The Buckinghamshire, Oxfordshire, and Berkshire West Joint Health Overview Scrutiny Committee met on Tuesday, 17 March 2026, to discuss the establishment of the Thames Valley Integrated Care Board (ICB) and related organisational changes within the NHS. The committee expressed significant concerns regarding transparency, public engagement, and the potential impact of these reforms on local services and vulnerable populations, ultimately agreeing to issue several recommendations to the Thames Valley ICB.

Buckinghamshire, Oxfordshire, and Berkshire West Integrated Care Board Update

The primary focus of the meeting was an update on the establishment of the Thames Valley ICB, presented by Sam Burrows, Managing Director of NHS Frimley ICB, and Caroline Corrigan, Chief Transition Officer. The committee raised numerous concerns about the process and the potential implications of the changes.

Consultation and Public Engagement: A key point of contention was the decision not to undertake formal public consultation for the new ICB, a departure from previous transitions. The committee noted that councillors were accustomed to extensive consultation for local authority reforms and expressed concern that these significant changes, encompassing neighbourhood working and place-based arrangements, were not subject to the same level of public scrutiny. The ICB stated this was a national decision, viewing the changes as organisational rather than directly impacting services. However, the committee reiterated its demand for transparency and engagement, particularly regarding the draft ICB constitution. While the ICB agreed to share the draft constitution and welcomed engagement with scrutiny, this was noted to be within national constraints.

Local Authority Representation and Partnership Working: The committee stressed the importance of improved local authority representation within the new arrangements. While the ICB committed to working in partnership with local authorities and acknowledged the challenges faced by those experiencing significant population growth, the proposed local authority roles on the ICB Board were clarified as providing expertise rather than formal representation of individual councils.

Healthwatch and the Patient Voice: The committee highlighted the crucial role of Healthwatch as an independent voice and a bridge between the public and the NHS. They reiterated their unanimous view from a previous meeting that the Healthwatch function must be retained as an independent local voice. While the ICB acknowledged the importance of a strong patient voice, the future of Healthwatch was noted as dependent on legislation and not yet fully clear. Concerns were raised about the lack of detail shared regarding proposals for the abolition of local Healthwatch, with members stressing the need for an independent voice during this period of transformation.

Inequalities, Rurality, and Data: The committee expressed concern that the report submitted by the ICB contained insufficient consideration of rural inequalities, which they argued differ from urban inequalities. They highlighted data gaps in rural areas and the challenges of access, including transport and service availability, as forms of inequality. The ICB acknowledged data imperfections and committed to addressing rural as well as urban inequalities, recognising the need for partnership with local authorities to improve understanding and data quality. Concerns were also raised about the ICB's response to questions on Marmot principles¹, given previous commitments to work with local authorities on inequality.

Public Engagement, Digital Exclusion, and Access: The committee warned that insufficient engagement risked creating public anxiety. They highlighted limited public engagement to date, particularly with vulnerable populations who do not use digital services, and raised concerns about travel distances and access to services. The Managing Director of NHS Frimley acknowledged the importance of transport and access, reinforcing the need for neighbourhood-based services closer to home.

Governance, Scrutiny, and Place-Level Engagement: Questions were raised about the placement of Thames Valley health scrutiny and place-based scrutiny within the proposed governance structure. Concerns were also voiced about the continuity of senior ICB representation at the place level, noting the loss of a full-time Director of Place role and its impact on relationships with local authorities and providers.

Funding, Innovation, and Sustainability: The committee discussed the reduction in ICB running costs and the allocation of approximately £58 million for an Innovation Fund. Questions were raised about the sustainability of this funding and its capacity to deliver the expected transformational change.

Workforce and Organisational Capacity: Concerns were raised about voluntary redundancies occurring before statutory consultation and the potential impact on workforce and organisational capacity. The committee stated that without sight of how functions had changed and where capacity had been reduced, it was impossible to scrutinise the implications for service delivery.

Primary Care, Estates, and Infrastructure: The committee highlighted significant population growth and worsening access to primary care in some communities. They questioned the change in capacity for work on primary care and estates, noting that the ICB did not possess capital that could easily be directly utilised for primary care estates.

Safeguarding and Vulnerable Populations: Members were concerned about how changes in ICB functions would affect inspection, assurance, and oversight, particularly in relation to mental health and learning disability out-of-county placements. Concerns were also expressed about how capacity changes might affect safeguarding and quality assurance for vulnerable populations.

ICB Constitution and Organisational Structure: The committee formally noted its concerns that, by this stage, it had not been provided with the draft ICB constitution or detailed information on the new organisational structure, despite previous assurances. The absence of detailed papers beyond the PowerPoint presentation meant it was not possible to gain assurance on a wide range of matters of concern.

The committee agreed to issue the following recommendations:

• For the draft constitution of the Thames Valley ICB to be sent to the BOB JHOC and JHOSCs at place level now and ahead of the first meeting of the ICB.
• For the Thames Valley ICB to ensure that system-level changes are brought to the attention of JHOSCs at Place until the first meeting of the Thames Valley JHOSC, and that the new ICB ensures senior representation of ICB staff to continue to engage with HOSCs during the period of transition toward a Thames Valley JHOSC.
• For the Thames Valley ICB to continue with informal engagements with a view to shape the new TV JHOSC constitution and agree a memorandum of understanding between the TV ICB and the new JHOSC.

Forward Work Plan

The committee noted that this was expected to be the final meeting of the Buckinghamshire, Oxfordshire, and Berkshire West Joint Health Overview Scrutiny Committee (BOB JHOSC), subject to the establishment of the Thames Valley ICB. A new Thames Valley JHOSC was to be established, which would include additional Local Authorities falling within the new Thames Valley ICB boundaries.