Health & Social Care Workshop
Warrington, November 2014
CIPFA North West Audit, Risk and Governance
Professional Development Group
Health & Social Care Workshop
Agenda
Integrated Health & Social Care:
 View from a Chief Finance Officer / Deputy Chief
Officer CCG
 View from a LA Assistant Director
Auditing the Better Care Fund:
 Governance and risks
 Expected Controls
 Effective commissioning and outcomes
•
Health & Social Care Workshop
Workshop Objectives
• To understand why integration of health & social care
is needed
• What we need to change
• What is the Better Care Fund
•
•
•
•
•
Audit approach
Governance and risks
Effective programme management
Network for future support
Health & Social Care Workshop
Why Integration?
• People are living longer, healthier lives but often living
with several complex conditions that need constant care
and attention
• People need more integrated and better co-ordinated
care
• System of health and care is under more pressure than
ever before
Health & Social Care Workshop
What do we need to change?
• Create a culture of co-operation
• Provide a seamless service focused on the individual
within their own home
• Work to avoid crises which too often result in hospital
admissions
• Embrace the potential of technology and shared
information
Health & Social Care Workshop
What is the Better Care Fund?
• £3.8bn Better Care Fund announced by the Government
in June 2013
• To ensure a transformation – integration of health and
social care.
• The Better Care Fund (BCF) is one of the most
ambitious ever programmes across the NHS and Local
Government.
• Creates a local single pooled budget to incentivise the
NHS and local government to work more closely
together
Background and challenges - what does integration
mean for Liverpool
Tom Jackson Chief Finance Officer/Deputy Chief Officer
NHS Liverpool Clinical Commissioning Group
Implementing the better care initiatives and integration
in Warrington
Simon Kenton Assistant Director Integrated Commissioning
Warrington Clinical Commissioning Group /Warrington
Council
Health & Social Care Workshop
Group session:
You are auditing the Better Care Fund, what do you consider are the key
risks in terms of:
•
Ensuring adequate governance arrangements are in place
•
Health & Wellbeing Board and their discharge of statutory duties;
•
BCF submission and engagement with relevant stakeholders
•
Programme and project management arrangements
•
Management Information
•
Joint Funding Agreements - Section 75 Agreements
Health & Social Care Workshop
Key Risks
• Lack of adequate governance arrangements
• HWB fail to reflect the priorities and perspectives of all interested
parties
• Insufficient local engagement means key priorities are not identified
• Lack of commitment to project strands and sign up by key
stakeholders
• Programme and project risks are not identified, recorded or
monitored
• Poor Data Quality
• Insufficient Management Information
• Information Governance – data sharing
• Poor financial management leading to project overspend and/or
project failure
Health & Social Care Workshop
Group session:
Having identified these key risks, what controls would you
expect to see in place and how would you test them?
Health & Social Care Workshop
Types of Controls
• Effective governance structures
• Decisions subject to appropriate levels of approval
Contractual arrangements and conditions
• Effective information governance arrangements including
Data Sharing Protocols
• HWB appropriate TOR, membership, regular meetings
• BCF submission discussed and agreed by relevant
parties, sign off and awareness of BCF submission
• Robust management information
• Robust project management arrangements
• Plans and exception reporting
Health & Social Care Workshop
Measuring Outcomes
• Purpose: Define objectives and measures and specify in
contracts
• Monitoring and management information: relate
monitoring to risk
• Define monitoring methods
• Data Capture / Data Sets / IT
• Reporting: publicise performance to stakeholders
Health & Social Care Workshop
Assurance: A focus for Health and Wellbeing
Boards
• How are services delivered
• How well are they delivered
• How much change / effect did we produce
Key Considerations:
• Information Governance
• Management Information and Data Quality
Health & Social Care Workshop
Further Details..……
www.england.nhs.uk
www.local.gov.uk/health-wellbeing-and-adult-social-care
Health & Social Care Workshop
Contact details…
Jean Gleave
Chief Internal Auditor
Warrington Council
T: 01925 442 354
E: jgleave2@warrington.gov.uk
Steve Connor
Commercial Director / Deputy Director
Mersey Internal Audit Agency
T: 0151 285 4511
E: steve.connor@miaa.nhs.uk