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.