Agenda item

Matthew Tait (Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board Chief Delivery Officer) and Stephen Chandler (Oxfordshire County Council Executive Director for People) have been invited to provide an update to the Committee on the BOB ICB operating model and the ongoing negotiations between the ICB and the County Council in that context.

There are THREE documents attached to this item:

1.    A report by the Health Scrutiny Officer outlining recommendations to the Committee on how to proceed with regard to the changes to the BOB ICB operating model in light of the response from the Secretary of State.

2.    A report from the ICB Chief Delivery Officer detailing the ICB’s revised operating model.

3.    The response received from the Secretary of State to the call-in request issued by the Committee in relation to the changes to the ICB operating model.

The Committee is RECOMMENDED to

1.    NOTE the response of the Secretary of State for Health and Social Care to the call-in request in relation to the Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board (BOB ICB) Restructure.

2.    AGREE to the need for the ICB to:

(a)  Engage in ongoing negotiations with Oxfordshire County Council to ensure that the ICB’s operating model supports effective commissioning and delivery of health and social care services at Place.

(b)  Ensure that delegated budgets relevant to Oxfordshire Place are retained at Place.

(c)  Support the continued existence of the role of Urgent Care Director for Oxfordshire.

(d)  Support the initiative to establish a Place Convenor for Oxfordshire, and for the ICB to clarify how it will be supportive of this role despite it not formally hosting this.

(e)  Clarify the nature and extent of the ICB Oxfordshire Executive Sponsor’s role and responsibilities.

3.    AGREE to engage in ongoing scrutiny of the changes to the ICB’s operating model until the above five points are addressed.

Matthew Tait (Buckinghamshire, Oxfordshire and Berkshire West Integrated Care Board [BOB ICB] Chief Delivery Officer); Stephen Chandler (Oxfordshire County Council Executive Director for People); Ansaf Ashar (Director of Public Health); and Karen Fuller (Director of Adult Social Care); were invited to provide an update to the Committee on the BOB ICB operating model and the ongoing negotiations between the ICB and the County Council in that context.

The Committee AGREED to the following recommendations concerning the BOB ICB Operating Model, which were outlined in the Health Scrutiny Officer report:

1.    NOTE the response of the Secretary of State for Health and Social Care to the call-in request regarding the Buckinghamshire, Oxfordshire, and Berkshire West (BOB) ICB restructure.

2.    AGREE to the urgent need for the ICB to:

a.    Engage in ongoing negotiations with Oxfordshire County Council to ensure that the ICB’s operating model supports effective commissioning and delivery of health and social care services at Place.

b.    Ensure that delegated budgets relevant to Oxfordshire Place were retained at Place.

c.     Support the continued existence of the role of Urgent Care Director for Oxfordshire.

d.    Support the initiative to establish a Place Convenor for Oxfordshire, and for the ICB to clarify how it will be supportive of this role despite it not formally hosting this.

e.    Clarify the nature and extent of the ICB Oxfordshire Executive Sponsor’s role and responsibilities.

f.      Clarify the role of associate directors for place.

3.    AGREE to engage in ongoing scrutiny of the changes to the ICB’s operating model until the above five points were addressed.

The Committee also NOTED the need to address the outstanding issues related to the BOB ICB operating model. These issues were identified in August 2024 and resolving them was important with the upcoming budget setting period.

The BOB ICB Chief Delivery Officer provided the Committee with a brief summary of the updated operating model. The Urgent Care Director role for Oxfordshire would focus on addressing local needs based on feedback the ICB received during its consultation period in the summer of 2024. As the Executive Sponsor for Oxfordshire, the Chief Delivery Officer would attend key meetings, engage with stakeholders, and represent Oxfordshire at the ICB board to address local issues. The Chief Delivery Officer would also participate in the Health and Wellbeing Board and Place-Based Partnership Boards, acting as the main representative for scrutiny Committees and involving experts when necessary. They were to act as a key decision-maker for joint decisions between the ICB and local structures, particularly in joint commissioning.

