Exclusive:John Swinney signals social care shake-up as controversial boards could face axe under NHS control plans
John Swinney has opened the door for Scotland’s social care services to come under the management of the NHS.
The SNP’s controversial £13 billion social care boards could be abolished under John Swinney’s proposed centralisation of services amid fears over cuts and poor decisions impacting the quality of care across Scotland.
It comes as Cosla president Shona Morrison warns Mr Swinney that local authority leaders will “fiercely defend local accountability of public services” in any shake-up of local authorities and health boards, with the potential for social care to come under the centralised NHS set-up.
Mr Swinney announced on Tuesday that Scotland’s 14 mainland health boards will be cut to two, managing services in the west and east of the country, while talks will begin over local councils being able to merge.
Pivotal to the overhaul, as well as dealing with financial pressures, is a blueprint to improve social care provision and the impact that issues are having on frontline NHS service, particularly as Scotland grapples with an ageing population.
The First Minister has now opened the door to controversial integration joint boards (IJBs), which spent around £13 billion of public money a year in Scotland, being scrapped, with responsibility potentially handed over to a centralised NHS under a new structure.
It is understood, however, that abolishing IJBs would require primary legislation at Holyrood, meaning any shake-up would not be an immediate priority under the Scottish government’s public sector reforms.
IJBs are made up of councillors, health officials and other stakeholders and are aligned with local councils across Scotland through health and social care partnerships.
The boards are responsible for planning and funding joint health and social care services under the SNP government’s integration model which has been championed by the party since 2015.
But a stark report from the Accounts Commission earlier this year warned that Scotland’s IJBs “are in a critical financial position” with budget gaps this year reaching £449m.
The spending watchdog has warned that IJB chiefs have “limited options for balancing budgets without reducing the services available and the eligibility of those who can access these services”.
Last year, Edinburgh IJB was embroiled in a standoff with community groups over swingeing cuts to charities providing vital services to vulnerable groups while other boards have agreed controversial cuts to addiction and mental health services.
The First Minister has now opened the door to the provision and funding for social care coming under the management of any new NHS management.
Mr Swinney said that “the pursuit of integration” was behind the Scottish government’s previous social care strategy.
He added: “That was the purpose of the integration joint boards, and I think that we have all come to the conclusion that however well-intentioned that approach was, it has not delivered the level of integration that is required.
“Although I am not proposing a prescriptive solution, I cannot see how we can deliver integration of social care without the National Health Service being in the lead.”
READ MORE: Scotland’s social care system has reached 'breaking point' and is 'piling pressure' on NHS
A Scottish government source suggested that there had been a frustration from politicians at Holyrood over some poor decisions made by IJBs that had lasting consequences that could not be overturned.
“That’s been the case for a while, too often, in too many IJBs”, the source added.
“You want better decisions in the first place, of course you do. But there’s going to be a certain proportion that is just not right. And it is actually the function of politicians to be the way in which that gets fixed. If they can’t, then it’s broken.”
Scottish Conservative health and care spokesman, Miles Briggs, said: “Integration joint boards were supposed to deliver better, more joined-up care, yet too often they have become synonymous with cuts, closures and buck-passing.
“The SNP cannot now dress up another restructuring exercise as reform while communities are being asked to pay the price through the loss of vital local services.
“If ministers genuinely believe the current model has failed, they need to be honest about it and put forward a system that strengthens local accountability and improves outcomes - not one that simply makes it easier to cut services.”
Scottish Liberal Democrat health spokesperson Adam Harley said: “Under SNP leadership, health and care services have been stretched to breaking point, and John Swinney has failed to explain how his plans will ease those years of pressure.
“It also remains completely unclear how this new system would be any different to the SNP’s previous centralisation projects, which have harmed services across the country, especially those in more rural areas.
“Tinkering with structures also won’t end the crisis in social care.”
A Scottish government spokesperson said: “Development of detailed proposals will include engagement with NHS boards, staff, trade unions, local government, integration authorities, social care partners and the public.
“We have also set out our commitment to intensive engagement over the coming three months to design the future of local governance and social care.”
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