Health and social care budget cuts need more scrutiny

Councillor Claire Miller is the Edinburgh Green Party Spokesperson on Health and Social Care, and sits on the Edinburgh Integration Joint Board which has responsibility for the strategic planning, resourcing and the operational oversight of Edinburgh’s health and social care services.

Here she talks about some of the challenges facing health and social care and why the role of elected representatives throughout them is to make sure the wellbeing of the people of Edinburgh remains front and centre.

This week, the board which directs health and social care services for Edinburgh met to set the budget for the new financial year. We have £809 million to spend this year, provided by the council and local NHS, and while this sounds like a great deal of funding, we are tasked with delivering a huge number of vital services ranging from social work and social care, through to GPs and services in their practices, to mental health services and geriatric medicine.

The thing which binds these and many other services together is the aim of maintaining health and wellbeing among our residents. Since it was formed in 2014, this board has brought together services from across the NHS, the Council, the private sector and also support from within communities and provided by charities. By integrating all of these health and social care services, the board aims to provide our residents with joined up services and to avoid ill health through preventative services. This approach is intended to achieve both good outcomes for people while also saving money for the public sector.

Even though the policy of integration should save money, our budget is incredibly stretched. It is barely able to pay for the services which were delivered in the year just ending, and officers’ calculations estimate that we would need an additional £47 million to deliver the same services this year. Efficiency savings are possible – like implementing a new IT system or re-designing services – but require budget investment to design and manage and there is no surplus funding for this kind of step change.

In this context, the board was asked to agree £12 million of cuts, and to work hard during the year to identify and implement a further £35 million of cuts. Some of the initial cuts include the loss of overnight support for disabled people, the closure of an older peoples’ mental health ward, de-commissioning of some interim beds in care homes for people stuck in hospital waiting for packages of care, and loss of some community transport services.

Because the board is being asked to make these extremely tough decisions, and everyone on the board wants to ensure they consider the options carefully, we have been poring over the impact which each change is predicted to have. When I went into the board meeting on Tuesday, it was with trepidation, because I did not feel that we had enough information about the detrimental impact that these cuts were likely to cause – despite repeatedly demanding this information.

The financial calculations did not take into account the knock-on impact of some of the proposed cuts, and so the figures that were presented as possible cost savings were not fully credible. For example, by taking 10 interim care home beds out of our planned spending, we run the risk of needing to buy more expensive additional interim beds if there are patients delayed in hospital.

The impact assessments were also lacking, for example, cutting costs for community transport by only offering group transport does not take into account the individually assessed needs of those who require solo transport. The impact assessments group all disabled people together as if they have homogenous requirements, the complete opposite of person-centred practice we are supposed to follow. As impact assessments were prepared so late in the budget process, they have not been used as a tool to shape the proposals, rather they have been written up to describe the outcomes which will transpire.

It will come as little surprise, therefore, that I pushed back against making these decisions. Working with other board members, I was able to question whether the board had enough information to be able to make these choices, and we decided that it was not possible. It felt very challenging to stand up and question the recommendations of the chief officers, but it would have been harder still to explain to our residents why we had put people at serious risk of ill health. Officers will now look again at impact and carry out further assessments which will provide the board with more information and analysis.

The next few meetings that we have will be tough, as we look at minimising the harm which our budget cuts will have on people across the city, and there will be many difficult decisions for us to make. But I hope that by demanding full impact assessments, we will be able to make informed if painful choices, which keep the wellbeing of our residents and workers at the heart of our health and social care system.