Councillors slam University Health Board over £1.2m shortfall in care payments

Richard Evans, Local Democracy Reporter

A University Health Board has been criticised for not paying local authorities enough for the care of older people.

Councillors slammed the Betsi Cadwaladr health board, citing a £1.2m shortfall in care fees, at a Conwy County Council finance and resources overview and scrutiny committee on Monday.

The council had originally budgeted for £42,724,000 to pay for “Older People and Hospital Social Work” at the start of 2026/27.

But the authority is now forecasting the cost at £43.9m, meaning there is a £1,271,628 shortfall.

The debate broke out following a discussion around the revenue budget for 2026/2027.

The report identified a potential shortfall of £1.89m following the first quarter of the financial year, with much of the “projected service pressures” in both social care and housing.

Cllr Gareth Jones asked if some of the pressures on social services were “tied into what’s happening at Betsi,” and if the health board was “pushing stuff” onto the council in terms of responsibilities and costs.

The argument related to who pays for older people’s care once they are released from hospital.

Cllr Jones suggested the NHS was “under pressure to get people out of the hospitals,” leading to people needing extra care which then fell on local authorities.

He added: “Are we on top of what Betsi owes us, and are we getting a fair share of that health budget? Are we able to bill them some more for some of these pressures?

“These pressures have a real effect on council tax because we are looking at £1.8m onto the council tax straight away with these overspends. So it is really important that we understand why they are happening and how we can actually get on top of them.”

Prudent forecasting 

Head of finance Amanda Hughes replied that the council had been “prudent” in forecasting expectations of income, including incomes expected from the health board, whilst negotiations continued over future payments.

The council’s head of integrated adults and community services, Catrin Perry, said there were payment delays from the NHS.

She said the delayed payments related to packages of care for people who had left hospital but needed further support, claiming payments were being “moved” from the health board to local authorities.

“There are pressures that were primarily health board-funded previously, and those pressures are coming onto us,” she said.

“At the moment we have pieces of work around packages of care delays. So the discharge work we are doing doing puts more pressure on us. In terms of the care that would have taken place in the hospital, that is coming out of the hospital to us, and therefore that is a cost pressure on us.

“And the preventative work we are doing in terms of the flow into hospitals, as well, is another cost pressure on us, so those are pressures, and so that cost is then being moved from a health board budget to a local authority pressure.”

She also added there were “pressures on the way the fees are set in the health board”, citing Funded Nursing Care (FNC) and Continuing Health Care (CHC), which is the enhanced rate for people with “more need”.

But she said the CHC funding from the health board was lower than the FNC rate mostly provided by the council, meaning care providers didn’t escalate the level of care to CHC because “it’s not in their interests to do that”.

This, she said, meant a lower level of care at a higher rate being charged to the council because CHC funding was not sufficient and cases were not being transferred back to the NHS.

Transfers not happening

She explained that the council funded most FNC care with a top up from the health board but added that CHC transfers weren’t happening.

“We’ve got unresolved disputes with particularly high-cost packages where the contribution from health hasn’t been resolved yet, and we’ve got dispute processes in place for that, so we’ve been conservative in terms of (forecasting) what percentage we think we are going to get,” she said.

Cllr Gareth Jones responded: “I really appreciate that it is a really difficult and massive pressure, and we have to actually step in and fulfil our obligations, but unless the health board (pay), that budget trickles through and comes through to us.

“The reality is our council tax payers will end up picking up the bill for it, or other services will have to be cut to actually pay for it.”
Cllr Cheryl Carlisle went even further in her criticism: “The CHC has long been a thorn in everyone’s side, hasn’t it, but it’s getting worse now,” she said.

Cllr Carlisle said the health board was “ramping up levels” of what they “choose to use against the local authorities”.

“It is absolutely not acceptable. We are caring for the people. They should be paying their way. It is just not right,” she said.
Cllr Charlie McCoubrey proposed that councillors agree the report. Cllr Emily Owen seconded this, and the vote was carried.

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