The cuts to ICBs announced earlier this month could mean merging systems into as little as 20 and reducing the need for regional teams, MPs have heard.
Speaking at the Health and Social Care Committee (HSCC) yesterday (26 March), Siva Anandaciva, director of policy, events and partnerships at The King’s Fund, speculated that ‘you could group together ICBs’.
He added that if ICBs merged, there would be questions over whether the functions of the NHS England regional teams would still be needed.
He said: ‘If what happens is ICBs start sharing roles, and you end up with only about 20-25 functional ICBs, there is a question over whether you need a regional presence.’
However, Nicholas Timmins, senior fellow at the Institute for Government, added that there were functions of NHS England regional teams that ‘need to be done somewhere’.
‘If you ended up with 25-30 ICBs, then you might not want some of the performance management, accountability stuff that sits in the regions,’ he said.
‘You might need the ICBs to be doing that themselves. You’ve got to be clear about what you want your ICBs to do.’
A number of ICBs have told Healthcare Leader it is too early to speculate how the cuts will be achieved across the system.
Derby and Derbyshire ICB said it had so far implemented a recruitment pause and ‘early preparatory work on our running cost base’.
But Mr Anandaciva also speculated that building neighbourhood integrated teams could be one of the things to go, as they are ‘not one of the statutory functions’.
‘On the ICBs, that’s a really good example of we know what is being destroyed, but we don’t yet know what kind of health system is being created. Because the last time there were 30% cuts, the narrative was squish ICBs and what they meant to be doing, make it more focused on strategic commissioning. Oversight goes to a region, and then a lot more of the day-to-day commissioning could go to provider collaborative,’ he said.
‘Now, if all of that is being squeezed at the same time, I think the question becomes, how do you want the health system to work in the future?’
When asked what was most likely to go from ICSs, Matthew Taylor, chief executive of NHS Confederation, said ‘we await further clarity from the centre’ about this.
‘Even when you have to make a 50% cut, you want form to follow function,’ he said.
He added that he thinks we will ‘hear in the next few weeks some more thoughts from the centre about how that 50% cut is achieved’, and that the new operating model would be a ‘major part’ of the 10-year plan which is due this Spring.
But he added that the 50% figure made him ‘uncomfortable’.
‘It feels like a made up number,’ he said.
In an earlier evidence session, director of policy and external affairs at National Voices, Sharon Brennan, said that the situation ‘feels at the moment chaotic’, with disruption to day to day work.
‘It feels a very big stretch to try and bring in these three shifts from digital health hospitals, community and treatment to prevention, while also trying to deliver the transition,’ she said.
‘The concern really is a disruption around that [transition], but also just really basic things, like the day-to-day stuff. The charity Mind told us that everyone in their ICB that they work with has been told they’re up for redundancy, people aren’t answering emails.’
Earlier this month, the chief financial officer of NHS England, Julian Kelly, said ICBs had been asked to cut their workforce by 50%, which equates to around 12,500 staff.
NHS England has revealed its transition team to help fold the functions of the system into the Department of Health and Social Care (DHSC).
