Fife Health and Social Care: Integrated board sets £682m budget

On Thursday afternoon, Fife’s Integrated Joint Board – also known as the Health and Social Care Partnership – set its £682 million budget in stone.

“Every part of the approach has been a can-do, upbeat approach,” Audrey Valente, the IJB’s chief finance officer said.

“The paper clearly articulates a funding gap of £39 million for the next financial year with funding of £674 million available to spend on IJB priorities.”

According to budget papers, it’s going to take £12 million worth of efficiencies, £6.4 million worth of service redesign, £15 million worth of previously approved savings, and the use of reserves to fill the £39 million blackhole facing the partnership this year.

Valente commented: “Financial sustainability is of paramount importance and as a result we’re started to gather information in relation to those future savings opportunities. These are currently at a very early stage of development and will require further discussions with all our key stakeholders.”

She continued: “However, I think this is demonstrating that can-do, upbeat position. We’re not standing still, we’re continually looking forward.”

Ian Dall, an IJB service user representative, questioned the boards ability to deliver on the significant amount of savings and efficiencies that it has promised. He pointed out that the IJB failed to deliver on a number of its savings goal in 2023/24 and he wondered what would be different this year.

However, Ms Valente pushed back, defending the IJB’s overall track record for delivering savings.

“If you’re referring to this year, I think the budget in March 2023 acknowledged that there were going to be delays. We recognised that and we agreed as an IJB to earmark £10 million in reserves to help us,” she said.

“And I think if the past is an indication for the future, I think we actually have quite a good track record of delivering savings. If you go back to previous years, we actually have a good track record of about 70-80% [savings delivery]. So I am quite comfortable with what we’ve presented today.”

EFFICIENCIES

As part of the 2024/25 budget and the medium term financial plan, the IJB has agreed to make a number of efficiencies and service redesigns to fill the £39 million gap.

The partnership has already been working on a medicines efficiencies programme, but they now hope to “expand the ambition” of it – which is projected to save the partnership £4.3 million.

“This is an expansion to the previously approved medicines efficiency saving to support effective prescribing and reduction of medicines waste,” the report stated.

“This additional work will focus on safely, efficiently and effectively reducing unnecessary prescribing in line with realistic medicine and realistic care.”

If approved, cleaning operations in care homes will also take a hit from this efficiency programme. The partnership has suggested going back to “Business as usual” cleaning practices and eliminating the enhanced cleaning procedures from the Covid-19 era.

The partnership also wants to improve the “commissioning of adult care packages” to save £2.4 million.

HSCP describes it as a “modernisation” of contracts and Service Level Agreements with care providers.

SERVICE REDESIGN

Redesign is another crucial part of the partnership’s savings plan and Mental Health Services are at the top of the list.

“Over the past 12 months mental health services have experienced a requirement to significantly increase the use of Locums [temporary substitutes to fill vacancies],” the report explained.

“This coupled with the increased use of agency nursing staff has resulted in a £6 million overspend within the service.”

The redesign would aim to reduce the cost of locum spend by 25% and increase the number of registered nurses to reduce the cost of locum spend within inpatient areas.

There will be an increased focus on early intervention in both community and urgent care responses as well.