1. Introduction

1.1 Integrated care systems (ICSs) are partnerships of organisations that come together to plan and deliver joined up health and care services. The integrated care partnership (ICP) is the statutory committee jointly formed between the NHS integrated care board (ICB) and all upper-tier local authorities that fall within the area, with membership of other partner organisations determined locally. The partnership is responsible for producing an integrated care strategy on how to meet the health and wellbeing needs of the population. The four core purposes of an ICS are to:

• improve outcomes in population health and healthcare
• tackle inequalities in outcomes, experience and access
• enhance productivity and value for money
• help the NHS support broader social and economic development.

1.2 ICBs are statutory NHS organisations responsible for developing a joint forward plan in collaboration with NHS trusts/foundation trusts and other system partners for meeting the health needs of their population, managing the NHS budget and arranging for the provision of health services in their defined area.

1.3 The geographical area of an ICB and an ICS are the same, and therefore any application for ICB boundary changes or mergers requires engagement with local authority partners and others within the ICPs as it will also be a change to the relevant ICSs. Changes may need to be considered where local authority boundaries are proposed to change, meaning that the existing ICB and ICS boundaries would no longer be coterminous with the new local authority boundaries. Changes may be proposed by local authority partners to ICBs in relation to the operation of ICSs. However, the application for change to NHS England can only be made by ICBs as statutory NHS bodies, and this is the focus of the procedure. Boundary changes or mergers may be proposed where there is a strong case that a new footprint would enable the roles and objectives of the ICS and ICB to be more effectively achieved.

1.4 No application from ICBs can progress if it is not supported by those local authorities with adult social care responsibilities within the existing and proposed new ICB boundaries which are the ICB’s statutory partners within the ICP. Ideally, the proposed change should also be supported by other partners within the existing and proposed new ICPs, including other local authorities and NHS providers.

1.5 NHS England has the power to make boundary changes on its own initiative, or where directed by the Secretary of State for Health and Social Care. Reference is only to ICB changes (rather than both ICB and ICS) in this document for expediency.

1.6 A boundary change is a change to the geographical area of two or more ICBs, with the ICBs involved remaining in existence. It may be classified as ‘major’ (as a guide, greater than 10% of the ‘sending’ ICB’s population) or ‘minor’ (as a guide, less than 10% of the ‘sending’ ICB’s population).

1.7 A merger between ICBs could involve either:

• abolition of an ICB and transfer of its staff, property and liabilities to one or more ICB(s); or
• abolition of two or more ICBs, establishment of a new ICB and transfer of the staff, property and liabilities of the existing ICBs to the new one.

1.8 Another possible scenario is for an existing ICB to be abolished and split up to form two or more new ICBs. For expediency, this procedure does not cover this scenario in detail as the considerations applying to boundary changes and mergers for the optimal sizing of ICBs and ICSs are the same.

1.9 A total of 42 ICBs were established on 1 July 2022 under the National Health Service Act 2006, as amended by the Health and Care Act 2022. Hereafter in this document references to ‘the Act’ are to the 2006 Act, as amended.

1.10 The schedule to the Integrated Care Boards (Establishment) Order 2022 specifies the legal name and area of each ICB. The area of each ICB is described using local government areas and LSOAs (lower layer super output areas) which are small geographical areas with an average population of 1500 people, created by the Office for National Statistics. The Order has been published alongside a map of ICBs on the NHS England website.

1.11 Each ICB constitution also sets out the ICB’s geographical area and provides for the constitution (including its area) to be varied by the ICB with the approval of NHS England or by NHS England on its own initiative.

1.12 In the case of boundary changes or mergers involving an ICB being abolished and its staff, property and liabilities transferring to one or more ICB(s), revised constitutions would be needed for the relevant ICB(s). For any new ICBs established through merger or the split of an existing ICB, a new constitution would be required.

1.13 In all cases of boundary changes or mergers, NHS England has a legal duty under section 14Z25 (7) of the Act to consult with any ICB it considers likely to be affected by any proposed variation of the Establishment Order i.e changes to existing ICB boundaries or mergers.

1.14 NHS England is under a duty to ensure that the areas of ICBs together cover the whole of England and that the ICB areas do not coincide or overlap (section 14Z25 of the Act). NHS England may vary the Establishment Order, to reflect new ICB areas created through boundary changes and abolishing/merging ICBs. Any variation to the Establishment Order would also need to be reflected in the published map on the NHS England website.

2. Equalities statement

2.1 NHS England has a duty to have regard to the need to reduce health inequalities in access to health services and health outcomes achieved as enshrined in the Act.

2.2 NHS England is committed to ensuring equality of access and non-discrimination, irrespective of age, gender, disability (including learning disability), gender reassignment, marriage and civil partnership, pregnancy and maternity, race, religion or belief, sex (gender) or sexual orientation.

2.3 In carrying out its functions, NHS England will have due regard to the different needs of protected equality groups, in line with the Equality Act 2010. This document is compliant with the NHS Constitution and the Human Rights Act 1998. This applies to all activities for which they are responsible, including policy development, review and implementation.

3. Considering and applying for boundary changes and mergers

Timeline and pre-application activity

3.1 The timeline of key dates to engage on, apply for and implement changes is shown in Figure 1. Changes will take effect from the start of the financial year (1 April). NHS England will consider applications from integrated care boards (ICBs) for changes to ICB boundaries and mergers submitted by 30 June in any financial year for proposed changes to take effect on 1 April of the following year. Only in exceptional circumstances (for example for minor boundary changes (as a guide, those involving less than 10% of the ‘sending’ ICB’s population)) will later applications be considered and/or in-year changes be made. Such circumstances are to be avoided to minimise the impact e.g on finance teams.

3.2 ICBs considering any change to their boundaries, particularly major changes or mergers, should discuss their proposal with the relevant NHS England regional team(s) at an early stage and well in advance of submission of a formal application. In addition, local government partners should be engaged at an early stage in discussions on the benefits and the impacts of any proposed changes.

3.3 The relevant NHS England regional team should immediately advise the NHS England national system transformation team of any proposed boundary changes or mergers.

3.4 For major boundary changes (as a guide, those involving more than 10% of the ‘sending’ ICB’s population) and mergers of ICBs, an outline proposal, prepared jointly by the ICBs, should be submitted in writing to the relevant NHS England regional team by 15 March. ICBs should discuss with their regional team whether a proposed boundary change should be deemed to be major well in advance of the 15 March deadline. If a proposed boundary change is deemed to be minor, a written outline proposal is not needed in advance of the formal application being submitted.

