NHS England’s ambitious mandate to halve corporate and integrated care board (ICB) costs is facing internal criticism, with senior board members questioning whether the 50 per cent figure is justified or achievable.
At a board meeting last Thursday, NHS England deputy chair Sir Andrew Morris openly challenged the rationale behind the sweeping cost-cut directive introduced by new chief executive Sir Jim Mackey in March. The policy, which demands a 50 per cent reduction in ICB and trust corporate spending, has prompted rapid restructuring proposals across the health service, but not without concern.
“My challenge is, if someone had said to me 18 months ago that we’d be taking 50 per cent out of ICBs’ costs, plus out of corporate costs, I’d have thought that was a bit too much, if I’m absolutely honest,” said Sir Andrew, who previously led Frimley Health Foundation Trust. “I just wonder why we’ve hit on 50 rather than 30 or 20... It would be good to convince ourselves that the 50 per cent is the right number, because it may well not be.”
Sir Mark Walport, another non-executive director, echoed the sentiment, emphasising the difficulty of enacting such deep cuts without a clearly defined target operating model. ICBs are expected to implement the reductions by December, yet guidance on the future roles of NHS England, its regional arms, and providers remains unclear.
Despite the concerns, Sir Jim Mackey defended the scale of the changes, acknowledging the challenge but insisting the NHS must simplify what he described as a “very complicated operating model”. While he hinted at some flexibility, suggesting cuts might land at “45 or 52 per cent” , he made clear that significant reductions are non-negotiable.
Early restructuring proposals from ICBs were due this week and will be reviewed by NHS England before further feedback is issued.
According to NHSE chair Penny Dash, many ICB leaders appear energised by the shift, with “well over half” expressing enthusiasm for a more streamlined future in which they act as “strategic commissioners”. Officials noted a “real sense of ambition” driving the work, contrary to expectations.
Meanwhile, plans to formally merge NHS England into the Department of Health and Social Care have once again been delayed. Although a high-level executive structure and operating model have reportedly been agreed, a detailed blueprint, originally due in April has now been pushed to mid-June.
A voluntary redundancy scheme is also being prepared, though funding arrangements with government have not yet been finalised.
As NHS England pushes ahead with one of the most significant operational overhauls in its recent history, questions remain not only about the feasibility of its cost-cutting goals, but also the readiness of its future model to sustain them.
