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ICBs to impose ‘minimum waiting times’ for services

NHS England has proposed introducing “minimum waiting times” for certain elective specialties as system leaders grapple with how to balance clinical needs and a real terms funding cut for local services.

The proposal was revealed in changes to the NHS Standard Contract for 2025-26, published by NHSE on Thursday, following the decision to ditch plans for a fixed cap on providers’ elective activity earnings.  This was how government and NHSE had planned to control costs in 2025-26, but it was branded “unworkable” by providers.

However, the Nuffield Trust warned the new proposals – out for consultation with a 28 April deadline – gave “no clear process to rationally decide which forms of activity it is least harmful to hold down and which, if necessary, should be permitted to exceed plans”.

The new contracting plan is based on the principle of commissioners agreeing “robust indicative activity plans” with providers under arrangements NHSE said required “material changes [to the] contract activity management provisions”.

The document also confirms that NHSE is proposing the introduction of minimum waiting times where local commissioners view this as appropriate. It is due to concern some providers carry out a large volume of certain procedures with short turnarounds – for example a few days – while commissioners may be unable to afford to address much longer waits for other services.

The plan says commissioners could set “activity planning assumptions” about “how the particular provider will manage activity once a referral has been accepted”.

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Source: HSJ, 11 April 2025

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ICBs should set up ‘escalation routes’ after 25 daily GP contacts, says new BMA guidance

ICBs should ensure there are ‘formal escalation routes’ in place for GPs after 25 daily clinical contacts, the BMA has said in new guidance.

From next week (15 May), GP practices are contractually required to offer an ‘appropriate response’ to patients the first time they get in contact, by offering them an appointment or redirection, rather than asking them to call back at a different time.

While GP leaders warned this would lead to increased pressure on NHS 111 and A&E, NHS England attempted to clarify in this week’s recovery plan that GPs should only redirect patients in ‘exceptional circumstances’. It also said practices should inform their ICB on each such occasion.

However, conflicting BMA guidance has now been published, warning that practices attempting to adhere to the new requirement ‘may do so at the expense of clinician wellbeing and patient safety’.

It reiterates the GP Committee for England’s safe working guidance recommending that clinicians have no more than 25 clinical contacts per day because anything beyond this "can lead to decision fatigue, clinical errors and patient harm, and clinician burn out".

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Source: Pulse, 11 May 2023

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ICBs ordered to cut costs by 50%

Integrated care boards have been told to cut their running costs in half by December.

ICBs had already been ordered to cut running costs by 20% over the past two years.

Sir Jim told the ICB CEOs the Treasury would cover the cost of redundancies, which are likely to be necessary, and that cuts must be made by the third quarter of 2025-26. HSJ understands they were also informed that trusts would be required to cut managerial costs.

The measures are part of a “financial reset” package due to be outlined by Sir Jim to NHS CEOs in London on Thursday. 

The cuts to integrated care board budgets will make it next to impossible for some individual ICBs to operate as a standalone organisations, or to carry out the full range of responsibilities originally given to them by the 2022 Health and Care Act.

One leader told HSJ the size and speed of the cut was “terrifying” and would throw management of the NHS “into chaos”. Another director briefed on the plan said it felt “like full panic mode and blunt cost cutting without clarity on purpose”.

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Source: HSJ, 12 March 2025

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ICBs missing checks on vulnerable children

Integrated care boards are warning they are failing to carry out health checks for vulnerable children in care because of a lack of paediatricians and rising demand, HSJ  has found.

ICBs are required to commission initial health assessments within 20 working days of a child entering care, arranged by a local authority, then a review six to 12 months later.

HSJ  has identified several ICBs warning they are not or may not meet the requirement – citing workforce pressures, complex cases and rising demand.

Missing the checks for children in care risks harming their physical and mental health, school attainment and future wellbeing, according to paediatricians. 

A community paediatrician working in the South East told HSJ  delayed assessments could have significant long-term impact — delaying intervention in developmental concerns, alcohol and drug use, oral health, immunisation and medications.

