1. Mitigate the potential loss of merger expertise in regions and ICBs

NHSE regional teams played a key role in supporting ICBs to merge, sharing expertise, solving challenges and escalating issues to national teams where needed. ICB leaders emphasised the importance of investing time in building strong relationships with their regional counterparts to help them manage the transition effectively, including regular check-ins. Regional teams are also subject to large reductions in their running costs, leading to a potential loss in expertise and technical knowledge of how to merge ICBs. This can be mitigated by supporting peer learning and knowledge exchange between regions and ICBs. 

Regional teams also played a key role in providing assurance to the national team that ICBs were meeting the required standards and milestones. In some cases, this assurance process became a barrier to timely delivery, taking away valuable capacity away from staff. In one region additional meetings were convened to understand variations in ICBs’ responses to an assurance submission. In another area, the regional team requested that legal advice be sought on the ICB’s alignment of a commissioning policy that had differed in the legacy organisations. ICB staff felt that this legal advice was unnecessary as they were accountable to their boards for this decision and had enough internal expertise to make decisions as an ICB. 

To ensure effective collaboration between regions and ICBs, a pragmatic and streamlined approach to assurance is most effective. Regional staff being part of ICB transition committees or boards was one approach that some areas took to make this happen.