Westminster’s ambitions for community focused, prevention-oriented, and coordinated care now rest directly with Integrated Care Boards (ICBs). However, delivering national priorities locally, starting from elective recovery to tackling health inequalities within neighbourhoods has proven far from simple. Recent guidance, regulator reports and independent analysis reveal a system still struggling to gain traction, where capable in some places, constrained in others.
Accountability Meets Austerity: The ICB Struggle to Deliver on ICS Goals
The 2024/25 annual assessment framework makes clear that ICBs contribution to four core purposes of the Integrated Care System (ICS) are: population health improvement, reducing unequal outcomes, productivity and value for money, and helping the NHS with wider social and economic development, paired with explicit assessments of planning, delivery and leadership. That framework ties local ambitions to national accountability.
Think tanks and regulators are flagging continuous gaps. In 2024, the Care Quality Commission (CQC) found many ICBs struggling on planning and workforce, finance and noted uneven understanding of local population needs - factors that hinder progress in reducing inequalities. Independent analysts similarly point to workforce and data deficits that impede effective system redesign.
Rising deficits and a ‘fundamental reset’ to their financial regimes are forcing hard choices about what ICBs can prioritise and fund, with recent coverage even suggesting job losses, tighter budgets and large scale organisational change. These financial constraints risk redirecting focus from sustained prevention and neighbourhood redesign to short-term cost management.
Turning Ambition into Action: Making ICBs Deliver Lasting Change
To unlock the true potential of the Integrated Care System, leaders must drive decisions in a singular, outcome-driven Joint Forward Plan (JFP) that clearly links investment to measurable population health gains. Stronger and precise local data and analytics are integral to target interventions and close inequality gaps, a weakness repeatedly flagged by CQC. Additionally, blended financing can secure prevention and transformation initiatives against short-term pressures, strengthened by well-evidenced business cases. Lastly, transparent governance should track progress against core purposes of the ICS, ensuring maintenance of accountability and public trust.
The issue repeatedly seen is the gap of ground reality and the scale of promise Westminster likes to imply. ICBs have the potential to deliver meaningful local change, but not without better sourcing and clearer system architecture. Practical interactive builds trust, as it sets a deliverable promise to the public, and achievable goals for ICBs. In this case, the bigger task is turning pilots into sustained mainstream delivery while weathering financial and organisational turbulence.
Westminster’s compass is pointing in the right direction with their attention on local populations’ needs, local leadership and joined-up services. In order for ICBs to convert ambition into sustainable and durable change, they need multi-year funding, more accurate data, investment in workforce and the sensibilities to balance national priorities and local discretion. In order to deliver this agenda, the ICBs should be less about single, isolated acts, but rather, steady long term evidence based systems.
