ICBs to be graded from July under new performance framework

ICBs are set to be ‘segmented’ by July, according to a new performance assessment framework document from NHS England.

The document was presented to the NHS England board last week by chief delivery officer Steve Russell and national director of system development, Adam Doyle.

It sets out a replacement for the Oversight Framework and is due to go out to consultation and testing during the first quarter of 2025/26, ahead of final publication at the end of the quarter and formal implementation in July.

The document said the new framework reflected the government’s new mandate to the NHS as well as the three shifts from treatment to prevention, analogue to digital and hospital to community.

It is designed to evaluate and improve the performance of ICBs and trusts.

The document also highlighted that there will be a strategic commissioning framework for ICBs published ‘shortly’, and further details of the ‘future operating model’.

How the framework will work

Under the framework, every ICB and provider will be allocated a ‘segment’ score from one to five to indicate level of delivery. One will be high performing, four poorly performing and five to indicate intensive support needed.

Individual organisations will be measured against metrics based on their responsibilities. But ICB scores will be system-adjusted, using system level metrics, called system considerations (see box), that will assess performance against national priorities.

‘This will give a picture of how the ICB is performing on its own responsibilities together with the overall performance of the system given their role as the leader of the local NHS,’ the framework document said. 

Provider scores will also include a separate capability rating based on the extent to which they are collaborating.

Organisations that are in financial difficulty will face a cap on the score they can achieve, with those in deficit limited to a three.

Leadership capability will also be assessed as part of the process, reviewing six ‘functional areas’ that measure ‘whether they are delivering their contribution to the ICS purposes and assure NHSE that they are discharging their statutory duties and powers’.

Guidance on this leadership capability assessment is still under development and will be published ‘in due course’.

The document said: ‘The framework provides the foundation for a number of other important policies and actions. That is why we have agreed with the incoming CEO and Chair the importance of launching it now, as we enter the new financial year, so that NHS colleagues are clear about how their performance is likely to be assessed as they finalise plans for 2025/26 and so it can be appropriately tested and iterated prior to final implementation.

‘In particular, a new strategic commissioning framework has been under development for some time, reflecting the importance of this role for ICBs both now and in the future.’

In response to the framework, Sarah Walter, director of the NHS Confederation’s Integrated Care Systems Network, said it was important to make sure the short timescale on consulting and finalising the document does not ‘create unintended consequences for staff and patients’.

She added: ‘We understand the short-term need to get a financial ‘grip’, but we have concerns that this new approach is too individualistic. ICBs are to be held accountable for all the organisations in their system while providers are not held to account for the part they have to play in system performance. This calls into question the ability of systems to achieve the three shifts.

‘Given that many of the intractable issues leading to poor performance are often system issues that can require partnership working to solve, we would want a long-term commitment to system – not just organisational – oversight. Otherwise, this could undermine the positive work undertaken so far to support greater integration across services.’

She added that NHS England should ‘seek to minimise the bureaucratic burden when applying the performance regime’.

‘ICB leaders were already frustrated at not having the levers they feel they need to enact change,’ she said.

‘There must be a balance between recovery and reform, we can’t wait until the system is recovered to make progress on the vital changes needed to put the NHS on a sustainable footing. ICBs have a key role to play in implementing the upcoming 10 Year Plan and the government’s three shifts, particularly bringing care increasingly into the community and improving preventative services.’

NHS Providers added: ‘The shift in the role and responsibility of ICBs towards strategic commissioning and away from provider oversight is very welcome.

‘We have continuously argued that ICBs’ day-to-day oversight of providers added burden, duplication and confusion, and undermined their role as system leaders and partners.’

‘The revised framework aligns ICBs’ and NHSE’s roles with legislation. We note, though, that providers are asked to escalate concerns about performance, finance or quality ‘through their ICB’. It is essential that providers also have direct access to their statutory regulator to escalate concerns, in circumstances where that is more appropriate.’

It comes as NHS England has named its transition team, with Sir James Mackey appointed as interim CEO and Dr Penny Dash as incoming chair of the board.

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