Efforts were being made to establish a place convener for Oxfordshire with the Oxfordshire County Council Executive Director for People. The joint commissioning model supported by a section 75 agreement remained unchanged, with budgetary decisions staying the same.

The Oxfordshire County Council Executive Director for People highlighted that a strong partnership with the BOB ICB Chief Delivery Officer was being built, and referred their collaboration in managing organisational tensions effectively. The solid section 75 agreement as well as the Joint Commissioning Unit were cited as critical factors in mitigating the risks of organisational changes. Both organisations were committed to fulfilling the recommendations set by the Committee last summer, making substantial progress in addressing feedback and realigning their relationship with a clear future vision.

Efforts were ongoing to establish the place convener post and explore ways to enhance the pooled budget arrangement. The Oxfordshire County Council Executive Director for People acknowledged the financial pressures facing both the Council and the ICB, with the Council reviewing its budget and potential cost-saving measures across adult services, children's services, and public health. Despite these challenges, officers remained optimistic about future collaboration, with gratitude expressed for the support from the BOB ICB Chief Delivery Officer.

The topic of the government’s upcoming devolution plans were discussed. The BOB ICB Chief Delivery Officer and the Oxfordshire County Council Executive Director for People discussed that January's place-based partnership meeting covered the devolution paper and the Council's fast-track request, establishing devolution as a regular update topic in monthly meetings. The partnership aimed to align national agendas, such as neighbourhood development and early intervention, with ongoing devolution discussions. There were concerns about scrutiny impacts due to statutory requirements involving district members.

The Committee inquired about how the ICB’s financial recovery programme would enhance leadership within NHS organisations across Oxfordshire and asked about the workforce plan to ensure adequate staffing. The BOB ICB Chief Delivery Officer explained that the financial recovery programme involved addressing challenges such as non-elective urgent care demand, waiting lists, and service redesign for productivity improvements. It was emphasised that effective place-based working was crucial for delivering change and achieving financial stability.

It was also mentioned that there was a system-wide workforce plan with initiatives to change workforce models and address recruitment challenges. The BOB ICB Chief Delivery Officer acknowledged the need to improve productivity and adapt to the complexity of patients and treatments. 

Members inquired whether the absence of an Oxford weighting placed the area at a disadvantage, particularly considering the government's plans to prioritise Oxford and Cambridge. They also questioned if implementing an Oxford weighting would significantly address workforce challenges in the region.

The ICB Chief Delivery Officer recognised the challenge presented by the absence of an Oxford weighting, particularly in comparison to the London weighting. It was indicated that although this situation was unlikely to change in the near future, efforts were being concentrated on maximising the advantages of living and working in Oxford and adopting flexible working arrangements to address the issue.

The Committee also asked about the ongoing confusion among the public regarding the ICB structures and governance, and how patients might contribute to service design and delivery. The ICB Chief Delivery Officer explained that the ICB had introduced a new engagement strategy to improve public engagement and address patient concerns. This strategy was presented at the last ICB board meeting, which outlined public engagement principles and next steps. Place-Based partnerships were also seen as essential vehicles for obtaining local insights and ensuring that patient concerns were integrated into decision-making processes. The place-based partnership meetings were to include regular updates on devolution and other relevant topics to keep all stakeholders informed and engaged.

It was highlighted that the Committee shared these concerns alongside Healthwatch, with members of the public not feeling engaged. In the spirit of ensuring the ICB was committed to public engagement, the Committee asked whether the ICB would be willing to engage with them around Key Performance Indicators (KPIs). The ICB Chief Delivery Officer indicated that the ICB was open to developing KPIs for meaningful public engagement.

