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Health and social care partnership ‘not financially sustainable’

SHETLAND’s health and social care partnership is “not financially sustainable and significant funding gaps are forecast for future years”, according to auditors.

Deloitte reaffirmed in an audit of the local integration joint board (IJB), which brings together Shetland Islands Council and NHS Shetland, that it needs to “prioritise and progress transformational change” in order to reach sustainability.

This includes considering alternative methods of service delivery or taking “difficult decisions” such as changes to levels of service.

The final audit report for the 2018/19 financial year was presented to members to the board on Thursday, but its recommendations are nothing new for the IJB, which had considered an interim audit report back in June.

Annual accounts for the IJB for 2018/19, also presented on Thursday, showed an overall deficit against budget of £3.116 million.

This included an overspend of services commissioned from NHS Shetland of nearly £3 million.

The council and health board made one-off additional contributions of £144,000 and £3.513m respectively in order to achieve the final IJB surplus for the year of £541,000.

The IJB is a separate legal entity and is expected to balance the books thanks to one-off payments from its two partners.

It also noted that only around £426,000 in savings were achieved during the year, despite a target of £2.276 million.

One of the main reasons for the financial imbalance was a reliance on temporary locum staff.

Councillor Robbie McGregor expressed worry at Thursday’s meeting over the recurring funding gap – particularly when Brexit is looming, as “services are demand driven”.

“It’s so difficult to see how these potential reductions in expenditure can be achieved,” he said.

Fellow councillor Emma Macdonald, meanwhile, called on the board to back projects which can deliver “transformational change”.

“I do think as the IJB we do have a responsibility to get behind some of the change,” she said.

“We can’t keep relying on things we have been relying on to keep making savings.”

In its audit report, Deloitte said that the IJB has “effective financial management processes in place. However, there is room for improvement in the budget-setting process, the reporting of progress against budget and changes to the budget in year”.

The auditors also said that the IJB has been “performing consistently against its targets”.

“However, performance has declined from 2017/18. There needs to be a clear link between cost and performance, and the IJB should consider the targets it sets on an ongoing basis to ensure they remain realistic, demonstrate a commitment to improvement and are aligned with the Scottish Government’s National Performance Framework,” it added.