Integration joint boards funding gap hits £450m as watchdog urges action

The funding gap for integration joint boards (IJBs) in Scotland has hit almost £500 million as the country’s spending watchdog pushed for action.

The bodies, which are tasked with integrating health and social care, faced a £457 million spending gap in the 2023-24 financial year, according to a report from the Accounts Commission, an increase from £357 million the previous year.

In 2023-24, according to the report, 24 of the 30 IJBs in Scotland reported a deficit in spending, with 11 receiving additional funding from local councils or NHS boards and 16 saying they had taken money from reserves.

The spending gap comes despite savings being made by boards, with a target of £214 million in savings across the country.

Some 79% of the target was met, but 43% of the savings made were on a non-recurring basis, meaning any future savings will have to come from elsewhere.

As a result, the total reserves available to boards have fallen by 40% in real terms, while contingency reserves have fallen by 49% in real terms between 2022-23 and 2023-24.

The report added that Aberdeenshire IJB used all of its reserves in the latest financial year, while four used all of their contingency reserves – which are often used to cover unforeseen costs.

Malcolm Bell, a member of the Accounts Commission, said: “For too long, integration joint boards have been firefighting immediate financial challenges.

“Now they must shift from making one-off savings and relying on reserves to transform how services are delivered if they are to tackle their precarious finances.

“A stronger focus on prevention is needed, with candid conversations with communities, councils and NHS partners vital around the difficult choices that need to be made.”

Scottish Conservative health spokesman Dr Sandesh Gulhane pointed his finger at the Government’s scrapped National Care Service, for which just under £30 million was spent in preparation.

“While near-universal opposition forced the Nationalists to ditch the NCS, they still wasted almost £30 million on it – money which could and should have gone to the frontline, given the huge financial pressures highlighted by the Accounts Commission,” he said.

“There’s a lack of joined-up thinking or vision from (Health Secretary) Neil Gray and his SNP colleagues on health and social care, where their abject failure to tackle delayed discharge is either a cause or a symptom of many crises.

“SNP ministers must heed these warnings from the Accounts Commission by putting an end to wasteful spending on bureaucracy and ensuring more funding reaches local care providers.”

Scottish Liberal Democrat leader Alex Cole-Hamilton said: “There is a mountain of pressure facing health and social care services.

“SNP ministers have failed to relieve that strain from boards. They’ve allowed problems to boil over and spill out into the rest of the NHS.

“If people can’t get a care home place or a care package, too often they are left sitting in hospital, even if they are otherwise well enough to leave. That gums up the whole medical system from A&E onwards.”

Councillor Paul Kelly is health and social care spokesperson at Cosla, which represents local government in Scotland.

He said: “With Scotland’s population aged 75 and over expected to rise to 774,000 by 2045, it is vital that we invest in prevention and early intervention in social care with this future in mind.

“Given the present challenges facing the system, there needs to be constructive collaboration between local government, Scottish Government, IJBs, and NHS partners around the scale of the challenge – and what this means for what people and stakeholders can expect from the system.

“We are committed to working with all partners to do everything we can to understand the impact the current and projected financial position is having on the system.”

A Scottish Government spokesperson said: “We have invested a record £21.7 billion in health and social care in 2025-26, which includes almost £2.2 billion for social care and integration – increasing investment by £1.2 billion since 2021-22.

“On top of that our Budget makes a record £15 billion available for councils for 2025-26.

“However, we understand the additional pressures caused by the UK Government’s proposed increase in Employer National Insurance Contributions.”