What is an HSCP?

The Health and Social Care Partnership (HSCP) is an independent public body whose duties are laid out in Scottish law. It is a partnership between NHS Highland and Argyll and Bute Council who both contribute to its budget. In Argyll and Bute the HSCP is the organisation that plans the delivery of all of our health and social care services.

How is the HSCP funded?

HSCP receives money from both partners, NHS Highland and Argyll and Bute Council, each year. The amount that each partner pays is a decision taken by their own Boards.

The HSCP then has to operate within the amount of money it has been given. This budget must be “balanced”; in other words, the HSCP cannot plan to overspend.

Setting the 2022/23 budget

The Integration Joint Board (IJB) is required to set a balanced budget for the Health and Social Care Partnership (HSCP) 2022/23 at its meeting scheduled for 30 March 2022.

The IJB is advancing its financial planning for 2022/23 and is awaiting final confirmation of funding from both NHS Highland and Argyll and Bute Council. The Scottish Government published its draft budget in December 2021 and the IJB welcomes the commitment made in the budget to increase funding to the Health and Social Care Sector. This additional funding does include additional commitments and priorities, including increasing pay rates throughout the sector. It is hoped that this will encourage staff to continue to work in the health and care sector and encourage new people to come and work with us. The HSCP is, however, still required to deliver savings and efficiency improvement. We also have significant debt to repay previous overspending which increases the financial challenge we face.  We need to reduce our spending by around £4.8m next year to enable us to meet our service and debt repayment commitments.

In recent years we have worked very hard to become more efficient. In the year 2021/22 alone we have reduced our spending by £6m. However, due to the ongoing Covid-19 pandemic, many transformational changes have not been made as fast as we originally anticipated, or have not been possible at all.  We will carry forward £1.5m of previously agreed savings plans into the new financial year. Together with the anticipated new funding gap of £4.8m, there is a substantial challenge ahead for us.

The total shortfall in the HSCP’s budget for 2022/23 is estimated to be £4.8m or approximately 1.5% of the budget.

Changes which HSCP can, and cannot, make

Many of the demands on HSCP’s budget are not wholly within its control. These include, for example:

• Provision of services because the law requires it
• Providing services in a specific way because this is laid down in national guidance and standards
• Increased demand for healthcare because of demographic pressures, e.g. growing numbers of older people
• People have increasingly complex needs, which increases the cost of some care packages
• The cost of new drugs
• Costs for GP services increasing due to new nationally set contracts
• Staff and supplier costs increasing on account of nationally agreed pay awards, pay increase commitments for care staff and the Scottish Living Wage
• Costs for services contracted through NHS Greater Glasgow & Clyde
• Services provided through nationally agreed GP, dentistry, pharmacy and optometry contracts

This means that the HSCP has relatively limited ways in which it can make savings.

There are 3 types of savings the HSCP can make:

1. Reducing overheads
2. Reducing or cutting services
3. Redesigning services to make them more efficient

Reducing overheads

In recent years there has been a far-reaching drive to cut overheads within the HSCP. The senior leadership team has continued to identify options for overhead savings and these will continue to contribute to the savings target. However, it must be recognised that there is now little potential for further significant reduction in this type of spend. We also recognise that we need to invest in the infrastructure we use to deliver health and social care services for the long term benefit of the communities we serve.

Reducing or cutting services

This is where we are proposing to offer less services, such as through limiting support we provide directly or commissioning fewer hours from our providers whilst ensuring we provide high quality and safe levels of care which seeks to meet the needs of the most vulnerable in our communities.

Changing how we work

Having limited resources and having to manage service pressures means that we cannot continue to deliver our services in the same way as we have previously and change is needed. Some of these changes are already being implemented including:

• More technology used to support people at home, by allowing remote monitoring of conditions and consultations with trained staff, thus avoiding hospital visits and unnecessary admissions
• More care delivered at home and more support for carers (especially family and friends), so nursing and care home beds will be used for people with higher care requirements.
• Most hospital treatments do not require overnight stays, so that beds can be prioritised for those with continuous medical needs.

However, more now needs to be done to ensure we can provide high quality care within our available budget.

The HSCP’s Senior Leadership Team has carefully reviewed all budgets to identify any areas where efficiencies can be made without adversely affecting quality and/or safety.  There has been an ongoing effort throughout the past 2 years to restrict non-essential expenditure.

We have identified new areas to reduce spending totalling £4.8m in the next financial year. Whilst we have sought to identify options with the minimum impact on services, some of these will potentially affect services you use and our staff. We want to understand your views on these. We expect that we will need to identify further savings in the coming years and would also value any suggestions you have on longer term options. We would like to know what matters most to you about HSCP services.

The diagram below shows a breakdown of how this year’s budget of £307m is spent:

• The biggest single area of spend is £68m on acute (specialist) services with NHS Greater Glasgow & Clyde. Our contract with them ensures people within Argyll & Bute have access to a full range of acute care. We also buy services worth £4m from other health boards.
• The second biggest area of spending is £58m on hospital based services.  This includes our hospital in Oban (£17m), and our community hospitals and services in Campbeltown, Dunoon, Lochgilphead, Mull and Iona, Islay, and Helensburgh.  All community based services like community nursing and allied health professionals are included here. 
• The third biggest area of spend of £38m on older people social care which includes care at home and care home placements.
• We spend £36m on Mental Health, Learning Disability and Physical Disability which includes both social care and NHS based services.
• Children and families services cost £23m include fostering and adoption, hostels and children’s’ houses, residential placements, child protection, children with disabilities, maternity services and school nurses, and justice social work.
• GP and other Primary Care services cost £35m and contracts are largely set nationally with little ability for the HSCP to make efficiencies.
• Prescribing costs account for £20m of annual spend. 

Management and corporate costs of £21.4m include the cost of running the Estate (£9m) and services such as planning, finance, IT, safety and quality and centrally held budgets.

Appendix 1: Proposed savings plans 2022/23