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Health / Increased emphasis on IJB savings amid top-up funding uncertainty

THERE is a “critical need” to prioritise savings targets and cost reduction initiatives this year in health and social care in Shetland, members of the isles’ integration joint board (IJB) have been warned.

This is because unlike in previous years funding partners Shetland Islands Council (SIC) and NHS Shetland are unable to offer assurances regarding their capacity to provide year-end top-up funding to the IJB to balance the books.

Members of the IJB approved the board’s £68 million 2024/25 budget at a meeting on Tuesday morning, although NHS Shetland still needs to consider it at a forthcoming meeting.

Members were told that it is an “extremely challenging” budget which is reliant on the delivery of £610,000 of savings from the NHS Shetland arm.

A report on the budget presented by chief financial officer Karl Williamson said that with NHS Shetland and the SIC facing their own challenges, there could be reductions in IJB budgets in the future.

It also reiterates how NHS Shetland may potentially require brokerage – extra financial support from the government – and that the SIC is facing an unsustainable draw from reserves of more than £20 million this financial year.

In the past the IJB has generally run to a deficit, but the NHS and SIC provide supplementary income to allow the board to achieve financial balance.

A report presented to the IJB in February showed there was an expected overspend of £5.7 million in 2023/24.

Williamson said he felt despite the challenges the 2024/25 budget was the “best offer at this time”.

During questioning councillor Robbie McGregor raised the “vexatious” issue of the cost of temporary locum staff.

He asked if there could be greater innovation in recruitment such as in inviting potential job candidates to Shetland to see what life is like in the isles –  to show them that is “not the back of beyond”.

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Lerwick councillor John Fraser also stressed caution, however, about the idea of financially incentivising working in Shetland beyond what is already on offer in terms of a relocation package.

He suggested people coming to work in Shetland for financial reasons may not stay in the long term.

But director of pharmacy Tony McDavitt also told the meeting that some locum doctors have opted to stay in Shetland and take up a substantive post after experiencing life in the isles.

New permanent IJB chief officer Jo Robinson told members that there has been recent success with recruitment, and that there have been some innovative approaches to contracts especially in terms of people who do not wish to work all year round.

With more success in recruitment, she said the “cost pressure has significantly reduced from what it is a year ago”.

Robinson also said this is starting to be felt in social care too.

But she warned that even if all vacant posts were filled there will would still be a financial deficit.

”We will still not break even,” Robinson said. “We need to reduce the level of cost of our services”.

She added that redesign is particularly important because of demographic pressures such as increasing numbers of older people and those needing support.

Meanwhile Robinson suggested much of the proposed workforce changes highlighted in the 2024/25 budget as cost reductions will not come as a surprise to staff, as some of the work already ongoing.

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