The watchdog warned that IJBs cannot manage future financial pressures in isolation, adding that collaboration across IJBs and between council and NHS partners is vital. The continuing high turnover of chief executive and chief financial officers is worrying at a time when strong and stable collaborative leadership is crucial, the report said.

IJB funding has increased in the past year, but there is ongoing overspending, running down of reserves and reliance on one-off savings. During 2023/24, reserves were depleted by 40%, with the projected funding gap for services increasing from £357 million in 2023/24 to £457m in 2024/25. This will hinder IJBs’ ability to address future budget gaps and make them less able to meet unexpected costs.  

IJBs, alongside their NHS and council partners, need to be transparent with communities about what this means for services, and collaborate to plan for the major reforms required.

Malcolm Bell, member of the Accounts Commission, said: “For too long, Integration Joint Boards have been fire-fighting immediate financial challenges. Now they must shift from making one-off savings and relying on reserves to transform how services are delivered if they are to tackle their precarious finances. 

“A stronger focus on prevention is needed, with candid conversations with communities, councils and NHS partners vital around the difficult choices that need to be made.”

Responding to the publication, COSA said the Accounts Commission has clearly demonstrated the immense challenges that IJBs and local government are having to work through in ensuring the local delivery of integrated health and social care services.

The findings released today come in the context of increased demand for social care services, workforce difficulties, and constrained finances across the health and social care sector.

As the bulletin points out, the majority of total planned savings were achieved for the 2023/24 financial year, but there still remains a projected funding gap of £457m for 2024/25.

COSLA said it recognises that a stronger focus on prevention is needed to help slow demand and improve outcomes for people and communities, however this needs to occur in tandem with appropriate funding for IJBs.

Health and social care spokesperson, Councillor Paul Kelly, said: “With Scotland’s population aged 75 and over expected to rise to 774,000 by 2045, it is vital that we invest in prevention and early intervention in social care with this future in mind.

“Given the present challenges facing the system, there needs to be constructive collaboration between local government, Scottish Government, Integration Joint Boards, and NHS partners around the scale of the challenge - and what this means for what people and stakeholders can expect from the system. We are committed to working with all partners to do everything we can to understand the impact the current and projected financial position is having on the system.

“Social care is and will remain a sector delivered by people for people, and I am encouraged by the work already taking place between IJBs, councils and other partners in the face of current pressures. The report rightly highlights the significant in-year financial contributions already made from partners, however, this is not a sustainable solution for IJBs and only adds to the pressures our councils are facing.”