my office shows that 160 people in the city are getting incomplete care packages, more than 600 people are waiting for a package to start and a whopping 1,200 people are waiting to be assessed. If Edinburgh cannot afford to stand still, how on earth will 2,000 of my constituents get the help that they desperately and urgently need?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

It is a bit ironic to have someone from the Labour Party suggest that I should live in the real world. Trust me, I live in the real world. It would be helpful to move away from the rhetoric and focus on the plan that was jointly agreed between COSLA, including all the Labour-led and other authorities, and the Government to increase the pace and delivery of integrated health and social care, which has seen significant success in many parts of our country.

Every single one of our IJBs needs to improve what it is doing, but COSLA and I have committed to direct action to intervene and support where necessary. However, once again, I remind members in the chamber that, if we want to devolve decision making to local bodies such as IJBs, we have to allow them to make decisions and not constantly ask the Government to jump in and fix things when we do not like those local decisions. We have to allow local flexibility but, where it does not meet the overarching priorities of the Government, we will of course act to assist the boards to do so.

Photo of Miles Briggs Miles Briggs Conservative

It is not about fixing things; it is about stopping them from being smashed in the first place. Across Scotland, there are proposals to close care homes for alcohol and drug partnerships, and primary care transformation funds, which the cabinet secretary says she is passionate about as a way of driving forward general practitioner reforms, are being raided. The integration of health and social care is something that we all agree on across the chamber, but it is being put at risk—this is not how it was meant to be.

How will Scottish National Party ministers deal with what is a growing financial crisis across our IJBs? The cabinet secretary wrote off £150 million of debt for health boards, and it is clear that our IJBs are going to be in a similar position. What is she doing to monitor that and to work with IJBs to help them to address the record debt?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I redirect Mr Briggs to two things, the first of which is the 26 per cent increase in the funding for health and social care integration. If you want more money for that, you will have to say where it will come from. I do not want to repeat what Mr Yousaf just said, but it takes brass neck to ask for money and resources for an area when you and your colleagues did not support the overall budget. I also redirect you to the joint review of integration and the actions that were taken as a consequence of that; the evidence that Councillor Currie and I gave to the committee on which you sit; the work that is going on with the IJB finance officers and the finance director in the Scottish Government; and the joint work that we are doing with COSLA to assist the IJBs with their financial planning so that they can work their way through any financial difficulties.

I do not accept that there is a financial crisis—I never accept, Mr Briggs, the hyperbole that you choose to use to get tomorrow’s newspaper headline. It is not true, and you need to deal with this matter seriously.

Photo of Kenneth Macintosh Kenneth Macintosh Labour

I encourage all members—not just the cabinet secretary—not to use the term “you”. Do not address each other; instead, refer all your remarks through the chair and talk about each other in the third person. Do not say “you”; otherwise the debate becomes very personal.

Photo of Emma Harper Emma Harper Scottish National Party

I am aware that Dumfries and Galloway NHS Board manages its health budget without using a set-aside model. Will the cabinet secretary confirm that the implementation of a set-aside budget has aided integration and say whether health boards and IJBs have discretion over its use?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

Ms Harper has pointed to an important part of the overall financial package for health and social care integration. It includes not only what is called set-aside funding but the significant reserves that some of our IJBs have and which have not been allocated for any specific purpose. Part of the overall work that we have agreed with COSLA is to put all of that into the mix not only to ensure parity of funding across all our IJBs but to get the best out of those funds.

What is referred to as set-aside funding is actually an allocation of money, the best use of which is determined by the IJB, given its responsibility for the planning and commissioning of local services. Some of that money might, with the IJB’s agreement, be used by a health board to deliver certain services, particularly around the unscheduled care that the set-aside money is targeted at covering. Of course, it does not have to cover only that, but the point is that the IJB is the decision maker in this area, and we have issued clear additional guidance to our health boards and IJBs to ensure that they understand that. Indeed, that will be part of the discussions that we will continue to have with IJB finance officers and our health boards.

Photo of Lewis Macdonald Lewis Macdonald Labour

Last month, the cabinet secretary wrote to the Health and Sport Committee to say that her expectation was that budgets for all integration joint boards would be in place in advance of the start of the new financial year. Will she confirm that budgets for Scotland’s other IJBs for 2019-20 have now been agreed? When does she expect them to be made public?

Photo of Jeane Freeman Jeane Freeman Scottish National Party

I think that there were two budgets outstanding, but I understand that one of them has now been confirmed and agreed. My understanding, therefore, is that the majority of budgets for IJBs have now been agreed.

There are one or two areas where we do not believe that the local authority has passed on the full amount from the additional £160 million that went from the health portfolio to local authorities for additional provision for integrated health and social care. I am meeting Councillor Currie this afternoon to go through a number of areas, including the overall budget and individual IJB situations.

As for publication, the budgets should be published in the coming weeks, but I will endeavour to get a final cut-off time and ensure that Mr Macdonald is made aware of it.

Photo of Alex Rowley Alex Rowley Labour

I worry that the cabinet secretary’s discussions with COSLA are failing to focus on the key issues. A former health secretary argued in Parliament a month or so ago that there needs to be bridge funding to allow the transfer from acute to primary care to take place.

That is clearly not happening today. Bedblocking is increasing further. Does the cabinet secretary agree with that? The former health secretary also talked about the Alaskan model. There is a crisis—it is not about who blames who. The people trying to access community care in Scotland are feeling that crisis when they do so.

Photo of Jeane Freeman Jeane Freeman Scottish National Party

The set-aside money was designed largely to act as a bridging fund. For example, the IJB in Dundee used the set-aside money and some of its reserves to engage in a service redesign and transformation to ensure that the services that it was planning and commissioning could be delivered sustainably in the long term. Some IJBs have sought to use their reserves and, in part, the set-aside money to do precisely that. I have made that point before when we have discussed the integration of health and social care. Across the 31 partnership areas, some are doing well in some aspects of their work, others doing less well and so on. It is a mixed picture, which is why the work with COSLA is targeted to look at those IJBs where improvement is required, either in financial planning or in the work on delayed discharge. The statistics that were published today show a reduction in the number of delayed discharges over the previous month—it is not good enough yet, but it is going in the right direction.

That is the kind of focus that we have between the Government and COSLA, in addition to the regular work that my officials engage in directly with the chief officers and finance officers as well as with the health boards. We are aware of the challenge and are trying in the integration review and the actions from it to take specific targeted action. In addition, as Mr Rowley knows, work continues to try to resolve the specific issue in Fife of the legacy deficit that the IJB started with. We are moving in the right direction and are focused. That is not to say that there is not more that we can do, and we are open to any additional measures that members think we should take.