Policy paper

Health Bill: ICBs as strategic commissioners - fact sheet

Published 19 May 2026

Applies to England

Introduction

As set out in the government’s 10 Year Health Plan for England, integrated care boards (ICBs) will focus on their role as strategic commissioners of local health services moving towards a broader approach to commissioning aimed at ensuring they make the best possible use of the resources they have to securing services that:

• improve population health
• reduce inequalities
• improve access to high-quality services
• give better outcomes for patients

To do this, we are making more services, including primary care services, the formal responsibility of ICBs. This will enable ICBs to use resources more effectively across the whole patient pathway, including:

• empowering commissioners to invest in neighbourhood health services
• delivering services closer to patients and the public

Background

The Health Bill (‘the bill’) implements several changes set out in the 10 Year Health Plan which will support ICBs to become strategic commissioners. These include:

• increasing the commissioning responsibilities of ICBs
• streamlining the planning process
• reforming ICB membership requirements
• reforming financial controls over the system, so organisations are responsible for their own performance, and ICBs are better able to make strategic decisions about how resources are allocated

Objectives of the bill

Increasing the commissioning responsibilities of ICBs

Passage of the bill would mean ICBs will take on a larger proportion of NHS commissioning than at present. For example, ICBs would be formally responsible for:

• commissioning primary care, which is currently the responsibility of NHS England, although it is now delegated to ICBs
• the commissioning of some ‘specialised services’ (responsibility for which currently also sits with NHS England, though again for many services, this responsibility has already been delegated to ICBs)

As a result, ICBs will be better placed to support innovation, design new models of care that emphasise prevention and care closer to home, and allocate resources to meet the needs of the people they serve. Where ICBs will benefit from joint ICB collaboration and a critical mass of expert commissioning capability (for example, to support more specialised commissioning), they will have the support of the 7 new offices for pan-ICB commissioning, one for each of the NHS regions:

• East of England
• London
• Midlands
• North East and Yorkshire
• North West
• South East
• South West

These will be hosted by ICBs and ensure expert commissioning capability is maintained for complex, high profile and often contentious areas of service provision. 

Streamlining the planning process

The 10 Year Health Plan committed to simplifying the planning system. This bill will realign the system to ensure it is more targeted to the needs of neighbourhood communities and produces multi-year strategic planning.

The bill will remove the requirement to form integrated care partnerships whose only statutory duty is to develop integrated care strategies. The duties to write a joint forward plan and a joint capital resource plan are also being removed.

Moving forward, each local authority area will continue to produce a joint strategic needs assessment. Health and wellbeing boards (HWBs) will ensure this includes a community-led appraisal of the health requirements of their area. These documents will inform a neighbourhood health plan, detailed in this bill and a population health improvement plan, which will be detailed in guidance.

Local leaders across health and care, both ICBs and local authorities, will develop the neighbourhood health plan. The plan is expected to outline how the NHS, local government and partners can better coordinate to improve the health and wellbeing of the people in its locality through a joined-up approach. The neighbourhood health plan should consider the wider social determinants of health such as housing, education, employment and environment. It should also articulate how local services can support national NHS priorities, further public service reforms and advance improvements in adult social care outcomes and local outcomes framework metrics. 

A population health improvement plan is expected to outline an ICB’s health strategy for its population over a 5-year period and will be informed by the neighbourhood health plan, developed by the HWBs within the ICB area. The population health improvement plan will set out how the ICB will allocate its resources and discharge its functions as a strategic commissioner of NHS services.

ICBs will contribute to planning at a neighbourhood level and lead at the ICB level. This will ensure greater coordination between the immediate and projected needs of neighbourhood communities and the long-term approach ICBs will take as health commissioners.

Integration and joint working between local authorities, ICBs and other relevant partners will remain crucial to the system more widely and the duties to cooperate are protected in this bill. However, there is value in being less prescriptive and allowing local partners to determine how they can best work together. Where it is helpful, we will share guidance to continue to support strong local relationships between partners.

Reforming ICB membership

As part of our commitment to strengthening ICBs’ ability to act as strategic commissioners, we are reforming ICB membership. We are proposing changes that will ensure the ICB is able to:

• meet their new commissioning responsibilities
• create stronger strategic alignment with mayoral strategic authorities
• reduce conflicts of interest

This bill proposes a requirement for the ICB constitution to provide for appointment of a member who has been nominated by each mayor of a mayoral strategic authority, covered in the ICB’s area. This will ensure close working between the ICB and strategic authority and recognises the increasingly significant role that strategic authorities will play in local areas. This member will replace the requirement to have at least one ordinary member jointly nominated by the local authorities covered in the ICB’s area. For areas which currently do not have strategic authorities, membership arrangements will be clarified in guidance.

Currently, ICBs are required to appoint at least one ordinary member nominated jointly by NHS trusts and NHS foundation trusts, and at least one ordinary member who provides primary medical services in the ICB’s area. We are proposing to remove these requirements, as it will be necessary for ICBs to:

• make strategic commissioning decisions in a forum that avoids conflicts of interest
• be trusted to make decisions about membership of their boards without legislative prescription

ICBs will continue to have requirements to ensure that they have at least one member with sufficient knowledge and experience of mental health services. In addition, ICB chairs will retain the discretion to appoint additional members if they deem it necessary. The Secretary of State can also provide further guidance to ICBs on their membership, to ensure boards react to shifting priorities and challenges. Beyond the legislation, we will continue to support ICBs to work in close partnership with health and care organisations in their areas and to maintain close working relationships with local authorities and their ongoing planning responsibilities.

Financial accountability

We are supporting the NHS to move into financial surplus over time. By March 2030, most NHS organisations are expected to be living within their means.

To achieve this, the way NHS finances are managed needs to change. Currently, the focus is on the financial position of the whole local area which is made up of ICBs and the NHS trusts they work with. Legislation requires these systems collectively to remain within national spending limits, rather than holding each organisation independently to account. In other words, it is the system as a whole that must balance the books.

However, this collective approach makes it harder to hold individual organisations accountable for their own financial performance. The 10 Year Health Plan shifts the emphasis towards the financial performance of each organisation, rather than relying primarily on the combined position of the local system. At the same time, as ICBs move towards a more strategic commissioning role, their focus will increasingly be on planning and organising local health services, rather than managing day-to-day financial pressures across their area.

To support these changes, the bill will remove mandatory duties for collective financial balance and instead strengthen accountability for each organisation’s own financial performance, alongside proportionate national oversight. The Secretary of State will retain the power to place joint financial objectives for ICBs and one or more of its partner NHS trusts and NHS foundation trust should this be needed.