Mark Tebbs presented the paper that provided an update to HOSC regarding the repayment of the financial assistance given to Cambridge and Peterborough STP during the 2019/20 planning process. The paper set out the steps taken to date and the overall financial flows in 2019/20.
Mark Barker provided Members with details of the financial NHS allocation process and referred to the funding allocations to the system at the start of 2019/20, the additional funding which flowed into the system during the year and the final 2019/20 year-end financial position. These figures can be viewed on page 112 of the agenda.
Councillor Ralph thanked Officers for the report and update.
Councillor Muldowney thanked Officers for the update and noted that it was good a finance officer was at this meeting to answer questions. Councillor Muldowney questioned whether a letter from the Chair as requested two meetings ago had been sent to the CCG from the committee and whether a response had been received. That it was still unclear from the report whether that money had or would be paid back and was the position that as Thurrock had received extra money in the last year, even though extra money should have been received for the Council to cope with the pandemic, that £480,000 was included in that. It was unclear from the figures in the report what this extra money was for and did other parts of the system get extra funding. Councillor Muldowney concluded that even though we had received extra funding this did not compensate for the £480,000 and we still wanted this back from Cambridge and Peterborough. This was not good enough for the residents of Thurrock and needed to understand from a finance level that everything had been done and questioned what the chair and the portfolio holder for health were now going to do to take this to the next level and take further action.
Mark Barker stated he was unable to say for certain whether the £480,000 had been received back but was able to confirm that significant more money had come into the system than was previously lost and significantly more than in 2019/20. That 2019/20 was not a COVID year, 2021 was the COVID year and the system had received an extra £42 million to support COVID expenditure, on top of that another £52 million for other initiatives, £60 million top-up funding and £8 million worth of growth. So significantly greater than the £29 million that was referred to in the report. Mark Barker stated that he was unable to pinpoint £480,000 but was able to pinpoint many figures which were in excess of £480,000. Even if we lobbied NHS England for the return of the £480,000 their answer may be that we had already received it and more in kind from the investments which had been given back. Out of those monies at least £9.2 million had come into Thurrock CCG which was a third of what was received in 2019/20.
Mark Tebbs confirmed that he had received a letter from the Chair requesting a report and for a finance colleague to present at this meeting. He reiterated what Mark Barker had said and that Members may have thought that when this money was returned it would be badged on a spreadsheet as Cambridge and Peterborough but this would not be the case. He believed that the money had been returned to the system into a much greater extent, more than the £480,000.
Councillor Muldowney questioned whether any of that money had actually come from Cambridge and Peterborough to which Mark Barker stated that no it did not come from Cambridge and Peterborough and likewise Thurrock would not have made payment to Cambridge and Peterborough, those monies would be redirected back to NHS England, where NHS England made that allocation to Cambridge and Peterborough. That no third party would be shown in the transactions. Members were reminded that all funding was received from NHS England.
Councillor Muldowney questioned what the transformation support was actually for. Mark Barker stated it was for a variety of transformation initiatives which included digitisation to investment in secondary care in the community. That a full breakdown was not available not could be provided if requested. There were at least 30 to 40 elements to it as allocations were received every month and some months 10 or 12 elements at a time.
Councillor Muldowney questioned whether we were the only system that received extra money in the year 2019/20 to which Mark Barker stated every system would have received some allocations.
Councillor Muldowney concluded that her position was that as Cambridge and Peterborough had received extra money they still needed to repay this money to Thurrock.
Councillor Ralph stated he had written the letter with the portfolio holder and had emailed Anthony McKeever and received a no answer when asked would Thurrock get the money back. That the explanation that the funding had come in which they had viewed as over and above what they had spent. The question raised was how Cambridge and Peterborough had a platinum mental health service when the role out of Thurrock’s mental health services had to be delayed, promises had been made that the money would be paid back and that this money had been taken after Thurrock’s budget had been set.
Councillor Holloway echoed the comments made by Councillor Muldowney and questioned what did “system” mean? Mark Barker stated this was the commissioners and providers within the Mid and South Essex, comprising five CCGs - Basildon, Thurrock, Mid Essex, Castlepoint and Rochford and Southend, and it also included two providers which were part of our system which were Mid and South Essex Foundation Trust and EPUT.
Councillor Holloway thanked Mark Tebbs for dealing with this issue at this committee and appreciated that Mark Barker was in attendance and was mindful that he had not been in his role for long.
Councillor Holloway stated that this was absolutely not acceptable and mindful that as we talk about system approach we do not know what money Thurrock would be getting but what we did know was that Cambridge and Peterborough were still better off. This was now a point of principle that Cambridge and Peterborough were able to run a platinum health service and Thurrock services had to be delayed. That this had now been going on for too long and was still totally unacceptable. Thurrock had managed a surplus, managed the budget and we were trying to go up at NHS systems level to get the money back at Thurrock CCG level. Councillor Holloway concluded that the money had been taken from Thurrock and we wanted it back.
Mark Barker stated that it was not in his gift to return the money but what had been done was to lobby to suggest that it was not appropriate to take money away from the system and not return it with the responses received that it had been returned in kind with more money on top. Mark Barker stated that they had not given up and continued to lobby for further monies to come back to Thurrock and to question whether this would be realistically achieved.
Councillor Ralph stated he did not foresee getting any different answers to this if we continued to bring this item to HOSC. They were convinced the money had been given back in kind, we know the promise was not kept and was unhappy that Cambridge and Peterborough were now running a platinum service. Councillor Ralph also stated that he was unhappy that the budget had already been set and Thurrock had plans for that money. That Thurrock did not accept this but would probably be forced to accept it which was unfortunate in the reality of the situation.
Councillor Redsell agreed that the committee should not let this go, if money was given by Thurrock, Thurrock should expect that money back and this committee had the ability to scrutinise that.
Councillor Ralph suggested that another joint letter be written again stating that we wished to proceed further.
Councillor Muldowney thanked Mark Tebbs and Mark Barker for their responses and stated that maybe they had done all that they could at this level and maybe Anthony McKeever had done all that he could at his level and we now needed to think about going to the next level up. Mark Barker stated it was for the committee to decide how best to proceed with his recommendation to continue to lobby for additional monies wherever we could. There was a good relationship with NHS England to secure additional funding and the system had continued to do that successfully in the current financial year. That it may be better to improve the relationship, continue to lobby for additional funding and secure that where we could. That continuing to lobby for a particular sum may damage that relationship and therefore unsettle improvements to funding.
Councillor Ralph stated there was no guarantee that this would keep happening but when someone was getting clearer health service benefits that all other councils were supporting was not good.
Councillor Holloway stated she appreciated the response however this was still not good enough. A suggestion from Councillor Holloway would be that the money had gone into the system and then out, now it had come back into the system and we could have £500K back into Thurrock CCG. We would not be asking for money outside of the system, the money had already gone into the system and all Thurrock were asking was for this be transferred back to them. Mark Barker stated that Thurrock had received £9.2 million so it could well be the £480,000 was part of that £9.2 million. Councillor Holloway suggested this item be taken off line to look at how this could be taken forward.
Councillor Ralph agreed that a line had to be drawn for this item on the HOSC work programme and agreed to contact Members outside the meeting