Report warns integration joint boards require ‘radical change’

Health and social care services delivered by integration joint boards (IJBs) in Scotland cannot be sustained without “radical change”, according to a new study.

An Accounts Commission report on the finances of IJBs shows many are using dwindling reserves to help meet the almost £450 million gap between demand and available funding.

The report is calling on IJBs together with their NHS and council partners to urgently make decisions on where to redesign, reduce or discontinue services.

Funding to Scotland’s 30 IJBs increased by more than 2% in 2024-25 to more than £12 billion.

However, the report highlights this was insufficient to meet rising costs and demands, and the boards have reached a critical point, with a significant risk they will become financially unsustainable within the next 12 to 24 months.

Malcolm Bell, of the Accounts Commission, said: “The cost of delivering services is rising faster than available funding.

“Tackling this could include difficult decisions about redesigning or reducing services, and whether new or additional charges need to be made.

“Whatever decisions are made, service users, their families and wider communities must be consulted.

“But without radical change the services delivered by IJBs can’t be sustained. The gap between funding available and the cost of meeting demand is widening, and the gap of nearly £450 million cannot be bridged with savings alone.”

Alongside savings and using reserves, the report said IJBs have been relying on substantial additional funding from their partners in the NHS and councils.

The report offers recommendations for IJBs to plan their finances more realistically to reduce this reliance.

Scottish Conservative MSP Craig Hoy said: “Health and social care in Scotland are mired in permanent crisis and this report indicates that things are likely to get even worse due to the SNP’s chronic mismanagement of the nation’s finances.

“It’s hard to see how the nationalists will reduce intolerable NHS waiting times and finally eradicate delayed discharge – which they promised to do a decade ago – when there’s a funding gap of almost half a billion pounds.

“Unless and until the SNP rein in Scotland’s ballooning benefits bill, frontline services will continue to suffer while hard-pressed Scots are clobbered with ever-rising taxes.

“Only the Scottish Conservatives opposed the SNP’s budget and offered credible, costed plans to cut tax and tackle unaffordable and unsustainable welfare spending.

“This report makes it clear that if the SNP remain in government, Scots will continue to pay more while getting less.

“The only way to stop that is for Scots to cast their peach-coloured ballot for the Scottish Conservatives in the upcoming election.”

Social care minister Tom Arthur said: “While this report acknowledges a real-terms increase in IJB funding between 2023/24 and 2024/25, we recognise the financial pressures facing the health and social care sector, and remain committed to meaningful reform.

“We have provided a record settlement for local government and will deliver funding of almost £22.5 billon to health and social care in 2026-27.

“The integration of health and social care planning is essential in ensuring services are well-co-ordinated and responsive to the population’s evolving needs. This report recognises the need for local collaboration in setting budgets.

“Through the national care service programme, and the delivery of the service renewal framework, we are taking practical steps towards our vision of a Scotland where people live longer, healthier and more fulfilling lives.”