“These children are incredibly vulnerable,” they said. “The quicker we get issues addressed, often putting them on SEN [special educational needs] or other support, the better they often do in school and in life.”

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Source: HSJ, 5 February 2025

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ICBs facing clash between PCNs and neighbourhood health

Dozens of primary care networks in some areas may need to be reorganised to take on neighbourhood contracts, because they do not cover a coherent geographic area.

Of 1,210 multipractice primary care networks nationally, between 166 and 392 (14% to 32%) have member GP practices that are intermingled with others, and/or do not serve a single joined-up area, HSJ analysis has found. They make up 900-2,000 of the 6,100 total practices nationally.

Five integrated care board areas – mainly in London and inner West Midlands – are particularly affected, with more than half of PCNs not serving a single joined-up patch (see below).

The pattern reflects how PCNs were formed in 2019. GPs were allowed to determine networks, with little challenge from NHS England. Many were decided based on factors such as pre-existing practice relationships or common working methods.

In contrast, ICBs and councils have set boundaries for neighbourhood teams largely based on municipal or other natural boundaries.

For now, ICBs are mainly working around the mismatch with PCNs. In urban areas, they have set “neighbourhood” or “locality” footprints with large populations, which they say will function with multiple intermingled PCNs within them.

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Source: HSJ, 28 May 2026

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ICBs exempt from performance regime

Integrated care boards will not be put into performance “segments” in 2025-26, while they go through major reorganisation and job cuts, NHS England has decided.

Its NHS Oversight Framework for 2025-26, finalised on Thursday after more than a year of development, says integrated care boards should this year focus on cutting their running costs by 50 per cent alongside delivery, and changing their role to match the model ICB blueprint.

ICBs already subject to the “recovery support programme” intervention will stay in it, and be monitored by NHS England.

But while trusts will be given a one (best) to five (worst) performance segment, ICBs will this year not be segmented.

This NOF will apply for one year, the document says, and be changed for 2026-27 based on the 10-Year Health Plan and the new “operating model” it will propose. It suggests it will be applied to ICBs again in the future, but other documents suggest they may be subject to a separate commissioning capability regime.

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Source: HSJ, 30 June 2025

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ICBs can scrap chief nurse and medic, says NHSE

Integrated care boards can now scrap the roles of chief nurse and chief medical officer – despite previous guidance saying they are required – NHS England has indicated.

NHSE told HSJ it was “for each ICB to determine which specific roles they require at board level to deliver their core functions”, after saying systems should reduce executive headcounts as part of its “model ICB blueprint”.

It comes as North East London ICB announced to staff it was scrapping its chief nurse and chief medical officer roles from its executive management team. It is restructuring in order to cut its costs in half and focus on “strategic commissioning” (see below), as instructed by government and NHSE.

The Royal College of Nursing has criticised NEL ICB’s removal of the chief nurse role – and said other systems may follow suit.

Patricia Marquis, executive director of RCN England, said: “The decision to remove the chief nurse post by the North East London ICB shows poor insight into the importance of nursing in ensuring safe patient care. Worryingly, we are now hearing that other ICBs across England are planning to follow suit. The RCN is monitoring the situation and will be supporting members to challenge decisions locally.

“As the biggest and most trusted profession in the NHS workforce, it is vital that nursing continues to have leaders in place to influence decision-making. Failure to do so risks devaluing the nursing profession and undermining the delivery of the NHS 10-Year Health Plan, which is so heavily dependent on the expertise and leadership of senior nursing staff.”

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Source: HSJ, 1 August 2025

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ICBs ‘detached’ from patient safety risks

A new reporting system has left integrated care boards “detached” from patient safety incidents, a watchdog has found.

The Health Service Safety Investigations Body (HSSIB) said some ICBs first heard of an incident when they were asked to provide a media statement.

In a report published today it highlighted views that a new reporting framework had “eroded assurance activities and patient safety oversight.”

The NHS has largely moved from the serious incident framework – where incidents were investigated locally but ICBs played a key role – to the patient safety incident response framework (PSIRF), which is less prescriptive about how trusts need to react to incidents and is not based on the level of harm involved.

