Agenda item

Sam Burrows (Chief System Development & Engagement Officer,Buckinghamshire, Oxfordshire and Berkshire West ICB & Frimley ICB), and Caroline Corrigan (Chief Transition Officer, Buckinghamshire, Oxfordshire and Berkshire West ICB & Frimley ICB have been invited to present the Integrated Care Board Update.

 

The purpose of this item is to provide an update on the following developments in relation to the establishment of a Thames Valley Integrated Care Board (ICB):

 

Ø  The national picture – why are these changes happening.

Ø  Dissolution of Frimley ICB and BOB ICB.

Ø  Establishment of the Thames Valley ICB.

Ø  The changing role of the ICB as a “strategic commissioning” organization.

Ø  The ICB’s commissioning intentions.

Ø  The ICB’s future operating model and the design choices.

Ø  What the above developments mean for ICB staff and partners.

 

The Committee is invited to consider the report, raise any questions and AGREE any recommendations arising it may wish to make.

The Chair introduced the item, noting that the Committee had been seeking clarity and transparency since July 2025 and expected a detailed and open discussion.

 

Introduction by the ICB

 

Sam Burrows (Managing Director, NHS Frimley ICB) and Caroline Corrigan (Chief Transition Officer) were invited to present the BOB ICB update.

 

Consultation, Public Engagement and the Draft Constitution

 

The Committee drew attention to the fact that the previous transition from Clinical Commissioning Groups (CCGs) to the BOB ICB had involved statutory public consultation, as well as engagement on the draft constitution.

 

The Chair stated that the Committee was therefore seeking to understand why a similar approach was not being taken on this occasion.

 

Members expressed concern that councillors were accustomed to extensive consultation in respect of local authority structural reforms, and that these changes were particularly significant because they encompassed a broad agenda, including neighbourhood working, place-based arrangements and prevention.

 

The Committee was informed that the decision not to undertake public consultation was a national one, based on the view that the changes were organisational and would not directly impact services.

 

In relation to the draft constitution, the ICB explained that there was not expected to be significant scope for change, and that the approach would therefore focus on engagement with partners rather than formal consultation.

The Chair asked explicitly whether this engagement would include the Committee, given that the Chair of the ICB had previously confirmed that they were keen to engage with scrutiny.

 

The Committee reiterated that there had been engagement on the previous draft constitution and asked whether the Committee would have sight of and engagement on the new constitution prior to its adoption. The ICB confirmed that the draft constitution could be shared and that engagement with scrutiny was welcomed, albeit within national constraints.

 

Local Authority Representation and Partnership Working

 

The Committee drew attention to the importance of improved local authority representation within the new arrangements. The Committee clarified that the proposed local authority roles on the ICB Board were intended to provide expertise, rather than formal representation of individual councils.

 

The ICB gave a commitment to working in partnership with local authorities. The Chief Executive had previously assured the Committee that there were, and would continue to be, regular meetings with chief executives of local authorities, recognising the significant challenges they faced.

 

The ICB acknowledged that some local authorities were experiencing population growth of 30–40%, which would drive increased demand for health services, estate and workforce.

 

The ICB recognised the importance of working with local authorities to ensure access to the best available data and to support strong place-based conversations.

 

Healthwatch and the Patient Voice

 

The Committee highlighted the very important role played by Healthwatch, noting that it had been extremely helpful to scrutiny and acted as a vital bridge between the public and the NHS.

 

The Committee reiterated its unanimous view, previously agreed in its public meeting on 16 October 2025, that the Healthwatch function must be retained as an independent local voice.

 

The Managing Director NHS Frimley recognised the importance of a strong patient voice and confirmed that responsibility for patient voice would sit with a member of the executive team. However, it was acknowledged that the future of Healthwatch depended on legislation and was not yet fully clear.

 

The Committee expressed concern that detail previously expected by December had not yet been shared and reiterated its strong concern about proposals for the abolition of local Healthwatch. Members stressed the importance of an independent voice, separate from both the NHS and local authorities, particularly during a period of major transformation.

 

Coterminosity and Mayoral Arrangements

 

The Committee raised concerns about coterminosity, describing this as the “elephant in the room”, particularly given that arrangements for a mayoral authority had not yet been determined.

 

Members asked what would happen if coterminosity was not achieved. The ICB stated that, given ministerial support for the Thames Valley ICB, it was reasonable to infer that mayoral arrangements would align with the ICB footprint.

