Make us feel ‘safe’ while we drive reform, ICBs tell NHSE

Greater “air cover” from NHS England and “assurance” that commissioning leaders will not suffer from making difficult decisions has been demanded by integrated care boards.

System chiefs have told NHSE they need greater support for potentially unpopular decisions on redesigning services, and have also called for more relaxed performance targets and financial flexibility in order to innovate.

ICBs have responded to a letter from NHSE chief executive Sir Jim Mackey sent earlier this year, which asked commissioners what the centre could do to “help accelerate the pace of change locally, including getting out of the way where necessary”.

Humber and North Yorkshire ICB has asked for regional and national “air cover for difficult system decisions” - such as when decommissioning, scaling back or consolidating services.

Bristol, North Somerset and South Gloucestershire, and Gloucestershire ICB meanwhile called for “the psychological safety and assurance needed” from the centre “to test new contractual and payment mechanisms locally”.

Norfolk and Suffolk wanted greater support for system leaders to “take calculated risks in redesigning services, particularly around financial flows”.

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Source: HSJ, 20 July 2026