Agenda item

The Integrated Care Board submits a report to provide an update on the national reform of the NHS operating model across England, which will involve the integration of the Department of Health and Social Care and NHS England, and a changed role for ICBs.

The Chief Strategy officer for the Leicester, Leicestershire and Rutland Integrated Care Board submitted a report to update the commission on national reform of the NHS operating model across England which will involve the integration of the Department of Health and Social Care and NHS England, and a changed role for ICBs.

It was noted that:

·       Dr Sanganee provided a brief update on the presentation slides and the reconfiguration process, including the clustering arrangements with Northamptonshire to form the LNR.

·       LLR and Northamptonshire ICBs remain separate statutory bodies. Working in partnership, however over time they would work as one cluster with

­    Single Board Governance

­    Unified Leadership Team

­   Shared staffing structure

·       Building a transformational cluster between NICB and LLR ICBs provided the opportunity to drive forward the Ten-Year Plan within communities and neighbourhoods, to continue improving health outcomes, while at the same time rising to the very real financial challenges faced

·       It was reported that the 10-year health plan had been launched, alongside structural changes within NHS England, with ICBs required to reduce their running costs by 50%. This would have significant impacts nationally.

·       The clustering process was explained as not being a merger, but separate bodies working in partnership under a single board governance structure. Progress was continuing at this stage.

·       Nationally, chair arrangements had been announced. For the LNR cluster, Anu Singh (former chair in the Black Country) had been appointed, and Toby Sanders, Chief Executive, would be the Chief Executive across the cluster. Further national announcements were still awaited.

·       Reference was made to the model ICB blueprint and running cost requirements, noting that Northamptonshire was already implementing these changes.

·       The Leicester, Leicestershire and Rutland ICB replaced the Leicester City, East Leicestershire and Rutland and West Leicestershire clinical commissioning groups. The ICB manages the budget for the provision of NHS services in LLR

·       The commission cycle was described as something already in practice, supporting stronger organisations through reductions in operational work.

·       The focus remained on the health and wellbeing of the population, delivering high-quality care, reducing waiting times and improving patient experience.

·       Partnership working with organisations and community leaders was ongoing, and the role of local authority colleagues was highlighted as increasingly important.

·       The cluster design and functions were outlined as a developing process, with an emphasis on keeping partners informed.

In discussions with Members and Youth Representatives, it was noted:

·       Members raised concerns that documents presented to the commission in March had been out of date.

·       It was confirmed that Paula Clark remained ICB Chair until 1 October when Anu Singh would take over a new Chair.

·       Concerns were raised around the complexity of the new structure, the lack of visibility of leaders attending Scrutiny Commission Meetings and how accountability would be maintained across Leicester, Leicestershire and Northamptonshire.

·       Concerns were expressed that the reports provided contained little information about Northamptonshire, and it was questioned how accountability would be ensured.

·       Members acknowledged the challenges for staff and suggested it would be helpful for the new Chief Executive and Chair to attend scrutiny in future

·       It was explained that both ICBs would remain statutory organisations with accountability through health overview and scrutiny, supported by a joint leadership team working across the LNR footprint.

·       Job losses were expected to be around a third, though exact figures were still subject to national negotiations.

·       Assurances were given that access and quality of care would remain the same, with further updates to follow as the national process developed.

·       Discussion took place on who the new structure would ultimately be accountable to. It was confirmed that accountability would remain dual, with scrutiny continuing in both LLR and Northamptonshire.

·       It was noted that under the national ICB blueprint, some functions would be transferred to providers, local authorities or other partners. This was still being worked through nationally and locally, with assurances that any transfers would be carried out safely, with engagement and without adverse impact on partners. Engagement with scrutiny would continue and updates would be provided.

·       Concerns were expressed that some changes had already been identified without wider awareness, and members requested early sight of such developments. It was clarified that organisational functions and commissioning decisions were distinct. Commissioning decisions would continue to be taken in partnership and subject to equity and quality impact assessments, with input from public health colleagues.

·       It was confirmed that preventing miscommunication between sectors was a high priority. Work was underway to improve interface working between GPs, hospitals and specialists, strengthen handovers, and integrate services around primary care and communities through the neighbourhood model. Communication with patients and the public was also being strengthened.

·       Members highlighted the importance of community leadership in shaping services. It was reported that strong relationships already existed with community teams and leaders, and more work would be undertaken to allow services to develop locally. Patient and citizen voices were identified as central to future service design.

·       Concerns were raised about the role of GPs as coordinators of services given reliance on locums and high staff turnover. It was confirmed that primary care networks would be fundamental building blocks of neighbourhood teams. In some areas GPs would lead, while in others community services would do so. Mapping work was being carried out to align GP, community, local authority and voluntary sector services.

·       Clarification was sought on the appointment of a new Chief Executive. It was explained that national guidance was being followed and the update was the most accurate available. Once confirmation was received, positions would be announced and new leaders would engage directly with scrutiny. Interim arrangements remained complex, with leadership currently working across two patches.

·       Members questioned how prevention, neighbourhood working and high-quality care could be delivered with reduced budgets and frozen posts. It was explained that the changes reflected the national agenda and the 10-year health plan. While impacts would not be immediate, the intention was to reduce duplication, particularly between NHS England and ICBs, and to streamline governance. The principles of accessible, local and high-quality care remained central, though commissioning and governance processes would evolve.

·       The NHS acute trust league table was discussed following the publication of a new national oversight framework. It was reported that the local trust had been placed in segment 3, reflecting its financial deficit but also recognising improvements in patient experience, quality and financial governance. The trust had exited the recovery support programme, showing progress compared to three or four years ago, though further improvement was required. The framework was acknowledged as complex, but the results reflected both challenges and areas of positive progress.

AGREED:

1.    That the report be noted.

2.    That acute trust performance would be brought back to a future meeting for further scrutiny

3.    The structure of the LNR be added to the work programme.