 

Inequalities, Rurality and Data

 

The Committee raised concerns that the word “rural” appeared only once in the report submitted for this item by the ICB and that there had not been sufficient consideration of rural inequalities, which differ from urban inequalities.

Members highlighted that rural areas often suffered from greater data gaps because rural indicators were not routinely gathered, and that lack of access, including transport and service availability, was itself a form of inequality.

 

The ICB acknowledged the imperfection of current data and committed to addressing rural as well as urban inequalities, recognising the need to work in partnership with local authorities to improve understanding and data quality.

 

Members also raised concerns about the ICB’s response to questions on Marmot principles, noting that the response was concerning given previous commitments to work with local authorities on inequality.

 

Public Engagement, Digital Exclusion and Access

 

The Committee expressed concern about how patients and the public were being taken with the reforms, warning that insufficient engagement risked creating public anxiety.

 

Members highlighted very limited public engagement to date, particularly with highly vulnerable populations, including the significant proportion of residents who did not use digital services. Concerns were also raised about travel distances and access to services, particularly for those communities most likely to be left behind.

 

The Managing Director NHS Frimley recognised the importance of transport and access and stated that this reinforced the importance of the neighbourhood agenda, with services closer to home. Wantage Community Hospital was cited as an example of shifting activity from acute to community settings.

 

Governance, Scrutiny and Place-Level Engagement

 

Members questioned where Thames Valley health scrutiny and place-based scrutiny sat within the proposed governance structure, noting that this was not included in the presentation.

 

Questions were also raised about the ongoing involvement of senior ICB representation at place level. The ICB responded that relevant senior staff would attend meetings depending on the item under discussion and suggested this was preferable to continuity of representation.

 

The Committee noted that the full-time Director of Place role had been lost the previous year and expressed concern that continuity of senior representation had been critical to strong relationships with local authorities, providers and effective scrutiny.

 

Funding, Innovation and Sustainability

 

The Committee discussed the reduction in ICB running costs and the separate allocation of approximately £58 million for an Innovation Fund, covering a range of grants from small to large. It was responded to the Committee that an independent panel had been used to assess bids.

Members also questioned the sustainability of this funding and how such a relatively small sum could deliver the transformational change expected across the system.

 

Workforce and Organisational Capacity

 

The Committee raised concerns that voluntary redundancies had taken place before the statutory consultation, questioning the impact on the workforce and organisational capacity.

 

Members expressed concern that, without sight of how functions had changed and where capacity had been reduced, it was not possible for the Committee to scrutinise the implications for service delivery and assurance.

 

Primary Care, Estates and Infrastructure

 

The Committee highlighted significant population growth and worsening access to primary care in some communities, noting that historically the NHS had not always claimed or used available funding for infrastructure.

Members noted that, following scrutiny, the ICB had recruited estates expertise, and asked what the change in capacity now was for work on primary care and estates: whether it had increased, remained the same or reduced.

 

It was responded that the ICB did not possess capital that could easily and directly be utilised for primary care estate, and recognised that this was an ongoing challenge.

 

Safeguarding and Vulnerable Populations

 

Members were concerned about how changes in ICB functions would affect inspection, assurance and oversight, particularly in relation to mental health and learning disability out-of-county placements, in light of recent neglect and abuse scandals elsewhere.

 

The Committee also expressed concern about how capacity changes might affect safeguarding and quality assurance for vulnerable populations.

 

 

ICB constitution and organisational structure:

 

The Committee formally noted its concerns that, by this stage, it had not been provided with the draft ICB constitution or detailed information on the new organisational structure, despite previous assurances.

 

Members observed that the absence of detailed papers beyond the PowerPoint presentation submitted by the ICB meant that it was not possible to gain assurance on a wide range of matters of concern to the Committee and the public.

 

The Committee AGREED to issue the following recommendations:

 

1. For the draft constitution of the Thames Valley ICB to be sent to the BOB JHOC and JHOSCs at place level now and ahead of the first meeting of the ICB.

 

2. For the Thames Valley ICB to ensure that system-level changes are brought to the attention of JHOSCs at Place until the first meeting of the Thames Valley JHOSC, and that the new ICB ensures senior representation of ICB staff to continue to engage with HOSCs during the period of transition toward a Thames Valley JHOSC.

 

3. For the Thames Valley ICB to continue with informal engagements a view to shape the new TV JHOSC constitution and agree a memorandum of understanding between the TV ICB and the new JHOSC.