Since being formally established by the Health and Care Act in 2022, ICBs have been positioned as leaders in their systems, with the clear expectation that they should oversee most providers on a day-to-day basis.
In our regulation survey last year, respondents were much more supportive of ICBs as system partners and conveners, rather than as performance managers. We also heard consistent feedback on the differences in maturity, behaviours and relationships with partners in their systems between ICBs.
Figure 3 below reiterates the views and concerns we heard in last year’s survey:
- 86% agreed or strongly agreed that ICBs should facilitate improvement and peer support among system partners.
- Less than a third (32%), however, agreed that they are comfortable with ICBs’ role as performance managers of trusts, as set out in the NHSE's operating and oversight framework. This is down from 37% last year. No representatives from ambulance trusts agreed with this statement, and three quarters of community trusts disagreed.
- More respondents disagreed or strongly disagreed (43%) than agreed or strongly agreed (33%) that the ICBs they work with strike the right balance between oversight and performance management, and other functions. Again, all ambulance trust respondents disagreed.
Only 16% agreed or strongly agreed that ICBs’ oversight and performance management activity does not duplicate NHSE’s. No respondents from ambulance and community trusts agreed with this statement.
Respondents gave mixed feedback in their comments about ICBs. Some shared positive local experiences of working with ICBs, and of them being an improvement on their predecessor – clinical commissioning groups (CCGs).
"We work well with our ICB … they allow us to get on with our core business but are there if we need support."
However, most comments identified challenges in relation to ICBs, linked to their variable maturity, leadership capacity and capability.
"Highly variable in construction, delivery and maturity."
"ICBs are duplicative and highly reliant on leadership capacity and capability. Collaborative system working happens by chance and not as an intention."
There were many comments around the persisting lack of clarity around their role, the duplication with NHSE, and the difficulty linked to the dual role they have been given.
"There needs to be much greater clarity about the role of the ICB. There is clearly significant variation between how ICBs operate, which needs attention."
"ICB role unclear. Difficult to move between regulation to partnership working. Immaturity of ICB leadership teams. Behaviours challenging in recent weeks as financial pressures have escalated."
"There remains a fair amount of overlap in our experience between their role and that of the London regional office of NHSE."