Under the terms of the NHS Act 2006, amended by the Health and Care Act 2022, NHS England is required to assess the performance of each integrated care board (ICB) and publish a summary of the outcomes of its assessments. This report does so for 2023/24, the first full year of ICBs being in operation. It is important to note that this report summarises an assessment of performance during the 2023/24 financial year and reflects NHS England’s views relating to that period only; it does not necessarily indicate NHS England’s views of performance at the time of publication.

Each assessment considered 5 core areas:

• How effectively has the ICB led the health and care partners within its integrated care system (ICS) and governed itself?
• How has the ICB contributed to each of the 4 core purposes of an ICS?
  • improving population health and healthcare
  • tackling unequal access, outcomes and experience
  • enhancing productivity and value for money
  • helping the NHS support broader social and economic development

Further information on how assessments were conducted can be found in our annual assessment guidance for 2023/24.

The operating context in 2023/24 was undoubtedly challenging with industrial action and major service reconfigurations. Our assessments recognised these challenges while also seeking to reflect the areas of outstanding practice and performance issues that need to be addressed.

In general, our assessments identified that ICBs are making progress but at different speeds. All have developed a joint forward plan alongside their partners detailing the aims of their system over the next 5 years and will continue to refresh this on an annual basis.

NHS England’s regional directors have issued individual assessments to ICB chairs and chief executives, and they have been asked to consider making these publicly available alongside their individual annual reports and accounts, which must be published under the terms of the Act.

North West integrated care boards

Cheshire and Merseyside

System leadership

The ICB is developing at pace, with a purposeful, cohesive executive structure and well-established, place-level structures. It leads effectively with its partners and facilitates system collaboration to tackle common problems. This is delivering positive shared outcomes such as the move toward a single Electronic Patient Record in Liverpool. Internal audit reports gave good assurance of the robustness of ICB governance and oversight.

Improving population health and healthcare

The ICB is seeing success, particularly in reducing inappropriate mental health out-of-area placements, performing strongly against cancer recovery measures and supporting Liverpool University Hospitals NHS Foundation Trust to exit the Recovery Support Programme. Urgent care remains a challenge, and we will continue to provide support through Tier 1 of the Urgent and Emergency Care (UEC) Recovery Programme. We will also be looking to see progress alongside local authorities to reduce patients without clinical reason to reside.

Tackling unequal access, outcomes and experience

The ICB has effectively led the development of a strategic approach to population health management and reducing health inequalities and will set this out in its forthcoming health and care partnership plan. Early progress on this agenda is already being seen in the ICB’s use of targeted lung health checks to support improvements in early-stage cancer diagnoses and exceeding the national target for establishing women’s health hubs. We look to see continued progress on this plan next year, underpinned by accurate data.

Enhancing productivity and value for money

Despite the ICB reporting an organisational surplus, the system reported a significant deficit against the breakeven plan, driven by higher than planned spending on continuing healthcare and primary care. The ICB delivered its efficiency plan but marginally under-delivered against its system plan. Both plans fell short on planned levels of recurrent saving. We have agreed a control total with the ICB for the year ahead and to achieve this the ICB must focus on boosting productivity and achieving further recurring efficiencies across the system.

Supporting social and economic development

The ICB is leveraging its role as a major anchor institution and was the first in the country to receive the Social Value Quality Mark^® Health Award in recognition of its commitment to this role. It has been instrumental in the development of the system’s social value charter and scaling up prevention priorities through the prevention pledge, promoting sustainability and tackling violence, discrimination and housing issues.

Greater Manchester

System leadership

The ICB has demonstrated an evolving approach to strategic planning, establishing a performance and quality committee to oversee performance and risk against priorities. It has an effective governance model in place and a clear functional map in its constitution showing how and where decisions are made and oversight takes place. This includes dedicated oversight of Great Manchester Mental Health NHS Foundation Trust as part of the Recovery Support Programme. The ICB’s integrated partnership working has established positive relationships with local authorities, providers and places as well as local populations.

Improving population health and healthcare

While the ICB has established clear governance, it still needs to address a significant number of operational, quality and finance challenges. We welcome the steps the ICB is taking to refresh its provider oversight model, and it has driven progress in elective care through its elective recovery and reform programme, as well as in cancer care, Category 2 ambulance response and mental health and learning disability services. Concern persists, however, around the number of mental health out-of-area placements.

Tackling unequal access, outcomes and experience

The system has established a Fairer Health for All framework in all localities to inform local approaches to reducing health inequalities, an initiative we welcome. Integrated neighbourhood teams are driving practical actions at local level: local data shows that the over 50,000 social prescribing interventions delivered over the year are leading to fewer primary and secondary care attendances. We will now seek realistic implementation plans that take the ICB’s ambitions forward with clear expected impacts.

Enhancing productivity and value for money

While the system’s financial plan for 2023/24 aimed for breakeven, reported significant early-year variances put this position at risk. We mandated financial support to address both ICB and system reporting year-end deficits. The ICB under-delivered on its efficiency plan: fewer than half the planned efficiencies were delivered and recurrent efficiencies were less than planned. We will continue to support the system to deliver its plan with a focus on improving productivity and delivering recurrent efficiencies across the system.

Supporting social and economic development

The ICB’s anchor network builds on the principles articulated in the Fairer Health for All framework, which was co-designed with local communities. We welcome the ICB strengthening its partnerships with Health Innovation Manchester and academic system partners to consider innovative practice. Good progress has been made on delivering the Greater Manchester care record as well as integrated plans to support innovative practice to prevent cardiovascular disease and diabetes. We will be looking to see the ICB continue to take forward innovation and welcome its work on a strategic alignment blueprint with the primary care collaborative.

Lancashire and South Cumbria

System leadership

The ICB has demonstrated strong system leadership in the development of the joint forward plan and local strategies and plans and continued strong partnership working with both local partners and the wider population. A long-term partnership strategy has been agreed and is supported by an advisory committee. We are satisfied that the ICB has effective governance processes, but the system improvement board must tackle the longstanding issues at Lancashire Teaching Hospitals NHS Foundation Trust.

Improving population health and healthcare

The ICB has met the governance requirements for quality as set out in National Quality Board guidance and is working with the Advancing Quality Alliance to develop a new quality management system. We welcome the ICB’s development of a population health academy in association with The King’s Fund to optimise these approaches. The ICB has made above average progress against many key operating priorities such as urgent care, but more work is required to ensure delivery against standards.

Tackling unequal access, outcomes and experience

The ICB can report against the measures in NHS England’s statement on information on health inequalities and is working to integrate this reporting as standard in routine board reports. It has identified the level of disparity within the Elective Recovery Programme and the system’s inequalities steering group oversees reporting against the identified issues. The ICB is also accelerating its tobacco dependency programme and working with the Department for Work and Pensions to roll out adolescent community treatment services.

Enhancing productivity and value for money

Financial challenges persisted with both the ICB and system reporting deficits against plan, driven by higher than planned expenditure on continuing healthcare and primary care prescribing. Both the ICB and its providers reported under-delivery against planned efficiencies, but the ICB did substantially over-deliver against recurrent plans. The system also reported an agency spend significantly above its cap. We have agreed a control total with the ICB for 2024/25 and to achieve this the ICB must focus on improving productivity and efficiency.

Supporting social and economic development

The ICB is working to establish itself as an anchor institution. With its place-based partnerships and health and wellbeing boards it is developing locality-based plans, and with key stakeholders acting to tackle public health challenges: for example, tackling vaping with Healthwatch Blackpool. The system’s green plan has been agreed and is supported by key infrastructure, including a net zero board and a dedicated project manager. We will be looking to see the outcomes of this work as it matures.

North East and Yorkshire integrated care boards

North East and North Cumbria

System leadership

The ICB’s comparatively strong operational performance reflects its strong system leadership and governance. It has clear strategic grip in place with the system’s joint forward plan supplemented by a range of service-level strategies. The ICB also demonstrates effective joint working with its partners and local population in the system review of urgent care and the co-design of 3 new women’s health hubs.

Improving population health and healthcare

The ICB has demonstrated grip across its system of both performance and quality and we welcome the appointment of a dedicated quality director to oversee this agenda. There have been positive results against many of the key access standards, including strong performance in A&E and cancer. Further action will be required to sustain performance across all sectors but with particular focus given to tackling the elective list, which has increased in size, and the significant challenges facing mental health services.

Tackling unequal access, outcomes and experience

The ICB has established a system-wide transformation programme that brings together public health and other stakeholders to consider prevention, inequalities and the determinants of ill-health. Data has been brought together to provide contemporary oversight of key metrics and track trends that inform the actions required. This data is highlighting positive recent trends such as for suicide prevention and smoking reduction, but exposing the need to address obesity, preterm births and mental health.

Enhancing productivity and value for money

Both the ICB and system met their breakeven duties, but the system position relied on non-recurrent financial support from NHS England. The ICB over-delivered against planned efficiencies but as most of these were non-recurrent the ICB will need to identify further efficiencies to become more financially sustainable. The ICB acknowledges that it has this work to do and is already developing a digital strategy to support this effort. We look to see the ICB and its partners driving this improvement.

Supporting social and economic development

The ICB took a leading role in developing the joint forward plan and aligning it to the wider system health and wellbeing strategy, and it has a clear grip on delivery of the plan. Feedback from the health and wellbeing board recognises the ICB’s engagement to develop alignment with the wider aims of local strategies. Maintaining this close partnership working and integration will be important following the ICB’s reorganisation. We will be looking to the ICB to expand planning to place level to ensure join-up across every part of the system.

Humber and North Yorkshire

System leadership

The ICB provides strong and effective system leadership, particularly in its efforts to work collaboratively and bring partners together. The Institute of Leadership has recognised it for this.  Health and wellbeing boards also recognise its partnership working but still want the ICB to engage more through place-level structures. The ICB has implemented a clinically-led model of care at system level and we look forward to seeing this expanded to place and provider footprints to deliver on the ICB’s aim for clinically-led transformation to integrated care.

Improving population health and healthcare

While the ICB has made some progress in the priority areas of diagnostics, cancer and long elective waits, it needs to drive further improvements against national standards. Performance against the UEC standard and level of ambulance handover delays were below target and the overall elective list increased. Despite this challenged performance, we welcome the ICB’s work to engage service users in shaping services, in particular its consultation on service changes in Scunthorpe and Grimsby and the relocation of Hull’s urgent treatment centre.

Tackling unequal access, outcomes and experience

The system has a well-articulated and ambitious vision to narrow inequality in healthy life expectancy and increase overall healthy life expectancy within the next 10 years. The ICB is guiding this through a population health and healthcare programme led by a population health and inequalities committee that works across all partners to embed a population health management approach. It is already making early progress in children’s services and cancer. We expect to see measurable progress in reducing inequalities and improving outcomes in future years.

