Letter to the health and care system from Mark Cubbon, NHS England Chief Delivery Officer

Classification: Official
Publication reference: B2068

12 October 2022


  • Trust and integrated care board Chief Executives
  • Trust and integrated care board Chairs

Dear colleague,

New NHS England Operating Framework

NHS England is today publishing a new operating framework which sets out how the NHS will operate in the new structure created by the 2022 Health and Care Act. The framework has been co-created with 300 system leaders, organisations and stakeholders, including Health Education England and NHS Digital. We are grateful for the input and insights that our partners have brought to the final framework.

The Health and Care Act formally established integrated care systems (ICSs) on a statutory basis, enabling local systems to plan and deliver health and care services more effectively. The new operating framework sets out the roles that NHS England, ICSs and providers will now play in the new structure. It describes how we would like to work together and shows how accountabilities and responsibilities will work.

NHS England’s role is to lead the NHS in England to deliver high quality services for all. We will set the national direction; allocate resources; ensure accountability; set the national approach to supporting and developing people; mobilise expert networks; give support to drive improvement; deliver services such as national procurement and digital services; and create the national approach to transformation.

NHS England will support local decision making, empowering local leaders to make the best decisions for their local populations. We will use input from ICSs to agree the mandate for the NHS with government and the resources needed to deliver it. We will be accountable to Parliament and government for national NHS performance and transformation, as set out in the NHS mandate and constitution. In July we announced that we will create a significantly smaller NHS England to deliver our role, as part of our
plans to simplify, and reduce bureaucracy in, the wider NHS.

Integrated care boards (ICBs) will provide effective system leadership which balances immediate and longer-term priorities. They will work with providers, local authorities and other partners to create local integrated care strategies, and deliver joint five-year forward plans for their system.

ICBs will bring the local NHS together to ensure the healthcare needs of their communities are met, and together with local authorities, act as the stewards of local population health outcomes and equity. ICBs will oversee and support NHS delivery of these strategies and plans including system-level delivery of NHS annual planning objectives and NHS Long Term Plan priorities. They will oversee system health budgets and will account for NHS system financial allocations. They will be responsible for working with partners to ensure effective arrangements are in place across systems for joint working to deliver plans, performance, outcomes and transformation. Oversight and performance management arrangements within each ICS area will be proportionate and streamlined, avoiding duplication or unnecessary bureaucracy.

Providers will ensure they meet their statutory responsibilities for the delivery of safe, effective, efficient, high-quality services, both now and longer term. They will be responsible for their contribution to effective system working and delivery of ICS strategies and plans.

Providers will also be responsible for meeting the financial and performance requirements set out in NHS planning guidance and complying with their provider licence and Care Quality Commission (CQC) standards. Providers will be expected to reduce unwarranted variation, for example through their participation in provider collaboratives.

The framework does not contain all the answers at this point. We will continue to codevelop our approach with you, as other aspects of policy are confirmed, such as CQC’s approach to assessing ICSs and the detail of how delegated commissioning will work.

The pandemic has shown the vital importance of having a single national health service. But the NHS has stood the test of time since 1948 because the service has continuously evolved to meet the needs of our patients. This new framework sets out how we can now realise the new opportunities to improve local patient care and health outcomes provided by our new structure, in a way that maximises taxpayer value for money.

The successful way we have developed this framework shows the importance of NHS England co-creating what we do with frontline leaders. So, please contact your regional director if you have any feedback on the framework and any thoughts on how we can continue to ensure it is effectively implemented.

Yours sincerely,

Mark Cubbon, Chief Delivery Officer, NHS England