Agenda item

Purpose: To provide an update on the formation of the BOB ICS in line with the proposals set out within the Health and Care Bill.

Niki Cartwright presented the item on the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System Update (Agenda Item 14).

The Health and Care Bill was progressing through Parliament and work was ongoing to interpret the guidance based on the draft legislation. It was expected that the ICS would be put on a statutory footing from April 2022, but it would take up to 18 months to become fully functional.

The ICS had four goals as set out in the NHS Long-Term Plan:

·         To improve outcomes in population health and healthcare

·         To tackle inequalities in outcomes, experience and access

·         To enhance productivity and value for money

·         To help the NHS support broader social and economic development

Key components of the new structure were:

·         Integrated Care System (ICS)

·         Integrated Care Partnership (ICP)

·         Integrated Care Board (ICB)

·         Board of the ICB (governance body)

·         Place Based Partnerships (PBPs)

From April 2022, Clinical Commissioning Groups (CCGs) would cease to exist, with all staff transferred to the ICB.

It was noted that the PBP would replace the ICP at Berkshire West Place level and the ICP would operate at System level. Also the ICS Body would become the ICB, and would support both System and Place.

The Buckinghamshire, Oxfordshire and Berkshire West ICS consisted of three Places. Most care delivery would be managed at Place. The System would orchestrate the overall strategy and delegations, while the Place would manage pooled budgets and deliver on urgent and emergency care, long-term conditions, and integrated care. Localities would also have a focus on  addressing inequalities. Provider collaboratives would deliver services beyond the Place level.

The current Integrated Care Partnership / Unified Executive would become the PBP, which would be a formal sub-committee of the ICB. This would take many of the decisions that currently sat with the CCG. ICB Place Teams would support the PBP as they did with the CCG.

The PBP would report to the Health and Wellbeing Board as well as to the ICB, while the Health and Wellbeing Board would feed into the ICP. It was also noted that a new Joint Health Overview and Scrutiny Committee had been set up to provide scrutiny of the System, while NHS England and the Care Quality Commission would also provide oversight.

ICB Board membership was determined by statute, with 10 members defined, including:

·         Chairman

·         Independent non-executive directors (x2)

·         Chief Executive

·         Partner members:

o   Local authority officer

o   Primary Care

o   NHS Provider

·         Finance, Medical and Nursing Directors

Dr James Kent had been appointed as Chief Executive.

The Chairman highlighted that discussions were ongoing amongst the three Berkshire West local authorities about the relationship between the leadership of the councils, the Health and Wellbeing Boards, Health and Wellbeing Portfolio Holders, and the ICB / ICP. He noted that the ICB Board had no political membership, just one local authority officer, but there were five local authorities within the System and the Berkshire West local authorities were concerned that they would not have adequate representation. He highlighted that there was no information about the composition of the ICP and suggested that the NHS Trusts would welcome representation. He asked what conversations were taking place in relation to political voices and governance.

ACTION: Niki Cartwright to ask Dr James Kent about representation on the ICB Board / ICP.

Councillor Martha Vickers also expressed concerns that West Berkshire would not be adequately represented and that the new structure would make everything more remote from local people.  She found the new structure confusing and complicated and suggested that local ward councillors should have a presentation to raise awareness of the changes and improve understanding.

The Chairman noted that the changes would not come into effect until April 2022 and there would be more comms in the coming months.

Councillor Steve Masters agreed that the structure seemed very complicated and further work was needed on communicating this to elected officials and professionals. He also echoed concerns about decision making becoming more remote and suggested that West Berkshire could potentially miss out in future.