The Director of Finance (Bradford Metropolitan District Council (BMDC)) and Director of Finance for Bradford City, Bradford Districts and Airedale, Wharfedale and Craven Clinical Commissioning Groups will submit Document “F” which provides an update on joint financial planning and budget discussions for health and social care between BMDC, the Clinical Commissioning Groups and health providers in Bradford District and Craven.

Recommended-

That the report be noted and the Board provides feedback on further areas of practice where efficiencies could be made and services improved through integration across health and social care or through greater emphasis on prevention and early intervention in health and wellbeing and other services.

                                                                        (Angela Hutton – 01274 434176)

The Director of Finance (Bradford Metropolitan District Council (BMDC)) and Director of Finance for Bradford City, Bradford Districts and Airedale, Wharfedale and Craven Clinical Commissioning Groups submitted Document “F” which provided an update on joint financial planning and budget discussions for health and social care between BMDC, the Clinical Commissioning Groups and health providers in Bradford District and Craven.

The Chief Finance Officer of the three CCG’s (Airedale, Wharfedale and Craven CCG, Bradford City CCG and Bradford Districts CCG) and the Director of Finance Bradford Council gave a joint presentation which included the following points:

·        The NHS needed to close a £22 billion deficit by 2020/21, which meant a £1 billion funding gap for West Yorkshire and a £221 million gap for the district.

·        The CCG’s had £800 million to spend each year, although that amount was not being cut, it was not keeping pace with demand, expectation and technology.

·        Health organisations had already found ways to save £106 million.

·        Health organisations were anticipating £18 million of extra funding via the Sustainability and Transformation Plan process to plug part of the gap but now needed to come up with a plan to close the rest of it.

·        Hospitals had already identified around £47 million of savings they could make, through reduced spending on drugs, controls on agency staff, reducing administration costs and boosting workforce productivity; similar sums still needed to be found and more drastic changes may need to be made.

·        The districts three CCG’s still needed to find £17 million of savings and the trusts which provided acute care – mainly hospitals – needed to find £46 million of extra savings.

·        Local Authorities were seeing significant budget reductions in addition to increasing demand for social care.

·        The Local Authority was looking at cuts of around £35 million to the amount it spent on Health and Social Care.

·        The Local Authority had managed to make the required savings but it was getting more and more difficult to continue to make further savings.

·        In closing the funding gap the Local Authority would need to undertake a comprehensive review of all Council activity using an outcome based approach – seeking to improve health and wellbeing as well as to reduce demand, supporting people to choose healthy lifestyles, personalised support and care, joined up health and social care provision; safeguarding people from abuse.

·        The Council had to make approximately a 5 % cut in net spending each year for the past few years and every year for the next 4 years.

·        The commitment needed from all organisations in the health, care and wellbeing sector was to maximise every £ that was spent.

·        Needed to look at solutions that where possible did not impact on quality and inequalities.

·        Needed to engage and consult where required.

·        A commitment was required by all leaders across the Health and Social System to make bold changes.

Rob Webster Senior Responsible Officer, West Yorkshire and Harrogate Sustainability and Transformation Plan (STP) reported on the linkages with the West Yorkshire and Harrogate STP, outlining the planning process and the broad priorities for a West Yorkshire wide approach.

He stated that the next step would be to submit a credible plan to NHS which outlined where the savings would be made; acknowledging that some decisions that would need to be made would be difficult.

He reported that West Yorkshire and Harrogate was one of 44 footprints across the Country working to address the gaps set out in the NHS’s Five Year Forward View; the Sustainable Transformation Plan was about Health and Wellbeing, Care and Quality, Finance and efficiency etc. The six West Yorkshire/Harrogate STP’s had broadly similar priorities as the overarching STP; STP’s did not replace statutory functions of individual organisations; final submission of the draft West Yorkshire Transformation Plan to NHS England would be on 21 October 2016.

Members stressed the importance of appropriate engagement with local people and all stakeholders.

The Chair of the Board queried where the funding was for the transformation agenda.

In response Rob Webster reported that it was a long term view of how much money there was and the difference it would make; there were political choices and consequences; difficult choices would spell these out; it was now clear that national Sustainability and Transformation Fund monies were meant for sustainability and not transformation.

A Member queried why there were no politicians involved in the STP; the Local Authority had a Statutory responsibility for looked after children; although it had input from NHS and Local Authority Officers there was no political input from the authority.

In response he reported that Chairs of Health and Wellbeing Boards were briefed at regular meetings as well as Councillors being engaged through the Health and Wellbeing Board; Health and Wellbeing Boards (H&WBB’s) made decisions on local STP’s; most political input was through H&WBB’s; a West Yorkshire wide meeting had been held to look at what could be further undertaken to have input from local politicians in a more visible way.

A Member commented that there was a difference between being involved and being consulted.

It was reported that priorities in the STP could be reshaped if they did not add benefit.

Members stressed the importance of focussing on local priorities in the STP. 

A Member raised concern that the whole process was quick and did not allow sufficient time for consultation.

In response it was reported that engagement could begin and that the local STP had been developed and would be delivered locally; a lot of work had been undertaken on the finance and efficiency gaps; focus now needed to be on other issues such as health and wellbeing and care and quality of services; needed to be clear where West Yorkshire fitted.

It was reported that even without the STP there would have been an issue with funding.

The Chair of the Board reported that there were already plans in place to deliver planned budget reductions but now other priorities had to be considered where further savings had to be made.

A Member stressed that although a lot of discussion had taken place about saving money; organisations also needed to look at using money differently to save money in the long term; for example through Self Care without Voluntary Sector support more people would be unable to look after themselves, needed to understand the value of volunteer support etc; need to be undertaking bold steps; not only did this approach make people healthier but saved money.

Members stressed the importance that any STP going forward should be based on local needs and priorities.

It was confirmed that the CCG’s were clear on the important role of the voluntary sector and where money worked best.

Members stressed the importance of input from politicians in the STP process and being fully informed in advance; Councillors had a lot of experience in engaging Members of the public.

It was reported that the Local STP also included broader local issues such as housing, employment, education, environment etc and what was going to be undertaken to improve lives of local people; it was an opportunity to grasp the STP agenda and work together to make things happen.

Members felt that the draft local STP should be submitted to the board before it was submitted to NHS England.

Resolved-

That the draft local Sustainability and Transformation Plan be submitted to an additional meeting of the Board for approval before it is submitted to NHS England on 21 October.

Action:          Strategic Director Health and Wellbeing