England's Integrated Care Boards (ICBs) are grappling with escalating instability at senior levels, with a spate of executive and non-executive departures raising serious alarms about organisational continuity and the successful delivery of strategic goals. This leadership vacuum comes at a critical juncture, as ICBs are simultaneously navigating severe financial constraints, resetting operational priorities, and preparing for significant mergers and boundary changes mandated for 2026 and 2027.
The immediate trigger for the latest wave of resignations was the abrupt exit of CEO Cathy Elliot from Cheshire and Merseyside ICB, one of England's largest, in late 2025. While specifics remain confidential, this departure initiated a ripple effect, leading to the subsequent resignations of key personnel, including Chief Medical Officer Dr Rowan Pritchard Jones and Chief Nursing Officer Chris Douglas. This pattern reflects a growing trend of leadership turnover across the ICB landscape.
This internal upheaval coincides with NHS England's outlined plans to restructure and realign ICB boundaries, creating a new integrated care systems landscape from April 2026. These reforms aim to optimise commissioning for population health needs but necessitate profound adjustments in governance, strategy, and operations.
Senior NHS stakeholders express unease, warning that frequent changes at the board level erode organisational memory, impede strategic execution, and complicate the effort to embed long-term priorities, particularly in vital areas like health inequalities, workforce planning, and community care integration. The uncertainty is also impacting staff. ICB employees report frustration and uncertainty regarding their roles, reporting lines, and future governance arrangements. Delays in clarifying new organisational structures are creating professional limbo, negatively affecting morale and retention as individuals await final confirmation of their positions within the merged entities.
Adding to the complexity, ICBs face mandates to significantly reduce running costs to meet efficiency targets and contribute to wider NHS cost-containment goals. This financial strain, combined with simultaneous structural and leadership changes, is reportedly stretching executive capacity and leading to frustration among board members juggling competing priorities.
The effects of leadership churn extend beyond internal operations. External partners, including local authorities, provider trusts, and voluntary organisations, rely on stable ICB leadership to build and execute collaborative strategies for population health improvement. Frequent senior departures can slow decision-making and weaken collective plans to reduce inequalities and improve access to care.
As policymakers look towards 2026, a critical question remains: will this current turbulence subside as the new organisational structures are implemented, or is sustained instability a risk during the complex merger and boundary change phase? The coming months will be decisive in determining whether integrated care systems can maintain their strategic focus and deliver promised improvements amidst ongoing leadership change.
