NHS England » Annual assessment of integrated care board performance 2024/25

Introduction

Under the terms of the NHS Act 2006, NHS England must conduct an annual performance assessment of each integrated care board (ICB), considering how well it has discharged its functions during the year, and publish a summary of each assessment. Individual assessments were conducted in quarter 1 of the 2025/26 financial year and issued to ICBs.

This report summarises each assessment that was undertaken and provides our views on how each ICB has performed against the 5 core roles aligned with the core purposes of an integrated care system:

provided system leadership and governance
improved population health and healthcare
reduced inequality
provided value for money
enhanced social value

Further information about the assessment process can be found on our website: NHS England » Annual assessment of integrated care boards (ICBs)

Our 2023/24 annual assessment noted the operating challenges, especially for elective care, linked to industrial action. The 2024/25 assessments rightly recognise the work of ICBs with their provider organisations to recover the elective waiting list, which was reduced by over 150,000 patients. Our assessments also recognise that the fundamental role of ICBs is evolving as part of wider NHS restructures, with a focus on ICB strategic commissioners, with responsibility for oversight of NHS provider organisations being transferred to NHS England.

In general, we recognise the positive work of commissioners as they continue to develop new pathways of care supporting the NHS 10 Year Health Plan’s ambitions to shift from analogue to digital, hospital to community and treatment to prevention. Many ICBs and their providers do, however, continue to have significant challenges and our assessment not only sets out where improvement is required but also how NHS England is supporting organisations as an active supportive system partner as well as a regulator.

East of England integrated care boards

Bedfordshire, Luton and Milton Keynes

System leadership and governance

Good progress has been seen on governance with external auditors rating ICB governance as green. A positive approach to collaboration and partnership working across the system is recognised, although there is further work to do, particularly with one trust to ensure effective performance management is in place.

Improving population health and healthcare

We continue to seek a strategic whole-system approach to population health to complement the local initiatives being encouraged by the ICB. While innovative system-level activity, such as an Unscheduled Care Co-ordination Hub to facilitate earlier discharge, are welcome, there remain areas for improvement. We also remain keen to see the ICB ensuring tobacco dependence treatment services in Milton Keynes are made available to all inpatients in line with the ambitions reiterated in the 10 Year Health Plan.

We welcome reductions in diagnostic waiting times and improvements in dental delivery, but we are concerned that performance in some areas remains challenged. We look to the ICB to continue to work with our support programmes on elective and maternity care, as well as paediatric audiology, where longstanding problems remain. Efforts should also be made to improve urgent care 4-hour performance which, while stable, remains below the target level of 78%.

Reducing inequality

The ICB works effectively with its partners to tackle inequality, as evidenced by the Denny Review in 2023, the learning from which continues to be implemented through several local projects. The ICB also continues to work with its partners to use funding to reduce inequality through schemes such as targeted cardiovascular health initiatives.

Productivity and value for money

We welcome the positive financial results of the system with both ICB and wider system reporting surpluses for 24/25, including a substantial reduction in agency whole time equivalents (WTEs). The ICB delivered against its efficiency plan and has worked effectively with both its acute trusts to reduce pay spend.

The ICB operates as an anchor institution advancing the system’s strategic priorities, including improving wellbeing and promoting local models to improve access for underserved populations. Progress continues to be made in reducing emissions and reducing medical waste in line with the system green plan, as well as taking targeted action to improve economic inclusion opportunities for disadvantaged groups and children and young people.

Cambridgeshire and Peterborough

System leadership and governance

The ICB continues to demonstrate its capability and maturity. This is recognised in its improvement from segment 3 to segment 2 under the NHS Oversight Framework in quarter 4 2024/25. We recognise and welcome the collaborative work and enhanced stability of leadership across the system, and we look for continued strengthening of partnership working with the system’s major tertiary provider, which has not yet reached the level needed.

Improving population health and healthcare

The approach to population health remains positive, based around an agreed system-level strategy underpinned by integrated neighbourhood working. There are strong relationships evidenced with a defined roadmap to neighbourhood care established. We particularly recognise the work the ICB has done in managing cardiovascular disease, with 83% of GP practices signed up to identify and support high-risk patients.

We recognise and welcome performance improvements, particularly on elective care and maternity. There do, however, remain areas of significant challenge, notably urgent care, where performance levels were not acceptable and Learning Disability and Autism services, where the 75% health check objective was not met.

Reducing inequality

The ICB has used its role as a commissioner to support reducing inequality by distributing primary care funding using a population needs model to target practices in high deprivation areas. It has also led targeted health programmes and tailored services towards underserved populations. Further targeted work is taking place using the Health Inequalities Challenge Fund and work to target immunisation and lifestyle programmes at underserved cohorts.

Productivity and value for money

The ICB is commended for its work in supporting system breakeven, including through delivery of its own surplus and achievement of recurring efficiencies. We recognise and welcome the achievements and now encourage focus on addressing deeper challenges, including the fragility of trust finances, particularly at Cambridgeshire and Peterborough NHS Foundation Trust, and on overall levels of productivity across the system.

The ICB has taken positive actions targeted at tackling local social and economic exclusion, including through the WorkWell programme and local apprenticeships. It has also led on the delivery of the system green plan providing funding for energy efficient upgrades, leadership in clinical sustainability and initiatives to reduce clinical emissions.

Hertfordshire and West Essex

System leadership and governance

We welcome the enhanced strategic vision set out by the ICB with enhanced devolution of responsibilities and accountability arrangements. The ICB’s willingness to work alongside partner organisations when developing services is welcome and this will need to be expanded in the year ahead particularly to provide strategic alignment with the delivery and impact of the provider collaborative particularly on fragile services.

Improving population health and healthcare

We have been particularly impressed with the work that the ICB has undertaken on population health management, with a data-driven stratification approach and empowered neighbourhood teams; Southwest Hertfordshire is nationally recognised as an exemplar. We now look to expand this learning to other parts of the system, in particular East and North Hertfordshire, where further development is needed.

We welcome a number of improvements this year, in particular, the movement of East and North Hertfordshire Trust out of the Maternity Safety Support Programme, the strong adoption of virtual capacity and the continued delivery of cancer and learning disability and autism objectives. We look for continued progress particularly in areas of recognised challenge such as long waits for community services.

Reducing inequality

The ICB’s population health management approach has allowed positive action to be taken on reducing inequality in line with strategic plans. We note, in particular, the work to deploy targeted investment to health equity programmes and a continued drive to tackle national priorities like cardiovascular disease prevention. We look to the ICB to continue to drive-down variation in practice across the patch to ensure parity between places.

Productivity and value for money

Both the ICB and the wider system delivered financial plans for the year, although breakeven was only possible with the non-recurrent deficit support funding. The ICB has shown strong leadership, and we commend the delivery of efficiency plans and temporary staffing cost reductions, although both areas will need to remain in focus to continue to deliver financial balance.

The ICB remains an effective partner within the Essex anchor network, focused on social and economic development. It has made welcome progress in reducing emissions in line with the system green plan, as well as seeking to enhance diversity and representation within its workforce and driving for more intensive activity to enhance employment and training opportunities for the local community.

Mid and South Essex

System leadership and governance

The ICB has reviewed and strengthened its governance procedures, as well as filling key vacancies, including the chief executive officer. NHS collaboration is positive and must remain intensive to address the significant operational challenges, but there must also be a focus on strengthening wider relationships, particularly with public health directors as part of work to improve overall population health and avoid preventable illness.

Improving population health and healthcare

While the agenda remains in its early stages, we are encouraged by the progress this year with improved collaboration with communities when designing services and improving processes to ensure accurate and targeted interventions. There do remain significant future opportunities to be exploited, with tobacco dependence services not yet universally in place and improvements being needed in treating cardiovascular disease and hypertension.

There are substantial operational challenges in the system at Mid and South Essex NHS Trust, which must be addressed with urgency. We will continue to offer our support through focused tiering interventions and wider wraparound support through the Recovery Support Programme, but the ICB will need to work effectively alongside us to address the significant challenges in elective, maternity, urgent care and paediatric care.

Reducing inequality

The ICB has demonstrated a commitment to reducing inequality and has distributed targeted funding for specific projects such as lung health check services, but there is much more that can be done. We urge the ICB to collaborate more significantly with wider system partners and consider how data can more effectively allow targeting of activity and alignment of agendas to progress improved outcomes.

Productivity and value for money

While the ICB delivered welcome results individually, balancing its own financial position and delivering against its efficiency plan, the wider system position remains challenged. The system did not deliver financial plans for the year, so even with deficit support, funding was unable to deliver breakeven; we welcome progress in reducing temporary staffing costs, but much more will be required to deliver provider efficiency plans, which are critical to wider system balance.

The ICB is an active partner in the Essex Anchor Institute, working with local authorities, educational partners and the third sector to collaborate on common goals. Integrated neighbourhood teams have seen a welcome expansion to support local employment and training in collaboration with Anglia Ruskin University, and we note progress on the ambitions of the system green plan, including eliminating the use of desflurane.

Norfolk and Waveney

System leadership and governance

The ICB has taken proactive steps to review its internal governance and operating model, and we have been pleased with the increased partnership and collaboration that have resulted from this activity. The ICB has shown positive leadership in developing a medium-term strategic plan, and we now urgently look to see how this aligns with the acute clinical strategy underpinning the system’s new hospitals programme.

Improving population health and healthcare

The ICB has established a broad population health management strategy, and we recognise positive outcomes in a number of areas particularly in childhood vaccination rates and the leading role the ICB has taken on tobacco dependency. There now needs to be a focus on more tailored activity at a local level through integrated neighbourhood health teams to drive local interventions to complement the wider strategy.

There are a range of operational performance issues that the medium-term strategic plan must drive improvement against with cancer, urgent care, elective and mental health performance all challenged. The ICB also chairs the improvement board for maternity services at James Paget University Hospitals NHS Foundation Trust, where the pace of improvement must now increase to address the inadequate services in this area.

Reducing inequality

We recognise that the ICB has a clear commitment to reducing inequality with a population health management approach focused on the social determinants of health. A system-wide improvement model is in development at place level, which we look to see guide collaboration and interdependency between partners to deliver more integrated and locally owned improvements in outcomes.

