Greater Manchester ICB has seen the highest fall in staff numbers from its integrated care system compared to other ICBs between 2023 and 2024, according to Healthcare Leader’s exclusive investigation.
Last year, systems were tasked with cutting their running costs, including staffing, by 30% by NHS England, with at least 20% of that to be delivered in 2024/25.
A freedom of information (FOI) request from Healthcare Leader, to which all 42 ICBs responded, looked at the number of staff members employed by each ICB as of May 2024. This question was answered by 39 ICBs, with the exception of Humber and North Yorkshire and Sussex which both said it was intended for future publication, and Suffolk and North East Essex which gave a full-time equivalent figure.
Greater Manchester, which is the largest ICB both in staff numbers and in population size, saw a drop of 181 roles between 2023 and 2024, when comparing the FOI figures from a similar Healthcare Leader investigation in February 2023 in which 29 ICBs gave headcount figures.
Greater Manchester ICB said the reasons for employees leaving during this time included organisational change, voluntary resignation, mutually agreed resignation and end of fixed term contracts.
A spokesperson added: ‘NHS GM formed in July 2022, it brought together 12 separate organisations and since that time we have been undergoing ongoing organisational change to develop a unified organisation.’
The second highest fall was in North East and North Cumbria, which saw staff numbers drop by 128 across the year, from 771 in 2023 to 643 in 2024.
David Purdue, chief nurse, allied health professionals and people officer at North East and North Cumbria Integrated Care Board, said: ‘As England’s largest ICB, we brought together eight former CCGs and were able to centralise a number of functions to make economies of scale. In addition, our employed staff draw on significant support from colleagues at North of England Care System Support (NECS) in areas like HR and business intelligence.
‘Like other ICBs, we have been through a challenging process in meeting the 30% target, but we are confident that we have created a structure that is strong and focused to deliver our priorities around Better Health for All in our region.’
Third highest was Bristol, North Somerset and South Gloucestershire ICB which went from 561 to 468, a drop of 93 roles.
However, despite being tasked with cutting costs, not every ICB saw a fall in roles. Of those who responded to the question, only 17 saw staffing figures fall. A further 12 added employees to their staff lists.
Cheshire and Merseyside was the highest of these with 139, second was Frimley with 94 and third Birmingham and Solihull with 62.
Cheshire and Merseyside ICB said the changes had come after some services had been transferred from NHS England with the transfer of responsibilities, and that some staff had also been ‘insourced’ from the commissioning support unit (CSU) to support a ‘consistent approach’ to service delivery across its nine places.
A spokesperson from Frimley ICB similarly said the increase was due to additional commissioning functions from NHS England.
They said: ‘NHS Frimley is in the final stages of implementing a full organisational change programme which delivers a 30% reduction in its full operating costs and optimises capacity in key areas.
‘The increase in staff numbers is due to additional commissioning functions being delegated from NHS England to ICBs, which NHS Frimley hosts on behalf of all ICBs across the southeast. Areas covered include Pharmacy, Optometry and Dentistry, and the primary care complaints function.
‘These services were transferred outside of the ICB requirement to reduce running costs. NHS Frimley has also in-housed some core capacity from CSU provision in finance and contracting which has enabled a reduction in our cost base. Establishment controls remain in place to manage headcount and align to running cost allowance (RCA) reductions.’
Behind Greater Manchester, the ICBs with the highest staff numbers in total are Cheshire and Merseyside ICB and West Yorkshire ICB, with 1,215 and 1,141, respectively.
The areas with the least staff are in Northamptonshire ICB (212), Cornwall and the Isles of Scilly ICB (304), and Shropshire, Telford and Wrekin (306).
ICB staff per population
The investigation also found a large variation in the number of ICB staff per resident across ICBs, with more than 2,000 extra residents per ICB board employee in some areas.
Despite seeing the second highest drop in ICB staff, North East and North Cumbria still had the largest staff to population ratio, with 4,900 patients per employee.
