Integration Joint Boards (IJBs), together with their NHS and council partners, must urgently take decisions on where to redesign, reduce or discontinue services.
Funding to Scotland’s 30 IJBs increased by over two per cent in 2024/25 to more than £12 billion. But this was insufficient to meet rising costs and demands, with many IJBs using dwindling reserves to help meet the almost £450 million gap between demand and available funding. This is not sustainable.
Increasing demand, rising costs and a growing number of people with long-term complex needs are placing mounting financial pressures on IJBs. The boards have reached a critical point, with a significant risk they will become financially unsustainable within the next 12 to 24 months.
Alongside savings and using reserves, IJBs have been relying on substantial additional funding from their partners in the NHS and councils. IJBs need to plan their finances more realistically to reduce this reliance, as health boards and councils face their own significant financial pressures.
Malcolm Bell, member of the Accounts Commission said: “The cost of delivering services is rising faster than available funding.
“Tackling this could include difficult decisions about redesigning or reducing services, and whether new or additional charges need to be made. Whatever decisions are made, service users, their families and wider communities must be consulted.
“But without radical change the services delivered by IJBs can’t be sustained. The gap between funding available and the cost of meeting demand is widening, and the gap of nearly £450 million cannot be bridged with savings alone.”
COSLA Health and Social Care spokesperson, Councillor Paul Kelly, commented: “The Accounts Commission report on Integration Joint Board finances for 2024-25 confirms the stark reality our Health and Social Care Partnerships face: that severe financial challenges continue to pose a risk to the sustainability of social care, which threatens the every day lives of our most vulnerable citizens and communities.
“The challenges also threaten the sustainability of our councils, who have continued to prioritise social care, with an additional £163m invested over and above Scottish Government funding in 2024-25. This level of additional funding is unsustainable for partners, but in many cases the only option given the diminishment of reserves held by Partnerships.
“The report makes clear the validity and need for our budget lobbying ask of an immediate investment of £750m in social care. We will continue to press the Scottish Government for this investment to avoid further cuts, reductions and increased charges in future.”
Whilst councils have made significant savings, the cost of delivering services is rising faster than available funding. This risks the financial sustainability of councils over the next three to five years, says public spending watchdog.
Although Scottish Government funding to councils has been increasing, this hasn’t kept pace with rising costs and demand. Councils are overspending on delivering services and borrowing more.
In its latest update on council finances, the Accounts Commission report that councils face a budget gap of nearly £1 billion by 2027.
In 2024/25, councils met 90 per cent of their savings targets. But for the first time in six years, they reported a collective overspend on the costs of delivering services. Debt levels are increasing. Many are relying on reserves.
Whilst councils are increasing the amount of money they raise through fees and charges, income generated isn’t keeping pace with rising costs and inflation.
With Scottish Government funding to deliver capital projects falling, councils are also taking on more debt to deliver local infrastructure projects such as building schools and housing.
Derek Yule, member of the Accounts Commission, said: “Despite increased funding and income, councils are struggling to cope with the financial pressures they face. A growing gap between costs to deliver services and funding available is risking the financial sustainability of councils.
“We’re already seeing the impact on services – the pace of improvement is slowing, some services are being cut or are harder to access and there are growing levels of dissatisfaction from communities. Councils must fundamentally reconfigure how they operate and deliver services.”
Commenting on the report, Cllr Ricky Bell, COSLA Spokesperson for Resources, said: “While we acknowledge increases in uncommitted funding in the local government settlement, today’s report reinforces the message that local government finances are under severe and growing strain.
“Councils have worked hard to manage budgets responsibly, delivering significant savings year on year and meeting the vast majority of savings targets. However, there is a clear limit to what can be achieved without impacting the services communities rely on. Increasing reliance on reserves, borrowing and fees and charges is not a sustainable long-term solution.
“As we look ahead to 2026/27, the budget settlement falls far short of what is needed to sustain essential local services without difficult decisions being made locally.
“We are especially concerned by the continued underfunding of social care and the Real Living Wage across portfolios.
“The medium-term outlook for local government is deeply concerning, with continued de-prioritisation and the prospect of significant real-terms cuts. If councils are to remain financially sustainable and continue delivering for communities, there must be a more honest conversation about funding, priorities and local flexibility.
“Urgent action is needed to ensure councils have the resources and certainty required to support Scotland’s people and places now and in the future.”
NHS Scotland spent £440m last year on beds for patients who were unable to get out of hospital despite being ready to be discharged, according to a new report by Scotland’s public spending watchdogs.
