NHS England has asked CCGs to work together to integrate primary, secondary and social care in a place-based system of provision of person-centred care. In Western Berkshire the approach chosen by the four CCGs (Newbury, South Reading, North and West Reading and Wokingham) is to form an Accountable Care System (ACS) clustered around the Royal Berks Hospital as the main acute provider. The CCGs and the main providers are to cede some sovereignty and work together under a common direction to integrate services. Payment structures are to be revised and patients' treatment to be coordinated between different providers. As the local authorities, providers and the CCGs in Western Berkshire have been working together for some time there is a basis for collaboration and cooperation. A model for this transformation is the change that occurred in New Zealand in 2001 when the provider/commissioner split was abolished and healthcare placed under the direction of District Boards. The success of an integrated development under the Canterbury District Health Board is cited as supporting evidence for this model. However, NHS England has decided that the right area ("footprint") over which to plan the service transformation was not Western Berkshire but a much larger area - Buckinghamshire, Oxfordshire and Western Berkshire (BOWB). It may be that they had the current reorganisation of Urgent and Emergency Care in mind, and intend to place the Oxford University hospitals as the Major Emergency Centre for the BOWB region. The current reorganisation of Urgent and Emergency Care is led by Prof Keith Willett of Oxford. The latest operational plan from South Reading CCG proposes to continue with the ACS development over Western Berkshire under the overall BOWB regional planning. The plan considers which functions should be allowed to the top-level BOWB region planning and which decided within Western Berkshire. The functions to be allowed to the the top-level BOWB region are:
- Specialised commissioning (takes place on an even wider basis)
- Workforce
- Procedures of Little Clinical Value and determination of Clinical Priorities
- Primary Care provider development
- Commissioning Support Unit
- Urgent and Emergency Care
At a recent Reading Borough Council meeting on 22nd March 2016, a motion was passed emphasising the importance of local democracy and decision-making for local healthcare ( see document linked below).