Nursing staff make up a notable proportion of the ICB workforce, according to our recent ICB workforce investigation, but what role do they play in the system? We take a closer look.
Nursing and midwifery employees make up the second largest staff group within the ICB workforce, second only to administrative staff.
A recent FOI investigation by Healthcare Leader found that there were 1,868 nurses employed across the 19 ICBs which responded. In total, 12,496 staff were employed across these ICBs, with 9,110 of those administrative and clerical staff.
The ICBs who hired the most nursing and midwifery staff were Cheshire and Merseyside (218), Lancashire and South Cumbria (197) and South Yorkshire (155). Those who hired the least were North East London (29), South West London (44) and Nottingham and Nottinghamshire (52).
The variation could be down to three things, Healthcare Leader understands: staff members who are doing system roles but happen to have nursing backgrounds, rather than nurses fulfilling nurse-specific functions; the roles being part time alongside a role in primary or secondary care; and variation based on the size and split of the system, with larger systems with more providers and population sizes more likely to have more staff.
The investigation uncovered the types of responsibilities these nurses are now undertaking as part of their ICB roles, from quality standards to safeguarding and mental health.
Nurses employed by ICBs are typically senior, band 7-9 and work for ICBs in non-patient facing roles that can be grouped into seven categories (see box), Healthcare Leader understands.
Hampshire and the Isle of Wight ICB, which employs 136 nursing and midwifery staff, said they employed nurses in the following roles:
- Continuing health care nurses that work directly with patients to assess their needs,
- Quality nurses who work across local providers ensuring quality standards are met,
- Safeguarding nurses – supporting the safeguarding processes of adults and children,
- Children’s nurses and midwives who support children with complex needs and maternity services across Hampshire.
Humber and North Yorkshire ICB, employs 154 nursing and midwifery staff, which are a mixture of full time and part-time nurses and midwives, some of which do patient-facing roles alongside their ICB responsibilities. They cover continuing health care (CHC) staff, safeguarding, quality and local maternity and neonatal services, according to a spokesperson.
North East and North Cumbria ICB, which employs 101 nurses and midwives, said these were made up of mental health nurses, registered general nurses and midwives.
In South West London ICB, where there were 44 nurses and midwives employed at the time of the FOI, the nurses are split across management, specialist advice, strategic leadership, operational management, clinical assessment management and clinical leadership roles.
These job roles include:
- Appeals clinical manager
- Assistant head of infection prevention control
- Quality assurance manager.
Categories of nurses employed by ICBS
- Quality – e.g. CQC compliance, investigating serious incidents, never events, managing the quality schedule, service level agreements,
- Safeguarding – this is split into adults and children,
- Continuing health care (CHC) – this is about ensuring patients placed in care are done so appropriately and properly commissioned. It can include learning disability nurses, mental health and paediatric nurses,
- Primary care – general practice nursing oversight and advising on primary care commissioning,
- Infection prevention and control across the whole system,
- Mental health commissioning – provider management across the system,
- Midwifery – quality assurance.
Nurses could also be fulfilling transformation roles at system level.
A recent job advertisement for the director of nursing in West Yorkshire ICB said this role would support the executive nurse and the ICB board with advice and guidance in aspects of the ICB’s statutory duties.
‘They will support and lead aspects of the quality improvement strategy for the ICB working with all providers and will ensure the ICB is able to deliver its statutory responsibilities for delivery at place in key areas such as CHC, SEND and safeguarding, quality, and safety,’ it said.
‘The role is part of the Executive Director of Nursing team to provide high quality clinical and professional leadership that this is embedded at all levels of the system as set out in the guidance on effective clinical and care professional leadership and will provide senior nursing leadership supporting the development and delivery of the long-term plan for the ICB working with the medical director and clinical communities across the integrated care system.’
It said there was also a particular focus on ‘developing and embedding the patient safety response framework and quality improvement at Place’.
Statistics from the Royal College of Nursing suggest that 41 out of the 42 ICBs have a registered nurse leader, saying they have a ‘fundamental role’ to play in the design, commissioning and delivery of health and care.
NHS England said the ICB’s director of nursing in particular would be a great candidate for the executive lead for safeguarding, alongside a strong role in the quality and oversight process.
In a document on executive roles within ICBs, it said regional chief nurses should also carry out quarterly assurance reviews in safeguarding.
In February 2023, the Queen’s Nursing Institute alongside NHS Confederation established an ICB Chief Nurse Network to enable ICB nurses to share ideas, experience and learning as ICBs developed.
Nurses hired by ICBs
| ICB | Nursing and midwifery registered staff |
| Cheshire and Merseyside | 218 |
| Lancashire and South Cumbria | 197 |
| South Yorkshire | 155 |
| Humber and North Yorkshire | 154 |
| Hampshire and the Isle of Wight | 136 |
| Norfolk and Waveney | 102 |
| North East and North Cumbria | 101 |
| Herefordshire and Worcestershire | 89 |
| Dorset | 89 |
| The Black Country | 87 |
| Bristol, North Somerset and South Gloucestershire | 81 |
| Hertfordshire and West Essex | 75 |
| Buckinghamshire, Oxfordshire and Berkshire West | 74 |
| Devon | 67 |
| Cambridgeshire and Peterborough | 62 |
| Cornwall and the Isles of Scilly | 56 |
| Nottingham and Nottinghamshire | 52 |
| South West London | 44 |
| North East London | 29 |
The FOI was issued on 2 May and all responses were received by 26 July.