But the HSSIB report revealed widespread dissatisfaction among ICBs about the new model, with commissioners saying many PSIRF responses did not trigger a report, leading to them having less visibility of risks from incidents.

This was a particular concern when risks arose when patients moved between providers. ICBs were also often uncertain how risks were being mitigated and what providers had done as a result of incidents.

The safety body was also critical of the Learn from Patient Safety Events database, highlighting problems with “the useability and utility of the data”, with one ICB saying it had “3,000 incidents downloaded but no way of understanding them.” Multiple ICBs had escalated issues with this to NHSE as the data was not useful for identifying hazards and risks.

Helen Hughes, chief executive of the charity Patient Safety Learning, said issues with database were “not simply a technical problem with a new digital service.”

“They will result in missed opportunities to identify patient safety risks, learn from them and ultimately prevent avoidable harm to patients,” she said.

“With greater clarity around the roles, ICBs and ICSs have the potential to drive systemic improvements in patient safety. However, to do so effectively, they require enhanced tools, capacity, and a more integrated approach to digital solutions, such as LfPSE, that support patient safety.”

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Source: HSJ, 13 February 2025

You can read Patient Safety Learning’s response to this report here.

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ICB whistleblowing process ‘not fit for purpose’

An integrated care board (ICB) has found its handling of whistleblowing “not fit for purpose”, after a complaint about safety incidents not being properly investigated.

A report by North West London ICB, obtained by HSJ, states: “The whistleblowing policy is not fit for purpose and requires immediate updating. The [Freedom to Speak Up] Guardian has been left blank and the policy does not include key components of best practice.”

It also found the “whistleblower should have been provided with a substantive response to their concerns within 28 days” but in fact waited 98 working days, “due to delays with starting the whistleblowing component of the grievance”.

The ICB reviewed its processes after a complaint from a staff member who raised concerns early last year about “a lack of, or poor, response” to reported patient safety incidents in the system, which are meant to be routinely reviewed by ICBs “prior to closure”. 

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Source: HSJ, 15 February 2024

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ICB shelves same-day hub plans due to GP and patient backlash

Same-day access hubs will not be mandated in North West London as the Integrated Care Board (ICB) bows to pressure from GPs and patients.

In a letter to GP teams, seen by Pulse, the ICB said that their controversial same-day access programme "will not form part of the single offer for enhanced services for 2024/25".

Instead, ICB leaders said they want to work with PCNs "to consider how access can be improved" and that they do not have a "presumption" about a "particular model" all PCNs should adopt.

They are now aiming for a new model to be implemented from April next year instead.

The hub model aimed to "deliver a single point of triage for same-day, low complexity" demand for all 2.1 million residents within the integrated care system, leaving GP practices with only longer-term, "complex" care.

But London GP leaders, as well as patients, raised "immense concern" with the plans, including patient safety, quality of care, and logistics.

In response to these concerns, the ICB confirmed yesterday that it has "adjusted" the same-day hub programme, and that it wants to "move forward collectively" to address both patient access issues and GP pressures.

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Source: Pulse, 6 March 2024

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ICB sends trust five safety warnings in six weeks

An integrated care board (ICB) has sent multiple warnings to a local trust highlighting ‘serious issues’ with the safety and quality of care provided.

East Kent Hospitals University Foundation Trust had had severe and widely reported issues in its maternity services but the five emails and letters from Kent and Medway ICB, sent across a six-week period in February and March, flagged concerns extending into other parts of the organisation. These included:

Serious incidents had “recurrent themes” and there was a “lack of evidence the trust is learning” from them. A spot audit had revealed more than one in five patients at the Queen Elizabeth The Queen Mother Hospital in Thanet had overdue modified early warning scores, which can show if a patient is deteriorating.

Further concerns about adult safeguarding “have been raised in relation to 18 allegations of abuse against people in positions of trust” despite the provider implementing a review on the issue 18 months earlier.

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Source: HSJ, 22 May 2023

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ICB seeks first GP and dentist integration

An integrated care board in the East of England is working to integrate general practice and dental care records, and exploring shared sites for the two primary care services.

