Agenda item

This report provides the Health and Wellbeing Board with an update on the reconfiguration of the ICB and potential implications on services.

Jonathan Turner introduced the report which set out the reconfiguration of Integrated Care Boards (ICBs) and potential implications on services. In introducing the report, he highlighted the following key points:

• In March 2025, NHS England provided notice that ICBs would face 50% reduction in costs in the 2025-26 financial year and a directive to reduce operating costs by 50%, which included people and estates.
• The government also announced a 10-year plan for the NHS and a merger of NHSE with the Department of Health and Social Care, followed by the publication of a Model ICB Blueprint, which set out ICBs’ role as a strategic commissioners rather than a deliverers of services.
• NWL ICB submitted a draft operating model to NHSE in May 2025, working within the new remit of ICBs, and received feedback in June 2025 which steered the ICB to develop an options appraisal on clustering NWL ICB with North Central London (NCL) ICB, considering both a full merger and viability to continue as individual organisations.
• Following this directive, NCL and NWL ICBs had received options appraisals to their Boards and endorsed on Tuesday 22 July 2025 and Wednesday 23 July 2025 the full merger option.
• The appraisal had identified benefits of merging, including reducing duplication and allowing more efficient use of resources given the reduction of funding now available. The operating model supported the shift to focusing on neighbourhood health, digital access to healthcare and early prevention and intervention.
• The main focus of attention for the ICB going forward would be on delivering population health and reducing health inequalities and, at a later stage, delivering neighbourhood health centres.
• The borough-based aspects of ICBs would no longer exist and would transfer to a provider organisation. Some other functions would also transfer, for example strategic workforce planning, which would transfer to regional teams, and continuing healthcare and infection control, which would transfer to providers to make the ICB more focused on the commissioning element of its functions.
• The borough-based partnership team were now looking at the modelling options and their impact locally for the integrator, looking at how providers could take on some of the functions of the borough-based partnership where there were duplications of roles, but there was currently no specific allocation of resource for that.

Robyn Doran provided further information:

• Many functions of the current ICB would be devolved locally to a system integrator at place level, which was likely to be one of the community or mental health provider trusts. Local authorities across NWL had fed back that they did not wish to be the integrator, there was no coherent federation of GPs to take on that role, and acute services did not wish to take on that role.
• Some functions would need to continue to be delivered by the ICB until legislation changed, such as SEND provision and safeguarding.
• She reiterated that there was no blueprint yet for ICBs to follow, so the ICB was taking things day by day operationally.

The Chair thanked colleagues for their introduction and invited input from those present, with the following issues raised:

• The Board paid tribute to ICB colleagues for their relationship with partners and contribution to the borough. 
• The Board highlighted that the paper presented had not offered clarity to members, and whilst recognising that this was a rapidly changing landscape based on very recent government guidance, they found a lot of their questions felt unanswered around the merger.
• The Board highlighted that the 2025-26 financial year had already started, and asked what would happen if the ICB was not able to implement the 50% reduction in costs in the ambitious timeframe set. Robyn Doran explained that the ICB had its current funding until the end of the financial year but was expected to have made decisions in relation to the reductions by the end of the financial year. She added that the ICB had recently gone through 30% reductions the previous year.
• The ICB had discussed the impact of the reforms on people and the risk of good colleagues leaving as a result.
• In response to concerns around the impact of the reforms on children’s safeguarding, Robyn Doran confirmed that statutory responsibilities that the ICB held, of which safeguarding was one, would remain the same for the time being unless the legislation changed. The ICB had been clear that there would be a need to change that legislation before any changes were made around the delivery of those services. As yet, future options had not been explored and there was no clear plan around those services.
• Patricia Zebiri highlighted that, as part of plans to reduce duplication, the Healthwatch Service would also end. Changes to statutory legislation would be required with Healthwatches remaining until that happened. The Board acknowledged this would cause challenges for the Health and Wellbeing Board in understanding that crucial independent input at a local level that Healthwatch facilitated.

As no further issues were raised, the Chair drew the discussion to a close and asked members to note the report. He advised Board members that the ICB papers, including the options appraisals, were available publicly and the meeting had been recorded and was available to view. In noting the report, he asked members to recognise the pace of change that had precluded the ICB engaging actively with partners and local government, but hoped for improved engagement and partnership working going forward. He highlighted the need to ensure that future arrangements were viable immediately to ensure a fully functioning organisation and partnership.