Agenda item

To consider a report by the Head of Finance (copy enclosed) which updates the Committee on the progress achieved to date with the development and establishment of pooled budgets across North Wales as per the requirements of Part 9 of the Social Services and Well-Being (Wales) Act 2014

10.10am – 10.45am

The Lead Member for Independence and Well-being introduced the Head of Finance’s report (previously circulated) which updated the Committee on the work undertaken to date to develop and establish pooled budgets between the Health Service and local authorities for the provision of certain functions, in accordance with the requirements of Part 9 of the Social Services and Well-being (Wales) Act 2014, across North Wales.  This work included the establishment of a pooled budget for the ‘exercise of care home accommodation functions’.

The Lead Member and officers advised that whilst the concept of pooled budgets for health and social care functions was commendable as its aim was to strengthen service delivery through the integration of services, the work required to establish them in line with the Act’s requirements was both complex and entailed a significant level of risk due to the financial amounts involved.  In accordance with the Act’s requirements a Part 9 Board or Regional Partnership Board had been established to progress this area of work.  Board members from both the Health Service and local authorities continued to have reservations on whether being compelled to establish pooled budgets for certain functions would deliver better seamless services for service-users, as at present there was only limited evidence to support this theory.  Whilst the Act was not specific about the scale of the ‘pool’, the Welsh Government (WG) Minister for Children, Older People and Social Care had, in early 2018, given a direction that all budget ‘pools’ should be on regional rather than a sub-regional basis i.e. to match the entire local Health Board area rather than the areas covered by the Health Board’s sub-divisions, or a ‘pool’ between each individual local authority and the Health Board.  Consequently, across all regions in Wales, local authorities and health boards had agreed to develop a ‘non-risk sharing’ pool.  This approach entailed an exercise to consolidate relevant information on expenditure on services to facilitate an in-depth analysis of each partner’s expenditure and the production of reports to test the feasibility of establishing formal ‘pooled budgets’ in future.  This exercise should help identify each partner’s potential over/under spend on proposed ‘pooled budget’ areas which would allow any risks relating to these to be addressed prior to the establishment of formal ‘pooled budgets’.  For North Wales the detail and format of the data required from each partner had been agreed, and was at present being collected and analysed by Denbighshire as the appointed Lead Authority.

Responding to members’ questions the Lead Member, Corporate Director:  Communities, Head of Finance and the Head of Regional Collaboration, North Wales Social Services Improvement Collaborative (NWSSIC) advised that:

·         whilst there was an expectation from WG that ‘pooled budgets’ be in place before April 2019 all partners in North Wales, and in other regions across Wales, were of the view that it was worthwhile to undertake an exercise to add value to current services across the region by piloting certain projects in order to assess the benefits, mitigate any risks and be better informed when establishing pooled budgets for those services in future.  Whilst this fell short of establishing formal pooled budgets the WG seemed to accept this approach;

·         the latest estimated figure, as at the end of 2017/18, for a ‘pooled budget’ for care home accommodation functions was circa £115m.  This figure highlighted the potential scale of any regional ‘pooled budget’ and reinforced all partners’ views why it was better to take sufficient time to effectively plan for their establishment, and to test all data, due to the financial risks associated with not getting it right;

·         all partners agreed with the spirit and the aims of the Social Services and Well-being (Wales) 2014 Act, including Part 9 of the Act which related to partnership arrangements and the establishment of ‘pooled budget’ arrangements. Whilst each partner aspired to deliver better seamless services for the residents of North Wales, the size, geography and population density of the area were an added challenge when attempting to deliver very local services and realising economies of scale;

·         the financial structures of the Health Board were very different to those of the local authorities;

·         there was also a need to clearly define which services were deemed to be social care services and which were health care services, as well as a need to determine the classification of those services which were currently regarded as a mixture of health and social care services;

·         no formal ‘pooled budget’ arrangements could be established without the support of the Executive of each of the six local authorities and the Betsi Cadwaladr University Health Board (BCUHB).  Currently all each organisation had agreed to was to enter into an ‘integration agreement’ which committed them to work collaboratively to integrate services where appropriate, hence the data consolidation exercise;

·         no formal Section 33 of the National Health Service (Wales) Act 2006 agreement had been signed by any of the partners to date.  The work currently underway related to a non-risk sharing pool which included the identification of potential ‘pooled budget’ services and each partner’s expenditure on those services.  This would help shape future ‘pooled budget’ proposals and mitigate any risks associated with them.  Once all parties entered into a formal Section 33 agreement they would be bound by law to honour all the financial and other commitments included in the agreement.  Consequently, there would be legal recourse for any obligations not met;

·         Denbighshire staff were currently taking the lead role in developing work around ‘pooled budget’ arrangements as per the ‘integration agreement’.  However, if in future Denbighshire was to become the host authority responsible for administering and managing the requirements of Part 9 of the Act sufficient organisational infrastructure to support that work would need to be put in place;

·         each partner’s contribution towards any future ‘pooled budget’ would be based on their current expenditure on the services covered by the ‘pooled budget’, not on a population size basis; and

·         by April 2019 the Part 9 Partnership Board was aiming to have the information consolidation exercise completed and to have a ‘non-risk sharing pool’ in place, not a formal Section 33 pooled budget.  The work on developing a formal Section 33 agreement would commence once the data had been robustly analysed and been sufficiently risk-assessed to enable potential pooled budget arrangements to be drawn up.  

At the conclusion of the discussion the Committee:

Resolved: - subject to the above observations to –

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

(ii)          receive the latest update and note the work being developed to produce regional financial information (a non-risk sharing pool); and

(iii)         request that a further progress report be presented to the Committee in twelve months’ time unless significant developments or changes necessitated a report to be presented to the Committee at an earlier date.