A vision for specialised commissioning: lessons for future delegation

On 1 April 2025, NHS England delegates responsibility for 70 specialised services worth £14 billion per year to integrated care boards (ICBs).

Delegation of these services is part of a wider shift away from siloed commissioning of individual services towards a more strategic, whole population approach that aligns with the government’s priorities for the NHS. Delegation offers new opportunities to increase resourcing for prevention, support shifts in care from acute to community settings, improve integration and staff experience, and design services that better enable underserved communities to access care. Early adopter systems have already begun to transform some services and establish new ways of working to capitalise on these opportunities.

However, the fragmented approach taken to delegation does not reflect the significance of this shift and the speed of the rollout has caused issues for early adopter systems in their first year. Issues include a need for further capacity and capability, missing data and information and the need to ensure the stability of specialised service providers.

Early adopters provided suggestions to mitigate these risks for the ICBs taking on responsibility in April 2025, such as allowing sufficient time and focus for the transition, working collaboratively with providers, and prioritising a few areas for initial transformation.

We recommend that NHS England works closely with systems to ensure they are stable, supported and sufficiently resourced to make these substantial shifts towards strategic commissioning.