Agenda item

Nick Broughton (Chief Executive BOB Integrated Care Board) and supporting ICB officers have been invited to attend this meeting to discuss the BOB Integrated Care Board proposed new structure and operating model.

It is recommended that the Committee AGREES on:

1.Whether or not the proposed restructure constitutes a substantial change.

2. How the Committee should proceed in light of the proposed restructure.

PLEASE NOTE: Reports relating to this item are to follow.

Matthew Tate (Chief Delivery Officer), and Hannah Iqbal (Chief Strategy and Partnership Officer), attended the meeting as representatives of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board (BOB ICB).

The Chief Delivery Officer highlighted that the consultation process with staff was ongoing, and that partner engagement was being actively sought. He acknowledged the concerns raised by various stakeholders about the potential impact of the restructure on place-based partnerships and service delivery. He assured the attendees that the feedback received would be carefully considered and that the final proposals would reflect the input from both staff and partners.

The Chief Delivery Officer explained the context and necessity of the restructuring. He highlighted that the ICB was required to reduce its running costs by 30%, which prompted a review of their management structures. This review aimed to drive economies of scale and ensure the ICB could address strategic challenges more effectively.

The Chief Delivery Officer outlined that the initial set of structures proposed in April had received significant feedback, particularly concerning the clarity of the operating model and the potential transfer of staff to other organisations. This feedback, combined with the ICB’s need to sign off a deficit position of £60 million, led to a revised set of proposals. These new proposals aimed to strengthen internal functions, such as finance and Continuing Healthcare (CHC), to better control and understand strategic issues.

The Chief Delivery Officer acknowledged the significant progress made by the place directors and the importance of maintaining strong relationships and collaborative working at the local level. He suggested that the new model could involve different leadership arrangements, with partners stepping into some of the roles previously held by ICB staff. He reiterated the commitment to supporting place-based partnerships and ensuring that the restructure would not undermine the progress made.

The Chief Strategy and Partnership Officer added context to the partnership development and collaboration aspects. She emphasised that the changes were not about altering service priorities or collaborative intent but were focused on management structures. She acknowledged the difficulty in balancing the consultation process with staff and the engagement with partners, given the sensitivity around potential redundancies.

The Executive Director of People in Oxfordshire County Council expressed his pride in the Oxfordshire contingent and his respect for the representatives from the BOB ICB. He provided a brief background of his career, highlighting his experience in the NHS and local government, emphasising the importance of collaborative work to achieve meaningful impacts on people’s lives.

He discussed the BOB ICB’s consultation document, agreeing with the importance of ICBs and their role as system leaders. The Executive Director stressed the need to balance system-level benefits with the individuality of place. He pointed out that Oxfordshire’s integrated health and care system, supported by a significant pooled budget, was unique within the BOB footprint and required adequate resources to maintain its effectiveness. He expressed concerns about the proposals in the consultation document, questioning their alignment with the policy goals of integrated care systems.

He raised specific concerns about the engagement process, arguing that it was insufficient given the scale of the proposed changes. The Executive Director highlighted the integrated nature of Oxfordshire’s commissioning arrangements and the potential risks to progress from the proposed changes. He emphasised the importance of the role of system conveners in fostering partnerships and innovation.

The Executive Director also addressed concerns about centralisation, arguing that local performance delivery was crucial, and that centralisation could undermine successful local initiatives, particularly in urgent care. He cited examples of effective local collaboration in reducing hospital discharge delays and improving patient outcomes.

The Director of Public Health at Oxfordshire County Council articulated the significant impact of local initiatives on the health and well-being outcomes of Oxfordshire residents. He emphasised the importance of understanding local populations to deliver tailored outcomes, highlighting the Community Board profiles work, which delved into the ten most deprived areas to identify their specific needs and assets. This approach revealed that while public health challenges were similar across communities, solutions needed to be customised to each community’s unique context. He expressed concern over standardisation, arguing that localised approaches were crucial for effective public health interventions.

The Director of Public Health co-chaired the Health Inequality Forum for Oxfordshire Place, which brought together partners across organisational boundaries to address health inequalities. He cited the Move Together programme as an example of a successful initiative that improved physical activity in local communities and reduced GP appointments, demonstrating the importance of place-based initiatives in reducing demand on frontline services.

He warned against the potential negative impact of centralising services and reducing staff, which could undermine local initiatives that had shown significant improvements in health outcomes and cost savings. The Director also highlighted the role of the Health and Wellbeing Board, which had recently refreshed its strategy with input from all partners. He raised concerns about maintaining senior representation and effective delivery of the strategy across multiple local authorities under the new structure. He stressed the importance of the Joint Strategic Needs Assessment in informing the health and wellbeing strategy and the need for continued collaboration across organisational boundaries.

He expressed concerns about infection prevention, particularly in light of the COVID inquiry report, which highlighted systemic unpreparedness for pandemics. He criticised the reduction of infection prevention staff at the local level, arguing that it contradicted the lessons learned from the pandemic. He emphasised the need for local capacity to manage outbreaks and emerging infections, such as measles and pertussis, which had seen increased prevalence due to reduced screening uptake post-pandemic.