Enhancing productivity and value for money

The ICB delivered a small organisational surplus, but the system’s breakeven position relied on non-recurrent financial support from NHS England. While the ICB over-delivered against planned efficiencies, half of these were non-recurrent and the ICB will need to identify further efficiencies to maintain financial sustainability. We have asked the ICB to collaborate with NHS partners across the system to achieve collective commitment to becoming a financially sustainable health system, and to consider how it can leverage system-wide collaboration to identify and capitalise on opportunities for allocative efficiencies and productivity improvements.

Supporting social and economic development

The ICB has established itself as an anchor institution. It has demonstrated consideration of the wider impact of its decisions on its population and its commitment to taking action to extend healthy life, as well as to ensuring integration and close working with its partners and wider population. Its green plan embeds net zero commitments, which as well as social impacts on the local area have the potential to reduce costs. As the system matures, we will be looking to see the translation of these ambitions into tangible, measurable actions and progress.

South Yorkshire

System leadership

The ICB leadership has demonstrated dedication to improving the quality of care and services, including in strengthening its board with a focus on performance and delivery. The ICB has worked closely with a broad range of system partners to maintain service improvement and delivery in the context of ongoing operational and financial challenges and has provided wider strategic leadership to the system in partnership with a range of professionals. We expect to see greater evidence of subsidiarity of resources and decision-making with places.

Improving population health and healthcare

The ICB has agreed an integrated performance framework with its system providers. This focuses on delivering improvements across the system alongside recognised quality and safety management systems, and it has performed strongly in some priority areas – the cancer 62-day standard met, long elective waits reduced and improvement in urgent care. We will expect to see further work next year to drive sustained improvements across these priorities as well as those areas for which performance is deteriorating, for example, ambulance handover delays.

Tackling unequal access, outcomes and experience

The ICB has demonstrated commitment in its use of data intelligence tools and forums to reducing health inequalities and improving experience. The board receives monthly performance reports to align strategic direction and funding to its outcomes framework. Notable work this year includes using deprivation data to target lipid lowering therapies to at-risk patients and diabetes audit data to improve access to and quality of care for young adults with Type 2 diabetes. We will now look to see measurable progress on the delivery of the system’s inequality priorities.

Enhancing productivity and value for money

The ICB had planned to deliver a surplus but delivered a deficit, and the system’s reported deficit was slightly less than planned. The ICB under-delivered against its planned inefficiencies and will need to consider how it can optimise its position next year. The ICB and its partners must work together to become a financially sustainable system, while maintaining the delivery of quality and safe services. We will continue to support the system in this aim and call on the ICB to consider how it can harness the benefits of system working to deliver the position needed.

Supporting social and economic development

The ICB has been an active partner in the development of the health and wellbeing strategy, a view echoed by health and wellbeing boards in their feedback. It has an opportunity, however, for further stakeholder engagement to take forward action plans that reflect the voices of patients and the public. We welcome the progress on estate improvements, including the new diagnostics centre in Barnsley and elective hubs in Sheffield and Doncaster, as well as the ongoing collaborative work to progress the system’s green plan.

West Yorkshire

System leadership

The ICB has demonstrated strong system leadership in developing clear priorities in conjunction with system partners and the wider population. It works closely with its system partners and involves patients and the public in decisions that affect them. The ICB’s effective governance framework describes how it assures itself with regards to operational, financial and quality performance and how it tracks delivery of strategic priorities.

Improving population health and healthcare

The ICB has made good progress against some key national priorities this year, notably cancer 62-day performance and mental health access. However, several operational challenges require further action, particularly the growing elective care list with planned reductions in long waiters not met. We will expect the ICB to deliver against its revised operating plan for elective care and make progress on urgent care and mental health inpatient priorities.

Tackling unequal access, outcomes and experience

The ICB sets out its approach to reducing inequalities in its joint forward plan and has made several key appointments to advance this, including a public health consultant and an inclusivity champion as a shared appointment with the local authority. Funding has been devolved to places to target local health needs. The launch of the Partnership of Sanctuary Scheme has made early progress in supporting health outcomes for refugees and asylum seekers and the launch of a health inclusion unit is helping to target effort around inequality by providing a better understanding of community needs.

Enhancing productivity and value for money

Both the ICB and system met their breakeven duties with the ICB’s surplus offsetting provider deficits. The ICB under-delivered against its planned efficiencies with a significant minority of these deficits being non-recurrent. We will require the ICB to articulate how it will make those savings and call on it to consider how it can effectively harness the benefits of system working to improve productivity and efficiency allocatively and at scale across multiple places and providers.

Supporting social and economic development

The ICB works in close partnership with the West Yorkshire Combined Authority on shared ambitions to improve the health and wellbeing of their population. Feedback from health and wellbeing board partners on this work has been positive overall. Stakeholders would welcome focus on wider sharing of learning, technology and resources across the patch as well as greater freedom and flexibility for local place teams under the auspices of a shared outcomes and commissioning framework. We back these suggestions and look forward to seeing further progress.

East of England integrated care boards

Bedfordshire, Luton and Milton Keynes

System leadership

The ICB worked collaboratively with its partners to develop an aligned and effective joint forward plan. Following restructuring the ICB now has a robust governance approach. We would now like to see greater joint working with the third sector as well as a focus on mental health, which we hope to see described in the upcoming transformation plan.

Improving population health and healthcare

The ICB is delivering population health through its place infrastructure and we would now like to see complementary system-wide approaches. The ICB met many national targets this year, including the UEC and cancer standards, and we hope to see this performance maintained. We have worked with the ICB to respond to maternity concerns in Bedfordshire and will continue to do so.

Tackling unequal access, outcomes and experience

The ICB has a clear focus on reducing health inequalities, flowing from the Denny Review, and works with the Institute of Healthcare Improvement and the University of Bedfordshire to target inequality reduction. It has a system-wide steering group to focus on reducing inequalities and we will expect to see continued progress, particularly on reducing tobacco dependence for which improvement opportunities have been identified.

Enhancing productivity and value for money

The ICB supported the system’s over-delivery against planned efficiencies. While we welcome the achievement of a system surplus, the significant use of non-recurrent funds to do so means the ICB needs to make further efficiency and productivity gains to maintain financial stability. The ICB is experiencing higher than average population growth and it will need to factor this into its future plans.

Supporting social and economic development

We welcome the establishment of a system strategic leadership group that brings together system partners to jointly consider the 5 key priorities underpinning the health and wellbeing strategy, including the establishment of a system-wide procurement approach. However, we consider wider system partners need to be brought in, particularly educational institutions.

Cambridgeshire and Peterborough

System leadership

The ICB has significantly matured and now has a high-quality executive team. We commend its strong partnership working to develop its key strategies and plans and its clear structure for overseeing quality and delivery. We retain significant concerns regarding the limited performance of a number of trusts within the patch and look to the ICB to support improvement. We accept, however, that the ICB’s comparatively low running costs allowance places limitations on the depth of leadership that can be provided and the range and scale of issues that can be addressed, in what is a complex system. The ICB should, therefore, focus on maximising and targeting its value-add within available resources.

Improving population health and healthcare

The ICB has demonstrated an effective strategic focus on population health management and achieved notable improvement this year in cancer and maternity performance including by supporting North West Anglia NHS Foundation Trust to exit the National Maternity Support Programme. However, some significant challenges persist, particularly with urgent care flow, diagnostics and primary care, and these must be addressed.

Tackling unequal access, outcomes and experience

The ICB has aligned its prevention, inequalities and population health programmes and taken steps to stratify areas for more inclusive recovery, focusing on musculoskeletal and children’s services. It has identified cardiovascular disease as a key priority and we welcome the development of the Your Healthier Future programme to tackle this. We hope to see focus on paediatric audiology and women’s health next year.

Enhancing productivity and value for money

The ICB worked across its system to deliver a small surplus and we welcome the level of recurrent efficiencies delivered as part of this position. The system has below average agency costs and, while we agree with the ambition to further reduce these costs, focus must remain on the overall pay bill.

Supporting social and economic development

The ICB has demonstrated a clear vision for the system. This recognises the social benefits of integrated care, leveraging the power of the NHS as a local employer and procurer of services and working with partners to improve public health. While the ICB has made progress in realising its vision, greater integration with local authorities is needed to fully realise opportunities.

Hertfordshire and West Essex

System leadership

The ICB has improved its collaborative approach to support the development of its medium-term plan and refresh its operating model. While the ICB has established key governance forums we will look to see further strengthening of its leadership around finance, strategy and transformation. The ICB will need to further enhance its risk appetite if it is to deliver its goals.

Improving population health and healthcare

The ICB has established a population health and outcomes committee to oversee and direct work on inequalities, population health and prevention and we hope to see progress next year. Performance against some key standards has significantly improved, including meeting the Faster Diagnosis Standard, reducing referral to treatment waiting times and cancer backlogs, and improving UEC performance. Work has also progressed to develop virtual wards in the region. Pockets of poor provider performance need to be addressed to deliver system improvements.

Tackling unequal access, outcomes and experience

The ICB has clear recovery plans that prioritise reducing inequality including through preventative programmes. We welcome this but will expect to see more detailed delivery plans that set out how commitments will be realised, particularly for smoking cessation services and NHS Long Term Plan pathway expansions.

Enhancing productivity and value for money

The ICB has driven impressive delivery against planned efficiencies, resulting in the system achieving a breakeven financial position despite provider deficits. The ICB must now exert strong leadership to support all organisations to return to financial sustainability and maintain focus on productivity gains. Increasing substantive staff numbers and decreasing use of temporary staff will be vital for future sustainability.

Supporting social and economic development

The ICB is part of the Essex anchor network that brings together partners across the system to consider strategic approaches to enhance quality of life and local prosperity: employment, procurement and investment. It works with the University of Hertfordshire and other education partners to consider approaches to employment and apprenticeships. The ICB needs to further refine its role in this agenda.

Mid and South Essex

System leadership

The ICB is demonstrating increasing maturity and has done challenging work on system restructuring. The stewardship programme is having impact in putting clinical leadership at the centre of transformational change. However, significant challenges persist and must be addressed, notably establishing an effective contract management function and filling key roles, particularly for chief operating officer.

Improving population health and healthcare

The importance the ICB attaches to population health management is seen in its establishment of a population health improvement board that has responsibility for targeting investment and promoting shared decision-making. It has made progress against key recovery priorities, particularly for the urgent care pathway, but other agreed standards such as those for cancer have not been met and need particular focus, work that we will continue to support.

Tackling unequal access, outcomes and experience

The ICB has taken a structured approach to addressing health inequalities by developing an integrated dataset that stratifies population to target interventions where inequalities are most acutely experienced. The ICB is taking action to address prevention priorities, including the development of an equality action plan for maternity services and rolling out asthma training and tools for primary care providers and families.