Productivity and value for money

The financial situation in the system remains a significant concern, with a substantial deficit reported, even taking into account non-recurrent deficit support funding. Support is being provided to the system to identify further potential productivity and efficiency savings, as significant levels of efficiencies and workforce transformation will be required to deliver balanced financial positions this year and into the future.

We recognise and welcome the ICB’s systemic approach to socioeconomic improvement, demonstrated through its framework for action setting out the strategic ambitions and role for anchor partners in this agenda. We look to see this now integrated with the emerging place and neighbourhood models to build on positive relationships, for example, with education partners to continue to advance this agenda.

Suffolk and North East Essex

System leadership and governance

The ICB is well recognised as providing excellent leadership, strong governance and a track record of collaboration. This was, rightly, recognised in the decision this year to elevate the ICB to segment 1 of the NHS Oversight Framework in Q4 2024/25; the only ICB in the country to achieve this status. Cross-system leadership remains a strength, and we congratulate the ICB for their achievements.

Improving population health and healthcare

The ICB is well-regarded for its population health management model, with a common framework tailored at place level to local needs. While there is variation in maturity, Ipswich and East Suffolk is furthest advanced, the ICB recognises the opportunities to learn and develop other places. Key public health metrics, such a smoking cessation during pregnancy and reducing hypertension, are also comparably high performing.

A number of operational areas remain high performing, such as reducing long community waits and urgent care where system level targets were met. There does, however, remain areas for further progress, for example, mental health performance, particularly in diagnosis rates for dementia, varies across the system, as does diagnostic capacity and performance. We look to the ICB to support reduction in local variation.

Reducing inequality

Reduction in inequalities is a core aim of the system’s joint forward plan, and the ICB continues to drive progress in this area linked to its wider population health agenda. Greater use of digital enablers has allowed a targeted focus on initiatives to reduce inequality, such as dedicated prevention programmes and using stratified data to ensure waiting lists are reduced in an equitable manner.

Productivity and value for money

The ICB continues to display exemplary financial management, with the system position breaking even and the ICB over-delivering against its surplus, as well as delivering its efficiency plan with 96% recurrent efficiencies. Trust level positions remain more mixed, particularly with regards to recurrent efficiencies, and we look to the ICB to continue its work with its partners to ensure financial balance is retained throughout the system.

The ICB works in close partnership with its system partners to deliver against anchor priorities, which include make most effective use of estate capacity, ensuring social value is embedded within procurement pipelines and progressing its system green plans to reduce emissions. The ICB also remains in the upper quartile of NHS staff survey scores for diversity, equity and inclusion.

London integrated care boards

North Central London

System leadership and governance

The ICB is recognised as having an effective and robust governance model with clear established reporting lines and an effective process to enable clinical and community voices to support decision-making. We recognise the ICB’s strong partnership ethos and particularly commend its supportive work this year in securing key strategic mergers in both the acute and non-acute sectors.

Improving population health and healthcare

The ICB has shown a data-driven approach to managing population health, with a rich understanding of local demand patterns enabling the targeting of resources and focus to areas most in need. There has been a mature focus on the preventative agenda with notable work on targeted immunisation campaigns for underserved communities and admirable analysis into inequalities associated with lifestyle factors such as smoking.

There remain considerable operating challenges in the system to be overcome, despite some areas of positive delivery. In particular, we look to see further action to reduce the elective waiting list, which has grown in the last year, despite activity being above plan, with the diagnostics waiting list also increasing. We do, however, recognise progress in areas such as mental health, as well as enhanced data quality, which is welcome.

Reducing inequality

The ICB has aligned its approach with NHS England’s statement on inequality and has worked effectively with its partners to enhance understanding of opportunities to reduce inequality. We particularly welcome the demonstrable outcomes as part of the distribution of inequalities funding with evidence of reducing healthcare interactions for populations targeted as part of these initiatives.

Productivity and value for money

Both the ICB and the wider system reported surpluses for the year, which is welcome, although efficiency plans were under-delivered, and there remains further opportunity to identify recurrent efficiency streams. We look to the ICB to maintain financial grip and control with particular focus on pay costs with WTEs increasing over the year despite planned reductions of 2.2%.

The ICB has worked effectively as an anchor institution delivering the London living wage across the system and working with the local training hub to deliver opportunities for training and development as well as being a national WorkWell pilot. The ICB has progressed its green plan, with all energy purchased from renewable sources and clear actions to improve representation and inclusion for its diverse population.

North East London

System leadership and governance

The ICB demonstrates a robust and effective approach to governance with evidence that approaches are inclusive and challenging, complemented by positive relationships between partners to share intelligence and learn from one another. There is good evidence of positive system working across a very diverse system, ensuring that partnerships are effective and enable holistic service design for the varied population.

Improving population health and healthcare

There is an established population health platform in place to stratify population data, combined with locally designed outcomes frameworks, giving a strong basis to the ICB’s approach to managing broader population health. A number of initiatives are underway working with peers and local groups, which we welcome, and we look to the nascent approach to neighbourhood health continuing to develop.

There were operational areas of high performance such as cancer services this year, which are to be commended, but other areas will need continued focus this year. We note that the 4-hour urgent and emergency care (UEC) target was not met and that overall waiting list sizes increased. We are keen to work with the ICB to understand how issues with special educational needs and disability (SEND) will be managed, particularly following inspections resulting in additional oversight.

Reducing inequality

There is a positive data-driven approach to reducing inequality, and we particularly welcome the approach to health equity combining established quality improvement approaches with local flexibility. The ICB has shown positive steps to tackling embedded inequality, such as differential outcomes across ethnic groups, and we would like to understand more fully some of the actions being undertaken to achieve specific outcome ambitions.

Productivity and value for money

While the ICB reported a surplus at organisation level, the system’s financial position was extremely challenged even after the provision of non-recurrent deficit support funding. In addition, a further deterioration was identified following external audit, which is being reviewed. This is a worse financial position than the previous year, which the ICB must work to improve this year; we note in particular, the continued high use of agency staffing, which offers potential for efficiencies.

The ICB has clear anchor commitments, which are to be commended, and has delivered clear tangible actions in this area, including becoming the first ICB to achieve accreditation as a London Living Wage employer, as well as demonstrating reductions in emissions across the system by over 30% since 2019/20. We welcome the work on improving diversity, equity and inclusion, with a system-wide anti-racism strategy now in place.

North West London

System leadership and governance

We are assured that the ICB has a robust governance structure that enables effective decision-making and assures the effective oversight of quality, finance and delivery. There are robust strategies and plans in place informed by local people and professionals. We have noted a strong focus on quality governance and welcome the sharing of examples of quality improvement more widely across London learning forums.

Improving population health and healthcare

The ICB has made positive progress in targeting interventions at those at increased risk of poor health, such as focused high-risk hypertension detection using machine learning, as well as advancing their integrated digital strategy to improve interoperability across the system. We would welcome greater insight into how the ICB is progressing in respect of specialised services such as epilepsy and diabetes care.

Performance in many areas, notably urgent care and cancer care, is very encouraging but there do remain areas requiring further focus. In particular, we look to the ICB to continue reducing long elective waits, as well as improving performance against the headline diagnostic standard, and to continue its progress in improving children and young people’s services and optimising governance in this area.

Reducing inequality

The ICB has a clear strategic ambition to reduce inequalities underpinned by 12 local inequality metrics that are routinely reported against. Positive activity is being taken to develop, with community networks, inclusive and targeted interventions based on ethnicity, as well as showing a mature approach to progressing prevention activity, including jointly funding posts on tobacco and obesity with local authorities.

Productivity and value for money

The ICB delivered an individual surplus for the year, which was used to offset provider deficits and ensure the system as a whole ended the year in surplus. The ICB also over-delivered against its efficiency plan, supporting the achievement of the wider system efficiency plan, which is to be commended. While spending on agency staff was below cap, total WTEs increased despite a planned reduction, which will require further focus this year.

The ICB remains an active anchor institution, taking a number of important steps to enhance wider social and economic value. The ICB launched a WorkWell programme, supporting residents with health conditions to find or retain work, as well as actively committing funds through voluntary, community and social enterprise (VCSE) partners. A sustainability strategy is also in place to support net zero targets in line with the system green plan, with regular reporting against SMART targets.

South East London

System leadership and governance

The ICB has demonstrated a robust approach to governance and management with evidence of effective structures and regular reflective practice through a schedule of internal audits as well as system leadership on risk and sustainability. The ICB has shown itself to be an effective system leader and partner, with positive feedback from partners on the shared approach to place-based management.

Improving population health and healthcare

The ICB has a system-level approach to managing population health with a clear approach to embedding evidence-based prevention activity throughout the system. We welcome the work the ICB has done to strengthen out-of-hospital services, including optimising primary care capacity through transformed digital services and expanding mental health access.

While we welcome these advances, we do recognise that in many areas operational performance levels are not at the standard required, which will require renewed focus in the year ahead. We note in particular that UEC targets were not met, and diagnostics performance was significantly below target. While elective waiting lists reduced, with activity above plan, the ICB did not remove the patients waiting the longest.

Reducing inequality

The ICB has a strong business intelligence function that enables the identification of inequalities, such as gender disparities in elective recovery, and we look to see this utilised to reduce avoidable ill health. The ICB has also demonstrated a positive approach to community engagement to tackle entrenched issues of inequality, such as vaccination services for underserved communities.

Productivity and value for money

Both the ICB and wider system delivered their plans for the year, though breakeven was reliant on non-recurrent deficit support funding. The system needs to work collectively to address the substantial underlying deficit position, including the deficit at King’s College Hospital, to move to long-term financial sustainability.

The ICB is an effective anchor institution using its influence and resources to support local initiatives. The ICB leads a Health and Care Jobs Hub connecting local people with jobs and training in healthcare, as well as using commissioning and procurement functions to enhance the local economy. The ICB has also progressed in increasing inclusion among the NHS workforce and reducing emissions in line with its system green plan.

