Something has to give on ICB redundancies
This article was first published in HSJ on 18 August 2025.
The ink is still drying on the government’s 10 Year Health Plan, but the current stasis in reducing the management costs of integrated care boards risks tying one hand of the plan’s implementation behind its back before it gets off the ground.
ICBs are stuck between a rock and a hard place. In March, they were asked by NHS England to achieve management costs of £19 per head of population by the end of December (an average reduction of 50 per cent) to help balance the books.
A blueprint on the future of ICBs also detailed a future role for them as strategic commissioners and set out what functions ICBs should do more of, and what they should do less of, with some functions - such as Continuing Healthcare, safeguarding, and infection prevention and control - mooted for transfer away from ICBs.
While helpful, this has also complicated the redundancy process with many repeated questions about what is in and out of scope for the reductions.
“Some have estimated the total cost for all ICBs reaching £1 billion and the number of job losses in the thousands”
In response, ICB leaders worked at record speed to come together in clusters, review their functions and structures, and develop cost reduction strategies. Many ICB leaders have told me they are forecasting costs of up to £50 million each to deliver this.
Recent board papers revealed that Greater Manchester ICB is planning for up to 400 redundancies and a £42million bill. Some have estimated the total cost for all ICBs reaching £1 billion and the number of job losses in the thousands. Those figures will be no surprise to system leaders, none of which were forecast for this financial year when budgets were originally planned.
Funding freeze halts action
But this hard work has now come to a standstill. Many ICBs were ready and waiting to initiate staff consultations on redundancies in July but have been held back due to a lack of certainty over the source of funding to cover them. Some are now telling staff that delivering NHSE’s ask this financial year is not possible. If ICBs are to fund redundancies themselves, they will need to spread the cost across this financial year and the next, and the opportunity for in-year financial savings – one of the primary drivers for the reductions – whittles away (as costs remain higher for longer).
With every passing day, staff anxiety increases. My peers have talked privately about the psychological harm uncertainty has on staff and mentioned increases in staff sickness since the reductions were announced. ICB leaders know they need their staff more than ever to fulfil the role set out for them in the 10 Year Health Plan.
“…either the Treasury finds the resources to support the redundancy process, or a new timeline is agreed”
HM Treasury plays a crucial role here in both clarifying whether the central government will support the funding of the overall redundancies, as well as approving the ICB redundancies.
Something has got to give: either the Treasury finds the resources to support the redundancy process, or a new timeline is agreed, with fast-tracked approvals to allow what can be afforded within ICB budgets to be delivered this year, and the remainder delivered as soon as possible in 2026/27. With the former unlikely, we are asking the Treasury to urgently prioritise the latter.
And to be clear, no solution should involve money being directed away from patient care.
The 10 Year Health Plan asks a lot of ICBs, and my peers and I are excited by this challenge. Commissioning for a neighbourhood health service and delivering the prevention agenda, for example, are among the reasons many ICB leaders took on their roles. Indeed, this is what matters most to patients and the public – and therefore, to us.
ICBs need to be supported by the government to do this. That requires change, now. And once this process is complete, ICBs need stability and backing to focus on the things most important to the public – making the 10 Year Health Plan a reality.
Dr Kathy McLean is chair of Nottingham and Nottinghamshire ICB; chair of Derby and Derbyshire ICB; and chair of the NHS Confederation ICS Network.