The report from the Audit Scotland and the Accounts Commission said one in nine hospital beds were occupied because of delayed discharges in the 12 months to April 2025.
It said the Scottish government must set out a plan to tackle the problem.
Delays in discharging patients from hospital affect people’s physical and mental health, and make it harder to admit others to hospital. Delayed discharges are a symptom of wider pressures across health and social care in Scotland.
The joint report by the Auditor General for Scotland and the Accounts Commission warns this has a significant effect, despite impacting only around three per cent of hospital patients. People medically ready to leave spent 720,000 unnecessary days in hospital in 2024/25. Whilst the full financial impact is unknown, the cost to the NHS in hospital days alone is an estimated £440 million a year.
The causes are complex, including rising demand for health and social care services, financial pressures, long-standing recruitment and retention problems across Scotland and for some, not having a Power of Attorney in place.
Reducing delayed discharges is a priority for the Scottish Government and their partners in health and social care, with significant activity underway to tackle this. But a lack of evaluation of initiatives across the country means it is difficult to measure what is having the greatest impact and whether these initiatives represent value for the money and time spent.
Stephen Boyle, Auditor General for Scotland, said: “Delayed discharges from hospital have far-reaching impacts on people’s health and well-being. The Scottish Government, health bodies, councils and other partner organisations agree on the need for major changes and are actively trying to reduce delayed discharges.
“Now they must improve how they collect, analyse and use data to evaluate the initiatives underway to tackle the problem. Without this, it’s impossible to understand the impacts and costs of delayed discharges and whether the initiatives across Scotland are improving lives, services and delivering value for money.”
Malcolm Bell, Member of the Accounts Commission said: “Significant change is critical across our health and social care services, shifting towards preventative care, greater use of technology and ongoing investment in the workforce. Without this, the care and support individuals need to leave hospital won’t always be available.
“The Scottish Government and COSLA’s joint health and social care service renewal framework is an opportunity for progress to be made with health and social care reform. But IJBs and social care need to be at the centre of planning and decision-making on service renewal, and it’s not clear how the framework will address the challenges faced by social care.”
‘The current approach has failed’
In response to the joint report into delayed discharges by the Auditor General for Scotland and Accounts Commission, Dr Fiona Hunter, RCEM Vice President for Scotland, said: “This report lays bare the scale of delayed discharge, and the impact it has on our health and social care system and the people it serves.
“720,000 days’ worth of unnecessary hospital stays in the 2024/25 financial year. That’s almost 2,000 years – an almost inconceivable amount of wasted resources which, if exit block had been addressed, could be used to help the patients lining the corridors of Emergency Departments day in, day out.
“The knock-on effect delayed discharge has on EDs cannot be overstated.
“Every hospital bed occupied by someone who does not need it, but cannot leave through no fault of their own, adds pressure to EDs which are receiving more patients than they can move on.
“And these unnecessary stays in a hospital bed puts patients at greater risk of hospital-born infection, and can lead to deconditioning, stripping them of their independence.
“This is something RCEM has been raising the alarm about for years now, and while the government has acknowledged the issue and taken some steps to address it – the total breakdown in hospital flow outlined in this report shows that the current approach has failed.
“Things cannot go on like this and I hope the government, health service and local authorities heed the recommendations set out by the Auditor General for Scotland.
“Improvements to data gathering and discharge planning, among the other recommendations, would be a step towards the system-wide approach we have long said is needed to fix Emergency Care.”
RCEM said earlier this week that The Scottish government must prioritise tackling delayed discharges and overcrowding in Emergency Departments (EDs) or risk the entire system collapsing under the strain of an incredibly difficult winter.
Th message from the Royal College of Emergency Medicine (RCEM), followed the release of ED performance figures on Tuesday (6 January) by Public Health Scotland (PHS) for November 2025.
One in 15 patients (8,065) waited 12 or more hours in a type-1 ED before being admitted, transferred or discharged in that month alone, the worst figures for a November since records began in 2007.
Further, the new data found that:
It was the worst November on record for eight-hour waits, which stood at 17,259, or 14.5% of patients attending a major ED
Only 63% of patients seen within four hours at type-1 EDs, a far cry from the government target of 95%
Compared to November 2018, waits of four or more hours were four times higher, eight-hour waits were 14 times higher, and 12-hour waits were 39 times higher
Meanwhile, the number of people attending ED was only 5.5% higher in November 2025 compared to November 2018
Dr Fiona Hunter, RCEM Vice President for Scotland, said: “This is yet another month of predictable broken records for Emergency Medicine performance in Scotland.
