Revealed: The ICB staff targeted for redundancy

Integrated Care Boards have been told to cut their running costs in half by October. 

In a letter to ICB, trust, and regional leaders seen by HSJ, NHS England transition chief executive Sir Jim Mackey said the boards “should look carefully at functions where there is duplication”. 

He added that this was likely to be found in assurance and regulatory functions such as safeguarding and infection control; wider performance (as opposed to contract) management of providers and “comms and engagement”. These functions were “already done” by others, the letter adds.

NHSE has already confirmed it will take on responsibility for provider management. 

Regional directors will “hold the ring” with ICB chief executives to identify “how we are going to make the reductions”, Sir Jim continued. This includes “recognising that successfully reducing these costs will, in part, rely on cross-system arrangements going forward”. On Monday, the new NHSE CEO said he expected substantial consolidation of ICBs.

The NHSE CEO stressed any cuts should be made  “without compromising statutory responsibilities” – although a health bill, whose timing is so far unclear, is expected to reduce their legal duties.

Tuesday’s letter also revealed NHSE plans to lift the cap on elective care funding.

Retaining talent

ICBs have been given until the end of May to plan how they will cut their costs. This is expected to include setting out plans for merger or shared teams by the end of May.

Three weeks on from the announcement of the 50 per cent cut, Tuesday’s letter does not set out how it will be defined or baselined, or how the requirement will be split around the country.

Instead, it says NHSE ”will share soon what we think is a reasonable running cost per head of the population via regional directors”. It is unclear whether this will allow for variation by ICB or region, which is currently significant.

NHSE will also share “the functional output of the ’model ICB’” by the end of this month, to feed into these plans. It should then be implemented between October and December.

The letter acknowledges the “challenge” of such steep cuts, but added: “It’s important we move on this as quickly as possible to retain talent.” It also makes clear that “any in-year savings can be used on a non-recurrent basis to address in-year transition pressures or risks to delivery in wider system operational plans”.

No voluntary redundancy scheme has yet been confirmed, but the letter continues: “We are in discussion with government colleagues about the impact this may have in terms of staffing reductions, and we are discussing the mechanisms this may entail, together with the costs and approvals of any exit arrangements.”

The future of continuing healthcare staff will be “considered”, suggesting the function may need to be rehoused away from ICBs.

However, the letter underlines the need “to maintain some core staff, such as recently delegated [specialised] commissioning staff”. It also stresses ”the need to maintain or invest” in finance and contracting; “strategic commissioning” functions, including “building skills and capabilities in analytics, strategy, and market management”; and development of neighbourhood health.