Agenda item

Interim Chief Financial Officer

Mr Paul McMenamin gave an overview of the content of the report and highlighted that it was a purely factual report and that actions were being taken to address the actions the report raised.

Mr David Robertson commented that the report was due to be submitted to the SBC Executive meeting the following day and he said that he would inform them that as the IJB meeting was inquorate no decisions on the content of the report could be made.

Mrs Jane Davidson suggested she would have expected, given the various overspends in health, that the report would have referred to the activation of Section 8 of the Scheme of Integration around financial recovery plans, especially given the level of overspend on NHS unscheduled care services. 

Mrs Susan Manion advised that in the first instance the paper detailed the current financial monitoring position.  She suggested a second issue was the process by which the social care fund would be accessed and allocated based on the content of the John Swinney letter and to address the pressures within the Health Board.  She commented that the social care fund would not address all the pressures across all the agencies.

The third issue related to how overspends and pressures would be dealt with.  She commented that discussions would take place with colleagues in the Health Board around recovery plans and scrutinising efficiency plans.

The Chair made further suggestions that the use of the social care fund be worked up taking into consideration the pressures in both SBC and NHS Borders to ensure a joined up partnership approach was taken to allow the IJB to make a fully informed decision.  She suggested a recovery plan be submitted to the IJB for the whole of the budget.

Mr McMenamin advised that since the 30 June further considerable pressures had emerged across the wider delegated budget.  He commented that in GP prescribing the financial pressure had significantly increased in recent months.  Mr McMenamin further advised that in his professional judgement, whilst he did not quote Section 8 of the Scheme of Integration, his report did refer to working in partnership to address the financial position.

Mr John Raine commented that whilst the IJB was unable to make a decision at that time on the £1.427m social care fund, any decision taken in isolation from all other pressures would be a problem for the IJB in the future as there were considerable budget pressures across both partner organisations.

Mrs Manion suggested there was an explicit expectation of how the social care fund would be spent and that the IJB had already agreed an element of that spend.  She commented that consideration and agreement in principle had been reached regarding spend on the flex beds within the Health Board, but she urged the IJB to be mindful that the allocation of the social care fund needed to be in line with the expectations of the Scottish Government.

Mrs Elaine Torrance commented that a lot of additionality was Scottish Government driven and SBC could not have estimated how much should have been put in the budget.  She suggested that if older people with mental health issues and the vulnerable were to be cared for at home then the budget needed to be allocated for that purpose in the first instance, in order to keep people safe in the community.

Mr David Davidson sought clarity that the recommendation in regard to the £1.427m had been discussed by both the Health Board Director of Finance, Scottish Borders Council Chief Financial Officer and the IJB’s Interim Chief Financial Officer, he commented that it was not clear if that had happened and if not he sought an explanation of the governance around that series of proposed allocations.  He suggested when the matter was to be discussed again more clarity on that point be given, as well as Elaine Torrance’s issues, what percentage uplift was to address past pressures and current issues and what the percentage spend would be on new services.

Mr McMenamin responded that Mrs Gillie and Mr Robertson and he had discussed the report and the main areas at the EMT.  He commented that at the last meeting of the IJB it had been noted that a report to the IJB of this nature contained his recommendations as professional advisor to the IJB and those of the Chief Officer and whilst he was keen for full consensus he had a stewardship role for the IJB and he believed the recommendations to be considered and measured. 

He further commented that he thought it strange that the social care fund came through the NHS funding mechanism as the letter was part of the local authority settlement.  He further commented that there were a range of ongoing pressures within the delegated budget which  had yet to be addressed, such as client payments for self directed support.   

Mr David Robertson commented that the information gathered to prepare the report had been produced by SBC and the Health Board and he advised that neither he nor Mrs Gillie had any difficulty with the factual accuracy of the report.  He advised that additional information could be provided to the IJB from the wider NHS and SBC finance departments.

The Chair commented that the IJB would inevitably need to take difficult decisions based on a full comprehensive report and reminded the IJB that the Audit Committee would also wish to scrutinise and challenge the whole budget at part of its governance and assurance role to the IJB.

Mrs Jeanette McDiarmid welcomed the opportunity for Mr McMenamin to provide more evidence on each of the pressure areas in social care and how they met the requirements of the John Swinney letter. 

Mrs Jane Davidson acknowledged the monitoring information provided and welcomed a joint quality discussion whereby both parties were part of a symbiotic relationship and could have an understanding of what was going into the financial report.  She welcomed the involvement of the Audit Committee and on a point of note suggested the report and discussion should not focus on the John Swinney letter per se but should focus on the provision of the social care fund resource by NHS Borders to the IJB as that was what was provided on a practical basis.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report and sought additional information in regard to the recommendations for the next meeting.  

Stephen Mather left the meeting.

Annabel Howell left the meeting.