“The Scottish government continues to shout about improvements to NHS waiting lists. We, of course, welcome these but a lack of political will to put the same emphasis on addressing delayed discharges means our departments are at risk of total derailment.
“We are now in the depths of winter. Patients are arriving into EDs only to find that there isn’t the space to treat them safely, let alone quickly.
“Very sick and injured people are lining corridors, crammed into whatever space we can find, because of exit block and a complete breakdown in flow out of hospitals.
“With warnings of storms, snow and freezing temperatures, the situation is likely to get a lot worse before it gets better.
“It’s unacceptable that this has been allowed to happen, but it’s not too late to act. We call on the government to support health boards so they can make the improvements needed to tackle delayed discharges and improve patient flow.”
The Scottish Government recorded a £1 billion underspend in 2024/25 but still needs to move away from short-term measures to address a stark forecast gap between its spending plans and funding.
The underspend was supported by over £2 billion of additional funding from the UK Government, meaning a plan to help balance the budget with £460 million of offshore wind leasing revenues was not needed.
Significant pressures remain in achieving financial balance in 2025/26, and many of the necessary savings identified and delivered so far are non-recurring. This continued short-term approach to managing spending is not supporting the fiscal sustainability of the Scottish public sector.
The Scottish Government’s latest Medium Term Financial Strategy projects a combined resource and capital funding gap of £4.7 billion by 2029/30. This is due to policy choices and higher workforce costs. However, the government’s plan to make savings over the next five years lacks detail on how they will be delivered.
Stephen Boyle, Auditor General for Scotland, said: “Although the Scottish Government reported a £1 billion underspend this year, it did so from a combination of additional funding from the UK Government and one-off savings.
“A forecast gap of nearly £5 billion remains between what ministers want to spend on public services and the funding available to them.
“The Scottish Government needs to prepare more detailed plans setting out how it will close that gap by the end of the decade.”
Councils are spending less on culture and leisure services, reviewing the services they offer and increasing or introducing charges. Yet gaps in the data collected at a local and national level means we don’t have a full understanding of the impact of these decisions on health, wellbeing and prevention.
Scotland’s councils play a vital role in supporting communities by delivering a wide range of cultural and leisure services. These services aim to keep communities healthy and connected, improving residents’ quality of life. The level of services offered, and how they are provided, is a decision for individual councils.
Whilst councils are spending more on services overall, spending on culture and leisure services reduced by three per cent in real terms in the five years from 2018/19. At the same time income from charges increased by 27 per cent, whilst overall satisfaction and attendance rates for some services remain below pre-pandemic levels.
Removing these important services risks increasing inequalities and exclusion, with rural and more deprived communities having a greater reliance on these facilities. Failure to adequately consult with communities and assess the equalities impacts of service changes has led to some councils reversing decisions and communities taking legal action.
Jo Armstrong, Chair of the Accounts Commission, said: “Culture and leisure services are vital to our health and wellbeing, supporting national and local priorities and supporting people to be better connected. Gaps in national data need to be addressed to better understand how these reductions in spending on culture and leisure are impacting communities.
“As councils manage continued pressures due to increasing demands and costs, culture and leisure services have experienced a disproportionate share of council savings measures.
“Communities must be fully consulted on decisions to close, centralise facilities or changes to charging. Failing to do this risks deepening inequalities and legal action by communities.”
Plans to improve Scotland’s care system have been slow to come together after not enough early delivery planning by the Scottish Government and COSLA.
The Promise, a national commitment to improving the lives of care experienced people by 2030, was made by the Scottish Government in 2020.
Organisations and individuals remain dedicated to achieving that goal. But five years on, there is still confusion about what different bodies should be doing to deliver the changes needed.
Plans to date have lacked detail and direction for individual sectors. New structures set up by the Scottish Government to help deliver The Promise have lacked clarity about their roles and responsibilities.
And Scottish Government efforts to streamline The Promise’s complex governance arrangements have been insufficient. This has contributed to slow progress and made collective accountability challenging.
From the outset, there was no assessment of what resources and skills were needed to deliver The Promise by 2030, or how success would be defined or measured.
A framework to measure progress was agreed in December 2024 but further work remains. The Scottish Government is working on national data, which is not currently good enough to assess if services are improving the lives of care experienced people.
Stephen Boyle, Auditor General for Scotland, said: “Public bodies remain committed to improving Scotland’s care system and the lives of people who go through it. But initial planning about how The Promise would be delivered didn’t provide a strong platform for success.
