What does the ICB landscape look like now?

Back in March, ICBs were thrown into the unknown with the announcement of 50% cuts to their systems and workforce, alongside the news of NHS England’s demise.

Since then, there has been a big shake up of the system, with 29 ICBs announcing plans to cluster or merge, two ICBs planning on working ‘closely’ or ‘aligning’ with another ICB, and the final 11 not expected to cluster or merge. This has moved the total number of ICBs from 42 to 26.

So, what does the ICB landscape look like now and how are the changes progressing?

ICB clusters and cuts   

Though ICBs were initially told they must cut by around 50% by October 2025, in May, this figure was updated to allow for more variation between ICBs. NHS England revealed a new running cost envelope for ICBs of £18.76 per head, to be reached by the end of Q3 in 2025/26, which would equate to December. This figure has since been increased to £19 per head for this financial year due to inflation, according to financial reset director at NHS England, Glen Burley, at a Health and Social Care Committee (HSCC) session on the work of the NHS this week.

‘That £19 calculation is per weighted capitation. I think that’s an important emphasis there, because that takes account of the needs of the local populations,’ he said.

The chief executive of NHS England, Sir James Mackey, revealed earlier this year that the variation in spend per ICB per head previously ranged from £49 to just less than £21 per head, therefore targets would be different for different ICBs.

But, ICBs were told they must submit their plans with how they would meet this new spend per head target by 30 May, which would then be assessed by NHS regional teams.

Since then, ICBs have unveiled their plans for their new systems.  

Most of these involve ‘clustering’. This is where senior appointments are jointly made, with combined teams and committees. But the ICBs would remain separate legal entities, each having to fulfil their statutory functions and manage their financial position.

Merging however, would mean abolishing the ICBs and establishing a new ICB, with a new board.

This week, it was confirmed that there will be six new ICBs established, abolishing 12 existing ones. This will come into effect on 1 April 2026, and they will be:

• NHS Norfolk and Suffolk ICB – abolishing Norfolk and Waveney ICB and Suffolk and North East Essex ICB
• NHS Essex ICB – abolishing Mid and South Essex ICB, incorporating West Essex and North East Essex
• NHS Central East ICB – abolishing Hertfordshire and West Essex ICB, Bedfordshire, Luton and Milton Keynes ICB, and Cambridgeshire and Peterborough ICB
• NHS Thames Valley ICB – abolishing Buckinghamshire, Oxfordshire and Berkshire West ICB and Frimley ICB, and incorporating East Berkshire from Frimley ICB
• NHS Surrey and Sussex ICB – abolishing Surrey Heartlands ICB and Sussex ICB, and incorporating Surrey wards from Frimley ICB
• NHS North Central London and North West London ICB (name to be confirmed) – abolishing North Central London ICB and North West London ICB
• NHS Hampshire and Isle of Wight ICB – boundary change to incorporate the Hampshire wards of Frimley ICB

With the plans currently set out, there will also be eight clusters. However, the government plans to approve further mergers for April 2027 next summer, as local government reform progresses. The remaining 11 ICBs are not set to cluster (see map).

Of the clustering ICBs, Bristol, North Somerset and South Gloucestershire ICB and Gloucestershire ICB also set out plans to merge either in April 2026 or April 2027. However, this merger has not been confirmed by NHS England yet.

North West London ICB and North Central London ICBs will also be moving forward with a ‘fully-integrated merger’, to create an organisation servicing 13 boroughs and 4.5 million people. It said this would get the best of both organisations, creating a ‘resilient and ambitious ICB’. A spokesperson for the ICBs confirmed that a CEO would be appointed to run both ICBs as individual organisations while they cluster, and this person will also be CEO of the single entity once the merger takes place.

In its recent board papers, BOB ICB said there was a national process to appoint designate ICB chief executives and it was ‘awaiting national/regional confirmation of next steps’.

Last week, the new chairs of the restructured ICBs were unveiled by NHS England, with Mike Bell taking on the chair position at the North West London and North Central London merged ICB (see box below).

The changes mean that the 10 smallest ICBs that served around or less than 1 million people will now be clustered or merged with another ICB.