3.5 For major boundary changes or mergers, the joint outline application from the relevant ICBs should include:

• a summary of why the change is being requested and what the expected benefits will be
• a summary description of the affected geography (identifying the number of affected lower super output areas (LSOAs) and GP practices)
• confirmation of support in principle from the boards of the ICBs
• a summary of engagement to date and confirmation of support in principle from the relevant local authorities i.e those with adult social care responsibilities within the existing and proposed new ICB boundaries which are the ICB’s statutory partners within the integrated care partnership (ICP)
• an outline plan for future engagement with system partners and stakeholders.

3.6 Following review by the region and the national system transformation team, the NHS England regional team will advise the ICBs by 31 March whether there is support in principle and whether they can proceed with a formal application to be submitted by 30 June. Following regional consideration, a final decision (subject to any major changes in circumstances) on the application will be taken nationally by NHS England by 30 September to enable the appropriate technical and organisational preparations to be made for the change to take effect on 1 April.

3.7 By 31 March, the national System Transformation team will ensure that other national teams (notably the Finance team, Digital team and Emergency Preparedness, Resilience and Response team) and relevant third-party suppliers are aware of any potential major boundary changes or mergers and are able to plan to change their arrangements and systems, subject to approval of the change by NHS England.

Timeline

1. Initial engagement with local government partners on any proposed change. For major changes/mergers, ICBs’ outline proposal submitted to regional team by 15 March at the latest; regional team to liaise with national System Transformation team prior to 31 March.
2. For major changes/mergers, regional and national review and agreement to proceed (with formal joint application) by 31 March; system transformation team to notify Department of Health and Social Care (ministerial briefing).
3. For all boundary changes/mergers, formal joint application submitted to regional team by ICBs – 30 June
4. Regional review by 31 August
5. NHS England Strategy Planning and Investment Committee review and decision by 30 September.
6. Technical and organisational preparation for change – 1 October to 31 March
7. Implementation of boundary change/merger on 1 April.

3.8 The System Transformation team will also inform the Department of Health and Social Care of any proposal for a minor boundary change or a major change or merger which NHS England has agreed may proceed to the formal application stage. Feedback from the Department of Health and Social Care will be communicated by the system transformation team as appropriate to the regions for them to pass on to the ICBs applying for the change.

3.9 The process of engaging on, applying for and implementing a change should not unduly distract the existing ICBs from business as usual, including delivering core performance standards.

Requirements for formal applications for boundary changes and mergers  

3.10 Different levels of information, proportionate to the scale and complexity of the proposed change, will be needed. ICBs are advised to contact their regional NHS England team(s) to confirm the exact expectations in each case, and to provide supporting/additional evidence to demonstrate their case of need. Elements of the checklist for mergers at Annex 1 may also be applicable to major boundary changes. Regional teams will support ICBs with local engagement/resolution of any issues identified in the engagement process as the formal application is developed.

3.11 A formal application for a boundary change or merger should be made jointly between the relevant ICBs. An application for an existing ICB to be split up into two or more ICBs together covering the existing ICB’s area would be made by that ICB.

3.12 Prior to submitting an application to NHS England, the ICBs should ensure that the application is made in accordance with their own governance arrangements.

3.13 The joint application should be signed off by the chief executives of the applicant ICBs and cover the following:

1. The reasons why the change is being requested; these must be set against the four core purposes of integrated care systems (ICSs), with particular emphasis on the expected benefits in improving population health outcomes and reducing health inequalities. The application should also set out the expected impacts on:
   • coterminosity with local authority boundaries (there is a strong presumption in favour of this but in exceptional and justified circumstances, it may not apply)
   • patient flows and NHS commissioner/provider relationships
   • partner member nominations to ICB boards and the membership of ICPs
   • staff
   • quality
   • place-based partnerships, provider collaboratives and clinical networks
   • commissioning functions (including delegation status)
   • financial allocations between the ICBs and running costs. The proposed changes to financial allocations should be agreed between the ICBs and the relevant NHS England regional finance team(s)
   • emergency preparedness, resilience and response arrangements including alignment with the footprints of local resilience forums.
2. A list of the impacted lower super output areas (LSOA) codes, and for any proposed GP practice moves, the relevant Organisation Data Service (ODS) (digital) codes. In addition, applications should include a map of the proposed change to LSOAs so that NHS England can assure itself that the proposed change will not result in any gaps or overlap in geographical coverage of England by ICBs.
3. Evidence of meaningful engagement with all relevant partners and stakeholders, including assurance that (where applicable) the ICBs have acted in accordance with their public involvement duty (under section 14Z45 of the Act and other relevant legal duties). Annex 2 contains detailed guidance about meaningful engagement, i.e actively seeking, listening to and responding to partners’ and stakeholders’ views,  concerns and alternative proposals. The ICBs should provide information on engagement with all relevant partners and stakeholders about the proposed change and demonstrate that such engagement was proportionate to the nature of the change being proposed. The application should describe the engagement that has taken place, who was involved, a rationale for the approach taken, what the feedback has been and any mitigations to any objections raised. As a minimum, engagement should take place with the impacted local authorities and other partner organisations within the relevant ICBs, the relevant ICPs, plus local MPs and local Healthwatch. Further advice on engagement for ICBs is available from regional teams or nationally from the system transformation team, together with support to develop the formal application. 
4. Confirmation of the approval of the proposed change by the boards of the ICBs, and support from the relevant local authorities and the ICPs, given that any proposed change to ICB boundaries is also one to ICS boundaries. No application from ICBs can progress if it is not supported by all relevant local authorities i.e as a minimum, those with adult social care responsibilities within the existing and proposed new ICB boundaries which are the ICB’s statutory partners within the ICP.
5. Details of any significant risks or issues e.g quality concerns or major financial deficits and how the proposed boundary change or merger may affect them or be affected by them.
6. A transition plan showing how, if their application is approved by NHS England, the existing ICBs intend to manage and resource the change process, including where appropriate proposed consultation with staff and further engagement with stakeholders, and any proposed arrangements for due diligence and the transfer of staff, assets, liabilities, rights and responsibilities. See section 5 for further details.