“The Scottish Government needs to work with its partners to clearly set out the action that will be taken over the next five years to deliver The Promise, and how that work will be resourced.”
Angela Leitch, a member of the Accounts Commission, said: “Despite public bodies working hard to support local and national change to the services underpinning Scotland’s care system, greater pace and momentum is now needed.
“Local bodies need to work with their national partners to clarify roles and responsibilities, and prioritise the work needed to achieve The Promise’s aims.”
Commenting on the latest report on the Promise by the Auditor General and the Accounts Commission, Mary Glasgow, chief executive of Children First, said: “This report makes it clear that time is running out to keep the Promise.
“Investing in prevention and whole family support is the best way to stop children going into care in the first place. No child should be taken into care because support isn’t available.
“Real efforts have been made across Scotland over the last five years but as today’s report recognises, lack of clarity and accountability and failure to value and invest in the crucial role of the third sector are standing in the way.
“Children can’t wait. At Children First our commitment to keeping the Promise is as strong as ever. But unless the recommendations of the Auditor General and the Accounts Commission are acted on immediately the Promise won’t be kept.”
Whilst some public bodies and councils are working well together to tackle flooding, they face gaps in leadership, skills and data, and there is uncertainty about funding. This is limiting what can be achieved and opportunities to maximise the benefit of money spent are being missed.
Climate change is increasing the severity and frequency of flooding in Scotland, with almost 400,000 properties potentially at risk by 2080. But there is a risk that the action needed to prevent and tackle the already clear harms of flooding won’t happen at the scale and speed needed.
With the Scottish Government placing much more emphasis on flood resilience, there remain multiple barriers to effective collaboration across the public sector and to support communities. There is a lack of clarity in roles, responsibilities and funding. More also needs to be done to support communities to prepare for, and recover from, flooding.
The process for allocating funding for major flood schemes is currently not fit for purpose. Existing major flood schemes are taking longer to complete, with expected costs more than doubling to over £1 billion. This means that fewer homes and communities are protected than originally expected.
Almost 400,000 properties in Scotland could be affected by flooding by 2080.
Urgent action is needed from the Scottish Government and other public bodies to better protect communities from flooding.
Stephen Boyle, Auditor General for Scotland said: “The Scottish Government and other public bodies must urgently address critical gaps in roles, responsibilities, information and data. Failing to do this risks ambitions to build communities that can better withstand and recover from flooding.
“Whilst there are good examples of the Scottish Government collaborating with councils, communities and other public bodies, this isn’t sufficient given the scale of future risks.
“It is vital that greater certainty and clarity about the funding available for major flood schemes is provided, with costs and impacts managed and measured, and national agreement on collaborating and engaging with communities secured.”
Andrew Burns, Deputy Chair of the Accounts Commission, said: “Communities are at the heart of future flood resilience. Whilst there are good examples of the work councils are doing, they face significant challenges. There are gaps in the data they need, uncertainty over funding and a shortage of skilled staff.
‘There are inconsistencies in the advice, money and support to enable communities to become both more resilient to flooding events and recover more quickly.
“These challenges need to be addressed by both local and national government.”
East Lothian Council must make significant progress in changing how it delivers public services as it addresses significant demographic challenges, with rapidly expanding younger and older populations.
In its latest report, the Accounts Commission recognises many of the council’s services have improved, or at least maintained levels of performance, in the face of financial pressures. But this has come at an unsustainable cost. The council can no longer rely on using money saved in reserves to support the delivery of services. It needs to be clearer about how it will balance its budget in a sustainable way.
Given financial constraints and increasing demand, the council now focuses on a smaller number of key priorities. The council’s commitment to engaging with residents and communities is encouraging. But it must be clear about the services deprioritised and the impacts, as it looks to bridge a £46 million budget gap in the four years from 2026/27.
The council must make significant changes in how it delivers services. It benefits from having plans for change in place, but now needs to invest further and set clear actions and targets to drive digital transformation and save money through efficiency. Continuing to develop opportunities to collaborate and share services in the face of recruitment and retention challenges is critical.
Jo Armstrong, Chair of the Accounts Commission said: ‘Unlike most councils in Scotland, East Lothian has numbers of both rapidly expanding younger and older populations.
“This presents real opportunities as well as significant challenges and strains on staff, money and resource.
“The council must continue to hold ongoing conversations with staff and communities to shape and agree the changes it needs to make to services.
‘It’s reassuring the council’s latest financial plans limit the use of reserves.
“Now we need to see progress on the council’s programme to change how it delivers services and improves efficiency.
