Background
Integrated Care Boards (ICBs) are responsible for planning, commissioning and managing local NHS budgets and services. In March 2025, NHS England (NHSE) announced that ICBs should reduce their running costs by 50% to become more efficient. NHSE has also announced changes to ICBs’ role and functions. In response, ICBs are taking steps to merge and cluster, reducing the total number of ICBs. They are also reducing their headcounts.
The plans to restructure ICBs are part of the Department of Health and Social Care’s (DHSC’s) wider organisational reforms, including plans to merge NHSE into DHSC by April 2027. In November 2025, DHSC announced that its reforms would involve the abolition of 18,000 administrative posts across DHSC, NHSE and ICBs. It expects to save £1 billion each year by the end of the Parliament.
Scope
This report will examine the planned changes to ICBs, including DHSC’s aims and objectives in restructuring ICBs, and the impact of changes to the size, role and function of ICBs on their capacity, capability and performance. We will examine:
- the rationale and objectives for the changes to ICBs
- changes to the role and functions of ICBs
- progress and impact of ICB consolidation and staff reductions
- DHSC’s oversight of whether the overall objectives of ICB restructuring are being met
We will draw on external findings and engage with a range of stakeholders as we progress the study.
NAO team
Director: Andy Morrison
Audit Manager: Heather Thompson