Equality and health inequalities and integration

3.14 For changes of any scale, ICBs should be mindful that the Act identifies a range of ICB obligations in relation to health inequalities, including duties to:

• Have due regard to the need to reduce inequalities between persons in access to health services, (section 14Z35) and the outcomes achieved. The outcomes achieved include patient experience (section 14Z34 and section 14Z35).
• Exercise functions with a view to securing continuous improvement in the quality of services provided to individuals or in connection with the prevention, diagnosis or treatment of illness; outcomes including safety and patient experience, including in respect of outcomes related to health inequalities (section 14Z34).
• Have a view to ensuring that health services are provided in an integrated way with health-related and social care services, where it considers that this would reduce inequalities in access to those services or reduce inequalities in the outcomes achieved and improve quality (section 14Z42).
• Have regard to wider effects of decisions in relation to the health and wellbeing of people and the quality of services provided to individuals including in relation to inequalities (section 14Z43). This is also known as the ‘triple aim’.
• Include, in a joint forward plan, an explanation of how they propose to discharge their duty to have regard to the need to reduce inequalities (section 14Z52).
• Include, in an annual report, an assessment of how effectively they discharged their duty to have regard to the need to reduce inequalities (section 14Z48) including in relation to information about inequalities integration (section 14Z42). These obligations underpin the discharge of functions in each ICB and should be considered when considering changes to the ICB boundaries.

3.15 ICBs are subject to section 149 of the Equality Act 2010 (the Public Sector Equality Duty) and other specific equality duties set out in the Act, as well as the wider provisions in the Equality Act 2010. ICBs should be mindful of the technical guidance on the Public Sector Equality Duty and the relevant statutory codes of practice, published by the Equality and Human Rights Commission, which can be found on their website, when considering the impact of any proposed changes to their boundaries.

Additional requirements for integrated care board merger applications

3.16 A merger between ICBs could involve either: (i) abolition of an ICB and transfer of its staff, property and liabilities to another ICB; or (ii) abolition of two or more ICBs, establishment of a new ICB and transfer of the staff, property and liabilities of the old ICBs to the new one.

3.17 In addition to all the application requirements outlined earlier, the joint application from ICBs proposing either type of merger outlined in paragraph 3.16, should also include the following:

1. Evidence of how the existing ICBs have already collaborated and any benefits of collaboration to date e.g improved quality, or cost savings.
2. Where appropriate, an outline proposal for the new constitution for the proposed new ICB (see policy and model constitution which can be found on the NHS England website), and evidence of engagement of each of the existing boards of the impacted ICBs in shaping this outline proposal.
3. Within the transition plan, proposals for recruitment to the new ICB board.
4. Additional documentation and plans to show how the new ICB is expected to operate.

3.18 Further details are set out in the checklist at Annex 1.

4. NHS England’s consideration of applications

4.1 The formal joint application for boundary changes or mergers must be submitted by 30 June to the relevant regional director(s). NHS England regional teams will acknowledge the application within two weeks of receipt. Integrated care boards (ICBs) will be notified in writing of the NHS England decision on any proposed boundary change/merger by the relevant regional director as soon as possible and at the latest by 30 September. Regional teams will keep the ICBs appraised of developments in the consideration of their application(s). ICBs are expected to continue to liaise with their partners to keep them updated as appropriate.

4.2 Outline proposals will initially be shared by the regional team with the national system transformation team. Formal joint applications will be shared with the Director of System Transformation and considered by the relevant regional support group (chaired by a regional director).

4.3 For any proposed major boundary changes or mergers, regional teams may invite ICBs to present their application and supporting evidence for scrutiny by a regional panel. This is an opportunity for ‘check and challenge’ of written information submitted.

4.4  NHS England will consider formal joint applications against the factors outlined earlier. NHS England may ask for clarification or additional information at any stage and/or consider any other relevant material, not just the application.

4.5 NHS England must ensure that the proposed boundary change is in accordance with the requirements of section 14Z25 of the Act in that it does not coincide or overlap with the area of any other ICB, and that the areas of ICBs together cover the whole of England. NHS England will consider the likely impact on any local authority whose area covers the whole or any part of the ICBs area and the likely impact on any other ICB which could be affected by the proposed change. NHS England will consult any such ICB that it considers likely to be affected.

4.6 Should the application be supported, the Regional Director and Director of System Transformation will make a recommendation to the NHS England Strategy, Planning and Investment Committee (chaired by the Chief Financial Officer) to approve the change to the Establishment Order, formally recognising the boundary change or merger, on behalf of NHS England. All decisions on varying the Establishment Order in respect of ICB boundary changes and mergers will be reported to the NHS England Board.

5. Implementing an approved boundary change or merger

Support and guidance

5.1 Following approval of the proposed boundary change or merger, NHS England will continue to provide integrated care boards (ICBs) with support and guidance throughout the preparation phase to develop their plans for the new organisation(s), place-based partnerships, provider collaboratives and integrated care partnership (ICPs) and to effect the necessary changes by the target date. This includes providing specialist support, for example on human resources and due diligence matters and how ICBs work with third party suppliers, for example on finance changes. Further details on the technical financial and digital and data changes required can be found in Annex 3. NHS England and ICBs need to work closely to jointly deliver the necessary changes and provide each other with assurance of progress of actions. In addition, ICBs may obtain their own independent advice, e.g legal advice, where needed.

Governance

5.2 The ICBs must apply to NHS England to make the necessary changes to their constitutions or approve a new constitution to come into effect on 1 April (unless there are exceptional circumstances which change the timing of the go live date). ICBs must follow the published procedure when applying to amend their constitution, which can be found on the NHS England website. Where a new constitution is required, this should be based on the NHS England ICB model constitution, which can be found on the NHS England website. A table showing the actions needed for each type of boundary change or merger can be found in Annex 4.

5.3 The revised or new constitution(s) will need to be submitted to the NHS England regional team for the Regional Director’s approval. Once approved, these documents, plus any revised or new supplementary governance documents within the ICBs’ governance handbook should be published on the relevant ICB websites on 1 April when the changes come into effect.

5.4 The amended Establishment Order, reflecting the revised boundaries of the relevant ICBs and/or the merger will be shared back with the applying ICBs to confirm the approved changes are accurately reflected, before being published on the NHS England website. The map of ICBs on the NHS England website will be updated to reflect the new geography on 1 April (unless there are exceptional circumstances which change the timing of the go live date).

