1. Introduction
- This guidance sets out the annual assessment process we will follow to assess integrated care board (ICB) performance in the 2025/26 financial year and should be read in conjunction with the 2025/26 priorities and operational planning guidance. This approach meets statutory requirements and provides a proportionate assessment process, while minimising administrative impact on ICBs during a period of change and setting the direction of travel for future assessments.
- Over 2025/26 the NHS operating landscape is evolving to enable ICBs to focus on their primary role as strategic commissioners. This transition will require the reconsideration of how ICB success is assessed. In future assessment will draw on process of ICB segmentation and capability described in the NHS Oversight Framework and reflect the evolution of ICB responsibilities as described in the strategic commissioning framework.
- A new ICB assessment model will be implemented in 2027/28 to consider ICB performance in 2026/27, the first financial year in which ICBs will receive segmentation under the NHS Oversight Framework and a capability rating.
2. Assessment approach and process
2.1 Scope and purpose
- NHS England has a legal duty (Section 14Z59 of the National Health Service Act 2006 as amended by the Health and Care Act 2022) to annually assess the performance of each ICB in respect of each financial year and publish a summary of each assessment. The assessment must consider how well the ICB has discharged its functions – both its powers (things that ICBs may do) and its duties (things ICBs must do) – during the year. It must include, but is not limited to, consideration of:
- the duty as to improvement in quality of services
- the duty as to reducing inequalities
- the duty to obtain appropriate advice
- the duty to have regard to the wider effect of decisions (the triple aim)
- the duty in respect of research
- the duty on public involvement and consultation
- the financial duties
- the duty to have regard to relevant strategic needs assessments, and local health and wellbeing and integrated care strategies.
- The outcome of the annual assessment will take the form of a letter sent from the relevant NHS England regional director to the ICB chair by the end of July 2026.
- For former ICBs that were abolished on 1 April 2026, and so will not be able to receive the assessment, the assessment will be issued to the chair of the successor ICB(s), to which relevant property, rights and liabilities have been transferred.
2.2 Assessment process
- The annual assessment process has been designed to be proportionate and minimise administrative impact on ICBs, reflecting the significant organisational changes and evolving responsibilities of ICBs. This approach balances statutory requirements with the need for flexibility and supports transition towards the future assessment model.
- The assessment process for 2025/26 will follow 5 sequential steps:
Table 1: Assessment process
| Step | Description |
|---|---|
| 1. Analyse and review data | NHS England will use the NHS Oversight Framework’s ICB contextual metrics data to understand each ICB’s relative performance against the high-priority objectives for 2025/26. This will ensure consistency in approach across ICBs. |
| 2. Assess performance and capability, using qualitative evidence and local insight | NHS England will assess each ICB’s performance and capability against a small number of targeted key lines of enquiry (KLOEs) that map to statutory duties (for example, improving quality, delivering financial balance and reducing inequalities). The assessment will draw primarily on existing evidence sources, such as ICB annual reports, to minimise burden and ensure consistency. This evidence will be used to prepare a narrative assessment of performance and capability. |
| 3. Review of formal intervention, support and partnership feedback | NHS England will summarise details of any formal interventions and support arrangements (for example, current legal undertakings or involvement in the Recovery Support Programme) that were in place at any point in the financial year and progress against any defined transition criteria or agreed key performance indicators. NHS England will also consult each relevant health and wellbeing board and, if deemed appropriate, seek feedback from health overview and scrutiny committees, the Integrated Care Partnership (ICP) or wider stakeholders – to give an opinion as to each ICB’s contribution to local priorities and partnership working. This will include seeking the health and wellbeing board’s view on any steps the ICB has taken to implement any relevant joint local health and wellbeing strategies. |
| 4. Agree and finalise the assessment conclusion | NHS England will discuss its assessment conclusions with each ICB and may offer the opportunity to supply further evidence and comment on factual accuracy before the conclusions are finalised. NHS England will communicate the outcome of its assessment in a letter to each ICB chair. This letter will set out the key messages and areas of strength or improvement. It is the authoritative output of the assessment. |
| 5. National report and publication | NHS England will summarise the individual regional reports and data in a single national summary report and publish this on its website. |
2.3 Approach and evidence sources
- The NHS Oversight Framework contextual metrics and system considerations provide the primary quantitative evidence base for the annual assessment. This ensures consistency in the assessment of system performance against measures set out in the NHS Oversight Framework. Qualitative evidence is used to contextualise the metric data, providing insight into areas such as leadership, capability and delivery that cannot be fully captured through data alone, and supporting a more rounded overall judgement to be reached.
