Community health and social care faces unprecedented pressures and financial uncertainty

Community health and social care faces rising unmet need. Managing the crisis is taking priority over prevention due to the multiple pressures facing the bodies providing these services.

Scotland’s Integration Joint Boards (IJBs) plan and commission many vital community-based health and care services. One in 25 people in Scotland receive social care, with this expected to rise sharply due to an ageing population. Seventy-six per cent of people receiving health and social care are aged 65 and over. By mid-2045 the number of people aged 65 and over is set to grow by nearly a third.

IJB funding has decreased by £1.1 billion (nine per cent) in real terms to £11 billion in 2022/23, with the funding gap set to triple in 2023/24.While there are examples of innovation, IJBs are increasingly having to make unsustainable savings through, for example, not filling staff vacancies and using their financial reserves.

Difficulty in filling posts also mean that vacancies are at a record high. Nearly half of services report vacancies, a quarter of staff leave jobs within their first three months and there is continued turnover in senior leadership.

Taken together, these pressures on IJBs mean that the current delivery and funding of services is unsustainable, and system change across a range of vital public services is needed to address the challenges.

Angela Leitch, Accounts Commission member said:

The pressures facing social care and community healthcare are complex, with health inequalities widening. These issues can’t easily be resolved, and the situation is getting worse. We’re already at the point of increasing levels of unmet need and tightening eligibility to access services. This could be impacting people’s quality of life but data quality is insufficient to fully assess this.

Integration Joint Boards can’t tackle these challenges alone – they need the support of councils, health boards, Scottish Government and other partners to help them make the urgent changes that are needed now. Without this collaborative approach to change, the pressures facing Integration Joint Boards will get worse.