Agenda item

Interim Chief Financial Officer

Mr Paul McMenamin gave an overview of the integration joint budget and highlighted adverse variances and projections on the budget.  He further highlighted: GP prescribing; AHP staffing budget; ability equipment store; social care funding; and remedial action plan.

Cllr John Mitchell enquired if the Health Board held a reserve that could be used towards the projected deficit.  Mrs Carol Gillie commented that the Health Board did not have and on-going reserve.  For the 2016/17 financial year she had put aside £2m, however at the end of September there was a £4.7m overspend. 

Mrs Evelyn Rodger commented that given NHS Borders had repeatedly reported through the Integration Joint Board that the pressures it was sustaining were around patient flow and occupied bed days for delayed discharges, why the Integration Joint Board did not ask for health and social work to jointly produce a recovery plan.  The Chair commented that there was a £1.8m overspend in prescribing.  Mrs Rodger maintained that a large proportion of the overspend was in relation to pressures on the system.

Mrs Susan Manion suggested that the reality was there were issues with capacity and flow as had been highlighted through previous financial reports.  She commented that resources had been directed through the Integration Joint Board via the Integrated Care Fund in order to lever change and improve flow.

Mrs Manion further advised that there was a requirement to agree plans for both NHS Borders and Scottish Borders Council in relation to the financial position and the reality was each organisation was still required to ensure it achieved a year end break even status.  She reiterated again the need for a jointly agreed recovery plan that helped the Integration Joint Board to achieve its outcomes and dealt with the issues in regard to the budget.

Mrs Rodger again enquired why directions would be given to NHS Borders and not Scottish Borders Council and Mrs Manion responded that it was because Scottish Borders Council were not in the same financial position.  Mrs Rodger stated that if NSH Borders were not carrying 30 delayed discharges it would be a healthier financial position and again suggested that directions should be given to both organisations to achieve a workable resolution to delayed discharges.

Mr McMenamin also commented that the direction was of a financial nature and was primarily for NHS Borders to reduce spend and deliver a balanced financial position.  He added that in getting to that point and developing a plan that was where social care would feed in.

Dr Angus McVean commented that prescribing was multi layered and was about cost prices and tariff changes, and suggested the label GP prescribing was incorrect and urged the use of the phrase prescribing costs.  Mrs Gillie echoed Dr McVean’s comments and stated that it was not a GP issue.

Mr David Davidson commented that in a joined up system he would expect that an area that was causing a pressure in another area, would divert funding to release the pressure and enquired if directions would be given to that effect in regard to delayed discharges.

Mr Davidson enquired what the value of the technical accounting adjustment was.  Mr McMenamin advised that it was one of a number of remedial actions being formulated and he could not confirm the value at that point in time. 

Mr Davidson suggested the financial report should provide examples of how to deal with the insufficient resources to address pressures.  Mr McMenamin advised that the partnership had direct marginal access in relation to social care funding and the integrated care fund for transformational change and improvement.  He emphasised that based on the social care fund there was £800k available on a recurring basis which was insufficient to meet the pressures identified and therefore he was seeking a remedial recovery action plan. 

The Chair suggested the Integration Joint Board seek a fully costed action plan and reconvene in November to go through it and set directions.

Cllr Sandy Aitchison sought the quantified savings or costs that were likely to be accrued.  Mrs Gillie confirmed that the figures would be shared with the Integration Joint Board as part of the recovery action plan.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the report and the monitoring position on the partnership’s 2016/17 revenue budget.

The HEALTH & SOCIAL CAREINTEGRATION JOINT BOARD noted the planned high-level actions of recovery currently being developed and implemented by NHS Borders.

The HEALTH & SOCIAL CAREINTEGRATION JOINT BOARD sought a costed recovery and action plan, at which point subsequent to that information it may consider the issuing of directions.

The HEALTH & SOCIAL CAREINTEGRATION JOINT BOARD agreed to an extra ordinary meeting to be held on 21 November 2016 to focus on the financial recovery and action plan.