Agenda item

CAB 18/18 

Integrated Commissioning and Section 33 Agreement for Care Homes for Older People in Gwent Region

Options Considered/Reasons for Decision

The Cabinet Member for Social Services presented the report, asking the Cabinet to support arrangements for integrated commissioning for care homes for older people in the Gwent region. 

These arrangements formed part of the authority’s statutory obligations under the Social Services and Wellbeing Act.  Part 9 of the Act detailed the duties and expectations around partnership working.  It was noted that this was statutory guidance rather than a Code of Practice, reflecting that it related to expected partnership arrangements between organisations.

An overview of integrated and pooled budget arrangements for the Gwent Region was the subject of a Ministerial report in January 2017 and copies were distributed to the Gwent Regional Partnership

Board and Leadership Group in February 2017. Supported by the National Commissioning Board (NCB) and Welsh Local Government Association (WLGA) the Gwent Regional Partnership Board agreed to be the pilot area for Wales for developing a Model Partnership Agreement (MPA) for pooled budget arrangements for older people under Part 9 of the SSWB Act.

The Project Team which had overseen this work were keen to ensure that the scope of the agreement and its design principles were cogent with that of the agreed Regional Joint Statement of Strategic Intent for Older People, adopted by Regional Partnership Board in late 2016, and taken through formal adoption by each statutory partner.

In terms of the size and scope of the care home market in Wales, a national market analysis was conducted in 2016 with a census undertaken at the same point in time across the country. This showed that in 2015/16 there were nearly 18,000 placements by local authorities and health boards, which included 4,877 placements of people funding their own care. There were 21,823 registered beds in care homes for older people at the time of the census and the combined local authority and health board spend was approximately £369 million. This excluded client contributions, third party payments and the fees paid by those individuals who fund their own care.

Part 9 of the Statutory Guidance (Partnership Arrangements) issued in consequence of the Social Services and Wellbeing (Wales) Act 2014, stated that Regional Partnership Boards would be expected to develop written agreements concerning any formal partnership arrangements which involve a delegation of functions.

Regulations allowed for the partners to enter arrangements for the establishment and maintenance of a fund which is made up of contributions from the partners and out of which payments may be made towards expenditure incurred in the exercise of National Health Service functions or health-related (Local Authority) functions.

This was the ‘Pooled Fund’ and money from this fund could be used for purposes agreed between the partners (in this case to carry out the Care Home Accommodation Functions) of the partners jointly, in arranging care for Older People in Registered Homes. While the legislation suggested that the partnership agreement may cover all care home functions, Welsh Government expected this to include care homes for older people (over 65) initially.

The Act envisaged that this would be a single fund which would remove the traditional Health/Social care division between partners, offering flexibility in the single fund’s use according to locally agreed needs. However, in the Gwent region and in other regions in Wales, the approach adopted towards the ‘mechanics’ of the pooled fund arrangement; at least in its initial stage, would not share financial risk nor introduce any potential cross-subsidy between the partners.

It was clarified that this was an in principle agreement, and further decisions would need to come back to Cabinet as implementation progressed.

Cabinet noted that funding provided by Newport would only be used to fund Newport residents.  Cabinet also noted the positive progress on this since the scrutiny committee’s review of care provision before the last election, and the leading role played by Newport’s officers in the development of these arrangements. 

Decision:

To approve the pooled budget arrangements for care home accommodation functions to be overseen by the Regional Partnership Board (RPB) and, in particular that the fund will not share financial risk nor introduce any potential cross-subsidy between the partners.

To agree that any changes to this approach will require further approval by all partners and further agreement by Cabinet.

To approve delegated powers to the Cabinet Member as Newport City Council member of the RPB, in the exercise of those functions, and consideration of any specific arrangements that need to be put in place to meet statutory duties at local and regional level.

To confirm the required key elements for these arrangements through development of a formal Partnership Agreement i.e a Section 33 agreement

To confirm resource implications for the local authority in relation to the pooled budget arrangements and oversight of the pooled budget agreements by the RPB.

