Dundee IJB Budget Consultation

What is the Dundee Integration Joint Board (IJB)?

Dundee Integration Joint Board (IJB) is the group of people (made up of local councillors, NHS board members, carers, service users, third sector and Trade Union representatives, supported by a range of professionals) responsible for planning, agreeing and monitoring community-based health, social work and social care services for adults. This includes making decisions about what services are delivered and how available budget is spent. The Plan for Excellence in Health and Social Care in Dundee 2023-2033 tells people about the IJB’s ambition and priorities. 

The services that the IJB plans for are delivered by Dundee Health and Social Care Partnership – this is the place where Dundee City Council, NHS Tayside and some organisations in the third and independent sector work together to deliver community-based adult health and social care services. Services delivered by the Partnership include:

• Adult and older people’s community social care services, for example support for people with drug and alcohol issues, people with a learning disability, residential care and care at home. 
• Community health services, for example community nursing, palliative care, mental health and learning disability services.

What is being proposed?

 The number of people who require health and social care supports is increasing, and so is their level and complexity of need. At the same time IJBs have had to achieve savings for several years; in Dundee this has been a total of £37 million since 2016/17, including over £10 million in 2024/25. Achieving these savings, while maintaining service levels in Health and Social Care Partnerships, has become increasingly difficult. This has been set out by Audit Scotland in a recent report.

Across Scotland, IJBs are having to consider options to reduce their spending so that they can meet their statutory duty to set a balanced budget. Dundee IJB can no longer support the Health and Social Care Partnership to provide the same services in the same way and must find efficiencies, transform how services work and do less going forward. These are difficult choices, as there are no easy options left to reduce spending or to do this in a way that doesn’t directly affect people. 

Dundee IJB must reduce spending by £19.7 million next year (2025/26). 

Options to make savings have been put forward by officers who work in the Dundee Health and Social Care Partnership. No decisions have been taken, and before the budget is set by the IJB, they want to hear from the public. 

More information about the health and social care needs of Dundee’s citizens' and the IJB’s budget can be found at the bottom of this page. 

What are the potential savings options being considered?

Some of this financial gap will be met through operational efficiencies - these are changes to the day-to-day way that the Health and Social Care Partnership works that help to reduce costs without altering service provision. However, other savings options will result in changes to how services are delivered or in some cases, stopping some services altogether.

Further information about each of the saving options, the rationale behind them and possible impacts and mitigations can be found here.  This information is also included within the consultation survey.

Who is being consulted?

It is essential that the IJB understands the impact that saving options would have on service users and the wider community. 

This is particularly the case for those who have characteristics protected by law: age, disability, gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex, and sexual orientation. 

However, it is important to stress that all members of the public are encouraged to have their say in the consultation.

Members of the health and social care workforce, organisations affected by specific options, and other stakeholders, are also invited to participate.

How can I take part in the consultation?

The survey can be completed online here.

 Free internet access is available in all libraries, with IT support from staff. 

From Monday, 17^th February 2025 paper copies of the questionnaires will be available from libraries and Claverhouse Social Work Centre. Alternatively, anyone requiring assistance filling out the survey can contact the Health and Social Care Partnership on 438300 or dundeehscp@dundeecity.gov.uk.

How long does the consultation last for?

The consultation will run from Friday, 14^th February to Wednesday, 5th March 2025.

How will the information I provide be used?

Although the survey is anonymous, should you choose to include any personal information in your response this will be processed in accordance with the UK GDPR (General Data Protection Regulation) and the Data Protection Act 2018. 

This survey has been developed to support Dundee IJB’s public functions, including making decisions around budgets, strategic planning and transformation programmes. We might also use the data you provide for research purposes. 

An analysis of responses provided will be used to inform the development of savings options reports for the IJB’s consideration and may also be included in reports submitted to Dundee City Council and NHS Tayside. IJB reports are published on the Health and Social Care Partnership’s website. Any information re-produced for these purposes will not be identifiable to any individual.

How will the consultation be promoted?

The consultation will be promoted through press releases, word of mouth, and the Dundee Health and Social Care Partnership website. Dundee City Council and NHS Tayside will also support the promotion of the consultation.

Social media platforms will be used to ensure as many people as possible are reached. This increases inclusion for those who prefer to get their information from legitimate platforms on social media. 

