ICBs have been told to target areas where there is duplication when making cuts, in a letter from new NHS England chief executive, Sir James Mackey.
It comes after the news last month that ICBs need to reduce their size by 50% and that NHS England will be abolished with functions brought back into the Department of Health and Social Care (DHSC) to ‘end duplication’.
Sir James said the 50% reduction to ICBs would ‘be a challenge’ but that it was important to act quickly to ‘seize the opportunities of ICBs acting primarily as strategic commissioners’.
He said to look carefully at assurance and regulatory functions, wider performance management and communications and engagement functions where there was duplication.
He added that regional directors would ‘hold the ring’ with ICB chief executives to identify how the reductions will be made.
Sir James, who was named as transition CEO of NHS England last month, said that there was a need to manage the transition ‘carefully’, maintaining some core staff such as delegated commissioning staff, and ‘in the short term’ continuing healthcare staff, as well as investing in strategic commissioning functions and developing neighbourhood health.
He added: ‘ICBs have a critical role to play in the future as strategic commissioners and this is going to be central to realising the ambitions that will be set out in the 10 Year Health Plan.’
NHS England will be sharing a reasonable running cost her head of the population via regional directors ‘soon’, he said.
ICBs are then expected to create ‘bottom-up’ plans that are affordable within this reduced running cost envelope. Plans are expected to be signed off by May and implemented during quarter three.
Areas of potential duplication that ICBs should ‘look carefully at’
- A number of assurance and regulatory functions (for example, safeguarding and infection control) where this is already done in providers and, in some cases, regions, without compromising statutory responsibilities,
- Wider performance management (as opposed to contract management) of providers which again already takes place in providers and at regional level,
- Comms and engagement which similarly exists in local authorities, providers and regions.
The letter to ICBs added that there has been a ‘substantial increase’ in the number of non-patient facing corporate nursing roles across NHS providers and ICBs since 2019.
It said while they have supported ‘significant improvements’ in the nursing workforce, such as sustained post pandemic low leaver rates and reductions in vacancy levels, that there is significant sector and regional variation with the deployment and proportion of these roles within NHS providers.
‘To ensure optimal deployment of the corporate nursing workforce, Duncan Burton, Chief Nursing Officer for England, will lead a benchmarking analysis to identify potential unwarranted variation and utilise this knowledge to set an appropriate threshold which we will ask systems and providers to align to in 2025/26. We aim to complete this work by the end of April 2025,’ the letter said.
An exclusive Healthcare Leader investigation found last year that nursing staff make up the second largest staffing group employed by ICBs. Out of the 12,496 staff employed by 19 ICBs, 1,868 of them were nursing and midwifery staff.
The letter also said the elective pay limit would be removed to set out a more flexible approach to planning elective activity. An urgent and emergency care delivery plan will also be published shortly.
In response to the letter, Matthew Taylor, chief executive of the NHS Confederation, said: ‘Our members will welcome Sir Jim setting out his ambitions on day one and recognising the efforts from leaders across the system as part of the 25/26 planning round.
‘We are pleased to see the significant reduction in the planned deficit to £311 million and the proposal to move towards a multi-year approach to planning. The letter provides health leaders with some further details about the considerations that need to be taken into account as they work to deliver some very challenging plans over the course of this financial year.’
He added that the letter’s restatement of the ‘central role’ that ICBs will play is ‘very welcome’.
‘With many systems at different stages some ICBs will need support on this journey to develop the necessary skills and capabilities to support their strategic commissioning function,’ he said.
‘We share NHS England’s and the government’s commitment to improving performance. But there is no shying away from the fact that some organisations will need to deliver eye-watering efficiency savings which will require some cuts to services while ICBs and trusts are tasked with reducing their running costs. These factors will make it challenging for NHS leaders to find the balance between improving performance and implement the reforms needed to put the NHS on a sustainable footing.’
