Four months into the financial year and Fife’s Health and Social Care Partnership is already reporting a £3.6 million deficit - and it's projected to grow into a £24m gap by March 2025. 

“It’s a difficult position,” Audrey Valente, the partnership’s chief finance officer, admitted at a meeting on Friday. 

“The combined health and social care partnership delegated and managed services are currently reporting a projected outturn of £24.3m overspend.” 

She continued: “It’s a very challenging year for Fife’s Integration Joint Board.

"We will continue to ensure delivery of savings and to reduce the risk of utilising the risk share agreement with our partners [NHS Fife and Fife Council].” 

Most of the overspend is down to the non-delivery of savings. That’s an issue that has plagued NHS Fife more generally throughout the past year as well. 

Complex and critical care services were slated to make £15m in savings, but the current project overspend includes non-achievement of savings of £9m.

Ms Valente confirmed: “Included within the overspend position, £18m is related to non-delivery of savings.”

However, even if the savings were delivered in full, which they said was impossible, the partnership would still need to find a further £6m of savings to balance the books by the end of the year. 

The cost of locums – temporary substitutes to fill vacancies – and agency staff are listed again as areas of overspend. 

Primary medical services are projecting a £1.4m overspend as a result of locum costs.

Those costs and recruitment difficulties are even higher for mental health services where there is a project overspend of £2.8m. 

“Care of the elderly is projecting to overspend by £4.7m due to continued use of agency staffing and surge beds,” the finance report continued. 

Older people nursing and residential services are also projecting a £3.7m overspend due to a greater number of beds being utilised than budget. 

Going forward, Ms Valente said there is increased scrutiny of the IJB from both NHS Fife and Fife Council. 

“As a result of the financial challenges faced by the IJB, we plan to increase the frequency of meetings with both partners and the chair and vice chair of the IJB,” the report explained. 

Ms Valente added: “We will be presenting [those further savings proposals] at the next IJB meeting in September, but given the challenge we’re presented with today there’s an increased risk of implementing the risk share agreement.”

The agreement would see NHS Fife and Fife Council called upon to fill the gap to balance the books. 

As it stands, the IJB reserves are low, and Ms Valente has already told members that they will be required in their entirety to help fill the gap at the end of the current financial year. 

“Although there are very little reserves remaining, there is recognition that they will be required to be utilised this year to ensure safe delivery of service for local residents,” she said. 

The IJB chairperson, Arlene Wood, called it “quite a concerning position”. 

Ian Dall, an IJB service user representative, was more critical. 

“Year after year I sit and hear that we have reviews and catch up plans and we keep on failing to reach the targets,” Mr Dall said. 

“The senior leadership team should really look at a new system because we can’t keep going year after year failing to make the savings that we project.” 

However, Ms Valente pushed back. She said the IJB has a “good proven track record” and believes the IJB can make the savings – it’s just a matter of timing. 

“We will deliver these savings,” she pledged.  “It’s the timing of delivery that’s crucial.

"We’re looking at how we can speed up delivery. We’re meeting weekly, our absolute focus is bringing that £18m savings down as far as possible during this financial year.”