Agenda item

6.1 Mrs Lizzie Turner provided an overview of the content of the paper and highlighted that there was not yet an offer from NHS Borders, however she anticipated that an offer would be supplied the following week. Mrs Turner drew the attention of the Board to the Scottish Borders Council offer of £81.5m and explained that the level of additional monies anticipated from the council for additional expenditure was unknown and work was taking place to provide clarity on that. She advised that the offer did meet the payment request issued in December 2023 and whilst there were new savings within the offer, there was also £1.1m of savings brought forward that were not delivered on a permanent basis.

6.2 Mr Andrew Bone commented that he appreciated how difficult it was for the IJB to be in such a position so close to the new financial year, where it was unable to set a budget due to the health budget offer not being available. He advised that circumstances surrounding the financial position in the NHS and NHS Borders had been fluid with lots of conditions being set and being subject to change and revision continually. Clarity on Scottish Government funding for a number of elements supplementary to core funding remained outstanding such as the 2023/24 and 2024/25 pay deals. The position in NHS Scotland in terms of funding remained uncertain with reviews of Health Board 4 budgets ongoing especially in relation to the delegated functions to the IJB. In regard to NHS Borders the biggest issue was the scale of the financial deficit and the inability to provide a balanced budget position. Overall NHS Borders faced a deficit position in excess of £40m with significant elements in relation to the delegated functions. Planning on savings continued to take place however less than 50% had been identified and the Scottish Government had offered support to identify any further savings.

6.3 Mr Bone commented that he recognised with hindsight that it would have been better to provide the IJB with an indicative budget based on the baseline of options with caveats pending progress on the NHS Borders budget. He committed to provide an indicative budget within the next 7 days.

6.4 Cllr David Parker challenged the situation and advised that the Scottish Borders Integration Joint Board was the only IJB in Scotland that was unable to set a budget. He welcomed the firm offer received from the local authority and showed his disappointment that an indicative offer had not been forthcoming from the health board. He reminded the Board that the Chief Officer had set out a clear mandate of what he had expected in terms of payment offers to the IJB. He suggested the IJB was being disrespected by the Health Board year on year in its inability to provide an indicative offer as it could not get the process right. He commented that the IJB would need to set savings targets and close surge beds, however it was unable to do any transformation work or savings work given it did not a budget offer from Health for the delegated functions. He advised that he was not happy and did not accept the excuses he had received.

6.5 Mrs Fiona Sandford commented that whilst she empathised with Cllr Parker’s position she was fully aware of just how incredibly difficult it had been both operationally and financially for the Health Board. She was concerned at how the challenges faced and savings to be made by health were communicated and she highlighted the statement by the Scottish Government via the BBC that all Health Boards in Scotland had been provided with an additional 3% in real terms increase, however Health Boards did not recognise that figure as it was not new money. She was keen to have the budget position resolved and asked the IJB to recognise how challenging a position it was for NHS Borders.

6.6 Cllr Tom Weatherstone agreed with Cllr Parker and commented that with only half a budget the IJB was unable to make decisions and move forward with any kind of certainty.

6.7 Mrs Karen Hamilton recognised the comments around the table and as an IJB member suggested she was also concerned and would find it helpful to understand a bit more especially if the Scottish Borders was the only IJB in Scotland without a budget offer. She welcomed the explanation by Mr Bone and understood how difficult it was. As the Chair of NHS Borders she advised that she had pushed hard to get an offer to the IJB that day. She was keen to ensure that the same situation did not repeat itself in future as it had added to the frustration shared by members around the table. She then enquired where the IJB sat in terms of the bigger picture across Scotland as she was 5 aware that some of the indicative offers to IJBs were very indicative and she questioned how helpful they really were.

6.8 Mr Chris Myers commented that some IJBs had confirmed budgets or were confirming budgets by the end of the financial year and the majority had received indicative offers from health boards. He did think the IJB was an outlier in not having received a payment offer from health to date.

6.9 The Chair summarised the conversation and reflected on what it meant for the rest of the meeting agenda. She heard the message of an indicative offer being made by health within a week and looked forward to receiving that offer. She was keen that the same situation would not arise in the future and requested that a timeline be drawn up and adhered to for future budget setting. Given the IJB was not in a position of having a full budget to approve she suggested the Local Authority offer be held until the Health Board offer was received and an extraordinary meeting be organised for approval of the budget as quickly as possible.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD deferred approval of the Payment Offer from Scottish Borders Council to the extraordinary meeting.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted that the Payment Offer from NHS Borders was outstanding and was required before the IJB budget could be finalised.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD charged NHS Borders to provide a Payment Offer by close of play Wednesday 27 March 2024.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD charged the Chief Officer with working up a timetable with the Chief Financial Officer and Director of Finance, NHS Borders for future budget offers.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD requested a full initial budget be brought to the IJB in April for approval upon receipt of the outstanding offer.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD noted the risks described in the paper.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to hold an extraordinary meeting to agree the budget.

The SCOTTISH BORDERS HEALTH AND SOCIAL CARE INTEGRATION JOINT BOARD agreed to defer items 5.2, 6.1 and 6.2 on the agenda to the extraordinary meeting.