South West London

System leadership and governance

We are satisfied that the ICB has a robust structure of governance in place with a demonstration of strengthened quality governance processes. The ICB has worked effectively with its partners as it continues to transform services, including the work to support the successful merger between Kingston NHS Foundation Trust and Hounslow and Richmond Community NHS Trust.

Improving population health and healthcare

The ICB has made good use of stratified population health tools to target public and population health projects, and we look to see robust evaluation going forward of activities such as the Community Health and Wellbeing Workers programme, targeted at improving access to particularly vulnerable and deprived populations across the system.

Operationally, we welcome the strong performance in urgent care and cancer care, but we remain concerned at progress on the elective agenda. Despite growth in elective activity, this was below the levels that were planned and the overall size of the system’s waiting list increased. We will continue to work closely with the ICB in the year ahead to reverse this position and deliver the necessary reductions in waiting lists.

Reducing inequality

We recognise the work of the ICB in reducing inequalities and, in particular, the development of its explorer dashboard to identify potential areas of inequality and the deployment of targeted funding to areas of value. The Core20 connectors programme has received additional funding, which is positive to see, with over 200 connectors recruited to support community outreach in deprived areas of the system.

Productivity and value for money

Both the ICB and the system delivered their plans for the year, although breakeven was reliant on non-recurrent deficit support funding, which is not sustainable in the long term. There remains a substantial underlying system deficit, and we look to the ICB to work with its system partners to take the necessary steps to ensure financial stability is delivered, including tackling pay spending, which remains significantly above plan.

The ICB has taken positive steps to enhance social and economic growth, with targeted local recruitment and partnership with education institutions, reflecting the role of the NHS as the system’s largest employer. We welcome the ICB’s work to establish an equality, diversity and inclusion (EDI) improvement plan, as well as its work to reduce emissions in line with its green plan, by securing additional targeted funding to deliver energy efficiency upgrades.

Midlands integrated care boards

Birmingham and Solihull

System leadership and governance

The ICB has continued to progress with its system operating model, with its integrated care approach receiving national interest. The ICB has also effectively led its wider system as host commissioner for primary care and specialised commissioning in the West Midlands. The ICB has strong governance processes in place, including oversight of operational performance and management of care quality.

Improving population health and healthcare

The ICB’s approach uses locality hubs and integrated neighbourhood teams focussing on a shift to community with East Birmingham already demonstrating positive shifts away from hospitals. We note success including targeted lung cancer screening which will expand to cover the whole integrated care system (ICS) by the end of the decade.

While the ICB has robust operational management, there are significant delivery concerns. We welcome reductions in long waits and achievement of the faster diagnosis standard, but University Hospitals of Birmingham remains highly challenged on cancer and diagnostics with tier 1 support in place. We also have concerns about the increasing number of inpatients with a learning disability, as well as ongoing maternity concerns in Birmingham, which is being supported through the Maternity Safety Support Programme.

Reducing inequality

The ICB’s approach to reducing inequality is data-led, with over 100 indicators stratified by ethnicity and deprivation to support its long-term strategy. We have seen positive progress for underserved communities, with 85 community cancer champions appointed and a welcome increase in MMR uptake. We welcome the work the ICB has done and hope to see further progress, particularly to address the needs of children and young people.

Productivity and value for money

The ICB delivered its breakeven plan, and the wider system delivered an overall surplus, which is welcome, although we do remain concerned at the reliance on non-recurrent efficiencies. We recognise strong financial leadership by the ICB to address in-year deficits and progress against potential efficiencies. However, we do believe there is further progress that can be made to fully realise the available opportunities.

We have been pleased with the ICB’s work to support local economic growth in its role as a WorkWell vanguard and its outreach programmes, supporting local people into NHS careers. We have also recognised improving staff survey results reflecting the dedication to improving EDI. While there has been success in reducing emissions, further work is required on other targets to successfully deliver the system green plan.

Black Country

System leadership and governance

Following the refresh of the system’s operating model in 2023/24, we note strengthened board governance processes and improved strategic alignment between key partners and aims. We look to now see progress maintained and greater evidence of how sub-ICB structures, such as place and provider collaboratives, align with the operating model.

Improving population health and healthcare

There have been several strategic commissioning changes within the system across the year, and we recognise the ICB’s work with the local population to support these changes. This includes the work on the opening of the Midlands Metropolitan University Hospitals and the reopening of Walsall Midwifery Led Unit within Manor Hospital.

Operational performance was positive in many areas, particularly cancer and primary care, as well meeting the urgent care 4-hour target and reducing the number of inpatients with a learning disability or autism. There do remain areas for further improvement, in particular, for elective care, where tier 2 support is in place, as well as variable performance against mental health objectives. We look to a future focus being the ICB’s out-of-hospital care programme as part of the shift from hospital to community.

Reducing inequality

The ICB has shown a clear commitment to the inequality agenda, hosting the system’s health inequalities and prevention board to oversee delivery of the health inequality strategy. The ICB has published a comprehensive statement on health inequalities as part of its annual report, and we have seen evidence of a number of examples of positive specific programmes delivered this year targeted at reducing inequality.

Productivity and value for money

In July 2024, enforcement undertakings were agreed with the ICB for finance, and we were pleased to see the wider system met the requirement to deliver to plan for the year. The ICB delivered a surplus, although we do recognise that delivery of the system breakeven position was reliant on significant non-recurrent deficit support funding. The ICB has demonstrated clear robust financial management with efficiency plans largely delivered and agency spend within cap. We look to the ICB to maintain this grip and continue to comply with the undertakings in 2025/26, particularly with the ambitious workforce reduction targets required.

The ICB has delivered as an anchor institution, being recognised as a pioneer in reducing economic inactivity. The ICB has also shown commitment to improving EDI, with its staff survey results demonstrating success, as well as receiving national recognition for its work on health and housing. Good progress is being made against greener NHS targets, and we now look to see the green plan being further embedded throughout the organisation.

Coventry and Warwickshire

System leadership and governance

We recognise the work that the ICB has done to provide effective system governance, especially covering major acute priorities; going forward, we look to see this approach expanded to cover all national objectives, and we will continue to provide focused support in specific areas such as mental health. The ICB continues to work effectively with its wider system partners in developing joint strategies and plans.

Improving population health and healthcare

We welcome the development of a long-term roadmap for population health within the system to explain the vision for implementing population health management at all levels supported by a common data picture. We also recognise strategic shifts with 2 community integrator contracts commissioned, allowing lead providers to deliver and commission community services.

Despite this, however, we do remain concerned at the level of performance across a range of areas. UEC, outpatients, elective and cancer targets were missed with University Hospitals of Coventry and Warwickshire escalating from tier 2 into tier 1 support for cancer at the start of this year. Mental health services also under-delivered, and we look to the ongoing system-wide governance review to strengthen oversight of these services.

Reducing inequality

The ICB’s strategic inequality plan has been refreshed, and we remain satisfied that there is defined leadership on this agenda with 29 projects funded via the innovation fund. We note the work described in the ICB’s annual report to reduce inequality, including work on improving severe mental illness (SMI) health check uptake rates, which did not meet the 65% standard this year, and enhancing uptake of vaccination among specific communities.

Productivity and value for money

We were pleased that the ICB exceeded its own financial plan, as well as contributing to the system plan delivery, although we do recognise that the system position was in part delivered through non-recurrent deficit support funding. The system efficiency plan was met, although planned recurrent efficiencies were less than forecast, and the agency cap was met but with bank spending above plan. We recognise strong financial governance, and this must translate to enhanced grip and control of provider spending in the year ahead.

The ICB plays a key role across the system’s anchor network, leading activity on social and economic development. We recognise local employment initiatives driven by a health and social care employability academy as well as a focus on EDI, but Health and Wellbeing Boards have fed back that there could be improved effectiveness from the ICB in supporting Joint Local Health and Wellbeing strategies. The ICB also did not meet all greener NHS objectives this year, which we look to see improved.

Derby and Derbyshire

System leadership and governance

We recognise the work done by the ICB to review and update its governance structures as well, as the work to commence a board development programme to enhance its leadership capability. The ICB works effectively with its wider system partners, however, further engagement with partners in developing shared strategic plans would be welcomed, and there should be continued focus on enhancing the impact and influence of clinical leadership going forward.

Improving population health and healthcare

The ICB has shown commitment to improving population health, with the Team Up Derbyshire initiative bringing partners together to deliver co-ordinated community support, preventing over 1,000 hospital avoidable contacts. We have seen good evidence of collaboration on prevention, but there is still much more to do to ensure there is reliable data to track population health measures and drive necessary improvements.

We recognise some positive progress this year, particularly on strengthening governance arrangements, which saw University Hospitals of Derby and Burton stepped down from cancer tiering. Performance does, however, remain challenged in several areas, and we will continue supporting the system on multiple fronts, including through tier 2 of the elective recovery programme and the maternity safety support programme.

Reducing inequality

The ICB has an established a prevention and health equities board supported by health inequalities data aligned with NHS England’s statement on inequalities. We welcome the steps taken on this agenda, including demonstrable improvements in uptake of SMI health checks, but we look to see greater improvement in the ability to disaggregate data to enable targeted strategic commissioning decisions in this space.

Productivity and value for money

The ICB under-delivered its planned surplus as part of risk pooling agreements that enabled the wider system to deliver its plan, which we recognise and welcome, although we do recognise that the system breakeven position was reliant on non-recurrent deficit support funding. Efficiency plans were under-delivered, highlighting the need to continue to identify recurrent long-term efficiencies. We welcome the ICB continuing to keep agency costs low compared to other systems, but bank spending was significantly above plan; further work is required to ensure temporary staffing remains within budget.

The ICB is part of the system anchor network, which has begun work on opportunities in workforce and procurement to reduce economic inactivity. We look to see this work now gather pace. We also recognise some progress in relation to the EDI and greener agendas and have highlighted where we would seek further improvement this year.

Herefordshire and Worcestershire

System leadership and governance

As part of our assessment, we have received substantial assurances regarding the effective governance model of the ICB, and we are satisfied that the general level of maturity in approach is high. We recognise the effective work of the ICB with its partners and wider community to ensure that strategy, commissioning decisions and outcomes are aligned effectively.

