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This diagram shows three concurrent process whereby the ICB has to get a better picture of its shorter spending, reduce the system deficit to £50m and then work on long-term reset from 2025.

BOB ICB Board Meeting – 29th May 2024 

Summary for VCSE Health Alliance 

Immediate grip, long-term reset: the ICB Board 21st May 

The BOB ICB Board continues to perform its leadership role at three levels: first is overseeing the management of the ICB as an organisation; second is the operational leadership role of the NHS health care providers; the third is a system convening role with wider public sector and VCSE organisations in BOB.

What we’re seeing here at the latest meeting (21st May 2024) is a greater focus on the second level. In this article, we draw attention to key issues relevant to the VCSE sector.  \

Multiple moves

The ICB is running an extended consultation about a staff re-organisation at the same time as moving the ICB office in Oxford.

The ICB is required nationally to save 30% of its core operating budget within two years but this doesn’t simply translate into a 30% reduction in staffing numbers because of mixed funding sources.

This is also tied up with a lot of changes as the ICB takes on specialised health care commissioning that had been held centrally by NHS England and works through how to balance system-wide with locally owned approaches. This came out quite well in the primary care strategy discussion where it’s understood that the goals and desired outcomes are determined BOB-wide after extensive consultation but the implementation (the ‘how’) will be localised and variable down to the level of each GP practice. 

What does it mean for VCSE? What we can expect is that the new ICB staff structure will begin to appear in the autumn with new roles and some people in new or revised roles. 

Balancing the books? 

Within the NHS health care system, there is significant pressure on the NHS Trusts and ICB collectively to constrain spending, which is set to amount to around £3.5bn in 2024/25.

The ICB is negotiating with NHS England about the acceptable and realistic level of overspending. The current figures are a planned NHS system deficit of £92m at the end of 2024/25 but the pressure is to get this down to £50m deficit. It’s not clear how that ‘saving’ would be realised within 10 months at the same time as delivering against national guidance and targets, let alone locally determined system priorities. 

The Board acknowledged that spending growth was going into mental health (with learning disability and autism) thanks to the mental health investment standard and the additional roles in primary care rather than the acute trusts. The acute trust representative was hopeful of seeing the benefit of this shift in easing pressure on acute services materialise this financial year.

The diagram below is worth a look to get a sense of the narrative: this is all being overseen by a system transformation & recovery board. 

What does it mean for VCSE?

It seems important to work out where partnership progress can be made in this highly constrained environment – and where it can’t, at least not this year.

We think the first is the primary care strategy which provides opportunities for new local conversations with PCNs and GP practices about prevention, inequalities and neighbourhood approaches; the other is the mental health, learning disability and autism because of the national standard and the recent work on transitions to adulthood. 

This diagram shows three concurrent process whereby the ICB has to get a better picture of its shorter spending, reduce the system deficit to £50m and then work on long-term reset from 2025.

Wider system leadership: keep talking!

The ICB is required to review and/or revise its Joint Forward Plan (JFP) which is NHS-focused. The original was developed with wider partners from VCSE and local government and published in July 2023. The JFP will continue to provide the strategic framework for NHS delivery.

In addition, there will be a number of system priorities. The first draft prioritisation proposed 14 which were then reduced to six. We have covered these before as the ‘system goals’ [LINK]. It looks like the system goals have now been reframed around the above turnaround programme for the next 10 months.  

The Alliance continues to have good engagement with the ICB on some topics and events more than others.

We were pleased to find several senior nurses working in charities who could attend the first BOB ICS Nursing & Midwifery Forum with ICB chief nurse Rachael Corser and national nursing leaders.

The VCSE input and role around social prescribing and neighbourhood teams were highly visible in the finalised primary care strategy and the report on system partner and public engagement. 

BOB VCSE Annual Health Assembly

Sim Scavazza, the ICB Chair, has accepted an invitation to address the BOB VCSE Health Assembly on Thursday 13th June to provide her assessment of NHS and system progress. She’ll also be taking questions and commenting there on the results of our membership survey which is live now. She mentions this in her Chair’s update paper for the Board. 

Please register for the Assembly here and complete the survey here. 

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