Suffolk and North East Essex ICB is exploring how to “bring primary care services together”, according to recent board papers.

Ed Garratt, its chief executive, said dental practices first began to collaborate through the ICB’s dental priority access and stabilisation scheme, which saw them offer 15,000 urgent appointments.

“We’re now thinking about how to create networks of dental practices that could work together with our general practice networks,” he told HSJ. He added that the ICB was also pursuing integrating the summary care record – a patient record held by GPs – so it could be shared with dentists.

Mr Garratt said having GPs and dentists working at the same hub sites was likely to be “the ultimate end stage” for this work.

He said the moves were designed to improve communication and holistic care across dental and other health. “Often, dentists and GPs might share the same patient, but they would never communicate about that patient. So you can have more holistic care potentially if people were working closer together,” he said.

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Source: HSJ, 10 April 2025

Further reading on the hub:

The challenges of navigating the healthcare system

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ICB restructure ‘paralysing neighbourhood health’

The restructuring of integrated care boards is leading to faltering progress on neighbourhood health, primary care leaders are reporting.

They said the cuts to ICB roles and resources  – and the distraction for staff as they embark on restructures and mergers – were harming the development of joined-up community services, which form a key part of the government’s 10-Year Health Plan.

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Source: HSJ, 21 November 2025

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ICB pauses ADHD referrals to service for many adults as expansion is ‘unaffordable’

A mental health trust has stopped accepting ADHD referrals for many adults, after integrated care board chiefs warned it was “unaffordable” to expand the service due to financial pressures, HSJ understands.

Adults referred in Hertfordshire will now only be taken on by Hertfordshire Partnership Foundation Trust’s ADHD service if their case is considered complex, despite soaring demand. 

The move comes as Hertfordshire and West Essex ICB, which commissions services in Hertfordshire, told HSJ that the scale of increased commissioning required to cope with “unprecedented demand” in the adult ADHD service was “unaffordable”, given its deficit position. 

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Source: HSJ News, 15 August 2024

Related reading

Long waits for ADHD diagnosis and treatment are a patient safety issue (Patient Safety Learning, 15 May 2023)

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ICB morale plummets amid restructures

Nearly half of integrated care boards (ICBs) opted out of the 2025 Staff Survey, and those that took part saw a huge drop in morale amid restructuring.

The 2025 data covers just 23 ICBs, because the remaining 19 decided not to take part amid major restructures.

The share agreeing they “would recommend my organisation as a place to work”, on average across the ICBs, plummeted from 54% to 36.9%. It was already lower than most provider trusts.

Drastic cuts to ICB budgets and a narrowing of their role were announced a year ago, followed by months of uncertainty and redundancy schemes running over the winter. Many ICBs have merged their leadership with neighbours. 

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Source: HSJ, 13 March 2026

Related reading on the hub:

Patient Safety Learning’s response to the NHS Staff Survey Results 2025

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ICB maternity plan risks increasing deaths, senior medics claim

The medical leaders of the maternity unit of a flagship hospital threatened with closure have written to their chief executive saying the downgrade would not be safe, HSJ has learned.

Nineteen obstetric and gynaecological staff, including the clinical director, wrote to the chair and CEO of the Royal Free London Foundation Trust this week saying the proposals to shutter services at the trust’s main site in Hampstead would increase the risk of harm to mothers.

Their letter said: “Whilst we accept, and support, the need to review provision of maternity and neonatal services across [north central London], aiming for care excellence and best outcomes, we have significant concerns about the current proposals.”

The letter said the Royal Free was the only unit in NCL to offer a “range of supporting specialist services for complex maternity care”, including rheumatology and neurology and is the “only hospital in NCL to provide both 24-hour interventional radiology and on-site acute vascular surgery and urology support”.

The medics’ letter said co-morbidities from cardiac, renal, haematological and neurological conditions had driven an increase in maternal mortality over the past decade and that RFH’s services were well-equipped to manage these complex cases.