Improving population health and healthcare

The ICB has a clear structure and strategy for overseeing population health management and has cited a range of positive steps taken this year, including greater empowerment to primary care teams to make integrated decisions and specific commissioning actions to deliver improved care for the local population, especially in diagnostics and women’s health.

We recognise improvements and positivity in the delivery of many operational areas such as elective care and cancer, where tier 2 support was ended, as well as exiting the maternity safety support programme, but there remain significant areas of challenge. Urgent care remains a particular area of concern, where we have deployed tier 1 support, as well as a need to develop a longer-term mental health services strategy.

Reducing inequality

The ICB is a strong local leader on addressing inequalities with a clear strategy, leadership, and a broad ambassador network. We note successes this year through investing in preventative cardiovascular disease programmes and positive improvements in tackling smoking and increasing community pharmacy use. The ICB is proactively reaching out to underserved communities to ensure fair distribution of resources and tackle entrenched inequality.

Productivity and value for money

We are pleased that the ICB delivered its own financial plan, as did the wider system, recognising that the system plan was reliant on receipt of non-recurrent deficit support funding to deliver breakeven. The ICB has effectively led work this year to develop a plan to deliver medium to long-term financial sustainability, including how to reduce over-reliance on temporary staff; we look to the ICB to lead the realisation of this plan with its partners.

The ICB is recognised by its Health and Wellbeing Boards as an active partner in the delivery of health and wellbeing plans. The “Grow your own” programme to recruit and retain local talent will be vital to deliver the financial sustainability plan, and we commend focus on this area. The system is not yet meeting the ambitions of its green plan and will need to ensure this area retains focus and expertise in the year ahead.

Leicester, Leicestershire and Rutland

System leadership and governance

There is effective ICB governance in place and good system collaboration, which supports the development of robust strategies and plans, but we would like to see more evidence of work with partners and communities beyond the NHS.

Improving population health and healthcare

We are assured that there is an embedded and effective approach to managing population health across the system, and the ICB can demonstrate that it understands and plans for its population. The system already sees high volumes of patients referred to community services, and we also recognise the advanced prevention activity across the system, including mature approaches to tobacco and alcohol dependence.

We recognise progress made during the year, including supporting University Hospitals of Leicester to exit elective tiering, but performance has since deteriorated, and significant focus is required to improve performance again in this area. Tier 1 support remains in place for diagnostics and cancer. Urgent care performance has improved but does not yet meet national standards. We will support the urgent care collaborative to continue its improving trajectory in the coming year.

Reducing inequality

There has been clear evidence supplied that health inequalities are embedded within system leadership with defined strategies and routine reporting against deliverables. The ICB is a recognised leader in many areas of this work with notable achievements in sophisticated data stratification on cancer screening uptake and a strategic long-term approach to primary care financing to level-up funding based on population need.

Productivity and value for money

The ICB achieved financial balance, although we do recognise that this was in part delivered through non-recurrent deficit support funding, but provider overspends meant the system breakeven plan was not achieved, even after provision of deficit support funding. We continue to provide support to University Hospitals of Leicester through the Recovery Support Programme. We look to the ICB to continue to work with us to realise the efficiencies that need to be achieved.

The ICB is an effective anchor institution and has provided evidence of a range of positive activity this year, including excellent work on improving diverse and inclusive practices within its own organisation and across the wider system. Positive delivery against some areas of the system green plan is noted, but other areas are either unreported or not embedded and could benefit from greater focus in the future.

Lincolnshire

System leadership and governance

We are assured that governance processes have continued to mature this year, with effective joint working relationships established across the system. We welcome in particular the work done between the ICB and its providers as part of a wider alliance, looking at how partners can work together to deliver transformation work aligned with the shift to delivering services closer to home.

Improving population health and healthcare

The alliance model that has been developed sets out how the system intends to progress its population health agenda, establishing working practices, transformation programmes and restructured care groups as part of this drive. The prevention agenda remains a significant priority, with smoking cessation performance remaining high and, from a low base, positive progress in increasing digital weight management referrals.

Operational performance did improve this year but remains challenged in many areas. We are providing specific support through tiering programmes for elective care, cancer care diagnostics and urgent care, all areas where further improvement is required. We recognise the good performance in mental health services and look for renewed focus on learning disability and autism progress.

Reducing inequality

The ICB has shown strategic understanding of inequalities and has a defined approach to reducing these. We note programmes using data-driven approaches aiming to tackle inequalities within urgent care, children and young person’s mental health and maternity pathways. We look to the system to maintain its focus on reducing inequalities, including improved equity for pregnant women in at-risk groups.

Productivity and value for money

The system submitted a breakeven plan for the year, but this was not realised with both the ICB and the wider system reporting deficits at year-end. More work will be required to enable financial duties to be met this year, and we believe there is evidence of significant unrealised productivity and efficiency gains to be achieved that will require strong focus to unlock.

In partnership with the University of Lincoln, the ICB established the UK’s first research centre for rural and costal research, looking at impacts of geography on health inequalities. The ICB also works well with local authority and wider system partners, and we note good work in supporting the needs of veterans and service personnel, as well as the proactive work planning for the health provision of asylum seekers.

Northamptonshire

System leadership and governance

The year has been challenging for the ICB, with senior leadership changes across both commissioner and providers, which will take time to embed. While we welcome the progress of the acute group model, the provider oversight arrangements must be further strengthened to fully achieve the benefits, with mutual accountability between partners and more effective collaboration and partnership working taking place across the system.

Improving population health and healthcare

We recognise the ambition to move to a community-driven system, reducing reliance on inpatient care, and we welcome work on frailty and women’s health as part of this agenda. Some positive action on prevention is also recognised, such as tobacco dependency and weight management, but in other areas much more is needed, particularly the digitisation of primary care with prospective access to records, which requires urgent focus.

Some positive operational performance indicators have been seen, such as increasing mental health access, but in many areas more progress is required. We will continue to support across the system, particularly with tier 2 support for urgent and emergency care and support from the Maternity Safety Support Programme at Kettering General Hospital.

Reducing inequality

The ICB has established solid foundations to drive its prevention agenda, with the Chief Medical Officer leading a clinically led review of services to prioritise service investments for the year ahead. The ICB has clearly articulated its ambitions to build on this progress with a data-driven approach at neighbourhood level, supporting more effective tracking of progress in reducing inequality.

Productivity and value for money

Although the ICB bettered its own financial plan, it remains of concern that the wider system reported a significant deficit position requiring substantial in-year support. An external financial review took place, which is welcome as stronger financial management across the system is required, particularly addressing pay spend, which exceeded both plan and threshold levels this year.

There are encouraging signs in this area with the ICB taking a core role in the system anchor network and showing clear intent to progress against social priorities, such as inclusion, sustainability and economic inclusion. We will look to the ICB in the year ahead to show how these ambitions are translating into defined action that can be monitored and used to demonstrate meaningful improvements.

Nottingham and Nottinghamshire

System leadership and governance

The ICB has strong governance arrangements and has demonstrated a robust approach to system operational planning. Partnership working is a particular strength, with good evidence of collaboration, including working with Nottinghamshire Healthcare Foundation Trust to progress improvements following the independent report into the care and treatment of Valdo Calocane.

Improving population health and healthcare

The ICB is well-regarded for managing population health. The ICB is recognised as a leader in promoting shared decision-making and patient choice as well as preventative care. A clear plan for the transformation of services away from acute settings and into neighbourhood care has been developed, working with primary care networks to develop plans for Integrated Healthcare Organisations.

There remains substantial operating and quality challenges across the system following CQC’s special review, which we continue to support through the Recovery Support Programme. We recognise the progress in addressing maternity concerns at Nottingham University Hospitals, but there is still more to be done. In the year ahead, we also look to see improvement in urgent care, cancer and SEND services.

Reducing inequality

The ICB has demonstrated a data-led approach to reducing inequality with evidence of high-quality data stratified by deprivation and ethnicity to understand underlying inequality and target informed action. There is evidence that all transformation programmes outline aims to reduce inequality, and funding is being appropriately managed and invested in effective interventions.

Productivity and value for money

Financial undertakings were agreed with the ICB, and we welcome the response to these with both the ICB and wider system delivering financial plans, although we do recognise that both ICB and system position were reliant on non-recurrent deficit support funding to deliver breakeven. Financial management must remain strong, and we welcome in particular the establishment of a Financial Sustainability Board to provide system-wide financial oversight and risk management.

The ICB operates as an effective anchor institution and entered into a civic agreement with educational and other partners to improve opportunity and prosperity. We also welcome the wider work, including with Derby and Derbyshire ICB, to develop a shared growth plan for the East Midlands. Positive results have been seen on some elements of the system green plan, but some areas are slightly behind plan and will require focus.

Shropshire, Telford and Wrekin

System leadership and governance

The ICB remains in the Recovery Support Programme following its entry in 2021 and continues to make progress against its transition criteria. We welcome the ongoing work to strengthen governance, including work with the Good Governance Institute to review and strengthen processes. It is recognised that the ICB works effectively with system partners but could do more to support the delivery of local health and wellbeing strategies.

Improving population health and healthcare

The ICB has continued to develop its approach to population health management with well-established place-based arrangements. We particularly note the work with the Highley Community Hub, bringing multiple teams together in a single space to deliver integrated community care. We note specific areas of success, including work on targeted lung health checks and consistently high volumes of referrals to the alcohol care team.

While ICB oversight of performance has been strengthened, we recognise that operational performance remains highly challenged with tier 1 support in place for urgent care, elective care, cancer and diagnostics. Improvements across these areas are being seen but need to be accelerated, and we will continue providing integrated support through the Recovery Support Programme.

Reducing inequality

The ICB has provided substantial evidence of its commitment to reducing inequality, and we have undertaken a focused system visit to observe the approach which was positive. We understand 53 individual projects have started this year focused on reducing inequality, and we now look to see more detailed empirical evidence of progress and outcomes in line with our statement on inequality.

Productivity and value for money

The ICB delivered a surplus, but the overall system delivered a significant deficit position. Both ICB and system positions include significant non-recurrent deficit support funding. Financial undertakings and mandated support were agreed, and we have been encouraged by the work undertaken since to develop longer-term stability modelling, resulting in a compliance certificate being issued; this work must continue this year to restore financial system balance.

