Wiltshire Council's radical step towards running Wiltshire's NHS
A plan outlining changes in the senior management structure of Wiltshire Council sprang a surprise by including - in a statement from Council leader Baroness Scott - a radical alteration to the provision of NHS services for the county.
The Council's new corporate director for adult social care will also take over the role of Wiltshire Clinical Commissioning Group's accountable officer - the CCG's most senior post.
In her statement Lady Scott spelled out the reasons for this development: "We recognise that the integration of health and social care is the only option if we are to manage the demand for these services in the coming years."
However her statement continued in terms that show little mutuality: "The NHS Wiltshire Clinical Commissioning Group has agreed to jointly fund the accountable officer post, which is the most senior post in the CCG and to combine this with the council’s corporate director for adult social care."
"This new post will provide the best opportunity to lead and deliver the integration of health and social care across the county."
One person we consulted was unsure whether this combination of responsibilities would be legal under the Coalition's Health and Social Care Act - the Lansley reorganisation. It will, of course, involve various conflicts of interest between the two parts of the role.
The Council's new corporate model agreed on June 20 is now out for consultation until June 29 - so short a consultation period could face a legal challenge.
There has been co-operation between the Council and the CGG for many years. This is now largely focused on the Better Care Fund (BCF) - a government scheme to prop up social services and find ways to keep the elderly from needing treatment in hospital.
The BCF is 'hosted' by the Council which holds the budget. In 2016-2017 the CCG moved £27,970,00 from its NHS budget to the BCF - against the Council's contribution of £4,960,000.
Eighteen months ago this co-operation nearly developed into a legal tussle over use of the NHS part of the BCF funding.
It is ironic that the CCG's recent 'interim' accountable officer, Tracey Cox, holds the same position at the Bath and North-East Somerset CCG. She had been told she could not continue to do the two jobs.
The CCG will soon have another interim accountable officer in post - Linda Prosser from NHS England (Southwest). She had previously worked in senior positions at Gloucestershire and Bristol Primary Care Trusts. It is assumed that this new combined Council/CCG post will be advertised next month.