How can national and regional partners support future ICB mergers?

NHS England, both regionally and nationally played a key role in supporting ICBs throughout the transition process - from approval of the mergers to technical guidance and support. ICB leaders reported that this collaboration worked best when focused on co-production, and empowering and enabling ICB leaders to execute their plans. With the much longer lead-in time ahead of the next wave of ICB mergers, there is an opportunity to improve on the timeliness and accuracy of national guidance and tools, reflecting the complexity of the change process. 

With the cost and time associated with delivering these mergers, we must ensure they are delivered as effectively as possible, mitigating the impact of organisational change on staff, services and patients and enabling ICBs to focus on their mission to improve population health. This is also a unique opportunity to enable closer collaboration between the NHS and mayoral strategic authorities, strengthening our ability to bring together public services for the benefit of our communities. 

We have identified three key recommendations for where NHS England and the Department of Health and Social Care can better support future mergers and boundary changes in 2027 and beyond:

1. Mitigate the potential loss of merger expertise in regions and ICBs.
2. Deliver timely, accurate and relevant national guidance and tools to ICBs.
3. Ensure decision-making for new boundaries is:

• timely, to allow ICBs as much time as possible to prepare
• locally flexible, to reflect local variation
• co-produced both nationally and locally, with ICBs, local government and relevant system partners and the Ministry of Housing, Communities and Local Government (MHCLG)
• clear on its purpose and intended outcome.