Agenda item

To consider a report by the Project Manager, Regional Collaboration Team (copy attached) to provide update on work that is developing to establish Pooled Budgets across North Wales.

11.05 a.m. – 11.45 a.m.

Councillor Gareth Lloyd Davies declared a personal interest as an employee of the Betsi Cadwaladr University health Board (BCUHB).

The Corporate Director:  Communities/Statutory Director of Social Services introduced the report and appendices (previously circulated) which outlined the progress made to date in relation to the establishment of pooled budgets for specific health and social care services across the North Wales region.  During her introduction the Director reminded members that the establishment of pooled budgets for specific services was a requirement under Part 9 of the Social Services and Well-being (Wales) Act 2014 (SSWB Act 2014). 

Members were informed that for the purpose of developing pooled budget arrangements the North Wales Regional Partnership Board (NWRPB) had established a Regional Pooled Budgets Working Group, made up of specialist technical experts from both the Health Service and local authorities.  This Group, chaired by Denbighshire’s Director of Social Services, had been tasked with examining the potential benefits of establishing pooled budgets, the operation and management arrangements for pooled budgets, identifying any risks and mitigating actions associated with them and the establishment of governance arrangements etc.  Denbighshire was well represented on the Group as its Director of Social Services chaired it and its Section 151 officer, Legal Services Manager, one of its Solicitors and a HR Specialist were members and technical advisors to the Group.

The Committee was advised that the NWRPB and Directors of Social Services across Wales were firmly of the view that pooled budgets should be viewed as a tool to support the journey towards integration not a form of integration in their own right.  Whilst progress has been made in developing a regional integration agreement, work was still underway in respect of scoping and developing pooled budgets for specific service areas.  A number of pilots were currently being conducted, or had recently concluded, to assess the practicalities of the utilisation of pooled budgets for delivering services in these areas.  Whilst considerably more work was required in a number of these areas prior to the introduction of pooled resources, it had become evident that North Wales, similar to all other regions in Wales, would not be in a position to establish a pooled budget for care home provision from April 2018, and therefore would not comply with the Act’s requirements.  The Welsh Government’s (WG) Minister for Social Services and Public Health had been notified of the position and had consequently permitted all Regional Partnership Boards an additional 12 months to comply with this requirement.  She had also made it explicitly clear that she would consider intervening if this requirement was not complied with by April 2019.  Members were advised that North Wales was ahead of the other regional partnerships in relation to progressing this requirement, but a large amount of detailed work and complex matters required to be worked through prior to an agreement being signed with regards to this particular pooled budget.

Responding to members’ questions the Lead Member, Corporate Director and officers:

·       requested members to raise directly with them any individual cases on which they had concerns about them being admitted into residential care/nursing care pending future medical treatment without undergoing a proper care/nursing care assessment;

·       advised that the law in relation to pooled budgets for care provision did not currently permit the pooled budget to be delegated to individuals for them to commission their own care package, all packages would require to be commissioned by Social Services/Health Service.  Partnership boards were lobbying the Government for the law to be changed in relation to this;

·       confirmed that neither Adult Mental Health Services nor Children and Adolescent Mental Health Services (CAMHS) were included within the scope of the pooled budget requirements of the SSWB (Wales) Act 2014.  Nevertheless, an integrated Health and Social Services Mental Health Team was already in operation in Denbighshire under the provisions of Section 33  of the National Health Service (Wales) Act 2006 which permitted the Health Service and local authorities, where appropriate, to enter into a partnership agreement for the delivery of integrated services.  One element of such agreements was the ability to pool funds to deliver an integrated service.  A report on pooled budgets in accordance with this legislative provision had been presented to members at the Committee’s meeting held on 14 September 2017;   

·       advised that the objective of the provisions of the SSWB (Wales) Act 2014 was to bring health and social care services closer together to improve the well-being of citizens;

·       informed the Committee that there was an element of nervousness on the part of all local authorities in North Wales and the Health Board in relation to the development of pooled budgets, particularly given the financial situation faced by the Health Board at present and the financial constraints on local authority budgets;

·       confirmed that local authorities across Wales had made representations to the WG Minister with regards to the practicalities of establishing pooled budgets for care home provision by 2018 due to the large amount of money that would be required to be paid into this pooled budget.  Some were already doubting whether the April 2019 date was achievable, particularly bearing in mind the amount of work required to establish the budget, putting in place the necessary procedures, safeguards and establishing sound governance arrangements;

·       emphasised that the NWRPB was not a decision-making body, any proposals formulated by the Board would require to be presented to each local authority and the Health Board’s decision making bodies for implementation approval;

·       advised they were confident that the conclusions of WIA undertaken in relation to the development of pooled budgets had been an accurate reflection of the proposals long-term sustainability, hence the reason for taking sufficient time and due care in exploring the legal and technical aspects associated with the establishment of pooled funds;

·       agreed that the concept of pooled budgets was commendable, as was the aim of the Act - to integrate the delivery of care and well-being services for the benefit of service users and to improve outcomes for them.  The greatest challenge would be to turn the vision into reality, particularly building a solid foundation to enable budgets to be effectively pooled and managed;

·       advised that the SSWB (Wales) Act 2014 stipulated that all local authorities within a local Health Board footprint area were required to work together to improve social care services and the well-being of residents within that area i.e. for North Wales the six local authorities within the Betsi Cadwaladr University Health Board (BCUHB) area.  This did not prohibit local authorities from entering into agreements with other Health Boards if they wanted to do so.  Earlier legislation that was still in force permitted local authorities to enter into partnership agreements to pool funds to deliver integrated services.  Nevertheless, it was anticipated that establishment of such partnerships would be few and far between;

·       acknowledged that the Health Board’s footprint area encroached into the county of Powys, with patients from north Powys being referred to hospitals in BCUHB’s area.  It was confirmed that the Powys Teaching Health Board (PTHB) and its associated local authorities were no further forward than the NWRPB with the development of pooled budgets;

·       confirmed that whilst the NWRPB was an operationally led Board its focus was the patients and citizens of the region.  For this reason it sought technical, financial and legal advice from experts in the field.  It was trialling a number of pilot projects in relation to pooled budgets with a view to identifying problems and good practice with the ultimate aim of establishing efficient and effective pooled budget arrangements; and

·       confirmed that HR experts were involved with the pooled budgets group’s work in order to identify HR related matters, such as staff’s terms and conditions etc. if a proposal was made to include staffing and staffing costs in any pooled budget arrangements.  It was emphasised that pooled budget arrangements did not have to include employment arrangements of staff, integrated working practices was sufficient.

At the conclusion of the discussion members:

RESOLVED:- subject to the above observations to

(i)              confirm that they had read, understood and taken account of the Well-being Impact Assessment as part of their consideration;

(ii)            note that North Wales as a region would not achieve the pooling of budgets for Care Homes by April 2018, whilst acknowledging the significant work underway across the region to develop work around integration and pooled budgets;

(iii)          recognise the resource requirements needed to complete the work involved with integration and pooled budgets within the timescales set out in the Act, including the potential costs and funding sources to deliver them; and

(iv)          request that a report on the progress made in developing and delivering pooled health and social care budgets and compliance with Section 9 of the Social Services and Well-being (Wales) Act 2014 be submitted to the Committee for consideration at its meeting in May 2018.