East Lothian’s Integration Joint Board (IJB) faces extremely difficult decisions to set a balanced budget for 2024/25 amidst a challenging financial climate.
East Lothian’s Integration Joint Board (IJB) faces extremely difficult decisions to set a balanced budget for 2024-2025 amidst a challenging financial climate, while prioritising the wellbeing of the people of East Lothian.
East Lothian’s IJB members will meet on Thursday 28 March to agree spending plans for the financial year ahead, with decisions required to address financial pressures in excess of £10 million.
The IJB receives funding from its partners, East Lothian Council and NHS Lothian to deliver integrated health and social care services for the people of East Lothian. The IJB must set a balanced budget outlining its allocated expenditure for the financial year ahead.
The current financial climate has resulted in increased financial pressures across the public sector, with the rate of inflation and the costs of goods and services significantly impacting daily operational delivery of services.
East Lothian Health and Social Care Partnership and other stakeholders including interested community groups, have given extensive consideration to identifying ways of bridging the funding gap. Around £6 million of savings have already been identified by applying tighter controls on spending and exploring the most cost-effective ways of providing services through improved internal processes.
On 28 March, further proposals which will have an impact on the strategic directions of the IJB will be presented. Each proposal has been subject to an Integrated Impact Assessment, the results of which will be presented alongside each proposal. The decision on the proposals lies with the IJB and if agreed will allow them to achieve a balanced budget.
Chief Officer and Joint Director of ELHSCP, Fiona Wilson explains, “The scale of the financial pressures facing the IJB is unprecedented. There are no easy solutions, but it is important that we act now to secure our current services and reduce the impact on people in years to come. We are fully aware that every decision impacts on service provision and have ensured we have mitigated against the risks of these proposals.”
“We continue to prioritise the wellbeing of our patients and service users now and into the future. ELHSCP has undertaken numerous community engagement projects over the last few months and years specifically relating to the provision of older peoples’ services. This engagement has proven invaluable and has been carefully considered when preparing these savings proposals. As part of this process, it is important that we are transparent with our thinking. We want our staff and communities to be part of this very difficult process. We want to clearly express why these proposals are being considered, and the impact these proposals may have. Our focus is on providing high quality and sustainable services for the people of East Lothian.”
Difficult decisions
“While these are incredibly difficult decisions to make, the proposals enable us to maintain the wider delivery of the best possible, integrated health and social care services. This includes the ability to provide community-based services that ensure the provision of care closer to home and allow individuals to live independently in their local communities. This process will be about making the best decisions for the people of East Lothian in an extremely challenging financial climate.”
Without agreement to these proposals the IJB will be unable to move forward with a balanced budget, preventing the delivery of much needed services.
Proposals
Edington in-patient beds
In response to the challenges posed by Covid-19 and significant workforce issues, the 9 in-patient beds, and associated staffing, were transferred from the Edington Hospital to East Lothian Community Hospital (ELCH) in September 2021. Ward 6 at ELCH was opened to accommodate this transfer.
It is proposed that the 9 in-patient beds associated with the Edington Hospital are closed on a permanent basis. This means, the in-patient beds currently accommodated in ward 6 (instead of the Edington) will be closed on a permanent basis.
Based on the Older People’s Provisioning Needs Assessment (2019-2023) it was identified that East Lothian Community Hospital currently possesses an ample supply of inpatient beds to meet the needs of East Lothian’s population, both now and for the foreseeable future.
By continuing to develop intermediate care and internal home care models, we can facilitate the reduction in the number of inpatient beds. These models offer a ‘home first’ approach and provide alternative care options for patients and their families /carers, which support a timely discharge from hospital.
The Edington site will continue to offer community health services including CTACs, vaccinations, the MSK service and North Berwick GP practice.
Belhaven Hospital and Blossom House Care Home
Belhaven Hospital has previously provided an in-patient GP-led medical unit, comprising of 6 hospital beds; an NHS managed nursing home, Blossom House, comprising of 11 care home beds and a community health services hub. In 2022, the hospital faced water quality issues on-site, leading to the temporary transfer of all residents, and Belhaven inpatients to ELCH. While care home residents returned to the site in January 2023, the NHS in-patient beds at Belhaven continue to be accommodated within East Lothian Community Hospital (Ward 6).
However, Belhaven is also facing challenges due to its outdated infrastructure, which does not fully meet care home and inpatient standards. The ongoing maintenance costs for the facility are increasing steadily and are anticipated to rise further.
Additional occurrences related to security and fire hazards within the community garden are being reported, posing risks to both staff and residents on the premises, particularly during non-operating hours. This has escalated further in recent weeks following an unannounced Scottish Fire and Rescue inspection which highlighted significant evacuation risks in the event of an emergency. This resulted in the immediate transfer of Blossom House residents to East Lothian Community Hospital to ensure their safety.
It is proposed that Belhaven’s care home and inpatient beds are closed on a permanent basis, due to the associated risk of fire hazards, security, and lone working. As part of this proposal, the community health services operating from this site would be relocated.
The Abbey Care Home
The Abbey Care Home is an old, converted building with a provision of 30 care home beds (28 single rooms and 1 double room).
The building lay out means that accommodation spans two floors with an accessible passenger lift. At present only 16 of the bedrooms feature an ensuite toilet and hand basin facilities. There is only one shower and two baths within the Abbey, which are shared between 29 residents. This is an inadequate provision of showering/bathing facilities for the number of residents and does not fully comply with infection protection and control protocols.
While significant work has been taken to maintain the building, the Abbey Care Home is no longer fit for the longer-term delivery of safe and effective care. Extensive work will be required to fully meet current and future care and safety standards. However, this level of refurbishment is not financially viable, especially as no capital funding is available.
ELHSCP was in a similar position in December 2022, when the Care Inspectorate issued an enforcement notice to Eskgreen Care Home, citing significant concerns about the condition of the building and the refurbishment upgrades required. It is likely the Abbey Care Home may find itself in a similar position. ELHSCP’s priority remains the safety and wellbeing of its care home residents. A planned approach needs to be considered before building conditions deteriorate further.
It is proposed that The Abbey Care Home is closed on a permanent basis due to the building’s infrastructure being unable to fully meet current and future care and safety standards.
Primary Care Link Workers
The Primary Care Link Worker programme provides additional support, and onward referrals to patients presenting at GP practices with complex needs, either due to the health conditions or challenges related to socio-economic circumstances.
Three third sector organisations currently deliver the programme, and it is due to be recommissioned later this year.
It is proposed that the budget allocation provided by ELHSCP to commission this service is significantly reduced. The impact from this funding reduction will require the remaining funding to be prioritised towards the GP practices with the highest levels of deprivation.
Commissioned Services and Carers Act Funding
ELHSCP currently commissions community based, third sector organisations to deliver both preventative and early intervention services, in addition to supporting carers to continue in their caring roles. The services are designed to prevent individuals escalating into more expensive crisis response services, including primary care and acute health services.
It is proposed that the Voluntary Organisations Budget is reduced by an overall 6%, with certain providers receiving an agreed % reduction. The reductions ensure continued stability and delivery of their services but will lead to potential waiting lists for some services.
View the IJB Papers for 28 March online
View the Integrated Impact Assessments for these proposals