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Changes to the Health and Care Landscape

In March 2025, the Government announced a requirement to reduce the running costs of ICBs, as part of a set of wider reforms to the health and care system. These reforms include:

• Nationally – NHS England will be abolished and its functions merged with the Department of Health and Social Care (DHSC) over a two-year programme, reducing their combined running costs by 50%.
• Regionally – NHS England regional teams will be replaced with reconfigured regional teams within the merged DHSC which will take over responsibility for some ICB functions, including the formal oversight of providers.
• At System level – ICBs will reduce staff costs by an average of 50% and will re-focus their role as strategic commissioners; and
• At Place level – providers will reduce growth in corporate running costs by 50% and place provider partnerships will be established as a vehicle for integration and supporting neighbourhood health.

In July 2025, the Government published Fit for the Future: a 10-Year Health Plan for England. ICBs will have a critical role as strategic commissioners in realising the ambitions of this plan. The success of NHS West Yorkshire ICB will be measured by the delivery of a refreshed Integrated Care Strategy and the NHS Joint Forward Plan for people and communities. To do this the ICB will continue to rely on its strong governance, mission, values and behaviours, and on the strength of its relationships with healthcare providers, local authorities and partners in the voluntary, community and social enterprise (VCSE) sector across West Yorkshire.

In May 2025, NHS England issued a Model ICB Blueprint to provide clarity on the direction of travel and a consistent understanding of the future role and functions of ICBs.

The Blueprint noted the Darzi Review’s conclusion that since ICBs were established in 2022, there have been differing interpretations of their role, with some leaning towards tackling the social determinants of health, some focused on working at a local level to encourage services to work more effectively together, and some focused on supporting providers to improve financial and operational performance.

Darzi concluded that the roles and responsibilities of ICBs needed to be clarified to provide more consistency and better enable the strategic objectives of redistributing resource out of hospital and integrating care. This would require a rebuilding of strategic commissioning capabilities, requiring a focus on strategy as much as performance and an investment in the skills required to “commission care wisely as much as to provide it well”.

Major organisational change programme

We are undergoing a major organisational change programme to address these challenges. It involves a radical re-shaping of the ICB’s structures and ways of working so that, through strategic commissioning, we can improve the health of the population, reduce health inequalities, and ensure access to consistently high quality and efficient care.

As well as achieving the required reduction in running costs, the changes we are making will enable the ICB to support the delivery of the Government’s three strategic shifts (from analogue to digital, from treatment to prevention, and from hospital to community) and the development of a Neighbourhood Health Service.

The Model ICB Blueprint set out the core functions of an ICB as:

• Understanding the local context
• Developing long-term population health strategy
• Delivering the strategy through payer functions and resource allocation
• Evaluating impact, and
• Governance and core statutory functions.

The ICB’s future role can be summarised under three broad headings: it will be the strategic commissioner for West Yorkshire, convenor of the Integrated Care System, and integrator of providers and services:

• Strategic commissioner – the ICB will ensure that services are planned and delivered in a way that meets the needs of the population both now and in the future. It involves a systematic approach to defining and measuring outcomes, using data and intelligence to make informed decisions about resource allocation and service delivery.
• Convenor– the ICB will bring together all partners in the Integrated Care System to agree and deliver its five-year strategy and ensure delivery of local and national priorities by working together effectively and taking mutual responsibility for the results. It will co-ordinate the governance of the partnership and its wider arrangements for collaboration, within a framework of distributed leadership.
• Integrator – place-based integrator teams will assess population health risk and facilitate place provider partnerships to co-design new integrated models of care.

The ICB will commission the majority of services from place provider partnerships, which will take on contracts to deliver services from April 2027, having worked in shadow form in 2026/2027. The most specialised services will be commissioned by the ICB at a West Yorkshire level through the WY provider collaboratives, including West Yorkshire Association of Acute Trusts (WYAAT), the Mental Health, Learning Disabilities and Autism Collaborative (MHLDA), the Community Care Collaborative and Hospice Collaborative.

The ICB will continue to have a convening role, bringing partners together to achieve shared goals and priorities. The WY Mayor will have a more formal role in health and care and the ICB will have a stronger and more formalised partnership with the Combined Authority.

Local Authorities will continue to have a key leadership role in places, working in partnerships with the ICB, providers and other partners. Health and Wellbeing Boards will lead the development of a neighbourhood health plan, drawn up by local government, the NHS and its partners. The ICB will bring together these local neighbourhood health plans into a population health improvement plan to inform commissioning decisions and the place provider partnerships will have a key role in its delivery.

We are committed to improving the diversity of our leadership as demonstrated in our West Yorkshire review report and our equity and fairness strategy – Power of one, power of many – by tackling health inequalities for minority ethnic communities and colleagues, understanding impact, reducing inequalities and supporting recovery so that it is more representative of the people we serve.