5.5 The ICBs will need to work with their system partners to ensure that the approved boundary changes are reflected in the membership of the relevant integrated care partnerships (ICPs) or where a new ICB has been legally established, that a new ICP is also appropriately established. In accordance with the Act, the ICB and all local authorities within the area of the ICB must form the membership of the ICP. In addition, ICBs will need to work with their local resilience forums to ensure that there is a seamless transfer to any new working arrangements in respect of emergency preparedness, resilience and response.

5.6 Any boundary change or merger that impacts on the services delegated to ICBs under the delegation agreement with NHS England, will need to be managed in accordance with clauses 25 (variation) and 26 (termination) of the delegation agreement. ICBs should contact their regional team in the first instance regarding what changes to their delegation agreement may be needed. For national policy support and coordination, regional teams should contact the national Commissioning Policy Unit directcommissioning@nhs.net. Any changes to existing delegation agreements will need to be signed by the ICB chief executive and relevant NHS England regional director.

Transfer of staff, assets, liabilities, rights and responsibilities

5.7 Under section 14Z28 of the Act, NHS England may make transfer schemes in connection with the variation of the constitution of an ICB, or the abolition of an ICB. Any such transfer scheme would cover the transfer of staff and property, liabilities, rights and responsibilities from one ICB to one or more other ICBs or, in exceptional circumstances, from an ICB to NHS England. Property includes data and the rights to use and hold data, and all contracts and rights to claim under contracts. Similarly, liabilities include claims and obligations arising under contracts.

5.8 In the case of merger, involving the abolition of one or more ICBs and them coming together to form a new ICB, or merging into an existing ICB, with a boundary entirely aligned to the combination of both their existing outer boundaries, a transfer scheme will always be required. The transfer scheme would generally be expected to provide for the transfer of all staff, property and liabilities of the ICB(s) being abolished into the new ICB, or the ICB that the ICB(s) being abolished are merging to. Where that is the case there would be no need for lists of staff and property transferring in the transfer scheme.

5.9 Whether a transfer scheme is required for a boundary change will depend on the extent of the change, and considerations about the impact on staff (for example, will any staff be required to change ICB employer?) and assets, liabilities, rights and responsibilities (for example, will the ICB estate have to be differently apportioned, or will there be any impact on contracts?). It may not be required in the case of a minor boundary change. Where a transfer scheme is required for more substantial boundary changes, it will need to be made with associated schedules listing the staff and property to transfer from one ICB to another. Staff will always need to be listed individually; a proportionate approach should be taken to the listing of property. In the scenario where an existing ICB is to be abolished and its geographical area is to be split between two other ICBs, its staff and property and liabilities will need to be apportioned accordingly. Any ICBs proposing to be split should discuss with their regional team in the first instance how the transfer scheme would provide for this.

5.10  As part of their due diligence, and in preparation for transfers where staff need to be listed individually, the existing ICBs must be able to confirm in writing that they have properly prepared a comprehensive list of information regarding their staff who are proposed to transfer. A template is available from the national system transformation team to ensure that the list includes all staff of the existing ICBs who are proposed to transfer, including those on long-term sick leave, maternity/adoption leave or career breaks, and those on secondment, or suspended, plus staff who are working for a contracted-out service that will be transferred under the scheme. Note: anyone who holds an external contract as an independent contractor should not be listed as staff transferring – but the contract should be listed under the property schedule. ICB people/human resources teams will need to ensure that there is appropriate consultation with staff and trade unions about the transfer in accordance with transfer of undertaking (TUPE)/Cabinet Office statement of practice (CoSOP) processes. Any schedules to the transfer scheme should be signed by the chief executives of the ICBs concerned (sender and recipient(s)).

5.11 The existing ICBs should undertake a thorough due diligence exercise for the transfer of any property, liabilities, rights and responsibilities (using a template and guidance available from the national system transformation team) in advance of the proposed boundary change or merger to understand and plan for the transfer, including checks of contracts and service level agreement documentation.

5.12 Use of transfer schemes negates the requirement for contracts (including contracts of employment) to be novated. However, existing ICBs should consider the suitability of their existing contracts to meet the requirements of the new ICB following the merger and may decide to make adjustments. They should engage with their contractors/service delivery partners to explain that contracts will continue with the new organisation, unless otherwise planned for and advised. The existing ICBs should consider whether any contracts/agreements will expire at or prior to the point of transfer, and whether these should be renewed or re-procured in advance. Contractors will need to be notified of changes associated with a merger such as points of contact and invoicing arrangements.

5.13 The transfer scheme would be signed by the NHS England Chief Executive, at the point at which the amended Establishment Order is amended and signed and will come into effect at the same time.

Formal notification of boundary changes and mergers

5.14 A formal letter confirming the ICB merger or boundary change (to take effect on 1 April) would be issued by the NHS Chief Executive to the relevant ICB chief executives, copying in the appropriate regional director(s). This will note the variation to the Establishment Order and the transfer scheme(s) approved and signed by the NHS Chief Executive and the revisions to the relevant ICB constitution(s) approved by the Regional Director.

5.15 The national System Transformation team will ensure that the relevant regional teams receive a copy of the Chief Executive’s letter and that national, regional and ICB communications teams are prepared and have taken appropriate action. This will include briefing the Department of Health and Social Care.

Annex 1 – Checklist for merger applications

NHS England may also request additional information for merger applications, so this checklist should be treated as an indicative list only. It is also recognised that similar documents may have different titles/descriptions, so there is flexibility around this. In addition, there is flexibility for integrated care boards (ICBs) to submit additional information in support of their application, but this should be kept to a minimum – and only included where it adds significant value to the case for merger. Aspects of the checklist may be applied for major boundary change applications also.

