Integrated Care Boards, the statutory bodies responsible for planning and funding NHS services across England, are set for another significant reorganisation of their geographical boundaries by 2029. The change follows a pledge by Andy Burnham to bring regional NHS boundaries into direct alignment with newly established local government footprints, a move that will require many ICBs to redraw their territories once again.

The prospect of further upheaval will be unwelcome news to many within the health service. ICBs were formally established in July 2022, replacing Clinical Commissioning Groups as the primary vehicle for commissioning NHS care at a local level. Their boundaries were drawn with reference to the geography that existed at the time, based on groupings of local authorities and, in many cases, on the footprints of the Sustainability and Transformation Partnerships that preceded them. Three years on, many boards are still settling into their current structures, having spent considerable time and resources building new governance arrangements, staffing structures and relationships with local partners. A further redrawing of lines threatens to unsettle work that has only recently found its footing.

The rationale behind the proposed change rests on the principle of coterminosity, the alignment of health and local government boundaries so that the geographical area covered by an ICB matches that of the local authorities it works alongside. Health planners have long argued that mismatched boundaries complicate efforts to pool budgets, coordinate services and plan jointly across health and social care. When an ICB's territory spans several councils, or when a single council falls within more than one ICB area, decision making becomes more cumbersome and accountability less clear. Proponents of coterminous boundaries contend that matching footprints would allow health and local authority leaders to plan public health measures, social care provision and NHS services as a single, coherent system rather than as separate and occasionally competing structures.

Burnham's involvement stems from his position as Mayor of Greater Manchester and his broader advocacy for devolved public services. He has argued that regional and local leaders are better placed than central government to coordinate health and care provision, and has used his platform to push for NHS structures that mirror the shape of devolved authorities. His pledge comes amid a wider restructuring of local government, with a number of areas expected to move towards new unitary authority models over the coming years. As those new council footprints take shape, the plan is for ICB boundaries to be redrawn to match them, rather than the other way round.

The proposal is likely to meet resistance from parts of the NHS management community. Reorganisations of this scale carry direct financial costs, including redundancy payments, rebranding, new information technology systems and the renegotiation of contracts and partnership agreements. They also carry less tangible costs in the form of lost institutional knowledge and disrupted working relationships, both of which can take years to rebuild. Critics within the health service have warned of reorganisation fatigue, the cumulative effect of repeated structural change on staff morale and organisational focus. With waiting lists still elevated in many parts of the country and winter pressures a recurring strain on hospital capacity, there are concerns that management attention could be diverted away from frontline performance and towards internal restructuring.

No firm legislative timetable has yet been set out, though the 2029 deadline suggests the transition is expected to unfold gradually rather than all at once, likely tracking the pace at which individual local government reorganisations are finalised. Any changes to ICB boundaries would require formal review and approval processes, alongside consultation with affected trusts, councils and local communities. The coming years are likely to see incremental adjustments in specific regions as new unitary authorities are confirmed, with the health service under pressure to demonstrate that the eventual gains in integration outweigh the disruption of yet another reorganisation.

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