2:45
25 minutes
Person(s) responsible: Head of Paid Service and Leader of the Council, OCC; Chief Executive and Clinical Chair, OCCG
Persons giving report: Chairman of HWB, Chief Executive, OCCG, Head of Paid Service and Director of Public Health, OCC
There will be an oral update on discussions and proposed process.
Minutes:
Peter Clark, Head of Paid Service, OCC, reported that since the last meeting, a formal response on devolution had yet to be received from the Department for Communities & Local Government (DCLG) for greater Health and Social Care integration within Oxfordshire. He reminded the Board that these proposals had been supported by the District Councils, the OCCG and a variety of other stakeholders.
He addressed the press statement made earlier that week from all Oxfordshire District Councils containing details of a proposed four unitary council model which would incorporate Cotswold District Council and South Northamptonshire Council. He stated that OCC, nor the affected CCGs outside of the current boundaries had been party to these proposals and that, as a consequence, OCC needed to think about how to take matters forward, following consideration of the full implications of this proposal. This would be with a view to conducting a separate discussion with the DCLG about how a more ‘joined up’ approach could be taken which would be both open and transparent and in the best interests of the residents of Oxfordshire.
The Chairman invited the Cabinet portfolio members and their relevant Directors to give their early thoughts on the issues and implications of the above proposal (without detracting from the proposals). These included the following:
- one of the biggest challenges experienced by small unitary councils was that of scale, capacity and cost;
- placements for very specialist care for children were difficult to finance;
- having one large organisation meant an ability for all stakeholders to work in close partnership, and an ability to input real expertise and skill base;
- co-terminosity with organisations such as Thames Valley Police and the OCCG brought great strength – changes to county boundaries could weaken this. Working with three Clinical Commissioning Groups and a number of NHS regional boundaries could result in co-ordination difficulties and would cut across their 5 year planning footprints. For example, there would be questions concerning the direction of travel in relation to the recent regionalisation of adoption services with Berkshire. It was understood that there had been no discussion with Gloucestershire and Nene (which includes South Northamptonshire) CCGs;
- the management of infectious diseases and emergencies, which currently relied on arrangements with Public Health England, would need to co-ordinate with 3 teams, thus making it both more challenging and complex;
- the current JSNA indicated significant areas of disadvantage in the County – the creation of 4 unitary authorities would result in these areas receiving a smaller share of government grant than currently received;
- there was currently 1 adult safeguarding board serving the whole of the county – it was likely that new legislation would be required if there was a split over 4 authorities, which could lead to a poor service for the residents of Oxfordshire.
Dr McManners commented that the OCCG Board had discussed and had decided to explore both the financial risks and governance issues behind the principle of a wholesale integration of Health and Social Care with a single budget and single accountability. The GP Locality Forums had also given reasonable support to the proposals. He added that, although the Board felt there was much merit in the proposals, it did not wish to be drawn into the politics behind them. David Smith concurred with the comments made by Dr McManners, pointing out that the District Councils had also included the integration of Health and Social Care within their proposals, as well as the county.
On being asked about whether any discussions had taken place with the Department of Health about the alternative proposals being put forward by the District Councils, Rachel Pearce clarified that she had not entered into any discussion with the Department of Health on this latest proposal as nothing had been put forward to NHS England about which to support or not to support. She further pointed out that NHS England had no direct relation with the Department for Communities & Local Government, only the Department of Health. She added her view that, to date, there had been good integration working at a strategic level and local level on the Transformation Plan and discussions would be undertaken with the CCGs involved looking at the merit of bringing Health and Social Care together in light of the new proposal.
Peter Clark, on summing up the discussion, recognised that there had been no official backing of a particular model at this stage and that all parties had agreed that unification in some form would take place; and there had been an expectation that a model would be produced. However, OCC believed that the people of Oxfordshire required services that were jointly provided and this provision must continue, adding that Health and NHS England were keen on the principle of integration of Health and Social Care. He stated that OCC needed to adopt its own view on a model which was fit for purpose for Oxfordshire residents; and needed to be given an opportunity to air some of the concerns a four unitary proposal would have in relation to services for the people of Oxfordshire.