The Panel discussed the Spring Budget, and in particular details of the additional funding for social care: £1bn of this will be provided in 2017-18, "ensuring councils can take immediate action to fund care packages for more people, support social care providers, and relieve pressure on the NHS locally." In practice, the Panel believed, the funding would be needed largely to offset undeliverable savings targets. Read the methodology for allocation and the amounts involved which were published on 9 March.
It was also reported that Simon Stevens has written to all clinical commissioning groups (CCGs) on this topic. The Panel believed it would be appropriate for Panel/H&I Board/CIPFA to set out in due course views on what might be included in the Green Paper on social care funding, as announced for the autumn. The Panel noted that children’s services, and indeed other local government services, were not mentioned although there were severe pressures in those areas too. The narrative appears too narrowly tied to older people and delayed transfers of care.
Updating on previous discussions regarding the inaccuracy of NHS Digital’s statistics on social care spend, the Panel agreed to (a) incorporate the accounting issues in an update of the CIPFA publication Pooled Budgets and the Better Care Fund and (b) seek to clarify of the basis of reporting by seeking improved ADASS and CIPFA consultation with NHSD (early exchanges with DH are encouraging in this respect). It is hoped to achieve improvements in time for the 2016/17 out-turn data (publication due October).
It was reported that, after some delay, the LGA had now decided it did not wish to pursue the joint approach to benchmarking proposed by the Panel in 2015. The Panel reasserted the underlying logic of the offer, ie that benchmarking is a difficult area (in time and money) for councils to support in present circumstances, and the current offerings across different bodies lead to duplication. A broader look is therefore needed.
The Panel discussed the draft report Reality Check: Making the Most of Developing STPs. It was felt, from a local government perspective, to give a fair picture. Comments made for possible further development were that:
- The bureaucracy of the BCF process had added no value to the transfer of funds effected, so if the sustainability and transformation partnerships (STPs) process replaces that in due course, that would help (the Panel noted that the 2017-19 BCF guidance is still not out).
- Planned savings per head of population varies widely, and could be commented on.
- The STP framework assumes that health and social care are similar, but health doesn’t ‘commission’ in the full sense found in social care, but simply manages contracts – which may obstruct full joint working unless the purchaser-provider split is removed from the NHS (which may well the direction things are going in).
- There could be more on the role of politics in STPs, perhaps emphasising the awkwardness of STP footprints for that interface, and recognising that local politicians cannot be expected to support controversial measures such as hospital closures if nationally, regionally (including MPs) there is no political backing.
- Many councils are restructuring, adding to the possibility of competing savings targets and ‘change overload’. The Panel also feared that including social care in accountable care organisations is difficult as the statutory roles of a local authority are not naturally compatible with that set-up.
- The panel heard about discussions on how local authorities and health might collaborate on capital spending, explaining that the need for capital resource cover in the NHS was a limiting factor, but that there are options which are already available and may need reinforcing.
Andy Whittingham reported on NAO activity, which has recently covered housing benefits, welfare reform and universal credit as well as integration. The Panel believed that the NAO had done an excellent job in these areas, but regretted that little change resulted. The PAC is likely to report on integration in May, requiring government departments to respond. The Panel continues to have concerns about welfare issues, and propose to invite the relevant CIPFA adviser, Sheldon Wood, to the next meeting.
The Panel agreed that the possibility of an ‘integration partnership’ with HFMA made sense.
The Panel reasserted the view that children’s services were less well set up than adults in terms of resource management, with little culture of resource management among managers (as evidenced in transition packages), and the personalisation agenda not yet taken forward. The problem is exacerbated by OFSTED’s tendency to require additional spending as a solution to any problems without reference to the financial position of the organisation. It was agreed that the budget risk tool in place for adults might usefully be adapted to children.