Health and social care integration: finance guidance

Section C Delegation between Partners - Lead Agency

1 Introduction

1.0.1 Under this model the partners will delegate functions and resources between each other. Before the functions are delegated, the Local Authority and the Health Board must jointly establish an integration joint monitoring committee for the purpose of monitoring the carrying out of the integration functions (Section 15).

1.0.2 The integration joint monitoring committee may issue reports to the host partner on any aspect of the carrying out of the integration functions, including recommendations as to how those integration functions should be carried out in future (Section 43).

1.1 Integration Scheme and Strategic Plan, Annual Financial Statement and Annual Performance Report

1.1.1 The Integration Scheme sets out the detail of the integration arrangement, as agreed by the Local Authority and Health Board and submitted to Scottish Ministers for approval (Section 7(1)). It covers a number of finance related matters (Section 1):

• Functions which are to be delegated to the Integration Authority;
• Functions of the host partner that will be used in conjunctions with the delegated functions;
• The method for the determination of the resources to be made available to the Integration Authority for the delegated functions;
• Reporting arrangements between the Integration Authority and the delegating partner;
• Financial management arrangements for variances and redetermination of payments and amounts set aside; and
• Arrangements for the use of capital assets in relation to the integration functions.

1.1.2 The host partner will lead the preparation of the Strategic Plan with other stakeholders, in line with the principles and duties set out in the legislation (Sections 29-39); the Strategic Plan will describe the capacity required by the partnership population along the spectrum of care and the resources available to deliver the outcomes.

1.1.3 The host partner will publish an Annual Financial Statement (Section 39) which will set out the amount that will be spent in each year of the strategic plan. Guidance on the content of the Annual Financial Statement is included in the Statutory Guidance for Strategic Planning.

1.1.4 The host partner will also publish an Annual Performance Report (Section 42) within four months of the year end with an assessment of its performance in planning and carrying out the integration functions. This will contain financial information for the reporting year on the following:

• Service type and the balance of care;
• Key care groups;
• Localities; and
• Assessment of performance in achieving best value.

1.1.5 Statutory Guidance on the content of the Annual Performance Report will be published by The Scottish Government separately.

1.2 Financial model

1.2.1 Resources within scope of the Strategic Plan

1.2.1.1 These will comprise the:

• Payment made to the host partner by the delegating partner (A);
• Budgets in the host partner for the services to be managed in conjunction with the delegated services (B); and
• Budget for services provided in large hospitals used by the partnership population (C).

1.2.1.2 The services in (A) and (B) will depend on which partner is the host and (C), may be included within the Integrated Budget when the Health Board is the host partner.

e.g. Where the Health Board is the host partner, (A) will be the budgets for adult social care services, (B) will be the budgets for primary and community healthcare services and community hospital services and (C) will be the Health Board budget for services in large hospitals within scope of the plan.

1.2.1.3 The minimum scope of services to be included in each of (A), (B) and (C) is set out in the legislation (Section 1). The Health Board and Local Authority may include other services, beyond the minimum requirement, within the scope of the plan and legislation takes powers for Ministers to set these out in regulations as well as the services which may not be delegated between partners.

1.2.1.4 The host partner may direct and make payment to the delegating partner to carry out the operational delivery of services; the direction must include the method for agreeing the value of the payment (Section 18).

1.2.2 Resources outside scope of the Strategic Plan

1.2.2.1 In addition to the services within scope of the Strategic Plan and overseen by the joint committee, the Health Board and Local Authority may delegate oversight of services that are outside of the scope of the Strategic Plan to the joint committee.

e.g. Children's community health services, children's social work services or other ex-Community Health Partnership (CHP) services that are outside the scope of the Strategic Plan.

1.2.2.2 The resource model is shown in figure 3 below. In this example, the Health Board is the host partner and the resources within scope of the Strategic Plan total £150m comprising £50m delegated from the Local Authority and £100m of Health Board budgets.

Figure 3: Delegation between partners.

1.3 Financial governance

1.3.0.1 The delegated resources will be subject to the financial governance processes of the host partner.

1.3.0.2 The host partner will be a "lead agent" for the delegating partner. The Health Boards and Local Authorities will be accountable to Scottish Ministers for the national outcomes for health and wellbeing

1.3.1 Financial accountability

1.3.1.1 The Chief Executive of the host partner will be jointly accountable to the Health Board and Local Authority for the management of the integrated services.

1.3.1.2 The accountable officers^[21] of the delegating partner discharge their responsibility, as it relates to the resources that are delegated to the host partner, by setting out in the Integration Scheme how the money is to be used in the integrated arrangement and the systems and monitoring arrangements for financial performance management. It is the responsibility of the accountable officer of the delegating partner to ensure that the provisions of the Integration Scheme enable them to discharge their responsibilities in this respect. (See "following the public pound" at 2.6)

1.3.1.3 The Integrated Budget will be managed using the financial regulations and controls of the host partner.