Fiona Wise, Executive Lead, Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS), submitted a paper entitled “The Future Arrangements for NHS Commissioning in your area” that sought views on the future arrangements for NHS commissioning in Buckinghamshire, Oxfordshire and Berkshire West.

The engagement period had begun to gather feedback on proposals about ways of working to support changes to NHS commissioning within the BOB ICS and would run until midnight on 1 December 2019.  Views were sought on the following two new ways of working:

• Local working in each of the three counties (the ‘integrated care partnerships’);
• Wider, at-scale working, across the three areas (the ‘integrated care system’).

Engagement was being carried out before the production of any Case for Change document was produced and was not part of any process the service was required to do; the intention was to have a dialogue to inform the Case for Change document by finding out what was really important to local partners.  Views were being sought on the following three proposals for change:

• Appointment of a single Accountable Officer and Shared Management Team across the BOB geography;
• Design of stronger Integrated Care Partnerships which were constituted using a set of common principles;
• A proposal to create a single commissioning organisation across the BOB geography.

In addition, NHS England were proposing that some commissioning services that they currently held, and that used to be commissioned locally, should be taken back at local level and commissioned by the CCG, for example, primary care services such as pharmacy services and ophthalmology.  This was due to the bigger framework that would result locally from the proposed changes and would also include some specialised services.  In addition, there was a requirement to reduce costs by 20% with the aim being to make reductions at a strategic level so that more funding could be allocated at local level.

There was a desire for local decision making and to give more responsibility to partners to do the best for the local population; the key to this would be the Integrated Care Partnership.  Decisions were also being taken countrywide with a general expectation to reduce the number of CCGs (and to align them with ICS footprints so that there is typically one CCG per ICS) and the costs of running them, although a merger of the CCGs in the local area would not take place any earlier than 2021.  However, there was a requirement to move to a shared financial control model by April 2020 and there had been a commitment by all those involved to set out what this shared financial control might be by Christmas 2019; a Case for Change document would not be published until this had been made clear.

The Committee discussed the proposals set out in the engagement document and a number of points and comments were made including the following:

• The proposals would need to be considered in the context of whether or not other decisions had been taken, or were going to be taken, nationally by NHS England;
• Partners working together to address local issues and looking at what local people needed, as had been happening in Berkshire West, was seen as being a better model than the much wider commissioning areas that was being proposed;
• The move to a wider commissioning area would need to be considered in terms of what the Council was trying to achieve;
• Budget control on the larger geographical area was also seen as a potential issue and there would need to be transparency around monies that were allocated to Reading and how it would be spent;
• It would not be possible to comment on the financial model as this would only be agreed initially by Christmas 2019;
• Governance and decision making of the wider area would also need to be clear, transparent and open and it would need to be made clear how decisions related to the local area;
• Clarity would also need to be sought on how Reading and the BOB ICS ensured that decision making was transparent for the local area working with all partners, how such decision making could be made real in the proposal and how local decision making would be embedded in the proposals;
• The proposals were seen as being NHS/Health centric and had little to do with social care and were primarily about the organisation of the Health Service at a high management level and not about frontline staff;
• In March 2013 the Strategic Health Authorities and Primary Care Trusts had been abolished as it was said that they had been too remote from the people on whose behalf decisions were being made, this had cost £2 billion, and it appeared that these proposals were taking the organisation back to the same position.

Finally, the Committee agreed that the views and comments detailed above should be put together by the Chair and the Lead Councillor for Health, Wellbeing and Sport and that a response to the engagement document submitted on behalf of the Committee.  The Committee noted that the deadline for submission is 1 December 2019.

Resolved –    That the views and comments detailed above be put together by the Chair and the Lead Councillor for Health, Wellbeing and Sport and a response to the engagement document submitted on behalf of the Committee.