Introduction

Integrated care boards (ICBs) are stewards of £164 billion of revenue spent on NHS services, which is some 19 per cent of all public sector spending in England and roughly equivalent to the gross domestic product of Slovakia. In the aftermath of COVID-19 and with demand outstripping the rate of economic growth, pressure on local services has never been so great. Too much public money is still being deployed to meet the challenges of a previous era. Commissioning is the process by which this money is spent to determine what health services are delivered, by whom, for whom and where. A more strategic approach to commissioning is required to fix the foundations of health and social care. This should build on the establishment of integrated care systems (ICSs), which aim to promote collaboration and the integration of services. 

The Secretary of State declared ICBs to be the ‘pioneers of reform’, tasked with ‘lead[ing] the transformation of care’ through strategic commissioning of services and the development of a new neighbourhood health service. To do so, ICBs must be not just purchasers of care from providers, but the drivers of public service reform, the guardians of taxpayers' money, and champions of patients' and residents' interests.

This report, commissioned by NHS England and produced independently by the NHS Confederation, draws on a series of roundtable discussions with leaders and staff working in ICBs and across systems more broadly. It describes a new vision for strategic commissioning, explains how it differs from the model that has come before, and identifies the changes needed to bridge that gap. It also highlights the skills and capabilities ICBs and their partners will need to fulfil their statutory duties and their wider role in driving and sustaining transformation in health and care.