The joint application should be clear and concise and cover the following:

1. Summary case for change document – to include:

• A declaration, signed by the existing ICB chief executives, that the decision to apply for merger is made jointly and in accordance with each of the existing ICBs’ governance arrangements.
• Summary of joint working to date, including any collaborative commissioning arrangements.
• If applicable, the proposed new ICB name i.e NHS [geographical descriptor] Integrated Care Board, the name of the new integrated care system (ICS) and the integrated care partnership (ICP), all reflecting the new geography.
• Map(s) and population details; reference to current health outcomes and health inequalities for each ICB.
• Reference to the Public sector equality duty (PSED) impact assessment for changes proposed.
• The reasons for the application with an outline description of the benefits of merger in relation to the four core purposes of ICSs, particularly in improving services and population health outcomes, and reducing health inequalities. Benefits should be measurable, with baseline figures provided to enable evaluation post-merger.
• The expected impacts on:
  • coterminosity with local authority boundaries (there is a strong presumption in favour of this but in exceptional and justified circumstances, it may not apply)
  • patient flows and NHS commissioner/provider relationships
  • partner member nominations to ICB boards and the membership of ICPs
  • staff
  • quality
  • place-based partnerships, provider collaboratives and clinical networks
  • commissioning functions (including delegation status)
  • financial allocations between the ICBs and running costs. The proposed changes to financial allocations should be agreed between the ICBs and the relevant NHS England regional finance team(s)
  • Emergency preparedness, resilience and response arrangements, including alignment with the footprints of local resilience forums.
• Confirmation of approval of the proposal to merge from each of the boards of the existing ICBs.
• Confirmation of support of the proposal to merge from each of the statutory local authorities with adult social care responsibilities in the existing integrated care partnerships (ICPs) (as shown in a letter/minutes of a meeting).
• Summary of communications and engagement undertaken in relation to the proposal, including assurance that the ICBs have complied with their public involvement duty (section 14Z45 of the Act) and other relevant legal duties (where applicable). There should be evidence that there has been engagement with (as a minimum) the impacted local authorities and other partner organisations within the relevant ICBs, the relevant ICPs, plus local MPs and local Healthwatch and that the ICBs have considered this feedback and any from other key stakeholders, including patients and the public and ICB staff. There should be an assessment of overall stakeholder support for the proposal and where any objections have been raised, how these have been considered, any mitigations that have been/will be put in place, and the feedback from the ICBs to stakeholders.
• The financial position of the ICBs (current and high-level forecast) and any expected cost savings.
• Confirmation of any proposed allocation transfers between ICBs, also agreed with the relevant NHS England regional finance team. These would include any pooled budgets with local authority partners e.g Better Care Fund.
• The performance of the existing ICBs as assessed through the NHS Oversight Framework.
• Details of any significant risks or issues and how the proposed merger may affect them or be affected by them.
• The current status of delegation of commissioning of specialised services and primary care services in each of the existing ICBs and the proposal to apply to NHS England for revisions to the existing agreement, or a new delegation agreement in the event that the merger application is successful.

2. Outline plans for the ICS and ICB

    For the ICS:

• Proposed membership and terms of reference of the new ICP.
• Outline integrated care strategy (with reference to the existing integrated care strategies) indicating how it is planned to improve population health outcomes and reduce health inequalities.

   For the ICB:

• A first draft of the new constitution, including the new ICB name, draft standing orders and the proposed composition of the new ICB board. The ICB model constitution can be found on the NHS England website.
• Proposed operating model – to provide clarity regarding form and function – including the outline organisational structure and how governance is proposed to work between the different levels: neighbourhood/primary care network (PCN)/place/system).
• Outline joint forward plan (linked to the integrated care strategy and with reference to existing joint forward plans).
• Outline financial strategy/plan – linked to the overall strategy/plan and showing how it is proposed funding will be allocated.
• Outline human resources/organisational development strategy/plan.
• Outline quality strategy/plan.
• Outline plan for use of commissioning support unit.
• Outline communications and engagement strategy/plan.

It is expected that all the above documents will be further developed as the merger preparations progress, and this will be taken into account at the point of assessment. They are needed at the point of application submission to show the thinking about how the new ICB is proposed to be set up, and to support the new ICB to operate as effectively as possible from the point of its establishment (pending approval by NHS England).

2. High level merger transition programme plan – to include:

• Resources (financial and staff) (to be) committed by the existing ICBs to the merger.
• Governance and reporting arrangements for the merger project – senior responsible officer, project management office, merger oversight group; external reporting to NHS England.
• Key workstreams: human resources and organisational development (including recruitment to ICB Board and other key roles), governance for the new organisation (including plan for production of a new constitution and standing financial instructions, finance, informatics, information governance, communications and engagement, estates and property (asset management).
• Key milestones.
• Key dependencies.
• Risks and issues.

Annex 2 – Engagement guidance

Introduction

The geographical area of an integrated care board (ICB) and an integrated care system (ICS) are the same, and therefore any application for ICB boundary changes or mergers requires engagement with, and support from, local authority partners and others within the integrated care partnerships (ICPs) as it will also be a change to the relevant ICSs.

This annex aims to provide practical advice for ICBs considering changing their boundaries or merging on their engagement with local authority partners with whom they have shared statutory duties, plus patients and the public, MPs, and other partners and stakeholders.

Legal position

The annex does not constitute legal advice, nor is it intended to place additional legal obligations on organisations or mandate that organisations may only discharge their legal duties in a particular way. It is not possible to provide blanket guidance in this regard, as every ICB boundary change or merger and local context within which the ICB is operating is different. Local circumstances and expectations around engagement with patients and the public, local authorities, and other key partners and stakeholders are important. ICBs may wish to seek legal advice to support their decision-making.

NHS England has issued statutory guidance to ICBs: Working in Partnership with People and Communities which can be found on the NHS England website. This includes guidance on ICBs’ public involvement duty under section 14Z45 of the National Health Service Act 2006, which requires ICBs to make arrangements to ensure that people are appropriately ‘involved’ in planning, proposals and decisions regarding NHS services. This also includes guidance on other relevant legal duties and principles relevant to engaging patients, the public and stakeholders, including the triple aim duty, health inequalities duty and public sector equality duty.

In all cases, ICBs should be able to demonstrate that they have complied with their public involvement duty and other relevant legal duties and principles. ICBs should refer to ‘Working in partnership with people and communities’ for detailed guidance on these duties, how to assess if they apply, and how to comply.

An ICB boundary change or merger requires a variation to the Establishment Order, the published map and the constitutions of impacted ICBs (or adoption of a new constitution for a newly formed ICB, depending on the approach taken). The ICBs’ public involvement duty under section 14Z45 of the National Health Service Act 2006 does not directly apply to such activities. This is because the public involvement duty only applies in relation to the ICBs’ ‘commissioning arrangements’ i.e any health services which are, or are to be, provided pursuant to arrangements made by an ICB in the exercise of its functions. The ICBs also do not have a separate specific statutory duty to undertake consultation in these circumstances but should take into account and apply (as appropriate) the procedure for varying the constitution and arrangements and principles for public involvement set out within their constitutions.

