Agenda item

To consider a report by the Project Manager- Regional Collaboration Team (copy attached) to provide an update of the Regional work underway to develop integration and pooled budgets for Health and Social Services.

9.35 a.m. -10.15 a.m.

Introducing the report (previously circulated)  the Corporate Director:  Communities (Statutory Director of Social Services) informed the Committee that the work underway to develop regional pooled budgets for North Wales, under the direction of the North Wales Regional Partnership Board (NWRPB), was still very much in its infancy.  Whilst Section 33 of the National Health Service (Wales) Act 2006 had created a legislative framework to facilitate the creation of pooled health and social care budgets, these provisions had not been widely used.  Consequently, the Welsh Government (WG) had in Section 9 of the Social Services and Well-being (Wales) Act 2014 made regulations requiring the establishment of pooled budgets for specific functions, these being:

·         Care home accommodation

·         Family support functions; and

·         Functions exercised jointly as a result of an assessment carried out under Section 14 of the 2014 Act, or any plan prepared under Section 14A of the same Act.

If appropriate pooled budgets could also be established to meet the costs of delivering other joint health and social care services.

Whilst the requirement to establish pooled budgets for family support functions and jointly exercised functions had come into effect from 6 April 2016, the pooled budget for care home accommodation functions would not become mandatory until 1 April 2018.  Agreements were already in place to facilitate the delivery of joint services in areas such as Integrated Family Support Services, the North Wales (Central) service covered Conwy and Denbighshire.  This practice would just need to be formalised in a legal agreement.   The Corporate Director explained that work was currently underway to establish which services, outside of the mandatory pooled budget services, could potentially benefit from a pooled budget approach.  Whilst the Health Board and local authorities were required by law to develop pooled budgets for the specified service areas, other organisations were not precluded from being partners in a pooled budget.  However, the driver for integration and pooled budgets should be needs identified within local Population Needs Assessments.  The NWRPB had established a Regional Pooled Budgets Project Group to develop a North Wales Integration Agreement for the approval of all six local authorities in the region and the Health Board.  At present the Project Group, chaired by Denbighshire’s Director of Social Services and supported by the Council’s Section 151 officer and Deputy Monitoring Officer, was exploring a number of areas for their suitability for pooled budget arrangements, as well as the viability of including current pooled budgets within future formal arrangements i.e. equipment stores etc.

Options on how best to deliver and govern ‘pooled budgets’ were currently being tested and quality assured by applying them to smaller budget commitment areas.  The results of this options appraisal would be presented to the NWRPB at its meeting in June 2017, for it to determine how best to proceed.  For care home accommodation pooled budget purposes individuals’ health and social care needs would be subject to the same assessment processes as at present.  A pilot project was due to be undertaken in Gwynedd to test out the legal aspects of care home accommodation pooled budget arrangements.   Legal aspects would be subject to thorough testing with a view to ensuring that one or more partners were not able to over utilise the pooled budget to alleviate their own budgetary pressures.  To safeguard against such practices robust governance arrangements would need to be established and embedded if pooled budgets were to realise their full potential.  Despite the need to ensure that all safeguards were robust prior to the establishment of pooled budgets the concept behind their establishment were commendable, as their creation would secure more buying power for commissioning bodies whilst at the same time focussing on the citizen’s needs.

The Lead Member for Social Care (Adults and Children’s Services) highlighted to the Committee that the WG’s recent White Paper ‘Reforming local government:  Resilient and renewed’ emphasised the need to work effectively on a regional basis to deliver quality services with a greater focus on prevention rather than intervention.  The UK Parliament’s Health Committee was currently examining the effectiveness of NHS England’s ‘Sustainability and Transformation Plans (STPs)’ and their success in keeping people healthier for longer and improving their care.  Whilst Denbighshire was proactively embracing this change in approach there was still some way to travel on the transition journey.

Responding to members’ questions officers advised that:

·         All services delivered via pooled budgets would require to conform to the new Welsh language standards.  From a procurement basis a regional ‘pooled budget’ would improve the buying power and widen the procurement base for specialist services in the service-user’s language of choice;

·         Quality monitoring and regulation of service delivery would continue to apply as at present;

·         They would not enter into any ‘pooled budget’ contract that would compromise current service quality.  Wherever possible the aim would be to continually improve services and deliver better outcomes for the individuals concerned; and

·         One of the key areas which would require clarification as part of any pooled budget agreement would be to have clear arrangements in place for end of year surplus/deficit budgets, their utilisation/funding.

Members thanked officers for explaining the pooled budgets concept and its associated risks to the Committee.  At the conclusion of the discussion the Committee:

Resolved: 

(i)           to confirm that, as part of its consideration, it had read, understood and taken account of the Well-being Impact Assessment (appendix 1);

(ii)          it had noted the scale of resource expended across the region on services for older people, some of which may form the basis of future pooled budget arrangements;

(iii)         noted the issues and risks highlighted from a financial governance perspective which would need to be evaluated;

(iv)        it had considered the resource requirements needed to complete the above within the timescales set out in the Act and potential costs and funding sources to deliver it;

(v)          that a report be presented to members in September 2017 outlining local arrangements already in place for setting, governance and utilisation of pooled budgets in relation to the provision of social care equipment; and

(vi)        that a further report be presented to members in November 2017 on the progress made in relation to developing pooled health and social care budgets, including proposed pooled budget models.