Buckinghamshire, Oxfordshire and Berkshire West ICB was just behind on 4,118 residents per employee. This was followed by Northamptonshire ICB with 3,836.
Gloucestershire ICB had the lowest population to system staff ratio, with 1,462 people per ICB employee, followed by Norfolk and Waveney on 1,584 and Dorset on 1,624.
A spokesperson for Northamptonshire ICB said: ‘In terms of workforce size, Northamptonshire ICB is one of the smaller ICBs in the country and reduced our workforce even further this year. With growing demands on Integrated Care Boards, we are required to ensure we have sufficient capacity and capability across our workforce to meet these demands, and we are confident our structures do that.’
Top five ICBs with the most staff
|
ICB |
Employees 2024 |
|
Greater Manchester |
1,682 |
|
Cheshire and Merseyside |
1,215 |
|
West Yorkshire |
1,141 |
|
North West London |
931 |
|
Hampshire and the Isle of Wight |
875 |
It follows the Darzi report which suggested that ICBs were a ‘sensible management structure’ but that their roles and responsibilities needed clarifying.
Though both the Conservatives and Reform UK parties called for a reduction in managers in the NHS during the July general election, Lord Ara Darzi added in his report that this was not a problem. Instead, he said there were ‘too few’ with the right skills and capabilities.
The FOI was issued on 2 May and all responses were received by 26 July.
| ICB | How many staff members employed May 2024 (headcount) | How many staff members employed Feb 2023 (headcount) | Difference between 23-24 |
| Greater Manchester | 1682 | 1863 | -181 |
| North East and North Cumbria | 643 | 771 | -128 |
| Bristol, North Somerset and South Gloucestershire | 468 | 561 | -93 |
| West Yorkshire | 1141 | 1211 | -70 |
| North East London | 817 | 873 | -56 |
| Surrey Heartlands | 617 | 667 | -50 |
| Mid and South Essex | 425 | 470 | -45 |
| Norfolk and Waveney | 683 | 721 | -38 |
| Cornwall and the Isles of Scilly | 304 | 341 | -37 |
| Derby and Derbyshire | 487 | 520 | -33 |
| Lincolnshire | 386 | 410 | -24 |
| South East London | 652 | 671 | -19 |
| South Yorkshire | 834 | 850 | -16 |
| Coventry and Warwickshire | 396 | 411 | -15 |
| Bath and North East Somerset, Swindon and Wiltshire | 488 | 502 | -14 |
| Bedfordshire, Luton and Milton Keynes | 409 | 414 | -5 |
| The Black Country | 547 | 549 | -2 |
| Leicester, Leicestershire and Rutland | 341 | 331 | 10 |
| North West London | 931 | 920 | 11 |
| Dorset | 505 | 488 | 17 |
| Gloucestershire | 462 | 443 | 19 |
| Cambridgeshire and Peterborough | 453 | 429 | 24 |
| Northamptonshire | 212 | 187 | 25 |
| South West London | 666 | 625 | 41 |
| Hertfordshire and West Essex | 742 | 691 | 51 |
| Nottingham and Nottinghamshire | 628 | 571 | 57 |
| Birmingham and Solihull | 561 | 499 | 62 |
| Frimley | 434 | 340 | 94 |
| Cheshire and Merseyside | 1,215 | 1076 | 139 |
| Hampshire and the Isle of Wight | 875 | – | – |
| Lancashire and South Cumbria | 843 | – | – |
| Kent and Medway | 646 | – | – |
| North Central London | 598 | – | – |
| Devon | 495 | – | – |
| Buckinghamshire, Oxfordshire and Berkshire West | 472 | – | – |
| Herefordshire and Worcestershire | 371 | – | – |
| Somerset | 361 | – | – |
| Staffordshire and Stoke-on-Trent | 313 | – | – |
| Shropshire and Telford and Wrekin | 306 | – | – |
| Humber and North Yorkshire | – | – | – |
| Suffolk and North East Essex | – | – | – |
| Sussex | – | – | – |
