Previous Reference: Minute 28 (2017/18)
The Board at its meeting held on 13 February 2018 considered a PowerPoint presentation on the financial position of the health and care economy.
The Board resolved:
(1) That the Health and Wellbeing Board receives assurance via regular updates in the Chair’s highlight report on progress with delivery of identified efficiency savings across the health and care system.
(2) That appropriate programme management arrangements are put in place to ensure necessary clarity, support and challenge for the delivery of system efficiencies.
As requested at the above meeting a presentation will be provided which
presents an update and re-assurance on the efficiency plan progress with
delivery of identified savings across the health and care system.
(Julie Lawreniuk – 01274 237642)
(Andrew Crookham – 01274 433656)
Minutes:
Previous Reference: Minute 28 (2017/18)
The Board at its meeting held on 13 February 2018 considered a PowerPoint presentation on the financial position of the health and care economy.
The Board resolved:
(1) That the Health and Wellbeing Board receives assurance via regular updates in the Chair’s highlight report on progress with delivery of identified efficiency savings across the health and
care system.
(2) That appropriate programme management arrangements are put in place to ensure necessary clarity, support and challenge for the delivery of system efficiencies.
As requested at the above meeting a presentation was provided to Members
which presented an update and re-assurance on the efficiency plan
progress with delivery of identified savings across the health and care
system.
It was reported that:
· The information presented to the Board in February 2018 showed that there was a financial gap before cost savings of £262m over a four year period to 2020/21.
· After planned cost savings of £210m, there was a remaining financial gap of £52m (CCGs - £2m, NHS Trusts - £50m, Local Authority - £nil) over this period.
· Since then, 2018/19 financial plans for NHS organisations had been revised to take into account the additional funding for the NHS announced in the Autumn Budget (2017) and actual performance for 2017/18 had been confirmed for all Bradford Place organisations.
· Plans would need to be further updated to take into account the long term funding settlement for the NHS announced in June 2018 and therefore this update concentrated on the 2018/19 position and the underlying position taken forward into 2019/20.
· Current year plan deficit position £10M better than original plan deficit.
· However, current year forecast outturn £14.4m worse than plan (Bradford Teaching Hospitals Foundation Trust and the Local Authority) due to lower savings realisation and increasing service demand. So overall, £4m worse than original plan.
· All organisations were relying on non-recurrent measures in 2018/19 to varying degrees to meet control totals or minimise the variance from the plan.
· This meant that there was an underlying deficit carried forward into 2019/20 of £23.5m which was £6.6m higher than the original plan.
· All Trusts, the Local Authority and Airedale, Wharfedale and Craven Clinical Commissioning Group had an underlying deficit position carried forward into 2019/20.
· In terms of the Local Authority the majority of the pressure was related to the Demand Management Programme in Adult Social Care; Home First Strategy was working successfully with older people; longer implementation time for working age adults; IMPower were working with the Council on the design and delivery of the remainder of the programme up to 2021/22. The other major upcoming programme in the scope of these figures was Prevention and Early Help in Children’s services which was currently on target.
· The Local Authority had to set a balanced budget even when there was a deficit at the start of the year; shortfall of 6.5m equated to half of the savings plan in 2019/20 mainly by demand management.
· In terms of the CCG’s the increasing deficit was due to increasing demand leading to higher expenditure than predicted. In addition some efficiency plans had not yielded the level of savings originally anticipated. In response additional demand management work was now being undertaken. For example in terms of urgent and emergency care additional alternatives to A&E were now in place including more access to primary care and voluntary and community services. It was acknowledged that we must continue to look at where things could be undertaken differently in the community to stop people from needing acute care and how the financial gap should be managed to create a sustainable system of health and care going forward.
It was reported that the financial plan update included:
· Aligning assumptions between organisations in places to help improve the “Place” financial positions.
· Understanding the impact of the long term funding settlement for the NHS and any changes in Local Authority funding on the medium term financial outlook, recognising that whilst there was a deficit position to address, existing demand pressures and new policy requirements needed to be met.
· Continuing to aligning the limited resources to where they could be put to best use.
It was reported that the Council was in the process of preparing a draft budget which would be submitted to the Executive in December; the funding review next year would have an impact on all partners; fair funding meant significant redistribution financially, there were changes around the business rate system and there was a demand management programme in Adult Care.
The Chair highlighted the importance of spending money in transformation and prevention and the importance of working together to meet the huge challenges.
The voluntary and community sector representative highlighted the importance of involving the voluntary sector as an equal partner and how organisations could work together to help each other.
The Chief Finance Officer for NHS Bradford City and Bradford Districts Clinical Commissioning Group emphasised that all partners were involved in the discussions and the importance they played in helping to transform services.
Importance of spending any money on priorities and where it made a difference was highlighted by Board Members.
Resolved-
(1) That Finance Directors continue their engagement with the partnership work undertaken through the Integration and Change Board and the Health and Care Partnership Boards relating to the delivery of savings across the health and care system, so that there is a shared understanding of delivery against organisational and whole system plans.
(2) That partners consider the development of a shared system position statement which can be communicated to Government about the forthcoming spending review.
(3) That the Leader’s regular meetings with Chairs of local organisations include consideration of the financial position and the impact of planned efficiency savings.
Action: Assistant Director Finance
