Agenda item

Mr Paul McMenamin gave an overview of the content of the paper highlighting: historical funding; temporary measures; savings targets; determination of 16/17, 17/18 and 18/19 budgets; mitigation of risks; horizon scanning; and the governance arrangements in place for the partnership.

Mrs Jane Davidson advised that the budget from NHS Borders was indicative as was the efficiency plan and that it would be confirmed as the year progressed as the Health Board had yet to approve the budget.  She reiterated that it was a fair and reasonable assessment of NHS Borders’ expectation from Scottish Government.

The Chair questioned if the amount of outstanding efficiency was reducing.  Mrs Davidson advised that the main areas were the Alcohol and Drug Partnership and Dental Services.  She advised that plans were being worked up to redesign to deliver similar outcomes and other opportunities were also expected to be identified.

Mr John Raine thanked Mr McMenamin for a comprehensive and detailed report.  He noted that the £5.26m made available by Scottish Government in respect of health and social care was to be split, with 50% of the sum used for releasing cost pressures in social work taking into account the living wage and cost of reducing charging thresholds.  Mr Raine enquired how the other 50% would be used, if it was intended to be additional monies and represented additionality, and if it was for the Health & Social Care Integration Joint Board to determine the use of that funding?

Mr McMenamin confirmed that the uncommitted amount in theory was for the Health & Social Care Integration Joint Board to direct as additionality and he cautioned that the full implications of the cost of the living wage on the full financial year were not yet known as well as other unknown factors.  Mr Raine sought confirmation that Mr McMenamin was suggesting the full £5.26m could be swallowed up in meeting the cost of the living wage and unknown factors as anticipated at present and Mr McMenamin confirmed that this may in fact be the case given the current estimates represented only a part year impact.

Mr Raine commented that he understood there was a clear steer from the Cabinet Secretary that part of the £5.26m (50%) would represent additional money to support integration for the Health & Social Care Integration Joint Board to develop integration in the way that it wished to see it developed.  Mr McMenamin commented that he aspired to that being the case and advised the letter from Mr Swinney was quite clear on the intended use of the £5.26m.

Mr David Robertson advised that the funding from the Scottish Government around the living wage was predicated on care home providers themselves providing 25% of the cost of the uplift and he suggested in reality that cost would flow back to the Health & Social Care Integration Joint Board in terms of care home providers.  He supported the aspiration of resources to be open to the Health & Social Care Integration Joint Board for integration and urged caution around specific sums.

Mr David Davidson sought clarity that the £5.26m would remain in the notional budget for the Health & Social Care Integration Joint Board until such time as the Health & Social Care Integration Joint Board issued directions as to its use.  Mr McMenamin advised that both he and Mrs Susan Manion were committed to that approach and he committed to bring back a report once the full implications of the living wage, etc were known so that the report could assist the Health & Social Care Integration Joint Board in its deliberations on where to direct the use of the full £5.26m funding.

Cllr John Mitchell enquired with regard to the set aside budget rising, if it had altered as the percentage had altered.  Mrs Manion advised that the set aside budget was set on the basis of what were considered to be services for acute care in hospital most related to the Strategic Plan for the Health & Social Care Integration Joint Board and that it was essentially around unscheduled care provision. 

Cllr Mitchell enquired if the cost of running wards were included.  Mr McMenamin explained that they were included and NHS Borders set aside budget as defined by the Scheme of Integration included the relevant wards/bed functions.  The set aside budgets were solely owned and managed by NHS Borders and simply supported the overall aims and objectives of the partnership.

Mr Raine commented that the Integrated Care Fund monies equated to £6.4m over the 3 year life of the Strategic Plan and were there to make a difference to integrating services.  He was pleased to see the fund referred to in the report as a key enabler of integration and he welcomed the review of the governance arrangements and requested a timescale for that review.  He further emphasised to colleagues that the Health & Social Care Integration Joint Board had to be the controlling influence over the fund.  Mrs Manion advised the Integrated Care Fund report would be submitted to the next meeting and would outline the timescales of, the work agreed, outcomes and proposed planned expenditure, as well as the review of the governance arrangements.

Mr Davidson sought clarification on the role of the Audit Committee and if it was to be an Audit and Risk Committee.  Mrs Jill Stacey clarified that the Terms of Reference agreed for the Audit Committee included the oversight of scrutiny of risk management arrangements and internal control and would fulfill the scrutiny role of governance in the widest sense.

The Chair summed up the conversation commenting that it had been a useful discussion and raised a range of issues to be worked through as the Health & Social Care Integration Joint Board entered its first year of business. 

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted and approved the estimated Health and Social Care partnership budget for 2016/17, including both the element delegated by NHS Borders/Scottish Borders Council and that retained by NHS Borders and set-aside, specifically:

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the key areas of financial risk in 16/17 and the proposed actions for mitigation.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD instructed the Chief Officer to identify, in partnership with NHS Borders and Scottish Borders Council, further proposals / directions for ensuring that the total budget delegated is fully funded by agreed levels of activity/efficiency savings across both delegated and notional areas of the integrated budget. 

Mrs Karen Hamilton advised she was supportive of the proposal provided it did not link to the plans to deliver £793k efficiency savings so that there was flexibility for that to be delivered.  Mrs Davidson advised it would difficult given that directions had yet to be issued and the annual financial statement required the inclusion of sums attached to spend and activity to be applied.

Mr McMenamin clarified that the financial plan remained a work in progress and was evolutionary and he would continue to work with colleagues across the partnership and he assured the Health & Social Care Integration Joint Board that it would remain business as usual on 1 April 2016.  Mrs Manion confirmed that directions were required to be agreed by all parties to enable the creation of change to deliver the strategic plan in the future.

Mr Davidson commented that as there was no confirmation of the national funding settlement for Health Boards, it was difficult to make an informed decision.  Mrs Davidson advised that she would be submitting a paper to the Health Board in early April which would recommend the level of resource to be provided to the Health & Social Care Integration Joint Board, and reiterated that the funding proposed at this stage was indicative.

The HEALTH & SOCIAL CARE INTEGRATION JOINT BOARD noted the risks which may emerge in future years and consider them and any others which may arise as part of the wider 2017/18 financial planning process.