Agenda item

To consider an update on the recent restructure of the North East and North Cumbria Integrated Care Board (NENC ICB).

The Committee received an update following the recent restructuring of North East and North Cumbria Integrated Care Board (NENC ICB).  Led by the NENC ICB Director of Policy, Involvement and Stakeholder Affairs, content included:

·       ICB 2.0 Organisational Restructure: A new way of working

·       Significant change

·       Executive team

·       The NENC way

·       Local Delivery Team comparison

·       Contracting and devolution of budgets

·       Networks and workstreams

·       Example - Clinical Networks and ODNs

·       Initial work - Networks and Alliances

·       Still work to do…

The Committee was informed that the NHS typically went through a period of restructure approximately every decade.  However, the formal implementation of the new national Integrated Care System (ICS) less than two years ago (mid-2022) already involved the merging of eight former Clinical Commissioning Groups (CCGs) into one regional organisation – the NENC ICB.  In addition, from the onset of these new arrangements, further responsibilities were adopted and other subsequent delegations (i.e. pharmacy / optometry and dental in April 2023) had followed, with more anticipated in relation to specialist commissioning.  Despite their relative infancy, ICBs had been instructed to reduce running costs by 30%, a task the NENC ICB was still working through (though around 100 posts had already been lost) – this exercise involved collaboration with each of the 14 Local Authority areas within the NENC footprint, reflecting the ICBs ‘place-based’ working approach.

Moving forward, several key elements would underpin ‘the NENC way’ – these included a clinically-led (multi-disciplinary) and managerially-enabled focus, a structure involving eight directorates with eight executive directors, and enabling and delivery teams (the latter seeing six teams mapped to the 14 Local Authority partners, one of which would be ‘Tees Valley’ (comprising five Local Authorities)) concentrated on the delivering the vision and constitutional standards.  Local committees mapped to each Local Authority area would continue.

Networks and workstreams were charted, with some inherited, some developing, and all at different levels of maturity.  Clinical networks were either managed by NHS England or were transitioning to the ICB.  Operational Delivery Networks (ODNs), managed within acute provider organisations but accountable to NHS England, outlined how pathways needed to work – these were listed along with the NENC clinical networks.  Regarding the latter, thematic groupings / alliances were being developed to give a better strategic view of specific health conditions.

In terms of work still to do, it was expected that the mapping of system, clinical, corporate and operational delivery networks and workstreams would conclude by April 2024, and that a set of recommendations would then be created which contributed towards a streamlined organisation (reducing duplication), ensured work was aligned to the NENC ICBs Better Health and Wellbeing for All strategy, and enabled teams to deliver in accordance with a clear Terms of Reference.  Clarity around funding and reporting mechanisms, as well as the provision of effective communication across the wider health and care system, was also envisaged.

Thanking the NENC ICB representative for the presentation, the Committee immediately drew attention to the quoted loss of 100 posts (following the request to reduce running costs by 30%) and the potential for significant redundancy costs.  In response, Members heard that the ICB inherited all CCG staff when it came into being, some of whom were permanent and others who were on a fixed-term contract.  Opportunities to apply for voluntary redundancy / early retirement were offered, and assurance was given that there were no additional costs incurred in relation to this reduction in the workforce.  It was noted that the vast majority of ICB expenditure was on its staffing resource.

Referencing the ‘Initial work – Networks and Alliances’ slide, the Committee commented that a number of the nine categories appeared to have some form of crossover with other identified themes listed.  Members were informed that the nine groupings merely represented initial thoughts, however, once confirmed, the work of these networks / alliances should benefit from a simpler decision-making process that a single ICB allowed (as opposed to the CCG era where strategic decision-making proved more challenging).

The Committee highlighted instances of people across Tees Valley accessing services in North Yorkshire (e.g. Friarage Hospital, Northallerton) and were given subsequent assurance that collaborative arrangements with neighbouring ICBs were in place to address issues that arose.  Members welcomed this, though also called for developments which may have an impact on the people of Tees Valley, wherever this may be, to be appropriately scrutinised (the former Durham, Tees Valley and North Yorkshire joint health scrutiny committee was referenced).

AGREED that the North East and North Cumbria Integrated Care Board restructure information be noted.