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Source: HSJ, 24 January 2024

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ICB functions radically reduced in national ‘blueprint’

More than a dozen functions have been earmarked for “transfer” out of integrated care boards, including workforce planning, primary care, and digital leadership.

Several of them will transfer to emerging “neighbourhood health providers”, according to NHS England’s new “model ICB blueprint”, which is meant to help the boards cut 50% from their overheads.

The document also orders integrated care boards to reduce their board-level headcount to focus on ”core model ICB priorities”.

The document names 18 functions and activities which ICBs should “transfer [out] over time”, six they should “selectively retain and adapt”, and 11 which should “grow”.

NHSE financial reset and accountability director Glen Burley, who has been overseeing the work so far, told HSJ it was a “first step in a joint programme of work to reshape the focus, role, and functions of ICBs”. 

“We are seeking to reduce the management costs of the NHS so that more money can be spent on the frontline,” he said. “This won’t be achieved by simply moving functions to different organisations – instead ICBs need to be working together to merge functions to cut duplication.”

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Source: HSJ, 6 May 2025

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ICB failure creating ‘absolute nightmare’ for vulnerable patients needing covid treatment

Many vulnerable patients are struggling to access covid treatments after commissioning responsibility switched to integrated care boards this week, charities have warned.

Approximately two million vulnerable patients must now contact local services themselves to access treatments designed to combat covid infections, such as the antivirals Paxlovid and Sotrovimab. Integrated care boards are expected to coordinate and fund “equitable” access.

Prior to 27 June, identification of patients and the delivery of treatment was coordinated nationally under pandemic arrangements.

However, a group of 20 patient charities have written to Steve Barclay warning that most ICBs have not drawn up plans to deliver this new responsibility, leaving patients and primary care clinicians unclear on how to access the treatments.

“Despite continually raising our concerns with those carrying out the planning, implementation, and communication of this [policy], we now find that we are in exactly the position we warned against,” they said. 

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Source: HSJ, 3 July 2023

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ICB defies NHSE over patient record access

An integrated care board (ICB) has advised its GP practices not to give patients automatic access to their records, contradicting NHS England national requirements. 

Instead, North East London ICB has suggested practices only allow access where patients request it, and subject to conditions.

The national go-live date for patients to be allowed automatic access to future entries in their records has been repeatedly delayed since initially being set at December 2021. GPs have argued they needed more time to redact sensitive information, ensure records are not inappropriately shared, and train staff. They have cited workload and safeguarding concerns.

The ICB’s chief clinical information officer Osman Bhatti, who is a GP, told HSJ the ICB instead “wanted a process where patients could access both prospective and retrospective records safely, with less workload for GPs and so patients who actually want access can have it”.

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Source: HSJ. 1 June 2023

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ICB cuts an ‘absolute shitshow’, say leaders

National policymakers are “working it out as they go along”, and integrated care board staff are “on their knees” amid a confused restructure, local leaders have reported.

A Health Foundation report based on interviews with integrated care board leaders throughout last year, shared exclusively with HSJ, found they were “scathing” about the “handling and subsequent management” of the announcement of 50% cuts to staffing budgets.

ICB leaders who spoke to researchers labelled the cuts as “disgraceful”, “unprofessional”, and “an absolute shitshow”. They described surprise at “manager bashing” from government and concern that this would deter “the next generation of managers” from joining the NHS.

Leaders also described ICB colleagues as being “on their knees” and having “terrible, terrible morale”, and raised questions about the future of partnership working and ICBs as organisations. 

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Source: HSJ, 11 March 2026

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Ian Paterson: Surgeon wounded hundreds amid 'culture of denial'

A culture of "avoidance and denial" allowed a breast surgeon to perform botched and unnecessary operations on hundreds of women, an independent inquiry has found.

The independent inquiry into Ian Paterson's malpractice has recommended the recall of his 11,000 patients for their surgery to be assessed.

Paterson is serving a 20-year jail term for 17 counts of wounding with intent. One of Paterson's colleagues has been referred to police and five more to health watchdogs by the inquiry.

The disgraced breast surgeon worked with cancer patients at NHS and private hospitals in the West Midlands over 14 years.

