Agenda item - Local Health and Social Care Integration

Joint report of the Chief Executive and the Accountable Officer for the CCG (copy attached).

1)            That the establishment of a shadow operational year commencing on 1^st April 2018 during which officers from BHCC and the CCG will prepare for full integration in April 2019 be agreed;

2)            That the formation of a joint officer board (BHCC and CCG) that will be tasked with planning the smooth introduction of the new integrated services be noted;

3)            That the initial scope of the activities to be included from the outset of the shadow year, through which period the confirmed longer term scope will be identified and brought back for formal agreement (see para 3.10), be noted;

4)            That an interim governance arrangement for 18/19 that gives authority for HWB to have oversight of the integrated budget as set out in appendix 1, be agreed;

5)            That the design principles set out in para 3.18 which will guide the development of the partnership be agreed;

6)            That authority be delegated to the Chief Executive, in consultation with the Chair and Deputy Chairs of the HWB, to take all steps necessary or incidental to progressing the project;

7)            That it be noted the CCG Governing Body will delegate to the Chief Accountable Officer authority to take all steps necessary or incidental to progressing the project; and

8)            That it be noted the proposals listed above do not change existing delegated powers or the constitution of either party.

48.1      The Committee considered a report of the Chief Executive that provided an update on the scope and interim governance arrangements for local health and social care integration and the roles of councillors and CCG Governing Body members during the shadow year of operation in 2018/19.

48.2      Councillor Sykes asked for clarification that the council’s net budget for Primary Care Services was zero as detailed on page 155 of the agenda as he understood there was an allocated budget of £18m for Public Health.

48.3      The Executive Director, Finance & Resources stated that the collaboration was at a very early stage and the detail and presentation of budgets had some way to go. Increased clarity would be found as work on the joint arrangement continued.

48.4      Referring to the governance arrangement diagram on page 160 of the agenda, Councillor Mac Cafferty asked for clarification as it appeared that PR&G Committee, Full Council and Health, Overview & Scrutiny Committee (HOSC) had no relationship. Councillor Mac Cafferty stated that there was a lack of detail in the report on the disputes over acute budgets and no detail on how that would work in the shadow arrangement. Councillor Mac Cafferty added his concern regarding the proposal to allocate further responsibility to HOSC as it was currently overworked in a number of areas, did not have the capacity at officer level and was currently refusing to commission new work. Councillor Mac Cafferty expressed further concern in relation to the officer board and specifically how Members could hold the board to account.

48.5      The Chief Executive clarified that the governance arrangement diagram was a working document and continual refinements would be made adding that there was a strong relationship between all committees and Full Council and any requests for additional resources would have to be considered by PR&G Committee. In reference to disputes over acute budgets, the Chief Executive provided assurance that on a practical level, there was daily dialogue between hospital and social care staff and there was further work for the officer group on the economics of the arrangement and whether more efficiency could be achieved from the current system. With reference to HOSC, continued support would be provided to scrutinise issues of policy and practice with policy matters ratified by the Health & Wellbeing Board. The Chief Executive provided clarification that the officer board would not be making any significant decisions and matters of policy and finance would be considered by PR&G Committee and Health & Wellbeing Board.

48.6      Referring to recommendation 2.4, Councillor Wealls asked how oversight was defined and determined.

48.7      The Chief Executive clarified there would be a suite of reports detailing how money was being spent, similar to the TBM reports received by this committee.

48.8      Councillor Yates stated that the proposals related to the arrangements for the shadow year and there would be much more detail as integration progressed. Councillor Yates stated that increased transparency was vital demonstrated by the fact that the Health & Wellbeing Board did not currently receive any budgetary reporting from the CCG. Councillor Yates stated that oversight of the way the council and CCG budgets interacted was crucial to minimise disputes and create an improved spending framework to deliver better services.

48.9      Councillor Janio stated that he agreed with the comments made by Councillor Yates, adding that it was very important to have increased Member oversight on Adult Social Care services, something that was currently lacking.

48.10   RESOLVED-

1)            That the establishment of a shadow operational year commencing on 1^st April 2018 during which officers from BHCC and the CCG will prepare for full integration in April 2019 be agreed;

2)            That the formation of a joint officer board (BHCC and CCG) that will be tasked with planning the smooth introduction of the new integrated services be noted;

3)            That the initial scope of the activities to be included from the outset of the shadow year, through which period the confirmed longer term scope will be identified and brought back for formal agreement (see para 3.10), be noted;

4)            That an interim governance arrangement for 18/19 that gives authority for HWB to have oversight of the integrated budget as set out in appendix 1, be agreed;

5)            That the design principles set out in para 3.18 which will guide the development of the partnership be agreed;

6)            That authority be delegated to the Chief Executive, in consultation with the Chair and Deputy Chairs of the HWB, to take all steps necessary or incidental to progressing the project;

7)            That it be noted the CCG Governing Body will delegate to the Chief Accountable Officer authority to take all steps necessary or incidental to progressing the project; and

8)            That it be noted the proposals listed above do not change existing delegated powers or the constitution of either party.