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The ICB Board update: strikes, SEND and financial challenges 

“Clearly we need to sort out the here and now… but we rapidly need to start thinking differently about how we deliver services. […] Investing more in community services, primary care, focusing far more on prevention, delivering pro-active care to people with long-term conditions will be not only the right thing clinically but also financially.” Nick Broughton, ICB CEO, at the ICB Board on 21 November in Newbury. 

Nick Broughton
Nick Broughton

The last ICB Board meeting took place on 21st November in Newbury: Board papers and recordings are publicly available. Nick Broughton’s CEO report provide a good sense of what’s going on. This time, the report noted that 25,000 appointments had to be re-arranged during industrial action in early October and noted the open ballot on further action by the BMA. Oxfordshire’s SEND inspection had found widespread or systemic failings, which must be urgently addressed; an action plan has been submitted to Ofsted and the Care Quality Commission and the council coalition has changed. 

The CEO report recognises that local authority partners are continuing to experience:

“significant financial challenges particularly reflecting the increasing demand for temporary accommodation, home to school transport, children’s services especially those for children with SEND, and support and long-term care for older adults”. 

Nick Broughton noted that he had brought system partners, including the VCSE, together at a leadership forum in late October (Garry Poulson and Stephen Barnett attended for the Alliance). We heard from Professor Mark Britnell on Global Lessons in Integrated Care which led into a discussion round that produced a longlist of potential system priorities for 2024/25. 

Alongside this development of system and partnership working, the CEO report talks about mid-year adjustments to operational and financial plans being undertaken across England. Across the ICS, the NHS partners are at a £59m deficit at the half-year point (on an indicative annual budget of £3.2bn) due to “inflationary pressures, industrial action, prescribing and continuing health care” (item 14 Finance report). From the NHS viewpoint, financial balance is among the national NHS priorities: 

“The agreed priorities for the NHS for the remainder of this financial year are to achieve financial balance, protect patient safety and prioritise emergency performance and capacity, whilst protecting urgent care, and both high priority elective and cancer care.” (Item 7 CEO report) 

Some of the ICB executive team had attended a South East strategy day whose key theme was balancing short-term challenges with long-term transformation. In particular, population health management, elective recovery, specialised services, productivity and workforce transformation were on the agenda. Looking ahead to 2024/25, the NHS budget for BOB is expected to rise by 3.2% but the ICB expects to have to have to reduce by its own operating budget –there should be more information on this after the January Board meeting. 

The 2024/25 priorities paper cited above was first circulated to the ICB Board and to the Integrated Care Partnership meeting in November. This sets out a longlist of thirteen potential priorities for system working across the four objectives of integrated care systems. Those with VCSE relevance seem to be improving children’s mental health and wellbeing; investment in our most deprived communities; and developing integrated neighbourhood teams. The Alliance has been asked for further input on this and we’ve emphasised prevention, health inequalities and community solutions. 

Rachel De Caux, ICB Chief Medical Officer and Sarah Adair, ICB Head of Communication drew attention to the engagement around the primary care strategy which is open here: https://yourvoicebob-icb.uk.engagementhq.com/primary-care-conversation. 

The next ICB Board will be held on 16th January in Aylesbury and you can register to watch a livestream here: https://www.bucksoxonberksw.icb.nhs.uk/about-us/board-meetings/  

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