By Jason Bloomfield, Chief Operating Officer, Finance Solutions, NHS Arden & GEM CSU
Many systems are clustering now – ahead of scheduled mergers and boundary changes in April 2026 – to reduce duplication and build their strategic commissioning capability in line with the 10 Year Health Plan’s three shifts.
In many cases, resources are being cut significantly and some services will close. It's a painful process, being felt across the NHS. For many, it can be hard to get past the frustrations of what may feel like the latest in a series of restructures. But there is opportunity here too.
Clustering ICBs are already working on future structures and will be at different stages of development. Delivering major transformation successfully is complex, but there are best practice principles which can help guide these organisations over the coming months. Drawing on our experience of working on change programmes with ICBs and providers, we have set out some key elements and techniques which can help leadership teams navigate immediate changes, with an eye on the long term need to maintain a resilient, patient-focused NHS.
1. Develop a collaborative vision
In the current, high-pressure environment, it's tempting to dive straight into delivery. However, this risks short-term financial viability becoming the principal focus, which is unlikely to see you through some of the more complex decision-making, particularly as formal mergers begin. Developing an agreed vision as a team takes you out of firefighting, reactive mode and gives you the headspace to properly consider population and patient needs. Building that team mindset will be crucial in breaking down silos and working successfully as a single organisation.
Using population health data and analysis to inform decision-making will help clusters have objective discussions about strategic commissioning priorities. Joint leadership teams can then start to look at the people, processes and systems that will be needed to support effective interoperability across organisations, including the governance structures to enable agile decision-making.
2. Review delivery options for every service
ICBs are already looking at which services can best be delivered locally versus at scale. This needs to include what can be commissioned more cost efficiently at a regional level, for example digital, data, procurement or transactional HR activities, compared with services which require a cluster, place or neighbourhood approach. Hub and spoke models may provide efficient and agile delivery options for many services, with commissioners able to flex the emphasis on hub versus spoke depending on service requirements and local variations.
But transformation at this scale and pace will require iteration. For example, due to the closure of Commissioning Support Units (CSUs), the window for ICBs to start taking on services currently delivered by CSUs is short, requiring a plan for a phased approach which stabilises, standardises and transforms. Initially this may mean a lift and drop of existing services, followed by a transformation phase focused on making the service work more effectively within a different structure. These are complex changes. Recognising this at the outset and planning realistic phases will help manage expectations and make the transition more manageable for both ICBs and CSUs.
3. Adopt a value-based approach to assessing services
The 'stop, start, continue' model provides a clear framework to help assess which services must continue, which could be stopped, and what clusters may need to start doing to address gaps in provision. We encourage ICBs to set this process in the context of outcomes-based decision-making, considering the amount of effort required and the resulting outcomes to clearly show which services are delivering most value. Put simply, if you can’t measure it, you can’t defend it.
Assessing outcomes helps identify any resource intensive services which aren't delivering as expected, giving commissioners the opportunity to refine, improve or remove low value activities. But this is not simply a cost exercise. As strategic commissioners, ICBs must consider both current health inequalities as well as the long-term consequences of inaction. Addressing inequalities or implementing more preventative health services may be more costly short term but deliver significant value, both in improved patient outcomes and reduced burden on services in years to come.
4. Embrace data, insight and technology
Data and insight is critical for all aspects of business intelligence, procurement, finance and workforce planning as well as population health and clinical delivery. As ICBs merge, data and insight need to become the engine room of these new organisations, providing a single source of truth to support effective and safe commissioning. This includes using technology to support more effective and sustainable uses of existing estates across health, care and voluntary sector partners. And let’s not forget – data quality will be more important than ever before.
Reducing headcount and delivering more cost-efficient services successfully also means embracing technology which help us do more for less, in line with the 10 Year Health Plan’s analogue to digital ambitions. Maximising automation and AI to reduce admin and safely speed up the processes that underpin healthcare delivery will become increasingly important as clusters look to minimise duplication and improve consistency. However, we cannot afford to be complacent around cyber and resilience. Clustered platforms increase risk, especially if governance is weak.
Building for continuous change
Although change in the NHS is inevitable, there is also increasing recognition of the need for a longer-term view of healthcare and greater investment in prevention. Arguably, transformation on the scale set out in the 10 Year Health Plan will prompt a sharper focus on the initiatives and structures that deliver greatest impact and long-term value for patients. But it is equally important to build a resilient health service with the people, processes, insight and agility to adapt to future change.
Throughout all this, ICBs will need to focus on the culture they want to build, which will likely include collaboration, a ‘single team’ philosophy and shared accountability for outcomes across the whole footprint. That means being explicit about the leadership behaviours the new organisation will expect and reward.
Clustering and merging ICBs isn’t a holding pattern, it’s the runway to strategic commissioning. There are no 'one size fits all' solutions here, but by combining the skills, experience and knowledge that exist across the sector, ICBs can merge and operate successfully as strategic commissioners.
This article was originally published by Healthcare Leader.
