NORTH ISLES councillor Gary Cleaver has resigned from the isles’ integration joint board (IJB) over his growing frustration about NHS Shetland’s capacity to deliver on budget objectives.
He said that he “couldn’t bring much more” to the local IJB, which directs both the NHS and Shetland Islands Council in health and social care, because of the health board’s apparent unwillingness to properly deal with its spending.
In response, NHS Shetland chairman Ian Kinniburgh said that while the “financial challenges for both the council and NHS are serious”, he does not accept the suggestion that NHS Shetland was “not controlling costs”.
The NHS boss, who was “surprised” by Cleaver’s comments, said while there were “inevitably lessons we can all learn as the two organisations begin to work differently together”, concerns from members should be raised “honestly and openly”.
In July 2015, Cleaver, together with Cecil Smith and Billy Fox, were appointed as council members to the new IJB formed to drive forward the Scottish Government’s policy of integrating council run services and health care provided by the NHS.
He has now quit the board because he believes members have been left “hamstrung” by the NHS, accusing it of “not controlling its costs” at a time when the IJB is in the process of budget planning.
In February the board will be asked to approve a strategic plan for the next three years, as well as setting its 2017/18 spending.
“The main reason that I decided to stand down was that I felt personally I couldn’t bring much more to the IJB,” Cleaver said.
“I’m hoping that maybe now that I’m not constrained by some of the behaviour that you have to work by, I can be a little bit more frank about some of my concerns about the local IJB and IJBs in general.”
The former vice-chairman of the now defunct SIC social services committee added: “I think that they (the NHS) sound great in theory, but the chances of them actually working in the real world are very, very slim.”
In 2017/18 the expected recurring shortfall in the NHS contribution to the IJB’s overall budget of more than £43 million is expected to be at least £2 million, while the council is expected to meet its contribution at the required level.
In December, the IJB agreed to request a one-off payment from the local health board to cover the forecast overspend in its NHS budgets in 2016/17.
NHS chief executive Ralph Roberts confirmed in a letter presented at the IJB’s latest meeting on Wednesday that while the health board’s position is very tight, it believes it will break even at the end of March as a result of a financial recovery plan which includes underspends and one-off asset measures.
If it doesn’t balance its books, the health board will have to ask the Scottish Government for additional one-off funding to break even, with discussions then needing to be held with the IJB about how this would be paid back in the future.
Cleaver, who is not standing for the council again in May’s election, said he had “nothing but admiration” for some of the people who have been trying to make the IJB work, including its chairman councillor Cecil Smith who has put in a “huge amount of effort”.
“But the trouble is that there are other people within the IJB project that I think haven’t embraced the true meaning of integration,” he added.
“I think that their objectives are ‘no change for us, everyone else has to change to accommodate our lack of ability to change’.
“I think an awful lot of that sits with the NHS. I’m dismayed to have to say it, but I see no efforts from the senior management team within the NHS to try to do anything other than try to get other people to do it for them.”
The councillor is not the first to publicly criticise the NHS’ conduct within the joint board.
Last autumn, councillor Billy Fox had an exchange of words with Kinniburgh on Shetland News’ letters page over the planned closure of the Gilbert Bain Hospital’s Ronas Ward.
Cleaver said the council has “done really hard work in managing the budget and delivering capacity” in a time when funding from the Scottish Government has reduced considerably.
He suggested, however, that the local NHS is not doing as much as it can to counter its own financial problems, with the health board needing to cut spending by around £4 million.
“The local health board are just not controlling their costs and they’re not coming up with any indications that they will ever be able to do so, so we are absolutely hamstrung with that problem,” Cleaver said.
“I felt I could no longer bring anything practicable to try to resolve that, because there was no enthusiasm from the health board to do that.”
Kinniburgh said the local health board has “never overspent” its annual budget from the Scottish Government and has “delivered ongoing savings of around 15 per cent of our core budget over the last five years”.
“As has been explained to IJB members, NHS Shetland has achieved this without the ability to draw on extensive reserves,” he said.
“NHS Shetland now needs to do even more to maintain financial sustainability and the IJB has to play an important role in this as they now control about 45 per cent of our budget and have the responsibility to plan all the community health and social care services.
“We therefore look forward to continuing to working with the council to develop how the IJB carries out its role and with members of the IJB who are committed to the idea of working in partnership effectively.”
Cleaver’s resignation came after Dr Catriona Waddington also stepped down from the IJB as member and vice-chair due to lack of free time.
NHS’ Marjorie Williamson has been appointed vice-chairwoman, Edna Mary Watson is a new temporary voting member and Kathleen Carolan was approved as a non-voting temporary member as a senior nurse.