Trusts to take on ICB responsibilities next year

The planning guidance said: “Beginning in 2025-26, we will move to a more devolved system where ICBs and trusts can earn greater freedom and flexibility…In mature, highly performing systems, it is expected that providers will be able to take on more responsibility for leading the planning and transformation of local services within a strategic framework set by ICBs.”

HSJ understands a small group of the highest performing ICSs will pilot the model in 2025-26.

After the publication of the guidance, NHSE contacted HSJ to say that trusts will only take on these additional responsibilities in “exceptional circumstances” - for example, in areas with both high performance and good local relationships.

NHS England chief executive Amanda Pritchard said in November, during an attempt to clarify the roles of trusts, ICB and her own organisation, that providers would have responsibility for “delivery, quality, and safety and on joining up pathways”.

ICBs were to focus on “strategic commisssiong”, while NHSE concentrated on “planning, assurance, and support”, and “intervening quickly…where performance is not acceptable”.

The remarks caused concern among ICB leaders, and NHSE and government sought to reassure them of their important role. However, the further suggestion of a transfer of responsibility to trusts is being widely interpreted as a recognition that providers in some systems are better placed to drive change. This is deemed to be especially the case in systems with strong provider collaboratives, such as North West London.

A new “strategic commissioning framework” to support this work is due by summer. This will be focused on ways providers can deliver “strategic commissioning directly”.

It will also seek to help ICBs “strengthen their commissioning around general practice, dentistry, optometry, and community pharmacy”. 

NHSE promises ‘deep understanding’

Choice of which trusts and systems are given increased freedom will be determined by NHSE’s new “improvement and assessment framework” which the planning guidance says will be published “shortly”, following long delays and revisions.

Further details of the framework were included in the Our operating model document published alongside the planning guidance. This also contained details of how performance management would be carried out in 2025-26. 

The document states that NHSE “regional directors and their teams will lead on co-ordinating our offers to systems, commissioning what they need from their national colleagues. They will work with their teams to monitor in-year delivery of system plans, performance metrics and the outcomes providers and systems are achieving.” 

It adds: “Discussions about performance will be led by colleagues at NHS England who have experience of addressing delivery challenges, with a focus on offering you practical, informed evidence and guidance that is grounded in a deep understanding of the operational challenges you face.”

NHSE said its overall ambition is to see “self-managing and self-improving systems across the country” and wants to “fully implement this [new operating] model by this summer”.

Our operating model also confirmed NHSE would seek to reach agreeement with systems and trusts about their performance and financial plans by the end of March.

Agreement will be finalised at “board-to-board” meetings between NHSE and ICB and trust chairs and chief executives.

The document addded “a compact will be agreed between NHS England and each system, setting out what each organisation is committing to deliver, how and by when. The compact will reflect the local context and support requested, and what each system partner will be accountable for”.