ICBs are to be segmented under the new oversight framework from 2026/27, NHS England has said.
In a letter to ICBs published on 26 June, the financial reset and accountability director at NHS England, Glen Burley, said ICBs will not be segmented from this financial year as it is a ‘year of significant change’ for them as they transform to meet the new model ICB blueprint and cost reductions.
‘Support for ICBs this year will focus on the safe implementation of their plans,’ he said.
He added that while they will not issue a comparative rating, ICB performance would still be reported.
‘ICBs will still be assessed through a statutory annual assessment, which reviews how well each ICB is performing its statutory duties. Where there are performance or governance concerns, NHS England will step in and we may use our regulatory powers to secure improvement. We will introduce the segmentation approach for ICBs in 2026/27,’ he said.
The segmentation approach was unveiled in April, with ‘formal implementation’ initially due to start in July.
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.
Last month, ICBs were told to delay pay uplifts to very senior managers until after they had been segmented under the framework, as those working in segment five will not receive these.
Mr Burley added that ICBs currently in the recovery support programme would continue in this, which will be equivalent to segment five.
The oversight framework for 2025/26 will be reviewed in 2026/27 to incorporate the new ICB operating model and the 10-year plan ambitions and priorities, it was added.
The framework set out the current clarified roles and responsibilities for ICBs, providers and NHS England (see box).
It added that primary care providers and primary care networks would not be allocated their own segments, but NHS England will ‘continue to keep under review arrangements for accountability’ as the system moves towards neighbourhood health.
Sarah Walter, director of the NHS Confederation’s Integrated Care Systems network, said: ‘Our members will welcome this framework, which sets out measures to address the significant operational and fiscal challenges facing the health service. The fact that NHS England will not this financial year place integrated care boards (ICB) into segments based on their performance shows they understand the pressure ICBs are under. It will also give systems an opportunity to focus on making the financial cuts and restructuring required of them in the short-term.
‘But it is vital that we strike the right balance between recovery and reform. While we welcome fewer targets, dropping key metrics could result in the omission of measures that would judge how successfully the NHS is implementing the reforms necessary to put it on a sustainable long-term footing, achieve the government’s three shifts and improve long-term outcomes.
‘We also continue to have concerns about the proposals to hold ICBs 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.’
Roles and responsibilities:
ICBs:
- Provide system leadership for population health, setting evidence-based and long-term population health strategy and working as healthcare payers to deliver this, maximising the value that can be created from the available resources,
- This includes holding their partners in the integrated care system (ICS) to account using the system levers that bind them together, such as joint system plans, partnership agreements, joint committees and collaboratives,
- Through effective strategic commissioning, invest in, purchase and evaluate the range of services and pathways required to ensure access to high quality care, to improve outcomes and to reduce inequalities within their footprint,
- This includes monitoring provider performance against their contractual obligations for the services purchased as part of the ICB’s population health strategy,
- Strategically align funding and resources with long-term population health outcomes and manage clinical and financial risks.
Providers (NHS trusts and foundation trusts):
- Deliver high quality (safe, effective and positive patient experience) and efficient care,
- Comply with the requirements of the NHS provider licence.
NHS England:
- Oversee overall delivery, performance and improvement of both ICBs and providers (a statutory responsibility,
- Conduct an ICB performance assessment each financial year,
- Determine how to support and drive improvement in each organisation, including where necessary the use of enforcement powers.
Source: NHS England
System performance for ICBs
These metrics relate to tests applied at a whole system level for ICBs. They are contextual metrics and not applied in 2025/26.
|
National priority |
Test |
|
Urgent and emergency care |
Has the system been in the lowest quartile for 4 hour UEC performance for each of the last three months? |
|
Elective care |
Has the system been in the lowest quartile for 18-week performance for each month of the last quarter? |
|
Cancer care |
Has the system been in the lowest quartile for 62-day performance for each month of the last quarter? |
|
Primary care |
Is the system in the lowest quartile for overall primary care patient satisfaction? |
|
Mental health |
Is the system in the lowest quartile for proportion of healthchecks for severe mental illness completed in the last year? |
|
Finance |
Is the system projecting an annual deficit of over 2.5% or a deficit below 2.5% that is over 1% off plan? |
Source: NHS England
