What the centre really expects of ICBs, trusts and regions in 2026 (HSJ, 29 September 2025)

Summary

In this article, the Health Service Journal (HSJ) gives its thoughts on how the ‘new’ NHS operating model will work.

If for example, you take the contentious issue of performance management. May’s model ICB blueprint states: “We have been clear that performance management of providers against the NHS Performance and Assessment Framework (NPAF) will transfer to Regions.” However, the ‘model regional blueprint’ circulated in September, suggests ICBs will be responsible for “performance management and quality oversight of commissioned contracts”.

The NPAF covers all major areas of NHS activity, most of which is commissioned by ICBs using contracts. So, who does the performance managing, then?

HSJ went looking for answers among those now running the show to answer this question. They found that ICBs will not be expected to do performance management in any circumstances regardless of what the guidance might say. Their job will be to plan, commission and monitor performance of both general and specialist services. If providers resist agreed changes, their performance declines or financial disaster looms, the ICB must alert the region and get back to its data crunching.