The NHS Confederation’s latest report shows that integrated care systems support the reform agenda, yet stresses that uncertainty around NHS redundancies funding is a significant barrier to delivering the three key shifts outlined in the ten-year plan
According to the NHS Confederation’s annual State of Integrated Care Systems report, health systems are making meaningful progress on the NHS Engnd reform agenda, particularly the three major shifts outlined in the government’s ten‑year plan. However, leaders warn that the substantial cost of NHS redundancies stemming from cost-reduction targets is creating operational uncertainty, hindering future planning and obstructing progress unless the Department of Health & Social Care provides urgent clarification on funding and timelines.
ICS leaders warn £1b redundancies and reorganisation hinder reform progress
The report, based on a survey of senior integrated care board (ICB) chief executives and chairs, as well as integrated care partnership (ICP) chairs (collectively referred to as ICS leaders), outlined strong support for the government’s reform agenda but also highlighted concerns about NHS reorganisation and cost reduction demands.
The survey revealed that 64% felt shifting health spending into the community by 2035 would make the most difference to their local communities.
Meanwhile, 36% commented that developing integrated health organisations (IHOs) that hold outcomes-based contracts will make a significant difference to their local communities.
The government has tasked ICBs with reducing their running costs by 50%, which will require significant redundancies at an estimated cost of £1 billion. The report highlighted that ICB leaders are concerned that ICB redundancies and NHS reorganisation have created a distraction and barrier to the progress of systems.
Notably, 95% of ICB respondents reported being very or fairly concerned about the impact of the required cost reductions on their ability to deliver against national and system priorities. ICBs are unable to provide certainty to staff and effectively plan for the future.
One ICB chair said that “all attention has been on the process of reorganisation itself”, which means ICBs are unable to shift focus towards the government’s three major shifts.
NHS leaders need funding clarification for redundancies
The report emphasised that ICS leaders want the Department of Health and Social Care (DHSC) and NHS England to urgently clarify funding and timelines for NHS restructuring, warning that these delays are threatening any progress towards the 10 Year Health Plan. This follows a recent call from the NHS Confederation and NHS Providers for the government to use the upcoming budget to fund these redundancies and other cost pressures.
The report makes a series of recommendations to both the DHSC and NHS England, including:
- Provide clear and regular communication to ICB leaders about the change programme, including support for systems, as well as any further staffing or service cuts, clustering, or merging.
- Support and resource the development of ICBs’ strategic commissioning skills and capabilities.
- Appoint a senior commissioning lead in the future DHSC structure to support ICBs.
- Model cross-government collaboration to promote integration between the NHS, local government and wider partners by aligning policy, guidance, legislation and the health and economic growth missions.
- Embed a more devolved operating model, giving ICBs the autonomy to make difficult commissioning decisions and co-produce the tools they need.
Sarah Walter, director of the NHS Confederation’s ICS Network, said: “ICS leaders are fully committed to implementing the government’s Ten-Year Health Plan and making the key shifts it sets out. This report, in fact, shows that many are making significant progress despite the challenging financial and operational pressures they face.
“But they need further clarity, support and the right tools to do so without urgent action to resolve funding for redundancies and provide strategic commissioning support, the NHS risks entering the next phase of reform on an unstable footing.
“The government must act now to ensure systems can move forward with confidence and deliver the transformation patients need and deserve.”