Where ICB boundary changes or mergers directly involve a change to services, it is essential that the ICB is satisfied and able to demonstrate that it has appropriate arrangements in place to involve the public in the planning of those services and consideration of proposals for changes and decisions that have an impact on the manner in which services are provided and the range of services available.

Where ICB boundary changes or mergers do not directly involve a change to services, there may be no legal requirement to make arrangements to involve the public; however ICBs may wish to consider whether involvement would be beneficial especially if it is anticipated that there will be changes to services in future as a result of plan and policy harmonisation further down the line. Early dialogue will pay dividends later and ensure that any future requirements for public involvement are identified at the earliest opportunity.

In addition to meeting legal obligations, ICBs should consider how best to build local relationships and support for the case for change.

Working with local government partners

No application from ICBs can progress if it is not supported by those local authorities with adult social care responsibilities within the existing and proposed new ICB boundaries which are the ICB’s statutory partners within the ICP.

Local government leadership is built into the structure of ICSs in several ways. The powers and duties are with local authorities with adult social care responsibilities, (they are not held by district councils). ICBs are legally required to have local government representation on their boards. Each ICS includes an integrated care partnership (ICP) that is jointly convened by ICBs and the local authority/authorities wholly or partially in the ICS footprint. In addition, local government partners are involved in locally determined place-based partnerships and programmes of work overseen by the ICB and ICP, as well as having statutory powers and duties with regard to health and wellbeing boards and health overview and scrutiny committees.

There will therefore be formal and informal channels available for engaging with local government partners on proposals for ICB boundary changes and it is essential that the ICB considers the range of these and involves local government partners in thinking at the earliest opportunity.

Engagement with local government should take account of local context and history in relation to coterminosity and boundary changes as these have the potential to be sensitive issues.

In planning engagement with local government, it is important to consider executive officers and elected members, and how any proposals will be formally shared with health overview and scrutiny committees. The structure of local government varies from area to area and ICBs will need to engage with both tiers of local government in areas where this is relevant (for example, where there is a county council and district council structure.)

Engagement with local government partners on proposed boundary changes should include seeking their views on the most appropriate ways to engage local residents. Most local authorities coordinate ward level/neighbourhood forums that can provide helpful opportunities for involving residents.

Other elected representatives such as directly elected mayors and MPs should also be engaged in proposals for ICB boundary changes. 

For the avoidance of doubt, while this guidance refers to engagement with local authorities via a variety of channels, including health overview and scrutiny committees, the consultation process set out under Regulation 23 of the Local Authority (Public Health, Health and Wellbeing Boards and Health Scrutiny) Regulations 2013 does not apply. This is because a boundary change is not a substantial development or variation in the provision of the health service.

Principles for wider engagement

1. Engage early with stakeholders to ‘bring people on the journey’ – building understanding and consensus. Ensure that all have a reasonable period of time to convey their views on the proposed change.
2. Ensure transparency and ongoing dialogue – this will help to build relationships and trust, as well as protecting the reputation of each of the ICBs involved.
3. Be clear about the rationale for the proposed boundary change or merger, and provide opportunities for people to have their say, ask questions and raise concerns.
4. Feedback to stakeholders about how their views have been considered, and if objections have been raised, how these may be mitigated.

Key considerations and actions

1. As a minimum, engagement should take place with the impacted local authorities and other partner organisations within the relevant ICBs, the relevant ICPs, plus local MPs and local Healthwatch. Other stakeholders include health overview and scrutiny committee(s) (which have specific statutory powers and duties to scrutinise health decisions), established patient groups including representatives of people with lived experience, relevant voluntary and community organisations, the local health and wellbeing board(s), the police and crime commissioner and combined authorities.
2. Prepare an engagement plan for the proposed boundary change or merger, and document engagement activities, including views shared by stakeholders, how these have been/will be taken on board, and provision of feedback.
3. Publish information about the proposed boundary change or merger on each of the impacted ICBs’ websites, along with open opportunities for discussion, and be open about when and where decisions will be made, for example at ICB Board meetings, so that people can attend and can see how views have been considered. Consider how to keep stakeholders, including members of the public, up to date on progress.
4. As part of completing an equality impact assessment, and ensuring compliance with the public sector equality duty, consider which ‘protected characteristic’ or ‘seldom heard’ groups are likely to be affected by, or particularly concerned about, the proposed boundary change or merger – and reach out to them.
5. Consider how the public can be kept abreast of connections between the proposed boundary change or merger and broader developments, notably integrated care strategies and joint forward plans. Could engagement activities provide opportunities for people to understand and comment on both the boundary change or merger and broader strategies or plans?
6. Non-executive ICB Board members have an important role in acting as a voice for local people, and will have valuable insight to share, but may also be personally affected by the proposed boundary change or merger. Take time to listen, consider and respond to their views and concerns.
7. Involve existing forums for working with people and communities, including those hosted by the ICB and local authorities, as well as other relevant groups that are active in the area. Seek views from providers about any potential impact on their patients/service users. Ensure the breadth of engagement reflects the scope of membership of the integrated care partnership for the system.
8. Plan how local people will be involved going forward, for example as members of decision-making committees in a new ICB formed by merger – or otherwise how a boundary change may affect existing arrangements for public participation. 

Further information and queries

For further advice contact the NHS England System Transformation Partnerships team england.systempartnerships@nhs.net or public participation team  england.engagement@nhs.net 

Annex 3 – Technical changes to implement approved boundary changes/mergers

Financial changes – integrated care board (ICB) boundary changes and mergers

1. ICB financial allocations are calculated primarily on lists of patients registered with GPs. Before 30 September, any proposed allocation transfers between ICBs which would result from a boundary change or merger should be confirmed to the central NHS England Finance team by regional NHS England finance teams.

Financial changes – integrated care board (ICB) mergers/splits resulting in the creation of a new ICB

2. The existing ICBs are required to submit to NHS Shared Business Services (SBS) a change request detailing the requirement to create a ledger for a new ICB at least six months before a merger, i.e by 30 September. Note: there are costs to the existing ICBs which need to be built into the business case, and these costs will be notified by the central NHS England Finance team to the region once agreed with NHS SBS. 