Enhancing productivity and value for money

The ICB did not deliver against the agreed system breakeven target with both trusts failing to meet their financial objectives and most of the delivered planned efficiencies were non-recurrent. We will continue to offer Mid and South Essex NHS Foundation Trust financial support as part of the Recovery Support Programme with the aim of making the system financially sustainable.

Supporting social and economic development

The ICB is part of the Essex anchor network, which has been recognised as a highly effective approach to wider system working to tackle structural social challenges in a cohesive way on a wide footprint. The ICB has demonstrated a clear commitment to being a critical partner in this network and focusing on improving local health and prosperity alongside other ICBs, local authorities and VCSE partners. We look forward to seeing continued progress from this work.

Norfolk and Waveney

System leadership

The ICB has fostered a collaborative approach to align strategic and operational delivery, underpinned by robust governance, clear escalation protocols and delegated decision-making, all of which are regularly reviewed. Strong system working has supported trust transitions from the Recovery Support Programme, and we are hopeful that Norfolk and Suffolk NHS Foundation Trust will exit the programme end of Q3. Further efforts are still needed to develop and embed place-based arrangements and to collaborate further with the VCSE sector.

Improving population health and healthcare

The ICB is working with patients and stakeholders to identify population health needs and actions. It has made progress against recovery programmes and national standards this year but needs to do more to realise these improvements sustainably. Further improvements to reduce bed occupancy and tackle the high number of elective waits are required as well as focus on enhancing mental health inpatient services and improving access to primary care services.

Tackling unequal access, outcomes and experience

The ICB’s strategic ambition to reduce inequality is clear from its establishment of a health inequalities oversight group to oversee actions in response to this agenda. It has taken steps to embed inequality reduction in recovery programmes such as by targeting patients at high risk of unplanned admissions and establishing proactive digital pathways to manage Type 2 diabetes. We will now expect to see more detailed delivery plans and timelines aligned to long-term plan priorities.

Enhancing productivity and value for money

The ICB has demonstrated commendable financial leadership in achieving a surplus against plan with notable efforts to help the most challenged provider to deliver a balanced organisational position. Efficiencies were marginally less than planned and the system has the largest gap in implied productivity in the region. Further efficiencies will need to be realised to maintain financial balance, building on the integrated work to date such as the development of a single Electronic Patient Record for all acute trusts.

Supporting social and economic development

The ICB has worked with its local partners in setting ambitious strategic plans to meet local needs. However, we will expect to see more detailed delivery plans that describe how strategic ambitions will be translated into meaningful actions. The ICB will be using The Health Foundation’s ‘How strong is your anchor’ toolkit to guide prioritisation and is seeking to build leadership capacity via the WorkWell programme. We look forward to seeing how these aims are taken forward next year.

Suffolk and North East Essex

System leadership

The ICB continues to demonstrate strong progress against its strategic aims and objectives, showing a positive leadership culture, effective grip on governance and performance, and meaningful partnership working both within and beyond its system. We recognise good governance at ICB and place level and encourage the ICB to take this further to provider level and promote alliance-led design and delivery for key priorities as part of the ICB’s realistic ambition to progress to segment 1 of the NHS Oversight Framework this year.

Improving population health and healthcare

Population health management is highly regarded within the ICB, with rapid advances in infrastructure leading to a wider intelligence function, hosted by Suffolk County Council, to drive decisions on investment and prioritisation. Despite a challenging operating context, the system has delivered against the national A&E target, achieved its cancer ambitions and exceeded elective backlog reduction plans. There remains, however, variation at trust level and we look to the ICB to strive to balance this delivery risk and advance acute trust collaboration.

Tackling unequal access, outcomes and experience

The ICB has bolstered leadership and focus on health inequalities and prevention, with the latest maturity assessment showing progress in reducing waiting list variation and improving equitable access to services. We welcome the embedding of health inequalities data within routine board reporting, as well as co-development of recovery plans using patient and user feedback. Positive steps have been taken on prevention, including approaches to improve maternal smoking cessation, and we hope to see these approaches rolled out to other areas such as alcohol care.

Enhancing productivity and value for money

The breakeven position the system delivered is welcome and the ICB is commended for its system work to achieve this, including intensive work with the most challenged provider. The ICB’s running costs were also underspent, giving further confidence in future delivery. We recognise the ICB’s record in innovation, transformation and research, with strong ties to the Universities of Suffolk and Essex. The ICB has a well-established digital roadmap and we anticipate seeing more developments in business process change as new solutions are implemented.

Supporting social and economic development

The ICB exemplifies effective cross-system collaboration, leading initiatives with partners to address broader health and wellbeing initiatives. The chief executive co-chairs the Essex anchor network and oversees the health inequalities and prevention committee, which makes plans to tackle economic inactivity. The further development of the Health and Care Academy and enhancing partnerships with further education institutions could enhance local pathways into education, entry-level careers and apprenticeships, supporting a sustainable workforce pipeline.

Midlands integrated care boards

Black Country

System leadership

The ICB has led the development of a system operating model to underpin system management. We welcome this infrastructure and areas of recognised best practice such as the clinical quality model. We do, however, need to see continued refinement and strengthening to show how the elements of the model interact to support strategic system delivery. The ICB has also taken a critical role in strategic decision-making and integration such as the transfer of services from Dudley Integrated Health and Care NHS Trust.

Improving population health and healthcare

The ICB is delivering against key priorities including meeting expectations for urgent care access, expanding access to primary care and exceeding cancer ambitions, but eradicating the longest waits for elective care and diagnostics has proved challenging and must remain a focus. While there are areas of strong performance and innovation, we look to the ICB to use its operating model to bring partners together to spread good practice and triangulate intelligence as part of a holistic model of oversight and improvement.

Tackling unequal access, outcomes and experience

The ICB has contributed to the wider system strategy on reducing inequalities and developed a range of data products to support progress, including a population outcomes framework, a financial allocations tool to target health inequality funding where it is most needed and detailed data stratification to identify inequalities across recovery priorities. While we welcome this work the financial position requires complex decisions, and we look to the ICB to demonstrate how it will use its tools and resources effectively to drive prioritisation.

Enhancing productivity and value for money

The ICB reported a surplus, but the system reported a deficit significantly above that initially planned and despite non-recurrent financial support from NHS England. In deploying financial support to the system, we agreed financial undertakings with the ICB and made it clear to the ICB that it and system providers need to strengthen their financial leadership, enhance control measures and embed financial discipline. We welcome the ICB’s response to this situation and its work to consider its organisational development needs.

Supporting social and economic development

The ICB has demonstrated commitment to supporting enhanced socioeconomic outcomes in its work with system partners, as reflected in positive feedback from health and wellbeing boards on the ICB’s contribution to system priorities. We will, however, look to see greater evidence of the ICB taking a leading role on these issues as well as supporting the activity of its system partners. We note the maturing progress against the system’s green plan and digital innovation as well as the positive culture of equality, diversity and inclusion reflected in the NHS Staff Survey results.

Birmingham and Solihull

System leadership

The ICB demonstrated strong leadership and its clear vision of integrated leadership in the joint forward plan started to be realised this year through a lead provider model for mental health, learning disability and autism services and a community care collaborative. The ICB’s governance is effective, with its system oversight group model being used as best practice in other systems. The ICB is demonstrating mature system response to a number of strategic challenges such as culture, workforce and finance.

Improving population health and healthcare

The ICB has overseen significant achievements against key targets this year – maintaining falls in long elective waits, delivering against cancer targets and making progress in outcomes for children and young people with mental health needs or who have a learning disability or are autistic. An urgent care challenge persists with the need to optimise capacity across the system and enhance the pace of service improvements for children and young people and those with a learning disability or who are autistic. We have supported the ICB to establish functioning quality governance and now look to the ICB to sustain this progress.

Tackling unequal access, outcomes and experience

The ICB has a strategic grip on reducing inequalities with a long-term plan established and underpinned by a robust governance structure. This will be further enhanced through a reconstituted health inequalities communities and economies committee that will report directly to the board on this agenda. Good progress has been made this year in using the Fairer Futures Fund to allocate funds to projects that tackle inequality and in enhanced data reporting, including a gap analysis against NHS England’s statement on information on health inequalities to identify areas for improvement.

Enhancing productivity and value for money

The ICB has good arrangements in place to oversee financial delivery and it and the system both delivered a surplus despite national and local financial challenges. The ICB has demonstrated a good strategic approach to workforce sustainability, recognising that the results of the 2023 NHS Staff Survey were a concern. While we welcome the work to improve staff engagement, workforce levels are higher than budgeted for and unsustainable. The ICB and its partners must focus on controlling this position to deliver long-term financial balance and sustainability.

Supporting social and economic development

Initiatives that use anchor institutions to drive local value are being undertaken across the system. Early success has been seen through the ‘I can’ programme that engaged with job seekers and young people from deprived backgrounds to support filling of entry-level jobs as well as the deployment of ethical procurement approaches. Following delay, progress is now being made on the net zero agenda in line with the system’s green plan, but we seek more effective articulation of how individual projects will together form part of a unified system approach.

Coventry and Warwickshire

System leadership

The ICB’s strong leadership and control is reflected in its movement into segment 2. Governance is strong with a programme board supported by provider review meetings; we will be looking to see evidence of the impact and effectiveness of these structures. The ICB has also played a key role in progressing large-scale transformation, with the review of out-of-hospital services that led to the introduction of the community integrator service of particular note.

Improving population health and healthcare

The system met most of the aims of its operational plan. It performed strongly in areas such as primary care and delivery against the 4-hour urgent care target. However, it did not meet its ambitions for others such as mental health, learning disability and autism services, and these will require renewed focus as well as planned targets for multi-year recovery. We welcome the progress so far and will look to see this trajectory continue.

Tackling unequal access, outcomes and experience

Progress on health inequalities has been strong, with a refreshed strategy and a robust delivery plan that includes the key deliverables for the most at-risk patients. The ICB published thematic analysis of Core20PLUS5 priority groups and in further publications will cover the domains of NHS England’s statement on information on health inequalities. Population health management processes are developing, and we advise the ICB to look beyond short-term deliverables to longer-term transformation across the life of the joint forward plan.

Enhancing productivity and value for money

Both the ICB and the system delivered a small surplus against plan although the level of recurrent efficiencies was relatively low. The ICB has strong financial leadership and capability, and we look to it to use this to drive an ambitious financial strategy that embeds financial sustainability in the longer term. Retention has improved and sickness absence reduced but we do call on the ICB to articulate more defined objectives around transformation as part of its strategic people plan.

Supporting social and economic development

The ICB is an anchor institution and part of an anchor alliance of responsible chief executives focused on strategic delivery. It has acted to improve local employment through a Health and Social Care Employability Academy that offered support to over 700 individuals in the last year. Progress has also been made against the system’s green plan with elimination of desflurane use and inhaler emissions reduced. We encourage the ICB to look for further opportunities to add local value through commissioning and procurement.