Consultation

Commissioning and Contracts Manager; Senior Finance Business Partner; Service Manager (Regional Commissioning and Partnerships) Torfaen County Borough Council.

Implemented By: Head of Adult and Community Services

The Cabinet Member for Social Services presented the report, asking the Cabinet to support arrangements for integrated commissioning for care homes for older people in the Gwent region. 

These arrangements formed part of the authority’s statutory obligations under the Social Services and Wellbeing Act.  Part 9 of the Act detailed the duties and expectations around partnership working.  It was noted that this was statutory guidance rather than a Code of Practice, reflecting that it related to expected partnership arrangements between organisations.

An overview of integrated and pooled budget arrangements for the Gwent Region was the subject of a Ministerial report in January 2017 and copies were distributed to the Gwent Regional Partnership Board and Leadership Group in February 2017. Supported by the National Commissioning Board (NCB) and Welsh Local Government Association (WLGA) the Gwent Regional Partnership Board agreed to be the pilot area for Wales for developing a Model Partnership Agreement (MPA) for pooled budget arrangements for older people under Part 9 of the SSWB Act.

The Project Team which had overseen this work were keen to ensure that the scope of the agreement and its design principles were cogent with that of the agreed Regional Joint Statement of Strategic Intent for Older People, adopted by Regional Partnership Board in late 2016, and taken through formal adoption by each statutory partner.

In terms of the size and scope of the care home market in Wales, a national market analysis was conducted in 2016 with a census undertaken at the same point in time across the country. This showed that in 2015/16 there were nearly 18,000 placements by local authorities and health boards, which included 4,877 placements of people funding their own care. There were 21,823 registered beds in care homes for older people at the time of the census and the combined local authority and health board spend was approximately £369 million. This excluded client contributions, third party payments and the fees paid by those individuals who fund their own care.

Part 9 of the Statutory Guidance (Partnership Arrangements) issued in consequence of the Social Services and Wellbeing (Wales) Act 2014, stated that Regional Partnership Boards would be expected to develop written agreements concerning any formal partnership arrangements which involve a delegation of functions.

Regulations allowed for the partners to enter arrangements for the establishment and maintenance of a fund which is made up of contributions from the partners and out of which payments may be made towards expenditure incurred in the exercise of National Health Service functions or health-related (Local Authority) functions.

This was the ‘Pooled Fund’ and money from this fund could be used for purposes agreed between the partners (in this case to carry out the Care Home Accommodation Functions) of the partners jointly, in arranging care for Older People in Registered Homes. While the legislation suggested that the partnership agreement may cover all care home functions, Welsh Government expected this to include care homes for older people (over 65) initially.

The Act envisaged that this would be a single fund which would remove the traditional Health/Social care division between partners, offering flexibility in the single fund’s use according to locally agreed needs. However, in the Gwent region and in other regions in Wales, the approach adopted towards the ‘mechanics’ of the pooled fund arrangement; at least in its initial stage, would not share financial risk nor introduce any potential cross-subsidy between the partners.

It was clarified that this was an in principle agreement, and further decisions would need to come back to Cabinet as implementation progressed.

Cabinet noted that funding provided by Newport would only be used to fund Newport residents.  Cabinet also noted the positive progress on this since the scrutiny committee’s review of care provision before the last election, and the leading role played by Newport’s officers in the development of these arrangements. 

Decision:

To approve the pooled budget arrangements for care home accommodation functions to be overseen by the Regional Partnership Board (RPB) and, in particular that the fund will not share financial risk nor introduce any potential cross-subsidy between the partners.

To agree that any changes to this approach will require further approval by all partners and further agreement by Cabinet.

To approve delegated powers to the Cabinet Member as Newport City Council member of the RPB, in the exercise of those functions, and consideration of any specific arrangements that need to be put in place to meet statutory duties at local and regional level.

To confirm the required key elements for these arrangements through development of a formal Partnership Agreement i.e a Section 33 agreement

To confirm resource implications for the local authority in relation to the pooled budget arrangements and oversight of the pooled budget agreements by the RPB.