Falkirk health board argues about money issues

Members of the board that oversees care of the elderly and most vulnerable in Falkirk have been locked in an argument over a shortage of cash to fund its work.

The Integrated Joint Board (IJB) – which brings health and social care services together – is being forced to choose between spending cash on vital NHS services including accident and emergency or keeping the money to improve services such as home care and community hospitals.

The IJB is facing an overspend this year of nearly £4 million– and it’s now up to members to decide how that will be funded.  At the moment, Falkirk Council and Forth Valley NHS both contribute to the funding required for health and social care partnership’s work – but they do not yet have a firm agreement on how any overspend is met. In previous years each has funded the areas they are responsible for. This year however,NHS Forth Valley has asked to use some of IJB’s reserves to fund half of the NHS overspend, which would mean £1.45m coming out of IJB coffers. 

They say this will be used in key areas of financial pressure – including accident and emergency, mental health and old people’s care – all of which are demand-led and very difficult to budget for.

NHS medical director Dr Andrew Murray explained how difficult the situation was for the NHS locally.

He said: “The emergency department when its busy is one of the most dangerous, risky environments in the whole sector and  if the demand rises we need to respond to that.”

He said he recognised that the idea of bringing health and social care services together was to reduce the pressure on areas including accident and emergency. But he added: “Ideally, we want to prevent people coming to ED but that isn’t happening and if the demand rises we need to respond to that.”

However, many members of the IJB are reluctant to use the money which they say is key to the partnership bringing in transformational change.

The board hopes that spending the money will help its mission to stop unnecessary hospital admissions and support people living in their own homes instead wherever possible.

Chief Officer Patricia Cassidy told the meeting that preventing admissions to hospital would require investment and all of the money in reserves was earmarked for specific projects. NHS Forth Valley finance director Scott Urquhart told the meeting that the NHS had already identified plans to manage overspends and improvements were underway.

And she is confident that as staff have only recently moved over into the Health and Social Care Partnership they can now start to make a difference.

She said: “We have limited resources and we need to do things differently and it’s a question of how we fund that while we keep services running.”

The debate highlights how far the two parts of the service are from being fully integrated, something that was mentioned critically in its annual audit last year.

It also shows the immense financial pressure each is under, with the IJB required to make £2 million of savings in the year 2020/21, while NHS Forth Valley has had to contend with a savings target of £19 million this financial year.

In recent years the NHS has made payments of over £6 million to fund the overspend – leading some to suggest  that there is consistent underfunding that needs to addressed.

NHS Forth Valley chief executive, Cathie Cowan, added that she would bring the NHS recovery plan to the IJB’s next board meeting.

Falkirk Council leader Cecil Meiklejohn suggested a compromise, using the much smaller amount in reserves that are not ring-fenced, and all members agreed that a separate committee to look at finances would be helpful.

The board did approve using the reserves for two parts of the overspend; £100,000 for aids and adaptations and £140,000 for the GPs out of hours service.

The final decision on using the reserves will be taken at an IJB meeting today (March 20).