Herefordshire and Worcestershire ICB Reset

Important developments affecting the future structure, leadership and management arrangements of NHS Herefordshire and Worcestershire Integrated Care Board (ICB).

Context and strategic direction

Earlier this year, NHS England (NHSE) and the Department of Health and Social Care (DHSC) announced plans to bring their operations closer together — a move designed to reduce duplication and support more joined-up national leadership. This is part of a wider transformation programme to radically reform the size and function of the NHSE team so that it is better positioned to support frontline delivery and drive forward the Government’s health and care reform priorities.

In parallel with these changes at the national level, NHSE confirmed that ICBs must also reduce their size and running costs by 50%. While this presents a significant challenge, it also creates an opportunity to reshape ICBs to focus more sharply on their core role as strategic commissioners — enabling greater impact on population health, reducing health inequalities, improving productivity, and supporting transformation across systems.

This evolving role of ICBs will be central to delivering the ambitions set out in the forthcoming 10-Year Health Plan, which will introduce a new NHS operating model focused on reducing management overheads and reallocating resources to strengthen neighbourhood and community-based health services.

NHS Herefordshire and Worcestershire ICB has responded proactively and collaboratively to this direction, working to ensure that we meet the new requirements while protecting our local partnerships and maintaining high-quality care for our patients.

Regional collaboration and clustered arrangements

Over the past three months, we have worked closely with the other five West Midlands ICBs to assess how the new expectations around strategic commissioning and cost reduction can best be delivered. This joint effort has focused on maintaining stability, retaining talent, and preparing ICBs for their future roles — all within the significantly reduced budget envelope.

With support from independent consultants, ICB Chairs and Chief Executives conducted a comprehensive review of the available options, including a detailed appraisal of possible shared management and leadership models. This work considered both national criteria and local deliverability considerations.

The preferred approach that emerged was for the six Midlands ICBs to form three strategic clusters, each developing shared leadership and management arrangements. These arrangements will provide the economies of scale needed to meet the cost reductions while enhancing regional commissioning capacity and maintaining strong local engagement. These arrangements have now been agreed by NHS England and the Department of Health and Social Care.

The agreed clusters are:

• NHS Herefordshire and Worcestershire ICB with NHS Coventry and Warwickshire ICB
• NHS Birmingham and Solihull ICB with NHS Black Country ICB
• NHS Shropshire, Telford and Wrekin ICB with NHS Staffordshire and Stoke-on-Trent ICB

It is important to stress that this is not a proposal to formally merge the ICBs. Each will remain a statutory organisation with its own legal responsibilities and local accountability. The focus is on sharing senior management resources to deliver he required level of cost savings and to support greater strategic coherence across larger footprints.

Next steps

Now that the clusters have been formally agreed, work is underway to further develop the proposed arrangements for our cluster. Immediate priorities include:

• Appointment of a single Chair for the cluster
• Appointment of a single Chief Executive for the cluster
• Development of a proposed organisational structure working across the combined cluster footprint (Herefordshire, Worcestershire, Coventry and Warwickshire).  

These changes will be implemented in a phased and managed way to ensure continuity of leadership, preservation of place-based delivery across Herefordshire and Worcestershire, and no disruption to patient care or local relationships.

These changes are being handled with great care, and with a clear focus on maintaining stability, continuity, and delivery for patients and partners. We are confident that this collaborative approach with NHS Coventry and Warwickshire ICB puts us in a strong position to meet national expectations while preserving the strengths of our local system.

The ICB  remains committed to engaging closely with partners throughout this process.