Issue - decisions
Graham Hodkinson, Director for Adult Care and Health, introduced a report on Wirral Health and Care Commissioning Pooled Funding Arrangements. The report was about the joining up of services to enable people to navigate what was a very complicated system; so that people told their stories only once, potential delays were reduced and people didn’t get lost in the system.
Wirral Health and Care Commissioning (WHaCC) had been in operation since May 2018. This was the contemporary name for the Integrated Commissioning Hub referred to in reports dated before May 2018. WHaCC was a formal strategic partnership created on behalf of Wirral Council and Wirral CCG. The partnership was created following agreement to progress into a formal partnership by Wirral Council Cabinet in November 2017 (minute 62 (27/11/17) refers) and NHS Wirral CCG’s Governing Body in December 2017.
This report presented the detail of how the agreement to create a single care and health commissioner for Wirral had been taken forward in terms of financial governance and decision making. The Section 75 pooled fund agreement (Appendix 3 to the report) set out the budget areas that were being pooled in 2018. It also referred to a shadow pool which referred to budgets that were not being pooled in 2018, in order to minimise exposure to financial risk. Financial and governance arrangements were included within the Section 75 agreement.
Importantly the key risks and mitigations had been considered and responded to by WHaCC in setting up pooled fund and financial governance arrangements.
He acknowledged that concerns had been expressed from a number of sources and further scrutiny of the risks as well as the benefits would need to happen before any further pooling was considered. The Board were being asked to agree to the pooled arrangements for 2018/19 only after which he proposed that there would be a pause whilst further scrutiny took place on any proposed expansion of the pooled fund.
In September 2017 a due diligence exercise was undertaken by Price Waterhouse Cooper (PWC). The report illustrated the benefits of integrated commissioning and set out their view of potential risks and mitigations on behalf of Wirral Council and Wirral CCG. The report was considered in advance of the decision to create WHaCC, but had not previously been in the public domain. At this stage the report could be read in conjunction with the arrangements that had been put in place to respond to the highlighted risks. He stated that some of the language used in the PWC report in relation to ‘accountable care organisations and accountable care systems’ was something which had not been adopted in Wirral. Wirral’s focus was on integrated care, collaboration and NHS providers working together and was not on the creation of an Accountable Care Organisation.
Mike Treharne, Chief Financial Officer, Wirral NHS CCG then spoke to the report and expanded further on some of its details. He referred to the key risks and mitigations appendix in the report and stated that the risks were well mitigated against. He elaborated further on the financial implications with £129.9m going into the pooled funding for 2018/19 and the need for a more sophisticated risk share arrangement to be developed for future years if additional areas were to be added to the pooled fund.
The Chair then invited questions and comments.
Councillor Bernie Mooney stated that she was pleased any additional pooled fund arrangements beyond those set out for 2018/19 would be halted until more scrutiny had taken place. There had been a number of scrutiny meetings up to now and she was clear that the Council would not take part in any arrangement that would involve the establishment of an Accountable Care Organisation or any form of privatisation. The language used in the PWC report was very unfortunate and very misleading as this was not what the Council would want to be a part of.
Dr Sue Wells assured the Board that for the CCG’s part this was about integrating care to help people to have a better health and care experience and was absolutely not about privatisation of the NHS.
The Chair echoed Councillor Mooney’s comments, having been a nurse for 40 years the last thing she would be involved with would be privatisation. The NHS had to be free at the point of need and at the point of care, the best quality of care and social care which could be provided.
The NHS Wirral CCG Members and Wirral Borough Council’s three Cabinet Members, sitting as a Committee of the Cabinet –
(1) That the Joint Strategic Commissioning Board endorses and supports the approach taken to mitigate financial risk.
(2) That the Section 75 agreement for 2018/2019 is agreed for sign off by Chief Officers on behalf of NHS Wirral CCG and Wirral Council.