NHS Arden & GEM was commissioned, in 2023, to support the NHS England North West Specialised Commissioning team with the delegation of regional responsibilities to ICBs.
A programme of work was delivered to design a target operating model, review actions for core functions, develop an organisational development plan and design principles of good governance.
The programme was underpinned by collaborative working and stakeholder engagement. As a result, the North West region has taken on full delegation of services as planned with robust shared working arrangements in place and a supportive transfer of staff.
The challenge
In 2023, the NHS England Board confirmed a decision to transfer responsibilities for the commissioning of 70 specialised services, worth £14 billion per year, from NHS England regions to ICBs.
The objectives of delegation were to:
- empower ICBs to better join up health and care
- improve population health
- reduce health inequalities
- ensure efficient use of NHS resources.
An initial list of services was designated as safe for delegation from 2024/25 with additional services to follow in 2025/26. The North West region reviewed the list of services and, following assessment of population needs and geography, categorised them as being suitable for decision making at either a single ICB or multi ICB level. Decisions about single ICB services would be integrated into existing ICB governance processes but where services were designated as multi ICB, a joint decision between all three North West ICBs would be required. In addition to establishing a joint decision-making committee, a target operating model, governance process and formal agreements were also needed.
Our approach
Having already supported the delegation of primary medical, pharmacy, ophthalmic and dental services within the region, the Arden & GEM Health and Care Transformation team was asked to provide programme management and organisational development expertise to the regional Specialised Commissioning team.
The CSU team managed programme oversight and the specific working groups established to develop core functions, and also supported the Joint Committee. Decisions about the host organisation, on behalf of the three ICBs, were agreed and the programme incorporated planned staff transfer (including IG, IT, data and digital) in line with national timelines.
Working in close collaboration with the Specialised Commissioning and ICB teams, Arden & GEM:
- Oversaw completion of the pre-delegation assessment
- Designed the overarching principles and target operating model (TOM) that shaped intended day-to-day working
- Managed the review of actions for core functions (HR, finance, contracting, IT and governance), within and across ICBs and NHS England
- Ensured readiness to transfer responsibility and staff to ICBs
- Developed and delivered an organisational development plan to support staff engagement, creation of new ways of working and culture development
- Designed principles of good governance and scenarios to support future decision making
- Created a communication pack for staff and to support onboarding new Non-Executive Directors to the Joint Committee.
The CSU also designed and facilitated staff engagement sessions – in the lead up to formal processes for transfer to the host ICB – which informed next steps for the team. This included exploring the target operating model in practice as well as current and future culture and ways of working.
Outcomes
The North West, having established shared working arrangements ahead of formal delegation, was one of three regions that demonstrated readiness to take on full delegation from April 2024 (59 services) and April 2025 (11 additional services).
The TOM created in 2023/24 provided a foundation for Specialised Commissioning and ICB staff to build upon.
Final programme outputs included a handbook which outlines the key operational processes for commissioning of specialised services and is informing post-delegation operation. The handbook includes core functions, principles for good governance, accompanying scenarios for exploration, and a communications pack about specialised services and delegation.
"Arden & GEM worked alongside the senior team for Specialised Commissioning to ensure we were well prepared and progressed in line with national guidance for safe delegation and processes to support staff transfer. The team are knowledgeable and skilled. They adapted effectively to the needs and challenges of designing and implementing a complex programme of work which included process design, governance, engagement and targeted organisational development support. We could not have achieved successful delegation without their support."
Andrew Bibby, Regional Director of Specialised Commissioning & Health and Justice, NHS England (North West)
Find out more about our support for specialised commissioning delegation.