Agenda item

The Chair advised the Board that given the urgency and pace of change within the Integrated Care Board, he had asked the Deputy Chief Executive Officer, NHS Dorset, to come to the Board and provide an update. 

The presentation included information regarding:

• The changing context – the scale of change
• A new model – model ICB blueprint
• The changing health and care landscape
• Strategic commissioning – what does it mean?
• How strategic commissioning would help focus on the longer view, on value and on early help & prevention
• Why this approach?
• The need for change
• Operational, target-driven focus misses the big picture opportunity
• Cluster arrangements: pre-cursor to merger and devolution
• Thinking about devolution…
• Still to come: the 10-year plan for health
• Next steps & timelines

During the presentation, the Board was updated on national changes to Integrated Care Boards (ICBs), which included a 50% reduction in running costs and significant job losses. The Board was advised that Dorset ICB was expected to lose 200–250 staff. The plan was for a cluster to be formed with Somerset and Bath and NE, Somerset, Swindon and Wiltshire (known as BSW) ICBs, transitioning to a shadow single ICB by April 2026, with a full merger anticipated by April 2027.

The Chief Executive, NHS Dorset, highlighted that some original ICB cluster proposals did not align with devolution boundaries, prompting pushback from central government. The Board was advised that alignment would likely be required as the transition progressed and confirmed that the proposals were under review by the Secretary of State for Health and Social Care.

The Chief Executive, NHS Dorset, also raised concerns about the local impact of national NHS workforce reductions, with Dorset expecting to lose up to 250 staff. Combined with local authority reductions, this posed risks to local employment and economic growth. She warned that insufficient re-employment opportunities could increase pressure on health inequality services due to reduced household income.

The Board discussed the presentation and in response to queries, was advised:

• The pace of change presented both professional and personal challenges for those involved, particularly whilst maintaining business as usual during the transition.
• The current safeguarding arrangements across Dorset and BCP were already resource-intensive, and there were concerns about how these would be managed under a shadow ICB structure before legislative changes were implemented.
• It was noted that concerns had been raised in both adults’ and children’s social care, with the hope that messages around capacity would be supported across the system.
• Multiple reforms were underway, particularly in children’s social care, and there were questions about whether there was sufficient capacity and understanding to deliver the required multi-agency responses.
• No additional capacity had been provided to health colleagues to support the transformation, and this was acknowledged as a significant issue.
• Directors of Public Health across the new cluster area were meeting regularly to consider how they could support the ICB’s population health responsibilities.
• The wider system’s capabilities would be important in light of expected headcount reductions across all ICBs, and there was a commitment to collaborative working.
• Nationally mandated changes were not subject to local scrutiny committee approval, but the ICB remained committed to keeping partners informed and was willing to attend scrutiny meetings to provide updates.
• Once the cluster proposals were approved by NHS England, an equality impact assessment would be undertaken and shared with the ICB Board at a future public meeting. ACTION.