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| Integrated Care Boards | |
|---|---|
| Name | Integrated Care Boards |
| Founded | 2022 |
| Predecessor | Clinical Commissioning Groups |
| Jurisdiction | England |
Integrated Care Boards are statutory bodies established in England to plan and commission health services within defined geographic areas. They succeeded Clinical Commissioning Groups as part of a legislative reconfiguration tied to the Health and Care Act 2022, embedding new arrangements for strategic planning alongside Integrated Care Partnerships and local government. Designed to align priorities across healthcare providers, they operate within a national framework set by NHS England and interact with a wide array of statutory and non‑statutory organisations.
The formation of Integrated Care Boards traces to policy reviews and reforms following the Five Year Forward View and the Long Term Plan (NHS) 2019. Proposals for greater system integration were advanced under successive Secretaries of State for Health and Social Care, including Jeremy Hunt and Matt Hancock, and were taken forward by ministers in the Johnson ministry. The Health and Care Act 2022 provided the statutory basis, dissolving Clinical Commissioning Groups and creating Integrated Care Boards alongside Integrated Care Systems and Integrated Care Partnerships. Early pilots and vanguard sites such as the New Care Models vanguard informed governance ideas later codified in 2021–2022 guidance from NHS England and the Department of Health and Social Care.
Integrated Care Boards are corporate bodies governed by a board of executive and non‑executive members including a chief executive, medical directors, and independent non‑executives. Their constitution and appointment processes are influenced by guidance from NHS England and statutory duties established under the Health and Care Act 2022. Boards typically include representatives from primary care, secondary care, and other stakeholders; formal partnerships are arranged with local authorities such as Greater Manchester Combined Authority or county councils like Surrey County Council in their areas. Where provider collaboratives exist, boards engage with entities including NHS Foundation Trusts and commercial providers such as Circle Health Group. Legal accountability operates alongside regulatory oversight from bodies including Care Quality Commission and Monitor (NHS)-related functions managed by NHS Improvement roles within NHS England.
Integrated Care Boards have statutory responsibilities to develop a five‑year strategy, determine commissioning priorities, and ensure the provision of specified NHS services within their footprint. They must collaborate with Integrated Care Partnerships to produce joint health and care strategies that reflect input from organisations like Public Health England (now functions in UK Health Security Agency and Office for Health Improvement and Disparities), primary care networks represented by groups such as the Royal College of General Practitioners, and specialist commissioners including Specialised Commissioning. Responsibilities span elective care pathways with providers like Royal Free London NHS Foundation Trust, urgent and emergency care involving NHS Ambulance Service trusts, and population health initiatives drawing on local authorities and voluntary sector partners including Age UK and Macmillan Cancer Support.
Funding to Integrated Care Boards is allocated by NHS England through allocations reflecting population need, historic spend, and policy adjustments. ICBs hold decision‑making authority over a substantial commissioning budget covering acute care, community services, mental health services often provided by organisations such as MIND and Rethink Mental Illness, and primary medical services contracted with GP practices and federations including NHS Trafford CCG successors. They may enter into commissioning arrangements with NHS trusts and NHS Foundation Trusts and procure services from independent providers such as Spire Healthcare and Circle Health Group. Financial frameworks require adherence to national tariffs like the National Tariff Payment System and accountability mechanisms overseen by NHS England financial regimes.
ICBs are subject to performance assessment via NHS England oversight, regulatory inspections by the Care Quality Commission, and statutory reporting obligations under the Health and Care Act 2022. Performance metrics include waiting times aligned to targets set in the Long Term Plan (NHS) 2019, emergency department performance measured against standards applied across trusts like Guy's and St Thomas' NHS Foundation Trust, and financial control totals. ICBs may be required to produce recovery plans and work with NHS Improvement functions where performance falls short. They also engage with parliamentary scrutiny through select committees such as the Health and Social Care Select Committee.
ICBs operate within Integrated Care Systems that bring together trusts, primary care, and local authorities to coordinate services. They form contractual and strategic links with NHS Foundation Trusts, acute hospitals such as University College London Hospitals NHS Foundation Trust, ambulance trusts like London Ambulance Service, mental health trusts such as South London and Maudsley NHS Foundation Trust, and private providers. Close working arrangements with unitary and county councils — for example Birmingham City Council or Kent County Council — underpin integration of social care and public health functions, while joint committees and pooled budgets may reflect models used in integrated care pioneers like Torbay and South Devon NHS Foundation Trust.
Critics highlight risks of centralisation, potential erosion of local accountability, and persistent financial pressures that mirror controversies from the era of Clinical Commissioning Groups. Analyses by think tanks such as The King's Fund and Nuffield Trust have pointed to challenges in workforce shortages affecting trusts like Royal Liverpool University Hospital and in delivering targets set out in the Long Term Plan (NHS) 2019. Concerns also include complex governance leading to unclear lines of responsibility between ICBs, Integrated Care Partnerships, and local authorities, and market‑related disputes involving independent providers like Spire Healthcare. Ensuring equitable resource allocation across diverse areas from City of London to rural Cornwall remains an ongoing policy and operational challenge.