Social care merger lacks funds and nurses, audit reveals

Health Secretary Jeane Freeman, whose policy of integration is designed to ease acute pressure on hospital wards. Picture: John Devlin
Health Secretary Jeane Freeman, whose policy of integration is designed to ease acute pressure on hospital wards. Picture: John Devlin
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Audits of the Scottish Government’s flagship plan to merge health and social care have flagged up red alerts including budget overspends, overpriced care, and a lack of district nurses putting safety at risk.

Internal documents, obtained by Scotland on Sunday, have identified a series of challenges faced by the project in Edinburgh, which have led to calls for more to be done to create the “cultural shift” to sort out the “crisis” in social care.

The policy to bring together care services that were once the preserve either of councils or of health boards has led to the creation of 31 Integration Joint Boards (IJBs) to oversee the transformation.

The merger, which has broad political backing, aims to create a system that will see more elderly people move out of hospital, where they take up valuable beds, and back into the community.

But the difficulties faced by those overseeing the transformation have been outlined in a number of internal audits examining how the merger is being conducted in terms of the Edinburgh IJB.

Opposition politicians believe the problems experienced in Edinburgh are replicated elsewhere and have called on Health Secretary Jeane Freeman to review the policy and make reforms to get it on track.

The final report of a City of Edinburgh Council internal audit into the health and social care partnership found several aspects of the project had high or red ratings, a category that suggests there could be a “significant” impact on the financing, operation or reputation of the project.

The points raised included overpayment for services provided, the potential risk of fraud, inaccurate payments, overpriced care packages and financial decisions made without approved authority levels.

Also flagged up with a red rating were points relating to “self-directed support” – a Scottish Government initiative to offer the elderly a range of options when it comes to how they receive their health and social care.

The audit said there was no funding allocation model established within the health and social care partnership to ensure care package budgets were based on an on-going assessment of the people in need of care.

There was “no evidence” to confirm that the self-directed support options had been fully discussed with those receiving care or that they were given the chance to choose from the options.

The document noted that the forecast overspend on the partnership’s home care purchasing budget was £12 million last year. It had been addressed by obtaining £4.2m from the social care fund and a one-off £7m contribution from the council.

It noted that additional cash did not address the “underlying root causes” of the overspend, adding that the Edinburgh IJB had not achieved social care delivery in line with budgets since 2014/15.

This was partly down to a lack of strategic action to offset increased demand for care at home and an inability to deliver approved budget savings.

Meanwhile, an internal audit of Edinburgh Integration Joint Board (EIJB) by the Audit and Risk Committee also identified a series of risks.

They included “a risk that the high vacancy levels within district nurses will impact on safe delivery of care”.

A lack of capacity in the community will reduce EIJB’s ability to reduce hospital delays, it said.

There is a risk that “lack of capacity and poor systems” in the community are impacting on getting access to care on time. Current levels of GP capacity were described as “unsustainable” and will fall further having “negative consequences for care”.

It also warned that “reputational damage” would result from missed performance targets.

Last night shadow health secretary Miles Briggs said: “Things are acute in Edinburgh but these problems exist elsewhere. We don’t really have any grasp of the finances of Integrated Joint Boards and I have written to Jeane Freeman saying that these details need to be made available for all 31 joint boards. Most IJB members I have spoken to say they are over-spent and that is across the country. It has a big bearing on decision-making and cut backs.”

He added: “I think the Health Secretary has to review where we are with health and social care integration and look at where it has not properly bedded in and make reforms where they need to be made.”

Cllr Sue Webber, a member of the Edinburgh IJB, said: “There are some serious risks identified in these reviews, many of which have been outstanding in terms of mitigating actions since 2016. As a member of the Integration Joint Board (Edinburgh) I am focused on seeking assurances that the IJB and its partner organisations, the City of Edinburgh Council and NHS Lothian are creating the essential culture shift and managing the required changes needed to address this crisis in adult social care.

“At this stage however, over 12 months since my appointment to the IJB I am troubled that I have yet to be shown any real evidence of the substantive changes needed. Often, we are discussing the same issues and reviewing the same recommendations as we were 12 months ago.”

Webber added: “I can see no reason why changes to internal systems and processes cannot be implemented and challenged head-on far more quickly than is currently the case.”

Cllr Ricky Henderson, chair of Edinburgh Integration Joint Board said: “There are no easy or quick answers to the challenges we face in Health and Social Care, but by embracing the concept of integration and ‘doing things differently’, I believe we have some firm foundations on which to build.

“Shifting the balance of care and supporting people to live as independently as possible for as long as possible in their own communities is a shared aspiration that is worth striving for.

A spokesperson for Jeane Freeman said: “These comments from the Tories come as no surprise, given this is not the first time they have shown themselves to be unaware of what is going on. Miles Briggs really needs to pay more attention as we are already reviewing the progress to date of Integration Joint Boards across Scotland. If the Scottish Government had followed the Tories’ tax plans then it would have meant cuts of £550m to public services like health and social care.”