Finance pressures risk further cuts to health and social care support

Challenges won't be overcome without cross-sector collaboration that keeps people at the centre.

Audit Scotland has published a finance bulletin for Integration Joint Boards (IJBs) in 2024-25, showing the difficult position facing integrated health and social care services.

Key risks to financial sustainability include significant budget gaps, lower levels of reserves to draw on, and reliance on non-recurring savings. To bridge this financial gap in the coming years, without additional funding, the report notes that IJBs will need to make difficult decisions about services. This will likely include reducing service provision, changing eligibility criteria, and introducing charges for some services. These are experiences we already know are being encountered. The Audit Scotland report helpfully highlights the importance of transparency about these challenges and their consequences for people in their communities.

Audit Scotland recommends further collaboration between IJBs, their local NHS boards and councils to set realistic budgets, engage with their communities, and set out how services will be made financially sustainable and how future demand will be managed through investment in prevention. Importantly, it also makes the point that appropriate impact assessments must be undertaken.

Research by the ALLIANCE has consistently shown the impact of budget cuts and financial pressures on people and services.

For example, our SDS briefing demonstrates how budget cuts negatively impact people’s independence, quality of life, carers’ respite, and right to equal participation in society. It also shows how increased pressure to tighten eligibility criteria leads to decisions and processes that don’t prioritise people’s needs, and how poorly communicated decisions result in people feeling disempowered and disrespected.

Furthermore, our Stretched to the Limit report shows how these difficulties have been compounded as third sector organisations face their own challenges from rising costs and long term structural issues. To manage long term pressures and ensure a sustainable health and social care system that fulfils everyone’s right to good health, IJBs must adopt a human rights based approach to funding and invest in services that reduce demand for acute interventions. This will take all sectors working together to deliver on shared outcomes.

Commenting, the ALLIANCE’s Chief Officer Sara Redmond said:

“The ALLIANCE is deeply concerned about the growing trend of cuts to services that provide essential preventative and self management support. These budget gaps will affect third sector organisations funded by IJBs and most importantly the people who access and rely on their services and support.

These financial pressures force IJBs to balance the need to shift towards a focus on prevention with cuts to the preventative and self management support that is essential for improving people’s health outcomes.  

We must prioritise lived experience in these decisions. We are already seeing a trend of worsening health and an increase in people providing unpaid care. Whilst this is a welcome report which continues to highlight the pressures facing vital public services, we must keep people at the centre of these conversations and not reduce this to a system issue.

Efforts to balance budgets will not improve health outcomes. Therefore, redesigning to a more preventative system is essential. The third sector plays a crucial role in delivering the innovation needed to achieve this. It is vital that efforts to redesign and develop strategic plans are done so in collaboration with the sector and people themselves.

We must also not overlook the need for fair funding for the third sector, to ensure the sustainability of these services which play a key role in meeting national ambitions for public service reform.”

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