FINANCE TRAINING INTRODUCTION AND SECTION 1: NHS FUNDING IN WALES 1

Finance Training Finance Training Core Sections Section 1: NHS Funding in Wales Section 2: Buying Goods and Services (NWSSP) Section 3: Employing and Paying Staff (NWSSP) Section 4: Managing Budgets Section 5: Delivering Savings and Sustainability Section 6: Countering Fraud 2

Finance Training Finance Training Optional Sessions Option 1: Commercial Development (Business Cases and Business Development) Option 2: Managing Capital Option 3: Charitable Funds and Cronfa Betsi Fund Option 4: Governance (Internal Audit and Governance Team) 3

SECTION 1: NHS FUNDING IN WALES 4

Areas to be covered Overview of Devolved Nations Funding Health as a part of the Welsh Government Budget BCU Allocations How Welsh Government influence Health Board priorities and spending plans Other Funds (Capital and Charitable) 5

Who said this? “We shall never have all we need.... expectations will always exceed reality” Aneurin Bevan, Minister of Health, 1948 As true today as ever? 6

7 The UK Funding Flow Taxes collected from Home Nations and paid into HM Treasury

8 The UK Funding Flow Funding allocated out to Devolved Nations based on the Barnett Formula

9 The Barnett Formula A “temporary measure” ….from the 70’s. ‘Convergence’ methodology moving towards population shares Not based on health or social need, or on measures of deprivation Devolved Nations then decide on local application of resources Effectively a Devolved Nations flavour within a National Health Service This is not how the English Regions are funded – their funding takes into account measures of need The Holtham Report The case for changing the formula and potential reasons why this has not happened

10 Barnett – An Example Lets say that a function which is devolved (ie Health, Education, etc) nationally gets £100 million extra funding

11 Welsh Government Budget

Health Board Allocations 2012/13 12

Ring Fenced Allocations 2012/13 13

NHS Wales Funding 14 OPENING ALLOCATIONS BY HEAD OF RESIDENT POPULATION 2011/12 RANKED IN ORDER OF TOTAL REVENUE SPEND PER HEAD Health Board HCHS RevenueDrugsGMS Comm PharmacyDental Total Revenue £000 Cwm Taf Betsi Cadwaladr Abertawe Bro Morgannwg Hywel Dda Aneurin Beavan Powys Cardiff & Vale All Wales Total

Revenue Spend per Head of Population 15 Allocations largely based on Population share Marginally adjusted for deprivation or health need Looking at the component elements; –BCU gets one of the lowest Dental shares –BCU gets one of the lowest Pharmacy shares –BCU gets one of the largest GMS shares –BCU gets one of the largest HCHS shares

16 Welsh Govt Decisions Ring-fenced Allocations Funding for Health Boards Resident population Population health needs Historic health costs BCU Allocation in 12/13 is £1.2 billion (£1,200 million) Protect services / elements of the budget Annual service targets incrementally change the emphasis of spend The bulk of spending remains relatively constant – public and political pressures resist change Periodic discussions on amending/influencing the Wales allocation formula – fraught with difficulties

17 Other Funds Charitable Funds  Held for the purpose donated  Charity Commission Regulations Capital Resources  Separate Welsh Govt Allocation  Major Capital – Welsh Govt managed  Discretionary Capital – Health Board control  The role of Business Cases