Table 1: Smallest 10 ICBs and who they are clustering with

ICB	Population before	Now clustered with	Combined population
Cornwall and the Isles of Scilly	610,076	Devon	1,916,383
Bath and North East Somerset	1,014,322	Somerset and Dorset	2,465,214
Dorset	839,750	Bath and North East Somerset and Somerset	2,465,214
Somerset	611,142	Bath and North East Somerset and Dorset	2,465,214
Gloucestershire	697,543	Bristol, North Somerset and South Gloucestershire	1,795,238
Shropshire, Telford and Wrekin	537,354	Staffordshire and Stoke-on-Trent	1,747,123
Lincolnshire	828,658	Derby and Derbyshire and Nottingham and Nottinghamshire	3,257,873
Northamptonshire	848,449	Leicester, Leicestershire and Rutland	2,086,597
Frimley	850,514	Buckinghamshire, Oxfordshire and Berkshire	2,864,490
Herefordshire and Worcestershire	837,510	Cambridgeshire and Peterborough and Bedfordshire, Luton and Milton Keynes	3,036,438

Source: NHS England ICB projections 2025/26

What does this mean for redundancies?

While the structures of ICBs are changing, there are also ground-level staff changes that are taking place to meet the cuts. This means redundancy schemes.

Frimley ICB recently said it was engaging with staff and key partners to design the new organisation, but that ‘regrettably, there will be staff redundancies and both ICBs are supporting staff during this difficult period’.

However, this will cost significant amounts of money, with reports of an estimated £1bn cost for ICBs altogether.

Several ICBs have suggested that they may have to fund the money to fund this, as there is no funding set aside nationally. Although, Sir Jim this week revealed that NHS England was in talks with the Treasury about funding this.

He said at an HSCC session that NHS England had ‘never said there was a central pot of money’, but that ‘it was always clear in the conversation that we’re going to try and secure that’.

‘We haven’t yet managed to do so,’ he told MPs at the committee.

When asked if he thought he would be able to secure this funding, Sir Jim said he was ‘confident we’ll find a solution’.

Pressed on the matter, MP Greg Stafford asked: ‘Clearly several ICBs aren’t clear where that money is coming from because they’ve paused voluntary redundancy schemes or decided to postpone reductions in staff to 2026/27 financial year due to the uncertainty. So when are you going to get clarity about how they’re going to pay for these redundancies?’

Sir Jim answered that he met with ICB chairs and CEOs last week.

‘We talked through the situation that we’re in with government in the negotiation about how redundancies will be funded,’ he said.

‘We talked through [that] there are a couple of paths and scenarios for this to work and as soon as this issue is resolved, which is hopefully in the next few weeks, we’ll go back to them and agree ICB by ICB how they can then proceed with their plan.’

But Somerset ICB told Healthcare Leader that the ICB had not set aside contingency funds for the redundancy programme, and that it would need around £10.8m to fund this process in total.

It said: ‘Somerset ICB has no flexibility in its 2025/26 financial plan to support cost of change, so any change needs to be self-funding or externally funded.’

Greater Manchester ICB’s board papers recently revealed that it was planning for between 350 and 400 redundancies, which would cost around £36.5m – £41.7m.

It said: ‘These costs would need to be met without central funding, given recent guidance, meaning that accounting recognition in 2025/26 would materially impact our control total. The expected time to recover the redundancy cost is 17.3 months, meaning for staff leaving in November 2025 costs would be fully recovered in May 2027.’

It added that the funding source had ‘yet to be confirmed’ and that discussions with NHS England on this were continuing.

Kent and Medway ICB revealed in board papers that the funding for redundancies had still not been agreed. But that it would need to deliver an average staffing reduction of 49% across the organisation.

It said the ICB was planning on running a mutually agreed resignation scheme that would enable staff to resign from their role voluntarily and exit the organisation with a severance payment. However, it was still waiting on NHS England approval at the time of publication.

In South Yorkshire ICB’s board papers from September, it revealed it would also be undertaking a redundancy scheme, with a need to reduce its operating costs from £61.7m to £30.2m, and its staffing from 800 whole time equivalent (WTE) to 425 WTE.

A spokesperson for Humber and North Yorkshire ICB said the ICB was ‘awaiting the national information needed to move forward, particularly in relation to redundancy funding arrangements’.

‘Until this clarity is provided, the ICB is not in a position to begin consultation or offer a voluntary redundancy scheme. This message has also been relayed to staff via internal communications,’ they added.

For Leicester, Leicestershire and Rutland and Northamptonshire ICBs, the target for cuts was recently revealed as 31%.

The ICB added that the changes and reductions should be in place by the end of the third quarter of this financial year, although it added ‘there has been some concerns about the pace of that change and the affordability of any redundancy implications’.

Another ICB told Healthcare Leader that it was in a holding pattern, waiting for the Treasury to give permission to proceed.

So, while the target is to meet the cost reductions by the end of Q3 of this financial year, with unconfirmed funding for the redundancy schemes, it’s unclear when ICBs will be able to move forward with their plans.

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