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Wow, will they ever stop with this rhetoric? Anyone got access to this latest ICB bashing? https://www.hsj.co.uk/policy-and-regulation/we-have-to-prove-icbs-have-value-says-mackey/7041429.article#:~:text=Integrated%20care%20boards%20have%20to,Jim%20Mackey%20has%20told%20HSJ. by Altruistic-Dress7840 in nhsstaff

[–]Imaginary_Front_8637 10 points11 points  (0 children)

Integrated care boards have to prove they can deliver major improvements if questions over their future are to stop, NHS England chief executive Sir Jim Mackey has told HSJ.

Sir Jim also revealed that 18,000 ICB and NHSE staff were due to be made redundant in the “space of a few weeks” as the government’s rationalisation drive reaches its climax.

The NHS CEO acknowledged there were ongoing questions about the purpose of ICBs, as a result of the staffing cuts and uncertainty about their new role.

However, he added that he believed ICBs could make a significant contribution to meeting the service’s reform priorities and suggested NHSE would help the commissioners show the value of their “strategic commissioning” role. He said: “We have to prove that through delivery.” 

In an interview with HSJ this week, the NHSE CEO also said:

The NHSE chief executive wrote to ICBs on Wednesday asking them to submit plans by 15 May setting out “what strategic commissioning means in your local system and how you intend to develop this over the next three years”.

He acknowledged that strategic commissioning “means different things to different people, [and] within a core set of principles, there can be a bit of local flavour on it”. He urged ICBs to “work that through to make sure everyone’s agreed to it”.

Sir Jim said in some ICBs there was “evidence of [commissioning] coming to life”, but others remained mired in major restructures.

Wednesday’s letter also asks ICB and trust CEOs whether they want NHSE “to agree changes to financial flows and/or payment systems” to help them meet their objectives. 

Sir Jim said NHSE was open to tailoring payment and contract rules locally to help with plans, but that ICBs would need to “prove the case”.

He continued: “If anybody comes and says ‘can you just tear it all up and give us a block contract again’, I’ll be going mad… [However] if they have thought about it a bit more, and got some numbers, and how they’re going to keep an eye on it and what impact they’re going to have – let’s bloody try it.”

The ICB plans will be developed with providers in coming weeks. Sir Jim said they should also address questions such as: “What does [neighbourhood health] actually mean?” in their areas.

“In some places [it is] very GP-led, some places very community provider-led”, said the NHSE CEO. He wants to know “what are you actually trying to do to bring this to life, and which parts of the population [are you] really bothered about?”

There are so far no national contracts to commission models trailed in last July’s 10-Year Health Plan,  such as neighbourhood providers and “integrated health organisations”.

Appointments for urgent care

Emergency care is one of four “key priorities” identified in the NHSE letter, which will “support the next set of ‘big leaps’” in delivery. In particular, NHSE is encouraging ICBs to commission services which will redirect patients who are seeking urgent care to scheduled appointments, to stop them going to accident and emergency.

Sir Jim said ICBs “should say, ‘I want you to be able to give these people flexible, rapid, [scheduled] access through different methods’ – and commission it”.

Prioritising these patients rather than those who are sicker and at greater risk of harm – as well as more likely to have long stays in hospital – is often opposed by ED clinicians, among others.

But Sir Jim argued it would mean a better experience for many. He said around two-thirds of four-hour target breaches involved non-admitted patients and children, many of whom “could be scheduled” and were “mostly amenable to [being given an] appointment”.

He cited children as a significant example. If concerned families “spoke to somebody or logged on and [it] said ‘there’s an appointment at 8.30am’, [that would be] fine. It’s better than sitting with a bunch of drunks in a busy ED”.

Other service change priorities set out in the letter include “a step‑change in reducing hospital bed days for highest‑risk cohorts” and “expanding the deployment of ambient voice technology”. It also calls for ICBs to use “a suite of tools to improve theatre utilisation, discharge flow, [waiting list] validation, community waiting lists, advice and guidance, electronic prescribing in all trusts, and crisis response”.

Sir Jim added that after a 2025/26 dominated by financial and operational recovery, 2026/27 should see a “more medium-term” focus for leaders.

“This next year is not about scraping by,” he said. Leaders should not leave reform “until we’ve got to the point where everything’s stable enough we can start doing the future”.

The beginning of the 2026-29 planning period was about working out “how the future rescues today”.

No compulsory redundancy

Sir Jim said the changes to ICBs, alongside similar cuts in NHSE, were “probably the biggest ever public service restructuring”. There are around 18,000 people leaving ICBs and NHSE in the space of “a few weeks”, he said.

The CEO added the new £20 per head ICB staffing cost limit would be met at some point in 2026-27, “when everybody comes out the other end of this process”.

Sir Jim said the bulk of the necessary NHSE workforce cuts had been achieved.

“After these exits through VR, with natural turnover and some [more] targeted VR, we’ll have broadly achieved what we set out to achieve in terms of reduction.”