The Committee began by questioning the lack of early engagement with partners and the short consultation period. They expressed concerns that the limited timeframe for consultation might not allow for comprehensive feedback from all stakeholders. The Chief Delivery Officer responded by acknowledging the tight timeline but emphasised that the ICB had made efforts to engage with key partners and gather input, and that they had received an extraordinary amount of feedback that suggested the timeframe was not inhibitive. He assured the Committee that the feedback received would be carefully considered in the final decision-making process.

The Chief Strategy and Partnership Officer added that feedback had been received from various partners, including Healthwatch, voluntary sector organisations, and primary care networks. Partners were notified of the proposed changes later than internal staff in order to allow staff to process the changes and potential redundancies.

The Committee expressed concerns about the short period for public and partner consultation, questioning whether the legal obligations for public involvement had been fully complied with. The Chief Strategy and Partnership Officer explained that the consultation was a management restructure, not a service change, and therefore different rules applied. They acknowledged the need for better partner engagement and admitted that there were lessons to be learned.

The Committee raised concerns about the potential impact on urgent care delivery in Oxfordshire, given the proposed changes to the resource supporting this area. They emphasised the importance of local knowledge and relationships in making improvements. The Chief Delivery Officer acknowledged the concerns and assured that the new model would support place-based change, and mentioned that the feedback might lead to changes in the proposed structures.

The Committee inquired about the alignment of the proposed restructuring with the national agenda on health and social care. They sought clarification on how the changes would support the broader goals of the NHS and the government’s health policies. The Chief Delivery Officer explained that the restructuring was designed to enhance the ICB’s strategic capabilities and ensure better alignment with national priorities. It was also highlighted that the changes aimed to improve efficiency and effectiveness in delivering health services while maintaining a strong focus on local needs.

The Committee raised a question regarding the substantial change toolkit, specifically addressing the lack of its completion by the ICB. The question highlighted that the toolkit had been sent to the ICB in July, shortly after the Committee learned about the proposed changes. In response, the Chief Strategy and Partnership Officer acknowledged that it was a mistake on their part not to have completed the toolkit. They were unaware that it had been sent and expressed willingness to rectify this oversight. The Chief Strategy and Partnership Officer committed to filling in the toolkit and completing it early the following week. They also reiterated the ICB’s commitment to transparency and the importance of the substantial change toolkit in facilitating scrutiny by the Committee.

The Committee questioned the capacity of the new structure to support place-based partnerships, given the reduction in the number of place directors. They expressed concerns about the ability of a centralised approach to address local needs effectively. The representatives from BOB ICB explained that the new structure would involve a mix of dedicated support and centralised teams, with a focus on strategic insight and capability. They acknowledged the concerns and stated that the feedback would be considered to ensure the new model supports effective local delivery.

The Committee also raised concerns about the capacity to continue progress on primary care estates and safeguarding. They questioned whether the proposed centralisation would impact ongoing projects and the ability to address safeguarding issues effectively. The Chief Delivery Officer reassured the Committee that the ICB remained committed to these priorities and that the restructuring would not hinder progress. He emphasised that the changes were intended to streamline management structures and improve overall service delivery.

The Committee addressed issues related to infection control and antibiotic stewardship. They were particularly concerned about the potential impact of centralising public health functions on these critical areas. The Chief Delivery Officer acknowledged there were opportunities to operate and learn at scale, particularly in linking with emergency response models to address specific areas effectively. The Chief Nursing Officer at BOB ICB had directly discussed some of the highlighted risks with the Director of Public Health and had been working on ways to mitigate these risks.

The Committee also highlighted the importance of maintaining progress on the Wantage Community Hospital implementation plan. They sought assurances that the restructuring would not delay or disrupt the implementation of this plan. The Chief Delivery Officer confirmed that the ICB was fully committed to the Wantage Community Hospital project. He emphasised that the ICB would continue to prioritise local health infrastructure projects and ensure their successful completion.

The Committee inquired about the future relationship between the ICB and scrutiny, particularly in light of the proposed removal of the place directors who had been key points of contact. In response, the Chief Delivery Officer reiterated the commitment to ensuring effective place-based partnerships. They explained that while the place directors’ roles were being restructured, there would still be dedicated senior posts focused on place-based functions. These roles would continue to be embedded in place-based partnership structures, health and wellbeing boards, and scrutiny processes. The Chief Delivery Officer also mentioned the possibility of having executive sponsors to support place dynamics, ensuring that there was clear executive leadership involved in these areas. They highlighted the importance of strategic alignment across all scrutiny bodies.

The Committee AGREED to issue the following recommendations:

1.           That the ICB proposed restructure constitutes a substantial change.

2.           To DELEGATE to the Health Scrutiny Officer, in consultation and with the support of the Chair and the Executive Director for People & Transformation at Oxfordshire County Council, to write to the Secretary of State for Health and Social Care to request a call-in in relation to the ICB restructuring proposals unless:

a.     The ICB addresses the key asks made by the Oxfordshire Place-Based Partnership by 18th August 2024, and

b.     It is deemed that a local resolution has been reached.