Agenda item

To receive a report on the changes relating to NHS England, Integrated Care Board and Healthwatch from Kirklees Health Partners.

Contact: Nicola Sylvester, Principal Governance and Democratic Engagement Officer. Tel : 01484 221000.

The panel received a presentation outlining proposed national and regional changes affecting NHS England, Integrated Care Boards (ICBs), and Healthwatch, and the implications for Kirklees. The presentation had been requested to provide assurance on governance, accountability, resource allocation, risk, finance and performance, and to clarify how relationships, local knowledge, and influence at place level would be maintained through the forthcoming reforms. The panel noted that the changes were intended to support strategic commissioning, population health improvement and the reduction of health inequalities.

The panel was advised of the future health and care landscape, including the evolving role of the ICB as a strategic commissioner, system convenor and integrator of services across West Yorkshire. Details were provided on the planned organisational redesign, including the move to three integrator teams and the consolidation of corporate and strategic commissioning functions. The panel noted that the future model would involve a significant reduction in establishment and that some functions would ultimately transfer to regional, national or provider-level organisations in line with national blueprints.

The presentation set out proposals for the development of the Kirklees Place Provider Partnership, including its vision, priorities and operating model. The panel noted that the partnership was intended to provide a stronger place-based approach, with greater collaboration between providers and increased autonomy over service delivery, while statutory accountability would remain with the West Yorkshire ICB. It was confirmed that the partnership would operate in shadow form from 1 April 2026, with no change to existing schemes of delegation or legal responsibilities during 2026/27, and that formal contracting arrangements were not expected to begin until April 2027.

The panel also considered the proposed governance arrangements for the Place Provider Partnership. It was reported that the approach aimed to reduce duplication, streamline decision?making and clarify accountability, while preserving arrangements that were working well. The panel noted that the Kirklees ICB Committee would continue in a streamlined form, alongside the shadow operation of the Place Provider Partnership, with collaborative

discussion taking place in advance of formal assurance and decision?making.

Finally, the panel received a presentation on proposed national changes to Healthwatch, including government intentions to abolish Healthwatch England and local Healthwatch networks, with legislative change expected from March 2027. The panel noted the risks highlighted if the independent patient and public voice were lost, including reduced trust, weaker challenge and reduced visibility of inequalities. Assurance was provided that Healthwatch Kirklees intended to continue operating as an independent charity and was actively exploring alternative funding to ensure that local people’s voices continued to inform health, social care and wellbeing services in Kirklees and Calderdale.

Questions and comments were invited from Members of the Health and Social Care Scrutiny Panel, and the following was raised:

·       The panel asked when the governance documentation for the Kirklees Place Provider Partnership (including terms of reference and memoranda of understanding) would be available for scrutiny review.

In response, it was confirmed that the documents had been developed at West Yorkshire level, were in draft form, and were expected to be circulated to all partners imminently, supported by accompanying communications.

·       The panel questioned whether all partners had signed up to the Place Provider Partnership and how decisions would be taken during the shadow phase.  It was explained that all statutory partners were engaged in development sessions, with chief executives represented at place level, and that the partnership would operate in shadow form with decision?making powers delegated through contracts from the West Yorkshire ICB.

·       The panel raised concerns about why Kirkwood Hospice was not proposed as a full member of the partnership and how smaller providers’ voices would be protected.  The response clarified that membership status related to statutory and financial accountability rather than exclusion, and that hospices and other specialist providers would be fully involved in relevant sub?groups where their expertise was most appropriate.

·       The panel sought clarity on whether the Place Provider Partnership itself would be a formal decision?making body.  It was confirmed that commissioning intentions and budgets would remain with the West Yorkshire ICB initially, with defined decision?making authority delegated to place within agreed financial envelopes.

·       The panel asked who sat on the Design Group leading the development of the partnership and what role Kirklees Council had played.  It was confirmed that the Design Group included representatives from local authorities, NHS providers and the voluntary sector, and that Kirklees Council officers had been actively involved throughout the development process.

·       The panel queried when the memorandum of understanding would be shared with Kirklees Council and whether scrutiny would have an opportunity to influence it.  It was stated that the intention was to share the document that week, with it going through partner organisations’ internal governance processes, including the Council’s executive arrangements.

·       The panel expressed concern about conflicts of interest, particularly in relation to commissioning decisions such as end?of?life care.  It was confirmed that existing conflict?of?interest processes would be retained and embedded within the new governance arrangements.

·       The panel highlighted concerns about the pace of change and limited engagement with overview and scrutiny bodies.  In response, officers acknowledged the speed of the reforms and undertook to raise the need for wider scrutiny engagement, including at West Yorkshire level.

·       The panel requested that the ICB return to scrutiny for a fuller discussion on governance and accountability before the new system went live.

·       The panel asked how scrutiny and Healthwatch would be informed of, and influence, major commissioning decisions under the new arrangements.  It was explained that discussions were ongoing locally and at West Yorkshire level to ensure public and patient voice continued to shape decision?making, including mapping current engagement mechanisms and identifying gaps.

·       The panel raised concerns about the loss of an independent statutory voice if Healthwatch were abolished.  It was confirmed that the proposed changes were national policy decisions, not locally driven, but that maintaining independence of engagement was recognised as essential.

·       The panel questioned how independence, transparency and trust would be preserved if engagement functions moved into statutory bodies. It was stated that options were being explored to commission independent engagement functions in future, even if Healthwatch ceased to exist as a statutory body.

·       The panel asked whether Healthwatch, if operating only as a charity, would retain sufficient influence on behalf of patients and residents.

·       It was acknowledged that statutory powers would be lost, but that there was an expectation that the value and credibility of independent patient voice would continue to carry influence within decision?making forums.

·       The panel sought clarity on whether Healthwatch organisations could still be commissioned after legislative change.  It was confirmed that while Healthwatch as a statutory body would cease, charities currently delivering Healthwatch functions could continue under different arrangements and potentially be commissioned if local systems chose to do so.

·       The panel expressed concern about the impact on seldom?heard communities and people reluctant to raise concerns directly with service providers.  It was recognised that this was a key risk of the reforms and one of the strongest arguments for retaining an independent engagement function.

RESOLVED –

1)    That officers from the ICB be thanked for their presentation and attendance at the meeting.

2)    That representatives from the ICB be invited to attend a future meeting of the Panel to provide a comprehensive explanation of the governance model, including decision?making arrangements, accountability, risk management and how the model would be subject to overview and scrutiny.