The East of England region is planning to go from six ICBs to just three, the Suffolk and North East Essex ICB board has said.
In board meeting papers, it was revealed that the ICBs are considering three different models of configuration (see box), with changes to the ICB footprints.
However, the board said these were ‘conceptual models’ that have needed further development and that ‘no decisions on preferred models have yet been made’.
Three models for East of England
Potential Model A
- Norfolk, Suffolk, Cambridgeshire & Peterborough (C&P)
- Greater Essex
- Hertfordshire, Bedfordshire, Luton & Milton Keynes (BLMK)
Potential Model B
- Norfolk & Suffolk
- BLMK & C&P
- Greater Essex & Hertfordshire
Potential Model C
- Norfolk & Suffolk
- BLMK, C&P & Hertfordshire
- Greater Essex.
In a paper on ICB organisational change, it was suggested that there were several principles to the redesign, including that each ICB cover at least one million lives and that each ICB could work effectively on neighbourhood transformation.
It said: ‘Initial analysis has looked at each ICB individually, considering factors such as population size, number – and boundaries of – local authority partners, where GP practices and hospitals are located, and costs for different options.
‘This work has also included local considerations, such as ways of working between local authorities, the desire to avoid significant variations in the population size covered by an ICB, and locations of specialised services.
‘We also expect that some teams or services may work across ICB boundaries in future, as part of shared regional arrangements.’
Regional design principles
- Each local authority only works with one ICB
- Each ICB includes more than one acute Trust
- Each ICB can work effectively on neighbourhood transformation
- Each ICB covers at least one million lives
- ICBs can be financially sustainable individually and collectively across the region
- Each ICB can operate with reduced running costs.
Source: SNEE board papers
The board also revealed that NHS England has told ICBs they should be planning to cluster as soon as possible.
It added that there was a difference between clustering and merging, with clustering being ICBs remaining separate legal entities that each have to ensure they individually fulfil their statutory functions and manage their financial position. But it would also include making joint senior appointments, such as chairs and chief executives (see box below).
Merging however would require abolishing the ICBs and establishing a new successor ICB, with staff and assets transferring to the new ICB and a new board being appointed.
It added that six months was needed before ‘go live’ in order to implement the technical transition, so a final decision would need to be made by 30 September 2025 if a merger was to happen by 1 April 2026.
Clustering and merging
Clustering of ICBs Clustering ICBs means:
- Making joint senior appointments, including chairs and chief executives and possibly non-executives – i.e. the individual is appointed by and has authority from each of the relevant ICBs (executives jointly appointed will have an employment contract with each of the ICBs).
- Forming combined teams, where relevant, whereby employees of different ICBs work together under shared management.
- Establishing joint committees between the ICBs and delegating authority to them, so as to minimise duplication in governance. We may also look to form committees in common when clustering.
The ICBs remain separate legal entities, having to ensure they each individually fulfil their statutory functions and manage their financial position.
Merging of ICBs
It is expected that rather than retaining one of the legacy ICBs, it will be preferable to take the following approach:
- NHS England abolishes the ICBs and establishes the new successor ICB (this would need to happen with effect from 1 April of the relevant year)
- Staff assets and liabilities transfer to the new ICB (via transfer scheme made by NHS England)
- A new ICB board is appointed
- The ICB and its partner local authorities form a new ICP
- The legacy ICBs are closed down.
It comes as five of the ten smallest ICBs have already announced plans to cluster with other ICBs, after Cornwall and the Isles of Scilly, Bath and North East Somerset, Dorset, Somerset and Gloucestershire have all declared plans.
Devon ICB has a population of 1,271,620, while Cornwall and the Isles of Scilly ICB serves 597,980 people. Their combined population would therefore be 1,869,600.
Bath and North East Somerset ICB has a population of 981,188, while Dorset has 820,228 and Somerset has 595,206, making a total combined population of 2,396,622.
BNSSG and Gloucestershire ICBs have respective population sizes of 1,059,770 and 675,447, meaning their combined population would be 1,735,217.
In the East of England, the ICBs as they are all cover populations of at least 1 million.
Populations in East of England ICBs
| NHS Bedfordshire, Luton and Milton Keynes ICB | 1,078,232 |
| NHS Cambridgeshire and Peterborough ICB | 1,015,210 |
| NHS Hertfordshire and West Essex ICB | 1,612,358 |
| NHS Mid and South Essex ICB | 1,253,347 |
| NHS Norfolk and Waveney ICB | 1,081,906 |
| NHS Suffolk and North East Essex ICB | 1,047,965 |
Source: NHS England ICB allocations 2023/24 to 2024/25
ICBs were told in March they must cut their running costs by around 50% by October 2025 and to focus on reducing duplication when making cuts.
Earlier this month it was revealed that the ICB running cost envelope will be reduced to £18.76 per head, and that this target must be reached by the end of Q3 in 2025/26.
The chief executive of NHS England, Sir James Mackey, revealed last month that the variation in spend per ICB per head currently ranges from £49 to just less than £21 per head.
The West Country were the most forthcoming with their plans to meet cut budgets, as last week Bristol, North Somerset and South Gloucestershire ICB and Gloucestershire ICB revealed a ‘provisional’ plan to ‘cluster’ with each other, followed by Cornwall and the Isles of Scilly ICB and Devon ICB, as well as Bath and North East Somerset, Swindon and Wiltshire ICB, Somerset ICB and Dorset ICB earlier this week, making three clusters in the South West.
A spokesperson for Mid and South Essex ICB said: ‘We are working to deliver the requirement set by NHS England to deliver corporate savings of 50%. Together with all ICBs, we have been tasked with ensuring that our running costs (not our spending on delivering front-line services) are the equivalent of £18.76 per head of our patient population, as set by NHS England.’
A spokesperson for Norfolk and Waveney ICB added: ‘As part of the national requirement for ICBs to reduce the running costs by 50%, all ICBs have been asked to reconsider their future delivery models, working with regional NHSE teams to agree a future model that meets the challenges we face today.
‘We have been engaging our colleagues and our key stakeholders on future ICB options, before submitting plans that meet our affordability challenge for agreement by NHSE at the end of May.’