“This must happen, to ensure the council’s future financial security.”
Mounting pressures from inflation, increasing costs and demand are exceeding the Scottish Government’s additional investment in Scotland’s councils.
In 2025/26 councils received over £15 billion in government funding, with more money set to be raised from council tax and charges for some services. With communities paying more for services, their expectations are increasing.
In its latest assessment of local government finances, the Accounts Commission reports that additional costs from wage increases, higher employer National Insurance contributions and intensifying service demands, including social care as Scotland’s population ages, mean councils must cover a budget shortfall of £647 million in 2025/26.
Whilst councils have partly met this shortfall through service savings and increased charges for services, continuing to use reserves and make one-off savings isn’t sustainable. It intensifies pressures on future budgets.
Longer-term change in the way services are delivered is happening but must accelerate. Action is also needed to better understand the impacts on the most vulnerable communities.
Capital funding is vital for councils to invest in public buildings such as schools and libraries, as well as roads. It also underpins the significant transformation needed in the ways services are delivered in the future.
Capital funding from the Scottish Government is increasing but has not returned to previous levels. Councils remain heavily reliant on borrowing to fund their planned £4.7 billion capital investment in 2025/26.
Mounting pressures mean Scotland’s councils must cover a budget shortfall of £647 million in 2025/26.
Difficult decisions lie ahead on what services can be delivered and how.
Derek Yule, Member of the Accounts Commission said: “There’s a growing expectation gap. Councils don’t have enough money to meet current demand, at a time when local communities are being asked to contribute more through increases in council tax and charges for some services.
“Councils need to provide clearer budget information and work with communities to determine how services will be delivered in the future. These conversations won’t be easy.
“With public finances tightening, however, not all cost increases faced by councils can be met by government funding. Local action is needed now to find solutions to immediate and future financial challenges.
“This means difficult decisions on what services can be delivered and making major changes in how they are delivered.”
The Scottish Government and councils must fundamentally rethink how they plan, fund and staff additional support for learning as part of core school education in Scotland.
Since legislation in 2004 to make additional support for learning (ASL) more inclusive, there has been an eight-fold increase in pupils recorded as receiving ASL; currently 40 per cent of Scottish pupils – or 285,000 children – receive ASL. Almost all support is now delivered in mainstream classrooms, and it has become an increasingly central part of what teachers do.
The Scottish Government failed to plan for the impacts of this inclusive approach, and poor data means it is not possible to determine the scale, complexity and nature of needs across Scotland. The Scottish Government and councils urgently need better information to understand pupils’ needs and appropriate level of resource to support them.
Existing measures show a wide gap in outcomes for pupils receiving additional support compared with other pupils, including being more likely to be absent or excluded from school. More appropriate ways of measuring the achievements of pupils who receive ASL are still to be developed.
Stephen Boyle, Auditor General for Scotland, said: “The Scottish Government has failed to plan effectively for its inclusive approach to additional support for learning. Current gaps in data mean it is unclear whether all children’s right to have an education that fully develops their personality, talents and abilities is being met.
“The Scottish Government and councils urgently need better quality data to understand pupils’ additional support needs and the resources required to provide support to enable all pupils to reach their full potential.”
Ruth MacLeod, Member of the Accounts Commission, said: “Councils and the Scottish Government must fundamentally rethink how additional support for learning is planned and provided as a core part of Scotland’s school education.
“This includes reviewing how mainstream and special education is provided to meet current and future additional support needs and demands.
“It is critical they work with pupils, parents and carers and staff throughout this process.”
COSLA’s Children and Young People Spokesperson, Councillor Tony Buchanan @antbuc1), has commented following report published today about Additional Support For Learning from the Auditor General and Accounts Commission.
The Auditor General and Accounts Commission published a briefing paper on additional support for learning (ASL) on 27th February 2025. It makes a series of recommendations to Scottish Government and Councils, touching on data, measuring the outcomes of children and young people with additional support needs, funding, workforce planning and school buildings.
The COSLA Children and Young People Board will discuss the briefing at their meeting on 7th March.
Councillor Tony Buchanan, said: “Local Government is fully committed to supporting all children and young people to learn and to providing opportunities so that they can realise their full potential. The briefing paper published by the Auditor General and Accounts Commission on additional support for learning is welcomed.
The COSLA Children and Young People Board will be updated next week, with an initial consideration of the recommendations. COSLA, alongside the Scottish Government, co-chair the Additional Support for Learning Project Board.
“There will be an opportunity for the project board to consider the recommendations fully when they meet next month and consider how these can inform their priorities.”
