Scotland’s local authority watchdog, the Accounts Commission, part of Audit Scotland, reports that Fife’s Integrated Joint Board (IJB) is expected to overspend by over £10 million in the 2019/20 financial year, against an annual budget of £555 million.
The IJB is jointly funded by NHS Fife and Fife Council and is responsible for the delivery of health and social care in the region. The Commission highlights that ongoing financial pressures will likely undermine the IJB’s efforts to improve health and social care services for Fifeers.
Whilst the Accounts Commission recognises the significant challenges faced by many IJBs beyond Fife IJB, the Commission identifies long-standing financial difficulties within Fife IJB that need to be addressed and insists the board addresses weaknesses in its performance reporting, commits to delivering on agreed recovery actions and address a lack of clarity regarding the roles and responsibilities of the IJB and its partners.
Graham Sharp, Chair of the Accounts Commission said: “The Accounts Commission are seriously concerned about slow progress in Fife IJB and its clear ongoing financial sustainability issues. If this persists it will inevitably affect the ability of the IJB and its partners, Fife Council and NHS Fife, to improve health and social care services local people depend on.
“We welcome some recent progress, including permanent appointments to the posts of Chief Officer and Chief Finance Officer and a review of its financial strategy. Now, as a matter of urgency, these plans must be actioned and delivered on. Above all, a robust financial recovery plan must be put in place.”
The Accounts Commission’s report follows harsh criticism of the Fife IJB by Audit Scotland published in September 2019 in which the Key Messages were:
1. Our audit opinions were all unqualified.
2 The unaudited accounts were not published on time Financial management and sustainability
3 Financial management arrangements need be strengthened to support effective scrutiny. A “turnaround” consultant report covering financial management appears to have had little effect.
4. The IJB did not set a balanced budget in 2018/19 and was unable to deliver the planned £4.5 million overspend. The year end outturn was a deficit of £9.3 million, with savings not being achieved in full. The deficit was again met by the partners resulting in year end “break-even.”
5. The IJB is not financially sustainable and continues to be dependent on additional year-end funding from NHS Fife and Fife Council.
6. The IJB does not have a long term financial plan Governance, transparency and value for money
7. Action has been taken to clarify governance arrangements, but more work is needed to ensure partners roles and responsibilities are clear.
8. There have been significant changes in the IJB leadership team.
9. The IJB has undertaken a self-evaluation based on recommendations in the Strategic Group for Health and Community Care report and has implemented relatively few of the recommendations.
10. A best value framework will be adopted from 2019/20.
11. The annual performance report did not include up to date national performance indicators and we were unable to assess whether performance had improved in the year.