Internal staff communication channels will be used to promote the consultation to members of the health and social care workforce, including e-mail distribution and staff intranet. 

All service providers in the third and independent sectors who are currently funded by the IJB to deliver health and social care services will be sent information about the consultation, inviting them to take part. 

Information will also be sent directly to individual, organisations and community groups who are known to represent the views and interests of people with characteristics protected by law. 

How will you ensure the consultation is accessible to all?

Questions have been asked using appropriate language. Paper copies will be made available.    

The website offers accessibility options which support users with conditions like visual impairments and dyslexia. The site also offers features to translate information into many different languages. The online survey can be accessed in a wide range of languages by using the auto-translate function within web browsers, such as Google Translate. Responses can be provided in other languages via the online form but please note these will be machine translated into English prior to analysis.

Alternative formats will be offered where requested and provision made to ensure that communications are accessible and inclusive. 

How will the consultation responses be analysed?

Dundee Health and Social Care Partnership will analyse and review responses.  

The Partnership will identify staff resources to support and respond to any queries arising as part of the process. Responses that are derogatory, demeaning and/or disparaging will not be considered. 

An analysis of survey responses will be presented to Dundee IJB at their 2025/26 budget setting meeting on Wednesday, 26^th March 2025. Responses will also inform the completion of equality impact and fairness impact assessments that will be completed for saving options that are being proposed.

How will I be able to find out the results of the consultation?

Following the analysis, the findings of the consultation will be part of a report to the IJB at their budget setting meeting on 26^th March 2025. This document will be published on the Health and Social Care Partnership’s website.

What are Protected Characteristic Groups? 

We will gather information to allow us to assess the positive or negative impacts of any final decision, particularly on those with protected characteristics. The nine protected characteristics as set out in the Equality Act 2010 are detailed below: 

• Age 

People can be unfairly treated based on assumptions and stereotypes related to their age. Both younger and older people can share similar issues such as unemployment, reduced or low income, not being listened to and not being valued. 

• Disability 

Disability is defined as a physical or mental impairment which has a substantial and long-term adverse effect on a person’s ability to carry out normal day-to-day activities. Disability includes mobility, dexterity, hearing, speech or vision impairments along with "hidden" conditions such as epilepsy, diabetes, dyslexia, mental health problems and mental illness. Cancer, HIV infection and Multiple Sclerosis are deemed disabilities under the Act from the time of diagnosis. 

• Gender Re-assignment 

Gender refers to socially constructed roles, behaviours, activities, and attributes, denoted by terms such as ‘masculine’ and ‘feminine’ and can be different from biological sex. The term ‘gender reassignment’ applies to the process of transitioning from one gender to another. The term used in the Equality Act to describe people who intend to transition, are transitioning or have transitioned is ‘transsexual’. 

• Marriage and Civil Partnership 

Service providers cannot treat customers less favourably, or refuse to provide them with services, on the basis that they are married to a person of the same sex or in a civil partnership, as opposed to being married to a person of the opposite sex. 

• Pregnancy and Maternity 

It is unlawful to subject a woman to unfavourable treatment during the ‘protected period' defined by the Act. Protection from discrimination starts when a woman becomes pregnant. 

• Race/Ethnicity

The Equality Act says you must not be discriminated against because of your race. Race can mean your colour or your nationality (including your citizenship). It can also mean your ethnic or national origins, which may not be the same as your current nationality. Race also covers ethnic and racial groups. 

• Religion or Belief

The meaning of religion or belief in the Equality Act is broad and is consistent with Article 9 of the European Convention on Human Rights which guarantees freedom of thought, conscience and religion. Religion means any religion and includes a lack of religion. A religion need not be mainstream or well known to gain protection. However, it must have a clear structure and belief system. 

Belief means any religious or philosophical belief (including, for example, Humanism and Atheism) and includes a lack of belief. To be protected under the Equality Act, a philosophical belief must:

• Be genuinely held.

• Be a belief and not an opinion or viewpoint, based on the present state of information available.

• Be a belief as to a weighty and substantial aspect of human life and behaviour.

• Attain a certain level of cogency, seriousness, cohesion and importance.

• Be worthy of respect in a democratic society, compatible with human dignity and not conflict with the fundamental rights of others

• Sex

A person's sex refers to whether they are biologically male or female. In relation to a group of people it refers to either men and /or boys, or women and / or girls. A comparator for the purposes of unlawful sex discrimination will be a person of the opposite sex.

