Agenda item

Wirral Health and Care Commissioning Pooled Fund Finance Report

A report of the Chief Finance Officer, NHS Wirral CCG and Wirral Health & Care Commissioning is attached.


Michael Treharne introduced a report that described the arrangements that had been put in place to support effective integrated commissioning.  The report set out the key issues in respect of:


·  the expenditure areas that are included in the 2018/19 shared pooled fund (live) and those expenditure areas in shadow form for 2018/19; and


·  the current and future risk and gain share arrangements.


Members noted that the approach to integrated commissioning, the business case and the proposed integrated arrangements for Wirral Health and Care Commissioning (WHaCC) had been well documented via Wirral NHS CCG Governing Body Board meetings on 2 May 2017 and 5 December 2017, and via Wirral Council’s Cabinet meetings on 27 March 2017 and 27 November 2017.


The following key features of integration were outlined as essential to success:


·  Pooling resources, intelligence and planning capacity.

·  Delivering the Right Care in the Right Place at the Right Time.

·  Managing demand and reducing the cost of care.

·  Clear accountability and governance arrangements.

·  Resilience and flexibility to emerging issues in service delivery.


Mr Treharne reported that Healthy Wirral had been established as the core programme for delivery of key transformational programmes of health and care.  WHaCC was the system lead for the delivery of this programme through the Healthy Wirral Partners Board. The financial challenge for the CCG and Council would continue, regardless of integration. The key for Wirral would be to ensure that integration of commissioning was seen as an opportunity to help to improve outcomes for people to make more effective use of the resources available (making the most of the “Wirral pound”,) rather than the financial challenges being seen as a barrier to integration. The risks and mitigations associated with integration would continue to be monitored and updated in the months to come.


The total fund contributed to the commissioning pool in 2018/19 amount to £130.4m, as per the table below:




Adult Social care


Public Health


Children and Young People




Better Care Fund





The total funds making up to the shadow pool in 2018/19 amounted to £531.2m as per the table below:




Adult Social Care







The budgets illustrated within the shadow pool comprised all other budgets within the Adult Social Care and CCG areas which were not formally pooled in 2018/19.


Mr Treharne informed that a proposal regarding the arrangements for the 2019/2020 Financial Year would be presented to the Joint Strategic Commissioning Board in due course.


Over time, services which were currently out of scope for WHaCC could potentially be included within the pooled funding arrangements (e.g. further Children’s Services).  The risks of adding these services to the pooled fund arrangement would need to be assessed and mitigated, prior to any decision to expand the pool further.


A full breakdown of the pool’s composition was set out in the report along with the current forecast.


Members noted that at 31 October 2018, the CCG had a developing year-end pressure of £1.1m spread across all areas of the live pool which formed part of the CCG’s overall net unmitigated risks currently reported to NHS England. Formally, the CCG was reporting a forecast out-turn in line with plan spread across both the live and shadow pools.


It was reported that following the Chancellor’s announcement of an additional £240m for Councils in 2018/19 to assist with winter pressures, Wirral Council had received confirmation that its share would be £1.8m. This would be fully used in-year to assist with improving the capacity of the domiciliary care market and to maximise independence and wellbeing.


Also included within the report were full details of the 2018/19 financial risks and challenges.  Members noted that the CCG had submitted a Formal Recovery Plan to NHS England, which had now been approved.  It had described how the £1.1m identified cost pressures within the pool for 2018/19 would be mitigated.


Further mitigations were currently being developed by the CCG.  As part of its directions from NHS England, a turnaround Director had recently been appointed with a remit to look at all expenditure lines across the entire CCG, to identify any further efficiency opportunities with a view to addressing the overall level of risk that was currently unmitigated.


Mr Treharne reported that the Council’s savings were on track to be delivered in full by the end of the year. Any slippage would be mitigated through over-achievement of other savings, as well as the identification new savings options and one-off actions. Any savings delivered above and beyond the savings target of £1.5m would contribute directly to the bottom line of the pooled fund and would be eligible to be shared between partners as described in the section 75.




That the financial position of the live and shadow pools, as at 31 October 2018, be noted.

Supporting documents: