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Health service finances look safe for the year, but ‘change needed’

NHS SHETLAND finances look set to balance at the end of the financial year if the Scottish Government makes good on indications it will write-off brokerage debts for health boards.

The local NHS had been on course for a £3.748 million overspend for services contracted to the Integration Joint Board alone, with the Shetland Islands Council, the other service partner to the IJB set for a £445k overspend.

But it appears that the widespread demand from health boards for brokerage – loans that must be repaid to the government – has convinced Edinburgh officials that boards are simply not getting enough money.

A report from NHS Shetland chief financial officer Karl Williamson says: “The latest information from the Scottish Government is that all brokerage up to the end of 2018/19 will be written off so the impact of brokerage on the IJB is expected to be minimal going into 2019/20.

“As a result of the above it is anticipated that the IJB, as a separate legal entity, will reach a break-even position for the financial year 2018/19.”

NHS Shetland chief executive Ralph Roberts said at an IJB meeting on Wednesday: “We have had a positive response from the Scottish Government because I think the Scottish Government believes we are doing the right things and there is a level of belief and trust that they should continue to support us.

“It’s true we spend more on health and social care than anywhere else in Scotland (per head) and there are valid reasons for a proportion of that cost being necessary.”

The meeting also considered the labyrinthine nature of health service funding; with the Scottish Government delivering its major money at the start of the year, which is topped up by separate pots and perhaps a final settlement nearer the end of the year – an arrangement that makes reconciling budgets with the health board’s “strategic plan” almost impossible.

The report also states that NHS Shetland needed to “identify £2.077m in savings in 2018/19, but to-date no recurrent or non-recurrent savings has been achieved.”

“The underlying gap is still there year on year and there is an additional gap as new costs emerge year on year. We will still have to rely on significant non-recurrent support next year to get us on target,” said Roberts.

The board’s financial headaches have spurred a widespread overhaul of service delivery. IJB chairwoman Marjorie Williamson said that even though a new strategic plan was being drawn up, what was needed was a detailed operational plan that would embrace the needed savings.

She said that with persistent lobbying the Scottish Government might be persuaded to up its funding to health boards given the widespread financial trouble that had unrolled this year.

The meeting also heard that the use of locum doctors must be eliminated and services that are presently delivered in Aberdeen should be available locally as much as possible.

The IJB’s “adverse variance” of £4.193 million was close to a figure quoted by IJB vice chairman Allison Duncan as NHS Shetland’s spend on locums over an 18 month period. Roberts said that the government would not provide extra money specifically for the cost of locums.