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What the Integrated Care Board (ICB) Blueprint Means for Service Reconfiguration

Published by Baxendale Team on

The recent publication of the model Integrated Care Board (ICB) blueprint has, as expected, sparked considerable discussion about what it signals for the future roles and responsibilities of ICBs.

While the blueprint does not explicitly reference service reconfiguration, several indicators suggest that:

  • Significant system transformation is anticipated; and
  • ICBs will retain a central role in delivering it.

One of the most notable areas of change is the evolving emphasis on involvement and co-design. In just the two months since the initial changes were announced, there has been a noticeable shift—not only in how prominently this is now positioned as a core responsibility, but also in terms of where accountability for it resides - remaining with ICBs rather than transferring to Providers.

The fact that involvement and co-design now sit alongside population health strategy and strategic commissioning as core responsibilities of ICBs may signal that substantial transformation is on the horizon.

Another key area to watch is the responsibility for ‘should costs’. The blueprint states that:

"ICBs will need to invest in (‘should cost’) analysis and wider finance functions, developing capabilities in strategic purchasing, contracting, design and oversight of payment mechanisms, utilisation management, and resource allocation."

This prompts the question that if systems are unable to meet their 'should costs' under the current service configuration, with ICBs now having tighter, more focused responsibilities, is this more likely to trigger service reconfiguration?

Governance is also central to this discussion—particularly the blueprint’s reaffirmation of ICBs’ core statutory functions, including duties related to equality and public involvement. This suggests that statutory responsibilities for service change, as set out in primary legislation, will remain with ICBs. 

Taken together, these signals suggest that ICBs are being positioned to:

  • Retain statutory duties for service configuration; and
  • Develop the analytical and engagement capabilities necessary to identify, plan, and implement major system transformations.

It is worth noting that ICBs were initially established with this transformational agenda in mind. However, when NHS England took on more of an assurance role, additional responsibilities were shifted to ICBs—diluting their original focus on service reconfiguration.

As a result, over the past five years, there have been few substantial service changes (outside of London), with only a handful of exceptions such as Oxfordshire, the Dorset maternity service reconfiguration, and the Kent stroke pathway. Even these have proven limited in scope and challenging to implement.

If service reconfiguration is once again becoming a strategic priority, it will require a substantial reinvestment in the skills, capacity, and expertise needed to plan and deliver change effectively and sustainably. This is especially critical in meeting the challenge of delivering care within defined ‘should cost’ parameters. It also underscores the ongoing need for a strong, evidence-based Case for Change, alongside early and meaningful engagement with citizens and, crucially the Scrutiny Committees - overseeing these changes.

By Simon Angelides