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Health / Recovery plan to look at reducing projected £5m health and social care overspend

A RECOVERY plan is being drawn up by health and social care bosses in Shetland in a bid to tackle increasing financial pressure – with a vacancy freeze one option being considered.

Services commissioned by Shetland’s integration joint board, which covers health and social care across the council and NHS, are expected to run at an overspend of £5.36 million this financial year.

Meanwhile NHS Shetland previously said it is projecting an overspend itself of around £4 million.

A warning was made at a meeting of the IJB on Thursday that “big decisions” will need to be made in the coming months.

Chief financial officer Karl Williamson highlighted that NHS Shetland may require brokerage – in effect a loan which needs to be repaid – from the Scottish Government for the first time to break even at the end of the financial year.

He said this would then impact on future budgets.

The IJB is a separate legal entity and it would receive top-up payments from Shetland Islands Council and NHS Shetland in order for it to balance the books at year-end.

The key driver behind the financial situation is the cost of temporary and agency staffing to fill gaps in service.

Williamson told Thursday’s meeting at IJB services were under “extreme pressure”. He said mental health, primary care, adult services, adult social work, community care resources and unscheduled care in the hospital are “heavy reliant” on agency staff.

The council has 30 plus applicants for jobs across the services at the moment, Williamson added.

The financial chief said a recovery plan is currently being drafted to look at ways to tackle rising costs, and this could include a “vacancy freeze” and more control over locum staff bookings – while longer term service redesign will need to be accelerated.

Following a question from councillor Robbie McGregor, Williamson gave reassurance that clinical needs will be taken into account as well as financial.

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IJB chief officer Brian Chittick added that the recovery plan would look in particular at a review of self-directed support, so best value can be demonstrated.

On temporary staff, he said: “It’s really looking at can we use the network to decrease that locum utility.

“So for example in areas like mental health and primary care could we be using a network with other island partnerships or other mainland Scotland areas to use our resource a lot better and a lot more efficiently and effectively, particularly around out of hours.

“So the patient shouldn’t notice any change, but maybe the person they’re talking to might not be based in Shetland.”

He said this something that is already being trialled locally.

Chittick said the recovery plan would also involve potential business improvements that can be scaled up, such as energy efficiency.

A report presented to IJB members added: “The Covid-19 pandemic continues to have an impact on service delivery and associated finances with current projected costs for the year being £1.617m. “These costs will be covered by the Covid element of the IJB’s general reserve.”

The budgetary pressures are reflected across the public sector, with the council itself projecting an overspend in 2022/23 of more than £2 million, with “stark” figures estimated for the coming years if no action is taken.

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