Argyll and Bute Health and Social Care Partnership (HSCP) - Budget Consultation 2020/21

Take part in the 2020/21 Budget Consultation (closing date:4th March 2020)

Argyll and Bute Health and Social Care Partnership (HSCP) delivers a broad range of services to our communities, many of which are most used by very vulnerable people.   Our vision is that people in Argyll and Bute will live longer, healthier, independent, happier lives and this underpins all that the HSCP does.

Our population is ageing, and this is happening faster than elsewhere in Scotland, so this gives us particular pressures and demands for Older People services. We have other pressing demands with treating long term health conditions like cancer, heart disease and stroke, for example, obesity is driving up demand for diabetes related services which now cost 9% of the total NHS budget in Scotland.

At the same time, the resources available to the HSCP are declining in real terms year on year. We simply cannot continue to provide the same services in the same ways.  We have to find efficiencies, transform how we operate, and do less going forward.  These are difficult choices, and there are no easy options left to reduce our spending.  We would really value your views to help us make the best decisions that will affect all of our lives.

This consultation is about high level budget decisions and how we prioritise our investment in local services, when it comes to the impacts on services being delivered, we will carry out further detailed community engagement over the coming year. This will include working with people who will be affected by these changes including patients, carers, our staff and partners to ensure we listen to and take into account their ideas and worries.

Thank you for taking the time to respond to this consultation.

Councillor Kieron Green
Chair, Integration Joint Board

 Context

The Integration Joint Board (IJB) is legally required to set a balanced budget for the Health and Social Care Partnership (HSCP) 2020/21 at its meeting on 25 March 2020.  Normally, by now the IJB would have a clear idea of our funding from Argyll and Bute Council and NHS Highland.  This year, because of the UK general election, the UK government budget has been delayed to 11 March 2020, and the Scottish Government has decided to set out its own budget in advance of that on 6 February 2020.  This means that there is still considerable uncertainty about our budget.  However, as of end January 2020 we are predicting that we need to reduce our spending in the region of £8.3m next year.

The Council is currently anticipating that its overall funding will be reduced by 2% and therefore in turn, it will reduce the funding given to the Argyll and Bute Health and Social Care Partnership by 1%.  NHS Highland is expecting an increase of 2.5% in funding from the Scottish Government and intends to pass this on in full to the HSCP using the nationally agreed formula (NRAC).

This expected level of funding will not cover our rising costs, for example:

  • Staff and supplier costs will increase on account of nationally agreed pay awards and the Scottish Living Wage
  • The cost of new drugs is expected to exceed funding made available for these
  • Costs for GP out of hours services are increasing due to new contracts
  • People have increasingly complex needs which increases the cost of some care packages

Over recent years we have worked very hard to become more efficient and in the year 2019/20 we reduced our spending by nearly £7m, however we did not find efficiencies for a further £3.6m. This will carry forward in April to the new financial year giving a total shortfall of £11.9m in our anticipated budget of £279.7m.

Changing how we work

Argyll and Bute HSCP’s Vision: “People in Argyll & Bute will live longer, healthier, independent, happier lives.”

Health and Social Care Partnerships came about in Scotland in 2016 and are responsible for providing joined up health and care. They are funded by NHS boards and local authorities. The work of Argyll and Bute’s HSCP is delivered in-line with our Strategic Plan. This includes looking after people at home, enabling people to be well, providing GP and emergency healthcare, supporting unpaid carers and delivering value for money. Read the full details of this plan

Having less money in our budget means that we cannot continue to deliver our services in the same way as we have previously and changes are needed.

Future Shape of Services 2020/21

  • A single Health and Social Care team will provide local round the clock services (Adults and Children's) and you will only need to contact one person for health and care needs.
  • We will use more technology to support care at home, by allowing remote monitoring of your condition and consultations with trained staff.
  • 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.
  • We will prioritise investment for healthy lifestyle programmes, to keep you healthy.
  • GP services will continued to be provided locally and there will be a wider range of services in-line with the national GP modernisation contract, including pharmacy, physiotherapy and mental health.
  • Your local hospital will continue to co-ordinate and deliver emergency medical care, with fast access to Glasgow hospitals if required.
  • Most hospital treatments will not require overnight stays and beds will be prioritised for those with continuous medical needs. This means we will have fewer hospital beds.

How to bridge the savings gap

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 2019/20 to restrict non-essential expenditure, for example, in-depth scrutiny of all vacancies.

We have identified new areas to stop spending of just under £4.2m next financial year. We have also identified £1.6m that will potentially affect services you use and our staff. We want to know your views on these.  We need to identify another £2.5m of savings and want your suggestions.  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 £278m is spent:

A&B HSCP Dudget Summary

  • The biggest area of spending is £83.86m on hospital based services and prescribing.  This includes our hospital in Oban (£15.95 million), and our community hospitals and services in Campbeltown, Dunoon, Lochgilphead, Mull and Iona, Islay and Bute.  All community based services like community nursing and allied health professionals are included here.  Prescriptions cost £18.78m.
  • The second biggest area of spend is £65.2m on acute (specialist) services with NHS Greater Glasgow & Clyde. We are currently in dispute with NHS GGC as we think we pay them too much.  We also buy services worth £3.89m from other health boards.
  • The third biggest area of spend of £55.36m is adult social care which includes older people, learning disabilities and mental health.
  • Children and families services cost £20.83m 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 services cost £17.25m and these are largely set nationally with little ability for the HSCP to make efficiencies.  The same applies to £13.79m costs for dentists, chemists and opticians.
  • Management and corporate costs of £16.4m include services such as planning, finance, IT, estates, safety and quality.