Decision details

The Integrated Care System 5 Year Plan was before the Board for discussion on priorities for Oxfordshire (HWB6).  

Louise Pattern in introducing the report, explained that most work took place within Oxfordshire and would continue to do so, but that there were areas of commonality where it made sense to come together at scale and do work, such as key areas around prevention and significant workforce issues (such as how housing could be influenced or a Oxfordshire weighting).  The plan was very Strategic looking at areas of commonality between places when planning care that would be fit for the 21^st Century.

Ian Hudspeth reported that there had been some concern around the BOB, in particular everything being decided at a very Strategic level.  He asked if Louise could give the Board some assurances around whether there would be three different workings, whether Sovereignty would remain with Oxfordshire, and that, although the timetable appeared to be very tight and driven; whether there would be the ability for everyone to be engaged and have an input?

Louise explained that the aim was to get the local Oxfordshire Place sorted by developing a Partnership Board.  At the moment, there was the ISDB, which needed to change shape to look at a different membership: commissioners, providers and public to start to look at how integration was started.  It would not be a different organisation, but a way to facilitate through system leadership and distributive leadership to get integration going.  At the moment, the current thinking was that they would pick some key areas to look at how services could be integrated and share information about the cost of care versus the money that was available for care to make those resources stretch, including delegated budget for Mental Health and Primary Care and Community Services, with oversight at the Health & Wellbeing Board.

Ian Hudspeth commented that there was a need to be careful that it was not about one area propping up another, but about coming together to provide the best outcome for patients.

Roz Pearce spoke in support of the comments around the need to keep decision making retained at Oxfordshire level.  She pointed out that Healthwatch had not been mentioned in the documentation. She further commented that as the five Health watches were not in agreement, they would not be signing it off at the moment.  She questioned what the long-term impact on the overview roles of Health & Wellbeing Boards and Scrutiny would be and how scrutiny would work at BOB level, together with how strategies could be aligned across the Health & Wellbeing Boards to integrate with BOB.

Louise explained that there was still a commitment to align with the local authority boundries across BOB, as that was where there was shared accountibilty for safeguarding and shared ways of working and overview & scrutiny and that there were no plans to change that.

Roz Pearce expressed concern that there was very little about Social Care in the plan and that it was very focused on Health and therefore did not address many of the issues around integration.

Steven Chandler explained that whilst the document did not explicitly reference inclusion, detailed conversations around inclusion had taken place.  The Wellbeing component was very important and the work being undertaken with communities that placed best focus was crucial.  He would expect to see a much more obvious place for social care and broader wellbeing in the next draft.

Louise Upton expressed the importance of recognising the work of groups such as the Archway Foundation (which carried out a lot of work with lonely or isolated people) and queried whether there could be any sessions with them, together with some funding to support them and in relation to value for money whether they could consider getting rid of the internal market?

In relation to the procurement of services such as cleaners or careworkers, she requested that officers made sure that it was taken into consideration, that if they were paid such low wages that the district councils were having to pay benefits to them, then they may not be best value for money.

Louise responded that they needed to get more organised about how they worked with voluntary organisations and that was the whole idea of having integration in Oxfordshire rather than up in the integrated care system.  Integration was about a cost base model where people were open and honest about what was available and what it was being spent on.  Officers would make it clear that they would weight any provider that was willing to integrate with our local services. Procurement and low wages would be monitored very carefully.

Lawrie Stratford felt that prevention and communications with the public was missing from the report, and that it was very important to get the public involved and behind the strategy.

Dr Kiren Collinson welcomed the report and commented that the Primary Care Network would be where a lot of our comments would go and where we would see most work being done on the ground.  She didn’t want people to view the integrated care system as a big unwieldly system but the best way to share resources and that the H&WBB focus should be what was happening at the Oxfordshire level.

Louise thanked everyone for their comments and undertook to take back the points made.