Progress towards integration of Wiltshire's health & social services has slowed down a bit
The process of integrating Wiltshire's health and social services - already agreed in principle by Wiltshire Council and the Wiltshire Clinical Commissioning Group (CCG) - is proving rather more complicated than either organisation anticipated.
Filling the joint post of the CCG's Accountable Officer (aka CEO) and Wiltshire Council's Director of Adult Services has been delayed till an unspecified date in 2018.
Both jobs are vacant at the moment and "...the job description, the process for recruitment and the employment model..." have been agreed.
However integration cannot proceed until there is agreement on "...the supporting legal agreements which are required to be in place in time for the appointment, including a Section 75 agreement and a Joint Employment Protocol." In addition the CCG has to submit a business case for the integration to NHS England who have to sign off on any appointment agreed between Council and the CCG.
The CCG has duties and responsibilities laid down in law. And the governance of the integration scheme must take into account how the political priorities of the Council can work safely and securely alongside the requirements of the Heath and Social Care Act (2012), which set up the system of CCGs, and the NHS Constitution.
A joint Council/CCG statement read to the CCG's board meeting (November 28) stated: "Taking account of the complexities of the legal and logistical framework needed for successful integration, it was agreed to revise the timeline, with the aim to have the post holder in place during 2018."
Integration will be made even more complex by the role of Wiltshire's Health and Wellbeing Board (also established by the 2012 Act of Parliament.) This is a co-ordinating (but non-decision-making) committee of Wiltshire Council.
Although it has members of the CCG on it, it is, as a committee of the Council, a political body. The joint statement noted: "In addition, the Health & Wellbeing Board also agreed a statement of intent for integration, noting that commissioning intentions need to be aligned in order to develop whole place commissioning, supported by a ‘contractual vehicle’ to facilitate an accountable care alliance of providers."
What this 'contractual vehicle' will be and how the NHS and social services budget will be apportioned and audited remains to be seen. The Integration Steering Group will meet again in February.
This integration will become both more complex and probably more urgent in light of the publication (December 1) of findings by the Competition and Markets Authority (CMA): the shortfall in council funding, it says, may force some care homes to close. The Authority identified a gap in Council funding for care home places of between £900 million and £1.1 billion a year.
Wiltshire care homes have a greater proportion of self-funders (i.e. not paid for by the Council) than many other counties. The CMA has highlighted the increasing support for the system that self-funders are making by way of the extra and often unexpected charges they are billed. The CMA intends to have these extra charges stopped.
Any closure of care homes would impact almost immediately on the NHS. A lack of care home places would lead to a rise in delayed transfers of care from hospitals - and consequent problems for those needing emergency hospital beds.
FOOTNOTE: Ironically, Section 75 Agreements were used widely by local authorities and Primary Care Trusts (PCTs - which were abolished under the 2012 Act of Parliament.) They can include arrangements for pooling resources and delegating NHS and local authority health related functions to other partners - "...if that would lead to an improvement in the way those functions are exercised."