Derby and Derbyshire

System leadership

The ICB has demonstrated a level of effective collaboration with its system partners and has a system-wide approach to service transformation delivered through a joint transformation co-ordinating group. There is clear evidence of shared ownership and development of common strategies and plans, and we now look to the ICB to consider how it can embed continuous reflection in its operating cycle. Clear governance structures are in place, but more clarity is required on how decision-making has due regard for the balance of impact on quality, outcomes and resources.

Improving population health and healthcare

The ICB has made progress on several fronts, particularly in reducing its 62-day cancer backlog and number of inpatients with a learning disability or who are autistic. While it did not meet its urgent care targets, the ICB has worked to enhance inpatient flow and with the East Midlands Ambulance Service to address operational challenges. We look to the ICB to share learning from this work with its peers. The ICB also did not meet its elective recovery targets and should explore better collaboration with providers to do so.

Tackling unequal access, outcomes and experience

The ICB has a strategic focus on health inequalities and population health management, led by a prevention and health inequalities board. Data analysis is targeting intervention at high priority areas and projects, and tangible progress is already being seen in identifying undiagnosed hypertension in ethnic minority communities. We will continue to support the ICB to enhance its data capabilities such that it can fully report against all elements of NHS England’s statement on information on health inequalities and better target funding and resources for intervention projects.

Enhancing productivity and value for money

The ICB reported a small surplus, but the system returned a deficit against its breakeven plan and less than half of the efficiencies the system delivered were recurrent. The ICB and its system partners have been working to address this position and will need to do further work to enhance their understanding of the drivers of the deficit and together agree a plan for financial sustainability in the medium term. We note, in particular, the overspend on the pay budget and we will work with the ICB to consider how best to strengthen workforce controls.

Supporting social and economic development

The ICB is establishing itself as an anchor institution, with a system anchor charter agreed and focus on workforce and procurement as the key strategic areas. The ICB and partners have already developed a project focused on economic opportunities for ethnic minority communities. Early progress has also been made against the aims of the system’s green plan including the elimination of desflurane use and meeting low emission vehicle targets. We look to see these aims comprehensively integrated into wider system strategies.

Herefordshire and Worcestershire

System leadership

The ICB has demonstrated effective leadership in developing key strategies with its system partners, but we look to see these foundations built on next year to increase the breadth and pace of strategic development. The ICB has also demonstrated clear leadership in configuring services to meet local needs with particular success in accelerating provider collaboration and the development of new models for dermatology and orthodontics care. While performance challenges do exist, the structure of the ICB’s provider review effectively identifies performance issues and, when identified, the ICB has been effective in supporting their resolution.

Improving population health and healthcare

The system has demonstrated commendable progress. It now requires a lower tier of support for cancer and elective recovery, and has made progress against the CQC maternity recommendations and in out-of-hospital services, with access to primary care, public health and urgent community response all improving. However, areas of challenge persist; long elective waits have not yet been cleared and performance is still below expectations for urgent care and mental health care. The ICB should review its approach, resourcing and plans for these areas to ensure progress.

Tackling unequal access, outcomes and experience

The ICB has detailed the range of programmes it is prioritising to target inequalities within the system, and we have confidence in its approach. It has integrated its duties in relation to inequality into business-as-usual processes and senior leadership and governance are committed to this agenda. A network of local health inequalities ambassadors ensures each programme board and enabler group has individuals trained in understanding inequality. We look forward to seeing further progress on this agenda including formal reporting against NHS England’s statement on information on health inequalities.

Enhancing productivity and value for money

Both the ICB and the system reported a deficit, and we provided non-recurrent funding support. The ICB has demonstrated it has a process of financial oversight and governance, but this did not deliver the balanced position required. We look to the ICB to support the development of sustainable medium-term financial plans alongside short-term improvements in the position. The workforce growth above plans and concurrent significant pay overspend in particular are not sustainable and the ICB needs to strengthen its workforce controls.

Supporting social and economic development

The ICB has used its partnerships to good effect as an anchor institution in promoting local economic opportunities. There has been targeted outreach for both apprentices and substantive employees in areas of comparative deprivation and with local education partners a focus on enhancing educational and training opportunities. The ICB has also strengthened delivery against its sustainability agenda with the reinstatement of its greener board. We look to the ICB to consider how it enhances social value in its approaches to procurement and commissioning.

Lincolnshire

System leadership

The ICB has collaborated effectively across the system and taken action to support transition from the Recovery Support Programme. We welcome the work done to enhance service integration including the proposed provider group arrangements from this year. Governance processes have continued to evolve, with the ICB working closely with partners to develop and monitor pathway delivery. The timely and consistent use of improvement methodologies will be crucial for sustaining progress.

Improving population health and healthcare

The ICB supports delivery with effective challenge and support and has seen some progress this year, including in primary care and children’s and young people’s services. While it did not meet national targets for cancer, elective care and urgent care, the ICB did make progress on these agendas and tiering support has now been withdrawn. We now look to the ICB to lead its system partners in achieving sustainable improvements and call on it to give particular focus to timely ambulance handovers and improving learning disability and autism services.

Tackling unequal access, outcomes and experience

The ICB has a systemic approach to addressing and reducing health inequalities. It has a range of projects to tackle inequalities for under-represented groups, in particular military personnel and their families, a virtual health inequalities hub with public health and the local authority to provide intelligence and analysis, and engages with health and wellbeing boards on how to best target funding. We would welcome further focus on areas where the system is an outlier such as earlier cancer diagnosis.

Enhancing productivity and value for money

The ICB and system both reported deficits despite receiving non-recurrent financial support from NHS England. However, its finance function is strong across the system, and it has a cohesive approach to financial challenges. The ICB’s exit from the Recovery Support Programme having met financial transition criteria is testament to this, as well as its strong action to reduce reliance on agency staff. The ICB now needs to build a track record of delivery and maintain financial stability.

Supporting social and economic development

The local authority, NHS providers and partners within the system have a history of collaboration and these relationships continue to support complex cross-system societal delivery such as accommodation and care for asylum seekers at RAF Scampton. The ICB is also working with its partners to make progress against core sustainability priorities such as reducing medical emissions and meeting use of low-emission vehicles targets. We look to see continued cross-system working to make further progress against this agenda.

Leicester, Leicestershire and Rutland

System leadership

The ICB is dedicated to engagement and collaboration with a wide range of system partners. It is led by a strong and capable team who have driven strategic focus against shared ambitions and shown willingness to take advice from and support its partners. Overall, strong governance is in place in priority areas, but we look to the ICB to ensure the same rigour is given to longer-term strategic priorities, particularly in assuring provider strategic objectives are as robust as their operational ones.

Improving population health and healthcare

While the system did not deliver against all the objectives in its operating plan, there were significant improvements, most notably the largest reduction in elective and cancer services backlog in the country. While urgent care did improve, challenges persist, particularly with ambulance handover delays and in maternity services, and we will continue to provide support through urgent care tiering and the Maternity Safety Support Programme respectively.

Tackling unequal access, outcomes and experience

The ICB is a leader in reducing health inequalities, sharing innovation and best practice with its peers. Its health inequalities unit uses research and business intelligence to target areas in a way that aligns with the system’s overarching inequalities strategy. The integration of inequalities with routine business management across the system enables performance and inequity to be considered together and this is leading to innovative integrated solutions for uptake of vaccination and screening programmes, for example.

Enhancing productivity and value for money

The ICB faced significant financial challenges with deficits at both ICB and system levels despite receiving non-recurrent funding support. The proportion of recurrent efficiencies delivered was low and agency spending was significantly above its cap. The ICB has worked with the Recovery Support Programme and University Hospitals of Leicester NHS Trust to develop a financial recovery plan, and we will continue to work with the system to address the underlying financial issues and ensure robust grip and control to deliver against the plan.

Supporting social and economic development

The ICB is working closely with its partners to implement shared local priorities, through aligned strategies and with strong and effective partnerships to support collective service delivery. System partners have developed a ‘one workforce’ approach to bring estates, resources and facilities together as part of a shared anchor agenda. The system has established a green plan, and early work has eliminated desflurane use and reduced inhaler emissions.

Northamptonshire

System leadership

The ICB has demonstrated strong strategic development and effective risk management, but partnership working has further to go to realise its potential benefits. Governance structures and oversight processes are evolving but we call on the ICB to go further, particularly in establishing an effective oversight model alongside the neighbouring ICB. The system’s mental health and community trust has deployed an effective group leadership model and we look to the ICB to learn from this success.

Improving population health and healthcare

The system has met several operational goals, including the cancer faster diagnosis and diagnostics standards, and made progress against mental health, learning disability and autism priorities. We applaud the ICB for providing support beyond its boundaries, notably facilitating mutual aid for robotic surgery. However, focus on improving urgent care performance and enhancing access to primary care services is needed, as well as driving collaboration to reduce the high long length of stay.

Tackling unequal access, outcomes and experience

The system’s health inequalities plan outlines a roadmap to achieve better outcomes across all life stages, emphasising collaborative approaches. This is underpinned by an analytical platform that consolidates local information to provide a detailed picture of population health that can drive decision-making. We welcome this focus and the detailed examples of interventions, but we will look to the ICB to ensure robust data is available and used to analyse the impact of interventions.

Enhancing productivity and value for money

Both the ICB and system reported a deficit. Greater ICB leadership will be needed to achieve the financial oversight and control required, and partners will need to work together to find a balance between maintaining high quality services, ensuring financial sustainability and enforcing workforce controls. A robust medium-term financial plan will be essential for return to balance. The ICB will need to build on skills such as digital innovation and find solutions to issues around recruitment and retention of a skilled workforce.

Supporting social and economic development

The ICB has developed its green plan, and this along with the joint forward plan and health inequalities plan support its role as an anchor institution. However, we will expect to see more detail on how priorities integrate to form a meaningful delivery plan. The ICB has demonstrated renewed leadership on overseeing the greener agenda across providers and this has achieved early successes such as eliminating desflurane use. We now look to see work on this agenda come together and align to the system’s strategic priorities.

Nottingham and Nottinghamshire

System leadership

The ICB demonstrates robust partnership working and uses a partnership agreement that guides collective commitment to shared goals. Engagement with partners in strategy and planning is evident, and feedback on engagement from health and wellbeing boards is positive. The ICB has strong corporate governance and its use of a robust framework to inform service changes and resource allocations ensuring the ‘triple aim’ is central to decision-making. The ICB shows leadership in shared decision-making and regularly shares best practice.

