Early IHO Skepticism Highlights Uncertainty Over Incentives, Risk Transfer and Real-World Benefits. A key partner, involved in an early bid to form an Integrated Health Organisation (IHO) a central pillar of the government’s 10 Year Health Plan voiced sharp scepticism regarding the forthcoming NHS initiative. In December 2025, the prospective partner bluntly stated that "The material advantages of becoming an IHO are not entirely clear," citing an "almost complete lack of any detail" on the expected benefits for partners who take on population level budgets and new structural responsibilities.
Integrated Health Organisations (IHOs) represent a new approach to population-based contracting in the NHS, aiming to overcome long-standing service fragmentation. Under the IHO model, an Integrated Care Board (ICB) commissions a capitated contract with a host provider; typically an advanced foundation trust or provider collaborative. This contract covers all health needs for a defined population. The IHO then assumes responsibility for aligning incentives and fostering collaboration across all services (primary, community, mental health, and hospital) by subcontracting to various partner organisations. Proponents suggest this framework can lead to better outcomes by shifting resources toward prevention.
However, partners must believe in a net benefit for this promise to succeed; a crucial point where clarity is currently insufficient. The draft NHS England guidance for the Advanced Foundation Trust Programme and the accompanying IHO (Integrated Care System Homecare Organisation) assessment criteria, currently under consultation, primarily focus on organisational capabilities. They offer limited detail on how organisations will tangibly realise and measure benefits, whether financial, clinical, or related to patient experience. Organisations require clear metrics and robust evidence to demonstrate that accepting an IHO contract will yield greater returns compared to existing, more traditional commissioning and delivery models.
The 10 Year Health Plan, the government's overarching strategy, positions Integrated Health Organisations (IHOs) as a mechanism to foster local innovation and ensure that "investment and savings occur in the same place." However, the essential operational specifics, such as how the government will distribute savings, manage risk, and transparently evaluate performance, are still undetermined. This ambiguity has made some system leaders hesitant to advocate for initial proposals.
Critics consider the lack of transparency a major concern because they fear that organisations, especially those with limited resources, will face significant financial and operational risks without a clear understanding of the potential benefits. Therefore, partners have called for more explicit models that detail expected savings, measurable health improvement results, clear risk-sharing protocols, and robust safeguards. These measures are necessary to prevent undesirable outcomes like the exacerbation of regional disparities or the undermining of current services.
NHS England plans to consult on and finalise the IHO assessment criteria in early 2026, which creates the vital path forward. They expect the first host provider selections later that year, with operational contracts starting in 2027. However, leadership's total transparency about the benefits, risks, and success metrics during the upcoming design phase fundamentally gains broad support. This commitment to openness is crucial for IHOs to move beyond a mere policy aspiration and demonstrate effectiveness as a tool for delivering major, evidence-based improvements in population health and overall value.
