ICB mergers: lessons for future success

On 1 April 2026, six new integrated care boards (ICBs) were established through mergers, and one changed its boundaries, in response to the requirement for ICBs to reduce their running and programme costs. 

These cost reductions are part of a wider set of changes in how the NHS operates, with a smaller, leaner centre as NHS England (NHSE) is merged into the Department of Health and Social Care (DHSC) and a reinforced role for ICBs as strategic commissioners. Refreshed ICB organisational structures should be enabling them to drive improvements in population health, through their commissioning role. 

To effectively prepare for the transition, the leaders of these first six merged ICBs drew on institutional knowledge of mergers but said that the scale, pace and complexity of this process was unprecedented. ICBs were simultaneously preparing to close down and create new organisations, delivering large-scale restructures, reshaping their role towards strategic commissioning, planning for the next financial year and in some cases, overseeing the split of some ICBs across multiple new geographies. 

The implementation of these mergers has been far from perfect and been particularly challenging for staff, who have experienced a long period of uncertainty and change since the initial announcement of the cost reductions. While principles for leading effective organisational change are well known, they can be sometimes be missed during fast-paced and complex processes and are shaped by the external environment. 

The government is expected to announce the next ICBs that have been approved to merge in autumn 2026, with changes coming into effect on 1 April 2027.

This guidance draws on engagement with leaders from the first six merged ICBs, setting out what they learned from their experience to inform how ICB leaders can implement future mergers and how the government and NHSE can best support them through mergers and boundary changes in 2027 and beyond. 

ICB leaders identified a number of enablers that support a successful transition, under three key themes:

1    Leading with purpose and supporting your people
2    Bringing people with you – communication and engagement 
3    Managing complexity – delivering the technical transition.

These enablers are also available to download as an infographic.