3. Following approval of a merger, the central NHS England Finance team will arrange for letters to be sent from the NHS England Chief Financial Officer to Government Banking Services at the Royal Bank of Scotland (RBS), HM Revenue and Customs and to IBM to detail the merger and request support to facilitate the merger process. The existing ICBs should agree between themselves which of their existing bank accounts is to be changed to the new ICB name from the date of its proposed establishment, and each one will need to write to RBS accordingly.

4. There will also need to be provision for both/all the existing ICBs’ financial arrangements to be closed down and they will need to request that closing accounts are drawn up. Chapter 20 of the SharePoint NHS England financial library provides detailed technical guidance on this and other financial considerations.

Digital, data, informatics and information governance – integrated care board (ICB) boundary changes

5. Boundary changes relate to the movement of Office for National Statistics (ONS) lower layer super output areas (LSOAs) from one ICB to another following approval by the NHS England Strategy, Planning and Investment (SPI) Committee. These changes will need to be reflected in the NHS postcode directory. If there are GP practice migrations with the boundary change, these should be implemented at the start of a financial year i.e in April. Note: there is a related but separate process and timescales for GP practice migrations (see paragraph 12).

6. Where the boundary changes are within one NHS England region, the NHS England regional team is the one that will be responsible for the key activities. If a boundary change traverses more than one NHS England region, the regional teams will agree between themselves who will be responsible for the key activities. The key activities for the change in the boundary between ICBs are as follows:

7. The responsible team should complete an Organisation Data Service (ODS) ICB boundary change form and submit it to ODS via helpdesk@nhs.net, including a copy of the formal approval of the change. The responsible team should also copy NHS England Data Services nationaldataplatform@england.nhs.uk in on their initial notification to ODS, so that reference tables and reporting can be updated.

8. If there are more than two ICBs involved in the boundary change, separate ODS ICB boundary change forms must be submitted for each pair of ICBs involved in the boundary change.

9. Upon submission, the responsible team must confirm the following in the ODS ICB boundary change form:

• a copy of the approval for the change – either an extract of the SPI Committee minutes confirming the change, or the formal notification of the change to the ICB chief executives
• the names and ODS codes of the two ICBs involved in the boundary change
• the ONS Lower Layer super output areas (LSOAs) codes and names of those that are moving from the sending ICB to the receiving ICB. If required, ODS can provide LSOA codes and names within the current ICBs
• if moves are one-way (LSOAs are moving from just one of the ICBs to the other) or two-way (LSOAs moving between the pair of ICBs)
• the current and new sub ICB location codes for the LSOAs that are moving
• if there are any GP practice migrations accompanying the boundary change
• if there are any pharmacy, ophthalmology or dentistry changes accompanying the boundary change.

10. The ODS will notify the Office for National Statistics (ONS) of the boundary change, confirming the boundaries of the new ICB for ONS to re-mapping these on the NHS postcode directory.

• ODS will publish the updated NHS postcode directory
• ODS will update any geographic relationships in organisation reference data (ORD) affected by the boundary change
• ODS will publish the updated ORD.

11. The ODS reconfiguration team will then communicate the changes made to:

• the ODS technical and business analysis work areas
• the relevant operational contact in an ICB for ODS (OC1)
• all ODS newsletter subscribers
• the ODS distribution list for customers and service providers.

12. GP practice migration: A boundary change may be accompanied by the movement of GP practices. Changes to GP practices will be reflected in ORD published by ODS, based on data managed by the NHS Business Services Authority (NHS BSA). GP practice changes should be implemented on 1 April to coincide with the implementation of the ICB boundary change. Minor boundary changes will be reflected in the NHS postcode directory issued in May and for major changes, ONS will be requested to issue a revised directory on 1 April.

13. The responsible team should complete the ODS GP practice migration form. This will include:

• a copy of the formal approval for the change
• the names and ODS codes of the GP practices that are moving
• the current and new ICB codes and names for these GP practices
• the current and new sub ICB location codes for these GP practices
• if there are primary care network (PCN) changes to follow
• if moves are one-way (GP practices are moving from just one of the ICBs to the other) or two-way (GP practices moving between the pair of ICBs).

14. The ODS team will inform NHS BSA of the GP practice migrations. BSA will verify and confirm these changes using their own processes.

15. The responsible team should also request that the authorised signatories in the ICBs (at the sub ICB location level) submit a request to NHS BSA in parallel. The relevant form can be found on the NHS BSA website.

16. In addition, the responsible team should request the authorised signatories in the ICBs to email notification forms to prescriptioninformation@nhs.net to inform NHS BSA of additions, deletions or changes to organisational and prescriber details for: NHS and private controlled drug (CD) pharmacy contractors, private CD prescribers and health and justice services, including their prescribers. Further information and the notification forms can be found on the NHS BSA website.

17. GP practice migrations required must be submitted to ODS by 1 December for implementation to take effect on the following 1 April.

18. The responsible team should ensure that Primary Care Support England (PCSE) which administers primary care on behalf of NHS England is informed of any GP practice migrations.

19. If there are any changes to the PCNs associated with the GP practices being migrated, the responsible team should complete and submit the PCN change form by 28 February, in order for the change to be actioned and take effect from 1 April. ODS will make any changes to any related PCNs for the GP practices being migrated.

20. The responsible team will need to ensure that the governance handbooks of the ICBs are updated to reflect the move of the GP practices as the ORD published by ODS needs to be aligned with that list.

21. NHS smartcards and the Care Identity Service: for GP practices being moved. The sending ICB will need to arrange the removal of any active user access and closing of positions. They will need to ensure required access is granted for users under new ICB codes.

22. Access must be granted under the new ICB codes before ICBs request removal of any active user access and closing of positions.

23. It is important to recognise that whilst the migration of corporate users should be completed by the target date, it may not be practical to migrate Registration Authority ‘child organisation’ users at the same time.

24. The responsible team should inform the national and regional analytical team of the boundary change and any GP practice migrations, so that they can ensure that data collection systems are updated.

Digital, data, informatics and information governance – integrated care board (ICB) mergers and splits

25. The responsible regional team should contact the NHS Organisation Data Service (ODS) via helpdesk@nhs.net to notify them of the merger or split as soon as it has been approved by the NHS England Strategy, Planning and Investment (SPI) Committee.