The Committee questioned how the ICB ensured that commissioning at the system level was evidence-based, the nature of the evidence used, how it was assessed, and how the ICB coordinated with Oxfordshire to ensure effective implementation. The ICB Chief Delivery Officer stated that the ICB was using comprehensive NHS data to enhance decision-making and support the 2024-2025 planning cycle by examining evidence and identifying areas for improvement. This process relied on local joint strategic needs assessments, with public health directors participating in weekly meetings for data verification. Furthermore, the ICB worked with Oxfordshire to facilitate evidence-based commissioning using local insights and data.

The ICB’s role ensured that strategic decisions were based on evidence and coordinated through Oxfordshire's place-based partnership. It collaborated with stakeholders such as the Council and Trusts to implement interventions like discharge efficiency, while focusing on joint efforts for evidence-based changes and financial sustainability. Transparency was upheld by sharing data with partners, and diverse system data was utilised for informed decision-making.

The Committee asked how stakeholders, such as the neurological alliance or other advocacy groups, know who to engage with and how to engage with the opportunities provided by the ICB, especially with the new delegation of neurology services. The ICB Chief Delivery Officer explained that the ICB coordinated with NHS England to inform stakeholders about changes in responsibilities, assess and update engagement models to improve stakeholder involvement, and value local neurology expertise by understanding specific needs and strengths for effective engagement.

The Committee inquired about the planning and management of all-age continuing care, and how significant inequalities and cost pressures would be addressed. The ICB Chief Delivery Officer explained how the ICB had restructured the All Age Continuing Care team and allocated additional resources to increase capacity. The aim was to ensure a consistent application of the national framework and improve coordination across different areas. While funding was not distributed equally, it was tailored to meet specific needs for effective service delivery. Addressing local needs and variations remained a key focus.

Performance and expenditure reports on continuing care in Oxfordshire were provided by the ICB, including metrics that monitor performance, delivery, and spending across the system. The ICB committed to transparency in resource-allocation and usage, ensuring reports effectively address Oxfordshire's needs.

The discussion also highlighted the imperative to expand primary care services in response to increased demand. The Committee heard that the ICB was committed to expanding primary care services by integrating the primary care team within the place-based matrix and collaborating with local stakeholders. The executive sponsor was essential in understanding and prioritising primary care issues, mobilising resources, and ensuring the model's effective operation.

Investment in primary care estates was a key priority, especially given the urgency driven by new housing developments. Establishing integrated neighbourhood teams was critical, and efforts had to be made to optimise the primary care model to support this initiative.

Cllr Van Mierlo joined the meeting at this stage.

The Committee asked about establishing a Place convener for Oxfordshire, whether the ICB supported this initiative and if it was committed to sharing data; as well as what role the ICB played in making this position effective. The ICB endorsed the establishment of a place convener for Oxfordshire and was committed to supporting and integrating this role effectively within its operations. The place convener was to be provided with necessary data, resources, and intelligence by the ICB to ensure coordination and informed decision-making.

Empowered by partners in the place-based partnership, the Place Convener would have the authority to direct resources and challenge decisions. As the executive sponsor, the BOB ICB Chief Delivery Officer was personally dedicated to making this role effective and ensuring it would contribute meaningfully to the partnership's goals.

The Committee asked about the importance of ongoing support and resources for Special Educational Needs and Disabilities (SEND) services and how the ICB would continue to play an effective role in this regard. It was explained that the ICB was committed to supporting SEND services through collaborative partnerships, with the BOB ICB Chief Delivery Officer playing a key role on the Improvement and Assurance Board as the director of vulnerable groups and SEND. Although financial challenges existed, the ICB remained focused on finding partnership solutions to address service issues.

The Committee AGREED to issue the following recommendation to the ICB:

Ø  For the ICB’s Executive Sponsor for Oxfordshire and the Director for Places and Communities to meet with the HOSC chair and Health Scrutiny Officer, as well as to meet with local MPs (as part of the national offer for facilitation), to initiate proper engagement with Oxfordshire Place. It is recommended that clear indicators are developed which demonstrate the levels of engagement being undertaken between the ICB and key stakeholders in Oxfordshire Place.

Cllr Pressel joined the meeting at this stage.