Matthew Tait (Chief Delivery Officer- Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board) and Stephen Chandler have been invited to provide an update to the Committee on the recent and ongoing NHS reforms. These reforms include the government’s plans to integrate NHS England into the Department of Health and Social Care, and to further reduce Integrated Care Board running costs.
The Committee is invited to; discuss the implications of these developments on Oxfordshire Place; raise any relevant questions; and AGREE any recommendations arising it may wish to make.
Minutes:
Dan Leveson, BOB ICB Director of Place and Communities, introduced an update on the NHS Reforms. The BOB ICB Director of Place and Communities sent the apologies of Matthew Tait, BOB ICB Chief Delivery Officer.
Stephen Chander, Executive Director for People, attended to take the Committee’s questions on the NHS Reforms update, with Cllr Kate Gregory, Cabinet Member for Public Health & Inequalities, also attending online. Veronica Barry, Executive Director of Healthwatch Oxfordshire, also attended as a guest of the Committee.
The BOB ICB Director of Place and Communities announced that the government required Integrated Care Boards (ICBs) to cut costs by 50%, targeting £18 per head. He highlighted areas like strategic commissioning and population health management, reducing performance activities. Southeast’s ICBs reduced from six to four, with BOB ICB possibly merging with East Berkshire. Rapid changes were planned, with stakeholder engagement in June and July, a new model agreed by September, staff consultation in October, and formalisation by April 2026 or 2027. A transition executive oversaw the reorganisation.
The Executive Director for People acknowledged there were significant proposed changes without clear details on their impact. He highlighted Oxfordshire's strong integrated work and viewed reforms as an opportunity for a local solution. The Place Based Partnership met in July to discuss Oxfordshire's offer to the ICB, aiming to mitigate risks and identify opportunities. He emphasised understanding the impact on services and the Committee's scrutiny role.
The Chair mentioned that as the Chair of the BOB HOSC, they have requested that the BOB HOSC be convened, with all the Committees across the three-county area in place, and further actions were to be considered.
Members asked if the ICB was required to make a 50% cut in addition to the cuts made last year or if it is a 50% reduction on top of the most recent changes to the operating model. The BOB ICB Director of Place and Communities clarified that the 50% reduction was on top of the previous 30% cuts made last year. The target is to reduce the total cost to about £19 per head of population. This involves further reductions in staff and an expansion of geographical boundaries.
Members enquired whether further restructuring would reduce Place staff and if there was a commitment to a place-based convener role. The BOB ICB Director of Place and Communities noted that workforce reductions were anticipated but the exact impact on Place staff was undetermined. He affirmed the importance of Place in the new operating model and committed to collaborating with Place-based partnerships. The concept of a Place-based convener role was still being considered.
The Committee asked about the implications of changes to the provider oversight role on monitoring and evaluation. The BOB ICB Director clarified that the new model aimed to minimise duplication and emphasise collaboration. The oversight and assurance role would evolve to focus on understanding performance, evaluating needs, and reducing unwarranted variation. The central team would handle regulation and performance management, allowing local teams to concentrate on needs assessment and evaluating effective practices.
Concerns were expressed regarding the impact of budget cuts on disease prevention, the distribution of burden, and the existence of a document detailing 'must-dos' for local systems. The Director acknowledged the challenge of balancing prevention efforts with high service demand and financial constraints. He reiterated the ongoing commitment to prevention and reducing health inequalities despite these challenges and mentioned an extensive list of statutory responsibilities guiding their actions.
Concerns were raised about the NHS app's functionality and consistency across surgeries. The BOB ICB Director of Place and Communities acknowledged these challenges, explaining that multiple systems and information governance requirements complicated improvements in digital technology use. There was a commitment to enhancing interoperability and consistency, with further discussions on oversight needed.
Members asked about accommodating Oxfordshire's growth and primary access support. The Director stated that the ICB worked with local planning departments to address primary care needs using Section 106 and CIL funds. Despite complexities in developing primary care estates, they focused on modernising general practice and expanding roles through the Additional Role Reimbursement Scheme. Neighbourhood health and care services were developed to support primary care amid demand and capacity challenges.
The Executive Director of Healthwatch Oxfordshire queried the ICB's plans to communicate and engage the public regarding remote versus local services amidst access challenges. The BOB ICB Director of Place and Communities acknowledged the need to involve communities despite potential communication resource reductions. He emphasised their statutory obligation to engage the public and committed to delivering the best services by organising care around different populations' needs.
The Chair inquired about the Didcot project's planning, funding status, and any immediate barriers. The BOB ICB Director of Place and Communities confirmed the Didcot project's priority, working through the final stages of the business case focusing on value for money and economic viability. He assured continued focus on priority projects like Didcot despite reorganisation.
The Committee enquired about the transparency of the new ICB operating model and whether early input from both the Committee and the public was possible. The BOB ICB Director of Place and Communities confirmed plans to engage stakeholders, including local authorities, starting from June, assuring maximum transparency due to sensitive impacts on staff and employment.
The Committee then raised concerns regarding the 50% budget cuts on the ICB amid the challenging healthcare environment and sought understanding of management plans for such reductions. The Director acknowledged the substantial challenge of the cuts and the prevailing sense of "not again" among staff given recent reorganisations. He stressed the importance of collaboration, avoiding isolated efforts, and focusing on opportunities for integration and collective action to improve population health despite difficulties.
The Committee AGREED to write a letter to the Chief Executive of the BOB ICB to ask if there was any support that could be provided from the Committee around the recent NHS reforms and the ongoing changes to the ICB’s operating model.