Improving population health and healthcare

The ICB faced a challenging year and did not meet several core urgent care, elective and cancer standards. Specialist inpatient services were also challenged with targets for learning disability and autism inpatient care services missed, and out-of-area mental health placements increasing. The ICB acknowledged the scale of challenge and has improved its performance oversight regime in response. We will look to see strategic progress with improved monitoring of clinical quality, particularly in maternity services where we will continue to provide targeted support.

Tackling unequal access, outcomes and experience

The ICB uses system intelligence in its approach to reducing healthcare and an integrated dataset to target cost-effective resource at this agenda. The ICB is a regional leader in using data and population health management to address community needs. It has senior strategic leadership in place for this, supported by local leadership, and targeted plans at primary care network level. A dedicated health inequalities and investment fund is in place and currently funds 9 community-level priority projects.

Enhancing productivity and value for money

The ICB faced significant financial challenges and it and the system both delivered a deficit against plan. It has responded to these challenges with collaborative working across the system and built strong system controls to support financial recovery, including a stocktake of all providers to identify opportunities for improvement. We are providing support and oversight of the agreed undertakings. We look to the ICB to continue this required work in the next year.

Supporting social and economic development

The ICB has established an anchor champion network of NHS and local authority institutions to define and facilitate strategic delivery, make connections and share best practice. The network reviews progress and agrees plans for the year ahead. It is currently focused on people, procurement, emissions and estates, as reflected in the refreshed joint forward plan. We commend the system as one of the most innovative and forward thinking for the greener NHS agenda, with the ICB taking a key leadership role in delivery.

Shropshire, Telford and Wrekin

System leadership

The ICB, along with Shrewsbury and Telford Hospitals NHS Trust, were placed into the Recovery Support Programme (RSP) in August 2021 and while both have made progress against agreed exit criteria in 2023/24, there remains significant work still to be done. The ICB has continued to steadily improve its leadership and governance and to improve system working by establishing integrated place partnership boards to identify and tackle local needs involving local people through its ‘Big Health and Wellbeing Conversation’. Governance structures have also been independently reviewed and recommendations accepted, and we look to the ICB to continue and accelerate progress against the refreshed Recovery Support Programme exit criteria.

Improving population health and healthcare

Formal enhanced oversight arrangements are in place between NHS England and the system, complemented by a range of support to facilitate rapid improvements including through the Recovery Support Programme and tiering. During the year, due to the lack of progress, we agreed legal undertakings with the ICB to ensure a consistent and formal set of expectations for improvement were understood. While we do recognise and welcome the progress made, including progress through tiering for cancer and electives and in addressing maternity challenges at the Shrewsbury and Telford Hospital NHS Trust in line with the Ockenden Review, there is significantly more to do. We expect the ICB to maintain focus on tackling long inpatient length of stay and improving urgent care, diagnostic and cancer performance. We will continue to provide support through tiering and the Recovery Support Programme and track progress against the agreed range of undertakings.

Tackling unequal access, outcomes and experience

The ICB has produced a high-level implementation plan for health inequalities, and this is supported by a dedicated board and monitoring framework. The integrated place partnership boards are leading the local implementation of the plan and targeting the needs of their places. Improved working between NHS and public health teams is enhancing shared intelligence. A health inequalities outcomes dashboard is being developed to track inequity and target focused work next year to understand inequalities in elective restoration.

Enhancing productivity and value for money

Both the ICB and the system reported a deficit against plan, despite receiving non-recurrent financial support from NHS England. While the proportion of recurrent efficiencies delivered was comparatively high, a gap remains and will need to be filled to maintain balance in future years. The significant issues around unfilled vacancies and retention must also be addressed to bring down dependency on high-cost temporary staff usage. We will continue to support the ICB in this area and expect the ICB to focus on changing the mindset on cost controls and financial monitoring across the system.

Supporting social and economic development

The ICB held a workshop with partners from across the system to reflect on how anchor institutions can best work together to enhance social value in the system. It will be running a second evaluation in 2024/25 to agree priorities. We look to see the outputs of this work informing the system’s joint forward plan by describing a strategic approach to socioeconomic development with defined goals. The system’s green plan sets out the ambitions to reach the net zero NHS commitment, with ongoing efforts led by a climate change group. Further work with providers is now needed to advance these priorities.

Staffordshire and Stoke on Trent

System leadership

The ICB has demonstrated effective partnership working and collaboration in the development of its strategic plans. We now look to the ICB to develop the local architecture that can deliver against these plans. The ICB takes a reflective approach to board development, and we welcome its review of governance, including on managing escalation and risk as a system. The ICB is leading work on major service reconfigurations and we hope to see progress next year, particularly in the urgent care and maternity pathways.

Improving population health and healthcare

While some progress has been made, performance remains challenged across many areas including urgent care, maternity, cancer and elective performance. We worked with the ICB following the CQC’s issue of a warning notice to University Hospitals of North Midlands NHS Trust regarding maternity care and we will continue to do so, as well as offering targeted support on cancer and elective care through Tier 1 of the recovery programmes. However, we look to the ICB to mature its leadership role in these areas in tandem with improvement.

Tackling unequal access, outcomes and experience

The ICB has taken initial steps toward tackling health inequalities, developing a broad strategy that it will implement next year. Work has been undertaken to stratify population health data in support of targeting interventions and resources. While we welcome the work to address core NHS inequality priorities, we look to the ICB to work through its local architecture to drive focused interventions targeted at specific issues as part of an integrated system approach.

Enhancing productivity and value for money

The ICB has faced significant challenges with both it and the system reporting year-end deficits driven in part by growing demand for and acuity in its continuing healthcare services. The ICB was subject to an independent financial review, and this made recommendations to enhance financial governance and control. The ICB has agreed to several actions in response to the recommendations and we will continue to support the system as it works toward financial sustainability.

Supporting social and economic development

The ICB’s approach to supporting wider social and economic development is maturing, as recognised in the benchmarking it undertook against the anchor institute framework. Other key steps include establishing governance for the system’s green plan and widening the ICB’s social influence with educational and environmental partners. We will now look to the ICB to translate its strategic ambitions into tangible delivery, alongside managing short-term pressures.

South East integrated care boards

Buckinghamshire, Oxfordshire and Berkshire West

System leadership

Following significant senior churn within the system, the ICB must now focus on establishing stable leadership and it will be supported in this by the board development programme. Following operating model consultation, there is now significant work to do to implement the revised model to right-size the organisation at the same time as tackling significant operational and financial challenges. We welcome the early steps the ICB has taken, including resetting the mental health and acute collaboratives, and will now look to see these having the desired impact.

Improving population health and healthcare

Despite the challenging operating context and leadership fluctuations, progress has been made against key priorities such as reducing the number of elective patients waiting over 65 weeks and cancer 62-day waits, and maintaining primary care access above regional averages. However, significant challenges persist, particularly around urgent care performance and very long waits for elective care, and we will continue to provide support through tiering. The ICB is also required to support maternity service improvements in Oxford following a recent CQC inspection.

Tackling unequal access, outcomes and experience

The ICB is placing focus on key prevention priorities, in particular prevention of cardiovascular disease in the most deprived areas, and is also progressing work to improve tobacco dependence services. However, we look to the ICB to increase work to identify and treat hypertensive patients and increase referrals to the NHS Digital Weight Management Programme. The ICB should also take a wider population health management approach to explore further opportunities.

Enhancing productivity and value for money

Confidence in the ICB’s grip on this agenda is dented by the significant and unexpected financial decline in the latter part of the year. The ICB must take steps to address vacancies in its financial team, assure its board that it receives appropriate information, deliver a coherent financial plan and work towards financial sustainability, focusing on areas like primary care prescribing. More ambitious workforce planning is also needed to address the existing temporary staffing variations and tackle the unfunded workforce growth.

Supporting social and economic development

The ICB has worked to address key prevention priorities as part of enhancing wider socioeconomic improvements, but we would expect to see wider contributions to this area as it is a fundamental purpose of an ICS. The ICB should continue to pursue opportunities for broader social and economic development alongside its key system partners and advance its sustainability agenda to meet the ambitions of its green plan. A clear strategy is needed to align these efforts with system-wide goals.

Frimley

System leadership

The ICB demonstrates strong leadership with well-developed capacity and capability. It has used an established change methodology to effectively balance business as usual operations with innovation and sustainability and is the only ICB in the country in segment 1. We commend its collaborative approach to tackling wider challenges, particularly in supporting Buckinghamshire, Oxfordshire and Berkshire West ICB through a shared chief people officer and ongoing connected care support.

Improving population health and healthcare

The ICB’s population health management programme is well regarded and is supporting ongoing reductions in admissions and GP consultations as part of the wider ambitions on demand management. This programme is supported by strong IT interoperability and investment and has seen significant successes in areas such as virtual wards and digital weight management. The ICB also continues to deliver against key performance targets, making good progress on elective, cancer, urgent care and discharge performance.

Tackling unequal access, outcomes and experience

The system’s population health management and digital maturity work has supported the ICB in reducing inequality across the system. The ICB has promoted digital weight management, and the system has made significant strides in delivering weight loss. The ICB has also revised its approach to the quality and outcomes framework including to raise awareness of hypertension. We look to the ICB to take learning from Leicester’s model of integrated care in considering how to embed inequality reduction in commissioning practice.

Enhancing productivity and value for money

Despite historical stability the system reported a deficit in 2023/24, attributed to the unexpected expenses incurred during industrial action and structural estates issues at Frimley Park Hospital. The ICB has identified further recurrent savings opportunities that, if realised, will support recovery of the underlying deficit and deliver breakeven in 2024/25. Alongside these efficiencies we look to the ICB to work with its providers to redesign safe staffing models that deliver further savings and to identify the current and future financial risk from the identified estates issues.

Supporting social and economic development

The ICB is working closely with its 5 health and wellbeing boards, engaging across public health, social care and community sectors. It has developed a proactive and integrated approach to prevention and personalised care at place and neighbourhood levels that is proving successful. We look to see the ICB continue to grow these partnerships at all levels in delivering its ambitious strategy, ensuring that health priorities interact with the broader social and economic development needs of the wider system.

Hampshire and the Isle of Wight

System leadership

The ICB, alongside system partners, entered the Recovery Support Programme due to financial concerns and the need for it to establish grip and control as a key component of recovery. Subsequently there has been significant under-delivery against the transformation objectives in the system-wide recovery and transformation plan that was developed in response to the challenges. However, the historically fractured commissioning arrangements are being addressed as part of collective accountability for delivery of the plan.

Improving population health and healthcare

The ICB has taken steps to optimise digital technology, through remote consultations and developing the virtual wards that are critical to demand management. Capacity and productivity in primary care is increasing but not at a sufficient rate to keep pace with demand, and the underspends in dentistry must be tackled. Urgent care performance did not meet the standard due to high volumes of stranded patients, an issue that must be addressed through the developing integrated neighbourhood model. Elective care was also challenged though progress was made in cancer care.

