Councillors in the capital are calling for a “recalibration of the relationship” between the local authority and NHS services after being forced to bail out a financially troubled health and social care services.
Edinburgh City Council is set to use around £14 million that it has underspent on this financial year to plug a gaping black hole in the Edinburgh Health and Social Care Partnership’s budget.
This process has become a regular occurrence, with the local council set to cancel plans to spend the money on other priorities such as tackling poverty and ensuring arms-length organisations pay the Living Wage.
Health and social care governance is directed by integration joint boards (IJBs), which decide where funding from both Edinburgh City Council and NHS Lothian is used.
Last month, council officials projected an “overspend of £13.2 million” for this financial year, which included “an increased funding shortfall of £16.7 million within the Edinburgh IJB”.
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The latest financial report from the IJB highlights that “a potential year-end overspend of £29 million is forecast”.
Officials have warned that “without the identification of additional mitigating actions”, the entire underspend from the council would be needed to help balance the books.
The IJB still has already brought forward a “full programme of savings”.
A stark warning from council officials states that “opportunities to deliver savings which do not impact on service delivery and can be realised by the end of the financial year are, however, assessed by the Interim Chief Officer to have been exhausted”.
It adds that “any such recovery plan will therefore set out proposals for service reductions which will inevitably lead to poorer outcomes for people, worsen performance and endanger delivery of the improvement plan”.
Councillors are set to agree to put the entire £13.7 million underspend towards health and social care services.
SNP finance spokesperson, Lesley Macinnes, who will table a cross-party motion in her name at today’s council meeting, said the intention is to “reset the relationship that the council has with this important organisation”.
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She added: “We are looking for greater transparency and closer working with the Edinburgh IJB and NHS Lothian to help us ensure that City of Edinburgh Council funding is appropriate and that we have a more effective longer-term relationship.
“We need to deliver many vital services through the Edinburgh IJB for many families and individuals in Edinburgh.”
Ms Macinnes added: “This year we will be sending an additional £14m to the Edinburgh IJB. This is money that could be spent on a number of different council priorities, including support for the most vulnerable in our city.
“By re-setting the relationship with the Edinburgh IJB we are stating clearly that we do not want to see this funding gap return next year.”
Labour leader of the city council, Cammy Day, warned that “the IJB has been underfunded since day one and carried a budget deficit every year”.
He added: “As people are living longer and longer, adding even more pressure to service, we need to get this right.
“Rather than pass the buck between the NHS and the council, we want to work together to come up with a process and a plan that works for everyone.
“The IJB system is flawed. If that means we have to go to the government and say maybe it’s not working and we need a better system for the city, then maybe we need to do that.
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“We need to pay the deficit this year, but going forward, we need a properly funded and properly governed health and social care service.”
Conservative MSP for the Lothians, Miles Briggs, said the intervention from councillors shows “the current system of integrated joint boards is not fit for purpose in Edinburgh”.
He added: “The separation for responsibilities between Edinburgh Council and NHS Lothian has led to a situation where the responsibilities of each organisation are unclear.
“The Edinburgh IJB is working on a deficit every year, which is not sustainable, to meet the high level of demand of social care in the capital.
“The delivery of social care in Edinburgh has always been challenging and the severe reduction of funding, from SNP ministers, has made a difficult situation even harder.
“Both Edinburgh Council and NHS Lothian receive lower funding per head of population, whilst also having an ageing population.
“SNP and Green Minister must pay attention to this motion at council to create a more efficient system, as every penny is important to deliver social care effectively in the capital.”
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Craig Marriott, director of finance at NHS Lothian, said: “We continue to work closely with Edinburgh City Council and the Edinburgh Health and Social Care Partnership through the Integrated Joint Board which is made up of both council and health representatives."
Mike Massaro-Mallinson, interim chief officer of Edinburgh Integration Joint Board, said that the council’s underspend being allocated to health and social care services “will help us to implement our improvement plan and financial strategy to ensure that health and social care services in Edinburgh remain sustainable”.
He added: “We welcome the City of Edinburgh Council’s motion for an ongoing two-way conversation on how we can improve financial clarity for elected members.
“There are still challenges for us to face to ensure that we can reduce our deficit in the coming years, however this has helped to put us on a path which benefits the people of Edinburgh.”
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