Funding gap for health and care bodies projected to increase 187%

Key bodies involved in providing health and care services across Scotland have seen their projected funding gap grow by a massive 187%, according to a report.

Watchdogs at the Accounts Commission revealed the rise as they warned of “unprecedented pressures” on Scotland’s Integration Joint Boards (IJBs) amid a reduction in funding and growing demand for services.

IJBs are responsible for planning and commissioning vital community-based health and care services across Scotland, dealing with areas such as social work for older people, GP services, pharmaceutical services, drug and alcohol services, mental health services and services for disabled adults.

But with their projected funding gap having risen to £357m in 2023-24, the Accounts Commission said IJBs are dealing with a “complex landscape of unprecedented pressures, challenges and uncertainties”.

It also highlighted the “unsustainable” reliance on the country’s estimated 800,000 unpaid carers as social care staff come under “increased pressure”.

It went on to warn that “the health inequality gap is widening”, highlighting the “increased demand for services and a growing level of unmet and more complex needs”.

Despite this growing demand, the report warned the financial position of IJBs – which bring together senior figures from councils and health boards – is “set to worsen”.

Colin Poolman, Scotland director of the Royal College of Nursing (RCN) said: “This damming report sets out the challenges facing community health and social care services.

“Too often the focus is on the crisis in acute hospitals, but hospital overcrowding is a symptom of the lack of investment and prioritisation of community services. The whole system is at breaking point.”

Scottish Conservative deputy health spokeswoman Tess White said: “This damning report exposes the scale of the crisis in Scotland’s social care system which the SNP are presiding over.

“The nationalists’ swingeing cuts to IJB budgets are having a devastating impact on some of our most vulnerable people, by exacerbating the desperate shortage of care home of places and staff.”

Labour social care spokesperson Jackie Baillie was also critical of the Scottish Government, saying: “A perfect storm of funding cuts, staffing shortages and growing demand has left social care and community health in Scotland at breaking point.

“If the SNP government does not address the mounting pressure on IJBs, it will have devastating consequences for people who rely on these services and for our entire healthcare system.”

Their comments came as the Accounts Commission said the projected funding gap for 2023-24 “has almost tripled in comparison to the previous year” and now stands at £357m – a 187% increase from £124m in 2022-23.

It said: “The financial outlook for IJBs continues to weaken with indications of more challenging times ahead.”

The report told how funding to IJBs in 2022-23 decreased by 9% in real-terms, or by 1% in real-terms once Covid-19 funding was excluded.

It added that IJBs – like other bodies in the public sector – face financial pressures linked to inflation, wage demands and costs related to the pandemic.

These are “making it difficult to sustain services at their current level”, it said.

The workforce is described as being “under immense pressure” as a result of the “wider pressures in the health and social care system”.

The Accounts Commission noted “difficulties in recruiting and retaining a skilled workforce” across the community health and social care sector, adding the pandemic, the cost-of-living crisis and Brexit had “deepened existing pressures”.

It said unpaid carers are now “increasingly relied on as part of the system”, adding: “Without significant changes in how services are provided and organised, these issues will get worse as demand continues to increase and the workforce pool continues to contract.”

While the creation of IJBs was meant to help bring about a shift in the balance of care, with more provided in the community rather than hospitals, the Accounts Commission said it had “not seen significant evidence” of this.

It said IJBs “operate within complex governance systems that can make planning and decision making difficult”, and added there should be a “clear national strategy for health and social care that will promote improved outcomes across Scotland but reflects the need to respond to local priorities”.

Accounts Commission member Angela Leitch said a “collaborative approach to change” – involving councils, health boards, the Scottish Government and others – is needed to improve the situation.

“The pressures facing social care and community healthcare are complex, with health inequalities widening,” she said.

“These issues can’t easily be resolved, and the situation is getting worse.

“We’re already at the point of increasing levels of unmet need and tightening eligibility to access services.

“This could be impacting people’s quality of life, but data quality is insufficient to fully assess this.

“Integration Joint Boards can’t tackle these challenges alone – they need the support of councils, health boards, Scottish Government and other partners to help them make the urgent changes that are needed now.

“Without this collaborative approach to change, the pressures facing Integration Joint Boards will get worse.”

A Scottish Government spokesperson said: “We have invested a record £19.5bn in health and social care in 2024-25. This includes an allocation of over £2bn for social care and integration to deliver on our commitment to increase spending in this area by 25% – two years ahead of target.

“Our funding supports the work delivered by Integration Joint Boards, but budgets and overall funding allocations are agreed by local authorities and health boards, not the Scottish Government.

“We understand the recruitment challenges within health and social care and offer funding to advertise vacancies.

“We remain committed to supporting the delivery of improved, sustainable health and social services across Scotland.”