Agenda item

To provide an update on the formation of the new bodies at 'system' and 'place' level and associated strategy development.

Matthew Tait (BOB ICB Interim Chief Delivery Officer) presented the item on the BOB ICS update (Agenda Item 8).

He summarised his responsibilities, which included: planning and performance; lead on urgent care and elective care; and overseeing the place directors.

Over the last three months, there had been a focus on the technical establishment of the ICB, transfer of functions and staff from the CCGs. The ICB constitution had been signed off and the ICB had been formally established on 1 July 2022. A working group had been established to work up proposals for the Integrated Care Partnership (ICP).

It was explained that the ICP was a joint committee between local authorities and the ICB. The ICB was the NHS statutory body. PBPs would be created as sub-committees of the ICB. Work was ongoing to understand how these would relate to the Health and Wellbeing Boards, but it was acknowledged that there was a strong baseline of partnership working. The final element was Provider Collaboratives, with NHS providers, local authorities and the voluntary sector coming together to delivery joined up services.

The ICB Goals were highlighted, including: tackling inequalities, improving population health and healthcare, enhancing productivity and value for money, and helping the NHS to support broader social and economic development.

Key roles of the ICB were: setting system priorities; orchestrating system working along whole patient pathways; allocating funding in line with the strategy; and earning a seat at the table by focusing on where the ICB could add value.

The Board met on 1 July 2022 to agree governance arrangements and receive various system level plans.

The ICB website was in development, only core information provided at this stage.

The ICB Board membership was detailed – this included: executives employed by the ICB; partner members from NHS trusts, primary care and local authorities; and non-executive members .

A high level strategy had been prepared on working with people and communities, which outlined a set of principles.

Place Based Partnerships (PBPs) were being developed and the ICB was keen to decision making as far as possible, since this would allow effective delivery, integration and work on wider determinants of health. These would build on existing partnerships.

A timeline was presented which showed how the focus was moving from technical tasks to developmental activities.

It was explained that Amanda Lyons was leading on strategy development. Initial work had focused on engagement and pulling together data.

A key focus of the strategy would be reducing healthcare inequalities. This would involve targeting areas of deprivation. It was noted that four out of the five local authorities were in the highest ranks in England in the overall health index.

ICP Strategy Guidance was awaited, but strategies were expected to consider the Joint Strategic Needs Assessments, the Health and Wellbeing Strategies and the NHS Mandate. New areas included: integrated commissioning, budgets, data sets, and health and care records.

The Chairman noted that the local authority representative on the ICB would be the Interim Chief Executive of Oxfordshire County Council who had a health background. Despite the timeline in the presentation showing 1 July as the deadline for the ICP and PBPs to be in place, these were not yet agreed. It was hoped that discussions could be concluded by October when the ICB Place Director was due to start.

It was highlighted that West Berkshire had two wards in the bottom two deciles for social deprivation, and so the approach may need to be focused on small pockets rather than wide areas. Members asked how these would be identified. It was noted that the small number was problematic in terms of detection and also in terms of self-perception. 

Matthew Tait agreed that joint work would be required through the Primary Care Networks to better understand these populations and develop interventions.

It was noted that although West Berkshire was amongst the top performers in the Health Index, it fared less well in terms of healthy places.

Concern was expressed about the need for West Berkshire to have a strong voice as it would be competing with neighbouring local authorities. It was explained that the leaders of the five first-tier local authorities had met, as had the chairmen of the five Health and Wellbeing Boards. Efforts were underway to achieve aligned strategies and determine what should be delivered at system, place and locality levels. A conversation would be needed around how the PBP for Berkshire West would operate.

Tracy Daszkiewicz explained that the ICB was working with the three Directors of Public Health to look at how a data profile could be built. This would draw on the Joint Strategic Needs Assessment, population health management programmes and connected care. This would also help to understand how people accessed services and any related barriers. She welcomed the focus on health inequalities, but stressed that Public Health should have greater involvement. She highlighted the need to use data to generate intelligence and insights to understand what mattered most to local populations.

There was some discussion about how funding would be allocated across the health system. It was noted that a joint bid had been prepared that had targeted Oxford and Reading as the areas with the highest levels of deprivation. The five Healthwatches had argued that some funding should also go to the other local authorities, but this had been rejected.

Further detail was sought as to the identities of the ICB’s non-executive directors.

Concerns were raised in relation to: Public Health being missing from / peripheral to key discussions; the need for a greater focus on prevention; and the fact that many West Berkshire residents used health services in neighbouring ICB areas and associated issues with transfer of patients records. A further point was made about explaining all acronyms in public meetings.

Matthew Tait indicated that further details would be circulated to stakeholders on the non-executive directors. (Details were available on the ICB’s website: https://www.bucksoxonberksw.icb.nhs.uk/what-is-the-icb/our-board-leadership/). He also undertook to look at how Public Health Directors could be better engaged.

A point was made about the need to provide evidence that the experience was improving for the local population. It was recognised that there was a degree of distraction during the period of organisational change. The focus had been on maintaining services during the pandemic, but the focus had since switched to recovery and progress had been made on tackling the backlog in elective care. It was acknowledged that urgent care was very pressured, but additional resource was being put in place in preparation for the autumn / winter period.

It was recognised that the Berkshire West local authorities had contributed to the integration agenda by developing a Joint Health and Wellbeing Strategy and Members asked if the Health and Wellbeing Boards would have additional teeth to be able to get things done.

Matt Tait explained that Health and Wellbeing Boards were fundamental to getting the PBP relationships right, but it was acknowledged that further work was needed.

The Chairman noted that Health and Wellbeing Boards had statutory functions, but going forward there would be more synergy. Conversations were happening  between the Health and Wellbeing Board Chairmen and there would be Health and Wellbeing Board representation at both system and place levels. There was also a Joint Local Health and Wellbeing Strategy across the three Berkshire West local authorities. He was hopeful that there would be population health benefits as a result of this synergy.