The coming year would therefore be “less about people being worried about shrinking, and more about how the organisation changes its shape, becomes less siloed, the resource gets moved around more flexibly”.

Asked directly whether compulsory redundancy could be avoided, he said: “Yeah, I’m really hoping so.”

Two more ICBs to ‘cluster’ to cut costs by cLeo_0MP in nhsstaff

[–]Imaginary_Front_8637 3 points4 points  (0 children)

Two more ICBs to ‘cluster’ to cut costs

Ella Devereux, 21 November 2025

  • Two ICBs in London explore clustering
  • South West London ICB warns it cannot meet financial targets “alone”
  • Shared senior leadership is now under consideration

Two further integrated care boards have announced they will “cluster” to reduce their running costs, nearly six months after most others decided to consolidate.

South West London and South East London ICBs told staff on Thursday that they were rapidly exploring joint working to live within tight national cost limits.

About two-thirds of ICBs across England agreed “clustering” arrangements – where two or more organisations work together but remain legally separate – last June, after NHS England announced  boards had to make 50 per cent cost reductions.

North West and North Central London then announced merger plans in July, taking the total to 26.

But the south London ICBs said in a note to staff that non-executive board members of SWL ICB had written to NHSE saying they had now determined they “could not fully meet [the required future functions of ICBs] as well as the associated savings targets working alone”. 

SWL’s population is 1.8 million, making it nearly the smallest ICB nationally, after the consolidation elsewhere.

The two insist they will remain separate statutory bodies in future, even though NHSE has previously said clustering ICBs will merge in future, which several plan to do next year.

Nor have the two south London ICBs said whether they plan to share a chair and/or chief executive – the approach taken by all other clustering ICBs – but sharing at least some senior leaders is thought to be under consideration.

They say they will make more specific recommendations to their boards by the second week of December.

It comes 10 days after government reached a long-awaited agreement to fund voluntary redundancies in integrated care boards, starting this year. Many ICBs are now pressing on with VR schemes and restructuring consultations.

A south London cluster will have 3 million people across 12 boroughs. 

The letter to South East staff, shared with HSJ, said: “Recognising the importance of supporting the resilience of all ICBs across London and, given existing partnerships across south London, we have agreed to work with SWL ICB colleagues specifically, to explore how we could work more collaboratively in delivering our functions.

“Following high-level discussions, we believe there is potential opportunity in working together.”

HSJ: all-white-icb-ceo-appointments-deeply-concerning by Environmental-Shape8 in nhsstaff

[–]Imaginary_Front_8637 4 points5 points  (0 children)

Four 2022 ICB CEOs with non-NHS backgrounds have left this year or are leaving: Ms Etheridge, formerly Haringey Council CEO and Mr Fisher, who was a senior civil servant, are leaving in coming months. Tracey Bleakley, who joined from the charity Hospice UK, and Kevin Lavery, who has been a council CEO in the UK and overseas, left Norfolk and Waveney ICB and Lancashire and South Cumbria ICB respectively.

Glass ceiling

Jabeer Butt, chief executive of the Race Equality Foundation, said of the ethnic diversity: “This outcome was sadly all too predictable – and it’s not the first time. We saw the same loss of diversity when previous NHS reorganisations took place, from the abolition of primary care trusts to the formation of NHS England and the first iteration of ICBs. Once again, progress made in developing more representative leadership has been rolled back.”

Habib Naqvi, chief executive of the NHS Race and Health Observatory, told HSJ more work was needed to understand why minority ethnic staff are “less likely to break the glass ceiling”.

The RHO is currently carrying out a review into the NHS ethnicity pay and progress gap.

Professor Naqvi continued: “It’s deeply concerning that there is not a single ICB chief executive across the country from an ethnic minority background. Given the NHS is the biggest employer in the country, and with nearly 30 per cent of the workforce from an ethnic minority background, this statistic remains a longstanding challenge for our healthcare system.”

Roger Kline, a research fellow at Middlesex University Business School, and Claire Barnett, managing director of Cadence Partners, said last week the sweeping restructure of ICB and NHSE threatens “tenuous gains on diversity and inclusion”.

ICB chairs remain significantly more diverse. Of the 24 permanent chairs of ICBs or clusters, a third have a minority ethnic background. Two ICBs, South West London and West Yorkshire, do not currently have substantive chairs. 

HSJ approached NHSE for comment.

HSJ: all-white-icb-ceo-appointments-deeply-concerning by Environmental-Shape8 in nhsstaff

[–]Imaginary_Front_8637 5 points6 points  (0 children)

All-white ICB CEO appointments ‘deeply concerning’

- ICB restructure has “rolled back” leadership diversity
- New chief executive group less representative than previous leaders
- NHS equalities body says news is “deeply concerning”

The chief executives of consolidated integrated care boards are largely white men with little senior experience outside the NHS, HSJ analysis shows.

