Specialised delegation delayed again for largest ICBs

Early in 2023, NHS England indicated it was likely to grant “full delegation” of substantial specialised commissioning to ICBs from April 2024, after a year of joint commissioning between NHSE teams and ICBs during 2023-24. 

However, it appears the shift is again likely to be delayed for many ICBs.

An ICB board paper this month states that in the North East and Yorkshire region “transfer of responsibility will be deferred until April 2025”.

Nationally, the services up for potential delegation by NHSE are worth around £13bn a year and include major trauma, congenital heart disease, and radiotherapy. Integrated care boards have begun forming regional joint committees, which – if they are delegated – would make decisions about most services rather than individual ICBs.

A South Yorkshire ICB board paper this month said: “Discussions are continuing between NHS England and the ICBs in the North East and Yorkshire regarding the delegation of responsibility for commissioning specialised services from April 2024. It has now been agreed by all parties that the transfer of responsibility will be deferred until April 2025. 

“This will allow for further due diligence to be undertaken and ensure a safe transfer of this responsibility. ICBs and NHSE are committed to our continued approach of joint work during this transition period.”

All the region’s ICBs are bigger than average, including the largest nationally, North East and Cumbria, and none are in NHS England’s segment 4, for those with the most severe performance, finance and leadership concerns – so are likely to be more eligible for delegation than elsewhere. The region has also passed more responsibility from NHSE to ICBs on other issues in recent years.

However, in a statement to HSJ, NHSE indicated it still planned substantial delegation in April, saying “it is anticipated that large parts of the country will be looking to take on [relevant] delegated responsibilities from April next year”, though this is subject to NHSE board approval in December.

Several ICB leaders in other regions told HSJ they also did not expect formal delegation in 2024-25, and instead, they had been told there would be a joint commissioning arrangement, but with NHSE retaining formal decision making, as was previously planned for 2023-24.

One ICB director said there would be “baby steps” of progress, with “NHSE still in control”. Others said they expected their NHSE region to adhere to ICB joint committee decisions, even though it would keep formal responsibility, but warned this would inhibit change in some services. 

Crucially, it will mean NHSE specialised commissioning staff continue working for NHSE and at the regional level, rather than some being transferred.

In February, NHSE said nine regional joint committees were emerging to commission specialised services. It’s not clear if these geographies have changed.

Previous delay

Last autumn, NHSE decided to delay full delegation to ICBs from April 2023, amid concerns about readiness and financial stability. Only two ICBs — South East London and South West London — formally told NHSE they were ready for the transfer.

The issue is highly controversial with the biggest specialised service providers, and some professional groups, which are concerned ICBs will spend less outside their area in favour of shifting spending to local trusts, and question whether there is the necessary expertise in ICBs.

Providers are also concerned about plans to no longer allocate specialised funding based on provider income but instead on population needs, with a focus on rural areas and those with older populations.

Of the total list of 154 specialised services, NHSE has deemed that 59 “are suitable and ready for ICB leadership in April 2023, while 29 (£1.5bn) are “suitable but not yet ready for greater ICB leadership”. A further 89 services (worth £1.3bn) will remain nationally commissioned.