The ICB has demonstrated a focus on this agenda and has a range of initiatives in place, with local education partners planned to be brought together under a wider anchor programme. It is recognised that the ICB has made progress against its people promise ambitions following its restructure, and this has been evidenced in improved staff survey results. It is also making continued progress against its greener NHS system plan ambitions.

Staffordshire and Stoke-on-Trent

System leadership and governance

The ICB has continued to develop its governance and leadership arrangements, with financial grip and control being recognised as a particular challenge. Supportive action was taken this year, which saw enhanced grip but did not deliver the planned results. We will continue to work with the ICB in the year ahead to ensure the appropriate levels of governance are in place in all areas to allow delivery against plans.

Improving population health and healthcare

We welcome the work undertaken this year to develop enhanced analytical capability to underpin population health, as well as demonstrable efforts to work with people and communities when designing services. While we welcome the efforts that have been taken, these have not yet resulted in a coherent strategy that delivers improved outcomes; the ICB must focus on the strategic direction as well as individual activities.

While there are elements of good operational practice, there remain considerable challenges in delivery of operating standards, especially at University Hospitals of the North Midlands where urgent and elective care both remain below expectations. We will continue to provide targeted support for urgent care, elective care and cancer through tier 2 support in all areas as we look to see improvements in these areas.

Reducing inequality

The ICB has demonstrated how it uses data to understand opportunities to reduce inequality and align these with joint health and wellbeing strategies for reporting purposes, which is welcome. There is more work needed to show how individual initiatives contribute empirically to wider strategic aims, and we look to the upcoming Equality Impact Assessment of 2025/26 operating plans to offer such assurances.

Productivity and value for money

Both the ICB and wider system overspent for the year, even though they received significant non-recurrent support deficit funding; enforcement undertakings were agreed with the ICB in response to its financial position, but there has been limited progress against them. We require the ICB and its providers to work together to deliver a balanced financial position this year, which will include, in particular, tackling the recognised issues with reducing headcount, which was not delivered as planned.

The ICB has shown itself to be an active and willing partner in the wider system, working to ensure alignment between the system’s joint forward plan and other strategies to deliver coherent activity. The ICB has shown a mature focus on equality, diversity and inclusion, adopting key standards, as well as making meaningful progress to reduce its gender pay gap.

North East and Yorkshire integrated care boards

Humber and North Yorkshire

System leadership and governance

We are satisfied that the evidence supplied by the ICB and our experience across the year demonstrates an effective model of system governance. We note that there were some leadership changes during the year, which impacted on progressing some operational and strategic developments, but the level of ambition is welcome, including the ambition to develop a joint committee to oversee health and care spending in a joined-up way.

Improving population health and healthcare

The ICB has seen some areas of positive progress in improving healthcare services for its population with its provision for armed services personnel an area of particular recognition. Public health initiatives, such as rolling out tobacco treatment provision in all acute settings, were met while improvements continue to be required in areas such as the effective management of hypertension and cholesterol.

Operational performance did see areas of improvement such as delivery against the primary care access and recovery plan ambitions, but in other areas, there remains more to do. We note, in particular, the under-delivery of the 52-week elective list position, the failure to meet national cancer standards, and that urgent care performance, while improved, did not meet national ambitions.

Reducing inequality

The ICB’s inequality strategy remains in place and refreshed, with the overarching ambition of increasing healthy life expectancy remaining the priority. The ICB has provided details of a range of programmes delivered this year, targeted at achieving this ambition, noting a recognition of the importance of delivering children and young people’s services as a priority to achieve the stated ambitions.

Productivity and value for money

Both the ICB and the wider ICS successfully delivered their planned balanced financial positions for the year and operated within required limits, although we do recognise that this was in part delivered through non-recurrent deficit support funding. We welcome the strategic vision to increasingly bring together health and care budgets and to delegate more empowered budgeting, for example, with inequalities funding being delegated to the North Yorkshire Place to take expert targeted funding decisions on this agenda.

Health and Wellbeing Boards have reported that they enjoy a positive and collegiate relationship with the ICB with shared endeavours to ensure local strategies align with wider system ambitions. The ICB has also demonstrated welcome leadership on the delivery of the system green plan, supporting reductions of emissions and supporting the estate to enhance its energy efficiency.

North East and North Cumbria

System leadership and governance

The ICB is recognised as a strong leader who works well with its partners, and we particularly welcome its work with us to pilot approaches to assess ICB capability, providing crucial feedback. The ICB undertook an organisational change programme this year, and we note the developments to governance structures supporting place-to-board oversight across the particularly large system geography.

Improving population health and healthcare

We welcome the work of the ICB, with its local population to deliver the shared aims of the Integrated Care Strategy agreed in 2022. We note continued progress against the strategic aims, recognising its focus on secondary prevention with good coverage of alcohol care teams, digital weight management referrals and tobacco dependence services but look for further improvement in managing long-term conditions.

Operational performance remains positive, in particular reaching the 78% UEC 4-hour standard and reducing long elective waits, but there do remain areas where greater focus and improvement is required. In particular, we look to see improvements in mental health services and acknowledge the implementation of recovery plans to tackle this recognised area for development.

Reducing inequality

The ICB publishes a bi-annual health inequalities report to its Board, and we welcome this transparency in demonstrating progress. The ICB has worked closely with partners to widen participation and use feedback to shape services in areas such as oncology and women’s health. The ICB has more to do to reduce inpatient care for patients with learning disabilities and we appreciate the work of the ICB with us to tackle this issue.

Productivity and value for money

Financial management remains a strength of the ICB, with particular recognition of the efforts taken this year to over-deliver efficiencies to enable additional surplus to be used to offset deficits in the provider sector, although we do recognise that this was in part delivered through non-recurrent deficit support funding. The ICB is commended for its efforts in achieving system financial balance, which will remain an area for continued disciplined management in the coming year.

Feedback from Health and Wellbeing Boards recognised a strong partner in the ICB with effective mature relationships to deliver shared priorities through local place plans. We look forward to these relationships continuing to develop with partners, calling for particular focus on primary care transformation and integration of out-of-hospital care, particularly through use of the Better Care Fund.

South Yorkshire

System leadership and governance

The ICB has continued to provide system leadership with a solid governance model that has been reviewed and strengthened throughout the year, including the development and implementation of a revised operating model to deliver within a reducing running cost allowance. We have also seen continued evidence of the ICB working in effective partnership with its stakeholders and wider community in the delivery of services.

Improving population health and healthcare

The ICB has shown effective use of data-driven approaches to understand community needs and opportunities and to target work effectively to improve population health. The ICB remains a forerunner in tobacco dependence services, as well as positive coverage of alcohol care teams and obesity referrals. We look to see more progress on hypertension and diabetes management going forward.

Although standards were not met, we do recognise the progress made on urgent care and the resultant award of additional capital funding for this agenda. We also acknowledge positive performance in cancer, mental health and primary care. While there was progress in reducing the overall elective waiting list, this was below plan, and there remains a challenge in tackling the longest waits, which needs to be progressed.

Reducing inequality

We have been pleased with the progress the ICB has made in seeking to reduce inequality; there has been a demonstration of a data-driven approach combined with local involvement to target investment and develop impactful priorities. We recognise a strong shared plan between system partners, and we look forward to seeing data on the impact of the approach in tangibly improving outcomes.

Productivity and value for money

While the ICB delivered an overall surplus, the wider system reported an overall deficit against its revenue position, this was despite non-recurrent support deficit funding. In the face of continuing financial pressures, the ICB and its system partners acknowledge the significant work that is required to deliver a financially sustainable system position. We will continue to support the system to balance service delivery and care quality within a sustainable funding envelope.

The ICB footprint is aligned to the combined mayoral authority footprint with a local model based on 4 place-based partnerships contiguous to a local authority. This model is used to drive local socioeconomic agendas aligned to the needs of each place, for example, through the focus on integrated high street healthcare services in Barnsley or the focus on reducing health inequalities in deprived areas of Sheffield.

West Yorkshire

System leadership and governance

We are assured that the ICB has the required governance structures in place to effectively discharge its responsibilities, with the System Control Centre to manage seasonal pressures noted as a particular success. The ICB has shown a collegiate approach to working together with system partners, including the local community, to develop its shared Joint Forward Plan against which it continues to lead delivery.

Improving population health and healthcare

The ICB has worked with local populations across the system through its place-based networks to focus on designing services around the people who need them and delivered through acute collaborative and community providers. There does remain more to do in primary prevention, in particular, ensuring 100% coverage of trust tobacco dependence services and effectively managing cholesterol, hypertension and diabetes.

Operationally, the system has made progress, notably in reducing the longest elective waits and delivering against cancer and primary care priorities. There does remain further progress needed, in particular, for urgent care where ambitions were not met, out of area placements for mental health patients, which remains high, and inpatients with learning disabilities where performance has declined relative to other systems.

Reducing inequality

The ICB works with the West Yorkshire Combined Authority to deliver a shared priority programme to reduce inequality, using funding effectively to target inequality across the system. We note in particular the work demonstrated in engaging with health inequities for homeless and traveller communities, as well as targeted action for groups such as sex workers and those in contact with the criminal justice system.

Productivity and value for money

The ICB delivered a financial surplus for the year, which was critical in offsetting provider sector deficits and ensuring that the system as a whole reported breakeven. The ICB is recognised for its effective financial governance, and we look to them to continue to maintain this grip in the year ahead, as well as taking action to enhance potential efficiencies, with digital maturity identified as one area for potential improvement.

The ICB refreshed the system’s joint forward plan which aligns with wider system strategy including that of the combined mayoral authority to ensure advancements in socio-economic value. We welcome progress to decarbonise the system in line with the green plan and the action taken to expand the network of research champions to ensure communities are informed about and can participate in system research initiatives.

North West integrated care boards

Cheshire and Merseyside

System leadership and governance

We welcome the head of internal audit view in the ICB’s annual report, confirming substantial assurance on control processes and highlighting that the ICB has satisfactorily described its governance and controls. We recognise the ICB’s proactive leadership throughout the year, including on major incidents. We do, however, seek greater use of joined-up data across this complex system to better inform strategic development.

