Some ICBs have ‘asked for permission’ to merge and consolidate, the health secretary Wes Streeting has told MPs today.
In a session of the Health and Social Care Committee (HSCC) on the recent changes to the NHS, Mr Streeting said that ICBs ‘are here to stay’ but that he had seen ‘demand’ from some ICBs to merge following the news that they would be required to make 50% cuts.
Mr Streeting said the Department of Health and Social Care (DHSC) were ‘very receptive and responsive to that kind of demand from below’, and that he hoped to see more ‘two-way interaction and leadership within the system’.
‘If it’s always top-down command and control, we will fail,’ he added. ‘And the more we get that pressure from below and that hunger to change, I think the more we will be succeeding, whether that is system leaders in ICBs or frontline clinical teams who are changing the way they do their elective surgery, for example, and having the support of executive leaders to do that.’
He confirmed that ICBs were definitely staying, and they would be central to realising the ambitions in the 10-year health plan.
However, the new chief executive of the NHS Sir James Mackey, who also gave evidence to the committee, confirmed that some ICBs may be asked to cut their costs by more than 50%, and some less.
‘It’s about addressing the overall running costs and trying to get everybody to the same amount of running costs per head of population,’ he said.
When asked whether demographics would be taken into account, Sir James said: ‘This running cost formula is simply cost per head to run those ICBs, where I don’t believe there’s a strong argument that demographics is a significant driver.’
He added that the variation in spend per ICB head currently ranges from £49 to just less than £21.
‘What we’re trying to go at here is the variation and for this to be more fair and more equally distributed and maximise the resource to the front line.’
When asked why the cuts were announced at the 50% level, Sir James said: ‘We needed to move more quickly and to send a signal that this needed to be dramatic because we’re moving very slow, improving slowly.
‘I think what we’re trying to communicate is we need a very much more rapid change and more significant change to deliver what we need in the future.’
Devolution
The health secretary echoed the Government’s previous reasonings that the changes facing the NHS were about devolution.
But when questioned on how ICBs will deliver more responsibilities devolved from NHS England with half the money, he said it was not only ICBs that would pick these up.
‘There is devolution of power not just to ICBs but also more freedoms and flexibilities closer to the front line across the range of NHS provider organisations,’ said Mr Streeting.
He added that ICBs will be focusing more on strategic commissioning and neighbourhood health. But that more details will be in the 10-year health plan, which will be published ‘in June around the spending review’.
Last week, Sir James told ICBs to target areas with duplication when making cuts. He 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’.
In March, the HSCC was told that the cuts to ICBs could result in as little as 20 ICBs and reduce the need for regional teams.
