1. Formal Partnerships & Pooled Budgets Steve Vaughan Health & Social Care Working Together to Develop the Workforce Swalec Stadium Cardiff

2. Agenda Formal Partnerships & Pool Funding Grants Pooled funding under the Children’s Act 2004.

3. Partnership with a Purpose Purpose Legal considerations Factors which assist with implementation Benefits Technical issues

4. Why formal partnerships? Increasing demand (www.daffodilcymru.org.uk) – e.g. Aged 85+ pop. Due to increase by over 100% in Wales over next 20 years - less carers aged 45-54www.daffodilcymru.org.uk Rising expectations Financial Pressures – efficiency agenda Opportunities for partnership working between local authorities & LA & LHBs. CES example local partnerships & Wales Procurement Framework. Improved outcomes for users / carers.

5. Formal Partnerships and Pooled Funding Introduced in Health Act 1999 Referred to as Health Act Flexibilities Aim to enable partners to achieve improved outcomes through joint working arrangements Overcome existing barriers to joint working The improved service is the aim and desired outcome not the partnership working itself.

6. Change of Legislation Health Act now replaced by NHS (Wales) Act 2006 Health Act section 31 – NHS (Wales) Act Section 33 Section 28a Health Act – Section 194 Section 28bb Health Act – Section 34 Completely different in England

7. Section 33 Partnership arrangements between Local Authority & NHS (LHBs) not third/private sectors – not police or probation No limit to number of partners e.g. GWICES – originally 11 partners. Partners may enter into arrangements for the exercise of any NHS functions or health related functions of LAs (if arrangements are likely to lead to an improvement in way which functions are exercised.

8. Section 33 NHS can delegate wide range of functions to LA excluding surgery, radiotherapy, terminations, endoscopy, class 4 laser treatments and other invasive treatments. LA can delegate wide range of functions to NHS excluding adoptions & inspections.

9. Section 33 e.g. Learning Disabilities Lead Commissioning NHS LA 1.£NHS –no partnership agreement - £LA 2.£NHS -------------------£NHS £LA Delegation of lead commissioning to LA Formal Partnership 3. £NHS - ------------------------£NHS & £LA Formal Partnership & Pooled Budget

10. Section 33 Lead Commissioning provides an opportunity to commission a range of services for a client group from a single organisation Integrated Provision provides an opportunity to provide services in a more co-ordinated way by allowing different professionals to work to one management structure and to arrange provision from one statutory organisation.

11. Section 33 Formal Partnerships & Pooled budgets offer more flexible use of staff resources on condition that staff work to level of competence. Both the NHS and LA retain their statutory responsibility even after delegating functions Need mechanisms to satisfy themselves that statutory duties being fulfilled – partnership board/ performance management – clarity re decision makers.

12. Section 33 Arrangements notified to WAG To be in writing & specify: Agreed aims & outcomes Contributions to be made by each partner Functions to be delegated Persons the service is for staff goods services or accommodation to be provided Duration monitoring

13. Money Transfer Grants Section 194 grant arrangements NHS to LA Section 34 grant arrangements LA to NHS Satisfied that payment is likely to serve a more effective use of public funds than equivalent use on own functions e.g. used closure long stay institutions.

14. Section 25 Children Act Relevant Partners Section 25 LA – Police authority & Chief of Police – Probation – YOT – LHB – Welsh Assembly Govt. (Learning & Skills Act Promote co-operation and well being Enable partnership innovation & change.

15. Section 25 Children Act Relevant Partners may: provide staff, goods, services or establish a pooled fund out of which payments may be made in the discharge of functions of the relevant partner or partners. This does not include a merging or delegation of functions. Application e.g. domestic violence – not sole responsibility of one agency but of interest to all

16. Section 33 Critical Success Factors Identify objectives at the outset Outcomes identified Focus on service users driven by strong values & principles Ownership by partners Realistic timetable & Project plan Invest in communication with service users & staff

17. Critical success factors Engage finance & legal early Costs, risks rewards sharing among partners Clear lines of accountability (template for report Financial contributions identified Robust procedures for monitoring performance Governance arrangements in place.

18. Staffing Issues Obligation to consult Trade Union engagement Staff continue to employed by employer or TUPE /Secondment Training & Development Pensions

19. Technical Issues VAT Finance & Accounting Complaints Eligibility Criteria Direct Payments Continuing Care

20. Barriers Management experience Ownership Finance input Development of agreement Control Management or Partnership Gain culture

21. Barriers Financial fears Loss of autonomy Added external scrutiny Involvement of others in decision making loss of ability to track spend Cross subsidisation

22. Benefits Transparent objectives Single service for user/ professionals Better use of resources – better use of purchasing power, removal of duplication – manage market Transparent budget Better management information Lead to other developments One performance management regime??? Stronger governance

23. Benefits for Providers (e.g. Third & private sectors) Coherent approach to marker Greater certainty for business planning One coherent approach to quality assurance Downside – fewer sources of funding

24. Areas for Partnership Residential / Nursing Home / Continuing Care Intermediate care / ReAblement Services Learning Disability Mental Health

25. Reading WAG: Advice Notes & Templates http://wales.gov.uk/topics/improvingservices/ poolbudgets/?lang=enhttp://wales.gov.uk/topics/improvingservices/ poolbudgets/?lang=en Means to an End http://www.audit- commission.gov.uk/nationalstudies/localgov/Pages /91029meanstoanend_copy.aspxhttp://www.audit- commission.gov.uk/nationalstudies/localgov/Pages /91029meanstoanend_copy.aspx Governing Partnerships http://www.audit- commission.gov.uk/nationalstudies/localgov/Pages /governingpartnerships.aspxhttp://www.audit- commission.gov.uk/nationalstudies/localgov/Pages /governingpartnerships.aspx

26. Reading To what extent does the use of Health Act Flexibilities Promote Effective Partnership Working and Positive Outcomes for Older People Kay Phelps and Emma Regan 2008

27. Questions 1.Are formal partnerships worth exploring? Why /Why not? 2.How could formal partnerships improve services? 3.Areas for potential agreements 4.Identify barriers / actions to overcome them.

28. Summary Partnership with a purpose Range of tools available – inc Children act Partnerships can improve outcomes for service users/ carers & improve use of resources Requires leadership / ownership/ commitment & win / win approach.