The model region blueprint: what you need to know
Key points
The model region is a key part of the new NHS operating model in England, intended to clarify organisational responsibilities, help improve operational performance and devolve decision-making. It follows the model ICB blueprint and comes ahead of the abolition of NHS England, with NHS regions absorbed into the Department of Health and Social Care as well as a 50 per cent headcount reduction across the two central bodies.
The model region blueprint restates the core functions of regional teams – which will retain their existing geographical footprints – and emphasises their performance management role, which no longer sits with integrated care boards (ICBs), alongside an array of additional responsibilities.
It also creates a new regional governance model, with an executive team, chief executive and non-executive chair in each region. This comes as many ICBs are reducing the size of their executive teams and providers are cutting their corporate spending.
The delegation of Section 7A public health functions, which was set out and in train since 2022, is being further paused and delayed until at least 2027.
No clarity is yet provided on where emergency preparedness, resilience and response (EPRR) responsibility sits.
Unlike the model ICB blueprint, the blueprint does not clarify what functions are being transferred elsewhere and which are additional. Overall, the document suggests an enhanced and expanded role for regional teams.
Overview
The model region blueprint sets out a high-level vision for the future role of NHS regions within a redesigned and streamlined national centre. It forms a key part of the new NHS operating model and the delivery of the 10 Year Health Plan. NHS England intends for the blueprint to support ICBs as they implement the model ICB, to clarify the future operating model and reduce the burden that central bodies place on systems and providers.
Core functions
The seven NHS regions – retaining the existing geographical footprints – will act as the strategic leadership interface between the national centre and local health systems. Their core purpose is to:
- Oversee regional health system performance.
- Drive improvement and reform, playing an “integrator” role between the centre and systems, as well as between systems.
- Coordinate transformation aligned with national priorities.
Regions will deliver their purpose through three core functions:
1. Strategic leadership
- Developing and overseeing medium-term regional strategic plans to deliver the 10 Year Health Plan.
- Overseeing service reconfigurations.
- Identifying and supporting candidates for new foundation trust assessment and integrated health organisation (IHO) development.
- Supporting the future development of regional innovation sones to experiment.
- Leading and overseeing emergency preparedness, resilience and response (although not, yet, actually deliver it).
- Providing whole-system strategic workforce planning to deliver the forthcoming ten-year workforce plan.
- Supporting regional digital transformation and scaling innovation and AI.
2. Performance oversight
- Providing holistic oversight of providers and ICBs, including board capability. Primary care oversight is out of scope and sits with ICBs.
- Identifying early warning indicators and managing risk.
- Ensuring alignment with national frameworks and standards.
3. Improvement and intervention
- Coordinating improvement programmes and regulatory interventions.
- Supporting capability development and spreading best practice.
- Facilitating rapid quality reviews and implementing early warning systems.
- Developing Modern Service Frameworks for care commissioning and provision.
4. Other developments
- Supporting and overseeing ICBs in strategic commissioning by collaborating with national colleagues to design and deliver a national commissioning development programme, including payment reform.
- By April 2027, regions will transfer all commissioning responsibilities –including specialised services, health and justice, vaccinations, screening and delegated primary care – to ICBs, with new Offices of Pan-IC Commissioning in 2025/26. This is a delay to the planned delegation of commissioning Section 7a health functions, originally scheduled for April 2025 then pushed back to 2027, now April 2027.
Enablers and capabilities
The new regions will be empowered through:
- A new governance model with regional chief executives and also chairs supporting non-executive directors. Senior leadership teams with board-level experience.
- Access to national resources for improvement and transformation.
- A ‘one team’ culture across the centre, regions and systems.
- Power to direct investment (capital / digital) in line with agreed medium-term plans.
Transition, implementation and next steps
Two programmes are guiding the transition:
- New Operating Model Programme Board: Co-chaired by senior regional and national leaders, this board will oversee the transition of functions between regions, ICB, and providers. It will ensure readiness for enhanced regional performance oversight from mid-2025/26.
- DHSC/NHS England Transformation Programme: Led by a joint team, this programme will design and implement the integrated centre, aligning regional roles with national strategy and reform priorities.
Additionally, the blueprint sets out further next steps regarding:
- Medical education: Further work is being undertaken to design the future form and function of directly managed postgraduate medical, dental, pharmacy and healthcare science programmes, which are currently out of scope of the model region. Immediate reform and improvements are being delivered ahead of this to drive effective and efficient operations
- EPRR: Further national work to determine where emergency preparedness, resilience and response best sits.
- Co-design, feedback and development: Stakeholders are encouraged to submit questions and insights via england.new-operating-model@nhs.net, which will inform future guidance and updates.
Analysis
The model region is a key part of the new NHS operating model in England, intended to clarify organisational responsibilities and help improve operational performance. Its publication is welcome after several months of work and is needed to help ICBs and providers understand what functions regions will be picking up as they are cut back – the two need to be done together.
The model region does not clearly specify what functions are new, existing or transferred elsewhere
However, the extensive range of functions set out in the document begs the question ‘what are regions not doing?’ Unlike the model ICB blueprint, the model region does not clearly specify what functions are new (including delegated from the centre), existing or transferred elsewhere. Nor does it provide a timeline for the functions which the model ICB blueprint suggests will be transferred to regions.
Regions’ future remit will include oversight of everything ICBs and providers are doing (with performance management stripped from ICBs), regulatory role (over foundation trust and IHO development), workforce planning, leadership of digital transformation and the power to direct capital spending. This is backed up by a more independent leadership structure – now with chief executives and chairs for each region – sitting in future within the Department of Health and Social Care after the abolition of NHS England in 2027.
The blueprint does not indicate any functions being devolved from regions. Meanwhile, the further delay to delegation of Section 7A public health functions, already delayed since the initial timetable in 2022, postpones consolidation of commissioning budgets at system level which is a key part of shifting resources from just treating illness to prevention.
There is one key function that regions, currently, are not doing: the future of crucial functions such as emergency preparedness, resilience and response (EPRR) – essentially determining who takes charge in a crisis or emergency – remain unresolved. As things stand, EPRR responsibility is set to be removed from ICBs but has nowhere to go.
It is not clear how the enlarged governance tier aligns with the blueprint’s commitment to “deliver a more… devolved health service and push power out to places, providers and patients”
This new enlarged regional role comes as ICBs are reducing the size of their executive teams and providers are cutting their corporate spending. While there is a clear logic to this expanded role, given ICBs’ capacity cut will be back by 50 per cent and forthcoming cuts to providers’ corporate capacity, it is not clear how this enlarged governance tier aligns with the blueprint’s commitment “to deliver a more… devolved health service and push power out to places, providers and patients”.
Regions will likely have to deliver this expanded remit with fewer staff, given the government’s commitment to reduce the combined headcount of DHSC and NHS England by 50 per cent overall (saving £500 million) as the two central bodies and integrated. It is not clear that regional teams will have the capacity to deliver all these functions effectively, putting them in a difficult position. Future iterations of the blueprint will need to wrestle with some of these questions.
How we are supporting members
We will continue to engage with NHS England and DHSC on behalf of members to represent their views and the reality of delivering services in the current environment. We will also continue to support members and aim to shape future iterations of the blueprint through our networks and forums, at every level across the system.