Tackling unequal access, outcomes and experience

A robust population health management framework has been established to address health inequalities, enhanced by strong collaboration between system partners. There has been good performance on vaccination uptake, improvements in maternity services and expansion of tobacco dependence services, and the ICB is seeking to make more progress on hypertension, cardiovascular disease and digital weight management. We welcome the appointment of a clinical director to drive these efforts, and we will enable peer support from higher performing neighbouring ICBs.

Enhancing productivity and value for money

Despite cash support to offset its planned deficit, the system’s financial position deteriorated significantly in 2023/24 and it ended the year with a deficit against plan. Key drivers of this deficit were industrial action, pay pressures, temporary staffing, medicines optimisation and delayed efficiency schemes. The ICB, with its NHS partners, is advancing a recovery and transformation plan to address the deficit, respond to increasing demand and improve service delivery. Progress has been made to reduce temporary staffing but the need for safe reductions in substantive workforce has still to be addressed as part of this plan.

Supporting social and economic development

The 4 health and wellbeing boards recognise the ICB’s contribution to developing joint health and wellbeing strategies that align with the ICB joint forward plan and wider integrated care strategy. However, they seek better partnership working with the ICB on shared priorities, in particular application of the Better Care Fund. The ICB’s digital innovations, such as virtual wards, are helping to reduce system carbon emissions and we look to see this trend continue as part of the ICB’s wider system green plan.

Kent and Medway

System leadership

The ICB has maintained a strong focus on collaboration and transformation. While there are still local tensions, good progress has been made with the challenging strategic redesign of service models, underpinned by a shared system vision and values. Good progress has also been made in establishing provider collaboratives, supported by an overarching provider collaborative board. Continued leadership development is needed at pace to strengthen operational governance along with further progress on the strategic transformation priorities.

Improving population health and healthcare

Good progress has been made with the clinical pathway design pilots, ensuring consistency with national standards. The system has taken significant steps to improve urgent care services and we expect it to exit Tier 1 support soon. Extended waits over 12 hours in departments need continued focus at pace, particularly in East Kent Hospitals University Foundation Trust and Medway NHS Foundation Trust. While mutual aid has been accessed effectively for elective care and diagnostics, a stronger focus is needed on reducing long waits and addressing delayed discharges where patients no longer meet the criteria to reside.

Tackling unequal access, outcomes and experience

The ICB has taken steps to tackle inequality for mental health patients. Numbers of mental health patients in emergency departments have substantially reduced with the establishment of alternative pathways. We look to the ICB to share its experience as well as turn its focus to reducing long waits for specialist care. The redesigned pathway for autism and ADHD has significantly reduced waiting lists and we look to see this have further impact next year. We also call on the ICB to work to reduce hypertension and smoking, including by setting up tobacco treatment services in East Kent.

Enhancing productivity and value for money

The ICB works effectively with its providers and other system partners but faces substantial financial challenges driven by industrial action, Cost Improvement Programme (CIP) underachievement and rising service delivery costs. Although the ICB reached the capital resource limit and used the total system capital allocation, it under-delivered on the efficiency plan and agency spend exceeded the agreed cap. The ICB and its partners must finalise a realistic and deliverable financial plan alongside a longer-term financial review that includes further focus on reducing temporary staffing.

Supporting social and economic development

The ICB faced significant operational and financial challenges across the year but enhancing social value remains a critical system purpose to which the ICB must continue to contribute. We ask that the ICB continues to focus on identifying and advancing opportunities to support broader social and economic development and works to deliver against the aims of the system’s green plan: lower overall and inhaler emissions and maximised use of electric fleet.

Surrey Heartlands

System leadership

The ICB has ambitious plans for leading and co-ordinating the system, but system relationships are challenging and will need careful management. The ICB has established a provider collaborative and is now embarking on establishing a community collaborative. It should continue to work with neighbouring systems on shared challenges and cross-border flows. The ICB has strengthened its accountability with its provider leadership and must continue work to strike an effective balance between intervention and support.

Improving population health and healthcare

The ICB has a robust approach to population health, reflected in its wide recognition for projects around discharge and primary care. Notable operational performance successes are the ICB’s very high performance on cancer treatment and diagnosis and progress on urgent care priorities. However, there are significant data quality issues at provider level and we look to the ICB to work with the trusts and technical partners to address these, ensuring that the system and the wider NHS are using accurate data.

Tackling unequal access, outcomes and experience

The ICB’s approach to population health management aligns with its strategic aims to reduce inequalities and some early successes have been seen, including high performance against tobacco dependency, digital weight management and blood pressure management objectives. The ICB was nationally recognised at the HSJ Partnership Awards for its work to reduce inequalities for patients with a learning disability. The move to a new operating model will offer opportunities to further progress strategic integration and ensure a cohesive system-wide approach on this agenda.

Enhancing productivity and value for money

The ICB achieved its revised deficit target despite challenging efficiency targets in continuing healthcare and medicines management. The deficit was primarily due to Surrey and Sussex Healthcare NHS Trust not meeting its efficiency goals, mitigated by non-recurrent savings allocated by the ICB. Agency costs have fallen by 30%. The system is continuing to identify efficiencies and encourage system-wide approaches to achieving financial savings, as recommended by the health and wellbeing board. However, it projects a deficit next year.

Supporting social and economic development

The ICB continues to demonstrate strong collaborative working with its partners and population to address wider local challenges. Notably, it became a vanguard footprint for the WorkWell service and has worked to create local employment opportunities for those facing health barriers to employment and developed the United Surrey Talent Strategy to pool workforce management and outreach to schools and families. We also commend the ICB’s work to support carers.

Sussex

System leadership

The ICB has demonstrated strong leadership in developing and implementing the ‘Improving Lives Together’ strategy with a high standard of integration and collaboration. This will see integrated community teams embedded across the system and a shared delivery plan will include reform of underlying delivery architecture and governance. While the clear collaborative approach is welcomed, we now seek focus on establishing acute and community collaboratives and review of acute services to identify how these could be reconfigured more efficiently.

Improving population health and healthcare

The ICB had made good progress in delivering against many of the core standards, including realising the ambitions for urgent care and cancer, and in reducing community waiting times, enhancing GP access and many areas of mental health. Elective care delivery remains a significant challenge with high numbers of patients waiting longer than 65 weeks, and a need to further reduce diagnostic waits and to increase new elective pathways. The ICB also needs to focus on reducing numbers of inpatients with long length of stay and improving mental health crisis response times.

Tackling unequal access, outcomes and experience

The ICB has demonstrated significant progress against its health inequalities ambitions, meeting 20 of 25 indicators for its 5 core system actions. Notably, it has delivered tobacco dependency treatment services in maternity settings ahead of target and is in the top-performing quartile nationally for these services, and the completeness of its data coding has significantly improved. We now look to the ICB to focus on completing its 2 remaining accelerated prevention programmes and ensuring there is effective provider inequality leadership.

Enhancing productivity and value for money

While the ICB has demonstrated commendable collaborative work with chief finance officers across the system, it reported a deficit against plan. Risks remain and we will continue to work with the ICB to agree how the residual gap to control total can be bridged for the year ahead. Agency costs were higher than planned and the ICB is now making progress in reducing temporary staffing costs, including by reducing off-framework usage and developing common rate cards. We look to the ICB to work with Sussex Partnership NHS Foundation Trust in particular to further reduce these costs.

Supporting social and economic development

The ICB has developed the Sussex Population Outcomes Framework with local authority teams at place level. This will enhance its understanding of local outcomes and support efforts to increase life-expectancy and reduce premature mortality. We encourage the ICB to continue to develop this focus to advance wider opportunities that promote broader social and economic development across the system. Additionally, the ICB must make further progress on its greener agenda and set out a clear approach to meeting its system sustainability targets.

South West integrated care boards

Bristol, North Somerset and South Gloucestershire

System leadership

The ICB has led the system effectively through a period of operational and structural challenge and has worked collaboratively with its partners to develop shared plans and strategies. Feedback from partners has been broadly positive and we encourage the ICB to continue to develop its locality partnership model to further drive mutual support and accountability. Robust governance has emerged from the ICB’s organisational development plan.

Improving population health and healthcare

The ICB has met several of its operating plan trajectories with notable improvements in UEC performance and ambulance response times for Category 2 incidents. However, further work is needed to make progress against several key targets. Despite some progress, further recovery work is still required for cancer and elective performance, and we will continue to provide support through cancer and elective tiering. Children’s and perinatal mental health, learning disability and autism inpatient services also require improvement, as does the rollout of virtual wards.

Tackling unequal access, outcomes and experience

The ICB has focused on inclusively restoring services and established a strategic prevention oversight group to identify system approaches that improve health and wellbeing. It has a ringfenced budget to support key projects that tackle inequalities and devolves funding to locality partnerships to target community-level inequality priorities. The ICB is involved in the Race and Health Observatory Learning and Action Network for maternity and is working to improve reporting against the key elements of NHS England’s statement on information on health inequalities.

Enhancing productivity and value for money

The ICB and system delivered a small surplus, with a small agreed overspend against capital plans but under delivery against planned efficiencies. The ICB needs to improve this position next year, including by reducing spend on temporary staffing. The ICB must continue to lead the development of a financial recovery plan to ensure return to recurrent balance in the medium term. This plan must include achieving further efficiencies, factor in the financial impact of reducing length of stay and ensure performance on continuing healthcare is maintained.

Supporting social and economic development

The ICB’s commitment to enhancing social value has achieved progress in several areas. Sustainability is embedded in decision-making with sustainability effects now used routinely as part of the ICB’s gateway process, and longer-term plans are underway to decarbonise the estate and move to a low or zero emission fleet. Work has also progressed to improve employment opportunities, with the ICB working closely with The King’s Trust to support employment among those who are disadvantaged and run schemes targeted at veteran and carer employment.

Bath and North East Somerset, Swindon and Wiltshire

System leadership

The ICB has demonstrated clear processes to oversee performance, quality and governance. A full review of governance considered structures and membership, and this noted that the ICB had 3 vacancies, 2 of which have now been tentatively filled. We look to the ICB to fill the remaining post on completion of the relevant contract award. The ICB also works effectively with partners, and this is reflected in health and wellbeing board feedback.

Improving population health and healthcare

The ICB has strategic approaches to improving quality and safety, with mortality reviewed across providers and learning from incidents used to ensure focused improvements through the patient safety community of practice. While progress against operating priorities has been made, significant challenges have still to be addressed and we look to see further progress on diagnostics, children’s and young people’s mental health access, eating disorder services, talking therapies and dementia, as well as maximising use of virtual wards and urgent community response. The ICB works with its patient and public voice group and through forums there is strong evidence for engagement on its care model.

