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Health / Staffing situation in community health and social care remains ‘extremely difficult’

THE STAFFING situation in community health and social care in Shetland is in an “extremely difficult” place right now amid increasing demand, a meeting heard this week.

Shetland Islands Council’s depute director of community health and social care Jo Robinson warned there was little prospect of bringing staff costs down.

It comes as the council is set to provide a further £2.43 million to Shetland’s health and social care integration joint board (IJB) above the original budget for services delivered in 2022/23.

Much of this is down to increased staffing costs, with many agency workers drafted in to fill gaps in services as recruitment remains a challenge.

At Monday’s meeting of the council’s policy and resources committee Shetland Central member Catherine Hughson asked how the level of spend compares to other local authorities.

The IJB brings together the council and NHS Shetland to oversee the delivery of health and social care services in the isles, with both sides contributing to its budget.

Jo Robinson.

SIC finance manager Paul Fraser indicated that the level of support “essentially relates to our spend broadly speaking on community health and social care”.

“Our cost of doing business continues to increase,” he added.

Robinson told councillors that agency staff are vital in keeping services going.

“I think that the staffing station in community health and social care is in an extremely difficult situation and generally speaking the need in the community is increasing – it’s increasing in volume and it’s increasing in complexity,” she said.

“We’re seeing people that we are not managing to meet their needs really struggling and their carers and their families really struggling.

“So I think it is extremely difficult to think that we will be able to bring the staff costs down for the amount of care across adult and children’s services that we need to provide.

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“If there was a decision around not using agency staff then it would have a significant impact on our ability to care for people in the community.”

Lerwick South councillor John Fraser, who is the vice-chair of the IJB, asked if the ongoing programme to shift the balance of care in Shetland may ease the financial pressure in the future.

This includes providing more care in community care settings, and individual homes when appropriate, rather than in hospital.

Robinson said she felt there are changes in models of care delivery that could make a difference and “enable us to provide to more people in a more economic way”.

She said this would have to be less residential and more community based.

Robinson said there is also work ongoing around alternatives to statutory provision, which involves looking at community run services instead.

While that could make things more affordable, it “will need to be balanced with the level of need that’s coming through” – particularly the level of people via from children’s services with complex needs.

“I think it’s a balance of us trying to deliver a better economic model and a more sustainable model staffing-wise, but balancing that with the complexity of need that we’re needing to deliver to,” Robinson said.

Council leader Emma Macdonald said she recognised people will see the the £2 million-plus increase at a time when the SIC is looking to cut back its spending.

“But we can’t lose sight of the fact that some of the people that receive those services are the most vulnerable people in our communities,” Macdonald said.

“We have a responsibility to do what’s right and give them the care that they require and that they deserve to have, and that comes at a cost – and a much higher cost here, so we do have to be prepared for that.”

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