To examine proposed changes to The NHS Herefordshire and Worcestershire Integrated Care Board, and their implications for the delivery of health and social care services in Herefordshire.

The committee received a report on the Integrated Care Board (ICB) reset. 

Simon Trickett, Chief Executive of NHS Herefordshire and Worcestershire ICB, presented the key elements of the reset, supported by David Mehaffey, Executive Director: Strategy, Health Inequalities and Integration.

The principal points of the discussion are summarised below:

1. The government has introduced a new 10-year plan for the NHS, with a central requirement for ICBs to reduce their running costs by 50%. For Herefordshire and Worcestershire this equates to a 43% cut, amounting to £12m savings by April 2026. 

2. This will include a reduction of 150–200 posts, though these will be confined to managerial and back-office functions. Frontline clinical roles will not be affected. 

3. An expression of interest has been run in a voluntary redundancy scheme with around 40 expressions of interest received to date. However, Treasury approval for redundancy funding has not yet been finalised. Natural turnover and vacancy management are expected to reduce compulsory redundancies.

4. To deliver efficiencies, Herefordshire and Worcestershire ICB will cluster with Coventry and Warwickshire ICB. The two organisations will remain separate statutory bodies, but a single executive team will operate across both areas. This will stretch capacity but is considered necessary to meet savings targets.

5. Several members expressed concern that Herefordshire, as the smallest partner in the new cluster, could lose influence. In response, the Chief Executive gave reassurance that strong local authority representation would remain, highlighting the active role of Herefordshire Council’s Chief Executive on the existing ICB board. 

6. Members emphasized that Herefordshire’s rural context is very different to urban areas, and questioned whether ‘neighbourhood health hubs’ designed for populations of 30–50,000 were suitable for market towns and rural communities. In response, the Executive Director: Strategy, Health Inequalities and Integration noted that national policy must be adapted to local geography, with outreach and mobile provision considered. 

7. Concern was raised about reliance on digital systems when some residents lack broadband or smartphones. The Executive Director: Strategy, Health Inequalities and Integration confirmed that while digital access would be expanded, face-to-face and outreach services would remain. 

8. The committee revisited the ongoing closure of MIUs at Leominster and Ross. Members questioned how new hubs could be developed when services had not been restored. The Chief Executive acknowledged the strength of feeling locally, but explained that staffing shortages, particularly of emergency nurse practitioners, made it difficult to reopen smaller MIUs. It was emphasized that new hubs should provide broader urgent primary care, including minor illness, which could be an improvement on previous MIU provision. 

9. Questions were asked about accountability mechanisms. It was noted that oversight and scrutiny arrangements for each local authority would continue, though with a wider geography covered moving forward. 

10. Members asked how GP practices would feature in the new arrangements. The Chief Executive highlighted that Herefordshire’s GP performance is strong nationally, and primary care networks (PCNs) would also help to form the backbone of neighbourhood health. 

11. The Director of Public Health stressed the opportunity to use data to target interventions at high-risk populations, reducing  ...  view the full minutes text for item 69