Agenda item

Mrs Carol Gillie presented the recovery plan to the Board and highlighted several key elements including: financial pressures; recurring projects to be brought forward; £5.6m overspend at the year end on the delegated budget; operational pressures; efficiency/savings within the delegated budget; and the NHS wide recovery plan of £13.5m.

Mrs Jane Davidson highlighted that the Health & Social Care Integration Joint Board had been made aware of the situation previously and whilst the presentation contained more detail the situation had not changed.

Several points were raised during discussion including: Volatility of drug costs; supply and demand for junior doctors and locums; agency nursing staff are from premium rate agencies as the Scottish Government contract agency walked away from the local contract; work underway on a regional nurse bank facility; advance recruitment to permanent staff in anticipation of staff turnover and to avoid agency costs; skill mix of nursing staff to reduce reliance on junior doctors; difficulties in staffing the whole unscheduled care pathway; working hours for junior doctors are controlled and monitored and a cost is attached to anyone who breaches their contracted hours; and consultants are restricted to the 48 hours a week working time directive.

Cllr Graham Garvie commented that whilst Scottish Borders Council had met their savings target NHS Borders still had an issue.  Mrs Gillie commented that the Health & Social Care Integration Joint Board had been aware from an early stage that there would be financial difficulties for NHS Borders in the current year and that mitigating actions had taken place, including, slippage on the capital programme, underwriting the revenue position; slippage on the Local Delivery Plan commitments; ring-fenced allocations; social care funding; and increased financial controls.

Cllr Garvie enquired what the Health & Social care Integration Joint Board could do to help the financial position?  Mrs Gillie commented that whilst the pressures were roughly 50:50 the focus had to be on the recurring position and that she and David Robertson were trying to do more joined up financial planning for the future.  For the current year it was clear a breakeven position would not be achieved and she enquired if the Social Care Fund or integrated Care Fund might be used to support the financial position.

The Chair commented that the Health & Social Care Integration Joint Board needed to have capacity to issue directions in relation to funding or a restructure to generate the required savings.  She suggested full information be available for the Health & Social Care Integration Joint Board on 30 January for it to be able to issue appropriate directions.

Mr David Davidson agreed that fuller information was required and suggested the Executive Management Team provide a series of recommendations, risks and choices to the Health & Social Care Integration Joint Board so that it could make informed decisions on the issue of appropriate directions. 

The Chair suggested there was a need to concentrate on investment funding and recurring savings, with difficult choices being made on what would be stopped from being done and what might be done differently to mitigate the same situation arising in the future.

Mrs Torrance commented that she was committed to working with Mr Robertson and Mrs Gillie to see what could be put in place to manage projects more effectively, to take difficult decisions and to achieve the changes required.  She further commented that Prof John Bolton had agreed to work with the partnership early in the new year and that he would be able to give an objective view which might help with the difficult decisions to be made in the future.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the recovery plan presentation.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD agreed to hold an Extra Ordinary meeting on 30 January 2017 to focus on resolution of the financial situation.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD (IJB) agreed to receive a report in advance of the Extra Ordinary meeting setting out the directions the IJB should issue to achieve a breakeven situation at the end of March and the associated risks involved.