• Sexual Orientation

The Equality Act says you must not be discriminated against because:

• You are heterosexual, gay, lesbian or bisexual.

• Someone thinks you have a particular sexual orientation - discrimination by perception.

• You are connected to someone who has a particular sexual orientation - discrimination by association.

Sexual orientation includes how you choose to express your sexual orientation, such as through your appearance or the places you visit. Discrimination occurs when you are treated differently because of your sexual orientation.

Find out more about the Equality Act 2010, which provides the legal framework to tackle disadvantage and discrimination.

Further information about the health and social care needs of Dundee’s citizens

• Dundee has the second lowest life expectancy in Scotland. In Dundee life expectancy is 76.7 years, whereas it is 79.1 years in Scotland as a whole.
• Dundee expects to see a 38% increase in the population aged 75 years and over by 2043.
• Dundee is the 5^th most deprived local authority area in Scotland. 
• Dundee has the 4^th highest prevalence of drug use in Scotland, Alcohol related harm is also high when looking at hospital attendances and alcohol-related deaths. In 2023 there were 46 drug-related deaths and 36 deaths as a direct consequence of alcohol use in Dundee. 
• Dundee has the 2^nd highest rate in Scotland of adults (aged over 16 years) who reported in the 2022 Census that they are living with a mental health condition (20,242 people). 
• Around 1 in 10 people aged over 65 has dementia.
• The number of people living with or dying from cancer is rising.
• Hospital admissions due to long-term health conditions are higher for the most deprived areas of the city.
• Since 2016 the number of admissions to hospital due to a stroke has been increasing. In 2016 there were 639 hospital admissions, but this has steadily increased to 1,001 admissions in 2022. 
• Dundee has the highest admissions to hospital rate for falls in Scotland. For every 1,000 people aged over 65 years, there are 35 admissions to hospital due to a fall.
• For people receiving home care services, an average of 45% had an emergency admission to hospital in the 28 days before the service started. 
• 62% of carers supported by local carer services provide an average of 50 or more hours of care per week. 

Further information about the financial challenges faced by the Dundee IJB

• The IJB has a total projected gross budget for 2025/26 of around £325 million. This is made up of £110 million from the Council and £215 million from NHS Tayside. 
• £75 million of this is ‘ring-fenced’ which means there are rules about how the money must be used. These can be set by the Scottish Government or the Health Board, an example of this is the ‘set aside’ budget of £21 million, which covers Dundee’s contribution to acute hospital services delivered by NHS Tayside.  This ring-fenced funding also includes money that we must pass on to NHS Independent Contractors, such as GP Practices and Community Pharmacies, to meet their contracted costs.  Some services must be delivered because the law requires this or must be provided in a specific way because this is set out in national guidance or standards. 
• This leaves £250 million where the IJB can be more flexible and look to identify budget savings. Within this figure our service budgets are shared as shown in the table below.

What is driving higher costs in health and social care services?

There are significant financial pressures facing the Scottish Government and IJBs across Scotland – health and social care services are costing more to deliver every year. Dundee IJB faces the same challenges. Dundee IJB is projecting:

• A current estimated funding gap for 2024/25 of £8.7 million.
• That the estimated recurring gap increases to £19.7 million in 2025/26 by which time most of the IJB’s reserves are expected to have been utilised. This means that the IJB will have no reserves (money set aside) to meet future unexpected costs. 

These figures change over time as the IJB gets more information however they reflect a range of issues which are increasing the costs of health and care services in Dundee. Some examples of these include:

• Significantly increasing prescribing costs as well as an unprecedented number of prescription items being in short supply and increases in the number of items purchased to meet growing demand.
• The IJB’s commitment to funding fair pay awards and additional pay-related commitments made by the Scottish Government.
• Ensuring that Care at Home service continues to support people to live safely at home for as long as possible and the IJB’s commitment to helping people to be discharged from hospital as soon as they are well enough.
• The increasing cost of contracts that are in place to support people in Dundee, because of challenges such as inflation.
• Increased and more complex needs for people being discharged from hospital and being supported in their own homes.

Overall, there is not enough money coming into the IJB to fund these increasing costs. This means that Dundee IJB can no longer support the Health and Social Care Partnership to provide the same services in the same way and must find efficiencies, transform how services work and do less going forward.