Tackling unequal access, outcomes and experience

The ICB has demonstrated a clear commitment to reducing health inequalities with ringfenced funding used for system-wide and locally led initiatives to address inequality. Strategic oversight of this agenda is provided through the population health board in conjunction with directors of public health. The ICB has an established inequalities strategy, and this has been translated into a costed implementation plan that was approved by the board. Ongoing inequality plans are informed by internal auditor commissioned reviews of the system’s inequality data and progress against NHS England’s statement on information on health inequalities.

Enhancing productivity and value for money

The ICB and system fell short of their breakeven positions and efficiency plans were under-delivered both in totality and for recurrent efficiencies. The ICB has submitted a deficit plan for next year and must develop a financial recovery plan with key milestones and actions described in terms of how they will impact the financial position. The ICB will also need to provide confidence that it has sufficient capacity and capability to deliver this plan. We expect the system to return to balance in 2025/26 without the need for recurrent support, but a medium-term financial plan must be put in place to maintain this position.

Supporting social and economic development

As an anchor institution the ICB has demonstrated a range of positive actions. The green plan has been strengthened through hosting a clinical fellow who has supported a range of sustainability projects across the system. The ICB’s commitment to greening the system is also demonstrated in the completion of the system’s first net zero building. The ICB has also improved economic inclusion through school outreach projects and supporting care leavers into employment. It has secured funding from the Department for Work and Pensions to support integration of healthcare and work for those with long-term conditions.

Cornwall and the Isles of Scilly

System leadership

The ICB has demonstrated system leadership during a period of challenge and change, implementing a range of positive changes and innovations over the course of the year. Collaboration with system partners is an area of strength and the ICB was recognised for this in the South West Integrated Personalised Care Awards. We expect to see continued collaborative working in the year ahead as well as strengthened governance around quality and finance.

Improving population health and healthcare

The ICB and system partners have made progress against operating plan trajectories and taken good steps on personalised care, but significant performance challenges persist and focused work is needed to make progress on long elective waits, mental health out-of-area placements, access and recovery rates for talking therapies, urgent care performance and general and acute bed occupancy. We will continue to support the urgent care system and Royal Cornwall Hospitals NHS Trust through elective and urgent care tiering.

Tackling unequal access, outcomes and experience

The director of public health submitted a report on system inequalities this year and this is informing the ICB’s strategic approach to reducing inequality. Progress in targeting deprived and vulnerable populations has been made, including new focused homeless services, a dental pilot for vulnerable children, diabetes ‘super clinics’ for quicker annual reviews and rollout of tobacco dependence projects in respiratory and maternity departments. We now look to the ICB to integrate its local priorities further with NHS England’s statement on information on health inequalities.

Enhancing productivity and value for money

Both the ICB and system achieved a small surplus against resource plans, with capital expenditure, running costs and cash spend all at or below planned levels. Planned efficiency targets were achieved, but next year the ICB should address those recurrent schemes for which the system under-delivered. We expect the ICB leadership to provide assurance that it has the capacity and capability to deliver its operating plan within budget and a medium-term financial recovery plan to ensure that the system can return to recurrent balance within 3 years.

Supporting social and economic development

The ICB has set out its strategic aims to reduce emissions in the system’s green plan and it is funding Volunteer Cornwall to support delivery of critical elements of the plan across primary care networks. Notable successes from the enhanced engagement through this partnership include 45 general practices switching inhalers and Cornwall recognised as one of the leading systems for inhaler carbon emission reduction. The ICB is also working with the Peninsula Pathology Network to identify opportunities to make the pathology service more sustainable.

Devon

System leadership

The ICB has faced a challenging year with significant turbulence at executive level. Despite this, it has led a range of meaningful changes, notably the opening of the Dartmouth Health and Wellbeing Centre and several community diagnostic centres. We will continue to support the ICB and its providers through the Recovery Support Programme and, to make progress towards meeting the agreed transition criteria, we expect focus on leadership, improved governance and planning.

Improving population health and healthcare

The ICB had a target exit date from the Recovery Support Programme of Q1 2024/25 but has not made sustainable progress against all transition criteria. The ICB and its providers have made some progress on elective, cancer and diagnostic performance, but Royal Devon University Healthcare NHS Foundation Trust, University Hospitals Plymouth NHS Trust and Torbay and South Devon NHS Foundation Trust remain in Tier 1 for urgent care, elective care and diagnostics. New transition criteria and measures are in place, with significant progress expected next year, particularly in financial stability and performance improvements.

Tackling unequal access, outcomes and experience

The ICB has established a population health improvement committee to lead its engagement with the One Devon approach to inequality reduction. Population health funding has been delegated to local care partnerships to drive local projects aligned with local ‘plus’ populations and the Core20PLUS5 groups. Key achievements include a shared approach to connect with high-frequency emergency department users, the establishment of the Healthy Devon Learning Lab focusing on obesity and targeted hypertension risk identification. The ICB is recognised as reporting effectively against all domains of NHS England’s statement on information on health inequalities.

Enhancing productivity and value for money

While the ICB achieved a surplus and met its capital resource limit, the system reported a deficit against a revised breakeven plan. The running costs duty was met and cash allocation was fully utilised. The system has submitted a deficit plan for next year and the ICB will lead efforts to implement the finance playbook, ensure sufficient system capacity and develop a medium-term recovery plan with the aim of improved financial breakeven in subsequent years. We will continue to support the system in achieving its financial goals through the Recovery Support Programme.

Supporting social and economic development

The ICB’s anchor steering group is responsible for progressing and communicating the key social value agenda and priorities within the organisation and system. Its early activity has included expanding opportunities and support for people with a learning disability and mental ill-health to access training and employment and expanding care hubs to include care leavers and young people not in education, employment or training. Progress has also been made on the greener NHS agenda through estate optimisation to reduce carbon emissions and promotion of low emission transport.

Dorset

System leadership

The ICB demonstrates sound operational management of its system, underpinned by its performance management framework to monitor and assess delivery of short and long-term priorities. It also demonstrates strong leadership development to support compassionate approaches to restructuring in line with cost reductions. It makes efforts to work collaboratively with system partners but the mixed views from health and wellbeing board partners highlight opportunity to improve relationships as part of the upcoming refresh of health and wellbeing strategies.

Improving population health and healthcare

While the ICB and system met many of their operating plan targets and national standards, areas of performance challenge remain. We look to the ICB to make further progress on access to community mental health services and reducing the use of out-of-area placements, to expand virtual ward capacity to support improved hospital flow, and to reduce the number of patients waiting over 65 weeks for elective procedures. We also call for the ICB to continue overseeing its maternity services, including the implementation of the Maternity Transformation Programme following CQC inspections, and to take the advised steps to enhance and clarify the review of its quality framework.

Tackling unequal access, outcomes and experience

The ICB’s commitment to reducing health inequalities is demonstrated in the steps it has taken to strengthen governance and leadership on this agenda. The development of a data and insights service dashboard is enabling targeted action for inclusive elective care and expansion of tobacco dependence treatment to women in Dorset. In the ICB’s inclusive approach to vaccination, promotion campaigns are targeted at underserved communities, pop-up clinics are used, and roving teams deliver Covid-19 vaccination to groups at risk of inequality. The ICB will provide a detailed health inequality report later this year.

Enhancing productivity and value for money

Both the ICB and system reported deficits and while the ICB delivered against its efficiency plan, the system did not. The system has agreed a financial deficit plan for next year and needs to develop a financial recovery plan to support its delivery. We look to the ICB to ensure the plan contains key milestones and actions to support medium-term financial sustainability, with an expectation that the system returns to balance in 2025/26. The ICB demonstrates commitment to research and innovation and its partnership with Hampshire and the Isle of Wight ICB is promoting a pan-Wessex approach to this agenda.

Supporting social and economic development

The ICB recognises its role as an anchor institution and has engaged with people and communities as part of its drive to fulfil this role. It has worked to develop its workforce, including by promoting health literacy training and inclusion training for its senior leaders to support in reducing inequalities. The ICB has also made progress against its green plan with sustainability leads in place for the ICB and each NHS organisation, and it has launched a digital platform for NHS partners to promote sustainability. The system has seen a 2% fall in prescription requests with a patient campaign to reduce unnecessary requests.

Gloucestershire

System leadership

The ICB has strong governance models and well-established processes to oversee operational performance. Its effective joint working with partners and the wider community is recognised in feedback from the health and wellbeing board chair, particularly around integrating health and wellbeing strategies with the system’s joint forward plan. The ICB has a good relationship with the University of Gloucestershire and University of Worcester with new courses being introduced that have the potential to increase the flow of newly qualified staff to the system.

Improving population health and healthcare

The ICB has made significant progress in reducing elective waiting times and a new community diagnostic centre is now operational in Gloucester, offering 80,000 more diagnostic appointments a year. However, further work is required to improve some areas of operational performance, notably for maternity, which continues to be supported through the Maternity Safety Support Programme to increase the pace of improvement. The use of virtual wards and referrals from NHS 111 to urgent community response services also need to increase, and access to primary care and dental services improve.

Tackling unequal access, outcomes and experience

The ICB has continued to make progress in tackling inequality with a range of activities. Strategic developments include providing funding for the Gloucester Community Building Collective to deploy people into communities to help address social issues and working with research and academic partners to bring under-represented groups into health research. Focused initiatives include work to enhance eyecare for homeless communities and, alongside midwifery teams, supporting new parents from groups most impacted by inequalities. The ICB will be providing an annual review of healthcare inequalities.

Enhancing productivity and value for money

The ICB and system delivered a small surplus against plan, with system capital expenditure at agreed levels but programme capital underspent. It over-delivered against both its efficiency plan and recurrent efficiencies, although the system under-delivered against both positions. We look to the system to deliver a balanced position next year, including by identifying savings and efficiencies and reviewing investments driving sustained growth in headcount. It will need to develop a financial recovery plan for the medium term that will return the system to recurrent balance.

Supporting social and economic development

A key feature of the ICB’s joint forward plan is enhancing local employment and the ICB has demonstrated a range of activities to deliver this aim. Highlights include the establishment of an employment alliance to progress collaborative actions alongside work to drive future workforce through engagement in schools and delivering a nursing associate apprenticeship with the University of Gloucestershire. The green plan has been updated to next year build on actions to date to reduce emissions, and Gloucestershire Hospitals NHS Foundation Trust successfully bid for grant funding from the Public Sector Decarbonisation Scheme.

Somerset

System leadership

The ICB leads its system effectively and operates a well-established model of assurance. Partnership working is well embedded across the system, both within and beyond the NHS, as reflected in positive feedback from the health and wellbeing board chair regarding joint working to align strategies and plans. The ICB’s approach to learning and transformation includes hosting a collaborative commissioning hub on behalf of its region’s ICBs and it ran an effective public consultation to review stroke services.