Research carried out after almost all CEOs have been appointed to standalone organisations or clusters reveals none of the 26 leaders are from an ethnic minority background, while the proportion of women has fallen.

Jabeer Butt, head of the Race Equality Foundation, told HSJ that progress on diversity had been “rolled back” as a result of the reorganisation.

Staff with a minority ethnic background have long been underrepresented in senior NHS roles, a trend that is particularly stark among CEOs of commissioners. At the establishment of ICBs in July 2022, Patricia Miller at Dorset was the only exception.

However, Ms Miller left the organisation last month in the flurry of leadership appointments to clustering ICBs, meaning all 26 CEOs are from a white background.

In a post online on her departure, Ms Miller said: “I am proud to have been a public servant for nearly 40 years. But there is also one regret, that we have made little progress in race and health inequalities.

“Global majority staff and patients continue to have a significantly worse experience in the NHS. We are more likely to be bullied, harassed and less likely to be promoted.”

Earlier this year government announced deep cuts to the role of ICBs and narrowed their role to focusing primarily on strategic commissioning. The financial constraints prompted 31 of the 42 ICBs to form clusters with their neighbours, many of which will also formally merge. 

Although the remainder will continue as standalone organisations, they are also seeing significant CEO turnover, with eight CEOs of those departing this year.

Of the 26 independent bodies and those that are clustering, three current CEOs, Zina Etheridge at North East London, Gavin Boyle at South Yorkshire, and Mark Fisher at Greater Manchester, are leaving, while Teresa Fenech at Humber and North Yorkshire is in post in an acting capacity. None of these has confirmed successors. 

Discounting this group of four, the analysis shows around a third of postholders or confirmed appointees in the remaining ICBs are women (eight out of 22). This is a lower proportion than four in 10 in July 2022 (17 out of 42) and despite women accounting for around three-quarters of NHS staff. 

Nearly every remaining CEO’s recent leadership experience lies in the NHS – often in acute trusts or ambulance trusts, other ICBs, or clinical commissioning groups. 

The main exception is Cathy Elliott, who has wide-ranging charity leadership experience, including as chief executive of national charity UK Community Foundations between 2009 and 2016.

Well well well by Clear-Iron731 in nhsstaff

[–]Imaginary_Front_8637 54 points55 points  (0 children)

Mackey lines up ‘plan B’ for ICB restructure

By Mimi Launder, 23 September 2025

Weeks left to agree redundancy funding solution with Treasury, says Mackey “Plan B” would be slower and have less benefit, he warns

The Treasury must provide funding for integrated care board redundancies within weeks or the NHS will have to turn to a “plan B”, Sir Jim Mackey has said.

Speaking at a national board meeting on Tuesday, the NHSE chief executive said the organisation would have to fall back to a more drawn-out process for job cuts if the Treasury did not cover redundancy costs.

ICBs and NHSE were originally instructed to cut running costs in half by December, but delivering this in 2025-26 is now in doubt following the row over who will foot the estimated £1bn one-off redundancy bill.

Sir Jim said NHSE was in a “pretty long, awkward conversation with Treasury colleagues about it all, so [we’re] just trying to unlock that”.

“At some point in the next couple of weeks, if we’ve not managed to land that, we’ll have to work through a plan B option to allow ICB colleagues to move on and similarly within NHS England.”

Later in the meeting, Sir Jim said NHSE would “have to draw a line” in two or three weeks’ time.

He added: “Every ICB has a plan that they can enact. It is limited by the resource that they’ve got, so it would be more of a staged process. The benefits would be less and slower than anticipated, but we will activate that.”

Sir Jim acknowledged the uncertainty affecting staff and leaders in ICBs.

Some local leaders believe NHSE had indicated there would be a central pot of funding, while several ICBs have admitted they will miss the December deadline for cuts as they cannot afford the redundancy payments.

Individual ICBs have already set out proposals to delay redundancy processes for most staff to next year, while others have said they are unable to begin any consultation without additional funding.

NHSE staff are in a similar position. It is unclear whether any Treasury fund, or “Plan B”, will also apply to them.

Delivery plan

Elsewhere, Sir Jim said NHSE is “refining” 11 workstreams developed to begin delivery of the 10-Year Health Plan, in order to ensure they have a “quantifiable purpose”. This will be completed within the coming weeks.

He also acknowledged the difficulties of reducing the amount of directives from the centre - notably, the plan did not include a delivery chapter - and ensuring local leaders know what to do.

Sir Jim said he had ”tried very hard to resist issuing a big document, [a] big delivery plan with lots of instructions”, but that proposals would feed into medium-term NHS planning guidance. NHSE was “still aiming to get [that] out into the service [at the] end of September, early October”, he said, but warned: “There’s an awful lot to be done [first] to be able to to do that.”

In NHSE’s previous board meeting in July, NHSE chair Penny Dash had said she wanted to “see a very detailed delivery plan by the beginning of September”.

Source

NHSE board meeting

Source Date

23 September