Faced with extremely difficult decisions in a challenging financial landscape, the East Lothian IJB have approved a balanced budget for 2024-25.

Thursday 28 March 2024

East Lothian’s Integrated Joint Board (IJB) have today, Thursday 28 March 2024 agreed a balanced budget for 2024-2025.

IJB members faced extremely difficult decisions today, due to the current challenging financial landscape that required savings in excess of £10 million to be delivered. 

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 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.

Around £6million of savings will be achieved by applying tighter controls on spending and exploring the most cost-effective ways of providing services through improved internal processes.  However, to bridge the gap, further proposals involving significant service redesign and the withdrawal of some services were submitted to the IJB to achieve a balanced budget.

These proposals included reductions in funding to support the primary care link worker programme and community based commissioned preventative and early intervention services.   Additionally, the proposals suggested the permanent closure of the inpatient hospital beds at the Edington (9 beds) and Belhaven (6 beds), as well as the decommissioning of The Abbey and Blossom House care homes.

The latter proposals outlined escalating concerns regarding the outdated building infrastructures, at the Belhaven and Abbey sites, which despite ongoing maintenance repairs are still not fully meeting health and care standards.  The Abbey has an inadequate provision of showering/bathing facilities for the number of residents and does not fully comply with infection protection and control protocols. While occurrences at the Belhaven site related to security, fire hazards and lone working are posing risks to staff and residents on the premises.

See statement from Thursday 21 March: Difficult decisions for IJB to set balanced budget for 2024/25

Chair of the IJB, Shamin Akhtar comments, “I’m bitterly disappointed that Scottish Government decisions have forced us into this difficult position. Despite lobbying for Fair Funding our calls have been ignored.

This year’s budget setting process has been unprecedented. East Lothian has one of Scotland’s fastest growing populations, and yet this has not been reflected in the Scottish Government’s funding allocations.  Without the appropriate level of funding, the IJB has been forced into this incredibly difficult position.”

“In approving a balanced budget today, the IJB is acutely aware that our decisions will have a direct impact on service provision and the people of East Lothian. After careful and considerate evaluation, it was agreed the financial saving proposals presented to the IJB, while unwelcomed, are necessary to ensure the wellbeing of our patients and service users, and sustain the wider delivery of the best possible, integrated health and social care services now and into the future.”

Andrew Cogan, Vice Chair IJB, reiterates, “It is with great regret that the IJB has been put into the position of facing these decisions today.  However, these are exceptional circumstances, and our commitment remains to the people of East Lothian.  We wish to assure them that over the coming months, we will deliver these changes appropriately, sensitively and at all times with dignity and respect.”

What happens now?

Operational efficiencies
East Lothian Health and Social Care Partnership (ELHSCP) will apply tighter controls on internal spending improving internal processes to deliver the most cost-effective ways of providing services. This includes redesign of staffing structures, ensuring income into the Partnership is maximised and there is robust financial rigour on all financial processes.  

Edington and Belhaven Inpatient Beds
The inpatient bed provisions for the Edington and Belhaven are currently located within East Lothian Community Hospital, ward 6.  Patients currently within ward 6 will be informed of the IJB decisions, and discussions will continue to plan their safe discharge from hospital.

A range of community health services are currently delivered from the Edington site.  These services will continue to operate and will not be directly impacted by this decision. 

Belhaven Hospital will close, and a timeline will be established to relocate community services currently based at this site.  Following the closure, any long-term future decisions regarding the Belhaven site will reside with NHS Lothian, however the IJB will engage in this process.

The Abbey and Blossom House Care Home
Later this year both these care homes will close.  Residents will be fully supported to move to an alternative care home of their choosing.  A staged process will be planned and communicated to each resident, and where appropriate their relatives.  Likewise, staff will be consulted with and supported.   This process will take time.  It will be undertaken sensitively in line with statutory and regulatory guidance. Independent advocacy will be involved to help residents make the right choice for them.

Over the coming months, a series of engagements, group and individual discussions will be arranged, to explain the process in detail, and ensure that the individual needs of each resident, their family members, and staff are carefully considered and addressed going forward.  In the meantime, residents will remain in situ, where their quality of care will not be compromised.  

Following the decommissioning of the Abbey Care Home, any long-term future decisions regarding this site will reside with East Lothian Council, however the IJB will engage in this process.

Primary Care Link Workers
The delivery of the Primary Care Link Worker programme will continue to operate until the commissioned contracts come to an end in October 2024.  Thereafter it is intended the Primary Care Link Worker programme is realigned to focus its provision on supporting individuals in areas with the highest deprivation and health inequality levels, whilst delivering alternative pathways to community support across all General Practices.

Commissioned Services Funding
From a £1million budget which supports community and third sector providers to deliver commissioned services, a £51k reduction has been approved for 2024-25.  

Discussions have already taken place with each of the commissioned providers regarding the now agreed % reductions for 2024-2025. 

The IJB remain committed to supporting the delivery of community based, preventative and early intervention support services.   ELHSCP management teams will do their utmost to ensure the continued stability and delivery of commissioned services and providers going forward.

Published: Thursday, 28th March 2024