The Associate Director of Finance (Wirral) presented this report which provided an update on the financial position for the Wirral Place health and care system partners as at the end of January 2024. It was reported that the Wirral Place overspend was forecast to be just under £19million. Wirral Community was on target to deliver a surplus which was being monitored by Cheshire and Merseyside ICB as part of the overall plan.  Wirral University Teaching Hospital had a forecast variant of £4.5million which was predominantly linked into industrial action costs both in terms of backfill and missed opportunities to derive more income and Cheshire and Wirral Partnership were in a break even position. The pooled fund was operating within the budget in terms of the Better Care Fund (BCF) element. If there was an overspend on BCF there was a risk share but the fund was in a break even position. The pooled fund had a Wirral Place element of £15million variance which was largely driven by cost of care costs, prescribing costs and an increase in the children and young people costs.

Members asked for clarification of the costs of industrial action by the NHS workforce and the main bulk of the cost  would be in the report from the Trust. It was explained that the costs related to lost income from the costs of not undertaking procedures and the additional costs of employing additional temporary staff and support staff.

Members asked about the CHC figures for Wirral which included the two aspects of continuing health care and mental health care packages aswell. There had been a significant increase in continuing health care which was around £10million which included a mix of inflation plus activity driven increases and one of the key things was a  significant increase in 1 to 1 packages.

Members discussed the 2024-2025 Cheshire and Merseyside plan. It was reported that the aim was to deliver a break even plan. Work was to continue around a number of key areas particularly around the workforce and with a real focus around urgent care and admission avoidance, mental health services and the flow into continuing care. In addition, the optimum service levels were to be considered.

It was highlighted that there was an opportunity for PCN’s to have more close working between primary and community services to help both admission avoidance and attendance avoidance. The focus was to turn reactive approaches, in terms of how money was spent, into more proactive approaches. Members stated that in the most challenging of situations it was key to optimise the available infrastructure. It was reported that virtual wards were nowhere near optimal level and the whole system needed to be looked at.

Resolved – That the report and the specific recommendations in relation to the Pooled Budget, listed below be noted,

• the forecast reported position for the Pool and the discharge fund as at Month 10 2023/24.

• the shared risk arrangements are limited to the Better Care Fund only, which is reporting a forecast breakeven position.

• the 2023/24 Section 75 agreement is signed and sealed.

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