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CIPFA North West Audit, Risk and GovernanceProfessional Development Group
Warrington, November 2014
Health & Social Care Workshop
Health & Social Care Workshop
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
Agenda
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
Tom Jackson Chief Finance Officer/Deputy Chief Officer NHS Liverpool Clinical Commissioning Group
Background and challenges - what does integration mean for Liverpool
Simon Kenton Assistant Director Integrated Commissioning
Warrington Clinical Commissioning Group /Warrington Council
Implementing the better care initiatives and integration in Warrington
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
Steve Connor
Commercial Director / Deputy Director
Mersey Internal Audit Agency
T: 0151 285 4511
