Delivery of health and care services in Dumfries and Galloway is faced with “significant financial challenges”, new documents reveal.
The 2020/21 Integration Joint Board papers document how the body is “required to operate within tight fiscal constraints for the foreseeable future”.
An outlined “savings challenge” totalling £24.16 million is projected for 2021/22, based on funding sourced from partners Dumfries and Galloway Council and the NHS board.
Despite identified savings of £11.23 million, an “opening gap” of £12.930 million remains.
The report blames a “continuing difficult national economic outlook and increasing demand for service” for the position in the unaudited draft accounts prepared as part of the annual report and financial statements for the year ended March 31, 2021.
They also reveal how 2020/21 “has undoubtedly been the most difficult year across health and social care in Dumfries and Galloway” since the body was created in 2015.
The coronavirus pandemic has been blamed for causing “significant harm, pain and suffering” to many in the region, as well as presenting the “largest crisis we have ever faced”.
IJB bosses reported a “balanced” 2020/21 financial position, including the carry forward of ring-fenced reserves of £2.5m – £2.3m in the social care fund and an additional £0.2m for alcohol and drugs partnership services – into the year.
But the draft accounts show an in-year increase in reserves to £16.4m.
The leap is attributed to “a combination of a slowing of spend on projects during the pandemic and additional resource from Scottish Government to support Covid-19 spend and also adult social care winter plans”.
They say any reserves earmarked for Covid-19 activity – currently totalling £7.8m – will be “the first call for use against Covid-19 costs for 2021/22”.
Papers outline how the sums “are ringfenced allocations and are fully committed and remain set aside for the purposes they were originally allocated to”.
The IJB was established in 2015 through a partnership between NHS Dumfries and Galloway and the council and has responsibility for planning and delivery of a defined range of health and adult social care services for the region’s residents.
It has no general reserves but can retain the monies for 2021/22 “to support management of pressures within social care and development and transformation of new services”.
Additional backing was provided in-year from the NHS Dumfries and Galloway board to the tune of £28.856 million to support health overspend in the delegated budget.
But the IJB itself “faces ongoing service and cost pressure”, the papers reveal, with “both of the parties” involved “facing challenges in meeting the demands for services within the finances available”, likely to result in “a direct consequence on the funding provided to the IJB”.
Major financial risks facing the joint board result from “demographic pressures and the consequent changes to demands for health and social care”, including “significant growth” in the number of older people and resulting need for services.
Documents also reveal how “innovative solutions” are required to the available funding to meet service demand.
An increase in “workforce sustainability pressures” is presenting more challenges in both Acute and Primary care, whilst: “the increasing medical locum bill reflects the challenges around recruitment of medical staff”.
But the pandemic has “created additional financial risk with a number of new services required to support the ongoing challenges associated with the management of Covid-19”.
The “longer term strategy” in relation to such costs is “not entirely certain” bosses say but the management of “financial risks” has been branded “critical”.
An increase in funding streams which “lack clarity on the recurring position” has also been flagged up.
Meanwhile, the IJB managed to deliver services such as cancer treatment, which continued throughout the year, with data revealing that 93.6 per cent of people diagnosed with cancer started treatment within 62 days of referral – up from 88.6 per cent over the same period in 2019.
Both figures are below the national target of 95 per cent.
Mental health services also continued with 67.8 per cent of people referred for psychological therapies beginning treatment within 18 weeks, down from 68.1 per cent in 2019 – the target is 90 per cent.
But in Community and Adolescent Mental Health Services 96.1 per cent of children and young people referred began treatment within 18 weeks of referral, up from 88.6 per cent in 2019 and above the 90 per cent target.