Agenda item

Mr Paul McMenamin gave a presentation on the current financial position.  He spoke of the Health & Social Care Integration Joint Boards’ delegated budget responsibility; the set aside budget; the projected financial position previously presented in August and the emerging delegated budget pressures, as well as other pressures in both NHS Borders and Scottish Borders Council.   

Mr David Davidson enquired if there was a sense of priorities for action from the Executive Management Team (EMT).  Mr McMenamin confirmed that the EMT had discussed in detail a number of areas under consideration and he was assured of their commitment to work in partnership to resolve the financial situation through minimising impact and maximising mitigation.

Mrs Jane Davidson commented that the matter was an in year situation and the bigger priority was to think ahead about budgeting into 2017/18 and she emphasised the commitment from EMT to ensure the right services were provided and sustained in the future.

Mrs Davidson also suggested there was a need to focus on a quicker delivery of the Strategic Plan objectives for health and social care.  The Chair suggested the Health & Social Care Integration Joint Board would require advice on the issue of directions to facilitate such delivery through the EMT.

Mrs Jenny Smith reminded the Health & Social Care Integration Joint Board that the Strategic Planning Group should be engaged with in terms of seeking advice on the Strategic Plan.  Mrs Smyth also suggested engaging with the third sector by seeking their thoughts on solutions to make efficiencies as she was mindful that there would be repercussions for the third sector in terms of commissioned services.

Dr Stephen Mather suggested squeezing spending further would put patient care at risk and he enquired if there was an identified point at which that squeezing would need to stop.  Mrs Davidson assured the Health & Social Care Integration Joint Board that she would not compromise patient safety and she commented that she believed there were still efficiencies to be made and services that could be provided better together. 

Mrs Tracey Logan echoed the commitment of a partnership approach to sustainable future services and the need to pursue the joint budgeting exercise. 

Dr Cliff Sharp arrived.

Dr Mather pursued the question of there being an identified point at which patient safety would be compromised?  The Chair reminded the Health & Social Care Integration Joint Board that the aim of the Strategic Plan was to shift the balance of care from acute to the community.  She reminded the Health & Social Care Integration Joint Board that it was the professionals that assessed the risk to patients and therefore suggested the question could not be answered at that time.

Mrs Elaine Torrance commented that as the Chief Social Work Officer she would ask if the care being sought was absolutely necessary and suggested the broader issues would be how that was managed.  She reiterated that it was a position for professionals on a daily basis to balance care requirements whilst being mindful of the financial consequences.

Mrs Karen Hamilton enquired about the next steps should the planned savings and efficiencies not be achieved.  Mr McMenamin commented that whilst it was a volatile area the focus remained on what needed to be delivered against the risks and issues with partners and individuals managing their budgets and mitigating actions in order to minimise any additional pressures.

Cllr Sandy Aitchison noted that there had been a failure to deliver on the savings and efficiencies planned for the 16/17 period, and he sought clarity on the consequences of further savings and efficiencies being identified and delivered in terms of personnel, range of services offered, reduction in services, longer waiting lists for services, etc.

Mrs Davidson commented that the efficiency plan for 16/17 had contained a number of high risk areas and some of the failure of delivery had been about efficiencies and savings taking longer to realise with some not being available until the 17/18 financial period.  She suggested that the EMT would be looking at pathways of care within the community setting to reduce the level of admissions to the acute sector and acknowledged that delayed discharges, surge beds remaining open and drugs costs had contributed to the difficult financial position for NHS Borders.  She further commented that the EMT were committed to looking more carefully at progressing things jointly in terms of pathways, services and opportunities for efficiencies. 

Cllr Aitchison urged swift action to resolve matters.  Mrs Davidson commented that NHS Borders had a Mid Year Review meeting with the Scottish Government the following week and she expected to be able to furnish Mr McMenamin with more detailed information to work from following that session.

Further discussion focused on: the Health & Social Care Integration Joint Board’s recovery plan; seeking assistance from the Scottish Government; ring fenced funding; funding of local government; special measures; transfer of capital to revenue; transformational approach to funding; and joined up budgeting for future years.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed to append the presentation to the minutes. 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the presentation and the proposals to be brought to the next meeting in December around the integration care fund, social care fund, working together to deliver efficiencies and other savings, and agreement on the directions to be issued to partners.