Challenges to the Delivery of Adult Health and Social Care in West Lothian - West Lothian Integration Joint Board

The survey can be accessed here: https://forms.office.com/e/eTzTgjh4d7

Background

The West Lothian Integration Joint Board (IJB) has responsibility for planning most health and social care services for adults in West Lothian.  The board's vision is to increase wellbeing and reduce health inequalities across all communities in West Lothian

The Integration Joint Board's role is to set the strategic direction for functions delegated to it and to deliver the priorities set out in its current IJB Strategic Plan & Delivery Plans

Finance

The IJB receives funding allocations from West Lothian Council and NHS Lothian to enable the delivery of local priorities for health and social care for adults and in 2024/25 has an annual budget of £307.5 million.  The Board gives directions to the council and health board as to how they must deliver their services to secure the delivery of the IJB's Strategic Plan.

Figure 1 below provides an overview of how the IJB spends the funds allocated to the Board.

The largest areas of spend for the IJB relate to staffing costs, payments to care providers for direct service provision and prescribing.

West Lothian IJB Financial Position

In 2023/24 the Board reported an operational deficit position of £1.488 million, which was in part funded by £0.585m of reserves held by the IJB.  Additional contributions were also made from West Lothian Council (£0.585m) and NHS Lothian (£0.318m) to achieve breakeven.  A balanced budget for 2024/25 was agreed, which incorporated £7.489 million of savings measures.

For 2024/25, it is projected that the IJB will overspend by £7.341 million, this will be managed through the use of reserves and an additional one-off payment from West Lothian Council.  

The IJB must set a balanced budget annually, with the 2025/26 budget due for consideration on 25 March 2025.

Challenges

In 2024/25, the IJB had a total annual budget of £307.5 million to deliver key services, however this has not been enough to cover the increasing costs of meeting the increasing demand for health and social care services in West Lothian.  Based on financial planning assumptions, the IJB has a recurring budget gap of approximately £10 million.

The West Lothian Integration Joint Board is faced with unprecedented challenges due to rising demand for services and complexity of support required as well as the increased cost of delivering these services. This is particularly in relation to services which support adults with learning disabilities, complex needs and mental health complex needs.

The demographic projections for West Lothian show a population where older adults are increasing in number and will form a greater proportion of the population over time.  The number of people of pensionable age in West Lothian is expected to increase by 10% by 2028 when compared to the Scottish average of 4%.  Over the same time period the number of people aged over 75 in West Lothian is expected to increase by 39% compared to the Scottish average increase of 25%.

Going forward from 2025/26, it is expected that the IJB will have to make further significant savings as the funding available will continue to be insufficient to meet the increasing cost of service delivery.

The scale of the savings required to deliver a balanced budget means that we need to fundamentally rethink how and what we deliver, and be transparent about where we will not be able to continue to deliver the same level or range of services.

The IJB will aim to maximise the care services that can be provided from the funding it will have available.

Themes

Officer are working on a range of proposals to reduce the budget gap and are focused on the following themes:

Maximise Efficiency

•  in the way that services are delivered through structured service review processes;
•  through the review of contracting arrangements with commissioned service providers to ensure best value;
• by prioritising and targeting services to those with the highest levels of need;
• by continue to deliver person centred services that give people choice and control.

Transformation

• through the exploration of further opportunities to develop more integrated, multi-disciplinary services for teams across the Health and Social Care Partnership;
• by building on the principles of values-based health and care by finding out what most matters to people and delivering services that make a positive difference to them;
• by improving services through digital innovation and maximising the use of digitally-enabled care technology, where appropriate.
• by considering where there are opportunities to deliver service in more economical and effective ways.

Difficult Choices

• By reducing or stopping services

The survey is just one part of the IJB's plan to engage with people who live and work in West Lothian and organisations that deliver services locally.  Further engagement will be undertaken on specific proposals for transformation and efficiency measures throughout 2025/26.

Your views will be used to inform the IJB's budget setting process for 2025/26 and beyond and will be very important in shaping the future delivery of health and social care services in West Lothian.

The survey can be accessed here: https://forms.office.com/e/eTzTgjh4d7