Improving population health and healthcare

The ICB has a dedicated population health leadership team and reports a range of initiatives focused on enhancing population health, including reducing instances of c-difficile and urinary tract infections. We look to the ICB to drive system-level improvements, such as improving experiences of discharge, working with families and carers and expanding the use of survey data to understand and enhance experience.

We are pleased with the work this year to deliver against national cancer standards and to reduce the elective backlog. We also note improving access to mental health and primary care services. There remains a significant challenge in urgent care with critical risks in capacity and flow that must be addressed. We will continue to work with the ICB and its providers through the UEC recovery programme with tier 1 support in place.

Reducing inequality

We are encouraged by the Health and Care Partnership working together to tackle inequalities in line with a shared plan. We welcome initiatives to tackle preventable ill health for deprived communities, including prevention of cardiovascular disease and supporting smoking cessation. We recognise the work to derive accurate data on health inequalities, which we now look to see being used proactively across the system.

Productivity and value for money

While the ICB delivered a surplus for 2024/25, this was below planned levels and was reliant on non-recurrent deficit support funding; the system reported a significant deficit with very large deficits at 2 acute trusts, for whom financial undertakings are in place. Significant work is still required to deliver a balanced financial plan this year, and we will continue to support the ICB and its trusts in delivering this.

The ICB continues to deliver in its role as an anchor institution. An anchor charter is established, with over 30 signatories across the system, with reporting against key metrics such as local employment and living wage embedded as routine. The ICB’s annual report has also reported continued progress against its stated equality objectives and system green plan as part of its wider anchor remit.Greater Manchester

System leadership and governance

In response to significant concerns regarding finance and governance, legal undertakings were agreed and a system improvement board established. We have been encouraged at the response to this, with 28 of the undertakings now satisfactorily resolved. We are satisfied that there have been improvements in governance and continued positive partnership working, and we look to see improvements sustained.

Improving population health and healthcare

Given Greater Manchester’s established devolution status, we recognise its advanced status on population health, and we particularly note the exemplar work that has been done on mitigating the impacts of poverty on outcomes, access and experience of care. We also note the work of the ICB on the prevention agenda, particularly its leading work on smoking cessation and progress on tackling cardiovascular disease.

We welcome improved governance and progress in some areas of operational performance, such as cancer and diagnostics, but there remains more to do. While the 4-hour urgent care target was not met, we do recognise improved performance this year along with meeting the C2 response time target. We will continue to support the system on urgent care through tier 1 of the urgent care programme.

Reducing inequality

The ICB has worked in close collaboration with its system partners, guided by the shared Making Manchester Fairer framework to deliver reductions in inequality across the system. We support the work that has been done, taking the learning from work on housing to a wider approach to brokering social value, and we would encourage consideration of further expansion to cover digital exclusion and inclusion health.

Productivity and value for money

The financial position in 2024/25 was acknowledged as highly challenged, with both ICB and wider system reporting significant deficit positions at year-end, despite high levels of non-recurrent support deficit funding. We appreciate the work that has been done following the application of undertakings related to finance with the ICB in a stronger position than previously, but the financial risk remains substantial and will require continued work to deliver with current constraints.

The ICB and its fellow partnership within the integrated care partnership have a sophisticated approach as anchor institutions to enhancing social and economic development. The ICB has been accepted as a well-working vanguard, with 18,000 local residents supported into work. The ICB is also signed up as a living wage employer, as well as continuing to deliver reductions in emissions.

Lancashire and South Cumbria

System leadership and governance

The ICB saw a very challenged year, particularly with regards to financial management with major intervention and legal undertakings required to address the deteriorating position. While we acknowledge the work the ICB has done with external consultants and the Recovery Support Programme, it is essential that the ICB engages proactively alongside us in coherent planning to deliver across the year ahead.

Improving population health and healthcare

We have seen good evidence of how the ICB manages this agenda with dedicated leadership and infrastructure and positive mechanisms for working with people and communities. It would be useful over the course of this year for the ICB to be able to provide evidence of the specific activity and ambitions to improve population health locally and the data used to inform these alongside national priority projects.

While we welcome operational improvements, it is recognised that performance across the system against operating priorities remains considerably challenged. We note in particular that urgent care and diagnostics performance did not meet national ambitions and was below planned levels, and the ambition to eliminate 65-week elective waits was not met.

Reducing inequality

We welcome the progress the ICB has made against national prevention priorities, in particular the work on embedding smoking cessation services and strong performance on obesity prevention. We would welcome additional focus in the year ahead on how data can be stratified to support targeted decision-making to ensure health equity across the system and outcome-based reporting to demonstrate success.

Productivity and value for money

The ICB’s financial position was significantly challenged this year, with a substantial deficit delivered even after deficit support funding had been allocated. We note the work that has been done in partnership with providers, ourselves and external advisors to address this position, and this work will need to continue in 2025/26 if we are to ensure that financial plans and long-term sustainability are delivered.

The ICB has demonstrated that it takes its role as an anchor institution seriously and has provided details of key initiatives to enhance economic opportunity locally. We continue to seek detailed outcomes data to show the impact of these initiatives. We welcome the progress on both the greener NHS and EDI agendas and acknowledge the ICB’s recognition of where progress on these agendas is required in the year ahead.

South East integrated care boards

Buckinghamshire, Oxfordshire and Berkshire West

System leadership and governance

Last year, we flagged the significant work required to implement the revised operating model, and we are pleased to see ICB leadership becoming more established this year as this work progresses. The changes to the future of ICBs have contributed to further complexity, which will need to be managed carefully. We look to the ICB to continue to work with partners to develop credible and safe transitional plans for the year ahead.

Improving population health and healthcare

We welcome the progress that has been made in improving the health of the local population, with improvements against national priorities for obesity, hypertension and cardiovascular disease, although there remains significant further potential for improvement. We look to the ICB to work with higher-performing peers to consider how to unlock this potential.

Some operational performance improvements were seen this year, including welcome reductions in long elective waits where tier 1 elective support remains in place, but there remain significant performance improvements needed in some areas notably urgent care and cancer treatment.

Reducing inequality

We are pleased with the ICB’s work as part of its new operating model to strengthen system relationships to tackle inequalities. We have been particularly pleased at how flexible commissioning rules have been used to deliver extra dental activity where it is needed, and we encourage sharing learning with others. The ICB has commissioned work to better understand local demand and improvement opportunities; this work should be used to inform strategic objectives aimed at reducing inequalities.

Productivity and value for money

The system overspent in 2024/25 even after applying deficit support funding, but we do note the work the ICB has done with our investigation and improvement regime to improve financial control, and we recognise improvements in financial governance with a breakeven plan for 2025/26 agreed. We look to the ICB to work alongside us to manage this plan and to identify further potential savings and improvements through the collaborative model being embedded.

The ICB is recognised by its system partners as playing a key role in delivering wider public health initiatives, which have actively supported reductions in NHS demand. The ICB is an active participant at system level and works together with local authorities in areas of mutual interest. The ICB should continue to identify further opportunities to leverage its status as an anchor institution to support further social and economic development across the system.

Frimley

System leadership and governance

The ICB is recognised as effective and well-led with strong governance and processes and capable leadership. We have been reassured by the ICB’s leadership of the system transformation programme, ensuring cohesion with the new hospital development, as well as hosting delegated primary care and complaints services, and the temporary staffing collaborative, which has seen early success.

Improving population health and healthcare

We welcome the strong collaborative approach the ICB has taken to population health, including its close work with directors of public health. Population risk profiles have been stratified and used to target positive interventions on areas such as cardiovascular disease prevention, weight management and pharmacy first, as well as evidence of strong collaboration and consultation with local communities.

The continued positive performance on elective, cancer and diagnostics is to be commended, as is the work done to improve access to primary care services. We do, however, remain concerned that urgent care issues have returned to the system with performance below both target and 2023/24 levels. We recognise the estate improvements to support flow and look to see restoration of emergency department performance this year.

Reducing inequality

The ICB’s use of data to stratify patient risk is used to underpin its approach to health inequalities, and we note continued positive progress to target interventions at areas of greatest need. This has included a fair funding model to allocate primary care resources to enhance access and outcomes for underserved populations and positive delivery of mental health service priorities in collaboration with its peers.

Productivity and value for money

Both the ICB and the wider system delivered their plans for the year, though deficit support funding was required to allow the system to break even; we note the positive achievements in delivering efficiency plans and reducing reliance on temporary staffing. Plans to achieve breakeven this year are in place with a continued welcome focus on shifting care away from acute settings with transformed approaches to general practice, neighbourhood health, urgent care and referral.

The ICB has a strong approach to neighbourhood health with positive feedback from Health and Wellbeing Boards, describing strong collaborative relationships between partners. The ICB has provided evidence of several positive local projects aimed at improving social mobility and tackling deprivation, as well as details of its WorkWell pilot to support people with musculoskeletal conditions to find and remain in work.

Hampshire and Isle of Wight

System leadership and governance

The ICB entered the Recovery Support Programme in 2023, and we note increased grip and control. While the advances are to be commended, there remain opportunities to improve, and it is essential that executive groups receive high-quality information in all areas. We recognise the work to unify community services under a single provider, and this must be now matched by a complementary acute strategy.

Improving population health and healthcare

The ICB has established a population health strategy, and in some areas, such as primary care access and vaccination, there have been significant achievements. We look for particular focus on improving performance against national objectives for cardiovascular disease and hypertension, as well as increasing referrals to obesity services which, while improved this year, remain a regional outlier.

As well as the successes in primary care provision, we also note positive performance in cancer services and welcome reduction in handover delays at Portsmouth. In the year ahead, we look for focus on reducing long elective waits, for which we will support through our clinical leaders, as well as a focus on enhancing community services and improving discharge to enhance emergency department flow, which is driving poor UEC performance figures.

Reducing inequality

The ICB’s work on population health strategy is recognised and welcomed but will need significant further work to deliver the required reductions in inequality. We note variation between GP practices in measurement of blood pressure, as well as an increase in never events. We encourage the system, with our support, to consider variation in access and outcome and ensure wider inequalities strategy is focused on reducing such difference.