His unregulated "cleavage-sparing" mastectomies, in which breast tissue was left behind, meant the disease returned in many of his patients. Others had surgery they did not need - some even finding out years later they did not have cancer.

Patients were let down by the healthcare system "at every level" said the inquiry chair, Bishop of Norwich the Rt Revd Graham James, who identified "multiple individual and organisational failures".

One of the key recommendations from the report is that the Government should make patient safety a the top priority, given the ineffectiveness of the system identified in this Inquiry. 

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Source: BBC News, 4 February 2020

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Ian Paterson: Further 1,500 patients to be recalled

A further 1,500 patients of convicted breast surgeon Ian Paterson are to be recalled and their treatment investigated.

Spire Healthcare, which runs private hospitals, said patients were being contacted after a trawl of IT systems.

Paterson was jailed for 20 years in 2017 for 17 counts of wounding people with intent.

The healthcare provider said it remained committed to tracking down all "outstanding patients".

The former surgeon subjected hundreds of patients to needless and damaging surgery over 14 years.

A 2020 independent inquiry ruled "a culture of avoidance and denial" left him free to perform botched operations in NHS and private hospitals in Birmingham and Solihull.

The inquiry recommended all 11,000 patients Paterson treated should be recalled for review.

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Source: BBC News, 1 February 2023

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Ian Paterson: Eleven further inquests set to open

A further 11 inquests are to be opened this week as part of an investigation into dozens of deaths linked to jailed breast surgeon Ian Paterson.

Paterson is currently serving a 20-year sentence after he carried out unnecessary or unapproved procedures on more than 1,000 breast cancer patients.

Judge Richard Foster said 417 cases of former patients had been reviewed.

The inquests will open and be adjourned on Friday. More than 30 deaths are already the subject of an inquest.

Paterson worked at Spire Parkway Hospital and Spire Little Aston Hospital in the West Midlands between 1997 and 2011, as well as NHS hospitals run by the Heart of England NHS Foundation Trust.

Paterson was jailed in 2017 after being convicted of 17 counts of wounding with intent.

An independent inquiry found he had been free to perform harmful surgery in NHS and private hospitals due to "a culture of avoidance and denial" in a healthcare system where there was "wilful blindness" to his behaviour.

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Source: BBC News, 10 July 2023

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Ian Paterson: Coroner to open inquests into breast surgeon’s victims’ ‘unnatural deaths’

Former patients of rogue breast surgeon Ian Paterson may have died of “unnatural deaths” two senior coroners have said.

Senior coroner for Birmingham and Solihull, Louise Hunt, and area coroner Emma Brown have said they believe there is evidence to suspect victims of Ian Paterson, who was jailed for 17 counts of wounding with intent in 2017, died unnaturally as a result of his actions.

They now plan to open four inquests into the deaths of patients who died from breast cancer after being treated by Paterson.

“Following preliminary investigations, the senior and area Coroner believe there is evidence to have reason to suspect that some of those deaths may be unnatural. In accordance with the Coroners and Justice Act 2009, inquests will now be opened in relation to four former patients of Mr Paterson.”

Deborah Douglas, a victim of Paterson who leads a support group in Solihull, told The Independent: "I have spoken to so many women over the years who have since died. This is what I have always known and fought for.

"Paterson lied about pathology reports and people did develop secondary cancers."

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Source: The Independent, 4 July 2020

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Ian Paterson victim calls for patient safety to be prioritised

A woman who underwent needless surgery at the hands of convicted surgeon Ian Paterson said patient safety was still not being prioritised.

Paterson was convicted of 17 counts of wounding with intent in 2017 and was jailed for 20 years.

Debbie Douglas, who now campaigns for his victims, said more still needed to be done following a damning report.

In December, the Department for Health said it was making "good progress" on changes.

The inquiry, published in 2020, made 15 recommendations and Ms Douglas called on health chiefs to "get on" with the improvements.

"It's three years and technically none of the recommendations are closed," she said.

"It's all around patient safety and it's not being given the priority it deserves."

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Source: BBC News, 9 February 2023

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