A report recommending to Council the establishment of a Joint Health Overview and Scrutiny Committee for the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System to consider any substantial development or variation in the provision of health services across the footprint of this area.

The Executive Director of Social Care and Health and the Monitoring Officer submitted a report recommending to Council the establishment of a Joint Health Overview and Scrutiny Committee for the Buckinghamshire, Oxfordshire and Berkshire West (BOB) Integrated Care System (ICS) to consider any substantial development or variation in the provision of health services across the footprint area.  A copy of the draft terms of reference for the Joint Health Overview and Scrutiny Committee was attached to the report at Appendix A.

The report explained that since the creation of the Buckinghamshire, Oxfordshire and Berkshire West Sustainability Transformation Plan in 2015, the health scrutiny leads from across the footprint had met, informally and on an ad hoc basis, with key health partners.  These meetings had been hosted by each authority with the last one having taken place in Buckinghamshire on 15 November 2019.  At that meeting, councillor health scrutiny leads (or representatives) and health scrutiny officers form across the footprint had heard from a number of BOB ICS Leads about the planned activity that was been carried out by the ICS.  It was at this meeting that the proposal to set up a joint health scrutiny committee had first been raised.  Health Services were required to consult a local authority’s Health Overview and Scrutiny Committee about any proposals they had for a substantial development or variation in the provision of health services in their area.  When these substantial developments or variations affected a geographical area that covered more than one authority, the local authorities were required to appoint a Joint Health Overview and Scrutiny Committee (JHOSC) for the purposes of the consultation.  The advice that had been received from the Centre for Public Scrutiny (CfPS) was that it endorsed the need for a joint health scrutiny committee and saw it as a key component of the work of the ICS.

The Council had adopted a Committee system of governance in May 2013 in place of the executive arrangements that had operated since May 2001.  Under the committee system the Council had chosen not to set up any scrutiny and overview Committees.  The statutory scrutiny responsibilities had been embedded in the terms of reference of the standing committees and the Adult Social Care, Children’s Services and Education Committee had Health scrutiny within its remit.

The Kings Fund had published a report in April 2020 “Integrated Care Systems explained: making sense of systems, places and neighbourhoods” which said that NHS England and NHS Improvement had adopted the terminology used in some systems to describe a three tiered model, System, Place and Neighbourhood:

System – Typically covering a population or 1-3 million people with key functions including setting and leading overall strategy, managing collective resources and performance, identifying and sharing best practice to reduce unwarranted variations in care, and leading changes that benefit from working at a larger scale such as digital, estates and workforce transformation.

Place – A town or district within an ICS, typically covering a population of 250-500,000.  This was where the majority of changes to clinical services would be designed and delivered and where population health management would be used to target intervention to particular groups.

Neighbourhood – A small area, typically covering a population of 30-50,000 where groups of GPs and community bases services worked together to deliver co-ordinated pro-active care and support, particularly for groups and individuals with the most complex needs.

The proposal was for ‘System’ activities to be scrutinised by the joint health scrutiny committee and activities at ‘Place’ and ‘Neighbourhood’ being dealt with by the relevant local authority through their existing health scrutiny arrangements.  This terminology had been incorporated into the draft terms of reference and further consideration would be needed to develop a protocol to ensure work was considered at the most appropriate level of scrutiny.

The recommended overall size of the Joint Committee was 19 members with the proposed membership for each of the respective local authorities based on population figures being as follows:

·         7 Members for Oxfordshire; 6 Members for Buckinghamshire; and 6 Members for Berkshire West;

·         Under this arrangement Reading would have two members both of whom could be appointed from the Council’s controlling group.

In addition, there was provision for two co-opted members on the BOB HOSC.

The report explained that to ensure that any local authority within the Joint Committee could independently decide to refer a matter to the Secretary of State the draft Terms of Reference contained a “Notwithstanding clause”.  This would allow member authorities the right to refer an issue to the Department of Health even if the BOB joint scrutiny committee had chosen not to do so.

The Chair of the joint Committee would be elected by the joint committee but would be expected to be a member of the host authority; the host authority would be for a two year period.  The draft terms of reference currently stated that the joint committee would be a standing committee and dates would be organised and put in the Committee Members diaries.  If there was no business to be discussed, then the meeting would be cancelled.

The draft terms of reference set out key issues in relation to the following matters:

·         Defining the work of the joint committee;

·         Membership of the committee;

·         Referral powers to the Secretary of State;

·         Frequency of meetings;

·         Election of Chairman and determining the host authority.

Resolved –    That the Joint Health Overview and Scrutiny Report be recommended to Council on 26 May 2021 for approval