Productivity and value for money

We note improved financial grip and control, and both ICB and wider system delivered their plans for the year, although breakeven relied on significant deficit support funding. We welcome the work to consolidate corporate services and reduce temporary staffing costs, but these initiatives must move at a faster pace to deliver breakeven this year. We will continue to support the financial position via the Recovery Support Programme.

Feedback from Health and Wellbeing Boards recognises the ICB’s contribution to local strategies but all boards call for more progress on the recognised priorities around improved community provision, in particular for enhanced collaboration with regards to the Better Care Fund. We also note progress in enhancing digital technology to progress virtual appointments in line with the system’s green plan.

Kent and Medway

System leadership and governance

There are robust governance processes in place within the ICB, having delivered the recommendations of the governance review, which included updating the ICB constitution. The ICB has worked collegiately with its system partners to develop a shared delivery plan with ongoing work to establish working relations with the new leadership of Kent County Council.

Improving population health and healthcare

The ICB has taken steps this year to enhance its ability to use data to stratify cohorts of patients and identify those patients at risk, supported by a dedicated unit to deliver sustainable healthcare. These innovations are positive, but there is recognition that the system is a significant outlier, particularly in areas like preventative activity, which will be essential to tackle as part of a left shift away from treatment.

There have been some positive changes operationally this year, specifically the growth of community diagnostics hubs to reduce pressure in acute sites. There remains a need to tackle long emergency department waits especially in Medway and East Kent for which tiering support will remain in place, as well as a need to go further and faster on reducing the number of patients waiting over 52 weeks for elective care.

Reducing inequality

While there remains strong leadership and focus on reducing inequality, this remains an area of substantial concern, and the ICB remains a national outlier in many areas such as smoking cessation and obesity management. The ambition and areas of progress are noted, such as in maternity services, but the ICB must work with public health teams to identify the drivers of outlying performance and develop plans to tackle them.

Productivity and value for money

Overall system balance was not achieved with efficiencies under-delivered and temporary staffing, while reduced, remaining high; this was despite non-recurrent support deficit funding being allocated. A major contributor to this position was the financial position of Medway NHS Foundation Trust, where we commissioned a financial governance review that identified a number of significant challenges to be addressed. The ICB must ensure it works with its trusts, particularly Medway, to ensure shared financial ownership of this year’s delivery plan, as the planned level of efficiencies to deliver balance are high and will require substantial collaborative work and strong governance to deliver.

The system has a shared work and health strategy, which will be progressed in the year ahead now that agreed leadership is in place. Progress also should be seen on the shift following awarding of a lead provider for community services. In recognition of the continued disappointing staff survey results, it is essential that remedial actions are taken post the publication of the independent culture review.

Surrey Heartlands

System leadership and governance

The ICB’s strong leadership is recognised, with a collegiate approach both within and outside its borders, exemplified by the ICB acting as single lead commissioner for both the ambulance services in the region. We welcome the integration ambitions, but there remains more to do to achieve the ambitions of the group models and collaborative approach between trusts. We look to the ICB to continue to facilitate this integration.

Improving population health and healthcare

The ICB has a strong commitment to improving population health and healthcare, and we have been encouraged by progress shown in reducing tobacco dependency and referrals to digital weight management. There remains more to do in other areas of population health, however, we particularly look to see improvements in reducing cardiovascular disease and tackling the system backlog in dentistry.

There are areas of strong performance in the system, in particular, cancer services where the system consistently performs highly. There does, however, remain a challenge in patient flow across the urgent and emergency care and elective pathways. We call on the ICB to work with us to consider how particularly type 1 and mental health flow in urgent care can be enhanced, as well as utilising the new elective hub at Ashford to tackle system-wide elective backlogs.

Reducing inequality

We are satisfied with the ICB’s work in reducing inequality, with demonstrated focus on using data to stratify opportunities, particularly in elective waiting lists to ensure waiting times are reduced equitably. There do remain pockets of inequality and inconsistency across the system, which will need to retain focus. We particularly welcome the joint working between Sussex and Surrey ICBs to better manage cross-border discharges.

Productivity and value for money

Both the ICB and wider system delivered their plans for the year, for which the ICB’s new financial leadership warrants specific mention, although we do recognise that non-recurrent deficit support funding was required to deliver breakeven. A breakeven plan for this year has been agreed, but this will require consolidated efforts across the system to achieve. We are continuing to work with the system on financial governance reviews, which will be integral in delivering the plans as described.

The ICB works in close partnership with its system stakeholders, and the Health and Wellbeing Board has fed back positively on the ICB’s contribution to their Joint Local Health and Wellbeing Strategy. We note a range of positive initiatives described to enhance local socio-economic improvement, including being signatories to the local end poverty pledge committed to ending poverty and improving lives in Surrey.

Sussex

System leadership and governance

Relationships across the ICB are continuing to mature, and we welcome constructive feedback from Health and Wellbeing Boards on how the ICB can work alongside them in delivering neighbourhood healthcare. Governance processes have been reviewed this year in light of the major services review and provider collaborative approach to establish the foundations for strategic commissioning and delivery across the system.

Improving population health and healthcare

As part of the major services review, population health profiles have been progressed, which will allow the future commissioning model to target and focus interventions across the system in line with the neighbourhood model. This will be critical work as it was noted that key prevention areas, such as smoking cessation, cardiovascular disease and obesity, need to see greater improvement at pace through the neighbourhood model.

While progress was seen in some areas, there do remain substantial challenges. We look to the ICB to continue supporting University Hospitals Sussex to improve maternity services and enhance outbound patient flow in response to the Care Quality Commission (CQC) section 29a notice and reduce the size of the elective waiting list. We also seek improvement in mental health services, with crisis response and out of area placements both remaining outliers.

Reducing inequality

The ICB has provided details of £8 million of health inequalities allocation funding across 61 projects targeted at CORE20Plus5 demographies. Analysis that has been presented shows a positive spread between high-cost and targeted interventions, and we look to the ICB to retain this focus in the year ahead and use the data flowing from the major services review to strategically target initiatives in an equitable way.

Productivity and value for money

The ICB delivered their financial plan, although we do recognise that non-recurrent deficit support funding was required to hit breakeven. The system reported a significant overspend driven particularly by deficits for East Sussex Healthcare and University Hospitals Sussex, despite deficit support funding being provided. The ICB commissioned improvement directors to support delivery of the revised deficit plan. As the system is highly financially challenged the ICB must show strong grip and control, particularly of pay spend, if the agreed financial plan for this year is to be achieved.

The ICB has strong relations with its partners, and feedback indicates it works well in contributing to delivery of Joint Health and Wellbeing Strategies. It will be essential as part of the major services review to ensure a focus on delivering a neighbourhood health model that not only delivers effective healthcare but supports local socioeconomic growth. We welcome the ICB’s ambition and look to see evidence of this being realised.

South West integrated care boards

Bath and North East Somerset, Swindon and Wiltshire

System leadership and governance

We note the head of internal audit opinion in the ICB’s annual report of significant assurance on the ICB’s governance processes, and this aligns with our view. We recognise the ICB’s collaborative work to lead its system with innovative commissioning and organisational arrangements to begin progress against the 3 shifts outlined in the 10 Year Health Plan. We now look to see SMART outcomes agreed as part of a longer-term strategy.

Improving population health and healthcare

We are encouraged by the work of the ICB in improving public health with a population health board established, chaired by the local public health director, to bring the system together. We particularly note the work on increasing vaccination uptake through community vaccination hubs, as well as active engagement with local communities.

We recognise improvements particularly the work to progress elective backlogs, with 2 trusts progressed out of tier 2 of the elective recovery programme. There remain significant performance issues to be addressed, particularly in urgent care, where patient flow must improve to reduce handover delays, long elective waits, especially for cancer and diagnostics, and access to children and young person’s mental health.

Reducing inequalities

Local inequality groups covering Wiltshire and Bath and North East Somerset have been established, and we look forward to a similar approach in Swindon. The population health insights team provides data to target interventions with 35 inequality projects funded using health inequalities grants. We welcome actions to improve access for underserved populations and look to see this translating into improved outcomes.

Productivity and value for money

While the system did achieve breakeven this year, this was only possible through non-recurrent deficit support funding. While we welcome evidence of increased grip and control through establishing a Financial Recovery Board and a protocol for approving new investments, the financial situation remains challenging. Achieving breakeven in 2025/26 is high risk and requires substantial transformation. We will look to the ICB to provide detailed assurances of how this will be achieved and tracked across the year.

The ICB has taken encouraging steps in its role as an anchor institution, particularly working to support local career and skills development and making progress on the system green plan. While we welcome these initiatives, we are keen to see more strategic alignment to local economic indicators. We will look to the ICB to strengthen its evaluation framework and continue cultivating necessary local relationships.

Bristol, North Somerset and South Gloucestershire

System leadership and governance

The ICB is recognised as a strong system leader with effective governance processes, and it takes a leading role in driving system collaboration. We particularly recognise efforts in co-designing a shared leadership compact, promoting mutual accountability, and the development of a sophisticated transformation framework, demonstrating an understanding of the conditions required for sustainable improvement.

Improving population health and healthcare

We recognise the work that has been done across the ICB to integrate services to drive better patient outcomes. Shared leadership arrangements are being established in the acute sector alongside new capacity in areas such as surgery and diagnostics, as well as the expansion of new community models and digital services to support people to receive more care closer to where they live.

While there were welcome improvements in many areas, such as reductions in elective waiting times and timely diagnosis of dementia, there remains much more to do. Urgent care performance targets and plans were not met and access to children and young people’s mental health services remains challenged. We recognise the progress this year and look to see this continuing and being sustained to reach the levels required.

Reducing inequality

We welcome the strategic approach taken to reducing inequality, with a responsible committee in place and defined published equality objectives for the system. There has been positive progress in using data-driven models of anticipatory care to move focus upstream in line with the shift to prevention, but there remains work to do to translate some of this into outcomes, particularly in areas such as mental health.

Productivity and value for money

The ICB delivered financial balance as a commissioner and wider system. While we commend this achievement, efficiency plans were under-delivered, and the system remains overly reliant on non-recurrent savings opportunities. We are pleased with the work done to develop a new benefits realisation framework in partnership with academia and look to see this applied practically to integrating finance and transformation agendas.

