Rising cost of care leaves us facing tough decisions - Katharina Kasper

Katharina Kasper, Chair of the Edinburgh Integration Joint Board

As we grapple with increasing demand on health and social care services, we need to make difficult but compassionate decisions to safeguard vital services and ensure that we discharge our legal duties while protecting our most vulnerable citizens wherever possible.

Edinburgh IJB has experienced significant financial difficulties since its inception in 2016 and has struggled to achieve a balanced budget each year. It is widely recognised that the EIJB has held a financial structural deficit reported as £32m since 2016 which has never been resolved. The financial situation has worsened each year due to increasing costs, demand on services and population growth within Edinburgh, placing immense pressure on our ability to deliver services within the existing budgets.

In recent years the EIJB has been required to seek financial support from the council and NHS partners to achieve a break-even position, however the funding gap has become unsustainable and until a longer term solution is agreed the EIJB will continue to struggle. This will result in more radical savings plans and a necessity to stop and reduce services which would include a further reduction in our workforce and a cessation of many services we currently rely on.

This year the EIJB was faced with a financial gap of £60m which resulted in the approval of a £48m savings plan. Looking further ahead, the budget gap for 2025/26 is estimated to be at least £50 million. These challenges will require the EIJB to make some extremely difficult decisions on how we prioritise spend.

That is why we have worked hard to refocus our energy and resources on providing those key services, concentrating on core business and ensuring that we can continue to provide care, support and protection.

Edinburgh has a vibrant and critical third sector and we have always shared good working relationships. However, the model we use to provide grant funding will have to change to ensure the EIJB remains accountable for effective, evidence based spend which is aligned to key priorities including early intervention and prevention.

While we recognise how difficult these decisions will be, the EIJB must ensure that spend is now prioritised to enable the Health and Social Care Partnership to discharge legal duties and protect our most vulnerable. This unfortunately means we need to stop some services and reduce others. This is not a decision we wish to make, but the alternatives – cuts to statutory provision impacting upon people’s basic health and care services – are all worse.

We are therefore moving to a more cooperative model where we work together as partners to provide solutions to the challenges facing Edinburgh and ensure third sector are supported to deliver core objectives and priorities as set out by the EIJB.

We know that decisions will be challenging in order to achieve financial sustainability and that this will often require an approach based on priority of service delivery.

We acknowledge that this will impact on the entire system, however remain hopeful that the future direction of travel will ensure stability and greater focus on core delegated services and our statutory responsibilities.

Katharina Kasper, Chair of the Edinburgh Integration Joint Board​