SNP warned health and social care services 'cannot be sustained' as boards poised for £450m black hole
Scotland’s integration joint boards are facing a funding gap of almost £450m for the next financial year
The financial sustainability of boards that deliver health and social care services has become “increasingly concerning”, Scotland’s spending watchdog has warned.
In a stark report, Audit Scotland has concluded that integration joint boards (IJBs), which are funded by NHS boards and local councils, must “urgently take decisions on where to redesign, reduce or discontinue services”.
The message has raised fears about cuts to frontline health and social care services - with a warning that “without radical change, the services delivered by IJBs can’t be sustained”.
At the end of the 2024/25 financial year, Scotland’s IJBs had a total of £404m in reserves, but £316m of that had been earmarked.
At the time of setting budgets for the 2025-26 financial year, IJBs faced a budget gap of £449m.
The Accounts Commission report has warned that despite funding to Scotland’s 30 IJBs increasing by 2.3 per cent between 2023/24 and 2024/25, “the financial position of IJBs has become increasingly concerning”.
It adds: “Financial pressures and demands on services continue to grow, outstripping increased funding and savings made, raising concerns around IJBs’ financial sustainability.
“IJBs must make difficult decisions about how services are delivered, determine the appropriate level of services, and decide where to redesign, reduce or discontinue services.
“They must be transparent with service users and the public about the potential impact of these changes on service performance and outcomes.”
The report stresses that increasing demand, rising costs and a growing number of people with long-term complex needs are placing mounting financial pressures on IJBs.
The spending watching has warned that IJBs have reached a critical point, with a significant risk they will become financially unsustainable within the next 12 to 24 months.
Alongside savings and using reserves, IJBs have been relying on substantial additional funding from their partners in the NHS and councils.
Malcolm Bell, member of the Accounts Commission said: ‘The cost of delivering services is rising faster than available funding.
“Tackling this could include difficult decisions about redesigning or reducing services, and whether new or additional charges need to be made. Whatever decisions are made, service users, their families and wider communities must be consulted.
“But without radical change the services delivered by IJBs can’t be sustained. The gap between funding available and the cost of meeting demand is widening, and the gap of nearly £450 million cannot be bridged with savings alone.”
Scottish Conservative finance spokesperson, Craig Hoy, said: “Health and social care in Scotland are mired in permanent crisis and this report indicates that things are likely to get even worse due to the SNP’s chronic mismanagement of the nation’s finances.
“It’s hard to see how the nationalists will reduce intolerable NHS waiting times and finally eradicate delayed discharge – which they promised to do a decade ago – when there’s a funding gap of almost half a billion pounds.
“Unless and until the SNP rein in Scotland’s ballooning benefits bill, frontline services will continue to suffer while hard-pressed Scots are clobbered with ever-rising taxes.”
Social care minister, Tom Arthur, said: “While this report acknowledges a real-terms increase in IJB funding between 2023-24 and 2024-25, we recognise the financial pressures facing the health and social care sector and remain committed to meaningful reform.
“We have provided a record settlement for local government and will deliver funding of almost £22.5bn to health and social care in 2026-27.
“The integration of health and social care planning is essential in ensuring services are well-coordinated and responsive to the population's evolving needs. This report recognises the need for local collaboration in setting budgets.”
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