The ICB makes a valued contribution to local society as an anchor institution, especially in its work to promote sustainability as part of the system green plan. We applaud North Bristol NHS Trust’s green operating day for neurospinal services, which received the Health Service Journal towards net zero award, and note the work of the Impact Accelerator Unit in ensuring research outcomes can be swiftly embedded into practice.

Cornwall and the Isle of Scilly

System leadership and governance

We have received feedback from the integrated care partnership and Health Wellbeing Boards recognising the strong progress made this year on system working, and this is to be welcomed. Bringing leadership together across the system has been a critical first step, and we now look to see more detailed shared plans setting out how partners will work together to deliver the ambitions of the integrated care strategy.

Improving population health and healthcare

We are pleased to see more regular use of the system quality group to routinely link with partners to consider how to actively improve the quality of care. We look to the ICB to continue making progress in this area in line with the National Quality Board’s risk escalation framework.

We remain particularly concerned with urgent care performance, with further improvement required in emergency department flow and ambulance response times. The system should consider optimising its virtual ward model, which benchmarks below peers to support decompression and ease non-elective flow.

Reducing inequalities

We remain pleased at the level of collegiate working between the ICB and its system partners, as well as its willingness to engage with local populations on services that affect them, including through dedicated community hubs and wellbeing workers supporting the most disadvantaged communities. We remain keen to see further progress on integrated strategic planning to tackle inequality as part of wider delivery.

Productivity and value for money

We commend the ICB and wider system for delivering the planned breakeven position for the year, as well as the system efficiency plan. We have also been pleased at the development of a joint commissioning strategy to align financial planning with activity and wider functions. 2025/26 is anticipated to be a challenging financial environment, and so we look to the ICB to consolidate and expand progress to ensure continued access to care within the system’s financial envelope.

The refreshed Joint Forward Plan included a new specific objective on reducing carbon emissions, and we continue to see good progress being made against the system green plan. We have also been pleased at the level of collegiate working across the system to deliver joined-up results for people, such as the dementia programme, and recognised work to improve local opportunities and experience through NHS employment.

Devon

System leadership and governance

The ICB remains on an improvement journey; the aim was to exit the Recovery Support Programme (RSP) this year, but transition criteria have not yet been sustainably met. RSP support will remain in place but with the aim to reduce this across the early part of this year. We look to the ICB to focus on effectively structuring acute services to reduce duplication and develop a clinical strategy, the lack of which remains a barrier to lasting change.

Improving population health and healthcare

The ICB has established governance and infrastructure through its Population Health Improvement Committee, informed by a data-driven approach, with the creation of the One Devon dataset a particular success. We now look to see the ICB using these foundations to strengthen the link between strategic planning and operational delivery in areas such as the management of long-term conditions.

We continue to see steady progress in improving delivery against operating priorities, which have been challenged for a substantial period of time. We welcome the transition of the ICB out of tier 1 of elective recovery, and the progress in urgent care at University Hospitals Plymouth, though recognising standards are not yet being met. These areas will need to continue to be improved sustainably in the year ahead.

Reducing inequality

We recognise that the ICB has made reducing inequality a clear area for focus, with leadership and governance established to drive this agenda. We have seen evidence on a range of programmes targeted at reducing inequality, which we welcome, but look to the ICB to establish a more consistent process of evaluating impact to demonstrate effective value for money and improved outcomes.

Productivity and value for money

Despite the ICB’s own surplus, the system’s financial position was in deficit even after the provision of non-recurrent deficit support funding. While there is a projected breakeven position agreed for 2025/26, this position has substantial risks, and we will continue to work closely with the ICB to manage this position. Also seeking assurances of a revised medium-term financial plan being agreed, articulating how stability will be returned to the system with clear alignment of budgets, incentives and outcomes.

The ICB has articulated a vision as an anchor institution, and we recognise areas of progress, including supporting internships and targeted talent management, as well as a focus on greener NHS and EDI initiatives. We look to see more evidence of impact through routine reporting to demonstrate how this vision translates into outcomes.

Dorset

System leadership and governance

The ICB has taken positive steps to strengthen its governance processes and ensure alignment between these structures and the wider strategic vision of the system. The ICB has also shown evidence of close working with stakeholders to develop refreshed strategic approaches. While we welcome this, we look to see the ICB supply a forward-thinking delivery plan, reflecting strategic changes as a result of NHS restructuring.

Improving population health and healthcare

The ICB has taken a number of positive steps towards improving population health and healthcare with a number of individual projects delivered to address areas of need. The development of the Dorset Intelligence and Insight Service offers an opportunity to use data to identify population insights and work with communities to develop solutions. We call on the ICB to exploit this opportunity going forwards.

The system demonstrated progress against operating priorities this year, with positive delivery of elective and cancer performance, as well as progress against exit criteria from the Maternity Safety Support Programme. We look to the ICB to maintain progress, as well as tackling areas where performance is more challenged, such as diagnostics and mental health care.

Reducing inequality

We welcome the strong commitment the system has shown to the inequality agenda and the leadership and governance it has established in this space. We recognise a range of successful initiatives this year in restoring services inclusively, tackling social mobility. The ICB should seek further use of inequality diagnostics across all areas of the system to ensure inequality is tackled in all services.

Productivity and value for money

The ICB’s financial position is recognised as particularly challenged with the ICB and the wider system both reporting deficits at year end despite non-recurrent deficit support funding being provided. Both efficiency and workforce plans were underdelivered, and there is much to do in the year ahead to address the underlying position. The ICB must ensure focus on supporting collective accountability and financial control in the system, with system-wide financial oversight, shared risk management and decision-making.

The ICB has strengthened as an anchor institution, expanding the use of apprenticeships and building relationships to champion skills and employment. We also note efforts to tackle long-term EDI challenges. We look to see increased pace on this agenda, improving monitoring and measurement using the enhanced intelligence position available.

Gloucestershire

System leadership and governance

It is recognised that the ICB models effective governance throughout its work, and we note the recognition of the CQC of the high-quality care delivered by the community interest company. System working is effectively modelled at all levels, notably the partnership between the ICB and West of England Academic Health Science Network, which earned a Health Service Journal (HSJ) award for integrated care and innovation in respiratory care.

Improving population health and healthcare

We welcome a range of positive activity that the ICB has delivered in advancing population health with effective quality governance underpinned by a detailed action plan and evidence of engaging the local population. We note specific positive initiatives, including community diagnostic centres, asthma-friendly schools and rapid response services, which have meaningfully reduced reliance on acute care this year.

There were areas of improvement against operating priorities, with reductions in long elective waits and improving access to primary care and some mental health services. There do remain areas where further improvement and focus are required, with urgent care performance below planned levels and concerns raised by CQC around maternity services for which Maternity Safety Support Programme support has been agreed.

Reducing inequality

The ICB has published a new health inequalities framework designed to offer a structured approach to understanding disparities and bringing system partners together around common goals. We welcome the ambition of the framework and the individual programmes’ evidence and now look for stronger use of data to target interventions where they will be most effective and identify opportunities to reduce inequality.

Productivity and value for money

There were small revenue surpluses delivered by both the ICB and the wider system, which we commend, as well as achievement of the system efficiency plan, albeit with additional non-recurrent efficiencies required to offset under-delivery of recurrent efficiencies. The system also stayed within its agency ceiling but will need to continue to manage finances effectively to deliver the sustainable balance required.

The ICB is contributing to its role as an anchor institution, with examples provided detailing the work it is doing to enhance local employment, reduce economic inactivity and tackle NHS emissions. We encourage the ICB to focus on evaluating initiatives to ensure value and sustainability of activity and to continue broadening the range of initiatives on which it focuses.

Somerset

System leadership and governance

We have been pleased with the ICB’s continued mature approach to governance, and we welcome the internal audit review of governance and procedures undertaken this year, which provided good assurance and recommendations for further improvement. We also recognise the strong working relationships that exist and look for further embedding of these relationships and alignment between local strategies.

Improving population health and healthcare

We have been encouraged by the work the ICB has done this year focused on moving services away from acute settings and into the community. We especially commend the ICB for its work on enhancing community diagnostics activity with 500,000 patients seen in community diagnostic hubs and the establishment of a care co-ordination hub to provide 7-day patient management in the community to reduce acute footfall.

We have been encouraged by performance improvements, notably in mental health where integration with community services has had positive outcomes. There remains further to go with urgent care, cancer and elective care. We also note CQC notices issued to Somerset NHS Trust regarding maternity and children’s services, and the ICB must work with us and system partners to address the actions from these reports.

Reducing inequality

The ICB has prepared a comprehensive report setting out its activity to reduce inequality in line with the NHS England statement on inequality, with stratified data to show opportunities and progress. Details of a range of positive intervention activities have been provided, including work to identify early cancers in vulnerable populations, improve children’s oral health and improve pharmacist-led consultations.

Productivity and value for money

We commend the ICB’s financial management with breakeven delivered at both an ICB and wider system level, as well as delivery against the efficiency plan. The capital pipeline has been managed effectively with funding released for priority projects to invest in local community services, as well as prioritising digital investment to enhance service delivery and patient care.

The ICB works with partners to maximise social and economic value with positive steps to align public sector estate to the combined effect for the population, including releasing surplus estate for local housing and infrastructure. We welcome this work but note that elements of the system green plan remain unrealised and call on the ICB to ensure that services are continuously monitored to ensure resilience to climate change impacts.

Publication reference: PRN02185

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Introduction

East of England integrated care boards

Bedfordshire, Luton and Milton Keynes

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

Cambridgeshire and Peterborough

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

Hertfordshire and West Essex

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

Mid and South Essex

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

Norfolk and Waveney

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

Suffolk and North East Essex

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

London integrated care boards

North Central London

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

North East London

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

North West London

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

South East London

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

South West London

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

Midlands integrated care boards

Birmingham and Solihull

System leadership and governance

Improving population health and healthcare

Reducing inequality

Productivity and value for money

Enhancing social value

Black Country

System leadership and governance

Improving population health and healthcare