26. The responsible team should then complete an organisation code request form and submit it to ODS via helpdesk@nhs.net for the new ICB(s) created from the merger or split. This should include the approval documentation for the merger or split from the NHS England SPI Committee or a copy of the formal notification of the NHS England decision to the ICB chief executive(s). Upon submission, the responsible team must confirm:

• which ICBs are forming the new ICB
• if one of the existing ICB organisation codes is to be retained or a new ICB code is required
• if the existing ICB is to be split between two or more other ICBs.

27. For any new ICB created, a new ICB ODS code will be required. ODS will reserve a new ICB code and one or more sub ICB level codes (depending on the requirements of the new ICB) and provide an organisation detail report containing the name and address of the headquarters for the new ICB and the newly reserved ICB code and sub ICB level code(s). This form will be sent to the responsible regional team for passing onward to the existing ICBs for them to progress further implementation work.

28. The responsible team should then complete an ODS ICB boundary change form and submit it to ODS via helpdesk@nhs.net, together with evidence of the formal approval of the merger. The responsible team should also copy NHS England Data Services via nationaldataplatform@england.nhs.uk in on their initial notification to ODS, so that reference tables and reporting can be updated.

29. If there are more than two ICBs involved in the merger/split, separate ODS ICB boundary change forms must be submitted for each pair of ICBs.

30. Upon submission, the responsible team must confirm the following in the ODS ICB boundary change form:

• the names and ODS codes of the two ICBs involved in the merger/split boundary change.
• the ONS lower layer super output areas (LSOAs) codes and names of those that are moving from the current (sending) ICB to the new (receiving) ICB
• the current and new sub ICB location codes for the LSOAs that are moving
• the names and ODS codes for any other ICB(s) involved in the merger/split
• confirm that all the LSOAs in the existing ICB to be abolished have been reallocated to another ICB (either existing or new).

31. GP practice migration: A merger/split will be accompanied by the movement of GP practices. Changes to GP practices will be reflected in organisation reference data (ORD) published by ODS, based on data managed by NHS BSA.

32. The responsible team must complete the ODS GP practice migration form. This will include:

• the names and ODS codes of the GP practices that are moving
• the current and new ICB codes and names for these GP practices
• the current and new sub ICB location codes for these GP practices
• if there are PCN changes to follow.

33. The ODS team will inform NHS BSA of the GP practice migrations. BSA will verify and confirm these changes using their own processes.

34. The responsible team should also request that the authorised signatories in the existing ICBs (at the sub ICB location level) submit a request to NHS BSA in parallel. The relevant form can be found on the NHS BSA website.

35. In addition, the responsible team should request the authorised signatories in the existing ICBs to email prescriptioninformation@nhs.net to inform NHS BSA of additions, deletions or changes to organisational and prescriber details for: NHS and private controlled drug (CD) pharmacy contractors, private CD prescribers and health and justice services, including their prescribers. Further information and the notification forms can be found on the NHS BSA website.

36. The responsible team should ensure that Primary Care Support England which administers primary care on behalf of NHS England is informed of any GP practice migrations.

37. If there are any changes to the PCNs associated with the GP practices being migrated, the responsible team must complete and submit the PCN change form by 28 February for the change to take effect on 1 April. ODS will make any changes to any related PCNs for the GP practices being migrated.

38. The responsible team will need to ensure that the governance handbooks of the ICBs are updated to reflect the move of the GP practices as the ORD published by ODS needs to be aligned with that list.

39. The responsible team should inform the national and regional analytical team of the merger/split so that they can ensure that data collection systems are updated.

40. The ODS will notify the Office for National Statistics (ONS) of the of the merger/split, confirming the boundaries of the new ICB for ONS to re-mapping these on the NHS postcode directory.

41. ODS will provide an ODS reconfiguration toolkit and reconfiguration guidance. The reconfiguration guidance provides a list of key systems and services known to be impacted by ODS code changes and is sent with the ODS code to the Regional Director for Digital Transformation to be passed on to the ICB. Note: the reconfiguration guidance does not contain an exhaustive list of impacts. ICBs will need to consider fully their own uses for ODS codes. The responsible team should ensure completion of key activities in relation to the ODS reconfiguration toolkit and the reconfiguration guidance.

42. The ODS reconfiguration toolkit actions include (but are not limited to):

• registering new ICB operational contacts (OC1s)
• registering new ICB site codes
• informing site code successor links
• Registering new Caldicott guardian, senior information risk owner and (where appropriate) information asset owner contacts.

43 The reconfiguration guidance includes (but is not limited to):

• undertaking a full assessment of how the ICBs utilise ODS codes
• contacting impacted systems and services to request that activity is either closed down or migrated to the appropriate successor ICB code, for example, NHS smartcards and the Care Identity Service, NHSmail, e-Referral Service, Health and Social Care Network.

44. The ODS reconfiguration team will communicate the changes made to:

• the ODS technical and business analysis work areas
• the relevant ICB OC1
• all ODS newsletter subscribers
• the ODS distribution list for customers and service providers.

45. NHS smartcards and the Care Identity Service – any ICB due to be abolished will need to arrange the removal of any active user access and closing of positions. They will need to ensure required access is granted for users under new ICB codes.

46. Access must be granted under the new ICB codes before ICBs request removal of any active user access and closing of positions.

47. It is also important to recognise that whilst the migration of corporate users should be completed by the target date, it may not be practical to migrate Registration Authority (RA) ‘child organisation’ users at the same time. Furthermore, if the new ICB plans to have multiple RA providers, this may delay migration of RA child organisations. 

48. The RA manager for the new ICB should be appointed as early as possible and no later than one month after the new ICB is formally established.

49. Existing ICBs need to publicly advise on their website in advance of merger/abolition that information that has been held by them will be transferred to the new ICB(s) on 1 April and that the new ICB(s) will then become the new data controller.

50. Data security and protection toolkit – Existing ICBs should ensure that they complete and publish the Data security and protection toolkit (DSPT) using their current ODS code and DSPT registration prior to any merger/abolition taking place. If they do not publish by 31 March, the new ICB would need to publish on their behalf by 30 June.

51. If any published DSPT does not indicate ‘standards met’, the new ICB must submit an improvement plan covering actions to be undertaken by 31 December. The improvement plan may contain actions relating to pre-existing ICBs and/or the new ICB.

52. Any new ICB will require a new DSPT registration code. In preparation for this the new ICB should log a call with the Exeter helpdesk via helpdesk@nhs.net to request their new ICB DSPT account to be set up.

Annex 4 – Summary of documentation for different types of boundary changes or mergers

Publishing reference: PRN00653