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Wiltshire Council U-turn on senior joint appointment with NHS Wiltshire

Wiltshire Council has decided to change its policy and scrap the planned joint appointment of a director of the Council's adult social care who would double as Wiltshire Clinical Commissioning Group's (CCG) most senior officer.
A year ago (21 June 2017) the leader of Wiltshire Council, Baroness Scott, announced a reorganisation of the Council's top jobs which included this joint post:  "We recognise that the integration of health and social care is the only option if we are to manage the demand for these services in the coming years."

"The NHS Wiltshire Clinical Commissioning Group has agreed that to jointly fund the accountable officer post, which is the most senior post in the CCG and to combine this with the council's corporate director for adult social care. This new post will provide the best opportunity to lead and deliver the integration of health and social care across the county."

This joint post is embedded in the Council's budget for 2018-2019 which was approved in February.

In making this policy change (June 11), the Council has pointed to the forthcoming Green Paper on the NHS.  The Council expects this "...will provide clarity on the future direction for NHS commissioning; particularly commissioning by CCGs of health services. On the basis of the anticipated change, Wiltshire Council and CCG have discussed and agreed that it would be sensible to reconsider the appointment of a joint accountable officer."

There are undoubtedly other and wider reasons for this sudden decision.  First, the Council is in the midst of a major 'transformation' of its adult social care system.  This will "...change the way the service provides and supports areas such as re-ablement [after hospital treatment] and Domiciliary Care [such as the Help to Live at Home programme], as well as how individuals are assessed at the 'Front Door'."

"Financial appraisals and payments are also being reviewed to secure efficiencies and improvement in income collection." 

This 'transformation' has to bring cost savings of £6,600,000 in the current financial year.  And over the period up to 2022 the new system is expected to ensure £15million of costs being "avoided".  It remains to be seen how this new, slimmer and cheaper policy for adult social care will impact on NHS services - in, for example, delayed transfers of care from hospitals.

Secondly, the CCG found it difficult to create proper governance and oversight of spending for the joint post that fitted with the legal responsibilities of their Accountable Officer - and with the legal responsibilities of the Council.  And in January the CCG reported: "Progress has been slowed by the unfortunate and unexpected change of personnel at the Council" - the sudden departure of the head of adult social services.

Thirdly, the Council has been given advance notice of the results from a review by the Care Quality Commission (CQC) of all Wiltshire's health and social care services.  This was carried out in February and March and the report is expected to be published in the next few days.

It has been widely rumoured that the CQC was somewhat critical of some issues around the leadership's decisions and ways of working in the fields of health and social care. 

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