Integrated care boards (ICBs) must deliver tangible improvements in performance and outcomes or risk continued scrutiny over their role within the NHS, according to Sir Jim Mackey, chief executive of NHS England. Speaking in early 2026, Mackey issued a clear warning that the future credibility of ICBs depends on their ability to demonstrate measurable progress, particularly in areas such as elective recovery, urgent care and system efficiency.
Pressure intensifies on system-level leadership
ICBs were established in 2022 as part of sweeping NHS reforms aimed at fostering collaboration between healthcare providers, local authorities and other partners. Their core purpose is to plan services, allocate resources and improve population health at a regional level. However, nearly four years on, questions are growing about whether they have delivered sufficient impact.
Mackey indicated that while the concept of integrated care remains sound, the results have been mixed. Some systems have made notable progress in reducing waiting times and improving coordination, while others continue to struggle with performance and financial control. He stressed that ICBs must now move beyond structural change and demonstrate clear outcomes, warning that continued underperformance could fuel debate about their long-term role.
Delivering measurable improvements
A central expectation from NHS England is that ICBs show concrete improvements in key performance indicators. These include reducing elective waiting lists, improving A&E performance, cutting ambulance delays and addressing health inequalities across local populations. Mackey has emphasised that success should be judged not by organisational structures or governance arrangements, but by real-world outcomes for patients.
This reflects a broader shift within the NHS towards accountability and delivery, with increasing focus on data-driven performance management. ICBs are also expected to play a leading role in financial recovery, as the NHS continues to face significant budgetary pressures in 2026.
Technology and data at the heart of accountability
From a health technology perspective, digital infrastructure is central to how ICBs are expected to demonstrate impact. The rollout of shared electronic patient records, population health management platforms and analytics tools is enabling systems to track performance more effectively and identify areas for improvement. Initiatives such as the Federated Data Platform are designed to provide ICBs with real-time insights into patient flow, demand patterns and service utilisation, supporting more informed decision-making.
These tools allow system leaders to monitor outcomes across organisations, coordinate care pathways and allocate resources more efficiently. However, variation in digital maturity remains a challenge. While some ICBs have advanced data capabilities, others are still developing the infrastructure needed to fully leverage these tools. This digital divide risks widening performance gaps between regions unless addressed through targeted investment and support.
Structural uncertainty and political context
Mackey’s comments come amid broader discussions about the future structure of the NHS. The government has signalled an intention to bring NHS England closer under ministerial control, raising questions about how system-level organisations such as ICBs will fit into a more centralised model.
Some policymakers and analysts have questioned whether ICBs add sufficient value, particularly given ongoing challenges with performance and accountability. Others argue that integrated care remains essential for addressing complex health needs, particularly in areas such as chronic disease management, prevention and community-based care. This debate creates a challenging environment for ICB leaders, who must deliver results while navigating organisational uncertainty.
Balancing collaboration with accountability
One of the key tensions facing ICBs is balancing collaboration with accountability. The integrated care model is designed to encourage partnership working across organisations, moving away from competition and fragmentation. However, this approach can make it more difficult to assign responsibility for performance, particularly when outcomes depend on multiple providers and services. Mackey has indicated that stronger accountability mechanisms may be needed to ensure that system-level collaboration translates into measurable improvements. This could include clearer performance targets, more transparent reporting and greater intervention where systems are not delivering.
A critical test for integrated care
As the NHS continues to face rising demand, workforce pressures and financial constraints, the role of ICBs is likely to remain under close scrutiny. Mackey’s message signals that the next phase of NHS reform will be defined less by structural change and more by delivery. For ICBs, this represents both a challenge and an opportunity: to prove that integrated care can deliver better outcomes, improved efficiency and more equitable services. Failure to do so could lead to renewed calls for restructuring or centralisation.
Outlook: proving value in a demanding environment
The coming year will be critical in determining the future of ICBs. With increasing access to data, growing expectations around performance and a shifting policy landscape, system leaders are under pressure to demonstrate clear and sustained impact.
Technology will play an important role in enabling this, but ultimately, success will depend on leadership, collaboration and the ability to translate strategy into tangible improvements. As Mackey’s warning makes clear, the question is no longer whether integrated care boards are the right model, but whether they can deliver the results needed to justify their place within the NHS.