- ICBs will not generally be expected to supply any additional information. NHS England will draw on existing evidence and intelligence including, but not limited to:
- the ICB’s annual report and accounts, which includes the ICB’s self-assessment of how it has performed its duties
- feedback from system partners including health and wellbeing boards and, where appropriate, health overview and scrutiny committees and ICPs.
- records of NHS England’s performance and development discussions with the ICB throughout the year
- delivery of 2025/26 operating plans
- progress towards agreed improvement goals
- where NHS England has used its legal powers of enforcement against an ICB as part of an improvement intervention within the year, the assessment will consider how far the ICB has met its undertakings or directions as part of the intervention
3. Key lines of enquiry
- The assessment will be against the high-level KLOEs set out in Table 2. The KLOEs support a consistent and structured approach to considering evidence, guiding how information is interpreted and ensuring that statutory duties, national objectives and local priorities are addressed in a balanced and proportionate way.
- The KLOEs directly map to specific ICB duties and are assessed using both NHS Oversight Framework contextual metrics and other existing evidence. They support professional judgement, draw out strengths, identify areas for improvement and ensure that the assessment is fair, transparent and proportionate.
- The KLOEs are grouped into 3 areas:
- ICB performance assessment
- ICB capability considerations
- support and interventions
Table 2: Key lines of enquiry (KLOE)
ICB performance assessment
| KLOE | Central ICB functions being assessed |
|---|---|
| How successfully has the ICB improved overall population health, taking account of its core functions and statutory duties? | – General function of an ICB – Duty/power to commission certain services – Duty as to improvement in quality of services – Duties as to reducing inequalities |
| How successfully has the ICB delivered the annual objectives set by NHS England in the 2025/26 priorities and operational planning guidance and its own operational plan? | – Duty to have regard to guidance published by NHS England – Duty to have regard to the wider effect of decisions (the triple aim) – Joint forward plans for ICBs and their partners – Joint capital resource use plans |
| How successfully has the ICB improved the effectiveness and safety of services in its area? | – Duty as to improvement in quality of services |
| How has the ICB improved the experience of care for its population? | – Duty as to improvement in quality of services |
| How successfully has the ICB reduced inequality in its area? | – Duties as to reducing inequalities – Public sector equality duty |
| How successfully has the ICB balanced its commissioning budget and its system budget? | – Financial duties of ICBs – Duty as to effectiveness, efficiency and economy – Duty to ensure financial sustainability and manage resources prudently – Joint financial objectives for ICBs and partners – Joint capital resource use plans – Financial directions by NHS England to ICBs for service integration – Financial directions by NHS England to ICBs about management or use of resources (including expenditure limits) |
| How successfully has the ICB improved its local social and economic fabric? | – Duty to have regard to relevant strategic needs assessments, and local health and wellbeing and integrated care strategies – Duty as to climate change – Duty to promote innovation – Duty in respect of research – Duty to have regard to the wider effect of decisions (the triple aim) |
ICB capability considerations
| KLOE | Central ICB functions being assessed |
|---|---|
| How effectively has the ICB commissioned services for its population, including those for which it has delegated responsibility? | Duty/power to commission certain servicesFunctions delegated to an ICB by NHS EnglandDuty as to effectiveness, efficiency, etc |
| How has the ICB ensured it is effective and well-run in delivering its operational responsibilities, with effective governance and decision-making arrangements, including a high performing board? | – Duty as to effectiveness, efficiency, etc – Duty to promote education and training – Duty to promote integration – Duties to co-operate between NHS bodies, and with local authorities – Duty as to public involvement and consultation – Duty to obtain appropriate advice – Duty to have regard to the wider effect of decisions (the triple aim) – Other general duties of an ICB under the NHS Act 2006 |
Support and interventions
| KLOE | Central ICB functions being assessed |
|---|---|
| Has any enforcement action been taken against the ICB and, if so, how far have any agreed expectations been met? | – Enforcement action is explained in NHS England’s enforcement guidance (for example, NHS England accepting undertakings or directing an ICB). |
| Has the ICB received any dedicated support interventions and, if so, is the ICB now delivering improvements? | – NHS England may provide support to NHS bodies and other providers of health or healthcare-related services. |
Publication reference: PRN02360