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Agenda item

Integrated Care System Update

Purpose: To update the Board on progress with the establishment of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System.

Minutes:

Matt Tait gave an update on the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (ICS) (Agenda Item 10). Key points from the presentation were as follows:

·         The date for establishing the Integrated Care Board had been pushed back from April to July 2022.

·         There was a need to ensure appropriate governance architecture and capacity to maintain the CCGs for another three months and the ICS was satisfied that the statutory responsibilities could be maintained.

·         There were some challenges around financial planning for an additional quarter year but the ICS was confident that this could be managed.

·         The delay allowed more time for engagement and discussion on structures and working practices, which was welcomed.

·         Javed Khan had been appointed as Chair Designate and James Kent had been appointed as Chief Executive Designate.

·         Interviews were being held to appoint the non-executive members of the Integrated Care Board (ICB).

·         Adverts would be going out shortly for the three statutory executive roles – chief financial officer, chief nurse and chief medical director.

·         The processes were being developed for the partner member nomination, assessment and appointment, taking account of the emerging legislation.

·         The working assumption was that the ICB would have the minimum membership, with just one local authority partner member, who would bring sector expertise rather than being a representative of a particular council.

·         It was noted that local authority members were no longer disqualified from sitting on the ICB, but the recommendation was that the role should be an executive member.

·         The Integrated Care Partnership (ICP) would need to be established on 1 July 2022 by its founder members – the Chair of the ICB and a representative from each of the five local authorities.

·         Place based sub-committees would need to be set up for each of the three ‘places’ within the ICS – this would be more complex within Berkshire West as it spanned three local authorities.

·         Consideration was being given to the process for developing the ICP Strategy, which would in turn inform the ICB Strategy – this was expected to take 9-12 months and steering groups would be set up in due course.

The Chairman asked for further details about the proposal for the ICP to contain the ICB Chair and five local authority representatives. Discussions had already taken place between the Leaders and Health and Wellbeing Portfolio Holders of the Berkshire West local authorities about how they would interact with the ICP. The Chairman also indicated that the Berkshire West local authorities had just approved a 10 year Health and Wellbeing Strategy and asked how the strategies for each place would interact with the system level strategy. In addition, the Chairman noted that current legislation required a member of the CCG to be appointed to the Health and Wellbeing Board and the West Berkshire Constitution required a CCG representative to be present in order for meetings to be quorate. He asked what would be proposed in terms of future Health and Wellbeing Board representation.

Matt Tait indicated that the ICP was always intended to be a broader, representative, discursive group. The ICS had received a lot of updated guidance as the Bill passed through Parliament – this guidance indicated that the ICP must be established on Day 1, with the founder members to include the ICB Chair and the local authority members. The challenges of coordinating the various strategies was recognised. Checks would be carried out on baseline information and the strategy would seek to build on the three place based strategies. Common themes and challenges would be identified together with opportunities for where the system could add value or impact on some of those issues.  It was proposed that strategy development could be incorporated into a future ICS report to the Health and Wellbeing Board. Matt Tait indicated that future representation on Health and Wellbeing Boards was not entirely clear, since there was no guidance on this as yet. However, Health and Wellbeing Boards would be important in terms of their relationship with the ICP and Place Based Partnerships. He suggested that it was likely that there would be some flexibility around representation. 

Action: The ICS to cover strategy development as part of a future update to the Health and Wellbeing Board.

Andrew Sharp noted that there had previously been four CCGs in Berkshire West with two lay members on each. He expressed concern that the ICB was planning to stick to the minimum membership. He noted that West Berkshire was a small part of a large system and many patients went out of the ICS area (e.g. to Swindon and Basingstoke). He suggested that only having two non-executive lay members on the ICB with no representation from Healthwatch would not be consistent with NHS England exemplar examples, such as in Leeds. He felt it was important for the patient voice to be heard and noted that the jointly funded Healthwatch Officer had left and had not been replaced. Healthwatch England had expressed concerns about West Berkshire being adequately represented. He asked that the minimum membership be reconsidered and to have patient representation. Andrew Sharp also expressed concern about Healthwatch and the voluntary sector being lumped together as a single group and highlighted that Healthwatch was a statutory body representing patients.

Matt Tait acknowledged these concerns - the starting point was the minimum membership and there was a need to build transparency and trust around the approach. It was confirmed that Healthwatch and patient involvement would be important for the ICP, but the approach was still developing. Also, it was acknowledged that the balance between the ICP, ICB, Place Based Partnerships, and Health and Wellbeing Boards was still in development. Concerns about line of sight and engagement would be mitigated through joint working. There was commitment to a Place Executive Director for Berkshire West, who would liaise with the three local authorities and Healthwatches. The separate roles of Healthwatch and the voluntary sector were recognised, and specific feedback was sought on where they had been lumped together. The point about Healthwatch engagement would be taken back to the Lead Director for Engagement.

Action: Andrew Sharp to provide specific details to Matt Tait.

Garry Poulson agreed about the need to separate the voluntary sector from the voice of the patient and that there should be a seat at the table for both.

Matt Pearce noted that the ICS had priorities around improving population health outcomes and tackling health inequalities, and stressed the need for Public Health to have a voice. It was noted that there was a Director for Public Health for Berkshire West as well as Public Health Teams in each of the three local authorities.

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