Improving population health and healthcare

The ICB and its system partners have made significant progress in meeting operating plan targets and national standards. Notable successes include Somerset achieving the lowest ambulance handover lost hours, meeting the 4-hour standard and eliminating elective waits over 2 years. However, further work is needed to improve mental health care access for children, increase dementia diagnosis rates and increase use of virtual wards and urgent community response. The ICB must also continue to work with its acute trust to improve maternity services following recent CQC warning notices issued to Somerset NHS Foundation Trust after inspections.

Tackling unequal access, outcomes and experience

The ICB has made progress in reducing health inequalities, including from piloting the use of key factors to flag vulnerable elective patients as part of waiting list prioritisation and to alert liaison teams that patients with a learning disability and autistic patients may need reasonable adjustments when attending appointments. The ICB’s approach to population health shares focus through a healthcare inequalities network and uses timely population health data to target interventions. Alongside local inequality reporting we look to see closer alignment of reporting with NHS England’s statement on information on health inequalities.

Enhancing productivity and value for money

The ICB and system achieved a breakeven position against revenue plans, with capital fully utilised but not overspent. The ICB also met its efficiency plan but the system underdelivered on its plan. The system has agreed a breakeven plan for next year and we look to the ICB to provide assurance that there is sufficient capacity and capability to deliver this plan and develop a medium-term sustainability plan to ensure recurrent balance within 3 years. The ICB is a founder member of Peninsula Research and Innovation Partnership alongside its partner ICBs, academic institutions and research partners with positive ambitions to use synergies to create positive impacts from research and innovation.

Supporting social and economic development

The ICB’s contribution to social value is demonstrated in its commitment to embed sustainability and carbon emission reduction in all procurements, and drive advances in digital transformation to reduce avoidable carbon emissions. It has also worked with the primary care network, a forerunner in primary care sustainability, to encourage prescribing of carbon neutral inhalers. The system has ambitious plans to transform a former hospital into a training academy for social care and healthcare by 2026/27, to improve employment opportunities.

London integrated care boards

North Central London

System leadership

The ICB demonstrates effective strategic leadership and provides support across the system, working closely with stakeholders and local partners to shape and lead proposals on service reconfigurations. It continues to lead a complex internal organisational change programme and review its governance models. We look to see greater involvement of partners in considering system quality challenges as well as improved relationships with local authorities.

Improving population health and healthcare

The ICB has continued to progress its population health approach by developing an outcomes framework to drive this agenda. Service improvements have been made particularly around primary care access and community mental health services, but significant operational challenges persist in meeting core standards. We will continue to support the system through Tier 1 of the national Urgent Care Programme and the Royal Free London NHS Foundation Trust through Tier 2 of the Cancer and Elective Programmes.

Tackling unequal access, outcomes and experience

The ICB has established a population health and health inequalities committee to unite these important agendas. Positive actions include steps to increase digital inclusion with a focus on primary care access and use of real-time data to identify gaps in care and support proactive intervention. The ICB is participating in the national Learning and Action Network aimed at addressing disparities in maternity pathways for women from ethnic minority groups.

Enhancing productivity and value for money

Both the ICB and system delivered surpluses and against efficiency plans and the Mental Health Investment Standard. It overspent on agency staff although that was driven by industrial action and not assumed in plans. The ICB is working to develop its relationships with key research partners and secure national funding to establish a research engagement network.

Supporting social and economic development

The ICB is acting as an anchor institution and supporting its NHS partners. Work against the system’s green plan is delivering reductions in inhaler emissions, procuring greener energy and increasing the use of electric vehicles. The ICB has met its ambition to be a London Living Wage employer and takes actions with others to develop and improve recruitment, employment and training opportunities.

North East London

System leadership

The ICB provides strategic leadership to its system. It has a well-developed working with people strategy and engages widely with the community in the development of its strategies and plans. The ICB has robust governance in place, including a clinical advisory group who provide guidance and support at all levels of activity across the system. Health and wellbeing board feedback is positive around the ICB’s close and collaborative relationships. 

Improving population health and healthcare

The ICB is supporting Barking, Havering and Redbridge University Hospitals NHS Trust to exit the Recovery Support Programme, and the progress it is making, particularly on urgent care, must be maintained. Significant challenges persist with reducing long elective waits, particularly at Barts Health NHS Trust, and we will continue working with the ICB to address these. The ICB underspent on System Development Programme funding and should take steps to ensure the full funding is used in future.

Tackling unequal access, outcomes and experience

The ICB has a well-developed place-led approach to reducing inequalities supported by multi-year programme grants for innovative projects that are already being nationally recognised. The system’s health equity academy is helping to develop skills, knowledge and expertise in reducing inequalities. An outcomes framework is being developed to underpin the population health management strategy and we look to see this interface with NHS England’s statement on information on health inequalities.

Enhancing productivity and value for money

The system’s significant underlying financial challenges worsened through the year, and it reported a deficit. The ICB under-delivered against planned efficiencies and the system had the highest growth in headcount in the region as well as overspending on its agency cap. Focus must be on development and delivery for future sustainability and we need to see this in the financial sustainability plan that is in development.

Supporting social and economic development

The system’s anchor charter sets out the objectives and priorities in this area, and some progress with these is already being made. The ICB and one of its trusts have been accredited as London Living Wage organisations and we look to see the other trusts achieve accreditation in 2024/25. Progress against the system’s green plan includes reducing inhaler emissions, incentivising environmentally friendly travel for staff and rolling out coaching in sustainable healthcare.

North West London

System leadership

The ICB has demonstrated robust leadership and vision across the system, with a concerted effort to embed partnership working and secure broad engagement with local populations. Feedback from health and wellbeing boards recognises the positive collaboration, which has been crucial in aligning priorities and initiatives. We look to see these relationships strengthened further. The ICB has undertaken extensive organisational redesign work, and we now look to see this work move into the implementation phase.

Improving population health and healthcare

The ICB has an effective approach to population health management, working together with system partners to share intelligence and prioritise quality improvements. Access to primary care and mental health services has improved and the urgent care performance target has been met. However, attention needs to be given to addressing challenges in elective recovery: the overall size of the system’s elective waiting list and number of long waiters have both increased. 

Tackling unequal access, outcomes and experience

The integration of inequalities work in the ICB’s approach to population health management is driving understanding of inequalities across the system. The ICB is holding its first health equity summit in 2024/25 and has proposals to further integrate reporting against key local inequality metrics and the measures in NHS England’s statement on information on health inequalities. We will look to see how this work influences the ICB’s future priorities.

Enhancing productivity and value for money

Both the ICB and the system reported a surplus, and although efficiencies were delivered against plan a significant proportion of these was achieved non-recurrently, which may pose challenges for future financial stability. The ICB has led the development of a system estates strategy to improve the quality and functionality of the estate, and we look to see this plan realised to reduce inefficiencies.

Supporting social and economic development

The ICB has taken steps to refresh its anchor charter by defining the roles of health and care bodies in addressing wider social, economic and environmental issues. The system’s Health and Social Care Skills Academy is supporting local residents to gain skills and find employment and the system is working to encourage volunteering. Progress has been more limited in implementing the system’s green plan, but work is underway to review and refresh the approach to sustainability.

South East London

System leadership

The ICB has led strategic and operational planning within the system and worked with partners and the community to take a range of local priorities forward. It has also worked across boundaries, particularly with South West London ICB and trusts in both systems to reconfigure and relocate children’s cancer services in South London. However, the revised joint forward plan reflects a challenging landscape and the ICB must continue to work effectively to deliver against these pressures.

Improving population health and healthcare

The system has faced significant performance challenges in urgent care, cancer and elective care and we will continue to support it to address these issues, including through elective and cancer tiering. The ICB has demonstrated high involvement and collaboration with the local maternity and neonatal system, and we look to it to share its learning with others in the region.

Tackling unequal access, outcomes and experience

The ICB has enhanced its public health management approach and, recognising that achieving its goals requires cultural change and enhanced capabilities, is recruiting to a catalyst team that will embed the necessary transformation throughout the system. The ICB has found it difficult to report against all domains of NHS England’s statement on information on health inequalities and continues work to address this. Necessary diagnostic work is also underway including a study into barriers to digital inclusion.

Enhancing productivity and value for money

While the ICB reported an overall surplus, the system reported a significant deficit, driven primarily by deterioration at King’s College Hospital NHS Foundation Trust. A medium-term financial plan for the system is a priority and we will support its development as part of the Recovery Support Programme. The ICB met its planned efficiencies, but provider efficiency plans were under-delivered. The ICB must continue to support the achievement of efficiencies across the system as part of financial sustainability as well as its own plan.

Supporting social and economic development

The ICB has an anchor system programme and has pledged to become a London Living Wage employer and support under-represented groups to secure employment in health and care settings. We look to see clear action plans and timelines to deliver on these pledges. Early progress has been made against the system’s green plan and the ICB is the first in London to host a sustainability clinical fellow.

South West London

System leadership

The ICB has demonstrated collaboration with a range of partners to further develop and implement key strategies, including refreshing the joint forward plan. It has given strong focus to engaging with underserved communities and worked across boundaries, particularly with South West London ICB and trusts in both systems to reconfigure and relocate children’s cancer services in South London. Health and wellbeing boards have shared positive experiences of working with the ICB and seek further integration and data sharing to support shared goals.

Improving population health and healthcare

The ICB has taken steps to improve quality of care and reduce unwarranted variation, and to address continuity of care, accessibility and digital integration. Notable achievements include meeting the urgent care standard and improving cancer performance. However, the overall size of the system’s elective list and number of long waiters have both increased, admittedly from a low base. The ICB underspent on System Development Programme funding and should take steps to ensure the full funding is used in future. 

Tackling unequal access, outcomes and experience

The ICB has strengthened its governance and leadership around health inequalities and its use of the Health Inequalities Investment Fund is balanced between existing scalable projects and innovative new initiatives. Projects are targeting digital exclusion, clinical prioritisation and outreach for vaccination. We look to the ICB to continue to develop data profiling and improve the quality of information it has to ensure activity is effectively targeted and improvement can be measured.

Enhancing productivity and value for money

While the ICB reported a small surplus, the system had significant financial challenges, with a worsening of the substantially funded system deficit over the year. Recovery will rely on developing a longer-term financial plan and the ICB has entered segment 3 in recognition of the support it needs to address these challenges. The ICB has made progress in optimising its research profile, including through the appointment of a researcher to work on public health priorities across the system.

Supporting social and economic development

The ICB has used its role as an anchor institution to strengthen employment prospects and opportunities across the health and care sector. The apprenticeship hub aims to optimise use of the apprenticeship levy, while the ICB has undertaken a skills audit to determine how it best uses and enhances its skill base, and it is driving implementation of the London Living Wage. It has taken action to progress the system’s green plan, including with estates heat decarbonisation plans to support the NHS net zero strategy across all NHS trusts in the system.

Publications reference: PRN01455